• Excess All-Cause Mortality in China After Ending the Zero #COVID Policy | Infectious Diseases | JAMA Network Open | JAMA Network
    https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808734

    Key Points
    Question Was the sudden end of China’s zero COVID policy associated with an increase in population all-cause mortality?

    Findings In this cohort study across all regions in mainland China, an estimated 1.87 million excess deaths occurred among individuals 30 years and older during the first 2 months after the end of China’s zero COVID policy. Excess deaths predominantly occurred among older individuals and were observed across all provinces in mainland China, with the exception of Tibet.

    Meaning These findings suggest that the sudden lifting of the zero COVID policy in China was associated with significant increases in all-cause mortality.

  • Communication of COVID-19 Misinformation on Social Media by Physicians in the US | Public Health | JAMA Network Open | JAMA Network
    https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808358

    Question What types of COVID-19 misinformation have been propagated online by US physicians and through what channels?

    Findings In this mixed-methods study of high-use social media platforms, physicians from across the US and representing a range of medical specialties were found to propagate COVID-19 misinformation about vaccines, treatments, and masks on large social media and other online platforms and that many had a wide reach based on number of followers.

    Meaning This study’s findings suggest a need for rigorous evaluation of harm that may be caused by physicians, who hold a uniquely trusted position in society, propagating misinformation; ethical and legal guidelines for propagation of misinformation are needed.

  • Experiences of US Clinicians Contending With Health Care Resource Scarcity During the COVID-19 Pandemic, December 2020 to December 2021 | Ethics | JAMA Network Open | JAMA Network
    https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2806178
    https://cdn.jamanetwork.com/ama/content_public/journal/jamanetworkopen/939157/zoi230572t1_1686250777.07615.png?Expires=2147483647&Signature=Nan0C

    Conclusions and Relevance 

    The findings of this qualitative study suggest that institutional plans to protect frontline clinicians from the responsibility for allocating scarce resources may be unworkable, especially in a state of chronic crisis. Efforts are needed to directly integrate frontline clinicians into institutional emergency responses and support them in ways that reflect the complex and dynamic realities of health care resource limitation.

    #états-unis #leadership #milliers_de_milliards

  • JAMA Health Forum – Health Policy, Health Care Reform, Health Affairs | JAMA Health Forum | JAMA Network
    https://jamanetwork.com/journals/jama-health-forum/fullarticle/2805494

    Conclusions and Relevance 
    In this secondary analysis of a randomized clinical trial, eliminating out-of-pocket medication expenses for patients with cost-related nonadherence in primary care was associated with lower health care spending over 3 years. These findings suggest that eliminating out-of-pocket medication costs for patients could reduce overall costs of health care.

    #dépenses #santé #gratuité

  • Risk of Parkinson Disease Among Service Members at Marine Corps Base Camp Lejeune | Movement Disorders | JAMA Neurology | JAMA Network
    https://jamanetwork.com/journals/jamaneurology/fullarticle/2805037

    Key Points
    Question Is Parkinson disease risk increased in military service members who were stationed at Marine Corps Base Camp Lejeune, North Carolina, during 1975-1985 when the water supply was contaminated with trichloroethylene and other volatile organic compounds?

    Findings 
    This cohort study of 340 489 service members found that the risk of Parkinson disease was 70% higher in Camp Lejeune veterans compared with veterans stationed at a Marine Corps base where water was not contaminated. In veterans without Parkinson disease, risk was also significantly higher for several prodromal features of Parkinson disease.

    Meaning 
    The study’s findings suggest that exposure to #trichloroethylene in water may increase the risk of Parkinson disease; millions worldwide have been and continue to be exposed to this ubiquitous environmental contaminant.

    #pollution #eau #maladie_de_parkinson

  • JAMA Health Forum – Health Policy, Health Care Reform, Health Affairs | JAMA Health Forum | JAMA Network
    https://jamanetwork.com/journals/jama-health-forum/fullarticle/2802095
    https://cdn.jamanetwork.com/ama/content_public/journal/jama-health-forum/939099/aoi230001f1_1677520778.51947.png?Expires=2147483647&Signature=ndStp
    #covid #mortalité

    Importance Many individuals experience ongoing symptoms following the onset of COVID-19, characterized as postacute sequelae of SARS-CoV-2 or post–COVID-19 condition (PCC). Less is known about the long-term outcomes for these individuals.

    Objective To quantify 1-year outcomes among individuals meeting a PCC definition compared with a control group of individuals without COVID-19.

    Design, Setting, and Participants This case-control study with a propensity score–matched control group included members of commercial health plans and used national insurance claims data enhanced with laboratory results and mortality data from the Social Security Administration’s Death Master File and Datavant Flatiron data. The study sample consisted of adults meeting a claims-based definition for PCC with a 2:1 matched control cohort of individuals with no evidence of COVID-19 during the time period of April 1, 2020, to July 31, 2021.

