siderea | Entries tagged with covid-19

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The internet is full of people enraged by the US CDC's reduction – and all but elimination – of isolation guidelines for COVID, pointing out that the CDC's new guidelines seem to be more about what is good for "the economy" – which is to say, good for business interests – than what is good for the health of the people.

I don't think anyone's wrong to be enraged. Nothing that I am about to say is meant to make anyone feel better about the CDC's decision. I do not explain this as any kind of excuse.

There is a sense in which the CDC's decision is right. Not good, mind you, but correct: it brings their guidance back into alignment with our larger society's beliefs about the value of human life and health.

( Ours has never been a society that has particularly highly valued the health and well-being of the people of it... Read more [2,460 words] )

This post brought to you by the 201 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.

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Hey, Americans, if you have not maxed out your requests for free tests from COVIDTests.gov, you have until Friday to do so. Then the program will be shut down.

If you cannot afford tests, check out the aforementioned NIH-run national telehealth service for COVID and influenza which I assume is still operating. It is a wholly separate program, and was sending free tests to those who qualify on grounds of being on public assistance.

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.

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0.

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.

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(h/t BoingBoing a, 2)

Whoa:

Well, it's really important we understand what went wrong in that first entire year. [...] We were late to testing, we were late to really talking about asymptomatic spread, and we were very late in recognizing the aerosol nature of this virus, which still lives with us today. And that's why it still spreads so easily indoors, because it remains suspended. It was never flu. It will never be flu.

That's Dr. Deborah Birx – remember Dr. Birx? She was the White House Coronavirus Response Coordinator under Trump in an interview with Chris Cuomo, 2024 Jan 10: Newsnation on Youtube: "Deborah Birx: Understanding COVID response failures critical for future". The chiron: "DR BIRX: CDC GOT COVID WRONG FROM BEGINNING".

She's not wrong about the failures of the CDC (which were also the failures of her administration) wrt testing (also a failure of the FDA), asymptomatic spread, and the aerosol nature of Covid, and migod it's good and rather surprising to hear her say so. But, to be clear, none of their responses in those regards would have been correct for an influenza pandemic either, and her "well, they wouldn't stop thinking of it like the flu" framing of her criticism is, um. There's no reason to assume influenza isn't also an aerosol. The assumption Covid wasn't was based on shitty science and that science isn't less shitty applied to influenza. Many of the things current aerosol science is finding true of Covid were observed true in 1918.

Apparently Dr. Birx is 100% a researcher/public health figure, and 0% a clinician, and I say that with bemused affection, because she gets gloriously amoral when Cuomo asks her about the comparison between HIV and Covid. Her answer was effectively that Covid is going to be just like HIV in how much wonderful medicine-revolutionizing science in generates, which is I'm pretty sure not remotely an answer to the question Cuomo thought he was asking her.

In other related news, remember Chris Cuomo? He was the NYC journalist (news anchor?) who got Covid in March or April 2020, band talked about his symptoms on air. I quoted him and linked to his account on YouTube on 2020 Apr 7. Well, he has recently "come out" as having Long Covid.

2024 Jan 7: BoingBoing: "Journalist Chris Cuomo opens up about his struggle with long COVID" (by Jennifer Sandlin):

On his NewsNation show "Cuomo," journalist and former CNN anchor Chris Cuomo recently opened up about his struggle with long COVID. He shared that he's currently been battling a cold for over a month, and also relayed that since contracting COVID in Spring of 2020, his health hasn't been the same as it was pre-COVID. He has always considered himself very healthy—he lifts weights and is in great shape—but in the years following his COVID infection, he has struggled with more frequent illnesses that he doesn't bounce back from like he used to. He stated, post-COVID, "I can beat nothing" without medicine. He also shared that he has lost bone density from COVID.

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.

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.)

