Wednesday, June 14, 2023

Looking Backward, Looking Forward

 

Vaccines new and old, CDC blues, the dwindling pandemic, liars cranks charlatans and scammers, relief and clawbacks, long COVID, SCOTUS, American uncivilization, and life in Muskland.

 

Treatment

The crystal structure of nattokinase


The “Holy Grail of COVID-19 Vaccine Detoxification”? That’s the claim notorious misinformation-monger Peter McCullough makes for nattokinase, which comes from a traditional Japanese food based on fermented soybeans. He says nattokinase will help long COVID patients and people suffering long-term harm from vaccines. The research this claim is based on? A Japanese study reporting that – in a test tube – nattokinase can break down an unspecified variant of the SARS-CoV-2 spike protein. The researchers themselves say nattokinase could conceivably help prevent or treat COVID-19, but don’t mention either “vaccine injury” or long COVID. Pretty far from a Holy Grail!

A couple of posts back I described a preprinted manuscript saying the venerable diabetes medication metformin could prevent long COVID in overweight or obese patients who took the drug early in their illness. I pointed out that it had that positive effect only in people who had foolishly never been vaccinated. Now that research has been published, in the prestigious Lancet, and it’s somehow impressed the usually brilliant Jeremy Faust. The published version has slightly different numbers, but my criticism still holds – and, furthermore, metformin only benefitted people who were obese rather than merely overweight.

 

Vaccines and prevention



I’ve mentioned the excellent home-grown vaccines in Cuba, and the country’s generosity in distributing internationally not just the vaccines themselves but the technology behind them. But now I’ve learned the shocking backstory from the Washington Post. An op-ed titled “Next pandemic, let Cuba vaccinate the world” reports that many needy countries declined to accept Cuban vaccines out of fear of contravening American sanctions. How sad.

Last fall’s updated COVID-19 vaccines were bivalent, containing spike protein mRNA that’s half Wuhan wild strain and half Omicron BA.5. But Omicron has evolved so far away from BA.5 that the World Health Organization now suggests the next version return to being monovalent, this time based on one of the XBB subvariants that dominate new cases in the USItaly and elsewhere. Such a vaccine can’t be developed overnight, but it might be available by autumnJeremy Faust discusses the issue pretty clearly. I’m not totally convinced, since the bivalent booster performed reasonably well against XBB in some though not all studies. It’s similarly unclear how well the original monovalent component that’s due to be purged works against recent Omicron subvariants, with some but not allreports finding the old wild-strain monovalents as effective as the new bivalents.

China has already approved two new boosters targeting XBB, and plans to start rolling them out soon to vulnerable populations. One is a trivalent protein-based vaccine, whereas the other might possibly include an mRNA component.

A Swiss research group has developed a “single-cycle vaccine” that yields sterilizing immunity when delivered intranasally to hamsters. I’m not clear what single-cycle vaccine means, or whether it protects against variants or just the wild strain. But in any case there’s many a slip ‘twixt hamsters and people.

Vaccinating the global South: last time I said the COVAX initiative had “failed abjectly” because only 25% (now 25.7%) of inhabitants of low-income countries were “fully vaccinated,” far short of COVAX’s stated 70% goal. Compare that to 81.3% in Italy, and 69.5% in the vaccine-hesitant USA. But one thoughtful and well-informed reader has pointed out to me that the 25.7% statistic is less dire than it seems, because the populations of many low-income countries are so young. Half of all Africans are under 19 and half of Indians under 29 (in Italy half are under 47, in the US 39). So most low-income countries have reasonably chosen to prioritize pediatric vaccines against killers such as measles and polio, rather than COVID-19, which rarely causes serious illness in children. 

Good news: a half-dozen African countries have bested the United States, exceeding 70% coverage, and 64.4% of the world’s population has now had at least a primary series. And, again, 76% of all human beings over age 60 have been vaccinated. But there’s a huge gap between rich and poor countries. As of March 2023, 92% of elderly people in high-income countries had completed a primary vaccine series, versus only 34% in low-income countries. I’m still scandalized by those 200 million expired doses that were discarded during 2022, and disappointed that only 27% of the doses administered in Africa were mRNA vaccines, the rest being less effective products from Johnson & Johnson (36%), AstraZeneca (16%), or China (21%).

