0:00

This Week in Virology, the

0:02

podcast about viruses, the kind

0:05

that make you sick. From

0:11

Microbe TV, this is Twiv.

0:13

This Week in Virology, episode 1076, recorded

0:15

on January 3rd, 2024.

0:23

I'm Vincent Draconiello, and you're listening to

0:25

the podcast all about viruses. Joining

0:28

me today from New York, Daniel

0:30

Griffin. Hello, everyone. Daniel and I

0:32

were just talking about whether One

0:35

Piece has more episodes than

0:37

Twiv. They have 1088, so we

0:40

are, this is 1076, we're

0:45

12 away. They're closing in, we're gonna catch

0:47

them because I'm sure they don't do two

0:49

a week. All right,

0:51

this is the downwind leg, right? We're

0:54

on the inside quarter, we're barren down,

0:56

we're about to pass. What's

0:58

on your tie today, Daniel? This

1:00

is Ebola. I'm wearing my Ebola

1:02

bow tie. Okay. I'll

1:05

start with my quotation. You don't have to

1:07

burn books to destroy a culture, just get

1:10

people to stop reading them. And

1:12

that's by Ray Bradbury. We

1:17

got asked that question on the live

1:19

stream. Well, what is the biggest mistake

1:21

during the pandemic? And my response, like

1:24

without pauses, not enough

1:26

education, not enough good science

1:28

communication. So, MPOCs,

1:31

to keep this on everyone's radar,

1:33

we read in Sid Rep, in

1:36

its latest monthly update, the WHO

1:38

reported 906 new MPOCs cases from

1:40

26 countries in November, reflecting

1:46

an increase of 26% compared

1:48

to October. I was thinking that was the

1:50

year, but that's just one month. With

1:53

nearly 300 cases, the

1:56

United States reported the steepest rise in

1:58

the Americas, followed by Portugal, reported... They

4:00

keep putting these things out there about, there's

4:02

a new strain, we're

4:05

all gonna die in the next week. Listen,

4:08

every December, January, we see an

4:11

increase in respiratory pathogens. And lo

4:13

and behold, we are seeing that

4:15

again. The wastewater data

4:17

has been updated in a little bit, again, I

4:20

like that, but really

4:22

big rise in the wastewater all

4:24

across the country, big rise in

4:26

cases, hospitalizations and deaths. But

4:29

there's stuff we can do about that. So that's what we're

4:31

here to discuss. Let's

4:33

start off with the article, Characteristics and

4:35

Clinical Outcomes of Vaccine-Eligible US

4:38

Children Under Five Years, Hospitalized

4:40

for Acute COVID-19 in a

4:42

National Network published in Pediatric

4:45

Infectious Disease Journal. So

4:47

here are the investigators enrolled in

4:50

patients, aged eight months to

4:52

less than five with acute, community

4:54

acquired COVID-19 across 28 US

4:56

pediatric hospitals from September, 2022 to May 31, 2023. They

5:03

assessed demographic and clinical factors,

5:06

including the highest level of

5:08

respiratory support and vaccination status,

5:10

defined as unvaccinated, incomplete

5:13

or complete primary series. Among

5:16

597 children, right? So

5:19

we have hundreds of children, 29.1% were admitted to

5:21

the ICU, 12.6%

5:24

had a life-threatening illness, including

5:27

8.5% of these little kids requiring

5:31

mechanical inhalation. Children

5:34

with underlying respiratory and

5:36

neurologic neuromuscular conditions more

5:38

frequently received higher respiratory support. Only

5:41

4.5% of children hospitalized had

5:46

completed their primary COVID-19 vaccination series. Yeah,

5:50

among 528 unvaccinated children, nearly

5:54

half were previously healthy. Three

6:01

of them required extracorporeal membrane

6:03

oxygenation and one of them

6:05

died. Completion

6:07

of the vaccine series was low in all regions,

6:10

but highest in the northeast, but not so impressive,

6:12

12.2, lowest in the south, 1.5%. So

6:18

they should be vaccinated, right, Daniel? Well,

6:20

yes. I mean, I think we have

6:23

a growing body of evidence. Well, as

6:25

you see here, hundreds of children in

6:27

the hospital, children on ventilators, children in

6:30

the ICU, children on ECMO, one

6:33

of these children ended up dying. That

6:35

was not a vaccinated child that died, so. All

6:38

right. The article SARS-CoV-2

6:41

perinatal transmission and neonatal outcomes

6:43

across four different waves of

6:45

COVID-19 pandemic, a nationwide prospective

6:47

cohort study from the Italian

6:49

Society of Neonatalogy was just

6:52

published in the International Journal

6:54

of Infectious Diseases. These

6:56

