TWiV 1340: Clinical update with Dr. Daniel Griffin

[00:00:00]This week in viology, the podcast about viruses, the kind that make you sick.

[00:00:10]From Micro TV, this is TWIV. This week in viology, episode 1340, recorded on July 16th, 2026.

[00:00:22]I'm Vincent Rakinello, and you're listening to the podcast all about viruses.

[00:00:28]Joining me today from New York, Daniel Griffin.

[00:00:31]>> Hello everyone.

[00:00:32]>> How's the air out there, Daniel? Is this smoky?

[00:00:34]>> So, it's really bad actually. Um, yeah, there were some of the camps were asking me what to do, but uh there's a system.

[00:00:41]I'm gonna we're going to talk about this actually. Okay. Yeah, it's bad.

[00:00:45]>> But, uh, here in New York, well, I haven't been out since this morning, but this morning it it's fine. Either that or I can't smell anything. I don't know.

[00:00:52]>> Yeah. No, it's a it's a health issue.

[00:00:54]Let's jump in and we're going to start off with a quotation which uh I will share with our listeners. Uh Vincent ran it through AI. See what AI had to think about this. And so uh the quotation is stupidity is the same as evil if you judge by the results. And that's Margaret Atwood from Surfacing. So what you were telling me what what did AI have to say?

[00:01:18]>> Well, I I didn't quite understand it.

[00:01:20]It's a little obscure, right? But it basically means if a house burns down, it doesn't matter if it was because of evil or stupidity, in the end, it's a big problem, right?

[00:01:33]>> Yeah.

[00:01:33]>> So that's why she says it's the same as evil if you judge by the results. That's the judge by the results kind of got me.

[00:01:39]But I think the quote could be better.

[00:01:41]>> Um but yeah, you can't just say like, "Oh, I didn't do it on purpose. That doesn't help. It's still the house burned down." Or what if the disaster might be? Yeah, I get it now. I'll let our listeners uh you know speculate uh about why this seemed appropriate, but okay.

[00:02:02]>> Uh so, you know, I got this little like news section right up front and you know, why did this catch my interest?

[00:02:08]Well, uh so we have this statement from Senator Mitch McConnell, right? And uh why why why do I care? Well, to my fellow Kuckians, this is from the statement Mitch McConnell. When you elected me to a seventh term and made me our Commonwealth's longest serving senator, you did so trusting that I'd keep showing up to fight for you every day. And over the past several weeks, Elaine and I have appreciated both your well-wishes, your honest questions about what was keeping me away from the Senate. You all know how folks of my generation often hesitate to share the vulnerability that comes with growing older. Even in the public eye, I feel that same instinct. I can't help it. But at the same time, it's where it gets interesting. I've had more than my share of experience with physical vulnerabilities.

[00:02:50]Surviving childhood polio meant spending my entire life with mobility challenges.

[00:02:57]They haven't exactly gotten easier to manage with age. And last month, I took a fall, which landed me in the hospital.

[00:03:04]My doctors have confirmed that I didn't break any bones or suffer a concussion.

[00:03:08]I didn't have a heart attack or a stroke. I didn't have any tumors or hemorrhages, but I was briefly unconscious and was taken to the hospital. While receiving excellent care over the past several weeks, I've also had to deal with a mild case of pneumonia.

[00:03:21]>> I just wanted to ask you, Daniel, I know you want to talk about postp polio.

[00:03:24]>> Yeah.

[00:03:25]>> First of all, if it was nothing, why was in the hospital for several weeks? And is there such a thing as mild pneumonia?

[00:03:33]>> There's also a little bit of somehow he lost consciousness, but he didn't get a concussion, right? I mean, you get whacked hard enough in the head that you lose consciousness. And not all of it makes sense. And you know, and this is like a question I think that got me in a lot of trouble at one point where I talked about um you know, illnesses in um in our elders are are not uh something just to just take in stride or or to write off. I mean, pneumonia um in a person over the age of 65, which Mitch McConnell is about a 10% mortality, one in 10 chance of not surviving. So quote unquote mild case of pneumonia. I mean pneumonia is infection of the lungs. it it has a mortality associated with it.

[00:04:12]So nothing's nothing's so mild when we get older.

[00:04:17]>> So this this is just a little bit slimy.

[00:04:19]I think still I don't think he's he's being straight.