Re COVID-induced immune dysregulation (previously)

2023 May 16: MedrXiv (pre-print server, but since accepted to the Family Medicine and Community Health Journal): "Disrupted seasonality and association of COVID-19 with medically attended respiratory syncytial virus infections among young children in the US: January 2010–January 2023" by Lindsey Wang, Pamela B. Davis, et al.:

Respiratory syncytial virus (RSV) infections and hospitalizations surged sharply in 2022 among young children. To assess whether COVID-19 contributed to this surge, we leveraged a real-time nation-wide US database of electronic health records (EHRs) using time series analysis from January 1, 2010 through January 31, 2023 [...]

Among 228,940 children aged 0–5 years, the risk for first-time medically attended RSV during 10/2022–12/2022 was 6.40% for children with prior COVID-19 infection, higher than 4.30% for the matched children without COVID-19 (risk ratio or RR: 1.40, 95% CI: 1.27–1.55); and among 99,105 children aged 0–1 year, the overall risk was 7.90% for those with prior COVID-19 infection, higher than 5.64% for matched children without (RR: 1.40, 95% CI: 1.21–1.62). These data provide evidence that COVID-19 contributed to the 2022 surge of severe pediatric RSV cases.

Now on the face of this, it looks like a simple case of correlation is not causation. After all, the risk factors that might lead to a child being more likely to catch COVID could also result in that child being more likely to independently catch RSV.

But the part I elided was this:

[...] we leveraged a real-time nation-wide US database of electronic health records (EHRs) using time series analysis from January 1, 2010 through January 31, 2023, and propensity-score matched cohort comparisons for children aged 0–5 years with or without prior COVID-19 infection.

Yeah they controlled for that, insofar as is apparently humanly possible. They controlled for: age, sex, race, ethnicity (meaning whether or not Hispanic), "adverse socioeconomic determinants of health", and a whole list of medical conditions and statuses, including vaccination.

So, while, yes, this merely establishes a correlation, and it might yet be that there is some other factor that is a co-cause of both elevated risk of getting COVID and RSV, they did knock out a bunch of the possibilities like, poorer kids might have had to be in daycare more because their parents didn't have the choice to WFH, which would elevate a kids risk of all respiratory diseases – but here they compared kids of similar socioeconomic status so that wouldn't be a differentiator.

Or at least they tried to. They are relying on treating clinicians having successfully used Z codes to flag the records of pediatric patients in situations of economic and housing precarity, and I honestly don't know to what extent pediatricians can be relied upon to use those codes consistently. I'll tell you right now that psychotherapists do not use those codes reliably, and as a profession have a pretty shirty attitude about them (tl;dr: a code for a condition insurance won't pay us to treat is a code we can't be arsed to look up, much less use) so any study that relied on our records to have that stuff coded would fall on its face. I am sincerely wondering to what extent pediatricians, especially pediatricians working in facilities that see almost exclusively impoverished patients, would lovingly bother to flag, e.g., housing insecurity, especially when it was every case.

So not sure how seriously we should take this research, but it is highly suggestive.

[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 )

Or, "Everybody Else* Discovers the Existence of Post-Acute Infection Conditions"

* Meaning everybody but those that have them, those paying attention to those that have them, and the fine folks working in infectious disease.

So this was headline news when I got up on Friday and through at least Sunday (I've been busy, haven't checked since).

2023 Oct 7: CBS News: Similar to long COVID, people may experience "long colds," researchers find by Sara Moniuszko:

Some people may experience "long colds," or long-term symptoms following common colds, flu, pneumonia or other respiratory illnesses, similar to the pattern seen in long COVID, according to a new study from Queen Mary University of London.

Published in The Lancet's EClinicalMedicine journal Friday, researchers found that even people with acute respiratory infections who tested negative for COVID-19 could still experience long-term symptoms at least 4 weeks after infection, including coughing, stomach pain and diarrhea. [...]

While long-lasting symptoms, also known as post-acute infection syndromes, are "not a new phenomenon," the authors write, they often go undiagnosed due to a wide range of symptoms and lack of testing.

The study in question:

2023 Oct 6: eClinicalMedicine (peer reviewed journal): "Long-term symptom profiles after COVID-19 vs other acute respiratory infections: an analysis of data from the COVIDENCE UK study" by Giulia Vivaldi, Paul E. Pfeffer, et al.

