0:00

This. Week Enviro a g

0:02

the podcast about viruses the

0:04

kind that make you sick.

0:10

From microbe T V this is to

0:12

with. This. Weekend Virology.

0:16

Episode. Eleven Await Recorded

0:18

on April. Twenty Four Twenty

0:20

Twenty Four. I'm Vincent. Rak

0:23

and yellow. And. You're listening

0:25

to the podcast All About Viruses.

0:28

Are joining me today? Not from New

0:30

York? Then. You're Griffin from

0:33

Yosemite Valley. Actually, I in Yosemite

0:35

and I using my phone is

0:37

a hotspot so there might be

0:39

a little glitches why not? No

0:42

advance in is saying and hopefully

0:44

it all come together at the

0:46

end. But let me I jumped

0:48

in. Hello everyone I have a

0:50

quotation as that John Muir. When.

0:53

We try to pick out anything by

0:55

itself. We find it hitched. Everything else

0:58

in the universe. That's

1:02

pretty. Serious, right?

1:04

The it is actually and it's just

1:07

stab you know it's It's really great

1:09

to some here with my wife and

1:11

Jessica and my son Barnaby and it's

1:13

just great to am. I think you

1:15

go learn so much coming to a

1:17

place like this and just seeing how

1:20

everything is connected. Iraq Today we were

1:22

up at the Am at the Grove

1:24

for they've got those Amp has massive

1:26

trees and and you know early on

1:28

they're trying to manage them but then

1:30

they realized by stopping the fires they're

1:33

they're not letting the cigarette trees grow.

1:35

Because you know the fire as part of

1:37

the whole cycle. So just amazing to see

1:39

how interconnected everything else and all these cycles.

1:43

But are at it will jump

1:45

and now interconnected we are are

1:47

all our when it comes to

1:49

infectious disease. With an update on

1:51

Measles as of April: Eighteen, Twenty

1:53

Twenty Four A total of a

1:55

hundred and twenty five Measles cases

1:57

are recorded from eighteen jurisdictions. And

2:00

you know events and I was get

2:02

know I was getting all these questions.

2:04

Those even has to be on the

2:06

Doctor Phil show right now and seven

2:08

now with you. But I would never

2:10

miss an opportunity to hang out with

2:12

you and and and Doctor Phil instead.

2:14

But I figured if everyone's asking why

2:16

should jump that So so what is

2:19

happening with H Five n One avian

2:21

flu and apps and certainly going as

2:23

Vincent A jump in on this on.

2:25

But. April. Twenty first

2:27

right are just few days before

2:29

recording this in a few days

2:32

before it drops the U S

2:34

T A published two hundred and

2:36

thirty nine objects sequences from the

2:38

U S H Five N One

2:40

played two point three point four

2:42

point four be Influenza virus recently

2:44

sand in samples of associated with

2:47

the ongoing highly pathogenic he the

2:49

and influenza outbreak in paltry wild

2:51

birds the and the reset each

2:53

five and one of that in

2:55

dairy cattle. I'm. Sequences posted

2:57

are from Cattle Cats, chicken skunk, raccoon

3:00

grackle and what a Crack a list.

3:02

Blackbird and goose were sticks and when

3:04

you need i'm you could look at

3:06

our for since and. Now.

3:10

He p H I S routinely

3:12

publishes an influenza genetic and sequence

3:15

on. T set so

3:17

that global initiative on sharing a

3:20

the and influence at data. However,

3:22

we hear that in the interest

3:24

of public public transparency and ensuring

3:27

the scientific community has access to

3:29

information as quickly as possible to

3:31

encourage disease research and development to

3:34

benefit the U S dairy industry.

3:36

A P H I S is

3:38

also rapidly sharing raw sequence data

3:41

to the National Institute of Health,

3:43

National Library of Medicine, National Center

3:46

for Biotechnology. Information and I'm

3:48

gonna leave of Lincoln to

3:50

that I'm announcement. So. What

3:53

are what are we now and on?

3:55

Her number of our folks who are

3:57

are making comments about this so. We

4:00

hear from Michael war be on

4:02

the doctor philosophy had as ecology

4:05

and Evolutionary Biology at the Department

4:07

of University of Arizona Tucson on

4:09

tells us that the virus was

4:12

confirmed in another dairy herd in

4:14

eye to racing the a number

4:16

of each five and one to

4:19

Texas to thirty three and Michael

4:21

tells us analysis of the hemoglobin

4:24

and neuraminidase an internal genes. it's.

4:26

That. Dinners has cheat since it changed

4:29

much from it's introduction into cattle

4:31

in late Twenty Twenty Three or

4:33

Twenty Twenty Four. The virus

4:35

could jump to cat once, but

4:37

the information from the sequences cap

4:39

rule out multiple introductions us on

4:41

the states. There's a strong possibility

4:43

that the virus has been circulating

4:45

undetected for months. Even.

4:47

Before a mysterious illness began

4:50

affecting Gary Cows inch viewers

4:52

we hear from Sam Scar

4:54

P. Know Phd Director of

4:56

I Love This Artificial Intelligence

4:58

and Life Sciences at Northeastern

5:00

University. He tells us the

5:02

genome data strengthen the evidence

5:04

for cow to cow transmission.

5:07

The. Early analysis shows no obvious changes

5:09

that would increase the human to human

5:11

transmission risk but he added that will

5:14

take time to fully analyze all the

5:16

all the genus. am I going to

5:18

leave that article into a said rabbits

5:20

to? The thing that tends to be

5:23

getting lot of gives the been senate

5:25

and hopefully we can weigh in on

5:27

this is that they are finding evidence

5:29

of the the genetic material in milk.

