COVID-19 treatment and vaccine update thread

[em2nought]

Not feeling like such an odd man out as I'm starting to see people other than me masked up. Don't think I've had it since the start, but I've never tested for it. I'm still the only person with a device on my shopping cart handle keeping me from actually touching that yucky thing.

[Kraken]

A few old people were wearing masks at the supermarket today. First time I've seen any in some time. I wasn't among them because I'm not old, dammit.

[stessier]

I'm not trying to be snarky. At this point I think barring folks who have been Smooving it up for 3.8 years and still never see others sans masks, etc, it's pretty likely that everyone's been pretty solidly exposed.

Okay, but exposure isn't the same as having Covid which is what we were originally responding to-the idea that everyone has had it at this point. I know I've been exposed - my wife had it last Christmas. No one else in the house got it. We chalk it up to early detection and then following the isolation, masking, air turnover protocols, and luck.

I'm not Smoove or LM, but I still attempt to decrease my risk of exposure whenever possible.

[Smoove_B]

I'm not Smoove or LM, but I still attempt to decrease my risk of exposure whenever possible.

Hey, I went out three times last year in public and spent time indoors unmasked! Three times!

No news on treatments, but another study published yesterday suggesting immune system dysfunction might be part of Long Covid:

We found that LC individuals exhibited systemic inflammation and immune dysregulation. This was evidenced by global differences in T cell subset distribution implying ongoing immune responses, as well as by sex-specific perturbations in cytolytic subsets. LC individuals displayed increased frequencies of CD4+ T cells poised to migrate to inflamed tissues and exhausted SARS-CoV-2-specific CD8+ T cells, higher levels of SARS-CoV-2 antibodies and a mis-coordination between their SARS-CoV-2-specific T and B cell responses. Our analysis suggested an improper crosstalk between the cellular and humoral adaptive immunity in LC, which can lead to immune dysregulation, inflammation and clinical symptoms associated with this debilitating condition.

I'll try to (poorly) translate, but essentially the idea is that very specific cells in your body that are involved in immune response - attacking/responding to foreign invaders - are being created at high levels - levels higher than necessary. And with overproduction comes general immune response in your body, including inflammation. It's almost as if your body is in a constant state of generalized early illness - where you might have fever, body and muscle aches and fatigue.

The core idea then is that your immune system is "stuck' in a state where it thinks you are sick, but you're not. I guess it would be like a CPU fan running at 120% normal speed because the temperature sensor thinks it is overheating. You're focused on the fan (because it's spinning loudly), but the temperature sensor is really he problem.

[Zaxxon]

I'm not trying to be snarky. At this point I think barring folks who have been Smooving it up for 3.8 years and still never see others sans masks, etc, it's pretty likely that everyone's been pretty solidly exposed.

Okay, but exposure isn't the same as having Covid which is what we were originally responding to-the idea that everyone has had it at this point. I know I've been exposed - my wife had it last Christmas. No one else in the house got it. We chalk it up to early detection and then following the isolation, masking, air turnover protocols, and luck.

I'm not Smoove or LM, but I still attempt to decrease my risk of exposure whenever possible.

I'm not saying exposure is the same as having it, but I am suggesting that exposure at the repeated (near-constant?) level that those who now venture out routinely are experiencing does make it seem like the odds of having had an asymptomatic case are high. Remember, based on the 'if you have a get-together with X people, the odds of >0 people carrying COVID are Y' stats we were throwing around going into the holidays, anyone going into a reasonably-sized office these days is statistically likely to be around someone spewing some level of COVID every single day. (Those odds have only gotten worse since we last discussed them.) As are those entering any non-barren store, school, etc.

[Smoove_B]

Study from this summer suggesting (at least) ~20% of people infected are asymptomatic:

To reach that finding, Hollenbach and her colleagues analyzed the genetic information of more than 1,400 unvaccinated people who tested positive for COVID-19 in April 2021 or earlier. Out of those people, 136 did not develop symptoms. (Many got tested because they had to for work or came into contact with someone who had COVID-19.)

I'd be kinda surprised to learn that holds through the variant soup we've experienced since 2021, but I would also expect there is a group of people that are indeed asymptomatic.

