The Perfect Enemy | COVID in California: Black hairy tongue, an unsightly but common symptom, gets fresh attention
December 1, 2022

COVID in California: Black hairy tongue, an unsightly but common symptom, gets fresh attention

COVID in California: Black hairy tongue, an unsightly but common symptom, gets fresh attention  San Francisco Chronicle

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President Biden this week reiterated the promise that most Americans will only need to receive an annual booster shot against COVID-19, despite widespread skepticism from infectious disease experts who think waning vaccine efficacy will necessitate more than one dose every 12 months. In California, Yosemite National Park officials have announced that the contentious reservation requirement enacted during the pandemic will not be in place next year.

Black hairy tongue, an unsightly but common symptom, gets fresh attention

Tongue discoloration is a condition that has been associated with various viral infections long before the coronavirus pandemic, but the symptom has drawn fresh attention since the death last month of author Julie Powell, the inspiration for the movie “Julie and Julia.” In her final tweet, the 49-year-old food writer who had recently recovered from a bout of COVID-19 said she woke up “with something that’s literally Black Hairy Tongue.” She added, “People, including my doctor, seem to think it’s no big deal, and will go away soon, but it certainly is gross.” Her husband said that the cause of her death was cardiac arrest, but many have questioned if the symptom was an indicator of something more serious tied to her coronavirus infection.

One study found that it is one of the many symptoms associated with a COVID-19 infection with about 1 in 500 patients experiencing it, with another paper saying it is “quite commonly demonstrated” among patients with the virus. Dr. Peter Chin-Hong, an infectious disease specialist at UCSF, told the New York Times that “it’s more common than people think.” The Mayo Clinic describes a black hairy tongue as a temporary, harmless condition caused by an overgrowth of dead skin cells. “I know it looks really scary to people,” Chin-Hong said, but he said people shouldn’t be “freaked out,” and is usually a better indicator of poor oral hygiene than worsening symptoms. Most people can use a tongue scraper or toothbrush to remove the dead cells.

COVID, flu and RSV strain Bay Area hospitals

Bay Area health officials on Wednesday said a substantial increase in flu activity and other respiratory viruses since the start of the month has led to a spike in emergency department visits and is already putting a strain on health systems across the region. “This is the first year where we’re not only facing COVID but also increased influenza activity and unusually high levels of RSV,” said Dr. Sarah Rudman, the assistant health officer for Santa Clara County, during a press briefing. 

The Santa Clara County health department said that the percentage of emergency department visits for influenza-like illness is three times higher this year than it was during the 2019-20 flu season, before the start of the COVID-19 pandemic. Bay Area pediatric hospitals are also seeing a rise in cases of the respiratory syncytial virus, or RSV, a common viral illness that can cause trouble breathing for infants and young children, and in older adults. 
The UCSF Benioff Children’s Hospitals are tallying “very high volumes” of respiratory illnesses including RSV, said chief medical officer Dr. Joan Zoltanski. It’s part of a nationwide surge that has grown particularly severe in some parts of the country.

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Permanent COVID memorial planned in L.A.

Los Angeles may soon install a permanent COVID-19 memorial, city officials said Wednesday as they announced the launch of the COVID-19 Pandemic Reflections Initiative. “The COVID pandemic has impacted all of us in a profound way, including through the loss of family members, friends, colleagues, and neighbors,” said Mayor Eric Garcetti in a news release. “This memorial will provide us with a physical space where we can honor and remember our loved ones.” First steps for the project include a citywide survey and community listening sessions, according to the release. “In recognition of the many lives lost as a result of the COVID-19 pandemic, this initiative will give the residents of Los Angeles the opportunity to honor the people we loved and to reflect, remember, and instill hope as we move forward in our recovery and healing,” said Daniel Tarica, interim general manager of the Department of Cultural Affairs.

