Sibylla Bostoniensis

I had been doing so well. (Yes, that's foreshadowing.)

I had done my own laundry. I had done my first substantive (though still quite basic) cooking project in 1.5 years. I washed my hair by myself. I even went on a small walk in a park on an unseasonably warm day. (Not all at once of course.) I could actually sit up on a chair for a whole half hour. I was getting physical therapy.

I had my follow-up appointment with my physiatrist on February 7th. My previous epidural was mid-September and I was told to anticipate that it would last about 3 months. Here we were at 5 months, and I was still going strong so it looked like maybe whatever was wrong had a chance to heal once the inflammation was controlled by the epidural.

Whelp, it turns out I was not actually getting better, it was the steroid epidural still working. Which it stopped doing a week ago Saturday. Over the course of the last nine days I've steadily regressed from being mostly resuming my life to being almost bedbound with pain. I went from "slightly sorer than yesterday" to "rather achey" to "oh that part of me hasn't hurt in months" to "that is rather uncomfortable" to "oh, fuck" between Sunday and Thursday, whereupon I called in to my physiatrist's office to request urgent assistance. I had asked back at the last appointment, given that we weren't making a further follow-up appointment, what the plan was if I found myself having trouble again, and he told me to just call in and he'd get me right on the schedule for another epidural, he was good to his word: I'm scheduled for next week.

So that's why no Siderea Posts for February. First I was too busy doing all of the things that I hadn't been able to do for over a year, then all my spoons abruptly disappeared, right during the time that I had reserved for writing.

Le sigh.

I suppose the good news is that now I have a lot of things I need to do and can't really do without enormous difficulty, so I am super motivated to procrastinate which is usually hugely motivating to write. Here's hoping.

There's been some real question whether getting too many Covid vaccines might have some deleterious effect on the immune system, but there's not really an ethical way to study that in humans.

To our rescue, a scoundrel in Germany who sold the service of getting Covid shots on behalf of antivaxxers so they wouldn't have to, and in the process, got 217 Covid shots in a 29 month period.

There was a study of him just published in the Lancet. tl;dr: he's fine.

2024 Mar 4: the Lancet (high-prestige, peer reviewed scientific journal): "Adaptive immune responses are larger and functionally preserved in a hypervaccinated individual" by Katharina Kocher, Carolin Moosmann, et al.:

Prime-boost vaccinations can enhance immune responses, whereas chronic antigen exposure can cause immune tolerance. In humans, the benefits, limitations, and risks of repetitive vaccination remain poorly understood.

Here, we report on a 62-year-old male hypervaccinated individual from Magdeburg, Germany (HIM), who deliberately and for private reasons received 217 vaccinations against SARS-CoV-2 within a period of 29 months (figure A; appendix 1 tab 1). HIM's hypervaccination occurred outside of a clinical study context and against national vaccination recommendations. Evidence for 130 vaccinations in a 9 month period was collected by the public prosecutor of Magdeburg, Germany, who opened an investigation of this case with the allegation of fraud, but criminal charges were not filed. 108 vaccinations are individually recorded and partly overlap with the total of 130 prosecutor-confirmed vaccinations (appendix 2 p 12). To investigate the immunological consequences of hypervaccination in this unique situation, we submitted an analysis proposal to HIM via the public prosecutor. HIM then actively and voluntarily consented to provide medical information and donate blood and saliva.

This procedure was approved by the local Ethics Committee of the University Hospital of Erlangen, Germany. Throughout the entire hypervaccination schedule HIM did not report any vaccination-related side effects. From November 2019, to October 2023, 62 routine clinical chemistry parameters showed no abnormalities attributable to hypervaccination (appendix 1 tab 2). Furthermore, HIM had no signs of a past SARS-CoV-2 infection, as indicated by repeatedly negative SARS-CoV-2 antigen tests, PCRs and nucleocapsid serology (figure A; appendix 1 tab 1).