Thoughts:

1) Man, that is not a great study. The two populations studied are, roughly, "those who had an upper respiratory infection and tested positive for COVID on an at-home test" and "those who had an upper respiratory infection and tested negative for COVID on an at-home test."

This means,

1.1) Some unknown percentage of the allegedly non-Covid subjects actually just had Covid, and were false negatives.

1.2) We have no idea with what pathogen the allegedly non-Covid subjects actually were infected, because they weren't tested for anything other than Covid. Not even influenza.

1.3) Consequently, contrary to the headlines, this study most definitely does not establish the existence of "long colds" because it never established that the condition the other patients had was a cold.

2) Nevertheless, it does seem to establish, "Hey, chuckleheads, post-acute infection syndromes are in fact a thing." I don't know that this actually needed establishing, but sometimes you have to act like you just discovered something in a moment in which the public is receptive to hearing about it to get the new concept to penetrate thick skulls. In which case: good job, researchers!

2.1) Unfortunately, by "the public" I mean an unfortunate number of physicians. (Stay classy, Meddit.)

3) Interestingly, there's a larger social context of hmmmmm. There was a recent paper – not even a research paper, a commentary, though it was published in a (allegedly) research journal, so looked like research to the unfamiliar – that got a lot of press as "proving" that Long Covid wasn't a thing. This earlier paper offered a bizarre argument that I'm not even going to try to explain right now (both because complicated, and also so wack you won't believe me) which the present paper, whether accidentally or on purpose, kind of treats as a bluff that they call. I have so much to say about that other paper and the present state of epistemology in medicine (not good!) that I might just write a whole post or two about just it. I had been going to try to explain it in terms of That Post I Had Made Explaining This Kind Of Shenanigan, only to discover that that post was approximately 10% written and still in my draft folder. (Eit.)

Got my booster, yay!

I found a slot at a sleepy suburban CVS near a restaurant we like, so we made a trip of it and got yummy takeout. I happened to arrive 10 min early (we allowed for traffic, there was none), there was almost nobody in the store, and I was in and out before my official appointment time.

Hey, yall. A discomfitting number of people I know and people related to people I know, including a lot of very Covid-cautious people who have worked very hard not to catch Covid, have caught Covid over the last month. Including some of the most vulnerable to severe disease that I know.

Horribly, some of them have caught it right around the time they got vaccinated, before the vaccine had a chance to do anything. (I wonder if some of them got the virus when they went to get vaccinated.)

This is your reminder that as best we know, the Covid vaccines work for about 5 months, and right now in the US most people haven't had a booster in about a year.

Personally, I'm wearing an n95 anytime I leave my home, and I'm acting as if I'm entirely unvaccinated until such time as I'm a good two weeks past whenever it is I finally do manage to get a booster. (Fingers crossed the CVS won't cancel the appointment I have for this coming Saturday, like they did for my last appointment.)

If you've been slacking off on your Covid game, possibly going with the flow of changing social norms, you might want to rethink that right now. At least until you're two weeks past your booster shot.

2023 Sep 25: NBCNews.com: "A blood test for long Covid is possible, a study suggests" (by Erika Edwards):

More than three years into the pandemic, the millions of people who have suffered from long Covid finally have scientific proof that their condition is real.

Scientists have found clear differences in the blood of people with long Covid — a key first step in the development of a test to diagnose the illness.
The findings, published Monday in the journal Nature [below – S.], [...] is among the first to prove that "long Covid is, in fact, a biological illness," said David Putrino, principal investigator of the new study and a professor of rehabilitation and human performance at the Icahn School of Medicine at Mount Sinai in New York.

[...]

Several differences in the blood of people with long Covid stood out from the other groups.

The activity of immune system cells called T cells and B cells — which help fight off germs — was "irregular" in long Covid patients, Putrino said. One of the strongest findings, he said, was that long Covid patients tended to have significantly lower levels of a hormone called cortisol.

