TWiV 872: COVID-19 clinical update

[@lesfaby8997]

02:10 Clinical Update Transcripts are Being prepared 02:47 BA.2 prevalence world wide up but total infections lower 03:24 impact on theraputics and US regional prevalence 05:23 NYC Case tracing ending per CDC recommending 05:48 Test to treat for quick treatment for high risk 07:49 possible some treatment might lower chances of long covid 10:33 Children and other vulnerable populations 11:36 Pfizer Vaccine effectiveness for kids after omicron preprint 14:02 MMWR US effectiveness for kids 18:52 Shot intervals 20:09 Orphans created by COVID-19 (Lancet) 21:07 Testing Rapid Antigen vs PCR seem to work with variants 23:32 most people have less risk of serious disease (CDC) 28:10 Masking 32:06 Evusheld change in dosage 33:40 WHO Guideline for treatment 34:52 Early treatment for at risk 35:52 paper on progression toi hospitalization 38:00 Monoclonals 38:84 early inflammatory phase 40:22 Long COVID 40:39 Delayed mortality in transplant recipients 41:24 Is Long Covid risk lower with vaccination 45:21 peripheral neuropathy paper 46:56 Global vaccinations 47:51 Donations matched 48:35 Q and A 48:41 Jennifer Long Covid cases tinnitus 50:40 Gale Fully vaccinated and masking 52:08 Chiam Criteria for stop wearing 52:40 Gabriel Quadraplegic Paxlovid and home test ease

[@GetOutsideYourself]

Imagine 2 years ago if you'd said "at one point we'll say 'and down to less than 2000 deaths per day' with a smile." And life will be getting back to normal. We've gotten boiled in the water with the frog.

[@yz492]

Were they fully vaccinated or not? You can lead a horse to water, but you can't make it drink. Freedom includes the freedom to fail. Personal responsibility.

[@janakingking3022]

Thanks! I have started looking for this every Friday night at midnight

[@doreeno3792]

You got me beat by a few hours...not an owl... but a huge fan of Vincent and Daniel.

[@Oughut88]

Thank you so much for your professionalism and time. So much appreciated by so many. Best wishes from England 🏴󠁧󠁢󠁥󠁮󠁧󠁿

[@genealogyandyou419]

Have you been studying the PFIZER TRAIL DATA DOCUMENTS? I am interested in your opinion on these documents.

[@1GratiaPlena]

Yes, me too

[@BigFred458]

I am going to continue to wear a mask when out and during Doctor visits.

[@Peter_S_]

There's probably no better place to mask up than a doctor's office, other than perhaps a hospital.

[@Tina06019]

Thank you - I listen to you on my way into my work week at a NYC metro-area hospital on Sunday evenings.

[@newsjunkie7892]

Thank you both for these updates.

[@ovrjoyd]

When I initially had C19, the post viral sequelae felt more like an EBV reactivation with fatigue and brain fog, but my second infection is when the scary Long Covid-coaster of symptoms started. At the time, my PCP said he had no other patients experiencing what I had. I have no idea if my complaints/symptoms were adequately documented early on, but I have just crossed the 26 month mark, and have had some improvement over the last 6 months. Now I am left with POTS, PEM, tinnitus, occasional brain fog and general fatigue. Pacing is crucial. I tried to start rebuilding my fitness with daily walks, but that can cause huge set backs, and I have had to eliminate my walks on most days if I have any household chores to accomplish. I believe LC it is due to inflammation, and any thing that can increase stress (physical and/or mental), tends to cause flare ups. It's like walking a tight rope.. Most of us come back with normal diagnostic tests, and bloodwork, so they may need new types of testing for specific inflammatory markers. If they can't properly identify and diagnose the cause of our symptoms, how do we expect clinicians to treat them?

[@deborahhebblethwaite1865]

I almost died with pneumonia from C19 in march 2020. Omicron was a headache and scratchy throat for two days. Sorry for your troubles but I sailed through my second infection. I had your symptoms with the first infection ….took six months to get better🇨🇦🙏

[@ovrjoyd]

@@seekinganhonestpolitician No. I don't think taking an anti-parasitic drug for inflammation is a good idea, and science has not shown it to be efficacious.

