IN THIS ISSUE
Big CDC grant supports public health infrastructure
Without testing, unreported HIV cases rise in Europe
COVID infection increases type 2 diabetes risk
Mpox public health emergency ending
New and Noteworthy
The Tripledemic is here. How much worse will COVID make it?
As predicted, the tripledemic of influenza, respiratory syncytial virus (RSV), and COVID has arrived. We echo Your Local Epidemiologist (YLE) Dr. Katelyn Jetelina’s reaction upon seeing CDC’s Fluview map for the week of Thanksgiving (shown here):
Holy cow. If you’re not sure what you’re looking at: Fluview maps show the level of “influenza-like illness” (cough and/or fever and/or sore throat) in the US, based on outpatient visits. The levels you’re seeing here are, according to YLE, “unprecedented” for this time of year. In fact, the highest (purple) level didn’t even exist before 2019.
What role will COVID play in this possible viral trimageddon? That depends on two factors – the number of people infected and how severe their illness is. As for the former, cases were up about 8% in the week after Thanksgiving, but that number
is much lower than the reality, due to lack of test reporting. Wastewater viral levels (reported on Biobot) tell a different story. As you can see in the chart above, US COVID-19 wastewater levels by region over time, July-November 2022, they are rising throughout the country - up 70% at the end of November, indicating that transmission has increased roughly 1.5x over the past three weeks.
How severe those cases become is a function of viral virulence (looks stable so far as BQ.1.1 becomes dominant) and the levels of immunity the virus has to overcome (lower than we would hope - just 12.7% of those eligible are bivalently boosted, including only 32.6% of seniors, who are most vulnerable). The earliest indicator of the net of these two drivers is new hospital admissions. For the first time in the pandemic, flu hospitalizations (~2800 per day) are approaching COVID levels (~3700 per day). Both are still rising.
No one knows how big this surge will be or how long it will last. So please, please stay safe: get your bivalent booster and your flu shot, if you haven’t already (happily, the flu shot is a very good match for this year’s version of the virus). Mask in crowded settings and test at least twice before family gatherings with vulnerable friends and family. And when you do get together, make sure the air in your gathering space is as fresh and clean as it can be.
CDC awards over $3 billion to support public health infrastructure
Last week, the CDC announced the first round of recipients in its Public Health Infrastructure Grant Program, awarding over $3 billion dollars in total with the goal of “strengthening US public health infrastructure, workforce, and data systems.” The vast majority of the money went to the state public health departments (all 50 got money) and to the public health departments of the country’s largest cities and counties by population. The remainder went to three National Partners (their caps, not ours) - whose job it is to keep tabs on how well the program is working, provide “training and technical assistance,” and make sure the grantees are playing well with one another and with the CDC.
Commentary: Notably not on the grantee list: Grass-roots community health groups, on whom federal and state public health officials leaned heavily for outreach throughout the pandemic. We’ve been calling for fiscal support for public health infrastructure on a non-emergency basis for a while now, so it’s great to see this money flowing out. Our hope now is twofold: That the feds will continue to support public health on an ongoing basis, and that the state public health offices will do right by the community health groups who have helped them so much.
Food for Thought
Another COVID consequence: Unreported HIV up due to lack of testing
The availability of HIV tests and testing centers has been distinctly reduced during most of the last two years. As a result, Europe (including Russia and Ukraine) saw a 25% decrease in the number of HIV cases reported in 2021; a drop too large to be from “natural reduction.” Modeling estimates indicate that one in eight people living with HIV in the region are now undiagnosed - a gap that threatens the ultimate goal of HIV eradication by 2030.
Quick Hits
COVID infection seems to increase the likelihood of type 2 diabetes. A Veteran’s Administration study of 180,000 COVID patients showed that they were 40% more likely to develop diabetes up to a year later than were veterans in the control groups. All COVID patients were impacted, but the more severe the infection was, the higher chance of diabetes.
Mpox will not be renewed as a public health emergency next year. Cases have fallen to an average of seven cases a day, and vaccination and tests are available. Much credit must go to the communities most affected by the disease, who got the word out about tests and shots and lined up to take advantage of them.