Global COVID monitoring is crashing as BA.2.86 variant raises alarm

WHO's COVID-19 technical lead, Maria Van Kerkhove, looks on during a press conference at the World Health Organization's headquarters in Geneva, on December 14, 2022.
Enlarge / WHO’s COVID-19 technical lead, Maria Van Kerkhove, looks on during a press conference at the World Health Organization’s headquarters in Geneva, on December 14, 2022.

With global attention and anxiety locked onto the latest coronavirus omicron subvariant BA.2.86, health officials and experts are still mostly in the dark about how the highly mutated virus will play out.

At the start of the week, amid a flurry of headlines, researchers had only six genetic sequences of the virus in the public repository GISAID, even though the virus had already spread to at least four countries (Denmark, Israel, UK, and the US). As of the time of publication of this article on Friday, there are still only 10 sequences from five countries (Denmark, Israel, UK, US, and South Africa). According to the World Health Organization, the variant has also appeared in wastewater sampling from Thailand and Switzerland.

As Ars reported Monday, BA.2.86 gained attention for having a large number of mutations compared with BA.2, the omicron subvariant from which it descended. The number of mutations in BA.2.86’s critical spike protein is over 30, rivaling the number seen in the original omicron subvariant, BA.1, which went on to cause a tidal wave of cases and hospitalizations. BA.2.86’s spike mutations appear geared toward evading neutralizing antibody protections built up from past infections and vaccinations. But with such scant and spotty detection, it’s impossible to say whether this variant can outspread its many omicron-subvariant cousins to cause a wave of infection. It’s also still not possible to determine if it can cause more severe disease than other variants. So far, severe disease symptoms have not been reported from the 10 cases—but that is not enough data to draw any conclusions. As the Centers for Disease Control and Prevention reported in a risk assessment Wednesday, it’s “too soon to know” the impact of BA.2.86 on transmission and disease severity.

The slow trickle of data on BA.2.86 is part of a larger, dramatic plummet in COVID-19 surveillance and reporting in general. Last October, WHO’s technical lead for COVID-19, Maria Van Kerkhove, noted, “The number of sequences that the world and our expert networks are evaluating has dropped by more than 90 percent since the start of the year. That limits our ability to really track each of these [omicron subvariants].”

The genetic surveillance landscape has eroded further since then. In a press conference Friday morning, Van Kerkhnove highlighted that even basic reporting is failing. Of 234 countries and territories, WHO is now only getting case count data from 103 countries. Only 54 countries are reporting deaths, just 19 are reporting hospitalization rates, and 17 are reporting data on intensive care utilization.

“We don’t have good visibility on the impact of COVID-19 around the world,” she said.

Critical surveillance

The lack of data makes it impossible to track trends and health impacts—potentially those from new variants—and get people the care they need, let alone adequately monitor for new variants, Van Kerkhove stressed.

While uncertainty lingers over what impact BA.2.86 will have (if any), with such sparse surveillance, health officials will have less chance to catch early rises in cases, severe disease, and deaths if a worst-case-scenario variant arises.

Although countries did impressive amounts of work to set up surveillance and reporting systems during the emergency phase of the pandemic, those critical tools are precipitously declining. Yet, the virus continues to circulate in all countries, and the little data we have shows increases in hospitalizations. In the US, new hospitalization admissions per week have nearly doubled since July 1, now up to over 12,600 in the week of August 12, according to CDC data.

“It is really important that surveillance continues,” Van Kerkhove said, “and this is on the shoulders of governments right now.” Those surveillance and reporting systems need to remain.

For now, the WHO has designated BA.2.86 as a “variant under monitoring (VUM),” which in the past was a designation only given to variants that have early signals of being able to outcompete other variants circulating. With so little data on BA.2.86, that’s not the case for this omicron subvariant. However, WHO altered the definition of VUM to accommodate BA.2.86. The designation now can include a variant that “has an unusually large number of antigenic mutations but with very few sequences and/or it is not possible to estimate its relative growth advantage.”

With so many mutations and so much concern about them, there’s also been some clamoring for BA.2.86 to have its own Greek letter, marking it beyond omicron. But, according to WHO’s current system, only variants designated “variants of concern (VOC)” are given Greek letters. To attain VOC status, BA.2.86 would have to meet at least one concerning criteria: clearly cause more severe disease; change epidemiology trends in a way that could imperil health care resources; or significantly evade vaccine protection from severe disease.

