This is a case update. I’ll also talk about yet another Project Veritas video that may have you concerned. This discussion will deal candidly with the very controversial issue of abortion.
Cases continue to come down in the US, California, and San Diego County. So far, we aren’t seeing any uptick from a possible Fall/Winter wave, except perhaps in Minnesota and Michigan. The rate of fall of cases is slowing down, however, suggesting that we may see a new persistent number of cases that is higher than we had before, as has been seen in other countries.
Yet another Project Veritas video was released last week, this time about the allegation that Pfizer used aborted fetal tissue to develop and/or produce the COVID v@¢¢!nes. Pro-life Americans are concerned about this development. As a pro-life person myself, I wanted to provide some context to this issue. I’m not going to tell you want to think about the issue, since it is largely a matter of conscience, but I do think when making moral decisions, it’s good to make them for the right reasons.
Scientists often use human cell lines to perform certain studies that require human cells that can be grown in a petri dish outside the body (doing biological things outside an organism is called in vitro, Latin for “in glass”). Generally, human cells do not grow when removed from the body. Human cells signal to each other and cells that are separated from others will undergo programmed cell death. For human cells to grow in a lab, they need to be “immortalized” in some way. This can be done in several ways. You may have heard of HeLa cells, human cancerous fibroblasts taken from a patient, Henrietta Lacks, in 1951. These cells grow well in vitro and have been used by countless scientists in countless labs since then, including by me. Another way is to use embryonic stem cells.
Many in the US, including me, think it is unethical to collect fresh embryonic stem cells, because this usually requires an abortion. It can also be done after a miscarriage. The HEK293 cell line was created using embryonic stem cells collected in the Netherlands in 1973. The specific origin of the stem cells is unclear. Like HeLa cells, HEK293 cells have been very useful to scientists because they grow well in the lab and have other useful properties.
It does appear that Pfizer used these cells in the development of the current COVID v@¢¢!nes, and perhaps even in the manufacturing process. I need to point out that no new cells were collected for this purpose. The creation of the COVID v@¢¢!ne does not create a new market for embryonic stem cells.
As I’ve stated before, I am generally pro-v@¢¢!ne, but I am not getting the COVID v@¢¢!ne, mostly because of the ADE issue and because of the potential toxicity of the Spike protein. However, when deciding how to think about an issue, it’s very helpful to develop your position based on facts and evidence rather than on assumptions.
As a matter of conscience, many pro-life people will take the position that taking a v@¢¢!ne which used HEK293 cells in any part of the process is unethical. I’m not going to ask you to violate your conscience. I will say again, however, that the cells used to create HEK293 cell line were collected long ago, and no new tissue has been collected for this process. For me, this means that getting the v@¢¢!ne would not be ethically illegitimate, at least not for this reason. I think people of good will can land on both sides of this issue.
Please let me know in the comments if you have questions. You can help me be more clear.
This is a case update. I’ll also discuss a new video from Project Veritas featuring interviews from employees of Pfizer.
The Delta wave continues to wane in the US, with cases overall continuing to go down sharply. This is great news, but I have to caution that last year’s Fall/Winter wave started in October, so there is a chance we will see a new wave starting in the Northern states. In fact, cases are starting to increase right now in Minnesota, Wisconsin, Michigan, and Maine, while they are going down in the Southern states.
Cases are also going down in California and San Diego, although there was a spike in cases last week. Since both regions saw the same spike, it suggests that the event causing the spike may have taken place in Southern California, but this is only speculation.
Pfizer employees discuss immunity: I always hate making politically charged posts, but this is another occasion when I must. Project Veritas posted another video just yesterday. In it, 3 scientists at Pfizer discuss the v@¢¢!nes, saying among other things that natural immunity is actually better protection against the virus than v@¢¢!ne mediated immunity. This is in agreement with the data from Israel published as a pre-print a few weeks ago.
As I’ve stated many times, for at risk people, a v@¢¢!ne is very likely to be of benefit. I have recommended that at risk people get v@¢¢!nated. If you’ve already had COVID, 1 dose of v@¢¢!ne is likely to provide extra benefit. However, if you’ve had COVID, your natural immunity is likely to provide better protection than “full v@¢¢ination”.
They also make the claim that v@¢¢!nation benefit drops over time because the antibodies gained from v@¢¢!nation drop off over time. I would also point out that another cause may be that new variants may diverge from the original Wuhan strain enough to makes v@¢¢!nes less effective, but this point is not addressed in this video.
