#including asymptomatic cases

[britcision]

Meanwhile, in Ontario the government not only ended our safety measures, they are actively underfunding healthcare by billions of dollars

(Which are instead going to a highway no one wants, or just sitting in a “surplus”)

To the extent that emergency rooms are being permanently closed and half of them can’t afford an MRI machine

Nothing can possibly go wrong

does anyone else think it’s crazy how we just casually reference “the pandemic” now. i catch someone in conversation saying “during the first quarantine…” and as comfortable as it feels to hear and say now, there’s still a twinge of like…. i cannot believe we’re using these words in real life in reference to real events. this isn’t a scifi movie this isn’t a young adult post apocalyptic novel we’re literally casually discussing a global pandemic that ravaged the entire world and it was REAL ?

[icewindandboringhorror]

A very interesting cloud formation!

[kira-akira]

What I Want You To Know About Long COVID

Well lads, I've been suffering from Long COVID for over a year now. My life is at a complete standstill. I'm 25 years old and I'm too sick to go back to school, I can't work, I had to move back in with my parents and I'm still stuck here.

Here are just a few things I wish people knew about Long COVID, including things I didn't know myself until I got it.

COVID destroys your immune system. Yes, even if you don't have Long COVID. Are you getting sick more often now? When you get sick, does it last longer? There are many studies showing that COVID causes t cell depletion, even in mild COVID cases! T cells are how your body remembers how to fight off infections you've had before so losing those cells? Bad news.

Your initial infection can be mild and you can still get Long COVID. Right from Yale Medicine, "Most people with Long COVID had mild acute COVID." (This is also a good link for a basic Long COVID overview).

There can be a gap of time between when you "get better" from the initial COVID infection to the onset of Long COVID symptoms. Some people get sick with an initial COVID infection and never get better. Some get better and then weeks or months later start developing Long COVID symptoms. Long COVID symptoms can even fluctuate over time, can go away for months and then suddenly come back.

So many people have Long COVID and don't realize it. Do you feel more tired lately but no matter how much you sleep, nothing helps? Is it harder to concentrate at work or school? Can you just not think like you used to? You could have Long COVID and not even know it. Even mild post-COVID symptoms are still Long COVID.

COVID can do anything to your body. Long COVID has over 200 recognized symptoms and can affect basically any part or system of your body. There is no one mechanism or cause of Long COVID which unfortunately also means there's no one cure either.

The effects of COVID are cumulative. Each COVID reinfection increases your chances of developing Long COVID. COVID is also affecting your body in other ways, yes, even if you're otherwise young and healthy! "Repeat COVID-19 infections increase risk of organ failure, death".

Once you have Long COVID, repeat COVID infections will make your symptoms worse. "80% [of Long COVID patients] saw their symptoms worsen [from reinfection]. In 60% of people who were in recovery or remission from Long COVID, reinfection caused a recurrence of Long COVID."

There is a lot more I want to say about Long COVID but I want to keep this post at least somewhat manageable to read. Like how when COVID is contracted during pregnancy, those COVID-exposed fetuses have a 6.3-fold increased risk of motor developmental delays, or that another study found 50% of babies exposed to COVID in utero had developmental delays.

You need to keep caring about COVID, for others around you and also for yourself even if you're "healthy". Everyone is at risk. And don't forget 40-60% of COVID infections are asymptomatic, which is why masking even if you feel fine is crucial. The only way right now to not get Long COVID is to not get COVID in the first place. It's not too late, if you've stopped masking it's never too late to start again! I know it's easy to get distracted by things in your life that seem more real than the possibility of getting sick some time in the future, and the peer pressure to not mask can be intense. But it only feels less real or less important until your entire life is having Long COVID. Trust me.

I know this is a complicated issue, many people can't afford to stay home when sick even if they want to because of their jobs, there are disgusting policies trying to ban wearing masks, but please if you can. Keep masking. Masking works, masking saves lives.

This post got a bit longer than I wanted so below the cut is a non-exhaustive list of my Long COVID symptoms and some of my experiences as one of the "healthy young people" who got "unlucky". cw brief mention of suicidal ideation.

Welcome to the Thunderdome that is my body with Long COVID. Keep in mind these are just my experiences and symptoms, Long COVID can cause any range of symptoms at varying severities.

Dysautonomia: Exercise intolerance, Post-Exertional Malaise (PEM), fatigue, and heat intolerance. What do those things mean? Here's some specific examples. Absolutely terrible circulation I am so cold all the time but also, if I get a little too warm I will pass out. Eating hot food makes my heart rate spike, I sweat, my body feels heavy. Blood pooling and pins and needles in my feet when I walk. Don't even think about exercising past walking, it's impossible. I used to work out an hour a day 4 times a week and now walking up one flight of stairs makes my heart pound and I can't breathe. Can't take even just warm showers anymore or I will pass out. Heat rashes from being in the sun for 10 minutes.

Digestive issues: Honestly too many to name but: constant bloating, extreme nausea, constipation, slow motility, lack of appetite, just so much cramping and pain. I lost 18 pounds from Long COVID, as someone who was already considered underweight their entire life, and almost had to get a shunt put into my chest to deliver nutrients because I was nearly completely unable to eat. For the first 6 months of Long COVID, if I could manage 600 calories a day, that was a good day.

Histamine intolerance: Oh boy. My worst symptoms, I don't even know where to start with it. If you know Mast Cell Activation Syndrome (MCAS) it's very similar. I can only eat 19 foods. If i eat a single bite of something not on that list, it's 48 hours of absolute hell. Coughing, migraines, itchy eyes, such extreme nausea I cannot even describe it, panic/feeling of doom, racing heart rate, derealization, rash, uncontrollable muscle tremors. I only learned about histamine intolerance 5 months into having Long COVID so before that, I was experiencing these symptoms nearly every single day. Terrifying isn't even a strong enough word to describe how it felt to experience all this and have no idea what it was, how to stop it, or if it would ever stop. Really dark times.

Neurological issues: More of that derealization. Inability to concentrate. Anxiety. OCD-like symptoms such as thoughts getting "stuck" in my head, repeating 24/7 completely unable to stop them, genuinely felt like my brain had cracked open and I had lost my mind. Constant dizziness like I'm on a boat.

Sleep issues: I sleep like garbage. I have insomnia, I wake up dozens of times every night and every single time I sleep I have intensely vivid dreams. I can't sleep longer than 7 hours total no matter how exhausted I am. It is exhausting. I'm exhausted, I'm so so tired.

And finally. Just. Really intense suicidal ideation. My body, my health, my entire life has been stolen from me because someone else decided my life was worth less to them than wearing a mask or staying home if they feel sick. Before I got Long COVID, I was preparing to go to South Korea to teach English, then on to a PhD in neurolinguistics, I was supposed to meet my long distance partner and had already booked plane tickets when I got sick. All of that has been destroyed.

Most of us with Long COVID are stuck in a cycle of being extremely sick, then if you're lucky you'll slowly get better over months, just to get reinfected and go right back where you started or worse. Honestly, I'm not scared of dying from COVID. I'm scared of living for a long time, suffering from Long COVID the entire time. This isn't living.

I don't know how to end this now. I'm still fighting, I'm trying experimental treatments, I'm not giving up yet. I hope everyone reading this stays healthy and well.

[brf-rumortrackinganon]

How is William's reason of not going to the olympics acceptable when he was literally mingling with other people through his work and privately? I mean the walkabouts, attending footballs games, attending concert.

Does it mean every person he meets particularly on walkabouts is medically assessed before going?

Because attending an international event on a different continent that his team has no control over and which 9.5 million other people from around the world also attended at the height of the summer Covid surge is not the same thing as attending local events that his team has full control over.

The private football games? William sits in the back row so there was no one breathing on him from behind. The people he goes to the games probably aren’t screened, but those guys definitely know not to be around him if they’ve got the sniffles.

The Euro football games? William sits in the royal box and there’s definitely a protocol for who sits there. Maybe they’re not getting swabbed and temperature-checked, but the people with access to that box and all the dignitaries who sit there know better than to be sick and go to an event. Additionally, William usually (but not always) sits in the front row when he’s on duty at a football game, so there’s less people breathing on him there.

That concert? He was in a private box with a very restricted number of people around him.

Those walkabouts? I’m only aware of 2 and those were tens of people, not the usual hundreds that pack in to small spaces that see him.

