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Omicron anecdata?


Not_a_Number

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WHO is attempting to redefine terminology for pathogens that transmit through the air: getting rid of the old "droplet" vs "airborne" IPAC categories, and replacing them with new terminology based on how infectious particles actually behave, rather than based on particle size.   Also an attempt to standardize terminology across academic disciplines.  This is long overdue.

WHO Global Technical Consultation Report on Proposed Terminology for Pathogens that Transmit Through the Air

CBC News summary, with some context.

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1 hour ago, wathe said:

WHO is attempting to redefine terminology for pathogens that transmit through the air: getting rid of the old "droplet" vs "airborne" IPAC categories, and replacing them with new terminology based on how infectious particles actually behave, rather than based on particle size.   Also an attempt to standardize terminology across academic disciplines.  This is long overdue.

WHO Global Technical Consultation Report on Proposed Terminology for Pathogens that Transmit Through the Air

CBC News summary, with some context.

Hopefully this acknowledgment of spread through the air will lead to enacting air cleaning policies as the recognition of waterborne illness did for water. 

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On 4/4/2024 at 7:12 PM, Mom_to3 said:

^That study might be used by insurance companies to deny payment for Paxlovid...I am already hearing of people being denied repeat Paxlovid for infections that are just a few months apart.

It absolutely will.  

CBC article from today: Who needs Paxlovid now? New guidelines suggest only highest-risk groups should get COVID drug; Recommendations for provincial drug plans feature narrower definition of who should qualify

Source document: CADTH Reimbursement Recommendation

Thought I'm don't think that's a bad thing.  It's a very expensive drug.  If it doesn't work (and the evidence suggests it doesn't for standard risk people), then it isn't a good use of public money to pay for it.  That money could be put to better use elsewhere.  

 

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1 hour ago, wathe said:

Gosh, I find this continued focus simply on acute outcomes to be so frustrating. It matters and people are still dying, but even more, large numbers of people are being left with long term effects up to and including potentially permanent disability. Such that this statement from the article: 

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"The risk of something bad happening to you because of COVID-19 is now very low," Dormuth said.

Sounds patently absurd to anyone who knows the long term risks. Why the continued looking the other way from the long term sequelae?

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Long-term outcome data is harder to evaluate and will take time.  It will come. 

I mean, insurance doesn't generally pay for expensive meds that maybe might work for a particular indication but haven't been  evaluated.  Especially in a publicly-funded system, where costs and adverse-events on a population level can be huge.

In non-pandemic-emergency conditions, I don't think that Paxlovid would ever have been approved in the first place.

I agree wholeheartedly that more research into long-term sequelae is needed.

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9 minutes ago, wathe said:

Long-term outcome data is harder to evaluate and will take time.  It will come. 

I mean, insurance doesn't generally pay for expensive meds that maybe might work for a particular indication but haven't been  evaluated.  Especially in a publicly-funded system, where costs and adverse-events on a population level can be huge.

In non-pandemic-emergency conditions, I don't think that Paxlovid would ever have been approved in the first place.

I agree wholeheartedly that more research into long-term sequelae is needed.

Right. I understand the issues as far as funding for people taking it for long Covid prevention, though I would argue that with the data we have, it would seem reasonable to at least have people who already have long Covid on the list of those eligible. It’s a terrifying prospect for many of those to consider getting reinfected and getting even worse, and the fact that Paxlovid has a number of studies indicating a strong benefit seems to make a good argument to at least allow compassionate use for  that group while waiting for more data.

My frustration in my post was more specifically to the statements that bad outcomes from Covid are rare now and the laser focus only on acute outcomes. While we don’t have treatments for long Covid, we certainly have enough research to say it remains a massive problem. I think it’s super irresponsible for doctors and other health related professionals to make statements to the media that people don’t need to worry about poor outcomes from Covid. 

Edited by KSera
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3 hours ago, wathe said:

EPIC SR review post from First10EM  (EBM FOAM-Ed site)

Thanks for posting. I'm still trying to parse the different possible meanings of the addition of "through day 28" to the primary outcome. I thought maybe it was to eliminate any potential effect from rebound, but then saw they did include rebound. All I can think is it's something to do with separating acute symptom resolution from onset of long covid symptoms, as there is very frequently time period between people feeling like they recovered from covid and when they start having post acute covid symptoms.

