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Health

Large new review underscores the risks of Covid-19 during pregnancy

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CNN
 — 

Pregnant women and their developing babies are at higher risk for severe outcomes if they get Covid-19, and now a large, international review is helping to underscore how devastating those risks can be.

The study draws on data from 12 studies from as many countries—including the United States. Altogether, the studies included more than 13,000 pregnant women—about 2,000 who had a confirmed or probable case of Covid-19. The health outcomes for these women and their babies were compared to about 11,000 pregnancies where the mother tested negative for Covid-19 or antibodies to it at the time of their deliveries.

Across the studies about 3% of pregnant women with Covid-19 needed intensive care, and about 4% needed any kind of critical care, but this was far higher than the numbers of pregnant women who needed that kind of care outside of a Covid-19 infection.

Compared to pregnant individuals who weren’t infected, those who got Covid-19 were nearly 4 times more likely to be admitted to an intensive care unit. They were 15 times more likely to be ventilated and were 7 times more likely to die. They also had higher risks for pre-eclampisa, blood clots, and problems caused by high blood pressure. Babies born to moms who had Covid-19 were at higher risk for preterm birth and low birth weights.

Previous studies have suggested that Covid-19 may increase the risk of stillbirth, but this study didn’t find that same link.

Still, the findings paint a clear picture that shows the risks of pregnancy are amplified by Covid-19 infections.

“It’s very clear and even it’s consistent, you know, whether we’re talking about Sweden where we have really generally great pregnancy outcomes to other countries that you know, have bigger problems with maternal morbidity and mortality, that having COVID and pregnancy increases risk for both mom and baby,” said lead study author Emily Smith, who is an assistant professor of global health at George Washington University.

The study has some caveats that may limit how applicable the findings are to pregnant individuals in the Omicron era.

First, the studies were conducted relatively early in the pandemic, at a time when most people were still unvaccinated and uninfected. That means people in the study were likely at higher risk not just because they were pregnant, but also because they were immunologically naïve to the virus—they didn’t have any pre-existing immunity to help them fight off their infections.

Since then, many pregnant individuals have gotten vaccinated, or had Covid-19 or both. As of the first week of January, about 72% of pregnant people in the U.S. have had their primary series of Covid-19 vaccines, and about 95% of Americans are estimated to have had Covid-19 at least once, or been vaccinated against it, according to data from the Centers for Disease Control and Prevention. That means it’s likely they have some immune memory against the virus that may help protect against severe outcomes.

That immune memory appears to fade over time, however. CDC data show just 19% of pregnant women have had an updated booster, meaning many people may not have as much protection against the virus as they think they do.

Lead study author Emily Smith, who is an assistant professor of global health at George Washington University, says the study results reflect the risk of Covid-19 and pregnancy in unvaccinated people.

Unfortunately, Smith says, many countries still don’t have clear guidelines advising vaccination during pregnancy. And there are some parts of the world, such as China, that still have substantial proportions of their population who’ve never been been infected.

For people who are trying to weigh the risks and benefits of Covid-19 vaccination during pregnancy, Smith says this study helps tip the scales firmly on the side of vaccination.

“It’s worth it to protect yourself in pregnancy,” Smith said.

She says this study didn’t look at the benefits of vaccination in pregnancy, but other studies have, showing big decreases in the risk of stillbirth, preterm birth and severe disease or death for mom.

“And so that’s kind of the complementary story,” said Smith.

Dr. Justin Lappen, division director of Maternal Fetal Medicine at the Cleveland Clinic, praised the study and said its findings reinforce and advance previous research, which has found that Covid-19 markedly increases the risk of severe outcomes for mom and baby. He wasn’t involved in the study.

He says the findings highlight the importance of preventing and treating Covid-19 in pregnant women.

Therapies that are indicated or otherwise recommended should not be withheld specifically due to pregnancy or breastfeeding, Lappen wrote in an email to CNN.

The study is published in the journal BMJ Global Health.

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Business

CDC identifies possible safety issue with Pfizer’s updated Covid-19 vaccine but says people should still get boosted

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CNN
 — 

The US Centers for Disease Control and Prevention said Friday that there is a possible safety issue with the bivalent Covid-19 vaccine made by Pfizer and BioNTech but that it is unlikely to represent a true risk. The agency said it continues to recommend that people stay up-to-date with Covid-19 vaccines.

The CDC said one of its vaccine safety monitoring systems – a “near real-time surveillance system” called the Vaccine Safety Datalink – detected a possible increase in a certain kind of stroke in people 65 and older who recently got one of Pfizer’s updated booster shots.

A rapid response analysis of that signal revealed that seniors who got an bivalent booster might be more likely to have ischemic strokes within the first three weeks after their shots, compared with weeks four through six.

Ischemic strokes, the most common form, are blockages of blood to the brain. They’re usually caused by clots.

The Vaccine Safety Datalink, or VSD, is a network of large health systems across the nation that provides data about the safety and efficacy of vaccines through patients’ electronic health records. The CDC said it had identified possible confounding factors in the data coming from the VSD that may be biasing the data and need further investigation.

Of about 550,000 seniors who got Pfizer bivalent boosters and were tracked by the VSD, 130 had strokes in the three weeks after the shot, according to a CDC official who spoke to CNN on condition of anonymity because they weren’t authorized to share the data. None of the 130 people died.

The number of strokes detected is relatively small, said Dr. William Schaffner, an infectious disease expert at Vanderbilt University and a member of the CDC Advisory Committee on Immunization Practices’ Covid-19 Vaccine Work Group.

