tag:blogger.com,1999:blog-62114059549430984012024-03-06T04:09:41.826+01:00Stethoscope On RomeThe straight dope on Italian health and medical care, from an American woman doctor who lives and works in Rome. Her memoir, Dottoressa, was published in May 2019.Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.comBlogger147125tag:blogger.com,1999:blog-6211405954943098401.post-59969238602614363772023-11-05T12:36:00.000+01:002023-11-05T12:36:11.570+01:00Is the United States Civilized?<p> <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIYPiDSWm1NzXtOHCcxvXXrtnnUEeXFXrisQ5R9SQ__KKsJ6Dytfz-7HoVFPOu-LmpD-68hgwK0E0dxDfmBgY_WcdEqwtHi3IsmEVV9N496-1n6mgXpK7tiX7DwG3yn0rZ5qiy96dXlSmAE0gycOmiMyTemKQ3d-zHcEOHZdsx2drsCs1qPNlLHH3sHzo/s1304/map%20universal%20healthcare.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="784" data-original-width="1304" height="241" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIYPiDSWm1NzXtOHCcxvXXrtnnUEeXFXrisQ5R9SQ__KKsJ6Dytfz-7HoVFPOu-LmpD-68hgwK0E0dxDfmBgY_WcdEqwtHi3IsmEVV9N496-1n6mgXpK7tiX7DwG3yn0rZ5qiy96dXlSmAE0gycOmiMyTemKQ3d-zHcEOHZdsx2drsCs1qPNlLHH3sHzo/w400-h241/map%20universal%20healthcare.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="https://wisevoter.com/country-rankings/countries-with-universal-healthcare/">Countries with universal healthcare</a><br /><br /></td></tr></tbody></table></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Paxlovid controversies, vaccines old and new, the red and the blue, unwindings, collateral damage, Boris Johnson, microbiomes, emergencies, RFKs, and comic relief.<o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td class="tr-caption" style="text-align: center;"><div style="text-align: left;"><style class="WebKit-mso-list-quirks-style">
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</style><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b> </b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Treatment<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f"><v:stroke joinstyle="miter"><v:formulas><v:f eqn="if lineDrawn pixelLineWidth 0"><v:f eqn="sum @0 1 0"><v:f eqn="sum 0 0 @1"><v:f eqn="prod @2 1 2"><v:f eqn="prod @3 21600 pixelWidth"><v:f eqn="prod @3 21600 pixelHeight"><v:f eqn="sum @0 0 1"><v:f eqn="prod @6 1 2"><v:f eqn="prod @7 21600 pixelWidth"><v:f eqn="sum @8 21600 0"><v:f eqn="prod @7 21600 pixelHeight"><v:f eqn="sum @10 21600 0"></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:formulas><v:path gradientshapeok="t" o:connecttype="rect" o:extrusionok="f"><o:lock aspectratio="t" v:ext="edit"></o:lock></v:path></v:stroke></v:shapetype><v:shape id="Picture_x0020_138" o:spid="_x0000_i1036" style="height: 232pt; visibility: visible; width: 347pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image001.jpg"></v:imagedata></v:shape><u><o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u></u></p><div class="separator" style="clear: both; text-align: center;"><u><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEqiIOQ1yPyoqj-OIkdWt9uJ5zd24Bg_zOxB2dWzjRChsDnWR8Qa5JiWtsAj6IcgUMIBr62C4w663lv1wv3VLZAhlK4eSAGSFWAJphHDgnvR2erpjTuTKDuS1zEGjzScM7kK2fRZKSagTPAVQMeNyNFCYHfkueoPZQomTmuQTJfk6mD6SiRjHYS2fMYsw/s850/Drinking-black-tea%20copy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="567" data-original-width="850" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEqiIOQ1yPyoqj-OIkdWt9uJ5zd24Bg_zOxB2dWzjRChsDnWR8Qa5JiWtsAj6IcgUMIBr62C4w663lv1wv3VLZAhlK4eSAGSFWAJphHDgnvR2erpjTuTKDuS1zEGjzScM7kK2fRZKSagTPAVQMeNyNFCYHfkueoPZQomTmuQTJfk6mD6SiRjHYS2fMYsw/s320/Drinking-black-tea%20copy.jpg" width="320" /></a></u></div><u><br /><br /></u><o:p></o:p><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="margin-right: 6pt;"><u>Paxlovid</u>: University of British Columbia researchers have published a <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809972">retrospective cohort study</a> finding that only people who are moderately-severely immunosuppressed benefit from treatment with nirmatrelvir-ritonavir, whereas those who are merely elderly or chronically ill have no improvement in rates of hospitalization or death. I’m skeptical, because these findings contradict similar studies from <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9928441/">Ontario</a>, <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2204919">Israel</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10332951/">Korea</a>, <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00118-4/fulltext">California</a>, <a href="https://academic.oup.com/cid/article/77/6/805/7156540">Quebec</a>, and <a href="https://www.acpjournals.org/doi/10.7326/M22-2141">Mass. General Brigham</a>, all of which found Paxlovid effective in vulnerable non-immunosuppressed populations.</p><p class="1obc" style="margin-right: 6pt;"><u>Molnupiravir</u><span style="font-size: medium;">: In mid-November Lagevrio will soon no longer be available from the American government free of charge but will </span><a href="https://www.reuters.com/business/healthcare-pharmaceuticals/us-plans-shift-merck-covid-treatment-commercial-market-2023-10-04/?">shift to the commercial market</a><span style="font-size: medium;">, with a “patient assistance program for people who cannot afford the drug.” Given molnupiravir’s inefficacy both in </span><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02597-1/fulltext">preventing severe disease</a><span style="font-size: medium;"> and in </span><a href="https://www.ndm.ox.ac.uk/news/paxlovid-r-clears-covid-19-more-rapidly-than-molnupiravir">clearing the virus</a><span style="font-size: medium;">, plus its potential to prolong </span><a href="https://www.nature.com/articles/s41586-023-06649-6">infection duration</a><span style="font-size: medium;">, </span><a href="https://www.medrxiv.org/content/10.1101/2022.12.21.22283811v1">induce mutations</a><span style="font-size: medium;"> transmissible </span><a href="https://www.nature.com/articles/s41586-023-06649-6">to other people</a><span style="font-size: medium;">, and breed </span><a href="https://www.newsweek.com/covid-drugs-creating-super-virus-scientists-1829175">new variants</a><span style="font-size: medium;">, it would have been better to withdraw authorization altogether as the European Union </span><a href="https://www.ema.europa.eu/en/medicines/human/withdrawn-applications/lagevrio#:">already has</a><span style="font-size: medium;">. Molnupiravir </span><a href="https://www.msn.com/en-us/money/markets/us-government-ceases-free-distribution-of-merck-s-covid-19-pill/ar-AA1hKc9T">never caught on</a><span style="font-size: medium;"> in the US, with only 1.4 million courses ever used, versus 10 million of Paxlovid.</span></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Paxlovid again</u>: A five-day course has cost the American government $529 ever since the drug came out, though it’s been distributed free of charge to all eligible patients. Paxlovid will move to the commercial market once government warehouses are depleted <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/us-plans-shift-merck-covid-treatment-commercial-market-2023-10-04/?">in mid-December</a>, whereupon Pfizer will <a href="https://www.washingtonpost.com/politics/2023/10/19/what-were-watching-next-two-gubernatorial-races/">triple the price</a> to <a href="https://www.wsj.com/health/healthcare/pfizer-covid-drug-paxlovid-pricing-80f83785?ns=prod/accounts-wsj">$1390</a>. But between a <a href="https://www.hhs.gov/about/news/2023/10/27/letter-to-covid-19-therapeutics-manufacturers-distributors-pharmacies-and-the-health-care-payer-community.html?utm_campaign=wp_the_health_202&utm_medium=email&utm_source=newsletter&wpisrc=nl_health202">patient assistance program</a>, subsidies, and private and public insurance programs, this lifesaving drug should likely remain available without co-pays to the vast majority of Americans who need it.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Fostamatinib (Tavlesse)</u>: Approved for a platelet disorder in the <a href="https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-fostamatinib-tablets-itp">US</a> and the <a href="https://www.ema.europa.eu/en/documents/overview/tavlesse-epar-medicine-overview_en.pdf">EU</a>, Tavlesse also benefits hospitalized patients severely ill with COVID-19, according to an <a href="https://www.medpagetoday.com/meetingcoverage/idweek/106788?">international study</a> presented at a medical meeting. All such reports need to be taken with a grain of salt, pending manuscripts with complete methods and results.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Extracorporeal membrane oxygenation</u>: This costly high-tech intervention, used as a last-ditch treatment in critically ill COVID-19 patients, is valueless and might even worsen prognosis, according to another <a href="https://www.medpagetoday.com/meetingcoverage/chest/106792?">conference presentation</a>. Same caveat as above.<u><o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Tea</u>: You might expect <a href="https://www.nature.com/articles/s41598-023-43563-3">an article</a> titled “Effects of tea, catechins and catechin derivatives on Omicron subvariants of SARS-CoV-2” to involve tea-drinking. Nope! The subjects didn’t drink tea but ate a tea-laced candy, and researchers didn’t study COVID-19 but put subjects’ saliva into a test tube together with the SARS-CoV-2 virus.<b><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Clorox</u>: I’ve written about the Grenons, a Florida-based father and three sons who gave Donald Trump <a href="https://www.theguardian.com/world/2020/apr/24/revealed-leader-group-peddling-bleach-cure-lobbied-trump-coronavirus">the idea</a> of treating COVID-19 by drinking bleach. The gang peddled a <a href="https://www.cbsnews.com/news/florida-men-accused-selling-fake-covid-cure-arrested-colombia/">deadly</a> “Miracle Mineral Solution” of industrial bleach to thousands of Americans to cure everything from <a href="https://www.cbsnews.com/news/mark-grenon-sons-convicted-selling-fake-covid-19-cure-online-church/">COVID-19 to autism</a>. Now, after more than three years including a period on the lam in Colombia, the DOJ has finally <a href="https://www.nytimes.com/2023/10/06/us/toxic-miracle-mineral-solution-sentencing.html">caught up with them</a>, sentencing two to 12 years in prison and the other two to five years.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Vitamin C</u>: Canadian researchers went to the trouble of doing a <a href="https://jamanetwork.com/journals/jama/fullarticle/2811212">randomized trial</a> of intravenous vitamin C to treat hospitalized COVID-19 patients. Anybody surprised it didn’t work?<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Convalescent plasma</u>: This simple treatment, which I’ve always thought promising, did fairly well in an open-label <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2209502">French/Belgian study</a> of critically ill patients with COVID-19. Of patients given plasma with high antibody titers only 35.4% died, versus 45.0% of patients who received standard care. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Simvastatin</u>: Surprisingly, high doses of this cholesterol-lowering drug <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2309995?">barely missed criteria</a> for improved outcomes in critically ill patients with COVID-19. A miss may be as good as a mile, but even being merely 91.9% likely to help seems impressive for such a benign intervention.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Vaccines<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_127" o:spid="_x0000_i1035" style="height: 313pt; visibility: visible; width: 241pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image002.png"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u></u></p><div class="separator" style="clear: both; text-align: center;"><u><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhThf0TX7DUC4dvhlY1U0iOfgNcMyXlLfsqYXJHKD8mr85JfwJdlo_lPppTn271fvLvFsrS3bEwUGlKHXLB9nj6xNTbeDk6jK4vOgZ4yRWb53Npre7v2-R9KdquNFItnp8IyeGKSpxppthZXulCLFb0g3UkRnqLA0yuvfGWz5kExhchgcxBbIhDtlET50w/s367/pregnant%20and%20protected.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="367" data-original-width="283" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhThf0TX7DUC4dvhlY1U0iOfgNcMyXlLfsqYXJHKD8mr85JfwJdlo_lPppTn271fvLvFsrS3bEwUGlKHXLB9nj6xNTbeDk6jK4vOgZ4yRWb53Npre7v2-R9KdquNFItnp8IyeGKSpxppthZXulCLFb0g3UkRnqLA0yuvfGWz5kExhchgcxBbIhDtlET50w/s320/pregnant%20and%20protected.png" width="247" /></a></u></div><u><br /><br /></u><o:p></o:p><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Novavax 1</u>: The FDA has <a href="https://www.fda.gov/news-events/press-announcements/fda-authorizes-updated-novavax-covid-19-vaccine-formulated-better-protect-against-currently">approved a Novavax booster</a> reformulated to match the XBB.1.5 spike protein, for anybody over 12 who’s fully vaccinated and has not received an XBB.1.5 mRNA booster from Pfizer or Moderna. During the <a href="https://www.usnews.com/news/us/articles/2023-09-29/around-1-8-million-americans-received-covid-shots-last-week-iqvia?">first week</a> of the US vaccination campaign, before Novavax arrived, about 1.8 million shots went into arms, one million Pfizer and 800,000 Moderna. </p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Novavax 2</u>: The original Novavax vaccine, was <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2810134">quite effective</a> according to researchers at the Italian equivalent of the CDC, cutting symptomatic Omicron variant COVID-19 in half. <a href="https://www.medpagetoday.com/infectiousdisease/covid19vaccine/106641?">The company predicts</a> the updated version will work well against EG.5 and several other current variants, but doesn’t mention either FL.1.5.1 or the hypermutated newcomer BA.2.86. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Novavax 3</u>: Thanks to <a href="https://ttowntruthseeker.com/">John Earl</a> for pointing me to a <a href="https://twitter.com/rolandbakeriii/status/1715490406421692896?s=43">thought-provoking tweet</a>: “My wife stopped by Costco to get the updated monovalent XBB vaccine booster this morning and the pharmacist asked her why is everyone asking for the Novavax booster instead of Pfizer and Moderna.” Two reasons this could be true: <o:p></o:p></p><p class="1obc" style="font-size: medium; margin: 5pt 6pt 5pt 0.5in;">1) Some people (foolishly) don’t want mRNA vaccines on principle. I doubt many current Novavaxers fall in this category, since <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-booster-percent-pop5">as of May 2023</a> more than 800 million mRNA shots had been given in the US, but only about one million Novavax.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin: 5pt 6pt 5pt 0.5in;">2) Others think Novavax gives fewer side effects. True! In the original Novavax trial about 28% had fatigue after the first dose, and 25% headache. Compare that to 40-50% for both with <a href="https://www.nejm.org/doi/full/10.1056/nejmoa2034577">Pfizer</a> and <a href="https://www.nejm.org/doi/full/10.1056/nejmoa2035389">Moderna</a>. Moderna<a href="https://assets.ctfassets.net/qxn1nenx7ve8/nmmw0JilPNZsD9fKtEYtc/500d22f9da3701eb151abbd7ebb78a79/Product_Monograph_SPIKEVAX_XBB15_mRNA-1273.815_EN_APPROVED_12Sept2023.pdf">reports</a> similar rates for the latest version: fatigue in 44%, headache in 34%.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">There is even, to my surprise, some evidence for pro-Novavax claims made in response to that tweet by “Hugh Wouldathunkit”: <a href="https://www.science.org/doi/10.1126/sciimmunol.adg7015">mucosal immunity</a> and <a href="https://ir.novavax.com/press-releases/2022-02-28-Novavax-Announces-Extended-Durability-of-Protection-Against-Infection-and-Disease-in-United-Kingdom-COVID-19-Vaccine-Phase-3-Clinical-Trial#:">longer duration of protection</a>. Having had a severe reaction to my first Pfizer shot, I may personally go for Novavax whenever it hits Rome. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Italy</u>: The XBB.1.5-targeted vaccine arrived on October 2, intended for administration in <a href="https://www.ilsole24ore.com/art/a-inizio-ottobre-nuovi-vaccini-contro-covid-cosa-devono-sapere-anziani-e-fragili-AFXpFAq">GP offices and pharmacies</a>. There should also be <a href="https://prenotavaccino-covid.regione.lazio.it/main/home">websites</a> for making appointments, but getting your hands on a dose <a href="https://www.adnkronos.com/salute/sanita/vaccino-covid-lazio-dal-2-ottobre-a-chi-spetta-come-si-prenota_6KHAXk44QG1HyW945c72xd">may not be easy</a>. Healthcare workers and nursing home residents were immediately eligible, followed two weeks later by people over 80, medically fragile, pregnant, or nursing. At the end of October the floodgates theoretically opened to all comers, provided they’re six months after their latest vaccine or bout of COVID-19 (three months would have been more reasonable). But in Rome there are no doses available at all, as my local pharmacist confirms; my one 84-year-old patient who succeeded in getting vaccinated lives far outside town. I am also concerned that the solo product around now is Pfizer-BioNTech, the one tested only in mice. <a href="https://modernacovid19global.com/it-IT">Moderna</a> and <a href="https://www.vaccinarsinliguria.org/notizie/2023/10/nuove-indicazioni-per-la-vaccinazione-anti-covid-19-autunnale#:">Novavax</a> are theoretically available but actually nowhere to be found.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Side effects</u>: After getting an mRNA COVID-19 vaccine most people have a sore arm for a day or two, but some have much stronger reactions. According to an <a href="https://www.medrxiv.org/content/10.1101/2023.09.26.23296186v2.full.pdf">American study</a> a more severe reaction – chills, fever, headache, fatigue, general malaise – predicts higher antibody levels against SARS-CoV-2 even six months later. So a severe side effects may possibly <a href="https://www.nytimes.com/2023/10/07/health/covid-vaccine-side-effects.html?">foretell better protection</a>. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Pulmonary damage</u>: There have been claims on social media that mRNA vaccines can damage the lungs. True, but extremely rare. Interstitial lung disease related to mRNA vaccines has been reported in a total of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942814/">eleven individuals</a>out of more than <a href="https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html">5.5 billion</a> people worldwide who have received at least one dose of vaccine, mostly Pfizer or Moderna.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Two-in-one</u>: Moderna has come up with an influenza/COVID-19 vaccine in a single syringe, and calls <a href="https://investors.modernatx.com/news/news-details/2023/Moderna-Announces-Positive-Phase-12-Data-from-mRNA-1083-the-Companys-Combination-Vaccine-Against-Influenza-and-COVID-19/default.aspx">preliminary results</a> in human beings promising, with elicited antibody levels similar to those following standalone flu or COVID-19 jabs, and side effects similar to the original Spikevax. Novavax <a href="https://ir.novavax.com/press-releases/2022-04-20-Initial-Results-from-Novavax-COVID-19-Influenza-Vaccine-Trial-are-First-to-Show-Feasibility-of-Combination-Vaccine">has developed</a> a similar product, with initial trials underway. I don’t approve, since an <a href="https://www.medrxiv.org/content/10.1101/2023.10.10.23296624v1.full.pdf">FDA study</a> found that combining the two vaccines – even one in each arm – carries a risk of stroke, especially in the very elderly. That study tested last year’s bivalent product, but there’s no reason to expect the XBB.1.5 vaccines to be different. I suggest leaving a couple of weeks between COVID-19 and influenza vaccines, especially if you are over 65.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Nasal sprays</u>: Sprays such as <a href="https://www.thelancet.com/journals/lansea/article/PIIS2772-3682(22)00046-4/fulltext#:">nitric oxide</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8493111/#:">Iota-carrageenan</a>, and <a href="https://www.sciencedirect.com/science/article/pii/S1386653222001809">proprietary agents</a> have been <a href="https://www.nytimes.com/2023/09/28/well/live/nasal-sprays-covid-treatment-prevention.html?">touted</a> as protection or treatment for COVID-19. Some clinical trials are ongoing, while the FDA <a href="https://www.ftc.gov/system/files/documents/cases/filed_complaint_xlear_v_jones_v.1.pdf">seeks injunctions</a> against other manufacturers for false medical claims.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Timing</u>: How quickly does vaccine efficacy fade over time? New analyses of the <a href="https://www.nejm.org/doi/full/10.1056/nejmoa2035389">principal Moderna trial</a>, described at a major medical meeting, suggest that – surprisingly – a booster dose was <a href="https://www.medpagetoday.com/meetingcoverage/idweek/106844?"><i>more</i> effective</a> in preventing Omicron COVID-19 if it was given 13 months after the primary series than if the gap was only 8 months. So an <a href="https://www.unmc.edu/healthsecurity/transmission/2023/10/17/the-case-for-a-yearly-covid-booster-shot/">annual booster strategy</a> (as the US plans) may be as valid as the more frequent jabs suggested for high-risk individuals by the World Health Organization. The usual caveats for conference presentations apply.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Pregnancy</u>: Pregnant women, who are at risk for severe outcomes, should be prioritized for COVID-19 vaccination. Now a <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2810937">study</a> by Canadian researchers reports that vaccination during pregnancy also prevents severe illness, ICU admission, and death among newborns. Nevertheless, pregnant women in the <a href="https://pubmed.ncbi.nlm.nih.gov/34138834/">US</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/36759282/">Canada</a>, and <a href="https://www.ambimed-group.com/it/le-donne-in-gravidanza-non-vaccinate-per-covid-19-sono-a-rischio-di-complicazioni-">Italy</a> are being vaccinated at <i>lower</i> rates than nonpregnant women. One possibly related phenomenon in the US is <a href="https://www.nytimes.com/2023/11/01/health/infant-mortality-rate-rise.html?">a rise</a> in both maternal and infant mortality. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Menstruation</u>: Getting an mRNA COVID-19 vaccine can change a woman’s next menstrual period, though <a href="https://scitechdaily.com/does-covid-19-vaccination-cause-changes-to-womens-periods/">probably no more</a> than <a href="https://www.medpagetoday.com/obgyn/generalobgyn/105877?">getting sick</a> with COVID-19. Estimates of frequency range from <a href="https://www.fhi.no/en/news/2023/vaginal-bleeding-after-covid-19-vaccination-among-non-menstruating-women/#:">7.3%</a> to <a href="https://www.science.org/doi/10.1126/sciadv.abm7201">42%</a>, not counting wild and <a href="https://www.fhi.no/en/news/2023/vaginal-bleeding-after-covid-19-vaccination-among-non-menstruating-women/#:">easily debunked</a> assertions that <a href="https://pubmed.ncbi.nlm.nih.gov/35857495/">66%</a> of postmenopausal women bleed after being vaccinated. Conspiracy theorist <a href="https://en.wikipedia.org/wiki/Naomi_Wolf">Naomi Wolf</a> goes way out in left field, <a href="https://www.viralityproject.org/rapid-response/vaccine-shedding-narratives-targeted-toward-women">claiming</a> that simply being near vaccinated people, or being in rooms where they had been, could cause bleeding and cramping. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Long vax</u>: Does a prolonged, long COVID-like reaction to vaccination exist? Articles in venues such as <a href="https://www.forbes.com/sites/brucelee/2023/07/08/is-long-vax-syndrome-a-rare-covid-19-vaccine-side-effect-heres-whats-known/">Forbes</a> and even <a href="https://www.science.org/content/article/rare-link-between-coronavirus-vaccines-and-long-covid-illness-starts-gain-acceptance">Science</a> claim the concept is <a href="https://www.science.org/content/article/rare-link-between-coronavirus-vaccines-and-long-covid-illness-starts-gain-acceptance">gaining acceptance</a>, but the evidence remains weak. A small case series of <a href="https://www.medrxiv.org/content/10.1101/2022.05.16.22274439v1.full.pdf">nerve-related symptoms</a> was preprinted in May 2022 but never published, which always raises doubts. <a href="https://www.nature.com/articles/s44161-022-00194-7">One study</a> did report a slight increase in POTS, a common long COVID symptom, following vaccination, and there are a few <a href="https://onlinelibrary.wiley.com/doi/10.1002/mus.27696">case reports</a>. I don’t think it adds up to much.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The reds and the blues<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_106" o:spid="_x0000_i1034" style="height: 218pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image003.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCb8TfxeAjY5AQq0-ovTtDzHj3IL5SRNtWVmuM3GiHNNIvu7Fo2Pis9stdROPEEfihHBe2ultz1HkuUrQLYzKmvSOzM5KR_b_4VgYjWhgYX9siHmtjRczCNcfOZJIq8mb_DOtoLB4OgjFjWgXMEmmDfu3M3ZZAb4pl-syUlYQU_P0viIpttFbRcS-wjdI/s945/partisan%20gap.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="454" data-original-width="945" height="308" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCb8TfxeAjY5AQq0-ovTtDzHj3IL5SRNtWVmuM3GiHNNIvu7Fo2Pis9stdROPEEfihHBe2ultz1HkuUrQLYzKmvSOzM5KR_b_4VgYjWhgYX9siHmtjRczCNcfOZJIq8mb_DOtoLB4OgjFjWgXMEmmDfu3M3ZZAb4pl-syUlYQU_P0viIpttFbRcS-wjdI/w640-h308/partisan%20gap.png" width="640" /></a></div><br /><br /><o:p></o:p><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Between <a href="https://www.pewresearch.org/science/2022/02/15/americans-trust-in-scientists-other-groups-declines/">January 2019 and December 2021</a> Americans who trusted medical scientists to work for the public good fell from 87% to 78%. But there was a sharp political divide: Democrats held steady at 87%-90%, while Republicans fell from 88% to 66%. A more recent poll, in May 2023, found <a href="https://www.americansurveycenter.org/research/americas-crisis-of-confidence-rising-mistrust-conspiracies-and-vaccine-hesitancy-after-covid-19/">trust in scientists</a> overall dropping to 59% from 86% in January 2019. With another striking partisan divide: Republicans went from 82% to 56%, Democrats from 91% to 82%.</p><p class="1obc" style="font-size: medium; margin-right: 6pt;">As of <a href="https://www.americansurveycenter.org/research/americas-crisis-of-confidence-rising-mistrust-conspiracies-and-vaccine-hesitancy-after-covid-19/">September 2023</a> 89% of Democrats and 58% of Republicans were vaccinated against COVID-19. This gap is the <a href="https://www.washingtonpost.com/health/2023/07/24/covid-vaccines-republicans-deaths/?">main reason</a> Republicans have died of COVID-19 at <a href="https://www.npr.org/2023/07/25/1189939229/covid-deaths-democrats-republicans-gap-study">far greater rates</a> than Democrats.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Winding and unwinding<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_109" o:spid="_x0000_i1033" style="height: 339pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image004.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYBZkkshaoxrxyIyKj4hgc39KiRoH6_PX64UNzUyriU648aLpKT78cDdU2PXv-L3ggrwblx78zAkfXNmHzK9Proa_T6bmyfU4Nb27RPEJIsZ2fJTMJVqO5cF3OV1Eb5d1S-H-EiMwibWj9_NpXF1vlmz4j8TKR43nHjOGfneT2HG8FyXhdFloEiRb9btY/s709/childcare%20center.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="531" data-original-width="709" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYBZkkshaoxrxyIyKj4hgc39KiRoH6_PX64UNzUyriU648aLpKT78cDdU2PXv-L3ggrwblx78zAkfXNmHzK9Proa_T6bmyfU4Nb27RPEJIsZ2fJTMJVqO5cF3OV1Eb5d1S-H-EiMwibWj9_NpXF1vlmz4j8TKR43nHjOGfneT2HG8FyXhdFloEiRb9btY/w400-h300/childcare%20center.jpg" width="400" /></a></div><br /><br /><o:p></o:p><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">As of November 1, 2023, the number of people <a href="https://www.vox.com/policy/2023/10/13/23914264/medicaid-health-insurance-enrollment-data-unwinding-october">kicked off Medicaid</a> hit an estimated <a href="https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-and-unwinding-tracker/">10,046,000</a>, about 11% of those who were on the rolls in January, with <a href="https://www.washingtonpost.com/health/2023/09/28/medicaid-unwinding-aca-health-plans/?">many fewer</a> transferring to Obamacare than would be entitled. That number, which includes nearly two million children, is <a href="https://www.kff.org/medicaid/issue-brief/how-many-people-might-lose-medicaid-when-states-unwind-continuous-enrollment/">expected to double</a> in the next six months. A <a href="https://www.washingtonpost.com/health/2023/09/21/medicaid-children-cut-off/?">computer glitch</a> caused half a million people, mostly children, to be purged so wrongfully that the federal government is demanding they be reinstated.</p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The extra Medicaid protections added during the pandemic aren’t all that’s being “unwound.” About <a href="https://www.cnbc.com/2023/09/12/more-than-70000-child-care-providers-may-close-as-federal-aid-ends.html">70,000 childcare providers</a> will also soon lose their <a href="https://www.whitehouse.gov/american-rescue-plan/" target="_blank">American Rescue Plan</a> funding, imperiling care for more than 3 million kids.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Then there’s the increased child tax credit payments that cut child poverty drastically between <a href="https://www.childrensdefense.org/wp-content/uploads/2020/12/Child-Poverty-in-America-2019-National-Factsheet.pdf">2019</a> (14.4%) and <a href="https://www.washingtonpost.com/dc-md-va/2023/09/12/us-poverty-rate-census-uninsured-2022/?">2021</a>(5.2%). That program ended in <a href="https://www.chn.org/voices/survey-the-end-of-expanded-child-tax-credit-payments-led-to-financial-stress-for-many/#:~:text=funding%20for%20LIHEAP.-,Survey%3A%20The%20end%20of%20expanded%20Child%20Tax%20Credit%20payments,to%20financial%20stress%20for%20many&text=When%20expanded%20Child%20Tax%20Credit,levels%20of%20financial%20stress%20increased.">December 2021</a>, and child poverty <a href="https://www.edweek.org/leadership/child-poverty-in-the-u-s-jumped-in-2022-as-pandemic-benefits-ended/2023/09#:~:text=As%20a%20result%2C%20the%20supplemental,said%20during%20a%20news%20conference.">leapt back</a> to 12.4%. <a href="https://www.washingtonpost.com/dc-md-va/2023/09/12/us-poverty-rate-census-uninsured-2022/?">Overall</a> 12.4% of all Americans were living in poverty in 2022, versus 7.8% in 2021. As the Washington Post Editorial Board <a href="https://www.washingtonpost.com/opinions/2023/09/12/best-vehicle-addressing-child-poverty-is-right-before-our-eyes/?">says</a>, it’s a damn shame <a href="https://www.nbcnews.com/politics/congress/build-back-better-demise-crushing-blow-child-tax-credit-payments-n1286286">Joe Manchin</a> and his Republican pals kept this great program from becoming permanent.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Shockingly, the Social Security Administration <a href="https://kffhealthnews.org/news/article/social-security-overpayments-congress-hearing/">has been dunning</a> disability pensioners for many thousands of dollars – contrary to stated SSA policy – because the COVID relief payments deposited in all Americans’ bank accounts pushed their assets over an eligibility threshold that hasn’t been adjusted for inflation in decades.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I know I sound like a broken record, but when will the US join the rest of the civilized world in providing health care to everybody? <a href="https://calmatters.org/commentary/2023/10/newsom-resurrect-single-payer-health-care/">California</a> is taking baby steps. Vermont tried and <a href="https://www.washingtonpost.com/national/health-science/why-vermonts-single-payer-effort-failed-and-what-democrats-can-learn-from-it/2019/04/29/c9789018-3ab8-11e9-a2cd-307b06d0257b_story.html">gave up</a>. <a href="applewebdata://C2A7A3E8-5E5C-4091-9E8F-892D86917791/Colorado,%20Nevada%20and%20Washington">Colorado, Nevada, and Washington</a> have at least passed a <a href="https://en.wikipedia.org/wiki/Public_health_insurance_option">public option</a>. A somewhat peculiar <a href="https://www.brookings.edu/wp-content/uploads/2023/10/20231026_THP_EinavFinkelstein_Proposal.pdf">proposal</a> for universal “basic” coverage has been <a href="https://www.nytimes.com/2023/07/18/opinion/universal-health-care.html">featured</a> in the New York Times. Even the American Medical Association, the doctors’ group that helped sink one health reform after another, <a href="https://www.washingtonpost.com/politics/2023/11/01/ama-may-reconsider-single-payer-health-care/">may be reconsidering</a> its objection to a single-payer system. And, marvelously, the American Academy of Pediatrics now <a href="https://publications.aap.org/pediatrics/article/doi/10.1542/peds.2023-064088/194465/Medicaid-and-the-Children-s-Health-Insurance?">recommends</a> automatically enrolling all U.S. infants at birth in public health coverage lasting until age 26. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://www.who.int/news/item/23-10-2023-seventy-countries-convene-to-step-up-primary-health-care">Two billion people</a> worldwide face severe financial hardship due to healthcare costs. Among high-income countries, Malta, the US, and particularly Switzerland have the <a href="https://www.comparethemarket.com.au/health-insurance/features/global-healthcare-costs/">highest out-of-pocket costs</a>. Even some countries with universal healthcare, such as Italy and the UK, have relatively high out-of-pocket averages due to <a href="https://www.lastampa.it/esteri/la-stampa-in-english/2019/06/14/news/one-in-three-italians-opt-for-private-health-care-1.36541011/">burgeoning privatization</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Long COVID<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_114" o:spid="_x0000_i1032" style="height: 289pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image005.jpg"></v:imagedata></v:shape><u></u></p><div class="separator" style="clear: both; text-align: center;"><u><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkO0YUV5xES8Bl7th61YV4gKLXdirpp32GtY2IQp76mCz9NaRneVFfUgB7xlN8BKMHOtcZEvRXo6Hp-XNM0lwUHMwLRUo0P3WTf56LdeUAP85CXqeNEYYaabbHVkmnbV8XKX0hf883nJhOD8_IwxR_IJpq3IJIwEAuNCfwbZ8263XmXwYSRGFYoRieZy8/s959/Long%20covid%20protest.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="610" data-original-width="959" height="256" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkO0YUV5xES8Bl7th61YV4gKLXdirpp32GtY2IQp76mCz9NaRneVFfUgB7xlN8BKMHOtcZEvRXo6Hp-XNM0lwUHMwLRUo0P3WTf56LdeUAP85CXqeNEYYaabbHVkmnbV8XKX0hf883nJhOD8_IwxR_IJpq3IJIwEAuNCfwbZ8263XmXwYSRGFYoRieZy8/w400-h256/Long%20covid%20protest.jpeg" width="400" /></a></u></div><u><br /><br /></u><o:p></o:p><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Paxlovid</u>: A major <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2802878">Veterans Administration study</a> found Paxlovid to substantially decrease the risk of developing long COVID. But since the VA patient population skews older and male many have doubted the same holds true more generally. Now a <a href="https://www.medpagetoday.com/meetingcoverage/idweek/106823?">study</a> reported at a “late-breaking abstract session” at a medical meeting – making it even more dubious than other conference presentations – suggests that adults over 50 are protected, but that teenagers who received the drug actually had <i>more</i> long-lasting symptoms. Remember, adolescents don’t often get COVID-19 in the first place, and <a href="https://aspe.hhs.gov/sites/default/files/documents/a19600d0dccfee0e9c595730d73fd66d/covid-antivirals-report.pdf">rarely</a> have preexisting conditions or immunosuppression severe enough to qualify for Paxlovid. I can’t access the abstract itself, much less a manuscript, so have no idea whether there’s any there there.</p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Serotonin</u>: A <a href="https://www.cell.com/cell/fulltext/S0092-8674%2823%2901034-6?">small study</a> claiming that low serotonin levels are at the root of long COVID made it into the <a href="https://www.nytimes.com/2023/10/16/health/long-covid-serotonin.html?">New York Times</a> in mid-October. If that were true, SSRI antidepressants should be extremely useful. One <a href="https://www.medtextpublications.com/open-access/long-covid-is-there-a-role-for-antidepressants-1249.pdf">review article</a> had lots of speculation but no evidence. Randomized trials are testing <a href="https://clinicaltrials.gov/study/NCT05874037">fluvoxamine</a> (Luvox) and <a href="https://classic.clinicaltrials.gov/ct2/show/NCT05047952">vortioxetine</a> (Trintellix, Brintellix); the latter trial has supposedly been completed, but I can’t locate any results. The only other <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9742030/">relevant research</a> I’ve found is a methodologically weak <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9905099/">Italian study</a> finding that vortioxetine can help treat depressive episodes that occur after COVID-19. Why shouldn’t it? Depression is depression.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Collateral damage<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_113" o:spid="_x0000_i1031" style="height: 302pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image006.jpg"></v:imagedata></v:shape></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBi5eH6xRWIjUSPqOPUVc1UqfDhq3QNkeIhxc3kjXcPK7nPkME2bAE5GGmRqmwPUc6elXzns1X0z276tVM4zqI3wRpmtxx2dzI9AwMBMJdvdjJ7CNKZIn0uXQqgdu3d9kPAZUW0Z0lp_kSkOyx32vifyqW8bY-aYcPFrtnAiKXOsVPuzXon34-sY8RUAw/s1254/Car-Robbery.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="837" data-original-width="1254" height="268" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBi5eH6xRWIjUSPqOPUVc1UqfDhq3QNkeIhxc3kjXcPK7nPkME2bAE5GGmRqmwPUc6elXzns1X0z276tVM4zqI3wRpmtxx2dzI9AwMBMJdvdjJ7CNKZIn0uXQqgdu3d9kPAZUW0Z0lp_kSkOyx32vifyqW8bY-aYcPFrtnAiKXOsVPuzXon34-sY8RUAw/w400-h268/Car-Robbery.jpg" width="400" /></a></div><br /><br /><o:p></o:p><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">A <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2810254">study</a> by Seattle-based researchers found that out-of-hospital cardiac arrests rose by 19% during the pandemic but treatment success fell. In 2018-2019 17.2% of patients survived with decent brain function, in 2020-2021 only 13.7%. The poor outcomes were related less to acute COVID-19 than to factors such as slower response to 911 calls and fewer bystander-witnessed events (see: lockdowns).</p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Pulmonary embolism may be another disease that is <a href="https://www.medpagetoday.com/meetingcoverage/chest/106700?">more deadly</a> in the presence of SARS-CoV-2 infection, with 19.8% of infected patients dying, versus only 7.1% of patients with PE alone. This is from a medical conference presentation, so the usual caveats apply.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">COVID-19 during pregnancy <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2309215?">might cause situs inversus</a>, where internal organs such as the heart are on the wrong side of the body, according to Chinese researchers who noted a fourfold jump in this rare condition during the unspeakable surge that infected an estimated 82% of China’s population after the zero-COVID policy was scrapped last December.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Pandemic recovery is one thing for the rich, another for the poor. In Manhattan, a poster child for income inequality, the richest fifth of households earned <a href="https://www.nytimes.com/2023/09/28/nyregion/nyc-income-gap-wages.html?">over 50 times</a> more in 2022 than the poorest fifth.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Murders in the US <a href="https://www.nytimes.com/2023/10/16/us/fbi-crime-data-murders.html?">fell by 6%</a> in <a href="https://www.fbi.gov/news/press-releases/fbi-releases-2022-crime-in-the-nation-statistics">2022</a>, but the huge surge in the first year of the pandemic left a lasting mark, with 25% more homicides in 2022 than in 2019. And the number of children shot to death <a href="https://www.nytimes.com/2023/10/16/us/fbi-crime-data-murders.html#:">increased by 12%</a>. Crimes against property have been soaring, with a million cars stolen in 2022 and that figure poised to <a href="https://www.washingtonpost.com/opinions/2023/10/30/carjacking-dc-crime-police-chase/?">double in 2023</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>State of the pandemic<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_139" o:spid="_x0000_i1030" style="height: 252pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image007.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaxZO53eRzbXmRCIQLCmZyZ-AAB-buvz-AMqVz0b7sdauqMcglB9MswJwBtfoGBv8SV2pRm2O-sMZIcJZvGZcnBMjoAD1bL7UA0H8bhwV3CtBHQYx9SOG1xHqeZRyMC8Z3sM9JMLyTBKEN8ntK6ofpdiXJ79_YGb1CjJo8Lhds0Rg_QFgNNrC1Dcjgk_U/s700/covid%20task%20force.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="390" data-original-width="700" height="224" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaxZO53eRzbXmRCIQLCmZyZ-AAB-buvz-AMqVz0b7sdauqMcglB9MswJwBtfoGBv8SV2pRm2O-sMZIcJZvGZcnBMjoAD1bL7UA0H8bhwV3CtBHQYx9SOG1xHqeZRyMC8Z3sM9JMLyTBKEN8ntK6ofpdiXJ79_YGb1CjJo8Lhds0Rg_QFgNNrC1Dcjgk_U/w400-h224/covid%20task%20force.jpg" width="400" /></a></div><br /><br /><o:p></o:p><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p>On <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-10-16..latest&facet=none&country=~ITA&pickerSort=desc&pickerMetric=total_cases&hideControls=true&Metric=Hospital+patients&Interval=7-day+rolling+average&Relative+to+Population=false&Color+by+test+positivity=false">July 22<sup>nd</sup> there were 728</a> COVID-19 patients in Italian hospitals, on October 27<sup>th</sup> <a href="https://lab24.ilsole24ore.com/coronavirus/">3,657</a>, more than 5 times as many. That’s lower than in previous surges, which hit 35,000, but here in Rome, at least, everybody knows someone who’s sick. There has been less of a peak in the United States, with hospitalizations <a href="https://covid.cdc.gov/covid-data-tracker/#hospitalizations">only tripling</a>, then <a href="https://ourworldindata.org/grapher/current-covid-hospitalizations-per-million?country=CAN~USA~ITA~NLD">trailing off</a>since mid-September. <a href="https://ourworldindata.org/grapher/current-covid-hospitalizations-per-million?country=CAN~USA~ITA~NLD">At last call</a> Sweden had about as many hospitalized patients per capita as the United States, Italy had 50% more, Canada more than double, England nearly double, Japan triple, and Holland fewer than half as many. Many Western European countries seem to have quit providing data <a href="https://ourworldindata.org/grapher/current-covid-hospitalizations-per-million?country=AUT~BEL~DNK~FRA~FIN~CHE~ESP~PRT">months ago</a>.</p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Johnsonthink<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_145" o:spid="_x0000_i1029" style="height: 300pt; visibility: visible; width: 198pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image008.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7HfEFfhc8ikHWi-_AYIpIHQDRHEYO1UVhU0iTo0UrRi2n-0k8ysQVJuPxSj0KETc4I5AwDyl1kXJQlhmY89TAgo3Z46brBRuu0ml5oCC-nndr4ut_EUHmtck6fAFo3ojMb0RFwN-r94p8JZ96t8cmhCNzt200aoiElXTPBpnqiO1IT99vidUIKhuUWUo/s600/Boris-Johnson-at-Shaftebu-001.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="600" data-original-width="397" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7HfEFfhc8ikHWi-_AYIpIHQDRHEYO1UVhU0iTo0UrRi2n-0k8ysQVJuPxSj0KETc4I5AwDyl1kXJQlhmY89TAgo3Z46brBRuu0ml5oCC-nndr4ut_EUHmtck6fAFo3ojMb0RFwN-r94p8JZ96t8cmhCNzt200aoiElXTPBpnqiO1IT99vidUIKhuUWUo/w266-h400/Boris-Johnson-at-Shaftebu-001.jpg" width="266" /></a></div><br /><br /><o:p></o:p><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I’ve already covered the part of the UK’s COVID-19 inquiry where the chief concern of the health ministry was said to be the adequate provision of <a href="https://www.bbc.com/news/health-66029325">body bags.</a></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">But the worst was yet to come. <a href="https://www.opendemocracy.net/en/boris-johnson-covid-natures-way-dealing-with-old-people-patrick-vallance-inquiry/">Now we hear</a> from the British government’s chief scientific advisor at the time that Boris Johnson, the Prime Minister at the height of the pandemic, was “obsessed with older people accepting their fate and letting the young get on with life and the economy going,” and that he believed, “Covid is just nature’s way of dealing with old people,” and “I think we should let the old people get it and protect others.” <a href="https://twitter.com/PaulBrandITV/status/1719323956560146746">One of his texts</a> begins: “I must say I have been slightly rocked by some of the data on covid fatalities. The median age is 82 – 81 for men 85 for women. That is above life expectancy. So get COVID and live longer.” Good God.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>COVID-19 miscellany<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_115" o:spid="_x0000_i1028" style="height: 213pt; visibility: visible; width: 320pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image009.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgspXD9L0OgUetesTa-E_m12M2FinjAfPG710-ePJm9WMUZtfgk73PFk68CSkcepxlseuIubXyXIwesJr5BC2IwDUwziZfs2I8DU3ZclNPkUBLBJjBGuyv659dPfT4_yHZqZwZwKYDiXYxwn4Ad9cvokmNGxv6oRzvHWLnjFnk545aYMVmz-prj13o9gKo/s640/microbiome%202+.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="427" data-original-width="640" height="214" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgspXD9L0OgUetesTa-E_m12M2FinjAfPG710-ePJm9WMUZtfgk73PFk68CSkcepxlseuIubXyXIwesJr5BC2IwDUwziZfs2I8DU3ZclNPkUBLBJjBGuyv659dPfT4_yHZqZwZwKYDiXYxwn4Ad9cvokmNGxv6oRzvHWLnjFnk545aYMVmz-prj13o9gKo/s320/microbiome%202+.jpeg" width="320" /></a></div><br /><br /><o:p></o:p><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Characteristics of the intestinal bacteria, specifically <a href="https://www.medpagetoday.com/meetingcoverage/chest/106716?">low microbiome diversity</a>, may be a risk factor for severe disease in people infected with SARS-CoV-2. Another conference presentation, to be taken with the usual grain of salt. The effect largely resulted from patients harboring Staphylococcus Aureus in their mouth and gut, a germ which if inhaled into the lungs can cause a particularly virulent pneumonia.</p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2787768#:">We've long said</a> that COVID-19 patients’ viral load, thus infectiousness, is highest on the day before and the day of symptom onset. This may have changed now, between Omicron and widespread immunity, with <a href="https://watermark.silverchair.com/ciad582.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAA9AwggPMBgkqhkiG9w0BBwagggO9MIIDuQIBADCCA7IGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMHY3-HoeFROXSOGNuAgEQgIIDgyQjzSJJ9BcdMVD2g58FMOGuehvCl4awINelo5cW-Ufa9zRH3b6l9SdBKzaobmCKNiTxD-g5ebrIub65vxyx6SITziEwswitkK6-DOO7Hrx67KkkZf7obLmW0xRk1hIKpJXiA4y2vzdHgVRa00o0pyOqYDQP9g-P2lFhBmy9S29Hv0gCj79paEwsebZl26gbLFt_5Iq1uXl-6b_p0tsvmLpAQ_ST7z_r948ag5BCX1ZncW0W2Dl_JWnwAEfFYrNYX89NP1PgvFFQTVpaZa7Zg71yMWk7TehxCtEkYyvflf53YUoz1oIefbwcTyWxd9S-RbPdnF_wuClEiobnv9wwyM2H9OTbkAavo0w6vzx-tiZ4c6RMRFpKYCM-kWJiQwEXMrEW7CeCBX2J9UpP1HPO_q8p6erzVnmsICCjioDGZuomopSKOshC5ppro88pTVxZ3I9fjPir7a6Od69QQeUhIECC7AZmlPNtqhI4pfhKJNriT-2MT59iL1Y52YHfGaIDv3jo_m8ODRxZijGMzPK_I45H2pHQhf6Cl_WF4wcSWBG2bgGDYLgSPNxisjehdHbluWgwKz0TVYEaHbtMzbQDU8qKuQenx2TocL8G_4QEFeVB41tIjzulTy12gJTgdstwIt68t9lQMMaelTsYqi7HKTdjiO66JmRJ7ocrY7buntXmYw9r2sirKlscIar_b9CtxkmUzTBvpiBMsAxVsqxE91yNmDNSaprt5LqFc5SF_lPdHtREPgviK7UGKcoHwozbhZ_M4Tkv-0sN-g6rGDvf2AlCHvzkTjtlUadSCQxQskmqXXR1xCbzpOLxecfn1pBp0owKYRsgge0K0eRQbb_YWP6RdW7EnVJZmZeRg1ZXFchu-He60Iu7E6G-LrWsSaH5FmZ9DnbUDgRR9mTxMW3SQUpGK9OlN4nSZ-CVFDoV2PbY_xGu7smITSHoV9MCuM1ZvdXrBWR__ObJknY0TaofH7xCmIN6aEMAB5MXrkyH3PKL9BhXUQM5YBdvqp8PEmC2bVJM8E3v4-d1s0Rhnbi4Rvg2taTgTkYZN6xB2v1TrbYgyhnJxwK5q9a6Ui9gIYMN3p9H1I4RG47A30PevhyFFU9TiQo35TZoB0nfqBYSTLTTVfifoIXa24gBEfSoK518yKHJIkOxf-hTkxyYPOH6nC0r97bSp38_BjOACoOZ1bEoxOvC">viral load peaking</a>about three days after symptoms begin. Two important implications: a negative antigen test early on is even less reliable than before, and you likely stay infectious longer.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">A <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2810939">research letter</a> in JAMA Pediatrics found the average duration of infectivity in children with Omicron to be three days after the first positive swab. Adults remain contagious <a href="https://www.nejm.org/doi/full/10.1056/nejmc2202092">somewhat longer</a>, for an average of five days. That means fully half of adults can infect others after five days have passed, contradicting <a href="https://www.cdc.gov/coronavirus/2019-ncov/your-health/isolation.html">CDC advice</a>; about <a href="https://www.nejm.org/doi/full/10.1056/nejmc2202092">one in four</a> patients is still infectious at eight days, and a few even longer. When I had COVID-19 myself a year ago, I remained antigen-swab positive, thus likely infectious, for two full weeks. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Emergencies<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_122" o:spid="_x0000_i1027" style="height: 264pt; visibility: visible; width: 352pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image010.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfEx_CyBZ1qccud-wBuxJSy_4LIcOQbS9IaPF0nvtWW2dvpEvMlZJcjOb2iWNO8COF0OjWSarRodx060W7dDP02Vri6vWyPZaolokfBL-4D1GM-w6cBY4nQlVX7kU144nWPlb95qhfZ6h-JI1Tsb7bsAwIdueGlDExOlcNNb79BIei2n534AXdilGyaKs/s567/Ambulanza.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="425" data-original-width="567" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfEx_CyBZ1qccud-wBuxJSy_4LIcOQbS9IaPF0nvtWW2dvpEvMlZJcjOb2iWNO8COF0OjWSarRodx060W7dDP02Vri6vWyPZaolokfBL-4D1GM-w6cBY4nQlVX7kU144nWPlb95qhfZ6h-JI1Tsb7bsAwIdueGlDExOlcNNb79BIei2n534AXdilGyaKs/s320/Ambulanza.jpg" width="320" /></a></div><br /><br /><o:p></o:p><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The head of Rome’s medical society has admitted that emergency calls to Italy’s 911 often <a href="http://direnl.dire.it/odm/anno/2023/settembre/05/?news=C01">don’t get answered</a> for 20 minutes, long waits for ambulances are the norm (few vehicles, scanty personnel), and that once an ambulance gets you to a hospital the Emergency Room is often so packed they won’t allow you into the waiting room. I thought emergency services were bad when I was finalizing <a href="https://www.amazon.com/Dottoressa-American-Doctor-Susan-Levenstein/dp/1589881397">my memoir</a> 6 years ago, but I see they’ve worsened with time.</p><p class="1obc" style="font-size: medium; margin-right: 6pt;">It’s not much better in the US. Living in notoriously inefficient Italy I’ve always imagined American ambulances arrived near-instantaneously, but in reality the average time nationwide before a 911 call is even answered is <a href="https://firefighternow.com/911-response-how-long-does-it-take/">seven minutes</a>. Another <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5831456/">nationwide study</a> says the time between when a 911 call is made and an ambulance shows up averages seven minutes in cities, eight in suburbs, and 14.5 in rural areas. Should that be <i>added</i> to the abovementioned seven minutes?<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>All the way with RFK<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_100" o:spid="_x0000_i1026" style="height: 233pt; visibility: visible; width: 320pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image011.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifMUDgcRIpySi8JDtfzOevxS-QJVv6HGZgsBJIpipKeQ5HZLwwzuZ_xEJgBEX7MsEGtFkpfg1CWNGxe6OvzSFpcE29m167AQEl2skqx4nluuwwumhNFK-5e0r1TuxkxO9BxiareXNS1NV1oZa-d_pKemTIjVjK0FSQRJ4KC_fGWzYn7fzGhRhLIGbDNGI/s640/rfk_versus_rfk_jr_.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="467" data-original-width="640" height="293" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifMUDgcRIpySi8JDtfzOevxS-QJVv6HGZgsBJIpipKeQ5HZLwwzuZ_xEJgBEX7MsEGtFkpfg1CWNGxe6OvzSFpcE29m167AQEl2skqx4nluuwwumhNFK-5e0r1TuxkxO9BxiareXNS1NV1oZa-d_pKemTIjVjK0FSQRJ4KC_fGWzYn7fzGhRhLIGbDNGI/w400-h293/rfk_versus_rfk_jr_.jpeg" width="400" /></a></div><br /><br /><o:p></o:p><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Robert Francis Kennedy, Jr.’s novaxx conspiracy theories have been <a href="https://www.nytimes.com/2023/07/15/us/politics/rfk-jr-covid-remarks.html?">drifting into antisemitism</a>. The <a href="https://nypost.com/2023/07/15/rfk-jr-says-covid-was-ethnically-targeted-to-spare-jews/">New York Post</a>obtained this from a private gathering: “Covid-19 is targeted to attack Caucasians and Black people. The people who are most immune are Ashkenazi Jews and Chinese.” For Jews, actually, <a href="https://jech.bmj.com/content/75/6/509">the opposite is true</a>. Apparently <a href="https://www.washingtonpost.com/politics/2023/07/17/rfk-covid-democrats/?">at the same gathering</a> he said the United States had “put hundreds of millions of dollars into ethnically targeted microbes,” which is what “those labs in the Ukraine are about: they’re collecting Russian DNA. They’re collecting Chinese DNA so we can target people by race.”</p><p class="1obc" style="font-size: medium; margin-right: 6pt;">He’s not alone. An Oxford University study early on found nearly <a href="https://www.timesofisrael.com/one-in-five-brits-believe-anti-semitic-virus-conspiracies-survey/" target="_blank">one in five Brits</a> believed, at least to some extent, that Jews created the coronavirus pandemic for financial gain. In the meantime, <a href="https://www.washingtonpost.com/technology/2023/09/14/biden-scotus-social-media-5th-circuit/">legal attacks</a> on the US government’s ability to combat health disinformation, and even on the <a href="https://www.washingtonpost.com/technology/2023/09/23/online-misinformation-jim-jordan/?">right of researchers</a> to study it, have been making shocking headway.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Comic relief<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRcxxRdTFD69_IExoTLlVrwd2l7x5tNKgOKK-wY-XRQRGiXxjJoyPTXsJYJLX_Ach6l1I71uhhIpoYYl4dZgJbAA2o7nRLdW_orWVST6IS3zXW6LwjSO00ZUFnvTxEbBrMwplh07vao71p1cK7X5LBnvpEJK6ztUeDOzhTLLihVAp6eifa4C64ezdSIqI/s1604/Crow%20and%20Thomas.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="792" data-original-width="1604" height="318" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRcxxRdTFD69_IExoTLlVrwd2l7x5tNKgOKK-wY-XRQRGiXxjJoyPTXsJYJLX_Ach6l1I71uhhIpoYYl4dZgJbAA2o7nRLdW_orWVST6IS3zXW6LwjSO00ZUFnvTxEbBrMwplh07vao71p1cK7X5LBnvpEJK6ztUeDOzhTLLihVAp6eifa4C64ezdSIqI/w640-h318/Crow%20and%20Thomas.JPG" width="640" /></a></div><b><br /></b><p></p><p class="1obc" style="font-size: medium;"><v:shape id="Picture_x0020_147" o:spid="_x0000_i1025" style="height: 224pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image012.jpg"></v:imagedata></v:shape><o:p></o:p></p><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://twitter.com/vigilantfox/status/1668337058027544582?s=43">“The COVID-19 Shots Are Turning Out to Be More of a Time Bomb Than Ever Imagined”</a></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://twitter.com/robinmonotti/status/1712760446388736453">C19 Vaccine-Induced “Turbo Cancers” May Be Treatable With Melatonin</a><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://www.theepochtimes.com/epochtv/your-next-salad-could-vaccinate-you-5503334">Your Next Salad Could Vaccinate You</a><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://twitter.com/VigilantFox/status/1711020283212005629">The Pfizer COVID-19 “vaccine” injected into billions of arms was not the same one used in Pfizer’s clinical trials. There was a “bait-and-switch.”</a><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://twitter.com/Acyn/status/1710777385153368153?">Donald Trump on the fictitious cannibal Hannibal Lecter</a>: You know why I like him? Because he said on television “I love Donald Trump” so I love him.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://twitter.com/robinmonotti/status/1711972307151868015">World Council For Health expert panel finds cancer promoting DNA contamination in COVID-19 vaccines</a> – the impressively-named World Council For Health <a href="https://en.wikipedia.org/wiki/World_Council_for_Health">is actually</a> “a pseudo-medical organisation dedicated to spreading misinformation.”<o:p></o:p></p></div></td></tr></tbody></table><p><br /></p>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com2tag:blogger.com,1999:blog-6211405954943098401.post-42412346499637927172023-10-01T21:09:00.000+02:002023-10-01T21:09:19.635+02:00Missing Americans<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxWXQulDCLLezA-HVln6vdrsMm1TIh2yeWVu-jsNNxlHtwzmlV3dINcjaA97lfM7gqwHOWd9SYTScUTgpx2h3o9FhemxgPi8oqlSFcdAdbqtEbXASz75h3ivdcte_uPdicpBOxCQY-OeBOkJFlJP__ahkqch3vfKC4mEgOTsfB9APEJfj36hHhqKG14gM/s654/missing%20americans%209++.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="654" data-original-width="420" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxWXQulDCLLezA-HVln6vdrsMm1TIh2yeWVu-jsNNxlHtwzmlV3dINcjaA97lfM7gqwHOWd9SYTScUTgpx2h3o9FhemxgPi8oqlSFcdAdbqtEbXASz75h3ivdcte_uPdicpBOxCQY-OeBOkJFlJP__ahkqch3vfKC4mEgOTsfB9APEJfj36hHhqKG14gM/s320/missing%20americans%209++.jpg" width="206" /></a></div><style class="WebKit-mso-list-quirks-style">
