COVID-19 The Eye of the Storm. Should the immunosuppressed take the blame?

C

This is not directly related to MS so read if intested dont if you are not interested

I was teaching on friday and got a meal voucher for the Cafe…so I went in to get a few cans of pop for ProfK and was amazed to see all the perspex shielding that stops the Cafe staff from being breathed upon, have been removed.

I went out to do a face to face exam and I had to do a risk assessment to travel…after a good few hours spent on this….it got to the question of wording and rather exasperated I asked for the wording that was appropriate for me to travel into work in London as I was convinced the risks of COVID were probably far higher than where I was going to. If you dont live in London you may not know that whilst it is mandated to mask up on public transport…essentially no-one is doing it. So I promised that I would not sue if I got COVID and tested myself everyday on every side of the trip and dodged the travelling bullet.

But we are in Deltaland and everyone thinks its over. However, we are at about 50,000 infections a day and yet we are taking the perspex down.  Like a hurricane we have devastation as the eye approaches and then a lull occurs when we are in the eye. So we think its OK to take the shutters off to get messed up as the eye moves on and we get the hurricane tail.

Yes the death rate is down thanks to vaccination, but what next? Is Omicron the problem? Is it a saviour and a mild highly infective variant and the hurricane tail, If the murmurs are true omicron spreads about seven times faster than delta and 500 times faster than Wuhan. Will it respond to the therapeutic antibodies…many think not and the efficacy of the MSD drug has been reduced to 30% from 50% to stop hospitalisation. Just what you need…Not

So think about this when you are out and about and remain cautious if you are vulnerable. If you get vaccinated and get your B and T cells going you will get some protection.

However being immunosuppressed, if infected you may not get rid of the virus quickly and allowing it to mutate. Immunosuppressed people were implicated in the Kent varian,t which had a few mutation. Again Immunosuppresssed people are being implicated in Omicron as it has 50 mutations. How does this appear “out of the blue

It is funny I was presenting a talk and the first introduction slide was this to say that cornivirus came from bats maybe via a wet market or a bit of a mess-up from labs studying bat viruses (the conspiracy theory). We saw mink get infected and this variant went back to human. But Minks and Ferrets should be more difficult to infect as their ACE2 is less human like. I was wondering if cows would get it, What would they do? Kill the cows and go Vegan?

However as you can see deer and hammy the hamster are high on the list for risk as there ACE2 is like that of humans. Hammy has already been co-opted into SARS-CoV-2 research. But I was interested to learn that white tail deer are now infected and so you have a natural reservoir of the SAR-COV-2 virus in the wild animal population. Maybe they could use the Astrazeneca vaccine the US don,t want to immunise their deer..only joking it probably wouldn’t work:-)

On the Gavi web site it says “80% of deer sampled in Iowa between November 2020 were positive”…maybe they can use these deer to assess herd immunity:-).

However it  says “There is the possibility that viral mutation in a reservoir host, such as white-tailed deer, could lead to new variants of the disease. These variants may lead to greater infection rates (Sounds like omicron), increased virulence (severity of symptoms…it could work the other way as seen in mink where it was reduced ) and prove more effective at evading the human immune system (Sounds like omicron). Likewise, any reinfection from wildlife reservoirs could also complicate our long-term efforts to fight and suppress the disease Omicron is a new variant with 50 mutations or which many have not been see before…There are awful lot of deer/antelopes in Southern Africa and the virus could happily of being mutating under the radar to infect deer/antelope, maybe we should have called it Bambi rather than omicrom. Even-toes ungulates Deer and antelopes and even include the Camel the potential source of MERS. Why didnt they call it Nu after all it was New and the next in line of the greek alphabet or Xi…perhaps too Chinese (Xi Jinping) 🙂

This may be of interest. It does not say a fourth vaccine boost will work if you have not responded after three this study is in transplantation and not MS. It points in the right direction

A fourth dose of the mRNA-1273 SARS-CoV-2 vaccine improves serum neutralization against the delta variant in kidney transplant recipientsBenotmane, I., Bruel, T., Planas, D., Fafi-Kremer, S., Schwartz, O., Caillard, S.10.1101/2021.11.25.21266704 — Posted: 2021-11-28

In immunocompetent subjects, the effectiveness of SARS-CoV-2 vaccines against the delta variant appears three-to five-fold lower than that observed against the alpha variant. While only 16% of patients harbored NAbs against the delta strain prior to the fourth injection  this percentage raised to 66% afterwards.

