WINTER FLU SEASON OUTLOOK

Posted on August 3, 2023 by John Bailey

Winter flu season outlook

A look ahead to winter respiratory virus season

By Dr.CAITLIN RIVERS (Reprinted with permission)

AUG 3, 2023

I don’t know about your household, but last winter was brutal for my family. I have young kids in school, and they were constantly hit with various bugs throughout the so-called “tripledemic.” I’m already starting to wonder: will this year be more of the same?

I did a pretty good job of calling last season. I suspected we would see an early-than-usual flu season in July, and

Your Local Epidemiologist

and I warned in September that childhood illnesses would flare. I thought I’d push my luck by trying a long-term forecast again this year.

This is guesswork, so think of it as you would a Farmer’s Almanac outlook.

Punchline

I anticipate this will be a high-normal winter respiratory virus season. It won’t be quite as bad as last year, but still higher than what we normally saw in pre-pandemic times.

Deep dive

I can’t think of a reason why COVID-19 would depart from its habit of surging in the winter months, so that’s my expectation again this year. We’ve been circulating through Omicron variants for over a year now, and they seem to have staying power, so we’ll likely get more of the same. (On the other hand, if a brand new variant does become dominant, we would be in for a larger wave.)

Many of the young children who are vulnerable to RSV will have gotten it last year, so I expect that the population-level susceptibility is lower now than it was last year. Still, even severe winter respiratory virus seasons don’t infection everyone, and new babies have been born since the last wave, so I expect the conditions for a worse-than-average year are present again. There was also a sizable wave of RSV in Australia, which is further evidence that it will be another significant RSV season in North America.

Older adults are also vulnerable to severe RSV, but I have less of a sense of the disease dynamics in that population. Luckily, there will be an RSV vaccine available to help protect people 60 years of age and older soon. It’s expected to become available this fall.

Australia’s 2023 RSV season was less severe than 2022, but still quite active. Source.

Influenza season is in full swing in Australia, so we can get a preliminary sense of how things are unfolding there.

Last flu season, Australia (and later the Northern Hemisphere) saw activity begin very early. They did not see that pattern this season, which suggests we can expect a more typical winter start here in the North. Peak week and duration are not unknown, but I think we can rule out a year of unusually low activity.

On the bright side, H1N1 is the most prevalent influenza strain again this year. It’s what dominated last year, and it’s included in the vaccine again this year. South Africa and parts of Southeast Asia are seeing some H3N2, which is also in this year’s vaccine. The seasonal influenza vaccine is generally available by September, and it’s a good idea to get it before Thanksgiving.

Australia’s 2023 flu season hints at what the Northern Hemisphere can expect. Source.

Lastly, I’m thinking that the other pesky respiratory viruses like the seasonal coronaviruses will behave similar to what I’m expecting for RSV, which is to say it may be another big season. There was a large buildup of the susceptible population in the years where people were wearing masks and social distancing. There is no way that one bad year reset things totally, so I think there will be plenty of activity again this year.

What it all means

For my family, I’m prepared for another year of stuffy noses and sick days. I just hope it’s not as extensive as the 2022-2023 season.

For healthcare systems that creaked under the load of respiratory virus season even before the pandemic, I do suspect that it may be another tough winter. I hope some of the thinking I’m sharing, imperfect though it may be, can help to shape early preparations.

How are you using this information? Let me know in the comments.

MIDST ONGOING OVERDOSE CRISIS, GOVERNOR HOCHUL ANNOUNCES NEW STATEWIDE MEDIA CAMPAIGN AND PODCAST SERIES TO EDUCATE PUBLIC AND HIGHLIGHT SERVICES AVAILABLE IN NEW YORK STATE

Posted on August 2, 2023 by John Bailey

Campaign Focuses on Dangers of Fentanyl, Harm Reduction Education, and How to Seek Help for Addiction

OASAS Launches Partnership with NEXT Distro to Supply Naloxone Free of Charge to All New Yorkers

Weekly Podcast Series Will Deliver Critical Information and Feature Addiction Services Professionals and Those Directly Impacted by Addiction.

SEE BELOW FOR HOW TO GET PODCASTS , TREATMENT OPTIONS, NALOXONE OVERDOSE-STOPPER.

Governor Kathy Hochul announced THIS WEEK the launch of a new statewide media campaign to raise awareness of addiction, and the services available in New York State for those impacted by addiction and their families.

