Covid articles and studies that caught my attention for January, 2024
Encapsulated for easy digestion.
January here in Philly was cold, rainy, gray, and generally nasty. However, we did eke out our first snowfall in a long time. You may be familiar with the front steps of the Philadelphia Museum of Art as immortalized by Rocky Balboa. But perhaps you did not know that there are steps around the back of the building as well, in addition to some decent hills for sledding. But why sled down powdery snow covered hills when you can take the stairs? Above is what some Philly fathers do on school nights around 7:30 PM - they take their daughters sledding and hope for cheap thrills, no broken bones, and memories of fun.
Besides the glories of a real snowfall, there were some really good studies on Covid last month. I’m going to present some bullet points to review the highlights I caught. Not all of these were published in January, but close enough.
CDC analyses of multiple studies found no statistically significant relation between incidence of COVID-19 rebound and previous treatment with antiviral drugs.
Although some studies have found evidence of “Paxlovid rebound,” the overall synthesis of the evidence shows this is not a thing. Since the beginning there has always been the potential for people to feel sick, get better for a couple days, and then get sick symptoms again. The former is caused by viral loads in the body, and the latter is usually caused by immune system cytokines and inflammation. Take home : don’t fear “rebound” when deciding to take medicine for Covid.
Thousands of frontline workers would have survived the COVID-19 pandemic if the US regulatory system had better protected them.
This analysis in the BMJ is damning, but also proposes good lessons for next time.
The CDC and federal leadership clung to notions that SARS CoV-2 was spread via droplets, and therefore surgical masks, six feet of distance, and hand washing were supposedly sufficient for protection.
Instead I listened to zeitgeist researchers/medical experts through Twitter, and insisted upon wearing my own self-procured N95 at work. Patterns of transmission were obviously airborne.
The president of the United States could have invoked the Defense Production Act to crank out N95’s and KN95’s for frontline workers in all industries. We could have better tamed the early pandemic, and returned to a semblance of real life much sooner if everyone had N95’s and were on the same team wearing them.
Instead the Defense Production Act was only invoked to force meat packers to keep packing meat. More meat. And more death.
Updated Covid vaccines and boosters keep helping kids, too.
In a U.S. surveillance study from July 2022–September 2023, vaccinated children aged 6 months–4 years had fewer emergency room visits and hospitalizations with COVID-19 than unvaccinated children.
Vaccine effectiveness for preventing ER visits or hospitalization in those receiving >2 vaccine doses was 40.0% when compared to unvaccinated children.
Another study showed that Covid vaccination in kids was extremely (>90%) effective at preventing severe disease and hospitalization in kids during the previous Delta and Omicron waves.
Over 2,000 have died in the United States from Covid, with many also developing lasting damage from infection.
Vaccines, and an increasing number of doses, positively correlate with prevention of post-Covid conditions (PCC, i.e. long Covid).
I love this one. Effectiveness at preventing PCC:
21% [1 dose]
59% [2 doses]
73% [≥3 doses]
The scale of the covid-19 pandemic showed the importance of post-viral conditions, an area of medicine that had been relatively neglected. Post-viral conditions can be disabling, fluctuant, and chronic.
A pre-print from Netherlands data showed a 70% vaccine effectiveness against hospitalization and ICU admission for those who got the XBB booster THIS FALL (2023 data).
This was officially published, too
I’m going to keep getting every updated vaccine offered or recommended. The data has never shown it’s better to skip a dose. I’m used to the idea of a yearly flu shot and have been for decades. Covid shots should be the same kind of paradigm, with perhaps every 6 months for the elderly and those at highest risk… until we come up with a better vaccine, nasal vaccine boost, etc. Stay tuned.
I’m still discussing this with my patients, and have given an average of 1-3 updated Moderna shots a day since the holidays to people who have not gotten around to doing so.