“These strokes are not a confirmed adverse event at the moment,” he said. “It’s like a radar system. You’re getting a blip on the radar, and you have to do further investigation to discover whether that airplane is friend or foe.”

The same safety signal has not been detected with the bivalent Moderna booster, the CDC said in its notice.

The agency noted that it has looked for and failed to find the same increase in strokes in other large collections of medical records, including those maintained by Medicare, the US Department of Veterans Affairs, as well as its Vaccine Adverse Event Reporting System, known as VAERS.

Neither Pfizer nor other countries that are using the vaccine have seen any increase in this kind of stroke, the agency said, and the signal was not detected in any other databases.

The CDC says that it does not recommend any change to vaccination practices at this time and that the risks of Covid-19 for older adults continue to outweigh any possible safety issues with the vaccine.

“Although the totality of the data currently suggests that it is very unlikely that the signal in VSD represents a true clinical risk, we believe it is important to share this information with the public, as we have in the past, when one of our safety monitoring systems detects a signal,” the notice says.

“CDC and FDA will continue to evaluate additional data from these and other vaccine safety systems. These data and additional analyses will be discussed at the upcoming January 26 meeting of the FDA’s Vaccines and Related Biological Products Advisory Committee.”

Pfizer said in a statement Friday, “Neither Pfizer and BioNTech nor the CDC or the U.S. Food and Drug Administration (FDA) have observed similar findings across numerous other monitoring systems in the U.S. and globally and there is no evidence to conclude that ischemic stroke is associated with the use of the companies’ COVID-19 vaccines.

“Compared to published incidence rates of ischemic stroke in this older population, the companies to date have observed a lower number of reported ischemic strokes following the vaccination with the Omicron BA.4/BA.5-adapted bivalent vaccine.”

The bivalent boosters from Pfizer/BioNTech and Moderna protect against the original strain of the coronavirus as well as the Omicron BA.4 and BA.5 subvariants. Only about 50 million Americans ages 5 and up have gotten them since they were authorized last fall, according to CDC data.

Schaffner said he was part of a briefing Thursday with members of the Covid-19 Vaccine Work Group. He couldn’t share specific details about the briefing but said the safety signal was discussed.

His biggest takeaway was that the safety surveillance system is working.

It’s very likely that this is a false signal, he said, but it’s being investigated, which is important.

“You want a surveillance system that occasionally sends up false signals. If you don’t get any signals, you’re worried that you’re missing stuff.”

Schaffner said he would absolutely tell people to get their Covid-19 booster if they haven’t done so yet – even those 65 and older.

“Undoubtedly, the risk of a whole series of adverse events, including hospitalization, is much, much greater with Covid-19 than it is from the vaccine,” he said.

He also said the signal – if real – may be more a factor of numbers than an indication that one manufacturer’s vaccine is riskier than the other.

Nearly two-thirds of the people in the US who’ve gotten an updated booster – 32 million – have gotten Pfizer, compared with about 18 million Moderna shots.

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Health

Flu activity peaked without post-holiday spike in cases, but respiratory virus season is still in full swing

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CNN
 — 

Flu continues to be very prevalent in the US, but the first wave of the season – which swept through the country weeks earlier than usual – appears to have peaked.

The weeks after the year-end holidays brought sustained high levels of transmission and hospitalization, but flu activity doesn’t seem to have spiked as many public health experts cautioned.

Still, even after weeks of improvement, data published Friday by the US Centers for Disease Control and Prevention shows that more than 12,400 people were admitted to the hospital for flu in the first week of the new year, and nearly 9% of lab tests were positive for flu.

About 4% of everyone who visited a health care provider last week had respiratory virus symptoms, including fever plus a cough or sore throat, which is nearly twice as high as the national baseline.

Flu is notoriously unpredictable, and a season can bring multiple peaks of activity.

“It’s pretty clear that there was a peak of activity, but that doesn’t mean we won’t have another one,” Lynnette Brammer, lead of the CDC’s domestic influenza surveillance team, said last week. “Things could turn around and go back up.”

Flu vaccination rates remain far below ideal levels, and hospitals remain very full, leaving the US vulnerable as respiratory virus season drags on.

“It’s certainly something we’re gonna watch really carefully. We’re just going to have to keep an eye on all the data, see what viruses are circulating and who’s getting sick, and what sort of impact that’s having,” Brammer said.

“And I want to remind people that if they haven’t yet gotten vaccinated, please do so. It’s not too late.”

As of December 31, about 171 million doses of flu vaccine have been distributed in the US – enough to cover only about half of the population. Just 40% of adults had gotten their shot by the end of November, and just 48% of children had gotten their shot by the end of December, according to CDC data.

Through January 7, the CDC estimates that there have been 24 million illnesses, 260,000 hospitalizations and 16,000 deaths from flu this season.

Although this season did hit earlier than usual, outcomes are within an expected range – at least so far.

“It’s not an unusually high influenza season. It’s sort of falling in with the mid- to higher range, but it’s within the limits of what we normally expect to see during a regular flu season, unfortunately,” Brammer said. “So basically, this is looking like a typical flu season, except in terms of the timing. It was just a little bit earlier than normal.”

Overall, flu and other respiratory virus activity remains “high” or “very high” in about half of states, according to the new CDC data, and the US continues to contend with multiple respiratory viruses that are circulating at high levels.

