The Importance of Pathogen Surveillance Networks

Updated on Jun 6, 2024 | Featured, Infectious Diseases, Research

High school students working in the lab of Florian Krammer, PhD, as part of the New York City Virus Hunters program. Image credit: Christine Marizzi, PhD, BioBus.

The H5N1 bird flu virus was detected for the first time in cows in March, and in May, a third person tested positive for bird flu, presumably from exposure to infected dairy cattle. With viral fragments detected in dairy, the Food and Drug Administration tested and announced that pasteurized milk was safe to drink, and the Centers for Disease Control and Prevention (CDC) has been working with city and state health authorities and institutions nationwide to monitor any new spread of the pathogen.

What goes into ensuring that we remain safe from pathogenic outbreaks? Are we adequately equipped to monitor, prevent, and treat another pandemic?

The co-directors of the Center for Vaccine Research and Pandemic Preparedness at the Icahn School of Medicine at Mount Sinai—Florian Krammer, PhD, Mount Sinai Professor in Vaccinology, and Viviana Simon, MD, PhD, Professor of Microbiology; Pathology, Molecular and Cell-Based Medicine; and Medicine (Infectious Diseases)—tell us how the research community worked to shed light on bird flu in cows, pathogenic surveillance, and what Mount Sinai is doing in this field.

Left: Florian Krammer, PhD. Right: Viviana Simon, MD, PhD.

Were the bovine cases of bird flu expected and detected quickly?

Dr. Krammer: It took a while before H5N1 avian influenza was detected in cows for several reasons. Typically, cows do not get infected with influenza A virus. So nobody’s looking at cows, because why would you look if it has historically not been there? Compared to the poultry industry, where there is a good system in place for rapid detection of any outbreaks. Also, in cows, the H5N1 avian influenza is a slow disease. In avian species, when they get infected, they tend to die quickly. Other mammals, like bears, raccoons, or foxes that get infected with H5N1 via ingestion of infected birds, they often get neurological symptoms and die quickly too. It is different with the cows.

Are there adequate systems to prevent and protect against unexpected pathogenic outbreaks?

Dr. Krammer: From a scientific perspective, we have very good capabilities for detecting pathogens quickly. But preventing outbreaks is a complex task that takes more than just good science. Take the cases of avian influenza in dairy cattle, for example: When the outbreak occurred, there were no legal grounds for initial testing, or even for restricting movement of cows across state borders—there was not much the government could do. Academic networks like the Centers of Excellence for Influenza Research and Response, funded by the National Institute of Allergy and Infectious Diseases, produced the first reports of the recent cases, and are much more flexible and can respond quicker. These networks work very closely with government agencies to provide needed recommendations to handle unexpected outbreaks. One of these centers is located at Mount Sinai and we have also been very active with H5N1 surveillance and research.

Dr. Simon: Besides global and national surveillance networks, local efforts are important, too, especially for a large metropolitan city such as New York City. We have known for a long time that because New York is a very popular place for tourists to visit, that makes it a very likely entry point for any virus or pathogen. The city and state have various surveillance programs, and Mount Sinai also has a pathogen surveillance program that is more than 10 years old. This program is co-directed by Harm van Bakel, PhD; Emilia Sordillo, MD, PhD; and myself. We have been tracking nosocomial infections—picked up while in a hospital—and gaining information about circulating pathogens, including influenza virus strains, bacteria, and fungi. Our Pathogen Surveillance Program has resulted in Mount Sinai being the only site in the United States that is part of the Global Hospital Influenza Surveillance Network, which works to provide a unified protocol on covering hospitalized cases of severe influenza at a global level.

Are there any particular pathogens these networks are keeping an eye out for?

Dr. Simon: Some pathogens that the Mount Sinai Pathogen Surveillance Program is watching include bacteria like Staphylococcus aureus, Enterococci and Clostridioides difficile; viruses like influenza, RSV, SARS-CoV-2, and hantavirus; as well as fungi such as Candida auris.

What are some research questions these surveillance networks are trying to answer?