2023 Sep 25: Nature: "Distinguishing features of Long COVID identified through immune profiling" (by Jon Klein, Jamie Wood, et al.) Abstract:

[...] Here, 273 individuals with or without LC [Long COVID] were enrolled in a cross-sectional study that included multi-dimensional immune phenotyping and unbiased machine learning methods to identify biological features associated with LC. Marked differences were noted in circulating myeloid and lymphocyte populations relative to matched controls, as well as evidence of exaggerated humoral responses directed against SARS-CoV-2 among participants with LC. Further, higher antibody responses directed against non-SARS-CoV-2 viral pathogens were observed among individuals with LC, particularly Epstein-Barr virus. Levels of soluble immune mediators and hormones varied among groups, with cortisol levels being lower among participants with LC. Integration of immune phenotyping data into unbiased machine learning models identified key features most strongly associated with LC status.

[The title is the actionable part. Most of the rest of this is just very interesting science.]

(h/t @unchartedworlds@scicomm.xyz)

2023 Sept 8: Northwestern Now (press release from Northwestern University): "COVID patients exhale up to 1,000 copies of virus per minute during first eight days of symptoms" (by Marla Paul) "First direct measure of SARS-CoV-2 viral copies exhaled over course of infection":

COVID patients exhale high numbers of virus during the first eight days after symptoms start, as high as 1,000 copies per minute, reports a new Northwestern Medicine study.

It is the first longitudinal, direct measure of the number of SARS-CoV-2 viral copies exhaled per minute over the course of the infection — from the first sign of symptoms until 20 days after.

On day eight, exhaled levels of virus drop steeply, down to near the limit of detection —an average of two copies exhaled per minute.

Northwestern investigators tested breath samples — collected multiple times daily from 44 individuals — over the entire course of infection to determine when a person is most infectious.

The study will be published in eLife and has been posted as a pre-print. [See below for link – S.]

Mild and moderately symptomatic patients with COVID still exhale large amounts of virus, though severely symptomatic cases exhale higher levels on average, the study reports.

Vaccinated and unvaccinated patients exhale similar levels of virus over the course of infection, the research shows.

The amount of virus being exhaled while infected was the same no matter which variant a person was infected with — people infected with Alpha exhaled just as much as those infected with Omicron, the study reports.

And:

“We developed this easy, cheap method and used it to collect over 300 breath samples from 44 patients over the course of their infections — multiple samples a day over multiple days,” Lane said.

With this new device, investigators detected viral RNA in 100% of specimens collected from COVID-positive patients who were within 10 days of symptom onset and in none of the specimens collected from COVID-19 negative patients — a very high rate of accuracy.

The study findings could be used to calculate the amount of time it takes for an individual to exhale an infectious dose of SARS-CoV-2, Lane.

“For example, if we assume the infectious dose for COVID is 300 copies, then a person who is exhaling 1,000 viral copies per minute would exhale an infectious dose in 20 seconds (highly risky in an elevator), whereas a person who is exhaling two viral copies per minute would exhale an infectious dose in about two hours (probably safe in an elevator),” Lane said.
It is not yet known what an infectious dose of viral airborne particles is.

Lots more fascinating stuff at the link above. (This may be the best press release about a research article I've ever seen.)

The study:
2023 Sep 8: medRxiv (pre-print server): "Quantity of SARS-CoV-2 RNA copies exhaled per minute during natural breathing over the course of COVID-19 infection" (by Gregory Lane, Guangyu Zhou, et al.):

Here, we collected exhaled breath specimens from COVID-19 patients and used RTq-PCR to show that numbers of exhaled SARS-CoV-2 RNA copies during COVID-19 infection do not decrease significantly until day 8 from symptom-onset. COVID-19-positive participants exhaled an average of 80 SARS-CoV-2 viral RNA copies per minute during the first 8 days of infection, with significant variability both between and within individuals, including spikes over 800 copies a minute in some patients. After day 8, there was a steep drop to levels nearing the limit of detection, persisting for up to 20 days. We further found that levels of exhaled viral RNA increased with self-rated symptom-severity, though individual variation was high. Levels of exhaled viral RNA did not differ across age, sex, time of day, vaccination status or viral variant.

[Actionable, though highly speculative, for people with Long Covid/PASC]

2023 Apr 14: Frontiers in Immunology (peer reviewed journal): "Hypothesis: inflammatory acid-base disruption underpins Long Covid" by Vicky van der Togt and Jeremy S. Rossman.