Headline from the Australian Broadcasting Corporation: “Australian garlic variety can limit internal spread of COVID and influenza A, Doherty Institute finds.” This unnamed variety would “combine with the [COVID] virus and prevent it from infecting the cells in our digestive tract.” Since you don’t get COVID-19 by swallowing SARS-CoV-2, this is silly on the face of it. And though we have neither a manuscript nor a press release to help us interpret those results, they are even less impressive knowing: 1) the study was commissioned and funded by “Australian Garlic Producers,” and 2) the research is in vitro, performed in a test tube, not in people or even mice.

How long do the bivalent boosters last?

Seven American states: In new data from the CDC, effectiveness against hospitalization in non-immunocompromised patients fell from 62% to 24% over 4-6 months as versus the entirely unvaccinated. It was even worse for immunocompromised individuals. In people who had had previous monovalent vaccines, added protection fell from 37% to 11%; all results were adjusted for age, sex, race, region, and date. Most interestingly, the boosters continued to protect well against critical illness and death for at least 6 months, and did if anything better against XBB than BA.4-5. The researchers admit their study has important limitations. 

North Carolina: A study in one state outside the CDC’s 7 had quite similar results: 67.4% effectiveness against severe illness at 2 weeks, 38.4% at the end of followup at 20 weeks.

Israel: But researchers at a giant Israeli insurance company found stronger results, reporting that a bivalent booster increased protection against hospitalization by 72% over monovalent vaccination alone, for 4 months. 

 

The state of the pandemic






As these maps show, things have cooled down enormously. Even cautious Israel has (unfortunately) removed mandatory masking in health facilities and now allows COVID-19 patients to exit self-isolation without a swab as soon as they feel better. 

But the pandemic isn’t over. 

The US is still running close to 300 deaths a day, and I encounter new cases at least once a week.

In Australia, COVID-19 hospitalizations have doubled since March. Some schools have reintroduced mask mandates and even distance learning, partly because so many teachers (11 out of 67 at one school) are out sick with COVID-19. A 5th wave that started in southern Australia is threatening to spread northward.

In New Zealand too, COVID-19 hospitalizations and deaths have doubled since early March. 

China anticipates a surge hitting 65 million cases a week by late June. While most Chinese are living like 2019, some are still trying for “zero COVID.”

Some European experts are warning against complacency, noting unacceptable risks of severe disease among the vulnerable and of long COVID following even mild-to-moderate disease.

 

Kennedy for President?


Robert F. Kennedy, Jr., “lying crank,” author of a vicious book about Anthony Fauci, banned from Facebook and Instagram for being among the worst purveyors of Novax lies, is challenging Joe Biden for the Democratic Presidential nomination. Doesn’t he look cute in the picture, though (top row, left)?

Scarily, he’s polled at 19% among Democrats on one Fox News poll. Are people mixing him up with his murdered father, going by the prestige of his last name, or genuinely enthusiastic?

Kennedy’s army of antivaxxers managed to scam one eminent medical historian, whose specialty is exposing racist research, into participating in a pseudo-documentary aimed at persuading African-Americans to refuse vaccination for themselves and their children against not only COVID-19 but measles, mumps, and rubella. Its title: “Medical Racism: The New Apartheid.” I won’t link to the video itself, only to its debunking at FactCheck.org.

Speaking of presidential candidates and COVID-19, I just now learned from Susan Barron that Trump boasted in the runup to the 2020 election of having saved 2 million lives. As per my last post, Anthony Fauci thinks that was underestimating by half. The difference is that Fauci attributed the saved lives to Operation Warp Speed vaccines, whereas Trump claimed they were thanks to his blocking travel from China and suggesting people stay home from mid-March through April.