results are from a large

6:58

prospective nationwide cohort study collecting

7:01

maternal and neonatal data in

7:04

case of maternal peripartum

7:06

SARS-CoV-2 infection between

7:08

February 2020 and March 2022. Data

7:13

was stratified across the

7:15

four observed waves among

7:18

5,201 positive mothers. The

7:22

risk of being symptomatic at delivery was

7:24

significant higher in the first and third

7:26

waves than in the

7:28

second and fourth. So almost twice as

7:31

high, like 20.8 compared

7:33

to 13.2 and 12.2. Among

7:36

mothers with symptomatic infections, the rate

7:38

of severe infection was significantly higher

7:40

in the first and third

7:43

waves. It's sort of interesting. It wasn't just

7:45

going down. Actually, first wave was 21.4. It

7:47

was actually 27.4 in the third

7:50

wave compared with the second

7:52

was 9.2, fourth, 5.6. Overall,

7:56

death during hospitalization occurred

7:58

in zero to... 0.2% of the SARS-CoV-2 positive

8:00

mothers didn't

8:04

see any difference across the periods. Among

8:07

their 5,284 neonates, the

8:10

risk of prematurity was significantly higher in

8:12

the first and third waves, so 15.6

8:14

and 12.5. The

8:18

risk of postnatal transmission during rooming

8:20

in was higher and

8:22

peaked at 4.5% during the fourth wave, 80%

8:27

of the positive neonates were asymptomatic. So

8:32

moving to testing and transmission and

8:34

all that, I'm gonna

8:36

leave in a link in our show notes, the

8:39

CDC guidance on improving ventilation in your

8:41

home. We've talked a little bit about

8:43

this, leave those fans

8:45

on, crack those windows, a

8:48

lot of transmission, right? People spending

8:50

hours together in a poorly ventilated

8:52

home, let's improve that ventilation. We've

8:55

talked a bunch about testing, the

8:58

benefits of vaccination, but

9:00

occasionally people still end up with COVID

9:03

and just NIH treatment guidelines. This

9:06

is not just my opinion. Number

9:08

one, Pax Lovit, number

9:10

two, Remdesivir, next,

9:13

Baldyperivir, in some cases,

9:16

convalescent plasma, and

9:18

we continue to have the same recommendations,

9:20

five days most transmission, next five days

9:22

wearing a mask because we're still seeing

9:25

some transmission in the last five days.

9:28

Week two, this is not rebound, this

9:30

is week two, the cytokine storm, the

9:32

early inflammatory phase. This

9:35

is when sometimes people start to feel crummy.

9:38

If you end up with oxygen saturation

9:40

less than 94%, steroids,

9:42

right time, right person, anti-covidation

9:45

guidelines, pulmonary support, still might

9:47

be some role for antiviral

9:49

therapy with Remdesivir, occasionally

9:51

immune modulation with tocilizumab.

9:55

But Then unfortunately, we're seeing folks who

9:57

continue to have issues after this first.

10:00

The couple weeks am people really

10:02

liked our discussion or then send

10:04

a couple weeks ago about how

10:06

long cove it is really just

10:08

one subset of the many post

10:10

accused the quality of cove it.

10:13

Or this week I wanted

10:15

to discuss the article Corticosteroids

10:17

for Covered Nineteen Induced Olfactory

10:19

Dysfunction a comprehensive systematic review

10:21

and men analysis of randomized

10:23

controlled trials published in Sauce

10:26

Want some not going to

10:28

point out or factory dysfunction?

10:30

gustatory dysfunctions, Issues with taste

10:32

and smell. This is not

10:34

just bothers some more than

10:36

just bothers some Olfactory succeed.

10:38

This can really have significant

10:40

impacts on quality of life.

10:43

We can see weight loss because

10:45

people becoming despondent because this is

10:47

one of the the pleasures of

10:49

why's that? they have now lost.

10:52

I'm here are seven randomized controlled

10:54

trials with Nine Hundred Ninety Nine

10:56

for dispense. We needed just one

10:59

more and compared with the control

11:01

group, corticosteroid treatment resulted in a

11:03

statistically significant improvement in all factory

11:05

score With a standardized mean difference

11:08

of zero point five five I'm

11:10

topical corticosteroids was down to be

11:12

effective. But systemic corticosteroids? we're

11:15

not. In addition, longer durations

11:17

and higher doses of corticosteroids

11:19

may also be a so

11:21

she was significant improvements in

11:23

olfactory scores. No

11:25

significant effect was observed on

11:27

the duration or recovery rates.

