geoffrey modest medical blogs

A prepublication and pre-peer reviewed article found that rhinovirus infection in asthmatics increased ACE2 levels (see  covid rhinovirus in asthmatics inc ACE2 amjrespcritcaremed2020  in dropbox, or  https://www.atsjournals.org/doi/pdf/10.1164/rccm.202004-1343LE )   Details: -- 22 asthmatic patients were evaluated in the initial cohort, with 8 more in a validation cohort. Each had nasal biopsies, subsequently used in tissue culture with interventions as below (ie, this was basically a lab study)   Results: -- 2 common rhinovirus infections (RV-A16 and RV-C15) inoculated onto the tissue samples resulted in a >3-fold increase in ACE2 expression in both the initial and validation cohorts -- rhinovirus was associated with increased ACE2 overexpression, which was associated with increased production of genes leading to high levels of many cytokines associated with severe    infection (IL-1, IL-2, IL-6, IL-8, IL-10, TNF, and interferon-gamma) -- ACE2 levels were also increased after expo

A recent vaccine efficacy trial in nonhuman primates found an impressive immunologic and protective benefit (see  covid vaccine mRNA primates nejm2020  in dropbox, or DOI: 10.1056/NEJMoa2024671)    Details :  -- 12 male and 12 female Indian-origin rhesus macaques, vaccinated with either 10 µg   or 100µg of mRNA-1273 vaccine or placebo, at week 0 and at week 4  -- all animals were then challenged with 7.6×10 5  plaque forming units of SARS-CoV-2 virus (a typical number found in infected people), with a combination of intratracheal and intranasal inoculations with the virus -- PCR was used to quantify viral RNA, and a subgenomic RNA was used to quantify replicating RNA in bronchoalveolar lavage (BAL) fluid and nasal swab specimens  -- histopathology was also done on lung tissue specimens    Results  (will give broader results, not the detailed immunologic changes; see the article for those details):  -- neutralizing antibody levels from the vaccine, expressed as the live-virus reciprocal

David Leonhardt had a truly frightening editorial in the NY Times today revealing the many ways that the right-wing press has undercut a consistent public health message about SARS-CoV-2, showing that the major right-wing news outlets (which, unfortunately, are the sole source of information for many people) are legitimizing lots of conspiracy theories and clearly false information, eg: a doctor interview stating that Fauci created the coronavirus from monkey cells, that doctors claim that masks are unnecessary and hydroxychloroquine is the answer, that social media is being used to publicize these claims, etc.  And these are the basic news sources for our current (and hopefully time-limited) leaders....  see  https://messaging-custom-newsletters.nytimes.com/template/oakv2?campaign_id=9&emc=edit_nn_20200729&instance_id=20734&nl=the-morning&productCode=NN&regi_id=96969620&segment_id=34620&te=1&uri=nyt%3A%2F%2Fnewsletter%2Faaa04a0f-6239-5aca-8a42-4c2e3bf64

The CDC reported a telephone survey of 292 outpatients with mildly symptomatic Covid-19 documented by PCR, finding that 35% had NOT returned to their prior state of health 2-3 weeks later (see  https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm?s_cid=mm6930e1_w#contribAff ).  Details: --292 patients, from 14 predominantly urban academic health systems in 13 states --274 (94%) reported at least one symptom at the time of testing, with symptom prevalence:       --fatigue 71%       --cough 61%       --headache 61%  --underlying medical conditions: hypertension 64 (22%), obesity 51 (17%), psychiatric condition 49 (17%), asthma 36 (12%), diabetes 16 (5%), rest <10 people  --study done from April 15-June 25  --median telephone interview: 16 days from testing date    Results:  --those returning to their usual state of health did so a median of 7 days after date of testing  --not returning to usual state of health, by age:       --age 18-34: 26%       --age 35-49: 32%       --age >49: 4