Here is your weekly summary of what has been happening this past week in the United States. The variant picture continues to shift rapidly. Read more on this below.
Weekly COVID-19 Statistics
The CDC’s map of community level of spread updated as of November 20th, indicates 19.48% of the US population lives in an area with medium to high transmission rates. This is a 4.12% decrease from the week prior.
As a disclaimer of sorts regarding the above map, it is important to understand that the CDC’s community transmission reports put more weight on COVID-19 hospitalizations than actual case counts (as they had done earlier in the pandemic). This has made it harder for those who are high-risk to accurately estimate the risk of COVID-19 infection based on case numbers in their community. With the frequent emergence of new and more contagious variants, the at-risk immunocompromised community must find other ways to estimate the presence of COVID-19 beyond hospitalizations.
Because of this, we are going to begin incorporating a graphic from the COVID-19 Wastewater Monitoring Project within these weekly reports. Wastewater is the used water from our showers, dishwashers, sinks, toilets and washing machines. Samples from wastewater have historically provided insight into the health of the population by measuring concentrations of other viruses like polio and influenza to identify geographic hotspots. It has been utilized inconsistently across the country throughout the pandemic until recently, mainly due to a lack of funding since it is performed independently. But we believe this is another good monitoring tool that can be used to gather information.
Another caveat to the above CDC community spread map is that many states have stopped reporting daily COVID-19 case numbers and are now only reporting weekly case counts, if at all. Also, the case numbers that the CDC does receive do not include unreported test results from the at-home rapid antigen tests. Many experts agree that due to the wide availability of at-home COVID-19 tests, actual case numbers have been massively underreported for some time now.
Thus, there is much value in watching the levels of the SARS-CoV-2 virus concentration present in wastewater samples taken from across the United States because it is not dependent upon the variations in reporting mentioned above. What has historically been seen with wastewater data is that the detectable viral amounts found provide a more accurate account of case numbers in real time. When a rise or fall in wastewater levels of COVID-19 is detected, we can expect to see the same occur in reported case numbers approximately two weeks later. So, this is a great tool to assist individuals in performing a more accurate personal risk assessment. You can see from the wastewater graphic below where the viral count in the wastewater (the dark blue line), starting with the Omicron wave in November 2021, outnumbered actual reported case counts (the light blue line), and that has continued to be true to this day. Here is the wastewater graphic that was last updated November 17th.
The rate of hospitalizations updated as of November 18th continues to show that hospitalizations remain relatively flat, with a slight 1.3% decrease from the prior recorded 7-day average. When broken down by age groups (as pictured in the graph on the right) those over the age of 70 continue to have a significantly higher hospitalization rate compared to all other age groups.
The number of deaths from COVID-19 in the US ending November 16th were 2,222. This continues to reflect a slow trend downward.
Current & Emerging Variants of Concern (VOC)
The main news this week is that BA.5 is no longer the dominant variant of concern in the US due to BQ.1 and BQ.1.1 continuing to show a significant growth advantage over BA.5 and all other circulating variants. The continued relevance of this news for the immunocompromised community is that Evusheld and Bebtelovimab retain activity against BA.5, but not BQ.1, BQ.1.1 and several other growing variants. Here is the overall breakdown of variants in the US as of November 19th.
Here is a summary of what we know about the current variants of concern and how they hold up against Evusheld and Bebtelovimab as of the time this update was written:
It is important to note that both Evusheld and Bebtelovimab are STILL EFFECTIVE against several of the minor variants including BA.5 (24% of cases), against BA.2 (1.2% of cases), and BA.2.75 (1.1% of cases). Preliminary data indicate that both COVID-19 monoclonal antibodies (CmAbs) may retain activity against BN.1 (5.1% of cases), BA.4 (0.1% of cases), and BF.7 (7.8% of cases).