Dr. Simon: Some major questions include how influenza strains change in humans—their escape from the human immune system or their change of glycosylation (the process where sugar molecules attach to lipids, proteins, or other organic molecules); how to improve vaccines; and ensuring our diagnostics are able to pick up all the strains that can cause disease in humans.

Dr. Krammer: The tracking of the changes is not a problem. The World Health Organization does that on a regular basis, and we can do that too at Mount Sinai. A bigger challenge might be: can we catch up with seasonal viruses with our vaccines, or are we always a step behind? One way to tackle that is trying to design a vaccine that gives us broad protection, no matter if the viruses change, or if the strain is an H5N1 or an H1N1. Mount Sinai is very active in working on a vaccine that would work against any type of influenza—a universal influenza virus vaccine. As for diagnostics, there are so many subtypes of influenza viruses, but you never know which one presents a risk. We’re trying to find out what are the pathogenicity markers that make a strain dangerous for humans and make it transmit well. Or, what determines the risk of avian influenza jumping to humans? That’s why we have a program that looks at not only human influenza, but also avian influenza in animals in an urban space in New York City.

What does it take for such surveillance networks to succeed?

Dr. Krammer: You have to consider the fact that influenza viruses were not human viruses originally—they were bird viruses—and to tackle the vast topic of “One Health,” an approach that seeks to address the health of people, animals, plants, and the environment interconnectedly, you might need a wide range of expertise. This includes epidemiologists, immunologists, molecular virologists, structural biologists, doctors of veterinary medicine, and medical doctors. And that’s the nice thing about health systems like Mount Sinai, where we have a lot of those experts and they are able to come together to tackle this issue.

Beyond the science, collaboration is key. We have initiated the New York City Virus Hunters program, which is our science outreach surveillance program for H5N1. In this program, we work with local high school students to collect samples from birds in urban parks and greenspaces in the city, which are then screened for the presence of the virus. This is done in collaboration with Christine Marizzi, PhD, from the science education nonprofit BioBus and the wild bird rehabilitation center Wild Bird Fund. What’s important about getting high school students involved, especially those from backgrounds traditionally underrepresented in science, is getting them interested in science and steering them towards careers in science, technology, engineering, and math (STEM), specifically in molecular biology, virology, and so on. It’s about building the next generation of biologists and about involving the community in pandemic preparedness.

Mount Sinai does not exist in a vacuum—we help by sharing our information with the New York City Department of Health and Mental Hygiene, as well as with the government agencies. On the COVID-19 side of things, we are actively participating in the National Institutes of Health’s SARS-CoV-2 Assessment of Viral Evolution (SAVE), which tracks emerging variants. Our information feeds into the scientific community, but it also feeds into government agencies, who use that information to make their health policy decisions.

Dr. Simon: To be able to do what Dr. Krammer outlined, we need to keep our infrastructures intact. And that is really hard because we need all the funding and support we can get from the school, hospital, and government. But we are excited for what we can learn to continue keeping everyone safe from outbreaks.

The New York City Virus Hunters program works with local high school students not only to track the presence and spread of H5N1 virus in animals, but also to foster an interest in science and a career in STEM fields among students.

Image credit: Christine Marizzi, PhD, BioBus.

Read more about the New York City Virus Hunters program

The Latest on COVID-19: What to Know About Testing

Updated on Sep 29, 2023 | COVID-19, Your Health

The Biden administration recently announced that it is making four more COVID-19 antigen tests, also known as rapid tests, available to each U.S. household for the fall of 2023. You can order your tests through the federal government’s COVID.gov website.

A positive result on one of these tests is a reliable indication that you have COVID-19, especially when you are also experiencing symptoms like fever, cough, or shortness of breath, says Bernard Camins, MD, Medical Director of Infection Prevention for the Mount Sinai Health System.

Dr. Camins says that if you test positive and have symptoms, you should schedule a follow-up virtual or in-person visit with a health care provider, especially if you are at high risk for complications. The provider can prescribe an antiviral medication like Paxlovid™ (nirmatrelvir/ritonavir), which can help if taken within five days after your symptoms begin. The medicine works by stopping the virus from multiplying in the body.

(The Centers for Disease Control and Prevention (CDC) also recommends that if you test positive, you isolate from other people for five days or until your symptoms improve, whichever is longer. If you need to be around other people during this time, wear a high-quality mask.)

