What we do (and don't) know about this COVID upswing

Also: Behind the baby formula shortage [View in browser](    [❤️]( May 16, 2022 Hello CommonHealth reader, I was taken aback late last week when two public health experts both told me they personally knew more people with COVID right now than at any previous point in the pandemic. It’s possible that Harvard epidemiologist Bill Hanage and Boston University infectious disease doctor Robert Horsburgh have similar networks. It’s also possible their circles have largely managed to dodge COVID for wo years. And now, omicron's infectious subvariants are seeking out those final pockets of the population that lack the extra immunity that comes from earlier infections, at a time when almost all policy-level precautions have been dropped. But their anecdotal experiences highlight a simple fact: There is currently a lot of COVID circulating in the Boston area. This past Thursday, more than 5,500 people tested positive in Massachusetts. On Friday, it was over 4,600. That's several times higher than the numbers were in mid-March, when the state was averaging just above 500 new cases a day. On Friday, I published [a new article about the current upswing and how long experts think it will last](. But I wanted to share two wonky (but interesting) details here that didn’t make it into the piece. First, there’s a mystery that’s stumping the experts. One of the reasons omicron went on a rampage is because it had so many genetic mutations. In other words, it was very different from the variants (beta, delta, etc.) that came before it. The dominant coronavirus strains now are subvariants of omicron — essentially cousins on the same genetic family tree. And while these subvariants are very similar to one anther, they are again spiking big changes in the number of cases. According to Massachusetts General Hospital infectious disease doctor Jacob Lemieux, just a few amino acids are the difference between these subvariants. “It's almost like having somebody who, I don't know, runs a two-hour, 30-minute marathon changing their sneakers and all of a sudden running a two-hour marathon," Lemieux said. (That's basically the difference between first place and 100th in the Boston Marathon.) "It doesn't make sense," he said. "It needs to be explained. These are minor changes in the virus genome, minor changes in the spike [protein] that are associated with new waves.” Second, there’s an interesting cycle in how a virus evolves, Hanage told me. In the first stage, when there’s not much immunity to a new virus, the virus evolves to spread quickly. The variants that survive are the ones that are the speediest. But after more people have gained immunity (through infection or vaccination), the variants of the virus that survive are the ones that can somehow outsmart our immune system. “When things are growing quickly, you get selection for transmissibility. When things are coming down because folks are immune, you get selection for immune escape,” Hanage said. Still, even as experts uncover patterns in how the coronavirus changes, some key details about the virus’s path — such as how big waves will be and where they will emerge — remain hard to predict, as this current moment has shown. Gabrielle Emanuel Health reporter [Follow]( Support the news  This Week's Must Reads [What to know about COVID's upswing in Massachusetts]( “The reality is that things are really not going well at the moment,” said Jacob Lemieux, an infectious disease doctor, noting the rise in cases. [Read more.]( [What to know about COVID's upswing in Massachusetts]( “The reality is that things are really not going well at the moment,” said Jacob Lemieux, an infectious disease doctor, noting the rise in cases. [Read more.]( ['They have to help us out': Mass. parents are feeling the nationwide formula shortage]( The supply chain, a factory shutdown and increased demand: Here's why Massachusetts parents are worried about a formula shortage. [Read more.]( ['They have to help us out': Mass. parents are feeling the nationwide formula shortage]( The supply chain, a factory shutdown and increased demand: Here's why Massachusetts parents are worried about a formula shortage. [Read more.]( [As cocaine and meth use rise in Mass., state commission outlines action plan]( In the first half of 2021, 52% of overdose deaths in the state involved cocaine. A state commission recommended several efforts, including widespread access to harm reduction supplies, more training for first responders and better access to new treatment options. [Read more.]( [As cocaine and meth use rise in Mass., state commission outlines action plan]( In the first half of 2021, 52% of overdose deaths in the state involved cocaine. A state commission recommended several efforts, including widespread access to harm reduction supplies, more training for first responders and better access to new treatment options. [Read more.]( [How Mass. doctors and tech companies are helping Ukraine via telemedicine]( From telesurgeries to teleclinics, the hope is that telehealth can relieve pressure on local health care systems and boost skills for caregivers on the ground. [Read more.]( [How Mass. doctors and tech companies are helping Ukraine via telemedicine]( From telesurgeries to teleclinics, the hope is that telehealth can relieve pressure on local health care systems and boost skills for caregivers on the ground. [Read more.]( [A substance found in young spinal fluid helps old mice remember]( A team at Stanford University has reversed memory loss in old mice by flooding their brains with spinal fluid taken from young animals. The finding may hold promise for Alzheimer's research. [Read more.]( [A substance found in young spinal fluid helps old mice remember]( A team at Stanford University has reversed memory loss in old mice by flooding their brains with spinal fluid taken from young animals. The finding may hold promise for Alzheimer's research. [Read more.]( What We're Reading 📚 As I’ve read about [parents struggling to find formula]( to feed their babies, I’ve been searching for articles that delve into the details of what’s causing the shortage. The answer is a complicated one, including COVID-related supply chain disruptions and the inner workings of the federal WIC program, which provides food assistance for mothers and young children. But two other underlying factors caught my eye this week. First, in [The Atlantic]( Derek Thompson writes about the red tape and policies that helped create the situation: “FDA regulation of formula is so stringent that most of the stuff that comes out of Europe is illegal to buy here due to technicalities like labeling requirements. Nevertheless, one [study]( found that many European formulas meet the FDA nutritional guidelines — and, in some ways, might even be better.” Second, in [The Wall Street Journal]( Joseph Walker looks at an Abbott Laboratories manufacturing plant in Michigan that’s been shuttered since February after the recall of its powdered formula. The plant is closed because of a possible bacterial (cronobacter sakazakii) contamination that’s sickened four babies — killing two of them. Walker’s reporting casts doubt on whether the infections can actually be linked to the Michigan plant. He writes: “Where inspectors did find traces of the bacteria, the areas weren’t in contact with formula products, the company said… Open containers from the four infants were tested, and three of them tested negative, Abbott said. One container tested positive for two strains of cronobacter, one of which matched the strain that caused the infant’s infection and the other that matched a strain found on a bottle of distilled water that was used to mix the formula. Neither strain matched those found in Abbott’s Michigan plant, the company said.” Whatever the reason for the baby formula shortage, I very much hope our country can fix this crisis quickly. “In the world of disaster medicine, telehealth is still kind of evolving.” — Gregory Ciottone, the head of disaster medicine at Beth Israel Deaconess, on the technology's [newfound role in Ukraine]( ICYMI [Cancer screenings and other medical care declined during the COVID pandemic, study finds]( The pandemic disrupted preventive health care for people across Massachusetts. That's raising concerns that cancers and other diseases are going undetected and untreated. [Read more.]( [Cancer screenings and other medical care declined during the COVID pandemic, study finds]( The pandemic disrupted preventive health care for people across Massachusetts. That's raising concerns that cancers and other diseases are going undetected and untreated. [Read more.]( Did you know...there are chopsticks that make food taste salty even when it’s not? Japanese researchers have created [computerized chopsticks]( that use an electrical stimulation waveform and might be useful for people who like salt but need a diet low in sodium. 😎 Forward to a friend. They can sign up [here](. 📣 Give us your feedback: newsletters@wbur.org 📧 Get more WBUR stories sent to your inbox. [Check out all of our newsletter offerings.]( Support the news     Want to change how you receive these emails? Stop getting this newsletter by [updating your preferences.](  I don't want to hear from WBUR anymore. 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