Coronavirus Tidbits #175 2/16/22

January 16, 2022 /

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Announcements:

First, there is now a Resources Page here for the most commonly asked questions I’m getting.

Happy to continue to answer your questions/concerns as best I can, so don’t be shy about that.

Recent posts:

ACIP Releases New Dengue Vaccine Recommendations

https://www.medscape.com/viewarticle/966519

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Some Prisoners Face Risk for COVID From the Community

https://www.medscape.com/viewarticle/965506

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CDC’s Isolation Guidelines Are Inadequate

https://www.medscape.com/viewarticle/966003

News 

Omicron:

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Other news:

Polish scientists have found a gene that more than doubles the risk of developing severe COVID-19. (Reuters)

https://www.reuters.com/business/healthcare-pharmaceuticals/polish-scientists-find-gene-that-doubles-risk-serious-covid-2022-01-13/

Diagnostics:

still an incredible, negligent last of testing.

Drugs and Vaccines:

Omicron thwarts some of the world’s most-used COVID vaccines

Inactivated-virus vaccines elicit few, if any, infection-blocking antibodies – but might still protect against severe disease.

Nature Elie Dolgin 13 January 2022

Inactivated-virus vaccines contain SARS-CoV-2 particles that have been chemically treated to make it impossible for them to cause an infection. Stable and relatively easy to manufacture, such vaccines have been distributed widely as part of China’s global vaccine diplomacy, helping them to become the jab of choice in many countries. But a multitude of experiments show that they are consistently hobbled by Omicron.

Many people who receive two jabs of an inactivated vaccine fail to produce immune molecules that can counter Omicron transmission. And even after a third dose of an inactivated vaccine, an individual’s levels of ‘neutralizing’ antibodies, which provide a potent safeguard against viral infection of cells, tend to remain low. A third shot of another type of vaccine, such as those based on messenger RNA or purified proteins, seems to offer better protection against Omicron.

The findings are prompting many scientists and public-health researchers to re-evaluate the role of inactivated vaccines in the global fight against COVID-19.

https://www.nature.com/articles/d41586-022-00079-6

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‘Killer’ immune cells still recognize Omicron variant

Nature Heidi Ledford 11 January 2022

Amid concerns over lost antibody defences, some researchers argue that more attention should be paid to T cells…

Last month, Pfizer and BioNTech announced that their COVID-19 vaccine failed to rouse a sufficient antibody response in children between two and five years old. As a result, the vaccine hasn’t been authorized in the United States for children under five. “They didn’t even look at T-cell response,” points out Robins….

T cells might also get more attention as more variants emerge – and if the world begins to shift its focus from the number of infections to the severity of disease, says Geurts van Kessel. “Are you interested in infectivity? Then antibodies might be the more important measurement to do,” she says. “Whereas if you are interested in severe disease – which may be the case for the disease we are looking into now – T cells become much more important.”

https://www.nature.com/articles/d41586-022-00063-0

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Kids’ low COVID-19 vaccination rates called a ‘gut punch’

Distrust, misinformation and delays because of the holidays and bad weather have combined to produce what authorities say are alarmingly low COVID-19 vaccination rates in U.S. children ages 5 to 11.

https://medicalxpress.com/news/2022-01-kids-covid-vaccination-gut.html?

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COVID-19 pill rollout stymied by shortages as omicron rages

Two brand-new COVID-19 pills that were supposed to be an important weapon against the pandemic in the U.S. are in short supply and have played little role in the fight against the omicron wave of infections.

https://medicalxpress.com/news/2022-01-covid-pill-rollout-stymied-shortages.html?

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What’s the Benefit of a Fourth COVID Vaccine?

– Experts say additional boosters could provide diminishing returns

The Goal of a Fourth Dose

While the uncertainty around future outbreaks or the emergence of new variants makes it difficult to determine whether or not a fourth dose will be necessary for more people in the U.S., experts said it is critical to understand the goal of a fourth jab before offering it.

Vaccines have two functions: to block infection and to block disease. In immunocompetent people who have received two doses and a booster shot, the current COVID-19 vaccines have “excellent disease-blocking activity,” Poland said.

But with Omicron — a variant characterized by its large number of mutations and high transmissibility — the vaccines’ ability to block infection is less effective.