Note: this is a journal article, but it's not an account of an experiment or other study. It's a hypothesis paper. It's not proving anything. It's making an argument, the point of which is, "Somebody should do science about this."

From the abstract:

Both acute and PASC patients show systemic dysregulation of multiple markers of the acid-base balance. Based on these data, we hypothesize that the shift to anaerobic respiration causes an acid-base disruption that can affect every organ system and underpins the symptoms of PASC. This hypothesis can be tested by longitudinally evaluating acid-base markers in PASC patients and controls over the course of a month. If our hypothesis is correct, this could have significant implications for our understanding of PASC and our ability to develop effective diagnostic and therapeutic approaches.

From the paper (emphasis mine):

[...] Based on studies on acute COVID-19, PASC and the related myalgic encephalomyelitis (ME; chronic fatigue syndrome), we hypothesize that an inflammatory acid-base disruption underpins PASC and that viral proteins, both acutely and persistently-expressed, cause disease symptomology through disseminated tissue damage and inflammatory acid-base disruptions.

In PASC, inflammation reduces microvascular blood flow (e.g. through endothelial inflammation, platelet and erythrocyte aggregation, clotting and neutrophil extracellular trap formation) (3), creating a hypoxic environment that causes cellular metabolic changes (e.g. anaerobic respiration) and altered tissue and immune functions (4). SARS-CoV-2 proteins also directly cause metabolic changes (5) similar to hypoxia, increasing anaerobic respiration and the generation of lactate and protons. Significant or persistent production of protons can exceed the cellular and systemic buffering capacity, causing localized or systemic acidosis that results in a range of symptoms, including muscle fatigue similar to that experienced after strenuous anaerobic exercise. As SARS-CoV-2 vRNA and proteins have been found in muscle tissue (6), this shift to anaerobic respiration may cause acidosis in skeletal, cardiac and smooth muscle even in the absence of strenuous exercise, leading to the most common symptoms of PASC: fatigue and muscle weakness (3). In PASC patients, abnormally high blood lactate has been found after even mild exertion, suggesting metabolic dysfunction and muscle acidosis (7). In ME, muscle usage also results in intramuscular acidosis with increased acid clearance time (8), suggesting that post-exertional malaise may be caused by persistent muscle acidosis following repeated use of hypoxic and metabolically-reprogrammed muscle tissue.

However, the body compensates for acidosis in multiple ways: by increasing the elimination of acidic compounds in the urine, by increasing bicarbonate production in the kidneys, by altering the expression of lactate dehydrogenase genes (LDH; mediating the interconversion of pyruvate to lactate) and by altering respiration to modulate the levels of CO2, and thus carbonic acid in the blood (9). In PASC patients, hyperventilation (10) may reflect a compensatory response to acidosis, lowering carbonic acid in the blood. However, over-compensation can lead to alkalosis, which is also seen in acute SARS-CoV-2 infections. 73% of patients with moderate-to-severe COVID-19 present with either acidosis or alkalosis (11), with acidosis or compensated respiratory alkalosis significantly increasing the risk of death (12). Similarly, acute disease outcomes were worse in patients with high or low blood bicarbonate levels (13) and in those with elevated LDH (14), suggesting that acidosis may play a role in the pathogenesis of acute COVID-19 (15). Additionally, dehydration during the acute infection, which can impair clearance of excess acid or base, increases the likelihood of developing PASC (16).

The effects of acid-base imbalance can affect any tissue, generating many of the symptoms of PASC, including brain fog, though acidosis in the blood does not typically affect the brain as the blood-brain barrier (BBB) is not freely permeable to protons. However, SARS-CoV-2 and viral proteins increase BBB permeability (17), which may enable the flow of protons into the brain. In addition, viral proteins have been found in the brain (3, 17) and may mediate metabolic reprogramming, inflammation and hypoxia. The resulting anaerobic respiration may directly affect the acid-base balance in the brain, as indicated by elevated lactate levels in the cerebrospinal fluid (CSF) in ME patients (18). Acidosis has been shown to impair executive functions (19), as seen in PASC patients suffering from brain fog (3). [...]