I don't know that I agree with his logic about placebo side effects. He says they should be set at 0% in order to not cover up any effects from the intervention, but if 24% of people in the placebo group reported side effects, that makes sense to be the baseline to compare against, because you would expect a similar amount of people in BOTH groups to report various adverse effects that aren't actually due to the drug at all. I don't know why it would be that everything counts in the drug group, but nothing counts in the control group. It's like with vaccine studies--it's entirely relevant to see how many people who received placebo reported adverse events, otherwise a vaccine looks much more dangerous than it is.

I'm glad he at least addressed long covid here, though it sounds like he's unaware that there are multiple studies of paxlovid for long covid being run. Or that several have already been run that found benefit. I'm aware of a couple that found a significant benefit and one that found no difference. Notably, the one that found no difference also found that Paxlovid had a higher incidence of rebound, which I think most agree now is not the case, which calls that study's results into question anyway. I think the jury is still out on that one, but still maintain that there is enough data to at least offer it to those already suffering long covid if they are infected. Metformin had stronger results than Paxlovid for long covid reduction, but that's a harder one to get prescribed for someone who doesn't usually take it.

I also disagree with his conclusion that there's no reason to test to determine if it's covid. I know part of this is a difference with publicly funded medicine. For people who end up with long covid symptoms though (which is a significant number), a documented history of a positive test is often important for receiving treatment. I think he just doesn't think this disease is much different from the flu at this point, and I think that's an emergency medicine bias.

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23 minutes ago, KSera said:

Notably, the one that found no difference also found that Paxlovid had a higher incidence of rebound, which I think most agree now is not the case, which calls that study's results into question anyway.

I was just looking at this more, and besides the fact that this one was based on a survey (and only 1/3 responded, calling selection bias clearly into question), this was an interesting quote from one of the researchers:

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Dursetnfeld said his study looked only at people who were experiencing their first COVID-19 infection, and thus they could not have previously had long COVID. "Paxlovid looks good if you count people in control group who already have long COVID," he explained.

I thought it was interesting that he acknowledges the results are going to look better if people who already have long covid are included. I'm very interested to see the results from the trials testing longer courses of paxlovid in long covid. It's not that I think paxlovid is a wonder drug and everyone should have it, it's just that there's nothing else out there being offered for reducing long covid risk and/or prevention of worsening in those who already have it. When it's the only option in a desperate situation, well, it's the only option.

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1 hour ago, KSera said:

Metformin had stronger results than Paxlovid for long covid reduction, but that's a harder one to get prescribed for someone who doesn't usually take it.

Thanks for sharing this part again. I have heard NOTHiNG about metformin for a long time and have been wondering!

1 hour ago, KSera said:

I also disagree with his conclusion that there's no reason to test to determine if it's covid. I know part of this is a difference with publicly funded medicine. For people who end up with long covid symptoms though (which is a significant number), a documented history of a positive test is often important for receiving treatment. I think he just doesn't think this disease is much different from the flu at this point, and I think that's an emergency medicine bias.

I think this is important—also, if metformin is still a valid option, a positive test would help a person get an Rx from their doctor.

95% of the time, I think he comes to great conclusions with solid thinking. The rest, I feel like he thinks through things well and then jumps off a cliff at the last minute, taking that good thinking with him into the abyss, lol!

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I just got off the phone with Accel Research. (I have a profile with them for studies) I have been recruited for a clinical trial for a new combined flu/Covid vaccine. It is Pfizer. It will be 3-4 visits. I think it is this one...

https://classic.clinicaltrials.gov/ct2/show/NCT06237049

I am not too hesitant ((if)) it is this trial because both vaccines are already licensed??? Anything I should know from anyone who has experience with such things? She did say that my autoimmune dx might exclude me. Sjogren's is specifically listed as an exclusion, so... It is up to the medical team at my location, I think. That is my only concern for my own safety. Should I do it? The lady on the phone couldn't tell me anything about what to expect except the first appt is 2.5 hours long. 

