Psoriasis Flares in Patients With COVID-19 Infection or Vaccination: A Case Series

Authors: Hemali ShahAna C. Busquets

Published: June 16, 2022 (see history) DOI: 10.7759/cureus.25987 Cite this article as: Shah H, Busquets A C (June 16, 2022) Psoriasis Flares in Patients With COVID-19 Infection or Vaccination: A Case Series. Cureus 14(6): e25987. doi:10.7759/cureus.25987

Abstract

Much of the literature involving COVID-19 and chronic inflammatory dermatological conditions have focused on the safety of immunomodulatory therapy in the setting of this highly infectious virus. While general mortality associated with the infection and vaccine has been studied in depth, the effects of the virus and vaccine on inflammatory skin disease states have not been. It is well known that psoriasis can be triggered by stress, infection, certain medications, and, although not as common, vaccinations. Further, existing literature has briefly commented on psoriasis flares after COVID vaccination, but these have not touched on flares among their patients’ current therapy, nor flares after COVID infection. In this case report, we report five cases observed at our institution over the last year of either new-onset psoriasis or flares of previously well-controlled psoriasis shortly after infection with COVID-19 or COVID-19 vaccination, with no other identifiable triggers. These cases can serve to raise awareness of issues related to managing stubborn psoriatic flares and bring to the forefront conversations that are likely to arise with our patients regarding the risks and benefits of COVID vaccination and boosters. While the definitive etiology of the association between COVID and psoriasis remains unclear, it is important that the dermatologic community be aware when evaluating patients with new-onset or worsening psoriasis as we move forward in times of this COVID-19 era.

Introduction

Much of the literature involving COVID-19 and chronic inflammatory dermatological conditions have focused on the safety of immunomodulatory therapy in the setting of this highly infectious virus. While general mortality associated with the infection and vaccine has been studied in depth, the effects of the virus and vaccine on inflammatory skin disease states have not been. Certainly, there are possible adverse effects of COVID vaccination with no long-term sequelae that are accepted as risks when compared to the severity of infection, but these have not been widely addressed in the literature [1,2].

It is well known that psoriasis can be triggered by stress, infection, certain medications, and, although not as common, vaccinations [1]. In this series, we report five cases observed at our institution over the last year of either new-onset psoriasis or flares of previously well-controlled psoriasis shortly after infection with COVID-19 or COVID-19 vaccination, with no other identifiable triggers. With this series, we hope to add to the limited existing literature by revealing that flares of psoriasis can occur in both untreated and chronically managed patients and as the result of both infection and vaccination.

Case Presentation

The first of our patients is a 22-year-old male who was well controlled on ustekinumab for four years. He was unvaccinated when he contracted a COVID-19 infection in December 2020. He developed a severe flare two weeks later that was not responsive to ustekinumab, risankizumab, or secukinumab, which is his current therapy. Further, he had an influenza infection in February 2021, which significantly worsened his flare. To date, his rash remains uncontrolled with plans to change therapy underway.

Next is a 70-year-old COVID-vaccinated male well controlled on apremilast for one year. He contracted a COVID-19 infection in August 2021 and flared one week later on his hands, left greater than right, which was similar to his initial presentation. His flare lasted four weeks and subsided without any additional therapeutic intervention. He had previously been vaccinated against COVID months earlier with no issues and received his booster shot one week prior to this office visit with no further flares.

The third patient is a 40-year-old COVID-vaccinated female with psoriasis refractory to secukinumab. She was then treated with adalimumab with improvement, but her course was then complicated by frequent urinary tract infections and worsening inverse psoriasis at the onset of the COVID pandemic. These isolated issues were managed and resolved with oral antibiotics and topical therapy. Because she was stable, she discontinued her immunobiological therapy due to personal concerns about tumor necrosis factor (TNF)-inhibitor therapy during the pandemic. She remained clear for seven months. Within two weeks of receiving her COVID booster vaccination, her psoriasis and psoriatic arthritis began to flare, with plaques re-appearing on her thighs and forearms, as well as below her breasts, leading to a body surface area (BSA) involvement similar to her refractory period presentations while on secukinumab. Plans to restart a TNF inhibitor are underway.

The fourth patient is a 51-year-old COVID-vaccinated female with longstanding, uncontrolled psoriasis for 20 years. She had been completely clear and stable on risankizumab for 2.5 years. She was infected with COVID despite being vaccinated months prior with no issues and noted her psoriasis began to flare several weeks after becoming infected. Her BSA involvement was limited enough to manage with mid- and high-potency topical corticosteroids.

The last patient is a 34-year-old COVID-vaccinated male who presented with new-onset psoriasis involving his scalp, ankles, knees, hips, and nails within one month of COVID infection. He had previously been vaccinated against COVID months prior to infection with no issues. His case is being successfully managed with topical clobetasol foam and calcipotriene cream. 

Discussion

The hallmark of psoriasis is sustained inflammation led by a T-cell-driven autoimmune response with elevated levels of interleukin (IL)-23, IL-17, and TNF-a [1,3]. Known psoriasis triggers, such as infections, can indirectly affect the interplay of these mediators. Psoriasis has also been associated with higher levels of angiotensin-converting enzyme type 2 (ACE2) than the general population. COVID-19 spike protein has been noted to have a high affinity for ACE2 receptors. This could be a possible causal mechanism of reactivity in the association between psoriasis and COVID-19 infection and vaccination [4].

Vaccination is an uncommon trigger for psoriasis flares. However, there have been reports of psoriasis flares after vaccination for influenza, pneumococcal pneumonia, and yellow fever [1]. With the recent increase in mRNA vaccinations, McMahon et al. studied (N=414) cutaneous reactions after COVID-19 vaccination and found only two cases of psoriasis flares [5]. Wei and colleagues reported seven cases at their institution as well as investigated 79 cases reported in the Vaccine Adverse Events Reporting System. This report, however, did not specify whether patients were controlled on therapy prior to flare. Other studies have also shown that while patients have flared with vaccination, there have not been documented flares among patients on biologic therapy. Rather, this has been assessed and deemed to not be a correlation [6]. The patients observed at our institution, however, flared with infection or vaccination while on current biologic therapy in three out of five cases.

