The Next Pandemic

In yesterday’s post, I outlined some of the factors that resulted in the very high COVID case rate in the US. Today I will discuss how we can prepare for the next pandemic.

I have a PhD in molecular biology, and I specialize in infectious disease testing. I am not a physician or epidemiologist. I have an informed but not expert opinion.

Identifying the threat:

First, most new infectious diseases do not pose a global threat.  SARS-2 was so dangerous because of its high infectivity, long incubation time, and asymptomatic spread. Most diseases do not have these parameters.  Whenever a new disease comes around, and they will, we should soberly and cautiously assess the real threat.  Coming to the wrong conclusions about the threat will lead to the wrong conclusions about combating it.

There have been several important new infectious disease outbreaks in the last few years, including Hantavirus (1993), SARS (2003), Avian Influenza (2004), H1N1 Swine Flu (2009), Ebola (2013), Zika (2015), and of course HIV in the 80s.  They all have different disease parameters which make them behave very differently.  Most of these diseases did not have global impact.  The first SARS for example was much less infectious than SARS-2, but much deadlier, so it was contained quickly and didn’t spread much beyond Asia.  HIV can be spread by asymptomatic victims for a full 8-10 years, avoids the immune system, and evades vaccination efforts, so it has become endemic in much of the world.

The following parameters determine how a new disease will behave:

  • Mechanism of spread
  • Infectivity
  • Asymptomatic/ambulatory spread – can the victim walk around and spread disease?
  • Incubation period
  • Fatality rate
  • Vector – what carries the virus to a new host
  • Non-human reservoir – diseases that come from non-humans are harder to control and cannot be eradicated.

Obviously, we cannot respond to different diseases in the same way. Part of the reason we failed to contain the virus was that we used measures that were designed for viruses that spread by droplet transmission against a virus that spreads through aerosol transmission.  Using the wrong measures was less effective.

Much of my concern with the SARS-2 virus was the Antibody Dependent Enhancement issue, which is very uncommon among viruses, so is not usually a concern.

Be cautious.
Whenever a new threat arises, it is wise to be extra cautious until information can be gathered.  Although many of our precautions turned out to be unnecessary, I still support taking extra precautions early on.  Remember that early estimates were that the fatality rate for COVID was 3.68%.  With the 82 million confirmed cases in the US, this would have been over 3 million deaths if the fatality rate had really been this high.  As it stands, we have had almost 1 million COVID related deaths, a death rate of approximately 1.2%.  Yes, I know we can debate how many of these are deaths really resulted from COVID and how many infections there really were.  But we cannot discount that COVID had an enormous impact.

What if COVID were deadlier? Or what if it had selectively killed children, or caused more long-term symptoms like polio did? Things would have been much different.

All this to say, I think caution was warranted in the beginning of COVID, and we should continue to be cautious in future pandemics. On the other hand, we should also learn to abandon precautions that are not effective.  Maintaining ineffective precautions wastes resources, causes extra economic and social suffering, and causes people to lose confidence in government agencies.  It started to become clear to me by May of 2020 that lockdowns were ineffective, and that transmission was happening mostly indoors, but I still see people wearing masks outside to this very day.

Persuasion, not coercion:
From the beginning of the pandemic, public communication was terrible.  Official guidelines were confusing and often contradictory.  Far worse, explanation or evidence was rarely given for policies.  Instead, disagreement was met with accusations of being anti-science, rather than persuasion.  This approach contributed to the loss in confidence in official channels. 

Going forward, officials need far better communication skills when dealing with emergencies.  Give evidence rather name-calling, and respect the population enough to tell the whole truth.

Then came the vaccine mandates.  Many people I know were coerced into getting vaccinated against their will, and many others were fired.  All at a time when information about the vaccines was being hidden from the public.  This is unacceptable, and no way to run an emergency.

Here is a link to my post on science communication:

Restoring Trust:
Both the CDC and FDA hid information from the public.  In order to restore confidence, senior leadership needs to be replaced and new leadership should explain how things will be better in the future.  Is likely to happen?  No, it is not.

Government agencies need to be far more transparent.  Lack of transparency forces people to wonder what is going on, and create their own theories.  Government agencies often decry conspiracy theories, but they had a big role in creating them.

Misinformation:
Freedom of speech, censorship, and misinformation had a major role in the public discussion over the pandemic.  Doctors and scientists were frequently censored, shunned, or fired for sharing ideas that went against WHO or CDC guidelines. This includes ideas like the lab leak hypothesis that later turned out to be likely.

Freedom of speech is a foundational principle of American life.  It’s in our DNA, as some would say.  We are not America without it.  Some will say that too much freedom of speech leads to misinformation and conspiracy theories.  While it’s true that this freedom allows the spread of falsehoods, it also allows all ideas to be debated, true ideas to be raised up, and false ideas to be discredited. Freedom of speech is the solution to misinformation, not the cause.  Most of the leaders in world history that wanted to control freedom of speech had something to hide. It is essential that we maintain this basic right.

State emergency powers:
As discussed in yesterday’s post, the US federal government has surprisingly little power to deal with a public health crisis.  The CDC can develop guidelines, but most of the real work is done at the state and local level.  State officials need to step up and realize it’s their responsibility to respond well.  Citizens need to hold state and local officials accountable.

Manufacturing:
The US needs to maintain manufacturing capacity for certain essential items like personal protective equipment, testing kits and equipment, and medications.  Tax incentives need to exist to encourage companies not to send these functions overseas.

