TWiV 1074: Clinical update with Dr. Daniel Griffin

In his weekly clinical update, Dr. Griffin discusses the outcomes of SARS-CoV-2, influenza and respiratory syncytial virus infection in pediatric communities under the age of 18 years, the treatment of infants with the human monoclonal anti-respiratory syncytial virus antibody to prevent hospitalizations, most recent statistics on the circulation of respiratory syncytial virus, influenza virus and SARS-CoV-2 virus in the US, how the SARS-CoV-2/COVID-19 pandemic affected school attendance and child healthcare, how exposure length influenced transmission of SARS-CoV-2, how the durability of the anti-SARS-CoV-2 antibody response to protect against virus re-infection, if administration of oral antiviral therapy affected viral rebound in either the unvaccinated or vaccinated populations, as well as a reminder of the ineffectiveness of antibiotics for treating COVID-19 and the effect of vaccination on post-COVID conditions in children between 5-17 years old.
Show notes at www.microbe.tv/twiv/twiv-1074/
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[@lesfaby8997]

_KZbin timestamps by Les_ 00:57 Bowtie 01:24 Quotation (H.L. Menkin) 02:15 outcomes of pediatric SARS C2 Omicron infection versus influenza and RSV infections (JAMA Pediatrics) 06:05 nurse s m for prevention of hospitalizations due to RSV and infants (New England Journal of Medicine) 11:28 School absenteeism as a marker for Community covid-19 rates (jids) 13:30 impact of covid-19 pandemic on pediatric preventive Healthcare among North Carolina children enrolled in Medicaid (jeds) 15:15 digital measurement of SARS2 transmission risk from 7 million 18:33 probably negative things about vaccines just to be fully honest so um there's some good news in this article also some 26:41 much time talking about our most effective tool after vaccines well the article oral covid-19 antiviral uptake among a highly vaccinated us cohort of adults with SARS K2 infection (open forum ID) 27:55 azadine and Nirmatrelvir in hospitalized patients with moderate to severe covid-19 emulation of a randomized Target trial (Journal of med vir) Week 1 recommendations Week 2 recommendations 32:18 Simastatin in critically ill patients with covid-19 (New England Journal of Medicine) 36:23 Please contribute 37:05 Dr D answers your Qs see www.microbe.tv/twiv/twiv-1074-letters/ 40:02 Maryann 41:03 Brian 42:36 Louise 44:01 Jay _Audio podcast timestamps by Jolene. Thanks._

[@Trees43]

Without Daniel to keep us grounded where would we be? As ever, many thanks for all your work, both Daniel and Vincent.

[@mrscott3961]

Great information as usual, wish you could get youtube to put the “from a qualified healthcare provider” or licensed physician etc that I see on other hospital and physician channels.

[@5amiann]

When I called for paxlovid, my doctor had just left for 4 days (preholiday weekend) and I didn't get called back until I was logically out of the period when the antiviral meds would actually work. Luckily, I did not get very ill, but was sick for those 4 days. I was improving by the time they called back. This seems to be a glaring hole in our medical system (rural usa). I am over 65.

[@keithrobinson2941]

I am about the same age as you. Where I live (People's Republic of British Columbia), we aren't allowed paxlovid until age 70. In other parts of Canada, you can get it if you are over 18 years. On the brighter side we have good access to vaccines, though the RSV immunization is a bit pricey for those who do not have extended medical coverage.

[@marklemont3735]

I had all my testing done and had a plan to take paxlovid if and when necessary, but when I called my doctor’s service on a weekend, his colleague was not a paxlovid advocate, to my surprise. Thank goodness it was not Covid, but something else the urgent care doctor could identify and treat. Then my doctor was out sick for the week. Now I need a new plan, to cover these situations, too!

[@misterk7040]

In the Chicago area, the pharmacist at either Walgreens or CVS can prescribe Paxlovid. I'm sure it's the same anywhere in the USA. Google how to get Paxlovid from Walgreens/CVS. Happy New Year.🥳

[@marklemont3735]

@@misterk7040 In my area the pharmacist needs to have access on their computer to your lab values, which must show your liver and kidney values. The labs must be less than a year old. They would not take a print out, the last time I checked.

