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

[marting]

Does anyone know how effective Paxlovid is?

https://www.scienceboard.net/index.aspx?sec=ser&sub=def&pag=dis&ItemID=5241

They performed an observational study using data from 28,000 patients provided by the UCHealth system, Colorado's largest statewide health system. They examined the data of patients with one or more risk factors for severe disease, hospitalization, or death, and who either did or did not receive Paxlovid. They found that Paxlovid's use significantly reduced hospitalization and death rates, effectively preventing hospitalization among almost all outpatient subgroups who qualified for the drug's use under the government's emergency use authorization (EUA).

Key thing with Paxlovid is it is only effective during the initial infection when things are relatively mild. Giving it to patients after they have become severely ill is not effective. So here it's only used for patients that are at high risk. Elderly, etc.

 

[angrysoba]

https://www.scienceboard.net/index.aspx?sec=ser&sub=def&pag=dis&ItemID=5241



Key thing with Paxlovid is it is only effective during the initial infection when things are relatively mild. Giving it to patients after they have become severely ill is not effective. So here it's only used for patients that are at high risk. Elderly, etc.

Great! That’s what I’m looking for. Okay, so it is not worth giving to low-risk groups or those who have been sick for a few days.

 

[marting]

Great! That’s what I’m looking for. Okay, so it is not worth giving to low-risk groups or those who have been sick for a few days.

Effectiveness is in the early stage <= 5 days after first symptoms. Severe disease, low spOx and such typically occurs after a lot of tissue damage in the second week and it is of no benefit then. At that point steroids are somewhat effective. Some docs here give steroids initially and that likely does more harm than good. First Pax in the first stage, then steroids in the second stage if disease progresses.

 

[Planigale]

Effectiveness is in the early stage <= 5 days after first symptoms. Severe disease, low spOx and such typically occurs after a lot of tissue damage in the second week and it is of no benefit then. At that point steroids are somewhat effective. Some docs here give steroids initially and that likely does more harm than good. First Pax in the first stage, then steroids in the second stage if disease progresses.

In the trials the benefit of steroids is in those with an oxygen requirement. I am aware of no evidence to justify early use. Whereas as you say Paxlovid's benefits are in those at high risk of severe disease, when given early.

 

[marting]

In the trials the benefit of steroids is in those with an oxygen requirement. I am aware of no evidence to justify early use. Whereas as you say Paxlovid's benefits are in those at high risk of severe disease, when given early.

Yep. Because there isn't any. But that hasn't stopped some docs from giving it in the initial stage which seems very unwise given how steroids supress immune response and the early stage is where you need it.

 

[The Atheist]

An interesting piece of info came out the other day, regarding covid infections in NZ - while XBB has increased its share of infections and become the dominant strain, the total number of infections has remained unchanged.

It also seems to have taken XBB a long time to gain dominance.

I think we can therefore say that while XBB might be the most infectious, its advantage is nowhere near as distinct as previous variants had.

 

[The Atheist]

Yep. Because there isn't any. But that hasn't stopped some docs from giving it in the initial stage which seems very unwise given how steroids supress immune response and the early stage is where you need it.

That touches on one of the things that seriously needs fixing - communication of what's going on.

Our government removed Molnupiravir from the list of treatment options, then didn't bother telling doctors or pharmacists. Given it had been heavily advertised on TV, doctors were being asked to prescribe and still were until the mess was highlighted in the media.

 

[Planigale]

Does anyone know how effective Paxlovid is?

Does it make mild illness go away more quickly or prevent mild illness becoming serious?

Is there any data that suggests it reduces mortality?

I am just wondering because I have not heard of anyone getting it in Japan. Literally nobody I know has taken it.

It reduces hospital admissions by 50% in those at high risk of severe disease when taken within 5 days of onset of symptoms. Deaths in the study were few so mortality as a separate outcome was not documented.

Overall, 180 351 eligible patients were included; of these, only 4737 (2.6%) were treated with Paxlovid, and 135 482 (75.1%) had adequate COVID-19 vaccination status. Both Paxlovid and adequate COVID-19 vaccination status were associated with significant decrease in the rate of severe COVID-19 or mortality with adjusted HRs of 0.54 (95% confidence interval [CI], .39–.75) and 0.20 (95% CI, .17–.22), respectively. Paxlovid appears to be more effective in older patients, immunosuppressed patients, and patients with underlying neurological or cardiovascular disease (interaction P < .05 for all). No significant interaction was detected between Paxlovid treatment and COVID-19 vaccination status.

https://academic.oup.com/cid/article/76/3/e342/6599020

 

[marting]

It reduces hospital admissions by 50% in those at high risk of severe disease when taken within 5 days of onset of symptoms. Deaths in the study were few so mortality as a separate outcome was not documented.
https://academic.oup.com/cid/article/76/3/e342/6599020

Yep, and vax reduced severe disease 80%. Even better, Pax and Vax reductions were additive so the Pax reduction is seen on top of the Vax reduction.

