SARS-CoV-2 and COVID-19 (30...)
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1margd
SARS-CoV-2+ participants initiating nasal irrigation were over 8 times less likely to be hospitalized than the national rate.
- 79 participants, hi risk adults within 24h of positive test | Sept-Dec 2020
- 2.5 mL povidone-iodine 10% or 2.5 mL sodium bicarbonate to 240 mL of isotonic nasal irrigation twice daily for 14 days.
- by day 28, one ED visit and no hospitalizations in 42 irrigating with alkalinization,
- by day 28 one hospitalization of 37 in the povidone-iodine group, (1.27%) and no deaths.
c.f. CDC cases, in which 9.47% were known to be hospitalized, with an additional 1.5% mortality in those without hospitalization data.
Amy L. Baxter et al. 2021. Rapid initiation of nasal saline irrigation to reduce severity in high-risk COVID+ outpatients: a randomized clinical trial compared to a national dataset observational arm. MedRxiv 8 Dec 2021
doi: https://doi.org/10.1101/2021.08.16.21262044 https://www.medrxiv.org/content/10.1101/2021.08.16.21262044v3
This article is a preprint and has not been peer-reviewed
ETA: Wonder if this still holds for Omicron? Michael Mina et al recommend swabbing throat and cheeks as well as nostrils for home tests. For Omicron, maybe one should gargle as well as irrigate the nose?
- 79 participants, hi risk adults within 24h of positive test | Sept-Dec 2020
- 2.5 mL povidone-iodine 10% or 2.5 mL sodium bicarbonate to 240 mL of isotonic nasal irrigation twice daily for 14 days.
- by day 28, one ED visit and no hospitalizations in 42 irrigating with alkalinization,
- by day 28 one hospitalization of 37 in the povidone-iodine group, (1.27%) and no deaths.
c.f. CDC cases, in which 9.47% were known to be hospitalized, with an additional 1.5% mortality in those without hospitalization data.
Amy L. Baxter et al. 2021. Rapid initiation of nasal saline irrigation to reduce severity in high-risk COVID+ outpatients: a randomized clinical trial compared to a national dataset observational arm. MedRxiv 8 Dec 2021
doi: https://doi.org/10.1101/2021.08.16.21262044 https://www.medrxiv.org/content/10.1101/2021.08.16.21262044v3
This article is a preprint and has not been peer-reviewed
ETA: Wonder if this still holds for Omicron? Michael Mina et al recommend swabbing throat and cheeks as well as nostrils for home tests. For Omicron, maybe one should gargle as well as irrigate the nose?
2margd
Bob Wachter @Bob_Wachter | 11:33 PM · Aug 27, 2022:
Chair, UCSF Dept of Medicine.
https://twitter.com/Bob_Wachter/status/1563731497382707200
https://threadreaderapp.com/thread/1563731497382707200.html
I’m not doing indoor dining, and I still wear a mask in crowded indoor spaces. While most in US have chosen to be less careful, in this 🧵 I’ll review the logic & math behind my decisions, hoping that some of you will find them useful in navigating today’s Covid landscape. (1/25)
Here’s my bottom line (in case this 🧵is TL;DR):
I’ll begin eating inside and removing my mask in most indoor spaces when the local reported case rate falls below 5/100,000/day.
You can find your local rate of cases/100K/day here @nytimes
: https://nytimes.com/interactive/2021/us/covid-cases-deaths-tracker.html (2/25)
US cases have ⬇ by 30% in past month, but they're still well above 5/100K/day. Today, the US is at 28. In SF it’s 19; in Marietta, GA (where I was yesterday, visiting my son) it’s 25 (Fig). Barring a bad new variant, I’m guessing we’ll be less than 5/100K/d in the next 1-2 months.(3/25)
Table ( https://twitter.com/Bob_Wachter/status/1563731504915701760/photo/1 )
Clearly, many will find my threshold too conservative; others too risky. Now that mandates are gone, we all need to make our own choices.
I won’t go into detail about why I’m still trying to avoid Covid– it's mostly Long Covid, as I explained here: https://washingtonpost.com/outlook/2022/06/28/long-covid-calculating-risk-masks/ (4/25)
How did I settle on this threshold of 5/100K/day, you ask? It's complicated.
Your odds of getting Covid from a given encounter (an airplane trip, for example, or an indoor meal) are determined by a few factors; most of them remain pretty stable over time. (5/25)
First is your immune status: it's ⬆ if boosted (4 shots better than 3; etc.); ⬆ if boosted recently (relatively little protection vs infection – though great protection vs severe infection – if last boost was more than 2 months ago); ⬆ if hybrid immunity (vax/boost & prior Covid). (6/25)
2nd factor that determines risk is virus's infectiousness. BA.5 is most infectious variant yet, so an exposure now is riskier than one with a prior variant, all else equal.
But what are the chances of becoming infected from a single exposure? That # is tricky to pin down. (7/25)
I estimate that the chances of getting Covid from a moderate exposure to an infected person (sitting in my row on a plane or a nearby table in a restaurant) is ~5-10%. That's a rough guess – & would vary depending on things like exposure time, ventilation, distancing, etc. (8/25)
Whatever odds you use, the main point is this: your risk of getting Covid is a product of your immune status AND the riskiness of an exposure & virus AND the odds that someone near you has Covid & is infectious. Since I can’t do much to change my immune status, and the … (9/25)
… setting (eg, indoor dining, 3-hour flight, etc) is what it is, the main variable subject to significant variation is the likelihood that a nearby person has Covid.
But it's not just one person – if you go maskless indoors, you’re likely to be exposed to several people.(10/25)
It seems logical to consider people within 10-20 feet (on a plane: passengers within a few rows; restaurant: tablemates plus waiter & folks at nearby tables) as posing the greatest risk. So I think about the odds that, in a group of 10 people, one of them will have Covid.(11/25)
Unfortunately, this number is not look up-able, so we’re forced to do some extrapolation. Here goes:
As you know if you’ve been following me, I am fond of using @UCSFHospitals' asymptomatic test positivity rate (ATPR) as a measure of the odds that someone (in SF)… (12/25)
... who feels fine actually has Covid. During the last two years, that number has been as high as 10% (1-in-10) during surges, and as low as 0.2% (1-in-500) during lulls. Unfortunately, the ATPR is not reported publicly at any hospital or city I know of (including mine). (13/25)
While the ATPR isn’t readily accessible, it correlates fairly well with a # that IS available – namely local cases/100K/day.
Let’s take today as an example to see how these numbers sync up. But before we discuss reported case rates, let’s answer the question that I’m… (14/25)
… sure is on your mind: “What about home testing?”
You’d be right to ask – today's publicly reported case numbers represent a small fraction of all positive tests. The best studies say that we should multiply reported case rates by 5 to get an estimate of actual cases.(15/25)
So SF’s current number of 19/100K/day is, to my mind, the equivalent of ~95/100K/day in the pre-home testing era.
Ergo, when I say my threshold is fewer than 5/100K/day, I’m really saying fewer than 25/100K/day based on pre-home testing standards. You may also recall that I used to cite… (16/25)
… a threshold of fewer than 10 cases/100K/day. I’ve raised it (& thus accepted a bit more risk) to a higher # (20-25/100K/day) because vax, boosting & Paxlovid have markedly lowered the chances of a severe case (hospitalization/death) & mildly lowered the probability of Long Covid.(17/25)
Today’s ATPR @UCSF is 2.9%, meaning that 1 in 35 people who feel fine would test + for Covid. On its face, 1-in-35 doesn’t sound like super-scary odds.
But remember, I’m interested in the probability that ANY of the ~10 people in aerosol distance of me might have Covid.(18/25)
If 2.9% of people test positive for Covid, in a crowd of 10 people, at least one person will be positive 25% of the time. 1-in-4: that’s too high for me to feel comfy ditching the mask.
What if the Covid case rate was 1/4th of today’s 19/100K/day– in other words, a... (19/25)
...reported case rate of 4.8/100K/day (remember, this is really a rate of 23.8/100K/d after we multiply by 5 to account for home tests).
Let’s assume that the ATPR would track with the case rate; ie, also 1/4th of today’s rate, so 0.73% instead of 2.9%. At that rate: (20/25)
In a crowd of 10, there’s now a 7% chance that at least 1 person is positive (see chart below).
Given my age, vax status, & risk tolerance, I’d accept a 1-in-14 chance that someone near me was positive & would resume indoor dining & remove my mask in most indoor settings.(21/25)
Table ( https://twitter.com/Bob_Wachter/status/1563731536008167427/photo/1 )
As you see, these are arbitrary cut-offs. Even today, a maskless person is unlikely to get Covid from a single encounter. (But the risk adds up with each contact.) And even when the case rate is below my threshold, the risk is never zero, just low enough for me to accept.(22/25)
I was asked this week by my 8 poker guys (all vaxxed/boosted) if I was up for playing inside. My response: yes, if everybody tested. Reasoning: in a crowd of 8 people in a city w/ an ATPR of 2.9%, there’s a 21% chance that one would have Covid, a bit high for my taste… (23/25)
… But if all 8 had a neg. pre-game test, odds would ⬇ by 80-90% (some false negatives, of course), bringing the risk below my threshold for a maskless indoor activity. So testing is a way to make a riskier setting safer than case #'s would imply. https://vox.com/even-better/23169635/test-covid-party-concert-event-gathering
(24/25)
https://www.vox.com/even-better/23169635/test-covid-party-concert-event-gatherin...
With no variant much more infectious than BA.5 on horizon, & a probable ⬆ in boosting soon w/ new bivalent vax, there's a good chance we’ll see continued ⬇ in case rates & ATPR this fall. If so, I’ll gladly join the ranks of the maskless – as long as the rates stay down!(25/end)
Chair, UCSF Dept of Medicine.
https://twitter.com/Bob_Wachter/status/1563731497382707200
https://threadreaderapp.com/thread/1563731497382707200.html
I’m not doing indoor dining, and I still wear a mask in crowded indoor spaces. While most in US have chosen to be less careful, in this 🧵 I’ll review the logic & math behind my decisions, hoping that some of you will find them useful in navigating today’s Covid landscape. (1/25)
Here’s my bottom line (in case this 🧵is TL;DR):
I’ll begin eating inside and removing my mask in most indoor spaces when the local reported case rate falls below 5/100,000/day.
You can find your local rate of cases/100K/day here @nytimes
: https://nytimes.com/interactive/2021/us/covid-cases-deaths-tracker.html (2/25)
US cases have ⬇ by 30% in past month, but they're still well above 5/100K/day. Today, the US is at 28. In SF it’s 19; in Marietta, GA (where I was yesterday, visiting my son) it’s 25 (Fig). Barring a bad new variant, I’m guessing we’ll be less than 5/100K/d in the next 1-2 months.(3/25)
Table ( https://twitter.com/Bob_Wachter/status/1563731504915701760/photo/1 )
Clearly, many will find my threshold too conservative; others too risky. Now that mandates are gone, we all need to make our own choices.
I won’t go into detail about why I’m still trying to avoid Covid– it's mostly Long Covid, as I explained here: https://washingtonpost.com/outlook/2022/06/28/long-covid-calculating-risk-masks/ (4/25)
How did I settle on this threshold of 5/100K/day, you ask? It's complicated.
Your odds of getting Covid from a given encounter (an airplane trip, for example, or an indoor meal) are determined by a few factors; most of them remain pretty stable over time. (5/25)
First is your immune status: it's ⬆ if boosted (4 shots better than 3; etc.); ⬆ if boosted recently (relatively little protection vs infection – though great protection vs severe infection – if last boost was more than 2 months ago); ⬆ if hybrid immunity (vax/boost & prior Covid). (6/25)
2nd factor that determines risk is virus's infectiousness. BA.5 is most infectious variant yet, so an exposure now is riskier than one with a prior variant, all else equal.
But what are the chances of becoming infected from a single exposure? That # is tricky to pin down. (7/25)
I estimate that the chances of getting Covid from a moderate exposure to an infected person (sitting in my row on a plane or a nearby table in a restaurant) is ~5-10%. That's a rough guess – & would vary depending on things like exposure time, ventilation, distancing, etc. (8/25)
Whatever odds you use, the main point is this: your risk of getting Covid is a product of your immune status AND the riskiness of an exposure & virus AND the odds that someone near you has Covid & is infectious. Since I can’t do much to change my immune status, and the … (9/25)
… setting (eg, indoor dining, 3-hour flight, etc) is what it is, the main variable subject to significant variation is the likelihood that a nearby person has Covid.
But it's not just one person – if you go maskless indoors, you’re likely to be exposed to several people.(10/25)
It seems logical to consider people within 10-20 feet (on a plane: passengers within a few rows; restaurant: tablemates plus waiter & folks at nearby tables) as posing the greatest risk. So I think about the odds that, in a group of 10 people, one of them will have Covid.(11/25)
Unfortunately, this number is not look up-able, so we’re forced to do some extrapolation. Here goes:
As you know if you’ve been following me, I am fond of using @UCSFHospitals' asymptomatic test positivity rate (ATPR) as a measure of the odds that someone (in SF)… (12/25)
... who feels fine actually has Covid. During the last two years, that number has been as high as 10% (1-in-10) during surges, and as low as 0.2% (1-in-500) during lulls. Unfortunately, the ATPR is not reported publicly at any hospital or city I know of (including mine). (13/25)
While the ATPR isn’t readily accessible, it correlates fairly well with a # that IS available – namely local cases/100K/day.
Let’s take today as an example to see how these numbers sync up. But before we discuss reported case rates, let’s answer the question that I’m… (14/25)
… sure is on your mind: “What about home testing?”
You’d be right to ask – today's publicly reported case numbers represent a small fraction of all positive tests. The best studies say that we should multiply reported case rates by 5 to get an estimate of actual cases.(15/25)
So SF’s current number of 19/100K/day is, to my mind, the equivalent of ~95/100K/day in the pre-home testing era.
Ergo, when I say my threshold is fewer than 5/100K/day, I’m really saying fewer than 25/100K/day based on pre-home testing standards. You may also recall that I used to cite… (16/25)
… a threshold of fewer than 10 cases/100K/day. I’ve raised it (& thus accepted a bit more risk) to a higher # (20-25/100K/day) because vax, boosting & Paxlovid have markedly lowered the chances of a severe case (hospitalization/death) & mildly lowered the probability of Long Covid.(17/25)
Today’s ATPR @UCSF is 2.9%, meaning that 1 in 35 people who feel fine would test + for Covid. On its face, 1-in-35 doesn’t sound like super-scary odds.
But remember, I’m interested in the probability that ANY of the ~10 people in aerosol distance of me might have Covid.(18/25)
If 2.9% of people test positive for Covid, in a crowd of 10 people, at least one person will be positive 25% of the time. 1-in-4: that’s too high for me to feel comfy ditching the mask.
What if the Covid case rate was 1/4th of today’s 19/100K/day– in other words, a... (19/25)
...reported case rate of 4.8/100K/day (remember, this is really a rate of 23.8/100K/d after we multiply by 5 to account for home tests).
Let’s assume that the ATPR would track with the case rate; ie, also 1/4th of today’s rate, so 0.73% instead of 2.9%. At that rate: (20/25)
In a crowd of 10, there’s now a 7% chance that at least 1 person is positive (see chart below).
Given my age, vax status, & risk tolerance, I’d accept a 1-in-14 chance that someone near me was positive & would resume indoor dining & remove my mask in most indoor settings.(21/25)
Table ( https://twitter.com/Bob_Wachter/status/1563731536008167427/photo/1 )
As you see, these are arbitrary cut-offs. Even today, a maskless person is unlikely to get Covid from a single encounter. (But the risk adds up with each contact.) And even when the case rate is below my threshold, the risk is never zero, just low enough for me to accept.(22/25)
I was asked this week by my 8 poker guys (all vaxxed/boosted) if I was up for playing inside. My response: yes, if everybody tested. Reasoning: in a crowd of 8 people in a city w/ an ATPR of 2.9%, there’s a 21% chance that one would have Covid, a bit high for my taste… (23/25)
… But if all 8 had a neg. pre-game test, odds would ⬇ by 80-90% (some false negatives, of course), bringing the risk below my threshold for a maskless indoor activity. So testing is a way to make a riskier setting safer than case #'s would imply. https://vox.com/even-better/23169635/test-covid-party-concert-event-gathering
(24/25)
https://www.vox.com/even-better/23169635/test-covid-party-concert-event-gatherin...
With no variant much more infectious than BA.5 on horizon, & a probable ⬆ in boosting soon w/ new bivalent vax, there's a good chance we’ll see continued ⬇ in case rates & ATPR this fall. If so, I’ll gladly join the ranks of the maskless – as long as the rates stay down!(25/end)
3margd
US: order free tests at covidtests.gov before Friday, Sept 2, 2022
Biden administration to stop sending free at-home Covid-19 tests Friday Sept 2
Monica Alba and Dennis Romero | Aug 29 2022
https://www.cnbc.com/2022/08/29/biden-administration-to-stop-sending-free-at-hom...
Biden administration to stop sending free at-home Covid-19 tests Friday Sept 2
Monica Alba and Dennis Romero | Aug 29 2022
https://www.cnbc.com/2022/08/29/biden-administration-to-stop-sending-free-at-hom...
4margd
News Release: SARS-CoV-2 antigen levels linked to patient outcomes
NIH | August 29, 2022
...The analysis revealed a strong correlation between higher SARS-CoV-2 antigen levels (≥1000 nanograms per liter) and worse pulmonary function at the time of enrollment. Importantly, participants with higher SARS-CoV-2 antigen levels in the blood at enrollment generally had decreased pulmonary function at day five, regardless of the severity of their illness at the time of study entry, and took longer to be released from the hospital. High blood antigen levels also correlated with some known risk factors for worse illness, such as being male. Three additional participant characteristics were found to correlate with lower antigen levels: the presence of SARS-CoV-2 antibodies, exposure to remdesivir prior to enrollment and longer time in hospital prior to enrollment. Finally, participants infected with the delta variant had higher antigen levels than those infected with prior circulating strains. The researchers concluded that antigen levels in the blood are likely a marker of ongoing viral replication and could be useful for predicting a patient’s disease progression and likely outcomes once they are admitted to the hospital. The authors note that these results suggest that a precision medicine approach could be helpful in future clinical trials of antiviral therapy. For instance, antigen levels could help determine those patients most likely to benefit from therapies directed at fighting the virus.
https://www.nih.gov/news-events/news-releases/sars-cov-2-antigen-levels-linked-p...
--------------------------------------------------------------------
Rogers et al. The association of baseline plasma SARS-CoV-2 nucleocapsid antigen level and outcomes in patients hospitalized with COVID-19. Annals of Internal Medicine DOI: 10.7326/M22-0924 (2022).
NIH | August 29, 2022
...The analysis revealed a strong correlation between higher SARS-CoV-2 antigen levels (≥1000 nanograms per liter) and worse pulmonary function at the time of enrollment. Importantly, participants with higher SARS-CoV-2 antigen levels in the blood at enrollment generally had decreased pulmonary function at day five, regardless of the severity of their illness at the time of study entry, and took longer to be released from the hospital. High blood antigen levels also correlated with some known risk factors for worse illness, such as being male. Three additional participant characteristics were found to correlate with lower antigen levels: the presence of SARS-CoV-2 antibodies, exposure to remdesivir prior to enrollment and longer time in hospital prior to enrollment. Finally, participants infected with the delta variant had higher antigen levels than those infected with prior circulating strains. The researchers concluded that antigen levels in the blood are likely a marker of ongoing viral replication and could be useful for predicting a patient’s disease progression and likely outcomes once they are admitted to the hospital. The authors note that these results suggest that a precision medicine approach could be helpful in future clinical trials of antiviral therapy. For instance, antigen levels could help determine those patients most likely to benefit from therapies directed at fighting the virus.
https://www.nih.gov/news-events/news-releases/sars-cov-2-antigen-levels-linked-p...
--------------------------------------------------------------------
Rogers et al. The association of baseline plasma SARS-CoV-2 nucleocapsid antigen level and outcomes in patients hospitalized with COVID-19. Annals of Internal Medicine DOI: 10.7326/M22-0924 (2022).
5margd
Previous infection by SARS-CoV-2 + intramuscular vaccination
= mucosal antibodies
= protection from infection.
May also be some protection from infection in intramuscularly vaxxed who were exposed to human coronaviruses (colds).
"Intranasal vaccines...that could successfully induce (antigen specific mucosal secretory IgA (SIgA) antibodies), should be sought for the control of the SARS-CoV-2 pandemic."
(Intramuscular vaxx protects from severe disease and hospitalization, if not always infection. Still, intramuscular vaccination elicited weak anti-SARS-CoV-2 SIgA antibodies in approximately half of seronegative individuals who did not have pre-existing anti-SARS-CoV-2 or cross-reacting anti-HCoV (=colds) SIgA antibodies prior to vaccination.)
Kaori Sano etal. 2022. SARS-CoV-2 vaccination induces mucosal antibody responses in previously infected individuals.nNature Communications volume 13, Article number: 5135 (1 Sept 2022) https://www.nature.com/articles/s41467-022-32389-8
= mucosal antibodies
= protection from infection.
May also be some protection from infection in intramuscularly vaxxed who were exposed to human coronaviruses (colds).
"Intranasal vaccines...that could successfully induce (antigen specific mucosal secretory IgA (SIgA) antibodies), should be sought for the control of the SARS-CoV-2 pandemic."
(Intramuscular vaxx protects from severe disease and hospitalization, if not always infection. Still, intramuscular vaccination elicited weak anti-SARS-CoV-2 SIgA antibodies in approximately half of seronegative individuals who did not have pre-existing anti-SARS-CoV-2 or cross-reacting anti-HCoV (=colds) SIgA antibodies prior to vaccination.)
Kaori Sano etal. 2022. SARS-CoV-2 vaccination induces mucosal antibody responses in previously infected individuals.nNature Communications volume 13, Article number: 5135 (1 Sept 2022) https://www.nature.com/articles/s41467-022-32389-8
6margd
>5 margd:
Monica Gandhi MD, MPH @MonicaGandhi9 | 5:52 PM · Aug 31, 2022:
MD, MPH; ID/HIV doctor, UCSF...
BOOSTERS: If you want one, don't get too early after your last infection or last booster: would suggest at least 4, preferably 6 months based on routine vaccinology & immunology principles (FDA today said 2 months for Omicron; seems too short per this NIH study & principles)
Quote Tweet
Jake Scott, MD @jakescottMD · Aug 31
Infectious diseases doc / clinical asst professor @StanfordDeptMed...
“When the interval {between infection & booster} is too short, the response induced by the recent infection appears to prevent B cells from responding to the subsequent booster vaccine…”
In other words, the immune system needs time after infection to generate & educate optimized antibody responses. A booster given too soon after infection can interfere with - and attenuate - that process.
(What’s your best guess as to optimal time between infection and the new booster?)
Immunologically, ~6 months, in my opinion.
Clarisa Buckner et al. 2022. Recent SARS-CoV-2 infection abrogates antibody and B-cell responses to booster vaccination. MedRxiv 31 Aug 2022. doi: https://doi.org/10.1101/2022.08.30.22279344 https://www.medrxiv.org/content/10.1101/2022.08.30.22279344v1
This article is a preprint and has not been certified by peer review
Abstract
SARS-CoV-2 mRNA booster vaccines provide protection from severe disease, eliciting strong immunity that is further boosted by previous infection. However, it is unclear whether these immune responses are affected by the interval between infection and vaccination. Over a two-month period, we evaluated antibody and B-cell responses to a third dose mRNA vaccine in 66 individuals with different infection histories. Uninfected and post-boost but not previously infected individuals mounted robust ancestral and variant spike-binding and neutralizing antibodies, and memory B cells. Spike-specific B-cell responses from recent infection were elevated at pre-boost but comparatively less so at 60 days post-boost compared to uninfected individuals, and these differences were linked to baseline frequencies of CD27lo B cells. Day 60 to baseline ratio of BCR signaling measured by phosphorylation of Syk was inversely correlated to days between infection and vaccination. Thus, B-cell responses to booster vaccines are impeded by recent infection.
Monica Gandhi MD, MPH @MonicaGandhi9 | 5:52 PM · Aug 31, 2022:
MD, MPH; ID/HIV doctor, UCSF...
BOOSTERS: If you want one, don't get too early after your last infection or last booster: would suggest at least 4, preferably 6 months based on routine vaccinology & immunology principles (FDA today said 2 months for Omicron; seems too short per this NIH study & principles)
Quote Tweet
Jake Scott, MD @jakescottMD · Aug 31
Infectious diseases doc / clinical asst professor @StanfordDeptMed...
“When the interval {between infection & booster} is too short, the response induced by the recent infection appears to prevent B cells from responding to the subsequent booster vaccine…”
In other words, the immune system needs time after infection to generate & educate optimized antibody responses. A booster given too soon after infection can interfere with - and attenuate - that process.
(What’s your best guess as to optimal time between infection and the new booster?)
Immunologically, ~6 months, in my opinion.
Clarisa Buckner et al. 2022. Recent SARS-CoV-2 infection abrogates antibody and B-cell responses to booster vaccination. MedRxiv 31 Aug 2022. doi: https://doi.org/10.1101/2022.08.30.22279344 https://www.medrxiv.org/content/10.1101/2022.08.30.22279344v1
This article is a preprint and has not been certified by peer review
Abstract
SARS-CoV-2 mRNA booster vaccines provide protection from severe disease, eliciting strong immunity that is further boosted by previous infection. However, it is unclear whether these immune responses are affected by the interval between infection and vaccination. Over a two-month period, we evaluated antibody and B-cell responses to a third dose mRNA vaccine in 66 individuals with different infection histories. Uninfected and post-boost but not previously infected individuals mounted robust ancestral and variant spike-binding and neutralizing antibodies, and memory B cells. Spike-specific B-cell responses from recent infection were elevated at pre-boost but comparatively less so at 60 days post-boost compared to uninfected individuals, and these differences were linked to baseline frequencies of CD27lo B cells. Day 60 to baseline ratio of BCR signaling measured by phosphorylation of Syk was inversely correlated to days between infection and vaccination. Thus, B-cell responses to booster vaccines are impeded by recent infection.
7margd
One more question in Canada, boost w BA1 or wait/travel for BA5?
Canada approved BA1, but invited submissions from Pfizer and Moderna for BA5.
Boosters approved in US contain BA5, whereas UK's has BA1.
All Your Omicron Booster Questions, Answered
What good is another booster—and when’s the best time to get it?
Hannah Docter-Loeb | Sept 03, 2022
https://slate.com/technology/2022/09/omicron-booster-vaccine-bivalent-vaccines-c...
Canada approved BA1, but invited submissions from Pfizer and Moderna for BA5.
Boosters approved in US contain BA5, whereas UK's has BA1.
All Your Omicron Booster Questions, Answered
What good is another booster—and when’s the best time to get it?
Hannah Docter-Loeb | Sept 03, 2022
https://slate.com/technology/2022/09/omicron-booster-vaccine-bivalent-vaccines-c...
8margd
Monica Gandhi MD, MPH @MonicaGandhi9 | 2:22 PM · Sep 3, 2022
MD, MPH; ID/HIV doctor, UCSF
ANTIBODIES CHILDREN: Children - neutralizing antibodies 16 months or more after infection (no difference by sex or symptoms); better in less than 5YO; suggests risk re-infection less in kids than adults, helps explain why kids so much less risk severe disease, timing of vax
--------------------------------------------------------
Chee Fu Yung et al. 2022. Analysis of Neutralizing Antibody Levels in Children and Adolescents Up to 16 Months After SARS-CoV-2 Infection (Research Letter). JAMA Pediatr. Published online August 29, 2022. doi:10.1001/jamapediatrics.2022.3072 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2795690
...study period covered the emergence of the original SARS-CoV-2 Wuhan strain up to and including the Delta variant.
...Discussion
This study provided evidence of the durability of neutralizing antibodies in children up to 16 months after infection. There were no differences in level and duration of neutralizing antibodies by sex or symptom status. However, younger age (less than 5 years) was associated with significantly rapid generation of neutralizing antibody levels during the acute phase of infection and less degradation over time, compared with older age.
...The findings suggest that risk of SARS-CoV-2 reinfection in younger children is lower than in adults, which has important implications for scheduling COVID-19 vaccination after infection. The findings also broaden the understanding about less severe clinical disease in younger children.
MD, MPH; ID/HIV doctor, UCSF
ANTIBODIES CHILDREN: Children - neutralizing antibodies 16 months or more after infection (no difference by sex or symptoms); better in less than 5YO; suggests risk re-infection less in kids than adults, helps explain why kids so much less risk severe disease, timing of vax
--------------------------------------------------------
Chee Fu Yung et al. 2022. Analysis of Neutralizing Antibody Levels in Children and Adolescents Up to 16 Months After SARS-CoV-2 Infection (Research Letter). JAMA Pediatr. Published online August 29, 2022. doi:10.1001/jamapediatrics.2022.3072 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2795690
...study period covered the emergence of the original SARS-CoV-2 Wuhan strain up to and including the Delta variant.
...Discussion
This study provided evidence of the durability of neutralizing antibodies in children up to 16 months after infection. There were no differences in level and duration of neutralizing antibodies by sex or symptom status. However, younger age (less than 5 years) was associated with significantly rapid generation of neutralizing antibody levels during the acute phase of infection and less degradation over time, compared with older age.
...The findings suggest that risk of SARS-CoV-2 reinfection in younger children is lower than in adults, which has important implications for scheduling COVID-19 vaccination after infection. The findings also broaden the understanding about less severe clinical disease in younger children.
9margd
Infographic from Thailand:
Measure Airborne COVID-19 Risk by Measuring CO2
https://twitter.com/brendancclynch/status/1565247526051233793/photo/1
Measure Airborne COVID-19 Risk by Measuring CO2
https://twitter.com/brendancclynch/status/1565247526051233793/photo/1
10margd
Free N95s are hard to find, the White House diverted $ meant to restock the SNS (Strategic National Stockpile) so the emergency reserves are low, the USG (US Government) signed no bid contracts with 3M saying the domestic mask industry collapsed & they don’t plan to save the few manufacturers that remain so we’re in bad shape
0:20 WH spokesman Dr. Ashish Jha ( https://twitter.com/PPEtoheros/status/1566161672255012866 )
- Nicolas Smit @PPEtoheros | 4:30 PM · Sep 3, 2022
0:20 WH spokesman Dr. Ashish Jha ( https://twitter.com/PPEtoheros/status/1566161672255012866 )
- Nicolas Smit @PPEtoheros | 4:30 PM · Sep 3, 2022
11margd
"Hopium": droplet v aerosol spread of SARS-CoV-2
Trisha Greenhalgh et al. 2022. How covid-19 spreads: narratives, counter narratives, and social dramas. BMJ 2022; 378:e069940 doi: https://doi.org/10.1136/bmj-2022-069940 (Published 31 August 2022) https://www.bmj.com/content/378/bmj-2022-069940
Trisha Greenhalgh and colleagues explore why inaccurate narratives about the mode of transmission of SARS-CoV-2 emerged early in the pandemic and shaped a flawed policy response, with tragic consequences
...Discussion
At the root of the UK’s limited success in controlling transmission of SARS-CoV-2 lie flawed droplet-but-not-airborne and situationally airborne narratives. These narratives, and the false certainty with which they were conveyed, produced ineffective public health measures, contributed to shocking levels of care home deaths, exacerbated toxic discourse on masking, and justified withholding adequate protection from most health and care staff.
Why did the flawed narratives prevail? We consider four complementary hypotheses. The first is psychological. Social representation theory holds that people faced with new information show two tendencies: anchoring (grounding the new in an existing framework of concepts, ideas, and values) and concretisation (in which something abstract is made meaningful by making it physical and tangible)... People are unlikely to change their beliefs in light of complex and contravening evidence because this requires effort and causes aversion... Policy makers are known to exhibit “satisficing”—meaning they narrow the parameters within which their decisions must make sense and be accountable, especially when threats are complex and urgent... These well documented psychological tendencies might underpin the tendency for business and policy decisions to show what has been termed “escalation of commitment to a failing course of action.”...
Our second hypothesis is scientific elitism. Scientists in infection control have amassed considerable scientific capital (influence, status, accolades); their favoured methods (randomised controlled trials) are greatly valued; and they have much to lose if they discard their long held droplet narrative and concede the importance of other kinds of evidence... The inside track for pandemic policy making in the UK and WHO was narrow and partisan,... enabling an unusual degree of power to be wielded against outside track scientific voices, imposing a narrow and rigid set of acceptable scientific methods (what Danziger called “methodolatry”...), and precluding the kind of interdisciplinary deliberation that might have allowed a full and fair consideration of important competing narratives. The low status of aerosol science in policy circles was perhaps compounded by the relative youth of this scientific field and the inherent technical difficulties of isolating viable virus from the air (resulting in inconsistent findings in air sampling studies, especially when undertaken by non-experts)... The science of indoor air quality (for example, how and when to open windows, what kinds of filters to use) might be (wrongly) viewed as unsophisticated compared with much of modern biomedicine...
Our third hypothesis is practical and logistical. As confirmed in official minutes, the national shortage of high grade respiratory protective equipment was a live discussion topic in UK policy advisory groups at the beginning of the pandemic. Although adherence to a droplet-but-not-airborne narrative was not consciously undertaken purely because of this shortage, it certainly helped to make existing stocks go further.
Our fourth hypothesis is political. Droplet precautions are, at least to some extent, under the control of individuals and hence resonate with neoliberal discourses about individual freedom, personal responsibility, and restraint of the state (although the “choice” to distance physically, for example, presupposes sufficient space in which to do so). Airborne precautions require a paradigm shift in policy making, with strategic actions from those responsible for public safety; this approach aligns with a more socialist leaning political discourse and requires considerable up-front investment in the built environment whose benefits may take years to accrue... WHO’s tweet (fig 1) emphasises how to protect yourself rather than what to expect of your employer, your child’s school, or your government. Relatedly, we hypothesise a role for populism, the modus operandi of which is cherry picking evidence that supports the policy drive and validating anti-science sentiment under the guise of bringing power to people... Populism drew on public desires to return to normalcy and further marginalised aerosol science by depicting its recommended measures... as obscure, unaffordable, and an enemy of the public interest...
Trisha Greenhalgh et al. 2022. How covid-19 spreads: narratives, counter narratives, and social dramas. BMJ 2022; 378:e069940 doi: https://doi.org/10.1136/bmj-2022-069940 (Published 31 August 2022) https://www.bmj.com/content/378/bmj-2022-069940
Trisha Greenhalgh and colleagues explore why inaccurate narratives about the mode of transmission of SARS-CoV-2 emerged early in the pandemic and shaped a flawed policy response, with tragic consequences
...Discussion
At the root of the UK’s limited success in controlling transmission of SARS-CoV-2 lie flawed droplet-but-not-airborne and situationally airborne narratives. These narratives, and the false certainty with which they were conveyed, produced ineffective public health measures, contributed to shocking levels of care home deaths, exacerbated toxic discourse on masking, and justified withholding adequate protection from most health and care staff.
Why did the flawed narratives prevail? We consider four complementary hypotheses. The first is psychological. Social representation theory holds that people faced with new information show two tendencies: anchoring (grounding the new in an existing framework of concepts, ideas, and values) and concretisation (in which something abstract is made meaningful by making it physical and tangible)... People are unlikely to change their beliefs in light of complex and contravening evidence because this requires effort and causes aversion... Policy makers are known to exhibit “satisficing”—meaning they narrow the parameters within which their decisions must make sense and be accountable, especially when threats are complex and urgent... These well documented psychological tendencies might underpin the tendency for business and policy decisions to show what has been termed “escalation of commitment to a failing course of action.”...
Our second hypothesis is scientific elitism. Scientists in infection control have amassed considerable scientific capital (influence, status, accolades); their favoured methods (randomised controlled trials) are greatly valued; and they have much to lose if they discard their long held droplet narrative and concede the importance of other kinds of evidence... The inside track for pandemic policy making in the UK and WHO was narrow and partisan,... enabling an unusual degree of power to be wielded against outside track scientific voices, imposing a narrow and rigid set of acceptable scientific methods (what Danziger called “methodolatry”...), and precluding the kind of interdisciplinary deliberation that might have allowed a full and fair consideration of important competing narratives. The low status of aerosol science in policy circles was perhaps compounded by the relative youth of this scientific field and the inherent technical difficulties of isolating viable virus from the air (resulting in inconsistent findings in air sampling studies, especially when undertaken by non-experts)... The science of indoor air quality (for example, how and when to open windows, what kinds of filters to use) might be (wrongly) viewed as unsophisticated compared with much of modern biomedicine...
Our third hypothesis is practical and logistical. As confirmed in official minutes, the national shortage of high grade respiratory protective equipment was a live discussion topic in UK policy advisory groups at the beginning of the pandemic. Although adherence to a droplet-but-not-airborne narrative was not consciously undertaken purely because of this shortage, it certainly helped to make existing stocks go further.
Our fourth hypothesis is political. Droplet precautions are, at least to some extent, under the control of individuals and hence resonate with neoliberal discourses about individual freedom, personal responsibility, and restraint of the state (although the “choice” to distance physically, for example, presupposes sufficient space in which to do so). Airborne precautions require a paradigm shift in policy making, with strategic actions from those responsible for public safety; this approach aligns with a more socialist leaning political discourse and requires considerable up-front investment in the built environment whose benefits may take years to accrue... WHO’s tweet (fig 1) emphasises how to protect yourself rather than what to expect of your employer, your child’s school, or your government. Relatedly, we hypothesise a role for populism, the modus operandi of which is cherry picking evidence that supports the policy drive and validating anti-science sentiment under the guise of bringing power to people... Populism drew on public desires to return to normalcy and further marginalised aerosol science by depicting its recommended measures... as obscure, unaffordable, and an enemy of the public interest...
12margd
Long COVID 14YO: 'inflammation & lung perfusion defects consistent with microemboli caused by microvascular & endothelial damage, which we hypothesised might be caused by chronic inflammation’. Treated w anti-coagulation 7 months after presentation.
Dr Claire Taylor @drclairetaylor | 5:36 PM · Sep 3, 2022:
Doctor | Special interest in Long Covid, POTS, ME/CFS, dysautonomia & MCAS |Former neuroscientist
1/ #LongCovid a case study we should learn from {Buonsenso et al 2021, below}
- 14 years old. Covid October 2020. Develops a fast heart rate and chest pain. 🫀
- 7 MONTHS later is admitted to hospital for investigations.
- what follows is a stream of normal results
➡️bloods/CT chest/cardiac MRI/ECG…
2/Yet the fast heart rate continues as does the fatigue. ❤️🔥
-She has a psychological assessment- normal
-She has a 6 minute walk test-her oxygen level doesn’t drop. But her heart races and she tires easily
- she has an exercise test (CPET) suggesting pulmonary hypertension
3/ She has some extra bloods
- IL-6, IL-1 and TNFα raised
-unusual B-cell and regulatory T-cell changes - these suggest inflammation.
4/ Finally,she has the test she needs.
➡️ A VQ SPECT scan
Result- significant perfusion defect was observed on SPECT images in the right upper lung lobe, which did not correspond to alterations on CT
➡️ conclusion: peripheral microvascular and endothelial damage. CLOTS
5/ Treatment➡️(7 months after presentation) anticoagulation 🩸⭐️
‘The decision was based on the presence of inflammation & lung perfusion defects consistent with microemboli caused by microvascular & endothelial damage,which we hypothesised might be caused by chronic inflammation’
6/ The reason her team did the SPECT was because they had read this study. {Dhawal et al 2021}⬇️👏
How would she be now if they had stopped at the normal results. This is where we seem to be stopping in the UK...
7/ Long Covid patients are not crazy.
They are not psychologically unwell.
We must take emerging evidence and apply it.
Find.the.clots
And remember- Covid makes kids sick too.
‘Listen to your patient, they are telling you the answer’.
...9/ How will we ever know if we have a pandemic of micro-emboli if we don’t look? 👀🩸
10/ added- given so many comments about the vaccine. This child had Covid Oct 2020. Her symptoms were ongoing for 7 months including several a&e attendances. Her clots were found may 2021. Vaccine not approved in Italy for teenagers until June 2021. https://www.rferl.org/amp/romania-covid-19-vaccinations-adolescents/31283776.htm....
Andrew L Callen MD @AndrewCallenMD | 6:09 PM · Sep 3, 2022:
Assistant Professor, Neuroradiology - University of Colorado Anschutz
Very interesting. Our recent study also suggests that there may be a link between long covid and endothelial dysfunction (Callen et al. 2022, below)
-----------------------------------------------------------
Danilo Buonsenso et al. 2021. Evidence of lung perfusion defects and ongoing inflammation in an adolescent with post-acute sequelae of SARS-CoV-2 infection. Lancet Child Adolesc Health. 2021 Sep; 5(9): 677–680. Published online 2021 Jul 31. doi: 10.1016/S2352-4642(21)00196-6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8324416/
...In conclusion, in this report we present the first detailed evaluation of PASC (post-acute sequelae of SARS-CoV-2 infection (PASC) or long COVID) in an adolescent, providing evidence of pulmonary circulation dysfunction with possible lung microvascular or endothelial damage as detected by CPET and chest SPECT/CT. Currently, most attention has been focused on long COVID in adults, with few studies including children, resulting in a lack of case definitions and management guidelines for this population. This report supports the emerging evidence on long COVID in children and highlights that, although children generally present with mild, acute COVID-19, they are at risk of prolonged organ damage, similar to what has been identified in adults. This report highlights the importance of doing a robust assessment of children presenting with PASC. SPECT/CT is useful to detect microvascular damage in patients with more severe and persisting symptoms. We urge clinicians and policy makers to not underestimate the risk of and consequences of long-term COVID-19 sequelae in children. We also call for urgent studies aiming for a better understanding of the PASC burden, with a particular focus on investigation of chronic organ damage to inform treatment and improve long-term COVID-19 outcomes in children. These data are urgently needed to identify risk factors for targeted prevention and support, inform management guidelines, and also provide indirect benefits to the understanding of other post-infectious conditions.
-----------------------------------------------------------
Ranju T Dhawan et al. 2021. Beyond the clot: perfusion imaging of the pulmonary vasculature after COVID-19. Lancet Respir Med. 2021 Jan; 9(1): 107–116.
Published online 2020 Nov 17. doi: 10.1016/S2213-2600(20)30407-0
Abstract
A compelling body of evidence points to pulmonary thrombosis and thromboembolism as a key feature of COVID-19. As the pandemic spread across the globe over the past few months, a timely call to arms was issued by a team of clinicians to consider the prospect of long-lasting pulmonary fibrotic damage and plan for structured follow-up. However, the component of post-thrombotic sequelae has been less widely considered. Although the long-term outcomes of COVID-19 are not known, should pulmonary vascular sequelae prove to be clinically significant, these have the potential to become a public health problem. In this Personal View, we propose a proactive follow-up strategy to evaluate residual clot burden, small vessel injury, and potential haemodynamic sequelae. A nuanced and physiological approach to follow-up imaging that looks beyond the clot, at the state of perfusion of lung tissue, is proposed as a key triage tool, with the potential to inform therapeutic strategies.
----------------------------------------------------------
Andrew L. Callen et al. 2022. Evaluation of Cerebrovascular Reactivity and Vessel-Wall Imaging in Patients With Prior COVID-19: A Prospective Case-Control MRI Study. American Journal of Roentgenology: -. 10.2214/AJR.22.28267 (Accepted Manuscript 15 Aug 2022). https://doi.org/10.2214/AJR.22.28267
https://www.ajronline.org/doi/10.2214/AJR.22.28267
Abstract
...Background: SARS-CoV2 infection is associated with acute stroke, possibly caused by viral tropism to the vascular endothelium. Whether cerebrovascular endothelial dysfunction and inflammation persist after acute infection is poorly understood.
Objective: To assess the association of prior SARS-CoV2 infection with cerebrovascular reactivity (CVR) and vessel-wall imaging (VWI) abnormalities, as well as to explore the association of CVR impairment with post-COVID neurologic conditions.
...Results: Mean whole-cortex CBF {cerebral blood flow} following acetazolamide administration was greater in never-infected than in previously infected participants (73.8...vs 60.5... mL/100 gm/min...). Whole-brain CVR was lower in previously infected than in never-infected participants (difference of -8.9 ml/100g/min...); significantly lower CVR was also observed in previously infected participants after excluding those with prior critical illness. Among previously infected participants, CVR was smaller in those with than without post-COVID neurologic conditions, although this difference was not significant (16.9 vs 21.0 ml/100g/min...). Six of fifteen (40%) previously infected participants versus one of ten (10%) never-infected participants had at least one VWI {vessel-wall imaging} abnormality... All VWI abnormalities were consistent with atherosclerosis.
Conclusion: SARS-CoV2 infection is associated with chronic CVR impairment. The mechanistic basis is unknown from this study.
Clinical Impact: Future studies are needed to determine the clinical implications arising from SARS-CoV2-associated CVR impairment.
Dr Claire Taylor @drclairetaylor | 5:36 PM · Sep 3, 2022:
Doctor | Special interest in Long Covid, POTS, ME/CFS, dysautonomia & MCAS |Former neuroscientist
1/ #LongCovid a case study we should learn from {Buonsenso et al 2021, below}
- 14 years old. Covid October 2020. Develops a fast heart rate and chest pain. 🫀
- 7 MONTHS later is admitted to hospital for investigations.
- what follows is a stream of normal results
➡️bloods/CT chest/cardiac MRI/ECG…
2/Yet the fast heart rate continues as does the fatigue. ❤️🔥
-She has a psychological assessment- normal
-She has a 6 minute walk test-her oxygen level doesn’t drop. But her heart races and she tires easily
- she has an exercise test (CPET) suggesting pulmonary hypertension
3/ She has some extra bloods
- IL-6, IL-1 and TNFα raised
-unusual B-cell and regulatory T-cell changes - these suggest inflammation.
4/ Finally,she has the test she needs.
➡️ A VQ SPECT scan
Result- significant perfusion defect was observed on SPECT images in the right upper lung lobe, which did not correspond to alterations on CT
➡️ conclusion: peripheral microvascular and endothelial damage. CLOTS
5/ Treatment➡️(7 months after presentation) anticoagulation 🩸⭐️
‘The decision was based on the presence of inflammation & lung perfusion defects consistent with microemboli caused by microvascular & endothelial damage,which we hypothesised might be caused by chronic inflammation’
6/ The reason her team did the SPECT was because they had read this study. {Dhawal et al 2021}⬇️👏
How would she be now if they had stopped at the normal results. This is where we seem to be stopping in the UK...
7/ Long Covid patients are not crazy.
They are not psychologically unwell.
We must take emerging evidence and apply it.
Find.the.clots
And remember- Covid makes kids sick too.
‘Listen to your patient, they are telling you the answer’.
...9/ How will we ever know if we have a pandemic of micro-emboli if we don’t look? 👀🩸
10/ added- given so many comments about the vaccine. This child had Covid Oct 2020. Her symptoms were ongoing for 7 months including several a&e attendances. Her clots were found may 2021. Vaccine not approved in Italy for teenagers until June 2021. https://www.rferl.org/amp/romania-covid-19-vaccinations-adolescents/31283776.htm....
Andrew L Callen MD @AndrewCallenMD | 6:09 PM · Sep 3, 2022:
Assistant Professor, Neuroradiology - University of Colorado Anschutz
Very interesting. Our recent study also suggests that there may be a link between long covid and endothelial dysfunction (Callen et al. 2022, below)
-----------------------------------------------------------
Danilo Buonsenso et al. 2021. Evidence of lung perfusion defects and ongoing inflammation in an adolescent with post-acute sequelae of SARS-CoV-2 infection. Lancet Child Adolesc Health. 2021 Sep; 5(9): 677–680. Published online 2021 Jul 31. doi: 10.1016/S2352-4642(21)00196-6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8324416/
...In conclusion, in this report we present the first detailed evaluation of PASC (post-acute sequelae of SARS-CoV-2 infection (PASC) or long COVID) in an adolescent, providing evidence of pulmonary circulation dysfunction with possible lung microvascular or endothelial damage as detected by CPET and chest SPECT/CT. Currently, most attention has been focused on long COVID in adults, with few studies including children, resulting in a lack of case definitions and management guidelines for this population. This report supports the emerging evidence on long COVID in children and highlights that, although children generally present with mild, acute COVID-19, they are at risk of prolonged organ damage, similar to what has been identified in adults. This report highlights the importance of doing a robust assessment of children presenting with PASC. SPECT/CT is useful to detect microvascular damage in patients with more severe and persisting symptoms. We urge clinicians and policy makers to not underestimate the risk of and consequences of long-term COVID-19 sequelae in children. We also call for urgent studies aiming for a better understanding of the PASC burden, with a particular focus on investigation of chronic organ damage to inform treatment and improve long-term COVID-19 outcomes in children. These data are urgently needed to identify risk factors for targeted prevention and support, inform management guidelines, and also provide indirect benefits to the understanding of other post-infectious conditions.
-----------------------------------------------------------
Ranju T Dhawan et al. 2021. Beyond the clot: perfusion imaging of the pulmonary vasculature after COVID-19. Lancet Respir Med. 2021 Jan; 9(1): 107–116.
Published online 2020 Nov 17. doi: 10.1016/S2213-2600(20)30407-0
Abstract
A compelling body of evidence points to pulmonary thrombosis and thromboembolism as a key feature of COVID-19. As the pandemic spread across the globe over the past few months, a timely call to arms was issued by a team of clinicians to consider the prospect of long-lasting pulmonary fibrotic damage and plan for structured follow-up. However, the component of post-thrombotic sequelae has been less widely considered. Although the long-term outcomes of COVID-19 are not known, should pulmonary vascular sequelae prove to be clinically significant, these have the potential to become a public health problem. In this Personal View, we propose a proactive follow-up strategy to evaluate residual clot burden, small vessel injury, and potential haemodynamic sequelae. A nuanced and physiological approach to follow-up imaging that looks beyond the clot, at the state of perfusion of lung tissue, is proposed as a key triage tool, with the potential to inform therapeutic strategies.
----------------------------------------------------------
Andrew L. Callen et al. 2022. Evaluation of Cerebrovascular Reactivity and Vessel-Wall Imaging in Patients With Prior COVID-19: A Prospective Case-Control MRI Study. American Journal of Roentgenology: -. 10.2214/AJR.22.28267 (Accepted Manuscript 15 Aug 2022). https://doi.org/10.2214/AJR.22.28267
https://www.ajronline.org/doi/10.2214/AJR.22.28267
Abstract
...Background: SARS-CoV2 infection is associated with acute stroke, possibly caused by viral tropism to the vascular endothelium. Whether cerebrovascular endothelial dysfunction and inflammation persist after acute infection is poorly understood.
Objective: To assess the association of prior SARS-CoV2 infection with cerebrovascular reactivity (CVR) and vessel-wall imaging (VWI) abnormalities, as well as to explore the association of CVR impairment with post-COVID neurologic conditions.
...Results: Mean whole-cortex CBF {cerebral blood flow} following acetazolamide administration was greater in never-infected than in previously infected participants (73.8...vs 60.5... mL/100 gm/min...). Whole-brain CVR was lower in previously infected than in never-infected participants (difference of -8.9 ml/100g/min...); significantly lower CVR was also observed in previously infected participants after excluding those with prior critical illness. Among previously infected participants, CVR was smaller in those with than without post-COVID neurologic conditions, although this difference was not significant (16.9 vs 21.0 ml/100g/min...). Six of fifteen (40%) previously infected participants versus one of ten (10%) never-infected participants had at least one VWI {vessel-wall imaging} abnormality... All VWI abnormalities were consistent with atherosclerosis.
Conclusion: SARS-CoV2 infection is associated with chronic CVR impairment. The mechanistic basis is unknown from this study.
Clinical Impact: Future studies are needed to determine the clinical implications arising from SARS-CoV2-associated CVR impairment.
13margd
Scientists say that inhaled and nasal vaccines may be needed to beat Omicron. China just approved
Grady McGregor | September 5, 2022
https://fortune.com/2022/09/05/cansino-china-worlds-first-inhaled-vaccine-omicro...
------------------------------------------------------
Lairun Jin et al. 2022. Antibody Persistence and Safety through 6 Months after Heterologous Orally Aerosolised Ad5-nCoV in individuals primed with two-dose CoronaVac previously. MedRxiv July 28, 2022. 28p. https://doi.org/10.1101/2022.07.26.22278072 https://www.medrxiv.org/content/10.1101/2022.07.26.22278072v1.full.pdf
Preprint. Not yet reviewed.
Abstract
Background: Heterologous orally administered adenovirus type-5 vector-based COVID-19 vaccine
(Ad5-nCoV) in individuals who were primed with two-dose CoronaVac (an inactivated SARS-CoV-2
vaccine, by Sinovac) previously, has been reported to be safe and highly immunogenic within 28 days
post-boosting. However, antibody persistence and safety up to 6 months of this regimen are not been
reported yet.
Methods: This is a randomized, open label, single-center trial on safety and immunogenicity of
heterologous boost immunization with an orally administered aerosolised Ad5-nCoV vs. homologous boost immunization with CoronaVac after two-dose priming with CoronaVac in Chinese adults aged 18 years and older (NCT05043259). We followed the participants in this trial, including 140 in the low-dose aerosolised Ad5-nCoV group, 139 in the high-dose aerosolised Ad5-nCoV group, and 140 in the
CoronaVac group for 6 months. Neutralising antibodies (NAbs) against live wild-type SARS-CoV-2 virus
and omicron variant, and receptor-binding domain (RBD)-specific IgG antibodies were detected in serum samples collected at 28 days, 3 months, and 6 months after the booster dose. Serious adverse events (SAEs) were documented till month 6.
Results: The low-dose and high-dose heterologous boost immunisation groups had NAb GMTs against
live wild-type SARS-CoV-2 of 1937.3 ... and 1350.8 ..., which were 26.4 folds and 18.4 folds higher than that the CoronaVac group did (73.5...) at 28 days. The low-dose and high-dose heterologous boost immunisation groups had NAb GMTs {Geometric Mean Titer} against live wild-type SARS-CoV-2 of 530.1 ... and 457.6 ..., which were 26.0 folds and 22.4 folds higher than that the CoronaVac group did (20.4 ...) at 3 months, respectively. At 6 months, the low-dose and high-dose heterologous booster groups had NAb GMTs against live wild-type SARS-CoV-2 of 312.9 ... and 251.1 ..., which were 30.1 folds and 24.1 folds higher than the CoronaVac group did (10.4 ...), respectively. Additionally, the low-dose and high-dose heterologous booster groups had NAb GMTs against live omicron variant of 52.0 ... and 23.1 ... at 28 days, 27.9 ... and 23.3 ... at 3 months, 16.0 ... and 12.0... at 6 months, respectively. However, nearly all participants had no detectable NAbs for omicron variant in the CoronaVac group at either 28 days, 3 months, or 6 months. No vaccine-related SAEs were observed.
Conclusions: These data suggested that heterologous aerosolised Ad5-nCoV following two-dose
CoronaVac priming was safe and persistently more immunogenic than three-dose CoronaVac, although
immune responses waned over time.
Key words: COVID-19 vaccines; immunity; antibody response; Ad5-nCoV vaccine.
