Episode 73: COVID-19 Summer Surge & Variant Updates

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So I wanted to jump into some information about the new COVID variants , because we are back in the middle of a summer surge and you know , I think it's important to stay up to date on the new variants , just even be comfortable with the names and see if there's any changes in the pathophysiology of COVID-19 or SARS-CoV-2 .

And this was actually a little harder to find . I don't know if it was just me , but it felt like it was a little bit more difficult to dig into some of the detail this time . A lot of the pathophys that exists on SARS-CoV-2 is still from 2020 , although there are some updated articles in 2022 , and I even found one from 2023 .

But a lot of the newer research is actually in relation to the long-term problems that COVID has caused , whether it's long COVID itself , issues with atherosclerosis , issues with brain fog , fatigue , autonomic dysfunction , that kind of thing .

So I did a little bit of digging and I just wanted to make sure there wasn't any drastic changes in the physiologic process , because that is important for us to understand how things are being transmissed Is that a word how the transmission of COVID occurs , and if there's just any changes , because that will also lead to potential changes in symptoms .

So I don't know if it's the good news , but the good news is there really isn't a ton of change on the big picture of COVID . I have some notes in front of me but I just want to kind of have all my stuff out in front .

But the actual virus itself is considered a positive sense single-stranded RNA with a spiked glycoprotein , the S-protein and we've heard a lot about the S-protein even in the media versus actual research articles and such .

I think we're all sort of familiar with some of these words and essentially the S-protein binds to the ACE2 receptor and that ACE2 receptor basically breaks down wherever it is and will enter the bloodstream . So the primary place that this occurs is actually the lung . So it is spread via respiratory droplet and aerosols and it is obtained via breathing it in .

So the alveoli is really one of the primary places where transmission occurs essentially , and so basically once we breathe in said particulate it's going to enter our system , bind to ACE2 . At the alveoli it will break down type 1 and type 2 pneumocytes . This will create vascular permeability at the alveoli , increase fluid potential and it enters the bloodstream .

And once it enters the bloodstream it has the ability to basically spread to other ACE2 sites . And , as we know , the symptom list is long and varied and I think this was something that really threw a lot of people early on as to why there was so much variability in COVID , its symptomatology and things like that .

And I think the easiest answer really is to say it's because ACE2 is very available throughout the body . So we have the systemic response , because ACE2 is located in the brain , the esophagus , the nares , the heart , the lungs , the GI system , even the reproductive system , so and vessels right Like .

There's just so much variability in the immediate symptomatology as well as the long-term problems that occur , and so , basically , wherever the virus binds to the ACE2 is likely why you develop certain symptoms .

There's still a lot of unknown as to why , with one variant , one person might have more of the runny nose cough , while another person might have higher fever or have more severe shortness of breath .

There's still question about you know the individual response and I think we keep learning more and more and we keep seeing some changes with the variants and it seems that some variants tend to have more of that , you know , congestion , sore throat sort of thing , while others are more high fever , chills , and then of course we have the no smell , no taste In

this current summer surge . It seems to be fever , fever and chills seems to be high . Cough seems to be high . It seems to start with the runny nose , sore throat sort of thing . Fatigue and body aches is still on the list . Headache is still on the list . Headache is still on the list .

I'm hearing and this part is anecdotal , I'm hearing less of nausea , vomiting , diarrhea , and I really haven't heard much about no smell , no taste . In this most recent surge I've been hearing more fever , more chills . I hear this quite a bit , usually kind of throughout is I thought it was just allergies .

I started with a runny nose , sore throat , that kind of thing , and so that kind of brings us to different times of the year . I think this is going to be one of those viruses that isn't just a winter virus . It seems to have this yearly summer surge .

There's some theory behind that , whether it's because we've had really high temps and people are indoors more to get relief from the high temps , versus maybe people are traveling more and interacting and being in more crowded places .

There's still a lot of question as to what the summer surge thing is about , but the virus exists pretty much throughout the year and so you can get it at any time of the year , and I think that's part of also having a little self-awareness about how you feel . Midsummer , july , august isn't really a high allergy time .

So if you are starting to have that runny nose or throat congestion Maybe you are in a high populated area or traveled recently it really is no harm in testing versus assuming that it's this and then all of a sudden you know , realizing it once you have the high fever . So that's , you know . Just a personal commentary on that .

I think it's better for the people around you , less risk of spread and also there's something about knowing that can be super helpful too . The winter is definitely harder . Right Winter you're going to have flu , covid , rsv .

Last year those three were like big high hitters COVID and flu being more than RSV , but still available or still a possibility and I found that last winter there was less overall testing when you went to get checked out . I'm not really sure what that's about . I think they're really clumping together a lot of the respiratory diagnoses right now .

