Photo by Florian Glawogger on Unsplash
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Welcome back to some monthly highlights from a place I call Covidlandia, a forgotten land between black and white, carefree and cautious, pandemic beginning and end. Here I present recent news, scientific discoveries, and medical knowledge that caught my attention and that is of interest to primary care. I try to curate and comment, and realize that one human being cannot possibly keep up with everything. But I try to collect useful, actionable stuff. Twelve editions from 2024 are still relevant. And so we begin 2025. This full post is too large to post on Kos, but can be read in full here..
I once thought of using a catchy phrase to go with this series, like Keep Covidlandia Weird. You know, like Portland, Oregon’s controversial slogan Keep Portland Weird? But there’s nothing weird about still paying attention to Covid-19, H5N1, and the viral rest. Plus, after the last election even weird has a new connotation.
So if there’s a motto to be had, perhaps in these destructive times targeting science and health communication, I’ll go with:
Covidlandia - truth spoken to power and patient.
What’s the current scenario?
Covid rates are high but improving, though we are still seeing a lot in our office. Influenza A has been rampant, too. The original post has graphs of current prevalence in wastewater, as well as estimates showing about 1 in every 88 people in the U.S. is currently infectious. Graph images did not work well in this format here, sorry.
Would you spray antibodies up your nose twice a day if it gave you 80% protection against contracting Covid?
A fascinating article was published in Science, and buried within it was an even more fascinating hope for future Covid prevention. Researchers identified SA55, an antibody showing promise against current and future SARS-CoV-2 variants, by studying people who recovered from the original SARS virus back in the day, and then later received Covid vaccines. Sinovac Biotech developed it into a nasal spray that showed 80% efficacy in preventing infections. The spray has been used by 300,000 people in China under compassionate use protocols, and while the study has not been officially published, the candidate nasal spray is reportedly in phase 3 clinical efficacy trials now.
I would consider using that before higher risk social activities. Will wait for more data.
The politicization of public health and healthcare
I wrote a note over the weekend about how disturbing the new administration’s silencing and freezing of health agencies and communication has been. It was read by ~7K people (who gave me 1.7K thumbs up and over 240 amazing comments of support). That bolsters one’s spirits. Here’s the original note, but I’ll condense the main points as follows:
The systematic dismantling of American public health institutions over the past two weeks demands attention, despite some requesting I write "uplifting" content instead. To do otherwise would turn a blind, cowardly eye to what’s happening in our country. None of us should be doing that. Truth must be spoken to power and patient alike.
Recent alarming developments include:
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Federal health agencies (CDC, FDA, NIH) forced to halt external communications, with critical resources like Vaccine Information Sheets that I use every day vanishing, and some H5N1 outbreak data gone
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Scientific meetings and research panels abruptly cancelled, crippling ongoing studies and clinical trials
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All public health communications now require political approval
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Collaboration with WHO halted during crucial, present H5N1 bird flu concerns
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Government-wide hiring freeze and worker intimidation implemented
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The nomination of RFK Jr. for HHS Secretary still alive, despite his well-documented history of vaccine misinformation for ongoing profiteering
All of this isn't mere disruption - it's destruction aimed at centralizing power at truth's expense. We can only hope for some luck, some bravery, some awakening.
Some regret.
Metformin as a Covid treatment
Some doctors have called metformin “the poor man’s Paxlovid” for pretty good reason. It’s cheap, generally well-tolerated, and more evidence keeps piling up that it helps. I highlighted the best studies in my self-treatment plan for Covid post, but a reader named Tara hooked me up with this excellent compendium of 103 other studies (of varying quality, design, and location) that keeps looking good.
According to research examining Metformin's effects on Covid, data from these 103 studies involving 350,869 patients across 29 countries indicates significantly lower risks for several outcomes including mortality, need for ventilators, ICU admission, hospitalization, disease progression, and recovery among patients treated with Metformin. This is in addition to the reduction in long Covid rates I have previously highlighted from RCTs.
This year’s updated Covid shots are working well
Did you get your annual Covid shot, like your annual flu shot? I did.
A study just released from the VA Healthcare System looked at the current 2024-2025 Pfizer COVID-19 vaccine’s effectiveness:
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The study evaluated vaccine effectiveness among 44,598 respiratory infections between September-November 2024, providing robust data on real-world performance of the updated Pfizer formulation.
