0:00

This. Week Enviro a g

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the podcast about viruses the

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kind that make you sick.

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From microbe T V this is to with.

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This. Weekend Viral eg. Episode.

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Ten Nine. The. Recorded. On

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February Twenty second, Twenty

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Twenty Four. I'm. Vincent

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Rak and Yellow in joining

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me today from someplace sunny

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Daniel Griffin, St. Augustine, Florida

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Hello everyone. Is. Really nice

0:31

there. And a it is I

0:34

am on the water. A couple

0:36

dolphins just went buys a bunch

0:38

of sailboats out there. arabs few.

0:40

Beautiful place. Have you gone to

0:42

Florida to pass some advice to

0:44

the Health Commissioner? I

0:47

don't think my a science evidence

0:50

based advice would be or their

0:52

site welcomed by everyone down here.

0:54

So sorry. That you have

0:56

a bow tie today so now know I know

0:58

it wouldn't even know who I was. So let's

1:00

get right into it. And I'm going to start

1:02

off with a quotation. You

1:05

know, maybe people know the history

1:07

of St. Augustine. Really fascinating history.

1:09

just amazing how much the history

1:11

is. is Spanish right? but it

1:14

also a lot of pirates and

1:16

so I I'm kicking a pirate.

1:18

Quotations: a quotation from a pyre

1:21

who actually interesting enough on the

1:23

the other side. Not that Griffin

1:25

O'connell. Cyber the other side

1:27

of the marriage there's descended

1:29

see from Francis Drake. Sir

1:31

Francis Drake. There.

1:34

Must be a beginning of any great matter.

1:37

But. The continuing until the end

1:39

until it be thoroughly finished yields

1:41

the true glory. Said.

1:44

A little bit of advice with sticking

1:46

sticking through you know. starts off as

1:48

a a bit of a pirate. Well

1:51

starts off as part and then by

1:53

the and he's got a fleet of

1:55

ships, he's got thousands of man. He

1:57

actually becomes Sir Francis. So. Just

2:00

see if you stick with piracy for a while what

2:02

can end up happening? Or

2:04

right into arse these am. Actually,

2:06

I think good news here. We've

2:08

really come off. we had kind

2:11

of that double peak, we've really

2:13

dropped down. So or as the

2:15

data for the United States is

2:17

really going in the right direction.

2:19

And oh my gosh, good news

2:21

on Arse. The vaccines both active

2:24

and passive despite some shortages with

2:26

the yourself a map through January,

2:28

forty point five percent of women

2:30

with babies ages eight months and

2:32

younger said their infants. Receive a forty

2:35

sixty point two percent of women at thirty

2:37

two or more. we said to station received

2:39

the Rc vaccine that's a prince though and

2:41

know there was some sort of confusion their

2:43

about which one you could get in. some

2:46

people got the other. Butcher. Such

2:48

a horrible foul as of February

2:50

Third, Twenty Twenty Four. An. Estimated

2:52

Twenty two point four percent of adults

2:55

sixty years and older. I had already

2:57

gotten their arse. the vaccine gonna thirteen

2:59

point to that. Definitely plan to get

3:02

it ourself without keep go to the

3:04

right direction. Influenza.

3:08

Right? kind of are, you know, sort

3:11

of went down, went back up and

3:13

it's actually still still pretty high up

3:15

in a lot of areas. But but

3:17

again, this is this is regional right?

3:20

So here in New York the New

3:22

York Long Island area will say here,

3:24

but I'll be back. Quote unquote Here

3:26

to New York on Saturday and we've

3:29

dropped down to serve a low minimum

3:31

level, which is great. That's also true

3:33

of a lot of the west, but

3:35

down here in Florida we are in

3:38

the sky. zone i'm in texas

3:40

the whole se he mexico particularly

3:42

am seeing lots and lots of

3:44

flu activity and new york city

3:46

itself is kind of an outlier

3:48

for the rest of new york

3:50

right it's actually in the abs

3:52

hi very high influence a level

3:55

so now it is actually kind

3:57

of interesting right like why can

3:59

things be different between New York City

4:01

and let's say Nassau Suffolk out here on Long

4:04

Island. Well, population density is

4:06

a big one, right? I think that's

4:08

huge, this population density, you know, and there might

4:10

be some other factors as well, but yeah, that's

4:12

a huge difference. Like people walking around on the

4:15

sidewalk. Yeah, and all the crowd is together. And

4:17

Nassau, I'm sure there's not a

4:19

big sidewalk traffic in Nassau, right? There

4:21

is not. A little bit

4:23

in the evenings when people are out with the dogs, but

4:25

no, otherwise. Quite different. Actually,

4:29

never ever reaching, you know, the levels it

4:31

does just north of the incubator there in

4:33

the city. Oh yeah. Sometimes

4:36

you can't even walk on the sidewalk,

4:38

Daniel. It's so crowded. It's crazy, right?

