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Health

For Future Viral Threats, Health Officials Look to Sewage

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When the virologist Kirsten St. George learned last summer that a paralyzed patient in New York’s Rockland County had tested positive for polio, she turned her attention to the state’s sewers.

Polio is particularly stealthy because most infected people never develop symptoms but can still spread the virus. A wastewater-surveillance network established during the Covid-19 pandemic helped officials at the New York State Department of Health’s Wadsworth Center track polio’s spread in several counties.

New York is now expanding wastewater monitoring and starting to look for flu, RSV, hepatitis A, norovirus and antibiotic-resistant genes in parts of the state, as health officials across the U.S. consider wastewater as a more permanent public-health tool for watching a variety of threats.

“Are we on the brink of another outbreak, if it’s rising? Is it just sort of holding steady?” asked Dr. St. George, Wadsworth’s director of virology. “These are all important public health questions.”   

Dr. Kirsten St. George of the Wadsworth Center is looking for clues in the state’s sewage.
An analysis conducted at the Wadsworth Center indicates the presence of the hepatitis A virus.

Dr. Kirsten St. George of the Wadsworth Center, which is starting to track the spread of pathogens including the hepatitis A virus.

For decades, researchers around the world used wastewater primarily to track poliovirus, which spreads through contact with an infected person’s feces. At the onset of the pandemic, scientists found that the Covid-19 virus’s genetic material could be detected in sewage. That meant sewage might help track other respiratory viruses, too.

Researchers built surveillance networks around the country to track Covid-19 and monitor for variants. 

Now they are starting to leverage that system to search for other pathogens they had wanted to track through the sewers for years including norovirus and antibiotic-resistant microbes, said Amy Kirby, program lead of wastewater surveillance at the Centers for Disease Control and Prevention. 

“Once you have this system, it’s much easier to activate it for a new pathogen,” Dr. Kirby said.

Sewage samples from treatment plants are sent to labs, where genetic material that can come from hundreds of thousands of people is isolated. Researchers usually test samples for pathogens with the PCR technology used in a Covid-19 lab test administered at the doctor’s office.  

Health officials use the data to track changing concentrations of a virus, which can help them monitor the spread of pathogens including flu and RSV for which many people might not be tested. The technique has yielded early evidence of Covid-19 outbreaks and helped officials tailor public messaging and decide where to open testing sites.

Biobot Analytics Inc., which works with the CDC to monitor Covid-19 and the renamed mpox, started tracking opioids in wastewater before the pandemic. It has collected data on substances including fentanyl in more than 100 counties across 47 states. Officials in Cary, N.C., used that data to encourage people to dispose of drugs properly and to distribute more overdose-reversal drugs, Biobot said.

Not everything can be tracked through sewage, and there isn’t a standard national system for collecting data and comparing readings from site to site. Privacy can be a concern in smaller communities or when tracking illicit substances, researchers said, though wastewater data is processed as an anonymous group sample. And some communities that collect wastewater data aren’t using it to guide public-health policy, researchers said. 

The wastewater treatment plant in Schenectady, N.Y., is participating in the study of sewage.
Workers at the Schenectady treatment plant collect samples and ship them for analysis.
Analysis of the wastewater samples is conducted at the Wadsworth Center in Albany, N.Y.

The wastewater treatment plant in Schenectady, N.Y., where workers collect samples and ship them for analysis at the Wadsworth Center in Albany, N.Y.

The National Academies of Sciences, Engineering, and Medicine said in a report Thursday that the U.S. should invest more in the CDC’s wastewater-surveillance network and expand its reach. The report recommended that the CDC should have an open process for picking which pathogens to track and establish an ethics committee, among other steps.  

“We’re at a critical juncture where it has gone from being a grass-roots effort to a more nationally recognized tool,” said Megan Diamond, head of the Rockefeller Foundation’s wastewater-surveillance program, who wasn’t involved with the report.

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After a polio case was confirmed in New York in July, health officials reviewed stored wastewater samples and found poliovirus in wastewater from several counties, including as far back as spring. Health officials urged people who weren’t vaccinated against polio to get the shots and alerted doctors.

The CDC extended poliovirus wastewater testing to a handful of counties with low vaccination rates or potential connections to New York’s polio case.

“What you might expect a virus to do when it starts circulating is exactly what we saw in the wastewater,” said Dan Lang, deputy director of New York’s Center for Environmental Health and head of the state’s wastewater-monitoring program.

No samples tested positive for poliovirus by the end of November, but it was detected again in Orange County last month. Health officials are planning to analyze past samples from additional counties for traces of the virus before deciding whether to widen poliovirus wastewater monitoring when the weather warms and the virus can spread more readily. 

