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Discussion thread VII - COVID-19: Endemic Stage

Dana Parish

@danaparish
·
18h
People are often asking what blood tests they can request to look for Covid vascular damage/ microclotting issues
1f447-1f3fc.svg

Quote Tweet
qJa5JqAs_normal.jpg

Resia Pretorius
@resiapretorius
·
Oct 29
We have shown that molecules secreted by damaged endothelia may be used in interim ‘til we have microclot lab tests.Try pathlabs for VWF, e-selectin and PECAM-1, ALSO alpha2antiplasmin. Most trapped in clots - so soluble fraction = not total concentration @dbkell @doctorasadkhan twitter.com/Sunny_Rae1/sta…
 

Myocarditis, good news

Dr. John Campbell

395,499 views 6 Nov 2022

Covid infection did not increase incidence of post-covid myocarditis or pericarditis.

The Incidence of Myocarditis and Pericarditis in Post COVID-19 Unvaccinated Patients-A Large Population-Based Study

https://pubmed.ncbi.nlm.nih.gov/35456309/


https://www.mdpi.com/journal/jcm


Myocarditis and pericarditis, post-acute cardiac sequelae of COVID-19 infection,

arising from adaptive immune responses.

? incidence

Retrospective cohort study

Study group, had infection

N = 196,992 adults after COVID-19 infection

(Clalit Health Services)

March 2020 to January 2021

Inpatient myocarditis and pericarditis diagnoses,

from day 10 after positive PCR

Israeli vaccination program initiated on 20 December 2020

Follow-up was censored on 28 February 2021

Control cohort, never infected

N = 590,976 adults,

with at least one negative PCR and no positive PCR

(age- and sex-matched)

Calculated backward from 15 December 2020

Results

Post-COVID-19 group

Nine post-COVID-19 patients developed myocarditis (0.0046%)

Eleven diagnosed with pericarditis (0.0056%)

Control group, never covid infected

27 developed myocarditis (0.0046%) P = 1

52 developed pericarditis (0.0088%) P = 0.17


Adjusted hazard ratio [aHR]

Myocarditis, male (aHR 4.42) regardless of previous COVID-19 infection

Pericarditis, (aHR 1.93)

Peripheral vascular disease, (aHR 4.20)

Follow up

Median, 4.1 months

Covid cohort, 700,040 person-months

Non covid cohort, 2,100,077 person-months

Conclusions

Post COVID-19 infection was not associated with myocarditis (aHR 1.08)

Post COVID-19 infection was not associated with pericarditis (aHR 0.53)

We did not observe an increased incidence of neither pericarditis nor myocarditis in adult patients recovering from COVID-19 infection.

Our data suggest that there is no increase in the incidence of myocarditis and pericarditis in COVID-19 recovered patients,

compared to uninfected matched controls.

https://www.youtube.com/watch?v=RMMA9bwDklQ
 
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WHO Director-General's opening remarks at the media briefing – 9 November 2022

9 November 2022

...
Now to the COVID-19 pandemic.

Just over 9,400 COVID-19 deaths were reported to WHO last week – almost 90% less than in February of this year, when weekly deaths topped 75,000.

We have come a long way, and this is definitely cause for optimism, but we continue to call on all governments, communities and individuals to remain vigilant.

Almost 10,000 deaths a week is 10,000 too many, for a disease that can be prevented and treated.

Testing and sequencing rates remain low globally, vaccination gaps remain wide, and the continued proliferation of new variants remains concerning.

WHO continues to urge caution, and we continue to urge everyone to be fully vaccinated – including getting your next dose if it’s due.

===
https://www.who.int/director-genera...marks-at-the-media-briefing---9-november-2022
 
In sum, in this study of 5,819,264 individuals, we provide evidence that reinfection contributes to additional health risks beyond those incurred in the first infection including all-cause mortality, hospitalization and sequelae in a broad array of organ systems. The risks were evident in the acute and postacute phases of reinfection. The evidence suggests that for people who already had a first infection, prevention of a second infection may protect from additional health risks. Prevention of infection and reinfection with SARS-CoV-2 should continue to be the goal of public health policy.

