Nerve damage may explain some cases of long COVID, U.S. study suggests - CBC News

A small study of patients suffering from persistent symptoms long after a bout of COVID-19 found that nearly 60 per cent had nerve damage possibly caused by a defective immune response, a finding that could point to new treatments, researchers have found.

The new U.S. study involved in-depth exams of 17 people with so-called long COVID, a condition that arises within three months of a COVID-19 infection and lasts at least two months.

"I think what's going on here is that the nerves that control things like our breathing, blood vessels and our digestion in some cases are damaged in these long COVID patients," said Dr. Anne Louise Oaklander, a neurologist at Massachusetts General Hospital and a lead author on the study published in the journal Neurology: Neuroimmunology & Neuroinflammation.

As many as 30 per cent of people who have COVID-19 are believed to develop long COVID, a condition with symptoms ranging from fatigue, rapid heartbeat, shortness of breath, cognitive difficulties, chronic pain, sensory abnormalities and muscle weakness.

Oaklander and colleagues focused on patients with symptoms consistent with a type of nerve damage known as peripheral neuropathy. All but one had had mild cases of COVID-19, and none had nerve damage prior to their infections.

After ruling out other possible explanations for the patients' complaints, the researchers ran a series of tests to identify whether the nerves were involved.

"We looked with every single major objective diagnostic test," Oaklander said. The vast majority had small fibre neuropathy, meaning damage to small nerve fibres that detect sensations and regulate involuntary bodily functions such as the cardiovascular system and breathing.

Findings consistent with earlier study

The findings are consistent with a July study by Dr. Rayaz Malik of Weill Cornell Medicine Qatar that found an association between nerve fibre damage in the cornea and a diagnosis of long COVID.

In the current study, 11 of the 17 patients were treated with either steroids or intravenous immunoglobulin (IVIG), a standard treatment for patients with small nerve fibre damage caused by an immune response. Some improved though none were cured.

While the results would only apply to long COVID patients with this type of nerve damage, it is possible that immunotherapy could be helpful, said Dr. Avindra Nath, an expert in neuroimmunology at the National Institute of Neurological Disorders and Stroke and a study co-author.

"To me, it suggests that we need to do a proper prospective study of these kinds of patients" testing the drugs in a randomized trial, Nath said.

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COVID plateau may last into April; medical officer cautious - Belleville Intelligencer

Publishing date:

Mar 02, 2022  •  36 minutes ago  •  3 minute read  •  Join the conversation

Members of the Hastings and Prince Edward Counties Board of Health listen as Dr. Ethan Toumishey, centre, speaks during Wednesday's meeting. Photo by Zoom

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Hastings and Prince Edward Counties’ top public health official is expressing guarded optimism about declining rates of COVID-19, saying cases are declining but there remains the potential for future variants and spikes.

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“If there’s anything I’ve learned … we just have to keep monitoring the trends over time and staying humble in the face of the pandemic,” medical officer of health Dr. Ethan Toumishey said.

He spoke one day after the Ontario government dropped some COVID-19 regulations, moving into another step of the province’s reopening. Premier Doug Ford is among the government officials who have said the government may lift masking regulations within a few weeks.

“I do support the approach of the province” in lifting the requirements for vaccination passports and capacity limits for buildings and gatherings, Toumishey said. He took no position on masking except to say it’s important that measures mirror local epidemiology – in short, how active COVID-19 is in a given area.

Hastings Prince Edward Public Health announced on Wednesday two more deaths of people with COVID-19. And on Tuesday, health unit data showed, the region’s count of active high-risk cases fell below 200 for the first time this year.

A total of 41 people have now died of or with COVID-19 since the pandemic began; the latest two were a person between ages 60 and 69 and one age 70 or older. The health unit does not release further details.

Its Wednesday COVID-19 update listed 81 new in high-risk settings compared to 68 on Monday. There were 191 active cases in those settings versus Monday’s 237.

The number of outbreaks in high-risk settings was unchanged at 12.

Hospitalizations declined from 25 on Monday to 23 on Wednesday. Two people were in intensive care, a number unchanged since Feb. 21.

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Due to Ontario’s limiting of molecular COVID-19 testing to high-risk settings, the actual total numbers of outbreaks, new cases and active cases is not known.

The number of active high-risk cases has been in decline since January, when the region saw the peak of the pandemic’s fifth wave. But the case count also hit a plateau in February.

The novel coronavirus is “still having an effect” on the region, he said.

Asked about the numbers which are known, Toumishey said, “Probably for March we’re going to continue to see similar numbers.”