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mso-style-parent:"";
margin:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.MsoListParagraph, li.MsoListParagraph, div.MsoListParagraph
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;}
p.MsoListParagraphCxSpFirst, li.MsoListParagraphCxSpFirst, div.MsoListParagraphCxSpFirst
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;}
p.MsoListParagraphCxSpMiddle, li.MsoListParagraphCxSpMiddle, div.MsoListParagraphCxSpMiddle
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;}
p.MsoListParagraphCxSpLast, li.MsoListParagraphCxSpLast, div.MsoListParagraphCxSpLast
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;}
span.Heading1Char
{mso-style-name:"Heading 1 Char";
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 1";
mso-ansi-font-size:14.0pt;
mso-bidi-font-size:16.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Arial;
mso-bidi-font-family:"Times New Roman";
mso-font-kerning:16.0pt;
font-weight:bold;
mso-bidi-font-weight:normal;}
span.Heading2Char
{mso-style-name:"Heading 2 Char";
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 2";
mso-ansi-font-size:13.0pt;
mso-bidi-font-size:13.0pt;
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Yu Gothic Light";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;}
span.Heading3Char
{mso-style-name:"Heading 3 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 3";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Yu Gothic Light";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#4472C4;
mso-themecolor:accent1;
font-weight:bold;}
span.Heading4Char
{mso-style-name:"Heading 4 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 4";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Yu Gothic Light";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;
font-style:italic;}
span.Heading5Char
{mso-style-name:"Heading 5 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 5";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Yu Gothic Light";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;}
span.Heading6Char
{mso-style-name:"Heading 6 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 6";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Yu Gothic Light";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#1F3763;
mso-themecolor:accent1;
mso-themeshade:127;}
p.text, li.text, div.text
{mso-style-name:text;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Plain Text";
margin-top:0in;
margin-right:0in;
margin-bottom:10.0pt;
margin-left:0in;
line-height:150%;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
span.PlainTextChar
{mso-style-name:"Plain Text Char";
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Plain Text";
mso-ansi-font-size:10.5pt;
mso-bidi-font-size:10.5pt;
font-family:Courier;
mso-ascii-font-family:Courier;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Courier;
mso-bidi-font-family:"Times New Roman";}
p.Heading, li.Heading, div.Heading
{mso-style-name:Heading;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Heading 1";
margin-top:12.0pt;
margin-right:0in;
margin-bottom:12.0pt;
margin-left:0in;
mso-pagination:widow-orphan;
page-break-after:avoid;
mso-outline-level:1;
font-size:12.0pt;
font-family:"Arial",sans-serif;
mso-fareast-font-family:"MS Mincho";
mso-bidi-font-family:"Times New Roman";
mso-font-kerning:16.0pt;
font-weight:bold;
mso-bidi-font-weight:normal;}
p.quotes, li.quotes, div.quotes
{mso-style-name:quotes;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Plain Text";
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
span.BalloonTextChar
{mso-style-name:"Balloon Text Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Balloon Text";
mso-ansi-font-size:9.0pt;
mso-bidi-font-size:9.0pt;
font-family:"Lucida Grande",sans-serif;
mso-ascii-font-family:"Lucida Grande";
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:"Lucida Grande";
mso-bidi-font-family:"Lucida Grande";}
p.quotesheadline, li.quotesheadline, div.quotesheadline
{mso-style-name:"quotes headline";
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:quotes;
mso-style-next:quotes;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Arial",sans-serif;
mso-fareast-font-family:"MS Mincho";
font-weight:bold;
mso-bidi-font-weight:normal;}
span.exldetailsdisplayval
{mso-style-name:exldetailsdisplayval;
mso-style-unhide:no;}
span.CommentTextChar
{mso-style-name:"Comment Text Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Comment Text";
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.UnresolvedMention1
{mso-style-name:"Unresolved Mention1";
mso-style-noshow:yes;
mso-style-priority:99;
color:#605E5C;
background:#E1DFDD;}
span.apple-converted-space
{mso-style-name:apple-converted-space;
mso-style-unhide:no;}
p.css-exrw3m, li.css-exrw3m, div.css-exrw3m
{mso-style-name:css-exrw3m;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.3m6-
{mso-style-name:_3m6-;
mso-style-unhide:no;}
span.3l3x
{mso-style-name:_3l3x;
mso-style-unhide:no;}
span.1lh7
{mso-style-name:_1lh7;
mso-style-unhide:no;}
span.1lld
{mso-style-name:_1lld;
mso-style-unhide:no;}
p.6coj, li.6coj, div.6coj
{mso-style-name:_6coj;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.6cok
{mso-style-name:_6cok;
mso-style-unhide:no;}
span.timestampcontent
{mso-style-name:timestampcontent;
mso-style-unhide:no;}
span.mbtext
{mso-style-name:mb_text;
mso-style-unhide:no;}
span.HeaderChar
{mso-style-name:"Header Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Header;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.FooterChar
{mso-style-name:"Footer Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Footer;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.5uzb
{mso-style-name:_5uzb;
mso-style-unhide:no;}
span.accessibleelem
{mso-style-name:accessible_elem;
mso-style-unhide:no;}
span.z-TopofFormChar
{mso-style-name:"z-Top of Form Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"z-Top of Form";
mso-ansi-font-size:8.0pt;
mso-bidi-font-size:8.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:Arial;
mso-bidi-font-family:Arial;
display:none;
mso-hide:all;}
p.1obc, li.1obc, div.1obc
{mso-style-name:_1obc;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.z-BottomofFormChar
{mso-style-name:"z-Bottom of Form Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"z-Bottom of Form";
mso-ansi-font-size:8.0pt;
mso-bidi-font-size:8.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:Arial;
mso-bidi-font-family:Arial;
display:none;
mso-hide:all;}
p.css-axufdj, li.css-axufdj, div.css-axufdj
{mso-style-name:css-axufdj;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.style-scope
{mso-style-name:style-scope;
mso-style-unhide:no;}
p.generic-articlesummary--li, li.generic-articlesummary--li, div.generic-articlesummary--li
{mso-style-name:generic-article__summary--li;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.diamond-blt, li.diamond-blt, div.diamond-blt
{mso-style-name:diamond-blt;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.font-copy, li.font-copy, div.font-copy
{mso-style-name:font-copy;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.dogb1923
{mso-style-name:dogb1923;
mso-style-unhide:no;}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:"Calibri",sans-serif;
mso-ascii-font-family:Calibri;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:Calibri;
mso-fareast-theme-font:minor-latin;
mso-hansi-font-family:Calibri;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;
mso-header-margin:.5in;
mso-footer-margin:.5in;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
/* List Definitions */
@list l0
{mso-list-id:-119;
mso-list-type:simple;
mso-list-template-ids:-1888465356;}
@list l0:level1
{mso-level-number-format:bullet;
mso-level-style-link:"List Bullet";
mso-level-text:;
mso-level-tab-stop:.25in;
mso-level-number-position:left;
margin-left:.25in;
text-indent:-.25in;
font-family:Symbol;}
@list l1
{mso-list-id:125974259;
mso-list-template-ids:-1612801510;}
@list l1:level1
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l1:level2
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:1.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:"Courier New";
mso-bidi-font-family:"Times New Roman";}
@list l1:level3
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:1.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level4
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:2.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level5
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:2.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level6
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:3.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level7
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:3.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level8
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:4.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level9
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:4.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l2
{mso-list-id:150560276;
mso-list-template-ids:-944067816;}
@list l2:level1
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level2
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:1.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level3
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:1.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level4
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:2.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level5
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:2.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level6
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:3.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level7
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:3.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level8
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:4.0in;
mso-level-number-position:left;
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</style><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Pills good and not-so-good, boosters hot off the presses, mask debates, variant watch, long COVID, First Family snafus, pandemic upticks, collateral damage, disastrous summings-up, human challenge studies, Africa, and an array of nonsense. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Treatment<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f"><v:stroke joinstyle="miter"><v:formulas><v:f eqn="if lineDrawn pixelLineWidth 0"><v:f eqn="sum @0 1 0"><v:f eqn="sum 0 0 @1"><v:f eqn="prod @2 1 2"><v:f eqn="prod @3 21600 pixelWidth"><v:f eqn="prod @3 21600 pixelHeight"><v:f eqn="sum @0 0 1"><v:f eqn="prod @6 1 2"><v:f eqn="prod @7 21600 pixelWidth"><v:f eqn="sum @8 21600 0"><v:f eqn="prod @7 21600 pixelHeight"><v:f eqn="sum @10 21600 0"></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:formulas><v:path gradientshapeok="t" o:connecttype="rect" o:extrusionok="f"><o:lock aspectratio="t" v:ext="edit"></o:lock></v:path></v:stroke></v:shapetype><v:shape id="Picture_x0020_132" o:spid="_x0000_i1036" style="height: 247pt; visibility: visible; width: 247pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image001.gif"></v:imagedata></v:shape><u><o:p></o:p></u></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5h-hVB0c_bZBB-tCXxuZXsf-g-1D2ctSwdNsVMKydcYDjevnquFDt7SMiPXsX3Ba6my1WHJxchgyZSDHnEJcYCDB4DUND3DHIDyBlinIQAHWmBJw83ZqYa621y8VaUZ-LOCEEMI9Ibc1gSYshD4semj2P_vtu3iyrK6ExcQxOVPL-7B897T_7YQ-VjNw/s600/VV116.gif" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="600" data-original-width="600" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5h-hVB0c_bZBB-tCXxuZXsf-g-1D2ctSwdNsVMKydcYDjevnquFDt7SMiPXsX3Ba6my1WHJxchgyZSDHnEJcYCDB4DUND3DHIDyBlinIQAHWmBJw83ZqYa621y8VaUZ-LOCEEMI9Ibc1gSYshD4semj2P_vtu3iyrK6ExcQxOVPL-7B897T_7YQ-VjNw/w200-h200/VV116.gif" width="200" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">The chemical structure of VV116</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>VV116</u>: Several <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2305030?">letters</a> to the New England Journal of Medicine have raised serious issues with the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2208822?query=TOC">study</a> claiming this experimental Chinese drug, an oral form of remdesivir, works just as well as Paxlovid. Their critiques have considerably dampened my initial enthusiasm.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Paxlovid</u>: Outcomes improve in vaccinated people over 50 years old, but what about younger folks? A <a href="https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciad400/7210778?redirectedFrom=fulltext&login=false">new study</a>, though with some <a href="https://www.medpagetoday.com/infectiousdisease/covid19/105359?">methodological limitations</a>, says it can benefit vaccinated adults under 50 with preexisting cancer or heart disease, but not those with asthma or chronic obstructive pulmonary disease.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Molnupiravir</u>: Merck’s oral antiviral has unfortunately resurfaced. An <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809779?">observational study</a> from the Cleveland Clinic, in the Omicron era, published in the pay-to-publish <a href="https://en.wikipedia.org/wiki/JAMA_Network_Open">JAMA Network Open</a>, claims that molnupiravir is as good as Paxlovid at preventing hospitalizations and deaths due to COVID-19. This contradicts the best <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02597-1/fulltext">previous research</a> and <a href="https://academic.oup.com/jac/article/78/7/1586/7160636">literature reviews</a> finding the drug so ineffective that <a href="https://www.dailyhealthindustry.it/covid-19-aifa-sospende-lantivirale-molnupiravir-no-problemi-di-sicurezza-ma-mancanza-benefici-ID27400.html">Italy</a> stopped using it and Merck <a href="https://www.merck.com/news/merck-and-ridgeback-provide-update-on-eu-marketing-authorization-application-for-lagevrio-molnupiravir-2/">withdrew its application</a> for full EU approval in the face of <a href="https://twitter.com/CharmsYahoo/status/1652162076360736770/photo/1">deauthorization</a>. We <a href="https://www.nejm.org/doi/suppl/10.1056/NEJMoa2116044/suppl_file/nejmoa2116044_appendix.pdf">already knew</a> it <a href="https://www.nejm.org/doi/suppl/10.1056/NEJMoa2116044/suppl_file/nejmoa2116044_appendix.pdf">didn't combat Delta</a> and didn’t <a href="https://www.businesswire.com/news/home/20230221005404/en/Merck-Provides-Update-on-Phase-3-MOVe-AHEAD-Trial-Evaluating-LAGEVRIO%E2%84%A2-molnupiravir-for-Post-exposure-Prophylaxis-for-Prevention-of-COVID-19?utm_campaign=wp_to_your_health&utm_medium=email&utm_source=newsletter&wpisrc=nl_tyh">reduce household transmission</a>. Plus <a href="https://www.fda.gov/media/154421/download">even more important issues</a>: <a href="https://www.ema.europa.eu/en/documents/referral/lagevrio-also-known-molnupiravir-mk-4482-covid-19-article-53-procedure-conditions-use-conditions_en.pdf">teratogenicity</a>, possible <a href="https://www.fda.gov/science-research/advancing-regulatory-science/investigation-potential-mutagenicity-molnupiravir-covid-19-patients">mutagenicity</a>, and especially the potential to prolong <a href="https://www.nature.com/articles/s41586-023-06649-6">infection duration</a>, <a href="https://www.medrxiv.org/content/10.1101/2022.12.21.22283811v1">induce mutations</a> transmissible <a href="https://www.nature.com/articles/s41586-023-06649-6">to other people</a>, and breed <a href="https://www.newsweek.com/covid-drugs-creating-super-virus-scientists-1829175">new variants</a>, leading some experts to demand its authorization be <a href="https://twitter.com/LongDesertTrain/status/1597353291868155906">revoked world-wide</a>. The Cleveland Clinic article doesn’t discuss the impact on its results of <a href="https://www.covid19treatmentguidelines.nih.gov/therapies/antivirals-including-antibody-products/summary-recommendations/#:~:text=Antiviral%20Agents%2C%20Including%20Antibody%20Products&text=Remdesivir%20and%20ritonavir%2Dboosted%20nirmatrelvir,the%20treatment%20of%20COVID%2D19.">NIH recommendations</a> that molnupiravir be used only when the more effective and less iffy drugs Paxlovid and remdesivir cannot be.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Vaccines<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_107" o:spid="_x0000_i1035" style="height: 255pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image002.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja1aqdJi4tDkzY-WT0T5uAXCYy9nXYqqyPIPhGwoYsAMfNpC99meNILWmhRrgu162YgXr5GVsNoliALHqtZRFAGXT2yenrBjJz8hw-X9Gt-dVaqwATMkUQzhifyCTb82zYALAlHkOvUJ-EZLoEFV0G5-FrTbMuGQN3yr1FMNdTONuYEoGKIcGaSGsfp4Q/s1240/charged%20for%20vaccine.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="698" data-original-width="1240" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja1aqdJi4tDkzY-WT0T5uAXCYy9nXYqqyPIPhGwoYsAMfNpC99meNILWmhRrgu162YgXr5GVsNoliALHqtZRFAGXT2yenrBjJz8hw-X9Gt-dVaqwATMkUQzhifyCTb82zYALAlHkOvUJ-EZLoEFV0G5-FrTbMuGQN3yr1FMNdTONuYEoGKIcGaSGsfp4Q/w400-h225/charged%20for%20vaccine.jpg" width="400" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The <a href="https://www.nytimes.com/2023/09/11/health/covid-vaccine-boosters-fda-pfizer-moderna.html?">FDA</a> and the <a href="https://www.pei.de/EN/newsroom/hp-news/2023/230919-omicron-vaccines-adapted.html">EU</a> have given full approval to XBB.1.5 boosters from <a href="https://www.ema.europa.eu/en/news/spikevax-ema-recommends-approval-adapted-covid-19-vaccine-targeting-omicron-xbb15">Moderna</a> and <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/eu-regulator-backs-authorizing-pfizers-vaccine-coronavirus-variant-xbb15-2023-08-30/">Pfizer</a> even though the latter has <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-09-12/11-COVID-Wallace-508.pdf">never been tested in people</a>. Contrary to expectation, the CDC recommends them <a href="https://www.cdc.gov/media/releases/2023/p0912-COVID-19-Vaccine.html">not only to the elderly</a> and the medically fragile, but to <a href="https://www.fda.gov/news-events/press-announcements/fda-takes-action-updated-mrna-covid-19-vaccines-better-protect-against-currently-circulating">all Americans</a> older than 6 months. Medicare and Medicaid are supposed to provide vaccines gratis, but see the above picture from a Medicaid recipient who had an appointment at CVS. The federal government is paying <a href="https://www.statnews.com/2023/09/28/covid-vaccines-higher-price/">three times as much</a> per dose than they did a year ago – $81.61 for Moderna and $85.10 for Pfizer – and private insurers even more. Compare that with <a href="https://www.statnews.com/2023/09/28/covid-vaccines-higher-price/">about $26</a> in Europe, on which the drug companies are presumably still making a profit. Those companies are supposed to provide doses gratis to uninsured Americans through a temporary <a href="https://www.cdc.gov/vaccines/programs/bridge/index.html">Bridge Access Program</a>. Articles in the <a href="https://www.washingtonpost.com/politics/2023/09/22/it-may-not-be-easy-get-latest-covid-vaccine/">Washington Post</a> and the <a href="https://www.nytimes.com/2023/09/22/well/covid-vaccine-booster-insurance.html?">New York Times</a> try to sort out the many glitches. The underlying problem is that in the US vaccines are now considered a commercial product rather than a public good. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The public <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-booster-percent-pop5">largely boycotted</a> last year’s bivalent boosters. Everyone over 60 or with chronic medical conditions should go for the new version, but despite FDA/CDC recommendations, I’m not convinced healthy young people need it. I advise choosing Moderna, which has been shown to induce antibodies in human beings. Pfizer tested its new vaccine only in mice, and <a href="https://ir.novavax.com/press-releases/2023-08-22-Novavaxs-Updated-Protein-based-XBB-COVID-Vaccine-Induced-Neutralizing-Responses-Against-Emerging-Subvariants%2C-Including-EG-5-1-and-XBB-1-16-6">Novavax</a>, whose booster is still under review, only in monkeys – see slide 34 of the <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-09-12/11-COVID-Wallace-508.pdf">CDC presentation</a>. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Updated boosters hit American pharmacies in <a href="https://www.axios.com/2023/09/15/cdc-covid-vaccine-booster-insurance-appointments">mid-September</a>, and in <a href="http://direnl.dire.it/odm/anno/2023/settembre/15/?news=N01">early October</a> should reach Italy, where they are recommended for people over 60 or medically fragile but will be provided on request – free of charge of course – to anyone over six months old.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">World Health Organization vaccine experts <a href="https://www.usnews.com/news/health-news/articles/2023-03-28/who-vaccine-advisory-group-endorses-covid-19-booster-shots-every-6-months-for-some">now recommend</a> that <i>some</i> older and medically vulnerable people get COVID-19 boosters <a href="https://www.who.int/news/item/28-03-2023-sage-updates-covid-19-vaccination-guidance">every six months</a>. This makes sense for these high-risk populations, since it’s about how long protection lasts. I hope the US will take that advice rather than sticking with a one-size-fits-all, once-a-year-with-the-flu-shot policy.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">An interesting study found that a vaccine mandate on a university campus <a href="https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1011596">lowered SARS-CoV-2 viral levels</a> in the entire surrounding community.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">For <a href="https://www.nature.com/articles/s41577-021-00583-2">years</a> people have been fantasizing about nasal spray vaccines. Some <a href="https://www.theguardian.com/commentisfree/2022/may/16/covid-19-pandemic-exit-roadmap?">COVID-19 experts</a> and <a href="https://www.nytimes.com/2022/06/13/opinion/covid-immunity.html?">immunologists</a> think they’d be <a href="https://www.theguardian.com/commentisfree/2022/may/16/covid-19-pandemic-exit-roadmap?">more effective</a>, and they’re a stated goal of <a href="https://www.washingtonpost.com/health/2023/04/10/operation-warp-speed-successor-project-nextgen/?">Project Next Gen</a>. Dartmouth researchers may have recently <a href="https://www.healthcarefinancenews.com/news/first-covid-19-nasal-spray-vaccine-being-developed-dartmouth-health-nih-and-exothera">come up with one</a>, though clinical trials are still only in the planning stage.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">And Ron DeSanctimonious is <a href="https://www.washingtonpost.com/politics/2023/09/16/desantis-booster-shots-covid-trump/">back on the warpath</a>: “I will not stand by and let the FDA and CDC use healthy Floridians as guinea pigs for new booster shots that have not been proven to be safe or effective.” His sidekick Joseph Ladapo <a href="https://floridahealthcovid19.gov/wp-content/uploads/2023/09/20230913-booster-guidance-final.pdf">decreed</a> that nobody under 65 should receive the new booster, <a href="https://www.politico.com/news/2023/09/21/desantis-delivered-covid-booster-warning-as-florida-led-the-nation-in-hospitalizations-00117284?utm_campaign=wp_the_health_202&utm_medium=email&utm_source=newsletter&wpisrc=nl_health202">whatever their health status</a>, and that even the elderly discuss “potential concerns” with their doctor rather than just making appointments for the jab. Ladapo instead urges people to eat their veggies and take the sun – while spewing <a href="https://www.nebraskamed.com/COVID/where-mrna-vaccines-and-spike-proteins-go">nonsense</a> about high levels of spike protein from vaccines persisting in the body “for an indefinite period of time, which may carry health risks.” Some Florida Republicans go even farther, calling vaccines <a href="https://www.facebook.com/reel/247344331626330">biological weapons</a>! Florida, alas, currently leads the nation in <a href="https://www.washingtonpost.com/politics/2023/09/14/florida-covid-vaccine-desantis-ladapo/">COVID-19 hospitalizations</a>. And Floridians’ uptake of the previous bivalent booster was <a href="https://wusfnews.wusf.usf.edu/health-news-florida/2022-11-21/florida-has-one-of-the-worst-updated-covid-19-booster-rates-in-the-country">particularly low</a>, despite its having one of the nation’s <a href="https://www.prb.org/resources/which-us-states-are-the-oldest/#:">highest proportions</a> of elderly residents.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Prevention and protection<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixzhtk37ucw59WENiTMsXGu_u_QjKs0HmVQb1zOgLMmUPgRKRBg3eSCpTDru8QWE5J5B5VFuxYWq_E91rqIWHVNMnD0k-m0nF2o43ppofWB6fB2SZuG9AR84MXPx07lmXzG7shqw_uJp8UFhJ5ULwCXcLa5xvOJo1O6SnQ-jBxCouEJ8jmsPS4aDNkWT4/s720/Surgical_Masks_vs._NIOSH_Approved_N95_Respirators.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="328" data-original-width="720" height="183" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixzhtk37ucw59WENiTMsXGu_u_QjKs0HmVQb1zOgLMmUPgRKRBg3eSCpTDru8QWE5J5B5VFuxYWq_E91rqIWHVNMnD0k-m0nF2o43ppofWB6fB2SZuG9AR84MXPx07lmXzG7shqw_uJp8UFhJ5ULwCXcLa5xvOJo1O6SnQ-jBxCouEJ8jmsPS4aDNkWT4/w400-h183/Surgical_Masks_vs._NIOSH_Approved_N95_Respirators.jpg" width="400" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_143" o:spid="_x0000_i1034" style="height: 206pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image003.jpg"></v:imagedata></v:shape>A <a href="https://pubmed.ncbi.nlm.nih.gov/36715243/">January Cochrane review,</a> later <a href="https://www.nytimes.com/2023/03/10/opinion/masks-work-cochrane-study.html">retracted</a> in part, has been widely cited by <a href="https://www.foxnews.com/media/twitter-divided-after-new-york-times-column-concedes-mask-mandates-did-nothing-conservative-a-hat">Fox “News”</a> and <a href="https://twitter.com/kanekoathegreat/status/1698166986520633788?s=43">others</a> as proving that facemasks don’t prevent the spread of COVID-19. I’ve mentioned the Cochrane group’s misplaced fetishization of randomized controlled trials as the be-all and the end-all of scientific evidence. They found only six such trials during the pandemic, and here’s what they say: “The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions.” <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">There is actually ample evidence of the efficacy of masking: <a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1313/5900759?searchresult=1">studies in Maryland</a>, <a href="https://news.vumc.org/2020/08/10/new-analysis-finds-association-between-masking-requirements-and-slower-growth-in-covid-19-hospitalizations/">Tennessee</a>, <a href="https://www.pnas.org/content/early/2020/12/02/2015954117">Germany</a>, <a href="https://www.poverty-action.org/sites/default/files/publications/Mask_RCT____Symptomatic_Seropositivity_083121.pdf">Bangladesh</a>, and <a href="https://www.nejm.org/doi/10.1056/NEJMoa2211029">Massachusetts</a>, a <a href="https://www.bmj.com/content/375/bmj-2021-068302">review and meta-analysis</a> in the BMJ, a <a href="https://www.ajpmonline.org/article/S0749-3797(21)00557-2/fulltext">comparison</a> of countries with and without mask mandates, a <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7106e1.htm?">case-control study</a> by the CDC, and most impressively an <a href="https://www.acpjournals.org/doi/full/10.7326/M22-1966">international trial</a> whose Canadian results are particularly convincing. Check out commentary by <a href="https://sciencebasedmedicine.org/the-cochrane-mask-fiasco-how-the-evidence-based-medicine-paradigm-can-produce-misleading-results/">David Gorski</a>, <a href="https://www.nytimes.com/2023/03/10/opinion/masks-work-cochrane-study.html">Zeynep Tufekci</a>, and <a href="https://www.factcheck.org/2023/03/scicheck-what-the-cochrane-review-says-about-masks-for-covid-19-and-what-it-doesnt/">others</a> on the flaws of the Cochrane study and the dubious history of its chief author, Tom Jefferson.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">A <a href="https://www.healthwatchusa.org/HWUSA-Presentations-Community/PDF-Downloads/20230608-CDC-IP_Workgroup_HICPAC-FINAL.pdf">CDC draft proposal</a> equating surgical masks with N95 respirators and KN95 masks for protecting against COVID-19 has drawn justified backlash from <a href="https://www.nbcnews.com/health/health-news/expected-cdc-guidance-n95-masks-outrages-health-care-workers-rcna104854">healthcare workers</a> and <a href="https://www.forbes.com/sites/judystone/2023/08/25/public-pushes-back-on-cdcs-plan-to-weaken-infection-control/">the public</a>, and a <a href="https://www.nationalnursesunited.org/sites/default/files/nnu/documents/0723_HICPAC_experts_letter_background_combined_FINAL.pdf">letter of protest</a> from several hundred experts in relevant fields.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Then there are the University of Liverpool researchers who claim to have found a <a href="https://scitechdaily.com/coronavirus-capture-breakthrough-the-material-revolutionizing-face-mask-efficiency/">new miracle facemask material</a>, still at the “proof of concept stage.” B.S.? <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Remember Regeneron, the company that made the first effective monoclonal antibody treatment? It’s begun working on an <a href="https://investor.regeneron.com/news-releases/news-release-details/regeneron-announces-agreement-barda-supporting-development-next">updated</a> product for immunosuppressed individuals, as an alternative to vaccines.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I mentioned in my June post that a year-old preprint saying the gene HLA-B*15:01 might protect people from getting sick if they’re infected with SARS-CoV-2 had not yet been published, saying I suspected it hadn’t survived peer review. Now it’s been published, sort of, in <a href="https://www.nature.com/articles/s41586-023-06331-x?">Nature Open Access</a> – which is equivalent to <a href="https://www.springernature.com/gp/open-research/about/the-fundamentals-of-open-access-and-open-research">self-publishing</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Variant watch<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_116" o:spid="_x0000_i1033" style="height: 302pt; visibility: visible; width: 425pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image004.jpg"></v:imagedata></v:shape></b><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwbJMAwY51_fef2FR8L3ThpYxr6yvcLHbjahgi9WqE6NUcye_zNjDW5n-zY3H3YRN-KeFZyKmS5tIIqUbcpplLRXPKh_Moau3LDDqEmoRBQhTaCWav5Z7QXA-myiwvvSS-wsmw4_4bndu4Bcm85TZUhX4FaCspurefu4V3gEx_HXa4udU-YgLHTu9S_LY/s1100/omicron%20subvariant%20tree.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="782" data-original-width="1100" height="284" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwbJMAwY51_fef2FR8L3ThpYxr6yvcLHbjahgi9WqE6NUcye_zNjDW5n-zY3H3YRN-KeFZyKmS5tIIqUbcpplLRXPKh_Moau3LDDqEmoRBQhTaCWav5Z7QXA-myiwvvSS-wsmw4_4bndu4Bcm85TZUhX4FaCspurefu4V3gEx_HXa4udU-YgLHTu9S_LY/w400-h284/omicron%20subvariant%20tree.jpg" width="400" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The dominant SARS-CoV-2 variant in both the <a href="https://covid.cdc.gov/covid-data-tracker/#variant-proportions">United States</a> and <a href="https://www.ecdc.europa.eu/en/news-events/epidemiological-update-covid-19-transmission-eueea-sars-cov-2-variants-and-public#:~:text=1.5%2Dlike%2BF456L%20lineages%20are,EEA%20countries%20(Figure%203).&text=ECDC%20SARS%2DCoV%2D2%20variant,2023%2C%20ECDC%20classified%20all%20XBB.">Europe</a> is now EG.5 (“Eris”). All current strains are in the XBB lineage, so should be susceptible to the new vaccines.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">There was <a href="https://www.washingtonpost.com/health/2023/08/25/covid-variant-ba-2-86-pirola/">concern</a> that one Omicron subvariant, BA.2.86, had mutated so extensively that the XBB.1.5 booster wouldn’t touch it. I’d like to thank epidemiologist Ken Rosenberg for pointing me to a <a href="https://twitter.com/lasradon/status/1698854734688375053?">tweet by Ninaad Lasrado</a>, whose lab at Harvard’s Beth Israel hospital <a href="https://www.biorxiv.org/content/10.1101/2023.09.04.556272v1.full.pdf">has shown</a> this worry to be misplaced. Six months after having XBB infections, patients had antibodies against BA.2.86 at levels if anything <i>higher</i> than those against variants such as EG.5. Swedish researchers have found similar <a href="https://twitter.com/BenjMurrell/status/1697751445351575656">results</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">…there’s also a doubly <a href="https://www.biorxiv.org/content/10.1101/2023.09.01.555815v1.full.pdf">encouraging preprint</a> from Chinese researchers, showing both that BA.2.86 is less capable of escaping prior immunity than was predicted from its number of mutations, and also that it seems less capable of invading cells than XBB.1.5 or EG.5.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Complications of COVID-19<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_137" o:spid="_x0000_i1032" style="height: 368pt; visibility: visible; width: 379pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image005.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigRptnSfIvA8oqeCMrH1InyaDTuCqUAWnhHZuZ6GN_7PrFltafiKbM5w-WTPCi9Gjsj_wNhlMG-ISJbssXwqmB1P059XL12arO5lrhQOPZaPbn5qr5XfAHCAAcwFxh5MA_Y9VOFaNeHVS1o9AAaD6rKktyVcShsta20I47xGt3tIlV_4P_sJOeyZheiuY/s775/mucormycosis-1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="754" data-original-width="775" height="311" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigRptnSfIvA8oqeCMrH1InyaDTuCqUAWnhHZuZ6GN_7PrFltafiKbM5w-WTPCi9Gjsj_wNhlMG-ISJbssXwqmB1P059XL12arO5lrhQOPZaPbn5qr5XfAHCAAcwFxh5MA_Y9VOFaNeHVS1o9AAaD6rKktyVcShsta20I47xGt3tIlV_4P_sJOeyZheiuY/s320/mucormycosis-1.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Mucormycosis<br /><br /></td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt;">I was excited to hear there had been a <a href="https://www.npr.org/sections/health-shots/2023/09/09/1198342040/long-covid-causes-treatment-research">conference in Santa Fe</a> entirely devoted to <a href="https://www.keystonesymposia.org/digital-toolkit/f12024">long COVID</a>. But the research, at least as described in the <a href="https://www.lakeshorepublicmedia.org/npr-news/2023-09-09/unraveling-long-covid-heres-what-scientists-who-study-the-illness-want-to-find-out">lay press</a>, seems underwhelming. I was particularly disappointed in Resia Pretorius, mother of the theory that circulation-clogging microclots lie at the root of long COVID. Her <a href="https://pubmed.ncbi.nlm.nih.gov/34425843/">first preliminary findings</a> were published fully two years ago and she <i>still </i>hasn’t done a proper clinical trial, instead <a href="https://www.researchsquare.com/article/rs-2697680/v1">reporting</a> before-and-after results, on 91 patients, of her usual antiplatelet/anticoagulant combo. Supposedly the number with cognitive complaints fell from 82 to 21, and the number with fatigue from 81 to 18. A before-and-after observational study without a control group is the weakest possible research methodology, and I am frankly scandalized that she would consider these results worthy even of a <a href="https://www.researchsquare.com/article/rs-2697680/v1">preprint</a>. And note that <a href="https://www.healthrising.org/blog/2022/10/29/coagulation-controversy-long-covid-chronic-fatigue-syndrome/">nobody else</a> has ever detected those microclots, which Pretorius claims to have seen in diseases from diabetes to lupus.<o:p></o:p></p><p class="1obc" style="font-size: medium;">I’ve always suspected Pretorius was on to something, however, and a <a href="https://www.nature.com/articles/s41591-023-02525-y">UK study</a> provides some very indirect support. A high fibrinogen level during hospitalization for COVID-19 predicted both objective and subjective cognitive deficits 6 and 12 months later, and elevated D-dimer levels predicted subjective brain fog. Fibrinogen and D-dimer are related to both clotting and inflammation, so the researchers adjusted for an inflammatory marker, C-reactive protein, and the results held. I don’t see much there there. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">On September 16<sup>th</sup> I searched a <a href="https://clinicaltrials.gov/search?cond=PASC&term=Long%20COVID&page=1&rank=7">definitive database</a> for treatment studies of long COVID, and wasn’t impressed. There’s a German phase 2 trial of “<a href="https://clinicaltrials.gov/study/NCT05911009">BC 007</a>,” a heart disease drug billed as “neutralizing functional autoantibodies directed against G-protein coupled receptors.” Other researchers propose dietary supplements, saunas, a glutamate modulator, SSRI antidepressants, a muscle relaxant, mindfulness meditation, beta blockers, sympathetic nervous system blocks, and intravenous immunoglobulin, none of which look particularly promising. A study of <a href="https://clinicaltrials.gov/study/NCT05669261">autologous stem cells</a>, a costly <a href="https://www.boulderbiologics.com/stem-cell-therapy">commercial product</a>, might conceivably be interesting, but hasn’t even reached phase one.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">COVID-19 increases the risk of dying if you have a <a href="https://www.cedars-sinai.org/newsroom/covid-19-surges-linked-to-spike-in-heart-attacks/#:~:text=The%20research%20team%20members%20say,is%20like%20nothing%20seen%20before.">heart attack</a>, chronic <a href="https://www.dovepress.com/mortality-from-covid-19-in-patients-with-copd-a-us-study-in-the-n3c-da-peer-reviewed-fulltext-article-COPD">lung disease</a>, or a <a href="https://www.bannerhealth.com/healthcareblog/advise-me/does-covid-19-increase-your-risk-of-stroke#:~:text=">stroke</a>. We can now add systemic fungal infections to that list. Not vaginal yeast or oral thrush, but aspergillosis and mucormycosis, infections that attack bodily organs and can be deadly. <a href="https://wwwnc.cdc.gov/eid/article/29/7/22-1771_article">CDC data</a> show that the mortality in patients hospitalized for such infections was 12.3% without COVID-19, 48.5% if the patient was co-infected with SARS-CoV-2.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The CDC’s <a href="https://www.cdc.gov/nchs/products/databriefs/db480.htm">latest update</a> tells us that in 2022 6.9% of American adults (about 18 million) had had long COVID, and 3.4% (about 9 million) were currently affected. Women were much more susceptible and wealthier people somewhat less so.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Leana Wen wrote <a href="https://www.washingtonpost.com/opinions/2023/09/12/long-covid-pandemic-kaine-treatment/">a column</a> for the Washington Post whose basic point is that long COVID exists and is important. Great! But she claimed the diabetes drug metformin is known to reduce the risk of post-covid conditions. Not really. As I wrote about <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4375620">the preprint</a> of a study of overweight and obese patients <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00299-2/fulltext">now published</a> in The Lancet Infectious Diseases, metformin only really benefited individuals who were unvaccinated, whose risk of long COVID fell from 14.1% to 6.3%. People who had received even just a primary vaccine series saw their risk drop only from 7.2% to 6.1%, confirming that vaccination cuts the risk of long COVID in half. The message should not be “take metformin” but “get vaccinated.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Wen followed up with <a href="https://s2.washingtonpost.com/camp-rw/?trackId=599d6acbae7e8a3d46e1400f&s=6515e24f76f05947a4f6dfe6&linknum=5&linktot=64&linknum=5&linktot=64">another column</a> arguing that the already overly lenient CDC guidelines be further liberalized. No, Leana, the CDC should not “treat covid like it does influenza and other viral illnesses,” at least not until we see “long influenza” and “long colds.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">When people get COVID-19 more than once, is each infection a new roll of the dice, or does long COVID become more – or less – likely with each new infection? One <a href="https://www.statnews.com/2023/09/20/do-long-covid-odds-increase-with-second-infection/">expert thinks</a> that question remains open, but points out that reinfection makes pre-existing symptoms worse.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">SARS-CoV-2, or perhaps just “viruses such as SARS-CoV-2” can cause <a href="https://www.science.org/doi/10.1126/sciadv.adg2248">brain cells to fuse</a> in the test tube. <a href="https://scitechdaily.com/covid-19-can-cause-brain-cells-to-fuse-leading-to-chronic-long-covid-neurological-symptoms/">The researchers</a> consider this a long COVID breakthrough. Maybe.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">NYU researchers have shown that SARS-CoV-2 can directly <a href="https://www.nature.com/articles/s44161-023-00336-5">infect coronary arteries</a>, explaining at least in part why COVID-19 patients have an increased risk of heart attacks etc. during the following year. <a href="https://www.valentinapuntmann.com/">Valentina Puntmann</a>, a German expert in long COVID, thinks that an immune response to persistent infection could contribute to its origins.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Another recurrent hypothesis is dysfunctional mitochondria. The brilliant <a href="https://www.statnews.com/2023/08/09/long-covid-mitochondria-sars-cov-2/">Eric Topol is impressed</a> by the <a href="https://www.science.org/doi/10.1126/scitranslmed.abq1533">latest study</a>, but its findings seem to me more relevant to the severity of COVID-19 than to the persistence of symptoms.<o:p></o:p></p><p class="1obc" style="font-size: medium;">An <a href="https://www.frontiersin.org/articles/10.3389/fmed.2023.1187163/full">article</a> in “Frontiers in Medicine,” China’s Ministry of Education <a href="https://www.springer.com/journal/11684">journal</a>, reviews similarities between long COVID and Chronic Fatigue Syndrome, notably proinflammatory cytokines, autoantibodies, and reactivation of latent herpesviruses. Yale researchers <a href="https://www.nature.com/articles/s41586-023-06651-y">confirmed</a> viral reactivation and additionally found low cortisol levels, high anti-SARS-CoV-2 antibody levels, <a href="https://www.medpagetoday.com/neurology/longcovid/106485?">and abnormalities</a> in both T-cell and B-cell lymphocytes.<o:p></o:p></p><p class="1obc" style="font-size: medium;"><a href="https://onlinelibrary.wiley.com/doi/10.1111/jrh.12796">California researchers report</a> that farmworkers, who are largely undocumented and have little access to healthcare, have shockingly high rates of long COVID.<o:p></o:p></p><p class="1obc" style="font-size: medium;">One of the most significant COVID-19 sequelae may turn out to be new-onset <a href="https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.123.21174">hypertension</a>, which developed in one in five hospitalized patients, bearing risk of stroke and heart attacks.<o:p></o:p></p><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Abusing the bully pulpit<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDwmTTEPhyphenhypheneI-b58ALhnpKvHqhw1-RFgm8jdnyvHwvCx-Ai8QEkD_CodJmlbQHgv6685Q64YfYX2Ec2391NAiSW4MJFPHrpCD1LBHTt9kQGyPT26D-FOW0cIrCXnm_JnZ_9bd1G57X7O_IoC5HmFoMWNCZJUFAFusADvx8yUOmOsnD7fx3E9Yw3X4ynxE/s595/Biden%20decorates%20veteran%20maskless.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="397" data-original-width="595" height="214" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDwmTTEPhyphenhypheneI-b58ALhnpKvHqhw1-RFgm8jdnyvHwvCx-Ai8QEkD_CodJmlbQHgv6685Q64YfYX2Ec2391NAiSW4MJFPHrpCD1LBHTt9kQGyPT26D-FOW0cIrCXnm_JnZ_9bd1G57X7O_IoC5HmFoMWNCZJUFAFusADvx8yUOmOsnD7fx3E9Yw3X4ynxE/s320/Biden%20decorates%20veteran%20maskless.jpg" width="320" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_120" o:spid="_x0000_i1031" style="height: 302pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image006.jpg"></v:imagedata></v:shape>After his <a href="https://www.washingtonpost.com/politics/2023/09/04/jill-biden-covid-positive/">wife fell ill</a> with COVID-19 on September 4<sup>th</sup>, Joe Biden said he’d follow CDC guidelines that merely required him to wear a KN95 mask for 10 days. But actions – the <a href="https://www.nytimes.com/2023/09/05/us/politics/biden-medal-of-honor-vietnam-pilot.html">picture's</a> from September 5<sup>th</sup> – speak louder than words. Remember, risk of transmitting COVID-19 <a href="https://www.webmd.com/covid/coronavirus-incubation-period#:">peaks the day <i>before</i></a> you develop symptoms. Adding injury to insult, a maskless Biden draped a Congressional Medal of Honor around the neck of an elderly veteran. He even joked the next day about flaunting the rules, saying to a packed room, “<a href="https://www.youtube.com/watch?v=k5RdBJ_dOXQ">Don't tell them I didn't have it on</a>.”<b><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Waves and wavelets<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_135" o:spid="_x0000_i1030" style="height: 302pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image007.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4EhnXff2HV5Jme8SybyTiC1cWLXcS7d27r-67SC0gnAdDA0hdour09aRhZVJ5wGloq7M2YCaRD0EBaMYn2Tzy8QJz9CGk2u2Y8SFTMMpGUN9mSZnggbtlaDSjti2HLhLa0rNlA7LLFOVpuqZcd2Yu1savUzc5TGLrBddq4GLSf6k9MQG8rG4W76CdVOk/s1200/jabeur-ons.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="800" data-original-width="1200" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4EhnXff2HV5Jme8SybyTiC1cWLXcS7d27r-67SC0gnAdDA0hdour09aRhZVJ5wGloq7M2YCaRD0EBaMYn2Tzy8QJz9CGk2u2Y8SFTMMpGUN9mSZnggbtlaDSjti2HLhLa0rNlA7LLFOVpuqZcd2Yu1savUzc5TGLrBddq4GLSf6k9MQG8rG4W76CdVOk/s320/jabeur-ons.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Ons Jabour, who became abruptly short of breath at the U.S. Open</td></tr></tbody></table><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;">Italians are freaking out about resurgent COVID-19, with front-page headlines such as “<a href="https://www.ilpost.it/2023/09/09/le-prime-pagine-di-oggi-3622/2_la_repubblica-333/">COVID Autumn</a>,” “<a href="https://www.ilpost.it/2023/09/09/le-prime-pagine-di-oggi-3622/11_libero-337/">The COVID Hawks are Back</a>,” and “<a href="https://www.ilpost.it/2023/09/09/le-prime-pagine-di-oggi-3622/12_domani-334/">COVID frightens, from the US Open to Italy</a>.” The number of confirmed weekly cases leapt from <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2023-05-10..latest&facet=none&country=USA~ITA&pickerSort=asc&pickerMetric=location&Metric=Confirmed+cases&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false">3320 in mid-July</a> to <a href="https://lab24.ilsole24ore.com/coronavirus/">38,775</a><b> </b>on September 29<sup>th</sup>. Those statistics are more reliable than in the US, since testing in Italy remained <a href="https://lab24.ilsole24ore.com/coronavirus/?refresh_ce">fairly steady</a> throughout the summer, whereas in the US nobody’s tracked those numbers for <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&country=USA~ITA&pickerSort=asc&pickerMetric=location&Metric=Tests&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false">a year</a>.</p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Italy is <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&country=USA~ITA&pickerSort=asc&pickerMetric=location&Metric=Hospital+admissions&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false">hospitalizing</a> fewer COVID-19 patients per capita than the US, though the rate is <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2023-05-19..latest&facet=none&country=USA~ITA&pickerSort=asc&pickerMetric=location&Metric=Hospital+admissions&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false">soaring</a> in both countries. The rolling average of daily Italian deaths <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2023-06-01..latest&facet=none&country=USA~ITA&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false">rose fivefold</a> between the end of July (2.4) and the first week in September (<a href="https://lab24.ilsole24ore.com/coronavirus/">13.4</a>). In the US, COVID-19 deaths <a href="https://covid.cdc.gov/covid-data-tracker/#trends_weeklydeaths_select_00">merely doubled</a> between early July and mid-September, possibly reflecting superior treatment of critically ill patients.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">In late June <a href="https://www.washingtonpost.com/health/2023/06/25/covid-precautions-summer-vaccines-deaths/?">Americans were</a> “like, ‘COVID, what’s COVID?’”, but a <a href="https://news.gallup.com/poll/511217/americans-covid-concerns-rise-restrained.aspx">Gallup poll</a> says many are starting to worry again. Nobody’s tracking case numbers but they are surely rising, judging from hospitalization rates that have <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2023-06-01..latest&facet=none&country=~USA&pickerSort=asc&pickerMetric=location&Metric=Hospital+admissions&Interval=7-day+rolling+average&Relative+to+Population=false&Color+by+test+positivity=false">more than tripled</a> since early July, cases among prominent Americans including the First Lady, persistently high <a href="https://biobot.io/data/">wastewater levels</a>, anecdotal reports of surging cases in schools in the <a href="https://www.washingtonpost.com/education/2023/09/07/dc-schools-covid-cases-masking/">D.C. area</a> and <a href="https://www.axios.com/2023/09/06/covid-19-school-cases-summer-surge">elsewhere</a>, and outbreaks at – for example – <a href="https://www.latimes.com/california/story/2023-09-07/summer-covid-wave-worsens">workplaces in Los Angeles</a> and probably the <a href="https://tennis-infinity.com/atp-wta/after-mcenroes-positive-covid-test-cases-of-players-reporting-sick-becoming-rife-at-us-open">U.S. Open</a> tennis tournament in New York. Unfortunately even hospitals – hotbeds of respiratory infections – have largely <a href="https://www.nytimes.com/2023/09/23/health/hospitals-masking-mandates.html">dropped mask requirements</a>. But the minisurge has been enough to make the Biden administration start distributing <a href="https://www.nytimes.com/2023/09/20/us/politics/free-covid-tests-biden.html?">free antigen tests</a> again.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Jeremy Faust <a href="https://insidemedicine.substack.com/p/covid-19-metrics-update-september">points out</a> that even those disturbing hospitalization figures are likely underestimates. US hospitals used to test all new admissions for COVID-19, but now only selected patients get tested, guaranteeing cases get missed. In Italy, public hospitals have similarly <a href="https://www.quotidianosanita.it/governo-e-parlamento/articolo.php?articolo_id=116467">stopped universal screening</a>, but when I was admitted to a private hospital six weeks ago with a broken hip I couldn’t go up to the ward without a negative swab. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I wrote last time about new post-Emergency surges in Australia and China. Now we can add Japan to the list, with hospitalizations rising tenfold over five months and <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2023-03-02..latest&facet=none&uniformYAxis=0&country=~JPN&pickerSort=asc&pickerMetric=location&Metric=Hospital+patients&Interval=Weekly&Relative+to+Population=true&Color+by+test+positivity=false">straining hospital capacity</a>, though they’ve fallen in the last few weeks.<o:p></o:p></p><p class="1obc" style="font-size: medium;">You might be interested to know how American COVID-19 <a href="https://www.washingtonpost.com/health/2023/09/07/covid-experts-masking-travel-restaurants/?">experts are handling</a> masking, eating out, travel, etc.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Summing up<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_136" o:spid="_x0000_i1029" style="height: 257pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image008.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQ4kewGh7TCOKXBi5qxTL8Vk_EtLAs1LLUw996eUsQZpVNgurTb6FV28x_Lfvqif5l8lfG5uBgHeoWkuasxrgZiUhFMlZ9RPmv3pKjXRS2g78qFpqI2K-qtDFa2LnzIaGCf02iVMcFSnkuLTnN_-JGMJH-0EmgK0xECzRSqgHF6kWEv4-K_vifhu-mTLU/s1356/Matt%20Hancock%20testifying.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="768" data-original-width="1356" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQ4kewGh7TCOKXBi5qxTL8Vk_EtLAs1LLUw996eUsQZpVNgurTb6FV28x_Lfvqif5l8lfG5uBgHeoWkuasxrgZiUhFMlZ9RPmv3pKjXRS2g78qFpqI2K-qtDFa2LnzIaGCf02iVMcFSnkuLTnN_-JGMJH-0EmgK0xECzRSqgHF6kWEv4-K_vifhu-mTLU/w400-h226/Matt%20Hancock%20testifying.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Matt Hancock testifying</td></tr></tbody></table><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;">Matt Hancock, who was Boris Johnson’s Health Secretary, <a href="https://www.bbc.com/news/health-66029325">has blasted</a> his own pandemic response as “completely wrong,” testifying at a public Covid inquiry that planning – believe it or not – was focused on “the provision of body bags and how to bury the dead, rather than stopping the virus taking hold.” When he tried to approach bereaved families to apologize, they turned their backs. </p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="font-size: medium;">Some of the glaring defects in the American public health system have been outlined in the New England Journal of Medicine by <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2306226?">two experts</a>, and more weakly by ex-CDC Director <a href="https://www.nytimes.com/2023/06/27/opinion/rochelle-walensky-cdc-pandemic-despair.html?">Rochelle Walensky</a>, who before stepping down faced idiotic <a href="https://www.washingtonpost.com/politics/2023/06/14/cdc-director-weathers-lawmakers-covid-criticism-one-final-time/">grilling</a> by a House committee. Walensky’s replacement, Mandy Cohen, sees her chief challenge as <a href="https://www.medpagetoday.com/special-reports/exclusives/106222?">rebuilding trust</a> in the agency. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Since the 1980s, longevity in the United States has lagged behind that of other advanced economies. Six years ago when I was completing my memoir, <a href="https://www.pauldrybooks.com/products/dottoressa">Dottoressa: An American Doctor In Rome</a>, Italians lived five years longer than Americans. Now American researchers have <a href="https://academic.oup.com/pnasnexus/article/2/6/pgad173/7185600?login=false">extended similar statistics</a> into the pandemic period and calculated what they call “missing Americans” – how many US deaths would have been averted if our death rate had equaled the average of 21 other wealthy nations: 622,534 excess deaths in 2019, and more than a million in both 2020 and 2021, half occurring in people under 65 and disproportionately in African-Americans and Native Americans. Though this important article is only marginally about COVID-19, I suggest checking it out, also an <a href="https://www.medpagetoday.com/opinion/second-opinions/104976?">opinion piece</a> at MedPage Today that explains why “Meaningful Healthcare Access Requires So Much More Than Insurance Coverage.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b> </b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Collateral damage?<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0V4WGi1kwMXp9T8THfCVB_gX4Oh4JhirINq4msTB21blzNZbut-08skCj8v2IA4KN7UGeOQmttFU5PvdGsSQpYAOTVW-uxJUBEQV3eLUStRNKY2M3r5PpSqe2Y3sYLusy6SOxuBmXn4FlGdMSsf08O8fq8KtQxaHykxR_BqwQG_IB7rVVQMX8Q9oYhvY/s2048/no%20school%20today.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1365" data-original-width="2048" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0V4WGi1kwMXp9T8THfCVB_gX4Oh4JhirINq4msTB21blzNZbut-08skCj8v2IA4KN7UGeOQmttFU5PvdGsSQpYAOTVW-uxJUBEQV3eLUStRNKY2M3r5PpSqe2Y3sYLusy6SOxuBmXn4FlGdMSsf08O8fq8KtQxaHykxR_BqwQG_IB7rVVQMX8Q9oYhvY/s320/no%20school%20today.jpg" width="320" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_129" o:spid="_x0000_i1028" style="height: 302pt; visibility: visible; width: 454pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image009.png"></v:imagedata></v:shape>In 2021 suicides among young people hit their <a href="https://www.cdc.gov/nchs/products/databriefs/db471.htm">highest rates ever</a>, 19% higher than in 2007, though those rates <a href="https://www.cdc.gov/media/releases/2023/s0810-US-Suicide-Deaths-2022.html">fell in 2022</a>. Since the greatest increase was before 2017, we can’t blame the pandemic.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Students’ test scores, on the contrary, plummeted during the pandemic and <a href="https://www.washingtonpost.com/education/2023/06/21/national-student-test-scores-drop-naep/?">haven’t come back</a>. A <a href="https://ebm.bmj.com/content/28/3/175?">BMJ article</a> makes a fairly convincing case against the school closings and distance learning that led untold millions of children to fall behind educationally. I have always thought elementary schools, at least, should have remained open. But more could have been done to protect teachers and staff, who were at higher risk for severe illness: improving ventilation, installing HEPA filters in classrooms, holding classes outdoors.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">New <a href="https://www.nih.gov/news-events/news-releases/annual-report-nation-part-2-new-cancer-diagnoses-fell-abruptly-early-covid-19-pandemic">diagnoses</a> of <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.35026">six types of cancer</a> plunged early in the pandemic, when people were avoiding all medical care. The dip only lasted a few months, but was deep enough that there were fewer new diagnoses overall in 2020 than in 2019, of major cancers eligible for screening (colorectal, breast, lung, and prostate).<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">But the opposite is true for <a href="https://nypost.com/2023/04/03/sti-rates-spike-significantly-in-nyc-officials-ramp-up-testing/">sexually transmitted infections</a>, which in New York City rose substantially between 2020 and 2021, especially among African-Americans, perhaps due to the “slutty summer” of 2021. Particularly worrisome: a nearly 30% surge in syphilis among women and the consequent increase in congenital syphilis.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Detection and transmission<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_111" o:spid="_x0000_i1027" style="height: 208pt; visibility: visible; width: 370pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image010.png"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKIZsavFZJhK1_L44D1EokIB4tdge0ntcNZL39rzcs-hDcg7VqN5v2M3X5Ln9JQ9DqnxlXfWepMv17hjJGYSYXt7zDe8GO_DKytHj0KYjto4ArpxAFANlc5ThkoD2zzN_TGVSpOp9R7vmnLBUTKT2h7casqgLhdBkZUC1ri_DcZ-qiuai_6Ia0lxR3l0o/s740/COVID_rapid_antigen_test.webp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="417" data-original-width="740" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKIZsavFZJhK1_L44D1EokIB4tdge0ntcNZL39rzcs-hDcg7VqN5v2M3X5Ln9JQ9DqnxlXfWepMv17hjJGYSYXt7zDe8GO_DKytHj0KYjto4ArpxAFANlc5ThkoD2zzN_TGVSpOp9R7vmnLBUTKT2h7casqgLhdBkZUC1ri_DcZ-qiuai_6Ia0lxR3l0o/s320/COVID_rapid_antigen_test.webp" width="320" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">In its <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(23)00101-5/fulltext">first and perhaps only paper</a>, the would-be momentous UK human challenge study has <a href="https://en.wikipedia.org/wiki/The_Mountain_in_Labour">brought forth a mouse</a>. Eighteen out of 34 young unvaccinated people who had wild-strain SARS-CoV-2 injected into their noses became infected and developed “mild-to-moderate” symptoms (defined rather vaguely in the <a href="https://www.thelancet.com/cms/10.1016/S2666-5247(23)00101-5/attachment/677714d9-1c00-46e0-8ad3-cf765bc85428/mmc1.pdf">Supplementary Appendix</a>). Viral RNA could be detected in about a quarter of air, surface, and hand samples, and in 43% of swabs from face masks; the amount of virus emitted by individuals varied hugely, and was unrelated to symptom severity. The researchers conclude: the nose is the most important source of transmission, fomites do carry some risk, a few individuals may be superspreaders, and being sicker doesn’t make you more contagious. One medical <a href="https://ttuhscep.edu/about/president/weekly-podcast/audio/2023/06/tthw20230623.mp3">podcaster</a> was more impressed than I was.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">In related news, Northwestern researchers have <a href="https://www.medrxiv.org/content/10.1101/2023.09.06.23295138v1.full.pdf">preprinted a study</a> tracking the number of viral particles exhaled during natural breathing by several dozen COVID-19 patients over the course of their infections. Patients averaged 80 virus particles per minute, though a few spiked as high as 800, unrelated to vaccination status or SARS-CoV-2 variant, and falling sharply after eight days. Viral RNA was collected only in close proximity to the patient’s mouth, and subjects were specifically told not to talk, shout, or sing during air collection, so this study sheds no light on the still-unresolved question of whether COVID-19 is spread by long-distance airborne transmission. And since the dose needed to transmit infection, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379270/">perhaps 300-800</a>, is not known precisely, these results are hard to interpret.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Home antigen tests are even <a href="https://journals.asm.org/doi/10.1128/spectrum.01295-23">worse than we thought</a> at detecting Omicron infections. A single test detected only 44% of all infections, and only 63% of infections with a viral load high enough to be contagious. The authors conclude that even daily tests can miss infectious cases. And the most serious error is <a href="https://edition.cnn.com/2023/09/18/health/covid-19-home-tests-still-work-wellness/index.html">testing too early</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The Africa exception<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_123" o:spid="_x0000_i1026" style="height: 285pt; visibility: visible; width: 283pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image011.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4hchSLyRrlstKB3QJZi9yrN8oxR55hOHnrU-ZMY8sRyzuXs3_Q0PfG1dhrk_cjAspSFnz-7ISpUjRnIXPehCbXODfb7o1DCxn1p9dcNCPNtkIv_6Kel6oqMH4Ly7xcRXzxj9nYyzlQ0AVhICalKYWFKLtnKr14XOuRUl_Dw1N8rco1-Kw1JEIrK8_m88/s285/Africa.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="285" data-original-width="283" height="285" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4hchSLyRrlstKB3QJZi9yrN8oxR55hOHnrU-ZMY8sRyzuXs3_Q0PfG1dhrk_cjAspSFnz-7ISpUjRnIXPehCbXODfb7o1DCxn1p9dcNCPNtkIv_6Kel6oqMH4Ly7xcRXzxj9nYyzlQ0AVhICalKYWFKLtnKr14XOuRUl_Dw1N8rco1-Kw1JEIrK8_m88/s1600/Africa.jpg" width="283" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Africa has reported <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&uniformYAxis=0&country=OWID_AFR~OWID_NAM~OWID_SAM~OWID_ASI~OWID_EUR&pickerSort=desc&pickerMetric=total_deaths&hideControls=true&Metric=Confirmed+deaths&Interval=Cumulative&Relative+to+Population=false&Color+by+test+positivity=false">far fewer COVID-19 deaths</a> per capita than Europe or the Americas, fewer even than Asia (which was dominated by zero-COVID China). This has been presumed due to a combination of youthful populations, low obesity rates, and inadequate testing. But a new <a href="https://www.sciencedirect.com/science/article/pii/S1201971223006318">review and meta-analysis</a> suggests still another contributory factor: prior immunity. In 26 studies examining pre-pandemic data sets, 11.5% of blood samples showed antibodies against SARS-CoV-2 at a level that could give some resistance to infection. People from areas with more malaria had more antibodies. This makes sense to me. Malaria and other diseases endemic on the continent create <a href="https://www.sciencedirect.com/topics/immunology-and-microbiology/hypergammaglobulinemia">high levels of gamma globulin</a>, which is mostly a slew of antibodies. I have observed this phenomenon in many of my own African patients.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Love ‘em!<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_31" o:spid="_x0000_i1025" style="height: 186pt; visibility: visible; width: 186pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image012.jpg"></v:imagedata></v:shape><b><o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCRbx6Olz0QkbTrWThQ_ozaiyeVyx_ok06JXLMtMGNt8KtmvTZnS282_5ooe9drEy3V-DkTBrbVZRMGxRsld1eOVj7CoZOjLw46voqZJl8DJmUeysfXaLhO1feS7LkTw7_ANy-oHfcLrF_TEb2kXxugzF5EoGU7c6S0AcpfT8QIv1l_gIaiZsM_WhIofM/s567/sea%20sponge.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="567" data-original-width="567" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCRbx6Olz0QkbTrWThQ_ozaiyeVyx_ok06JXLMtMGNt8KtmvTZnS282_5ooe9drEy3V-DkTBrbVZRMGxRsld1eOVj7CoZOjLw46voqZJl8DJmUeysfXaLhO1feS7LkTw7_ANy-oHfcLrF_TEb2kXxugzF5EoGU7c6S0AcpfT8QIv1l_gIaiZsM_WhIofM/w200-h200/sea%20sponge.jpg" width="200" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">“<a href="https://www.independent.co.uk/news/health/covid-cure-prevention-sea-sponge-discovery-b2258510.html?r=7676">Compounds that could stop covid and flu viruses infecting human cells have been discovered in sea sponges</a><span class="MsoHyperlink">.”</span>Researchers say “their discovery paves the way for new antivirals than can help treat the virus.” But hydroxychloroquine also blocks entry of SARS-CoV-2 into human cells is, but is utterly useless against COVID-19.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The mRNA vaccine <a href="https://www.clarkcountytoday.com/news/cdc-confirms-heart-disease-risk-soars-13200-percent-among-vaccinated/">increases the risk</a> of “autoimmune heart disease” by 13,000%. Hardly worth <a href="applewebdata://E8744953-B264-450B-8DDB-73A2E1ED5BBD/is_from_webapp=1&web_id=7132901470265525803">debunking</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">SHOCKING: New Study proves <a href="https://www.instagram.com/p/CwKipDpLBDN/">Pfizer mRNA induced turbo cancer</a>. One mouse (!) died of lymphoma 2 days after a Pfizer COVID-19 vaccine. <a href="https://factcheck.afp.com/doc.afp.com.33PC3M3">So what?</a><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://ia600507.us.archive.org/0/items/screenshot-2023-09-08-113449/Screenshot%202023-09-08%20113449.png">“According to new CDC data, the Covid vaccine could take 24 years off of your life”</a> What will they think of <a href="https://eu.usatoday.com/story/news/factcheck/2023/09/19/no-evidence-covid-19-vaccines-shorten-life-expectancy-fact-check/70796776007/">next</a>?<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">“The CDC <a href="https://archive.org/details/covid-cause-of-death">has just quietly admitted</a> that over 99% of reported ‘Covid deaths’ were faked in order to scare the public into taking the experimental covid jab.” <a href="https://eu.usatoday.com/story/news/factcheck/2023/09/18/cdc-covid-19-deaths-correctly-represented-in-data-fact-check/70781817007/">Hah hah!</a><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">“<a href="https://eu.usatoday.com/story/news/factcheck/2023/09/16/no-pfizers-covid-19-vaccine-doesnt-cause-vaids-fact-check-children/70865407007/">Pfizer’s COVID Vaccine Causes VAIDS in Children, Study Proves</a>,” that would be vaccine-induced AIDS, a non-existent condition. And the cited <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2023.1242380/full">"study"</a> says <a href="https://www.mcri.edu.au/news-stories/a-statement-regarding-a-recent-covid-19-vaccination-publication">nothing of the sort</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">My new favorite: <a href="https://twitter.com/vigilantfox/status/1674521641148137476?s=43">Gates Foundation Is Working On Engineering Flying Vaccines via Mosquitoes</a>.<o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><br /></div><br />Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com2tag:blogger.com,1999:blog-6211405954943098401.post-66013472949694817012023-08-30T16:08:00.000+02:002023-08-30T16:08:05.219+02:00Don't Look Up<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHLmujrmOwv30mygvyAIYXtp5yZyVCeeqxtBSyeSSePH-fWCzo0dpA2KAQzUyHfV8MfsCOSwMtGlwi4EXc_xvRIYBhu-XmfaSLpSzcDS1HJNUEraBq5F8w9JU4wamnOd4ZuMt2mtnVvkDlqAyAihcDIvp4DDlzDOIhWx4EdcgbDCU2l67swcrgAB-PCxk/s1032/don't%20look%20up%202++.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1032" data-original-width="1000" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHLmujrmOwv30mygvyAIYXtp5yZyVCeeqxtBSyeSSePH-fWCzo0dpA2KAQzUyHfV8MfsCOSwMtGlwi4EXc_xvRIYBhu-XmfaSLpSzcDS1HJNUEraBq5F8w9JU4wamnOd4ZuMt2mtnVvkDlqAyAihcDIvp4DDlzDOIhWx4EdcgbDCU2l67swcrgAB-PCxk/s320/don't%20look%20up%202++.jpg" width="310" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">I need to apologise for the time that’s passed – 2 1/2 <span> </span>months – since my last post. This lengthy gap was due first to a snorkeling vacation in Bali – see <a href="https://www.youtube.com/watch?v=6kWmJu2t3BU" style="color: #954f72; text-decoration: underline;">https://www.youtube.com/watch?v=6kWmJu2t3BU</a> and <a href="https://www.youtube.com/watch?v=yqLwZLoQQY0" style="color: #954f72; text-decoration: underline;">https://www.youtube.com/watch?v=yqLwZLoQQY0</a> and then, unfortunately, by my tripping on a Roman pothole and fracturing my left hip. Only now, 3 weeks after the fall, am I finding the mental energy to publish another post. It will touch on vaccines and other protective factors, innovative testing methods, the state of the pandemic, long COVID, pandemic fraudsters, Medicaid purges, a variant watch, DeSanctimoniosity, origin stories, and miscellaneous mishegos.</p><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both; text-align: center;"><br /></div><style class="WebKit-mso-list-quirks-style">
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span.6cok
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span.timestampcontent
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span.dogb1923
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div.WordSection1
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</style><p class="1obc" style="font-size: medium; margin-right: 6pt;"> <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Prevention<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f"><v:stroke joinstyle="miter"><v:formulas><v:f eqn="if lineDrawn pixelLineWidth 0"><v:f eqn="sum @0 1 0"><v:f eqn="sum 0 0 @1"><v:f eqn="prod @2 1 2"><v:f eqn="prod @3 21600 pixelWidth"><v:f eqn="prod @3 21600 pixelHeight"><v:f eqn="sum @0 0 1"><v:f eqn="prod @6 1 2"><v:f eqn="prod @7 21600 pixelWidth"><v:f eqn="sum @8 21600 0"><v:f eqn="prod @7 21600 pixelHeight"><v:f eqn="sum @10 21600 0"></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:formulas><v:path gradientshapeok="t" o:connecttype="rect" o:extrusionok="f"><o:lock aspectratio="t" v:ext="edit"></o:lock></v:path></v:stroke></v:shapetype><v:shape id="Picture_x0020_117" o:spid="_x0000_i1038" style="height: 270pt; visibility: visible; width: 172pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image001.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdSiCjc89tdrIHDGBpUL7XqbeE7zXof9Dmmzc3t3rp7WzgH2EFHbVOCM6WXY_rvOb0_MRZ94yO9fTSlN-ggzfvN8Orx5Aw9fpwc1LAjXSSuMhCtF2b_F-w3zPNtrEVW0mBTjNzlNmyNNudAKF2p0k1yrDmG1ETh-tv135xaFH_bG8YZOB5-xkphFyrzug/s545/nose-picker%206+++%20copy.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="545" data-original-width="347" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdSiCjc89tdrIHDGBpUL7XqbeE7zXof9Dmmzc3t3rp7WzgH2EFHbVOCM6WXY_rvOb0_MRZ94yO9fTSlN-ggzfvN8Orx5Aw9fpwc1LAjXSSuMhCtF2b_F-w3zPNtrEVW0mBTjNzlNmyNNudAKF2p0k1yrDmG1ETh-tv135xaFH_bG8YZOB5-xkphFyrzug/s320/nose-picker%206+++%20copy.jpeg" width="204" /></a></div><br /><u><br /></u><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Bivalent boosters</u>: A <a href="https://academic.oup.com/ofid/article/10/6/ofad209/7131292?login=false">study</a> of Cleveland Clinic employees has been widely misinterpreted in social media as saying that boosters increase the likelihood of COVID-19, <a href="https://twitter.com/toadmeister/status/1670008447356526594">e.g.</a> “it finds the boosted are 33% more likely to get Covid than those not.” Not exactly. What it actually found was that the bivalent booster improved protection by 29% during the BA.4/5 period and 20% during the BQ period, but hardly at all against XBB subvariants. The researchers did report that infection risk increased with the total number of vaccine doses, but this association, rather than being causative, is probably because staff who work directly with patients <a href="https://healthfeedback.org/claimreview/cleveland-clinic-study-didnt-find-more-covid-19-vaccine-doses-causes-increased-covid-19-risk-association-alone-doesnt-imply-causation/">chose to get more doses</a>. A <a href="https://www.factcheck.org/2023/06/scicheck-cleveland-clinic-study-did-not-show-vaccines-increase-covid-19-risk/">post</a> at FactCheck.org discusses in detail the issues raised by this interesting and controversial study.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Monovalent vaccines</u>: Following the <a href="https://www.who.int/news/item/18-05-2023-statement-on-the-antigen-composition-of-covid-19-vaccines">recommendations</a> of the World Health Organization, both <a href="https://www.healio.com/news/infectious-disease/20230818/moderna-pfizer-say-updated-covid19-vaccines-protect-against-eg5">Moderna and Pfizer</a>have developed new mRNA vaccines targetting only the currently dominant Omicron subvariant XBB.1.5, eliminating the Wuhan wild strain component that filled out last year’s bivalent boosters. Both vaccines should be ready for rolling out to elderly and otherwise at-risk Americans in <a href="https://www.nbcnews.com/health/health-news/covid-boosters-fda-panel-recommends-new-xbb-shots-fall-rcna89331">September</a>, and <a href="https://www.italiaoggi.it/news/covid-il-ministero-della-salute-annuncia-l-avvio-della-campagna-vaccinale-da-ottobre-202308171524356351">a month later</a> in Italy. Novavax <a href="https://ir.novavax.com/press-releases/2023-06-15-Novavax-Prepared-to-Deliver-Protein-based-Monovalent-XBB-COVID-Vaccine-Consistent-with-FDA-VRBPAC-Recommendation-for-the-Fall">has promised</a>a protein-based booster aimed at XBB.1.5. That might get a little traction with people who mistrust mRNA technology.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Novavax</u>: Speaking of Novavax, a <a href="https://www.science.org/doi/10.1126/sciimmunol.adg7015">study</a> in macaque monkeys has found that a spike-protein booster did better than a bivalent Moderna booster at lowering SARS-CoV-2 viral load in the upper airways after an intranasal challenge. But when it came to the all-important <i>lower</i> airways, the results were ambiguous: all 12 of the Novavax-boosted animals developed mild-to-moderate lung inflammation, while 3 of the 6 Moderna vaccinees had moderate-to-severe lung inflammation. So which is better? I dunno. Furthermore, the variant they tested was the now long-gone BA.5.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>HLA types</u>: The <a href="https://en.wikipedia.org/wiki/Human_leukocyte_antigen">human leukocyte antigen </a>(HLA) complex is a group of genes that help regulate the immune system, and all of us carry multiple variants of HLA antigens. Some are linked with autoimmune diseases, such as ankylosing spondylitis (HLA-B27), Behçet’s disease (HLA-B51), Type I diabetes (HLA-DR3 and DR4), and celiac disease (HLA-DQ8). Now it seems that a specific HLA type, HLA-B*15:01, <a href="https://www.washingtonpost.com/science/2023/07/19/genetic-variant-asymptomatic-covid/?">may help protect</a> people infected with SARS-CoV-2 from developing clinical COVID-19, helping to explain why at least <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003346">one in 5</a> infected individuals never develop symptoms.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Schnozzes</u>: Do you pick your nose? Odds are you do, given that when Dutch researchers asked a sample of <a href="https://www.washingtonpost.com/wellness/2023/08/02/nose-picking-covid-research/">health care workers</a>, 85% said yes. They found that nose-picking <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0288352">nearly tripled</a> the risk of becoming seropositive to SARS-CoV-2 during the earliest phase of the pandemic, perhaps because nose-pickers were transferring viral particles from the hands to the nose. They also studied other risk factors – I was surprised to see that having a beard, which makes wearing a well-fitting mask impossible, did <i>not</i> increase the risk of infection.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Masking</u>: When St. Louis University eliminated distancing requirements in classrooms but continued to mandate universal masking and up-to-date vaccinations, COVID-19 cases <a href="https://www.healio.com/news/infectious-disease/20230707/university-with-universal-masking-saw-no-increase-in-covid19-after-ending-distancing">did not increase</a>. This makes sense, because most transmission in colleges likely takes place not in classrooms but in locker rooms and social settings.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Antibiotics</u>: Here’s an odd one: having multiple courses of antibiotics in the last few years apparently <a href="https://www.manchester.ac.uk/discover/news/study-links-overuse-of-antibiotics-with-severe-covid-19-side-effects/">puts you at increased risk</a> for severe or fatal COVID-19. The authors suggest that either previous exposure to antibiotics makes you more vulnerable to all kinds of infections, or that changes in the gut microbiome could be responsible.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Testing<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_125" o:spid="_x0000_i1037" style="height: 302pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image002.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhF_nO_UeKlX0qZP7y0G-5x87vZ6ZPb2UAtWQfkmU4D1_lS00WwpQqWymlmkAMINW_0M-DCDFMIVB3Zg0m0yEJgMzuVD0wqy-WKA_76cCphN0mJTFoeykcTEwizBFOaAu47-OK2QJmVgJi5GXC8zKyJWvwWsHg34Tyfs1t6uaVaqUZts6zwwnsySBUUIyw/s567/covid%20breathalyzer.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="378" data-original-width="567" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhF_nO_UeKlX0qZP7y0G-5x87vZ6ZPb2UAtWQfkmU4D1_lS00WwpQqWymlmkAMINW_0M-DCDFMIVB3Zg0m0yEJgMzuVD0wqy-WKA_76cCphN0mJTFoeykcTEwizBFOaAu47-OK2QJmVgJi5GXC8zKyJWvwWsHg34Tyfs1t6uaVaqUZts6zwwnsySBUUIyw/w400-h266/covid%20breathalyzer.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">A COVID-19-detecting breathalyzer</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Even back when Delta and the original Omicron variants were dominant, a single <a href="https://drive.google.com/file/d/1j8tbDREnDtMN0AiXDZXOVWMPIh7AUKkq/view">rapid antigen test only detected</a> 10% of asymptomatic PCR-positive cases, and fewer than 60% of those with symptoms. Only by repeating the test several times could you get to 75% and 92% respectively. Better fast-acting tests would certainly be useful, especially if a new surge materializes.</p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Washington University St. Louis researchers have developed an <a href="https://medicine.wustl.edu/news/scientists-develop-breath-test-that-rapidly-detects-covid-19-virus/">ultra-rapid breath test</a> for COVID-19, using a breathalyzer like the ones for detecting drunk drivers. It’s touted as giving highly accurate results within 60 seconds, but check out the devilish details. First of all, the scientific <a href="https://pubs.acs.org/doi/full/10.1021/acssensors.3c00512">article</a> appears in “ACS Sensors,” a pay-to-publish journal that corruptly recruits its reviewers by asking authors for suggestions. Secondly, results using inactivated viral particles suggest the technique would miss about 30% of symptomatic Omicron BA.1 cases, about the same as our old-fashioned home tests. And third, it was only tested in 6 (six!) infected patients, during the BQ.1 era, and came up positive in 4. Not very impressive, and given that in late 2022 there was <i><a href="https://www.nytimes.com/interactive/2023/us/city-of-st-louis-missouri-covid-cases.html">plenty<span style="font-style: normal;"> of COVID-19</span></a></i> around in St. Louis I can see no excuse for doing such limited validation.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The very same Washington U. research team <a href="https://pubs.acs.org/doi/full/10.1021/acssensors.3c00512">has invented</a> a cubic-foot-sized gadget that can supposedly <a href="https://www.nature.com/articles/s41467-023-39419-z">test indoor air</a>for COVID-19 practically in real time, detecting minimal levels of virus. Thus far it’s just a prototype, far from commercial availability, and is noisy enough at 75-80 decibels that sustained exposure could lead to hearing loss.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>State of the pandemic<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6AAQQPtIyXFGVYzOMnKH2E40rSbNEcoy7AorZfc-GViZGro1oL5Lkxt7db74wDw81b8DzTfG9HTcO2bVW2sf-rzLfWBBIlyVIXXpGQegMfuwhXcHpFc_G4n0FyD5mTo6YO0roxI-qoC26kAn7zpmy-mbl6zBfJ_yA5sJYKSRZCSPAUN9aZ3kucjP9zUY/s1432/covid%20wastewater%20aug%2028%2023.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1216" data-original-width="1432" height="341" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6AAQQPtIyXFGVYzOMnKH2E40rSbNEcoy7AorZfc-GViZGro1oL5Lkxt7db74wDw81b8DzTfG9HTcO2bVW2sf-rzLfWBBIlyVIXXpGQegMfuwhXcHpFc_G4n0FyD5mTo6YO0roxI-qoC26kAn7zpmy-mbl6zBfJ_yA5sJYKSRZCSPAUN9aZ3kucjP9zUY/w400-h341/covid%20wastewater%20aug%2028%2023.jpg" width="400" /></a></div><br /><p></p><p class="MsoNormal" style="font-size: medium;"><v:shape id="Picture_x0020_533" o:spid="_x0000_i1036" style="height: 385pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image003.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Given that Americans have thrown all caution to the winds, it’s no surprise that wastewater measurements now show increasing levels of SARS-CoV-2 <a href="https://peoplescdc.substack.com/p/peoples-cdc-covid-19-weather-report-3b1?">virtually</a><span class="MsoHyperlink"> all over</span> the country.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_128" o:spid="_x0000_i1035" style="height: 250pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image004.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiskzlbG5hxomSFiVwTh6WcWMvUTGuc-MG2bWxk1qdsAIt3PhyL_hYkm49Gvfk9nWuZCSc0ViZT0ezVsg5pUQPPlByVfIMYZImbXsXdQ78wyTsbo08AFOqLABG8QX_0yr86sDOaDzxZf5uq9VyFEG2w9BN4UqYevHj04w_3aeFqPgTmcbJH3gO12dUuzV0/s1024/covid%20admissions%20USA.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="566" data-original-width="1024" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiskzlbG5hxomSFiVwTh6WcWMvUTGuc-MG2bWxk1qdsAIt3PhyL_hYkm49Gvfk9nWuZCSc0ViZT0ezVsg5pUQPPlByVfIMYZImbXsXdQ78wyTsbo08AFOqLABG8QX_0yr86sDOaDzxZf5uq9VyFEG2w9BN4UqYevHj04w_3aeFqPgTmcbJH3gO12dUuzV0/w400-h223/covid%20admissions%20USA.jpg" width="400" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">COVID-19 hospitalizations, too, are <a href="https://peoplescdc.substack.com/p/peoples-cdc-covid-19-weather-report-796?">on the rise</a> nationwide. And the New York Times <a href="https://www.nytimes.com/2023/08/28/us/covid-cases-hospitalizations.html">reports</a> various local outbreaks.<o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIL54U1bQOHaHiN_9fgna0mM9az_XLI95KW_1WKLCx4An3nCb8btlyxZPsHoql34pNP99ZoacnOSTTRY1wJyIgHXFYCqGvk43oUVM28QxKqooRy4s0ZhLJHUzU3GZK5gAeHkkU7TQrWF7SWiWRcfpybgWClCdKGna9IsVXcMiIA26Ct62VkvHNrhb8V24/s567/covid%20hospitalizations%20NYC.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="390" data-original-width="567" height="275" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIL54U1bQOHaHiN_9fgna0mM9az_XLI95KW_1WKLCx4An3nCb8btlyxZPsHoql34pNP99ZoacnOSTTRY1wJyIgHXFYCqGvk43oUVM28QxKqooRy4s0ZhLJHUzU3GZK5gAeHkkU7TQrWF7SWiWRcfpybgWClCdKGna9IsVXcMiIA26Ct62VkvHNrhb8V24/w400-h275/covid%20hospitalizations%20NYC.jpg" width="400" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_130" o:spid="_x0000_i1034" style="height: 312pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image005.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">New York City is doing even worse. There were fewer than 200 people in hospital with COVID-19 for most of July but that number is <a href="https://peoplescdc.substack.com/p/peoples-cdc-covid-19-weather-report-796?">now pushing 500</a>. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5BhwIDFTJhlgcGFIFA3ta6luGhETSPScENiLeJwU8JFnRIFpK_pzYoe4Pbou_2f1YrH5b_f7r4KyCR-8I0l3oTazrgblGn7Toob6omD3mH_pIGh2MOk_LT85KDS4tbIvhyRq2o9zEW6MP1KA7KFHR2njKKrikU4O6JATcecqxYYdj7hqE0cD-WSotU-A/s946/Italy%20hosps%20deaths.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="730" data-original-width="946" height="247" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5BhwIDFTJhlgcGFIFA3ta6luGhETSPScENiLeJwU8JFnRIFpK_pzYoe4Pbou_2f1YrH5b_f7r4KyCR-8I0l3oTazrgblGn7Toob6omD3mH_pIGh2MOk_LT85KDS4tbIvhyRq2o9zEW6MP1KA7KFHR2njKKrikU4O6JATcecqxYYdj7hqE0cD-WSotU-A/s320/Italy%20hosps%20deaths.jpg" width="320" /></a></div><p class="1obc" style="font-size: medium; margin-right: 6pt;">In Italy absolute numbers of hospitalizations and deaths <a href="https://lab24.ilsole24ore.com/coronavirus/?refresh_ce">remain low</a>, but there are hints of a new wavelet (ricoverati = hospitalized, terapie intensive = ICU). </p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBQntdRkdYQEP9XEzRe8ki1LG6987N7qdiLgrbz24nrf_mJcYQkEgex78lh8BNbseLxJLBduZWNZfeN5zoz-U2cRM2_VArWYNpS6AAVGJHUwLA11IT4pNytBYEMbgzP904r0FT8Z7XnaNmAB7kk19TOfUqW4cxu0nEYikJ94dbHnkyVMeXLy0S0Hu-kUI/s901/Italy%20hospitalizations.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="455" data-original-width="901" height="203" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBQntdRkdYQEP9XEzRe8ki1LG6987N7qdiLgrbz24nrf_mJcYQkEgex78lh8BNbseLxJLBduZWNZfeN5zoz-U2cRM2_VArWYNpS6AAVGJHUwLA11IT4pNytBYEMbgzP904r0FT8Z7XnaNmAB7kk19TOfUqW4cxu0nEYikJ94dbHnkyVMeXLy0S0Hu-kUI/w400-h203/Italy%20hospitalizations.jpg" width="400" /></a></div><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">COVID-19 deaths in Italy have more than <a href="https://coronavirus.gimbe.org/">doubled since mid-July</a>, hospitalizations are up by more than 60%, and the transmissibility index has <a href="https://www.epicentro.iss.it/coronavirus/bollettino/Bollettino-sorveglianza-integrata-COVID-19_16-agosto-2023.pdf">crept back</a> above one, the “epidemic” cutoff. But the Health Minister has chosen nonetheless to join <a href="https://www.health.gov.au/topics/covid-19/testing-positive#:">Australia</a>, <a href="https://www.service-public.fr/particuliers/actualites/A15610?lang=en#:">France</a>, and <a href="https://www.bbc.com/news/explainers-54239922">the UK</a> <a href="https://www.salute.gov.it/portale/nuovocoronavirus/dettaglioNotizieNuovoCoronavirus.jsp?lingua=italiano&menu=notizie&p=dalministero&id=6329">in scrapping obligatory self-isolation</a> for people with COVID-19, in favor of mere recommendation.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Then there’s China, which as you may remember abruptly ditched its zero-covid policy and virtually all other precautions in December 2022. A group of Seattle researchers used obituaries and other sources <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808734">to calculate</a> that while the disease ripped through the population over the following two months an astonishing 1.87 million excess deaths occurred, mostly among men and the elderly. Their calculation is consistent with prior forecasts of <a href="https://www.airfinity.com/articles/airfinitys-covid-19-forecast-for-china-infections-and-deaths">one to two million</a>while greatly exceeding official Chinese government estimates of 60,000. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Long COVID<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_29" o:spid="_x0000_i1031" style="height: 342pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image008.png"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2xu0E1cTY2OAVEBHSfR3NB6t9fnX3sU5cDZDzQ1Nx57V6ZI6ZFXnHGM3q_duEsRpznUFD-czQpsiCyUalGusCiwb463I8BuAdre0W-0UrmsALNcToEXoUTm37XC2IDV_demu95yd-9fvKl2zsjQvHxDetmqZZaGhb-ph2xE2B1Sbh11YyyJvwHVaK7Ig/s706/disabled%20people%20in%20US.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="532" data-original-width="706" height="301" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2xu0E1cTY2OAVEBHSfR3NB6t9fnX3sU5cDZDzQ1Nx57V6ZI6ZFXnHGM3q_duEsRpznUFD-czQpsiCyUalGusCiwb463I8BuAdre0W-0UrmsALNcToEXoUTm37XC2IDV_demu95yd-9fvKl2zsjQvHxDetmqZZaGhb-ph2xE2B1Sbh11YyyJvwHVaK7Ig/w400-h301/disabled%20people%20in%20US.png" width="400" /></a></div><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">There are now about 4 <a href="https://peoplescdc.substack.com/p/peoples-cdc-covid-19-weather-report-3b1?">million</a> more disabled Americans than just before the pandemic – the numbers on the graph are in thousands – a surge reasonably attributable to long COVID. Fortunately, <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7232a3.htm?">fewer American adults</a> are suffering from long COVID now (6.0%) than there were a year ago (7.5%), probably due to a lower risk with Omicron.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Does vaccination prevent long COVID, over and above its rather limited ability to keep you from getting sick in the first place? Probably yes, with most but not all research finding a preventive effect, according to a recent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9978692/">systematic review</a> of 19 studies, all pre-Omicron. “Complete” vaccination seems to decrease by about 30% the risk that SARS-CoV-2 infection will evolve into long COVID, and a booster dose provides additional protection.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">We already knew from research in China and <a href="https://time.com/6246564/how-long-does-long-covid-last/">elsewhere</a> that long COVID can drag on for two years and more. Now <a href="https://www.nature.com/articles/s41591-023-02521-2">a study</a> from the US Veterans Administration says the same. And <a href="https://deliverypdf.ssrn.com/delivery.php?ID=450091020087110089092070077110102112027038009000020002096043103035020045037027119082066111000089011062097011018115125025115016036093074045093013001109042025098065004020065007112095013122125033033036040072064052077006031083103104007120081092002103094096016089089026077013092087126016008126022&EXT=pdf&INDEX=TRUE">Spanish researchers report</a> that only 7.6% of long COVID sufferers recovered completely after two years – but this finding must be taken with a grain of salt and not extrapolated to new cases, because most of their patients were infected during the first wave of COVID-19, when the rate of long COVID and especially of severe long COVID was extremely high.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2808237">Another VA study</a> reports that the well-known <a href="https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(22)00087-4/fulltext#:~:text=Increased%20risk%20of%20death%20from,array%20of%20causes%20of%20death.">increased risk of dying</a> after COVID-19 is limited to the first six months after infection, and to patients sick enough to require hospitalization – in agreement with <a href="https://www.bmj.com/content/382/bmj-2023-076222">some</a> but <a href="https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(22)00087-4/fulltext#:~:text=Findings,9%2D3%C2%B73).">not all</a>other research. From months 7 through 24, COVID-19 patients had if anything a <i>lower</i> risk of dying than matched controls, though the early death rate was high enough to make COVID-19 survivors more likely to die over the course of the entire 2-year study. The researchers hypothesize that the apparent protective effect might be due to survivors of severe COVID-19 receiving particularly careful medical attention.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">According to the head of the American Academy of Neurology, long COVID is now the <a href="https://www.aan.com/AAN-Resources/Details/about-the-aan/board-of-directors/presidents-column/july-2022/">third most common</a>neurological disorder in the United States, after tension headaches and migraine. And <a href="https://news.un.org/en/story/2023/06/1138157">36 million Europeans</a>, one in 30 inhabitants, are estimated to be currently affected. The best estimates of persistent symptoms nowadays are <a href="https://www.washingtonpost.com/health/2023/03/18/long-covid-less-likely/">6.2%</a> after COVID-19 treated as an outpatient, and perhaps as high as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10036151/">34%</a> after hospitalization, at least in inner-city settings. These rates are lower than earlier in the pandemic, because of widespread vaccination, Paxlovid treatment, and the relatively benign Omicron variant.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Some <a href="https://www.unmc.edu/healthsecurity/transmission/2023/07/25/long-covid-persists-as-a-mass-disabling-event/">have compared</a> the casual way the world is treating long COVID to the satirical film Don’t Look Up, where scientists couldn’t get anybody to take a genuine apocalyptic threat seriously.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">After futzing around for <a href="https://www.nih.gov/about-nih/who-we-are/nih-director/statements/nih-launches-new-initiative-study-long-covid">well over two years</a>, the NIH has <a href="https://www.washingtonpost.com/health/2023/07/31/long-covid-treatment-studies-nih/">finally started</a> a study of prolonged courses of Paxlovid for long COVID (“RECOVER-vital”) under the <a href="https://recovercovid.org/">RECOVER</a> umbrella. Or has it? The Stanford <a href="https://classic.clinicaltrials.gov/ct2/show/NCT05576662">STOP-PASC study</a> using Paxlovid, which infamously allowed its researchers to be unmasked in patients’ presence, has apparently <a href="https://news.knowledia.com/US/en/articles/stanford-study-of-paxlovid-for-long-covid-stopped-early-6327ceea056f31953f5c68d32fc12fb1bf0ab133">stopped enrolling subjects</a> because of unpromising interim analyses. I haven’t managed to track down details.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Other RECOVER studies are <a href="https://www.nih.gov/news-events/news-releases/nih-launches-long-covid-clinical-trials-through-recover-initiative-opening-enrollment#:~:text=Today%2C%20the%20National%20Institutes%20of,expected%20in%20the%20coming%20months.">“still under review.”</a> “RECOVER-neuro,” focussed on brain fog and other cognitive issues, will test 3 approaches: a web-based brain training program (BrainHQ), a “goal management training program,” and a noninvasive <a href="https://www.yingchitech.com/en/product/transcranial-magnetic-stimulator-m-series/?">electrical brain stimulation device</a> intended to boost cerebral activity and blood flow. That device is billed as developed in New Jersey, but the phone number listed for it is in China. RECOVER-sleep will target both excessive sleepiness, apparently using wakefulness drugs such as modafinil (Provigil), and insomnia. Also under consideration: addressing the postural orthostatic tachycardia syndrome (POTS) using treatments used for “immune diseases” and “heart failure,” and addressing exercise intolerance/fatigue with as-yet undefined interventions. Interestingly, perhaps fortunately, there seems to be no overlap between these treatments and those being tested in the British <a href="https://www.stimulate-icp.org/faq">STIMULATE ICP trial</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium;">Some patients say they have had <a href="https://www.theguardian.com/science/2023/jul/09/microbiome-chronic-fatigue-me-long-covid-research?CMP=Share_iOSApp_Other">symptom relief from probiotics</a> aimed at regenerating the gut microbiome. And a few posts back I described a controlled study saying much the same.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Then there’s a <a href="https://www.sciencedirect.com/science/article/pii/S2667257X22001000">pilot study</a> by Yale researchers, claiming relief of long COVID brain fog from a combination of acetylcysteine (a commonly-used, benign mucolytic) and guanfacine (a drug I’d never heard of, apparently used for attention deficit hyperactivity disorder and high blood pressure). I honestly don’t think this paper should have been published, partly because there is no excuse for doing any study of long COVID, however small, without including a placebo control group, and partly because guanfacine’s “<a href="https://www.epocrates.com/online/drugs/1287/guanfacine#adverse-reactions">common side effects</a>” include sleepiness, dizziness, fatigue, impotence, low blood pressure, lethargy, mood swings, and irritability, all symptoms typical of long COVID.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The makers of a “photobiomodulation (PBM) device” delivering intensive light to either the whole body or <a href="https://neuronic.online/products/1070nm-helmet">just the skull</a>, also <a href="https://neuronic.online/blogs/photobiomodulation-press-releases/pbm-treatment-demonstrates-success-in-alleviating-long-covid-symptoms?">claim</a> it can help the brain fog and fatigue of long COVID sufferers. Their pilot study enrolled merely 14 patients, with no placebo- or sham-treatment control group, and the whole concept sounds a bit like quackery We’ll see if some proper research surfaces.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Ripoffs<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_101" o:spid="_x0000_i1030" style="height: 255pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image009.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbDgPfPnFs-7qiNXlSBqmJAP1KnHOKvDkPRKJXlENWFdJh8HDEfcOyVAWeDp31mdOVVi-R2V1l554CLlkw3XnMZ0-iuap5mSYQzsf7SpGFfkJAt4T-c_uo1F0YXUcZI0zst5pR0LdG4omiiCUOE_FRVuVeJxLzmHpy-Dx6rIORshiQ8uqHY1JUR-kYWpE/s1200/the%20fortune-teller%20georges%20de%20la%20tour.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="992" data-original-width="1200" height="333" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbDgPfPnFs-7qiNXlSBqmJAP1KnHOKvDkPRKJXlENWFdJh8HDEfcOyVAWeDp31mdOVVi-R2V1l554CLlkw3XnMZ0-iuap5mSYQzsf7SpGFfkJAt4T-c_uo1F0YXUcZI0zst5pR0LdG4omiiCUOE_FRVuVeJxLzmHpy-Dx6rIORshiQ8uqHY1JUR-kYWpE/w400-h333/the%20fortune-teller%20georges%20de%20la%20tour.jpeg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">The Fortune Teller, Georges De La Tour</td></tr></tbody></table><div style="text-align: center;"><br /></div><p class="1obc" style="font-size: medium; margin-right: 6pt;">Maybe you think COVID-19 relief fraud is mostly about, say, ineligible workers applying for enhanced unemployment benefits. Nope. The very rich are up to it too, <a href="https://www.nbcnews.com/politics/justice-department/biggest-fraud-generation-looting-covid-relief-program-known-ppp-n1279664">looting</a> an estimated $80 billion from the Paycheck Protection Program to buy Lamborghinis, Ferraris, Teslas, mansions, and private jet flights. </p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Then there’s the professional tax preparer in New Jersey who told his customers the government was distributing “free money” in the form of pandemic relief to business owners. <a href="https://www.justice.gov/usao-nj/pr/new-jersey-tax-preparer-arrested-fraudulently-seeking-over-124-million-covid-19" target="_blank">More than 1,000 false tax forms</a> fraudulently claimed more than $124 million in Covid-19 <a href="https://www.nytimes.com/2023/05/26/us/politics/employee-retention-credit-tax-fraud.html#:~:text=Businesses%2C%20including%20nonprofit%20organizations%20and,their%20revenues%20during%20that%20time.">employment tax credits</a> for businesses owned by himself and others.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">And take Ron DeSantis, who <a href="https://www.washingtonpost.com/politics/2023/06/28/desantis-hosseini-interstate-covid-money/?">diverted $92 million</a> of Florida’s COVID-19 relief funds to a pet highway construction project of one of his major donors.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The Feds are using a <a href="https://www.nytimes.com/2023/08/06/us/politics/pandemic-fraud.html?">variety of tricks</a> to go after all those fraudsters. Without much success, if only $30 billion (or perhaps only <a href="https://www.nytimes.com/2023/08/23/business/pandemic-relief-fraud-justice-department.html?nl=todaysheadlines&emc=edit_th_20230824">$1.4 billion</a>!) of the 200 billion estimated purloined dollars have been recouped thus far. As of the end of June, there were 163,000 open fraud complaints related to <a href="https://www.oig.dol.gov/public/oaprojects/2023%20Revised%20Pandemic%20Response%20Oversight%20Plan.pdf">unemployment insurance</a> alone. But now it seems that the Feds may finally be getting off their butts, <a href="https://www.washingtonpost.com/business/2023/08/23/covid-aid-fraud-justice/?">undertaking 718 cases</a> to recover $836 million in stolen coronavirus funds that were used among other purposes to – get this! – “solicit murder for hire.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">What a shame that plenty of money was allocated legitimately but never used, <a href="https://www.nytimes.com/2023/08/09/opinion/air-filter-covid-smoke-schools.html?">for instance</a> <a href="https://www.nytimes.com/2023/08/27/health/schools-indoor-air-covid.html?">half a trillion dollars</a>intended to improve air quality in classrooms. American researchers have reported that better ventilation plus air filtration <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7021e1.htm?">can cut</a> a school’s COVID-19 cases nearly in half, and an <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2022.1087087/full">Italian study</a> found even better results.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Variant watch<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnugGnOKLZUsRRf4cqtp0h77-GOV6fYyYdpWc6nNVjUQyDSmjfOX0vEshBsepe1dyRx6BHFs3rP0ugQomLb98DpmaQBltftqPBXx6R_RxKvIWSKkDo-ZKm3ze70pfTO5cWwlRax7xkjzjbRmiYSzFA0KbkQqWnq9NpzQIIx_rczI0TZq3s6VVsjId5KEE/s1496/omicron%20family%20tree.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1186" data-original-width="1496" height="510" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnugGnOKLZUsRRf4cqtp0h77-GOV6fYyYdpWc6nNVjUQyDSmjfOX0vEshBsepe1dyRx6BHFs3rP0ugQomLb98DpmaQBltftqPBXx6R_RxKvIWSKkDo-ZKm3ze70pfTO5cWwlRax7xkjzjbRmiYSzFA0KbkQqWnq9NpzQIIx_rczI0TZq3s6VVsjId5KEE/w640-h510/omicron%20family%20tree.jpg" width="640" /></a></div><br /><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_119" o:spid="_x0000_i1029" style="height: 359pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image010.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://www.medpagetoday.com/special-reports/features/106013?">BA.2.86: (“Pirola”)</a>: There’s been some alarm in <a href="https://www.medpagetoday.com/special-reports/features/106013">medical venues</a> and in the popular press of the <a href="https://www.health.com/new-covid-variant-ba286-7852574">United States</a>, <a href="https://tg24.sky.it/salute-e-benessere/2023/08/29/variante-covid-ba-2-86">Italy</a>, and <a href="https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/whats-the-difference-between-eris-and-ba-2-86-new-viral-strains-of-covid-19/photostory/103130155.cms?from=mdr">elsewhere</a>, about this new entry. With 35-plus mutations on the spike protein, many of them entirely novel, Pirola may be even better than earlier Omicron subvariants at <a href="https://www.washingtonpost.com/health/2023/08/25/covid-variant-ba-2-86-pirola/?">escaping immunity</a> from infections and vaccines. <a href="https://www.cdc.gov/respiratory-viruses/whats-new/covid-19-variant.html">The CDC</a>doesn’t seem very concerned, though, and they may be right. The number of documented cases worldwide can still be counted on your fingers and toes, current tests and treatments are expected to work, and there’s no evidence BA.2.86 causes more severe disease. I do worry a bit, though, because this subvariant is so different from the XBB.1.5 targetted in this fall’s monovalent booster that it might escape its protection altogether. Eric Topol <a href="https://www.washingtonpost.com/health/2023/08/25/covid-variant-ba-2-86-pirola/?">shares my concern</a>, and uses BA.2.86 as a <a href="https://erictopol.substack.com/p/a-quick-update-on-the-ba286-variant">springboard</a> for reproposing his “dream vaccine” against all coronaviruses.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Two other recent variants, <a href="https://www.medpagetoday.com/infectiousdisease/covid19/105231?">EU.1.1</a> and <a href="https://www.washingtonpost.com/health/2023/08/08/eris-covid-variant-eg-5-omicron/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines\">EG.5</a>, on the other hand, are part of the XBB lineage and thus likely to be susceptible to the new monovalent vaccines.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Winding and unwinding<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTjcS8zBjbWt1AVkUjY-4pcG58Ei7b7P4e7bZF6R9Jw3882XuwRHFwSKz3VK5rWdtAytLDU6yHykRz83NRJoqzogv3KH4gUgMcUwXMc6RH1d5i2taOKtLa5bxd92JEToapUBKCnFmTubKsqoXl84J-8_hrOxVM80uEoM0jzZqHhjfzBQ2qx2-Bwgo_6iQ/s340/Medicaid-Unwinding.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="340" data-original-width="340" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTjcS8zBjbWt1AVkUjY-4pcG58Ei7b7P4e7bZF6R9Jw3882XuwRHFwSKz3VK5rWdtAytLDU6yHykRz83NRJoqzogv3KH4gUgMcUwXMc6RH1d5i2taOKtLa5bxd92JEToapUBKCnFmTubKsqoXl84J-8_hrOxVM80uEoM0jzZqHhjfzBQ2qx2-Bwgo_6iQ/s320/Medicaid-Unwinding.png" width="320" /></a></div><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_126" o:spid="_x0000_i1028" style="height: 340pt; visibility: visible; width: 340pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image011.png"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">As of August 21<sup>st</sup> more than a third of all Americans on Medicaid – <a href="https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-and-unwinding-tracker/?utm_campaign=wp_the_health_202&utm_medium=email&utm_source=newsletter&wpisrc=nl_health202">5.2 million people</a> – had been kicked off the program during the so-called “unwinding” of special pandemic concessions – in <a href="https://www.washingtonpost.com/politics/2023/06/29/will-more-states-press-pause-medicaid-disenrollments/">75% of cases</a> for procedural reasons such as not returning paperwork on time, rather than from ineligibility. Texas <a href="https://www.nytimes.com/2023/08/13/us/politics/texas-medicaid-coverage-loss.html?">leads the pack</a>, having already given a shocking 72% of its Medicaid recipients the boot. But pushback is starting. In <a href="https://healthlaw.org/news/suit-challenges-florida-over-illegal-medicaid-terminations-marking-first-lawsuit-amid-chaotic-nationwide-medicaid-unwinding/">a lawsuit</a> filed by two expelled Florida families who allege lack of due process, <a href="https://www.npr.org/sections/health-shots/2023/08/22/1195226831/two-families-sue-florida-for-being-kicked-off-medicaid-in-unwinding-process">an agent</a> is quoted as saying, “I'm not going to sit here and answer your questions” and “I have a rule that says I cannot talk to you for over 20 minutes.” Michigan has decided to slow-walk its unwinding process to allow more time for outreach, and at least <a href="https://www.washingtonpost.com/politics/2023/06/29/will-more-states-press-pause-medicaid-disenrollments/">ten more states</a> may follow suit. The Centers for Medicare and Medicaid Services are also <a href="https://www.agentbrokerfaq.cms.gov/s/article/What-is-the-unwinding-period-and-how-can-I-prepare-to-assist-consumers-during-this-time">offering help</a>, and they’ve opened a <a href="https://www.cms.gov/technical-assistance-resources/temp-sep-unwinding-faq.pdf">special enrollment period</a> under Obamacare to help people find alternative affordable insurance. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">On the positive side, <a href="https://www.healthcarefinancenews.com/news/south-dakota-expanding-medicaid-52000-residents#:~:text=South%20Dakota%20has%20decided%20to,members%20of%20South%20Dakota%20tribes.">South Dakota</a> is about to become the 41<sup>st</sup> state (including D.C.) to fully expand Medicaid under the Affordable Care Act, leaving only <a href="https://thehill.com/homenews/state-watch/3914916-these-10-states-have-not-expanded-medicaid/#:~:text=Wyoming%2C%20Kansas%2C%20Texas%2C%20Wisconsin,but%20cannot%20access%20it%20because">10 holdouts</a>. One of the latter is Georgia, which has “generously” broadened its Medicaid eligibility to cover everyone up to the US poverty level, but has added a uniquely disgusting and onerous <a href="https://www.washingtonpost.com/health/2023/06/28/medicaid-work-requirements/">work requirement</a> for anybody newly gaining coverage.