Thanks for the link!

 

[marting]

TWIV interviews Mohsan Saeed about the GoF episode

An in depth discussion about research to determine the degree to which the Omicron mutations in the spike protein were the cause of the relatively milder disease. This was done by creating a chimera with the Omicron spike.

Here's the Nature paper:
Spike and nsp6 are key determinants of SARS-CoV-2 Omicron BA.1 attenuation
https://www.nature.com/articles/s41586-023-05697-2

Most of the lower virulence was due to the spike but not all. Really nice discussion. Learned a lot including details of where Omicron disease differs from the Wuhan original.

TWiV 997: Inside Omicron with Mohsan Saeed
https://www.youtube.com/watch?v=eciWFYH3wiI

Back in Oct this created an intense, badly reported, media (and congressional) storm. While most of the video discusses exactly what experiments were done and with what approvals, for those not familar with the hubub, Mohsan goes through it starting at about 1:14:00 in the video.

Here's one of the more extreme examples:

Fauci-Funded Scientist Engineers New COVID-19, Deadlier Than Omicron, In Boston Lab
https://dailycaller.com/2022/10/18/...h-omicron-gain-of-function-boston-university/

factcheck.org
https://www.factcheck.org/2022/10/s...-of-what-causes-severity-of-covid-19-strains/

 

[The Atheist]

WHO has removed emergency status and made some very amusing comments about the pandemic, and others to come.

“Lives were lost that should not have been. We must promise ourselves and our children and grandchildren that we will never make those mistakes again.”

Good sense of humour, that man. Not only will we make the same mistakes, next time things will be far worse, because countries will be less likely to react with stringent measures, people will take fewer precautions, and the next virus will probably be more virulent.

With the emergency phase now over I thought I'd look at the numbers to see if the attempted panic over "kraken", "arcturus" and all the other names conspiracists are using has had any affect.

Not a sign of trouble, as numbers continue to decline to a current state of ~300 deaths a day worldwide, lower than the numbers dying from hepatitis or being burnt alive.

Won't stop some people panicking, no doubt.

I'll be interested to see where we go with vaccines from here on. I'm picking an annual shot will be recommended and sensible.

 

[marting]

Cytokinopathy with aberrant cytotoxic lymphocytes and profibrotic myeloid response in SARS-CoV-2 mRNA vaccine–associated myocarditis
https://www.science.org/doi/10.1126/sciimmunol.adh3455

Interesting paper in Science. I wasn't previously aware that Myo/Periocardidtis cases were so close to vaccination with most well under a week.

Our clinical cohort consists of 23 patients with vaccine-associated myocarditis and/or pericarditis. The cohort was predominately male (87%) with an average age of 16.9 ± 2.2 years (ranging from 13 to 21 years), in congruence with prior epidemiological reports (24). Patients had largely noncontributory past medical histories and were generally healthy before vaccination. Most patients had symptom onset 1 to 4 days after the second dose of the BNT162b2 mRNA vaccine (Fig. 1A and tables S1 and S2).

Jeez. The following error (0.3% instead of the actual: 0.03%) just jumped out at me. What the hell is going on with their editing/peer review? The following is from their introduction:

A study of vaccine-associated myopericarditis incidence from our own health care network (Yale New Haven Hospital) between January and May 2021 identified eight cases from 24,673 individuals aged 16 to 25 (0.3%) given two doses of mRNA vaccine.

Their data set dates back 2 years. Why did this paper take so long to be published. There is a real need to be doing the longitudinal studies they recommend to solidify the vaccine risk/benefit for male youths to deal with anti-vax bs. Those should have been started almost 2 years ago.

 

[The Atheist]

Jeez. The following error (0.3% instead of the actual: 0.03%) just jumped out at me. What the hell is going on with their editing/peer review? The following is from their introduction:

That's unforgivable. A factor of 10 times - they may as well just hand **** to antivaxers.

 

[marting]

That's unforgivable. A factor of 10 times - they may as well just hand **** to antivaxers.