Grady McGregor | September 5, 2022
https://fortune.com/2022/09/05/cansino-china-worlds-first-inhaled-vaccine-omicro...
------------------------------------------------------
Lairun Jin et al. 2022. Antibody Persistence and Safety through 6 Months after Heterologous Orally Aerosolised Ad5-nCoV in individuals primed with two-dose CoronaVac previously. MedRxiv July 28, 2022. 28p. https://doi.org/10.1101/2022.07.26.22278072 https://www.medrxiv.org/content/10.1101/2022.07.26.22278072v1.full.pdf
Preprint. Not yet reviewed.
Abstract
Background: Heterologous orally administered adenovirus type-5 vector-based COVID-19 vaccine
(Ad5-nCoV) in individuals who were primed with two-dose CoronaVac (an inactivated SARS-CoV-2
vaccine, by Sinovac) previously, has been reported to be safe and highly immunogenic within 28 days
post-boosting. However, antibody persistence and safety up to 6 months of this regimen are not been
reported yet.
Methods: This is a randomized, open label, single-center trial on safety and immunogenicity of
heterologous boost immunization with an orally administered aerosolised Ad5-nCoV vs. homologous boost immunization with CoronaVac after two-dose priming with CoronaVac in Chinese adults aged 18 years and older (NCT05043259). We followed the participants in this trial, including 140 in the low-dose aerosolised Ad5-nCoV group, 139 in the high-dose aerosolised Ad5-nCoV group, and 140 in the
CoronaVac group for 6 months. Neutralising antibodies (NAbs) against live wild-type SARS-CoV-2 virus
and omicron variant, and receptor-binding domain (RBD)-specific IgG antibodies were detected in serum samples collected at 28 days, 3 months, and 6 months after the booster dose. Serious adverse events (SAEs) were documented till month 6.
Results: The low-dose and high-dose heterologous boost immunisation groups had NAb GMTs against
live wild-type SARS-CoV-2 of 1937.3 ... and 1350.8 ..., which were 26.4 folds and 18.4 folds higher than that the CoronaVac group did (73.5...) at 28 days. The low-dose and high-dose heterologous boost immunisation groups had NAb GMTs {Geometric Mean Titer} against live wild-type SARS-CoV-2 of 530.1 ... and 457.6 ..., which were 26.0 folds and 22.4 folds higher than that the CoronaVac group did (20.4 ...) at 3 months, respectively. At 6 months, the low-dose and high-dose heterologous booster groups had NAb GMTs against live wild-type SARS-CoV-2 of 312.9 ... and 251.1 ..., which were 30.1 folds and 24.1 folds higher than the CoronaVac group did (10.4 ...), respectively. Additionally, the low-dose and high-dose heterologous booster groups had NAb GMTs against live omicron variant of 52.0 ... and 23.1 ... at 28 days, 27.9 ... and 23.3 ... at 3 months, 16.0 ... and 12.0... at 6 months, respectively. However, nearly all participants had no detectable NAbs for omicron variant in the CoronaVac group at either 28 days, 3 months, or 6 months. No vaccine-related SAEs were observed.
Conclusions: These data suggested that heterologous aerosolised Ad5-nCoV following two-dose
CoronaVac priming was safe and persistently more immunogenic than three-dose CoronaVac, although
immune responses waned over time.
Key words: COVID-19 vaccines; immunity; antibody response; Ad5-nCoV vaccine.
14margd
>13 margd:
Daniel Griffin MD PhD @DanielGriffinMD | 8:29 PM · Sep 5, 2022:
A physician-scientist, board certified in Infectious Disease w expertise in Global Health, Tropical Medicine, Parasitology, and Virology...
Read closely as we see no data on actual mucosal antibody levels or actual mucosal protection just a different way of boosting those serum antibodies. Is this the mucosal vaccine we are looking for? https://medrxiv.org/content/10.1101/2022.07.26.22278072v1.full.pdf
Daniel Griffin MD PhD @DanielGriffinMD | 8:29 PM · Sep 5, 2022:
A physician-scientist, board certified in Infectious Disease w expertise in Global Health, Tropical Medicine, Parasitology, and Virology...
Read closely as we see no data on actual mucosal antibody levels or actual mucosal protection just a different way of boosting those serum antibodies. Is this the mucosal vaccine we are looking for? https://medrxiv.org/content/10.1101/2022.07.26.22278072v1.full.pdf
15margd
BA.5: "An estimated 21.5%... of respondents with a SARS-CoV-2 infection more than 4 weeks prior reported long COVID symptoms."
Eric Topol @EricTopol | 10:25 PM · Sep 6, 2022:
What is the prevalence of #LongCovid with the BA.5 variant? A new report from US, June-July, w/o controls, is the first crack at the question: 21.5% had symptoms more than 4 weeks
More data, w/controls, follow-up, comparison w/prior waves needed to nail this down
Saba Qasmieh et al. 2022. The prevalence of SARS-CoV-2 infection and long COVID in US adults during the BA.5 surge, June-July 2022. MedRxiv 6 Sept 2022. doi: https://doi.org/10.1101/2022.09.04.22279588 https://medrxiv.org/content/10.1101/2022.09.04.22279588v1
This article is a preprint and has not been certified by peer review
Abstract
... An estimated 17.3%... of respondents had SARS-CoV-2 infection during the two-week study period, equating to 44 million cases as compared to 1.8 million per the CDC during the same time period. SARS-CoV-2 prevalence was higher among those 18-24 years old (aPR (age and gender adjusted prevalence ratios) 2.2...) and among non-Hispanic Black (aPR 1.7...) and Hispanic (aPR 2.4...). SARS-CoV-2 prevalence was also higher among those with lower income (aPR 1.9...), lower education (aPR 3.7 ...), and those with comorbidities (aPR 1.6...). An estimated 21.5%... of respondents with a SARS-CoV-2 infection more than 4 weeks prior reported long COVID symptoms. The inequitable distribution of SARS-CoV-2 prevalence during the BA.5 surge will likely drive inequities in the future burden of long COVID.
Table 3 Prevalence and Ccharacteristics of US aults with Long COVID July 2022
https://twitter.com/EricTopol/status/1567338254147649536/photo/1
Eric Topol @EricTopol | 10:25 PM · Sep 6, 2022:
What is the prevalence of #LongCovid with the BA.5 variant? A new report from US, June-July, w/o controls, is the first crack at the question: 21.5% had symptoms more than 4 weeks
More data, w/controls, follow-up, comparison w/prior waves needed to nail this down
Saba Qasmieh et al. 2022. The prevalence of SARS-CoV-2 infection and long COVID in US adults during the BA.5 surge, June-July 2022. MedRxiv 6 Sept 2022. doi: https://doi.org/10.1101/2022.09.04.22279588 https://medrxiv.org/content/10.1101/2022.09.04.22279588v1
This article is a preprint and has not been certified by peer review
Abstract
... An estimated 17.3%... of respondents had SARS-CoV-2 infection during the two-week study period, equating to 44 million cases as compared to 1.8 million per the CDC during the same time period. SARS-CoV-2 prevalence was higher among those 18-24 years old (aPR (age and gender adjusted prevalence ratios) 2.2...) and among non-Hispanic Black (aPR 1.7...) and Hispanic (aPR 2.4...). SARS-CoV-2 prevalence was also higher among those with lower income (aPR 1.9...), lower education (aPR 3.7 ...), and those with comorbidities (aPR 1.6...). An estimated 21.5%... of respondents with a SARS-CoV-2 infection more than 4 weeks prior reported long COVID symptoms. The inequitable distribution of SARS-CoV-2 prevalence during the BA.5 surge will likely drive inequities in the future burden of long COVID.
Table 3 Prevalence and Ccharacteristics of US aults with Long COVID July 2022
https://twitter.com/EricTopol/status/1567338254147649536/photo/1
16margd
Infusions are an inefficient delivery route--hope these two antibodies can be incorporated into a pill or vaxx.
Two antibodies identified in Israel can fight all known COVID strains, study finds
Infusible to patients, antibodies are so powerful neutralizing the coronavirus they could eliminate the need for more vaccine boosters, peer-reviewed research says
Nathan Jeffay | 7 Sept 2022
...According to (microbiologist Dr. Natalia Freund, who directed the new study), on a technical level, the reason for the success of the two antibodies seems to be that they bind to a different part of the coronavirus spike protein than most others...
https://www.timesofisrael.com/two-antibodies-identified-in-israel-can-fight-all-...
-------------------------------------------------------
Ruofan Li et al. 2022. Conformational flexibility in neutralization of SARS-CoV-2 by naturally elicited anti-SARS-CoV-2 antibodies. Communications Biology volume 5, Article number: 789 (5 Aug 2022) https://www.nature.com/articles/s42003-022-03739-5
...Discussion
...To summarize, our study provides functional and atomic-level structural data on the interactions between naturally elicited antibodies and SARS-CoV-2 variants. Both TAU-2303 and TAU-2212 are potently neutralizing but arise through different B cell developmental programs. Neutralization by TAU-2212 is successful for most of the mutations with the exception of E484K. We therefore conclude that combining mAbs that can bind E484K, such as TAU-1109, −2303 or −2310 with TAU-2212 may be useful for broad spectrum anti-viral neutralization.
Two antibodies identified in Israel can fight all known COVID strains, study finds
Infusible to patients, antibodies are so powerful neutralizing the coronavirus they could eliminate the need for more vaccine boosters, peer-reviewed research says
Nathan Jeffay | 7 Sept 2022
...According to (microbiologist Dr. Natalia Freund, who directed the new study), on a technical level, the reason for the success of the two antibodies seems to be that they bind to a different part of the coronavirus spike protein than most others...
https://www.timesofisrael.com/two-antibodies-identified-in-israel-can-fight-all-...
-------------------------------------------------------
Ruofan Li et al. 2022. Conformational flexibility in neutralization of SARS-CoV-2 by naturally elicited anti-SARS-CoV-2 antibodies. Communications Biology volume 5, Article number: 789 (5 Aug 2022) https://www.nature.com/articles/s42003-022-03739-5
...Discussion
...To summarize, our study provides functional and atomic-level structural data on the interactions between naturally elicited antibodies and SARS-CoV-2 variants. Both TAU-2303 and TAU-2212 are potently neutralizing but arise through different B cell developmental programs. Neutralization by TAU-2212 is successful for most of the mutations with the exception of E484K. We therefore conclude that combining mAbs that can bind E484K, such as TAU-1109, −2303 or −2310 with TAU-2212 may be useful for broad spectrum anti-viral neutralization.
17margd
Rare, but all kids who died were unvaccinated as were nearly all of the hospitalized kids.
Dan-Yu Lin and Bradford Wheeler. 2022 Effects of Vaccination and Previous Infection on Omicron Infections in Children. NEJM September 7, 2022. DOI: 10.1056/NEJMc2209371 https://www.nejm.org/doi/full/10.1056/NEJMc2209371 https://www.nejm.org/doi/full/10.1056/NEJMc2209371
...when the omicron variant was dominant. Here, we report on the protection conferred by the BNT162b2 vaccine {Pfizer} and by previous SARS-CoV-2 infection against infection and coronavirus disease 2019 (Covid-19)–related hospitalization and death in children 5 to 11 years of age.
...effectiveness of two doses of BNT162b2 and of previous SARS-CoV-2 infection against Covid-19–related hospitalization were higher than estimates of the effectiveness against infection, but uncertainties were greater owing to a smaller number of events...
Both the BNT162b2 vaccine and previous infection were found to confer considerable immunity against omicron infection and protection against hospitalization and death. The rapid decline in protection against omicron infection that was conferred by vaccination and previous infection provides support for booster vaccination...
Dan-Yu Lin and Bradford Wheeler. 2022 Effects of Vaccination and Previous Infection on Omicron Infections in Children. NEJM September 7, 2022. DOI: 10.1056/NEJMc2209371 https://www.nejm.org/doi/full/10.1056/NEJMc2209371 https://www.nejm.org/doi/full/10.1056/NEJMc2209371
...when the omicron variant was dominant. Here, we report on the protection conferred by the BNT162b2 vaccine {Pfizer} and by previous SARS-CoV-2 infection against infection and coronavirus disease 2019 (Covid-19)–related hospitalization and death in children 5 to 11 years of age.
...effectiveness of two doses of BNT162b2 and of previous SARS-CoV-2 infection against Covid-19–related hospitalization were higher than estimates of the effectiveness against infection, but uncertainties were greater owing to a smaller number of events...
Both the BNT162b2 vaccine and previous infection were found to confer considerable immunity against omicron infection and protection against hospitalization and death. The rapid decline in protection against omicron infection that was conferred by vaccination and previous infection provides support for booster vaccination...
18margd
Brain fog...
Ed Yong @edyong209 | 8:32 AM · Sep 12, 2022:
Science writer at The Atlantic. Many words; some awards. Author of AN IMMENSE WORLD.
🚨I wrote about “brain fog”—one of the most common & disabling symptoms of long COVID (and many other pre-pandemic conditions), and one of the most misunderstood.
Here’s what brain fog actually is, and what it’s like to live with it. 1/
One of Long COVID’s Worst Symptoms Is Also Its Most Misunderstood
Brain fog isn’t like a hangover or depression. It’s a disorder of executive function that makes basic cognitive tasks absurdly hard.
Ed Yong | September 12, 2022
https://www.theatlantic.com/health/archive/2022/09/long-covid-brain-fog-symptom-...
First, what it’s not: Brain fog isn't anxiety, or depression. It’s not psychosomatic. It’s really nothing like a hangover, stress, or tiredness, and comments equating it to those things—“hey we all forget stuff”—trivialize what people are going through. 2/
Despite the name, brain fog isn’t a nebulous umbrella term. It’s a disorder of executive function—the mental skills that inc. focusing attention, holding info in mind, & blocking distractors. Without that foundation, one's cognitive edifice collapses. 3/
That’s why people w/ brain fog struggle with concentration, multitasking, & planning—which underlie almost everything. It raises unconscious activities to the level of effortful consciousness, and makes easy tasks absurdly hard. 4/
Text { https://twitter.com/edyong209/status/1569304439139229696/photo/1 }
https://theatlantic.com/health/archive
Executive function problems also affect memory: The brain can’t effectively focus on what to store or retrieve that info. Many long-haulers feel like they lose parts of themselves. Hannah Davis told me: “It feels like I'm a void & I’m living in a void.” 5/
There’s a spectrum. Most people improve & can function normally—but below their old baseline and with MANY accommodations. Some have been sick since the pandemic’s start (900+ days). Others got brain fog from pre-covid illnesses decades ago. 6/
Brain fog isn’t unique to long COVID. The same specific problems affect many HIV patients, epileptics post-seizures, cancer patients w/ chemo brain & folks w/ chronic illnesses like ME/CFS. Many of these conditions have long been stigmatized & neglected 7/
Some people argue that the colloquial term ‘brain fog’ delegitimizes and trivializes the condition. But disability communities have used it for decades; there are many reasons why it & its associated conditions are neglected, the name least among them. 8/
E.g. Most research/teaching about cognitive impairment centers around degenerative diseases of elderly people; docs largely don’t learn about viruses causing neurological problems in young people, and hubris leads to discounting of patient experiences. 9/
Also people w/ brain fog are also good at hiding it—it’s intermittent and they just don’t see people on the worst days. Stigma also motivates them to present as normal in social situations or doctors’ appts, furthering the false idea that they’re fine. 10/
Many docs also use inappropriate tests—like MoCA, which was only validated for elderly people with dementia—that even people with severe brain fog can ace. Hence: more dismissal. Bad testing is a comorbidity of long COVID. 11/
And yet brain-scan studies, blood flow studies, immunological studies, & more all point to physical & chemical changes in the nervous systems of people who have brain fog. It’s a real neurological problem that brings real cognitive impairments. 12/
Also, the basic science and the patients’ experiences *cohere*. The possible mechanisms for why brain fog occurs—as detailed in this piece—make total sense of why it affects executive function, why thinking feels slugging, why the fog waxes and wanes. 13/
Based on those likely mechanisms, many of the scientists I spoke to were also hopeful that brain fog is reversible. It just needs a lot more research, of the kind that hasn’t happened thus far. That’ll take time, and for now, people need help. 14/
Most of the approaches to treating brain fog are about managing symptoms. And that can do a lot. Several people I spoke to can work and do normal things again—but more slowly, at higher cost, with a ton of lifehacks & recovery periods. 15/
The single most important advice I've heard from clinicians & patients: You. Have. To. Pace. Yourself. Because brain fog often goes hand in hand with postexertional malaise—where people crash severely after even minor physical OR MENTAL exertion. 16/
I cannot stress this enough: For most people with brain fog, exercise—and strenuous mental activity counts, because cognitive work IS physical work—is a completely inappropriate treatment, and could make them substantially worse. 17/
I hope this piece makes those of you who have experienced brain fog feel seen. I hope it shows everyone else what it really means. Thanks to everyone who talked to me for this story. 18/
Finally, a very common thing that people with brain fog tell me is that they find it very hard to read. This is an almost 3000 word piece. I’m trying to get an audio version put together, and am told it will happen. More on that when I know more. 19/
...
Ed Yong @edyong209 | 8:32 AM · Sep 12, 2022:
Science writer at The Atlantic. Many words; some awards. Author of AN IMMENSE WORLD.
🚨I wrote about “brain fog”—one of the most common & disabling symptoms of long COVID (and many other pre-pandemic conditions), and one of the most misunderstood.
Here’s what brain fog actually is, and what it’s like to live with it. 1/
One of Long COVID’s Worst Symptoms Is Also Its Most Misunderstood
Brain fog isn’t like a hangover or depression. It’s a disorder of executive function that makes basic cognitive tasks absurdly hard.
Ed Yong | September 12, 2022
https://www.theatlantic.com/health/archive/2022/09/long-covid-brain-fog-symptom-...
First, what it’s not: Brain fog isn't anxiety, or depression. It’s not psychosomatic. It’s really nothing like a hangover, stress, or tiredness, and comments equating it to those things—“hey we all forget stuff”—trivialize what people are going through. 2/
Despite the name, brain fog isn’t a nebulous umbrella term. It’s a disorder of executive function—the mental skills that inc. focusing attention, holding info in mind, & blocking distractors. Without that foundation, one's cognitive edifice collapses. 3/
That’s why people w/ brain fog struggle with concentration, multitasking, & planning—which underlie almost everything. It raises unconscious activities to the level of effortful consciousness, and makes easy tasks absurdly hard. 4/
Text { https://twitter.com/edyong209/status/1569304439139229696/photo/1 }
https://theatlantic.com/health/archive
Executive function problems also affect memory: The brain can’t effectively focus on what to store or retrieve that info. Many long-haulers feel like they lose parts of themselves. Hannah Davis told me: “It feels like I'm a void & I’m living in a void.” 5/
There’s a spectrum. Most people improve & can function normally—but below their old baseline and with MANY accommodations. Some have been sick since the pandemic’s start (900+ days). Others got brain fog from pre-covid illnesses decades ago. 6/
Brain fog isn’t unique to long COVID. The same specific problems affect many HIV patients, epileptics post-seizures, cancer patients w/ chemo brain & folks w/ chronic illnesses like ME/CFS. Many of these conditions have long been stigmatized & neglected 7/
Some people argue that the colloquial term ‘brain fog’ delegitimizes and trivializes the condition. But disability communities have used it for decades; there are many reasons why it & its associated conditions are neglected, the name least among them. 8/
E.g. Most research/teaching about cognitive impairment centers around degenerative diseases of elderly people; docs largely don’t learn about viruses causing neurological problems in young people, and hubris leads to discounting of patient experiences. 9/
Also people w/ brain fog are also good at hiding it—it’s intermittent and they just don’t see people on the worst days. Stigma also motivates them to present as normal in social situations or doctors’ appts, furthering the false idea that they’re fine. 10/
Many docs also use inappropriate tests—like MoCA, which was only validated for elderly people with dementia—that even people with severe brain fog can ace. Hence: more dismissal. Bad testing is a comorbidity of long COVID. 11/
And yet brain-scan studies, blood flow studies, immunological studies, & more all point to physical & chemical changes in the nervous systems of people who have brain fog. It’s a real neurological problem that brings real cognitive impairments. 12/
Also, the basic science and the patients’ experiences *cohere*. The possible mechanisms for why brain fog occurs—as detailed in this piece—make total sense of why it affects executive function, why thinking feels slugging, why the fog waxes and wanes. 13/
Based on those likely mechanisms, many of the scientists I spoke to were also hopeful that brain fog is reversible. It just needs a lot more research, of the kind that hasn’t happened thus far. That’ll take time, and for now, people need help. 14/
Most of the approaches to treating brain fog are about managing symptoms. And that can do a lot. Several people I spoke to can work and do normal things again—but more slowly, at higher cost, with a ton of lifehacks & recovery periods. 15/
The single most important advice I've heard from clinicians & patients: You. Have. To. Pace. Yourself. Because brain fog often goes hand in hand with postexertional malaise—where people crash severely after even minor physical OR MENTAL exertion. 16/
I cannot stress this enough: For most people with brain fog, exercise—and strenuous mental activity counts, because cognitive work IS physical work—is a completely inappropriate treatment, and could make them substantially worse. 17/
I hope this piece makes those of you who have experienced brain fog feel seen. I hope it shows everyone else what it really means. Thanks to everyone who talked to me for this story. 18/
Finally, a very common thing that people with brain fog tell me is that they find it very hard to read. This is an almost 3000 word piece. I’m trying to get an audio version put together, and am told it will happen. More on that when I know more. 19/
...
19margd
Tarraso et al. 2022: 23% of adult patients with bilateral COVID-19 pneumonia, discharged May 1 - July 30, 2020 {so original strain?}, had abnormal 12-month CT chest scans.
Ayoubkhani et al. 2022: "We found that receiving two COVID-19 vaccinations at least two weeks before SARS-CoV-2 (Delta) infection was associated with a 41% decrease in the odds of developing long COVID symptoms at least 12 weeks later, relative to not being vaccinated when infected."
---------------------------------------------------------------------------
40% of COVID pneumonia patients still had lung problems at 1 year
Mary Van Beusekom (U Minn) | Sep 13, 2022
https://www.cidrap.umn.edu/news-perspective/2022/09/40-covid-pneumonia-patients-...
-----------------------------------------------------------
Julia Tarraso et al. 2022. Lung function and radiological findings 1 year after COVID-19: a prospective follow-up. Respiratory Research volume 23, Article number: 242 (12 Sept 2022) https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-022-02166...
Abstract
...Method...Pulmonary functional outcomes and chest computed tomography sequelae were analyzed 12 months after hospital discharge and we classified patients into three groups according to severity...over time...
Results
Among 488 hospitalized patients with COVID-19 pneumonia, 284 patients had completed the entire evaluation at 12 months. Median age was 60.5 ... and 55.3% were men. We found between-group differences in male sex, length of hospital stay, radiological involvement and inflammatory laboratory parameters. The functional evaluation of pulmonary sequelae showed that severe patients had statistically worse levels of lung diffusion at 2 months but no between group differences were found in subsequent controls. At 12-month follow up, however, we found impaired lung diffusion in 39.8% unrelated to severity. Radiological fibrotic-like changes at 12 months were reported in 22.7% of patients (102/448), only associated with radiological involvement at admission (OR: 1.55...) and LDH* (OR: 0.99...).
Conclusion
Our data suggest that a significant percentage of individuals would develop pulmonary sequelae after COVID 19 pneumonia, regardless of severity of the acute process.
* Lactate dehydrogenase (LDH) is a marker of cell and tissue damage in the body. While it is normal to have some amount of LDH in the body, high levels are associated with many different diseases and conditions. LDH measurements can show if tissue damage has occurred... https://www.testing.com › tests › lactate-dehydrogenase-ldh
____________________________________________________
Daniel Ayoubkhani et al. 2022. Risk of Long Covid in people infected with SARS-CoV-2 after two doses of a COVID-19 vaccine: community-based, matched cohort study. Open Forum Infectious Diseases, ofac464, https://doi.org/10.1093/ofid/ofac464. Published: 12 September 2022. https://doi.org/10.1093/ofid/ofac464https://academic.oup.com/ofid/advance-articl...
Accepted manuscript--not yet copy-edited or type-set.
Abstract
We investigated Long Covid incidence by vaccination status in a random sample of UK adults from April 2020 to November 2021. Persistent symptoms were reported by 9.5% of 3,090 breakthrough SARS-CoV-2 infections and 14.6% of unvaccinated controls (adjusted odds ratio 0.59, 95% CI: 0.50-0.69), emphasising the need for public health initiatives to increase population-level vaccine uptake.
Ayoubkhani et al. 2022: "We found that receiving two COVID-19 vaccinations at least two weeks before SARS-CoV-2 (Delta) infection was associated with a 41% decrease in the odds of developing long COVID symptoms at least 12 weeks later, relative to not being vaccinated when infected."
---------------------------------------------------------------------------
40% of COVID pneumonia patients still had lung problems at 1 year
Mary Van Beusekom (U Minn) | Sep 13, 2022
https://www.cidrap.umn.edu/news-perspective/2022/09/40-covid-pneumonia-patients-...
-----------------------------------------------------------
Julia Tarraso et al. 2022. Lung function and radiological findings 1 year after COVID-19: a prospective follow-up. Respiratory Research volume 23, Article number: 242 (12 Sept 2022) https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-022-02166...
Abstract
...Method...Pulmonary functional outcomes and chest computed tomography sequelae were analyzed 12 months after hospital discharge and we classified patients into three groups according to severity...over time...
Results
Among 488 hospitalized patients with COVID-19 pneumonia, 284 patients had completed the entire evaluation at 12 months. Median age was 60.5 ... and 55.3% were men. We found between-group differences in male sex, length of hospital stay, radiological involvement and inflammatory laboratory parameters. The functional evaluation of pulmonary sequelae showed that severe patients had statistically worse levels of lung diffusion at 2 months but no between group differences were found in subsequent controls. At 12-month follow up, however, we found impaired lung diffusion in 39.8% unrelated to severity. Radiological fibrotic-like changes at 12 months were reported in 22.7% of patients (102/448), only associated with radiological involvement at admission (OR: 1.55...) and LDH* (OR: 0.99...).
Conclusion
Our data suggest that a significant percentage of individuals would develop pulmonary sequelae after COVID 19 pneumonia, regardless of severity of the acute process.
* Lactate dehydrogenase (LDH) is a marker of cell and tissue damage in the body. While it is normal to have some amount of LDH in the body, high levels are associated with many different diseases and conditions. LDH measurements can show if tissue damage has occurred... https://www.testing.com › tests › lactate-dehydrogenase-ldh
____________________________________________________
Daniel Ayoubkhani et al. 2022. Risk of Long Covid in people infected with SARS-CoV-2 after two doses of a COVID-19 vaccine: community-based, matched cohort study. Open Forum Infectious Diseases, ofac464, https://doi.org/10.1093/ofid/ofac464. Published: 12 September 2022. https://doi.org/10.1093/ofid/ofac464https://academic.oup.com/ofid/advance-articl...
Accepted manuscript--not yet copy-edited or type-set.
Abstract
We investigated Long Covid incidence by vaccination status in a random sample of UK adults from April 2020 to November 2021. Persistent symptoms were reported by 9.5% of 3,090 breakthrough SARS-CoV-2 infections and 14.6% of unvaccinated controls (adjusted odds ratio 0.59, 95% CI: 0.50-0.69), emphasising the need for public health initiatives to increase population-level vaccine uptake.
20margd
As I recall, the UK and Canada went w BA.1 booster, so this is good news. (Canada also asked for BA.5 to review.) US went with BA.5 booster.
Eric Topol @EricTopol | 10:06 PM · Sep 13, 2022:
The Moderna bivalent BA.1 booster vaccine had similar results as the bivalent BA.5 vaccine vs. BA.5 in the mouse model for induced level of neutralizing antibody, reduced viral load and inflammatory response in the lung
Graphs ( https://twitter.com/EricTopol/status/1569870275478712321/photo/1 )
Suzanne M. Scheaffer et al. 2022. Bivalent SARS-CoV-2 mRNA vaccines increase breadth of neutralization and protect against the BA.5 Omicron variant. BioRxiv 13 Sept 2022.
doi: https://doi.org/10.1101/2022.09.12.507614 https://biorxiv.org/content/10.1101/2022.09.12.507614v1
Eric Topol @EricTopol | 10:06 PM · Sep 13, 2022:
The Moderna bivalent BA.1 booster vaccine had similar results as the bivalent BA.5 vaccine vs. BA.5 in the mouse model for induced level of neutralizing antibody, reduced viral load and inflammatory response in the lung
Graphs ( https://twitter.com/EricTopol/status/1569870275478712321/photo/1 )
Suzanne M. Scheaffer et al. 2022. Bivalent SARS-CoV-2 mRNA vaccines increase breadth of neutralization and protect against the BA.5 Omicron variant. BioRxiv 13 Sept 2022.
doi: https://doi.org/10.1101/2022.09.12.507614 https://biorxiv.org/content/10.1101/2022.09.12.507614v1
21margd
WesElyMD @WesElyMD | 8:13 AM · Sep 13, 2022:
ICU Doctor. Vanderbilt & VA. Our @CIBScenter studies COVID19 & Long Covid, Delirium, Dementia, PTSD, PICS.
https://twitter.com/WesElyMD/status/1569660543245352962
1/🧵 Land Mines in Long COVID - BostonGlobe
Alex was training for 2024 Olympic Trials 🥇
That dream exploded 💣
New #LongCOVID science
📌Viral reservoirs at 1 year
📌Cardiac edema at 1 year
📌Dementia at 2 years
📌Hijacked mitochondria
ScreenShot https://twitter.com/WesElyMD/status/1569660543245352962/photo/1
of Boston Globe article (https://bit.ly/3U77u4r)
2/ It’s one thing to concede that Long COVID exists as a societal problem for those w vulnerabilities like advanced age, pre-existing health conditions, or nearly dying in ICU.
What about nationally ranked D-1 long-distance runners⁉️
Paywall so read 🧵
https://bit.ly/3U77u4r
3/ Alex Schell is 21 & based his life decisions on making the 2024 Olympic trials.
“Not only can I not run due to #LongCOVID, I’ve also lost everything I hoped for. Who I envisioned myself to be is a past idea. It’s a monumental loss.” (story w perm)
What causes LongCOVID?
4/A cutting-edge explanation of what implants volatile “land mines” of long COVID throughout some patients’ bodies, after even mild COVID, is that people suffering long COVID end up w reservoirs of active SARS-CoV-2 virus in the lungs, brain & GI tract.
(Accepted Manuscript) https://bit.ly/3Qw8Q5N
https://twitter.com/WesElyMD/status/1569660560660119553/photo/1
https://twitter.com/WesElyMD/status/1569660560660119553/photo/2
5/ This produces ongoing levels of viral spike protein in our blood sometimes as high at 1-year as we had during early infection.
This theory was corroborated in the majority of 37 patients w #LongCOVID & in NONE of 26 control patients.
WSJ: https://on.wsj.com/3DcJzKV
(Screenshot) https://twitter.com/WesElyMD/status/1569660569396862976/photo/1
6/ Cardiac Edema:
A new investigation of a selected group of 346 patients with documented mild COVID found diffuse swelling of heart muscle on cardiac MRI at 3 & 12 months after infection vs 95 controls without COVID.
https://go.nature.com/3RRF2l
(Screenshot) https://twitter.com/WesElyMD/status/1569660581136711693/photo/1
7/ None of these people w heart muscle swelling at 3 & 12 months had any pre-existing cardiac conditions & none was even hospitalized for their COVID, yet 73% had shortness of breath, palpitations & chest pain at 3 months with 57% still had these symptoms at 1 year.
(Screenshot Extended Data Fig 1) https://twitter.com/WesElyMD/status/1569660587054964737/photo/1
8/ In the thread below, I unpack the science of #BrainFog & #Dementia in Long COVID. Basically, our astrocytes & other glial cells are directly infected, which leads to indirect neuronal death & brain shrinking even after mild COVID.
Dastardly 😤
(Thread on brain fog & dementia) https://twitter.com/WesElyMD/status/1562847021568229378
9/ Brain Science 🧠
…of Long COVID is summarized in this recent @WashingtonPost Op-Ed (screenshot below):
http://wapo.st/3Tf0WQR
Thank you, @EricTopol, for your highlighting:
https://twitter.com/EricTopol/status/1563899846343667713/photo/1
10/ In case you missed it, here is @EricTopol’s recent 5 STAR review in @latimes
that places new data in context for us.
He points out the urgent need for new trials & emphasizes that our best approach to avoid Long COVID is prevention.
Ask your doctor about the #BA5 #booster
(Screen shot LA Times) https://twitter.com/WesElyMD/status/1569660597695823872/photo/1
11/ COVID hijacks mitochondria in both heart muscle & brain cells, which may provide a link to the neck-up & neck-down disease plaguing Long COVID patients.
#Mitochondria allow us to use food & oxygen to harness energy for everything we do in life.
https://bit.ly/3x70vP1
(Infographic COVID & mitochondria) https://twitter.com/WesElyMD/status/1569660605497475073/photo/1
12/ Mitochondria inside Neurons & Astrocytes in the brain are hijacked.
This study used biomarkers from an array of patients to show mitochondrial health was sacrificed in long COVID patients, helping explain widespread neuropsychological disability.
(Link to study) https://onlinelibrary.wiley.com/doi/10.1002/ana.26350
13/ COVID is a form of viral sepsis, and we know that there is an association between recovery from sepsis & mitochondrial dysfunction.
(Link to study) https://www.sciencedirect.com/science/article/abs/pii/S014067360209459X?via%3Dih...
14/ People often compare Long COVID to #MECFS {Chronic Fatigue syndrome}, which some posit is often driven by diseased mitochondria.
Unfortunately, we’re still early in this line of research w much to learn before specific therapies are available.
(Link to study CFS and mitochondria) https://pubmed.ncbi.nlm.nih.gov/32470498/
15/ HOPE = Hang On Pain Ends
I see 3 paths forward:
☑️ Research
☑️ Prevention
☑️ Empathy & Validation
1st, we must have better trials. The NIH & other groups - eg @microbeminded2’s LCRI @research_long - offer great hope for answers on the near horizon.
(Photos of scientists on Long Covid Research Initiative - a collaboration of researchers, clinicians, and patients working to rapidly study and treat Long Covid.)
https://twitter.com/microbeminded2/status/1567865725250830337/photo/1
https://twitter.com/microbeminded2/status/1567865725250830337/photo/2
16/ Second, prevention of infection.
Whether by masking or vaxx or both.
Remember that COVID-related deaths in 2022 are 5-times lower in vaccinated than in unvaccinated people.
Updated graphs available on death rates of vaxxed v. unvaxxed: https://bit.ly/3BmgcV5
(Graph death rates vaxxed v. unvaxxed April - July 2022) https://twitter.com/WesElyMD/status/1569660621196763136/photo/1
17/ In addition, vaccination lowers the risk of Long COVID by as much as 75% to 85%, and the new bivalent B5 booster vaccine is now available.
Read 🧵 w data: 👇@JAMA_current
https://twitter.com/WesElyMD/status/1546628748950343682
Matthew J. @infinitywaltz
That's a lot more optimistic news than some of the studies showing 10-15 percent reduction (admittedly in an already extremely high-risk population).
WesElyMD @WesElyMD
Yes and I don’t know if these large numbers will hold up, but on the whole I think the message is in favor of vaccination both to reduce hospitalization and reduce long Covid risk.
ICU Doctor. Vanderbilt & VA. Our @CIBScenter studies COVID19 & Long Covid, Delirium, Dementia, PTSD, PICS.
https://twitter.com/WesElyMD/status/1569660543245352962
1/🧵 Land Mines in Long COVID - BostonGlobe
Alex was training for 2024 Olympic Trials 🥇
That dream exploded 💣
New #LongCOVID science
📌Viral reservoirs at 1 year
📌Cardiac edema at 1 year
📌Dementia at 2 years
📌Hijacked mitochondria
ScreenShot https://twitter.com/WesElyMD/status/1569660543245352962/photo/1
of Boston Globe article (https://bit.ly/3U77u4r)
2/ It’s one thing to concede that Long COVID exists as a societal problem for those w vulnerabilities like advanced age, pre-existing health conditions, or nearly dying in ICU.
What about nationally ranked D-1 long-distance runners⁉️
Paywall so read 🧵
https://bit.ly/3U77u4r
3/ Alex Schell is 21 & based his life decisions on making the 2024 Olympic trials.
“Not only can I not run due to #LongCOVID, I’ve also lost everything I hoped for. Who I envisioned myself to be is a past idea. It’s a monumental loss.” (story w perm)
What causes LongCOVID?
4/A cutting-edge explanation of what implants volatile “land mines” of long COVID throughout some patients’ bodies, after even mild COVID, is that people suffering long COVID end up w reservoirs of active SARS-CoV-2 virus in the lungs, brain & GI tract.
(Accepted Manuscript) https://bit.ly/3Qw8Q5N
https://twitter.com/WesElyMD/status/1569660560660119553/photo/1
https://twitter.com/WesElyMD/status/1569660560660119553/photo/2
5/ This produces ongoing levels of viral spike protein in our blood sometimes as high at 1-year as we had during early infection.
This theory was corroborated in the majority of 37 patients w #LongCOVID & in NONE of 26 control patients.
WSJ: https://on.wsj.com/3DcJzKV
(Screenshot) https://twitter.com/WesElyMD/status/1569660569396862976/photo/1
6/ Cardiac Edema:
A new investigation of a selected group of 346 patients with documented mild COVID found diffuse swelling of heart muscle on cardiac MRI at 3 & 12 months after infection vs 95 controls without COVID.
https://go.nature.com/3RRF2l
(Screenshot) https://twitter.com/WesElyMD/status/1569660581136711693/photo/1
7/ None of these people w heart muscle swelling at 3 & 12 months had any pre-existing cardiac conditions & none was even hospitalized for their COVID, yet 73% had shortness of breath, palpitations & chest pain at 3 months with 57% still had these symptoms at 1 year.
(Screenshot Extended Data Fig 1) https://twitter.com/WesElyMD/status/1569660587054964737/photo/1
8/ In the thread below, I unpack the science of #BrainFog & #Dementia in Long COVID. Basically, our astrocytes & other glial cells are directly infected, which leads to indirect neuronal death & brain shrinking even after mild COVID.
Dastardly 😤
(Thread on brain fog & dementia) https://twitter.com/WesElyMD/status/1562847021568229378
9/ Brain Science 🧠
…of Long COVID is summarized in this recent @WashingtonPost Op-Ed (screenshot below):
http://wapo.st/3Tf0WQR
Thank you, @EricTopol, for your highlighting:
https://twitter.com/EricTopol/status/1563899846343667713/photo/1
10/ In case you missed it, here is @EricTopol’s recent 5 STAR review in @latimes
that places new data in context for us.
He points out the urgent need for new trials & emphasizes that our best approach to avoid Long COVID is prevention.
Ask your doctor about the #BA5 #booster
(Screen shot LA Times) https://twitter.com/WesElyMD/status/1569660597695823872/photo/1
11/ COVID hijacks mitochondria in both heart muscle & brain cells, which may provide a link to the neck-up & neck-down disease plaguing Long COVID patients.
#Mitochondria allow us to use food & oxygen to harness energy for everything we do in life.
https://bit.ly/3x70vP1
(Infographic COVID & mitochondria) https://twitter.com/WesElyMD/status/1569660605497475073/photo/1
12/ Mitochondria inside Neurons & Astrocytes in the brain are hijacked.
This study used biomarkers from an array of patients to show mitochondrial health was sacrificed in long COVID patients, helping explain widespread neuropsychological disability.
(Link to study) https://onlinelibrary.wiley.com/doi/10.1002/ana.26350
13/ COVID is a form of viral sepsis, and we know that there is an association between recovery from sepsis & mitochondrial dysfunction.
(Link to study) https://www.sciencedirect.com/science/article/abs/pii/S014067360209459X?via%3Dih...
14/ People often compare Long COVID to #MECFS {Chronic Fatigue syndrome}, which some posit is often driven by diseased mitochondria.
Unfortunately, we’re still early in this line of research w much to learn before specific therapies are available.
(Link to study CFS and mitochondria) https://pubmed.ncbi.nlm.nih.gov/32470498/
15/ HOPE = Hang On Pain Ends
I see 3 paths forward:
☑️ Research
☑️ Prevention
☑️ Empathy & Validation
1st, we must have better trials. The NIH & other groups - eg @microbeminded2’s LCRI @research_long - offer great hope for answers on the near horizon.
(Photos of scientists on Long Covid Research Initiative - a collaboration of researchers, clinicians, and patients working to rapidly study and treat Long Covid.)
https://twitter.com/microbeminded2/status/1567865725250830337/photo/1
https://twitter.com/microbeminded2/status/1567865725250830337/photo/2
16/ Second, prevention of infection.
Whether by masking or vaxx or both.
Remember that COVID-related deaths in 2022 are 5-times lower in vaccinated than in unvaccinated people.
Updated graphs available on death rates of vaxxed v. unvaxxed: https://bit.ly/3BmgcV5
(Graph death rates vaxxed v. unvaxxed April - July 2022) https://twitter.com/WesElyMD/status/1569660621196763136/photo/1
17/ In addition, vaccination lowers the risk of Long COVID by as much as 75% to 85%, and the new bivalent B5 booster vaccine is now available.
Read 🧵 w data: 👇@JAMA_current
https://twitter.com/WesElyMD/status/1546628748950343682
Matthew J. @infinitywaltz
That's a lot more optimistic news than some of the studies showing 10-15 percent reduction (admittedly in an already extremely high-risk population).
WesElyMD @WesElyMD
Yes and I don’t know if these large numbers will hold up, but on the whole I think the message is in favor of vaccination both to reduce hospitalization and reduce long Covid risk.
22margd
Alzheimer’s Disease Risk 50–80% Higher in Older Adults Who Caught COVID-19
Case Western Reserve University | September 15, 2022
https://scitechdaily.com/alzheimers-disease-risk-50-80-higher-in-older-adults-wh...
Lindsey Wang et al. 2022. “Association of COVID-19 with New-Onset Alzheimer’s Disease”. Journal of Alzheimer’s Disease vol. 89, no. 2, pp. 411-414, 13 Sept 2022. DOI: 10.3233/JAD-220717 https://content.iospress.com/articles/journal-of-alzheimers-disease/jad220717
Abstract
An infectious etiology of Alzheimer’s disease has been postulated for decades. It remains unknown whether SARS-CoV-2 viral infection is associated with increased risk for Alzheimer’s disease. In this retrospective cohort study of 6,245,282 older adults (age 65 years and older) who had medical encounters between 2/2020–5/2021, we show that people with COVID-19 were at significantly increased risk for new diagnosis of Alzheimer’s disease within 360 days after the initial COVID-19 diagnosis (hazard ratio or HR:1.69...), especially in people age 85 years and older and in women. Our findings call for research to understand the underlying mechanisms and for continuous surveillance of long-term impacts of COVID-19 on Alzheimer’s disease.
Case Western Reserve University | September 15, 2022
https://scitechdaily.com/alzheimers-disease-risk-50-80-higher-in-older-adults-wh...
Lindsey Wang et al. 2022. “Association of COVID-19 with New-Onset Alzheimer’s Disease”. Journal of Alzheimer’s Disease vol. 89, no. 2, pp. 411-414, 13 Sept 2022. DOI: 10.3233/JAD-220717 https://content.iospress.com/articles/journal-of-alzheimers-disease/jad220717
Abstract
An infectious etiology of Alzheimer’s disease has been postulated for decades. It remains unknown whether SARS-CoV-2 viral infection is associated with increased risk for Alzheimer’s disease. In this retrospective cohort study of 6,245,282 older adults (age 65 years and older) who had medical encounters between 2/2020–5/2021, we show that people with COVID-19 were at significantly increased risk for new diagnosis of Alzheimer’s disease within 360 days after the initial COVID-19 diagnosis (hazard ratio or HR:1.69...), especially in people age 85 years and older and in women. Our findings call for research to understand the underlying mechanisms and for continuous surveillance of long-term impacts of COVID-19 on Alzheimer’s disease.
23margd
1 in 20 Patients Hospitalized With COVID-19 Develop AFib
Marie Rosenthal | 15 sept 2022
One in 20 {hospitalized} patients with COVID-19 develop new-onset atrial fibrillation (AFib) that is strongly associated with increased in-hospital mortality and major cardiovascular events, according to a new report from the American Heart Association’s (AHA’s) COVID-19 Cardiovascular Disease Registry.
Those who developed new-onset AFib experienced longer hospital stays and had a greater need for ICU care and intubation; approximately 45% died in the hospital (Circ Arrhythm Electrophysiol 2022;155:e10666)...
https://www.pharmacypracticenews.com/Covid-19/Article/09-22/Covid-19-Pandemic-AF...
-----------------------------------------------------------
Anna G. Rosenblatt al. 2022. New-Onset Atrial Fibrillation in Patients Hospitalized With COVID-19: Results From the American Heart Association COVID-19 Cardiovascular Registry. Circulation: Arrhythmia and Electrophysiology May 2022 Vol 15, Issue 5. https://doi.org/10.1161/CIRCEP.121.010666 https://www.ahajournals.org/doi/10.1161/CIRCEP.121.010666
Abstract
...Conclusions:
New-onset AF was common (5.4%) among patients hospitalized with COVID-19. Almost half of patients with new-onset AF died during their index hospitalization. After multivariable adjustment for comorbidities and disease severity, new-onset AF was not statistically significantly associated with death, suggesting that new-onset AF in these patients may primarily be a marker of other adverse clinical factors rather than an independent driver of mortality. Causality between the MACE (major adverse cardiovascular events) composites and AF needs to be further evaluated....
Marie Rosenthal | 15 sept 2022
One in 20 {hospitalized} patients with COVID-19 develop new-onset atrial fibrillation (AFib) that is strongly associated with increased in-hospital mortality and major cardiovascular events, according to a new report from the American Heart Association’s (AHA’s) COVID-19 Cardiovascular Disease Registry.
Those who developed new-onset AFib experienced longer hospital stays and had a greater need for ICU care and intubation; approximately 45% died in the hospital (Circ Arrhythm Electrophysiol 2022;155:e10666)...
https://www.pharmacypracticenews.com/Covid-19/Article/09-22/Covid-19-Pandemic-AF...
-----------------------------------------------------------
Anna G. Rosenblatt al. 2022. New-Onset Atrial Fibrillation in Patients Hospitalized With COVID-19: Results From the American Heart Association COVID-19 Cardiovascular Registry. Circulation: Arrhythmia and Electrophysiology May 2022 Vol 15, Issue 5. https://doi.org/10.1161/CIRCEP.121.010666 https://www.ahajournals.org/doi/10.1161/CIRCEP.121.010666
Abstract
...Conclusions:
New-onset AF was common (5.4%) among patients hospitalized with COVID-19. Almost half of patients with new-onset AF died during their index hospitalization. After multivariable adjustment for comorbidities and disease severity, new-onset AF was not statistically significantly associated with death, suggesting that new-onset AF in these patients may primarily be a marker of other adverse clinical factors rather than an independent driver of mortality. Causality between the MACE (major adverse cardiovascular events) composites and AF needs to be further evaluated....
24margd
Florian Krammer (Icahn, Mt Sinai) @florian_krammer | 6:07 AM · Sep 17, 2022:
I don't like BA.2.75.2
Quote Tweet
Ben Murrell @BenjMurrell | 3:48 PM · Sep 16, 2022:
Researcher at Karolinska. Viruses. Antibodies. Sequencing. Assaying. Modelling. Computing. Work used to be dry, but is now often wet.
https://twitter.com/BenjMurrell/status/1570862185819303937
https://threadreaderapp.com/thread/1570862185819303937.html
BA.2.75.2 exhibits more extreme antibody escape than any variant we've seen so far. A short 🧵
Graph neutralization titers Omicron variants ( https://twitter.com/BenjMurrell/status/1570862185819303937/photo/1 )
As with our previous work, this effort was led by @DannySheward, with @PeacockFlu helping us accelerate things.
@EricTopol made a gutsy call a while back, saying that BA.2.75 was "a scariant". This may turn out to be correct, but BA.2.75's daughter, BA.2.75.2, with just three additional mutations, is genuinely scary.
In 18 random blood donor samples in Stockholm, sampled just a couple of weeks ago, BA.2.75.2 was neutralised, on average, five-fold less potently than BA.5. These are recent samples in a city that has good vaccine coverage and likely relatively high prior infection rates.
As an important caveat, we don't know the individual histories of these samples.
We also looked at BA.4.6 and BA.2.10.4, but neither show nearly as much evasion of neutralisation by serum antibodies as BA.2.75.2.
In terms of clinical monoclonal antibodies, Evusheld is completely gone for BA.2.75.2. Sotrovimab looks similar between BA.2.75.2 and BA.5 (that is: not great, but not completely knocked out - clinical utility unclear?). Bebtelovimab's potency survives, alone.
https://twitter.com/BenjMurrell/status/1570862197827567620/photo/1
A short preprint has been uploaded to BioRxiv, which we'll be updating with more data soon. Thanks to all the collaborators involved, and a special thanks to all the clinicians and researchers who work so hard to sequence these emerging variants. We'd be blind without you.
Additional thanks to others involved @NillaKH
@Jan_Albert_
@bjorkstrom_lab
@saireddy911
and a few who aren't on twitter!
And this is our short preprint, which we'll continue to update.
Daniel J Sheward et al. Omicron sublineage BA.2.75.2 exhibits extensive escape from neutralising antibodies. BioRxv 16 Sept 2022. doi: https://doi.org/10.1101/2022.09.16.508299 https://biorxiv.org/content/10.1101/2022.09.16.508299v1
This article is a preprint and has not been certified by peer review.
Abstract
Several sublineages of omicron have emerged with additional mutations that may afford further antibody evasion. Here, we characterise the sensitivity of emerging omicron sublineages BA.2.75.2, BA.4.6, and BA.2.10.4 to antibody-mediated neutralisation, and identify extensive escape by BA.2.75.2. BA.2.75.2 was resistant to neutralisation by Evusheld (tixagevimab + cilgavimab), but remained sensitive to bebtelovimab. In recent serum samples from blood donors in Stockholm, Sweden, BA.2.75.2 was neutralised, on average, five-fold less potently than BA.5, representing the most neutralisation resistant variant evaluated to date. These data raise concerns that BA.2.75.2 may effectively evade humoral immunity in the population.
I don't like BA.2.75.2
Quote Tweet
Ben Murrell @BenjMurrell | 3:48 PM · Sep 16, 2022:
Researcher at Karolinska. Viruses. Antibodies. Sequencing. Assaying. Modelling. Computing. Work used to be dry, but is now often wet.
https://twitter.com/BenjMurrell/status/1570862185819303937
https://threadreaderapp.com/thread/1570862185819303937.html
BA.2.75.2 exhibits more extreme antibody escape than any variant we've seen so far. A short 🧵
Graph neutralization titers Omicron variants ( https://twitter.com/BenjMurrell/status/1570862185819303937/photo/1 )
As with our previous work, this effort was led by @DannySheward, with @PeacockFlu helping us accelerate things.
@EricTopol made a gutsy call a while back, saying that BA.2.75 was "a scariant". This may turn out to be correct, but BA.2.75's daughter, BA.2.75.2, with just three additional mutations, is genuinely scary.
In 18 random blood donor samples in Stockholm, sampled just a couple of weeks ago, BA.2.75.2 was neutralised, on average, five-fold less potently than BA.5. These are recent samples in a city that has good vaccine coverage and likely relatively high prior infection rates.
As an important caveat, we don't know the individual histories of these samples.
We also looked at BA.4.6 and BA.2.10.4, but neither show nearly as much evasion of neutralisation by serum antibodies as BA.2.75.2.
In terms of clinical monoclonal antibodies, Evusheld is completely gone for BA.2.75.2. Sotrovimab looks similar between BA.2.75.2 and BA.5 (that is: not great, but not completely knocked out - clinical utility unclear?). Bebtelovimab's potency survives, alone.
https://twitter.com/BenjMurrell/status/1570862197827567620/photo/1
A short preprint has been uploaded to BioRxiv, which we'll be updating with more data soon. Thanks to all the collaborators involved, and a special thanks to all the clinicians and researchers who work so hard to sequence these emerging variants. We'd be blind without you.
Additional thanks to others involved @NillaKH
@Jan_Albert_
@bjorkstrom_lab
@saireddy911
and a few who aren't on twitter!
And this is our short preprint, which we'll continue to update.
Daniel J Sheward et al. Omicron sublineage BA.2.75.2 exhibits extensive escape from neutralising antibodies. BioRxv 16 Sept 2022. doi: https://doi.org/10.1101/2022.09.16.508299 https://biorxiv.org/content/10.1101/2022.09.16.508299v1
This article is a preprint and has not been certified by peer review.
Abstract
Several sublineages of omicron have emerged with additional mutations that may afford further antibody evasion. Here, we characterise the sensitivity of emerging omicron sublineages BA.2.75.2, BA.4.6, and BA.2.10.4 to antibody-mediated neutralisation, and identify extensive escape by BA.2.75.2. BA.2.75.2 was resistant to neutralisation by Evusheld (tixagevimab + cilgavimab), but remained sensitive to bebtelovimab. In recent serum samples from blood donors in Stockholm, Sweden, BA.2.75.2 was neutralised, on average, five-fold less potently than BA.5, representing the most neutralisation resistant variant evaluated to date. These data raise concerns that BA.2.75.2 may effectively evade humoral immunity in the population.
25margd
Uh oh?
"These results suggest herd immunity established by natural infection could hardly stop RBD (Receptor-Binding Domain) evolution, and vaccine boosters using BA.5 may not provide sufficiently broad protection. Broad-spectrum SARS-CoV-2 vaccines and NAb (neutralizing antibodies) drugs development should be in high priority and the constructed convergent mutants could serve to examine their effectiveness in advance."
Yunlong Richard Cao @yunlong_cao | 7:49 PM · Sep 16, 2022:
Biochemistry & Immunology | Host Immune Response, Antibody Drug & Vaccine Design | Assistant Professor at BIOPIC, Peking University
https://twitter.com/yunlong_cao/status/1570922875590414336
Sharing our investigation on the unprecedented convergent RBD evolution of BA.2.75 and BA.5 on sites including 346, 356, 444-446, 450, 460, 486, which have generated highly concerning variants such as BA.2.75.2, BR.1, BJ.1, and BQ.1.1. (1/n)
In this paper, we tried to solve the following three questions:
1) How immune evasive could these variants be?
2) Why do they evolve mutations on these converging sites?
3) What could this convergence evolution finally lead to? (2/n)
As many have noticed, recent evolution of Omicron has led to numerous subvariants that exhibit high growth advantages over BA.5. Interestingly, mutations on their receptor-binding domain (RBD) converge on several hotspots, including R346, R356, K444, L452, N460 and F486. (3/n)
https://twitter.com/yunlong_cao/status/1570922886495633412/photo/1 ...
...............................................................