Data from Israel show that after a third dose of the COVID-19 vaccine, antibodies began to wane around the 10-week mark, leaving individuals susceptible to infection with Omicron. Although preliminary evidence shows a sharp increase in antibody production following a fourth dose, it is unclear how long those antibodies will remain at high levels.

The important thing is that people have expanded memory B-cell and T-cell immunity to block severe disease and hospitalization — which has continued to be the case with the current vaccines, Sette said.

“The fact that you have memory B cells that can restart an antibody response at any point in time is what matters,” he said in an interview.

Immune System Exhaustion? Unlikely, Experts Say

While concerns have been raised that fourth doses or continued booster shots as the pandemic goes on may be harmful, or cause a sort of immune system fatigue, experts said that immune system exhaustion is an unlikely possibility.

“We are exposed to pathogens on a regular basis, over and over again,” Liu said. “It’s not like we lose our immunity to them, and not like our T cells get exhausted from that.”

However, another possibility is a concept called “original antigenic sin.” This occurs when the immune system refines its response to an original strain of a pathogen, making its response against subsequent variants less effective.

Liu said that we have not seen much evidence that original antigenic sin will be detrimental to our vaccine responses against new variants. Regarding both Delta and Omicron, higher antibody levels that have been generated by mRNA vaccines against the original spike protein have been able to overcome the reduced specificity of those antibodies against mutated strains.

“So far, we have gotten lucky in that way,” she said.

https://www.medpagetoday.com/special-reports/exclusives/96591?

Devices:

Wearable air sampler assesses personal exposure to SARS-CoV-2

https://medicalxpress.com/news/2022-01-wearable-air-sampler-personal-exposure.html 

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Finally, CDC joins scientists in telling people to wear better masks!

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Epidemiology/Infection control:

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One in ten people may still be infectious for COVID after ten days–

supporting the recommendation to test before leaving quarantine.

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Viral load of omicron can be at its highest at day five so cutting isolation period doesn’t make sense

https://medicalxpress.com/news/2022-01-viral-omicron-highest-day-isolation.html?

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When will this COVID wave be over? Four numbers to keep an eye on and why

Before Australia’s recent changes to COVID testing, working out when we reached the peak of cases was, in principal, straightforward. – What goes into modeling?

https://medicalxpress.com/news/2022-01-covid-eye.html?

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Too Much Focus on Boosters, Says FDA Vaccine Advisor

– At the hospital level, COVID-19 remains “a disease for the unvaccinated,” says

Paul Offit, MD

https://www.medpagetoday.com/publichealthpolicy/healthpolicy/96635?

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Tips, general reading for public:

Tatiana Prowell (@tmprowell) and others have tips for newly infected and/or exposed, below. See also https://cleanaircrew.org/someone-in-my-home-has-covid-how-do-we-isolate-safely/

1/ The first thing to say is that if someone has #COVID19 symptoms (#Omicron most common: nasal congestion/runny nose, scratchy sore throat, fever, & aches), you have to assume they have it. You may not have a test (urgent cares are still open & do) or they may still be neg.

2/ You, as the person exposed to the one with symptoms, have to assume that you both do & don’t have #Omicron too. Wait, what?  I mean: assume you could infect others now & take care to avoid exposing them, BUT don’t assume it’s too late for you to avoid getting it.

3/ Especially in households with #vaccinated (& #boosted) family members, I have seen people manage to limit #Omicron to the first person who was infected. This #CovidVariant is incredibly contagious, but It CAN be done. Don’t give up on the idea!

4/ If you have N95/KN95/KF94 masks, get in them immediately. If you have only 1, put the sick person in it for source control. If you have >1 but not enough for all put the sick one & the highest risk (older, #immunocompromised) people in them. Then get outside, & leave door open.

5/ Fresh air is a friend & shared air is an enemy. The more you can ventilate your , now & until this is over, the better. You want the concentration of #omicron in air as low as possible. This decreases odds of infection & may make you less sick if you do get infected.

6/ Plan to bundle up if you’re in a  climate, because you’re going to need to leave doors & windows open enough for air exchange, esp for next 5d or so, & a cross draft. If you have a fresh HVAC filter, change it. If a hardware place is open, get a MERV13 HVAC filter. (Amazon has too.)

