Latest / Morning Medical with Dr. Chow / Updated COVID-19 Vaccines, Alcohol Risks in Pregnancy, and GLP-1 Weight Loss Drugs

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Updated COVID-19 Vaccines, Alcohol Risks in Pregnancy, and GLP-1 Weight Loss Drugs · Morning Medical with Dr. Chow

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Good morning and welcome to Morning Medical with Dr.
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Chow, your daily dose of the latest medical and health news from around the globe.
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I'm your host, Dr.
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Chi-Ming Chow.
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Today, we'll be diving into some important updates, including the approval of an updated
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COVID-19 vaccine by Health Canada, new insights into the origins of COVID-19, and more.
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So, let's get started with today's top story.
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Health Canada has just authorized an updated version of Novavax’s COVID-19 vaccine, known as
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Nuvaxovid.
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This new formulation is designed to protect against the currently circulating variants of
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the virus, specifically targeting the JN.1 subvariant of Omicron.
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This is a significant update from the previous version, which targeted the XBB.1.5 subvariant
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of Omicron.
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The approval comes at a crucial time as Health Canada has recently instructed provinces and
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territories to dispose of their older COVID-19 vaccines.
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This measure ensures that only the most current and effective vaccines will be used during this
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fall’s respiratory virus season.
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Many provinces have already complied by destroying their expired and unused shots that
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targeted the earlier XBB variant.
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In addition to Novavax, Health Canada has also approved Moderna’s updated mRNA COVID-19
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vaccine earlier this week.
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They are still in the process of reviewing Pfizer’s updated mRNA vaccine, with a decision
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expected soon.
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This series of approvals is part of Health Canada's ongoing efforts to ensure that
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Canadians have access to the most effective tools in combating COVID-19 as the virus
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continues to evolve.
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The updated Nuvaxovid vaccine is protein-based, which differentiates it from the mRNA vaccines
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developed by Moderna and Pfizer.
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This type of vaccine uses a different mechanism to stimulate an immune response, potentially
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offering an alternative for those who may have concerns about mRNA vaccines.
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As we approach the fall and winter months, it's more important than ever to stay informed about
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the latest developments in COVID-19 vaccines.
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The updated vaccines are expected to play a critical role in reducing the spread of the
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virus and protecting vulnerable populations during the respiratory virus season.
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That's it for this segment on the updated Novavax COVID-19 vaccine.
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Stay tuned as we continue to bring you the latest in medical and health news.
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Up next, we’ll explore new genetic evidence shedding light on the origins of COVID-19.
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Don't go away.
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A team of scientists says it is “beyond reasonable doubt” that the COVID-19 pandemic
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started with infected animals sold at a market, rather than from a laboratory leak.
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They were analyzing hundreds of samples collected from Wuhan, China, in January 2020.
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The results identify a shortlist of animals – including raccoon dogs, civets, and bamboo rats
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– as potential sources of the pandemic.
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Despite even highlighting one market stall as a hotspot of both animals and coronavirus, the
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study cannot provide definitive proof.
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The samples were collected by Chinese officials in the early stages of COVID-19 and are one of
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the most scientifically valuable sources of information on the origins of the pandemic.
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An early link with the Huanan Seafood Wholesale Market was established when patients appeared
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in hospitals in Wuhan with a mystery pneumonia.
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The market was closed, and teams swabbed locations including stalls, the inside of
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animal cages, and equipment used to strip fur and feathers from slaughtered animals.
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Now, a team in the United States and France says they have performed even more advanced
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genetic analyses to peer deeper into COVID-19’s early days.
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It involved analyzing millions of short fragments of genetic code – both DNA and RNA –
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to establish what animals and viruses were in the market in January 2020.
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"We are seeing the DNA and RNA ghosts of these animals in the environmental samples, and some
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are in stalls where the COVID virus was found too," says Professor Florence Débarre, of the
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French National Centre for Scientific Research.
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The results, published in the journal Cell, highlight a series of findings that come
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together to make their case.
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It shows COVID virus and susceptible animals were detected in the same location, with some
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individual swabs collecting both animal and coronavirus genetic code.
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This is not evenly distributed across the market and points to very specific hotspots.
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"We find a very consistent story in terms of this pointing - even at the level of a single
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stall - to the market as being the very likely origin of this particular pandemic," says
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Professor Kristian Andersen, from the Scripps Institute in the United States.
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However, being in the same place at the same time is not proof any animals were infected.