[@jonnash5196]

Sometimes in a situation like that people go to (or call into ) a walk in clinic or ER to get the paxlovid scrip.

[@johndoe09876]

38:55 Seems like cruise ships offer a great opportunity for transmission research. I'm guessing the companies want nothing to do with that. I'm surprised (or unaware) the navy doesn't study transmission on it's air craft carriers. Seems like the perfect environment to do all sorts of interesting measurements.

[@traceybutler5420]

I look forward to this every week! thank you for continually educating me and the rest of the world

[@jonetyson]

The hazard ratio for infant hospitalization from RSV with or without nirsevimab underestimates the utility of nirsevimab, because it ignores the benefit of reducing disease spread. It's time to stop thinking about vaccines and antibodies in medical terms, to the exclusion of public health considerations. Everyone should do their part to prevent RSV.

[@beckyconstantinides2546]

Thank you both! Full avoidance would seem like a wise choice. May the Season bring you joy and delight. The airline and cruise industries don’t want you to know how well viruses spread through the air. Shared air sucks!

[@NotesFromPittsburgh]

As always, outstanding episode. My very early Saturday morning listening. Thanks so much, and happy new year!

[@WillNewcomb]

Time of exposure: these figures will be means so times outside of these are still realistic. There are at least 2 papers documenting almost instantaneous infection (results from passing an infected person in the street, both unmasked) in Australia and one in my part of the city in China. You still need to be careful everywhere.

[@WillNewcomb]

I read another quote on Twitter today "People don’t want to believe me when I tell them my husband was also infected while wearing a fit tested N95. We suspect his eyes may have been the site of entry but it’s hard to know. We DO know it took only 5-10 minutes in a room with 10 people. 😔"

[@janakingking3022]

Love the quotation! That’s a keeper

[@artmaven]

Thank you, gentlemen.

[@WillNewcomb]

Interesting hearing about Azvudine. Here in China the experts talk about Antivirals to combat C19 but never mention any names. Not even Paxlovid even though a manufacturing facility for it was completed about a year ago!

[@jmer9126]

Love you guys. Thanks for the consistent excellent information

[@Frank-sy3li]

Thank you Vincent and Daniel. Another good episode!

[@JillKnapp]

Really great episode, though I wish some of the news was better. Another donation coming your way! Thank you for all you do. Here's to a healthier 2024! ❤

[@marg716]

Thank you again 👏👏👏 And happy new year (almost)!

[@DudeFun-yi7nu]

Around the corner from 1100 episodes, amazing, thank you so much

[@sandracollins347]

Great episode as always. Happy New Year 🎉

[@mariea1431]

Thanks!

[@sbartdbarcelona44]

Was Covid positive for about 5 days over new year holiday. Very sick, headaches, lightheaded and stomach cramps. No paxlovid since very quick Covid bout. Mild Symptoms persist despite being covid negative.

[@markbrad123]

Simple answer - do nothing, don't go out don't get infected.

[@WillNewcomb]

Nasal sprays: I recently saw an MD tweeting about these but have given them a miss. I did however see a paper a year ago talking about the benefits of saline nasal irrigation v C19. Any comment?

[@highlandbob2470]

FLCCC recommends Nasal spray with 1% povidone-iodine: 2-3 times a day. This is in their early treatment protocol.

[@WillNewcomb]

@@highlandbob2470 But FLCCC recommend Ivermectin and Hydroxychloroquine so I won't take anything they say to be authoritative.

[@brendanmay9585]

​@@highlandbob2470FLCCC protocols have been disproven.

[@Sceince007]

@@highlandbob2470 and the evidence of benefit ? FLCCC has made millions selling junk that does not work and can be harmful . Also those that seek help there often don’t get better prevention

[@lauchlanguddy1004]

iodine sol , eyes ears nose throat

[@karenkaren3189]

Everyone should be maximizing their immune systems. I am fully vaccinated. I also wear a mask when I volunteer at my hospital. I also take vitamin d and zinc everyday. I take melatonin for sleep.

