Omicron anecdata?

[Terabith]

A friend of mine finally tested negative after testing postive on rapids for TWENTY days.  She is not, to her knowledge, immune compromised, on any immune suppressing drugs, nor was she particularly ill (more like bad cold symptoms than anything).  She only knew she was infectious for so long because she kept testing.  

[KSera]

41 minutes ago, bookbard said:

Just being reported now that the current covid wave in Australia is higher than during the height of winter. I assume it's the new variant. My son's going to a sports day camp next week . . . 

Has this happened with any of the other variants, where the Australia wave has lined up with the US wave? I feel like they have usually been staggered, but I’m not sure. It’s interesting for sure, and I’d think driven more by holiday behavior than anything else. Have your past Christmas/New year seasons not been as high Illness as your midwinter wave? 

16 minutes ago, Terabith said:

A friend of mine finally tested negative after testing postive on rapids for TWENTY days.  She is not, to her knowledge, immune compromised, on any immune suppressing drugs, nor was she particularly ill (more like bad cold symptoms than anything).  She only knew she was infectious for so long because she kept testing.  

I hope she recovers fully with no lasting effects 🤞. 

[bookbard]

4 hours ago, KSera said:

Has this happened with any of the other variants, where the Australia wave has lined up with the US wave? I feel like they have usually been staggered, but I’m not sure. It’s interesting for sure, and I’d think driven more by holiday behavior than anything else. Have your past Christmas/New year seasons not been as high Illness as your midwinter wave? 

5 hours ago, Terabith said:

We seem to be getting a summer wave and a winter wave since December 2021, when all the protections were removed. I think it's because we get the new variants from Europe and America as there's a lot of travel happening at that time, and of course because Christmas/New Year involves a lot of parties. 

[bookbard]

Oh and apparently covid is showing a preference for the wetter time of the year, which for the last few years has been summer in Australia. We've had flood after flood since December. 

[mommyoffive]

https://yourlocalepidemiologist.substack.com/p/covid-19-research-roundup-jan-11?utm_source=post-email-title&publication_id=281219&post_id=140522284&utm_campaign=email-post-title&isFreemail=true&r=q2z70&utm_medium=email

[Mrs Tiggywinkle Again]

The hospital system I work for went back to mandatory masking for employees working in patient areas…but not mandatory masking for patients or visitors. Patients I sort of understand, because every admission gets tested for Covid, but it still makes no sense not to require visitors to mask.

They also said in the memo that the variant they are seeing locally is JN.1 and has an increased ability to evade the immune system as well as increased transmission abilities in comparison to variants seen over the last year. So yay. 
Also so much RSV.  Seeing so very many very very sick babies and toddlers. And back to no available inpatient beds anywhere.

Edited January 11 by Mrs Tiggywinkle Again

[KSera]

1 hour ago, Mrs Tiggywinkle Again said:

it still makes no sense not to require visitors to mask.

I agree. I’m glad they’re requiring it for staff, but I’d be upset and frustrated if my elderly family member were exposed in hospital by someone else’s unmasked visitor. Maybe people need to remember that the other option is not being allowed to visit at all. Perhaps wearing a mask for a visit won’t seem like such a burden then. Mask or don’t visit. 

[popmom]

5 hours ago, mommyoffive said:

https://yourlocalepidemiologist.substack.com/p/covid-19-research-roundup-jan-11?utm_source=post-email-title&publication_id=281219&post_id=140522284&utm_campaign=email-post-title&isFreemail=true&r=q2z70&utm_medium=email

This is exactly the info I have been looking for—thanks!

[bookbard]

I posted in December I think about my friend who had Covid for the 4th time. Her whole family now has Covid for the 5th time. 

So many people locally have had Covid over the Christmas/NY period. They aren't really encouraging boosters for anyone under 65 any more, so very few people have had them. 