“We’re worried about a big sort of roaring back,” said Dr. Eli Rosenberg, a lead epidemiologist who coordinates New York’s polio response. “We’re using this time now to prepare.”

Poliovirus was found in Orange County, N.Y., last month.

Write to Brianna Abbott at brianna.abbott@wsj.com

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Health

Exercise Helps Blunt the Effects of Covid-19, Study Suggests

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People who exercise regularly had lower rates of hospitalization and death from Covid-19 in a study published recently in the American Journal of Preventive Medicine. 

Regular exercise improves overall health and healthier people generally have fewer serious complications with Covid-19 infections. Earlier research has shown an association between exercise and better Covid-19 outcomes. This latest study goes a step further and suggests that even people whose age or health conditions make them higher-risk have better outcomes if they are regular exercisers. 

Higher amounts of physical activity were associated with lower rates of death and hospitalizations from Covid across nearly all demographics, says Jim Sallis, a public health professor at the University of California San Diego and co-author of the study. A very active 70-year-old still had a higher risk of Covid-related complications than did a similarly active 40-year-old, but the exercisers in both groups had hospitalization rates lower than those who didn’t work out. 

The study used data from nearly 200,000 adult Covid-19 patients across the Kaiser Permanente network in Southern California. It asked patients to self-report the number of minutes of moderate exercise they did per week and analyzed the records of how many people in the study cohort were hospitalized, experienced deterioration, such as admission into an intensive-care unit, or died within 90 days of a Covid diagnosis. 

The new bivalent vaccine might be the first step in developing annual Covid shots, which could follow a similar process to the one used to update flu vaccines every year. Here’s what that process looks like, and why applying it to Covid could be challenging. Illustration: Ryan Trefes

“You don’t have to run, you don’t have to sweat, you don’t have to do anything except get up and go out for a walk,” Dr. Sallis says. “That’s what most people do, and we see how much protection they’re getting from that.”

The findings add to a growing body of evidence that physical activity provides several types of protection from severe illness. 

Exercise improves the body’s immune response by mobilizing and redistributing immune cells that can recognize and kill infected cells, says Richard Simpson, a professor at the University of Arizona whose research focuses on exercise immunology and who wasn’t involved with the Kaiser Permanente study. Without exercise, viruses have more time to replicate inside our bodies, which can result in more severe symptoms, he says. 

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Physical activity can also help reduce inflammation, the body’s natural immune response to damage or pathogens. Chronic inflammation has been linked to more severe Covid-19 outcomes, especially in the lungs. Cytokines, small messenger proteins that help regulate inflammation, are released during exercise.

The study data were collected from the beginning of the pandemic to May 2021, when vaccines were just starting to become more available and before more recent waves of Covid. However, the researchers believe the results of the study are still broadly applicable.

“Exercise is as effective as many of the drugs that we use and has no side effects,” says Jordan Metzl, a sports medicine physician in New York City who wasn’t involved with the study. “We want to get people taking it every day.”

Write to Alex Janin at alex.janin@wsj.com

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Health

250,000 kindergartners are vulnerable due to drop in vaccination rate

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Nearly a quarter of a million kindergartners are vulnerable to measles due to a dip in vaccination coverage during the pandemic, according to the Centers for Disease Control and Prevention.

The CDC, in a report published Thursday, found that 93% of kindergartners were up to date with state-required vaccines during the 2021-22 school year, a decline of 2% from 2019-20.

“While this might not sound significant, it means nearly 250,000 kindergartners are potentially not protected against measles,” Dr. Georgina Peacock, head of the CDC’s immunization services division, said during a call with reporters Thursday.

“And we know that measles, mumps and rubella vaccination coverage for kindergartners is the lowest it has been in over a decade,” Peacock said.

Kindergartners are required to be vaccinated against measles, mumps and rubella; chickenpox; polio; and diphtheria, tetanus and pertussis. The vaccination rate for measles, mumps and rubella was 93.5% during the 2021-22 school year, below the target coverage of 95% to prevent outbreaks.

An ongoing measles outbreak in Columbus, Ohio, has spread to 83 children, 33 of whom were hospitalized. None of the children have died. The overwhelming majority of the kids, 78, were not vaccinated.

“These outbreaks harm children and cause significant disruptions in their opportunities to learn and grow and thrive,” said Dr. Sean O’Leary, who heads the American Academy of Pediatrics committee on infectious disease. “This is alarming and it should be a call to action for all of us.”

The CDC report looked at whether the kindergartners had received the second dose of their measles, mumps and rubella vaccine. Two doses are 97% effective at preventing disease and one dose is about 93% effective, according to the CDC.

Measles is a highly contagious virus that spreads when someone coughs or sneezes and contaminates the air, where the virus can linger for up to two hours. It can also spread when a person touches a contaminated surface and then touches their eyes, nose or mouth.

