- Breakthrough Omicron BA.1/BA.2 infections in the triple-vaccinated linked to broad-based immunity News-Medical.Net
- Severe SARS-Cov2 pneumonia in vaccinated patients: a multicenter cohort study | Scientific Reports Nature.com
- Establishment of a rapid and accurate SARS-CoV-2 antigen detection kit able to identify Omicron mutants News-Medical.Net
- New study suggests Omicron BA.1 breakthrough infection drives long-term remodeling of memory B cell repertoire in vaccinated populations News-Medical.Net
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Tag Archives: infections
CDC says an eye drop brand may be connected to drug-resistant bacterial infections
A brand of over-the-counter eye drops may be linked to a bacterial infection that left one person dead and three others with permanent vision loss, according to the Centers for Disease Control and Prevention.
The CDC has identified at least 50 people in 11 states with Pseudomonas aeruginosa, which is a type of bacterium resistant to most antibiotics. So far, there have been cases in California, Colorado, Connecticut, Florida, New Jersey, New Mexico, New York, Nevada, Texas, Utah and Washington.
The agency said it is investigating, and that a majority of people affected reported using preservative-free EzriCare Artificial Tears before they became infected, according to a Jan. 20 statement.
Among the reported cases, 11 people developed eye infections, including at least three who were blinded in one eye. Others who became ill had respiratory infections or urinary tract infections, and one person died after the bacterium entered their bloodstream.
YEARLY COVID VACCINE AS PROPOSED BY FDA? ‘CART BEFORE THE HORSE,’ SAYS DOCTOR
A brand of over-the-counter eyedrops may be linked to a bacterial infection that left one person dead and three others with permanent vision loss, according to the Center for Disease Control and Prevention.
(iStock)
It remains unclear at this time if those affected had underlying eye conditions, such as glaucoma or cataracts, that would have made them more susceptible. Eye infection symptoms include pain, swelling, discharge, redness, blurry vision, sensitivity to light and the feeling that an object is stuck in the eye.
Pseudomonas aeruginosa bacteria are commonly found in water, soil and on the hands of otherwise healthy people. These infections typically take place in hospitals among people with weakened immune systems. This type of bacterium is often resistant to standard antibiotics.
The CDC has identified at least 50 people in 11 states with Pseudomonas aeruginosa, which is a type of bacterium resistant to most antibiotics.
(iStock)
The eye drops in question are labeled as preservative-free, meaning the product does not contain anything that could prevent microbiological growth.
It is possible that the drops were contaminated during the manufacturing process or when a person with the bacteria on their skin opened the container.
The CDC discovered the bacteria in the eye drop bottles and is conducting tests to determine whether that bacteria matches the strain found in patients.
RON DESANTIS PUSHES FOR SWEEPING PROTECTIONS AGAINST COVID-19 MANDATES IN FLORIDA
Eye infection symptoms include pain, swelling, discharge, redness, blurry vision, sensitivity to light and the feeling that an object is stuck in the eye.
(iStock)
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EzriCare Artificial Tears had not been recalled as of Tuesday evening.
The CDC is recommending that clinicians and patients stop using the product until the investigation and laboratory analysis are complete.
EzriCare eye drops: CDC advises against use as it investigates dozens of infections and one death in 11 states
CNN
—
The US Centers for Disease Control and Prevention is urging health care providers and consumers to stop using EzriCare Artificial Tears as it conducts an investigation into at least 50 infections in 11 states that have led to instances of permanent vision loss, hospitalization and one death.
Most of the people with these infections reported using artificial tears, and EzriCare was the most common brand, the agency says. These eye drops are preservative-free, meaning they don’t have ingredients to prevent bacterial growth.
Testing of open EzriCare bottles identified Pseudomonas aeruginosa bacteria that were resistant to carbapenem antibiotics as well as the antibiotics ceftazidime and cefepime. Testing of unopened bottles is ongoing, the CDC says.
“CDC recommends that clinicians and patients immediately discontinue the use of EzriCare Artificial Tears until the epidemiological investigation and laboratory analyses are complete,” the agency says.
New Jersey-based EzriCare says in a statement dated January 24 that it has not received any consumer complaints or adverse event reports.
“We have not been asked to conduct a recall. EzriCare does not manufacture the Lubricant Eye Drops,” the statement says.
“Nevertheless, and in an abundance of caution, EzriCare recommends that during this evolving situation you discontinue use of any portions of EzriCare Artificial Tears Lubricant Eye Drops you may have until we can discover more details about any potential safety concerns.”
Pseudomonas bacteria are common in the environment, such as in soil and water. Pseudomonas aeruginosa is usually spread in health care settings, the CDC says, and is increasingly difficult to treat because of antibiotic resistance. It caused more than 32,000 infections in hospitalized patients and about 2,700 deaths in the US in 2017.
Vaccination to prevent dementia? New research suggests one way viral infections can accelerate neurodegeneration
One in nine Americans ages 65 and over had Alzheimer’s disease in 2022, and countless others were indirectly affected as caregivers, health care providers and taxpayers. There is currently no cure – available treatments primarily focus on prevention by encouraging protective factors, such as exercise and healthy diet, and reducing aggravating factors, such as diabetes and high blood pressure.
