0:00

week in virology

0:02

the podcast about

0:04

viruses the kind

0:07

that make you

0:09

sick from microbe tv

0:11

this is twiv this week

0:14

in virology episode

0:16

11 96 recorded

0:18

on february 27

0:21

2025 i'm

0:23

vincent racon yellow and you're listening to

0:25

the podcast all about viruses Joining

0:29

me today from New York,

0:31

Daniel Griffin. Hello,

0:34

everyone. Oh, the Parasites

0:36

Without Borders bowtie. Right

0:39

with the world and the Ascarus

0:41

worm all wrapped around it. How

0:44

many bowties do you have? Like 50? It's

0:47

got to be over 100 at this point. So

0:49

we're never going to see the same one in

0:51

a year. You know, there

0:53

are certain ones I realize that

0:55

I... So I

0:57

probably have about 50 that are microbes,

0:59

but I also have a whole bunch

1:01

of like sailing ties and, you know,

1:04

I have a bunch of like Mickey

1:06

Mouse pediatric ties. Do you have a

1:08

favorite microbe tie? Yeah,

1:10

what is what is my go -to? You

1:13

know people probably know like when I

1:15

travel like if I'm just gonna throw

1:18

one in there It'll probably be my

1:20

my gonorrhea the clap bow tie because

1:22

it's it's a bright sort of Okay,

1:25

yeah, so let's say you're gonna watch

1:27

and you're gonna have a meeting with

1:29

RFK jr. What

1:31

bow tie you're gonna wear? So, you

1:33

know, as I have done, like in

1:36

certain situations like that, I've

1:38

got this really nice coronavirus

1:40

bow tie, and it's sort

1:42

of a black with a

1:44

gold coronavirus. Yeah. Oh,

1:47

I can hear the conversation. Dr.

1:49

Griffin, what's that on your tie? And you

1:51

say it's a coronavirus, and he said, oh,

1:53

that doesn't exist. Good.

1:56

All right, so let's get

1:59

into it. I'm going to start

2:01

off with a quotation, which, you know,

2:03

I was looking this up because I've

2:05

been hearing this, well, since I was

2:07

a small lad from my grandmother. So

2:10

I figured like where, you know, who

2:12

was the first who said this? So

2:14

apparently this is attributed to Samuel Langhorn

2:16

Clemens. Never let the truth

2:18

get in the way of a good story.

2:22

So Mark Twain and and

2:24

unfortunately this is a quotation

2:26

for our times or a

2:28

lot of folks seem to

2:30

feel this way and Not

2:32

to be political Vincent but

2:34

meeting of key CDC vaccine

2:36

advisory panel under scrutiny by

2:38

RFK junior is postponed Officials

2:41

say the session will be

2:43

rescheduled but provides no details.

2:46

And so the advisory committee on immunization

2:49

practices was to meet from February 26

2:51

to 28, like right now as we're

2:53

talking. It's first gathering

2:56

since the Trump administration took

2:58

office. That will not

3:00

happen according to Andrew Nixon,

3:02

the HHS Director of Communications.

3:06

There was a notice of

3:09

postponement posted on the American

3:11

Committee on Immunization Practices homepage.

3:15

The ASIP work groups met as

3:17

scheduled this month, but we still

3:19

do not know about the ASIP

3:21

meeting. I do have a link

3:23

here to the draft agenda where they were to

3:25

talk about meningitis vaccines,

3:27

drunken gunia vaccines, flu

3:30

vaccines, RSV vaccines, HPV

3:33

vaccines, Mpox vaccine, Lyme

3:36

disease, COVID -19

3:38

vaccines, and CMV vaccines. And

3:41

this is where they were going to

3:44

select, like, hey, which flu shot are

3:46

we going to recommend next year? That's

3:48

the verb back, right, at the

3:51

FDA? Yeah, so the FDA. So

3:53

two meetings, two important meetings,

3:56

canceled Daniel. What messages

3:58

are Americans to get from

4:00

this? Probably most of them

4:02

would like to get some of these

4:05

vaccines. And so what does

4:07

this mean? That we get no guidance from

4:09

the administration. Well, it's tough. I

4:11

mean, we were told that they're looking

4:13

for a larger room. People

4:16

who are not allowed to talk to

4:18

people told me this, that the excuse

4:20

they're giving is we want a larger

4:22

room because what we would like is

4:24

we would like to have a lot

4:26

of public there so that when they're

4:28

trying to have a discussion that the

4:31

public can quote unquote weigh in with

4:33

loud voices. The challenge

4:35

here and this is something I want

4:37

people to think about. So, you know,

4:39

we're going to talk about Texas and

4:42

measles and you see 97 % of

4:44

the children there are vaccinated. So, you

4:46

know, vaccinating children is still a mainstream

4:49

recognized thing that we do here in

4:51

the US. But. There's

4:54

ways to undermine vaccines which are a

4:56

little, let's say, sneaky, and I think

4:58

that's the right word, right? So the

5:01

way that vaccines get covered is you

5:03

have these meetings and then the advisory

5:05

committee goes through the data and they

5:08

say, you know, this is the flu

5:10

vaccine and we're going to recommend this

5:12

and, you know, similar to some of

5:14

these other vaccines. And then the CDC

5:17

makes a recommendation, and

5:19

then we have recommended vaccines,

5:21

and then after that Medicare pays for

5:24

it, insurance pays for it. If you

5:26

don't let these groups meet, then there

5:28

are no recommended vaccines. you

5:30

know, quote unquote, we're going to let parents

5:33

and their doctors make a decision. But what

5:35

this is going to lead to is that

5:37

we're not going to necessarily have those vaccinations

5:39

covered. So when, you know, mom says, yeah,

5:41

I really feel like I do want to

5:43

protect my child from, you know, encephalitis and

5:45

death and all these other horrible things. The

5:49

next thing may be, yeah, but your insurance

5:51

isn't going to cover it because we've, you

5:53

know, sort of undermine the process here. Great.

5:56

What a great plan. Well,

5:58

it's sneaky is what it is.

6:01

They use rhetoric and the rest,

6:03

but we'll get... This is crazy.

6:06

The federal government, with trillions of

6:08

dollars, had to cancel a meeting

6:10

because they couldn't find a big

6:13

room. This is the most elevated

6:15

form of BS I've ever heard,

6:17

Daniel. Well, it's disingenuous. This is

6:19

an incredibly important meeting where we're

6:21

deciding on vaccine recommendations. Yeah,

6:24

that's dishonest. And we'll get into

6:27

some more dishonesty later on. But

6:29

I don't think it's OK to

6:31

just blatantly lie like that. So

6:34

in the same talking about what

6:36

about science in the US, So

6:40

I get these New York Times emails, right,

6:42

where they give you like what's there to

6:45

read about in the day and I read,

6:47

you know, my New York Times emails early

6:49

this morning because one of my dogs may

6:51

have gotten into some stuff that she shouldn't

6:53

have gotten into. So at four something this

6:55

morning she was up having a bit of

6:57

a problem, a bit of a problem that

6:59

I actually stepped in. So

7:04

after hopping down the hall and washing my

7:06

foot and cleaning the floor and taking care

7:08

of her and being up since then, I

7:10

was reading some of these. But this I

7:12

had read a little bit earlier with a

7:14

completely clean, untinged foot. And

7:16

so there was a section by Benjamin

7:18

Mueller. And I'm going to read this.