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The Free State of Florida<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_110" o:spid="_x0000_i1027" style="height: 167pt; visibility: visible; width: 258pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image012.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhc1Zm-T9fjVKV7IvKf822nyOQ57yGWclYi9FaBLF9z3oDc0xxmzSwUetV6ZGzvHO_nruJbrW1Ufj-W8CImOZiD_q1nOz86_qsg-qLoQIBf2LdAoNvhIPb9QjIhAtjUNK6iqZ8oIuTKTMGQZA-Z7SYwuJX0gow7R8diYAg_dE0EpfK6nB4K0wkdnkVsImg/s345/Jolly%20slaves.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="223" data-original-width="345" height="259" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhc1Zm-T9fjVKV7IvKf822nyOQ57yGWclYi9FaBLF9z3oDc0xxmzSwUetV6ZGzvHO_nruJbrW1Ufj-W8CImOZiD_q1nOz86_qsg-qLoQIBf2LdAoNvhIPb9QjIhAtjUNK6iqZ8oIuTKTMGQZA-Z7SYwuJX0gow7R8diYAg_dE0EpfK6nB4K0wkdnkVsImg/w400-h259/Jolly%20slaves.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">DeSantian fantasy of a jolly slave family</td></tr></tbody></table><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;">During <a href="https://www.nytimes.com/2023/07/21/us/desantis-florida-black-history-standards.html?smid=nytcore-android-share">breaks</a> from saying that slavery was often <a href="https://www.washingtonpost.com/politics/2023/07/22/desantis-slavery-curriculum/">beneficial to the enslaved</a>, claiming African-Americans were <a href="https://www.nbcnews.com/news/us-news/new-florida-standards-teach-black-people-benefited-slavery-taught-usef-rcna95418">perpetrators of violence</a> during notorious massacres of black Americans, and seeking to cut <a href="https://www.washingtonpost.com/business/2023/07/22/gop-social-security-trump-rivals-cuts/">Social Security benefits</a>for the next generation, Florida governor Ron DeSantis notoriously <a href="https://www.factcheck.org/2022/12/scicheck-desantis-dubious-covid-19-vaccine-claims/">backtracked</a> on his <a href="https://www.washingtonpost.com/politics/2022/12/17/desantis-vaccine-reversal/">early enthusiasm</a> for COVID-19 vaccines. A New York Times <a href="https://www.nytimes.com/2023/07/22/us/politics/ron-desantis-covid.html?">investigation</a> has documented the results: during the deadly Delta variant wave in late 2021 Florida – with 7% of the US population – suffered 14% of the deaths, 40% of them in people younger than 65. The authors estimate that if the vaccination rates in Florida had matched those in New England, more than 16,000 deaths and 61,000 hospitalizations could have been prevented in the Sunshine State.</p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Back to origins<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_112" o:spid="_x0000_i1026" style="height: 213pt; visibility: visible; width: 319pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image013.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLaxTP-Hh7rwxfWWm2ojylD-B0ff9SUzOshnSBMQP1sQ1JDihj-sfAzmxNj4nqwhxwPEw1ZcidQ8LEVKevlVqh-UAhcbU1laIN-wjzrLHjKgzwWb_JhVYbWPEQ4FV5rW5ZgdQQcrDpvU_NRcfaF90CSCHq98sRB5s6wQpN9Fe9sPZhZqSPYJnpHTiGZ4A/s639/wet%20market.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="426" data-original-width="639" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLaxTP-Hh7rwxfWWm2ojylD-B0ff9SUzOshnSBMQP1sQ1JDihj-sfAzmxNj4nqwhxwPEw1ZcidQ8LEVKevlVqh-UAhcbU1laIN-wjzrLHjKgzwWb_JhVYbWPEQ4FV5rW5ZgdQQcrDpvU_NRcfaF90CSCHq98sRB5s6wQpN9Fe9sPZhZqSPYJnpHTiGZ4A/w400-h266/wet%20market.jpeg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">The infamous Huanan "wet market"</td></tr></tbody></table><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;">Fairly plausible new claims that the <a href="https://public.substack.com/p/first-people-sickened-by-covid-19?">first 3 people</a> to have COVID-19 were all working at the Wuhan Institute of Virology have shaken for the first time my own conviction that the pandemic started with species spillover at the Huanan wet market, and made me take the lab leak hypothesis more seriously. Just to be on the safe side, the US has decided to <a href="https://www.washingtonpost.com/health/2023/07/19/coronavirus-origin-wuhan-lab-us-funding/?">cut off all funding</a> to the lab at the center of the controversy. As I’ve said many times, I don’t feel passionately about the issue and am not strongly invested in either hypothesis. </p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Zeynep Tufekci <a href="https://www.nytimes.com/2023/06/21/opinion/covid-lab-leak-origins.html?">has weighed in</a> with a thoughtful, readable, and ultimately agnostic article, while two other distinguished commentators have taken on the origins issue in a <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2305081?">perspective piece</a> in the New England Journal of Medicine. They lambast China for stonewalling investigations, but conclude after careful consideration that the scientific evidence supports natural emergence with spillover from animals.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Bottom line: the truth may <a href="https://www.nytimes.com/2023/06/21/us/politics/covid-pandemic-lab-leak-intelligence.html?">never be known</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The foul smell of musk<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_118" o:spid="_x0000_i1025" style="height: 192pt; visibility: visible; width: 4in;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image014.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhN67waDqF_xN6IvqS4ly7eL1dcCp2mv2U8PQpP9oA-FZcwXNXE7naQmL_0pZtGcHR6FPxuMDaTIFOpvu1vqRUa8xQxud7K56hZWuEoWweJlNEXlvj0722Go-umBsVMNu3-CfiThqwiUW6tenrNPcXYlzkCiP_fhSSTNjQUCE0C8l_KHG9m6Gn6Nfl39Hk/s1200/Bronny%20James%20with%20ball.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="800" data-original-width="1200" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhN67waDqF_xN6IvqS4ly7eL1dcCp2mv2U8PQpP9oA-FZcwXNXE7naQmL_0pZtGcHR6FPxuMDaTIFOpvu1vqRUa8xQxud7K56hZWuEoWweJlNEXlvj0722Go-umBsVMNu3-CfiThqwiUW6tenrNPcXYlzkCiP_fhSSTNjQUCE0C8l_KHG9m6Gn6Nfl39Hk/w400-h266/Bronny%20James%20with%20ball.jpeg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Lebron James's son Bronny</td></tr></tbody></table><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;">Elon is at it again, <a href="https://floridaphoenix.com/2023/07/28/fl-surgeon-general-blames-covid-19-vaccine-for-basketball-player-bronny-james-cardiac-arrest/">joined by</a> Ron DeSantis’s novax Surgeon General Joseph Ladapo. This time he’s <a href="https://thehill.com/policy/healthcare/4119186-musk-bronny-james-cardiac-arrest-covid-vaccine/?">blaming COVID-19 vaccines</a> – rather than the congenital heart defect likely to have <a href="https://www.espn.com/mens-college-basketball/story/_/id/38260006/bronny-james-cardiac-arrest-caused-congenital-heart-defect">actually been at fault</a> – for Bronny James’ cardiac arrest during a recent college basketball practice session. And he made “X” <a href="https://www.forbes.com/sites/antoniopequenoiv/2023/07/25/twitter-deletes-fact-check-of-musk-connecting-bronny-james-cardiac-arrest-to-covid-vaccine/">delete</a> a post that fact-checked his own “tweet” or whatever they’re called now. USA Today ran its own <a href="https://floridaphoenix.com/2023/07/28/fl-surgeon-general-blames-covid-19-vaccine-for-basketball-player-bronny-james-cardiac-arrest/">fact check</a> if you’re interested. Note that Bronny James <i>did</i> receive a COVID-19 vaccine but it was <a href="https://floridaphoenix.com/2023/07/28/fl-surgeon-general-blames-covid-19-vaccine-for-basketball-player-bronny-james-cardiac-arrest/">two years before his cardiac arrest</a>.</p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Guess how many U.S. adults believe the false claim that coronavirus vaccines have caused thousands of sudden deaths in otherwise healthy people? 34%! And an astonishing 20% (24% of Republicans, 12% of Democrats) think that more people have died from the COVID-19 vaccines than have died from COVID-19 itself. These numbers come from a remarkable <a href="https://www.kff.org/coronavirus-covid-19/poll-finding/kff-health-misinformation-tracking-poll-pilot/">new Kaiser poll</a>, whose key findings have been <a href="https://www.washingtonpost.com/politics/2023/08/22/republicans-vaccines-polls/?">summarized</a> by the Washington Post. The same poll found that 42% of US adults believe that people who have a firearm in their household are less likely to be killed by a gun than those who don’t. That’s <a href="https://med.stanford.edu/news/all-news/2022/04/handguns-homicide-risk.html">wrong</a>, <a href="https://injuryprevention.bmj.com/content/9/1/48">wrong</a>, and <a href="https://academic.oup.com/aje/article/160/10/929/140858">wrong</a> again.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">One of the nuttier novaxxers, an osteopath named Sherri Tenpenny, claimed COVID-19 vaccines magnetized people. Remember pictures of spoons sticking to people’s foreheads? She’s now been <a href="https://www.cleveland.com/open/2023/08/this-doctor-said-vaccines-magnetize-people-ohio-suspended-her-medical-license.html">stripped of her medical license</a>, as has – temporarily – a <a href="https://www.washingtonpost.com/health/2023/07/26/covid-misinformation-doctor-discipline/">hydroxychloroquine-monger</a> in Massachusetts. Wish somebody would do the same with <a href="https://www.nytimes.com/2021/07/24/technology/joseph-mercola-coronavirus-misinformation-online.html">Joseph Mercola</a> and his ilk. Red states are running in the opposite direction, though, with Florida recently <a href="https://www.washingtonpost.com/health/2023/07/26/covid-misinformation-doctor-discipline/">passing a law</a> that prevents professional boards from punishing doctors who spread COVID-19 misinformation, and <a href="https://legiscan.com/MO/text/HB2149/2022" target="_blank">Missouri</a>, <a href="https://legiscan.com/ND/text/HB1514/id/2451255" target="_blank">North Dakota</a> and <a href="https://legiscan.com/TN/text/SB2188/2021" target="_blank">Tennessee</a> following suit. Speaking of Florida, <a href="https://eu.palmbeachpost.com/story/news/columns/2023/04/19/radical-doc-gets-fla-medical-license-while-locked-up-for-capitol-riot/70122381007/">Simone Gold</a> (of America’s Frontline Doctors notoriety) received a state medical license while in prison for participation in the January 6<sup>th</sup> insurrection, after refusing to complete the “criminal history” section of her application. One Wisconsin physician was <a href="https://www.washingtonpost.com/health/2023/07/26/covid-misinformation-doctor-discipline/">reprimanded</a> by his state medical board with a slap on the wrist, while an Idaho pathologist who referred to coronavirus vaccines as “<a href="https://www.washingtonpost.com/health/2021/09/16/idaho-covid-gop-ryan-cole/?itid=lk_inline_manual_96" target="_blank">needle rape</a>” isn’t even under investigation.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://twitter.com/stkirsch/status/1659989834122002432">“I just heard from a reliable source that 98% of SIDS deaths happen within 10 days of vaccination.”</a> Irrelevant to COVID-19 vaccines, of course, since none are approved for babies under 6 months old, the age group suffering <a href="https://www.medicalnewstoday.com/articles/sids-risk-by-age#risk-by-age">90%</a>of Sudden Infant Deaths. If you have any suspicion that other childhood vaccines might increase the risk of SIDS, look <a href="https://www.chop.edu/centers-programs/vaccine-education-center/vaccines-and-other-conditions/vaccines-sudden-infant-death-syndrome-sids">here</a> and <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016363">here</a> and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0264410X06008978">here</a> and <a href="https://www.bmj.com/content/322/7290/822">here</a> and you will see that if anything the opposite is true.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://twitter.com/vigilantfox/status/1660673063556456456?s=43">“Health Outcomes for Unvaccinated Kids ‘Look Great’ as More Parents Decide to Go Natural”</a> The author of this gem cites an actual article in an actual medical journal, called SAGE Open Medicine, the only journal I’ve ever known to achieve an <a href="https://www.resurchify.com/impact/details/21100932751?utm_content=cmp-true">impact factor of 0.00</a>, meaning that no articles it published in 2021 have ever been cited in any other published articles. For comparison, the New England Journal of Medicine clocked in at <a href="https://impactfactorforjournal.com/journals-with-impact-factor/">176</a>, JAMA Neurology at <a href="https://en.wikipedia.org/wiki/JAMA_Neurology">30</a>. Psychosomatic Medicine, my professional society’s journal, stands at <a href="https://journals.lww.com/psychosomaticmedicine/pages/aboutthejournal.aspx">4.3</a>, considered <a href="https://www.scijournal.org/articles/good-impact-factor?">very respectable</a>.<o:p></o:p></p></div><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p></p><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p></p>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com2tag:blogger.com,1999:blog-6211405954943098401.post-59692826318636547482023-06-14T16:02:00.001+02:002023-06-14T16:02:35.012+02:00Looking Backward, Looking Forward<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNmgmF4SiVLcikCCM2S_Lih0cELftJe7rM-mbcpNCRrZmsdAF7itKrFzM1hibN0FayBlLR9G0CIE6uzE8OtWx1P356XOh8Aub_1N59T7OT5lgbot5cbILAh3dys6xg6uugDt0q_Qemp9SgbStoO0AFV28Pj28ECXQSxyI2G8h_FqigJXvnusdlAmXF/s444/yesterday%20today%20tomorrow%201.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="444" data-original-width="283" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNmgmF4SiVLcikCCM2S_Lih0cELftJe7rM-mbcpNCRrZmsdAF7itKrFzM1hibN0FayBlLR9G0CIE6uzE8OtWx1P356XOh8Aub_1N59T7OT5lgbot5cbILAh3dys6xg6uugDt0q_Qemp9SgbStoO0AFV28Pj28ECXQSxyI2G8h_FqigJXvnusdlAmXF/w256-h400/yesterday%20today%20tomorrow%201.jpg" width="256" /></a></div><style class="WebKit-mso-list-quirks-style">
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margin-right:0in;
margin-bottom:6.0pt;
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text-indent:-.25in;
mso-pagination:widow-orphan;
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tab-stops:list .25in;
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font-family:"Times New Roman",serif;
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mso-fareast-theme-font:minor-fareast;}
a:link, span.MsoHyperlink
{mso-style-priority:99;
color:#0563C1;
mso-themecolor:hyperlink;
text-decoration:underline;
text-underline:single;}
a:visited, span.MsoHyperlinkFollowed
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mso-style-priority:99;
color:#954F72;
mso-themecolor:followedhyperlink;
text-decoration:underline;
text-underline:single;}
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margin:0in;
mso-pagination:widow-orphan;
font-size:10.5pt;
font-family:Courier;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;
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p
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margin-right:0in;
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mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;}
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{mso-style-noshow:yes;
mso-style-priority:99;
mso-style-link:"Balloon Text Char";
margin:0in;
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font-family:"Lucida Grande",sans-serif;
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mso-fareast-theme-font:minor-fareast;}
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mso-style-priority:99;
mso-style-unhide:no;
mso-style-parent:"";
margin:0in;
mso-pagination:widow-orphan;
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mso-fareast-font-family:"Times New Roman";}
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{mso-style-priority:34;
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margin-right:0in;
margin-bottom:6.0pt;
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font-family:"Times New Roman",serif;
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p.MsoListParagraphCxSpFirst, li.MsoListParagraphCxSpFirst, div.MsoListParagraphCxSpFirst
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;}
p.MsoListParagraphCxSpMiddle, li.MsoListParagraphCxSpMiddle, div.MsoListParagraphCxSpMiddle
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;}
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{mso-style-priority:34;
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mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;}
span.Heading1Char
{mso-style-name:"Heading 1 Char";
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 1";
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mso-bidi-font-size:16.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Yu Mincho";
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mso-hansi-font-family:Arial;
mso-bidi-font-family:"Times New Roman";
mso-font-kerning:16.0pt;
font-weight:bold;
mso-bidi-font-weight:normal;}
span.Heading2Char
{mso-style-name:"Heading 2 Char";
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 2";
mso-ansi-font-size:13.0pt;
mso-bidi-font-size:13.0pt;
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
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mso-fareast-font-family:"Yu Gothic Light";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;}
span.Heading3Char
{mso-style-name:"Heading 3 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 3";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Yu Gothic Light";
mso-fareast-theme-font:major-fareast;
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mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#4472C4;
mso-themecolor:accent1;
font-weight:bold;}
span.Heading4Char
{mso-style-name:"Heading 4 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 4";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Yu Gothic Light";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
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mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;
font-style:italic;}
span.Heading5Char
{mso-style-name:"Heading 5 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 5";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Yu Gothic Light";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;}
span.Heading6Char
{mso-style-name:"Heading 6 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 6";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Yu Gothic Light";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#1F3763;
mso-themecolor:accent1;
mso-themeshade:127;}
p.text, li.text, div.text
{mso-style-name:text;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Plain Text";
margin-top:0in;
margin-right:0in;
margin-bottom:10.0pt;
margin-left:0in;
line-height:150%;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
span.PlainTextChar
{mso-style-name:"Plain Text Char";
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Plain Text";
mso-ansi-font-size:10.5pt;
mso-bidi-font-size:10.5pt;
font-family:Courier;
mso-ascii-font-family:Courier;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Courier;
mso-bidi-font-family:"Times New Roman";}
p.Heading, li.Heading, div.Heading
{mso-style-name:Heading;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Heading 1";
margin-top:12.0pt;
margin-right:0in;
margin-bottom:12.0pt;
margin-left:0in;
mso-pagination:widow-orphan;
page-break-after:avoid;
mso-outline-level:1;
font-size:12.0pt;
font-family:"Arial",sans-serif;
mso-fareast-font-family:"MS Mincho";
mso-bidi-font-family:"Times New Roman";
mso-font-kerning:16.0pt;
font-weight:bold;
mso-bidi-font-weight:normal;}
p.quotes, li.quotes, div.quotes
{mso-style-name:quotes;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Plain Text";
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
span.BalloonTextChar
{mso-style-name:"Balloon Text Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Balloon Text";
mso-ansi-font-size:9.0pt;
mso-bidi-font-size:9.0pt;
font-family:"Lucida Grande",sans-serif;
mso-ascii-font-family:"Lucida Grande";
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:"Lucida Grande";
mso-bidi-font-family:"Lucida Grande";}
p.quotesheadline, li.quotesheadline, div.quotesheadline
{mso-style-name:"quotes headline";
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:quotes;
mso-style-next:quotes;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Arial",sans-serif;
mso-fareast-font-family:"MS Mincho";
font-weight:bold;
mso-bidi-font-weight:normal;}
span.exldetailsdisplayval
{mso-style-name:exldetailsdisplayval;
mso-style-unhide:no;}
span.CommentTextChar
{mso-style-name:"Comment Text Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Comment Text";
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.UnresolvedMention1
{mso-style-name:"Unresolved Mention1";
mso-style-noshow:yes;
mso-style-priority:99;
color:#605E5C;
background:#E1DFDD;}
span.apple-converted-space
{mso-style-name:apple-converted-space;
mso-style-unhide:no;}
p.css-exrw3m, li.css-exrw3m, div.css-exrw3m
{mso-style-name:css-exrw3m;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.3m6-
{mso-style-name:_3m6-;
mso-style-unhide:no;}
span.3l3x
{mso-style-name:_3l3x;
mso-style-unhide:no;}
span.1lh7
{mso-style-name:_1lh7;
mso-style-unhide:no;}
span.1lld
{mso-style-name:_1lld;
mso-style-unhide:no;}
p.6coj, li.6coj, div.6coj
{mso-style-name:_6coj;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.6cok
{mso-style-name:_6cok;
mso-style-unhide:no;}
span.timestampcontent
{mso-style-name:timestampcontent;
mso-style-unhide:no;}
span.mbtext
{mso-style-name:mb_text;
mso-style-unhide:no;}
span.HeaderChar
{mso-style-name:"Header Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Header;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.FooterChar
{mso-style-name:"Footer Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Footer;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.5uzb
{mso-style-name:_5uzb;
mso-style-unhide:no;}
span.accessibleelem
{mso-style-name:accessible_elem;
mso-style-unhide:no;}
span.z-TopofFormChar
{mso-style-name:"z-Top of Form Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"z-Top of Form";
mso-ansi-font-size:8.0pt;
mso-bidi-font-size:8.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:Arial;
mso-bidi-font-family:Arial;
display:none;
mso-hide:all;}
p.1obc, li.1obc, div.1obc
{mso-style-name:_1obc;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.z-BottomofFormChar
{mso-style-name:"z-Bottom of Form Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"z-Bottom of Form";
mso-ansi-font-size:8.0pt;
mso-bidi-font-size:8.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:Arial;
mso-bidi-font-family:Arial;
display:none;
mso-hide:all;}
p.css-axufdj, li.css-axufdj, div.css-axufdj
{mso-style-name:css-axufdj;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.style-scope
{mso-style-name:style-scope;
mso-style-unhide:no;}
p.generic-articlesummary--li, li.generic-articlesummary--li, div.generic-articlesummary--li
{mso-style-name:generic-article__summary--li;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.diamond-blt, li.diamond-blt, div.diamond-blt
{mso-style-name:diamond-blt;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.font-copy, li.font-copy, div.font-copy
{mso-style-name:font-copy;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.dogb1923
{mso-style-name:dogb1923;
mso-style-unhide:no;}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:"Calibri",sans-serif;
mso-ascii-font-family:Calibri;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:Calibri;
mso-fareast-theme-font:minor-latin;
mso-hansi-font-family:Calibri;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;
mso-header-margin:.5in;
mso-footer-margin:.5in;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
/* List Definitions */
@list l0
{mso-list-id:-119;
mso-list-type:simple;
mso-list-template-ids:-1888465356;}
@list l0:level1
{mso-level-number-format:bullet;
mso-level-style-link:"List Bullet";
mso-level-text:;
mso-level-tab-stop:.25in;
mso-level-number-position:left;
margin-left:.25in;
text-indent:-.25in;
font-family:Symbol;}
@list l1
{mso-list-id:125974259;
mso-list-template-ids:-1612801510;}
@list l1:level1
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l1:level2
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:1.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:"Courier New";
mso-bidi-font-family:"Times New Roman";}
@list l1:level3
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:1.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level4
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:2.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level5
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:2.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level6
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:3.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level7
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:3.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level8
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:4.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level9
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:4.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l2
{mso-list-id:150560276;
mso-list-template-ids:-944067816;}
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</style><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">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.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Treatment<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f"><v:stroke joinstyle="miter"><v:formulas><v:f eqn="if lineDrawn pixelLineWidth 0"><v:f eqn="sum @0 1 0"><v:f eqn="sum 0 0 @1"><v:f eqn="prod @2 1 2"><v:f eqn="prod @3 21600 pixelWidth"><v:f eqn="prod @3 21600 pixelHeight"><v:f eqn="sum @0 0 1"><v:f eqn="prod @6 1 2"><v:f eqn="prod @7 21600 pixelWidth"><v:f eqn="sum @8 21600 0"><v:f eqn="prod @7 21600 pixelHeight"><v:f eqn="sum @10 21600 0"></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:formulas><v:path gradientshapeok="t" o:connecttype="rect" o:extrusionok="f"><o:lock aspectratio="t" v:ext="edit"></o:lock></v:path></v:stroke></v:shapetype><v:shape id="Picture_x0020_96" o:spid="_x0000_i1039" style="height: 211pt; visibility: visible; width: 207pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image001.png"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAYjtLhjAFrQ-JSsjkCig884cp3q4leHJJYMbfwK1dzcTt2mTgpAXB-JIfAsDNIw13kL_eDtAqXXNmzWsz4RFT4MH1T4HQSabmNkYKh8UuJJcbUvhdYreIK0LQmc_ZPtGuPnki4uLXdUe8Yf1rrNyeRW1UKDZGvcZT88q_PHErRjam6MMYzcbaI9eq/s449/Crystal%20structure%20of%20nattokinase.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="449" data-original-width="440" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAYjtLhjAFrQ-JSsjkCig884cp3q4leHJJYMbfwK1dzcTt2mTgpAXB-JIfAsDNIw13kL_eDtAqXXNmzWsz4RFT4MH1T4HQSabmNkYKh8UuJJcbUvhdYreIK0LQmc_ZPtGuPnki4uLXdUe8Yf1rrNyeRW1UKDZGvcZT88q_PHErRjam6MMYzcbaI9eq/s320/Crystal%20structure%20of%20nattokinase.png" width="314" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">The crystal structure of nattokinase</td></tr></tbody></table><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The <a href="https://web.archive.org/web/20230317191350/https:/petermcculloughmd.substack.com/p/dissolution-of-spike-protein-by-nattokinase">“Holy Grail of COVID-19 Vaccine Detoxification”?</a> That’s the claim notorious misinformation-monger <a href="https://healthfeedback.org/authors/peter-mccullough/">Peter McCullough</a> 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 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9458005/">can break down</a> 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!<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">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 <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00299-2/fulltext">Lancet</a>, and it’s <a href="https://insidemedicine.substack.com/p/did-a-clinical-trial-just-prove-that?utm_source=substack&utm_medium=email">somehow impressed</a> 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.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Vaccines and prevention<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_26" o:spid="_x0000_i1038" style="height: 193pt; visibility: visible; width: 399pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image002.jpg"></v:imagedata></v:shape></b><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgievv3E7dw2r5IGZJHWASBpyPYAj9WqBjTV9mSYsL7CMHzx6isUeC201MXbS8ZbeGcQYCIs24Wafen3CT7ymPEBcQWHcnSvNp-nucFVMP6Srx9v8XjLHeCd2KUAhM3BJ4FApy1JO0TJKue3zEBdp3YFynRrZrCtcMS9Y47FlXrfTBbK7h36oC6GjIA/s810/Lio.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="341" data-original-width="810" height="169" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgievv3E7dw2r5IGZJHWASBpyPYAj9WqBjTV9mSYsL7CMHzx6isUeC201MXbS8ZbeGcQYCIs24Wafen3CT7ymPEBcQWHcnSvNp-nucFVMP6Srx9v8XjLHeCd2KUAhM3BJ4FApy1JO0TJKue3zEBdp3YFynRrZrCtcMS9Y47FlXrfTBbK7h36oC6GjIA/w400-h169/Lio.png" width="400" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I’ve mentioned the excellent home-grown vaccines in Cuba, and the <a href="https://www.stethoscopeonrome.com/2021/11/extra-welcome-omicron.html">country’s generosity</a> in distributing internationally not just the vaccines themselves but the technology behind them. But now I’ve learned the <a href="https://www.washingtonpost.com/opinions/2023/06/01/pandemic-vaccines-cuba-who-planning/">shocking backstory</a> 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.<b><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">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 <a href="https://www.who.int/news/item/18-05-2023-statement-on-the-antigen-composition-of-covid-19-vaccines">World Health Organization now suggests</a> the next version return to being monovalent, this time based on one of the XBB subvariants that dominate new cases in the <a href="https://peoplescdc.substack.com/p/peoples-cdc-covid-19-weather-report-4c8?">US</a>, <a href="https://www.epicentro.iss.it/coronavirus/pdf/sars-cov-2-monitoraggio-varianti-rapporti-periodici-28-aprile-2023.pdf">Italy</a> and elsewhere. Such a vaccine can’t be developed overnight, but it might be available by <a href="https://www.cnbc.com/2023/06/12/new-covid-vaccines-in-fall-need-to-target-xbb-variant-fda-staff-says.html">autumn</a>. <a href="https://insidemedicine.substack.com/p/who-recommends-next-covid-booster?">Jeremy Faust</a> discusses the issue pretty clearly. I’m not totally convinced, since the bivalent booster performed reasonably well against XBB in <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7205e1.htm?">some</a> though <a href="https://www.nature.com/articles/s41591-022-02162-x">not all</a> studies. It’s similarly unclear how well the original monovalent component that’s due to be purged works against recent Omicron subvariants, with <a href="https://www.medrxiv.org/content/10.1101/2023.03.17.23287411v2">some</a> but <a href="https://www.nejm.org/doi/10.1056/NEJMc2215471">not all</a>reports finding the old wild-strain monovalents as effective as the new bivalents.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">China <a href="https://www.globaltimes.cn/page/202305/1291118.shtml">has already approved</a> two new boosters targeting XBB, and plans to start rolling them out soon to vulnerable populations. One is a trivalent <a href="https://www.prnewswire.co.uk/news-releases/china-approves-the-worlds-first-vaccine-against-xbb-descendent-lineages-of-sars-cov-2-for-emergency-use-301846885.html">protein-based vaccine</a>, whereas the other might possibly include an <a href="https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(23)00080-9/fulltext">mRNA component</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">A Swiss research group <a href="https://www.biorxiv.org/content/10.1101/2023.05.17.541127v1.full.pdf">has developed</a> 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.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Vaccinating the global South: last time I said the COVAX initiative had “failed abjectly” because <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&uniformYAxis=0&country=USA~Low+income~ITA&pickerSort=desc&pickerMetric=total_deaths&hideControls=true&Metric=People+fully+vaccinated&Interval=Weekly&Relative+to+Population=true&Color+by+test+positivity=false">only 25% (now 25.7%)</a> of inhabitants of low-income countries were “fully vaccinated,” far short of COVAX’s stated 70% goal. Compare that to <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&uniformYAxis=0&country=USA~Low+income~ITA&pickerSort=desc&pickerMetric=total_deaths&hideControls=true&Interval=Weekly&Relative+to+Population=true&Color+by+test+positivity=false&Metric=People+fully+vaccinated">81.3%</a> 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 <a href="https://www.wilsoncenter.org/blog-post/africas-median-age-about-19-median-age-its-leaders-about-63#:~:text=The%20Median%20Age%20of%20Its%20Leaders%20Is%20about%2063.,-By%20Ambassador%20Mark&text=Africa%20has%20the%20world%27s%20youngest,median%20age%20are%20in%20Africa.">under 19</a> and <a href="https://www.worlddata.info/average-age.php">half of Indians</a> 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. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Good news: a half-dozen African countries have bested the United States, <a href="https://africacdc.org/covid-19-vaccination/">exceeding 70% coverage</a>, and <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-10-16..latest&facet=none&country=ITA~USA~Low+income~OWID_WRL&pickerSort=desc&pickerMetric=total_cases&hideControls=true&Metric=People+fully+vaccinated&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false">64.4% of the world’s population</a> has now had at least a primary series. And, again, <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7205a1.htm?">76% of all human beings over age 60</a> have been vaccinated. But there’s a huge gap between rich and poor countries. As of March 2023, <a href="https://reliefweb.int/report/world/covid-19-vaccine-delivery-partnership-situation-report-february-and-march-2023">92% of elderly people</a> 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 <a href="https://africacdc.org/covid-19-vaccination/">27% of the doses</a> administered in Africa were mRNA vaccines, the rest being less effective products from Johnson & Johnson (36%), AstraZeneca (16%), or China (21%).<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Headline from the Australian Broadcasting Corporation: <a href="https://www.abc.net.au/news/2023-05-31/australian-garlic-limits-spread-of-covid-and-flu-medical-study/102414668">“Australian garlic variety can limit internal spread of COVID and influenza A, Doherty Institute finds.”</a> 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 <a href="https://www.sbs.com.au/news/article/can-garlic-really-cure-covid-heres-what-you-need-to-know/4bbz3oh22">in vitro</a>, performed in a test tube, not in people or even mice.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>How long do the bivalent boosters last?</u><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Seven American states</u>: In new <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7221a3.htm?">data from the CDC</a>, 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. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>North Carolina</u>: A <a href="https://www.nejm.org/doi/10.1056/NEJMc2302462">study</a> 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.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Israel</u>: But researchers at a giant Israeli insurance company found <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00122-6/fulltext">stronger results</a>, reporting that a bivalent booster increased protection against hospitalization by 72% over monovalent vaccination alone, for 4 months. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The state of the pandemic<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_82" o:spid="_x0000_i1037" style="height: 252pt; visibility: visible; width: 286pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image003.jpg"></v:imagedata></v:shape><v:shape id="Picture_x0020_84" o:spid="_x0000_i1036" style="height: 252pt; visibility: visible; width: 287pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image004.jpg"></v:imagedata></v:shape><v:shape id="Picture_x0020_86" o:spid="_x0000_i1035" style="height: 252pt; visibility: visible; width: 286pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image005.jpg"></v:imagedata></v:shape><v:shape id="Picture_x0020_90" o:spid="_x0000_i1034" style="height: 252pt; visibility: visible; width: 287pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image006.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhz-qjdmvCtxu1ue0LpJhY3iUjuuRu-xVMd7GTgki43G98weObztJZtZWBHsU-AhaSQNt55A_A73uGC-v18zQIBaMWc3Axqt4l0fa47bOc3ccWOqr302QzgAaup-dew8JwuqKlbYNB9miUVVx8VHAyynG2XO6oRr66rW1XMC43K1PSCLFX-ZjcSRVqG/s1106/world%20covid%205:20.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="972" data-original-width="1106" height="281" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhz-qjdmvCtxu1ue0LpJhY3iUjuuRu-xVMd7GTgki43G98weObztJZtZWBHsU-AhaSQNt55A_A73uGC-v18zQIBaMWc3Axqt4l0fa47bOc3ccWOqr302QzgAaup-dew8JwuqKlbYNB9miUVVx8VHAyynG2XO6oRr66rW1XMC43K1PSCLFX-ZjcSRVqG/s320/world%20covid%205:20.jpg" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4lZCfWHKniO_giIfazaN6z0ijARxdLc4sr0ZpB9mqR5j22jud9aKzs_81oAyq4FpT-vnxZw4gM5Xs9BVfKybSEK0D-Xy6TLv2Hs-xF5dSt7pzpYPvRPrbuRMEm4VeRX-G2z8fjGYC3MqXkFV_NG516R4-3HH9jr3_DtnAiDiSjgrh9gHJ8wG27JLs/s1106/world%20covid%205:21.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="972" data-original-width="1106" height="281" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4lZCfWHKniO_giIfazaN6z0ijARxdLc4sr0ZpB9mqR5j22jud9aKzs_81oAyq4FpT-vnxZw4gM5Xs9BVfKybSEK0D-Xy6TLv2Hs-xF5dSt7pzpYPvRPrbuRMEm4VeRX-G2z8fjGYC3MqXkFV_NG516R4-3HH9jr3_DtnAiDiSjgrh9gHJ8wG27JLs/s320/world%20covid%205:21.jpg" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjT11kwxQiUn0L6ArgzK7zOnho0cV4V5fy_L6yln3DJpbCA-n5U5KNrl9NTgvl4S4EEXr7WkSHk0ppqnooohLPQPcjXLW2jZLjIiv1XO4UjQ3WmHT9j2mSiYkqL1eyUss8mjr7pYSS9jFyjGAderwwikNvozRraYaE9QO2aO3Py1xfk2K6RW7HHSLYA/s1106/world%20covid%205:22.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="972" data-original-width="1106" height="281" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjT11kwxQiUn0L6ArgzK7zOnho0cV4V5fy_L6yln3DJpbCA-n5U5KNrl9NTgvl4S4EEXr7WkSHk0ppqnooohLPQPcjXLW2jZLjIiv1XO4UjQ3WmHT9j2mSiYkqL1eyUss8mjr7pYSS9jFyjGAderwwikNvozRraYaE9QO2aO3Py1xfk2K6RW7HHSLYA/s320/world%20covid%205:22.jpg" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUYW-t37YWdgzRmFlVbS4AcWmQXIyKjvhmjDjcWtCHitK0JVDP-LoQ3bOwnasHtPilFrnfwgOdDvDRbf0jigS53cCCIVMIJ0hkNHt8q8QTa30rMk1nUoWQ3243txmoUQuPkgbAORsd4O9m7Txs7lcJtrdL9ZC8a-Rgm2K1tQ2WFpXHulKzYW7UUq8m/s1106/world%20covid%205:23.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="972" data-original-width="1106" height="281" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUYW-t37YWdgzRmFlVbS4AcWmQXIyKjvhmjDjcWtCHitK0JVDP-LoQ3bOwnasHtPilFrnfwgOdDvDRbf0jigS53cCCIVMIJ0hkNHt8q8QTa30rMk1nUoWQ3243txmoUQuPkgbAORsd4O9m7Txs7lcJtrdL9ZC8a-Rgm2K1tQ2WFpXHulKzYW7UUq8m/s320/world%20covid%205:23.jpg" width="320" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">As these maps show, things have cooled down enormously. Even cautious <a href="https://www.timesofisrael.com/health-ministry-announces-cancellation-of-few-remaining-covid-restrictions/">Israel</a> 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. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">But the pandemic isn’t over. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The US is still running <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-10-16..latest&facet=none&country=~USA&pickerSort=desc&pickerMetric=total_cases&hideControls=true&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=false&Color+by+test+positivity=false">close to 300 deaths</a> a day, and I encounter new cases at least once a week.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">In Australia, COVID-19 hospitalizations <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-10-16..latest&facet=none&uniformYAxis=0&country=~AUS&pickerSort=desc&pickerMetric=total_cases&hideControls=true&Metric=Hospital+patients&Interval=7-day+rolling+average&Relative+to+Population=false&Color+by+test+positivity=false">have doubled</a> since March. Some schools have <a href="https://www.visiontimes.com/2023/05/21/australia-schools-revert-covid-masks-remote-learning-measures.html?fbclid=IwAR3viG3YmY97zlczivr-IF1sHl-h9Iw-FGfRU1Qrt5EHXii7pOkDflPu2F0">reintroduced</a> 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 5<sup>th</sup> wave <a href="https://www.abc.net.au/news/2023-05-23/covid-omicron-fifth-wave-winter-2023/102374504">that started</a> in southern Australia is threatening to spread northward.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">In New Zealand too, COVID-19 hospitalizations and deaths have <a href="https://www.phcc.org.nz/briefing/aotearoa-new-zealands-fourth-wave-covid-19-and-why-we-should-care">doubled</a> since early March. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">China anticipates a surge hitting <a href="https://www.financialexpress.com/healthcare/covid-19/chinas-new-covid-wave-set-to-see-65-million-cases-a-week/3098373/">65 million cases a week</a> by late June. While most Chinese are living like 2019, some are <a href="https://www.washingtonpost.com/world/2023/06/06/china-covid-zero-restrictions-cases/?">still trying for</a> “zero COVID.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Some European experts <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01012-7/fulltext#%20">are warning against complacency</a>, noting unacceptable risks of severe disease among the vulnerable and of long COVID following even mild-to-moderate disease.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Kennedy for President?<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_83" o:spid="_x0000_i1033" style="height: 213pt; visibility: visible; width: 266pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image007.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmaH91a7-xZk7OtQkqv4kXtYU0btctZphVWQ-5yDvfNAbRUbwTmcoH1DBAJd-ViWEL-xiD0cOtmsMaMVYyyh48z3Q0JuFxX5yKuVMWlll6ADtQ1eSN_HxwmYKnZN3yglpiPfzOISxCXCwP-Of3eFI27xkZjxQ7l2vDojLLX7kBlwUKl1wHHnJ5WgFh/s2048/RFK%20jr%20top%20left.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1636" data-original-width="2048" height="256" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmaH91a7-xZk7OtQkqv4kXtYU0btctZphVWQ-5yDvfNAbRUbwTmcoH1DBAJd-ViWEL-xiD0cOtmsMaMVYyyh48z3Q0JuFxX5yKuVMWlll6ADtQ1eSN_HxwmYKnZN3yglpiPfzOISxCXCwP-Of3eFI27xkZjxQ7l2vDojLLX7kBlwUKl1wHHnJ5WgFh/s320/RFK%20jr%20top%20left.jpeg" width="320" /></a></div><br />Robert F. Kennedy, Jr., “<a href="https://www.currentaffairs.org/2023/05/rfk-jr-is-a-lying-crank-posing-as-a-progressive-alternative?fbclid=IwAR1SJaV931deJrY83RsiTTE-J-cDBf_LXshR8Tpu4NXMMEF3BP9d4L8-GRQ">lying crank</a>,” author of a vicious <a href="https://www.amazon.com/Real-Anthony-Fauci-Democracy-Childrens/dp/1510766804">book</a> about Anthony Fauci, banned from Facebook and Instagram for being among the <a href="https://counterhate.com/research/the-disinformation-dozen/">worst purveyors</a> of Novax lies, is <a href="https://www.nytimes.com/2023/04/17/us/politics/robert-f-kennedy-jr-vaccines.html">challenging Joe Biden</a> for the Democratic Presidential <a href="https://www.washingtonpost.com/politics/2023/06/05/rfk-jr-democratic-primary-biden/">nomination</a>. Doesn’t he look cute in the picture, though (top row, left)?<o:p></o:p><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Scarily, he’s polled <a href="https://www.foxnews.com/official-polls/fox-news-poll-trump-still-top-2024-republican-preference-desantis-slipping">at 19%</a> among Democrats on one <a href="https://www.washingtonpost.com/politics/2023/04/27/robert-kennedy-jr-democratic-primary/">Fox News poll</a>. Are people mixing him up with his murdered father, going by the <a href="https://s2.washingtonpost.com/camp-rw/?trackId=599d6acbae7e8a3d46e1400f&s=647e4b22e49da13a6d4901e6&linknum=4&linktot=53&linknum=4&linktot=53">prestige of his last name</a>, or <a href="https://www.theguardian.com/commentisfree/2023/jun/14/ignoring-robert-f-kennedy-jr-not-an-option">genuinely enthusiastic</a>?<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Kennedy’s army of antivaxxers <a href="https://www.npr.org/sections/health-shots/2021/06/08/1004214189/anti-vaccine-film-targeted-to-black-americans-spreads-false-information">managed to scam</a> 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 <a href="https://www.factcheck.org/2021/03/scicheck-rfk-jr-video-pushes-known-vaccine-misrepresentations/">debunking</a> at FactCheck.org.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">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 <a href="https://www.politifact.com/factchecks/2020/oct/21/donald-trump/trump-says-he-prevented-2-million-covid-19-deaths-/">saved 2 million lives</a>. As per my last post, Anthony Fauci thinks that was <a href="https://www.nytimes.com/interactive/2023/04/24/magazine/dr-fauci-pandemic.html">underestimating by half</a>. 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.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>CDC blues<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_99" o:spid="_x0000_i1032" style="height: 193pt; visibility: visible; width: 127pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image008.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEc_kmvxObtoPvgwI7Dw3ub_ryQsf-xQvXvWmtXysIIyUsyPyK4kkPx0tRzIx9Rs5BI5ZIxyN5sJAqjVr_ck2cl61BBAlqTJf2IpVQhT6H7DMCqrGV8dRvH_F4lx3wETO4nCB1L4fmIXa41Bcpvq4H4_l5MHtM3W6VvRlv3ZeHXmpQ-8cjQpk-iMJQ/s886/Mandy%20Cohen.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="886" data-original-width="584" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEc_kmvxObtoPvgwI7Dw3ub_ryQsf-xQvXvWmtXysIIyUsyPyK4kkPx0tRzIx9Rs5BI5ZIxyN5sJAqjVr_ck2cl61BBAlqTJf2IpVQhT6H7DMCqrGV8dRvH_F4lx3wETO4nCB1L4fmIXa41Bcpvq4H4_l5MHtM3W6VvRlv3ZeHXmpQ-8cjQpk-iMJQ/w213-h320/Mandy%20Cohen.jpg" width="213" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Mandy Cohen</td></tr></tbody></table><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">“<a href="https://peoplescdc.org/2023/01/10/what-to-do-if-you-have-covid/">The People’s CDC</a>” does much better than the <a href="https://www.cdc.gov/coronavirus/2019-ncov/your-health/isolation.html">real CDC</a> at advising people how to handle COVID-19. And an infectious disease nurse gives <a href="https://twitter.com/sobsinepi/status/1625621637012783104?">additional good advice</a>, starting with warning people you might have exposed (a step the People’s CDC neglects). <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">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 <a href="https://peoplescdc.substack.com/p/peoples-cdc-covid-19-weather-report-457?">“People’s CDC” webpage</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I’ve said that <a href="https://www.washingtonpost.com/health/2023/05/02/covid-outbreak-cdc-annual-conference/?utm_campaign=wp_the_health_202&utm_medium=email&utm_source=newsletter&wpisrc=nl_health202">35 of the 1800</a> people who attended a Centers for Disease Control’s conference had come down with COVID-19. But now we know <a href="https://www.washingtonpost.com/health/2023/05/26/cdc-covid-outbreak/">more</a> 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 <a href="https://jamanetwork.com/journals/jama/fullarticle/2805540">about 18</a> 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.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The People’s CDC <a href="https://peoplescdc.substack.com/p/peoples-cdc-covid-19-weather-report-4c8?">points out</a> that the embarassing CDC outbreak is “an unfortunate example of its own ineffective policies” based on pushing individual choice over a population health approach.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">A propos of the CDC, there’s <a href="https://www.washingtonpost.com/health/2023/06/01/cdc-director-mandy-cohen/">now a candidate</a> 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 <a href="https://s2.washingtonpost.com/camp-rw/?trackId=599d6acbae7e8a3d46e1400f&s=6479d89b49fef7411d0230b2&linknum=4&linktot=54&linknum=4&linktot=54">and to Anthony Fauci</a>, though apparently some current CDC personnel have reservations.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Giving with one hand…<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_92" o:spid="_x0000_i1031" style="height: 238pt; visibility: visible; width: 359pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image009.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkaVKuJYTKHexdDUaYcHbev8laXDUj5EFAE-zba7dDr6WD2-mlBtF_znSSj7UWT7GlOGJDGkANLnaUIXvBbfPtPgL8QsNh2ssX5OZW-SZsLFWQ9YzBsMzKyH9qxQf4QcSWWPrQEvZKckpD5BRpebB-1feiQNUlg4PYqrxJOdCnLpx-UIpMgGWNe9GZ/s1292/Ming%20Lin.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="856" data-original-width="1292" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkaVKuJYTKHexdDUaYcHbev8laXDUj5EFAE-zba7dDr6WD2-mlBtF_znSSj7UWT7GlOGJDGkANLnaUIXvBbfPtPgL8QsNh2ssX5OZW-SZsLFWQ9YzBsMzKyH9qxQf4QcSWWPrQEvZKckpD5BRpebB-1feiQNUlg4PYqrxJOdCnLpx-UIpMgGWNe9GZ/s320/Ming%20Lin.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Ming Lin</td></tr></tbody></table><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://www.healthaffairs.org/content/forefront/maintaining-coverage-gains-during-medicaid-unwinding">Unwinding</a> pandemic Medicaid expansions: <a href="https://www.nytimes.com/2023/05/26/us/politics/medicaid-coverage-pandemic-loss.html?">More than half a million</a> 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 <a href="https://www.hhs.gov/about/news/2023/06/12/letter-us-governors-from-hhs-secretary-xavier-becerra-medicaid-redeterminations.html?utm_campaign=wp_the_health_202&utm_medium=email&utm_source=newsletter&wpisrc=nl_health202">offers strategies</a> to overcome. The <a href="https://ccf.georgetown.edu/2023/05/31/new-cbo-estimates-of-the-impact-of-unwinding-on-medicaid-enrollment-uninsured/#:~:text=With%20unwinding%2C%20CBO%20expects%2015.5,are%20estimated%20to%20be%20children.">latest estimate</a> 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 <a href="https://www.myflfamilies.com/sites/default/files/2023-03/Appendix%20A-7%20Family-Related%20Medicaid%20Income%20Limit%20Chart.pdf">Florida</a>, a single person must have a monthly income under $1215 a month, and a family of four under $2500. In <a href="https://www.myflfamilies.com/sites/default/files/2023-03/Appendix%20A-7%20Family-Related%20Medicaid%20Income%20Limit%20Chart.pdf">Florida</a> and <a href="https://www.helpadvisor.com/medicaid/south-carolina-medicaid#~:text=People%20who%20live%20in%20South,%2414%2C580%20or%20less%20a%20year.">South Carolina</a>, it’s again $1215 a month for singles but just $1643 for that family of 4. <a href="https://www.alabamapublichealth.gov/allkids/assets/2023allkidsincomeguide.pdf">Alabama</a> generously allows a family of 4 to have up to $3,650 per month and remain on Medicaid. <a href="https://www.benefits.gov/benefit/1640%7D#:~:">In Texas</a> 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.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">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 <a href="https://www.nytimes.com/2023/05/26/us/politics/employee-retention-credit-tax-fraud.html?">“Tidal wave” of fraud</a>. 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 <a href="https://www.gao.gov/products/gao-23-105331">3.7 million</a> recipients of Small Business Administration funds with warning signs suggesting potential fraud; between <a href="https://www.pandemicoversight.gov/spotlight/unemployment-insurance-fraud">$163 billion</a> and <a href="https://www.axios.com/2021/06/10/pandemic-unemployment-fraud-benefits-stolen">$400 billion</a>in enhanced unemployment insurance is thought to have been improper; and a business tax refund program seems to have been scammed for <a href="https://www.nytimes.com/2023/05/26/us/politics/employee-retention-credit-tax-fraud.html?">$152 billion</a>. These numbers are staggering, and swamp by an order of magnitude the <a href="https://www.npr.org/2023/05/31/1178996725/debt-ceiling-deal-unspent-covid-relief-money-democrats-republicans">paltry $27 billion</a> 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 <i>have</i>run across is the case of a former Connecticut lawmaker <a href="https://apnews.com/article/connecticut-coronavirus-fraud-lawmaker-sentencing-5fc0a1014afe40b23f8c7c87a78e4a34">who’s been sentenced</a> 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.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">…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 <a href="https://m.facebook.com/story.php?story_fbid=10216583796603708&id=1122938346&ref=content_filter">COVID-19 protocols</a>, and is now nobly <a href="https://www.cascadiadaily.com/news/2023/may/31/fired-from-st-joes-bellingham-doctor-stands-his-ground/">insisting on going to trial</a> to obtain an admission of wrongdoing, rather than settling for a monetary award as his ACLU lawyers advise. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Scammers and charlatans<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_30" o:spid="_x0000_i1030" style="height: 237pt; visibility: visible; width: 297pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image010.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg22PVJiVYISHTMHtDEAu6R5g0Pwx_M9k1b6rCsbz5VBZli5_R4eJJ4rBuvNKv2umF8o9bNpDHMTmOXE2XoyuitY4WT9jKsk-ZLi0GmZb5IGHuswQrKACiVoq_nSwcMijRf4BBTzIZGXo17LvYmDWofqd97qscFjdD2i3AfDQ9B0JISOSqrNmt8W9BK/s454/AFLD.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="362" data-original-width="454" height="319" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg22PVJiVYISHTMHtDEAu6R5g0Pwx_M9k1b6rCsbz5VBZli5_R4eJJ4rBuvNKv2umF8o9bNpDHMTmOXE2XoyuitY4WT9jKsk-ZLi0GmZb5IGHuswQrKACiVoq_nSwcMijRf4BBTzIZGXo17LvYmDWofqd97qscFjdD2i3AfDQ9B0JISOSqrNmt8W9BK/w400-h319/AFLD.jpeg" width="400" /></a></div><br /><u><br /></u><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>“America’s Frontline Doctors”</u>: Not content with having murdered untold numbers of gullible COVID-19 patients with <a href="https://time.com/6092368/americas-frontline-doctors-covid-19-misinformation/">quack cures</a>, now AFD has <a href="https://time.com/6278831/ivermectin-americas-frontline-doctors-lawsuits-covid-19/">moved on to</a> charging thousands of dollars for treating “post-vaccine syndrome” and peddling ivermectin as a cure for ovarian cancer.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Pathological pathologists</u>: 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 <a href="https://idahocapitalsun.com/2022/05/06/idaho-doctor-who-falsely-links-covid-19-vaccine-to-cancer-has-misdiagnosed-patients/">misdiagnosing cancer</a> 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 <a href="https://www.factcheck.org/2021/04/scicheck-idaho-doctor-makes-baseless-claims-about-safety-of-covid-19-vaccines/">debunked</a> here.