A technical advisory group for WHO will conduct a risk assessment of BA.2.86 as data accumulates, from which they’ll determine if a designation change is warranted.

https://arstechnica.com/?p=1963498




Amid US’s shameful maternal death rate, survey finds widespread mistreatment

Amid US’s shameful maternal death rate, survey finds widespread mistreatment

With the US maternal death rate already the highest among affluent countries and still rising, a new study by the Centers for Disease Control and Prevention suggests pregnant people experience high levels of mistreatment and discrimination during maternity care.

The survey of 2,402 mothers from around the country found that one in five experienced some type of mistreatment by health care providers during their maternity care. The most common forms included having health concerns ignored or dismissed (10 percent), being shouted at or scolded (7 percent), having their physical privacy violated (5 percent), and having a provider threaten to withhold treatment or force them to accept unwanted treatment (5 percent). Additionally, nearly 30 percent of survey takers reported experiencing discrimination during their maternity care, including their race, age, weight, and income.

Black, Hispanic, and multi-racial mothers reported the highest rates of mistreatment and discrimination. These racial disparities mirror disparities seen in pregnancy outcomes; mothers in these groups face the highest maternal mortality rates in the country. Black mothers, for instance, are three times more likely to die from pregnancy-related causes than white mothers.

Overall, 45 percent of the survey respondents said they held back from discussing health concerns during pregnancy and delivery with their care provider. They often did this because they thought what they felt was normal; they didn’t want to make a big deal about a problem; they didn’t want to seem “difficult;” and they felt their health care provider was rushed.

The survey study has many limitations—including that it’s not nationally representative, it was taken years after some respondents’ pregnancies, and responses are subject to recall bias. But, it offers a glimpse into the lived experiences of pregnant people in the US, who continue to die and suffer severe health problems at remarkably high rates. Between 2018 and 2021, the US maternal mortality rate rose from 17.4 deaths per 100,000 live births to 32.9 deaths. Those numbers easily surpass the rates of other high-income countries, which have generally seen maternal mortality decline in recent years. In 2020, when the US rate was 23.8, the country with the next highest rate was New Zealand, with a rate of 13.6 deaths per 100,000 live births, according to a report by the Commonwealth Fund. Across the northern border in Canada, the rate was 8.4, and in the UK, it was 6.5.

Tragic outcomes

The current survey study does not draw a direct line from mistreatment and discrimination to deaths and morbidity. But, CDC officials suggest it clearly plays a role, noting that higher scores for the quality of maternity care are associated with lower risks of pregnancy complications.

In a media briefing Tuesday, Debra Houry, CDC’s chief medical officer, called the study’s findings “unacceptable” and said that it’s clear that mistreatment and discrimination lead to bad outcomes.

“We have heard too many heartbreaking stories of women, particularly Black women, who knew something wasn’t right with their pregnancy and voiced it, but were not heard and died as a result,” Houry said. “CDC’s own Dr. Shalon Irving was one of these women.”

Irving was a lieutenant commander in the US Public Health Service and an epidemiologist at the CDC who focused on racial disparities in health. Despite her work, her PhD, her two master’s degrees, her excellent health insurance plan, and a care team at the highly regarded health system at Emory University, Dr. Irving died in 2017 several weeks after giving birth due to high blood pressure.

Irving, who was Black, died “despite continuously visiting her providers where she kept insisting something was wrong and was being dismissed,” Houry said. “As a healthcare community, we have to do better at providing unbiased and respectful maternity care, equally, to all mothers.”

The CDC has laid out strategies for health care providers and patients to avoid such tragic outcomes via a campaign called “Hear her.” For providers, the CDC recommends hiring and retaining a diverse workforce, providing training on unconscious bias and stigma, and supporting doulas and midwifery models of care. For patients, the CDC offers tips on how to talk with health care providers about concerns, what questions to ask, and what urgent warning signs to know.

https://arstechnica.com/?p=1962480




Florida malaria outbreak still going with local cases now at 7

<img src="https://rassegna.lbit-solution.it/wp-content/uploads/2023/07/florida-malaria-outbreak-still-going-with-local-cases-now-at-7.jpg" alt="An Anopheles stephensi mosquito, which can carry the malaria parasite.”>
An Anopheles stephensi mosquito, which can carry the malaria parasite.

A seventh person has been diagnosed with a locally acquired case of malaria in Florida’s Sarasota County, state health officials reported this week.

The rare outbreak is now in its third month after authorities in the Sunshine State reported the first case in May. When Florida had identified four cases by late June, the Centers for Disease Control and Prevention released a health alert to clinicians calling locally acquired malaria cases in the US a “public health emergency.”

Florida’s outbreak and a single unrelated case in Texas from June collectively mark the first time in two decades that the US has seen locally acquired malaria cases, which, if left untreated, can be deadly. In the last instance, in 2003, Florida officials reported a small outbreak of at least seven people in Palm Beach.