At the Olympics, he’d have been around thousands of people. He’d have been sitting smack in the middle of a crowd, no priority seating next to controlled open spaces for him. And considering that there were 40 Olympians confirmed to have COVID during the games (including some of the Australian team), that means there were far higher numbers of unreported cases, undisclosed symptoms, and asymptomatic cases. Then consider how quickly the virus spreads, how you can be asymptomatic but quite contagious, and the risk increases exponentially. All it takes is one person.

And, I’ll bet you didn’t know this, but the Tour de France actually implemented COVID restrictions after a number of athletes tested positive. If the Tour de France is implementing COVID restrictions 2 weeks before the Olympics are kicking off, then yes, Olympic organizers and global health experts were absolutely concerned about the Olympics turning into a superspreader event for the COVID summer surge.

And yes, everyone William meets - planned or on an impromptu walkabout - does undergo a health screening to meet him. No, they’re not getting swabbed and tested and temperature-checked, but there’s definitely an aide around who’s asking the people likely to meet William “hey, have you had any symptoms in the last couple of weeks?” If there’s an aide who goes around collecting people’s consent to be photographed by the media, there’s an aide doing health screenings. It’s not a foolproof system and yes, people can lie if they really want to meet or see William, but the point is that his team is controlling everything to the best of their abilities to help him help Kate’s health because they were and are in charge of planning and coordinating the events. They wouldn’t have been able to do that in Paris at the Olympics because they weren’t the ones organizing the events and managing the crowds.

It was smart that William chose not to go to the Olympics to keep his immunocompromised wife as healthy as possible because he and his team didn’t have the same control in Paris that they do over appearances and events in Britain. That alone is all the justification anyone needs.

I’ll close with this soapbox: William is smart enough to conduct his own risk analyses of where he goes and what he does. Why can’t we trust his judgement that an international sporting event in another country that the whole globe attends was much too risky for him to attend than a local event in his own city? You don’t need my analysis breaking it all down; you just need to trust that William knows what’s best for himself and his family. After all, he’s the one with all the information and data about Kate’s health, her treatments, her recovery, etc., since all we know is that Kate had abdominal surgery, she was in the hospital for 2 or 3 weeks, there was cancer present, she underwent chemotherapy, and sometimes she has good days and sometimes she has bad days. We don’t know how bad the bad days are. We don’t know what her medications are or what side effects she may be experiencing. We don’t even know if William is undertaking additional medical precautions - for instance, is he changing clothes and washing up in the mud room before he goes into the house to see Kate? How often is he washing his hands? Does he self-isolate for a day or so at KP after he goes to these events to avoid bringing something home to Kate?

We just don’t know. But William knows. All we can do is trust his judgment, and he decided that it was far too risky and medically unsafe to go to an international event with millions of other people in another country than to go to sports at a local arena.

If you don’t trust William’s judgment, then that’s fine. But this isn’t the incident to accuse him of covid hypocrisy. Just call him out for not working. (But note that if anyone does say that to me, my response is going to be “then why aren’t you upset that Queen Camilla didn’t go to the Olympics?“)

[rjzimmerman]

Anthony Fauci: A Mosquito in My Backyard Made Me the Sickest I’ve Ever Been. (New York Times)

Excerpt from this New York Times Op-Ed by Anthony Fauci:

There is no treatment for West Nile virus disease, and I was left to deal with its toll on my body. It was terrifying. I could not swing my legs over the side of the bed to sit up without help from my wife and three daughters. I could not stand up without assistance and certainly could not walk. A very scary part of the ordeal was the effect on my cognition. I was disoriented, unable to remember certain words, asking questions of my family that I should have known the answers to. I was afraid that I would never recover and return to normal.

Fortunately, over a period of a few weeks slow improvement began. I was able to walk with a walker and then without any assistance. Now I can walk a few miles per day with only minimal fatigue, and my cognitive issues have completely resolved. I am on my way to a total recovery, but it has been a harrowing experience.

I tell my story because West Nile virus is a disease that, for many people, can have devastating and permanent consequences. At my age of 83, I was at risk of permanent neurological impairment and even death. Yet the public may be unaware of the danger of this disease and that it continues to spread across the United States; it has been identified in 46 states this year. Unfortunately, very little is being done about it from scientific and public awareness perspectives.

West Nile virus belongs to the family of flaviviruses that also includes yellow fever and dengue viruses. It was first detected in the United States in the New York City area in 1999, most likely introduced from the Middle East or parts of Africa where it is prevalent. Mosquitoes get the virus from infected birds, and then pass the virus on to humans by a bite. West Nile virus infection is by far the most common mosquito-borne disease in the United States: Since 1999, about 60,000 cases have been reported. The actual number of infections is surely higher, no doubt in the millions, since many cases are not reported because infections are often asymptomatic or are confused with other common maladies such as flu. Among the reported cases in the United States, more than 30,000 have had neurological symptoms like mine, resulting in about 23,000 hospitalizations and close to 3,000 deaths.

As climate change makes it easier for mosquitoes to proliferate in many places, West Nile virus disease as well as other mosquito-borne illnesses are emerging as greater threats in this country and elsewhere. Yet, efforts to develop a vaccine or treatment for this illness are modest compared with those for other diseases of public health importance.

So, how do we address this emerging public health threat? Vaccine development must go forward; however, to be successful, clinical trials must be international and include countries with a consistent and large number of cases each year. The pathway to a vaccine cannot be in the United States alone. Global public-private partnerships between the N.I.H. and the drug industry have historically proved successful in the development of a number of important vaccines such as those against hepatitis B and Covid. There is no reason this shouldn’t also be the case for a West Nile virus vaccine.

The same holds true for the development of antiviral drugs. There is no insurmountable scientific obstacle to developing safe and effective antiviral drugs for West Nile virus infection. The pharmaceutical industry in collaboration with the N.I.H. and other partners had remarkable success in developing effective drugs for other emerging viral infections. Examples include lifesaving drugs for H.I.V. infection, therapies for hepatitis C infection and useful drugs for Covid-19 and influenza. With international research partnerships and political will spurred by an engaged activist community such as we have seen with H.I.V. and now long Covid, West Nile virus treatments and prevention tools should be within our grasp.

[covid-safer-hotties]

Also preserved in our archive (Daily updates!)

by Dr. Monica M. Bertagnolli

In 2021, NIH launched the Researching COVID to Enhance Recovery (RECOVER) Initiative , a nationwide research program, to fully understand, diagnose, and treat Long COVID. We continue to learn more about this condition, in which some people experience a variety of symptoms for weeks, months, or even years after infection with SARS-CoV-2, the virus that causes COVID-19. But we’re still working to understand the underlying reasons why people develop Long COVID, who is most likely to get it, and how best to treat or prevent it.

Studies have shown that for some people, SARS-CoV-2 doesn’t completely clear out after acute infection. Scientists have observed signs that the virus may persist in various parts of the body, and many suspect that this lingering virus, or remnants consisting of SARS-CoV-2 protein, may be causing Long COVID symptoms in some individuals. Now, in a new study supported by RECOVER, scientists found that people with Long COVID were twice as likely to have these viral remnants in their blood as people with no lingering symptoms. The findings, reported in Clinical Microbiology and Infection , add to evidence that Long COVID may sometimes stem from persistent infection or SARS-CoV-2 protein remnants.

The study team, led by David Walt and Zoe Swank at Brigham and Women’s Hospital in Boston, had earlier found preliminary evidence in a small pilot study that a SARS-CoV-2 protein could often be detected in the bloodstreams of people with Long COVID up to a year after the initial infection. In the new study, they wanted to better quantify this in a much larger group of people with Long COVID. The researchers developed a highly sensitive test to look for whole and partial proteins from the SARS-CoV-2 virus. They analyzed 1,569 blood samples collected from 706 people at various times after SARS-CoV-2 infection.

Overall, 21% of those in the study had detectable levels of a SARS-CoV-2 protein between 4 and 7 months after infection. In total, 82% of the study’s participants (578 people) had at least one symptom of Long COVID more than a month after their infections. Commonly reported symptoms included fatigue, brain fog, muscle pain, joint pain, back pain, headache, sleep disturbance, loss of smell or taste, and gastrointestinal symptoms. More than half of participants in this group (378 people) reported experiencing ongoing cardiopulmonary, musculoskeletal, or neurologic symptoms, and among those participants, 43% (165 people) had detectable virus protein. Also of note, of the asymptomatic people, about 20% had detectable virus protein.