Psoriasis is also known to be triggered by infections. For example, the streptococcal infection has been associated with new-onset or flares of guttate psoriasis, which has been well reported in the literature [7]. A review article by Aram et al. found that flares of psoriasis were common after COVID infection, but these were largely attributed to the use of anti-malarial drugs or discontinuation of immunomodulatory therapy secondary to infection [8]. Our patients, in contrast, flared without the use of these medications or concurrent discontinuation of long-term therapy.

The pandemic has been a cause for irregular dermatological consultations and difficulty obtaining medications, and it has led to significant stress in the lives of many individuals, from social isolation to concerns about employment to the inability to seek medical care in a timely manner [9]. Psoriasis is often triggered by stress, including psychosocial stressors as well as physical stress on the body, which is important to note when addressing flares during the pandemic. However, all of our patients with these flares denied significant life or psychosocial stressors around the time preceding the onset of their psoriasis.

These cases are interesting for several reasons. First, the psoriasis flares noted occurred secondary to both COVID infection and vaccination. This suggests that one’s immune response to the virus is being replicated during vaccination; thus, these psoriatic manifestations are more certainly a result of the immune response rather than a direct viral assault. We, therefore, can likely continue to expect similar skin reactions whether a patient gets infected with COVID or receives the vaccination. Second, reactions happened in both stable, treated patients, as well as undiagnosed patients. It is possible that the hyper-inflammatory state induced by COVID-19 causes an upregulation of previously controlled cytokines, unmasking a genetic predisposition for psoriasis and that treatment with targeted anti-psoriatic systemic medication does not necessarily mitigate this risk.

Conclusions

These cases can serve to raise awareness of issues related to managing stubborn psoriatic flares and bring to the forefront conversations that are likely to arise with our patients regarding the risks and benefits of COVID vaccination and boosters. Further, our cases show that these flares can occur in previously stable patients treated with immunobiologic therapies. While the definitive etiology of the association between COVID and psoriasis remains unclear, it is important that the dermatologic community be aware when evaluating patients with new-onset or worsening psoriasis as we move forward in times of this COVID-19 era, and we urge our colleagues to contribute to the literature surrounding this topic.


References

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COVID Variant That Beats Our Immunity Is Finally Here

Authors: David Axe Updated Oct. 16, 2022

A new subvariant of the novel-coronavirus called XBB dramatically announced itself earlier this week, in Singapore. New COVID-19 cases more than doubled in a day, from 4,700 on Monday to 11,700 on Tuesday—and XBB is almost certainly why. The same subvariant just appeared in Hong Kong, too.

A highly mutated descendant of the Omicron variant of the SARS-CoV-2 virus that drove a record wave of infections starting around a year ago, XBB is in many ways the worst form of the virus so far. It’s more contagious than any previous variant or subvariant. It also evades the antibodies from monoclonal therapies, potentially rendering a whole category of drugs ineffective as COVID treatments.

“It is likely the most immune-evasive and poses problems for current monoclonal antibody-based treatments and prevention strategy,” Amesh Adalja, a public-health expert at the Johns Hopkins Center for Health Security, told The Daily Beast.

That’s the bad news. The good news is that the new “bivalent” vaccine boosters from Pfizer and Moderna seem to work just fine against XBB, even though the original vaccines are less effective against XBB. They won’t prevent all infections and reinfections, but they should significantly reduce the chance of severe infection potentially leading to hospitalization or death. “Even with immune-evasive variants, vaccine protection against what matters most—severe disease—remains intact,” Adalja said.

As the novel-coronavirus evolves to become more contagious and more resistant to certain types of drugs, keeping current on your boosters is “the most impactful thing you can do in preparation for what might come,” Peter Hotez, an expert in vaccine development at Baylor College, told The Daily Beast.

Scientists first identified XBB in August. It’s one of several major subvariants that have evolved from the basic Omicron variant, piling on more and more mutations on key parts of the virus—especially the spike protein, the part of the virus that helps it grab onto and infect our cells.

XBB has at least seven new mutations along the spike. Mutations that, taken together, make the subvariant harder for our immune systems to recognize—and thus more likely to evade our antibodies and enter our cells to cause infection.

This accumulation of mutations isn’t surprising. Changes along the spike protein have characterized most of the major new variants and subvariants of SARS-CoV-2 as the pandemic grinds toward its fourth year.

What is surprising is how much competition XBB has as it fights to become the next dominant form of the novel-coronavirus. Several other Omicron subvariants are also in circulation. All of them are highly evolved. Many of them actually share a subset of key mutations, especially on the spike.

So while XBB appears to be gaining traction in Asia, a close cousin of XBB called BQ.1.1 is spreading fast in Europe and some U.S. states. There are others in contention, too, including BA.2.75.2. Hotez calls these viral cousins the “Scrabble” subvariants, a nod to the classic word game and the jumble of scientific designations of closely related viruses.

The Scrabble variants are indicative of what scientists call “convergent evolution.” That is, separate viral sublineages that are picking up more and more of the same mutations. It’s as though Omicron’s children are all separately learning how to be a better virus than their parent, and becoming more like each other in the process.

Immune-escape is the common quality. At least two of the Scrabble subvariants—XBB and BQ.1.1—are pretty much unrecognizable to existing antibody therapies and somewhat less recognizable to the antibodies produced by the prime doses of the leading messenger-RNA vaccines.

In evading some of our therapies and, to a lesser extent, our original vaccines, XBB and its cousins are showing us where the novel-coronavirus is heading, genetically speaking. The current surge in infections in places like Singapore is a preview of a potential global surge, this coming winter or spring, as XBB or one of its relatives becomes dominant everywhere.

It’s possible to mitigate the worst outcomes. Natural antibodies from past infection are still the best and most durable antibodies. They don’t last forever. But while they do last—a few months or potentially a whole year—the chance of catching a bad case of COVID is pretty low.

So if you had an earlier form of Omicron—say, during the wave of infections that started last Thanksgiving and peaked around February—you might still have good antibodies for a few months. More than enough time to reinforce those fading natural antibodies with a dose of the latest mRNA boosters.

Pfizer and Moderna formulated these new boosters to include some genetic instructions specifically for attacking the BA.5 subvariant of Omicron, which is still the dominant form of SARS-CoV-2 but is disappearing fast as XBB and the other Scrabble subvariants outcompete it.

