29 November Blog Post: COVID Update

29 November Blog Post: COVID Update

Three days ago, while we were all enjoying a return to “normal” Thanksgiving, the World Health Organization designated a new variant of concern (B.1.1.529), which they named Omicron. The variant was first reported to WHO from South Africa on 24 November 2021. About 24% of the population of South Africa is considered fully vaccinated.
The epidemiological situation in South Africa has been characterized by three distinct peaks in reported cases as seen in Figure 1 below.
The most recent peak (June through September 2021) was predominantly due to the more transmissible Delta variant. Interestingly, case rates after peaking then dropped below previously seen baseline levels perhaps reflecting concurrent vaccine uptake. You can see from Figure 1 that infections have markedly increased over the past several weeks. The first known confirmed B.1.1.529 infection was from a specimen collected on 9 November 2021.
So why is this particular variant concerning? Primarily because it has a large number of mutations any one of which can confer either an increased risk of transmissibility, severe disease or death. The number of cases of this variant appears to be increasing in almost all provinces in South Africa and has been detected at faster rates than previous surges in infection (although this finding may simply reflect an increased availability and accessibility of testing).
Multiple countries have already reported the presence of the variant, including a case in Belgium with no known travel history to South Africa (indicating community-based spread, link: https://www.euronews.com/…/germany-reported-first…) and, as of this morning, in Canada (link: https://www.washingtonpost.com/…/covid-omicron-variant…/). Undoubtedly cases already exist in the United States.
Omicron, while having concerning features, isn’t really a huge unknown as we have had successive waves of COVID-19 allowing us to refine our public health and personal response. So here are the big questions, point by point.
Transmissibility: It is not yet clear whether Omicron is more transmissible (e.g., more easily spread from person to person) compared to other variants, including Delta. Although I would be hard pressed to imagine a variant more transmissible than delta. Travel bans make little sense at this point, given its likely wide detection only 5 days after being reported to the WHO. How do we cut down on transmissibility? Increasing ventilation, participating in outdoor activities over indoor ones (difficult as the weather turns colder), wearing a mask indoors (preferably an N95 which are now widely available), washing your hands, and covering your sneeze/cough. Oh and staying home from work when you are sick!
Severity of disease: This is probably the most important feature – and it is not yet clear whether infection with Omicron causes more severe disease compared to infections with other variants, including Delta. Preliminary data suggests that there are increasing rates of hospitalization in South Africa, but this may be due to increasing overall numbers of people becoming infected, rather than a result of specific infection with Omicron. There is currently no information to suggest that symptoms associated with Omicron are different from those from other variants.
Effectiveness of prior SARS-CoV-2 infection: This is a big question mark for Omicron and for other variants as well. Those who follow my blog know that I am not a big proponent of community-acquired infection as a pathway to immunity given the risks of morbidity/mortality and long term effects from infection.
Effectiveness of vaccines: This question goes hand in hand with the severity of disease topic above. Vaccines remain critical to reducing severe disease, hospitalization, ICU admission and death, including against the currently dominant circulating variant, Delta. Current vaccines remain effective against severe disease and death and should be an impetus towards
There has been a steep drop off in vaccination doses administered in South Africa over the past several months despite 75% of the country remaining unvaccinated. This is a trend that needs to be reversed
The United States isn’t doing much better, with a sharp decline in vaccines given over the last week (due to the Thanksgiving Holiday) and much of the slow rise from October representing booster doses. Only 58% of the US population has received two doses of the vaccine.
Effectiveness of current tests: The widely used PCR tests continue to detect infection, including infection with Omicron, as we have seen with other variants as well. Studies are ongoing to determine whether there is any impact on other types of tests, including rapid antigen detection tests. If Omicron is indeed more transmissible it would be expected to produce a higher viral load which would, in turn, make antigen testing even more accurate than it is already.
Effectiveness of current treatments: There would be little reason to think that Omicron would not respond to treatments, of which we now have many. For those with early and symptomatic COVID-19 as well as risk factors for progression to severe disease, monoclonal antibodies delivered by IV infusion have significant benefit. Novel antiviral agents (molnupiravir and Paxlovid) are waiting in the wings for approval, although the more recent analysis of molnupiravir’s 5 day treatment shows a lowered effectiveness as compared to preliminary data.
A study of Fluvoxamine (a medication given for depression and obsessive-compulsive disorder at 100mg given twice daily for 10 days) showed a reduction in COVID-19 mortality by 90% and a reduction in ICU admissions by 65%.
We have all been to this COVID rodeo before. Delta was a game-changer, for sure, with increased viral loads and high transmissibility leading even to spread among those already vaccinated. But vaccination has significantly reduced the risk of severe disease, hospitalization and deaths. It seems likely that Omicron is already responsible for community-based spread in various regions across the world, and the same will occur here. But vaccination, boosters, N95 masks, handwashing, frequent testing (preferably with cheaper rapid antigen tests that can lead to earlier detection than PCR), and ventilation will all reduce its individual and collective impact.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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Timing of the test matters too

