January 30th, 2023
We are months into a highly infectious Omicron wave with new strains XBB/.1.5 supplanting BA.4/5 with absolutely no signs of worsening disease severity or morbidity. The country as a whole is in the best place since the pandemic began and then became an endemic state. For most Americans, we are dealing with mild disease only. Severity and poor outcomes remains in the at risk groups despite the CDC not releasing
the actual known data regarding risk stratification that could help drill down actual need. The FDA is meeting to recommend annual boosters of the bivalent covid vaccine for all. Below you will find a comprehensive coverage of this reality that I am not in favor of.
Omicron US strains: as of January 21st data - variants make up: BF.7 is 2%, BA.5 is 2%, BQ.1 is 13%, BQ1.1 is 27%, XBB1.5 is 49% and XBB is 2%
XBB.1.5 the dominant strain where there was no increased risk of hospitalization or death in countries like Singapore where data has been tracked.
None of these VOC's are showing signs of increased disease morbidity.
Little else to report here. (CDC Variants)
Next week, I am releasing a follow up podcast with Dr. Paul Offit regarding vaccines moving forward with covid. It is a stimulating conversation as he lays out the science of the why and how we should boost and whom. Do children need the vaccine anymore? Which high risk groups?
Stay Tuned
Quick Hits and other musings -
1) An article in Nature looks at the ways that covid has affected our ability to mount a response to future variants. They discuss imprinting, affinity maturation and more related to the ancestral SARS2 strain and the current variants of omicron. This is covered in detail in the article as well as the upcoming podcast with Dr. Offit part 2. From the article: "Imprinting equips the immune system with a memory of an invader that helps it prepare to do battle again. The key players are memory B cells, which are generated in lymph nodes during the body’s first exposure to a virus. These cells then keep watch in the bloodstream for the same foe, ready to develop into plasma cells that then churn out antibodies. The snag comes when the immune system encounters a similar, but not identical, strain of a virus. In this case, rather than generate new, or ‘naive’, B cells to produce tailored antibodies, the memory-B-cell response kicks in. This often leads to the production of antibodies that bind to features found in both the old and new strains, known as cross-reactive antibodies. They might offer some protection but are not a perfect fit to the new strain. Imprinting was first observed in 1947 by Jonas Salk and Thomas Francis, the developers of the first flu vaccine, together with another scientist, Joseph Quilligan. They found that people who had previously had flu, and were then vaccinated against the current circulating strain, produced antibodies against the first strain they had encountered. Francis gave the phenomenon the tongue-in-cheek name ‘original antigenic sin’, although today most researchers prefer to call it imprinting." (Brazil R. 2023)
This is the major reason why the current bivalent Covid vaccine has no benefit offered over the original vaccine and or prior infection.
2) Dr. Offit in the NEJM: "Fortunately, SARS-CoV-2 variants haven’t evolved to resist the protection against severe disease offered by vaccination or previous infection. If that happens, we will need to create a variant-specific vaccine. Although boosting with a bivalent vaccine is likely to have a similar effect as boosting with a monovalent vaccine, booster dosing is probably best reserved for the people most likely to need protection against severe disease — specifically, older adults, people with multiple coexisting conditions that put them at high risk for serious illness, and those who are immunocompromised. In the meantime, I believe we should stop trying to prevent all symptomatic infections in healthy, young people by boosting them with vaccines containing mRNA from strains that might disappear a few months later." (Offit P. 2023)
I agree wholeheartedly.
3) In the New York Times, we see a piece discussing the FDA's plans to push a yearly annual Covid booster for all. Many of the advisors are not in favor of the plan as stated in the article questioning the lack of data to support the decision and the lack of severe disease in the vast majority of the population. (Mandavilli A. 2023)
I will be against a mandatory vaccine annually and for a personal choice to vaccinate every year for those that feel that the science warrants it. I will not be getting or encouraging a yearly vaccine for my wife, children or myself. I am full tilt focused on my family's and mine own immune health through solid lifestyle based principles.
