Kathryn writes:
Dear Twiv,
I was very interested to learn about coal dust impacting the health of neighborhood communities in Epitope 1141. Yet another example of how particulate air pollution is terrible for our health. (https://arstechnica.com/science/2024/07/coal-pollution-is-killing-people-even-when-were-not-burning-it/).
One of you commented that coal trains will continue because “coal is cheap”. Let me hasten to bring you good news. US coal use for electricity generation is in freefall precisely because coal isn’t cheap when compared to other sources of energy. (https://ember-climate.org/). As you can see below, coal used for electricity generation has dropped from 2000 TWh to about 600 TWh since the year 2000 in the US. According to the IEA WEO 2023 (International Energy Agency World Energy Outlook), wind and solar are the cheapest new source of electricity in most of the world and coal use for electricity generation is most of coal consumption. (Page 147 https://www.iea.org/reports/world-energy-outlook-2023) See how this happened at Our World in Data. https://ourworldindata.org/cheap-renewables-growth
Unfortunately for the communities studied in that particular report, a lot of the coal that goes to the port cities of the west coast is metallurgical coal and is exported for making iron. While there are significant efforts to decarbonize steelmaking, it is still early days for that industry (though recycled steel can be very low carbon already).
I could go on, but I thought I would keep this little romp through the energy transition as succinct as possible.
Yours very sincerely,
Kathryn in Seattle, home of the Nucor electric arc furnace
Anonymous writes:
Dear TWIV team,
(Please redact my name and affiliation), I hope the following answers some questions and expands on some of the things the TWIV team raised about mpox in your last episodes.
I am a public health official from a G7 country and just wanted to clarify a few points that you have been discussing about mpox.
The Public Health Emergency of Continental Concern: (PHEC) This is an Africa CDC declaration // as the public health organisation of the African Union. This is a new power from them. This is separate to the WHO’s declaration of a Public Health Emergency of International Concern (PHEIC). From an external view, Africa CDC declared a PHEC to put pressure on the WHO to declare a PHEIC in order to receive external support that has been far too lax in recent months. The DRC mpox situation has been monitored for quite some time now in my country.
Mpox Clade Ia / Clade Ib: Clade Ia as you have described historically has a CFR of 10%. Its thought to be mainly zoonotic jumps from animals to humans and limited human-human transmission.
Clade Ib is centred in the east of the DRC at the moment in North & South Kivu. It arose out of a mining town in South Kivu, likely spreading to the provincial capital and then back to the mining town. Whilst it appeared to have arose through prolonged transmission in humans and through hetero-sexual contact // close contact, it is concerning that it has spilled over into children. It is fairly obvious / incorrect to say children are having sexual contact. It is more likely they have been infected through close contact in their family and likely children playing together/the close contact is causing the spread.
There is also limited publicly available info, but I can tell you in confidence that the CFR increases as patient age decreases. Ie the average CFR for the entire DRC for mpox is c~3.5%. In children, this goes to as high as 8% as age decreases from 15 years and younger.
There are many unknowns, such as exact modes of transmission (fomites), limited aerosol (?). Vaccine efficacy, none have yet to be conducted with Clade I mpox.
Public health is concerned that it appears clade Ib mpox is spreading out of “isolated” clade I outbreaks and GBMSM and limited transmission chains and into more vulnerable populations such as children. The African population also has a subset with co-morbidities with HIV etc and we have seen limited data that clade II mpox can have a high CFR -> see recent South Africa clade II cases with a CFR of 12.5% in GBMSM that also had HIV.
Spread: Sweden’s case limited public details. Thailand’s reported case had recent travel from the DRC, more specifically Bukavu which is the provinical capital of South Kivu (the epicentre of Clade Ib cases).
Kenya has detected 2 cases, particularly concerning its border with Uganda. Uganda has now reported 4 cases (+2 since first detection at the beginning of the month). Burundi has reported over 170 cases spread across the country.
Open source epidemic intelligence monitoring suggests that Uganda has alot more unreported or unknown cases. The risk is international spread via the countries bordering the DRC that have more/better travel links to other countries.
Ruth writes:
Hi,
Recently, an infographic that I made about Mpox went viral on Twitter. (see https://x.com/CatchTheBaby/status/1825741995303907450) One of my colleagues from the Stanford Long COVID clinic, Bob Shafer MD, recommended that I share it with you.
I also write a weekly newsletter on COVID, Long COVID and other infectious diseases at https://drruth.substack.com/.
Sincerely,
Ruth Ann Crystal MD
Adjunct Clinical Faculty, Stanford University School of Medicine
John writes:
Hello Twiv Team.
At the end of episode 1153 there were some statements that Dr Baric had correctly predicted that SARS-CoV-2 would become an endemic virus taking its place along side the other common cold Coronaviruses. I have been thinking about this topic for quite a while now as I remembered Dr Baric’s statement in episode 591. I’m not sure SARS-CoV-2 has reached that point yet.