RSV activity has also peaked in the US, reaching a season high in mid-November. But even after a sharp decrease in trends over the past month and a half, weekly hospitalization rates for RSV remain higher than the peaks for most recent seasons.

RSV is particularly dangerous for children, and at least 13 out of every 100,000 children younger than 5 were hospitalized for RSV in the last week of the year, bringing the cumulative hospitalization rate this season up to 5 out of every 1,000 children in this age group.

Meanwhile, Covid-19 activity has been trending up for the past few months.

Hospitalizations have been on the rise since November and have surpassed the most recent peak from this summer, before the updated booster shot was available, federal data shows.

Case reporting has become more irregular over the course of the pandemic, but wastewater monitoring data from Biobot Analytics suggests that Covid-19 activity is higher than it was during the Delta surge, too.

The rapidly growing Omicron subvariant XBB.1.5 now accounts for an estimated 43% of new Covid-19 cases in the US, according to the CDC, making it the strain that is causing the most new infections in the US.

Notably, it is the only variant that is gaining ground in the U.S.

XBB.1.5 was first detected in New York in October. It grew quickly throughout the Northeast, and the CDC estimates that it accounts for more than 80% of new cases in that region.

From there, XBB.1.5 seems to be picking up steam along the Eastern Seaboard. It now accounts for about half of Covid-19 cases in the mid-Atlantic states and nearly one-third of cases in the Southeast. It is less prevalent in other US regions.

The rise of XBB.1.5 has coincided with an increase in Covid-19 hospitalizations, especially among seniors.

XBB.1.5 has a key mutation that helps it bind more tightly to cells. Experts believe that may be helping it be more infectious.

Still, just 16% of the US population has received their updated Covid-19 booster shot. Data from October shows that people ages 5 and up who had received an updated booster had 19 times lower risk of dying from Covid-19 compared with those who were unvaccinated. Chances of testing positive were three times lower for those who had their updated booster.

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Health

Long-term symptoms from mild Covid resolve within year, study says

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CNN
 — 

The majority of long Covid symptoms resolve within the first year after infection for people with mild cases of Covid-19, according to a large study conducted in Israel.

“Mild disease does not lead to serious or chronic long term morbidity in the vast majority of patients,” said study coauthor Barak Mizrahi, a senior researcher at KI Research Institute in Kfar Malal, via email.

The study, published Wednesday in the journal The BMJ, compared thousands of vaccinated and unvaccinated people with mild Covid symptoms who were not hospitalized with people who tested negative for the virus. Long Covid was defined as symptoms that continue or appear more than four weeks after an initial Covid-19 infection.

“I think this study is reassuring in that most ongoing symptoms following COVID do improve over the first several months following the acute infection,” said Dr. Benjamin Abramoff, director of the Penn Medicine Post-COVID Assessment and Recovery Clinic, via email. He was not involved in the study.

But not for everyone. Abramoff said his clinic continues to see many patients with severe long Covid symptoms lasting longer than one year following their infection.

“This is particularly true in those individuals who had severe persistent symptoms early after their acute infection,” said Abramoff, who leads the American Academy of Physical Medicine and Rehabilitation’s long Covid collaborative.

Dr. Jonathan Whiteson, an associate professor of rehabilitation medicine at the NYU Grossman School of Medicine, sees the same in his clinic.

“I continue to see many patients from the ‘first wave’ of COVID who had mild to moderate acute COVID (and were) never hospitalized who have significant persistent and functionally limiting symptoms nearly 3 years later,” said Whiteson via email. He was not involved with the study.

Israeli researchers analyzed the medical records of nearly 300,000 people diagnosed with mild cases of Covid-19 and compared their health over the next year with approximately 300,000 people who didn’t have Covid. The average age of those who tested positive for Covid was 25 years, and 51% were female.

Researchers looked for 65 conditions that have been associated with long Covid and divided those into two time frames: early, or the first 30 to 180 days after catching Covid; and late, or 180 to 360 days post infection.

After controlling for age, sex, alcohol and tobacco use, preexisting conditions, and the different variants of Covid-19, researchers found a significant risk of brain fog, loss of smell and taste, breathing problems, dizziness and weakness, heart palpitations, and strep throat in both the early and late time periods.

Chest pain, cough, hair loss, muscle and joint pain, and respiratory disorders were significantly increased only during the early phase, according to the researchers.

Difficulty with breathing was the most common complaint, the study found. Being vaccinated reduced the risk of respiratory issues, but researchers found vaccinated individuals had a “similar risk for other outcomes compared with unvaccinated infected patients,” according to the study.

“Because of the study’s size, it was possible to look at the change in symptom prevalence over time and the effects of other factors on persistent symptoms,” said Dr. Peter Openshaw, a professor of experimental medicine at Imperial College London, in a statement.

“Smell disorder typically resolved at about 9 months, but when they were present concentration and memory changes tended to be more persistent,” said Openshaw, who was not involved in the study.

Only slight differences appeared between men and women in the study, but children had fewer early symptoms than adults, which were mostly gone by year’s end. No real differences were found between the original wild-type of SARS-CoV-2 (March 2020 to November 2020), the Alpha variant (January 2021 to April 2021) and the Delta variant (July 2021 to October 2021).

“Patients with mild Covid-19 had an increased risk for a small number of health outcomes, with only a few symptoms persisting a year from SARS-CoV-2 infection and their risk decreased with time from infection,” Mizrahi said via email.