The virus is so contagious that a single person can spread the virus to 90% of people close to them who do not have immunity through vaccination or a previous infection, according to the CDC.

Measles can be dangerous for children younger than 5, adults older than 20, pregnant women, and people with compromised immune systems.

About 1 in 5 unvaccinated people who catch it are hospitalized. About 1 in 20 kids get pneumonia, and one in 1,000 have brain swelling that can cause disabilities. Symptoms begin with a high fever, cough, runny nose and red eyes. White spots appear in the mouth two to three days later, and a rash breaks out on the body.

CDC officials said disruptions to schools and the health-care system during the Covid pandemic are largely responsible for the decline in vaccination rates.

“We know that the pandemic really had a disruption to health-care systems,” Peacock said. “Part of it is that well-child visits maybe were missed and people are still trying to catch up on those well-child visits.”

“We know that the schools had a lot of things to focus on and in some cases maybe they were not able to gather all that documentation on the vaccinations,” Peacock said. “Or because children were at home for a lot of the pandemic, that may have not been the emphasis while they were focused on testing and doing all those other things related to the pandemic.”

In a separate report published Thursday, the CDC found that coverage for what’s known as the combined seven-vaccine series actually increased slightly among children born in 2018-19 by the time they turned two, compared with kids born in 2016-17.

This seven-vaccine series includes shots against measles, chickenpox, polio, hepatitis B, streptococcus pneumoniae, haemophilus influenzae or Hib, and diphtheria, tetanus and pertussis.

However, the CDC found that there were major income and racial disparities. Vaccination coverage declined by up to 5% during the pandemic for those living below the poverty level or in rural areas. Black and Hispanic children had lower vaccination rates than white children.

O’Leary said that while misinformation about vaccines is a problem, the vast majority of parents are still getting their kids vaccinated. He said inequality is the bigger issue.

“The things we really need to focus on are addressing access and child poverty,” O’Leary said.

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World

omicron XBB.1.5 is immune evasive, binds better to cells

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The Covid omicron XBB.1.5 variant is rapidly becoming dominant in the U.S. because it is highly immune evasive and appears more effective at binding to cells than related subvariants, scientists say.

XBB.1.5 now represents about 41% of new cases nationwide in the U.S., nearly doubling in prevalence over the past week, according to the data published Friday by the Centers for Disease Control and Prevention. The subvariant more than doubled as a share of cases every week through Dec. 24. In the past week, it nearly doubled from 21.7% prevalence.

Scientists and public health officials have been closely monitoring the XBB subvariant family for months because the strains have many mutations that could render the Covid-19 vaccines, including the omicron boosters, less effective and cause even more breakthrough infections.

XBB was first identified in India in August. It quickly become dominant there, as well as in Singapore. It has since evolved into a family of subvariants including XBB.1 and XBB.1.5.

Andrew Pekosz, a virologist at Johns Hopkins University, said XBB.1.5 is different from its family members because it has an additional mutation that makes it bind better to cells.

“The virus needs to bind tightly to cells to be more efficient at getting in and that could help the virus be a little bit more efficient at infecting people,” Pekosz said.

Yunlong Richard Cao, a scientist and assistant professor at Peking University, published data on Twitter Tuesday that indicated XBB.1.5 not only evades protective antibodies as effectively as the XBB.1 variant, which was highly immune evasive, but also is better at binding to cells through a key receptor.

Scientists at Columbia University, in a study published earlier this month in the journal Cell, warned that the rise of subvariants such as XBB could “further compromise the efficacy of current COVID-19 vaccines and result in a surge of breakthrough infections as well as re-infections.”

The XBB subvariants are also resistant to Evusheld, an antibody cocktail that many people with weak immune systems rely on for protection against Covid infection because they don’t mount a strong response to the vaccines.

The scientists described the resistance of the XBB subvariants to antibodies from vaccination and infection as “alarming.” The XBB subvariants were even more effective at dodging protection from the omicron boosters than the BQ subvariants, which are also highly immune evasive, the scientists found.

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Dr. David Ho, an author on the Columbia study, agreed with the other scientists that XBB.1.5 probably has a growth advantage because it binds better to cells than its XBB relatives. Ho also said XBB.1.5 is about as immune evasive as XBB and XBB.1, which were two of the subvariants most resistant to protective antibodies from infection and vaccination so far.

Dr. Anthony Fauci, who is leaving his role as White House chief medical advisor, has previously said that the XBB subvariants reduce the protection the boosters provide against infection “multifold.”

“You could expect some protection, but not the optimal protection,” Fauci told reporters during a White House briefing in November.

Fauci said he was encouraged by the case of Singapore, which had a major surge of infections from XBB but did not see hospitalizations rise at the same rate. Pekosz said XBB.1.5, in combination with holiday travel, could cause cases to rise in the U.S. But he said the boosters appear to be preventing severe disease.