One person even states “I mean, I still feel like I work for an evil corporation.” I want to make a comment about this. It’s easy for us to blame big corporations for some of the decisions they make, since most of us aren’t in that position. I worked for Quest Diagnostics, a large medical testing company. The vast majority of the people who worked there believed in the mission of providing high quality information to our client doctors and patients. However, as with any large organization, there were those who were focused on profit, at times over the interests of the clients. Most often this came in the form of passing over projects that would help patients, but would not bring in a lot of income. They would argue something like “We aren’t a charity. We need to bring in money to survive as a business.” This is of course partially true. Director Spike Lee once commented in an interview that the most interesting conflicts are those in which both sides are correct.
Of course, a company or an individual can cross a line after which their actions become unambiguously wrong. This often happens because they’ve made well intentioned compromises until they have lost their moral sensitivity. But I want you to remember something important. The Presidents and CEO of companies work most directly for the board of directors. The board of directors works most directly for the shareholders. In our modern investment environment, which includes mutual funds, many of the shareholders don’t even know they are part owners of a company! As far as they know, they just own a mutual fund. As far as their mutual fund goes, they only care if it’s making them money, since they don’t know what companies they hold, or what their business practices are! So the CEOs are ultimately working for people for whom profit is the only concern. Folks, those people are you and me!
Yes, companies that behave unethically should be held accountable. If Pfizer has misled the public, then they should be held accountable. But we can’t forget that anyone who holds a mutual fund that includes Pfizer has a voice in this as well. I will tell you that I am talking to myself as well. I currently have no idea what companies are in the mutual funds that I own. We should all take the time an find out what companies we hold the most stock in, and consider finding out what they are doing. You can then contact your mutual fund company and make suggestions about what they can communicate to these companies, or consider selling funds with stocks you don’t like. The small choices we make every day do have an impact.
V@¢¢!ne mandates: V@¢¢!nes will certainly benefit at-risk individuals. In addition, it is clear that countries with large v@¢¢!nation programs have had lower fatality rates during the Delta wave than other countries. However, I am not v@¢¢inated, and am firmly against v@¢¢!ne mandates. It is especially counter productive for hospitals and other organizations to be letting go of highly trained people who have chosen not to be v@¢¢!nated. I hope this new information will bring some balance to the current discussion.
This is a case update. With some trepidation, I’ll also discuss the new video by Project Veritas concerning vaccines.
It appears that the US has reached the peak of the Delta Variant, with cases clearly starting to come down. On the other hand, as numbers start to come down in the South, we may already be starting to see increasing cases in the North, as Wisconsin, Pennsylvania, Ohio, and Iowa are experiencing increased cases right now. If last year was any pattern, we may see large case numbers in the North as people start to spend more time indoors.
California and San Diego County are continuing to improve. LA County has “achieved” something in the last week, improving enough to give up the spot as the county with the most cases since last Winter. 2 counties in Texas, Harris (Houston) and Tarrant (Fort Worth), have had more cases in the last 2 weeks than LA County.
Project Veritas released a video of a taped conversation between medical workers at a medical center in Phoenix. In it, the workers use, shall we say, colorful and scientifically imprecise language to suggest that the COVID vaccines are not performing as expected.
There is a lot to say about this! First, let me say that available data is still insufficient to say with any certainty how many adverse effects there are, and of what kind. I will speculate here, so keep in mind that I am mostly guessing, since I don’t have sufficient information to know exactly what’s going on.
Anecdotal evidence is based on the experiences of a few people, often relayed as a story or rumor. This kind of evidence is an important pointer that something may be going on, but very often, it is insufficient to understand the situation with any clarity or as a foundation for policy. At best, anecdotal evidence gives researchers the motivation to conduct a careful study of a situation so there can be more understanding. At worst, they can cause rumors to overwhelm careful thinking, and lead to wrong conclusions in the minds of many. This kind of evidence must be taken with a grain of salt, with final judgement reserved until more information is available.
My own thinking on adverse events has evolved a lot since the vaccines came out. All vaccines carry risks, with a few adverse events happening with even routine vaccines like the flu. On balance, vaccines have been extremely beneficial to individuals and society as a whole, effectively ending diseases like smallpox and polio. So when rumors of adverse reactions to the COVID vaccines first started coming out, I initially dismissed them as the standard rare event.
But then came the suggestion that the Spike protein itself was responsible for the vaccine’s toxicity. While still not proven, this idea makes sense to me because it could explain the wide variety of reported adverse events. Increased inflammation aggravates the part of your body that is already under stress. The Spike protein causes inflammation, so it’s no wonder that the vaccine causes strange and varying symptoms in some individuals. As someone with an auto immune disease, inflammation is a big deal for me.