The US usually sees around 2,000 malaria cases each year, usually all in people who had recently traveled from areas where the mosquito-borne pathogen is endemic. Outbreaks are uncommon but usually limited in scope. The mosquitoes that transmit malaria parasites, in the Anopheles genus, are typically evening and nighttime biters. Transmission is significantly hindered by people having screened windows and air conditioning. Thus, outbreaks in the US tend to fizzle out.

But, the Florida outbreak appears to be stubbornly hard to smack down. The Sarasota area has been under a mosquito-borne illness alert since June 19. In the last week of June, the area reported two new cases, bringing the total at the time to six. In the first week of July, there were no new cases, offering hope that the applications of insecticide by aircraft, vehicles, and crews had successfully knocked out the parasite’s spread. But, this week, authorities identified a new case.

According to the Sarasota Herald-Tribune, authorities began investigating the new case last Thursday, and testing by the CDC has since confirmed the infection. So far, all of the cases have been in the Desoto Acres and Kensington Park areas in north Sarasota County, according to Wade Brennan, the manager of Sarasota County Mosquito Management Services. Brennan told reporters Tuesday night, “We still need everybody to be diligent about avoiding mosquito bites.”

The mosquito management officials have been trapping mosquitoes and sending them off for testing at the CDC. Of the 130 or so tested so far, three mosquitoes have been positive for the malaria parasite Plasmodium vivax, but those were all from early in the outbreak. No mosquitoes have tested positive since June 5, officials said.

P. vivax causes a relatively milder type of malaria than some other Plasmodium species, namely P. falciparum, the deadliest cause of the disease that is concentrated in some African countries. However, P. vivax is known for going dormant in the liver, leading to chronic and relapsing disease if left untreated. People infected are typically given an intravenous antimalarial treatment for several days to kill the parasite in the blood and then a longer oral course to kill parasites in the liver.

Dr. Manuel Gordillo, an infectious disease specialist at Sarasota Memorial Hospital, told NBC News that some of the local cases have required more extensive treatment.

“They are dehydrated, some of them. They have low blood counts, especially platelets, which puts them at risk for bleeding. Some of them have had renal kidney failure, which is one of the complications of malaria,” Gordillo said.

State health officials did not immediately respond to Ars’ request for more information about the cases and the state of the outbreak.

https://arstechnica.com/?p=1955210




A third of US deer have had COVID—and they infected humans at least 3 times

Image of young deer leaping a roadside gulley.

People in the US transmitted the pandemic coronavirus to white-tailed deer at least 109 times, and the animals widely spread the virus among themselves, with a third of the deer tested in a large government-led study showing signs of prior infection. The work also suggests that the ubiquitous ruminants returned the virus to people in kind at least three times.

The findings, announced this week by the US Department of Agriculture, are in line with previous research, which suggested that white-tailed deer can readily pick up SARS-CoV-2 from humans, spread it to each other, and, based on at least one instance in Canada, transmit the virus back to humans.

But the new study, led by the USDA’s Animal and Plant Health Inspection Service (APHIS), provides a broader picture of deer transmission dynamics in the US and ultimately bolsters concern that white-tailed deer have the potential to be a virus reservoir. That is, populations of deer can acquire and harbor SARS-CoV-2 viral lineages, which can adapt to their new hosts and spill back over to humans, causing new waves of infection. It’s conceivable that viruses moving from deer to humans could at some point qualify as new variants, potentially with the ability to dodge our immune protections built up from past infection and vaccination.

“Deer regularly interact with humans and are commonly found in human environments—near our homes, pets, wastewater, and trash,” Dr. Xiu-Feng “Henry” Wan, an expert in emerging infectious diseases at the University of Missouri who led some of the research, said in a statement. “The potential for SARS-CoV-2, or any zoonotic disease, to persist and evolve in wildlife populations can pose unique public health risks.”

Between late 2021 and 2022, the USDA, along with researchers and state partners, surveyed over 11,000 white-tailed deer from 26 states and Washington, DC. Of those, 31.6 percent had antibodies indicating a previous infection with SARS-CoV-2, and 12.2 percent had detectable SARS-CoV-2 virus.

For another part of the study, researchers collected around 9,000 respiratory samples from deer in 26 states and Washington, DC, between late 2021 and early 2022, then sequenced the viral genomes of nearly 400 SARS-CoV-2 viruses isolated. An evolutionary analysis of the genetic sequences suggested there were at least 109 spillover events from humans to deer, with evidence of onward transmission in deer from there. The viruses found in deer spanned multiple variants circulating in humans, including Alpha, Gamma, Delta, and Omicron. The data also found evidence of deer-specific genetic changes to the SARS-CoV-2 viruses as they moved from deer to deer.