“It does look like the vaccine, the bivalent booster is providing continued protection against hospitalization with these variants,” Pekosz said. “It really emphasizes the need to get a booster particularly into vulnerable populations to provide continued protection from severe disease with these new variants.”

Health officials in the U.S. have repeatedly called on the elderly in particular to make sure they are up to date on their vaccines and get treated with the antiviral Paxlovid if they have a breakthrough infection.

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World

China to Open Borders as Covid-19 Cases Rise

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BEIJING—Chinese health authorities plan to lift Covid-19 quarantine requirements on international arrivals early next month, taking one of the country’s biggest steps to ease restrictions since the pandemic began even as case numbers remain high.

China has maintained among the world’s most restrictive coronavirus lockdown measures, slowing its economy significantly and sparking anger. Following waves of protests this fall, authorities abruptly abandoned the country’s stringent zero-Covid-19 strategy early this month.

From Jan. 8, China will scrap all quarantine measures for Covid-19, including requirements for inbound visitors, both foreigners and Chinese nationals, according to the National Health Commission.

The commission late Monday issued a plan to stop treating Covid-19 as a “Class A” infectious disease, which calls for stringent control measures, and downgrade the management of the virus to “Class B,” which requires more basic treatment and prevention. The Wall Street Journal reported last month that China was weighing such a move, which would give it room to further loosen public-health measures.

The change means people traveling to China from abroad will need to have only a negative Covid-19 test within 48 hours to be allowed into the country, the NHC said. International arrivals will no longer be required to be tested on arrival or undergo quarantine—a major step toward opening up for a country that has been largely closed off to the outside world for three years.

The commission in its statement pledged to facilitate foreigners’ visits to China, including those for business, studying and family reunions, and to provide visa assistance.

The shift came as fever clinics and hospital emergency rooms in Beijing continued to overflow with patients on Monday and Chinese leader

Xi Jinping

called on local officials to take pains to save lives.

Before Monday’s loosening of Covid restrictions, Mr. Xi addressed his country’s new pandemic reality for the first time in comments marking the 70th anniversary of the Patriotic Health Movement, a campaign to wipe out flies and mosquitoes launched by

Mao Zedong

during the Korean War to fortify China against the possibility of American germ warfare.

“At present, our country’s Covid prevention and control efforts are facing new circumstances and a new mission,” Mr. Xi said. China should launch “a more targeted Patriotic Health Movement” to “effectively guarantee the lives and health of the people.”

Visits to three major hospitals in Beijing by the Journal on Monday showed the capital’s healthcare system still swamped with an influx of patients following the government’s about-face on Covid-19 controls, which has left many citizens, especially the elderly, scrambling to find treatment.

In the emergency room of eastern Beijing’s Chaoyang Hospital, known for treating respiratory diseases, hallways at the intensive-care unit were packed with dozens of elderly patients lying on portable beds. One nurse said all the ICU beds were full and only patients with the most life-threatening symptoms were being admitted. “Those patients with less severe symptoms can only get a temporary bed and stay in the hallway,” she said.

To cope with the surge in patients, Beijing’s Chaoyang Hospital opened a second fever clinic in a nearby sports stadium for some Covid-19 patients.



Photo:

Chen Zhonghao/Zuma Press

On Monday, the Chinese Center for Disease Control and Prevention issued a report showing fewer than 2,700 new infections and no new deaths on Christmas Day. Over the weekend, local officials presented a much grimmer picture. 

A senior health official in the coastal province of Zhejiang, home to e-commerce giant

Alibaba Group Holding Ltd.

, said on Sunday that new daily infections had topped one million, with the wave expected to peak at around two million cases around New Year’s Day.

Roughly half a million people were being infected every day in the northeastern city of Qingdao, a local health official said in a since-removed interview with a state-owned broadcaster.

To minimize the impact of the infection surge on China’s already battered economy, some cities said people could return to work even if they had mild symptoms. Authorities in Shanghai said Saturday that the city’s 25 million residents wouldn’t need to be isolated at home for more than seven days, even if they are still testing positive.

Rapid transmission of Covid-19 in China raises the likelihood for fresh outbreaks beyond its borders and the emergence of risky virus variants, said

Michael Osterholm,

director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

“New variants are a huge possibility, and they could have a tremendous impact on the rest of the world,” Dr. Osterholm said.

In his own comments marking the anniversary of the Patriotic Health Campaign, which evolved over the years to target infectious diseases such as malaria, China’s Premier

Li Keqiang

said adjustments to the country’s Covid-19 policies were being implemented in an orderly manner, but urged officials at every level of government to address public demands for medical care and supplies.

