From a listener question re: if wildfire exposure affects COVID outcomes: Dr. Griffin doesn’t know of any studies about #COVID, but there have been flu studies that show that exposure to poor air quality can make someone more susceptible to flu lower in the lungs.

#TWiVTLDR 13/13

Renowned scientist Bob Krug writes in about Xofluza, a Tamiflu alternative. You have to take it within 48 hours of #flu symptoms starting, but it is VERY effective! Dr. Griffin points out there was some observation of flu virus mutations, and it’s about $150 a pill.

#TWiVTLDR 12/

From listener q re: vaccine efficacy w/ variants & not being able to get Paxlovid: Vaccines continue to protect against severe disease and hospitalizations even w/ current #variants. Evidence coming in that being vaxxed also protects against #LongCOVID. But if you’re at risk and can’t get #Paxlovid, Dr. Griffin suggests to talk to your doctor about other treatments like metformin. (Although he also points out that it’s not officially recommended by any society anywhere...)

#TWiVTLDR #COVID 11/

From a listener question: Reactivation of herpes virus happens in #LongCOVID but also in other post-viral conditions.

#TWiVTLDR 10/

A meta-analysis of #COVID convalescent plasma (CCP) studies show that CCP treatment reduces hospitalization by 30%. But the antibody levels in the plasma have to be high, and the CCP has to be given within 5 days after symptoms start. Otherwise there’s no benefit at all. CCP is more an option for people who literally cannot be treated with anything else.

#TWiVTLDR 9/

Real world data about Paxlovid - it reduces hospitalization by 69%. The effect is greater in people who didn’t finish the primary vaccine series, while it didn’t help as much for people who finished the primary #vaccine series. (Although, #Paxlovid definitely helped people severely immunocompromised or over 70, when their last shot was more than 6 months ago.)

#TWiVTLDR #COVID 8/

Dr. Griffin reiterates that boosters are really only for people like, over 85 with multiple health conditions. It doesn’t really help others. Generally, they believe the primary vaccine dosing should be standardized to 3 shots, with the last shot at least 6 months out from the second.

#TWiVTLDR #COVID #boosters 6/

FDA recommended monovalent XBB.1.5 vaccines for #COVID, not bivalent #vaccines because of the concerns of “original antigenic sin”. (Basically, the idea that your immune response is lower if it’s seen an antigen before.) Dr. Griffin mentions that the data shows there doesn’t seem to be a huge difference in immune response between monovalent or bivalent formulas. But this belief has already permeated science, hence the focus on monovalent vaccines now…

#TWiVTLDR 5/

…Dr. Griffin is not happy with the binary of “cultureable” and “not cultureable” virus, when in the lab it’s really a wide spectrum. And Dr. Racaniello says if there was transmission “without cultureable” virus, then their assay was not sensitive enough! (Lots of talk about how plaque assays are “a dying art.“)

So yeah, science is hard. 😅

#TWiVTLDR #COVID 4/

Finally, a study on cultureable virus over time in #COVID positive cases and how it impacts COVID transmission in households! But uhh, hold up: 21% of people WITHOUT culturable virus transmitted it to household members in this study. With wide confidence intervals..

#TWiVTLDR 3/

The CDC also officially endorsed the RSV vaccines for people over 60. Although, not everyone on the advisory committee was totally on board, so the takeaway is that high risk individuals should talk to their doctors about the #RSV #vaccine.

#TWiVTLDR 2/

From a listener question: Some people are still having trouble getting #Paxlovid before traveling. Dr. Griffin says now that Paxlovid is fully licensed, doctors are able to prescribe Paxlovid “off-label” so that they have more flexibility and use their discretion. But of course, rich people are able to do that more easily than poor people. Dr. Griffin says he hopes the #COVID inequities will start to lessen.

#TWiVTLDR 16/16

Dr. Griffin joked #metformin (an inexpensive diabetes drug) is now considered a “poor man’s #Paxlovid,” which goes into the next paper: metformin reduced viral load (aka RNA copy number), but only by a teeny bit. The hosts were NOT impressed by the impact, and Dr. Racaniello wanted them to look at infectious virus. Dr. Griffin wryly observed that he wouldn’t be surprised if eventually, rich people got Paxlovid and poor people got the crappier metformin. 😅

#TWiVTLDR 14/

…An earlier #metformin study used 1500mg as a dose and they actually had to stop the study because there were too many side effects. People couldn’t tolerate it.

Metformin mostly helped people under 45, the unvaccinated, and those with BMI over 30.

#TWiVTLDR 13/

A pre-print they discussed before is now published! Outpatient treatment with metformin helped reduce #LongCOVID risk by about 41%, with an absolute reduction of 4%. Dr. Griffin notes that the amount of #metformin used in this study needed to be titrated - from 500mg to 1000mg over 2 weeks. Which means if you want metformin, you need to work closely with your doctor on dosing, they can’t just give you a script for the whole regimen at once…

#TWiVTLDR 12/

Being anemic (hemoglobin under 13 g/dl for males, 12g/dl for females) makes people 2.7x more likely to die if they get #COVID. (And #anemic people are 2.3x more likely to have a severe case.)

#TWiVTLDR 10/

Two blood cancer patients who were sick with #COVID for 6 months (including testing positive the whole time) were successfully treated with Paxlovid over 2 weeks. Both cases finally tested negative after this extended #Paxlovid treatment.

#TWiVTLDR 9/

From public opinion polls, 35-42% of US public believe COVID #vaccines are “very safe” for most children. But opinions of other routine vaccinations for kids are actually higher (54-61% pre-pandemic, up to 70% in late 2022.) Maybe compared to the new #COVID vaccines, the “traditional” ones seem safer? Whatever, it’s a relief that COVID anti-vax “spillover” didn’t happen. Support for routine vaccines went up, but people seem to be anti-mandate instead. https://www.healthaffairs.org/content/forefront/has-covid-19-threatened-routine-childhood-vaccination-insights-us-public-opinion-polls

#TWiVTLDR 8/

...The most virus was emitted on day 3, with very little emission before any symptoms (7%) and “hardly any” (2%) before first positive RAT. Higher viral emissions correlated with higher viral load from nasal swabs vs throat swabs. Stronger #COVID symptoms were not correlated with higher viral load. Interestingly, only 2 participants emitted 86% of all airborne virus, which definitely supports the “superspreader” theory.

(Personal note: my hubs did not get COVID when 👶🏻 and I did.)

#TWiVTLDR 6/

Some really 👀 updates about #COVID: Back in 2021, researchers in the UK recruited 36 unvaccinated, NOVID folks to get (ancestral) COVID up their nose, locked them into negative pressure rooms for 14 days, then took lots of swabs and measured how much virus they “emitted” into the air and on surfaces. Here are the results: https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(23)00101-5/fulltext

53% of the participants got sick after getting COVID up their nose.…

#TWiVTLDR 5/