Before we get started I need to fill you in on the last month and why you have not seen an update lately. It turns out our old friend, the CDC NWSS has been giving our group at the WHN fits. One problem is that it lags the current variant proportion analysis by 2 or more weeks. The variant proportion analysis for all 10 regions also has a similar lag. So the MAPS forecast, which depends on regional information, has been in limbo. I am doing my best to overcome these issues and will have my best attempt out this weekend.
In the meantime, there have also been other distractions, like this one below.
Her name is Rose. She does not like it when I work on the computer. Probably the last puppy I will have and she has brought me a lot of joy. Oh, and I have this other new distraction. I never thought I would own one of these, it speaks to my age. It is awesome!
As you can see I have been rather busy, but there is one more thing that we have been working on at the WHN that is extremely important for you to read and distribute widely, a PSA. It has gone viral so you might have seen it. Here is a little snippet.
OK, I also had the pleasure of interviewing one of the co-founders of WHN and the founder of the New England Complex Systems Institute (https://necsi.edu/). We have had over 20,000 views! One of the most intelligent, compassionate, and empathetic humans I know. If you listen to this I would not be surprised if you rushed over to the WHN and signed up to volunteer. It is designed to utilize your personal abilities, whatever they may be.
The WHN has posted a new interview you might be interested in. Dr. Eric Fiegl-Ding is another human I hold with the utmost respect and admiration.
I also was interviewed by the Matt McNeil show. You can hear about H5N1, Covid, and MPOXV.
As fall comes and Rose ages, I will be settling back into my normal pattern again. Thanks for your patience.
This is the first installment of the Dr. Joffe-inspired “Daily Feed of Brain Damage.” During this and subsequent, I will be detailing the effects of Sars-CoV-2 on the brain, which is one of the most important aspects of what we refer to as Long Covid (LC) or Postacute Sequelae of SARS-CoV-2 (PASC) Infection. It is becoming clear that the current variants are very efficient in targeting the brain relative to other variants. First, you need to understand the basic manifestations. The paper listed above does just that in the form of a comprehensive review and meta-analysis. My intention here is to merely give you a background on the neuro implications of even a mild infection. In the future I will also add a paper that Drs. David Joffe and Andrew Ewing were the main authors on that goes into general Long Covid titled “Long COVID Clinical Evaluation, Research and Impact on Society: A Global Expert Consensus”.
Let’s begin with the stated purpose and methodology of the review.
Introduction: The aim of this systematic review and meta-analysis was to evaluate the prevalence of thirteen neurological manifestations in people affected by COVID-19 during the acute phase and at 3, 6, 9 and 12-month follow-up time points.
….
Methods: A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [15]. The study was registered in the PROSPERO database (CRD42022325505). All study authors reviewed the study protocol and gave their feedback prior to its registration.
There are plenty of details on the methods in the paper.
…
Results: Among 6,565 screened articles, 132 fulfilled the eligibility criteria, reporting on 126 unique studies (Fig. 1). Online supplementary Table 2 reports the reasons for exclusion during the full-text screening. No additional paper was manually identified from the reference list of the retrieved studies. The included papers are listed in the online supplementary Table 3. Forty-six countries from all continents except Antarctica were represented (Fig. 2 and online suppl. Table 4). Most of the reports came from Italy, the USA, Spain and the UK (online suppl. Table 4).
Now here is the kick, talk about an “N”!
The total study population included 1,542,300 cases. Thirty-two studies included both cases (n = 1,499,263) and controls (n = 15,039,056), and 94 studies included cases only (n = 43,037). The number of included cases per study ranged from 5 to 735,870
Here is all the what they sorted through at various points in time.
I think you have an idea of the robustness of this paper. Check out Table 2 which characterizes the included studies. So let’s look at some more results.
Think there is a strong indication of neurological manifestions! The pre-COVID19 numbers (grey) are small in the 13 characterizations listed. Firstly a quick side note.
Other disorders such as neuromuscular disorders, encephalopathy, cerebrovascular disorders, and seizures, which occurred with high prevalence during the acute phase of COVID-19, portrayed more fluctuating trajectories with wide confidence intervals at each follow-up time point (Fig. 3, 4). Complete information about the pooled prevalences over time for each of the neurological disorders is available in the online supplementary Tables 5–10. Overall, reported prevalences varied greatly across neurological disorders and time points, which needs to be taken into consideration when interpreting the results and their trends as depicted in Figures 3 and 4. In addition, variability/heterogeneity measures and the large confidence intervals indicate significant heterogeneity for each neurological manifestation at each follow-up (online suppl. Tables 5–10). Furthermore, we were unable to perform analyses according to age groups and sex, as disaggregated information was largely missing.