[@charlestongren2860]

@@seekinganhonestpolitician Not for C19. Campbell started out ok but now a quick. Dr. Griffin and Vincent are both Parasitologists. Griffin has Rxd 1000s of Rxs for IVM for parasitic diseases.

[@IvyRoad]

I was happy to see the mask question. I agree that I get the impression that Vincent is not now a big fan of masks. I’m with Daniel; I’ll be wearing a mask in indoor public settings until things are very different than they are now.

[@charlestongren2860]

Don't understand Vincent's new stance & find it rather alarming. Especially as more information comes out about Long Covid.

[@IvyRoad]

@@charlestongren2860 Yes, it’s a surprising and disappointing development.

[@cjsloane2636]

Transcripts are very helpful. I often wish I had a searchable transcript to find some nugget I heard about but didn't fully commit to memory.

[@teatime9923]

We can't do much for long Covid, said Vincent...I understand that the medical researchers and all, can't do much...so please, please keep us in mind until you find more options for long Covid!~!! love your podcast!

[@kw7807]

At least not now..hopefully we can address this..

[@ovrjoyd]

Careful pacing and time. We've got nothing but time. I gave up any type of food or drink that can cause inflammation, and it helped a lot. I lost a lot of weight as a result, and that helped too. I'm 26 months into this. Last year I was so bad off I was considering a wheelchair, but now I am fully ambulatory. Still dealing with POTS, PEM, tinnitus, and occasional brain fog.

[@lucid118]

@Les Faby Thank you so much the timeline is very helpful!

[@miltz76]

Thank you Vincent and Daniel!

[@renaderba1111]

Can we talk about low dose Naltrexone for some long COVID symptoms please !

[@ZaK47-d4s]

The BNT dose for 5-11 will have to be increased .It is losing antibody neutralisation fast Compared TO 12-17 .

[@mikeo2693]

The information conveyed by these professionals about CDC revised mask guidance was troubling. As a lay person, I infer that these two were sparing this medically sophisticated audience of highly charged outrage, opting instead to let the data speak for itself. The arbitrary shift in community infection rates used to set the standard for what constitutes “safe enough” to drop masks, the lack of data behind the new guidelines and the CDC’s apparent discounting the risk of Long COVID from the overall threat assessment were some but not all of the concerns they seemed to have. My question for those more familiar with the forum like this. Were these guys actually conveying a sentiment like “what the fucking fuck , CDC?” But just doing it with a more collegial demeanor. Am I reading the room correctly? Today I went to the grocery store without dawning my N95 Mask for the first time in almost two years. I’m certainly not in the minority. But I get the feeling that those in the know would wear a hazmat suit if forced to attend the south by southwest music festival here in Austin. (Which went from red to green in CDC overnight in CDC terms) I know it doesn’t come across this way…but my My takeaway is the the first half of this video was an eloquent takedown but they just choose to drive the bus conservatively as they roll it over the CDC. Am I off the mark? Long COVID is simply not talked about much in the media. So I appreciate videos like these a lot even though I’m clearly not the target audience.

[@kathybrady4033]

Why did you remove your mask if you believe these professionals think the CDC guidance is way off? It’s your right to!!

[@mikeo2693]

@@kathybrady4033 Pretty simple. Because I hadn’t seen the video.

[@charlestongren2860]

Why would you stop wearing a N-95? Inexplicably, Vincent is meh on masks now. Daniel is WTF CDC. So am I and my doctors.