In addition, we should have national and state stockpiles of certain equipment.  I know many hospitals and labs are now creating stockpiles of their own.

Testing:
Most countries that did well produced lots of COVID testing early.  In the US, the CDC tried to manage all the testing themselves, and quickly became overwhelmed.  By the time private labs were allowed to develop their own tests, it was way too late.  Testing capacity didn’t become nearly adequate until at least July of 2020. Next time, the CDC needs to allow testing by private labs right away.  Ideally, anyone who wants a test and anyone potentially exposed to an agent should be tested.

Quarantine, not Lockdown:
Countries that did well did not quarantine healthy individuals, although some of these countries had more restrictions during the big Winter waves.  Instead, only COVID positive people should be quarantined.  This is only effective when tests are readily available.

Later in the pandemic, some outlets acknowledged that most infections were happening in private settings.  Basically, people would get infected outside, then bring COVID home to infect everyone in the household.

Here is a very interesting video using computer models to show why our model of lockdown was not effective.  Computer models are only as good as they are programmed to be, so this is only for demonstration purposes, and is not data.

Contact tracing:
Contact tracing was very successful in some countries, but the long incubation time of COVID made this difficult.  Successful programs involved tracking of individuals by cell phone and credit card data, practices that would probably not be tolerated in the US. Such programs would need to be voluntary to not trigger the creepiness factor and violate constitutional rights.

Masking:
I was a big proponent of wearing a medical grade respirator (N95, KN95, or KN94) indoors during the pandemic.  Because COVID spread as an aerosol as well as droplet form, cloth and blue surgical masks were ineffective.  Simpler masks can be effective against colds and flu, however.  So the choice of mask depends on the agent in question.  CDC guidelines need to reflect the method of spread of the agent in question. 

So what should Dr. Fauci have said early on?  Something like this:

N95 masks offer the best protection against infection by the SARS-2 virus. However, our current supply is very low, and we desperately need to save these masks for our medical professionals.  Please do not purchase N95 masks at this time.  In the mean time, there are some options that will help reduce the risk…

In actuality, of course, I didn’t see an N95 in a store from March 2020 until at least February of 2021, so I couldn’t have bought one if I’d wanted to!

Treatment:
Most medical facilities in the US didn’t treat COVID until a patient was experiencing respiratory distress.  By then, treatment options were limited.  To their credit, intubation was largely abandoned by the medical community when it was learned that this treatment was largely ineffective.

However, controversy swirled over potential treatments that became disfavored by the medical community.  Doctors are usually granted the right to prescribe “off label” medications, meaning they can use medications for treatments outside the guidelines of the manufacturer.  But drugs like Hydroxychloroquine, Ivermectin, and others quickly become forbidden, and some doctors even got fired for prescribing them.  Research on these drugs were minimal.

I am not arguing here that these drugs are effective against COVID.  I’m simply saying that forbidding doctors from working with or publishing papers about these drugs was a big mistake.  While it is of course wise for a doctor to consider guidelines, treating a novel virus may require some “outside the box” thinking.

Let me know in the comments if I missed something important!

Don’t fear, but be smart!
Erik

What Went Wrong?

Today I’ll discuss the approach to the pandemic in the United States, and all the factors which contributed to our very high case load during the pandemic.  This article ended up being longer than I thought, so I’ll have a separate post later in the week about how we can prepare for the next pandemic. I have a PhD in molecular biology, and I specialize in infectious disease testing. I am not a physician or epidemiologist. I have an informed but not expert opinion.

The COVID-19 pandemic finally seems to be drawing to a close.  For most of the pandemic, the US had the highest number of daily cases, and has had the most cases over all.  As I write this on May 17th, 2022, the US has 82,629,736 total confirmed cases, approximately 25% of the population, and an unknown but likely very large number of unconfirmed infections.

Meanwhile, the US has the most technologically advanced and well funded medical system in the world.  So what happened? This is a very important question because answering it correctly will help us respond to the next pandemic.

First, we can ask what policies the US had in place, and contrast them with policies that were successful.

Countries that initially did well were Taiwan, Japan, Singapore, and South Korea.  These countries are right next to China, which is the natural source for the seasonal flu.  This is because flu viruses exist natively in aquatic birds from southern China, and there is no practical way to eradicate the flu. We can expect dangerous respiratory viruses to arise from China from time to time.  Neighboring countries know this and are naturally vigilant.  The citizens of Asian countries are used to wearing a mask whenever they have the sniffles, and they are prepared for local epidemics. 

South Korea had the following strategy:

  • Early free testing for anyone who wanted a test.
  • Contact tracing of people exposed to infected individuals. Cell phone and credit card data was used to track residents and produce contact information for infected people.
  • Quarantine COVID positive patients at home, fines imposed for breaking quarantine.
  • Nearly all citizens wore masks in public.
  • Treatment of patients with moderate symptoms.
  • No “Lockdowns”, that is quarantining COVID negative individuals, but schools, cinemas, and gyms were closed. Most stores were open.  Vaccine passports allowed access to high risk areas during the Fall and Winter of 2021/22.

By contrast, the US, and most of the Western world, had the following policies:

  • Testing only for symptomatic people.
  • Treatment only for severe cases.
  • Early “Lockdowns” of all but essential workers.
  • Contact tracing applied too late to be effective.
  • Early communication on masks was incorrect and even deceptive to avoid a run on N95s which happened anyway.  Mask wearing remained controversial and unevenly applied, medical grade respirators unavailable or rarely used for most of the pandemic.