4:41

Yeah, it really gets crowded there. All

4:43

right, COVID right into it. A little

4:46

bit of a tick in a

4:48

positive direction. I'm still averaging

4:50

about 200 deaths a

4:52

day, but this last week we

4:55

were a little bit lower. But

4:59

then let us look at the wastewater,

5:01

right? We had a really high peak,

5:03

right? End of December, January. Things

5:05

came down, going in the right direction. But

5:08

now actually, if you look at the national average, it's

5:10

actually starting to rise a little and a lot of

5:12

that is being driven by the southeast

5:15

and by the upper Midwest. So we'll

5:18

keep an eye on where we end up with that. Moving

5:22

back into testing, right? I

5:24

think this is one of those

5:27

times where you just keep reminding

5:29

people. The article, self-administered versus clinician

5:31

performed by next now COVID rapid

5:33

tests, a comparison of accuracy was

5:35

published in clinical microbiology. And

5:38

so, you know, as I started to say,

5:40

I think it is worth reminding everyone that

5:43

yes, those rapid tests still work. These

5:45

are results of a single center study at

5:48

a free community testing site in

5:50

Baltimore City to assess the accuracy

5:52

of self-performed rapid antigen tests for

5:54

COVID-19. Self-administered by

5:56

next now rapid antigen tests were

5:58

compared with COVID-19. clinician performed rapid

6:01

antigen tests. And they're going to

6:03

use a reference

6:05

molecular test as the gold standard.

6:08

So in this study of 953 participants, about

6:11

15% were positive for SARS-CoV-2, as

6:14

determined by PCR. The

6:17

sensitivity and specificity were actually similar

6:19

and quite outstanding for both self

6:22

and clinician performed rapid antigen

6:25

tests. So sensitivity, 83.9% versus

6:27

88%. Specificity,

6:32

99.8% versus 99.6%, great specificity. Subgroup

6:38

comparisons based on age and race

6:40

yield similar results. Now, an

6:42

interesting issue was that 5.2% of

6:45

the positive results were potentially

6:48

missed due to participant misinterpretation

6:50

of the self-card. So I

6:52

sort of want to remind clinicians when someone, oh,

6:54

I did that test, it was positive, it was

6:56

negative, I was asking, can you take a photo?

6:59

Can you send that to me? Can I take a look

7:01

at it? Because sometimes people kind

7:03

of miss the interpretation. Some of them

7:05

have two, some of them have three

7:07

lines. And I do want

7:09

to point out that the test did very

7:12

well in symptomatic individuals with

7:14

both self and clinician performed testing

7:16

sensitivity at 88% and 90%. So

7:21

Daniel, when they say specificity, what

7:24

are they comparing it to? Yeah,

7:26

so this would be, this is great.

7:28

So just a reminder, we throw these

7:30

words out there. So sensitivity is someone

7:32

actually has COVID. They

7:34

have a positive RTP seromolecular test.

7:37

How good are you at actually getting that? So

7:40

about 90% of the time in

7:42

symptomatic, you're going to get a positive when you

7:44

should be getting one. But specificity is this issue.

7:46

If you get a positive test, is

7:49

it really positive? Because you end up with a

7:51

positive test and the person doesn't actually have it.

7:53

And here we're seeing a fraction of a percent.

7:55

We're seeing 0.2, maybe 0.4% of the time. positive

8:00

test, but they don't actually have a

8:02

PCR that's positive. So there's

8:04

some – yeah, so they have something

8:06

else if they're symptomatic, right? Yeah, so

8:09

they're symptomatic. Maybe they've got parainfluenza. Maybe

8:11

they've got, you know, rhinovirus. Maybe they've

8:13

got the flu, but you get a

8:15

positive COVID test. But as

8:18

we saw, that's happening, you know,

8:20

a couple per thousand tests. Right,

8:22

so the PCR confirmation is the key

8:24

there, right? Yeah, that's how you know

8:26

that this person – you know, someone

8:28

has a positive PCR or even better

8:30

yet, someone has a negative PCR, but

8:32

you get a positive rat, you don't

8:34

believe the rat. Okay. Probably

8:36

something wrong there. Got it.

8:39

All right, ventilation transmission. I say, I

8:42

found this interesting. I spent a

8:44

lot of time on this article.

