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In the latest episode of the “This Week in Virology” podcast, hosts Vincent Racaniello and Daniel Griffin discuss various topics related to viruses and COVID-19. The episode, recorded on May 18, 2023, covers a range of subjects, including testing, ventilation, vaccination, and long COVID. However, the main focus of this blog post will be on the trial results discussed in the episode.

Testing and the Performance of Rapid Antigen Tests:

One of the topics covered in the podcast is the clinical performance of a SARS-CoV-2 rapid antigen test, specifically concerning the Omicron variant. The study examined the sensitivity of the Sofia SARS-CoV-2 antigen rapid detection test compared to PCR testing. The results showed that the sensitivity of the antigen test was 93.2% in samples with a high viral load. However, the sensitivity was lower in cases with lower viral loads, which is important to consider during the Omicron variant surge. The study also found that the test was more sensitive in men and older patients.

Ventilation and Mitigation Strategies:

The hosts also discussed the importance of ventilation in reducing the concentration of viral particles in indoor spaces. The CDC guidance recommends a minimum of five air changes per hour to lower the risk of viral infection. Proper ventilation can help reduce the inhalation of viral particles and their accumulation on surfaces. The hosts emphasized the need for ventilation standards to be clearly posted, enabling people to make informed decisions about indoor activities.

Trial Results on Selective Serotonin Reuptake Inhibitors (SSRIs):

Another significant trial discussed in the episode focused on the mortality rates of individuals using selective serotonin reuptake inhibitors (SSRIs) in relation to COVID-19. The retrospective cohort study conducted in Denmark found that SSRI users had a 32% higher mortality rate compared to non-users. This finding challenges the hypothesis of repurposing SSRIs for COVID-19 treatment. The hosts emphasized the importance of evidence-based medicine and the potential harm that can come from adopting interventions without proper scientific research.

Long COVID and Obstructive Sleep Apnea:

The podcast also touched on the topic of long COVID and its association with obstructive sleep apnea. An electronic health record-based analysis found that individuals with pre-existing obstructive sleep apnea had a higher risk of developing long COVID. The odds ratio for probable long COVID ranged from 1.41 to 3.93 in adults and children with a pre-existing diagnosis of obstructive sleep apnea. This discovery raises questions about the relationship between sleep apnea and COVID-19, warranting further investigation.

In the rest of the episode, Dr. Daniel Griffin provides some helpful links and resources for virtual physical therapy for long COVID patients. He emphasizes the importance of guided exercise and the need for physical therapists who understand the specific needs of individuals with post-exertional malaise.

The episode also discusses several listener questions. One question pertains to a patient who had B-cell lymphoma and relapsed with persistent viral replication despite previous treatments. Dr. Griffin suggests considering the use of monoclonal antibodies or exploring the potential benefits of convalescent plasma or the administration of antibodies from someone with a robust immune response.

Another question is from a pediatrician who raises concerns about the strict five-day isolation rule for COVID-19. The pediatrician wonders if there will be a time when COVID-19 can be treated more like other viral respiratory infections, where individuals can return to work or school when feeling better, with the addition of wearing masks if symptomatic. Dr. Griffin acknowledges the challenges in balancing public health guidance and individual circumstances and suggests the need for updated data to inform guidance adjustments.

Lastly, a listener asks about the necessity of the latest bivalent COVID-19 booster for older individuals who have been cautious and followed preventive measures. Dr. Griffin clarifies that the vaccines are not ineffective but explains that antibody levels drop over time, and the ability to generate neutralizing antibodies against current variants diminishes. He highlights the potential benefits of updated vaccinations to reduce transmission during peak periods but notes that the current bivalent boosters may not provide the desired extended period of neutralizing antibodies.

In a nutshell:

In this episode of “This Week in Virology,” the hosts highlighted several crucial trial results related to COVID-19. The findings underscore the importance of accurate testing, proper ventilation, evidence-based medicine, and understanding the long-term effects of the virus. As the fight against COVID-19 continues, staying informed about the latest research findings remains vital in navigating this ongoing pandemic.

Overall, the episode touches on various aspects of COVID-19 management, including physical therapy for long COVID, treatment options for persistent viral replication, evolving public health guidance, and the considerations surrounding booster shots for older individuals.