COVID-19 treatment and vaccine update thread

[gilraen]

My job is with software that hospitals use to track employee compliance with vaccination programs. It's very noticeable to me. Some of our clients - big hospitals - that maintained "mandatory" flu vaccination programs (only exemptions allowed are medical or religious) for years and years have suddenly switched this flu season to allow declinations for any reason ("I just don't want it").

[Smoove_B]

It is known. They (CDC, public health) understand why. Political capital has been eviscerated and the will to enact anything on a state or local level has vaporized. It blows my mind that I'm still getting paid to tell people about how important these things are in a timeline where clearly they aren't.

[Zarathud]

Politics. Management would rather deal with the staff shortages during outbreaks than OUTRAGE! and lawsuits over mandatory vaccination. Never mind that OSHA regulates workplace conditions down to the type of extension cords used.

[LawBeefaroni]

We mandated flu and offered COVID. But when I got my flu shot, they were out of covid (only 12 doses ??!).

It's been a pain in the ass to get, and I'm at a hospital at least 4 days a week. I cant imagine many people going way out of their way to get a COVID shot.

[LawBeefaroni]

Politics. Management would rather deal with the staff shortages during outbreaks than OUTRAGE! and lawsuits over mandatory vaccination. Never mind that OSHA regulates workplace conditions down to the type of extension cords used.

Maybe a rebate/reduction on health insurance premiums would do it. They already have that for smokers/non-smokers and there just as direct a line between preventing COVID and healthcare savings as with not smoking. Get the vax, get $N off your insurance deduction every two weeks, or whatever the cadence is.

[hitbyambulance]

it's now been 90 days since the end of my COVID bout. time to get the booster?

[Smoove_B]

I'm no doctor, but that is what the current guidance recommends, yes - get thee to a vaccination site!

[hitbyambulance]

going through CVS for the government 'bridge' program since i don't currently have health insurance. i found out they only issue Novavax several times a month - the CVS by me does it on the 10th and 20th of each month, and the one at the downtown Target does it on Fridays - something about not wasting multidose vials. nothing about this is mentioned on cvs.com or on vaccines.gov - CVS only says Novavax 'does not require an appointment' unlike Moderna or Pfizer.

[Smoove_B]

CVS only says Novavax 'does not require an appointment' unlike Moderna or Pfizer.

Novavax is stored at refrigerated temperatures so it doesn't required advanced prep (like Moderna or Pfizer which are stored frozen). Is your local (county) health department offering weekly clinics or partnered with a hospital system to offer free/low cost vaccinations for those without insurance?

[Smoove_B]

First study I've seen confirming anecdotal reports that using a throat swab is more accurate for rapid testing:

Today in JAMA Network Open, a randomized clinical trial shows that a single healthcare worker (HCW)-collected throat swab had significantly higher sensitivity for COVID-19 rapid antigen testing (RAT) than an HCW-collected nose swab during Omicron predominance, but self-collected nose swabs were more sensitive than self-collected throat swabs among participants with symptoms.

However, it's important to note that self-collecting a throat sample is not as easy as a self-collected nasal sample. Take away:

The findings "demonstrate that the throat sample technique is more challenging than obtaining a nasal sample, as we found a lower sensitivity and a higher number of inconclusive rapid antigen test results for self-collected throat specimens compared with HCW-collected throat specimens," the researchers wrote. "In contrast, no difference was found between HCW-collected and self-collected nasal specimens."

Using both nasal and throat swabs increased sensitivity for HCW- and self-collected specimens by 21.4 and 15.5 percentage points, respectively, compared with a single nose swab.

"Our findings suggest that the current testing recommendations should include throat specimens to improve the sensitivity of rapid antigen testing," the study authors wrote. "Further research should confirm our findings using redesigned and other rapid antigen testing devices and explore whether throat specimens can also improve the detection of other common airway infections."

[Smoove_B]

In not great news, another study about the impacts of the virus on infants:

A new study based on a cohort of Brazilian infants shows those who were exposed to SARS-CoV-2 infections in the uterus may be at an increased risk for developmental delays in the first year of life.

...

"All mothers were unvaccinated at the time of cohort inclusion, and maternal demographics were similar in the two groups," the authors wrote.

At 12 months, 20.3% of COVID-exposed children and 5.9% of the controls received a diagnosis of neurodevelopmental delay (risk ratio, 3.44; 95% confidence interval, 1.19 to 9.95).