[00:04:22]>> Well, but the reason I'm I'm I like this statement is it really u it it brought postp polio syndrome into um into discussion. And so there was a SIDRAP uh discussion of postpolio syndrome. What what is this? Um and I have to say postp polio syndrome uh you know Vincent you're probably steeped in this with your kind of world but many providers many individuals here in the US were not really familiar are not familiar with postpolio syndrome um and I I was actually when I came through you know NYU School of Medicine that August institution um no one had ever taught me actually about postpolio syndrome and I didn't really become acquainted with it until I started practice in Colorado >> then you saw some >> I saw a lot of folks. Um there was a big big outbreak there um back during a time sort of a dark time in the history of Colorado. We had a clan governor if you can imagine that. Fort Collins was the home of the KKK newspaper, you know, it's you know, so uh and so so SIDRAP has this nice discussion. So let me just uh share a bit of that because I think this is really important, right? when when we're we're at risk or well we're starting to see these uh vaccinereventable illnesses um come back into the US. Uh so many people today know polio which paralyzed up to 58,000 Americans a year at its peak. Uh thanks to vaccination the disease was eliminated the United States in 1979 and throughout the western hemisphere in 1994. Today wild polio virus circulates routinely only in Afghanistan and Pakistan. Um, I like the comment, why are we distinguishing between wild type and uh vaccine derived, right? I mean, still paralyzing people with vaccinerived polio. So, there's still polio virus circulating. People are still getting paralyzed. We're still putting um, you know, oral polio, vaccinerived polio back into the environment. Anyway, um, yet the polio virus continues to harm nearly 300,000 Americans. Ready? 300,000 Americans in the form of postp polio syndrome. Um, and I don't think people were familiar that there were hundreds of thousands of Americans still suffering from postpolio syndrome with an array of medical problems that occurred decades after the original infection. Um, now no infectious virus has been covered from post-p polio patients. The syndrome is thought to arise as a result of years decades of additional stress work of the unparalized uh limbs. after years of health. You notice they spelled uh limbs wrong. They spelled it with a P.

[00:06:59]>> I think they were thinking limp and limbs. After years of health, 25 to 40% of polio survivors may suffer pain, renewed muscle weakness, fatigue, problem speaking or swallowing. I just think that's like something to really point out because people think of, oh, it's it's polio, you get it, nothing happens or you're that rare person. We quote these numbers. One in 2,000 depending upon, you know, which type of polio we're talking about. This is huge.

[00:07:27]25 to 40% of people that survived polio will go on to develop post polio syndrome. We have hundreds of thousands of people in the US still with that.

[00:07:36]That's why so many um of these senior folks got so upset with RFK's attack on vaccines and uh and the polio vaccine.

[00:07:46]McConnell, the former Senate majority leader, has long had an unsteady gate, has fallen several times in recent years. He's often seen using a wheelchair to get around the capital.

[00:07:55]United States, most polio survivors are in their 70s or 80s. Number of people with postpolio syndrome is declining as these folks age and pass away. Now, around the world, the burden of polio is much greater with estimates showing as high as 15 million to 20 million suffering with postpolio u symptoms. Um so this this is like you know people who've had polio um when you look at the percent of people that have issues down the road. So we may do be doing what we're doing now but there still are all these people suffering and if polio comes back not only going to see the acute paralysis but every time you have polio sweep through an area you're going to have this you know quarter to a third or more folks end up with postpolio issues. telling that polio continues as you know now it's mainly vaccine derived polio but it's still polio it paralyzes so there will always be postp polio as long as there is polio >> yeah yeah it doesn't matter if it's vaccinerived >> it does not >> it's interesting that they called it postp polio and not long polio and it's interesting that they called it long covid and not postcoid isn't it >> yeah it is interesting right yeah >> yeah I mean because is basically >> it's basically a long polio.

[00:09:12]>> I think it's long polio. Yeah. I I lump it together when I talk about people who have like long flu, long polio, >> you know, long chicken ga, long Ebola. I mean, you know, there is this um I think now hopefully well recognized issue with multiple infectious diseases where you have an acute illness, you have a a period of time afterwards and then you have this it could be years years of ongoing issues.

[00:09:38]Um this is the clinical update, right?

[00:09:40]So air quality issues like you started to talk about Vincent.

[00:09:44]>> It's totally relevant. Absolutely.

[00:09:46]>> You know, and it not only puts people in the hospital because of all the inflammatory issues, but people with underlying lung diseases, this puts them puts them at risk. So right now, for those of you who are following this, those of you who are living in this, uh right now we're sitting in a in a period with really uh poor air quality. Um, and there's a whole scale and uh basically based upon the the amount of particulate matter in um in the environment and there's even an an air now.gov where you can look and see what's going on in my area. Now um today it got up into the the 190s which is really like upper limit of unhealthy. 2011 is when you move into very unhealthy and there's all kinds of guidance about what to do when the air quality is this is this bad. And um really interesting. It was like a few years back, right, when we had those really bad um again it was similar. You had forest fires, you had un you know unhealthy air. Uh maybe people at that point were a little more sensitive to the fact that they didn't want to harm themselves, their children. A number of the camp said, "Okay, we're not going to do outdoor activities today." Yeah.

[00:10:53]Today the kids are all out there breathing in the smoke.

[00:10:57]>> I'm looking at this in New York City air quality index. It's really very nice.

[00:11:01]Um, it's going to go down tomorrow and it's not going to be in the 190s. It's going to be like 60s.