11:30

Of olfactory to succeed but. Let

11:33

me go through a bit odd you

11:35

know not only going to this Met

11:37

analysis of a little bit on how

11:39

one might want to approach men analysis

11:41

papers The South's gonna recommend People apps

11:44

and I think this is behind a

11:46

pay wall and the one of the

11:48

first things I usually have people look

11:50

at his the forest bots A there's

11:52

a nice figure two forest plots and

11:54

what you see here is different studies

11:57

pulled out and then you can see

11:59

for each. Study not only the

12:01

am number of dispense in the

12:03

treatment in control groups but you

12:05

can also see the analysis as

12:08

far as the the. Difference

12:11

that each study was showing. i'm

12:13

twenty six I like people to

12:15

look at is the number of

12:17

folks in the different studies how

12:19

much each study might potentially contribute.

12:21

So is this really just a

12:23

matter? Analysis of many papers wars

12:26

have met, analysis, just a republic

12:28

east and of a just large

12:30

single study that push things in

12:32

one direction. Or the

12:34

next thing that this paper has that

12:36

I really like is a Senior Surrey

12:39

which is a and assessment of Eastern

12:41

Studies in can go back and forth

12:43

on where they're high risk or low

12:45

risk of any kind of bias whether

12:47

a lot of concerns. The

12:50

fortunately here we weren't seeing any have included

12:52

studies were at high risk of bias. About.

12:55

Three of the studies Really solid

12:58

low risk of any concerns, but

13:00

for of the seven studies they're

13:02

actually concerns on as far as

13:04

selection of the airport. A result,

13:06

the measurement of the outcome. May.

13:09

Be missing outcome data and randomization

13:12

process which is always really importance

13:14

and then they also have a

13:17

nice figure three where they show

13:19

the impact on duration of recovery

13:21

of really interesting serve Really for

13:24

studies that get included they're two

13:26

of them don't really so much

13:28

difference actually to them seem to

13:31

be going in the wrong direction

13:33

suggesting that corticosteroid therapy may actually

13:36

have a negative impact upon I

13:38

to recover. are

13:41

i'd suggest something to keep in

13:44

mind there and the article covered

13:46

nineteen convalescent plasma therapy long term

13:48

implications recently published in open form

13:51

infectious disease and suits hear this

13:53

reminds me of that a paper

13:55

we publish where we looked at

13:58

monoclonal antibody ab therapies nuts what

14:00

happens acutely, but let's follow

14:02

these folks out a little bit. So

14:04

here we see the data from the

14:06

ContainXtend study. The ContainXtend study

14:09

examined 281 participants

14:11

from the original Contain COVID-19 trial at

14:13

18 months post hospitalization

14:17

for a COVID-19,

14:20

symptom surveys, global health assessments,

14:22

and biospecimen collection was

14:25

performed from November 2021 to October 2022. Multivariable

14:30

logistic and leaner regression, estimated

14:32

association between randomization arms, self-reported

14:35

symptoms, and promise

14:37

scores adjusted for covariables.

14:41

Just by the way, PROMIS stands for

14:43

patient reported outcome measurement information system.

14:45

So what we're really doing here is

14:48

we're asking folks with

14:50

a patient reported outcomes, how are

14:52

you doing and are we

14:54

going to see any impact basically on

14:56

long COVID between the folks that got

14:58

the benefit of the convalescent COVID

15:01

plasma. While some previous studies

15:03

have shown benefits in certain populations, if

15:05

given at the right time, in

15:08

short-term outcomes, looking at longer-term

15:10

outcomes, there was no difference

15:12

in symptoms or promise scores

15:14

between the convalescent COVID

15:16

plasma folks and placebo. CCP

15:20

demonstrated no lasting effect

15:22

on past symptoms or overall health in

15:25

comparison to placebo in this particular study.