Also of note:

In saliva, HIM had detectable anti-spike IgG, unlike the control participants (appendix 2 p 12 F).

And in conclusion:

In summary, our case report shows that SARS-CoV-2 hypervaccination did not lead to adverse events and increased the quantity of spike-specific antibodies and T cells without having a strong positive or negative effect on the intrinsic quality of adaptive immune responses. While we found no signs of SARS-CoV-2 breakthrough infections in HIM to date, it cannot be clarified whether this is causally related to the hypervaccination regimen. Importantly, we do not endorse hypervaccination as a strategy to enhance adaptive immunity.

Canonical link: https://siderea.dreamwidth.org/1832343.html




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Protecting yourself from Covid requires understanding Covid correctly. One of the things that you should understand about Covid, and any infectious illness, is the dose-response relationship.

That's the fancy highfalutin' medical way of talking about a very simple idea you already have and use all the time: the bigger a dose of something you get, the stronger its effect on you.

This is usually true of medicines, of course, but it's also true of poisons. Consider lead poisoning, for example. Medical science tells us no amount of lead in the bloodstream is safe. But, as you're probably already aware, even so, having more lead in your blood is worse than having less. Somebody who has only 5 µg/dL of lead in their bloodstream is definitely lead poisoned, but they're in much better shape than somebody who has 500 µg/dL.

It turns out viruses and other infectious microbes are like poisons. Research strongly suggests viruses also have a dose-response relationship: generally speaking, the more of the virus you have inside of you, the worse your symptoms are and the greater the threat to your health.

( When you think about it, that's not really a surprise, is it? [Read more, 4,560 Words] )

This post brought to you by the 199 readers who funded my writing it – thank you all so much! You can see who they are at my Patreon page. If you're not one of them, and would be willing to chip in so I can write more things like this, please do so there.

Please leave comments on the Comment Catcher comment, instead of the main body of the post – unless you are commenting to get a copy of the post sent to you in email through the notification system, then go ahead and comment on it directly. Thanks!

American adults! You all now have access to a free, 24/7 on demand telehealth system for COVID-19 and influenza so you can get prescribed Paxlovid or anti-flu medications, any time, day or night, that you test positive.

That way you can get your prescription and get it filled faster than waiting for your doctor's office to open and get you in, because time is of the essence when starting anti-virals.

They can either send the prescription a convenient pharmacy near you, or ship the medication right to you.

It is being run by the NIH:

This program is funded by the National Institutes of Health (NIH) to better understand how technologies such as at-home tests and telemedicine can improve healthcare access for individuals across the country. Findings will be used to inform future public health programs for the American people. Any data shared with researchers will be limited to what is necessary to evaluate the program and will not include information which can identify you.

[..]

Please note, this program is free, and we will never request your specific payment or insurance information, nor will bill or contact any insurance provider you may have.

You must be at least 18 years old to participate.

ALSO! If you are poor, old, or a veteran, you can register with the service and they'll ship you free at-home Covid and flu tests. (One need not be poor/old/a veteran to get the telehealth for Covid or flu.) Note that there's not really a way for them to rush you tests once you're symptomatic, so that's a thing to do in advance of getting sick. You can sign up at any time. Eligibility for free tests: "uninsured or underinsured adult (18+), on Medicare, Medicaid, in the VA healthcare system, or receive care from the Indian Health Services."

All of the above is available at Test2Treat.org.

You can read more about it here, which is where I learned about it:

2023 Dec 6: Time Magazine (Time.com): "How to Get Free Flu and COVID-19 Tests and Treatments" by Alice Park.

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As a side note, as Romneycare became Obamacare, this is the NIH rolling out to the whole US the sort of Paxlovid telehealth service Massachusetts has had mid-2022.

On behalf of Charlie Baker, whose administration did this, and the Commonwealth of Massachusetts, you're welcome.