[@mikeo2693]

@@charlestongren2860 because the cdc turned austin green from red signaling low risk for vaxed go maskless. But the implication here and elsewhere is that the cdc guidance isn’t to be trusted. They were really nice about it. But I get the sense that those who know the most like these dudes no longer consider cdc a reliable source for politically blind just the facts science when it comes to mask guidance and overall risk mitigation. Two years is a long time to go in a mask. But I’ll go for five if that’s what the science says to properly risk mitigate Sadly I look to KZbin pundits now to help me make an informed decision because my personal physician admits that she has a gun to her head to follow cdc guidance even though she doesn’t buy a lot it. In fact she wink wink nod nod encouraged me to get a booster last summer by gaming the system elsewhere because she thought it a good idea in my situation. But she wouldn’t do it herself because it’s too costly for her personally to go sgainst the guidance. And at the time boosters weren’t authorized. By the way she was one of the front line clinicians running the JnJ study. She’s knew protection waned fast from that single shot regimen I took her advice and lied my way into a send shot. My takeaway from the last two years is that healthcare in the Us is more fucked than I realized. That wink wink nod nod has been typical of my experience in it recently .. And I’ve always thought it to be quite fucked up in the first place. But I’ve upgraded “Way the fuck fucked up”

[@randyjones9762]

My friends still don't know what covid is after years of this disease

[@RalfStephan]

There are case reports of antihistamines helping with long COVID.

[@deborahhebblethwaite1865]

Yes they do and should be used with initial symptoms of covid.

[@BlakeSuperior_Beats]

Which one(s)?

[@charlestongren2860]

@@BlakeSuperior_Beats Don't take any that are steroids as they suppress the immune system just when you need it the most. Listen/read past updates by Daniel. Steroids should not be taken unless you've progressed to the inflammatory stage where you have shortness of breath.

[@charlestongren2860]

@@DS-nb5cz Daniel has never recommended this. Don't believe everything you read.

[@briancase6180]

Thanks again for such a great service to the public. TWiV uber alles. 👍

[@brendabrass2715]

Thanks guys!

[@darcybrown7369]

usual excellent information and education

[@frankbradford9616]

Show Notes are excellent!

[@kellycasperhanson4426]

I REALLY look forward to these updates, and share the info with many people. As for masks😷, I'm in Portland, Oregon, and, even though our numbers have always been low, I will definitely continue to wear mine for the foreseeable future!

[@cloudpoint0]

How will you convince the people around you to wear a mask? Masks are 90% for the benefit of others, with just a small benefit to the mask wearer if any.

[@lor3999]

A legitimate, high quality mask like an N95 will protect the wearer a great deal. I wear one at work with the public. ( So does Dr. Griffin. ) Many co workers have had Covid. I and my immunosuppressed husband have continued to be careful, and have not caught this respiratory pathogen.

[@toby9999]

@@cloudpoint0 So wearing a correctly fitted mask only provides a 10% risk reduction? Don't think so.

[@cloudpoint0]

​@@toby9999 Probably no additional risk reduction at all according to most studies / experts but a few purely lab-based studies do suggest a little protection is also afforded to the wearer so I defer to them though flaws are apparent in their methodology. I think how the pandemic has spread speaks volumes as to how little difference they make. Just look at South Korean now where masks are worn more than any other place on Earth, even before the pandemic.

[@Turtledove2009]

@@cloudpoint0 I'm sure you've seen many "mask wearers" with their noses exposed or under the chin, or there are huge gaps. Most definitely they would not work! I have been wearing an N95 as soon as I could find them and have had not even a cold these last few years. Knowing when to take them off is also important. Along with common sense, those masks definitely work well.

[@elinannestad5320]

long covid frightens me. Social dancing is what makes my life worth living but I do not know when I will get back to it.

[@silverwolf4095]

Fear is clear. Covid is inevitable. 99.7% your choice

[@minRef]

@@silverwolf4095 your sloganeering reminds me of a post by satire of an alternate universe Jon Snow: “For critics saying we are moving too quickly to reopen after our most recent wave of cholera in the 1854 epidemic, I ask you: Why not reopen now? We aren't going to fix sewers to eliminate fecal contamination in the drinking water. Might as well get used to it sooner than later!”

[@toby9999]

@@silverwolf4095 That's defeatist. Might be inevitable but over what time frame? Why not push the likelihood out from months to years by using some level of caution? I haven't had a cold in 2 years vs mulitiple bouts annually pre pandemic and I'm loving the difference. I'll continue being cautious and wearing masks because I enjoy not feeling ill.

