week ending 2022-10-13 General – COVID-19 in British Columbia

There seem to be an unusually high percentage papers and articles this week which I’m bored with. Things like:

Oh look, the pandemic is not over!
Huh, boosters actually do work!
Yes, vaccines are safe for pregnant women (and COVID-19 is really bad for pregnant women).
Myocarditis in young men is a rare, mild side effect, and is much more benign than myocarditis from a COVID-19 infection.
Bummer, intramuscular vaccine effectiveness wanes.
That permission to leave isolation after five days? Yeah, that’s totally bogus.
Here’s a deeply technical paper which would be a bitch to explain, and it shows good results in Golden Syrian hamsters but that might or might not ever translate to good results in humans.
Here’s a really interesting paper which touches on many facets of Very Important Subject, so many that it’s impossible to summarize in a paragraph. (Those go into the Recommended Reading section.)
There’s a geographical area outside of BC which is really getting slammed/starting to get slammed by COVID! (See, for example, Ontario, Quebed, Germany, Austria, …)
There’s an epidemic of some other virus happening! (See, for example, monkeypox, ebola,

I am still summarizing Long COVID papers (even though we know it’s real and a problem, so that’s kind of boring) because papers have had such wildly different findings that I want to keep showing them all. (Me I believe that Long COVID affects between 3-5% of people who catch COVID, and about 1% are basically disabled for basically forever.)

Long COVID

This preprint from USA found that people with Long COVID were missing essentially all of their interferon-gamma and interleukin-8, and were low in five other interleukins. They think that “immune exhaustion” is why. However, this preprint from USA seems to say that interleukin-8 is elevated, and I’m not good enough to say which paper looks correct.

Yet another paper, this one from Scotland, says that Long COVID is real and bad. It was a really big study (~100K people), and while it was a survey study, it had a solid control group. It said that 6% of people had not recovered by 18 months, and 42% had only partially recovered.

There were some scraps of good news:

If you had an asymptomatic infection, you were unlikely to get Long COVID.
Vaccination reduced the risk of various symptoms:
- loss of smell (42% lower)
- loss of taste (61% lower)
- poor appetite (28% lower)
- balance problems (29% lower)
- confusion/difficulty concentrating (28% lower)
- anxiety/depression (24% lower).

Worryingly, they found a cohort of 11% which kept getting worse. 😬

Here’s a mass-media article on the study.

This preprint from Denmark found that the risks of Long COVID symptoms were different during Omicron and Delta. Post-infection symptoms that were clearly more common in Delta were (with the risk difference in parentheses):

Loss of smell (15.1%)
Taste disorder (11.6%)
Fatigue (4.0%)
Shortness of breath (3.0%)
Headache (3.9%)
Runny nose (2.2%)
Sore throat (2.2%)
Reduced in strength legs/arms (2.1%)

The only symptom which was more clearly more common in Omicron than Delta was anxiety, with a relative risk difference of 3.9%.

They also looked at Omicron risk vs. never-infected controls. Symptoms which were clearly worse in people who had Omicron vs. controls (with the risk difference in parentheses) were:

Fatigue (5.2%)
Shortness of breath (4.8%)
Sleeping legs/arms (3.0%)
Loss of smell (2.9%)
Runny nose (2.8%)
Dizziness (2.7%)
Headache (2.7%)
Reduced strength in legs/arms (2.5%)
Red runny eyes (2.4%)
Hot flushes/sweat (2.4%)
Screwed up taste (2.3%)
Sore throat (1.8%)
Cough (1.7%)
Chest pain (1.4%)
Chills (1.3%)
Fatigue (measured by the DePaul Symptom Questionnaire)(5.3%)
Fatigue (measured by Fatigue Assessment Scale) (5.0%)
Cognitive complaints (2.8%)

Getting an mRNA booster dropped the risks (vs. 2 mRNA doses) for almost all of the symptoms, although the error bars were high enough that you can’t say so clearly except for:

Reduced appetite (1.7%)
Chills (1.9%)
Loss of smell (2.0%)
Sleeping legs/arms (2.3%)
Messed up taste (2.4%)
Cough (2.5%)
Chest pain (2.6%)
Headache (2.9%)
Dizziness (3.2%)
Reduced strength in legs/arms (4.2%)
Depression (3.7%)
Anxiety (4.9%)
Fatigue – DSQ (6.2%)
Fatigue – FAS (6.3%)
Difficulties concentrating (1.4%)
Memory issues (1.4%)
Mental exhaustion (1.6%)

This preprint from the USA says that pre-infection vaccination cuts Long COVID risk by about 40%.