5:34

When when lots of lots of calls from

5:36

are followers to do a plaque assets on

5:38

the milk samples. Where. They they

5:40

should look for infectious virus records

5:42

are doing Pcr? Yeah, but let's

5:44

assume. It is in fact as far as

5:46

milk is passed her. right? For

5:49

most people young, if you drink

5:51

raw milk you're taking risks. Folks

5:53

the some do it. but if

5:55

it's fast your eyes is going

5:57

to inactivity. Avian. Influenza.

5:59

Viruses. I. Don't think that's. A.

6:01

Risk. What is? the real question is whether

6:04

this will. Become. A human virus or

6:06

not. right? Because now many animals are

6:08

infected. Many cows. But I just got

6:10

back from Ohio. Where.

6:12

Cows are infected In humans are

6:14

getting infected from the cows, but.

6:16

Is. Very interesting. The.

6:19

Getting conjunctivitis. Yeah.

6:22

Success Instead Rights Yes, the I has

6:25

Alpha Two, Three Selleck acid receptors for

6:27

a V H Five N One virus.

6:30

And the rest of this. Up or Track

6:32

does not. It's only deeper down in the long, so.

6:35

This. Is good and away. And

6:38

those virtues of in mild and human

6:40

so far so that the say it

6:42

won't change his nose evidence for human

6:44

to human transmission that could change as

6:46

well. But. The

6:49

thing is that don't worry about the milk,

6:51

even the beef. That. I'm

6:53

probably going to cook it. This. Not the issue.

6:55

The. Issue is human to human community.

6:57

Transmission of a respiratory virus is that

7:00

should ever happen and nobody can predict

7:02

it. Weather. Will happen or

7:04

not I think we should be ready to

7:06

let seat. We have a couple of anti

7:08

virus we have tamiflu, relenza and the lock

7:11

severe. Yeah. Some experimental H

7:13

Five and one anti vaccines. I think

7:15

we're better prepared than we were for

7:17

Kovac, don't you? Yeah, no. I really

7:19

think we are. I mean, I think

7:21

that is. It's great that people are

7:24

into said I think it's great if

7:26

we continue to. I'm straight than our

7:28

surveillance systems are. But yet this. how

7:30

do I keep myself safe? I keep

7:32

my family safe. You know, don't drink

7:35

on pasteurized milk. drink past rests on

7:37

the other. As our Twitter followers of

7:39

Common Wheat. We don't have enough. It's

7:41

infectious. Virus in their of there's picking up

7:44

I'd next purchase that that isn't lot of

7:46

thing com unit for those of you that

7:48

to drink your milk rocks. But.

7:52

So moving into Code Red, you know it.

7:55

We really are apt to say we are

7:57

moving in. I continue to move in a

7:59

positive, direct. Then and the percentage of

8:01

provisional damn something as at serve

8:03

Talk to people. The following really

8:05

is less than two percent are

8:07

in in much of the country,

8:10

really less than less than one

8:12

percent in most of the country.

8:14

So we're really moving into eight

8:16

and number hopefully a number of

8:18

better months and the waste water

8:20

is really tracking down to add

8:22

to the love of where it

8:24

was on the I say ah

8:26

this time last year. So.

8:29

National trends going in the right direction.

8:32

Or it so. Ah, children

8:34

and other vulnerable populations just

8:36

a little time, money and

8:38

then wr durability of original

8:40

monovalent and marnie vaccine effectiveness

8:42

against Kobe Nineteen, I'm Chronos.

8:44

Oh shit. hostile. They should

8:46

have children. Adolescents. United States,

8:48

Twenty Twenty One. Twenty Twenty

8:50

Three. So despite the fact

8:52

that Coven Nineteen Nation was

8:54

shown to be effective against

8:56

pediatric club at night teams hospitalization

8:58

during the person said the

9:00

Omnicom variant. There has

9:03

not been great uptake that

9:05

yeah trick populations. I'm here.

9:07

We get on vaccine efficacy

9:09

of greater than or equal

9:11

to two original monovalent cover

9:13

Nike vaccine doses against covered

9:15

nineteen related hospitalizations across thirty

9:17

four. Overcoming. Cove

9:20

in nineteen. Network. Sites on

9:22

yet see value Waited using

9:24

a case control design. Ah

9:26

the case patients were children,

9:28

adolescents five eighteen who are

9:30

hospitalized for cute covered nineteen

9:32

received a positive Sars Toby

9:34

to test results control patients

9:36

hospitalized for coven a team

9:38

like illness were mass to

9:40

case patients by side age

9:42

group mission date but had

9:44

a negative Sars could be

9:46

to test a critical covered

9:48

nineteen Related illness was defined

9:51

as. Receipt of noninvasive or

9:53

invasive mechanical ventilation are

9:55

they so acted infusions,

9:57

extra corporal member and

9:59

auction. And I'm and illness

10:01

result think. That

10:04

seen as a sea of

10:06

original monovalent Mrt coveted nineteen

10:08

vaccines against Kobe nineteen related

10:10

hospitalizations was fifty two percent.

10:13

When. The most recent vaccine dose

10:15

was received am seven two hundred

10:17

and eighteen days before hospitalization. I'm

10:19

missing and dropped a nineteen percent

10:22

when it was received. more than

10:24

one hundred and twenty out to

10:26

three hundred sixty four days before

10:28

hospitalization. I'm and thirty one percent

10:30

of he just kind of grouped

10:33

everything together in the previous year.

10:35

Vaccine efficacy that's critical covered next,

10:37

you related illness was fifty seven

10:39

percent when it does was seven

10:41

two hundred eighty days before hospitalization.

