Marc Johnson Profile picture
Jun 4, 2023 15 tweets 4 min read Read on X
Ohio cryptic lineage update.

We’ve made no progress identifying the individual, but we have learned a few things.
1/ Image
First, the signal is almost always present in the Columbus Southerly sewershed, but not always at Washington Court House. I assume this means the person lives in Columbus and travels to WCH, presumably for work.
2/ Image
Second, the signal is increasing with time. Washington Court House had its highest SARS-CoV-2 wastewater levels ever in May, and the most recent sequencing indicates that this is entirely the cryptic lineage.
3/ Image
Third, I’ve tried to calculate how much viral material this person is shedding. (Multiply the cryptic concentration by the total volume). I’ve done this several times and gotten pretty consistent results.
They are shedding a few trillion (10^12) genomes/day.
4/
What does this tell us? How much tissue is infected? It’s impossible to know for sure. Chronically infected cells probably don't release much, but acutely infected cells produce a lot more. I gather a typical output in the lab is around 1,000 virus per infected cell.
5/
If we assume we are getting 1,000 viral particles per infected cell, that would mean there are at least a billion infected cells. The density of monolayer epithelial cells is around 300k cells/sq cm. A billion cells would represent around 3.5 square feet of epithelial tissue!
6/
Don’t get me wrong. The intestines have a huge surface are and 3 square feet is a tiny fraction of the total.
But it’s still a massive infection, no matter how you slice it.
7/
I do not know of any persistent infections that shed this much virus without killing the patient. (Correct me if I’m wrong). The closest would probably be HCV, an infection that often ends in liver cancer.
8/
My point is that this patient is not well, even if they don’t know it, but they could probably be helped if they were identified.
9/
How do you figure out if you have a COVID GI infection. Most rapid antigen test are not explicitly for stool. However, I know of at least one that is. The instructions from that test say to mix a ‘matchhead’ worth of feces with the buffer.
10/

dyonmedical.com/en/corona-ag-a… Image
I can tell you that with very positive wastewater samples we got a positive by just sticking the swab into the wastewater before adding it to the buffer. Either way, it is essential to use the buffer provided or the test doesn’t work.
11/
If you do get a positive reading, I would suggest having someone else try with the same kind of test with their feces to be sure it isn’t a false positive. Weird shit happens.
12/
If you are the individual, let me know. There is a lab in the US that can do 'official' tests for COVID in stool, and there are doctors that I can put you in contact with that would like to try to help you.
13/
What's more, if we can figure out how these infections occur, and how to treat them, it could potentially help out a whole lot of people.
14/ Image
Two comments I should have made in my thread.

Washington Court House is a town of 15k (not an actual courthouse).

I haven't invaded anyone's privacy. Approximately 1600 people commute between Columbus and WCH. That isn't enough information to pinpoint the source.

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More from @SolidEvidence

Aug 22
It’s been 2 days, 143 comments, and I’ve been called lots of bad names.
Here’s what I learned about protein based Novavax (NV) vs mRNA COVID vaccines.
1/
The pretty universally agreed on difference is that Novavax has fewer side effects.
If you have bad vaccine reactions, it is probably the better choice.
2/
There are other differences too. NV is protein based, so the immune response is antibody focused, while the mRNA is response is broader and produces both antibodies and CTLs.
3/
Read 11 tweets
Aug 17
It’s been 2 years since BA.2.86 first appeared (and I’m give the variant update to SAVE on Monday), so I thought I would do a little summary about this era of SARS-CoV-2 evolution.
1/ Image
SARS-CoV-2 lineages come up with new constellations of mutations in 3 main ways.
1. Sequential acquisition of mutations during normal circulation.
2. Recombination.
3. Sweeping new lineages (almost certainly from persistent infections).
2/
BA.2.86 was one of the sweeping changes. When it first appeared in Israel I thought it was a persistent infection, most of which never spread. Then it appeared in Denmark too.
3/
Read 13 tweets
Aug 16
I read @EricTopol's Super Agers book while we were traveling this summer.

Wow. That was the most rigorous (>1,500 refs), comprehensive, and bullshit-free book on health I’ve ever seen.

Too much info for a thread, but I’ll mention some highlights.

1/simonandschuster.com/books/Super-Ag…
Fact 1, it’s not just genetics.
@EricTopol spent years sequencing the genomes of the ‘wellderly’ (people over 80 that have never had a chronic illness) to find the genes associated with healthy aging.
Their conclusion – there wasn’t much there. It’s not just genetics.
2/
Fact 2, intake matters.

1. Drinking coffee has real health benefits (who knew?)
2. Drinking alcohol really doesn’t (bummer)
3. Ultra Processed Foods (UPFs) are REALLY bad for you. It goes well beyond being empty calories.

3/
Read 10 tweets
Jul 18
A 'new' Texas cryptic lineage popped up this week.

We've got another traveler.

1/ Image
This one was from a Texas sewershed from July 1 with a population of 1,000,000, which means it had to have been one of the Dallas sewersheds.

2/ Image
It's a little surprising we found this one because the sequence coverage was kind of spotty.

It popped up in one of our screens because it had a few mutations that we've only seen in cryptics so far.
3/ Image
Read 11 tweets
Jul 9
I've always found this frustrating.

You or your child has a respiratory infection. It's not flu or COVID. Your doctor can only tell you, 'you have a virus'.

Could it be a little bit more specific?

We hope to help answer this question, non-invasively, and for free.
1/ Image
Contrary to my prior assumptions, many of the most common pathogens are not everywhere, all the time. They occur in discrete waves, often nationwide.

I wrote about this recently with Rhinoviruses, the most frequent cause of the common cold.

2/
As promised, we've now added a standalone readout of the rhinoviruses on our wastewater dashboard.

3/
lungfish-science.github.io/wastewater-das…Image
Read 10 tweets
Jun 29
This is cool. I was poking around at the Rhinovirus (common cold) data and realized that my perception about these viruses was completely wrong.
1/ Image
Rhinoviruses (Rhino is Greek for nose) are picornaviruses in the enterovirus genus (same as polio). Enteros can be GI or respiratory (or both), but Rhinos are usually respiratory, and are the main cause of the common cold.

2/cdc.gov/rhinoviruses/a…
There are 3 species of Rhinoviruses (A, B, and C), and over a hundred antigenically distinct serotypes.

3/en.wikipedia.org/wiki/Rhinovirus
Read 16 tweets

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