I will point out that most countries, even Japan, South Korea, and Taiwan, had major outbreaks during the Omicron wave.  These countries did have some COVID related restrictions during the Winter of 2020/21 and during the Omicron wave.  I leave China out of the analysis because I don’t trust their data.

Most respiratory viruses like cold and flu are spread by droplet or contact transmission.  However, SARS-2 is spread by aerosol transmission.  Droplets and aerosols are similar, but an aerosolized droplet is much smaller and can linger in the air for much longer than a droplet, more like a cloud than a spray.

Several precautions than became common and even required are designed to prevent droplet transmission rather than aerosol transmission.  These precautions include 6 foot distancing, cloth and blue surgical masks, and those plastic shields at the store.  These measures are mostly ineffective at preventing the spread of aerosols because they do not prevent the movement of small particles.  As you know, I was a strong advocate of masks indoors during the pandemic, but only the medical grade respirators like N95s, KN95s and KF94s.

Peculiarities of the US:
In addition to prevention policies, the US has several cultural and demographic factors which contribute to our high infection numbers. 

Population: Americans know that the 2 most populace countries in the world are China and India, with about 1 billion people each.  These populations appear to dwarf our own estimated population of 330 million.  But we forget that the US is the 3rd most populace country in the world, with number 4 being Indonesia at 272 million. Japan has 125 million, and the most populace European country, aside from Russia is Germany at only 82 million.

Mobility: The US is an enormous country, and Americans are used to traveling much more than other peoples.  We may not fly to other continents as much as the Germans do, but we don’t hesitate to drive several hours for the weekend, or fly across the continent. I was having lunch with an Englishman once who said they might plan for weeks to take a trip that would involve a 3 hour drive.  Many Americans may only plan for a few hours for such a trip. Our high mobility certainly contributed to our high COVID numbers.

Independence:  Our independent nature has been an enormously useful quality, contributing to our high innovation, personal freedom, and economic prosperity.  So I’m certainly not arguing against American individualism.  But I have to acknowledge that our fierce sense of independence did contribute to non-compliance with government recommendations.  And yes, I totally understand that many official recommendations were ineffective or unlawful. But this factor is part of the equation that we will need to consider in order to deal with future pandemics.

Federalism: The US Government has a lot less power than most people think.  The 10th amendment states:

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

This means that the only powers the federal government has are those expressly given to it in the Constitution. Much of what the US government does now goes beyond the powers given by the Constitution, and is only done because no one has stopped them.  New federal powers are often popular, so they go forward unchecked. 

The pandemic has caused many to lose trust in several previously trusted federal agencies, and States have started to pull back power from the US.  Many were surprised to discover how limited the President’s power was during the pandemic, limited to suggesting guidelines and creating regulation for federal property and interstate travel.  The vaccine mandate attempted to use private companies to enforce vaccination, but even this was struck down by the Supreme Court. 

Emergency powers outlined in the Constitution only apply in the case of an insurrection or invasion. Unless a Constitutional amendment is passed, the Federal Government can only impose martial law if an emergency forces the courts to close (Duncan v. Kahanamoku, 1946).

States have much broader powers.  In California, the Emergency Services Act allows the Governor to declare a state of emergency at any time, a state which grants him broad powers, including the power to suspend certain laws.  Some have said that this state can only last 90 days without approval from the Assembly, but the ESA allows the Governor to end the state of emergency whenever he deems it necessary, “at the earliest possible date that conditions warrant.” (§8629).

All this to say, the states have much more power to address a pandemic than does the federal government.  Whether you find this good or bad news depends on your own political leanings, and the state you live in!

Manufacturing:
The national shortage of N95 masks early on in the pandemic painfully revealed that our domestic capacity for manufacturing certain necessary items fell woefully short. Other items in short supply were hospital gowns, gloves, disinfectant, certain medications, and yes, even toilet paper. 

This shortage meant that almost no-one had effective masks early on.  In addition, confused messaging from Dr. Fauci and the CDC later produced a condition in which ineffective masks were common in public areas.  This certainly had a big negative impact on our case load.

Misinformation and freedom of speech:
I have written on this before, so I won’t repeat this now.  Suffice it to say that many Americans lost confidence in government agencies, including the CDC and FDA during the pandemic.  Lost trust is hard to regain and it can take a long time to get back.  I’ll discuss this more in my next post.

Political polarization:
Similar to the erosion of trust in government agencies, the response to the pandemic quickly became a “team sport” with some responses being typical of the “blue team” and others typical of the “red team”.  Unfortunately, both sides often opposed reasonable ideas simply because they came from the other side.  Also, some terrible ideas had a longer life span than they should have because they were favored by certain political groups.  As I’ve said many times before, science and politics are a terrible combination.  When politics gets involved in science, the results are usually terrible. 

Frankly, things have become so polarized that I am pessimistic about the future.  Republicans and Democrats seem to disagree strongly about nearly everything these days, having fundamental worldview differences, not just differences in approach. I know lots of people who lost contact with friends and even family during the pandemic, as have I myself.

Let me know in the comments what factors you think contributed to our response. Later this week, I’ll post on the next pandemic, and how we can prepare.

Don’t fear, but be smart,
Erik

Misinformation and Censorship

Originally part of a post on August 26, 2021, Video: “Top 3 vaccine Myths” and Tech Censorship.

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.
______________________________________________

Originally part of a post on August 30, 2021, Possible low efficacy of current vaccines against Delta, possible Delta enhancement in the future.