8:46

So the article, annual N95 respirator

8:48

fit testing, an unnecessary burden on

8:51

healthcare. So this

8:54

article is published in Infection Control and Hospital

8:56

Epidemiology. This is one of those journals that

8:58

I always look through the table of contents,

9:00

see if there's anything interesting. And

9:03

this article looks at whether we need

9:06

that yearly N95 fit testing. And

9:09

part of what I liked was, I have to say, the intro

9:11

was worth reading. So I'm going to share a little bit of

9:13

this. So let me read. The

9:16

control of airborne respiratory infection transmission

9:19

in healthcare settings is achieved through

9:21

a combination of administrative measures. So

9:23

for example, moving persons with the

9:26

possibility of infection to single patient

9:28

rooms, engineering measures,

9:30

so that's the negative pressure

9:33

rooms, hospital ventilation, high efficiency

9:35

particulate air filters, those HEPA

9:37

filters, and respiratory protection

9:40

devices. So those N95

9:42

respirators that we've all gotten familiar with.

9:46

Now the effectiveness of N95 respirators

9:48

in the prevention of TB and

9:50

other airborne infections has not been

9:53

well established but remains the standard

9:55

of practice in most healthcare settings.

9:57

And I'm reading the article here. that

10:00

evaluated the hospital transmission of TB in the

10:02

late 1980s and 1990s during implementation of

10:06

control measures, administrative and engineering measures

10:08

most likely led to

10:10

the substantial decrease in transmission, rather

10:13

than the use of respiratory protection

10:15

devices. In addition, comparisons

10:18

between N95 respirators and surgical

10:20

masks in the transmission of

10:23

laboratory confirmed respiratory infection, influenza-like

10:25

illness, or workplace absenteeism have

10:28

not demonstrated a significant difference.

10:31

And now, so everyone's all in a fuss

10:33

here, but then we get in italics, it's

10:35

okay. However, more recent work

10:38

has indicated the utility of N95

10:40

respirators in the prevention of SARS-CoV-2

10:42

transmission in a combination of

10:44

healthcare and non-healthcare settings. And

10:47

we've actually covered some of those studies. Now,

10:50

after saying all that, they're gonna

10:52

restrict their investigation to an evaluation

10:54

of the probability of failing respirator

10:56

fit test over time among

10:59

a population of healthcare workers in Southern

11:01

California. So we've got 15,757

11:03

persons with at least one fit test results

11:09

after fit testing for an N95 respirator,

11:12

the probability of fit test failure

11:15

on the same respirator within three

11:17

years is likely to be less

11:19

than 0.5% based on this study. So

11:22

this is the whole idea, we're getting tested every

11:24

single year, but what are you really

11:26

picking up? Over those three years, you're picking

11:28

up one in about every 200 people that

11:30

is failing the fit test. And

11:33

they go on to say, based upon this, in

11:36

addition to the hassle factor and

11:38

the time commitment for getting this

11:40

retesting yearly, they estimated that the

11:42

total annual cost to healthcare in the United States

11:44

for fit testing is in the range of US

11:46

$200 to $400 million. Now

11:51

that more and more people are using N95s, this

11:53

may even be an underestimation of the time

11:55

economic burden. Sorry,

11:58

but I don't know if you know about this Vincent. listeners

12:00

do. But particularly for me who

12:02

practices at three different healthcare systems, the

12:04

traditional thing is I had to go

12:06

to the Catholics, I had to get

12:08

my fit testing, and they're doing the

12:10

saccharine, and I'm moving my head around

12:12

and singing and reading something. Do

12:15

I taste that sweetness? But to me, it's bitter.

12:17

But I know if I don't say sweet, I

12:19

don't pass. And then I go over to Northwell,

12:21

and then I've got to go to Columbia. You

12:23

go right in the lobby of Milstein, it's over

12:25

in the corner there on the right. So I've

12:27

got to do that at all three healthcare systems

12:30

every single year, and it never fails. I've been doing

12:32

this, I don't know, for 30 years. But anyway,

12:35

they're just it's amazing how many hundreds

12:37

of millions of dollars is devoted to

12:39

this annual testing. But

12:43

where are the data that says it matters? Well,

12:47

that's what I think is interesting about their

12:50

whole introduction. They're like, come on, we're dealing

12:52

with this level of data, but yet we're

12:54

spending hundreds of millions of dollars. So they're

12:56

sort of basically saying, maybe we need to

12:58

think about that allocation of funds. All

13:01

right. Moving

13:04

on to COVID active vaccination.

13:07

So another article actually demonstrating

13:10

protection against long COVID. And

13:12

the article, the impact of COVID-19

13:14

vaccination prior to SARS COVID-2 infection

13:17

on prevalence of long COVID

13:19

among a population based probability

13:21

sample of Michiganders. I like

13:23

that word. 2020 through 2022,

13:25

published in Annals of Epidemiology.