While the researchers can’t definitively show that persistent infections are the cause of some Long COVID symptoms, the findings add to growing evidence that low levels of viral protein being present may explain some but not all cases of Long COVID. The authors and many other researchers suspect that Long COVID likely has multiple underlying causes. For instance, it’s possible that the virus may lead to harmful changes in the immune system that play a role in some cases of Long COVID.

Scientists also want to see if there is a subset of people with Long COVID or persistent symptoms who may benefit from antiviral treatment. To this end, RECOVER is supporting a clinical trial evaluating whether the antiviral drug Paxlovid (a combination of nirmatrelvir and ritonavir), which is used to treat COVID-19, could also be used to improve Long COVID symptoms. The trial is using the SARS-CoV-2 blood test developed by the Brigham and Women’s study team to evaluate whether Paxlovid can eliminate viral proteins from participants’ blood.

More study is needed to understand the causes of Long COVID symptoms in people who test negative for persistent infection, the researchers note. They are conducting follow-up studies in even more people with Long COVID, including those with compromised immune systems. They hope to learn more about what causes some people to be at higher risk for retaining some SARS-CoV-2 protein remnants and Long COVID.

Reference:

Swank Z, et al; RECOVER consortium authors. Measurement of circulating viral antigens post-SARS-CoV-2 infection in a multicohort study. Clinical Microbiology and Infection. DOI: 10.1016/j.cmi.2024.09.001 (2024).

Study Link: www.sciencedirect.com/science/article/abs/pii/S1198743X24004324?via%3Dihub (PAYWALLED)

[the-bad-batch-baroness]

Health Update

First, I want to say thank you to everyone who reached out or commented on the latest installment of Where's Mommy? to wish me good health. I am so grateful for all of you 💚

However, the health issue I'm currently dealing with isn't due to a virus or bacteria, and there's a possibility it won't get better.

A little history.

Back in 2022, there was a two week period where I felt like my blood sugar was dropping, and I was very symptomatic. There was a moment where I slumped down a wall at work because of it, and they had to dump sugar packets from the break room into my mouth to rouse me. It was a very scary time.

After those two weeks, I went to my Primary Care Physician who ordered blood tests and had me purchase a glucometer to test my blood sugar several times a day. However, during the two weeks she had me do this, I never got a reading below 70, and the same symptoms did not develop as they did prior. My blood work came back clean, and without a reading lower than 70, my PCP dismissed it and told me I was having anxiety attacks, lol. She told me to come back if the symptoms came back, and they never did.

Backing up a couple more years.

Without revealing too much of my medical history, I have a chronic illness called POTS (postural orthostatic tachycardia syndrome). It's a dysautonomia or a dysfunction of the autonomic nervous system, the system that controls all of the automatic functions of the body. It was caused by my battle with Lyme Disease in 2010 and is currently incurable. I was diagnosed with POTS in 2018, after being told for 6 years that I had anxiety, lol.

POTS is not a very well-known illness, but it's getting more attention these days. It garners a host of different symptoms, including tachycardia, chronic fatigue, brain fog, orthostatic intolerance, migraines, gut issues, syncope, dehydration, blood pooling, etc. Everyone's POTS presents differently, and most people with a POTS diagnosis live on disability. I made the choice not to.

Fast forward to 2024.

Fast forward again to this past Wednesday.

Well, I finally was able to get a POTS specialist in my state this year. A huge win! When I had my initial consultation, I had mentioned the low blood sugar episodes in 2022 and asked if it could be related to POTS. The doctor told me that they don't see POTS patients having low blood sugar issues, but we're concerned enough to refer me to an endocrinologist. Another big win!

I had my consultation with the endocrinologist, and he ordered more blood tests, some of the same tests as before, and some different (y'all, they took like 20 vials from me). He also gave me a CGM (continuous glucose monitor) to wear for 14 days so they can track my highs and lows to see if they can catch anything.

Well, the next night, my blood sugar dropped below 70, 20 times, and 55, 9 times. Which means I was woken up 9 times throughout the night. I got only about 2 hours of sleep, and still had to go to work the next morning. But, once again, it went back up by itself without any intervention from me.

Y'all, it caught A LOT in just the first day, actually night. My blood sugar dropped below 70, 11 times, and below 55, 4 times while I was sleeping. Now, because anything below 55 is considered critical and could be fatal, there is an alarm that cannot be overridden and will sound. It sounds like a smoke alarm. So, I was awoken 4 times.

The odd thing is that my blood sugar dropped, then went back up on its own. I didn't eat or drink anything. Blood sugar doesn't really do that, so I thought it was odd. This also begs the question: If I'm asymptomatic at 53, then what level was I at in 2022 when I had symptoms? Honestly, I don't want to know.

Here is a nifty graph!

All of the red is considered low blood sugar, below 70, and anything close to that 50 line is considered critical low blood sugar. And again, I did not eat anything during the night.

There are four major anomalies with my low blood sugar occurences:

Most cases of hypoglycemia are seen in diabetics, I am not diabetic

Most cases of hypoglycemia seen in non-diabetics are sporadic, mine are consistent

Hypoglycemia is normally corrected by consuming sugar, mine auto-corrects

When blood sugar drops, it creates symptoms, I do not get symptoms

There are only a handful of things that can cause hypoglycemia in a non-diabetic and even less consistently at night time. The doctor has already ruled out insulinoma (insulin producing tumors in the pancreas), so that leaves even less, and also the good old "we don't know what's wrong with you".

I'm not going to lie. This whole thing terrifies me. There's no telling how long my blood sugar has been doing this, and it only takes one dip below 50 for me to slip into a coma and die in my sleep. Luckily, my blood sugar does this crazy autocorrect thing, and I haven't died yet! Humor makes this easier.

Right now, I'm emotionally, mentally, and physically exhausted. Adding this on top of my already difficult life with POTS has been hard to cope with, and I'm crying a lot.

Hopefully, I'll get results soon, and my endocrinologist can figure out why this is happening and how to manage/fix it if it can be managed/fixed. Maybe I've got a completely new illness, and you'll find me in a medical journal! Wouldn't that be something.

Anyway, thanks for the continued support. I have a lot of IRL support from friends and family, but while I go through this process, I may seem distant, my posting might be sporadic, I may not keep my fic posting schedule, etc. And when I have an update, I promise to let y'all know!

Much love 💚💚💚

Steph

[flyonthewallmedstudent]

Q Fever

Aka, Query fever. What a weird name for a disease. Imagine telling people that's what you got.

in the 30s-40s, an Australian pathologist in QLD/Brisbane, came across an outbreak of the same or similar illness among abbatoir or slaughterhouse workers.

At the time, he called the disease "Q" fever or query as a temporary name until the pathogen could be identified. Unfortunately it stuck.

decades later, now nobel prize winner and virologist, MacFarlane Burnett isolated and identified the microbe responsible. I think this discovery contributed to his prize. i forget already.

Microbe responsible: Coxiella burnetti. Named for Burnett and HR Cox, the American bacteriologist who found the genus Coxiella where C burnetti falls under.

Initially they felt it was related to Rickettsia, responsible for Rocky Mountain Spotted Fever, but as science progressed, this was disproven.

Now for a Case Report

A 55 yo Italian man with a history of aortic valve replacement was diagnosed with pyrexia of unknown origin twice. Further signs included myalgias/splenomegaly/night sweats. The 2nd time he was admitted for PUO he deteriorated rather dramatically and was put on meropenem and teicoplanin.

A host of organisms was tested for on serological testing based on the man's travel and epidemiological history, all negative. Even a rheumatological panel was done, also less revealing. He also had a history of MGUS (a haem disoder), which is kind of a red herring here.

Cultures were negative, no vegetations were seen on a TTE - so they did consider IE. Which is an important differential for PUO.

Eventually a PET-CT was done (often favoured when investigations do not yield much for a sick patient with fevers), finally revealing a focus of infectious on his ascending aorta, where he'd also had previous surgery done. And in a round about way, they also further identified Coxiella Burnetti. He was treated doxycycline and hydroxychloroquine. As it's so rare in Italy, it wasn't really considered even though he mentioned rural travel.

Bottomline: Q Fever is an important consideration in the work up for culture negative IE. Further to this, always consider IE in the differentials for PUO particularly if they're at increased risk for IE (prosthetic valves, damaged valves, select congenital heart issues, previous IE). IE can present with night sweats, fevers, weight loss and splenomegaly. It can be insidious and chronic in nature. other risk factors can be more suggestive as we'll get into below.

