COVID
Long COVID
This article from Poland (2024-05-08) reports on a conference presentation which found that people with Long COVID have much lower immunoglobulin gamma antibodies against the nucleocapsid. They theorize that could mean the virus (or viral components) could hang around longer in the body.
This paper from Italy (2024-05-07) found that children with Long COVID tested lower on cardiopulmonary exercise testing (e.g. peak VO2) than controls.
This article from China (2024-12-25) found that people who got both an influenza vaccine and a COVID-19 vaccine had a lower risk of getting Long COVID than those who only got a flu shot. Compared to people who got both shots, the risks (adjusted for age and sex) were:
- 72% higher for those who only got a COVID-19 shot;
- 119% higher for those who only got a flu shot;
- 88% higher for those who didn’t get either shot.
I don’t know why not getting either is lower risk than getting a flu shot but not a COVID-19 shot. Maybe
- people who had logistical difficulties getting a shot took mitigation measures because they knew they were vulnerable, while
- the people who only got a flu shot were logistically able to get shots but actively rejected a COVID-19 shot because they didn’t believe in COVID-19 and so didn’t take any mitigation measures?
It might be important to note that this was in China, where the COVID-19 vaccinations were (IMHO) not as effective as the mRNAs, plus a lot of elderly people in China did not get vaccinated per this article (2022-04-02) and this article (2022-02-19). One big problem is that the Chinese vaccines were tested elsewhere (because rates were so low in China (due to zero-COVID measures)), in countries with populations a lot younger than China. That meant that initially, they didn’t have a lot of data on elderly people, so the vaccines were only offered to people under 60. That meant that a lot of elderly people (and doctors!) got the impression that the vaccines were bad for people over 60, so they shied away from them. Sigh.
This paper from Canada (2024-04-29) found that women with Long COVID had lower levels of neutralizing antibodies to COVID-19 than controls, but higher levels of two inflammatory cytokines. Both things point to a continued COVID-19 infection.
COVID-Related Excess Sickness and Death
This press release from Korea (2024-05-11) reports on research which found that among people who had had heart failure, those who had two or more COVID-19 shots had an 82% lower risk of all-cause mortality, a 47% lower risk of hospitalization for heart failure, and a 13% lower risk of COVID-19 infection compared people who had one or zero doses.
This paper from USA (2024-05-09) found that people who gave birth in 2020 had and had COVID-19 had more pregnancy complications than those who did not have COVID-19. Interestingly, people who did not have COVID-19 and gave birth in 2020 had fewer complications than those who gave birth in 2019. (Maybe because they had lower exposure to other viral infections?)
This paper (2025-05-14) found that mice and human cells in test tubes which were deliberately infected with SARS-CoV-2 became more susceptible to Parkinson’s Disease.
This paper from UK (2024-05-08) reports that an unusually high number of cases of an obscure auto-immune disease showed up in England and correlated with COVID-19 waves there, even in people who didn’t think they’d ever gotten COVID-19 (i.e. asymptomatic/mild cases). (This article from USA (2024-05-09) says that it’s happening in the US as well.)
The disease, anti-MDA5 (Melanoma differentiation-associated protein-5) is bad. It can look like rash on the palms and muscle pain, but it also causes a fast-moving interstitial lung disease (ILD) that is usually fatal.
The innate immune system isn’t as deadly as the adaptive immune system, but because it doesn’t need to get trained up, it’s much faster. It does so in part with proteins called pattern recognizer receptors which are pretty good (not great, pretty good) at recognizing viruses in general. (The metaphor use is that, the adaptive immune system has looked at the WANTED poster and can identify the exact bad guy, while the innate system just keeps an eye out for people looking shifty with a bulge under their coat.) MDA5 is a pattern recognizer receptor in the innate immune system, and anti-MDA5 is a disease where the body’s antibodies glom onto the MDA5 molecules. From what I understand (disclaimer! I am not an immunologist!), the antibody glomming on triggers the MDA5 in the exact same way that a virus triggers it — making the MDA5 start screaming that it found a virus help help help help help! This causes the immune system to charge in hard — with negative consequences for the person using the body.
Further disclaimer: I am not sure that my mental model is correct, especially since a treatment for COVID-19 which works really really well in mice (per this paper) is to activate RIG-I, which is a closely-related pattern recognizer receptor. The difference might be in when/how long the pattern recognizer receptor screams for help. The RIG-I agonist (<- i.e. “thing which turns it on”) is used to stimulate an interferon early in the disease cycle, when there are lots of viruses to attack. Anti-MDA5 disease (I think!) happens after the viruses are gone, when the innate immune system doesn’t have bad guys to attack (so all it does is cause collateral damage).
Autoimmune diseases are a bitch to treat, in part because the body keeps making antibodies for as long as there is something the immune system thinks is not supposed to be there. That means that it is very worrying that there is a correlation between anti-MDA5 and COVID-19. Correlation does not imply causation, but sometimes correlation does come from causation.
This paper from USA (2024-05-14) found that COVID-19 can make people more susceptible to mouth fungus. (Yeah, ick.)
This paper from China (2024-05-09) found that people who had had COVID-19 infections scored worse on a battery of cognitive tests than controls — and the mild COVID-19 cases didn’t do any better than the severe COVID-19 cases.
Pathology
This paper from USA (2024-05-14) on pre-vaccination outcomes found that 18% of hospitalized COVID-19 patients and 44.2% of ones admitted to ICU died. Men had higher case hospitalization rates (CHRs) (6.2%) than women (5.2%) and men died more (1.9%) than women did (1.5%). The CHR for people 74 to 84 years old was a whopping 25.9%, while their case fatality rate (CFR) was ~12%. The CFR for people over 84 was 23.6%. (CHR is the percent of people who catch something who then get hospitalized, CFR is the percent who die.)