13:28

They use data from the Michigan

13:30

COVID-19 recovery surveillance study, a population

13:32

based probability sample of adults with

13:34

COVID. They've got 4,695. They considered 90

13:36

day long COVID, considered

13:42

other stuff, but I'm focused on this.

13:44

Illness duration of greater than or equal

13:46

to 90 days. They compared vaccinated, who

13:49

completed initial series greater than or

13:51

equal to 14 days before the

13:53

COVID-19 onset to unvaccinated individuals, accounting

13:56

for differences in age, sex, race,

13:58

ethnicity, education, employment, health insurance

14:01

and morality and

14:03

urbanicity. The

14:07

fully unvaccinated comparison group was

14:09

further divided into historic and

14:11

concurrent comparison groups based on

14:13

timing of COVID-19 onset relative

14:15

to vaccine availability. And

14:17

we end up getting prevalence ratios, right? We're going to

14:19

look at the prevalence and we're going to do a

14:21

ratio. Compared to the full

14:24

unvaccinated comparison group, the adjusted prevalence

14:26

of 90-day long COVID

14:28

was lower among vaccinated individuals. We've

14:30

got a prevalence ratio here of

14:32

0.42. And

14:35

then we've got a confidence interval. So

14:37

giving us a 47 to 66% lower

14:41

prevalence of long COVID in 90 days

14:44

in the vaccinated. And these estimates were

14:46

consistent across the comparison groups, the full,

14:48

the historic and the concurrent. Moving

14:52

into COVID early phase, really

14:54

just keep hammering on this. You

14:56

test positive. You're at risk of

14:58

progression. Number one, Pax lovid,

15:01

best efficacy data there. Number

15:04

two, Remdesivir, proved

15:06

down to 28 days of age. Mollupurivir

15:10

inferior, but still another

15:13

effective option. Convalescent

15:15

plasma in a particular select subgroup.

15:19

And isolation for the infected. We may get

15:21

to that in our questions. Has that changed?

15:25

COVID, the cytokine storm. That's that second

15:27

week. Remember, we did not include steroids

15:29

in that first week. This is associated

15:31

with an increased risk of bad outcomes.

15:33

But during that second week, in

15:36

patients with oxygen saturations less than 94%, dexamethasone

15:40

six milligrams a day times six days,

15:42

growing data that dexamethasone may actually be

15:44

the best steroid, the steroid of choice.

15:47

We have anticoagulation guidelines

15:49

for American society of hematology, pulmonary

15:52

support. Remdesivir still in the first

15:54

10 days. And

15:56

modulation, consider things like tocilizumab.

15:59

And remember. Avoid the unnecessary

16:01

antibiotics and unproven therapies. There will be

16:03

certain times when you want to use

16:05

an antibiotic, when it may be appropriate

16:07

and beneficial, but we don't just throw

16:10

these at 90% of folks as

16:12

historically has been done. All

16:15

right. And we're going to spend a lot

16:17

of time again on COVID, the late phase

16:20

past long COVID. And I'm

16:22

going to start with the MMWR notes

16:24

from the field, long COVID prevalence among

16:26

adults, United States, 2022. And

16:30

as we've discussed, getting an exact number

16:32

in terms of long COVID incidence is

16:34

challenging. Here, long COVID

16:36

was defined as the self-report of

16:38

any symptoms lasting for greater

16:41

than or equal to three months that were

16:43

not present before having COVID-19. Respondents

16:46

were sampled using random digit

16:49

dialing of both landline and

16:51

cellular telephones. That

16:54

had to be fun. Self-reported age,

16:56

sex, previous COVID-19 diagnosis, and

16:59

ever having experienced long COVID

17:01

were ascertained via telephone interview.

17:04

I'm trying to decide what's more fun, like the

17:06

cold calling to see if someone's going to vote

17:08

for your candidate or cold calling to ask about

17:10

this stuff. Who gets hung up

17:12

on more often? So remember,

17:14

it's a telephone interview. Now,

17:16

nationally, 6.4% of

17:19

non-institutionalized US adults reported

17:21

ever having experienced long

17:23

COVID. But

17:26

there were notable regional differences, and we really

17:28

have a nice figure with a map. So

17:30

that's really what I thought it would be

17:32

worth discussing. There's really quite a bit of

17:34

variation. We have areas with

17:37

an 8.9% to 10.6% report, based

17:41

on this telephone interview, areas

17:44

like, what is that, Mississippi

17:46

or Alabama? I can never tell those two

17:48

apart. Can you tell, Vincent? Alabama.