[00:11:08]>> So, it's going to be back to back to moderate and then hopefully we'll get back into the good air quality again going forward. So, >> and but this is the result of of forest fires, right?

[00:11:18]>> Exactly. Them Canadians.

[00:11:20]>> Well, aren't there some out west also in the US?

[00:11:22]>> Actually, yeah. So, there's a there's a fire um pretty big fire um out in Colorado and this is that that time of year when we start having these fires.

[00:11:31]So, all right. And uh we finally got a health alert. Uh cycllosporatenis.

[00:11:40]I mean, it's gotten to the point. It's embarrassing, right? We we hear about this in the um in the just mainstream media and and the uh uh what's the Twitter and that stuff? Like social stuff. What they call social social media >> social media like you know and then like after the fact like weeks go by and you know finally it's like oh hey by the way we should like let the doctors know we should send out an alert like you know yeah we we we already know by the way CDC um so um I even looked at the CDC data it's it's not it's not really up to date which a little disappointing um but I'm going to leave in a link actually to the epidemiologist newsletter that's by uh Caitlyn Jetina and Marissa Donnelly I'm actually going to be doing a podcast with uh Catelyn Gelina and maybe I'll learn how to pronounce her name properly, but um they have a nice newsletter um you know it's nice map reported cycllo pspriasis cases and you could see um you know and this matches up when you go to the Michigan um department of health 2,640 um cases uh we've got dozens of people hospitalized um you know Ohio and New York we're we're competing uh to have the most number of cases. Ohio's at 661, New York 470.

[00:12:58]Um, so if you go to New York City, we have like almost 400 of those cases just right in the city. And we've got some got some on Long Island. Um, >> but Michigan has a ton. Mi >> Michigan has, you know, thousands. Um, and those are those are confirmed cases, right? So >> So this is a bit higher than last year apparently. Three times higher.

[00:13:18]>> Yeah. So, a lot a lot higher in New York and much higher in Michigan.

[00:13:23]>> So, this happens often, but this year it's worse than usual and we don't know why, right?

[00:13:28]>> Well, that's what we're figuring out.

[00:13:30]The the the smoking gun at this point um is is um lettuce. And so, so how do people get it? Just a primer. We talked about this a little last time is cycllosporatenis only human beings, right? So, you're getting this from an infected human being. Feces on the hands, ends up on the vegetables or the fruits. Um, it's not on the deep fried food, right? So, you can keep eating your deep fried food, it's all good there. Um, it it's really usually not on frozen stuff. Um, because if you if you do that really aggressive um freezing that they do, or even if you freeze it for a long period of time, you're going to you're going to kill the cycllospora. But, so it's going to be fresh. Um, usually the the washed bag lettuce is what we're thinking. In the past, it was raspberries. In the past it was basil. In the past it was lettuce also. Um so yeah that's probably what it is and we're just trying to pin down and there was a discussion about why is it taking so long, right? Because when it takes long people keep getting infected and so um the the issue is that there's still you know you start off with you identify hey this is more than usual. It's worth investigating and then you start talking to people about how might have you been exposed. Um, and then you can do genetic analysis on the people. You know, at this point it's pretty clear it's coming from some kind of a source that isn't just sporadic and and a little bit higher than normal. And then you can then start testing the different uh potential lettucees and other vegetables.

[00:14:56]>> Got it.

[00:14:57]>> All right. Legionella. Um, I think we're doing a little bit better. Um, as of July 14th, 63 total cases. Uh but you can see we had that that peak eight nine ten a day and now it's been one case one case. Um so the last positive uh was on the 13th but this is updated the 14th so we'll see what happens. Um so July 14th just a few days ago for folks listening um New York City Health said 76 cooling towers on the upper east side had tested positive for Legionella. Um now what to say about that? It's a molecular test very sensitive. We don't know if if this is living Legionella. We don't know if it's a high enough um amount of Legionella that that's getting everyone sick, but basically going ahead and everyone is cleaning those towers. Uh there was a discussion. I I was listening I listened to the Brian Lair show on NPR. Full disclosure there. Um and there there was a New York City health person talking. They were a little evasive when someone said, "Hey, can I still go to New York City and go to the Guggenheim and do I have to worry about getting Legionella walking around the streets?" And they wouldn't answer the question. I'm going to answer the question. Say, "It's okay. You can go to the, you know, you're not going to be out there standing, breathing long enough. I mean, what the idea is, you've got these cooling towers and then unfortunately there's usually an intake to the building and then you end up with enough of an exposure." Um, but we don't really think that like you're you're on your way to uh to go to a museum and somehow you pass through a neighborhood and you get Legionnaire's disease. Just full disclosure on that.

[00:16:32]>> So, what you're saying is you have to be in the building a a prolonged period of time.

[00:16:35]>> Well, you really need a you need an actual inoculum of this. You know, it's it's probably not one bacteria. It's not like you walk through or your taxi or your bus goes through a neighborhood and you end up. So, people don't need to avoid the upper east side of New York City. Um, but we do need to do a better job. I mean we we keep having these outbreaks. People keep getting sick. So we need we need better better approach to this.