For the exposed group, the prevalence of neurodevelopment impairment using the Ages & Stages Questionnaire (ASQ-3) was 35.7% at 4 months, 7.0% at 6 months, and 32.1% at 12 months.

More details:

Previous studies conducted in the United States and elsewhere have shown a risk of delays in infants exposed to COVID-19 infections in utero, but this is the first study to look at the phenomenon in northern Brazil.

In follow-up of exposed infants, the researchers found 10% had an abnormal result on cranial ultrasonography, mainly mild ventriculomegaly, a swelling in the brain caused by cerebrospinal fluid buildup.

"That has been described with other congenital infections, like cytomegalovirus and Zika virus," they wrote. "Although the findings were mostly mild, there was an association between the diagnosis of abnormalities and the risk of developmental delay."

[Sudy]

First study I've seen confirming anecdotal reports that using a throat swab is more accurate for rapid testing:

[...]

Hey I wanted to ask your opinion: in the middle-late stages of "back when people took COVID seriously", my grandmother's care home started doing a cheek swab before doing the nasal swap (with the same swab) when rapid testing. Is that something I can/should be doing with the home test kits I have that only instruct to do nasal swabs? Is there any way that could mess the test up? I'm not sure how home tests may vary.

[Smoove_B]

Yeah, that was all part of the anecdotal evidence suggesting throat and cheek swabs (in combination with nose) were better at detecting the virus. However, I'm only aware of this study which suggested the cheek swab wasn't as effective as nasal for detection. I think I mentioned it on the other side of the fence, but over the summer (I think) I was following someone on social media that came down with COVID-19 and they were using different test kits and sampling from nose, throat and cheek to see if the various kits would pick up the virus. There were different results from kits not only in location but also in whatever day it was they were testing. All unofficial, but it does suggest there's more to it.

I am guessing there's still so much we don't know and more testing (with larger pools of people) is needed. It's also possible different variants colonize different areas (or at different rates) so mixed-site testing works better. Endless questions....

[Zaxxon]

more testing (with larger pools of people) is needed.

I've got great news about a gigantic ongoing test--spans billions of participants across all sorts of backgrounds & borders!

[hitbyambulance]

CVS only says Novavax 'does not require an appointment' unlike Moderna or Pfizer.

Novavax is stored at refrigerated temperatures so it doesn't required advanced prep (like Moderna or Pfizer which are stored frozen). Is your local (county) health department offering weekly clinics or partnered with a hospital system to offer free/low cost vaccinations for those without insurance?

so vaccines.gov said to go get it at CVS since they are in the 'Bridge' program (which offers vaccination for free for those without insurance). got it today at the downtown Target - all they needed was my SS#. i'm going to be flying to MN in a couple weeks, so i wanted time for the immunity to start gearing up...

i may be the first Novavax recipient on this forum? i've been following Novavax's development since the beginning. (initial series and booster were both Moderna, then the last one i got last year was Pfizer)

[Smoove_B]

From the latest summary, coverage as of 12/2/23 is embarrassingly low:

6.9% of children
16.0% of adults
33.3% of seniors

[Smoove_B]

If you're going to have a medical emergency, try to schedule that sooner than later:

Hospitals and emergency rooms could be forced to ration care by the end of this month, the Centers for Disease Control and Prevention warned Thursday, saying recent trends in COVID-19 and influenza are now on track to again strain America's health care system. The new COVID variant JN.1 is making up an increasing share of cases, the CDC's tracking shows.

"COVID-19 hospitalizations are rising quickly," the agency said in its weekly update. "Since the summer, public health officials have been tracking a rise in multisystem inflammatory syndrome in children (MIS-C), which is caused by COVID-19. Influenza activity is growing in most parts of the country. RSV activity remains high in many areas."

[Smoove_B]

One for the "It's just like the flu crowd:

The study, a comparative analysis with 18 months of follow-up of hospital admissions for those with COVID-19 and those with seasonal flu, found that COVID-19 patients experienced significantly higher rates of death, healthcare utilization, and adverse health outcomes in most organ systems than did patients with the flu. Its results were published on Dec. 14 in the infectious diseases section of the medical journal The Lancet.

...

Al-Aly’s study undertook a comparative analysis of 94 pre-specified health outcomes and found that over 18 months of follow-up, COVID was associated with a “significantly increased risk” for 64 of them, or nearly 70%. The disease’s enhanced risk list includes everything from cardiac arrest, stroke, chronic kidney disease, and cognitive impairment to mental health and fatigue, two characteristics often associated with long COVID.

