Something is Brewing in China and It’s Not Tea

Yesterday the Promed network reported a widespread epidemic of what is being described as “pneumonia of unknown cause”, affecting huge numbers of school age children in China. Reports in the Chinese press describe overwhelmed pediatric clinics and hospitals with children being treated with intravenous medication filling the lobby of one hospital. Cases are being reported from Beijing and Liaoning, which is 800 km away, closer to the North Korean border, so this is not a localized event. There has been no official comment from the Chinese government or health authorities, which is disturbing since rapid tests are available for all the common respiratory pathogens; and you would think that the government would be quick to dispel rumors and panic if they had diagnosed a temporal surge of a common viral illness. We will see what transpires over the next few days, and hopefully the Chinese will be more forthcoming with information than recent history suggests.

The COVID disease update will be brief today. We are beginning to see the usual effects of colder weather on disease activity, quite likely to be followed by a post Thanksgiving bump, with record travel numbers anticipated. As you can see from the following CDC graphs, last week recorded a 7% increase in COVID related ER visits, an 8.6% increase in hospitalizations, and a 9.1% increase in deaths. The decrease in deaths I was anticipating never happened.

There is nothing concerning on the variant front. The viral sequences gaining ground on all the others are HV.1 and JD.1.1, and the previous winners now being eclipsed are EG.5 and FL.1.5.1. All of these are members of the Omicron family and nothing startlingly new or different. This information is supplied for those people interested in viral lineages, and whose lives are as exciting as my own.

There is some important new information on COVID drug therapy. In my last post I discussed Paxlovid treatment of acute COVID having no effect on the frequency of Post COVID Syndrome in an older population. Last week’s Annals of Internal Medicine published a study specifically looking at the rate of viral rebound after Paxlovid treatment compared to no treatment. The group receiving treatment was a bit older and had received more doses of vaccine. The surprising result was that viral rebound was 20.8% in the treated group and only 1.8% in the untreated group. All patients experiencing PCR rebound had positive viral cultures and prolonged shedding of replication competent virus compared to untreated participants (median 14 days vrs 3 days). Treatment with Paxlovid was the only variable significantly associated with rebound. Oops! This is glaringly different from the information abstracted from the original Paxlovid trial, which has been widely accepted to show there was little difference in rebound rates. The rub is that the original trial was an efficacy and safety trial, and NEVER DESIGNED to look at viral rebound. It should come as no shock that you don’t measure what you are not looking for, and equally no shock that we continue to frequently accept post hoc analysis of data from studies not designed to answer a given question as proven fact. The bottom line here is you should not take Paxlovid unless you are truly at high risk for bad COVID outcome and need the reduction in severity, and if you do take Paxlovid, recognize there is a significant probability of relapsing contagious virus (mostly with symptoms) and remaining infectious for a prolonged period. Caveat Emptor.

SARS-CoV-2 Virologic Rebound With Nirmatrelvir–Ritonavir Therapy: An Observational Study: Annals of Internal Medicine: Vol 0, No 0. https://doi.org/10.7326/M23-1756

Moving on with repurposed drugs for COVID (yes the nirmatrelvir component of Pax was a repurposed hepatitis C drug). Fluvoxamine, which is an anti-depressant, received quite a bit of enthusiasm as a treatment for COVID, based on some in vitro data and observational reports of benefit. A November 17th publication in JAMA Networks of a randomized trial of high dose Fluvoxamine in 1175 people showed zero benefit in terms of time to recovery and every other parameter looked at. Fluvoxamine never engendered the furor surrounding hydroxychloroquine or Ivermectin, but let’s face it—it was one endorsement away from a similar battle.

Higher-Dose Fluvoxamine and Time to Sustained Recovery in Outpatients With COVID-19: The ACTIV-6 Randomized Clinical Trial | Infectious Diseases | JAMA | JAMA Network. https://jamanetwork.com/journals/jama/fullarticle/2812204

The next item I find worth reviewing is a report from all the pediatric oncology hospitals and clinics in Italy summing up their experience with COVID in the most compromised children with HSCT (Stem Cell) transplants or active cancer receiving chemotherapy. We knew very early on that SARS2-Cov19 was much milder in children than adults. You might remember that a possible reason for this is children have much lower amounts of the ACE2 receptor on their airway cells, and that the amount of that viral receptor increases steadily with age. This study looked at 455 consecutive patients between April 2020 and November 2022, so there was a good mix of both early pre-vaccine cases and later cases with variants dominant. Their conclusion was that COVID in this highly compromised population was a “relatively benign disease”; and that the major complication was delay in administration of chemotherapy or surgery. Out of the 455 consecutive cases of COVID only 9 died and COVID was judged not to be the cause of death in any of them. Over time they found a higher percentage of symptomatic cases (that seems quite surprising but perhaps it reflects changing variants) and a decreasing trend to delay chemotherapy. This might not jive with your expectations from media reports throughout the Pandemic, but seems to be in line with other prior publications describing COVID infection in this particular population.