Lastly, the genetic data suggested three spillovers of deer-adapted SARS-CoV-2 viruses back to humans—two in North Carolina and one in Massachusetts. For this, the researchers compared the deer SARS-CoV-2 sequences to sequences of viruses isolated from humans, available via public databases. In all three possible spillover cases, SARS-CoV-2 isolates from human cases were over 99.9 percent identical to deer-adapted viruses collected from deer in the corresponding states. These findings were published this week by Wan and colleagues in Nature Communications.

Since collecting and analyzing this data, APHIS has expanded its surveillance of SARS-CoV-2 in deer. For now, while the data continue to point to the potential for deer to act as a reservoir, there’s no evidence that they are playing a significant role in SARS-CoV-2 transmission. There’s also a host of unknowns that researchers will try to address, including how exactly deer-to-human and human-to-deer transmission occurs.

https://arstechnica.com/?p=1953643




Green electricity won’t help with pollution disparities

Image of exhaust coming out of the tailpipe of a bus.

In the US, minorities are exposed to higher pollution levels than other populations. This is at least partly explained by the fact that we tend to build things like power plants and freeways in low-income neighborhoods, which is also where minorities tend to live. The shift away from fossil fuel use can potentially lower the burden on minorities, shuttering fossil fuel plants and reducing the number of vehicles that burn fuel.

A new analysis on decarbonization’s effects on pollution shows that minorities will see their exposure fall. But it indicates that minorities are likely to still be disproportionately affected unless we specifically focus on reducing their exposure.

Exposure

Burning fossil fuels releases a variety of pollutants into the environment. Chief among these are particulates; one category alone (PM 2.5) is estimated to lead to 100,000 premature deaths annually in the US. Before their death, people are often saddled with extensive health costs and lost productivity.

In the US, those burdens largely fall on those least able to afford them. People who live in low-income areas are generally more likely to receive higher exposure to particulate pollution due to the proximity of these neighborhoods to the sources of this pollution. As minorities are over-represented among the lower-income brackets, they disproportionately bear the burden of fossil fuel use.

All of this should mean that reducing our reliance on fossil fuels will improve the situation for minorities in the US. Making electricity production and transport greener means fewer particulates and fewer of the problems that come with them. But even if the absolute pollution exposure drops, that doesn’t mean that the disproportionate pattern of exposure will change. Overall, pollution can fall while exposure remains unevenly distributed.

To determine whether greening our electricity and transport will help shift some of the undue burden, a team of researchers based in San Diego did two analyses focused on PM 2.5 exposure. One of them examined several potential routes to meeting the US’s climate goals; the second performed a large set of random reductions to look at why minorities have so much of the burden in the first place.

Testing priorities

All of the scenarios tested by the researchers focused on meeting the emissions cuts pledged by the US as part of the Paris Agreement. The researchers start with a list of known pollution sources, eliminate enough of them to reach the targeted emissions cuts, and then create a new map that projects what the ensuing pollution would look like. Using county-level demographic data, they then explore how different populations within the US would see their exposure to PM 2.5 change.

The key difference among the scenarios is how the elimination of pollution sources is prioritized. There are lots of combinations of cuts that would get the US to its Paris Agreement targets, and choosing the combination will depend on what values we prioritize. In different scenarios, the researchers “target counties with high historical pollution, high fraction [people of color], low income, lowest cost of mitigation, and by equal fraction without any prioritization.”

https://arstechnica.com/?p=1949385




Deadly fungal meningitis cases nearly double as CDC rushes to find exposed

One of the medical clinics suspended by Mexican health authorities, in Matamoros, Tamaulipas, Mexico, on May 19, 2023.
Enlarge / One of the medical clinics suspended by Mexican health authorities, in Matamoros, Tamaulipas, Mexico, on May 19, 2023.

Cases have nearly doubled in a deadly outbreak of fungal meningitis linked to tainted cosmetic surgeries in Matamoros, Mexico, the Centers for Disease Control and Prevention reported this week.

To date, there have been 34 cases identified in the outbreak: 18 suspected, 10 probable, and six confirmed. That’s up from just 18 cases—nine suspected, nine probable, zero confirmed—late last month. The death toll from the cases has risen from two to four since then. The CDC is investigating 172 other people who are thought to have been exposed.

