COVID-19 Chronicle July 2022 and
Monkeypox Update

A- Researchers are learning more on the loss of smell and taste seen with COVID-19 and the ability to recover. Many clinical trials are on the way including the use of steroid and blood plasma. Smell disruption is becoming less frequent as the virus SARS-CoV-e evolves. A study published last month by Valentina Parma, a psychologist at the Monell Chemical Senses Center in Philadelphia PA who helped survey around 617,000 people found the first 2 years of the pandemic, that people who have been infected with the original virus (Alpha variant) were 50% likely to have a chemosensory disruption. With the Dela variant the probability fell down to 44% and was even less with the Omicron 17%. The one who developed the loss of sense with the Delta, still experience the symptoms in 46% of the cases. It may be reasonable to conclude that in a given 500 million of people who have contracted COVID-19 in the world, at least 10 million of them are still experiencing the smell and taste problems. No need to say that it can be emotionally distressing.

B- Earlier in the pandemic, it was demonstrated that the coronavirus attacked cells in the nose, called “sustentacular cells” which provide nutrients and support to the odour-sensing neurons. Since then, at Columbia University in NY, a biochemist Starvros Lomvardas studied the phenomenon on cadavers and found that the neurons were intact but the membrane -embedded receptors were deficient in the odour molecules and the nuclear architecture of the neurons were unrecognizable. In another study, they found out that there may be a genetic mutation in people who has lost the greater propensity for smell and taste. They called 2 DNA mutations UGT2A1 and UGT2A2 which both encode the proteins that remove odour molecule from the nostril. More studies are still needed. They found also evidence of changes in the brain of people with loss of smell and structural changes in the olfactory centers were observed in United Kingdom after repeated brain scans.

C- Treatments have been explored and the most consistent is the “smell training” Where patients are given samples of strong-smelling substances to sniff and try to identify. This method seems to work only with people with partial loss of smell. Many investigators are using steroids to reduce inflammation. In the USA, they found that platelet-rich-plasma render people more sensitive to smells. Vitamin A also has been used to help in any form of smell loss. It will take more time to know if it is effective,

D- Paxlovid has been used in COVID-19 patients who keep becoming positive again for the disease. By day 4 taking the antiviral pills, the symptoms resolved and the isolation was terminated and the negative status was confirmed by PCR (rapid antigen test) forcing the CDC to issue a health advisory on COVID-rebound in people using Nirmatrelvir/Ritonavir. A risk foe progression to severe disease. Because of the rebound phenomenon, we still do not know what is the best way in using these drugs. These drugs are still being prescribed for mild to moderate COVID-19 non-hospitalized patients older than 12 years old. Patients with obesity, cancer or chronic disease like Diabetes Mellitus can be also candidates to use the drug via a 3-pills dose. Ritonavir who is used to boost HIV protease inhibitors may show an effective way in decreasing the risk of hospitalization in mild COVID-19’ Unfortunately, it does not prevent individual from becoming positive and symptomatic. Both antivirals were associated with lower all-cause mortality risks.  More studies are being performed.

E- About guidance for the Monkeypox outbreak. If any person irrespective of gender identity or sexual orientation can acquire and spread the virus of Monkeypox. Remember that many of the cases reported in the USA have been found in the homosexual community and the gay population. It takes a skin-to-skin contact or sexual contact with a person with the disease to get contaminated. You will need to report the cases, Remember the symptoms of Fever, Malaise, Headache. Then isolate self and if there is no rash appearing within the next 5 days, the illness is unlikely to be Monkeypox. 

Maxime Coles MD
Boca Raton Fl
July 2022

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