[@lauchlanguddy1004]

vit D and vit K........research please

[@shokuchideirdrecarrigan7402]

Over one year of vax reaction. Hair loss, physical pain, brain fog, other neurological problems. After one year caught COVID, most reactions disappeared snd 2 ½ months later remain disappeared. COVID consisted mainly of extreme fatigue, lung congestion, mild sore throat. Age 75.

[@graysonric]

You seem confused

[@TE-7302-]

@@graysonric😂

[@WillNewcomb]

Infectious? I read a paper showing that 10% patients were still infectious after 10 days. "The median time to symptom resolution was 6 days, and 12% of participants still had symptoms at day 10. Overall, the median time to non-infectious virus load was 5 days after symptom onset, with 75% of participants meeting the non-infectious threshold by 7 days, and 90% by 10 days. Ten participants were still infectious at 10 days, but only one was symptomatic, with a cough. "On the day of symptom resolution, 43 of 87(49%) had met the threshold of non-infectiousness, with 52 (60%) having reached the threshold as of the first day post symptom resolution," the authors wrote."

[@brendanmay9585]

I can hear Vincent responding to this with the point that 'viral load' is incorrect terminology. It should be RNA copy number and we do not have a proxy for infectiosness based on RNA copy number. We need assays, but even assays are not a reliable proxy for infectiosness.

[@WillNewcomb]

@@gferraro8353 Ah yes. When 'the precautionary principle' still existed!!!

[@WillNewcomb]

@@brendanmay9585 But 'viral load' is NOT mentioned. Infectious load IS!

[@brendanmay9585]

@@WillNewcomb but how / where do they establish what 'viral load' is infectious. I have heard Vincent complain about this 1000 times. What techniques did they use to establish the so-called viral load. If it was PCR then that is a problem because we have no way to distinguish between viable virus and destroyed RNA bits with PCR.

[@WillNewcomb]

@@brendanmay9585 I took the quote from CIDRAP article published December 13, 2023. I believe CIDRAP is a reputable research establishment.

[@frederiquecouture3924]

Happy Bowties!

[@traianliviudanciu8665]

May be ,,mask wearing,,not only stop droplets, but also maintain higher mucouseal respiratory temperature. If SARS COV2 better replicate at very low tissue temperature, higher mucouseal respiratory temperature protect against SARS COV2 infection

[@frederiquecouture3924]

The Gravestones. Henry?

[@shawnlennen7871]

Give all studies from natural immunity after infection quit pushing the shot in young people who don't need it

[@christopherrobinson7541]

INCORRECT

[@graysonric]

Have your mommy make an appointment with your pediatrician.

[@badddkattt]

You have to survive COVID to get “natural” immunity; you are much more likely to survive a SARs2 infection if you have been fully vaccinated, and survive without debilitating post COVID (long COVID) complications.

[@KellyRiemerCusick]

I don't understand your philosophical statement "No one is safe until everyone is safe." This does not strike me as factual. At the very least, I believe it is true that there are always at least a few individual anomalies who are immune to a particular disease for some rare, peculiar reason related to their own physiology. That fact may not be helpful to the rest of us, but it does seem to me that it puts a constraint on the accuracy of your statement. In general, I always feel like ABSOLUTE statements are less believable than those with a bit of nuance or wiggle-room.

[@ShedOnYou]

It's a statement of empathy and community. Definitely not a "you-do-you" philosophy.

[@Logotic]

Love the opening quote from one of my favorite writers. Dr. Griffin actually looks a wee bit like H.L. Mencken, though with less hair and far fewer gin blossoms.

[@Logotic]

And Mencken would have had great fun wit' these people and their nasal sprays!

[@frederiquecouture3924]

🕶️🤓🕶️.

[@NathansHVAC]

Flu is worse than omicron

[@lauchlanguddy1004]

flu can be very bad for some and C virus not noticed