That’s so easy I could do it with my mouth closed! Read more in And now for something completely different …
MAPS
KP.3.1.1 is the dominant U.S. and global variant. This variant and subsequent clade members will continue to dominate over the next few months. Here is the most recent update of variant proportions.
Here is the one from 2 weeks ago.
The latest MAPS forecast which uses the 8-31 proportions for initialization shows a disturbing outlook. Instead of dropping down to a case level of less than 500,000 new daily infections, it indicates it will hover around 750,000 or greater! You also see the familiar rise at the end of the year.
Dr. Michael Hoerger has come out with a new forecast on 9-9-2024. I repeat, this is his new model with a beautifully designed dashboard. As you can see Mike’s numbers indicate a slow decline of the infections to just under 1 million new daily infections, quite similar to MAPS.
This weekend, I will be doing a new forecast based on the newest wastewater and variant proportions. In addition I will include a masking study that demonstrates the utility of the best mitigation tool we have, masks.
Daily Feed of Brain Damage Part II
Here is the study we will examine today, titled “Comprehensive clinical assessment identifies specific neurocognitive deficits in working-age patients with long-COVID”.
In this paper the authors examine 205 (39 years old) working-age patients by performing assessments of “symptoms, WHO performance status, cognitive testing, CPET, lung function, high-resolution CT chest, CT pulmonary angiogram, and cardiac MRI) of previously well, working-age adults in full-time employment was conducted to identify physical and neurocognitive deficits in those with severe or prolonged COVID-19 illness”.
Note that this is a 6-month follow-up and remember the study I posted in the last newsletter. We saw there that by 6 months the Long Covid criteria were beginning to show up clearly, although at 9 months it was even more strong of a signal in the results.
This table summarizes the criteria they employed. #3 and #4 are particularly concerning, given these are criteria most of us would have little problem avoiding.
However, they are not done with testing, further demonstrating the robust nature of their research. You don’t have to read through this or understand the precise meaning of this, I merely add this to demonstrate this is not something many will think the doctors, or even patients for that matter, are making up. This is an excellent study and I hope you pass it on to your doctor(s).
Patient symptoms and cognitive testing
All participants reported their acute and ongoing symptoms. Symptoms were recorded (present/absent) according to a pre-determined list of 37 symptoms. Standardised questionnaireswere completed for breathlessness (modified BORG, 0–10 breathlessness scale); fatigue(fatigue assessment scale, FAS) [15,16]; anxiety (generalised anxiety disorder-7, GAD-7) [17], depression (patient health questionnaire 9, PHQ-9) [18], post-traumatic stress (posttraumatic stress disorder check list for DSM 5, PCL-5) [19] and alcohol consumption (alcohol audit) [20]. Population appropriate thresholds were employed for each questionnaire tool. For the FAS, >21 has been suggested as a threshold for ‘substantial fatigue’ [21] and >34 for ‘extreme fatigue’ [22]. The GAD-7 is a widely used screening tool for anxiety with a cut-off score of 10 identified to consider diagnosis based on a criterion standard study compared to independent mental health professional diagnosis [17]. The PHQ-9 is a commonly used screening tool for depression with a frequently used cut-off of 10 points to consider the diagnosis. Bivariate meta-analysis of 18 validation studies identified cut-off scores between 8–11 as optimal for detecting major depressive disorder [18]. Signal detection analysis comparing the PCL-5 to the gold standard clinician administered PTSD scale indicated a score of 31–33 as an optimal cut-off for the diagnosis of PTSD in an US veteran population [19]. The EQ5D quality of life instrument was used to measure subjective wellbeing. This tool uses a visual analogue scale (0–100), similar to a thermometer, to record the participant responses [23,24]. Cognitive testing was undertaken using the National Institute of Health (NIH) cognition battery of the NIH Toolbox of Neurological and Behavioural Function (NIH-TB) which has been well-validated for this purpose [13]. A score more than 1.5 standard deviations below the mean was taken to represent a clinically significant deficit [25]. Cognition, which is one of four batteries, includes measures which map to several cognitive dimensions including executive function, episodic memory, language, processing speed, working memory and attention. Cognitive testing was supervised by trained personnel with neurological and psychology oversight and review of results. Testing was undertaken in a controlled environment. The output scores of cognitive testing permit the separation of cognitive performance into the ‘fluid composite’, which is recognised to be vulnerable to aging and biological insult and the ‘crystallised composite’ which is relatively preserved in the face of systemic disturbance and over the course of life [14]. In brief, the fluid component of cognition tends to deal with our current ability to react to, reason and deal with complex information whilst the crystallised component represents learning and knowledge acquired through life. The cognitive battery utilises a computeradaptive testing paradigm allowing a comprehensive assessment to be completed rapidly. The ordering of the testing disseminates tests mapping to both the above composite scores throughout the test period, thus participants are effectively blinded to the output. This allows objective determination of the fluid and crystallised scores.
Here is a summary of the results they present. I encourage you to examine Tables 3-6 in the text, the numbers should give you pause when someone says “It ain’t real, it is just made up”. I get rather assertive if I hear someone say that!
