Anita Y Cheng<p>From a listener question: The renal dose of Paxlovid should only be given to patients who have documented kidney function issues. Some doctors prescribe it to anyone older than 65, but Dr. Griffin says it’s better to give the full dose of <a href="https://mastodon.publicinterest.town/tags/Paxlovid" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>Paxlovid</span></a> unless really warranted.</p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 9/9</p>
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#twivtldr
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Anita Y Cheng<p>A small study showed that people with <a href="https://mastodon.publicinterest.town/tags/LongCOVID" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>LongCOVID</span></a> do not have reactivated Epstein-Barr virus in their blood. Dr. Griffin wants to reframe this, since some of his long COVID patients do have reactivated EBV, but some do not. It’s certainly true it’s not causative, but it also highlights the fact that a blood test for long COVID is still a ways off.</p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 8/</p>
Anita Y Cheng<p>Another thing that doesn’t help with <a href="https://mastodon.publicinterest.town/tags/COVID" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>COVID</span></a> disease progression - Conestat A (ConA) a recombinant human C1 inhibitor, which generally affects inflammation. They even stopped the study early because of how useless it was.</p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 7/</p>
Anita Y Cheng<p>Taking 100mg of fluvoxamine 2x a day (an SSRI mostly used for OCD treatment) does not help people recover faster from mild to moderate <a href="https://mastodon.publicinterest.town/tags/COVID" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>COVID</span></a>. Apparently a bunch of people really thought this would work, because it was a thing that people told each other to take for COVID recovery. Sorry, it doesn’t work!</p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 6/</p>
Anita Y Cheng<p>The middling results of using COVID convalescent plasma (given to <a href="https://mastodon.publicinterest.town/tags/immunocompromised" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>immunocompromised</span></a> ppl who can’t take anything else) may be down to timing - if you give it late, it doesn’t have much of an effect. Also, the vast majority given plasma were also on steroid drugs at the time, which may have affected the plasma’s impact. (You take steroids to reduce inflammation from hyperactive immune response.) It emphasizes the importance of giving <a href="https://mastodon.publicinterest.town/tags/COVID" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>COVID</span></a> convalescent plasma in first week.</p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 5/</p>
Anita Y Cheng<p>…Both Drs. Griffin and Racaniello point out how “odd” this is, and question how you’re going to measure “rebound” if nobody goes to zero to rebound from? The study did find that people who took <a href="https://mastodon.publicinterest.town/tags/Paxlovid" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>Paxlovid</span></a> have fewer symptoms and lower viral load than untreated, so it should still help with transmission. And observe that symptom rebound is a separate thing from viral rebound. So Paxlovid should really be prescribed for everyone with <a href="https://mastodon.publicinterest.town/tags/COVID" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>COVID</span></a> who is high risk.</p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 4/</p>
Anita Y Cheng<p>And another Paxlovid “rebound” study, comparing <a href="https://mastodon.publicinterest.town/tags/COVID" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>COVID</span></a> patients of similar health histories that were treated or untreated with <a href="https://mastodon.publicinterest.town/tags/Paxlovid" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>Paxlovid</span></a>. To start, they really broaden the definition of “rebound” so that 20% of the untreated group would qualify as having “rebound.” Many people in both treated and untreated groups still report having at least 1 COVID symptom even after day 15 (70%). Also, only about 20% of people in both groups were testing negative on PCR tests by day 10…</p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 3/</p>
Anita Y Cheng<p>A VA study found that people taking immunosuppressive drugs (so, <a href="https://mastodon.publicinterest.town/tags/immunocompromised" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>immunocompromised</span></a>) for organ transplants, rheumatoid arthritis, inflammatory bowel disease (IBD), or psoriasis are still somewhat likely develop severe COVID-19 even if they’ve been vaccinated. 22.7% of organ transplant recipients are likely to get severe <a href="https://mastodon.publicinterest.town/tags/COVID" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>COVID</span></a>, 12.8% of rheumatoid arthritis patients, 6.9% of IBD patients, and 7.3% of psoriasis patients. And Paxlovid helped a lot. </p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 2/</p>
Anita Y Cheng<p>Still catching up. 😅 This Week in Virology for November 22, 2023: <a href="https://www.microbe.tv/twiv/twiv-1064/" rel="nofollow noopener noreferrer" target="_blank"><span class="invisible">https://www.</span><span class="">microbe.tv/twiv/twiv-1064/</span><span class="invisible"></span></a></p><p>The CDC released 70K+ more doses of the <a href="https://mastodon.publicinterest.town/tags/RSV" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>RSV</span></a> vaccines for babies. Get those shots! 💉</p><p>The anti-vaccine movement is starting to show in measles cases. Increase of 18% in cases and 43% increase in deaths worldwide from 2021 to 2022. Most of the <a href="https://mastodon.publicinterest.town/tags/measles" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>measles</span></a> deaths are in young kids. 😔</p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 1/</p>
Anita Y Cheng<p>The hosts also discuss how some doctors avoid prescribing Paxlovid for nonsensical reasons, like <a href="https://mastodon.publicinterest.town/tags/rebound" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>rebound</span></a> symptoms being worse than nontreated COVID (they aren’t) and preventing transmission during rebound (uhh, <a href="https://mastodon.publicinterest.town/tags/Paxlovid" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>Paxlovid</span></a> is an antiviral and should help with that...??). There also aren’t any indications that anyone taking Paxlovid has ever transmitted COVID onwards.</p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 7/7</p>
