Coronavirus Tidbits #230 1/29/23
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.
Reminder, Resilience: One Family's Story... is increasingly pertinent, as some of our politicians shift rightward. All proceeds go to Holocaust education.
In its weekly situation report, WHO said Covid cases have declined 25% over last 4 weeks. However, deaths rose 13%. #Covid deaths have been rising since early Dec, even without adding the more than 72,000 hospital deaths reported from China's recent surge
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A very important thread on #LongCovid from Hannah Davis:
Protein decoys for viruses may battle COVID-19 and more
Drugs designed to resemble pathogen’s cellular targets could prevent infection
Science 26 JAN 2023
As the fight against COVID-19 wears on and the virus continues to mutate, vaccines and several monoclonal antibody drugs are losing some of their punch. That’s added urgency to a strategy for preventing and treating the disease that, in theory, could stop all variants of SARS-CoV-2. The idea is to flood the body with proteins that mimic the angiotensin-converting enzyme 2 (ACE2) receptor, the cell-surface protein that SARS-CoV-2 uses to gain entry into cells. These decoys would bind to the virus’ spike protein, disarming it. The molecules might both protect people from getting infected and help COVID-19 patients clear the virus from the body.
One ACE2 decoy recently completed initial safety trials in humans, and trials of other decoy designs are expected to launch soon. A new preprint also shows that giving mice a gene coding for a decoy can provide long-term protection, a strategy that might help millions of immune-compromised patients who are unable to mount a robust immune response to vaccines. Success against COVID-19 might also boost efforts to develop decoys against other infectious diseases ranging from influenza to Ebola.
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Covid and Diabetes:
Acute and post-acute COVID-19 (i.e., long COVID) were associated with new DM only among hospitalized patients, with the highest risk among those hospitalized with severe disease. Those patients should be followed and monitored post-discharge for new DM. Patients who were not hospitalized did not have higher risk of new-onset DM.
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What doctors wish patients knew about COVID-19 reinfection
While many people assumed that getting infected meant higher protection from future encounters with the virus, the latest wave of COVID-19 cases shows that reinfections are becoming more common with newer variants—such as the XBB.1.5 subvariant of Omicron—contributing to second or even third infections...
“It can be problematic if you are reinfected,” “We know from a pretty elegant study that was recently published in Nature Medicine that each subsequent COVID infection will increase your risk of developing chronic health issues like diabetes, kidney disease, organ failure and even mental health problems.”
Such evidence “dispels the myth that repeated brushes with the virus are mild and you don’t have to worry about it,” he added, noting that “it is akin to playing Russian roulette.”
“There are some studies that have suggested that the more times you get reinfected, the more likely you're going to develop long COVID,” said Dr. Crum, noting “there was a recent study out of Washington University School of Medicine in St. Louis that looked at this question. They studied over 5 million veterans and dependents through a VA system.
“The bottom line is, if you get vaccinated, you are less likely to get sick, less likely to wind up in the hospital.” Only ~11% have gotten the bivalent vax in the US.
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As a clinician, I've seen young patients die of sepsis from atypical organisms with lymphopoenia weeks after acute COVID. I've seen deaths from TB and endocarditis. I've treated multidermatomal shingles. I routinely look out for post-COVID lymphopoenia 🧵https://t.co/6olE3uPIea— Dr Satoshi Akima FRACP 『秋間聰』 (@ToshiAkima) January 24, 2023
is not gone: see this case of a woman with no risk factors who contracted the disease, the journal Emerging Infectious Diseases reports. That’s in contrast to last year’s global outbreak: About 95% of cases were attributed to close physical contact and more than 98% were among men.
The woman in question, in her 20s and living alone, had no sexual or close physical contact with anyone suspected of having mpox during the two months before a rash developed on her face and mpox was confirmed. She had two massages in the two weeks before the rash developed, each time lying face down on a massage table, on top of a circular pillow covered by thin linen or a towel. The researchers suspect she caught it from contaminated linen and urge doctors not to rule out mpox too quickly in cases like hers.
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Avian flu (aka Bird flu, H5N1)
Mink-farm outbreak shows bird flu can spread between mammals
A new variant of H5N1 influenza could pose an increased risk to people and wild animals.
Nature Saima May Sidik 24 January 2023
An outbreak of avian influenza on a mink farm in Spain provides the strongest evidence so far that the H5N1 strain of flu can spread from one infected mammal to another.