[mommyoffive]

https://thosenerdygirls2.substack.com/p/is-covid-19-surging?utm_source=post-email-title&publication_id=2045987&post_id=140654802&utm_campaign=email-post-title&isFreemail=true&r=q2z70&utm_medium=email

[mommyoffive]

https://insidemedicine.substack.com/p/one-question-frontline-doctors-cant?utm_source=post-email-title&publication_id=1183526&post_id=137530164&utm_campaign=email-post-title&isFreemail=false&r=q2z70&utm_medium=email

[kbutton]

1 hour ago, mommyoffive said:

https://insidemedicine.substack.com/p/one-question-frontline-doctors-cant?utm_source=post-email-title&publication_id=1183526&post_id=137530164&utm_campaign=email-post-title&isFreemail=false&r=q2z70&utm_medium=email

This is a paid one only—can you share the gist of the article?

[KSera]

1 hour ago, mommyoffive said:

https://insidemedicine.substack.com/p/one-question-frontline-doctors-cant?utm_source=post-email-title&publication_id=1183526&post_id=137530164&utm_campaign=email-post-title&isFreemail=false&r=q2z70&utm_medium=email

I was really interested to hear where he was headed with this, but hit a paywall after the intro!

[mommyoffive]

5 minutes ago, kbutton said:

This is a paid one only—can you share the gist of the article?

Odd.  I don't have a paid one and I can read it.

[mommyoffive]

View in browser     One question frontline doctors can’t answer. JEREMY FAUST, MD JAN 14   ∙   PAID     READ IN APP   Recently, a non-medical colleague I respect asked me a question about the latest wave of Covid-19. What was I seeing, they wanted to know. Any sign that this new variant is worse than past ones? I thought about it. Poked around. Asked a few people I knew who were infected how they were doing. I went to the ER and worked a shift. I gave my answer. The bigger question, though, is can clinicians ever really tell what is going on? Or are we just as prone to delusion-by-anecdote as those with less scientific minds? I’ve been thinking about this for a while, running a number of scenarios. My conclusions might surprise you—as they surprised me. What did I tell my colleague? And what does any of this have to do with the Boeing 737 Max? First, I told my colleague that from what I can determine, there is no discernible difference between this latest Covid-19 variant and recent ones, in terms of severity. But the question merited a longer discussion. Can clinicians reliably answer questions like, “What are you seeing in the hospital?” Even if I qualify my opinion with disclaimers, no matter what I say, some people will take my answer without the “grain of salt” I insisted upon. They’ll take it as “the incontrovertible truth from the frontlines.” But what if my experience is too dependent on randomness? Uncertainty loves company. One defense against this is to check whether my own anecdotal experiences match those of my colleagues. If we’re all seeing the same thing, I reason, I’ll give my own observations more credence. But there's also the risk of groupthink and the power of suggestion. I recently conducted an informal poll online where I instructed people to stay absolutely still for 10 seconds. I asked how many noticed their fingers tingling during those 10 seconds. Many did. Most hadn’t noticed that before. That sense of tingling—noticeable only when attending to it—is almost universally meaningless. Imagine though, if I told you (falsely) that this was a sign of  some environmental toxin. Panic! Math is better. Assuming I’m going it alone (i.e., not asking colleagues what they are seeing), the real answer to the “should I answer this question” debate lies in math and epidemiology. Yay. My favorite. Whether I should answer the question hinges on: The effect (cases, case severity, rate of hospitalization, death, etc.). How the effect is measured. Are all hospitalized cases being detected, as they were for 2020-2022? How does one define “severity”? But the most important variables involve epidemiology: The baseline rate of events. How large the change is. Analysis #1. Death. It’s pretty hard for most clinicians to know whether death rates are up in their hospital without seeing internal data. Take Massachusetts General Hospital, the hospital with the most deaths per year in this state (due to its size and the complexity of cases its world-renowned experts attract). Typical week: 30 deaths. This week: 39 (30% increase). Context: A 30% increase in all-cause mortality is very large. Outside of some Covid waves, it never happens on a state level. If a patient dies anywhere on the premises, a “Code Blue” is called on the hospital-wide overhead PA system (unless that person is on hospice, in which case they die in peace without CPR). So, it’s possible that an ER doctor like me might notice a massive increase in Code Blues. But even a 30% increase really shouldn’t register. Assuming I work 36 clinical hours per week, it would be hard to notice a  difference between a typical week and this bad one. Would I really notice whether there’s a code every 5.6 hours instead of one every 4.3 hours? It could take several 8-10 hour ER shifts before I would even suspect something was up. And due to randomness, I could hear 2 or 3 codes one day, and 0 the next. Long story short: outside of extreme circumstances, it’s hard for hospital clinicians to reliably detect even large increases in all-cause mortality, let alone from a single cause. Now, early Covid-19 was an exception. When mortality more than doubled in April of 2020 in Massachusetts, suddenly there would be more than 3 codes during an average shift, as opposed to the usual 0, 1, or maybe 2. In some New York hospitals, things were worse—with 6 times the mortality compared to usual, at the peak. Only in extreme circumstances, then, can doctors be sure that their anecdotal experience is meaningful with respect to changes in mortality rates.

