Lunchtime pandemic reading.
Standard disclaimer: this is a roundup of informative pieces I've read that interest me on the severity of the crisis and how to manage it. I am not a qualified medical expert in ANY sense; at best I am reasonably well-read laity. ALWAYS prioritize advice from a qualified healthcare provider who knows your specific medical situation over advice from people on the Internet.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.
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COVID causes neurological damage. "So excited to be a part of this important study led by @michelle_monje on how significant longterm neurologic damage can occur after a mild respiratory-only SARS-CoV-2 infection. My own🧵on the findings of this study with relevance to #longCovid (1/)
How can a mild respiratory SARS-CoV-2 infection lead to longterm neurological symptoms? Possibilities include 1) direct infection of 🧠, 2) autoimmunity, and 3) inflammatory impact of infection distal to the 🧠. In this study, we focused on 3) 👇🏽 (2/)
To achieve this goal, @peowenlu & @ericsongg used a mouse model developed by @BenIsraelow & @ericsongg in which we can control where the infection happens. Using AAV-hACE2 intratracheally, we can confine the SARS-CoV-2 infection only to the lungs. (3/)
In fact, mice infected only in the respiratory tract show no evidence for weight loss (a disease measurement)(B),and no evidence of SARS-CoV-2 infection in the brain (C). (4/)
So what do systemic (serum) and local (cerebrospinal fluid; CSF) cytokines look like after this mild respiratory-only infection? Not surprisingly, we see many elevated cytokines 7 days after infection in the serum. We also see elevated cytokines in the CSF. (5/)
Somewhat unexpectedly, we also see that some of these cytokines remain elevated at 7 weeks post infection in both sera and CSF. Similarly elevated cytokines have been reported from the sera of long COVID patients by others, months after primary infection. (6/)
What does a respiratory-only mild COVID do to the brain? @ThisIsAnthonyFC and @AnnaGeraghty2 examined the subcortical white matter of two independent strains of mice and found consistently increased microglial reactivity at 7 days and 7 weeks post infection. (7/)
Next, with @nathavindra, autopsies from 9 individuals found to be SARS-CoV-2-positive by nasal swab PCR at the time of death were examined. Brains from those with even mild or asymptomatic SARS-CoV-2 infection had microglial reactivity in subcortical white matter. (8/)
Neurogenesis in the hippocampus is thought to support memory function. Reactive microglia can impair this process. Indeed, mice that had mild SARS-CoV-2 infection 7 days or 7 weeks prior had significantly lower # of neuroblasts than controls. This could ⬇️ memory function. (9/)
What can lead to impaired neurogenesis in hippocampus? We looked into a chemokine called CCL11 (eotaxin-1) which was shown to reduce neurogenesis (Villeda et al). In our mice, CCL11 was elevated in the CSF 7 weeks after mild respiratory infection. (10/)
In collaboration with @PutrinoLab at @MountSinaiNYC, we found significantly elevated circulating levels of CCL11 in long COVID patients who reported brain fog vs. those who did not. Many 🙏🏼 to @wood_jamie_1 @LauraTabacof @GeneticHeartDoc #DaynaMcCarthy & the patients! (11/)
What other changes are happening in the brain of mice with mild respiratory infection? Within just 7 days of infection, we found a loss of ~1/3 of oligodendrocytes, which persisted for at least 7 weeks! Analysis by @ThisIsAnthonyFC and @AnnaGeraghty2 (12/)
This loss of oligodendrocytes was accompanied by reduced myelinated axon density in subcortical white matter within 7 days of infection. This could lead to ⬇️ neural circuit function, axon health and to numerous deleterious neurological consequences of SARS-CoV-2 infection. (13/)
This study was led and executed by my amazing colleague, @michelle_monje & her team + @PutrinoLab @MountSinaiNYC, @nathavindra et al. From our Yale team, I wish to highlight @peowenlu @ericsongg and others listed here 💪🏼 (14/)
In a nutshell, this study illustrates that respiratory-only mild SARS-CoV-2 infection can lead to detrimental changes in the brain, likely mediated by inflammatory factors. Similar neuropathobiology may be shared in chemo-brain, post-ICU syndrome and ME/CFS. (15/)
This study also opens up all kinds of questions and possibilities. For example, therapies that can 1) block inflammatory cytokines, 2) block inducers of such cytokines, or 3) reset reactive microglia can be considered for future clinical trials. Thank you for reading till end."
Source:
Source: https://www.biorxiv.org/content/10.1101/2022.01.07.475453v1.full
Commentary: We are still uncovering all the different ways COVID-19 damages the body, but it is clear that it's a systemic virus and causes problems in multiple systems. Get vaccinated and boosted, and stay masked up. Keep it out of your body.
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Omicron spreads longer. "Patients with the omicron variant of covid-19 shed virus for longer after symptoms emerge, show data from Japan, potentially jeopardising hopes that the period of isolation for people testing positive could be shortened.
Preliminary data from the National Institute of Infectious Diseases—which conducts disease surveillance in Japan—suggest that the amount of viral RNA is highest three to six days after diagnosis or symptom onset.1
The isolation period for people testing positive for covid-19 was recently cut from 10 days to seven in England if two lateral flow tests returned negative results on days six and seven. Similar cuts to isolation have followed in Scotland, Wales, and Northern Ireland.
Staff absences because of isolation have caused severe workforce shortages for critical services, including the NHS, schools, and transport, leading to calls for the UK to follow the US and cut the isolation period to five days.