Yunlong Cao et al. 202. Imprinted SARS-CoV-2 humoral immunity induces converging Omicron RBD evolution. BioRxiv 16 September 2022. doi: https://doi.org/10.1101/2022.09.15.507787
This article is a preprint and has not been certified by peer review
Abstract
Continuous evolution of Omicron has led to numerous subvariants that exhibits growth advantage over BA.5. Such rapid and simultaneous emergence of variants with enormous advantages is unprecedented. Despite their rapidly divergent evolutionary courses, mutations on their receptor-binding domain (RBD) converge on several hotspots, including R346, R356, K444, L452, N460K and F486. The driving force and destination of such convergent evolution and its impact on humoral immunity established by vaccination and infection remain unclear. Here we demonstrate that these convergent mutations can cause striking evasion of convalescent plasma, including those from BA.5 breakthrough infection, and existing antibody drugs, including Evusheld and Bebtelovimab. BA.2.75.2 is the most evasive strain tested, and only BQ.1.1 could compare. To clarify the origin of the convergent evolution, we determined the escape mutation profiles and neutralization activity of monoclonal antibodies (mAbs) isolated from convalescents of BA.2 and BA.5 breakthrough infection. Importantly, due to humoral immune imprinting, BA.2 and especially BA.5 breakthrough infection caused significant reductions of neutralizing antibody epitope diversity and increased proportion of non-neutralizing mAbs, which in turn concentrated humoral immune pressure and promoted the convergent RBD evolution. Additionally, the precise convergent RBD mutations and evolution trends of BA.2.75/BA.5 subvariants could be inferred by integrating the neutralization-weighted DMS profiles of mAbs from various immune histories (3051 mAbs in total). Moreover, we demonstrated that as few as five additional convergent mutations based on BA.5 or BA.2.75 could completely evade most plasma samples, including those from BA.5 breakthrough infections, while remaining sufficient hACE2-binding affinity. These results suggest herd immunity established by natural infection could hardly stop RBD evolution, and vaccine boosters using BA.5 may not provide sufficiently broad protection. Broad-spectrum SARS-CoV-2 vaccines and NAb drugs development should be in high priority and the constructed convergent mutants could serve to examine their effectiveness in advance.
"These results suggest herd immunity established by natural infection could hardly stop RBD (Receptor-Binding Domain) evolution, and vaccine boosters using BA.5 may not provide sufficiently broad protection. Broad-spectrum SARS-CoV-2 vaccines and NAb (neutralizing antibodies) drugs development should be in high priority and the constructed convergent mutants could serve to examine their effectiveness in advance."
Yunlong Richard Cao @yunlong_cao | 7:49 PM · Sep 16, 2022:
Biochemistry & Immunology | Host Immune Response, Antibody Drug & Vaccine Design | Assistant Professor at BIOPIC, Peking University
https://twitter.com/yunlong_cao/status/1570922875590414336
Sharing our investigation on the unprecedented convergent RBD evolution of BA.2.75 and BA.5 on sites including 346, 356, 444-446, 450, 460, 486, which have generated highly concerning variants such as BA.2.75.2, BR.1, BJ.1, and BQ.1.1. (1/n)
In this paper, we tried to solve the following three questions:
1) How immune evasive could these variants be?
2) Why do they evolve mutations on these converging sites?
3) What could this convergence evolution finally lead to? (2/n)
As many have noticed, recent evolution of Omicron has led to numerous subvariants that exhibit high growth advantages over BA.5. Interestingly, mutations on their receptor-binding domain (RBD) converge on several hotspots, including R346, R356, K444, L452, N460 and F486. (3/n)
https://twitter.com/yunlong_cao/status/1570922886495633412/photo/1 ...
...............................................................
Yunlong Cao et al. 202. Imprinted SARS-CoV-2 humoral immunity induces converging Omicron RBD evolution. BioRxiv 16 September 2022. doi: https://doi.org/10.1101/2022.09.15.507787
This article is a preprint and has not been certified by peer review
Abstract
Continuous evolution of Omicron has led to numerous subvariants that exhibits growth advantage over BA.5. Such rapid and simultaneous emergence of variants with enormous advantages is unprecedented. Despite their rapidly divergent evolutionary courses, mutations on their receptor-binding domain (RBD) converge on several hotspots, including R346, R356, K444, L452, N460K and F486. The driving force and destination of such convergent evolution and its impact on humoral immunity established by vaccination and infection remain unclear. Here we demonstrate that these convergent mutations can cause striking evasion of convalescent plasma, including those from BA.5 breakthrough infection, and existing antibody drugs, including Evusheld and Bebtelovimab. BA.2.75.2 is the most evasive strain tested, and only BQ.1.1 could compare. To clarify the origin of the convergent evolution, we determined the escape mutation profiles and neutralization activity of monoclonal antibodies (mAbs) isolated from convalescents of BA.2 and BA.5 breakthrough infection. Importantly, due to humoral immune imprinting, BA.2 and especially BA.5 breakthrough infection caused significant reductions of neutralizing antibody epitope diversity and increased proportion of non-neutralizing mAbs, which in turn concentrated humoral immune pressure and promoted the convergent RBD evolution. Additionally, the precise convergent RBD mutations and evolution trends of BA.2.75/BA.5 subvariants could be inferred by integrating the neutralization-weighted DMS profiles of mAbs from various immune histories (3051 mAbs in total). Moreover, we demonstrated that as few as five additional convergent mutations based on BA.5 or BA.2.75 could completely evade most plasma samples, including those from BA.5 breakthrough infections, while remaining sufficient hACE2-binding affinity. These results suggest herd immunity established by natural infection could hardly stop RBD evolution, and vaccine boosters using BA.5 may not provide sufficiently broad protection. Broad-spectrum SARS-CoV-2 vaccines and NAb drugs development should be in high priority and the constructed convergent mutants could serve to examine their effectiveness in advance.
26margd
Lifting the booster fog: "For now: get a booster. It's the best shot you have to stay maximally protected (unless you had BA.5). It's worth the early side-effects. For the future: we need a better strategy that prevents infections, transmission (ergo #LongCovid) and is far more durable, variant-proof"
{Original Antigenic Sin? Original Antigenic Sin: How First Exposure Shapes Lifelong...Virus Immune Responses https://www.jimmunol.org/content/202/2/335}
Eric Topol (Scripps) @EricTopol | 2:14 PM · Sep 18, 2022:
https://twitter.com/EricTopol/status/1571563341772107777
Lifting the booster fog
The evidence supporting boosters is incontrovertible. Summary of data for 4th vs 3rd shots for survival benefit, age 50+
The unequivocal benefit is for enhanced protection vs severe Covid
Table--4th dose vs 3rd dose ( https://twitter.com/EricTopol/status/1571563341772107777/photo/1 )
2. The most recent @CDCgov data, compared with unvaccinated, age 50+
4 shots: 94% reduction of death
3 shots: 83.5% reduction of death
Graph ( https://twitter.com/EricTopol/status/1571563347757379584/photo/1 )
3. The magnitude of benefit has been consistent over time, for different Omicron subvariants. Here in May, across all ages, H/T @redouad , 96% reduction of death for 4 shots vs unvaccinated
Bar graph ( https://twitter.com/EricTopol/status/1571563355508473856/photo/1 )
4. There is also evidence that boosters help protect vs #LongCovid (point estimate 84% reduction for 3 shots in this cohort of health care workers)
Table 2 https://jamanetwork.com/journals/jama/
https://twitter.com/EricTopol/status/1571563361766350848/photo/1
5. So why haven't the majority of even high-risk (age 50+) gotten a 2nd booster? Updated data
https://covid.cdc.gov/covid-data-tracker/#vaccination-demographics-trends
Graphs ( https://twitter.com/EricTopol/status/1571563369693585408/photo/1 )
6. Today's NY Times front page
https://nytimes.com/2022/09/18/us/covid-vaccine.html?smid=nytcore-ios-share&
by @jackhealyNYT @sharonNYT @amyyqin
https://twitter.com/EricTopol/status/1571563379567001600/photo/1
https://twitter.com/EricTopol/status/1571563379567001600/photo/2
Reasons: lack of perceived benefit, reactogenecity side-effects, unaware, "it's over"
I'll come back to "potent" subsequently
7. More on lack of enthusiasm for new bivalent Omicron boosters (actual data to be released this week)
Omicron booster finds few takers
by @nprscottsimon @robsteinnews | 17 Sept 2022
https://npr.org/2022/09/17/1123629711/covid-booster-rollout-proceeds-smoothly-ev... NPR
8. Yet the overall data to support the need for boosters is clearcut.
What about the bivalent Omicron vaccine that matches up to BA.5 (and BA.4.6) that account for ~99% of American cases?
The data for a BA.1 bivalent vaccine was published @NEJM 16 Sept
https://twitter.com/EricTopol/status/1570805370037366784
9. Let's zoom in further on these data (here's the fog part)
The antibody response to Omicron BA.1 (geometric mean titer) was multi-fold less than against the ancestral strain for the bivalent or original booster
https://twitter.com/EricTopol/status/1571563394586804227/photo/1
10. Is this because Omicron BA.1 is less immunogenic or because of imprinting (responding preferentially to 1st exposure strain)?
Same pattern of reduced antibody response in mice (and humans) to BA.1 and BA.5 compared with ancestral
Bar Graphs--https://twitter.com/EricTopol/status/1571563403176742912/photo/1
11. Figures from the outstanding threads by @EllingUlrich and @yunlong_cao
https://twitter.com/EllingUlrich/status/1571052854139551746
https://twitter.com/yunlong_cao/status/1570922875590414336
that suggest imprinting as at least part of the explanation for this observation
Diagram--https://twitter.com/EricTopol/status/1571563409837264896/photo/1
Graphs--https://twitter.com/EricTopol/status/1571563409837264896/photo/2
12. There are no data to show durability of boosters vs severe Covid beyond 4-6 months. Or to even show that the new (? more potent) bivalent Omicron BA.5 will perform better than original or BA.1 bivalent boosters. A 2-time-or-more booster strategy per year is untenable, long term.
For now: get a booster. It's the best shot you have to stay maximally protected (unless you had BA.5). It's worth the early side-effects
For the future: we need a better strategy that prevents infections, transmission (ergo #LongCovid) and is far more durable, variant-proof
{Original Antigenic Sin? Original Antigenic Sin: How First Exposure Shapes Lifelong...Virus Immune Responses https://www.jimmunol.org/content/202/2/335}
Eric Topol (Scripps) @EricTopol | 2:14 PM · Sep 18, 2022:
https://twitter.com/EricTopol/status/1571563341772107777
Lifting the booster fog
The evidence supporting boosters is incontrovertible. Summary of data for 4th vs 3rd shots for survival benefit, age 50+
The unequivocal benefit is for enhanced protection vs severe Covid
Table--4th dose vs 3rd dose ( https://twitter.com/EricTopol/status/1571563341772107777/photo/1 )
2. The most recent @CDCgov data, compared with unvaccinated, age 50+
4 shots: 94% reduction of death
3 shots: 83.5% reduction of death
Graph ( https://twitter.com/EricTopol/status/1571563347757379584/photo/1 )
3. The magnitude of benefit has been consistent over time, for different Omicron subvariants. Here in May, across all ages, H/T @redouad , 96% reduction of death for 4 shots vs unvaccinated
Bar graph ( https://twitter.com/EricTopol/status/1571563355508473856/photo/1 )
4. There is also evidence that boosters help protect vs #LongCovid (point estimate 84% reduction for 3 shots in this cohort of health care workers)
Table 2 https://jamanetwork.com/journals/jama/
https://twitter.com/EricTopol/status/1571563361766350848/photo/1
5. So why haven't the majority of even high-risk (age 50+) gotten a 2nd booster? Updated data
https://covid.cdc.gov/covid-data-tracker/#vaccination-demographics-trends
Graphs ( https://twitter.com/EricTopol/status/1571563369693585408/photo/1 )
6. Today's NY Times front page
https://nytimes.com/2022/09/18/us/covid-vaccine.html?smid=nytcore-ios-share&
by @jackhealyNYT @sharonNYT @amyyqin
https://twitter.com/EricTopol/status/1571563379567001600/photo/1
https://twitter.com/EricTopol/status/1571563379567001600/photo/2
Reasons: lack of perceived benefit, reactogenecity side-effects, unaware, "it's over"
I'll come back to "potent" subsequently
7. More on lack of enthusiasm for new bivalent Omicron boosters (actual data to be released this week)
Omicron booster finds few takers
by @nprscottsimon @robsteinnews | 17 Sept 2022
https://npr.org/2022/09/17/1123629711/covid-booster-rollout-proceeds-smoothly-ev... NPR
8. Yet the overall data to support the need for boosters is clearcut.
What about the bivalent Omicron vaccine that matches up to BA.5 (and BA.4.6) that account for ~99% of American cases?
The data for a BA.1 bivalent vaccine was published @NEJM 16 Sept
https://twitter.com/EricTopol/status/1570805370037366784
9. Let's zoom in further on these data (here's the fog part)
The antibody response to Omicron BA.1 (geometric mean titer) was multi-fold less than against the ancestral strain for the bivalent or original booster
https://twitter.com/EricTopol/status/1571563394586804227/photo/1
10. Is this because Omicron BA.1 is less immunogenic or because of imprinting (responding preferentially to 1st exposure strain)?
Same pattern of reduced antibody response in mice (and humans) to BA.1 and BA.5 compared with ancestral
Bar Graphs--https://twitter.com/EricTopol/status/1571563403176742912/photo/1
11. Figures from the outstanding threads by @EllingUlrich and @yunlong_cao
https://twitter.com/EllingUlrich/status/1571052854139551746
https://twitter.com/yunlong_cao/status/1570922875590414336
that suggest imprinting as at least part of the explanation for this observation
Diagram--https://twitter.com/EricTopol/status/1571563409837264896/photo/1
Graphs--https://twitter.com/EricTopol/status/1571563409837264896/photo/2
12. There are no data to show durability of boosters vs severe Covid beyond 4-6 months. Or to even show that the new (? more potent) bivalent Omicron BA.5 will perform better than original or BA.1 bivalent boosters. A 2-time-or-more booster strategy per year is untenable, long term.
For now: get a booster. It's the best shot you have to stay maximally protected (unless you had BA.5). It's worth the early side-effects
For the future: we need a better strategy that prevents infections, transmission (ergo #LongCovid) and is far more durable, variant-proof
27margd
>26 margd: contd.
To boost or not to boost. Should that be the question?
Eric Topol (Scripp MD-scientist)| 18 Sept 2022
...In summary, there’s ample evidence that a 3rd shot or 4th shot (1st or 2nd booster) will help provide important protection, and that is especially vital for people age 50+, with ample support for the recommendation for all age 12 and older to get boosters. The right question is about the 5th booster, for which there are no clinical data yet, but will likely extend a high level of protection against severe Covid. But 4 or 6 months isn’t going to cut it as a public health protection policy, as there will be further attrition of interest and uptake for boosters as we go forward. Fortunately, we’re declining in cases and will likely experience a fairly quiescent phase (further descent, no surge) with respect to infections and hospitalizations for the next couple of months until BA.2.75.2 gets legs (or an alternative BA.2 derivative).
Now is the time to stop chasing SARS-CoV-2 and start mounting an aggressive get- ahead strategy. There’s the intertwined triad to contend with: more immune escape, more evidence of imprinting, and the inevitability of new variants that are already laying a foundation for spread. Enough of the booster after booster, shot-centric approach; it has been formidable, lifesaving, sickness-avoiding, and essential as a bootstrap, temporizing measure. Now we need to press on with innovation for more durable, palatable, and effective solutions. They are in our reach.
https://erictopol.substack.com/p/to-boost-or-not-to-boost
To boost or not to boost. Should that be the question?
Eric Topol (Scripp MD-scientist)| 18 Sept 2022
...In summary, there’s ample evidence that a 3rd shot or 4th shot (1st or 2nd booster) will help provide important protection, and that is especially vital for people age 50+, with ample support for the recommendation for all age 12 and older to get boosters. The right question is about the 5th booster, for which there are no clinical data yet, but will likely extend a high level of protection against severe Covid. But 4 or 6 months isn’t going to cut it as a public health protection policy, as there will be further attrition of interest and uptake for boosters as we go forward. Fortunately, we’re declining in cases and will likely experience a fairly quiescent phase (further descent, no surge) with respect to infections and hospitalizations for the next couple of months until BA.2.75.2 gets legs (or an alternative BA.2 derivative).
Now is the time to stop chasing SARS-CoV-2 and start mounting an aggressive get- ahead strategy. There’s the intertwined triad to contend with: more immune escape, more evidence of imprinting, and the inevitability of new variants that are already laying a foundation for spread. Enough of the booster after booster, shot-centric approach; it has been formidable, lifesaving, sickness-avoiding, and essential as a bootstrap, temporizing measure. Now we need to press on with innovation for more durable, palatable, and effective solutions. They are in our reach.
https://erictopol.substack.com/p/to-boost-or-not-to-boost
28margd
“Repeated infections come with elevated risk of problems that match the symptoms of long COVID, the study found. The more reinfections, the more long COVID.” Instead of “herd immunity”, the herd is increasingly immunocompromised.
- Alderman Hopkins (Chicago's 2nd Ward) @AldermanHopkins | 4:13 AM · Sep 19, 2022
Dreaded Side Effect Rears Its Ugly Head in Latest COVID Variant
ACT FAST
David Axe | Sep. 18, 2022
Scientists agree that we’re not doing enough to address a “silent” COVID crisis that seems to be spiraling out of control...
https://www.thedailybeast.com/scientists-warn-of-spike-in-long-covid-cases-acros...
- Alderman Hopkins (Chicago's 2nd Ward) @AldermanHopkins | 4:13 AM · Sep 19, 2022
Dreaded Side Effect Rears Its Ugly Head in Latest COVID Variant
ACT FAST
David Axe | Sep. 18, 2022
Scientists agree that we’re not doing enough to address a “silent” COVID crisis that seems to be spiraling out of control...
https://www.thedailybeast.com/scientists-warn-of-spike-in-long-covid-cases-acros...
30margd
Jonas R. Kunst (Psych prof, U Oslo) @KunstJonas | 9:00 AM · Sep 19, 2022:
🚨 A new study shows that after a "neuropsychological rehabilitation program," 44.9% of the #LongCovid patients were still unable to perform their pre-COVID-19 work activity, and 81.2% reported difficulties in their activities of daily living.
A.García-Molina et al. 2022. Neuropsychological rehabilitation for post–COVID-19 syndrome: Results of a clinical program and six-month follow up. Neurología (English Edition) Available online 15 September 2022. In Press, Journal Pre-proof. https://doi.org/10.1016/j.nrleng.2022.06.007 https://www.sciencedirect.com/science/article/pii/S2173580822000943
Abstract
...Method
...outpatient post-COVID-19 neurorehabilitation program, including respiratory therapy, physiotherapy, and neuropsychological rehabilitation...
Results
...Seventy-four per cent (n = 91) had cognitive impairment and underwent cognitive treatment (experimental group); the remaining 26% (n = 32) constituted the control group. After the intervention, the experimental group improved in working memory, verbal memory (learning, recall and recognition), verbal fluency and anxious-depressive symptomatology. The control group showed changes in immediate memory, verbal memory (learning and recognition) and depressive symptomatology, although the effect size in the latter two was smaller than in the experimental group. Six months after treatment, 44.9% of the patients were unable to perform their pre-COVID-19 work activity, and 81.2% reported difficulties in their activities of daily living...
🚨 A new study shows that after a "neuropsychological rehabilitation program," 44.9% of the #LongCovid patients were still unable to perform their pre-COVID-19 work activity, and 81.2% reported difficulties in their activities of daily living.
A.García-Molina et al. 2022. Neuropsychological rehabilitation for post–COVID-19 syndrome: Results of a clinical program and six-month follow up. Neurología (English Edition) Available online 15 September 2022. In Press, Journal Pre-proof. https://doi.org/10.1016/j.nrleng.2022.06.007 https://www.sciencedirect.com/science/article/pii/S2173580822000943
Abstract
...Method
...outpatient post-COVID-19 neurorehabilitation program, including respiratory therapy, physiotherapy, and neuropsychological rehabilitation...
Results
...Seventy-four per cent (n = 91) had cognitive impairment and underwent cognitive treatment (experimental group); the remaining 26% (n = 32) constituted the control group. After the intervention, the experimental group improved in working memory, verbal memory (learning, recall and recognition), verbal fluency and anxious-depressive symptomatology. The control group showed changes in immediate memory, verbal memory (learning and recognition) and depressive symptomatology, although the effect size in the latter two was smaller than in the experimental group. Six months after treatment, 44.9% of the patients were unable to perform their pre-COVID-19 work activity, and 81.2% reported difficulties in their activities of daily living...
31margd
Updated {BA.1} COVID booster tied to strong Omicron immune response
Mary Van Beusekom | News Writer | CIDRAP News | Sep 19, 2022
The new bivalent (two-strain) Moderna COVID-19 vaccine booster triggered stronger neutralizing antibody responses against the highly transmissible Omicron variant at 28 days than the previously authorized booster, with no safety concerns, according to the interim results of a phase 2/3 open-label, nonrandomized study ...
https://www.cidrap.umn.edu/news-perspective/2022/09/updated-covid-booster-tied-s...
----------------------------------------------------------
Spyros Chalkias et al. 2022. A Bivalent Omicron-Containing Booster Vaccine against Covid-19
List of authors. NEJM September 16, 2022. DOI: 10.1056/NEJMoa2208343 https://www.nejm.org/doi/full/10.1056/NEJMoa2208343
Abstract
Background
The safety and immunogenicity of the bivalent omicron-containing mRNA-1273.214 booster vaccine are not known.
Methods
In this ongoing, phase 2–3 study, we compared the 50-μg bivalent vaccine mRNA-1273.214 (25 μg each of ancestral Wuhan-Hu-1 and omicron B.1.1.529 BA.1 spike messenger RNAs) with the previously authorized 50-μg mRNA-1273 booster. We administered mRNA-1273.214 or mRNA-1273 as a second booster in adults who had previously received a two-dose (100-μg) primary series and first booster (50-μg) dose of mRNA-1273 (≥3 months earlier). The primary objectives were to assess the safety, reactogenicity, and immunogenicity of mRNA-1273.214 at 28 days after the booster dose.
Results
Interim results are presented. Sequential groups of participants received 50 μg of mRNA-1273.214 (437 participants) or mRNA-1273 (377 participants) as a second booster dose. The median time between the first and second boosters was similar for mRNA-1273.214 (136 days) and mRNA-1273 (134 days). In participants with no previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the geometric mean titers of neutralizing antibodies against the omicron BA.1 variant were 2372.4 ... after receipt of the mRNA-1273.214 booster and 1473.5 ... after receipt of the mRNA-1273 booster. In addition, 50-μg mRNA-1273.214 and 50-μg mRNA-1273 elicited geometric mean titers of 727.4 ... and 492.1 ...., respectively, against omicron BA.4 and BA.5 (BA.4/5), and the mRNA-1273.214 booster also elicited higher binding antibody responses against multiple other variants (alpha, beta, gamma, and delta) than the mRNA-1273 booster. Safety and reactogenicity were similar with the two booster vaccines. Vaccine effectiveness was not assessed in this study; in an exploratory analysis, SARS-CoV-2 infection occurred in 11 participants after the mRNA-1273.214 booster and in 9 participants after the mRNA-1273 booster.
Conclusions
The bivalent omicron-containing vaccine mRNA-1273.214 elicited neutralizing antibody responses against omicron that were superior to those with mRNA-1273, without evident safety concerns.
Mary Van Beusekom | News Writer | CIDRAP News | Sep 19, 2022
The new bivalent (two-strain) Moderna COVID-19 vaccine booster triggered stronger neutralizing antibody responses against the highly transmissible Omicron variant at 28 days than the previously authorized booster, with no safety concerns, according to the interim results of a phase 2/3 open-label, nonrandomized study ...
https://www.cidrap.umn.edu/news-perspective/2022/09/updated-covid-booster-tied-s...
----------------------------------------------------------
Spyros Chalkias et al. 2022. A Bivalent Omicron-Containing Booster Vaccine against Covid-19
List of authors. NEJM September 16, 2022. DOI: 10.1056/NEJMoa2208343 https://www.nejm.org/doi/full/10.1056/NEJMoa2208343
Abstract
Background
The safety and immunogenicity of the bivalent omicron-containing mRNA-1273.214 booster vaccine are not known.
Methods
In this ongoing, phase 2–3 study, we compared the 50-μg bivalent vaccine mRNA-1273.214 (25 μg each of ancestral Wuhan-Hu-1 and omicron B.1.1.529 BA.1 spike messenger RNAs) with the previously authorized 50-μg mRNA-1273 booster. We administered mRNA-1273.214 or mRNA-1273 as a second booster in adults who had previously received a two-dose (100-μg) primary series and first booster (50-μg) dose of mRNA-1273 (≥3 months earlier). The primary objectives were to assess the safety, reactogenicity, and immunogenicity of mRNA-1273.214 at 28 days after the booster dose.
Results
Interim results are presented. Sequential groups of participants received 50 μg of mRNA-1273.214 (437 participants) or mRNA-1273 (377 participants) as a second booster dose. The median time between the first and second boosters was similar for mRNA-1273.214 (136 days) and mRNA-1273 (134 days). In participants with no previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the geometric mean titers of neutralizing antibodies against the omicron BA.1 variant were 2372.4 ... after receipt of the mRNA-1273.214 booster and 1473.5 ... after receipt of the mRNA-1273 booster. In addition, 50-μg mRNA-1273.214 and 50-μg mRNA-1273 elicited geometric mean titers of 727.4 ... and 492.1 ...., respectively, against omicron BA.4 and BA.5 (BA.4/5), and the mRNA-1273.214 booster also elicited higher binding antibody responses against multiple other variants (alpha, beta, gamma, and delta) than the mRNA-1273 booster. Safety and reactogenicity were similar with the two booster vaccines. Vaccine effectiveness was not assessed in this study; in an exploratory analysis, SARS-CoV-2 infection occurred in 11 participants after the mRNA-1273.214 booster and in 9 participants after the mRNA-1273 booster.
Conclusions
The bivalent omicron-containing vaccine mRNA-1273.214 elicited neutralizing antibody responses against omicron that were superior to those with mRNA-1273, without evident safety concerns.
32margd
Isaac Bogoch @BogochIsaac | 7:41 AM · Sep 22, 2022:
Infectious Diseases physician and scientist, with thoughts on Infectious Diseases, Tropical Medicine, HIV Prevention, Public Health, and Global Health issues {U Toronto}
1/ Some solid data emerging, reiterating:
1. The importance of COVID booster vaccines, especially in those over the age of 60.
https://bit.ly/3UsvH5v {McMenamin et al. 2022, below}
2. Two doses of COVID vaccine PLUS recovery from infection provided equivalent protection VS 3 doses. https://bit.ly/3fcEbNR {Carazo et al. 2022, below}
Graphs--risk reduction by vaxx & pre-omicron & omicron infection
( https://twitter.com/BogochIsaac/status/1572913944570007555/photo/1 )
Graph--age, % severe & fatal cases by dose
( https://twitter.com/BogochIsaac/status/1572913944570007555/photo/2 )
2/ The hybrid immunity data above is important for informing vaccine policy, especially for younger cohorts (teens/20s) given their elevated relative risk of myocarditis.
90+ day clinical follow up & outcomes of myocarditis cases 👇
https://bit.ly/3LxmODE {Kracalik et al. 2022}
Bar graph--biomarkers 90+ days since myocarditis diagnosis after vaxx ( https://twitter.com/BogochIsaac/status/1572913950551052288/photo/1 )
-------------------------------------------------------------
Martina E McMenamin et al. 2022. Vaccine effectiveness of one, two, and three doses of BNT162b2 and CoronaVac against COVID-19 in Hong Kong: a population-based observational study. The Lancet Infectious Disease. Volume 22, ISSUE 10, P1435-1443, October 01, 2022.
DOI:https://doi.org/10.1016/S1473-3099(22)00345-0 https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00345-0/fullt...
Abstract
...Findings
Between Dec 31, 2020, and March 16, 2022, 13·2 million vaccine doses were administered in Hong Kong's 7·4-million population. We analysed data from confirmed cases with mild or moderate (n=5566), severe or fatal (n=8875), and fatal (n=6866) COVID-19. Two doses of either vaccine {Pfizer BNT162b2 and CoronaVac} protected against severe disease and death within 28 days of a positive test, with higher effectiveness among adults aged 60 years or older with BNT162b2 (vaccine effectiveness 89·3%...) compared with CoronaVac (69·9% ...). Three doses of either vaccine offered very high levels of protection against severe or fatal outcomes (97·9%...).
-------------------------------------------------------------
Sara Carazo et al. 2022. Protection against omicron (B.1.1.529) BA.2 reinfection conferred by primary omicron BA.1 or pre-omicron SARS-CoV-2 infection among health-care workers with and without mRNA vaccination: a test-negative case-control study. The Lancet Infectious Disease. September 21, 2022. DOI:https://doi.org/10.1016/S1473-3099(22)00578-3 https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00578-3/fullt...
...Added value of this study
We conducted a test-negative case-control study to estimate the protection against omicron BA.2 reinfection conferred by previous pre-omicron or omicron BA.1 primary infection, with and without mRNA vaccination, in the population-based cohort of health-care workers aged 18 years or older in Quebec, Canada.
Previous omicron BA.1 infection alone was the single most protective factor against BA.2 reinfection (risk reduction of 72%), and was associated with higher protection than pre-omicron primary infection alone (38%) or even than three doses of mRNA vaccine in people with no previous infection (46%). Hybrid immunity conferred by previous omicron BA.1 primary infection plus vaccination increased estimated protection against BA.2 reinfection, similarly to 96% with two or three vaccine doses, and this protection was maintained for at least 5 months after primary infection...
-------------------------------------------------------------
Ian Kracalik et al. 2022. Outcomes at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination in adolescents and young adults in the USA: a follow-up surveillance study. The Lancet Child and Adolescent Health. September 21, 2022. DOI:https://doi.org/10.1016/S2352-4642(22)00244-9 https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00244-9/fullt...
Abstract
...Interpretation. After at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination, most individuals in our cohort were considered recovered by health-care providers, and quality of life measures were comparable to those in pre-pandemic and early pandemic populations of a similar age. These findings might not be generalisable given the small sample size and further follow-up is needed for the subset of patients with atypical test results or not considered recovered.
Infectious Diseases physician and scientist, with thoughts on Infectious Diseases, Tropical Medicine, HIV Prevention, Public Health, and Global Health issues {U Toronto}
1/ Some solid data emerging, reiterating:
1. The importance of COVID booster vaccines, especially in those over the age of 60.
https://bit.ly/3UsvH5v {McMenamin et al. 2022, below}
2. Two doses of COVID vaccine PLUS recovery from infection provided equivalent protection VS 3 doses. https://bit.ly/3fcEbNR {Carazo et al. 2022, below}
Graphs--risk reduction by vaxx & pre-omicron & omicron infection
( https://twitter.com/BogochIsaac/status/1572913944570007555/photo/1 )
Graph--age, % severe & fatal cases by dose
( https://twitter.com/BogochIsaac/status/1572913944570007555/photo/2 )
2/ The hybrid immunity data above is important for informing vaccine policy, especially for younger cohorts (teens/20s) given their elevated relative risk of myocarditis.
90+ day clinical follow up & outcomes of myocarditis cases 👇
https://bit.ly/3LxmODE {Kracalik et al. 2022}
Bar graph--biomarkers 90+ days since myocarditis diagnosis after vaxx ( https://twitter.com/BogochIsaac/status/1572913950551052288/photo/1 )
-------------------------------------------------------------
Martina E McMenamin et al. 2022. Vaccine effectiveness of one, two, and three doses of BNT162b2 and CoronaVac against COVID-19 in Hong Kong: a population-based observational study. The Lancet Infectious Disease. Volume 22, ISSUE 10, P1435-1443, October 01, 2022.
DOI:https://doi.org/10.1016/S1473-3099(22)00345-0 https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00345-0/fullt...
Abstract
...Findings
Between Dec 31, 2020, and March 16, 2022, 13·2 million vaccine doses were administered in Hong Kong's 7·4-million population. We analysed data from confirmed cases with mild or moderate (n=5566), severe or fatal (n=8875), and fatal (n=6866) COVID-19. Two doses of either vaccine {Pfizer BNT162b2 and CoronaVac} protected against severe disease and death within 28 days of a positive test, with higher effectiveness among adults aged 60 years or older with BNT162b2 (vaccine effectiveness 89·3%...) compared with CoronaVac (69·9% ...). Three doses of either vaccine offered very high levels of protection against severe or fatal outcomes (97·9%...).
-------------------------------------------------------------
Sara Carazo et al. 2022. Protection against omicron (B.1.1.529) BA.2 reinfection conferred by primary omicron BA.1 or pre-omicron SARS-CoV-2 infection among health-care workers with and without mRNA vaccination: a test-negative case-control study. The Lancet Infectious Disease. September 21, 2022. DOI:https://doi.org/10.1016/S1473-3099(22)00578-3 https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00578-3/fullt...
...Added value of this study
We conducted a test-negative case-control study to estimate the protection against omicron BA.2 reinfection conferred by previous pre-omicron or omicron BA.1 primary infection, with and without mRNA vaccination, in the population-based cohort of health-care workers aged 18 years or older in Quebec, Canada.
Previous omicron BA.1 infection alone was the single most protective factor against BA.2 reinfection (risk reduction of 72%), and was associated with higher protection than pre-omicron primary infection alone (38%) or even than three doses of mRNA vaccine in people with no previous infection (46%). Hybrid immunity conferred by previous omicron BA.1 primary infection plus vaccination increased estimated protection against BA.2 reinfection, similarly to 96% with two or three vaccine doses, and this protection was maintained for at least 5 months after primary infection...
-------------------------------------------------------------
Ian Kracalik et al. 2022. Outcomes at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination in adolescents and young adults in the USA: a follow-up surveillance study. The Lancet Child and Adolescent Health. September 21, 2022. DOI:https://doi.org/10.1016/S2352-4642(22)00244-9 https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00244-9/fullt...
Abstract
...Interpretation. After at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination, most individuals in our cohort were considered recovered by health-care providers, and quality of life measures were comparable to those in pre-pandemic and early pandemic populations of a similar age. These findings might not be generalisable given the small sample size and further follow-up is needed for the subset of patients with atypical test results or not considered recovered.
33margd
Just in time for fall, there’s a brand-new COVID variant making headway in the U.S.
BY Erin Prater | September 20, 2022
...BF.7—short for BA.5.2.1.7—comprised 1.7% of sequenced infections last week in the U.S.
...BA.5...85%
...BA.4.6...10.3%
...BA.2.75...1.3%.
Scientists are taking notice of BF.7 because it’s making headway in an increasingly crowded field of Omicron subvariants. For months they’ve watched BA.2.75—dubbed Centaurus by the Twitterverse—as a variant of interest with potential to surge this fall. But this week, BF.7 surpassed it.
Potentially more transmissible than BA.5
So far Belgium has seen the lion’s share of BF.7 cases identified globally: 25%. Denmark, Germany, and France have each seen 10% of the world’s identified cases so far
While nothing is known about the severity of disease BF.7 might cause, so far all Omicron subvariants have had similar severity... It’s unknown how effective the new bivalent Omicron vaccines will be against it.
The new subvariant has a change in the spike protein—a feature that allows it to enter cells—seen in other Omicron strains making headway. It also has a change in the nucleotide sequence—sometimes referred to as the blueprint of an organism—that could cause it to behave differently than other subvariants. But the extent to which it will diverge, if it does at all, is currently unknown...
Continue to mask and get your booster.
https://fortune.com/well/2022/09/20/bf-7-new-covid-subvariant-rising-in-united-s...
BY Erin Prater | September 20, 2022
...BF.7—short for BA.5.2.1.7—comprised 1.7% of sequenced infections last week in the U.S.
...BA.5...85%
...BA.4.6...10.3%
...BA.2.75...1.3%.
Scientists are taking notice of BF.7 because it’s making headway in an increasingly crowded field of Omicron subvariants. For months they’ve watched BA.2.75—dubbed Centaurus by the Twitterverse—as a variant of interest with potential to surge this fall. But this week, BF.7 surpassed it.
Potentially more transmissible than BA.5
So far Belgium has seen the lion’s share of BF.7 cases identified globally: 25%. Denmark, Germany, and France have each seen 10% of the world’s identified cases so far
While nothing is known about the severity of disease BF.7 might cause, so far all Omicron subvariants have had similar severity... It’s unknown how effective the new bivalent Omicron vaccines will be against it.
The new subvariant has a change in the spike protein—a feature that allows it to enter cells—seen in other Omicron strains making headway. It also has a change in the nucleotide sequence—sometimes referred to as the blueprint of an organism—that could cause it to behave differently than other subvariants. But the extent to which it will diverge, if it does at all, is currently unknown...
Continue to mask and get your booster.
https://fortune.com/well/2022/09/20/bf-7-new-covid-subvariant-rising-in-united-s...
34margd
DH's resting heart rate soared when he had what we thought was COVID, and # steps dropped precipitously as he toughed it out on the sofa and bed... He offered researchers his data for background -- at the time they were looking for volunteers from CA only, as I recall.
Eric Topol (Scripps) @EricTopol | 7:54 PM · Sep 22, 2022:
Why wrist sensor surveillance should be part of pandemic monitoring
Jennifer M Radin et al. 2022. Sensor-based surveillance for digitising real-time COVID-19 tracking in the USA (DETECT): a multivariable, population-based, modelling study. The Lancet Digital Health.
Available online 22 September 2022 (In Press, Corrected Proof) . https://doi.org/10.1016/S2589-7500(22)00156-X https://www.sciencedirect.com/science/article/pii/S258975002200156X
Summary
Background
Traditional viral illness surveillance relies on in-person clinical or laboratory data, paper-based data collection, and outdated technology for data transfer and aggregation. We aimed to assess whether continuous sensor data can provide an early warning signal for COVID-19 activity as individual physiological and behavioural changes might precede symptom onset, care seeking, and diagnostic testing.
Methods
...Using sensor data, we collected each participant's daily resting heart rate and step count during the entire study period and identified anomalous sensor days, in which resting heart rate was higher than, and step count was lower than, a specified threshold calculated for each individual by use of their baseline data...
Findings
Between April 1, 2020, and Jan 14, 2022, 35 842 participants enrolled in DETECT, of whom 4006 in California and 28 527 in the USA were included in our main cohort. The H1 model significantly outperformed the H0 model in predicting the 7-day moving average COVID-19 case counts in California and the USA. For example, Pearson correlation coefficients for predictions 12 days in the future increased by 32·9% in California (from 0·70... to 0·93 ...) and by 12·2% (from 0·82 ... to 0·92 ...) in the USA from the H0 model to the H1 model. Our validation model also showed significant correlations for predictions in real time, 6 days in the future, and 12 days in the future.
Interpretation
Our study showed that passively collected sensor data from consenting participants can provide real-time disease tracking and forecasting. With a growing population of wearable technology users, these sensor data could be integrated into viral surveillance programmes.
Eric Topol (Scripps) @EricTopol | 7:54 PM · Sep 22, 2022:
Why wrist sensor surveillance should be part of pandemic monitoring
Jennifer M Radin et al. 2022. Sensor-based surveillance for digitising real-time COVID-19 tracking in the USA (DETECT): a multivariable, population-based, modelling study. The Lancet Digital Health.
Available online 22 September 2022 (In Press, Corrected Proof) . https://doi.org/10.1016/S2589-7500(22)00156-X https://www.sciencedirect.com/science/article/pii/S258975002200156X
Summary
Background
Traditional viral illness surveillance relies on in-person clinical or laboratory data, paper-based data collection, and outdated technology for data transfer and aggregation. We aimed to assess whether continuous sensor data can provide an early warning signal for COVID-19 activity as individual physiological and behavioural changes might precede symptom onset, care seeking, and diagnostic testing.
Methods
...Using sensor data, we collected each participant's daily resting heart rate and step count during the entire study period and identified anomalous sensor days, in which resting heart rate was higher than, and step count was lower than, a specified threshold calculated for each individual by use of their baseline data...
Findings
Between April 1, 2020, and Jan 14, 2022, 35 842 participants enrolled in DETECT, of whom 4006 in California and 28 527 in the USA were included in our main cohort. The H1 model significantly outperformed the H0 model in predicting the 7-day moving average COVID-19 case counts in California and the USA. For example, Pearson correlation coefficients for predictions 12 days in the future increased by 32·9% in California (from 0·70... to 0·93 ...) and by 12·2% (from 0·82 ... to 0·92 ...) in the USA from the H0 model to the H1 model. Our validation model also showed significant correlations for predictions in real time, 6 days in the future, and 12 days in the future.
Interpretation
Our study showed that passively collected sensor data from consenting participants can provide real-time disease tracking and forecasting. With a growing population of wearable technology users, these sensor data could be integrated into viral surveillance programmes.
35margd
Rhinovirus/SARS-CoV-2 viral interference?
Meaghan Kall @kallmemeg | 6:10 AM · Sep 23, 2022:
Epidemiologist @UKHSA... Tweet about HIV & COVID-19. #Nature10 scientist. Female data lad.
Whole family has a cold 🤧
*checks stats*
Looks about right. 🦏
Graph of respiratory viruses incidence, England weekly by last year
( https://twitter.com/kallmemeg/status/1573253488477605890/photo/1 )
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Gerald Evans 🇺🇦 @skepticalIDdoc | 9:27 AM · Sep 23, 2022:
Prof @QueensuDOM | Infect Dis Doc | EIC of @JAMMI_Journal | Affiliate Scientist @ICESOntario
Welcome to early Fall. Same thing here. Let’s hope the reported Rhinovirus/SARS-CoV-2 viral interference* helps reduce infection from the latter for a bit.
--------------------------------------------------------------
Jocelyne Piret and Guy Boivin. 2022. Viral Interference between Respiratory Viruses. Emerg Infect Dis. 2022 Feb; 28(2): 273–281. doi: 10.3201/eid2802.211727 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8798701/
Abstract
Multiple respiratory viruses can concurrently or sequentially infect the respiratory tract and lead to virus‒virus interactions. Infection by a first virus could enhance or reduce infection and replication of a second virus, resulting in positive (additive or synergistic) or negative (antagonistic) interaction. The concept of viral interference has been demonstrated at the cellular, host, and population levels. The mechanisms involved in viral interference have been evaluated in differentiated airway epithelial cells and in animal models susceptible to the respiratory viruses of interest. A likely mechanism is the interferon response that could confer a temporary nonspecific immunity to the host. During the coronavirus disease pandemic, nonpharmacologic interventions have prevented the circulation of most respiratory viruses. Once the sanitary restrictions are lifted, circulation of seasonal respiratory viruses is expected to resume and will offer the opportunity to study their interactions, notably with severe acute respiratory syndrome coronavirus 2.
Also, by same authors:
Jocelyne Piret, Guy Boivin. 2022. Viral Interference between Respiratory Viruses, PERSPECTIVE.
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 28, No. 2, February 2022 273. https://www.cdc.gov/media/eid/2022/02.html
Meaghan Kall @kallmemeg | 6:10 AM · Sep 23, 2022:
Epidemiologist @UKHSA... Tweet about HIV & COVID-19. #Nature10 scientist. Female data lad.
Whole family has a cold 🤧
*checks stats*
Looks about right. 🦏
Graph of respiratory viruses incidence, England weekly by last year
( https://twitter.com/kallmemeg/status/1573253488477605890/photo/1 )
-------------------------------------------------------------
Gerald Evans 🇺🇦 @skepticalIDdoc | 9:27 AM · Sep 23, 2022:
Prof @QueensuDOM | Infect Dis Doc | EIC of @JAMMI_Journal | Affiliate Scientist @ICESOntario
Welcome to early Fall. Same thing here. Let’s hope the reported Rhinovirus/SARS-CoV-2 viral interference* helps reduce infection from the latter for a bit.
--------------------------------------------------------------
Jocelyne Piret and Guy Boivin. 2022. Viral Interference between Respiratory Viruses. Emerg Infect Dis. 2022 Feb; 28(2): 273–281. doi: 10.3201/eid2802.211727 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8798701/
Abstract
Multiple respiratory viruses can concurrently or sequentially infect the respiratory tract and lead to virus‒virus interactions. Infection by a first virus could enhance or reduce infection and replication of a second virus, resulting in positive (additive or synergistic) or negative (antagonistic) interaction. The concept of viral interference has been demonstrated at the cellular, host, and population levels. The mechanisms involved in viral interference have been evaluated in differentiated airway epithelial cells and in animal models susceptible to the respiratory viruses of interest. A likely mechanism is the interferon response that could confer a temporary nonspecific immunity to the host. During the coronavirus disease pandemic, nonpharmacologic interventions have prevented the circulation of most respiratory viruses. Once the sanitary restrictions are lifted, circulation of seasonal respiratory viruses is expected to resume and will offer the opportunity to study their interactions, notably with severe acute respiratory syndrome coronavirus 2.
Also, by same authors:
Jocelyne Piret, Guy Boivin. 2022. Viral Interference between Respiratory Viruses, PERSPECTIVE.
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 28, No. 2, February 2022 273. https://www.cdc.gov/media/eid/2022/02.html
36margd
“Our nationwide study suggests a possible association between COVID-19 and new-onset type 1 diabetes”, says Dr Hanne Løvdal Gulseth, lead author and Research Director at the Norwegian Institute of Public Health. “However, the absolute risk of developing type 1 diabetes increased from 0.08% to 0.13%, and is still low. The vast majority of young people who get COVID-19 will not go on to develop type 1 diabetes but it is important that clinicians and parents are aware of the signs and symptoms of type 1 diabetes. Constant thirst, frequent urination, extreme fatigue and unexpected weight loss are tell-tale symptoms.”
Eric Topol (Scripps MD-scientist) @EricTopol | 11:12 AM · Sep 23, 2022
Two new independent reports, one Norway nationwide, and the other US-based, indicate increased risk of Type 1 (autoimmune) diabetes from Covid in children and teens
News Release: COVID-19 infection may increase risk of type 1 diabetes, suggests nationwide study of 1.2 million children
Diabetologia | 22-Sep-2022
https://eurekalert.org/news-releases/965465
Text ( https://twitter.com/EricTopol/status/1573329404008316929/photo/1 )
Ellen K. Kendall et al. 2022. Association of SARS-CoV-2 Infection With New-Onset Type 1 Diabetes Among Pediatric Patients From 2020 to 2021 (Research Letter). JAMA Netw Open. September 23,2022;5(9):e2233014. doi:10.1001/jamanetworkopen.2022.33014 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796649
Figure--Risk Type 1 diabetes in children, Covid v other respiratory viruses
( https://twitter.com/EricTopol/status/1573329404008316929/photo/2 )
Eric Topol (Scripps MD-scientist) @EricTopol | 11:12 AM · Sep 23, 2022
Two new independent reports, one Norway nationwide, and the other US-based, indicate increased risk of Type 1 (autoimmune) diabetes from Covid in children and teens
News Release: COVID-19 infection may increase risk of type 1 diabetes, suggests nationwide study of 1.2 million children
Diabetologia | 22-Sep-2022
https://eurekalert.org/news-releases/965465
Text ( https://twitter.com/EricTopol/status/1573329404008316929/photo/1 )
Ellen K. Kendall et al. 2022. Association of SARS-CoV-2 Infection With New-Onset Type 1 Diabetes Among Pediatric Patients From 2020 to 2021 (Research Letter). JAMA Netw Open. September 23,2022;5(9):e2233014. doi:10.1001/jamanetworkopen.2022.33014 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796649
Figure--Risk Type 1 diabetes in children, Covid v other respiratory viruses
( https://twitter.com/EricTopol/status/1573329404008316929/photo/2 )
37margd
Diego Bassani, PhD @DGBassani | 6:45 PM · Sep 27, 2022:
🇨🇦 Senior Scientist/Epidemiologist @SickKidsNews @SickKidsGlobal Assoc. Prof @UofTMedicine @UofT_DLSPH ...
Robust study, scary findings. In what universe are these increases in risks of thrombotic diseases following SARS-CoV-2 infection in the population under 40 years of age acceptable?
Table 5. Hazard Ratios (95% CI) Compared w Nn COVID-19 for First Venous Thromboembolism According to Time Since COVID-19 Diagnosis
( https://twitter.com/DGBassani/status/1574892959811747841/photo/1 )
-----------------------------------------------------
Jonathan Sterne @jonathanasterne | 5:29 AM · Sep 21, 2022:
Health Data Science and Medical Statistics at Bristol Medical School/ BNSSG NHS CCG, analysis of large scale routine datasets with a focus on risk prediction.
https://twitter.com/jonathanasterne/status/1572518441017540608 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.060785
🧵1/ JUST PUBLISHED: Association of COVID-19 with major arterial and venous thrombotic diseases: a population-wide cohort study of 48 million adults in England and Wales. https://ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.060785 .*
An amazing team effort...
* Rochelle Knight et al. 2022. Association of COVID-19 With Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales. Circulation Vol. 146, No. 12. Originally published19 Sep 2022. https://doi.org/10.1161/CIRCULATIONAHA.122.060785Circulation .
Abstract
Background:
Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces a prothrombotic state, but long-term effects of COVID-19 on incidence of vascular diseases are unclear.
Methods:
We studied vascular diseases after COVID-19 diagnosis in population-wide anonymized linked English and Welsh electronic health records from January 1 to December 7, 2020. We estimated adjusted hazard ratios comparing the incidence of arterial thromboses and venous thromboembolic events (VTEs) after diagnosis of COVID-19 with the incidence in people without a COVID-19 diagnosis. We conducted subgroup analyses by COVID-19 severity, demographic characteristics, and previous history.
Results:
Among 48 million adults, 125 985 were hospitalized and 1 319 789 were not hospitalized within 28 days of COVID-19 diagnosis. In England, there were 260 279 first arterial thromboses and 59 421 first VTEs during 41.6 million person-years of follow-up. Adjusted hazard ratios for first arterial thrombosis after COVID-19 diagnosis compared with no COVID-19 diagnosis declined from 21.7 ... in week 1 after COVID-19 diagnosis to 1.34 ... during weeks 27 to 49. Adjusted hazard ratios for first VTE after COVID-19 diagnosis declined from 33.2 ... in week 1 to 1.80 ... during weeks 27 to 49. Adjusted hazard ratios were higher, for longer after diagnosis, after hospitalized versus nonhospitalized COVID-19, among Black or Asian versus White people, and among people without versus with a previous event. The estimated whole-population increases in risk of arterial thromboses and VTEs 49 weeks after COVID-19 diagnosis were 0.5% and 0.25%, respectively, corresponding to 7200 and 3500 additional events, respectively, after 1.4 million COVID-19 diagnoses.
Conclusions:
High relative incidence of vascular events soon after COVID-19 diagnosis declines more rapidly for arterial thromboses than VTEs. However, incidence remains elevated up to 49 weeks after COVID-19 diagnosis. These results support policies to prevent severe COVID-19 by means of COVID-19 vaccines, early review after discharge, risk factor control, and use of secondary preventive agents in high-risk patients.
🇨🇦 Senior Scientist/Epidemiologist @SickKidsNews @SickKidsGlobal Assoc. Prof @UofTMedicine @UofT_DLSPH ...
Robust study, scary findings. In what universe are these increases in risks of thrombotic diseases following SARS-CoV-2 infection in the population under 40 years of age acceptable?
Table 5. Hazard Ratios (95% CI) Compared w Nn COVID-19 for First Venous Thromboembolism According to Time Since COVID-19 Diagnosis
( https://twitter.com/DGBassani/status/1574892959811747841/photo/1 )
-----------------------------------------------------
Jonathan Sterne @jonathanasterne | 5:29 AM · Sep 21, 2022:
Health Data Science and Medical Statistics at Bristol Medical School/ BNSSG NHS CCG, analysis of large scale routine datasets with a focus on risk prediction.
https://twitter.com/jonathanasterne/status/1572518441017540608 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.060785
🧵1/ JUST PUBLISHED: Association of COVID-19 with major arterial and venous thrombotic diseases: a population-wide cohort study of 48 million adults in England and Wales. https://ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.060785 .*
An amazing team effort...
* Rochelle Knight et al. 2022. Association of COVID-19 With Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales. Circulation Vol. 146, No. 12. Originally published19 Sep 2022. https://doi.org/10.1161/CIRCULATIONAHA.122.060785Circulation .
Abstract
Background:
Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces a prothrombotic state, but long-term effects of COVID-19 on incidence of vascular diseases are unclear.
Methods:
We studied vascular diseases after COVID-19 diagnosis in population-wide anonymized linked English and Welsh electronic health records from January 1 to December 7, 2020. We estimated adjusted hazard ratios comparing the incidence of arterial thromboses and venous thromboembolic events (VTEs) after diagnosis of COVID-19 with the incidence in people without a COVID-19 diagnosis. We conducted subgroup analyses by COVID-19 severity, demographic characteristics, and previous history.
Results:
Among 48 million adults, 125 985 were hospitalized and 1 319 789 were not hospitalized within 28 days of COVID-19 diagnosis. In England, there were 260 279 first arterial thromboses and 59 421 first VTEs during 41.6 million person-years of follow-up. Adjusted hazard ratios for first arterial thrombosis after COVID-19 diagnosis compared with no COVID-19 diagnosis declined from 21.7 ... in week 1 after COVID-19 diagnosis to 1.34 ... during weeks 27 to 49. Adjusted hazard ratios for first VTE after COVID-19 diagnosis declined from 33.2 ... in week 1 to 1.80 ... during weeks 27 to 49. Adjusted hazard ratios were higher, for longer after diagnosis, after hospitalized versus nonhospitalized COVID-19, among Black or Asian versus White people, and among people without versus with a previous event. The estimated whole-population increases in risk of arterial thromboses and VTEs 49 weeks after COVID-19 diagnosis were 0.5% and 0.25%, respectively, corresponding to 7200 and 3500 additional events, respectively, after 1.4 million COVID-19 diagnoses.
Conclusions:
High relative incidence of vascular events soon after COVID-19 diagnosis declines more rapidly for arterial thromboses than VTEs. However, incidence remains elevated up to 49 weeks after COVID-19 diagnosis. These results support policies to prevent severe COVID-19 by means of COVID-19 vaccines, early review after discharge, risk factor control, and use of secondary preventive agents in high-risk patients.
38margd
Halal vaxx
Two Houston doctors nominated for Nobel Peace Prize for work on COVID vaccine
Brittany Ford | September 30, 2022
...Dr. Peter Hotez and Dr. Maria Elena Bottazzi... made the prototype for the “Indo-Vac” vaccine, allowing BioFarma, an Indonesia pharmaceutical company, to scale it up and make it their own.
The company is expected to produce 20 million doses this year.
"This will build a lot of trust and confidence from the Muslim world,” said Bottazzi.
Hotez says the Indo-Vac is in the final stages of receiving a special certification that will make it acceptable within Islamic law.
“It's a vegan technology, so no animal cells, no human cells, no animal protein, no human protein. It's not a big leap, we think we will get that halal certification," he said.
Last December, similar technology from Texas Children’s was used for another COVID vaccine that was used in India.
The groundbreaking technology has landed Dr. Hotez and Bottazzi a nomination for a 2022 Nobel Peace Prize for their contributions to global vaccine equality.
...The winners of the 2022 noble peace prize will be announced next week....
https://www.khou.com/article/news/health/coronavirus/houston-doctors-nobel-peace...