4) For a thorough look at this topic read the sub stack articles by Dr. Vinay Prasad. He writes: "The average American will now only be tasked with getting a yearly unproven booster, and the primary series will be ignored. Kids and older Americans will have to get 2 doses of the bivalent shot and then placed on the perpetual booster train. Pfizer will keep earning billions. There is no talk of: Running randomized trials to ensure annual boosters actually lower severe disease in healthy young adults and kids; The risks of myocarditis from a perpetual booster strategy, which are disproportionately faced by young men who have the least (perhaps nothing) to gain; The fact that these vaccines will always be chasing the last variant; The fact these vaccines provide no benefit to others because they cannot stop spread; If one zooms out on all of human existence (8 billion people and 1 trillion human interactions a day) any and all vaccine programs cannot even slow spread. Eric Rubin of NEJM fame says exactly my position: "I think we need to raise the bar and require more evidence.""(Prasad V. 2023) He does raise an interesting point regarding the revolving door of FDA employees leaving and joining Big Pharma including former FDA commissioner Scott Gottlieb who is on Pfizer's board of directors currently. Can you say conflict of interest.
As noted in a 2018 Science article: "FDA staffers play a pivotal role in drug approvals, presenting evidence to the agency's advisory panels and influencing or making approval decisions. They are free to move to jobs in pharma, and many do; in a 2016 study in The BMJ, researchers examined the job histories of 55 FDA staff who had conducted drug reviews over a 9-year period in the hematologyoncology field. They found that 15 of the 26 employees who left the agency later worked or consulted for the biopharmaceutical industry." (Piller C. 2018) Even more can be found in a Wall Street Journal Article by A. Finley with discussions about Pfizer and Moderna cherry picking data to support their decisions and not being fully transparent.
5) Novavax's new vaccine has the ability to be as beneficial to naive humans across the globe as the mRNA types without having to deal with the cold purity chain requirements. New data shows that this is likely the best or at least one of the best vaccines for the world. (Bhiman et. al. 2023)
6) For the immunology interested: An article on innate immune evasion by SARS2 variants. "Initial infection in the airways results in productive viral replication, transforming infected cells into viral factories and hampering first-line IFN-mediated defences required to slow this process. Complicating things further, SARS-CoV-2 also engages the cell to promote a pro-viral environment, which incidentally activates aspects of later-stage innate immune defences. This imbalanced response consequently recruits pro-inflammatory cells to the airways while virus replication progresses unchecked, causing extensive inflammation and respiratory damage. As infected cells die, inflammatory material associated with the virus begins to appear in the extracellular milieu, enabling the induction of the IFN response by local bystander cells. As the virus population expands, accumulation and detection of inflammatory debris accelerates, resulting in an IFN signature that can be documented in every organ of the body. This response, which can persist for 7–10 days following infection, offers some protection against distal infections, but can also result in organ dysfunction should any underlying condition exist. In healthy individuals, the acute phase of infection can materialize with few consequences and result in successful virus neutralization and resolution of infection." (Minkoff et. al. 2023) SARS2 is a little trixter that never ceases to amaze with its technical ability to trouble our immune response.
7) A comprehensive review article on Long Covid/PACS in Nature Reviews Microbiology is worth a read. (Davis et. al. 2023)
Non Covid Research
8) Meat substitutes from plant origins are not as billed on the label when it comes to iron presence and subsequent consumption induced absorption patterns because of phytic acid blockade. "Lead author Cecilia Mayer Labba said: “Among these products, we saw a wide variation in nutritional content and how sustainable they can be from a health perspective. In general, the estimated absorption of iron and zinc from the products was extremely low. This is because these meat substitutes contained high levels of phytates, antinutrients that inhibit the absorption of minerals in the body. “Both iron and zinc also accumulate in protein extraction. This is why high levels are listed among the product’s ingredients, but the minerals are bound to phytates and cannot be absorbed and used by the body.” (Diabetes.co.uk 2023)
Another reason to eat a balanced diet with mostly plants, but also meats for a rounded exposure to minerals in an easily absorbable state. Also, a great reason to soak beans and legumes in general before cooking and or consuming.
That's all this week!
Dr. M
Brazil Nature
Offit NEJM
Mandavilli NYTimes
Prasad Substack
Prasad Substack #2
Piller Science
Finley WSJ Opinion
Bihman Nature Scientific Reports
Minkoff Nature
Davis Nature Reviews Microbiology
Diabetes.co.uk
CDC MMWR
CDC Variants Page
CDC Covid Deaths
