Cont: The One Covid-19 Science and Medicine Thread Part 4

[dann]

They may have used face masks with and without filters. Or comatose patients!
Excellent Twitter thread by Trisha Greenhalgh, professor of Primary Health Care, Oxford, independent SAGE, about the recent Cochrane and other face-mask studies.

 

[dann]

Also:

Do masks work?
Recently, some ppl have started claiming it's proven that they don't. Is this true?
I dove into the details, went to the sources, and what I found was so ridiculous it was FUNNY
Tomas Pueyo (Twitter thread, Feb 27, 2023)

Based on Thomas Pueyo's Twitter thread:

‘So ridiculous’: Major flaw with ‘gold standard’ Covid mask study exposed (The Courier Mail, Feb 28, 2023)

 

[marting]

Back in April 2020, I posted a link to a Nature paper that evaluating exhalation mask efficacy against various common infections pre-covid including coronavirus and influenza.

What struck me at the time was the marked difference between them for both droplet and aerosol components. For droplets, both flu and corona were attenuated effectively. But for aerosol sizes, there was significant leakage for flu and especially for rhino but none for corona. See fig. 1.

http://www.internationalskeptics.com/forums/showpost.php?p=13046099&postcount=1803

From that it may well be that the numerous previous mask studies on flu may not apply to covid-19 and the Chochrane paper has a paucity of covid-19 studies.

 

[dann]

Covid-19 continues to be more lethal than influenza in severe cases requiring hospitalization, according to a new study carried out at the University of Lucerne, Switzerland, released here today by a specialized source.

According to the research, people hospitalized with Omicron variant infections were 54 percent more likely to die, compared to those admitted with the flu.

The results of the study, published in JAMA Network Open and cited this Thursday by Infomed, Cuba’s Health Network, continues to discredit a previous belief since the beginning of the pandemic that the flu was the more dangerous of the two respiratory viruses.

The experts noted that the lethality of the disease-causing SARS-CoV-2 compared to influenza persisted “despite evolution of the virus and improved management strategies.”The investigation included 5,212 patients in Switzerland hospitalized with one of the two conditions, between January 15, 2022 and March 15, 2022 (for Covid-19), while the influenza data covered cases since January 2018 until March 15, 2022. It showed that seven percent of Covid-19 patients died, compared to 4.4 percent of those diagnosed with the flu.
Covid-19 continues to be deadlier than the flu (Prensa Latina, March 2, 2023)

There were also more patients hospitalized with SARS-CoV-2 than with the flu:

Of 5212 patients included from 15 hospitals, 3066 (58.8%) had SARS-CoV-2 Omicron variant infection in 14 centers and 2146 patients (41.2%) had influenza A or B in 14 centers.
Hospital Outcomes of Community-Acquired SARS-CoV-2 Omicron Variant Infection Compared With Influenza Infection in Switzerland (JAMA, Feb 15, 2023)

 

[marting]

There were also more patients hospitalized with SARS-CoV-2 than with the flu:

Kind of expected since the study was Jan 15 to March 15 2022. That was Omicron infecting a large percentage of everyone. Much more than Flu at that time.

The article's headline is somewhat incomplete and misleading.

Covid-19 continues to be deadlier than the flu

Here's the more complete initial paragraph.

Havana, Mar 2 (Prensa Latina) Covid-19 continues to be more lethal than influenza in severe cases requiring hospitalization, according to a new study carried out at the University of Lucerne, Switzerland, released here today by a specialized source.

Therefor one can not conclude that if infected, Omicron is more deadly than the flu especially since, at the time, Omicron was infecting far more people than influenza.

 

[dann]

It is not unusual that the text says more than the headline, and "the more complete initial paragraph" was the first sentence in my quotation from the article.

Flu deaths versus COVID-19 deaths in the USA this season:

The CDC estimates that, so far this season, there have been at least 24 million illnesses, 260,000 hospitalizations, and 16,000 deaths from flu.
4 infections that are on the rise since the COVID-19 pandemic (World Economic Forum, Feb 1, 2023)

I haven't found the exact dates for the start of the flu season in the USA. It begins in week 40 in Denmark. In 2022 that would be Oct 3.
Cumulative confirmed COVID-19 deaths in the USA, Oct 3, 2022 to Feb 1, 2023: from 1,06 million to 1,11 million, so approximately* 50,000 COVID-19 deaths.

From Oct 3 to Dec 1, 2022, i.e. before the flu season peaks, the numbers for COVID-19 deaths were 1.06 million and 1.08 million, i.e. approximately 20,000 COVID-19 deaths.

I haven't found the cumulative number of hospitalizations to compare with the CDC's estimated total number of hospitalizations for flu in the current season.
Number of COVID-19 patients in hospital in the USA, Oct 3, 2022, to Feb 1, 2023. The number of hospitalizations for COVID-19 in the current flu season was at no point lower than 20,862, peaking on Jan 4 with 43,644.

