TWiV 1110: Clinical update with Dr. Daniel Griffin

In his weekly clinical update, Dr. Griffin begins with discussing if the antibiotic neomycin is really a pan-antiviral countermeasure, then reviews the recent statistics on SARS-CoV-2 infection before deep diving into if shedding and the rapid antigen test results correlate, the guidelines for spring administration of COVID vaccines boosters, whether COVID booster associates with the long COVID prevalence, discusses the emergency use application of a pre-exposure prophylactic, revised guidelines for how to treat respiratory viral infection guidelines by the CDC, the caveats for improper use of antibiotics to treat SARS-CoV-2 (a viral infection), continues to dispel the myth of viral rebound, when to use steroids and the benefits of convalescent plasma, what do when healthcare workers succumb to SARS-CoV-2 infection, if administration of an anti-immunoglobulin E monoclonal antibody can be used for COVID-19 treatment, if inhibiting T-cell activation will reduce secretion and production of inflammatory cytokines including IL-6, if changes in the gut microbiome associate with post -acute COVID-19 syndrome, and the pulmonary and neurologic determinants of long COVID-19 such as the presence of neurofilament light chain in plasma. For more information about this body of work, listen to TWiV 1088.
Show notes at www.microbe.tv/twiv/twiv-1110/
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[@johnwurtele9601]

You 2 are GREAT! Thanks for all the work and time necessary for the Updates.

[@WillNewcomb]

RE: Lisa's question about subsequent vaccines/boosters. Don't forget about lowering your risk of Long Covid by 25% by getting the latest jab! LC is no joke. Keep your risk as low as possible!

[@patriciahoke4722]

Having gotten covid twice in less than 6 months, I went back to my early days practices, including NAC and nasal iodine. Yes, I took paxlovid, but of course it was a weekend call, after hours, and this time, the on-call didn't want to Rx it for me, but I convinced her. That's too much stress for me (in addition to my job). I just can't get it again.

[@Hdc2390]

It's terrible to be in that situation it should be easier to be able to just live with it. It's definitely not a cold or flu.

[@marklemont3735]

I am glad you were able to convince the doctor. That is the problem with on call doctors who are not your primary doctor in some practices, I have found, when I thought I might have Covid and I called for a PCR RX.

[@danielasuncion9991]

Does the Ebola bow tie confer some immunity against Ebola? Or, perhaps, the (t)ie increases the vigor of T cell activity. p.s. Keep up the good work! I ❤ these discussions. Fascinating to listen to virus experts talking to each other.

[@acoslow8321]

as a ER PA I do not use antibiotics or steroid in covid. but many people have a comorbid COPD. so I do consider the standard COPD treatments of Zithromax inhalers and steroids. after listening to you for 3 years,I try to put off this COPD approach and just use Paxlovid unless we are in the 2nd week and I will treat the COPD exacerbation as usual. So some of the antibiotic use is or overuse is coming from treating COPD. Mark Coslow

[@MNP208]

Today’s Medpage Today article stated the rancher’s specimens were sent to the CDCs lab at Texas Tech. Basically, those of us working in urgent care have no way of diagnosing H5N1. I have a sense of foreboding. This is reminiscent of what occurred in 2019 - when all of us front line nurses could see the Covid steam train rolling toward us. 😕

[@Turtledove2009]

Please keep us informed if ou see the H5N1 steam train rolling toward us!

[@Trees43]

I got the previous to this most recent Feb.2024 recommended booster., in December 2023 so don't want to get the Feb. recommended booster just yet. I'm 80 and in relatively good health. Just heard that there will be another Fall 2024 recommended booster. At this point it feels like they are piling up on each other and so I'll get the Feb. recommended booster in probably June. As for the Fall 2024 one, well, we'll see. I'm feeling like there just might be too many at this time and am looking into if there are tests to see how strong our immune system is so that we can make a decision based on those tests. So much to consider and finally, these weekly updates are so necessary and I'm thankful for them. Thanks Daniel and Vincent.

[@WillNewcomb]

As a complete layperson I'm dumbstruck that Dr are prescribing antibiotics for Covid! My American friend was prescribed Paxlovid, antibiotics and dexamethazone ALL AT THE SAME TIME!!!

[@MNP208]

That's crazy! Our MDs do NOT typically do that!

[@WillNewcomb]

@@MNP208 I emailed my friend and pointed some things out such as antibiotics are for bacterial infections, and she said they were prescribed as 'precautionary'. Dr Griffin remarks that it's not unusual!!! And just look at that paper from Germany!!! There are far too many Dr who are NOT following the science!

