COVID Update-Latest on COVID, contagious length, boosters, Monoclonal treatments…

COVID Update-Latest on COVID, contagious length, boosters, Monoclonal treatments…

Covid contagious; how long are people contagious after being infected?

For someone who is infected with Covid, symptoms from any of the omicron subvariants generally appear two to four days after infection.  

How contagious one is COVID depends on how much of the virus, known as the viral load, is in their body. Viral load peaks soon after symptoms start, according to Dr. Chanu Rhee, an infectious disease physician and associate professor of medicine at Harvard Medical School. This means someone is likely most contagious a day or so before symptoms appear and during at least the first two or three days after.  

As their immune system reduces the viral load, their infectiousness should decline in tandem. 

“If folks are still very, very symptomatic, with a lot of coughing and a lot of upper respiratory symptoms, then the thought is they’re probably more infectious,” said Dr. Lisa. A. Cosimi, an infectious disease specialist at Harvard Medical School.
But determining if someone is still somewhat infectious during the waning days of a Covid illness can be tricky.

The Centers for Disease Control and Prevention recommends that people who are experiencing moderate to severe symptoms to isolate for 10 days. If the Covid illness is mild, the CDC advises that to protect others, one should consider themselves infectious for at least five days from the onset of symptoms — or five days after a positive test, which counts as day zero. 

A study of 66 people with nonsevere Covid published in the New England Journal of Medicine in July found that the median time until the participants were likely no longer infectious from omicron, is eight days. (For the Delta variant, it was six days.) According to an October study of 4,565 people with Covid, “overall, existing data suggest that infectiousness (using viral culture as a proxy) beyond 10 days is possible although less common.”

COVID boosters against the latest variants

Gerti Morell, a marketing director in Cleveland, said she had not gotten the new COVID-19 booster because she was concerned about side effects. Morell, 67, said she experienced dizziness, blurry eyesight, and heart palpitations after getting her first booster in November 2021. But Morell still urges other people to stay current with their booster shots.

“It just scared me having that experience, and I don’t want to go through it again,” Morell told NBC News.

Morell’s sentiments are shared by many adults over 65 who have yet to get their updated booster shots. An NBC News analysis based on data from the U.S. Centers for Disease Control and Prevention (CDC) shows that only 31 percent of people over 65 received their updated booster shots, even though around 85 percent of COVID deaths in November were among people in this age group.

Experts think fatigue at the pace of Covid shots and not realizing that boosted adults who get COVID tend to have mild cases and can avoid hospitalization are among the reasons why older adults aren’t getting boosted.

In addition, the decrease in the number of reported COVID cases may also contribute to older adults holding off on getting boosters. For example, NBC News estimated the average number of daily COVID cases was around 42,000 in November, less than half the number at the same time last year. The statistics do not represent the true number of the virus spread since many people use at-home COVID test kits.

“When people hear that cases are rising, they’re more likely to go out and get vaccinated,” Dr. Manisha Juthani, commissioner of the Connecticut Public Health Department, told NBC News. “With Covid, it’s been relatively flat, and people have been hearing about it for going on three years. It’s hard to remain vigilant about something that is a constant, ever-present threat.”

Older adults’ reluctance to get boosters comes at a time when scientists, doctors, and public health officials are keeping a close watch on BQ.1 and BQ.1.1, two new rapidly evolving Omicron subvariants that now make up the vast majority of new COVID-19 infections. The number of cases involving BA.4, BA.5, and XBB Omicron subvariants has decreased in proportion to the number of cases involving the new subvariants.

The new boosters from Pfizer-BioNTech and Moderna provide better protection against BA.4 and BA.5, compared to both companies’ original boosters, but are not as effective against BQ.1. and BQ.1.1, according to the CDC. Several studies have found that BQ.1. and BQ.1.1 can evade prior immunity from infections and vaccines.

FDA Revokes EUA for Monoclonal Antibody Treatments

The U.S. Food and Drug Administration (FDA) initially gave emergency use authorization (EUA) to six monoclonal antibody treatments for COVID-19. The treatments were for people with weak immune systems who could not take Paxlovid and other FDA-approved COVID-19 treatments.

Due to the numerous Omicron variants that evolved over the past two years, the drugs became less effective, and the FDA gradually revoked EUA for these treatments. On Nov. 30, the FDA revoked authorization for Bebtelovimab, the last monoclonal antibody drug with EUA, citing that the treatment is not expected to neutralize BQ.1 and BQ.1.1.

In February, the FDA issued an EUA for Bebtelovimab, a nearly hour-long, single-dose injection used to treat mild-to-moderate COVID-19 in adults and children ages 12 and older who are at high risk of progressing to a severe case of the disease (including hospitalization or death) but cannot take Paxlovid and other FDA-approved treatments. The monoclonal antibody, manufactured by Eli Lilly, was effective against earlier Omicron variants.

“The big problem is that monoclonal antibodies bind to a very small piece of the virus,” Dr. Arturo Casadevall, a professor of medicine at the Johns Hopkins School of Medicine, explained to NBC News. “As the virus changes, we are now in a position in which we lost them all because they don’t bind to the virus anymore.”

The FDA revoking EUA of treatments for people with weak immune systems leaves immunocompromised patients with fewer treatment options, according to Dr. Rodney Rohde, chair of the Clinical Laboratory Science Program at Texas State University.

“There are still segments of the population that have probably very little protection,” Dr. Rohde said. “You worry about that last push of this virus this winter and going to the spring if we see higher mortality or hospital beds being filled.”

Ways To Boost Your Vaccine Response

The CDC says that it’s not too late to get a COVID-19 shot or a flu shot. Once you’ve been vaccinated, medical experts say there are steps you can take to boost your immune system’s response to the vaccines:

1. Sleep well after getting vaccinated. Sleep promotes immune functions, and studies have found that adequate sleep boosts the immune system’s response to vaccines. For example, a 2011 study found that sleep after a Hepatitis A vaccination doubled the number of immune cells formed in response to the vaccine. A 2012 study found that participants who slept less than six hours after receiving a Hepatitis B vaccination were less likely to have the appropriate immune response.

“People with chronic sleep loss have higher levels of inflammation and are relatively more immunosuppressed,” Dr. Peter Chin-Hong, an infectious disease physician at the University of California San Francisco, explained.

2. Get vaccinated in the morning. The immune system is influenced by circadian rhythm, also known as the body’s 24-hour internal clock, and the immune response varies at different times of the day. A 2021 study showed that getting COVID-19 vaccines in the morning resulted in a stronger immune response than getting the vaccines in the afternoon.

“Get a vaccine when it is most convenient to you,” Dr. Chin-Hong said. “Immune cells circulate around the body 24/7. But if you can prioritize getting it in the morning, you may get a small advantage.”

3. Avoid taking over-the-counter medications before getting a vaccine. Some people take ibuprofen, acetaminophen, or aspirin to help prevent the side effects of a vaccine. However, some studies found that taking pain relievers before getting vaccinated may reduce immune response.

“Both Tylenol and NSAIDs like ibuprofen may prevent inflammation and theoretically reduce the ability of the immune system to respond to a vaccine,” Dr. Chin-Hong said.

The most important step to take is to get vaccinated no matter the circumstances because vaccines still work to reduce the risk of severe illness. According to Dr. Chin-Hong, getting vaccinated is “better than not getting a vaccine at all.”

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