A negative rapid test does not necessarily mean that you do not have COVID-19, Dr. Camins says. Especially if you have symptoms, a negative test may just mean it was too early to detect the virus.

The Food and Drug Administration (FDA) recommends that people who have COVID-19 symptoms and test negative on a rapid test take another test 48 hours later. If you were exposed to COVID-19 but do not have symptoms, the FDA recommends that you test three times, with 48 hours between each test.

You can also take a laboratory test called a polymerase chain reaction (PCR) test, which is more reliable than a rapid test but must be given at a medical office. Mount Sinai Health System offers several ways to get a PCR test in the New York metropolitan region:

  • If you do not have any symptoms but need a test, contact your primary care provider or find a test site near you.
  • If you need a test due to mild symptoms, our Mount Sinai Urgent Care locations throughout New York City accept both walk-in and scheduled appointments 365 days a year.
  • Please wear a mask and practice social distancing. It is especially important to wear a face mask on the way to your appointment to help prevent the spread of any respiratory virus you may have.

Should I Be Concerned About “Flesh-Eating Bacteria” in New York?

Updated on Aug 29, 2023 | Infectious Diseases, Your Health

If you live in the New York City region, you probably heard news reports of a “flesh-eating bacteria” that has sickened several people. The disease is caused by an infection from a bacteria called Vibrio vulnificus, which can cause severe wound infections and, sometimes, blood stream infections, sepsis, and even death.

While worrisome, Vibrio vulnificus is extremely rare. Every year, there are about 100 cases reported in the United States. Vibrio vulnificus is less concerning for the general population, but is a major risk if you have a weakened immune system.

Timothy Sullivan, MD

In this Q&A, Timothy Sullivan, MD,  an infectious diseases physician and Associate Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai, discusses why people are getting infected with Vibrio vulnificus in New York City, how to prevent it, and what to do if you’ve been infected.

Why are people suddenly getting infected with Vibrio vulnificus in the New York City region?

Vibrio vulnificus tends to grow in brackish water, which is a mixture of saltwater and freshwater that occurs in estuary areas where rivers meet ocean water, such as the Long Island Sound. As the bacteria tend to grow more rapidly in warm water, the disease has always been more common during the summertime. However, there seems to be a link between climate change and these infections. In recent years, it seems these infections have become increasingly common in more northern climates as ocean water temperatures rise globally.

What are the risks?

Those most at risk are people with weakened immune systems, which can be caused by a number of issues, including having an underlying liver disease, if you are a transplant recipient, or if you are undergoing cancer treatment. Among these individuals, you are at risk if you have open wounds, recent tattoos or piercings, and have been exposed to brackish water, or if you eat raw or undercooked shellfish.

What are the symptoms?

The symptoms depend on whether you were exposed to Vibrio vulnificus through brackish water or by eating raw or undercooked shellfish. If you were exposed through water, you can develop a wound infection, which would include redness, pain, and swelling near the wound. With this disease in particular, wound infections can progress very rapidly and progress to a condition called necrotizing fasciitis that destroys tissue beneath the skin, which is why the disease is referred to as “flesh-eating bacteria.” That infection can develop into severe redness and pain that spreads rapidly from the area of initial infection. The first signs and symptoms of infection following eating raw or undercooked shellfish include nausea, vomiting, diarrhea, and abdominal pain. If a severe infection develops, you may experience fevers, chills, rapid heart rate, low blood pressure, and confusion, which are all signs of a very severe bloodstream infection.

How is the disease treated?

A Vibrio vulnificus infection is typically treated with intravenous antibiotics. If you develop a severe wound infection, you may need to undergo surgery. In the most severe cases that develop into necrotizing infections, amputation may be required.

What should I do to avoid infection?

These recommendations are not for the general population but primarily for people who have weakened immune systems. Do not eat raw or undercooked shellfish, not only to avoid infection from Vibrio vulnificus but other potentially harmful bacteria, as well. You should also avoid direct exposure to brackish water or estuary regions. Even if you don’t have open wounds, avoid brackish water and handling shellfish, since you could injure yourself, such as being in a boating accident or cutting yourself while shucking oysters. If you are at risk for severe infection and have a wound that has been exposed to brackish water, raw seafood, or seafood juices, wash the wound as soon as possible with soap and water. If you want to eat shellfish, make sure it is well cooked.