7:20

Late last month when the Trump administration

7:23

froze government grants, a federal judge said

7:25

it couldn't just hold back money. Congress

7:27

had agreed to spend. But

7:29

spending at the NIH. which awards more

7:32

than 60 ,000 grants per year isn't

7:34

so simple. So this is going to

7:36

be this strain of let's undermine things

7:39

in a disingenuous dishonest way. So

7:42

new grants actually go through

7:44

a as he describes a

7:46

tortured bureaucratic process The agency

7:48

has to notice notify the

7:50

public of grant review meetings

7:52

in the federal register as

7:54

a government publication Then scientists

7:56

and NIH officials meet to

7:58

discuss the proposals the problem

8:00

is that the Trump administration

8:02

banned these announcements indefinitely so

8:04

no new research projects can

8:06

get approved so In effect,

8:08

scientists say the Trump administration

8:10

is circumventing the court order

8:12

with this bureaucratic trick. So

8:15

if you're a cancer doctor, we hope you're

8:17

happy that we've cracked that nut and you're

8:19

not really interested in any new treatments or

8:22

cures. Much like what RFK

8:24

Jr. is doing with vaccines, you

8:26

can undermine vaccines, you

8:29

can hobble cancer research just

8:31

by stalling this ability to

8:34

move things forward. You

8:36

can stall our ability to understand chronic

8:38

disease. And what you're doing

8:40

is you're saying, OK, yeah, Congress

8:42

controls the purse, but we're going

8:44

to break the system so you

8:46

can't actually get those funds out

8:48

there by basically hobbling the bureaucracy.

8:52

You know, Daniel, a smart lawyer can

8:54

get around this. OK, so that's what

8:56

they need to be doing. you're

8:59

obstructing congressional appropriations by

9:01

doing multiple things, fix

9:04

them all. That's it.

9:07

Yeah. No, and it's really, I mean, this

9:09

is what they did with PEPFAR is they

9:11

said, oh, okay, we're going to give special

9:13

letters of exemption. Those HIV

9:15

medicines can go out there. But

9:18

there's no computers. They shut down the

9:20

computer. So even if the HIV medicines

9:22

showed up somewhere, you wouldn't know who

9:24

gets what. Um, you know,

9:26

so they've just, they've figured out ways

9:28

to basically be sneaky and dishonest. So,

9:31

I mean, I'm trying not to be

9:33

political, but, uh, yeah, I mean, we,

9:35

we have, you know, it's, it's hard

9:38

to not be political when you have

9:40

people dying. Well, it's people's health at

9:42

stake and also the health of the

9:44

US science established. We have great, great

9:47

science here in the US. There's no

9:49

reason to break it. There's zero reason.

9:51

And if anyone in the US thinks

9:54

it should be broken, I'd like you

9:56

to tell me why. So

9:59

this is ridiculous. Yeah. No, I

10:01

mean, this is part of what makes America

10:03

great. We are the world leaders, and I'm

10:05

going to say this, world leaders in science

10:07

and have been for decades now. And do

10:09

we not want to do that? Do we

10:11

want to let someone else take over? Yeah,

10:14

that's a problem. A few individuals have

10:16

decided that we want to destroy it,

10:18

Daniel. That's what kills me. A few

10:21

individuals. Yeah. Yep.

10:25

But there has to be ways around it,

10:27

Daniel. We cannot give up. We're not going

10:29

to give up. And we're going to circle

10:31

back. We're even going to get more angry

10:33

in a few minutes. So Ebola, I

10:36

got some good news. We're going to pepper in

10:38

a little bit of good news. And then don't

10:40

worry, we'll be back to doom and gloom. As

10:42

suggested last week, we may have a win regarding

10:44

Ebola in Uganda. We hear

10:46

from the WHO that Uganda has

10:48

entered a crucial 42 -day countdown.

10:52

So what's going on here? 42 days

10:54

is twice the 21

10:56

days, the maximum incubation

10:58

period of Ebola, the

11:00

Sudan Ebola virus here.

11:03

And so if you can get

11:05

past that, if there's no further

11:07

infections during this period, then you

11:09

can confidently declare that the outbreak

11:11

is over. And I'm

11:13

hearing confirmation of this on the ground.

11:16

I was actually able to get to

11:18

the WHO website, so I don't know

11:20

what happened before. All

11:23

right polio a little bit about

11:25

polio here the global polio eradication

11:27

initiative gpei Said on 24th of

11:29

February 2025 during the fourth riyadh

11:31

international humanitarian forum that Saudi Arabia

11:34

has formally committed 500 million dollars

11:36

to end global polio It's sort

11:38

of like they they reinforced like

11:40

yeah, we said we're gonna do

11:43

that. We're actually gonna really do

11:45

that But unfortunately Vincent I haven't

11:47

seen that they They've updated their

11:49

their thinking. It seems like, hey,

11:51

here's a lot of money for

11:54

a lot of more oral polio.

11:56

Yes, exactly what they're going to

11:58

do. And it's not going to

12:00

help eradicate anything because they're just

12:03

pouring more virus into the environment.

12:05

Yeah, it's a little bit disturbing

12:08

there. All right. Now,

12:10

this is where. where I actually

12:12

am quite upset. So I will

12:14

admit I try to try to

12:16

be balanced and calm. But this

12:18

is upsetting because as we're going

12:20

to get to in a moment,

12:22

a child's already died. And so

12:25

since we get Tuesday and Friday

12:27

updates from the Texas Health and

12:29

Human Services, we got this first

12:31

update on February 25th. And at

12:33

that point, the Texas Department of

12:35

State Health Services reporting on this

12:37

measles outbreak in the South Plains

12:39

region of Texas, kind of like

12:41

West South Texas. At that

12:44

time, 124 cases had been identified,

12:46

right? These are like identified confirmed

12:48

cases. 18 of the

12:51

patients have been We're going to

12:53

talk about that. Only five of

12:55

the cases are among vaccinated. But

12:57

I'm going to say five of

12:59

the cases, like this is starting

13:01

to be so much exposure that

13:03

we're actually even seeing vaccinated folks

13:06

be identified as having cases. But

13:08

the rest are basically unvaccinated or

13:10

no confirmation of vaccine. Now,

13:13

the CDC has said it

13:15

will provide only weekly updates.

13:19

But then we actually get an update

13:21

because something really upsetting happened. The

13:23

first child has died in the

13:25

Texas outbreak. The patient

13:28

was an unvaccinated school -aged

13:30

child, according to officials. As

13:33

we learn, most of the cases have been

13:35

centered in Gaines County, an area on the

13:37

western edge of the state. It's

13:40

home to thousands of men and knights,

13:42

which they describe as an insular Christian

13:44

group that historically has lower vaccination rates.

13:47

and officials said that the child who

13:49

died Wednesday had lived in Gaines County.

13:52

The last pediatric death in the

13:55

US for measles was in 2003.

13:58

It's been 22 years since this has

14:00

happened. We

14:03

read in an article here

14:05

in the measles book published

14:07

by Children's Health Defense. The

14:09

anti -vaccine nonprofit founded by

14:11

Mr. Kennedy wrote that measles

14:13

outbreaks have been fabricated to

14:15

create fear, leading government

14:17

officials to inflict unnecessary and

14:19

risky vaccines on millions of

14:21

children for the sole purpose

14:23

of fattening industry. profits. For

14:26

context here, for every 1

14:29

,000 children who get measles, One or

14:31

two will die. I'm going to say

14:33

acutely in the first couple of weeks,

14:35

according to CDC data. But

14:38

I was just re -listening

14:40

to immune 26. There's

14:43

a lot more to measles, right? So there

14:45

may be one or two who die in

14:47

the first couple of weeks. There may be

14:50

20%, we're actually seeing 40 % last year

14:52

of children end up in the hospital. But

14:55

the virus also harms the immune system.