Another note on misinformation: My post from last Thursday generated a lot of discussion regarding censorship and misinformation. I argued strongly that the dangers of misinformation do not outweigh the benefits of free speech. Many of you are pro-vaccine and others are suspicious of the vaccine. I would simply urge this:

1) If you use the words “misinformation” and “disinformation” in a post or in a discussion, please come ready with evidence to support whatever claim your making! Don’t just throw out this word, support it!

I recently saw a video with a pro-vaccine medical person saying “we just need to keep pounding this information into people”. That is the wrong approach. With someone who is not yet convinced to get a vaccine, “pounding” away on them is just going to raise their defenses and exasperate you. Instead, gently show them your reasons for believing what you do! Explain to them what the data means. You may not convince them, but you may move them toward being more open to your view.

2) If someone makes a claim that sounds unfounded or that you don’t trust, don’t just tell them they’re wrong or make a counter claim, ask them to provide evidence, or where they got their information. You don’t have to do their homework for them! If they can’t produce any evidence, you are under no obligation to counter it. I’ve saved myself A LOT of work with this approach. It’s OK that they just heard it somewhere IF their source is reliable and has evidence themselves. You can still ask them to provide you with a link or something to that person’s statement. However, “I just heard it somewhere” is not evidence.

Part of the reason I’m not so worried about “misinformation” for myself is because of my regular use of suggestion #2.

Don’t fear, but be smart!
Erik

Case Update, May 6th, 2022; Yet Another Omicron Sub-Variant, New Drug Paxlovid.

This is a case update.  I’ll also give an update on new Omicron variants and briefly discuss a new anti-Coronavirus drug, Paxlovid.

In the US, cases continue to increase modestly, and may have peaked.  This increase in cases are likely due to Omicron sub-variants BA.2 and BA.2.12.1 (more on these later). However, new deaths are still decreasing.  I will caution that a rise in new deaths often trails new cases by 2-5 weeks. For the first Omicron wave, deaths followed cases by 2 weeks, and we are currently 4 weeks in to the BA.2 wave.

Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a logarithmic format to emphasize small numbers. Note that each number on the left is 10x higher than the one below it.
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.
Endcoronavirus County Level Map, May 6th, 2022
Endcoronavirus State Level Map, May 6th, 2022

In California and San Diego County, cases are up modestly.  Again, new deaths have not yet begun to rise.

Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a logarithmic format to emphasize small numbers. Note that each number on the left is 10x higher than the one below it.
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.
Graph is by me, from data collected from San Diego County Public Health. Graph is presented in a logarithmic format to emphasize small numbers. Starting on May 2nd, 2022, San Diego County only releases information Monday and Thursday each week. Data points shown are extrapolated using this information.
Graph is by me, from data collected from San Diego County Public Health. Graph is presented in a linear format. Starting on May 2nd, 2022, San Diego County only releases information Monday and Thursday each week. Data points shown are extrapolated using this information.
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.

New Omicron sub-variants, BA.2 and BA.2.12.1: BA.2 has been well known for a few weeks.  I’ve stated before that BA.2 is very similar to the first Omicron variants, and predicted that it will not have a large impact.  A new variant BA.2.12.1 likely falls into the same category.  These variants now dominate the current cases with 98% of new cases being due to one of these variants. 

From the CDC page on Variant Proportions. Accessed May 6th, 2022.

These variants are more infectious than the first Omicron sub-variants, but it is still unknown if they are more or less pathogenic.  Viruses tend to become more infectious and less pathogenic over time.

Some Eastern states like New York were the first to see modest new waves due to BA.2.  New York has yet to see a significant increase in deaths.

From Worldometer, Daily New Cases, New York State.
From Worldometer, Daily New Deaths, New York State.

All this to say, for now, the BA.2 and BA.2.12.1 wave still appears to be somewhat insignificant.

If you had COVID from mid-December to now, you probably had Omicron.  Because BA.2 and BA.2.12.1 are very similar to Omicron, you should not be concerned about reinfection until a significantly new variant arises.  Some people who had Delta have also been infected with Omicron.

Omicron sub-variants get a lot of press, much more than previous sub-variants.  I’ll let you guess why that is. For now, don’t be alarmed about a new Omicron sub-variant.  They will probably all fall into the “don’t stress about it” category.

The pandemic isn’t quite over. If you don’t have immunity, you may want to continue to take precautions by wearing an N95, KN95, or KF94 when indoors in public. Cloth masks or blue surgical masks will not protect you from Omicron variant SARS-2 viruses.

Paxlovid:  2 friends of mine got COVID just this week.  They were both prescribed Paxlovid, a new anti-SARS medication.  The drug is a protease inhibitor, which prevents viruses from maturing as they are formed inside a human cell.  Protease inhibitors do not prevent infection, but they can significantly reduce viral load and improve symptoms.  Both of my friends are doing well now, one feeling significantly better within just 24 hours.  2 people is a very small sample size so this should not be taken as an endorsement. I’m just pointing out that there is a new therapeutic available.

I will point out that Paxlovid is a Pfizer product.  For some, this will cause concern because Pfizer has lost significant trust due to the vaccine mandates and the attending creepiness.

Don’t fear, but be smart,
Erik

Case Update, April 20th, 2022; Mask Mandates End on Airplanes

This is a case update.  I’ll also have a comment about the recent end of the mask mandate on airplanes.

The BA.2 variant is now causing a very modest uptick in cases in the US.  93.4% of cases in the US are now caused by BA.2, some caused by a new subvariant called BA.12.1.  Most of the uptick in cases in the US is driven by a rise in cases in Northeast states like New York, New Jersey, Massachusetts and Vermont.  Cases remain flat in the rest of the country. 

Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a logarithmic format to emphasize small numbers. Note that each number on the left is 10x higher than the one below it.
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.
Endcoronavirus County Level Map, April 20th, 2022
Endcoronavirus State Level Map, April 20th, 2022
Endcoronavirus State Level Map, April 20th, 2022
Endcoronavirus State Level Map, April 20th, 2022
From the CDC page on Variant Proportions. Accessed April 20th, 2022.
Hospitalizations, from the CDC website.

In California, we may be seeing a rise in cases, but reporting has become sporadic, so it’s hard to say for sure. Some days show zero new cases. 

Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a logarithmic format to emphasize small numbers. Note that each number on the left is 10x higher than the one below it.
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.

Cases are dropping in San Diego County, and are lower than they were between the Delta and Omicron waves.

Graph is by me, from data collected from San Diego County Public Health. See also regularly updated slides from SD County. Graph is presented in a logarithmic format to emphasize small numbers. Note that each number on the left is 10x higher than the one below it.
Graph is by me, from data collected from San Diego County Public Health. See also regularly updated slides from SD County. Graph is presented in a linear format.

World wide, cases are dropping quickly, reflecting the drop in Omicron cases in many countries.

Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.

A friend of mine pointed out to me today that more COVID is being detected in waste water, suggesting another upcoming wave.  The only authoritative looking story I’ve seen on this is out of date, from mid-March, so I don’t know how much of an impact this will have.

Mask mandate ends on planes: On Monday, a federal judge struck down the mask mandate for airplanes and other transportation.  The judge ruled that the mandate exceeded the CDC’s authority under the Public Health Services Act. Within hours, the news was announced to cheers on aircraft across the country. I’m sure flight attendants are happy to have fewer arguments with passengers!

I was actually all for the mask mandate for most of the pandemic because I traveled a lot and it was kind of alarming to be on a full plane during COVID.  I did find it troubling, however, that the mandates allowed nearly useless masks like the blue surgical masks, and did not require the much more effective N95s, KN95s, and KF94s. Why require masks if you aren’t going to require useful masks?

In my last several trips, just in the last few weeks, I went into restaurants, hotel lobbies, stores, gas stations, and everywhere else.  The only places still requiring masks were airports, airplanes, and some laboratories.  This is especially ironic since the air on an airplane is HEPA filtered and is some of the safest air you will encounter in your life.

Omicron is the last gasp of the pandemic, and cases are now very low.  Some estimate that 90% of the American population now has vaccine mediated or natural immunity.  I am now in favor of ending the mask mandate on airplanes.  If you need to travel by air, haven’t had COVID yet, and are concerned about getting COVID on the plane, I strongly encourage you to wear an N95, KN95, or KF94 while you travel.  Don’t bother with a cloth mask or blue surgical mask.

Also, as I’ve stated before, studies now show that vaccine effectiveness drops after 3 months. Also, those with multiple vaccinations, more than a few months old, are now 3x more likely to get an Omicron infection than those who haven’t been vaccinated. For details, see my March 25th post. This is because of Antibody Dependent Enhancement. So if you’re in a high risk category and were vaccinated more than 3 months ago, consider getting a booster. Consult your doctor when making medical decisions.

Don’t fear, but be smart,
Erik

Case Upate, April 8th, 2022; Pfizer Docs Released

This is a case update.  I’ll also talk about a report from Kim Iverson from The Hill regarding finding in the trove of documents release by Pfizer in March and April.

Cases are currently flat in the US.  During the Omicron wave in December and January, the US lagged behind cases in the UK by 2 weeks.  While the Omicron subvariant BA.2 produced a wave in the UK, it has not yet produced a wave in the US, despite it being 5 weeks since the BA.2 wave started in the UK.  I’m going to go out on a limb and say that the slowing of the decrease of cases in the US is all we are going to see of the BA.2 wave in the US. I’ll let you know if this changes. BA.2 cases now constitute 72% of cases in the US.

Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a logarithmic format to emphasize small numbers. Note that each number on the left is 10x higher than the one below it.
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.
Endcoronavirus County Level Map, April 7th, 2022
Endcoronavirus State Level Map, April 7th, 2022
From Worldometer.
From the CDC page on Variant Proportions. Accessed April 8th, 2022.

Cases continue to go down in California and San Diego County.

Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a logarithmic format to emphasize small numbers. Note that each number on the left is 10x higher than the one below it.
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.
Graph is by me, from data collected from San Diego County Public Health. See also regularly updated slides from SD County. Graph is presented in a logarithmic format to emphasize small numbers. Note that each number on the left is 10x higher than the one below it.
Graph is by me, from data collected from San Diego County Public Health. See also regularly updated slides from SD County. Graph is presented in a linear format.

XE variant: Just a few days ago, news emerged of a new COVID variant called XE in the UK.  The variant is a hybrid of Omicron variants BA.1 and BA.2 and is more transmissible than BA.1.  Since XE is very similar to other Omicron variants, I don’t expect it to cause a large wave of cases in the US.

Pfizer Document Analysis from Kim Iverson: Kim Iverson of The Hill released a video claiming that newly released documents from Pfizer confirm what many knew already.  The shocking claim is that Pfizer has known the following for a long time:

  1. Natural immunity is as effective as vaccine mediated immunity.
  2. The rate of adverse events is at least 10/100,000 (33,000 for the US population). It’s unclear from Iverson if this is just for Myocarditis or for all adverse events.
  3. It is unknown if the reproductive systems of women are impacted by vaccination.  This contradicts public claims that vaccination does not affect reproduction.
  4. A more severe case of COVID triggered by Antibody Dependent Enhancement could not be ruled out.  The Lewnard et al paper a surveillance report from the UK have confirmed that higher Omicron infection rates in vaccinated people are likely due to ADE.  As far as I’ve seen so far, ADE has not lead to more severe cases.

