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Tag: covid

Zorro Returns

Zorro Returns

A recent issue of the New England Journal of Medicine had an editorial (not a research paper) titled “Strategic Masking to Protect Patients from all Respiratory Viral Infections”.   It was written by four Harvard physicians whose specialty is epidemiology and public health. 

The authors preamble alludes to the understandable mask wearing pushback/mask use fatigue in both the general population and in healthcare workers.  That’s very understandable.  We are all sick of constraints.  But the focus of the article is with the first word: “strategic”.  They make a rational argument for what they call strategic masking.  Myriads of studies during the Covid 19 pandemic came to diverse findings on mask benefit.  From “doesn’t seem to do much” to “has a major impact on transmission”.  The authors point out that the naysay findings are probably due to inappropriate mask type or improper use.  How many times have you seen people wearing a mask covering their mouth but not their nose.  Duh!  Collating all the data it seems that there is up to a 60 to 70% effectiveness of preventing viral transmission with masking.  This includes the SARS-COV-2 virus along with other pesky viruses: influenza, RSV, human metapneumovirus, parainfluenza and rhinovirus.  One fifth of patients hospitalized for pneumonia have a viral pathogen not a bacterial one.  Influenza alone accounts for 50 to 60 thousand deaths a year in the US.

The strategies they offer are several.  One is to consider mask use in public places and health care facilities during months of the year with high viral illness.  Another is to consider universal masking in health care settings when patients being attended to are at a higher risk due to age or underlying premorbid conditions.

My own personal experience does not constitute science.  But prior to Covid-19 and mask use this aging physician was catching two to three viral respiratory infections a year.  Since my mask use over the past 4 years, I have not been sick. 

Long Haulers

Long Haulers

The plodding nature of scientific research is a source of frustration to many of us, especially with reference to this Covid pandemic and the long haulers.  But recent research at Stanford University seems to provide new insight.  In their studies of long haulers, they discovered that the majority of them continue to shed live virus in their stool.  Moreover, some of the long haulers who were “stool negative” did show live virus in biopsies of the intestinal lining.  And yet these patients were not shedding virus in their respiratory membranes (nasal swab negative). 

These findings have led the Stanford group to posit that sequestered but active infection in the GI tract elicits an ongoing immune inflammation that can affect the entire body but most specifically the areas that were most severely impacted with the early infection be it lungs, heart, brain, or other organ systems.  If this turns out to be true then eradicating the GI infection should provide a cure for the long haulers. 

Microglia and COVID

Microglia and COVID

The last issue of this newsletter had an article about COVID brain studies in the UK.  A recent article in Science adds to these preliminary findings.  Neuroscientists in this country have noticed that the neurologic symptoms seen in many COVID patients (fatigue, brain fog, trouble remembering and headache) are very similar to those seen in other viral infections and with disorders such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and even with chemotherapy. 

In addition to similar symptoms, the brains in all these cases show changes in the microglia.  Microglia are the supporting and nurturing cells for the neuronal cells that allow us to think and act.  It seems that immune activation of these cells in response to COVID infection causes the microglia to go into hyper drive and interfere with normal neuronal function. 

Spinal taps done on patients with “COVID brain” show higher levels of immune activating proteins than normal patients.  One of these proteins is CCL11, which is also found in the spinal fluid of patients with dementia.