The outbreak of H5N1 flu, described in a report in Eurosurveillance on 19 January1, occurred on an American mink (Neovison vison) farm in Carral in October 2022. Genetic sequencing showed that the animals were infected with a new variant of H5N1, which includes genetic material from a strain found in gulls, as well as a genetic change known to increase the ability of some animal-flu viruses to reproduce in mammals.
In the United States, infections have been found in about a dozen species, including raccoons, foxes, seals and grizzly bears.
Until this particular outbreak, all mammalian infections could be attributed to direct contact with virus-contaminated material, says Hualan Chen, a virologist at the Harbin Veterinary Research Institute in China. For example, animals that ingest wild-bird droppings, or that prey on infected animals, can develop the disease. But its spread between mammals “implies that this H5N1 virus may pose a higher risk to public health”, Chen says.
Study: Home COVID tests lead to vast undercount of cases, positivity rates
With over 80% of US COVID-19 tests now being conducted at home, official case counts underreport the number of positive results and greatly underestimate the number of true infections, suggests a research letter published yesterday in JAMA Network Open.
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Some troubleshooting for people who think they have COVID but are testing negative on rapid tests.
how to increase your chances of accuracy next time:
You’re testing too early: the early signs of Covid-19 — like fever and fatigue — are typically caused by your immune system’s initial response to the virus and are not necessarily a reflection of viral load.
Rapid tests are best used as an indicator of when you’re contagious with Covid-19 rather than when you’re infected with it,
You need to test again: A large meta-analysis of over 150 independent studies of rapid tests reported that, on average, the tests correctly detect a Covid-19 infection 73 percent of the time when a person is symptomatic. For asymptomatic infections, the accuracy drops to 55 percent...The accuracy of rapid tests improves a few days into an infection. A large study released as a preprint paper last year showed that rapid tests were only 60 percent accurate on the first day of a person’s infection if they had symptoms. Doing a second test 48 hours later improved rapid test accuracy to 92 percent for people with symptoms and 51 percent for asymptomatic infections. A third test after another 48 hours improved accuracy to 75 percent for people without symptoms.
the FDA now recommends so-called serial testing: If you think you’ve been infected with the coronavirus but test negative, test again in 48 hours, after the virus has had more time to replicate. If you’re still negative, take one more test in another two days.
You’re testing incorrectly: blow your nose beforehand. Tests for Covid-19 detect the virus in the cells that line the inside of your nose, not in your mucus, Also, make sure you’re going far enough up inside your nose.
Drugs and Vaccines:
Study shows updated bivalent boosters are more effective at preventing hospitalization and death from Omicron
In a peer-reviewed study on the real-world effectiveness of updated bivalent mRNA vaccines, researchers at the University of North Carolina's Gillings School of Global Public Health found that bivalent boosters are more effective than original monovalent boosters at preventing COVID-19 hospitalization and death. The study was published today in The New England Journal of Medicine.
The study analyzed vaccination and infection data of more than six million North Carolina residents from May to December of 2022, during which the Omicron variant's BA.4.6/BA.5 and BQ.1/BQ.1.1 strains were predominant in the United States. Both the Pfizer and Moderna bivalent vaccines were included in the study, which also considered different age groups, previous infection status, and the number of booster doses already received.
Booster effectiveness peaked at approximately four weeks after receipt of booster and waned afterward. Average effectiveness against severe infection resulting in hospitalization or death over a three-month period was 25% for one monovalent booster dose and 62% for one bivalent booster dose.
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Bivalent COVID Vaccines Stop Illness From XBB.1.5
Currently authorized bivalent COVID-19 boosters demonstrated similar protection against symptomatic illness from the XBB/XBB.1.5 Omicron subvariants as from BA.5-related subvariants, according to a CDC study.
From December 2022 to January 2023, the bivalent boosters' vaccine effectiveness (VE) against symptomatic infection was a similar 48% versus XBB/XBB.1.5-related strains and 52% versus BA.5-related sublineages-- in Morbidity and Mortality Weekly Reportopens in a new tab or window (MMWR).
In another CDC study: protection against symptomatic illness from BA.5- and XBB/XBB.1.5-related sublineages tended to be higher among younger individuals:
- 18-49 years: 52% and 49%, respectively
- 50-64 years: 43% and 40%
- 65 and older: 37% and 43%
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Researchers find immune response to COVID strengthens over time
Immunity from COVID-19 appears to gather strength with more time between vaccination and infection, a new laboratory study from researchers at Oregon Health & Science University suggests. The findings carry implications for vaccine recommendations as the pandemic transitions to an endemic state.
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'Annual COVID Boosters for All' Is All About Convenience
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Reading about "imprinting" and confused?
