This post is about a new California law seeking to limit misinformation.
California’s Governor Gavin Newsom signed AB 2098 into law on Friday. The new law allows the Medical Board of California to punish health care providers for spreading misinformation. The law does this by adding the act of spreading misinformation to the definition of “unprofessional conduct” used by the Medical Board of California. Unprofessional conduct is punishable in California by up to the suspension or loss of a license to perform medicine.
The law defines “misinformation” as “false information that is contradicted by contemporary scientific consensus contrary to the standard of care.”
There are many, many examples of ideas in science and medicine that were opposed by the scientific consensus and later accepted as true. There are so many examples of this, that it should be considered as a normal part of the scientific process. Examples include:
The Earth revolves around the Sun
Not cleaning surgical tools between operations can lead to increased mortality in patients
Ulcers are caused by the bacteria H. pylori, not by spicy food
Viruses can cause cancer
Cells produce energy by passing electrons through a membrane
The universe began at a discrete moment, and then expanded to its current form, creating both space and time in the process
The SARS-2 virus was created in a laboratory in Wuhan*
The idea that misinformation can reasonably be defined as an idea that is contradicted by scientific consensus is itself contradicted by centuries of scientific practice.
Scientific ideas come to be seen as true not merely by achieving consensus, but also by surviving challenge by new ideas. No scientific idea is immune to this process. Science is not a set of facts set in stone, but a constantly changing set of ideas guided by the scientific process, a process which includes debate among scientists. Requiring that new ideas achieve consensus immediately would freeze the advance of science in place, the current, and often wrong, ideas remaining dominant forever.
Of course, I have not yet addressed the obvious First Amendment violation this new law creates. The First Amendment clearly allows freedom of speech, a cornerstone of American life. This law will quickly be challenged by First Amendment advocates and will almost certainly be struck down.
As I’ve stated before, freedom of speech is not the cause of misinformation. It is the antidote. Only if we allow the free flow of ideas can these 3 things happen:
All ideas to be aired Good ideas to be confirmed and adopted Bad ideas to be discredited
Dr. Mobeen Syed points out several other negative impacts this law will have:
Doctors will be suspicious of their patients, compromising the doctor/patient relationship.
Doctors will only give consensus advice, making going to the doctor more like going to a call center.
Laws will expand to include other kinds of “misinformation” further compromising the exchange of ideas.
Law will be used unequally to silence only certain kinds of speech.
Doctors may choose not to practice in California.
If I’m being too subtle, I’ll just say that this is a bad, unconstitutional law and should simply be ignored.
Don’t fear, but be smart, Erik
* I’m taking a little liberty on this one. This idea was rejected totally early in the pandemic. It is not yet universally recognized as true, but many scientists, including me, see it as most likely to be true.
This is a case update. I’ll also comment on new variant, new boosters, and the President’s announcement that the pandemic is over.
Cases continue to go down in the US, California and San Diego County. Again, since most people are now testing themselves using over the counter tests, the official case numbers are probably a gross underestimation of actual cases. Hospitalizations are a better measure, and they are also going down.
Variants BA.4.6 and BF.7: In my last post, I introduced a new variant BA.4.6. While hospitalizations are down, this new variant is now 11% of COVID cases in the US, and 20% of cases in the Midwest. Still, I don’t think this new variant is likely to have a big impact on the pandemic at the moment, and I expect cases to continue to go down. Deaths remain relatively low compared to the Omicron variant in April after the Winter wave. A newer variant, BF.7, is already growing in prevalence, but so far, there isn’t a lot of news about it.
New boosters including Omicron strains: In August, the FDA announced emergency authorization of new boosters by Pfizer, Moderna, and Novavax. This new class of boosters produces spike proteins from the original Wuhan strain, but also from Omicron variants BA.4 and BA.5. People have been asking me my opinion about these new boosters. To preface my comments, I’ll say again that I am not a physician, epidemiologist, or immunologist, so my opinion is informed but not expert.