Either way, I think anyone engaging in high risk behaviors right now (and for the last 3+ weeks) is playing virus roulette. As I've been saying, there are times to be out and about unmasked. I do not believe now is that time.

[Zaxxon]

anyone engaging in high risk behaviors right now

To translate this to the discussion not involving public-health experts: anyone*.


* +/- 1% of the population.

[Smoove_B]

anyone engaging in high risk behaviors right now

To translate this to the discussion not involving public-health experts: anyone*.


* +/- 1% of the population.

Seen recently on social media as commentary on the latest surge:

"i should be fine, i mean, its me, the main character."

[Zaxxon]

‘Florida Man Discouraged to Realize He’s Only An NPC’

[Smoove_B]

Oy. New study going around today:

COVID-19 patients commonly present with signs of central nervous system and/or peripheral nervous system dysfunction. Here, we show that midbrain dopamine (DA) neurons derived from human pluripotent stem cells (hPSCs) are selectively susceptible and permissive to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. SARS-CoV-2 infection of DA neurons triggers an inflammatory and cellular senescence response. High-throughput screening in hPSC-derived DA neurons identified several FDA-approved drugs that can rescue the cellular senescence phenotype by preventing SARS-CoV-2 infection. We also identified the inflammatory and cellular senescence signature and low levels of SARS-CoV-2 transcripts in human substantia nigra tissue of COVID-19 patients. Furthermore, we observed reduced numbers of neuromelanin+ and tyrosine-hydroxylase (TH)+ DA neurons and fibers in a cohort of severe COVID-19 patients.

Ok, that's a lot of technical stuff. What does it mean?

Our findings demonstrate that hPSC-derived DA neurons are susceptible to SARS-CoV-2, identify candidate neuroprotective drugs for COVID-19 patients, and suggest the need for careful, long-term monitoring of neurological problems in COVID-19 patients.

(emphasis added)

Or from later in the paper:

"Given our findings, we posit that over the coming years, there is a need to closely monitor COVID-19 patients for an increased risk of developing Parkinson's disease related symptoms."

[hepcat]

I've been back to work now for about a week and a half. But man, I just cannot drop the cough. It's not frequent, but it's definitely annoying.

[Smoove_B]

I've been back to work now for about a week and a half. But man, I just cannot drop the cough. It's not frequent, but it's definitely annoying.

Word on the street is that it's unofficially being called "the 100 day cough".

[hepcat]

[gilraen]

In all fairness, though, I've gotten that kind of cough long before Covid was a thing. Way longer than 100 days, too.

[Smoove_B]

Possible blood test for Long Covid; continues to suggest link to immune dysregulation:

Long Covid has long eluded scientists looking for its cause. Not knowing what triggers its persistent and distressing symptoms makes the condition challenging to treat; it’s hard to even say definitively who has it. New research published Thursday in Science has identified proteins present in the blood of people with long Covid that could point the way to a much-needed diagnostic test and possibly to future therapeutic targets.

Scientists at the University of Zurich discovered high levels of proteins involved in the complement system — an important part of the immune system bridging innate and adaptive responses — that were disrupted in people with long Covid symptoms, but not in those who got better after the initial Covid-19 infection or in those who had recovered from long Covid symptoms after six months. The team also found damaged red blood cells and platelets as well as signs of harm to the endothelial cells that line blood vessels.

These biomarkers appeared after the researchers performed high-throughput analyses of more than 6,500 proteins found in the blood serum of 113 people infected with Covid, including 40 people who developed long Covid, and controls who were not infected.

Being able to definitively diagnose people would be a game-changer. However, figuring out what to do next is still unknown. That said, this should help...

[Zaxxon]

Note: positive news in the COVID thread! Remain calm!

[Alefroth]

Possible blood test for Long Covid; continues to suggest link to immune dysregulation:

Long Covid has long eluded scientists looking for its cause. Not knowing what triggers its persistent and distressing symptoms makes the condition challenging to treat; it’s hard to even say definitively who has it. New research published Thursday in Science has identified proteins present in the blood of people with long Covid that could point the way to a much-needed diagnostic test and possibly to future therapeutic targets.

