2024-01-05 General – Pandemics in British Columbia

Someone in the US tooted that there are 1000 COVID-19 deaths per week there, and is kind of incredulous that people don’t take it more seriously. “If I were to tell you that 5 to 10 airliners would fall from the sky every week, half of the US wouldn’t set foot in a plane.”

I don’t think that’s true. There were 825 motor vehicle fatalities per day in the USA in 2022, and people still get into cars all the time.

I didn’t learn about the Spanish Flu of 1919 until I was well past the age of majority, even though my grandparent’s generation would have lived through it. I always wondered why there was this collective amnesia about it. Partly there were other things going on (like, you know, The Great War). But I understand there was the same kind of rancor and divisiveness then around the pandemic. They didn’t have anti-vaxxers (because they had no vax), but they certainly had anti-maskers. Maybe the societal divisions were so strong that everybody stopped talking about it because you never knew if mentioning it was would precipitate a big argument?

Or maybe it’s just that people couldn’t remember much? Many (most?) people apparently have few strong memories of the early COVID-19 days because it was really boring. (I once met a Dutch woman who had spent time in WW2 in a Japanese prison camp in Indonesia. When I asked her what it was like, she said, “Boring!”)

Testing

I want to remind you that the rapid tests by BTNX (the “green box” ones) falsified results to get approved, and they turn out to be pretty shit for lower levels of virus. Use the “blue box” ones instead. (Here’s an article.)

Long COVID

This paper from Germany found that ME/CFS patients and Long COVID patients had very similar self-reported symptom profiles compared to controls:

This preprint from UK (2023-12-24) found that people with Long COVID cost the health system 43% more than comparable controls.

This paper from Denmark (2023-12-28) found that people who had been hospitalized with COVID scored worse on brain health than regular controls, but weren’t actually any worse off than people who had been hospitalized for other things.

This paper from UK (2023-12-26) estimates that the productivity loss in the UK up to 13 February 2023 due to Long COVID was £5.7 billion (CAD$9.63 billion).

This tweet reports that in a meeting, the US National Institute of Health announced in a meeting that RECOVER, the big Long COVID research grant, got another USD$200M of funding. It’s a little strange because I have not been able to find corroboration, and governments usually loooooove to shout about investing in anything. If the announcement is true, that’s great news (though a friend thinks that they should give it to anybody but RECOVER, since RECOVER botched their first billion so badly!).

This paper from Netherlands (2024-02-04) found that they can see and measure the causes of post-exertional malaise (PEM) — the thing that many Long COVID patients get where they don’t recover like normal people after exercising. Muscle biopsies show visible damage, including amyloid deposits. So yet again, Long COVID is real, PEM is real, it’s not just people slacking off!

This paper from USA (2024-01-03) classified formerly hospitalized COVID patients into four types based on survey responses: no or minimal significant symptoms, mostly physical symptoms, mostly mental/cognitive symptoms, and multidomain (i.e. both physical and mental/cognitive domains). They found that different symptom types had different markers:

People with lots of physical symptoms (i.e. classified into the physical OR multidomain buckets) had had higher viral loads and lower neutralizing antibodies during the acute phase;
People with lots of mental symptoms (i.e. classified into the mental/cognitive or multidomain buckets) had had higher levels of fibroblast growth factor 21 (FGF21) (no, I don’t know what that is, either).
People classified into the multidomain bucked had had lower levels of B cells during the actute phase of the disease.

This paper from USA (2024-01-04) found that they were unable to find an effect of Paxlovid on the chances of getting Long COVID and neither did having Paxlovid rebound, at least not in vaccinated, unhospitalized patients. (Paxlovid did appear better, but it was not a statistically significant difference. I wonder if the study was just underpowered? Sorry, but I’m not going to dust off my stats textbooks to figure that out.)

This paper from Sweden (2024-01-05) found that 3% of people who had gotten COVID-19 diagnoses were on sick leave for at least a full year afterwards.