PULSE OXIMETETRY

Evaluating the impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in patients with covid-19 assessed in Accident and Emergency departments in England: a retrospective matched cohort studyBeaney, T., Clarke, J., Alboksmaty, A., Flott, K., Fowler, A., Benger, J. R., Aylin, P., Elkin, S., Darzi, A., Neves, A. L.10.1101/2021.11.25.21266848 — Posted: 2021-11-29

This is a device that measures your oxygen saturation levels

All patients with a positive covid-19 test from 1st October 2020 to 3rd May 2021 who attended A&E from three days before to ten days after the date of the test.

Participants enrolled onto CO@h were matched using demographic and clinical criteria to participants who were not enrolled

Initial eligibility criteria for CO@h included adults aged 65 years or over, those designated as clinically extremely vulnerable (CEV), or where clinical judgment applied. However, eligibility criteria varied across sites, and from February 2021, sites were encouraged to extend the age criteria to the 50+ age group. Those enrolled (“onboarded”) were encouraged to record three oximetry readings daily and advised to attend or call emergency services if the
reading was 92% or less, or to contact primary care services for readings of 93-94%

5,621 participants were included in the primary analysis, of whom 639 were enrolled onto CO@h and 14,982 were controls.

Odds of death were 52% lower in those enrolled (95% CI: 7%-75% lower) compared to those not enrolled on CO@

Conclusions These findings indicate that for patients assessed in A&E, pulse oximetry remote monitoring may be a clinically effective and safe model for early detection of hypoxia and escalation, leading to increased subsequent A&E attendance and admissions, and reduced critical care requirement and mortality.

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MouseDoctor

15 comments

  • Living and working in London I have been dodging public transport by cycling most days I need to be in the office. I’ve found when I do take the tube, mask compliance depends on the time of day/week. Rush hour: high compliance. Any other time: low.

    I did take the tube today as I am working 9:30am to 9:30pm and I won’t have the energy to cycle after that!
    Only one person in a packed carriage was not wearing a mask. There were more signs up to tell people masks are mandatory. We’ll see if it’s the same when I’m on my way home at 9:45 this evening!

    Work have asked us to test daily now though I doubt colleagues are. One of my team won’t even get vaccinated though thankfully I mostly see him online and he never works from the same office as me.

  • MD hi,

    I had my first round of alemtuzumab, freshly served by the lovely ladies of 11D, just a couple of weeks ago (week starting the 15/11).
    I do not live in London but shielding is impossible for me, with m3 kids under the age of 5 attending schools, nurseries, gymnastics, swimming poool, etc.. daily. Furthermore, I have builders in the house fixing things and my parents will be travelling to the UK via Heathrow to stay with us in a couple of weeks.

    No I record on a spreadsheet SpO2 levels once a day, resting BPM, heart pressure maxima and minima, non metric symptoms and take a lateral flow test at home every other day.

    What else can I do to?

    Tony

  • Yep the word is – immunocompromised!
    https://www.science.org/content/article/uk-variant-puts-spotlight-immunocompromised-patients-role-covid-19-pandemic

    Thanks for the reminder that we need to be careful – it’s too easy to forget since restrictions were lifted back in the summer. Yesterday I walked into a restaurant wearing a mask and walked out again without it🤦🏻‍♀️
    Woulda been sensible for the mandatory to have been extended to hospitality venues!

  • Nice post

    Omicron is a new variant with 50 mutations

    Mutations can be advantageous,,deleterious,or neutral for virus replication

    Do we know allready?

    80% of deer sampled in Iowa between November 2020 were positive”

    It remind me of that virus experiment in Australia to control rabits

    Myxoma virus was the first virus intentionally introduced into the wild with the purpose of eradicating a vertebrate pest, namely the European rabbit in Australia and Europe. The long-term failure of this strategy has been due to natural selective pressures on both the rabbit and virus populations, which resulted in the emergence of myxomatosis-resistant animals and attenuated virus variants. The process is regarded as a classical example of host–pathogen coevolution following cross-species transmission of a pathogen

    Will it happen with deer?

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

  • Thanks! Great post . As far as the animal population goes what about house cats? Seems like I’ve seen many articles bout the big cats in zoos catching Covid.

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