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The vaccine showed strongest protection against severe disease, demonstrating 68% effectiveness in preventing COVID-19 hospitalizations.
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For preventing emergency department and urgent care visits, the vaccine was 57% effective
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In outpatient settings (my primary care world), the vaccine showed 56% effectiveness at preventing COVID-19 visits.
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But despite these positive effectiveness findings, the researchers noted that uptake of these updated vaccines remains low among the population.
Since this study was conducted within the VA Healthcare System, results may differ in other populations. Additionally, longer-term effectiveness data would be needed to assess durability of protection.
Updated vaccines are the victim of conspiracy theories and even low doctor enthusiasm. But based on the above data, and the data for every additional Covid shot so far, the logical conspiracy would, however, go like this:
You’re just telling me to get this updated shot so that your office will have less Covid visits, your health system less urgent care and ER visits, and your hospital less Covid admissions - all of which adds up to millions of dollars of lost revenue!
To which I would answer: That’s right, plus less long Covid and other cumulative stuff. Maybe try Novavax if you react strongly to mRNA. Read on.
Immunodeficiency from COVID
I read at least three articles this month on the taboo subject, one that you definitely will not hear from any folks telling you that Covid is just a cold. Sometimes it is, and sometimes it isn’t. We need to keep living our lives, but I bend the percentages when I can to avoid or at least treat Covid in my life.
Synthesizing this study in the journal Science, with this article from The Sick Times, with this post from LIL Science, I can present the following take home points about immunodeficiency.
The relationship between COVID-19 and immune system dysfunction is more complex than initially understood. Recent research with 113 patients revealed that Long Covid involves specific damage to complement and coagulation systems, creating microclots and inflammation. However, early attempts to characterize this immune damage led to two problematic narratives.
First, some advocates drew parallels to HIV/AIDS, but this comparison is scientifically inaccurate. While HIV directly targets and destroys T-cells, COVID-19 affects cells differently, though both diseases faced similar patterns of public health minimization and stigmatization.
Second, the theory of "Immunity Debt" emerged, incorrectly suggesting that isolation during the pandemic weakened immune systems. This has been disproven by data from Sweden, where minimal lockdowns still led to severe respiratory virus seasons. Instead, evidence points to COVID-19 itself causing immune dysfunction through multiple mechanisms, including reduced T-cell counts and altered immune responses.
Understanding these distinctions is crucial for developing targeted treatments and implementing effective prevention strategies. The science suggests focusing on preventing COVID-19 infection and utilizing treatment, rather than worrying about immune system "debt" from isolation.
OK, I’ve hit a reasonable word count for a Daily Kos diary so I’ll stop here.
But here’s what you will learn/review by having read this and the original post.
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Current COVID Scenario: rates are improving but still present at pretty high levels, like 1 out of every 88 people potentially infectious.
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Nasal Antibody Spray: shows 80% efficacy against Covid transmission in Chinese trials. More work to be done
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Metformin: Analysis of 103 studies confirms metformin's effectiveness as a low-cost Covid treatment, reducing multiple negative outcomes.
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Public Health Politicization: Major disruptions in federal health agencies including communication freezes and resource removal are raising serious concerns.
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COVID Shots: VA study shows the current 2024-2025 vaccine is significantly effective, with 68% protection against hospitalization.
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Immunodeficiency: Research reveals Covid causes specific immune system damage, distinct from previously assumed "immunity debt."
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Pandemic Lessons: Five years into the pandemic, key challenges include declining public trust and political divisions affecting response measures.
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Air Filters: Research confirms portable air filters significantly reduce transmission in indoor spaces.
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Azvudine: New antiviral shows 18% lower death risk compared to Paxlovid in large study.
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Cardiovascular Effects: Covid can damage blood vessels and heart, with statins potentially helping to reduce inflammation.
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Vaccine Effectiveness: VA study shows vaccinated individuals have similar Covid outcomes to flu, while unvaccinated face higher risks.
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Paxlovid Research: Shows mixed results for Long Covid but clear benefits for kidney disease patients and general Covid treatment
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H5N1 and Flu Shots: Seasonal flu vaccines might offer limited cross-protection against H5N1, mainly benefiting younger populations temporarily
Take good care!
See you there?