Contra Costa County to provide residents with free test kits

Residents of Contra Costa County can receive free at-home COVID-19 test kits through a new mail-order program, the county’s health department said Tuesday. County residents can order up to four test kits per household – with two tests per kit – online or by phone, with kits mailed to people’s homes within a week. “Testing gives people the information they need to make healthy choices and reduce the spread of COVID, especially during the winter holiday season when families and friends gather indoors,” Dr. Sofe’ Mekuria, the county’s deputy health officer, said in a release. The program will run through the holidays and potentially longer depending on test kit supply, the county said. Health officials have said that a single negative at-home test result does not always rule out the possibility of a coronavirus infection and suggest following up a negative test with a second test 24-to-48 hours later, especially if having symptoms.

Americas see a sharp spike in cases and deaths

COVID-19 cases increased by 17% in the Americas over the past week, with virus-related deaths jumping in South America and Central America, the director of the Pan American Health Organization told a press briefing on Wednesday. “Every time we become complacent with this virus, we run the risk of a resurgence. We cannot lower our guard,” Dr. Carissa Etienne said, adding that other respiratory viruses are also rising after being dormant for two years. Etienne said health systems in Mexico, Brazil, Uruguay, and the U.S. are already under strain due to a surge in RSV infections. “Multiple respiratory infections on the rise at the same time should put us all on alert,” Etienne said.

Job listing for Fauci’s replacement goes live

The National Institutes of Health has officially listed an opening for a new director of the National Institute of Allergy and Infectious Diseases, the position currently held by Dr. Anthony Fauci. “A nationally/internationally recognized scientist is desired,” the job description reads. “Candidates must exhibit a broad scientific vision, demonstrating skill in managing a broad and complex biomedical research program, and the ability to lead and inspire a staff with expertise in diverse scientific disciplines to accomplish the overall mission and strategic goals.”

Fauci is expected to step down from his role as the president’s chief medical adviser in December. Earlier this week, he told CBS that he’s “not even close” to retiring. “I don’t know precisely what I’m going to do because I really can’t negotiate a post-government job while I’m in government,” he said. “My broad general theme, even though I don’t know the venue in which it’s going to happen, would be to continue to stay in the arena of science, medicine and public health.”

United expects busiest travel day since start of pandemic

United Airlines expects to carry 5.5 million passengers during the Thanksgiving travel period, marking a 12% increase over last year, Reuters reports. The carrier said Wednesday it will operate more than 3,700 flights per day on average between Nov. 18-30, accommodating as many passengers as it did over the same period in 2019 before the COVID-19 pandemic. The airline forecasts that Sunday, Nov. 27, will be its busiest day with more than 460,000 passengers.

Bay Area cases ‘creeping up’ ahead of the holiday, says UCSF doc

COVID-19 cases and hospitalizations are “creeping up slowly” in the Bay Area ahead of the Thanksgiving holiday, according to Dr. Peter Chin-Hong, an infectious disease specialist at UCSF. He told CBS News on Wednesday that while the gradual increase “feels invisible to a lot of people,” the number of patients with confirmed COVID-19 in the hospital has doubled over the past two weeks, from 10 to 18, with two people in intensive care unit beds. He said that San Francisco’s test positivity rate and wastewater samples also show an increase in virus activity as newer immune-evasive omicron subvariants spread.

“BA.5 is not the only game in town,” Chin-Hong said. “All of them are sort of like omicron’s grandchildren and they’re feistier.” While at-home rapid antigen tests are still effective at detecting strains such as BQ1., BQ.1.1, and BN.1, he said, “you can’t just stop at one negative, particularly if you have symptoms. They are best used if done repeatedly. You have to keep on doing them over and over again.” Chin-Hong added that omicron tends to start in the throat before moving up into the nose so people should “combine your nose and throat swabs together.”

As far as safely gathering for the holiday? He said ventilation, mask-wearing, testing, and having everyone get the updated bivalent booster is key. “Get it with your flu shots as soon as possible,” Chin-Hong said.

Napa rep tests positive for COVID

Rep. Mike Thompson, D-Napa, tested positive for COVID-19, according to a statement from his office. Thompson said he was experiencing only mild symptoms, and that the positive result followed a routine PCR test. He said he was fully vaccinated and had received “both booster shots.”