What should I do if I think I’m infected?

A Vibrio vulnificus infection may be a medical emergency, so if you have a possible exposure to Vibrio vulnificus and signs of infection, you should go to the hospital immediately. You would need to be started on appropriate antibiotics and, if necessary, undergo surgery. Communicate to your doctor your risk factors and exactly how you were exposed, so they can accurately diagnose you and start your appropriate treatment as soon as possible.

 

Learn more about Your Health.

How to Protect Yourself From COVID-19, Flu, and RSV This Fall

Updated on Sep 13, 2023 | COVID-19, Featured, Your Health

Respiratory viruses, such as influenza and respiratory syncytial virus (RSV), tend to pick up during fall. On top of that, COVID-19 is still circulating, with cases increasing in recent weeks. To fight off what some are calling a “tripledemic” of all three viruses, state and federal health officials are urging people to protect themselves with vaccines.

In an interview, Bernard Camins, MD, Professor of Medicine (Infectious Diseases), and Jennifer Duchon, MD, Associate Professor of Pediatrics (Newborn Medicine), at the Icahn School of Medicine at Mount Sinai, provided additional background about vaccines that will be available this fall.

COVID-19

COVID-19 cases and hospitalizations are not as high as they used to be at the height of the pandemic. But hospitalization counts—which are still being reported—have risen in recent weeks.

“We can’t just forget about COVID-19 yet,” says Dr. Camins.

On Monday, September 11, the U.S. Food and Drug Administration (FDA) cleared updated COVID-19 vaccines for use that are formulated to more closely target currently circulating variants. The FDA approved the Pfizer and Moderna vaccines—known as “messenger RNA” or “mRNA” vaccines for the type of technology they use—for people 12 and over. It granted emergency use authorization to the same vaccines for people six months to 11 years old.

On Tuesday, September 12, a panel of the Centers for Disease Control and Prevention (CDC) voted to recommend the updated vaccines for everyone six months and older. The CDC recommended that most people get one dose of the new vaccine, at least two months after their most recent vaccine dose. People who are immunocompromised, and parents of young children, should consult their doctor for recommended dosing.

Dr. Camins said the updated COVID-19 shots from Pfizer and Moderna are monovalent vaccines—meaning they are designed to target a single variant of SARS-CoV-2, the virus that causes COVID-19—but are expected to provide broad protection against the other currently dominant circulating variants of SARS-CoV-2 as well. He said patients should check with their primary care doctor’s office or local pharmacy to find out how and when they can get the new vaccines.

“Based on past developments, it could be within a matter of days for the shots to be available to the public once the recommendation is made,” says Dr. Camins.

The number of people hospitalized due to COVID-19 has been rising steadily in the city in August. Source: NYC Department of Health and Mental Hygiene

RSV

The respiratory syncytial virus commonly causes mild, cold-like symptoms in most healthy adults and goes away after a few days. However, for infants and older adults with pre-existing heart disease or lung disease, RSV can cause severe disease. This year, new vaccines are available for these vulnerable groups.

“RSV is ubiquitous,” says Dr. Duchon. “You can try to prevent it, but even then options are limited. While parents can practice good hand hygiene and stay away from other sick people, babies often have siblings who go to school or go to daycare.”

Most of the deaths or severe disease—typically lower-respiratory-tract disease—from RSV occur in infants ages 0 to 6 months, says Dr. Duchon.

In July, the FDA approved Beyfortus™ (nirsevimab-alip), marketed by Sanofi in the United States, for use in infants entering their first RSV season and up to 24 months of age for those in vulnerable groups. In August, the FDA approved Abrysvo™, from Pfizer, as a maternal vaccine to protect infants from birth through six months of age. Beyfortus is administered directly to infants after they are born, while Abrysvo is given to mothers at 32 weeks through 36 weeks of gestation.