10:44

But not significant when you got vr

10:47

two hundred twenty to three hundred sixty

10:49

four days, thirty eight percent when the

10:51

most recent does was see that any

10:53

points than the previous year. So really

10:55

really seeing you know that there is

10:58

Africa see here but there seems to

11:00

be this this last that see as

11:02

time goes out. Than do

11:04

they tracked death at all. I'm

11:07

so they They do mention that they were

11:09

looking at that, but it's it's really sort

11:11

of in the nice combines points. When.

11:14

You think about this is I'm surprised to

11:16

this age group felt so low. Amazon says

11:19

surprise that is waning right? Ah yes yep

11:21

that numbers are because I would think that

11:23

at that age you make a good T

11:25

So response right? and that's going to be.

11:28

And conserve. So. I'm some

11:30

very surprised that these numbers and and also

11:32

it think that we're going to have five

11:34

or there's just so much coveted is sort

11:36

of these you know repeated exposure think there

11:38

be some kind of as escape from that

11:41

to get out of it but suppressed. My.

11:44

right? Now this

11:46

this is the controversial parked a

11:49

little excitement in the ventilation transmission

11:51

area this week. Vincent ah but

11:53

his sex get get ready for

11:55

are lots of the most and

11:57

on the let let's walk through.

12:00

In the news release, waiting

12:02

health agencies outline updated terminology

12:04

for pathogens that transmit through

12:07

the air. So the Wh

12:09

out. Said. The terminology challenge

12:12

stemmed from a lack of

12:14

common terminology across several scientific

12:16

disciplines, a problem that became

12:18

more cute when experts across

12:20

disciplines were tucked away in

12:22

with guidance and recommendations. So

12:24

from the six hundred, ninety

12:26

two or three minute read

12:28

news release, let me ask.

12:30

Call. This an the extensive

12:32

consultation resulted in the introduction

12:35

of the following common to

12:37

scriptures to characterize the transmission

12:39

of pathogens through the air

12:42

under typical circumstances. So

12:44

individuals infected with a respiratory

12:47

pathogen can generate or expel

12:49

and senses verticals containing the

12:51

pathogen to their mouth. Or.

12:53

Nose by breathing, talking, singing,

12:56

spitting, coughing or sneezing. These

12:58

particles should be described with

13:00

the term ready for this

13:02

infectious respiratory particles for I

13:05

are peace, And.

13:07

Arms use exist on a

13:09

continuous spectrum of sizes and

13:11

no single task points should

13:14

be applied to distinguish smaller

13:16

from larger particles. This facilitates

13:18

moving away from the dichotomy

13:21

of previously used terms care

13:23

Sauce previously small particles and

13:25

droplets generally larger purpose. The

13:28

descriptive through the air can be

13:30

used in general way to characterize

13:32

infectious disease where them mean mode

13:35

of transmission involves the pathogen traveling

13:37

through the air are being suspended

13:39

in the air under the umbrella

13:41

of through the air transmission. I

13:45

see I see nodding your head so we take a

13:47

little break your were what what he is a good

13:49

read said what's going on. My

13:51

for. And why

13:54

infectious respiratory particles. It's.

13:56

A droplet right. Infectious

14:00

respect to droplets. Why? a particle

14:02

that's so confusing? As

14:04

big the problems that are, it's

14:07

is that people since nineteen nineteen

14:09

twice as early part an eighteen

14:11

hundreds. Thanks to a chaplain and

14:14

his efforts to fight against the

14:16

concept miasma I'm actually traded the

14:18

concepts of a droplet as he

14:21

says that call particle that would

14:23

hit you would strike you in

14:25

the eyeball, strike you in the

14:28

mouth and then you would get

14:30

a direct germ theory contacts. So

14:32

in the early description. Contact

14:35

me touching something that was

14:37

infectious Are getting punched sprayed

14:39

by I physical chirps. Of

14:45

fact, that's weird. Sorry, I don't,

14:47

That Particles works. This has a

14:49

Grecian dumb. I

14:52

think we should. To.

14:54

School at droplets and know that droplets are not

14:56

the smallest ones, but I think we could homogenize

14:58

it. And of yeah, I

15:00

think I think the chance you're trying to

15:03

get away from was that that hundred and

15:05

ten year old idea that only certain things

15:07

could make you sick when you got more

15:09

than six feet away. and and I still

15:12

remember when I was in medical school out

15:14

soon. research on to perky Less in the

15:16

history there was, You know we had moved

15:18

from the idea of you know that them

15:21

now air getting people sex and even when

15:23

they did these experiments with a had guinea

15:25

pigs acquiesced guinea pigs on the other end

15:28

of this air shaft rights they had the

15:30

person. Costing with tuberculosis in the one

15:32

rooms and the the instead she was

15:34

spreading in effect guinea pigs like much

15:36

more than six feet away and separate

15:38

room he could only have gotten their

15:40

of. Somehow things floated through the air

15:42

to where the guinea pigs works do

15:45

so out of resistance. And.

15:47

The interesting issue a lot of the resistance

15:49

I have to say is on. Financial.

15:52

right because for a hospital for a

15:55

medical center to happy quip people with

15:57

and magnifies for them to have to

15:59

have the air exchanges, that's

16:02

actually quite costly. So,

16:06

yeah, so anyway, so they do

16:08

go on to basically give us

16:10

this updated terminology where the IRPs

16:14

fall under the number one

16:16

airborne transmission or inhalation, but

16:18

not the old fashioned airborne

16:21

aerosol, but this transmitted through the

16:23

air versus direct deposition.