Covid-19 cases in China have surged after authorities scrapped most of its restrictions, prompting residents to self-isolate and stockpile medication. WSJ’s Jonathan Cheng reports from Beijing on the risks that come with the country’s rapid reopening. Photo: Xiaoyu Yin/Reuters

China’s health system, thinly resourced even before the pandemic, has struggled to contend with the fast-spreading Omicron variant. The growth in infections has sent people scrambling to buy up home test kits along with ibuprofen and other medications.

At Chaoyang Hospital’s emergency room on Monday, digital screens showed a long wait list for people seeking treatment at the internal-medicine department. In an interview last week with China’s state broadcaster, Mei Xue, deputy director of the hospital’s emergency department, said around 400 patients were coming seeking internal medicine treatment every day—roughly four times the normal number.

“These patients are all elderly people with underlying diseases. After the combination of fever and respiratory infection, they are all very seriously ill,” he said.

A staffer with Beijing’s emergency medical center, which coordinates requests for urgent medical care in the city, said he and his colleagues had been working nonstop to transfer patients to Chaoyang Hospital in recent weeks and he expected the current situation to last for a few more weeks.

To cope with the surge in patients, the hospital has opened a second fever clinic in a nearby sports stadium for Covid-19 patients with mild symptoms.

Peking Union Medical College Hospital and Peking University First Hospital, both located in the center of Beijing, were similarly overwhelmed.

A sign outside the Peking Union emergency room warned patients it could take more than four hours to see a doctor. A nurse at Peking Union’s fever clinic said that for weeks patients had been forced to wait in the hallways for beds to open up. One elderly patient, unable to secure a bed, was lying on a metal bench just inside the entrance of the fever clinic.

A nurse at Peking University First Hospital’s emergency room said beds there were all full and the wait time at the internal medicine department was roughly six hours. The hospital public address system announced that nearly 50 patients were waiting to be seen.

In recent weeks, doctors and nurses from around China have been dispatched to Beijing to support the capital. Shandong province sent a team of medical staff to Beijing, according to state media reports.

In the U.S., the State Department on Friday updated its travel advisory and is asking that people reconsider travel to China due to the surge in Covid-19 cases, arbitrary enforcement of local laws and Covid-19-related restrictions.

—Xiao Xiao and Dominique Mosbergen contributed to this article.

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Health

Mystery of Smell Loss After Covid-19 Might Be Solved

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The nose knows why some people still can’t smell long after recovering from Covid-19.

A haywire immune response in the olfactory system was found to explain why some people still can’t smell long after symptoms of the disease have abated, according to a small, peer-reviewed study published Wednesday in the journal Science Translational Medicine. In some cases, the immune or inflammatory response was detected in patients with smell loss up to 16 months after recovery from Covid-19.

Compared with people who can smell normally, patients with long-term smell loss had fewer olfactory sensory neurons, cells in the nose responsible for detecting smells and sending that information to the brain. Patients with lingering loss of smell had an average of 75% fewer of the neurons compared with healthy people, said

Brad Goldstein,

a study co-author and sinus surgeon at Duke University.

“We think the reduction of sensory neurons is almost definitely related to the inflammation,” Dr. Goldstein said.

Loss of smell is a common Covid-19 symptom, though its prevalence varies widely depending on factors including which variant caused the infection, head and neck specialists said.

Most Covid-19 patients who experience smell loss regain the sense within weeks of infection. But the symptom can stick around for a year or longer for up to 7% of patients, a February analysis said.

Dr. Goldstein said he and his colleagues sought to identify what was damaged or altered in people with long-term smell loss. “If we don’t know what’s broken, it’s hard to tell how to fix it,” he said.

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They took samples from the nose tissue of nine patients who couldn’t smell long after Covid-19 infections and compared them with cells from healthy people. Patients with persistent smell loss had more T-cells, a type of white blood cell that plays a critical part in immune response, in their noses, the study said. The T-cells were making interferon-gamma, a substance linked to inflammation, Dr. Goldstein said, and support cells appeared to be reacting to it.

The support cells protect and nourish olfactory sensory neurons. Without them, the olfactory sensory neurons can’t survive. Research has shown that the virus that causes Covid-19 doesn’t infect olfactory sensory neurons directly, but that it can attack such support cells.

Patients with smell loss also had fewer of a certain type of anti-inflammatory cell and more of a particular inflammatory cell than healthy people, said the study of 24 patients. The healthy group included two people who had recovered from Covid-19 but didn’t have long-term smell loss.

Covid-19 researchers said the study bolstered evidence that inflammation could be a culprit in long-Covid symptoms. An April study in the journal JAMA Neurology found inflammation among deceased Covid-19 patients in the olfactory bulb, the part of the brain responsible for receiving and processing information from olfactory sensory neurons in the nose.

