0:00

This week in virology,

0:02

the podcast about viruses,

0:05

the kind that make

0:07

you sick. From Microbe

0:09

TV, this is Twiv,

0:11

this week in virology,

0:14

episode 12, recorded

0:17

on April 24, 2025.

0:19

I'm Vincent Rackin

0:21

Yellow, and you're

0:23

listening to the

0:25

podcast all about viruses.

0:28

Join me today from Paris, France,

0:30

Daniel Griffin. Hello everyone. Yes,

0:32

Paris, France, not Paris, Texas. No, you

0:35

don't want to be in Paris. I

0:37

saw the movie Paris, Paris, Texas, years ago.

0:39

Did you see it? I did not see

0:41

it. Am I missing something? It's a very

0:43

interesting movie, but the Paris,

0:46

Texas, is nothing, so don't go there.

0:48

I'm sorry if anyone from Paris,

0:50

Texas, is listening. Now you have on

0:52

your tie, you have a black tie with

0:54

tiny, with tiny points. Yes, it is

0:57

it's a difficult one to to

0:59

okay see diff. Yeah, you got

1:01

yeah One of our listeners having

1:04

a bit of a see difficulty

1:06

lately. So I thought that was

1:08

a good But let's jump right

1:11

into it. So I'm here in

1:13

Paris, and I did a walking

1:16

tour the other day, and it

1:18

was Americans in Paris, you know,

1:20

Ben Franklin, Thomas Jefferson, Tom Payne,

1:23

kind of an interesting connection there.

1:25

It's a late 17, early

1:27

1800s. But start off with

1:29

the Thomas Jefferson quotation, if

1:31

ignorance is bliss, why are

1:33

more people happy? I thought

1:35

that was entertaining. But then the

1:37

other is, you know, and this is

1:39

sad for, I was raised Catholic. I

1:42

think you were raised Catholic also, right?

1:44

Yes, you was. And Pope Francis passed.

1:46

He was actually really a special

1:48

individual. I lit a candle for

1:50

him myself, and I lit one

1:52

for my mom on his behalf

1:54

as well. But really, you know, pets

1:57

go to heaven, just a lot of

1:59

kindness here. tremendous law. So I

2:01

thought I would, a quotation, because

2:04

I think maybe people need to

2:06

remember their moral compass in these

2:08

difficult times. And I'm going to

2:10

go to Notre Dame tomorrow to

2:13

pay respects as well. But here's

2:15

a quotation from Pope Francis,

2:17

a person who thinks only about

2:19

building walls whenever they may be,

2:22

and not building bridges, is not

2:24

Christian. So just

2:26

to start with that. But all

2:29

right, I am going to, this

2:31

is like a correction actually. So

2:33

correction and update clarification from your

2:36

fired friend at CDC. Yes, you

2:38

can say that there's no more

2:41

getting in trouble. And dear Daniel,

2:43

thank you for reading my email

2:45

on the 419 episode regarding the

2:48

cruel treatment of CDC employees, as

2:50

if we are criminals. I had

2:53

a small correction for the record

2:55

and an embellishment. Last

2:57

week you said emerging infectious

2:59

diseases, EID, is the agency

3:01

mouthpiece. Actually EID is a

3:04

peer-reviewed journal and scientifically

3:06

independent of the agency.

3:08

MMWR is the mouthpiece. It

3:11

is not peer-reviewed and has

3:13

to have gone, has to

3:15

have everything published approved by

3:17

the agency leaders. EID has

3:19

been defunded and in the

3:21

proposed RFK budget along

3:24

with another CDC peer-reviewed

3:26

journal. MMWR will continue

3:29

it, albeit requiring approvals.

3:31

A hidden problem with the funding

3:34

of the EID is that

3:36

the U.S. government will be

3:38

cutting out yet another early

3:40

warning source of global health

3:42

security info. As both political

3:44

parties can agree, no American

3:46

is safe unless everyone is

3:48

safe. Because EID doesn't charge

3:50

authors to publish open access,

3:52

there are no fee barriers

3:54

to submit early data from

3:56

novel outbreaks. For example, in

3:58

April 2020, EID received a

4:00

case report from a local health

4:02

department in rural China which had

4:05

bypassed Beijing health authorities to report

4:07

directly to us one of the

4:09

earliest reports of pre- symptomatic SARS

4:12

COVID-2 transmission. As the editor I

4:14

could then involve relevant CDC peer

4:16

reviewers which helped inform the agency

4:19

about the threat. planned defunding

4:21

of EID journal of hepar

4:23

activities in dozens of low-resourced

4:26

country, firing technical lead expertise

4:28

at CDC, along with epidemiologists

4:30

like me and shattering diplomatic

4:32

outpost, etc., all would serve

4:35

to reduce USG's access, you

4:37

know, its government's access to

4:39

early information, which limits our

4:41

ability to respond in timely

4:44

manner to save lives as

4:46

pandemics arise. You know, we've... talk for

4:48

weeks about how bad things

4:51

are, but it's going to

4:53

get worse because

4:55

these individuals don't know

4:57

what they're doing. They

5:00

are malignantly incompetent. All right,

5:02

bird flew. I'm not going to stop

5:04

criticizing Daniel because this is horrible what's

5:06

going on and you know that too.

5:09

No and I think it's important you

5:11

know and I do I get feedback

5:13

people like to know that they're not

5:15

alone they feel like what is going

5:18

on and and we've gotten a lot

5:20

of positive feedback about people appreciate the

5:22

fact that we're calling this out and

5:24

we're saying no this is unacceptable you're

5:27

not alone and feeling like this is

5:29

a disaster this is not make America

5:31

great we are stepping away from

5:33

greatness in science and public

5:35

health and so many things. And

5:38

there's no reason to do that. So,

5:40

all right, Bird flu, the

5:42

article, the American Public's

5:44

Disengagement with highly pathogenic

5:46

avian influenza, considerations for

5:49

vaccination and dietary changes,

5:51

was published in the

5:53

American Journal of Public

5:55

Health. This was from a US

5:57

respondents, a survey where we learned.