14:57

So you actually see another increase in

14:59

mortality with the secondary bacterial infections that

15:02

are going to occur like after the

15:04

first one or two weeks. You're also

15:06

going to see an increased risk of

15:09

death in the two to five years

15:11

afterwards because you take these kids and

15:13

you basically wipe out their immune system

15:16

for a while. So

15:18

a 2015 study estimated that

15:20

before widespread vaccination, measles may

15:22

have accounted for as many

15:24

as half of all infectious

15:26

disease deaths in children. And

15:29

even now, right, the consequences can be

15:31

serious. So I want to,

15:33

I'm going to leave in a link here because

15:36

I don't want, you know, us to be saying,

15:38

oh, this is what RFK Junior said. But I'm

15:40

going to leave in a link where you can

15:42

actually watch RFK Junior speak at the cabinet meeting,

15:44

head of HHS. So he's, you know, he says

15:46

he's on top of this. So he says, two

15:48

people have died. That's incorrect, right? It's

15:50

supposed to be head of the HHS. He tells us

15:53

he's on top of this. He doesn't even know how

15:55

many children have died, whether it's one or two for

15:57

him is not a problem to have wrong. He

16:00

downplays the fact that this is

16:02

the first measles death in, I'm

16:04

going to say, 20 more years.

16:07

He goes on to say, it's

16:09

not unusual. We have measles outbreaks

16:11

every year. He then acknowledges

16:14

that children are being hospitalized. But

16:16

get this, he says that, you know, most

16:18

of the children being hospitalized are there for

16:20

quarantine purposes. I'm going to

16:23

say a comment that needs fact -checking, and

16:25

let's go ahead and fact -check that right

16:27

away. Let's go talk to the chief medical

16:29

office at Covenant Children's Hospital in Lubbock, Dr.

16:31

Lara Johnson, who says no. The

16:34

children who were hospitalized were admitted

16:36

because they were having trouble breathing.

16:39

They needed supportive care, such as

16:41

supplemental oxygen. And I

16:43

quote from Dr. Johnson, we don't

16:45

hospitalize patients for quarantine purposes. It's

16:49

unbelievable. I mean, it's

16:51

just, it astounds me. Here's the

16:53

head of HHS who told Cassidy

16:55

under oath a bunch of stuff.

16:58

And here, it's only been a couple of

17:00

weeks. Like normally when you have an outbreak

17:02

like this, when things are getting out of

17:04

control, the CDC comes in, they

17:07

help people get up to date. How do

17:09

we provide the best care? How do we

17:11

talk to these, you know, people in these

17:13

communities. You know, when we had

17:15

that issue with polio in upstate New York, you

17:17

know, people who normally wouldn't vaccinate said, okay, this

17:19

is different. We're going to jump in. But already

17:22

one child has died and this man's only been

17:24

in this position for what, two weeks? What

17:27

really bothers me is he said, we

17:29

have outbreaks all the time. Well, in

17:32

fact, we don't when we're

17:34

vaccinating people. Most of the country doesn't

17:36

have outbreaks. In fact, When

17:38

the vaccine was introduced in the 60s

17:41

or hundreds of thousands of cases a

17:43

year those slowly went down by 2000

17:45

was declared eliminated There were no more

17:47

outbreaks until the Wakefield business started getting

17:49

parents not to vaccinate in the US

17:51

So he's wrong on every front. He

17:53

doesn't read anything. He doesn't study He

17:55

didn't come prepared to that meeting doesn't

17:57

know anything that's going on. I mean,

17:59

can we get rid of him in

18:01

some way? I mean

18:03

I'm sort of I'm sort of hoping

18:06

that you know I mean how many

18:08

how many honestly how many children will

18:10

have to die before before the president

18:12

says listen you you just you can't

18:14

do this job you know you can't

18:16

have children in the U .S. dying

18:18

of measles and the person who's supposed

18:20

to be protecting our health the senior

18:22

person where the buck stops not thinking

18:24

it's a big deal. So just to

18:26

remind people that measles is bad stuff.

18:29

There was a thing on his side, I think we

18:31

talked about it last week. Hey, how

18:33

come no one talks about the good side of

18:35

measles? There's no good side of measles. Kids

18:38

get infected. They are incredibly miserable if

18:40

you've ever taken care of a child

18:43

with measles. posted

18:45

in this nice measles symptoms timeline that

18:47

I got from a sub -stack from

18:49

Dr. Emily Smith, great sub

18:51

-stack, just talking about

18:54

what goes on, how the

18:56

kids start off with cold

18:58

-like symptoms, then they develop

19:00

the famous coplic spots. then

19:03

they get the rash, and then

19:05

you start seeing pneumonia, ear

19:08

infections, diarrhea, some

19:10

kids go blind, ear infections,

19:12

some kids go deaf, encephalitis, and

19:15

then even years later, you

19:17

can have this subacute

19:20

sclerosing pancephalitis, which, you

19:22

know, 100 % mortality.

19:26

I mean, this is horrible. And as I

19:28

mentioned, it wipes out

19:30

all that immune memory that

19:32

you've earned, all that natural

19:34

immunity, all those vaccines, everything.

19:37

70 % of the antibody repertoire

19:39

is wiped out with one measles

19:42

infection in someone who's not vaccinated.

19:45

And I do want to point out

19:47

just that this is still a fringe.

19:49

This is still a fringe thing, right?

19:51

So we have a nice table here.

19:53

Maybe Dave, I'll have it up for

19:55

folks that, you know, if you look

19:57

at the different vaccines, you look at,

19:59

you know, diphtheria, tetanus, isoleopertosis, hepatitis A

20:01

or B, the MMR,

20:04

polio, chickenpox

20:06

vaccine, you know, the

20:08

percent completely vaccinated is actually

20:10

quite high when you look

20:12

at. Texas kindergartens. And

20:14

then if you actually look at the

20:16

state, I mean, we're 94, 95

20:19

% and above. But then there are

20:21

these pockets, right? And we see pockets.

20:23

And so really, there are these communities

20:25

where we don't have that. And one

20:27

of the problems, like why do we

20:29

care if your kids are vaccinated or

20:31

not, is this is an incredibly contagious

20:34

disease. And so think about all those

20:36

children under the age of one who

20:38

are not old enough to get the

20:40

protection. putting them at

20:42

risk. Think about pregnant individuals.

20:45

They're at risk. So yeah, this is one

20:47

of those things. Your freedom to wave your

20:49

arms ends at the tip of my nose.

20:52

Your freedom to, you know, spread

20:54

a deadly disease is something that

20:56

we really have to talk about

20:58

when we live in a community.

21:01

I remember what I was going to say. There

21:03

are pockets of unvaccinated kids here in New York

21:06

City. Right, it's the same

21:08

everywhere and it's just a matter

21:10

of the virus being introduced in

21:12

them and then you will have

21:14

an outbreak Yeah, mean we had

21:16

that outbreak in in a community

21:18

in Brooklyn not too many years

21:20

back. Yeah, that's right Yeah, yeah

21:22

All right Very disturbing very disturbing

21:24

and you know, maybe maybe people

21:26

need to see those You know

21:28

those little kids like you know

21:30

struggling to breathe being brought into

21:32

the hospital, you know when RFK

21:35

Junior seems not to actually care.

21:37

All right, bird flu. A few

21:39

things here. And maybe

21:41

there's some good things here. Maybe we'll

21:44

see. So I thought the first article,

21:46

will the egg shortage affect flu shots?

21:48

It's a little encouraging. Millions of vaccine

21:50

doses are made using chicken eggs each

21:52

year. This is actually a

21:54

nice article where they really go into

21:56

the fact that there's a whole biosecurity

21:58

around hens and egg production. And

22:01

then even if that fell apart, we

22:03

have other options like recombinant flu vaccine,

22:05

flu block, and the cell -based vaccine.

