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

[junkshop]

So I guess covid has been eradicated in the UK now.

I can only assume this is the case given that I had my iinitial vaccine (AZ) in May '21, a booster (MOD) in December '21, and have not been offered anything since.

Ain't that dandy?

 

[novaphile]

So I guess covid has been eradicated in the UK now.

I can only assume this is the case given that I had my iinitial vaccine (AZ) in May '21, a booster (MOD) in December '21, and have not been offered anything since.

Ain't that dandy?

I'm not sure about the "offered anything" part above.

I've just had my fifth vaccine, all Pfizer, the latest one being a bivalent vaccine that covers the original 2020 strain and the Omicron variant BA.1.

Note that no one 'offered' these vaccines to me, I had to seek them out, make appointments etc.

 

[junkshop]

I'm not sure about the "offered anything" part above.

I've just had my fifth vaccine, all Pfizer, the latest one being a bivalent vaccine that covers the original 2020 strain and the Omicron variant BA.1.

Note that no one 'offered' these vaccines to me, I had to seek them out, make appointments etc.

By 'offered' I meant 'made available in any way shape or form through the NHS (the only source of Covid vaccinations and boosters in the UK)'. This is the current availability.

I've not yet turned 50, and am therefore immune until I do, apparently.

 

[Sherkeu]

By 'offered' I meant 'made available in any way shape or form through the NHS (the only source of Covid vaccinations and boosters in the UK)'. This is the current availability.

I've not yet turned 50, and am therefore immune until I do, apparently.

From your link it says

"Coronavirus (COVID-19) vaccine booster doses are offered seasonally. The next COVID-19 booster doses will be available later in the year and if you are eligible the NHS will contact you when it’s your turn to be vaccinated."

So, in Autumn you can get one.

Seroprevalence in the U.K is over 96% (above 179ng/ml). Odds are you've got Omicron antibodies already. Maybe several variant exposures.

see u.k. data here:
https://www.ons.gov.uk/peoplepopula...s/coronaviruscovid19latestinsights/antibodies

 

[zooterkin]

From your link it says

"Coronavirus (COVID-19) vaccine booster doses are offered seasonally. The next COVID-19 booster doses will be available later in the year and if you are eligible the NHS will contact you when it’s your turn to be vaccinated."

So, in Autumn you can get one.

Seroprevalence in the U.K is over 96% (above 179ng/ml). Odds are you've got Omicron antibodies already. Maybe several variant exposures.

see u.k. data here:
https://www.ons.gov.uk/peoplepopula...s/coronaviruscovid19latestinsights/antibodies

I’ve highlighted the crucial word. As junkshop said, only over-50s, and some who are vulnerable, were eligible for the latest booster.

 

[Skeptic Ginger]

We are strongly discouraged from using broad spectrum antibiotics.

That's not the question I asked you.

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.

That's not the standard of care here. They would be given an antiviral for influenza*. If the patient was sick enough to be seen, they probably should have the flu treated.

*If they'd had symptoms for say a week or so, then it might be too late to give a flu med.

I understand adding the antibiotic, but then why did you just say you are discouraged from using broad spectrum antibiotics? Doxy is moderate to broad spectrum.

 

[marting]

Eric Topol's has a new, excellent substack piece discussing the endemic phase we are now in He notes that no new variants have appeared showing the high relative advantage of earlier ones. Also discusses risks in the coming years.

https://erictopol.substack.com/p/a-break-from-covid-waves-and-a-breakthrough

Topol does a great job anotating the metformin trial I recently posted. Much more readable. He goes on to call it a "A Breakthrough for Prevention of Long Covid" He rarely uses "breakthrough."

He suggests a head to head RCT with Paxlovid:

The only other drug to date with some promising data to prevent Long Covid is Paxlovid, but that is from a large observational database, not derived from a randomized trial. Ideally, a 2X 2 factorial design trial would be conducted to test metformin plus paxlovid, either drug alone, or placebo.

Don't expect pharma to spring for the study. Metaformin is dirt cheap.

And he notes nothing to date treats long covid and this is badly needed:

And to emphasize, we still have no drug validated to treat Long Covid, only 1 that now appears likely to help prevent it.

 

[Sherkeu]

I’ve highlighted the crucial word. As junkshop said, only over-50s, and some who are vulnerable, were eligible for the latest booster.

Seems Canada has similar guidelines published Mar 4:

Public health no longer advising boosters for most Canadian adults

...The recommendation excluded Canadians under the age of 65 – so long as the person did not have complex medical needs or live in a long-term care home.

Public health recommends booster-shots exclusively to at-risk groups because Covid-19 has stabilized in Canada, Dr. Tam said. She wrote the general population has high levels of antibodies, resulting from vaccination and previous infections.