He again thanked everyone who had followed public health regulations and those who had been vaccinated.

“The better spot we’re in is all due to their efforts.”

Reopening may cause increase

Yet the doctor also cautioned the reopening process “will probably affect” the local statistics.

“We are seeing more reopening, more contact, more mobility in the community.” Past periods of increased contact and mobility have been linked to more transmission of the virus, provincial officials have said.

He said a further decline may not occur until a few weeks after Tuesday’s reopening and after the arrival, possibly in April, of better weather. Respiratory viruses such as COVID-19 circulate more when people are indoors, he and other doctors have said.

Toumishey said he still “strongly encourages” everyone to be vaccinated.

“As we continue to see COVID-19 circulating in the community, the need to protect your health is still very much there,” he said.

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“Stay up to date on your vaccines.”

After a period of outreach involving mobile and pop-up vaccination programs, he said, “we’ll be winding down our mass (vaccination) sites.” He did not provide a timeline for the change.

“We will continue to provide access to the vaccine,” Toumishey said. The local rates of vaccination have been increasingly, but only incrementally.

Among this week’s vaccination statistics, only the number of people ages five and older with at least two doses had changed. It increased from 82 per cent on Monday to 83 per cent on Wednesday. Among adults, the rate was 88 per cent.

But only 51 per cent of people ages five and older and 61 per cent of adults have boosters.

Toumishey said the region has “very broad coverage” of vaccination.

Ontario’s chief medical officer of health, Dr. Kieran Moore, has said at least 90 per cent of the population needed to have full vaccination to prevent future pandemic waves. The province still defines full vaccination as two doses of vaccine, though Moore, Toumishey and other experts have advised getting third and – for the most vulnerable – fourth doses.

“I think we’re going to continue to see a downward trend” in vaccination, board chair Jo-Anne Albert said. She said the lack of need to have vaccination certificates could make people less likely to seek vaccines.

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‘Likely COVID’: Saskatchewan emergency rooms seeing more children under five - Global News

Saskatchewan is seeing a spike in emergency room visits among children between the ages of one and four who are showing up with respiratory-like illnesses.

Chief medical health officer, Dr. Saqib Shahab, said it’s likely to be COVID-19, because there’s little influenza transmission in the province and vaccines against the virus have not yet been approved for children under five.

“Any COVID-like illness presentation in emergency rooms — where even you may not have been screened in every case — it’s likely COVID-19,” Shahab said in a recent interview with The Canadian Press.

Read more: Dropping Sask. COVID-19 isolation requirement erodes accountability - USask expert

The latest data from the Ministry of Health, dated Feb. 19, showed preschoolers were visiting emergency rooms at a weekly rate of 110 patients per 1,000. That was higher than the average rate — 87.5 patients per 1,000 visits — in the previous six weeks for the same age group.

Children between one and four years old were almost three times more likely to visit the emergency room compared to all age groups combined.

Saskatchewan no longer publishes daily COVID-19 data, but releases a weekly epidemiology report that includes COVID-like illnesses in emergency rooms.

Shahab said it’s a way to track how much transmission is in the community, since Saskatchewan no longer does extensive testing and limits PCR lab tests to people with specific risk factors.

“It’s a good idea of how much respiratory illness is out there. Right now it’s moderate throughout the province,” Shahab said.

He added that any child under the age of five who has a fever, rapid breathing, or is not eating properly should be taken to for emergency care.

“That remains important.”

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Read more: Saskatchewan students and teachers react to COVID-19 restrictions lifting

Dr. Ayisha Kurji, a pediatrician based in Saskatoon, said the Omicron variant has been affecting the airways of children and, in some cases, can trigger diabetes or cause pancreatitis.

“Most kids (who get COVID-19) still do well, that is true. But not all kids,” Kurji said. “Sometimes previously healthy kids are still ending up in the emergency room or come to the hospital to get admitted.”

She said children are showing up at hospitals with diarrhea, vomiting and croup — an infection of the upper airway that obstructs breathing and causes a characteristic barking cough.

How long they stay varies. Some children are coming in for oxygen to help with breathing, while some end up in intensive care.

Kurji recommended parents take their children to the hospital if they are dehydrated or not urinating regularly, breathing fast or having difficulty breathing, and are especially sleepy or fussy.

“Don’t think of it in terms of COVID or not … but look at the symptoms,” Kurji said.

“The big thing is you know your child, so if you’re worried about your child, and your instincts are saying you should go, it’s always better to be safe and go get it checked out.”

Read more: Long COVID app needs more Saskatchewan input

Saskatchewan has said it will continue to monitor COVID-like illnesses throughout the spring and fall.