    Exposures Individuals experiencing postacute sequelae of SARS-CoV-2 using a Centers for Disease Control and Prevention–based definition.

    Main Outcomes and Measures Adverse outcomes, including cardiovascular and respiratory outcomes and mortality, for individuals with PCC and controls assessed over a 12-month period.

    Results The study population included 13 435 individuals with PCC and 26 870 individuals with no evidence of COVID-19 (mean [SD] age, 51 [15.1] years; 58.4% female). During follow-up, the PCC cohort experienced increased health care utilization for a wide range of adverse outcomes: cardiac arrhythmias (relative risk [RR], 2.35; 95% CI, 2.26-2.45), pulmonary embolism (RR, 3.64; 95% CI, 3.23-3.92), ischemic stroke (RR, 2.17; 95% CI, 1.98-2.52), coronary artery disease (RR, 1.78; 95% CI, 1.70-1.88), heart failure (RR, 1.97; 95% CI, 1.84-2.10), chronic obstructive pulmonary disease (RR, 1.94; 95% CI, 1.88-2.00), and asthma (RR, 1.95; 95% CI, 1.86-2.03). The PCC cohort also experienced increased mortality, as 2.8% of individuals with PCC vs 1.2% of controls died, implying an excess death rate of 16.4 per 1000 individuals.

    Conclusions and Relevance This case-control study leveraged a large commercial insurance database and found increased rates of adverse outcomes over a 1-year period for a PCC cohort surviving the acute phase of illness. The results indicate a need for continued monitoring for at-risk individuals, particularly in the area of cardiovascular and pulmonary management.

  • Evaluation of Waning of #SARS-CoV-2 Vaccine–Induced Immunity: A Systematic Review and Meta-analysis | Infectious Diseases | JAMA Network Open | JAMA Network
    https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2804451

    Key Points

    Question How does the effectiveness of #COVID-19 vaccines against laboratory-confirmed Omicron infection and symptomatic disease change at different times from last dose administration and number of doses, and how does this compare with previously circulating SARS-CoV-2 variants and subvariants?

    Findings This systematic review and meta-analysis of secondary data from 40 studies found that the estimated vaccine effectiveness against both laboratory-confirmed Omicron infection and symptomatic disease was lower than 20% at 6 months from the administration of the primary vaccination cycle and less than 30% at 9 months from the administration of a booster dose. Compared with the Delta variant, a more prominent and quicker waning of protection was found.

    Meaning These findings suggest that the effectiveness of COVID-19 vaccines against Omicron rapidly wanes over time.

    […]

    VE [vaccine effectiveness] against severe disease, hospitalization, and mortality has been estimated to decrease more slowly compared with the end points considered in our analysis,4,5 granting a longer-lasting protection against severe outcomes.

    […]

    Boosters were found to be associated with a restoration of the vaccine protection against symptomatic disease to levels comparable to those estimated soon after completion of the primary cycle.

    #vaccins #vaccination

  • Parental Nonadherence to Health Policy Recommendations for Prevention of #COVID-19 Transmission Among Children | Pediatrics | JAMA Network Open | JAMA Network
    https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802004

    One hundred fifty participants (25.9%) reported misrepresentation and/or nonadherence in at least 1 of 7 behaviors; the most common behaviors were not telling someone who was with their child that they thought or knew their child had COVID-19 (63 of 263 [24.0%]) and allowing their child to break quarantine rules (67 of 318 [21.1%]) (Table 1). The most common reason was wanting to exercise personal freedom as a parent. Additional reasons included wanting their child’s life to feel normal and not being able to miss work or other responsibilities to stay home (Table 2). In an exploratory multiple logistic regression, no characteristics (eg, education, religiosity) were associated with misrepresentation or nonadherence.

  • #COVID-19 is a leading cause of death among US children and teens, study shows | Live Science
    https://www.livescience.com/coronavirus-cause-of-death-children

    COVID-19 was the top infectious disease killer for kids and teens in the U.S. between August 2021 and July 2022, a new analysis shows. It also ranked among the leading causes of death for any reason for U.S. children and teens in the same time period, the researchers determined

    Source :
    Assessment of COVID-19 as the Underlying Cause of Death Among Children and Young People Aged 0 to 19 Years in the US | Pediatrics | JAMA Network Open | JAMA Network
    https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800816

    #enfants

  • Assessment of Efficacy and Safety of mRNA #COVID-19 Vaccines in Children Aged 5 to 11 Years: A Systematic Review and Meta-analysis | Pediatrics | JAMA Pediatrics | JAMA Network
    https://jamanetwork.com/journals/jamapediatrics/fullarticle/2800743