One of these aggravating factors is viral infections. Researchers have identified that certain viruses such as herpes simplex virus type 1 (HSV-1, which causes cold sores), varicella zoster virus (VZV, which causes chickenpox and shingles) and SARS-CoV-2 (which causes COVID-19) can lead to a higher risk of Alzheimer’s disease and dementia following infection.
Figuring out how and when these viruses contribute to disease could help scientists develop new therapies to prevent dementia. However, researchers have been unable to consistently detect suspect viruses in brains of people who died of Alzheimer’s. Because the Alzheimer’s disease process can start decades before symptoms, some researchers have proposed that viruses act early in a “hit-and-run” manner; they trigger a cascade of events that lead to dementia but have already taken off. In other words, by the time researchers analyze patient brains, any detectable viral components are gone and causation is difficult to establish.
We are a neurovirologist, neurologist and neuroscientist team interested in the role viruses play in neurodegenerative diseases. In our recently published research, we use new technology to search for the tire tracks of these viruses in Alzheimer’s patients. By focusing on the most vulnerable entry point to the brain, the nose, we discovered a genetic network that provides evidence of a robust viral response.
Focusing on the olfactory system
Many of the viruses implicated in dementia, including herpesviruses and the virus that causes COVID-19, enter the nose and interact with the olfactory system.
The olfactory system is constantly bombarded with odors, pollutants and pathogens. Particles inhaled through the nostrils bind to specific olfactory receptor cells in the tissue lining the nasal cavity. These receptors send messages to other cells in what’s called the olfactory bulb, which acts like a relay station that transmits these messages down the long nerves of the olfactory tract. These messages are then transferred to the area of the brain responsible for learning and memory, the hippocampus.
The hippocampus plays a critical role assigning contextual information to odors, such as danger from the foul smell of propane or comfort from the smell of lavender. This area of the brain is also dramatically damaged in Alzheimer’s disease, causing devastating learning and memory deficits. For as many as 85% to 90% of Alzheimer’s patients, loss of smell is an early sign of disease.
The mechanism leading to smell loss in Alzheimer’s disease is relatively unknown. Like muscles that atrophy from lack of use, sensory deprivation is thought to lead to atrophy of the brain regions that specialize in interpreting sensory information. Strong sensory input to these regions is critical to maintain general brain health.
Olfactory inflammation and Alzheimer’s disease
We hypothesize that viral infections throughout life are both contributors to and potential drug targets in Alzheimers’s disease. To test this idea, we used emerging, state-of-the-art technology to investigate the mRNA and protein networks of the olfactory system of Alzheimer’s disease patients.
The body uses mRNA, which is transcribed from DNA, to translate genetic material into proteins. The body uses specific mRNA sequences to produce a network of proteins that are used to fight against certain viruses. In some cases, the body continues to activate these pathways even after the the virus is cleared, leading to chronic inflammation and tissue damage. Identifying which mRNA sequences and protein networks are present can allow us to infer, to a degree, whether the body is or was responding to a viral pathogen at some point.
Previously, sequencing mRNA in tissue samples was difficult because the molecules degrade very quickly. However, new technology specifically addresses that issue by measuring small subsections of mRNA at a time instead of trying to reconstruct the whole mRNA sequence at once.
We leveraged this technology to sequence the mRNA of olfactory bulb and olfactory tract samples from six people with familial Alzheimer’s, an inherited form of the disease, and six people without Alzheimer’s. We focused on familial Alzheimer’s because there is less variability in disease than in the sporadic, or nonfamilial, form of the disease, which can result from a number of different individual and environmental factors.
In the familial Alzheimer’s samples, we found altered gene expression indicating signs of a past viral infection in the olfactory bulb, as well as inflammatory immune responses in the olfactory tract. We also found higher levels of proteins involved in demyelination in the olfactory tract of familial Alzheimer’s samples than in the controls. Myelin is a protective fatty layer around nerves that allows electrical impulses to move quickly and smoothly from one area of the brain to another. Damage to myelin stalls signal transduction, resulting in impaired neural communication and, by extension, neurodegeneration.
Based on these findings, we hypothesize that viral infections, and the resulting inflammation and demyelination within the olfactory system, may disrupt the function of the hippocampus by impairing communication from the olfactory bulb. This scenario could contribute to the accelerated neurodegeneration seen in Alzheimer’s disease.
Implications for patient health
Epidemiological data supports the role of viral infections in the development of Alzheimer’s disease. For example, the varicella zoster virus is linked to a nearly threefold risk of developing dementia within five years of infection for patients with a shingles rash on their face. A recent report also found a nearly 70% increased risk of getting diagnosed with Alzheimer’s within a year of a COVID-19 diagnosis for people over 65.
These studies suggest that vaccination may be a potential measure to prevent dementia. For example, vaccination against the seasonal flu virus and herpes zoster is associated with an up to 29% and 30% reduced risk of developing dementia, respectively.
Further research investigating how viral infections can trigger neurodegeneration could aid in the development of antiviral drugs and vaccines against the viruses implicated in Alzheimer’s disease.
Report written by Andrew Bubak, Assistant Research Professor of Neurology; Diego Restrepo, Professor of Cell and Developmental Biology; and Maria Nagel, Professor of Neurology and Ophthalmology, all from the University of Colorado Anschutz Medical Campus. This article is republished from The Conversation under a Creative Commons license. Read the original article.