17:50

That's Alabama? So one state I've never

17:53

been to. So we've got Alabama, we've

17:55

got Tennessee, we've got West Virginia, we've

17:57

got Oklahoma, Montana, North Wyoming,

18:00

all with these really high incidences.

18:02

And then, you know, some of

18:04

the lowest incidences, US Virgin Islands,

18:06

DC, 3.7 to 5.3% in the

18:09

Great Pacific Northwest, up in the Northeast

18:11

as well. So

18:18

really interesting, gives you a chance to

18:20

sort of ponder what might be the

18:22

factors associated with the different incidences of

18:24

long COVID or the different incidences of

18:27

not slamming down that phone when you

18:29

get called. Yeah, that's right.

18:31

But I also think that, you know,

18:34

states are artificial boundaries, right? So

18:36

there's probably a blurring

18:39

that we don't see in these data, but it

18:41

is self-reported, you know, that's always a concern, right?

18:44

Yeah, it definitely is. But interesting that we're seeing

18:46

some kind of a pattern here. All

18:50

right. The article, Estimates of

18:53

Incidents and Predictors of Fatigue

18:55

Illness After SARS-CoV-2 Infection, was

18:57

published in EIS, Emerging Infectious

19:00

Diseases. What does that stand

19:02

for? Emerging Infection. Actually,

19:05

it should be EID, right? Emerging

19:07

Infectious Diseases. Okay.

19:10

So this is a retrospective

19:12

cohort analysis. Here,

19:15

the investigators analyzed electronic health

19:17

record data of 4,589 patients

19:20

with confirmed COVID-19 during February 2020

19:22

through February 2021, who were filed

19:25

for a median of 11.4 months,

19:28

and compared this data to data from 9,022

19:31

propensity score match non-COVID-19 controls. This

19:36

data was collected from the University of Washington

19:38

that included three hospitals. So we've got Harborview

19:41

Medical Center, UW

19:43

Medical Center Northwest, and UW

19:46

Medical Center Montlake, and

19:48

greater than 300 primary care

19:50

and specialty clinics providing healthcare services

19:52

across the state of Washington. Just

19:56

a moment to look at the methods, and

19:58

I thought this was interesting. Fatigue

20:00

was defined by them basically

20:02

finding that a physician had

20:04

coded an ICD-10 diagnostic

20:07

code or ICD-9

20:09

code. So

20:12

diagnostic codes recorded in the electronic

20:14

health care system, the electronic health

20:16

record during the post-acute period. And

20:18

these are the ones they're looking for. They're

20:21

looking for G93.3 post-viral fatigue syndrome, R53.82 chronic

20:23

fatigue unspecified code,

20:29

I use a fair amount, R53.83 other

20:32

fatigue, 780.71 chronic fatigue syndrome, post-viral fatigue

20:39

syndrome, or 780.79 malaise and fatigue. So

20:45

they defined incident fatigue as a

20:47

patient who had greater than one

20:49

diagnostic code for fatigue during

20:51

the post-acute period. As

20:54

we talked about last week, this is

20:56

dependent on the treating provider, not just

20:58

recognizing the fatigue, but actually adding this

21:00

coding to the visit. And

21:02

I sort of made a note to self here, like we

21:04

did not see the G93.32 code in there, sort of

21:09

a subset of the G93.3,

21:11

that's the myalgic encephalitis chronic

21:13

fatigue syndrome, so the ME-CFS

21:15

code. But it is a subset

21:17

of the G93.3. Now

21:20

among COVID-19 patients, about

21:22

15% were hospitalized for COVID-19, 85% weathered the storm

21:26

outpatient, the incident rate of COVID

21:29

was 10.2 per 100 person years, and the rate

21:33

of chronic fatigue was 1.8 per 100 person

21:35

years. Compared

21:39

with non-COVID-19 controls, the hazard

21:41

ratios were 1.68, so about

21:44

two times as likely for fatigue, and

21:46

4.3, more

21:49

than four times for chronic fatigue. The

21:52

observed dissociative between COVID-19 and the

21:54

significant increase in the incidence of

21:56

fatigue and chronic fatigue reinforces the

21:58

need for the COVID-19. need for

22:00

public health actions to prevent SARS-CoV-2

22:02

infections. And what I

22:04

thought was really interesting here, right, forget

22:07

about definitions, forget about, you know, the

22:09

people that don't believe or we're

22:12

actually seeing people going, people

22:15

having a recognized chronic fatigue

22:17

diagnosis four times higher after

22:19

they had COVID-19. But

22:23

Daniel says here, to prevent

22:25

SARS-CoV-2 infections, that's not correct.

