Hi TWiV Team,
Thanks again for all that you are doing. I am really looking forward to this week’s discussion about Vitamin D with Dr. Griffin.
Vitamin D is considered a marker of coexisting conditions and frailty. That fact confounds the associations of low vitamin D levels with critically ill patients when looking at Vitamin D replacement as a modifiable risk factor. I refer you to the RCT phase 3 trial published by NEJM last fall which showed no statistical benefit for early high dose Vit D administration vs. placebo with respect to 90-day mortality or other nonfatal outcomes among critically ill, vitamin D-deficient patients.
The practice of medicine would become a stilted narrow endeavor with very little joy if we were guided by ironclad evidence to guide every decision. Many clinical questions will never garner the interest or the funds for evidence based trials. At best a wise clinician will be guided by the best science tempered with judgement that is often seasoned with anecdotal input. The older we get the more tempting that expanding body of anecdotal experience becomes. We are human.
With that in mind it is a particular challenge to step into the murky waters of Vitamin D science. It is a pond clouded with previous high hopes and disappointing reversals. I’ve got a bottle of vitamin D sitting on the shelf. Outdated probably. I am tempted to reach for it but haven’t yet. I still might.
Stay well and thanks.
“Hello Everyone!”, one of my favorite Dr. Daniel Griffin’s quotes.
The temperature is 72 degrees Fahrenheit and cloudy, 24 Air Quality (AQI) US, but it could be 94 degrees by 3 pm without any warning in Oklahoma.
Since February, my family and I are now dedicated listeners and fans of the show. We look forward with anticipation to every new episode and enjoy listening to all of your banter! Of course, we also have your merchandise for the family, coffee cups, and T-shirts. If you make an umbrella in the future, I will buy it, or baseball caps, my sister- in- law will.
My questions for Dr. Griffin, since he is around many people with the SARS CoV-2, what preventative steps does he take at home to prevent spreading the virus?
—–Would he do anything else in addition to that regarding at-home prevention if he had a family member at increased risk, i.e., transplant recipient, autoimmune diseases, Lupus, and MS in particular?
—–Since March, with more time passing and data accumulated, do people with autoimmune diseases have increased morbidity and mortality if they contract COVID?
—–If the answer is yes, how so, at what part of the progression of COVID-19 and are they at increased risk for a cytokine storm?
The show makes me proud of my degree in biology, and I wonder what my life would have been like if I had picked a career path in research. However during my undergraduate time back in the 80s, I did some extra work in the lab with mice in cages, and I quickly learned I have issues with rodents!
Thank you for all your time, energy, and work to produce such an informative and enjoyable show!
PS Waiting impatiently at home for the home rapid saliva test!
Hi TWIV team.
I understood that the viral load at which an Antigen test becomes positive is of the order of hundreds of thousands of viral particles and that this is likely still below the infectious viral load.
I am a GP in the Northern Territory of Australia. We currently have no community spread of SARS CoV2. It is likely we will have devastating outcomes if this virus makes its way into the NT and particularly beyond the confines of the main population centre of Darwin as we have significant populations of Indiginous peoples at great risk from COVID-19 living in close proximity to each other with much movement within and between communities. All our testing is currently PCR with major logistical barriers related to capacity in the remote clinics and distances.
It would seem an perfect scenario for use of rapid cheap Antigen testing on a frequent basis if this were to demonstrated to be effective. How good is the evidence to support the assertion of an Antigen test reliably becoming positive before someone is infectious or in other words the false negative rate of an Antigen tests detecting someone who is infectious. I expect this is currently impossible to know certainly but I would be interested in your opinions.
Is Antigen testing ready for Prime Time? If so which?
Many thanks for your wonderful podcast.
Dear beloved TWiVers,
You are the perfect roundtable to discuss the POTUS SARS-CoV-2 hotspot.
Is this not the perfect study of the COVID-19 phenomenon?
The office of POTUS is seemingly well prepared to measure all aspects of the process.
1) The behavior of the central figures is recorded in detailed photographs and video(?).
2) There is rapid and PCR testing available prior to and after the discovery of the hot spot.
3) The contact tracing may well be well recorded in all the official and personal calendars available.
4) The event is of historic consequence?
What are the points for and against this being a ‘golden opportunity’?
I am sitting on the edge of my seat waiting for you ‘guys’ and ‘gals’ to deal with this one. I hope, I hope, I hope!
-·. .· ·. .><((((º>·. .· ·. .><((((º>·. .· ·. .><((((º> .··.· >=- =º}}}}}><
Joseph G. Kunkel, Emeritus Professor
Thank you so much for adding knowledge and joy on my drive to and from work.