Association of social isolation and loneliness with risk of incident hospital-treated infections: an analysis of data from the UK Biobank and Finnish Health and Social Support studies
Study design and population
We assessed the association of loneliness and social isolation with hospital-treated infectious diseases using data from the prospective UK Biobank cohort study,
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- Sudlow C
- Gallacher J
- Allen N
- et al.
UK Biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age.
and replicated this analysis using data from an independent cohort, the nationwide population-based Finnish Health and Social Support (HeSSup) study.
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- Korkeila K
- Suominen S
- Ahvenainen J
- et al.
Non-response and related factors in a nation-wide health survey.
Baseline data for the UK Biobank were collected between 2006 and 2010 in 22 research assessment centres across the UK. We included participants aged 38–73 years, who were linked to national health registries, had no history of hospital-treated infections at or before baseline, and had complete data on loneliness or social isolation. The HeSSup study comprised a random sample of individuals in Finland aged 20–54 years.
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- Korkeila K
- Suominen S
- Ahvenainen J
- et al.
Non-response and related factors in a nation-wide health survey.
We included individuals from the HeSSup study with available data on loneliness or social isolation who were linked to national health registries. The HeSSup study included repeated assessments of loneliness and social isolation (in 1998 and 2003), which allowed evaluation of reverse causality. We excluded participants with missing data on hospital-treated infections, loneliness, and social isolation from both cohorts. The outcome of interest was defined as hospital admissions with a primary diagnosis of infection, ascertained via linkage to electronic health records.
All participants provided written informed consent for the baseline assessments and for registry linkage. The UK Biobank was approved by the National Health Service National Research Ethics Service (11/NW/0382), and the HeSSup study by the ethics committee of Turku University Central Hospital and the Finnish Population Register Centre (VRK 2605/410/14).
Procedures
In the UK Biobank, loneliness was assessed by asking two questions: “Do you often feel lonely?” (no, 0; yes, 1) and “How often are you able to confide in someone close to you?” (0, almost daily–once every few months; 1, never or almost never). We defined a person as lonely only if they responded positively to both questions. In the sensitivity analysis, we used a single-item measure (“Do you often feel lonely?” Yes or no) to measure loneliness, as such single-item measures are highly correlated with the UCLA loneliness scale, the most commonly used multi-item measure of loneliness in population surveys.
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- Hughes ME
- Waite LJ
- Hawkley LC
- Cacioppo JT
A short scale for measuring loneliness in large surveys: results from two population-based studies.
In the UK Biobank, social isolation was assessed by asking three questions:
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- Sudlow C
- Gallacher J
- Allen N
- et al.
UK Biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age.
(1) “Including yourself, how many people live in your household? Include those who usually live in the house such as students living away from home during term time, and partners in the armed forces or in professions such as pilots” (1 point for living alone); (2) “How often do you visit friends or family or have them visit you?” (1 point for less than one friend or family visit per month); and (3) “Which of the following (leisure or social activities) do you engage in once a week or more often? You may select more than one” (1 point for not participating in any social activities at least weekly). The sum of the responses to these three questions resulted in a scale ranging from 0 to 3. We classified respondents with 2 or 3 points as socially isolated. The loneliness and social isolation measures were dichotomised with no weighting of responses.
In the HeSSup study, we constructed binary variables of loneliness and social isolation measures to make the measures and distributions as comparable as possible with those in the UK Biobank. Loneliness was assessed by asking “Do you currently feel lonely?” (Yes, very much so; yes, to some extent; no). We dichotomised responses to this question into yes versus no. The social isolation measure included four items of the longer Social Support Questionnaire, reflecting different ways of receiving support.
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- Sarason IG
- Sarason BR
- Potter EH
- Antoni MH
Life events, social support, and illness.
The respondents could choose one or more of six alternatives (husband, wife, or partner; some other relative; close friend; close co-worker; close neighbour; or someone else close). The responses to the items were combined so that each source of support contributed one point to the final social support score (range 0–20).
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- Sarason IG
- Sarason BR
- Potter EH
- Antoni MH
Life events, social support, and illness.
We used dichotomised scores in our analyses (0–6, socially isolated; 7–20, not isolated). Additional references and a description of validity issues are provided in the appendix (p 2).
Data regarding sex were acquired from central registry at recruitment, but in some cases were updated by the participant (categories were male and female). We selected baseline covariates based on factors used in previous studies in the field (appendix p 2), including demographic characteristics such as age, sex, and ethnicity, which can act as confounders, and other factors that can act as confounders, mediators, or both (appendix p 3). In the UK Biobank, baseline covariates (self-reported unless otherwise specified, as in the HeSSup study) were sex, age, ethnicity (White or non-White), education (low [no secondary education], intermediate [secondary education], or high [university degree]), the Townsend deprivation index (a continuous measure of neighbourhood deprivation), chronic diseases (self-reported long-standing illness without any specific diagnosis), current smoking (yes or no), physical activity (moderate and vigorous physical activity five or more times a week vs other), frequency of alcohol intake (three or four times a week or more vs once or twice a week or less), BMI (kg/m2), depressed mood in the past 2 weeks (Patient Health Questionnaire classified as low [not at all, several days] and high [more than half of my days, nearly every day]), and C-reactive protein (mg/L). Using linked electronic health records, we assessed physical conditions that, according to the US Centers for Disease Prevention and Control (2017), increase the risk of infectious diseases (a list of conditions with International Classification of Diseases 10th Revision [ICD-10] codes is provided in the appendix p 2).
