Officials: Sewage signals Covid-19 surge

Health officials in several parts of the United States are seeing worrying signals in sewage monitoring data that the coronavirus may be spreading more widely than recent numbers of new cases suggest, and that a steeper wave may be coming.

Sewage monitoring only provides a rough picture of virus prevalence in a given community, but the readings it provides are near real-time and do not depend on people searching for tests and reporting results. Health authorities are therefore looking for wastewater data to provide early warning of trends. And in some places, these warnings are flashing red.

The data is like a “canary in a coal mine” for New Orleans, said Dr. Jennifer Avegno, chief of the city’s health department.

The case numbers are a “gross underrepresentation” as many people are choosing to get tested at home rather than going to hospitals or doctor’s offices. Avegno said the rising prevalence of viruses seen in sewage tests has prompted the city to mobilize resources to prepare for another surge.

While the city is not considering reinstating mandates, it is making other preparations. City officials have started planning mask gifts and are ramping up their campaign to encourage residents to get vaccinated and empowered.

The number of new cases in the city is averaging 155 a day, five times the rate a month ago, and sewage tests show elevated levels of coronavirus in residential and tourist areas.

“It looks like a wave in slow motion,” Avegno said. “It’s not the sharp increase that we’ve seen with delta and definitely not with omicron.”

Houston is another city where sewage data shows ominous signs of rising infections.

“I don’t know if it’s going to be the magnitude that we saw in the previous spike, but I definitely think we’re beginning to see more community infections,” said Lauren Stadler, who does wastewater collection and analysis at Rice University directs Thursday.

Harris County, where Houston is located, has seen a 175% increase in cases over the past two weeks, according to a New York Times database.

Stadler said health officials in the city are trying to use the sewage data to decide what an increase looks like these days.

“I definitely think the sewage is telling us it’s spreading through the community. But does that mean we will see an increase in hospitals? What does that mean in terms of the severity of the disease,” said Stadler. She added that sewage collection also makes it difficult to know exactly who is getting infected, as the data is less individualized.

Scott W. Long, medical director for diagnostic microbiology at Houston Methodist Hospital, said he hoped people would start taking more precautions to lessen the severity of the surge in Houston.

“In my personal everyday life, I know that outside of work and when I travel, I will mask more,” he said.

In Maine, state health officials have been seeing an increase “for a while,” said Mike Abbott, a senior sewage screening analyst for the Maine Centers for Disease Control and Prevention, on Thursday. He noted that the increase in cases began in mid-April, with the slope becoming steeper in May.

A New York Times database shows that in the last week of April and into May, Maine saw a strong upward trend in cases that matched the levels the state saw during the delta rise in late August.

“We rode that wave,” Abbott said. “Now what’s going to happen next and what we’re worried about, I mean, we’re certainly hoping that this isn’t the start of a surge similar to what we saw in January with the original variant.”

Experts claim that the best way to fight surges and protect yourself from the virus is to get vaccinated.

“My advice to the takeaway people is that vaccines are still our best defense. Get boosted when you’re due for one,” Long said.

GET KIDS BOOSTER

Children ages 5 to 11 should get a booster dose of Pfizer’s Covid-19 vaccine, US government advisers said Thursday.

The Centers for Disease Control and Prevention was quick to adopt the panel’s recommendation, opening up a third Covid-19 shot for healthy elementary school-age children — the same as what’s already recommended for everyone as young as 12.

The hope is that an extra shot will boost protections for children aged 5 to 11 as infections rise again.

“Vaccination with a primary series in this age group has lagged behind other age groups, leaving them vulnerable to serious disease,” said CDC Director Dr. Rochelle Walensky in a statement.

“We know these vaccines are safe and we need to keep increasing the number of children protected,” she said.

Earlier this week, the Food and Drug Administration approved Pfizer’s child-sized booster shot to be offered at least five months after the youth’s last vaccination.

The CDC takes the next step by recommending who actually needs vaccinations. His advisers debated whether all otherwise healthy 5- to 11-year-olds needed an extra dose, especially since so many children became infected during the great winter tide of the Omicron variant.