Data indicate that Bebtelovimab will no longer be effective against the following variants:
- BQ.1
- BQ.1.1
These two variants together made up 49.7% of cases nationwide as of November 20th.
Data indicate that Evusheld will no longer be effective against the following variants:
- BA.4.6
- BA.2.75.2
- BQ.1
- BQ.1.1
- BF.7
- BN.1
- BA.5.2.6 (new this week)
These seven variants together made up over 68.9% of cases nationwide as of November 20th.
Remember, there are significant regional differences in the percentage (or prevalence) of all variants of concern. So, it is of utmost importance right now to keep an eye on the percentage of variants in your region by watching the breakdown that is updated every Friday on the CDC’s regional variant tracker.
We would like to urge particular caution to all of those with CLL / SLL living in the following states where Evusheld no longer works against the majority of variants causing COVID-19 infections there:
- New York
- Texas
- Louisiana
- Arkansas
- Oklahoma
- New Mexico
- Arizona
- California
- Nevada
Of note, when looking at the area of the country where BQ.1 and BQ.1.1 proportions are currently the highest (such as Texas, Arizona, and New Mexico) we are beginning to see an uptick in cases according to the New York Times COVID Data Tracker. So, watching to see if hospitalizations and/or deaths subsequently follow in these particular states over the next month or so will be an important data point to keep an eye on.
Paxlovid and Remdesivir are still very effective antivirals that are holding up well against all variants of concern. However, it is absolutely key to get tested early and often if you have known exposure or are exhibiting symptoms as an immunocompromised individual (preferably obtaining a PCR test). This is because Paxlovid must be started orally within five days of symptom onset and Remdesivir must be started intravenously within seven days of symptom onset. And remember to notify your healthcare provider as soon as you test positive so that they can more quickly arrange for you to obtain antiviral therapy as appropriate.
COVID-19 in the News This Week
An article posted in the JAMA looking at 700 patients who were infected with COVID-19 showed that over half of them (67.5%) were still experiencing at least one post-COVID-19 symptom (also sometimes called Long-COVID) two years after their infection, regardless of whether or not they were hospitalized with severe disease. The most prevalent symptoms for the hospitalized and non-hospitalized groups at the two-year follow-up were fatigue, pain (including persistent headaches), and memory loss. This information is significant because most previous studies looking at post-COVID symptoms had much shorter follow-up periods.
Another study was published supporting the Pfizer’s bivalent COVID-19 vaccine booster which found good neutralizing activity against some of the newer circulating variants as discussed above. This indicates it will be more protective than the original vaccine formula specifically against recent Omicron subvariants. For example, antibody titers against BQ1.1 were increased 8.7-fold. While we do not yet know how this translates to those who are immunocompromised, it is still good news for the general population who receive the updated booster.
This large meta-analysis study aimed to see if there was any association between developing a new diagnosis of diabetes after being infected with COVID-19, as a growing body of scientific evidence has suggested. It examined four million people who were infected with COVID-19 to more than 34 million people who did not. Researchers reported the risk of developing either Type 1 or Type 2 diabetes was 1.6 times higher in those infected with COVID-19 compared to those who were never infected. This increase in relative risk of developing diabetes after COVID-19 infection was found across all age groups, including children, and there was no difference in the risk based on gender. This study further supports that COVID-19 may cause immune dysregulation and autoimmunity that can have life-long implications.
In Summary
We cannot stress this enough to our community: Mask up and make sure to do all the things we learned were important for infection control earlier in the pandemic!
We realize the timing of this is not ideal with the holidays being right around the corner. CLL Society believes it is important to continue raising awareness about the potential “winter of discontent” that may be coming for those who are immunocompromised. We sincerely care about our community, and we are concerned about the safety and well-being of those with CLL / SLL in the upcoming months without Evusheld. Especially for those who are still completely unaware that they will no longer be protected by Evusheld at all in a couple more weeks.