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The animal which came up most frequently in the samples was the common raccoon dog.
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This has been shown to both catch and transmit COVID-19 in experiments.
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Other animals identified as a potential source of the pandemic were the masked palm civet,
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which was also associated with the SARS outbreak in 2003, as well as hoary bamboo rats
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and Malayan porcupines.
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The experiments have not been done to see if they can spread the virus.
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The depth of the genetic analysis was able to identify the specific types of raccoon dogs
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being sold.
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They were those more commonly found in the wild in South China rather than those farmed for
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their fur.
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This gives scientists clues about where to look next.
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The research teams also analyzed the genetic code of the viral samples found in the market,
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and compared them to samples from patients in the early days of the pandemic.
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Looking at the variety of different mutations in the viral samples also provides clues.
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The samples suggest, but do not prove, that COVID-19 started more than once in the market
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with potentially two spillover events from animals to humans.
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The researchers say this supports the idea of the market as the origin, rather than the
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pandemic starting elsewhere with the market adding fuel to the fire in a super-spreading
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event.
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The scientists also used the mutations to build the virus’s family tree and peer into its past.
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"If we estimate when do we believe most likely the pandemic started versus when do we believe
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most likely the outbreak at the market started, these two overlap, they’re one and the same,"
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says Professor Andersen.
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In their scientific publication, the full genetic diversity of coronavirus seen in the
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early days of the pandemic was found at the market.
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Professor Michael Worobey, of the University of Arizona, said: "Rather than being one small
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branch on this big bushy evolutionary tree, the market sequences are across all the branches of
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the tree, in a way that is consistent with the genetic diversity actually beginning at the
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market."
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He said this study, combined with other data – such as early cases and hospitalizations being
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linked to the market – all pointed to an animal origin of COVID-19.
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Professor Worobey said: "It's far beyond reasonable doubt that this is how it happened",
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and that other explanations for the data required "really quite fanciful absurd
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scenarios".
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"I think there's been a lack of appreciation even up until now about how strong the evidence
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is."
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The lab-leak theory argues that instead of the virus spilling over from wildlife, it instead
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came from the Wuhan Institute of Virology, which has long studied coronaviruses.
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It is located a 40-minute drive away from the market.
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The United States intelligence community was asked to weigh up the likelihood of a leak –
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either accidental or deliberate.
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In June 2023, all the agencies involved said either a leak or animal origins were plausible
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scenarios.
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The National Intelligence Council and four other agencies said animals were the likely
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source.
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The FBI and the Department of Energy thought it was more likely to be a laboratory incident.
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Professor Andersen said: "To many this seems like the most likely scenario - 'the lab is
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right there, of course it was the lab, are you stupid?'.
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I totally get that argument." However, he says there is now plenty of data that "really points
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to the market as the true early epicenter" and "even locations within that market".
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Identifying the animals that could have been the source of the pandemic does provide clues
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to where scientists could look for further evidence of an animal origin.
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However, because farms destroyed their animals in the early days of COVID-19 it means there
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may no longer be any evidence left to find.
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"In all likelihood, we missed our chance," says Professor Worobey.
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Professor Alice Hughes, from the University of Hong Kong, who was not involved in the
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analysis, said it was a "good study".
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"[But] without swabs from the actual animals in the market, which were not collected, we cannot
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obtain any higher certainty." Professor James Wood, the co-director of Cambridge Infectious
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Diseases, said the study provided "very strong evidence" of the pandemic starting in wildlife
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stalls at the market.
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However, he said it could not be definitive because the samples were collected after the
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market closed, and the pandemic probably started weeks earlier.
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And he warned "little or nothing" was being done to limit the live trade in wildlife, and
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"uncontrolled transmission of animal infections poses a major risk of future pandemics".
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People who are pregnant or trying to get pregnant are advised by their health-care
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providers to stay away from alcohol because of the potential risks to their baby.
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But what are these risks, as U.S.
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data suggests a small increase in recent years in the number of people drinking during
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pregnancy and amid Fetal Alcohol Spectrum Disorder Awareness Month?
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According to the Centers for Disease Control and Prevention, 13.5 percent of pregnant adults
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in the United States reported current drinking between 2018 and 2020, and 5.2 percent reported
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binge drinking.
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These measures were up by 2 percentage points compared to the 2015 to 2017 period.
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In Canada, it is estimated that 10 to 15 percent of pregnant women use alcohol during
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pregnancy.