22:27

It's to prevent symptomatic infections,

22:29

because we just saw that

22:32

vaccination, which doesn't prevent infection, decreases

22:34

the incidence of long

22:37

COVID. So you don't

22:39

need to prevent an infection. You just need

22:42

to prevent having some sort of symptom.

22:45

Yeah, whatever it is that triggers this long

22:47

COVID is what we really need to prevent.

22:49

Because yeah, I think it's probably great that

22:51

you point this out, because the whole idea,

22:53

if you set this idea that you're never

22:55

going to end up with a positive PCR,

22:57

that's just probably an unethical goal. No, it

22:59

can't happen. Nope. All

23:02

right. And I

23:04

was left with lots of questions

23:06

after reading the following article, Long-Term

23:08

Risk of Respiratory Diseases in Patients

23:10

Infected with SARS-CoV-2, a longitudinal population-based

23:12

cohort study published in eClinical Medicine.

23:14

So let's go through this and

23:16

see if I can tease out

23:19

a little bit about what this

23:21

study is telling us. So this

23:23

is a longitudinal population-based cohort study.

23:26

They built three distinct cohorts, aged 37 through

23:28

73 years, using the UK Biobank database. So

23:34

we've got a COVID-19 group diagnosed in

23:36

medical records between January 30th, 2020, and

23:38

October 30th, 2022, and

23:43

two control groups. So we've got a

23:45

contemporary control group and

23:47

an historical control group. And

23:50

they have these different cutoff dates. So October

23:52

30th, 2022, contemporary. October

23:55

30th, 2019, respectively, right? So

23:58

pre. The follow-up

24:00

period of all three groups was 2.7 years. They

24:03

included 112,311 individuals in the COVID-19 group, with

24:09

a mean age of about 56.2, 359,671

24:13

in the contemporary control, 370,979

24:18

in the historical control. They

24:22

found elevated hazard ratios for a

24:25

number of different respiratory disorders in

24:27

the COVID-19 group. They

24:29

reported for asthma, hazard ratio 1.49, bronchiectasis

24:33

1.3, COPD 1.6, interstitial

24:38

lung disease 1.8, pulmonary

24:40

vascular disease 1.59. And

24:42

this is the one that kind of caught me, lung

24:44

cancer 1.39. What

24:47

is up with that? Spent a lot of time looking

24:50

through and the discussion. And so as I

24:52

mentioned, it was caught by this lung cancer

24:54

connection, but the authors suggest that our

24:57

study found a significant association between

24:59

COVID-19 and lung cancer, but we

25:01

fully recognize that this may be

25:03

due to large scale chest CT

25:06

scans performed on a large proportion

25:08

of suspected or confirmed patients with

25:10

COVID-19 leading to

25:12

more early tumor cases being detected.

25:15

Therefore clinically, more caution is required

25:17

when interpreting the association between them.

25:20

So I thought it was interesting. It makes sense. You know,

25:22

I was looking for a mechanism, this is make sense, to

25:25

see that someone may have had damage to

25:27

their lungs. And so

25:29

we may see the COPD, we

25:31

may see the interstitial lung disease, but

25:34

yeah, the association with lung cancer

25:36

in this 2.7 year cutoff suggests

25:40

to me that probably not

25:42

driven by the SARS-CoV-2, probably

25:45

driven by the diagnostic testing.

25:48

So some discussion about the mechanism for the

25:50

other respiratory issues, but they

25:52

conclude our research suggests that patients

25:54

with COVID-19 may have an increased

25:56

risk of developing respiratory diseases and

25:59

the risk increase. with the severity

26:01

of infection and reinfection. So,

26:03

Daniel, if you have influenza or

26:06

respiratory syncytial virus disease or others,

26:08

do you see an increase

26:10

of other lung problems after those as well?

26:13

There's some increase, but not as dramatic as

26:16

where we're seeing reported here. Is

26:19

that just because there are so many cases

26:22

of SARS-CoV-2 infection, or are they

26:24

comparable with the other viruses? So,

26:27

I don't know. Is there something, is

26:30

there more inflammation, is there more damage? I

26:32

mean, if you've got someone who ends up,

26:34

let's say, parainfluenza virus,

26:37

really severe, ends up in the

26:39

ICU. And I

26:41

think we've looked at some studies where you end up

26:43

with a really severe respiratory infection.

26:46

You can have a lot of these sequally afterwards. So,

26:48

yeah, a lot of this, you know, you'd probably want

26:50

to do a study where you compare apples to

26:52

apples on this. Also, remember that

26:55

different influenza viruses have different virulence.