The bivalent boosters should work pretty well against forms of the virus that are closely related to BA.5, including the Scrabbles. “That is because one of the two components [in the boosters] induces an immune response to BA.5, and most of the new Scrabble variants look more BA.5 like than [the] original China lineage,” Hotez told The Daily Beast.

The implication, of course, is that we’re eventually going to need another new booster in order to keep pace with the fast-evolving virus. Sure, the bivalent boosters work against BA.5 and BA.5’s immediate descendants. But what about the next generation of Omicron subvariants, the one after XBB and its cousins?

More and more health officials are coming around to the idea of an annual COVID booster. U.S. president Joe Biden even endorsed the idea in a statement last month. “As the virus continues to change, we will now be able to update our vaccines annually to target the dominant variant,” Biden said. “Just like your annual flu shot, you should get it sometime between Labor Day and Halloween.”

But one booster a year might not be enough if, as some epidemiologists fear, natural antibodies fade faster and the novel-coronavirus mutates at an accelerating rate. One concern, if it turns out we need twice-a-year new boosters, is whether industry can develop fresh jabs fast enough and health agencies can swiftly approve them.

There’s an even bigger question, however. “The more important factor is just having folks get a more recent booster,” James Lawler, an infectious disease expert at the University of Nebraska Medical Center, told The Daily Beast.

Even if a new booster is available every six months or so, will enough people get it to make a difference in the overall rates of severe illness and death? Booster uptake is declining globally, but especially in the United States, where just 10 percent of people have gotten the bivalent booster since federal regulators approved them in August.

XBB is a nasty little subvariant. But it’s not the final word on COVID. The novel-coronavirus will keep mutating, and finding new ways to evade our antibodies, whether or not many people are paying attention.

The virus isn’t done with us. Which means we can’t be done with it. Get boosted. And be prepared to get boosted again in 2023.

Adverse effects of COVID-19 vaccines and measures to prevent them

Authors: Kenji Yamamoto  Virology Journal volume 19, Article number: 100 (2022) 

Abstract

Recently, The Lancet published a study on the effectiveness of COVID-19 vaccines and the waning of immunity with time. The study showed that immune function among vaccinated individuals 8 months after the administration of two doses of COVID-19 vaccine was lower than that among the unvaccinated individuals. According to European Medicines Agency recommendations, frequent COVID-19 booster shots could adversely affect the immune response and may not be feasible. The decrease in immunity can be caused by several factors such as N1-methylpseudouridine, the spike protein, lipid nanoparticles, antibody-dependent enhancement, and the original antigenic stimulus. These clinical alterations may explain the association reported between COVID-19 vaccination and shingles. As a safety measure, further booster vaccinations should be discontinued. In addition, the date of vaccination should be recorded in the medical record of patients. Several practical measures to prevent a decrease in immunity have been reported. These include limiting the use of non-steroidal anti-inflammatory drugs, including acetaminophen to maintain deep body temperature, appropriate use of antibiotics, smoking cessation, stress control, and limiting the use of lipid emulsions, including propofol, which may cause perioperative immunosuppression. In conclusion, COVID-19 vaccination is a major risk factor for infections in critically ill patients.

Dear Editor,

The coronavirus disease (COVID-19) pandemic has led to the widespread use of genetic vaccines, including mRNA and viral vector vaccines. In addition, booster vaccines have been used, but their effectiveness against the highly mutated spike protein of Omicron strains is limited. Recently, The Lancet published a study on the effectiveness of COVID-19 vaccines and the waning of immunity with time [1]. The study showed that immune function among vaccinated individuals 8 months after the administration of two doses of COVID-19 vaccine was lower than that among unvaccinated individuals. These findings were more pronounced in older adults and individuals with pre-existing conditions. According to the European Medicines Agency’s recommendations, frequent COVID-19 booster shots could adversely affect the immune response and may not be feasible [2]. Several countries, including Israel, Chile, and Sweden, are offering the fourth dose to only older adults and other groups rather than to all individuals [3].

The decrease in immunity is caused by several factors. First, N1-methylpseudouridine is used as a substitute for uracil in the genetic code. The modified protein may induce the activation of regulatory T cells, resulting in decreased cellular immunity [4]. Thereby, the spike proteins do not immediately decay following the administration of mRNA vaccines. The spike proteins present on exosomes circulate throughout the body for more than 4 months [5]. In addition, in vivo studies have shown that lipid nanoparticles (LNPs) accumulate in the liver, spleen, adrenal glands, and ovaries [6], and that LNP-encapsulated mRNA is highly inflammatory [7]. Newly generated antibodies of the spike protein damage the cells and tissues that are primed to produce spike proteins [8], and vascular endothelial cells are damaged by spike proteins in the bloodstream [9]; this may damage the immune system organs such as the adrenal gland. Additionally, antibody-dependent enhancement may occur, wherein infection-enhancing antibodies attenuate the effect of neutralizing antibodies in preventing infection [10]. The original antigenic sin [11], that is, the residual immune memory of the Wuhan-type vaccine may prevent the vaccine from being sufficiently effective against variant strains. These mechanisms may also be involved in the exacerbation of COVID-19.

Some studies suggest a link between COVID-19 vaccines and reactivation of the virus that causes shingles [1213]. This condition is sometimes referred to as vaccine-acquired immunodeficiency syndrome [14]. Since December 2021, besides COVID-19, Department of Cardiovascular Surgery, Okamura Memorial Hospital, Shizuoka, Japan (hereinafter referred to as “the institute”) has encountered cases of infections that are difficult to control. For example, there were several cases of suspected infections due to inflammation after open-heart surgery, which could not be controlled even after several weeks of use of multiple antibiotics. The patients showed signs of being immunocompromised, and there were a few deaths. The risk of infection may increase. Various medical algorithms for evaluating postoperative prognosis may have to be revised in the future. The media have so far concealed the adverse events of vaccine administration, such as vaccine-induced immune thrombotic thrombocytopenia (VITT), owing to biased propaganda. The institute encounters many cases in which this cause is recognized. These situations have occurred in waves; however, they are yet to be resolved despite the measures implemented to routinely screen patients admitted for surgery for heparin-induced thrombocytopenia (HIT) antibodies. Four HIT antibody-positive cases have been confirmed at the institute since the start of vaccination; this frequency of HIT antibody-positive cases has rarely been observed before. Fatal cases due to VITT following the administration of COVID-19 vaccines have also been reported [15].