Unfortunately, the vaccines cannot work without producing the Spike protein, because the protein is needed to produce a working immune response. The Spike protein is an unavoidable risk.
The recent Project Veritas video is a remarkable piece of anecdotal evidence. It does not provide scientific or statistical evidence, but it does demonstrate that more information on adverse events is desperately needed.
The most disturbing part of the video to me is the claim that adverse events are not being reported to the CDC VAERS system simply because the forms take too much time to fill out! If true, this is frankly typical of a program from the CDC. Since long before the pandemic started, the CDC has sought to keep tight control of information and guidance regarding the spread of infectious disease and related matters. Legitimately, they try very hard to be accurate. During a pandemic, however, information changes too quickly for this approach to be effective. They are so careful to publish only accurate information, that information is often hopelessly out of date. Ironically, in an effort to always be right, the CDC has usually been wrong. Nothing illustrates this better than the mixed messaging on masks. Now almost everyone is hopelessly confused on this issue.
When there is a large vacuum of information, people will attempt to fill it with speculation. People from the federal government often complain about misinformation, but the CDC has contributed to it by leaving a huge hole for people to fill with guesses.
A form that takes 30 minutes to fill out is useless if no-one has the time to fill it out. In response to the video, the CDC should immediately re-make the form, making it take only 5 minutes or even 30 seconds to fill out. Yes, they will be missing some information from each patient, but they’re getting nothing on them right now, so it will still be an improvement. Instead of making the necessary changes, the CDC will probably just call the video misinformation, and try to send it behind the Digital Curtain.
A note on the VAERS system: the system is meant to capture all data that may point to a vaccine producing a pattern of adverse reactions. Any negative medical event that happens within a few days after a vaccination is recorded. This even includes events that are unlikely to be attached to the vaccination. The hope is that patterns may be recognized by immunologists that will point to a problem with a vaccine. For example, if you notice that a lot of people report hitting their head after a vaccination, this may suggest dizziness or disorientation.
Because of this practice not all adverse reactions are vaccine related. Careful study of cases by a scientist may be required to notice patterns. The data is not presented in a user friendly fashion!
Of course, the usefulness of this system is limited if a systematic problem, like a long form, is preventing events from being reported!
Vaccine rumors: I still get questions about vaccine rumors like the following:
The vaccines will re-write your DNA The vaccines will keep women from getting pregnant. The vaccines will make you shed Spike protein into the environment
When addressing questions like this, I always ask “What evidence do you have that this is happening.” Almost always, it’s just something they heard. I can’t disprove that any of these things are happening. Trying would take an enormous amount of time. I can say, however, that I haven’t seen any evidence that they are. This doesn’t mean they aren’t happening! But if there isn’t any evidence for them, we don’t have to spend time and emotional energy worrying about them.
If you have any evidence, aside from persistent rumors, that any of above things or things like them are happening, please let me know. If you see an article or blog post that argues for any of the above, they should contain actual data that supports these ideas, not just speculation.
In the interest of openness and full disclosure, I need to share a video with you that I just watched. Dr. Zubin Damania is a Youtube commentator that I actually listen to a lot, and I find him more reliable than many. He just posted a video “Top 3 COVID Vaccine Myths“. Two of his myths are:
2) The Spike protein is toxic. 3) Antibody Dependent Enhancement may cause vaccinated individuals to experience more severe disease if infected with SARS-2.
If you have been reading my posts, then you know I have been concerned about both these issues. So am I spreading myths?
2). My concerns about Spike protein toxicity are based on persistent rumors of people having moderate severe reactions to the vaccines. For awhile, I dismissed these as just the standard reaction that some have had to any vaccine, including those for flu. But more and more rumors piled up and made me wonder if something else was going on. Then I saw the video by Bret Weinstein and Robert Malone. Dr. Malone is the inventor of the mRNA vaccine technology. The video argues that the Spike protein itself is toxic. Dr. Malone’s credentials are at least as good as Dr. Damania’s on this matter, likely better, so I can’t dismiss his view.
Unfortunately, I haven’t yet been able to find enough reliable information on adverse events to form my own opinions based on the data, so I’ve been relying on others to inform me. Frankly, because of the politicized nature of the vaccine issue, I don’t feel at all confident that I can get reliable information. So I may never be able to develop an informed opinion on this matter.
Dr. Damamia claims that convincing evidence exists that demonstrates that Spike protein is not toxic, but he doesn’t give it in this video. This of course is very common.