ACIP has recommended that Beyfortus be given to all infants younger than 8 months born during—or entering—their first RSV season, typically fall through spring. For children 8 to 19 months who are at increased risk of severe RSV disease, such as those who are immunocompromised, a second dose is recommended.

Abrysvo has yet to receive ACIP recommendation, though news reports have stated that meeting could likely occur in September.

~1-3%

of children under 12 months of age in the U.S. are hospitalized each year due to RSV

~60,000-120,000 hospitalizations and ~6,000-10,000 deaths

among adults 65 years of age and older are due to RSV

Source: CDC

It is possible that the ACIP could recommend Abrysvo on top of Beyfortus. “We are hoping that the infant vaccine will help prevent severe disease, and that the maternal vaccine will add an additional layer of protection,” says Dr. Duchon. However, she notes that given how the clinical trials were set up, the expert panel will likely examine the data closely and deliberate on the messaging.

“This could be a shared decision-making situation between a mother and her doctor,” Dr. Duchon adds.

For older adults, the FDA approved Arexvy™ as a vaccine for people ages 60 and older, in May. “Particularly for people with  heart or lung disease, RSV can exacerbate their conditions,” says Dr. Camins.

Older people in that vulnerable group should speak with their health provider on whether they should take the vaccine, especially as RSV season approaches, says Dr. Camins.

Influenza

The influenza virus season from fall 2022 to spring 2023 was marked by an early peak in November and December last year, according to the CDC. When the 2023-2024 flu season will peak is hard to pinpoint, but the CDC issued a recommendation in August for people to receive their flu shots in September or October.

“We are starting to see some influenza A cases here in our  health system, which has a connection to how influenza A and B trends might play out through fall and winter,” says Dr. Camins. It is not a prediction of an early or bad flu season by any means, but he recommends that unless contraindicated, everyone older than six months of age take the flu shot.

The annual flu vaccine has been updated with a new formula, as is common, to target strains most likely to circulate this season. Anyone six months and older is recommended to receive it, according to the CDC.

Last year, the City Department of Health and Mental Hygiene encouraged people to receive both their flu shots and COVID-19 shots together, where possible. Officials have been urging a similar message for New Yorkers to be caught up on their routine vaccinations.

“Even if you’re not at high risk for complications from the flu, getting the vaccine may prevent you from getting sick, or even if you do get sick, your symptoms will be milder if you take the shot than if you didn’t,” says Dr. Camins. “Everyone should be getting the flu vaccine.”

Read more about Mount Sinai and vaccines

COVID-19 Cases Have Been Rising. Here’s What You Need to Know.

Updated on Jan 9, 2024 | COVID-19, Featured

If you are noticing that people you know are getting COVID-19, you are probably not alone. In fact, the number of cases in the New York area has risen recently. But this type of periodic fluctuation has been expected and is generally not a reason for concern, experts say.

“There is no reason to dramatically change our behavior when it comes to basic safety precautions and protecting vulnerable people,” says Bernard Camins, MD, MSc, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and the Medical Director for Infection Prevention for the Mount Sinai Health System.

Among the possible reasons for an uptick in hospitalizations could be the recent extreme hot weather that pushed people to stay indoors, or that people are gathering more because of summer travel.

The New York City Department of Health and Mental Hygiene reports hospitalizations in New York surged in July, but the number is still a small fraction of what it was in January of 2022 during the last big surge. There have been virtually no deaths for several months.

You may have heard about a new variant of COVID-19, known as Eris. Mutations or changes in the virus are normal and expected, and experts track them closely. In this case, there does not seem to be anything significantly different about this new subvariant. It causes the same symptoms, and people do not get sicker when infected by it.

Most important, Dr. Camins’ recommendations remain unchanged:

  • Those at risk of complications from COVID-19 may want to wear a protective mask (N95 or KN95) in crowded areas.
  • Always wash your hands when you get home or arrive at work.
  • Individuals at high-risk should talk with their health care provider and have a plan for how to get antiviral medications if they become infected, as these prescription medications must be taken within the first five days of symptom onset. Those at high-risk include older adults, those with chronic medical conditions, such as diabetes, and those with reduced ability to fight infections, such as those being treated for some cancers.
  • If you feel stick, stay at home.