Neuroinflammation could be a contributor to loss of smell and other neurological symptoms related to long-Covid such as brain fog, said

Cheng-Ying Ho,

a co-author of the April study and an associate professor of pathology at Johns Hopkins University School of Medicine.

Dr. Ho, who wasn’t involved in the new study, said inflammation that starts in the nasal cavity could extend to the brain. She said that the new study was compelling but that its small sample size necessitated further work in more patients. Because the vaccination status of participants wasn’t collected, she said it wasn’t clear whether getting the shots played a role in the olfactory system’s inflammatory response. 

In a survey published last year of more than 400 patients with smell loss, more than 40% reported depressive symptoms and almost 90% reported enjoying food less.

“People might think smell loss is not really an important Covid symptom compared with severe symptoms such as pneumonia, but it can really bother some patients,” Dr. Ho said. 

Researchers said regions of the brain linked to the sense of smell are closely associated with brain regions that control memory and emotion.  

Sandeep Robert Datta,

a co-author of the new study and a professor of neurobiology at Harvard Medical School, said he and others are conducting more research into the reasons for smell loss following Covid-19 infection smell loss. The research could lead to potential targets for treatment. There are no effective treatments for long-term smell loss, Dr. Datta said.

“Smell gives you a sense of place. It can be very disorienting without it,” Dr. Datta said.

Write to Dominique Mosbergen at dominique.mosbergen@wsj.com

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Health

CDC expands BMI charts for severely overweight kids

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The Centers for Disease Control and Prevention on Thursday released new body mass index charts for children in response to the growing obesity crisis in the U.S.

The previous BMI chart for children ages 2 to 19, published in 2000, is based on data from 1963 to 1980, but obesity and severe obesity in children has increased significantly since the ’80s. More than 4.5 million children and teenagers had severe obesity in 2018, according to the CDC.

BMI is calculated using a mathematical formula that measures body fat, generally by dividing an individual’s height by their weight. For adults, a healthy BMI runs from 18.5 to 24.9, or 111 lbs. to about 150 lbs. for someone who is 5’5″. At 5’10”, a healthy BMI runs between 129 lbs. and 175 lbs. For adults ages 20 and older, a BMI of 30 and above is considered obese.

The previous charts for children did not go beyond a BMI of 37. The new charts extend to a BMI of 60 and measure whether it falls within healthy parameters based on a percentile measured against other children of the same age and gender.

“Prior to today’s release, the growth charts did not extend high enough to plot BMI for the increasing number of children with severe obesity,” said Dr. Karen Hacker, director of the CDC’s National Center for Chronic Disease Prevention and Health Promotion.

BMI for kids up to 20-year-olds runs along a sliding range, depending on age and gender. Under the new guidelines, healthy BMI for kids can range from as low as around 13 to about 17 for a 6-year-old girl or boy to a range of as much as roughly 18 to around 26 for a 20-year-old young woman.

The extended charts will help health-care providers work with families to treat children who are suffering from obesity, Hacker said. The BMI charts from 2000 will still be used for children who are not obese, according to the CDC.

Obesity has increased significantly among children over the past 40 years. During the four-year period ended in 1980, 5.5% of children ages 2 to 19 were obese and 1.3% were severely obese. By 2018, 19.3% of kids were obese and 6.1% were severely obese, according to National Center for Health Statistics.

Obesity for children is defined as a BMI that is higher than 95% of kids of the same age and gender, according to the CDC. Severe obesity is a BMI that is 120% higher than the 95th percentile.

Although children’s BMI is calculated using the same formula as adults, a healthy weight is measured in relation to other kids of the same age and gender. This is because children’s height and weight can vary significantly as they grow.

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Health

BQ, XBB omicron subvariants pose serious threat to boosters

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Evusheld injection, a new COVID treatment that people can take before becoming symptomatic, in Chicago on Friday, Feb. 4, 2022.

Chris Sweda | Tribune News Service | Getty Images

The omicron subvariants that have become dominant in recent months present a serious threat to the effectiveness of the new boosters, render antibody treatments ineffective and could cause a surge of breakthrough infections, according to a new study.

The BQ.1, BQ.1.1, XBB and XBB.1 omicron subvariants are the most immune evasive variants of Covid-19 to date, according to scientists affiliated with Columbia University and the University of Michigan. These variants, taken together, are causing 72% of new infections in the U.S. right now, according to data from the Centers for Disease Control and Prevention.

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The scientists, in a study published online Tuesday in the peer-reviewed journal Cell, found that these subvariants are “barely susceptible to neutralization” by the vaccines, including the new omicron boosters. The immune response of people who were vaccinated and had breakthrough infections with prior omicron variants was also weaker against the subvariants.