Edited January 14 by mommyoffive

[mommyoffive]

Analysis #2: Hospitalization.

Can we really tell if Covid hospitalizations are up? Early in the pandemic, it was easy. Rates were off-the-charts high—with hospitalization rates exceeding 15% of infections in older people—while all other kinds of non-Covid emergencies decreased if not vanished. During the transition from Delta to Omicron it was also fairly easy to tell something was going on. The prevalence of Covid-related hospitalizations jumped 750% from early November to the peak in early January. Hospitals were full, and with far sicker patients than usual. Yes, we could reliably see a difference.

Putting numbers to this, in early December of 2021 (late Delta), around 35 patients per week were hospitalized at Mass General with Covid-19. A month later, during the peak of early Omicron, that number had swelled to 135 patients per week. That means that in December, an ER doctor working 36 hours per week would have seen around 21% of the patients (she’s there for 36 of the week’s 168 hours), translating to two patients hospitalized for Covid during each shift (assuming she either took care of all the Covid patients, or was aware of all cases in the department) By January, though, that same

doctor would have seen 7 or 8 Covid-19 patients per shift. That’s noticeable and on a scale that was meaningful. But it was also extreme. More recent peaks have been far smaller, than the one in January of 2022. So, it’s hard for frontline doctors to give you a reliable answer on this most of the time—even now. What about when rare (or non-existent) diseases suddenly appear, but aren’t as prevalent as Covid? Mpox is a perfect example. There have been 472 Mpox cases in Massachusetts since the outbreak of 2023. There are over 600 infectious diseases doctors in this state (with around half working in a magnet hospital where the cases are likely referred by primary care). So maybe each ID doctor would expect to see a case or two, on average. It’s also important to remember that a few specialists received many Mpox referrals, while everyone else saw 0 or perhaps 1 case. What everyone might have noticed, though, were emails from hospital or practice leadership discussing cases that came through, reminders on the test and treatment algorithms, and general policies. But that is not the same as seeing cases. That’s essentially hearsay. What about ER doctors like me? There are around 1,900 ER doctors in Massachusetts. Even if every case were diagnosed in an ER (which is untrue), on average 1 in 4 ER doctors would’ve seen a single case. Assuming even distribution, you could’ve asked 4 ER doctors whether Mpox was “really a big deal” and 3 of them would have never diagnosed a case. And yet, on a population level (specifically within high-risk behavior groups), the virus seemed to be everywhere. In fact, you might recall that I personally diagnosed two cases out of the 474 cases statewide! How? Because I was convinced (long before it was widely accepted) that patients did not need to have a rash to spread the disease, nor have classic symptoms to warrant testing. So, I pushed for tests when others may not have (I believe I tested three people; two were positive). One of my Mpox patients had no rash. The other did, but it wasn’t “classic” Mpox. If you’d asked me, “What is going on with Mpox,” during the outbreak, my answer would have been, “It’s far more common in high-risk behavior groups than anyone realizes. But it’s still rare for everyone else.” Analysis #3: Case severity. Case severity trends are very hard for frontline doctors to assess. First, everyone’s definition of severe is different and doctors tend to ignore official criteria when answering these questions. Second, if you combine rates and a distribution of severity into one analysis, the numbers we each see become too small for drawing reliable conclusions. Back to Covid as an example. Let’s say during a bad wave that I see 10 patients per shift with Covid-19. The distribution of severity for all cases might look like the green line. But let's say, by chance, the 10 cases shown as red stars show up. Image: Jeremy Samuel Faust and ChatGPT. Imagine five doctors see 2 of these cases each. One doctor would see the extremely severe case. Even if the other case that this particular doctor saw was moderate or mild, how might he answer if asked how severe this disease is? Another doctor who saw one mild and one moderate case would give a very different answer. The point is that when our sample size is too low, it’s easy to be mislead. This is especially true in hospitals, where mild cases are less likely. Now imagine that, by chance, 2 out of 10 cases turn out to be extremely severe. (Unlikely given the green line, but it could