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"We know that there is no safe amount of alcohol that should be consumed during
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pregnancy, and as a result, the impact of alcohol consumption in pregnancy can vary
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depending on the exposure," Dr.
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Naana Jumah, an obstetrician-gynecologist in Thunder Bay, Ontario, said in an interview with
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Global News.
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The Society of Obstetricians and Gynecologists of Canada also states that “abstaining from
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alcohol during pregnancy is the safest option.” Dr.
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Jumah said it does not matter which trimester a person is in; the no-alcohol guidance applies
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throughout pregnancy.
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"We cannot say that there is a certain amount that will not result in having any problems at
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all.
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So really, the safest thing is to not consume alcohol in pregnancy, and that will prevent
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these issues with growth and development for the child."
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For people who are not pregnant, the latest national guidance in Canada that was released
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last year recommends limiting alcohol consumption to two drinks or less per week.
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One of the known risks of drinking during pregnancy is fetal alcohol spectrum disorder,
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which is estimated to impact approximately four percent of the Canadian population.
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Fetal alcohol spectrum disorder is a lifelong but preventable disability that affects the
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brain and body of someone who was exposed to alcohol in their mother’s womb, according to
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Health Canada.
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Jocelyn Cook, chief scientific officer of the Society of Obstetricians and Gynecologists of
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Canada, said fetal alcohol spectrum disorder is a “constellation of effects” of prenatal
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alcohol exposure during pregnancy and these impact different people differently.
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"When an individual has fetal alcohol spectrum disorder, they meet criteria for brain effects,
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neurodevelopmental disabilities and issues with learning and development," said Cook, who is
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also the senior research lead for the Canada Fetal Alcohol Spectrum Disorder Research
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Network.
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A diagnosis can sometimes be made as early as when the baby is still in the womb through an
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ultrasound, Dr.
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Jumah said.
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But oftentimes this is something that is picked up after a baby is born, she said.
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In newborns, there are three facial features strongly associated with prenatal alcohol
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exposure that doctors look for, Cook said.
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These include small eye openings, a thin upper lip and a little dent between the nose and
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upper lip.
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If a baby is not gaining weight as well as they should or rolling over, this could also point
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to fetal alcohol spectrum disorder, Dr.
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Jumah said.
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However, most of the diagnosis is made later in school-aged children.
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Neurobehavioral clues that signal fetal alcohol spectrum disorder include having trouble
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sitting and paying attention in class, lagging behind academically, difficulty in learning
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language or reading, as well as issues with social interactions, experts say.
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According to the Canada Fetal Alcohol Spectrum Disorder Research Network, this disorder
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impacts more people in Canada than autism, cerebral palsy and Down syndrome combined.
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September marks Fetal Alcohol Spectrum Disorder Awareness Month, and experts say drawing
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attention to this disorder is key to preventing it and supporting those who suffer from it.
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The only way to prevent fetal alcohol spectrum disorder is to not consume alcohol during
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pregnancy.
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"It is really a simple intervention, but for some people it can be quite difficult,
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especially people who have issues with alcohol use and it is really important to support those
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individuals to limit their consumption during pregnancy and to help them to make better
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choices," Dr.
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Jumah said.
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Cook said individuals with fetal alcohol spectrum disorder have many strengths and they
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can be very successful, but they do need “some patience and understanding and that comes from
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awareness and education.”
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A Senate bill by an independent senator is calling to develop a national framework on
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fetal alcohol spectrum disorder that would set out standards for prevention, diagnosis and
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support measures for those who are impacted by it.
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Besides the potential risks to the baby, alcohol may also have negative health
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implications for the expectant mother.
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Cook said alcohol is “an empty source of nutrition,” so it replaces calories from other
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healthy options that can fuel both mom and baby.
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Physiologically speaking, alcohol is “ubiquitous” as it affects different cells and
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organs and that can put “chemical stress” on the developing body, she said.
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Binge-like alcohol exposure late in pregnancy is also associated with preterm birth and small
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for gestational age babies.
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Preterm birth is when the baby is born before 37 weeks of pregnancy.
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Small for gestational age birth is when the baby is born with a birth weight below the
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tenth percentile among an infant population of the same sex and gestational age.
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Let's move on to our next topic: the potential impact of GLP-1 weight loss drugs on mood.
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These medications, specifically semaglutide and tirzepatide, are sold under the brand names
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Wegovy and Zepbound.