What bugs me is that presumably everyone reviewing the paper has the background to know that 0.3% is insanely high for something that's diagnosed when presenting at a hospital or emergency room. Maybe the reviewers just skipped over the numbers and went to their area of their specialty in the paper.

At least they provided the numerator and denominator so folks could do their own, 6th grade arithmetic.

 

[dann]

Reality Check

The Atheist is not a big fan of documentation. Not even when he quotes WHO's Director general, Dr Tedros Adhanom Ghebreyesus, does he link to a site with the quotation, and he is even less inclined to present links (or references to any kind of source) when he claims to "look at the numbers".
There is an obvious reason for that:

WHO has removed emergency status and made some very amusing comments about the pandemic, and others to come.

“Lives were lost that should not have been. We must promise ourselves and our children and grandchildren that we will never make those mistakes again.”

Good sense of humour, that man. Not only will we make the same mistakes, next time things will be far worse, because countries will be less likely to react with stringent measures, people will take fewer precautions, and the next virus will probably be more virulent.

With the emergency phase now over I thought I'd look at the numbers to see if the attempted panic over "kraken", "arcturus" and all the other names conspiracists are using has had any affect.

Not a sign of trouble, as numbers continue to decline to a current state of ~300 deaths a day worldwide, lower than the numbers dying from hepatitis or being burnt alive.

Won't stop some people panicking, no doubt.

I'll be interested to see where we go with vaccines from here on. I'm picking an annual shot will be recommended and sensible.

I guess it counts as a kind of progress that The Atheist seems to have finally figured out that it is not a good idea to use road deaths for comparisons in his continuous attempts to downplay the impact of SARS-CoV-2 on human lives and health.
Now he resorts to "being burnt alive," so I guess it's time for another one of those The Atheist Reality Checks that are always necessary when he makes up numbers and predictions:

According to the latest WHO data published in 2020 Fires Deaths in New Zealand reached 17 or 0.06% of total deaths.
NEW ZEALAND: FIRES (WORLDHEALTHRANKINGS*)

How about the NZ death toll from COVID-19, then?
2020: 25
2021: 26
2022: 2,280
2023, so far: 405, and Winther Is Coming ...
2020 and 2021 were the two years when New Zealand achieved ZeroCovid, and even then the death toll from COVID-19 was slightly higher than the death toll from fires.

According to the latest WHO data published in 2020 Hepatitis B Deaths in New Zealand reached 14 or 0.05% of total deaths.
According to the latest WHO data published in 2020 Hepatitis C Deaths in New Zealand reached 30 or 0.11% of total deaths.

Let us see what else WHO's Tedros had to tell us:

Almost 7 million deaths have been reported to WHO, but we know the toll is several times higher – at least 20 million.
(...)
Yesterday, the Emergency Committee met for the 15th time and recommended to me that I declare an end to the public health emergency of international concern.** I have accepted that advice.

It is therefore with great hope that I declare COVID-19 over as a global health emergency.

However, that does not mean COVID-19 is over as a global health threat.

Last week, COVID-19 claimed a life every three minutes – and that’s just the deaths we know about.

As we speak, thousands of people around the world are fighting for their lives in intensive care units. And millions more continue to live with the debilitating effects of post-COVID-19 condition.

This virus is here to stay. It is still killing, and it’s still changing. The risk remains of new variants emerging that cause new surges in cases and deaths.

The worst thing any country could do now is to use this news as a reason to let down its guard, to dismantle the systems it has built, or to send the message to its people that COVID-19 is nothing to worry about.
WHO Director-General's opening remarks at the media briefing – 5 May 2023 (WHO, May 5, 2023)

Sending a message that COVID-19 is nothing to worry about, of course, is exactly what The Atheist has been doing for a very long time already, which makes it obvious who's panicking.

* I don't know how reliable WORLDHEALTHRANKINGS is, but its number for NZ road deaths seems to be correct.


** ETA: I can see one reason to "declare an end to the public health emergency of international concern." A few countries have actually managed to almost put an end to the virus and its damage to health and lives: Singapore and Cuba (there may be more that I am not aware of). And it's not at all a secret how they managed to do it: by taking it seriously and do what was required to fight it.

 

[dann]

... lower than the numbers dying from hepatitis ...

Professor Baker said the global status change made sense at this stage, but it did not impact whether Covid-19 was still a pandemic.
Covid-19 was still New Zealand's number one killer when it came to infectious disease and people should make sure they were vaccinated and take sensible precautions, he said.
WHO Covid-19 status change makes no practical difference to management of cases- Baker (RNZ.co.nz, May 7, 2023)

But maybe hepatitis is not considered to be an infectious disease in New Zealand ...

