Volume 11, Letter 33 Coronavirus Update 41
August 2nd, 2021
I was really hoping that the COVID newsletters would disappear and the weekly newsletter would revert to general medicine and pediatrics. Alas, it looks like we may be doing this for a bit longer.
Delta is here in significant volumes and almost all cases are in unvaccinated individuals, but there are some cases in vaccinated individuals. These vaccinated breakthrough cases with the delta variant are NOT causing significant disease in almost all cases.
To my knowledge, there are fleetingly few reported death in the US in a vaccinated person. The rates of death among fully vaccinated people with COVID-19 were even lower, effectively zero (0.00%) in all but two reporting states, Arkansas and Michigan where they were 0.01%. (Note: Deaths may or may not have been due to COVID-19.)(KFF.org)
The changes are not an accident of viral activity so much as a problem of choice and outcome. If you have had 2 doses of an mRNA vaccine, you have a very very small risk of a significant breakthrough infection, even less chance of hospitalization and almost no chance of death from the Delta variant based on statistics overall.
Most states are at a steady state with vaccinations with some increasing vaccinations again as delta has changed some peoples minds. Disease from SARS2 is rising quickly because of Delta's increased transmissibility and an available unvaccinated population . Almost all cases are in unvaccinated persons. There are increasingly larger pockets of disease in poorly vaccinated communities. Hospitalizations are on the rise for unvaccinated communities and people.
The vaccines continue to be effective against all of the variants including Delta. We will be watching the lambda variant closely for vaccine response but it also appears sensitive to the mRNA vaccines.
As it stands today, the United States has had 35 million known cases and almost 613,000 deaths. This is 5000 more deaths than 2 weeks ago.
There is still no change in the knowledge that more than 80% of deaths are skewed toward the over 55 age group and 94% of all deaths occurred in a person with a co-morbid chronic health disease. More biological antibody medicines are on the horizon that may along with a mixture of vitamin A , D, zinc, quercetin and melatonin be employed for a safe resolution to COVID19. If you did not read the newsletter about an Integrative approach to health in the COVID era, read this link and this link.
As with the first newsletter on this topic, keep solace with the fact that there is a 99+% chance of survival for all of us.
Mathematically, you now have a 99.9998% chance of survival once vaccinated and the vaccine safety for the mRNA vaccines continues to look good.
This is much safer than driving a car!
Do you believe that masks made a difference in the SARS2 transmission control?
73% said yes
Will you vaccinate your teenager?
58% said yes
The Women and Children First Podcast with Dr. Benjamin is now live and really worth your time as he is very articulate and full of knowledge about our current predicament. We get deep into his research on COVID in NC schools as well as masking/vaccine understandings for teenagers.
1) A few people are asking about the need to vaccinate if you have already had COVID natural illness. What is the story here? Hot off of the press from Cell Reports Medicine, we see: "Ending the COVID-19 pandemic will require long-lived immunity to SARS-CoV-2. Here, we evaluate 254 COVID-19 patients longitudinally up to 8 months and find durable broad-based immune responses. SARS-CoV-2 spike binding and neutralizing antibodies exhibit a bi-phasic decay with an extended half-life of >200 days suggesting the generation of longer-lived plasma cells. SARS-CoV-2 infection also boosts antibody titers to SARS-CoV-1 and common betacoronaviruses. In addition, spike-specific IgG+ memory B cells persist, which bodes well for a rapid antibody response upon virus re-exposure or vaccination. Virus-specific CD4+ and CD8+ T cells are polyfunctional and maintained with an estimated half-life of 200 days. Interestingly, CD4+ T cell responses equally target several SARS-CoV-2 proteins, whereas the CD8+ T cell responses preferentially target the nucleoprotein, highlighting the potential importance of including the nucleoprotein in future vaccines. Taken together, these results suggest that broad and effective immunity may persist long-term in recovered COVID-19 patients." (Cohen et. al. 2021)
This builds upon other studies finding very good long term memory B and T cell responses after natural infection especially with increasing severity of the natural illness. This means that in most cases, you are well protected from COVID after a natural infection. However, some RARE individuals will have a low antibody response and may also mount a weaker immune response the second time around as has been shown in some cases. Predicting who these individuals are is not possible at this time on a population basis. Thus, there is a reasonable argument for COVID naturally infected individuals to get one booster dose of an mRNA vaccine to insure a quality response immunologically upon preexposure to the virus. I cannot find any reasonable data or reason to get a two dose series in these people. (Krammer F. et. al. 2021)(Saadat et. al. 2021)(Abu Jamal et. al. 2021)
2) More on the "Do you need a second vaccine dose" if you know that you had COVID already naturally? Now we have a longitudinal study that also finds that the second dose has no added benefit for those persons in the convalescent phase of SARS2. They looked specifically at the T cell response and found that: "Vaccine-elicited spike-specific T cells responded similarly to stimulation by spike epitopes from the ancestral, B.1.1.7 and B.1.351 variant strains, both in terms of cell numbers and phenotypes. In infection-naïve individuals, the second dose boosted the quantity but not quality of the T cell response, while in convalescents the second dose helped neither. Spike-specific T cells from convalescent vaccinees differed strikingly from those of infection-naïve vaccinees, with phenotypic features suggesting superior long-term persistence and ability to home to the respiratory tract including the nasopharynx." (Neidleman et. al. 2021)
If you had natural infection and received one dose of a COVID vaccine, the T cell function and by definition your outcome if re-exposed again looks great. Thus, it makes logical sense now to prioritize vaccinating the global population with appropriate doses based on known convalescent history.
