TWiVTLDR 1064

, a 2 min read

My summary for This Week in Virology Clinical Update #1064:

  • The CDC released 70K+ more doses of the RSV vaccines for babies.
  • The anti-vaccine movement is starting to show in measles cases. Increase of 18% in cases and 43% increase in deaths worldwide from 2021 to 2022. Most of the deaths are in young kids.
  • A VA study found that people taking immunosuppressive drugs for organ transplants, rheumatoid arthritis, inflammatory bowel disease (IBD), or psoriasis are still somewhat likely develop severe COVID-19 even if they’ve been vaccinated. 22.7% of organ transplant recipients are likely to get severe COVID, 12.8% of rheumatoid arthritis patients, 6.9% of IBD patients, and 7.3% of psoriasis patients. And Paxlovid helped a lot.
  • And another Paxlovid “rebound” study, comparing COVID patients of similar health histories that were treated or untreated with Paxlovid. To start, they really broaden the definition of “rebound” so that 20% of the untreated group would qualify as having “rebound.” Many people in both treated and untreated groups still report having at least 1 COVID symptom even after day 15 (70%). Also, only about 20% of people in both groups are testing negative on PCR tests by day 10. Both Drs. Griffin and Racaniello point out how “odd” this is, and question how you’re going to measure “rebound” if nobody goes to zero to rebound from? The study did find that people who took Paxlovid have fewer symptoms and lower viral load than untreated, so it should still help with transmission. And observe that symptom rebound is a separate thing from viral rebound. So Paxlovid should really be prescribed for everyone who is high risk.
  • The middling results of using COVID convalescent plasma (given to immunocompromised people who can’t take anything else) may be down to timing - if you give it late, it doesn’t have much of an effect. Also, the vast majority of the people given COVID convalescent plasma were also on steroid drugs at the time, which may have affected the plasma’s impact. (You take steroids when you want to tamp down inflammation from a hyperactive immune response.) It basically emphasizes the importance of giving COVID convalescent plasma during the first week.
  • Taking 100mg of fluvoxamine 2x a day (an SSRI mostly used for OCD treatment) does not help people recover faster from mild to moderate COVID. Apparently a bunch of people really thought this would work, because it was a thing that people told each other to take for COVID recovery. Sorry, it doesn’t work!
  • Another thing that doesn’t help with COVID disease progression - Conestat A (ConA) a recombinant human C1 inhibitor, which generally affects inflammation. They even stopped the study early because of how useless it was.
  • A small study showed that people with long COVID do not have reactivated Epstein-Barr virus in their blood. Dr. Griffin wants to reframe this, since some of his long COVID patients do have reactivated EBV, but some do not. It’s certainly true it’s not causative, but it also highlights the fact that a blood test for long COVID is still a ways off.
  • From a listener question: The renal dose of Paxlovid should only be given to patients who have documented kidney function issues. Some doctors prescribe it to anyone older than 65, but Dr. Griffin says it’s better to give the full dose unless warranted.