Please revisit your COVID-19 Action Plan if you have not already done so, practice good hand hygiene, do all you can to ensure there is good air-flow/ventilation whenever you are around others indoors (especially those who are unmasked), make sure you have received your bivalent COVID-19 booster (encourage those around you to do the same if appropriate), and practice social distancing/avoid indoor gatherings as much as possible right now. Remember, it is okay to discuss your personal safety boundaries with family members surrounding infection precautions when it comes to helping to help aid in keeping you safe from COVID-19 (and all the other diseases going around right now) this holiday season.
Keep learning and stay well.
Robyn Brumble, MSN, RN
Director of Scientific Affairs & Research
CLL Society
Paxlovid and Remdesivir are still very effective antivirals that are holding up well against all variants of concern. However, it is absolutely key to get tested early and often if you have known exposure (preferably obtaining a PCR test if symptoms persist but you are having negative home rapid tests) or are exhibiting symptoms as an immunocompromised individual. This is because Paxlovid must be started orally within five days of symptom onset and Remdesivir must be started intravenously within seven days of symptom onset. And remember to notify your healthcare provider as soon as you test positive so that they can more quickly arrange for you to obtain antiviral therapy as appropriate.
COVID-19 in the News This Week
An article posted in the JAMA looking at 700 patients who were infected with COVID-19 showed that over half of them (67.5%) were still experiencing at least one post-COVID-19 symptom (also sometimes called Long-COVID) two years after their infection, regardless of whether or not they were hospitalized with severe disease. The most prevalent symptoms for the hospitalized and non-hospitalized groups at the two-year follow-up were fatigue, pain (including persistent headaches), and memory loss. This information is significant because most previous studies looking at post-COVID symptoms had much shorter follow-up periods.
Another study was published supporting the Pfizer’s bivalent COVID-19 vaccine booster which found good neutralizing activity against some of the newer circulating variants as discussed above. This indicates it will be more protective than the original vaccine formula specifically against recent Omicron subvariants. For example, antibody titers against BQ1.1 were increased 8.7-fold. While we do not yet know how this translates to those who are immunocompromised, it is still good news for the general population who receive the updated booster.
This large meta-analysis study aimed to see if there was any association between developing a new diagnosis of diabetes after being infected with COVID-19, as a growing body of scientific evidence has suggested. It examined four million people who were infected with COVID-19 to more than 34 million people who did not. Researchers reported the risk of developing either Type 1 or Type 2 diabetes was 1.6 times higher in those infected with COVID-19 compared to those who were never infected. This increase in relative risk of developing diabetes after COVID-19 infection was found across all age groups, including children, and there was no difference in the risk based on gender. This study further supports that COVID-19 may cause immune dysregulation and autoimmunity that can have life-long implications.
In Summary
We cannot stress this enough to our community: Mask up and make sure to do all the things we learned were important for infection control earlier in the pandemic!
We realize the timing of this is not ideal with the holidays being right around the corner. CLL Society believes it is important to continue raising awareness about the potential “winter of discontent” that may be coming for those who are immunocompromised. We sincerely care about our community, and we are concerned about the safety and well-being of those with CLL / SLL in the upcoming months without Evusheld. Especially for those who are still completely unaware that they will no longer be protected by Evusheld at all in a couple more weeks.
Please revisit your COVID-19 Action Plan if you have not already done so, practice good hand hygiene, do all you can to ensure there is good air-flow/ventilation whenever you are around others indoors (especially those who are unmasked), make sure you have received your bivalent COVID-19 booster (encourage those around you to do the same if appropriate), and practice social distancing/avoid indoor gatherings as much as possible right now. Remember, it is okay to discuss your personal safety boundaries with family members surrounding infection precautions when it comes to helping to help aid in keeping you safe from COVID-19 (and all the other diseases going around right now) this holiday season.
Keep learning and stay well.
Robyn Brumble, MSN, RN
Director of Scientific Affairs & Research
CLL Society