[@JasonCunliffe]

TWIGB = This Week in Garage Biology 😂 👃🎉

[@WillNewcomb]

Currently low incidence of Covid in USA (lowest for c. a year) thank God. BUT the variant picture is changing very fast. It's no longer all JN.1 but now a big mix of JN.x & KP.2. It's NOT time to drop your guard! If incidence is still low in 6 months time...

[@circa1890]

Yep, still wearing my N95 in public places. (Still haven't been infected yet but know that eventually I'll catch it.)

[@WillNewcomb]

@@circa1890 What a star!!!

[@posvid]

You seem to be implying that at some stage in future the "variant picture" will stop changing and at that point it will be time to "drop you guard" but the reality is that it's inevitable that new variants will continue to emerge. It's also inevitable that incidence will continue to go through peaks and troughs. This is the way coronaviruses behave. So it really is time now to consider how you want to spend the rest of your life. If you're happy living life with your guard up that's absolutely fine but don't delude yourself it'll all be over at some stage in the future.

[@WillNewcomb]

@@posvid I agree that this coronavirus will continued to mutate as it has shown in the last 4 years. But I will continued to be on my guard. I don't want Long Covid. I've read too many sad stories and now my sister has it. I'd far rather be healthy and a bit more careful.

[@WillNewcomb]

Just read that the risk of Long Covid jumps to 40% on the 3rd infection. You don't want it. Stick that N95 on!

[@GadZookz]

Study papers tend to come out one at a time a one after another but what happens when a singular study is retruded?

[@Cajeput]

Pemgarda is not the new Evusheld. The new Evusheld is sipabivart and it hasn't been approved yet. Still waiting for Astra Zenica to produce the data. I am on the new Evusheld (sipabivart) trial.

[@WillNewcomb]

早上好，来自中国长沙 Zǎoshang hǎo, láizì zhōngguó chǎngshā Good morning from Changsha, China

[@judychambers919]

Recently had covid for first time Too late for Paxlovid. This happened while my husband was on hospice and dying of Alzheimer’s. Fully vaxed. Miserable at a hard time.

[@Hdc2390]

Do we ever shed this virus? Does the repeat infections eventually lead to LC and the virus is persistent in the body maybe until it causes another disease or death? If true it's something we all need need to know.

[@circa1890]

This is my concern, as well. We have evidence that with each infection there is a good possibility of vascular damage and loss of I.Q. What will humans be like in 20 years after repeated infections?

[@Hdc2390]

@@circa1890 They're only thinking about short term for the economy. There was no going back to normal it doesn't exist anymore. It clearly shows in everything a bandaid approach hoping that people will comply with getting infected by a deadly virus for their agenda. The government has no idea what is going to happen they avoid it bc they are responsible for what is unfolding in front of our eyes. They have Davos safe environments and healthcare they aren't affected personally.

[@WillNewcomb]

I never got to say Thank you!!!

[@sanfransardine]

I stick to intravenous interferon before I go on an overseas flight

[@leodikinis7390]

Daniel's ending email gave me concern. Is there a H5N1 vaccine available for domestic cats?

[@marklemont3735]

IDK but IMHO it’s a good time to teach cats to enjoy being indoors for their safety. When I had cats they were good at bringing me “gifts” from outdoors.

[@zachthayer]

Can't find email Dr. Griffin

[@wednesdayschild3627]

I took this nasal spray over the counter, and non drug. It does seem like I do not get so many colds. Maybe it helps. I just saw a double blinded control trial on it.

[@Hdc2390]

A lot of doctors will not prescribe paxlovid why

[@4everyoung24]

Uninformed or lazy or maybe just too busy. It takes too much time to adjust medications to prevent drug-drug interactions.

[@misterman3379]

@@4everyoung24…..are you a physician? Maybe it’s not a necessary or helpful drug in the view of the aforementioned doctors who won’t prescribe it.

[@4everyoung24]

@@misterman3379 I’m a nurse practitioner. I have had plenty of patients who should have been put on Paxlovid. Some who landed in hospital and some who have died-several after the vaccine and Paxlovid were available. Just last week I saw a diabetic who was put on prednisone and Doxycycline in the first week instead of Paxlovid. He didn’t meet the criteria for prednisone at all and didn’t have a contraindication for Paxlovid. His blood sugar was through the roof! He would have been better off without anything. I treat patients with bacterial infections, some that are really complex, and I am frequently having to deal with drug-drug interactions. I understand it’s tough. But l also know we still have to do what is in the best interest of our patients. Being informed and knowing how to apply that information is essential for good care.