While the inclusion of BA.4 and BA.5 targets will make these new boosters an improvement over previous versions, I think most people will not benefit from them. For anyone who has had COVID, which is now arguably most of us, they will not really benefit you. Natural immunity has been shown in many studies to be equal or superior to vaccine mediated immunity in preventing infection and severe disease.
I suggested that my own parents get vaccinated in the Spring of 2021. But I am not suggesting that they receive the new booster. If you do choose to get the new booster, try and find a provider who will aspirate before injection.
President Biden announces that the pandemic is over: On September 19, CBS News released a video in which President Biden stated that the pandemic is over. In the interview, the President said “The pandemic is over. We still have a problem with COVID. We’re still doing a lotta work on it. … But the pandemic is over.” Of course, this triggered a debate on whether the pandemic is really over. At least a few health care officials said the health crisis is still ongoing, and that caution is still warranted. Debates are now ongoing as to the appropriateness of ongoing emergency measures like vaccine mandates and emergency use authorizations.
As for me personally, I had difficult time with COVID in January, and a much more mild case in July. I am basically behaving normally at this point. Most places I go, even in California, are basically going back to normal.
On other hand, hospitals are still seeing COVID patients and laboratories are still doing lots of COVID testing, so for them, COVID is still a reality they have to deal with.
If you’ve never had COVID, I would still recommend wearing a high quality medical respirator indoors in public (N95, KN95, or KF94). Blue surgical and cloth masks are not effective against Omicron variants.
This is a COVID case update. I’ll also have a brief warning about Hurricane Kay, which I’ve heard very little about in the news.
Confirmed cases continue to decrease in the US, California, and San Diego County. Hospitalizations are down too, especially in San Diego County.
A newly recognized variant, BA.4.6 is growing relative to BA.5, so is likely more infectious. I haven’t been able to determine from news stories if it is more or less pathogenic (disease causing) than BA.5. BA.5 never caused an increase in deaths, despite it being more dangerous than previous Omicron strains.
My guess is that BA.4.6 will be less dangerous than BA.5, and that we’ll see fewer hospitalizations and deaths. This is just my speculation at this point.
Important Hurricane Kay warning for San Diego: Last weekend and this week, our increased heat and humidity was caused by Tropical Storm Javier, which traveled up the coast just west of Baja California before heading out to sea. Following closely after is Kay, currently a Hurricane off of Southern Baja. Kay will likely get much closer to San Diego than Javier did. San Diego is likely to see rain and even winds up to 23 miles and hour on Friday, according to the Weather Channel on Thursday morning. Kay will likely be downgraded to Tropical Storm by the time it gets to the waters West of San Diego, but it will still likely bring rain and stronger than normal winds. Consider securing loose items like patio furniture, tarps, and garden gnomes. No one likes a flying garden gnome.
This is a COVID case update. I’ll also discuss the CDC’s recent changes in policy.
We have some good news this week. New cases are going down by every available metric. New confirmed case numbers are coming down in all 3 regions. More importantly, hospitalizations are coming down as well, sharply in San Diego County. BA.5 continues to be the most common variant in the US by far. BA.5 was feared to be more dangerous than previous variants, but deaths have not risen significantly since BA.5 appeared.
World wide, new cases are coming down. After spending most of the pandemic at the top of the list of countries with the most new cases, the US is now at #3 on John’s Hopkins list, behind both Japan and South Korea, and at #7 on Worldometer’s list. Sorry, the US still has double as many total cases as #2, India.
I’ve discussed several times before that the CDC is primarily responsible for the poor US response to the pandemic. Even worse, they have done great damage to the public’s trust in the medical community and in science in general. I’m glad she intends to fix the agency, but I’m afraid this will not be a speedy process and may essentially be impossible. In order to be successful, they will need to be transparent, and probably fire some people top leadership in order to regain the public’s trust.
• Those exposed to COVID need not quarantine. Test on day 5, and wear a mask in public for 10 days.
• If you test positive for COVID, quarantine for 5 days. If after 5 days you are fever-free for 24 hours without the use of medication, and your symptoms are improving, or you never had symptoms, you may end isolation after day 5. Wear a mask until day 11, and stay away from high risk people.
