July 4th, 2022
Volume 12, Letter 29
Coronavirus Update 65 plus other stuff
Long covid research today
We are seeing very limited Covid disease in kids for weeks now. No significant MIS cases.
In NC, we are ticking up to 6% of admitted patients needing a ventilator and 13% needing an ICU bed for Covid.
The 7 day moving average of cases for the US in recent weeks has plateaued at 100,000 to 115,000.
The risk of death is 0.000033 once vaccinated with a two dose series or survived natural infection.
As it stands today, the United States has had 87 million known cases and almost 1.01 million deaths. The case numbers will continue to vastly underestimate true case volume.
If you did not read the newsletter about an Integrative approach to proper health in the COVID era and frankly all future infectious diseases, read this link and this link.
As with the first newsletter on this topic, keep solace with the fact that there is a 99+% chance of survival for all of us regardless of vaccination. However,
mathematically, you now have a 99.9998% chance of survival once vaccinated and the vaccine safety for the mRNA vaccines continues to look good.
Omicron US strains: as of June 25th data - variants make up: BA.2 is 6%, BA.4 is 16%, BA.5 is 37%, and B2.12.1 is 42%. This Covid wave is inline with volumes from wave three which was delta. BA.5 is taking over as the new strain with excellent immune evading and vaccine evading skills. It and BA.4 are very contagious.
All strains show no signs of increased disease morbidity.
R0 infectiousness is in the range of measles: the new reproductive rate is 1 infects 12 which infects 144 which infects 1,728 which infects 20,736 which infects 248,832. That is a very very fast spread rate.
Little else to report here. (CDC Variants)
The government is now pressing for Omicron strain specific vaccines for the fall which makes sense if we want to slow transmission as the current generation one boosters are not very useful. Novavax is going to be in this space as well for those that are uninterested in the mRNA vaccine type. This will be a win for all at risk individuals moving forward for disease risk as well as post disease issues and PASC. Good quality vaccines are a major tool in the long term fight against disease as we all age.
Quick Hits and other musings -
1) In another in a long string of confusing studies reversing earlier data we see these conclusions published: No discernable differences in protection against symptomatic BA.1 and BA.2 infection were seen with previous infection, vaccination, and hybrid immunity. Vaccination enhanced protection among persons who had had a previous infection. Hybrid immunity resulting from previous infection and recent booster vaccination conferred the strongest protection. (Funded by Weill Cornell Medicine–Qatar and others.) (Altarawneh et. al. 2022)
The group cherry picked time of testing to maximize the booster benefit by analyzing risk within 45 days of receipt of dose three. Most people begin waning antibody protection by 8 weeks. They do rightly state in the body of the paper: The analysis of the effectiveness of previous infection, two-dose vaccination, and three-dose vaccination as a function of time since the immunologic event (previous infection or vaccination) showed rapidly waning vaccine protection after the second and third doses but slowly waning protection from previous infection.
For me, this data speaks again to the reality that current boosters are of limited value and for a very short time. High risk is a must to boost. Newer omicron specific vaccines should be much more useful.
2) Paxlovid causes some people to get better and then get sick again in short order testing positive again. To read about this mystery go to the JAMA article. (Rubin R 2022) I have no commentary on the why it occurs. Strange indeed.
3) Covid, like other viruses, is triggering Postural Orthostatic Tachycardia changes in infected individuals. Patients diagnosed with covid and presenting with "passing out or nearly so" symptoms were evaluated using a tilt table test to show postural low blood pressure changes called hypotension. 23 of the 24 tested subjects had positive signs of orthostatic dysfunction indicating that the autonomic nervous system has been compromised by SARS2. These symptoms lasted for months. Patients exhibited cognitive problems, elevated heart rates and fatigue. (Jamal et. al. 2022) It is likely based on emerging data that viral remnants in the gut and other places are triggering these PASC symptoms akin to Ebstein Barr Viral illness.