22:07

flu cell backs. So I'll

22:09

leave out link into that. Another,

22:12

this was an opinion piece in the Wall

22:14

Street Journal. I'm going to do a couple

22:16

Wall Street Journal ones here, which came first,

22:18

the chicken slaughter or the egg shortage. I

22:20

thought that was clever. And

22:23

here they discuss options, including vaccinating

22:25

the hens. But really the thing

22:27

I want to point out here,

22:29

and I think people just want

22:31

to hear people talking, I don't

22:33

think they understand highly. pathogenic avian

22:35

influenza. If chickens get

22:37

infected, if your flock of hens

22:39

get infected, 90 to 100 percent

22:41

of those birds will be dead

22:43

within 48 hours. And it's a

22:45

horrible death for those birds. So

22:48

many of the veterinarians, when they're talking

22:50

about these, you know, killing the chickens

22:52

in mass, part of it is gassing

22:55

them is just that it's just inhumane

22:57

to let them suffer and to have

22:59

this almost 100 percent mortality. I'm

23:02

going to leave in a link to

23:04

the CDC page. Avian influenza in birds

23:06

causes and how it spreads. And here

23:08

you get that reference to that 90

23:11

% to 100 % mortality. And

23:13

they actually go through a lot of,

23:15

I'll say, sort of important information. But

23:17

they do talk about the fact that,

23:19

yeah, what's happening is that 90 %

23:22

to 100 % of these chickens are

23:24

going to die horrible death within 48

23:26

hours. Now, the ducks that are flying

23:28

over and spreading it They're actually usually

23:30

doing pretty well. They don't actually get

23:32

particularly sick at all. So

23:34

some wild bird species seem to

23:36

be able to get infected with

23:39

these particular, you know, say highly

23:41

pathogenic in chicken virus subtypes, but

23:43

they tend to spread it. So

23:45

I think it's important to understand

23:47

the disease before I heard a

23:49

news commentator saying, well, maybe, you

23:51

know, we just need to let

23:54

the hens just all get natural

23:56

immunity. Brilliant. Yeah, wasn't that brilliant? Let

23:59

our hens, let our little

24:01

girls just develop that robust,

24:03

wonderful, natural immunity. I don't

24:06

think they've ever seen a

24:08

group of hens get avian

24:10

influence. It's horrible. It's horrible,

24:12

and there's lots of suffering.

24:15

But we do have, and I

24:17

was impressed by this, Agriculture Secretary

24:20

Brooke Rollins has a five -point

24:22

plan to lower egg prices. And

24:25

I'm just going to run through this, and I'll leave in a link.

24:28

So first, dedicating, are

24:30

you ready for this? up to

24:32

500 million to help protect US

24:35

poultry producers with gold standard biosecurity

24:37

measures. They actually create a way

24:39

to protect the birds from those

24:42

introductions, right? So, you know, when

24:44

you're entering or exiting where the

24:46

hens are, you put on special

24:49

suits, you wash stuff down, you

24:51

create these barriers to keep the

24:53

ducks and migrating. foul

24:55

away from your hands. Second

24:58

is providing up to $400

25:00

million of increased financial assistance

25:02

to help the farmers whose

25:05

flocks have been affected, so

25:07

help them get back to

25:09

safe operations after an outbreak.

25:11

And this was shocking, Vincent.

25:14

Third, USDA is exploring the

25:16

use of Vaccines

25:18

and therapeutics for laying

25:21

chickens. They

25:23

say, well, vaccines aren't a standalone

25:25

solution. We will provide up

25:27

to $100 million in research and

25:29

development of vaccines and therapeutics, saying

25:31

this should help reduce the need

25:33

to depopulate flocks, right? Because if

25:35

your hands are vaccinated and then

25:38

they get an exposure, you're not

25:40

going to have that 90 %

25:42

to 100%. Death

25:44

or 100 % if we if we continue

25:46

to you mainly address this fourth They say

25:48

they're gonna take other actions to lower the

25:50

price of eggs I think this is they're

25:52

gonna remove regulatory hurdles And actually if you

25:55

look in closely what they're gonna do is

25:57

like right now there are rules like come

25:59

on These are animals and they should have

26:01

at least a certain amount of space around

26:03

them and they're like yeah You don't need

26:05

so much space cram them closer together. The

26:08

chickens don't need to be happy. We just

26:10

need those eggs Yeah.

26:12

Then we'll get one egg for chicken. Just great.

26:14

That just bothered me. Yeah. It was like, listen,

26:16

I think we're being too nice to the hens.

26:19

I mean, I don't know. Have you ever seen

26:21

a mass hen, you know, where

26:23

they burn off the, you know, the beaks?

26:25

Okay. And fifth, and this is, I don't

26:27

think going to make too many people happy.

26:30

This idea that we're going to make America

26:32

great by importing eggs from other countries. Yeah.

26:35

I heard we're buying some from Turkey now.

26:39

Turkey eggs. Daniel,

26:42

I don't know that this vaccine

26:45

makes any sense. It doesn't prevent

26:47

transmission. So it's not going to

26:49

protect the flock. I

26:51

guess what the idea is, it won't

26:54

necessarily protect spread. But if you always

26:56

say, OK, we're going to have all

26:58

our hens in America vaccinated, if the

27:00

flu gets into the population, now

27:02

getting an infection after being vaccinated is much

27:04

more mild. We always say it's not going

27:06

to keep you from getting infected. but

27:09

it is going to reduce the

27:11

disease. So vaccinated chickens don't all

27:13

die from highly pathogenic avian influenza.

27:16

All right, but they still have virus. Maybe

27:18

it gets into the eggs. They

27:21

better just be bloody careful. It sounds

27:23

like they don't really know what they're

27:26

talking about. This 500

27:28

million for biosecurity, I don't think that's anywhere

27:30

near enough. Yeah, it sounds

27:32

like a big number, but just think

27:35

about the... What is it, over 300

27:37

million? I think it's like we need

27:39

350 million egg laying hens to sort

27:42

of meet our capacity. That's like, yeah,

27:44

a buck a bird. Not

27:46

a lot of money in a country our size.

27:48

Folks, give up your eggs and you can blame

27:51

the administration. All

27:54

right. So flu is still

27:56

really high. Influenza A

27:58

is still at high levels. Looking

28:00

across the country, we're still seeing hot

28:03

spots most everywhere. Actually, even Montana actually

28:05

was doing a little better. It was

28:07

getting into the minimal. It's back up

28:09

into the moderate. What's

28:12

really disturbing is that we used to get

28:14

weekly updates on what's going on. And one

28:16

of the things I would always look for,

28:18

because it just seemed to motivate people, is

28:20

seeing how many children had died the last

28:22

week. And this has not been updated since

28:24

February 7. That was the week when we

28:26

had 10 children die. So we don't really

28:28

get that updated. That's a problem to me,

28:31

that we don't get the information we would

28:33

like. But maybe we're coming

28:35

off the peak. I mean, we're still

28:37

really high. It looks like we're coming

28:39

off the peak. Our hope is that

28:41

we don't get that second. hump, which

28:43

we sometimes get. And I worry, right?

28:45

Because here we are end of February,

28:47

early March. We're going to start to

28:49

see spring break. So do the kids

28:51

come home, go back, and do we

28:53

get that rebound that we sometimes get

28:55

when school vacation timing is associated? Daniel,

28:58

what's the purpose of withholding

29:00

information? Is it to have an

29:02

uninformed population so they don't know what's happening? I

29:06

mean, there's different reasons why you

29:09

might want to do it. So

29:11

one is there's the concern that

29:13

if people think like, hey, things

29:15

are kind of bad out there

29:17

that might affect the stock market.

29:19

Some people like everyone to be

29:22

optimistic and positive. And if you

29:24

know that something is going on,

29:26

then maybe you'll be a little

29:28

bit negative or pessimistic. Maybe it'll

29:30

influence consumer spending or something. So

29:32

yeah, the other is that an

29:34

uninformed population Yeah, it's

29:37

dangerous thing. This is bad to

29:39

have to be withholding information from

29:41

your from your constituents. Only bad

29:44

things can happen. It's going

29:46

to leak out and then you're not going to know where to

29:48

believe it. And it's going to be a mess. Yeah.