In the HeSSup cohort, all covariates were self-reported and included age, sex (categories male and female), education (low [no occupational education], intermediate [vocational education], or high [university education]), current smoking (yes or no), alcohol consumption (none or moderate [1 to 21 units], or heavy [>21 units per week]), BMI (kg/m2), and depressed mood (moderate depression based on Beck Depression Inventory [score >18]). Physical activity was assessed as Metabolic Equivalent of Tasks
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- Eisenberger NI
- Moieni M
- Inagaki TK
- Muscatell KA
- Irwin MR
In sickness and in health: the co-regulation of inflammation and social behavior.
(METs) and was dichotomised on the basis of median split (high, 3·6 or more; low, <3·6 METs; this produced a broadly similar distribution to that in the UK Biobank study and a threshold close to that recommended previously).
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- Mendes MA
- da Silva I
- Ramires V
- et al.
Metabolic equivalent of task (METs) thresholds as an indicator of physical activity intensity.
The UK Biobank participants were linked to the Hospital Episode Statistics Admitted Patient Care (England), the Scottish Morbidity Records General/Acute Inpatient and Day Case Admissions (Scotland), and the Patient Episode Database (Wales) until Feb 7, 2018. HeSSup participants were linked to the Finnish National Registry for Hospitalisations until Dec 31, 2012. In both studies, we retrieved primary diagnoses of infectious diseases from inpatient hospital discharge information using ICD-10 codes.
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- Sipila PN
- Heikkila N
- Lindbohm JV
- et al.
Hospital-treated infectious diseases and the risk of dementia: a large, multicohort, observational study with a replication cohort.
We classified hospital-treated infectious diseases according to 925 ICD-10 codes (appendix pp 5–9). For comparison, we examined the associations of loneliness and social isolation with other broad disease categories including cancers; diseases of the endocrine, circulatory, respiratory, digestive, musculoskeletal, genitourinary, and nervous systems; diseases of the blood, eye, ear, and skin; and mental and behavioural disorders.
Statistical analysis
On the basis of a log-rank test and assuming a 5% confidence level and a statistical power of 80%, the minimum sample size for the detection of a small relative risk of 1·1 was 15 055 for loneliness and 14 925 for social isolation. After we assessed the proportional hazards assumption (appendix pp 9–10), we used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% CIs separately for the associations of loneliness and social isolation with the first hospital-treated infection episode. Participants with a hospital-treated infection at or before baseline were excluded before the analysis. Follow-up was from study entry until the first hospital episode due to infection, death, or end of follow-up, whichever came first (no data were available on migration). These analyses applied to both the UK Biobank and HeSSup studies (HeSSup data did not include information on ethnicity, area deprivation, or C-reactive protein).
We examined the associations of loneliness and social isolation with hospital-treated infectious diseases separately in the following steps. First, the associations were tested in the UK BioBank cohort by adjusting HRs and 95% CIs for age, sex, and ethnicity. To examine whether the associations were observable in subgroups, we conducted analyses stratified by sex, age, education, C-reactive protein, long-term disease status, and depressed mood at baseline. These variables were selected because they are potential effect modifiers and were used in stratified analyses in previous UK Biobank studies on loneliness.
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- Elovainio M
- Hakulinen C
- Pulkki-Raback L
- et al.
Contribution of risk factors to excess mortality in isolated and lonely individuals: an analysis of data from the UK Biobank cohort study.
,
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- Elovainio M
- Lahti J
- Pirinen M
- et al.
Association of social isolation, loneliness and genetic risk with incidence of dementia: UK Biobank cohort study.
The interaction effect was tested by adding interaction terms into each model.
Second, we performed stepwise multivariable analyses in the UK BioBank cohort to test the extent to which the associations were independent of baseline covariates, and whether the multivariable-adjusted results were replicable in the first 3 years of follow-up and from year 3 onwards. All models included loneliness or social isolation as the exposure and covariates were added as follows. Model 1 included age and sex. In addition to age and sex, other models included ethnicity (Model 2); education and the Townsend deprivation index (Model 3); smoking, alcohol consumption, physical activity, and BMI (Model 4); long-term illness (Model 5); C-reactive protein (Model 6); depressed mood (Model 7); and all the aforementioned covariates (Model 8). Given that the covariates can act as both as confounders and mediators, we interpreted the results cautiously and considered the association between loneliness or social isolation and infectious diseases independent of other factors only if the association remained significant after adjustment for the covariates. We calculated the percentage of excess risk attributable to covariates (PERM) for the associations of social isolation and loneliness with infections using the following formula:
PERM% = ([HR(age and sex) – HR(age, sex, and covariates adjusted)]/[HR(age and sex adjusted) – 1]) × 100.
Third, in sensitivity analyses of the UK BioBank cohort, we tested whether the associations were robust to the exclusion of participants with physical conditions that increase the risk of infectious diseases. To examine reverse causation in the HeSSup study, we tested whether infectious diseases at baseline were associated with loneliness or social isolation at follow-up among those who did not report these exposures at baseline. The exposure was a hospital-treated infectious disease and the outcome loneliness or social isolation. We included those with and without an infectious disease at baseline (the exposure) but excluded those who reported being lonely or isolated. Incident cases were those who had become lonely or socially isolated at follow-up. To investigate disease specificity, we examined associations between loneliness or social isolation and other disease categories. In each step, participants with missing data on covariates were excluded from the analysis.