There's more. Read it at the link, above.

Now, this is where things get particularly interesting.

This hypothesis is tantalizing because if true, it suggests a line of investigation for treatment: can symptoms be ameliorated by tinkering with the body's acidity?

Well, as it happens, both authors themselves have Long Covid, and one of them has been informally experimenting on herself, and has discussed it on Mastodon.

2023 Apr 14: Vicky van der Togt @vickyvdtogt@mastodon.nl: https://mastodon.nl/@vickyvdtogt/110196831965873773

[...] I decided to put the hypothesis to the test and came up with a treatment consisting of multiple components that would, in theory, enable me to rebalance my acid-base levels.

After trying this treatment for a couple of days I started to see significant improvements in my full range of #LongCovid symptoms.

And after continuing this makeshift treatment for a couple of weeks, I improved to a point where I was completely and stably symptom free. Since then I’ve been working with Dr. Jeremy Rossman to put this mechanism on paper, so that it can be shared and further researched, tested, and proven.

( Vicky van der Togt on how she self-treated her Long Covid below this cut. CW: diet, exercise. )

[This is actionable]

A multi-site study of ICU patients with Covid found that "Dehydration during acute COVID-19 infection [...] is associated with protein degradation and physical long-COVID." That is opposed to mental long-COVID symptoms, for which they did not find a relationship.

2022 Oct 21: BMC Critical Care (peer reviewed journal): "Dehydration is associated with production of organic osmolytes and predicts physical long-term symptoms after COVID-19: a multicenter cohort study" by Michael Hultström, Miklos Lipcsey, et al. From the abstract:

The study includes 374 COVID-19 patients from the Pronmed cohort admitted to the ICU at Uppsala University Hospital. Dehydration data was available for 165 of these patients and used for the primary analysis. Validation was performed in Biobanque Québécoise de la COVID-19 (BQC19) using 1052 patients with dehydration data. Dehydration was assessed through estimated osmolality (eOSM = 2Na + 2 K + glucose + urea), and correlated to important endpoints including death, invasive mechanical ventilation, acute kidney injury, and long COVID-19 symptom score grouped by physical or mental.

Results

Increasing eOSM was correlated with increasing role of organic osmolytes for eOSM, while the proportion of sodium and potassium of eOSM were inversely correlated to eOSM. Acute outcomes were associated with pronounced dehydration, and physical long-COVID was more strongly associated with dehydration than mental long-COVID after adjustment for age, sex, and disease severity. Metabolomic analysis showed enrichment of amino acids among metabolites that showed an aestivating pattern.
Conclusions

Dehydration during acute COVID-19 infection causes an aestivation response that is associated with protein degradation and physical long-COVID.

Trial registration: The study was registered à priori (clinicaltrials.gov: NCT04316884 registered on 2020-03-13 and NCT04474249 registered on 2020-06-29).

So, uh, that old advice about drinking a lot of fluids if you get sick? Yeah, do that if you get Covid.

This result is particularly tragic – I mean no blame by this – in light of dehydration being used delibereately in ICU ARDS patients early in the pandemic to try to keep fluid out of the lungs, for want of much else to try.

[This is actionable!]

Summary:

So it turns out that high CO2 concentrations in one's local atmosphere may prolong the longevity of SARS-CoV-2 circulating as an aerosol.

A study into the factors that affect the viability of SARS-CoV-2 circulating as an aerosol finds it impacted by pH, living longer in more acidic environments.

CO2, which we exhale and which builds up in enclosed spaces, is acidic.

Consequently, flushing out indoor spaces with fresh air to reduce CO2 concentrations might not just dilute concentrations of exhaled SARS-CoV-2, it might kill it.

Details:

2023 June 20: Phys.org (press release from University of Bristol): "Scientists discover critical factors that determine the survival of airborne viruses":

Critical insights into why airborne viruses lose their infectivity have been uncovered by scientists at the University of Bristol. The findings, published in the Journal of the Royal Society Interface today, reveal how cleaner air kills the virus significantly quicker and why opening a window may be more important than originally thought. The research could shape future mitigation strategies for new viruses.
[...]