    Results
     

    Two randomized clinical trials and 15 observational studies involving 10 935 541 vaccinated children (median or mean age range, 8.0-9.5 years) and 2 635 251 unvaccinated children (median or mean age range, 7.0-9.5 years) were included. Two-dose mRNA COVID-19 vaccination compared with no vaccination was associated with lower risks of SARS-CoV-2 infections with or without symptoms (OR, 0.47; 95% CI, 0.35-0.64), symptomatic SARS-CoV-2 infections (OR, 0.53; 95% CI, 0.41-0.70), hospitalizations (OR, 0.32; 95% CI, 0.15-0.68), and multisystem inflammatory syndrome in children (OR, 0.05; 95% CI, 0.02-0.10). Two randomized clinical trials and 5 observational studies investigated AEs among vaccinated children. Most vaccinated children experienced at least 1 local AE following the first injection (32 494 of 55 959 [86.3%]) and second injection (28 135 of 46 447 [86.3%]). Vaccination was associated with a higher risk of any AEs compared with placebo (OR, 1.92; 95% CI, 1.26-2.91). The incidence of AEs that prevented normal daily activities was 8.8% (95% CI, 5.4%-14.2%) and that of myocarditis was estimated to be 1.8 per million (95% CI, 0.000%-0.001%) following the second injection.

    #enfants

  • #COVID-19 Symptoms and Duration of Rapid Antigen Test Positivity
    https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797070#full-text-tab

    Figure 2. Rapid Antigen Diagnostic Test Positivity Among 942 People With COVID-19 Who Underwent Repeated Testing During the Omicron BA.1 Period by Day of Symptom Onset (if Symptomatic) or Day Since Initial Positive Test (if Asymptomatic)

    Among persons with COVID-19 retesting on day 5, 80.2% of symptomatic people and 48.9% of asymptomatic people remained RAT–positive. [...] This high proportion of positive repeat tests is unsurprising given existing data on the viral dynamics of Omicron BA.1 and other variants. In a cohort from the National Basketball Association composed predominantly of people who had received a booster, the duration of the acute phase of the Omicron BA.1 variant (proliferation and clearance) was 9.9 days, which is similar to prior variants.28,29

    We found that RAT positivity remained high even 10 days following symptom onset. Additional epidemiologic studies are needed to assess whether people remain infectious at this juncture. Studies examining viral dynamics show a strong correlation between rapid antigen positivity and viable virus, although the correlation appears lower farther out from infection. One longitudinal study of people with the Omicron BA.1 variant found culturable virus for a median of 8 (IQR, 5-10) days, and another study from the pre-Omicron era found a strong correlation between RATs and only 1 person with culturable virus between 11 and 14 days. Overall, existing data suggest that infectiousness (using viral culture as a proxy) beyond 10 days is possible although less common.

    A positive RAT result correlates with having viable virus and thus identifies persons with the highest degree of infectivity to others. The US Centers for Disease Control and Prevention currently allows for people leaving isolation with a well-fitting mask after 5 days of symptoms if symptoms are improving, regardless of repeated testing results. Acknowledging the need for further epidemiologic data that correlate transmission risk and RAT positivity or culturable virus, our data support current California Department of Public Health guidelines.

  • Cette étude sur près de 30 000 travailleurs du secteur de la santé en janvier 2022 établit que ceux avec 3 doses de vaccin avaient été contaminés à 19,8%, alors que ceux avec 4 doses n’avaient été contaminés qu’à 6,9%.

    Association of Receiving a Fourth Dose of the BNT162b Vaccine With SARS-CoV-2 Infection Among Health Care Workers in Israel
    https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794864

    Question Was there a benefit of vaccinating health care workers with a fourth dose of BNT162b2 vaccine during the Omicron variant outbreak of the COVID-19 pandemic?

    Findings In this multicenter cohort study of 29 611 health care workers in Israel, the breakthrough infection rate among those who received 4 doses was 6.9% compared with 19.8% in those who received 3 doses.

    Meaning These findings suggest that a fourth vaccine dose was effective in preventing breakthrough COVID-19 infections in health care workers, helping to maintain the function of the health care system during the pandemic.

    En France notre joyeux gouvernement qui se base sur l’état de la science a déjà décrété qu’il n’y aurait de 4e dose que pour la désormais mythique « population cible » (tautologie : tu es ciblé par cette campagne justement parce que tu fais partie de la « population cible », et inversement).

    Pour les autres, la théorie LaRem-Médiapart est qu’il faudra attraper le Covid pour se protéger contre le Covid…

  • Two-Year Prevalence and Recovery Rate of Altered Sense of Smell or Taste in Patients With Mildly Symptomatic #COVID-19 | Olfaction and Taste | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
    https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2794937

    In this cohort study, 88.2% of patients reporting a COVID-19–related smell or taste dysfunction completely recovered within 2 years. A late recovery [> 6 months] was observed in 10.9% of patients.