happen!) Image: Jeremy Samuel Faust and ChatGPT Depending on the roll of the dice, a doctor might see zero or both terrible cases. Whether he does will drastically influence his assessment of current disease severity. Even if 10 doctors see 3 cases of Covid per day, around half would not see an extremely severe cases on a particular day. Does that mean the disease is not severe in the patient population? No. And if they saw 10 cases of Covid per day, they might notice a difference. But again, it would depend on chance. It would take dozens of cases to really sort this out—and then doctors would have to remember what things were like before. Not easy. Another problem is that doctors are not comfortable telling you how many patients they have seen with a particular condition. In some instances, we over-estimate, because we might be aware of (or even involved in) severe cases that we were not directly caring for. (We try to help each other in tough cases.) The asymmetry of anecdote. As I’ve written before, anecdotal evidence is asymmetric. If I see zero cases of a new and dangerous disease, that could be meaningful or meaningless depending on how common the disease is. If this disease supposedly affects 1 in 10,000 people in Boston, and I see 30 random ER patients in a given shift, I’m unlikely to see a case. My failure to see a case hardly means the problem isn’t real? But if I see 3 cases of what is supposed to be a rare disease in one shift, I should be worried. Not enough to conclude that something terrible is certainly happening, but enough to be concerned. This is what I experienced when I saw my first 3 Covid cases in one night in March of 2020, and I wasn’t even allowed to test them all—they hadn’t traveled to Asia (I knew by then that didn’t matter). My level of concern for Covid skyrocketed: the disease was probably more common than anyone realized and we had nowhere near enough tests. That night changed my life. What does this all have to do with the Boeing 737 MAX? In October 2018, one of Boeing’s new 737 MAX 8 planes crashed in Indonesia, killing everyone on board. I remember being surprised but thinking it could just be bad luck (it was early in the plane’s rollout, and the 737 had a great safety record overall). When another 737 MAX 8 crashed in March of 2019, again killing everyone on board, I knew we had to assume that there was a gigantic and systemic problem. This is not because I’m an expert on planes. This is because I am an expert on risk assessment. So, I looked up the numbers. Data show that the commercial aviation industry loses around one jet plane to a catastrophic accident around every 6.5 million flights or so. When the first crash happened, the MAX had flown around 260,000 times (I’m estimating based on some published numbers; if I am wrong, someone tell me.) Given that, the odds of a catastrophic loss happening this soon were around 3.8%. Put another way, if Boeing rolled out 26 entirely new categories of plane like the MAX, one of them would have an accident this soon, just on bad luck alone. So, while alarming, the crash was not a statistical impossibility. By the time the 2nd crash happened, around 400,000 MAX flights had been completed. The odds of two crashes occurring in the first 400,000 flights was far far lower—0.18%. If Boeing rolled out 561 entirely new categories of plane, only one would be statistically “expected” to have two crashes that soon based on bad luck alone. Here’s a stat: out of the 387 new 737 MAX jets that had been delivered to commercial operators by March 2019, two had already been destroyed after plunging into the Earth. This was a statistical bombshell. Based on the second anecdote—two fatal crashes in such a short time—the 737 MAX was grounded worldwide. The underlying problem was quickly identified and fixed. There hasn’t been a fatal incident since (including the window accident on Alaska Airlines earlier this month.) Conclusion: When you ask doctors about what they’re seeing on the ground, think about how common the condition is and how many cases the doctor is likely to have seen themselves (and therefore, how prone to randomness their views are). Also think about what outcome you’re asking about. Sudden changes in disease severity and death rates may be hard to notice, while sudden fluxes in hospitalization rates may be more reliable (albeit, as we are seeing with Covid, it can depend on whether universal testing is in place). Also, be aware that we doctors are apt to conflate our personal clinical experience with what we’re seeing in our emails and hearing from our colleagues. Still, anecdotes can be meaningful. The problem is that by the time we have the data to confirm anecdotes early in a crisis, things might have already spiraled out of control.