While being #COVID19 tested is important, the timing of the test matters too. Today we are outdoor, rapid antigen testing students after returning from Thanksgiving travel and before starting back to school.

The Critical Challenge of Tracking Breakthrough Infections, and Why We Still Need Better Data Standards

The Critical Challenge of Tracking Breakthrough Infections, and Why We Still Need Better Data Standards

Despite ample vaccine supplies, outbreaks among unvaccinated populations in the US and the appearance of the Delta variant promote infection in fully vaccinated individuals. These breakthrough infections must be carefully tracked.
As the percentage of Americans considered fully vaccinated reached 58 percent, and Covid-19-related deaths surpassed three quarters of a million, concerns over breakthrough infections continue to grow. Breakthrough infections tend to be mild, and the risk of secondary transmission from these infections, while real, especially in high-risk settings, is low compared to those who have not been fully vaccinated. What do breakthrough cases mean in the context of ending this pandemic? The answer is neither simple nor short.
How are states reporting breakthrough infection data?
Between March 2020 and March 2021, The COVID Tracking Project collected data on Covid-19 tests, cases, hospitalizations, and deaths from all 50 U.S. states, the District of Columbia, and five U.S. territories. These metrics were inconsistently defined and reported by the 56 jurisdictions. The same seems to be true of the tracking of metrics associated with breakthrough cases, resulting in a similar patchwork of data and creating an incomplete picture of the true incidence of Covid-19 infections in fully vaccinated individuals in the U.S.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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17 November 2021 Blog Post: Mix and Match

17 November 2021 Blog Post: Mix and Match

With three options for initial adult vaccinations (J&J, Pfizer and Moderna) and three choices for boosters (J&J, Pfizer and Moderna), is there a ‘best’ option of vaccine + booster? Do you stick with the same or consider a ‘mix and match’ scenario?

Unsurprisingly (for those of you that have been following the pandemic), there are very little data available to help make this decision. The only head to head study comes from the NIH (link: https://www.medrxiv.org/content/10.1101/2021.10.10.21264827v2.full), in which 458 volunteers who had been fully immunized with either Pfizer’s, Moderna’s or J&J’s shot were given a booster four to six months after completing their initial vaccine regimen. They were divided into groups based on the vaccine they first received, then given either a matching booster from the same developer or a shot from one of the other two. Each group has only about 50 observations (range: 48-51). The table below summarizes the observed increase in antibody binding Units/ml with the Day #1 to Day #15 increases associated with each mix/match scenario. 

The paper does include antibody levels up to Day #29 for all groups except for those receiving the Pfizer booster. So to present as complete as data as possible, results from Day #15 are summarized here:

So what do we see from these data?

  1. In all cases, the additional dose increased antibody levels against the coronavirus, a change that’s generally associated with greater protection from COVID-19.
  2. At  baseline (month 4-6 from primary vaccine series completion), J&J has significantly lower antibody levels than the mRNA vaccines (Pfizer/Moderna). 
  3. Moderna had the highest antibody levels at baseline among all 3 vaccine groups
  4. Moderna also appeared to provide the biggest ‘boost’ among all 3 vaccine groups
  5. Boosting an initial J&J vaccination with either of the mRNA vaccines appeared to provide a much higher (nearly 10-fold) neutralizing antibody level (2549, Pfizer; 3203, Moderna) than did a second J&J (326)

But here is the biggest limitation:  the Moderna dose used in the study was the 100 microgram dose currently authorized, rather than the 50 microgram dose the company has requested and was subsequently FDA approved as a booster shot. (The New York Times commented that ‘it seems unlikely there will be much of a difference” – link: https://www.nytimes.com/2021/10/27/well/live/covid-booster-shot-mix-and-match.html).  