COVID-19 is not the flu, episode #293,849,274: this study from USA (2024-05-15) found that people hospitalized with COVID-19 in winter 2022-2023 were 60% more likely to die than people hospitalized in the same period with influenza, and 35% more likely in winter 2023-2024.
Vaccines
This preprint from Scandinavia (2024-05-09) found that in the fall/winter 2023-2024, at twelve weeks from vaccination, the XBB boosters were
- 60.6% effective against hospitalization;
- 77.9% effective against death.
This paper from China (2024-05-09) studied the effectiveness of college-age people nagging encouraging their grandparents to get a COVID-19 booster. Grandparents who the students encouraged were twice as likely to get a booster as grandparents with non-encouraging grandchildren.
This paper from USA (2024-05-14) is paywalled, but I got a copy from the author. The paper goes through a LOT of different of different combinations of Moderna vaccines, and looks at the effect of the which the patients got first on later antibody neutralization, or imprinting.
Imprinting is a well-known sometimes-thing in immunology: if you get some immunity to strain X.1 (either from vaccination or infection), then a vax against X.2 might not get as good immunity against X.2 than you would have if you only got an X.2 vax. Think of it this way: if the first fight training you got was club training, you’ll might try to use club techniques against a knife, which might not be as effective as if you’d gotten training against spearmen directly. Or, as my beloved spouse put it, “you’re fighting the last war”.
Back to the paper. The paper looked to see if blood from people who had mixed vaccinations — say X.1 first, then X.2 — had antibodies that were specific only to X.2 or antibodies that worked against both X.1 and X.2. Did they take the shields they made to use against the clubs and make it bigger, or did they make some club shields and some brand new armour? They found that the antibodies did the former: the blood had improved X.1 antibodies instead of additional X.2 antibodies.
While I didn’t see quantitative information on how good same-vax series were compared to different-vax series, they did say that antibodies in blood from people vaccinated with
- COVID Classic, then
- COVID Classic, then
- COVID Classic, then
- COVID Classic + BA.5 bivalent, then
- XBB.1.15 monovalent
had some effect against other strains — including SARS1 and a pangolin coronavirus! (Alas, they didn’t neutralize MERS at all.)
Bottom line: it looks like getting vaccinated with all-the-same-variant gives you stronger protection against that variant, but getting a bunch of shots different strains gives you weaker but broader protection.
Treatments
Good news! Remember Evusheld, the antibody shot that immuncompromised people could take to prevent COVID-19 sort of like a vaccine, which stopped being effective when XBB.1.5 showed up? Well, this press release (2024-05-16) says that a phase three trial of sipavibart found that it works with more current variants!
Testing
This press release from US FDA said that people should stop using the Cue Nucleic Acid Amplification COVID-19 test. Cue was naughty: they changed things and didn’t tell the FDA they were doing so (and didn’t provide any data which justified the changes).
Mitigation Measures
This paper from UK (also see the press release) (2024-05-15) looked at biweekly PCR between 21 November 2021 and 7 May 2022 tests of a sample of the population, coupled with survey questions about the participants and their behaviour. They found lots of things, many of them counter-intuitive to me, but the one that’s getting the headlines is “masks didn’t work” for Omicron.
However, they did find that before the second wave of Omicron (BA.2), “never wearing” a mask increased the risk of getting COVID-19 by about 30% for adults and 10% for children over “always wearing”. However, by the second Omicron wave, masking didn’t reduce the risk.
The authors had three theories about that:
- The people who didn’t wear masks were all infected in the first Omicron wave, so had immunity for the second Omicron wave.
- Masking was good enough to stop Delta, but Omicron was so infectious that it wasn’t good enough to stop Omicron. Note that “masking” didn’t distinguish between cloth masks, “baggy blues”, and N95s. What we might be seeing is that cloth masks and “baggy blues” were adequate to stop Delta, but not Omicron.
- “Wearing face coverings became less expected after the announcements that COVID-19 restrictions were being lifted” (which happened around 1 March 2022).
Recommended Reading
This essay gives background on why people should not ignore COVID-19. If you are a regular reader of this blog, you won’t need to read this, but if you came looking for something to help you explain to someone else why you are still cautious, you can send them this link.
H5N1
Transmission
Cook your beef! This report from the US FDA (2024-05-16) found that cooking burgers to 145F (medium) or 160F (well done) killed off all H5N1, but cooking to 120F (rare) only killed most of it.
This twitter thread does a nice job of explaining why H5N1 is not scary at the moment. It cannot both have a fatality rate of 50% and be widespread-but-so-far-undetected. If it were both, we’d be seeing lots of dead people… and we aren’t.
This article from California (2024-05-11) reports that many raw-milk enthusiasts are ignoring the FDA’s guidance to stay away from raw milk (despite half the cats which drank raw milk dying!). Not only that, there are apparently quite a few people phoning up raw milk suppliers asking for raw milk hoping to get immunity to H5N1 from it!
Testing
The US CDC made a national wastewater dashboard to track influenza. While they are not breaking out H5N1 separately, there are very low levels of “normal” influenza right now. Thus, any place with high levels of influenza A in the wastewater is suspect. (We still won’t be able to know if it is coming from humans, cow feces, or dumped milk, however.)
This preprint from USA (2024-05-10) says they found H5N1 in the wastewater of nine Texas cities, from March 4th to April 25th, 2024. It isn’t clear what animal the H5N1 came from, but other commentary suggests it’s likely not humans, as it doesn’t seem to have human-specific genetic changes.
This article (2024-05-15) reports that the count stands at 49 infected herds in nine states.
Recommended Reading
This article from USA (2024-05-17) has an in-depth discussion of why testing at dairy farms is so hard. Spoiler: it’s not technical or logistical, it’s about the money.