[kbutton]

https://www.chop.edu/news/chop-researchers-find-elevated-biomarker-related-blood-vessel-damage-all-children-sars-cov-2?fbclid=IwAR0Oe31B6IUcidoNiDXXcszjZqL1m2DmcKJqOvgChQYzSnVUDpvDh2kSBgY_aem_AVuHb6TAFyXZAvlp6Dfw1pT5uDBgtnt20QFT8ayWR3GKInLHlNg_S_ffU35Eey23wkU
 

complement activation in kids with Covid regardless of severity

Edited January 14 by kbutton
Spelling

[KSera]

23 minutes ago, kbutton said:

complement activation in kids with Covid regardless of severity

That’s a concerning finding. It continues to blow my mind the potential implications of passing this new disease off as no longer a concern and letting kids be infected over again while we are clearly still at the beginning of having any idea the long term implications of this. 

[mommyoffive]

https://caitlinrivers.substack.com/p/outbreak-outlook-national-january?utm_source=post-email-title&publication_id=1017072&post_id=140518737&utm_campaign=email-post-title&isFreemail=true&r=q2z70&utm_medium=email

[mommyoffive]

https://longcovidweekly.substack.com/p/long-covid-weekly-76-long-covid-senate?utm_source=post-email-title&publication_id=999185&post_id=140681076&utm_campaign=email-post-title&isFreemail=true&r=q2z70&utm_medium=email

[wathe]

Paxlovid evidence: still very little reason to prescribe

A summary and analysis of the current state of the evidence, by one of my favourite Canadian emergency medicine EBM people.

[mommyoffive]

https://insidemedicine.substack.com/p/data-snapshot-covid-19-hospitalizations?utm_source=post-email-title&publication_id=1183526&post_id=140722200&utm_campaign=email-post-title&isFreemail=false&r=q2z70&utm_medium=email

[mommyoffive]

https://thosenerdygirls.substack.com/p/a-lot-more-americans-are-dying-of?utm_source=post-email-title&publication_id=366170&post_id=140718090&utm_campaign=email-post-title&isFreemail=true&r=q2z70&utm_medium=email

[mommyoffive]

https://yourlocalepidemiologist.substack.com/p/measles-trends-and-collective-amnesia?utm_source=post-email-title&publication_id=281219&post_id=140623814&utm_campaign=email-post-title&isFreemail=true&r=q2z70&utm_medium=email

[Terabith]

Not covid but I have the flu. I was vaccinated, but I still can’t remember the last time I felt this sick.  

[KSera]

1 hour ago, Terabith said:

Not covid but I have the flu. I was vaccinated, but I still can’t remember the last time I felt this sick.  

Oh gosh, I’m sorry! Hopefully this is the last one for you for a long time. I hope you feel better soon!

[mommyoffive]

https://yourlocalepidemiologist.substack.com/p/long-covid-research-roundup?utm_source=post-email-title&publication_id=281219&post_id=140782384&utm_campaign=email-post-title&isFreemail=true&r=q2z70&utm_medium=email

[knitgrl]

On 1/15/2024 at 12:51 PM, wathe said:

Paxlovid evidence: still very little reason to prescribe

A summary and analysis of the current state of the evidence, by one of my favourite Canadian emergency medicine EBM people.

I had Covid once before I was diagnosed with cancer. It gave me a horrible, very distinct Covid headache. After starting cancer treatments, I have had Covid twice, and both times have been very grateful for Paxlovid, which at least stopped the Covid headache, if it did nothing else. I understand that it might not be for everybody, but it dropped my misery level from about a 10 to maybe a 6 or 7. For me, it is totally worth it.

[bookbard]

Ugh, so annoyed. My sister's boyfriend refused to wear a mask on the plane - he's now given her covid which, not only has made her very sick, but she'll have to put off a very important specialist appointment. She tried to isolate, but he became extremely ill and so she had to care for him. It's just so frustrating. 

[Rosie_0801]

42 minutes ago, bookbard said:

Ugh, so annoyed. My sister's boyfriend refused to wear a mask on the plane - he's now given her covid which, not only has made her very sick, but she'll have to put off a very important specialist appointment. She tried to isolate, but he became extremely ill and so she had to care for him. It's just so frustrating. 