6:00

that only about a quarter knew

6:02

that bird flu can spread to

6:04

people and over half were over

6:06

half were unaware that pasteurized

6:08

milk is safer than raw

6:10

milk. I think you're you drink

6:13

a glass of pasteurized milk

6:15

there there Vincent? No, it's

6:18

just watered down. Also less

6:20

than one-fifth of respondents understood

6:23

that H5N1 had been detected

6:25

in cattle, nearly a third... were

6:28

unwilling to change their diet

6:30

to reduce their risk of

6:32

exposure to the virus or

6:35

take a vaccine if it

6:37

were available, even if it

6:39

was recommended by the CDC,

6:41

and only 26% of

6:43

participants knew that people

6:46

can get H5N1. You know, this

6:48

is a problem. This is why

6:50

many people think measles

6:52

is mild, right? There's no

6:55

awareness of science. Yeah, I

6:57

mean, I feel bad. We're doing

6:59

the best we can, but we've

7:02

fallen down. We didn't just get

7:04

here yesterday. So we'll keep doing

7:06

what we can do, but yeah,

7:09

I think we need to keep

7:11

pointing out that, yes, bird flu,

7:13

H5N1, is something that human beings

7:16

can get. It can be highly

7:18

pathogenic. And several cases where we've

7:20

seen particular types of bird flu

7:23

have resulted in really high mortality.

7:25

And yes, we've seen cattle get

7:28

this. We've seen transmission from

7:30

cattle to people. So far,

7:32

it's only been a benign

7:34

type of H5N1. And yes,

7:36

if there's a vaccine to

7:38

a disease that can kill you,

7:40

it's really frightening that people

7:43

would not be willing to

7:45

do that. So a lot

7:47

of education to keep going

7:49

there. And along those lines,

7:51

the University of Cambridge-based Dio

7:53

Sinvax and Singapore's ACM Bio

7:55

Labs have signed a deal

7:58

to jointly develop a next. generation

8:00

universal avian flu vaccine with

8:02

the potential for a mucousal

8:05

delivery. Now this is MRNA

8:07

technology. The MRNA vaccine would

8:10

target all major clades of

8:12

the H5 avian flu and

8:14

the bird flu and would

8:17

be scalable for rapid global

8:19

distribution. And the whole idea

8:22

here is this would be

8:24

just a spray up your nose.

8:26

So we'll see what happens with

8:28

that. We had this thing a few

8:30

months back, two months back, where they

8:32

shut down all those poultry markets in

8:34

New York. Remember that? And so everyone

8:37

rushed to sell the infected birds before

8:39

it became effective. This reminds me of

8:41

one of the hospitals where they said,

8:43

you know, we've found that this particular

8:46

treatment is not really effective and we're

8:48

going to stop like using this for

8:50

treatment of COVID effective Monday morning. What

8:52

do you mean, effective Monday morning? Well,

8:55

not now. We know right now. You

8:57

just said it doesn't work. We're going

8:59

to use up our supply, right?

9:01

Yes. We've already purchased it. So

9:03

please go ahead and use up

9:05

the supplies of this useless, but

9:07

expensive medicine. So, all right. Bird

9:09

flu continues to spread among live

9:11

poultry markets after shutdown order. Bird

9:13

flu cases continue to be detected in

9:16

live poultry markets in the city

9:18

two months after the state temporarily.

9:20

shut them down to contain the

9:22

virus, highly pathogenic avian influenza which

9:24

is deadly in birds and other

9:26

animals, but not known to be

9:28

transmissible among humans. That's critical. So

9:30

so far we're not seeing human-to-human

9:32

transmission, but it's been found in

9:34

15 live poultry markets operating across

9:36

four of the five barrels, two

9:39

more in Westchester and Long Island

9:41

since the February 7th directive. All

9:44

right, inbox is a little exciting

9:47

here. We have found an animal

9:49

source of inbox emerges and it's

9:51

a squirrel. So this is a

9:53

nice news piece in the journal

9:56

Nature, but currently this discovery is

9:58

available in a pre- The

10:00

preprint is entitled Fire

10:02

Footed Rope Squirrels. We'll

10:04

get the Latin name

10:07

there. Are a reservoir

10:09

host of monkey pox

10:11

virus. The orthopox virus

10:13

monkey pox. These investigators

10:16

started with an outbreak

10:18

of the impox virus in

10:20

a group of wild-sooty

10:23

Mangabees. Entai National Park

10:25

Coat Devore. Cote d'avar. How

10:27

do I pronounce that? Do you know

10:29

that? Cote d'Ivois. Awesome. I

10:31

mean I'm the one in

10:33

France, right? Yeah, you are.

