I’m pleased to share my Commentary on the newly published *positive trial* finding metformin decreased Long Covid (Dr. Carolyn Bramante + ⁦@boulware_dr⁩)!

The therapeutic validation of long COVID. Lancet Infectious Diseases ⁦@TheLancetInfDis⁩ thelancet.com/journals/lanin… “First, to our knowledge, this is the first high-quality evidence from a randomised controlled trial to show that the incidence of long COVID can be reduced by a medical intervention, metformin—an inexpensive treatment with which clinicians have ample experience…

Quick poll.

Stop what you’re doing.

Put your hands in your lap.

Don’t move for 5 seconds.

Can you feel your hands or fingers tingling?

Even a tiny bit? If you answered yes, were you aware of this before?

Breaking: Covid-19 antiviral Molnupiravir not effective in preventing hospitalization and death among vaccinated patients with high risks.

It did shorten recovery time...

But that's not even the most interesting part...

open.substack.com/pub/insidemedi… This is the first randomized controlled human trial that has studied Covid-19 outcomes among *only vaccinated* people that we’ve ever seen.

That’s an absolutely astonishing fact, if you think about it.

(Assuming I am correct here. Am I wrong?)

The asymmetry of anecdote.

If you aren’t seeing a disease whose true prevalence is ~1% of the population and has a 10 day course, consider the fact that if you see 20 patients in a day, your odds that none will have it is about 82%.

And yet 3m Americans would have it.

1/ This means that your small sample size is fooling your “I can’t think beyond what I can see” big brain energy.

Proceed with caution before making any declarations.

It’s to notice and even share it. It is not okay to tell people “it’s over.”

However… 2/

Moderna files for emergency use for its Covid vaccine for children 6 months to 6 years.

They are saying 51% effective against symptomatic Covid for ages 6 months to 2 years and 37% for ages 2 to 6.

Sounds mediocre but here's why it may be MUCH better than that....
🧵 The data reflect a lot of cases during Omicron.

We know these vaccines provide very good short-term protection against infection, but that's a honeymoon phase.

That's important. But the way these vaccines were designed, and how they work best, is not really about infection...

Our new paper on deaths among adults ages 25-44 in Texas is out.

I want to highlight some key findings...
🧵

Causes of Death Among Young Adults by Race and Ethnicity in Texas During the COVID-19 Pandemic, 2020 ja.ma/3CChpFb via @JAMAInternalMed part of @JAMANetwork Among Texas adults ages 25-44:
1. Covid-19 was the leading cause of death in July and December of 2020.

2. Covid-19 was the 2nd leading cause from the start of the outbreak thru December 2020.

3. Covid-19 was *by far* the leading cause of death among Hispanic residents.

Know any teens or parents on the fence for getting a Covid-19 vaccine?

Make. Them. Read. This!

Vaccines are keeping kids safe (out of the hospital).

Even in the face of Delta!

Fully analysis here: insidemedicine.bulletin.com/66557093149437…

But let's do a TOP 10 takeaways from new CDC study!🧵 Top 10 findings from this VERY IMPORTANT new paper out today.

1. Pfizer vaccine 93% effective in preventing Covid-19 hospitalization. 1/
insidemedicine.bulletin.com/665570931494374

BREAKING: Booster added protection for a month in recipients ages ≥60.

Will it last?

Protection was already waning on days 22-24, but went up again on day 25, the last day for which we have data.
Talk about a cliff-hanger!

Full analysis here:
insidemedicine.bulletin.com/14297076708278… First, I applaud the authors for their work (and thank them for politely answering dozens of emails from me). That said, this study has some problems. The main one is that it is a fancy version of a before-and-after analysis.

insidemedicine.bulletin.com/14297076708278…

One of the facile errors respecting pediatric Covid vaccine statistics?

Citing "absolute risk reduction."

ARR has vastly different implications depending on disease; whether *eventually all people will get it unless vaccinated* (endemic virus) or not (cancer)=key.

Join me!🧵 Not everyone sees this.

Allow me to explain!

Let's imagine that you have a medical intervention that reduces the rate of a disease from 1.5% to ZERO.

Let's imagine 2,200 test subjects.

16 cases in control.
0 deaths in vaccine group.

ARR=1.5%

Is this a big or small number?

Let's talk about the background risk of CVST (cerebral venous sinus thrombosis) versus in those who got J&J vaccine.

We are going to focus in on women ages 20-50.

We are going to compare the same time period and the same disease (CVST).

DEEP DIVE🧵 KEY NUMBERS! Spoiler: After an engaging convo with @ashishkjha tonight, I now believe we already have enough info to END the pause on J&J for everyone over 50, probably enough for all men (assuming we don't get a rush of bad news in the next couple of days), and women 20-50 in most situations

Two highly concerning papers now live in the New England Journal of Medicine regarding the adenovirus-based AstraZeneca/Oxford vaccine.