We are on the front end of the wave of understanding these issues in humans post covid and other viral diseases that trigger the same. For more on this topic, listen to Dr. Peter Rowe's Podcast at this link.
4) Long Covid has a cousin model in hamsters: The report noted results that SARS-CoV-2 exceeded Influenza A's ability to damage the lung and kidney, the olfactory bulb and epithelial lining. No viral particles were found but the make up and activation of the myeloid white cells and T cell activation was pro inflammation with enhanced proinflammatory cytokine production for a month post viral clearance. These changes could be seen in tissue isolated from individuals who recovered from COVID-19. These data highlight a molecular mechanism for persistent COVID-19 symptomology and provide a small animal model to explore future therapeutics. (Science Frere et. al. 2022) An animal model is not a human model, but at least a place to try and figure out pathways and therapeutics.
5) Long Covid 50% less likely from Omicron than the Delta variant according to new data from the Lancet. The disease remains 5-10% more common for women and is clustered around the age of 53. (Antonelli et. al. 2022) This is not surprising as I, hypothetically, believe that inflammation and immune characteristics are underlying risk. Delta occurred in a more SARS2 naive world and was more inflammation promoting.
6) Sleep and Fatigue remain a major problem for Long Covid sufferers. Two thirds of patients reported at least moderate fatigue, while one fifth reported severe fatigue. Almost 1 in 2 reported at least moderate sleep disturbances. Obesity, mood disorders, and Black race emerged as contributors to problems with sleep and fatigue after COVID. Black race was associated with a 3 fold higher risk of moderate to severe sleep disturbances. (Brooks 2022) The race predilection remains an unknown as to why according to the article.
7) PACS/long Covid and the microbiome - from the British Medical Journal Gut: Gut microbiota composition at admission was associated with occurrence of PACS. Patients without PACS showed recovered gut microbiome profile at 6 months comparable to that of non-COVID-19 controls. Gut microbiome of patients with PACS were characterised by higher levels of Ruminococcus gnavus, Bacteroides vulgatus and lower levels of Faecalibacterium prausnitzii. Persistent respiratory symptoms were correlated with opportunistic gut pathogens, and neuropsychiatric symptoms and fatigue were correlated with nosocomial gut pathogens, including Clostridium innocuum and Actinomyces naeslundii. Butyrate-producing bacteria, including Bifidobacterium pseudocatenulatum and Faecalibacterium prausnitzii showed the largest inverse correlations with PACS at 6 months. (Liu et. al. 2022)
This begins the process of identifying which bacteria are associated with health from an infectious perspective. F. prausznitzii is associated with many positive outcomes when found in abundance. Low levels have been associated with inflammatory bowel disease. We are a long way away from treatments with targeted bacteria, however, that time will come as we aggregate more data.
8) Other studies suggest why only some people experience long-term smell loss. In January, a research team reported finding a genetic mutation in people that was associated with a greater propensity for smell or taste loss. The mutation — a change to a single ‘letter’, or base, of DNA — was found in two overlapping genes, called UGT2A1 and UGT2A2. Both encode proteins that remove odor molecules from the nostrils after they have been detected. But it’s not yet clear how SARS-CoV-2 interacts with these genes. (Marshall M. 2022)
9) Weight gain during the pandemic remains a problem to be dealt with. Statistics show 5 to 15 pound weight gain for a large swath of adults depending on which study you look at. (Wing et. al. 2022) Children had similar issues and we saw this first hand in clinic. Sedentary behavior from a lack of school and work attendance drove a large percentage of weight increases in my mind. Couple this to an already problematic dietary pattern in this country and we have the outcome.
10) In an excellent article in Science, the authors lay out the current evolving science behind long covid. There are three major theories in play: 1) micro clots that are blocking blood flow to important tissues, 2) persistent viral RNA remnants causing the system to remain in the fight, 3) a dysregulated immune system that is in an inflammatory mode for months. The article is worth a read. (Couzin-Frankel J. 2022)
That's all this week,
Dr. M