To conduct the research, the team used a next generation bioaerosol technology instrument that they developed called CELEBS (Controlled Electrodynamic Levitation and Extraction of Bioaerosols onto a Substrate), that allowed them to probe the survival of different SARS-CoV-2 variants in laboratory generated airborne particles that mimic exhaled aerosol. They examined how environmental factors, such as temperature and humidity, particle composition and the presence of acidic vapors such as nitric acid alter virus infectivity over a 40-minute period.

Through manipulating the gaseous content of the air, the team confirmed that the aerostability of the virus is controlled by the alkaline pH of the aerosol droplets containing the virus. Importantly, they describe how each of the SARS-CoV-2 variants has different stabilities while airborne, and that this stability is correlated with their sensitivities to alkaline pH conditions.

The high pH of exhaled SARS-CoV-2 virus droplets is likely a major driver of the loss of infectiousness, so the less acid in the air, the more alkaline the droplet, the faster the virus dies. Opening a window may be more important than originally thought as fresh air with lower carbon dioxide, reduces acid content in the atmosphere and means the virus dies significantly quicker.

(As a side note, if this is also true of influenzas, it would be yet another mechanism to explain the findings of William Brooks in his Oct 1918 article in The American Journal of Public Health, "The Open Air Treatment of Influenza" (also at https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.8.10.746 - this one a textual PDF, not just image): that the Spanish Flu patients hospitalized in the tent hospital on Corey Hill fared better than the ones hospitalized indoors.)

Freshening the air isn't the only way to reduce the acidity of the air:

Dr. Haddrell added, "Our results indicate that the high pH of exhaled aerosol drives the loss of viral infectivity. So, any gas that affects aerosol pH may play a role in how long the virus remains infectious in the air. For example, bleach gives off acidic vapor that may increase SARS-CoV-2 stability in the aerosol phase. Conversely, ammonia which gives of alkaline vapor may have the opposite effect."

Nor is that all they found. Here's the actual paper:

2023 June 21: Journal of the Royal Society Interface: "Differences in airborne stability of SARS-CoV-2 variants of concern is impacted by alkalinity of surrogates of respiratory aerosol" by Allen Haddrell, Mara Otero-Fernandez, et al.

[...] Using a next-generation bioaerosol technology, we report measurements of the aero-stability of several SARS-CoV-2 variants of concern in aerosol droplets of well-defined size and composition at high (90%) and low (40%) relative humidity (RH) upwards of 40 min. When compared with the ancestral virus, the infectivity of the Delta variant displayed different decay profiles. At low RH, a loss of viral infectivity of approximately 55% was observed over the initial 5 s for both variants. Regardless of RH and variant, greater than 95% of the viral infectivity was lost after 40 min of being aerosolized. Aero-stability of the variants correlate with their sensitivities to alkaline pH. Removal of all acidic vapours dramatically increased the rate of infectivity decay, with 90% loss after 2 min, while the addition of nitric acid vapour improved aero-stability. Similar aero-stability in droplets of artificial saliva and growth medium was observed. A model to predict loss of viral infectivity is proposed: at high RH, the high pH of exhaled aerosol drives viral infectivity loss; at low RH, high salt content limits the loss of viral infectivity.

There's lots in this paper, and I've only just begun to read it. Maybe more later! Thought I should get this out, so it gets out at all.

2023 June 10:

nohaaboelatamd on Twitter, https://twitter.com/NohaAboelataMD/status/1667409023963140096:

I've been wondering why I never see ads for masks for covid. I'm guessing this explains it in part? It'll be interesting to see what's next in the commercialization of the pandemic response.

Transcription of relevant part:
"Dear Advertiser,

Google will be removing restrictions on coronavirus (COVID-19) content under our Sensitive events policy in June 2023. Ads that contain COVID-19 related terms will no longer be restricted, including ads for certain types of face masks, vaccines, and other COVID-19 related products and services..."

1.