Two Houston doctors nominated for Nobel Peace Prize for work on COVID vaccine
Brittany Ford | September 30, 2022
...Dr. Peter Hotez and Dr. Maria Elena Bottazzi... made the prototype for the “Indo-Vac” vaccine, allowing BioFarma, an Indonesia pharmaceutical company, to scale it up and make it their own.
The company is expected to produce 20 million doses this year.
"This will build a lot of trust and confidence from the Muslim world,” said Bottazzi.
Hotez says the Indo-Vac is in the final stages of receiving a special certification that will make it acceptable within Islamic law.
“It's a vegan technology, so no animal cells, no human cells, no animal protein, no human protein. It's not a big leap, we think we will get that halal certification," he said.
Last December, similar technology from Texas Children’s was used for another COVID vaccine that was used in India.
The groundbreaking technology has landed Dr. Hotez and Bottazzi a nomination for a 2022 Nobel Peace Prize for their contributions to global vaccine equality.
...The winners of the 2022 noble peace prize will be announced next week....
https://www.khou.com/article/news/health/coronavirus/houston-doctors-nobel-peace...
39margd
Just in time for the holidays, a BQ.1.1 wave? 🙁
According to Peking U's Yunlong Richard Cao, "BQ.1.1 escapes Evusheld and bebtelovimab, making all clinically available antibody drugs ineffective."
Mask and boost up, boys and girls...
Cornelius Roemer @CorneliusRoemer | 7:32 PM · Oct 2, 2022:
Epidemiologist @UKHSA, mom, wife. Born 🇺🇸 Migrated 🇬🇧. Tweet about HIV & COVID-19. #Nature10 scientist.
https://twitter.com/CorneliusRoemer/status/1576716682512388096
With 11 days more data, it is becoming quite clear that BQ.1.1 will drive a variant wave in Europe and North America before the end of November
Its relative share has kept more than doubling every week
It has taken just 19 days to grow 8-fold from 5 sequences to 200 sequences 1/
...
-----------------------------------------------------------------
Kashif Pirzada, MD @KashPrime | 11:08 PM · Oct 2, 2022:
Emergency Physician {Toronto}
Looks like the BA.5 booster might be a better bet for BQ.1.1 than the BA.1 booster in the UK and Canada?
Quote Tweet
Yunlong Richard Cao @yunlong_cao | 3:17 PM · Sep 23, 2022:
Biochemistry & Immunology | Host Immune Response, Antibody Drug & Vaccine Design | Assistant Professor at BIOPIC, Peking University
https://twitter.com/yunlong_cao/status/1573391241664147456
BA.2.75.2 is slightly more evasive than BQ.1.1 against plasma from BA.2/BA.5 breakthrough infections. Its due to the enriched NTD-NAbs elicited by BA.2/BA.5 infections, which BQ.1.1 can't escape. Note that these variants are approaching SARS-CoV-1 level escaping capability. (2/4)
Graphs https://twitter.com/KashPrime/status/1576771116617457664/photo/1
As expected, BQ.1.1 escapes Evusheld and bebtelovimab, making all clinically available antibody drugs ineffective. BQ.1.1 and BA.2.75.2 both displayed sufficient hACE2 binding capability. (3/4) ...
According to Peking U's Yunlong Richard Cao, "BQ.1.1 escapes Evusheld and bebtelovimab, making all clinically available antibody drugs ineffective."
Mask and boost up, boys and girls...
Cornelius Roemer @CorneliusRoemer | 7:32 PM · Oct 2, 2022:
Epidemiologist @UKHSA, mom, wife. Born 🇺🇸 Migrated 🇬🇧. Tweet about HIV & COVID-19. #Nature10 scientist.
https://twitter.com/CorneliusRoemer/status/1576716682512388096
With 11 days more data, it is becoming quite clear that BQ.1.1 will drive a variant wave in Europe and North America before the end of November
Its relative share has kept more than doubling every week
It has taken just 19 days to grow 8-fold from 5 sequences to 200 sequences 1/
...
-----------------------------------------------------------------
Kashif Pirzada, MD @KashPrime | 11:08 PM · Oct 2, 2022:
Emergency Physician {Toronto}
Looks like the BA.5 booster might be a better bet for BQ.1.1 than the BA.1 booster in the UK and Canada?
Quote Tweet
Yunlong Richard Cao @yunlong_cao | 3:17 PM · Sep 23, 2022:
Biochemistry & Immunology | Host Immune Response, Antibody Drug & Vaccine Design | Assistant Professor at BIOPIC, Peking University
https://twitter.com/yunlong_cao/status/1573391241664147456
BA.2.75.2 is slightly more evasive than BQ.1.1 against plasma from BA.2/BA.5 breakthrough infections. Its due to the enriched NTD-NAbs elicited by BA.2/BA.5 infections, which BQ.1.1 can't escape. Note that these variants are approaching SARS-CoV-1 level escaping capability. (2/4)
Graphs https://twitter.com/KashPrime/status/1576771116617457664/photo/1
As expected, BQ.1.1 escapes Evusheld and bebtelovimab, making all clinically available antibody drugs ineffective. BQ.1.1 and BA.2.75.2 both displayed sufficient hACE2 binding capability. (3/4) ...
40margd
Eric Topol {Scripps MD scientist} @EricTopol | 5:23 PM · Oct 3, 2022:
New report on myocarditis after mRNA Covid vaccines w/verification of cases*...
Overall incidence ages 5-39
1st dose: 1 in 200,000
2nd dose: 1 in 30,000
3rd dose: 1 in 50,000
"the benefits of mRNA vaccination greatly outweigh the risk"
Text, highlighted
https://twitter.com/EricTopol/status/1577046829220274176/photo/1
Table, highlighted
https://twitter.com/EricTopol/status/1577046829220274176/photo/2
---------------------------------------------------------------
*Kristin Goddard et al. 2022. Incidence of Myocarditis/Pericarditis Following mRNA COVID-19 Vaccination Among Children and Younger Adults in the United States. Annals of Internal Medicine, 4 October 2022. https://doi.org/10.7326/M22-2274 https://www.acpjournals.org/doi/10.7326/M22-2274
New report on myocarditis after mRNA Covid vaccines w/verification of cases*...
Overall incidence ages 5-39
1st dose: 1 in 200,000
2nd dose: 1 in 30,000
3rd dose: 1 in 50,000
"the benefits of mRNA vaccination greatly outweigh the risk"
Text, highlighted
https://twitter.com/EricTopol/status/1577046829220274176/photo/1
Table, highlighted
https://twitter.com/EricTopol/status/1577046829220274176/photo/2
---------------------------------------------------------------
*Kristin Goddard et al. 2022. Incidence of Myocarditis/Pericarditis Following mRNA COVID-19 Vaccination Among Children and Younger Adults in the United States. Annals of Internal Medicine, 4 October 2022. https://doi.org/10.7326/M22-2274 https://www.acpjournals.org/doi/10.7326/M22-2274
41margd
ETA: Tweet RETRACTED
Safety in Numbers @SafetyinNumbrz | 7:32 PM · Oct 5, 2022:
Paved w/ good intentions -
I just deleted a good-faith tweet {>41 margd:} I posted, using publicly-available data about US kid COVID deaths. Data were real from the CDC & treated transparently.
But I misunderstood the limits of these data, leading to unreliable conclusions. I retract it.
----------------------------------------------------------------
Safety in Numbers @SafetyinNumbrz | 1:14 AM · Oct 4, 2022:
Embrace critical thinking, fact-checking and open, respectful discourse. Judge me for my words & actions, not my demographics.
https://twitter.com/SafetyinNumbrz/status/1577165210858553344
https://threadreaderapp.com/thread/1577165210858553344.html
UPDATED *PROVISIONAL* US Child Mortality Rates for Jan-Aug 2022
🚨COVID is #2 cause of death in children, 2nd to cancer!
COVID kills kids more than drowning, flu, car accidents, guns, poison, fire, suffocation, heart disease, asthma or diabetes - & deaths likely undercounted.
Chart of major single underlying causes of death in kids in US for Jan-Aug 2022. Highest is cancer, followed by COVID. MUCH lower rates for all other causes.
Graph--2022 PROVISIONAL Child Mortality Rates by Underlying Cause through August 2022
https://twitter.com/SafetyinNumbrz/status/1577165210858553344/photo/1
{THREAD}
Safety in Numbers @SafetyinNumbrz | 7:32 PM · Oct 5, 2022:
Paved w/ good intentions -
I just deleted a good-faith tweet {>41 margd:} I posted, using publicly-available data about US kid COVID deaths. Data were real from the CDC & treated transparently.
But I misunderstood the limits of these data, leading to unreliable conclusions. I retract it.
----------------------------------------------------------------
Safety in Numbers @SafetyinNumbrz | 1:14 AM · Oct 4, 2022:
Embrace critical thinking, fact-checking and open, respectful discourse. Judge me for my words & actions, not my demographics.
https://twitter.com/SafetyinNumbrz/status/1577165210858553344
https://threadreaderapp.com/thread/1577165210858553344.html
UPDATED *PROVISIONAL* US Child Mortality Rates for Jan-Aug 2022
🚨COVID is #2 cause of death in children, 2nd to cancer!
COVID kills kids more than drowning, flu, car accidents, guns, poison, fire, suffocation, heart disease, asthma or diabetes - & deaths likely undercounted.
Chart of major single underlying causes of death in kids in US for Jan-Aug 2022. Highest is cancer, followed by COVID. MUCH lower rates for all other causes.
Graph--2022 PROVISIONAL Child Mortality Rates by Underlying Cause through August 2022
https://twitter.com/SafetyinNumbrz/status/1577165210858553344/photo/1
{THREAD}
42margd
Big COVID-19 waves may be coming, new Omicron strains suggest
Emerging subvariants have hit on a combination of mutations that makes them more immune evasive than ever
Gretchen Vogel | 27 Sep 2022
https://www.science.org/content/article/big-covid-19-waves-may-be-coming-new-omi...
-----------------------------------------------------------
In a lo-ong, but readable, thread, U Guelph evolutionary biologist T Ryan Gregory explains convergent evolution and the variant cloud that appears to be in our cOVID future:
T. Ryan Gregory {evolutionary biology U Guelph} @TRyanGregory | 7:09 AM · Oct 5, 2022:
https://twitter.com/TRyanGregory/status/1577617070979694593
....@DGBassani proposed months ago that what we were beginning to see was multiple variants evolving and overlapping in parallel, rather than replacing each other in series. As he noted, the less we do to stop transmission, the more this will occur...
Seeing as how we did not try to mitigate transmission (quite the opposite -- many places dropped what protections we did have), it is not surprising that this is exactly what has happened.
...We have not seen the evolution of major new, deeply divergent lineages of variants recently, but instead it has all been rapid diversification of lineages within the large Omicron clade.
...Mutations happen as chance errors, but what happens to them once they arise is non-random if they happen to confer some advantage in a particular environment...
The current environment for SARS-CoV-2 is a population of hosts with varying levels of immunity, be it from vaccination, prior infection, or both. Immunity wanes, but there is strong selective pressure whereby mutations that confer an ability to circumvent immunity are very fit.
What we're seeing as a result is the same mutations arising by chance in multiple variant lineages, with the variants that happen to have those mutations increasing in frequency as they escape immunity and outcompete variants that lack immune-evading traits.
Similar traits can occur in different species for a couple of reasons. First, they may be similar simply because they all inherited the same trait from a shared ancestor (this is known as "homology"). Fur in different mammal species is homologous, for example.
Similar traits can also evolve independently in different lineages, which is known as "homoplasy" or "convergent evolution" (or "analogous {vs. homologous} traits").
Convergent evolution often happens when separate lineages evolve under similar environmental pressures....
Emerging subvariants have hit on a combination of mutations that makes them more immune evasive than ever
Gretchen Vogel | 27 Sep 2022
https://www.science.org/content/article/big-covid-19-waves-may-be-coming-new-omi...
-----------------------------------------------------------
In a lo-ong, but readable, thread, U Guelph evolutionary biologist T Ryan Gregory explains convergent evolution and the variant cloud that appears to be in our cOVID future:
T. Ryan Gregory {evolutionary biology U Guelph} @TRyanGregory | 7:09 AM · Oct 5, 2022:
https://twitter.com/TRyanGregory/status/1577617070979694593
....@DGBassani proposed months ago that what we were beginning to see was multiple variants evolving and overlapping in parallel, rather than replacing each other in series. As he noted, the less we do to stop transmission, the more this will occur...
Seeing as how we did not try to mitigate transmission (quite the opposite -- many places dropped what protections we did have), it is not surprising that this is exactly what has happened.
...We have not seen the evolution of major new, deeply divergent lineages of variants recently, but instead it has all been rapid diversification of lineages within the large Omicron clade.
...Mutations happen as chance errors, but what happens to them once they arise is non-random if they happen to confer some advantage in a particular environment...
The current environment for SARS-CoV-2 is a population of hosts with varying levels of immunity, be it from vaccination, prior infection, or both. Immunity wanes, but there is strong selective pressure whereby mutations that confer an ability to circumvent immunity are very fit.
What we're seeing as a result is the same mutations arising by chance in multiple variant lineages, with the variants that happen to have those mutations increasing in frequency as they escape immunity and outcompete variants that lack immune-evading traits.
Similar traits can occur in different species for a couple of reasons. First, they may be similar simply because they all inherited the same trait from a shared ancestor (this is known as "homology"). Fur in different mammal species is homologous, for example.
Similar traits can also evolve independently in different lineages, which is known as "homoplasy" or "convergent evolution" (or "analogous {vs. homologous} traits").
Convergent evolution often happens when separate lineages evolve under similar environmental pressures....
43margd
>41 margd: RETRACTED: tweet re child mortality due to COVID.
Safety in Numbers @SafetyinNumbrz | 7:32 PM · Oct 5, 2022:
Paved w/ good intentions -
I just deleted a good-faith tweet {>41 margd:} I posted, using publicly-available data about US kid COVID deaths. Data were real from the CDC & treated transparently.
But I misunderstood the limits of these data, leading to unreliable conclusions. I retract it.
Safety in Numbers @SafetyinNumbrz | 7:32 PM · Oct 5, 2022:
Paved w/ good intentions -
I just deleted a good-faith tweet {>41 margd:} I posted, using publicly-available data about US kid COVID deaths. Data were real from the CDC & treated transparently.
But I misunderstood the limits of these data, leading to unreliable conclusions. I retract it.
44margd
Strokes, heart attacks, sudden deaths: Does America understand the long-term risks of catching COVID?
Carolyn Barber | October 6, 2022
https://fortune.com/2022/10/06/strokes-heart-attacks-sudden-death-america-long-t...
Carolyn Barber | October 6, 2022
https://fortune.com/2022/10/06/strokes-heart-attacks-sudden-death-america-long-t...
45margd
Pregnancy complications spiked during the pandemic. No one knows exactly why.
Ariana Eunjung Cha | October 8, 2022
...While the vast majority of people who are infected do not experience complications, the risk of preeclampsia and other severe issues has been documented to be much higher with infection.
...Preeclampsia, a leading cause of maternal death across the globe, usually begins with small signs like high blood pressure, bubbly urine or vision changes but can progress rapidly to send a person’s entire body into crisis. It typically occurs midway through pregnancy, after about the 20th week, in roughly 2 to 6 percent of pregnant people in the United States.
...While most cases resolve when the baby is delivered or the pregnancy ends, there is no clear treatment in the meantime and the condition can result in organ failure and death.
During the pandemic, pregnant people infected with the coronavirus — whether symptomatic or not — were found to have a 60 percent greater risk of preeclampsia than those who were not infected, according to a number of studies. They also experienced higher rates of other complications, ranging from preterm birth and infection, to dying within six weeks of the pregnancy ending.
...no one knows exactly why the coronavirus can affect pregnancy so severely
...Amy Heerema McKenney, a Cleveland Clinic pathologist whose job involves figuring out why some babies die...found what she calls “disturbances” — or changes in infection-fighting T cells and other immune system changes — that might have long-lasting consequences. She and her colleagues described the differences as a “remodeling of the immunological landscape” or “immunological scars.”
These signs showed up even in people who were asymptomatic or had mild covid-19 symptoms, and Messaoudi wonders whether the immune responses might be part of what caused changes in the placenta linked to stillbirths {seen w Delta, but not Omicron}...
https://www.washingtonpost.com/health/2022/10/08/covid-pregnancy-preeclampsia-st...
Suhas Sureshchandra et al.2022. Single-cell RNA sequencing reveals immunological rewiring at the maternal-fetal interface following asymptomatic/mild SARS-CoV-2 infection. Cell Reports. Volume 39, ISSUE 11, 110938, June 14, 2022. DOI:https://doi.org/10.1016/j.celrep.2022.110938. https://www.cell.com/cell-reports/fulltext/S2211-1247(22)00720-3.
Highlights
• Asymptomatic and mild COVID-19 significantly remodels the maternal-fetal interface
• Altered frequency of decidual macrophages, T regs, and activated T cells
• Antigen presentation and type I IFN signaling are attenuated in decidual macrophages
• T cell repertoire diversity in circulation and decidua is reduced
Ariana Eunjung Cha | October 8, 2022
...While the vast majority of people who are infected do not experience complications, the risk of preeclampsia and other severe issues has been documented to be much higher with infection.
...Preeclampsia, a leading cause of maternal death across the globe, usually begins with small signs like high blood pressure, bubbly urine or vision changes but can progress rapidly to send a person’s entire body into crisis. It typically occurs midway through pregnancy, after about the 20th week, in roughly 2 to 6 percent of pregnant people in the United States.
...While most cases resolve when the baby is delivered or the pregnancy ends, there is no clear treatment in the meantime and the condition can result in organ failure and death.
During the pandemic, pregnant people infected with the coronavirus — whether symptomatic or not — were found to have a 60 percent greater risk of preeclampsia than those who were not infected, according to a number of studies. They also experienced higher rates of other complications, ranging from preterm birth and infection, to dying within six weeks of the pregnancy ending.
...no one knows exactly why the coronavirus can affect pregnancy so severely
...Amy Heerema McKenney, a Cleveland Clinic pathologist whose job involves figuring out why some babies die...found what she calls “disturbances” — or changes in infection-fighting T cells and other immune system changes — that might have long-lasting consequences. She and her colleagues described the differences as a “remodeling of the immunological landscape” or “immunological scars.”
These signs showed up even in people who were asymptomatic or had mild covid-19 symptoms, and Messaoudi wonders whether the immune responses might be part of what caused changes in the placenta linked to stillbirths {seen w Delta, but not Omicron}...
https://www.washingtonpost.com/health/2022/10/08/covid-pregnancy-preeclampsia-st...
Suhas Sureshchandra et al.2022. Single-cell RNA sequencing reveals immunological rewiring at the maternal-fetal interface following asymptomatic/mild SARS-CoV-2 infection. Cell Reports. Volume 39, ISSUE 11, 110938, June 14, 2022. DOI:https://doi.org/10.1016/j.celrep.2022.110938. https://www.cell.com/cell-reports/fulltext/S2211-1247(22)00720-3.
Highlights
• Asymptomatic and mild COVID-19 significantly remodels the maternal-fetal interface
• Altered frequency of decidual macrophages, T regs, and activated T cells
• Antigen presentation and type I IFN signaling are attenuated in decidual macrophages
• T cell repertoire diversity in circulation and decidua is reduced
46margd
Almost 1 in 2 Americans Didn't Tell The Truth About COVID, Study Finds
Carly Cassella | 11 October 2022
https://www.sciencealert.com/almost-1-in-2-americans-didnt-tell-the-truth-about-...
Andrea Gurmankin Levy et al. 2022. Misrepresentation and Nonadherence Regarding COVID-19 Public Health Measures. JAMA Netw Open. 10 Oct 2022;5(10):e2235837. doi:10.1001/jamanetworkopen.2022.35837 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797071
Key Points
Question What are the prevalence of and reasons for misrepresentation and nonadherence regarding public health measures against COVID-19?
Findings In this national survey study of 1733 US adults, nearly half of participants reported misrepresentation and/or nonadherence regarding COVID-19 public health measures. The most common reasons included wanting life to feel normal and wanting to exercise personal freedom.
Meaning These findings suggest that misrepresentation and nonadherence regarding COVID-19 public health measures constitute a serious public health challenge.
Carly Cassella | 11 October 2022
https://www.sciencealert.com/almost-1-in-2-americans-didnt-tell-the-truth-about-...
Andrea Gurmankin Levy et al. 2022. Misrepresentation and Nonadherence Regarding COVID-19 Public Health Measures. JAMA Netw Open. 10 Oct 2022;5(10):e2235837. doi:10.1001/jamanetworkopen.2022.35837 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797071
Key Points
Question What are the prevalence of and reasons for misrepresentation and nonadherence regarding public health measures against COVID-19?
Findings In this national survey study of 1733 US adults, nearly half of participants reported misrepresentation and/or nonadherence regarding COVID-19 public health measures. The most common reasons included wanting life to feel normal and wanting to exercise personal freedom.
Meaning These findings suggest that misrepresentation and nonadherence regarding COVID-19 public health measures constitute a serious public health challenge.
47margd
Jon Levy @jonlevyBU | 1:10 PM · Oct 11, 2022:
Professor and Chair of @busphEH. Focused on environmental justice across air, climate, housing, and now COVID-19. Trying to make a difference.
Dr. Jha mentions call to action for building owners. http://whitehouse.gov/cleanindoorair launching today as a resource. ARP funding to schools and elsewhere to improve ventilation. Also working on technical capacity for schools to give necessary expertise. New RFI out from EPA on clean air.
whitehouse.gov
Clean Air in Buildings
Pledge Opportunity
The White House is inviting organizational leaders and building owners and operators across the country to join us in our efforts to continue fighting the spread of COVID-19 by publicly pledging to meet the Clean Air in Buildings Challenge.
https://www.whitehouse.gov/cleanindoorair/
{Thread https://twitter.com/jonlevyBU/status/1579913616043954177 }
Professor and Chair of @busphEH. Focused on environmental justice across air, climate, housing, and now COVID-19. Trying to make a difference.
Dr. Jha mentions call to action for building owners. http://whitehouse.gov/cleanindoorair launching today as a resource. ARP funding to schools and elsewhere to improve ventilation. Also working on technical capacity for schools to give necessary expertise. New RFI out from EPA on clean air.
whitehouse.gov
Clean Air in Buildings
Pledge Opportunity
The White House is inviting organizational leaders and building owners and operators across the country to join us in our efforts to continue fighting the spread of COVID-19 by publicly pledging to meet the Clean Air in Buildings Challenge.
https://www.whitehouse.gov/cleanindoorair/
{Thread https://twitter.com/jonlevyBU/status/1579913616043954177 }
48margd
Vaccination Cut Long COVID Risk for Rheum Patients
— Significantly lower rates of post-acute symptoms seen in prospective cohort study
John Gever | October 11, 2022
...When the data were adjusted for age, sex, race, comorbidities, and use of immunosuppressant drugs {in 280 rheumatic disease patients}, the odds that a vaccinated patient would develop post-acute COVID symptoms, also called "long COVID," through day 90 were just one-tenth that of unvaccinated patients...
Rates of post-acute symptoms lasting 28 days were also lower for the vaccinated patients: 41% versus 54%...
https://www.medpagetoday.com/rheumatology/generalrheumatology/101166
-----------------------------------------------------
Naomi J. Patel et al. 2022. Impact of vaccination on post-acute sequelae of SARS CoV-2 infection in patients with rheumatic diseases. MRxiv 7 Oct 2022. doi: https://doi.org/10.1101/2022.10.06.22280798 https://www.medrxiv.org/content/10.1101/2022.10.06.22280798v1
— Significantly lower rates of post-acute symptoms seen in prospective cohort study
John Gever | October 11, 2022
...When the data were adjusted for age, sex, race, comorbidities, and use of immunosuppressant drugs {in 280 rheumatic disease patients}, the odds that a vaccinated patient would develop post-acute COVID symptoms, also called "long COVID," through day 90 were just one-tenth that of unvaccinated patients...
Rates of post-acute symptoms lasting 28 days were also lower for the vaccinated patients: 41% versus 54%...
https://www.medpagetoday.com/rheumatology/generalrheumatology/101166
-----------------------------------------------------
Naomi J. Patel et al. 2022. Impact of vaccination on post-acute sequelae of SARS CoV-2 infection in patients with rheumatic diseases. MRxiv 7 Oct 2022. doi: https://doi.org/10.1101/2022.10.06.22280798 https://www.medrxiv.org/content/10.1101/2022.10.06.22280798v1
49margd
Denmark: 120 Covid variants sequenced in one month ⚠️
Denmark has just provided graphic evidence of that variant soup. It has just published a list of no less than 120 variants found circulating in the country in the last 4 weeks in its latest report.
Denmark: A soup of 120 Covid variants sequenced in one month -
https://www.coronaheadsup.com/science/variants/denmark-a-soup-of-120-covid-varia...
- Jess @MeetJess8:44 AM · Oct 11, 2022
Denmark has just provided graphic evidence of that variant soup. It has just published a list of no less than 120 variants found circulating in the country in the last 4 weeks in its latest report.
Denmark: A soup of 120 Covid variants sequenced in one month -
https://www.coronaheadsup.com/science/variants/denmark-a-soup-of-120-covid-varia...
- Jess @MeetJess8:44 AM · Oct 11, 2022
50margd
Eric Topol {Scripps MD scientist} @EricTopol | 11:45 AM · Oct 12, 2022:
Let me (be) perfectly clear about the evidence for myocarditis after mRNA vaccines
1. There is a notable increased incidence, age 12-39, males, with each dose (Table)
https://acpjournals.org/doi/10.7326/M22-2274
Table ( https://twitter.com/EricTopol/status/1580223148942712832/photo/1 )
2. It is usually mild, with complete recovery in most
https://thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00244-9/fulltext
3. There are NO credible data linking this adverse effect with cardiac deaths, despite a flawed widely disseminated Florida study based on 20 deaths
https://washingtonpost.com/health/2022/10/11/florida-surgeon-general-ladapo-covi... ddiamond
Breakdown of multiple, systematic flaws
https://twitter.com/kmpanthagani/status/1578921562761465857
Let me (be) perfectly clear about the evidence for myocarditis after mRNA vaccines
1. There is a notable increased incidence, age 12-39, males, with each dose (Table)
https://acpjournals.org/doi/10.7326/M22-2274
Table ( https://twitter.com/EricTopol/status/1580223148942712832/photo/1 )
2. It is usually mild, with complete recovery in most
https://thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00244-9/fulltext
3. There are NO credible data linking this adverse effect with cardiac deaths, despite a flawed widely disseminated Florida study based on 20 deaths
https://washingtonpost.com/health/2022/10/11/florida-surgeon-general-ladapo-covi... ddiamond
Breakdown of multiple, systematic flaws
https://twitter.com/kmpanthagani/status/1578921562761465857
51margd
>47 margd: contd.
October 13, 2022
Dr. Joseph Allen Presenting at White House Summit on Indoor Air Quality (IAQ)
(Picture: The White House. Watch the full summit on the White House’s YouTube channel. https://www.youtube.com/user/whitehouse/videos )
October 11, 2022 – Dr. Joseph Allen, associate professor for exposure assessment science and director of the Healthy Buildings program at Harvard T.H. Chan School of Public Health, was a guest panelist at the first White House Summit on Indoor Air Quality (IAQ). The summit underlined the relevance of IAQ for public health and human well-being...
https://www.hsph.harvard.edu/healthybuildings/2022/10/13/dr-joseph-allen-present...
October 13, 2022
Dr. Joseph Allen Presenting at White House Summit on Indoor Air Quality (IAQ)
(Picture: The White House. Watch the full summit on the White House’s YouTube channel. https://www.youtube.com/user/whitehouse/videos )
October 11, 2022 – Dr. Joseph Allen, associate professor for exposure assessment science and director of the Healthy Buildings program at Harvard T.H. Chan School of Public Health, was a guest panelist at the first White House Summit on Indoor Air Quality (IAQ). The summit underlined the relevance of IAQ for public health and human well-being...
https://www.hsph.harvard.edu/healthybuildings/2022/10/13/dr-joseph-allen-present...
52margd
London researchers say people with Long COVID have unique blood markers
Craig Needles | October 13, 2022
...blood vessels of people with Long COVID changed rapidly after they got COVID-19. They also found that patients with long COVID had 14 elevated blood biomarkers associate with blood vessels and two of the biomarkers could be used to diagnose Long COVID with 96% accuracy.
...Researchers say these biomarkers may not just help diagnose a disease, they may also provide a path to discovering potential treatments...
https://blackburnnews.com/london/london-news/2022/10/13/london-researchers-say-p...
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Maitray A. Patel et al. 2022. Elevated vascular transformation blood biomarkers in Long-COVID indicate angiogenesis as a key pathophysiological mechanism. Molecular Medicine volume 28, Article number: 122 (10 Oct 2022) https://molmed.biomedcentral.com/articles/10.1186/s10020-022-00548-8
ABSTRACT
...Conclusions
Long-COVID patients suffer prolonged, diffuse symptoms and poorer health. Vascular transformation blood biomarkers were significantly elevated in Long-COVID, with angiogenesis markers (ANG-1/P-SEL) providing classification accuracy of 96%. Vascular transformation blood biomarkers hold potential for diagnostics, and modulators of angiogenesis may have therapeutic efficacy.
...Discussion
...Our data indicate a unique Long-COVID blood proteome; two vascular transformation biomarkers were identified that distinguished Long-COVID patients from acutely ill COVID-19 inpatients and healthy control subjects (classification accuracy of 96%). Our data suggest that one or both of the two leading biomarkers, ANG-1 and P-SEL, have potential as disease biomarkers. Moreover, given the primary roles of these two biomarkers in angiogenesis, accelerators or inhibitors of microvascular re-modelling may provide therapeutic potential for Long-COVID patients. The test data was validated in a consecutive, secondary Long-COVID patient cohort.
... Long-COVID patients were more likely to be older, have greater body mass index and be female sex ... They suffered diffuse symptoms, such as fatigue, post-exertional malaise, anosmia and cognitive dysfunction, and across multiple organ systems ...
Our study has identified 14 vascular transformation proteins that are significantly elevated in Long-COVID outpatients, with the leading two proteins (ANG-1 and P-SEL) accurately identifying Long-COVID status...The {two}molecules are critical for vascular transformation and suggest they play a wound-healing role in the Long-COVID patients....
... Previous studies have shown ANG-1 to have vasculature protective effects including suppressing plasma leakage, inhibiting vascular inflammation, preventing endothelial death, and enlargement of existing vessels ... As COVID-19 patients have increased angiogenesis due to the endothelial injury, the significantly elevated ANG-1 observed in our Long-COVID patients may represent a long-term, wound-repairing angiogenesis response.
P-SEL is a type-1 transmembrane glycoprotein that is expressed on endothelial cells and platelets ... During infection, the endothelium is activated and P-SEL facilitates platelet aggregation and adhesion... P-SEL also serves a critical role in angiogenesis by promoting early inflammatory mononuclear cell proliferation..., and mediating endothelial cell migration ... P-SEL is acutely elevated in COVID-19, and it is associated with COVID-19 symptom severity ... Lymphocyte binding along specialized high endothelial venules is initiated by P-SEL ..., and may be associated with our observation of elevated lymphocytes in Long-COVID outpatients, relative to acutely ill COVID-19 inpatients. We could not establish an association between P-SEL and platelet number, suggesting the role of P-SEL in Long-COVID may be skewed towards angiogenesis and lymphocyte migration, rather than platelet aggregation.
Accumulating evidence suggests that females have a greater chance of being affected by Long-COVID ... we cannot corroborate those findings directly. However, ANG-1 was significantly elevated in our female Long-COVID patients, as opposed to males.
Our study has also identified ANG-1 to be significantly elevated in Long-COVID individuals receiving no interventions at follow-up. There were no sex differences for individuals receiving interventions and those without interventions. These latter findings suggest that ANG-1 is critically important for angiogenesis and it is protective at higher levels, perhaps by hastening the healing response.
Long-COVID has been compared to Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is an overwhelming fatigue that is not improved by rest and worsened by any physical or mental exertion. Our data suggests that Long-COVID is biochemically distinct from ME/CFS as all 14 vascular transformation biomarkers increased significantly in plasma from Long-COVID patients when compared to healthy control subjects. In contrast, plasma levels of P-SEL, MMP-1, ICAM-1, VEGF-A and VEGF-D either do not change with ME/CFS or are depressed ... In addition, plasma ANG-1 is unchanged or depressed in common autoimmune and inflammatory diseases, such as rheumatoid arthritis ... and systemic lupus erythematosus ...
Conclusion
Long-COVID diagnosis and treatment suffers from lack of diagnostic biomarkers and therapeutic targets. In this study, we identify two diagnostic biomarkers (ANG-1 and P-SEL), as well as angiogenesis as a potential therapeutic target. These results are valuable for future hypothesis-generating studies analyzing Long-COVID at a molecular level, developing diagnostic tests, and investigating therapeutic targets. Future studies should also correlate vascular transformation markers with other inflammatory markers to better define potential causal pathways.
Craig Needles | October 13, 2022
...blood vessels of people with Long COVID changed rapidly after they got COVID-19. They also found that patients with long COVID had 14 elevated blood biomarkers associate with blood vessels and two of the biomarkers could be used to diagnose Long COVID with 96% accuracy.
...Researchers say these biomarkers may not just help diagnose a disease, they may also provide a path to discovering potential treatments...
https://blackburnnews.com/london/london-news/2022/10/13/london-researchers-say-p...
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Maitray A. Patel et al. 2022. Elevated vascular transformation blood biomarkers in Long-COVID indicate angiogenesis as a key pathophysiological mechanism. Molecular Medicine volume 28, Article number: 122 (10 Oct 2022) https://molmed.biomedcentral.com/articles/10.1186/s10020-022-00548-8
ABSTRACT
...Conclusions
Long-COVID patients suffer prolonged, diffuse symptoms and poorer health. Vascular transformation blood biomarkers were significantly elevated in Long-COVID, with angiogenesis markers (ANG-1/P-SEL) providing classification accuracy of 96%. Vascular transformation blood biomarkers hold potential for diagnostics, and modulators of angiogenesis may have therapeutic efficacy.
...Discussion
...Our data indicate a unique Long-COVID blood proteome; two vascular transformation biomarkers were identified that distinguished Long-COVID patients from acutely ill COVID-19 inpatients and healthy control subjects (classification accuracy of 96%). Our data suggest that one or both of the two leading biomarkers, ANG-1 and P-SEL, have potential as disease biomarkers. Moreover, given the primary roles of these two biomarkers in angiogenesis, accelerators or inhibitors of microvascular re-modelling may provide therapeutic potential for Long-COVID patients. The test data was validated in a consecutive, secondary Long-COVID patient cohort.
... Long-COVID patients were more likely to be older, have greater body mass index and be female sex ... They suffered diffuse symptoms, such as fatigue, post-exertional malaise, anosmia and cognitive dysfunction, and across multiple organ systems ...
Our study has identified 14 vascular transformation proteins that are significantly elevated in Long-COVID outpatients, with the leading two proteins (ANG-1 and P-SEL) accurately identifying Long-COVID status...The {two}molecules are critical for vascular transformation and suggest they play a wound-healing role in the Long-COVID patients....
... Previous studies have shown ANG-1 to have vasculature protective effects including suppressing plasma leakage, inhibiting vascular inflammation, preventing endothelial death, and enlargement of existing vessels ... As COVID-19 patients have increased angiogenesis due to the endothelial injury, the significantly elevated ANG-1 observed in our Long-COVID patients may represent a long-term, wound-repairing angiogenesis response.
P-SEL is a type-1 transmembrane glycoprotein that is expressed on endothelial cells and platelets ... During infection, the endothelium is activated and P-SEL facilitates platelet aggregation and adhesion... P-SEL also serves a critical role in angiogenesis by promoting early inflammatory mononuclear cell proliferation..., and mediating endothelial cell migration ... P-SEL is acutely elevated in COVID-19, and it is associated with COVID-19 symptom severity ... Lymphocyte binding along specialized high endothelial venules is initiated by P-SEL ..., and may be associated with our observation of elevated lymphocytes in Long-COVID outpatients, relative to acutely ill COVID-19 inpatients. We could not establish an association between P-SEL and platelet number, suggesting the role of P-SEL in Long-COVID may be skewed towards angiogenesis and lymphocyte migration, rather than platelet aggregation.
Accumulating evidence suggests that females have a greater chance of being affected by Long-COVID ... we cannot corroborate those findings directly. However, ANG-1 was significantly elevated in our female Long-COVID patients, as opposed to males.
Our study has also identified ANG-1 to be significantly elevated in Long-COVID individuals receiving no interventions at follow-up. There were no sex differences for individuals receiving interventions and those without interventions. These latter findings suggest that ANG-1 is critically important for angiogenesis and it is protective at higher levels, perhaps by hastening the healing response.
Long-COVID has been compared to Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is an overwhelming fatigue that is not improved by rest and worsened by any physical or mental exertion. Our data suggests that Long-COVID is biochemically distinct from ME/CFS as all 14 vascular transformation biomarkers increased significantly in plasma from Long-COVID patients when compared to healthy control subjects. In contrast, plasma levels of P-SEL, MMP-1, ICAM-1, VEGF-A and VEGF-D either do not change with ME/CFS or are depressed ... In addition, plasma ANG-1 is unchanged or depressed in common autoimmune and inflammatory diseases, such as rheumatoid arthritis ... and systemic lupus erythematosus ...
Conclusion
Long-COVID diagnosis and treatment suffers from lack of diagnostic biomarkers and therapeutic targets. In this study, we identify two diagnostic biomarkers (ANG-1 and P-SEL), as well as angiogenesis as a potential therapeutic target. These results are valuable for future hypothesis-generating studies analyzing Long-COVID at a molecular level, developing diagnostic tests, and investigating therapeutic targets. Future studies should also correlate vascular transformation markers with other inflammatory markers to better define potential causal pathways.
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"Pretty troublesome": New COVID variant BQ.1 now makes up 1 in 10 cases nationwide, CDC estimates
Alexander Tin | October 14, 2022
...BQ.1 and BQ.1.1 each currently make up an estimated 5.7% of infections around the country, the agency said. The remainder of BA.5 {parent of BQ.1 and BQ.1.1}, which had dominated a wave of cases over the summer, has shrunk to 67.9% of circulating variants.
...New York and New Jersey area has the largest proportion of BQ.1 and BQ.1.1 infections. Around 20% of infections...{BQ.1 variants have already outpaced many rival strains in European nations from England to Germany, which have already seen renewed waves begin.}
...{cases are down, hospitalizations are down} But data from Health and Human Services Region 2, which spans New York and New Jersey, has also tracked a recent uptick in COVID-19 hospitalizations and nursing home infections.
...worries that the variant's mutations might evade medications like Evusheld, which is a key antibody drug used to help protect immunocompromised Americans from the virus...
https://www.cbsnews.com/news/covid-variant-bq-1-omicron-cdc-estimates/
Alexander Tin | October 14, 2022
...BQ.1 and BQ.1.1 each currently make up an estimated 5.7% of infections around the country, the agency said. The remainder of BA.5 {parent of BQ.1 and BQ.1.1}, which had dominated a wave of cases over the summer, has shrunk to 67.9% of circulating variants.
...New York and New Jersey area has the largest proportion of BQ.1 and BQ.1.1 infections. Around 20% of infections...{BQ.1 variants have already outpaced many rival strains in European nations from England to Germany, which have already seen renewed waves begin.}
...{cases are down, hospitalizations are down} But data from Health and Human Services Region 2, which spans New York and New Jersey, has also tracked a recent uptick in COVID-19 hospitalizations and nursing home infections.
...worries that the variant's mutations might evade medications like Evusheld, which is a key antibody drug used to help protect immunocompromised Americans from the virus...
https://www.cbsnews.com/news/covid-variant-bq-1-omicron-cdc-estimates/
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Nicolas Smit @PPEtoheros's mask guide (infographic)
https://twitter.com/ariccio/status/1581433541744766976/photo/1
- Alexander Riccio (@co2trackers) @ariccio | 7:55 PM · Oct 15, 2022
https://twitter.com/ariccio/status/1581433541744766976/photo/1
- Alexander Riccio (@co2trackers) @ariccio | 7:55 PM · Oct 15, 2022
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Dr Peter Beaver (sociologist) @PeterJBeaver | 3:42 AM · Oct 16, 2022
Sociologist (patient safety). Doing qualitative market research.
This is the first study of SARS-2 reinfection.
The risk of at least one sequela at 180 days increased from 135% after one infection, to 211% after two, to 300% after three.
SARS-2 hits you harder each time.
Fig 5, Al-Aly et al. 2022, outcomes at 1, 2, 3+ infections
https://twitter.com/PeterJBeaver/status/1581551119842492416/photo/1
-------------------------------------------------------------
A reinfection red flag
Why a new report is so troubling
Eric Topol (Scripps MD-scientist) | Jun 21, 2022
...The first finding is the comparison of people with reinfections vs those with only 1 infection. Note the doubling of all-cause mortality, cardiovascular, and lung adverse outcomes, 3-fold risk of hospitalization, and impact on other health domains...
Next is the durability of these adverse outcomes for this same comparison (reinfections vs 1 infection) in 30-day increments, indicating that much of the hit was up front, but persistent increased risk was evident for most endpoints throughout the 6 months follow-up...
Finally, there is the “dose-response” effect of multiple reinfections. By that I mean with additional episodes of Covid, for every outcome there was a stepwise increased risk, both relative...and absolute...
The new Omicron subvariants portend much more reinfections
The Omicron BA.1-specific vaccine booster remedy?
...recent Nature paper (concluded) “Together, our results indicate that Omicron may evolve mutations to evade the humoral immunity elicited by BA.1 infection, suggesting that BA.1-derived vaccine boosters may not achieve broad-spectrum protection against new Omicron variants.” ...
What should we do about this?
Despite lack of warnings by CDC, there should be gearing up with N95/KN95 masks, distancing when possible, attention to ventilation, air filtration, and all of the non-pharmacologic measures that we have at our disposal to limit infections and reinfections.
Booster shots can help, especially when more than 4 months have elapsed from primary vaccination or a third shot...
...hyper-aggressively pursue pan-B-coronavirus and nasal vaccines
https://erictopol.substack.com/p/a-reinfection-red-flag
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Ziyad Al-Aly et al. 2022. Outcomes of SARS-CoV-2 Reinfection. Research Square Version 1 posted 17 Jun, 2022. https://doi.org/10.21203/rs.3.rs-1749502/v1 https://www.researchsquare.com/article/rs-1749502/v1
...risks and 6-month burdens of all-cause mortality, hospitalization, and a set of pre-specified incident outcomes. We show that compared to people with first infection, reinfection contributes additional risks of all-cause mortality, hospitalization, and adverse health outcomes in the pulmonary and several extrapulmonary organ systems (cardiovascular disorders, coagulation and hematologic disorders, diabetes, fatigue, gastrointestinal disorders, kidney disorders, mental health disorders, musculoskeletal disorders, and neurologic disorders); the risks were evident in those who were unvaccinated, had 1 shot, or 2 or more shots prior to the second infection; the risks were most pronounced in the acute phase, but persisted in the post-acute phase of reinfection, and most were still evident at 6 months after reinfection. Compared to non-infected controls, assessment of the cumulative risks of repeated infection showed that the risk and burden increased in a graded fashion according to the number of infections. The constellation of findings show that reinfection adds non-trivial risks of all-cause mortality, hospitalization, and adverse health outcomes in the acute and post-acute phase of the reinfection. Reducing overall burden of death and disease due to SARS-CoV-2 will require strategies for reinfection prevention.
Sociologist (patient safety). Doing qualitative market research.
This is the first study of SARS-2 reinfection.
The risk of at least one sequela at 180 days increased from 135% after one infection, to 211% after two, to 300% after three.
SARS-2 hits you harder each time.
Fig 5, Al-Aly et al. 2022, outcomes at 1, 2, 3+ infections
https://twitter.com/PeterJBeaver/status/1581551119842492416/photo/1
-------------------------------------------------------------
A reinfection red flag
Why a new report is so troubling
Eric Topol (Scripps MD-scientist) | Jun 21, 2022
...The first finding is the comparison of people with reinfections vs those with only 1 infection. Note the doubling of all-cause mortality, cardiovascular, and lung adverse outcomes, 3-fold risk of hospitalization, and impact on other health domains...
Next is the durability of these adverse outcomes for this same comparison (reinfections vs 1 infection) in 30-day increments, indicating that much of the hit was up front, but persistent increased risk was evident for most endpoints throughout the 6 months follow-up...
Finally, there is the “dose-response” effect of multiple reinfections. By that I mean with additional episodes of Covid, for every outcome there was a stepwise increased risk, both relative...and absolute...
The new Omicron subvariants portend much more reinfections
The Omicron BA.1-specific vaccine booster remedy?
...recent Nature paper (concluded) “Together, our results indicate that Omicron may evolve mutations to evade the humoral immunity elicited by BA.1 infection, suggesting that BA.1-derived vaccine boosters may not achieve broad-spectrum protection against new Omicron variants.” ...
What should we do about this?
Despite lack of warnings by CDC, there should be gearing up with N95/KN95 masks, distancing when possible, attention to ventilation, air filtration, and all of the non-pharmacologic measures that we have at our disposal to limit infections and reinfections.
Booster shots can help, especially when more than 4 months have elapsed from primary vaccination or a third shot...
...hyper-aggressively pursue pan-B-coronavirus and nasal vaccines
https://erictopol.substack.com/p/a-reinfection-red-flag
-------------------------------------------------------------
Ziyad Al-Aly et al. 2022. Outcomes of SARS-CoV-2 Reinfection. Research Square Version 1 posted 17 Jun, 2022. https://doi.org/10.21203/rs.3.rs-1749502/v1 https://www.researchsquare.com/article/rs-1749502/v1
...risks and 6-month burdens of all-cause mortality, hospitalization, and a set of pre-specified incident outcomes. We show that compared to people with first infection, reinfection contributes additional risks of all-cause mortality, hospitalization, and adverse health outcomes in the pulmonary and several extrapulmonary organ systems (cardiovascular disorders, coagulation and hematologic disorders, diabetes, fatigue, gastrointestinal disorders, kidney disorders, mental health disorders, musculoskeletal disorders, and neurologic disorders); the risks were evident in those who were unvaccinated, had 1 shot, or 2 or more shots prior to the second infection; the risks were most pronounced in the acute phase, but persisted in the post-acute phase of reinfection, and most were still evident at 6 months after reinfection. Compared to non-infected controls, assessment of the cumulative risks of repeated infection showed that the risk and burden increased in a graded fashion according to the number of infections. The constellation of findings show that reinfection adds non-trivial risks of all-cause mortality, hospitalization, and adverse health outcomes in the acute and post-acute phase of the reinfection. Reducing overall burden of death and disease due to SARS-CoV-2 will require strategies for reinfection prevention.
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Bonnie LaFleur et al. 2022. No evidence that analgesic use after COVID-19 vaccination negatively impacts antibody responses. MedRxiv Oct 17, 2022. doi: https://doi.org/10.1101/2022.10.14.22281103 https://www.medrxiv.org/content/10.1101/2022.10.14.22281103v1
This article is a preprint and has not been certified by peer review
Abstract
...We found no negative impact of analgesic use on antibody levels, and in fact observed slightly elevated concentrations of anti-Spike antibodies in individuals who used painkillers. Logistic regression analyses demonstrated a higher proportion of those experiencing fatigue and muscle aches between NSAID users and those not taking pain medication, suggesting that the elevated antibody levels were likely associated with inflammation and mild adverse events rather than analgesic use per se. Together, our results suggest no detriment to painkiller use to alleviate symptoms after vaccination against COVID-19.
This article is a preprint and has not been certified by peer review
Abstract
...We found no negative impact of analgesic use on antibody levels, and in fact observed slightly elevated concentrations of anti-Spike antibodies in individuals who used painkillers. Logistic regression analyses demonstrated a higher proportion of those experiencing fatigue and muscle aches between NSAID users and those not taking pain medication, suggesting that the elevated antibody levels were likely associated with inflammation and mild adverse events rather than analgesic use per se. Together, our results suggest no detriment to painkiller use to alleviate symptoms after vaccination against COVID-19.
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Hannah Davis @ahandvanish | 4:36 PM · Oct 17, 2022:
Research, generative music, machine learning/AI, anti-bias in AI data. #LongCovid research & advocacy
So for those keeping track: official statistics show
3.4% of the UK,
4.6% of Canada, and
7.5% of the US populations
currently have #LongCovid.
Direct comparisons between countries aren’t really possible given vastly different determinants of health, including paid time off, access & quality of healthcare, etc.
The point is that each country now has a significant % with debilitating chronic illness….
Should have added that this is of the adult populations!
---------------------------------------------------------
Canada:
https://www150.statcan.gc.ca/n1/daily-quotidien/221017/dq221017b-eng.htm
US:
https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220622.htm
The Netherlands (1 in 8):
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01214-4/fullt...
Research, generative music, machine learning/AI, anti-bias in AI data. #LongCovid research & advocacy
So for those keeping track: official statistics show
3.4% of the UK,
4.6% of Canada, and
7.5% of the US populations
currently have #LongCovid.
Direct comparisons between countries aren’t really possible given vastly different determinants of health, including paid time off, access & quality of healthcare, etc.
The point is that each country now has a significant % with debilitating chronic illness….
Should have added that this is of the adult populations!
---------------------------------------------------------
Canada:
https://www150.statcan.gc.ca/n1/daily-quotidien/221017/dq221017b-eng.htm
US:
https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220622.htm
The Netherlands (1 in 8):
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01214-4/fullt...
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Radiographic Lung Changes Common With Pulmonary Long COVID Symptoms
— But significant declines in pulmonary, physical function not evident in interim analyses
Salynn Boyles | October 17, 2022
(Stephen Goertzen, DO, of Brooke Army Medical Center in Houston...presented the findings in a session devoted to long COVID research at CHEST 2022, the annual meeting of the American College of Chest Physicians. )
...Fully 55% of the subset of persistently symptomatic patients (dyspnea, respiratory symptoms, chest pain) with a high-resolution CT showed radiographic evidence of pulmonary pathology at least 3 months post-infection in an 80-patient interim analysis of a study exploring the physiology of long COVID.
These radiographic changes did not correlate with significant changes in pulmonary function test findings or declines in physical function as measured by 6-minute walking test (6MWT)
In all, 55% of those with CT scans showed radiographic evidence of pulmonary pathology, including nodular pattern (38%), mosaic attenuation (34%), residual ground glass opacities (28%), septal thickening (14%), emphysema (10%), and other patterns (20%).
However, about 18% of patients who had an EKG showed evidence of non-specific changes. Of patients who had echocardiography, 8% showed evidence of right atrial dilation and 4% showed evidence of left atrial dilation.
...Evidence of lung obstruction was noted in just under 9% of the population, and positive bronchodilator response was noted in about 10%...
...a significant percentage of patients exhibited evidence of small airway disease.
..."There was an improvement in lung function metrics in our post-acute sequelae of COVID-19 cohort, which is consistent with other reports"
...concern that the rapidly evolving nature of COVID-19 is complicating the identification and study of ongoing symptoms...commonly reported long COVID symptoms during the early months of the pandemic -- when the SARS-CoV-2 Alpha variant was predominant -- differ from those most often seen during later Delta and Omicron predominant periods....
https://www.medpagetoday.com/meetingcoverage/chest/101258
— But significant declines in pulmonary, physical function not evident in interim analyses
Salynn Boyles | October 17, 2022
(Stephen Goertzen, DO, of Brooke Army Medical Center in Houston...presented the findings in a session devoted to long COVID research at CHEST 2022, the annual meeting of the American College of Chest Physicians. )
...Fully 55% of the subset of persistently symptomatic patients (dyspnea, respiratory symptoms, chest pain) with a high-resolution CT showed radiographic evidence of pulmonary pathology at least 3 months post-infection in an 80-patient interim analysis of a study exploring the physiology of long COVID.
These radiographic changes did not correlate with significant changes in pulmonary function test findings or declines in physical function as measured by 6-minute walking test (6MWT)
In all, 55% of those with CT scans showed radiographic evidence of pulmonary pathology, including nodular pattern (38%), mosaic attenuation (34%), residual ground glass opacities (28%), septal thickening (14%), emphysema (10%), and other patterns (20%).
However, about 18% of patients who had an EKG showed evidence of non-specific changes. Of patients who had echocardiography, 8% showed evidence of right atrial dilation and 4% showed evidence of left atrial dilation.
...Evidence of lung obstruction was noted in just under 9% of the population, and positive bronchodilator response was noted in about 10%...
...a significant percentage of patients exhibited evidence of small airway disease.
..."There was an improvement in lung function metrics in our post-acute sequelae of COVID-19 cohort, which is consistent with other reports"
...concern that the rapidly evolving nature of COVID-19 is complicating the identification and study of ongoing symptoms...commonly reported long COVID symptoms during the early months of the pandemic -- when the SARS-CoV-2 Alpha variant was predominant -- differ from those most often seen during later Delta and Omicron predominant periods....
https://www.medpagetoday.com/meetingcoverage/chest/101258
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Eric Topol (Scripps MD-scientist) @EricTopol | 5:00 PM · Oct 19, 2022:
"Our study indicates that Pfizer vaccine-induced myocarditis in adolescents appears to be a rare adverse event (
"Our study indicates that Pfizer vaccine-induced myocarditis in adolescents appears to be a rare adverse event (
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Pfizer says COVID-19 vaccine will cost $110-$130 per dose
Tom Murphy | October 21, 2022
Pfizer will charge $110 to $130 for a dose of its COVID-19 vaccine once the U.S. government stops buying the shots, but the drugmaker says it expects many people will continue receiving it for free.
Pfizer executives said the commercial pricing for adult doses could start early next year, depending on when the government phases out its program of buying and distributing the shots.
The drugmaker said it expects that people with private health insurance or coverage through public programs like Medicare or Medicaid will pay nothing. The Affordable Care Act requires insurers to cover many recommended vaccines without charging any out-of-pocket expenses.
A spokesman said the company also has an income-based assistance program that helps eligible U.S. residents with no insurance get the shots.
...price reflects increased costs for switching to single-dose vials and commercial distribution.
...last year that it was charging the U.S. $19.50 per dose...
https://medicalxpress.com/news/2022-10-pfizer-covid-vaccine-dose.html
Tom Murphy | October 21, 2022
Pfizer will charge $110 to $130 for a dose of its COVID-19 vaccine once the U.S. government stops buying the shots, but the drugmaker says it expects many people will continue receiving it for free.
Pfizer executives said the commercial pricing for adult doses could start early next year, depending on when the government phases out its program of buying and distributing the shots.
The drugmaker said it expects that people with private health insurance or coverage through public programs like Medicare or Medicaid will pay nothing. The Affordable Care Act requires insurers to cover many recommended vaccines without charging any out-of-pocket expenses.
A spokesman said the company also has an income-based assistance program that helps eligible U.S. residents with no insurance get the shots.
...price reflects increased costs for switching to single-dose vials and commercial distribution.