[@silverwolf4095]

@@toby9999 the bloke literally said his life is not worth living because of covid fear. Wakey wakey

[@kathybrady4033]

Eli just DANCE!! Live your life! I traveled the world and got married and wore my mask and never got sick. Played golf, had a few friends over, made Thanksgiving dinner. We are all going to be exposed. Stay healthy my friend but keep your positivity any way you can. We are social creatures!!!

[@jeffalexander5842]

I'm sure some parents do freak out and rush kids to the ER, but I don't know that going to the ER constitutes a hospitalization. I think they have to be admitted and that is the doctor's discretion. I don't think a Dr. lowers the bar for admission for kids vs. adults...maybe I am wrong 🤷

[@christopherrobinson7541]

In the US visiting the ER is counted as a hospitalization. In the UK visiting A & E is not counted as a hospitalization.

[@jeffalexander5842]

@@christopherrobinson7541 where are you getting that information? Everything I have seen says it's not unless you are admitted overnight.

[@charlestongren2860]

@@christopherrobinson7541 Incorrect. You have to be admitted.

[@ZaK47-d4s]

The gap between astrazeneca vector vaccine was 12 weeks still effectiveness was a great worry for just two doses so in some T cells are not working well enough .

[@denisespencer395]

I have recently been diagnosed with a blood cancer , not leukemia but polycythemia.!I am now wary of taking the booster. I got Omicron on New Years with congestion and a cough here or there. I took the second jab in August. I believe I started experiencing slightly winded breathing; slightly so I’m am not sure if u should bypass the booster

[@heatherlavender8236]

In November of 2020 I got the Alpha and my main sickness was done in about a month, but I continued with slight shortness of breath, exhaustion, sore throat, and sinuses draining till February and shortness of breath slightly I had off and on till July. Is that a version of long covid? Thanks I just found you and I will continue to keep up with you. I also had the Delta for sure a year later, and then I had Omicron and finally about two months I feel I am done but got hit in the gi track with a heartburn that lasted for more than two months and I am finally just getting over it with Apple Cider Vinegar. I have never been vaccinated because I already got it and heard I didn't need to. Each time was a little better and I got hit in totally different areas so never more than once, thanks!

[@zinnialady5153]

Thank you.

[@markgivens3225]

Good discussion. Two comments, 1)Regarding ‘test to treat’ i observe that ‘best diagnostic and outpatient treatment guidelines’ should have ALWAYS been available at the point of public test sites. We can discuss what would be in those but at least pulse oximeter and guidelines would make sense, probably also other over-the-counter and home remedy type suggestions (for example, I understand Vick’s vapo-rub showed notable benefit in 1918 pandemic), sunshine, vitamin D, fresh air also make sense. 2) Regarding CDC community levels - I am disappointed that they only update on a weekly basis (this was Not stated proactively within my perception. And the ‘raw data set’ for community level is not made easily visible or accessible to the common user. The weekly update timing means that potentially 6 days a week the community level may seem inconsistent with the daily update data tracker. Consider Cuyahoga county in Ohio as one example of ‘misalignment’ during the past week.

[@charlestongren2860]

Use World in Data, World o Meter, Johns Hopkins or your county's public health department.

[@markgivens3225]

I know what to.use, just disappointed CDC does not have it ‘best’ and still tends to ‘confuse’.

[@2listening1]

2:42 Listening and watching are Not enough for us, Doc! We also want you to sell your complete line of bow ties as a fundraiser for TWiV! 😀👍

[@cardsfaninkc5]

It's a tougher sell to continue to tell everyone to wear masks indefinitely, regardless of personal risk level or spread within the community, than it is to tell people to wear masks when risk levels are highest. Telling everyone to mask indefinitely, even when spread is low, erodes public trust in the CDC amongst the decreasing population who is still willing to listen. At some point, the CDC needs to find a way to begin restoring public trust.

[@Turtledove2009]

I think at this point of the pandemic, we should feel confident to decide for ourselves using risk/benefit analyses whether to wear a mask. I will continue to do so until I'm satisfied with the research and the numbers. One day I will discard it.