The documents were obtained because of a Freedom of Information Act (FOIA) lawsuit which required the FDA to produce the documents.  Yes, this means that the FDA has had this information and did not disclose these conclusions to the public, instead often releasing information which contradicted these conclusions.

There will continue to be more document releases every month until the end of the year.  There will likely be more bombshells, but most of the releases will simply confirm what people have suspected for months but couldn’t prove.  I will discuss the most interesting, but not all of these releases.

Full list of Pfizer Documents released so far. Click “Date Produced” on the top line of the document list to bring April documents to the top of the list.
Request for Priority Review
Sorry, I couldn’t find the link to the consent form.

If you have risk factors like obesity, age, or respiratory problems, you should consider getting a booster.  Also, as I said last week, since vaccine effectiveness is substantially reduced after 3 months, those who have been vaccinated with risk factors will need to get a booster every 3-6 months.  Try and find a provider who will aspirate before injection!  There is no medical reason for someone who has had Omicron or Delta variants to get vaccinated or a booster. Talk to your doctor when making medical decisions.

I am posting about every 2 weeks now instead of every week.  I’ll likely post even less unless interesting news comes out.

Don’t fear, but be smart,
Erik

Other links:
James Cintolo discusses Adverse Events:
Document 5.3.6.

Case Update, March 25, 2022; BA.2 cases in Europe, Persistence of Vaccine mRNA in Lymph Nodes, Higher Omicron Infection in Vaccinated individuals in UK

This is a brief case update. I’ll also make some more comments on BA.2 related waves in Europe, a new paper suggesting that vaccine mRNA persists in the lymph nodes. Also, new evidence from the UK suggests that vaccines lose potency after 6 months and certain vaccinated individuals are more likely to be infected than unvaccinated people.

Cases continue to go down in the US, although the rate of decrease is slowing.  As you’ll read below, some suspect that an Omicron variant, BA.2, may cause cases to rise in the US.

Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a logarithmic format to emphasize small numbers. Note that each number on the left is 10x higher than the one below it.
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.
Endcoronavirus County Level Map, March 25th, 2022
Endcoronavirus State Level Map, January 25th, 2022
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a logarithmic format to emphasize small numbers. Note that each number on the left is 10x higher than the one below it.
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.
Graph is by me, from data collected from San Diego County Public Health. See also regularly updated slides from SD County. Graph is presented in a logarithmic format to emphasize small numbers. Note that each number on the left is 10x higher than the one below it.
Graph is by me, from data collected from San Diego County Public Health. See also regularly updated slides from SD County. Graph is presented in a linear format.

More on BA.2: I have commented on BA.2 before.  This variant is a version of the Omicron variant, which is slightly more infectious than Omicron itself.  It continues to follow the general trend of new variants being more infectious than older ones. Like the original Omicron, equal portions of B.1.1.529 and BA.1.1, BA.2 has a low fatality rate as compared to previous versions, including Delta. 

I originally held that BA.2 is not particularly interesting because of its similarity to the first Omicron strains.  This still may be true, but some countries like the UK and the Netherlands have seen significant new peaks after BA.2 became prominent. BA.2 is likely contributing to rising cases globally.

From Worldometer.
From Worldometer.
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.

Right now in the US, BA.2 is increasing in prevalence, and is currently 1/3 of SARS-2 found in the US.  It’s similarity to previous Omicron versions means that it is displacing B.1.1.529 and BA.1.1, just like Omicron displaced Delta before it. We now have 0% Delta in the US.

From the CDC page on Variant Proportions. Accessed March 25th, 2022.

Currently, new case numbers in the US are still going down, although the rate of decrease is slowing.  John Campbell, a physician and COVID commentator in the UK, argues that a new peak in the US due to BA.2 is inevitable, and he may be right.  But we aren’t seeing it yet.  We may see it the next few weeks.  Campbell also argues that “cases”, the number of infections recognized by the NHS, is much lower than actual infections.  This is certainly true, but we can’t know how many infections there are, since they aren’t reported. This was almost certainly true in the US as well during the Omicron wave.

Does BA.2 significantly change the picture?  I still say no, since the fatality rate with BA.2 is still very low, perhaps even lower than with other Omicrons.  We may or may not see a significant BA.2 wave, depending on how many Americans already have resistance to BA.2. If you had Delta or Omicron, you almost certainly won’t get BA.2.  Vaccination is only partially effective against Omicron variants.

Most people in my area, northern San Diego County, are basically going back to normal.  This is warranted for most.  If you have risk factors like age, obesity, or respiratory issues, you will want to remain vigilant and consider a booster.  I do not recommend a booster for those without risk factors, and certainly not for those with natural immunity.  Talk to your doctor when making medical decisions.

mRNA and Spike Protein Persist in Lymph System for up to 8 weeks:  The Journal Cell just published a paper (Röltgen et al) which argues that mRNA and spike protein are present in vaccinated individuals for up to 8 weeks after vaccination. Cell is the third most highly respected journal in cell and molecular biology.