The campaign is designed to educate the public about the potential risks of fentanyl, as well as the importance of harm reduction services, and how and where to find help for addiction in New York State.

As part of this campaign, the New York State Office of Addiction Services and Supports is also launching a partnership with NEXT Distro to increase access to the overdose reversal medication, naloxone. This partnership is funded through New York State’s Opioid Settlement Fund, and will allow individuals to receive naloxone by mail, free of charge. To compliment these efforts, OASAS is also premiering a new educational podcast series, entitled “Addiction: The Next Step.” The podcast will educate the public about all aspects of addiction and the work of OASAS and highlight stories of individuals in recovery.

“The impact of fentanyl and the ongoing opioid and overdose crisis continues to be felt by New Yorkers in every community across the state, and we are working around the clock to address this public health emergency,” Governor Hochul said. “We need to take every possible step to save lives which starts with educating New Yorkers on the dangers of these substances and the resources available to help all those who have been impacted.”

New York State Office of Addiction Services and Supports Commissioner Dr. Chinazo Cunningham said, “We are experiencing the worst overdose crisis in history. It is more important than ever that we inform the public about the ongoing risks, as well as the services and supports available here in New York. This campaign and podcast series is another way for us to get the message out that help is available, every step of the way, no matter what support people need or where they live. In addition, by supplying naloxone for free, we are giving people an important tool to help stop overdoses and save lives in their communities.”

Fentanyl is a potentially extremely dangerous substance, which can be 100 times more potent than heroin.

While fentanyl has certain legal medical uses, use of illegal fentanyl and synthetic analogs continues to rise and can have devastating consequences. Fentanyl is especially dangerous because it is often mixed into other drugs such as heroin or cocaine without the knowledge of people using those substances, which substantially raises the risk of a potential overdose. Fentanyl is now present in approximately 75% of overdose deaths in New York State.

OASAS has worked to raise awareness of the potential dangers of fentanyl use through numerous efforts, including educating people on how to recognize signs of a fentanyl or opioid overdose, how to respond to an overdose and administer naloxone, and tips on how to avoid an overdose. Our ongoing prevention programming and education efforts across the state, including in schools, are also focused on informing New Yorkers about fentanyl and other illicit substances.

Earlier this year, OASAS partnered with NY MATTERS to launch a new ordering system for both providers and individuals to obtain fentanyl test strips.

Since launching in February, more than 1.1 million fentanyl strips have been ordered. Free xylazine test strips and naloxone are also available through the same ordering system, and more than 230,000 xylazine test strips have been ordered since they were first made available in May.

Harm Reduction Delivered Campaign

The Harm Reduction Delivered Campaign builds on these ongoing efforts, with a PSA campaign to educate New Yorkers on the potential dangers of fentanyl. This multimedia campaign features PSA announcements on TV, radio, billboards and other public locations, and digital ads including on social media.

In addition to highlighting the potential dangers of fentanyl, and how New York State is working to address this crisis, the campaign will also raise awareness of harm reduction services. Harm reduction is an important part of the continuum of addiction care available throughout the state, and includes things like naloxone and test strip distribution, efforts to increase medication for addiction treatment, work to reduce stigma, and education on overdose prevention.

The campaign also addresses the growing number of opioid-related overdoses across New York State through a new partnership to supply naloxone.

OASAS is partnering with NEXT Distro to supply naloxone free of charge to individuals throughout the state. Previously, only OASAS and Office of Mental Health providers were able to order naloxone directly. Through a new ordering portal, individuals can now place orders for naloxone to be mailed directly to them. In addition to naloxone, educational materials on how to use naloxone, where to find treatment for opioid use disorder, and other resources will also be provided.

For individuals looking to learn how to use naloxone, OASAS offers virtual naloxone trainings, which are open to the public, and educate individuals on how to recognize an overdose, respond by administering naloxone, and what to do after naloxone is given.

This campaign is being supported with federal funding through the State Opioid Response and Substance Abuse Prevention and Treatment grants, as well as funding from New York State’s Opioid Settlement Fund.

Addiction: The Next Step Podcast

OASAS is also launching a podcast to educate the public about addiction, the services and supports available for New Yorkers, and how to access help. “Addiction: The Next Step” is hosted by former broadcast journalists and will include providers and other OASAS employees as guests, sharing their expertise about various aspects of addiction and the system of care in New York State.