One of the proponents of shortening isolation, Paul Hunter, a professor in medicine at the University of East Anglia, said that the latest Japanese data “muddy the waters.”
“I’m still working my way through the evidence for and against given that the Japanese study has now shifted the balance,” he said.
Previous studies suggest that the peak transmission period for people with other variants was between two days before symptoms emerged and three days afterward, with virus shedding peaking on or before symptom onset.2 The Japanese study suggests that with omicron, the peak of virus shedding may be two or three days later, Hunter said."
Source: https://www.bmj.com/content/376/bmj.o89
Commentary: The only sure way to prove that you're no longer contagious is daily rapid testing. A fixed time period - 5 days, 10 days, whatever - is unreliable and unscientific. If you've been infected, test until the rapid tests show you're no longer spreading the virus, however long it takes. Two rapid tests in a row negative should be enough proof you're clear.
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More data supporting Omicron's longer contagiousness. "One in 10 people with COVID-19 still could be infectious beyond 10 days, and some could remain so for as long as two months, a new study suggests.
U.K. researchers reported that a new test can detect whether the coronavirus is potentially still active. They used it to analyze samples from 176 people who had tested positive on standard PCR tests.
After 10 days, 13% of the people had levels of active virus, indicating they could potentially still be infectious. These levels continued in some of the participants for up to 68 days, according to the study.
"While this is a relatively small study, our results suggest that potentially active virus may sometimes persist beyond a 10-day period, and could pose a potential risk of onward transmission," said Lorna Harries, a University of Exeter Medical School professor who oversaw the study. "
Source: https://www.upi.com/Health_News/2022/01/14/UK-COVID-19-infectious-more-than-10-days-study/5321642177829/
Commentary: As before, testing is the only way to prove you're clear.
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A reminder of the simple daily habits we should all be taking.
1. Wear the best mask available to you when you'll be around people you don't live with, even after you've been vaccinated. Respirators are back in stock at online retailers, too. Wear an N95/FFP2/KN95 that's NIOSH-approved or better mask if you can obtain it. If you can't get an N95 mask, wear a surgical mask with a cloth mask over it.
2. Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
3. Get vaccinated as soon as you're able to, and fulfill the full vaccine regimen, including boosters. Remember that you are not vaccinated until everyone you live with is vaccinated. If you received an adenovirus vaccine (J&J/AstraZeneca), consider getting an mRNA single shot booster (Pfizer/Moderna) if available. If it's available, choose Moderna as your first choice for both vaccine and booster, Pfizer as your second choice. However, remember than any vaccine is better than no vaccine.
4. Wash/sanitize your hands every time you are in or out of your home.
5. Stay out of indoor spaces that aren't your home and away from people you don't live with as much as practical. Minimize your contact with others and avoid indoor places as much as you can; indoor spaces spread the disease through aerosols and distance is less effective at mitigating your risks.
6. Aim to have 3-6 months of living expenses on hand in case the pandemic gives another crazy plot twist to the economy.
7. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
8. Ventilate your home as frequently as weather and circumstances permit, except when you share close airspaces with other residences (like a window less than a meter away from a neighboring window).
9. Masks must fit properly to work. Here's how to properly fit a mask:
10. If you think you may have been exposed to COVID-19, purchase a rapid antigen test. This will detect COVID-19 only when you're contagious, so follow the directions clearly. https://amzn.to/3fLAoor
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Common misinformation debunked!
There is no basis in fact that COVID-19 vaccines can shed or otherwise harm people around you.
Source: https://www.reuters.com/article/factcheck-covid19vaccine-reproductivepro-idUSL1N2MG256
There is no mercury or other heavy metals in the Pfizer mRNA vaccine.
Source: https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
There is no basis in fact that COVID-19 vaccines pose additional risks to pregnant women.
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2104983
There is no genomic evidence at all that COVID-19 arrived before 2020 in the United States and therefore no hidden herd immunity:
Source:
There is no evidence SARS-CoV-2 was engineered, nor that it escaped a lab somewhere.
Source: https://www.washingtonpost.com/world/2020/01/29/experts-debunk-fringe-theory-linking-chinas-coronavirus-weapons-research/
Source: https://www.nature.com/articles/s41591-020-0820-9
Source: https://www.nationalgeographic.com/science/2020/05/anthony-fauci-no-scientific-evidence-the-coronavirus-was-made-in-a-chinese-lab-cvd/
Source: https://www.smh.com.au/national/are-we-ignoring-the-hard-truths-about-the-most-likely-cause-of-covid-19-20210601-p57x4r.html
There is no evidence a flu shot increases your COVID-19 risk.
Source: https://www.factcheck.org/2020/04/no-evidence-that-flu-shot-increases-risk-of-covid-19/
Source: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa626/5842161
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Disclosures and Disclaimers
I declare no competing interests on anything I share related to COVID-19. I am employed by and am a co-owner in TrustInsights.ai, an analytics and management consulting firm. I have no clients and no business interests in anything related to COVID-19, nor do I financially benefit in any way from sharing information about COVID-19.
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A common request I'm asked is who I follow. Here's a public Twitter list of many of the sources I read.
https://twitter.com/i/lists/1260956929205112834
This list is biased by design. It is limited to authors who predominantly post in the English language. It is heavily biased towards individual researchers and away from institutions. It is biased towards those who publish or share research, data, papers, etc. I have made an attempt to follow researchers from different countries, and also to make the list reasonably gender-balanced, because multiple, diverse perspectives on research data are essential.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.