It's like , well , you either have COVID flu or RSV . In my personal opinion , they shouldn't be treated as the same because they're not the same and how they spread and such . But it's sort of leaning that way , even with some of the recommendations .

So what I have seen , actually just recently , is that they're doing some more home tests with like three in one type testing , so it's COVID flu A and flu B . I would love to see one with RSV as well . That would be just a great way to either articulate to the docs or just to know for yourself .

Either articulate to the docs or just to know for yourself . Right , I think it's important to know if you have COVID , especially for the long-term potential consequences . Like you know , in two , three months , if you're having this extraordinary fatigue and brain fog .

But you don't have a documented date of COVID , that can be a little bit tricky and , you know , maybe figuring something else out . So I personally think that it should have its own diagnosis and although you do very similar things in helping to prevent spread of multiple types of respiratory diagnosis .

I think they're different in the sense of like timeframe , of how long things last . So that's my opinion on that . So just for some knowledge of variant names they do not make this easy , I'm telling you whoever's in the naming department of COVID I think we need like a marketing check up in here .

So JN.1 was the primary variant pretty much throughout the winter , so like right around Thanksgiving last year , december , january , february , march are all in this like JN1 variety . That was the primary variant and so now they have these like additional cutesy names attached to them to show their mutations .

So JN1 is considered a slip and the slip is a capital S , capital L , ip , and what that is showing is that there is a mutation at site 455 of this variant and it switches the L for the S . So SLIP , s-l-i-p . This is what I'm saying . It's not easy to keep track of these names .

As you can imagine , this has now mutated more , and so the most current variants at this time are KP3 , which is the most prevalent at the moment , kp2 , and LB1 . And there's also KP3.3 , 3.1 . Hold on , it's right now in the US KP3 at 20.1% , lb1 at 16% and KP2.3 at 14% . So we have a couple of variants out there .

The long and the short of it is that they are sub-variants or descendants of the JN1 , which are essentially sub-variants of Omicron . So there's all these lineages , there's like a whole map of these variants that exist , but essentially it is like the grandchildren of Omicron and JN1 are the parents right now .

So these new variants that are currently out are considered the FLIRT variants , f-l-i and then again capital RT , and so it's just showing where the mutations exist . Getting into nitty gritty , this is definitely not my area of expertise area of expertise , but there's a mutation at position 456 for the F , for the L , so that's the FL part of FLIRT .

And then there's another mutation at 346 , where there's an R for a T , so there's like flipping flop , and so you know , the important stuff about this is that the virus is still mutating . It probably will continue to do this forever .

In some situations it might become less contagious , in some situations it might become less transmissible and in other situations it can become more hardy , more what's the word ? More severe in its presentation . So at this moment it's not more severe . Pretty much most of the COVID cases are considered mild .

I'm putting that in air quotes because mild still feels like crap . And so if we remember from , like the really early COVID , mild to severe . Like mild is like all of the you know big regular stuff fever , chill , sore throat , body aches , fatigue , and then severe is like intubated . So quite the variety . So mostly mild cases .

What is interesting with this most recent variant is that the mutations that are occurring are making it easier to bind to ACE2 , however , it has mutated itself and everything that has descended from the JN1 is more efficient in immune evasion .

So immune evasion essentially means that if you've had prior COVID , if you've had prior vaccines , this will evade that protection . So higher risk of transmission again . So they are expected to come out with the new vaccine in the fall they're predicting late September , early October I think last year was October , like second week in October .

So I would guess it would be the same thing or around the same timeframe and essentially it would probably be beneficial to wait for the new vaccine .

If you're intending on getting vaccinated to help prevent the newer versions of the variants , you'll have better protection , basically because the new vaccines will essentially help to combat the new variants , combat the new variants and from my understanding based on the literature , the monovalent COVID-19 was more specific to the XBB15 , which was one of the primary

variants last year , like last summer , last fall . So it's going to keep evolving . There's going to continue to be changes with the vaccines . From what I'm understanding , the COVID-19 antigen tests as well as the PCR tests , are still being effective in catching the new variants . Last year this time they were talking more about test evasion .

I'm not hearing that this year . Apparently , the tests are doing a good job catching it and very anecdotally from you know friends and family who have had COVID . They have even checked themselves on some of the expired tests and some of the expired tests are even catching it .

So you know people will get PCR tested or do an appropriate not expired test and then they'll just check themselves with the expired . Some people like to check see if these things are still working and a lot of people said yeah , it just lit up right away . So there is a link on CDC that has dates for extension of expiration dates per each antigen test .

I can link that below just for some quick reference points . I still have some old ones . I probably should check to see if they have extended the dates . Anything else ? All right . So we talked about the variant names . We talked about the symptoms .

Oh , one thing I wanted to talk about was the updated isolation precautions , or lack thereof , and just kind of talk about what exists in recommendations . So the new guidelines are very vague and open-ended and I think it's meant to do that for a number of reasons , as I talked about on a previous podcast .