 

[Sherkeu]

Eric Topol's has a new, excellent substack piece discussing the endemic phase we are now in He notes that no new variants have appeared showing the high relative advantage of earlier ones. Also discusses risks in the coming years.

https://erictopol.substack.com/p/a-break-from-covid-waves-and-a-breakthrough

Topol does a great job anotating the metformin trial I recently posted. Much more readable. He goes on to call it a "A Breakthrough for Prevention of Long Covid" He rarely uses "breakthrough."

Will be interesting to see why it wasn't used outpatient before-

It seems that this study of older overweight/obese populations with Covid-19 would be prone to known covid glucose spikes, covid-onset diabetes, and steroidal additions to that -- even if participants have never been formally diagnosed with diabetes.

Metformin, as a diabetes drug to regulate glucose seems like a logical choice for outpatient care of these at-risk groups with a milder cases that dont require a hospital stay with insulin management. Not just for covid, but other illnesses/surgeries that can cause dangerous spikes. Hyperglycemia can do damage.

But having read the study, there were no tests or blood panels done. It doesnt even mention insulin in a study specific to overweight/obese persons getting a diabetic drug. Seems odd to me it is not addressed.

 

[marting]

Metformin, as a diabetes drug to regulate glucose seems like a logical choice for outpatient care of these at-risk groups with a milder cases that dont require a hospital stay with insulin management. Not just for covid, but other illnesses/surgeries that can cause dangerous spikes. Hyperglycemia can do damage.

But having read the study, there were no tests or blood panels done. It doesnt even mention insulin in a study specific to overweight/obese persons getting a diabetic drug. Seems odd to me it is not addressed.

Since they did exclude candidates that were already taking metaformin, the study population has underweighted diabetics. It appears their only interest was the interaction of mataformin with the general, long covid risk cohort. But had they included those taking metaformin, presumably for type 2, it would have required a larger N to get anything useful.

This does bring up the issue of how at risk diabetics on mataformin are relative to those that aren't or even the general population of similar age and BMI. Good areas for futher study. Especially since metaformin was only given for 2 weeks and started days after symptoms. Diabetics would have been on the drug before, at, and during, the time of infection.

There is a discussion of the relevant safety issues in non-diabetics.

 

[dann]

Eric Topol's has a new, excellent substack piece discussing the endemic phase we are now in He notes that no new variants have appeared showing the high relative advantage of earlier ones. Also discusses risks in the coming years.

https://erictopol.substack.com/p/a-break-from-covid-waves-and-a-breakthrough

Sounds good ... so far.

Topol does a great job anotating the metformin trial I recently posted. Much more readable. He goes on to call it a "A Breakthrough for Prevention of Long Covid" He rarely uses "breakthrough."

He suggests a head to head RCT with Paxlovid:



Don't expect pharma to spring for the study. Metaformin is dirt cheap.

Since Paxlovid isn't cheap, shouldn't that make it easier to persuade public health care authorities to participate in a Metaformin test? I assume health insurance companies would also be interested in a cheaper alternative to Paxlovid.

And he notes nothing to date treats long covid and this is badly needed:

I don't think long Covid should be considered as one disease with one treatment. That treatment is needed doesn't mean that treatment is possible. Blood clots. Liver, heart, kidney and/or lung damage. Brain fog. Autoimmune diseases. It's a long list. The treatment will have to depend on how the infection damaged the individual patients or groups of patients.

And in many cases, I don't think any treatment can be expected. It will be 'wait and hope that the body will be able to repair the damage to some extent once the infection is gone'. And maybe palliative care in the meantime.

As almost always, prevention is preferable to treatment.

 

[marting]

Sounds good ... so far.
I don't think long Covid should be considered as one disease with one treatment. That treatment is needed doesn't mean that treatment is possible. Blood clots. Liver, heart, kidney and/or lung damage. Brain fog. Autoimmune diseases. It's a long list. The treatment will have to depend on how the infection damaged the individual patients or groups of patients.

Indeed. The unknown is how much and kind of long covid is a result of the infection that is no longer there and how much is due to some, ongoing, chronic infection. There are studies that show covid-19 can be detected upwards of 6 months after initial infection in around 10% of cases.

But likely most long covid is the multi-organ damage from the initial infection. So one can just treat, not cure, the damage done if not done early.

So the best hope is early treatment in the first days of infection. And right now, the 2x2 study of Paxlovid and Metaformin that Topol suggests makes all kinds of sense.