[00:16:55]>> Well why why do these water towers get contaminated? They are they open? Is that the problem?

[00:17:01]>> Well so the the legional bacteria will will be in the water at a small amount and then you end up with this warm weather. The bacteria proliferates um you know it's in there with the parramium and and then it's going to be a natural cycle, right? It's going to cool down. The bacteria is not going to do as well. It's going to go down and Yeah. So the water in these towers is pumped up. It's reservoir water basically from upstate New York, right?

[00:17:26]So you're saying that Legionella is already present in the reservoir water.

[00:17:29]>> That's that's the problem. Yeah. And usually it's at a small amount, but then you get the right conditions, it multiplies, you start getting enough inoculum that people are getting sick.

[00:17:37]>> But why are there if it's the everywhere? Why are there so kind of isolated, right? We had the Harlem outbreak.

[00:17:42]>> Yeah.

[00:17:42]>> I guess last year, now we have this. Why isn't it everywhere?

[00:17:45]>> Yeah. I think particular cooling towers and this is an issue. You actually get fined for this for like finding that your cooling tower has Legionella bacteria. Um you know there are in place protocols for how you're supposed to clean these and how often you're supposed to clean these um to prevent >> to me that we should put a some kind of a UV sterilizer in these and just >> I like the idea. Yeah. Somehow like prevent this from happening. Yeah.

[00:18:09]>> Yes. Someone asked me last night on the stream if we need a Legionella vaccine.

[00:18:13]What do you think? So I don't think we do. Um it's yeah it's one of those risk benefit just we don't see enough cases for it to warrant probably number needed to vaccinate.

[00:18:23]>> What would be the number >> here? We have uh what do we have in New York? 63 cases.

[00:18:28]>> Yeah. In a city of millions. Yeah.

[00:18:30]>> What would it be?

[00:18:32]>> As we've seen like a few people end up in the hospital. Right. So we've had um we've had 12 you know currently hospitalized 40 discharge. Right. So, you know, of the 63 cases that came to attention, a number ended up hospitalized. Nobody died. Um, I think that's part of it, too.

[00:18:48]>> And this is also a city mainly a city thing.

[00:18:52]>> Uh, no. No. So, uh, we see it in other areas. Um, basically all you need to do is get that Legionella in some kind of a water system and then so people can can inhale it, right? We uh there was a we talked about it ID Puscas where a couple cases down in the Virgin Islands where people are hanging out in hot tubs.

[00:19:10]Somehow the hot tub, you know, had the >> Wow.

[00:19:12]>> Yeah.

[00:19:12]>> So, what about your little window air conditioner? They usually have some water in them.

[00:19:17]>> That could Yeah, that could be a source.

[00:19:18]Yeah. And sometimes we'll see that like end of the season um when people just haven't been cleaning those and the water gets in there and you start Yeah.

[00:19:26]>> Okay.

[00:19:27]>> So, all right. And moving on to screworm. Uh we're still seeing more cases. Uh no fly trap detections yet. Um at some point we're going to have to talk about fly traps and I'll bring a visual because that's kind of a cool idea that we have these. Uh but you know as as we're seeing here we're up to 37 cases. A couple of these have been in in pets and dogs. Um so uh we're we're not really uh putting an end to this. So we'll have to see what happens with the millions of sterile um irradiated males being released. But the big the big thing going on, this is really a huge problem is Ebola. The Ebola outbreak in Eastern Congo is now the fastest growing one in history. Um, and if you look at DRC, over 2,000 cases. We're up to over 750 confirmed deaths. That's just in the DRC. We've also got the cases in in Uganda. We have that one confirmed case uh in France. Um, and what are we doing about it? University of Oxford has launched the first human trial of a vaccine against bundio Ebola virus.

[00:20:29]>> Bundi bio bund say this again >> there's a there's a soft g bundio >> bundi bio >> bio bio >> bio >> like think bgeoa bio >> bio okay I'm gonna write I'm gonna have to write in some new pneumonics here >> um and call it the BD bolivirus in the meantime but Booio Bio Bio. Okay.

[00:20:58]>> All right. This is not going to turn into a YouTube short, I hope. Okay. So, they got a vaccine.

[00:21:04]>> Get a lot of views.

[00:21:05]>> Early stage trial and it's it's known as the VD-B.

[00:21:12]Now, that's actually what it's named.

[00:21:13]They don't they don't mispronounce it like I do. Um, and they're going to look at safety. They're going to look at immune response. But this is tiny, right? They're they're only going to vaccinate 50 healthy adults aged 18 to 55. So >> that's a phase one, right? Phase one, basically.

[00:21:27]>> This is phase one.

[00:21:28]>> Yeah. You have to do this. You can't just put it in phase two.

[00:21:30]>> Yeah. So you got to start with this phase one. See if you had an immune response. See if there's any safety issues. Um and then we can move on.