29:50

And we'll we'll see in the modern world

29:53

of, you know, social media and misinformation. Like,

29:55

can you keep spinning? Can you keep lying

29:57

to people? You know, what is

29:59

it? Lie to me once, like, you know, lie

30:01

to me twice and then the third time. And

30:04

you know this is also another thing like

30:07

so we're huge proponents of education You know

30:09

and I know people like oh with the

30:11

with the vaccines there were mandates and they

30:13

were out there and no money was spent

30:16

on education So I was really excited when

30:18

the CDC had that I'm gonna say wonderful

30:20

flu educational series the wild to mild campaign

30:22

remember this Vincent with like do the Lions

30:24

or the shark turns into a goldfish the

30:27

lion turns into a little kitty cat And

30:29

I thought it was great because he was

30:31

really I think what RFK had talked about.

30:33

He wants people to be able to make

30:36

decisions. He wants them to have the information.

30:38

And this was really informative. This was forget

30:41

about this whole idea that a flu vaccine

30:43

will mean you never get the flu. It's

30:46

going to reduce severity. It's going

30:48

to reduce disease. This was great

30:50

stuff. Well. the Trump administration yanked

30:53

the CDC flu vaccine campaign. Now,

30:56

unfortunately, this is like what's typical. The

30:58

news was shared with staff during a

31:00

meeting. And then two of

31:02

the staffers who were not actually

31:04

supposed to tell anyone that this

31:06

was ending, agreed to speak, you

31:08

know, with anonymity, know, as

31:11

long as you can, you know, guarantee my anonymity

31:13

as long as you don't tell who's telling you

31:15

this. So, yeah,

31:17

it's disgusting that they would cancel a

31:19

campaign that's meant to inform people about

31:22

the value of the vaccine. It is

31:24

just disgusting that this administration does this.

31:28

Okay, RSV. We're actually

31:30

still high with RSV.

31:33

So that's kind of across the board, but

31:35

maybe a little bit of good news. You

31:37

ready for this? COVID dropped to medium. I

31:39

was wondering, like, does the wastewater have the

31:42

ability to drop from high? Will we ever

31:44

drop? And we're actually seeing a drop in

31:46

the amount of wastewater SARS -CoV -2. So

31:49

we're starting to drop. We've got our

31:51

map here where most of it is

31:53

kind of moving into the less than

31:56

2 % of the deaths we're seeing

31:58

are due to COVID. And we seem

32:00

to be coming off the peak here

32:02

with the CDC data on the national

32:05

trend. So nationally, we're starting to come

32:07

down. I don't see our nice chart

32:09

with all the colors in the ups

32:11

and downs for all over the country.

32:13

What happened to that? You can click

32:16

on that here. I'm going to paste

32:18

it in in real time. Let's go

32:20

here, Vincent. it's still there. We

32:22

have to click on it. No, we'll do it.

32:24

Because what you're going to see as I paste

32:26

it in, this will only take seconds, is

32:29

that it got a

32:32

little bit busy. You

32:35

know, depending on which part of the country.

32:37

All right, so we're almost to pasting in

32:39

it. And what you're going to say when

32:42

I paste this in as I get back

32:44

to our episode, are you ready, Vincent? I'm

32:46

ready. Yeah, see excitement. And maybe this is

32:48

something that will be painted up there by

32:50

David from the look out on YouTube. So

32:53

across the country, we're starting to go down. I'm

32:55

trying so hard to be optimistic. But then you're

32:57

like, but in the Midwest, it's starting to go

32:59

back up again, isn't it? So I didn't want

33:01

to show that. Well, I started to

33:04

know if it's going up or it's just plateau. Most

33:07

of them are plateauing, it seems to me.

33:09

Yeah. See, I'm trying to get the stock

33:12

market to go up and can't keep spreading

33:14

all this, you know, the bad news, the

33:16

truth. All right. So now

33:18

we're going to talk about COVID vaccines. Oh,

33:20

my gosh. And this is

33:22

this article. And this

33:24

is, I thought was really interesting, caught my

33:26

eye. Effectiveness of the original. Monovalent

33:29

Mesture RNA coronavirus disease COVID -19

33:31

vaccination series against hospitalization for COVID

33:33

-19 associated venous thromboembolism. So enough

33:35

people remember in the early days,

33:37

it was this, you know, came

33:39

out of China, don't give anyone

33:41

anticoagulation because COVID -19 is associated

33:43

with people just bleeding out. And

33:46

then so initially nobody anticoagulated. We're

33:48

like, what's going on? I remember

33:50

one day at Plainview Hospital where

33:52

we did these CAT scans looking

33:54

for pulmonary in like 20 patients

33:56

and 15 of them had had

33:58

clots somewhere this is where we're

34:00

like just that's ridiculous and also

34:02

I know it disturbs some of

34:05

the researchers because they're like we

34:07

need to do trials we're like

34:09

we can't do trials when 75

34:11

% of our patients are dying

34:13

of these clots we're gonna actually

34:15

start anticoagulating. Anticoagulation will be

34:17

our standard of care and your trial

34:20

can be deviating from that. We were

34:22

accused of witchcraft, but anyway, we

34:25

were accused of witchcraft by these

34:27

PIs sitting at their home drinking

34:29

wine, dosing their wives with ivermectin

34:31

and hydroxychloroquine, but we won't go

34:33

there. So

34:36

they use a test negative design

34:38

to basically say, are the COVID

34:41

-19 vaccines going to protect folks

34:43

from getting these deep venous clots?

34:46

So they look at

34:48

18 ,811 patients, 9

34:51

,792 are admitted with

34:53

vaccinations. They got 44

34:55

% vaccinated. And

34:58

then they've got a group of

35:00

these test negative controls, also with

35:02

73 % of those are vaccinated.

35:05

Now, among the patients, they're going to do

35:07

all the calculation here. They

35:10

end up seeing that

35:12

the venous thromboembolism, these

35:14

deep clots, were significantly

35:16

more common in unvaccinated

35:18

than vaccinated. It's about

35:20

a 50 % reduction, and

35:22

it varies with the different

35:24

variants. So you end up,

35:26

when you do the calculation,

35:28

you're seeing an 84 % overall

35:31

protection with vaccines, seeing about 88

35:33

% for alpha, 93

35:35

% for delta, and then what

35:37

drops us down still, 68 %

35:39

for the Omicron variants. Gee.

35:43

They work. Yeah,

35:46

not only do they protect you from severe disease,

35:48

but they protect you from getting pulmonary emboli and

35:50

getting these clots. This has

35:53

really actually changed in a lot

35:55

of ways our practice when it

35:57

comes around to anticoagulation in the

35:59

hospital, where we're usually recommending a

36:02

prophylactic, because we've got pre -existing

36:04

immunity in many cases from vaccines

36:06

protecting. Can people continue

36:08

to pick on these vaccines,

36:10

saying they're pathogenic with all

36:13

kinds of nonsensical data, yet

36:15

they work? Yeah. I

36:17

mean, the problem is, if you actually

36:19

want the truth, here it is. If

36:21

you want to support some agenda, some

36:23

bias, some conspiracy theory, then yeah, you

36:26

can go get some fake news. All

36:29

right, early viral phase. Do

36:32

you remember the days of hydroxychloroquine

36:34

and ivermectin? They're coming back. I

36:37

thought they never left. Yeah, they

36:39

sort of went down and then came back.

36:41

So we have this article, demographic

36:44

variation in US outpatient hydroxychloroquine

36:46

and ivermectin used during the

36:48

COVID -19 pandemic. And

36:50

here they use insurance claims. from

36:53

this big database with over 8

36:55

million patients, all 50 states. Basically,

36:58

you know what happened? These

37:01

two unproven treatments that were

37:03

touted as COVID -19 treatments

37:05

during the pandemic, we saw

37:08

that there was a doubling

37:10

in the prescriptions for hydroxychloroquine

37:13

and ivermectin increased. tenfold.

37:17

And I want to add, we still get

37:19

people asking for, oh, I need Ivermectin for

37:21

my COVID, you know, or it's

37:23

really like the sun in Florida calling,

37:25

my dad better get Ivermectin for his COVID

37:28

-19. Or I even had a gentleman

37:30

recently asked for Ivermectin for his heart

37:32

failure. It's become a snake oil cure all.

37:35

And what do you do? I

37:38

have a nice respectful

37:40

conversation. I share the

37:42

information. I've never really

37:44

had it not work out for

37:46

them, following my sage advice at

37:48

the end of the day. But

37:51

I've just been lucky because I've

37:53

certainly been peripheral to some conversations

37:55

that did not go quite so

37:57

well. All

37:59

right. Paxilovid. This

38:01

is a big one, Vincent. This is

38:04

a huge, huge trial. I actually was

38:06

surprised when I saw that this, you

38:08

know, was being done and came out.

38:10

But this is a randomized control trial,

38:13

a phase three randomized control trial, the

38:15

article, alleviation of COVID

38:17

-19 symptoms and reduction in

38:19

health care utilization among high

38:21

-risk patients treated with neurotralovir,

38:24

ritanovir, a phase three randomized

38:26

trial published in CID. So,

38:28

yeah. Phase 3 randomized

38:31

trial, we're still doing these. And

38:34

so these are the results

38:36

from this double -blind randomized

38:38

one -to -one study that

38:41

assessed Paxilovid versus placebo for

38:43

five days in high risk,

38:46

unvaccinated, non -hospitalized symptomatic adults

38:48

with COVID -19 from 343

38:50

sites across 21 countries. among

38:54

2 ,113 randomized patients

38:56

enrolled from July 2021

38:58

through December 2021. We

39:01

ended up with 977 get

39:04

Paxilovid, 989 getting placebo. The

39:08

Nermitrelvir, the Paxilovid,

39:10

significantly reduced two things,

39:13

times to sustained alleviation

39:15

by two days, so

39:17

13 from 15, and

39:19

resolution, basically. completely gone,

39:22

not just alleviated, not

39:24

just reduced, but completely

39:26

resolved. And that

39:28

was from 19 days, shortening that

39:31

time to resolution to 16 days,

39:33

and significantly reduced the number of

39:35

COVID -19 related medical visits and

39:38

the proportion of patients with such

39:40

visits. Now, hospitalized

39:42

patients treated with Paxilovid, right, so you

39:44

end up with those, they had shorter

39:47

stays. None of them ended up

39:49

in the ICU. None of them

39:51

required mechanical ventilation. All were discharged

39:53

to home or self -care. And

39:57

fewer of the Paxilovid treated patients required

39:59

any additional treatment. No

40:01

Paxilovid treated patients died through week

40:04

24 compared to 15 that died

40:06

in the placebo group. are

40:10

the ages here? Do you know, roughly?

40:12

So they're mostly going to be older

40:14

folks because remember this is going to

40:16

be your high risk folks. They're

40:19

mostly unvaccinated. So

40:22

65, 70 years and older.

40:25

Yeah. Yeah, they have

40:27

a nice graphical

40:29

abstract. We get a little bit more information

40:31

here. We sort of break down different things

40:34

like ER visits, going to see your doc,

40:36

going to the urgent care. You

40:38

can see some Kaplan -Meier curbs over time.

40:41

You know, the big thing here I think is, so

40:44

yeah, we already knew that Paxlovid reduces your

40:46

chance of death. We knew it reduces your

40:48

chance of ending up in the hospital. But

40:50

there was always kind of this discussion that we

40:53

didn't want to say. I remember you were saying

40:55

last time, Vincent, that when you

40:57

had COVID, you started Paxilovid. By the

40:59

next day, you felt great. I had

41:01

that same experience. I went to the ASTM and

41:03

H conference. I took a risk. I came back.

41:05

My throat was a little scratchy. I was about

41:07

to go for a run. I don't know if

41:09

I was going to record it on Strava or

41:11

not. I was like, no, I was at this

41:13

big meeting. I should just probably check. And

41:16

it was positive. And I started Paxilovid right

41:18

away. By the next day, I had zero

41:20

symptoms. Don't tell my wife, because I still

41:22

spent five days working on the next textbook

41:25

of parasitic disease as a recluse, keeping her

41:27

safe. So yeah, there

41:29

is all this sort of anecdotes of

41:31

people starting Paxilovid and feeling better quicker.

41:34

Here's actually some data. Here's some data that,

41:36

yeah, actually it looks like that's the case.

41:38

People feel better quicker when we start Paxilovid.

41:40

So this is probably helpful because we have

41:42

docs out there. I don't know. People get

41:44

Paxilovid and then they feel worse and they

41:46

have rebound. Actually, the

41:48

sciences that people that take Paxilovid,

41:50

they feel better quicker. And

41:53

even if they have those issues during

41:55

the second week, as we've discussed, a

41:57

90 % reduction in the severity of

41:59

those symptoms during the second week. So

42:02

this is a huge

42:05

study, right? Thousands

42:07

of patients. I remember I sent

42:09

you yesterday some study saying there's no

42:11

help in older hospitalized patients, but this

42:13

contradicts that. Well, if you look closely

42:15

at that other study and I really

42:17

thought it was not only was it

42:19

a bad study but that the headlines

42:21

were bad So one of the things

42:23

to be a little closely at that

42:25

study said, you know early on we

42:28

were seeing an absolute reduction in you

42:30

know mortality and progression of 5 %

42:32

now the absolute reduction is only 1

42:34

% You still were seeing the reduction

42:36

They were just saying like when you've

42:38

got a high -risk population that you

42:40

know, you're gonna end up with like,

42:42

you know, I don't know what what

42:44

the you know, let's say it's 20

42:46

% of people early on were ending

42:48

up in the hospital and you reduce

42:50

that 20%, you know, you get an

42:52

absolute reduction. They're saying now that people

42:54

are vaccinated, they're not getting like, you

42:56

know, poisoned with hydroxychloroquine and ivermectin quite

42:58

so much, you know, now maybe it's

43:00

like 2 % of people are going

43:02

to end up going to the hospital.

43:04

So you reduce that, you know, so,

43:06

you know, it's the number needed to

43:08

treat has grown, but Paxloven still works.

43:11

Yeah, I mean, they were saying the headline said

43:13

doesn't work at all, which is not

43:16

correct. It does work. And

43:18

so even though it may be reduced,

43:20

you're still going to use it because

43:22

you can still save lives. Yeah.

43:24

It's like airbags, you know, are much more important

43:26

when you're doing, you know, 100 miles an hour

43:28

on the Audubon, but they're still pretty good at

43:31

55. Yeah. Right. All

43:34

right. So Paxilobid,

43:36

Remdesivir. malnupiravir, convalescent

43:39

plasma in certain circumstances.

43:42

And then that second week, right? We

43:45

can really reduce chances of folks ending

43:47

up here with vaccines and all these

43:49

other things we've talked about. But that

43:52

second week is still when we are

43:54

still seeing folks in the hospital. We're

43:56

still seeing the need in certain cases

43:59

for steroids, anticoagulation, pulmonary support, remdesivir,

44:01

and in some cases, immune modulation.