I hope she dumps the disrespectful sod.

[KSera]

4 hours ago, mommyoffive said:

https://yourlocalepidemiologist.substack.com/p/long-covid-research-roundup?utm_source=post-email-title&publication_id=281219&post_id=140782384&utm_campaign=email-post-title&isFreemail=true&r=q2z70&utm_medium=email

Mixed feelings on her long covid update. I won't give all my thoughts, but one is her take on the risk of long covid with repeat infections. First, though the risk of long covid is higher with severe infections, there are so many more mild infections that most cases are occurring in people who had mild acute cases. Also, if someone already has long covid after their first infection, they don't get counted again when they get a repeat infection and continue to have long covid. Trying to think what bias that is--it's a similar idea to survivorship, but not quite that since we're not talking deaths. How people phrase this also makes a difference in how people interpret it. People like to hear their risk of long covid is less with each subsequent infection, but equally true is that their risk of long covid increases with each covid infection they have, because that risk is additive and adds on each time (if it's 7% after the first infection and 4% for a second infection, and 3% for a third infection, that means two infections is an 11% risk and three is a 14% risk). People need to know and hear that.

Today was a big day for long covid in that the senate had their HELP committee hearing on Long Covid. It was well attended and we will see what it does for funding. Stark difference in masking behavior on the part of the patients and long covid doctors in attendance vs the senators.

 

[Ausmumof3]

https://www.abc.net.au/news/2024-01-19/vaccination-campaign-as-11-polio-cases-detected-indonesia/103367914
 

Polio outbreak in Indonesia. Definitely concerning, both for Indonesia and for many Australians who travel there for family holidays, hopefully it encourages people to keep up to date with vaccines before travelling.

 

Edited January 19 by Ausmumof3

[mommyoffive]

14 hours ago, bookbard said:

Ugh, so annoyed. My sister's boyfriend refused to wear a mask on the plane - he's now given her covid which, not only has made her very sick, but she'll have to put off a very important specialist appointment. She tried to isolate, but he became extremely ill and so she had to care for him. It's just so frustrating. 

I am so sorry, your poor sister.  I hope she feels better soon.

[Paige]

On 1/15/2024 at 12:51 PM, wathe said:

Paxlovid evidence: still very little reason to prescribe

A summary and analysis of the current state of the evidence, by one of my favourite Canadian emergency medicine EBM people.

Anectdotal, but I received paxlovid and it made my symptoms literally go from feeling miserable to no symptoms overnight. My family members who didn't qualify were actually sick with symptoms for days, sometimes weeks,  while I had no symptoms except for the few hours of sickness I felt before getting pax. 

[wathe]

Re personal anecdotes from individuals who believe that paxlovid worked for them:  It's not actually possible to know.

The trouble with illnesses that are generally self-limited (like acute mild covid illness), is that the acute symptoms were going to go away on their own anyway;  for most mild acute covid cases, it's a matter of when, not if.  For any individual, it's impossible to know if symptoms went away when they did because of the paxlovid, or if they were going resolve on their own at that time anyway.    

We really, really need prospective, properly blinded  RTC to establish efficacy.

The trial has been done (EPIC-SR).  Symptom alleviation was a primary end-point.  It did not achieve statistical significance (the paxlovid didn't work to alleviate symptoms).   Unfortunately, the trial outcome has been "published" by press release only.  The trial has not been formally published or peer-reviewed.   It was funded and run by the drug manufacturer --- who has $$$$$$$ to lose by publishing a negative trial.   Maintaining a state of uncertainty for as long as possible is good for their bottom line.

 This is a serious problem: this data is incredibly important, important on a population level, important enough to society that it should be a public good, yet it is being hidden by a drug company who stands to gain by hiding it, because that's just the way the scientific publishing and drug company research works in our system.   IME, it's akin to fraud (Pfizer is promoting and selling a drug that I strongly suspect they know doesn't work), but it's business-as-usual.   

It't all very reminiscent of tamiflu.  My prediction:  Independent research will eventually establish lack of efficacy (or maybe I will be surprised and they will demonstrate efficacy, but I highly doubt it).  There will be investigations.  Pressure will mount, and the EPIC-SR trial data will come out eventually -- perhaps it will require legal action to make it happen.  Governments who spent $$$$$ on this drug (like mine) will seek damages.   It won't matter, because it will all be tiny drop in the bucket compared to profits made.  And the cycle will repeat.