• Vaccinated and unvaccinated people will not be treated differently.
Some of these changes are in response to the improving situation, while others are long overdue.
If you think you may have been exposed to COVID, review the changes on the CDC website.
This is a case update. I’ll also have an update on the Monkeypox epidemic.
Not much has changed in the last 2 and a half weeks. Cases are still at a moderate level, at least according to official case numbers in the US, California and San Diego County. However, deaths in all 3 regions are still relatively low. This situation has persisted since early May. Even the more dangerous BA.5 has not really produced a large increase in official cases.
Most people are not getting tested in a medical setting right now, preferring to test themselves with over the counter antigen tests. As I posted a few weeks ago, these tests are producing a lot of false negatives right now, so many with COVID think they just have a cold. I believe I had COVID in mid July, but I tested negative twice, and never tested positive.
A better measure of case load is hospitalizations. In the US, hospitalizations likely peaked just a few weeks ago, and are now headed down. In San Diego County, hospitalizations likely peaked on around July 10th.
Right now, 89% if the COVID in the US is of the BA.5 variant. This variant is theoretically more dangerous than previous Omicron variants, but has not had a large impact, likely because of a lot of immunity in the population, either vaccine or naturally acquired. As for me, my case in January was much more severe than my case in July, despite my case in July being a more “dangerous” variant.
Most in the public are acting as if the pandemic is basically over. For the vast majority, there is really no longer a danger of severe disease or death. If you have not yet had COVID, you may still want to take precautions to prevent infection. Wear a medical respirator (N95, KN95, or KF94) when indoors in public.
Monkeypox Update: Despite being only moderately infectious, Monkeypox has continued to spread in many countries. There are now 11,000 confirmed cases in the US. The disease is similar to Smallpox, but is much less severe. It is spread primarily by skin to skin contact. With medical attention, Monkeypox is very rarely fatal, with currently only 3 fatalities in Europe. Monkeypox is endemic in central Africa, and occasionally produces outbreaks.
Monkeypox virus has been found on surfaces and in airborne droplets, so it is theoretically possible to contract it via these routes. However, there have been no confirmed cases of airborne transmission in the UK, according to a UK government document.
Some people living with infected persons have also contracted Monkeypox, so it appears that prolonged indirect contact can also spread this disease.
At the moment, 95.3% of cases in the UK are in a category called “men who have sex with men” (MSM), and this rate is likely similar in the US, but if cases continue to go up in the US, we will likely see more cases in the broader community. The good news is, new daily cases in the UK peaked in early July and are coming down now, so the US will likely start seeing a reduction in cases soon. Hopefully, the Monkeypox epidemic will be short lived.
A note on symptoms. Most of the public and even physicians assume that Monkeypox produces boils similar to smallpox or chickenpox. While it often does, it commonly seems to produce small rashes instead, leading to misdiagnosis. So if you or someone you know has small rashes, they should assume Monkeypox, isolate themselves, and seek medical attention. Smallpox vaccine appears to be effective against Monkeypox, so a vaccine is already available, but it is in short supply right now.
This post is about the over the counter Antigen tests that a lot of us have used in the last few months, and whether they really work.
As we’ve discussed, BA.5 is re-infecting lots of people, even those who’ve had Omicron just a few months ago. Those with recent cases generally have a mild case the second time around, even with BA.5
I just got back from summer camp with a bunch of high school students. I knew I could get COVID again, but since I had Omicron in January, I figured I’d be OK, even if I got BA.5. One of our counselors got sick while we were there, and tested negative for COVID, with an antigen test. I got sick on Sunday morning, after we were back, and also tested negative for COVID using an antigen test. On Sunday I just had a sore throat, Monday and Tuesday morning I had fatigue, sore throat, and just a little coughing. My sore throat felt very similar to the one I had in January, kind of like a weird heart burn, so I tested myself again on Monday. Still negative.
Meanwhile, the other counselor tested negative again when he got home, but then tested positive after that. His wife too. So he had 2 negative tests before testing positive.
