January 11th, 2021
Sars2/Covid19 is neither predictable nor ordinary. Many specialists and leaders predicted all kinds of realities that never came to pass which should have been expected in the chaotic world of a viral pandemic. Predicting outcomes was and is impossible. We learned that a pandemic is a lose lose situation, end of story. We learned that media on both sides are hell bent on swaying opinion to the path that they prescribe using x expert to push x agenda.
We learned that most of this was garbage and we were tasked with figuring out truths on our own as the virus presented them to us. Let us look at what happened nationally. The state of California used the most draconian lockdown/control measures and thrust them upon it's citizens believing them to be the most useful. The initial goal was always to try and flatten the curve only to prevent hospital overwhelm. When viral volume was not significantly circulating in the spring, the choice appeared effective. (Chin et. al. 2020)Then the virus showed up and people had simultaneous lockdown fatigue in the summer. These are unpredictable events. The results are as follows: highest case and 3rd highest death number in the United States - which is not surprising as it is the most populous state. The point is that predicting any of these outcomes was next to impossible. Texas followed a completely different approach with no lockdowns and loose guidance based on the CDC's recommendations. Texas had the second highest case number and the second highest death rate behind New York. Most other states were some mix of these two. These situational realities played out similarly in Europe between Sweden, England and many other European states.
My takeaways from the first year of the pandemic are:
Only the virus has been successful on all fronts.
We learned that Walmart and Costco could sell clothes while Banana Republic and the Gap were not allowed to. We learned that casinos and alcohol beverage stores would stay open while churches, massage therapy and gyms could not. We learned that gambling and numbing the mind are more important than faith and exercise. You cannot make this stuff up.
We learned that there are brilliant scientists tirelessly trying to solve this problem. We learned that we are getting really good at understanding the pathology and physiology of a pandemic like never before. We learned that we were not prepared for this problem at the outset. We learned that we need a homegrown source of personal protective equipment, testing, medicines, machines and anything important in a pandemic. We learned that toilet paper and Lysol are precious commodities. We learned that some people are really greedy but most are not.
We learned that we are very resilient in the face of stress, hardship and fear. We learned that this is not true for everyone and that we need better support resources for everyone in need. We learned that family is so important and hard to live without. We learned that we are social creatures that HATE isolation and lockdowns/stay at home orders. We learned that we like going to the gym, store, church and restaurant. We learned that most people are good and willing to help others.
But most of all, what we really learned is that self care is the MOST important choice for human longevity and pandemic survival. While we watch governments around the world make decisions that are loosely rooted in science, we see the media castigate them in all directions based on what the virus does. We see constant media coverage of mask wearing and social distancing, which are important, but little to no coverage of personal lifestyle choices that could save your life. We see negative outcomes that are driven primarily by human long term choices around food, stress, sloth and toxin exposure.
This pandemic has been the greatest window into human risk of death, our own choices.
Good bye 2020!
New COVID Quick Hits - hold on to your seat!
1) "It’s at least a reasonable, “parsimonious” explanation of what might have happened.
This may be the great scientific meta-experiment of the 21st century. Could a world full of scientists do all kinds of reckless recombinant things with viral diseases for many years and successfully avoid a serious outbreak? The hypothesis was that, yes, it was doable. The risk was worth taking. There would be no pandemic. I hope the vaccine works." (Baker N. 2020)
This article is one of the more shocking of the last 12 months. Mr. Baker writes in the New York Times Magazine about the possible origins of SARS2/COVID19. I will readily admit, that after studying medicine for 29 years, the thought that SARS2 was a natural event seemed dubious. While I am not a virologist, critical thinking and all of my learning have forced me to look closely at these odd events that led to the pandemic. This article is long and thorough and goes over large gaps in information that coalesce into a more plausible story than that which has been propagated since February. It is absolutely worth reading in its entirety. Anything less than a full read will leave you with a partial picture.
Regardless of where you fall on the origins story, I fully believe that we should investigate the origins story at an international level. Millions have died and answers are necessary.
2) New strains of SARS2 - Recent data has shown that there are new circulating strains of the SARS2 virus in California, Colorado and other states. That means it is now effectively going to be everywhere. It still appears that the newer versions have slight genetic modifications to the spike protein on the viral surface that is increasing the infectivity. The good news is that there has not been a change in the morbidity or mortality related to the mutation. We will be watching this closely. (Kupferschmidt K. 2020)
There are murmurings that the new variant in South Africa also has a significant change in the spike protein gene. This would be very concerning if the change allows for decreased vaccine effectiveness. All of this is unknown at this time but appears unlikely.
The downside to increased infectivity and stable or less mortality comes from a furthering of the exponential spread and breakdown of control measure success. The reproductive rate of these new variants may be 50% or higher creeping up toward 2 or 3. This means many more infected and more deaths by sheer volume.