Causative organism

Coxiella burnetti, it's a zoonoses - i.e. transmissible from animals. Special powers: very tough/hardy, can survive extreme environments (high temps and UV light etc.) over prolonged periods and is resistant to many common disinfectants/surface cleaners.

It's an intracellular pathogen and gram negative coccobacilli (PINK!)

name coccobaccili reminds me of cocopuffs.

it's mainly associated with farm animals, which the CDC so wholesomely displays on its website on Q fever (wtf).

goats, sheep, cattle typically (but many other animals, even birds, dogs and horses can be reservoirs)

in particular bodily fluids - amniotic fluid, placenta, faeces/urine, milk etc.

you can get it through unpasteurized milk and through inhaling it if it lands on dust in the area

ever visit a farm or petting zoo lately? OMG WASH YOU HANDS.

That said, it's typically inhaled in inorganic dust. You inhale it, it goes to the lungs, and then the bloodstream.

Increased risk for Coxiella burnetti (What to take on history of exposures and when to strongly consider it)

live on a farm or near one

exposure to a farm

work as a vet on a farm

farm worker, dairy workers, researchers on these animals/facilities

slaughterhouse/abbatoir

Also from CDC:

Clinical presentation

Most won't get sick after exposure and remain asymptomatic, a very small minority does. even though it is highly infectious.

incubation time is 2-3 weeks (consider this time in your history of exposure, did they work on the farm 2-3 weeks ago as opposed to yesterday).

Nonspecific acute infectious symptoms:

nonspecific systemic fevers/malaise/arthralgias/myalgias--> key is high fevers though and can be associated with headache and photophobia.

non specific GI - N/V/diarrhoea

respiratory ones - SOB or cough, consider it as atypical cause of community acquired pneumonia.

rare: hepatitis and jaundice (granulomatous) or encephalitis with neurological complications such as demyelinating disease or CN palsies, also haemolytic anaemia and HLH (yikes)

really it's the history of exposure that will lead you down the garden path to Q fever.

Chronic Q fever is perhaps worse, and can present as culture negative IE/PUO. Months/years later, as B symptoms as above above + LOW/LOA, night sweats. More likely to occur if you are predisposed for IE as above, have a weakened immune system for any reason, including pregnancy.

Chronic Q fever has a mortality of 10% if left untreated. About <5% of those with acute Q fever develop this if left untreated. Speculation is that it's more of an autoimmune process or abnormal immunological response to the bacteria.

To be honest, most who walk in the door with community acquired pneumonia get treated empirically for atypicals anyway, (standard course of doxycycline), so we hardly really ponder the question of Q fever in every patient. But if they present chronically and did not have atypical cover at the onset of acute symptoms, then it's something important to consider.

Other important conditions - can cause complications in pregnant women and 20% will get post Q fever syndrome. like chronic fatigue.

investigations

Serology! nice and easy. Look for IgG antibodies in the chronic presentation. Or PCR. Down side to serology - can take 2-3 days for the body to make said antibodies to the bacteria for detection. PCR can be done on any fluids/tissue sent.

Cultures useless, hence it fall under the umbrella of culture negative (hard to grow outside a host cell, it is an obligate intracellular pathogen).

Other hints on bloods (as serology/PCR takes time to return) - elevated or low platelet's, transaminitis with normal bili, opacities in CXR with hilar lymphadenopathy, CSF will show raised protein levels if done when encephalitis is suspected.

imaging can also support the diagnosis.. as illustrated by the case report.

Treatment

Acute disease - as standard for atypical bugs, doxycycline 100 mg BD for 14 days. Alternatives - TMP SMX or Clarithromycin.

Chronic Q fever or IE:

native valves: doxycycline and hydroxychloroquine (200 TDS) for 18 months

prosthetic: same but 24 months

why hydroxy: enhances the action of doxycycline (increases the pH of the phagolysosome)

Follow-up: look for 4 fold decrease in IGG

Sources:

CDC

Stat Pearls

Wiki as linked above

[madamepestilence]

H5N1: What to know before fear spreads

What is H5N1?

H5N1 is a 1996 strain of the Spanish or Avian Flu first detected in Chinese birds before spreading globally across various avian species. H5N1 is similar to H1N1, but spreads slower and has a much higher mortality rate.

H5N1 may also be referred to as Influenza A. The American Association of Bovine Practitioners has seen fit to rename H5N1 to Bovine Influenza A Virus, or BIAV, and are encouraging others to use the same terminology.

I would not be surprised if the colloquial name among the public becomes Bovine Flu or American Flu in the coming months, and may be referred to as the Chinese Flu by the same folks who took the spark of the SARS-CoV-2 (COVID-19) pandemic as an excuse to be publicly racist to East Asian people without social repercussions.

BIAV is a virus, meaning that it is a (probably) non-living packet of self-replicating infectious material with a high rate of mutation. BIAV is structured similarly to SARS-CoV-2, having a packet of infectious material encased in a spherical shell with a corona, or crown, of proteins that can latch to living cells to inject RNA.

Image source with interactive model: ViralZone - H5N1 subtype

What is the history of BIAV?

In 1996 and 1997, an outbreak of BIAV occurred among poultry and infected 18 people in Hong Kong, 6 of which died. This seemingly isolated incident then infected ~860 people with a >50% death rate.

At the time, BIAV was known as Highly Pathogenic Avian Influenza, or HPAI, and killed nearly 100% of chickens within a 48 hour period.

From 2003 to 2005, continual outbreaks occurred in China and other East Asian countries, before spreading to Cambodia, the Netherlands, Thailand, and Vietnam.

From 2014 to 2016, it began being detected in American fowl, as well as mutating the H5N6 (lethal in birds, no human to human transmission) and H5N8 (largely spread through turkeys, ducks had immunity) viruses.

BIAV has since evolved into a clade known as 2.3.4.4b, and was first detected in 2021 in wild American birds. This then caused outbreaks in 2022 among wild and domesticated birds (such as chickens) alike, but was largely being overshadowed by the pressing SARS-CoV-2 pandemic at the time.

From 2022 to 2023, it was observed to be spreading among various mammals, including humans. Now, in 2024, we're having the most concerning rapid outbreak of BIAV since 2003.

BIAV is known to spread from mammal to mammal, particularly between cows and humans. BIAV may also be spread from cow to cow (highly likely, but not confirmed - this is likely the reason the virus has spread to Idaho from Texan cattle), and is known to be lethal to domestic cats and birds within 48 hours.

How does BIAV spread?

BIAV spreads through fomites - direct contact with infected animals or infected surfaces and then touching parts of your face or other orifices - as well as through airborne particulates, which may be inhaled and enter the sinuses and lungs.

BIAV is known to spread through:

Asymptomatic Ducks, geese, swans, various shorebirds

Symptomatic, may be lethal Foxes, bears, seals, sea lions, polar bears, domestic cats, dogs, minks, goats, cows, (potentially human to human, but unconfirmed - there have only been 8 potential human to human cases in 2024).

How can I protect against BIAV?

As BIAV is a type of Influenza A, existing protocols should do fine.

Current recommendations are to wash your hands vigorously after interacting with birds (I would also recommend doing this with mammals), avoid touching your face or other open orifices, and wear N95 masks.

Avoid sick or dead animals entirely - I would also recommend reporting them to your local Animal Control or veterinary centre and warning them about the infection risk. People who work with animals are recommended to also wear full PPE such as N95 masks, eye protection, gloves, and partake in vigorous hand washing.

If you suspect you've caught BIAV, seek medical attention immediately. Existing medications such as oseltamivir phosphate, zanamivir, peramivir, and baloxavir marboxil can reduce BIAV's ability to replicate.

Standard flu shots will not protect against BIAV. Remember - symptoms of BIAV may not manifest for between 2 to 8 days, and potentially infected people should be monitored for at least 10 days.

How far has BIAV spread?

BIAV is currently a global virus, though the current infection location of note is the United States.

Image Key: Dark red - Countries with humans, poultry and wild birds killed by H5N1 Deep red - Countries with poultry or wild birds killed by H5N1 and has reported human cases of H5N1 Light red - Countries with poultry or wild birds killed by H5N1

Image source: Wikipedia - Influenza A virus subtype H5N1 - File: Global spread of H5N1 map

Image source: Metro.co.uk - Map shows where bird flu is spreading in US amid new warning - File: The Centers for Disease Control and Prevention’s H5N1 bird flu detections map across the United States

Should I be afraid?