Scientists at the University of Zurich discovered high levels of proteins involved in the complement system — an important part of the immune system bridging innate and adaptive responses — that were disrupted in people with long Covid symptoms, but not in those who got better after the initial Covid-19 infection or in those who had recovered from long Covid symptoms after six months. The team also found damaged red blood cells and platelets as well as signs of harm to the endothelial cells that line blood vessels.

These biomarkers appeared after the researchers performed high-throughput analyses of more than 6,500 proteins found in the blood serum of 113 people infected with Covid, including 40 people who developed long Covid, and controls who were not infected.

Being able to definitively diagnose people would be a game-changer. However, figuring out what to do next is still unknown. That said, this should help...

Yay. More reason to not take it seriously.

[Blackhawk]

Being able to definitively diagnose people would be a game-changer. However, figuring out what to do next is still unknown. That said, this should help...

Yes, please. My brain fog/cognitive hassles started before COVID, and I've never tested positive, but it's still entirely possible that the way it's gotten worse over the last couple of years could be the result of an asymptomatic infection.

[Moliere]

Being able to definitively diagnose people would be a game-changer. However, figuring out what to do next is still unknown. That said, this should help...

Yes, please. My brain fog/cognitive hassles started before COVID, and I've never tested positive, but it's still entirely possible that the way it's gotten worse over the last couple of years could be the result of an asymptomatic infection.

The great thing about Covid is that, depending on your political persuasion, you can blame the virus or the vaccine for all that ails you. I tend to lean towards getting older causes me more issues.

[Blackhawk]

Being able to definitively diagnose people would be a game-changer. However, figuring out what to do next is still unknown. That said, this should help...

Yes, please. My brain fog/cognitive hassles started before COVID, and I've never tested positive, but it's still entirely possible that the way it's gotten worse over the last couple of years could be the result of an asymptomatic infection.

The great thing about Covid is that, depending on your political persuasion, you can blame the virus or the vaccine for all that ails you. I tend to lean towards getting older causes me more issues.

I'm not blaming it for anything. I'm trying to get a diagnosis when one of the most likely causes (late aftereffects of chemotherapy) is impossible to test for. The best I can do is eliminate the other possibilities.

[Zarathud]

It is also possible that some other environmental factor is making Americans dumb. Like Romans with lead dishes and pipes.

[Moliere]

It is also possible that some other environmental factor is making Americans dumb. Like Romans with lead dishes and pipes.

Hookworms in the South.

[Pyperkub]

==https://www.cnn.com/2024/01/25/health ... d spike...

Some Robitussin Honey cough syrups sold nationwide are being recalled because of microbial contamination, according to an announcement posted Thursday. ..

... Immunocompromised people who use the products could experience “severe or life-threatening adverse events” such as fungemia — fungus in the blood — or a fungal infection, according to Haleon. In healthy individuals, life-threatening infections are not likely to occur.

“However, the occurrence of an infection that may necessitate medical intervention cannot be completely ruled out,” the announcement said.

To date, Haleon has not received any reports of adverse events related to this recall, the company said.

But is one 'healthy' when looking for the Robitussin?

[Max Peck]

Healthy is just so much easier to type (and read) than immunouncompromised.

[Smoove_B]

I'd posted that info in the recall thread this morning, fwiw.

Anecdotally, this report matches what I've heard:

Four out of five Veterans Affairs (VA) patients who had mild COVID-19 but had compromised immune systems were not offered the use of COVID antivirals, according to a study today in Morbidity and Mortality Weekly Report.

The study, though small, illustrates the reluctance of providers to prescribe antivirals, including Paxlovid, to patients who present with mild illness, but are at risk of progressing to severe disease.

Currently in the United States, anyone age 12 and older at risk for severe progression of disease is eligible for antiviral use at the first sign of a COVID-19 diagnosis. The antiviral drugs nirmatrelvir/ritonavir (Paxlovid) and remdesivir (Veklury) are approved by the Food and Drug Administration, and molnupiravir (Lagevrio) is authorized for emergency use.

When used within 5 days of symptom development, antivirals can reduce the severity and duration of the disease. But currently reported antiviral use among the general adult population has been 35% or less.