...last year that it was charging the U.S. $19.50 per dose...
https://medicalxpress.com/news/2022-10-pfizer-covid-vaccine-dose.html
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US clears Novavax COVID booster dose
October 20, 2022
...The Food and Drug Administration said (Novavax's) new booster option is for people 18 and older who can't get the updated omicron-targeting Pfizer or Moderna boosters for medical or accessibility reasons—or who otherwise would not receive a COVID-19 booster shot at all.
...to be used as a first booster—not for people who've already had one or more booster doses already—at least six months after completing their primary shots.
...Novavax is a protein-based vaccine unlike the other COVID-19 vaccines available in the U.S. ...
...The new Novavax booster is made with that company's original formula; it still is testing an omicron-targeted recipe.
https://medicalxpress.com/news/2022-10-novavax-covid-booster-dose.html
October 20, 2022
...The Food and Drug Administration said (Novavax's) new booster option is for people 18 and older who can't get the updated omicron-targeting Pfizer or Moderna boosters for medical or accessibility reasons—or who otherwise would not receive a COVID-19 booster shot at all.
...to be used as a first booster—not for people who've already had one or more booster doses already—at least six months after completing their primary shots.
...Novavax is a protein-based vaccine unlike the other COVID-19 vaccines available in the U.S. ...
...The new Novavax booster is made with that company's original formula; it still is testing an omicron-targeted recipe.
https://medicalxpress.com/news/2022-10-novavax-covid-booster-dose.html
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Dr. Topol is writing from a US perspective:
A {BA5} booster is your best shot now
We're heading into a new BQ.1.1 variant led wave
Eric Topol {Scripps MD-scientist} | 23 Oct 2022
...For now, the best defense we have against the BQ.1.1-led wave is to get a {BA5} booster. It will markedly raise neutralizing antibodies and our cellular immune response, and just-in-time to broaden our immunity to be ready for BQ.1.1 and related variants with marked immune evasiveness. As you well know, it takes a couple of weeks to get the immune response built, so this is the right time to get it done. It will help prevent severe Covid for at least 4-5 months ahead. Be ready. The pandemic isn’t over—yet. Preserve your health and that of your family, friends, and network.
https://erictopol.substack.com/p/a-booster-is-your-best-shot-now
A {BA5} booster is your best shot now
We're heading into a new BQ.1.1 variant led wave
Eric Topol {Scripps MD-scientist} | 23 Oct 2022
...For now, the best defense we have against the BQ.1.1-led wave is to get a {BA5} booster. It will markedly raise neutralizing antibodies and our cellular immune response, and just-in-time to broaden our immunity to be ready for BQ.1.1 and related variants with marked immune evasiveness. As you well know, it takes a couple of weeks to get the immune response built, so this is the right time to get it done. It will help prevent severe Covid for at least 4-5 months ahead. Be ready. The pandemic isn’t over—yet. Preserve your health and that of your family, friends, and network.
https://erictopol.substack.com/p/a-booster-is-your-best-shot-now
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CONTD.: #133 in thread 28 (Xie et al. 2022)
COVID-19 takes serious toll on heart health—a full year after recovery
Giant study shows striking rise in long-term heart and vessel disease
Meredith Wadman | 9 Feb 2022
From very early in the pandemic, it was clear that SARS-CoV-2 can damage the heart and blood vessels while people are acutely ill. Patients developed clots, heart inflammation, arrhythmias, and heart failure.
Now, the first large study* to assess cardiovascular outcomes 1 year after SARS-CoV-2 infection has demonstrated that the virus’ impact is often lasting. In an analysis of more than 11 million U.S. veterans’ health records, researchers found the risk of 20 different heart and vessel maladies was substantially increased in veterans who had COVID-19 1 year earlier, compared with those who didn’t. The risk rose with severity of initial disease and extended to every outcome the team examined, including heart attacks, arrhythmias, strokes, cardiac arrest, and more. Even people who never went to the hospital had more cardiovascular disease than those who were never infected.
The results are “stunning … worse than I expected, for sure,” says Eric Topol, a cardiologist at Scripps Research. “All of these are very serious disorders. … If anybody ever thought that COVID was like the flu this should be one of the most powerful data sets to point out it’s not.” He adds that the new study “may be the most impressive Long Covid paper we have seen to date.”...
https://www.science.org/content/article/covid-19-takes-serious-toll-heart-health...
doi: 10.1126/science.ada1117
* Yan Xie et al. 2022. Long-term cardiovascular outcomes of COVID-19. Nature Medicine volume 28, pages 583–590 (2022) https://www.nature.com/articles/s41591-022-01689-3#MOESM1
____________________________________________
Heart attack deaths jumped sharply among young U.S. adults in 2nd year of COVID pandemic
Cathie Anderson | Updated October 25, 2022
https://www.sacbee.com/news/local/health-and-medicine/article267801482.html
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COVID-19 Surges Linked to Spike in Heart Attacks
Cedars-Sinai | Oct 24, 2022
https://www.cedars-sinai.org/newsroom/covid-19-surges-linked-to-spike-in-heart-a...
---------------------------------------------------------------
Yee Hui Yeo et al. 2022. Excess risk for acute myocardial infarction mortality during the COVID-19 pandemic. J of Medical Virology. First published: 29 September 2022. https://doi.org/10.1002/jmv.28187
https://onlinelibrary.wiley.com/doi/10.1002/jmv.28187
Abstract
... Before the pandemic, AMI-associated (acute myocardial infarction) mortality rates decreased across all subgroups. These trends reversed during the pandemic, with significant rises seen for the youngest-aged females and males even through the most recent period of the Omicron surge (10/2021–3/2022). The SAPC* in the youngest and middle-age group in AMI-associated mortality increased by 5.3%...and 3.4%..., respectively. The excess death, defined as the difference between the observed and the predicted mortality rates, was most pronounced for the youngest (25–44 years) aged decedents, ranging from 23% to 34% for the youngest compared to 13%–18% for the oldest age groups. The trend of mortality suggests that age and sex disparities have persisted even through the recent Omicron surge, with excess AMI-associated mortality being most pronounced in younger-aged adults.
* "Serum amyloid P component (SAP), also known as pentraxin-2, is a member of the pentraxin protein family with an established relationship to the immune response...SAP may serve as both a diagnostic marker and a therapeutic target for many immune-related diseases, such as cardiovascular, pulmonary, nephritic, neurological and autoimmune diseases. In the cardiovascular system, SAP has been defined as the culprit in amyloidosis in the heart. SAP may also exert a protective role during the early stage of atherosclerosis and myocardial fibrosis..." https://pubmed.ncbi.nlm.nih.gov/25828303/
COVID-19 takes serious toll on heart health—a full year after recovery
Giant study shows striking rise in long-term heart and vessel disease
Meredith Wadman | 9 Feb 2022
From very early in the pandemic, it was clear that SARS-CoV-2 can damage the heart and blood vessels while people are acutely ill. Patients developed clots, heart inflammation, arrhythmias, and heart failure.
Now, the first large study* to assess cardiovascular outcomes 1 year after SARS-CoV-2 infection has demonstrated that the virus’ impact is often lasting. In an analysis of more than 11 million U.S. veterans’ health records, researchers found the risk of 20 different heart and vessel maladies was substantially increased in veterans who had COVID-19 1 year earlier, compared with those who didn’t. The risk rose with severity of initial disease and extended to every outcome the team examined, including heart attacks, arrhythmias, strokes, cardiac arrest, and more. Even people who never went to the hospital had more cardiovascular disease than those who were never infected.
The results are “stunning … worse than I expected, for sure,” says Eric Topol, a cardiologist at Scripps Research. “All of these are very serious disorders. … If anybody ever thought that COVID was like the flu this should be one of the most powerful data sets to point out it’s not.” He adds that the new study “may be the most impressive Long Covid paper we have seen to date.”...
https://www.science.org/content/article/covid-19-takes-serious-toll-heart-health...
doi: 10.1126/science.ada1117
* Yan Xie et al. 2022. Long-term cardiovascular outcomes of COVID-19. Nature Medicine volume 28, pages 583–590 (2022) https://www.nature.com/articles/s41591-022-01689-3#MOESM1
____________________________________________
Heart attack deaths jumped sharply among young U.S. adults in 2nd year of COVID pandemic
Cathie Anderson | Updated October 25, 2022
https://www.sacbee.com/news/local/health-and-medicine/article267801482.html
--------------------------------------------------------------
COVID-19 Surges Linked to Spike in Heart Attacks
Cedars-Sinai | Oct 24, 2022
https://www.cedars-sinai.org/newsroom/covid-19-surges-linked-to-spike-in-heart-a...
---------------------------------------------------------------
Yee Hui Yeo et al. 2022. Excess risk for acute myocardial infarction mortality during the COVID-19 pandemic. J of Medical Virology. First published: 29 September 2022. https://doi.org/10.1002/jmv.28187
https://onlinelibrary.wiley.com/doi/10.1002/jmv.28187
Abstract
... Before the pandemic, AMI-associated (acute myocardial infarction) mortality rates decreased across all subgroups. These trends reversed during the pandemic, with significant rises seen for the youngest-aged females and males even through the most recent period of the Omicron surge (10/2021–3/2022). The SAPC* in the youngest and middle-age group in AMI-associated mortality increased by 5.3%...and 3.4%..., respectively. The excess death, defined as the difference between the observed and the predicted mortality rates, was most pronounced for the youngest (25–44 years) aged decedents, ranging from 23% to 34% for the youngest compared to 13%–18% for the oldest age groups. The trend of mortality suggests that age and sex disparities have persisted even through the recent Omicron surge, with excess AMI-associated mortality being most pronounced in younger-aged adults.
* "Serum amyloid P component (SAP), also known as pentraxin-2, is a member of the pentraxin protein family with an established relationship to the immune response...SAP may serve as both a diagnostic marker and a therapeutic target for many immune-related diseases, such as cardiovascular, pulmonary, nephritic, neurological and autoimmune diseases. In the cardiovascular system, SAP has been defined as the culprit in amyloidosis in the heart. SAP may also exert a protective role during the early stage of atherosclerosis and myocardial fibrosis..." https://pubmed.ncbi.nlm.nih.gov/25828303/
64margd
Li T, Katz A & Siegel J. (2022). Reducing transmission of
COVID-19 through improvements to indoor air quality: a checklist for community spaces. Unity Health Toronto, University of Toronto, University of Waterloo, Queen’s University and Toronto Metropolitan University. 36 p. Available at: http://maphealth.ca/ventilation https://maphealth.ca/wp-content/uploads/Reducing-Transmission-of-COVID-19-Throug...
A plain language, step-by-step guide outlining how community spaces can use indoor air quality measures to help reduce transmission of COVID-19. The latest revision of this checklist was Oct 26, 2022.
Please see the summary of revisions here {couple housekeeping details}.
https://maphealth.ca/wp-content/uploads/Summary-of-Revision-RTC.pdf
COVID-19 through improvements to indoor air quality: a checklist for community spaces. Unity Health Toronto, University of Toronto, University of Waterloo, Queen’s University and Toronto Metropolitan University. 36 p. Available at: http://maphealth.ca/ventilation https://maphealth.ca/wp-content/uploads/Reducing-Transmission-of-COVID-19-Throug...
A plain language, step-by-step guide outlining how community spaces can use indoor air quality measures to help reduce transmission of COVID-19. The latest revision of this checklist was Oct 26, 2022.
Please see the summary of revisions here {couple housekeeping details}.
https://maphealth.ca/wp-content/uploads/Summary-of-Revision-RTC.pdf
65margd
Heart Failure Patients Unvaccinated Against COVID-19 Are Three Times More Likely to Die From It Than Boosted Heart Failure Patients
Mount Sinai study shows dramatic protective effects of vaccination in this high-risk population, which often demonstrates vaccine hesitancy
...the unvaccinated and partially vaccinated patients were three times more likely to die from COVID-19-related illness than fully vaccinated and boosted patients. The study goes on to show that unvaccinated and partially vaccinated patients were 15 percent more likely to be hospitalized if infected with the virus and nearly twice as likely to be admitted to the ICU when compared to fully vaccinated and boosted patients....
https://www.mountsinai.org/about/newsroom/2022/heart-failure-patients-unvaccinat...
-----------------------------------------------------------
KIPP W. JOHNSON et al. 2022. Association of Reduced Hospitalizations and Mortality Rates Among COVID-19-Vaccinated Patients With Heart Failure (Brief Report). J of Cardiac Failure Vol 28, No. 99. 2022. https://doi.org/10.1016/j.cardfail.2022.05.008 https://www.onlinejcf.com/article/S1071-9164(22)00536-X/pdf
------------------------------------------------------------
Ankeet S. Bhatt et al. 2022. Coronavirus Disease-2019 and Heart Failure: A Scientific Statement From the Heart Failure Society of America. Volume 28, ISSUE 1, P93-112, January 01, 2022. DOI:https://doi.org/10.1016/j.cardfail.2021.08.013 https://www.onlinejcf.com/article/S1071-9164(21)00354-7/fulltext
Mount Sinai study shows dramatic protective effects of vaccination in this high-risk population, which often demonstrates vaccine hesitancy
...the unvaccinated and partially vaccinated patients were three times more likely to die from COVID-19-related illness than fully vaccinated and boosted patients. The study goes on to show that unvaccinated and partially vaccinated patients were 15 percent more likely to be hospitalized if infected with the virus and nearly twice as likely to be admitted to the ICU when compared to fully vaccinated and boosted patients....
https://www.mountsinai.org/about/newsroom/2022/heart-failure-patients-unvaccinat...
-----------------------------------------------------------
KIPP W. JOHNSON et al. 2022. Association of Reduced Hospitalizations and Mortality Rates Among COVID-19-Vaccinated Patients With Heart Failure (Brief Report). J of Cardiac Failure Vol 28, No. 99. 2022. https://doi.org/10.1016/j.cardfail.2022.05.008 https://www.onlinejcf.com/article/S1071-9164(22)00536-X/pdf
------------------------------------------------------------
Ankeet S. Bhatt et al. 2022. Coronavirus Disease-2019 and Heart Failure: A Scientific Statement From the Heart Failure Society of America. Volume 28, ISSUE 1, P93-112, January 01, 2022. DOI:https://doi.org/10.1016/j.cardfail.2021.08.013 https://www.onlinejcf.com/article/S1071-9164(21)00354-7/fulltext
66margd
To paraphrase a psalm, we are wonderfully made!
Gerald Evans 🇺🇦 @skepticalIDdoc | 4:41 PM · Oct 27, 2022
Prof @QueensuDOM | Infect Dis Doc | EIC of @JAMMI_Journal
| Affiliate Scientist @ICESOntario
One of the cool things about our immune system are mechanisms that refine the production of antibodies following exposure to an antigen either from a vaccine or a pathogen. This process of Ab affinity maturation is nicely described in the video below.
Antibody affinity maturation (4:30)
https://twitter.com/skepticalIDdoc/status/1585733424626552833
-----------------------------------------------------
Antibody affinity maturation (4:30)
Immunology Toronto | Sep 14, 2012
This short video describes how the binding strength of antibodies are increased. This process is called affinity maturation of the antibody response and occurs in B cells within the germinal center. This process is regulated by the enzyme activation-induced cytidine deaminase (AID). B cells, which are part of the immune system, play critical roles in the clearance of pathogens from our bodies.
Video by Julian Kirk-Elleker. Brought to you by the Department of Immunology and Biomedical Communications at the University of Toronto.
https://www.youtube.com/watch?v=kkewDUuBwFI
--------------------------------------------------------
Then there are T cells, which act against our infected cells (not the virus itself, as with antibodies): https://www.youtube.com/watch?v=9E_UxnC_L2o
Amazing! Who would have thought all that is going on as we recover from a cold or whatever??
Gerald Evans 🇺🇦 @skepticalIDdoc | 4:41 PM · Oct 27, 2022
Prof @QueensuDOM | Infect Dis Doc | EIC of @JAMMI_Journal
| Affiliate Scientist @ICESOntario
One of the cool things about our immune system are mechanisms that refine the production of antibodies following exposure to an antigen either from a vaccine or a pathogen. This process of Ab affinity maturation is nicely described in the video below.
Antibody affinity maturation (4:30)
https://twitter.com/skepticalIDdoc/status/1585733424626552833
-----------------------------------------------------
Antibody affinity maturation (4:30)
Immunology Toronto | Sep 14, 2012
This short video describes how the binding strength of antibodies are increased. This process is called affinity maturation of the antibody response and occurs in B cells within the germinal center. This process is regulated by the enzyme activation-induced cytidine deaminase (AID). B cells, which are part of the immune system, play critical roles in the clearance of pathogens from our bodies.
Video by Julian Kirk-Elleker. Brought to you by the Department of Immunology and Biomedical Communications at the University of Toronto.
https://www.youtube.com/watch?v=kkewDUuBwFI
--------------------------------------------------------
Then there are T cells, which act against our infected cells (not the virus itself, as with antibodies): https://www.youtube.com/watch?v=9E_UxnC_L2o
Amazing! Who would have thought all that is going on as we recover from a cold or whatever??
67bnielsen
>66 margd: "Amazing! Who would have thought all that is going on as we recover from a cold or whatever??"
Yes. And once in a while something goes wrong. I just heard a talk about how narcolepsy might be explained by the immune system destroying certain brain cells that produce a peptide called hypocretin. (It is a rare disease, so one of the hints was an increase of new patients in China right after a flu epidemic.)
Yes. And once in a while something goes wrong. I just heard a talk about how narcolepsy might be explained by the immune system destroying certain brain cells that produce a peptide called hypocretin. (It is a rare disease, so one of the hints was an increase of new patients in China right after a flu epidemic.)
68margd
>67 bnielsen: Like embryology, it's amazing our immune system gets it right as often as it does! A "silver lining" of pandemic is that science of immunology will get a boost for autoimmunity and post-viral diseases... Long COVID sounds like something we all will want to avoid. :(
69margd
Good for mice! Look forward to clinical trials in humans, checkmate to infection by all COVID variants and an end to this $#$&*)% pandemic.
Tianyang Mao et al. 2022. Unadjuvanted intranasal spike vaccine elicits protective mucosal immunity against sarbecoviruses. Science
27 Oct 2022. First Release. DOI: 10.1126/science.abo2523 https://www.science.org/doi/10.1126/science.abo2523
Abstract
The SARS-CoV-2 pandemic has highlighted the need for vaccines that not only prevent disease, but also prevent transmission. Parenteral vaccines induce robust systemic immunity, but poor immunity at the respiratory mucosa. Here we describe the development of a vaccine strategy we term “prime and spike” that leverages existing immunity generated by primary vaccination (prime) to elicit mucosal immune memory within the respiratory tract using unadjuvanted intranasal spike boosters (spike). We show that prime and spike induces robust resident memory B and T cell responses, IgA at the respiratory mucosa, boosts systemic immunity, and completely protects mice with partial immunity from lethal SARS-CoV-2 infection. Using divergent spike proteins, prime and spike enables induction of cross-reactive immunity against sarbecoviruses.
Tianyang Mao et al. 2022. Unadjuvanted intranasal spike vaccine elicits protective mucosal immunity against sarbecoviruses. Science
27 Oct 2022. First Release. DOI: 10.1126/science.abo2523 https://www.science.org/doi/10.1126/science.abo2523
Abstract
The SARS-CoV-2 pandemic has highlighted the need for vaccines that not only prevent disease, but also prevent transmission. Parenteral vaccines induce robust systemic immunity, but poor immunity at the respiratory mucosa. Here we describe the development of a vaccine strategy we term “prime and spike” that leverages existing immunity generated by primary vaccination (prime) to elicit mucosal immune memory within the respiratory tract using unadjuvanted intranasal spike boosters (spike). We show that prime and spike induces robust resident memory B and T cell responses, IgA at the respiratory mucosa, boosts systemic immunity, and completely protects mice with partial immunity from lethal SARS-CoV-2 infection. Using divergent spike proteins, prime and spike enables induction of cross-reactive immunity against sarbecoviruses.
70margd
Opportunistic fungi...
New Disease X? WHO warns of ‘fungal threat’ to humanity
In an echo of the agency’s warnings about viruses ahead of the pandemic, a list killer fungi is unveiled
Harriet Barber | 25 October 2022
...An estimated 4,300 Covid patients lost their lives to (an aggressive “black fungus”, “Disease X”) in India during the second wave of the (COVID) pandemic in 2021.
...the World Health Organization (WHO) warned on Tuesday, the risk that fungal attack poses to humans is skyrocketing. The surge has been driven by Covid, mounting resistance to drugs and an increase of immunocompromised patients.
...The WHO has separated the 19 most worrying fungal pathogens into three categories – critical, high and medium priority – based on the public health burden of the disease, antimicrobial resistance, and the availability of diagnostics. (Table)
...Although cases are rising, there are only four classes of antifungal medicines currently available.
...The WHO has warned that resistance to the limited number of medications is rising, too.
https://www.telegraph.co.uk/global-health/science-and-disease/who-warns-new-fung...
New Disease X? WHO warns of ‘fungal threat’ to humanity
In an echo of the agency’s warnings about viruses ahead of the pandemic, a list killer fungi is unveiled
Harriet Barber | 25 October 2022
...An estimated 4,300 Covid patients lost their lives to (an aggressive “black fungus”, “Disease X”) in India during the second wave of the (COVID) pandemic in 2021.
...the World Health Organization (WHO) warned on Tuesday, the risk that fungal attack poses to humans is skyrocketing. The surge has been driven by Covid, mounting resistance to drugs and an increase of immunocompromised patients.
...The WHO has separated the 19 most worrying fungal pathogens into three categories – critical, high and medium priority – based on the public health burden of the disease, antimicrobial resistance, and the availability of diagnostics. (Table)
...Although cases are rising, there are only four classes of antifungal medicines currently available.
...The WHO has warned that resistance to the limited number of medications is rising, too.
https://www.telegraph.co.uk/global-health/science-and-disease/who-warns-new-fung...
71margd
>66 margd:
Gerald Evans 🇺🇦 @skepticalIDdoc | 10:28 AM · Oct 29, 2022:
Prof @QueensuDOM | Infect Dis Doc | EIC of @JAMMI_Journal | Affiliate Scientist @ICESOntario
This* has been an unfortunate theme throughout the pandemic. Following their development, MAbs {monoclonal antbodies, like Evushield} do not change, unlike #SARSCoV2. Conversely, Abs {antibodies} produced by B cells after vaccination undergo refinement via a process called affinity maturation. #GetVaccinated
* The End of Evusheld
If you’re immunocompromised, this … isn’t great.
Katherine J. Wu | October 29, 2022
https://www.theatlantic.com/health/archive/2022/10/covid-variants-antibody-treat...
Gerald Evans 🇺🇦 @skepticalIDdoc | 10:28 AM · Oct 29, 2022:
Prof @QueensuDOM | Infect Dis Doc | EIC of @JAMMI_Journal | Affiliate Scientist @ICESOntario
This* has been an unfortunate theme throughout the pandemic. Following their development, MAbs {monoclonal antbodies, like Evushield} do not change, unlike #SARSCoV2. Conversely, Abs {antibodies} produced by B cells after vaccination undergo refinement via a process called affinity maturation. #GetVaccinated
* The End of Evusheld
If you’re immunocompromised, this … isn’t great.
Katherine J. Wu | October 29, 2022
https://www.theatlantic.com/health/archive/2022/10/covid-variants-antibody-treat...
72margd
COVID and the brain--
"A lot of new science, some therapy suggestions {for brain fog, etc.}.
Peer reviewed, preprints, news commentaries, videos. 55 tweets"
Andrew Ewing @AndrewEwing11 | 7:28 PM · Oct 29, 2022:
Research on nano/neuro chemistry, echem, chemical imaging @goteborgsu . Member Swedish Academy of Science.
https://twitter.com/AndrewEwing11/status/1586500342841475072
https://threadreaderapp.com/thread/1586500342841475072.html
...
"A lot of new science, some therapy suggestions {for brain fog, etc.}.
Peer reviewed, preprints, news commentaries, videos. 55 tweets"
Andrew Ewing @AndrewEwing11 | 7:28 PM · Oct 29, 2022:
Research on nano/neuro chemistry, echem, chemical imaging @goteborgsu . Member Swedish Academy of Science.
https://twitter.com/AndrewEwing11/status/1586500342841475072
https://threadreaderapp.com/thread/1586500342841475072.html
...
73margd
Eric Topol (Scripps, cardiologist) @EricTopol | 11:21 AM · Oct 29, 2022:
Good summary of the variant swarm/soup status nature
by @ewencallaway with @CorneliusRoemer @yunlong_cao
https://nature.com/articles/d41586-022-03445-6
Bar graph variants by country
https://twitter.com/EricTopol/status/1586377756635381760
--------------------------------------------------------
Eric Topol (Scripps, cardiologist) @EricTopol | 11:15 AM · Oct 29, 2022:
An encouraging sign for one of the (if not the) most immune evasive new variants
XBB is dominant in India and Bangladesh without a rise in cases or deaths to date
https://cov-spectrum.org and @OurWorldInData
Graph India Pakistan case rate Mar 2020 - Oct 2022
https://twitter.com/EricTopol/status/1586376119757873152/photo/1
Good summary of the variant swarm/soup status nature
by @ewencallaway with @CorneliusRoemer @yunlong_cao
https://nature.com/articles/d41586-022-03445-6
Bar graph variants by country
https://twitter.com/EricTopol/status/1586377756635381760
--------------------------------------------------------
Eric Topol (Scripps, cardiologist) @EricTopol | 11:15 AM · Oct 29, 2022:
An encouraging sign for one of the (if not the) most immune evasive new variants
XBB is dominant in India and Bangladesh without a rise in cases or deaths to date
https://cov-spectrum.org and @OurWorldInData
Graph India Pakistan case rate Mar 2020 - Oct 2022
https://twitter.com/EricTopol/status/1586376119757873152/photo/1
75margd
Jonas R. Kunst @KunstJonas | 4:00 AM · Oct 31, 2022:
Professor of Psychology @UniOslo. Past Yale Harvard @UiB. Founder @Advances1n.
🚨 #LongCovid can hit everyone. In a sample of recreational athletes, exercise dropped 58% after a month and was still 36% lower after 3 months.
Coen C W G Bongers et al. 2022. Impact of a COVID-19 infection on exercise levels of recreational athletes one- and three-months post-infection. J Sports Sci. 2022 Oct 29;1-7. doi: 10.1080/02640414.2022.2140919. https://pubmed.ncbi.nlm.nih.gov/36309479/
Abstract
...Median exercise level at baseline in the COVID-19 group was 3528 ...MET*-min/week. One-month post-COVID-19 infection, exercise level dropped 58% (2038 MET-min/week), which partly stabilized to 36% (1256 MET-min/week) below baseline values 3 months post-COVID-19 infection. Moreover, in both the COVID-19 (pre-COVID-19 infection) and non-COVID-19 group exercise levels during the pandemic decreased with ~260 MET-min/week. These results illustrate that even a relatively physically active population of recreational athletes is significantly affected by a COVID-19 infection, particularly those athletes who are overweight. COVID-19 disease burden, age, sex, comorbidities and smoking were not associated with reduced exercise levels.
* The metabolic equivalent of task (MET) is the objective measure of the ratio of the rate at which a person expends energy, relative to the mass of that person, while performing some specific physical activity. (Wikipedia)
Professor of Psychology @UniOslo. Past Yale Harvard @UiB. Founder @Advances1n.
🚨 #LongCovid can hit everyone. In a sample of recreational athletes, exercise dropped 58% after a month and was still 36% lower after 3 months.
Coen C W G Bongers et al. 2022. Impact of a COVID-19 infection on exercise levels of recreational athletes one- and three-months post-infection. J Sports Sci. 2022 Oct 29;1-7. doi: 10.1080/02640414.2022.2140919. https://pubmed.ncbi.nlm.nih.gov/36309479/
Abstract
...Median exercise level at baseline in the COVID-19 group was 3528 ...MET*-min/week. One-month post-COVID-19 infection, exercise level dropped 58% (2038 MET-min/week), which partly stabilized to 36% (1256 MET-min/week) below baseline values 3 months post-COVID-19 infection. Moreover, in both the COVID-19 (pre-COVID-19 infection) and non-COVID-19 group exercise levels during the pandemic decreased with ~260 MET-min/week. These results illustrate that even a relatively physically active population of recreational athletes is significantly affected by a COVID-19 infection, particularly those athletes who are overweight. COVID-19 disease burden, age, sex, comorbidities and smoking were not associated with reduced exercise levels.
* The metabolic equivalent of task (MET) is the objective measure of the ratio of the rate at which a person expends energy, relative to the mass of that person, while performing some specific physical activity. (Wikipedia)
76margd
Alberto Gómez-Carballa et al. 2022. Is SARS-CoV-2 an oncogenic virus? J Infect. 2022 Nov; 85(5): 573–607.
Published online 2022 Aug 9. doi: 10.1016/j.jinf.2022.08.005 https://www.journalofinfection.com/article/S0163-4453(22)00469-8/fulltext
Highlights
• Npa2 and Npa3 SARS-CoV-2 protein have the ability to hijack and degrade p53.
• Gene expression of p53 is downregulated in blood of COVID-19 patients.
• Downregulation of p53 persists at least 24 weeks after infection in long COVID-19 patients.
• Long-term reduction of p53 could have impact on carcinogenesis.
...We show convergent evidence from three different transcriptomic datasets and techniques that represent a molecular proof of concept that p53 may be acutely and persistently reduced after severe SARS-CoV-2 infection. A persistent reduction of the p53 tumor suppression functions, as might be the case in long-COVID-19 severe patients, may constitute a risk factor for oncogenesis comparable to pathogenic mutations in TP53. Such long-term reduction of p53 might trigger cancer onset or contribute to worsen the course of patients with an ongoing tumoral process .... Future efforts should target larger cohorts and follow-up time, and assess additional types of samples, including lung tissue. A causal relationship between SAR-CoV-2 and cancer has not been demonstrated but, if confirmed, it would have enormous impact on public health.
Published online 2022 Aug 9. doi: 10.1016/j.jinf.2022.08.005 https://www.journalofinfection.com/article/S0163-4453(22)00469-8/fulltext
Highlights
• Npa2 and Npa3 SARS-CoV-2 protein have the ability to hijack and degrade p53.
• Gene expression of p53 is downregulated in blood of COVID-19 patients.
• Downregulation of p53 persists at least 24 weeks after infection in long COVID-19 patients.
• Long-term reduction of p53 could have impact on carcinogenesis.
...We show convergent evidence from three different transcriptomic datasets and techniques that represent a molecular proof of concept that p53 may be acutely and persistently reduced after severe SARS-CoV-2 infection. A persistent reduction of the p53 tumor suppression functions, as might be the case in long-COVID-19 severe patients, may constitute a risk factor for oncogenesis comparable to pathogenic mutations in TP53. Such long-term reduction of p53 might trigger cancer onset or contribute to worsen the course of patients with an ongoing tumoral process .... Future efforts should target larger cohorts and follow-up time, and assess additional types of samples, including lung tissue. A causal relationship between SAR-CoV-2 and cancer has not been demonstrated but, if confirmed, it would have enormous impact on public health.
77margd
Not linked to COVID?
Study finds 30% increase in 'young stroke' incidence in Hong Kong
The University of Hong Kong | October 31, 2022
https://medicalxpress.com/news/2022-10-young-incidence-hong-kong.html
Study finds 30% increase in 'young stroke' incidence in Hong Kong
The University of Hong Kong | October 31, 2022
https://medicalxpress.com/news/2022-10-young-incidence-hong-kong.html
78margd
Post-COVID Immune Deficiency may also be at play? A study found that immunological dysfunction persists for more than 8 months following initial mild-to-moderate COVID-19 infection... https://nature.com/articles/s41590-021-01113-x?s=09
I've read that ~80% of kids have been exposed to COVID?
The Worst Pediatric-Care Crisis in Decades
“This is our 2020.”
Katherine J. Wu | October 31, 2022
...Across the country, children have for weeks been slammed with a massive, early wave of viral infections—driven largely by RSV, but also flu, rhinovirus, enterovirus, and SARS-CoV-2. Many emergency departments and intensive-care units are now at or past capacity, and resorting to extreme measures. At Johns Hopkins Children’s Center, in Maryland, staff has pitched a tent outside the emergency department to accommodate overflow; Connecticut Children’s Hospital mulled calling in the National Guard. It’s already the largest surge of infectious illnesses that some pediatricians have seen in their decades-long careers, and many worry that the worst is yet to come. “It is a crisis,” Sapna Kudchadkar, a pediatric-intensive-care specialist and anesthesiologist at Johns Hopkins, told me. “It’s bananas; it’s been full to the gills since September,” says Melissa J. Sacco, a pediatric-intensive-care specialist at UVA Health. “Every night I turn away a patient, or tell the emergency department they have to have a PICU-level kid there for the foreseeable future.”...
https://www.theatlantic.com/health/archive/2022/10/rise-of-rsv-flu-covid-infecti...
I've read that ~80% of kids have been exposed to COVID?
The Worst Pediatric-Care Crisis in Decades
“This is our 2020.”
Katherine J. Wu | October 31, 2022
...Across the country, children have for weeks been slammed with a massive, early wave of viral infections—driven largely by RSV, but also flu, rhinovirus, enterovirus, and SARS-CoV-2. Many emergency departments and intensive-care units are now at or past capacity, and resorting to extreme measures. At Johns Hopkins Children’s Center, in Maryland, staff has pitched a tent outside the emergency department to accommodate overflow; Connecticut Children’s Hospital mulled calling in the National Guard. It’s already the largest surge of infectious illnesses that some pediatricians have seen in their decades-long careers, and many worry that the worst is yet to come. “It is a crisis,” Sapna Kudchadkar, a pediatric-intensive-care specialist and anesthesiologist at Johns Hopkins, told me. “It’s bananas; it’s been full to the gills since September,” says Melissa J. Sacco, a pediatric-intensive-care specialist at UVA Health. “Every night I turn away a patient, or tell the emergency department they have to have a PICU-level kid there for the foreseeable future.”...
https://www.theatlantic.com/health/archive/2022/10/rise-of-rsv-flu-covid-infecti...
79margd
COVID-19 activates similar response to Parkinson's disease, study suggests
Janelle Miles | 31 Oct 2022
Key points:
Researchers say it may explain some of the symptoms occurring in patients with brain fog
The research found cells infected with the virus became highly inflammatory
Scientists say while it needs to be monitored, it's not cause for alarm
...(Queensland U) researchers studied the effect of SARS-CoV-2 on the brain's immune cells, known as microglia, which are key cells involved in the progression of brain diseases, such as Parkinson's and Alzheimer's disease.
They grew microglia from the donor blood of healthy volunteers and infected the cells with the virus.
"We identified that the cells became highly inflammatory, we like to think of them as angry microglia, and they turned on a pathway called the inflammasome, which we have previously shown is linked to certain brain diseases, like Parkinson's and Alzheimer's," Professor (Lead researcher Trent Woodruff, from the university's neuro-inflammation laboratory) said.
"It didn't matter whose blood it was or whose cells we looked at, all the cells reacted quite strongly to this virus."
The researchers also compared mice infected with SARS-CoV-2 and those which had not been infected with the virus.
They found inflammasome activation in the brains of the mice infected with SARS-CoV-2.
But the researchers, including Professor Woodruff's UQ colleague Eduardo Albornoz Balmaceda, also identified a potential treatment....
https://www.abc.net.au/news/2022-11-01/qld-covid-parkinsons-disease-research-bra...
---------------------------------------------------
Eduardo A. Albornoz et al. 2022. SARS-CoV-2 drives NLRP3 inflammasome activation in human microglia through spike protein.
Molecular Psychiatry (1 Nov 2022) https://www.nature.com/articles/s41380-022-01831-0
Abstract
Coronavirus disease-2019 (COVID-19) is primarily a respiratory disease, however, an increasing number of reports indicate that SARS-CoV-2 infection can also cause severe neurological manifestations, including precipitating cases of probable Parkinson’s disease. As microglial NLRP3 inflammasome activation is a major driver of neurodegeneration, here we interrogated whether SARS-CoV-2 can promote microglial NLRP3 inflammasome activation.
...we established the presence of virus in the brain together with microglial activation and NLRP3 inflammasome upregulation
...we identified that SARS-CoV-2 isolates can bind and enter human microglia in the absence of viral replication. This interaction of virus and microglia directly induced robust inflammasome activation
...we demonstrated that purified SARS-CoV-2 spike glycoprotein activated the NLRP3 inflammasome in LPS-primed microglia, in a ACE2-dependent manner.
...Finally, we demonstrate SARS-CoV-2 infected hACE2 mice treated orally post-infection with the NLRP3 inhibitory drug MCC950, have significantly reduced microglial inflammasome activation, and increased survival in comparison with untreated SARS-CoV-2 infected mice. These results support a possible mechanism of microglial innate immune activation by SARS-CoV-2, which could explain the increased vulnerability to developing neurological symptoms akin to Parkinson’s disease in COVID-19 infected individuals, and a potential therapeutic avenue for intervention.
Janelle Miles | 31 Oct 2022
Key points:
Researchers say it may explain some of the symptoms occurring in patients with brain fog
The research found cells infected with the virus became highly inflammatory
Scientists say while it needs to be monitored, it's not cause for alarm
...(Queensland U) researchers studied the effect of SARS-CoV-2 on the brain's immune cells, known as microglia, which are key cells involved in the progression of brain diseases, such as Parkinson's and Alzheimer's disease.
They grew microglia from the donor blood of healthy volunteers and infected the cells with the virus.
"We identified that the cells became highly inflammatory, we like to think of them as angry microglia, and they turned on a pathway called the inflammasome, which we have previously shown is linked to certain brain diseases, like Parkinson's and Alzheimer's," Professor (Lead researcher Trent Woodruff, from the university's neuro-inflammation laboratory) said.
"It didn't matter whose blood it was or whose cells we looked at, all the cells reacted quite strongly to this virus."
The researchers also compared mice infected with SARS-CoV-2 and those which had not been infected with the virus.
They found inflammasome activation in the brains of the mice infected with SARS-CoV-2.
But the researchers, including Professor Woodruff's UQ colleague Eduardo Albornoz Balmaceda, also identified a potential treatment....
https://www.abc.net.au/news/2022-11-01/qld-covid-parkinsons-disease-research-bra...
---------------------------------------------------
Eduardo A. Albornoz et al. 2022. SARS-CoV-2 drives NLRP3 inflammasome activation in human microglia through spike protein.
Molecular Psychiatry (1 Nov 2022) https://www.nature.com/articles/s41380-022-01831-0
Abstract
Coronavirus disease-2019 (COVID-19) is primarily a respiratory disease, however, an increasing number of reports indicate that SARS-CoV-2 infection can also cause severe neurological manifestations, including precipitating cases of probable Parkinson’s disease. As microglial NLRP3 inflammasome activation is a major driver of neurodegeneration, here we interrogated whether SARS-CoV-2 can promote microglial NLRP3 inflammasome activation.
...we established the presence of virus in the brain together with microglial activation and NLRP3 inflammasome upregulation
...we identified that SARS-CoV-2 isolates can bind and enter human microglia in the absence of viral replication. This interaction of virus and microglia directly induced robust inflammasome activation
...we demonstrated that purified SARS-CoV-2 spike glycoprotein activated the NLRP3 inflammasome in LPS-primed microglia, in a ACE2-dependent manner.
...Finally, we demonstrate SARS-CoV-2 infected hACE2 mice treated orally post-infection with the NLRP3 inhibitory drug MCC950, have significantly reduced microglial inflammasome activation, and increased survival in comparison with untreated SARS-CoV-2 infected mice. These results support a possible mechanism of microglial innate immune activation by SARS-CoV-2, which could explain the increased vulnerability to developing neurological symptoms akin to Parkinson’s disease in COVID-19 infected individuals, and a potential therapeutic avenue for intervention.
80margd
delthia ricks 🔬 @DelthiaRicks | 2:18 PM · Nov 1, 2022:
Award-winning science writer. Author. Citizen Scientist. Bylines: Newsday, Discover Magazine, Journal of the Nat'l Cancer Institute, Ms Magazine, Medical Xpress
Non-hospitalized people w/ mild Covid were were 2.7x more likely to develop blood clots than those who never had Covid. British study. Hospitalized: 27x more likely to have clots, 21x more likely to suffer heart failure & 17x more likely to have a stroke
-----------------------------------------------------
Raisi-EstabraghZ, Cooper J, Salih A, et al. 2022. Cardiovascular disease and mortality sequelae of COVID- 19 in the UK Biobank.
Heart Epub ahead of print: 2 Nov 2022. doi:10.1136/heartjnl-2022-321492 https://heart.bmj.com/content/heartjnl/early/2022/09/21/heartjnl-2022-321492.ful...
...In this prospective analysis of 17 871 UK Biobank participants, we demonstrate association of past COVID-19 with increased incidence of a wide range of cardiovascular disease and mortality events.
These risks were almost entirely confined to those requiring hospitalisation and were highest in the first 30 days postinfection but
remained augmented for a prolonged period thereafter...
Award-winning science writer. Author. Citizen Scientist. Bylines: Newsday, Discover Magazine, Journal of the Nat'l Cancer Institute, Ms Magazine, Medical Xpress
Non-hospitalized people w/ mild Covid were were 2.7x more likely to develop blood clots than those who never had Covid. British study. Hospitalized: 27x more likely to have clots, 21x more likely to suffer heart failure & 17x more likely to have a stroke
-----------------------------------------------------
Raisi-EstabraghZ, Cooper J, Salih A, et al. 2022. Cardiovascular disease and mortality sequelae of COVID- 19 in the UK Biobank.
Heart Epub ahead of print: 2 Nov 2022. doi:10.1136/heartjnl-2022-321492 https://heart.bmj.com/content/heartjnl/early/2022/09/21/heartjnl-2022-321492.ful...
...In this prospective analysis of 17 871 UK Biobank participants, we demonstrate association of past COVID-19 with increased incidence of a wide range of cardiovascular disease and mortality events.
These risks were almost entirely confined to those requiring hospitalisation and were highest in the first 30 days postinfection but
remained augmented for a prolonged period thereafter...
81margd
Marc Johnson @SolidEvidence | 5:06 PM · Nov 1, 2022:
Molecular virologist, Professor, and wastewater detective. U Missouri School of Medicine
https://twitter.com/SolidEvidence/status/1587551682388295680
https://threadreaderapp.com/thread/1587551682388295680.html
For those of you that have asked me why I am convinced that cryptic lineages are coming from people, I can finally point to a pre-print with dho and many fantastic collaborators in the UWisc and Wisc Public Health.
It's pretty straightforward. We started with a sewershed that produces enough wastewater to fill about 30 olympic swimming pools a day. We sampled about a quarter cup.
But something didn't smell right.
It had a cryptic lineage, a SARS-CoV-2 RNA that was completely unknown.
For the next several months my collaborators continued to take sub-samples from throughout the sewershed and sent them to me to figure out which one 'didn't smell right'.
With each round of sampling we further narrowed the source of the cryptic lineage.
We finally narrowed the source to a single manhole, and then to a single set of bathrooms.
The sample from that bathroom contained by far the most SARS-CoV-2 RNA I had ever seen from a wastewater sample. We could have diluted it a million-fold and still detected the lineage.
This bathroom was not used by any rats or white tailed deer. The signal was coming from a person.
We also learned from this 'homogeneous sample' about the complete viral sequence. It was from a lineage that circulated over a year ago.
The person has been infected a long time.
We still don't know which person is the source (most were tested by nasal swabs and were negative), and more importantly, we don't know why the lineage is not spreading.
We suspect that the source is a long-term COVID infection of someone's GI tract.
There are still a lot of questions that need to be answered, but we have at least started to figure out what the right questions are.
------------------------------------------------
Devon A Gregory et al. 2022. Tracing the origin of SARS-CoV-2 Omicron-like Spike sequences detected in wastewater. MedRxiv 31 )ct 2022 doi: https://doi.org/10.1101/2022.10.28.22281553 https://www.medrxiv.org/content/10.1101/2022.10.28.22281553v1
Molecular virologist, Professor, and wastewater detective. U Missouri School of Medicine
https://twitter.com/SolidEvidence/status/1587551682388295680
https://threadreaderapp.com/thread/1587551682388295680.html
For those of you that have asked me why I am convinced that cryptic lineages are coming from people, I can finally point to a pre-print with dho and many fantastic collaborators in the UWisc and Wisc Public Health.
It's pretty straightforward. We started with a sewershed that produces enough wastewater to fill about 30 olympic swimming pools a day. We sampled about a quarter cup.
But something didn't smell right.
It had a cryptic lineage, a SARS-CoV-2 RNA that was completely unknown.
For the next several months my collaborators continued to take sub-samples from throughout the sewershed and sent them to me to figure out which one 'didn't smell right'.
With each round of sampling we further narrowed the source of the cryptic lineage.
We finally narrowed the source to a single manhole, and then to a single set of bathrooms.
The sample from that bathroom contained by far the most SARS-CoV-2 RNA I had ever seen from a wastewater sample. We could have diluted it a million-fold and still detected the lineage.
This bathroom was not used by any rats or white tailed deer. The signal was coming from a person.
We also learned from this 'homogeneous sample' about the complete viral sequence. It was from a lineage that circulated over a year ago.
The person has been infected a long time.
We still don't know which person is the source (most were tested by nasal swabs and were negative), and more importantly, we don't know why the lineage is not spreading.
We suspect that the source is a long-term COVID infection of someone's GI tract.
There are still a lot of questions that need to be answered, but we have at least started to figure out what the right questions are.
------------------------------------------------
Devon A Gregory et al. 2022. Tracing the origin of SARS-CoV-2 Omicron-like Spike sequences detected in wastewater. MedRxiv 31 )ct 2022 doi: https://doi.org/10.1101/2022.10.28.22281553 https://www.medrxiv.org/content/10.1101/2022.10.28.22281553v1
82margd
>81 margd:
Eric Topol @EricTopol | 9:10 PM · Nov 1, 2022
Certain individuals have an astounding amount of persistent SARSCoV2 viral RNA in their gut, as traced to a single set of restrooms, with up to 1.6 billion genome copies/ L
Extraordinary work by @SolidEvidence dho and colleagues,
🧵explainer (at >81 margd: above)
_______________________________________________
margd: in comments re Gregory et al. 2022, for which Marc Jonson is senior author, takeaway is that infectious new variants can come from certain individuals, brewed up in their intestines--a rare occurrence, to be sure. Introduced into human population by aerolization in public bathrooms.
Eric Topol @EricTopol | 9:10 PM · Nov 1, 2022
Certain individuals have an astounding amount of persistent SARSCoV2 viral RNA in their gut, as traced to a single set of restrooms, with up to 1.6 billion genome copies/ L
Extraordinary work by @SolidEvidence dho and colleagues,
🧵explainer (at >81 margd: above)
_______________________________________________
margd: in comments re Gregory et al. 2022, for which Marc Jonson is senior author, takeaway is that infectious new variants can come from certain individuals, brewed up in their intestines--a rare occurrence, to be sure. Introduced into human population by aerolization in public bathrooms.
83margd
>79 margd: contd
COVID-19 Activates Same Brain Inflammation As In Parkinson’s Disease
The study findings show that COVID-19 affects the brain in a similar way to some dementia diseases.
Johannes Van Zijl | Nov 1, 2022
...“So if someone is already pre-disposed to Parkinson’s, having COVID-19 could be like pouring more fuel on that ‘fire’ in the brain,” Woodruff said. “The same would apply for a predisposition for Alzheimer’s and other dementias that have been linked to inflammasomes.”
Interestingly, what the study authors went on to test was if current inflammatory inhibitory drugs that are being tested in clinical trials could be used to block this inflammation caused by COVID-19.
“We found it successfully blocked the inflammatory pathway activated by COVID-19, essentially putting out the fire,” Albornoz Balmaceda said. “The drug reduced inflammation in both COVID-19-infected mice and the microglia cells from humans, suggesting a possible treatment approach to prevent neurodegeneration in the future."...
https://www.iflscience.com/covid-19-activates-same-brain-inflammation-as-in-park...
COVID-19 Activates Same Brain Inflammation As In Parkinson’s Disease
The study findings show that COVID-19 affects the brain in a similar way to some dementia diseases.
Johannes Van Zijl | Nov 1, 2022
...“So if someone is already pre-disposed to Parkinson’s, having COVID-19 could be like pouring more fuel on that ‘fire’ in the brain,” Woodruff said. “The same would apply for a predisposition for Alzheimer’s and other dementias that have been linked to inflammasomes.”
Interestingly, what the study authors went on to test was if current inflammatory inhibitory drugs that are being tested in clinical trials could be used to block this inflammation caused by COVID-19.
“We found it successfully blocked the inflammatory pathway activated by COVID-19, essentially putting out the fire,” Albornoz Balmaceda said. “The drug reduced inflammation in both COVID-19-infected mice and the microglia cells from humans, suggesting a possible treatment approach to prevent neurodegeneration in the future."...
https://www.iflscience.com/covid-19-activates-same-brain-inflammation-as-in-park...
84margd
Florian Krammer @florian_krammer | 5:49 AM · Nov 2, 2022:
Professor at the Department of Microbiology Icahn School of Medicine at Mount Sinai
Now there is data suggesting the bivalent booster is inducing better responses to BA.2.75.2 and BQ.1.1. This is in contrast to earlier reports a few days ago. The difference may be caused by the assays used (pseudotype versus authentic virus). @SutharLab
Graphs ( https://twitter.com/florian_krammer/status/1587743799471706112/photo/1 )
Meredith E. Davis-Gardner et al. 2022. mRNA bivalent booster enhances neutralization against BA.2.75.2 and BQ.1.1. BioRxiv November 1, 2022. https://doi.org/10.1101/2022.10.31.514636 https://www.biorxiv.org/content/10.1101/2022.10.31.514636v1.full.pdf
...Results
...In the one monovalent booster cohort, relative to WA1/2020, we observed a reduction in neutralization titers of 9-15-fold against BA.1 and BA.5 and 28-39-fold against BA.2.75.2 and BQ.1.1.
In the BA.5-containing bivalent booster cohort, the neutralizing activity improved against all the Omicron subvariants. Relative to0
WA1/2020, we observed a reduction in neutralization titers of 3.7- and 4-fold against BA.1 and BA.5, respectively, and 11.5- and 21-fold against BA.2.75.2 and BQ.1.1, respectively. These data suggest that the bivalent mRNA booster vaccine broadens humoral immunity against the Omicron subvariants...
Professor at the Department of Microbiology Icahn School of Medicine at Mount Sinai
Now there is data suggesting the bivalent booster is inducing better responses to BA.2.75.2 and BQ.1.1. This is in contrast to earlier reports a few days ago. The difference may be caused by the assays used (pseudotype versus authentic virus). @SutharLab
Graphs ( https://twitter.com/florian_krammer/status/1587743799471706112/photo/1 )
Meredith E. Davis-Gardner et al. 2022. mRNA bivalent booster enhances neutralization against BA.2.75.2 and BQ.1.1. BioRxiv November 1, 2022. https://doi.org/10.1101/2022.10.31.514636 https://www.biorxiv.org/content/10.1101/2022.10.31.514636v1.full.pdf
...Results
...In the one monovalent booster cohort, relative to WA1/2020, we observed a reduction in neutralization titers of 9-15-fold against BA.1 and BA.5 and 28-39-fold against BA.2.75.2 and BQ.1.1.
In the BA.5-containing bivalent booster cohort, the neutralizing activity improved against all the Omicron subvariants. Relative to0
WA1/2020, we observed a reduction in neutralization titers of 3.7- and 4-fold against BA.1 and BA.5, respectively, and 11.5- and 21-fold against BA.2.75.2 and BQ.1.1, respectively. These data suggest that the bivalent mRNA booster vaccine broadens humoral immunity against the Omicron subvariants...
85margd
Eric Topol (Scripps MD-scientist) @EricTopol | 10:27 AM · Nov 2, 2022
Confirmation of some loss of protection of vaccines/boosters vs hospitalizations and deaths in the BA.5 wave, age 50+, Ontario, Canada
@DrJeffKwong
@ICESOntario
@PublicHealthON
@UofT
Graphs ( https://twitter.com/EricTopol/status/1587813617633673216/photo/1 )
Ramandip Grewal et al. 2022. Effectiveness of mRNA COVID-19 vaccine booster doses against Omicron severe outcomes. MedRxiv 1 Nov 2022. https://doi.org/10.1101/2022.10.31.22281766
https://medrxiv.org/content/10.1101/2022.10.31.22281766v1
Preprint. Not peer-reviewed.
Abstract
...Conclusion: Our findings suggest that 1 or 2 booster doses of monovalent mRNA COVID-1956 vaccines initially restored very strong protection against Omicron-associated severe outcomes in all age groups, but VE subsequently declined over time with some age-related differences, and particularly so during a period of BA.4/BA.5 predominance.
Methods
...Approximately 95% of subjects received mRNA vaccines (mRNA-1273 or BNT162b2) for all doses. Omicron represented nearly 100% of all positive samples by late January 2022...
Confirmation of some loss of protection of vaccines/boosters vs hospitalizations and deaths in the BA.5 wave, age 50+, Ontario, Canada
@DrJeffKwong
@ICESOntario
@PublicHealthON
@UofT
Graphs ( https://twitter.com/EricTopol/status/1587813617633673216/photo/1 )
Ramandip Grewal et al. 2022. Effectiveness of mRNA COVID-19 vaccine booster doses against Omicron severe outcomes. MedRxiv 1 Nov 2022. https://doi.org/10.1101/2022.10.31.22281766
https://medrxiv.org/content/10.1101/2022.10.31.22281766v1
Preprint. Not peer-reviewed.
Abstract
...Conclusion: Our findings suggest that 1 or 2 booster doses of monovalent mRNA COVID-1956 vaccines initially restored very strong protection against Omicron-associated severe outcomes in all age groups, but VE subsequently declined over time with some age-related differences, and particularly so during a period of BA.4/BA.5 predominance.
Methods
...Approximately 95% of subjects received mRNA vaccines (mRNA-1273 or BNT162b2) for all doses. Omicron represented nearly 100% of all positive samples by late January 2022...
86margd
Jonas R. Kunst @KunstJonas | 3:46 AM · Nov 3, 2022:
Professor of Psychology @UniOslo. Past Yale Harvard @UiB. Founder @Advances1n.
"Outpatients with #LongCovid exhibited extensive hypometabolism (low glucose consumption) in brain clusters. Patients with more numerous symptoms during the initial phase and with a longer duration of symptoms were at higher risk."
Images of brains ( https://twitter.com/KunstJonas/status/1588075181062475777/photo/1 )
François Goehringer et al. 2022. Brain 18F-FDG PET imaging in outpatients with post-COVID-19 conditions: findings and associations with clinical characteristics (Short Communication). European Journal of Nuclear Medicine and Molecular Imaging (2 Nov 2022). https://link.springer.com/article/10.1007/s00259-022-06013-2
Abstract
...Results
Outpatients with post-COVID-19 conditions exhibited diffuse hypometabolism predominantly involving right frontal and temporal lobes including the orbito-frontal cortex and internal temporal areas. Metabolism in these clusters was inversely correlated with the number of symptoms during the initial infection (r = − 0.44...) and with the duration of symptoms (r = − 0.39...). Asthenia {abnormal physical weakness or lack of energy.} and cardiovascular, digestive, and neurological disorders during the acute phase and asthenia and language disorders during the chronic phase... were associated with these hypometabolic clusters.
