geoffrey modest medical blogs

Just when you thought that Covid was over (and blogs on covid would stop):   Older adults with a prior Omicron infection may have an increased likelihood of reinfection, more than those without a prior infection (see covid omicron infection in elderly assoc with inc risk of reinfection Lancet2023 in dropbox, or https://doi.org/10.1016/j.eclinm.2023.102148   Details: -- 750 vaccinated residents of long-term care and retirement homes in the observational cohort COVID In Longer-Term Care Study in Ontario, Canada. The observation period for this study was from July to September 2022     -- patients were in 27 long-term care and retirement homes in Ontario -- median age 87, 64% female, 57% in long-term care residence -- all received 4 mRNA monovalent vaccines (36% had only mRNA-1273, 18% had only BNT162b2, and 46% a mixture), none received a bivalent vaccine; time since 4th vaccination was mean of 138 days, 60% living in residence with <6 outbreaks, clinical frailty sc...

  i think that most of us are suffering from covid fatigue, including myself.  but after 257 (!!!) blogs on covid, i will indulge yet another time or 2, given a couple of important articles on long covid: this one a large meta-analysis of many smaller studies, helping to clarify the sometimes conflicting conclusions about risk factors for long covid. The next blog later this week will review studies showing significant long-term pathological organ impairment by SARS-CoV-2 virus. For the current article , see  covid risk factors for long covid JAMA2023  in dropbox, or  doi:10.1001/jamainternmed.2023.0750       Details :   -- 41 articles were found documenting predictors of long covid (they used the WHO term: post-covid condition, PCC), in individuals at least 18yo       -- 30 were rated as “high quality” and 11 as ”moderate quality”       -- 860,783 patients were included   -- all studie...

  A recent lab study found that the antiviral agent molnupiravir seems to be effective against the newest omicron subvariants (BQ.1.1 and XBB): see  covid omicron molnupravir effective NEJM2022  in dropbox, or DOI: 10.1056/NEJMc2214302 Background : -- there have been 3 sublineages of the initial omicron variant (B.1.1.529): BA.1, BA.2, and BA.5 (see second graph below)     -- the current ones that are the circulating the most in the US (and much of the world): BQ.1.1 (a subvariant of BA.5) and XBB (a BA.2 subvariant) and now on its ascendency     -- in fact, a recent article indicates XBB is becoming the dominant variant (and is already so in the Northeast), along with its own subsubvariants XBB.1 and XBB.1.5:  https://edition. pagesuite.com/popovers/ dynamic_article_popover.aspx? artguid=458fe1fe-e157-4442- aa54-105c127b7904  from the Boston Globe -- these variants have large numbers of important substitutions in the rece...