People's CDC, COVID-19 Weather Report, December 16, 2024

Awaiting updates for winter surge, the critical importance of extending telemedicine funding through CMS, & optimism for increased funding for the RECOVER-TLC program to advance Long COVID research

Dec 17, 2024

The Weather

The most recent CDC national wastewater map with data from December 1st through December 7th 2024 shows 18 states reporting ‘High’ or ‘Very High’ levels of the virus. Mississippi, Missouri, and South Dakota have limited coverage. No data is available for Guam, the Virgin Islands, Puerto Rico, and North Dakota.

With regard to trends, the CDC has determined national levels are “low,” though the Midwest is experiencing “Moderate” wastewater levels.

A line graph with the title, “COVID-19 Wastewater Trends as of December 14, 2024” with Wastewater Viral Activity Level indicated on the left-hand vertical axis, going from “minimal” to “very high”, and “Week Ending” across the horizontal axis, with date labels ranging from 06/15/24 to 11/30/24. A key at the bottom indicates line colors. National is black, Midwest is orange, South is purple, Northeast is light blue, and West is green. Overall, based on provisional wastewater data, viral levels are increasing nationally and in all regions except for the Northeast region. Text at the bottom reads “People’s CDC. Source: CDC.”

Graphic source: CDC

Thanks for reading People's CDC! This post is public so feel free to share it.

Please remember that the determination of the categories of “Very High,” “High,” “Moderate,” “Low,” and “Minimal” is independent of any relationship to community transmission. In other words, these categories do not necessarily reflect one’s risk of getting sick in each region at any given time. Wastewater data is best suited to reveal if levels in your area are increasing or decreasing, or how levels in your area compare with other times throughout the course of the pandemic.

Also notably, while our organization historically has used the CDC wastwater data for this report while encouraging readers to find and use local data whenever it is available, we want to highlight the WastewaterSCAN dashboard this week. The WastewaterSCAN dashboard’s most recent update on December 14th shows a markedly steep increase in wastewater levels, particularly in the Midwest, and a much higher level: nearly two-thirds the level of this summer’s peak. The CDC map updated just two days prior, on the other hand, suggests current midwest levels at less than half that of the summer peak.

In any case, it appears that the holiday surge is here, most obviously in the Midwest, but we expect rates to increase in other regions in the weeks ahead.

A line graph with the title, “WastewateSCAN-based data-19 Wastewater Trends as of December 14, 2024” with wastewater viral level” indicated on the left-hand vertical axis, going from “0” to “1200” in increments of 200, and months across the horizontal axis, with labels ranging from July to December. A key at the bottom indicates line colors. National is black, Northeast is green, South is neon yellow, Midwest is orange, West is blue. Wastewater levels are increasing in the West, Midwest, and South. Northeast seems to be decreasing. Text at the bottom reads “People’s CDC. Source: WastewaterSCAN.”

Graphic source: CDC

As of December 10th, 2024, the CDC’s Epidemic Trends dashboard suggests that COVID infections are increasing or likely increasing in 28 states: most of these states are in the eastern and midwestern parts of the country.

Of note, this model uses emergency department visit data to estimate COVID transmission’s R_t, which is an estimate of the average number of new infections caused by each infectious person. An R_t greater than 1.0 indicates that infections are growing, while an Rt less than 1.0 indicates that they’re declining.

A map of the United States color-coded in shades of purple, teal, and gray displaying the CDC COVID Model: Current Epidemic Growth Status based on emergency department visits as of December 10, 2024, where purple tones indicate growing or likely growing, teal tones indicate declining or likely declining, and gray indicates “Stable or Uncertain.” States without predictions are represented in white. Text above the map reads “CDC Predicts transmission is ‘Growing’ or ‘Likely Growing’ in 28 states.” One state is dark teal and __ have “Declining” or “Likely Declining” status. Three states are light purple and have “Likely Growing” Status. All other states and territories are either “Stable or Uncertain” or did not receive estimates. Text at the bottom reads “People’s CDC. Source: CDC.”

Graphic source: CDC

While we usually focus on COVID-19, it is worth noting that rates of RSV are high nationally and that influenza rates are increasing throughout the country. You can protect yourself and your community from all of these viruses through masking, cleaning indoor air, and/or gathering outdoors. Check out our brief, updated version of the Safer Gatherings Guide ahead of the holidays. The full guide will be available shortly. As always, practice multilayered precautions to minimize the risk of transmission.

On Long COVID

A new cross-sectional study in Health Services Research (2024) analyzed the financial impact of COVID across income and education levels using the 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey. Among the 271,076 respondents, 7.5% reported Long COVID symptoms. Individuals with Long COVID in the lowest income categories experienced a 2-10% increase in the probability of food insecurity, although all income and education groups experienced heightened food insecurity, inability to pay bills, and the threat of losing services. Low income individuals were also disproportionately exposed to COVID at work, and faced loss of hours and employment termination. Widespread financial adversity highlights the necessity of flexible work-from-home employment, equitable access to credit, and increased accessibility in the healthcare system.