Health officials in the US and Mexico suspect that the infections stem from cosmetic procedures, including liposuction, that involved epidural anesthesia, a component of which may have been contaminated with the fungus Fusarium solani. The US cases are linked to procedures performed from January 1, 2023, to May 13 at two specific clinics in Matamoros, which sits across the border from Brownsville, Texas. Both clinics—River Side Surgical Center and Clinica K-3—have since been shuttered by Mexican health officials, who have also closed other area clinics amid the investigation.

Even with all the links so far, health officials are still struggling to nail down the source and those infected. The outbreak highlights both the dangers of cut-rate surgical procedures in facilities with little oversight and the lethal vagaries of what happens when fungi make their way into people’s spinal cords and brains.

The source

Despite knowing the clinics, the procedures, and the drugs used in the cases, health officials are skeptical that they’ll ever be able to confirm the source of the fungus. “It’s not like you can go to the clinic and find the meds on the shelf and go test them,” Dr. Tom Chiller, Mycotic Diseases Branch chief for the CDC, told Ars.

In Mexico, anesthesiologists procure their own drugs and bring them into clinics, Chiller explained. To track down a contamination problem, “you got to find the anesthesiologist and find out where they bought [the drugs] from and more than likely, they’re gone, because they’ve used them already,” he said.

Chiller emphasized that the Mexican authorities—who have jurisdiction over the outbreak investigation, not the CDC—are doing their best and being open with the CDC. But he highlighted the significant challenges they face. The city of Matamoros is in the state of Tamaulipas, which is heavily influenced by cartels.

So far, Chiller said, the authorities there are skeptical that the source of the infection is the anesthetic medicine itself. It’s “a pretty common anesthetic that’s widely distributed across Mexico,” he said. If it were contaminated during manufacturing, “they think they would be seeing signals other places.” But the anesthetic drug is mixed with morphine before being injected into people’s spinal columns, he noted. And the morphine may be the source. It’s in short supply and hard to get in Mexico right now, he said. One hypothesis Mexican officials have is that the morphine may be coming from black or gray markets while being sold as legitimate.

In addition to bad morphine, another hypothesis is bad practices. “If the anesthesiologists are bringing their medicines in and they’re accessing these vials multiple times, or they’re just doing poor practices, they could contaminate a vial, and then that vial could be reused multiple times,” he noted.

That was thought to be the cause of a fungal meningitis outbreak last year in Durango, Mexico. That outbreak mostly affected women having epidurals during cesarean section births in private hospitals. The cases were also Fusarium solani infections. The outbreak resulted in 80 cases and 39 deaths as of the latest outbreak update on June 6. Whether or not the outbreak in Durango is linked to the one stemming from Matamoros is an open question, Chiller said.

https://arstechnica.com/?p=1948611




Pandemic lessons: More health workers, less faxing—an Ars Frontiers recap

[embedded content]
Our panel on pandemic lessons included Dr. Jennifer Nuzzo (center) and Dr. Caitlin Rivers (right).

In many ways, modern advancements stole the show in the COVID-19 pandemic. With unprecedented speed, researchers decoded and shared the genetic blueprints of SARS-CoV-2. They developed highly effective, safe vaccines and treatments. Near real-time epidemiological data were at people’s fingertips, and global genetic surveillance for viral variants reached unrivaled heights.

But while the marvels of modern medicine and biotechnology wowed, the US struggled with the basics. Health departments were chronically underfunded and understaffed. Behind slick COVID-19 dashboards, health workers shared data in basic spreadsheets via email—and even fax machines. Long-standing weaknesses in primary care deepened health inequities. And useful pandemic prevention tools, like masks, became maligned in the disconnect between communities and local health departments.

At our Ars Frontiers conference this year, I virtually sat down with two leading experts in pandemic preparedness, who talked through these takeaways from the COVID-19 pandemic. I spoke with: Dr. Jennifer Nuzzo, the director of the Pandemic Center and a Professor of Epidemiology at Brown University’s School of Public Health, and Dr. Caitlin Rivers, a senior scholar at the Johns Hopkins Center for Health Security and founding associate director of the Center for Forecasting and Outbreak Analytics at the Centers for Disease Control and Prevention.

More health workers

The conversation started with a big-picture question fielded by Nuzzo on how we generally did with COVID-19. She went through some high points: We all became familiar with pandemic tools, which will be helpful to draw upon in the future; we got real-time data collection going, setting the bar for the next pandemic; and we bulked up health departments with contractors.

But, this last point was also a point of concern because the staff that was hired during the pandemic was brought on with emergency funding—and those positions lapsed when the emergency funding did.