 

CDC blues

Mandy Cohen


The People’s CDC” does much better than the real CDC at advising people how to handle COVID-19. And an infectious disease nurse gives additional good advice, starting with warning people you might have exposed (a step the People’s CDC neglects). 

I wrote last time that the Massachusetts General Hospital had stopped requiring masks, but the reality was even worse: MGH physicians were refusing to mask up even when patients requested it. At least on that one small point the backlash has resulted in a victory! This I learned from the latest “People’s CDC” webpage.

I’ve said that 35 of the 1800 people who attended a Centers for Disease Control’s conference had come down with COVID-19. But now we know more about. First, the event became a superspreader, with 181 known cases. Second, only about 30% of attendees wore masks and just a quarter of the COVID-19 patients received antiviral medications. Nevertheless, none got sick enough to need hospitalization, thanks to vaccination (in 99%), previous infections (in 48%), and relative youth (median age 38). But about 18 of the 181 are likely to have long COVID in 6 months. Another, smaller CDC conference is coming up in June, with masks encouraged but still – amazingly – not required.

The People’s CDC points out that the embarassing CDC outbreak is “an unfortunate example of its own ineffective policies” based on pushing individual choice over a population health approach.

A propos of the CDC, there’s now a candidate to replace Rochelle Walensky at its helm. Walensky had never previously held any kind of government leadership role, but Mandy Cohen has been the North Carolina health secretary and a senior official at the Centers for Medicare and Medicaid Services. She looks good to me and to Anthony Fauci, though apparently some current CDC personnel have reservations.

 

Giving with one hand…

Ming Lin


Unwinding pandemic Medicaid expansions: More than half a million people have already lost their coverage, with Florida leading the pack. Most got the boot not for being found ineligible but because of procedural hurdles and red tape, which HHS Secretary Xavier Becerra offers strategies to overcome. The latest estimate is that 15.5 million people, 20% of all Medicaid recipients, will eventually get kicked off, and more than 6 million will remain permanently uninsured. Examples of pre-pandemic eligibility criteria: in Florida, a single person must have a monthly income under $1215 a month, and a family of four under $2500. In Florida and South Carolina, it’s again $1215 a month for singles but just $1643 for that family of 4. Alabama generously allows a family of 4 to have up to $3,650 per month and remain on Medicaid. In Texas low income isn’t enough. You must also be either pregnant, blind, disabled, over 65, or caring for a child or a disabled household member.

Relief cheats: Five trillion dollars in relief money was distributed by Presidents Trump and Biden in 2020-21, and reliance on the honor system resulted in what the New York Times last August called a “Tidal wave” of fraud. Money was sent to dead people, to “farms” that were really front yards, and to 342 individuals who said their name was “N/A.” As of this spring the U.S. Government Accountability Office had flagged 3.7 million recipients of Small Business Administration funds with warning signs suggesting potential fraud; between $163 billion and $400 billionin enhanced unemployment insurance is thought to have been improper; and a business tax refund program seems to have been scammed for $152 billion. These numbers are staggering, and swamp by an order of magnitude the paltry $27 billion in unspent funds set to be clawed back by the debt ceiling package recently passed by Congress. I haven’t heard of any large-scale initiative to recoup that fraudulently obtained money – correct me if I’m wrong. What I haverun across is the case of a former Connecticut lawmaker who’s been sentenced to 27 months in prison for stealing $1.2 million in pandemic relief funds from the city of New Haven, largely to fuel his gambling addiction.

…a propos of legal cases, let me give a shoutout to Ming Lin, an ER physician who was fired from his hospital early in the pandemic for advocating reasonable COVID-19 protocols, and is now nobly insisting on going to trial to obtain an admission of wrongdoing, rather than settling for a monetary award as his ACLU lawyers advise. 

 

Scammers and charlatans



“America’s Frontline Doctors”: Not content with having murdered untold numbers of gullible COVID-19 patients with quack cures, now AFD has moved on to charging thousands of dollars for treating “post-vaccine syndrome” and peddling ivermectin as a cure for ovarian cancer.