The first episode features Commissioner Chinazo Cunningham, offering an introduction to OASAS, its mission, and the addiction services system in New York State.

Future episodes will focus on OASAS prevention, harm reduction, treatment, and recovery services, and how these specialized services are integral to helping New Yorkers access the individualized help they need. Several episodes will also include conversations with New Yorkers in recovery, as well as others who have personal experience helping those affected by addiction.

Episodes will be released weekly and are available through audio and podcast apps, and will also be posted on the OASAS website and the agency’s Twitter, Facebook, and Instagram pages.

New York State is receiving more than $2 billion through various settlement agreements with opioid manufacturers and pharmaceutical companies that were secured by Attorney General Letitia James. A portion of the funding from these settlements will go directly to municipalities, with the remainder deposited into a dedicated fund to support prevention, treatment, harm reduction and recovery efforts to address the ongoing opioid epidemic.

The same legislation that established the dedicated fund also created the Opioid Settlement Fund Advisory Board, which is tasked with making recommendations on how settlement dollars should be allocated to best serve those in need. Board members issued their first recommendations on November 1, 2022, identifying the expansion of harm reduction services and treatment as top priorities.

New York State has instituted an aggressive, multi-pronged approach to addressing the overdose epidemic, and created a nation-leading continuum of addiction care with full prevention, treatment, recovery, and harm reduction services. The state has worked to expand access to traditional services, including crisis services, inpatient, outpatient, and residential treatment programs, as well as medication to treat addiction, and mobile treatment and transportation services.

Governor Hochul was a member of the NYS Heroin and Opioid Task Force, which in 2016, recommended new, non-traditional services, including recovery centers, youth clubhouses, expanded peer services, and open access centers, which provide immediate assessments and referrals to care. These services have since been established in numerous communities around the state and have helped people in need access care closer to where they live.

New Yorkers struggling with an addiction, or whose loved ones are struggling, can find help and hope by calling the state’s toll-free, 24-hour, 7-day-a-week HOPEline at 1-877-8-HOPENY (1-877-846-7369) or by texting HOPENY (Short Code 467369).

Available addiction treatment including crisis/detox, inpatient, residential, or outpatient care can be found using the NYS OASAS Treatment Availability Dashboard at FindAddictionTreatment.ny.gov or through the NYS OASAS website.

If you, or a loved one, have experienced insurance obstacles related to treatment or need help filing an appeal for a denied claim, contact the CHAMP helpline by phone at 888-614-5400 or email at [email protected]

FREE LUNCHES FOR TEENS AT WHITE PLAINS LIBRARY

Posted on August 2, 2023 by John Bailey

Summer Meals at the Library

Monday through Friday
11:30 a.m. – 1:00 p.m.
In the Gallery

Through Friday, August 18th, kids and teens ages 18 and under can get free, healthy meals at the Library. There is no need to sign up. Just show up! Meals are limited, while supplies last. Food must be eaten on-site when picked up.

This program is made possible by the White Plains City School District, local sponsor of the Summer Food Service Program, administered by NY State Dept. of Ed.

RIDING THE COVID 19 WAVES 2023 STYLE WITH YOUR LOCAL EPIDEMIOLOGIST

Posted on August 1, 2023 by John Bailey

Riding the COVID-19 waves: 2023 style.

NEW!SENIORS PAXLOVID HAS TO BE GIVEN WITHIN 5 DAYS OF SYMPTOMS.

NURSING HOMES PRACTICES RAISE QUESTIONS AGAIN.

INTERPRETING ANTIGENS RESULT WHAT THEY MEAN–IF POSITIVE YOU MUST ISOLATE WEAR MASK

BY DR. KATELYN JETELINA (REPRINTED WITH PERMISSION)

AUG 1, 2023

We find ourselves in the middle of a COVID-19 wave.

Again.

If this summer follows the previous three, we should expect ~10-15% of Americans to get infected.

A nursing home outbreak recently spilled over to my extended family. They had a lot of great questions, particularly about how to manage this virus in 2023. Here are some answers. I hope it helps you, too.

Does health insurance cover at-home tests?