But the US is now recording an average of 100,000 new cases per day for the first time since February. Finally, CDC advisors pointed to increasing evidence from older children and adults that two primary shots plus a booster shot provide the best protection against the latest coronavirus variants.

“Perhaps this should always have been a three-dose vaccine,” said Dr. Grace Lee of Stanford University, who chairs the CDC Advisory Board.

Parents are still eagerly awaiting the opportunity to vaccinate children under the age of 5 – the only group not yet eligible in the United States.

dr Doran Fink of the Food and Drug Administration said the agency was “working as quickly as possible” to evaluate an application from vaccine maker Moderna and is awaiting definitive data on competitor Pfizer’s youngest children. FDA’s own advisors are expected to publicly discuss data from one or both companies over the next month.

In the case of 5 to 11-year-olds, it is not yet clear how much catching up there will be. Only about 30% of this age group have received their first two doses of Pfizer since vaccines opened up to them in November.

Thursday’s decision also means 5- to 11-year-olds with severely compromised immune systems, who were originally scheduled to receive three shots, are eligible for a fourth dose.

Pfizer and its partner BioNTech currently provide the only Covid-19 vaccine for children of all ages in the United States. The 5 to 11 year olds will receive a dose that is one third of the amount given to everyone aged 12 and over.

In one small study, Pfizer found that a booster increased the levels of virus-fighting antibodies in these children — including those able to fight the super-contagious Omicron variant — the same kind of jump adults get from an extra injection obtain.

THERAPY AVAILABLE

As Covid-19 surges again in the US, many people are turning their backs on time-sensitive therapeutics like Paxlovid because doctors worried about shortages are reluctant to prescribe the drugs. But the situation has changed and supplies are now plentiful.

Paxlovid, a combination of pills taken for five days, reduces the risk of hospitalization by nearly 90%, according to manufacturer Pfizer. But to be effective, it must be taken within five days of the onset of symptoms — which include everything from a sore throat, runny nose, cough, and chills to fever, body aches, headache, nausea, vomiting, diarrhea, and difficulty breathing loss of taste or smell.

The Food and Drug Administration has granted emergency use authorization for the drug to treat mild to moderate Covid-19 in people at high risk for serious illness. The Centers for Disease Control and Prevention defines these as people aged 50 years or older, unvaccinated or with certain medical conditions such as kidney, liver, lung and heart disease, diabetes, cancer and HIV. It also recommends the drug for people with weakened immune systems, pregnant women, the obese, cigarette smokers or people with mood disorders.

In March, the Biden administration launched a nationwide initiative to provide fast access to Paxlovid and other oral antivirals. Through this program, people can go to one place to get tested for Covid-19 and get a prescription the same day. These one-stop locations can be found using the Department of Health and Human Services’ Test to Treat Locator.

Some of the country’s largest pharmacy chains are participating, including CVS Health Corp., which operates 1,200 MinuteClinics in select stores in 35 states and Washington.

“The number of patients prescribed oral antivirals at our MinuteClinic locations has increased steadily over the past three months,” the company said in an email. Paxlovid is available in nearly all CVS pharmacies, along with Merck & Co.’s Covid pill, molnupiravir, the company said.

Critics of the program say these life-saving drugs are not reaching those who need them most. In March, NPR reported that a large percentage of the pills the government shipped to pharmacies for free were on store shelves. CNN found the government’s site locator tool was missing key locations like Zuckerberg San Francisco General Hospital, which also offers test-to-treat services.

One limitation of the test-to-treat program is that pharmacists are not authorized to write prescriptions for Paxlovid, and allowing them to do so would increase access, said Jason Gallagher, a clinical pharmacy specialist in infectious diseases at the Temple University, in a briefing held by the Infectious Disease Society of America on Friday. Paxlovid isn’t for everyone, especially for people with certain kidney and liver conditions, and there needs to be more education about interactions with common medications, herbal supplements, and over-the-counter treatments, Melanie Thompson, an internist and HIV specialist associated with Piedmont Hospital Atlanta said in the briefing.

Information for this article was contributed by Isabella Grullón Paz of The New York Times, Lauran Neergaard of The Associated Press, and Martine Paris of Bloomberg News.

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