You needn't be afraid, just prepared. BIAV has a concerningly high lethality, but this ironically culls its spread somewhat.

In the event human to human transmission of BIAV is confirmed, this will likely mainly affect marginalized communities, poor people, and homeless people, who are likely to have less access to medical care, and a higher likelihood of working in jobs that require frequent close human contact, such as fast food or retail jobs.

Given the response to SARS-CoV-2, corporations - and probably the government - may shove a proper response under the rug and refuse to participate in a full quarantine, which may leave people forced to go to work in dangerous conditions.

If this does spread into an epidemic or pandemic, given our extensive knowledge about Influenza, and the US having a backup vaccine for a prior strain of H5N1, a vaccine should be able to be developed relatively quickly and would hopefully be deployed freely without charge - we won't have to worry about a situation like The Stand.

Wash your hands, keep clean, avoid large social gatherings where possible, wear an N95 mask if you can afford them (Remember: Cloth masks are the least protective, but are better than nothing. If you can't afford N95 masks, I recommend wearing a well-fitted cloth mask with a disposable face mask over it to prevent pneumonia from moisture buildup in the disposable mask), support the disabled, poor, and homeless, and stay educated.

We can do better this time.

Further things to check out:

YouTube: MedCram - H5N1 Cattle Outbreak: Background and Currently Known Facts (ft. Roger Seheult, M.D.)

Wikipedia - Influenza A virus subtype H5N1

Maine.gov - Avian Influenza and People

CDC.gov - Technical Report: Highly Pathogenic Avian Influenza A(H5N1) Viruses

Wikipedia - H5N1 genetic structure

realagriculture - Influenza infection in cattle gets new name: Bovine Influenza A Virus (BIAV)

[plumbits]

Leptospirosis: What it is, what it does, and how you can protect yourself and your pets.

People always have questions about leptospirosis (lepto) when they come into the clinic, especially in regards to the vaccine. This post will hopefully clear up those questions or any confusion regarding lepto and its vaccine, and why it's so serious. The information in this post comes from my formal education as a LVT, as well as other sources including the CDC, PAHO, and AVMA. If I missed anything or you see something that's incorrect, please let me know!

First and foremost: What is leptospirosis?

Leptospirosis is a bacterial disease that effects human and non-human animals. It's caused by bacteria in the genus Leptospira. In humans, it can cause a wide range of symptoms that can be very general. This leads to misdiagnoses. Animals such as dogs, livestock, and certain wildlife are all susceptible to infection.

How is leptospirosis spread?

Lepto is most often spread through contact with the urine of an infected animal. This is especially the case (but not the only case) with wild rodents. Infected dogs can seem healthy, but still pass the bacteria on in their urine. In urine-soaked soil, the bacteria can survive for weeks to months.

Dogs typically become infected when their mucous membranes or open wounds come into contact with urine or urine contaminated surfaces (like soil or water). Infection can also be spread through urine-contaminated bedding or food, or the tissues from the carcass of an infected animal. There have been rare instances where lepto has been transmitted by bite or breeding. A pregnant dog who is infected may pass the bacteria to her puppies through the placenta.

Humans contract lepto pretty much the same way: through contact with urine from an infected animal or urine-contaminated surfaces.

What are the signs and symptoms?

In humans:

High fever

Headache and muscle aches

Chills

Jaundice

Vomiting and diarrhea

Redness of the eyes

Abdominal pain

Rash

Humans can also be asymptomatic, which is particularly concerning. It usually takes anywhere from 2 days to 4 weeks post-exposure to the infection source before any symptoms are displayed. The illness begins abruptly and it may occur in 2 phases. The first phase is where you will see a lot of the general symptoms listed above. The person infected may recover for a period of time, but become ill again. The second phase is more severe, leading to kidney or liver failure, and possible meningitis. The illness can last a few days to 3 weeks or longer.

Without treatment, recovery can take several months.

In dogs:

Signs and symptoms may vary slightly depending on the strain of the infected bacteria. The signs are also very general in dogs, but the most common ones include:

Loss of appetite

Vomiting and diarrhea

Lethargy

Abdominal pain

Jaundice

Dehydration

Increased thirst and urination

Weight loss

Stiffness or muscle pain

The disease can also progress to kidney and liver failure in dogs, with damage to other organ systems also noted in the literature. Lepto can also cause bleeding disorders, which can lead to blood in urine, vomit, feces, or saliva, and petechiae on the mucous membranes or light colored skin.

Who is most at risk?

For humans, those who are most at risk include those who work with animals or outdoors where you come into contact with wildlife. The Pan American Health Organization (PAHO) also mentions that sewer workers and military personnel are at-risk populations. Farmers (and generally people who work with livestock) also make the list, as do veterinarians, veterinary technicians, and veterinary assistants.

For dogs, it's all of them. "All dogs are at risk of leptospirosis, regardless of age, breed, lifestyle, geographic location, time of year, and other factors." (source: AVMA)

Situations that can increase the risk of your dog contracting leptospirosis are listed below:

Exposure to drinking from slow-moving or stagnant water sources (this includes puddles)

Roaming on rural property

Exposure to wild animals or farm animals, even if it's only in the yard

Contact with other dogs (such as in urban areas, dog parks, boarding, or training facilities.

How is leptospirosis treated and diagnosed?

Disclaimer: I am NOT a medical doctor or DVM, but I am an LVT. If you think you're experiencing these symptoms, PLEASE go see your doctor. If you think your dog or any of your other animals are experiencing these symptoms, PLEASE take them to your vet.

Diagnosis in non-human animals:

Unfortunately, routine blood tests alone cannot diagnose leptospirosis. That's why it's important for your vet to use all information available to them (i.e. diagnostics, signs and symptoms, lifestyle, etc). There WILL be abnormal results for blood work, most likely high liver and/or kidney values and high white blood cell count. There are specific tests available for diagnosing lepto, such as the DNA-PCR and MAT tests. Both may be needed to reach or confirm a diagnosis. False negatives are possible, so your pet may be treated as if they have leptospirosis, even if the test results are negative. False positives are exceedingly rare.

Diagnosis in humans:

Leptospirosis is diagnosed in a similar fashion in humans. A physical exam, blood work, and urinalysis will likely be run. The same style of tests are used: DNA-PCR and MAT.

Treatment in non-human animals:

Leptospirosis is treated with antibiotics and supportive care. Doxycycline is most commonly used, and will likely be prescribed for 2 weeks or more. Supportive care includes hospitalization with IV fluids and management of electrolyte levels. Additional medications and procedures may be necessary.

Treatment in humans:

The treatment is similar in humans, with antibiotics (usually doxycycline). Your doctor may also suggest to take ibuprofen and monitor yourself at home for less severe cases. If the case is severe, then you'll likely spend time in the hospital. Additional medications or procedures may also be necessary.

Outcomes:

In non-human animals:

Leptospirosis is responsive to treatment with antibiotics. Complete recovery is possible, but some animals that survive may be left with chronic kidney and liver disease. Some animals may not survive if the infection has gotten to the point where it causes severe organ damage or the ability of blood to form clots.

In humans:

You can survive leptospirosis. Most cases have either very mild symptoms that go away on their own, or none at all. Without treatment, leptospirosis can cause kidney damage, meningitis, liver failure, trouble breathing, and even death. PLEASE go see a doctor if you think you're experiencing any of these symptoms, especially together.

Prevention

How can you prevent infection and protect your pets?

For dogs, there's the leptospirosis vaccine. This is an annual vaccine that vaccinates against multiple strains of Leptospira. If you're worried about your dog having a vaccine reaction, let your vet know and they can administer an injection of diphenhydramine (generic benadryl) beforehand, OR you can ask them what the appropriate dose is for your dog and give them the respective amount at home (in tablets or liquid). Vaccine reactions are uncommon, but if they do happen, it's usually immediately after exposure to the vaccine. You can ask to stick around in the lobby/waiting area of your vet clinic for a few extra minutes if you're still concerned.

Limit your dog's access to standing water. Don't let them drink from it. Prevent rodent problems where you can by properly storing food items in appropriate containers, securing your garbage, and patching up any access points into your house if you see them. Try to avoid contact with wildlife, when possible.