It's meant to do that for a number of reasons , as I talked about on a previous podcast , but it's really putting the onus on the person and essentially there's one real objective measure . And then the second one is kind of where the you know subjective nature comes in .

So the objective measure is that if you had a fever , you have to be fever free for 24 hours without medication in order to go back to regular activity , and that can include work , school , what have you . And then the second guideline is that your symptoms are overall getting better , and that's as open-ended as it comes .

And so they basically allude later on in the guidelines that you can return to regular activities for the next five days at you know , once you decide to go back . So you're going back to work for the additional five days

. Basically , it would be recommended to wear a mask to decrease your distance from people and large groups , and obviously washing hands is super important . Also , you know , rechecking your testing can help with that . But we also know that you can test positive for weeks if you're very symptomatic .

So that's not always the best option but it can be helpful , especially if you're in that early period . We do know that you're most contagious the first day or two before you show symptoms and the next two or three days after showing symptoms . So you know kind of keep an eye on how many days you have been symptomatic .

Obviously , if you're still coughing and such , if you're still coughing and such , definitely wear a mask out in the community . So a lot of variability in that I can 100% understand , especially with the five-day rules of having to take off from work .

The hard part also , if you have kids who are sick and those five days turn into 10 days , turns into 15 days as it makes its way through the family , it can be very detrimental to , you know , regular life and I 100% understand the give and take of that .

But it does put a lot more onus on the individual and so I just hope that we're all respectful of each other when it comes to this . They are essentially lumping in flu RSV with COVID in these protocols .

So basically , if you have a respiratory something going on , they're recommending that you're not out in your regular day life work , school , gym while you're symptomatic , or you should at least be improving and not having an active fever . There was also talk about rebound COVID . I didn't dig super deep into it .

I actually haven't heard a lot about rebound symptoms outside of Paxlovid , so I'm going to give that a little bit of a dig next .

But basically , if you start feeling worse again and or your fever comes back , you should then go back to isolating and so they're just a little looser with some of their terms and definitions and things like that and again puts more onus on the person themselves .

The last thing I dove into a little bit because I haven't in a while was actually looking at the size of the droplet right , like we're four years into this pandemic . I want more information for teaching purposes and just like general understanding , so that when rules are made or recommendations are made , we can have more of a conversation as to why .

And so very early in COVID I was digging into this stuff . I was doing . I was assisting with PPE management at the university doing presentations on what we knew at that time , and so I did a presentation summer 2020 , when we first got back onto campus . You know what the diagnosis is , how it's trans I'm having a hard time with that word .

What is the conjugation for the transmission ? Is it transmissed ? How we , how we spread said disease . English is hard , but back in , so that must've been June , june 2020 , when I was looking at transmission . There was a lot of conversation of is it droplet , is it airborne ? Is it droplet , is it airborne ? And just kind of as a blanket statement .

The WHO and CDC characterize respiratory droplet diagnoses as greater than five micrometers and aerosols which are smaller , particulate are categorized , defined , as less than five micrometers . Back in June 2020 , and I have a link to my article here they were talking about SARS-CoV-2 as being less than 100 nanometers , which is equal to 0.1 micrometers .

So back in June 2020 , there was conversation about size of droplet and it was stated that it was 0.1 micrometers which would fall in the aerosol definition , making it an airborne disease .

There's still been a lot of controversy on respiratory droplet versus aerosol since this time and early on I could really understand lack of PPE , not having enough N95s , essentially making do with what was available and utilizing PP where it was needed . I get that this far out . I feel like we should have a better understanding of this .

So I was surprised , as I was digging again , that there still isn't a ton of data research on size of the particulate . And even on the CDC website it's kind of it's like in the middle ground between droplet and aerosol and they actually had a name attached to it Novel air precautions was the terminology wrapped around it on the updated PPE recommendations .

So you know , I'm just like well , how big is it ? It shouldn't be this difficult of you know information to find out and was a case study and it was actually a super interesting case study .

I know we can't put a ton of weight on a case study , but it was a case on one person who had just been diagnosed with COVID and then they followed that person for I think it was four or five days and they had them talk , speak , breathe , sing for 30 minutes in a room and then basically check the air and particle size .

And in that specific case study there was a lot of interesting information and I think if this was done on a bigger scale would be a great study . So they basically measure the particulate of one single person with known COVID . They were able to track when they were diagnosed and then like how many days out , and the range of particulate size was between .

In total the four days was , the majority were less . The average was less than 4.5 micrometers , which again fit the definition of aerosols . In their introductory conversation they talked about other studies where the range ranged from less than 0.25 micrometers to greater than 8 to 10 .

