If we were hit with another covid-like pandemic soon, are we ready? As USG & (likely soon) WHO end the "emergency" phase of #Covid19, we need to avoid panic-neglect cycles. I think this is the bigger emergency.
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Abraar Karan
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infectious disease doctor, researcher
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An important thread here— are we set up well, including from the angle of which research gets funded, to stop the next big one?
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We also traveled to Guinea and Madagascar to better understand how deforestation can seed outbreaks — and how this deadly trend can be reversed.
You can read the full series here: propublica.org/series/roots-o
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From the New York Times “next pandemic” newsletter :
“I will spend less (none at all) time on social media trying to convince people to act in their own interest. — Ben Leaf, 58, San Diego, Calif.”
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We are proud to announce the official launch of the International Pathogen Surveillance Network (IPSN) by & partners at #WHA76
This represents a significant milestone, as we unite countries & experts to strengthen disease surveillance, response & prevention
#IPSNLaunch
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1/ Three studies on the effectiveness of Jynneos vaccine against MPOX:
VE vs MPOX disease
💉1 dose 75%
💉💉2 doses 86%
cdc.gov/mmwr/volumes/7
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WHO advisers recommend switch to monovalent XBB COVID vaccine.
"recommended that vaccine makers drop the ancestral strain and switch to a monovalent (single-strain) vaccine that contains an XBB.1 descendant lineage such as XBB.1.5."
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In our clinic at the VA, I care for veterans who have been living with HIV for over 30 years. At the same time, we have patients in their 30s with uncontrolled AIDS who have died of mpox/monkeypox this year. wwwnc.cdc.gov/eid/article/29
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1/ Tpoxx (Tecovirimat) resistance in immunocompromised patients, many of whom received multiple courses of treatment. Reminder- tpoxx is our first-line antiviral against monkeypox/mpox.
Important pre-print from CDC Monkeypox/mpox response team
medrxiv.org/content/10.110
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6/ What happens when outbreaks 'end'? Who still suffers? We all do. We are deeply interconnected, esp when talking about transmissible infectious diseases. A virus with resistance to first-line treatments is a serious issue if/when there is wider spread.
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5/ These are patients who have been severely sick and/or died despite the availability of medications, including antiretrovirals for HIV/AIDS and antivirals (tpoxx,brin) + VIGIV for mpox being available. Our care systems failed them
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4/ As the #mpox outbreak slowed down, media coverage labeled this as being 'over' but at health departments, we saw ongoing low-level transmission esp among our society's most vulnerable--> patients w/ homelessness, uncontrolled AIDS, psychiatric disease, etc
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3/ Health equity again is at the core of epidemic response. Over time, it is possible that we see circulation of these #mpox variants even in patients who have not been exposed to tecovirimat yet (more on this soon), esp if we see a resurgence this year.
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2/ Having worked on surveillance for a number of cases for the past several months, I think key is that many are patients also w/ tough social challenges which have made adherence to antiretroviral medications difficult, setting them up for a double-hit with AIDS + mpox
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1/ Tpoxx (Tecovirimat) resistance in immunocompromised patients, many of whom received multiple courses of treatment. Reminder- tpoxx is our first-line antiviral against monkeypox/mpox.
Important pre-print from CDC Monkeypox/mpox response team
medrxiv.org/content/10.110
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#Mpox may be re-emerging in the US. Caitlin Contag, , , , , , and colleagues at San Mateo DPH show the utility of Mpox testing in patients being screened for other STIs.
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Quoted in this piece— we saw a big shift in reporting as covid testing moved away from hospitals/clinics to at-home tests. This calls for a system that allows for easy, possibly automated reporting for disease surveillance purposes.
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Quoted in piece — our world in these post-acute phases of the pandemic is one made up of those who survived. Many who are vulnerable may not be so lucky with the next pathogen unless we get much better at prevention for all.
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Truly historic. Tysm CDC! Ventilation webpage is most highly cited, for 1st time CDC website states ACH number for public. Many of us were pleading w/ CDC for year or more. Our letter and CDC’ reply in JAMA has full context.
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Wow! I know that push played a role here as well. We have had numerous emails/calls with CDC/NIOSH — really awesome to see this
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Historic day. For 40 years we've been saddled with bare minimum ventilation standards that were not designed for health. Today, CDC released the 1st ever federal guidance on higher ventilation standards, and ASHRAE also released a doc for public comment
cdc.gov/coronavirus/20
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3/ Mpox virus detected in various types of biological samples during this outbreak
--> while close contact/sex were main drivers, this need not hold true depending on future mutations that have effect on transmissibility
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2/ Unclear vaccine durability or real world effectiveness (some limited data)
Vaccine equity/coverage remains low globally
Other clades with higher virulence also with risk for spread
Variants already circulating with resistance to first-line antiviral tecovirimat
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Yesterday, the emergency committee for #mpox met and recommended to me that the outbreak no longer represents a public health emergency of international concern.