26:58

H3N2 and H1N1 are different, so you

27:00

have to be careful not to mix

27:02

them all together. Exactly, exactly. Alright,

27:05

so I'm going to wrap it up here. I do it last

27:07

time we spent over an hour, so I'm going to keep it

27:09

a little shorter this time. No

27:11

one is safe until everyone is safe. So

27:15

I do want everyone to pause the

27:17

recording right here. Go to parasites.org.com and

27:19

click Donate because we are doing our

27:21

American Society of Tropical Medicine and Hygiene

27:23

fundraiser, where for February, March, and April,

27:25

we will double your donations to

27:28

a potential maximum donation of $20,000. And

27:31

I should point out, this money

27:33

mainly goes to scholarships,

27:36

bringing women from low

27:38

income and low middle income

27:40

countries to the annual event,

27:42

giving them a chance to make connections,

27:45

network, and really open up the opportunities

27:47

for them. Time

27:50

for your questions for Daniel. You can

27:52

send yours to danielatmicrobe.tv. Peter

27:54

writes, listening to your

27:56

fine show, Twiv1088, or post

28:01

influenza sequa. My

28:03

wife picked up HPIV2 and

28:05

came down with overall feeling very weak, went

28:08

to local clinic, displayed heart rate of 160,

28:10

ambulance took her

28:12

to Cleveland Clinic here in Vero Beach, given

28:14

a denocine along the way, VQ and ER

28:16

because she was allergic to iodine, displayed

28:19

EF of 26%. Pam usually is

28:23

fine living with RA, methotrexate,

28:25

SVT was also apparent, so

28:27

angiogram was performed clean and

28:29

ablation for the SVT, along

28:31

with Entresto B. metroprolol and

28:33

Eliquis sent home in a

28:35

life vest to have

28:38

to uncomfortably wear for three months.

28:40

Are you seeing this virus in

28:42

adults? 70 years old

28:45

and having Swiquelli like this, January

28:47

16th entering ER, February

28:49

18th feeling great, just

28:51

wears out early. Okay,

28:53

yeah so a lot of jargon in there for our

28:55

listeners but this is human

28:58

para influenza type 2. We actually

29:00

have seen a lot of severe

29:02

cases of human para

29:04

influenza type 3. Often

29:07

they can be quite severe, there's a little

29:09

bit of a hierarchy between you know severity

29:11

and a population level but as an individual

29:14

we can see people end up in the

29:16

ICU, we can see really severe cases, we

29:18

can even see this as described here, this

29:21

reduction in cardiac function. So

29:23

the RA, rheumatoid arthritis on methotrexate,

29:25

so we have a immunosuppressed

29:27

individual here and so yeah and

29:30

I think maybe this goes back

29:32

to your point before, we've really

29:34

learned a lot, we really have

29:36

SARS-CoV-2 and COVID-19 sequela under a

29:38

microscope but a lot of

29:40

our other respiratory viruses can, well we talked

29:42

about RSV, 10 to 20,000 adults

29:45

die each winter from that. Hundreds

29:48

of children don't survive because of RSV,

29:51

you know human menenoma virus right coming

29:53

in a little bit after the big

29:55

three but the para influenza

29:57

viruses can cause a tremendous amount of of

30:00

morbidity as well. Roberta

30:03

writes, I wanted to provide you with

30:05

an update following our discussion during the

30:07

recent TWIV 1088 regarding vaccine

30:10

eligibility. First, I want to

30:12

express my appreciation for the advice you provided. I

30:14

took steps and inquired at three

30:17

additional different chain pharmacies about the

30:19

possibility of paying out-of-pocket for vaccine.

30:23

Regrettably, I received the same response from

30:25

each pharmacy. Despite my willingness to cover

30:28

the cost, I did not qualify due

30:30

to corporate protocols. Despite my request, they

30:33

declined to show me the protocols. Undeterred,

30:35

I continued my efforts to secure the

30:38

vaccine and endeavored to educate the pharmacies

30:40

on the need for additional vaccinations. Unfortunately,

30:42

it appeared that they were not up to date with

30:45

the latest information. However, I am pleased to

30:47

share that my persistence paid off at

30:50

a fourth chain pharmacy. The pharmacist

30:52

agreed to check corporate

30:54

protocols and had an

30:56

understanding of waning immunity and the need

30:58

for additional vaccination. He checked corporate protocol

31:00

and successfully ran the Novavax through my

31:02

insurance. I received confirmation that

31:05

it passed through both. As a result,

31:07

I received my vaccine and

31:09

no payment was necessary. I'm going to

31:11

try and contact corporate to obtain these protocols.

31:14

Once again, thanks for your help and encouragement.