As I mentioned last month, when my parents (both in their late 70s) went to their (separate) doctors for a cough, fever and malaise in early December, they weren't even tested for COVID-19, much less offered an antiviral. I guess because they managed to walk in, they were deemed fine. For the record my moms is seemingly better (her cough lasted a solid month) but my dad is still coughing 6+ weeks later. He has early stage pulmonary fibrosis (diagnosed for the first time a year ago) so to suggest I'm beyond frustrated for him is an understatement.

[Smoove_B]

New study about cognitive slowing:

We identified pronounced cognitive slowing in patients with PCC (Post Covid Conditions), which distinguished them from age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest PCC. Cognitive slowing was evident even on a 30-s task measuring simple reaction time (SRT), with patients with PCC responding to stimuli ∼3 standard deviations slower than healthy controls. 53.5% of patients with PCC's response speed was slower than 2 standard deviations from the control mean, indicating a high prevalence of cognitive slowing in PCC. This finding was replicated across two clinic samples in Germany and the UK. Comorbidities such as fatigue, depression, anxiety, sleep disturbance, and post-traumatic stress disorder did not account for the extent of cognitive slowing in patients with PCC. Furthermore, cognitive slowing on the SRT was highly correlated with the poor performance of patients with PCC on the NVT measure of sustained attention.

So that's something.

[Smoove_B]

Yeah, just me. New study on infants:

A new study finds that babies born to women who got COVID while they were pregnant were three times more likely to develop serious breathing problems than infants whose mothers didn’t have the disease during pregnancy, even if the infants weren’t infected themselves. Seventeen percent of the babies in the study who were exposed to COVID before birth developed respiratory distress, compared with only about 5 to 6 percent of newborns in the general population before the pandemic. The findings were published on Wednesday in Nature Communications.

...

Notably, COVID vaccination in the mothers conferred significant protection to their baby, the researchers found. Infants whose mother received at least one dose of an mRNA vaccine were 67 percent less likely to experience serious breathing problems than those whose mother was unvaccinated.

Relatively few pregnant women in the study, which involved babies born from April 2020 to August 2022, received two doses of a COVID vaccine before giving birth. Given the evidence from other studies showing the benefits of vaccination in pregnant people and babies, the authors of the new paper say that two doses or more likely provide even better protection against newborn respiratory distress.

So that's short term - what we are potentially seeing in infants after they are born. What are we going to see in the next decade? In 2045?

The researchers followed the infants for six months and don’t know if any of the babies had longer-term complications.

[Isgrimnur]

[Smoove_B]

I feel this in my soul

[Smoove_B]

Since we're in "transition" between the Fall 2023 shot and whatever is happening now (until the Fall 2024 shot), this this is a good resource:

Regarding protection:

Another factor influencing immunity is how severe the infection is. Jeremy Kamil, an epidemiologist at Louisiana State University Health Shreveport, says that if you get a mild infection, "your body's not going to respond with its most heavy armaments as it would when you get a [more severe] infection." That latter bodily response is what triggers longer lasting immunity. So if you tested positive but weren't really too sick from your most recent case of COVID, you might not have as much immunity protecting you from reinfection.

Dr. Abraar Karan, an infectious disease physician and researcher at Stanford University, says there would "likely be some protection" afforded from being infected from one variant to another, but adds that post-infection immunity isn't predictable enough to count on for very long.

Regarding when to test:

The thing is, those at-home tests detect the antigens that build up in your body as the virus multiplies — and it might take up to four or five days for those antigens to register on a test.

Data from a study published last September in the journal Clinical Infectious Diseases suggests that on the first day you feel sick, home antigen tests are only about 30-60% accurate at confirming you're infected. On the fourth day of symptoms, when your viral load is higher and the antigens pile up, those tests are closer to 80% accurate.

When to stop masking after a positive test (remember masking?):

As for when to unmask when you're recovering from a confirmed case of COVID, our experts say it's safe to do so after a single properly performed negative test.

But they emphasized that it is important to think about others when making the decision to unmask and you may want to be extra cautious in certain environments. "Context is everything," says Kamil. If it's only been a day since you tested negative and you're going to be around people who are elderly, immunocompromised or unvaccinated, consider keeping your mask on for a while to minimize the risk of passing COVID to those people.