16:25

And this is where these IRPs

16:27

are expelled into the air from

16:30

an infectious person and then directly

16:32

deposited on the mouth, nose, or

16:34

eye. So I

16:36

feel like they started so strong with this

16:39

concept of let's just say transmission of pathogens

16:41

through the air as

16:43

we do its transmission of pathogens

16:45

through food or through water. And

16:47

then this one and two almost

16:50

seem like they're just reframing the

16:52

airborne versus direct droplet deposition. Yeah.

16:56

I see a quote here of someone who said, the

16:59

old categories were more straightforward.

17:02

Well, I love this. So Carl Zimmer

17:04

has an article in the New York

17:06

Times. They should

17:09

have certain New York Times articles that just get

17:11

tagged as it should be open for everyone. So

17:13

unfortunately, but here we

17:15

have Dr. Walter Zing, an infectious disease

17:17

expert at the University of Zurich and

17:19

a member of the advisory group, said

17:22

the old categories offered more straightforward guidance,

17:24

staying a few feet from someone coughing

17:26

and sneezing was once thought to be

17:28

an effective way to

17:30

avoid droplet

17:33

transmission. It was simplistic and probably

17:36

not true, but it served a

17:38

purpose. Yeah. I

17:41

love the way he brings it together. It

17:43

was simple. It probably wasn't true. Now,

17:48

if it wasn't true, it's

17:50

not useful, right? I think that was the problem

17:52

is this was simple. It was straightforward. It's what

17:55

we all were taught, but now, in

17:58

the words of the father. in,

18:00

you know, in that famous Mary Poppins

18:02

and how we are confusing things with

18:04

the truth. Yeah. So,

18:08

let's go back to simpler times when it

18:10

wasn't necessarily good guidance, didn't necessarily keep everyone

18:12

safe, but it was simple, it was easy

18:14

to understand. All

18:16

right. With that aside, COVID

18:20

active vaccination immunity. Remember,

18:23

there's that recommendation from the end

18:25

of February for that additional monovalent

18:27

dose for folks 65 and

18:29

older. And we did

18:32

hear on March 22nd about PEMGARDA,

18:34

which is going to be the

18:36

pre-exposure prophylaxis. I'm still

18:38

waiting for more on that. All right. Let's

18:41

move into COVID early viral phase.

18:44

Now, I'm going to keep believing links

18:46

to the NIH treatment guidelines, the IDSA

18:48

guidelines. But then I'm also going to

18:50

talk about an article about guidelines. Comparison

18:53

of WHO versus national

18:55

COVID-19 therapeutic guidelines across the

18:57

world, not exactly a perfect

18:59

match published in the BMJ

19:01

Global Health. The

19:03

authors were able to obtain COVID-19 therapeutic

19:05

national guidelines from 109 of

19:08

the 194 WHO member states. They

19:12

report that therapeutic recommendations

19:14

in many national

19:17

guidelines differed substantially from the

19:19

WHO guidelines. Overall,

19:21

in late 2022, 93%

19:26

of the national guidelines were recommending

19:28

at least one treatment which had

19:30

proved to be ineffective in large

19:32

random mouse trails and were not

19:34

recommended by the WHO. Corticose

19:37

steroids were not recommended in severe

19:39

disease in nearly 10% of the

19:42

national guidelines, despite this being not

19:44

only inexpensive but overwhelming evidence for

19:46

their benefits. Now,

19:48

the national guidelines from countries with

19:51

low resource settings showed the greatest

19:53

divergence. Now, I feel

19:55

confident that most of our listeners can

19:57

guess many of the recommended therapies. that

20:00

just don't work. There were many

20:02

of these guidelines such as vitamin

20:04

C, zinc, ibramectin.

20:08

So I have a couple comments. One is

20:10

when you mix science and politics, you get

20:13

politics. But perhaps a less cynical view

20:15

is that some of the effective therapeutics

20:18

are expensive. So there's a motivation to

20:20

avoid including them in areas where they

20:22

might be cost prohibitive. And as we've

20:24

seen with some therapies, if it's difficult,

20:26

if it's challenging, if the doctor has

20:29

to look through drug-drug interactions and make

20:31

adjustments, they would prefer if that

20:33

wasn't in the guidelines as well. All

20:37

right. So I

20:39

had sort of a standing on a

20:41

soapbox thing here, Vincent, which I feel

20:43

like I've vented enough already. So

20:46

we will move into what is recommended. So

20:50

one, taxilovit, two,

20:52

remdesivir, three, molympirivir, four,

20:54

convalescent plasma. And

20:56

we have the updated isolizin guidance. We'll

20:59

see how they kind of incorporate this

21:01

new terminology of the particles. And

21:04

then we have the early

21:06

inflammatory week, steroids with the right time and

21:08

the right patient, anticoagulation

21:10

guidelines, pulmonary support.

21:13

And what about remdesivir? We

21:15

have the article, remdesivir is

21:17

associated with reduced mortality in

21:19

patients hospitalized for COVID-19, not

21:22

requiring supplemental oxygen, publishing open

21:24

form infectious disease. So here,

21:26

the investigators used a large,

21:28

multi-center US hospital database to

21:30

look at in-hospital mortality among

21:33

patients hospitalized for COVID-19, not

21:35

requiring supplemental oxygen and admission between

21:38

December 2020 and April 2022, receiving

21:42

or not receiving remdesivir. So it's

21:44

going to be matched one to

21:46

one. They're going to

21:48

use propensity score matching. They're going

21:50

to look at 14 and 28 day

21:53

in-hospital mortality or discharge to hospice Among

21:56

the 121,336 eligible patients. The.

22:01

Thousand Hundred and Eighty eight Ram

22:03

disappear treated patients were matched with

22:05

seventeen thousand Five Hundred Seventy Four.

22:07

It's neat, non rem disappear patients.