(Massholes, our system is still available, and is open 8am to 10pm, 7 days a week. Covid only, no tests. Still free.)

Well, this is pretty incredible if true. Here's a little distopian SF story for you, only it's non-fiction.

Over on Meddit, a physician posted: they had learned about the use of electricity to stimulate wound healing through a science fiction book, thought it was made up, saw a note that it was real, so looked it up and discovered to their shock it was a real thing with science and clinical evidence and everything, so posted to Meddit to ask if it was really a real thing and if anybody used it.

In reply, u/Bearacolypse, who is flaired "PT" which presumably means "Physical Therapist", wrote (2024 Jan 11):

This is a PT wound care thing since it uses would healing modalities (Estim). That's where you will find the most research. Since wound care PTs have been phased out of many health care systems there are not a lot of people using evidence based wound healing modalities nationwide.

PT wound focuses on interventions vs nursing wound care which mostly focuses on dressing changes.

Reimbursement dropped suddenly about 10-15 years ago for these procedures. To the point where 15 minutes of Estim for wound care is like a $20 service and so most places stopped offering it. Even though the research supports it. Medicare don't care with their fee schedules.

Same thing with compression, serial debridement, NPWT, pulse lavage, ultrasound MIST, UV light treatment, maggot therapy, and iontophoresis. All of which are evidence based and have a significant impact of wound healing outcomes.

Since these are all procedural the drop in reimbursement made the therapists who were doing it too expensive.

I was lucky enough to work as a wound care PT in a level 1and got to do all of the above stuff. It was so cool and legit saved lives. I had to quit because they refused to pay us more than $36/hour and my loans are too much for that salary.

Our wound center had 3 wound docs who were super limited in what they could offer outpatient because of reimbursement. They would actually admit people for us to see because it was easier to get insurance to cover wound vacs and debridement that way.

Edit: forgot to elmention that in some states WOCRNs may do similar treatments but I've never seen a WOCRNs who had extensive education on modalities. Most are okay with wound vacs and very iffy on the rest.

So, yeah, to hear this Reddit user tell it, apparently there's an entire little branch of medicine – interventional wound care – that just... disappeared from the US because payers, primarily Medicare with the others following suit, decided they didn't want to pay a living wage to the professionals trained in it any more.

Canonical link: https://siderea.dreamwidth.org/1829989.html

This was a thread I originally declaimed over on Mastodon, to the lords and ladies of the Fediverse, of what is past, or passing, or to come.

So that's the original audience. You, loyal readers, may also find it interesting.

It has been lightly edited, structured, and translated from the original plain text into HTML.

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There are two problems that are coming for Mastodon of which apparently an awful lot of people are unaware. These problems are coming for Mastodon not because of anything specific to Mastodon: they come to all growing social media platforms. But for some reason most people haven't noticed them, per se.

The first problem is that scale has social effects. Most technical people know that scale has technological effects. Same thing's true on the social side, too.

For instance, consider the questions "How likely, statistically speaking, are you to run into your boss on this social media platform?" and "How likely, statistically speaking, are you to run into your mother on the social media platform?" While obviously there is wide individual variation based on personal circumstances, in general the answer to those questions is going to be a function of how widespread adoption is in one's communities.

Thing is, people behave differently on a social media platform when they think they might run into their boss there. People behave differently when they think they might run into their mother.

And it's not just bosses and mothers, right? I just use those as obvious examples that have a lot of emotional charge. People also behave differently depending on whether or not they think their next-door neighbors will be there (q.v. Nextdoor.com).

How people behave on a social media platform turns out to be a function of whom they expect to run into – and whom they actually run into! – on that social media platform. And that turns out to be a function of how penetrant adoption is in their communities.

And a problem here is that so many assume that the behavior of users of a given social media platform is wholly attributable to the features and affordances of that social media platform!

