I'm not close to the monoclonal treatment stuff but I did see this in my feed today:The spousal unit just got a call from her doctor telling her she has COVID and needs monoclonal antibody treatment... which we cannot find available anywhere! There are plenty of clinics around that offer it, including all local hospitals, but the Alabama Dept of Public Health is only sending 6 treatments per week to each facility, and therefore the waiting list is VERY long!
She is a diabetic, plus she has asthma and pneumonia so is high risk... and she cannot get the meds she needs. This seriously sucks!!!
Chuck, I meant to ask in my prior note, have you heard much about monoclonal treatments and Omicron?
Can I catch BA.2 after having BA.1 or am I immune after having the prior infection?
Chuck, have you heard about any use (or any trials) of ACE-2 inhibitors/blockers? I used to have high blood pressure, so I'm somewhat familiar with these drugs.
The "spike" protein attaches itself to the cell wall at ACE-2 (angiotensin converting enzyme) sites, and is able to enter the cell there. ACE-2 sites are found throughout the lining of the lungs, throat, and nose (and a bunch of other places). Binding of the virus to the ACE-2 sites in the heart may be responsible for the damage seen there.
Chuck, are you seeing many people testing positive on PCR after they are fully recovered? I know this has been reported on, but I don't have a feel for is that 1% of people and it just grabs attention, or is it rather common. If you are seeing this kind of thing, how long do these post-infection positives typically last?
As I understand it, the issue from your second point does not make it harder to find the virus, but it removes a marker that allowed to infer the Omicron variant in PCR assays (S-gene dropout). One practical implication is that it makes it harder to decide wether a patient should receive certain monoclonal antibodies that are effective against Delta but not a good use of limited resources against Omicron.Three observations on BA.2:
- I believe it will be no different in hospitalization and death. I expect the mild lineage to be similar.
- PCR will be less effective at detecting the virus. A deletion caused a change that alters part of what we look for when testing for COVID.
- Vaccines may be less effective against the subvariant. It has similar changes to Omicron and these changes may be similar or slightly worse than its sister.
As I understand it, the issue from your second point does not make it harder to find the virus, but it removes a marker that allowed to infer the Omicron variant in PCR assays (S-gene dropout). One practical implication is that it makes it harder to decide wether a patient should receive certain monoclonal antibodies that are effective against Delta but not a good use of limited resources against Omicron.
In case anybody is interested:
(Please take with a grain of salt, I'm not an expert, just interested)
PCR tests are targeting parts of the virus genome, instead of analyzing the whole genome like gene sequencing. Those targets are only detected when an exact match is found. If the target is mutated, it can escape detection.
To ensure infections are not missed in case of mutations, manufacturers usually select multiple targets and at least one target that resides in a stable region that is unlikely to mutate. One example is the N-gene (for the nucleocapsid). The N-gene of SARS-COV-2 is still quite similar to other bat-associated betacoronaviruses like the original SARS-COV-1.
Other genes like the S-gene (for the spike protein) are more likely to mutate. If such a mutation affects a target, S-gene target failure (also called S-gene target dropout) happens. So when a PCR test doesn't find one of its targets but confirms the presence of other targets, this is an indication for a different variant.
This is how the Alpha variant was initially noticed in the UK, before it was confirmed by sequencing. Apparently, the UK just happened to use a test widely that was affected by the S-gene dropout. The UK also sequences a lot more than most other countries.
Like Alpha, Omicron subtype BA.1 has a deletion on the S-gene at 69-70 that causes S-gene dropout on certain PCR tests. This deletion is not present on the wild type, Delta and Omicron subtype BA.2. Therefore Delta and Omicron BA.2 can't be distinguished with those PCR tests, but I guess one could create specialized PCR tests for that purpose. Sequencing also works regardless of variant, but is not as widely available.
Further reading:
About PCR target selection
Manufacturer information of a variant selective test
Reinhard
Does the vaccine help against Omicron?
Thanks. A good reminder of why to get the booster.
Yes. It plateaued in GA but it not dropping yet. My prior thoughts were premature.Here's some encouraging news. Omicron appears to be well on the decline in Florida. The 7 day average new cases dropped below 30k. It hasn't been that low in a month. If this trend continues, COVID may become endemic and manageable like the flu by spring.
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We do not have excess so any deployment creates a hole somewhere.
What do you mean by research does not account for behavior changes?
I saw a 60 Minutes episode about the success of a COVID treatment in the military hospitals. What can you tell me about it?
Two questions:
1. My limited understanding of the SARS outbreak in '05 is that it petered out because the virus mutated into a less virulent strain. In fact, a vaccine was developed but never put into production because it was not needed. Why haven't we seen the same happening with the covid virus? And could it peter out and disappear with future mutations?
2. We obviously weren't prepared for this. What changes can we implement to mitigate the economic and social impacts of a future pandemic? What can we do to be better prepared?
Chuck, I recently received an advertisement from CVS stating that the CDC has recommended a second booster for those who have had COVID-19. Is this reliable information? Should I seek a second booster since I've tested positive and am now asymptomatic?
The medical community is better prepared with contingency plans. Our plans allow us to institute testing and treatments in novel ways. I have unique training and we were able to stand up testing and treating in 7 days. Most facilities took a little longer. Most have maintained lessions learned and can do this again.
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