“We know kids under five aren’t vaccinated yet, so we can’t give them the same protection that we can give ourselves and that we can give older kids,” Kurji said.

“It’s important to know what’s happening with them, and is something that we need to maybe make some different decisions to keep them protected.”

Saskatchewan lifted all of its public health orders Monday, including a requirement to self-isolate if positive for the virus.

Kurji said people can keep themselves and others at risk safe by continuing to wear a mask and getting fully vaccinated, including a booster shot.

2:08 Dropping Sask. COVID-19 isolation requirement erodes accountability: USask expert

Dropping Sask. COVID-19 isolation requirement erodes accountability: USask expert

© 2022 The Canadian Press

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Salix and Colon Cancer Coalition Join Forces for 'Faces of Blue' Story Series to Raise Awareness of Colorectal Cancer Screenings - Canada NewsWire

MINNEAPOLIS and BRIDGEWATER, N.J., March 1, 2022 /CNW/ -- The Colon Cancer Coalition, a national nonprofit organization focusing on grass roots efforts to increase screening and awareness for colorectal cancer, and Salix Pharmaceuticals ("Salix"), the gastroenterology (GI) business of Bausch Health Companies Inc. (NYSE/TSX: BHC) ("Bausch Health") and one of the largest specialty pharmaceutical companies in the world committed to the prevention and treatment of gastrointestinal diseases, are joining for the second consecutive year to raise awareness of the importance of colorectal cancer screenings. The Faces of Blue campaign will highlight the personal stories of patients and survivors touched by colorectal cancer to encourage preventive colorectal cancer screening.

In May 2021, the United States Preventive Services Task Force lowered the colorectal cancer screening age to 45 from 50 for those of average risk, matching the American Cancer Society's guideline recommendation that was released in 2018. Approximately 45 million Americans are now eligible for a potentially life-saving colorectal cancer screening, and this new guidance emphasizes the need for awareness programs to educate patients about risk factors and the importance of on-time screening for early detection.

"Personal stories resonate and can help influence behavior," notes Chris Evans, president, Colon Cancer Coalition. "Over the last decade the Colon Cancer Coalition has shared stories to encourage screening for colorectal cancer. Now that the recommended screening age has been lowered to age 45, there is a new group of people who need to hear this life-saving message."

"Salix and the Colon Cancer Coalition are teaming up to help reduce the impact of colorectal cancer on the at-risk population by encouraging preventative screening that can lead to early detection," said Robert Spurr, president, Salix. "We're honored to support the Faces of Blue story series, and we are launching new resources and social media partnerships to encourage and empower patients to take preventive action for their health by scheduling a colonoscopy."

Salix is also launching a new educational website during the month of March and partnering with social influencers to educate people about the risks of colorectal cancer and stress the importance of early, life-saving screenings.

The 2022 #FacesOfBlue story series will be published regularly throughout Colorectal Cancer Awareness Month and semi-monthly throughout the rest of the year. These stories are posted to the Colon Cancer Coalition's website and will then be shared by both the Coalition and Salix on social media accounts.

To learn more about colorectal cancer and the importance of screening, visit ColonCancerCoalition.org.

About the Colon Cancer Coalition
The Colon Cancer Coalition is a non-profit organization based in Minneapolis, Minn., dedicated to encouraging screening and raising awareness for colon cancer. The organization's signature Get Your Rear in Gear® and Tour de Tush® events are volunteer-driven in communities throughout the United States. Since 2004, millions of dollars have been granted by the Colon Cancer Coalition to local programs that promote early prevention, screening and patient support services for this disease. By making the words colon, colorectal and colonoscopy a part of the everyday language, we believe we can overcome the fear and decrease deaths from this largely preventable cancer. For more information, visit ColonCancerCoalition.org. 

About Faces of Blue
The Faces of Blue Series, in its 11th year, features the personal stories of patients, survivors and others touched by colorectal cancer. The Colon Cancer Coalition features a special place on its website dedicated to this shared colorectal cancer experience. By publishing these accounts of courage, endurance, strength and even humor, the Colon Cancer Coalition hopes to share a common experience and provide encouragement for all affected by this disease. To read these stories of colorectal cancer resilience and perseverance, visit ColonCancerCoalition.org/FacesOfBlue.

