October 10th, 2022
North Carolina is in a good place.
No Multi Inflammatory Syndrome cases in our clinic.
In NC, we are at 4% of admitted patients needing a ventilator and 12% needing an ICU bed for Covid.
The 7 day moving average of cases for the US in recent weeks is 40,000 although we all know that this is vastly less than accurate with most people getting, using and not reporting positive home tests.
The risk of death is 0.000033 once vaccinated with a two dose series or survived natural infection.
As it stands today, the United States has had 1.06 million deaths. The case numbers will continue to vastly underestimate true case volume so I will stop reporting the number as it is meaningless now.
As with the first newsletter on this topic, keep solace with the fact that there is a 99+% chance of survival for all of us regardless of vaccination. However,
mathematically, you now have a 99.9998% chance of survival once vaccinated and the vaccine safety for the mRNA vaccines continues to look good.
Omicron US strains: as of September data - variants make up: BA.4 is 1%, BA.4.6 is 14%, BA.2.75 is 1%, BF.7 is 5%, BA.5 is 79%.
BA 4.6 and BF.7 are mildly gaining ground against BA.5. BF.7 is very interesting as it is apparently slightly more infectious than BA.5. That is amazing.
BF.7 has mutations in the spike and nucleotide regions of the RNA genome giving it potential for both infectiousness and immune evasion. Time will tell. No higher level of morbidity noted.
None of these VOC's are showing signs of increased disease morbidity.
Little else to report here. (CDC Variants)
From Monika Gandhi: "However, such a short interval is not optimal if we are aiming for robust fall/winter-long protection and could also be counter-productive. The CDC should recommend a 6-month interval between a previous booster or infection and the new updated vaccine for healthy adults for two primary reasons: updated immunologic studies and recognition that millions of Americans had post-vaccination infection with Omicron variants this year and thereby have strong current protection against re-infection with BA.5."
Quick Hits and other musings -
1) "The FDA and CDC both approved the updated bivalent COVID-19 vaccines last week. The promise of the mRNA vaccine technology platform was always that we could update them quickly. We may finally have achieved an advantage over SARS-COV-2 as the updated vaccine recipe matches the current dominant circulating BA.5 strain (and slow growing BA.4.6 strain) without another more transmissible variant of concern yet on the horizon. However, we are concerned that the CDC may again be missing the boat with its recommendations on timing for when most American adults should receive this booster. Following its Advisory Committee on Immunization Practices (ACIP) meeting on September 1, the CDC stated that adults who completed their primary vaccine series are eligible for the updated booster if it’s been at least two months since their previous vaccine. They advised those who recently had an infection to wait 3 months before getting boosted.
However, such a short interval is not optimal if we are aiming for robust fall/winter-long protection and could also be counter-productive. The CDC should recommend a 6-month interval between a previous booster or infection and the new updated vaccine for healthy adults for two primary reasons: updated immunologic studies and recognition that millions of Americans had post-vaccination infection with Omicron variants this year and thereby have strong current protection against re-infection with BA.5." (Daignault et. al. 2022)
This makes completes sense to me and is the process that I am engaged in.
2) From The Lancet: 258,007 SARS-CoV-2 tests were done during the study period. Pre-omicron primary infection was associated with a 38% reduction in BA.2 infection risk, with higher BA.2 protection among those who had also received one 56%, two 69%, or three 70%, mRNA vaccine doses. Omicron BA.1 primary infection was associated with greater protection against BA.2 infection risk reduction of 72%, and protection was increased further among those who had received two doses of mRNA vaccine 96%, but was not improved with a third dose 96%.
Health-care workers who had received two doses of mRNA vaccine and had previous BA.1 infection were subsequently well protected for a prolonged period against BA.2 reinfection, with a third vaccine dose conferring no improvement to that hybrid protection. If this protection also pertains to future variants, there might be limited benefit from additional vaccine doses for people with hybrid immunity, depending on timing and variant and their risk. (Carazo et. al. 2022)
More evidence that we need to individualize the process of vaccination over time. Risk remains the greatest reason to vaccinate often.