22:11

Over off five percent of

22:13

Rammed Us to be treated

22:15

and seven point three percent

22:17

of non rem disappear patients

22:19

died within forty days, while

22:21

eight percent of industry treated

22:23

and nine point eight percent

22:25

of non Rem this year

22:27

patients died within twenty days.

22:29

I'm so actually seeing this

22:31

statistically significant reduction in a

22:33

hospital mortality with the introduction

22:35

us up Ramdev Severe. And

22:38

eat. The interesting thing is a really

22:40

nice figure. We get to look at

22:42

all the different very enough concern periods

22:44

and the significant mortality benefit endured across

22:46

all the different via secrets. Guy I

22:49

mentioned he then and se most striking

22:51

a the figure during the Ahmed Rock

22:53

period. Gay.

22:55

And moving into Kobe delayed face

22:57

fast cove. Onto this section we

22:59

have the mm of you are

23:01

Nurse in the Field Long covert

23:03

prevalence among Adults United States Twenty

23:05

Twenty One. Frantic

23:08

Song Public that says they tossed

23:11

number to pin down as we

23:13

have discussed before and hear the

23:15

Cdc analyze data from non. It's

23:17

to size us adults aged eighteen

23:19

all day for speeding in the

23:22

twenty Twenty Two Behavioral risk factor

23:24

surveillance systems, a population base cross

23:26

sectional survey. Respondents. Were

23:28

sampled using random digit dialing

23:30

a both landline and cellular

23:32

telephones. It sounds like fun!

23:34

I'm self reported age, sex

23:36

previous covered nineteen, Diagnosis and

23:38

ever having experienced are covered

23:40

were ascertained via telephone interview.

23:44

Long Cove It was defined as the

23:46

self reported Any symptoms lasting greater than

23:48

three months that were not present before

23:50

haven't covered eighteen. Are you

23:52

see some potential biases right? And been a

23:54

lot of folks upon co then says joking

23:56

aside art at home that able to work

23:59

public answering that. Landline and they

24:01

report that six point four

24:03

percent of non institutionalized Us

24:05

adults reported ever having spirits

24:08

long cooked. Some. The

24:10

waited age and sex year as

24:12

problems range from one point nine

24:14

percent for the Us Virgin Islands

24:16

to ten point six percent for

24:18

West Virginia and exceeded a point

24:20

eight percent the highest prevalence cut

24:22

off it's seven states prevalence tended

24:25

to be lowered england and Pacific

24:27

higher in the south, midwest, and.

24:30

An essay: Have a nice nap.

24:32

We can see these dark areas

24:34

where you have to the highest

24:36

inserts and kind of amazing right.

24:38

Montana, Wyoming, North Dakota. I'm

24:41

Oklahoma. Can

24:43

see West Virginia. That's

24:45

Alabama hours at Mississippi. Hard to tell

24:48

us to apart am one of those

24:50

down there. Why? Do you

24:52

think this is state by state

24:54

variation? You

24:56

know one are the things that has

24:59

come up over time and was the

25:01

the protection that vaccines offered so I

25:03

don't know. In on we we don't

25:05

really get the granularity look at this.

25:07

were speculating on the was it areas

25:10

that were able to get vaccines and

25:12

then the sexes raft organ see a

25:14

significant reduction. I'm. An know I

25:16

don't know. Be great to do some pilot

25:18

analysis to see. You know why Is this

25:21

prevalent so different? And.

25:24

I don't. I. Mean a

25:26

lot of reasons, right? Unearthing incidents is

25:28

one of them, right? Because that's pretty

25:30

even stay knows what did spend yes,

25:32

really been all the sorry I mean

25:34

it could be used. To. Help

25:36

the health status of. People. In

25:39

certain states could vary based on health

25:41

care systems and other issues as well.

25:43

right? That's an attractive right? Yeah, But.

25:46

You know, none of the northeast. Really?

25:49

Have. The. Highest rates. California.

25:52

Does not. Know. States with really

25:54

good health care systems. Cat.

25:56

New England voice like it did really well. I'm

25:58

up in the as a person. Civic northwest

26:00

of the doing quite well as well. As.

26:04

I will this. We also have

26:06

a another rather on contentious article

26:08

we will talk about I'm and

26:10

it's really the topic seems to

26:13

be fraught with lots of binged

26:15

misinterpretation. So the article the persistence

26:17

of source code to in tissues

26:19

and it's association with bomb code

26:21

symptoms A cross sectional covert study

26:23

in China published in The Lancet

26:25

Infectious Diseases. So

26:27

my first word of caution as

26:29

we discussed this article is the

26:31

important distinction between. Persistence.

26:34

Of replication confident Virus.

26:37

versus. The persistence of viral

26:39

runs. So. When people

26:41

talk about barrel persistence, the To: usually

26:43

not just talking about the skeletal remains,

26:46

the virus in the form of Arnie

26:48

or protein am. So let's be clear

26:50

full here as we review this article.

26:53

For. These results of a

26:56

single center cross sectional cord study

26:58

done at the China Japan Friendship

27:00

Hospital in Beijing. Time calling the

27:02

I'm A Crime wave of covert

27:04

nineteen December. Twenty Twenty Two. Individuals

27:07

with mild coburn nineteen confirmed

27:10

by Pcr war a lateral

27:12

slow Tests scheduled to undergo

27:14

Gazprom to be surgery or

27:16

chemotherapy or schedule for treatment

27:19

in hospital for other reasons

27:21

at one month to month

27:23

for months after infection were

27:25

rolled in. Studies: residual surgical

27:27

samples. Gastroscope. He samples

27:30

blood samples were collected these time points

27:32

at one month to month and four

27:34

months I'm after exception. Telephone.

