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24 September 2021
1. West Nile Virus (WNV) "bioweapon attack" in Phoenix--NOT:
Maricopa County (Phoenix area, where I now live!) experienced its fourth WNV death of the year, an 86-year-old man who apparently contracted the virus while sitting outside his home 31 August. He was the 4th person to die this year, out of 90 reported cases; last year there were only 3 cases and 1 death. This reminds one of the time in 1999, when WNV came to the US, infecting 1641 persons in 32 states; 80 died, for a mortality rate of around 5%. The CIA, at the urging of Senator Patrick Leahy, investigated whether Saddam Hussein had weaponized the virus and used it against us. They found no evidence of this at all. When the UN finally destroyed Saddam's virology research facility buildings, however, they did find evidence of one CDC Category A Bioterrorism agent; again there was no evidence of its having been used. Trivia question: what was it? (Hint: it spreads by aerosol rather than mosquitoes. Second hint: it's a neurotoxin.)
2. Fentanyl exposure overdose:
On 3 July two San Diego sheriff deputies were investigating what was suspected to be fentanyl at the scene of an arrest. The training officer told his partner that he was getting too close, whereupon the latter took two steps backward and collapsed. The only symptom the casualty experienced was "not feeling right" and then falling. Fortunately the trainer immediately recognized what had happened, and quickly administered naloxone via a nasal spray. The fentanyl was in a white powdery substance.
3. Radiation countermeasures for hematopoietic acute radiation syndrome:
The FDA has approved four medications for the hematopoietic acute radiation syndrome (H-ARS). Neupogen (filgramostim) and its PEGylated form Neulasta (PEG, or polyethylene glycol, is attached to the medication molecule, thus prolonging its time of effectiveness) are largely recombinant growth factors that promote proliferation and function of neutrophils. Leukine, or sargramostim, supports neutrophils and also macrophages/monocytes, dendritic cells, and hematopoietic progenitors. This January Nplate (romiplastim) was approved, which stimulates platelet generation. So far there is no similar drug targeting gastrointestinal ARS (G-ARS), but research is underway. (Full article available upon request.)
4. CDC panel backs boosters for seniors but not healthcare workers:
Yesterday the CDC recommended the FDA approve third doses, or a booster dose, of the Pfizer-BioNTech vaccine for seniors 65 years and older, residents of long-term care facilities, adults 50-64 with underlying medical conditions that increase their risk for SRS-CoV-2 infection, and adults 18-49 with underlying medical conditions if they want the booster. The majority of the committee felt that healthcare workers didn't have sufficient repeated exposures in the workplace to justify a booster. For now, persons initially vaccinated with either Moderna or Johnson and Johnson vaccines are excluded from booster recommendations. CDC Director Dr. Rochelle Walensky will decide whether or not to sign off on the panel's recommendations. Notably, WHO Director-General Tedros Adhanom Ghebreyesus has called for the U.S. to pause giving booster shots and instead give vaccines to underdeveloped nations. Obviously such a rationale is not based on what's best for the individual patient himself/herself but on what provides better political optics.
5. "Texas Prison Blues":
In a jail or prison environment "social distancing" (aside from those in solitary confinement) is very difficult. An outbreak of COVID-19 last July at an unnamed Federal prison somewhere in Texas exposed 233 inmates. Of the vaccinated inmates 120 of 185 (70%) tested positive on rapid antigen testing. Of the unvaccinated inmates 39 of 42 (93%) tested positive. Time since vaccination was important; 80% of those vaccinated at least 4 months prior to the outbreak tested positive vs. 61% of those vaccinated 2 weeks to 2 months earlier. Four patients, three of whom were unvaccinated, required hospitalization; one of these died. Genomic sequencing was performed on 58 specimens; all of these were the Delta variant. The high number of infections in vaccinated persons as well as the infection of both vaccinated and unvaccinated persons (though fewer of the former) indicates that in certain situations where physical distancing is challenging even high vaccination coverage is inadequate; other prevention strategies must be adopted as well.
6. mRNA vaccination and myopericarditis:
A recent prospective case series study from the University of Ottawa Heart Institute in Ontario, Canada conducted in June and July identified all cases with a myocarditis/pericarditis diagnosis less than one month after mRNA vaccination at an academic medical center. A total of 32 patients were identified; 18 had myocarditis, 12 myopericarditis, and 2 with pericarditis alone. Median age was 33. Of these cases 29 were male. In 5 cases symptoms developed after a single dose of mRNA vaccine; in 27 cases symptoms developed after the second dose. Median time between vaccination and symptom onset was 1.5 days (1-26 days). Overall incidence of myopericarditis was approximately 10 cases for every 10,000 inoculations. The good news is that no major adverse cardiac events or significant arrhythmias were noted during hospitalization after injection(s). Followup studies of these cases to determine long-term outcomes will be done.
7. Medical WMD Trivia:
Potassium iodide (KI) is the only drug that is widely stockpiled for radiation injury. It blocks thyroid uptake of the radioactive iodine that would be released during a nuclear attack or nuclear power plant (NPP) reactor breach. Theoretically a radiological dispersal device (RDD) could also release radioactive iodine, but most iodine isotopes are short-lived and are taken up by the thyroid once ingested or inhaled. Consequently there are several "better" RDD materials much more likely to be used than radioactive iodine. KI must be administered during the first 12 (maximum 24 hours) after exposure; else the iodine isotope(s) are rapidly taken up by the thyroid and can't be removed. There are KI stockpiles around NPPs for rapid distribution of KI to the general population in event of a major reactor breach. Congratulations to Dariusz Basiaga, Dr. Bruce Cohen, Pat Hebert, Dr. Jacquelline Placette, Gus Potter, Kevin Ryan, and Ed Waller for getting this one!
To your health,
Rad Doc Consultant, Inc