  • Examination of #SARS-CoV-2 In-Class Transmission at a Large Urban University With Public Health Mandates Using Epidemiological and Genomic Methodology | Genetics and Genomics | JAMA Network Open | JAMA Network
    https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794964

    #Vaccination + #masque (le type n’est pas précisé) +#aération +#dépistage

    Pas de distanciation sociale dans ces conditions

    Objective
    To assess whether in-class instruction without any physical distancing, but with other public health mitigation strategies, is a risk for driving SARS-CoV-2 transmission.

    Design, Setting, and Participants 
    This cohort study examined the evidence for SARS-CoV-2 transmission on a large urban US university campus using contact tracing, class attendance, and whole genome sequencing during the 2021 fall semester. Eligible participants were on-campus and off-campus individuals involved in campus activities. Data were analyzed between September and December 2021.

    Exposures 
    Participation in class and work activities on a campus with mandated vaccination and indoor masking but that was otherwise fully open without physical distancing during a time of ongoing transmission of SARS-CoV-2, both at the university and in the surrounding counties.

    Main Outcomes and Measures 
    Likelihood of in-class infection was assessed by measuring the genetic distance between all potential in-class transmission pairings using polymerase chain reaction testing.

    Results 
    More than 600 000 polymerase chain reaction tests were conducted throughout the semester, with 896 tests (0.1%) showing detectable SARS-CoV-2; there were over 850 cases of SARS-CoV-2 infection identified through weekly surveillance testing of all students and faculty on campus during the fall 2021 semester. The rolling mean average of positive tests ranged between 4 and 27 daily cases. Of more than 140 000 in-person class events and a total student population of 33 000 between graduate and undergraduate students, only 9 instances of potential in-class transmission were identified, accounting for 0.0045% of all classroom meetings.

    Conclusions and Relevance 
    In this cohort study, the data suggested that under robust transmission abatement strategies, in-class instruction was not an appreciable source of disease transmission.

    #covid-19

  • De plus en plus systématiquement, quand j’explique qu’on continue à faire attention, vu qu’on voudrait éviter de l’attraper… la personne finit par m’expliquer « ah mais de toute façon, si ça se trouve vous l’avez déjà eu… ».

    Avec ça, on n’est pas loin du stade ultime de la propagande pour la varicellisation du Covid : on a réussi à convaincre les gens que même s’ils pensent ne pas l’avoir eu, en fait ils l’ont déjà eu.

    Alors qu’on se dise que, oui, statistiquement, on aurait pu être asymptomatiques, c’est une possibilité. Ce qui m’étonne, c’est que l’argument sort de manière automatique ces derniers temps. Dès que tu dis qu’on fait encore bien gaffe, hop ça sort.

    Je pense que c’est une manière polie de dire : « ah mais tu nous fais chier avec tes précautions… ».

    • À propos de cette croyance répandue du « probablement déjà eu », voir cette (modeste) enquête menée auprès de 816 adultes non vaccinés, publiée par l’université Johns-Hopkins de Baltimore :

      Many Adults Who Thought They Had COVID-19 Actually Didn’t | MedPage Today
      https://www.medpagetoday.com/infectiousdisease/covid19/97007

      Parmi les sondés n’ayant jamais été testés positifs, la présence d’anti-corps marqueurs d’une infection au Covid-19 a pu être identifiée chez seulement :
      – 55% de ceux qui pensaient l’avoir déjà contracté
      11% de ceux qui pensaient y avoir échappé

    • @arno oui et ces résultats vont plutôt complètement à l’encontre du rassurisme ambiant...

      Une autre remarque d’ailleurs : dans le tableau de résultats il apparait aussi que ce sont celleux qui imaginent (à tort ou à raison) l’avoir déjà eu qui
      – déclarent le plus ne « jamais » porter le masque (18%)
      – déclarent le moins le porter « régulièrement » (10%)

    • @monolecte en l’occurrence l’enquête concernait aussi un gros tiers de personnes qui elles avaient été testées positives dans les 20 derniers mois, et chez 99% desquelles les marqueurs étaient toujours bien présents, ce qui renforce les résultats et évacue l’hypothèse de la disparition des traces..? D’autant plus que chez tous ces contaminés, sont mesurés des taux d’anti-corps restés en moyenne constants quelle que soit la durée écoulée depuis l’infection.

      Among 295 reported COVID-confirmed participants, 293
      (99%) tested positive for anti-RBD antibodies (≥250 U/mL,
      44%; ≥500 U/mL, 27%; ≥1000 U/mL, 15%). A median of 8.7
      (IQR, 1.9-12.9; range, 0-20) months passed since reported
      COVID-19 diagnosis. The median anti-RBD level among those
      who tested positive was 205 (IQR, 61-535) U/mL. There was
      no evidence of association between time after infection and
      antibody titer (0.8% increase [95% CI, –2.4% to 4.2%] per
      month, P = .62) (Figure).

      Figure. Anti-Spike RBD Levels by Time Since COVID-19 Diagnosis

      https://cdn.jamanetwork.com/ama/content_public/journal/jama/0/m_jld220008f1_1643832764.34688.png?Expires=1647769802&Signature=Wb5

      Bon, en revanche et pour tempérer, les auteurices modèrent un peu la tentation de généraliser les résultats, notamment à cause d’un possible de biais de sélection dû au mode de recrutement.