“Together, our findings indicate that BQ and XBB subvariants present serious threats to current COVID-19 vaccines, render inactive all authorized antibodies, and may have gained dominance in the population because of their advantage in evading antibodies,” the scientists wrote.

Although these subvariants are more likely to cause breakthrough infections, the vaccines have been shown to remain effective at preventing hospitalization and severe disease from omicron, the scientists wrote.

The study examined blood samples from people who received three or four shots of the original vaccines, those who received the new omicron boosters after three shots of the original vaccines, and individuals vaccinated with the original shots who also had breakthrough infections from the BA.2 or BA.5 subvariants.

For people who received the omicron boosters, antibodies that block infection were 24 times lower against BQ.1, 41 times lower against BQ.1.1, 66 times lower against XBB and 85 times lower against XBB.1 compared to their performance against the ancestral strain that emerged in Wuhan, China in 2019.

However, people who received the omicron boosters had modestly higher antibody levels against all of these subvariants compared with people who received three or four shots of the original vaccines, according to the study.

People who were vaccinated and had breakthrough infections had the highest antibody levels of any group in the study, though neutralization was also much lower against the subvariants than the ancestral strain.

The subvariants have evolved away from previous versions of omicron in dramatic fashion. BQ.1.1, for example, is about as different from omicron BA.5 as the latter subvariant is from ancestral Covid strain, according to the study.

“Therefore, it is alarming that these newly emerged subvariants could further compromise the efficacy of current COVID-19 vaccines and result in a surge of breakthrough infections, as well as re-infections,” the scientists wrote.

XBB.1, however, presents the biggest challenge. It is about 49 times more resistant to antibody neutralization than the BA.5 subvariant, according to the study. XBB.1, fortunately, is currently causing no more than 1% of infections in the U.S., according to CDC data.

BQ.1.1 and BQ.1 represent 37% and 31% of new infections respectively, while XBB is causing 4.7% of new infections, according to CDC data.

Antibodies ineffective

Key antibody drugs, Evusheld and bebtelovimab, were “completely inactive” against the new subvariants, according to the study. These antibodies are used primarily by people with weak immune systems.

Evusheld is an antibody cocktail used to prevent Covid in people with weak immune systems who don’t respond strongly to the vaccines. Bebtelovimab is used to prevent Covid from progressing to severe disease in organ transplant patients and other individuals who cannot take other treatments.

“This poses a serious problem for millions of immunocompromised individuals who do not respond robustly to COVID-19 vaccines,” the scientists wrote. “The urgent need to develop active monoclonal antibodies for clinical use is obvious.”

The FDA has already pulled its authorization of bebtelovimab nationwide because it is no longer effective against the dominant omicron variants in the U.S. Evusheld remains authorized as the only option for pre-exposure prophylaxis.

New Covid infections increased by about 50% to 459,000 for the week ending Dec. 7, according to CDC data. Covid deaths increased 61% to nearly 3,000 during the same week. Hospital admissions have plateaued at 4,700 per day on average after rising in November, according to the data.

White House chief medical advisor Dr. Anthony Fauci, in a press briefing last month, said U.S. health officials are hoping there’s enough immunity in the population from vaccination, infection or both to prevent the massive surge of infections and hospitalizations the U.S. suffered last winter when omicron first arrived.

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CDC encourages people to wear masks to prevent spread of Covid, flu, RSV

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The Centers for Disease Control Prevention on Monday encouraged people to wear masks to help reduce the spread of respiratory illnesses this season as Covid, flu and RSV circulate at the same time.

CDC Director Dr. Rochelle Walensky, in a call with reporters, said wearing a mask is one of several everyday precautions that people can take to reduce their chances of catching or spreading a respiratory virus during the busy holiday season.

“We also encourage you to wear a high-quality, well-fitting mask to prevent the spread of respiratory illnesses,” said Walensky, adding that people living in areas with high levels of Covid transmission should especially consider masking.

The CDC director said the agency is considering expanding its system of Covid community levels to take into account other respiratory viruses such as the flu. The system is the basis for when CDC advises the public to wear masks. But Walensky encouraged people to take proactive action.

“One need not wait on CDC action in order to put a mask on,” Walensky said. “We would encourage all of those preventive measures — hand washing, staying home when you’re sick, masking, increased ventilation — during respiratory virus season, but especially in areas of high Covid-19 community levels.”

About 5% of the U.S. population lives in counties where the CDC is officially recommending masks due to high Covid levels. The CDC continues to recommend masking for anyone travelling by plane, train, bus or other forms of public transportation, Walensky said.

People with weak immune systems and those who otherwise face a heightened risk of severe disease should also consider wearing a mask, the CDC director said.