3) Variants continue to be a HOT and getting hotter topic - SARS2 Version B 1.617.2 Delta is now at 90% of US cases. Data for the delta variant is still showing significantly increased transmissibility (60% higher than the original UK strain). The mRNA vaccines are still working quite well. The breakthrough cases in vaccinated persons with the delta variant have been almost entirely asymptomatic with little to no risk of outcome negativity. There are reports out of Israel that the mRNA vaccines are less effective 39% at preventing infections, however, they remain 88-91% effective at preventing hospitalizations and deaths respectively. This conflicts with the data out of the UK that remains at 88% for any symptomatic disease. (Jones R. 2021)
The DELTA VARIANT IS SIGNIFICANTLY MORE INFECTIOUS THAN THE ORIGINAL SARS2 STRAIN BUT NOT MORE DEADLY OVERALL. It appears to have viral loads a 1000x greater than the original strain as reported recently from China. (Li et. al. 2021) This is important to reflect upon. Until we see a huge uptick in mortality, we can safely assume that our overall risk for a problem once vaccinated even with a breakthrough case remains very very very small. History tells us that these pandemics are rarely if ever shifted into more deadly variants as this offers no advantage to the virus where the increase in spread provides a huge advantage. Remember that the virus only evolves to enhance its survival. Killing the host is not in any circumstance more advantageous.
According to recent CDC documents, the risk of contracting SARS2 once vaccinated with 2 doses is reduced from 186 per 100,000 weekly cases for the unvaccinated to 21 per 100,000 an 8X reduction. Hospitalization is a 25X reduction and death is a 25X reduction. (CDC Site) The take-home point remains that vaccination is the only way to massively reduce risk. As the pandemic rages on again, mask usage in higher risk locales while you continue to practice high quality lifestyle choices will keep the risk to the lowest possible level.
Therefore, the simple answer here is as follows: 1) get vaccinated and take the guess work out of this. 2) follow the links in the introduction above for an integrative approach to remaining immune solvent to reduce all cause infectious mortality risk. 3) live every day like it is your last by honoring your mission to be a great human while you love people around you and while you love yourself.
Still zero evidence that the delta variant is more problematic to children at any age.
The Lambda variant that started in Peru is now in Texas . It is responsible for over 90% of cases in South America with similarly high transmissibility and similar morbidity to Delta. mRNA vaccines continue to look effective for Lambda despite some poorly sensationalized media coverage stating vaccine failures without making it clear that this data is based on the Chinese vaccine Coronvac. As of this newsletter, I find no evidence that the Pfizer or Moderna, our vaccines, are failing for Lambda. This continues to follow the Delta variant research to date.
There is some news that a gamma variant that is endemic in French Guiana has a high rate of mRNA vaccine misfire or poor efficiency. However, this is not playing out anywhere else yet. This likely leads to a conclusion of a problem of cold storage during vaccine transport and the chain of events leading up to administration. In the US, there have been very few breakthroughs overall at 555 and only 28 were the gamma variant. (CDC) It is so important to follow the rules for vaccine storage, preparation and delivery as this case likely points out.