    • là, je pige pas... j’ai envisagé de faire une sérologie afin d’essayer de vérifier si je n’ai pas été contaminé et asymptomatique, et ma toubib me dit, ce qui semble logique, que le fait d’être vacciné et donc de disposer d’anticorps interdira de savoir ce qu’il en est (mais elle est assez rigide et a trouvé moyen de me dire qu’une étude sur les covid long avait conclu que 50 % de celleux qui se manifestaient comme tel.les n’avaient jamais eu le covid)

    • pas tout-à-fait le message délivré par la toubib de @colporteur, mais on n’en est pas loin : d’après cette étude (08/11/21), le covid long serait associé aux cas de covid auto-déclarés, pas aux covid confirmés

      Association of Self-reported COVID-19 Infection and SARS-CoV-2 Serology Test Results With Persistent Physical Symptoms Among French Adults During the COVID-19 Pandemic | Infectious Diseases | JAMA Internal Medicine | JAMA Network
      https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2785832

      Key Points
      Question Are the belief in having had COVID-19 infection and actually having had the infection as verified by SARS-CoV-2 serology testing associated with persistent physical symptoms during the COVID-19 pandemic?

      Findings In this cross-sectional analysis of 26 823 adults from the population-based French CONSTANCES cohort during the COVID-19 pandemic, self-reported COVID-19 infection was associated with most persistent physical symptoms, whereas laboratory-confirmed COVID-19 infection was associated only with anosmia. Those associations were independent from self-rated health or depressive symptoms.

      Meaning Findings suggest that persistent physical symptoms after COVID-19 infection should not be automatically ascribed to SARS-CoV-2; a complete medical evaluation may be needed to prevent erroneously attributing symptoms to the virus.

    • @colporteur, l’enquête/étude en question portait sur des adultes non vaccinés, donc chez qui la présence d’anticorps permettait d’établir sans faute qu’ils avaient été contaminés.

      edit : d’après @olaf ci-dessous la sérologie permet aussi de faire la distinction chez les vaccinés.

    • @mammut le labo à côté de chez moi m’a dit que les tests sérologiques peuvent faire la différence entre anticorps élus par la vax et ceux élus par le virus ; c’est juste pas une séro « habituelle », ils ont très peu de demandes, et expédient les échantillons à un presta à Paris qui les passe en basse-priorité, alors faut compter 2-3 semaines de délai pour le rendu.

      @colporteur j’ai l’impression qu’une bonne partie des toubibs exécutent les ordres et refusent de prescrire des sérologies covid voire découragent les gens de les faire, même juste pour savoir ; c’était déjà le cas au début de la campagne de vax de l’été 2021.

      Ceci-dit, tu peux aller t’en payer un, c’est dans les 30 balles et ça dose les anticorps dirigés contre la protéine N (nucléocapside) du virus - les vax arn font des anticorps dirigés contre la S (spike).

    • ouais, ELISA « sandwitch » même, d’après la dame ; les gens de SAPRIS-SERO ont fait (font encore ?) du test ELISA aussi.

  • A National Strategy for #COVID-19 Medical Countermeasures
    Vaccines and Therapeutics https://jamanetwork.com/journals/jama/fullarticle/2787946

    The US needs a strategy for a “new normal” of living that includes COVID-19. This “new normal” will occur when total respiratory viral infections, hospitalizations, and deaths inclusive of those from COVID-19 are no higher than what typically occurred in the most severe influenza years before the current pandemic. Integral to achieving and sustaining this “new normal” are both faster development and more efficient deployment of vaccines and therapeutics.

  • COVID-19 isn’t just a cold

    This thread is long, and hard to read - not just because of the technical language, but because “it’s just a cold,” “the vaccine protects me,” and “at least our children are safe” are comforting fairy tales.

    I wish they were true.

    This virus is like measles and polio: a virus with long-term impact.

    Even a “mild” case in a vaccinated individual can lead to long-term issues which cause a measurable uptick in all-cause mortality in the first 6 months, and get progressively worse with time.

    SARS-CoV-2 is a systemic disease which has multiple avenues to induce long-term impairment, attacking the brain, heart, lungs, blood, testes, colon, liver, and lymph nodes, causing persistent symptoms in more than half of patients by six months out.

    The CoVHORT study, limited to non-hospitalized patients in Arizona - “mild” cases - found a 68% prevalence of 1 or more Covid symptom after 30 days, rising to 77% after 60 days. (We will explore an explanation later).

    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254347

    To prevent panic, @CDCgov has been using the term “mild” to describe any case of COVID-19 which does not require hospitalization.