When I look at the number of COVID-19 deaths in the world and in the USA this year, Jan 1 to May 3, I notice something strange:
World: 6.72 million --> 6.92 million, i.e. approximately 200,000
USA: 1.08 million --> 1.12 million, i.e. approximately 40,000

Population:
World: 7.888 billion
USA: 0.332 billion

In the USA the population has had access to the vaccines, but in many other parts of the world, people haven't, so I don't think that there is reason to assume that disproportionally many more people have died from the virus in the USA than in the rest of the world. As Tedros Adhanom Ghebreyesus put it: "Almost 7 million deaths have been reported to WHO, but we know the toll is several times higher – at least 20 million."

I would say, at the very least.

 

[The Atheist]

The Atheist is not a big fan of documentation.

Yet again, I find it hilarious that you have to resort to falsifying data to try to make my post look incorrect.

I specifically used figures for deaths by fire and and hepatitis for the entire world, and linked to those numbers, which are clearly higher than covid deaths.

Only the most dishonest poster would try to link my post to numbers from NZ.

And yet that's exactly what happened.

 

[dann]

The Atheist's post had no figures, no numbers and no link, and yet I'm the one who is supposed to "resort to falsifying data" and be "the most dishonest poster."
The Atheist really, really hates NZ facts!

 

[dann]

It would be really unfortunate if the moderators deleted the numbers and links in The Atheist's posts when he specifically uses those numbers and also links to them. It would make him look like a liar and a fraud if they did, so I hope that's not the case.

I specifically used figures for deaths by fire and and hepatitis for the entire world, and linked to those numbers, which are clearly higher than covid deaths.

And since The Atheist, for whatever reason, finds it dishonest of me to confront him with New Zealand's numbers, I found some numbers from another country whose statistics are fairly reliable, I think. After all, The Atheist is a Kiwi and I'm not, so maybe he knows something about NZ statistics that I don't.

In 2021, 1,353,500 fires resulted in 3,800 civilian deaths and 14,700 injuries.
Fire-related Fatalities and Injuries (National Safety Council: Injury Facts)

In the same year, there were 464,288 confirmed COVID-19 deaths, i.e. 122 times more C-19 deaths than fire deaths! (This year, so far, it's approximately 50,000 confirmed C-19 deaths, so already 13 times more C-19 deaths in the first four months than the number of fire deaths in all of 2021.)

But those were only the civilian fire-related fatalities. COVID-19 was also more fatal to firefighters than actual fires in 2021:

In addition, there were 70 non-COVID-19 on-duty firefighter deaths and 78 firefighter deaths resulted from COVID-19 in 2021.

Not much more fatal, but still.
If only there was some kind of protective gear that could be issued to firefighters as well as to civilians to prevent them from dying of COVID-19, some kind of personal protective equipment (PPE), preferably something that wouldn't inconvenience them too much in their daily lives when they go shopping, go to a movie theater or have to use the subway.
Maybe some day researchers will come up with something ...

I am not as certain about the numbers for hepatitis deaths, but this is what I have found for 2020:
Hepatitis A: 179
Hepatitis B: 1,752
Hepatitis C: 14,863
I haven't found any numbers for deaths related to hepatitis D & E.

But there was this:

The findings in this report should be interpreted with caution. The number of viral hepatitis cases reported to CDC in 2020 may be lower than in years before the COVID-19 pandemic began. This decrease may be related to fewer people seeking healthcare and being tested for viral hepatitis during the COVID-19 pandemic.
https://www.cdc.gov/hepatitis/statistics/2020surveillance/index.htm

 

[jt512]

Calm the **** down

What bugs me is that presumably everyone reviewing the paper has the background to know that 0.3% is insanely high for something that's diagnosed when presenting at a hospital or emergency room. Maybe the reviewers just skipped over the numbers and went to their area of their specialty in the paper.

At least they provided the numerator and denominator so folks could do their own, 6th grade arithmetic.

Decimal point errors are easy to make and easy for readers or reviewers to overlook, especially when the number, expressed as a percentage, is less than 1. People have trouble interpreting these numbers and would have to think carefully about what 0.3% or 0.03% actually mean. Everybody knows that 3% means 3 per 100, but one has to stop and think that 0.3% means 3 per 1000 and 0.03% means 3 per 10,000.

I recently made the mistake myself, but in the opposite direction, understating something-or-other by a factor of 10 for a conference presentation, but luckily catching the error before publishing the result. No one at the conference questioned the number even though it was implausibly small.