However, “we are not claiming there are no patients who suffer from long COVID symptoms like dyspnea (difficulty breathing), weakness, cognitive impairment etc.,” he added. “(Our study) does not contradict evidence that a small number of patients do suffer from long lasting symptoms as seen in this analysis.”

Researchers pointed to certain limitations in the study, such as the possibility of diagnostic errors or failure to record some milder symptoms over time. Abramoff agreed.

“This design of this study is not able to detect the severity of these symptoms, and there are potentially other missed patients due to using medical coding to detect persistent Long COVID symptoms,” Abramoff said.

It could also be difficult to apply the findings of the study to other countries, such as the United States, due to differences in how doctors code symptoms. For example, the study did not identify several conditions frequently found in long Covid clinics in the US, said Dr. Monica Verduzco-Gutierrez, professor and chair of the department of rehabilitation medicine at the Long School of Medicine at UT Health, San Antonio.

“The most common symptom of Long COVID is fatigue, and that was not on this list. Also missing was post-exertional malaise, dysautonomia/POTS, or ME/CFS. These are some of the major presentations I am seeing in my clinic population, so it is a major limitation of this study to not have those outcomes,” said Verduzco-Gutierrez, who was not involved in the new study.

Post-exertional malaise is an overwhelming exhaustion after even a minimal amount of effort. Unlike regular exhaustion, it can take days to weeks for a person to recover, and the malaise can be reactivated if activity is resumed too quickly.

Postural orthostatic tachycardia syndrome, or POTS, is a bump in heart rate after sitting up or standing that can lead to dizziness or fainting. It’s a form of dysautonomia, a disorder of the autonomic nervous system. “There is usually no cure for dysautonomia,” according to the National Institute of Neurological Disorders and Stroke.

Myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS, is a serious long-term illness, in which people have overwhelming fatigue that is not improved by rest. The condition can impact sleep and thinking processes, cause pain in many parts of the body, and keep people from doing most daily activities.

Responding to this concern, Mizrahi told CNN that “post exertional malaise was not included in this study as it is not a diagnosis that commonly prescribed in Israel.” In addition, he said, dysautonomia/POTS was only assigned an International Classification of Diseases, or ICD medical code, as of October 2022, so it too was not included in the study.

However, symptoms of POTS and other conditions may have been included under more general categories such as cardiac arrhythmias or palpitations, he said.

In addition, Mizrahi said fatigue was coded under “weakness” in the study. In fact, researchers found weakness to be the second most common symptom reported in the study, and it continued to plague people ages 19 to 60, for months.

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World

Post-zero-Covid: What the return of Chinese tourists means for the global economy

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Hong Kong
CNN
 — 

In the years before Covid, China was the world’s most important source of international travelers. Its 155 million tourists spent more than a quarter of a trillion dollars beyond its borders in 2019.

That largesse fell precipitously over the past three years as the country essentially closed its borders. But, as China prepares to reopen on Sunday, millions of tourists are poised to return to the world stage, raising hopes of a rebound for the global hospitality industry.

Although international travel may not return immediately to pre-pandemic levels, companies, industries and countries that rely on Chinese tourists will get a boost in 2023, according to analysts.

China averaged about 12 million outbound air passengers per month in 2019, but those numbers fell 95% during the Covid years, according to Steve Saxon, a partner in McKinsey’s Shenzhen office. He predicts that figure will recover to about 6 million per month by the summer, driven by the pent-up wanderlust of young, wealthy Chinese like Emmy Lu, who works for an advertising company in Beijing.

“I’m so happy [about the reopening]! ” Lu told CNN. “Because of the pandemic, I could only wander around the country for the past years. It was difficult.”

“It’s just that I’ve been stuck inside the country for a little too long. I’m really looking forward to the lifting of the restrictions, so that I can go somewhere for fun! ” the 30-year-old said, adding that she wanted to visit Japan and Europe the most.

As China announced last month it would no longer subject inbound travelers to quarantine starting January 8, including residents returning from trips abroad, searches for international flights and accommodations immediately hit a three-year high on Trip.com

(TCOM).

Bookings for overseas travel during the upcoming Lunar New Year holiday, which falls between January 21 and January 27 this year, have soared by 540% from a year ago, according to data from the Chinese travel site. Average spending per booking jumped 32%.

The top destinations are in the Asia Pacific region, including Australia, Thailand, Japan and Hong Kong. The United States and the United Kingdom also ranked among the top 10.

“The rapid buildup in … [bank] deposits over the past year suggests that households in China have accumulated significant cash holdings,” said Alex Loo, a macro strategist for TD Securities, adding that frequent lockdowns have likely led to restraints on household spending.

There could be “revenge spending” by Chinese consumers, mirroring what happened in many developed markets when they reopened early last year, he said.

That’s good news for many economies battered by the pandemic.

“We estimate that Hong Kong, Thailand, Vietnam and Singapore would benefit the most if China’s travel service imports were to return to 2019 levels,” said Goldman Sachs analysts。

Hong Kong — the world’s most visited city with just under 56 million arrivals in 2019, most of them from mainland China — could see an estimated 7.6% boost to its GDP as exports and tourism income increase, they said. Thailand’s GDP may be boosted by 2.9%, while Singapore would get a lift of 1.2%.

Elsewhere in the world, Cambodia, Mauritius, Malaysia, Taiwan, Myanmar, Sri Lanka, South Korea and Philippines are also likely to benefit from the return of Chinese tourists, according to research by Capital Economics.