A two-sided p value of less than 0·05 was considered to indicate statistical significance. Because this was a hypothesis-testing study with multiple sensitivity analyses rather than an exploratory study with multiple independent tests, we did not correct for multiple testing.
In the HeSSup study, the analyses were done in two steps, first adjusted for age and sex and second adjusted for age, sex, education, alcohol consumption, smoking status, physical activity, and depressive symptoms.
We did all data analyses in R (version 4.1.1) between December, 2021, and January, 2022. The code for the analyses is available in the appendix (pp 11–44).
Trial for single shot targeting three different infections
A vaccine trial is underway to combat a triple threat of infections with just one single jab.
The University of the Sunshine Coast has started clinical trials of a new Moderna vaccine which works as a triple-barrel shot to target COVID-19, RSV and influenza.
“If you could go to the doctor and get one vaccine that essentially covers you for influenza, COVID-19 and RSV – that would be helpful,” Dr Nischal Sahai said.
“The aim is to see whether a combination vaccine will be as tolerable as giving all three vaccines separately.”
The vaccine poses a major shake-up to Australia’s annual vaccine rollout to help ease the burden on an overloaded system.
“One visit, one vaccination and possibly a booster compared to three visits and boosters,” participant Carolyn Rose said.
“I think that will take a big load off our current health system.”
It can take several years to collate enough data before the vaccine can be rolled out safely but researchers are now looking to expand their pool of participants and are calling for more volunteers.
“We are looking for people who are generally in good health between 50 and 75 – they can be male or female,” senior clinical trial coordinator Joan Stark said.
The process includes seven clinic visits and eight phone calls over a period of up to 13 months with all participants compensated.
Rare glimpse of China covid infections from airport test data
Countries around the world soon implemented increased testing requirements for arrivals from China, which have gone into effect during the run-up to heightened travel during the Lunar New Year holiday in late January. The new rules come into effect amid reports of overflowing hospitals and medicine shortages in China after it reversed its “zero covid” policy.
Among the strictest are policies in Italy, South Korea, Japan and Taiwan, which require on-arrival testing for passengers from China. The United States requires proof of a negative test before departure, while other countries are testing wastewater from aircraft on flights originating in China.
Official data showed infection rates of more than 20 percent among travelers from China to neighboring South Korea and Taiwan in the first week of January.
Data from the Korea Disease Control and Prevention Agency obtained by The Washington Post showed a 23.2% infection rate for short-term visitors from China to Korea (or 314 out of 1,352 tested at the airport) from Jan. 2 to Jan. 6. The KDCA expects to publish data on all travelers from China next week, an official told The Post.
According to the Taiwan Centers for Disease Control, from Jan. 1 to Jan. 5 about one in five travelers (21%) from mainland China tested positive for covid, or 1,111 out of 5,283 arrivals.
On Friday, Japan’s Ministry of Health, Labor and Welfare reported that about 8 percent of visitors from China from Dec. 30 to Jan. 6 had tested positive for covid, or 408 out of 4,895 arrivals. Data from Italy was not immediately available.
“These numbers are certainly [the] tip of the iceberg, highlighting the immense size of infections in China,” Yanzhong Huang, Senior Fellow for Global Health at the Council on Foreign Relations, wrote in an email, responding to early reports suggesting an infection rate of 20 to 50 percent among Chinese travelers.
The numbers are particularly high, “if we consider that people typically would not travel overseas unless they feel well and healthy, or do not show symptoms,” he said.
However, given the high levels of exposure to covid in many countries, “it is not reasonable to view [visitors from China] as diseased or dangerous,” he said.
Benjamin Cowling, an epidemiologist at the University of Hong Kong, called the high early infection rates “completely consistent with forecasts that the majority of the population of major cities have already been infected.” He said in an email that people can remain positive on PCR tests for weeks.
“Since most infections have occurred in late December and early January, and more than half of the population in major cities have already been infected, it is quite plausible that high percentages of travelers have been testing positive,” he wrote. “Those testing positive will mostly have recently recovered from infection rather than still being sick and/or contagious.”
Last month, China partly lifted domestic restrictions in a move seen as a response to a rare public backlash directed at the country’s notoriously stringent zero-covid policy.
On Sunday, China will end extensive quarantine requirements for inbound passengers, a decision that will mostly benefit Chinese who want to leave or Chinese nationals abroad who want to return. Mainland China is still closed to foreign tourists.
The move comes just weeks before the Lunar New Year, which begins on Jan. 22. Before the pandemic, travel during China’s “Golden Week” national holiday was believed to be the world’s largest annual human migration.
The Chinese holiday “will ensure that the virus reaches every last corner of the country by the end of January,” Cowling said.
Huang said the holiday season will encourage “retaliation tourism” — travel making up for time lost during the pandemic — and is likely to cause a peak in outbound infections. But he also said it is unlikely that travelers leaving China will make the virus worse elsewhere.
“So far, there is no evidence of emerging new subvariants from China,” he said. “Given that most of these countries have learned to coexist with covid-19, the influx of Chinese visitors are not going to lead to spike of cases in these countries.”
The changes also come amid wider scrutiny of Beijing, which has stopped counting asymptomatic covid cases. The World Health Organization has questioned China’s data and requested more information from Beijing.
