Navigating the Tripledemic: JN.1, RSV, and Flu Update

The respiratory viruses are out there. Wastewater viral activity levels for COVID-19, as reported by the Centers for Disease Control and Prevention, have reached the highest point since the Omicron surge in 2022. The levels are also high in Canada. The three primary respiratory illnesses continue to circulate at very high levels. But despite the triple threat of SARS-Cov-2, respiratory syncytial virus (RSV) and the flu, there is a notable lack of community attention.

 JN.1 (Pirola, BA.2.86, with additional L455S mutation, descending from a de-escalated variant of concern BA.2), initially detected on August 25 2023, has evolved from a variant under monitoring to a variant of interest.

Variants like Acrux (XBB.2.3, that began to spread worldwide soon after WHO declared the end of the pandemic) are no longer relevant, but a few now less prevalent variants such as Centaurus (BA.2.75) and XBB, a hybrid of Centaurus with BA.2 lineage, that gave rise to Eris, its descendant HV.1 and FLips) are still among variants of interest.  

JN.1 has become the predominant global variant, gaining prevalence in the US, Europe and surging in Asia. Recent updates from CanadaFinlandBelgiumAustralia, and India confirm this trend. Symptoms of this variant, such as anxiety, sleep disturbances, and sore throat, are becoming increasingly prominent. Unlike other Omicron sublineages, Jn.1 and BA.2.86 enter Calu-3 lung cells with high efficiency and in a serine- but not cysteine-protease-dependent manner. Projections indicate an expected excess mortality of approximately 13%-20% in January-February linked to JN.1. (Stay informed on the latest variant proportions in the US by referring to this link).

JN.1 and BA.2.86, the precursor to JN.1, currently hold the position of the most prevalent variant among travelers, in wastewater, and according to projected testing data. Since its initial detection in the US in September, JN.1 has undergone a rapid surge, escalating from 3.5% of COVID cases in mid-November to over 21% by December, as per estimates from the CDC.

Prominent figures, including Howard Stern, have encountered breakthrough COVID-19 for the first time this season. Stern, despite being vaccinated and acknowledging the vaccine's efficacy, highlighted the severity of his illness. Anecdotal reports on social media  raise concerns concerns about the potential for more severe repeat infections, prompting discussions on long-term implications.

New hospital admissions have surged by 42% in nearly 50 countries, with the highest increases observed in Europe and the Americas. Intensive care unit admissions have seen an even steeper rise, with a 62% increase compared to the figures reported in November. 

Over a thousand Americans are dying from COVID each week, which is ten times the number of deaths caused by the flu. Weekly deaths are at a high point. In 2023, deaths from all causes were slightly lower than in 2022 for the first half of the year. However, 10,000 people across the U.S. died from COVID in November and December, with 10,000 deaths worldwide in December alone, and data for the end of the year is still pending compilation, leaving room for surprises.

The Wikipedia list of list of celebrities who succumbed to COVID-19 in December 2023 and January 2024 includes notable individuals. Some, like Derek Draper, died from Long COVID, a condition they had been grappling with since their initial infection in 2020.

7 December 2023Sang Guowei82PoliticianChina
11 December 2023Ken Kelsch76CinematographerUnited States (Hackettstown, NJ)
12 December 2023Mario Valdemarin96ActorItaly (Rome)
13 December 2023Yılmaz Atadeniz91Film directorTurkey (Istanbul)
24 December 2023Vasilis Karras70SingerGreece (Thessaloniki)
28 December 2023Vijayakanth71Actor and politicianIndia (ChennaiTamil Nadu)
2 January 2024Noel Aguirre63politician, economist and academicBolivia
Chris Karrer76guitarist and composerGermany (KemptenBavaria)
3 January 2024Derek Draper56lobbyist and political adviserEngland (ChorleyLancashire)

Not featured on this list is Denny Laine, the English singer/songwriter and co-founder of both The Moody Blues and Wings, who passed away on December 5, 2023, at the age of 79. Laine had been dealing with serious health concerns, including ILD, after contracting COVID-19 in 2022. Alec Musser, best known for playing Del Henry on All My Children, passed away on January 12, 2024, at the age of 501. His fiancée, Paige Press, suspects that COVID-19 contributed. Another individual, Laura Lee Fisher Mattern Brooks, passed away in the early morning of December 5 after spending over two weeks in ICU due to complications with Covid.

Two children died in Kentucky in January, one from one from influenza and the other from COVID-19. Neither child had been immunized against the viruses that caused their deaths. In Russian Saint Petersburg, a 2-year-old died from stroke caused by COVID-19. 

Recent study findings indicate that while pandemic waves correlated with beta-coronaviruses' seasonality, there is no clear or consistent evidence that the stringency of NPIs (non-pharmaceutical interventions) or vaccination significantly reduced the pandemic's progression. Despite the demonstrated effectiveness of Paxlovid treatment in managing acute COVID-19 among high-risk unvaccinated individuals, it does not mitigate the risk of Long COVID for vaccinated, non-hospitalized individuals experiencing their first COVID-19 infection.


REFERENCES

https://www.msn.com/en-us/entertainment/news/what-is-interstitial-lung-disease-denny-laine-cause-of-death-explored-as-moody-blues-co-founder-dies-aged-79/ar-AA1l4ttJ

https://www.gofundme.com/f/denny-laine-Final-medical-expenses-funeral

https://www.theguardian.com/music/2023/dec/05/denny-laine-star-musician-with-moody-blues-and-wings-dies-aged-79

https://en.wikipedia.org/wiki/Denny_Laine

Tracy Torgeson - This is how I want to remember the incomparable... | Facebook

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Excess mortality in England post COVID-19 pandemic: implications for secondary prevention (thelancet.com)

https://rockcellarmagazine.com/denny-laine-dies-79-wings-moody-blues-details/

https://www.wusa9.com/article/news/nation-world/denny-laine-dead-moody-blue-wings-musician/507-6f37a684-0d2d-4f00-8029-fdfddc765d32

Kuhbandner C, Reitzner M (May 23, 2023) Estimation of Excess Mortality in Germany During 2020-2022. Cureus 15(5): e39371. doi:10.7759/cureus.39371

https://www.reddit.com/r/COVID19positive/comments/191x4mz/fifth_infection_and_i_want_to_protect_myself_from/

National Center for Health Statistics. Monthly Provisional Counts of Deaths by Select Causes, 2020-2023. Date accessed: January 9, 2024. Available from https://data.cdc.gov/d/9dzk-mvmi.

https://biobot.io/risk-reports/influenza-and-rsv-wastewater-monitoring-in-the-u-s-week-of-december-25-2023/

https://www.ecdc.europa.eu/en/covid-19/variants-concern

https://erictopol.substack.com/p/sotp-state-of-the-pandemic

List of deaths due to COVID-19 - Wikipedia

Quarterly Provisional Estimates for Mortality Dashboard (cdc.gov)

Quinn, Gerry A., Michael Connolly, Norman E. Fenton, Steven J. Hatfill, Paul Hynds, Coilín ÓhAiseadha, Karol Sikora, Willie Soon, and Ronan Connolly. 2024. "Influence of Seasonality and Public-Health Interventions on the COVID-19 Pandemic in Northern Europe" Journal of Clinical Medicine 13, no. 2: 334. https://doi.org/10.3390/jcm13020334

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