Hong Kong has suffered particularly acutely from the closure of its border with mainland China. The city’s pillar industries of tourism and real estate have been hit hard. The financial hub expects GDP to have contracted by 3.2% in 2022.

The city government announced Thursday that up to 60,000 people would be allowed to cross the border daily each way, starting Sunday.

Several other Southeast Asian countries reliant on tourism have kept entry rules relatively relaxed for Chinese tourists, despite the record Covid-19 outbreak that has swept through China in recent weeks. They include Thailand, Indonesia, Singapore and the Philippines.

“This is one of the opportunities that we can accelerate economic recovery,” Thailand’s health minister said this week.

New Zealand has also waived testing requirements for Chinese visitors, who were the second largest source of tourist revenue for the country before the pandemic.

But other governments are more cautious. So far, nearly a dozen countries, including the United States, Germany, France, Canada, Japan, Australia and South Korea, have mandated testing.

The European Union on Wednesday “strongly encouraged” its members states to require a negative Covid test for visitors from China before arrival.

There is clearly “conflict” between the tourism authorities and the political and health officials in some countries, said Saxon, who leads McKinsey’s travel practice in Asia.

Airlines and airports have already blasted the EU’s recommendations for testing requirements.

The International Air Transport Association, the airline industry’s global lobby group, together with airports represented by ACI Europe as well as Airlines for Europe, issued a joint statement on Thursday, calling the EU move “regrettable” and “a knee-jerk reaction.”

But they welcomed the additional recommendation to test wastewater as a way of identifying new variants of the disease, saying it should be an alternative to testing passengers.

Besides restrictions, it will take time for international travel to fully rebound because many Chinese must renew their passports and apply for visas again, according to analysts.

Lu from Beijing said she was still considering her travel plans, taking into consideration the various testing requirements and the high price of flying.

“The restrictions are normal, because everyone wants to protect people in their own country,” she said. “I’ll wait and see if some policies will be eased.”

Liu Chaonan, a 24-year-old in Shenzhen, said she had initially wanted to go to the Philippines to celebrate the Chinese New Year, but didn’t have time to apply for the visa. So she switched to Thailand, which offers quick and easy electronic permits.

“Time is short and I need to leave in about 10 days. People may choose some visa-friendly places and countries to travel to,” she said, adding that she plans to learn scuba diving and wants to buy cosmetics. Her total budget for the trip could exceed 10,000 yuan ($1,460).

Saxon said he expected China’s outbound international travel to fully recover by the year end.

“Generally, individuals are pragmatic and countries will welcome Chinese tourists due to their spending power,” he said, adding that countries may remove restrictions quickly when the Covid situation improves in China.

“It will take time for international tourism to get going, but it will come rushing back, when it happens.”

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Health

MIS-C has been more common and more severe than previously reported, study finds

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CNN
 — 

Although still rare, MIS-C after Covid-19 has been more common and more severe than previously reported, and there are significant racial disparities in cases, according to a study published Thursday in JAMA Network Open.

Multisystem inflammatory syndrome in children – which primarily emerges after a Covid-19 infection – causes inflammation in various parts of the body and can affect major organs including the kidneys, brain, lungs and heart. It can be serious, or deadly.

The US Centers for Disease Control and Prevention currently has relied on voluntary case reporting from local health departments for MIS-C surveillance. Through November, they’ve logged a total of about 9,000 cases and 74 deaths from MIS-C out of the millions of Covid-19 cases among children.

A formal diagnosis code was established for MIS-C in 2021, and the new research analyzed records collected by the Agency for Healthcare Research and Quality from thousands of hospitals representing more than three-quarters of the US population.

It found that for every 100 children hospitalized with Covid-19 in 2021, there were about 17 MIS-C hospitalizations. MIS-C hospitalizations were typically younger and more likely to occur in male children than were Covid-19 hospitalizations.

The more organs affected, the worse outcomes were. As the number of organ systems affected increased from two to six or more, mortality increased from 1% to 6%, according to the new research. The length of stay in the hospital doubled from four to eight days and adverse medication events more than tripled from 5% to 18%.

Overall, more than 60% of children hospitalized with MIS-C had more than two organ systems affected. Of them, about 8% of patients had at least six organ systems affected.

Racial disparities in Covid-19 outcomes are well-established, and this new research found even starker differences in MIS-C outcomes.

MIS-C hospitalizations were twice as likely among Black children as they were among White children. And while Black children represented about 24% of all MIS-C cases, they represented 32% of the most severe cases that affected at least six organ systems.

The researchers also found that the “severity of MIS-C for Black children was likely exacerbated by socioeconomic factors,” with those living in the most socially vulnerable communities typically spending an extra day in the hospital. They did not find the same connection in regards to Covid-19 hospitalizations.

These findings “increase our knowledge of MIS-C and COVID-19 disparities and outcomes, shedding light on the risks and impacts of increasing organ system dysfunction,” according to a commentary on the study from pediatricians and researchers from the University of Colorado School of Medicine.

But they raise even more critical questions, including specific reasons for the vast racial disparities.

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US

XBB.1.5 may be ‘most transmissible subvariant of Omicron to date,’ scientists warn

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CNN
 — 

Health experts voiced concern Wednesday over the rapid growth of the new Omicron sublineage XBB.1.5, advising the public to stay informed but not alarmed as they work to learn more.

Over the month of December, the percentage of new Covid-19 infections in the United States caused by XBB.1.5 rose from an estimated 4% to 41%.

