2024-01-12 General – Pandemics in British Columbia

In my little corner of the COVID-cautious world, there’s a real sense of bafflement as to why the whole world stopped caring. There’s a faction which is very bitter and angry at the government for deliberately misleading people in order to get us to be good little automatons and go back to economy-boosting (i.e. stock portfolio value-increasing) activities. That doesn’t feel correct to me, and so I keep wondering why everybody is so content to ignore easy mitigation measures (like masking).

Then I thought about the Before Times. I remember going to the British Museum in when I had a cold, because I didn’t want to miss the opportunity, and I didn’t think anything at all about infecting other people. I thought colds were just kind of “in the air” (so to speak!), so my going didn’t appreciably raise anybody’s risk, and besides, it wasn’t a big deal. Stuffy nose, sore throat, a little bleary, but not a big deal.

Even back then, there were immunocompromised people. I knew that, and I didn’t care. If they were immunocompromised, like if they had cancer, they should just stay home. Because “everybody” went out when sick, then immunocompromised people were already in danger from “everybody else”, and it wouldn’t matter if I went out. Instead of collective responsibility, we had collective irresponsibility.

Even back then, getting a viral infection could trash you. I knew that — I had a friend whose heart failed after getting a mild upper respiratory infection. He got a heart transplant, will have to spend the rest of his life on immunosuppresants, and will probably die within 15 years. I knew that. I had heard of a friend of a friend who caught what seemed to be a cold and died. I knew that.

So, I asked myself, is now really any different?

For me, it is.

In the before times, I didn’t know how dangerous viral infections were long-term. In the two cases I knew about, the unpleasantness happened shortly after they got infected. I didn’t know that the Spanish Flu elevated your risk of Parkinson’s. I didn’t know that Epstein-Barr virus (probably) triggers Multiple Sclerosis. I didn’t know that there is evidence Alzheimer’s is caused by/triggered by Herpes Simplex Virus 1. So now, not only do I know that COVID-19 can lead to Long COVID, but I now know about 45 other “long” diseases.
The risks are sooo much higher. Yes, I knew about the death and the heart failure that I mentioned above, but those were flukes (I thought). It seemed like those were one-in-a-million things. Now, bad Long COVID is IMHO something that happens to a really high percentage of the people who get COVID. (It’s really hard to know what fraction, but the number I personally use is 5%.)
COVID-19 also damages your body in ways which we don’t fully recognize or understand. Your risk of many nasty things — autoimmune disorders, neurological disorders, and cardiovascular disorders — goes up significantly for at least a year after you get COVID-19. (And we don’t even know what happens after five years, after ten years, after twenty years, because we haven’t had enough time with this disease.)

However, I realize that most people don’t marinate in COVID-19 research, so they don’t know. They don’t know how bad viral diseases are, they don’t know how high the risk of Long COVID is, they might not even know that Long COVID is a thing, and they don’t know how COVID-19 damages your body. So of course they would go back to behaving how they did in the Before Times.

Long COVID

This paper from UK (2024-01-05) found that people who had been hospitalized with COVID-19 scored lower on a battery of cognitive tests, equivalent in magnitude to ageing from 50 to 70 years of age. The decline was general, not so much any particular cognitive areas, and the patients had markers of traumatic brain injury. The median scores got better after their first followup (102 to 163 days afterwards) but didn’t really get much better between the first followup and the second (which I think was a year afterwards, but hard to tell from the paper).

This paper from USA (2024-01-11) found that people with Long COVID had systemic inflammation and immune system dysfunction. In particular, they found higher levels of SARS-CoV-2 antibodies and a mis-coordination between their SARS-CoV-2-specific T and B cell responses in Long COVID patients.

This paper from Spain (2024-01-11) using electronic data records from really huge datasets from UK (2 datasets), Spain, and Estonia found quite a range in effectiveness of one dose of vaccine against Long COVID compared to unvaccinated people:

54% in the first UK dataset;
48% in the second UK dataset;
71% in the Spanish dataset;
59% in the Estonian dataset.

They also found that Pfizer was 15% more effective than AZ. (I know the UK used a lot of AZ, in part due to national pride; I don’t know what the proportions were in Spain and Estonia.)

COVID-Related Excess Disease and Sickness

This article from South Korea (2024-01-10) says that alopecia areata (hair loss) is 82% higher in people who have had COVID-19 infections than those who have not. Not only that, but people who have had COVID-19 are 6.5 times more likely to have telogen effluvium (rapid shedding of hair).

So if you won’t put on a mask to save yourself from Long COVID, put a mask on to save yourself from hair loss!

This paper from USA (2024-01-11) found that from September 2022–March 2023, people who had gotten a bivalent vax were at significantly lower risk of getting COVID-related strokes, blood clots, and heart attacks than people who had only gotten monovalent vax:

53% lower risk for people over 65;
49% lower risk for adults with end stage renal disease.