15:27

Do you know when that plasma was

15:29

administered? It would have been in the

15:32

first few days. Yeah,

15:34

so that's always the challenge and we tried to even

15:36

do that with our monoclonal anyway,

15:38

trying to figure out exactly. Because you'd

15:40

love to say, well maybe if we

15:42

looked at people that got it in

15:45

the first three days and then they

15:47

got the right high titer convalescent plasma,

15:49

yeah, so this doesn't necessarily tease

15:51

out subtle things like that that might

15:53

actually have an impact. And

15:56

before we get to our letters, I

15:59

will say as a... been saying for a while, no

16:01

one is safe until everyone is safe. We

16:03

are in the third and final

16:05

month of our Parasites Without Borders

16:07

microbe TV fundraiser. We're now raising

16:09

money for microbe TV. November, December,

16:11

January, we will double your donations

16:14

up to a potential maximum donation

16:16

of $20,000. It's

16:20

Tom, you're just for Daniel. You can

16:23

send yours to Daniel at

16:26

microbe.tv. Now Daniel, as you might imagine,

16:28

we had a lot of letters about the

16:30

Florida Surgeon General statement

16:32

about COVID

16:35

mRNA vaccines. And

16:37

for example, one from Winnie, I live in

16:39

upstate New York. I work as a flight

16:41

paramedic in the US Virgin Islands, which requires

16:43

me to maintain a Florida license. I'm

16:46

embarrassed to be associated with the Florida. Every

16:49

time I receive an email like this

16:51

one, could you please discuss the science

16:53

or lack thereof behind these assertions? Yeah.

16:56

So I will encourage people to listen

16:59

to our live stream where Vince and I

17:01

have a little bit of a deep dive

17:03

into this. But yeah, I mean, the Surgeon

17:05

General Florida, you know, he has the right

17:07

credentials, MD, PhD, Harvard trained, you

17:10

expect to hear good science based

17:12

advice. But unfortunately, that's not what

17:15

you're getting here. You're

17:17

hearing more more anti science

17:19

communication here, more of an

17:21

anti vaccination, more of an

17:23

undermining trust in

17:25

the vaccines coming from from this individual.

17:29

It really is one of these, you

17:32

know, throw the hands up and

17:34

confuse the issue that the concern is

17:37

that there is some DNA in

17:39

these vaccines, there's DNA in every

17:41

vaccine, DNA is really pretty ubiquitous.

17:44

It was a suggestion that instead, people should

17:46

go get the Novavax vaccine, which has grown

17:48

in insect cells, by the way, also some

17:50

DNA in there. The

17:53

whole fear is that, you know,

17:56

this DNA could somehow incorporate into ourselves

17:58

no, no, no science. to suggest

18:01

that's a concern. Billions

18:03

of vaccine doses, we're not seeing this.

18:05

This whole, I think this feeds into

18:07

this crazy turbo cancer, I don't know

18:09

if you've heard about that, Vincent, on

18:12

social media stories of like, I

18:14

knew this guy who got a vaccine six days

18:16

later, died of a turbo cancer. I mean, none

18:19

of this makes any scientific sense. So

18:22

unfortunately, seeing a person in a

18:24

position like this undermining

18:26

what are really incredibly safe,

18:29

effective vaccines. Hannah

18:32

writes, early 2023, I had strep throat and

18:35

COVID at the same time. I

18:39

only found out about COVID since I was given

18:41

rapid tests for strep influenza and COVID at the

18:43

urgent care. COVID was either asymptomatic

18:45

or outshined by the dramatic symptoms of

18:48

strep throat. The strep rapid was positive,

18:50

a throat culture was not performed influenza

18:52

negative. Pretty consistent

18:54

with my symptoms, rapid fever onset swollen

18:56

tonsils with putrid discharge and pain when

18:59

swallowing and speaking. I was given a

19:01

10 day course of amoxicillin. My

19:03

symptoms began to improve quickly. However,

19:05

of day nine, I developed disturbing swelling and

19:07

deeply itchy patches of rashes on

19:10

my hands and feet. Telehealth appointments

19:12

surmised I probably had amoxicillin allergy

19:14

or mono. The rash

19:16

swelling went away over a couple of

19:18

days with dexamethasone and difenhydramine. I

19:21

later tested for pen, amoxicillin

19:23

and other antibiotic allergies, all

19:25

negative, and have taken amoxicillin

19:27

since then without issue. A quick and dirty

19:29

PubMed search linked mono with a

19:31

delayed B cell reaction causing the swelling and rash,

19:34

which is commonly referred to as an allergy, but

19:36

isn't a true allergic response. I wouldn't ever know

19:38

for sure if I had mono in addition to

19:41

COVID and strep. But do you know of penicillin,

19:43

amoxicillin rash occurring in COVID patients? Could you explain

19:46

the immunological mechanism of the

19:48

delayed reaction? Would, could COVID

19:50

reactivate latent mono EBV

19:52

infection? So

19:54

there's a lot, there's a lot in here. So let, I'm

19:56

going to sort of answer my own questions. So the

19:58

first, and I think this is really. really important. Did

20:01

you, like John Hickam says, get two things

20:04

at the same time? Did

20:06

you get COVID and strep throat at

20:08

the same time? And, Pat, I'd love

20:10

to know your age and risk factors

20:13

for strep throat, because we are certainly

20:15

seeing COVID present as an acute pharyngitis.