Bernard Camins, MD, MSc

Here are four key takeaways from Dr. Camins and heath care experts about how we are all living with COVID-19 now.

It’s endemic

COVID-19 is now considered endemic in our society, which means it is a constant presence, and we should expect it to come and go, such as the common cold or the seasonal flu. The U.S. Centers for Disease Control and Prevention (CDC) officially declared the end of the pandemic in May, 2023. A pandemic refers to a disease that spreads rapidly and beyond control around the world.

Be sure to check the right number

Since the official end of the pandemic, health authorities are no longer reporting the daily cases of COVID-19. One reason is those figures are no longer an accurate measure because so many people are testing at home if they suspect they may be infected. Hospitalizations are still being reported. Ongoing measurements of the level of SARS-CoV-2 virus in wastewater may be a better measure of how widespread the virus is in the population, and that has shown a slight uptick in recent weeks, according to Dr. Camins.

New vaccines are on the way

The U.S. Food and Drug Administration (FDA) is working with vaccine manufacturers to prepare a new COVID-19 vaccine booster for the fall that will target the latest variants. Any new vaccine must be approved for use by the FDA and then recommended by the CDC and state health authorities before you can get it.

Don’t forget your flu shot

Now is the time to begin thinking about getting your flu shot. September and October are the best times to get the flu shot, according to the CDC. In addition, you may want to talk with your provider about the a vaccine against Respiratory Syncytial Virus (RSV), a common respiratory virus that usually causes mild, cold-like symptoms but can be serous for infants and older adults. The CDC is recommending the vaccine for older adults, adults with chronic heart or lung disease, with weakened immune systems, or those living in nursing homes or long-term care facilities. A CDC advisory committee has recommended the vaccine for infants under eight months.

Three Years After the Start of the Pandemic, Reasons for Hope and Continued Vigilance

Updated on Mar 17, 2023 | COVID Response, COVID-19, Featured, Your Health

It has been three years since COVID-19 was declared a pandemic on March 11, 2020, by the World Health Organization. With New York City as an early epicenter, residents were hit hard. But from that experience, health care providers and researchers across the city found the opportunity to learn more about the virus and how to prepare for future pandemics.

Today, the city’s level of community transmission of COVID-19 is considered low, and the percentage of people who have completed their primary series of COVID-19 vaccinations is relatively high, according to the Centers for Disease Control and Prevention (CDC). Similarly, hospitalization and mortality rates from COVID-19 remained low in recent months, compared to the period between 2020 and 2022.

Bernard Camins, MD

These factors mean that New Yorkers can probably afford to relax their vigilance compared to previous years, notes Bernard Camins, MD, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and Medical Director for Infection Prevention at the Mount Sinai Health System.

“We have come a long way. However, we still need to monitor how COVID-19 is affecting those who are at high risk of complications.”

Bernard Camins, MD

Who should remain vigilant?

Vulnerable groups include those who are immunocompromised, and those aged 50 and older, even if they’ve been vaccinated for COVID-19. People with certain underlying medical conditions, such as cancer; chronic kidney, lung, or liver disease; dementia; diabetes; heart conditions, or obesity are also considered at heightened risk.

For younger or healthy individuals, having COVID-19 these days might involve cold-like or mild symptoms, says Judith Aberg, MD, Chief of Infectious Diseases for the Mount Sinai Health System and Dr. George Baehr Professor of Clinical Medicine at the Icahn Mount Sinai. But vulnerable populations are at risk for developing severe disease, she adds. This includes hospitalization, needing intensive care, requiring a ventilator to breathe, or even death.

For at-risk groups, masking is recommended, as is avoiding large indoor gatherings. People planning to be organ donors should also remain vigilant for signs and symptoms of COVID-19, as an active infection could complicate one’s ability to donate, Dr. Aberg says.

“Also, people seem to have forgotten about hand hygiene; that is still important,” she notes.

What protection measures are available today?

With the federal Test to Treat initiative in place nationwide since 2022, symptomatic individuals who test positive for COVID-19 at testing sites can receive antiviral treatment, such as Paxlovid, on the spot.