( It's very easy to mistake what are effects of being a niche or up-and-coming platform for something the platform is getting right in its design.... Read more [7,670 words] )

This post brought to you by the 199 readers who funded my writing it – thank you all so much! You can see who they are at my Patreon page. If you're not one of them, and would be willing to chip in so I can write more things like this, please do so there.

Please leave comments on the Comment Catcher comment, instead of the main body of the post – unless you are commenting to get a copy of the post sent to you in email through the notification system, then go ahead and comment on it directly. Thanks!

Two recent things of note in infectious disease news:

1.

Something's going on with chronic wasting disease (CWD) – a prion disease, like mad cow disease – in whitetail deer, and a couple of other species in North America: they're suddenly been a rash of stories about animals testing positive. I haven't found one news story that discusses this as a national phenomenon, just many local news stories announcing that infected animals have been found in various different states. This video, "'Zombie' deer disease is spreading" (2023 Nov 21, Fox 5 NY), has a talking head saying that it is now found in most states in the US.

Meanwhile, it turns out that back last summer, there was a research published that "Ticks may be able to spread chronic wasting disease between deer" (2023 Jul 7, U of Wisconsin press release, by Elise Mahon), that found that viable amounts of CWD prions are found in ticks that feed from infected deer, and it was already known that deer eat ticks off of one another. The press release involved an interview with the lead researcher which has the immortal sentence, "'[Ticks are] just like a little CWD Tic-Tac that are possibly being eaten by the deer,' Inzalaco says."

2023 May 15: Scientific Reports (peer-reviewed scientific research journal): "Ticks harbor and excrete chronic wasting disease prions" by H. N. Inzalaco, F. Bravo-Risi, et al.

2.

2023 Nov 20: CNN: "A mysterious respiratory illness is spreading among dogs and baffling veterinarians. Here’s what owners can do" Chris Boyette and Holly Yan:

From New Hampshire to Oregon, researchers are trying to figure out what’s causing an infectious respiratory disease among dogs that has turned deadly in rare cases.

The mysterious illness is described as an “atypical canine infectious respiratory disease,” the Oregon Department of Agriculture said in a November 9 news release. Symptoms include coughing, sneezing, eye or nose discharge and lethargy.

Veterinarians in Oregon have reported more than 200 cases of the disease since mid-August. Other cases have been reported in Colorado, Illinois and New Hampshire.

Read more at that link.

If you are someone in MA getting your health insurance through the MAHealthConnector, and you make less than $72k as an individual or $99k for a couple or larger family, you need to start paying attention immediately. There has just been a HUGE change to your available choices which could hit you in the pocketbook pretty hard.

Last month I got a letter from the HealthConnector telling me that for my next year's health insurance, I was approved for a ConnectorCare (MA state subsidized) plan which was surprising to say the least, given how much I earn. "That's odd. They must be having another one of their wild computer glitches (like the year they decided I have an annual salary of $16k and canceled my health insurance because clearly I couldn't afford the premiums) because the only other explanation is that their income max for ConnectorCare plans went WAY up."

"Anyway," I thought, "I'd better log in and send them fresh income information."

Lo and behold:

Exciting news: Massachusetts is making health care more affordable and accessible for thousands of people through the ConnectorCare program. These changes will be in effect beginning January 1, 2024. [...] Income limits for ConnectorCare have been expanded from 300% of the Federal Poverty Level to 500%. This means that more people will now qualify for this program, as the income limit for individuals increases from $43,470 in 2023 to $72,900 in 2024 [and more for families].

Awwwww, sounds nice, right? Extending subsidized plans to way, way more people?

No, actually.

It's possible this won't be awful, but...

For the first problem,

ConnectorCare plans offer great coverage

has been a goddamned lie.

I went to GREAT LENGTHS to escape ConnectorCare, and I was paying for a more premium commercial plan precisely because I was tired of the doors to care being slammed in my face. Historically, ConnectorCare was "there's more MDs per capita here than anywhere else on earth, and in this whole 30 mile radius we'll give you a choice of three of them who are so overworked they don't have time to see you".