Pathological pathologists: I once had a patient whose breast needle biopsy was deliberately misdiagnosed as cancer in order to enrich a surgeon. Another version of this cruel scam, perhaps even worse, is an Idaho pathologist who’s been misdiagnosing cancer to push the novax cause, claiming the cancers were due to COVID-19 vaccination. One of his videos was viewed more than 600,000 times before being purged from the internet. It gets debunked here.

And these are the Shkreli award runners-up:

-       Hospital charges facility fee for patients who never set foot in the facility

-       Doctor who makes living from surprise billing sues feds for protecting patients from surprise bills

-       Liberal prescription of Adderall helps telehealth app “Cerebral” grow and retain patient base

-       Blood thinners are billion-dollar boondoggle for price-hiking pharma buddies

-       Government program designed to forgive student loans saddles healthcare workers with more debt

 

Looking backward

An Emergency Room waiting room in England

The Royal College of Emergency Medicine calculates that an astonishing 23,000 of the 47,000 excess UK deaths during 2022 were caused not by COVID-19 but by prolonged waiting times in Emergency Rooms. The National Health Service calls that figure exaggerated, largely because the RCEM based their calculations on rates for 2016 and 2018, before the pandemic had caused Emergency Rooms to be overwhelmed. That makes no sense to me, since the overwhelming is just the point.

An interesting study has found that a UK program intended to bring people back into restaurants late in the first year of the pandemic worked great – at the cost of a leap in new cases.

A specific gene, HLA-B*15:01, may possibly protect people from getting sick if they’re infected with SARS-CoV-2, though it doesn’t prevent their getting infected in the first place. The manuscript reporting this fascinating finding was posted as a preprint more than a year ago and hasn’t managed to get published yet. Why not? I suspect that expert journal reviewers detected a fatal flaw that makes the research unpublishable.

 

Long COVID



Many long COVID symptoms now seem rooted in the brain. Not only the obvious – brain fog, post-traumatic stress disorder, mood swings – but also fatigue, POTS (postural orthostatic tachycardia syndrome), even pain. Mechanisms might include inflammation, impaired blood flow, or a combination of the two. It’s not yet clear how this insight might inform therapy. 

One study from the NIH’s RECOVER initiative has gotten a lot of attention in both the medical press and the mass media. All it really does, though, is describe 12 well-known symptoms of long COVID, making it in my view a poster child for the crappy research being done under the RECOVER umbrella. It does say, helpfully, that about 10% of people with Omicron infections will still be having symptoms after 6 months, and that repeat infections increase risk. Long COVID advocacy groups are getting so discouraged they’re shutting down left and right. 

How come all the NIH can do is tell us long COVID patients have fatigue and brain fog, when UK scientists are full steam ahead, testing multiple therapies in the STIMULATE ICP trial, with preliminary results likely to arrive this year.

 

The Supremes



Justice Clarence Thomas gets the prize for corruption and Justice Alito, arguably, for racism… but for public health ignorance Neil Gorsuch takes the cake. Here’s what he has to say about the relatively modest measures taken in the US to curb the worst pandemic in a century: “Since March 2020, we may have experienced the greatest intrusions on civil liberties in the peacetime history of this country.” The greatest? Really? New York Times columnist Jamelle Bouie points out a few other contenders: chattel slavery, massive forced sterilization starting in the 1920s, McCarthyite purges in the 1950s, FBI surveillance in the 1960s of everyone from Martin Luther King, Jr. and Eleanor Roosevelt (!) to Jane Fonda. Justice Gorsuch may deserve points for acting on his principles: he refused to wear a facemask when urged by Chief Justice Roberts, obliging Sonia Sotomayor, who has diabetes, to participate in some deliberations via Zoom.

 

Civilization



Time Headline: “More Than 70% of Americans Feel Failed by the Health Care System.” Sixty percent in a Harris Pollgave the system a C, D, or F rating, while 26% said their own families’ finances were strained by healthcare costs; 49% of urban and rural adults had delayed or skipped healthcare in the last two years, of whom half said their mental or physical health had suffered as a result.