“This is a thing that I’m really, really worried about, probably, perhaps most of all,” Nuzzo said. “If you remember three years ago, when we started this pandemic, we didn’t have anywhere near the kind of public health infrastructure, the public health defenses that we need in terms of people working in health departments to help us make sense of the data and tell us what to do to help us live, you know, healthier, safer lives. … They’re the infrastructure that should be in our communities to help keep us perpetually safe.”

Better data infrastructure

While the state of the people-based infrastructure at the foundation of our response is a big problem, so too is our data infrastructure, Rivers explained. With the public health emergency, the federal government gave the CDC authority to compel states and jurisdictions to share COVID-19-related data, setting the stage for near real-time pandemic tracking at a national level. But, without an emergency declaration, the agency doesn’t have that power. And to get basic disease data from individual states and jurisdictions, the agency has to hammer out individual legal agreements with each state and jurisdiction for each disease, resulting in non-standardized data.

“These are not blanket agreements,” Rivers explained. “They’re disease-specific about when and how and what data will flow. And as you can imagine, it takes weeks, if not months, to organize a single agreement. We’re talking hundreds of agreements altogether, and it’s a very slow process.” The burden of negotiating these “is one of the real challenges that we have with our public health data infrastructure.”

Another is the anachronistic way health departments collect and share data—often in basic spreadsheets, shared via email or archaic fax machines.

“There’s a lot of manual data entry. There’s a lot of faxing. There’s a lot of emailing spreadsheets. And if we could claw back some of that manpower and put it towards public health practice, put it towards actually keeping people healthier, that’s going to be a huge win,” Rivers said.

While she was very optimistic about the new funding Congress has approved for data modernization, she noted that “when you’re starting from fax machines, it’s gonna be a long road back.”

Address inequities and build trust

While our infrastructure needs revamping, we could also be doing more to prepare the public to respond to pandemic threats, Nuzzo said. She noted an example of pandemic drills in Taiwan, where they’ve used mass vaccination of seasonal flu vaccines as practice for emergency vaccinations. The drills help people know what to do and where to go, while officials can test how quickly they can roll out shots and reach high-risk populations like the elderly.

While the US was able to get mass vaccination set up, there were “deep inequities” in who knew where to go and what to do.

“I think one of the biggest lessons of this pandemic is that our underlying social vulnerabilities turned out to be our biggest pandemic vulnerabilities,” Nuzzo said, adding it will take “community-based participation” and policies, like paid sick leave, to address.

Building trust between health experts and communities, particularly vulnerable communities, is critical to responding to the next threat, Nuzzo and Rivers noted.

“One of the things that the pandemic has really exposed is how much of a primary health care crisis we have in this country and that if people can’t regularly access medicine, such that they can build those trusted relationships … I think we’re gonna have a hard time,” Nuzzo said.

Rivers made a similar point, noting that the pandemic responses lacked trusted, known sources for health information. “I’m not sure the public ever had an opportunity to really get to know an epidemiologist or a public health official that could talk to them regularly, day over day, about what is happening and what they should be doing,” she said. The next crisis, she said, needs a “warm face.”

Listing image by Ars Frontiers

https://arstechnica.com/?p=1944284




Woman with untreated TB finally in custody—held in “negative pressure” room

<img src="https://rassegna.lbit-solution.it/wp-content/uploads/2023/06/woman-with-untreated-tb-finally-in-custody-held-in-negative-pressure-room.jpg" alt="Mycobacterium tuberculosis.”>
Enlarge / Mycobacterium tuberculosis.

Law enforcement officials in Washington state have finally apprehended a Tacoma woman with tuberculosis who has refused treatment and isolation for over a year and has spent the past several months actively evading the sheriff’s department’s efforts to execute a civil arrest warrant against her.

She is now being held in the Pierce County Jail, Nigel Turner, division director of Communicable Disease Control for the Tacoma-Pierce County Health Department, said in an update late Thursday.

“She will be housed in a room specially equipped for isolation, testing, and treatment. We are hopeful she will choose to get the life-saving treatment she needs to treat her tuberculosis,” he added. He also thanked local law enforcement who “supported public health with this necessary intervention.”

Pierce County Sheriff’s spokesperson Sgt. Darren Moss told Ars over email Friday that the woman was taken into custody at her home without incident. “She was transported in a vehicle that had the air separated between the cabin and the back of the vehicle,” he added. A press release from the Sheriff’s department noted that deputies booked her into “a negative pressure room in the Pierce County Jail where she will get treatment as ordered by a Pierce County Superior Court Judge.”

Last last resort

The woman’s legal saga dates back to January 2022, when the health department resorted to court orders to try to get her to treat her deadly infection—or at least prevent her from readily spreading it in the community. “The Local Health Officer ordered [the woman] to self-isolate and treat; which she declined to do. [The woman] has not complied with such efforts, has discontinued treatment and is unwilling to resume treatment or voluntarily self-isolate,” court documents from January 2022 read.