May be US only, not stopping to check:

brainwane alerted me to the fact that Lucira home tests – these aren't the cheap drugstore antigen tests, but the fancy molecular/NAAT rapid tests which usually sell for about $75 – are available from Vault Health for $12.50, AND there's an additional 25% off discount code, "SPRING23". Why the fire sale prices?

The catch is that these are tests with expiration dates in July. But if you have exposure risks this summer, this is actually an excellent deal.

[...]

Lucira was just acquired by Pfizer and has paused producing the tests; the Lucira customer service rep told me that they do plan to resume production but he couldn't give me an exact date.

Also, poking about the site I discovered they are also liquidating their stock of conventional antigen test, Flowflex, for just $4.50 ea, because they're expiring in "less than 4 months".

I don't know if Vault Health ships outside the US. They charge $12 for shipping orders under $50, and free over that; they have an expedited option for money.

She also tells me another source of the Lucira tests is Peach Medical, selling ones that expire in July for $35, and ones that expire in October for $45. Don't know anything about them

2.

International:

She passed along this:

Here is the info on rapid tests from K, "the cheap rapid tests are at maskwholesale.eu the more tests you buy, the cheaper shipping comes out to be, so if you order over 120 tests, they end up being around $1 each. My friend J recommends Green Spring brand tests based on the data they have found." J is immunocompromised, so K trusts their research into this stuff, but you can of course verify. The shipping may be a bit high for individuals, but it worked out well for the bulk order for our house.

They ship world-wide via DHL. They're selling, e.g. Flowflex for EUR 0.83 each (less for bulk orders!) while shipping to the US or Canada is about EUR 50 for up to 10kg (EUR 20 within the EU, EUR 35 to the UK, EUR 65 to AU). They have many, many brands and types of tests, including combined Covid + Influenza A/B tests(!).

No idea about expiration dates. This could be a great deal for a group of people or kitting out a convention. In addition to individually boxed tests, they also have tests by the case.

Canonical link: https://siderea.dreamwidth.org/1805095.html

There are two kinds of truth. One of them we can call social truth: there are things that are so, simply because we agree, in our society, that that is so.

( Read more [5,220 Words] )

This post brought to you by the 159 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!

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0.

I wrote a series, The Great Age of Plagues, setting out the case for expecting a dramatic increase in the rate of infectious disease outbreaks. I was asked what advice I had for dealing with what is coming.

I thought a lot about this, and I wrote a lot about it, and I eventually came to realize that what I really had to say about it is this.

( I would propose that the most important asset for surviving in the world as it is becoming rests between your ears. (Read more [5,380 words]) )

This post brought to you by the 159 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!

Sibylla Bostoniensis

Everything Unravels, Everything Will Fade

Business as Usual [COVID, labor, ethics, P/A/S, Patreon]

US free COVID test program to end Friday [COVID, US]

So this dude from Germany got 217 Covid vaccine shots [COVID-19, sci/bio/med]

Covid and the Dose-Response Relationship [Covid, Sci/Bio/Med, Patreon]

Interesting "Where are they now?": Dr. Deborah Birx & Chris Cuomo [COVID-19]

National US Free Paxlovid Telehealth Service [COVID-19, US]

Covid and RSV [sci/bio/med]

Covid + immune dysregulation research news [Covid, sci/bio/med]

Long Colds [sci/bio/med, Covid]

Boosted [me, Covid]

Super Germy Out There Right Now [COVID]

Study finds Long Covid characterized by immune disreg [sci/bio/med]

Covid exhalate drops only after 8th day of infection [COVID, sci/bio/med]

Long Covid: the acidosis/alkalosis hypothesis [COVID, sci/bio/med]

Study: dehydration during acute Covid predictive of physical Long Covid [COVID, sci/bio/med]

Aerosol SARS-CoV-2 found sensitive to pH, CO2 is acidic [COVID, sci/bio/med]

Google was apparently suppressing PPE and vaccine ads [el goog, COVID-19]

Cheap Good Covid Tests [COVID-19]

The Two Truths [p/a/s, Patreon]

Thinking about Survival in the Great Age of Plagues [p/a/s, pestilence, Patreon]

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