[00:21:38]Probably going to be a phase 23 the way they do that these days. And um so TWWI 1339, right? Um yeah, we'll >> Yeah, we'll leave a link into that. uh >> he thinks that it's mainly infection control that limits these outbreaks. He doesn't believe that the vaccines do much good.

[00:21:56]>> I wonder if the vaccines help with just uh you know healthcare workers feeling comfortable going into these areas feeling sort of that security and then they're more comfortable willing to help.

[00:22:06]>> I I would think a healthare worker should get a vaccine for sure. Yeah, that would >> we need to make sure right that they're effective. But then, but what about PEP?

[00:22:16]What about uh ebo pep? So, July 14th, the first participants were rolled in a trial testing Gilead Scienc's experimental antiviral drug Oel desae.

[00:22:29]It sounds familiar as postexposure prophylaxis PEP for preventing disease for the ongoing uh outbreak the DRC.

[00:22:39]Uh the trial called EOP PEP is being conducted in Etorii province the epicenter of the outbreak. It's being run by the National Institute for Biomedical Research in Kinshasha and several humanitarian partners. Uh so so Vincent is it fair to think of this as oral remesae? Very interesting question.

[00:22:57]So when you take these drugs they are not not the final drug that actually inhibits. It's a precursor has to be activated and both Obel desave and rem desave the final drug is an inhibitor of the RNA dependent RNA pulmerase. So that final drug is exactly the same but the precursor is different. So rem desave is given IV. It has a um phosphoramidate prod drug which means it has a little chemical structure that looks like a phosphate but it's hidden because things with phosphates don't get into cells very well. So you have to hide it and then when it gets in the cell the cell takes off the the hiding group and now you have the first phosphate you have to have three. Getting the first one on is rate limiting. It's very inefficient in cells. So that's really cool that rem desave goes in already with that. That's a that's a chemistry that was done years ago and it's very revolutionary. Now Oel Oel desave is not like that. It is it's got a protective group but it doesn't look like a phosphate. It's removed in the stomach because that's orally taken whereas rem desave it's it goes up in the liver and this now has to get into cells without a phosphate and get phosphorolated inside the cell which is less efficient. But that's why it's different because the act the pre the prod drug form is what we call it is different for the two but the actual drug is the same.

[00:24:25]>> Yeah. Interesting chemistry, right? It's amazing.

[00:24:27]>> Oh, the chemistry is fabulous. This chemistry of making a hidden phosphate is revolutionary. It's really great.

[00:24:33]>> So people thinking of going into chemistry, right? Think of it. This is cool stuff.

[00:24:37]>> Oh my gosh, chemistry. Last night on the on the live stream, I gave a mini lecture on monoconal antibodies and oh my gosh, the things that they can do. It is revolutionary.

[00:24:48]>> Amazing.

[00:24:48]>> All right, so this has a bunch of folks upset. So CDC is assessing travelers arriving United States who have recently been in DRC or Uganda as well as neighboring South Sudan for symptoms of and possible exposure to Ebola. To reduce the risk of Ebola importation into United States, CDC under Title 42 and the Department of Homeland Security under Title 49 are currently working together on a do not board process regard to the DRC.

[00:25:19]Um, American citizens who are departing from the DRC may be subject to a do not board order. Americans are able to return to the United States 21 days after leaving the DRC. So, you've been in the DRC, you've been in one of these areas, you got to go somewhere else for 21 days before we'll let you in the US, US citizens.

[00:25:37]>> And this is despite us having Ebola treatment centers here in the US, which are very capable.

[00:25:42]>> Yeah. Yep.

[00:25:46]All right. Measles. Um, we're we're getting, you know, if you look at the Hopkins tracker, we're already past uh last last year's uh so we're up to 2,250.

[00:25:56]The CDC has 2231.

[00:25:59]Um, last year was 2,242 confirmed. So, um, yeah, I mean, at this point we are now past um, and here we are, it's mid July, right? We're recording in mid July and we already surpassed um, the over 2,000 cases that we saw last year um, in the United States. This this is terrible.

[00:26:18]So, all right. So, moving on to our multicolored curves for CO. What is going on with CO? I even did a zoom in so we could see like what's been going on over the last few years. But then it's flat.

[00:26:33]>> It's flat, but there's a little blip there.

[00:26:35]>> Is there a blip? You think >> it's very tiny, but >> Well, someone wrote in and said there are cases of COVID throughout the country.

[00:26:45]>> Yeah, it's got to be a few. I mean, there are few areas. Yeah.

[00:26:48]>> Yeah. Not not a lot, but so uh be interesting to see what happens. I mean this this data is only to 74 to July 4th. There also are some issues and a lot of people have uh commented about how reliable are we getting all the information that we historically got that went into this. So um we'll keep an eye on and also I'm going to keep an eye and share if we start seeing cases um you know in the hospitals and the clinics the urgent care. So >> So you haven't seen any so far?