3) COVID prevention strategies are still putting off influenza and viral upper respiratory season. (Jones et. al. 2020) As of this weekend, we have yet to see any influenza in children this year. According to the CDC, only 0.1% of all tested cases had influenza. This is an unbelievably low volume for this time of the calendar year. (CDC flu stats)
4) In the United States, there are now over 21,000,000 positive SARS2 cases. This is likely a gross underestimation of the total number of previously infected individuals as we have learned that many individuals do not have symptoms therefore never get tested. This is especially true because children under age 5 are not registering as PCR positive often despite having been infected and recovered based on antibody testing(See below from 2 weeks ago). It is likely 2 to 3 times that number if we counted T cell and memory B cell SARS2 activity. If, for sake of argument, I am correct, then 50,000,000 Americans may have some level of immunity at this moment. What does this mean for transmission? In the Journal of Infection, Dr. Hanrath and colleagues give us a look at this story. They looked at over 17,000 health care workers for reinfection and found that no previously infected healthcare worker developed a reinfection within 5 months of a positive PCR test. (Hanrath et. al. 2020)(Lumley et. al. 2020)(Reynolds et. al. 2020)
Bear with me here. If 50,000,000 Americans are already immune for 6 to 12 months or possibly longer and vaccinations ramp up in the next month, we could be at 1/3 of America partially or completely immune by early summer. This is not herd immunity, but it is a huge step toward slowing this pandemic.
If we follow the logic of prior infections and reduced death risk when reinfected, we are likely to see a significant drop off in death even when immunity wanes and reinfections occur.
As stated above, these are all huge guesses in a chaotic pandemic world. However, the science is at least sound.
(from 2 weeks ago) Children have the ability to see the virus, develop a rapid response, not experience any symptoms, not shed virus and ultimately become immune. In one study, children never tested positive for PCR infectivity yet developed neutralizing antibodies. (Tosif et. al. 2020) Adult infected COVID-19 patients had anti-spike IgG, IgM and IgA antibodies as well as anti-nucleocapsid IgG antibodies, while children predominantly only developed antibodies against the spike protein and not the nucleocapsid. The nucleocapsid antibody is a later finding as it is in response to the massive viral replication. (Weisberg et. al. 2020) Thus, the lack of it in children indicates that they are rapidly developing a robust immune response to the virus before it replicates widely. (Nogrady 2020)
5) Women have more Toll like receptors than men by roughly two fold. The toll like receptor is a pattern or pathogen recognition receptor that sits on immune cell surfaces waiting for a viral particle to float by and trigger it to sound the alarm and get the immune killing machine started. Lacking TLR7 or having less of them allows the SARS2 virus to replicate unchecked for a while leading to huge viral loads and cytokine storms. This is one more reason for the disparity of men dying at higher rates than women. Genetic variants of TLR7 are also associated with premature COVID19 death with young healthy individuals. (EurekAlert Article)(van Der Made et. al. 2020)
6) Following up on previous data related to brain pathology and COVID disease, we have autopsy reports from a group of patients. Patients with severe disease had MRI and pathologic evidence of vascular inflammation, immune activation and an absence of viral pathogen post mortem. (Lee et. al. 2020) They noted that the inflammation and vascular injury was occurring in the brain in the absence of detectable virus meaning that it truly was a self destructive process immunologically initially caused by SARS2 but self propagating in diseased individuals. This is yet another reflection on the reality that the metabolically injured individual is a set up for an initial viral explosion followed by a viral independent unchecked immune over reaction. This over expression of immune cells leads to all of the pathology of a post SARS2 survival case. These are the folks with persistent loss of smell and taste, long haulers and other neurologically injured individuals.
7) Allergic reactions to the mRNA vaccines for COVID are occurring at 10 x the normal rate for influenza. "In a conference call with reporters, the U.S. public health agency said allergic reactions are occurring at a rate of 11.1 per 1 million vaccinations. That compared with flu vaccines, in which such reactions occur at a rate of 1.3 per 1 million shots." (Mishra M. 2020) This is unfortunate and seems to be frustratingly related to PEG chemicals that are used in everyday products and now in the lipid nano capsule of the vaccine.
8) More good news on the quarantine front from a study published by the CDC. The authors studied quarantined individuals who tested negative at day 7 and were asymptomatic. None of these people tested positive in the next week. (Jones et. al. 2020) This data set reinforces the choice to test and release folks from quarantine at day 7 if they are PCR test negative and without any symptoms.
9) Loss of smell is more common with mild COVID than severe disease. At 6 months post infection, 95% of individuals can smell again. (Lechien et. al. 2020) That means that 5% of post COVID infected humans are anosmic or cannot smell and therefore cannot effectively taste. This is a hot mess. Run the earlier numbers for known sick persons at 5% of 21,000,000 - just over 1 million people.
Couple this data with: the long hauler data, the death data, the tissue damaged survivors and that is enough to push me toward a vaccine if I was ever hesitant. That is a lot of unhealthy risk to take a chance with.
Folks - this virus is special. Regardless of the origins story, it is here and present in a nasty way. The death data is and has improved over time and that is good. The harder part now may start to be what is left behind for the survivors with severe disease or those milder cases that cannot smell anymore.
Again, I am presenting the data and my opinions based on it. We all must choose our paths.
Dr. M
NYTimes Magazine Baker
Kupferschmied Science Magazine
AAP Numbers
Chin MedRxIV
Jones Nature
Hanrath J of Infections
Reynolds Science Immunology
Moseman Science Immunology
Nogrady Nature
Tosif Nature Communications
Weisberg Nature Immunology
Van der Made JAMANetwork
Lumley NEJM
Sayampanathan Lancet
Lee NEJM
Mishra Reuters
Jones CDC MMWR Report
Lechien J of Internal Medicine