As a safety measure, further booster vaccinations should be discontinued. In addition, the date of vaccination and the time since the last vaccination should be recorded in the medical record of patients. Owing to the lack of awareness of this disease group among physicians and general public in Japan, a history of COVID-19 vaccination is often not documented, as it is in the case of influenza vaccination. The time elapsed since the last COVID-19 vaccination may need to be considered when invasive procedures are required. Several practical measures that can be implemented to prevent a decrease in immunity have been reported [16]. These include limiting the use of non-steroidal anti-inflammatory drugs, including acetaminophen, to maintain deep body temperature, appropriate use of antibiotics, smoking cessation, stress control, and limiting the use of lipid emulsions, including propofol, which may cause perioperative immunosuppression [17].

To date, when comparing the advantages and disadvantages of mRNA vaccines, vaccination has been commonly recommended. As the COVID-19 pandemic becomes better controlled, vaccine sequelae are likely to become more apparent. It has been hypothesized that there will be an increase in cardiovascular diseases, especially acute coronary syndromes, caused by the spike proteins in genetic vaccines [1819]. Besides the risk of infections owing to lowered immune functions, there is a possible risk of unknown organ damage caused by the vaccine that has remained hidden without apparent clinical presentations, mainly in the circulatory system. Therefore, careful risk assessments prior to surgery and invasive medical procedures are essential. Randomized controlled trials are further needed to confirm these clinical observations.

In conclusion, COVID-19 vaccination is a major risk factor for infections in critically ill patients.

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More people are catching coronavirus a second time, heightening long COVID risk, experts say

Authors: Rong-Gong Lin II, Luke Money Mon, August 1, 2022  LA Times

Emerging evidence suggests that catching the coronavirus a second time can heighten long-term health risks, a worrisome development as the circulation of increasingly contagious Omicron subvariants leads to greater numbers of Californians being reinfected.

Earlier in the pandemic, it was assumed that getting infected afforded some degree of lasting protection, for perhaps a few months.

As the coronavirus mutates, though, that’s no longer a given. And each individual infection carries the risk not only for acute illness but the potential to develop long COVID.

“The additive risk is really not trivial, not insignificant. It’s really substantial,” said Dr. Ziyad Al-Aly, clinical epidemiologist at Washington University in St. Louis and chief of research and development at the Veterans Affairs Saint Louis Healthcare System.

According to a preprint study examining U.S. veterans, of which Al-Aly was the lead author, getting infected twice or more “contributes to additional risks of all-cause mortality, hospitalization and adverse health outcomes” in various organ systems, and can additionally worsen risk for diabetes, fatigue and mental health disorders.

“Reinfection absolutely adds risk,” Al-Aly said. The study suggested that, compared with those infected only once, individuals who caught the coronavirus a second time were at 2½ times greater risk of developing heart or lung disease and blood clotting issues. Subsequent infections also were associated with a higher risk of potentially serious health problems, as well as death from COVID-19.

It’s possible that a repeat coronavirus infection will leave someone just fine, which is what happens to most people, Al-Aly said. “But you might be one of the unlucky ones and … get some really serious health problem with an infection.”

Los Angeles County Public Health Director Barbara Ferrer recently cited Al-Aly’s pre-print study as rationale for wearing masks in indoor public settings to avoid reinfection.

“They also saw that those with repeat infections had a higher risk of gastrointestinal, kidney, mental health, musculoskeletal and neurologic disorders, as well as diabetes,” Ferrer said of the study. “Moreover, the risk of developing a long-term health problem increased further with each reinfection. The risk of having long-term health conditions was three times higher for those infected compared to those who were uninfected.”

Older viruses, such as those that cause measles and chickenpox, are quite stable — meaning that the vaccinations are highly effective and surviving either illness typically confers lifelong immunity.

Not so with the coronavirus, which has mutated wildly since the pandemic began. Someone who got infected with the variant that dominated California in late 2020, for instance, was vulnerable to catching the Delta variant the following summer. And those who survived Delta faced the risk of catching the later Omicron variant.

But the reinfection landscape has been upended even further as California has been walloped with a family of increasingly transmissible Omicron subvariants. The most recent of those, BA.5, has shown particular proficiency for reinfection — with the ability to target even those who survived an earlier Omicron case mere weeks before.

“This concept of building immunity, it really only works if you’re encountering the same beast again and again and again,” Al-Aly said. But in the world of COVID-19, BA.5 is actually a “very different beast” than earlier variants.

It’s possible that the acute phase of a second bout of COVID-19 could be milder than the first. But a subsequent attack can still leave more extensive cumulative damage to the body than if there had been only one infection.

Think of coronavirus infections like earthquake sequences: It’s possible an aftershock could be less severe than the first temblor but cumulatively could add more damage. And just because your home is still standing after one quake doesn’t mean you shouldn’t explore ways to make it seismically safer.

“Part of the reason why things, for many people, feel like they’re not so bad right now is because we are being very aggressive in countering the virus with vaccines, with treatments,” Dr. Ashish Jha, the White House COVID-19 response coordinator, said during a healthcare summit hosted by the Hill. “If we took our foot off the pedal, we’re going to see this virus come back in a way that’s much more dangerous. So we’ve got to stay on that front footing and continue fighting this thing.”

As it relates specifically to long COVID — a condition in which symptoms can persist months or even years after an initial infection — getting vaccinated and boosted likely reduces risk, but studies differ as to the degree of protection.

“I think having some preexisting immunity — whether it’s natural or from a vaccine — appears to reduce your risk of long COVID, but it’s still there. It’s not zero,” said Dr. Steven Deeks, a professor of medicine at UC San Francisco and principal investigator of the Long-term Impact of Infection With Novel Coronavirus, or LIINC, study.

Another report, observing triple-vaccinated Italian healthcare workers who weren’t hospitalized for COVID-19, found that two or three doses of vaccine were associated with a lower prevalence of long COVID.

A separate report suggested that even adults who had received a booster dose still have to consider the risk of long COVID. A British report said that, during the initial Omicron wave, about 1 in every 25 triple-vaccinated adults self-reported having long COVID three to four months after their first infection.

Still, some clinicians say that long COVID sufferers tend to be either unvaccinated or missing their boosters.