[00:27:15]>> No, it's been actually a little while.

[00:27:17]So >> all right. Well, oh, did you see? We can combine a polio story. The lady, the last lady in an iron lung from polio in the US just died.

[00:27:27]>> I heard that. I heard that.

[00:27:28]>> She was in it since 1953.

[00:27:31]>> Wow.

[00:27:32]>> Yeah. And um she died of COVID.

[00:27:37]>> Yeah.

[00:27:38]>> Isn't that terrible?

[00:27:38]>> It's really terrible.

[00:27:40]>> I mean, I don't know what how they treated her, but it seems to me that well, she shouldn't have died, right?

[00:27:45]>> Yeah. It's horrible.

[00:27:46]>> But she used to she used to sleep in it.

[00:27:48]She would get out during the day and move around and do things. She would just sleep in it. But then when she got CO, she was in it all the time.

[00:27:54]>> Yeah, it's tough. Uh well, a couple couple articles here to uh wrap us up.

[00:27:59]And these are these are our long postcoid papers, Pasque papers. So the first one, the article long-term ocular symptoms following CO 19 linked to immune dysregulation, dysotenomia, and peripheral neuropathy published in nature communications. So, uh, prospective cross-sectional study that examined, uh, persistent ocular symptoms, POS, emerging in non-hospized individuals after CO 19. Um, and they're going to they're going to use, um, individuals without persistent ocular symptoms, without POS, post recovery controls, using symptom quality of life data, clinical examinations, biofluid proteomics. They documented ocular symptoms persisting from three months to up to three years post infections. Pos persistent ocular symptoms led to significant vision disability and was linked to clinical findings not detectable in routine exams but only with specialized tests. Um these folks ended up with uh near vision disturbances, stbismas, weakened autonomic uh pu pupilary uh reflexes, corneal neurodeeneration, chronic activation of ocular surface dendritic tea cells. Um and they actually they identify um this particular proteomic profile um really really interesting stuff. Um so really finding some objective differences in these folks and they they actually come up with these diagnostic models um um basically 77 to 91% accuracy and implicate chronic TE-C cell mediated neuroinflammation in the pathogenesis.

[00:29:38]So all right and this this I think hits home for a lot of um ideas about what's been going on and this is this article vagal olanurgic denervation of the gastric mucosa in longcoid 19 in vivo evidence of structural autonomic dysfunction published in the international journal of infectious diseases. Um great figure here. So they conducted a case control study including 12 patients with long COVID. Eight control patients undergoing routine um gastroscopy. So they're putting the scope down. Um gastric mucosal biopsies were analyzed using aminoistochemistry with the pan neuronal marker protein gene product 9.5 PGP 9.5 and vasoactive intestinal peptide as a marker of cononergic fibers. nerve fiber density was quantified in both fundus and anal samples and um and hopefully we'll have for the people watching this on YouTube or hopefully for people we'll leave a link into this uh it's really striking to just look compared with controls longcoid 19 patients exhibited a significant reduction in mucosal intervation density um 2.1 versus 3.9 in the fundus so about half um 1.9 versus 3.9 in the antrum so again about half The reduction in colonergic interv inter intervent in inter innervation was most pronounced in the fundus and also evident in the antrum gastric nerve density correlated u with some of these parameters that they give us. But look at look at these figures. I mean you can see very striking Daniel really striking >> but is is it a cause or a consequence?

[00:31:19]>> It's a good question. We don't know.

[00:31:21]>> Don't don't know. I mean long co may have caused this. We don't know if this caused long co right.

[00:31:25]>> Yeah. Yeah. We don't know. the g the gastric the gastric part. That's what they're looking at here. Yeah.

[00:31:30]>> Yeah. Yeah.

[00:31:31]>> So, really, really interesting stuff.

[00:31:33]All right. So, I'm going to wrap us up there. No one is safe until everyone is safe. Uh we are um we're actually in the final month of our foundation international medical relief of children fundraiser. Again, doubling your donations, trying to get to that donation of $10,000, which really goes a long way um in uh in Uganda. Um so, uh go to parasites withoutborders.com, click on the donate button. Um, and yeah, for all the folks that have already stepped up, thank you so much for that support.

[00:32:02]>> It's time for your question for Daniel.

[00:32:06]Your questions for Daniel. You can send yours to Daniel at microbe.tv. David writes, "Interested in your thoughts on how the Legionella outbreak is being handled in New York City. They seem to be waiting on cultural results to release data about which buildings are responsible. PCR and whole genome sequencing would give a faster and more detailed view of the outbreak. Matching strains from infected individuals to populations in cooling towers would rapidly pinpoint sources of concern. And he David sends a link to a Twitter post, an ex post by someone says New York City should be required to release the concentration detected by a PCR and the culture results as they get reported. then we'll be able to evaluate how effective the approach of listing any building with detectable Legion elevia PCR is in terms of advancing the response and reduction uh of risk to the public.