10:35

The track its origin. They

10:38

analyzed rodents and wildlife carcasses

10:40

from the region. They identified

10:42

an infected fire-footed rope squirrel

10:44

found dead three kilometers

10:46

from the Mangabee territory 12

10:48

weeks before the outbreak. The

10:51

genomes from the squirrel and

10:53

the Mangabe were identical. They

10:55

found, you're ready for this,

10:57

one video record of consumption

11:00

of the same squirrel species in

11:02

2015. In addition, they identify

11:04

two fecal samples containing the

11:06

DNA of the fire-footed rope

11:08

squirrel, I guess was eaten

11:10

by a mango bee, and

11:12

then they've got the DNA

11:14

and the poo. And so

11:16

one of these samples was

11:18

also the first positive for

11:20

the virus in the Maga

11:22

P group. This represents an

11:24

exceptionally rare case of direct

11:26

detection of an inner species

11:28

transmission event made possible only

11:30

by long-term health monitoring. They

11:33

conclude with our findings strongly

11:35

suggest rope squirrels were the

11:37

source of the... The monkey pox

11:39

virus or the impox virus

11:41

outbreak in mango bees, since

11:43

squirrels and non-human primates are

11:45

hunted, traded, and consumed by

11:47

humans in West and Central

11:50

Africa, exposure to these animals

11:52

is likely responsible for at

11:54

least a fraction of human

11:56

impox outbreaks. And we got a

11:58

cute little picture of a fire. footed

12:00

rope squirrel. So this is

12:02

this paper been accepted

12:04

or so right now this paper

12:06

is is a preprint and

12:08

we're actually getting this newspiece

12:10

from nature that that goes

12:12

through the okay so it's

12:15

been it's under review under

12:17

review yeah okay okay now

12:19

I realize this you know we

12:21

we talk a little about pertussis

12:23

on this weekend virology pertussis is

12:26

actually a It's a bacteria, so

12:28

it may not be a virus,

12:31

but it makes you sick. And

12:33

so I guess we're sliding, squeezing

12:35

it into our clinical update. But

12:38

I thought this was important to

12:40

bring to people's attention, because we're

12:43

seeing a significant issue here. The

12:45

US has reported 600 cases of

12:47

whooping cough, pertussis, in the first

12:50

three months of 2025. More than

12:52

four times the number. at the

12:54

same point last year, 25 times

12:56

as many had been reported at

12:58

the same point in 2023. If

13:01

the current trend continues, the country

13:03

will be on course for the

13:05

highest number of infections since the

13:07

vaccination was introduced in 1948. There

13:10

was a nice article in NBC News

13:12

that I thought did a good job

13:14

of capturing the human suffering, and so

13:16

I just wanted to share a bit

13:19

about this because, you know, we always

13:21

say people don't remember what you say,

13:23

but they remember how you made them

13:25

feel. And I think if we can

13:27

connect this feeling with pertussis, this

13:30

vaccine preventable illness, we might

13:32

move the needle. And here, let

13:34

me, let me read, Kate and

13:36

Greg Moore, weren't thinking whooping cough

13:38

when their son. 13-year-old Joe started

13:40

having coughing fits in early March.

13:43

Joe probably just had a

13:45

late winter virus. The blooming

13:47

Field Hills Michigan couple figured.

13:49

Maybe it was spring allergies. Other

13:51

than the coughing he seemed

13:53

fine. Cough medicine didn't touch

13:55

Joe's brutal and increasingly violent

13:58

coughing jags. Sometimes every... five

14:00

to ten minutes for hours at a time.

14:02

It was a very violent cough. I just

14:04

had to pause what I was doing and

14:06

wait until I was done coughing, Joe said.

14:08

Sometimes it felt like I'd throw up. It

14:11

was difficult to watch Joe's

14:13

body convulse uncontrollably, said his mother

14:15

Kate. Nothing seemed to be working,

14:17

she said. It just seemed really

14:20

aggressive. He doubled over. tests revealed

14:22

that Joe had pertussis, a bacterial

14:24

infection. It's also called whoop and

14:27

cough because of the sound some

14:29

kids make during the coughing fits

14:31

that Joe experienced. Really seeing

14:34

a lot of suffering here. And

14:36

these are mostly people who are

14:38

not vaccinated, right? It's really

14:40

the issue. This is a

14:42

vaccine preventable illness. And again,

14:44

as we've talked about, vaccine

14:47

won't necessarily protect you from

14:49

getting infected, but they'll protect

14:51

you from the disease, from

14:53

the severity of disease. And we

14:55

are seeing numbers rise. All right,

14:57

well measles, you know, and this

14:59

this goes right to your pessimism

15:01

I hate to say Vincent CDC

15:03

cancels measles help for school Texas

15:06

schools amid staff layoffs You know

15:08

normally the CDC jumps in they

15:10

help they they assess ventilation and

15:12

things like that in the schools,

15:14

but This is being canceled. The staff

15:16

that was involved in helping the schools

15:18

and monitoring the ventilation, they were called

15:21

back it. Some of the things they

15:23

point out, and I think we just

15:25

realize this is reality, is a lot

15:28

of times the schools will have ordered

15:30

these proper filters that need to go

15:32

in so that the air is clean,

15:35

so your kids are actually getting hepa

15:37

filtered air and not necessarily breathing in

15:39

those viruses from everyone else. But a

15:42

lot of times those... Those filters will

15:44

stay in the boxes and then

15:46

the CDC shows up, they get

15:48

out of the boxes, they get

15:50

installed, we see improvements, but this

15:52

is not happening. So let's get

15:54

everyone updated here. So start off

15:56

with the total US. We are

15:58

up to 800 cases. Now, about

16:00

a third of those, a little

16:03

less than a third or under

16:05

five, over a third or in

16:07

that five to 19. And actually,

16:10

the other third are basically 20

16:12

plus and up. And 96% of

16:14

this are unvaccinated or not known

16:17

to be vaccinated. So this really

16:19

continues to be an issue. And

16:21

11%, so 85 of those 800

16:24

have ended up in the hospital.

16:26

So this is not just. Go

16:28

ahead, sorry, sorry, sorry. No, I

16:31

was going to say this, and

16:33

this is not for quarantine. These

16:35

are people who are sick, people

16:38

struggling to breathe, and in some

16:40

cases, not surviving. I understand that

16:42

epidemiologic tracing has been limited because

16:45

of staff, because people have been

16:47

fired, and it was a vaccine

16:50

push in Dallas. They had to

16:52

cancel because they didn't have enough

16:54

people to do it. They were

16:57

going to do emergency vaccinations. So,

16:59

you know. This is a tragedy

17:01

on all sides. Yeah, this did

17:04

not need to happen, does not

17:06

need to happen because it is,

17:08

it's ongoing and the Epi Center

17:11

still is in Texas. We get

17:13

updates on Tuesday and Friday. Texas,

17:15

624 cases since January, another 27

17:18

since our last update. And most

17:20

of it is clustered in that

17:22

western part of Texas, right where

17:25

it borders with New Mexico. This

17:27

is happening because one person does

17:29

not believe in infectious diseases. It's

17:32

really, it's, well, it's amazing that

17:34

what one person can do. I

17:36

would never have believed it if

17:39

I didn't see it now. One

17:41

person can do this and, you

17:43

know, everybody else understands the nature

17:46

of infectious diseases, the importance of

17:48

vaccination, and one person is thwarting

17:50

all of this. So

17:54

we'll leave in a lot

17:56

of links for vaccinations, all

17:58

the myths, all the safety,

18:00

all the stuff there. So

18:02

we'll continue. to do as

18:04

much as we can to

18:06

keep this on everyone's radar.

18:08

Things are going in the

18:10

right direction with flu. You

18:12

know, almost the entire country

18:14

is in the green, low

18:16

to minimal. Except what is

18:18

that orange state up there

18:20

in the Northeast? You recognize

18:22

that state, Vincent? Yes, it's

18:24

New York State. Yeah, but

18:26

we have high activity. Yeah,

18:28

it's still, it's, but it's,

18:31

it's an outlier, I think

18:33

this little blip, and then

18:35

we're gonna come on down.

18:37

New York State is a

18:39

very populous state in a

18:41

particular New York City, right?