So am I. Three articles to help:
Katherine Wu's "Are Our Immune Systems Stuck in 2020?" in The Atlantic
and Ed Nirenberg's blog, in which he says, just get the vaccine.
A @nature feature nature.com/articles/d4158 by
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The benefit of vaccination after Covid to prevent #LongCovid, a ~40% reduction, across multiple organ systems (including lung, neurologic, diabetes) jamanetwork.com/journals/jaman
*New resource* for advocates for Masks in Schools
We have created a FAQ page and a downloadable, customizable template summarizing arguments for mask requirements in schools:
Mask mandates in schools reduce student and teacher absences
via Catherine Clase @email@example.com
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Interesting post on Ventilation: @PatrickHeizer
Pandemic Lesson #3: We Need an Air-Quality Revolution A simple intervention that will profoundly change society for the better is right in front of our noses.
A new study suggests the prevalence of long COVID was 36%
among George Washington University students, faculty, staff and other members of the campus community who had tested positive for COVID-19 between July 2021 and March 2022
Tips, general reading for public:
Florida Gov. Ron DeSantis (R) falsely said the bivalent COVID booster vaccine increases chances of SARS-CoV infection, according to a fact-checking report. (Tampa Bay Times)
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A California law targeting COVID misinformation was halted by a U.S. district court. (San Francisco Chronicle)
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New Randy Rainbow: Speaker of the House... Cunning little chap...
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- major government spending bill that she's dubbed the "omnimonster."
- She also did not attend an address at the Capitol by Ukrainian President Volodymyr Zelenskyy on Wednesday.
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Abortion, Reproductive rights:
Companies like Amazon, Chevron, Boeing, and Walmart all pledged support for abortion access and LGBTQ rights while giving political donations to the Alabama AG who has hinted at prosecuting medication abortions and banning gender-affirming care.
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Oregon launches abortion hotline offering free legal advice
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There are two Americas': Pregnancy-related deaths up to three times more likely in states with abortion bans
the Commonwealth Fund, an independent health care research foundation, that found maternal death rates in 2020 were 62% higher in states with abortion bans or restrictions compared to states where abortion is accessible.
- Babies born in states with abortion bans after the overturn of Roe v. Wade were 30% more likely to die in their first month of life.
- Twice as many single mothers were uninsured in banned states, compared to supportive states.
- Teen birth rates were twice as high in banned states.
- While fewer than 1 in 10 people live in Texas, 1 in 7 of all maternal deaths took place in the state, which has among the most limited abortion access in the country.
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A big step for W. MD: Letter to the Editor from The Mountain Maryland Alliance for Reproductive Freedom — A new organization in Mountain Maryland
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A poignant video of the 450+ protestors killed thus far in Iran. It’s not a coincidence that many of them are remembered singing and dancing; they died protesting a regime that has criminalized both activities. pic.twitter.com/mReLyPQmlD— Karim Sadjadpour (@ksadjadpour) December 7, 2022
Feel good du jour:
Labor protections for migrant workers:
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People ask me, "What exactly is #empathy?"— Hardeep Phull MD (@HardeepPhullMD) January 22, 2023
From now on, my answer will be, "THIS IS!"
Watch how this barber shows deep #compassion for the woman who is about to start #chemotherapy and appears devastated with losing her #hair and #Identity .
(bravos.barbeariaa on Instagram) pic.twitter.com/zq6vgHMco7
"UNHAND ME WOMAN"— Paul Bronks (@SlenderSherbet) January 27, 2023
📹: https://t.co/ddY2oRjYKv pic.twitter.com/NpdrUJUnlh
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"I've been compromised. Abort mission, I repeat, abort mission"— Paul Bronks (@SlenderSherbet) January 25, 2023
🎥: https://t.co/JxUaXArrz8 pic.twitter.com/o4HQlmSd5F
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Pelican’t.. 😂 pic.twitter.com/0Pd5b6JkX3— Buitengebieden (@buitengebieden) January 27, 2023
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After telling his wife that he was only going for one beer after work, Graham breaks under questioning and admits the truth.— Paul Bronks (@SlenderSherbet) January 24, 2023
🎥: https://t.co/5dtzDHiFZ3 pic.twitter.com/IrCr0T1wan
"The problem is that we are looking for someone to grow old with. And we really have to find someone, with whom we can remain children."
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David Crosby on how to live your twilight years:
"“If you spend that time doing everything you can to be happy, to help other people, to create, to make new things — to make anything better for anybody — if you spend your time doing positive stuff like that, then the time that you have left — whatever amount it is — will be well-spent. And that, I think, is the key.”"
Bits of beauty: