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🦘Cacatman's Personal Coronavirus COVID-19 Update Thread

Thanks for this. I'd like to see results for PULS testing in controls and those who suffer from COVID 19 at the equivalent times. The vaccines are expected to provoke an immune response so this is unsurprising in one sense.

When the fully published results are available, I'd like to see it.

Anyone can submit an abstract and I note that it is by a single author with no provided statistical analysis of his claims.
 
Improve Home Ventilation
Install CO2 sensors - 800 ppm shows inadequate ventilation
Install better filters
Open windows


Risk of infection could be three times higher in a poorly ventilated room as opposed to one that underwent 10 air changes per hour.
Evolution of spray and aerosol from respiratory releases: theoretical estimates for insight on viral transmission | Proceedings of the Royal Society A: Mathematical, Physical and Engineering Sciences


Virus transmission is “happening indoors in under-ventilated places.

To effectively reduce the amount of tiny droplets and aerosol particles lingering in a room, Allen first recommends bringing in more outdoor air by opening up one, two or as many windows as possible.

Second, if you have a mechanical ventilation system, he says to update the filter to a MERV 13 filter. Typical buildings have MERV 8 filters, which only capture up to 20% of particles, whereas the MERV 13 filter can capture 80%, he says.
 
Predictors for Poor Outcomes in COVID-19

Low Sodium

This study shows for the first time that patients presenting at the hospital with COVID-19 and low sodium are twice as likely to need intubation or other means of advanced breathing support as those with normal sodium.

Additionally, the researchers found that patients who develop high sodium levels during the hospital stay were three times more likely to die than those who have normal sodium levels throughout hospitalization.
 
Long Haulers/Long Covid/PASC (Post Acute Syndrome COVID)

Definition
- “signs and symptoms that develop during or following an infection consistent with COVID-19 which continue for more than 12 weeks and are
not explained by an alternative diagnosis.”

Almost a third of recovered COVID-19 patients in a UK study ended up back in the hospital within five months — and up to one in eight died of complications from the illness.

Researchers at the UK’s Leicester University and the Office for National Statistics found that out of 47,780 people discharged from the hospital, 29.4 percent were readmitted within 140 days.

Of the total, 12.3 percent ended up dying.

Respiratory disease was diagnosed in 14,140 of the COVID cases after discharge, with 6,085 of the diagnoses in patients who had no history of respiratory conditions.

The mean age of study participants was 65 years.

Weeks and months later, some people who have had COVID-19 continue to have problems. Came out of Italy. published in JAMA. 179 sample size. 143 overall. Mean age 56 yo. 63% men. 73% had pneumonia. Average length of stay 2 weeks. BMI average 26. Most had symptoms 2 months later.13% had no symptoms at 2 months. 32% had 1-2 symptoms. 55% had 3+ symptoms as at the beginning. 44% said their quality of life got worse!!! Fatigue, dyspnoea, joint pain and chest pain, cough could all still remain. Seems to be worse in the morning. Telogen Effluvium (temporary hair loss) also seems to occur.


Info about the so called "Long haulers"

Overall, the chance of being impacted by long covid increased with age. Long COVID was found to affect around 10% of 18-49 year olds who become unwell with coronavirus, rising to 22% of over 70s.
The team found that while most people with COVID-19 reported being back to normal in 11 days or less, around one in seven (13.3%) had COVID-19 symptoms lasting for at least four weeks, with around 1 in 20 (4.5%) staying ill for eight weeks and 1 in 50 (2.3%) suffering for longer than 12 weeks.

Mental Health is an issue also. See here.

In this cohort of individuals with COVID-19 who were followed up for as long as 9 months after illness, approximately 30% reported persistent symptoms. A unique aspect of our cohort is the high proportion of outpatients with mild disease. Persistent symptoms were reported by one-third of outpatients in our study, consistent with a previously reported study,4 in which 36% of outpatients had not returned to baseline health by 14 to 21 days following infection. However, this has not been previously described 9 months after infection.