The cells in your body are surrounded by a fluid called “interstitial fluid”.  This fluid carries nutrients from nearby blood vessels to your cells, and also carries waste back to the blood vessels.  The lymph system is a one-way circulatory system that carries excess interstitial fluid from the extremities of your body back to veins near your arm pits.  On the way, they pass through the lymph nodes, a biological filter and part of your immune system that checks for invading particles. 

The Röltgen et al paper suggests that vaccine mRNAs from the interstitial fluid collect in the lymph nodes and can persist there for many weeks.  They continue to produce spike protein during this time.  Remember that vaccines are intended to be given in an intra-muscular manner, meaning that they are intended to be injected to a muscle and stay there.  This paper shows that they are able to migrate to the lymph nodes. 

The paper does not discuss the medical importance for this in terms of adverse events.  Given the relative rarity of adverse events, I would guess that the presence of vaccine mRNA does not produce adverse events, and that these events are caused by vaccine injection into a vein. Again, the data is not conclusive on this, so this is just my guess at this point.

mRNA technology note:  At this point, I have no evidence to suggest that the problem with the new vaccines is the mRNA technology.  In my estimation, the likely reason the new vaccines lead to adverse events is that they produce the SARS-2 Spike protein which likely causes inflammation throughout the body.  This may only be in vaccine recipients who receive a vaccination in a vein rather than an intra-muscular injection.  If you choose to get a vaccination or booster, ask the health care provider to aspirate before injection.

Certain vaccinated individuals are more likely to be infected by Omicron than the unvaccinated:  A UK surveillance report shows that vaccine effectiveness against symptomatic Omicron infection goes from around 65% effective soon after 2 doses of vaccine, to around 5% 6 months later.  Protection from hospitalization goes down to just 35% after 6 months. These findings suggest that to maintain full protection against Omicron, a vaccinated person will need to get a booster every 3 to 6 months.

From UK Surveillance Report, March 17, 2022, Table 1b. Effectiveness of Pfizer vaccine at preventing symptomatic COVID infection after 2 doses, and after a Pfizer or Moderna booster.
From UK Surveillance Report, March 17, 2022, Table 2b. Effectiveness of Pfizer vaccine at preventing hospitalization after 2 doses, and after a Pfizer or Moderna booster.

In another finding from the report, people with 3 doses of vaccine are 3x more likely to be infected with Omicron than unvaccinated individuals.  This is the clearest evidence yet that Omicron may be using Antibody Dependent Enhancement (ADE) to infect people. The Lewnard et al paper from a few months ago has a similar finding.  For both studies, a certain number of vaccine doses are more likely to increase the chance of infection.  If viruses are using the ADE pathway, this effect would be explained more by the timing than by the number of doses per se.  For ADE to work, a person needs to have a mediocre immune response to an agent, not a strong or weak one. Since we know vaccine mediated immunity goes down over time, then a person becomes more likely to be reinfected as their immune response goes from strong to mediocre.

From UK Surveillance Report, March 17, 2022, Table 13. New case rates among UK residents with at least 3 doses of vaccine, and with no vaccination. Numbers are normalized for the percentage of people in each group.

So should you get a booster? Again, if you have risk factors like age, obesity or respiratory problems, you might want to get a booster every 3 – 6 months. Otherwise, you may choose instead to just take extra precautions as Omicron cases continue to fall in the US. If you choose to get a booster, ask them to aspirate before injection. Talk to your doctor when making medical decisions.

I know this is all very complicated.  Your questions will help me make this more clear.

Don’t fear, but be smart,
Erik

Case Update, March 14th, 2022; Continued Enforcement of Vaccine Mandates

Here’s a brief case update. I’ll also have a brief comment about vaccine mandates.

Cases continue to come down in the US, California and San Diego County. Cases in the US are now approaching being as low as they were in the Spring before Delta started. The only current outbreaks, according to endcoronavirus, is in the Twin Falls area in Idaho. Cases are dropping in San Diego County too, but unfortunately, not as fast as other places. LA and San Diego Counties are now #1 and #2 for new case numbers in the US.

Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a logarithmic format to emphasize small numbers. Note that each number on the left is 10x higher than the one below it.
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.
Endcoronavirus County Level Map, March 10th, 2022
Endcoronavirus County Level Map, March 10th, 2022
Endcoronavirus State Level Map, March 12th, 2022
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a logarithmic format to emphasize small numbers. Note that each number on the left is 10x higher than the one below it.
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.
Graph is by me, from data collected from San Diego County Public Health. See also regularly updated slides from SD County. Graph is presented in a logarithmic format to emphasize small numbers. Note that each number on the left is 10x higher than the one below it.
Graph is by me, from data collected from San Diego County Public Health. See also regularly updated slides from SD County. Graph is presented in a linear format.

World wide, the US is now in 8th place for countries with the most new COVID cases in the last month. This is a welcome change, since the US has spent large majority of the pandemic in 1st place. Ironically, the country in first place right now is South Korea, which has been doing well for the majority of the pandemic, serving as an example for other countries to follow. The majority of cases country wide have happened in the last month, due to the super infectious but less virulent Omicron variant.

Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.

Vaccine mandates still enforced: In January 2022, the Supreme Court struck down the vaccine and testing mandate for all but a few health care workers. Mandates for federal workers are still working their way through the courts. In spite of this, some companies and municipalities are still enforcing the mandates. They often cite vaccine mandates, but the vaccine mandates still do not officially exist, having been struck down. So these entities are enforcing mandates entirely on a voluntary basis, and of their own volition. These entities do not acknowledge the now well known data that natural immunity is better than vaccine mediated immunity at preventing infection and the spread of SARS-2.