“The number of patients I’m seeing who were vaccinated and boosted who are coming in with long COVID is very low,” said Dr. Nisha Viswanathan, director of the UCLA Health Long COVID Program.

Long COVID also doesn’t prevent you from becoming infected with the coronavirus again. Viswanathan said she’s had patients who have seen their long COVID symptoms improve, then get sickened with another bout of COVID-19, and then see long COVID signs return.

The best way to prevent long COVID is to not get COVID-19. Many officials and experts cite non-pharmaceutical interventions such as masking as key tools, since vaccinations reduce, but do not entirely eliminate, the risk.

Masking is not a terrible thing to ask of people, especially in probably the places that are the most crowded, and the places that maybe are the highest risk of transmission,” Viswanathan said. Taking activities outside is also safer than being unmasked indoors.

Some of Viswanathan’s patients have downplayed the risk of COVID-19, commenting how it’s become a mild illness, and adding they don’t see the point of taking precautions. But, she said, better knowledge about long COVID and its disabling effects would help people understand the importance of masking and getting vaccinated and boosted.

A UCLA study published in the Journal of General Internal Medicine, of which Viswanathan was a co-author, found that of 1,038 patients with symptomatic COVID-19 between April 2020 and February 2021, nearly 30% developed long COVID. The most common symptoms were fatigue and shortness of breath among hospitalized patients.

While many are weary of COVID-19 preventive measures after nearly two and a half years, they remain important, said Dr. Anne Foster, vice president and chief clinical strategy officer for the University of California Health system.

The burden of long COVID following this wave is unknown. The official case tallies are likely vast undercounts, given that so many at-home tests are being used, and that could suggest that the burden of long COVID in subsequent months will be hard to predict, Foster said.

“I know everyone has moved on and people are going back to the way things were, and I sort of get it,” Deeks said. “But people do need to be aware that there is this additional risk that’s not going away and they might adjust their lives accordingly.

“But everyone’s going to figure this out on their own.”

Adverse effects of COVID-19 vaccines and measures to prevent them

Authors: Kenji Yamamoto Virol J. 2022; 19: 100. Published online 2022 Jun 5. doi: 10.1186/s12985-022-01831-0 PMCID: PMC9167431PMID: 35659687

Abstract

Recently, The Lancet published a study on the effectiveness of COVID-19 vaccines and the waning of immunity with time. The study showed that immune function among vaccinated individuals 8 months after the administration of two doses of COVID-19 vaccine was lower than that among the unvaccinated individuals. According to European Medicines Agency recommendations, frequent COVID-19 booster shots could adversely affect the immune response and may not be feasible. The decrease in immunity can be caused by several factors such as N1-methylpseudouridine, the spike protein, lipid nanoparticles, antibody-dependent enhancement, and the original antigenic stimulus. These clinical alterations may explain the association reported between COVID-19 vaccination and shingles. As a safety measure, further booster vaccinations should be discontinued. In addition, the date of vaccination should be recorded in the medical record of patients. Several practical measures to prevent a decrease in immunity have been reported. These include limiting the use of non-steroidal anti-inflammatory drugs, including acetaminophen to maintain deep body temperature, appropriate use of antibiotics, smoking cessation, stress control, and limiting the use of lipid emulsions, including propofol, which may cause perioperative immunosuppression. In conclusion, COVID-19 vaccination is a major risk factor for infections in critically ill patients.

COVID Vaccines Increase Adverse Events and Weaken The Immune System

The coronavirus disease (COVID-19) pandemic has led to the widespread use of genetic vaccines, including mRNA and viral vector vaccines. In addition, booster vaccines have been used, but their effectiveness against the highly mutated spike protein of Omicron strains is limited. Recently, The Lancet published a study on the effectiveness of COVID-19 vaccines and the waning of immunity with time [1]. The study showed that immune function among vaccinated individuals 8 months after the administration of two doses of COVID-19 vaccine was lower than that among unvaccinated individuals. These findings were more pronounced in older adults and individuals with pre-existing conditions. According to the European Medicines Agency’s recommendations, frequent COVID-19 booster shots could adversely affect the immune response and may not be feasible [2]. Several countries, including Israel, Chile, and Sweden, are offering the fourth dose to only older adults and other groups rather than to all individuals [3].

The decrease in immunity is caused by several factors. First, N1-methylpseudouridine is used as a substitute for uracil in the genetic code. The modified protein may induce the activation of regulatory T cells, resulting in decreased cellular immunity [4]. Thereby, the spike proteins do not immediately decay following the administration of mRNA vaccines. The spike proteins present on exosomes circulate throughout the body for more than 4 months [5]. In addition, in vivo studies have shown that lipid nanoparticles (LNPs) accumulate in the liver, spleen, adrenal glands, and ovaries [6], and that LNP-encapsulated mRNA is highly inflammatory [7]. Newly generated antibodies of the spike protein damage the cells and tissues that are primed to produce spike proteins [8], and vascular endothelial cells are damaged by spike proteins in the bloodstream [9]; this may damage the immune system organs such as the adrenal gland. Additionally, antibody-dependent enhancement may occur, wherein infection-enhancing antibodies attenuate the effect of neutralizing antibodies in preventing infection [10]. The original antigenic sin [11], that is, the residual immune memory of the Wuhan-type vaccine may prevent the vaccine from being sufficiently effective against variant strains. These mechanisms may also be involved in the exacerbation of COVID-19.

Some studies suggest a link between COVID-19 vaccines and reactivation of the virus that causes shingles [1213]. This condition is sometimes referred to as vaccine-acquired immunodeficiency syndrome [14]. Since December 2021, besides COVID-19, Department of Cardiovascular Surgery, Okamura Memorial Hospital, Shizuoka, Japan (hereinafter referred to as “the institute”) has encountered cases of infections that are difficult to control. For example, there were several cases of suspected infections due to inflammation after open-heart surgery, which could not be controlled even after several weeks of use of multiple antibiotics. The patients showed signs of being immunocompromised, and there were a few deaths. The risk of infection may increase. Various medical algorithms for evaluating postoperative prognosis may have to be revised in the future. The media have so far concealed the adverse events of vaccine administration, such as vaccine-induced immune thrombotic thrombocytopenia (VITT), owing to biased propaganda. The institute encounters many cases in which this cause is recognized. These situations have occurred in waves; however, they are yet to be resolved despite the measures implemented to routinely screen patients admitted for surgery for heparin-induced thrombocytopenia (HIT) antibodies. Four HIT antibody-positive cases have been confirmed at the institute since the start of vaccination; this frequency of HIT antibody-positive cases has rarely been observed before. Fatal cases due to VITT following the administration of COVID-19 vaccines have also been reported [15].