Nature Medicine - Acute and postacute sequelae associated with SARS-CoV-2 reinfection - November 10, 2022


--------------------------------------------------------------------------

There should be continuing free vaccines, free test kits, free N95 to anyone that wants them. This should be the public policy referenced above. Government mandates are not feasible but free prevention supplies is feasible and, in fact, should be considered as important as the expenditure for the defense department.

Defense of the health of our population.
 
"Retrospective cohort study of 196,992 adults after COVID-19 infection in Clalit Health Services members in Israel between March 2020 and January 2021."
So that would span the early variants, but it doesn't look like Delta hit Israel until the summer of 2021.
I haven't seen any indication that Omicron would be more likely to trigger myocarditis, but there are two case reports here.
https://academic.oup.com/ehjcr/article/6/10/ytac407/6748255

But those two men had 3 doses of Pfizer's vaccine.

This study looked at antibody responses in children with vaccine induced myocarditis.
https://academic.oup.com/cid/article/75/9/1645/6571576

Those kids had higher levels of antibodies than healthy kids. Higher antibody levels don't always equate to better health.
 

Dr Claire Taylor
@drclairetaylor
1/ Mast Cell Monday. What are ‘mast cells’? They are part of the immune system and constantly looking for trouble! Handy wee things when you need them- they release histamine+ other things to draw other cells to the area. The problem is when they go rogue…
10:20 AM · Nov 14, 2022·Twitter for iPhone
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Dr Claire Taylor
@drclairetaylor
·
22h
Replying to
@drclairetaylor
2/ they can go rogue for no reason and this is called ‘mast cell activation syndrome’ Eg the mast cells are acting like there is a big problem and releasing all these chemicals eg Histamine and prostaglandins that can then cause symptoms in every part of the body.
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Dr Claire Taylor
@drclairetaylor
·
22h
5/ the list of symptoms is endless but commonly fast heart rate, rashes, reflux, headaches, fatigue, gastro symptoms. Triggers can be food, temperature, smells, chemicals, exercise, stress or nothing at all. At worst can lead to anaphylaxis (should stress this is rarer).
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Dr Claire Taylor
@drclairetaylor
·
22h
6/ how common is it? According to one dr up to 17% of the population. Answer is we don’t really know but it’s associated with #mecfs #LongCovid and other immune medicated diseases
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Dr Claire Taylor
@drclairetaylor
·
22h
7/ why hasn’t your Doctor heard of it? It appears in the ICD-10 coding of diseases https://aapc.com/codes/icd-10-codes/D89.4… Yet there are no guidelines and not a huge amount of research. There is an international consensus statement

pubmed.ncbi.nlm.nih.gov
Diagnosis of mast cell activation syndrome: a global "consensus-2" - PubMed
The concept that disease rooted principally in chronic aberrant constitutive and reactive activation of mast cells (MCs), without the gross MC neoplasia in mastocytosis, first emerged in the 1980s,...
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Dr Claire Taylor
@drclairetaylor
·
22h
8/ Are there tests? Yes. But any mcas patient will tell you that they are often negative - blood tryptase level -24 urine tests that have to be kept on ICE and degrade quickly.
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Dr Claire Taylor
@drclairetaylor
·
22h
9/ is there treatment? Yes! Which is why we need to raise awareness of it as a condition. We have seen a huge increase in #mcas after Covid.
@BethanMyers
has written the best paper on it. I bow to her expertise.