3) I’ve talked a lot about the ADE issue. In this video, Dr. Damania claims that ADE has not been an issue in the vaccine roll out, and the new variants have not caused more severe symptoms. I agree with both of these points. I point these out in my November 2020, December 2020, and April 2021 updates to my ADE post. I am still concerned about that new variants may someday arise that can use the ADE pathway, or that a new SARS strain, a hypothetical “SARS-3” will arise that will be different enough to trigger ADE. So while I agree with Dr. Damania’s point on ADE, it’s not quite the point that I’m still concerned with.
As I’ve stated many times, the vaccines are likely to help you if you have a risk factor and I have several friends and family members that I have recommended get the vaccine. So I am not anti-vax per se. But I don’t think it’s the obvious choice for everyone, and I’m staunchly for personal medical freedom in regards to COVID vaccines.
So what do I do now? What should a thinking person do when confronted with new information from a trusted source that you’re not sure about? These things are all true when dealing with complicated issues:
People you generally agree with may say something you don’t agree with. People you generally disagree with may say something you agree with or makes you think about an issue in a new way.
Both of these are normal. When dealing with a complicated issue like COVID, race relations, worldview, politics in general, it is critical to keep an open but critical mind. You have to read widely from both your side and others to hope to get a clear view of the issues involved.
I respect Dr. Damamia. He might be right! I’ll have to think about his points, do some more homework, and reassess my opinion. There are 3 possibilities.
I will abandon my position and accept his. I will learn new things that will reinforce my position. I will do a bunch of research, but will not find conclusive information that will allow me to form a new opinion either way.
If I can arrive at a place closer to the truth, then the exercise will be a good one. If I decide I think Dr. Damania is wrong on these points I’ll likely still watch his videos, since I think he is right more often than he is wrong, and he’s more open minded than most, so I think he is at least being honest about what he believes, which is a very valuable trait! Dr. Damania is both for COVID vaccination and against vaccine mandates.
I started out posting on COVID because as a scientist I felt a responsibility to help my non-scientific friends and family members make some sense of the pandemic, especially when scientific communication is so often poor. I hope I have done that. I can’t claim to always be right, and have changed by view several times. But I have given you the truth as best as I can find it, and supported it with evidence.
A word on tech censorship: The WHO said 2 false things early on:
SARS-2 is not human to human transmissible SARS-2 is not transmissible as an aerosol.
Both of these things were demonstrably false, and perhaps politically motivated, even at time the WHO stated them. In in spite of this, the social media platforms came to hold the WHO as the gold standard for the truth on COVID matters. To this day, F@¢3b00k may place a tag on the end of this post claiming the WHO as the authority on COVID matters. Most platforms would delete or restrict anything that ran against the WHO. Yes, computer programmers in Silicon Valley are still pulling down information posted by medical doctors and scientists. Even Dr. Damania has had videos censored!
One of the worst results of the pandemic in the US is censorship of divergent opinions. Freedom of speech allows 3 things:
All opinions to be held up to public scrutiny. True things to rise to the surface. False things to be discredited.
When freedom of speech is restricted, none of these can happen. If a wrong thing becomes the “orthodox” view, and no other views are permitted, then the orthodox view will always be wrong, and we will end up solving all of the wrong problems. If there is a hole in your gas tank, it doesn’t matter how many times you put gas in it. It will always be empty. Fix the real problem first.
This is why all the claims of misinformation, from all sides, are so insidious. When you claim misinformation, you are claiming to have the whole truth on an issue. Sure, we can and should argue against views we think are false. But we must also protect the right to air all views! Or we are doomed only to have the first view that becomes dominant, and we are less likely to find the truth!
I also found an article on why some are still vaccine hesitant. For those of you who are wondering, you should read it.
This is a COVID new case update. I’ll also discuss new cases world wide, and discuss a new video from immunologist Shane Crotty with lots of important information on vaccines and variants.
In the US, we’re starting to see an increase in new case numbers in several states, Michigan and New York in particular. This may be because of the relaxing of requirements by many municipalities, but may also be because of some of the new variants arriving in the US. More on the new variants below.
New case numbers have stabilized in California and San Diego County with around 2000 new cases a day in California and 300 in San Diego. We have yet to see a clear uptick in cases in those 2 regions, but we may see this soon.
Internationally, the US and UK are doing better than average at the moment, but many countries scattered all over the world, with concentrations in Eastern Europe and South America, are seeing new surges in cases. The US and UK are both vaccinating heavily right now, with vaccine rollouts moving slowly in continental Europe, so vaccination may play heavily in this pattern. Also several new variants of the SARS-2 virus are more infectious than the original strain and likely factor in these new surges.