The SARS-CoV-2 infection in the Pediatric Oncology Population: The Definitive Comprehensive Report of Infectious Diseases Working Group (IDWG) of AIEOP Journal of Infectious Diseases, Nov. 14, 2023

In a previous post I discussed the emergence of a new mutant of Feline Infectious Peritonitis Virus in Cypress. For a quick review, this is a virus found in many cats which is harmless, except in the rare instance where the virus mutates within the cat’s intestine into a lethal but non-infectious form, killing the unlucky kitty. Earlier this year a form of the virus emerged on the island which was both highly lethal and very contagious. This led to the deaths of many thousands of cats (reported numbers vary widely), and a strict quarantine of the island’s felines. Despite the quarantine, the first case of this disease has just been reported in the UK, and the virus is identical to the Cypriot version. What is of great interest is this virus appears to be a recombinant of a canine corona virus with the typical feline corona virus, conferring not only increased lethality but also the ability to spread rapidly between cats. Corona viruses are adept at mutation, variation and recombination, and they are not finished with us or the kitties.

This is the editorial section, designed to ease you into a post turkey tryptophan coma. In my last post I alluded to cracks in the Woke World, and in the spirit of trying to back up my conclusions with facts here are some recent observations. This week SNL, which hasn’t been remotely funny for several years (I could be wrong about that since I gave up watching) had a skit with Jason Momoa poking fun at men competing in women’s sports. To begin with—how daring of SNL to allow this concentrated bundle of toxic masculinity to host for the second time, and in an unapologetic take down of one of Wokedom’s cherished endeavors. This just happens to fortuitously coincide with news of a biologic male braking a long standing female swimming record at a New Jersey college. I’m sure women across the country must be celebrating this feat.

Next up is one of my personal favorites, illustrating how recently Woke sacred cows are coming to slaughter. From very early on in the Pandemic I argued that prolonged school closures were criminal, and destined to have enduring malignant results, particularly impacting poor and disadvantaged children. Now from the NYT (the former news agency which told you over and over that people demanding the opening of schools just wanted “to kill grandma”), comes the following.

New York Times: In the thick of the Covid-19 pandemic, Congress sent $190 billion in aid to schools, stipulating that 20 percent of the funds had to be used for reversing learning setbacks. At the time, educators knew that the impact on how children learn would be significant, but the extent was not yet known. The evidence is now in, and it is startling. The school closures that took 50 million children out of classrooms at the start of the pandemic may prove to be the most damaging disruption in the history of American education. It also set student progress in math and reading back by two decades and widened the achievement gap that separates poor and wealthy children (New York Times) 

Moving on in the demise of Wokism I present Cardi B (who despite my living in a cave and having minimal exposure to the outside world, I recognize as an influential Hip Hop artist) presenting a long excoriation of NYC having to spend so much on illegal migrants that the city is forced to reduce education funds by a billion dollars, and reduce police roles to below the lowest level since 1980, in the midst of a crime wave. She chastises our federal government for supporting two wars (I don’t happen to agree there), and for failing to prevent the consequences of an open border with respect to the inevitable further decline in education and public safety. Who knew Woke would be attacked from the most unlikely directions?

Next up is Mayor Adams of NY speaking at a synagogue and delivering an incredibly moving anthem in support of Jews and the state of Israel. A heartfelt delivery with no back pedaling or equivocation, as we hear from so many politicians, and a challenge to Muslims to separate in their minds Islam from the despicable terrorists who seem to have co-opted it.

Have a relaxing Thanksgiving and spend a few microseconds reflecting on all that is right in the world. Then tuck into the turkey and pie. Don’t hesitate to hit the like button; hundreds of turkeys will be pardoned, the Iranian Mullahs will develop a passion for golf instead of Jihad, and there will be a fantastic sequel to the Barbie movie entitled Barbie Does Washington.