Disclaimers:

1) I am talking about acute covid illness here.  Long covid is a whole different discussion.  For which the data pool is even worse.

2) EPIC-HR did show efficacy in preventing covid-associated hospitalization and death in patients who were high-risk and unimmunized and covid-naive (with lots of methodological tricks to favour a postive outcome, I might add).  That population essentially doesn't exist anymore.  EPIC-SR is the study we need to see published, because it the population it studied matches the population for which we prescribe paxlovid.  

 

[KSera]

17 minutes ago, wathe said:

It't all very reminiscent of tamiflu.  My prediction:  Independent research will eventually establish lack of efficacy (or maybe I will be surprised and they will demonstrate efficacy, but I highly doubt it).  There will be investigations.  Pressure will mount, and the EPIC-SR trial data will come out eventually -- perhaps it will require legal action to make it happen.  Governments who spent $$$$$ on this drug (like mine) will seek damages.   It won't matter, because it will all be tiny drop in the bucket compared to profits made.  And the cycle will repeat.

Yet Tamiflu is still recommended in the US as a reason to get tested for flu so that you can get treatment right away. Is it that way in Canada? The Tamiflu thing is one of the things that undermined my trust in medical reommendations.

Paxlovid seems like something that should be pretty easy at this point for us to get good data on. I hear a lot of anecdotes as well, particularly people who feel it helped their symptoms quickly. My own family member who took it didn't seem to improve any quicker than I expect they would have anyway (started improving about 48 hours after starting it, but still sick for many days after that and tested positive for about 12 days). I was quite disappointed with the most recent study indicating it didn't actually reduce risk of long covid, but a lot of people (me included) want to see if a longer course changes that, as if it's addressing viral persistence in a subset of long covid sufferers, it's widely thought it takes more than a 5 day course to clear that. There are some trials of longer courses to see if it can clear long covid in some people.

[mommyoffive]

https://erictopol.substack.com/p/lighting-up-long-covid?utm_source=post-email-title&publication_id=587835&post_id=140823975&utm_campaign=email-post-title&isFreemail=true&r=q2z70&utm_medium=email

[Ausmumof3]

https://www.abc.net.au/news/2024-01-21/covid-safe-strategies-australian-scientists-virus-infection/103335466?utm_campaign=abc_news_web&utm_content=link&utm_medium=content_shared&utm_source=abc_news_web
 

None of this is new, but definitely the most detailed take I’ve seen on mainstream news here.

[popmom]

25 minutes ago, Ausmumof3 said:

https://www.abc.net.au/news/2024-01-21/covid-safe-strategies-australian-scientists-virus-infection/103335466?utm_campaign=abc_news_web&utm_content=link&utm_medium=content_shared&utm_source=abc_news_web
 

None of this is new, but definitely the most detailed take I’ve seen on mainstream news here.

That was very helpful—thank you!

[Mom_to3]

Try to read the entire thread, starting with Jha's first post. 

 

[KSera]

58 minutes ago, Mom_to3 said:

Try to read the entire thread, starting with Jha's first post. 

 

Are you able to share more? I don’t have an X account (and won’t) and it no longer lets me see anything but the first post on a thread. I want to know what Jha is saying on this though (he’s been a disappointment for me through the latter part of this pandemic—he used to be a solid voice I followed, but he switched to saying what people want to hear when he took the White House job). 

[Amoret]

You can see it via Nitter here (you don't need a log-in)

5 minutes ago, KSera said:

Are you able to share more? I don’t have an X account (and won’t) and it no longer lets me see anything but the first post on a thread.

[KSera]

39 minutes ago, Amoret said:

You can see it via Nitter here (you don't need a log-in)

I forgot about this. Thank you!

4 hours ago, Ausmumof3 said:

https://www.abc.net.au/news/2024-01-21/covid-safe-strategies-australian-scientists-virus-infection/103335466?utm_campaign=abc_news_web&utm_content=link&utm_medium=content_shared&utm_source=abc_news_web
 

None of this is new, but definitely the most detailed take I’ve seen on mainstream news here.