44:04

All right, and I just have a few

44:07

articles here in the last bit. So

44:09

this first article, Interventions for Long COVID,

44:11

a narrative review published in the Journal

44:13

of General Internal Medicine. Now, this is

44:16

behind a paywall. It's a little bit

44:18

annoying, right? It took me like I

44:20

had to wait till finally I could

44:22

access it through the Columbia site and

44:24

then I did. So I'll

44:26

go through a little bit. So they start with Comments

44:29

along COVID continues to impose

44:31

a significant burden on COVID

44:33

-19 survivors, presenting with

44:36

diverse symptoms and clinical uncertainty.

44:38

We have talked about the fact that now

44:40

it's probably about one to two percent of

44:42

folks after. on acute

44:45

COVID versus early on, it was

44:47

like 15 or 20 people were

44:49

still sick at three months. So

44:51

that's much better, but still 1

44:54

% of hundreds of thousands of

44:56

people getting infected all the time.

44:58

So now the review looked at

45:00

evidence from 97 studies, including 26

45:03

randomized controlled trials, 15 non -randomized

45:05

comparative studies, looking at the effectiveness

45:07

and comparatives of different interventions. There's

45:11

actually a nice table and so which this

45:13

wasn't behind a paywall because it would be

45:15

nice for for clinicians and maybe patients to

45:17

be able to look at some of these

45:19

tables. Some of the different

45:21

things that were studied like they

45:23

talked about that that probiotic sim

45:25

01 study that we talked about

45:28

where they had certain effects on

45:30

brain fog and fatigue. They

45:32

talked about some of the vagal stimulation

45:34

they talked about. some

45:37

of the now Trekzone studies and

45:39

they actually have, here's the intervention,

45:41

here's the studies that we saw,

45:43

here's what it showed. So it's

45:45

a good paper for people to

45:47

look at, but it's long, the

45:49

tables stretch, and it's behind

45:51

a paywall. So that's just, but

45:54

I'll leave in a link and. We

45:56

also have JAMA Network Open, the

45:59

article, COVID -19 Vaccination and Odds

46:01

of Post -COVID -19 Conditioned Symptoms

46:03

in Children, aged 5 to 17.

46:06

Case Control Studies, 622

46:08

participants. And yes,

46:10

vaccines were associated with a 57

46:12

% decreased odds of one or

46:14

more post -COVID conditions and a

46:17

73 % decreased odds of two

46:19

or more post -COVID conditions. So,

46:21

you know, people are always saying,

46:23

I don't know, vaccines for the

46:25

little kids. Yeah, I

46:27

mean, this is the issue for the

46:29

little kids. It's the post -COVID conditions.

46:31

It's the months of not being able

46:34

to get back to school. It's the

46:36

months of headaches, fatigue, learning challenges, and

46:38

we're seeing pretty good protection here with

46:40

the vaccines. And,

46:42

you know, hey, I understand, I don't

46:44

know, mRNA vaccines in my children, maybe

46:47

there's some misinformation here, but we've got

46:49

Novavax, right? And Novavax is authorized for

46:51

use in individuals 12 years of age

46:54

and older. chunk of

46:56

these folks. You can go

46:58

ahead, traditional protein -based vaccine.

47:01

All right. And I will finish off, right?

47:04

No one is safe until everyone is safe. And

47:06

so I'm hoping, you know, these are tough times.

47:08

We're going to need your support, you

47:11

know, as we sort of

47:13

suggested last time. Yeah, we've

47:15

gotten... threats. People would like

47:18

some of our science communicators

47:20

to stop communicating. So

47:22

we may need your support to keep doing

47:24

what we're doing. We may need your support

47:26

for lawyers, right, Vincent? And

47:29

we're doing our Floating Doctors fundraiser

47:32

where February, March, and April, we're

47:34

a third of the... third of the way in.

47:37

We're going to do our fundraiser

47:39

hopefully to get up to a

47:41

maximum donation of $20 ,000 and

47:43

just a little update from on

47:45

the ground there in Panama where

47:47

I'm heading in a couple weeks.

47:49

Our clinic in La Sabana turned

47:51

out to be a great opportunity

47:53

as we had an occupational therapist

47:55

working with us who's able to

47:57

give in -depth attention to multiple

47:59

patients, particularly women needing pelvic floor

48:01

training and older patients with bladder

48:03

issues. I think this is nice.

48:06

It's not about just doling out medicines. She

48:09

also visited two young brothers with

48:11

progressive muscle weakness, provided environmental adaptations

48:13

and exercises that can help implement

48:15

to improve their quality of life.

48:18

We've got them connected to the hospital

48:20

system for specialist intervention. And

48:23

she'll continue consulting on these patients when she

48:25

returns to the state. So that's this great

48:27

thing about the connectivity is even when people

48:29

go, they can stay connected and keep helping

48:31

these folks. It's

48:34

time for your questions for Daniel. You

48:36

can send yours to Daniel at microbe

48:38

.tv. Louis writes, important,

48:41

more detailed data about

48:43

TB in Kansas City.

48:46

The perspective would be important

48:48

in characterizing what's happening there

48:50

for listeners. These are data

48:52

as of February 9th. The

48:54

recent TB cases in Kansas

48:56

City include both active TB

48:58

and latent TB infections. As

49:00

of January 31st, there are

49:02

67 confirmed active and 79

49:04

latent. associated with the outbreak

49:07

in Wyandotte and Johnson County,

49:09

so 176 apparent infections. Active

49:11

TB cases must be treated

49:13

while latent cases represent individuals

49:15

infected with M tuberculosis, but

49:17

without illness or being contagious.

49:20

They may be treated to prevent

49:22

activation at a later date based

49:24

on pretty clear clinical guidelines from

49:26

CDC. Excellent. Yeah,

49:28

thank you for sending us this. this

49:30

our way. I had a patient this

49:33

weekend. I should follow up on the

49:35

results here, but get the busy weekend,

49:37

covering a number of hospitals, get the

49:40

call that Mr. So

49:42

-and -so's. Sputum came back.

49:44

The culture is now growing acid

49:46

fast bacilli. So, you

49:49

know, we're worried about, you know, different

49:51

mycobacterial species. So I go over

49:53

and I talk to this gentleman. It

49:55

turns out he grew up in Western

49:57

Long Island or Brooklyn, as my parents

50:00

like to call it. And

50:02

I told him, I said, hey, here's

50:04

the result that came back. You know,

50:06

are you familiar with tuberculosis? That's what

50:08

people are concerned about here. He

50:10

was very familiar. He said, yeah, when I was

50:12

a kid, a lot of people had tuberculosis. His

50:16

daughter was there. What tuberculosis? Isn't

50:18

that gone? Isn't that in

50:20

the history books? And so it was

50:23

entertaining for me to let him teach

50:25

his daughter and son -in -law about

50:27

tuberculosis. And yeah, that may

50:30

have been a risk factor. This may

50:32

have been an individual who now has

50:34

some other things going on and the

50:36

immune system drops down and you get

50:39

infected 60 years before it stays latent

50:41

and then can activate. Another

50:43

thing that I worry about with

50:45

all the measles in Texas is

50:47

people will often end up losing

50:49

their ability to contain tuberculosis if

50:52

they're unvaccinated and get a measles

50:54

infection. Yeah. Julie

50:57

writes, I'm having trouble accessing

50:59

Pemgarta in New York City.