“That’s a stunning increase,” Dr. Ashish Jha, the White House Covid-19 response coordinator, wrote in a Twitter thread.

Officials at the World Health Organization shared similar thoughts Wednesday.

“We are concerned about its growth advantage,” said Maria Van Kerkhove, an epidemiologist who is the WHO’s technical lead on Covid-19.

Van Kerkhove noted that XBB.1.5, which was first detected in the United States, has spread to at least 29 countries and “is the most transmissible form of Omicron to date.”

“We do expect further waves of infection around the world, but that doesn’t have to translate into further waves of death because our countermeasures continue to work,” she said.

Jha noted that effective tools to avoid severe Covid-19 infections include rapid tests, high-quality masks, ventilation and filtration of indoor air, oral antiviral pills and updated vaccines.

“We will soon have more data on how well vaccines neutralize XBB.1.5,” Jha said, suggesting that research to determine vaccine effectiveness against the new sublineage is underway.

Jha said XBB.1.5 is probably more able to slip past our immune defenses and may be more contagious. But he said it’s still not clear whether it causes more severe disease, something that was also stressed by Van Kerkhove.

She said WHO is working on a risk assessment for this sublineage and hopes to publish it within the next few days. The group’s technical advisers are looking at both real-world data on hospitalizations and lab studies to assess severity.

Jha said that although he is concerned about XBB.1.5, he doesn’t think it represents a huge setback in the fight against Covid-19.

“And if we all do our part,” he wrote, “We can reduce the impact it will have on our lives.”



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Business

From the unwinding of zero-Covid to economic recovery: What to watch in China in 2023

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Editor’s Note: A version of this story appeared in CNN’s Meanwhile in China newsletter, a three-times-a-week update exploring what you need to know about the country’s rise and how it impacts the world. Sign up here.


Hong Kong
CNN
 — 

After a tumultuous end to a momentous and challenging year, China heads into 2023 with a great deal of uncertainty – and potentially a glimpse of light at the end of the pandemic tunnel.

The chaos unleashed by leader Xi Jinping’s abrupt and ill-prepared exit from zero-Covid is spilling over into the new year, as large swathes of the country face an unprecedented Covid wave.

But the haphazard reopening also offers a glimmer of hope for many: after three years of stifling Covid restrictions and self-imposed global isolation, life in China may finally return to normal as the nation joins the rest of the world in learning to live with the virus.

“We have now entered a new phase of Covid response where tough challenges remain,” Xi said in a nationally televised New Year’s Eve speech. “Everyone is holding on with great fortitude, and the light of hope is right in front of us. Let’s make an extra effort to pull through, as perseverance and solidarity mean victory.”

Xi had previously staked his political legitimacy on zero-Covid. Now, as his costly strategy gets dismantled in an abrupt U-turn following nationwide protests against it, many are left questioning his wisdom. The protests, which in some places saw rare demands for Xi and the Communist Party to “step down,” may have ended, but the overriding sense of frustration has yet to dissipate.

His New Year speech comes as China’s lockdown-battered economy faces more immediate strain from a spiraling outbreak that has hit factories and businesses, ahead of what is likely to be a long and complicated road to economic recovery.

Its tightly-sealed borders are gradually opening up, and Chinese tourists are eager to explore the world again, but some countries appear cautious to receive them, imposing new requirements for a negative Covid test before travel. And just how quickly – or keenly – global visitors will return to China is another question.

Xi, who recently reemerged on the world stage after securing a third term in power, has signaled he hopes to mend frayed relations with the West, but his nationalist agenda and “no-limits friendship” with Russia is likely to complicate matters.

As 2023 begins, CNN takes a look at what to watch in China in the year ahead.

The most urgent and daunting task facing China in the new year is how to handle the fallout from its botched exit from zero-Covid, amid an outbreak that threatens to claim hundreds of thousands of lives and undermine the credibility of Xi and his Communist Party.

The sudden lifting of restrictions last month led to an explosion of cases, with little preparation in place to deal with the surging numbers of patients and deaths.

The country’s fragile heath system is scrambling to cope: fever and cold medicines are hard to find, hospitals are overwhelmed, doctors and nurses are stretched to the limit, while crematoriums are struggling to keep up with an influx of bodies.

And experts warn the worst is yet to come. While some major metropolises like Beijing may have seen the peak of the outbreak, less-developed cities and the vast rural hinterland are still bracing for more infections.

As the travel rush for the Lunar New Year – the most important festival for family reunion in China – begins this week, hundreds of millions of people are expected to return to their hometowns from big cities, bringing the virus to the vulnerable countryside where vaccination rates are lower and medical resources even scarcer.

The outlook is grim. Some studies estimate the death toll could be in excess of a million, if China fails to roll out booster shots and antiviral drugs fast enough.

The government has launched a booster campaign for the elderly, but many remain reluctant to take it due to concerns about side effects. Fighting vaccine hesitancy will require significant time and effort, when the country’s medical workers are already stretched thin.

Beijing’s Covid restrictions have put China out of sync with the rest of the world. Three years of lockdowns and border curbs have disrupted supply chains, damaged international businesses, and hurt flows of trade and investment between China and other countries.

As China joins the rest of the world in living with Covid, the implications for the global economy are potentially huge.

Any uptick in China’s growth will provide a vital boost to economies that rely on Chinese demand. There will be more international travel and production. But rising demand will also drive up prices of energy and raw materials, putting upward pressure on global inflation.