“Taking Paxlovid provides that extra protection from developing complications, and the sooner it is taken, the better,” says Dr. Camins. Patients are recommended to receive antiviral treatment within five days of developing symptoms.

“One mistake people make with antivirals is that they wait to see if they feel better or worse before seeking treatment.”

Judith Aberg, MD

“If you’re a senior citizen, or have any of the underlying health conditions, when you test positive and have any symptoms, go seek treatment immediately. Do not wait,” says Dr. Aberg.

All individuals, and especially vulnerable populations, should stay up to date with COVID-19 vaccines, including the bivalent boosters, which are authorized for those ages 5 and older. “However, among people who were recommended to receive the bivalent booster, very few of them did,” Dr. Camins points out. “It seems many people have moved on regarding the pandemic before we really should.”

Judith Aberg, MD

According to the CDC, 17 percent of the U.S. population ages 5 and up have received the updated booster. In New York, that number is 18 percent.

Data have shown that the updated boosters either prevented infection or reduced the possibility of developing severe disease in people who received them. Another possible benefit of keeping up to date with vaccination is that it might prevent new variants from being as deadly as previous strains, Dr. Aberg says.

Will we need annual boosters?

Just as the bivalent boosters were updated to protect against current circulating variants and strains of SARS-CoV-2, the virus that causes COVID-19, researchers and officials are monitoring how the pathogen continues to evolve. Most of the scientific and medical community believe that the virus is headed in the direction of becoming endemic, or regularly occurring, Dr. Aberg says. “However, the jury is still out on whether annual updated boosters will be necessary,” she adds.

Neither the Food and Drug Administration nor the CDC has made any determinations on recommending annual COVID-19 shots, unlike what they have done with the flu. The data on COVID-19 collected over the recent winter could provide clarity on whether another shot might be needed this fall, says Dr. Aberg.

There are other seasonal coronaviruses and rhinoviruses that cause respiratory infections that do not require annual boosters. “It’s hard to predict whether the virus will take another turn to cause more morbidity or mortality. We’ll have to wait to see what the data shows us,” Dr. Aberg says.

What other things about COVID-19 should we be aware of?

The public health emergency declaration, which has been in place since 2020, will come to an end on Thursday, May 11, 2023. This might have implications regarding cost sharing or coverage regarding various COVID-19-related services, such as testing, treatment, or vaccinations. This might mean some services will no longer be free or will start requiring copays, depending on the insurance.

While the New York State Department of Health has not released any guidance on cost impacts, providers need to inform their patients and communities to follow up with their insurance companies and be aware of possible coverage changes, Dr. Aberg says.

“People need to be informed about potential costs before seeking COVID-19 care,” Dr. Aberg notes. “But on the other hand, we don’t want people to avoid seeking help because of cost.” If a patient experiences troubling symptoms, such as shortness of breath or fever, they should see a primary care doctor or go to the emergency room, she adds.

The medical and science community is also closer to understanding post-acute sequelae of COVID-19, or the condition colloquially known as “long COVID.”

Anyone who is infected with COVID-19 has a risk of going on to develop long COVID, in which individuals experience symptoms that persist beyond three months after the acute phase. An estimated 1 in 13 adults in the United States have long COVID, according to the CDC.

“We’re starting to zero in on specific biomarkers for people with long COVID,” says David Putrino, PhD, Director of Rehabilitation Innovation for the Mount Sinai Health System. These include platelet hyperactivation, microclots, immune dysfunction, and microbiome dysfunction.

“We are getting the science to a place where we may finally be able to identify this condition objectively.”

David Putrino, PhD

David Putrino, PhD

This has allowed providers to be better educated about the sorts of things that could cause long COVID symptoms to flare up, Dr. Putrino says. The availability of objective biomarkers also means the ability to start testing therapeutics to treat long COVID.

“A year ago, I would have thrown my hands in the air and said there were no good drug trials for long COVID,” Dr. Putrino says. “Now, I feel a little confident that we can start promising patients that these trials are on the horizon.”

“We’re getting close to getting therapeutics to prescribe. I’m hoping that will be a reality over the next two years or so,” Dr. Putrino says.

Read more about how COVID-19 research has progressed throughout the pandemic

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