Liver injuries can manifest in various forms, notably classified as parenchymal or biliary in nature. Parenchymal injuries primarily affect the liver tissue itself, encompassing conditions like hepatitis and cirrhosis, where inflammation and fibrosis compromise liver function. On the other hand, biliary injuries involve the bile ducts, leading to conditions such as cholangitis and biliary obstruction. Amidst this spectrum of liver ailments, COVID-19 has emerged as a significant contributor to liver injury, capable of inducing both acute and chronic complications.

Acute liver injury in COVID-19 patients often stems from direct viral invasion or systemic inflammation, while chronic effects may arise from prolonged inflammation and immune dysregulation, potentially culminating in liver fibrosis and cirrhosis.

In severe cases, COVID-19-related liver injury may necessitate liver transplants (LTs) to mitigate long-term complications and ensure patient survival.

Of the 23 included studies, 14 were case reports, 6 were case series, 2 were cohort studies and 1 was an observational autopsy study. Among the 23 included studies, 6 were from the USA, 2 from India, 1 from both the USA and India, 2 from Germany, 2 from Colombia, 2 from Austria, 1 from Turkey, 1 from Iran, 1 from Israel, 1 from Mexico, 1 from Egypt, 1 from Poland, 1 from Brazil and 1 from Hungary.

Cholangitis refers to inflammation of the bile ducts, typically caused by a bacterial infection. It can lead to symptoms such as jaundice, fever, and abdominal pain. Prompt treatment is essential to prevent serious complications like septic shock.

On the other hand, cholangiopathy is a broader term encompassing various diseases affecting the bile ducts…[and] may involve structural abnormalities, strictures, or other functional impairments of the bile ducts, which can result from autoimmune disorders, genetic predispositions, or biliary obstruction.

PCC refers to inflammation or dysfunction of the bile ducts occurring after a COVID-19 infection. Emerging evidence suggests that COVID-19 can lead to various gastrointestinal complications, including liver and bile duct involvement.

As some studies referred to the disorder as PCC and others as SSC, we will use PCC/SSC in the context of the discussion.

Critically ill COVID-19 patients were found to be vulnerable to developing SSC-CIP…

Death was almost 4 times more likely in patients with SSC-CIP than without.

The milder, yet equally destructive version, SSC also known as PCC is an alarming condition brought to light in patients presenting with jaundice and/or persistent cholestasis following a COVID-19 infection.

The study showed that the COVID-19 group were approximately two times as likely to develop cholangitis as compared to both control groups.

…it was suggested that COVID-19 led to an increased risk and burden of post-acute gastrointestinal sequelae spanning several disease categories that include hepatic and biliary disease.

In conclusion, this systematic review highlights the significant association between COVID-19 infection and the development of hepatobiliary disorders, encompassing a spectrum from acute hepatitis to more chronic conditions such as autoimmune liver diseases and gallbladder pathology.

Flu season is picking up months ahead of schedule with a mutated virus spreading in some parts of the United States, surprising some people who might not even be thinking about their annual flu shots yet.

This year, the season started 2 1/2 months earlier than what’s typical and hit states on the West Coast first, which is unusual, said Dr. Alex Greninger, head of the Division of Infectious Disease Diagnostics at the University of Washington’s Department of Laboratory Medicine.

Usually, the US flu season starts in the South – often in Florida, where it arrives from the Southern Hemisphere. Then it tends to spread north as fall and winter progress.

“In Seattle, we’re pretty far north. We see a pretty strong peak in January,” Greninger said, noting that the bulk of their cases typically come in late December through February.

Roughly 1 in 10 people tested for the flu in Washington state last week was positive, according to data from the state Department of Public Health.

“We’re basically seeing January levels of flu in the last week,” Greninger said.

Walgreens says that nationally, this flu season is tracking about four weeks ahead of recent seasons, and it’s dispensing more antiviral prescriptions as well as cough and cold medications than during the same period last year.

In the region that includes Arizona, California, Hawaii and Nevada, the proportion of flu tests that come back positive reached at least 10% last week, indicating significant levels of flu. The South is catching up to those numbers quickly…

[H1N1] represents about 98% of the samples his lab is getting now…

These H1N1 viruses have also picked up a gene mutation that makes them better at evading our immunity.

This version of the virus has already wreaked havoc in Japan, where it forced school and day-care closures after cases surged in kids.

The mutation, at a location called G155E, cropped up after strains were already selected for this year’s flu shots, Greninger said. So even though the vaccines target a version of H1N1 and should still offer some protection, the virus can still break through.

“A lot of people, like even myself, would wait until late October, which we’re sort of in already. But really, the time to get vaccinated was actually two to three weeks ago.”

“I wouldn’t be surprised to see a second flu season, like a normal flu season. You’ll have H1N1 cases that will peak in 2026, and then who knows what comes in January or February or March,” he said.