About Salix
Salix Pharmaceuticals is one of the largest specialty pharmaceutical companies in the world committed to the prevention and treatment of gastrointestinal diseases. For more than 30 years, Salix has licensed, developed and marketed innovative products to improve patients' lives and arm health care providers with life-changing solutions for many chronic and debilitating conditions. Salix currently markets its product line to U.S. health care providers through an expanded sales force that focuses on gastroenterology, hepatology, pain specialists and primary care. Salix is headquartered in Bridgewater, New Jersey. For more information about Salix, visit www.Salix.com and connect with us on Twitter and LinkedIn.

About Bausch Health
Bausch Health Companies Inc. (NYSE/TSX: BHC) is a global company whose mission is to improve people's lives with our health care products. We develop, manufacture and market a range of pharmaceutical, medical device and over-the-counter products, primarily in the therapeutic areas of eye health, gastroenterology and dermatology. We are delivering on our commitments as we build an innovative company dedicated to advancing global health. For more information, visit www.bauschhealth.com and connect with us on Twitter and LinkedIn.

©2022 Salix Pharmaceuticals or its affiliates.
SAL.0029.USA.22

SOURCE Bausch Health Companies Inc.

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Kingston Health Sciences Centre keeps COVID-19 restrictions in place - The Kingston Whig-Standard

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Kingston Health Sciences Centre is keeping all COVID-19 restrictions in place for at least the next few weeks, despite an easing of the restrictions effective Tuesday throughout Ontario.

Some of the restrictions at Kingston General Hospital and Hotel Dieu Hospital include mandatory proof of COVID-19 vaccinations, limited family presence for hospital visitors, COVID-19 screening for both staff and patients, masking and appropriate personal protective equipment must still be worn by staff, and physical distancing requirements for everyone are still in place.

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“Patients and families will continue to access our two hospital sites through the main entrance and must continue to register upon entry,” a KHSC news release stated. “Staff should continue to access the hospital through the two staff entrances and answer screening questions upon arrival.”

“We know that this cautious approach does not align with quicker reopening plans in other community settings, but as a hospital, it is important for people to understand that we cannot revise or remove restrictions as quickly as the community,” KHSC president and CEO Dr. David Pichora said in a statement.

“Our mission to care for the sick and vulnerable means we must carefully monitor the impact of reopening on COVID-19 prevalence, outbreaks and hospital capacity in order to determine what and when changes to our COVID-19 policies can occur.”

KHSC’s decision to keep its current COVID-19 policies in place is largely consistent in approach with many acute care hospitals in the province, the release said.

KHSC also continues to experience very high numbers of staff who are unable to work due to testing positive for COVID-19 themselves or having a positive family member at home.

“COVID-19 is still with us, and the emergence of the Omicron variant reminded us that the virus can evolve quickly,” Dr. Gerald Evans, head of infectious diseases at KHSC, said. “We must continue to practise extreme caution against COVID-19 within our hospital walls and be ready to respond as we transition to the next phase of the pandemic.

“Our first priority will always be the safety of our patients, families, visitors, staff and volunteers.”

imacalpine@postmedia.com

twitter.com/IanMacAlpine

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Mutated SARS-CoV-2 Detected in White-Tailed Deer in Ontario - Infection Control Today

Mounting evidence is supporting the spread of SARS-CoV-2 in animals. The latest report is from Ontario, Canada, and has added to the evidence that white-tailed deer can become infected with SARS-CoV-2. This report comes on the heels of another report documenting spread of the Omicron variant in Staten Island deer. SARS-CoV-2 was first reported to infect white-tailed deer on January 12, 2021. This first report was also from Ontario, Canada. Other reports have found SARS-CoV-2 in up to 82.5% of deer (80 of 97 samples) in Iowa; and in deer residing in Michigan, Pennsylvania, Illinois, and New York.
 
The recent study from Ontario presents several disturbing findings. The SARS-CoV-2 virus found in the deer was a highly mutated virus, with 49 mutations compared with the closest known strain in humans. This is “suggestive of sustained viral transmission.” In other words, the virus may have found a stable host or reservoir in the white-tailed deer population. The authors also point out that there are significant human-to-deer interfaces, along with interfaces with other wildlife.
 
The authors believe the newly detected Ontario white-tailed deer virus (Ontario WTD) may have its distant ancestor from a lineage identified in Michigan. Thus, the Ontario WTD likely represents a case of spread from humans to deer.

Of concern is that the authors also presented information that supports a case of deer-to-human spread of this highly divergent variant. The human case had “highly similar mutations” as the Ontario WTD virus, occurred in the same region as the infected animals, and the patient also had known close contact with white-tailed deer.
 
Infection Control Today® was one of the first to report animal SARS-CoV-2 infections and the possibility of animal hosts on August 5, 2021. Spread of the virus in animal hosts was 1 of mechanisms of virus evolution, which was proposed by the United Kingdom’s Scientific Advisory Group for Emergencies (SAGE).