The testing requirements targeting arrivals from China has drawn ire from Chinese authorities. “Some of these measures are disproportionate and simply unacceptable,” a Chinese Foreign Ministry spokesperson said at a Jan. 3 news conference. “We firmly reject using COVID measures for political purposes and will take corresponding measures in response to varying situations based on the principle of reciprocity.”
Julia Mio Inuma in Tokyo and Lily Kuo in Taipei, Taiwan, contributed to this report.
China’s big cities are starting to look past Covid, while rural areas brace for infections
Subway passenger traffic in Shanghai is quickly returning to levels seen before the latest Covid wave, according to Wind data. Pictured here is a subway car in the city on Jan. 4, 2023.
Hugo Hu | Getty Images News | Getty Images
BEIJING — China will likely be able to live with Covid-19 by the end of March, based on how quickly people have returned to the streets, said Larry Hu, chief China economist at Macquarie.
Subway and road data show traffic in major cities is rebounding, he pointed out, indicating the worst of the latest Covid wave has passed.
“The dramatic U-turn in China’s Covid policy since mid-Nov implies deeper short-term economic contraction but faster reopening and recovery,” Hu said in a report Wednesday. “The economy could see a strong recovery in Spring.”
In the last several days, the southern city of Guangzhou and the tourist destination of Sanya said they’d passed the peak of the Covid wave.
Chongqing municipal health authorities said Tuesday that daily visitors to major fever clinics was just over 3,000 — down sharply from Dec. 16 when the number of patients received topped 30,000. The province-level region has a population of about 32 million.
Chongqing was the most congested city in mainland China during Thursday morning’s rush hour, according to Baidu traffic data. The figures showed increased traffic from a week ago across Beijing, Shanghai, Guangzhou and other major cities.
As of Wednesday, subway ridership in Beijing, Shanghai and Guangzhou had climbed significantly from the lows of the last few weeks — but had only recovered to about two-thirds of last year’s levels, according to Wind Information.
Caixin’s monthly survey of services businesses in December found they were the most optimistic they’d been in about a year-and-a-half, according to a release Thursday. The seasonally adjusted business activity index rose to 48 in December, up from a six-month low of 46.7 in November.
That below-50 reading still indicates a contraction in business activity. The index for a separate Caixin survey of manufacturers edged down to 49 in December, from 49.4 in November. Their optimism was the highest in ten months.
Poorer, rural areas next
Shanghai medical researchers projected in a study that the latest Covid wave would pass through major Chinese cities by the end of 2022, while rural areas — and more distant provinces in central and western China — would be hit by infections in mid- to late-January.
“The duration and magnitude of upcoming outbreak could be dramatically enhanced by the extensive travels during the Spring Festival (January 21, 2023),” the researchers said in a paper published in late December by Frontiers of Medicine, a journal sponsored by China’s Ministry of Education.
Typically hundreds of millions of people travel during the holiday, also known as the Lunar New Year.
The researchers said senior citizens, especially those with underlying health conditions, in China’s remote areas face a greater risk of severe illness from the highly transmissible omicron variant. The authors were particularly worried about the lack of medicine and intensive care units in the the countryside.
Even before the pandemic, China’s public health system was stretched. People from across the country often traveled to crowded hospitals in the capital city of Beijing in order to get better health care than they could in their hometowns.
Oxford Economics senior economist Louise Loo remained cautious about a rapid rebound in China’s economy.
“A normalisation in economic activity will take some time, requiring among other things a change in public perceptions towards contracting Covid and vaccine effectiveness,” Loo said in a report Wednesday.
The firm expects China’s GDP will grow by 4.2% in 2023.
Lingering long-term risk
The medical researchers also warned of the risk that omicron outbreaks on the mainland “might appear in multiple waves,” with new surges in infections possible in late 2023. “The importance of regular monitoring of circulating SARS-CoV-2 sublineages and variants across China shall not be overestimated in the months and years to come.”
However, amid a lack of timely information, the World Health Organization said Wednesday it was asking China for “more rapid, regular, reliable data on hospitalizations and deaths, as well as more comprehensive, real-time viral sequencing.”
China in early December abruptly ended many of its stringent Covid controls that had restricted business and social activity. On Sunday, the country is set to formally end a quarantine requirement for inbound travelers, while restoring the ability of Chinese citizens to travel abroad for leisure. The country imposed strict border controls beginning in March 2020 in an attempt to contain Covid domestically.
Infectiousness of SARS-CoV-2 breakthrough infections and reinfections during the Omicron wave
Using detailed epidemiologic data from SARS-CoV-2 surveillance within the California state prison system, we found that vaccination and prior infection reduced the infectiousness of SARS-CoV-2 infections during an Omicron-predominant (subvariants BA.1 and BA.2) period. Vaccination and prior infection were each associated with similar reductions in infectiousness during SARS-CoV-2 infection, and, notably, additional doses of vaccination (for example, booster doses) against SARS-CoV-2 and more recent vaccination led to greater reductions in infectiousness. Of note, reductions in transmission risk associated with vaccination and prior infection were found to be additive, indicating an increased benefit conferred by vaccination for reducing cases’ infectiousness even after prior infection. Irrespective of vaccination and/or prior natural infection, SARS-CoV-2 breakthrough infections and reinfections remained highly infectious and were responsible for 80% of transmission observed in the study population, which has high levels of both prior infection and vaccination. This observation underscores that vaccination and prevalent naturally acquired immunity alone will not eliminate risk of SARS-CoV-2 infection, especially in higher-risk settings, such as prisons.
