I love the format of today's newsletter: what we knew? new info? why does this matter? it makes it very easy to focus and highlight what's new and important and why. I wish medical journals did this more often
Regarding the iron research: I am a nephrologist and my specialty has a complex literature on iron and chronic inflammation. Since dialysis in the U.S. is our one corner of socialized medicine (Thanks to of all people Richard Nixon, another story, another time), there is a vast amount of public data on the clinical features of patients with end stage renal disease.
Since hemodialysis patients all become iron deficient over time due to blood loss, nephrologist prescribe a significant amount of intravenous iron. A typical clinical dilemma are the patients with a high ferritin level, a low total iron level, a low transferrin saturation level, anemia, and erythropoietin resistance.
My conclusion regarding the research cited in today's Substack:
The problem is not iron deficiency, it's that the immune system is sequestering all the iron as part of "starving" the microbial invaders. As with dialysis patients, in the setting of long COVID it is probably a well intentioned response gone rogue. The main problem is not the iron, it's the chronic inflammatory response that can't find the off switch.
Bottom line: if you have long COVID only take iron after having a thoughtful discussion with a physician well versed in chronic inflammation.
So how do we stay up to date on vaccinations when we aren't allowed to get boosters, even every year. I'm apparently not infirm in the correct ways to let me get a booster every year with no new variants, even though we know protection wanes. It also doesn't seem to matter that I live with and take care of my extremely high risk cancer survivor mom. Her asthma is so bad that she can't mask. I'm 42 so I'm not old enough to even get the Shingles vaccine. If we know all this, why don't the recommendations and the availability reflect the data? And how are we supposed to continue to protect ourselves with vaccination if we can't access them? Why were the CDC recommendations to Americans in foreign countries different (better) from our domestic policies (worse)? This is why some of us can no longer safely participate in public life. I basically can't leave my house for anything other than necessities. It's been 4 years and vulnerable communities are still being told over and over again that we are expendable. That we don't matter. That we can't protect ourselves when no one else will. We need to do so much better for everyone.
The hyper vaccinated individual could probably use some help with mental health, but on another level has provided a rare research opportunity and a spectacular undermining of vaccination fears.
I’m going to do a deep dive with speculation on the iron study soon - some real potential for adding this to a treatment regimen, but will need prospective trials.
“Why does this matter? It doesn’t really, as clinical trials fail all the time”
In referring to pre term births and an increased rate of deaths the above statement seems quite cold and callous. I understand that this was not intended, but glossing over the rationale for actually ending the study early discounts those deaths which could possibly be attributed to the study.
I do appreciate what you’re doing and I appreciate your posts.
Thank you for validating one thing, which is on topic, but also off. I've been struggling with an iron deficiency over the last five or so months ( I have Sjogren's). I am seronegative, as I have only had two tests confirm my diagnosis ( lip biopsy and early Sjogren's panel).
This part of your post really resonated with me, mainly because a doctor recently tried to gaslight me into thinking that autoimmune cannot cause the anemia I am experiencing....One of the immune system’s tricks for dealing with infections is hiding the body’s iron supply so that germs can’t use the nutrient to thrive. However, if this goes on too long, it can cause anemia (insufficient red blood cells to get oxygen to your tissues)."
There is so much the medical community still doesn't know about autoimmunity and iron/the heart!
Regarding the RSV monoclonal “Low rates were in large part due to access issues”, was mostly the problem. Access was abysmal, to say the least.
Sanofi is asking Pediatricians to preorder doses costing over $400 each… for babies that have yet to be conceived! for next season. Hospitals have yet to pledge to administer the drug in the newborn nurseries, the logical place to do it, but this could change leaving us unclear how much to purchase. Reassurance of buybacks only happens after it expires… 18 months later.
In pediatrics the burden of vaccinating the public rests with small offices, strained already trying to vaccinate whole practices for seasonal influenza, now Covid19, and now Beyfortus.
Just needed to point out, there’s a lot to unpack regarding this.
It’s an amazing product. It’s not a simple roll out.
For the GSK RSV trial: I know what you were trying to say . . . but it does matter because stopping the trial shows that patients were protected and scientific medical trials do work. This is a good example of an expensive trial being halted, even in the face of direct competition and race to produce, to protect patients. Scientists care about patient outcomes and safety. This should reassure patients.
Is there any update on which variant will be selected for the fall ‘24 boosters? JN.1 seems to still be dominant yet many of us have already been exposed to it.
Also, any update on how effective the Army’s universal vaccine might be and when it might become available?
Have you written the authors of the study asking for age breakdown?