So did I have COVID again? I still don’t know. I’m at the “just getting over a cold” stage right now and am feeling pretty normal. I had 2 negative tests and I’m not going to test myself again.
Doing a good scientific study is a slow process, and we’re probably unlikely to get good scientific articles on how well the antigen tests work for every new variant. The only articles I could find on BA.5 and antigen tests were from Slate and CNET. I usually don’t bother to read popular level articles on COVID since journalists often get things wrong, but that’s all we have. Both basically say that yes, they work, but you may need to take several tests. Well, that’s kind of like saying they don’t work very well.
How Antigen tests work: There are 2 kinds of tests that use antibodies for testing. One is an Antibody test. This kind of test looks for human antibodies against SARS-2 proteins. It actually determines whether you’ve been infected at some point in the past. IgM antibodies appear after a few days and persist for about a week. IgG antibodies appear after about a week and persist for weeks or months. So a positive SARS IgM tests says you basically have COVID right now, while a positive IgG test you have it now, or had it weeks or months ago. An IgG test is not useful if you want to know if you have COVID now.
An Antigen test detects actual SARS-2 proteins. They usually detect the Nucleocapsid protein (N), a protein on the inside of the virus which does not mutate rapidly. In theory, these tests should work well even if the Spike protein changes, which is by far the most common changes in new variants. They are not usually thoroughly tested with each new variant.
The Slate article suggests the tests may not be working as well because the BA.5 variant may not be as present in the nostrils as previous variants. Scientists know that a Nasopharyngeal (back of the nose/throat) site is better, but patients far prefer a nostril test. So this may be why the tests are not working as well for BA.5.
Antigen tests are less sensitive than a PCR test, but they are far cheaper, faster, and easier to use, which is why they are so common now. If you really need to know if you have COVID, a PCR test is the way to go. I frankly am pretty disappointed that a clearly symptomatic person can test negative for COVID right now with an Antigen test.
All this to say, if you have cold-like symptoms in the next few weeks, you’re better off staying at home and laying low for a few days, even if you have a negative Antigen test. You may actually have COVID.
Happily, if I indeed have COVID now, it’s a very mild case.
This is a COVID update. I’ll also briefly discuss a mystery from a few months ago, a hepatitis in children of unknown cause.
It’s been almost 3 weeks since my last post. Since then, we’ve seen remarkably little change in either infections or deaths in the US, California, or San Diego County.
Some scientists now argue that since so many who are newly infected test themselves with over the counter tests, hospitalization is really the new measure of how much COVID is in the population. In the US, BA.5 has caused hospital admissions to go from about 4000 to about 6000 per day.
BA.5 is more dangerous than previous Omicron versions because it replicates down deep in the lungs like the original Wuhan strain, Alpha, Beta, and Delta strains. Most Omicron strains were less dangerous because they replicate in the trachea, thus can’t cause pneumonia. BA.5 is now 80% of new infections in the US.
John Campbell has an interesting new video out about BA.5. He argues that while BA.5 reinfect those with previous infections, even Omicron, natural immunity does give substantial protection. Dr. Campbell is from the UK, so much of his data comes from the National Health Service, which as been doing a better job at publishing data than the CDC.
Campbell discussed a paper from Altarawneh et al that claims that only 15% of Britons have no previous infections. 55% of new BA.5 cases come from this 15%. That means that 45% of new BA.5 cases come form the other 85% of people who have no previous infections.
After doing all the math, the authors suggest that infection with a pre-Omicron variant is 28% effective at preventing infection with BA.5, and infection with a previous Omicron version was 79.7% effective against reinfection with BA.5. All this to say, if you’ve had COVID before, you are less likely to get BA.5, and will likely have less symptoms as well.
Adenovirus is a very, very common virus in humans. It’s so common in fact, that most of us catch when we are very young, and have no symptoms, which is why we don’t hear about it much. Some adenovirus infections can look like a common cold. Adenovirus does not cause hepatitis.