For humans, the recommendations remain similar. Don't wade or swim in stagnant water, ESPECIALLY if you have open wounds. Avoid contact with wildlife. WASH YOUR HANDS, often and appropriately. USE PPE if you work in a veterinary setting and properly clean and disinfect surfaces and equipment. Make sure you know or research the area that you're in if you like swimming and boating. Check to see if there have been any recent lepto infections. Cover your scrapes and wounds with waterproof bandages and wear water shoes if possible.

I hope this post answered a lot of your questions! Thanks for reading.

Sources under the cut.

Sources:

[maddisandy]

September is Chiari Malformation Awareness Month!

Hi yes hello! Since many people probably aren't aware of it, I wanted to bring attention to something we ourselves have called chairi malformation at the start of its awareness month! Its recognized with a purple ribbon usually with a zipper on it (for the zipper scars of those who've had Chiari surgery)

What is Chiari Malformation?

Chiari (key-arr-ee) Malformation is a brain malformation in which the brain is too large, skull is too small, or some combination on the both, causing the cerebellar tonsils (and in some instances the brain stem) to slip through the skull and into the spinal chord.

Chiari is most typically a congenital effect. There are two main types (though they aren't the only ones). The most common of the two us Chiari 1, in which only the cerebellar tonsils are descended through the skull. The second most common, Chiari 2 (also known as Arnold-Chiari malformation) has more tissue herniation in the cerebellar tonsils and even the cerebellum, as well as brain stem herniation as well.

(See Below, the Cerebellar tonsils are marked in red while the brainstem is marked in green and yellow. This is considered a normal MRI)

Chiari malformation is likely to occur in 1 in 1,000 people, making it uncommon but not rare. The statistics are likely to be slightly higher than that for Chiari 1, as many people don't present symptomatically (and many incidents are only found in cases where the person was receiving radiological imaging for other instances such as head injury, so many people are unaware they had Chiari to begin with).

The only way to diagnose Chiari is through radiological imaging (many arguing upright MRI specifically is the only proper way to view the real level pf herniation). Herniation is measured down from the McRae line to the lowest point on the cerebellar tonsils. Depending on the accuracy of the machine (and which imaging tool is used) herniation can appear at different levels at different times. (See below, my first MRI looks markedly less in comparison to my second MRI, which features a roughly drawn on McRae line. In the second image I was noted to have a 7-8mm herniation.)

Symptoms

Chiari is marked by a number of symptoms and commorbidities, even moreso depending on the type you have. Symptoms can occur at any level of herniation. Some people with Chiari can have a 3mm descent and have debilitating symptoms, while some may have a 15 mm descent and be completely asymptomatic. The most common of these is occipital headaches & migraines, ranging from mild to severe, but many more are possible. These range from...

Balance Issues

Dizziness & Vertigo

Neck & Shoulder Pain

Difficulty Swallowing

Sore Throat

Sleep Apnea

Nausea & Vomitting

Tinnitus & Hearing Loss

Blurred Vision, Visual Snow, & Vision Loss

Muscle Weakness

Numbness or Pins & Needles (Caused by Nerve Damage)

Poor Motor Skills

Fatigue

Cognitive Difficulties (including but not limited to Brain Fog, Memory Problems, Confusion, & Difficulty Speaking)

Insomnia

Photophobia/Light Sensitivity

Syncope, Fainting, & Drop Attacks

Seizures

Dysautonomia

Since the cerebellar tonsils block the opening to the base of the skull, Chiari can halt the proper flow of CSF (Cerebral Spinal Fluid) between the brain and the spinal chord. Because of this, Syringomylia (cysts filled with CSF formed on the spine called Syrinxs) is considered common with Chiari. Other common disorders with Chiari are Scoliosis, EDS & Cervicocranial Instability, POTS, Tethered Spinal Chord Syndrome, Spina bifida, & Hydrocephalus.

So What's the Solution?

Well, the only known solution for Chiari as of right now is surgery. This surgery is called posterior fossa decompression-- in which a small portion of the base of the skull is removed from the Chiari patient to relieve pressure and give more room for the brain. The surgeon can then do for sone patients a duraplasty, in which the dura (or opening of the brain) is cut open and a patch of tissue is sewed into the incision to make the dura bigger and give even more room for the brain. Surgery can also be done as a preventative measure against syrinxes for those without them. In the case the patient also has a syrinx, more surgical procedure can be done to drain the cyst. In patients with EDS, special procedures must be made to avoid surgical complications and making things worse.

Surgery is not guaranteed to completely alleviate symptoms, but typically helps with some. However, due to large misunderstanding and disagreement on proper diagnostic traits of Chiari from doctors (most typically neurologists and neurosurgeons) many may be denied surgery for a number of years, and Chiari Diagnosis can take on an average of 4 years to officially receive.

Some go years experiencing symptoms and having "low lying cerebellar tonsils" (or similar language, such as incidental tonsillar ectopia) noted on their radiology reports without doctors officially recognizing it as Chiari. In this time many are misdiagnosed with other disorders such as chronic headaches, multiple sclerosis, fibromyalgia, and more before finally finding a doctor who will listen. Many will brush off the radiological findings as just a difference in your brain being formed at birth before admitting the symptoms can be due to Chiari. It can take years of your own patient advocacy before someone finally listens.

This is why awareness to it is so important, in hopes of reaching other people and doctors and forming a stronger understanding of the condition from information found by experts on it and those with Chiari themselves. With more awareness comes more accessibility to treatment and surgery so those who are symptomatic can hopefully find some relief. So this month send a little love & luck to those with Chiari!

[permalockdown]

long post containing a lockdown infodump so LOCK IN. there will be stim gifs!

tl;drs will be included

so i’ve been doing a lot of research on covid, especially on why we went into lockdown in the first place?

covid was so unknown at the time, having ONE viral relative: SARS (the epidemic in 2003/04, no cases since). so i researched SARS. (scroll

checkpoint one: SARS

tl;dr, SARS didnt burn itself out, it was still contained due to human intervention, but it had very little asymptomatic cases and was not known to spread until symptom onset.

tl;dr two, covid was most transmissible before its symptom onset, and had LOTS of transmittable asymptomatic cases.

SARS-CoV-1 is an abbreviation for severe acute respiratory syndrome, coronavirus one. it caused a global epidemic in 2003-04, and a case hasnt been reported since then. covid is SARS-CoV-2. the two were about 80% similar, but those differences are key in covids boom.

im not gonna go in-detail about the specific mutations that cause these things (but i do know them, i think u guys might get bored) but covid had a much higher asymptomatic case rate (as high as 40%, estimated by wastewater) and still remained contagious. SARS on the otherhand had very little asymptomatic cases, and it did not remain contagious.

this is really important to consider, as 50-70% of SARS victims needed oxygen supplementation, and 20-30% were in the ICU. 13% of cases died. this is a lot compared to the 15-20% of hospitalizations due to covid, and 3-5% needing critical care.

quarantining and isolation was a lot easier when the virus wasnt spread until symptom onset, and most of the time caused severe enough illness to warrant hospitalization.

there was no cure or vaccine for SARS, you just had to wait it out and treat its symptoms.

checkpoint two: COVID

tl;dr, covid was a more severe illness with an extremely contagious nature. nobody knew what to do, and the american leadership added more strain due to the fact that trump tried to downplay the virus.

now that we know that covid was very unknown at the time, its parent virus had no cure and no vaccine, and covid bumped the transmission into gear, we can actually understand why lockdowns happened.

covid wasn’t mild like the flu or the common cold, but was still extremely contagious. shelter-in-place orders were placed so that the virus didn’t spread as quickly and mutate to become either more contagious, more deadly, or both, as more cases means more mutations.

i live in the united states, so im going to focus a little bit on that. right-wing ideology had gotten much more severe since 2003, and former president donald trump is, well, an idiot. he made false claims about the virus and his administration was focused on downplaying the situation rather than ramping up on medical supplies and telling the people what to do.

the election year had a lot to do with the pandemic, especially with america as a large world leader, and most right-wingers would die for their beloved trump. they refused to listen to anyone on the left-leaning.

we went into lockdown due to global unpreparedness, world leader unpreparedness, and general lack of knowledge.

checkpoint three: what would another lockdown need?

another lockdown would still need relevant political interference, which, hooray! is still happening in the united states. if you research the social aspects of any new diseases, right-wing folk tend to say they’re not falling for a “ploy to get biden back in office”. this includes not wearing masks, not quarantining, not getting vaccines, etc.

for a known virus to cause a pandemic, it would need to mutate so fast that it becomes extremely different from its parent. it would need to transmit human-to-human, have many asymptomatic cases, and still manage to cause severe infection in previously healthy people.

i’m not really counting on monkeypox 1b to cause a pandemic, but idk! things always happen :3 i am however counting on bird flu, as it clearly has less of a watchful eye over it, has never transmitted h2h before, and causes severe illness.

like and subscribe

[mariacallous]

Toward the end of last year, US health authorities got a tip-off about an upcoming wave of respiratory syncytial virus, a seasonal virus that kills 160,000 people globally every year. Before hospitals reported an uptick in patients, they could see that RSV was more acute in the northeast of the country, with concentrations of the virus ultimately reaching levels more than five times greater than in the western United States. Their early warning system? Wastewater.

