Good morning. It’s Thursday, September 10. Once again we’re doing things a little later this morning. I wrote last week I thought I’d have plenty of time on my hands here in Evanston, but I underestimated how much time it would take me to unpack and set up my room, so between a busy day yesterday and the one-hour time change, you’re getting this a couple hours later than normal. I promise to keep this issue shorter (unlike my failed attempt last week).
The weather has been unseasonably cool here, with temperatures this week in the mid-60s, making it seem less like the second week of September and more like the second week of May. But after receiving my negative COVID test result — with an impressive turnaround time of roughly 31 hours — I’m looking forward to playing my first round of golf since returning to Evanston.
You’ll likely be seeing a variation of this picture in the future (with better quality), as the view of Lake Michigan and the Chicago skyline is the money shot from campus.
Trends
Look at that shade of blue! How about that?! For the first time since June 7, the national percent positivity rate for all tests run is under five percent. And while case positivity isn’t everything, it is an indicator of community spread and how much testing we’re doing. As you can see, a pretty steep drop in daily positive cases accompanies a decrease in daily testing, which supports the notion that the intensity of the US epidemic continues to fall.
Hospitalizations in another week could approach their lowest levels since early June, before cases spiked again, while we had an unusually solid week of death trends. As of yesterday, the seven-day rolling average of daily deaths was 730 compared to 859 one week ago. While a trend line like that of this week might be too much to expect going forward, deaths should decline as hospitalizations do the same and if (that’s a big if) daily positive cases don’t shoot up. Even so, you can compare the death curves and see the markedly lower in-hospital fatality rates since hospitals nationwide reported virtually the same number of patients at the peaks.
With many of the recent hotspot states now on the right side of their epidemic curves and fewer people getting sick, testing demand has plummeted. This is good if looking through the lens of fewer people feel ill and understanding the virus has ran its course, but it still points to the need that the United States needs to be mass screening asymptomatic individuals with daily, cheap, rapid antigen tests to resume many facets of society.
Visualize more: COVID-19: See Your State
First positive news on long-haulers
One of the things that emerged this COVID summer was people experiencing long-term symptoms after “recovering” from the novel coronavirus, known as Long COVID. Of course, this is a novel virus and disease, and so like with many other things during this pandemic, sometimes patience is paramount, as annoying as that can be. Science doesn’t speed up for social media, as much as we want it to.
So the point about Long COVID is that we just don’t know exactly how long-term these effects are since it’s too early to declare what “long-term” means. This disease has hardly been around for seven to eight months (en masse, at least). But hardly has any research around long-haulers been positive. Until now, that is.
New research presented to the European Respiratory Society International Congress shows the first signs of improvement and hope for people suffering from symptoms well after their body clears the virus. In a study run out of a hard-hit Austrian town, over 150 formerly hospitalized patients are participating in a study to evaluate their post-discharge states.
Patients returned for evaluation six, 12 and 24 weeks after discharge from hospital. During these visits, researchers performed several tests, including clinical examinations, laboratory tests, analysis of the amounts of oxygen and carbon dioxide in arterial blood, lung function tests, computed tomography (CT) scans and echocardiograms. They found some encouraging if preliminary results. It’s too early to have results from 24-week evaluations, but the percent of patients still showing lung damage on CT scans decreased from 88 percent at their first visit to 56 percent at the next visit.
“The good news is that the impairment tends to ameliorate over time, which suggests the lungs have a mechanism for repairing themselves," said Dr Sabina Sahanic, clinical PhD student at the University Clinic in Innsbruck, part of the team that carried out the study
The research also found that undergoing pulmonary rehabilitation early in their recovery process was associated with improvements in lung capacity, balance, muscle strength, fatigue and certain risk factors of depression and anxiety.
It’s important to note the average age of the patients for whom there is data is 61, and 65 percent of them are overweight or obese. Nevertheless, the point still holds that we’ve got to just continue studying the body and its many responses to COVID-19 so we can better understand what we’re dealing with. As much has been written about the way SARS-CoV-2 tricks our immune system and turns it against itself, the human body is a pretty miraculous thing, and it’s able to recover from a lot.