pubmed.ncbi.nlm.nih.gov
Mast cell activation syndrome and the link with long COVID - PubMed
Mast cells are innate immune cells found in connective tissues throughout the body, most prevalent at tissue-environment interfaces. They possess multiple cell-surface receptors which react to...
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Dr Claire Taylor
@drclairetaylor
·
22h
10/ treatment can start with most basic H1 and H2 blockers ( eg antihistamines and H2 blockers formerly used mainly for stomach problems). There are then various groups of meds that can be worked up to if things are not settling.
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Dr Claire Taylor
@drclairetaylor
·
22h
11/ this study showed that Long-COVID patients had similar severity of numerous MCAS symptoms

ijidonline.com
Mast cell activation symptoms are prevalent in Long-COVID
The COVID-19 pandemic has spread throughout the world, with calamitous outcomes for some of those acutely infected and for those who struggle with Long-COVID (LC), also known as Long-Haul COVID and...
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Dr Claire Taylor
@drclairetaylor
·
22h
12/ children also get it. This paper from 2020 questions whether multisystem inflammation is actually severe MCAS https://mastcellaction.org/assets/2021/09/17/53330e05-1552-4b3b-9238-25a39a80ec0b.pdf?v=1…
@LongCovidKids
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Dr Claire Taylor
@drclairetaylor
·
22h
13/ is irritable bowel syndrome actually MCAS? This study showed IBS patients had increased mast cells near the nerves.

sciencedirect.com
Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable...
Background & Aims: The mechanisms underlying abdominal pain perception in irritable bowel syndrome (IBS) are poorly understood. Intestinal mast cell i…
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Dr Claire Taylor
@drclairetaylor
·
22h
14/ MCAS is associated with #MECFS #LongCovid #EhlersDanlos #pots It’s hard to get numbers on how many are affected but from clinical observation it appears to be a lot. So we have a treatable avenue but patients have to actively seek out diagnosis and treatment
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Dr Claire Taylor
@drclairetaylor
·
22h
16/ MCAS is different from mastocytosis. In MCAS there are normal cells that rerelease chemicals when they shouldn’t. Mastocytosis is when the body makes too many mast cells.
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Dr Claire Taylor
@drclairetaylor
·
22h
17/ I hope this is helpful for patients and #MedTwitter Picture of mast cell ( from https://marekdoyle.com/mast-cell-activation-messenger/…) #NEISvoid

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Dr Claire Taylor
@drclairetaylor

21h
Haven’t a clue where tweets 3+4 went. That’s what happens when you tweet and parent at the same time
1f62d.svg
 
This makes me so mad. Jha has no idea what is going to happen this winter. No one knows. And as for the 90% of the population who has taken one covid shot - when was this? 2021? The evidence is unclear on how long natural immunity lasts but it is known that many people have had repeated COVID-19 infections. I have several family members who have had multiple infections. I don't even ask them anymore.

I think the government knows that they can not control the population so the new COVID-19 message is "don't worry, be happy".

As we have been saying since the beginning....evaluate your situation and make decisions accordingly. We are all on our own.

Take care of you.


US - Jha, the White House Covid-19 coordinator, isn’t predicting a severe Covid surge this holiday season - (or maybe he doesn't actually know) - November 15, 2022
 
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Raj Rajnarayanan
@RajlabN
#CoronaVirusUpdates #China 11/17/2022

Closely watching in new reported #COVID19 cases from China Poised to become larger than the April 2022 peak soon.

FhxpZDhXkAQ8o7o


9:28 AM · Nov 17, 2022·Twitter Web App
-----------------------------------------------

Raj Rajnarayanan
@RajlabN
·
Nov 17
Replying to
@RajlabN

New clues from Airport surveillance of specimen collected from travelers w/ travel history: China. XBB.1.1 (specimen collection date: 11/02/2022)

FhxqbnvWQAw4k6f


...
https://twitter.com/RajlabN/status/1593264822891823111
 
Translation Google

Antoine FLAHAULT
@FLAHAULT

We are in this dystopia where nothing is done to stop a disease that will infect 90% of the population in 2022, sometimes 2 or 3x, kill 40,000 people, 7x more children than in 2020 or 2021, in the most perfect acceptance of the executive to renounce all prevention.
----------------
1/5 - Western Europe is experiencing the very likely start of a new (ninth) pandemic wave of #COVID19 .
This is the fifth wave of the year 2022, after two waves in 2020 and two waves in 2021: the pandemic is accelerating.