Anita Y Cheng<p>And in this very study, only 8 of the ~70 <a href="https://mastodon.publicinterest.town/tags/COVID" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>COVID</span></a> participants who experienced a “<a href="https://mastodon.publicinterest.town/tags/rebound" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>rebound</span></a>” in viral load (based on this “rigged” definition) experienced any symptoms at all…</p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 6/</p>
Anita Y Cheng<p>…They walk through the figures of this "rigged” <a href="https://mastodon.publicinterest.town/tags/COVID" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>COVID</span></a> <a href="https://mastodon.publicinterest.town/tags/rebound" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>rebound</span></a> paper anyway, and discuss how RNA copy number is not correlated 1:1 with infectivity due to the scale of the measurements used. (And you cannot tell how infectious you are on how dark your positive antigen test is either!) They acknowledge that even though symptoms can return and some jump in viral detection based on current test protocols, nobody who experienced a <a href="https://mastodon.publicinterest.town/tags/Paxlovid" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>Paxlovid</span></a> “rebound” needed to go to the hospital. </p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 5/</p>
Anita Y Cheng<p>More observational studies about <a href="https://mastodon.publicinterest.town/tags/Paxlovid" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>Paxlovid</span></a> rebound! Dr. Griffin notes the “controversial” paper redefined what “<a href="https://mastodon.publicinterest.town/tags/rebound" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>rebound</span></a>” is - not just return of symptoms, but checking people 3x a week with PCR tests, for any sort of detectable viral particles, or a 4x increase of viral particles even if it never goes to zero. Both Dr. Racaniello and Dr. Griffin “cry foul” for this new definition of rebound - “the game is rigged….”</p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 4/</p>
Anita Y Cheng<p>Babies younger than 6 months are protected somewhat from <a href="https://mastodon.publicinterest.town/tags/COVID" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>COVID</span></a> infection when their birth parents are vaccinated during <a href="https://mastodon.publicinterest.town/tags/pregnancy" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>pregnancy</span></a>. There’s no difference when the birth parent is vaccinated before pregnancy - it’s best to get a booster during the third trimester.</p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 3/</p>
Anita Y Cheng<p>Dr. Griffin notes that people are assuming endemic <a href="https://mastodon.publicinterest.town/tags/COVID" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>COVID</span></a> would have similar seasonalities to flu...and not other coronaviruses. 😅 Scientists have modeled it and have come up with a really interesting prediction of where COVID will peak in the future around the world: <a href="https://journals.asm.org/doi/10.1128/mbio.01426-23#F3" rel="nofollow noopener noreferrer" target="_blank"><span class="invisible">https://</span><span class="ellipsis">journals.asm.org/doi/10.1128/m</span><span class="invisible">bio.01426-23#F3</span></a> (😅 on Amsterdam always being at a moderate risk with no peak or lull...)</p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 2/</p>
Anita Y Cheng<p>Still catching up, but now knitting so maybe I’ll catch up faster…. <a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> for November 17: <a href="https://www.microbe.tv/twiv/twiv-1062/" rel="nofollow noopener noreferrer" target="_blank"><span class="invisible">https://www.</span><span class="">microbe.tv/twiv/twiv-1062/</span><span class="invisible"></span></a></p><p>More kindergarteners are being exempted from “required” <a href="https://mastodon.publicinterest.town/tags/vaccinations" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>vaccinations</span></a> for various things nowadays, including DTap and <a href="https://mastodon.publicinterest.town/tags/polio" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>polio</span></a>. The percentage of exempted children is more than 5% in 10 states. (<a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7245a2.htm#F2_down" rel="nofollow noopener noreferrer" target="_blank"><span class="invisible">https://www.</span><span class="ellipsis">cdc.gov/mmwr/volumes/72/wr/mm7</span><span class="invisible">245a2.htm#F2_down</span></a>) Most exemptions were “philosophical.” 😅</p><p>1/</p>
Anita Y Cheng<p>From a pediatrician listener question: There is a shortage of monoclonal treatments for <a href="https://mastodon.publicinterest.town/tags/RSV" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>RSV</span></a>, so it’s incredibly important for pregnant people to get the RSV <a href="https://mastodon.publicinterest.town/tags/vaccine" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>vaccine</span></a> and then breastfeed to protect their newborns.</p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 11/11</p>
Anita Y Cheng<p>From a listener question: Dr. Griffin doesn’t believe <a href="https://mastodon.publicinterest.town/tags/Paxlovid" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>Paxlovid</span></a> actually goes bad on their printed expiration dates. If you have <a href="https://mastodon.publicinterest.town/tags/COVID" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>COVID</span></a>, take it anyway!</p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 10/</p>
Anita Y Cheng<p>People with mild <a href="https://mastodon.publicinterest.town/tags/COVID" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>COVID</span></a> who lose their sense of taste and <a href="https://mastodon.publicinterest.town/tags/smell" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>smell</span></a> generally all get it back within 3 years. Note that this was a 3-year study in total, so it was looking at where everybody was at the end. You also have to pay to read the article (boo) and the hosts didn’t discuss any timeline data, if it was even available to begin with. </p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 9/</p>
Anita Y Cheng<p><a href="https://mastodon.publicinterest.town/tags/COVID" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>COVID</span></a> convalescent plasma (for <a href="https://mastodon.publicinterest.town/tags/immunocompromised" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>immunocompromised</span></a> people who can’t take anything else) given to ventilated patients had the greatest effect if given within 48 hours. Waiting to see how people do is not useful.</p><p><a href="https://mastodon.publicinterest.town/tags/TWiVTLDR" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>TWiVTLDR</span></a> 8/</p>
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