4) More on Delta from Nature, "According to current estimates, the Delta variant could be more than twice as transmissible as the original strain of SARS-CoV-2. To find out why, epidemiologist Jing Lu at the Guangdong Provincial Center for Disease Control and Prevention in Guangzhou, China, and his colleagues tracked 62 people who were quarantined after exposure to COVID-19 and who were some of the first people in mainland China to become infected with the Delta strain. The team tested study participants’ ‘viral load’ — a measure of the density of viral particles in the body — every day throughout the course of infection to see how it changed over time. Researchers then compared participants’ infection patterns with those of 63 people who contracted the original SARS-CoV-2 strain in 2020. In a preprint posted 12 July1, the researchers report that virus was first detectable in people with the Delta variant four days after exposure,compared with an average of six days among people with the original strain, suggesting that Delta replicates much faster. Individuals infected with Delta also had viral loads up to 1,260 times higher than those in people infected with the original strain. The combination of a high number of viruses and a short incubation period makes sense as an explanation for Delta’s heightened transmissibility, says epidemiologist Benjamin Cowling at the University of Hong Kong. The sheer amount of virus in the respiratory tract means that superspreading events are likely to infect even more people, and that people might begin spreading the virus earlier after they become infected." (Reardon 2021)
5) Why vaccinate teenagers? A few people asked this question recently. The simple answer is as follows. Although, teenagers are at very low risk for a problem, they are not at zero risk. The safety of the mRNA vaccines is excellent. Is it worth the off chance that your child loses his or her sense of taste and smell possibly for life or worse has a serious myocarditis from a natural infection? I am seeing these types of cases in clinic. It, as always, is a weighing experiment on the scales of risk. I find the risk of natural infection to far outweigh a vaccine event.
6) More on the origins theory of COVID. Katherine Eban and Dr. Peter Attia discuss her investigations into COVID origins on The Drive Podcast episode #169. It is a very deep discussion into the lies, stories, and unknowns related to the start of this pandemic. The end result is as expected. We will likely never know the answer because the World Health Organization, The Chinese Government and the US agencies involved did not do a remotely reasonable assessment of etiology and frankly obstructed the process. Mrs. Eban is very clear that she is not stating a final decision as we cannot without hard science proving a cause. However, the researchers still have not found an intermediary animal nor the index case bat, making the lab leak theory possible if not outright more likely than a natural source in my opinion. The podcast is worth your time purely for the understanding of why each position as to the cause of COVID has merit and where that is.
7) "T-cell immunity is important for recovery from COVID-19 and provides heightened immunity for re-infection. However, little is known about the SARS-CoV-2-specific T-cell immunity in virus-exposed individuals. Here we report virus-specific CD4+ and CD8+ T-cell memory in recovered COVID-19 patients and close contacts. We also demonstrate the size and quality of the memory T-cell pool of COVID-19 patients are larger and better than those of close contacts. However, the proliferation capacity, size and quality of T-cell responses in close contacts are readily distinguishable from healthy donors, suggesting close contacts are able to gain T-cell immunity against SARS-CoV-2 despite lacking a detectable infection. Additionally, asymptomatic and symptomatic COVID-19 patients contain similar levels of SARS-CoV-2-specific T-cell memory. Overall, this study demonstrates the versatility and potential of memory T cells from COVID-19 patients and close contacts, which may be important for host protection." (Wang et. al. 2021)
8) The effectiveness of the Pfizer mRNA vaccine against the delta variant is 88% according to a new study in the NEJM this week. (Bernal et. al. 2021) This continues to be inline with other studies and is good news for the vaccinated population of the US overall.
Therefore, 12% will have a poorer response allowing for an infection, although likely very mild. Wearing a mask if you are high risk seems to be a really good idea in indoor high risk environments.
Highlights of the Women and Children First Podcast with Dr. Danny Benjamin, Professor of
Pediatric Infectious Diseases at Duke University:
COVID mRNA vaccines for 12 and over - a few days ago, I had the pleasure of interviewing Dr. Danny Benjamin, Professor of Pediatric Infectious Diseases at Duke University and Principal Investigator on the NC school COVID study, about the COVID vaccine, variants and risk factors for problems in children. He is a brilliant and thoughtful teacher and someone that I truly trust. Our interview is live now at the Women and Children First Podcast on Apple podcasts.
According to Dr. Benjamin, the COVID vaccine has already surpassed the necessary amount of time and number of inoculated children over 12 years of age to steadfastly discuss safety as a net known entity. In the history of vaccine development, there has never been a case of a new unknown side effect being discovered 6 months post any individual vaccination if enough people have been vaccinated to see a signal. As was the case with Rotashield, it took a few years to see the intussusception signal that caused the vaccine to be halted. The mRNA Covid vaccines have been administered to enough children, that we have passed that threshold. According to the CDC over 7 million children have received both doses of the vaccine.