We conducted further analyses of hospitalised versus non-hospitalised people suffering from COVID-19 (online suppl. Table 11). Fifty-four studies reported on hospitalised individuals only, 24 on non-hospitalised individuals only, 28 included mixed populations, and in 20 studies, it was unknown whether subjects were hospitalised or not (Table 2). For our analysis, we referred to the 54 studies with hospitalised and 24 studies with non-hospitalised individuals, which included 131,520 and 8,702 individuals, respectively. Prevalences were significantly higher in non-hospitalised subjects for the following manifestations: sleep disorders in the preCOVID-19 phase; headache, fatigue, anosmia/hyposmia, and sleep disorders in the acute phase of COVID-19; dysautonomia at 3-month follow-up; cognitive impairment at 6-month follow-up; neuromuscular disorders at 9-month follow-up; and anosmia/hyposmia at 12-month follow-up. Only the prevalence of sleep disorders at 9-month follow-up was higher in hospitalised subjects (online suppl. Table 11)
So let’s turn our attention to the all-important discussion. You will first notice the acute phase numbers, larger in all 13 categories except dysautonomia. Dysautonomia is a condition in which the autonomic nervous system (ANS) does not perform within normal parameters. Think of what you take for granted as functioning normally, like your heart and many other organs.
You will also notice that the LC takes time to rear its ugly head. It is not like after the acute phase a switch flips and you have LC. You can see a clear progression over time and it becomes the most prevalent after 9 months. I have known many sufferers since early in the pandemic and it still surprises them with new symptoms and more frequent manifestations.
The authors Conclusion sums up many aspects we need to address in the future.
Conclusion
Despite the above limitations, the results from our study appear to be in line with recent large-scale studies with comparable study design; neurological manifestations seem to be highly prevalent after the acute phase of COVID-19. The neurological disorders with the highest overall prevalences were fatigue, cognitive impairment, sleep disorders, anosmia/hyposmia, and headache. The prevalence of sleep disorders and cognitive impairment even increased after the acute phase, while other neurological manifestations tended to decrease over time. In our study, prevalences appeared to be lowest at the end of the data collection period, suggesting that neurological manifestations in the early post-COVID-19 phase may be long-lasting but not permanent. However, this needs to be interpreted in light of fewer studies and, hence, fewer included individuals at the 12-month follow-up time point. More robust data at later follow-up time points are needed to elucidate the long-term trajectory of neurological disorders after the acute phase of COVID-19.
I urge you to read the entire text in detail. It is important that you understand that the longer we continue to treat COVID-19 as the flu, endemic, or whatever the hell want to minimize it as millions worldwide are being infected daily. Think of how many are showing neurological manifestations of LC daily and you quickly realize this is not sustainable. I will have plenty more on this and related topics in upcoming newsletters.
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. My best guess beyond that is that we will see recombinants emerge, the most recent being XEC. There is also LF.7 to keep your eye on. Although early calculations indicate it has a significant growth advantage over KS.3.1.1 the current timing for it to take off might be curtailed by the high number of cases in the last month. There is also LF.7 to keep your eye on.
How many cases in the last month or so one might ask? Let’s take a look at the WHN wastewater page and see what has been occurring. Here is a look at new daily infections since July 1st. The last reliable date for the WHN data is 8-9-2024 currently. The graph indicates we have been around the 1.4 million mark since 7-18 and that the overall number of infections since July 1st is 68 million. A 5-14% Long Covid rate means there are likely 3.4-10.1 million likely Long COVID outcomes. We are seeing is one of those plateaus that has been observed in past variants, for example, BA.5. Without looking at a forecast, and knowing that the days after 8-13 are going to be higher than what is reported it appears likely that we will surpass 1.5 million new infections a day. One could also anticipate a slow drop-off since the transmission rates are so large.
Dr. Michael Hoerger has come out with a new forecast on 9-2-2024. This is his new model with a beautifully designed dashboard. As you can see Mike’s numbers are quite similar and his recent curve and forecast indicate a slow decline of the infections. Keep in mind that there are regions across the country that now trending up (Midwest, Northeast, South) so we could very well see a secondary peak.
Here are some of the new infographics Mike has added. I must admit I better improve my forecast graphics after seeing his page.
I will provide the MAPS forecast in the coming days, and I will integrate it into January. The next substack will also update the MPOXV (it is airborne!) and H5N1 situation.
Stay safe and help those who need it most.
take care,
Joe
Interviews Dr. Michael Hoerger and Dr. David Joffe
I want to hammer on this one more time today. 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.
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)
Thank you. I do not check individual sites like I used to. Too darn busy. The more eyes the better!
Are there many "Novids" left in the world? How many of us are suffering from LONG-COVID and don't realize it...because we are suffering from LONG-COVID! Will IQ and SATs and...productivity suffer? In ten years, what will we have lost? Will we know what we've lost?
And -- what, in the current "shrug" political and economic climate -- can be done about it?
Signed,
a somewhat isolated and always-masking-indoors elderly person with plenty of health problems -- and considerable stress and concern.