So 8 to 10 would put you over the respiratory droplet amount and the 0.25 would put you well under the aerosol . So there seems to be variety of particulate size .

And again , I am no expert on how they are measuring it Wild study , reading the methodology they like extract it it almost sounds like they dehydrate it , take the water vapor out and then they assess it . That's well beyond my scope .

But the other piece that was super interesting about this in this case study the range was from 0.94 , hold on , let me back up . The total range was 0.34 to greater than 8.1 over the course of four days . But what they were showing was the concentration of the RNA in the particulate size , which is also something to consider .

How long does said particulate stay infected ? Stay infected because time that it's suspended and infected would also increase transmission . So that was interesting . They looked at the amount of concentration available in the particulate and the highest RNA concentration were in the 0.94 to 2.8 micrometer particulate 0.94 to 2.8 micrometer particulate .

And then the other thing I really liked was that they looked at the concentration of the particulate as well as size in each consecutive day , and the concentration was highest on day of symptom start and decreased every day thereafter . So obviously there's a high variability between people on level of infection time .

But if we could make this case study on a bigger scale , this would be great information . You'd get particulate size , you'd get concentration of said RNA , which would equal infection . You know transmissibility . That would be awesome . It would help with the . How many days are you really contagious , right ? So I think there's still four years in .

There is still a lot to be determined . The general consensus on the world of PPE is that it seems to fall somewhere between droplet and airborne , and I think you have to respect the airborne .

In my opinion , based on the things I have read over the last four years , it seems to be a smaller aerosolized particulate , which would make me lean towards the airborne precaution . So N95 plus eyewear . And it also can be transmitted via fomite .

So if I cough on a pen , remote doorknob , you know what have you and I was then going to touch that , that would be able to spread said infection . So hand hygiene is super important . High quality mask , super important . Eyewear because the eyes are another mucosal organ super important . So I think that's going to be a debate for a long period of time .

How long we should be isolating is still kind of this guesstimate range . Again , I have my original lecture up here and the amount of viral shedding was typically two to seven days , which can be as long as 10 to 14 , with the incubation period being average five to two days .

So in June 2020 , that was the information , I don't think it's changed that much and I think five days is probably that close marker as to how that virus is shedding , depending on how severe your symptoms are . So still a lot of variety . In my opinion , if you are still actively coughing , feeling crummy , please wear a mask in public .

You don't know what other people have around you and their level of risk and you know it's just spreading and all that stuff . So do your due diligence , do the best that you can and when in doubt , you know high quality mask is super beneficial . So hopefully this was a good update . The long and the short of it is that we have lots of variant names .

It's going to continue to mutate . The names right now that are around are your KP331 , your KP3 , your KP2 , your LB1 , which are descendants of JN1 and Omicron . That is the summary of the variants .

The symptoms are pretty much the same Fever , chills , cough , runny nose , congestion , sore throat , fatigue , body aches , headaches seem to be the big picture right now . Less of the nausea , vomiting , diarrhea , and no smell , no taste this time around . But again , a lot of that's anecdotal , based on what I saw on CDC and there was another , oh , it was some .

No , I can't think of the name of it Wasn't the WHO , wasn't CDC , but it's another tracker for . Covid Also alluded to more of the fever , chills , cough , runny nose as being the primary symptoms and , as we know , cdc changed their recommendations I believe it was March 1st and it's giving a little bit more freedom , a little bit more onus on

the person . So basically , you shouldn't have a fever for 24 hours and you should be decreasing your symptoms before returning to work , school life , that kind of thing , and it is recommended that you wear a mask for about five days outside of that time once you start leaving your house and such .

So much less restriction , but a little vague pros and cons to both . Again , I 100% get it , but definitely if you are someone who is more at risk and you are concerned about a summer surge or anything . High quality mask in crowded areas , especially if you're traveling or going to , like small venues . All the same stuff exists .

So you have the information and then do with it what you will . Hopefully this is helpful , though , because I know it's hard to . I know it's hard to keep up with this stuff and , to be quite honest , I thought this was the hardest time , or I had to dig harder to really get more updated information .

I guess the good news is the stuff really hasn't changed a ton , but there is some mutations that are either dampening the response or making it more evasive in some ways , and so I think it's important to know , and I think we're going to be living with this for a long time , probably forever , and it's just going to become part of our routine and you know

we'll see how it all goes . So hopefully this was helpful . Hopefully you don't get hit with the summer surge , including myself and new , updated vaccine should be coming out sometime in October which should help with the new mutations . Just some updated information there . There's no date out there . I looked , can't find anything and I think that's all I have .

So if you have any questions , please reach out to me . You can hit me up on Instagram . Shoot me a text message , an email I'm a little slow with the text message would be great or Instagram messaging , and that's all I got for you today . So I hope you all have a wonderful day and whatever you have to do , get after it .