    #LongCOVID, however, is anything but “mild”, as the replies to @ahandvanish’s thread make heartbreakingly clear.

    https://twitter.com/ahandvanish/status/1423017721822949376

    A University of Washington study found that 30% of Covid patients had reduced Health Related Quality of Life, with 8% of the patients limited in routine daily activities.

    https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776560

    These patients are struggling with real physical issues.

    This Yale study demonstrated reduced aerobic capacity, oxygen extraction. and ventilatory efficiency in “mild” COVID patients even after recovery from their acute infection.

    https://journal.chestnet.org/article/S0012-3692(21)03635-7/abstract

    It’s also a vascular disease. A Columbia study found “significantly altered lipid metabolism” during acute disease, which “suggests a significant impact of SARS-CoV-2 infection on red blood cell structural membrane homeostasis.”

    https://pubs.acs.org/doi/full/10.1021/acs.jproteome.0c00606

    Oregon Health & Science University found that “symptomatic or asymptomatic SARS-CoV-2 infection is associated with increased risk of [fatal] cardiovascular outcomes and has causal effect on all-cause mortality.”

    https://www.medrxiv.org/content/10.1101/2021.12.27.21268448v1

    Let’s review: SARS-CoV-2 causes an increase in mortality and reduced aerobic capacity even after asymptomatic cases, and remains in the body months after the initial infection.

    No, it’s not “just a cold.”

    But we’re just getting started. It gets worse. Way worse.

    The virus appears to be able to cross the blood-brain barrier and cause significant neurological damage.

    The ability of the spike protein to cross the blood-brain barrier was demonstrated in mice at the University of Washington.

    https://pubmed.ncbi.nlm.nih.gov/33328624

    A joint study by Stanford and Germany’s Saarland University found inflammation in the brain, and “show[ed] that peripheral T cells infiltrate the parenchyma.”

    https://www.nature.com/articles/s41586-021-03710-0

    For context, the parenchyma is the functional tissue of the brain - your neurons and glial cells. It isn’t normally where T cells are:

    “In the brain of healthy individuals, T cells are only present sporadically in the parenchyma.”

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751344

    The Stanford study also discovered microglia and astrocytes which displayed “features .. that have previously been reported in human neurodegenerative disease.”

    Post-mortem neuropathology in Hamburg, Germany found “Infiltration by cytotoxic T lymphocytes .. in the brainstem and cerebellum, [with] meningeal cytotoxic T lymphocyte infiltration seen in 79% [of] patients.”

    https://www.sciencedirect.com/science/article/pii/S1474442220303082#

    An autopsy of a 14-month-old at Brazil’s Federal University of Rio de Janeiro found that “The brain exhibited severe atrophy and neuronal loss.”

    https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00038-7/abstract

    The UK Biobank COVID-19 re-imaging study compared before and after images of “mild” cases, and found “pronounced reduction in grey matter” and an “increase of diffusion indices, a marker of tissue damage” in specific regions of the brain.

    https://www.medrxiv.org/content/10.1101/2021.06.11.21258690v3

    That seems to explain why there is evidence of persistent cognitive deficits in people who have recovered from SARS-CoV2 infection in Great Britain.

    https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00324-2/fulltext

    Also worrisome are syncytia, where an infected cell extrudes its own spike protein and takes over its neighbors, fusing together to create a large multi-nucleus cell.

    Delta’s particular aptitude for this may partly explain its severity.

    https://www.news-medical.net/news/20211006/SARS-CoV-2-emerging-variants-display-enhanced-syncytia-formation.aspx

    And, yes, syncytia formation can happen in neurons. For our visual learners, here is video of syncytia and apoptosis (cell death) in a (bat) brain:

    https://twitter.com/nytimes/status/1429604323047133185

    Luckily, the University of Glasgow found that “Whilst Delta is optimised for fusion at the cell surface, Omicron .. achieves entry through endosomal fusion. This switch .. offers [an] explanation for [its] reduced syncytia formation.”

    https://www.gla.ac.uk/media/Media_829360_smxx.pdf

    If you’re interested in further understanding the host of neurological symptoms and the mechanisms underlying them, this Nature article is an excellent primer:

    https://www.nature.com/articles/d41586-021-01693-6

    Let’s review: SARS-CoV-2 can cross the blood-brain barrier, and even “mild” or asymptomatic cases can cause loss of neurons and persistent cognitive defects?

    That doesn’t sound “mild” to me; I like my brain.

    But it keeps getting worse.

    The brain isn’t the only organ affected: Testicular pathology has found evidence of “SARS-Cov-2 antigen in Leydig cells, Sertoli cells, spermatogonia, and fibroblasts” in post-morten examination.

    https://onlinelibrary.wiley.com/doi/10.1111/andr.13073

    A Duke pathology study in Singapore “detected SARS-CoV-2 .. in the colon, appendix, ileum, haemorrhoid, liver, gallbladder and lymph nodes .. suggesting widespread multiorgan involvement of the viral infection.”

    https://gut.bmj.com/content/gutjnl/early/2021/06/13/gutjnl-2021-324280.full.pdf#page1

    The same study found “evidence of residual virus in .. tissues during the convalescent phase, up to 6 months after recovery, in a non-postmortem setting,” suggesting that “a negative swab result might not necessarily indicate complete viral clearance from the body.”