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-bottom: 0in; margin-right: 5.75pt; margin-top: 5pt;">And these are the Shkreli award <a href="https://lowninstitute.org/2022-shkreli-awards-dishonorable-mentions/">runners-up</a>:<o:p></o:p></p><p class="1obc" style="margin-bottom: 5pt; margin-left: 0.5in; margin-right: 5.75pt; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Hospital charges facility fee for patients who never set foot in the facility<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l41 level1 lfo24; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Doctor who makes living from surprise billing sues feds for protecting patients from surprise bills<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l41 level1 lfo24; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Liberal prescription of Adderall helps telehealth app “Cerebral” grow and retain patient base<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l41 level1 lfo24; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Blood thinners are billion-dollar boondoggle for price-hiking pharma buddies<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l41 level1 lfo24; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Government program designed to forgive student loans saddles healthcare workers with more debt<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Looking backward<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin: 5pt 6pt 5pt 0.5in;"><v:shape id="Picture_x0020_81" o:spid="_x0000_i1029" style="height: 296pt; visibility: visible; width: 296pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image011.png"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQs9kmVOObnHVVuMz1eHzp2kLRBWhCK5YVDL7TF6cJt2MuTEKMNCwi5H3bid1HfbpdT-oUuFAhYH1__GgjXEIO4B6xbqnSIau9ej7onoV2Aw-x52i_L4PF1J788Rjz-OEnHjmPKLRSpoh9atVwB1bB0Zx3Pb4SgJEo7t2qMNeGjlVXNKJY039jJOcw/s1200/UK%20ER%20waiting%20room.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1200" data-original-width="1200" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQs9kmVOObnHVVuMz1eHzp2kLRBWhCK5YVDL7TF6cJt2MuTEKMNCwi5H3bid1HfbpdT-oUuFAhYH1__GgjXEIO4B6xbqnSIau9ej7onoV2Aw-x52i_L4PF1J788Rjz-OEnHjmPKLRSpoh9atVwB1bB0Zx3Pb4SgJEo7t2qMNeGjlVXNKJY039jJOcw/s320/UK%20ER%20waiting%20room.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">An Emergency Room waiting room in England</td></tr></tbody></table><br />The Royal College of Emergency Medicine <a href="https://news.sky.com/story/nhs-around-23-000-excess-deaths-in-2022-were-linked-to-a-e-waits-college-claims-12821720">calculates</a> 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 <a href="https://talk.tv/news/2128/23000-excess-patient-deaths-linked-to-ae-waits">exaggerated</a>, 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.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">An <a href="https://academic.oup.com/ej/article/132/643/1200/6382847?login=false">interesting study</a> 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.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">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 <a href="https://www.medrxiv.org/content/10.1101/2021.05.13.21257065v2.full.pdf">preprint</a> 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.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Long COVID<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_93" o:spid="_x0000_i1028" style="height: 237pt; visibility: visible; width: 379pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image012.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4_RQaxn6OoZ3vJJmJ5mT972Tg2JCXxhGv5ueCQwuw-USGWc2efZUBPpoqFzTRqKRrWIsRe4bd7yLMmwa5NFzJlJnOf3yzHl91Il5ILvmY-D_C9Whqp_tO--EUK90QTNhUuT8VGS0ktK3RgNEh0C3vKxcW0M87J4rwiNhfG9Fpt6YswUSzyW5j0iVf/s768/stimulate_icp4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="480" data-original-width="768" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4_RQaxn6OoZ3vJJmJ5mT972Tg2JCXxhGv5ueCQwuw-USGWc2efZUBPpoqFzTRqKRrWIsRe4bd7yLMmwa5NFzJlJnOf3yzHl91Il5ILvmY-D_C9Whqp_tO--EUK90QTNhUuT8VGS0ktK3RgNEh0C3vKxcW0M87J4rwiNhfG9Fpt6YswUSzyW5j0iVf/s320/stimulate_icp4.jpg" width="320" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Many long COVID symptoms now seem <a href="https://www.scientificamerican.com/article/long-covid-now-looks-like-a-neurological-disease-helping-doctors-to-focus-treatments/">rooted in the brain</a>. 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 <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2805366">inflammation</a>, impaired <a href="https://www.mdpi.com/1999-4915/14/9/2000">blood flow</a>, or a <a href="https://www.statnews.com/2023/02/16/the-haunting-brain-science-of-long-covid/">combination</a> of the two. It’s not yet clear how this insight might inform therapy. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://jamanetwork.com/journals/jama/fullarticle/2805540">One study</a> from the NIH’s RECOVER initiative has gotten a lot of attention in both the <a href="https://www.medpagetoday.com/neurology/longcovid/104705?">medical press</a> and the <a href="https://www.washingtonpost.com/wellness/2023/05/25/long-covid-symptoms-recover-study/">mass media</a>. 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 <a href="https://www.covid.gov/assets/files/National-Research-Action-Plan-on-Long-COVID-08012022.pdf">RECOVER umbrella</a>. 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 <a href="https://www.washingtonpost.com/health/2023/05/29/long-covid-patients-public-health-emergency/">shutting down</a> left and right. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">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 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9931100/">multiple therapies</a> in the <a href="https://www.stimulate-icp.org/faq">STIMULATE ICP trial</a>, with preliminary results likely to arrive this year.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The Supremes<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_58" o:spid="_x0000_i1027" style="height: 142pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image013.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgw_gYNGbad0vMKqMF_ZUlxaajNREalYZmBkZNtND4FK6tfw93S6EmaMNmh0DazRQTCRahXzqlSfjNu21oik9KPNNT45m8lW-pF4MNYN-TaGbPVJLj18z2NPxxQa99atNMtyF-sAE2MBEU2addSHWvKdC7G8zalIAoW7p-azICZc5ax9I92swOlyewL/s1726/Gorsuch%20unmasked.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="542" data-original-width="1726" height="202" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgw_gYNGbad0vMKqMF_ZUlxaajNREalYZmBkZNtND4FK6tfw93S6EmaMNmh0DazRQTCRahXzqlSfjNu21oik9KPNNT45m8lW-pF4MNYN-TaGbPVJLj18z2NPxxQa99atNMtyF-sAE2MBEU2addSHWvKdC7G8zalIAoW7p-azICZc5ax9I92swOlyewL/w640-h202/Gorsuch%20unmasked.jpg" width="640" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Justice Clarence Thomas gets the prize for <a href="https://www.theguardian.com/us-news/2023/apr/17/clarence-thomas-investigation-fox-news-juan-williams">corruption</a> and Justice Alito, <a href="https://scholars.law.unlv.edu/cgi/viewcontent.cgi?article=2359&context=facpub">arguably</a>, for <a href="https://www.youtube.com/watch?v=ZqYGIZFGv9o">racism</a>… but for public health ignorance <a href="https://apnews.com/article/supreme-court-justice-covid-emergency-restrictions-85401feb29bea6db2f2ea4ac61cdeff2?">Neil Gorsuch</a> takes the cake. Here’s what he <a href="https://www.nytimes.com/2023/05/23/opinion/neil-gorsuch-covid-civil-liberties.html?">has to say</a> 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 <a href="https://www.nytimes.com/2023/05/23/opinion/neil-gorsuch-covid-civil-liberties.html">points out</a> a few other contenders: chattel slavery, massive forced sterilization starting in the 1920s, McCarthyite purges in the 1950s, <a href="https://en.wikipedia.org/wiki/Mass_surveillance_in_the_United_States#:">FBI surveillance</a> 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.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Civilization<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_91" o:spid="_x0000_i1026" style="height: 258pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image014.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjhkbUhNiC5C757-dhvqR8D_UYBQMTVV-d_tTupK01JbuvE3qRu_vcsAEVyUoCZq2Y5LgKKJJLEgo9BMXxoquUKYlEzaW2KJ-wSX7II278X7lGAX_NdcNTMAMyR37m7OTrHEDlHNImZOLL1hPd8h71qR21sJ0WPoJb9xM3JOAd6aEDdpvFkdYwbLCL/s1642/life%20expectancy%20wealthy%20countries.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="934" data-original-width="1642" height="364" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjhkbUhNiC5C757-dhvqR8D_UYBQMTVV-d_tTupK01JbuvE3qRu_vcsAEVyUoCZq2Y5LgKKJJLEgo9BMXxoquUKYlEzaW2KJ-wSX7II278X7lGAX_NdcNTMAMyR37m7OTrHEDlHNImZOLL1hPd8h71qR21sJ0WPoJb9xM3JOAd6aEDdpvFkdYwbLCL/w640-h364/life%20expectancy%20wealthy%20countries.jpg" width="640" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://time.com/6279937/us-health-care-system-attitudes/">Time Headline</a>: “More Than 70% of Americans Feel Failed by the Health Care System.” Sixty percent in a <a href="https://time.com/6279937/us-health-care-system-attitudes/">Harris Poll</a>gave 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.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">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 <a href="https://www.cnbc.com/2023/05/17/sanders-pushes-medicare-for-all-to-end-totally-broken-health-system.html">Bernie Sanders</a> and company are proposing their <a href="https://www.laprogressive.com/healthcare-issues/we-must-enact-medicare-for-all">Medicare for All</a> 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 <a href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2801230">national</a> and <a href="https://ohiocapitaljournal.com/2023/05/24/bill-to-create-universal-health-care-coverage-in-ohio-re-introduced-in-house/">state</a> levels.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">In related news, life expectancy at birth in the United States, which has lagged far below other wealthy countries for years, has <a href="https://www.washingtonpost.com/opinions/2023/06/01/american-life-expectancy-decline-covid/">continued to fall</a> throughout the pandemic even while other industrialized nations bounced back. In 2023 it’s <a href="https://www.washingtonpost.com/opinions/2023/06/01/american-life-expectancy-decline-covid/">even worse</a> 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. <a href="https://www.washingtonpost.com/opinions/2023/06/01/american-life-expectancy-decline-covid/">Not only</a> is America’s <a href="https://www.hsph.harvard.edu/news/hsph-in-the-news/whats-behind-shocking-u-s-life-expectancy-decline-and-what-to-do-about-it/#:~:text=2022%20Multimedia-,What%27s%20behind%20%27shocking%27%20U.S.%20life%20expectancy%20decline%E2%80%94and%20what,December%20data%20from%20the%20CDC.">health system a mess</a>, 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.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"> <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Folly in Muskland: some priceless Tweets<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_66" o:spid="_x0000_i1025" style="height: 175pt; visibility: visible; width: 320pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image015.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-vaZ5ze2J2k6MEZiCOYapgvZEkJlc6eCWQIwmAk_sFLux_wOGjsikIoSEFEgkLFcUNKPZj1IJehNAdKdDzJZaIEM5pH6ZDU7s3elMVdZ5j9Z29wvUBb1yN5I751Q3JdkFZYQnTGFVJVnz61FPpRZUbgIXkoeCVJGFvKQKQq7QGdFqaQmb5sZYuWBJ/s640/Amish.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="351" data-original-width="640" height="220" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-vaZ5ze2J2k6MEZiCOYapgvZEkJlc6eCWQIwmAk_sFLux_wOGjsikIoSEFEgkLFcUNKPZj1IJehNAdKdDzJZaIEM5pH6ZDU7s3elMVdZ5j9Z29wvUBb1yN5I751Q3JdkFZYQnTGFVJVnz61FPpRZUbgIXkoeCVJGFvKQKQq7QGdFqaQmb5sZYuWBJ/w400-h220/Amish.jpeg" width="400" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://twitter.com/stkirsch/status/1660769433856638976?s=43">“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."</a> In reality, at least during 2020, excess mortality among the Amish and Mennonites <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8195242/">paralleled</a> excess mortality in the US as a whole. More debunking links <a href="https://factcheck.afp.com/covid-19-did-not-spare-us-amish-communities">here</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://twitter.com/RiverGal45/status/1662180496263053312">“I was a healthy 62 yr old, until I got the 1st vaccine, and had a stroke, a week later in my brain.”</a> Coincidence. A giant <a href="https://www.ahajournals.org/doi/10.1161/STROKEAHA.122.040430">study in Norway</a> has proven that if anything the risk of stroke is <i>lower</i> during the month after vaccination that during the previous month.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://twitter.com/stkirsch/status/1662632276591788033">“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.”</a> In reality the only safety signal identified in the <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2805184">linked article</a> 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. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://twitter.com/simonateba/status/1663132178576728064">“Dr. David Martin Shows COVID-19 Pandemic Was Pre-Meditated Domestic Terrorism”</a> Love it!<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://ia601602.us.archive.org/25/items/screenshot-2023-05-24-131943/Screenshot%202023-05-24%20131943.png">“AIDS-associated diseases and cancers have increased by 338x since the rollout of the (covid-19 vaccine), according to the CDC.”</a> If you <a href="https://leadstories.com/hoax-alert/2023/05/fact-check-cdc-did-not-say-aids-related-diseases-and-cancers-increased-338x-since-rollout-of-covid-vaccine.html">believe that one</a> I’ve got a splendid bridge I’d like to sell you!<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://twitter.com/vigilantfox/status/1663610352242769921?s=43">“Miscarriage, Vision Loss, Immunotoxicity: Alarming COVID Vaccine Issues.”</a> Yeah, sure.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://twitter.com/drsimonegold/status/1665148888641159169?s=43">“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.</a> This one from the president of the notorious <a href="https://en.wikipedia.org/wiki/America%27s_Frontline_Doctors">America’s Frontline Doctors</a> 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 <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-limits-use-janssen-covid-19-vaccine-certain-individuals#:~:text=The%20FDA%20has%20determined%20that%20the%20reporting%20rate%20of%20TTS,million%20doses%20of%20vaccine%20administered.">3 people in every million</a> who received the vaccine, and has killed 9 Americans, fewer than one death in 2 million doses. Another rare J&J complication is Guillain-Barré syndrome, which occurred in <a href="https://www.nytimes.com/2021/07/12/health/covid-guillain-barre-vaccines.html">100 American J&J vaccinees</a> (about 8 per million) and was fatal in a single case.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://twitter.com/vigilantfox/status/1663684974988386304?s=43">“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.”</a> Along the same lines: <a href="https://twitter.com/RobertKennedyJr">@RobertKennedyJr</a>: “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 <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2116846#:~:">outpatients</a> remdesivir reduces the risk of hospitalization or death by nearly 90%. In appropriate <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9751993/#:">hospitalized patients</a>, 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 <a href="https://pubmed.ncbi.nlm.nih.gov/33763917/#:~:text=For%20the%20treatment%20of%20Covid,are%20reported%20as%20adverse%20events.">contraindication</a>. Heart failure? Exactly two patients <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511861/#:">had cardiac deaths</a> 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.<o:p></o:p></p>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com0tag:blogger.com,1999:blog-6211405954943098401.post-29269474408633019792023-05-14T16:40:00.003+02:002023-05-15T11:38:00.599+02:00Wraps and Recaps<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxYwzLVsE-zWvqFujmvpqHk5cO6CxChArFm_TE4uXFB3eDhSJaLoHzKV7Hz4bEz1CwstEC6DtB_EhHI5aG-CPxbzR8Liafyf-4H_soz3NuO9qmXRQuHWmXwQgP65bgKxuz6x8Z3jnZhyD2kFG2Rk-u7xUXnX5p3R4DHqp_TMnlbWkChMHstfFu_4uD/s600/that's%20a%20wrap+.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="434" data-original-width="600" height="290" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxYwzLVsE-zWvqFujmvpqHk5cO6CxChArFm_TE4uXFB3eDhSJaLoHzKV7Hz4bEz1CwstEC6DtB_EhHI5aG-CPxbzR8Liafyf-4H_soz3NuO9qmXRQuHWmXwQgP65bgKxuz6x8Z3jnZhyD2kFG2Rk-u7xUXnX5p3R4DHqp_TMnlbWkChMHstfFu_4uD/w400-h290/that's%20a%20wrap+.jpg" width="400" /></a></div><span style="font-size: medium;"><br /></span><p></p><p><span style="font-size: medium;">Vaccine news, new variants, long COVID, emergencies leave and summings-up arrive, origin stories and Chinese “research,” the 2023 Shkreli Awards, and an assortment of conspiracy theories.</span></p><style class="WebKit-mso-list-quirks-style">
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mso-bidi-theme-font:major-bidi;
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font-style:italic;}
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mso-bidi-theme-font:major-bidi;
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mso-themecolor:accent1;
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{mso-style-name:"Heading 6 Char";
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mso-style-link:"Heading 6";
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mso-bidi-theme-font:major-bidi;
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mso-themecolor:accent1;
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{mso-style-name:text;
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margin-right:0in;
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margin-left:0in;
line-height:150%;
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{mso-style-name:quotes;
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span.BalloonTextChar
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span.exldetailsdisplayval
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span.CommentTextChar
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span.UnresolvedMention1
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mso-style-priority:99;
color:#605E5C;
background:#E1DFDD;}
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span.3m6-
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span.3l3x
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span.1lld
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margin-left:0in;
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span.6cok
{mso-style-name:_6cok;
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span.timestampcontent
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span.mbtext
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span.HeaderChar
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mso-style-link:Header;
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mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
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span.FooterChar
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mso-style-link:Footer;
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mso-hansi-font-family:"Times New Roman";
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span.accessibleelem
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span.z-TopofFormChar
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span.z-BottomofFormChar
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margin-left:0in;
mso-pagination:widow-orphan;
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mso-fareast-font-family:"Times New Roman";}
span.style-scope
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mso-style-unhide:no;}
p.generic-articlesummary--li, li.generic-articlesummary--li, div.generic-articlesummary--li
{mso-style-name:generic-article__summary--li;
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mso-margin-top-alt:auto;
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margin-left:0in;
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p.diamond-blt, li.diamond-blt, div.diamond-blt
{mso-style-name:diamond-blt;
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p.font-copy, li.font-copy, div.font-copy
{mso-style-name:font-copy;
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mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
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mso-fareast-font-family:"Times New Roman";}
span.dogb1923
{mso-style-name:dogb1923;
mso-style-unhide:no;}
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mso-default-props:yes;
font-family:"Calibri",sans-serif;
mso-ascii-font-family:Calibri;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:Calibri;
mso-fareast-theme-font:minor-latin;
mso-hansi-font-family:Calibri;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;
mso-header-margin:.5in;
mso-footer-margin:.5in;
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div.WordSection1
{page:WordSection1;}
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{mso-level-number-format:bullet;
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{mso-level-number-format:bullet;
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{mso-level-number-format:bullet;
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@list l3
{mso-list-id:180240054;
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</style><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Treatment<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f"><v:stroke joinstyle="miter"><v:formulas><v:f eqn="if lineDrawn pixelLineWidth 0"><v:f eqn="sum @0 1 0"><v:f eqn="sum 0 0 @1"><v:f eqn="prod @2 1 2"><v:f eqn="prod @3 21600 pixelWidth"><v:f eqn="prod @3 21600 pixelHeight"><v:f eqn="sum @0 0 1"><v:f eqn="prod @6 1 2"><v:f eqn="prod @7 21600 pixelWidth"><v:f eqn="sum @8 21600 0"><v:f eqn="prod @7 21600 pixelHeight"><v:f eqn="sum @10 21600 0"></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:formulas><v:path gradientshapeok="t" o:connecttype="rect" o:extrusionok="f"><o:lock aspectratio="t" v:ext="edit"></o:lock></v:path></v:stroke></v:shapetype><v:shape id="Picture_x0020_98" o:spid="_x0000_i1033" style="height: 255pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image001.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivequ0vGFzFAbQj-f4nNPx6mk6AjL3vasBzl6nDWLqXl76OfcssO0ejdifrYJ7gGih-RButAcX9S3NUNGw31UJU7irUTuAdLEpmBAkDLQZjr3AFcpcnskyM1oI9Hbcj2bcKCfhcuL2IOcFyiMwYPMYvrBgPmlYvmSFFHr5p2jmD5bUv3TWx_RykZ7C/s567/patient%20on%20oxygen.jpeg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="319" data-original-width="567" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivequ0vGFzFAbQj-f4nNPx6mk6AjL3vasBzl6nDWLqXl76OfcssO0ejdifrYJ7gGih-RButAcX9S3NUNGw31UJU7irUTuAdLEpmBAkDLQZjr3AFcpcnskyM1oI9Hbcj2bcKCfhcuL2IOcFyiMwYPMYvrBgPmlYvmSFFHr5p2jmD5bUv3TWx_RykZ7C/s320/patient%20on%20oxygen.jpeg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Patient on oxygen in hospital</td></tr></tbody></table><u><br /></u><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Steroids in hospitalized patients</u>: Doctors often prescribe corticosteroids such as dexamethasone to COVID-19 outpatients, under the theory that if steroids decrease mortality in severely ill hospitalized patients (as per the RECOVERY trial) then surely they’ll get patients with mild disease better faster. Nope! There’s even evidence that steroids might make outpatients worse. A <a href="https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200283">new study</a> goes further, finding that even hospitalized patients, unless they’re sick enough to need supplemental oxygen, are <i>more</i>, not <i>less</i> likely to die is they are given steroids. And <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00510-X/fulltext">a new RECOVERY trial analysis</a> shows that higher than standard doses of dexamethasone also increase mortality.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Old drugs</u>: I used to prescribe a cocktail of colchicine, fluvoxamine, and inhaled budesonide to at-risk adults with early COVID-19, but I stopped when fluvoxamine flunked <a href="https://jamanetwork.com/journals/jama/fullarticle/2800448">a major trial</a>. Now Brazilian researchers <a href="https://www.acpjournals.org/doi/10.7326/M22-3305?">have tested</a> a combination of the latter two medications and say it halves the rate of clinical deterioration. But since in my experience few people tolerate their dose of fluvoxamine, I’d stick with Paxlovid when indicated, or budesonide alone in patients who have respiratory symptoms but are ineligible for Paxlovid.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b> </b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Vaccines etc.<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_103" o:spid="_x0000_i1032" style="height: 255pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image002.jpg"></v:imagedata></v:shape><u><o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg08TVZDiecrMugFiuH4pniuujx9Alt6BmL6Uu1_gQ1t-jPQbkBuUobRU3CoOo30wI1XTbQbcefzGvqkJcD55alabkrInoZIgkma6bhyy-ezjD-HsDwLAyLJvk68PXtt-8mNyG5edJtztwR01qusTgIZoFOKA6hjh8isBie2pbe8unAq9QHpLsRIR3T/s567/dog%20in%20school.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="319" data-original-width="567" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg08TVZDiecrMugFiuH4pniuujx9Alt6BmL6Uu1_gQ1t-jPQbkBuUobRU3CoOo30wI1XTbQbcefzGvqkJcD55alabkrInoZIgkma6bhyy-ezjD-HsDwLAyLJvk68PXtt-8mNyG5edJtztwR01qusTgIZoFOKA6hjh8isBie2pbe8unAq9QHpLsRIR3T/w400-h225/dog%20in%20school.jpeg" width="400" /></a></div><u><br /></u><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Vaginal bleeding</u>: Menstrual abnormalities have long been described as a side effect of COVID-19 vaccines, but only after reading a <a href="https://www.washingtonpost.com/opinions/2023/04/18/period-kate-clancy-coronavirus-vaccines-menstruation/?">Washington Post article</a> did I know how severe the bleeding could be. According to the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9294036/">systematic review</a> that article cites, half of all vaccinated women experienced menstrual problems. But reading the original source I saw that those sky-high rates were largely based on a single <a href="https://www.science.org/doi/10.1126/sciadv.abm7201">large study</a> that found a 42% rate of excess bleeding, and also claimed that two-thirds of menopausal women bled vaginally after being vaccinated. This was highly dubious on the face of it, since only a couple of the many hundreds of vaccinated older women I’ve known have told me they bled. Those results became even more dubious when I saw how vaguely the large study’s researchers described their methodology, as a “convenience sample” taking a web-based survey. That’s basically confessing their results are crap. The <a href="https://www.bmj.com/content/381/bmj-2023-074778">only study</a> that has compared post-vaccination months with non-vaccination months, a Swedish analysis of 3 million women, found little association with either menstrual irregularities or post-menopausal bleeding (increases of 12-13%, barely reaching statistical significance).<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>First bivalents</u>: Enough people had updated boosters early in the fall for some data to arrive on how long protection lasts. Researchers from North Carolina <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2302462?">report</a> that prevention of hospitalization or death peaked at 67.4% two weeks after vaccination, fell to 44.3% at 10 weeks, and hit 38.4% at 20 weeks. So bivalent boosters, like other boosters, probably last only 4-5 months. Protection against infection was minimal in this study, contradicting some <a href="https://www.fda.gov/media/164816/download">earlier reports</a>. And <a href="https://www.medrxiv.org/content/10.1101/2023.04.28.23289254v1.full.pdf">some other data</a> exist saying that infection and vaccination each protect against severe disease for at least a year.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Second bivalents</u>: FDA authorization for a second bivalent booster <a href="https://www.nytimes.com/2023/04/18/health/covid-booster-shots-seniors.html">came through</a> faster than predicted, in mid-April instead of May. As expected, you’re eligible you’re over 65 and had your other bivalent 4 months ago, or immunocompromised and had it 2 months ago. Repentant no-vaxxers can get a single dose as their primary vaccine course, though there’s no evidence that a single dose of the bivalent works, and <a href="https://www.thinkglobalhealth.org/article/dont-be-seduced-two-shots-are-better-one">excellent evidence</a> that a single dose of monovalent vaccines doesn’t. Pregnant women will also be eligible, because pregnant women and small babies with COVID-19 are at such high risk for severe disease. <a href="https://www.washingtonpost.com/opinions/2023/05/02/biden-vaccines-next-gen-operation-warp-speed/?">The government is hinting</a> they might try for a new bivalent booster aimed at post-BA.5 variants such as XBB, even though the BA.5-targetted bivalent seems to <a href="https://www.aha.org/news/headline/2023-01-25-cdc-updated-covid-19-booster-helps-protect-against-omicron-xbb-variants">protect fairly well</a> against them.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Sanofi-GSK</u>: A manufacturers’ press releast claims it’s effective <a href="https://www.sanofi.com/en/media-room/press-releases/2022/2022-06-24-05-29-02-2468538">against Omicron</a>. But that’s only the original Omicron variant, and perhaps BA.5. No news about the XBB subvariants that are now dominant in the UK, the US, and Europe.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Novavax</u>: <a href="https://www.nature.com/articles/s41598-023-27698-x">Two doses are useless</a> against Omicron, though a third dose offers some protection. Again, no XBB data.<o:p></o:p></p><p class="1obc" style="font-size: medium;"><u>COVAX</u>: The ambitious initiative to vaccinate the global South has <a href="https://www.washingtonpost.com/world/2023/01/04/covid-vaccine-demand-covax-2023/">failed abjectly</a>, discarding 200 million expired doses during 2022 and lowering its goals going forward. <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&uniformYAxis=0&country=USA~Low+income~ITA&pickerSort=desc&pickerMetric=total_deaths&hideControls=true&Metric=People+fully+vaccinated&Interval=Weekly&Relative+to+Population=true&Color+by+test+positivity=false">Only 25%</a> of inhabitants of low-income countries are “fully vaccinated,” partly due to rampant <a href="https://www.nature.com/articles/s41591-022-02185-4">vaccine hesitancy</a> in Africa and Eastern Europe. One bit of good news, though: <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7205a1.htm?">76% of all human beings over age 60</a> (who account for 80% of COVID-19 deaths), have had at least a primary series. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Idaho</u>: In my last post I said some Idaho legislators were trying to make using mRNA vaccines “in an individual or any other mammal in this state” a misdemeanor. They’ve now softened the bill – but only by removing the reference to other mammals! It’s unlikely to become law.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>BCG (bacille Calmette–Guérin)</u>: Countries that use the BCG tuberculosis vaccination once seemed to have lower rates of COVID-19. Nope. Two randomized trials testing BCG for COVID-19 prevention were already negative, and <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2212616">in a third</a>, among front-line healthcare workers, not only was BCG not protective but a trend toward <i>increased</i> risk approached statistical significance. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>K-9’s</u>: I thought COVID-19-sniffing dogs had gone the way of most cute ideas, i.e. down the drain. But now they’re <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2804205">trying them</a> in California schools and finding decent accuracy despite distracting noises and scampering young kids, though few infections were detected given the low current prevalence. A proposal that could actually be useful: have dogs work the crowds in airports.<u><o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Variant watch<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_87" o:spid="_x0000_i1031" style="height: 148pt; visibility: visible; width: 223pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image003.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAFd9x5zJPdQc3SSuEnTd5prLeKZ8T7BEn6J17QaP7wyEO7b9BEIBCHKcbgJWqTDtheMIRgwXFAUQ9dM5vtDBRxbJqM98frKGHROgO1J8WTq75Aif7B1L_BGXjRrqiZFRjvhpz68Sn7qMs18Ls4pxPiMTG8Ly8uCYh351VmmugNRX52OrzOXQD4PDc/s567/prurulent%20conjunctivitis.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="378" data-original-width="567" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAFd9x5zJPdQc3SSuEnTd5prLeKZ8T7BEn6J17QaP7wyEO7b9BEIBCHKcbgJWqTDtheMIRgwXFAUQ9dM5vtDBRxbJqM98frKGHROgO1J8WTq75Aif7B1L_BGXjRrqiZFRjvhpz68Sn7qMs18Ls4pxPiMTG8Ly8uCYh351VmmugNRX52OrzOXQD4PDc/s320/prurulent%20conjunctivitis.jpg" width="320" /></a></div><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The “Kraken” Omicron subvariant, XBB.1.5 is now causing most new cases in the United States, the UK, <a href="https://www.nbst.it/927-che-cosa-sappiamo-sulle-varianti-covid-19.html">Italy</a> and the rest of <a href="https://covid19-country-overviews.ecdc.europa.eu/#4_Variants_of_concern">Europe</a>. XBB.1.16, “<a href="https://www.washingtonpost.com/health/2023/04/14/covid-variant-arcturus-india-explained/">Arcturus</a>,” (“Arturo” in Italy), spread so rapidly in India that some states reinstituted mask mandates, and already causes <a href="https://covid.cdc.gov/covid-data-tracker/#variant-proportions">12.5% of new cases</a> in the US, though only now arriving <a href="https://www.fanpage.it/innovazione/scienze/quali-sono-i-nuovi-sintomi-covid-della-variante-arturo-arrivata-in-italia/">in Europe</a>. One typical Arcturus symptom is a nasty conjunctivitis (pinkeye). Then there’s “Acrux,” XBB.2.3, which similarly began in India but is <a href="https://www.ilmeteo.it/notizie/covid-scoperta-una-nuova-variante-si-chiama-acrux-situazione-in-italia-161206">spreading in Europe</a>, and its younger siblings XBB.2.3.2 and <a href="https://twitter.com/TRyanGregory/status/1652353374380081158">XBB.1.9.1</a>. <a href="https://www.washingtonpost.com/health/2023/04/14/covid-variant-arcturus-india-explained/?">These variants</a> are more and more transmissible, but people usually get less sick, both because Omicron strains are intrinsically milder and because most of us are protected from severe illness by vaccination and/or previous infections.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">XBB.1.16 cannot be considered entirely benign, though, if <a href="https://www.independent.co.uk/news/health/arcturus-covid-variant-deaths-uk-b2325658.html">5 of the first 105</a> documented cases in the UK were fatal, hinting that Arcturus might be a particularly virulent type of Omicron.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Long COVID<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_85" o:spid="_x0000_i1030" style="height: 180pt; visibility: visible; width: 271pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image004.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbFCQiSOPEUvC6fuIn2fzK0ZGrMEev2UNS7zgzb0-AnWUJmNntwo68n9cafzc1YkfrU_u5eSj-IhMNTUjNDJd_lhTHepY_HuOVdu8cNYD_sIW0DhMy-l22k9CrZD_yWQjN60urVoakqSDW8nopHZNcVVvtgVEqmGtQWOYxrKjZV3s8Dt33aiihIwqi/s709/psilocybin%20mushrooms.jpeg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="471" data-original-width="709" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbFCQiSOPEUvC6fuIn2fzK0ZGrMEev2UNS7zgzb0-AnWUJmNntwo68n9cafzc1YkfrU_u5eSj-IhMNTUjNDJd_lhTHepY_HuOVdu8cNYD_sIW0DhMy-l22k9CrZD_yWQjN60urVoakqSDW8nopHZNcVVvtgVEqmGtQWOYxrKjZV3s8Dt33aiihIwqi/s320/psilocybin%20mushrooms.jpeg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">The "magic mushrooms" that contain psilocybin</td></tr></tbody></table><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The “magic mushrooms” that contain psilocybin<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Tripping</u>: <a href="https://time.com/6271806/psychedelics-long-covid-treatment/">Time magazine</a> featured an article touting hallucinogenic drugs to cure long COVID. Mainly, it’s two case reports, one of a woman who microdoses on LSD and another woman who says a single trip on psilocybin worked miracles. Beyond that, there’s just a pilot study underway at Columbia University and a bill in Arizona that would allocate a million dollars to study psilocybin for conditions that include long COVID. Don’t expect magic.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Gut bugs</u>: There’s always probiotics. A promising placebo-controlled trial in Hong Kong found that long COVID patients who took SIM01, a cocktail of 3 bifidobacteria, for 6 months, <a href="https://www.medpagetoday.com/meetingcoverage/ddw/104419">had fewer</a> digestive symptoms, cognitive issues, and “general unwellness” than those on placebo. However: there’s no proper manuscript yes, and SIM01 is a proprietary mix not commercially available.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Causes</u>: Malfunctioning monocytes (a kind of white blood cell) <a href="https://erj.ersjournals.com/content/early/2023/02/23/13993003.02226-2022">may be related</a> to breathlessness, and immune abnormalities in the <a href="https://nn.neurology.org/content/10/4/e200097">central nervous system</a> to brain fog. <a href="https://www.medpagetoday.com/meetingcoverage/aan/104084">Previous infections</a> with other coronaviruses and <a href="https://academic.oup.com/sleep/advance-article/doi/10.1093/sleep/zsad126/7155872?login=false">sleep apnea</a>are the latest risk factors reported.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Research</u>: The National Institutes of Health have allocated and spent a billion dollars on the long COVID RECOVER initiative. Shockingly, STAT News says all they’ve done so far is watch how patients are doing over time and plan some clinical trials, without as of April 20<sup>th</sup> having administered treatments to <a href="https://www.statnews.com/2023/04/20/long-covid-nih-billion/?utm_campaign=wp_the_health_202&utm_medium=email&utm_source=newsletter&wpisrc=nl_health202">a single patient</a>. To boot, RECOVER is running out of money. This shocked and disgusted me, as it did Eric Topol and other <a href="https://www.statnews.com/2022/03/29/nih-long-covid-sluggish-study/">prominent researchers</a>. A <a href="https://www.scientificamerican.com/article/we-need-an-operation-warp-speed-for-long-covid/">headline</a> in Scientific American reads, rightly, “We Need an Operation Warp Speed for Long COVID.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Reinfection</u>: Among 596 long COVID patients who experienced a repeat bout of COVID-19, <a href="https://www.nature.com/articles/d41586-023-01371-9?">80%</a> said it <a href="https://www.longcovidkids.org/post/a-world-first-effect-of-covid-reinfection-on-people-living-with-long-covid">made their symptoms worse.</a>...<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Masks</u>: … making it even more shocking that Stanford University researchers enrolling long COVID patients in a Paxlovid <a href="https://med.stanford.edu/news/all-news/2023/03/long-covid-pandemic-anniversary.html">study</a> are <a href="https://www.reddit.com/r/covidlonghaulers/comments/132by0h/fyi_stanford_research_staff_have_stopped_masking/">not themselves wearing facemasks</a>. Some patients have walked out in mid-session, saying this “calls into question the legitimacy of the entire study.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Prevention</u>: Last time I debunked the diabetes drug metformin as a long COVID preventive. The latest supposed magic wand is the antiviral molnupiravir. I remain skeptical. In a <a href="https://www.bmj.com/content/381/bmj-2022-074572.short">VA study</a>, people who took molnupiravir early on, a small group because it is recommended only as a last resort, were 14% less likely to develop long COVID, not very impressive. A 38% reduction in deaths after the acute phase of illness is, on the contrary, extremely impressive. But I was confused to see that there were only 14% fewer post-acute <i>hospitalizations</i>, suggesting that most of those deaths happened at home, not in the hospital, where <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7218a4.htm">60% of all US deaths</a> occur.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The 2023 Shkreli Awards<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_95" o:spid="_x0000_i1029" style="height: 245pt; visibility: visible; width: 212pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image005.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimWjDixKBIG7s1Ub-0QFfOCQvP8-pcuHxWsPUdldzIxj4vQO29WNkYdeVU386JI2TvNsq-lmL0cDBLgSAaCbDQNN7jvU3mWn_CddXOG1MvXjLTZaJX69HwPvsulm3PaZeneZaS5OhZXtjuq29_nDPIsbTdoNXwLuP6zm0MfeeDMwmUoUOz_5htmXfB/s491/Charmoli%203++.jpeg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="491" data-original-width="425" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimWjDixKBIG7s1Ub-0QFfOCQvP8-pcuHxWsPUdldzIxj4vQO29WNkYdeVU386JI2TvNsq-lmL0cDBLgSAaCbDQNN7jvU3mWn_CddXOG1MvXjLTZaJX69HwPvsulm3PaZeneZaS5OhZXtjuq29_nDPIsbTdoNXwLuP6zm0MfeeDMwmUoUOz_5htmXfB/s320/Charmoli%203++.jpeg" width="277" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Scott Charmoli at work</td></tr></tbody></table><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The <a href="https://lowninstitute.org/">Lown Institute</a> has presented its 6th annual Shkreli Awards, the top ten worst examples of profiteering and dysfunction in healthcare, named for the infamous price-gouger and security fraudster <a href="https://en.wikipedia.org/wiki/Martin_Shkreli">Martin Shkreli</a>. <a href="https://lowninstitute.org/projects/2022-shkreli-awards/">Here’s</a> this year’s countdown, which I think you’ll like seeing even though it’s COVID-free:<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-bottom: 0in; margin-left: 0.6in; margin-right: 5.75pt; text-indent: -0.3in;">10) <b>Dentist bags a bundle by breaking patients’ teeth</b>: How did Wisconsin dentist Scott Charmoli go from making 434 crowns a year to more than 1,000? By purposely breaking patients’ teeth, according to federal prosecutors. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-bottom: 0in; margin-left: 0.6in; margin-right: 5.75pt; text-indent: -0.3in;">9) <b>“Dangerous” doctor deemed a star by leadership despite disgraceful malpractice record.</b> Leaders of Catholic Medical Center in Manchester, NH knew cardiac surgeon Dr. Yvon Baribeau had one of the worst malpractice records in the country. Yet they continued to let Baribeau keep operating, and even featured him in hospital advertisements.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-bottom: 0in; margin-left: 0.6in; margin-right: 5.75pt; text-indent: -0.3in;">8) <b>Medical labs bilk Medicare for $300 million in elaborate bribery scheme</b>: Three laboratories in North Texas allegedly bribed physicians to order unnecessary drug tests and blood work, so as to score extra Medicare reimbursements.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-bottom: 0in; margin-left: 0.6in; margin-right: 5.75pt; text-indent: -0.3in;">7) <b>Patients qualified for financial assistance; hospital sends them to debt collection instead</b>: Nonprofit hospitals are required to provide financial assistance to low-income patients. Instead, Providence health system hounded them to pay and sent debt collectors after them when they didn’t.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-bottom: 0in; margin-left: 0.6in; margin-right: 5.75pt; text-indent: -0.3in;">6) <b>When smokers get sick, this tobacco company has the treatment</b>: Philip Morris has spent 175 years selling products that cause heart and lung disease. Now it is poised to make more money treating the very conditions it helped create, by acquiring companies that develop inhaled therapeutics.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-bottom: 0in; margin-left: 0.6in; margin-right: 5.75pt; text-indent: -0.3in;">5) <b>Pharma giant exploits bankruptcy loophole to avoid legal responsibility for cancer-causing product</b>: Johnson & Johnson had known for decades that asbestos, a deadly carcinogen, could be contaminating their talc baby powder products, but continued selling them anyway. Now <a href="https://www.npr.org/2022/09/19/1123567606/johnson-baby-powder-bankruptcy-lawsuits">J&J has faced lawsuits</a> from 60,000 cancer patients, largely Black women, the preferred targets of their baby powder marketing. To avoid the lawsuits, J&J created a subsidiary company with all of the baby powder-related liabilities and then declared this shell company bankrupt. After that slick maneuver was <a href="https://www.bloomberg.com/news/articles/2023-01-30/j-j-can-t-use-bankruptcy-to-end-cancer-suits-appeals-court-says?">thrown out of court</a>, J&J tried a second time, but <a href="https://www.reuters.com/legal/jj-unit-goes-bankrupt-second-time-pursue-89-bln-talc-settlement-2023-04-04/">now it seems</a> an $8.9 billion settlement<b> </b>has been reached.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-bottom: 0in; margin-left: 0.6in; margin-right: 5.75pt; text-indent: -0.3in;">4) <b>Hospice CEO allegedly tells employees to hasten patient death to avoid caps on government reimbursements</b>: CEO Bradley Harris and other employees of Novus Hospice in Frisco, Texas, have been sentenced to a combined 84 years in prison for healthcare fraud. Staff received pre-signed prescription pads and were told to dispense opiates without physician oversight. Harris allegedly told employees to deliberately overdose patients so as to hasten death, in order to reduce average patient stays and avoid caps on government reimbursement. One employee was allegedly sent a text message saying, “You need to make this patient go bye-bye.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-bottom: 0in; margin-left: 0.6in; margin-right: 5.75pt; text-indent: -0.3in;">3) <b>System keeps community hospital on life support to cash in on drug discount program meant to serve the poor</b>: The 340B drug program gives safety net hospitals deep discounts on medications to ensure access to care for low-income patients. Richmond Community Hospital in Virginia, owned by Bon Secours Health System, has profited heavily off of this program, yet they don’t have an intensive care unit, a maternity ward, or a functional MRI machine, because Bon Secours diverts the profits to its other hospitals in wealthier, whiter neighborhoods.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-bottom: 0in; margin-left: 0.6in; margin-right: 5.75pt; text-indent: -0.3in;">2) <b>Private equity-backed firm runs rural hospitals into ground, leaves patients in unsafe conditions and employees without health insurance</b>: When Noble Health bought two rural hospitals in Missouri, residents hoped this might offer a lifeline to the struggling institutions. Instead, employees faced shortages in supplies and medications, and Noble stopped paying for employees’ health insurance despite deducting “premium” money from their paychecks. Some staff members faced hundreds of thousands in medical bills because they didn’t know they were uninsured.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-bottom: 0in; margin-left: 0.6in; margin-right: 5.75pt; text-indent: -0.3in;">1) <b>Insurers systematically overbill Medicare Advantage, siphoning billions of taxpayer money</b>: Most of the large MA insurers have been accused of fraud or overbilling by the US government, costing taxpayers as much as $25 billion in 2020.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Bye-bye Goodbye<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_97" o:spid="_x0000_i1028" style="height: 155pt; visibility: visible; width: 155pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image006.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSjVSl76y0FiLJx4GaLAlKfgo4Si-O2t07lXxfsdECZEzDiDZyKKqVVMiB0AsFfD4hZjkb8qZQFqImaQ1vxcXgVKFG6cQlU1oG0_Mi9GoW8QjNcP-lebVAvwqYIkoQRAj8AVgIRplNDNZlPNQxsf_4b4VogXl4nDiPcl8mTrajWzrSAFyyt_yGB31d/s2048/CDC%20reset.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2048" data-original-width="2048" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSjVSl76y0FiLJx4GaLAlKfgo4Si-O2t07lXxfsdECZEzDiDZyKKqVVMiB0AsFfD4hZjkb8qZQFqImaQ1vxcXgVKFG6cQlU1oG0_Mi9GoW8QjNcP-lebVAvwqYIkoQRAj8AVgIRplNDNZlPNQxsf_4b4VogXl4nDiPcl8mTrajWzrSAFyyt_yGB31d/s320/CDC%20reset.jpeg" width="320" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Even before the Public Health Emergency evaporated, <a href="https://www.washingtonpost.com/health/2023/05/05/covid-forecast-next-two-years/">experts started warning</a> that a new COVID-19 surge rivaling the Omicron tsunami could hit during the next two years, estimating 20%-40% probability. And while <a href="applewebdata://299AC636-0255-4AB0-9826-FCE2EC8EA84D/It%20is%20excellent%20strategy%20by%20MGH.%20%20Creating%20thousands%20of%20additional%20cases%20of%20Long%20COVID%20guarantees%20sustained%20demand%20for%20medical%20services.">over 1000</a> Americans still die every week and multiple other metrics <a href="https://peoplescdc.substack.com/p/peoples-cdc-covid-19-weather-report-af9?">suggest prudence</a>, the great Massachusetts General Hospital has stopped requiring facemasks, prompting <a href="https://twitter.com/MAHealthEquity/status/1654230770318278656?">street demonstrations</a> and sarcastic comments such as, “It is excellent strategy by MGH. Creating thousands of additional cases of Long COVID guarantees sustained demand for medical services.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The threat that uninsured individuals will have to either pay for COVID-19 vaccines out of pocket or depend on Byzantine “patient assistance programs” from Moderna and Pfizer may be lifting, as the Biden administration <a href="https://www.nytimes.com/2023/04/18/us/politics/covid-vaccines-uninsured.html">arranges directly with pharmacies</a> to keep vaccines free of charge. Unfortunately <a href="https://view.newsletters.cnn.com/messages/1681907739294563a013e3012/raw?">it’s not clear</a> which chains will sign on. The same “<a href="https://s2.washingtonpost.com/39c311f/643fd7fbafd891675411fdeb/599d6acbae7e8a3d46e1400f/30/62/643fd7fbafd891675411fdeb">bridge access program</a>” is supposed to guarantee free access to COVID-19 testing and treatment through <a href="https://www.washingtonpost.com/health/2023/05/04/covid-public-health-emergency-end/?">September 2024</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Many Americans are <a href="https://edition.cnn.com/2023/04/09/politics/covid-pandemic-americans-normal-polling/index.html">partying like it’s 2019</a>. Not so fast! In April a national track-and-field event caused at least <a href="https://www.radioiowa.com/2023/05/02/covid-outbreak-hits-drake-university/?">76 infections</a>. And at the CDC’s own annual conference, <a href="https://www.washingtonpost.com/health/2023/05/02/covid-outbreak-cdc-annual-conference/?utm_campaign=wp_the_health_202&utm_medium=email&utm_source=newsletter&wpisrc=nl_health202">at least 35</a> of the <a href="https://www.washingtonpost.com/health/2023/04/28/covid-cases-cdc-conference/">2000 attendees</a> came down with COVID-19. No masking, no distancing, apparently no enhanced ventilation.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Speaking of the CDC, director Rochelle Walensky is unexpectedly <a href="https://www.nytimes.com/2023/05/05/health/walensky-cdc-resignation.html?">stepping down</a>. Though <a href="https://executivegov.com/2023/05/cdc-director-rochelle-walensky-to-leave-office-in-june/#:~:text=%E2%80%9CAs%20Director%20of%20the%20CDC,health%20threats%20and%20protect%20Americans.%E2%80%9D">Joe Biden claims</a>, “Walensky leaves CDC a stronger institution,” the public disagrees. The percentage of Americans who say they trust it <a href="https://s3.documentcloud.org/documents/21184709/220027-nbc-news-january-poll.pdf">fell from 69% to 44%</a> over the first 20 months of the pandemic, and ever since Walensky was hired in January 2021 I’ve been saying she wasn’t up to the task. Nice, well-meaning, but in over her head. Maybe now the agency will get the overhaul that <a href="https://www.nytimes.com/2023/05/07/opinion/cdc-overhaul.html?">distinguished scientists</a> including the <a href="https://peoplescdc.org/2023/04/05/too-many-deaths-too-many-left-behind-a-peoples-external-review-of-the-cdc/">People’s CDC</a> think it so urgently needs. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Omicron is mild compared to previous strains, and by 2022 most Americans were vaccinated, but COVID-19 was nonetheless the <a href="https://www.nytimes.com/2023/05/04/health/covid-deaths-2022.html">fourth leading cause of death</a> in the United States last year. Only cancer, heart disease, and unintentional injuries killed more people. That’s half the COVID-19 deaths in 2021, but still. The official death toll was 250,000, and 100,000 more are predicted to die this year – 35,000 have already. But we may never get those figures straight, since the CDC <a href="https://www.nytimes.com/2023/05/05/health/cdc-covid-tracking.html">has stopped tracking</a> COVID-19 cases, transmission rates, and deaths, now that the PHE is gone and states and laboratories are <a href="https://www.washingtonpost.com/health/2023/05/09/covid-data-public-health-emergency-ends/">no longer obliged</a> to collaborate, as emphasized in a <a href="https://www.nytimes.com/2023/04/30/opinion/pandemic-virus-response.html?">Times op-ed</a> by creators of the late great <a href="https://coronavirus.jhu.edu/">Johns Hopkins Coronavirus Research Center</a>. Deaths will be followed using the <a href="https://www.cdc.gov/nchs/covid19/covid-19-mortality-data-files.htm">National Vital Statistics System</a>, with substantial delays. <a href="https://www.npr.org/sections/health-shots/2023/05/05/1174112653/cdc-to-change-how-it-reports-covid-information-and-stop-reporting-new-cases">Hospitalizations and wastewater</a> levels will still be tracked, through data sources are spotty to incomplete. I find the CDC’s own <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7219e1.htm?">explanatory document</a> confusing. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Italy too has ended its state of emergency, with all COVID-19-related restrictions gone as of May 1<sup>st</sup> except <a href="https://www.fanpage.it/politica/dal-1-maggio-stop-mascherine-in-ospedale-e-rsa-obbligo-solo-in-reparti-con-fragili-e-cure-intensive/">mask mandates</a> in nursing homes and on hospital wards that house fragile or elderly patients (most do, of course). But I still hear of so many infections that I will continue to wear masks in shared indoor spaces and will renew the supply I keep to give my patients. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The World Health Organization too <a href="https://www.nytimes.com/2023/05/05/health/covid-who-emergency-end.html">has declared an end</a> to the COVID-19 global health emergency, while adding that the pandemic is not yet over and warning countries not to dismantle response systems, a warning likely to go unheeded in the US. One month after Covid Czar Jeff Zients was replaced by Ashish Jha, they’re <a href="https://www.politico.com/news/2023/05/05/pandemic-command-center-biden-00095469?utm_campaign=wp_the_health_202&utm_medium=email&utm_source=newsletter&wpisrc=nl_health202">again struggling</a> to find a new one, with hints that they’re getting down near the bottom of the barrel.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The never-ending origin story<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_89" o:spid="_x0000_i1027" style="height: 192pt; visibility: visible; width: 4in;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image007.