“In the short run, I believe China’s economy is likely to experience chaos rather than progress for a simple reason: China is poorly prepared to deal with Covid,” said Bo Zhuang, senior sovereign analyst at Loomis, Sayles & Company, an investment firm based in Boston.

Analysts from Capital Economics expect China’s economy to contract by 0.8% in the first quarter of 2023, before rebounding in the second quarter.

Other experts also expect the economy to recover after March. In a recent research report, HSBC economists projected a 0.5% contraction in the first quarter, but 5% growth for 2023.

Despite all this uncertainty, Chinese citizens are celebrating the partial reopening of the border after the end of quarantine for international arrivals and the resumption of outbound travel.

Though some residents voiced concern online about the rapid loosening of restrictions during the outbreak, many more are eagerly planning trips abroad – travel websites recorded massive spikes in traffic within minutes of the announcement on December 26.

Several Chinese nationals overseas told CNN they had been unable or unwilling to return home for the last few years while the lengthy quarantine was still in place. That stretch meant major life moments missed and spent apart: graduations, weddings, childbirths, deaths.

Some countries have offered a warm welcome back, with foreign embassies and tourism departments posting invitations to Chinese travelers on Chinese social media sites. But others are more cautious, with many countries imposing new testing requirements for travelers coming from China and its territories.

Officials from these countries have pointed to the risk of new variants emerging from China’s outbreak – though numerous health experts have criticized the targeted travel restrictions as scientifically ineffective and alarmist, with the risk of inciting further racism and xenophobia.

As China emerges from its self-imposed isolation, all eyes are on whether it will be able to repair its reputation and relations that soured during the pandemic.

China’s ties with the West and many of its neighbors plummeted significantly over the origins of the coronavirus, trade, territorial claims, Beijing’s human rights record and its close partnership with Russia despite the devastating war in Ukraine.

The lack of top-level face-to-face diplomacy certainly didn’t help, neither did the freeze on in-person exchanges among policy advisers, business groups and the wider public.

At the G20 and APEC summits, Xi signaled his willingness to repair relations with the United States and its allies in a flurry of bilateral meetings.

Communication lines are back open and more high-level exchanges are in the pipeline – with US Secretary of State Antony Blinken, French President Emmanuel Macron, Dutch Prime Minister Mark Rutte and Italy’s newly elected Prime Minister Giorgia Meloni all expected to visit Beijing this year.

But Xi also made clear his ambition to push back at American influence in the region, and there is no illusion that the world’s two superpowers will be able to work out their fundamental differences and cast aside their intensifying rivalry.

In the new year, tensions may again flare over Taiwan, technological containment, as well as China’s support for Russia – which Xi underlined during a virtual meeting with Russian President Vladimir Putin on December 30.

Both leaders expressed a message of unity, with Xi saying the two countries should “strengthen strategic coordination” and “inject more stability into the world,” according to Chinese state media Xinhua.

China is “ready to work” with Russia to “stand against hegemonism and power politics,” and to oppose unilateralism, protectionism and “bullying,” said Xi. Putin, meanwhile, invited Xi to visit Moscow in the spring of 2023.

Beijing has long refused to condemn Russia’s invasion of Ukraine, or even refer to it as such. It has instead decried Western sanctions and amplified Kremlin talking points blaming the US and NATO for the conflict.

As Russia suffered humiliating military setbacks in Ukraine in recent months, Chinese state media appeared to have somewhat dialed back its pro-Russia rhetoric, while Xi has agreed to oppose the use of nuclear weapons in Ukraine in meetings with Western leaders.

But few experts believe China will distance itself from Russia, with several telling CNN the two countries’ mutual reliance and geopolitical alignment remains strong – including their shared vision for a “new world order.”

“(The war) has been a nuisance for China this past year and has affected China’s interest in Europe,” said Yun Sun, director of the China Program at the Washington-based think tank Stimson Center. “But the damage is not significant enough that China will abandon Russia.”

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Health

Respiratory viruses could surge following the holidays, public health experts warn

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CNN
 — 

There is growing concern among infectious disease and public health experts that the US could face even more respiratory infections in January.

It is “highly likely” that respiratory viruses could spread even more following holiday gatherings and New Year’s Eve celebrations, Dr. William Schaffner, a professor in the Division of Infectious Diseases at Vanderbilt University Medical Center and medical director of the National Foundation for Infectious Diseases, told CNN on Monday.

“These are highly contagious viruses – and people have generally put Covid-19 and Covid vaccination behind them. They haven’t been all that attentive to flu. They’re not wearing masks,” Schaffner said. “And if you’re close together with other people, it’s an opportunity for all three of these viruses – flu, Covid, and even RSV – to spread from one person to another. So, we do expect a post-holiday surge in these viruses.”

At the same time, across the country, there has been a wave of flight cancellations and families stuck at the airport during their holiday travels.

When that happens, “People are together for very long periods of time, and they’re not wearing masks, and they’re weary and tired and stressed, and those are occasions where people are more apt to spread the virus,” Schaffner said, adding that his own granddaughter had four flights canceled over the holidays. He recommends masking up while in the airport and on an airplane.

“I think all of us in infectious diseases and public health would recommend that masks are not perfect, but they are an additional layer of protection,” Schaffner said.

Some local health officials are bracing for a possible surge in respiratory illnesses following the winter holidays since that was seen recently following Thanksgiving, Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials, said in an email to CNN on Monday.