Conclusion
Outpatients with post-COVID-19 conditions exhibited extensive hypometabolic right fronto-temporal clusters. Patients with more numerous symptoms during the initial phase and with a longer duration of symptoms were at higher risk of persistent brain involvement.
Professor of Psychology @UniOslo. Past Yale Harvard @UiB. Founder @Advances1n.
"Outpatients with #LongCovid exhibited extensive hypometabolism (low glucose consumption) in brain clusters. Patients with more numerous symptoms during the initial phase and with a longer duration of symptoms were at higher risk."
Images of brains ( https://twitter.com/KunstJonas/status/1588075181062475777/photo/1 )
François Goehringer et al. 2022. Brain 18F-FDG PET imaging in outpatients with post-COVID-19 conditions: findings and associations with clinical characteristics (Short Communication). European Journal of Nuclear Medicine and Molecular Imaging (2 Nov 2022). https://link.springer.com/article/10.1007/s00259-022-06013-2
Abstract
...Results
Outpatients with post-COVID-19 conditions exhibited diffuse hypometabolism predominantly involving right frontal and temporal lobes including the orbito-frontal cortex and internal temporal areas. Metabolism in these clusters was inversely correlated with the number of symptoms during the initial infection (r = − 0.44...) and with the duration of symptoms (r = − 0.39...). Asthenia {abnormal physical weakness or lack of energy.} and cardiovascular, digestive, and neurological disorders during the acute phase and asthenia and language disorders during the chronic phase... were associated with these hypometabolic clusters.
Conclusion
Outpatients with post-COVID-19 conditions exhibited extensive hypometabolic right fronto-temporal clusters. Patients with more numerous symptoms during the initial phase and with a longer duration of symptoms were at higher risk of persistent brain involvement.
87margd
Rick Wilson (Lincoln Project) @TheRickWilson | 10:48 AM · Nov 3, 2022
1/ The President of the United States makes an important speech about the dangers posed to our constitutional republic and democratic system of government.
It is reasoned, passionate, truthful, and timely.
The reaction by the political and media class is largely...
2/ ..."Whatever, bro. Did you hear about the crime ads and muh red wave?"
I get it; democracy and a functioning republic is an abstraction, a luxury good, a distraction from the horserace and easy both-sidesism.
Every nerd kid who goes to DC to work in media or...
3/ ...politics (raises hand) learns the inside game is fascinating and fun.
We're not in that game any more. We're in a new territory where the stakes aren't "What will the highest marginal tax rate be?"
Now, it's a matter of "will we be a nation with the rule of law?"
1/ The President of the United States makes an important speech about the dangers posed to our constitutional republic and democratic system of government.
It is reasoned, passionate, truthful, and timely.
The reaction by the political and media class is largely...
2/ ..."Whatever, bro. Did you hear about the crime ads and muh red wave?"
I get it; democracy and a functioning republic is an abstraction, a luxury good, a distraction from the horserace and easy both-sidesism.
Every nerd kid who goes to DC to work in media or...
3/ ...politics (raises hand) learns the inside game is fascinating and fun.
We're not in that game any more. We're in a new territory where the stakes aren't "What will the highest marginal tax rate be?"
Now, it's a matter of "will we be a nation with the rule of law?"
88margd
Isaac Bogoch @BogochIsaac | 8:04 PM · Nov 3, 2022
Infectious Diseases physician and scientist, with thoughts on Infectious Diseases, Tropical Medicine, HIV Prevention, Public Health, and Global Health issues {U Toronto}
A lot of confident takes related to the surge in paediatric illness lately.
Back on planet earth, there is still uncertainty on:
1. The impact of viruses on relatively immuno-naïve children with delayed 1st exposure to infection.
2. COVID-related immune dysregulation.
{Interesting discussion ensued on relative merits of both explanations and policy implications at https://twitter.com/BogochIsaac/status/1588321249771786241 }
Infectious Diseases physician and scientist, with thoughts on Infectious Diseases, Tropical Medicine, HIV Prevention, Public Health, and Global Health issues {U Toronto}
A lot of confident takes related to the surge in paediatric illness lately.
Back on planet earth, there is still uncertainty on:
1. The impact of viruses on relatively immuno-naïve children with delayed 1st exposure to infection.
2. COVID-related immune dysregulation.
{Interesting discussion ensued on relative merits of both explanations and policy implications at https://twitter.com/BogochIsaac/status/1588321249771786241 }
89margd
Paxlovid and Long Covid
A new study sheds light on a bonus benefit after the acute phase
Eric Topol | 11/6/2022
...in March-June 2022 during Omicron and subvariant waves...occurrence of Long Covid over time, a 26% reduction for Paxlovid...a 48% reduction of death and 30% reduction in hospitalizations after the acute phase...
https://erictopol.substack.com/p/paxlovid-and-long-covid
A new study sheds light on a bonus benefit after the acute phase
Eric Topol | 11/6/2022
...in March-June 2022 during Omicron and subvariant waves...occurrence of Long Covid over time, a 26% reduction for Paxlovid...a 48% reduction of death and 30% reduction in hospitalizations after the acute phase...
https://erictopol.substack.com/p/paxlovid-and-long-covid
90margd
Mild/ asymptomatic COVID can reactivate Herpes viruses and endogenous retroviruses {associated w malignant cancer of the testes}--esp in people w chronic fatigue syndrome. (Shingles is caused by a Herpes virus?) (Some people w Long COVID reported improvement after vaxx?)
Jonas R. Kunst @KunstJonas | 9:12 AM · Nov 7, 2022:
Professor of Psychology @UniOslo. Past Yale Harvard @UiB. Founder @Advances1n.
🚨A new study shows that mild/asymptomatic COVID-19 infection "is a potent trigger for reactivation of latent herpesviruses (EBV, HHV6) and endogenous retroviruses (HERV-K)." This was especially the case among people with #MECFS.
Eirini Apostolou et al. 2022. Saliva antibody-fingerprint of reactivated latent viruses after mild/asymptomatic COVID-19 is unique in patients with myalgic-encephalomyelitis/chronic fatigue syndrome. Front Immunol. 2022 Oct 20;13:949787. doi: 10.3389/fimmu.2022.949787. https://www.frontiersin.org/articles/10.3389/fimmu.2022.949787/full
Abstract
Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic disease considered to be triggered by viral infections in a majority of cases. Symptoms overlap largely with those of post-acute sequelae of COVID-19/long-COVID implying common pathogenetic mechanisms....
...Results: At 3-6 months after mild/asymptomatic SARS-CoV-2 infection, virus-specific antibodies in saliva were substantially induced signifying a strong reactivation of latent viruses (EBV { Epstein–Barr virus, mononucleosis}, HHV6 { two of the nine known herpesviruses that have humans as their primary host} and HERV-K {family of human endogenous retroviruses associated with malignant tumors of the testes}) in both cohorts. In patients with ME/CFS {Chronic Fatigue Syndrome}, antibody responses were significantly stronger, in particular EBV-encoded nuclear antigen-1 (EBNA1) IgG {Immunoglobulin G, a type of antibody} were elevated in patients with ME/CFS, but not in HDs {healthy donors}. EBV-VCA IgG {antibodies to Epstein Barr viral capsid antigen} was also elevated at baseline prior to SARS-infection in patients compared to HDs.
Conclusion: Our results denote an altered and chronically aroused anti-viral profile against latent viruses in ME/CFS. SARS-CoV-2 infection even in its mild/asymptomatic form is a potent trigger for reactivation of latent herpesviruses (EBV, HHV6) and endogenous retroviruses (HERV-K), as detected by antibody fingerprints locally in the oral mucosa (saliva samples). This has not been shown before because the antibody elevation is not detected systemically in the circulation/plasma.
...Discussion
...Our results can contribute to setting immunological tests that are easy to collect and may strengthen the diagnosis of ME/CFS {Chronic fatigue syndrome} and possibly PASC {post-acute sequelae of COVID-19, long-COVID}. Furthermore, our results highlight that treatment options directed to boost antiviral immune responses, may benefit patients with ME/CFS by tuning the fine balance between latent virus reactivation and an appropriate immune response.
Jonas R. Kunst @KunstJonas | 9:12 AM · Nov 7, 2022:
Professor of Psychology @UniOslo. Past Yale Harvard @UiB. Founder @Advances1n.
🚨A new study shows that mild/asymptomatic COVID-19 infection "is a potent trigger for reactivation of latent herpesviruses (EBV, HHV6) and endogenous retroviruses (HERV-K)." This was especially the case among people with #MECFS.
Eirini Apostolou et al. 2022. Saliva antibody-fingerprint of reactivated latent viruses after mild/asymptomatic COVID-19 is unique in patients with myalgic-encephalomyelitis/chronic fatigue syndrome. Front Immunol. 2022 Oct 20;13:949787. doi: 10.3389/fimmu.2022.949787. https://www.frontiersin.org/articles/10.3389/fimmu.2022.949787/full
Abstract
Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic disease considered to be triggered by viral infections in a majority of cases. Symptoms overlap largely with those of post-acute sequelae of COVID-19/long-COVID implying common pathogenetic mechanisms....
...Results: At 3-6 months after mild/asymptomatic SARS-CoV-2 infection, virus-specific antibodies in saliva were substantially induced signifying a strong reactivation of latent viruses (EBV { Epstein–Barr virus, mononucleosis}, HHV6 { two of the nine known herpesviruses that have humans as their primary host} and HERV-K {family of human endogenous retroviruses associated with malignant tumors of the testes}) in both cohorts. In patients with ME/CFS {Chronic Fatigue Syndrome}, antibody responses were significantly stronger, in particular EBV-encoded nuclear antigen-1 (EBNA1) IgG {Immunoglobulin G, a type of antibody} were elevated in patients with ME/CFS, but not in HDs {healthy donors}. EBV-VCA IgG {antibodies to Epstein Barr viral capsid antigen} was also elevated at baseline prior to SARS-infection in patients compared to HDs.
Conclusion: Our results denote an altered and chronically aroused anti-viral profile against latent viruses in ME/CFS. SARS-CoV-2 infection even in its mild/asymptomatic form is a potent trigger for reactivation of latent herpesviruses (EBV, HHV6) and endogenous retroviruses (HERV-K), as detected by antibody fingerprints locally in the oral mucosa (saliva samples). This has not been shown before because the antibody elevation is not detected systemically in the circulation/plasma.
...Discussion
...Our results can contribute to setting immunological tests that are easy to collect and may strengthen the diagnosis of ME/CFS {Chronic fatigue syndrome} and possibly PASC {post-acute sequelae of COVID-19, long-COVID}. Furthermore, our results highlight that treatment options directed to boost antiviral immune responses, may benefit patients with ME/CFS by tuning the fine balance between latent virus reactivation and an appropriate immune response.
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What If COVID Reinfections Wear Down Our Immunity?
Dr. Anthony Leonardi is a lightning rod for debate. If he’s right, this pandemic poses a greater threat than widely assumed.
Andrew Nikiforuk | 7 Nov 2022
...how valid are {U.S. immunologist Anthony} Leonardi’s warnings proving to be as research on COVID and immune responses has mounted? Let’s look at six key issues, comparing his statements with what the scientific literature now says or suggests.
For starters, Leonardi warned that the virus undermined and aged the immune system by hyperactivating and exhausting T cells. This overstimulation could in turn damage organs including the heart, brain and kidneys.
He predicted that the pandemic would reduce life expectancy around the world, most harming people aged 50 and over.
He hypothesized that the virus, by harming the immune system, could make people more vulnerable to other infections and cancers.
He speculated that COVID reinfections could be big trouble and should be avoided.
Given the virus’s ability to undermine and age the immune system, he argued that exposing children repeatedly to a virus that impairs the immune system and causes vascular disease and brain shrinkage was bad policy.
And, very early in the pandemic, he argued that herd immunity was wishful thinking and could not be achieved...
...{Leonardi} does not know when the pandemic will end. He suspects an excellent nasal spray vaccine combined with long-term changes to public infrastructure to clean the air could reduce COVID’s menace.
Until then evolution may have the upper hand as the virus becomes more skilled at evading the immunity prompted by previous COVID infections and vaccine shots...
https://thetyee.ca/Analysis/2022/11/07/COVID-Reinfections-And-Immunity/
Dr. Anthony Leonardi is a lightning rod for debate. If he’s right, this pandemic poses a greater threat than widely assumed.
Andrew Nikiforuk | 7 Nov 2022
...how valid are {U.S. immunologist Anthony} Leonardi’s warnings proving to be as research on COVID and immune responses has mounted? Let’s look at six key issues, comparing his statements with what the scientific literature now says or suggests.
For starters, Leonardi warned that the virus undermined and aged the immune system by hyperactivating and exhausting T cells. This overstimulation could in turn damage organs including the heart, brain and kidneys.
He predicted that the pandemic would reduce life expectancy around the world, most harming people aged 50 and over.
He hypothesized that the virus, by harming the immune system, could make people more vulnerable to other infections and cancers.
He speculated that COVID reinfections could be big trouble and should be avoided.
Given the virus’s ability to undermine and age the immune system, he argued that exposing children repeatedly to a virus that impairs the immune system and causes vascular disease and brain shrinkage was bad policy.
And, very early in the pandemic, he argued that herd immunity was wishful thinking and could not be achieved...
...{Leonardi} does not know when the pandemic will end. He suspects an excellent nasal spray vaccine combined with long-term changes to public infrastructure to clean the air could reduce COVID’s menace.
Until then evolution may have the upper hand as the virus becomes more skilled at evading the immunity prompted by previous COVID infections and vaccine shots...
https://thetyee.ca/Analysis/2022/11/07/COVID-Reinfections-And-Immunity/
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The Astounding Physics of N95 Masks (6:07)
minutephysics
...The physics & engineering of N95 mask design is pretty incredible...
https://www.youtube.com/watch?v=eAdanPfQdCA
minutephysics
...The physics & engineering of N95 mask design is pretty incredible...
https://www.youtube.com/watch?v=eAdanPfQdCA
93margd
Carl Zimmer (NYT) @carlzimmer | 10:18 AM · Nov 8, 2022:
Seroprevalence of SARS-CoV-2 in Virginia animals. "Human commensals like squirrels, and raccoons had high seroprevalence, ranging between 62%-71%, and sites with high human use had three times higher seroprevalence than low human-use areas."
Image ( https://twitter.com/carlzimmer/status/1590000811043872768/photo/1 )
---------------------------------------------------
Amanda R Goldberg et al. 2022. Wildlife exposure to SARS-CoV-2 across a human use gradient. BioRxiv 7 Nov 2022. doi: https://doi.org/10.1101/2022.11.04.515237 https://biorxiv.org/content/10.1101/2022.11.04.515237v1.abstract https://biorxiv.org/content/10.1101/2022.11.04.515237v1.abstract
This article is a preprint and has not been certified by peer review
Abstract
The spillover of SARS-CoV-2 into humans has caused one of the most devastating pandemics in recorded history. Human-animal interactions have led to transmission events of SARS-CoV-2 from humans to wild and captive animals. However, many questions remain about how extensive SARS-CoV-2 exposure is in wildlife, the factors that influence wildlife transmission risk, and whether sylvatic cycles can generate novel variants with increased infectivity and virulence. We sampled 18 different wildlife species in the Eastern U.S. and detected widespread exposure to SARS-CoV-2 across wildlife species. Using quantitative reverse transcription polymerase chain reaction and whole genome sequencing, we conclusively detected SARS-CoV-2 in the Virginia opossum and had equivocal detections in six additional species. Species considered human commensals like squirrels, and raccoons had high seroprevalence, ranging between 62%-71%, and sites with high human use had three times higher seroprevalence than low human-use areas. SARS-CoV-2 genomic data from an infected opossum and molecular modeling exposed previously uncharacterized changes to amino acid residues observed in the receptor binding domain (RBD), which predicts improved binding between the spike protein and human angiotensin-converting enzyme (ACE2) compared to the dominant variant circulating at the time of isolation. These mutations were not identified in human samples at the time of collection. Overall, our results highlight widespread exposure to SARS-CoV-2 in wildlife and suggest that areas with high human activity may serve as important points of contact for cross-species transmission. Furthermore, this work highlights the potential role of wildlife in fueling de novo mutations that may eventually appear in humans.
Seroprevalence of SARS-CoV-2 in Virginia animals. "Human commensals like squirrels, and raccoons had high seroprevalence, ranging between 62%-71%, and sites with high human use had three times higher seroprevalence than low human-use areas."
Image ( https://twitter.com/carlzimmer/status/1590000811043872768/photo/1 )
---------------------------------------------------
Amanda R Goldberg et al. 2022. Wildlife exposure to SARS-CoV-2 across a human use gradient. BioRxiv 7 Nov 2022. doi: https://doi.org/10.1101/2022.11.04.515237 https://biorxiv.org/content/10.1101/2022.11.04.515237v1.abstract https://biorxiv.org/content/10.1101/2022.11.04.515237v1.abstract
This article is a preprint and has not been certified by peer review
Abstract
The spillover of SARS-CoV-2 into humans has caused one of the most devastating pandemics in recorded history. Human-animal interactions have led to transmission events of SARS-CoV-2 from humans to wild and captive animals. However, many questions remain about how extensive SARS-CoV-2 exposure is in wildlife, the factors that influence wildlife transmission risk, and whether sylvatic cycles can generate novel variants with increased infectivity and virulence. We sampled 18 different wildlife species in the Eastern U.S. and detected widespread exposure to SARS-CoV-2 across wildlife species. Using quantitative reverse transcription polymerase chain reaction and whole genome sequencing, we conclusively detected SARS-CoV-2 in the Virginia opossum and had equivocal detections in six additional species. Species considered human commensals like squirrels, and raccoons had high seroprevalence, ranging between 62%-71%, and sites with high human use had three times higher seroprevalence than low human-use areas. SARS-CoV-2 genomic data from an infected opossum and molecular modeling exposed previously uncharacterized changes to amino acid residues observed in the receptor binding domain (RBD), which predicts improved binding between the spike protein and human angiotensin-converting enzyme (ACE2) compared to the dominant variant circulating at the time of isolation. These mutations were not identified in human samples at the time of collection. Overall, our results highlight widespread exposure to SARS-CoV-2 in wildlife and suggest that areas with high human activity may serve as important points of contact for cross-species transmission. Furthermore, this work highlights the potential role of wildlife in fueling de novo mutations that may eventually appear in humans.
94margd
Manina M. Etter et al. 2022. Severe Neuro-COVID is associated with peripheral immune signatures, autoimmunity and neurodegeneration: a prospective cross-sectional study. Nature Communications volume 13, Article number: 6777 (9 Nov 2022) https://www.nature.com/articles/s41467-022-34068-0
...Introduction
...observations indicate a compromised antiviral response pointing towards immune-mediated mechanisms responsible for severe Neuro-COVID...
Here, we perform an in-depth characterization of immune mediators in the CSF and plasma of clinically well-characterized Neuro-COVID patients and correlate these findings with brain imaging data and a 13-month follow-up. A vigorous microglia reactivity, a dysfunctional blood-brain barrier (BBB) and CNS (Central Nervous System) ingressing B cells mainly characterized severe Neuro-COVID. We observe a plasma cytokine storm combined with a non-inflammatory CSF profile, even in severe Neuro-COVID. However, particular CSF and plasma inflammatory parameters are associated with decreased regional brain volumes in COVID-19 patients and post-acute COVID-19 syndrome. These findings may be addressed to prevent COVID-19 related neurological impairment in the future...
____________________________________
Fotuhi, M., Mian, A., Meysami, S. & Raji, C. A. Neurobiology of COVID-19. J. Alzheimers Dis. JAD 76, 3–19 (2020). https://content.iospress.com/articles/journal-of-alzheimers-disease/jad200581
...Fig 4. NeuroCovid Stage I, II, and III. SARS-Cov2’s neurological manifestation can be grouped into three stages...
Stage I, the virus damage is limited to epithelial cells of nose and mouth...
Stage II, patients may experience blood clots in their brain or have auto-antibodies that damage their peripheral nerves and muscles...
Stage III, the cytokine storm damages the blood-brain barrier and patients may develop seizures, coma, or encephalopathy...
...Introduction
...observations indicate a compromised antiviral response pointing towards immune-mediated mechanisms responsible for severe Neuro-COVID...
Here, we perform an in-depth characterization of immune mediators in the CSF and plasma of clinically well-characterized Neuro-COVID patients and correlate these findings with brain imaging data and a 13-month follow-up. A vigorous microglia reactivity, a dysfunctional blood-brain barrier (BBB) and CNS (Central Nervous System) ingressing B cells mainly characterized severe Neuro-COVID. We observe a plasma cytokine storm combined with a non-inflammatory CSF profile, even in severe Neuro-COVID. However, particular CSF and plasma inflammatory parameters are associated with decreased regional brain volumes in COVID-19 patients and post-acute COVID-19 syndrome. These findings may be addressed to prevent COVID-19 related neurological impairment in the future...
____________________________________
Fotuhi, M., Mian, A., Meysami, S. & Raji, C. A. Neurobiology of COVID-19. J. Alzheimers Dis. JAD 76, 3–19 (2020). https://content.iospress.com/articles/journal-of-alzheimers-disease/jad200581
...Fig 4. NeuroCovid Stage I, II, and III. SARS-Cov2’s neurological manifestation can be grouped into three stages...
Stage I, the virus damage is limited to epithelial cells of nose and mouth...
Stage II, patients may experience blood clots in their brain or have auto-antibodies that damage their peripheral nerves and muscles...
Stage III, the cytokine storm damages the blood-brain barrier and patients may develop seizures, coma, or encephalopathy...
95margd
Anthony J Leonardi, PhD, MS @fitterhappierAJ | 10:14 PM · Nov 9, 2022:
PhD (T cell differentiation) BS MS MPH (student) JohnsHopkins
2022 Kavli Fellow Honorary Research Fellow ...
Guys, let me make it very clear
The average adult gets flu once every 5 years
Before Omicron, covid was estimated to infect every 16 months
Covid dysregulates far more than flu, it infects T cells and depletes dendritic cells
What do you think the cumulative effect will be?
-----------------------------------------------------
The meaning of DYSREGULATION is impairment of a physiological regulatory mechanism (as that governing metabolism, immune response, or organ function). (Merriam-Webster)
T cells (also called T lymphocytes) are major components of the adaptive immune system. Their roles include directly killing infected host cells, activating other immune cells, producing cytokines and regulating the immune response. https://teachmephysiology.com/immune-system/cells-immune-system/t-cells/
Dendritic cells are central to the initiation of primary immune responses. They are the only antigen-presenting cell capable of stimulating naive T cells, and hence they are pivotal in the generation of adaptive immunity. https://pubmed.ncbi.nlm.nih.gov/15984324/
PhD (T cell differentiation) BS MS MPH (student) JohnsHopkins
2022 Kavli Fellow Honorary Research Fellow ...
Guys, let me make it very clear
The average adult gets flu once every 5 years
Before Omicron, covid was estimated to infect every 16 months
Covid dysregulates far more than flu, it infects T cells and depletes dendritic cells
What do you think the cumulative effect will be?
-----------------------------------------------------
The meaning of DYSREGULATION is impairment of a physiological regulatory mechanism (as that governing metabolism, immune response, or organ function). (Merriam-Webster)
T cells (also called T lymphocytes) are major components of the adaptive immune system. Their roles include directly killing infected host cells, activating other immune cells, producing cytokines and regulating the immune response. https://teachmephysiology.com/immune-system/cells-immune-system/t-cells/
Dendritic cells are central to the initiation of primary immune responses. They are the only antigen-presenting cell capable of stimulating naive T cells, and hence they are pivotal in the generation of adaptive immunity. https://pubmed.ncbi.nlm.nih.gov/15984324/
96margd
Raina MacIntyre 😷💉📈 @Globalbiosec | 3:57 PM · Nov 10, 2022:
Physician.Field Epi🔎 Prevention, detection & response 2 epidemics, pandemics & bioterrorism; DarkWinter http://unsw.press/books/dark-win… Epiwatch_BSP 🇦🇺
Kids have significantly higher risk of cardiac, neurological and other disorders after #COVID19 #LongCovid See blue dots on left. If the estimate does not cross 1, it is significantly raised. #children
https://twitter.com/Globalbiosec/status/1590811026135875584/photo/1
Fig 2. Estimated IRRs with 95% CIs and IRs per 1,000 person-years in COVID-19 cohort for children/adolescents and adults by outcome domain and diagnosis/symptom complex.
IRs in the control cohort are shown in pale color. COVID-19, Coronavirus Disease 2019; ENT, ear, nose and throat; IR, incidence rate; IRR, incidence rate ratio; 95% CI, 95% confidence interval.
----------------------------------------------------
Martin Roessler et al. 2022. Post-COVID-19-associated morbidity in children, adolescents, and adults: A matched cohort study including more than 157,000 individuals with COVID-19 in Germany. PLOS MEDICINE. Published: November 10, 2022. https://doi.org/10.1371/journal.pmed.1004122 https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004122
Abstract
Background
...Utilizing comprehensive healthcare data on approximately 46% of the German population, we investigated post-COVID-19-associated morbidity in children/adolescents and adults.
Methods and findings
...Overall, 96 prespecified outcomes were aggregated into 13 diagnosis/symptom complexes and 3 domains (physical health, mental health, and physical/mental overlap domain)... The specific outcomes with the highest IRR (incidence rate ratios) and an incidence rate (IR) of at least 1/100 person-years in the COVID-19 cohort in children and adolescents were malaise/fatigue/exhaustion (IRR: 2.28..., IR Control: 5.51), cough (IRR: 1.74..., IR COVID-19: 36.56, IR Control: 21.06), and throat/chest pain (IRR: 1.72..., IR COVID-19: 20.01, IR Control: 11.66). In adults, these included disturbances of smell and taste (IRR: 6.69..., IR COVID-19: 12.42, IR Control: 1.86), fever (IRR: 3.33..., IR COVID-19: 11.53, IR Control: 3.46), and dyspnea (IRR: 2.88..., IR COVID-19: 43.91, IR Control: 15.27). For all health outcomes combined, IRs per 1,000 person-years in the COVID-19 cohort were significantly higher than those in the control cohort in both children/adolescents (IRR: 1.30, IR COVID-19: 436.91, IR Control: 335.98) and adults (IRR: 1.33..., IR COVID-19: 615.82, IR Control: 464.15). The relative magnitude of increased documented morbidity was similar for the physical, mental, and physical/mental overlap domain. In the COVID-19 cohort, IRs were significantly higher in all 13 diagnosis/symptom complexes in adults and in 10 diagnosis/symptom complexes in children/adolescents. IRR estimates were similar for age groups 0 to 11 and 12 to 17. IRs in children/adolescents were consistently lower than those in adults. Limitations of our study include potentially unmeasured confounding and detection bias.
Conclusions
In this retrospective matched cohort study, we observed significant new onset morbidity in children, adolescents, and adults across 13 prespecified diagnosis/symptom complexes, following COVID-19 infection. These findings expand the existing available evidence on post-COVID-19 conditions in younger age groups and confirm previous findings in adults.
Physician.Field Epi🔎 Prevention, detection & response 2 epidemics, pandemics & bioterrorism; DarkWinter http://unsw.press/books/dark-win… Epiwatch_BSP 🇦🇺
Kids have significantly higher risk of cardiac, neurological and other disorders after #COVID19 #LongCovid See blue dots on left. If the estimate does not cross 1, it is significantly raised. #children
https://twitter.com/Globalbiosec/status/1590811026135875584/photo/1
Fig 2. Estimated IRRs with 95% CIs and IRs per 1,000 person-years in COVID-19 cohort for children/adolescents and adults by outcome domain and diagnosis/symptom complex.
IRs in the control cohort are shown in pale color. COVID-19, Coronavirus Disease 2019; ENT, ear, nose and throat; IR, incidence rate; IRR, incidence rate ratio; 95% CI, 95% confidence interval.
----------------------------------------------------
Martin Roessler et al. 2022. Post-COVID-19-associated morbidity in children, adolescents, and adults: A matched cohort study including more than 157,000 individuals with COVID-19 in Germany. PLOS MEDICINE. Published: November 10, 2022. https://doi.org/10.1371/journal.pmed.1004122 https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004122
Abstract
Background
...Utilizing comprehensive healthcare data on approximately 46% of the German population, we investigated post-COVID-19-associated morbidity in children/adolescents and adults.
Methods and findings
...Overall, 96 prespecified outcomes were aggregated into 13 diagnosis/symptom complexes and 3 domains (physical health, mental health, and physical/mental overlap domain)... The specific outcomes with the highest IRR (incidence rate ratios) and an incidence rate (IR) of at least 1/100 person-years in the COVID-19 cohort in children and adolescents were malaise/fatigue/exhaustion (IRR: 2.28..., IR Control: 5.51), cough (IRR: 1.74..., IR COVID-19: 36.56, IR Control: 21.06), and throat/chest pain (IRR: 1.72..., IR COVID-19: 20.01, IR Control: 11.66). In adults, these included disturbances of smell and taste (IRR: 6.69..., IR COVID-19: 12.42, IR Control: 1.86), fever (IRR: 3.33..., IR COVID-19: 11.53, IR Control: 3.46), and dyspnea (IRR: 2.88..., IR COVID-19: 43.91, IR Control: 15.27). For all health outcomes combined, IRs per 1,000 person-years in the COVID-19 cohort were significantly higher than those in the control cohort in both children/adolescents (IRR: 1.30, IR COVID-19: 436.91, IR Control: 335.98) and adults (IRR: 1.33..., IR COVID-19: 615.82, IR Control: 464.15). The relative magnitude of increased documented morbidity was similar for the physical, mental, and physical/mental overlap domain. In the COVID-19 cohort, IRs were significantly higher in all 13 diagnosis/symptom complexes in adults and in 10 diagnosis/symptom complexes in children/adolescents. IRR estimates were similar for age groups 0 to 11 and 12 to 17. IRs in children/adolescents were consistently lower than those in adults. Limitations of our study include potentially unmeasured confounding and detection bias.
Conclusions
In this retrospective matched cohort study, we observed significant new onset morbidity in children, adolescents, and adults across 13 prespecified diagnosis/symptom complexes, following COVID-19 infection. These findings expand the existing available evidence on post-COVID-19 conditions in younger age groups and confirm previous findings in adults.
97margd
>86 margd: contd.
Jonas R. Kunst @KunstJonas | 3:12 AM · Nov 11, 2022:
Professor of Psychology @UniOslo . Past Yale Harvard @UiB . Founder @Advances1n ...
🚨A new study "points to a pathogenic role for compromised anti-SARS-CoV-2 responses in the cerebrospinal fluid, likely resulting in incomplete virus clearance from the brain and persistent neuroinflammation, in the development of neurological #LongCovid."
----------------------------------------------------
Marianna Spatola et al. 2022. Neurologic sequalae of COVID-19 are determined by immunologic imprinting from previous Coronaviruses.
MedRxiv 10 Nov 2022. doi: https://doi.org/10.1101/2022.11.07.22282030 https://www.medrxiv.org/content/10.1101/2022.11.07.22282030v1
This article is a preprint and has not been certified by peer review
Abstract
... Overall, these findings point to a pathogenic role for compromised anti-SARS-CoV-2 responses in the CSF (cerebrospinal fluid), likely resulting in incomplete virus clearance from the brain and persistent neuroinflammation, in the development of post-acute neurologic complications of SARS-CoV-2 infection.
Jonas R. Kunst @KunstJonas | 3:12 AM · Nov 11, 2022:
Professor of Psychology @UniOslo . Past Yale Harvard @UiB . Founder @Advances1n ...
🚨A new study "points to a pathogenic role for compromised anti-SARS-CoV-2 responses in the cerebrospinal fluid, likely resulting in incomplete virus clearance from the brain and persistent neuroinflammation, in the development of neurological #LongCovid."
----------------------------------------------------
Marianna Spatola et al. 2022. Neurologic sequalae of COVID-19 are determined by immunologic imprinting from previous Coronaviruses.
MedRxiv 10 Nov 2022. doi: https://doi.org/10.1101/2022.11.07.22282030 https://www.medrxiv.org/content/10.1101/2022.11.07.22282030v1
This article is a preprint and has not been certified by peer review
Abstract
... Overall, these findings point to a pathogenic role for compromised anti-SARS-CoV-2 responses in the CSF (cerebrospinal fluid), likely resulting in incomplete virus clearance from the brain and persistent neuroinflammation, in the development of post-acute neurologic complications of SARS-CoV-2 infection.
98margd
bob dudas @bobdudas | 3:51 PM · Nov 11, 2022
Chief, Academic Pediatrics at Johns Hopkins All Children's Hospital. Peds hosp fellowship director, learning technology, #meded
I'm sending positive vibes out to all those pediatricians out there
Graph flu by week 2017-2022 (https://twitter.com/bobdudas/status/1591171745574457345/photo/1)
Chief, Academic Pediatrics at Johns Hopkins All Children's Hospital. Peds hosp fellowship director, learning technology, #meded
I'm sending positive vibes out to all those pediatricians out there
Graph flu by week 2017-2022 (https://twitter.com/bobdudas/status/1591171745574457345/photo/1)
99margd
China approves first homegrown COVID antiviral
Yvaine Ye | 26 July 2022
...China’s drug regulator granted conditional approval on Monday for an HIV drug to be used to treat COVID-19. The drug, Azvudine, developed by Chinese drugmaker Genuine Biotech, is the first oral antiviral for the disease made in China.
Genuine Biotech, headquartered in Pingdingshan, applied for regulatory approval earlier this month. In an announcement, the company said that 40% of people with COVID-19 who were given Azvudine for a week in a phase III clinical trial showed “improved clinical symptoms”, compared with 11% of those given a placebo. However, detailed data from the trial, including whether the treatment reduced the risk of hospitalization or death, have not been released.
Although drug-efficacy data are lacking, Jun Wang, a pharmacologist at Rutgers University in New Brunswick, New Jersey, says because Azvudine is already approved in China as an HIV treatment, it should have abundant safety data, which would have fast-tracked its application. Genuine Biotech will need to submit more post-marketing data in order for the drug to receive full approval.
Most antivirals target two SARS-CoV-2 proteins that are essential for replication, a polymerase and a protease. Azvudine tricks the virus’s polymerase into incorporating the drug into its RNA, which stops the virus from replicating...
https://www.nature.com/articles/d41586-022-02050-x
Yvaine Ye | 26 July 2022
...China’s drug regulator granted conditional approval on Monday for an HIV drug to be used to treat COVID-19. The drug, Azvudine, developed by Chinese drugmaker Genuine Biotech, is the first oral antiviral for the disease made in China.
Genuine Biotech, headquartered in Pingdingshan, applied for regulatory approval earlier this month. In an announcement, the company said that 40% of people with COVID-19 who were given Azvudine for a week in a phase III clinical trial showed “improved clinical symptoms”, compared with 11% of those given a placebo. However, detailed data from the trial, including whether the treatment reduced the risk of hospitalization or death, have not been released.
Although drug-efficacy data are lacking, Jun Wang, a pharmacologist at Rutgers University in New Brunswick, New Jersey, says because Azvudine is already approved in China as an HIV treatment, it should have abundant safety data, which would have fast-tracked its application. Genuine Biotech will need to submit more post-marketing data in order for the drug to receive full approval.
Most antivirals target two SARS-CoV-2 proteins that are essential for replication, a polymerase and a protease. Azvudine tricks the virus’s polymerase into incorporating the drug into its RNA, which stops the virus from replicating...
https://www.nature.com/articles/d41586-022-02050-x
100margd
Stephen L. Archer @DrStephenArcher | 9:07 PM · Nov 14, 2022:
Head Dept. Medicine Queen’s University, MD-Scientist: Mitochondria, O2-sensing, Therapies for Pulmonary Hypertension and Cancer
24 scientists working since April 2020 @QueensuDOM discover virus causing COVID-19 attacks mitochondria causing lung injury & impairing oxygen sensing...
How Does COVID-19 Damage the Lungs? (TVO, 23:29)
https://twitter.com/DrStephenArcher/status/1592338360302915584
https://www.youtube.com/watch?v=o_RxKCKkV_c
---------------------------------------------------------
How COVID-19 damages lungs
Monday October 31, 2022
By Stephen L Archer, Professor, Head of Department of Medicine Queen's U
https://www.queensu.ca/gazette/stories/how-covid-19-damages-lungs
https://theconversation.com/how-covid-19-damages-lungs-the-virus-attacks-mitocho...
Head Dept. Medicine Queen’s University, MD-Scientist: Mitochondria, O2-sensing, Therapies for Pulmonary Hypertension and Cancer
24 scientists working since April 2020 @QueensuDOM discover virus causing COVID-19 attacks mitochondria causing lung injury & impairing oxygen sensing...
How Does COVID-19 Damage the Lungs? (TVO, 23:29)
https://twitter.com/DrStephenArcher/status/1592338360302915584
https://www.youtube.com/watch?v=o_RxKCKkV_c
---------------------------------------------------------
How COVID-19 damages lungs
Monday October 31, 2022
By Stephen L Archer, Professor, Head of Department of Medicine Queen's U
https://www.queensu.ca/gazette/stories/how-covid-19-damages-lungs
https://theconversation.com/how-covid-19-damages-lungs-the-virus-attacks-mitocho...
101margd
Gerald Evans 🇺🇦 (Queen's U infectious disease MD) @skepticalIDdoc
11:20 AM · Nov 15, 2022:
Watching #COVID19 numbers tank during this early seasonal rise in #influenza and #RSV numbers raises the spectre of viral interference. Like many biological systems, competition between viruses may be at work here.
Jocelyne Piret and Guy Boivin. 2022. Viral Interference between Respiratory Viruses. Emerg Infect Dis. 2022 Feb; 28(2): 273–281.
doi: 10.3201/eid2802.211727 https://wwwnc.cdc.gov/eid/article/28/2/21-1727_article
Abstract
Multiple respiratory viruses can concurrently or sequentially infect the respiratory tract and lead to virus‒virus interactions. Infection by a first virus could enhance or reduce infection and replication of a second virus, resulting in positive (additive or synergistic) or negative (antagonistic) interaction. The concept of viral interference has been demonstrated at the cellular, host, and population levels. The mechanisms involved in viral interference have been evaluated in differentiated airway epithelial cells and in animal models susceptible to the respiratory viruses of interest. A likely mechanism is the interferon response that could confer a temporary nonspecific immunity to the host. During the coronavirus disease pandemic, nonpharmacologic interventions have prevented the circulation of most respiratory viruses. Once the sanitary restrictions are lifted, circulation of seasonal respiratory viruses is expected to resume and will offer the opportunity to study their interactions, notably with severe acute respiratory syndrome coronavirus 2.
11:20 AM · Nov 15, 2022:
Watching #COVID19 numbers tank during this early seasonal rise in #influenza and #RSV numbers raises the spectre of viral interference. Like many biological systems, competition between viruses may be at work here.
Jocelyne Piret and Guy Boivin. 2022. Viral Interference between Respiratory Viruses. Emerg Infect Dis. 2022 Feb; 28(2): 273–281.
doi: 10.3201/eid2802.211727 https://wwwnc.cdc.gov/eid/article/28/2/21-1727_article
Abstract
Multiple respiratory viruses can concurrently or sequentially infect the respiratory tract and lead to virus‒virus interactions. Infection by a first virus could enhance or reduce infection and replication of a second virus, resulting in positive (additive or synergistic) or negative (antagonistic) interaction. The concept of viral interference has been demonstrated at the cellular, host, and population levels. The mechanisms involved in viral interference have been evaluated in differentiated airway epithelial cells and in animal models susceptible to the respiratory viruses of interest. A likely mechanism is the interferon response that could confer a temporary nonspecific immunity to the host. During the coronavirus disease pandemic, nonpharmacologic interventions have prevented the circulation of most respiratory viruses. Once the sanitary restrictions are lifted, circulation of seasonal respiratory viruses is expected to resume and will offer the opportunity to study their interactions, notably with severe acute respiratory syndrome coronavirus 2.
102margd
Severe RSV-- previous COVID? co-infection w flu?
Mask up. Flu shot might help prevent severe RSV?
------------------------------------------------
T. Ryan Gregory @TRyanGregory | 8:17 PM · Nov 15, 2022:
Professor of evolutionary biology. {U Guelph, Ontario}
I noted recently that claims about exceptionally high rates of RSV this year, caused by "immunity debt" and explaining the high number of children in hospital, is an empirical claim that requires data. Well, we now have this for Canada thanks to @wikisteff (follow him btw!). 🧵
https://twitter.com/TRyanGregory/status/1592688156658520064
Here is a plot of RSV rates since winter 2013/2014. As you can see, it's a very regular seasonal pattern for all the years up to the start of the COVID pandemic. There was essentially no RSV two years ago when schools were closed (winter 2020/2021).
Graph RSV Canada 2013-2023 ( https://twitter.com/TRyanGregory/status/1592688156658520064/photo/1 )
And it's not just RSV. There was almost no flu or colds caused by other coronaviruses (not SARS2) two years ago either.
Tweet @wikisteff ( https://twitter.com/Wikisteff/status/1592668936935378944 )
So, we can conclude two things right away: 1) mitigations worked extremely well and absolutely crushed respiratory virus transmission, and) the first assumption of "immunity debt" holds, namely that there was a season without kids being infected with RSV or flu.
BUT, look at last year. Winter 2021/2022 was a record season for RSV. It is simply not accurate that we are seeing three years' worth of RSV cases this year. RSV was back last year after many mitigations were lifted.
Graph RSV Canada 2013-2023 ( https://twitter.com/TRyanGregory/status/1592688164560592898/photo/1 )
Last year, there were lots of cases of RSV but hospitals were not overwhelmed like they are right now. This year, RSV season has started early but the case numbers are not exceptionally high yet. Still, many kids are in the hospital already.
So, this doesn't fit with the simple "immunity debt" hypothesis. Something else seems to be going on. Of course, high rates of severe infection without more cases is consistent with the "immunity theft" hypothesis in which past COVID infection impairs immune function.
But there is another interesting observation pointed out by @Prassas
, namely that flu was NOT back last year the way RSV was. Is there something about RSV and flu co-infections that matters? Immunity debt to flu but not RSV? Is flu more severe this year?
Ioannis Prassas @Prassas | 6:56 PM · Nov 15, 2022:
{Molecular biologist, Mt Sinai Hospital Toronto}
Winter 22: max positivity for all viruses (incl. RSV) but no flu --> No exceptional kid ICU crisis
Fall 22: Reduced positivity for all viruses, BUT flu is back --> Exceptional kid ICU crisis
Who's to blame?
1.Flu alone?
2.Flu/RSV (coinfections)?
3.Post-covid effects??
Graph RSV Canada 2013-2023 ( https://twitter.com/TRyanGregory/status/1592643473924304896/photo/1 )
Stef @wikisteff@mastodon.social Christensen @Wikisteff | 7:18 PM · Nov 15, 2022
{PhD in AI}
Here's the Canadawide data, over a longer time series:
Graph RSV flu Canada 2013-2023 ( https://twitter.com/Wikisteff/status/1592673301343920128/photo/1 )
And here are the series for Ontario.
Look how sharply aligned those curves are...
Graph RSV flu Ontario ( https://twitter.com/Wikisteff/status/1592674877403967489/photo/1 )
We still don't know what exactly is happening. What is pretty clear, though, is that assuming that it's simply "immunity debt" after two years of no RSV infections is false in Canada. This is why we need to test multiple hypotheses and why we need data, not just-so stories.
In the meantime, we *know* that mitigations work against the viruses that are leading to kids becoming very ill and pediatric hospitals being overwhelmed. Whatever the explanation, the right thing to do *right now* is to reduce transmission of these viruses in children. #MaskUp
Again, huge thank you to @Wikisteff for the data sleuthing -- this is exactly what we need. Also, as he noted:...the data scientists at @GovCanHealth deserve all the credit. Without their multiple *years* of care and painstaking work collating data AND publishing it in the open, none of this would be even possible.
For a bit more on "immunity debt" vs. "immunity theft" (the latter being only a slightly modified-for-catchiness version of @FurnessColin
's "immunity robbery").
https://twitter.com/TRyanGregory/status/1591764627394035723
Don't forget to check out this fantastic discussion on @TheAgenda. Note that a couple of the claims made by Dr. McGeer (three years of RSV all at once after two years without, this only being a problem with pediatric hospitals in Canada) are not accurate.
32:18 ( https://twitter.com/TRyanGregory/status/1592688153949016064 )
It bears noting that there *is* a mechanism by which COVID infection can impair defence against RSV.
https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1009742
https://www.frontiersin.org/articles/10.3389/fimmu.2022.843342/full
https://www.mdpi.com/1999-4915/12/1/102
https://www.nature.com/articles/s41423-021-00728-2
Mask up. Flu shot might help prevent severe RSV?
------------------------------------------------
T. Ryan Gregory @TRyanGregory | 8:17 PM · Nov 15, 2022:
Professor of evolutionary biology. {U Guelph, Ontario}
I noted recently that claims about exceptionally high rates of RSV this year, caused by "immunity debt" and explaining the high number of children in hospital, is an empirical claim that requires data. Well, we now have this for Canada thanks to @wikisteff (follow him btw!). 🧵
https://twitter.com/TRyanGregory/status/1592688156658520064
Here is a plot of RSV rates since winter 2013/2014. As you can see, it's a very regular seasonal pattern for all the years up to the start of the COVID pandemic. There was essentially no RSV two years ago when schools were closed (winter 2020/2021).
Graph RSV Canada 2013-2023 ( https://twitter.com/TRyanGregory/status/1592688156658520064/photo/1 )
And it's not just RSV. There was almost no flu or colds caused by other coronaviruses (not SARS2) two years ago either.
Tweet @wikisteff ( https://twitter.com/Wikisteff/status/1592668936935378944 )
So, we can conclude two things right away: 1) mitigations worked extremely well and absolutely crushed respiratory virus transmission, and) the first assumption of "immunity debt" holds, namely that there was a season without kids being infected with RSV or flu.
BUT, look at last year. Winter 2021/2022 was a record season for RSV. It is simply not accurate that we are seeing three years' worth of RSV cases this year. RSV was back last year after many mitigations were lifted.
Graph RSV Canada 2013-2023 ( https://twitter.com/TRyanGregory/status/1592688164560592898/photo/1 )
Last year, there were lots of cases of RSV but hospitals were not overwhelmed like they are right now. This year, RSV season has started early but the case numbers are not exceptionally high yet. Still, many kids are in the hospital already.
So, this doesn't fit with the simple "immunity debt" hypothesis. Something else seems to be going on. Of course, high rates of severe infection without more cases is consistent with the "immunity theft" hypothesis in which past COVID infection impairs immune function.
But there is another interesting observation pointed out by @Prassas
, namely that flu was NOT back last year the way RSV was. Is there something about RSV and flu co-infections that matters? Immunity debt to flu but not RSV? Is flu more severe this year?
Ioannis Prassas @Prassas | 6:56 PM · Nov 15, 2022:
{Molecular biologist, Mt Sinai Hospital Toronto}
Winter 22: max positivity for all viruses (incl. RSV) but no flu --> No exceptional kid ICU crisis
Fall 22: Reduced positivity for all viruses, BUT flu is back --> Exceptional kid ICU crisis
Who's to blame?
1.Flu alone?
2.Flu/RSV (coinfections)?
3.Post-covid effects??
Graph RSV Canada 2013-2023 ( https://twitter.com/TRyanGregory/status/1592643473924304896/photo/1 )
Stef @wikisteff@mastodon.social Christensen @Wikisteff | 7:18 PM · Nov 15, 2022
{PhD in AI}
Here's the Canadawide data, over a longer time series:
Graph RSV flu Canada 2013-2023 ( https://twitter.com/Wikisteff/status/1592673301343920128/photo/1 )
And here are the series for Ontario.
Look how sharply aligned those curves are...
Graph RSV flu Ontario ( https://twitter.com/Wikisteff/status/1592674877403967489/photo/1 )
We still don't know what exactly is happening. What is pretty clear, though, is that assuming that it's simply "immunity debt" after two years of no RSV infections is false in Canada. This is why we need to test multiple hypotheses and why we need data, not just-so stories.
In the meantime, we *know* that mitigations work against the viruses that are leading to kids becoming very ill and pediatric hospitals being overwhelmed. Whatever the explanation, the right thing to do *right now* is to reduce transmission of these viruses in children. #MaskUp
Again, huge thank you to @Wikisteff for the data sleuthing -- this is exactly what we need. Also, as he noted:...the data scientists at @GovCanHealth deserve all the credit. Without their multiple *years* of care and painstaking work collating data AND publishing it in the open, none of this would be even possible.
For a bit more on "immunity debt" vs. "immunity theft" (the latter being only a slightly modified-for-catchiness version of @FurnessColin
's "immunity robbery").
https://twitter.com/TRyanGregory/status/1591764627394035723
Don't forget to check out this fantastic discussion on @TheAgenda. Note that a couple of the claims made by Dr. McGeer (three years of RSV all at once after two years without, this only being a problem with pediatric hospitals in Canada) are not accurate.
32:18 ( https://twitter.com/TRyanGregory/status/1592688153949016064 )
It bears noting that there *is* a mechanism by which COVID infection can impair defence against RSV.
https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1009742
https://www.frontiersin.org/articles/10.3389/fimmu.2022.843342/full
https://www.mdpi.com/1999-4915/12/1/102
https://www.nature.com/articles/s41423-021-00728-2
103margd
David Fisman (U toronto) @DFisman | 11:54 AM · Nov 17, 2022
https://twitter.com/DFisman/status/1593286561004666881
This is fun, and will undoubtedly generate howls of rage, but early covid data from Ontario showed a marked reduction in risk of death in healthcare workers with covid relative to non-HCW, even after adjustment for age, sex and comorbidity.
I think this probably represents anisotropy in infection...infection via different routes is associated with different disease severity. Historically this was the basis of smallpox INOCULATION (pre-vaccines), where smallpox was given via scarification in the skin...
{smaller infective dose in masked HCW, more widespread testing in HCW}
...or scabs from smallpox patients ground up and used as snuff. (blech).
But the same effect has been demonstrated with covid in non-human primates. Inhalation enhances virulence....
ActLikeOurHouseIsOnFire(ItIs) @ActLikeOurHous1
Plain language for all non med and non statistic aware folks? Does this mean microdosing because of mask wearing reduces mortality rates if infected?
David Fisman @DFisman
Probably, or being infected via another site (conjunctiva e.g.)
https://twitter.com/DFisman/status/1593286561004666881
This is fun, and will undoubtedly generate howls of rage, but early covid data from Ontario showed a marked reduction in risk of death in healthcare workers with covid relative to non-HCW, even after adjustment for age, sex and comorbidity.
I think this probably represents anisotropy in infection...infection via different routes is associated with different disease severity. Historically this was the basis of smallpox INOCULATION (pre-vaccines), where smallpox was given via scarification in the skin...
{smaller infective dose in masked HCW, more widespread testing in HCW}
...or scabs from smallpox patients ground up and used as snuff. (blech).
But the same effect has been demonstrated with covid in non-human primates. Inhalation enhances virulence....
ActLikeOurHouseIsOnFire(ItIs) @ActLikeOurHous1
Plain language for all non med and non statistic aware folks? Does this mean microdosing because of mask wearing reduces mortality rates if infected?
David Fisman @DFisman
Probably, or being infected via another site (conjunctiva e.g.)
104margd
Vaccine Breakthrough Could Finally Bring COVID to Its Knees
David Axe | Sat, November 19, 2022
...The key to the NIH’s potential vaccine design is a part of the virus called the “spine helix.” It’s a coil-shaped structure inside the spike protein, the part of the virus that helps it grab onto and infect our cells.
Lots of current vaccines target the spike protein. But none of them specifically target the spine helix. And yet, there are good reasons to focus on that part of the pathogen. Whereas many regions of the spike protein tend to change a lot as the virus mutates, the spine helix doesn’t.
That gives scientists “hope that an antibody targeting this region will be more durable and broadly effective,” Joshua Tan, the lead scientist on the NIH team, told The Daily Beast.
Vaccines that target and “bind,” say, the receptor-binding domain region of the spike protein might lose effectiveness if the virus evolves within that region. The great thing about the spine helix, from an immunological standpoint, is that it doesn’t mutate. At least, it hasn’t mutated yet, three years into the COVID pandemic.
So a vaccine that binds the spine helix in SARS-CoV-2 should hold up for a long time. And it should also work on all the other coronaviruses that also include the spine helix—and there are dozens of them, including several such as SARS-CoV-1 and MERS that have already made the leap from animal populations and caused outbreaks in people...
https://www.yahoo.com/news/vaccine-breakthrough-could-finally-bring-034316828.ht...
---------------------------------------------
Cherrelle Dacon et al. 2022. Rare, convergent antibodies targeting the stem helix broadly neutralize diverse betacoronaviruses. Cell Host & Microbe. Open Access Published: November 07, 2022. DOI:https://doi. org/10.1016/j.chom.2022.10.010 https://www.cell.com/cell-host-microbe/fulltext/S1931-3128(22)00523-6#secsectitl...
Summary
Humanity has faced three recent outbreaks of novel betacoronaviruses, emphasizing the need to develop approaches that broadly target coronaviruses. Here, we identify 55 monoclonal antibodies from COVID-19 convalescent donors that bind diverse betacoronavirus spike proteins. Most antibodies targeted an S2 epitope that included the K814 residue and were non-neutralizing. However, 11 antibodies targeting the stem helix neutralized betacoronaviruses from different lineages. Eight antibodies in this group, including the six broadest and most potent neutralizers, were encoded by IGHV1-46 and IGKV3-20. Crystal structures of three antibodies of this class at 1.5–1.75-Å resolution revealed a conserved mode of binding. COV89-22 neutralized SARS-CoV-2 variants of concern including Omicron BA.4/5 and limited disease in Syrian hamsters. Collectively, these findings identify a class of IGHV1-46/IGKV3-20 antibodies that broadly neutralize betacoronaviruses by targeting the stem helix but indicate these antibodies constitute a small fraction of the broadly reactive antibody response to betacoronaviruses after SARS-CoV-2 infection.
David Axe | Sat, November 19, 2022
...The key to the NIH’s potential vaccine design is a part of the virus called the “spine helix.” It’s a coil-shaped structure inside the spike protein, the part of the virus that helps it grab onto and infect our cells.
Lots of current vaccines target the spike protein. But none of them specifically target the spine helix. And yet, there are good reasons to focus on that part of the pathogen. Whereas many regions of the spike protein tend to change a lot as the virus mutates, the spine helix doesn’t.
That gives scientists “hope that an antibody targeting this region will be more durable and broadly effective,” Joshua Tan, the lead scientist on the NIH team, told The Daily Beast.
Vaccines that target and “bind,” say, the receptor-binding domain region of the spike protein might lose effectiveness if the virus evolves within that region. The great thing about the spine helix, from an immunological standpoint, is that it doesn’t mutate. At least, it hasn’t mutated yet, three years into the COVID pandemic.