Pierce County Superior Court Judge Philip Sorensen issued an order of involuntary isolation on January 19, 2022, but it did little good. The woman continued to refuse treatment and isolation, leading to a steady drum of renewed court orders throughout 2022.

In January, the department seemed to hit a breaking point after the woman was involved in a car accident as a passenger—clearly indicating that she was not isolating. She went to an emergency department the next day, complaining of chest pain, and X-rays revealed her tuberculosis infection was progressing. She did not tell the medical staff at the hospital of her infection, and they initially thought she had cancer based on the state of her lungs.

On January 20, Sorensen said that if she didn’t finally follow the court orders, she could face electronic home monitoring or possible jail time. That ultimatum was unheeded. On March 2, Sorensen upheld a finding of contempt and issued a civil arrest warrant to have her involuntarily detained in a facility that could safely house her for isolation, testing, and treatment. Turner called the move “the very, very last option.”

But even an arrest warrant wasn’t enough. The woman began evading law enforcement agents who attempted to execute the warrant safely. Meanwhile, she continued flouting orders to isolate—a law enforcement agent surveilling the woman watched as she took a city bus to go to a local casino. The monthslong effort to apprehend the woman led to some local frustration, with an opinion editor for a local news outlet writing that “the time for excuses has passed.”

Tuberculosis is a potentially life-threatening infection caused by the bacterium Mycobacterium tuberculosis, which often infects the lungs and can spread through the air at close range. The infection killed 1.6 million people in 2021, according to the World Health Organization, and is one of the top infectious disease killers in the world.

https://arstechnica.com/?p=1943990




Study narrows long COVID’s 200+ symptoms to core list of 12

A long COVID patient sits with her daughter in her wheelchair while receiving a saline infusion at her Maryland home on Friday, May 27, 2022.
Enlarge / A long COVID patient sits with her daughter in her wheelchair while receiving a saline infusion at her Maryland home on Friday, May 27, 2022.

Tens of millions of people worldwide are thought to have developed long-term symptoms and conditions in the wake of a SARS-CoV-2 infection. But this sometimes-debilitating phenomenon, often called long COVID, remains a puzzle to researchers. What causes it? Who gets it? And, perhaps, the most maddening one: What is it?

Long COVID patients have reported a wide spectrum of more than 200 symptoms. Some are common, like loss of smell, while others are rarer, like tremors. Some patients have familiar constellations of symptoms, others seem to have idiosyncratic assortments.

Researchers hypothesize that long COVID may simply be an umbrella term for a collection of variable—and potentially overlapping—post-COVID conditions that may have different causes. Those causes might include autoimmunity, immune system dysregulation, organ injury, viral persistence, and intestinal microbiome imbalances (dysbiosis).

As millions continue to struggle with the realities of their conditions, research on long COVID is, unfortunately, still in its infancy. But a study published Thursday in JAMA offers a hopeful small step toward understanding the condition. With data from 9,764 participants, researchers whittled down long COVID’s more than 200 symptoms to a weighted list of 12 core symptoms. The list is not a final definition of long COVID as it needs to be validated in further studies. But it’s a start. It could help direct further research, identify different subtypes of long COVID, and develop diagnostic tools, like biomarkers.

The study—part of the National Institutes of Health’s Researching COVID to Enhance Recovery (RECOVER) Initiative—surveyed symptoms and conditions among people with a past SARS-CoV-2 infection (8,646 people) and those without (1,118). Researchers looked at the frequency of each symptom identified and the symptoms that differentiated the infected from the uninfected.

They came to a core list of 12 symptoms and assigned each symptom a score that represented the odds of it being related to COVID-19. The scores for each of the 12 symptoms ranged from 1 to 8, and the researchers added up the symptom points for each person in the trial. Based on the spectrum of score totals seen among uninfected people, the researchers concluded that a score of 12 was a reasonable cutoff for determining if someone had long COVID. And that cutoff was validated when they looked at how it correlated with the participants’ reports of quality of life and health.

Here is the list of 12 symptoms and their scores:

Symptoms Score
Loss of smell or taste 8
Post-exertional malaise (feeling tired after minor physical or mental activity) 7
Chronic cough 4
Brain fog 3
Thirst 3
Palpitations 2
Chest pain 2
Fatigue 1
Changes in sexual desire or capacity 1
Dizziness 1
Gastrointestinal symptoms 1
Abnormal movements 1
Hair loss 1

https://arstechnica.com/?p=1942604




Woman with untreated TB still on the lam three months after arrest warrant

<img src="https://rassegna.lbit-solution.it/wp-content/uploads/2023/05/woman-with-untreated-tb-still-on-the-lam-three-months-after-arrest-warrant.jpg" alt="Scanning electron micrograph of Mycobacterium tuberculosis bacteria, which cause TB.”>
Scanning electron micrograph of Mycobacterium tuberculosis bacteria, which cause TB.

