Cold Covid - part the nineteenth

All animals are equal, but some are more equal than others.
-- Aldous Huxley

The same view, it turns out, is true of Covid-ο. It's tedious, but spend some time with the graphs the NYT provides us. They're a mother lode of insight. Today's conundrum: Minnesota. Across the USofA, Covid-ο has meant a vertical increase in Covid-19, and Minnesota is a bit different. There are piquant differences with many other states.

- case count hasn't been a rocket launch, combining Covid-δ and Covid-ο starting in mid-December as in many/most of the other (even initial Cold Covid ones) states, but rather a 45-ish degree trudge since the minimum in late July, with a marked retracement at the end of December; that could well be non-reporting.

- a very odd hospitalization by age cohort graph. the other states have displayed a wide gap between the Geezer cohort and the rest. not Minnesota, where the cohorts are, by eye at least, equally separated. compare with New York.

- unlike many other states where deaths have budged only a tad, here they are tracking upwards with cases in nearly lockstep. compare with New York, for instance; completely different universe.

I, for one, wonder what Olsterholm has to say by way of explanation. He's in Minnesota, after all.

Toto, I don't think we're in Kansas anymore.

Cold Covid - part the eighteenth

It's been mentioned a number of times around these here parts that home testing for Covid is a bargain with the Devil. In some ways, an accurate home test makes it easier for Real Libertarian Americans to control their lives without interference from Big Gummint. Which, of course, is horseshit in the case of epidemics.

Even if home tests were 100% accurate and timely, one might argue such would be the worst case scenario, the public health authorities are totally handicapped in managing the pathogen. Without central data collection Covid-ο would never have been identified. All we would know, today, is that hospitalizations are rising, significantly, over the last month.

Finding new mutations, there will continue to be new mutations thanks in no small part to the Rednecks refusing to mitigate and vaccinate, is the only way we get out of this mess. OTOH, if we can rely on Constant Power^©, we may see Covid-19 devolve into the fifth common cold coronavirus. And, by the bye, that coronaviruses are a source of the common cold is a new discovery.

Another possibility is that this "flu" was actually a coronavirus pandemic. The finger has been pointed at a virus first isolated in the 1960s, though today it causes nothing more serious than a common cold. In fact, there are four coronaviruses responsible for an estimated 20 to 30 per cent of colds. Only recently have virologists begun to dig into these seemingly humdrum pathogens and what they have found suggests the viruses have a far more deadly past. Researchers now believe that all four of these viruses began to infect humans in the past few centuries and, when they did, they probably sparked pandemics.

I'll wager that such is the basis for some of the more vocal whackoes yelling that ALL coronaviruses evolve to 'just a cold'. We already know better with Covid-19. We only avoided Covid-β's scourge because Covid-δ and now Covid-ο took up the space.

This blasé attitude evaporated in 2002 when a new member of the coronavirus family began infecting humans. By the time the epidemic of severe acute respiratory syndrome (SARS) was brought under control the following year, the SARS-CoV-1 virus had affected 26 countries and killed one in 10 of the 8000 plus people it infected. The fact that a coronavirus could be so deadly was a wake-up call. A sleepy backwater in the world of virology was suddenly in the spotlight.

Oops. And, by the way, other sources I've read have put share of coronavirus colds as high as 40%; not irrelevant.

[P]eople are less likely to be hospitalised with HKU1 and NL63 than with 229E and OC43, possibly indicating that the former pair have more ancient roots in human populations.

AKA, coronaviruses evolve to transmissibility over lethality and given more time more strongly so, just as Darwin would predict.

Sugar Shack

More than a decade ago my PCP informed me that I was pre-diabetic. Being, for almost all my full-grown life, possessing a BMI around 20.5, which is near dead center of the CDC 'Healthy' designation, I was not happy. But, truth be told, the incident reminded me of two other, somewhat odd events. The first was my PCP back when I was in my mid-20s advised me to cut back on the orange juice. I don't recall whether she mentioned the 'D' word, or just waistline management. The second was, many years later, when my Pappy (a few inches taller, but same build) mentioned in passing (at about the age I am now) that he had 'a touch of the sugar diabetes'. That last bit of redundancy was common parlance to his generation.

A few years later, my doctor decided that the condition was no longer 'pre-', and put me on some medicine. What was somewhat ironic was that Dr. Jones was short and round, a la Danny DeVito at least, while I was back to being StrawMan. Being informed, along with 99.44% of the population, that sugar diabetes is the punishment for overindulgence and obesity, I complained to Dr. Jones, in effect: he is the prototypical diabetic while I was the in-control, exercising, healthy Mr. GoodBody. Not fair!! What the hell happened?

I recall reading up to that time, every now again, that diabetes can be caused by viruses. At the time, none had been implicated. But the notion certainly made sense, given my BMI. Dr. Jones agreed that a viral insult seemed the most likely explanation. That my Pappy and I had attracted D-2, argued for a common environmental attack.

Which brings us to news I just heard on FakeNews: CDC has documented kids infected with Covid-19 have a higher probability of D-2 and D-1!! The latter is a nucular Boy Howdy.

Earlier (in a relative sense) studies have suggested such. One recent report.

Previous studies have linked viruses to diabetes, and recent studies have suggested that enteroviruses could potentially trigger diabetes, although its direct effect in vivo as well as its mechanism of action at the molecular level were unknown. A recent mouse study by researchers at the Spanish National Cancer Research Centre (CNIO) reveals how the enterovirus coxsackievirus type B4 (CVB4) could induce diabetes.