Wins

The Researching COVID to Enhance Recovery (RECOVER) initiative, which was launched in 2021 to study and treat Long COVID patients, was allocated $147 million from the National Institutes of Health (NIH). The program’s developments in clinical trials, biospecimen collection, observational studies, and pathobiology studies will help us understand underlying mechanisms of and to help develop treatments for Long COVID. This funding is in addition to the $515 million the NIH provided earlier this year, bringing the 2024 total to $662 million. The NIH launched the RECOVER Treating Long COVID (RECOVER-TLC) for a new phase of clinical trials this July, following backlash from the first-wave studies (where only 15% of funding went towards clinical trials, including a controversial exercise study). Second-wave trials are increasing accessibility by expanding enrollment criteria to non-PCR confirmed infections, the pediatric population, and providing further accommodations for ME/CFS patients. Community representatives and patients are encouraged to submit questions and suggest therapeutics to investigate.

Variants

The CDC’s Variant Proportions Dashboard, most recently updated on December 7th, shows XEC as the dominant variant, followed by KP.3.1.1, and an emerging variant, MC.1. MC.1 is a descendent of KP.3.1.1, and XEC is a recombinant lineage of two JN.1 variants (KS.1.1 and KP.3.3).

It is not too late to get an updated vaccination if you haven’t already. Visit the national vaccine finder to find options in your area. Contact your local health department to ask about free and low-cost COVID and flu vaccine events in your area.

Two stacked bar charts with two-week periods for sample collection dates on the horizontal x-axis and percentage of viral lineages among infections on the vertical y-axis. Title of the first bar chart reads “Weighted Estimates: Variant proportions based on reported genomic sequencing results” with collection dates ranging from 8/31/24 to 11/29/24. The second chart’s title reads “Nowcast**: model-based projected estimates of variant proportions,” dates labeled 11/23/24 and 12/07/24. Within the 11/23 Nowcast projections, KP.3.1.1 (light teal) is at 44%, XEC (green) increases to 39%, KP.2.3 (blue) decreases to 1%, MC.1 (ochre) is 6%, and LB.1 remains at 1%. Other variants are at smaller percentages represented by a handful of other colors as small slivers. The legend with a list of variants, proportions, and their associated colors is on the far right of the bar charts.

Graphic source: CDC Variant Tracker

H5N1 Updates

The spread of bird flu is progressing rapidly, with one recently confirmed pediatric case in California. The source of exposure remains unknown. Genomic analyses reveal that the virus samples are closely related to those previously identified among dairy workers in California, the current epicenter of most human cases. Over the last 30 days, there have been 303 new outbreaks in livestock, predominantly in California (302) and one in Nevada. Additionally, a presumptive human case has been reported in Louisiana.

To date, 60 confirmed human cases have been reported in the US in 2024.The majority of these cases (37) resulted from exposure to cows, 21 from poultry, and 2 cases of unknown origin from Missouri and California.

On December 6th, 2024, the USDA’s Animal and Plant Health Inspection Service announced its new National Milk Testing Strategy (NMTS) in response to the escalating outbreaks. The NMTS federal order mandates the routine testing of milk siloes nationwide. The NMTS builds upon the Federal Order issued in April 2024, which requires testing of all lactating cows transported over state lines.

While there is no confirmed human-to-human spread yet, each infection increases the risk of new mutations, some of which may cause human transmission. To mitigate the risk of further spread, robust surveillance, contact-tracing, vaccine development, and widespread PPE distribution are essential.

Take Action

Demand the Centers for Medicare and Medicaid Services extend funding for telehealth 2025 and onwards. Beginning January 1st, 2025, the Centers for Medicare and Medicaid (CMS) will end its financial support for telehealth services. Join us in urging Congress to provide indefinite funding for telemedicine by December 18th, 2024.

Reach out to your local and state elected officials using our Action Network campaign or email or call them using their contact information and ask if they have heard of any plans to introduce mask bans in your area, and regardless of their answer, register your dissent. Invite one friend to do the same. Visit our website for more background on the rising threat of mask bans.

Volunteer and find support with a Mask Bloc or other COVID Action group in your area. Taking action together we can create larger and larger waves of change.

We will be taking time to rest during this holiday season, expect our next Weather Report on January 13, 2025.

Notes: 1) The numbers in this report were current as of 12/14/2024. 2) Check out the links throughout & see our website for more at https://peoplescdc.org. 3) Subscribe to our newsletter: People’s CDC | Substack.