I could not help but wonder when in a recent episode it was mentioned that OC43 jumped to humans perhaps as late as 70-120 years ago that the time of the flu pandemic of 1918 is in that period. Wonder if anyone has ever looked at if this jump was coincident with the novel flu strain making it a double whammy.
Also with far UVC I wonder about cataracts with long term use. Short term no damage in the lab but everyday in a medical setting makes me a bit cautious long term.
Thanks to Alan for the info on the vaccines. I had to give a talk to my office staff about the upcoming vaccines and it really helped!
64 F and nice outside in Murfreesboro TN
Eric Clark MD
MTSU Student Health Center
Hi TWIV crew,
In episode 666 you discuss the use of far UV 220 nm lighting for sterilization. This is only the second episode I have listened to so far, but I’m already hooked.
I think the use of far UV 220 nm is very exciting work and I agree that it could be quite helpful in public places. I’m not sure how I feel about common use in private homes over extended periods, particularly when those homes hold young children with naive little immune systems in need of a quality education. I believe a few studies have shown now that early exposure to a wide variety of microbes is critical to a healthy and robust immune development. Can you comment on the use of this sort of continual sterilization in the home environment as it pertains to issues tied to an uneducated immune system?
Also, along these lines, microbiota of exposed skin surfaces would presumably be affected. I believe skin microbiota may be important in education of the cutaneous immune system, not to mention the role of a healthy skin microbial community in inhibiting colonization of potentially harmful visitors that would love to set up residence. Presumably skin surfaces protected by clothing would not be affected, and so one may argue that sterilized areas could easily be re-colonized. However I believe microbial communities may vary on different skin areas. Could you comment on the effects of continuous UV sterilization here as well?
Dear Vincent and friends,
Regarding your discussion of the Russian SARS-CoV-2 vaccine, I want to make three comments:
First, you did not emphasize this, but the trials described in the Lancet article can hardly be described as Phase 1/2. The liquid vaccine and the lyophilized vaccine have to be treated as different products because they follow different manufacturing processes. Thus, one should not bundle the results of the two together and the actual trial of each vaccine involved not 76, but only 38 people. Of these 38, 9 received Ad5, 9 received Ad26 and 20 received both. Authors call the first 9 and 9 as Phase 1, but that is not accurate. Since their final vaccine product has both Ad26 and Ad5, these first 18 people should not be called phase 1 trial of the vaccine. The 20 people that got both Ad26 and Ad5 are the true phase 1 participants. To be clear, the vaccine was “licensed” based on the data from these 20 volunteers, which barely qualifies as Phase 1, and is certainly a major stretch to be called phase 2.
Second, you were not sure what were the issues raised about the data in the Lancet paper. Here’s the link to the Letter to editors with these concerns: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31960-7/fulltext (it has a link to the helpful Open Letter highlighting the exact issues they identified). And here’s the link to Author’s Response: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31970-X/fulltext, which seems quite reasonable to me. I don’t see any serious problems with the data, but you can make your own judgement.
Finally, you were curious about the status of the vaccine in Russia. Being from former Soviet Union, I follow Russian news pretty closely and can tell you that the phase 3 trial began on September 9. 40 thousand people are expected to be enrolled and the last I heard they were up to 4-5 thousand. It’s not clear whether anyone is getting vaccinated outside of the trial, but I seriously doubt it. Various folks from Russian government (and even Putin’s daughter) claim to have received the vaccine, but it’s certainly not available en masse yet. One can only hope that it won’t be until the trial is done. We’ll just have to wait and see. The institute that developed the vaccine is not a pharma company, so it would have to transfer the technology somewhere before mass production can begin.
Yegor Voronin, PhD
Chief Operating Officer
Worcester HIV Vaccine
I have a cousin in Russia who has not been tested (I am not sure what is the testing status there) but feeling mildly sick all week (she said symptoms are unusual and come in waves). So by the end of the week she decided to stimulate her immunity with over-the-counter-available drug Kagocel (I looked it up-it stimulates interferon production). She takes 4 tablets in one evening and next day -high temperature, difficulty breathing head-ache, and intermittent running nose….
So my question is can interferon boosted in the middle of COVID-19 progression tip over someone into worse symptoms?
Also, I am fearing she is going to continue self-medicate (it is a custom there – lots of drugs, if any, require prescription). So far I suggested to limit herself with vitamin D and paracetamol…
Thank you so much in advance for your response. Really appreciate your time
NB: Interesting info: I asked my cousin why wouldn’t she take Russian anti-covid vaccine? She said only those who are willing commit suicide are taking it…. – so here is general public attitude to home vaccine there ☹