27:37

Follow was done it for months

27:39

post infection To assess the association

27:41

between the persistence a source to

27:43

are in a and long Cove

27:45

It's anthems. Between January

27:47

third and he pulled twenty twenty

27:49

twenty three, three hundred and seventeen

27:52

tissue samples were collected from two

27:54

hundred twenty five patients, including two

27:57

hundred one residual surgical. Specimens.

27:59

To. In I guess basket be

28:01

samples fifty seven blood components samples

28:04

viral on a was detected in

28:06

thirty percent of the fifty three

28:09

solid tissue samples collected at one

28:11

month. Twenty Seven percent

28:13

in two months. Eleven percent

28:16

for months. Viral Army was

28:18

distributed across ten different types of

28:20

solid tissues including liver, kidneys and

28:22

make in tested brain blood vessel

28:24

on breast, skin and pirate. I'm

28:26

now This can get a bit

28:28

more interesting as we read. Some.

28:31

To no mic irony was detected

28:33

in forty three percent of sixty

28:35

one solid tissue samples for to

28:37

gnomic or nay that also tested

28:39

positive for firearm. And. We're

28:41

getting. Get back to that. What? What?

28:43

What Exactly Does that mean? Hundreds, So

28:46

much. Two hundred thirty patients who completed

28:48

the telephone crush near. Thirty. Four

28:50

percent reported at least one long

28:52

covert sentiment to T V. The

28:54

most frequent detection of viral Arnie

28:56

and recovered patients was significant associate

28:59

with the development of Long Cove

29:01

It's symptoms. Patients with higher virus

29:03

copy numbers had a higher likelihood

29:05

is helping long of it's symptoms

29:08

help the like the next heart

29:10

attack. It's interesting in an attempt

29:12

to investigate the potential mechanisms underlying

29:14

the association between this persist in

29:17

a bar remnants and Long Cove

29:19

It symptoms. They did transcript

29:21

tom sequencing of eleven blood vessels

29:23

and twenty four long issues. So

29:26

in that and that. Long.

29:28

Tissues they observed down relay,

29:30

get down regulation of several

29:32

genes involved in the need

29:34

an adaptive immune our defense

29:36

against pathogens in the viral

29:38

persistence group. They. Also noted

29:41

is significant down really regulation of

29:43

zinc finger protein late teens in

29:45

that persistence of viral remnant group

29:47

arm which they say may play

29:49

a role in defense in Sars

29:51

could be to have any interpret

29:54

these findings as suggesting that dysfunction

29:56

and most immune defense my contribute

29:58

to poor. Virus. I'm.

30:01

In a blood vessel samples with

30:03

persistence of arrow remnants of the

30:06

Nfl this regulation of teens related

30:08

to the compliment and cry glacial

30:10

cascade of the also observed is

30:13

rather see teens had Baltic cholesterol

30:15

metallic wasn't pathways so they they

30:17

go on to conclude that these

30:20

findings suggest that persistence of viral

30:22

remnants might affect who sell functions

30:24

which could be another contributing factor

30:26

to the occurrence of long covets.

30:31

So then I I don't know. The.

30:33

Details but. To. The

30:35

have people without. Long. Covered.

30:37

That. They get comfortable time points of tissues

30:40

to look at exactly exactly and and so

30:42

what they're doing is they've got. They've got

30:44

these groups so it's basically the whole group

30:46

and they get the samples and then they're

30:48

going to ask the people say who's got

30:50

long coveted who does it so they can

30:53

divide up the people I guess. A Okay,

30:55

so we've got people that. Have

30:57

want of it? Got people that don't

30:59

and then boy that people aren't Oh

31:01

they'd hire percent of the time are

31:04

We can end up with a positive

31:06

on Pcr. For. Picking up but

31:08

not. it's not black and white. Supply

31:10

com sat back and white. Coat.

31:13

Attorney. And. I don't know any this

31:15

means because I think if you did this for

31:17

any infectious disease you would find you would find

31:19

reactor material and multiple tissues. We just never looked.

31:21

To. This extent and with such sensitive

31:24

essays before. And actually that's

31:26

interesting because that was one of the

31:28

for there is a couple leave a

31:30

couple nice discussions on this is so

31:32

one was a nice discussion by the

31:34

Nello I'm. Blonde. Send so

31:36

and kill and and to Siro

31:38

long covered and sars coby to

31:40

persistence new, answer more questions and.

31:43

A lot of what they bring up this is this

31:45

so unique for is this something that goes on in

31:48

other in such a threat because we talk about local

31:50

that that is also a long. Slow.

31:53

and there's other posts an

31:55

acute quell i am not

31:57

just cove it's and served

31:59

this girl literature that there

32:01

might be persistence of certain

32:04

genetic material, certain proteins, and certain body

32:06

tissues and cells that might be associated

32:08

with those ongoing symptoms. So sort of

32:10

nice in that but I think a

32:12

couple, what I think is sort of

32:14

critical as this gets all

32:16

heated up and emotional is that

32:19

we're not sure and I'm

32:21

not saying anything here tells

32:23

us either way whether this

32:25

is ongoing replication-competent virus.