18:43

It's very crowded, so. And

18:45

also last, last week, we,

18:47

we had a school break.

18:49

So we actually went from

18:51

this moderate low. We went

18:53

up, you know, back into

18:55

sort of the lower edge

18:57

of high. I think it's

18:59

going to come back down.

19:01

So here's something for you

19:03

today. I get on the

19:05

train. It's full of mothers

19:07

and their daughters. So it's

19:10

apparently bring your daughter to

19:12

work today. So the dozens

19:14

of kids are in there

19:16

without masks. This is how

19:18

transmission occurs. Oh, kids don't

19:20

transmit things. So I wear

19:22

my mask as I always

19:24

do, but you know, you

19:26

don't think about these isolated

19:28

ways that people live, and

19:30

that's it. Yeah, I mean,

19:32

it's great to have that

19:34

mask in your body. You

19:36

get in a situation like

19:38

that, and suddenly you're like

19:40

really glad you can whip

19:42

that mask on, and you

19:44

know, I mean, nobody likes

19:46

to be sick. Today, actually,

19:49

the air quality in the

19:51

region is poor because they're

19:53

these forest fires in southern

19:55

Jersey. You have pretty significant

19:57

fires down there, yeah. So

19:59

you can smell it and

20:01

they say, wear a mask

20:03

if you go outside because

20:05

it's bad for your lungs

20:07

to inhale the particles. Yep.

20:09

All right, moving into RSV,

20:11

and actually we are coming

20:13

out of the RSV season,

20:15

levels are low, but we

20:17

did get a little bit

20:19

of an update actually, so

20:21

I'm going to start with

20:23

the headline, RSV vaccine. Right?

20:25

So trial shows waning efficacy

20:28

of RSV vaccine across three

20:30

seasons and older adults. A

20:32

study of the single dose

20:34

respiratory sensitional virus RSV vaccine

20:36

in older adults shows that

20:38

vaccine efficacy waned across three

20:40

RSV seasons, but suggests a

20:42

booster vaccination one year after

20:44

initial vaccination did little to

20:46

provide additional efficacy. So a

20:48

little surprise there. So let's

20:50

let's go through the data.

20:52

So we've got this article,

20:54

efficacy, safety, and immunogenicity of

20:56

the A.S.01e. Adjevented, respiratory, sensational

20:58

virus, prefusion, F, protein, vaccine.

21:00

in older adults over three

21:02

respiratory sensational virus seasons, a

21:04

multi-center randomized observer-blinded placebo-controlled phase

21:07

three trial published in the

21:09

Lancet Respiratory Medicine. So these

21:11

are the results from a

21:13

randomized observer-blind placebo-controlled phase three

21:15

trial of erectsny by GSK.

21:17

With participants aged 60 years

21:19

or older, in 275 centers

21:21

across 17 countries, Africa, Asia,

21:23

Oceania, Europe, and North America.

21:25

Participants were randomly assigned one

21:27

to one to either receive

21:29

the vaccine or placebo before

21:31

RSV season one. RSV, let's

21:33

see, before season, and then

21:35

you end up with a

21:37

certain group who got it

21:39

the first season, and they

21:41

get a second dose. or

21:43

placebo and we're going to

21:46

go forward and we're going

21:48

to look at the primary

21:50

objective which could be efficacy

21:52

against first occurrence of RSV

21:54

lower respiratory tract disease over

21:56

one RSV season. So efficacy

21:58

analysis. included

22:00

12,468 RSV pre-F3 recipients, so we'll

22:03

say vaccinated recipients, 12,498 placebo recipients,

22:05

cumulative efficacy over three seasons, and

22:07

I'm gonna go through all the

22:09

data, but let's actually just look

22:12

at kind of what happened here.

22:14

So I'm gonna go to the

22:16

figures, I've got some great figures,

22:18

and we'll do it there. So

22:21

we'll start off with figure two.

22:23

And so we're gonna see the

22:25

single dose. Pre-season one, and then

22:27

we'll talk about what about folks

22:30

that get that extra dose. So

22:32

season one was great, right? 82.6%

22:34

efficacy. We're really impressed. Season two,

22:36

it drops to 56. Season three,

22:39

it drops to 48. So we're

22:41

starting to see it come down.

22:43

But really wide confidence intervals, right,

22:45

Vincent? I mean, these are huge

22:48

confidence intervals. Huge, yeah. And that's

22:50

gonna present a challenge when they

22:52

go ahead and they say, well,

22:54

what about, you know. dose, you

22:56

know, one pre-season one, plus you're

22:59

going to get that re-vaccination. And

23:01

then when you get into season

23:03

two, you're comparing a 56.1 without,

23:05

55.9 with that, that boost, we'll

23:08

call it. And then you get

23:10

to season three, with the boost,

23:12

you're getting 68.4, without the boost,

23:14

you've dropped to 48, but these

23:17

very big overlapping confidence intervals. Yes.

23:20

Right. So it's sort of interesting.

23:23

Like initially you walk away like,

23:25

ah, it didn't really help to

23:27

get that extra dose. What's going

23:29

on? Well, I think they may

23:31

not have enough numbers. They may

23:33

not really, you've got confidence intervals

23:35

going from 20% to 90, I

23:38

mean, pretty hard to show that

23:40

you're going to end up with

23:42

something outside of that. Yeah. This

23:44

is because, you know, population is

23:46

different. Everybody's different. So you're going

23:48

to get a wide range of

23:51

values in these kinds of studies

23:53

in these kinds of studies, right.

23:55

Yeah, but it is nice if

23:57

you look at one of the

23:59

figure one, I guess I'll say.