“After the Thanksgiving holiday period, we saw an uptick in COVID cases by about 58% through the beginning of the Christmas holiday on December 21,” Freeman wrote. “Deaths from COVID also rose during that same time period by about 65%.”

Flu also surged after Thanksgiving, with more than a third of all flu hospitalizations and deaths at the time this season being reported in the first full week of data post-Thanksgiving, and cases also jumped nearly as much.

Currently, seasonal flu activity remains high in the US, but continues to decline in most parts of the country, according to data published Friday by the US Centers for Disease Control and Prevention. Despite improvements, flu may not have peaked yet.

CDC estimates that, so far this season, there have been at least 18 million illnesses, 190,000 hospitalizations and 12,000 deaths from flu.

As for the current state of Covid-19, increases appear to be relatively mild. Hospitalizations are ticking up in most states, although the overall rate is still just a fraction of what it was during other surges. New hospital admissions have jumped nearly 50% over the past month. Hospitalizations among seniors are nearing the peak from the Delta surge – and rising fast.

Freeman said it is expected that reports after the winter holidays will continue to show increases in Covid-19 cases and deaths, likely attributable to increased travel across the country, large family gatherings, fewer people being up to date on their Covid-19 vaccinations and flu shots, and fewer people following mitigation measures, such as masking and social distancing.

“Air travel is also back to pre-pandemic levels and there are no more restrictions on mask wearing on airplanes or in airports where viruses can easily circulate. Same for bussing,” Freeman said. “Fortunately, we are seeing less RSV in children from our high points earlier in December, so that respiratory illness is stabilizing and becoming less of a part of the triple threat of COVID, flu, and RSV.”

As health officials brace for a possible surge in respiratory viruses in the coming weeks, it might not be just flu, Covid-19 and RSV that sickens people, said Dr. Georges Benjamin, executive director of the American Public Health Association.

“We’re focusing on those three, but there are others out there – the common cold and others,” Benjamin said.

Overall, “we should expect more respiratory diseases,” he said. “The best way to reduce your risk is of course to get fully vaccinated for those that which we have a vaccine, so influenza and Covid, with the new bivalent version, are the two most important right now.”

Benjamin added that it also remains important to wash your hands often, wear a mask during holiday travels and stay home when sick.

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World

Leaked notes from Chinese health officials estimate 250 million Covid-19 infections in December: reports

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Hong Kong
CNN
 — 

Almost 250 million people in China may have caught Covid-19 in the first 20 days of December, according to an internal estimate from the nation’s top health officials, Bloomberg News and the Financial Times reported Friday.

If correct, the estimate – which CNN cannot independently confirm – would account for roughly 18% of China’s 1.4 billion people and represent the largest Covid-19 outbreak to date globally.

The figures cited were presented during an internal meeting of China’s National Health Commission (NHC) on Wednesday, according to both outlets – which cited sources familiar with the matter or involved in the discussions. The NHC summary of Wednesday’s meeting said it delved into the treatment of patients affected by the new outbreak.

On Friday, a copy of what was purportedly the NHC meeting notes was circulated on Chinese social media and seen by CNN; the authenticity of the document has not been verified and the NHC did not immediately respond to a request for comment.

Both the Financial Times and Bloomberg laid out in great detail the discussions by authorities over how to handle the outbreak.

Among the estimates cited in both reports, was the revelation that on Tuesday alone, 37 million people were newly infected with Covid-19 across China. That stood in dramatic contrast to the official number of 3,049 new infections reported that day.

The Financial Times said it was Sun Yang – a deputy director of the Chinese Center for Disease Control and Prevention – who presented the figures to officials during the closed-door briefing, citing two people familiar with the matter.

Sun explained that the rate of Covid’s spread in China was still rising and estimated that more than half of the population in Beijing and Sichuan were already infected, according to the Financial Times.

The estimates follow China’s decision at the start of December to abruptly dismantle its strict zero-Covid policy which had been in place for almost three years.

The figures are in stark contrast to the public data of the NHC, which reported just 62,592 symptomatic Covid cases in the first twenty days of December.

How the NHC came up with the estimates cited by Bloomberg and the Financial Times is unclear, as China is no longer officially tallying its total number of infections, after authorities shut down their nationwide network of PCR testing booths and said they would stop gathering data on asymptomatic cases.

People in China are also now using rapid antigen tests to detect infections and are under no obligation to report positive results.

Officially, China has reported only eight Covid deaths this month – a strikingly low figure given the rapid spread of the virus and the relatively low vaccine booster rates among the elderly.

Only 42.3% of those aged 80 and over in China have received a third dose of vaccine, according to a CNN calculation of new figures released by the NHC on December 14.

Facing growing skepticism that it is downplaying Covid deaths, the Chinese government defended the accuracy of its official tally by revealing it had updated its method of counting fatalities caused by the virus.

According to the latest NHC guidelines, only deaths caused by pneumonia and respiratory failure after contracting the virus are classified as Covid deaths, Wang Guiqiang, a top infectious disease doctor, told a news conference Tuesday.

The minutes of the Wednesday closed-door NHC meeting made no reference to discussions concerning how many people may have died in China, according to both reports and the document CNN viewed.

“The numbers look plausible, but I have no other sources of data to compare [them] with. If the estimated infection numbers mentioned here are accurate, it means the nationwide peak will occur within the next week,” Ben Cowling, a professor of epidemiology at the University of Hong Kong told CNN in an emailed statement, when asked about the purported NHC estimates.

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