So a vaccine that binds the spine helix in SARS-CoV-2 should hold up for a long time. And it should also work on all the other coronaviruses that also include the spine helix—and there are dozens of them, including several such as SARS-CoV-1 and MERS that have already made the leap from animal populations and caused outbreaks in people...
https://www.yahoo.com/news/vaccine-breakthrough-could-finally-bring-034316828.ht...
---------------------------------------------
Cherrelle Dacon et al. 2022. Rare, convergent antibodies targeting the stem helix broadly neutralize diverse betacoronaviruses. Cell Host & Microbe. Open Access Published: November 07, 2022. DOI:https://doi. org/10.1016/j.chom.2022.10.010 https://www.cell.com/cell-host-microbe/fulltext/S1931-3128(22)00523-6#secsectitl...
Summary
Humanity has faced three recent outbreaks of novel betacoronaviruses, emphasizing the need to develop approaches that broadly target coronaviruses. Here, we identify 55 monoclonal antibodies from COVID-19 convalescent donors that bind diverse betacoronavirus spike proteins. Most antibodies targeted an S2 epitope that included the K814 residue and were non-neutralizing. However, 11 antibodies targeting the stem helix neutralized betacoronaviruses from different lineages. Eight antibodies in this group, including the six broadest and most potent neutralizers, were encoded by IGHV1-46 and IGKV3-20. Crystal structures of three antibodies of this class at 1.5–1.75-Å resolution revealed a conserved mode of binding. COV89-22 neutralized SARS-CoV-2 variants of concern including Omicron BA.4/5 and limited disease in Syrian hamsters. Collectively, these findings identify a class of IGHV1-46/IGKV3-20 antibodies that broadly neutralize betacoronaviruses by targeting the stem helix but indicate these antibodies constitute a small fraction of the broadly reactive antibody response to betacoronaviruses after SARS-CoV-2 infection.
105margd
US: A winter surge is approaching
Dr. Saskia Popescu @SaskiaPopescu | 8:17 PM · Nov 20, 2022:
ID Epi & IP | Senior Fellow @CSRisks | Asst Prof @ScharSchool | @uarizona | @georgetown_ghss | @JHSPH_CHS ELBI
COVID cases are up 4% in the US the past two weeks, which may not sound like a lot, but some states are getting hit hard. AZ is up 110%, Nebraska 153%, California has a 62% increase in cases, Texas 57%, and Washington is seeing a 41% spike. A winter surge is approaching (1/2)
So…get your booster! Mask. Stay home when sick. Test if exposed. Be mindful of indoor gatherings & improve ventilation. Wash those damn hands..and clean/disinfect surfaces/high-touch objects (helps to reduce many diff types germs)...
Dr. Saskia Popescu @SaskiaPopescu | 8:17 PM · Nov 20, 2022:
ID Epi & IP | Senior Fellow @CSRisks | Asst Prof @ScharSchool | @uarizona | @georgetown_ghss | @JHSPH_CHS ELBI
COVID cases are up 4% in the US the past two weeks, which may not sound like a lot, but some states are getting hit hard. AZ is up 110%, Nebraska 153%, California has a 62% increase in cases, Texas 57%, and Washington is seeing a 41% spike. A winter surge is approaching (1/2)
So…get your booster! Mask. Stay home when sick. Test if exposed. Be mindful of indoor gatherings & improve ventilation. Wash those damn hands..and clean/disinfect surfaces/high-touch objects (helps to reduce many diff types germs)...
106margd
Something bad is happening in China: https://ourworldindata.org/coronavirus/country/china
Graph daily cases China Nov 2020-Nov 2022
https://twitter.com/Crof/status/1593812367435239424/photo/1
Quote Tweet
BNO News @BNOFeed · Nov 18
China reports 24,473 new coronavirus cases, up 105% from last week. It includes a record 515 cases in Beijing
- Crawford Kilian @Crof | 10:44 PM · Nov 18, 2022:
Retired college teacher & persistent writer. Now on Substack https://crawfordkilian.substack.com Born 1941 (CO2 ppm: 310). Polio survivor.
Graph daily cases China Nov 2020-Nov 2022
https://twitter.com/Crof/status/1593812367435239424/photo/1
Quote Tweet
BNO News @BNOFeed · Nov 18
China reports 24,473 new coronavirus cases, up 105% from last week. It includes a record 515 cases in Beijing
- Crawford Kilian @Crof | 10:44 PM · Nov 18, 2022:
Retired college teacher & persistent writer. Now on Substack https://crawfordkilian.substack.com Born 1941 (CO2 ppm: 310). Polio survivor.
107margd
>106 margd: contd.
JWeiland @JPWeiland | 12:33 AM · Nov 22, 2022:
Wow, 6 day doubling time in China
Straight line on the log chart
Graph ( https://twitter.com/JPWeiland/status/1594926931476094976/photo/1 )
JWeiland @JPWeiland | 12:33 AM · Nov 22, 2022:
Wow, 6 day doubling time in China
Straight line on the log chart
Graph ( https://twitter.com/JPWeiland/status/1594926931476094976/photo/1 )
108margd
Kimberly Prather, Ph.D. @kprather88 | 12:25 PM · Nov 24, 2022:
Director @CAICECCI & Distinguished Professor {Scripps}...
https://twitter.com/kprather88/status/1595831028383293440
https://threadreaderapp.com/thread/1595831028383293440.html
I am asked about travel a lot. I have flown across the US and to/from Europe and not caught COVID or any respiratory bug. I carry my CO2 sensor to determine where to sit in airports. Lounges are typically poorly ventilated and everyone is eating/drinking with no mask. (1/3)
I only remove my mask to eat and drink at high altitude when I know air handling system is operating. I have air above me blowing down on me directly to dilute air surrounding me. (2/3)
Boarding and unboarding (and using crowded restrooms) are the riskiest parts. Sitting on tarmac is also high risk. Now that cases are going up again, I will limit my air travel.
Director @CAICECCI & Distinguished Professor {Scripps}...
https://twitter.com/kprather88/status/1595831028383293440
https://threadreaderapp.com/thread/1595831028383293440.html
I am asked about travel a lot. I have flown across the US and to/from Europe and not caught COVID or any respiratory bug. I carry my CO2 sensor to determine where to sit in airports. Lounges are typically poorly ventilated and everyone is eating/drinking with no mask. (1/3)
I only remove my mask to eat and drink at high altitude when I know air handling system is operating. I have air above me blowing down on me directly to dilute air surrounding me. (2/3)
Boarding and unboarding (and using crowded restrooms) are the riskiest parts. Sitting on tarmac is also high risk. Now that cases are going up again, I will limit my air travel.
109margd
🚨Another reason to err on the side of caution: If you get COVID-19, your risk of incident diabetes rises by 66%.
- Jonas R. Kunst @KunstJonas | 10:15 AM · Nov 24, 2022
Professor of Psychology @UniOslo. Past Yale Harvard
@UiB . Founder @Advances1n .
----------------------------------------------
Paddy Ssentongo et al. 2022. Association of COVID-19 with diabetes: a systematic review and meta-analysis. Sci Rep. 2022 Nov 23;12(1):20191. doi:10.1038/s41598-022-24185-7. https://pubmed.ncbi.nlm.nih.gov/36418912/
Abstract
Emerging evidence suggests that coronavirus disease-2019 (COVID-19) may lead to a wide range of post-acute sequelae outcomes, including new onset of diabetes...meta-analysis...estimate the incidence of newly diagnosed diabetes in survivors of COVID-19...Search dates were December 2019-October 16, 2022. ...We identified 8 eligible studies consisting of 4,270,747 COVID-19 patients and 43,203,759 controls. Median age was 43 years ..., and 50% were female. COVID-19 was associated with a 66% higher risk of incident diabetes (risk ratio, 1.66...). The risk was not modified by age, sex, or study quality. ... In this systematic review and meta-analysis, COVID-19 was associated with higher risk for developing new onset diabetes among survivors. Active monitoring of glucose dysregulation after recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is warranted.
- Jonas R. Kunst @KunstJonas | 10:15 AM · Nov 24, 2022
Professor of Psychology @UniOslo. Past Yale Harvard
@UiB . Founder @Advances1n .
----------------------------------------------
Paddy Ssentongo et al. 2022. Association of COVID-19 with diabetes: a systematic review and meta-analysis. Sci Rep. 2022 Nov 23;12(1):20191. doi:10.1038/s41598-022-24185-7. https://pubmed.ncbi.nlm.nih.gov/36418912/
Abstract
Emerging evidence suggests that coronavirus disease-2019 (COVID-19) may lead to a wide range of post-acute sequelae outcomes, including new onset of diabetes...meta-analysis...estimate the incidence of newly diagnosed diabetes in survivors of COVID-19...Search dates were December 2019-October 16, 2022. ...We identified 8 eligible studies consisting of 4,270,747 COVID-19 patients and 43,203,759 controls. Median age was 43 years ..., and 50% were female. COVID-19 was associated with a 66% higher risk of incident diabetes (risk ratio, 1.66...). The risk was not modified by age, sex, or study quality. ... In this systematic review and meta-analysis, COVID-19 was associated with higher risk for developing new onset diabetes among survivors. Active monitoring of glucose dysregulation after recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is warranted.
110margd
T. Ryan Gregory @TRyanGregory | 4:44 PM · Nov 24, 2022
:
Professor of evolutionary biology. {U Guelph, Ontario}
How could COVID be involved in the pediatric health crisis resulting from a surge in RSV and flu in various places (Canada, USA, Europe)? There are at least three ways. 🧵
First, let me get the "immunity debt" idea out of the way, so I can focus on the alternative (or, more likely, additional) explanations. I have already done some threads on this subject.
https://twitter.com/TRyanGregory/status/1592688153949016064
https://twitter.com/TRyanGregory/status/1589786839246069762
https://twitter.com/TRyanGregory/status/1591764627394035723
First, I don't think the newly-coined (2021) term "immunity debt" is useful or well chosen. It is being used to refer to two very different ideas and is prone to confusion or equivocation. It doesn't help that one of those ideas is trivially true and the other is nonsense.
The version that is trivially true occurs at the population level. If a lot of people avoid infection in one season, then there will be less immunity in the population and larger numbers of susceptible hosts in the following season. Obviously.
This population-level version of "immunity debt" is very unlikely to actually account for what we're seeing right now, but at least it isn't nonsensical. "Debt" would not be the right term for this in any case.
The other version of immunity debt refers to the individual level rather than the population as a whole. It assumes that the immune system is like a muscle, and not using it against pathogens weakens it, making individuals more prone to severe infections.
The immune-system-as-muscle idea is a corruption of the (still debated) "hygiene hypothesis", which does NOT say that kids need to be exposed to *pathogens*. Let your kids play in the dirt, yes. Don't let them run around in a biohazard lab.
If we are stuck with the term "immunity debt", then the alternative idea to explain what is happening is "immunity theft" (same idea as "immunity robbery" coined by @FurnessColin ).
The concept of "immunity theft" is simply that COVID infection (let alone repeated infections) may rob people of a working immune system, which puts them at risk for other infections.*
https://thetyee.ca/Analysis/2022/11/07/COVID-Reinfections-And-Immunity/
This is not merely an academic debate. Proponents of immunity debt tend to be the same people who advocated against efforts to mitigate COVID in schools. They are now blaming remote learning and masks for surges in other viruses like RSV and flu in kids. They still oppose masks.
On the other hand, *IF* immunity theft is the cause, then letting COVID rip in schools was a disastrous idea, and we urgently need to prevent further immune-depleting infection with COVID and with other viruses that will now be having more severe effects than they usually would.
* {Another virus, measles, affects immunity against other pathogens: "Measles not only weakens your immune system in the short term, bouts with the virus seem to wipe your immune system's memory, causing the body to forget how to fight off things that you may have already conquered. For some people, this so-called immune amnesia may linger for months to years after an infection."
https://www.nationalgeographic.com/science/article/measles-vaccine-protect-disea...
:
Professor of evolutionary biology. {U Guelph, Ontario}
How could COVID be involved in the pediatric health crisis resulting from a surge in RSV and flu in various places (Canada, USA, Europe)? There are at least three ways. 🧵
First, let me get the "immunity debt" idea out of the way, so I can focus on the alternative (or, more likely, additional) explanations. I have already done some threads on this subject.
https://twitter.com/TRyanGregory/status/1592688153949016064
https://twitter.com/TRyanGregory/status/1589786839246069762
https://twitter.com/TRyanGregory/status/1591764627394035723
First, I don't think the newly-coined (2021) term "immunity debt" is useful or well chosen. It is being used to refer to two very different ideas and is prone to confusion or equivocation. It doesn't help that one of those ideas is trivially true and the other is nonsense.
The version that is trivially true occurs at the population level. If a lot of people avoid infection in one season, then there will be less immunity in the population and larger numbers of susceptible hosts in the following season. Obviously.
This population-level version of "immunity debt" is very unlikely to actually account for what we're seeing right now, but at least it isn't nonsensical. "Debt" would not be the right term for this in any case.
The other version of immunity debt refers to the individual level rather than the population as a whole. It assumes that the immune system is like a muscle, and not using it against pathogens weakens it, making individuals more prone to severe infections.
The immune-system-as-muscle idea is a corruption of the (still debated) "hygiene hypothesis", which does NOT say that kids need to be exposed to *pathogens*. Let your kids play in the dirt, yes. Don't let them run around in a biohazard lab.
If we are stuck with the term "immunity debt", then the alternative idea to explain what is happening is "immunity theft" (same idea as "immunity robbery" coined by @FurnessColin ).
The concept of "immunity theft" is simply that COVID infection (let alone repeated infections) may rob people of a working immune system, which puts them at risk for other infections.*
https://thetyee.ca/Analysis/2022/11/07/COVID-Reinfections-And-Immunity/
This is not merely an academic debate. Proponents of immunity debt tend to be the same people who advocated against efforts to mitigate COVID in schools. They are now blaming remote learning and masks for surges in other viruses like RSV and flu in kids. They still oppose masks.
On the other hand, *IF* immunity theft is the cause, then letting COVID rip in schools was a disastrous idea, and we urgently need to prevent further immune-depleting infection with COVID and with other viruses that will now be having more severe effects than they usually would.
* {Another virus, measles, affects immunity against other pathogens: "Measles not only weakens your immune system in the short term, bouts with the virus seem to wipe your immune system's memory, causing the body to forget how to fight off things that you may have already conquered. For some people, this so-called immune amnesia may linger for months to years after an infection."
https://www.nationalgeographic.com/science/article/measles-vaccine-protect-disea...
111margd
Fingers crossed that COVID, flu, RSV interfere w each other's spread:
Eric Topol {Scripps MD-scientist} @EricTopol | 2:58 PM · Nov 24, 2022:
The growing body of evidence that the 3 respiratory viruses (Covid, flu, RSV) interfere with each other’s spread, limiting a tripledemic's threat
Text, highlighted ( https://twitter.com/EricTopol/status/1595869562532044800/photo/1 )
Competition between respiratory viruses may hold off a ‘tripledemic’ this winter
Researchers say there is a growing body of evidence these viruses interfere with each other’s spread
Jon Cohen | 18 Nov 2022
https://science.org/content/article/competition-between-respiratory-viruses-may-...
_______________________________________
ETA. Note of caution:
T. Ryan Gregory (evol bio U Guelph)@TRyanGregory | 6:00 PM · Nov 24, 2022
Can't wait for this effect to kick in. Any minute now.
Eric Topol {Scripps MD-scientist} @EricTopol | 2:58 PM · Nov 24, 2022:
The growing body of evidence that the 3 respiratory viruses (Covid, flu, RSV) interfere with each other’s spread, limiting a tripledemic's threat
Text, highlighted ( https://twitter.com/EricTopol/status/1595869562532044800/photo/1 )
Competition between respiratory viruses may hold off a ‘tripledemic’ this winter
Researchers say there is a growing body of evidence these viruses interfere with each other’s spread
Jon Cohen | 18 Nov 2022
https://science.org/content/article/competition-between-respiratory-viruses-may-...
_______________________________________
ETA. Note of caution:
T. Ryan Gregory (evol bio U Guelph)@TRyanGregory | 6:00 PM · Nov 24, 2022
Can't wait for this effect to kick in. Any minute now.
112margd
"COVID could very plausibly be making this season much worse"--three ways:
T. Ryan Gregory (evol bio U Guelph)@TRyanGregory | 4:44 PM · Nov 24, 2022
1. Co-infection.
COVID, RSV, and flu are all circulating right now. Being infected with more than one of them at the same time makes things worse.
Here are some papers about co-infection with COVID making RSV and flu infections more severe:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00383-X/fullt...
https://pubmed.ncbi.nlm.nih.gov/36112521/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8561020/
2. COVID infection during pregnancy affects fetal lung development.
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00060-1/fullt...
This doesn't cause respiratory distress by itself at birth, but it could become relevant when infected with respiratory viruses.
Text ( https://twitter.com/TRyanGregory/status/1595896223655157761/photo/1 )
3. Immunity theft, in which COVID infection damages the ability of the immune system to fight off other infections.
How could this happen?
One mechanism is by COVID infection affecting dendritic cells.
https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1009742
https://frontiersin.org/articles/10.3389/fimmu.2022.843342/full
Those cells are important in fighting RSV infections.
Some patients with long COVID show dysfunction in the immune system for at least 8 months post-infection even if the acute case was mild.
https://www.nature.com/articles/s41590-021-01113-x
There are other ways that COVID infection can affect immune function, including exhaustion of T cells. This article summarizes these and other ideas that have been discussed by @fitterhappier
very well: https://thetyee.ca/Analysis/2022/11/07/COVID-Reinfections-And-Immunity/
So, to summarize, there are three major ways that COVID could very plausibly be making this season much worse:
1. Co-infection with COVID and RSV or flu.
2. Infection during pregnancy affecting fetal lung development.
3. Immunity theft (several mechanisms).
A reduction in population level immunity and thus more susceptible hosts is obviously a factor (though, again, there was lots of RSV last year in many places). But it matters a great deal whether there are other factors.
A very large fraction of people, including children, were infected with Omicron variants over the past year. So, this would be the first season of RSV and flu in which this would be a major factor in most places. The season is starting early and many hospitals are overwhelmed.
It's worth noting that Sweden, which never had lockdowns, had a bad RSV surge last year.
From Nov 2021:
https://www.thelocal.se/20211105/rsv-warning-in-sweden-keep-your-children-at-hom...
If COVID has made the severity of RSV and flu infections worse, then we need to mitigate the spread of these viruses now to protect children who are more vulnerable. We do not need to let them get infected to pay an immunity debt.
It is also important to consider what this would mean as more and more people get infected (or reinfected) with COVID. What about future seasons? Other viruses? Bacterial and fungal infections?
What we need is data, not assumptions.
One quick clarification. The claim is not that *all* RSV and flu infections are more severe. It's that more of the infections that occur will be severe because in *some* kids COVID has these effects. I don't want people misconstruing the claims made.
Another possible factor besides "immunity debt" or COVID is that the RSV or flu viruses in circulation this year are different and more virulent and/or transmissible. Here's a recent study on RSV variants that result in longer infection, for example.
https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiac442/6827492
T. Ryan Gregory (evol bio U Guelph)@TRyanGregory | 4:44 PM · Nov 24, 2022
1. Co-infection.
COVID, RSV, and flu are all circulating right now. Being infected with more than one of them at the same time makes things worse.
Here are some papers about co-infection with COVID making RSV and flu infections more severe:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00383-X/fullt...
https://pubmed.ncbi.nlm.nih.gov/36112521/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8561020/
2. COVID infection during pregnancy affects fetal lung development.
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00060-1/fullt...
This doesn't cause respiratory distress by itself at birth, but it could become relevant when infected with respiratory viruses.
Text ( https://twitter.com/TRyanGregory/status/1595896223655157761/photo/1 )
3. Immunity theft, in which COVID infection damages the ability of the immune system to fight off other infections.
How could this happen?
One mechanism is by COVID infection affecting dendritic cells.
https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1009742
https://frontiersin.org/articles/10.3389/fimmu.2022.843342/full
Those cells are important in fighting RSV infections.
Some patients with long COVID show dysfunction in the immune system for at least 8 months post-infection even if the acute case was mild.
https://www.nature.com/articles/s41590-021-01113-x
There are other ways that COVID infection can affect immune function, including exhaustion of T cells. This article summarizes these and other ideas that have been discussed by @fitterhappier
very well: https://thetyee.ca/Analysis/2022/11/07/COVID-Reinfections-And-Immunity/
So, to summarize, there are three major ways that COVID could very plausibly be making this season much worse:
1. Co-infection with COVID and RSV or flu.
2. Infection during pregnancy affecting fetal lung development.
3. Immunity theft (several mechanisms).
A reduction in population level immunity and thus more susceptible hosts is obviously a factor (though, again, there was lots of RSV last year in many places). But it matters a great deal whether there are other factors.
A very large fraction of people, including children, were infected with Omicron variants over the past year. So, this would be the first season of RSV and flu in which this would be a major factor in most places. The season is starting early and many hospitals are overwhelmed.
It's worth noting that Sweden, which never had lockdowns, had a bad RSV surge last year.
From Nov 2021:
https://www.thelocal.se/20211105/rsv-warning-in-sweden-keep-your-children-at-hom...
If COVID has made the severity of RSV and flu infections worse, then we need to mitigate the spread of these viruses now to protect children who are more vulnerable. We do not need to let them get infected to pay an immunity debt.
It is also important to consider what this would mean as more and more people get infected (or reinfected) with COVID. What about future seasons? Other viruses? Bacterial and fungal infections?
What we need is data, not assumptions.
One quick clarification. The claim is not that *all* RSV and flu infections are more severe. It's that more of the infections that occur will be severe because in *some* kids COVID has these effects. I don't want people misconstruing the claims made.
Another possible factor besides "immunity debt" or COVID is that the RSV or flu viruses in circulation this year are different and more virulent and/or transmissible. Here's a recent study on RSV variants that result in longer infection, for example.
https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiac442/6827492
113margd
"The group analysis showed that COVID recovered subjects had significantly higher susceptibility imaging values in regions of the frontal lobe and the brain stem."
Frontal lobe: voluntary movement, expressive language and for managing higher level executive functions.
Brain stem: breathing, heart rate, blood pressure, and several other important functions.
Diego Bassani, PhD @dgbassani@mstdn.science
@DGBassani | 4:53 PM · Nov 24, 2022:
🇨🇦 Senior Scientist/Epidemiologist @SickKidsNews @SickKidsGlobal. Assoc. Prof @UofTMedicine @UofT_DLSPH
. 🇧🇷 Alumnus @ufrgsnoticias @UFPel
As if we needed more evidence of COVID lingering effects in the brain.
Brain MRIs ( https://twitter.com/DGBassani/status/1595898339085664258/photo/1 )
Sapna S Mishra et al. 2022. Susceptibility-Weighted Magnetic Resonance Imaging Highlights Brain Alterations in COVID Recovered Patients. MedRxiv 22 Nov 2022.
doi: https://doi.org/10.1101/2022.11.21.22282600 https://medrxiv.org/content/10.1101/2022.11.21.22282600v1
This article is a preprint and has not been certified by peer review
Abstract
The increasing number of reports of mild to severe psychological, behavioral, and cognitive sequelae in COVID-19 survivors motivates a need for a thorough assessment of the neurological effects of the disease. In this regard, we have conducted a neuroimaging study to understand the neurotropic behavior of the coronavirus. We hypothesize that the COVID-recovered subjects have developed alterations in the brain which can be measured through susceptibility differences in various regions of the brain when compared to healthy controls (HCs). Hence, we performed our investigations on susceptibility-weighted imaging (SWI) volumes. Fatigue, being of the most common symptoms of Long COVID, has also been studied in this work. SWI volumes of 46 COVID and 30 HCs were included in this study. The COVID patients were imaged within six months of their recovery. We performed an unpaired two-sample t-test over the pre-processed SWI volumes of both groups and multiple linear regression was performed to observe group differences and correlation of fatigue with SWI values. The group analysis showed that COVID recovered subjects had significantly higher susceptibility imaging values in regions of the frontal lobe and the brain stem. The clusters obtained in the frontal lobe primarily show differences in the white matter regions. The COVID group also demonstrated significantly higher fatigue levels than the HC group. The regression analysis on the COVID group yielded clusters in the anterior cingulate gyrus and midbrain, which exhibited negative correlations with fatigue scores. This study suggests an association of Long COVID with prolonged effects on the brain and also indicates the viability of the SWI modality for analysis of post-COVID symptoms.
Frontal lobe: voluntary movement, expressive language and for managing higher level executive functions.
Brain stem: breathing, heart rate, blood pressure, and several other important functions.
Diego Bassani, PhD @dgbassani@mstdn.science
@DGBassani | 4:53 PM · Nov 24, 2022:
🇨🇦 Senior Scientist/Epidemiologist @SickKidsNews @SickKidsGlobal. Assoc. Prof @UofTMedicine @UofT_DLSPH
. 🇧🇷 Alumnus @ufrgsnoticias @UFPel
As if we needed more evidence of COVID lingering effects in the brain.
Brain MRIs ( https://twitter.com/DGBassani/status/1595898339085664258/photo/1 )
Sapna S Mishra et al. 2022. Susceptibility-Weighted Magnetic Resonance Imaging Highlights Brain Alterations in COVID Recovered Patients. MedRxiv 22 Nov 2022.
doi: https://doi.org/10.1101/2022.11.21.22282600 https://medrxiv.org/content/10.1101/2022.11.21.22282600v1
This article is a preprint and has not been certified by peer review
Abstract
The increasing number of reports of mild to severe psychological, behavioral, and cognitive sequelae in COVID-19 survivors motivates a need for a thorough assessment of the neurological effects of the disease. In this regard, we have conducted a neuroimaging study to understand the neurotropic behavior of the coronavirus. We hypothesize that the COVID-recovered subjects have developed alterations in the brain which can be measured through susceptibility differences in various regions of the brain when compared to healthy controls (HCs). Hence, we performed our investigations on susceptibility-weighted imaging (SWI) volumes. Fatigue, being of the most common symptoms of Long COVID, has also been studied in this work. SWI volumes of 46 COVID and 30 HCs were included in this study. The COVID patients were imaged within six months of their recovery. We performed an unpaired two-sample t-test over the pre-processed SWI volumes of both groups and multiple linear regression was performed to observe group differences and correlation of fatigue with SWI values. The group analysis showed that COVID recovered subjects had significantly higher susceptibility imaging values in regions of the frontal lobe and the brain stem. The clusters obtained in the frontal lobe primarily show differences in the white matter regions. The COVID group also demonstrated significantly higher fatigue levels than the HC group. The regression analysis on the COVID group yielded clusters in the anterior cingulate gyrus and midbrain, which exhibited negative correlations with fatigue scores. This study suggests an association of Long COVID with prolonged effects on the brain and also indicates the viability of the SWI modality for analysis of post-COVID symptoms.
114margd
AARP article reviews Xie et al (Feb) 2022 findings:
Can Even a Mild Case of COVID Cause Heart Damage?
Even a less serious infection may increase your risk of stroke, blood clots, heart attack and heart failure, according to new research.
Peter Urban | February 18, 2022
...Those who tested positive for the coronavirus were found to be:
72% more likely to suffer from coronary artery disease
63% more likely to have a heart attack
52% more likely to experience a stroke...
https://www.aarp.org/health/conditions-treatments/info-2022/covid-heart.html
Reference:
Yan Xie et al. 2022. Long-term cardiovascular outcomes of COVID-19. Nature Medicine volume 28, pages 583–590 (7 Feb. 2022) https://www.nature.com/articles/s41591-022-01689-3
Can Even a Mild Case of COVID Cause Heart Damage?
Even a less serious infection may increase your risk of stroke, blood clots, heart attack and heart failure, according to new research.
Peter Urban | February 18, 2022
...Those who tested positive for the coronavirus were found to be:
72% more likely to suffer from coronary artery disease
63% more likely to have a heart attack
52% more likely to experience a stroke...
https://www.aarp.org/health/conditions-treatments/info-2022/covid-heart.html
Reference:
Yan Xie et al. 2022. Long-term cardiovascular outcomes of COVID-19. Nature Medicine volume 28, pages 583–590 (7 Feb. 2022) https://www.nature.com/articles/s41591-022-01689-3
115margd
One-page infographic how to build Corsi Rosenthal Box
https://twitter.com/.../status/1598099273434165249/photo/1
Corsi Rosenthal Box filters viral particles from the air. Effective. Cheap. DIY. (More info at https://cleanaircrew.org .)
https://twitter.com/.../status/1598099273434165249/photo/1
Corsi Rosenthal Box filters viral particles from the air. Effective. Cheap. DIY. (More info at https://cleanaircrew.org .)
116margd
Impact of COVID-19 on sperm quality
Tarun Sai Lomte | Dec 1 2022
...Males aged 20 to 50 years visiting the in vitro fertilization (IVF) unit at the Adana City Training and Research Hospital were included. Males who tested SARS-CoV-2-positive in the past three months and those with less than 1.5 ml of semen were excluded.
Participants with a confirmed history of SARS-CoV-2 infection in the past four months to one year were included in the COVID-19-positive group, and those without COVID-19 served as controls...
...the researchers observed significantly elevated sperm concentrations in males without COVID-19 infection relative to those who had been COVID-19-positive. No significant differences were observed in sperm motility or morphology between the two cohorts. However, azoospermia was detected in four SARS-CoV-2-positive males...
https://www.news-medical.net/news/20221201/Impact-of-COVID-19-on-sperm-quality.a...
Aksak T, Satar DA, Bağci R, Gülteki̇n EO, Coşkun A, Demi̇rdelen U. (2022). Investigation of the effect of COVID‐19 on sperm count, motility, and morphology. Journal of Medical Virology. doi:10.1002/jmv.27971 https://onlinelibrary.wiley.com/doi/10.1002/jmv.27971
Tarun Sai Lomte | Dec 1 2022
...Males aged 20 to 50 years visiting the in vitro fertilization (IVF) unit at the Adana City Training and Research Hospital were included. Males who tested SARS-CoV-2-positive in the past three months and those with less than 1.5 ml of semen were excluded.
Participants with a confirmed history of SARS-CoV-2 infection in the past four months to one year were included in the COVID-19-positive group, and those without COVID-19 served as controls...
...the researchers observed significantly elevated sperm concentrations in males without COVID-19 infection relative to those who had been COVID-19-positive. No significant differences were observed in sperm motility or morphology between the two cohorts. However, azoospermia was detected in four SARS-CoV-2-positive males...
https://www.news-medical.net/news/20221201/Impact-of-COVID-19-on-sperm-quality.a...
Aksak T, Satar DA, Bağci R, Gülteki̇n EO, Coşkun A, Demi̇rdelen U. (2022). Investigation of the effect of COVID‐19 on sperm count, motility, and morphology. Journal of Medical Virology. doi:10.1002/jmv.27971 https://onlinelibrary.wiley.com/doi/10.1002/jmv.27971
117margd
Uh oh (China):
Raj Rajnarayanan @RajlabN | 3:04 AM · Dec 4, 2022
Assistant Dean of Research and Associate Professor, NYITCOM at Arkansas State University
31,824 new #COVID19 cases (4,213 symptomatic and 27,611 asymptomatic) reported in #China (12/4/22)
2 new deaths (1 in Shandong and 1 in Sichuan)
Source (NHC, China): http://nhc.gov.cn/xcs/yqtb/202212/28e1dd700f754528bf521edc54e3ff47.shtml
Chart: @OurWorldInData
https://twitter.com/RajlabN/status/1599313727660007424/photo/1
Raj Rajnarayanan @RajlabN | 3:04 AM · Dec 4, 2022
Assistant Dean of Research and Associate Professor, NYITCOM at Arkansas State University
31,824 new #COVID19 cases (4,213 symptomatic and 27,611 asymptomatic) reported in #China (12/4/22)
2 new deaths (1 in Shandong and 1 in Sichuan)
Source (NHC, China): http://nhc.gov.cn/xcs/yqtb/202212/28e1dd700f754528bf521edc54e3ff47.shtml
Chart: @OurWorldInData
https://twitter.com/RajlabN/status/1599313727660007424/photo/1
118margd
What Long COVID is like (from a patient's perspective):
Morgan Stephens @morganstephensa | 7:19 PM · Dec 4, 2022:
journalist, production cnn, words @thedailybeast cnn cnnopinion @huffpost, USC forever, contributing author to The Long Covid Survival Guide
Just a reminder that @CDCgov stated 1 in 5 Americans who have had Covid-19 now have #LongCovid. Now that we’re heading into winter, a PSA.
It’s pure hell. It will change your life as you know it. 🧵
What many don’t understand is there’s a spectrum of disability and severity in long haulers. As my friend @D_Bone says, he unfortunately got the “Long Covid Platinum Package.” Some, if they’re very lucky, get out in a three to six months. Others are sick for years.
There is no treatment for Long Covid. Again, there is not a single treatment for Long Covid. If you develop it, you’re on your own.
Most long haulers lose the ability to work and/or function at some point, and need to rely on others. Best case, you improve and are able to return to work, but live with fatigue and it’s a rollercoaster—LC is notorious for being fickle and unpredictable in its good/bad days.
I’d be remiss to say that some do, indeed, return quickly and steadily to those pre-Covid baselines. We call those unicorns. Let’s hope and pray you’re a unicorn.
There’s also different recovery timelines. Will you be betterish (don’t expect to be better-better, tamper those expectations) in three months or two years? Will you improve then get pulled back and be back at square one? This is a gamble you must be willing to take.
And if you improve, don’t expect to be the same person you were before. This virus takes and takes and takes. It leaves you clinging onto any semblance of yourself from before. So, gather every bit of strength. You’ll need it.
Last, get those finances in order. This is an expensive disease. Want every invasive scan and bloodtest under the sun to rule out cancer, tumors, MS, autoimmune diseases, encephalitis, etc? Oh, 99% come up negative so you’ll keep searching and spending. The cycle continues.
Do you want endless doctor’s appts? Do you want to hemorrhage money? Do you want to list off your symptoms over and over as your inflamed brain glitches and the world spins, only to have the specialist you waited months for blink at you before he recommends Peloton?
That’s what you’re in for, should you unfortunately join this club. Just thought the world should know what post-Covid life is really like—what long haulers live with every day.
That’ll be all.
Morgan Stephens @morganstephensa | 7:19 PM · Dec 4, 2022:
journalist, production cnn, words @thedailybeast cnn cnnopinion @huffpost, USC forever, contributing author to The Long Covid Survival Guide
Just a reminder that @CDCgov stated 1 in 5 Americans who have had Covid-19 now have #LongCovid. Now that we’re heading into winter, a PSA.
It’s pure hell. It will change your life as you know it. 🧵
What many don’t understand is there’s a spectrum of disability and severity in long haulers. As my friend @D_Bone says, he unfortunately got the “Long Covid Platinum Package.” Some, if they’re very lucky, get out in a three to six months. Others are sick for years.
There is no treatment for Long Covid. Again, there is not a single treatment for Long Covid. If you develop it, you’re on your own.
Most long haulers lose the ability to work and/or function at some point, and need to rely on others. Best case, you improve and are able to return to work, but live with fatigue and it’s a rollercoaster—LC is notorious for being fickle and unpredictable in its good/bad days.
I’d be remiss to say that some do, indeed, return quickly and steadily to those pre-Covid baselines. We call those unicorns. Let’s hope and pray you’re a unicorn.
There’s also different recovery timelines. Will you be betterish (don’t expect to be better-better, tamper those expectations) in three months or two years? Will you improve then get pulled back and be back at square one? This is a gamble you must be willing to take.
And if you improve, don’t expect to be the same person you were before. This virus takes and takes and takes. It leaves you clinging onto any semblance of yourself from before. So, gather every bit of strength. You’ll need it.
Last, get those finances in order. This is an expensive disease. Want every invasive scan and bloodtest under the sun to rule out cancer, tumors, MS, autoimmune diseases, encephalitis, etc? Oh, 99% come up negative so you’ll keep searching and spending. The cycle continues.
Do you want endless doctor’s appts? Do you want to hemorrhage money? Do you want to list off your symptoms over and over as your inflamed brain glitches and the world spins, only to have the specialist you waited months for blink at you before he recommends Peloton?
That’s what you’re in for, should you unfortunately join this club. Just thought the world should know what post-Covid life is really like—what long haulers live with every day.
That’ll be all.
119margd
Eric Feigl-Ding @DrEricDing | 2:18 AM · Dec 7, 2022:
Epidemiologist, health economist. Co-founder @TheWHN. Fmr 16 yrs Harvard. Early warnings—https://nym.ag/3olszuo ✍️SUBSCRIBE: http://drericding.substack.com/subscribe
Excerpted text of Chinese rule changes, in English, at https://twitter.com/DrEricDing/status/1600389242269491200
🔔HUGE COVID RULES CHANGES—China lays out a new 10-point #COVID policy change. But it is **not** a Western ‘let it rip’. Key highlights:
📌asymptomatic/mild cases can now quarantine at home (but still needs 2x consecutive PCR negative tests on days 6&7)
🧵
http://nhc.gov.cn/xcs/gzzcwj/202212/8278e7a7aee34e5bb378f0e0fc94e0f0.shtml
2) 📌Rapid antigen tests allowed.
📌Mass PCR testing of population suspended except for in hospitals, nursing homes, and schools.
📌Blanket lockdowns of entire communities/streets no longer used—but stratify high risk area by households or building/floors.
3) 📌You no longer need to test negative with PCR and show negative test certificates to travel between regions (between cities and provinces)
📌Negative tests no long needed for “landings” - presumably airport arrivals? Unclear if just for domestic or international as well.
4) 📌Close contacts still need to quarantine at home for 5 days.
📌Close contacts still need 1x PCR negative tests on day 5. (When was the last time you see that in the West?)
📌High risk areas still need “quick sealing”. But once there’s no new cases in 5 days, it’s unsealed.
5) I like this next one:
📌Find all high risk people with cardiovascular disease, COPD, diabetes, kidney disease, cancers, and immunocompromised in area — and target risk management and for vaccinations.
📌Non high risk areas shall not restrict movement of people or workers
6) This one is great—
📌Blocking fire passages, doors, and community entrances is strictly forbidden to ensure emergency avoidance possible and medical care can be received
➡️this is clearly in response to the XinJiang incident that sparked the protests
https://washingtonpost.com/world/2022/11/
7) 📌Provide special medical facilities just for elderly, minors, pregnant women, persons with disabilities, and people with chronic disease living alone. (Wow!)
📌Schools must implement scientifically precise prevention and control motivations.
📌Schools open if no epidemic.
8) 📌But schools with epidemics must accurately delineate / mark high risk areas (per the scientifically precise measures alluded to above).
Overall the government is fixing its old “one size fits all” approach. But it seems lots of rigorous testing and mitigation still remain!
9) To be clear—this is not the end of China COVID mitigations that many in Western media are touting this to be. Still lots of testing. Still isolation of positives and quarantine of close contacts. Still negative tests to exit isolation, negative to exit for close contact…
10) Moreover, China has not ended local restrictions — they are just now more targeted by buildings and by floors and by families, not by entire neighborhoods or streets. This is much better and still good. And they will still use lots of rapid tests. PCR still for high risk.
11) What I didn’t see:
Explicit reference to masks and ventilation and air disinfection. We need to raise the alarm to #BringBackMasks in high risk areas and awareness that #COVIDisAirborne.
Also 🇨🇳 didn’t mention what kind of vaccinations they are using—mucosal vaccine now.
12) this WSJ
is biased bullshit. China did not scrap “most testing” rules nor scrap most quarantine rules. China just refined them and shortened some. The only thing it “scrapped” entirely was intercity/ inter regional negative testing.
Epidemiologist, health economist. Co-founder @TheWHN. Fmr 16 yrs Harvard. Early warnings—https://nym.ag/3olszuo ✍️SUBSCRIBE: http://drericding.substack.com/subscribe
Excerpted text of Chinese rule changes, in English, at https://twitter.com/DrEricDing/status/1600389242269491200
🔔HUGE COVID RULES CHANGES—China lays out a new 10-point #COVID policy change. But it is **not** a Western ‘let it rip’. Key highlights:
📌asymptomatic/mild cases can now quarantine at home (but still needs 2x consecutive PCR negative tests on days 6&7)
🧵
http://nhc.gov.cn/xcs/gzzcwj/202212/8278e7a7aee34e5bb378f0e0fc94e0f0.shtml
2) 📌Rapid antigen tests allowed.
📌Mass PCR testing of population suspended except for in hospitals, nursing homes, and schools.
📌Blanket lockdowns of entire communities/streets no longer used—but stratify high risk area by households or building/floors.
3) 📌You no longer need to test negative with PCR and show negative test certificates to travel between regions (between cities and provinces)
📌Negative tests no long needed for “landings” - presumably airport arrivals? Unclear if just for domestic or international as well.
4) 📌Close contacts still need to quarantine at home for 5 days.
📌Close contacts still need 1x PCR negative tests on day 5. (When was the last time you see that in the West?)
📌High risk areas still need “quick sealing”. But once there’s no new cases in 5 days, it’s unsealed.
5) I like this next one:
📌Find all high risk people with cardiovascular disease, COPD, diabetes, kidney disease, cancers, and immunocompromised in area — and target risk management and for vaccinations.
📌Non high risk areas shall not restrict movement of people or workers
6) This one is great—
📌Blocking fire passages, doors, and community entrances is strictly forbidden to ensure emergency avoidance possible and medical care can be received
➡️this is clearly in response to the XinJiang incident that sparked the protests
https://washingtonpost.com/world/2022/11/
7) 📌Provide special medical facilities just for elderly, minors, pregnant women, persons with disabilities, and people with chronic disease living alone. (Wow!)
📌Schools must implement scientifically precise prevention and control motivations.
📌Schools open if no epidemic.
8) 📌But schools with epidemics must accurately delineate / mark high risk areas (per the scientifically precise measures alluded to above).
Overall the government is fixing its old “one size fits all” approach. But it seems lots of rigorous testing and mitigation still remain!
9) To be clear—this is not the end of China COVID mitigations that many in Western media are touting this to be. Still lots of testing. Still isolation of positives and quarantine of close contacts. Still negative tests to exit isolation, negative to exit for close contact…
10) Moreover, China has not ended local restrictions — they are just now more targeted by buildings and by floors and by families, not by entire neighborhoods or streets. This is much better and still good. And they will still use lots of rapid tests. PCR still for high risk.
11) What I didn’t see:
Explicit reference to masks and ventilation and air disinfection. We need to raise the alarm to #BringBackMasks in high risk areas and awareness that #COVIDisAirborne.
Also 🇨🇳 didn’t mention what kind of vaccinations they are using—mucosal vaccine now.
12) this WSJ
is biased bullshit. China did not scrap “most testing” rules nor scrap most quarantine rules. China just refined them and shortened some. The only thing it “scrapped” entirely was intercity/ inter regional negative testing.
120margd
A Plea From Experts to Pregnant Women: Get Vaccinated Against COVID
Apoorva Mandavilli | December 8, 2022
...COVID can kill pregnant women and can result in miscarriage, preterm births and stillbirths even when the women have asymptomatic or mild illness. The infection may also affect the baby’s brain development.
...Dozens of studies have shown that the COVID vaccine is safe for pregnant women. Immunization of the mother also passes along protective antibodies to her fetus...
...among pregnant women infected with COVID, about 1 in 3 ended up in the hospital, compared with about 6% of women who were not pregnant.
Infected pregnant women were 50% more likely to be admitted to intensive care units and 70% more likely to need a ventilator.
...pregnant women are vulnerable ... The growing uterus compresses the lungs, hindering the ability to take in air, for example. Pregnancy can also cause conditions like diabetes and high blood pressure, which themselves put a person at risk for severe COVID.
Studies have shown that the placenta of pregnant women who are infected with the coronavirus resembles that of women with preeclampsia, a form of dangerously high blood pressure in pregnancy.
The placenta is a sponge of blood vessels that enables the exchange of oxygen and nutrients between the mother and fetus. It takes on the role of lungs, liver and kidneys for the fetus, but COVID can ravage it...
...pregnant women are vulnerable ... The growing uterus compresses the lungs, hindering the ability to take in air, for example. Pregnancy can also cause conditions like diabetes and high blood pressure, which themselves put a person at risk for severe COVID.
Studies have shown that the placenta of pregnant women who are infected with the coronavirus resembles that of women with preeclampsia, a form of dangerously high blood pressure in pregnancy.
The placenta is a sponge of blood vessels that enables the exchange of oxygen and nutrients between the mother and fetus. It takes on the role of lungs, liver and kidneys for the fetus, but COVID can ravage it...
https://www.yahoo.com/news/plea-experts-pregnant-women-vaccinated-191744893.html
Apoorva Mandavilli | December 8, 2022
...COVID can kill pregnant women and can result in miscarriage, preterm births and stillbirths even when the women have asymptomatic or mild illness. The infection may also affect the baby’s brain development.
...Dozens of studies have shown that the COVID vaccine is safe for pregnant women. Immunization of the mother also passes along protective antibodies to her fetus...
...among pregnant women infected with COVID, about 1 in 3 ended up in the hospital, compared with about 6% of women who were not pregnant.
Infected pregnant women were 50% more likely to be admitted to intensive care units and 70% more likely to need a ventilator.
...pregnant women are vulnerable ... The growing uterus compresses the lungs, hindering the ability to take in air, for example. Pregnancy can also cause conditions like diabetes and high blood pressure, which themselves put a person at risk for severe COVID.
Studies have shown that the placenta of pregnant women who are infected with the coronavirus resembles that of women with preeclampsia, a form of dangerously high blood pressure in pregnancy.
The placenta is a sponge of blood vessels that enables the exchange of oxygen and nutrients between the mother and fetus. It takes on the role of lungs, liver and kidneys for the fetus, but COVID can ravage it...
...pregnant women are vulnerable ... The growing uterus compresses the lungs, hindering the ability to take in air, for example. Pregnancy can also cause conditions like diabetes and high blood pressure, which themselves put a person at risk for severe COVID.
Studies have shown that the placenta of pregnant women who are infected with the coronavirus resembles that of women with preeclampsia, a form of dangerously high blood pressure in pregnancy.
The placenta is a sponge of blood vessels that enables the exchange of oxygen and nutrients between the mother and fetus. It takes on the role of lungs, liver and kidneys for the fetus, but COVID can ravage it...
https://www.yahoo.com/news/plea-experts-pregnant-women-vaccinated-191744893.html
121margd
What are the most common COVID symptoms now? It’s no longer fever, loss of taste
Alabama.com | Dec. 13, 2022, 9:28 a.m.
...According to (The ZOE Health Study, a joint effort by researchers at Massachusetts General Hospital, the Harvard T.H. Chan School of Public Health, King’s College London, Stanford University School of Medicine, and the health app ZOE -- https://health-study.joinzoe.com) these are the top 10 reported COVID symptoms in the last 30 days:
Sore throat
Runny nose
Blocked nose
Sneezing
Coughing without phlegm
Headache
Coughing with phlegm
Hoarse voice
Muscle aches and pains
Altered sense of smell
All of these symptoms have been listed as COVID side effects since the start of the pandemic in March 2020. Missing from the latest list, however, were gastrointestinal-related symptoms such as diarrhea, nausea or vomiting as well as some of the earlier hallmarks of the virus – loss of sense of taste, shortness of breath and fever.
https://www.al.com/news/2022/12/what-are-the-most-common-covid-symptoms-now-its-...
Alabama.com | Dec. 13, 2022, 9:28 a.m.
...According to (The ZOE Health Study, a joint effort by researchers at Massachusetts General Hospital, the Harvard T.H. Chan School of Public Health, King’s College London, Stanford University School of Medicine, and the health app ZOE -- https://health-study.joinzoe.com) these are the top 10 reported COVID symptoms in the last 30 days:
Sore throat
Runny nose
Blocked nose
Sneezing
Coughing without phlegm
Headache
Coughing with phlegm
Hoarse voice
Muscle aches and pains
Altered sense of smell
All of these symptoms have been listed as COVID side effects since the start of the pandemic in March 2020. Missing from the latest list, however, were gastrointestinal-related symptoms such as diarrhea, nausea or vomiting as well as some of the earlier hallmarks of the virus – loss of sense of taste, shortness of breath and fever.
https://www.al.com/news/2022/12/what-are-the-most-common-covid-symptoms-now-its-...
122margd
You can order free COVID tests again by mail
NPR Staff | December 15, 2022
Americans can order four more free COVID-19 tests through the mail, starting on Thursday. It's part of the Biden administration's plan to deal with an increase in COVID cases sparked by indoor holiday gatherings.
The tests can be ordered on COVIDtests.gov and will start to ship the week of Dec. 19, a senior administration official told reporters on a conference call. The government is urging people to test themselves when they have symptoms, and before visiting with family...
https://www.npr.org/2022/12/15/1142926180/free-covid-tests-mail-order
NPR Staff | December 15, 2022
Americans can order four more free COVID-19 tests through the mail, starting on Thursday. It's part of the Biden administration's plan to deal with an increase in COVID cases sparked by indoor holiday gatherings.
The tests can be ordered on COVIDtests.gov and will start to ship the week of Dec. 19, a senior administration official told reporters on a conference call. The government is urging people to test themselves when they have symptoms, and before visiting with family...
https://www.npr.org/2022/12/15/1142926180/free-covid-tests-mail-order
123margd
SARS-CoV-2 cellular distribution and persistence in the human body and brain... :(
Sydney R. Stein et al. 2022. SARS-CoV-2 infection and persistence in the human body and brain at autopsy.
Nature (14 Dec 2022) https://www.nature.com/articles/s41586-022-05542-y
Abstract
...We show that SARS-CoV-2 is widely distributed, predominantly among patients who died with severe COVID-19, and that virus replication is present in multiple respiratory and non-respiratory tissues, including the brain, early in infection. Further, we detected persistent SARS-CoV-2 RNA in multiple anatomic sites, including throughout the brain, as late as 230 days following symptom onset in one case. Despite extensive distribution of SARS-CoV-2 RNA throughout the body, we observed little evidence of inflammation or direct viral cytopathology outside the respiratory tract. Our data indicate that in some patients SARS-CoV-2 can cause systemic infection and persist in the body for months.
MAIN
...Between 26 April 2020 and 2 March 2021, we carried out 44 autopsies...
Discussion
...We show that SARS-CoV-2 disseminates early in infection in some patients, with a significantly higher viral burden in respiratory than non-respiratory tissues. We demonstrated ... that viral replication may occur in non-respiratory tissues for several months. ...
... We ...conclusively demonstrate that SARS-CoV-2 is capable of infecting (heart, lymph node, small intestine and adrenal gland) and replicating within these and many other tissues, including brain. Specifically, we report the recovery of replication-competent SARS-CoV-2 from thalamus... prove definitively that SARS-CoV-2 is capable of infecting and replicating within the human brain.
...demonstrates homogeneous virus populations in many tissues, while also revealing informative virus variants in others. ...
Our results show that although the highest burden of SARS-CoV-2 is in respiratory tissues, the virus can disseminate throughout the entire body. ...our data support an early viraemic phase, which seeds the virus throughout the body following infection of the respiratory tract...suggesting that children may develop systemic infection with SARS-CoV-2 without developing a generalized inflammatory response.
Although the respiratory tract was the most common location in which SARS-CoV-2 RNA persisted, 50% or more of late cases also had persistent RNA in the myocardium, lymph nodes from the head and neck and from the thorax, sciatic nerve, ocular tissue, and in all sampled regions of the CNS, except the dura mater. Notably, despite having more than 100 times higher SARS-CoV-2 RNA in respiratory compared to non-respiratory tissues in early cases, this difference greatly diminished in late cases. Less efficient viral clearance in non-respiratory tissues may be related to tissue-specific differences in the ability of SARS-CoV-2 to alter cellular detection of viral mRNA, interfere with interferon signalling, or disrupt viral antigen processing and presentation... Understanding mechanisms by which SARS-CoV-2 evades immune detection is essential to guide future therapeutic approaches to facilitate viral clearance.
We detected subgenomic RNA in tissue from more than 60% of the cohort, including in multiple tissues of a case at D99. Although subgenomic RNA is generated during active viral replication, it is less definitive than cell culture at demonstrating replication-competent virus because subgenomic RNA is protected by double-membrane vesicles that contribute to nuclease resistance and longevity beyond immediate viral replication...data suggest that detection of SARS-CoV-2 subgenomic RNA probably reflects recent viral replication. Prolonged detection of subgenomic RNA in a subset of our cases may, however, represent defective rather than productive viral replication, which has been described in persistent infection with measles virus—another single-strand enveloped RNA virus—in cases of subacute sclerosing panencephalitis*.
...although it is tempting to attribute clinical findings observed in post-acute sequelae of SARS-CoV-2 {Long Covid} to viral persistence, our study was not designed to address this question...our findings fundamentally improve the understanding of SARS-CoV-2 cellular distribution and persistence in the human body and brain and provide a strong rationale for pursuing future similar studies to define mechanisms of SARS-CoV-2 persistence and contribution to post-acute sequelae of SARS-CoV-2.
* Subacute sclerosing panencephalitis (SSPE) is a progressive neurological disorder of children and young adults that affects the central nervous system (CNS). It is a slow, but persistent, viral infection caused by defective measles virus. ( https://www.ninds.nih.gov , Jul 25, 2022)
Sydney R. Stein et al. 2022. SARS-CoV-2 infection and persistence in the human body and brain at autopsy.
Nature (14 Dec 2022) https://www.nature.com/articles/s41586-022-05542-y
Abstract
...We show that SARS-CoV-2 is widely distributed, predominantly among patients who died with severe COVID-19, and that virus replication is present in multiple respiratory and non-respiratory tissues, including the brain, early in infection. Further, we detected persistent SARS-CoV-2 RNA in multiple anatomic sites, including throughout the brain, as late as 230 days following symptom onset in one case. Despite extensive distribution of SARS-CoV-2 RNA throughout the body, we observed little evidence of inflammation or direct viral cytopathology outside the respiratory tract. Our data indicate that in some patients SARS-CoV-2 can cause systemic infection and persist in the body for months.
MAIN
...Between 26 April 2020 and 2 March 2021, we carried out 44 autopsies...
Discussion
...We show that SARS-CoV-2 disseminates early in infection in some patients, with a significantly higher viral burden in respiratory than non-respiratory tissues. We demonstrated ... that viral replication may occur in non-respiratory tissues for several months. ...
... We ...conclusively demonstrate that SARS-CoV-2 is capable of infecting (heart, lymph node, small intestine and adrenal gland) and replicating within these and many other tissues, including brain. Specifically, we report the recovery of replication-competent SARS-CoV-2 from thalamus... prove definitively that SARS-CoV-2 is capable of infecting and replicating within the human brain.
...demonstrates homogeneous virus populations in many tissues, while also revealing informative virus variants in others. ...
Our results show that although the highest burden of SARS-CoV-2 is in respiratory tissues, the virus can disseminate throughout the entire body. ...our data support an early viraemic phase, which seeds the virus throughout the body following infection of the respiratory tract...suggesting that children may develop systemic infection with SARS-CoV-2 without developing a generalized inflammatory response.