As a safety measure, further booster vaccinations should be discontinued. In addition, the date of vaccination and the time since the last vaccination should be recorded in the medical record of patients. Owing to the lack of awareness of this disease group among physicians and general public in Japan, a history of COVID-19 vaccination is often not documented, as it is in the case of influenza vaccination. The time elapsed since the last COVID-19 vaccination may need to be considered when invasive procedures are required. Several practical measures that can be implemented to prevent a decrease in immunity have been reported [16]. These include limiting the use of non-steroidal anti-inflammatory drugs, including acetaminophen, to maintain deep body temperature, appropriate use of antibiotics, smoking cessation, stress control, and limiting the use of lipid emulsions, including propofol, which may cause perioperative immunosuppression [17].

To date, when comparing the advantages and disadvantages of mRNA vaccines, vaccination has been commonly recommended. As the COVID-19 pandemic becomes better controlled, vaccine sequelae are likely to become more apparent. It has been hypothesized that there will be an increase in cardiovascular diseases, especially acute coronary syndromes, caused by the spike proteins in genetic vaccines [1819]. Besides the risk of infections owing to lowered immune functions, there is a possible risk of unknown organ damage caused by the vaccine that has remained hidden without apparent clinical presentations, mainly in the circulatory system. Therefore, careful risk assessments prior to surgery and invasive medical procedures are essential. Randomized controlled trials are further needed to confirm these clinical observations.

In conclusion, COVID-19 vaccination is a major risk factor for infections in critically ill patients.

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Duration of Shedding of Culturable Virus in SARS-CoV-2 Omicron (BA.1) Infection

Authors: Julie Boucau, Ph.D. Caitlin Marino, B.S. Ragon Institute, Cambridge, MA

James Regan, B.S. Brigham and Women’s Hospital, Boston, MA Rockib Uddin, B.S.
Massachusetts General Hospital, Boston, MA Manish C. Choudhary, Ph.D.
James P. Flynn, B.S. Brigham and Women’s Hospital, Boston, MA Geoffrey Chen, B.A.
Ashley M. Stuckwisch, B.S. Josh Mathews, A.B. May Y. Liew, B.A. Arshdeep Singh, B.S.
Taryn Lipiner, M.P.H. Massachusetts General Hospital, Boston, MA Autumn Kittilson, B.S. Meghan Melberg, B.S. Yijia Li, M.D. Brigham and Women’s Hospital, Boston, MARebecca F. Gilbert, B.A. Zahra Reynolds, M.P.H. Surabhi L. Iyer, B.A. Grace C.Chamberlin, B.A. Tammy D. Vyas, B.S. Marcia B. Goldberg, M.D.Jatin M. Vyas, M.D., Ph.D.Massachusetts General Hospital, Boston, MAJonathan Z. Li, M.D.Brigham and Women’s Hospital, Boston, MA Jacob E. Lemieux, M.D., D.Phil. Mark J. Siedner, M.D., M.P.H.Amy K. Barczak, M.D.Massachusetts General Hospital, Boston, MA

July 21, 2022 N Engl J Med 2022; 387:275-277 DOI: 10.1056/NEJMc2202092

The B.1.1.529 (omicron) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a shorter incubation period and a higher transmission rate than previous variants.1,2 Recently, the Centers for Disease Control and Prevention recommended shortening the strict isolation period for infected persons in non–health care settings from 10 days to 5 days after symptom onset or after the initial positive test, followed by 5 days of masking.3 However, the viral decay kinetics of the omicron variant and the duration of shedding of culturable virus have not been well characterized.

We used longitudinal sampling of nasal swabs for determination of viral load, sequencing, and viral culture in outpatients with newly diagnosed coronavirus disease 2019 (Covid-19).4 From July 2021 through January 2022, we enrolled 66 participants, including 32 with samples that were sequenced and identified as the B.1.617.2 (delta) variant and 34 with samples that were sequenced and identified as the omicron subvariant BA.1, inclusive of sublineages. Participants who received Covid-19–specific therapies were excluded; all but 1 participant had symptomatic infection. This study was approved by the institutional review board and the institutional biosafety committee at Mass General Brigham, and informed consent was obtained from all the participants. Figure 1.Viral Decay and Time to Negative Viral Culture.

The characteristics of the participants were similar in the two variant groups except that more participants with omicron infection had received a booster vaccine than had those with delta infection (35% vs. 3%) (Tables S1 and S2 in the Supplementary Appendix, available with the full text of this letter at NEJM.org). In an analysis in which a Cox proportional-hazards model that adjusted for age, sex, and vaccination status was used, the number of days from an initial positive polymerase-chain-reaction (PCR) assay to a negative PCR assay (adjusted hazard ratio, 0.61; 95% confidence interval [CI], 0.33 to 1.15) and the number of days from an initial positive PCR assay to culture conversion (adjusted hazard ratio, 0.77; 95% CI, 0.44 to 1.37) were similar in the two variant groups (Figure 1A through 1C and S1 through S3, and Tables S3 through S5). The median time from the initial positive PCR assay to culture conversion was 4 days (interquartile range, 3 to 5) in the delta group and 5 days (interquartile range, 3 to 9) in the omicron group; the median time from symptom onset or the initial positive PCR assay, whichever was earlier, to culture conversion was 6 days (interquartile range, 4 to 7) and 8 days (interquartile range, 5 to 10), respectively. There were no appreciable between-group differences in the time to PCR conversion or culture conversion according to vaccination status, although the sample size was quite small, which led to imprecision in the estimates (Figure 1D and 1E).

In this longitudinal cohort of participants, most of whom had symptomatic, nonsevere Covid-19 infection, the viral decay kinetics were similar with omicron infection and delta infection. Although vaccination has been shown to reduce the incidence of infection and the severity of disease, we did not find large differences in the median duration of viral shedding among participants who were unvaccinated, those who were vaccinated but not boosted, and those who were vaccinated and boosted.