Please mention Joseph Lapado, the Florida Surgeon General’s unscientific and unethical attack on Covid Vaccines claiming they cause myocarditis in young people, especially men. He has been kicked out of the Florida Medical Association, but I understanding he is suing them, claiming they refused to admit there is one case of a young man dying of heart disease after vaccination. Like all recommendations in medicine, there is a risk/benefit ratio and far more young people have died of Covid, compared to this one vaccine heart death. Almost all cases of myocarditis are mild
I have tried unsuccessfully to get the American College of Physicians to censure Lapado and kick him out of the ACP. Maybe public pressure would help.
Thank you for yet another insightful and very informative post. I really do love your updates and share with my internal (at work) and external partners. Your guidance helps inform my COVID and flu project planning team here in Florida, yes IN Florida.
I would like to know what it will take to get disability listed as a key demographic indicator in these studies. Seriously what have we as a public health community gotta do to include the disability community in this?
My husband lost his hearing after having COVID last month. This seems to be unusual. Do you have any information about hearing loss and whether it will come back.
What explains excess deaths in recent years, in western countries. Dr John Campbell, from the UK, has spoken quite a bit about this. Yet in the US we hear little or nothing about it?
COVID-19 pandemic: This has been the leading cause of excess mortality since 2020. Not only deaths directly attributed to COVID-19, but also those from overwhelmed healthcare systems and individuals delaying seeking treatment for other conditions due to the pandemic.
Indirect effects of COVID-19: Disruptions in healthcare services, lockdowns impacting mental health, and socioeconomic consequences can all contribute to excess deaths.
Other potential factors: These could include aging populations, lifestyle factors like obesity or lack of exercise, and potential long-term effects of COVID-19 infections.
Dr. John Campbell's focus on excess deaths is valuable. Researchers are still actively investigating the specific causes and how much each factor contributes. Some resources to learn more:
PNAS (Proceedings of the National Academy of Sciences) - Variability in excess deaths across countries with different vulnerability during 2020–2023: This study explores the difference in excess deaths between vulnerable and less vulnerable countries.
I'm not buying the "improve your heart health by getting more covid vaccines" narrative. In the Phase III trials for Pfizer and Moderna, we didn't see cardiac benefits. Quite the opposite in fact.
I love the format of today's newsletter: what we knew? new info? why does this matter? it makes it very easy to focus and highlight what's new and important and why. I wish medical journals did this more often
After your last several posts, I wanted to share a clear, empathetic and actionable post from The Nerdy Girls on the new isolation guidelines.
https://open.substack.com/pub/thosenerdygirls/p/what-should-i-do-if-i-get-sick-the?r=6q5yk&utm_campaign=post&utm_medium=email
Off topic but relevant to clear, helpful health policy information.
Thank you for keeping us updated.
Regarding the iron research: I am a nephrologist and my specialty has a complex literature on iron and chronic inflammation. Since dialysis in the U.S. is our one corner of socialized medicine (Thanks to of all people Richard Nixon, another story, another time), there is a vast amount of public data on the clinical features of patients with end stage renal disease.
Since hemodialysis patients all become iron deficient over time due to blood loss, nephrologist prescribe a significant amount of intravenous iron. A typical clinical dilemma are the patients with a high ferritin level, a low total iron level, a low transferrin saturation level, anemia, and erythropoietin resistance.
My conclusion regarding the research cited in today's Substack:
The problem is not iron deficiency, it's that the immune system is sequestering all the iron as part of "starving" the microbial invaders. As with dialysis patients, in the setting of long COVID it is probably a well intentioned response gone rogue. The main problem is not the iron, it's the chronic inflammatory response that can't find the off switch.
Bottom line: if you have long COVID only take iron after having a thoughtful discussion with a physician well versed in chronic inflammation.
So how do we stay up to date on vaccinations when we aren't allowed to get boosters, even every year. I'm apparently not infirm in the correct ways to let me get a booster every year with no new variants, even though we know protection wanes. It also doesn't seem to matter that I live with and take care of my extremely high risk cancer survivor mom. Her asthma is so bad that she can't mask. I'm 42 so I'm not old enough to even get the Shingles vaccine. If we know all this, why don't the recommendations and the availability reflect the data? And how are we supposed to continue to protect ourselves with vaccination if we can't access them? Why were the CDC recommendations to Americans in foreign countries different (better) from our domestic policies (worse)? This is why some of us can no longer safely participate in public life. I basically can't leave my house for anything other than necessities. It's been 4 years and vulnerable communities are still being told over and over again that we are expendable. That we don't matter. That we can't protect ourselves when no one else will. We need to do so much better for everyone.
The hyper vaccinated individual could probably use some help with mental health, but on another level has provided a rare research opportunity and a spectacular undermining of vaccination fears.
I’m going to do a deep dive with speculation on the iron study soon - some real potential for adding this to a treatment regimen, but will need prospective trials.
I’m going to pick on your tone for a second.