A woman with an untreated infectious case of tuberculosis and a months-old civil warrant out for her arrest continues to evade the sheriff’s department in Tacoma, Washington, drawing local frustration.

On Friday, the woman failed to show up to yet another court hearing, to which she has been summoned on a roughly monthly basis since January 2022. That’s when the county health department began using court orders to try to compel her to get her deadly respiratory infection treated and/or remain in isolation to protect the public until she is no longer infectious.

Pierce County Superior Court Judge Philip Sorensen ruled once again Friday that the woman—known only by the initials “V.N.” in court documents—was in contempt of those court orders. Sorensen had initially issued a civil arrest warrant on March 2, 2023, ordering her to involuntary detention for testing and treatment. He extended the warrant Friday.

In an opinion piece on Saturday, Matt Driscoll, the opinion editor for local outlet The News Tribune, wrote that the situation has “far surpassed” the “point of ridiculousness.” Driscoll called out local law enforcement for not apprehending the woman after lengthy efforts to get her to comply with health measures and nearly three months after Sorensen issued the arrest warrant.

“[T]he time for excuses has passed,” he wrote, calling the woman’s case “a unique and potentially dangerous rarity that Pierce County’s public health system and the courts provide a remedy for.”

Pierce County Sheriff’s spokesperson Sgt. Darren Moss told a reporter for the outlet that when (or maybe if) “V.N.” is apprehended, she will go to the Pierce County Jail, where she can be held in one of two negative-pressure rooms that help prevent the spread of airborne infections.

Driscoll spoke with Moss as well and pressed him on why the department had yet to apprehend “V.N.” The fact seems particularly frustrating to Driscoll given that court documents last month revealed law enforcement had surveilled “V.N.,” observing her getting on a city bus—potentially exposing fellow riders to a deadly bacterial infection—and then arriving at a local casino. Despite the observation, law enforcement didn’t execute the arrest warrant then. And since that trip, law enforcement said the woman has been actively evading them.

Is it a priority?

Moss told Driscoll that the surveillance information should have never been made public because it could have potentially hindered efforts to apprehend “V.N.”

“We have a team that was on it, but if they can’t find her, at some point, you know, how much effort should we put into that versus the homicide guy that we arrested two days ago? Or we had a guy who severely beat a woman and was on the run, almost beat her to death, and we had to go look for him,” Moss told Driscoll. “Is it a priority? Somewhat. … But it’s a civil [warrant] versus a criminal warrant for something like attempted murder, assault or first-degree robbery, so it’s like, when we have time we get to it.”

After “V.N.” failed once again to show up to a court hearing Friday, Moss told the outlet: “She’s refusing to turn herself in, (her) attorney’s not making her come in and the family’s not helping as well. … If we can’t find her, we can’t arrest her. If we knew where she was, she would be in custody.”

In an email to Ars Tuesday, Moss confirmed that the department was still trying to locate “V.N.” and detain her. “I cannot give out any information as to how we are trying to locate her, where we are looking or any other details as it can ruin the efforts by our deputies.” He added that the only update they can provide is “when she is taken into custody.”

Tuberculosis is a potentially life-threatening infection caused by the bacterium Mycobacterium tuberculosis. It spreads through the air when an infected person coughs, sneezes, spits, or otherwise launches bacterial cells in the airspace around them. While just a few bacterial cells can spark an infection, people are most at risk from prolonged contact with an infected person. Treatment requires lengthy antibiotic courses, spanning four to up to 20 months, depending on whether the bacteria have developed resistance.

Court documents indicate that “V.N.” had started treatment at some point but did not complete it, increasing the risk of her infection becoming resistant to antibiotics. X-rays from January of this year indicated that her case of tuberculosis was progressively worsening, according to court documents.

Tuberculosis killed 1.6 million people in 2021, according to the World Health Organization. It is one of the top infectious disease killers in the world. The Centers for Disease Control and Prevention reported a provisional count of 8,300 US cases in 2022, an increase from 7,874 cases reported in 2021. There were 600 tuberculosis deaths in the US in 2020. Washington state averages around 200 cases per year, and Pierce County averages about 20, the Tacoma-Pierce County Health Department reported.

https://arstechnica.com/?p=1941465