Important new video with Dr. Shane Crotty: MedCram has posted a new video interview with Dr. Shane Crotty, an immunologist in San Diego. His work looks into immune system responses to vaccination as well as native infection. He has several very interesting points to make about SARS-2 immunity and vaccines. First, he says that those infected with SARS-2 do have significant lasting immunity for many months, although it does go down a bit over time. Different people can respond very differently, however, and reinfection is possible in some.
Regarding vaccines, he said that those who have been infected have a good but not great immune response, but it is significantly boosted by a single vaccine dose, gaining an immune response higher than those vaccinated alone. So there is a good reason to be vaccinated if you have already been infected. Of course, if you’ve been infected, you may choose to wait until at-risk people have been vaccinated before you get a vaccine booster.
As for variants, he says there are 2 broad categories of variants, those similar to the UK variant (now commonly called B.1.1.7), and those similar to the South Africa variant (B.1.351). Both new strains are more infectious than the original Wuhan strain. The big difference between them is that those who have had SAR-2 are immunized against the UK strain, but not the South Africa strain. Also, the Astra-Zeneca vaccine does not protect well against the South African strain, and the Pfizer and Moderna vaccines appear to be less effective as well. The good news is, the Johnson and Johnson and Novavax vaccines do appear to protect against the South Africa strain. This suggests that although the South Africa strain is different, it isn’t so radically different that we have nothing to fight it with.
_____________________________ Update, April 6th A new small study from Pfizer suggests that their vaccine does work on the South Africa variant. The patient number in this trial is small, so they still don’t know exactly how effective it is. _____________________________
Soberingly, the South Africa strain has reached the US, so if we see a surge in the next few weeks, this strain may be at least partially responsible.
Impact on ADE? If you’ve read my posts on ADE, then you know that the danger from ADE may come when a different strain arises. With the South Africa strain arriving in the US, we may be able to see if ADE will have an impact with SARS-2 in the next few weeks and months. So far, new death numbers have come down with Wave 3, and there is no apparent impact from ADE on case severity. I will certainly be watching to see if this changes.
A quick note, I posted an update yesterday, but I accidentally only sent it to one person, so for the weekly update, check your feed for yesterday morning, or check my timeline.
Many people have asked me about a video that was posted yesterday by a group called “America’s Frontline Doctors”. The original video has since been removed from Facebook, YouTube and the group’s website has even been dropped by the host, Squarespace. All this to say, you may have a hard time watching it if you want to. I found a different version.
As I’ve said before, politics and science should never go together. Whenever a scientific issue becomes political, it becomes very difficult for free scientific inquiry to move forward, and nearly impossible for non-scientists to figure out what the truth is. So I’m sorry to those of you who are confused and are trying to pursue the truth. The video was put together by the Tea Party Patriots and Breitbart News, 2 right leaning organizations. This is a red flag for me because I know that the message will have a political angle, and that I’ll need to watch with extra care. As I said in my July 14th post, however, just because you disagree with someone in general doesn’t mean they have nothing good to contribute to the discussion. Especially with politically charged issues, we need to get information from a variety of sources in order to be as informed as we can. I know for many of us, it’s nearly impossible to have time for that, so we often just pick someone we trust to get our information from. I definitely have political opinions, but whenever a scientific issue comes up, I do my best to set those aside and look at the evidence. I hope this has been valuable to you. You may have noticed that some of my thoughts about the Coronavirus have been “left-wing” and others have been “right-wing.” I’m doing my best to be objective. And yes, I consider it a tragedy that opinions on scientific issues can be categorized as either left or right.
I want to discuss some of the main points of the video and offer my informed but not expert opinion. I am a Ph.D. molecular biologist specializing in infectious disease testing. I am not a physician or an epidemiologist. I will give my opinion and also why I think that way.
Hydroxychloroquine (HCQ): The video focuses to a great degree on HCQ as a potential “cure” for the Coronavirus. As soon as President Trump mentioned it as being potentially helpful for treating Coronavirus, it became a subject of immediate and hot controversy. Democrats seemed to reflexively dismiss HCQ, and Republicans seemed to reflexively support it. President Trump dug in his heels and seemed to support its use before all the evidence was in. Obviously, this is not how science should be done. Careful and well-reasoned studies should be done, and conclusions made based on evidence. Early studies seemed to support both conclusions. Opponents claim that HCQ doesn’t work and is even harmful to patients, causing heart problems in some. Supporters claim that HCQ works when given early in the disease, and with Zinc and perhaps azithromycin.