[@ScotHarkins]

Hang on...in Immune 52 Gabriel Victora spoke of the 2nd shot at 3-4 weeks actually giving a boost at just the right time to lock in the initial response. The 3rd dose then appears to further broaden coverage, makes the learned response even more durable, and even tunes the innate response to be more sensitive to initial contact with Coronaviruses generally. The idea of a 2-shot more-spaced course with these initial vaccines seems to have been put to bed. At the very least the necessity of 3 shots is now well-established. An affinity for a 2-shot course should not override the data supporting 3 shots. Immune 52 was really a very fascinating discussion.

[@charlestongren2860]

But many other immunologists feel the spacing should be longer, as do Vincent and Daniel. The initial time-frame was because we were in a pandemic but the UK delaying 2nd dose showed that was a better plan. On Q&A, this has been discussed a lot.

[@megsayaers7918]

In Australia, we aim to do an 8 week interval for 5 to 11 year olds betqeen dose 1 and 2, unless there's a compelling reason to justify an interval of less (minimum 3 week interval).

[@leonjohansson6542]

Question: Can wearing a mask attenuate the Corvid -19 viral load/exposure and reduce the infectivity, thus resulting in milder clinical symptoms? Perhaps lower the viral load enough so the in infection is asymptomatic? PS. I wear two masks and may continue to mask up in crowded social situations long after this pandemic is over. And of coarse I have all the Moderna shots.

[@cloudpoint0]

Yes in theory if the sick person spreading the virus wears a mask but there is just a small reduction unless you are almost nose to nose or someone is sneezing in your face or you spend a long time indoors with them (most people don't actually spread the virus when sick). Not much difference for recipients of the virus who wear a mask unless they have a HEPA filter between them and the virus.

[@cloudpoint0]

​@@terjeoseberg990 N100 is not equal HEPA, at least not the HEPA kind that truly work and need powered blowers so you can breathe. Incoming particles are not stopped by any regular mask material. Once the viral particles lose their surrounding moisture droplets in the air, masks are like using chicken wire to keep out flies. 0.3 microns doesn't cut it. SARS-CoV-2 is ≈0.1 microns in diameter, and as small as 0.02 microns. N95 respirators are actually rated for 99.5% so N100's are barely different if they are rated for 99.97%. However, clinical trials of N95 respirators showed they only reduced infections by 58% in home care settings. And regular medical masks rated just slightly worse than N95 in head-to-head hospital trials.

[@cloudpoint0]

@@SeaMower It’s an academic debate since 57 clinical trials have shown little or no infection benefit to medical masks against a virus in a real world community setting and none support masks. Countless observational studies show inconsistent results as you would expect if something is of little benefit and other factors matter more.

[@charlestongren2860]

@@SeaMower Use surgical tape.

[@charlestongren2860]

@@cloudpoint0 @cloudpoint You are completely incorrect. Many studies show the benefit. The 95 is the indication of % of particles 2 microns or larger stopped that penetrate inside the mask. Most C19 virions have some degree of droplets surrounding them-some a lot, making them larger. The electrostatic charge in one of the layers of an N-95 is to stop the particle from penetrating to the inside of the mask. If secured with surgical tape it's virtually impenetrable. You can also get N-100s. Or elastomeric respirators.. N-95s are respirators, not masks and worn to protect wearers in industrial settings where hazard is from environment so obviously made to protect wearer. If hazard is petroleum based, you wear a P-95.

[@sureshrao8904]

5 to 11 kids received a tenth of the dose compared to the 12 to 17 age group. Considering the vast variation in body size of this age group did they look at small vs larger kids in the 5 to 11 group? A larger dose might be the solution here with an 8 week gap leading to lower side effects.

[@jeffalexander5842]

5-11 receives 1/3 the dose

[@sureshrao8904]

@@jeffalexander5842 my mistake. I meant the 6m to 4 11 got the one tenth dose.

[@charlestongren2860]

Body weight is not the factor, per Daniel. It's maturation of the immune system.

[@ZaK47-d4s]

Test to treat -you need Rapid Antigen tests with 95% Sensitivity - some are only 80 % NOT GOOD ENOUGH .

[@charlestongren2860]

Binax is excellent.