TWiV #1180: Addressing Current Viral Threats and Public Health Messaging
0:00 - Fundraising Drive: Micro TV is having its annual fundraising drive and encourages listeners to share how the platform empowers their "inner scientist" via audio or video submission.
0:09 - Introduction: Vincent Racaniello introduces the episode with guest Daniel Griffin.
0:01:35 - Jimmy Carter Tribute: Daniel starts by quoting Jimmy Carter, highlighting his work on neglected tropical diseases, particularly guinea worm. He shares a personal anecdote of meeting Carter and receiving a water filter.
0:02:51 - Guinea Worm: The discussion delves into the history of the guinea worm eradication effort, which Carter spearheaded. The disease is described, noting it is nearly eradicated due to these efforts.
0:05:18 - Norovirus: The episode shifts to discussing a high level of norovirus activity, or "winter vomiting disease," and emphasizes the need for thorough handwashing with soap and water. They question why the outbreaks are so large, possibly due to lack of prior respiratory infections providing some cross-immunity.
0:07:00 - Avian Influenza (H5N1): The discussion moves into recent publications regarding H5N1 avian influenza, including its spread to dairy cows. A mnemonic is introduced to distinguish between strains: B for "Bovine" and D for "Ducks" or "deadly." They highlight a severe case in a Canadian adolescent.
0:09:59 - H5N1 Mutations: Mutations found in the H5N1 virus from the Canadian case are discussed, including their possible link to increased virulence.
0:11:37 - H5N1 Vaccines and Treatments: Current H5N1 vaccine candidates and antiviral treatments are described, with emphasis on their efficacy. It's noted that the current strain is susceptible to available antiviral drugs.
0:12:29 - H5N1 - Emerging Threat: The hosts discuss the emerging threat of H5N1, emphasizing that this isn't a new virus, but it's expanding its range to more species. They clarify that there is currently no sustained human-to-human transmission.
0:13:47 - Concern for over-worrying: The hosts discuss how some media personalities are over-worrying about H5N1 and that this is not as critical as it is being portrayed.
0:14:57 - Gain of Function: The concept of "gain of function" is discussed, with the note that viruses may gain transmissibility but lose virulence.
0:15:17 - H5N1 Transmission: The 30 year history of no human-to-human transmission of the H5N1 strain is highlighted, while noting that H1, H2, and H3 are the only hemagglutinins that can infect people.
0:15:46 - Respiratory Illness Update: The discussion moves to a respiratory illness update, with a focus on current high levels of influenza, RSV, and COVID-19.
0:16:17 - COVID-19 vs Flu: A Swiss study that found that healthcare-associated COVID-19 (Omicron) and influenza have similar case fatality rates (around 6%) is discussed, noting that COVID-19 is not worse than the flu. They also noted that the rates might be even higher in regions with less access to care.
0:19:00 - Cautions: The hosts highlight that severity is not only a property of the virus, but also the property of the healthcare system.
0:19:12 - Flu and RSV Levels: The hosts discuss the high level of both influenza and RSV in the US, with some cities like New York City potentially considering masking for RSV. A hospital system that doesn't isolate for RSV is also mentioned.
0:21:22 - COVID-19 Update: COVID-19 wastewater data is discussed showing an exponential rise in cases across the US. The hosts express their desire for more transparency in sharing wastewater data for polio and other viruses.
0:21:55 - Polio Discussion: The lack of public data on polio is highlighted, with the host noting that they are concerned the lack of public access to this type of data would allow for the delicensing of polio vaccine.
0:22:35 - Importance of Public Data: The hosts emphasize the importance of sharing public health data and the impact this could have on making sure people are aware that a virus is circulating.
0:22:59 - Testing Recommendations: The hosts recommend people stock up on testing supplies because Flu, RSV, and Covid are very high. The only way to tell what you have is to test.
0:23:45 - COVID-19 Treatments: Current COVID-19 treatment guidelines are summarized. Paxlovid, Remdesivir, and Molnupiravir effectiveness and recommendations are discussed.
0:24:28 - Molnupiravir Effectiveness: They highlight a real world study that shows the effectiveness of Molnupiravir, with a 42% and 50% reduction in mortality (all cause and COVID-19 related respectively). The hosts note how easy Molnupiravir is to use compared to other treatments.
0:26:10 - COVID-19 Isolation: The discussion covers the importance of isolating in the early phases of COVID to prevent transmission.
0:26:30 - Late-Phase COVID: The hosts discuss people in the later stages of COVID infection with consideration of steroids, anticoagulation and pulmonary support.
0:27:45 - Long COVID: The hosts discussed rehabilitation and cognitive behavioral therapy (CBT) in the context of long covid. They note that studies on pacing have shown that these studies should be carefully done to ensure that post exertional malaise isn't triggered.
0:28:25 - "No one is safe until everyone is safe:" The hosts emphasize the importance of donating and supporting their program, noting that their donations are matched for the year end.
0:28:54 - Listener Questions: Daniel addresses a listener question about a media source's incorrect statement regarding human-to-human transmission of avian influenza and clarifies the lack of current human-to-human transmission.
0:29:54 - Norovirus Vaccine Trials: The hosts discuss the development of norovirus vaccines, and encourage people to sign up for vaccine trials.
0:30:52 - At-Home Testing: The hosts praise an at-home test that covers all three of flu, COVID, and RSV available in Germany for about 2 euros. They discuss a listener's comments and concerns about the cost of at-home tests and lack of insurance reimbursement in the US, emphasizing that the clinical impact of knowing if you have RSV is that people will now know to not take antibiotics, plus it increases public awareness that vaccines are now available.
0:32:32 - Public Health Awareness: The hosts highlight the benefits of more public awareness via testing to encourage vaccinations, reduce antibiotic use, and promote public health messaging.
0:33:21 - Asymptomatic Transmission: The hosts discuss a listener's question about changes in asymptomatic COVID-19 transmission over time and explain the lack of quality data to support a specific conclusion. They acknowledge that the available data is no longer of the quality that was seen earlier in the pandemic due to less public testing.
0:35:13 - COVID-19 Isolation: The hosts discuss an email from a listener who had a recent COVID-19 infection, and question current CDC isolation guidelines based on the listener's experience. They admit that they don't have updated data on isolation at home recommendations.
0:37:51 - Conclusion: The episode concludes with closing remarks.