However, with the recommendation for everybody in the State of California over the age of 18 to now receive a booster, it would have been helpful to have more robust data to support matching or mixing.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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06 November 2021 Blog Post: A Guide to Your Local Indian Grocery Store

6 November 2021 Blog Post: A Guide to Your Local Indian Grocery Store

This is something completely different than our usual posts – but in the spirit of Diwali, the Hindu festival of lights, it is a timely post.  The is a great read and gas good insight into Indian grocery stores here in Los Angeles.  My favorite store is the Culver City location of India Sweet and Spices (he references the store in Los Feliz). Not only do they have grocery items, but also a takeout counter (all vegetarian), samosas, desserts and even South India dishes like dosa and idli.
For those of you who may not know, I spent my last two years of High School at a boarding school in Northern India. Diwali was the biggest holiday of the year – not counting India/Pakistan cricket test matches. Fireworks, lights and a genuinely festive environment characterized the holiday and it was a true celebration.
Like Nik Sharma (the author of this article), I too am a fan of garlic and mixed pickle (aachars). I’ve been more liberal with its use now that we are all wearing masks!

A Guide to Your Local Indian Grocery Store

by: Nik Sharma

Hello, Hello!

Happy belated Diwali 🪔

I hope y’all ate a lot of good Indian food and sweets last night.

Unsurprisingly, our Diwali celebration at home was smaller than previous years. In the past I invited our family, friends, and colleagues over for dinner but with the house being packed up for the remodel, it didn’t make sense to host a big party. We decorated with fresh marigolds and lit the diyas (the little clay lanterns) to bring in the holiday spirit. Now this might sound like a glorious feast for a handful of people at a tiny Diwali dinner but I love to include several different dishes at the table. We had pooris, potatoes in a spiced tomato gravy,a smoked eggplant raita, chole, saag paneer, and lots of aachars (Indian pickles that I got from my local Indian grocery store in L.A.). Of course, the meal ended with a lot of sweets with gulab jamuns, ladoos, sandesh, ras malai and kaju katli among others. The last two desserts were sparingly shared because those two belong in my top tier Indian sweets. And kheer, I can’t believe I forgot to mention kheer, since it’s rice pudding, I like to eat that for breakfast too (IMO it’s basically a high-end version of cereal).

When people ask me where is the best place for them to find ingredients like curry leaves or asafoetida/hing and other ingredients used in Indian cooking, I tell them to first ask their local Indian restaurant where they source their ingredients from, second look on the internet to see if there is an Indian grocery store near them, and if all else fails, buy the ingredients online. My go-to store in L.A. is India Sweets and Spices in Los Feliz, this is a big store and I think one of the biggest ones I’ve been to in America (They also sell cooking utensils for Indian restaurants). They also sell food to order. When we lived in Oakland, CA, Vik’s Chaat House and Bombay Spice House were the two stores I visited the most.

A couple of tips when visiting the Indian grocery store to make the experience fun and easy,

  • Avoid going on the day of a holiday like Diwali, it can get crowded. I like to go a day or two ahead of time and then get my shopping done.

  • Like any trip to a grocery store, go with a list. It’s easy to get side tracked.

  • Ask for help! If you are unfamiliar with spices, the brands, etc. ask the store owner for help. Since I haven’t lived in India in more than two decades, I’m unfamiliar with many of the newer brands. I usually ask my mother, sister (who live in India) and of course, the store owner. Store owners and their staff are always so helpful and willing to help. The good thing with a smartphone is that you can pull up a photo of the ingredient and then hunt for it.

  • Indian stores sell ingredients in various sizes. I prefer to buy smaller quantities for ingredients I won’t go through as fast. You don’t want a large bag of fennel or ground chillies, if you aren’t using them often. Spices like most food even though they’re dried will lose their potency over time. Even flours like atta will smell a little off, if they get old (the naturally present oils in grains go rancid).

