Here is this week’s COVID Update from Baylor’s Dr. Paul Klotman. The fast take on this update consists of the following:

  • The WHO is taking a lot of criticism for its inability to determine the source of the SARS-CoV-2 virus. It’s all political theater, I say. Who gives a damn? As Dr. Klotman observes, we need higher lab safety and security measures, better disease surveillance systems, and more rapid vaccine development and deployment strategies. Anguishing over the cause of the last pandemic is a fruitless endeavor!
  • Omicron variant XBB.1.5 continues to dominate the US COVID scene. No surprise here.
  • COVID activity across the US and world is uneven – Europe, China, and the US have much of the current burden of active disease.
  • In the US, COVID mortality continues to be highest among folks my age – 65+.
  • While the COVID hospitalization and death rates continue to decline, we are still looking at thousands of new cases each day and an estimated 120,000 deaths per year. For purposes of comparison, we lose 30-40,000 Americans to Influenza each year. Anyone who tells you that COVID is no worse than the Flu hasn’t done the assigned readings and doesn’t know WTF they are talking about.
  • The viral loads in wastewater continue to decline, but like cases and deaths, the distribution across the country is uneven.
  • The best protection against serious COVID is initial vaccination and boosting followed by a bivalent booster such as the m-RNA vaccines from Pfizer and Moderna.

Susan and I decided to accept more risk this week. Like Dr. Klotman, we carry our masks with us but are more willing to enter a store or business without wearing one. After listening to Dr. Klotman’s update this week, I am thinking that we may have set our masks aside too soon. It is probably reasonable to go maskless if you are a healthy 40-something – less so if you are a 70-something on multiple medications.

My friends and clinical colleagues, Drs. Archie Dan Smith and Enrique Spindel share relevant COVID-related articles that they have read, and I include those as well as others that I have encountered in the last week or two. Here are some recent reports:

  • For those who worry about COVID relapses after taking Paxlovid, a study from Jonathan Z. Li, MD, associate professor of infectious disease at Brigham and Women’s Hospital and Harvard Medical School revealed that 25% of untreated COVID patients experienced COVID relapse characterized by a return of symptoms and an increase in nasal viral loads.
  • The CDC’s Advisory Committee on Immunization Practices concludes that there is insufficient evidence to support any more than one annual COVID vaccine booster.
  • A recent study of COVID’s effects on the brain shows that even patients with mild COVID can experience significant brain changes including shrinkage of certain brain areas. The limbic system changes can be accompanied by symptoms of depression and anxiety. You will recall that the limbic system is closely associated with the sense of smell and plays a central role in the formation of memories. How or why these changes occur in some individuals is not clear.
  • Metformin, a medication used to treat Type II diabetes as well as polycystic ovary disease, has been shown to have a significant benefit in preventing Long COVID in older (>45yo) obese or diabetic people. The study regimen involved a 14-day course of Metformin. The study has not been replicated, but the initial results are very promising.
  • It seems likely that we will see another big SARS-CoV-2 mutation event in the future – something that brings a radically new variant – like Omicron was different from the original Wuhan virus and variants including Delta. This new virus will likely have one or more of the following: a) much greater mortality, b) a much greater infectivity, c) effective evasion of immunity conferred by prior COVID illness and/or vaccinations.

The last of these conjectures is the most disturbing, of course. Imagine going through another coronavirus pandemic (Influenza pandemics occur about every ten years) especially with our less-than-competent American and World Health responses.

Shit.

By: llcPosted on