And my new hero Dr. Jonathan Howard wrote a great piece on boosters in which he lists at least 51 studies showing beneficial, protective outcomes in patients receiving boosters when compared to those not receiving boosters. These 51 studies are not about antibody titers, but instead document real life better disease outcomes. He also cites 8 systematic review meta-analyses which are even more authoritative in the hierarchy of evidence quality.
Masks DO help reduce Covid transmission, and respirators are even better.
Ok, so this one was published in JAMA in the late fall, but I really like it. So I read it again in January. It makes for a great reply to mask haters and contrarian physicians who still don’t get it.
As American rapper and singer Doja Cat states in her song “Paint the Town Red”: Called your bluff, better cite the source.
And if mask haters cite that faulty mask review from the Cochrane folks (who are otherwise a good source for meta-analysis), holler back with this take down of the inherent biases and quantitative errors in that embarrassingly shoddy study.
Complement system activation after acute COVID-19 lasted for at least 6 months in patients with long COVID.
We continue to learn of pathways by which long Covid occurs, and the persistent activation of a part of our innate immune systems called the complement system is one. This study may help with future lab tests to identify the condition, and provides additional therapeutic targets to investigate for treatment.
Another study showed:
Long COVID manifests with T cell dysregulation, inflammation and an uncoordinated adaptive immune response
The immune system takes a hit with each Covid infection. As a clinician I see some people getting back to back to back respiratory infections… more than I ever recall pre-pandemic. The immune system usually gets back up after the fight, but like any good corner man in a boxing fight, it’s best to protect your fighter for future rounds.
40% of children recovering from Covid are still infectious after symptom resolution, and 25% are still contagious at day 7.
Wouldn’t it be nice if kids stayed home while they were sick, and wore masks for like 5 days when they came back to school? My child’s school tries to do this, but it’s not cool to wear a mask. Teachers, fellow students, and the community beyond the school pay the price. Up to 70% of Covid cases transmitted in the home are due to children bringing it home.
COVID-19 vaccine is tied to a 40-50% lower risk of long COVID in kids
Long Covid is estimated to affect 0.5 - 2% of children. Doesn’t sound that bad, but multiply that by 73 million children under age 18 in the U.S.
Do you know what the long term effects of repeat Covid infections will be on kids in 20 years? Me neither. I worry about that, much more than I would consider worrying about approved vaccines.
An analysis of more than 20 million vaccinated and unvaccinated people showed that vaccination was 30-50% effective at preventing long Covid
This was a massive study pulled from data in three European countries (the UK, Estonia, and Spain).
Vaccines against Covid are not just about reducing infection risk, but they have also consistently reduced long Covid rates. They have always been important for “low risk people”, too. Long Covid is most common in the 35-50 year old age group.
Covid can damage midbrain dopaminergic neurons and may be associated with a higher risk of Parkinsons disease in the future.
Medicines like riluzole, metformin (I recently wrote about this), and imatinib may lower this risk as they have been shown to protect the same dopaminergic neurons to some extent, and are worth additional study.
Influenza can do the same thing, and after the 1918 influenza pandemic there were higher rates of Parkinson’s disease years later.
A small study of 16 previously unvaccinated patients suffering from Long Covid showed that vaccination can improve symptoms and biomarkers of the condition.
A very small study, but in some individuals (10 out of the 16) there was some improvement after vaccination, with only one person demonstrating worsening symptoms. We don’t know which long Covid patients might improve after getting a vaccine or boost, but some absolutely do. Figuring out the many subtypes of this umbrella term will help in the future.
Ok, that’s my highlight reel for Covid reading this month! There is so much out there, but I liked these the best. Sledding down the stairs of the Art Museum was WAY more fun.
I hope you have a peaceful and restful sleep tonight. I’m going home now, it’s been a busy half week already.
Take good care, this first day of February and beyond!
Burning the midnight oil again? Nice synopsis! Don't forget we have a few other respiratory diseases out there. ;-)
https://www.wired.com/story/the-physics-of-the-n95-face-mask/
It’s physics!