* Our World in Data no longer has a more precise number than this.

 

[The Atheist]

Therefor one can not conclude that if infected, Omicron is more deadly than the flu especially since, at the time, Omicron was infecting far more people than influenza.

I think we're close to being able to say the mortality isn't a lot different any longer.

CDC notes 18-54k deaths from influenza since 1 October 2022 Take the middle ground of ~36k deaths.

Covid has killed 60k in the same period in USA.

Given covid being vastly more infectious than influenza, you'd expect 2-3 times as many deaths if both diseases have a similar fatality rate.

 

[marting]

It is not unusual that the text says more than the headline, and "the more complete initial paragraph" was the first sentence in my quotation from the article.

Yep, you did. I'm just annoyed at the article's headline but such is common these days where clickbait rules.

Flu deaths versus COVID-19 deaths in the USA this season:

Covid deaths are much higher in the USA so far this season (summer to summer). I was expecting even larger waves of covid given the incredible relative growth rate of XB* and even a larger flu wave but neither happened.

Influenza took off in Oct. but has peaked and rapidly declined since. This was the earliest flu wave on the CDC's historicals. Made sense given the extremely low flu levels over the last three years and decline of immunity. But how to make sense of the rapid decline in the middle of what should be peak flu season?

Covid formed a small peak then has gradually dropped. Sample testing shows covid still is relatively prevelant with about 1 in 25 to 40 currently infected (generating +pcr if tested) but with many assymptomatic and a very small portion tested/recorded.

 

[Skeptic Ginger]

When it comes to total deaths, COVID is a year-round pathogen at the moment with some peaks and valleys. Flu for the most part is a seasonal winter disease. ... Just saying.

So there are 3 comparisons to consider:

Deaths per capita
per year
per case​

I think COVID is still more deadly.

 

[marting]

Given covid being vastly more infectious than influenza, you'd expect 2-3 times as many deaths if both diseases have a similar fatality rate.

I think the most likely scenario is a gradual decreasing in covid-19 hospitalizations/deaths as the holes in the population immunity wall get filled. Could well be another year or so before deaths get to normal flu levels even if covid-19 IFR is similar or lower than influenza.

Unknowns are possible new variants that are more lethal and just as transmissible. But as more time goes on that becomes less likely.

 

[Chris_Halkides]

NYT article on paxlovid regarding resistance among physicians

““What I’m doing for a living is weighing the benefits and the risks for everything,” said Dr. Robert Wachter, the chair of the medicine department at the University of California, San Francisco. In deciding whether to prescribe Paxlovid, he said, the benefits significantly outweigh the risks…Wachter agreed that more data would be good, but argued that the existing studies show convincing evidence of Paxlovid’s benefit. “If you’re an impartial reader and sit down to look at the research and compare it to other research we used to decide people should take statins or have their blood pressure treated, Paxlovid feels like it’s in the same category,” he said.” NYT

I know an immunocompromised person over 80 who was recently infected. Their physician discouraged them from taking Paxlovid, which left me scratching my head.

 

[marting]

When it comes to total deaths, COVID is a year-round pathogen at the moment with some peaks and valleys. Flu for the most part is a seasonal winter disease. ... Just saying.

So there are 3 comparisons to consider:

Deaths per capita
per year
per case​

I think COVID is still more deadly.

It's certainly killing more people. Way more. But it's also way more infectious as it cleans up in weak corners of the current vax/prior infection immunity wall.

The flu has been doing that for decades. But I'm actually surprised at the flu early dropoff this season. Will be interesting to see how the two evolve over the next several years.

 

[Planigale]

““What I’m doing for a living is weighing the benefits and the risks for everything,” said Dr. Robert Wachter, the chair of the medicine department at the University of California, San Francisco. In deciding whether to prescribe Paxlovid, he said, the benefits significantly outweigh the risks…Wachter agreed that more data would be good, but argued that the existing studies show convincing evidence of Paxlovid’s benefit. “If you’re an impartial reader and sit down to look at the research and compare it to other research we used to decide people should take statins or have their blood pressure treated, Paxlovid feels like it’s in the same category,” he said.” NYT

I know an immunocompromised person over 80 who was recently infected. Their physician discouraged them from taking Paxlovid, which left me scratching my head.

You are not alone. Come into hospital with a cough and fever and you will be given an antibiotic even in the absence of a proven bacterial infection. Come in with flu or covid proven on PCR and you may not be given antivirals. The is despite he fact most antivirals are safer than antibiotics and in general there is no greater evidence of efficacy. There seems to be a reluctance to give antivirals which doesn't apply to antibiotics.

 

[Myriad]

When it comes to total deaths, COVID is a year-round pathogen at the moment with some peaks and valleys. Flu for the most part is a seasonal winter disease. ... Just saying.

So there are 3 comparisons to consider:

Deaths per capita
per year
per case​

I think COVID is still more deadly.