Fhy21lRWAAAbA-m



3:04 PM · Nov 17, 2022·Twitter for iPhone
...
2/5 - In France, contaminations and hospitalizations are increasing almost simultaneously, deaths are no longer falling and should increase again soon, with already more than 33,000 #COVID19 deaths since the start of 2022.
...
3/5 - The ninth wave seems to be driven by the #BQ11 sub-variant of #Omicron. There are no reports of abnormally severe forms and the vaccine (<6 months old) seems to continue to protect against severe forms. This variant escapes the monoclonal Abs which prevented hospitalisations/deaths.
...

https://twitter.com/FLAHAULT/status/1593349403682775040
 
Madagascar -

Translation Google

EPIDEMIC - A new symptom of Covid-19 identified

Doctors have noticed a new symptom of the coronavirus, in this resurgence of the epidemic. “Patients have blood in the stool. This is the particularity of this new wave of the epidemic.”, indicate Dr Denis Rafalison and Dr Naly Andrianera, free doctors who take care of many patients with Covid-19, in this resurgence of the disease. epidemic. Those blood-stained stools wouldn't be much of a concern.

“The covid suffers from several inflammations in his body. This could explain the presence of blood in the stool. It's not very dangerous. What could be worrying is blood clotting, which can cause a pulmonary embolism, for example,” says Dr. Naly Andrianera. Dr. Denis Rafalison is still looking for explanations for this symptom.

“It may be related to digestive issues. The patient can make a digestive hemorrhage, for example. ”, he supposes. Abroad, the symptoms of covid-19 would evolve with the circulation of new variants. The circulation of a new variant of covid-19 is not yet confirmed in Madagascar. Doctors note, however, that the resurgence of the epidemic often coincides with the circulation of a new variant. The other usual symptoms of the disease are still observed. Namely, colds, headaches, body aches, diarrhea, fever, dry cough, feeling of general malaise, fatigue, dizziness, among others.

...

https://lexpress.mg/18/11/2022/epide...-19-identifie/
 
Steven Lome



20h • 13 tweets • 5 min read Bookmark Save as PDF My Authors
I ran a half marathon this past weekend. I feel quite honored to work as a cardiologist and use my training for the benefit of others, but I never expected those skills to be needed in this manner outside of work.
At mile 3 right in front of me a runner went down. Cardiac arrest. Started CPR…people called 911. Defibrillator arrived in about 6 minutes and rhythm was ventricular fibrillation (fatal arrhythmia). One shock and normal heart rhythm restored.
Got the patient into the ablulance with paramedics and he was awake/alert and stable off to the hospital. Somewhat frazzled I kept running to finish the race (no way I was going to catch my 16 yo daughter and 14 son at this point, they were ahead of me anyways)...

THEN…
I crossed the finish line and threw my arms in the air…and ANOTHER runner goes down right in front of me. Completely out. No pulse. Started CPR. Within 1-2 minutes a race volunteer brought an AED (defibrillator). Placed the pads on his chest.
Shock advised indicating a fatal arrhythmia is again present. One shock and I restart chest compressions. He opens his eyes and says “Why am I down here?” then proceeds to stop his Strava on his watch and wants to get up. To the hospital he goes.
Both had undiagnosed heart disease, out of hospital cardiac arrest and made full recoveries.

What are the odds that two people have a cardiac arrest in one race?

What are the odds they both make a full recovery (normally only 5% survive out of hospital cardiac arrest)?
What are the odds that the same cardiologist happens to be right behind them both???

Kudos to the medical volunteers at the race and the Big Sur Marathon Foundation for their efforts organizing the event with ample medical volunteers that were well trained and ready to act.
Being alert and ready to bring an AED as fast as possible saved two lives. The @American_Heart Association and @ACCinTouch have been great promoting this.