“Why does this matter? It doesn’t really, as clinical trials fail all the time”
In referring to pre term births and an increased rate of deaths the above statement seems quite cold and callous. I understand that this was not intended, but glossing over the rationale for actually ending the study early discounts those deaths which could possibly be attributed to the study.
I do appreciate what you’re doing and I appreciate your posts.
Thank you for validating one thing, which is on topic, but also off. I've been struggling with an iron deficiency over the last five or so months ( I have Sjogren's). I am seronegative, as I have only had two tests confirm my diagnosis ( lip biopsy and early Sjogren's panel).
This part of your post really resonated with me, mainly because a doctor recently tried to gaslight me into thinking that autoimmune cannot cause the anemia I am experiencing....One of the immune system’s tricks for dealing with infections is hiding the body’s iron supply so that germs can’t use the nutrient to thrive. However, if this goes on too long, it can cause anemia (insufficient red blood cells to get oxygen to your tissues)."
There is so much the medical community still doesn't know about autoimmunity and iron/the heart!
Good round up- thank you.
Regarding the RSV monoclonal “Low rates were in large part due to access issues”, was mostly the problem. Access was abysmal, to say the least.
Sanofi is asking Pediatricians to preorder doses costing over $400 each… for babies that have yet to be conceived! for next season. Hospitals have yet to pledge to administer the drug in the newborn nurseries, the logical place to do it, but this could change leaving us unclear how much to purchase. Reassurance of buybacks only happens after it expires… 18 months later.
In pediatrics the burden of vaccinating the public rests with small offices, strained already trying to vaccinate whole practices for seasonal influenza, now Covid19, and now Beyfortus.
Just needed to point out, there’s a lot to unpack regarding this.
It’s an amazing product. It’s not a simple roll out.
For the GSK RSV trial: I know what you were trying to say . . . but it does matter because stopping the trial shows that patients were protected and scientific medical trials do work. This is a good example of an expensive trial being halted, even in the face of direct competition and race to produce, to protect patients. Scientists care about patient outcomes and safety. This should reassure patients.
Thanks for this great roundup.
Is there any update on which variant will be selected for the fall ‘24 boosters? JN.1 seems to still be dominant yet many of us have already been exposed to it.
Also, any update on how effective the Army’s universal vaccine might be and when it might become available?
Have you written the authors of the study asking for age breakdown?
Please mention Joseph Lapado, the Florida Surgeon General’s unscientific and unethical attack on Covid Vaccines claiming they cause myocarditis in young people, especially men. He has been kicked out of the Florida Medical Association, but I understanding he is suing them, claiming they refused to admit there is one case of a young man dying of heart disease after vaccination. Like all recommendations in medicine, there is a risk/benefit ratio and far more young people have died of Covid, compared to this one vaccine heart death. Almost all cases of myocarditis are mild
I have tried unsuccessfully to get the American College of Physicians to censure Lapado and kick him out of the ACP. Maybe public pressure would help.
Thank you for yet another insightful and very informative post. I really do love your updates and share with my internal (at work) and external partners. Your guidance helps inform my COVID and flu project planning team here in Florida, yes IN Florida.
I would like to know what it will take to get disability listed as a key demographic indicator in these studies. Seriously what have we as a public health community gotta do to include the disability community in this?
My husband lost his hearing after having COVID last month. This seems to be unusual. Do you have any information about hearing loss and whether it will come back.
Am I missing something? I don't see anything explicit about Sweden.
What explains excess deaths in recent years, in western countries. Dr John Campbell, from the UK, has spoken quite a bit about this. Yet in the US we hear little or nothing about it?
COVID-19 pandemic: This has been the leading cause of excess mortality since 2020. Not only deaths directly attributed to COVID-19, but also those from overwhelmed healthcare systems and individuals delaying seeking treatment for other conditions due to the pandemic.
Indirect effects of COVID-19: Disruptions in healthcare services, lockdowns impacting mental health, and socioeconomic consequences can all contribute to excess deaths.
Other potential factors: These could include aging populations, lifestyle factors like obesity or lack of exercise, and potential long-term effects of COVID-19 infections.
Dr. John Campbell's focus on excess deaths is valuable. Researchers are still actively investigating the specific causes and how much each factor contributes. Some resources to learn more:
Our World in Data - Excess mortality during the Coronavirus pandemic (COVID-19): https://ourworldindata.org/grapher/excess-mortality-p-scores-average-baseline
PNAS (Proceedings of the National Academy of Sciences) - Variability in excess deaths across countries with different vulnerability during 2020–2023: This study explores the difference in excess deaths between vulnerable and less vulnerable countries.
I'm not buying the "improve your heart health by getting more covid vaccines" narrative. In the Phase III trials for Pfizer and Moderna, we didn't see cardiac benefits. Quite the opposite in fact.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9428332/