    It also causes microclots: “Fibrin(ogen) amyloid microclots and platelet hyperactivation [were] observed in [Long COVID] patients,” in this work by Stellenbosch University of South Africa, which also explored potential treatments.

    https://www.researchsquare.com/article/rs-1205453/v1

    Let’s review - SARS-CoV2 attacks our veins, blood, heart, brain, testes, colon, appendix, liver, gallbladder and lymph nodes?

    No, it’s not “just a respiratory virus”.

    Not even close.

    There are also immunology implications:

    Johns Hopkins’ @fitterhappierAJ found that “CD95-mediated [T cell] differentiation and death may be advancing T cells to greater effector acquisition, fewer numbers, and immune dysregulation.”

    https://www.frontiersin.org/articles/10.3389/fimmu.2020.600405/full

    This Chinese military study of the initial Wuhan outbreak concluded that “T cell counts are reduced significantly in COVID-19 patients, and the surviving T cells appear functionally exhausted.”

    https://www.frontiersin.org/articles/10.3389/fimmu.2020.00827/full

    The study authors went on to warn, “Non-ICU patients with total T cells counts lower than 800/μL may still require urgent intervention, even in the immediate absence of more severe symptoms due to a high risk for further deterioration in condition.”

    Those warnings have since been proven by discovery of autoimmune features.

    This study of 177 Los Angeles healthcare workers found that all had persistent self-attacking antibodies at least 6 months after infection, regardless of illness severity.

    https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-021-03184-8

    In the words of T-cell immunologist Dr. Leonardi (@fitterhappierAJ)

    https://twitter.com/fitterhappierAJ/status/1475227891034210314

    This Kaiser Permanente S.California study found that, although natural immunity provided substantial protection against reinfection, “Hospitalization was more common at suspected reinfection (11.4%) than initial infection (5.4%).”

    https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(21)00422-5/abstract

    In fact, remember those cytokine storms? It turns out that even that even severe COVID-19 may not be a viral pneumonia, but an autoimmune attack of the lung.

    https://twitter.com/DaveLeeERMD/status/1413816137570205697

    Let’s review - it’s autoimmune: SARS-CoV2 convinces our body to attack itself.

    That might explain why the Arizona study saw more symptoms after 60 days than at 30 days.

    It also means “natural immunity” isn’t something to count on.

    But if you’re counting on vaccination to feel safe, there’s even more bad news.

    A study of Israel healthcare workers found that “Most breakthrough cases were mild or asymptomatic, although 19% had persistent symptoms (>6 weeks).”

    https://www.nejm.org/doi/full/10.1056/NEJMoa2109072

    Perhaps the most terrifying study is from Oxford University, which examined the effects of vaccination on long COVID symptoms, because not only did it find that vaccination does not protect against Long Covid, but that Long Covid symptoms become more likely over time:

    In the words of the study authors, “vaccination does not appear to be protective against .. long-COVID features, arrhythmia, joint pain, type 2 diabetes, liver disease, sleep disorders, and mood and anxiety disorders."

    https://www.medrxiv.org/content/10.1101/2021.10.26.21265508v3

    “The narrow confidence intervals rule out the possibility that these negative findings are merely a result of lack of statistical power. The inclusion of death in a composite endpoint with these outcomes rules out survivorship bias as an explanation.”

    That finding contradicts the findings from the UK Zoe app study, which found that “the odds of having symptoms for 28 days or more after post-vaccination infection were approximately halved by having two vaccine doses.”

    https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00460-6/fulltext

    However, the structural limitations of the Zoe study - discussed in detail by @dgurdasani1 in the linked thread - may explain why it is particularly susceptible to bias against detecting a progressive degenerative condition.

    https://twitter.com/dgurdasani1/status/1422802883632893952

    Let’s review: we’ve now shown that vaccination appears to offer no protection against the long-term autoimmune effects of COVID - which we know causes T-cells to attack the lungs, and can cause T-cells to enter the brain.

    Why are we letting this run wild?!

    You may think, at least our children are safe.

    They are not.

    The CDC is tracking incidence of a life-threatening multisystem inflammatory syndrome in children following an acute COVID-19 infection, with 5,973 cases as of November 30, 2021.

    https://covid.cdc.gov/covid-data-tracker/#mis-national-surveillance

    Children also suffer from Long Covid.

    “More than half [of pediatric patients] reported at least one persisting symptom even 120 days [after] COVID-19, with 42.6% impaired by these symptoms during daily activities.”

    https://www.medrxiv.org/content/10.1101/2021.01.23.21250375v1

    Focusing exclusively on pediatric deaths is vastly underselling the danger to children.