20:18

People go in, oh my gosh, I've got a

20:20

horrible sort of throat. My gentleman

20:22

today described it as, felt like someone had

20:25

glass in the back of his throat. So

20:28

a lot of times that really severe sore

20:30

throat is actually COVID.

20:34

20% of people will have strep in

20:36

the back of their throat. They won't

20:38

necessarily have a strep pharyngitis, but it'll

20:41

be perulite back there, it'll look horrible.

20:44

That can, all that can actually be from the COVID. So

20:46

I just want to point that out. And

20:48

it can be hard to make the distinction. So, you

20:51

know, 80% of people getting antibiotics with

20:53

acute COVID, there are certain circumstances where I

20:55

could see where you say, gosh, I'm really

20:57

not sure. You've got pud or

20:59

lymph nodes, you've got fever, you've got perulin

21:01

X-edate. You know, you don't want to not treat

21:04

the strep throat. So that's the first thing I want to point out.

21:07

The next is that, yeah,

21:09

we have seen, this is

21:12

kind of the classic with mono where

21:14

someone has mononucleosis and they get amoxicillin,

21:16

they have this rash that gets triggered.

21:20

We don't actually know what is involved, what triggers that.

21:22

And they're not allergic to petticillin, they're going to

21:24

be fine again in the future. There's

21:26

been a few case reports where people got

21:28

amoxicillin, oh my gosh, you

21:30

know, with acute COVID and then developed

21:32

the rash and then we're fine afterwards.

21:36

Not sure if there's really a causal connection

21:38

there or if it just happened a few

21:40

times. Russell

21:43

writes, I'm a

21:45

family doctor acting as the sole hospitalist

21:47

with two nurse practitioners in a rural

21:49

hospital, as well as being the medical

21:51

director of two nursing homes with 100 patients. By

21:54

default, I became the local COVID-19 expert, which

21:57

after 40 years in practice has been highly

21:59

interesting. I've read a gigantic amount, but

22:01

certainly have learned much from your podcast as well.

22:04

In 2020, we had a terrible outbreak

22:06

in both homes, lost 40 patients to

22:08

COVID before vaccines became available. Recently, we

22:10

had another outbreak of 28 patients in

22:12

a facility. Six of

22:14

these patients with positive tests seemed

22:17

to have no symptoms, at least

22:19

that we identified. Eventually, three of

22:21

these ended up being hospitalized with

22:23

apparent COVID-related symptoms, including one that

22:25

needed biphasic CPAP. So my

22:27

inclination and my question is, should we just

22:29

treat all positive tests in the

22:31

nursing home patients with Paxlovid, Remdesivir, Molnupia,

22:34

Rivere? I appreciate your thoughts. Yeah,

22:37

so this is something that's come

22:39

up since these medicines got this

22:41

indication to treat COVID-19, right? So

22:44

the indication is not to treat a positive

22:46

test, but the indication is to treat a

22:48

disease. So you have

22:50

an individual and there almost was this

22:52

sort of binary suggestion. The person says, I got a

22:54

little bit of a cough, I got a headache, I

22:57

got some congestion. Okay, you got COVID-19,

23:00

your risk of progression is whatever, 40%. The

23:05

vaccine has dropped that to 4% or 5%. Well,

23:07

sort of the numbers you're giving me, 6 out of 28,

23:09

right? So yeah, pretty

23:12

high percent of your folks end up progressing. We

23:15

also know, and this is the lesson that we've tried

23:18

to repeat over, how bad

23:20

your symptoms are during that first week. Do

23:22

not necessarily predict what's going to happen during

23:24

the second week. What predicts the second week?

23:27

It's age, it's risk factors. So

23:30

it's pretty hard for me. I had a

23:32

gentleman today, he's in the hospital, he's got

23:34

bacteremia, we're treating him for endocarditis,

23:38

getting ready to leave. They

23:40

do the COVID test, it comes back positive.

23:42

Really minimum symptoms. It really is sort of

23:44

hard to know like, are these symptoms even

23:47

attributed to the COVID? Are they

23:49

attributed to just being an older

23:51

gentleman? Are they attributed to the bacteremia?