31:18

Well, I think you followed right, like in

31:20

the words of Francis Drake, and you finally

31:23

yielded that true glory at the end. So

31:25

congratulations for the rewards of your

31:27

perseverance on that. Anne

31:30

Wright, given that you happen to live on Long

31:32

Island, I'm hoping that you have an opinion as

31:35

to why Nassau County for months have been doing

31:37

measurably worse than New York City or Suffolk, or

31:39

the rest of the country for that matter, at

31:41

least according to the New York

31:43

Times. What's going on? You

31:46

know, I don't know, but let

31:48

me speculate. You know, doing worse.

31:51

Are we doing worse as far as numbers of

31:53

diagnoses? Maybe, but

31:55

maybe that's a good thing, right? If You don't test for something,

31:57

you don't see it. I Know our Nassau County is doing worse.

32:00

The county and providers. I hear me

32:02

hopefully echoing in their ears every time

32:04

they they see something. Think about Kobe,

32:06

treat the cove. It's hopefully we're doing

32:09

better when it comes to outcomes. But

32:11

no as its clay is, it's amazing.

32:13

Things really change when you move from

32:15

that was really population dense New York

32:18

City of Nassau County. So your initial

32:20

idea would be that we we should

32:22

be doing better. We've gotta serve better

32:24

environments less population density. so I can

32:27

only speculate. To

32:29

my rights, My physician. Who. Specializes

32:32

in geriatric care. does not like

32:34

to prescribe packs. love it for

32:36

her cozad positive patients because of.

32:39

Problematic. Drug interactions rebound

32:41

an undesirable side effects.

32:44

She. Says he prescribes mother peers

32:46

year as an alternative. I

32:48

tried to convey your explanation, a rebound and

32:50

how this phenomenon hadn't seen even before Packs

32:52

Loved was on the market. When.

32:55

I'm not sure she was convinced.

32:58

I. Am a sixty nine you

33:00

have female I'm pre diabetic, have

33:02

high cholesterol, have cured and neuropathy

33:04

in my seat. My.

33:07

Husband has berets the sausages for which

33:09

he takes of pp I. I

33:11

we're basically healthy. Can you comment on

33:13

whether mole new pair of year is

33:15

as effective as packs Love it? If

33:17

not, would you recommend finding another doctor

33:19

who would prescribe. Packs, Loves it.

33:23

So it's not as effective. We've listed the

33:25

study some in the initial saying we're very

33:27

excited but then when it finally came out

33:29

thirty percent reduction compared to eighty nine percent.

33:31

So well not a third as effective. So

33:33

yeah, clearly not as effective. It's an easier

33:35

left I'll give you that you don't have

33:37

to sit there run the medicine through a

33:39

drug drug interactions that to my that that's

33:41

what we're paid to do. We actually we

33:43

get paid to actually quite well even though

33:46

we crumble and right so he it off

33:48

your if your providers not willing to spend

33:50

a few minutes to run the medicines through

33:52

with for those. drug drug interactions understand

33:54

how to prescribe medicine and many

33:56

other this is sort of a

33:58

telltale thing If your

34:00

provider believes COVID rebound, Paxlovid

34:03

rebound is a thing, I

34:06

think you've got to ask how much other

34:08

science are they getting wrong. And

34:11

finally, Will writes, what evidence, if

34:14

any, does CDC have for abandoning

34:16

five-day isolation guidance for COVID-19 patients?

34:21

There's a nice US News and

34:23

World Report article where I discuss

34:26

what might be going on here.

34:28

And I think my quotation is along the

34:30

lines of, the science hasn't changed. And

34:33

the CDC is struggling to

34:35

make public health recommendations that

34:38

will improve our behavior, that

34:40

will improve our health. And

34:42

it's a tough arena to be in. In

34:45

the early days, when it was 14 days, we had

34:47

a 2% compliance with the

34:49

14-day recommendation. When

34:51

they shortened it, still was never great.

34:54

Currently, the five-day recommendation, we've talked

34:56

about studies where 75% of people,

34:59

they'll lie, they won't even test.

35:02

People don't want the repercussions. So the

35:04

science has not changed as far as

35:07

the transmission. But there are

35:09

a number of things that have changed, vaccination,

35:12

pre-existing immunity, or

35:15

unfortunately, the privileged access

35:17

to medications. But

35:20

I think it's just a realization that no

35:22

one's really doing the five days. If

35:24

I'm thinking about being around

35:27

older individuals, my parents, I'm not

35:29

going to suddenly say, oh,

35:31

as soon as my fever goes away, I'm not contagious. That's

35:34

not the science. So the

35:37

science hasn't changed, this public health guidance

35:39

has. That's Twiv

35:41

weekly clinical update with Dr. Daniel Griffin. Thank

35:43

you, Daniel. Oh, thank

35:45

you. And everyone, be safe. Thank you,

35:47

everyone. Be safe.