However, doctors recently discovered that all of the children tested were positive for an unusual virus called Adeno-associated virus-2. This weird virus can only replicate in a human that is already infected with an adenovirus. So this is an unusual case in which 2 simultaneous infections are required to cause disease. AAV2 appears to be the actual cause of hepatitis in children.
At this point, researchers believe that the lack of exposure to common pathogens during the lockdowns has lead to the result that many children do not have immunity to common viruses that they usually do. AAV2 hepatitis does not happen in adults because they already have immunity to Adenoviruses.
So what should you do if you have small children? Well at first, in my opinion, allowing a normal social schedule is likely a good idea at this point. Death rates from COVID are still low and have not really increased due to BA.5, so the risk to others is likely low. You may want to limit their contact those who are at high risk for COVID.
Also, if your child experiences any of the following, especially in combination, seek medical attention immediately, at least a phone call to your doctor:
Nausea Abdominal pain Vomiting Diarrhea Jaundice (yellowing of the skin)
This is a case update. I’ll also discuss important new data in regards to BA.4 and BA.5 variants which you may want to take into account as you move around in our “post-COVID” world. You should especially read this if you’re one of the few who have never had COVID. I’ll also suggest a range of strategies that you may employ to keep yourself safe.
The update is actually not much different in the US from last week. Cases are medium-high but flat right now, and we have happily not yet seen increased deaths due to Omicron BA.2.12.1, BA.4, and BA.5 variants.
BA.4 and BA.5 now predominate in the US, being 17% and 54% of cases respectively. Together, they are 70% of new cases. Hospitalizations are up slightly, but not nearly so high as in January, at the height of the Omicron wave.
Keep in mind that many and perhaps most people who have COVID right now are not getting tested by a health care provider, and are not being treated, so they are not a “case” and do not appear in current statistics. While it’s great news that we haven’t yet seen increased deaths in the US, there is sobering news which may cause a change in this in the next few weeks.
BA.5 reinfecting Omicron patients: A few weeks ago, an urgent care doctor friend of mine said that he had seen some patients who have had Omicron twice. Just this week, some friends of mine who had Omicron in January, just like me, came down with it again. They have COVID right now. Like me, they were pretty miserable in January for a full 2 weeks. Happily, their symptoms are moderate now, like a bad cold, just for 2 or 3 days.
Dr. Campbell’s newest video has some sobering information about BA.4 and BA.5 variants. As you can see from the data above, BA.5 is more infectious than BA.2 and BA.4, and will probably become dominant in the US in the next few weeks.
While still being called an Omicron variant, I wouldn’t be surprised if BA.5 gets it’s own Greek letter. Maybe Pi or Rho.
For some good news, reinfections are usually milder than previous cases. So if you’ve already had COVID, BA.5 is likely nothing to be worried about.
Portugal had a lot of BA.4 and BA.5 in May and June, and they experienced more hospitalizations and deaths. Some worry that BA.5 may produce more severe cases in “naive” people, those with neither natural nor vaccine mediated immunity. Drs. Kei Sato and Stephen Griffin claim that BA.5 is growing deep in the lungs, like pre-Omicron versions, which makes it more likely to produce pneumonia. Most Omicron variants grow primarily in the trachea, which is why they are less likely to produce severe disease.
Last, Dr. Campbell argues from a letter by Hachmann et al, that prior infection plus vaccination offers better protection than either alone, but that BA.5 is still escaping neutralization. In my personal view, vaccination carries risks of it’s own, so if you are still not vaccinated, I would suggest taking increased precautions rather than vaccination at this point.
Cases in the UK are rising quickly right now, and often is a few weeks ahead of the US in any recent COVID trend. If data from Portugal and the UK hold true in the US, we may expect increasing cases in the US and perhaps more deaths as well.
Viruses have a tendency to become more infectious and less pathogenic over time. While this has been shown to be true many times in the last century, this is only a tendency and does not always hold true. While BA.5 is more infectious than previous versions, it’s tendency to grow in the lungs may make it more dangerous, so BA.5 is bucking the trend.
Strategies: Of course, it can be very hard to predict what will happen next. We also have a lot of different COVID experiences in the US in terms of whether someone has had COVID, what variant they had, whether they were vaccinated, etc. So any suggestions I make may not pertain to you.