By regularly testing virus levels in public wastewater, health institutions are able to target treatments and interventions to the worst-affected areas before doctors on the ground realize something’s going on. “If you can get the information to hospitals or clinics weeks earlier, that gives the opportunity to start thinking about what treatments they might need,” says Marisa Donnelly, senior principal epidemiologist at Biobot Analytics, which helped develop a wastewater surveillance system for the US Centers for Disease Control.

RSV is very common: Every year, 64 million people worldwide get an RSV infection, according to the US National Institute for Allergy and Infectious Diseases—but it’s particularly problematic for the very old and very young. Preventative measures are available, including vaccines and monoclonal antibodies. But often, by the time a community recognizes it has an RSV outbreak, it’s too late to mount the most effective response. Getting hold of enough drugs can also be tricky. “Wastewater analysis gives you better situational awareness of what’s going on and how much it’s fluctuating over time, because we have [historically] very much underdetected RSV cases,” says Bill Hanage, associate director of the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health.

The concept of tracking a virus through wastewater came to prominence in the early days of the Covid-19 pandemic in 2020, says Tyson Graber, associate scientist at the Children's Hospital of Eastern Ontario Research Institute, who worked on wastewater analysis as part of Ontario’s Covid response. Initially, researchers weren’t too hopeful. “Nobody thought that you could actually detect bits and pieces of material from a respiratory virus,” says Graber. Yet it proved possible: The scientists were able to detect the presence of SARS-CoV-2, the virus behind Covid-19.

This near-real-time analysis of the virus’s spread helped improve responses to the pandemic not just in Ontario, but worldwide. In the US, the CDC launched its National Wastewater Surveillance System in September 2020.

While each pathogen has its own “predilections and eccentricities,” says Graber, it was possible to adapt the process to look for RSV. Regular RSV testing in wastewater now takes place in the US, Canada, Finland, and Switzerland.

A study of the Ontario experiment in RSV wastewater tracking found that it gives more than a month’s notice in identifying when RSV season begins, and nearly two weeks’ warning of a surge, compared to waiting for people to turn up sick. “We definitely see increases in [RSV in] wastewater starting before we see those same increases in clinical data like hospitalizations,” says Donnelly.

Jasmine Reed, a CDC spokesperson, says that wastewater analysis complements other surveillance systems. “It can capture asymptomatic cases and other cases independent from medical systems, and provides a broader population-level perspective on disease spread,” she says.

The CDC’s program is set up so that, if RSV levels are high in a particular community, local health departments can prioritize interventions, including testing, infection control, and vaccination efforts.

Donnelly envisions wastewater surveillance becoming like a public health “weather app” where communities can check virus activity in their area and make informed decisions on behaviors like masking or vaccination​. “We want this system to be expanded across the United States so that everybody has access to wastewater information and add additional tools to keep themselves healthy,” she says. Hanage foresees wastewater analysis being used to track other communicable viruses, like mpox.

While there’s plenty of excitement about the technique, others are more cautious. “It’s one of those sciences that has got a lot of people really excited,” says Paul Hunter, a virologist and professor in medicine at the University of East Anglia. “You either think it’s brilliant or you think it’s pointless, and there’s very little in between.”

Hunter recognizes that wastewater analysis can pick up the spread of disease—and points to evidence that it did so in the Covid-19 pandemic—but questions whether the extra cost is worth the extra insights it provides. “Certainly in Covid, we didn’t think it was [necessary] in the UK, and I think that was the correct judgment,” he says.

But proponents say it’s worth it for RSV—especially given some of the challenges around drug shortages. Last year’s RSV season proved particularly vexing to the US health system, as shortages of nirsevimab, an antibody injection given to infants, were reported across the country.

There’s hope that things will be different when RSV season begins again in the coming weeks. “If you can get the information to hospitals or clinics weeks earlier, that gives the opportunity to start thinking about what treatments they might need,” says Donnelly.

[covid-safer-hotties]

Also preserved in our archive

By Jess Thomson

"Very high" levels of SARS-CoV-2—the virus that causes COVID-19—have been detected in wastewater samples in the U.S.

Between October 27 and November 2, wastewater sampling from New Mexico revealed "very high" levels of the virus, with "high" levels being detected in Oregon, Arkansas, and Maine, according to the U.S. Centers for Disease Control and Prevention (CDC).

Meanwhile, "moderate" levels were detected in Arizona, Colorado, Idaho, Kentucky, Massachusetts, Michigan, Minnesota, Montana, Nebraska, Ohio, South Dakota, Virginia, and Wyoming.

Additionally, 19 states have "low" levels, and 13 states and D.C. have "minimal" levels, according to the CDC.

(follow link to see interactive map)

However, South Dakota, New Hampshire, Mississippi, Pennsylvania, and Virginia all have limited coverage, meaning that "data for the most recent week are based on a small part (less than 5 percent) of the population and may not represent viral activity levels for the entire state," the CDC explains.

This data represents a change from last week, where "very high" levels of viral activity were detected in Montana, and "high" levels in Arkansas, Maine, Minnesota, Nebraska and Wyoming.

The level of viruses in wastewater, especially when tracking viruses like SARS-CoV-2, is used to gauge the presence and spread of infections in a community. By analyzing the genetic material (like viral RNA) present in sewage, scientists can estimate the number of infected individuals in a given area, including those who may not have been tested or are asymptomatic.

"Wastewater (sewage) can be tested to detect traces of infectious diseases circulating in a community, even if people don't have symptoms," the CDC states. "You can use these data as an early warning that levels of infections may be increasing or decreasing in your community."

This method is especially helpful for early detection of outbreaks, as changes in wastewater virus levels can indicate a rise in cases before symptoms appear in the population or testing data reflects the increase.

Map shows where coronavirus has been detected in the wastewater across the U.S. Dark red states (New Mexico) have "very high" levels, while red states are "high", dark orange are "moderate", light orange are "low" and yellow are "minimal".

National COVID wastewater levels appear to be the lowest they have been since June, although levels in the Midwest seem to be on the rise in recent weeks.

A recent surge in COVID-19 cases has been mainly driven by a new set of subvariants, known as FLiRT, named for the locations of mutations on the virus's spike proteins—the structures that allow it to enter human cells.

These spike proteins also serve as targets for the immune system and vaccines, so changes in their makeup may enable the virus to evade the body's defenses more effectively. However, current vaccines are still expected to offer some protection against severe illness and long COVID-19.

As of November 2, the leading subvariant, KP.3.1.1 made up over 45 percent of COVID-19 cases in the U.S. over the prior two weeks, while the new XEC variant accounted for 9 percent, according to the CDC. KP.3 made up 21 percent, JN.1 made up 10 percent, and "other" made up 15 percent.

"There is no evidence, and no particular reason to believe, that XEC causes different symptoms than all the other SARS-CoV-2 currently in circulation," Professor Francois Balloux, a computational systems biologist at University College London in England, previously told Newsweek. "XEC is not expected to cause more (or less) severe symptoms than other lineages currently in circulation."

While COVID levels across the U.S. have been dropping since the summer, the "high" and "very high" levels in some states may indicate that winter infections may be about to leap.