    Anybody telling you that SARS-CoV-2 is “just a cold” or “safe for children” is lying to you. They are ignoring the massive body of research that indicates that it is anything but.

    Since our vaccines don’t stop transmission, and don’t appear to stop long-term illness, a “vaccination only” strategy is not going to be sufficient to prevent mass disability.

    This isn’t something we want to expose our kids to.

    Let’s review: even for children and vaccinated people, a “mild” case of COVID causes symptoms that point to long-term autoimmune issues, potentially causing our own body to attack our brains, hearts, and lungs.

    Scared? Good.

    Now we’re ready to get to work.

    “This is the virus most Americans don’t know. We were born into a world where a virus was a thing you got over in a few weeks.” — @sgeekfemale, to whom I owe a “thank you” for her editing assistance on this thread.

    The viruses they know in Kolkota, Kinshasa, and Wuhan are different: dangerous, lethal beasts.

    Since 2020, the field has been leveled. Willing or no, we’ve rejoined the rest of the world. We are, all of us, vulnerable in the face of an unfamiliar threat.

    The first step is acknowledging the threat.

    That means acknowledging that our response has been woefully inadequate, and that is going to be uncomfortable.

    The thought that we could have prevented this, but didn’t, will feel unconscionable to some.

    The knowledge that we could start preventing this today, but haven’t, is unconscionable to me.

    https://twitter.com/IanRicksecker/status/1426584062827712512

    It’s time to quit pretending “it’s just a cold,” or that there is some magical law of viruses that will make it evolve to an acceptable level.

    There’s no such law of evolution, just wishful thinking, easily disproven by:

    Ebola. Smallpox. Marburg. Polio. Malaria.

    There are things we can do to reduce our individual risk, immediately.

    That starts with wearing a good mask - an N95 or better - and choosing to avoid things like indoor dining and capacity-crowd stadiums.

    https://twitter.com/LazarusLong13/status/1440398111445188618

    This isn’t a choice of “individual freedom” vs “public health”. It isn’t “authoritarian” to ask people to change their behavior in order to save lives.

    https://www.thehastingscenter.org/individual-freedom-or-public-health-a-false-choice-in-the-covid-e

    As Arnold @Schwarzenegger argued so convincingly in @TheAtlantic, it is our patriotic duty:

    “Generations of Americans made incredible sacrifices, and we’re going to throw fits about putting a mask over our mouth and nose?”

    https://www.theatlantic.com/ideas/archive/2021/08/schwarzenegger-schmuck-mask-vaccines/619746

    “Those who would sacrifice essential liberty for a little bit of temporary security deserve neither!”

    What is the essential liberty here?

    It is the liberty to be able to breathe clean air, to live our lives without infecting our families and risking disability.

    To get there, we need to listen to our epidemiologists and public health experts - the ones who have been trying to tell us this since the beginning:

    https://twitter.com/EpiEllie/status/1444088804961304581

    It is time — long past time — to give up on the lazy fantasy that we can let it become “endemic” and “uncontrolled” because it inconveniences us, because it is killing our political opponents, or because the virus will magically evolve to some “mild” state.

    It is time — long past time — to begin controlling this virus.

    It’s possible: Japan, New Zealand, and South Korea have done it.

    It saves lives:

    It’s even good for the economy:

    “Globally, economic contraction and growth closely mirror increases and decreases in COVID-19 cases... Public health strategies that reduce SARS-CoV-2 transmission also safeguard the economy.”

    https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06357-4

    It’s time.

    https://threadreaderapp.com/thread/1478611650760437765.html

    sur twitter :
    https://twitter.com/IanRicksecker/status/1478611650760437765

    #long-covid #covid-19 #coronavirus #covid_long #long_covid #séquelles #post-covid

  • The Flawed Science of Antibody Testing for #SARS-CoV-2 Immunity | Infectious Diseases | JAMA | JAMA Network
    https://jamanetwork.com/journals/jama/fullarticle/2785530

    […] some tests detect antibodies the immune system likely produces only after natural infection with the virus. Depending on the assay, people who weren’t previously infected could test negative for antibodies despite having vaccine-induced immunity.

    […]

    […] the laboratory tests haven’t been standardized. “That’s a problem when people say, ‘Okay, I want to go see if I should get a booster or not,’” Theel said. Some SARS-CoV-2 serology assays simply give a positive or negative result, without antibody values. Those that are quantitative use varying methods, detect different antibody classes, and report values using different units of measurement.

    According to Theel, if and when correlates and thresholds of protection are determined, the tests will need to be standardized and calibrated, as has been done with antibody tests for other vaccine-preventable diseases, including tetanus, diphtheria, and measles. So far, only one commercially available SARS-CoV-2 antibody test, from Ortho-Clinical Diagnostics, has been calibrated to the World Health Organization’s reference standard, she said.

    #immunité #anticorps #vaccination #sérologie