Because the public health emergency ended, coverage depends on your specific insurance plan:

Medicaid: Tests are covered until September 2024.
Private insurance: Coverage is optional, so you must check. (Very few do.)
Flexible spending account (FSA) or a health savings account (HSA): You can use the money to purchase at-home COVID-19 tests.
Uninsured: There’s a stockpile of free tests; use this search tool to find a location.

Do antigen tests expire?

Expiration ranges from 6 months – 2 years, depending on the brand. The date on the box may be incorrect, as the FDA later extended dates. Here is an updated list to see if it’s still good after brushing off cobwebs.

Antigen tests can get too hot (and too cold).

Antigen tests can withstand heat from regular shipping processes. But, if your test has been living inside your car and getting very hot for days, consider it defective.

If you get a negative…

False negatives at the beginning of infection are very common, thanks to the virus mutating. In a recent study, antigen and PCR tests only agreed 47-58% of the time. If they did agree, there was a 1-8 day delay between a PCR turning positive and an antigen test turning positive.

The higher we are in a wave, the more skeptical you should be of a negative result. There are two things you can do to help reduce skepticism (i.e., false negatives):

Swab throat and salvia. These are positive days before the nose.
Repeat testing. Two tests within 48 hours catch 92% of symptomatic cases and 39% of asymptomatic cases. Three tests 48 hours apart detected 94% of symptomatic and 57% of asymptomatic patients.

If you get a positive…

Positives are positives. You’re infectious.

The faintness of a line provides clues, though:

Very bold line= you’re very contagious.
Barely see the line= you’re at the beginning or the end of your infection window.

Should I report my positive to the health department?

I wouldn’t bother. Wastewater is where it’s at these days, and, fortunately, that doesn’t require you to do anything different.

Isolate for five days, at minimum.

When is Day 0? The first day of symptoms (not the day you get a positive test).
When do we leave isolation? Technically the CDC says Day 5. But 2 out of 3 people will still be infectious, so if you do, wear a mask. It’s best to stay in isolation until you have a negative antigen test or it’s been at least ten days.
Where was I infected? Wherever you were ~48 hours before symptoms started.

If you’re over 65, get Paxlovid!

The first question to my 93-year-old relative was: Did you get Paxlovid? I was incredibly disappointed with the answer. The nursing home waited too long to test, so she was outside the eligibility window. (Paxlovid has to be given within five days of symptoms starting.)

She’s not alone. A recent study found only 1 in 4 nursing home residents with COVID-19 were prescribed an antiviral. This is absolutely unacceptable.

How long will I have symptoms?

~6-12 days. Maybe longer, maybe shorter. It depends on a lot of individual factors.

But having symptoms doesn’t necessarily mean you’re infectious. A great way to know is to test to exit (if negative, you’re clear).

Pink eye with kids?

According to the American Academy of Ophthalmology, the newer subvariants of COVID-19 are responsible for some cases of pink eye. In a small study in China, 25% of children aged 2-11 had pink eye during COVID-19 infection. Among adults, it’s much lower rates (1-2% of cases have pink eye).

Should I wear a mask?

In your house: Masks work. A recent study found that if the index case (i.e., infected person) was masked at home, household transmission was reduced by 67%. Not sharing a bathroom reduced risk by 78%.
Going outside. You don’t need to wear a mask to walk your dog.

Does this mean I’m in the clear for Winter?

Maybe. Data from the UK shows that, on average, people get 1-2 infections yearly. You’ll have good protection going into the fall respiratory season. (I would delay a fall booster by at least six months; more on this later).

I’ve never had an infection. Do I have superpowers?

Maybe. Or, perhaps, an infection went undetected. Scientists recently discovered that if you have two copies of a specific gene (HLA-B*15:01), you are 8x more likely to remain asymptomatic. Unfortunately, there’s no way for the average person to know. So, harm reduction is still the name of the game.

Bottom line

A COVID-19 wave is here. Thanks to our immunity wall, 2023 looks very different, but we can still use tools to help minimize disruption. To me, it’s still worth it. (I really don’t want to miss an upcoming summer vacation.)

As we say when catching ocean waves in San Diego: Shaka.

Love, YLE

“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH Ph.D.—an epidemiologist, wife, and mom of two little girls. During the day, she is a senior scientific consultant to several organizations. At night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health world so that people will be well-equipped to make evidence-based decisions. This newsletter is free, thanks to the generous support of fellow YLE community members. To support this effort, subscribe below: