TWiV 1126: Clinical update with Dr. Daniel Griffin

In his weekly clinical update, Dr. Griffin discusses RSV vaccination recommendations and revisions to guidelines before reviewing the recent statistics on SARS-CoV-2 infection, data suggesting that individuals with high HLA-DQA2 expression (MHC class II) are better at preventing the onset of a sustained viral infection, how moderate coffee intake can reduce risk of COVID-19 severity but cannabis use resulted in more severe disease but reduced risk of mortality, where to find PEMGARDA, if statin use prevented severe COVID-19, the benefit of administering nirmatrelvir and ritonavir after 5 days, convalescent plasma, what do when healthcare workers succumb to SARS-CoV-2 infection, if fecal microbiota transplants aid in recovery from COVID-19, and the definition of characteristics and clinical patterns for the diagnosis of long COVID.
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[@DS-nb5cz]

I am sorry for the loss of your 33 yo patient to Covid 19 Dr. Griffin. Thank you for another very informative podcast.

[@wolpumba4099]

*Summary* *RSV Vaccination (**0:00**)* - CDC revised RSV vaccination recommendations for adults 60 and older. - Recommends vaccination for everyone aged 75 and older. - Recommends vaccination for individuals 60-74 with specific chronic medical conditions (e.g., heart or lung disease) or living in nursing homes. - Recommends against routine vaccination for those 60-74 without risk factors. - No recommendation yet for individuals aged 50-59. - Durability of protein-based RSV vaccines (GSK, Pfizer) appears better than mRNA-based vaccines at this time. *SARS-CoV-2 (**8:08**)* - COVID-19 cases and hospitalizations are rising in Puerto Rico. - Study highlights different infection responses: (9:58) - Abortive: Detectable immune response but no positive PCR or symptoms. - Transient: Positive PCR but only one detection over time. - Sustained: At least two detectable PCR results over time. - Moderate coffee consumption may reduce COVID-19 severity. (14:28) - Cannabis and tobacco use associated with increased risk of hospitalization and ICU admission. (15:08) - XBB booster effective against hospitalization and ED visits, but older vaccines show no significant protection after one year. (16:51) [unclear if this is because these are mRNA vaccines and if classical protein-based vaccines would protect longer] - Paxlovid may benefit hospitalized patients even if started after five days of symptoms. (23:41) - Fecal microbiota transplantation shows promise for treating insomnia in long COVID patients. (26:45) - Three main long COVID symptom clusters identified: sensory, fatigue/cognitive, and breathing/exercise intolerance. (30:47) *General Recommendations (**32:08**)* - Continue to follow CDC guidelines for COVID-19 prevention. - Get vaccinated and boosted as recommended. - Consider the potential benefits of early treatment with Paxlovid if you test positive. - Support organizations like Floating Doctors by donating to their fundraiser (parasiteborders.com). i used gemini 1.5 pro to summarize the transcript

[@misterk7040]

Well done.👍

[@peony286]

Dear Daniel and Vincent, thank you very much for another informative and intellectual scientific talk! This week I feel so interested in fecal transplant and insomnia.

[@JW4REnvironment]

Kurt Vonnegut really showed a remarkable dry wit in his writings like Slaughterhouse Five. Thanks to Daniel for mentioning this excellent author, and many thanks for his continuing insights into Covid 19 and other infectious diseases. I truly appreciate Daniel’s taking his valuable time to bring his expertise to the public through these podcasts. I tell all my friends about Paxlovid’s benefits thanks to TWIV! Now I will probably get the Novavax before traveling in a couple of weeks…

[@Logotic]

Kurt Vonnegut was uniquely brilliant. Each one of his sentences evokes a whole world.

[@gayluinstra1396]

Whenever I hear about someone young getting hospitalized or dying of covid it makes me very sad and scared for young people. I’m sorry you lost a patient to covid.

[@DavidDavisL]

Thank you for the insights regarding potential differences between mRNA and protein based vaccine durability. I will be more strongly considering the Novavax booster this fall for a number of reasons, and look forward to your analysis of future research in this area.