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjJCxSBgO1EuAXOhlsqlSyyUCTfPaJzS8hhJsclXyxO16uyQZvFXSxFU3mML4jGw6NfCi8BKqicTDdyxZ9gJEOOYhnUBJdavnxFUPNlHfynk3w8PTPtalBRnCVVkstv2n2S4Q2aVvj1ZG1Tx_8fXqu9l6UBs1bae4rW58gSqCSr0L2SyUMOWCb8nFt/s2048/Wuhan%20university.jpeg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1365" data-original-width="2048" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjJCxSBgO1EuAXOhlsqlSyyUCTfPaJzS8hhJsclXyxO16uyQZvFXSxFU3mML4jGw6NfCi8BKqicTDdyxZ9gJEOOYhnUBJdavnxFUPNlHfynk3w8PTPtalBRnCVVkstv2n2S4Q2aVvj1ZG1Tx_8fXqu9l6UBs1bae4rW58gSqCSr0L2SyUMOWCb8nFt/w400-h266/Wuhan%20university.jpeg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">The University of Wuhan</td></tr></tbody></table><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;">We have had many hints the Chinese government suppressed information about the origins and the early days of COVID-19, but until reading a recent <a href="https://www.nytimes.com/2023/04/23/world/europe/chinese-censorship-covid.html?">New York Times article</a> I had no idea of the lengths they had gone to and the degree to which they had succeeded – and are still succeeding – in quashing scientific research. Highly recommended, and chilling.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I mistakenly wrote last time that the manuscript linking Huanan Market raccoon dogs to SARS-CoV-2 had already been published. But now it has, <a href="https://www.science.org/doi/10.1126/science.abp8715">in Science</a>, and got toned down considerably following peer review. There is now more emphasis on the previously-reported case clustering and much less on the genetic findings that were touted as proof of a market origin. Harvard scientist <a href="https://ayjchan.medium.com/evidence-for-a-natural-origin-of-covid-19-no-longer-dispositive-after-scientific-peer-review-af95b52499e1">Alina Chan</a>, New York Times columnist <a href="https://www.nytimes.com/2023/05/03/opinion/covid-origin-science.html?">David Wallace-Wells</a>, and several online commentators now discount its conclusions altogether. I too no longer believe the genetic findings to be a smoking gun.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Meanwhile, both <a href="https://www.nytimes.com/2023/05/12/opinion/covid-lab-safety.html?">Zeynep Tufekci</a> and a <a href="https://www.washingtonpost.com/opinions/2023/04/15/covid-origins-china-mystery/">Washington Post Editorial</a> have showcased poor biosafety practices in virology labs, and not only or even mostly in China. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Drawing conclusions<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_104" o:spid="_x0000_i1026" style="height: 302pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image008.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEis2pGDDcNWWMAIy10twXGZt0qgyZ5omqqkGY9IjwmjBuNqG7DZIXamM1ukjwpjHjjdLfJ4H9yhG-FbkCj8q1Xm0fhLZd44o2XrVMsaUmRixcvB9DfFrozgqKcAdok_2TcIE6vH8Q5z1aC7lYKAwzARMKt1wdjr-uEFTmSIwWnxvgg735liNnIEQSJ3/s700/summing%20up%2011++.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="467" data-original-width="700" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEis2pGDDcNWWMAIy10twXGZt0qgyZ5omqqkGY9IjwmjBuNqG7DZIXamM1ukjwpjHjjdLfJ4H9yhG-FbkCj8q1Xm0fhLZd44o2XrVMsaUmRixcvB9DfFrozgqKcAdok_2TcIE6vH8Q5z1aC7lYKAwzARMKt1wdjr-uEFTmSIwWnxvgg735liNnIEQSJ3/s320/summing%20up%2011++.jpg" width="320" /></a></div><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The end of the emergency has brought an epidemic of summings-up. A New York Times editorialist <a href="https://www.nytimes.com/2023/05/11/opinion/covid-pandemic-emergency-lessons.html?">nicely proposes</a> pandemic lessons. Jeremy Faust <a href="https://insidemedicine.substack.com/p/the-end-of-the-public-health-emergencyon">offers his take</a>. Education professors <a href="https://www.nytimes.com/interactive/2023/05/11/opinion/pandemic-learning-losses-steep-but-not-permanent.html?">describe</a> education gaps. And members of Biden’s COVID-19 team <a href="https://www.nytimes.com/2023/05/11/opinion/covid-pandemic-lessons.html?">lay down</a> 13 other lessons, though I confess to having issues with numbers 1, 6, 7, and 10.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">An <a href="https://www.eurekalert.org/news-releases/964445">authoritative report</a> has described the response to the pandemic as a massive global failure, saying notably that:<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l40 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->There were “widespread failures of prevention, transparency, rationality, basic public health practice, and operational cooperation and international solidarity that resulted in an estimated 17.7 million deaths.”<b><o:p></o:p></b></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l40 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Governments were “unprepared and too slow in their response, paid too little attention to the most vulnerable groups in their societies, and were hampered by a lack of international cooperation and an epidemic of misinformation.” <b><o:p></o:p></b></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l40 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->The disastrous global response “reversed progress made towards the UN Sustainable Development Goals (SDGs) in many countries”<b><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The American response was particularly shameful, bringing <a href="https://www.nytimes.com/interactive/2022/05/23/health/covid-death-toll-world.html">greater per-capita excess mortality</a> than almost any other developed economy, <a href="https://www.nytimes.com/2023/02/02/opinion/covid-pandemic-deaths.html">not all of it directly from COVID infections</a>. This revealed “a collective national incompetence in government,” according to in-depth analyses published by a set of experts in the book <a href="mailto:https://covidcrisisgroup.org">Lessons From the COVID War: An Investigative Report</a>. As <a href="https://www.washingtonpost.com/books/2023/04/25/lessons-covid-war/">described in the Washington Post</a>, its overall message is that the United States started out with more capabilities than any other country in the world, but its leaders “could not apply their country’s vast assets effectively enough in practice,” with Trump’s only commendable action Operation Warp Speed. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Anthony Fauci did his own summing-up in a <a href="https://www.nytimes.com/interactive/2023/04/24/magazine/dr-fauci-pandemic.html" target="_blank">long interview</a> with David Wallace-Wells: <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-bottom: 0in; margin-left: 0.6in; margin-right: 5.75pt; text-indent: -0.1in;">- He attributes the dreadful United States outcomes mostly to a low vaccination rate that he blames on Republicans know-nothings, but also to the “fractured” American healthcare system with its enormous racial and ethnic health disparities. (Americans of color have been <a href="https://www.healthsystemtracker.org/brief/racial-disparities-in-premature-deaths-during-the-covid-19-pandemic/#All-cause%20mortality%20rate%20for%20people%20under%20age%2075%20per%20100,000%20people%20under%20age%2075,%20by%20race/ethnicity,%202015-2022">more likely</a> to die prematurely during the pandemic, and lost many more years of life.) <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-bottom: 0in; margin-left: 0.6in; margin-right: 5.75pt; text-indent: -0.1in;">- He estimates that without Operation Warp Speed it would have taken 3 years to develop a vaccine instead of 11 months, and that 5 million Americans would have died instead of one.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-bottom: 0in; margin-left: 0.6in; margin-right: 5.75pt; text-indent: -0.1in;">- He defends standard practices like masking, distancing, and contact tracing.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-bottom: 0in; margin-left: 0.6in; margin-right: 5.75pt; text-indent: -0.1in;">- He defends himself against accusations that amount to not having had a functional crystal ball in January-February 2020. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-bottom: 0in; margin-left: 0.6in; margin-right: 5.75pt; text-indent: -0.1in;">- He explains why herd immunity can never be reached against COVID-19, emphasizing asymptomatic spread, viral mutation, and short-lived immunity. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-bottom: 0in; margin-left: 0.6in; margin-right: 5.75pt; text-indent: -0.1in;">- He nicely summarizes the debate over the pandemic’s origin, focusing on the improbability of a lab leak, the irrelevance of NIH funding of the Wuhan Institute of Virology, and the confusion over “gain-of-function” research.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"> <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Lies and damned lies<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_88" o:spid="_x0000_i1025" style="height: 194pt; visibility: visible; width: 347pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image009.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxpQs4AGcRZhfnosoOuQCaNIhQPVydiMbPo1oWc-xd3fDr43VwAqR2s5lVE7OWYicUl0KWUC6E-5K_XMXORQoolLxD7lNCI7m25LeqZUZtkf4byazvdNPodGAmJmRC4hsdRmokGBbCixQ-xS8ufbl5C1BkcxfCaPXUF-opL8v7oNBeNDZ94_Ogfy6P/s1428/Bill%20Gates%20vaccines%20in%20food.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="798" data-original-width="1428" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxpQs4AGcRZhfnosoOuQCaNIhQPVydiMbPo1oWc-xd3fDr43VwAqR2s5lVE7OWYicUl0KWUC6E-5K_XMXORQoolLxD7lNCI7m25LeqZUZtkf4byazvdNPodGAmJmRC4hsdRmokGBbCixQ-xS8ufbl5C1BkcxfCaPXUF-opL8v7oNBeNDZ94_Ogfy6P/w400-h225/Bill%20Gates%20vaccines%20in%20food.jpg" width="400" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">“<a href="https://web.archive.org/web/20230410054155/https:/gellerreport.com/2023/04/switzerland-bans-the-covid-vaccines.html/">Switzerland Bans the COVID Vaccines</a>” reads the headline in The Geller Report, the mouthpiece of Pamela Geller, whose books (banned from Amazon) include such titles as The Post-American Presidency: The Obama Administration’s War On America, and Stop the Islamization of America: A Practical Guide to the Resistance. Nope, Switzerland hasn’t banned COVID-19 vaccines. It simply isn't recommending mass boosters during the spring and summer of 2023, preferring to wait until fall, allowing exceptions for particularly high-risk individuals.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">“<a href="https://twitter.com/VigilantFox/status/1647551985674080256">The Unvaccinated Won't Be Unvaccinated for Long With mRNA in the Food Supply</a>” is a tweet that’s been viewed 1.9 million times. The most <a href="https://apnews.com/article/fact-check-covid-vaccine-food-misinformation-41aaa639bc1ff056be7037dacf43116e">inventive novax tale</a> ever?<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">A spinoff: “Produce from AeroFarms contains COVID-19 vaccine.” The video (no longer viewable) apparently has text that asks, “Are Whole Foods customers being (injected) with the C19 mRNA shot via food products without their customer's knowledge or consent?” and adds, “This is attempted murder.” <a href="https://eu.usatoday.com/story/news/factcheck/2023/05/09/no-covid-19-vaccines-are-not-in-aerofarms-produce-fact-check/70174876007/">Factcheck by USA Today</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">“3 entire years of Covid vaccine propaganda, <a href="https://www.instagram.com/p/CrZdmMPh_jf/">FDA now says</a> unsafe & ineffective.” <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-changes-simplify-use-bivalent-mrna-covid-19-vaccines">Oh yeah</a>?<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">“Practically everyone is immunocompromised to at least some extent post-Covid infection,” says Hannah Carter on Facebook. See <a href="https://www.nature.com/articles/d41586-023-01371-9?">this</a> and <a href="https://www.manchester.ac.uk/discover/news/does-covid-really-damage-your-immune-system-and-make-you-more-vulnerable-to-infections-the-evidence-is-lacking/">this</a> for why this statement is bullshit.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">“Face masks may raise risk of stillbirths, testicular dysfunction and cognitive decline due to build-up of carbon dioxide.” This <a href="https://www.dailymail.co.uk/health/article-11982039/Face-masks-raise-risk-stillbirths-testicular-issues-cognitive-decline-study-says.html">Daily Mail headline</a> is based on a <a href="https://www.cell.com/heliyon/pdf/S2405-8440(23)01324-5.pdf">German study</a> that’s complete nonsense. Which figures, since the article appears in a pay-to-publish journal so corrupt that it has to <a href="https://www.cell.com/heliyon/guide-for-referees">bribe its peer reviewers</a>!<o:p></o:p></p>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com2tag:blogger.com,1999:blog-6211405954943098401.post-47640099161215085612023-04-15T20:18:00.001+02:002023-04-20T19:39:11.918+02:00Does it Fly Through the Air with the Greatest Of Ease?<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9zAWMfpsqMI2nx808mva2Sq76SyQ5JYMIWAqrnG_mNJgPjK578p7Du17tXV_0GQ70RXoIXCeUuFc3_cKsyM9uswNdrR3yYNxMIV0F9NZE1G-gRDqZwhNWhdgohoWo3e7LZzr8xoHFwE2gGNUS6muqM6qFLbXJkMGzQXDWoyYGiOyBwWoW5siN1Cwo/s567/the-flying-trapeze-Alexander%20Calder.jpg" style="display: block; margin-left: auto; margin-right: auto; padding: 1em 0px; text-align: center;"><img alt="" border="0" data-original-height="482" data-original-width="567" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9zAWMfpsqMI2nx808mva2Sq76SyQ5JYMIWAqrnG_mNJgPjK578p7Du17tXV_0GQ70RXoIXCeUuFc3_cKsyM9uswNdrR3yYNxMIV0F9NZE1G-gRDqZwhNWhdgohoWo3e7LZzr8xoHFwE2gGNUS6muqM6qFLbXJkMGzQXDWoyYGiOyBwWoW5siN1Cwo/s400/the-flying-trapeze-Alexander%20Calder.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Alexander Calder, the Flying Trapeze, 1925</td></tr></tbody></table><style class="WebKit-mso-list-quirks-style">
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span.timestampcontent
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span.dogb1923
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div.WordSection1
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</style><p class="1obc" style="font-size: medium; margin-right: 6pt;">Featuring metformin, masks, surfaces, aerosols, boosters, emergencies, politics, Raccoon dogs, long COVID, and malarky.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Treatment<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpvtHJrIullFyq7PsQxI0mJdM0nwHpE0TXUCMDFBbTBJC7rSbLT3cN3n6g4kEWK0Srvq1LNAp_s6uQwgZPEynqdNLoCeBE-NJdSEqJhgxtWvTR4JDfw7lbcfCovvafwDuKuyuKx9EKw8RW9KRssFiMP-PB8hGNmWl0jffc93KgFMSUhcMXiWJBySwP/s700/enovid%20larger.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="700" data-original-width="700" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpvtHJrIullFyq7PsQxI0mJdM0nwHpE0TXUCMDFBbTBJC7rSbLT3cN3n6g4kEWK0Srvq1LNAp_s6uQwgZPEynqdNLoCeBE-NJdSEqJhgxtWvTR4JDfw7lbcfCovvafwDuKuyuKx9EKw8RW9KRssFiMP-PB8hGNmWl0jffc93KgFMSUhcMXiWJBySwP/w200-h200/enovid%20larger.jpeg" width="200" /></a></div><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f"><v:stroke joinstyle="miter"><v:formulas><v:f eqn="if lineDrawn pixelLineWidth 0"><v:f eqn="sum @0 1 0"><v:f eqn="sum 0 0 @1"><v:f eqn="prod @2 1 2"><v:f eqn="prod @3 21600 pixelWidth"><v:f eqn="prod @3 21600 pixelHeight"><v:f eqn="sum @0 0 1"><v:f eqn="prod @6 1 2"><v:f eqn="prod @7 21600 pixelWidth"><v:f eqn="sum @8 21600 0"><v:f eqn="prod @7 21600 pixelHeight"><v:f eqn="sum @10 21600 0"></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:formulas><v:path gradientshapeok="t" o:connecttype="rect" o:extrusionok="f"><o:lock aspectratio="t" v:ext="edit"></o:lock></v:path></v:stroke></v:shapetype><v:shape id="Picture_x0020_74" o:spid="_x0000_i1038" style="height: 252pt; visibility: visible; width: 252pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image001.jpg"></v:imagedata></v:shape><u><o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Metformin</u>: An <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2201662">August 2022 publication</a> from the American COVID-OUT study showed no significant prevention of severe COVID-19 among overweight adults for fluvoxamine, metformin, or ivermectin, but hinted at a benefit for metformin. Now <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4375620">a preprint</a> from the same group reports a substantial reduction with metformin, during the Omicron era, of the risk of long COVID. But metformin only really benefited people who were unvaccinated, whose risk fell from 14.1% to 6.3%. In people who had received even just a primary vaccine series, long COVID risk fell only from 7.2% to 6.1%, confirming aside from anything else that vaccination cuts the risk of long COVID in half. What shocked me most was that fully half the subjects were unvaccinated: the chief lesson should be not “take metformin” but “get vaccinated”! <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Ensitrelvir</u>: Infectious disease guru <a href="https://twitter.com/PaulSaxMD/status/1628432552016089088">Paul Sax is impressed</a> by this antiviral’s potential to prevent long COVID. I’m not. The data were presented as <a href="https://www.shionogi.com/global/en/news/2023/02/20230222.html">exploratory analyses</a> at a conference; we need at least a proper manuscript.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Vilobelimab (Gohibic)</u>: The FDA has emitted an <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-authorizes-gohibic-vilobelimab-injection-treatment-covid-19">Emergency Use Authorization</a> for this monoclonal antibody in critically ill COVID-19 patients, despite a horrifying set of side effects, on the basis of a study showing it reduced mortality from 42% to 32%. It’s been a long time since we had new treatments for very sick COVID-19 patients, and this one is welcome.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Nitric oxide</u>: <a href="https://www.businesswire.com/news/home/20220511005194/en/Clinical-Study-Suggests-SaNOtize-Nitric-Oxide-Nasal-Spray-Is-Effective-at-Preventing-COVID-19-after-High-Risk-Exposure?">Thai researchers</a> offered nitric oxide, in the form of Enovid nasal spray 4 times a day, to students whose roommates had COVID-19 and university staff with high-risk exposures. Of those who actually used the spray, 6.4% became infected with SARS-CoV-2, versus 25.6% of those who did not. Since these results were reported informally in May 2022 and have not yet led to a manuscript much less a publication, there’s likely no there there.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Vaccines<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeI_q6TTu2AIxf-U4o8_fU82ywO9JHVRGivNSHF6Kgi5R1QJ7n0ddhMoFtisD9ONjoKhQn7lKB8D1fDmiJOEApTpGgay6VJQnKzSp9rRYva4U-rUTzUdE9R9NhgYWEajwsg1atuLWRqSc7VUS9e0edh2u0Sb12biTHH0Xfgr6_5fO-daO6lRpEmMxJ/s1820/Idaho%20vaccine%20ban.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="782" data-original-width="1820" height="173" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeI_q6TTu2AIxf-U4o8_fU82ywO9JHVRGivNSHF6Kgi5R1QJ7n0ddhMoFtisD9ONjoKhQn7lKB8D1fDmiJOEApTpGgay6VJQnKzSp9rRYva4U-rUTzUdE9R9NhgYWEajwsg1atuLWRqSc7VUS9e0edh2u0Sb12biTHH0Xfgr6_5fO-daO6lRpEmMxJ/w400-h173/Idaho%20vaccine%20ban.jpg" width="400" /></a></div><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u><v:shape id="Picture_x0020_59" o:spid="_x0000_i1037" style="height: 195pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image002.jpg"></v:imagedata></v:shape>Repeat doses</u>: Not a day passes without someone asking me whether they should get a second bivalent booster now, since boosters largely wear off by 6 months, or wait for the fall. I think yes if you’re over 65 or otherwise at risk, and if you have plans that might put you particularly at risk (foreign travel, a wedding), you should try to get it a week or two beforehand. The problem is that second bivalent boosters have not been authorized in either the US or Italy, though they have been in <a href="https://www.gov.uk/government/publications/covid-19-vaccination-spring-booster-resources/a-guide-to-the-covid-19-spring-booster-2023">the UK</a> and <a href="https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/national-advisory-committee-immunization-guidance-additional-covid-19-booster-dose-spring-2023-individuals-high-risk-severe-illness-due-covid-19.html#a5">Canada</a> with quite restrictive criteria. It now looks like the FDA <a href="https://www.nytimes.com/2023/04/04/us/politics/updated-covid-booster-fda.html?">will follow suit</a>in May, for people who are over 65 or immunocompromised and had a bivalent booster at least 4 months earlier. One caveat: if you’re double-boosted and have had COVID-19 within the last 6-8 months, you might give the second bivalent a pass, because combined protection likely lasts a year. The World Health Organization recently issued <a href="https://www.who.int/news/item/28-03-2023-sage-updates-covid-19-vaccination-guidance">similar guidelines</a>, recommending further boosters after 6-12 months to “high-priority” individuals: elderly, immunocompromised, pregnant, or front-line healthcare workers.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Vascular complications</u>: Some months some saw a slight hint of ischemic strokes in American older people following the bivalent booster. Further analyses more or less wiped out the initial concern, and now a <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2302134">French study</a> gives additional evidence. Similarly, <a href="https://www.nature.com/articles/s41467-023-36494-0">a British study</a> reports that cardiac death increases after SARS-CoV-2 infection, but not after mRNA vaccines or boosters.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Immune imprinting</u>: A careful <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00058-0/fulltext">retrospective cohort study</a> out of Qatar, whose authors include Jeremy Faust, highlights the downsides of (monovalent) boosters. A 61.4% increase in effectiveness against Omicron infection nearly disappeared by 6 months, and during months 7-12 people who had had boosters were actually <i>more</i> likely to get infected than those who had had only the primary series, suggesting what has been called negative immune imprinting, where repeated exposures tire out the immune response. Pfizer boosters were confirmed as more effective than Moderna. But the authors acknowledge their data have important limitations, and the heightened protection against severe or fatal illness remained high over the full year-long followup period (76.6% in high-risk and 57.9% in low-risk individuals). Since we already knew that unboosted vaccination gives almost no protection against any Omicron variant, and that all SARS-CoV-2 vaccinations tend to lose most of their value against infection by 6 months, I see no reason this study should make anyone hesitate to get boosted.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Novel vaccines</u>: After Trump’s $18-billion-dollar Operation Warp Speed comes Biden’s $5-billion-dollar <a href="https://www.washingtonpost.com/health/2023/04/10/operation-warp-speed-successor-project-nextgen/?">Project Next Gen</a>, aimed at updating <a href="https://www.washingtonpost.com/health/2023/04/10/operation-warp-speed-successor-project-nextgen/?">vaccines</a> with <a href="https://erictopol.substack.com/p/project-next-gen-the-united-states">mucosal (nasal) versions</a>, new bivalents, and possibly even the holy grail, pancoronavirus vaccines that could cover future variants.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Wow!</u> Here’s one for you: the Idaho state legislature has gone beyond banning vaccine mandates to pass a bill <a href="https://jamanetwork.com/journals/jama/fullarticle/2802699#:">banning mRNA vaccines</a> altogether, making it a misdemeanor to administer them. Will Governor Brad Little sign it?<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The state of COVID research<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_57" o:spid="_x0000_i1036" style="height: 167pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image003.png"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEii80WwZ43iLpX-_PL_7DNj2YJRQq4J1CbtMh6HIkpmfxSZvL1gfBOWsDY_yEnxDNSLnoQUh3St4ZVAE35ItJ1jtSBMKfVgtNbj7vc4AoQPHUl70C53U_cLETE0P-UheOxPs9sprAVL78AIoByOHiJsxU7Nnzb0ixRlZcxpUwK8HrlSPDr5QxeSAv1K/s850/ivermectin.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="313" data-original-width="850" height="238" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEii80WwZ43iLpX-_PL_7DNj2YJRQq4J1CbtMh6HIkpmfxSZvL1gfBOWsDY_yEnxDNSLnoQUh3St4ZVAE35ItJ1jtSBMKfVgtNbj7vc4AoQPHUl70C53U_cLETE0P-UheOxPs9sprAVL78AIoByOHiJsxU7Nnzb0ixRlZcxpUwK8HrlSPDr5QxeSAv1K/w640-h238/ivermectin.png" width="640" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Expert observers have found COVID-19 research to be generally <a href="https://www.science.org/content/article/pivot-covid-19-research-eases-publishing-surge-starts-level">low quality</a>, with researchers often overreaching their areas of expertise. This is not limited to politicized drugs such as hydroxychloroquine and <a href="https://www.vox.com/future-perfect/22776428/ivermectin-science-publication-research-fraud">ivermectin</a>, and is especially true for observational studies; at least 6 apparently promising drugs <a href="https://academic.oup.com/jac/advance-article/doi/10.1093/jac/dkac437/6961797?login=false">flopped</a> when they were properly studied in randomized controlled trials. Even in RCTs the results are <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790259">all too often</a> “fragile” rather than “robust,” i.e. if just a few patients had had a different outcome the results would no longer be statistically, or clinically, significant. Maybe some of the dross will start getting picked up earlier with <a href="https://www.nature.com/articles/d41586-022-04245-8?">new tools</a> designed to weed out bogus research.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Bye bye pandemic, goodbye</b></p><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWcv-vEjG5sby4uDKxnR6lvrChgHvd3-W_GW1-MoMtKHntQu5hzRbfO9h-KAidaUKDJuwa4UY0ER6ur5B5GLn9eejT1pUrhTLzy0NzvJdYb_cz4zEOnfCMBjTzshrrNFuVNGj2sBKvKNldq3glNfuzoIXk0UGcfwNSlqVhikufQevD-a6bgwUsm1bH/s1000/post-pandemic%20schools.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="488" data-original-width="1000" height="196" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWcv-vEjG5sby4uDKxnR6lvrChgHvd3-W_GW1-MoMtKHntQu5hzRbfO9h-KAidaUKDJuwa4UY0ER6ur5B5GLn9eejT1pUrhTLzy0NzvJdYb_cz4zEOnfCMBjTzshrrNFuVNGj2sBKvKNldq3glNfuzoIXk0UGcfwNSlqVhikufQevD-a6bgwUsm1bH/w400-h196/post-pandemic%20schools.png" width="400" /></a></div><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://insidemedicine.substack.com/p/data-snapshot-covid-has-faded-from?">Jeremy Faust has graphed</a> the dwindling attention to COVID: <o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtjdlWM4HEKpxbBfQTWvVBFnTJapZRznzRNOUZfNslNclAwItKnSkKW_SmjJA1cvYv2nMgcW5dotBNmIuNlw_mXLlUYF9zK14JcZEnXc_F7WIl1PddtagXZitIiIjupI8ZZDEX4XCsfDAJb73-2rUaVN1O4dN4-EAfruuruYe1XlIksMVsXm_pDeHe/s1456/Faust%20NYT%20mentions%20of%20pandemic.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="966" data-original-width="1456" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtjdlWM4HEKpxbBfQTWvVBFnTJapZRznzRNOUZfNslNclAwItKnSkKW_SmjJA1cvYv2nMgcW5dotBNmIuNlw_mXLlUYF9zK14JcZEnXc_F7WIl1PddtagXZitIiIjupI8ZZDEX4XCsfDAJb73-2rUaVN1O4dN4-EAfruuruYe1XlIksMVsXm_pDeHe/s320/Faust%20NYT%20mentions%20of%20pandemic.jpeg" width="320" /></a></div><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_53" o:spid="_x0000_i1034" style="height: 249pt; visibility: visible; width: 375pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image005.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">But even if nobody cares much any more, COVID-19 is still killing <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&uniformYAxis=0&pickerSort=desc&pickerMetric=total_deaths&hideControls=true&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=false&Color+by+test+positivity=false&country=GBR~ITA~USA">nearly 300 Americans</a> every day. And if you’re sick enough to be hospitalized, the risk of dying is <a href="https://jamanetwork.com/journals/jama/fullarticle/2803749?">61% higher</a> for Omicron than for influenza. I hear personally of new cases daily, among friends in the US or patients in Italy, often dragging on at length. The pandemic is not over, though the Biden administration has basically <a href="https://inthesetimes.com/article/covid-1200-vaccine-health">abandoned all leadership</a> on COVID-19 by <a href="https://www.washingtonpost.com/politics/2023/03/22/biden-disband-covid-team/?">disbanding</a> its COVID-19 team and fully privatizing testing and treatment. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Slightly good news: <a href="https://www.kff.org/medicaid/report/medicaid-and-chip-eligibility-enrollment-and-renewal-policies-as-states-prepare-for-the-unwinding-of-the-pandemic-era-continuous-enrollment-provision/?">43 states estimate</a> that they will need a year or more to go through all their Medicaid recipients to see whether they are still eligible. But the impact of the Emergency ending still <a href="https://www.nytimes.com/2023/04/03/us/politics/medicaid-enrollment-pandemic.html">promises to be tragic</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">My joy at seeing that Moderna would be establishing a “patient assistance program” to get free vaccines to uninsured/underinsured people has already been tempered, in that similar existing programs <a href="https://www.npr.org/sections/health-shots/2023/03/08/1161353892/modernas-covid-vaccine-gambit-hike-the-price-offer-free-doses-for-uninsured">have a reputation</a> for making people jump through hoops to get access to the promised drugs. The online red tape is expected to be daunting, particularly for uninsured populations, who are likely to be less tech-savvy.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">An ill-advised <a href="https://www.washingtonpost.com/opinions/2023/04/12/covid-cdc-five-day-isolation-guidance/">Op-Ed</a> in the Washington Post suggests scrapping the 5-day self-isolation period for COVID-19 patients in favor of “stay home when sick,” arguing that’s how we handle other viral syndromes that can be contagious for 7-8 days. But for one thing fully 80% of COVID-19 patients are <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797070">still contagious</a> after 5 days, and many after 10. And, for another, colds don’t give you long COVID.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Leaks and leaps<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_42" o:spid="_x0000_i1033" style="height: 285pt; visibility: visible; width: 380pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image006.png"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjo1t8dJX3bl8S_NzlsHUA2VHGvGtT7VJ3a5utEHEntjZJf_PtxRpxlGcraku9ANdECpxEOjl1TP-Z-1gDEH6cJ_vfvJxZVVFOOwmMLz7Kt575I8wtbYk5wURq3_jugIg2vnoB04oWHOu5dj0HFc4GABsmdlbKgGG0PxTQrlglbRxtk66Cv8bYLMgII/s567/Raccoon%20dog.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="425" data-original-width="567" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjo1t8dJX3bl8S_NzlsHUA2VHGvGtT7VJ3a5utEHEntjZJf_PtxRpxlGcraku9ANdECpxEOjl1TP-Z-1gDEH6cJ_vfvJxZVVFOOwmMLz7Kt575I8wtbYk5wURq3_jugIg2vnoB04oWHOu5dj0HFc4GABsmdlbKgGG0PxTQrlglbRxtk66Cv8bYLMgII/s320/Raccoon%20dog.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Raccoon dog</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">On March 7<sup>th</sup> <a href="https://www.washingtonpost.com/opinions/2023/03/07/evidence-covid-origin-spillover/">an op-ed</a> by a virologist and an infectious-disease epidemiology researcher made a clear case for why spillover from animals is by far the most plausible source for SARS-CoV-2, the COVID-19 virus.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">And no sooner had that op-ed appeared than <a href="https://apnews.com/article/covid-virus-origins-coronavirus-lab-leak-wildlife-wuhan-raccoon-dog-4dafbb46a575e14eff9fedf2e705aee2">possibly the strongest evidence yet</a> emerged in favor of a species leap: “Mining a trove of genetic data taken from swabs at the Huanan Seafood Wholesale Market in Wuhan in early 2020, virus experts said they <a href="https://www.nytimes.com/2023/03/16/science/covid-wuhan-market-raccoon-dogs-lab-leak.html">found samples containing genetic material</a> from both the coronavirus and illegally traded raccoon dogs. The finding, while hardly conclusive, pointed to an infected animal.” I.e., animals at the Huanan seafood market – specifically “raccoon dogs” bred for fur and meat – seem to have been carrying SARS-CoV-2. Those findings have <a href="https://zenodo.org/record/7754299#.ZCB9AC8RqL3">already been published</a>, and though not definitive they are both timely and suggestive, and have been put nicely in context by the <a href="https://www.nytimes.com/2023/03/19/us/politics/covid-origins-lab-leak-politics.html?">New York Times</a> and <a href="https://www.nature.com/articles/d41586-023-00827-2">Nature</a>. Clearly China has plenty of evidence it has never shared, and its safety protections in virus labs <a href="https://www.washingtonpost.com/investigations/interactive/2023/china-lab-safety-risk-pandemic/">seem weak</a>; it <a href="https://www.washingtonpost.com/opinions/2023/03/25/release-genetic-sequences-wuhan-market-covid-origins/?">would be nice</a> if they cooperated with investigations, as the WHO <a href="https://www.science.org/doi/10.1126/science.adi0490?">urges vigorously</a>, and as they <a href="https://www.nytimes.com/2023/04/08/world/asia/china-covid-data-who.html">claim unconvincingly</a> to have done all along.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Bleach your veggies?<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_47" o:spid="_x0000_i1032" style="height: 212pt; visibility: visible; width: 212pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image007.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYQQ4hBpVGdImKhIRoVrawOnSRyB47Oo1drbwSvR8zEXECNYgGpwhqCUXDuGyIvo8C-zxVcgDM6SwOWfDRx5G1lPWbkv9eXb4brBwK5sZoGc8EJzA0TN_TA3ldBK8JsOjcNUrITijCLbtZyatdUlelziq1W3b4ZcbFSq1YF-VwrpcCYrgsVySx7lem/s425/disinfecting%20packages%20in%20China%20copy.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="425" data-original-width="425" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYQQ4hBpVGdImKhIRoVrawOnSRyB47Oo1drbwSvR8zEXECNYgGpwhqCUXDuGyIvo8C-zxVcgDM6SwOWfDRx5G1lPWbkv9eXb4brBwK5sZoGc8EJzA0TN_TA3ldBK8JsOjcNUrITijCLbtZyatdUlelziq1W3b4ZcbFSq1YF-VwrpcCYrgsVySx7lem/s320/disinfecting%20packages%20in%20China%20copy.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Disinfecting packages in China</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">British researchers have <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(23)00069-1/fulltext?">reported</a> that the presence of SARS-CoV-2 on surfaces increased the risk that household contacts of COVID-19 patients would get infected themselves. So should we go back to disinfecting our packages like in spring 2020, when we thought the virus spread mainly through contaminated surfaces? Nope! For one thing, the association between surface contamination and infection was small and barely reached statistical significance. For another, even just one dose of a COVID-19 vaccine had a huge protective effect, cutting risk by 75% (p = 0.015), overwhelming the 66% increased risk from virus on surfaces (p = 0.044). I think what these data say is get vaccinated and don’t fret about surfaces. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p><b>Do masks work?</b></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_79" o:spid="_x0000_i1031" style="height: 208pt; visibility: visible; width: 368pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image008.png"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKH9QzND5hRR9YxmgMZ7N9aiKVkb7w7Jq-zK-1G4_4MLJFqSR9ZDiJryZAILAS0n_zsYVyM3aYZNph73R3WNBYuC6UNHSJRVfsrBWT1rIQun-6wxU4J6LcG7q1rteYOes0HBV3X7pibO0LAG4YPKQ7o9ZMdZygeRMohc61cH7aJHJT83JAHR0UXAoF/s1436/Tom%20Jefferson%20and%20interviewer.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="812" data-original-width="1436" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKH9QzND5hRR9YxmgMZ7N9aiKVkb7w7Jq-zK-1G4_4MLJFqSR9ZDiJryZAILAS0n_zsYVyM3aYZNph73R3WNBYuC6UNHSJRVfsrBWT1rIQun-6wxU4J6LcG7q1rteYOes0HBV3X7pibO0LAG4YPKQ7o9ZMdZygeRMohc61cH7aJHJT83JAHR0UXAoF/w400-h226/Tom%20Jefferson%20and%20interviewer.jpg" width="400" /></a></div><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">After all the fuss over the Cochrane review that was misinterpreted as saying masking is useless, <a href="https://www.nytimes.com/2023/03/10/opinion/masks-work-cochrane-study.html">now we learn</a> from Zeynep Tufekci that the Cochrane project’s chief plans to <a href="https://www.cochrane.org/news/statement-physical-interventions-interrupt-or-reduce-spread-respiratory-viruses-review">publish a rebuttal</a>, correcting both the Plain Language Summary and the scientific abstract. Tufekci explains why, and <a href="https://www.washingtonpost.com/opinions/2023/02/16/cochrane-study-masks-covid-pandemic/">Leana Wen chimes in</a>. The worst misinterpretation actually came from the review’s lead author, Tom Jefferson, who said <a href="https://maryannedemasi.substack.com/p/exclusive-lead-author-of-new-cochrane">in an interview</a> that the review determined “there is just no evidence that [masks] make any difference.” Jefferson has a history of making terrible calls during the pandemic, including back in April 2020. When New York City had seen thousands of deaths and was setting up field hospitals in Central Park, he considered it just a <a href="https://www.cebm.net/covid-19/covid-19-deaths-compared-with-swine-flu/">prolonged flu season</a>. And he kept <a href="https://www.journalofhospitalinfection.com/article/S0195-6701(22)00283-3/fulltext">pressing the fomite theory</a> of COVID-19 transmission long after it was discredited.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I recommending the <a href="https://sciencebasedmedicine.org/the-cochrane-mask-fiasco-how-the-evidence-based-medicine-paradigm-can-produce-misleading-results/">thorough explanation</a> of the flaws in the Cochrane mask review from David Gorski at Science-Based Medicine. He slams Tom Jefferson, whom he’s followed since 2009, and also explains how the Cochrane people fetishize the randomized clinical trial. If RCTs were the only source of valid medical information, we’d have never known, for example, that cigarette smoking causes lung cancer. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The politics of public health<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_36" o:spid="_x0000_i1030" style="height: 205pt; visibility: visible; width: 307pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image009.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5OoTAAqFjgfnxGu62SGnCugEp3-gdeyLHYnD2Yevvm7WehamPgDeqYpVdFKerlLkW8aqhVO6GaHFJ7vYpk-GOc0ESf-2Fyt23KFNHpUart1uvjLI6rHKN_0uNVOnhkJjTGTW_PsZmuDaR7IQFe9nfqXmfg30Q0b8fi1GTYw7ylPcnd2VPxRrS1Jm4/s1200/CDC%20official%20Anne%20Schuchat%20with%20DJT.jpeg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="800" data-original-width="1200" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5OoTAAqFjgfnxGu62SGnCugEp3-gdeyLHYnD2Yevvm7WehamPgDeqYpVdFKerlLkW8aqhVO6GaHFJ7vYpk-GOc0ESf-2Fyt23KFNHpUart1uvjLI6rHKN_0uNVOnhkJjTGTW_PsZmuDaR7IQFe9nfqXmfg30Q0b8fi1GTYw7ylPcnd2VPxRrS1Jm4/s320/CDC%20official%20Anne%20Schuchat%20with%20DJT.jpeg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">CDC official Anne Schuchat with DJT</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Curious how things were inside Trump’s Centers for Disease Control in the early months of the pandemic? We knew it was bad, but recent reporting from the <a href="https://www.washingtonpost.com/health/2022/10/17/trump-cdc-pressure-covid-pandemic-house-report/">Washington Post</a>, the <a href="https://www.nytimes.com/2023/03/21/health/covid-cdc.html">New York Times</a>, and <a href="https://khn.org/morning-breakout/trump-white-house-interfered-with-cdc-covid-reports-house-panel-finds/">Politico</a> shows that the corruption, bullying, and political interference with its scientific mission were worse than even I thought.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The United States has always had a <a href="https://www.ncbi.nlm.nih.gov/books/NBK154469/">relatively weak public health</a> system, and now state lawmakers and conservative/libertarian lawsuits have been hobbling what systems have been functional up to now. At least 30 red states <a href="https://www.washingtonpost.com/health/2023/03/08/covid-public-health-backlash/?">have passed laws</a> limiting the ability of public health officials faced by future pandemics to enforce such standard control measures as vaccines, facemasks, quarantining the exposed, or closing businesses, schools, or churches that are epicenters for outbreaks. I find this terrifying.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Ladapo, redux<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_80" o:spid="_x0000_i1029" style="height: 119pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image010.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSjHfBYfXSsXCfowCMXvA7Ip1xYbZq2o7KuThSuPkach2RUwGHsLVBI7dpvyqCmxREWsSgBNUOptCD8AJp2H3oNkveUtHPI3y-rYPU-3LsPZ8OHwxzrPwtHNAx1jylDxzMNOhyskGcqGqn6ahaQwlY9HFuDgx8BpB9kXlkKWBnVo1gk5Frq_DuQ9MK/s2098/Ladapo%20at%20UCLA.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="550" data-original-width="2098" height="170" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSjHfBYfXSsXCfowCMXvA7Ip1xYbZq2o7KuThSuPkach2RUwGHsLVBI7dpvyqCmxREWsSgBNUOptCD8AJp2H3oNkveUtHPI3y-rYPU-3LsPZ8OHwxzrPwtHNAx1jylDxzMNOhyskGcqGqn6ahaQwlY9HFuDgx8BpB9kXlkKWBnVo1gk5Frq_DuQ9MK/w640-h170/Ladapo%20at%20UCLA.jpg" width="640" /></a></div><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Allow me to re-introduce Joseph Ladapo, Ron DeSantis’s surgeon general. He belonged to the <a href="https://eu.usatoday.com/story/opinion/voices/2020/08/03/americas-frontline-doctors-dangerous-viral-video-column/5550377002/?fbclid=IwAR3sI4yLLLtN_zvftF-hDCg8NmLzaoZRD3zLMR5jVy7px3Vp5TaJPZCs_ko">right-wing COVID-19-denier</a> group “Frontline Doctors.” He advocated consistently <a href="https://eu.usatoday.com/story/opinion/2020/03/24/coronavirus-shutdowns-worth-public-health-system-unprepared-column/2898324001/">against shutdowns</a>, and a year and 600,000 American deaths later was still complaining about “<a href="https://www.wsj.com/articles/an-american-epidemic-of-covid-mania-11618871457">overreaction to the virus</a>.” He boasts of his affiliation with UCLA’s prestigious David Geffen School of Medicine, but that institution has <a href="https://www.politico.com/states/florida/story/2021/09/29/how-a-doctor-who-questioned-vaccine-safety-became-desantis-surgeon-general-pick-1391488">expunged him from their website</a>. His claims to have treated COVID-19 patients <a href="https://www.msnbc.com/rachel-maddow/watch/sources-dispute-florida-surgeon-general-s-claims-about-treating-covid-patients-at-ucla-125758021888">seem to be false</a>. Now, in response to his recommending against COVID-19 vaccines for <a href="https://eu.usatoday.com/story/news/nation/2022/03/07/florida-surgeon-general-joseph-ladapo-recommend-against-covid-vaccine-healthy-kids/9412641002/">children</a> and <a href="https://www.forbes.com/sites/brucelee/2022/10/09/florida-surgeon-general-warns-against-young-men-getting-covid-19-mrna-vaccines-whats-his-justification/?sh=78e436694105">young men</a>, he <a href="https://apnews.com/article/florida-surgeon-general-covid-vaccine-study-b3be9c2f22974176ae15d38025882335">has received </a>a <a href="https://www.fda.gov/media/166159/download">scathing letter</a> from the chiefs of the FDA and the CDC warning him that his misinterpretations of vaccine data are “incorrect, misleading and could be harmful to the American public.” <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Long COVID<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_63" o:spid="_x0000_i1028" style="height: 245pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image011.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvn_ajneZSLyGXGMlVQwNgEHJtRBccHXBPNyn7v6JvGe8gAlSJkpeMlfDwsPgrn-BEcAYPMBLYFOKlCETgr8FDybhxP4tpEQD_wCmTvzTXSzO9I_b1_DIOPY4_C414-TLHNvD_A8RsB0vI_S0veFAnrTOW08NJi1kwXwubrCy-71MgnFj86sRC2wtL/s1408/long%20covid%20sx.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="762" data-original-width="1408" height="346" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvn_ajneZSLyGXGMlVQwNgEHJtRBccHXBPNyn7v6JvGe8gAlSJkpeMlfDwsPgrn-BEcAYPMBLYFOKlCETgr8FDybhxP4tpEQD_wCmTvzTXSzO9I_b1_DIOPY4_C414-TLHNvD_A8RsB0vI_S0veFAnrTOW08NJi1kwXwubrCy-71MgnFj86sRC2wtL/w640-h346/long%20covid%20sx.jpg" width="640" /></a></div><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The VA study suggesting that Paxlovid reduces the risk of long COVID, which I described as a <a href="https://www.medrxiv.org/content/10.1101/2022.11.03.22281783v1.full">preprint</a>, has now been <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2802878">published</a>. But as an <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2802879">editorialist points out</a>, much of the protective effect could result from Paxlovid’s ability to prevent <i>severe</i> COVID-19, which carries a higher risk of long-lasting symptoms.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">People generally assume that Omicron infections, being milder, would be much less likely to lead to long COVID. Now a giant retrospective study (5 million COVID-19 cases) sponsored by the Washington Post, Epic Systems, and the Kaiser Family Foundation <i>seems</i> to have found just that. There’s no manuscript yet, so all we have to depend on is an <a href="https://www.washingtonpost.com/health/2023/03/18/long-covid-less-likely/?">article in the Washington Post</a>. That article says, first, that non-white ethnicity and poverty did not increase risk, probably because of methodology biased in favor of detecting cases among people with better access to health care. (Known risk factors <a href="https://www.washingtonpost.com/opinions/2023/02/08/long-covid-challenges-economy-health-care/?">include</a> severe COVID-19, female gender, older age, <a href="https://www.washingtonpost.com/health/2023/03/18/long-covid-less-likely/?">obesity</a>, chronic lung disease, chronic kidney disease, and <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2802877">smoking</a>.)<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">But the key finding is supposedly that the rate of long COVID after Omicron is a quarter what it was for Delta and a seventh what it was for the Wuhan wild strain. Blogger mikethemadbiologist <a href="https://mikethemadbiologist.com/2023/03/20/some-good-ish-news-about-long-covid-and-omicron/">has pointed out</a> some major limitations. First, the researchers problematically define long COVID as at least one symptom the patient did not have before having COVID-19. Symptom number and severity don’t count, though long COVID typically involves multiple organ systems. Furthermore, the symptom has to be brand-new, so that for instance an asthmatic whose cough and shortness of breath merely worsen wouldn’t qualify. Furthermore, the baseline symptom rate during the Omicron era looks suspiciously higher than during the other waves, possibly due to undiagnosed COVID-19 infections that had left patients slightly unwell. This artifactually makes any <i>increase</i> in symptoms less evident. If one instead assumes a similar baseline symptom rate before all infections, the long COVID rate after Delta is no longer quadruple the rate after Omicron but about twice as high, in line with <a href="https://pubmed.ncbi.nlm.nih.gov/36861893/">other reports</a>. A commenter points out that people with Omicron are more likely to have been vaccinated, thus more protected against long COVID. <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&uniformYAxis=0&pickerSort=desc&pickerMetric=total_deaths&hideControls=true&Metric=Vaccine+doses%2C+people+vaccinated%2C+and+booster+doses&Interval=7-day+rolling+average&Relative+to+Population=false&Color+by+test+positivity=false&country=~USA">Data indicate</a> that in the middle of the Omicron wave Americans were 12% more likely to have been vaccinated than at the end of the Delta wave, and 2.5 times more likely to have been boosted.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Another, better examination of variants and long COVID has been <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00260-7/fulltext#seccestitle140">published in The Lancet</a>. The researchers cleverly matched more than a million COVID-19 patients with people with other respiratory infections, on parameters including demographics, COVID-19 risk factors, and vaccination status. Most had had the Wuhan wild strain, but there were about 40,000 each with Alpha, Delta, and Omicron variants. Six months later, COVID-19 patients were significantly more likely than their matched controls to have developed muscle disease, anxiety, mood disorders, brain fog, dementia, epilepsy, psychosis, insomnia, Guillain-Barré syndrome, or stroke. There was particularly high excess risk (25%-plus) for brain fog, dementia, muscle disease, and psychosis. Mood disorders and stroke saw risk subside after a few months, but risk for cognitive problems, dementia, psychotic disorder, and seizures persisted for 2 years or more. Risks were largely similar at all ages, except that only children developed encephalitis or peripheral nerve disorders, children had no excess risk of depression or anxiety, and their brain fog resolved more quickly; and the elderly were more at risk for psychosis and dementia. Omicron patients were more likely than Delta patients to develop dementia or peripheral nerve problems, and less prone to mood disorder, brain fog, insomnia, or encephalitis; otherwise the two variants were similar.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Leana Wen <a href="https://www.washingtonpost.com/opinions/2023/03/16/covid-pandemic-anniversary-three-questions/">wrote recently</a>: “We might come to expect some frequency of post-covid symptoms, and the resulting disability, as a ‘new normal.’ In that case, health resources must shift from avoiding the coronavirus to reducing and treating its worst consequences – including long COVID.” Huh??? Long COVID still happens, vaccination and Paxlovid reduce risk only moderately, and we <i>still</i> have no decent treatments.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Special populations<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_46" o:spid="_x0000_i1027" style="height: 302pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image012.jpg"></v:imagedata></v:shape><u><o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDWC_nksl_DcCZ7cfClXcy_ivHm89b4euK-5p2R4AvC29MoCbmy94QCvQTk-SbCSNye6LxfxevBR_DFKpxyGZpQ_2JJhmxMxhh2m2ksVQXxhcjrk29kUVfRaTKo0vJZhKbkVdpWgkYPQs0zcuUHtArgBc8lqEZdkkLzJcDSnCU68q-UxdflWUZ0fVf/s709/wall%20of%20Cook%20County%20jail.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="472" data-original-width="709" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDWC_nksl_DcCZ7cfClXcy_ivHm89b4euK-5p2R4AvC29MoCbmy94QCvQTk-SbCSNye6LxfxevBR_DFKpxyGZpQ_2JJhmxMxhh2m2ksVQXxhcjrk29kUVfRaTKo0vJZhKbkVdpWgkYPQs0zcuUHtArgBc8lqEZdkkLzJcDSnCU68q-UxdflWUZ0fVf/w640-h426/wall%20of%20Cook%20County%20jail.jpg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Wall of Cook County jail</td></tr></tbody></table><u><br /></u><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Immunocompromised youth</u>: According to at least one <a href="https://pubmed.ncbi.nlm.nih.gov/34785268/">large prospective study</a> immunocompromised children and young people are, unlike adults, not at increased risk of <a href="https://www.clinicaltrialsarena.com/comment/immunocompromised-adults-covid/">severe</a> or <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004086">fatal</a> COVID-19<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Incarcerated people</u>: COVID-19 mortality in prison was even <a href="https://www.nytimes.com/2023/02/19/us/covid-prison-deaths.html?">worse than we thought</a>, with total death rates of incarcerated people up 50% in 2020 as compared to 2019, and in 6 states more than doubling.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Men</u>: Men are more likely to get infected with SARS-CoV-2 and if infected more likely to die. <a href="https://www.nytimes.com/2022/01/19/health/covid-gender-deaths-men-women.html">Most of us assumed</a>that was due to a combination of hormonal differences, women’s higher <a href="https://www.nytimes.com/2021/04/22/health/covid-vaccines-rates-men-and-women.html">vaccination rates</a>, and women’s <a href="https://www.pnas.org/doi/10.1073/pnas.2012520117">greater caution</a> with masking and distancing. But I missed <a href="https://www.sciencedirect.com/science/article/pii/S0277953622000193#!">an article</a> from a year ago pointing out another very important factor: men are more likely to work in sectors such as transportation, factories, and meatpacking, and more likely to be incarcerated or homeless.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Pregnant women</u>: The United States sees <a href="https://www.nytimes.com/2023/03/16/health/covid-pregnancy-death.html?">far more women</a> die in childbirth than other industrialized nations, <a href="https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries">twice as many</a> as France, with <a href="https://www.healthsystemtracker.org/indicator/quality/maternal-mortality/#Pregnancy-related%20deaths%20per%20100,000%20live%20births,%201987-2017">vast racial disparities</a>, and the pandemic has only made things worse. Deaths among pregnant and recently-pregnant women rose sharply, especially if they were black or American Indian, <a href="https://www.nytimes.com/2023/01/27/health/pregnancy-maternity-women-deaths.html">by 29%</a> between 2019 and 2020, and <a href="https://www.nytimes.com/2023/03/16/health/covid-pregnancy-death.html?">by 40%</a> between 2020 and 2021. The <a href="https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm">huge increase in 2021</a> was <a href="https://www.nytimes.com/2023/03/16/health/covid-pregnancy-death.html?">caused largely</a> by COVID-19 deaths, whereas in 2019-2020 it was <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800862?">more related</a> to nonpregnancy causes such as drug overdoses, homicide, car accidents, and (among American Indian women) suicide. Inadequate <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9756085/">prenatal</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/34403823/">postnatal</a> care during the pandemic surely contributed, and the Dobbs decision reversing Roe v. Wade will <a href="https://www.axios.com/2022/12/14/maternal-deaths-dobbs-abortions-us-health">put the cherry on top</a>, given that states that sharply limit abortion access already have <a href="https://www.commonwealthfund.org/publications/issue-briefs/2022/dec/us-maternal-health-divide-limited-services-worse-outcomes">62% higher</a> maternal mortality.