He added a clarification post interview:
There are adverse events, AE, that are: a) discovered “late” in the life cycle of the vaccine (e.g., we did not see myocarditis in the mRNA vaccine until they were on the market 6 months, primarily because young people were not getting the vaccine which is the group primarily affected). This can occur, but is extremely unlikely now because so many people have received the mRNA vaccine. The one caveat is that not many young children have received the vaccine, so this is still possible for children <12. b) the belief that there are AE's discovered 12 months or 3 years after an individual receives the vaccine. E.g., the delusion that mRNA impacts fertility. This category has not happened in the history of vaccinology.
Based on the weight of the evidence and my trust in Dr. Benjamin, I am now steadfastly recommending an mRNA vaccine for all children that are 12 and older regardless of risk or comorbid health condition. Changing my mind is a reflection of the changing known data sets, safety of vaccination versus contracting the virus and my trust in Danny. I take these decisions very seriously as I impart this information to you. I always make these decisions based on my own children and your child as well. That being said, this is a personal choice and not one that I would force on any one. As always, I am here to help with data and decision making and that is all. Please do not email me if you are upset with my analysis and choice unless you have data that is useful. I know that there are those of you out there that disagree with this assessment and that is ok. Discourse is the key. We are all in this together.
A second take away from the interview was that masking worked very well in schools during the pandemic. The secondary attack rate for children in schools was less than 1%. Which is to say that if a child had Covid in an NC school, they infected less than 1 in 100 other children. Dr. Benjamin stated that no matter what happens moving forward, we should be back in school face to face full time as masking works to stop the spread of SARS2 in schools. Regardless of vaccination status and area SARS2 volume, school activity is safe with masking in place. There has been a lot of fuss over masking for good reason as it is a major annoyance, terrible for the environment and difficult socially for children. However, we have never faced a virus of this infectious capability coupled to its morbidity strength. Therefore, we really need to think about our frustrations in a new light, children's health and in person education. This week the CDC has stated that they would teachers and children masked in school regardless of vaccination status until things cool down again. This seems prudent as many kids are still unvaccinated and Delta is raging all over.
The MOST IMPORTANT EVENT THAT MUST OCCUR IN THE FUTURE FULL STOP is that children NEED TO BE IN SCHOOL FACE TO FACE FULL TIME FOREVER! We can no longer sanction the educational and emotional nightmare that was last year's virtual learning debacle. And it was all of that and more!
Thus, if we have to suffer masks, which I hope that we do not but it appears that we will, in school and out in the environment to have in person school, then we must do this. In my mind, we should all get vaccinated and prevent this problem from manifesting as it is starting to again with the delta variant. Almost all cases that are occurring now are in unvaccinated individuals making the threat of all kinds of dysfunctional methods like lock downs and virtual schooling leave the lips of some in power. We should never go back to that reality as it will haunt us for decades as our stunted children's health and economic trillion dollar handout has to be reckoned with.
I agree with my friend that masking in schools should occur if there is another major spike in disease as many children will not have the opportunity to receive the vaccine coupled to the fact that they are not the major spreaders of disease to begin with but need to be in school no matter what. Currently, masking does not seem necessary for outdoor sports.
The K through 8 age does not have the opportunity to get vaccinated and this changes the above calculus regarding masking in a surge of COVID in the community. Rate of death in this age group is 2 per 100,000 and although a small number overall, it is never insignificant for any child to die. MIS or multi inflammatory syndrome remains equally rare.
2 major takeaways from the first half of the interview: mask if necessary during a surge of COVID cases especially in the K through 8 grade age range. The older groups should absolutely vaccinate with an mRNA vaccine, Moderna and Pfizer. If there is a variant switch that evades the mRNA vaccine, then schools should stay open and kids should where a mask. Education takes precedence.
The second half of the interview focuses primarily on the morbidity risks of a child developing myocarditis with and without a vaccine, damage to the brain especially the sensory regions of the brain for taste and smell, long covid including brain fog and fatigue. I have covered this information extensively over the last 5 newsletters.
1 per 100,000 vaccines given will be a side effect for COVID mRNA vaccines. The vast majority will be mild self limited myocarditis or mild cardiac inflammation. These issues will not require any treatment other than mild ibuprofen. Severe cardiac inflammation is exceedingly rare and almost entirely associated with the natural infection and 1000 times more likely. The vaccine is not the problem here while COVID is.
National Geographic has a comprehensive article on the delta variant LINK