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Originally intended to treat type 2 diabetes, they've become increasingly popular for weight
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loss.
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However, some users have reported experiencing heightened feelings of anxiety, depression, and
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even suicidal ideation, prompting an investigation by the United States Food and
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Drug Administration.
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The September 3 report published in the journal JAMA Internal Medicine shows that there are "no
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clinically meaningful differences" in mental health scores between people using semaglutide
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and those who are not.
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This study, led by Dr.
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Thomas Wadden, a researcher on obesity treatment and a professor of psychology in
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psychiatry at the Perelman School of Medicine at the University of Pennsylvania, aligns with
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the ongoing investigation by the United States Food and Drug Administration, which has also
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not yet found evidence of increased risk of suicidal ideation.
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Dr.
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Davide Arillotta, a resident doctor in the department of neurosciences, psychology, drug
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research, and child health at the University of Florence in Italy, notes that the interplay
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between the medication and mental health is complex.
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He explains that receptors for GLP-1 are found in the pancreas, the gut, and several regions
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of the brain involved in mood regulation.
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These receptors can affect the release and activity of neurotransmitters such as dopamine
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and serotonin, which play a crucial role in emotional well-being.
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For these reasons, GLP-1 receptor agonists are thought to have antidepressant effects.
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Dr.
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Peter Ueda, an assistant professor and resident physician in endocrinology at the Karolinska
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Institutet and Centre for Diabetes in Stockholm, Sweden, suggests that because type 2
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diabetes and depression can have overlapping causes, GLP-1 drugs that improve diabetes
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markers could also improve mental health outcomes.
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Dr.
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Ueda was not involved in Dr.
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Wadden's study but was a researcher on another study on GLP-1 drugs and suicidality risk, also
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published on September 3 in JAMA Internal Medicine.
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Tara Schmidt, lead dietitian at the Mayo Clinic Diet, an online weight loss program, points out
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that the changes in blood glucose levels induced by GLP-1 medications could impact mood.
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She explains that extremes in blood sugar can lead to irritability or anxiety.
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If you are not meeting your calorie and nutrient needs due to side effects or simply a
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lack of hunger, this undernourishment can become a factor in low mood.
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Dr.
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Amira Guirguis, professor of pharmacy and MPharm program director at Swansea University
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in Wales, adds that the social and lifestyle changes accompanying weight loss can also play
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a role.
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For some, the societal approval that often follows weight loss generates pressure to
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sustain the new body size, potentially encouraging harmful practices like restrictive
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dieting or excessive exercise.
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These changes can exacerbate symptoms of body dysmorphic disorder, resulting in increased
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anxiety, depression, and suicidal ideation.
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Dr.
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Wadden emphasizes that the relationship with food and weight might have been protective for
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some people, particularly those who have experienced trauma or abuse.
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Losing weight can make these individuals feel vulnerable, and the social and lifestyle
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changes that come with rapid weight loss may require other aspects of life to change, such
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as coping strategies or relationships.
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This can be overwhelming and affect mental health.
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To protect your mood while taking GLP-1 medications, experts recommend taking an
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intentional approach to meeting your calorie, nutrient, and hydration needs.
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Tara Schmidt suggests treating this like a schedule, ensuring you have balanced meals at
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regular intervals.
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Avoid high-sugar, ultra-processed foods and beverages, and incorporate regular exercise and
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adequate sleep into your routine.
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For those with existing severe depression or suicidal ideation, it's crucial to pay careful
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attention to mood changes when starting any medication, including GLP-1 drugs.
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Discuss your history of significant mental illnesses with your doctor before starting
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these medications.
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Even if you do not have such a history, work closely with your healthcare team and discuss
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any mood changes you notice.
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Dr.
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Wadden advises not to navigate this journey alone.
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While social media can be a great source of support and wisdom, it's essential to check in
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with health professionals.
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Keeping an open line of communication with your healthcare provider can help you manage any
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potential mental health effects while on GLP-1 medications.
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That wraps up today's episode of Morning Medical with Dr.
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Chow.
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We've covered a range of important topics, from the approval of an updated COVID-19 vaccine by
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Health Canada to the complexities of mood changes associated with GLP-1 weight loss
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drugs.
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Remember to stay informed and consult your healthcare provider for any medical concerns.
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Thank you for tuning in, and we'll see you tomorrow for another update on the latest in
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medical and health news.
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Have a great day!