<o:p></o:p></p><p class="1obc" style="font-size: medium;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The COVID trapeze<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_56" o:spid="_x0000_i1026" style="height: 191pt; visibility: visible; width: 342pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image013.png"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjumBNke4pCKkRvbc6UDNMXzsGlv3XlR0be9Ec7O7-boYK5_iUjA1NyWGSSfQx_HR5bl5xDa2dgvhNMt1oN3WzC5KC3fvSDBZ8_dSPH1Na_Nzkaqt_PQQlRs6FRhLw08v4GOcO55BPsVHvwUkhNDqk88wQEO9aLM48IODD4PdZ3bKvrB52bSRLjCOhM/s685/airborne%20transmission.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="383" data-original-width="685" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjumBNke4pCKkRvbc6UDNMXzsGlv3XlR0be9Ec7O7-boYK5_iUjA1NyWGSSfQx_HR5bl5xDa2dgvhNMt1oN3WzC5KC3fvSDBZ8_dSPH1Na_Nzkaqt_PQQlRs6FRhLw08v4GOcO55BPsVHvwUkhNDqk88wQEO9aLM48IODD4PdZ3bKvrB52bSRLjCOhM/w400-h225/airborne%20transmission.png" width="400" /></a></div><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Most <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8831082/">experts believe</a> that transmission of tiny aerosol particles at large distances is a – or even the – major way SARS-CoV-2 spreads from one person to another. I’ve honestly never been convinced of this theory, though I have chosen to act prudently as though it were true, including by installing a HEPA filter in my office. A systematic <a href="https://www.bmj.com/content/377/bmj-2021-068743">review article</a> published in the BMJ last May only added to the uncertainty by saying the concept is based on low-quality research, mostly from very early in the pandemic. An <a href="https://www.bmj.com/content/377/bmj.o1408">editorialist</a> called the evidence “tenuous,” but still came down in favor. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Now we finally have <a href="https://www.medrxiv.org/content/10.1101/2022.01.08.22268944v1.full.pdf?">a study</a> that is based neither on circumstantial evidence from small local outbreaks, nor on theoretical models. Researchers directly measured the amount of viable, transmissible SARS-CoV-2 virus particles in tiny airborne droplets of cell culture medium, duplicating aerosolized droplets in exhaled air. The infectivity of the aerosol dropped by half in the first 5 seconds, and had fallen to 10% at the end of 20 minutes. This makes it unlikely that COVID-19 gets transmitted by tiny droplets traveling long distances. <a href="https://academic.oup.com/pnasnexus/article/2/2/pgac301/6960684">Another study</a> using a different coronavirus found that if you construct your droplets with artificial saliva, they can stay airborne for 2 hours in dry air, but their measurements seem to be at only 40 cm, failing to document the long-distance transmission central to the airborne hypothesis.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Makary Malarky<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_51" o:spid="_x0000_i1025" style="height: 194pt; visibility: visible; width: 194pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image014.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJhiU7lMYzP5ck6sHt0ApGurd2empfHrGsFqKjot4j9n8y767mTsXjMsY3ES8Ej9rVhxJl2Q7VzB-B7wC-WnTmL4gy3uHFcbyxNvf-FcyblRGz6C7D2YC6B47mfaMs_PBBHNVZKcGYJUqEl4WrZIUp7PegHX6xB_ebfuVDpOavCP3F2-a5RJF8Npgj/s440/Marty%20Makary%202.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="440" data-original-width="440" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJhiU7lMYzP5ck6sHt0ApGurd2empfHrGsFqKjot4j9n8y767mTsXjMsY3ES8Ej9rVhxJl2Q7VzB-B7wC-WnTmL4gy3uHFcbyxNvf-FcyblRGz6C7D2YC6B47mfaMs_PBBHNVZKcGYJUqEl4WrZIUp7PegHX6xB_ebfuVDpOavCP3F2-a5RJF8Npgj/s320/Marty%20Makary%202.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Marty Makary</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">In an <a href="https://www.newsweek.com/fauci-leaves-broken-agency-his-successor-opinion-1770215">article</a> published in Newsweek, Johns Hopkins surgeon and bestselling author Marty Makary opines that the real problem with COVID-19 research was Anthony Fauci’s NIH agency failing to distribute funds fast enough during the first year of the pandemic. Despite Makary’s lofty credentials and his laudable denunciations of the profit motive in American medicine, the errors in this particular article are so over the top that I feel moved to refute them in detail:<o:p></o:p></p><p class="1obc" style="font-size: medium; margin: 5pt 6pt 5pt 0.5in;">- Main gripe: “The average time from the funding opportunity announcement to the award notice date was 151 days.” But it was worse <i>before</i> the pandemic, as per the NIAID website: “For applications funded on the first try [most aren’t], it <a href="https://www.niaid.nih.gov/grants-contracts/timelines-due-dates">typically takes</a> between 8 and 20 months after the due date to get an award.” <o:p></o:p></p><p class="1obc" style="font-size: medium; margin: 5pt 6pt 5pt 0.5in;">- He claims the CDC kept saying COVID-19 was mainly spread by fomites and on surfaces until August 2021. Actually its website <a href="https://www.washingtonpost.com/health/2020/05/21/virus-does-not-spread-easily-contaminated-surfaces-or-animals-revised-cdc-website-states/">said the opposite</a> in May 2020.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin: 5pt 6pt 5pt 0.5in;">- “The NIH spent almost $1.2 billion on long COVID research, but virtually nothing on masks, natural immunity, COVID in children, or vaccine complications.” Vaccine complications, natural immunity, and masks have been studied up the wazoo. And thank heavens they’re researching long COVID!!!<o:p></o:p></p><p class="1obc" style="font-size: medium; margin: 5pt 6pt 5pt 0.5in;">- “We still don't have randomized trials for so many drug recommendations, including the new bivalent vaccine, COVID vaccine boosters in young people, the optimal vaccine dosing interval, and even the antiviral drug Paxlovid in vaccinated people.” There have been at least two good studies of Paxlovid in vaccinated people, and the evidence for the updated boosters is burgeoning, as per my last post. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin: 5pt 6pt 5pt 0.5in;">- He blasts the NIH for not studying dexamethasone as a treatment for COVID-19 inpatients. Why should they have? The British RECOVERY trial of dexamethasone began enrolling patients in March 2020, and its main results were <a href="https://www.medrxiv.org/content/10.1101/2020.06.22.20137273v1">published</a> just 3 months later.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin: 5pt 6pt 5pt 0.5in;">- He claims vitamin D does miracles against COVID-19, but the <a href="https://www.nature.com/articles/s41598-022-24053-4#Abs1">study</a> he cites is bullshit research. It merely confirms that people who take supplements of vitamin D, who are more health-conscious, eat better diets, of higher SES, and less likely to be essential workers – less often get severe COVID-19. <a href="https://www.bmj.com/content/378/bmj-2022-071230">Randomized trials</a> of vitamin D have proven the opposite.<o:p></o:p></p>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com6tag:blogger.com,1999:blog-6211405954943098401.post-71804935517369967742023-03-04T15:14:00.001+01:002023-03-04T15:16:34.033+01:00Leak Or Leap?<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKVG7gHOl7Q39L3pAoA8bEK8OBPvCvjX7rDAVhQnr35C5JXEJSWDbRmCpdV4dUzx-3Xm8vgCd1jcExlgoHX52VCATIpPeXtS_AVsM3gTlyCX5968v4uV_DZRSGHfwzSXcGqCUY11bF7rz8n705E6iz-sXrxtj8LIdG2xRaG-jO9Y6UpJiNAXkzsv65/s1442/leak%20or%20leap.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="504" data-original-width="1442" height="141" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKVG7gHOl7Q39L3pAoA8bEK8OBPvCvjX7rDAVhQnr35C5JXEJSWDbRmCpdV4dUzx-3Xm8vgCd1jcExlgoHX52VCATIpPeXtS_AVsM3gTlyCX5968v4uV_DZRSGHfwzSXcGqCUY11bF7rz8n705E6iz-sXrxtj8LIdG2xRaG-jO9Y6UpJiNAXkzsv65/w400-h141/leak%20or%20leap.jpg" width="400" /></a></div><p></p><p class="1obc" style="margin-right: 6pt;">Promising treatments new and old, more and better data on vaccine effectiveness, the origin battle featuring the phony House investigation, international oddities, masks and other shields, the impending non-emergency, and varieties of bunk.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>Treatment<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b><span><v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f"><v:stroke joinstyle="miter"><v:formulas><v:f eqn="if lineDrawn pixelLineWidth 0"><v:f eqn="sum @0 1 0"><v:f eqn="sum 0 0 @1"><v:f eqn="prod @2 1 2"><v:f eqn="prod @3 21600 pixelWidth"><v:f eqn="prod @3 21600 pixelHeight"><v:f eqn="sum @0 0 1"><v:f eqn="prod @6 1 2"><v:f eqn="prod @7 21600 pixelWidth"><v:f eqn="sum @8 21600 0"><v:f eqn="prod @7 21600 pixelHeight"><v:f eqn="sum @10 21600 0"></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:formulas><v:path gradientshapeok="t" o:connecttype="rect" o:extrusionok="f"><o:lock aspectratio="t" v:ext="edit"></o:lock></v:path></v:stroke></v:shapetype><v:shape id="Picture_x0020_75" o:spid="_x0000_i1035" style="height: 200pt; visibility: visible; width: 312pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image001.jpg"></v:imagedata></v:shape></span><span><o:p></o:p></span></b></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkmCYtXax15l5CdjFOSQMKLxXdKSdFBy7p-8IwWtmex9Rb2ca14o7qEVN01-rB5B8lkL8wchDZFix42KccRjJ2PQxtNHtN_shLPeMBpWxusXPoJxx9JtGSBknx_4g0GQsJzCKLzGUi9rpR0uswjfAWa8-yIsvNDKvz_0DD-7UyFtmQ7jCyLX0jhXAl/s625/Interferons.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="401" data-original-width="625" height="205" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkmCYtXax15l5CdjFOSQMKLxXdKSdFBy7p-8IwWtmex9Rb2ca14o7qEVN01-rB5B8lkL8wchDZFix42KccRjJ2PQxtNHtN_shLPeMBpWxusXPoJxx9JtGSBknx_4g0GQsJzCKLzGUi9rpR0uswjfAWa8-yIsvNDKvz_0DD-7UyFtmQ7jCyLX0jhXAl/s320/Interferons.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">How interferon spurs the innate immune system to attack viruses</td></tr></tbody></table><br /><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Molnupiravir</u>: Evidence is <a href="https://www.science.org/content/article/could-popular-covid-19-antiviral-supercharge-pandemic">starting to come in</a> that the failed antiviral molnupiravir is actually, not just theoretically, breeding new variants. Here’s <a href="https://www.medrxiv.org/content/10.1101/2023.01.26.23284998v2.full">one</a> study, and here’s <a href="https://www.medrxiv.org/content/10.1101/2022.12.21.22283811v1">another</a>. Though in early 2022 it was being <a href="https://www.news-medical.net/news/20230203/Molnupiravir-related-mutational-signatures-among-COVID-19-patients.aspx">prescribed widely</a>, more recently molnupiravir has been largely discarded in favor of Paxlovid and remdesivir. In Australia it was the most widely prescribed antiviral <a href="https://www1.racgp.org.au/newsgp/clinical/molnupiravir-to-be-used-only-as-a-last-resort-task">until December</a>, when new guidelines recommended it only as a last resort. In <a href="https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065%2822%2900217-6/fulltext">Hong Kong</a> it is still being used. UK authorities now <a href="https://www.reuters.com/world/uk/britains-nice-recommends-against-nhs-use-5-covid-treatments-not-cost-effective-2022-11-16/">recommend against it</a>, but only because of its cost, the <a href="https://www.bmj.com/content/379/bmj.o2759">same reason</a>they shamefully <a href="https://www.nhs.uk/medicines/remdesivir-veklury/who-can-and-cannot-have-remdesivir/">restrict</a> the use of remdesivir. Following proof that molnupiravir <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02597-1/fulltext">does not work</a> to prevent progression of COVID-19, Merck <a href="https://www.businesswire.com/news/home/20230221005404/en/Merck-Provides-Update-on-Phase-3-MOVe-AHEAD-Trial-Evaluating-LAGEVRIO%E2%84%A2-molnupiravir-for-Post-exposure-Prophylaxis-for-Prevention-of-COVID-19?utm_campaign=wp_to_your_health&utm_medium=email&utm_source=newsletter&wpisrc=nl_tyh">has been forced to report</a> that it also does nothing to prevent the transmission of SARS-CoV-2 among household members. This drug should be scrapped.</p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Paxlovid in hospitalized patients</u>: Paxlovid is effective in reducing severe outcomes in COVID-19 outpatients, but does it help people who are already gravely ill? A <a href="https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(23)00012-3/fulltext" style="color: #954f72; text-decoration: underline;">Chinese study</a> of patients hospitalized in April-May 2022 leaves the question open. Among 132 patients randomized to Paxlovid, 5 died within 28 days, versus 8 among the 132 getting standard care alone, a superiority that was not statistically significant. Omicron so rarely kills that it would have taken a much much larger study to give a definitive answer. The researchers chose their sample sizes assuming that 30% of the hospitalized patients would die, whereas only <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7137a4.htm" style="color: #954f72; text-decoration: underline;">4.9%</a> actually did.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Paxlovid in the Age of Omicron</u>: In a <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00011-7/fulltext" style="color: #954f72; text-decoration: underline;">study</a> from the University of Colorado high-risk patients – mostly vaccinated and boosted – who received Paxlovid were less than half as likely to require hospitalization and just an eighth as likely to die as those who did not.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Interferon</u>: A single subcutaneous injection of an immune booster, pegylated interferon lambda, has been reported to <a href="https://www.nytimes.com/2023/02/08/health/covid-drug-eiger-interferon.html" style="color: #954f72; text-decoration: underline;">halve rates</a> of a combination endpoint (hospitalization plus prolonged ER visits) in high-risk, mostly double-vaccinated Brazilian COVID-19 patients. There were hardly any side effects, because lambda is a Type 3 interferon, unlike the toxic drugs formerly used for hepatitis C. The <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2209760?" style="color: #954f72; text-decoration: underline;">senior author</a> founded the manufacturing company and sits on its Board, the sort of thing that raises red flags. Jeremy Faust, who’s as skeptical an observer as I am but clearly a more careful reader, also <a href="https://insidemedicine.substack.com/p/impressions-of-pegylated-interferon?" style="color: #954f72; text-decoration: underline;">noticed</a>, buried in Supplementary Table 4 in the online Appendix, that when the researchers looked at all-cause rather than COVID-19-specific ER visits, hospitalizations, or death, the benefit completely disappeared. He says sensibly, “As a patient, I don’t really care whether I die of Covid or of something else. If a drug lowers my Covid death rate, but not my overall death rate, I sort of lose interest.” Also, the drug did nothing to shorten illness (remember, Paxlovid doesn’t either). And Faust thinks one injection will likely cost many thousands of dollars, <a href="https://www.nytimes.com/2023/02/08/health/covid-drug-eiger-interferon.html" style="color: #954f72; text-decoration: underline;">if it ever hits the market</a> at all. The NEJM has posted a <a href="https://www.nejm.org/doi/full/10.1056/NEJMe2302292" style="color: #954f72; text-decoration: underline;">superb oral discussion</a> of interferon lambda, though I’m afraid it may go over the head of non-medical listeners. <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Convalescent plasma</u>: Now that monoclonal antibody treatments have lost the race with COVID-19 variants, interest might rekindle in convalescent plasma, which has a similar mechanism but whose efficacy has always been unclear. A <a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciad088/7048396?" style="color: #954f72; text-decoration: underline;">new meta-analysis</a>, however, suggests that giving COVID-19 patients serum with high levels of anti-SARS-CoV-2 antibodies within 5 days of their falling ill cuts the risk of disease progression in half.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Snake oil</u>: Republicans are more likely than Democrats to believe in quack COVID-19 cures such as hydroxychloroquine and ivermectin. Now we know one reason why – their doctors are too. In a <a href="https://www.washingtonpost.com/politics/2023/02/06/coronavirus-pandemic-conservatives-ivermectin/?" style="color: #954f72; text-decoration: underline;">new study</a>, physicians who self-identified as conservative were 5 times more likely than liberal or moderate ones to prescribe hydroxychloroquine to a hypothetical patient with severe COVID-19. They were also just as likely as conservative laypeople to think vaccines were ineffective. In case you’re curious, the prize for biggest malprescriber goes to the infamous Stella Immanuel, of <a href="https://www.washingtonpost.com/technology/2020/07/28/stella-immanuel-hydroxychloroquine-video-trump-americas-frontline-doctors/" style="color: #954f72; text-decoration: underline;">demon sex/alien DNA</a><span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"> fame,</span>who wrote 69,000 prescriptions for hydroxychloroquine and 32,000 for ivermectin in 2021 (but only 30,996 and 16,085 in 2022!). Enough to sprain anybody’s writing hand.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Ensitrelvir fumaric acid</u>: This new antiviral, like Paxlovid an oral protease inhibitor, <a href="https://www.nih.gov/news-events/news-releases/nih-trial-evaluate-shionogi-antiviral-adults-hospitalized-covid-19?" style="color: #954f72; text-decoration: underline;">will now be tested</a> on hospitalized COVID-19 patients in a trial sponsored by the US National Institutes of Health as part of ACTIV-3. Why not test it on outpatients instead, as in the main Japanese study? According to a <a href="https://www.shionogi.com/global/en/news/2022/09/20220928.html" style="color: #954f72; text-decoration: underline;">press release</a>, this drug proved its efficacy by shortening the duration of symptoms, though the difference between 167.9 and 192.2 hours seems clinically insignificant to me. Frankly, I’m <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2208822?query=TOC" style="color: #954f72; text-decoration: underline;">much more optimistic</a> about the new Chinese antiviral, VV116, a derivative of remdesivir.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Remdesivir</u>: First used in hospitalized patients, this drug was found to be much more effective when given to outpatients during their first few days of illness. Now for the first time a study, or rather a <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00528-8/fulltext" style="color: #954f72; text-decoration: underline;">large meta-analysis</a>, has succeeded in showing that it does in fact reduce mortality in selected inpatients. The death rate fell by only 12%, though, and patients on ventilators actually did a bit <i>worse</i> on remdesivir. I’m not impressed.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>Vaccines<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b><span><v:shape id="Picture_x0020_73" o:spid="_x0000_i1034" style="height: 233pt; visibility: visible; width: 375pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image002.png"></v:imagedata></v:shape></span><span><o:p></o:p></span></b></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhN_woCLoO9y4BcESpqNfydQS2QPWqCWKRlN87W-K99jfN-Gc3NG-l25L-J9T6Fu-U5lAY_cuwoBusO8Mur8AIQI5B87fXnC19I67e14J0KyvD2sxRxruDskm7NTVSuaTLz43v_2wPiLEyE7WDdxVmBcrFe7bJ_lrdFV0BOkFfYK9GuI-qCCwNrOTZJ/s751/one%20of%20several%20vaccine%20options.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="467" data-original-width="751" height="250" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhN_woCLoO9y4BcESpqNfydQS2QPWqCWKRlN87W-K99jfN-Gc3NG-l25L-J9T6Fu-U5lAY_cuwoBusO8Mur8AIQI5B87fXnC19I67e14J0KyvD2sxRxruDskm7NTVSuaTLz43v_2wPiLEyE7WDdxVmBcrFe7bJ_lrdFV0BOkFfYK9GuI-qCCwNrOTZJ/w400-h250/one%20of%20several%20vaccine%20options.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">One proposed approach for new and better vaccines</td></tr></tbody></table><br /><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Covifenz</u>: The Canadian company making this grown-on-tobacco COVID-19 vaccine <a href="https://www.cbc.ca/news/canada/montreal/covid-vaccine-maker-medicago-shuts-down-1.6735521">has folded</a>. I always suspected the whole story was something of a scam.</p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Next generation</u>: Here’s a summary of some of the <a href="https://www.nature.com/articles/d41586-023-00220-z" style="color: #954f72; text-decoration: underline;">new directions</a> researchers are going in order to get better and broader vaccines.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Booster composition</u>: <a href="https://insidemedicine.substack.com/p/future-covid-19-booster-vaccinations?utm_source=substack&utm_medium=email" style="color: #954f72; text-decoration: underline;">Jeremy Faust thinks</a> that future ones should be all Omicron instead of half-and-half. I’m not so sure, because of how well the old monovalent Wild strain boosters have continued protecting against severe disease. He also has written <a href="https://insidemedicine.substack.com/p/the-two-sides-of-the-bivalent-booster" style="color: #954f72; text-decoration: underline;">a balanced presentation</a> of the bivalent debate that may have been outdated by the studies I report below…<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Booster effectiveness</u>: An <a href="https://www.fda.gov/media/164816/download" style="color: #954f72; text-decoration: underline;">FDA report</a> says, on the positive side, that bivalent boosters are quite effective against XBB sublineages. On the negative side, that protection starts waning fast. In people over 65 the added protection against symptomatic COVID-19 at 2-4 weeks after the shot was 55% against BA.5 and 50% against XBB, but it fell at 2-3 months to 32% and 42% respectively. Protection against hospitalization was considerably better, starting at 73-83% and fading more slowly. A <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2215471?" style="color: #954f72; text-decoration: underline;">study</a> from the University of North Carolina compared bivalent to monoclonal boosters in late 2022, and found the bivalent version much more effective in preventing severe COVID-19 or death: 61.8% vs. 24.9% overall. Followup was long enough to be able to see that the updated boosters’ effectiveness <a href="https://www.nejm.org/doi/suppl/10.1056/NEJMc2215471/suppl_file/nejmc2215471_appendix.pdf" style="color: #954f72; text-decoration: underline;">started to wane</a>after just a month, and that by 14 weeks it had dropped to under 30%. <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Booster frequency</u>: A CDC expert panel has <a href="https://www.reuters.com/world/us/not-enough-data-support-multiple-annual-covid-boosters-us-cdc-advisers-say-2023-02-24/" style="color: #954f72; text-decoration: underline;">recommended</a> that everybody, even the immunocompromised, get boosters only once a year. The final decision is <a href="https://www.nytimes.com/2023/01/23/health/covid-boosters-fda.html" style="color: #954f72; text-decoration: underline;">still unclear</a>. Given that their effectiveness plummets after just a few months, I’m skeptical. FDA advisers Eric Rubin, Jerry Weir, and Pamela McInnes, plus my most trusted experts <a href="https://www.nytimes.com/2023/01/23/health/covid-boosters-fda.html" style="color: #954f72; text-decoration: underline;">Paul Offitt</a>, <a href="https://www.washingtonpost.com/health/2023/01/23/covid-vaccine-once-a-year/" style="color: #954f72; text-decoration: underline;">Eric Topol</a>, and <a href="https://insidemedicine.substack.com/p/are-yearly-covid-19-boosters-the" style="color: #954f72; text-decoration: underline;">Jeremy Faust</a>, all <a href="https://www.nbcnews.com/health/health-news/fda-advisers-raise-doubts-moving-yearly-covid-boosters-rcna67491" style="color: #954f72; text-decoration: underline;">share my doubts</a>. <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>CoronaVac</u>: Protection against hospitalization from this Chinese whole-virus vaccine <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800935" style="color: #954f72; text-decoration: underline;">was as long-lasting</a> as from Pfizer’s vaccine. But we have always known that CoronaVac’s efficacy against infection and milder disease is weak.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Little kids</u>: Results from the <a href="https://pubs.rsna.org/doi/10.1148/radiol.222888" style="color: #954f72; text-decoration: underline;">Phase 3 study</a> of 3-dose Pfizer vaccination in babies and toddlers shows overall efficacy of 71.8% against symptomatic COVID-19. Unfortunately they had only 4 months’ follow-up, and even more unfortunately the efficacy was only 13.3% against BA.4, based on 3 cases. The researchers will continue to follow their subjects until at least June 2023, so we’ll have a chance to see how the protection evolves over time and against new variants.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>Leak vs. leap<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_68" o:spid="_x0000_i1033" style="height: 435pt; visibility: visible; width: 335pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image003.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjAQxFxs52rROS6uJPOep5w0vslMw8j78dkNOsJiC5RT9O_zqSwuVtGYEFPoM1IdNvbuX2O2erwzYKW79Yjvvm_Me8WCPBQ0ROZak0YHLDpaCbIzTMZlH-p5ypmaS1-UJzBUdTlRuZjxv0hheBkW8kllc3HS_h7qAXGG89Uw-2IQ3Ld5I1Op_7Gxm6/s1024/Fauci-FBI-Unredacted-791x1024.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="791" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjAQxFxs52rROS6uJPOep5w0vslMw8j78dkNOsJiC5RT9O_zqSwuVtGYEFPoM1IdNvbuX2O2erwzYKW79Yjvvm_Me8WCPBQ0ROZak0YHLDpaCbIzTMZlH-p5ypmaS1-UJzBUdTlRuZjxv0hheBkW8kllc3HS_h7qAXGG89Uw-2IQ3Ld5I1Op_7Gxm6/w494-h640/Fauci-FBI-Unredacted-791x1024.jpg" width="494" /></a></div><br /><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Debates over the pandemic's origin are definitely the hottest recent COVID-19 stories.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Newly unredacted emails show that prominent NIH scientists <a href="https://theintercept.com/2023/01/19/covid-origin-nih-emails/" style="color: #954f72; text-decoration: underline;">once seriously considered</a> the possibility that a lab leak was behind the pandemic. Let me point out that those emails are from January-February 2020, even before a pandemic had been declared, when we knew next to nothing about COVID-19 or the SARS-CoV-2 virus that causes it, and two years before strong <a href="https://www.science.org/doi/10.1126/science.abp8715" style="color: #954f72; text-decoration: underline;">epidemiological</a> and <a href="https://www.science.org/doi/10.1126/science.abp8337" style="color: #954f72; text-decoration: underline;">molecular</a> evidence of a species leap was published in Science. One of the scientists who harbored those initial suspicions, Robert Garry, <a href="https://www.nature.com/articles/s41591-020-0820-9" style="color: #954f72; text-decoration: underline;">changed his tune</a> just a month later and by late 2022 had become a prominent voice <a href="https://www.pnas.org/doi/10.1073/pnas.2211107119" style="color: #954f72; text-decoration: underline;">arguing for</a> a natural origin of the virus, <a href="https://www.nytimes.com/2021/06/14/science/covid-lab-leak-fauci-kristian-andersen.html" style="color: #954f72; text-decoration: underline;">as was Kristian Anderson</a>, who also featured in those emails.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">As I’ve said in previous posts, I don’t care very passionately whether SARS-CoV-2 leaked or leapt. But given how many people do, I don’t think the <a href="https://www.science.org/content/article/now-charge-house-republicans-launch-flurry-investigations" style="color: #954f72; text-decoration: underline;">addition of that subject</a> to the mission of the House Coronavirus select subcommittee is a bad thing, even though the chief characters behind that shift, <a href="https://oversight.house.gov/wp-content/uploads/2022/01/Letter-Re.-Feb-1-Emails-011122.pdf" style="color: #954f72; text-decoration: underline;">Jim Jordan and James Comer</a>, are the last people to look to regarding anything scientific. See Washington Post columnist Philip Bump’s <a href="https://www.washingtonpost.com/politics/2023/02/27/china-covid-wuhan-lab-energy-department/" style="color: #954f72; text-decoration: underline;">nice summary of</a>both the politics and the science. The Coronavirus House Energy and Commerce Committee held a hearing on February 8<sup>th</sup> where their prime witness, the acting director of the National Institutes of Health, <a href="https://www.nytimes.com/2023/02/08/us/politics/house-covid-lab-leak.html" style="color: #954f72; text-decoration: underline;">pushed back strongly</a>against the lab leak theory. Now the Coronavirus select subcommittee itself has begun <a href="https://oversight.house.gov/release/wenstrup-comer-launch-first-select-subcommittee-investigation-into-covid-origins-and-u-s-taxpayer-dollars-funneled-to-the-wuhan-lab%EF%BF%BC/?" style="color: #954f72; text-decoration: underline;">issuing subpoenas</a>, including to Anthony Fauci who is <a href="https://www.bloomberg.com/news/articles/2023-02-14/house-gop-seeks-fauci-testimony-in-probe-of-covid-19-origins?utm_campaign=wp_to_your_health&utm_medium=email&utm_source=newsletter&wpisrc=nl_tyh#xj4y7vzkg" style="color: #954f72; text-decoration: underline;">eager to testify</a>. <b><o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>The subcommitte has now officially kicked off its investigation, and I was horrified though frankly not surprised to learn that <a href="https://www.washingtonpost.com/nation/2023/02/28/fbi-director-christopher-wray-wuhan-lab/" style="color: #954f72; text-decoration: underline;">it did so</a> with a roundtable featuring three COVID-19 conspiracy theorists: Jay Bhattacharya and Martin Kulldorff, who wrote the notorious <a href="https://en.wikipedia.org/wiki/Great_Barrington_Declaration" style="color: #954f72; text-decoration: underline;"><span style="text-decoration: none;">Great Barrington Declaration</span></a> pushing a discredited herd immunity concept, and Marty Makary, who has been on Tucker Carson’s show spouting such absurdities as “We don’t even know if any healthy child has ever died of covid.” THE 3-MINUTE <a href="https://www.foxnews.com/video/6321448163112" style="color: #954f72; text-decoration: underline;">MAKARY VIDEO</a> IS WORTH A WATCH!<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">In reality, as of February 2023, 1,460 children 1-17 <a href="https://www.statista.com/statistics/1191568/reported-deaths-from-covid-by-age-us/" style="color: #954f72; text-decoration: underline;">had died</a> of COVID-19 in the US, and <a href="https://data.unicef.org/topic/child-survival/covid-19/" style="color: #954f72; text-decoration: underline;">at least 17,400</a> worldwide, and when it’s not deadly, pediatric COVID-19 is not always (though it usually) brief and benign. <a href="https://www.nature.com/articles/s41598-022-13495-5" style="color: #954f72; text-decoration: underline;">One study</a> found that 25% of children who got COVID-19 with pre-Omicron variants had symptoms that lasted 4 weeks or more; and <a href="https://www.cidrap.umn.edu/covid-19/kids-similar-risk-long-covid-adults-study-suggests" style="color: #954f72; text-decoration: underline;">some</a>though <a href="https://www.aafp.org/pubs/afp/issues/2022/1100/editorial-long-covid.html" style="color: #954f72; text-decoration: underline;">not all</a> researchers have found true long COVID to be just as common in children as in adults. <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Both the US Energy Department and the FBI <a href="https://www.nytimes.com/2023/02/26/us/politics/china-lab-leak-coronavirus-pandemic.html" style="color: #954f72; text-decoration: underline;">have now declared</a> in favor of the lab leak hypothesis, on the basis of secret new intelligence which <a href="https://www.washingtonpost.com/national-security/2023/02/27/little-known-scientific-team-behind-new-assessment-covid-19-origins/" style="color: #954f72; text-decoration: underline;">may come from</a> an obscure group of scientists known as the Z-division; I suggest checking out a <a href="https://www.washingtonpost.com/politics/2023/02/28/what-fueled-this-week-debate-over-covid-19-origins/?" style="color: #954f72; text-decoration: underline;">nice summary</a> of the controversy in the Washington Post. I continue to come down squarely on the side of natural transmission from animals to humans. The Chinese, who are best placed to know, have never cooperated fully with investigations. About the only new (though tangential) <a href="https://www.nytimes.com/2023/01/25/science/nih-ecohealth-coronavirus-lab-leak.html" style="color: #954f72; text-decoration: underline;">support</a> I see to the lab leak theory is a <a href="https://oig.hhs.gov/oas/reports/region5/52100025.pdf" style="color: #954f72; text-decoration: underline;">recent report</a>from the Inspector General of the Health and Human Services Department concluding that the National Institutes of Health were sloppy in their oversight of the virus research they funded in Wuhan through Ecohealth Alliance.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">I do care passionately about regulating research in such a way as to prevent new pandemics. On that front, two National Science Advisory Board Working Groups recently produced <a href="https://osp.od.nih.gov/wp-content/uploads/2023/01/DRAFT-NSABB-WG-Report.pdf" style="color: #954f72; text-decoration: underline;">a draft report</a> with detailed recommendations for preventing the kind of gain-of-function virus research that could lead to the most disastrous lab leaks. <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>Which country is craziest?<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>China<o:p></o:p></u></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_64" o:spid="_x0000_i1032" style="height: 145pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image004.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOl_Ng1dkeDjDv9KYe2L__Jov0W2OD1_DMgBEQI0mel3QXAN6Vk-kLg2WGaDNsU5UmkBPs1DU0Nh2n3Q5oeGUGOqWRKFBCfBGZE2XYoMCOewGn3UVW4cVdYaE9JBhsUxgArQort-A_b2e6J26gMfwf2p057G1oxHM4hynaspVDstFay-E5kfbJeQHi/s1410/obits%20nov%20vs.%20dec.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="453" data-original-width="1410" height="206" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOl_Ng1dkeDjDv9KYe2L__Jov0W2OD1_DMgBEQI0mel3QXAN6Vk-kLg2WGaDNsU5UmkBPs1DU0Nh2n3Q5oeGUGOqWRKFBCfBGZE2XYoMCOewGn3UVW4cVdYaE9JBhsUxgArQort-A_b2e6J26gMfwf2p057G1oxHM4hynaspVDstFay-E5kfbJeQHi/w640-h206/obits%20nov%20vs.%20dec.jpg" width="640" /></a></div><br /><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">The New York Times has <a href="https://www.nytimes.com/interactive/2023/02/05/world/asia/china-obits-covid.html?nl=todaysheadlines&emc=edit_th_20230206" style="color: #954f72; text-decoration: underline;">shown graphically what happened</a> after China dumped its COVID-19 restrictions, by tracing obituaries of members of the Chinese Academy of Engineering and the Chinese Academy of Sciences. Left: obituaries published in November 2022. Right: obituaries published in December.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">The Times has also revisited the most notorious COVID-19 fatality, with <a href="https://www.nytimes.com/2022/10/06/world/asia/covid-china-doctor-li-wenliang.html" style="color: #954f72; text-decoration: underline;">new details</a> about the death of Dr. Li Wenliang, the physician who tried in vain to blow the whistle on impending disaster. The article raises some doubts as to the adequacy of his treatment during his final days.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Sweden<o:p></o:p></u></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxEdY0HdwTZOWM7wha51RnCbls3zg5btqtWO1crIpMnjz_oVClMzsFgBzFOuOExAQxFwo9CavubhQwYVmqgKk_1HtMhYqrud53laniZEpf99kmKXdV5ZAPfBrecO2Z5FqWnMUgXSczAIynTn0V_WNHseA-0XjUQlLfQmghWQa-mopPU405eGrySuvZ/s1166/Sweden%20tweet.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="670" data-original-width="1166" height="231" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxEdY0HdwTZOWM7wha51RnCbls3zg5btqtWO1crIpMnjz_oVClMzsFgBzFOuOExAQxFwo9CavubhQwYVmqgKk_1HtMhYqrud53laniZEpf99kmKXdV5ZAPfBrecO2Z5FqWnMUgXSczAIynTn0V_WNHseA-0XjUQlLfQmghWQa-mopPU405eGrySuvZ/w400-h231/Sweden%20tweet.jpg" width="400" /></a></div><br /><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">I’ve always thought the Swedes were sensible people, and that the herd immunity philosophy had been suggested but never really caught on. But according to <a href="https://www-svt-se.translate.goog/nyheter/inrikes/fhm-snuva-inte-anledning-att-stanna-hemma?_x_tr_sl=auto&_x_tr_tl=en&_x_tr_hl=en&_x_tr_pto=wapp" style="color: #954f72; text-decoration: underline;">one Swedish source</a> the latest official advice in her country is to abandon all caution and tell people with respiratory symptoms to just go to work as normal. No tests, no self-isolation, just let it rip, infecting as many people as possible. But no – in reality this seems to be nonsense, because whereas the person who <a href="https://twitter.com/virpiflyg/status/1626155457831227394?s=46&t=NBQmvY_QBj33W3kVIyBRKQ" style="color: #954f72; text-decoration: underline;">tweeted it out</a> said the changed guideline took effect February 15<sup>th</sup>, the <a href="https://www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/communicable-disease-control/covid-19/how-to-protect-yourself-and-others-covid-19-recommendations/symptoms-of-covid-19/" style="color: #954f72; text-decoration: underline;">official government public health page</a>updated on that precise date continues to say the exact opposite: “Stay home from work, school, preschool, and other activities if you feel ill and have symptoms that could be due to COVID-19.”<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Florida<o:p></o:p></u></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_44" o:spid="_x0000_i1031" style="height: 195pt; visibility: visible; width: 292pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image005.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6rGrQu7QShGPRrfxBE0UAXKB-ulZo4EPt5RO8gdEYLSIyUC5jnKMtQu9YgE4-ZkYIIYM08PX8V-teC24hU95bJC9Qh2i_VGZiG2kWB-g08wQoYlB3dgWkn-CDV3XeY7JR1gTGGcWgqseYbKoTAN3QtOkFpXnwdeZ-of0FWrvO13U8O_-Va0Z_em4p/s1200/Ladapo%20DeSantis.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="800" data-original-width="1200" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6rGrQu7QShGPRrfxBE0UAXKB-ulZo4EPt5RO8gdEYLSIyUC5jnKMtQu9YgE4-ZkYIIYM08PX8V-teC24hU95bJC9Qh2i_VGZiG2kWB-g08wQoYlB3dgWkn-CDV3XeY7JR1gTGGcWgqseYbKoTAN3QtOkFpXnwdeZ-of0FWrvO13U8O_-Va0Z_em4p/s320/Ladapo%20DeSantis.jpeg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Joseph Ladapo and Ron DeSantis</td></tr></tbody></table><br /><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Governor Ron DeSantis once more leads the pro-COVID pack, <a href="https://www.theguardian.com/us-news/2023/jan/21/ron-desantis-covid-mandates-florida" style="color: #954f72; text-decoration: underline;">permanently banning</a> vaccine and mask mandates in the state of Florida. His henchman Surgeon General Joseph Ladapo, seems to have recently come out with a “<a href="https://floridahealthcovid19.gov/wp-content/uploads/2022/10/20221007-guidance-mrna-covid19-vaccines-analysis.pdf" style="color: #954f72; text-decoration: underline;">study</a>” explaining why young men shouldn’t be vaccinated against COVID-19. I put study in quotes and say “seems to have” because the document is not only not peer-reviewed, it’s not even signed. A medical school faculty task force from the University of Florida, where Ladapo is <a href="https://www.msn.com/en-us/news/us/after-more-than-a-year-in-office-uf-has-yet-to-reveal-dr-joseph-ladapos-duties/ar-AA15cxwN" style="color: #954f72; text-decoration: underline;">earning $337,000</a> a year for unclear duties, have presented a <a href="https://www.washingtonpost.com/documents/c4032b72-fdee-40e4-9148-612db8dbbc4a.pdf?itid=lk_inline_manual_2" style="color: #954f72; text-decoration: underline;">detailed critique</a>of this so-called research. The task force recommended the university investigate, but it <a href="https://www.washingtonpost.com/education/2023/01/04/ladapo-surgoen-general-university-florida/" style="color: #954f72; text-decoration: underline;">has declined</a> to do so. I guess black history isn’t the only <a href="https://www.nytimes.com/2023/02/01/us/college-board-advanced-placement-african-american-studies.html" style="color: #954f72; text-decoration: underline;">subject whose study is banned</a> in Florida. <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>Long COVID<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_71" o:spid="_x0000_i1030" style="height: 272pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image006.png"></v:imagedata></v:shape></span><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdSTvTlP-ucHWrouMbNTOfe4B6Ihqf-Yc_xW5HovkyuCRKNur4WvTEt5rHN5oJANalUNqEoDPSbnuEjDqYR3gQPg6JS9rptrKk4vHky77T9Ve1FtL0SC6qIaYekFNr24tj3YOnno2Hj2otuhuNJTz9webGc-X89oCLqXiGnKT2EHbhUptH7vBpebur/s1240/brain%20MRI%20in%20covid.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="744" data-original-width="1240" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdSTvTlP-ucHWrouMbNTOfe4B6Ihqf-Yc_xW5HovkyuCRKNur4WvTEt5rHN5oJANalUNqEoDPSbnuEjDqYR3gQPg6JS9rptrKk4vHky77T9Ve1FtL0SC6qIaYekFNr24tj3YOnno2Hj2otuhuNJTz9webGc-X89oCLqXiGnKT2EHbhUptH7vBpebur/s320/brain%20MRI%20in%20covid.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Brain MRIs of long COVID patients</td></tr></tbody></table><br /><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">A <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2801413?">study</a> from the University of Michigan reports that patients who had been hospitalized for COVID-19 got worse, not better, over 6 months. For example 67.3% had heart and lung problems one month after discharge and 75.4% five months later, fatigue rose from 40.7% to 50.8%. This is odd, because all the other studies I’ve seen report long COVID symptoms resolving by 6 months in almost all cases. Perhaps the explanation is that all these patients started out so sick they had to be hospitalized.</p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">A <a href="https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-023-03049-1" style="color: #954f72; text-decoration: underline;">small study</a> looking at MRIs in patients with long COVID following mild illness reports that they have measurably less grey matter in their brains than norms taken from a large UK databank.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2800885" style="color: #954f72; text-decoration: underline;">A publication</a> from the Nurses’ Health Study, a huge prospective research project, reports that adherence to a healthy lifestyle prior to falling ill with COVID-19 cuts the risk of developing long COVID in half. I’m not convinced, based on cases I’ve treated and read about.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">A <a href="https://pubs.rsna.org/doi/10.1148/radiol.222888" style="color: #954f72; text-decoration: underline;">Chinese study</a> of people who survived severe COVID-19 in January-March 2020 has reported that more than a third of them had respiratory symptoms and abnormal chest CAT scans of the lungs 2 years after being discharged from the hospital. This is not really surprising, and seems to me irrelevant to people catching COVID-19 today. Current variants are milder, and most people are vaccinated and/or previously infected, so many fewer patients get sick enough to require hospitalization.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">In <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8710949/" style="color: #954f72; text-decoration: underline;">a small-scale study</a> using peculiar methodology, reported only as an abstract from a medical conference, an anticoagulant-like drug called Sulodexide was said to improve a variety of symptoms in a subgroup of long COVID patients who were considered to have dysfunctional blood vessel linings. Low-dose naltrexone has been proposed as <a href="https://casereports.bmj.com/content/13/1/e232502" style="color: #954f72; text-decoration: underline;">another candidate</a>. I was mystified that the otherwise thorough <a href="https://www.nature.com/articles/s41579-022-00846-2" style="color: #954f72; text-decoration: underline;">review article</a> where I found these two references failed to mention the only treatment that has been validated by a <a href="https://www.nature.com/articles/s41598-022-15565-0" style="color: #954f72; text-decoration: underline;">sham-controlled double-blind study</a>, hyperbaric oxygen therapy. Also the NIH is <i>finally</i> sponsoring a <a href="https://www.niaid.nih.gov/news-events/covid-autopsy-study" style="color: #954f72; text-decoration: underline;">trial of Paxlovid</a>, which I’ve been hoping for since forever! <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>Prevention<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_72" o:spid="_x0000_i1029" style="height: 189pt; visibility: visible; width: 185pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image007.jpg"></v:imagedata></v:shape></span><u><o:p></o:p></u></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2k7fd-rIIZT6PA7L2H5gQrUoBkOvK_2Y65S7svW6Cjg80IqsLvBSESy5jeAKKc74OmGYOrC3NAEu7NRQdXI-H8p_X-wkarHDEACb19xh3XTgBTKAnYfUBOykLXfJVPL8PZBxnF-zyURg8V1woKOEVHD3G68vzjgs88IuxOYAhv9RYaJBLRqyA03jf/s1142/theory%20of%20BCG%20vs.%20covid.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1142" data-original-width="1116" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2k7fd-rIIZT6PA7L2H5gQrUoBkOvK_2Y65S7svW6Cjg80IqsLvBSESy5jeAKKc74OmGYOrC3NAEu7NRQdXI-H8p_X-wkarHDEACb19xh3XTgBTKAnYfUBOykLXfJVPL8PZBxnF-zyURg8V1woKOEVHD3G68vzjgs88IuxOYAhv9RYaJBLRqyA03jf/s320/theory%20of%20BCG%20vs.%20covid.jpg" width="313" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Possible mechanisms for BCG against COVID-19</td></tr></tbody></table><br /><u><br /></u></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Natural immunity</u>: A <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02465-5/fulltext" style="color: #954f72; text-decoration: underline;">meta-analysis in The Lancet</a>, similarly to the <a href="https://link.springer.com/article/10.1007/s40121-022-00753-2" style="color: #954f72; text-decoration: underline;">review</a> I cited last time, found a BA.1 Omicron infection to give only 45.3% protection against a second bout with the same identical variant. This is again no surprise, we all know people who’ve had one Omicron infection after another.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>BCG</u>: Early in the pandemic, it seemed people living in countries where this tuberculosis vaccine was given may have been having lower rates of COVID-19, and it was <a href="https://www.nature.com/articles/s41577-020-0337-y" style="color: #954f72; text-decoration: underline;">hypothesized</a> that the vaccine might be enhancing the immune system in a nonspecific way, as per the illustration above. Two small studies, one among <a href="https://www.cell.com/cell-reports-medicine/fulltext/S2666-3791(22)00271-3" style="color: #954f72; text-decoration: underline;">diabetics</a> and the other in <a href="https://www.cell.com/cell-reports-medicine/fulltext/S2666-3791(22)00271-3" style="color: #954f72; text-decoration: underline;">older patients with comorbidities</a>, gave some support to this concept. But in two larger trials with better methodology, one in <a href="https://pubmed.ncbi.nlm.nih.gov/35489606/" style="color: #954f72; text-decoration: underline;">the Netherlands</a> and the other in <a href="https://pubmed.ncbi.nlm.nih.gov/35582122/" style="color: #954f72; text-decoration: underline;">South Africa</a>, BCG flopped both for preventing infection and for reducing progression.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">“<u>SHIELD</u>”: <a href="https://www.nature.com/articles/s41563-023-01475-7" style="color: #954f72; text-decoration: underline;">A study</a> that somehow got published in the top journal Nature reports that an inhaled powder designed to reinforce upper respiratory tract mucus protected monkeys from COVID-19 pneumonia – but only if they inhaled it shortly <i>before</i> being exposed to the SARS-CoV-2 virus. I can’t see any way this study could be relevant to protecting human beings from COVID-19.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Facemasks</u>: <a href="https://freebeacon.com/coronavirus/this-study-could-be-scientific-nail-in-the-coffin-for-masks/" style="color: #954f72; text-decoration: underline;">One headline</a> from the Washington Free Beacon, an ultraconservative rag funded by “vulture capitalist” and activist <a href="https://en.wikipedia.org/wiki/Paul_Singer_(businessman)" style="color: #954f72; text-decoration: underline;">Paul Singer</a>, reads “This Study Could Be 'Scientific Nail in the Coffin' for Masks.” <a href="https://www.nytimes.com/2023/02/21/opinion/do-mask-mandates-work.html?" style="color: #954f72; text-decoration: underline;">Another</a>, from moderate conservative New York Times columnist Bret Stephens, is “The Mask Mandates Did Nothing. Will any lessons be learned?”<b> </b>What they’re both talking about is a <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full" style="color: #954f72; text-decoration: underline;">Cochrane Library review</a> that was unable to document benefits for face masks against the spread of respiratory infections on the basis of controlled trials performed up until October 2022. Here’s how the authors themselves begin their conclusions: “The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions.” Almost all the studies were pre-2016 and involved not COVID-19 but influenza or flu-like illnesses. In response, <a href="https://www.washingtonpost.com/opinions/2023/02/16/cochrane-study-masks-covid-pandemic/" style="color: #954f72; text-decoration: underline;">Leana Wen</a> correctly emphasizes that face masks can only decrease community levels of respiratory diseases if the vast majority of people in the community are wearing them, true of almost none of the studies under review. Incidentally, the review ran through October 2022, and the two best studies during the pandemic, both supportive of masking, were both published after that date. One found that kids had lower rates of COVID-19 in <a href="https://www.nejm.org/doi/10.1056/NEJMoa2211029" style="color: #954f72; text-decoration: underline;">school districts</a> that required face masks, and the other that <a href="https://www.acpjournals.org/doi/full/10.7326/M22-1966" style="color: #954f72; text-decoration: underline;">KN95 masks are better</a> than surgical masks at protecting healthcare workers, provided that community levels of SARS-CoV-2 are low enough that the workers aren’t being exposed elsewhere.<b><o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>By any other name<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_69" o:spid="_x0000_i1028" style="height: 284pt; visibility: visible; width: 220pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image008.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcGTnBF7Ug-LaT_SD3xiKdq52ZxNMr5eQ7hQcT6OD1Kr1DuZXqwZOOKJ88T1rL3FTIpFBQLq8_bgMnWeAGsBq76i0sZcLvuWTenmhz22b98DZNPteNRRmryTqNkDieH5Wy0xzA1V0EaB_L99Km0mgIRR_s4ySEEk3bfVP0XNyx8G0O_sIfToBwb_E3/s900/a-rose-by-any-other-name-charme-curtin.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="900" data-original-width="696" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcGTnBF7Ug-LaT_SD3xiKdq52ZxNMr5eQ7hQcT6OD1Kr1DuZXqwZOOKJ88T1rL3FTIpFBQLq8_bgMnWeAGsBq76i0sZcLvuWTenmhz22b98DZNPteNRRmryTqNkDieH5Wy0xzA1V0EaB_L99Km0mgIRR_s4ySEEk3bfVP0XNyx8G0O_sIfToBwb_E3/s320/a-rose-by-any-other-name-charme-curtin.jpg" width="247" /></a></div><br /><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">An excellent <a href="https://www.nytimes.com/2023/02/05/opinion/doctors-universal-health-care.html" style="color: #954f72; text-decoration: underline;">op-ed</a> by physician Eric Reinhart in the New York Times maintains that physicians’ widespread demoralization – one in 5 has imminent plans to leave practice – commonly described as “burnout,” shouldn’t be interpreted as a matter of individual psychology. The author argues, persuasively in my view, that the root cause is the awfulness of working within the chaos of the American healthcare non-system that, uniquely in the world, is based on maximizing profits rather than health.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>New dangers<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_70" o:spid="_x0000_i1027" style="height: 310pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image009.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieGD_r6-1lHzZo3aJvkxDW6LtszET0rhfMu1UITYNN-owBcsoQSyT8ot2P6yrFPxqR0jtnYW0_ZtdDc3P8u7J-TvJtP1cr5KcxChXu_MdIkZLGfe0SZsv9lyBiJTStBFFNabLFRaSNpbaK-12Xvj4XhD_V-DGO09qQjfK6fQvvPJdzuVKL7zgIQM60/s693/WhitetailedDeer.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="474" data-original-width="693" height="219" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieGD_r6-1lHzZo3aJvkxDW6LtszET0rhfMu1UITYNN-owBcsoQSyT8ot2P6yrFPxqR0jtnYW0_ZtdDc3P8u7J-TvJtP1cr5KcxChXu_MdIkZLGfe0SZsv9lyBiJTStBFFNabLFRaSNpbaK-12Xvj4XhD_V-DGO09qQjfK6fQvvPJdzuVKL7zgIQM60/s320/WhitetailedDeer.JPG" width="320" /></a></div><br /><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">It seems that deer, that ubiquitous and charming American pest, may constitute a <a href="https://www.nytimes.com/2023/01/31/health/coronavirus-variants-deer.html" style="color: #954f72; text-decoration: underline;">reservoir of old variants</a> of SARS-CoV-2 that could come back to bite us.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">And that the next big one could be an <a href="https://www.nytimes.com/2023/02/03/opinion/bird-flu-h5n1-pandemic.html?" style="color: #954f72; text-decoration: underline;">H5N1 bird flu</a>, which risks being <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370932/" style="color: #954f72; text-decoration: underline;">similar to the virus</a> that killed more than 50 million people in 1918-19.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Then there’s the latest new variant, CH.1.1 ("<a href="https://www.theoi.com/Ther/KuonOrthros.html" style="color: #954f72; text-decoration: underline;" target="_blank" title="Opens in a new tab or window">Orthrus</a>"), which is now causing more than 10% of cases in Europe but very few as yet in the US. In addition to being extraordinarily <a href="https://www.biorxiv.org/content/10.1101/2023.01.16.524244v1.full" style="color: #954f72; text-decoration: underline;">capable of escaping immunity</a> related to vaccines and previous infections, it shares a mutation with the Delta variant, raising alarm in some circles that it might turn out to be more virulent than other Omicron subvariants.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>States of emergency<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_76" o:spid="_x0000_i1026" style="height: 302pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image010.