[00:32:59]>> Yeah, I mean David these are these are good comments. So, uh, basically what they've done is, um, they've tested all the cooling towers. If it's PCR positive, they say get it cleaned and the majority of them have been cleaned like within 48 hours, right? So, it's been really, really good, u response.

[00:33:15]Um, but you bring up some interesting things. So, so they're not waiting on culture results to go ahead and clean the towers. So, that's number one. Um, number two is the issue. Um, is that, you know, you point out a really interesting thing. Can you use genetics, right? Can you do the sequence like you know folks that have been hospitalized compare those sequences to the sequences we're getting and then see if it looks like hey it's the same same source that got these folks sick. No, these these are excellent but I do think they're moving ahead pretty quickly. Um another question somebody asked why don't they just clean them all? Say every cleaning tower in New York City needs to be cleaned right now. Um depending on the size of the building, depending on the size of the cleaning tower, we can be talking about thousands or tens of thousands of dollars per building. So there's a big um Yeah, there could be a big cost. So um you know, we're talking about what 70 80 buildings, you know, let's say it's 5,000. It's a lot of money. It's a lot of money.

[00:34:10]>> Well, also you're going to just when you refill them, you're just going to put more Legionella back.

[00:34:14]>> Yeah. That's why we need a solution like the UV or some some way to actually >> something like that. Yeah.

[00:34:19]>> Yeah. I like that idea.

[00:34:20]>> All right. Christine writes, "I'm a dedicated listener of both Tw and TWIV clinical update. I've been a nurse for 40 years and returned to school to get my MPH from TUS School of Medicine during the pandemic. I appreciate the depth with which you cover all topics, viruses, parasites, bacteria, and the like. I too share your concerns for the current direction of our nation's health and under this administration. I'll digress here to say I'm delighted to hear that Dr. Griffin's daughter is a teacher at McGrder. I hope she has found her people. There are many William and Mary grads who remain in the area and the Virginia Education Association has robust membership in and around town. I live in Williamsburg and volunteer at a local community health clinic. We work with area school nurses to ensure that all students have access to age appropriate vaccines and will be holding two free vaccine clinics in August. If she would like more information, she may reach me at this email. Virginia is now a measles outbreak location with 177 cases this week as compared to five for all of last year.

[00:35:25]Recently, you've been reporting that the CO 19 summer wave is virtually non-existent. Sadly, I can report that it is alive and well in the historic triangle. Anecdotally, folks are posting po photos of positive antigen tests on Facebook. This seems to correspond with a higher wastewater analysis for the week of 75 at the York River collection site as reported by the Virginia Department of Health. Though nothing of significance has been reported from the Williamsburg collection site, I wonder if given the hypothesis that a large majority of the population has a degree of hybrid immunity this many years in, the collective viral load from COVID cases is less and thus not reflective of the number of cases but the degree of severity. Also, I've not opted to get a six-month summer booster as it seems that we might not have an an updated vaccine formulation until the fall. What are your thoughts about the efficacy of new vacc versus fizer or madna's latest mRNA formulation? I've been partial to Madna.

[00:36:25]Thank you for reminding us that none of us are safe until all of us are safe.

[00:36:30]The same can be said about gun violence prevention and the current dismantling of protective policies that were enacted during the Biden administration. Perhaps you will consider including the uniquely American public health crisis of gun violence in a future discussion. It can spread like a virus in our communities.

[00:36:49]>> Yeah. No, Christine, thank you for your email. Um, I guess I'll jump in one question that you ask about um comparing the efficacy of the vaccines. uh neuvo n newvaxid versus fizer versus madna um you know there are some comparative right where madna's uh newer formulation looked like there was a little bit of improved efficacy compared to the original spike vax um but in general these are effective a lot of the issue can be a difference in reactogenicity sometimes it could be an issue of of access um so people that maybe have had a lot of reacttogenicity with the mRNAs are looking at the new vacid. Um but no, they're they're all very effective, very safe. Um and uh I think things that vaccines that should be part of our um routine going forward.

[00:37:40]>> Kathy writes, "Thank you for all you do.

[00:37:43]I started listening to TWIV during the pandemic. Find it very interesting, educational, and often over my head. I have a question. I have asked my GP who referred me to an asthma and immunology doctor who said he does not know but suggested a possible approach. Sorry this is so long but here's the story.

[00:38:00]One, as far as I know, I never had chickenpox.

[00:38:03]As a child I child, I lived in a typical Michigan neighborhood. Went to public school. The four kids next door had chickenpox, but I did not. I'm currently 62 to in 97 when I was pregnant with my first child. My OB uh guy ran a titer test. She said, "You never had chickenpox." She recommended I get the vaccine. After my pregnancy, after I gave birth, I got the vaccine. Two doses in 99 when I was pregnant. Same OB gave ran the test and said, "Did you get the vaccine?" And I said, "Yes." She said, "It must not have worked because the titers were negative." And she said, "I should do it again." So, she didn't do it again because of work and having another baby. So I'm trying to figure out how to proceed as I am at the age where my doctors keep recommending I get shingles vaccine and I have to explain this story. First GP said everyone has a chickenpox so just get the vaccine. I no longer see that doctor. My current GP consulted an ID doc who said due to my sluggish response to the chickenpox vaccine back in 98. He suggested we check my overall immune capacity to rule out an imunogloabbulin deficiency. So, I had my IGG levels tested and you can see those Daniel >> there.