Our results should be interpreted within the context of a small sample size, which limits precision, and the possibility of residual confounding in comparisons according to variant, vaccination status, and the time period of infection. Although culture positivity has been proposed as a possible proxy for infectiousness,5 additional studies are needed to correlate viral-culture positivity with confirmed transmission in order to inform isolation periods. Our data suggest that some persons who are infected with the omicron and delta SARS-CoV-2 variants shed culturable virus more than 5 days after symptom onset or an initial positive test.

New England Journal of Medicine: “Conspiracy Theory” confirmed

The America First Report breaks the story: July 12, 2022

Several recent studies have indicated the Covid-19 vaccines actually increase the risk of contracting the disease over time, but these studies have been ignored or even debunked by corporate media and Big Pharma for months. Now, they’ll have to contend with a new study published in the highly respected New England Journal of Medicine.

This study was huge in scale, sifting through data collected from over 100,000 people infected by the Omicron variant. It lends credibility to the statistical significance of the findings, which are absolutely startling. Here are the key points:

  • Those who have been “fully vaccinated” with two shots from Moderna or Pfizer are more likely to contract Covid-19 than those who have not been vaccinated at all
  • Booster shots offer protection approximately equal to natural immunity, but the benefits wane after 2-5 months
  • Natural immunity lasts for at least 300-days, which is the length of the study; it likely lasts much longer

This jibes with the current narrative coming from Big Pharma and their minions in government and corporate media that the jabs are supposed to mitigate the effects. But even that claim has been called into question as recent studies indicate the vaccinated may be dying even more than the unvaccinated. According to The Exposé:

The Government of Canada has confirmed that the vaccinated population account for 4 in every 5 Covid-19 deaths to have occurred across the country since the middle of February 2022, and 70% of those deaths have been among the triple vaccinated population.

Despite the scope of the study and the credibility of the source, it will not receive any attention from corporate media. It is imperative that our readers get the word out because this is an absolute narrative-buster for Big Pharma. Now more than ever, we must alert the people of the truth because we are on the verge of seeing millions of children under the age of five-years-old injected.

Children do not readily acquire this pathogen, spread to other children, spread to adults, take it home, get severely ill, or die from it. It is that simple. We know children tend not to transmit Covid-19 virus and that the concept of asymptomatic spread has been questioned severely, particularly for children.

Children, if infected, just do not spread Covid-19 to others readily, either to other children, other adults in their families or otherwise, nor to their teachers. This was demonstrated elegantly in a study performed in the French Alps. The pediatric literature is clear science on this. Overwhelming data shows that the SARS-CoV-2-associated burden of severe disease or death in children and adolescents is very low (statistically zero).

Swedish data by Ludvigsson reported on the 1,951,905 children in Sweden (as of December 31, 2020) who were 1 to 16 years of age who attended school with largely no lockdowns or masks. They found zero (0) deaths. “Despite Sweden’s having kept schools and preschools open, we found a low incidence of severe Covid-19 among schoolchildren and children of preschool age during the SARS-CoV-2 pandemic.”

recent German study (collating evidence from three sources 1) a national seroprevalence study (the SARSCoV-2 KIDS study), 2) the German statutory notification system and 3) a nationwide registry on children and adolescents hospitalized with either SARS-CoV-2 or Pediatric Inflammatory Multisystem Syndrome (PIMS-TS)) reported that there were zero (0) deaths in children 5 to 18 years old across the period of study.

Governments and public health officials have driven this pandemic of fear and propaganda. But parents willing to assess this purely from a benefit versus risk position might ask themselves: ‘If my child has little if any risk, near zero risk of severe sequelae or death, and thus no benefit from the vaccine, yet there could be potential harms and as yet unknown harms from the vaccine (as already reported in adults who have received the vaccines), then why would I subject my child to such a vaccine?

Because the life of your child (or yourself) is a price the purveyors of this genocide are entirely willing to pay in exchange for a nice, fat paycheck.

Comport yourselves accordingly.

Study: Natural Immunity Is 97 Percent Effective Against Severe COVID After 14 Months

Authors: Susan Berry, PhD | Star News Jul 15, 2022

A study has found that natural immunity following COVID infection provides protection against severe illness that is superior to that imparted by the COVID vaccines.

In a preprint article published at MedRxiv, Qatar researchers revealed they found people who survived COVID-19 infection, and were not vaccinated, had outstanding protection against severe COVID disease or death from COVID.

“Effectiveness of primary infection against severe, critical, or fatal COVID-19 reinfection was 97.3% … irrespective of the variant of primary infection or reinfection, and with no evidence for waning,” the researchers noted. “Similar results were found in sub-group analyses for those ≥50 years of age.”

The study, which was conducted on the total population of Qatar, set out to answer three questions:

  • 1) When infected with a pre-Omicron variant, how long does protection persist against reinfection with pre-Omicron variants?
  • 2) When infected with a pre-Omicron variant, how long does protection persist against reinfection with an Omicron subvariant?
  • 3) When infected with any variant, how long does protection persist against severe, critical, or fatal COVID-19?

“Despite waning protection against reinfection, strikingly, there was no evidence for waning of protection against severe COVID-19 at reinfection,” the researchers found. “This remained ∼100%, even 14 months after the primary infection, with no appreciable effect for Omicron immune evasion in reducing it.”

Just days after the release of the study, White House COVID-19 Advisor Dr. Anthony Fauci admitted it is “clear from the data” the COVID vaccines government health officials have been pushing do not actually work well in preventing the infection.

“One of the things that’s clear from the data,” Fauci told Fox News host Neil Cavuto of Your World Tuesdayis that the vaccines, “because of the high degree of transmissibility of this virus – don’t protect overly well, as it were, against infection.”

But Fauci then quickly moved on from his admission to assert the vaccines still “protect quite well against severe disease leading to hospitalization and death”:

And I believe that’s the reason, Neil, why at my age, being vaccinated and boosted, even though it didn’t protect me against infection, I feel confident that it made a major role in protecting me from progressing to severe disease. And that’s very likely why I had a relatively mild course.

“So, my message to people who seem confused because people who are vaccinated get infected – the answer is if you weren’t vaccinated, the likelihood [is] you would have had [a] more severe course than you did have when you were vaccinated,” he said.