The last time I was considered for a Sjogren's Study, I was sent a lot of detailed information about what the study entailed. I'm hoping I will receive something similar for this. I ended up declining the other study. 

Edited by popmom
typo
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We're heading into winter term now so I am going to get my (now annual) Covid vax. I had Pfizer up until last time when I had Spikevax (makes me think of vampires). What is the most recent recommendations? I haven't reacted badly to either Pfizer or Moderna. I don't know if we can get Novavax - the local chemist does stock it but I've heard that you have to have a reason. 

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Not Covid related, but just read a warning about measles in my area.  I live in small town and we now have reported measles cases very close.   I am feeling all the feels right now.  Like come on, why is this even happening???  I know why though and it just upsets me.    Totally swearing right now too.

 

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5 hours ago, bookbard said:

We're heading into winter term now so I am going to get my (now annual) Covid vax. I had Pfizer up until last time when I had Spikevax (makes me think of vampires). What is the most recent recommendations? I haven't reacted badly to either Pfizer or Moderna. I don't know if we can get Novavax - the local chemist does stock it but I've heard that you have to have a reason. 

If you can manage to get a Novavax, that’s what’s I’d do. Have you had much in the way of side effects with the Pfizer or Moderna? If so, that might be a reason you could give. Far and away, most people I know who had an unpleasant time with previous shots had little to no reaction after getting Novavax (including myself). It has also shown longer durability than the others. 

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18 hours ago, KSera said:

If you can manage to get a Novavax, that’s what’s I’d do. Have you had much in the way of side effects with the Pfizer or Moderna? If so, that might be a reason you could give. Far and away, most people I know who had an unpleasant time with previous shots had little to no reaction after getting Novavax (including myself). It has also shown longer durability than the others. 

Just found out that you can't get Novavax in Australia at the moment. The previous lot expired and the new XBB hasn't been approved. So I guess I'll just go with Moderna.

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5 hours ago, bookbard said:

Just found out that you can't get Novavax in Australia at the moment. The previous lot expired and the new XBB hasn't been approved. So I guess I'll just go with Moderna.

That’s what I would do too in that case. When Pfizer and Moderna are the only choices, I pick Moderna except for teen to young adult boys who get Pfizer. 

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My MIL was sick a few weeks ago and tested negative for Covid, but had many of the symptoms of the variant that seems to be going around (she was tested around day 6 of symptoms).  

She was just taken to the hospital last night with stroke symptoms - mostly aphasia.  They did all kinds of testing on her and her troponin levels were high, continued to rise, and now have started to drop.  I haven't had time yet to see if there's a connection between Covid and troponin, plus she did test negative but it seems like quite a coincidence.  

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^My 90+ aunt eventually tested positive at the hospital around the same time she was diagnosed with early heart failure. Had tested negative beforehand while symptomatic (I don't know which tests were used when). Obviously, she could have caught covid during one of the doctor visits to deal with her respiratory symptoms (so on top of an earlier cold).. Either way it's not great news.

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I got a slightly alarming voicemail from the CDC encouraging me to call back today.  Called back to find out it was a survey about covid and other respiratory virus vaccines and attitudes towards covid and towards vaccination.  Glad they're doing it!

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One of the studies that was mentioned in passing in Eric Topol's interview with Akiko Iwasaki was a study on the use of probiotics to improve symptoms of long covid (PACS). A pilot study found that probiotics "improved gut dysbiosis, hastened antibody formation, and decreased nasopharyngeal viral load and plasma pro-inflammatory immune markers" in hospitalized patients during acute covid infection, and their follow-up study on patients with PACS found that the same probiotics significantly improved fatigue, memory loss, difficulty concentrating, gastrointestinal symptoms, and general feelings of wellness, compared to a placebo.

The specific pro- and prebiotics they used were "a micro-encapsulated lyophilised powder containing 20 billion colony-forming units of three bacterial strains, Bifidobacterium adolescentis, Bifidobacterium bifidum, and Bifidobacterium longum with three prebiotic compounds including galacto-oligosaccharides, xylo-oligosaccharides, and resistant dextrin."