Consistent with existing literature, fatigue was the most commonly reported symptom.2-4This occurred in 14% of individuals in this study, lower than the 53% to 71%2-4 reported in cohorts of hospitalized patients, likely reflecting the lower acuity of illness in our cohort. Furthermore, impairment in HRQoL has previously been reported among hospitalized patients who have recovered from COVID-19; we found 29% of outpatients reported worsened HRQoL.

About a third of patients with coronavirus disease 2019 (COVID-19) reported persistent symptoms in a survey completed an average of 6 months after the onset of their illness, a small study from the University of Washington found.

Most of those surveyed—150 (84.7%)—were outpatients who reported mild symptoms, 11 (6.2%) were asymptomatic and 16 (9%) were hospitalized with moderate or severe illness.

The most common persistent symptoms reported in the follow-up survey were fatigue and loss of taste or smell, both of which were reported among 24 patients (13.6%). Other symptoms included brain fog (2.3%). Health-related quality of life (HRQoL) was worse for 51 (30.7%) outpatients and hospitalized patients, and 14 patients (7.9%) reported negative impacts on at least 1 activity of daily living such as household chores.

Via the telephone interview, the researchers found that 244 patients (51 percent) declared at least one symptom that did not exist before COVID-19, including fatigue, cognitive symptoms, and new-onset dyspnea in 31, 21, and 16 percent, respectively. One hundred seventy-seven patients (37 percent) underwent further examination. The median 20-item Multidimensional Fatigue Inventory score was 4.5 and 3.7 for reduced motivation and mental fatigue, respectively. Sixty-three percent of the patients had computed tomographic lung-scan abnormalities, mainly subtle ground-glass opacities. Nineteen percent of the patients had fibrotic lesions; in all but one patient, the lesions involved less than 25 percent of parenchyma. Thirty-nine percent of survivors with acute respiratory distress syndrome had fibrotic lesions. Anxiety, depression, and posttraumatic symptoms were seen in 23, 18, and 7 percent, respectively, of 94 former intensive care unit patients.

New Symptoms Common Four Months After COVID-19

244 patients (51 percent) declared at least one symptom that did not exist before COVID-19, including fatigue, cognitive symptoms, and new-onset dyspnea in 31, 21, and 16 percent, respectively. One hundred seventy-seven patients (37 percent) underwent further examination. The median 20-item Multidimensional Fatigue Inventory score was 4.5 and 3.7 for reduced motivation and mental fatigue, respectively. Sixty-three percent of the patients had computed tomographic lung-scan abnormalities, mainly subtle ground-glass opacities. Nineteen percent of the patients had fibrotic lesions; in all but one patient, the lesions involved less than 25 percent of parenchyma. Thirty-nine percent of survivors with acute respiratory distress syndrome had fibrotic lesions. Anxiety, depression, and posttraumatic symptoms were seen in 23, 18, and 7 percent, respectively, of 94 former intensive care unit patients.

The researchers found that depression/anxiety and autoimmune disease were the most frequent comorbidities (42 and 16 percent, respectively). Brain fog, headache, numbness/tingling, dysgeusia, anosmia, and myalgias were the main neurologic manifestations (81, 68, 60, 59, 55, and 55 percent, respectively); only anosmia was more frequent in SARS-CoV-2-positive versus SARS-CoV-2-negative patients (74 versus 36 percent). Fatigue was experienced by 85 percent of patients. Both groups had impaired quality of life in the cognitive and fatigue domains. Compared with a demographic-matched U.S. population, SARS-CoV-2-positive patients performed worse in attention and working-memory cognitive tasks.

Post Acute COVID-19 Syndrome
View attachment 856668

Long COVID in children is lowish compared to what occurs in the normal population
For 11-17 yo, it is something like 2-14% 15 weeks later. I suspect it's less in younger kids.
Long COVID - the physical and mental health of children and non-hospitalised young people 3 months after SARS-CoV-2 infection; a national matched cohort study (The CLoCk) Study.