Fauci insisted “we’re certainly not over” the pandemic, and asserted many Americans are not making use of the “available interventions,” namely, the COVID vaccines:

Let me give you an example. 67% of the people in this country are vaccinated. We rank very low among developed and developing nations in the proportion that are vaccinated of those who were vaccinated. Only about half of them have gotten their first boost. Again, we’ve got to do better than that. We’re giving the virus the opportunity to continue to spread in our community. And if we do simple things, which are not disruptive in any major way, vaccination, boosting, testing, for example, if you’re going to go to a function, you want to get tested to make sure you’re negative so that if you are infected and you have minimal symptoms, you don’t spread it.

“Those are relatively easy things to do, Neil, and yet we’re not doing enough of it,” Fauci complained.

The confusing narrative is addressed in a new soon-to-be-released film.

Vaccine Choice Canada provides links to several trailers to Uninformed Consent, a documentary that investigates the COVID-19 narrative people continue to hear from government officials in many countries.

The exclusive worldwide premiere of Uninformed Consent, will take place one night only on July 23. Viewers will also have the opportunity to participate in an interactive Q & A with the creators, producers, and doctors behind the documentary.

“This film explores our recent loss of human rights while weaving in the devastating impact of mandates and the deeply powerful story of one man’s loss,” Vaccine Choice Canada writes. “Hear the truth from doctors and scientists unafraid to stand up against Big Pharma and the Elite Class who profit from these mandates

New Study Contradicts ‘Experts’ – Shows Unvaccinated Adults Found “No increase in Myocarditis and Pericarditis” Following COVID Infection

Authors:  Jim Hoft July 8, 2022 Gateway Pundit

A new study from Israel reveals that there was “no increase in the incidence of myocarditis and pericarditis” in unvaccinated adults who had COVID-19 infection.

This contradicts the findings of earlier studies that suggested there may be a connection between cardiac inflammation and coronavirus infections.

In a study published in the Journal of Clinical Medicine, the researchers concluded that there is “no increase in the incidence of myocarditis and pericarditis in COVID-19 recovered patients compared to uninfected matched controls.”

“Myocarditis and pericarditis are potential post-acute cardiac sequelae of COVID-19 infection, arising from adaptive immune responses,” the study stated. “We aimed to study the incidence of post-acute COVID-19 myocarditis and pericarditis.”

A total of 787,968 Clalit Health Services adult members were included in the study between March 2020 and January 2021. Out of that total, 196,992 adults were found to be infected with the COVID-19 virus (16,632 adults with previous vaccination were excluded from the group).

The control cohort of 590,976 adults with no Covid were age- and sex-matched, according to the study (5 adults with previous vaccination were excluded from the group).

“Nine post-COVID-19 patients developed myocarditis (0.0046%), and eleven patients were diagnosed with pericarditis (0.0056%). In the control cohort, 27 patients had myocarditis (0.0046%) and 52 had pericarditis (0.0088%),” the study stated.

“In the current large population study of subjects, who were not vaccinated against SARS-CoV-2, we observed no increase in the incidence of myocarditis or pericarditis from day 10 after positive SARS-CoV-2.”

The researchers went on and stated, “Multivariable analysis did show male sex as associated with a higher risk of developing myocarditis or pericarditis, regardless of previous COVID-19 infection.”

Delta reinfection risk low among unvaccinated children

But scientists warn that the findings do not mean that children should not be vaccinated against COVID-19.

Authors: Heidi Ledford July 4, 2022 NATURE

Children and adolescents who had not been vaccinated against COVID-19 mounted a long-lasting immune response to infection with the Delta variant of the coronavirus SARS-CoV-2, according to a large study of Israeli health records1. The study, which has been published as a preprint on medRxiv, has not yet been peer reviewed.

A year and a half after an infection, the resulting immune response was still about 80% effective at preventing reinfection, the study found. But it isn’t clear how the results will translate to infections by coronavirus variants of the Omicron lineage, which is now dominant in many countries. “There is a much less-robust immune response to Omicron among previously infected and/or vaccinated individuals,” says Yvonne Maldonado, chief of paediatric infectious diseases at Stanford School of Medicine in California. “Such immune responses are also significantly less durable.”

Even so, the study — which includes data from about 300,000 children and adolescents — is a welcome addition to the relatively small pool of knowledge about immune responses to SARS-CoV-2 in children, says paediatrician Nigel Crawford at the Murdoch Children’s Research Institute in Melbourne, Australia, who studies vaccinology. “They’re a group for which we haven’t seen a huge amount of data to date,” he says.

When Delta dominated

The study’s authors collected data on coronavirus infections from Maccabi Healthcare Services, an Israeli health-insurance plan. They focused on the risk of infection from 1 July to 13 December 2021, when the Delta variant was dominant in Israel.

The team found that unvaccinated children and adolescents were 89% less likely to be infected with SARS-CoV-2 3–6 months after their first infection than were children who had not previously been infected. For the 12–18 age group, this protection against reinfection dropped to 82.5% from 9 months to a year after infection and remained at around that level until up to 18 months post-infection.

Children aged 5–11, however, maintained the same level of protection. That, says Crawford, could fit with observations that young children often experience milder COVID-19 than do adolescents and adults.

The study authors are now working to collect data on Omicron infections, but that analysis will be more difficult because many people in Israel switched from PCR tests to at-home rapid antigen testing in December 2021. This means that fewer positive test results have since been reported in electronic health records.

Overall, the study design is robust, says clinical data scientist Hossein Estiri at Harvard Medical School in Boston, Massachusetts. He notes that some Twitter users have picked up on the preprint and are touting it as evidence that children who have had SARS-CoV-2 infections do not need to be vaccinated. But Estiri says it’s not clear from the study how well protection from natural infection stacks up to that from vaccines, because the researchers did not include a head-to-head comparison. “This study doesn’t say that those children don’t need to be vaccinated.”

Don’t discount vaccines

And because severe COVID-19 is rare in children, the study could not make strong conclusions about protection from serious illness and hospitalization. “We know that a lot of vaccine efficacy is against severe disease,” he says.

In addition, Crawford notes that people who have both been vaccinated and had a SARS-CoV-2 infection often experience a super-charged immune response compared with those who have had only a vaccine or infection. “You wouldn’t want to rely purely on infection alone for immunity,” he says. “We have no idea what the next wave will bring.”