There will need to be separate diagnostic criteria for long-COVID sufferers and for those who recover from COVID and have long-lasting secondary effects... this will require new drugs and biologics to rejuvenate damaged tissues, not just manage viral load.
Additionally, edge cases which will be increasingly more common e.g., autoimmunity (whether precipitated by COVID or pre-existing and exacerbated) — will require new looks at autoimmune dampening strategies.
It would be a bad move to simply continue classifying COVID as a binary outcome of survival vs. death, and hospitalization or not. Our entire healthcare system needs to be revamped to prioritize improving people’s health and preventing chronic conditions, not just treating them.
With 10 organ systems affected and more than 200 symptoms presenting among COVID sufferers, the rush to sweep the pandemic under the rug in light of vaccination while tens of millions of people have been infected in US alone may be this generation’s greatest public health threat.
We somehow are forgetting about long-term damage of this virus...
This is not a good time to deprioritize the development of therapeutics. We need everything we’ve got to combat latent and long-COVID infections as well as acute infections and persistent health issues in people recovering / recovered from COVID. Regenerative medicine is needed.
And, the emphasis on drug development should not just be on addressing the needs of hospitalized patients. Clinical trials and treatment protocols should evolve to enroll and support minimal need for clinical oversight during drug administration (e.g. IV vs. other MOAs).
Of course this is different in early safety studies with certain compounds, but as medicine evolves so will its precision and minimization of side effects.
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Nicotine exhibits 6.6-fold stronger binding for ACE2 in the presence of the SARS-CoV-2 spike protein, and reduces the binding affinity of the spike protein for the ACE2 receptor.
The effects of nicotine on increasing antibody binding affinity to the SARS-CoV-2 spike protein in competition with ACE2 should also be explored.
With new variants exhibiting even stronger ACE2 binding than the original strain of SARS-CoV-2, and while coupling these findings to the decreased binding affinity of neutralizing antibodies to some of the new strains, nicotine may end up serving an immune-enhancing purpose.
An analysis of 96,057 COVID-19 cases among a ~1.5 million population between March and December of 2020 found a 50% increase in cases during days of low wind speed (<5.5mph) than on days of high wind speed (>5.5mph).
This is an argument for mask wearing.
It will be good to see more data that accounts for individual time spent outdoors versus indoors over the course of a week or two, and integrating contact tracing data and the like. And, creating better assays in outdoor environments to simulate breathing and exposure thresholds.
In the above study, they adjusted an 8-day moving average case count to account for lag between infection and presentation of symptoms.
Some research on changes in neutralizing antibody potency of some SARS-CoV-2 variants of concern (VOC): namely, 1) E484K, 2) N501Y, 3) ∆69/70 + N501Y + D614G, and 4) E484K + N501Y + D614G. Out of these VOCs, E484K mutants are showing greatest escape potency for vaccinated serum.
N501Y:
"The N501Y mutation in SARS-CoV-2 spike leads to morbidity in obese and aged mice and is neutralized by convalescent and post-vaccination human sera" medrxiv.org/content/10.110…
Recalling a conversation with a successful biotech founder who had raised several hundred million with 2x exits, asking what I can do to move things forward faster. He told me to stop and smell the roses.
Good reminder that working more doesn’t always make things move faster.
Certainly, the founder mindset should be “what else can I do,” and setting up to do the critical things at superhuman speeds. At the same time, especially when it is a long game, the clarity of silence and resetting your mind can lead to hyper-productive, time-saving insights.
“[W]e've come to believe that world-class performance comes after 10,000 hours of practice. But that's wrong. It comes after 10,000 hours of deliberate practice, 12,500 hours of deliberate rest, and 30,000 hours of sleep.”
Compiling some research on risk of antibody-dependent enhancement (#ADE)...
It's important to emphasize that this does not reflect support of vaccine hesitance, and that the data on vaccine efficacy is extremely good.
[Thread on recent scientific articles to keep in mind...]
It would be good to include broader antibody panels separating "good" neutralizing antibodies from potentially deleterious antibodies and correlating this to strain emergence... the concern is not just the neutralizing sites at the ACE2-binding interface and "good" antibodies.
While the public health benefit of vaccines is huge, and COVID is orders of several magnitude more dangerous to older populations than vaccination, we should remain vigilant about these potential issues emerging over time, and preempt the problem with better immunomodulators.
Phenomenal paper from the @jbloom_lab exploring neutralization by antibodies from recovered versus vaccinated individuals and examining all possible mutations at the receptor binding motifa—the portion that binds to ACE2–of the virus.
Using yeast display technology, where the yeast fluoresces, they expressed a few thousand mutant versions of the spike protein receptor binding domain and exposed each mutant to serum from convalescent vs. vaccinated individuals.
They then took key mutants and infected ACE2-expressing cells with pseudotyped lentiviruses producing each key receptor binding domain.