24:01

You really see a nice separation

24:03

between placebo and RSV. you see

24:06

a really nice separation between RSV

24:08

and placebo with the re-vaccination as

24:10

well. So it looks like you're

24:12

continuing to get some level of

24:14

protection, 50% or greater. In that

24:16

third year, it's just not clear

24:19

that we have enough data. And

24:21

we may need a lot of,

24:23

you know, people call real world,

24:25

basically. you know, post-marketing observation to

24:27

see what's kind of happening as

24:29

we go forward. Because we're still

24:31

trying to figure out, you know,

24:34

when's the next time to get

24:36

another dose of this vaccine. And

24:38

COVID, COVID update really moving in

24:40

in the right direction here all

24:42

across, you know, and I will

24:44

sort of jump forward to that

24:46

wonderful multi-colored wastewater tread. And you

24:49

can see we are solidly. into

24:51

the low area and on a

24:53

nice downward trend. Really looking like

24:55

where we were about a year

24:57

ago. And it goes to this

24:59

low level. It never goes away

25:02

completely. Yeah, sometimes it gets just

25:04

to the edge of the very

25:06

low, which I think we're almost

25:08

at. So I'm hoping we got

25:10

like a few weeks, maybe a

25:12

month or so, reprieve, and then,

25:14

you know. Well, last year it

25:17

started up again, right, in May

25:19

June. Yeah. That's weird for a

25:21

respiratory virus, so maybe it's going

25:23

to lose its weirdness this year.

25:25

We'll see. I would hope, I

25:27

would, you know, I'd love to

25:30

have, you know, just one peak,

25:32

you know, I mean, yeah. Yes,

25:34

in the fall winter, yeah. Yeah,

25:36

so. Start acting like a normal

25:38

respiratory packaging, please, you know, if

25:40

you... Well, I think it's still

25:42

close to where it... originated, you

25:45

know, 2020, right, 2019, 2020, is

25:47

not that long ago, and maybe

25:49

it will take more time for

25:51

it to settle into this seasonality.

25:53

We just have to look. Yeah,

25:55

it's only five years, so yeah,

25:57

we're seeing, we're learning, you know,

26:00

as this happens. So, all right,

26:02

well, we're going to move ahead

26:04

to COVID early viral phase, and

26:06

I wanted to start off with,

26:08

you know, so we talk about,

26:10

you know, someone gets acute COVID,

26:13

you know, the recommendation, number one,

26:15

is is paxlobed. So I wanted

26:17

to talk a little bit about

26:19

Pope Francis, because what did Pope

26:21

Francis die of, right? So, so

26:23

recently, you know, about two months

26:25

ago, Pope Francis got multi-lobar people

26:28

called double pneumonia, was quite ill,

26:30

was in the hospital, survived that,

26:32

the acute phase of that. But

26:34

one of the things we've talked

26:36

about quite often is that for

26:38

the few months. after an acute

26:41

respiratory infection, particularly those that end

26:43

up requiring hospital support to get

26:45

through it. There's a significant post-infection

26:47

increased risk of major cardiovascular events,

26:49

right? Heart attacks and strokes. And

26:51

so Pope Francis, he made it

26:53

through that hospitalization. He got out

26:56

there. He drove around in the

26:58

Pope Mobile for Easter. But then

27:00

as we find out, he died.

27:02

There was a stroke. heart failure.

27:04

So really, you know, a lot

27:06

of us have seen this quite

27:09

often before a man of advanced

27:11

age, ends up with pneumonia, gets

27:13

out of the hospital, but then

27:15

just doesn't last much longer. Unfortunately,

27:17

that's what we saw here. So

27:19

one of the interesting questions with

27:21

COVID is there something we can

27:24

do about that. If we jump

27:26

in in that first week with

27:28

an antiviral and in this case...

27:30

pack slovid, can we reduce your

27:32

risk of getting a stroke or

27:34

dying in that three months post-diagnosis

27:36

is what we're going to look

27:39

at here? Because a lot of

27:41

people are like, I'm not sure

27:43

if I need that pack slovid,

27:45

I don't feel that bad, I

27:47

probably won't end up in the

27:49

hospital. But I think one of

27:52

the things that frightens a lot

27:54

of us is, boy, I certainly

27:56

don't want to have a stroke.

27:58

And is there any way I

28:00

can reduce my risk of having

28:02

a stroke in the three months

28:04

after this acute COVID infection? So

28:07

here we have the article, long-term

28:09

stroke, really not that long-term, but

28:11

long-term stroke. stroke and mortality risk

28:13

reduction associated with acute phase paxlovid

28:15

use in mild to moderate COVID-19

28:17

published in the journal of medical

28:20

virology. So here we have a

28:22

retrospective cohort study where they investigated

28:24

whether paxlovid or metralvir ritonovir used

28:26

during the acute phase of mild

28:28

to moderate COVID-19 reduces the risk

28:30

of ischemic or hemorrhagic stroke occurring

28:32

more than three months post-postdiagnosis. So

28:35

they use this tri-NetX electronic health

28:37

records. They're looking at 118 million

28:39

patients in the United States, a

28:41

very robust study, looking at adults

28:43

aged 18 years or older. Probably

28:45

could have looked at older. It's

28:47

now this down, but looking at

28:50

those with a confirmed COVID-19 diagnosis

28:52

between 2022 and 2023. And they're

28:54

going to look at folks that

28:56

got paxlovid within five days of

28:58

diagnosis, and then the folks who

29:00

did not get paxlovid. among 181,992

29:03

matched pairs. Paxlovid use was associated

29:05

with a significantly reduced risk of

29:07

ischemic and hemorrhagic stroke. It was

29:09

about a 15% reduction. And we're

29:11

also seeing all-cause mortality reduced by

29:13

32% during this long COVID period.

29:15

So they're defining this as that

29:18

three months or 90 days post-diagnosis.

29:20

They went ahead and they said,

29:22

well, what about age, what about

29:24

sex, what about, you know? carrying

29:26

too much weight, hypertension, diabetes, hypolipidemia,

29:28

vaccination status or not, all the

29:31

way across the board, consistent protective

29:33

events. So, you know, you're getting

29:35

this 15% reduction in your chance

29:37

of having a stroke. You're getting

29:39

this 32% reduction of death. And

29:41

this is in that 90 days,

29:43

those, you know, three months after

29:46

the acute COVID. So pretty compelling

29:48

for I think a lot of

29:50

people who you know, they're not

29:52

that worried You know, I mean

29:54

for me I'm like, you know,

29:56

I might die one day, but

29:58

I certainly don't want to have

30:01

a stroke. It's too bad there

30:03

isn't a similar treatment for pneumonia,

30:05

right? Bacterial pneumonia. You know, it

30:07

is tough. I think, you know,

30:10

this is one of our, the

30:12

sooner we can jump in with

30:14

antibiotics, the more impact we think

30:17

we have on this, but yeah,

30:19

we certainly see this post-hospitalization increase

30:21

in major cardiovascular events in bacterial

30:24

pneumonia as well. Remdesivir,

30:26

malnipurivir, convalescent plasma.