 

[marting]

As a personal anecdote, my brother, just under 70 y/o, almost certainly got covid in late June 2021. A friend he had spent time with two days earlier tested positive the day after and my brother got sick as a dog for a week just 2 days after spending time with the friend. This was 3 months after he got the second Pfizer shot and at the start of the rise of Delta. Delta showed significant immune escape and the vaccine effectiveness starts to wane at 3 months. Probably lucky he got the shot even if he did get sick. BTW, he didn't have a bad reaction to the vaccine, just the usual arm soreness for a few days.

While he almost certainly got covid-19, he wasn't tested. He and his wife live nearly an hour away from the nearest town or testing place in the mountains of the mid-west. She got a mild case a few days after him lasting about 3 days. No indication of long covid in either.

 

[junkshop]

From your link it says

"Coronavirus (COVID-19) vaccine booster doses are offered seasonally. The next COVID-19 booster doses will be available later in the year and if you are eligible the NHS will contact you when it’s your turn to be vaccinated."

So, in Autumn you can get one.
Seroprevalence in the U.K is over 96% (above 179ng/ml). Odds are you've got Omicron antibodies already. Maybe several variant exposures.

see u.k. data here:
https://www.ons.gov.uk/peoplepopula...s/coronaviruscovid19latestinsights/antibodies

Not this autumn.

Not until autumn 2025.

Four years after my last dose.

This is fine because clearly there is no more covid, and even if there is, there's no chance of new variants emerging when most of the population are essentially unvaccinated.

This is fine, because politics, over science.

This is fine.

Everything is fine.

 

[Sherkeu]

Not this autumn.

Not until autumn 2025.

Four years after my last dose.

This is fine because clearly there is no more covid, and even if there is, there's no chance of new variants emerging when most of the population are essentially unvaccinated.
This is fine, because politics, over science.

This is fine.

Everything is fine.

Most of the Earth's population now has antibodies for Omicron or it's substrains, the current viruses going around- without additional boosters. Vaccination is just one way. Given the x100 or x1000 transmission capability since the start of the pandemic, most people have natural immunity at this point- as the seroprevalence studies are showing.... and keep showing.

Protection wanes faster in older or immunocompromised persons.
If you are one of those persons at high risk, you have a case to get the additional booster, and it is recommended. If you have concern for your own health, I'm sure you have asked your doctor about this already. What did they say?

 

[dann]

You seem to forget or ignore that immunity, whether natural or vaccine-induced, isn't worth much with "new variants emerging" capable of evading the already acquired immunity.

And then there are problems like this one - even though you are not one of those persons at high (or any) risk of this particular ailment:
Prior COVID-19 infection associated with increased risk of newly diagnosed erectile dysfunction (Nature, Mar 15, 2023)
However, since the erectile dysfunction may be due to the microclots caused by Covid-19, it may give rise to many other ailments. Women are at risk of those microclots, too. The more infections, the higher the risk of sequelae.

 

[marting]

Prior SARS-CoV-2 infection enhances and reshapes spike protein–specific memory induced by vaccination

https://www.science.org/doi/10.1126/scitranslmed.ade0550

From the abstract:

Together, our data suggest that prior SARS-CoV-2 infection increases the titers of SARS-CoV-2 spike protein–specific antibody responses elicited by subsequent vaccination and induces modifications in the composition of the spike protein–specific memory B cell pool that are compatible with enhanced functional protection at mucosal sites.

 

[The Atheist]

You seem to forget or ignore that immunity, whether natural or vaccine-induced, isn't worth much with "new variants emerging" capable of evading the already acquired immunity.

Except, as marting has taken pains to point out, new variants outside the omicron line aren't emerging, or seem at all likely to.

In other covid news, even arch-protective South Korea is ditching mask mandates and has stopped pre-departure testing for Chinese travellers.

 

[Dr.Sid]

Japan ditched masks outside months ago. People still used them. This Monday they ditched masks inside. And as for what I can tell from webcams .. over 80% of people still are using them everywhere. But at least you can see a rebel here and there. And people in cars, traveling alone, with a mask ? Yep.
That might bite back, as recent spread of other viruses everywhere shows.
Of course I mainly want the habit to die down before my May trip. I learned to hate the masks last October, when I was there.

 

[angrysoba]

Japan ditched masks outside months ago. People still used them. This Monday they ditched masks inside. And as for what I can tell from webcams .. over 80% of people still are using them everywhere. But at least you can see a rebel here and there. And people in cars, traveling alone, with a mask ? Yep.
That might bite back, as recent spread of other viruses everywhere shows.
Of course I mainly want the habit to die down before my May trip. I learned to hate the masks last October, when I was there.

I’m in the gym now here in Osaka. About 80% are masked. I am in the 20%.

The same is true is walking around and even more so on trains or in shops. The vast majority are still masked.