Thanks so much for this share! As you say, it’s all stuff those following closely know, but the mainstream news hasn’t been saying it, so this is excellent to see. 

[KSera]

45 minutes ago, Amoret said:

You can see it via Nitter here (you don't need a log-in)

Well 🤔.  He says Covid doesn’t cause people to become immune compromised, and his clarification is that it causes immune dysfunction instead. It’s even worse with him saying this this week, right on the heals of the study published in Science this week showing that patients with long Covid have persistent dysregulation of the immune system’s complement cascade. His post is misleading at BEST (and I think that’s over generous). 

[KSera]

Also, Jha’s posts that Covid doesn’t do this, but measles does should have given him pause considering we only learned this about measles in 2019. How many years was that after measles first began circulating? And he feels like he can say definitely now that covid doesn’t do this just 4 years since it first appeared.

[mommyoffive]

https://www.nbcnews.com/health/health-news/california-changed-covid-isolation-guidelines-differ-cdc-rcna134696

[Halftime Hope]

13 hours ago, KSera said:

Also, Jha’s posts that Covid doesn’t do this, but measles does should have given him pause considering we only learned this about measles in 2019. How many years was that after measles first began circulating? And he feels like he can say definitely now that covid doesn’t do this just 4 years since it first appeared.

I would characterize this as making a large splash in popular press in 2019, but it was not unknown before then.

I very well remember discussion in the mid-1990s of immune amnesia as a sequel to measles, as were several other complications including encephalitis and the very rare SSPE and eye issues.

The sources I was reading and listening to (getting CEUs at the time) were practicing pediatricians, so maybe it was observational data on their part, confirmed 20 years later in studies...or perhaps finally there was a mechanism identified and therefore published?

Anyway, this has no bearing on your argument, it's just a bit of interesting trivia, and perhaps instructive for the future: we can often deduce patterns in observational data which could be confirmed -- or not -- through prospective trials.  We should be attentive and not dismissive of parents' concerns. 

I'd like to see what evidence Jha is using to support his statement. (If it's like many other of his statements, he is shooting from the hip with no evidence.)

 

 

[KSera]

4 minutes ago, Halftime Hope said:

I would characterize this as making a large splash in popular press in 2019, but it was not unknown before then.

I very well remember discussion in the mid-1990s of immune amnesia as a sequel to measles,

From what I can glean in reading back, it appears it had been known for quite awhile that measles was doing *something* to the immune system, but it seems the 2019 study was a landmark in determining just what that was. This is a good round up published the day after the 2019 studies came out: https://www.cidrap.umn.edu/measles/measles-does-long-term-damage-immune-system-studies-show

I’d like to know what Jha is basing that on as well. The fact that he goes on to clarify that it does cause immune system dysfunction just seems odd to me. I’ve been trying to see if there’s some specific definition of immune compromise versus immune dysfunction and I’m so far not seeing it. It’s widely established and acknowledged that a number of common infections, including the flu, temporarily suppress the immune system after infection, so I don’t know why he’s doubling down on that not being an issue with Covid. 

[kbutton]

3 hours ago, mommyoffive said:

https://www.nbcnews.com/health/health-news/california-changed-covid-isolation-guidelines-differ-cdc-rcna134696

I stopped reading after they said they’re focusing efforts on helping the vulnerable or something like that—I highly doubt that they are actually protecting the vulnerable by mandating that people who are ending isolation early and work with old people don an N-95.

[KSera]

12 minutes ago, kbutton said:

I stopped reading after they said they’re focusing efforts on helping the vulnerable or something like that—I highly doubt that they are actually protecting the vulnerable by mandating that people who are ending isolation early and work with old people don an N-95.

No one making rules like these cares one wit about protecting the vulnerable. It was clear way back when they first ended mask mandates and said that people only needed to wear them if they were going to be around vulnerable people, which basically expects that all vulnerable people from that point forward need to stay in their homes. The guidelines are still very clear that anyone ending isolation before 10 days or a negative test is supposed to be wearing a high quality mask, but that’s just not happening at all either. Even in settings where it should be enforceable, like schools. It’s incredibly frustrating. Honestly haven’t read the above story because just the headline is upsetting to me. I’ll go back and do so when I’m up to it.