[@WillNewcomb]

Returning to China this week after 4 weeks in UK upset my routine and i forgot about the Clinical Update! What a nice surprise!!! I noted I was one of only two masked on a full flight of 250 passengers. With KP.2/3 incidence rising I felt it was too risky since it was 11 hr flight and a study showed that flights of > 6 hrs increases risk of infection 25x!!!

[@redhen689]

I flew from London to NY yesterday. I guess I should have worn a mask…. We’ll see.

[@patriciahoke4722]

Puerto Rico - not to be hyperbolic, but lots of young people are leaving or have left, leaving a lot of older and sicker people with decaying infrastructure behind.

[@tleighb]

I look forward to this every week! Thanks for the info!

[@nevets4ever4]

Another fine and informative episode - thank you both. And - I could only imagine the TV advertisement campaigns for "crapsules."

[@GothikBeerTV]

Weed-vaper here! Dr. Griffin, I love your wall! It's precisely what I want in my house.

[@DudeFun-yi7nu]

Thank you so much, I hope TWiV will survive the end of democracy

[@marg716]

Lol while also 😢

[@dougmicheals6037]

I dont think you know what democracy is.

[@marg716]

Thank you again ya’ll. 🎉🎉🎉

[@4everyoung24]

“Smokin’ on the weed.” “Crapsules” What a show!!! 😂😂😂😂😂😂😂

[@Logotic]

"Swallowing Crapsules to cure your anxiety and insomnia" sounds exactly like a Kurt Vonnegut line...

[@riok6234]

It sounds like we still have much to learn about mRNA technology.

[@donnamunro2090]

Vincent looks super cool and young in the t-shirt and black jacket!

[@Logotic]

He does. I wish we could see what was on the t-shirt.

[@jonetyson]

I would hesitate to judge mRNA's platform based on V1 of their RSV vaccine: Could they have just picked too low a dose? Too bad Vincent didn't say what reasons that immunologist at the Karolenska had for suspecting protein vaccines were more durable the mRNA. I'm also curious to know how such reasoning applies to Moderna's individual neoantigen therapy (aka cancer vaccine) for Melanoma, although that vaccine is given with many boosters and the phase 2 data going out 3 years showed a durable effect, both in recurrence free survival and distal metastatsis free survival.

[@yru435]

Thank you so much for sane science talk.

[@paulam3987]

Thanks for covering the FMT research. My impression of this area is that the transplant evokes positive responses in the short term but the benefits don't persist. I don't recall the time dimension of the study period described by Dr. G., but there wasn't a long term followup evaluation. Since the FMT is generally not an ongoing treatment (eg., multiple doses over time), long-term follow-up will be key.

[@alijawad2042]

That was very good.Thank you very much

[@Ramiiam]

Is the implication that the localized immune response in the transiently infected individuals prevented a systemic infection?

[@terrydoyle1141]

Well done, guys! I'd like to know how much weed was smoked for this 1.8x increased hospitalization odds. Please, Vincent, you rightly want quantification of all science claims. Me too in this case.

[@frogsong100]

Bravo, as usual. 🎉🎉🎉

[@Rene-uz3eb]

Puerto Rico probably enjoyed a bit of island isolation with the travel restrictions so for many it's the first exposure to covid now.

[@brendanmay9585]

Unlikely this late in the pandemic.

[@wednesdayschild3627]

Wouldn't they always have less exposure because it is an island.

[@katiehettinger7857]

Population density on the island and older members of the community returning to participating in social gatherings may also account for the increase.

[@AnnetteKapple]

I was vaccinated against COVID in October and came down with COVID 5 days ago. I'm thinking my immunity wore off. This has kicked my butt the last 5 days. The cough is causing muscle pain. I'm hoping my cough gets better by the 10th day.

[@gymjoedude]

Remember vaccines didn't prevent infection, they reduce severe disease and hospitalization. Antibodies go up after immunization then go down, but your t cells remember the vaccine and flight it.

[@laurier3348]

Annette, you need a Booster.

[@danielasuncion9991]

Annette: Sounds like you had been exposed to an ENORMOUS amount of COVID-19 germ. I heard of a study where volunteers who were currently suffering from Covid, had their virus output measured. It was noticed that the volunteer who breathed out the most virus, gave off A MILLION TIMES more virus, than the volunteer who gave off the least amount of COVID-19 virus.