  • There seems to be a notion that in India everyone grinds their own spices to make masalas/spice blends from scratch and pickle their own aachars, I want to dispel this myth. It’s partially true. Just like in the West, Indian people also prefer convenience in the kitchen just like everyone else. If we have the time and want to make them from scratch we will, there ain’t no shame in store-bought.

  • Some stellar spice brands include Everest, Priya, and MDH. There are subtle differences in flavor because of regional preferences of consumers in India but they’re all good.

  • This is more of a spice specific purchasing note, when buying asafoetida/hing check the label to see if it is cut (mixed) with wheat flour or rice flour if you’re gluten intolerant.

  • Indian cookies aka biscuits are very good and they form a huge huge part of our daily chai ritual. The cookie options are endless and I highly recommend grabbing some to try e.g. Parle G, Marie, Good Day, Bourbon, Krack Jack, are some of my favorites from childhood (and in adulthood).

  • Maggie’s Hot and Sweet Tomato Ketchup, get it and use it wherever you would ketchup.

  • Buy aged basmati rice, at least one that says it’s a year old. Aged basmati carries the strongest aroma because the grains are allowed to rest and develop their fragrance.

  • Curry leaves, frozen coconut, dried coconut, frozen drumsticks, frozen okra, jaggery (they usually sell sugarcane jaggery and not palm jaggery) are just some of the ingredients that you will find at your Indian grocery store.

  • Get your Diwali diyas and Indian cookware here! Rolling pins, large serving spoons, dosa ladles, katooris (small metal bowls to serve food), clay pots to make yogurt, etc. here.

  • I also buy a lot of things I probably don’t need, I’ve been known to do some impulse purchasing.

    Those of you that have a favorite local Indian grocery store, share it in the comment section below so people can find out where you shop. If you live in L.A. and have a spot you think I need to try out, please let me know! I’m still new to L.A. and learning so much about this lovely city.


In the spirit of Diwali, I’m sharing some of my favorite South Asian food creators whose products I love to use in my kitchens. Please check them out (hint, there are lots of great holiday gift ideas here.).

Brooklyn Delhi If you want to learn more about and taste Indian aachars (pickles) this is your spot. They also recently released a simmer sauce line that will make cooking Indian food easier especially during the busy week. I use their tomato aachar to dip my leftover pizza crust and eat but it’s also great in sandwiches. Chitra Agarawal who started this company is one of my oldest friends in the food world, we both started out blogging many years ago and she’s also written a stellar cookbook on South Indian food called Vibrant India

Diaspora Co. My friend Sana Javeri Kadri, who started this company, sells the brightest turmeric I’ve ever used. Diaspora Co. makes sure the farmers in India and Sri Lanka are compensated properly for their work and also ensures fair trade and ethical practices are met in production. They’ve got 30 fantastic spices to choose from and they sell a brass tinted masala dabba – a spice container that makes a fantastic and glamorous addition to any kitchen.

Spicewalla by Chef Meherwan Irani and based in Asheville, N.C. this is another lovely and reliable place to buy small quantities of spices both common to Indian cooking and other world cuisines. They’ve got a huge selection of spice blends, rubs, and more to choose from. I love their Kashmiri chilli powder for its robust smoky flavor and bright red color. I use a lot of their products when I cook at home and for my cookbooks.

Madhu Chocolates Full credit for finding this amazing brand of chocolate goes to my husband who did his research and got this as a birthday gift for me Madhu chocolates makes some of the most delicious and innovative flavor pairing combinations that I’ve eaten. Their saffron infused chocolate and cashew coconut milk are two of my favorites.

Just Date Syrup When I don’t have the time to make date syrup, I get a bottle of date syrup Just Date Syrup along with a jar of their Chai Caramel. These are essentials that your pantry should have in stock all the time. Thick crisp wedges of apples dipped into that jar of chai caramel is pure joy!

What I’m reading this weekend:

I’m not reading too much this week. I need to wrap up testing the recipes for my next cookbook or my lovely and very patient tester, Lisa might kill me. I see the finish line in sight!

What I’m watching this weekend:

I’ve got to wrap up the final episode of The Long Call on Britbox this weekend. It’s based off the book by Anne Cleeves and so far, I’ve enjoyed it. I won’t give much away but the videography and soundtrack are absolutely wonderful.

CTTO: https://niksharma.bulletin.com/258480299569751/

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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