week ending 2022-12-02 General – COVID-19 in British Columbia

This is a day late because the province didn’t have numbers ready yesterday, so I did other things.

Mitigation Measures

According to this post on a Twitter web page, as of 23 November, Twitter will allow COVID-19 disinformation.

This paper found that in Canada, Pakistan, and Israel, N95-class masks worked significantly better than medical masks — ~1.5x in Pakistan and Israel and 2.8x in Canada. In Egypt, the N95s .95x as effective as medical masks. That of course makes me wonder what was going on in Egypt!

Long COVID

This paper from the USA used machine learning to classify Long COVID patients, and it found four different groups:

Cardiac and renal (a quarter to a third);
respiratory, sleep, and anxiety (around a third);
musculoskeletal and nervous system (just under a quarter);
digestive and respiratory system (just over 10%).

This paper from Switzerland found that on a survey filled out by parents, 9.1% of COVID-seropositive kids and 5.0% of COVID-seronegative kids had various symptoms over twelve weeks (a prevalence difference of 4.1%). It was worse for adolescents, with a prevalence difference of 8.3%.

Something that bugs me is the really high rate of symptoms in seronegative kids, i.e. kids that presumably never had COVID! What is making the kids so sick? Or are the surveys that unreliable?

Vaccines

This paper from the USA describes how they made an mRNA vaccine with all twenty (count them! twenty!) different influenza subtypes. The vax protected mice and ferrets really well from all the different influenzas.

If it works for influenza, maybe it will work for COVID-19!

This paper with data from Denmark, Sweden, Finland, and Norway found that:

A Pfizer booster on top of one AZ shot+one Pfizer was significantly better than one AZ+one Pfizer (i.e. no booster) (Not a surprise.)
A Moderna booster on top of two Pfizer shots was significantly better than no booster. (Not a surprise.)
A Pfizer booster on top of one AZ+one Pfizer was about the same or slightly better than three Pfizers.
A Moderna booster on top of two Pfizers was usually a bit better than a Pfizer booster on top of two Pfizers.
A Pfizer booster on top of one AZ+one Pfizer was usually slightly better than three Pfizers.

This paper from Sweden found that mRNA intramuscular vaccinations induced low but long-lasting levels of IgA in spit. The levels were low because it was intramuscular and not mucosal, but it’s encouraging that they were long-lasting. That gives me hope that a mucosal vaccine could maybe give high levels of long-lasting antibodies at just the place (the respiratory mucosa) that they are needed!

This paper is dense and technical and hard to summarize (in part because I don’t understand all of it), but I have the sense that it’s really important. The researchers took a lot of data from blood samples from a lot of studies with a lot of different vaccines, before and after vaccination, to try to figure out why some people generated a lot more antibodies than others. They found that people with high pre-inflammatory innate responses before vaccination did better. From the blood signatures, they think that one way the pre-inflammatory innate responses gets boosted is from a bacterial infection. They think that people exposed to lots of bacteria (i.e low- and middle-income country’s populations) might respond better to vaccination.

They made a passing mention to adjuvants, but maybe this explains some of why adjuvants improve vaccine response? Maybe the adjuvants irritate the inflammatory system and thus make the vaccine more effective?

Pathology

This preprint from Austria and the USA found that they could find COVID-19 in lung tissue as long as 359 days after the acute phase of the disease, including in people who tested negative via nasal swab.

This study from the USA, done with electronic records, found that 19.2% of RSV-infected children had been infected before with COVID-19, while 9.7% of RSV-infected children had not been infected with COVID-19. Note: while they easy thing to say is “COVID-19 makes kids more vulnerable to RSV!”, it might be that there is something about those kids that makes them more susceptible to viruses in general. It would be interesting to do a similar comparison with influenza/COVID and influenza/RSV.

Transmission

Last week, I mentioned a study which estimated that 94% of Americans had gotten COVID-19. That was so high, it was hard for me to believe it, so I went looking for seroprevalence studies. This page covers multiple seroprevalence studies, and yeah, a shitton of Americans have been infected with COVID-19 by now. (Orange is antibodies generated from vax or infection, blue is by infection only.)

Treatments

This paper from the USA reports finding some monoclonal antibodies that work really well on a broad class of betacoronaviruses — including SARS, MERS, and two of the “common cold” coronaviruses! These target the “stem helix”, a part of the spike protein.

This Twitter thread has a list of papers which have found that COVID-19 messes up the gut biome. Some explicitly say that taking probiotics helps. Probiotics are really really cheap, really really safe, and really really easy to take, so I have explicitly added taking probiotics to my recommendations for what to do if you catch COVID-19.

This press release from the US FDA says they pulled authorization for bebtelovimab because it doesn’t do shit against BQ.1 or BQ.1.1 and those are now above 50% of the cases in the USA.

Variants

This paper says that BQ.1.1 and XBB* are really really evasive, and that even a bivalent booster doesn’t help much. The paper points out that in terms of antigenic distance (see chart below), BQ.1.1 is as far away from BA.4/5 and BA.4/5 is from COVID Classic, and that XBB.1 is farther away.

Influenza

This graph with US data shows how early the influenza season is there this year:

Testing

This article says that testing of all kinds is backed up across Canada, even for pap tests.