7/ Run the fan on your thermostat on high. Filter that #Omicron ! If you need supplies of any kind, please do curbside pickup or same-day delivery or drive-thru. No one exposed should be indoors in public, & def not the one with symptoms, to prevent further spread.

8/ If you don’t have any N95/KN95/KN94 masks, please see if a nearby friend or neighbor has unused ones you can have & order them replacements. The nonprofit @projectn95  (http://projectn95.org) is a great place to get them. Your backup plan for right now is a surgical mask.

9/ A surgical mask (ASTM level 3, 3-ply is best) has good filtration but usually not good fit. There are often gaps. Knot ear loops where they join the mask & then tuck to improve the mask fit. Here’s a short video demo: https://youtu.be/GzTAZDsNBe0. Put a cloth mask over the surg mask.

10/ Now it’s time to create the space where the infected person or people will isolate for 10d to let #Omicron run its course. This prior  of mine covers what is helpful to have in there & other things to consider.

11/ This whole scenario assumes that things are going ok with the person who has #Omicron. How do you know if they are ok? As I mentioned before, if you have a pulse oximeter (O2 sat monitor)-the thing drs put on your fingertip to measure O2-use it. See guide in .

12/ If you don’t have a pulse oximeter, many pharmacies carry them. They are over the counter. Ask the pharmacist if you don’t see them. You can order them online from many places too. Get one highly rated by many people. They need not be expensive. $15 gets a very good one.

13/ Some of your devices (smart watches, fitness trackers) can detect heart rate (60-100 normal for adults) & less reliably O2 levels. If you have them & they read low O2 levels, def do call a dr or seek care. Video calls are helpful to check on the sick as well.

14/ If the person w/ #Omicron is high-risk (especially #immunocompromised, organ or bone marrow transplant, active #cancer, #pregnant, #diabetes, older, etc), they should contact a dr even if they seem ok. There are outpatient treatments that sig risk of being hospitalized.

15/ These include monoclonal antibodies (some brands no longer work vs #Omicron, but 1 called sotrovimab remains effective). It is given IV as a single dose. There are also two types of pills taken for 5d at home. All are in short supply at the moment. https://google.com/amp/s/abcnews.go.com/amp/Health/omicron-treatments-monoclonal-antibodies-work-variant/story%3fid=81893922….

16/ All of these things to treat outpatients w/ #Omicron, the monoclonal antibody sotrovimab, as well as the pills (Paxlovid: https://google.com/amp/s/www.nytimes.com/2021/12/22/health/pfizer-covid-pill-fda-paxlovid.amp.html…) & (molnupiravir: https://google.com/amp/s/www.nytimes.com/2021/12/23/health/covid-pill-merck.amp.html…) are new, so they are being reserved for higher-risk folks while supply increases. [Paxlovid is better imho] 17/ If you are not the sick person, but one of the exposed, & you can walk-up/drive-up (NOT indoors & ONLY in a !) to #GetVaccinated, do it. If age 16+ & 6+ mos post dose 2 of vaccine (or 2+ post J&J), go #GetBoosted now! The booster protects w/in a wk! 19/ If you are high-risk #immunocompromised or #immunosuppressed, we know that #vaccineswork less well in many of you. While you should still #GetVaccinated & #GetBoosted, an injection (Evusheld) can decrease your risk of #COVID19. It’s given every 6 mos. ~ ~ ~ Also #Remdesivir might be available as an outpatient for high-risk- (1.6%) in the remdesivir group and 21 of 252 (8.3%) hosp or death in placebo https://www.nejm.org/doi/full/10.1056/NEJMoa2116846 I suggest contacting the local health department +/- hospital to see where any of these drugs might be available. There are very limited supplies.

Politics:

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This clarification from Daniel Dale does not take away the fact that Walensky’s comments were, at best, ablest and, at worse, smacked of eugenics. She should know better.

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https://twitter.com/ReportsDaNews/status/1482175185797140481?s=20

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Feel good du jour:

The eye doctor restoring sight to nomadic herders

https://medicalxpress.com/news/2022-01-eye-doctor-sight-nomadic-herders.html?

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Comic relief:

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Perspective/Poem:

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Bits of beauty:


 

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