This paper from Canada has found yet another biomarker for Long COVID. This one has classification accuracy of 96%, using two markers (ANG-1/P-SEL) for new blood cell growth.

Mitigation Measures

This study from the UK set out to see if rapid-test-to-stop-isolating was almost as good as a fixed ten-day isolation period. Much to my surprise, the test-to-emerge had a lower household transmission rate than the ten-days-to-emerge group (especially since the test-to-emerge got to emerge after seven days, regardless of what their test said).

I suspect that what’s going on is that ten days is a really long time to stay isolated, and so people would despair — and cheat. The people in the other group, however, could keep telling themselves that maybe tomorrow they’d be sprung, and that would give them the mental fortitude to keep isolating.

Vaccines

This article reports that Health Canada has approved Pfizer’s bivalent BA.4/5 vaccine.

This paper from the UK says that a nasally-delivered version of the AstraZeneca vaccine was pretty worthless. I am having a sad about that.

This paper from Moderna (probably with trial participants from the USA) says that a bivalent Moderna vax with Covid Classic and Beta (remember Beta? Which hit South Africa hard but not really anywhere else?) gave higher antibodies than the Moderna COVID Classic booster against COVID Classic, Beta, Omicron BA.1 and Delta:

Pfizer is in the middle of a Phase 2/3 study on it’s bivalent BA.4/5 booster, and issued a press release saying vague things about BA.4/5 provoking a better immune response after seven days than the Pfizer Classic, but they didn’t say how much. They promise more data in the coming months.

Influenza

I’m going to start posting a small amount about influenza shots, because BC is promoting getting your flu shot at the same time as your COVID-19 shot, and people have been asking me about the wisdom of doing that.

Let me get this out of the way: your immune system does not care if you get your flu shot at the same time as your COVID-19 booster. Studies say both your flu and COVID-19 shots are equally effective. You can get them both in one arm and have one arm with no pain, or spread it over two different arms, it’s fine.

Is it wise to get a flu shot right now? Probably. BC hasn’t started publishing flu information yet, but

The flu shot wanes also (see e.g. this report), by about 5-10% per month so you want to get it about two weeks before the shit hits the fan.
The US CDC’s chart shows a recent steep increase in positivity and a slightly less steep increase in the absolute number of cases.
Note that while we used to have a good idea of when “flu season” was, that’s all gone out the window due to nobody getting flu in winter 2020-2021 (because of COVID-19 mitigation measures). There was a peak at the end of 2021, just like normal… but then there was a big fat wide peak between April and June, and that’s totally bizarre.

Thus it is completely possible that if you get a shot right now, it won’t protect you from a wave in May. However, WE DON’T KNOW what May will bring, and it does look like November will bring flu.

Good news: the vaccine is a really good match this year for what is circulating. It’s almost all subtype A, and nobody has seen the B-Yamagata family since April 2020. (That doesn’t mean it’s not out there, but it hasn’t gotten reported.)

(What is the difference between this graph and the one above it? The source of the data. I don’t understand completely, but the US CDC flu surveillance page says that they use the top graph to tell “how much?” and the bottom to tell “what kind”.)

Variants

You might hear chatter about “Pentagon” variants. No, these are not variants developed in secret US labs. These are variants which have independently evolved a specific set of five mutations.

Pathology

This article (referring to this paper from the UK) says that they have found a gene which makes you less susceptible to COVID-19. Interestingly, it’s not that it changes the shape of the ACE2 receptor or something like that so SARS-CoV-2 can’t get into the cells, it’s actually something which boosts the immune system: people with the useful gene had higher antibody levels after vaccination. (The useful version of DQB1*06 is found in ~40% of people in the UK.)

This paper from Qatar found that people who had gotten an infection pre-Omicron and then an Omicron infection were less likely to get re-infected after that than people who had only gotten an Omicron infection. This is important because it argues against antigenic imprinting. (There are some diseases where catching strain A makes you less able to fight off strain B; that’s called antigenic imprinting or “original antigenic sin”. This article gives evidence that that’s NOT happening with COVID-19.)