Symptoms of COVID, according to the CDC, include:

Fever or chills Cough Shortness of breath or difficulty breathing Sore throat Congestion or runny nose New loss of taste or smell Fatigue Muscle or body aches Headache Nausea or vomiting Diarrhea

[miscfandomwrites]

A/N: I wanted a road trip fic, and considering this idea has been gathering dust for about a month now I figured I could give it life. I love Carol Danvers-She’s my wife (Diana Prince is DC wife) and I’ve honestly lost track of how many times I’ve seen Captain Marvel. Not to mention the poster (I had, it got torn -_-), the keychain, THE HAT (Like in the photo! I have one!), the little lego figure, the lunchbox…. Yeah, she’s my wife. Also kind of a slowburnish fic for the first part. I am considering making this into a small series. 

Pairing: Carol Danvers x F! Reader

Warnings: Language, talk about COVID in USA. Dissing the USA’s government. 

Words: About 1.5k

Tagging: @tyler-t0t

Summary: After being cooped up in the tower for months during quarantine, you need to get out and get moving. You’re restless, and can barely fall asleep because of it. Then, Carol Danvers makes you an offer: A two-week road trip to see her friend and her god daughter. It’s two weeks straight in a car, with minor detours depending. With nothing better to do and the fact that you might rip your hair out if you have to stay inside for another fucking week-you accept.

~~

“I need to get the hell out of this tower.” I grumbled as I paced by the bay windows. Natasha watched in interest as my rapid steps thundered throughout the room.

“Well they’re still trying to find a cure for the virus. We can go out, but we need to distance ourselves and wear masks.” She replied, lazily picking at her nails.

“Yeah, but I need to get out of this city. As much as I love the bustle of New York, I need to get out - take a break from the noise, the smells, the city itself. I need to get out into the country again.” I said as I walked towards the kitchen.

Despite quarantine making almost everyone gain some weight, I had stretched and done nearly everything I could indoors. It included working out, and I was happy with the results of that hobby. Arts and crafts were burned out, as well as movies and tv shows. Actually, the only thing I really did anymore was swim and read. Everything else I’d done to the point of mental exhaustion.

I opened the fridge and pulled out a beer, ignoring the fact that it wasn’t even four in the afternoon yet. 

“Well, you could go on a road trip.” She said, her torso leaned back over the arm of the couch as she stared at me. Stretching like a lazy cat, she got up and silently padded to the kitchen. I handed her a beer and lifted myself up to sit on the island counter. 

She nodded in thanks and took a sip from it. “I’ve got nowhere and no one to go to, Nat. Not even Clint’s family, because if I have the virus I don’t want to give it to them.” I replied.

She nodded, remembering what we’d agreed on. 

“We can’t do anything to help. I’d actually look bad if we went out and did anything. The best thing is to stay here, and only if we’re absolutely needed, then we leave.” Steve said as he flipped through the folder on the table. We’d finally gotten the official word from S.H.I.E.L.D. about what we were supposed to do. Or rather, what would look good to the press. 

Cases were rising and it seemed everyday they doubled, or tripled, in some states. I wasn’t worried for anyone in the tower, save Tony because even though the man had a metal heart, I doubted he washed his hands often. 

“And in the meantime?” Sam asked him, flipping through his folder. Steve started listing off ideas and I tuned out, starting to look through my own folder. 

Inside were some lists and things we could do, put together by the ever-loving government. Most ‘Ideas’ included making  our social media presence known and trying to encourage people to stay home, followed by training when we didn’t have anything better to do. 

“I’m not going back home, not with travel restricted and asymptomatic people.” Clint spoke, his hands resting on the back of his chair as he stared blankly at the table.

“It’s going to be okay, Clint. As soon as we’re cleared and the lockdown ends, we’ll be off. Until then, no one gets to visit your family. It’s for their safety.” Natasha said, soothingly rubbing a hand  on his back.

First thing on my list was sleeping, because I’d barely gotten back from a six week mission when this shitstorm started. Staying home for a while sounded nice.

“(Y/N), what’s the first thing you’re going to do?” Bruce’s voice ripped me out of my thoughts. I gave him a small, sleepy smile and replied that I was probably going to sleep for a week or so. The doctor chucked and patted my shoulder as he left the room, the others slowly draining out.

I sighed as I flipped through the folder some more, rereading the paper until it was memorized. I headed out of the conference room and to my floor, only stopping to get some food from the kitchen. We might have a small kitchen on our floors, but the best food was kept in the main kitchen. 

I yawned as I set the basket and the folder down on the kitchen island, and headed to my room. I kicked my shoes off and practically collapsed on the bed. I was out before my head hit the pillow. 

“I know that Clint isn’t even going to them. It’s horrible, I have no idea why we’re still not on lockdown.” I said as I absentmindedly read the label on the bottle. 

Natasha sighed as she drained her beer, and tossed in the garbage. “Because our government is filled with horrible people who value their own wealth over the lives of others. Greed is what America has become.” She said over her shoulder as she headed to the elevators.

Where she was off to wasn't my business and I had a feeling she’d rather shoot me than have me find out about it. I stayed in the kitchen while I finished my beer, going through my ‘inspirational’ Instagram feed of people doing their routines and workouts from home. I grew tired of it rather quickly, and tossed my empty bottle in the trash. Maybe I should just delete social media in general. 

I walked out of the kitchen, busy enough deleting Snapchat and Instagram that I didn’t notice I was about to bump into someone until we collided.

“I am so sorry!” Immediately came out of my mouth as I stepped back, looking at the figure who was….

Carol freaking Danvers. 

I had no idea she was staying here, let alone that she was on this planet. 

“Hey, it’s no big deal. I was actually looking for you.” She said as she straightened her jacket. Her blonde hair was growing long, just barely running past her shoulders. Dressed in a pair of workout pants and her windbreaker with a white pair of sneakers - and the fact that she had her bluetooth headphones around her neck, it seemed like she just got back from a run outside.

“Me?” I questioned, raising an eyebrow. She grinned and I swore my heart shuddered at the sight. It wasn’t known that I had a moderate-to-severe crush on her, and as far as I was publicly concerned, only Natasha and Wanda knew about it. The latter had told the former. Damn mind readers.

“Natasha said you were about to go insane from being cooped up in here.” She replied, heading past me and into the kitchen. I turned and watched her start to make a protein shake.

“I’m taking a road trip to see my friend. It’s a two week drive, because she lives in the middle of nowhere. I was looking for someone to come along with me.” She said as she prepared her drink. 

My jaw opened and closed like a rusty gate before my brain finally registered the words and formed an answer to them. 

“Yeah, sure. When do we leave?” I asked. I finished deleting all the social media, save Pinterest, Tumblr, and Youtube off my phone. Bye-Bye snap streaks. 

“Tomorrow. I was figuring we’d stop and get some snacks before we headed out on the road. You’re not allergic to cats, are you?” She asked me, sipping her drink. 

I shook my head. A two week road trip with my crush? Holy shit…

She nodded at me. My phone buzzed, and with a glance I knew that Natasha had set me up for this.

Wow. Sometimes you love your red headed assassin friends. 

“Okay then. Guess I’ll go pack.” I said as I turned, headed for the elevator. 

Holy shit. 

[follow-up-news]

Americans with well-treated HIV can no longer be barred from enlisting in the U.S. military, a federal judge ruled Tuesday, striking down the Pentagon’s last remaining policy limiting the service of those with the virus.  “Defendants’ policies prohibiting the accession of asymptomatic HIV-positive individuals with undetectable viral loads into the military are irrational, arbitrary, and capricious. Even worse, they contribute to the ongoing stigma surrounding HIV-positive individuals while actively hampering the military’s own recruitment goals,” wrote Judge Leonie Brinkema of the U.S. District Court for the Eastern District of Virginia. In her ruling, Brinkema mentioned her landmark 2022 decision that ended the Defense Department’s long-standing policy of forbidding service members who were diagnosed with HIV after enlisting from deploying in active duty outside the continental U.S. and being commissioned as officers. “Modern science has transformed the treatment of HIV, and this Court has already ruled that asymptomatic HIV-positive service members with undetectable viral loads who maintain treatment are capable of performing all of their military duties, including worldwide deployment. Now, defendants must allow similarly situated civilians seeking accession into the United States military to demonstrate the same and permit their enlistment, appointment, and induction,” she wrote.  ​​Research has shown that people with HIV who have an undetectable viral load thanks to antiretroviral treatment, as is the case for the vast majority of people on HIV treatment, cannot transmit the virus to others through sex. Advances in care and treatment of the virus have extended the lifespan of people with the virus to near normal. People with well-treated HIV are effectively healthy. However, they are still at higher risk of various health conditions related to aging, including heart disease and various cancers.