[00:39:13]>> Y >> um the immunologist suggested I get Numovax 23 and test my IGG after the vaccine. I have not yet done this. My understanding is a person with low IGG is typically sick often.

[00:39:27]I'm not a sick person. I get a cold once a year and uh that's and I did have mild COVID, but I'm not sick. My question is, would you recommend a a specialist to go see to help me figure out the following?

[00:39:38]My understanding is I do not need the shingles vaccine if I had not had chickenpox. My understanding is also that the shingle vaccine does not protect me from chickenpox. Should I get the chickenpox vaccine again since it appears I don't have immunity and there are less children receiving the vaccine?

[00:39:54]My research also says I can get chickenpox from someone who has shingles. If I get chickenpox vaccine, do I need to get the shingles vaccine because the chickenpox is a infectious virus? If I get the chickenpox vaccine, should I have my dieters tested? These were all my original questions. I am not against vaccines, but I don't want to get one that's not necessary or that will do nothing for me. Oh, Kathy, this is great. I mean, this is like one of the reasons like I why I went into medicine. I love I love things like this. So, okay. So, um, going back a little to the different, um, imunogloabbulin subasses. So, yeah, the the way you figure out what's going on here is, sure, there ranges, you can check stuff, but what you really want to do is what the immunologist suggested is you do a challenge, right? So, you get the Numavax 23 vaccine, um, and you're going to do the IGG levels before and then 30 days after the vaccine. So, that that's going to tell us about your ability to respond. Now, what are we going to do with that information? I'm not really sure at this point because we're going to sort of move forward. So you'll get that information. You'll see if there's an issue there. It sounds to me like you're absolutely fine. So I'm not sure we're going to really do much with that information other than kind of move forward to try to figure out what's going on. So here's the here's your questions. One, my understanding I do not need the shingles vaccine if I have not had chickenpox. So that's true. If you never had chickenpox, you don't really need a shingles vaccine to prevent shingles. But if you've never had chickenpox and you're potentially vulnerable to chickenpox, ideally you want to be protected. Sounds like you already went ahead and got the chickenpox vaccine. Um you may not have gotten the the antibbody levels. Um but you know, you you hopefully got some kind of a cellular response. So you're going to fall into this category like so many young people these days get chickenpox vaccine when they're younger.

[00:41:38]their risk of going on to get shingles is incredibly low to the point now where we really have not started to routinely um suggest it. Um so yeah, so I mean at the end of the day um I'm not sure you need the shingles vaccine. I'm not sure you need any more chickenpox vaccines.

[00:41:54]Probably could just go on with life.

[00:41:58]All right. And Quzicotal writes from a cool and rainy Scotland. I was listening to the recent clinical update at 1338 and heard of long west Nile and wondered if there was long polio other than paralysis.

[00:42:16]So >> this is so appropriate.

[00:42:19]>> Does long polio exist and what are the symptoms? Every search and resource I find comes back with the obvious paralytic issues. Are there any papers on this? First world countries tracking of chronic conditions was poor before elimination of polio and places with polio now tend to have poorer followup.

[00:42:37]>> Yeah. So we can talk a little bit about this. I mean this is as we talked early on sort of appropriate with this email is this incredibly high 25 to 40% of folks that get polio years go by and they're going to end up with postp polio syndrome with all those lists of different things gate issues weakness falls. Uh sometimes it can even be breathing issues, right? They could start ending up having a higher incidence of pulmonary infections. Um you you jump in Vincent, this is your bread and butter.

[00:43:08]>> I am not aware of any non-paralytic lung polio. Okay. So this is an acute infection. Well, so is SARS KV2.

[00:43:17]>> Y and there are many undiagnosed polio infections. you know, you can have abortive polio, you can have non-specific flu-l like symptoms, and most of these people recover, but we don't know if there are some people who have a continuing issue, but it's not ever it's never tied in with polio because they were never diagnosed with polio.

[00:43:40]>> So, >> yeah, I think that's a good point. Yeah, it's really theoretically destruction of the nerves, the fatigue, the brain fog, the other things that we hear about. I don't really see that in postp polio.

[00:43:52]Yeah. So I I think the I mean the major concern is there's still ongoing polio and so there will still be postpolio and this happens many years later right 20 to 40 years later. So >> that's bad.

[00:44:06]>> That's TWIV weekly clinical update with Dr. Daniel Griffin. Thank you Daniel.

[00:44:11]>> Oh thank you and everyone be safe.