As you may have noticed, I’ve been tapering off the frequency of my updates as the pandemic recedes. As things continue to improve, I will post more infrequently.

Don’t fear, but be smart,
Erik

Case Update, February 25, 2022; Trouble at the CDC

I have a brief case update today. I’ll also do some more complaining about the CDC, with some vindication from other sources. I’ve complained about them a lot before, so if you’re not interested in more complaints, you can skip the last part of the post.

Cases are still coming down in the US, California, and San Diego County. Cases are about as high in the US now as they were in November, before the Omicron variant appeared. They are still not as low as they were in late June and early July, when the vaccines had been released to everyone, but Delta had not yet ruined the party. Things are improving greatly, and I’m enjoying going out with my new hard won immunity, but the pandemic isn’t over quite yet.

Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a logarithmic format to emphasize small numbers. Note that each number on the left is 10x higher than the one below it.
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.
Endcoronavirus County Level Map, February 25th, 2022
Endcoronavirus State Level Map, February 25th, 2022
Endcoronavirus State Level Map, February 25th, 2022
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a logarithmic format to emphasize small numbers. Note that each number on the left is 10x higher than the one below it.
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.
Graph is by me, from data collected from San Diego County Public Health. See also regularly updated slides from SD County. Graph is presented in a logarithmic format to emphasize small numbers. Note that each number on the left is 10x higher than the one below it.
Graph is by me, from data collected from San Diego County Public Health. See also regularly updated slides from SD County. Graph is presented in a linear format.
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.

A brief look at endcoronavirus state and county level maps shows that Maine is having an outbreak right now. Looking at a higher resolution graph, the outbreak is actually already over, and cases are dropping again. This may be a real outbreak, but it may also reflect reporting practices in Maine.

Trouble at the CDC: If you’ve been reading my posts, you know that I regard the CDC as one of the main villains of the US response to the pandemic. I don’t have enough data to say that they intentionally under performed, and most pundits I’ve heard chalk this up to simple incompetence. Early on, they basically agreed with whatever the WHO said, even though is was clear that the WHO was repeating Chinese government talking points. Later, I assumed that their slow release of information was because they were just very careful, waiting until there was certainty before releasing information that was already nearly obvious to everyone.

Later, however, things took a dark twist. As useful papers began to come in from other countries like Japan, South Korea, the UK, Israel, South Africa, Sweden and Denmark; Morbidity and Mortality Weekly (MMWR) and Emerging Infectious Diseases (EID), the CDC’s own journals, produced very few useful papers on the pandemic. This despite the fact that the CDCs mission, it’s only job, and supported by 11,000 employees, is to produce information and guidance on the prevention of infectious disease. They don’t even have to implement or enforce their recommendations. The federal and state governments do that.

Then OSHA produced it’s official vaccine mandate. On the FAQ page, OSHA waived the requirement that employers must report adverse events from the COVID vaccination of it’s employees. They explicitly state that “OSHA does not wish to have any appearance of discouraging workers from receiving COVID-19 vaccination, and also does not wish to disincentivize employers’ vaccination efforts.” Yes, as of today, February 25, 2022, this ridiculous and damning statement is still on their website. Many have been suspicious that the CDC has not been diligent in collecting data for the Vaccine Adverse Event Reporting System (VAERS), but it was hard to prove it. The statement from OSHA confirmed that the CDC was intentionally blinding itself to data that would help answer questions about the vaccines.

Screenshot from OSHA FAQ on vaccines. February
25th, 2022

While the vaccines have certainly been helpful in reducing COVID severity and deaths for many, it is suspected that thousands have died directly from the toxic effects of the Spike protein in the vaccine, and many thousands have suffered long term negative health effects. Only recently did a CDC paper admit that natural immunity was better than vaccine mediated immunity, even though that has been known for months, thanks to an Israeli paper.

The New York Times has been supportive of the CDC for much of the pandemic. However, on February 20th, 2022, the Times published an article claiming that the CDC has been withholding information from the public. Better late than never, I suppose. Data withheld includes hospitalization rates for various categories including vaccinated individuals, and the effectiveness of boosters for those younger than 50. Unfortunately, the author says that this is likely only a fraction of the information the CDC has been sitting on like an egg. When asked why so much information had been withheld, a spokesperson said it was because they feared the data would be misinterpreted. This from 11,000 people we pay to communicate to the public.

The United States is the third most populace country in the world, and we have 53 separate approaches to pandemic. The CDC has or could have had a wealth of data that could provide science based guidance to the world. Unfortunately, it appears to me that they have mostly been motivated to sell vaccines, rather than to serve their central function.

FDA corruption: In the meantime, Project Veritas released 2 videos featuring an FDA official revealing corrupt relationships between the FDA and the pharmaceutical companies. These relationships influenced regulation of COVID treatments.

FDA Corruption, Part 1:
FDA Corruption, Part 2:

What should be done about the CDC: In general, I’m not for abolishing things willy nilly. I will say, however, that the CDC needs top to bottom review and serious reform. The Director as well as much of senior leadership should be fired. Will any of this happen? Not for the foreseeable future. The CDC is empowered by Congress and overseen by the Executive Branch. Members of Congress are typically motivated by political considerations more than by producing sensible policy. I know I’m stating the obvious. Only when Congress changes will reforms happen. I will also point out that members of all political parties are prone to being absorbed into the Washington Hive. So vote carefully in primary elections! Do your best to select honest people to Congress, and don’t forget to vote local too.

Don’t fear, but be smart,
Erik