30:29

Early inflammatory phase, that's at

30:31

week two, potentially the bad

30:34

phase. That's when we think

30:36

about steroids, anic regulation, pulmonary

30:38

support, maybe remdesive, or immune

30:40

modulation. And I'm gonna wrap

30:42

us up here with COVID,

30:45

late phase, past long COVID,

30:47

leaving a bunch of links

30:49

as we do, but I

30:51

wanted to talk about the

30:53

article, the effect of COVID-19

30:55

vaccination on the risk. a

30:57

persistent post-COVID-19 condition cohort study

30:59

the results of a population-based

31:02

cohort study in Stockholm Sweden

31:04

to investigate the effect of

31:06

CO-19 vaccination on the risk

31:08

of developing persistent. post-COVID-19 condition

31:10

and individuals surviving the first

31:12

year after a SARS-COB2 infection.

31:14

This is something we've repeatedly

31:17

shared data on, but here

31:19

they're looking at 3301,042 individuals.

31:21

And let's go through the

31:23

data. So you've got your

31:25

unvaccinated as your reference. One

31:27

dose of vaccine, you're seeing

31:30

a 19% reduction, two doses,

31:32

you're seeing a 58% reduction,

31:34

and that. third dose is

31:36

giving you a 63% reduction

31:38

in your chance of getting

31:41

long COVID. And they break it

31:43

down with preamochron, amochron, are you

31:45

female, are you male, male, they

31:47

use 65 as a cutoff, and

31:50

you're seeing consistent, and then even,

31:52

I thought this was really interesting,

31:54

if you look at no previous

31:57

infection and people who've gotten

31:59

infected. before Rex people, I

32:01

was infected before, there should be

32:03

this protection there. In folks that

32:05

got two or three doses, after

32:07

a verified previous infection, you're seeing

32:09

a 60 and a 65% reduction

32:11

in your risk of more COVID.

32:14

Is there any, are they all getting the same

32:16

vaccine or is it a mix

32:18

of different vaccines? So it's a

32:20

mix of different vaccines, but this,

32:22

yeah, makes a different vaccine. But

32:25

it's really interesting, right? Because a

32:27

lot of people are like bitter.

32:30

Like why did they encourage me

32:32

to get vaccinated if I already

32:34

had an infection? I was already

32:36

fine. Well, a lot of people

32:38

are not already fine. I think

32:40

many, many more people are suffering

32:42

from post-covid conditions than died. And

32:45

so seeing this 60% reduction in

32:47

post-covid conditions, heart failure, strokes. chronic

32:49

fatigue type syndrome, all the rest.

32:51

That's huge. This is really a

32:53

strong argument for encouraging people to

32:55

get vaccinated, even if they already had

32:58

previous infection, even if they survived that

33:00

first infection. And what people should understand

33:02

is that at the beginning of a

33:04

new virus circulating, right, a pandemic, you

33:07

don't know, you don't know a lot

33:09

of things, so you exercise the utmost

33:11

caution, you get vaccinated. And so

33:13

why did they vaccinate? Daughter was

33:15

the best thing to do and now when

33:17

we finally did these studies, it is. We

33:20

realize we confirmed that it was the best

33:22

thing to do. Yeah. It's all that bliss

33:24

of ignorance. It's all that

33:26

joy. They just can't contain

33:28

the joy of ignorance. All

33:30

right, orchestra, orchestra, Delphi, consensus,

33:33

diagnostic, and therapeutic management of

33:35

post-covid 19 condition and vulnerable

33:37

populations. Recently published in CMI.

33:39

And so this is a

33:41

consensus document. They end up

33:43

with 11 statements, six on

33:46

features, risk factors of post-covid

33:48

conditions in clinically vulnerable populations,

33:50

two on diagnosis management, three

33:52

on prevention. A couple highlights,

33:54

chronic fatigue was identified as

33:57

the most frequent presentation of

33:59

post-covid. conditions. They suggest that

34:01

a different case definition of

34:04

post-covid condition is required for

34:06

people with rheumatic diseases. You

34:09

know, because a lot of

34:11

times autoimmune disorders, post-covid conditions

34:14

can kind of be an

34:16

overlap here. So, you know,

34:18

looking at people like that.

34:21

So, just sort of throw that

34:23

out in a link for people. And

34:25

there was a recent article in

34:27

Spectrum News about the Mount Sinai

34:29

Long COVID clinic. So I'm a

34:32

little highlight for the Mount Sinai.

34:34

The medical director of this clinic

34:36

is Zijian Chen, MD, an endocrinologist

34:38

and associate professor of Mount Sinai.

34:41

The individuals they interview for this,

34:43

or the individual they interview for

34:45

this article, is David Patrino, with

34:47

whom I've spoken. He's a physical

34:50

therapist with a PhD in neuroscience.

34:52

He's a full professor of Mount

34:54

Sinai. David Patrino has, he's become

34:56

the face of this clinic with

34:58

a number of media appearances and

35:01

publications. And I was thinking, you

35:03

know, this whole trust in science

35:05

issue from last week, do we,

35:07

maybe we trust physical therapists more

35:09

than MDs, or what about neuroscientists? So

35:12

I looked at that chart

35:14

from last week, right? Because

35:16

we've got, you know, because,

35:18

you know, Dr. Chen is

35:20

the MD, but then we've

35:22

got David Patrino, who's licensed

35:24

physical therapists, and I look

35:26

through the thing, and actually,

35:28

neuroscientists are quite well trusted. Do

35:30

you see that? Yes. I just

35:32

wanted to point that out. But

35:35

the article highlights the 10 million

35:37

dollar center for post-covid at Mount

35:40

Sinai. This is part of the

35:42

Cohen Center for Recovery from Complex

35:44

Chronic Illnesses, of which David Patrino

35:47

is the Nash Family Director. The

35:49

center began as a specialized clinic

35:52

for long COVID treatments, but expanded.

35:54

They now treat a range of

35:56

conditions, including MECFS, tick-borne, vector-borne illnesses,

35:59

things like... Lyme, people have

36:01

issues after Lyme, connective tissue

36:03

disorders. Now, this clinic is

36:05

not funded by any federal

36:07

funding, not supported by any

36:09

federal funding, so safe for now.

