Coronavirus Tidbits #236 3/12/23

Bye-bye, Data:

The major providers of data on daily Covid-19 cases and deaths either aren’t going to do it anymore or are switching to less frequent reporting. At their best, they’ve alway been snapshots, but Johns Hopkins is shutting down its tracker today, CDC will update its stats only weekly (which may be bumpier due to delays at its sources), and Our World in Data has switched over to WHO’s weekly updates.

All this comes as few home testing results are reported to public health entities, adding a big asterisk to those case totals and making that snapshot blurrier.

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Covid backlash hobbles public health and future pandemic response

Lawsuits and legislation over COVID-19 response measure have weakened public health authority and the ability to respond to future pandemics, the Washington Post reported yesterday. It noted that at least 30 states have passed laws since 2020 limiting public health authorities and that more than half the country is barred from issuing mask mandates, closing schools, and taking other response steps.

https://www.washingtonpost.com/health/2023/03/08/covid-public-health-backlash/

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Long COVID is much less likely after omicron than after initial pandemic variant

https://medicalxpress.com/news/2023-03-covid-omicron-pandemic-variant.html?

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Study associates long COVID with physical inactivity

by Theo Ruprecht, FAPESP

The link between symptoms of COVID-19 and physical inactivity is increasingly evident. An article recently published in the journal Scientific Reports by researchers at the University of São Paulo (USP) in Brazil describes a study in which COVID-19 survivors with at least one persistent symptom of the disease were 57% more likely to be sedentary, and the presence of five or more post-acute sequelae of infection by SARS-CoV-2 increased the odds of physical inactivity by 138%.

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rats are susceptible to infection with SARS-CoV-2 

Bad news for big cities...

with Alpha, Delta and Omicron variants of SARS-CoV-2 and wild rats in the New York City municipal sewer systems and elsewhere in the city have been exposed to SARS-CoV-2.

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Indoor air is full of flu and COVID viruses. Will countries clean it up?

The current pandemic has focused attention to the importance of healthy indoor air and could spur lasting improvements to the air we breathe.

Nature   Dyani Lewis

Bars in Belgium could be among the healthiest places to have a drink, come July. That’s when a new law goes into effect, requiring public venues to meet air-quality targets and display real-time measurements of carbon dioxide concentrations — a proxy for how much clean air is piped in.

Consumers in Belgium will get even more information in 2025, when gyms, restaurants and indoor workspaces must all show air-quality ratings given through a certification system. In the event of a future pandemic, Belgium’s rating system could determine whether or not a venue is closed.

The law, enacted in July 2022, is the boldest in a string of moves that countries have taken in the wake of the COVID-19 pandemic to make indoor spaces safer in the face of infectious diseases caused by viruses such as SARS-CoV-2 and influenza.

https://www.nature.com/articles/d41586-023-00642-9

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Very good news
Metformin significantly helped prevent #LongCovid in a placebo-controlled randomized trial, a 42% relative reduction https://t.co/go20dm3NnN by @BramanteCarolyn
and colleagues pic.twitter.com/4uUZVINq62

— Eric Topol (@EricTopol) March 6, 2023

But a new randomized, placebo-controlled trial of metformin has yielded exciting results—the first drug to be shown to help prevent Long Covid. Over a thousand people with mild-to-moderate Covid were randomly assigned to 2 weeks of metformin (500 mg pills, 1 on day 1, twice a day for 4 days, then 500 mg in AM and 1000 mg in PM for 9 days) or placebo. There was a 42% reduction of subsequent Long Covid as you can see by the event curve below, which corresponds to an absolute decrease of 4.3%, from 10.6% reduced to 6.3%.

Of note, the participants in the trial were fairly representative of the people who most often go on to manifest Long Covid, outpatients with a median age of 45 years and 56% were female. The low risk subgroups of people age <30 years or with a normal BMI were excluded. There were no treatment by subgroup interactions—that is there were overlapping 95% confidence intervals for the direction of benefit for metformin for all subgroups; no clear evidence that metformin worked better or worse for each. That’s consistency, although the statistical power for an interaction term is limited with only ~1,000 patients and a larger trial would be needed to know whether any of the subgroups below had differential effects with metformin. The findings in the trial also reinforced the higher risk of unvaccinated vs vaccinated status to get Long Covid (14 vs 7% , respectively, among placebo assignees). The diagnosis of Long Covid in the trial relied upon it being documented by a medical provider. The mechanism of metformin’s apparent benefit is unknown, but perhaps is related to its impact on reducing oxidant stress and inflammation, or suppressing viral replication, as has been demonstrated in the lab and in vivo models with the SARS-CoV-2 virus.

There are no other adequately sized or rigorous trials that have evaluated metformin to date. So the question is, without an independent replication, whether this trial’s data should be considered sufficient to now recommend metformin in clinical practice. My view is yes, since the risk of side effects for 2 weeks of metformin is near zero (from both the trial itself and the huge experience with metformin over decades for chronic use) and the cost is remarkably low, in fact as low as $1-2 dollars for the 2 week course. The only other drug to date with some promising data to prevent Long Covid is Paxlovid, but that is from a large observational database, not derived from a randomized trial. Ideally, a 2X 2 factorial design trial would be conducted to test metformin plus paxlovid, either drug alone, or placebo. And to emphasize, we still have no drug validated to treat Long Covid, only 1 that now appears likely to help prevent it.

https://erictopol.substack.com/p/a-break-from-covid-waves-and-a-breakthrough

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New report warns long COVID could be "mass disabling event"

Canada’s chief science adviser estimated that 10-20% of people with COVID-19 develop long COVID. “Some patients have not recovered two to three years after the initial infection and it is uncertain whether a proportion may ever fully recover,” Nemer said in the report, adding that the lack of consensus on a clear definition and diagnostic criteria can make it difficult to lodge claims for social assistance, disability supports, and insurance.

“significant impacts on the labour market and the Gross Domestic Product (GDP), in addition to health costs and demands.”

https://www.insurancebusinessmag.com/ca/news/breaking-news/new-report-warns-long-covid-could-be-mass-disabling-event-439109.aspx

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Other:

The world's first mRNA vaccine for deadly bacteria

https://medicalxpress.com/news/2023-03-world-mrna-vaccine-deadly-bacteria.html…

Interesting because it should enable more rapid vaccine development against bacteria like plague and antibiotic resistant bacteria. Promising development.

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How the brain senses a flu infection — and orders the body to rest

Scientists trace the neurons in the throat that detect signs of infection and relay this information to the brain.

Nature   Liam Drew   08 March 2023

A case of influenza can make even the toughest people take to their beds and lose their appetites. Now, scientists have identified neurons in mice that notify the brain of a flu infection, triggering decreases in movement, hunger and thirst¹.

Similar neurons connecting to other parts of the body might notify the brain of other infections, too, the authors say. The work was published on 8 March in Nature.

“This study flips previous thinking on its head,” says Ishmail Abdus-Saboor, a sensory biologist at Columbia University in New York City who was not involved in the research. “This is paradigm-shifting in terms of how we think about sickness behaviour.”

The new results don’t tell the full story. The infection-sensing tonsil neurons are responsible for sickness behaviour only during a flu infection’s first stage, which affects the upper airway and lasts roughly a week. As the virus moves into the lower respiratory tract over the course of the illness, another nerve pathway takes over the job of driving sickness behaviours. “If we could find a way to block that second pathway, that, in combination, could have tremendous clinical impact,” Liberles says.

https://www.nature.com/articles/d41586-023-00675-0