At 6 months, "faecal microbiota showed a higher richness and distinct composition in the SIM01 group compared with the placebo group," including an "abundance of beneficial bacteria and [suppression] of pathogenic bacteria associated with PACS, such as those of the Klebsiella genus" as well as "enrichment of several pathways involved in short-chain fatty acid production."

Source: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00685-0/fulltext

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3 hours ago, Corraleno said:

One of the studies that was mentioned in passing in Eric Topol's interview with Akiko Iwasaki was a study on the use of probiotics to improve symptoms of long covid (PACS).

That's exciting - I'm really hopeful about some of this research on probiotics and hope it becomes easier to access via doctors and pharmacies rather than just having to look on the internet and hope the company is not lying about what they're selling. For example, there was a study showing a big reduction in motor symptoms in Parkinson's after a certain probiotic. I am forwarding on stuff like that to my brother, but tracking the right stuff and dosage down from a study isn't easy. And as someone who is obese, I'm also seeing research on probiotics and would love it to become part of mainstream medicine. 

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Posted (edited)
1 hour ago, bookbard said:

That's exciting - I'm really hopeful about some of this research on probiotics and hope it becomes easier to access via doctors and pharmacies rather than just having to look on the internet and hope the company is not lying about what they're selling. For example, there was a study showing a big reduction in motor symptoms in Parkinson's after a certain probiotic. I am forwarding on stuff like that to my brother, but tracking the right stuff and dosage down from a study isn't easy. And as someone who is obese, I'm also seeing research on probiotics and would love it to become part of mainstream medicine. 

Was is L Plantarum PS128? I am taking it, and I think I will take it for the rest of my life. It is mainly promoted (and has been studied for) Parkinson's and autism. I didn't want to offer it to my autistic dd without trying it myself, and I was really surprised at how much it helped me. I have ADHD-inattentive type. But it helped with some other quirky neuro stuff I deal with, too. 

 

Edited by popmom
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7 minutes ago, popmom said:

Was is L Plantarum PS128? I am taking it, and I think I will take it for the rest of my life. It is mainly promoted (and has been studied for) Parkinson's and autism. I didn't want to offer it to my autistic dd without trying it myself, and I was really surprised at how much it helped me. I have ADHD-inattentive type. But it helped with some other quirky neuro stuff I deal with.

Do you have a link for that?

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Posted (edited)
2 hours ago, mommyoffive said:

Do you have a link for that?

Neuralli

It's crazy expensive, but me, my husband, and one of my daughters are taking it with results that make it worth it to us. We will do without other stuff. 🙂

eta: I have recently discovered that the less expensive "Mood" with half the amount of PS128 works just as well for me as the "medical". I think it's probably best to start with the medical tho.

Edited by popmom
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Astra Zeneca vaccine is being withdrawn due to the thrombosis. I’m feeling extra cranky because all the antivaxxers are coming out with the truth had to come out eventually, now the rest, etc etc.  but this was a known rare side effect from almost the beginning - it’s not like they’ve only just realised. It’s just that we now have plenty of safer alternatives.  Of course I do think more openness about the issues with AZ upfront would have been good. Handling of the Covid vaccine rollout has done so much damage to public trust in vaccinations in general 😞 

 

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1 hour ago, Ausmumof3 said:

Handling of the Covid vaccine rollout has done so much damage to public trust in vaccinations in general 😞 

I agree - and it's still being badly handled. There's a massive push for people to get flu shots and yet nothing about Covid. People are still dying every day in Australia from Covid. 

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1 hour ago, TexasProud said:

Can you explain this.  i am not sure what she meant by this.  

My take, based on having read similar elsewhere, is that it is anxiety provoking to see first hand what Covid is doing to people’s brains and bodies. Covid causes some pretty concerning changes in the brain, even after just mild infections, so I take it the tech was seeing that and it freaked him out.

The long Covid part I take as meaning that long Covid patients know very well already how badly it affected their bodies, and most of them also had only mild infections, and it’s pretty darn freaky to see most people living life as if this isn’t happening and would never happen to them.


 

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