We’re back to Vitamin D
One of the first studies I featured in PATP back in May was one from Northwestern researchers showing the association of vitamin D levels with mortality in COVID patients. It said those with severe deficiency are twice as likely to experience severe complications, including death. While things cooled off on that front, scientists recently published some interesting research on vitamin D relating to the risk of being infected with the coronavirus.
A University of Chicago retrospective cohort study of 489 patients who had a vitamin D level measured in the year before COVID-19 testing found people with likely deficient vitamin D levels had a relative risk of testing positive for COVID-19 1.77 times greater compared with patients with likely sufficient vitamin D status, which is statistically significant.
Of course, anyone with a baseline knowledge in statistics knows correlation doesn’t equal causation, and the authors acknowledge the need for a randomized trial to determine if vitamin D affects one’s risk for contracting COVID-19.
To add to the evidence, an Israeli study studied over 52,000 infected patients with over 524,000 controls to evaluate the relationship between vitamin D levels and testing positive for SARS-CoV-2. They found a “highly significant correlation between prevalence of vitamin D deficiency and Covid-19 incidence” with the highest risk of COVID-19 observed for severe vitamin D deficiency. Interestingly, the research also noted a “significant protective effect was observed for members who acquired liquid vitamin D formulations (drops) in the last 4 months.”
I’m no doctor, and this newsletter doesn’t purport to give medical advice, but I’m taking my daily vitamin D, and it doesn’t seem like it can hurt. I’m fascinated to see what further research reveals on this relationship.
Read more: Vitamin D deficiency may raise risk of getting COVID-19
Quick hits
Nanobodies (human and animal)!
Scientists just love to develop potential therapies from recovered patients, whether those are people or animals. We met Winter the llama back in May, and now researchers are focused on her cousin the alpaca. A paper published last week showed an alpaca-derived antibody fragment neutralizes the spike protein of a SARS-CoV-2 pseudovirus as a nanobody, which the authors said could become a promising candidate as a COVID intervention. The treatment, which specifically targets the receptor binding domain (RBD) of the SARS-CoV-2 spike and directly prevents ACE2 engagement, has the characteristics to be manufactured at scale.
Meanwhile, another research team has created synthetic peptide called SARS-BLOCK™. It’s an antidote designed to combine the benefits of a therapeutic and vaccine, with the characteristics of a prophylactic and reactive antiviral.
In the lab, it completely inhibited the aforementioned spike protein RBD from binding to the ACE2 receptor. Someone associated with the development of the product said they’re currently working with the National Institutes of Health and intend to apply for an Emergency Use Authorization as a treatment with the hopes of use starting in the first quarter of 2021.
Pharma to the safety rescue?
Amidst the pretty obvious political pressure being applied by the Trump administration to produce a vaccine before Election Day, there’s concern the president will try to shepherd a vaccine through the FDA before enough safety and efficacy data is recorded. But in a twist of fate, nine drugmakers sought to restore public trust in their vaccines, guaranteeing a through review of large, quality clinical trials before bringing any inoculation to market.
It’s a welcome sight considering our best shot at ending this pandemic has been toyed with as a political ploy. And, after all, pharmaceutical companies want people to get their vaccines, otherwise it’s no good for them either. The recent AstraZeneca trial stoppage for an adverse event — which may be completely unrelated to the vaccine — shows the necessity to go through the normal safety protocols and not issue a premature approval.
The youth
See Scott’s tweet below. A DC hospital study found no difference in hospitalization rates, intensive care unit admission rates, and mechanical ventilator use between children with COVID-19 and children with the A & B strains of the flu.
That’s all for me today. Have a great weekend, and I’ll see you next week. Who knows what we’ll have learned by then.
Once again, I appreciate your reading Positivity Amid the Pandemic. Have questions, comments and/or suggestions for me? Want to send me something to include in a future issue? Send me an email at EKarp@u.northwestern.edu or DM me on Twitter @karp_eli.
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