Walensky strongly encouraged everyone eligible to receive their flu shot and Covid booster. Flu vaccination coverage is lagging for at-risk groups — children under age 5, pregnant women, and at-risk seniors — compared with last year, the CDC director said. There is no vaccine for RSV.

“I want to emphasize that the flu vaccine can be life saving and importantly, there’s still time to get vaccinated to be protected against flu this season and its potential serious consequences,” Walensky said.

The flu has arrived early and hit the U.S. hard with hospitalizations at a decade high for this time of year. More than 8.7 million people have fallen ill, 78,000 have been hospitalized, and 4,500 people have died from the flu this season, according to CDC data. Fourteen children have died from the flu so far this season.

More than 19,000 people were hospitalized with the flu during the week ending Nov. 26, nearly double the previous week, according to CDC data.

People hospitalized with Covid also increased 27% during the week ending Dec. 2, according to CDC data. And respiratory syncytial virus, or RSV, has been hospitalizing children at higher rate than in previous years. Walensky said RSV appears to have peaked in the Southeast and may be leveling off in the Mid-Atlantic, though circulation of the virus remains high in much of the nation.

“We now face yet another surge of illness. Another moment of overstretched capacity and really one of tragic and often preventable death,” Walensky said, as she thanked health-care workers for their service during the repeated surges of illness they have confronted since the Covid pandemic began.

Dr. Sandra Fryhofer, board chair of the American Medical Association, said the circulation of Covid, flu and RSV at the same is a “a perfect storm for a terrible holiday season.” Fryhofer said she understands many people are tired of receiving repeated Covid shots, but getting vaccinated is the best way to avoiding falling ill over the holidays.

“You could get really, really sick this year and ruin your holiday celebrations if you don’t get vaccinated,” Fryhofer said during Monday’s call.

The Children’s Hospital Association and the American Academy of Pediatrics last month asked the Biden administration to declare a public health emergency in response to the surge of pediatric hospitalizations from RSV and the flu.

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Biden administration will end monkeypox public health emergency

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People line up to get a monkeypox vaccination at a new walk-up monkeypox vaccination site at Barnsdall Art Park on Tuesday, Aug. 9, 2022 in Hollywood, CA. 

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The Biden administration will end the public health emergency declared in response to the monkeypox outbreak, as new infections have declined dramatically and vaccination rates have increased.

The Health and Human Services Department does not expect it will renew the emergency declaration after it expires on Jan. 31 “given the low number of cases today,” HHS Secretary Xavier Becerra said in a statement Friday.

“But we won’t take our foot off the gas — we will continue to monitor the case trends closely and encourage all at-risk individuals to get a free vaccine,” he said. “As we move into the next phase of this effort, the Biden-Harris Administration continues working closely with jurisdictions and partners to monitor trends, especially in communities that have been disproportionately affected.”

Becerra declared an emergency in August in an effort to accelerate a vaccination and education campaign as the virus was spreading swiftly in the gay community. The spread of the virus, dubbed “mpox” on Monday by the World Health Organization in order to reduce stigma associated with its name, has slowed drastically since.

Mpox has infected nearly 30,000 people and killed 15 in the U.S. since health officials confirmed the first domestic case in May, according to the Centers for Disease Control and Prevention. The U.S. outbreak is the largest in the world.

But infections have slowed dramatically since August, when new cases peaked at 638 per day on average. The U.S. is currently averaging about seven new cases a day, according to CDC data.

U.S. health officials have said the outbreak has slowed because vaccinations have increased dramatically, and people have changed their behavior in response to education campaigns about how to avoid infection.

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The vaccination campaign got off to a rocky start, with limited supplies resulting in long lines at clinics and protests in some cities. But vaccinations increased significantly after the White House created a task force and HHS declared a public health emergency.

More than 1.1 million doses of the Jynneos vaccine have been administered in the U.S. since the summer. CDC Director Dr. Rochelle Walensky has said about 1.7 million gay and bisexual people who are HIV positive or are taking medication to prevent HIV infection are at highest risk from mpox.

Mpox has spread primarily through sexual contact among men who have sex with men. The virus causes rashes resembling pimples or blisters that can develop in sensitive areas and be very painful. Though mpox is rarely fatal, people with compromised immune systems are at higher risk of severe disease.

The CDC, in a report published in late October, said it is unlikely the U.S. will eradicate mpox in the near future. The virus will probably continue to circulate at low level primarily in communities of men who have sex with men, according to CDC. Though anyone can catch mpox, there’s little evidence of the virus spreading widely in the general population so far, according to CDC.

The global mpox outbreak this year is the largest in history with more than 80,000 confirmed cases in more than 100 countries. The current outbreak is highly unusual because the virus is spreading widely between people in Europe and North America.

Historically, mpox spread at low levels in remote areas of West and Central Africa where people caught the virus from infected animals.

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