32:28

I mean that's I wish it was

32:30

right because then we could just throw

32:32

antivirals at it. We could put people

32:34

on long courses of remdish or Paxilovid

32:37

and I mean those trials are ongoing and we're not

32:39

even hearing any sort of you know whispers

32:42

of good news. So

32:45

is there you know is this

32:47

that these viral remnants are triggering

32:49

ongoing issues or are they evidence that

32:51

something was wrong with the host immune function

32:54

upfront that allows these to be in all

32:56

these tissues? Yeah that's

32:58

what it is exactly and I think

33:00

the antiviral

33:02

effect is going to be important

33:04

because I agree I don't

33:06

think this is continuing replication and

33:09

if there's no effect of remdesivir,

33:12

extended remdesivir, then that

33:14

will confirm it something else going on and maybe

33:16

as you say there's something wrong with the host

33:18

and therefore they can't clear virus. It doesn't mean

33:20

it's the other way around right? Yeah

33:22

and we don't we don't know. And

33:26

it will be difficult to know because we don't have

33:28

an animal model where you could do the right kinds

33:30

of experiments. So yeah that's very tough. Alright

33:34

so low and middle income countries you

33:37

know I just always like to wrap up here

33:39

as I have for the last four years no one

33:41

is safe until everyone is safe. I'm

33:43

going to encourage everyone to pause the recording

33:45

right here we're coming towards the end of

33:48

April and we're still not there in our

33:50

American Society of Tropical Medicine and Hygiene Fundraiser.

33:53

We're trying to get up to a potential

33:55

maximum donation of $20,000 so you know even

33:58

a small amount helps we're going to be doubling your

34:00

money to get up to that goal.

34:02

And a portion of these funds will

34:04

go to providing travel awards for two

34:06

female qualified students, early career investigators. It's

34:10

time for your questions for Daniel. You can

34:12

send them to daniel at microbe.tv. Alan

34:15

writes, if you've never seen it, this

34:17

XKCD should bring a smile. Thank you

34:19

for your lucid, informative, and

34:21

engaging contributions to Twiv. And if

34:23

you don't know, XKCD is a

34:26

comic strip. Okay. Here

34:29

is one. The first

34:31

panel, we have someone at a lectern. An

34:34

apple a day keeps a doctor away, or

34:36

at least it used to. In panel two,

34:38

the guy's pointing to a chart.

34:41

Over time, some doctors have developed a

34:43

resistance to apples. Keeping them

34:45

away takes two or three apples instead

34:47

of just one. And there are worrying signs

34:50

that a few doctors may have become

34:52

completely immune. Third panel.

34:54

So we must stockpile our finest apples

34:57

in reserve using them to fend off

34:59

only the very worst doctors. Honey crisps

35:01

still work on most of them, but

35:03

we don't know for how long. I

35:05

love that. It's funny. A

35:08

good parody of antimicrobial

35:10

resistance, right? Yes, exactly.

35:13

Right, thank you, Alan. Mary Ann writes, I

35:15

was just reading in the New York Times today about

35:17

dead H5N1 viral particles

35:20

found in milk would

35:22

ingesting these dead particles and abre

35:24

our immune systems to recognize and

35:26

help kill the live H5N1 virus

35:29

if we were to become infected. I

35:31

don't know enough about virology or immunology,

35:33

but I know enough to ask you

35:35

and Vincent. Thank you for continuing clinical

35:37

updates on Twiv. No, thank

35:40

you. No, Daniel, it's always important

35:42

to know who to ask, right? I

35:44

think that's one of the things. Since

35:46

our knowledge is by definition finite, it's always

35:49

important to be able to reach out

35:51

and ask the right people. And

35:53

boy, are we the right people here? I hope

35:55

so, Vincent. Well,

35:58

I like the fact that you're... to

36:00

these as dead H5N1. Yeah,

36:03

we have no evidence to date that this is

36:06

replicating, replication competent or some

36:08

people would say live virus

36:10

in the milk samples. And

36:12

as mentioned by the time it's pasteurized, you're going to be

36:14

in good shape. Now, pasteurization, so

36:16

that heating is going to do a

36:18

few things. One thing is

36:20

actually going to modify the protein. So I'm

36:23

not really sure that you want to be rushing

36:25

out there thinking that if you drink enough of

36:28

this contaminated milk, you're going to develop some sort

36:30

of immunology, some sort of immunity. Vincent,

36:32

what do you think? I

36:35

don't think there's enough. So I

36:37

don't think there's enough antigen in

36:39

the milk to immunize a mucosal

36:41

surface, right? And you

36:44

know, we don't have any infectious

36:46

viruses can do that, right? Like poliovirus

36:48

and norovirus and rotavirus, they can get

36:50

into your gut and infect the

36:52

gut and get an immune response. But these are not going

36:54

to do that. And so I don't

36:56

think there's enough antigen to do that whatsoever.

36:59

Yeah. All right. But

37:01

thanks for asking. Janet

37:04

writes, we are planning a 99th birthday party for

37:06

the matriarch of the family. The first week in

37:08

July in Seattle, family members from all over the

37:11

country will be attending. One of

37:13

those will be the newest addition, our now five month

37:15

old grandson, who will be seven at

37:17

the time, he'll be flying with his parents

37:19

and healthy vaccinated two year old and 13

37:21

year old sisters. I'm concerned about the recent

37:23

rise in measles cases in the US you've

37:25

been discussing on Twiv in recent

37:28

months. And the fact that standard vaccination protocol

37:30

is that a child received their first MMR

37:32

between 12 and 15 months of age. A

37:35

quick Google search reveals that for people

37:37

traveling with infants internationally to areas with

37:39

known measles outbreaks, babies six to 11

37:41

months old should receive their first MMR

37:44

vaccine dose at least two weeks before traveling.

37:47

I understand they will still need the two dose

37:49

series if they receive a dose before age 12

37:51

months. Would you think it prudent

37:53

that my grandson get vaccinated about two

37:55

to four weeks prior to traveling to

37:57

Seattle when he will be just six

37:59

months old or am I. by being

38:01

overly worried grandmother. Are there any significant

38:03

downsides to getting vaccinated early? Other

38:06

than the fact that he would need to

38:08

be react, be vaccinated and thus would be

38:10

getting an extra shot. If he were to

38:13

get vaccinated early, is there a separate measles

38:15

vaccine or only the combination MMR formulation? Okay.