3) Results of a recent study suggest that more than half of adults with recent Omicron variant infection were unaware that they were infected. 56% of the infected individuals were unaware. (Joung et. al. 2022)
This study shows us that in general two things are happening: 1) people are having very mild illness now in general when they have been vaccinated and or had prior illness with Omicron SARS2. 2) People are not testing if they have mild symptoms. Only 10% of the positive infected individuals had symptoms which were consistent with a common cold.
4) If you had prior infection with Sars2 Omicron BA.1, then you are 75% protected from BA.5 or other variants according to a new report in the NEJM. (Malato et. al. 2022) This study came out of Portugal where the BA.5 variant has been active for a while. Multiple studies reinforcing #2.
5) In a fascinating report from Nature, we see: Severe acute respiratory syndrome coronavirus 2 caused the pandemic of COVID-19, in part because of its ability to effectively suppress host cell responses. Previous research has shown us that viral proteins can dampen antiviral responses by mimicking critical regions of human histone proteins particularly those containing post-translational modifications required for transcriptional regulation. In other words, the SARS2 virus can act like an epigenetic modifier changing protein production in our cells. In this study, we see that the SARS-CoV-2 protein encoded by ORF8 functions as a histone mimic of the ARKS motifs in histone H3 to disrupt host cell epigenetic regulation. Deletion of either the ORF8 gene or the histone mimic site attenuates the ability of SARS-CoV-2 to disrupt host cell chromatin, affects the transcriptional response to infection and attenuates viral genome copy number. These findings demonstrate a new function of ORF8 and a mechanism through which SARS-CoV-2 disrupts host cell epigenetic regulation. Further, this work provides a molecular basis for the finding that SARS-CoV-2 lacking ORF8 is associated with decreased severity of COVID-19. (Kee et. al. 2022)
This is yet another piece of the puzzle as to why some people fair worse than others against this virus. In the future, folks with ORF8 susceptibility should be prioritized to risk stratification
Non Covid Research
6) In a very important piece of research we see a connection between dairy based casein proteins and the myelin proteins of the nervous system of the brain. From the article: Multiple sclerosis (MS) is the most prevalent autoimmune disease of the central nervous system (CNS), leading to irreversible deficits in young adults. Its pathophysiology is believed to be influenced by environmental determinants. As far back as the 1990s, it had been suggested that there is a correlation between the consumption of cow’s milk and the prevalence of MS. Here, we not only demonstrate that a high percentage of MS patients harbor antibodies to bovine casein, but also that antibody cross-reactivity between cow’s milk and CNS antigens can exacerbate demyelination. Our data broaden the current understanding of how diet influences the etiology of MS and set the stage for combining personalized diet plans with disease-modifying treatment strategies. (Chunder et. al. 2022)
This is critical! We see a biomarker linking cow milk and dairy consumption to the autoimmune attack on the myelin sheath proteins of the nerves that conduct electrical impulses across distances. The damage to them is part of the pathophysiology to MS. Finally, we are getting concrete evidence that diet interventions can and will alter the phenotypic outcome of a disease. The next shoe to drop will be gluten proteins and maybe more.
If there is a risk of MS in your family lineage, this is especially important.
7) Microplastics are finding their way into foods, especially marine life and now in our lungs. From a recent study we see that microplastics are defined as plastic particles between 1 μicrometer and 5 millimeters. They have been found in the environment from marine and freshwater bodies, to soil, to food and drinking water, and finally air. Other studies have demonstrated that humans are being exposed to higher concentrations of MP within their homes or outdoor areas of high human activity. (Jenner et. al. 2022) The question remains? How bad are they for us if they find their way into our lungs, GI tract or cells? This current study demonstrated that of the 13 samples tested, the lung tissue of 11 had elevated levels of MP's in them. If they are there, will they harm us? The immune system is loath to allow a foreign product to exist in us. So it will inflame and kill. The long term effect of this reality remains to be seen.
A quick google search: microplastics in the lungs and immune response leads to many articles discussing risk of lung cancers and other disorders - NOT PROVEN YET. It appears that the innate immune system can eat the plastics but has a hard time clearing them leading to local inflammation. This is likely not good long term.
Avoid microplastics where you can. The tricky part is that no one has a good answer on what to do other than reduce plastic use. That is not happening societally. For me the answer is more in line with keeping a robust immune system to control the possible inflammatory response. We have discussed that a ton these past 2 years.
That's all this week,