This systematic review and meta-analysis shows that 80% (95% CI 65–92) of individuals with a confirmed COVID-19 diagnosis continue to have at least one overall effect beyond 2 weeks following acute infection. In total, 55 effects, including symptoms, signs, and laboratory parameters, were identified, with fatigue, anosmia, lung dysfunction, abnormal chest X-ray/CT, and neurological disorders being the most common (Table 1, Fig. 2). Most of the symptoms were similar to the symptomatology developed during the acute phase of COVID-19. However, given that all of the surveys were predefined, there is a possibility that other effects have not yet been identified. In the following paragraphs, we will discuss the most common symptoms to illustrate how complex each one can be. However, further studies are needed to understand each symptom separately and in conjunction with the other symptoms. The five most common effects were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). The recovery from COVID-19 should be more developed than checking for hospital discharge or testing negative for SARS-CoV-2 or positive for antibodies25.
View attachment 892487

Long COVID symptoms

Postacute sequelae of COVID-19 (PASC)
Review of 57 studies comprising more than 250 000 survivors of COVID-19, most sequelae included mental health, pulmonary, and neurologic disorders, which were prevalent longer than 6 months after SARS-CoV-2 exposure.

5 of 10 survivors of COVID-19 developed a broad array of pulmonary and extrapulmonary clinical manifestations, including nervous system and neurocognitive disorders, mental health disorders, cardiovascular disorders, gastrointestinal disorders, skin disorders, and signs and symptoms related to poor general well-being, including malaise, fatigue, musculoskeletal pain, and reduced quality of life. Short- and long-term rates of PASC were similar, highlighting the potential for pathological sequelae long after exposure to the SARS-CoV-2 virus.


Vaccinated people can get long COVID
The study confirmed that vaccination greatly lowers a person’s risk of death, ICU admission, and health problems such as respiratory failure, the need for oxygen treatment, psychotic disorders, and hair loss in breakthrough cases.

“On the other hand, previous vaccination does not appear to be protective against several previously documented outcomes of COVID-19 such as long-COVID features, arrhythmia, joint pain, type 2 diabetes, liver disease, sleep disorders, and mood and anxiety disorders,” the study said.
https://www.medrxiv.org/content/10.1101/2021.10.26.21265508v1.full.pdf

The 5 most common manifestations were fatigue (58%, 95% CI 42–73), headache (44%, 95% CI 13–78), attention disorder (27% 95% CI 19–36), hair loss (25%, 95% CI 17–34), dyspnea (24%, 95% CI 14–36) (Table 2, Fig. 2). Other symptoms were related to lung disease (cough, chest discomfort, reduced pulmonary diffusing capacity, sleep apnea, and pulmonary fibrosis), cardiovascular (arrhythmias, myocarditis), neurological (dementia, depression, anxiety, attention disorder, obsessive–compulsive disorders), and others were unspecific such as hair loss, tinnitus, and night sweat (Table 2, Fig. 2, Supplemental Figure S1). A couple of studies reported that fatigue was more common in females, and one study reported that post-activity polypnea and alopecia were more common in females4,24. The rest of the studies did not stratify their results by age or sex.
 
Treatment - Fluvoxamine 100mg TDS helpful
Treatment of mild, symptomatic coronavirus disease 2019 (COVID-19) with fluvoxamine (Fluvoxamine is a strong S1R agonist) may reduce the risk of clinical deterioration, according to the findings of a double-blind, randomized clinical trial. It showed that none of the 80 outpatients in the fluvoxamine group had clinical deterioration, compared with 6 of the 72 outpatients in the control group.

Treatment - Fluvoxamine 100 mg BD for 10 days may decrease hospitalisations
The primary outcomes was emergency room observation for more than 6 hours or hospitalization up to 28 days after randomization; the secondary outcomes were viral clearance at day 7, the time to hospitalization, death, and adverse reactions.

Of the included patients, 739 received fluvoxamine, 733 placebo, and 1,766 other treatments including hydroxychloroquine, lopivinar/ritovinar, metformin, ivermectin, doxazosin, and interferon lambda.

The investigator reported that of those receiving fluvoxamine, the risk of emergency room observation for over 6 hours or hospital admission was lower compared with placebo, i.e., 77 of 739 compared with 108 of 733, respectively.