This paper from Germany (2023-12-10) found that 13.1% of adults who had a positive COVID-19 test between October 2020 and April 2021 had an impaired ability to work compared to their pre-pandemic abilities.

Pathology

This paper from Brazil (2023-12-05) found that babies whose mothers had COVID-19 while pregnant were 3.4 times as likely to have a diagnosed neurodevelopmental delay in their first year as controls.

This paper from Germany (2024-01-02) found that risk factors for hospitalized pediatric COVID patients going into ICU were obesity, neurological/neuromuscular diseases, genetic defects (e.g. Down’s Syndrome), and coinfections.

This article referencing this paywalled paper from USA (2023-12-30) reports that during the BA.5 period, people hospitalized with COVID-19 had more severe outcomes than people hospitalized with the flu. However, only people aged 18 to 49 died more from COVID-19 than from the flu; older and younger age groups had basically the same mortality from both COVID-19 and influenza.

This paper from Italy (2023-12-15) found that healthcare workers who had been infected with COVID-19 in 2020 or 2021 (but not 2022, oddly) measured worse on various lung function tests (Forced Vital Capacity divided by Forced Expiratory Volume 1, and Peak Expiratory Flow) than those who had not been infected. Furthermore, those who were vaccinated did significantly better than those who were not vaccinated.

This paper from USA (2023-12-25) found that people who had pre-existing Traumatic Brain Injury, Multiple Sclerosis, or Spinal Cord Injury had a 22% higher chance of catching COVID-19 than controls. They were 54% more likely to develop new weakness, 66% more likely to develop new mobility issues, and 79% more likely to develop cognitive problems than controls. There was no difference in hospitalization, length of stay, total hospitalizations, six-month all-cause mortality, fatigue, pain, or shortness of breath.

Transmission

This paper from Hong Kong (2024-02, first published 2023-01-02) says that 72.1% of Omicron cases were asymptomatic. They observe that such a high fraction of asymptomatic cases made controlling the spread difficult.

Treatments

This paper from USA (2024-01-04) was designed to study Long COVID (see above), but buried in the paper, it mentioned that 21% of vaccinated, non-hospitalized people who took Paxlovid had rebound symptoms, and 25.7% of participants who regularly took rapid antigen tests had measured-positivity rebound. (They did not report how many of the people who did not take Paxlovid had any rebound.) This conflicts with this paper from USA (2023-12-30) that I talked about in the previous General post.

Mitigation Measures

This paper from USA (2023-12-11) found that probiotics were a useful prophylactic against COVID. They took people who had a known exposure less than seven days earlier (usually household members), and had half of them take Lacticaseibacillus rhamnosus GG (LGG) for 28 days. The ones who took LGG got symptoms about 40% less often than the controls. The study was too small to definitively say if it decreased the risk of getting diagnosed with COVID-19, but they were able to conclusively say that the time to diagnosis was statistically significantly longer for the LGG group.

Vaccines

This preprint from USA (2023-12-28) found that people who got the Moderna XBB 1.5 vax had relative risks (compared to not getting an XBB 1.5 booster) as follows:

63% lower risk of being hospitalized;
58% lower risk of being admitted to ICU
58% lower risk of an outpatient visit.

Importantly, they also found that people who had never been vaccinated and those who had only been vaccinated with the older, pre-XBB 1.5 vaccines had comparable risk profiles, including for hospitalization. Folks, stay current on your vaccinations!

NB: These data do not split out people who have had COVID-19 infections from those who have not. A recent infection probably provides some immunity.

Variants

People have wondered where new variants come from, and one of the leading conjectures was that strains evolved in immunocompromised people who never shook the virus, so it could keep evolving. Well, in this paper from South Africa (2023-12-28) they monitored virus in one such long-term infection and caught it in the act: yes, it evolved into something more dangerous. 🙁

Unforeseen Side Effects

This paper from USA (2024-01-03) found that pediatric urinary tract infections dropped by about a third, without an increase in measures of disease severity. This suggests a possibility that pediatric UTIs were over-diagnosed (as misdiagnoses?) before the pandemic.