36:11

They provide clinical care and access

36:14

to research studies, and I'm going

36:16

to leave in some links in

36:18

case people want to explore this

36:20

clinic. I've had several patients go

36:23

there. And then I'm going to

36:25

wrap us up if you want

36:27

to reach out to your representatives.

36:29

house.gov,/representative, slash find your representative. So

36:32

you can let them know what

36:34

you would really like, what you

36:36

want our government to be doing

36:38

for you in the world. Because as

36:41

we've been saying for five plus years,

36:43

no one is safe until everyone is

36:45

safe. That's how we make America great

36:47

by making the world great. I want

36:50

everyone to pause our recording right here.

36:52

Go to parasites.border.com. Click donate. Every bit

36:54

counts. Thank you so much for the

36:56

people that have stepped up this last

36:59

week. We're now doing our floating doctor's

37:01

fundraiser. We're February, March, and April. We're

37:03

going to double your donations. We're going

37:05

to get to that maximum donation

37:08

of $20,000. It's time for your

37:10

questions for Daniel. You can send

37:12

yours to Daniel at microbe.TV.

37:14

Michael writes, dear Dan, he calls you Dan,

37:16

I don't know if you know, Michael. I am a

37:18

slightly less energetic ID physician than

37:20

yourself. I'm amazed that all you

37:23

accomplish as an ID clinician and

37:25

communicator. Why do you think? They

37:27

have not tried Posaconazole antifungal prophylaxis

37:30

in the last of us. Yeah,

37:32

so why not pose a connoise,

37:35

or a connoisell? So maybe people

37:37

need a little background. I don't

37:39

know if all our listeners are

37:42

the last of us fishnoughtos or

37:44

watchers, but so the last of

37:46

us is this fantastic TV show

37:49

that I will endorse, which starts

37:51

off with cortiseps, which is the

37:54

zombie ant fungus. There's a form

37:56

of cortisep that is mutated and

37:58

is now infected. human beings and

38:01

turning us into zombies. And it's

38:03

really interesting to think about how

38:05

it works in the ants. So

38:07

they initially get exposed to the

38:09

spores, and then the spores then,

38:11

you know, germinate and then they

38:13

end up with fungi and the

38:15

fungi develops close to the brain

38:17

and actually activate certain neurotransmitters and

38:19

and gets the ants to engage

38:21

in different behavior than they would

38:23

normally. There's a there's a fungus

38:25

that infect spiders that gets this

38:27

precludes type of spider to like

38:29

come out into the open. Well in

38:31

the movie that people are getting infected. Actually

38:34

I got to say Vincent I've watched a

38:36

lot of zombie movies. These zombies are

38:38

really fast. One of the most recent

38:40

episodes, I don't know if it's much

38:42

of a spooler, but like the horses

38:45

are having trouble out running zombies. And

38:47

horses are fast, right? So suddenly

38:49

these, but apparently even in the

38:51

ants, the fungi can actually get

38:53

involved, get into the legs and

38:55

can actually secrete things that are

38:58

sort of, you know, stimulants. So

39:00

maybe that's what's, who knows what's

39:02

going on. But yeah, so would

39:04

it make sense? Now, unfortunately a

39:06

lot of the time of the

39:08

interaction between these zombified human beings

39:10

and the regular humans involves a

39:12

lot of violence and pretty significant

39:14

biting and significant biting. This is

39:17

some good ideas. They should be

39:19

thinking about them. Why not? People

39:21

are taking Ivermectin and other things.

39:24

I think in the time of

39:26

the zombies, I'm sure there would

39:28

be a black market for a

39:31

pozzi-conazole, Voreconazole. Yeah. They're

39:33

just going to take

39:35

Ivermectin. Good idea, Michael. Got

39:37

to test it out. Carol writes, my

39:39

son and daughter-in-law are expecting their first

39:42

child in October. What vaccine should my

39:44

daughter in law get during her pregnancy

39:46

and when? So this is great. I'm glad

39:48

you're asking this question. So, you know, it's

39:51

going to have this conversation, you know, with

39:53

your daughter-in-law's OBGYN, but maybe you kind of

39:55

go in with the knowledge at a time.

39:57

So let's think about what's recommended during that.

40:00

last trimester. So during the last

40:02

trimester thinking about you know this

40:04

this young lady going into going

40:06

into October, right? So you're going

40:08

to want to think about how

40:10

does she protect herself, you know,

40:12

during that fall as well as

40:14

into the winter, how does she

40:16

protect the newborn? So some of

40:18

the things that we've talked about,

40:20

so COVID, we'll start with the

40:22

COVID vaccine, getting that COVID about

40:24

three months before, so right into

40:26

the beginning of that third trimester,

40:28

that's going to protect her, increased

40:31

risk, also going to... passively protect

40:33

the baby during the first six

40:35

months. We also recommend the flu

40:37

shot. Don't forget the flu shot.

40:39

We also have an RSV shot

40:42

to do during that period of

40:44

time. We also have the T-depth,

40:46

the tetanus, diphtheria, acellular pertus. And

40:48

then, just the little thing is

40:51

once the baby is born, we've

40:53

now talked about doing not only

40:55

the RSV shot for mom, but

40:57

also doing the nurse haremab, the

41:00

passive antibody for the newborn

41:02

baby. And of course, be for

41:04

the baby also, right? Yes. Yeah.

41:06

There will be all those childhood

41:08

vaccines. Philip

41:10

Wright's Columbia is seeing a wave of yellow

41:13

fever. I had the vaccine in 91 at

41:15

33 years of age. I repeated it before

41:17

I turned 67. I had no adverse effects.

41:19

The nurse practitioner said my risk

41:21

was lower as I had been vaccinated

41:24

before. I'm happy with the NP at

41:26

my travel clinic. My wife is

41:28

Colombian and we planned to spend

41:30

time in Colombia in retirement as

41:32

well as countries that might require

41:34

a vaccination. My wife is 71

41:37

good health. Prior vaccination status is

41:39

unknown. Like I said, I have a

41:41

good NP. I told her about Twive

41:43

and she was impressed. My conversation with

41:45

the NP involved effectiveness of the 91

41:47

shot versus odds of getting infected. Was

41:49

it riskier to get the shot or

41:52

the infection? What would your concerns

41:54

be with giving a 71-year-old her

41:56

first yellow fever vaccination? How about

41:58

Chicken Gunja vaccine? Yeah, so

42:00

these are some great questions here. So

42:02

first let's start off with what we

42:05

know about the yellow fever vaccine. So

42:07

it used to be you got the

42:09

yellow fever vaccine and then every 10

42:12

years you got a yellow fever vaccine

42:14

booster. The current thinking is one shot

42:16

is adequate for a lifetime protection. So

42:19

it's not clear that you need another

42:21

shot. But it's also as far as

42:23

side effects, we'll get into a moment.