Prior studies during the Delta variant wave and before widespread booster vaccination are mixed on whether SARS-CoV-2 breakthrough infections in vaccinated individuals are potentially less infectious6,7,8 or equally infectious9,10 to primary infections. In more recent household contact studies during the Omicron variant era11,12,13, vaccination often led to reduced SARS-CoV-2 infectiousness. Several factors may have enhanced our ability to observe statistically meaningful findings in the present study. The risk of transmission among close contacts in the prison setting and consistency in contact structure, especially in light of increased transmissibility of the Omicron SARS-CoV-2 variant, may have enhanced statistical power in our sample. Relatedly, a higher proportion of index cases in our sample were previously vaccinated or infected, further enhancing the opportunity to compare transmission risk from vaccinated or unvaccinated index cases and from those who were previously infected or previously uninfected.
A key result is that the vaccine-mediated reduction in infectiousness of SARS-CoV-2 breakthrough infections appears to be dose dependent. Each dose of the vaccine provided an additional average 11% relative reduction in infectiousness, which was mostly driven by residents with a booster dose. The findings of this study support the indirect effects of COVID-19 vaccination (especially booster doses) to slow transmission of SARS-CoV-2 and build on evidence of the direct effects of COVID-19 vaccination23 to emphasize the overall importance of COVID-19 vaccination. The public health implication of these findings is further support for existing policy using booster doses of vaccination24 to achieve the goal of lowering population-level transmission. The impact of additional bivalent vaccine doses, which are now authorized for individuals over 5–6 years of age25, on transmission should be a priority for further study. Additional considerations about the timeliness of vaccine doses are also necessary, as we found that index cases with more distant history of COVID-19 vaccination had a higher risk of transmission of infection to close contacts. Given this finding, this study raises the possibility of timed mass vaccination in incarcerated settings during surges to slow transmission.
The findings from this study have direct implications in addressing COVID-19 inequities in the incarcerated population through additional vaccination. In California state prisons at the time of this study, although 81% of residents and 73% of staff have completed a primary vaccination series, only 59% of residents and 41% of staff have received the number of vaccination doses recommended by the Centers for Disease Control and Prevention based on their age and comorbid medical conditions26. Our findings also provide a basis for additional considerations for housing situations of cases based on prior vaccination and infection history in future surges and can be used alongside other measures, such as depopulation and ventilation interventions, to protect incarcerated populations.
However, this study also underscores the persisting vulnerability to COVID-19 among residents and staff in correctional settings despite widespread vaccination, natural immunity and use of non-pharmaceutical interventions. The overall attack rate of SARS-CoV-2 in the study population (who were generally moved into isolation after symptoms or a positive test) was 30%, and index cases with breakthrough infections or reinfections remained highly infectious, which call into question the ability of high vaccination rates alone to prevent all SARS-CoV-2 transmission in correctional settings. In the United States, which incarcerates more residents per capita than any other country in the world26 and has a quarter of the world’s incarcerated population, correctional settings are characterized by poorly ventilated facilities, populations with increased rates of comorbid health conditions, high-risk dormitory housing and overcrowding18,27,28,29. Given the inability of current efforts to reduce transmission of SARS-CoV-2, decarceration efforts may be the most likely to have substantial effects on reducing cases.
The secondary attack rate in this study was on the lower end of published estimates when comparing to household studies. Of note, the secondary attack rate of the SARS-CoV-2 Omicron variant in recent household studies ranges from 29% to 53%11,12,13, in contrast to a 30% attack rate in this study. The prison environment has distinct epidemiologic differences to households. The dense living environment increases the likelihood of transmission in the prison environment compared to a household, whereas the frequent asymptomatic testing (with isolation of positive cases) in the prisons likely reduced the exposure time and subsequent transmission risk compared to households. The transmission of the prison cell is also likely more uniform than a household.
Strengths of this study include access to detailed records of all residents in the California state prison system, encompassing individuals’ prior COVID-19 vaccine receipt and prior natural infection history (based on frequent testing throughout the pandemic), as well as a social network given record of where residents slept each night over the study period. We use a consistent definition of social contact between the index case of COVID-19 and close contact based on the uniformity of cell type. The frequent testing ensures early identification of infections and systematic capture of asymptomatic and symptomatic infections to avoid bias by participants’ immune status (which could affect temporal onset of symptoms). The risk of misclassification of close contacts is low given that most follow-up testing in close contacts occurred well after first exposure to an index case (Supplementary Notes). The large sample size facilitates analyses of the contribution of combinations of prior vaccination statuses and natural infection on risk of transmission, including analyses examining the impact of booster doses.