Dr. Immanuel made an impassioned case for the use of HCQ, having successfully used it to treat over 300 patients. This kind of evidence is what scientists call “anecdotal”. Anecdotal evidence, basically stories, is often not considered scientific because in a large pool of people, you can find stories supporting all kinds of claims. Anecdotal evidence also usually does not carefully consider other factors that may contribute to a conclusion. An example would be “I ate ice cream and then I got attacked by a shark, so eating ice cream leads to shark attacks.” This is obviously a silly example, but many pieces of anecdotal evidence you hear suffer from the same lack of critical thinking. However, this is not at all to say that anecdotal evidence is not useful! These kinds of stories may not be scientific per se, but can often trigger more rigorous studies that prove the claims of a story.
Several scientists I’ve heard from will point out that HCQ is useful when given early and given in combination with Zinc, and also in appropriate dosages. I actually agree that some of the studies arguing against HCQ use have given it too late or in inappropriately high dosages. I would like more rigorous studies to be done, however at the moment, I think HCQ is well worth consideration by the medical community. Other treatments also exist and may actually be better, such as the MATH+ protocol I described in my summary post on June 22nd, Dexamethasone, Remdesivir, and perhaps Budesonide. For the HCQ protocol, it appears that Zinc is actually most responsible for anti-viral activity, with HCQ mostly helping Zinc enter cells to interact with the virus.
Some have pointed out that Dr. Immanuel has some beliefs that are well outside accepted scientific views. As I pointed out before, even folks who you generally disagree with can bring helpful information to the table. Her HCQ experience may be true despite her unorthodox beliefs. So even if you justifiably don’t consider a person reliable, you should resist the urge to dismiss them outright.
Lastly on the issue of HCQ, physicians have the right to use drugs “off-label” meaning they are granted by their medical degree the right to try medications in ways that are not necessarily supported by the literature or guidelines. This right is granted in the interest of patients, because careful studies can take a prohibitively long time to be published, and to encourage the development of helpful new protocols. In my opinion, government agencies should not be restricting the use of HCQ by doctors at this time.
School reopening: In some ways, there is reason to re-open schools in the Fall. It appears to be true that children under 10 do not get infected at high rates, do not carry a high viral load when infected, do not get severe disease, and do not seem to spread virus to others. So there is a case to be made for reopening schools for young children. However, because of the ADE issue I’ve written about before, I am not currently in support of re-opening schools in the Fall. Just to recap, ADE (Antibody Dependent Enhancement) is the phenomena in which some viruses can use antibodies presented on immune cells to infect those cells and cause more severe disease. So a second infection with a similar strain can lead to much worse symptoms. SARS-1 and MERS, cousins of SARS-2, can both use this pathway, so with current evidence, it seems likely that SARS-2 will as well. But we won’t know for sure until another SARS strain develops and we see how people respond to it. I will point out in full disclosure, that almost no-one is talking publicly about ADE. Dr. Fauci has mentioned it, but just in passing. So I could be out to lunch about this, but it is a major concern of mine. I have had a few epidemiologists mention in private conversations that they think ADE is a real issue, but they aren’t comfortable talking publicly about it either.
Sweden and Herd Immunity: Dr. Dan Erickson, who made a video back in April, also spoke. I was critical of his original video because his analysis of the death rate used the wrong number for total cases. This time he spoke mostly about the lock-downs, and most of his comments were more measured. He argued against lock-downs and suggested Sweden as a model.
I am also critical of lock-downs as they were done in much of the US, with people asked to stay home at all times. However, I am not supportive of the Swedish model either, in which few precautions are taken. While I am not for people staying at home, and I think people should find ways to get back to work, I also think people should wear masks while indoors in public. Small outdoor meetings are fine, even without masks, but large outdoor gatherings with closely packed people are dangerous in my opinion. Again because of the ADE issue, I am not in support of the idea of obtaining herd immunity as a way out of the crisis.
Masks: Some have taken away from the video the idea that we should not wear masks. I didn’t get this from the video. Dr. Gold explicitly said she thinks masks should be worn indoors, but not necessarily outside. I agree with this approach.
As you can see, I agree with some aspects of the video, and disagree with others. When possible, study all sides of the issues, and make the best most reasoned choices for you and your family.
My basic rules are as follows:
1) Wear a mask or face covering in public. Avoid places with unmasked people. 2) Keep 6 ft away from others. 3) Avoid indoor gatherings, especially ones in which singing or shouting is likely. 4) Small outdoor gatherings are fine, even without masks, if everyone maintains a distance. Have guests bring their own food. 5) While many restaurants are open for limited indoor seating, I personally am still not comfortable eating indoors at a restaurant. I enjoy eating outdoors at restaurants, however.