No significant adverse events were seen compared with placebo on the viral clearance at day 7, mortality, time to death, number of days on ventilation, or other secondary outcomes.



Among study participants who took the drug as directed and did so in the early stages of the disease, COVID-19-related deaths fell by roughly 90% and the need for intensive COVID-19-related medical care fell by roughly 65%.

Another trial involved 1,497 COVID-19 positive outpatients with a risk factor for severe disease. Overall, those who took fluvoxamine spent less time in the emergency room and were less likely to transfer to the hospital than those who got placebo (RR 0.68, 95% CI 0.52-0.88).

Not a randomised control trial, so should be regarded for just interest only - Seftel conducted his own experiment, offering fluvoxamine to patients exposed to COVID-19 at a racetrack, and comparing those who accepted it with those who did not. None of those who took the drug were hospitalized, while 12.5% of those who refused the drug were, they reported in Open Forum Infectious Diseases.
 
Radiological results post COVID
■ Approximately one-third of participants (40 of 114, 35%) recovered from severe coronavirus disease 2019 developed fibrotic-like changes in the lung within 6 months of disease onset.
■ Older age (>50 years), acute respiratory distress syndrome, and higher baseline CT lung involvement score (≥18 out of a possible score of 25) were associated with fibrotic-like changes in the lung.
■ Twenty-seven of 104 participants (26%) had an abnormal diffusing capacity of the lung for carbon monoxide, or DLCO, at 6-month follow up, which more frequently occurred in participants with fibrotic-like changes in the lung than in those without fibrotic-like changes.
 
Vaccine Efficacy
Decreases by 18.5% 6 months after last shot.

Protection against serious COVID illness, including hospitalisation or death, does not seem to be reduced to the same extent, only by about 8 percentage points.

This is likely because other components of the immune response (T cells and immune memory cells) stay in the body for longer than antibodies and prevent serious illness.

Ab levels after booster doses are higher than those after the initial vaccination course.
file-20211209-19-158sqg2.png?ixlib=rb-1.1.png


A recent clinical trial showed several COVID vaccines, including all three currently available in Australia (Pfizer, Moderna and AstraZeneca), and the Novavax and Janssen vaccines, produce strong immune responses after a course of either Pfizer or AstraZeneca vaccines.

Shorter intervals of < 6 months doesn't boost the immune response as much.

A longer interval between the first and second dose of COVID is better.

The study was based on data collected between 27 November and 24 December 2021. It provides the first formal assessments of booster vaccine effectiveness against severe disease, Eric Topol the director of the Scripps Research Translational Institute, tweeted on Friday.
Here are the stats.

For hospitalization (all vaccine brands combined):
  • One dose: 52% reduced risk of hospitalization compared to unvaccinated.
  • Two doses: 72% reduction within 24 weeks of the second dose.
  • Two doses (longer term): 52% reduced risk over 24 weeks of the second dose.
  • Three doses: 88% reduced risk two weeks after the third shot.
For symptomatic disease (all vaccine brands combined):
  • One dose: 26% reduction of risk of catching symptomatic COVID-19 within four weeks of the first dose.
  • Two doses: 18% reduction within 24 weeks of the second dose.
  • Two doses (longer term): 2% reduction over 24 weeks of the second dose.
  • Three doses: 63% reduced risk two weeks after the third shot.
Since the data was from the UK it isn't totally applicable to the US, which uses a different set of vaccines.

Most older people in the UK were given the AstraZeneca vaccine, which the US hasn't used. The UK never used the single-shot Johnson & Johnson vaccine. Both countries use the Pfizer and Moderna vaccines, and the UK is using those two exclusively in its booster rollout.
 
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Impact of COVID-19 on Adrenal Gland
The adrenal gland is a prominent target for the viral infection and ensuing cellular damage, which could trigger a predisposition for adrenal dysfunction. Whether those changes directly contribute to adrenal insufficiency seen in some patients with COVID-19 or lead to its complications (such as long COVID) remains unclear.
 

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