Maybe they've fixed the problems with ConnectorCare. They seem to have strong-armed several payers into playing ball with it, and now a bunch of my physicians and preferred hospitals who weren't covered by ConnectorCare plans are showing up as taking some of them. Maybe this will work out great. Maybe this stands to kill me. Remains to be seen.

For a second problem,

ConnectorCare plans have $0 or low monthly premiums, low out-of-pocket costs, and no deductibles

So much for getting to choose to have a HDHP + HSA unless you're making $72k+/yr.

ConnectorCare plans are only Silver level plans. No more chosing Bronze or Gold or Platnum plans to meet your coverage needs.

You don't have the choice of paying for a Gold plan to get PPO features such as out-of-network coverage.

You don't have the choice any more to trade off a deductible for some other feature you want. For instance, this year, I opted into a plan with a $2000 deductible in exchange for a bigger network of doctors, because I have serious medical needs.

Which brings us to this coming year.

I just checked the the 2024 Plan Comparison Tool and it looks like to stay on the cheapest plan that covers all my physicians from the same insurer, my monthly premium is going to go up $233.

To save me a $2000/year deductible (which I have barely needed to scratch!), these motherfuckers are going to charge me another $2,796/year in premiums.

Btw, you know how much the Massachusetts subsidy is for that plan?

$35.36 per month.

So, it's looking like MA cut some deal where middle-income people buying insurance on the exchage get sold out to the insurance companies: they get to railroad us into low-value, over-priced Silver ConnectorCare plans, and the only "upside", if you can call it that, is absolutely trivial contributions from the state.

What "extended ConnectorCare to people making up to 500% of the FPL" apparently means is "we rebranded a bunch of shitty Silver plans 'ConnectorCare' and took away your alternatives if you make less than 500% of the FPL", not "We're making health insurance any better for people making 300%-500% of the FPL".

As a side note, in many states, Silver plans are the worst value for the price, because of a hack called Silver loading. Not sure whether MA is doing this. The fact that MA is railroading a population into Silver plans is suspicious to me.

Anyways, happy open enrollment, Massachusetts. If you haven't checked your options on the HealthConnector, you might want to do that sooner rather than later.

If you don't want to actually divulge your info before you're ready, the Get an Estimate page is there. That will tell you what level you're approved for. Then head to the 2024 Plan Comparison Tool to give it the names of doctors/hospitals/medications you want to check plans for covering.

Canonical link: https://siderea.dreamwidth.org/1828323.html




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I have been hearing since the day it happened that Hamas' massacre of Israeli civilians was Israel's 9/11. God, I hope not. I mean, yes, probably. But speaking as an American, I sincerely hope nobody in Israel is looking at how America responded to 9/11 and going, "Ah, yes, that was a great idea." Obviously it worked out astonishingly terribly for the people of the countries – plural! – we invaded, but it didn't work out so hot for us Americans either.

( Read more [4,970 words] )

This post brought to you by the 197 readers who funded my writing it – thank you all so much! You can see who they are at my Patreon page. If you're not one of them, and would be willing to chip in so I can write more things like this, please do so there.

Please leave comments on the Comment Catcher comment, instead of the main body of the post – unless you are commenting to get a copy of the post sent to you in email through the notification system, then go ahead and comment on it directly. Thanks!

[This is probably not actionable.]

Two bits of research that just crossed my desk that seemed interesting to me. Both concern patients with severe Covid, which means Covid so bad it requires hospitalization. It's not clear whether these findings are pertinent in cases of people who have less severe Covid; indeed these studies may be surfacing what makes some people's Covid much more severe than garden variety Covid.

But of course what makes them interesting to me is that both of them have to do with enduring changes to the immune systems of Covid patients. (Previously)

( 1. Re COVID induced immunodeficiency  )

( 2. A fungus-covid immune system connection )