Don’t fear, but be smart!
A version of the America’s Frontline Doctors video: NOTE: The below video was removed by YouTube a day after this blog posted.
This is a case update. For the US and California, cases continue to rise. The number of daily deaths have begun to rise as well in the last week, running about 3 weeks behind the rise in daily confirmed cases.
The news is better in San Diego. Daily new cases has flattened and may even be going down. A caution is always that Sunday and Monday are always low days of the week in terms of new cases, so you have to be careful about saying things are getting better on a Tuesday! The number of active cases in San Diego may be flattening as well.
After a spike in cases in Imperial County, east of San Diego, hospitals in El Centro have become overwhelmed and COVID patients are being sent to San Diego, Orange and other counties. This stresses the importance of keeping case loads low so as not to overwhelm hospitals and ICU deparments.
If you’ve reading my posts, you won’t be very surprised by the entries, they are pretty consistent with what I’ve thought myself.
The information was obtained by polling Texas doctors, so the data probably reflects what they know about their own patient’s histories, and also probably some opinion.
Budesonide: A very interesting video was posted last week featuring Dr. Richard Bartlett. He claims to have a very effective new treatment, using a nebulized anti-inflammatory normally for asthma, Budesonide. It will be very interesting to watch if others have success with this method.
The video introduces another topic that is very timely. If you watch the whole video, you’ll notice that Dr. Bartlett has some views about the virus that I don’t share. However, I think the video is still worth watching. Often these days, people dismiss people with whom they disagree on any topic. In reality, it’s very common to be able to take at least some truth from those with whom we disagree. In fact, on complicated topics, I find that with almost anyone I read or watch, even people I respect highly, there is often some topic that I think they’re wrong about. If I refuse to learn from people that I disagree with, I’d have to quit listening to most of the people I respect! With all that’s going on in the US right now, we will need to listen to and learn from all kinds of people to move forward. Even if you disagree, learning a person’s position will help you understand the topic better.
Today I’m going to discuss the JP Morgan study on transmission (among other things), how the Moral Matrix effects how people see the fight against the virus, and the boom stage in many Southern Hemisphere countries.
Frankly, when I think about anti-coronavirus efforts, I have tended to lump lockdowns and social distancing together, especially since many use these terms interchangeably. Notably, the study separates these 2 concepts and suggests that will social distancing (staying a distance away from people in public) may be valuable, lockdowns (staying in your home) is not.
You might say there have been 2 primary models for dealing with the pandemic in the last month after we’ve flattened the curve, but have not brought the numbers down, at least not in the US. I’ll call those models the Lockdown and the Re-opening models. Some want to continue the lockdowns to keep everyone safe from the virus, others want to re-open right away without restrictions. For several weeks, I have been gravitating toward a third Adaptive model. Of course, there can be many flavors of this model. Personally, I think masks, even bad ones, are far better than nothing, especially when worn by everyone, and can help us get back out of our houses and help us re-start the economy with reasonable safety. So I’m very open to the idea that the lockdowns have not been beneficial. Some of you will disagree.
The JP Morgan study is at odds with the endcoronavirus.org study, which recommends brief, very strict lockdowns. It could actually be that these 2 studies actually agree, depending on the time frame you’re talking about. I do think the lockdown was very helpful in the initial “boom” stage of the epidemic here in the US, but may have lost its usefulness later.
The Moral Matrix: ZDoggMD is a physician and medical YouTuber with a very silly screen name, but who posted VERY interesting video on how different people see the pandemic we are all facing. Using Jonathan Haidt’s work on the Moral Matrix, he talks about how different people’s moral framework shapes how we are viewing different efforts to address the issue. I was aware of Haidt’s work, but not had yet applied it to the pandemic in my mind. As someone who is sometimes exasperated with people who disagree with me (as they are with me I’m sure), this video is helping me remember to see their point of view. If you’re exasperated with your friends or family, I HIGHLY recommend you watch this video.
Upsurge in the Southern Hemisphere: Lastly, I just want to mention that many countries which have been relatively little effected until now, are now experiencing a big upsurge in cases. These countries include Russia, Brazil, and Mexico, and many are in the Southern Hemisphere, which is in the late Autumn months right now. Let’s hope they are able to get things under control quickly.
Don’t fear, but be smart!
PS. We went hiking in nearby Calaveras Park today for the first time in months, without our masks. There were a lot of people on the trail, and most were well behaved. When I can’t avoid someone on a narrow trail, I use an old SCUBA diving trick for ascending without getting the bends. Just close your mouth and blow slowly out of your nose as you pass someone. You’ll gently move any virus away from your nose! To maintain my friendliness, I greet people early, with plenty of time to start this little maneuver!