[@danielasuncion9991]

Before the pandemic, I had a flu like infection that resulted in a cough EVERY waking minute. After I was on the mend, I was sent for chest X-ray, because I felt like I had cracked a rib!

[@laurier3348]

@@danielasuncion9991 Was it H7N9 ?

[@leonjohansson6542]

Dr. Daniel Griffin is looking trim and tan. Lost some weight?

[@suekoi3885]

I’m confused. My limited understanding is that a protein based vaccine is the traditional way vaccines have been developed. Why was a new mRNA Covid vaccine developed instead of just going with the protein based? Is it because mRNA vaccine can be modified quicker to match a current variant? Would it be ironic that a protein based Covid vaccine is better because it lasts longer?

[@KiwikimNZ]

The mRNA vaccine is modified genetic material from the covid virus, this causes the body to make the appropriate antibodies. Protien vaccination is using a protein that is mimicing the covid virus, triggering the body to produce antibodies, they do not contain any genetic material,this type of vaccine is the same as traditional vaccines we had been using for many years. From what Incan gather the protein one gets a better immune response, less side effects, mRNA is reactogenic, so you may expect fatigue, muscle pain, joint pain, headache maybe some nausea, vomiting, maybe a little fever and myocardidtisis. I think they are hoping this will have linnger lasting immunity, confusing I know!

[@christinaduffy6618]

Is there a current protein based vaccine??This MRNA info is kind of scary

[@KiwikimNZ]

Yes Hep B and HPV etc which have been around firvseveral decades.

[@redhen689]

I had the Novavax COVID vaccine in October. I have COVID now.

[@marklemont3735]

8 months later. Sorry you have covid. May you fully recover soon.

[@westonhuffman7908]

Well, I wanna get a fecal microbiota transplant.

[@judithparker4608]

Such as Scurvy or Rickets ??

[@AnnetteKapple]

I didn't pursue getting Paxlovid because a friend said she felt worse on it. Don't know if unpleasant side effects are common?

[@OldOneTooth]

It's common for symptoms to get worse in the 2nd week of the disease if I recall right. The first time I got it, it was so mild at first then the symptoms of disease hit me hard. No paxlovid back then. It's best to get antivirals early rather than later if I recall the general advice right. Later once the virus is cleared it's more calming your immune system down. So if your friend got worse under paxlovid it might simply have been the natural disease progression. It also may not have been as bad as it could have been without it.

[@brendanmay9585]

​@@OldOneToothyes, but let's also not pretend that there are no side effects. Particular GI issues are common with paxlovid. But, it reduces chance of serious disease and probably also long COVID/sequelae

[@JW4REnvironment]

I only had a small funny taste from Paxlovid but my symptoms improved a lot in only a day or so. I will definitely get Paxlovid again if I get another case of covid 19! I would ask my doctor to give it to you if I were you!😊

[@OldOneTooth]

@@brendanmay9585 why we look at studies rather than individual cases to decide effectiveness are side effects.

[@katiehettinger7857]

Isn't the real question are you willing to chance hospitalization and death or face the possibility of a few unpleasant side effects?

[@chinupduck4849]

@19:29 and so it begins

[@laurier3348]

Your 33 yo patient died because he was not vaccinated.

[@terranceoliver6984]

I don't trust these guys.

[@JW4REnvironment]

I really trust Dr. Griffin, who donates his really expert time to this! He was very accurately a big booster of Paxlovid and continues to explain how extremely effective and helpful it is. Even though he doesn’t make any money off of Paxlovid…it just helps his patients as it really helped me through 2 cases of Covid 19!

[@JW4REnvironment]

I trust them! Dr. Griffin donates his valuable time to help us listeners out. He is totally right about Paxlovid. It helped me tremendously through 2 cases of Covid 19!

[@suesaxton3058]

Why don't you trust these guys ???

[@katiehettinger7857]

No one made you listen to them. They are reporting the latest science published on subjects that could be a life or death issue for you. This program is talking about illnesses that are emerging, the inform will change as scientists and doctors used new medications and better understand how diseases effects our bodies.