23:54

So I almost err in the other side. If

23:56

I say, you know what, there's anything here that

23:59

allows me to make... the clinical diagnosis of

24:01

COVID-19. These

24:03

medicines are incredibly safe if you know what you're doing,

24:05

and it sounds like 40 years of experience, you probably

24:07

know what you're doing by now. Yeah,

24:10

it's always better to err on the

24:12

side of treating with an effective antiviral

24:14

rather than missing that window and having

24:16

folks progress. Vin

24:19

writes, I'm an urgent care physician seeing

24:21

many patients with mild COVID. My question

24:23

is how do you approach those newly

24:25

positive patients with a diagnosis of asthma

24:28

or COPD who always get steroids from

24:30

their PCP, from their clinician when they

24:32

get a URI who are minimally hypoxic

24:34

in that first week of infection? Do

24:37

you prescribe steroids with a CXR or

24:39

wheezing guide? Your decision, many patients are

24:41

hesitant to go to the ER with

24:43

a SAT of 92 to 94%. The

24:48

worry, of course, is blunting the

24:50

immune response in that first week compared

24:52

with actuality of hypoxia or potential COPD

24:54

exacerbation. No, this

24:57

is a great question. This comes up all the time,

24:59

and so hopefully we'll get a chance to walk through

25:01

it here. I

25:03

really try not to use steroids during that

25:05

first week. It's a really

25:07

like, think of it as the anti-paxilovid,

25:09

right? We've discussed studies where a five-fold

25:11

increase in your risk of progression to

25:14

the hospitalization, you're really shutting

25:16

down, like why did you even bother to vaccinate

25:18

someone if now you're gonna shut down their immune

25:20

system with those steroids? Maybe

25:23

this is tempered to some degree if you are able

25:25

to get that person on an antiviral during

25:28

that first week. The

25:30

inhaled steroids, those are reasonable. I don't

25:32

think those are harmful. They actually were

25:35

studied for potential benefit, maybe no benefit,

25:37

but also it doesn't look like there's

25:39

any harm. Really try

25:41

as much as possible to avoid steroids in

25:43

those first seven days. A

25:46

person who's got COPD, it's

25:49

probably a high-risk person, so really wanna be

25:51

looking at which antiviral to get them on.

25:54

But still really trying to avoid those

25:56

steroids during the first seven days. And

25:59

finally, Matthew writes, my question has to do

26:01

with testing. While visiting

26:03

family recently, I had an illness with many

26:06

COVID symptoms, but tested negative five times in

26:08

as many days. And

26:10

therefore my brother and his son

26:12

turned positive. So despite the lateness,

26:14

I did start Pax Loved. I'm

26:17

seeing a crown in multiple vaccinations and previous

26:19

bouts of COVID. It can take two to

26:21

three days to get a positive. This makes

26:23

it hard to start Pax on a month,

26:25

wherein one gets the

26:27

maximum benefit. I've also read that

26:30

yield may be higher by combining throat

26:32

and nasal sampling. Could you please comment?

26:34

Thank you. Yeah. So there's

26:36

several things that you talk about there. So if

26:38

you're going to combine, we'll start off with the

26:41

test. If you're going to combine NARES and oral

26:43

fair and jail testing, use the test that's validated

26:45

for that, right? So you want to use the

26:47

test, get a reliable answer. Most

26:50

of the tests out there are not validated

26:52

for those double tests. PCRs are, right? PCR,

26:54

it's just a PCR. So you can actually

26:57

swab. And you're not swabbing your tongue or

26:59

the bucomicosa. You're actually back there, the palatine

27:01

console is the back of the throat. So

27:04

the PCR, particularly oral fair and

27:07

jail and nasal, okay, you can get

27:09

an earlier detection or sensitivity there. But

27:12

I don't want people to feel like you fall off a cliff

27:14

here, right? So we talked about a 2% difference

27:16

whether or not you're getting treatment in the first

27:18

three days versus day four and five. We

27:21

talked about a Hong Kong study where they actually

27:23

were after day five and still getting a benefit.

27:26

So, you know, we really are trying to

27:28

get the Paxilovid in the first five days.

27:31

But it's day five or six. It's not like you

27:33

just fell off a cliff. That's

27:36

Twiv's weekly clinical update with Dr.

27:38

Daniel Griffin. Thank you, Daniel. Oh,

27:41

thank you. And everyone, happy new year and be safe.