Although the respiratory tract was the most common location in which SARS-CoV-2 RNA persisted, 50% or more of late cases also had persistent RNA in the myocardium, lymph nodes from the head and neck and from the thorax, sciatic nerve, ocular tissue, and in all sampled regions of the CNS, except the dura mater. Notably, despite having more than 100 times higher SARS-CoV-2 RNA in respiratory compared to non-respiratory tissues in early cases, this difference greatly diminished in late cases. Less efficient viral clearance in non-respiratory tissues may be related to tissue-specific differences in the ability of SARS-CoV-2 to alter cellular detection of viral mRNA, interfere with interferon signalling, or disrupt viral antigen processing and presentation... Understanding mechanisms by which SARS-CoV-2 evades immune detection is essential to guide future therapeutic approaches to facilitate viral clearance.
We detected subgenomic RNA in tissue from more than 60% of the cohort, including in multiple tissues of a case at D99. Although subgenomic RNA is generated during active viral replication, it is less definitive than cell culture at demonstrating replication-competent virus because subgenomic RNA is protected by double-membrane vesicles that contribute to nuclease resistance and longevity beyond immediate viral replication...data suggest that detection of SARS-CoV-2 subgenomic RNA probably reflects recent viral replication. Prolonged detection of subgenomic RNA in a subset of our cases may, however, represent defective rather than productive viral replication, which has been described in persistent infection with measles virus—another single-strand enveloped RNA virus—in cases of subacute sclerosing panencephalitis*.
...although it is tempting to attribute clinical findings observed in post-acute sequelae of SARS-CoV-2 {Long Covid} to viral persistence, our study was not designed to address this question...our findings fundamentally improve the understanding of SARS-CoV-2 cellular distribution and persistence in the human body and brain and provide a strong rationale for pursuing future similar studies to define mechanisms of SARS-CoV-2 persistence and contribution to post-acute sequelae of SARS-CoV-2.
* Subacute sclerosing panencephalitis (SSPE) is a progressive neurological disorder of children and young adults that affects the central nervous system (CNS). It is a slow, but persistent, viral infection caused by defective measles virus. ( https://www.ninds.nih.gov , Jul 25, 2022)
124margd
Opinion: We don't know what's causing the tsunami of sick kids, but we'd better figure it out fast
Joe Vipond, Lisa Iannattone, T. Ryan Gregory |
Published Dec 15, 2022
...The solutions for dealing with immunity debt {gap} versus immunity theft are diametrically opposed: either avoiding infection to prevent infection (theft) or accepting infection to prevent infection (gap/debt). So if we are to stop this tsunami, it is essential that we science our way to the correct theory, in order to create the appropriate policies in response...
https://calgaryherald.com/opinion/columnists/opinion-we-dont-know-whats-causing-...
Joe Vipond, Lisa Iannattone, T. Ryan Gregory |
Published Dec 15, 2022
...The solutions for dealing with immunity debt {gap} versus immunity theft are diametrically opposed: either avoiding infection to prevent infection (theft) or accepting infection to prevent infection (gap/debt). So if we are to stop this tsunami, it is essential that we science our way to the correct theory, in order to create the appropriate policies in response...
https://calgaryherald.com/opinion/columnists/opinion-we-dont-know-whats-causing-...
125margd
Senate passes defense bill rescinding COVID vaccine mandate {military}
KEVIN FREKING | 16 Dec 2022
...To win GOP support for the 4,408-page bill, Democrats agreed to Republican demands to scrap the requirement for service members to get a COVID-19 vaccination. The bill directs Defense Secretary Lloyd Austin to rescind his August 2021 memorandum imposing the mandate...
https://apnews.com/article/biden-china-covid-lloyd-austin-12e622d1f07a9fec6ef230...
KEVIN FREKING | 16 Dec 2022
...To win GOP support for the 4,408-page bill, Democrats agreed to Republican demands to scrap the requirement for service members to get a COVID-19 vaccination. The bill directs Defense Secretary Lloyd Austin to rescind his August 2021 memorandum imposing the mandate...
https://apnews.com/article/biden-china-covid-lloyd-austin-12e622d1f07a9fec6ef230...
126margd
New COVID model* predicts over 1 million deaths in China through 2023
Julie Steenhuysen and Deena Beasley | December 17, 2022
https://www.reuters.com/world/china/new-covid-model-predicts-over-1-mln-deaths-c...
*US-based Institute of Health Metrics and Evaluation
Julie Steenhuysen and Deena Beasley | December 17, 2022
https://www.reuters.com/world/china/new-covid-model-predicts-over-1-mln-deaths-c...
*US-based Institute of Health Metrics and Evaluation
127margd
Don't delay in filling your Rx.
COULD be shortages in the next few months... 🙁
-----------------------------------------------------------
Michael Olesen 💉😷🇺🇸🇺🇦 @maolesen | 2:20 PM · Dec 18, 2022:
Epidemiologist and federal disaster medicine team member....Minneapolis, MN
"Now in China, the doubling time is like hours."
Goodbye pharmaceuticals, other supply chains, and the global economy. This is the surge I've been warning about.
------------------------------------------------------------
COVID spreading faster than ever in China. 800 million could be infected this winter
Heard on Morning Edition (4 min). Transcript.
Michaeleen Doucleff & A Martínez | December 15, 2022
...about 10% of the planet's population may become infected over the course of the next 90 days....
Epidemiologist Ben Cowling (U of Hong Kong)... thinks that ultimately China will still fare much better against COVID than America has...h(e)ld back the virus for three years...vaccinated such a high percentage of its population...the death toll will likely be high, given the sheer number of people infected, but it could have been much worse without the vaccinations, he explains.
"The mortality rate in China isn't going to surpass America's mortality rate (0.3%) at this point," he says. "But China has a really tough winter ahead."
https://www.npr.org/sections/goatsandsoda/2022/12/15/1143002538/china-appears-to...
COULD be shortages in the next few months... 🙁
-----------------------------------------------------------
Michael Olesen 💉😷🇺🇸🇺🇦 @maolesen | 2:20 PM · Dec 18, 2022:
Epidemiologist and federal disaster medicine team member....Minneapolis, MN
"Now in China, the doubling time is like hours."
Goodbye pharmaceuticals, other supply chains, and the global economy. This is the surge I've been warning about.
------------------------------------------------------------
COVID spreading faster than ever in China. 800 million could be infected this winter
Heard on Morning Edition (4 min). Transcript.
Michaeleen Doucleff & A Martínez | December 15, 2022
...about 10% of the planet's population may become infected over the course of the next 90 days....
Epidemiologist Ben Cowling (U of Hong Kong)... thinks that ultimately China will still fare much better against COVID than America has...h(e)ld back the virus for three years...vaccinated such a high percentage of its population...the death toll will likely be high, given the sheer number of people infected, but it could have been much worse without the vaccinations, he explains.
"The mortality rate in China isn't going to surpass America's mortality rate (0.3%) at this point," he says. "But China has a really tough winter ahead."
https://www.npr.org/sections/goatsandsoda/2022/12/15/1143002538/china-appears-to...
128margd
>127 margd: contd.
Kashif Pirzada, MD (Emergency MD, Toronto) @KashPrime | 11:46 PM · Dec 18, 2022:
China is out of Advil, not just for kids, but for adults too. What does that mean for our own supply?
From @TheRavenApp’s news browser, which translates news from many countries:
https://ravenapp.org/f/greater-china/s/southern-weekly-news/n/0f2719839b9b52e3d6...
Text translated fr Chinese ( https://twitter.com/KashPrime/status/1604699741324967936/photo/1 )
Last edited 11:46 PM · Dec 18, 2022
Kashif Pirzada, MD (Emergency MD, Toronto) @KashPrime | 11:46 PM · Dec 18, 2022:
China is out of Advil, not just for kids, but for adults too. What does that mean for our own supply?
From @TheRavenApp’s news browser, which translates news from many countries:
https://ravenapp.org/f/greater-china/s/southern-weekly-news/n/0f2719839b9b52e3d6...
Text translated fr Chinese ( https://twitter.com/KashPrime/status/1604699741324967936/photo/1 )
Last edited 11:46 PM · Dec 18, 2022
129margd
Chinese hospitals, crematoria... :(
(crowded) hospital in #CCPChina :
0:21 ( https://twitter.com/jenniferzeng97/status/1604654633556840448 )
this hospital is in #Shenyang city, #Liaoning Province in China: https://www.epochtimes.com/gb/22/12/19/n13887513.htm
0:29 ( https://twitter.com/jenniferzeng97/status/1604821925049798657 )
Smoke of the Babaoshan crematorium in #Beijing, #CCPChina. All crematoriums in Beijing are operating 24 hours but still cannot handle all the bodies:
0:11 ( https://twitter.com/jenniferzeng97/status/1603936717316186113 )
- Jennifer Zeng 曾錚 @jenniferzeng97 | Dec 16-19, 2022
First-hand info & unique insights about China & CCP.
(crowded) hospital in #CCPChina :
0:21 ( https://twitter.com/jenniferzeng97/status/1604654633556840448 )
this hospital is in #Shenyang city, #Liaoning Province in China: https://www.epochtimes.com/gb/22/12/19/n13887513.htm
0:29 ( https://twitter.com/jenniferzeng97/status/1604821925049798657 )
Smoke of the Babaoshan crematorium in #Beijing, #CCPChina. All crematoriums in Beijing are operating 24 hours but still cannot handle all the bodies:
0:11 ( https://twitter.com/jenniferzeng97/status/1603936717316186113 )
- Jennifer Zeng 曾錚 @jenniferzeng97 | Dec 16-19, 2022
First-hand info & unique insights about China & CCP.
130margd
American life expectancy is now at its lowest in nearly two decades
Yuki Noguchi | December 22, 2022
The average life expectancy for Americans shortened by over seven months last year, according to new data from the Centers for Disease Control and Prevention.
That decrease follows an already big decline of 1.8 years in 2020. As a result, the expected life span of someone born in the U.S. is now 76.4 years — the shortest it has been in nearly two decades.
The two reports, released by the CDC on Thursday, show deaths from COVID-19 and drug overdoses, most notably synthetic opioids like fentanyl, were the primary drivers of the drop in life expectancy...
...the pandemic claimed nearly 417,000 lives last year — more than even the year before — making COVID-19 the third leading cause of death for the second consecutive year...
https://www.npr.org/sections/health-shots/2022/12/22/1144864971/american-life-ex...
Yuki Noguchi | December 22, 2022
The average life expectancy for Americans shortened by over seven months last year, according to new data from the Centers for Disease Control and Prevention.
That decrease follows an already big decline of 1.8 years in 2020. As a result, the expected life span of someone born in the U.S. is now 76.4 years — the shortest it has been in nearly two decades.
The two reports, released by the CDC on Thursday, show deaths from COVID-19 and drug overdoses, most notably synthetic opioids like fentanyl, were the primary drivers of the drop in life expectancy...
...the pandemic claimed nearly 417,000 lives last year — more than even the year before — making COVID-19 the third leading cause of death for the second consecutive year...
https://www.npr.org/sections/health-shots/2022/12/22/1144864971/american-life-ex...
131margd
COVID-19 is associated w deteriorating oral health, e.g., tooth loss, apparently via dysregulation of the mitochondrial β-oxidation pathway...
SARS-CoV-2 structural proteins trigger periodontal fibrosis
Dr. Chinta Sidharthan | Dec 20 2022
....Conclusions
Overall, the study provided novel insights into the impact of SARS-CoV-2 infections on periodontal health. The results revealed that the SARS-CoV-2 membrane and envelope proteins alter fatty acid degradation pathways in the mitochondria that are essential to maintain energy homeostasis. The dysregulation of the mitochondrial β-oxidation pathway leads to the hyperproliferation of periodontal fibroblasts, causing fibrosis, and increased apoptosis and senescence. These results could contribute to a better understanding of the long COVID symptoms manifesting in other organ systems and provide targets for treatment.
https://www.news-medical.net/news/20221220/SARS-CoV-2-structural-proteins-trigge...
-----------------------------------------------------------------
Yan Gao et al. 2022. SARS-CoV-2 causes periodontal fibrosis by deregulating mitochondrial β-oxidation. BioRxiv 15 Dec 2022. doi: https://doi.org/10.1101/2022.12.15.520561 https://www.biorxiv.org/content/10.1101/2022.12.15.520561v1
This article is a preprint and has not been certified by peer review
Abstract
The global high prevalence of COVID-19 is a major challenge for health professionals and patients. SARS-CoV-2 virus mutate predominantly in the spike proteins, whilst the other key viral components remain stable. Previous studies have shown that the human oral cavity can potentially act as reservoir of the SARS-CoV-2 virus and COVID-19 is likely to be connected with poor periodontal health. However, the consequence of SARS-CoV-2 viral infection on human oral health has not been systematically examined. In this research, we aimed to study the pathogenicity of SARS-CoV-2 viral components on human periodontal health. We found that human periodontal tissues, particularly the fibroblasts highly expressed ACE2 and TMPRSS2. Exposure to SARS-CoV-2, especially by the viral envelope and membrane proteins induced fibrotic pathogenic phenotypes, including periodontal fibroblast hyperproliferation, concomitant with increased apoptosis and senescence. The fibrotic degeneration was mediated by a down-regulation of mitochondrial β-oxidation. Fatty acid β-oxidation inhibitor, etomoxir treatment could mirror the same pathological consequence on the fibroblasts, similar to SARS-CoV-2 infection. Our results therefore provide novel mechanistic insights into how SARS-CoV-2 infection can affect human periodontal health at the cell and molecular level.
SARS-CoV-2 structural proteins trigger periodontal fibrosis
Dr. Chinta Sidharthan | Dec 20 2022
....Conclusions
Overall, the study provided novel insights into the impact of SARS-CoV-2 infections on periodontal health. The results revealed that the SARS-CoV-2 membrane and envelope proteins alter fatty acid degradation pathways in the mitochondria that are essential to maintain energy homeostasis. The dysregulation of the mitochondrial β-oxidation pathway leads to the hyperproliferation of periodontal fibroblasts, causing fibrosis, and increased apoptosis and senescence. These results could contribute to a better understanding of the long COVID symptoms manifesting in other organ systems and provide targets for treatment.
https://www.news-medical.net/news/20221220/SARS-CoV-2-structural-proteins-trigge...
-----------------------------------------------------------------
Yan Gao et al. 2022. SARS-CoV-2 causes periodontal fibrosis by deregulating mitochondrial β-oxidation. BioRxiv 15 Dec 2022. doi: https://doi.org/10.1101/2022.12.15.520561 https://www.biorxiv.org/content/10.1101/2022.12.15.520561v1
This article is a preprint and has not been certified by peer review
Abstract
The global high prevalence of COVID-19 is a major challenge for health professionals and patients. SARS-CoV-2 virus mutate predominantly in the spike proteins, whilst the other key viral components remain stable. Previous studies have shown that the human oral cavity can potentially act as reservoir of the SARS-CoV-2 virus and COVID-19 is likely to be connected with poor periodontal health. However, the consequence of SARS-CoV-2 viral infection on human oral health has not been systematically examined. In this research, we aimed to study the pathogenicity of SARS-CoV-2 viral components on human periodontal health. We found that human periodontal tissues, particularly the fibroblasts highly expressed ACE2 and TMPRSS2. Exposure to SARS-CoV-2, especially by the viral envelope and membrane proteins induced fibrotic pathogenic phenotypes, including periodontal fibroblast hyperproliferation, concomitant with increased apoptosis and senescence. The fibrotic degeneration was mediated by a down-regulation of mitochondrial β-oxidation. Fatty acid β-oxidation inhibitor, etomoxir treatment could mirror the same pathological consequence on the fibroblasts, similar to SARS-CoV-2 infection. Our results therefore provide novel mechanistic insights into how SARS-CoV-2 infection can affect human periodontal health at the cell and molecular level.
132margd
DH built one. Boxier, but more effective than our storebought air purifier.
The Homemade Air Purifier That’s Been Saving Lives During the Covid-19 Pandemic
Made from everyday items found in hardware stores, the Corsi-Rosenthal box is a testament to the power of grassroots innovation
Douglas Hannah | March 7, 2022
https://www.smithsonianmag.com/innovation/homemade-air-purifier-thats-been-savin...
The Homemade Air Purifier That’s Been Saving Lives During the Covid-19 Pandemic
Made from everyday items found in hardware stores, the Corsi-Rosenthal box is a testament to the power of grassroots innovation
Douglas Hannah | March 7, 2022
https://www.smithsonianmag.com/innovation/homemade-air-purifier-thats-been-savin...
133margd
35) Epic long lines at crematoriums… imagine having to not just wait for hours to cremate you loved ones, but have to do it carrying their deceased bodies for all those hours… let’s have empathy for the horrific #COVID19 wave 🌊 crashing into China. 🙏
0:59 ( https://twitter.com/DrEricDing/status/1607305917711753216 )
From Sujit Gupta
- Eric Feigl-Ding @DrEricDing | 4:22 AM · Dec 26, 2022
0:59 ( https://twitter.com/DrEricDing/status/1607305917711753216 )
From Sujit Gupta
- Eric Feigl-Ding @DrEricDing | 4:22 AM · Dec 26, 2022
134margd
Eric Topol (Scripps) @EricTopol | 12:24 AM · Dec 28, 2022:
We’ve just launched a new research program for immuncompromised individuals in the US with free home molecular testing and rapid access to medications when needed. Please help spread the word 👇
Julia MV @julialmv | 5:46 PM · Dec 27, 2022:
Let's increase health equity Now: @AllofUsResearch at @ScrippsRTI & #LongCovid patient-researcher
Then: @RockefellerUniv & @nygenome
https://twitter.com/julialmv/status/1607870638278209536
https://threadreaderapp.com/thread/1607870638278209536.html
We're launching a study that aims to reduce the risk of #COVID19 for #immunocompromised individuals.
We hypothesize that detecting and treating COVID quickly can improve outcomes.
The study is completely remote and available across the US at: immunocare.scripps.edu
Eligible participants will receive 10 @CueHealth tests per month as well as access to Cue's on-demand telehealth and prescription delivery services at no cost.
These tests are much more sensitive than antigen tests.
immunocare.scripps.edu
2/3
I hope this helps the immunocompromised community. I know what a challenge it can be to have such different risk/benefit calculations from those around you.
Feel free to share with the immunocompromised people in your life.
immunocare.scripps.edu
3/3
We’ve just launched a new research program for immuncompromised individuals in the US with free home molecular testing and rapid access to medications when needed. Please help spread the word 👇
Julia MV @julialmv | 5:46 PM · Dec 27, 2022:
Let's increase health equity Now: @AllofUsResearch at @ScrippsRTI & #LongCovid patient-researcher
Then: @RockefellerUniv & @nygenome
https://twitter.com/julialmv/status/1607870638278209536
https://threadreaderapp.com/thread/1607870638278209536.html
We're launching a study that aims to reduce the risk of #COVID19 for #immunocompromised individuals.
We hypothesize that detecting and treating COVID quickly can improve outcomes.
The study is completely remote and available across the US at: immunocare.scripps.edu
Eligible participants will receive 10 @CueHealth tests per month as well as access to Cue's on-demand telehealth and prescription delivery services at no cost.
These tests are much more sensitive than antigen tests.
immunocare.scripps.edu
2/3
I hope this helps the immunocompromised community. I know what a challenge it can be to have such different risk/benefit calculations from those around you.
Feel free to share with the immunocompromised people in your life.
immunocare.scripps.edu
3/3
135margd
A new variant alert
The XBB.1.5 variant is on a growth spurt in the United States
Eric Topol {MD-scientist Scripps} | Dec 23
As everyone who has been following the Omicron family of SARS-CoV-2 descendants in recent months, there’s a swarm of new subvariants. One of these is XBB, which is a recombinant (fusion) of 2 different BA.2 variants, BJ.1 (BA.2.10.1.1) and BA.2.75 (BA.2.75.3.1.1.1), depicted below by both the tree and mutation map...
...Now it appears that in New York State, XBB evolved further to XBB.1.5, with new mutations, which was aptly first noted by JP Weiland a couple of weeks ago, coincident with the beginning of a steep rise of hospitalizations there.
The key mutation of XBB.1.5 is clearly F486P, which had been identified many months ago by the Bloom lab as one that would be tied to immunity escape ...
What does all this mean?
The United States is the first country to have a XBB.x (subvariant) become dominant regionally following Singapore’s XBB. Singapore had a significant wave in October as shown here for cases and deaths. Fortunately, there was some uncoupling of the case-to-death ratio from its previous waves. It should also be noted that Singapore has one of the highest vaccination and booster rates in the world (compared with the United States below).
New York is the bellwether for what is happening with XBB.1.5 and it doesn’t look good with a marked rise in hospitalizations, especially among seniors, in recent weeks as this variant has been taking hold. Of course, other factors are likely contributing such as waning of immunity, indoor/holiday gatherings, cold weather, lack of mitigation. But it is noteworthy that New York’s Covid hospital admission rate is the highest since late January (and also exceeds the summer 2021 Delta wave, but with some ambiguity as to how hospitalization were categorized then and now).
So we don’t know for sure how much of this is being driven by XBB.1.5, but it doesn’t look favorable. It is at the very least contributing—too much of a coincidence to see such a striking rise of the variant along with New York’s data. But only time will tell in the weeks ahead in contiguous states with XBB dominance how this will play out. Connecticut may indeed be showing the effect among people age 70+, as is New Jersey.
What can be done about it?
This week in NEJM, the Emory group published the data on the bivalent BA.5 booster and how it helped against XBB: "Persons who received the BA.5-containing bivalent booster had better neutralizing activity against all Omicron subvariants (especially against BA.2.75.2, BQ.1.1 and XBB) than those who received 1 or 2 monovalent {original} boosters." This finding of some cross-immunity protection has been backed up by live virus lab studies by 3 other groups.
Although we don’t know precisely how well the bivalent booster does against XBB.1.5 yet, the new lab data, showing lack of added immune evasiveness, supports there would be cross-immunity protection (just as seen with XBB). So if you haven’t had a booster in the past 4+ months, this would be well advised. Other than the bivalent booster, it’s the usual stuff of high quality masks, ventilation, air filtration, testing, etc. ...
XBB.1.5 is not a welcome addition to the holiday season, to say the least. The purpose of this post is to raise awareness of its existence and trajectory, and to keep your guard up. As the editorial in Nature published today was titled: “There’s no room for COVID complacency in 2023.” While there’s still much to learn about this variant, it doesn’t have the look of a “scariant” (a term I coined in the pandemic for variants that have no functional significance but scare us). This one is the real deal and we’re betting on our immunity wall of infections, vaccinations, boosters and their combinations to help withstand its impact...
https://erictopol.substack.com/p/a-new-variant-alert
The XBB.1.5 variant is on a growth spurt in the United States
Eric Topol {MD-scientist Scripps} | Dec 23
As everyone who has been following the Omicron family of SARS-CoV-2 descendants in recent months, there’s a swarm of new subvariants. One of these is XBB, which is a recombinant (fusion) of 2 different BA.2 variants, BJ.1 (BA.2.10.1.1) and BA.2.75 (BA.2.75.3.1.1.1), depicted below by both the tree and mutation map...
...Now it appears that in New York State, XBB evolved further to XBB.1.5, with new mutations, which was aptly first noted by JP Weiland a couple of weeks ago, coincident with the beginning of a steep rise of hospitalizations there.
The key mutation of XBB.1.5 is clearly F486P, which had been identified many months ago by the Bloom lab as one that would be tied to immunity escape ...
What does all this mean?
The United States is the first country to have a XBB.x (subvariant) become dominant regionally following Singapore’s XBB. Singapore had a significant wave in October as shown here for cases and deaths. Fortunately, there was some uncoupling of the case-to-death ratio from its previous waves. It should also be noted that Singapore has one of the highest vaccination and booster rates in the world (compared with the United States below).
New York is the bellwether for what is happening with XBB.1.5 and it doesn’t look good with a marked rise in hospitalizations, especially among seniors, in recent weeks as this variant has been taking hold. Of course, other factors are likely contributing such as waning of immunity, indoor/holiday gatherings, cold weather, lack of mitigation. But it is noteworthy that New York’s Covid hospital admission rate is the highest since late January (and also exceeds the summer 2021 Delta wave, but with some ambiguity as to how hospitalization were categorized then and now).
So we don’t know for sure how much of this is being driven by XBB.1.5, but it doesn’t look favorable. It is at the very least contributing—too much of a coincidence to see such a striking rise of the variant along with New York’s data. But only time will tell in the weeks ahead in contiguous states with XBB dominance how this will play out. Connecticut may indeed be showing the effect among people age 70+, as is New Jersey.
What can be done about it?
This week in NEJM, the Emory group published the data on the bivalent BA.5 booster and how it helped against XBB: "Persons who received the BA.5-containing bivalent booster had better neutralizing activity against all Omicron subvariants (especially against BA.2.75.2, BQ.1.1 and XBB) than those who received 1 or 2 monovalent {original} boosters." This finding of some cross-immunity protection has been backed up by live virus lab studies by 3 other groups.
Although we don’t know precisely how well the bivalent booster does against XBB.1.5 yet, the new lab data, showing lack of added immune evasiveness, supports there would be cross-immunity protection (just as seen with XBB). So if you haven’t had a booster in the past 4+ months, this would be well advised. Other than the bivalent booster, it’s the usual stuff of high quality masks, ventilation, air filtration, testing, etc. ...
XBB.1.5 is not a welcome addition to the holiday season, to say the least. The purpose of this post is to raise awareness of its existence and trajectory, and to keep your guard up. As the editorial in Nature published today was titled: “There’s no room for COVID complacency in 2023.” While there’s still much to learn about this variant, it doesn’t have the look of a “scariant” (a term I coined in the pandemic for variants that have no functional significance but scare us). This one is the real deal and we’re betting on our immunity wall of infections, vaccinations, boosters and their combinations to help withstand its impact...
https://erictopol.substack.com/p/a-new-variant-alert
136margd
T. Ryan Gregory @TRyanGregory | 9:49 PM · Dec 29, 2022:
Prof of evolutionary biology. U Guelph, Ont.
BF.7 appears to be the main variant surging in China right now. It did not originate in China (more likely in Belgium). It has been circulating at low levels outside of China since August. The XBBs and BQs are far more concerning. The worst, XBB.1.5, evolved in the USA. (>135 margd:)
Prof of evolutionary biology. U Guelph, Ont.
BF.7 appears to be the main variant surging in China right now. It did not originate in China (more likely in Belgium). It has been circulating at low levels outside of China since August. The XBBs and BQs are far more concerning. The worst, XBB.1.5, evolved in the USA. (>135 margd:)
137margd
Eric Topol (MD-scientist, Scripps) @EricTopol | 1:20 PM · Dec 29, 2022:
For people age 65+, the bivalent booster linked to greater than 80% protection vs Covid hospitalizations
Diya Surie et al. 2022. Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19–Associated Hospitalization Among Immunocompetent Adults Aged ≥65 Years — IVY Network, 18 States, September 8–November 30, 2022. Morbidity and Mortality Weekly Report (MMWR). December 30, 2022 / 71(5152);1625–1630. https://cdc.gov/mmwr/volumes/71/wr/mm715152e2.htm?s_cid=mm715152e2_w
...Among immunocompetent adults aged 65 years or older hospitalized in the multistate IVY Network, a bivalent booster dose provided 73% additional protection against COVID-19 hospitalization compared with past monovalent mRNA vaccination (designed against the ancestral strain of SARS-CoV-2) only.
...During September 8–November 30, 2022, a total of 1,168 immunocompetent adults aged 65 years or older were enrolled in the IVY Network.
...When compared with unvaccinated patients, VE of a bivalent booster dose in preventing COVID-19–associated hospitalization was 84%...
...Discussion
Among immunocompetent adults aged 65 years or older hospitalized within the IVY Network in 18 states, a bivalent booster dose received after 2 or more monovalent mRNA doses provided strong protection against COVID-19–associated hospitalization during a period of Omicron BA.5 or BQ.1/BQ.1.1 predominance... Substantial additional protection from a bivalent booster dose was observed when compared with remote monovalent-only mRNA vaccination, which suggests important incremental benefit for persons eligible to receive a bivalent vaccine booster. These early findings from a cohort of adults aged 65 years or older, 74% of whom had multiple underlying conditions, are among the first to document real-world evidence that receipt of a bivalent booster dose after completion of at least a primary COVID-19 mRNA vaccination series is protective against COVID-19 hospitalization. Continued monitoring will be important to understand ongoing protection in the context of expanding Omicron sublineages and new emerging variants, as well as whether waning of bivalent vaccine-induced immunity over time is observed, similar to that seen after monovalent COVID-19 mRNA vaccine booster doses...
Table 2 ( https://twitter.com/EricTopol/status/1608528430097891329/photo/1 )
For people age 65+, the bivalent booster linked to greater than 80% protection vs Covid hospitalizations
Diya Surie et al. 2022. Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19–Associated Hospitalization Among Immunocompetent Adults Aged ≥65 Years — IVY Network, 18 States, September 8–November 30, 2022. Morbidity and Mortality Weekly Report (MMWR). December 30, 2022 / 71(5152);1625–1630. https://cdc.gov/mmwr/volumes/71/wr/mm715152e2.htm?s_cid=mm715152e2_w
...Among immunocompetent adults aged 65 years or older hospitalized in the multistate IVY Network, a bivalent booster dose provided 73% additional protection against COVID-19 hospitalization compared with past monovalent mRNA vaccination (designed against the ancestral strain of SARS-CoV-2) only.
...During September 8–November 30, 2022, a total of 1,168 immunocompetent adults aged 65 years or older were enrolled in the IVY Network.
...When compared with unvaccinated patients, VE of a bivalent booster dose in preventing COVID-19–associated hospitalization was 84%...
...Discussion
Among immunocompetent adults aged 65 years or older hospitalized within the IVY Network in 18 states, a bivalent booster dose received after 2 or more monovalent mRNA doses provided strong protection against COVID-19–associated hospitalization during a period of Omicron BA.5 or BQ.1/BQ.1.1 predominance... Substantial additional protection from a bivalent booster dose was observed when compared with remote monovalent-only mRNA vaccination, which suggests important incremental benefit for persons eligible to receive a bivalent vaccine booster. These early findings from a cohort of adults aged 65 years or older, 74% of whom had multiple underlying conditions, are among the first to document real-world evidence that receipt of a bivalent booster dose after completion of at least a primary COVID-19 mRNA vaccination series is protective against COVID-19 hospitalization. Continued monitoring will be important to understand ongoing protection in the context of expanding Omicron sublineages and new emerging variants, as well as whether waning of bivalent vaccine-induced immunity over time is observed, similar to that seen after monovalent COVID-19 mRNA vaccine booster doses...
Table 2 ( https://twitter.com/EricTopol/status/1608528430097891329/photo/1 )
138margd
Dr. Jeff Gilchrist
PhD Biomedical researcher, data scientist, and finder of large prime numbers. Views are my own. Mastadon: @jeffgilchrist@mstdn.science
https://twitter.com/jeffgilchrist/status/1608809251572715521
https://pingthread.com/thread/1608809251572715521
What actions to end the global threat to public health have global experts agreed to?
This thread highlights the main recommendations from a multinational Delphi consensus of 386 multidisciplinary experts ( https://www.nature.com/articles/s41586-022-05398-2 )...
... From the Delphi consensus, the 10 highest ranked recommendations are:
1. Pandemic preparedness and response planning should adopt a whole-of-society approach that includes multiple disciplines, sectors and actors. 12/
2. Community leaders, scientific experts and public health authorities should collaborate to develop public health messages that build and enhance individual and community trust and use the preferred means of access and communication for different populations. 13/
3. All countries should adopt a vaccines-plus approach that includes a combination of COVID-19 vaccination, prevention measures, treatment and financial incentives.
4. Pandemic preparedness and response should address pre-existing social and health inequities. 14/
5. Public health authorities should partner with individuals and organizations that are trusted within their communities to provide accurate, accessible information about the pandemic and inform behaviour change. 15/
6. Government, philanthropic and industry funding should include a focus on developing vaccines that provide long-lasting protection against multiple SARS-CoV-2 variants. 16/
7. Public health professionals and authorities should combat false information proactively based on clear, direct, culturally responsive messaging that is free of unnecessary scientific jargon. 17/
8. Preparedness and response strategies should adopt whole-of-government approaches (for example, multi ministry coordination) to identify, review and address resilience in health systems. 18/
9. Global trade and health organizations should coordinate with countries to negotiate the transfer of technologies enabling manufacturers in low- and middle-income countries to develop quality assured and affordable vaccines, tests and therapeutics. 19/
10. Promote multisectoral collaboration to accelerate the development of new therapies for all stages of COVID-19 (for example, outpatient, hospitalization and long COVID). 20/ ...
PhD Biomedical researcher, data scientist, and finder of large prime numbers. Views are my own. Mastadon: @jeffgilchrist@mstdn.science
https://twitter.com/jeffgilchrist/status/1608809251572715521
https://pingthread.com/thread/1608809251572715521
What actions to end the global threat to public health have global experts agreed to?
This thread highlights the main recommendations from a multinational Delphi consensus of 386 multidisciplinary experts ( https://www.nature.com/articles/s41586-022-05398-2 )...
... From the Delphi consensus, the 10 highest ranked recommendations are:
1. Pandemic preparedness and response planning should adopt a whole-of-society approach that includes multiple disciplines, sectors and actors. 12/
2. Community leaders, scientific experts and public health authorities should collaborate to develop public health messages that build and enhance individual and community trust and use the preferred means of access and communication for different populations. 13/
3. All countries should adopt a vaccines-plus approach that includes a combination of COVID-19 vaccination, prevention measures, treatment and financial incentives.
4. Pandemic preparedness and response should address pre-existing social and health inequities. 14/
5. Public health authorities should partner with individuals and organizations that are trusted within their communities to provide accurate, accessible information about the pandemic and inform behaviour change. 15/
6. Government, philanthropic and industry funding should include a focus on developing vaccines that provide long-lasting protection against multiple SARS-CoV-2 variants. 16/
7. Public health professionals and authorities should combat false information proactively based on clear, direct, culturally responsive messaging that is free of unnecessary scientific jargon. 17/
8. Preparedness and response strategies should adopt whole-of-government approaches (for example, multi ministry coordination) to identify, review and address resilience in health systems. 18/
9. Global trade and health organizations should coordinate with countries to negotiate the transfer of technologies enabling manufacturers in low- and middle-income countries to develop quality assured and affordable vaccines, tests and therapeutics. 19/
10. Promote multisectoral collaboration to accelerate the development of new therapies for all stages of COVID-19 (for example, outpatient, hospitalization and long COVID). 20/ ...
139brone
In a recent hearing on the Virus from China a Pfizer director admits that the vaccine was never tested on preventing transmission, That being admitted Robert Kennedy Jr, is quoted as saying, "get vaccinated for others" was always a lie. he went on to say the last three years wll go down in history as a time when the medical-industrial complex mounted a war against our kids, closing their schools, masking them up, isolating them from each other, and most recently authorizing bivlen vaccines for babies as young as 6 mo. The media, health and gov agencies are held captive and devolved into scribes for Big Pharma's narrative. Parents are now skeptical and question the consistent parroting of the, "safe and effective" spiel and the relentless vilification of anyone who would dare to question official Orthodoxy. Kennedy goes on to say, "we won a revolution before". "we can win it again" against "the medical-industrial- complex mounted war against our children"....AMDG....
140jjwilson61
Do you really believe that anyone in the public health community wants to wage a war on children... Or are you just trying to score some rhetorical points?
141prosfilaes
>139 brone: Robert Kennedy Jr. is hardly a reliable, neutral source.
If the vaccine was never tested to reduce transmission, it's not surprising; medical studies are expensive and slow, and they put all their work into making sure it was safe and effective. However, a disease that has someone coughing all over the place will generally be more transmissible than one without major side effects.
If the vaccine was never tested to reduce transmission, it's not surprising; medical studies are expensive and slow, and they put all their work into making sure it was safe and effective. However, a disease that has someone coughing all over the place will generally be more transmissible than one without major side effects.
142margd
>139 brone: AMDG, WWJD? The virus is somewhat less transmissible in MRNA-vaxxed, but because it's administered intramuscularly it doesn't repel virus as well in nose and throat where virus first gains hold. It's expected that nasal-spray, next-gen vaxx will better prevent transmission, as well as serious disease. Until then, closing schools, masking, isolating, ventilation are also important for preventing transmission.
Discussed more in https://www.librarything.com/topic/338757#, I think.
Discussed more in https://www.librarything.com/topic/338757#, I think.
143brone
>140 jjwilson61: Not my quote, Kennedy's quote. I do believe however It's also what they don't know that can kill too....JMJ....
144brone
>141 prosfilaes: Not surprizing it's criminal....AMDG....
145margd
The study* shows increased likelihood of hospitalization, cardiovascular effects, blood disorders, diabetes, fatigue, kidney damage, mental health effects, musculoskeletal damage, neurological deficits, and pulmonary damage with each COVID-19 infection
Rising Risks with COVID Reinfection
Emerging evidence on severe complications
Jonathan Shaw | 12.15.22
https://www.harvardmagazine.com/2022/12/covid-reinfection
--------------------------------------------------------------
* Benjamin Bowe et al. 2022. Acute and postacute sequelae associated with SARS-CoV-2 reinfection. Nature Medicine volume 28, pages 2398–2405 (10 November 2022) https://www.nature.com/articles/s41591-022-02051-3
Abstract
First infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with increased risk of acute and postacute death and sequelae in various organ systems. Whether reinfection adds to risks incurred after first infection is unclear. Here we used the US Department of Veterans Affairs’ national healthcare database to build a cohort of individuals with one SARS-CoV-2 infection (n = 443,588), reinfection (two or more infections, n = 40,947) and a noninfected control (n = 5,334,729). We used inverse probability-weighted survival models to estimate risks and 6-month burdens of death, hospitalization and incident sequelae. Compared to no reinfection, reinfection contributed additional risks of death (hazard ratio (HR) = 2.17...), hospitalization (HR = 3.32...) and sequelae including pulmonary, cardiovascular, hematological, diabetes, gastrointestinal, kidney, mental health, musculoskeletal and neurological disorders. The risks were evident regardless of vaccination status. The risks were most pronounced in the acute phase but persisted in the postacute phase at 6 months. Compared to noninfected controls, cumulative risks and burdens of repeat infection increased according to the number of infections. Limitations included a cohort of mostly white males. The evidence shows that reinfection further increases risks of death, hospitalization and sequelae in multiple organ systems in the acute and postacute phase. Reducing overall burden of death and disease due to SARS-CoV-2 will require strategies for reinfection prevention.
Rising Risks with COVID Reinfection
Emerging evidence on severe complications
Jonathan Shaw | 12.15.22
https://www.harvardmagazine.com/2022/12/covid-reinfection
--------------------------------------------------------------
* Benjamin Bowe et al. 2022. Acute and postacute sequelae associated with SARS-CoV-2 reinfection. Nature Medicine volume 28, pages 2398–2405 (10 November 2022) https://www.nature.com/articles/s41591-022-02051-3
Abstract
First infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with increased risk of acute and postacute death and sequelae in various organ systems. Whether reinfection adds to risks incurred after first infection is unclear. Here we used the US Department of Veterans Affairs’ national healthcare database to build a cohort of individuals with one SARS-CoV-2 infection (n = 443,588), reinfection (two or more infections, n = 40,947) and a noninfected control (n = 5,334,729). We used inverse probability-weighted survival models to estimate risks and 6-month burdens of death, hospitalization and incident sequelae. Compared to no reinfection, reinfection contributed additional risks of death (hazard ratio (HR) = 2.17...), hospitalization (HR = 3.32...) and sequelae including pulmonary, cardiovascular, hematological, diabetes, gastrointestinal, kidney, mental health, musculoskeletal and neurological disorders. The risks were evident regardless of vaccination status. The risks were most pronounced in the acute phase but persisted in the postacute phase at 6 months. Compared to noninfected controls, cumulative risks and burdens of repeat infection increased according to the number of infections. Limitations included a cohort of mostly white males. The evidence shows that reinfection further increases risks of death, hospitalization and sequelae in multiple organ systems in the acute and postacute phase. Reducing overall burden of death and disease due to SARS-CoV-2 will require strategies for reinfection prevention.
146prosfilaes
>144 brone: Do you want to claim specifically what was criminal about it? We let any number of "herbal supplements" with claims ranging from the unproven to the preposterous on the shelves. How is it criminal to test a vaccine for what the FDA required, that is, actual protection against the disease?
147margd
Rachael Wood et al. 2021. Sharing a household with children and risk of COVID-19: a study of over 300 000 adults living in healthcare worker households in Scotland. March 2021 Archives of Disease in Childhood 106(12):archdischild-2021-321604. DOI:10.1136/archdischild-2021-321604 https://www.researchgate.net/publication/350177104_Sharing_a_household_with_chil...
(Abstract) Conclusion Between March and October 2020 (i.e., pre-omicron), living with young children was associated with an attenuated risk of any COVID-19 and COVID-19 requiring hospitalisation among adults living in healthcare worker households. There was no evidence that living with young children increased adults’ risk of COVID-19, including during the period after schools reopened.
----------------------------------------------------------
Dr CJ Houldcroft 🕷️ @DrCJ_Houldcroft | 4:36 AM · Jan 3, 2023:
Lecturer working on virus evolution, from a scale of weeks (within a single patient) to millennia (between humans and Neanderthals).
https://twitter.com/DrCJ.../status/1610208401338028033
My favourite study of "how often does a family with small children get a respiratory infection?" is this one, from the USA:
https://doi.org/10.1093/cid/civ486
Children
(Abstract) Conclusion Between March and October 2020 (i.e., pre-omicron), living with young children was associated with an attenuated risk of any COVID-19 and COVID-19 requiring hospitalisation among adults living in healthcare worker households. There was no evidence that living with young children increased adults’ risk of COVID-19, including during the period after schools reopened.
----------------------------------------------------------
Dr CJ Houldcroft 🕷️ @DrCJ_Houldcroft | 4:36 AM · Jan 3, 2023:
Lecturer working on virus evolution, from a scale of weeks (within a single patient) to millennia (between humans and Neanderthals).
https://twitter.com/DrCJ.../status/1610208401338028033
My favourite study of "how often does a family with small children get a respiratory infection?" is this one, from the USA:
https://doi.org/10.1093/cid/civ486
Children
148brone
Arrivals from China have to have a negative test of 48 hrs, it seems to me that whole cities in China have been closed down causing huge opposition to their own policy, now all of a sudden, we read 48hrs and you're in, I may be wrong havn't the "experts" been telling us all along how fast this leak from China spreads....JMJ....
149margd
COVID-19 Virus Found in the Brain: Autopsies Reveal Startling New Information
Jim Wappes, University of Minnesota | January 2, 2023
https://scitechdaily.com/covid-19-virus-found-in-the-brain-autopsies-reveal-star...
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Sydney R. Stein et al. 2022. SARS-CoV-2 infection and persistence in the human body and brain at autopsy”. 14 December 2022, Nature. DOI: 10.1038/s41586-022-05542-y https://www.nature.com/articles/s41586-022-05542-y
Abstract
Coronavirus disease 2019 (COVID-19) is known to cause multi-organ dysfunction ... during acute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with some patients experiencing prolonged symptoms, termed post-acute sequelae of SARS-CoV-2 ... However, the burden of infection outside the respiratory tract and time to viral clearance are not well characterized, particularly in the brain ... Here we carried out complete autopsies on 44 patients who died with COVID-19, with extensive sampling of the central nervous system in 11 of these patients, to map and quantify the distribution, replication and cell-type specificity of SARS-CoV-2 across the human body, including the brain, from acute infection to more than seven months following symptom onset. We show that SARS-CoV-2 is widely distributed, predominantly among patients who died with severe COVID-19, and that virus replication is present in multiple respiratory and non-respiratory tissues, including the brain, early in infection. Further, we detected persistent SARS-CoV-2 RNA in multiple anatomic sites, including throughout the brain, as late as 230 days following symptom onset in one case. Despite extensive distribution of SARS-CoV-2 RNA throughout the body, we observed little evidence of inflammation or direct viral cytopathology outside the respiratory tract. Our data indicate that in some patients SARS-CoV-2 can cause systemic infection and persist in the body for months.
---------------------------------------------------------
NIAID Pandemic Autopsy Study Fosters Long COVID Treatment Trial
Early Findings of Widespread, Long-Lasting Virus Helped Inform Research
...Findings from the autopsies, which took place between April 2020 and March 2021, confirmed that SARS-CoV-2 primarily infected and damaged the airway and lungs. But scientists also found virus fragments (viral RNA) in 79 of 85 body locations, with some virus found up to 230 days after patient’s symptoms began. Scientists found virus in cardiovascular, lymphoid, gastrointestinal, renal, endocrine, reproductive, muscle, brain and other tissue – although none of these areas sustained significant inflammation compared to what they found in the respiratory tract.
...Finding the viral fragments in tissue throughout the body – and sharing those findings with colleagues a year ago – helped scientists explore a relationship between the viral fragments and Long COVID.
Long COVID gets its name from the persistent symptoms some people experience after having COVID-19; symptoms can be debilitating, and the cause is not known. Though the study in Nature did not specifically explore Long COVID, finding the viral RNA throughout the body raised speculation that those fragments might contribute to the persistent symptoms, according to (Senior study author Dr. Daniel Chertow). Treating people with an effective COVID-19 antiviral such as Paxlovid could, therefore, eliminate the persistent symptoms.
The Paxlovid trial, which is expected to begin in 2023, is part of the NIH-funded RECOVER project (Researching COVID to Enhance Recovery) ... one branch of RECOVER includes tissue pathology studies, and obtaining material from autopsies is in progress; these autopsies include people who both were vaccinated and infected with variants of concern – data not available in the earlier study ...
“We’re hoping to replicate the data on viral persistence and study the relationship with Long COVID,” (Dr. Stephen Hewitt of NCI, who collaborated on the paper in Nature, and serves on a steering committee for the RECOVER project) said, adding that the project is scheduled to last four years. “Less than a year in we have about 85 cases, and we are working to expand these efforts.”
https://www.niaid.nih.gov/news-events/covid-autopsy-study
Jim Wappes, University of Minnesota | January 2, 2023
https://scitechdaily.com/covid-19-virus-found-in-the-brain-autopsies-reveal-star...
-------------------------------------------------------
Sydney R. Stein et al. 2022. SARS-CoV-2 infection and persistence in the human body and brain at autopsy”. 14 December 2022, Nature. DOI: 10.1038/s41586-022-05542-y https://www.nature.com/articles/s41586-022-05542-y
Abstract
Coronavirus disease 2019 (COVID-19) is known to cause multi-organ dysfunction ... during acute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with some patients experiencing prolonged symptoms, termed post-acute sequelae of SARS-CoV-2 ... However, the burden of infection outside the respiratory tract and time to viral clearance are not well characterized, particularly in the brain ... Here we carried out complete autopsies on 44 patients who died with COVID-19, with extensive sampling of the central nervous system in 11 of these patients, to map and quantify the distribution, replication and cell-type specificity of SARS-CoV-2 across the human body, including the brain, from acute infection to more than seven months following symptom onset. We show that SARS-CoV-2 is widely distributed, predominantly among patients who died with severe COVID-19, and that virus replication is present in multiple respiratory and non-respiratory tissues, including the brain, early in infection. Further, we detected persistent SARS-CoV-2 RNA in multiple anatomic sites, including throughout the brain, as late as 230 days following symptom onset in one case. Despite extensive distribution of SARS-CoV-2 RNA throughout the body, we observed little evidence of inflammation or direct viral cytopathology outside the respiratory tract. Our data indicate that in some patients SARS-CoV-2 can cause systemic infection and persist in the body for months.
---------------------------------------------------------
NIAID Pandemic Autopsy Study Fosters Long COVID Treatment Trial
Early Findings of Widespread, Long-Lasting Virus Helped Inform Research
...Findings from the autopsies, which took place between April 2020 and March 2021, confirmed that SARS-CoV-2 primarily infected and damaged the airway and lungs. But scientists also found virus fragments (viral RNA) in 79 of 85 body locations, with some virus found up to 230 days after patient’s symptoms began. Scientists found virus in cardiovascular, lymphoid, gastrointestinal, renal, endocrine, reproductive, muscle, brain and other tissue – although none of these areas sustained significant inflammation compared to what they found in the respiratory tract.
...Finding the viral fragments in tissue throughout the body – and sharing those findings with colleagues a year ago – helped scientists explore a relationship between the viral fragments and Long COVID.
Long COVID gets its name from the persistent symptoms some people experience after having COVID-19; symptoms can be debilitating, and the cause is not known. Though the study in Nature did not specifically explore Long COVID, finding the viral RNA throughout the body raised speculation that those fragments might contribute to the persistent symptoms, according to (Senior study author Dr. Daniel Chertow). Treating people with an effective COVID-19 antiviral such as Paxlovid could, therefore, eliminate the persistent symptoms.
The Paxlovid trial, which is expected to begin in 2023, is part of the NIH-funded RECOVER project (Researching COVID to Enhance Recovery) ... one branch of RECOVER includes tissue pathology studies, and obtaining material from autopsies is in progress; these autopsies include people who both were vaccinated and infected with variants of concern – data not available in the earlier study ...
“We’re hoping to replicate the data on viral persistence and study the relationship with Long COVID,” (Dr. Stephen Hewitt of NCI, who collaborated on the paper in Nature, and serves on a steering committee for the RECOVER project) said, adding that the project is scheduled to last four years. “Less than a year in we have about 85 cases, and we are working to expand these efforts.”
https://www.niaid.nih.gov/news-events/covid-autopsy-study
150brone
Reading posts, you are human aint you I get the feeling you might be calculators AI is a big thing today. Seriously look at your posts your calculations are everywhere. Especially calculating what may or not be. It goes on and on it chases out morality, truth, and freedom, are we to believe this calculating elitist class, who when not confusing the rest of us with all these studies,it's how many carbon footprints you left in your wake. Calculators are usually low risk in terms of consequences. Freedom and dignity cannot come from these technological systems of control....AMDG....
151margd
I have to read this more closely, but I HOPE worst outcomes not associated with DRY Age-Related Macular Degeneration?
(BTW, OTC vitamin formula, Preservision AREDS2, helps delay progression of moderate (dry) ARMD in clinical trials--dunno if it lowers expression of PDGF. More recently saffron, of all things, also seems to delay/reverse ARMD: https://www.medicalnewstoday.com/articles/how-much-saffron-should-i-take-for-mac...
Age-Related Macular Degeneration a Risk Factor for COVID-19 Infection and Severe Disease
Boston University · January 3, 2023
Summary: More severe COVID-19 outcomes associated with age-related macular degeneration likely arise from a genetic predisposition in addition to higher levels of Pdgf in blood serum.
Recent evidence has emerged to suggest that age-related macular degeneration (AMD) is a clinical risk factor for increased risk for infection and mortality. AMD has been reported to confer higher risk of severe complications of SARS-CoV-2 infection, including respiratory failure and death (25 percent), a risk which is higher than Type 2 diabetes (21 percent) and obesity (13 percent)...
...findings suggest that lowering PDGFB gene activity and serum PDGF concentration may reduce the severity of COVID-19, particularly among older people.
...“Therapeutic strategies combining anti-VEGF therapy (a current treatment for AMD that limits blood vessel growth in the eye that can harm vision) with antagonists (drugs that bind to receptors) for blocking PDGF signaling have been considered even more effective than the single VEGF treatment and are currently under investigation in clinical trials,” added co-corresponding author Manju L. Subramanian, MD, associate professor of ophthalmology...
https://neurosciencenews.com/amd-covid-22161/
--------------------------------------------------------------
Lindsay A. Farrer et al. 2022. Genome-Wide Pleiotropy Study Identifies Association of PDGFB with Age-Related Macular Degeneration and COVID-19 Infection Outcomes. Journal of Clinical Medicine J. Clin. Med. 2023, 12(1), 109; Published: 23 December 2022. https://doi.org/10.3390/jcm12010109 https://www.mdpi.com/2077-0383/12/1/109
Abstract
...Our study demonstrated that the liability of AMD is associated with an increased risk of COVID-19, and PDGFB may be responsible for the severe COVID-19 outcomes among AMD patients.
(BTW, OTC vitamin formula, Preservision AREDS2, helps delay progression of moderate (dry) ARMD in clinical trials--dunno if it lowers expression of PDGF. More recently saffron, of all things, also seems to delay/reverse ARMD: https://www.medicalnewstoday.com/articles/how-much-saffron-should-i-take-for-mac...
Age-Related Macular Degeneration a Risk Factor for COVID-19 Infection and Severe Disease
Boston University · January 3, 2023
Summary: More severe COVID-19 outcomes associated with age-related macular degeneration likely arise from a genetic predisposition in addition to higher levels of Pdgf in blood serum.
Recent evidence has emerged to suggest that age-related macular degeneration (AMD) is a clinical risk factor for increased risk for infection and mortality. AMD has been reported to confer higher risk of severe complications of SARS-CoV-2 infection, including respiratory failure and death (25 percent), a risk which is higher than Type 2 diabetes (21 percent) and obesity (13 percent)...
...findings suggest that lowering PDGFB gene activity and serum PDGF concentration may reduce the severity of COVID-19, particularly among older people.
...“Therapeutic strategies combining anti-VEGF therapy (a current treatment for AMD that limits blood vessel growth in the eye that can harm vision) with antagonists (drugs that bind to receptors) for blocking PDGF signaling have been considered even more effective than the single VEGF treatment and are currently under investigation in clinical trials,” added co-corresponding author Manju L. Subramanian, MD, associate professor of ophthalmology...
https://neurosciencenews.com/amd-covid-22161/
--------------------------------------------------------------
Lindsay A. Farrer et al. 2022. Genome-Wide Pleiotropy Study Identifies Association of PDGFB with Age-Related Macular Degeneration and COVID-19 Infection Outcomes. Journal of Clinical Medicine J. Clin. Med. 2023, 12(1), 109; Published: 23 December 2022. https://doi.org/10.3390/jcm12010109 https://www.mdpi.com/2077-0383/12/1/109
Abstract
...Our study demonstrated that the liability of AMD is associated with an increased risk of COVID-19, and PDGFB may be responsible for the severe COVID-19 outcomes among AMD patients.
152prosfilaes
>150 brone: You've tossed out enough numbers when they've served your purpose. You were big on a guy who enslaved the Native Americans and complained about the licentiousness of the modern day, so I don't see freedom coming from your systems. Freedom to do what, exactly? Destroy the environment, leave the world nigh uninhabitable, but not the freedom for two lovers to live as man and husband.
In any case, on the issue of COVID-19, the question is inherently calculating. Should we take some action requires understanding what will help and what won't. If the vaccine provided perfect protection at no risk, then no one could ethically be against it. If it was pure cyanide, no one could ethically be for it. Since it's neither, one must figure out how good it is and what the costs are. You even complained that Pfizer never calculated certain factors.
In any case, on the issue of COVID-19, the question is inherently calculating. Should we take some action requires understanding what will help and what won't. If the vaccine provided perfect protection at no risk, then no one could ethically be against it. If it was pure cyanide, no one could ethically be for it. Since it's neither, one must figure out how good it is and what the costs are. You even complained that Pfizer never calculated certain factors.
Ce sujet est poursuivi sur SARS-CoV-2 and COVID-19 (31...).