“As COVID-19 continues to evolve, I recommend every American to get their updated COVID-19 vaccine and booster to stay healthy and protect their friends and families,” Thompson said.

About 1 in 5 Paxlovid users experience rebound symptoms, study finds

About 19% of COVID-19 patients who used the oral antiviral Paxlovid experienced symptoms of a rebound infection, according to a preprint paper published Tuesday by researchers at Scripps Research Transitional Institute. In the study conducted between Aug. 4 and Nov. 1, 2022, the team tracked the progress of 170 study participants completed the 16-day procedures, with 127 in the Paxlovid treatment group and 43 in the control group. The results showed that viral rebound incidence was 14.2% in the Paxlovid group and 9.3% in the control group, while COVID-19 symptom rebound incidence was higher in the Paxlovid group (18.9%) compared to the control group (7.0%). The researchers found that age, gender, and pre-existing conditions did not play a role in increased incidence.

“This preliminary report of our prospective study suggests that rebound after clearance of test positivity or symptom resolution is higher than previously reported,” the authors wrote. “However, we observed a similar rate of rebound in both in the Paxlovid and control groups. Large studies with diverse participants and extended follow-up are needed to better understand the rebound phenomena.”

A clinical trial by drug manufacturer Pfizer showed that Paxlovid could reduce the risk of hospitalization and death from COVID-19 by 89%. The antiviral was made available under an emergency use authorization from the U.S. Food and Drug Administration in December 2021. Pfizer’s trial estimated that about 1% of users experience rebound symptoms. Infectious disease experts believe rebound of COVID-19 symptoms following a full five-day course of Paxlovid treatment is likely due to insufficient drug exposure, according to research by UCSF.

S.F. offers assistance program to small businesses that fell behind on city fees

San Francisco officials on Tuesday announced a program assist small businesses, mostly restaurants and food-industry-related businesses, impacted by the COVID-19 pandemic. Specifically, certain businesses that fell behind on payments for health department license fees can continue to operate with valid licenses as long as they enter into a payment plan by April 30, the mayor’s office announced. “We know that COVID-19 placed extraordinary challenges on small business owners,” said Treasurer José Cisneros. “Providing businesses with an opportunity to enter into payment plans will provide needed flexibility for small businesses during this recovery period without sacrificing revenue.”

The press release says that  more than 1,000 businesses fell behind on fees totaling $2.6 million to the San Francisco Department of Health and $7 million in other taxes to the city. They will now be able to pay back those funds in installments.

“This new law will provide tremendous help to small businesses, especially immigrant and people of color owned businesses who have to overcome so other challenges beyond the impacts of COVID,” said Connie Chan, District 1 supervisor. “Offering these businesses the opportunity to pay outstanding fees in installments will help reduce barriers for them to operate so they can thrive in San Francisco.”

Newer variants cause more symptoms and greater disruption, study finds

Newer coronavirus variants cause a wider variety of symptoms than their predecessors, according to a new study from Imperial College London. Researchers tracked transmission and symptoms among more than 1.5 million randomly selected adults, including 17,448 COVID-19 patients, from May 2020 to March 2022. About 76% of the patients who were infected with BA.2, the dominant variant at the time the study concluded, reported at least one of 26 symptoms, compared with 70% of those infected with BA.1, 63.8% of those with delta, 54.7% with alpha, and 45% with the original wild-type strain. “Contrary to the perception that recent variants have become successively milder, omicron BA.2 was associated with reporting more symptoms, with greater disruption to daily activities, than BA.1,” the authors wrote.

At least 17.6% of the people infected with BA.2 said their symptoms impacted their ability to complete daily activities “a lot,” compared with 10.7% of those infected with BA.1 and 10.5% with delta. “With restrictions lifted and routine testing limited in many countries, monitoring the changing symptom profiles associated with SARS-CoV-2 infection and effects on daily activities will become increasingly important,” they said.