The number of news cases has been erratic in the last week, but at least in the US, it continues to trend downward. I’ve started collecting the number of new cases in the US and California, and while I’m not sure how to integrate that data into my Excel spreadsheet yet, I can tell you that more tests definitely mean more new confirmed cases. So some of the erratic graphs were seen are definitely because of more testing. In the long run, I expect to see new cases come down drastically as we continue to increase testing.
Rt.live is showing that 45 of 50 states have an Rt value below 1 yesterday. This is great news, as it shows that in most states, the virus is slowly disappearing. I’m watching with great interest to see how the states that have started re-opening do. Keep up the great work! We are having an impact!
Also included is a very interesting video I ran across, Simulating an Epidemic, showing a non-scientific computer model of possible epidemic outcomes given different approaches. Keep in mind, this model is NOT attempting to show what will happen in the COVID epidemic, just some theoretical things that might happen given different approaches. He does NOT attempt to prove that any of these things are what’s happening.
The most interesting parts for me were when he compared 2 methods that have been used in different places. At 6:00 minutes, he talks about the Detect and Isolate method, which I favor. This is were you find an infected person and quickly quarantine them until they have recovered. He argues that this is the most effective method in an epidemic like the current one. We haven’t been able to do this, really, because of our lack of testing in the beginning. My fervent hope is that if we get a second wave in the Fall or Winter, we will be ready for this approach.
At 16:50, he talks about a method that I think we are kind of using, the shelter in place, but with trips to central locations. He says that without other measures, these locations become a source of new infections. This is probably not happening as badly in real life because so many are wearing masks to the store!
Friends, This one is going to be a little mathy. Several people have sent me the video titled “Dr. Erickson COVID-19 Briefing”. I’ve watched the first 12 minutes of the 52 minute video. Dr. Erickson argues that we have a large number of current cases, and that when comparing this number to deaths, he calculates the fatality rate at between 0.03 and 0.07%. This is less than the typical flu. He uses data from his home county of Kern County in California, NYC, the US, Spain, and others. Unfortunately, Dr. Erickson makes a critical error in his calculations.
For the US, he says we have 802,000 confirmed cases (around April 20th) and around 4 million tests. This would give him a positivity rate of 20% for the country. He then calculates that we then have 64 million cases in the country and only 45,000 deaths, giving us a fatality rate of 0.07%
The mistake he makes is that he assumes that tests given represents a random sampling of the population. Anyone who has tried to get a test and failed knows that not everyone who wants a test gets one. And not everyone requests a test either. Dr. Erickson has what’s called a sampling bias. You have to make sure you have a sample that represents the group you want test if you want to say anything about that group. Instead of testing the general population, Dr. Erickson is testing just people who meet the criteria for testing by the CDC or other health care body. This group is far smaller, and far more likely to have the virus than the general population. He over-estimates the number of COVID cases, by maybe 10 fold.
Several studies, some not yet published, have tested random selections of the population using PCR and antibody tests (see references 1, 2, 3, below). In those studies, fatality rates range from 0.12 – 0.7%, 2 – 23x higher than Dr. Erickson’s estimate. Also, the studies by Bendavid and Sood (2, 3) suggested that approx. 4% of the populations of Santa Clara County (San Jose) and Los Angeles were infected in early to mid April. So 96% of the population is still susceptible. At the 0.12 – 0.7 death rate, that’s 6,000 – 37,000 potential deaths for those 2 places alone. Even these studies, with fatality rates far higher than Dr. Erickson’s, have been criticized for an estimate that is too low because of sample bias (4).
We won’t really know how many people have had it until there is wide spread testing. South Korea has done extensive testing, and their fatality rate is 2.24%. This might be in the ballpark of the rate in the US.
So I have to reiterate, SARS-2 is not the average flu. In addition to being up to at least 5x more deadly, it’s also 4x more infectious. The very good news is, our efforts are paying off, and the daily rate of new cases for the US is now just 2.46%, down from a terrifying 46% on March 19th. It’s right for some living in rural areas to wonder if they can begin the process of going back to normal. Some can, but it needs to be done carefully and watchfully, with lots of testing for exposure, not just for symptoms (See my April 9th and April 22nd posts). The entire state of Minnesota plans to do just that. We can watch in real time to see how it goes for them. We don’t want another Albany, Georgia! Urban areas like coastal California and the Acela Corridor will have to wait awhile longer.