A small number of patients appear to have had serious clotting events with implications.
🧵
nejm.org/doi/full/10.10…
nejm.org/doi/full/10.10… First, the top-line findings are concerning.

In Germany and Austria, 11 patients developed clotting problems and of these 6 died. The median age was 36.

In Norway, 5 had the condition, 3 died.

Some if not many of these patients were previously healthy.

📰Major update on “external causes” of death (CW suicide, homicide, accidents).

Our team carefully analyzed new CDC datasets for US deaths from January thru July of 2020.

Drug overdoses: up.
Homicide: up.
Suicide: down (!)
Vehicle: down, then up.

medrxiv.org/content/10.110…
🧵/ We took a close look at these causes, modeling the changes over time, and generating expected ranges for 2020.

Drug overdoses: Way up. Even though they were up already before the pandemic, it's clear that things got worse.

Access to buprenorphine may be partly responsible.

Update: most of my colleagues had no symptoms or just arm pain after coronavirus vaccination.

Naturally, *I had to be one of the 10-15% with symptoms (chills, fatigue) bothersome enough to disrupt my usual activities for 24-36 hours.

I affectionately call it “manaphylaxis” 😂 But after a couple doses of Tylenol or Advil I’m mostly ready to do my usual stuff. Similar to my first dose (less arm pain this time).

I mention this because it’s a known thing. This happens to some people.

It’s a lot better than getting actual COVID-19, lemme tell you that!👇

No time to write threads lately, but I must now.

A 41-year old Congressman-elect from Louisiana has died of COVID-19.

But this kind of thing has been happening all along.

This is the crux of my recent work with @RWalensky @hmkyale @Cleavon_MD etc

jamanetwork.com/journals/jama/…

1/🧵 We found that thousands of young adults have died of COVID-19 and that thousands more have died of other causes during the pandemic.

Things have gotten much WORSE since re-opening.

Do not attempt to blame lockdowns.

Data do not support that.

Below is ALL CAUSE mortality.

This Spring, I noticed my colleague @Cleavon_MD tweeting about young people dying of COVID.

Many people of color.

I wondered if these sad cases were statistical anomalies.

Must be that these were "rare" cases, I thought.

I was wrong.

It was real. ja.ma/38b4ayh
🧵 I gathered together a team of people to help look at this.

In various ways, we assessed the data.

It led to the work above and this @nytimes op-ed as well.

nytimes.com/2020/12/16/opi…

You have done incalculable harm.

https://twitter.com/scottwatlas/status/1333574072756682752

That said, we will try to sum it up in tomorrow’s @Brief_19.

Follow for that and subscribe free here to get research and policy analysis on covid from frontline physicians.

brief19.com/subscribe/

“I said that if the virus was left to its own devices, it would cause a considerable degree of devastation because that’s what pandemic viruses do. However, I also said that there was an opposing force to that; and that opposing force is us.”

—Dr. Anthony Fauci.

https://twitter.com/nowthisnews/status/1333146966985908224

I love this man.

Well folks, it’s been real.
🤯 Let me be clear: I’m still going to work and I am protected...for the moment.

But if things continue to worsen, and I die because of this, I blame the weak federal response and incompetence in the face of our sustained pleas for adequate PPE.

Let's have a Friday catch-up on this week in Covid-19 policy, as covered in @Brief_19!

Here's a thread of what we have covered and links to you need to know from our last five briefings.

1/ #1 Pfizer Vaccine Implementation Limitations. Was Last Week's Major Announcement Actually 'News We Can Use'?

Not If It Can't Reach You.

Read up on the challenges and approaches.

brief19.com/2020/11/16/bri…

🦠Happy Friday, everyone.

This was a big week for COVID-19 Research and the team @Brief_19 was all over it.

Let's do a thread what we learned in a short threat with links to the briefs!

(And as always, to get them first in your inbox for free ➡️ brief19.com/subscribe/)

1/🧵 Monday: What Happens To Patients 60 Days After They Are Hospitalized With Covid-19?

This look at the early phase of #LongCovid and follow-up in patients discharged from the hospital is harrowing.

More people died and many more had lingering symptoms
brief19.com/2020/11/16/bri…

On this day of great anxiety, I thought I'd share a little personal story to lighten the mood.

It's about what is right with people both here, and I suspect everywhere.

(Hopefully someone can find the hero of this story and thank him, a couple decades later!)

Here we go!
🧵1/ I was 20.

I had just arrived back to San Francisco for summer vacation.

This story happened after my first day working in Jonathan Weissman's @Jswlab lab at @UCSF.