Another factor to take into account is that Covid infections can result in injuries to organs that flu doesn't cause (or does much more rarely), persisting after the infection itself is cleared. It appears those injuries heal over time (weeks or months) in most cases, but in cases where healing is impaired e.g. by pre-existing chronic conditions, medications, or mobility issues, it wouldn't be surprising if life can be shortened in the long run. It's like getting the flu and having a bad fall at the same time (though the specific likely injuries are different).

 

[marting]

““What I’m doing for a living is weighing the benefits and the risks for everything,” said Dr. Robert Wachter, the chair of the medicine department at the University of California, San Francisco. In deciding whether to prescribe Paxlovid, he said, the benefits significantly outweigh the risks…Wachter agreed that more data would be good, but argued that the existing studies show convincing evidence of Paxlovid’s benefit. “If you’re an impartial reader and sit down to look at the research and compare it to other research we used to decide people should take statins or have their blood pressure treated, Paxlovid feels like it’s in the same category,” he said.” NYT

I know an immunocompromised person over 80 who was recently infected. Their physician discouraged them from taking Paxlovid, which left me scratching my head.

This really is a puzzle. Pax is effective in the early stages and docs really need to be more proactive prescribing it early for anyone older or with comorbitities. Even when symptoms are mild as they usually are at first.

Wachter has a really good "Grand Rounds" with Eric Topol reviewing the state of all things Covid with a bit of AI thrown in. These two are my primary, trusted sources.

https://youtu.be/gjoYq-plKsk

Also, Bob regularly posts an analysis of his current thinking on when and what precautions he takes. At this point his concerns are largely long term secondary effects, not as much surviving covid.

https://twitter.com/Bob_Wachter/status/1631833973914578944

 

[The Atheist]

I think the most likely scenario is a gradual decreasing in covid-19 hospitalizations/deaths as the holes in the population immunity wall get filled. Could well be another year or so before deaths get to normal flu levels even if covid-19 IFR is similar or lower than influenza.

Unknowns are possible new variants that are more lethal and just as transmissible. But as more time goes on that becomes less likely.

As usual, we're completely in agreement here, with the rider that we could be doing much better:

There seems to be a reluctance to give antivirals which doesn't apply to antibiotics.

That's an outrage, and it works both ways, because the same Joe Public who feels cheated if he visits the doctor and doesn't get a prescription doesn't want to take Paxlovid.

 

[Skeptic Ginger]

You are not alone. Come into hospital with a cough and fever and you will be given an antibiotic even in the absence of a proven bacterial infection. Come in with flu or covid proven on PCR and you may not be given antivirals. The is despite he fact most antivirals are safer than antibiotics and in general there is no greater evidence of efficacy. There seems to be a reluctance to give antivirals which doesn't apply to antibiotics.

Is there a wide-spectrum antiviral you had in mind? Something equivalent to a wide spectrum antibiotic one might start a patient on before the cultures come back?

 

[Planigale]

Is there a wide-spectrum antiviral you had in mind? Something equivalent to a wide spectrum antibiotic one might start a patient on before the cultures come back?

We are strongly discouraged from using broad spectrum antibiotics.

An example; a high risk patient (mild immunosuppression and chronic lung disease) presents to ED with cough and increased breathlessness. They have a point of care test that is positive for Flu, negative for covid and RSV. They are sent home (reasonable) on an antibiotic (doxycycline) to cover for secondary bacterial infection (no evidence that they had one) but no antiviral for their primary viral infection. Despite the patient clearly meeting the national guideline criteria for treatment. Guideline in fact authorised empirical anti-flu treatment for a person with suspected influenza who was high risk. So even without a positive flu test the person would have met criteria.

 

[marting]

Blinded RCT on metformin in early treatment shows long covid reduction

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4375620

Outpatient Treatment of COVID-19 and the Development of Long COVID Over 10 Months: A Multi-Center, Quadruple-Blind, Parallel Group Randomized Phase 3 Trial

Findings: Of 1323 randomized trial participants, 1125 consented for long-term follow up, and 95.1% completed >9 months of follow up. The median age was 45 years (IQR, 37 to 54), and 56% were female (7% pregnant). The median BMI was 30 kg/m2 (IQR, 27 to 34). Overall, 8.4% reported a medical provider diagnosed them with Long COVID; cumulative incidence: 6.3% with metformin and 10.6% with matched placebo. The hazard ratio (HR) for metformin preventing Long COVID was 0.58 (95%CI, 0.38 to 0.88; P=0·009) versus placebo. The metformin effect was consistent across subgroups, including viral variants. When metformin was started within <4 days of symptom onset, the HR for Long COVID was 0.37 (95%CI, 0.15 to 0.95). No statistical difference in Long COVID occurred in those randomized to either ivermectin (HR=0.99; 95%CI, 0.59 to 1.64) or fluvoxamine (HR=1.36; 95%CI, 0.78 to 2.34).

 

[The Atheist]

That looks like a good finding, with a safe drug.