42:26

If you tolerated the first one, you're

42:28

fine, second shot, you're going to be

42:30

fine. Here's. We have seen, and it's

42:32

about one in a hundred thousand folks,

42:35

will get a side effect if they

42:37

get that first yellow fever vaccine over

42:39

the age of 65. But you can

42:42

kind of look at like, well, how

42:44

healthy is this? 71-year-old that we're talking

42:46

about. But no, we have seen in

42:49

individuals about a one in a hundred

42:51

thousand will actually end up having a

42:53

pretty significant side effects from this replication

42:56

competent yellow fever vaccine. The other, you

42:58

ask about the chicken gunya vaccine. Yeah,

43:00

you want to look at that. This

43:02

is now, we just got recent, hot

43:05

off the press recommendations for travelers going

43:07

to areas where there's ongoing chicken gunya

43:09

or active chicken gunya cases. I think

43:12

Reunion is actually having a big outbreak

43:14

at the moment. So yeah, chicken gunya

43:16

is now on the list of recommended

43:19

for travelers that are heading to areas

43:21

with significant chicken gunya activity. Carson writes,

43:23

I tested positive for COVID by rat

43:26

on April 2nd, same day as symptom

43:28

onset. By 4-8, I was negative. I

43:30

know, I know, I'm not supposed to

43:32

retest, but I wanted to know. Since

43:35

then, I've had a mild occasional cough.

43:37

However, since 420, my cough has gotten

43:39

progressively worse. Note, I did not partake

43:42

in any 420 related activities. At first,

43:44

I thought it might just be a

43:46

residual effect of COVID or maybe COVID

43:49

rebound. Eh. I blame my progressively worsening

43:51

congestion and failure on the cough kicking

43:53

up mucus and make it difficult to

43:56

sleep, but now for 23... I'm starting

43:58

to feel pretty sniffly unrelated to the

44:00

cough. And I'm wondering if I'm just

44:02

sick again. I did test again for

44:05

COVID. It was negative. Could it be

44:07

COVID rebound three weeks out? Or did

44:09

I get another cold virus? And a

44:12

side question, at what point is it

44:14

not overdromatic to go to my doctor

44:16

about this cough? And I did not

44:19

take pects a little bit. OK. So.

44:21

I'm trying to figure out, you didn't

44:23

take pectylovid, but I don't have any

44:26

age or risk factor, so I don't

44:28

know about that criteria there. This does

44:30

not sound like any kind of rebound.

44:32

So remember thinking about what we have

44:35

here. So we have the cute viral

44:37

week, then we have that inflammatory second

44:39

week. Now, during the third week, some

44:42

people, you know, that's when we see

44:44

the secondary bacterial infections, right? in the

44:46

airways, number of changes in your immune

44:49

system, increased vulnerability to getting something down

44:51

the road. You know, if you've got

44:53

ongoing cough, you've got you're not feeling

44:56

well, I don't think it's overly dramatic

44:58

to go to the doctor. Let them

45:00

listen to your lungs, let them look

45:02

at your throat, let them try to

45:05

figure out what's going on. And hopefully

45:07

they're gonna be wise in determining whether,

45:09

you know, what exactly would be the

45:12

best thing for you. Never over dramatic

45:14

to go check in with the physician.

45:16

And Lauren writes, I would love listening

45:19

to your podcast have a question about

45:21

chicken pox and shingles vaccine. I had

45:23

a very mild case of chicken pox

45:26

as an infant, developing just a few

45:28

spots when my sister had a full-fledged

45:30

case, had the vaccine in my mid-20s,

45:32

and then had a lab confirmed breakthrough

45:35

case of chicken pox in 2020 when

45:37

I was 39, despite rarely leaving the

45:39

house during the pandemic. My PCP can't

45:42

decide if I'm at increased or reduced

45:44

risk for shingles, given my recent chicken

45:46

pox infection. What do you think? Does

45:49

an adult breakthrough case of chicken pox

45:51

increase or decrease the risk of getting

45:53

shingles? If it increases risks, should someone

45:56

who got chicken pox as an adult

45:58

get their shingle vaccine early? Yeah,

46:01

so this is a great scenario.

46:03

So, you know, something has me

46:05

a little concern. Like, so here

46:07

you get chicken pox, you know,

46:10

it sounds like it was a

46:12

mild case initially when your sister

46:14

had this full-fledged. Then you get

46:16

the vaccine, right? So we're thinking

46:18

at this point, oh, you're protected,

46:20

your risk is very low. But

46:22

then you actually go ahead and

46:25

you get a full-fledged lab confirmed.

46:27

breakthrough, post-vaccination, post-infection case of chicken

46:29

pox. There's something up with your

46:31

immune system that made you susceptible.

46:33

That is not a common, that's

46:35

a rare occurrence. So yeah, I

46:37

think you're, I would say, just

46:40

putting this all together, you know,

46:42

you're probably with an end of

46:44

one here, you're probably at an

46:46

increased risk of shingles. So then

46:48

this really becomes a good question.

46:50

Do we wait to 50 before

46:52

you go ahead? That is the

46:55

recommendation. Or do you start thinking

46:57

about getting that earlier? So we

46:59

don't know. This is one of

47:01

those limited data zones. But I

47:03

think you're raising a lot of

47:05

really good questions. Certainly the day

47:07

you turn 50, go ahead and

47:10

get your shiggles vaccine if you

47:12

hadn't gotten it any earlier. 2020,

47:14

so now she's 44, right? Daniel?

47:16

Yeah, so we're almost, we're almost

47:18

there, right? Or she'll be turning

47:20

the 44 this year. So she's

47:22

pretty close, pretty close. Yeah. That's

47:25

two of weekly clinical update with

47:27

Dr. Daniel Griffin. Thank you, Daniel.

47:29

Oh, thank you. And everyone, be

47:31

safe.