Limitations should also be considered. We cannot exclude the possibility of some residual confounding (for example, behavioral differences that affect risk of transmission) between individuals who were vaccinated against SARS-CoV-2 and those who were unvaccinated. There is a possibility that close contacts who test positive for SARS-CoV-2 were not infected by their assigned index case but, instead, by interaction with infectious individuals outside of their cell. However, this misattribution would be expected to dampen apparent associations of transmission risk with index cases’ vaccination status and infection history but not bias the relative estimates. To further address the risk of misattribution, we adjusted for background SARS-CoV-2 incidence and matched contact pairs by facility and time. Our study population is a subset of the entire incarcerated population in California and may not represent all incarcerated settings. Studies of SARS-CoV-2 infectiousness may be subject to biases30,31,32. The strict inclusion and exclusion criteria in this study may introduce bias into the analysis, although we performed sensitivity analyses on these criteria with overall consistent findings. We also adjusted for prior infection in analyses to account for potential concerns about differential susceptibility related to prior infection in vaccinated versus unvaccinated individuals. Given limited SARS-CoV-2 testing capacity early in the pandemic and some residents’ decision to decline testing, it is possible that infections among some residents may not have been captured, although such misclassification would be expected to bias our findings to the null. SARS-CoV-2 testing was variable over time in the prison system, with periods of routine weekly testing and other periods of reactive testing; however, periods without reactive testing align with times during which SARS-CoV-2 was unlikely to be circulating at high levels within the facilities, suggesting that this is unlikely to bias results substantially. The study findings on boosters may also be related to recent vaccination effects. This study design did not provide a basis for identifying effects of vaccination and prior infection on risk of acquiring SARS-CoV-2 among close contacts, although we did adjust for prior infection and vaccination in close contacts in the primary analysis. Of note, vaccine effectiveness against infection among incarcerated persons has been reported within this population during earlier periods33,34. We do not have a detailed record of person-level masking, symptoms, cycle thresholds for polymerase chain reaction (PCR) testing or serologic testing. During the study, the predominant Omicron subvariants in California and California prisons were BA.1 and BA.2 based on genomic surveillance, although we did not genotype every SARS-CoV-2 isolate in this study.
This study demonstrates that breakthrough COVID-19 infections with the Omicron variant remain highly infectious but that both vaccination and natural infection confer reductions in transmission, with benefit of additional vaccine doses. As SARS-CoV-2 breakthrough infections and reinfections become the predominant COVID-19 case, this study supports the importance of booster doses in reducing population-level transmission with consideration of mass timed vaccination during surges, with particular relevance in vulnerable, high-density congregate settings.
China manufacturing contracts sharply as Covid infections soar
A textile factory on December 30, 2022 in Jiangxi Province. Chinese manufacturing activity contracted at its sharpest pace in nearly 3 years in December.
Vcg | Visual China Group | Getty Images
China’s factory activity shrank for the third straight month in December and at the sharpest pace in nearly three years as Covid infections swept through production lines across the country after Beijing’s abrupt reversal of anti-virus measures.
The official purchasing managers’ index (PMI) fell to 47.0 from 48.0 in November, the National Bureau of Statistics (NBS) said on Saturday. Economists in a Reuters poll had expected the PMI to come in at 48.0. The 50-point mark separates contraction from growth on a monthly basis.
The drop was the biggest since the early days of the pandemic in February 2020.
The data offered the first official snapshot of the manufacturing sector after China removed the world’s strictest Covid restrictions in early December. Cumulative infections likely reached 18.6 million in December, UK-based health data firm Airfinity estimated.
Analysts said surging infections could cause temporary labour shortages and increased supply chain disruptions. Reuters reported on Wednesday that Tesla plans to run a reduced production schedule at its Shanghai plant in January, extending the reduced output it began this month into next year.
Weakening external demand on the back of growing global recession fears amid rising interest rates, inflation and the war in Ukraine may further slow China’s exports, hurting its massive manufacturing sector and hampering an economic recovery.
While (the factory PMI) was lower than expected, it is actually hard for analysts to provide a reasonable forecast given the virus uncertainties over the past month.”
Zhou Hao
chief economist, Guotai Junan International
“Most factories I know are way below where they could be this time of year for orders next year. A lot of factories I’ve talked to are at 50%, some are below 20%,” said Cameron Johnson, a partner at Tidalwave Solutions, a supply chain consulting firm.
“So even though China is opening up, manufacturing is still going to slow down because the rest of the world’s economy is slowing down. Factories will have workers, but they will have no orders.”
NBS said 56.3% of surveyed manufacturers reported that they were greatly affected by the epidemic in December, up 15.5 percentage points from the previous month, although most also said they expected the situation will gradually improve.
Recovery hopes?
“While (the factory PMI) was lower than expected, it is actually hard for analysts to provide a reasonable forecast given the virus uncertainties over the past month,” said Zhou Hao, chief economist at brokerage house Guotai Junan International.
“In general, we believe that the worst for the Chinese economy is behind us, and a strong economic recovery is ahead.”
The country’s banking and insurance regulator pledged this week to step up financial support to small and private businesses in the catering and tourism sectors that were hit hard by the Covid-19 epidemic, stressing a consumption recovery will be a priority.
The non-manufacturing PMI, which looks at services sector activity, fell to 41.6 from 46.7 in November, the NBS data showed, also marking the lowest reading since February 2020.
The official composite PMI, which combines manufacturing and services, declined to 42.6 from 47.1.
“The weeks before Chinese New Year are going to remain challenging for the service sector as people won’t want to go out and spend more than necessary for fear of catching an infection,” said Mark Williams, Chief Asia Economist at Capital Economics.
“But the outlook should brighten around the time that people return from the Chinese New Year holiday – infections will have dropped back and a large share of people will have recently had Covid and feel they have a degree of immunity.”