205 consecutive patients, age 39 (IQR30.0–46.7) years, 84% male, were assessed 24 (IQR17.1–34.0) weeks after acute illness. 69% reported �3 ongoing symptoms. Shortness of breath (61%), fatigue (54%) and cognitive problems (47%) were the most frequent symptoms, 17% met criteria for anxiety and 24% depression. 67% remained below pre-COVID performance status at 24 weeks. One third of lung function tests were abnormal, (reduced lung volume and transfer factor, and obstructive spirometry). HRCT lung was clinically indicated in <50% of patients, with COVID-associated pathology found in 25% of these. In all but three HRCTs, changes were graded ‘mild’. There was an extremely low incidence of pulmonary thromboembolic disease or significant cardiac pathology. A specific, focal cognitive deficit was identified in those with ongoing symptoms of fatigue, poor concentration, poor memory, low mood, and anxiety. This was notably more common in patients managed in the community during their acute illness.
Here are a couple of Figures that provide a summary of many of the numbers and show the differences between hospitalized and community patients rather starkly.
The authors reach the following conclusions.
Discussion
Despite low rates of residual cardiopulmonary pathology in this young active cohort, with very low rates of premorbid illness, a high burden of symptoms remained and a large proportion had not recovered pre-COVID function when assessed 6-months after acute illness. One third had not returned to their pre-COVID functional status (physician rated WHO performance status) and only one in five self-rated as ‘fully fit’. This persistent impairment disproportionately impacted those managed in the community. These functional limitations were similar to a comparable UK post-hospital cohort (PHOSP-COVID) of ~1,000 middle aged UK citizens (mean age 58, 36% female, 2/3 working at the time of acute illness) at 5.9 months post hospital discharge. In this group only 29% of patients felt fully-recovered. In our study, systematic cognitive assessment identified specific deficits, which appear to contribute significantly to the symptomatology of long-COVID.
Six months after acute COVID-19 illness, despite a low frequency of cardiopulmonary pathology, a young, comparatively fit cohort, in full-time employment, continue to experience high rates of persistent symptoms; demonstrable cognitive impairment, akin to ageing by ten years, and the majority have not regained their pre-COVID function.
The authors have a long discussion about strengths and weaknesses, and I encourage you to read it. I must ask. Are you getting a better idea about Long COVID now? There are many aspects to it and we will have many more installments of Dr. Joffe’s “Daily Feed of Brain Damage”. I thank him for putting together an amazing collection of articles to read.
Remember the PSA I published in the last newsletter? Here is a new 1 pager for you to distribute.
And now for something completely different ….
This is awesome. My first thought was the disabled. Totally exciting!
Recent technological advances have enabled the development of a wide range of electronic devices designed to improve people's quality of life and assist them in completing their everyday activities. Most existing devices are operated via touch screens, keyboards, mouse pads and other hand-based interfaces.
Researchers at the National University of Singapore have developed a smart mouthguard that could allow people to operate their devices using their mouth, instead of their fingers. This new device, introduced in a paper in Nature Electronics, could also allow dentists to collect medical data from inside their patients' mouths and help to monitor the recovery of athletes or enhance their performance.
"Our paper was inspired by the need to develop more intuitive and accessible assistive technologies for individuals with restricted mobility," Xiogang Liu, supervising author of the paper, told Tech Xplore.
"Conventional input devices, such as touchscreens or voice recognition, are often challenging in certain environments or for users with limited hand function. Our goal was to develop a more flexible, user-friendly interface that can be operated using the tongue and teeth, which are capable of precise and fatigue-free movements."
The smart mouthguard they designed is equipped with soft and yet sensitive sensors. These sensors allow users to tackle various tasks, including typing, gaming and wheelchair navigation, via movements of their tongue and teeth, instead of tapping or sliding their fingers on a touch screen.
"The wearable tactile oral pad we developed functions similarly to a touchscreen (e.g., i-Pad) but can be controlled by tongue movements and teeth biting," explained Liu.
"It consists of a carbon nanotube-silicone composite sensor array embedded in a flexible, biocompatible pad that fits inside the mouth. When the tongue slides across the pad, it mimics the movements of finger swipes on a touchscreen, and when the teeth bite down on the pad, it acts like a mouse click."
The wearable device developed by the researchers detects swiping tongue movements and pressure applied by the teeth via an array of sensors. The device is also lightweight, flexible and cost-effective, which could facilitate its commercialization and real-world deployment.
The new smart mouthguard
How cool is that!
You might like this too.
Stay safe and help those who need it most.
take care,
Joe
FYI’s:
SARS-CoV-2 is a vascular virus, not just a respiratory virus. To make it simpler for folks call it a whole-body virus. No organ is spared. It infects our entire body and creates reservoirs throughout and should be thought of as a Long Covid virus and will exploit pre-existing risk factors.
Interviews Dr. Michael Hoerger, Dr. David Joffe, and Dr. Yaneer Bar-Yam.
Check out this article. I love this article, an easy read but it stimulates the brain in many ways.
Viruses Finally Reveal Their Complex Social Life - Quanta Magazine
Where do viruses hide in the human body? | The BMJ
Understanding immunity and viruses through the John Snow Project
Variant tracking at the CDC
Infections at WHN (updated!)
The neuroinvasiveness, neurotropism, and neurovirulence of SARS-CoV-2: Trends in Neurosciences (cell.com)
Yes, it is our only choice. We (at the WHN that works with it) have spent months cleaning up the data and going back to the first year to get the correct conversion to infections. I have the ability to go back to deaths and hospitalization to derive them but that data is no longer specific enough and asymptomatic rates have skyrocketed. We are in the process of getting the raw wastewater data converted on a state by state basis which will improve the forecast. Remember I also use the CDC wastewater variant proportions to initialize the variants. I used to use it on a regional basis (10 regions) for initialization but the regional analysis lags by about a month unfortunately.
Interesting...Covid positive cases spiking in HHS Region 2 consistent with wastewater spike in the northeast. Maybe noise...but interesting.