I have accepted that advice, and am pleased to declare that mpox is no longer a global health emergency.
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Recent French #mpox cluster brings up important ? re vaccine efficacy/effectivness of Jynneos; durability of immunity from vaxx as we enter year 2; & relevance of mutations in mpox strains wrt immune evasion. Some mutations have conferred R to tpoxx.
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2/ Unclear optimal vaccine strains for future boosting/schedule; & global vaccine inequity
3/ much work left on understanding chronic immune dysfunction secondary to infection
4/ If/when problematic variants confront us, public inertia against polarizing NPIs will be an issue
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The "on-off" labeling of "emergency" for #Covid19 can be confusing and unhelpful, and certainly is oversimplified. We are in a very different place now w/ vaccines and antivirals, but a number of challenges remain
a few:
1/ Global surveillance of viral mutants/ data sharing
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Great weekend celebrating — we are indebted to Joel Katz & Marshall Wolf (and many others!) who took us under their wings & supported us in our passions. With my brother
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Back at the old stomping grounds for reunion weekend! Epic morning report from Marshall - funny enough I barely made it to almost any of these during residency but made it to the most important one of them all after
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We have seen mpox strains w/ mutations leading to resistance to tpoxx; to what extent we will see strains evasive to immunity from wildtype virus is an important question
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.@UKHSA is doing a study to try to map out immunity to #mpox. It had been assumed mpox was a one-and-done type of infection, but there have been a few reports of what looks like repeat infections, like this recent paper in Lancet. thelancet.com/action/showPdf gov.uk/government/new
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Very bizarre claims that mask-wearing 'explains Long Covid' in the form of a mask-induced exhaustion syndrome
Those making such claims know little about masks or Long Covid.
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2/ Some key challenges- pandemic response is truly multisectoral & requires bipartisan support. Navigating this in a large government is inherently challenging. Heading into an election year, we are faced with the task of making prevention a priority issue (has never gone well)
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1/ As the pandemic emergency ends at the federal level, important questions remain as to what comes next. Gratitude to the work of & others who came in at a crucial time & with a very tough job at hand.
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Nominate/vote for someone who utilized social media for good during the #COVID19 pandemic:
socmedawards.com/2023/
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This will hopefully help reduce administrative burden too— although eventually is the patient communicating more with a computer than their doctor? Does it matter? Lots to think about
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Noteworthy: a new study comparing #ChatGPT vs doctors for responding to patient queries demonstrated clearcut superiority of #AI for improved quality and empathy of responses @JAMAInternalMed
jamanetwork.com/journals/jamai
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Apparently Dyson makes headphones with an air purifier attachment?
Not endorsing this but I figured it wouldn’t take long for new tech to come into play besides masks
dyson.com/headphones/zon
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3/ Tecovirimat must be taken with a high calorie meal for adequate absorption. While it’s reported here that all patients completed 14 days of therapy, hard to be sure if all had complete absorption. We have found this to be a common issue in cases w ongoing lesions
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2/ Because not all post-treatment lesions were tested for presence of mpox DNA and there is no culture data, hard to say whether there could be viable virus present in these lesions / if these patients still pose a transmission risk
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1/ The authors describe here that lesions had improved after tecovirimat but not that they had completely resolved. A few considerations — we have now seen many mpox samples w/ mutations associated w tecovirimat resistance in patients around the country (no WGS done here though)
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New MMWR highlights patients in NYC treated with tecoviromat for #mpox who developed new lesions after treatment completion. Most new lesions resolved without additional treatment. Further research is needed to understand this phenomenon. Learn more: bit.ly/mm7217a5
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South Korean president Yoon Suk Yeol grabbed a mic and sang the Don Mclean classic “American Pie” to an astonished audience at the White House state dinner.
“I had no damn idea you could sing,” Biden told his counterpart. wapo.st/442KwRf
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Important thread on #SARSCoV2 origins— the relevance of raccoon dog data seems more questionable than earlier media reports made it out to be.
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Viral material is most co-mingled w material from fish & livestock products, but virus clearly did NOT originate w those species & products.
It’s simply that environmental samples taken over month after humans started spreading virus do not reliably indicate outbreak origin.
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