I still can’t believe this happened. Enjoy every day. Focus on your health.
THIS is why we need to focus America on prevention of heart disease since the first symptom of heart disease in 1 out 3 people is sudden death like these two individuals almost succumbed to.

Eliminate processed foods.
Dramatically reduce or eliminate animal foods, focus on eating as much unprocessed plant based foods as you can. Exercise is only 20% of heart health, diet is the most important part!

For those in healthcare, check out the American College of Lifestyle Medicine. @ACLifeMed
To learn more about diet and heart health, watch The Game Changers on Netflix @gcmovie Forks Over Knives @ForksOverKnives and read the book How Not to Die by Dr Michael Greger @nutrition_facts

Support @PCRM
When I give community presentations I always end with telling people that even if you are not in healthcare treating patients… YOU have the power to save lives by promoting a healthy lifestyle including eating a more whole food plant based diet.

Stay healthy and safe.

---------------------------------------------------------------------------


Dr. @lisa_iannattone@med-mastodon.com
@lisa_iannattone
·
2h
Replying to
@SteveLome
Cardiac arrest during marathons were historically a 0.54 in 100,000 event. Since SARS2 infections became rampant (a virus that raises the risk clotting/cardiac arrest for months post infection), the “marathoner drops dead” theme is a regular in the news. SARS2 is bad for your
2665.svg
.

 
https://www.msn.com/en-us/health/ot...-fan-of-the-latest-covid-boosters/ar-AA13RD7y
Paul Offit, Philly’s most vocal vaccine advocate, on science, truth, and why he’s not a fan of the latest COVID boosters
Story by Jason Laughlin, The Philadelphia Inquirer

Philadelphia’s most prominent immunization expert isn’t planning to get the latest COVID-19 booster shot, and doesn’t think most others need to either.

Paul Offit, who is among the Food and Drug Administration’s advisers on which vaccines the public should receive, disagrees with the current recommendations of the White House, FDA, and Centers for Disease Control and Prevention that everyone over the age of 5 should get the new vaccine.

Offit says he is standing up for science. He has dedicated his career to advancing vaccines to save children from preventable illnesses. He thinks the new vaccines are safe but notes the Biden administration issued recommendations without strong evidence they offer significantly greater protection than the shots being given since 2020.
“This product was grossly oversold,” said Offit, who was in the minority on the FDA’s panel of independent experts who voted 19-2 in June to recommend that the COVID vaccines used for boosters should be updated to the bivalent vaccine now being offered across the nation.

He shrugs to see his opposition amplified on social media by groups that oppose most vaccines in general, and have been frequent foes of Offit’s.
“If Dr. Offit is questioning these vaccines, shouldn’t you??” one Twitter account, the Mama Bears Project, tweeted in October. Other vaccine skeptics are citing his comments in videotaped remarks circulating on social media that “the fix was in,” claiming falsely that COVID vaccines are part of a conspiracy.

A minority voice

Offit does support the latest bivalent vaccines for vaccinated seniors 75 and older, or others particularly vulnerable to COVID due to underlying medical conditions. He doesn’t see the need for healthy people to keep taking vaccine doses — yes, they may contract COVID, he notes, but are unlikely to suffer a serious case...
 
Added this to the link to clarify -

The abnormal findings were in long/post Covid patients, not in people who are fully recovered. (See title of first link) The study doesn't seem to be available in print yet, and we don't know if the brains of post/long Covid patients had the same abnormalities prior to getting sick. No mention is made of their vaccine or health status or age prior to illness. It is not clear to me if the healthy control group are recovered Covid.

https://www.canindia.com/iit-delhi-...t-brain-abnormalities-in-long-covid-patients/

"IIT-Delhi researcher reveals significant brain abnormalities in long Covid patients"
https://scitechdaily.com/significant-post-covid-brain-abnormalities-revealed-by-special-mri/
 
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