By comparison, the seasonal flu was associated with increased risk in only six of the 94 conditions specified. Further, while COVID increased the risks for almost all the organ systems studied, the flu heightened risk primarily for the pulmonary(lung) system. Those findings, Al-Aly says, suggest that “COVID is really a multi-systemic disease, and flu is more a respiratory virus.”

...

The result: COVID-19 poses a much higher risk, both in the short run and long term, than flu. But the flu remains “a formidable foe,” Al-Aly says. “Going into this winter season where cases of COVID and flu are rising, people should make sure they are vaccinated for both, and for RSV if they qualify, and take precautions to lower their risk.”

I think the biggest thing to note (however, after some detailed reading) is that the study is focusing on people that have been hospitalized. In other words, the group they're pulling data from is not a healthy population, i.e. it's likely they already had diseases and conditions prior to the COVID-19 diagnosis. Similar to the Long Covid study that was don on elder white military veterans, it's not something we should be scaling out to the general public...yet.

[Moliere]

I came down with Covid symptoms. Not sure if it's actually Covid, but the symptoms gave me a great excuse to socially isolate from the in-laws during the Christmas party.

[hepcat]

My lucky streak may be over. I started getting a sore throat and cold on Thursday of last week. Today I took a self test and it showed positive for Covid. This may be it, folks. The damn thing may have finally caught up to me.

So far it's just like a head cold with a bad sore throat. Although I'm also a bit light headed. It's been about 5 days. Hopefully it will start to get better soon. I'm going to hit up a minute clinic in the morning for an official test though.

[Zarathud]

A going away present from Ohio, hepcat.

[hepcat]

And 2nd test was positive. Quarantine time. Thankfully, my throat is feeling much better and my congestion is almost gone. So I suspect I'm on the downward end of the trip.

[Zaxxon]

And 2nd test was positive. Quarantine time. Thankfully, my throat is feeling much better and my congestion is almost gone. So I suspect I'm on the downward end of the trip.

Congratudolences!

[hepcat]

The only really concerning part of is that light headedness, as I mentioned. I wasn't expecting that. Feels like I'm high.

[Isgrimnur]

Are you comfortably numb?

[Smoove_B]

The only really concerning part of is that light headedness, as I mentioned. I wasn't expecting that. Feels like I'm high.

You didn't ask, but I'm telling -- so many researchers seem to be coming to the conclusion that we're severely underestimating how important rest is, even for so called "mild" cases of COVID-19. Vaccinations are absolutely important in reducing risk of hospitalization and death, but we really seem to be in the Wild West with how to advise people that (1) are vaccinated and (2) have mild cases. Sure, there's a general "take it easy" mentality that is communicated, but we might end up finding that COVID-19 puts everyone at increased risk for microscopic damage to organs or organ systems - similar to how many will have an enlarged spleen after mono. In this case it seems to be a concern that even for mild cases, there's increased risk for heart attacks and strokes, in addition to general fatigue (which they're not entirely sure how or why) that can linger for months.

Anyway, there seems to be more and more evidence suggesting that we need to communicate that people avoid returning to exercise and/or a normal "40 hour work week routine" too quickly even after having what most describe as a mild case. My point here is that even if you're feeling better, don't push yourself and maybe take a few more weeks off from your full-contact Sudoku league.

[hepcat]

My crime fighting days as Glue Gun Gus have been put on hold for now.

I’m amazed that 4 years after everyone else started getting it, it finally hits me. Although I wonder if perhaps I had it and didn’t realize it before.

What’s the latest guidance on when I’m no longer infectious? And I don’t mean the infectious laughter my appearance usually elicits from bystanders?

[Jeff V]

AFAIK, it's still 5 days after testing positive. Wife's home test was the slightest bit positive after returning from a cruise (go figure) and her job insisted she take the week off.

[Smoove_B]

10 days seems to be the magic number for still being potentially contagious. Which is why it totally makes sense that everyone is returning to normal after Day 5.

Current (August 2023) recommendations are for people to wear masks through Day 10, but you can test to remove mask earlier (which I'm totally sure every person returning to work after Day 5 is doing).

There's some variation in the guidance based on severity and underlying health status, but I'd go with 10. And to make sure you're counting the days correctly - Day 1 (of 10 or 5) is the day *after* you start showing symptoms.

[hepcat]

Wife's home test was the slightest bit positive after returning from a cruise (go figure)

I would think getting Covid is mandatory for those taking cruises. I believe it’s actually on the receipt you get. “Covid and diarrhea are expected. Explosive diarrhea if you order the Seafood Tower.”