Regarding "boosters" (I'm putting it in quotes because we're really trying to get away from calling it a booster):

Our experts say it's ideal to get boosted about every six months to keep your immunity at its highest. Even if you can't manage to get boosted that often, epidemiologist Jeremy Kamil says that at a minimum you should aim to get boosted once a year.

...

One exception to this rule is if you've had COVID in the last three or four months. Then, Kamil says, "you might want to wait until you're closer to six months out [from being infected]," before getting boosted in order to get the fullest effects of vaccination. If your immune system is already primed from a recent case of COVID, the vaccine won't enhance your protection by much.

That's actually the first I can recall seeing someone say to wait 6 months after an infection to get boosted. It certainly tracks with everything else I know about immunity and other illnesses, but I don't know if that's widely accepted yet for COVID-19; I guess we'll see.

[stessier]

Getting a shot every 6 months is nice in theory but no one offers them that often (as far as I can tell).

[Smoove_B]

Getting a shot every 6 months is nice in theory but no one offers them that often (as far as I can tell).

I think you're right, yes. Unless you (possibly) meet very specific health criteria and have approval from a doctor. Considering many doctors won't even prescribe Paxlovid, I'm not sure what to make of this comment in the article. It could be the disconnect between research vs practice.

[LordMortis]

Getting a shot every 6 months is nice in theory but no one offers them that often (as far as I can tell).

I think you're right, yes. Unless you (possibly) meet very specific health criteria and have approval from a doctor. Considering many doctors won't even prescribe Paxlovid, I'm not sure what to make of this comment in the article. It could be the disconnect between research vs practice.

The and is important. My new PCP could probably fight to get me another shot of the current strain in March but we're new to each other and we're too busy trying to get all my chronic conditions settled in while also meeting all of the medicaid requirements I must meet, as I couldn't qualify for the ACA with my lack of real income.

[Smoove_B]

Given the presumed levels of virus that just washed over everyone (inferring from wastewater data), it's anyone's guess how the Spring will start trending. Will there be enough temporary acquired immunity to keep circulating levels lower? Or will the new variant(s) just zip through all the people that haven't received a shot since Fall of 2022 and just start cutting through communities again in March and into April?

Anecdotally I get the impression people are still sick with "something mysterious" and/or have been sick on and off since Thanksgiving. Will that stop soon or continue? I guess we'll see. I mean, you'll all see - I'm still in my bunker.

[LordMortis]

I never hear mysterious. I hear, "oh it's just...."

Also here, it's April things go nuts because people go nuts the weekend of St Patty's day. Local COVID super spread explosion part five is right around the corner. I'm on four months of antibiotics, so I'm still good with not going out... Year five? Holy shit! That's a damned felony prison sentence!

[Smoove_B]

You can ask Trent Steel and RM9 - I'm sure for them it is like I've been sent to prison. I have largely disappeared from public life and I honestly don't see that changing any time soon; at this point I've adapted.

And yes, I'd fully expect things to potentially become elevated around Spring Break and St. Patrick's Day - but again, the levels of viral circulation have been so high for the last ~2 months, will that have passed on enough (any?) short-term immunity that will help keep overall circulation down as we head into April? My gut feeling is yes, it will be a lower level of community spread in the Spring of 2024, possibly setting us up for a surge in June or July then. It's a total guess though and doesn't in any way account for variants.

About the only thing I know is that it will still be around in 2024. What life will be like this year and into the Fall? I guess we'll see.

[Trent Steel]

About the only thing I know is that it will still be around in 2024. What life will be like this year and into the Fall? I guess we'll see.

Probably exactly like it is now.

[Smoove_B]

Probably exactly like it is now.

Oh no. There's definitely potential for it to be much worse.

The question is whether or not I hold out hope for it being better.

[Anonymous Bosch]

Probably exactly like it is now.

Oh no. There's definitely potential for it to be much worse.

The question is whether or not I hold out hope for it being better.

[stessier]

I'm in an audit this week and this lunch break the auditors are giving their opinions on COVID and vaccines. Fun times.