One might wonder whether all those Red Neck Phat Boys would refuse an anti-diabetes vaccine? Still be able to have an RC and a Moon Pie breakfast each and every day, and only have to pay the price of blowing up like the Stay Puft Man.

Cold Covid - part the seventeenth

Well, another professional heard from. And his piece reads like Constant Power^© applies. I certainly feel better, but don't expect a call from the Nobel Committee, as deserved as it may be.

Our models project that the United States is likely to document more Covid-19 cases in January than in any previous month of the pandemic, but a smaller fraction of those cases will require hospitalization. Whether hospitals experience more or less strain than they did in January 2021 will depend on case numbers and how severe they are. For example, if twice as many people become infected but these people are half as likely to be hospitalized, the demand for hospital beds would be the same. This calculus also applies to estimated deaths from the virus, as well as expected disruptions to the work force.

Alas, he doesn't show his work, math/stats behind his conclusions. Suffice to say, he supports the notion that estimating beyond the data is fraught with danger. A few weeks at most. Interesting that he skips the PI/CI differences, and simply analogizes to hurricane path predictions: cone of uncertainty. I like that.

[NOTE: The NYT tells me that I can link to 10 articles/per month without paywall block on you, dear reader. We'll see.]

Cold Covid - part the sixteenth

You had to know it was coming, right?

Covid-19 hospitalizations in the United States have surpassed September's peak during the Delta surge and are quickly approaching the record high from last year, according to data from the US Department of Health and Human Services.

So, Idiot Child Ron Johnson, this is why everybody should get vaccinated. As these missives have said.

And, as expected, kids are getting worse. In fact, from the age cohort graph, the geezers are rising faster than the other cohorts, including kiddies. This is not good. And it's been reported that Covid-ο is peculiar in that it's an upper respiratory infection, which, it turns out, is more problematic to kiddies than adults. Stay tuned.

Will we get past the January, 2021 level of hospitalizations? I'll bet my left gonad. If you look at the full map of the USofA in the NYT, you'll see something instructive: Covid-ο is moving from east to west, so there's a whole lot of country to invade. Despite the stupidity of the Idiot Child Ron Johnson, if you're not vaccinated, and America's Heartland is where most of his fellow Idiots live, you're going to get badly infected. It's just a matter of time. Not much, naturally.

Cold Covid - part the fifteenth

Constant Power^© came to my geezer brain in a flash of obviousness that while ago. What didn't, not being of the medical community, was exactly how the trade-off between virulence and transmissibility is executed. Well, recent news provides a reasonable answer. And it's a Do'h moment. I feel so ashamed.

The reason that Omicron is milder may be a matter of anatomy. Dr. Diamond and his colleagues found that the level of Omicron in the noses of the hamsters was the same as in animals infected with an earlier form of the coronavirus. But Omicron levels in the lungs were one-tenth or less of the level of other variants.

So, not so much in the lungs, thus not so much lung damage. Less virulent, check.

"It's all about what happens in the upper airway for it to transmit, right?" he said. "It's not really what happens down below in the lungs, where the severe disease stuff happens. So you can understand why the virus has evolved in this way."

So, lots more in the upper tract, thus lots more to spew out. More transmissible, check.

Well, on the other hand, another voice heard from:

"These studies address the question about what may happen in the lungs but don't really address the question of transmissibility," said Sara Cherry, a virologist at the Perelman School of Medicine at the University of Pennsylvania.

Woof

Drug development is a crapshoot. Promising compounds in early trials often end up failing later on.

There's that old saw about the kid who goes to school without his homework, and invokes 'the dog ate my homework' excuse. Turns out that sometimes happens in drug development, and every once in a while, it's true. Herein lies a tale.

BridgeBio Pharma is developing a drug for a particular form of heart failure, and the recently released trial results were dismal.

This result is disappointing and baffling. I am, along with many others, searching for answers regarding the 6MWD.
-- Chief Executive Neil Kumar

The drug's name is acoramidis. It happens that BridgeBio Pharma is running behind Pfizer in this indication, which has an approved drug called Tafamidis. Both drugs are of the same class: Transthyretin Stabilizer.

OK, so one drug works and, may be, the other doesn't. But the thing is, both drugs' trials used the same measure for the trial endpoint, a walk distance test. And this is where it gets interesting. Here is a report on the Pfizer trial result. The measure of 'goodness' is the reduction in 'badness' in the test. If you scroll down about halfway, you can see that the placebo arm loses a substantial distance along the time line. There is a clear differentiation between the drug and placebo. It's all good.

So, when BridgeBio Pharma ran its trial, they expected, of course, a similar response in the placebo cohort. And why not? Yet, somehow, the placebo cohort did better than the drug. Huh? As the CEO said, "baffling and disappointing".

The report from the trial was

ATTRibute-CM did not meet its primary endpoint at Month 12. Mean observed six-minute walk distance (6MWD) decline for the acoramidis and placebo arms were 9 meters and 7 meters, respectively. Both declines are similar to healthy elderly adults and less than prior untreated ATTR-CM cohorts.

Now, if we compare the drug's 6MWD at 12 months to the Pfizer drug (eyeballing the graph) which looks to be in the neighborhood of 18 meters, then the BridgeBio Pharma drug should be a winner. But no, that placebo cohort is nowhere near what the Pfizer trial demonstrated, a ~60 meter loss at 12 months. Boy howdy.

The dog ate the homework. The high-level conclusion? The folks designing and running the trial really screwed the pooch seven ways to Sunday.

A year and a half from now, study end, it might all work out. Ya wanna bet?