There's some variation in the guidance based on severity and underlying health status, but I'd go with 10. And to make sure you're counting the days correctly - Day 1 (of 10 or 5) is the day *after* you start showing symptoms.

Thanks. I’ll definitely go with 10 days then.

[Jeff V]

Wife ordered the sushi boat twice. Sushi is #1 on the click-bait slideshow of foods never to have on a cruise.

The boat had 6000 people on board (4500 passengers, 1500 crew), and among the shops on board, there was nothing like a drug store for meds and sundries. Wife would have very much appreciated Immodium or some such. There was a single 3' wide rack in the liquor store selling OTC meds (and not that one), and toiletries. Yet there was several jewelry stores selling expensive bling.

[Smoove_B]

This story is making the rounds today, so I'm sharing it here. It's a bit long, but it's fantastic storytelling. It's also completely apolitical and an excellent reminder we're all potentially one health event away from being disabled:

I had my health. I had a job. And then, abruptly, I didn’t.

...

One symptom would fade and a new one would assert itself. My ankles deflated and I started wearing the new sneakers, but my breathing and stamina steadily worsened. A wheeze or cough would interrupt my talking. On the mile-long walk back from school with my younger son, the route we’d been taking for two years, I lagged behind, guiltily asking him to slow down. I started buying five-pound bags of rice from H Mart instead of ten-pound ones. Then I just started getting rice delivered.

...

When I started hearing about the late-summer COVID wave, it occurred to me that now I was one of those people myself. This is what disability advocates have said all along, not that it usually sinks in: The able and the disabled aren’t two different kinds of people but the same people at different times. Last year, I was healthy; this year, I had a breathing ailment, even if nobody could say exactly what that ailment was.

[hepcat]

Wife ordered the sushi boat twice. Sushi is #1 on the click-bait slideshow of foods never to have on a cruise.

Do NOT watch the movie Triangle of Sadness.

[Kraken]

This story is making the rounds today, so I'm sharing it here. It's a bit long, but it's fantastic storytelling.

It is a good story. It is also more than a bit long. Before you devote the time to read it, you might like to know the ending.

Spoiler:

I despise those stories where a writer tells you all about some mystery for thousands of words and then fails to deliver the solution. Usually with some metaphysical vamping about the unknowability of all things. What are you even telling anyone about it for? But I didn’t have an answer, and I still don’t.

[Smoove_B]

It is a good story. It is also more than a bit long. Before you devote the time to read it, you might like to know the ending.

It's a meta piece

Spoiler:

Frustrated because you don't know why after all that reading? Now imagine you're him.

The only article I've seen about what's happening now in my area of America:

Hospitals throughout the state are seeing an increase in COVID-19 admissions. There’s also been a slight rise in deaths, experts say.

What are we doing about it? Nada. I'll keep saying it - I don't know how hospital workers are doing it. What we're repeatedly asking of them is beyond absurd.

[stessier]

Anecdotally, everyone I work with is sick. I'm in management and am not allowed to ask if they have taken COVID tests. I can only recommend they check with their doctor to be cleared to return to work - but they don't actually have to. This annoys me.

[Smoove_B]

I am absolutely astounded at how hard we're going at this - the complete attempt to ignore/minimize what is happening. I'll leave it there because it'll likely skirt into R&P, but anecdotally I've heard from friends that lab work has also been weirdly impacted. Specifically there seems to be an attitude that PPE in labs isn't nearly as important as it used to be. People that would always have gloves and goggles on are more lax (for example) and have been reminded by supervisors to put stuff on. I'm not sure if its' the same in other industries (I know PPE use has always been an issue in certain jobs), but it's like the virus is affecting people's brains. Maybe we all in a horror movie. A slow moving yet still terrifying horror movie....

[hitbyambulance]

'the virus has achieved a sort of intelligence and, like some bacteria/parasites, is now selected to alter people's personalities to drop precautions against transmission and infection'

or this also could work in a Gaia Hypothesis larger view - population control at work in a natural way which people don't _want_ to fight. 'it's been encoded in human nature that after reaching a certain population threshold that people will willingly submit to culling'

[Zaxxon]

'the virus has achieved a sort of intelligence and, like some bacteria/parasites, is now selected to alter people's personalities to drop precautions against transmission and infection'

Wouldn't be the first...

[Smoove_B]

Wouldn't be the first...

I thought you were going to mention one of my favorite parasites - Toxoplasma...