51:02

I'm 66, have bronchiectasis take, is

51:05

a thioprin for myasthenia gravis. I

51:07

always wear masks. I had three

51:09

COVID vaccines. I

51:11

forgot to mask. When

51:14

two men did work in my apartment in early December,

51:16

got COVID, I had Pax Lovid on hand

51:18

and took it immediately. My symptoms

51:21

were mild, but triggered a current flare of

51:23

MG symptoms, which I'm trying to manage with

51:25

my neurologist. My Columbia primary

51:27

care doctor prescribed more Pax Lovid

51:29

to have on hand and also

51:32

did an e -consult with respect

51:34

to Pem Guarda. And

51:36

basically, there's a statement from

51:39

Columbia Infectious Diseases, which said

51:41

it would be reasonable to

51:43

pursue Pamifibart, but access has

51:46

been limited. So

51:48

try prime infusions for Pamgarda. So

51:51

she got through to prime and

51:53

they sent her back to the

51:55

doc for prescription. And the doc

51:57

said, I'm going to request that

51:59

you meet formally with ID to

52:02

discuss the prescription. their questions regarding

52:04

efficacy, blah blah blah. Two

52:06

questions. Would you recommend Pemgarta for someone

52:08

in my position? And is the efficacy

52:11

of Pemgarta now in doubt? So

52:14

the efficacy is, I'm going to say

52:16

it's not in doubt, but let's talk

52:18

about what the data is. So when

52:20

this was studied, there was a particular

52:22

variant circulating at a time when it

52:25

was studied, we had a 75 %

52:27

reduction in medically attended symptomatic COVID -19.

52:30

So the data was good then. We

52:32

don't necessarily... check it again.

52:34

So I'm just to be

52:37

full disclosure there. But

52:39

yeah, what you're running into here is probably a

52:41

doctor who's not familiar with Pemgardia. They don't know

52:43

how to write the script. It's every three months.

52:45

They may not know the dose. They may not

52:47

know the frequency. It's

52:50

amazing how many hoops you're having to

52:52

jump through here just to get access

52:54

to a to a medication that has

52:56

this indication. Great group of ID docs

52:58

at Columbia, so when you do get

53:00

in to see one of my colleagues,

53:02

make sure you say hello. We

53:06

had a lot of questions

53:08

about measles vaccine boosters. Dome

53:10

writes, I saw

53:12

a post suggesting adults over 35 should

53:15

get MMR and Tdap boosters giving falling

53:17

vaccination coverage. Do you suggest this or

53:19

other boosters for adults? who believe they

53:21

are vaccinated kids only if you live

53:23

in certain high -risk areas. Should you

53:25

get your antibody checked before you do

53:28

this? You know,

53:30

it's interesting. We're not making this

53:32

recommendation across the board. It

53:34

is interesting. I have seen some recommendations like if you're

53:37

in a high -risk area or you're going to a

53:39

high -risk area, consider. We definitely

53:41

do titers on healthcare workers who, interesting,

53:43

are probably not as high -risk as

53:45

people living in these communities where we're

53:47

having outbreaks. So we don't

53:50

make that recommendation. There is the idea

53:52

that if you've had measles, if you've

53:54

got your MMR, that there's lifelong protection.

53:57

But remember, a lot of the data

53:59

came when we probably were still getting

54:01

boosted from exposures. So far, we're not

54:04

making this recommendation. Now, the TDAP is

54:06

a little different. We

54:08

are having issues with pertussis. So you

54:11

do want to, even though it's driven

54:13

by the tetanus, you do want to

54:15

periodically get that pertussis protection bumped up.

54:19

And Megan has a similar question. I

54:21

saw a CBS report that said

54:24

people born after 1957 but vaccinated

54:26

for measles before 68 are at

54:28

higher risk from a measles outbreak.

54:31

Is this true? Is

54:33

there anything I can do? Should I get

54:35

a booster? Check my titers. So,

54:38

Megan, yeah, this is like a

54:40

little subtlety window here. So, the

54:42

idea was... 1957, there was so

54:45

much measles that like everyone born

54:47

before 1957 probably got exposed, probably

54:49

got infected. So they have like

54:52

that, you know, that survivor protection.

54:55

But then we actually, we had a variation

54:57

in the measles vaccine. I think we were

54:59

only doing like a single shot. And so

55:01

there actually were a few measles outbreaks. I

55:04

remember my little brother was Fort Collins, Colorado.

55:06

He ended up like locked in his dorm.

55:08

And so yeah, there is this little window.

55:10

So if you fall in. that you should

55:12

go ahead and get that second MMR booster.

55:16

Daniel, I had measles as a kid probably

55:18

in the 60s before the vaccine. It

55:21

was awful. I was covered with the rash.

55:24

It was really bad. And

55:26

then I got vaccinated as soon as the

55:28

vaccine came out. So I feel I'm good.

55:30

I'm not doing it. Yeah, no, I would

55:32

say like for you, that would be a

55:35

perfect situation. And yeah, maybe a reminder, people

55:37

having me is miserable. I

55:39

mean, these kids like I've been in

55:41

I've been in areas where like kids

55:43

are dying of malaria and they just

55:45

they stop eating and they're listless. But

55:48

oh my gosh, the kid with measles

55:50

stands out. They're so miserable and they're

55:52

fussing and they're crying and it is

55:54

just crummy. I

55:57

mean, I had this one huge blister on

55:59

my belly. I remember I watched it every

56:01

day. Everything else went away. It was still

56:03

there. I still have a scar from it

56:05

today. Oh, their noses

56:08

are running. Their eyes are red. Everything

56:10

hurts. It's miserable. All right.

56:12

This is unfortunately redundant. But

56:14

Lisa was born in 61.

56:16

Should she get a measles

56:18

vaccine? Yeah, so she falls

56:20

right into that kind of

56:23

window. So, yeah, born after

56:25

57. But actually, let's

56:27

see, yeah, and then if you were

56:29

vaccinated before 68, so sort of, you

56:31

know, those are kind of your things.

56:33

Yeah, talk to your doctor about this

56:35

stuff. mean, I think that's one of

56:37

the things, I feel sort of too

56:39

bad about where medicine is gone. But,

56:41

you know, this idea, you come in,

56:43

what's your diagnosis? I mean, it's too

56:45

bad that we haven't created a better

56:47

opportunity for people just to schedule a

56:49

point with, hey, doc, I just want

56:51

to talk about my vaccine. am I

56:53

up to date and should I get

56:55

any boosters and I have questions? Because

56:57

if we don't create an opportunity as

56:59

MDs, as DOs, as other clinical providers

57:01

of having these discussions, don't worry, there's

57:03

some snake oil salesmen out there ready

57:05

to have that conversation. And they're

57:08

not actually gonna feel like they're gonna let the

57:10

truth stand the way of their good story. So

57:13

the second dose was recommended in

57:15

1989. So

57:19

I don't know where this

57:21

68 comes from, 1968. Do

57:25

you understand that? I think there was

57:28

a change in the vaccine. And

57:30

with the update in the vaccine, then it became

57:32

a two dose. And before that,

57:35

it was a single dose. Yeah. And

57:37

this is the whole discussion. And we should

57:40

probably have like an episode where it was

57:42

like, when we made that change, was it

57:44

a good idea to make that change? We

57:46

have just stuck with the original one. But

57:48

there are issues, right? We talk about this

57:51

that very rarely will people have issues with

57:53

measles vaccination. Like you

57:55

might have a couple febrile seizures

57:57

per 100 ,000 kids vaccinated. You

58:00

know and some kids will actually

58:02

get a rash after the measles vaccination

58:05

So yeah, there are some you know when they

58:07

make the choice the the current one as a

58:09

two series I think it's great the earlier one

58:11

that was a one -shot series. I believe If

58:13

I get this all right, Yeah All

58:16

right. Last one. Abulaziz

58:18

I took the meningococcal

58:20

polysaccharide vaccine A -C -Y -W,

58:22

my next Umrah. Do I

58:24

also need the meningococcal

58:26

B vaccine? Yes. So,

58:29

you get all those letters there,

58:31

You you got A, C, Y, W, you missin'

58:33

B, and B is something we

58:35

worry about for people heading Heading

58:37

to the Middle East for Umrah. That's

58:41

TWIV, weekly weekly clinical update

58:43

with Dr. Daniel Griffin. Thank you, Daniel.

58:45

Oh, thank you And everyone

58:47

be safe