We cannot assume that white-tailed deer are the only animal hosts (or virus reservoirs) or that deer were exposed directly from humans. There could be an intermediate host. Dogs, cats, bears, gorillas, baboons, snow leopards, minks, and rodents can also carry the virus. Rats have been implicated in the emergence of the Omicron variant (this variant carries 7 out of the 7 mutations that promote transmission in rodents).
 
There are several important lessons here:
1. The virus is spreading easily outdoors among deer. The same should be true with mankind. Droplet spread can still occur outdoors if you are within 6 feet of someone.
2. An animal host all but guarantees that herd immunity in humans will not eradicate the virus.
3. The variants arising in animals will have no regard for the lethality in humans. Thus, increases and decreases in the variant’s human case fatality rate will be random. The virus does not need humans to live and evolve.
 
Above all, the report by Bradley Pickering et al underscores the importance of One Health, the idea that animals and mankind live in the same biosphere and you cannot optimally promote health in mankind without also addressing the health and spread of disease in animals. It is unlikely we can stop the emergence of future dangerous variants by vaccinating all of mankind. We must also address the health of animals and modify how we interact with domesticated and wild species.

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Researchers may have ID’ed first deer-to-human SARS-CoV-2 transmission - Ars Technica

Photograph by imelda

One of the more disturbing aspects of the SARS-CoV-2 coronavirus is its ability to readily hop between a variety of species, ranging from domesticated animals like cats and mink to wild deer. This creates a potential risk. While spreading in other animals, the virus can pick up mutations that make it look unfamiliar to the human immune system or evolve to cause a different collection of symptoms.

These risks, however, depend on the virus being able to move back to humans after evolving in a different host. And, so far, the only cases where that's known to have happened all involve people who have worked on mink farms. But a pre-peer-review manuscript is now indicating that Canadian health authorities have identified an instance where a SARS-CoV-2 variant circulating in deer ended up back in a human patient.

Deer season

In response to findings in the US, where SARS-CoV-2 appears to be widespread in both wild and farmed deer populations, Canadian health authorities decided to initiate screening of their own deer population. During the last two months of 2021, which overlapped with deer hunting season, samples were collected from nearly 300 deer killed by hunters; those were all screened for the presence of SARS-CoV-2.

The good news is that, in contrast to events south of the border, the presence of the virus appears to be relatively low, with only six percent of the samples producing a positive test result.

Things got less reassuring when the researchers obtained genomes from some of these samples. All turned out to be distantly related from the rest of the SARS-CoV-2 family tree—roughly as distant from the common ancestor of the pandemic as the omicron variant is. Their closest relatives turned out to be a lineage that had spread from humans to mink in Michigan that had been identified about a year earlier. But in the intervening time, the lineage had picked up 76 additional mutations—in fact, all the genomes had some small differences with each other.

The team also found a single additional genome belonging to this same lineage. This one was isolated from a human during the same time period and in the same region as the survey of deer. The individual had had contact with deer, suggesting the virus may have jumped back from deer to humans.

Threat assessment

If the virus were evolving to adapt to deer as a new host, it might pick up mutations that enable it to spread more readily in that species. But there's little evidence that it's doing so. The mutations it has picked up appear to be spread randomly throughout the genome—the frequency with which a gene carried a mutation was proportional to the gene's size. And there was no clear bias for mutations that changed a protein vs. those that were neutral.

The researchers also tested the spike protein encoded by the deer variant and found that it was effectively neutralized by antibodies made by vaccinated individuals. So, all indications are that this variant doesn't pose a distinct risk to human populations.

That said, the research indicates that this virus had circulated among animals for roughly a year prior to jumping back into humans. Which means that, even if we were to ever limit the virus's circulation in humans, we'd still potentially be at risk of infection. As the researchers put it, "Secondary wildlife reservoirs have the potential to fundamentally alter the ecology of SARS-CoV-2."

While that's safe to conclude from the existing data, it's important to emphasize that the data is only a very incomplete picture of what's going on. While the researchers identified 21 deer carrying SARS-CoV-2, they managed to obtain genomes from only five of them. And they note that, by the time deer hunting season wrapped up in Ontario, the omicron wave had hit, meaning that tracking human cases was probably limited as well.

As such, it's difficult to be certain that this variant spread from deer to human and not the other way around or whether there really was a single instance of a human infected with this variant. The work should also serve as a caution that we still need to improve our ability to monitor the spread of variants—both in humans and in other species prone to infection.

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