38:18

So I'm going to sort of be doing this

38:20

backwards. So the first question you had is, so

38:23

is there any, is there any downside, right? Because

38:25

we are making this recommendation in certain context. If

38:28

a baby was going to be six to 11

38:30

months, they're going to be traveling internationally, particularly

38:33

to international destinations where there

38:36

is significant ongoing measles

38:38

transmission. Really

38:41

a very safe thing to be recommending.

38:44

But then the other comes is, is this really

38:46

high risk? Is this an experience

38:48

that warrants that? A lot

38:50

of, you know, as we keep people updated, we

38:52

talk about where the outbreaks are, what's going on.

38:55

They're occurring in different contexts.

38:57

Traveling in the US out

38:59

to the great Northwest is really a

39:02

pretty low risk activity. So

39:04

this really wouldn't be a part where

39:06

we would be generally recommending

39:08

vaccines for this kind of a context.

39:12

Sue writes, a letter to

39:14

you in clinical update 1106 made

39:17

me realize I've had a question for you all

39:19

along. What have you learned

39:21

today, Dorothy? My husband's

39:23

three, count him three types of arthritis, have

39:25

gradually made a near complete comeback, especially the

39:28

worst of them for psoradic. Psoradic,

39:30

how do you say that, Daniel? Psoradic? Psoradic,

39:35

in the four years since the COVID-19 pandemic

39:37

made him reluctant to suppress his immune systems

39:39

to any degree with methotrexate, plus the danger

39:41

then of visiting his rheumatologist in a high-rise

39:43

office deep in New Orleans when we were

39:45

a hotspot. He now suffers frank pain

39:47

in his hands, left knee, and right hip. Risky,

39:50

discomforting flare of skin psoriasis on his lower legs

39:52

is resolved by his old drug regimen, keep him

39:54

in long pants all summer, and this climate now

39:56

harder than ever. He

39:59

used to take methotrexate. humira, biweekly

40:02

injections, supplement folate in D3, and

40:04

colchicine is needed for thankfully infrequent

40:06

bounce of acute gout. Maybe

40:09

something else I don't recall. Osteo

40:11

ticks along in the background. It's too vastly

40:13

improved by that regimen. If that makes sense,

40:15

what do I know? I'm just a biochemist

40:18

who became a radiographer for better job security

40:20

and a lot less sexual harassment. Back in

40:22

the day, lucked into meeting this wonderful partner.

40:26

Oh, my question. Does

40:29

being on any immunosuppressant always decrease the efficacy

40:31

of any vaccines or boosters? Can you go

40:33

off the meds for a time, get your

40:36

booster, wait for a while to build

40:38

up your arsenal of programmed immune cells, and then

40:40

go back on, say methotrexate, and maintain your level

40:42

of immunity with a

40:44

normal rate of diminution of immunity if that's

40:46

why we get boosters apart from new variants?

40:49

Oh, God. She has another question. Going

40:52

back on these meds, erase any of the

40:54

immunity he's gotten in three years of vaccine

40:56

testing and boosting is recommended. If this sort

40:58

of strategy is a thing, can you all

41:00

point me to timing guidance out there where

41:03

I suggest a program yourself is

41:05

overworked, GP doesn't even want to talk about

41:07

it. Oh, okay. Well, I'm happy to talk

41:09

about it. So

41:11

the nice thing is we started thinking about

41:13

this early on because there are millions of

41:16

others in the same situation as your

41:18

husband here. So what to do? Well,

41:21

one of the things we've realized, so

41:23

we'll take certain medications, certain of the

41:25

immunosuppressive medications like methotrexate, and this has

41:27

been studied. If you stop them for

41:29

two weeks and then get vaccinated, you're

41:31

going to get a better response than

41:34

getting vaccinated while staying on this. But

41:37

then the other issue that you bring up

41:39

is once you get back on those, you're

41:41

going to have that immunosuppressive issue associated with

41:43

that. So what do we recommend? You

41:46

know, if you could get off these for two

41:48

or three weeks, do that. That's the timing. So

41:50

you get your vaccine, and then when you need

41:52

to get back on them, then you just realize

41:55

they continue to have that immunosuppressed issue. And

41:58

that's why we're hoping something like Pemgarta. can

42:00

actually get out there and give us another option for

42:02

these drugs. And

42:04

Will writes, in yesterday's clinical update, you

42:06

talked about active and passive vaccination.

42:10

I understand that a baby can have passive immunity

42:12

from the mother for a few months after birth,

42:14

but what is passive vaccination? I've not

42:17

come across the term before. Yeah,

42:20

so this is great. This is actually a distinction

42:22

we've talked about for a while, and I think

42:24

during the days of COVID, this is sort of

42:26

down to the main screen. So

42:30

the active vaccination is we're expecting

42:32

your immune system to be active

42:34

in the process. You got to

42:36

do some work. So you're exposed

42:38

to the antigen in some way,

42:40

and then you mount a T

42:42

and a B cell response. The

42:44

passive vaccination is we give you

42:46

the immunity in the form of

42:49

preformed, preestablished, pre-generated antibodies

42:51

in most cases. And

42:54

this is something that we've done when

42:56

someone gets exposed to certain things, like

42:58

with rabies with the immunoglobulins, we're actually

43:00

using this passive strategy.

43:02

And now we're actually starting to use

43:04

it for COVID-19. That's

43:07

Twiv weekly clinical update with Dr.

43:09

Daniel Grissom. Thank you, Daniel. Thank

43:12

you. And everyone, be safe.