What Adam is Reading - Week of 09-05-22

On a recent trip, I had an Uber driver hit 105 MPH on an open stretch of highway. I am undecided if I give the driver 1 star for terror or five stars for efficiency. To be sure, I better appreciate the shortcomings of a single-question rating system (in this case, Uber's 5-star 'How was your trip with [Driver Name]?'). In retrospect, I may have just ordered the wrong service - a capitalist marketplace demands rideshare companies co-brand with Grand Theft Auto and Fast and Furious franchises, right? Think of the "bespoke riding experiences" potentially offered by Uber adrenaline and Uber XXX.

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In the U.S., COVID case rates and hospitalizations are declining in almost all states. About 450-500 people are still dying daily, with 35,000 to 40,000 hospitalized patients. 

N.Y. Times Tracker

https://www.nytimes.com/interactive/2021/us/covid-cases.html

Country Comparison from FT.com

https://ig.ft.com/coronavirus-chart/?areas=eur&areas=usa&areas=twn&areas=nzl&areas=e92000001&areas=fra&areasRegional=usny&areasRegional=usnm&areasRegional=uspr&areasRegional=ushi&areasRegional=usfl&areasRegional=usco&cumulative=0&logScale=1&per100K=0&startDate=2021-06-01&values=deaths

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The FDA and CDC have approved using Pfizer and Moderna's bivalent COVID-19 vaccines as a booster dose. These reformulated vaccines offer better protection against the Omicron BA.1, BA.4, and BA.5 variants of the coronavirus.

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-moderna-pfizer-biontech-bivalent-covid-19-vaccines-use

Remember:

• The COVID vaccines offer 3-4 months of maximal protection from infection but much longer protection against hospitalization and death.
• There will be more variants, and, like the yearly Flu vaccine, it is increasingly clear we will need updated COVID vaccines at some ongoing interval (unclear how frequently).
• Updated vaccines are being shipped and should be available in the coming weeks.

CNN offered a helpful overview of the bivalent vaccines.

https://www.cnn.com/2022/09/01/health/covid-omicron-booster-explainer-wellness/index.html

I have scheduled an appointment to receive a bivalent booster next weekend (assuming it is in stock by then).

A loyal reader asked that I review "long covid."

• While there are a lot of unknowns, many data points exist. For clarity, I am using the term Long COVID and defining Long COVID as symptoms lasting for many weeks after a diagnosed COVID infection. However, both the definition and the name of the constellation of symptoms can vary (including long-haul COVID, post-acute COVID-19, post-acute sequelae of SARS CoV-2 infection (PASC), long-term effects of COVID, and chronic COVID.)

• This Science article from June 2022 highlights the three major hypotheses about what is going on - micro clots in various organs, persistent virus or viral parts stimulating an immune response, and immune system dysregulation. Or some combination of these.

https://www.science.org/content/article/what-causes-long-covid-three-leading-theories

• As for incidence, the most consistent data I have found is that somewhere between 10% and 20% of individuals have prolonged symptoms after a COVID infection. I could find no reliable clinical information on the prevalence (though some economic data below hints at a number). Despite Long COVID being broadly defined symptoms without an agreed-upon set of measurable findings, patients qualify as having an ADA disability in the United States. The CDC webpage has some good information: 

https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html

• Some underlying risk factors (type 2 diabetes, the persistence of SARS-CoV-2 RNA, Epstein-Barr virus viremia, and specific auto-antibodies) seem to be associated with an increased chance of developing long covid symptoms after a COVID infection.

https://www.cell.com/cell/fulltext/S0092-8674(22)00072-1

• Certain hormone levels appear to be an associated cause (or effect). But please remember that many articles show associations between some medical events, blood tests, or underlying disease states and Long COVID without clear causation.

https://www.bloomberg.com/news/articles/2022-08-11/striking-drop-in-stress-hormone-predicts-long-covid-in-study 

• Numerous viruses are associated with prolonged post-viral symptoms (post-acute infection syndromes or PAISs). Due to relatively low levels of other infections, PAISs may not be commonly recognized (unless you have had one), and Long COVID may be just one type of PAIS.

https://www.nature.com/articles/s41591-022-01810-6

• Here is a case study about Long COVID (shared with me by a loyal reader):

https://twitter.com/drclairetaylor/status/1566178375953260547?s=21&t=efmC154vQPEPFfuxN7M6IQ

• There are multiple Long COVID clinics at academic medical centers throughout the U.S. Two examples include:

UCLA

https://www.uclahealth.org/medical-services/long-covid

Penn

https://www.pennmedicine.org/for-health-care-professionals/for-physicians/covid-information/post-covid19-assessment-and-recovery-clinic-at-penn

• (Here is the prevalence data.) The estimated economic impact of Long COVID seems *potentially* large, and I have seen a wide array of estimates. For instance, a recent Brookings Institute report associated Long COVID with the ongoing labor shortage.

https://www.brookings.edu/research/new-data-shows-long-covid-is-keeping-as-many-as-4-million-people-out-of-work/

• Bottom line: not getting infected (masks, ventilation) and vaccinating with the latest vaccine reduces the likelihood of getting sick and developing prolonged COVID symptoms. Otherwise, offering clear or consistent medical advice is challenging given the many unknowns.

Random Medical Technologies and Realities

A small collection of notable drugs derived from animals and plants:

Gila Monster venom yields the injectable medication for type 2 diabetes Byetta

https://type2diabetes.com/living/gila-monster-venom

Pigs are the source of numerous medications, including the anticoagulant heparin and some variations of thyroid hormone.

https://porkcheckoff.org/pork-branding/facts-statistics/everything-but-the-oink/

(Please note this link is to a website run by the National Pork Board. (Which I learned is comprised of 15 pork producers or importers, nominated by Pork Act Delegates at the National Pork Forum and appointed by the U.S. Secretary of Agriculture.))

Leeches are the source of hirudin; a synthetic form is called bivalirudin, another anticoagulant.

https://en.wikipedia.org/wiki/Hirudin

Here is a definitive list of drugs derived from animals:

https://twitter.com/carlzimmer/status/746398796469440512/photo/1

Infographics

A good week to remind ourselves about making RNA vaccines:

https://twitter.com/cenmag/status/1565061886504312834/photo/1

Things I learned this week

Science fiction is, I believe, no longer an accurate phrase. There is science fact or science not yet reality. More evidence supporting my assertion: an update on efforts to "de-extinct" mammoths and Tasmanian tigers. The article has an ominous, unstated "Michael Crichton told you what would happen if you do this" tone. https://www.scientificamerican.com/article/de-extinction-company-aims-to-resurrect-the-tasmanian-tiger/

For those looking for broader Crichtonian wisdom:

https://collider.com/life-lessons-the-jurassic-world-trilogy-taught-us/

Growing up in the '80s, adults often expressed a common trope that loud, angry music was corrupting my generation (think Kiss and Ozzy Osbourne). This week, I found the latest in a surprisingly large amount of research about the impact of heavy metal music on the teenage psyche and behavior. The introduction reviews a series of correlative studies demonstrating the potential ills of "extreme music." However, the author's research shows that chaotic and loud music may help some teenagers process their emotions. My aunt (who expressed disgust at Van Halen's MCMLXXXIV album cover at our 1984 family Hanukah party) may want to rethink her opinion.

https://www.frontiersin.org/articles/10.3389/fnhum.2015.00272/full

The album cover that stoked my aunt's derision:

https://en.wikipedia.org/wiki/1984_(Van_Halen_album)

Clean hands and sharp minds team,
Adam