Since I had COVID in January, I’ve been behaving in public as if I’m totally protected against a new infection. This may have been warranted, since I haven’t been infected again. I’ve even visited people with COVID at their house, treating it as an opportunity for a free booster. But this new information gives me pause. I may be more vulnerable to BA.5 than I had hoped.
On the other hand, even BA.5 is mild in those with previous infections, so I will likely be OK if I get BA.5. I am still not vaccinated and don’t intend to be. So going forward, I am going to continue to behave as normal, without masking in public at this point.
My main reason for being so careful before I got infected was the Antibody Dependent Enhancement (ADE) issue. Now that I’ve been infected, it’s not useful for me to continue with my previous caution. In fact, the “free booster” method may now help me with future versions more than avoiding infection would.
If you have never had COVID, you may choose to take increased precautions to prevent infection. Wear an N95, KN95, or KF94 mask when indoors in public. Don’t wear a cloth or blue surgical mask. These masks will not protect you from BA.5. Vaccination alone is not likely to be of much protection from BA.5.
If you do end up being infected with BA.5, regardless of the severity of your symptoms, stay home until you’re COVID negative to protect those around you who may be vulnerable.
Will COVID be endemic? A client of mine was kind enough to recommend my posts to his board, saying that my COVID predictions always come true! I would love this to be that case, but I can’t claim that kind of record. I have certainly been wrong during the pandemic. In particular, I’ve said that Omicron will end the pandemic, and that it will won’t likely have a new dangerous variant. BA.5 may end up proving me wrong on both counts. The lightning speed that new variants are developing also challenges my previous statements. I can’t claim to always be right, but I will tell you as soon as possible if I’ve been wrong.
So will COVID last forever? In spite of BA.5, I still say no. While it has exceptions, the tendency for new viruses to be less pathogenic still holds true. I still expect new variants to generally be less dangerous than older ones. In fact, BA.5 will likely still have less impact than previous versions simply because so may people have previous infections.
However, something else very interesting happened. Dr. Fauci took Paxlovid, which I’ve discussed briefly before, and became COVID negative. But after his 5 day course, he became positive again with worse symptoms. This means that a standard 5 day course of Paxlovid will not necessarily reduce your viral load to zero, and patients may experience “Paxlovid rebound”. Fauci even claims that this kind of rebound with Paxlovid is starting to be seen as “typical” as more patients use it.
With so many rebound cases, it’s likely that 5 days is not adequate to eliminate all viruses from the system, allowing rebound. However, Paxlovid does have side-effects, so don’t take it for more than 5 days without consulting your doctor! Hospitals are now only prescribing Paxlovid to high risk patients.
Whenever taking anti-viral or anti-bacterial medications, always take the full course of treatment. If any virus or bacteria survive treatment, they may give rise to a more resistant strain. Don’t just stop your treatment when you feel better. I take anti-biotics as a last report, but when I do, I take the full course. I even made a doctor give me the full 10 day course when she just wanted to give me a half course!
Just to repeat the point on the vaccines, I still hear ads on the radio encouraging vaccination. At this point, the vaccines are really not doing anything against the current COVID variants. There is really no benefit to getting a vaccine or a booster. If you haven’t had COVID yet, I would simply recommend preventative measures. Wear an N95, KN95, or KF94 mask when indoors in public. Cloth and surgical masks will not prevent infection.
This is a brief COVID update. Cases have been flat in the US, California, and San Diego County, neither rising or falling. This may be partially because of the introduction of 2 new variants, BA.4 and BA.5. These new variants are both of the Omicron vintage. The good news is that deaths have not risen for many weeks even after cases rose due to the BA.2 variants.
My guess is that BA.4 and BA.5 will continue to drive new cases for a few more weeks before we start seeing cases come down. It appears that the fatality rate for these new variants is also very low when compared to other COVID variants.
The contribution BA.4 and BA.5 variants in the US is growing, as they new represent approximately 50% of the total SARS-2 viruses in the country.