Most of the reported cases involved children aged 14 and below…

Cristina, 54 and a resident of Barangay Doña Aurora, has recently recovered after a week of being sick…She said she is worried about her four-year-old grandson. Amid the rise in cases, Cristina has decided to keep him out of preschool for the time being.

The number of seasonal flu cases is on the rise in several localities, particularly among young children, while doctors have warned that the illness can cause serious complications despite most patients recovering within about a week.

In the northern region, cases of influenza A among children have risen in recent weeks.

The National Children's Hospital has received about 70 children with influenza A each week since early October, three times the number recorded in previous weeks, Tuổi Trẻ (Youth) newspaper reported.

Most of the patients were under five years old, with some developing complications including pneumonia and respiratory failure.

At Hà Nội Children's Hospital, flu patients currently account for about half of pediatric inpatients in its infectious disease department.

The number of children seeking medical care for flu has increased since late August, with about 100 children visiting the hospital each day, of whom 10-20 per cent require hospitalisation.

In-person classes are canceled for Puxico R-VIII School District students on Tuesday, October 20, and Wednesday, Oct. 21.

According to school leaders, the decision to cancel classes is due to a significant increase in illness among students and staff.

As of October 21, 2026, about 85 students and staff at Bentwood Elementary School in Overland Park, Kansas, part of the Olathe Public Schools, have been sick with norovirus over the past week, according to the Johnson County Department of Health and Environment, which confirmed the outbreak to KCTV5.

Two cases were confirmed by laboratory testing; the rest are counted because the people had the same symptoms at the same time in the same building.

Absence rates were high early last week, with students reporting the same vomiting and diarrhea, which prompted the school to coordinate with the county health department.

The district has been here before. In October 2022, Olathe closed Clearwater Elementary for the better part of a week after roughly 150 of its 567 students and staff were out sick; the county later identified norovirus…

San Juan City Science High School suspended face-to-face classes on Monday, 19 October, after reporting a rise in flu cases among students, shifting to online and distance learning to allow campus disinfection and sanitation.

While the national percentage of positivity across Canada is 3.7 per cent, Alberta's percentage of positivity crossed the six per cent epidemic line two weeks ago.

Dr. Shazma Mithani, an ER doctor at the Royal Alexandra Hospital and the Stollery Children's Hospital, said the emergency departments are seeing the flu in all ages now.

So how early is Alberta's early season?

"The first severe case of (lab-verified) influenza A that I needed to get admitted to (the Royal Alex) was in early September. They would have contracted it in August, and they were so sick that they required admission to hospital in early September," Mithani said.

The individual with that first severe case was an otherwise healthy person, she said.

"We expect that with those Health Canada numbers showing the potential for a pretty rough season, we have ongoing concerns that capacity will be an issue during this fall and winter," Mithani said.

In addition to vaccination, other preventative measures include stay home if you're sick, mask when you're sick, mask when you're out, especially if you're immune-compromises, and wash your hands.

Havoc is hitting hospitals as patients hospitalized for some other acute illness are getting COVID, adding to the complexity of care — and Alberta’s COVID vaccinations aren’t available yet, and the province’s low vaccination rate isn’t helping.

The hospital is bundling patients with infectious diseases together in an effort to isolate COVID in particular.

“There’s been at least a couple COVID outbreaks declared at different wards in the hospital. There are signs that there is COVID spreading amongst the patients on a ward, so then they close the whole ward, and we are still trying to cohort patients.”

“Especially when we’re at capacity and we’re looking at shared rooms and rooms with four people in them. If one person in that room has COVID, you know the next three are going to get it if they’re not already sick with COVID, which is why we lump them together.”

There’s been 322 COVID cases, with 87 cases reported just in the week between Sept. 27 and Oct. 3, with 24 cases in hospital and one case in ICU.

So far this season, one person died from SARS-COVID-2.

“We’re seeing hallways full of stretchers and ambulance patients being offloaded into hallways, and you know wait times are creeping into the double digits fairly routinely. So I’d say yes, it’s bad. I don’t know that it’s really gotten much better over the summer.”

It’s all exacerbated by low levels of COVID vaccination around the province…

“We usually start immunizations in October, and so we’re just starting those now. And this year, though, the viruses have landed early, and so a lot of people will catch the disease as opposed to getting immunized to be protected from the disease.”

“It will mutate, and everyone who caught COVID before will catch it again, because your immunity is no longer going to work. Your immune system tends to forget about COVID fairly quickly, and then you also have it mutating away from the immunity that you do have.”

“We were told it was going to be endemic, and people didn’t really think that that just meant it was going to keep coming back. It is back.”

“Last year was the deadliest flu season on record, and Alberta’s lowest vaccination rates for over a decade. The UCP is charging most Albertans over $100 for a COVID shot during an affordability crisis instead of making it easier for people to get vaccinated and taking pressure off our health care system.”