I think in general, no one worries about getting a cold. You feel bad for a couple of days, crummy for a few more and then back to normal. Each time you get a cold you expect the same outcome. You don’t need annual or semi-annual vaccines, anti-virals or worry about ending up in the hospital or worse. As Dr. Griffin shares with us on his weekly update, people are still dying from COVID because they were not offered Paxlovid. You may get COVID multiple times and your symptoms with the next infection may not be predicted by your prior infections. I have had COVID 3 times so far and the symptoms each time were different.
To me, it does not seem that SARS-CoV-2 is ready to be considered a common cold just yet. Am I missing something?
Kind Regards,
John
Tom writes:
In https://www.microbe.tv/twiv/twiv-1142/
One question for all including Paul Offit
Reactogenicity is a real thing.
I like to think that mRNA vaccines are “too good”.
As a senior I am offered a flu vaccine that is 4x a standard dose.
A standard dose of influenza vaccine hardly bothers my arm.
I cannot tell a 4x dose from a standard dose except when the volume of the injection is larger.
I would love to see data on a pair of child dose SARS-CoV-2 mRNA vaccine
administered 8-12 weeks apart. Brianne Barker, Ph.D noted years ago that first opportunity to obtain T & B cellular immunity was ~4 weeks but mused what is optimum. Hints from the early inventory stretch in the UK could put optimum at 12 weeks. Overlay this T & B cellular immunity musing the levels of antibodies that retreat over time and one MIGHT see a better immune response. Especially in elder care facilities where the effective R(e) might be high because of air flow, density of residents, staff contact with nearly “all residents” in a shift.
Antibodies are easy to measure. Cellular immunity testing is easy in a “rare” subset of labs.
We are or soon will pass the urgent pandemic situation where “first opportunity” can yield to optimization. Any vaccine product could see this tactic applied, obviously compliance or lack should be pondered.
Regards,
Tom
PS
67°F
Precipitation: 1%
Humidity: 56%
Wind: 5 mph
. 19°C
—
T o m M i t c h e l l (on NiftyEgg[.]com )
Jerod writes:
Hi viriiphiles!
I just finished the episode and you discussed some preserved microbes most likely in lung samples. There is a tour you can go on here in Seattle underneath the city and see the wooden pipes that were used for sewage long ago. (1930’s)
(https://pauldorpat.com/2020/01/23/seattle-now-then-water-from-lake-youngs-1930/)
It is not as old as the lungs in your show today, but it I’m still struck by the potential value of the microbial history waiting inside.
(The tour guide was a little surprised to see me grinning at wooden sewer pipes)
-Jerod in Seattle
John writes:
Drs TWiV:
Because I listed my long-ago post-doc at Karolinska on my Linked-In page, I periodically get notifications that someone from KI has posted something. I thought you might find this one interesting, from Peter Andreasson , Director of Communications at KI (L-I’s translation), since it touches on one of the themes of TWiV:
“I wrote it in a previous post, but it deserves to be repeated. At times when there is uncertainty, there is potential worry and fear, and there are many questions, it is especially important that those who have expertise make themselves available, communicate and share their knowledge.
In recent days, I have seen, heard and read many interviews about the outbreak of mpox with researchers from Karolinska Institutet. It makes me proud to note that our employees at KI take “the third task” – collaboration with the surrounding society – very seriously.
Many thanks to Johan von Schreeb (https://www.linkedin.com/in/johan-von-schreeb-25899282/ ), Anna Mia Ekstrom (https://www.linkedin.com/in/anna-mia-ekstr%C3%B6m-4a3a119/ ), Matti Sallberg (https://www.linkedin.com/in/matti-sallberg-529203121/ ), Helena Hervius Askling (https://www.linkedin.com/in/helena-hervius-askling-a279bb189/ ), Ali Mirazimi (https://www.linkedin.com/in/ali-mirazimi-845846a1/ ), Jan Albert and others. Through your efforts, facts and evidence are given a clear and obvious place in the flows and noise. And the world is getting a little better.”
Maybe you even recognize some of those names?
Otherwise, with another of TWiV’s favorite topics, here’s the WaPo today on the recent climatology: https://www.washingtonpost.com/weather/2024/08/28/quiet-hurricane-season-storm-risks/
Cheers,
John
Adrianne writes:
Hi TWiV!
Listening to the new episode discussing the Polio outbreak in Gaza and something was just brought up that I am a little concerned about…
I distinctly remember getting OPV as a child in the 80s. Core memory. I thought it was candy drops.
Y’all just said OPV used to be used but now the standard is IPV. Wondering if I should figure out how to rustle up IPV vaccination for myself and the rest of the elder millennials? I have had TDAP booster – but I think not all of them include Polio? I’m quite sure I had Boostrix TDAP when I was pregnant 10 years ago & I am also pretty dang sure it does not include Polio.
Just wondering if you have any insight as to this?
Adrianne