I’ve frequently expressed the hope that the COVID-19 pandemic might goad the United States into joining the rest of the civilized world by instituting universal health care. Now Bernie Sanders and company are proposing their Medicare for All bill again, though Sanders himself admits that only slivers have any chance of being passed. Other kinds of universal coverage systems have recently been proposed at both national and state levels.

In related news, life expectancy at birth in the United States, which has lagged far below other wealthy countries for years, has continued to fall throughout the pandemic even while other industrialized nations bounced back. In 2023 it’s even worse than in 2021, falling from 77.2 years to 76.4, while Japan’s reached 85.0 and Italy’s rose from 83.5 in 2020 to 84.0 in 2023. Not only is America’s health system a mess, its safety nets inadequate, and its diets and alcohol use unhealthy, but no other country shares our gun obsession, our opioid epidemic, our wealth gap, or our profound and pervasive racial inequities.

 

Folly in Muskland: some priceless Tweets



“I could only find the names of just 3 unvaxxed Amish people who died from COVID in Lancaster, PA where there are over 50,000 never vaxxed Amish." In reality, at least during 2020, excess mortality among the Amish and Mennonites paralleled excess mortality in the US as a whole. More debunking links here.

“I was a healthy 62 yr old, until I got the 1st vaccine, and had a stroke, a week later in my brain.” Coincidence. A giant study in Norway has proven that if anything the risk of stroke is lower during the month after vaccination that during the previous month.

“CDC has discovered over 770 safety signals with the Covid vaccines but they’re not telling anybody about any of them… Including the death Safety signal.” In reality the only safety signal identified in the linked article or any of its online Supplements is the well-known association with myocarditis in adolescent boys. The word “death” occurs only once, to specify that if a child died during follow-up (none did), follow-up would end the day they died. 

“Dr. David Martin Shows COVID-19 Pandemic Was Pre-Meditated Domestic Terrorism” Love it!

“AIDS-associated diseases and cancers have increased by 338x since the rollout of the (covid-19 vaccine), according to the CDC.” If you believe that one I’ve got a splendid bridge I’d like to sell you!

“Miscarriage, Vision Loss, Immunotoxicity: Alarming COVID Vaccine Issues.” Yeah, sure.

“WOW: The FDA revoked Johnson and Johnson’s emergency us authorization for the COVID jab.” They’re trying to undue the harm that they’ve caused and hope we don’t notice. No. We notice. This one from the president of the notorious America’s Frontline Doctors might be about a clotting problem, thrombosis with thrombocytopenia syndrome, the major complication specific to the J&J and AstraZeneca vaccines. It happened in about 3 people in every million who received the vaccine, and has killed 9 Americans, fewer than one death in 2 million doses. Another rare J&J complication is Guillain-Barr√© syndrome, which occurred in 100 American J&J vaccinees (about 8 per million) and was fatal in a single case.

“14 California Families Sue 3 Hospitals for Deadly Remdesivir Protocol Remdesivir is so lethal it got nicknamed “Run Death Is Near” after killing thousands of C19 patients.” Along the same lines: @RobertKennedyJr: “Tony Fauci Knew That Remdesivir Would Kill You” “How does it kill you?” he asked. “Kidney failure, heart failure, and all-organ collapse.” These are dangerously vicious lies, discouraging patients from accepting a potentially life-saving medication. Facts: in high-risk COVID-19 outpatients remdesivir reduces the risk of hospitalization or death by nearly 90%. In appropriate hospitalized patients, it cuts mortality by more than half, and 42% fewer patients wind up on ventilators. Side effects? Yes, it can damage the kidneys, but only if they are already functioning badly, so even moderate kidney failure is considered a contraindication. Heart failure? Exactly two patients had cardiac deaths during remdesivir treatment as part of clinical studies. Both were hospitalized, and one also had fulminant Ebola virus infection. No such deaths are known among outpatients.

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