[@Rene-uz3eb]

31:57 let me just give a shot at this one: vitamin c increases bifidobacteria population (2022 paper). And vitamin C ameliorated fatigue in long covid (2021 paper) 37:38 neurofilament nfl associated with myelin damage (2022 paper), and vitamin C suspected necessary for myelin formation (vitamin c hypomyelination 2011 paper) Probably more relevant for someone with chronic infection, since that depletes vitamin c

[@ginilinenkemper9261]

How effective is booster right now. My pulmonologist suggested I wait for new one in Aug/Sept. because this booster would be ineffective to strain of Covid out there right now. I am going to huge family reunion in June and unsure what to do. I am 70.

[@traianliviudanciu8665]

Interferon inductors increase interferon production only a period of time,( some weeks?), after that interferon decrease more.

[@traianliviudanciu8665]

If You do ,,plake assay,, you can see temperature sensitivity of SARS COV2. At TWiV 659 at min29 virologist Christian Drosten suggest that SARS COV2 better replicate at very low tissue temperature.

[@traianliviudanciu8665]

Use of oxigenoterapy with oxigen mix warmed at body temperature,can be, theoretically, better if cryoglobuline like antibody occur.

[@traianliviudanciu8665]

Also can stop SARS COV2 infection,If SARS COV2 is temperature sensitive At TWiV 659 at min29 virologist Christian Drosten reveal that SARS COV2 better replicate at low tissue temperature

[@traianliviudanciu8665]

May be patients who use antibiotics also use antipiretics more ? when SARS COV2 infection did occur

[@D.V.KrishnaRao-df2ot]

You are always on fund riser? Year long fund riser?

[@marklemont3735]

They are a nonprofit and do not choose to have commercials support their science education.

[@zachthayer]

O'Malley you may and yes I do remember allergie doctor

[@traianliviudanciu8665]

May be neomicine afect ribosomal RNA and stop viral replication ? Or may be chelate Zn decreasing activity of Zn related enzimatic chains ? Theoretically any toxic that affect cell methabolism can decrease viral replication in hyjaked cell.

[@razerginn]

Uhh Really! There's like thousands of possibilities but where's the evidence? Anything that raises body temperature should help against viral replication. Sauna?

[@Designer-Alan]

Listen through that section again. The effect of neomycin is to stimulate interferon production, but that’s really the only definite result of the study. It’s not news because the same effect has already been shown to occur in other studies with different tissues.

[@traianliviudanciu8665]

@@Designer-Alan may be not only interferon induction ?

[@alevendel16]

It amazes that doctors are still reluctant to consider corona virus as a possible cause of persons presenting with "typical symptoms".

[@salsasecret]

Please stop throwing bona fide physicians under the bus. We are not providers, we are not PCPs, and we are not the ones giving out zpak’s and steroids inappropriately. If you think non-physician practitioners, especially those practicing independently, instead of physician-led care, as they were designed and trained to function safely, and are following NIH and ISDA you’ve got to be kidding. Maybe not all of us study, maintain licensure and certifications and we practice evidence based medicine.

[@Cajeput]

My family has been using Enovid (Nitric Oxide) nasal spray in high risk situations for a year now to prevent covid. So far so good!

[@suesaxton3058]

I've just looked at that it's VERY expensive.

[@DeannaPiercy]

@@suesaxton3058 - There are a couple of other options - Covixyl or Betadine Cold Defence Nasal Spray (contains iota carrageenan). Our family uses all three according to risk assessment. After a known exposure my husband and I used Enovid 5 times a day per recommendation and did not get Covid. Due in part to the expense we reserve that one for high risk situations. I'd like to see someone do head-to-head studies on these options. Iota carrageenan seems like a good barrier so we generally use that pre-exposure. Hope that helps.

[@Cajeput]

@@suesaxton3058 Yes indeed but if you buy VirX from Germany it is cheaper. Its the same product

[@Henry-fk7cq]

Im one of the few tie wearers, like Daniel. Where is he getting those ties? I wear bow ties too!. A tie is an accessory, not limited to females. Come on guys, dress appropriatly. That includes you Vincent. Dress better, the women will appreciate it.

[@srr9281]

Daniel buys the fabric and his daughter sews them (from a previous clinical update).

[@badddkattt]

@@srr9281He buys fabric with printed pathogens? 🦠 He must have his selected microbes printed on it.