This paper from China (2024-01-10) found that people who had COVID-19 infections were more likely to have digestive issues than the historical rates:

38% higher risk of GI dysfunction;
23% higher risk of peptic ulcer disease;
41% higher risk of gastroesophageal reflux disease (GERD);
21% higher risk of gallbladder disease;
35% higher risk of severe liver disease;
36% higher risk of pancreatic disease.

Re-infection was also bad. People who had two COVID-19 infections had a 157% higher risk of pancreatic diseases than those with only one infection.

Pathology

This paper from Brazil (2024-01-09) found that people with plant-focused diets (vegetarians and near-vegetarians) had a 39% lower risk of catching COVID-19 than omnivores did. However, the study has gotten some criticism both because it’s a relatively small study and because they thought that the study didn’t make adequate adjustments to compensate for the plant-focused group being healthier to start with.

This paper from France (2023-11-02) says that some monkeys infected with COVID-19 still had living virus in their longs past six months, even thought they no longer tested positive for COVID-19 on PCR tests. They found that monkeys that had persistent virus had natural killer (NK) cells which didn’t produce as much gamma globulin as the monkeys that had cleared the virus from their lungs. (NK cells can kill virus-infected cells without training. They don’t know how the NK cells recognize infected cells, but maybe they kill cells that don’t have MHC I on them. MHC I molecules normally present fragments of the cell internals, so that Killer T cells can recognize fragments of Bad Things and kill the cells. Bad Thing can hide from the Killer T cells by telling the cell to stop making MHC I… but that gives NK something they can recognize infected cells by. (Have I mentioned how much I liked Immune by Dettmer?))

This paper from Italy (2023-12-17) did not find any increase in sudden cardiac death among young people after COVID-19 arrived, neither in the pre-vaccination nor post-vaccination periods.

This paper from USA (2023-10-11) found that marijuana users had better prognoses when hospitalized for COVID-19 than non-weed users did, including a 52% lower chance of death. The authors speculate that this could be due to marijuana making it more difficult for viruses to get into cells.

This paper from Brazil found that COVID-19 was about three times as deadly in hospitalized children as other common respiratory viruses. The risk of death was 6.5% from COVID, 2.3% for influenza.

Transmission

This study in hamsters found that changing the temperature and relative humidity did not change COVID-19 airborne transmission rates significantly. In other words, COVID-19 is not very seasonal (something I’ve been yelling about for a while).

To be fair, they only checked three conditions:

10 °C, 45% relative humidity (RH),
22 °C, 45% RH, and
27 °C, 65% RH.

Other studies have said that the sweet spot for relative humidity is between 40% and 60%, and this experiment didn’t go much out of that range. However, 10 °C is a big change from room temperature, and it didn’t give a statistically significant change.

Okay, maybe the study was just underpowered and unable to find statistical significance. Maybe? But even if you look at the raw results, the hamsters did better at cold temperatures!

Vaccines

This paper from USA (2024-01-09) found that in children and adolescents, the Pfizer vax had these effectivenesses compared to unvaccinated children and adolescents:

Against	Effectiveness
Delta infection	98.4%
Omicron infection	74.3%
Omicron moderate or severe	75.5%
Omicron ICU admission	84.9%
Omicron infection in adolescents	85.5%
Omicron moderate or severe in adolescents	84.8%
ICU admission in adolescents	91.5%

Remember that as time goes on, the unvaccinated cohort will have more and more infections, so will gain some immunity — which makes the difference between the vaxxed and unvaxxed (the effectiveness) smaller.

They also found that the effectiveness dropped for four months, then stabilized, and that vaccination didn’t seem to make a difference in heart health.

This paper from Denmark (2024-01-10) also showed high effectiveness in children vaccinated between May 28, 2021, and April 30, 2023. After six months, the VE compared to unvaccinated for two doses of Pfizer was 72.6%; the VE for two doses of Moderna was 86.0%, and VE was 80.7% for those who got one dose of each.

Prevention

This paper from researchers all over the globe (2024-01-09) found that a particular monoclonal secreted alpha antibody named DXP-604, which, when sprayed in the nose, knocked down COVID-19 really well. The immunity lasts about a day, which unfortunately means you can’t really use DXP-604 like a vaccine. The researchers imagine using this spray as a preventative measure or for people who just got exposed. (They don’t mention cost; this article says that it takes USD$100-200 to make one dose of monoclonal antibodies, which seems like a lot for a prophylactic that you’d use every day-ish.)

Testing

I have seen a number of articles like this one and this one which say that rapid antigen tests now take until about four days after infection to return an accurate test. (NB: I have not seen scholarly papers on this.) One theory is that as we have developed immunity, we do a better job of fighting it off for a few days. Another theory is that the variants circulating now are different enough from the original strain that they don’t do a good job of catching it. (I like the former theory better.)

Does that mean that you aren’t infectious until later in the illness? My personal opinion is hell no, given that rapid tests are not very accurate at anything but the highest viral loads. 🙁 Does that mean that RATs aren’t useful for telling you when you are sick? Yes, I think so. (Get some NAATs instead!) Does that mean that RATs are completely useless? No, I think RATs are useful for telling you when you can stop isolating.