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirP9RAXTe-zHMUg0hAwJn2KxRk9G5LX4VWSdIq9XHyPixjW7MrNGdUVc7369T9E7wvgpWNnxqsXnhIKyjwSqZzk2Fa20QuttyYFGxrqrZ5Ychjjv0QchswqGZ59klakFztVSMzL91YjF1Okqhp6a26H5-ug1CYaZmWkURyLThkzry5MU-e3SQNDRJo/s1026/JHCRC%20global%20map%202-3-23.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="684" data-original-width="1026" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirP9RAXTe-zHMUg0hAwJn2KxRk9G5LX4VWSdIq9XHyPixjW7MrNGdUVc7369T9E7wvgpWNnxqsXnhIKyjwSqZzk2Fa20QuttyYFGxrqrZ5Ychjjv0QchswqGZ59klakFztVSMzL91YjF1Okqhp6a26H5-ug1CYaZmWkURyLThkzry5MU-e3SQNDRJo/w400-h266/JHCRC%20global%20map%202-3-23.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">A Johns Hopkins Coronavirus Resource Center map of global hotspots</td></tr></tbody></table><br /><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Leana Wen, after having been the only pundit who leapt to agree with Joe Biden last September when <a href="https://www.nytimes.com/2022/09/19/us/politics/biden-covid-pandemic-over.html" style="color: #954f72; text-decoration: underline;">he said</a> the pandemic was over, has followed up with <a href="https://www.washingtonpost.com/opinions/2023/01/31/biden-covid-pandemic-national-emergency-end/?" style="color: #954f72; text-decoration: underline;">a column</a> approving the impending end to the COVID-19 state of emergency. She does mention, and of course condemn, the fact that many million Medicaid recipients will be left high and dry without insurance.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">A emergency-end twist I hadn’t known about is that <a href="https://www.cnbc.com/2023/02/09/the-covid-emergency-in-the-us-ends-may-11-hhs-officials-say-heres-what-to-expect.html" style="color: #954f72; text-decoration: underline;">laboratories will no longer</a> be required to report COVID-19 test results to the CDC, so CDC statistics will become useless. Also, hospitals will no longer be able to be able to expand capacity if new surges happen.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Another nasty one: SNAP (Food Stamps) will <a href="https://www.reuters.com/world/us/us-food-benefits-poor-shrink-pandemic-provisions-end-2023-02-16/" style="color: #954f72; text-decoration: underline;">cut its benefits</a> and start kicking people off its rolls in March, even before the emergency ends. Its <a href="https://www.cbsnews.com/news/food-stamps-snap-benefits-cuts-march-2023/" style="color: #954f72; text-decoration: underline;">42 million recipients</a> will lose an average of $82 a month towards buying food, just when the price of groceries has been soaring. For a family of four that’s $328 less a month, and apparently elderly Americans receiving the minimum benefit could see their SNAP payments tumble from $281 to as little as $23 per month.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">And yet another: The Johns Hopkins Coronavirus Resource Center is going to <a href="https://hub.jhu.edu/2023/02/10/coronavirus-resource-center-ending-tracking/?" style="color: #954f72; text-decoration: underline;">stop tracking COVID-19 statistics</a> on March 10<sup>th</sup>. The best excuse they’ve come up with is “After three years of round-the-clock work building and maintaining a 24/7 global resource, we have reached the appropriate time to close this chapter of our response.” This shutdown could really be disastrous, since sources from the New York Times to Our World In Data depend on the JHCRC for authoritative data.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">In my last post I listed 3 silver linings of the impending end to the pandemic emergency in the US, but two of them are losing their shine: 1) enhanced federal funding to Medicaid <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2301021?" style="color: #954f72; text-decoration: underline;">starts shrinking</a> in April and will dry up entirely at the end of the year, so not so many people will get to stay on Medicaid just because of states <a href="https://edition.cnn.com/2022/12/22/politics/spending-bill-medicaid-enrollment/index.html" style="color: #954f72; text-decoration: underline;">dragging their heels</a>. 2) Title 42 <a href="https://www.nbcnews.com/politics/immigration/title-42-covid-ban-southern-border-may-end-may-11-rcna68502" style="color: #954f72; text-decoration: underline;">may in fact end</a>, but Biden is by now <a href="https://edition.cnn.com/2023/02/21/politics/asylum-policy-biden-administration/index.html" style="color: #954f72; text-decoration: underline;">nearly as tough</a> on asylum seekers as Trump.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>But there’s some good news – REALLY good news! Moderna <a href="https://investors.modernatx.com/Statements--Perspectives/Statements--Perspectives-Details/2023/Modernas-Commitment-to-Patient-Access-in-the-United-States/default.aspx?" style="color: #954f72; text-decoration: underline;">has backpedaled</a> on its outrageous plan to charge uninsured Americans $120 or so for each dose of its vaccine once the emergency ends. Now it says the vaccines will be free for people who are “uninsured or underinsured,” through a “patient assistance program.” Pfizer has <a href="https://eu.usatoday.com/story/news/2023/02/15/free-covid-vaccines-still-accessible-uninsured/11266890002/" style="color: #954f72; text-decoration: underline;">promised</a> to follow suit with a similar program, but <a href="https://www.pfizerrxpathways.com/updates" style="color: #954f72; text-decoration: underline;">is less clear</a> on what it means by that.<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b><o:p> </o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>Nuts and bolts, especially nuts<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_65" o:spid="_x0000_i1025" style="height: 166pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image011.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8PZLK1z-OGYp8e8g9LZvNd5OmyWxnsb7-cQf1ESfZ07TUb5i5wVryzM_6BRIT15Kan4CApskuLHwDKNGzF57h8jfWcNQdl0tspR2LMVvuhzSmujfL-kE6Y_t6wCVts7ZDf1dAuMCVF-YGnNqF1yxZLdQM0JykTxmyfgwMkq2xckAqqMEU8BxyGcKq/s1178/Pfizer%20head%20of%20R&D%20actual-supposed.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="432" data-original-width="1178" height="237" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8PZLK1z-OGYp8e8g9LZvNd5OmyWxnsb7-cQf1ESfZ07TUb5i5wVryzM_6BRIT15Kan4CApskuLHwDKNGzF57h8jfWcNQdl0tspR2LMVvuhzSmujfL-kE6Y_t6wCVts7ZDf1dAuMCVF-YGnNqF1yxZLdQM0JykTxmyfgwMkq2xckAqqMEU8BxyGcKq/w640-h237/Pfizer%20head%20of%20R&D%20actual-supposed.jpg" width="640" /></a></div><br /><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">The notorious <a href="https://en.wikipedia.org/wiki/Project_Veritas" style="color: #954f72; text-decoration: underline;">Project Veritas</a> has moved on from trashing Planned Parenthood and CNN to producing what looks to me like a <a href="https://www.forbes.com/sites/brucelee/2023/01/28/no-project-veritas-video-doesnt-prove-pfizer-is-mutating-covid-19-who-is-jordon-trishton-walker/?sh=489b6cf3623d" style="color: #954f72; text-decoration: underline;">blatantly</a> fake and <a href="https://www.medpagetoday.com/special-reports/exclusives/102895?" style="color: #954f72; text-decoration: underline;">in any case</a> heavily edited <a href="https://www.medpagetoday.com/special-reports/exclusives/102895?" style="color: #954f72; text-decoration: underline;">video</a> that within two days had been viewed 15 million times, showing “Jordan Trishton Walker,” identified as the head of Research and Development for Pfizer, chatting away in a bar about his company’s gain-of-function viral research. Pfizer’s actual head of R&D is on the left, the supposed one on the right. There is no evidence that the other guy even works for Pfizer, except for an <a href="https://www.sportskeeda.com/pop-culture/who-jordan-tristan-walker-pfizer-project-veritas-covid-mutation-video-scandal-explained" style="color: #954f72; text-decoration: underline;">crudely doctored CV</a> and the word of the founder of Project Veritas, whose own Board <a href="https://www.washingtonpost.com/politics/2023/02/20/james-okeefe-exits-project-veritas/" style="color: #954f72; text-decoration: underline;">recently gave him the boot</a>. That was after internal arguments in which he accused his opponents of “fabricating stories” – talk about the pot calling the kettle black! I must say that <a href="https://www.pfizer.com/news/announcements/pfizer-responds-research-claims" style="color: #954f72; text-decoration: underline;">Pfizer’s related press release</a> seems a bit evasive.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">An article by economist Mark Skidmore that somehow succeeded in <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-023-07998-3" style="color: #954f72; text-decoration: underline;">getting published</a> in a legitimate medical journal claims that the number of Americans who have been killed by COVID-19 vaccines could be as high as 278,000. <a href="https://drbannonsblog.aprendo.co.uk/drbannonsblog_wp/2023/02/12/is-this-the-worst-covid-research-ever/" style="color: #954f72; text-decoration: underline;">Medical blogger Colin Bannon asks</a>, “Is this the worst COVID research ever?” and does a brilliant job of ripping it to shreds. If it’s the worst, it’s had plenty of strong competition to overcome.<b><o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">An <a href="https://ia804701.us.archive.org/8/items/2-7-2023-instagram-post-by-the-liberal-purge/2%207%202023%20Instagram%20post%20by%20the_liberal_purge.JPG" style="color: #954f72; text-decoration: underline;">utterly fictitious claim</a> from a well-known <a href="https://en.wikipedia.org/wiki/David_Icke" style="color: #954f72; text-decoration: underline;">conspiracy theorist</a> says, “Thailand to BAN Pfizer After Thai Princess Falls Into a Coma Following Booster Jab.”<o:p></o:p></p><p><style class="WebKit-mso-list-quirks-style">
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</style></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">One blogger goes far beyond COVID-19 by saying viruses (all viruses, not just SARS-CoV-2) <a href="https://www.thenakedscientists.com/forum/index.php?topic=68196.0">don’t exist</a>. “The concept of a virus is illogical because viruses don't have any means of locomotion or any sensory organs. Thus, they can't protect themselves or hunt their prey,” and “The conception of the virus is just a money making scam.” <o:p></o:p></p>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com6tag:blogger.com,1999:blog-6211405954943098401.post-63004898450271925952023-02-04T16:11:00.000+01:002023-02-04T16:11:21.623+01:00Emergencies Come, Emergencies Go<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhziqmEyaUiYNAbXvBGFueMITxunq7Lpwn136sz_nb_jDRXBFJDPfbGIWaukbVFm7RxhIY_KO1stsqBg-Knz61ZQkBXRrXzUXJk1Gu0sp39m7iq0wWPWlq3Sm6VP4MbOylFZyt93YTe3kREO5QXhgyr9OJSy4Qfkulkua6eZnIvVYsq2c8-vb03g0L7/s479/Emergency%20series.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="479" data-original-width="340" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhziqmEyaUiYNAbXvBGFueMITxunq7Lpwn136sz_nb_jDRXBFJDPfbGIWaukbVFm7RxhIY_KO1stsqBg-Knz61ZQkBXRrXzUXJk1Gu0sp39m7iq0wWPWlq3Sm6VP4MbOylFZyt93YTe3kREO5QXhgyr9OJSy4Qfkulkua6eZnIvVYsq2c8-vb03g0L7/s320/Emergency%20series.jpg" width="227" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Much more data about bivalent boosters, interesting long COVID news, a looming post-Emergency disaster, airplane panic, the Swedish model, deaths with vs. deaths from, and updates on both the pandemic and its conspiracy theories.<o:p></o:p></p><div class="separator" style="clear: both; text-align: left;"><style class="WebKit-mso-list-quirks-style">
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span.timestampcontent
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</style><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b> </b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Treatment<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOKyn30Y78cuGbX-9_DEIWPwVH73LDdc0ouzYCBHpCqGTvAdh4PXgDCmxmr1guwe9qqyoLIyv5alvsM4mAsRKl9Zh-GGSlpDHYB1TgynZ4buMM-oKA_DoVIRt1Q5HbmCxh1zas-1re_iJqxB4qzk5w7owe4CMkECCZHVLNnPwgdeviV9nyZcj6owfK/s1442/Huahai%20Pharmaceutical.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="954" data-original-width="1442" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOKyn30Y78cuGbX-9_DEIWPwVH73LDdc0ouzYCBHpCqGTvAdh4PXgDCmxmr1guwe9qqyoLIyv5alvsM4mAsRKl9Zh-GGSlpDHYB1TgynZ4buMM-oKA_DoVIRt1Q5HbmCxh1zas-1re_iJqxB4qzk5w7owe4CMkECCZHVLNnPwgdeviV9nyZcj6owfK/w400-h266/Huahai%20Pharmaceutical.jpg" width="400" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>China</u>: <a href="https://www.usnews.com/news/top-news/articles/2023-01-15/in-china-no-easy-way-to-get-pfizers-covid-drug-paxlovid">Pfizer shipped</a> millions of Paxlovid courses to mainland China in January, complementing those to be manufactured by Huahai Pharmaceutical. Patients <a href="https://www.chinadaily.com.cn/a/202301/12/WS63bf5ac3a31057c47eba919d.html">might theoretically</a> be able to obtain it cheap, but between <a href="https://www.usnews.com/news/top-news/articles/2023-01-15/in-china-no-easy-way-to-get-pfizers-covid-drug-paxlovid">slow-walked prescribing and price-gouging</a>, many eligible patients die first. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Fluvoxamine</u>: For months I prescribed this antidepressant to high-risk COVID-19 patients, based on what seemed convincing research. Now, though, a <a href="https://jamanetwork.com/journals/jama/fullarticle/2800448">trial</a> giving fluvoxamine to 674 patients and placebo to 614 proves beyond the shadow of a doubt that it doesn’t reduce symptom duration or prevent severe outcomes. This is a relief of sorts, since so many patients couldn’t tolerate its side effects.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Molnupiravir</u>: If you feel like taking a deep dive into the current status of this controversial antiviral I suggest the superb presentation – and the comments – at <a href="https://blogs.jwatch.org/hiv-id-observations/index.php/after-the-panoramic-study-whither-molnupiravir/2023/01/17/">Paul Sax’s blog</a>. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Paxlovid</u>: It’s now been shown to prevent severe disease in vaccinated older people in <i>two</i> studies, in <a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciac443/6599020">Israel</a> and <a href="https://www.acpjournals.org/doi/10.7326/M22-2141">the US</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Vaccines and testing</b></p><div class="separator" style="clear: both; text-align: center;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTp8Gaw22_OSA6NLPOuDRxXkOFKFG16DZ3EMiRAg-wMwEL8mjUpg2SKXFglpmZY3EJ9gy9O2yizgndFcDgYiRC9gL40WMs-Pc0Wm7PlNEC7ya0D3ODwMF5u516hKZUXcdqtoHQ4Ngs9Zurqpq1r-dBdXixG8NHFLG2zbNvp3iX9kUsVZaJJUXtZq0l/s567/rapid%20test.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="375" data-original-width="567" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTp8Gaw22_OSA6NLPOuDRxXkOFKFG16DZ3EMiRAg-wMwEL8mjUpg2SKXFglpmZY3EJ9gy9O2yizgndFcDgYiRC9gL40WMs-Pc0Wm7PlNEC7ya0D3ODwMF5u516hKZUXcdqtoHQ4Ngs9Zurqpq1r-dBdXixG8NHFLG2zbNvp3iX9kUsVZaJJUXtZq0l/s320/rapid%20test.jpg" width="320" /></a></b></div><b><br /><o:p></o:p></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><br /></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_54" o:spid="_x0000_i1035" style="height: 300pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image002.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Price-gouging</u>:<b> </b><a href="https://www.wsj.com/articles/moderna-considers-price-of-110-130-for-covid-19-vaccine-11673289609?mod=hp_lista_pos2">Moderna</a> and <a href="https://www.wsj.com/articles/pfizer-targets-covid-vaccine-price-of-at-least-110-a-dose-11666306202?mod=article_inline">Pfizer-BioNTech</a> will start charging Americans between $110 and $130 per dose of COVID-19 vaccine once the federal government stops providing them free, which should happen <a href="https://www.fiercepharma.com/pharma/pfizer-set-charge-between-110-and-130-covid-vaccine-when-us-goes-commercial-model">within months</a>. Senators <a href="https://www.sanders.senate.gov/wp-content/uploads/Moderna-Letter-01.09.20231.pdf">Sanders</a> and <a href="https://www.warren.senate.gov/imo/media/doc/2022.12.12%20Letter%20to%20Pfizer%20on%20Vaccine%20Price%20Hikes.pdf">Warren</a> have righteously protested. On the low government price per dose, $19 to Pfizer and $22 to Moderna for the original vaccines and <a href="https://www.washingtonpost.com/politics/2023/01/10/republicans-iron-out-more-details-what-their-covid-panel-will-do/">about 50% more</a> for the bivalent boosters, both companies have made tens of billions of dollars and Moderna’s CEO has become a <a href="https://www.sanders.senate.gov/wp-content/uploads/Moderna-Letter-01.09.20231.pdf">multibillionaire</a>. <a href="https://www.fiercehealthcare.com/payers/health-plans-prepare-cover-covid-19-vaccine-tests">Insurers will likely</a> foot the bill, but the uninsured may wind up paying list price.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Myocarditis</u>: A Harvard group that detected circulating SARS-CoV-2 spike protein in the blood of long COVID sufferers (see below) has <a href="https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.061025">also found</a> it floating around in the blood of 14 out of 16 patients with post-vaccine myocarditis, versus none of 45 healthy, vaccinated, age-matched controls. I’m not sure what to make of this.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Evusheld</u>: AstraZeneca’s monoclonal antibody cocktail, intended to prevent COVID-19 for months at a time in people too immunocompromised to mount an antibody response to vaccines, has had its <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-announces-evusheld-not-currently-authorized-emergency-use-us">Emergency Use Authorization revoked</a> in the USA because more than 90% of new cases are now caused by resistant variants. Unfortunately, contrary to the <a href="https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization#coviddrugs">FDA’s cheery</a> “Paxlovid, Veklury (remdesivir) and Lagevrio (molnupiravir) . . . are expected to work against currently circulating variants,” Paxlovid <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2214302?">is the only one</a> likely to treat the currently dominant BQ.1.1 and especially XBB.1.5, “<a href="https://globalnews.ca/video/9386904/new-covid-subvariant-xbb-1-5-most-transmissible-detected-yet-who">the most transmissible subvariant that has been detected yet</a>.” With Evusheld <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-releases-important-information-about-risk-covid-19-due-certain-variants-not-neutralized-evusheld">helpless</a> against those strains, the immunocompromised are left <a href="https://www.washingtonpost.com/opinions/2023/01/12/immunocompromised-covid-pandemic-policies/">out on a limb</a><span class="MsoHyperlink">.</span><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Monovalents</u>: They’re history. The FDA <a href="https://www.fda.gov/media/164699/download">will no longer authorize</a> products aimed only at the Wuhan wild strain of the SARS-CoV-2 virus, recommending updated bivalent vaccines for both primary series and boosters. Boosters will be given yearly in the fall, based on which variant was predicted in the spring, with those at high risk possibly advised to get two doses instead of one. Given how quickly protection fades, it might be better to offer vulnerable populations more frequent boosters. And given how frequently variants appear and disappear, a fixed timetable seems foolish. Better to give targetted boosters for new strains when surges are looming. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Novavax</u>: Spike protein vaccine makers haven’t thrown in the sponge but are, I’d say, behind the times. The New England Journal of Medicine has, strangely, published a <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2215509?">research letter</a> saying that 4 doses of Novavax can neutralize the BA.5 variant, despite BA.5 being long gone in the US and on its way out in Europe.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Waning</u>: A <a href="https://link.springer.com/article/10.1007/s40121-022-00753-2">review</a> concludes that protection against symptomatic COVID-19 from both vaccination and previous infection fades over time, more quickly with vaccines (down 25-33% after 6 months) than with natural infection (only marginally at 12 months), and that a combination of both, “hybrid immunity,” may be longer-lasting. Unfortunately the studies it cites are almost all pre-Omicron. People who had COVID-19 from the original Wuhan virus <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30764-7/fulltext">almost never</a> got it again, but by the BA.5 era, having had pre-Omicron disease lowered the risk of reinfection by <a href="https://www.nejm.org/doi/10.1056/NEJMc2209306">only 36%</a>. Even infection with BA.1 Omicron lowers symptomatic reinfection by only <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00578-3/fulltext">72%</a> to <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2209306">76%</a>. I’ve personally seen people with Omicron infections just <a href="https://www.medrxiv.org/content/10.1101/2022.02.19.22271112v1">2 or 3</a> months apart. And later subvariants BQ.1, BQ.1.1, BF.7, XBB, and XBB.1 are even more likely to escape existing immunity. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Kids</u>: A <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2800743">thorough review</a> and meta-analysis found a two-dose regimen of mRNA vaccines quite effective in children 5 to 11. It cut symptomatic infections by 47%, hospitalizations by 68%, and multisystem inflammatory syndrome by 95%. Most of the studies were performed in the Omicron period, when adults were on the contrary nearly unprotected without a booster. Mild side effects were common, but myocarditis after the second dose occurred in fewer than one in 500,000 children (compare one in 5000-8000 adolescent boys).<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Antigen tests</u>: A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013705.pub3/full">meta-analysis</a> has concluded that rapid tests detect only 73% of symptomatic infections, a false-negative rate of more than one in four. A <a href="https://www.nytimes.com/2023/01/25/well/mind/covid-rapid-tests.html">New York Times article</a> makes useful suggestions on how to beat the odds.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Masking</u>: World Health Organization guidelines <a href="https://www.who.int/news/item/13-01-2023-who-updates-covid-19-guidelines-on-masks--treatments-and-patient-care">have upgraded</a> their masking recommendations, advising everybody at high risk for severe COVID-19 and anyone in “a crowded, enclosed, or poorly ventilated space,” to wear a mask. They also advocate for wider use of Paxlovid and, unfortunately, liberalize self-isolation guidelines.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Bivalent boosters, new data<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZeZGHJ2565YnY69z499mtlzwolU91DgD4cGDEQwmdlJGpYnNLm939vGorpEokEm0iszYluaet-UUHbUHWMD81-vUwPn8dHBQtDAJ8VhDnsSN7fsl0coLjx9v1YGyP9RP_uATTgZm-53UI-vwQ9SVDx5Qkmw0wNpWP-xWmld_VrLBpVBHtYR6aaiHp/s940/Better-COVID-Booster-Better-Protection-10.21.22.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="788" data-original-width="940" height="268" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZeZGHJ2565YnY69z499mtlzwolU91DgD4cGDEQwmdlJGpYnNLm939vGorpEokEm0iszYluaet-UUHbUHWMD81-vUwPn8dHBQtDAJ8VhDnsSN7fsl0coLjx9v1YGyP9RP_uATTgZm-53UI-vwQ9SVDx5Qkmw0wNpWP-xWmld_VrLBpVBHtYR6aaiHp/s320/Better-COVID-Booster-Better-Protection-10.21.22.png" width="320" /></a></div><br /><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_52" o:spid="_x0000_i1034" style="height: 268pt; visibility: visible; width: 320pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image003.png"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>In the lab</u>:<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">One small <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2214293">American study</a> reported higher neutralizing antibody levels against BA.2.75.2, BQ.1.1, and XBB with bivalent than monovalent boosters. But another <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2213907?query=TOC">one</a> found no difference, with both doing poorly against BA.2.75 and BA.2.75.2. The only subjects with decent antibody levels against those recent strains were those who had had breakthrough BA.4-BA.5 infections after 3 or 4 monovalent doses. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">A <a href="https://clinicaltrials.gov/ct2/show/NCT05472038">large Harvard study</a> that I cited some months back in preprint as showing superiority for bivalent boosters seems less positive in <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2213948?">published form</a>. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">A <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2213082?">much larger study</a> in an older population only adds more confusion. First because it examined not the Wuhan/BA.5 booster but a BA.1 bivalent vaccine that is not currently being used anywhere. Second because it yielded high levels of neutralizing antibodies against BA.1, which is long gone, moderate levels against BA.5, which is nearly gone, but low levels against BA.2.75, which is itself more susceptible to neutralization than the XBB.1.5, BQ.1.1 and BQ.1 subvariants that now cause more than 90% of new cases in the <a href="https://www.nebraskamed.com/COVID/what-covid-19-variants-are-going-around">United States</a> and 60% <a href="https://www.iss.it/en/web/guest/-/comunicato-stampa-n%C2%B004/2022-covid19-flash-survey-iss-il-10-gennaio-la-variante-omicron-al-100-">in Italy</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>In the real world<o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Israel</u>: A <a href="https://deliverypdf.ssrn.com/delivery.php?ID=085025117117089005101108021007084025020087072045017035073043108005102011056113097047000069002000028102109030110019082071066044025087078042078079112119098124089004078074036059002077004033123055035032004075002049040118102099103126006031097075099029073111099011021088066092113029028091088031112&EXT=pdf&INDEX=TRUE">Lancet preprint</a> says that elderly Israelis who received the bivalent Pfizer booster were 81% less likely to wind up hospitalized for COVID-19 than those who did not. That’s close to the 71% reduction reported in a similar population <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm715152e2.htm?s_cid=mm715152e2_w">by the CDC</a>. Three major caveats apply. First, <i>no</i> studies have compared monovalent to bivalent boosters head-to-head. Second, since the updated boosters have been available for only a few months, we have no idea of how long the added protection lasts. Third, only a minority of those eligible in either country went in for the updated booster, and they are likely the same kind of people who will wear masks and avoid crowds, making the vaccines falsely appear more effective.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Cleveland Clinic</u>: Researchers <a href="https://www.medrxiv.org/content/10.1101/2022.12.17.22283625v1.full.pdf">report</a> that the bivalent booster reduced employees’ risk of becoming infected with SARS-CoV-2 by only 30%, even though the local Omicron subvariants mostly matched the booster. The authors unfortunately didn’t distinguish between symptomatic and asymptomatic cases; if many infections were detected because of exposures rather than because of symptoms, that would lower the apparent effectiveness of the booster. Since protection against clinical COVID-19 is regularly found to be higher than protection against mere infection (and lower than protection against hospitalization), 30% against infection is compatible with the 50% or so against symptomatic COVID-19 <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7148e1.htm?s_cid=mm7148e1_w#T3_down">reported by the CDC</a>. And the above 3 caveats apply here as well.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>North Carolina</u>: University of North Carolina researchers have done the closest yet to a <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2215471?query=TOC">head-to-head study</a> of old vs. new boosters, by comparing people boosted during the summer of 2022 using a monovalent booster with those who received a bivalent version in September-October. Protection against COVID-19 hospitalization 15-99 days after the dose was 25.2% for the monovalent booster and 58.7% for the updated version. Pretty impressive. But until mid-November the dominant strain in the US was BA.5, whose spike protein is targeted in those boosters, after which more immune-evasive subvariants took over.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>United States</u>: <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7205e1.htm?">CDC data</a> from December-January now indicate that the bivalent booster is <a href="https://www.washingtonpost.com/health/2023/01/25/covid-bivalent-booster-xbb15-infections/">just about as effective</a>against symptomatic XBB.1.5 as it is against BA.5, and lasts at least 3 months. The added protection is unfortunately lower in older people (52% ages 18-49, 43% ages 50-64, 37% 65+),<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Bottom line</u>: <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">More than 4 months after the updated boosters were introduced, it’s <i>still</i> not 100% sure they offer any advantage over another dose of the original vaccines, as <a href="https://insidemedicine.substack.com/p/the-two-sides-of-the-bivalent-booster?utm_source=substack&utm_medium=email">Jeremy Faust</a> and <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2215780?query=TOC">Paul Offit</a> point out. Offit suggests boosters be given only to those most at risk for severe disease, rather than offering young healthy people short-lived, partial protection from strains that may disappear a few months later. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Special risk factors<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg44BK7d6A1XLq0D3PsuRWQnYLvqRJ6KKmr2EjYL1rEFZXPgubYaJIjBYbl5SC1xCZ8hjRtsvL25aRSOCr-CrCVG2GwIiIvKd_eLVbfZb4BdXl31qbELKb4JPETwhQdGieFxM9XIsHyMra4kActbDAUdbEkwDIBNGgrjWZQ140O2tV7pay2BNGFAAQC/s1189/covid%20on%20airplanes.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1083" data-original-width="1189" height="291" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg44BK7d6A1XLq0D3PsuRWQnYLvqRJ6KKmr2EjYL1rEFZXPgubYaJIjBYbl5SC1xCZ8hjRtsvL25aRSOCr-CrCVG2GwIiIvKd_eLVbfZb4BdXl31qbELKb4JPETwhQdGieFxM9XIsHyMra4kActbDAUdbEkwDIBNGgrjWZQ140O2tV7pay2BNGFAAQC/s320/covid%20on%20airplanes.jpg" width="320" /></a></div><br /><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_42" o:spid="_x0000_i1033" style="height: 233pt; visibility: visible; width: 350pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image004.jpg"></v:imagedata></v:shape><u><o:p></o:p></u></p><p class="MsoNormal" style="font-size: medium;"><u>Air travel</u>: A <a href="https://twitter.com/celinegounder/status/1611361380946305024">terrifying tweet</a> from an apparently reliable sourse was titled, “Testing wastewater from planes found that almost all flights had passengers with COVID,” says that SARS-CoV-2 was found in 96% of flights. True… but a little sleuthing revealed that those were flights arriving in <a href="https://todaytimeslive.com/world/193286.html">Kuala Lumpur</a><span class="MsoHyperlink">!</span> Malaysia apparently tests every plane that lands. The CDC <a href="https://edition.cnn.com/2023/01/05/health/airplane-wastewater-covid-testing/index.html">may start</a> similar testing in the United States, though I’ll bet they’ll only do it on flights from China instead of – as they should – on random samples of all flights.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Pregnancy</u>: We’ve <a href="https://www.nhs.uk/pregnancy/keeping-well/pregnancy-and-coronavirus/">always known</a> that COVID-19 late in pregnancy puts babies at risk, but we’ve now learned, from an <a href="https://gh.bmj.com/content/bmjgh/8/1/e009495.full.pdf">analysis</a> of studies involving more than 13,000 pregnant women, that COVID-19 during pregnancy can kill mothers as well, raising maternal mortality by a shocking factor of 7.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Chills</u>: Why do respiratory infections of all kinds peak in the winter? The medical party line has always been that it’s because people are spending more time indoors, in company. Now an <a href="https://www.jacionline.org/article/S0091-6749(22)01423-3/fulltext">interesting study</a> suggests there may be a physiological mechanism as well, with colder temperatures impairing the functioning of the innate immune system. I have to question the real-world importance of these findings given that the two countries that come closest to the US death toll, <a href="https://www.worldometers.info/coronavirus/countries-where-coronavirus-has-spread/">Brazil and India</a>, are both tropical,. Thanks to my brother <a href="http://www.chambermusicsf.org/about_whoweare.htm">Daniel</a> for the tip.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The next superspreader event?<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_43" o:spid="_x0000_i1032" style="height: 227pt; visibility: visible; width: 340pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image005.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDA5_eQE30V51XUo9UBFfwj1RlfyDLUq4q2rW2tgM1oNm9MZIPr2EemogwsE6R3OTAQ2vtsk4rmMVFB6Tdmz_7-vPkW9y2bF5LShb9SoK2ixuy-r72IkQ-phN74QHz92AcVK3gzT3Yz_XLogsfkDrwf26ZajLBgL3OaAxb4SOEnsLLLoiQVl8_CqeL/s2048/House%20unmasked.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1365" data-original-width="2048" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDA5_eQE30V51XUo9UBFfwj1RlfyDLUq4q2rW2tgM1oNm9MZIPr2EemogwsE6R3OTAQ2vtsk4rmMVFB6Tdmz_7-vPkW9y2bF5LShb9SoK2ixuy-r72IkQ-phN74QHz92AcVK3gzT3Yz_XLogsfkDrwf26ZajLBgL3OaAxb4SOEnsLLLoiQVl8_CqeL/w400-h266/House%20unmasked.jpeg" width="400" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">At a moment when the US was <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2021-02-28..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=false&Color+by+test+positivity=false&country=~USA">running 500</a> confirmed COVID-19 deaths every day and the US House of Representatives was meeting and voting nonstop there was nary a mask in sight. I suspect if anyone caught the bug there we’ll never find out.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Speaking of the Republican takover of the House, they’ve <a href="https://www.science.org/content/article/now-charge-house-republicans-launch-flurry-investigations">drastically changed the mission</a> of the existing coronavirus committee, <a href="https://www.statnews.com/2023/01/09/republicans-redirect-house-coronavirus-committee/">intending</a> to hype the lab leak hypothesis, blast pandemic restrictions, and blame Anthony Fauci for everything under the sun. This has already had real-world implications, <a href="https://www.washingtonpost.com/health/2023/01/18/lab-leak-theory-virologist/">discouraging scientists</a> from working to prevent the next pandemic – though I confess that the research described at Boston University looks a little worrying even to me. Last fall ProPublica <a href="https://www.propublica.org/article/editors-note-a-review-of-criticisms-of-a-propublica-vanity-fair-story-on-a-covid-origins-report">drew intense criticism</a> for publishing a <a href="https://www.propublica.org/article/senate-report-covid-19-origin-wuhan-lab?">long article</a> about an interim report on the origins of COVID-19 released by the Republican oversight staff of a Senate committee, promulgating a laboratory origin for the SARS-CoV-2 virus. <b><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b> </b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Long COVID<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHwASIb_7gkXiIBUWHkEXwKHtl2qXYqwYMQu87ZlKJ9u6n9z7R6D0ieI7YbhdfxEqyRGcVDq7huygD1d8IJ2K5_xZdSp4yYFqftNhtcY-sierDsmPau8oWkd5C1Sc5BdZkpGUHqKhPKVojsfozFM6fLKmQXWFwPxNfg7H-7FPJCg8oxqWr7MzY6aqx/s1486/spikes.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1052" data-original-width="1486" height="227" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHwASIb_7gkXiIBUWHkEXwKHtl2qXYqwYMQu87ZlKJ9u6n9z7R6D0ieI7YbhdfxEqyRGcVDq7huygD1d8IJ2K5_xZdSp4yYFqftNhtcY-sierDsmPau8oWkd5C1Sc5BdZkpGUHqKhPKVojsfozFM6fLKmQXWFwPxNfg7H-7FPJCg8oxqWr7MzY6aqx/s320/spikes.jpg" width="320" /></a></div><br /><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_61" o:spid="_x0000_i1031" style="height: 211pt; visibility: visible; width: 299pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image006.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Numbers</u>: A December 2022 <a href="https://www.cdc.gov/nchs/covid19/pulse/long-covid.htm">CDC survey found</a> that <a href="https://www.axios.com/2022/10/06/long-covid-cdc-data-disabling">24 million Americans</a> currently had long COVID, and that 14.4% of <i>all</i> adults have had it at some point during the pandemic, about 30% of everybody ever diagnosed with COVID-19. Montana and Wyoming were the worst-off states, at nearly 20%. Of those currently affected, 19 million said it gave them trouble carrying out their daily activities, including 6 million with “a lot” of trouble; as of <a href="https://www.brookings.edu/research/new-data-shows-long-covid-is-keeping-as-many-as-4-million-people-out-of-work/">last August</a> 4 million still weren’t capable of working. Another study, of <a href="https://www.nytimes.com/2023/01/24/health/long-covid-work.html?">workman’s compensation claims</a> in New York State, diagnosed long COVID if people were still under medical treatment or still out of work 60 days after COVID-19 they caught on the job, while admitting that these criteria probably miss many patients who are either “toughing it out” or don’t know they’re eligible for workman’s comp. Particularly interesting findings: the incidence of long COVID increased linearly with age rather than peaking in middle age; 71% of patients still qualified after 6 months; 18% were unable to work for a year or more; and a disproportionate number were essential workers. A <a href="https://www.brookings.edu/research/is-long-covid-worsening-the-labor-shortage/">Brooking Institution study</a> suggests that at any given moment more than 3 million Americans are either working reduced hours or not working at all due to long COVID. The impact on our workforce is clearly severe. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Spikes</u>: In a pilot study, Harvard researchers <a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciac722/6686531?login=false">detected</a> SARS-CoV-2 spike protein circulating in the blood of two-thirds of patients with long COVID, even 12 months after their initial illness, and in none who had recovered fully. This suggests persistent viral reservoirs in the body in some long COVID patients, and a possible therapeutic role for antivirals such as Paxlovid and remdesivir.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Cytokines</u>: Memorial Sloan-Kettering researchers support <a href="https://www.cell.com/cancer-cell/fulltext/S1535-6108(21)00051-9">a different etiology</a> by <a href="https://psscra.org/2021/02/10/cancer-researchers-discover-whats-driving-brain-fog-in-people-with-covid-19/">finding</a> proinflammatory cytokines in the cerebrospinal fluid of cancer patients with substantial neurological symptoms that persist after hospital discharge. Their patients, who were immunocompromised because of cancer and had severe COVID-19, were not your run-of-the-mill long COVID patient. And the research was done in 2020, long before vaccines or therapies. This study does, however, faintly suggest that corticosteroids might benefit post-COVID-19 brain fog.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Mono</u>: By age 25, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883578/">more than than 90%</a> of people have been exposed to the Epstein-Barr virus. Only <a href="https://www.healthline.com/health/mononucleosis">a quarter</a> of them had classic mononucleosis, with the rest mimicking the common cold. EBV is relevant both because mononucleosis can sometimes be followed by chronic fatigue syndrome and because EBV can reactivate when a person becomes sick or immunocompromised (EBNA IgG antibodies reappear). It’s been suspected that reactivated EBV may be involved in some cases of long COVID, and now we have some <a href="https://www.jci.org/articles/view/163669">solid evidence</a>. Researchers in San Francisco evaluated post-COVID symptoms and viral reactivation in 280 patients over 4 months. The 74% of patients with at least one long COVID symptom at 16 weeks and the 35% who had severe cases (more than 5 symptoms) were much more likely to have EBNA IgG antibodies than those who had recovered completely (45% and 47% vs. 28%). EBV reactivation was particularly associated with fatigue and brain fog. They also examined 2 other viruses: HIV (which <i>was</i> associated with cognitive difficulties), and reactivated cytomegalovirus (which was actually <i>protective</i> against long COVID, especially against brain fog).<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Pacing</u>: Chronic Fatigue Syndrome (“myalgic encephalomyelitis”) has been considered the closest relative of long COVID. Now UK researchers have performed a <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60096-2/fulltext#%20">randomized trial</a> of 3 proposed treatments for CFS: cognitive-behavioral therapy, graded exercise therapy, and adaptive pacing therapy, all provided by experienced clinicians over 12 months. Though <a href="https://www.washingtonpost.com/wellness/2023/01/16/long-covid-fatigue-pacing/?utm_campaign=wp_the_health_202&utm_medium=email&utm_source=newsletter&wpisrc=nl_health202">many patients are convinced</a> that adaptive pacing is the best approach, it was far outrun by the other 2, giving no benefit over standard medical care, whereas CBT and especially graded exercise yielded substantial improvements in fatigue and general physical function. I remain skeptical, after seeing pacing help individual long COVID patients, but maybe what this study really means is that long COVID isn’t as similar to CFS as we thought.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Recovery</u>: An <a href="https://www.bmj.com/content/380/bmj-2022-072529">Israeli study</a> reports that outpatients who developed long COVID pre-Omicron usually felt fine a year later. <a href="https://www.washingtonpost.com/opinions/2023/02/02/long-covid-new-research-pandemic/?">Leana Wen thinks</a> this is reassuring. I don’t. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The state of the pandemic</b><v:shape id="Picture_x0020_45" o:spid="_x0000_i1030" style="height: 238pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image007.jpg"></v:imagedata></v:shape><b><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKoUL9-H0ASg4gWdoOediFGGsjYqKNDqLP9CgJtUy62pcPHdUlekYFEMVqfZgQI3Xd131jPbSwFfgsv3HJ9CGkzHza6YRWD_eHAF1IN08B0WeBoeOYxIqZIFieqNZazjxnPx18KV6o2aezq_H4Dftr3KF6lYu_vxUSb6EOQfxe8_xBiSTYphoqvsnM/s1856/new%20parking%20lot%20outside%20Chinese%20funeral%20home.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="974" data-original-width="1856" height="336" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKoUL9-H0ASg4gWdoOediFGGsjYqKNDqLP9CgJtUy62pcPHdUlekYFEMVqfZgQI3Xd131jPbSwFfgsv3HJ9CGkzHza6YRWD_eHAF1IN08B0WeBoeOYxIqZIFieqNZazjxnPx18KV6o2aezq_H4Dftr3KF6lYu_vxUSb6EOQfxe8_xBiSTYphoqvsnM/w640-h336/new%20parking%20lot%20outside%20Chinese%20funeral%20home.jpg" width="640" /></a></div><br /><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>China</u>: China officially reported exactly 37 COVID-19 deaths between December 7<sup>th</sup> and January 8<sup>th</sup> despite evidence – including from <a href="https://www.washingtonpost.com/investigations/2023/01/09/china-crematorium-covid-deaths/?">these satellite photos</a> of a new parking lot outside a funeral home – that a surge was raging. On January 14<sup>th</sup> they <a href="https://www.washingtonpost.com/world/2023/01/14/china-covid-death-toll-revision/">revised</a> those figures upward, to 59,938. Then, going from one extreme to the other, the head of the Chinese CDC <a href="https://www.washingtonpost.com/world/2023/01/27/china-covid-travel-lunar-new-year/">apparently said</a> on January 21<sup>st</sup> that 80% of <i>all</i> Chinese had had COVID-19 during the present surge. I don’t think that’s even medically possible, given the 3-day average incubation period.<o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZBOkPXjawChej0DtmojlArnvLZwirTysUUuSv-TMXxnyDCrvte6uac66N3DfYjOPGy8Nc2HRPj4PuiOA1xY28bGKLmSAawtvp-cyqpm68jmVut2OWRBKM8b2YHwP269VFTj0AmO7Gh4QbW-AnTQknxB2en73EXIw40ZMjhYxJTdpXQGBygRaJz5EB/s1770/US%20and%20Europe%20covid%20deaths%20Oct%20to%20Jan.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1112" data-original-width="1770" height="402" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZBOkPXjawChej0DtmojlArnvLZwirTysUUuSv-TMXxnyDCrvte6uac66N3DfYjOPGy8Nc2HRPj4PuiOA1xY28bGKLmSAawtvp-cyqpm68jmVut2OWRBKM8b2YHwP269VFTj0AmO7Gh4QbW-AnTQknxB2en73EXIw40ZMjhYxJTdpXQGBygRaJz5EB/w640-h402/US%20and%20Europe%20covid%20deaths%20Oct%20to%20Jan.jpg" width="640" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_35" o:spid="_x0000_i1029" style="height: 274pt; visibility: visible; width: 384pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image008.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>United States</u>: Is the winter COVID-19 surge fizzling out, as the <a href="https://www.washingtonpost.com/health/2023/01/22/covid-declining-flu-rsv-tripledemic/">Washington Post says</a>? I’m not convinced. COVID-19 deaths do seem to have passed their peak in the EU, though not in the UK (ignore the phony zero death tolls) and certainly not in the US, where they’re holding steady or continuing to rise. I limited the above chart to recent months for clarity, but here’s a simplified <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&pickerSort=desc&pickerMetric=total_cases&hideControls=true&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=GBR~ITA~USA">all-time version</a>. <o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjR3bCl5QdzZpyr5O3X-4jQrAD4MsB2Emx0EIZeLdDJ_U5UfgXBI7hqxtcqM4uhIrAf9tktE87FIKSVRkVeeg3U1k95fViw8KdxYv3965oHu2nFLUE1PSg-GI-EfQ9URyN_buevRROICQSBqAdCgxEOD06vWvfrHYlUn3q3MSCP-NhYiv-T_6fek3Hm/s1784/deaths%20US-Italy%20entire%20pandemic.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1130" data-original-width="1784" height="406" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjR3bCl5QdzZpyr5O3X-4jQrAD4MsB2Emx0EIZeLdDJ_U5UfgXBI7hqxtcqM4uhIrAf9tktE87FIKSVRkVeeg3U1k95fViw8KdxYv3965oHu2nFLUE1PSg-GI-EfQ9URyN_buevRROICQSBqAdCgxEOD06vWvfrHYlUn3q3MSCP-NhYiv-T_6fek3Hm/w640-h406/deaths%20US-Italy%20entire%20pandemic.jpg" width="640" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_55" o:spid="_x0000_i1028" style="height: 231pt; visibility: visible; width: 365pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image009.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Admittedly recent deaths are much fewer than in earlier surges, but I agree with <a href="https://www.who.int/news/item/30-01-2023-statement-on-the-fourteenth-meeting-of-the-international-health-regulations-%282005%29-emergency-committee-regarding-the-coronavirus-disease-%28covid-19%29-pandemic?utm_campaign=wp_to_your_health&utm_medium=email&utm_source=newsletter&wpisrc=nl_tyh">the WHO</a> that the pandemic is not over yet.</p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Leana Wen recently wrote a <a href="https://www.washingtonpost.com/opinions/2023/01/13/covid-pandemic-deaths-hospitalizations-overcounting/">Washington Post column</a> titled “We are overcounting covid deaths and hospitalizations. That’s a problem.” In it she claimed that most of those hundreds of daily American COVID-19 deaths are “with” not “from,” swabs incidentally positive in patients hospitalized for other reasons. As often before, I find her position nonsense. It reminds me of how the Chinese – until January – considered a death to be related to COVID-19 only if the patient died in respiratory failure. “Incidental” positive swabs are particularly relevant in people who are seriously ill; someone hospitalized for a heart attack is much more likely to die if they’re infected with SARS-CoV-2. Jeremy Faust <a href="https://insidemedicine.substack.com/p/data-snapshot-are-we-overcounting">sees it</a> exactly as I do, urging Dr. Wen to at least change her headline. Now even the CDC has chimed in, with its Chief Medical Officer writing a <a href="https://www.washingtonpost.com/opinions/2023/01/30/covid-deaths-not-overcounted-us/">direct rebuttal</a> to Wen titled bluntly, “We are not overcounting covid deaths in the United States.”<b><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The COVID-19 emergency in the United States was first <a href="https://edition.cnn.com/2023/01/11/politics/covid-19-public-health-emergency">extended through February</a>, then 9 days later scheduled to <a href="https://www.nytimes.com/2023/01/30/us/politics/biden-covid-public-health-emergency.html">expire on May 11</a>; the WHO <a href="https://edition.cnn.com/2023/01/30/health/who-covid-public-health-emergency/index.html">says only</a> that the pandemic is at a transition point. The consequences for Americans will be dire. <a href="https://edition.cnn.com/2021/04/02/politics/food-stamps-hunger-americans-relief/index.html">Enhanced food stamp benefits</a> will end on March 1<sup>st</sup>, and starting April 1<sup>st</sup> as many as 19 million people (or as “few” as <a href="https://aspe.hhs.gov/sites/default/files/documents/404a7572048090ec1259d216f3fd617e/aspe-end-mcaid-continuous-coverage_IB.pdf?utm_campaign=wp_the_health_202&utm_medium=email&utm_source=newsletter&wpisrc=nl_health202">15 million</a>) could be kicked off Medicaid, about 6 million of whom will have no other road to health insurance. Childhood nutrition will also deteriorate, with millions of <a href="https://www.nytimes.com/2023/01/22/us/politics/universal-school-meals-free-lunches.html?">schoolkids no longer eligible</a> for free lunches at school. Not to speak of new bills for vaccines, tests, and treatments that will particularly devastate the uninsured while <a href="https://www.nytimes.com/2023/02/01/well/live/covid-public-health-emergency.html">also harming the insured</a>. I see 3 silver linings: 1) there are so many people currently on Medicaid that states may take <a href="https://edition.cnn.com/2022/12/22/politics/spending-bill-medicaid-enrollment/index.html">many months</a> to review all their cases; 2) Medicare coverage of telemedicine <a href="https://www.medicare.gov/coverage/telehealth">runs through 2024</a>; 3) Title 42 <a href="https://www.nbcnews.com/politics/immigration/title-42-covid-ban-southern-border-may-end-may-11-rcna68502">should end</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The Swedish model<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Fantasy: <a href="https://www.news.com.au/technology/science/sweden-has-the-lowest-excess-mortality-rate-after-the-pandemic-despite-refusing-to-lock-down/news-story/df50001366bb09b6a20421520cbfbf53">Headline:</a> Sweden has the lowest excess mortality rate after the pandemic, despite refusing to lock down. “Proof”: <a href="https://twitter.com/JamesMelville/status/1596815870676041729?">this chart</a> of data through June 2022. <o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwC_TBitRAnquYW9m1FOBcHB0ShJO3CGeEPnrfqSJA2C6cZxVHtD-lXovT17UerizPMWvityBdoELJZr7OaIEMvSqU_IjZGlnbdg8zCM2aAWtD1X6g-vvxAk-tmCNq0SzKkDWeODA3BJQ37Bokp_tzT7SfgesLfQKwp0j8taIG_hjYhTJy-sGFcUAI/s607/excess%20mortality%20from%20Beito.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="607" data-original-width="603" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwC_TBitRAnquYW9m1FOBcHB0ShJO3CGeEPnrfqSJA2C6cZxVHtD-lXovT17UerizPMWvityBdoELJZr7OaIEMvSqU_IjZGlnbdg8zCM2aAWtD1X6g-vvxAk-tmCNq0SzKkDWeODA3BJQ37Bokp_tzT7SfgesLfQKwp0j8taIG_hjYhTJy-sGFcUAI/w399-h400/excess%20mortality%20from%20Beito.jpeg" width="399" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_48" o:spid="_x0000_i1027" style="height: 230pt; visibility: visible; width: 229pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image010.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Reality: <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=earliest..2022-06-26&facet=none&pickerSort=desc&pickerMetric=total_cases&hideControls=true&Metric=Excess+mortality+%28%25%29&Interval=Cumulative&Relative+to+Population=true&Color+by+test+positivity=false&country=GBR~ITA~USA~SWE~DNK~NOR~NZL">here's excess mortality</a> through June 2022 from the authoritative Our World In Data:<o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDpG7XSlQpakzYfnNa_E7r9uSPKD8C-fjk_FV3Z0mfpqVkFV2Y33JUyiVAD7K7wgbc8sWiH9TpOdvvOM_gDCu-49Lp4gLtT4-_FukZhM5Q0uNrlys7tjN_ty_tPmepZ0d43AigjTFp-GUMDCTa4XCDNYNzRMpZP1ajsjtYiYA-x1Pu3cgfZ-6ctDPg/s1646/excess%20mortality%20OWID.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1132" data-original-width="1646" height="275" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDpG7XSlQpakzYfnNa_E7r9uSPKD8C-fjk_FV3Z0mfpqVkFV2Y33JUyiVAD7K7wgbc8sWiH9TpOdvvOM_gDCu-49Lp4gLtT4-_FukZhM5Q0uNrlys7tjN_ty_tPmepZ0d43AigjTFp-GUMDCTa4XCDNYNzRMpZP1ajsjtYiYA-x1Pu3cgfZ-6ctDPg/w400-h275/excess%20mortality%20OWID.jpg" width="400" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_49" o:spid="_x0000_i1026" style="height: 244pt; visibility: visible; width: 355pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image011.jpg"></v:imagedata></v:shape></b><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Sweden’s excess mortality at that date was lower than the US, Italy, or the UK, but that’s not saying much. It was 63% higher than Norway’s, 3 times Denmark’s, and far far from New Zealand, which runs <i>fewer</i> deaths than expected <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&pickerSort=desc&pickerMetric=total_cases&hideControls=true&Metric=Excess+mortality+%28%25%29&Interval=Cumulative&Relative+to+Population=true&Color+by+test+positivity=false&country=GBR~ITA~USA~SWE~DNK~NOR~NZL">even today</a>. Incidentally, Sweden is currently running the <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2022-09-06..latest&facet=none&pickerSort=desc&pickerMetric=total_cases&hideControls=true&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=GBR~ITA~USA~SWE~FRA~DEU~ESP~NOR~DNK">highest daily average</a> of COVID-19 deaths in Western Europe, 76% higher than the runner-up UK, and triple the US.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Recent pandemic madness<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_28" o:spid="_x0000_i1025" style="height: 143pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image012.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiw7LAJaJyMcYFZpnD5qLYDgSoE0Ra1LK8IK0_yATC3sAsPk0ABHgt1p4ikOgovSnotfV8BnGC77XJRjb3aqQMSdp6h7g_ThpRKrqtyAaC3ll6EUbQQQF8euiArRshh_bxDuo8jv0AWKLcY3Odfkb9zXVVFYch29P5pXfk8we-5fdDtU8FwzTnG6Awo/s1266/Ron%20Johnson,%20Juli%20Mazi.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="400" data-original-width="1266" height="202" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiw7LAJaJyMcYFZpnD5qLYDgSoE0Ra1LK8IK0_yATC3sAsPk0ABHgt1p4ikOgovSnotfV8BnGC77XJRjb3aqQMSdp6h7g_ThpRKrqtyAaC3ll6EUbQQQF8euiArRshh_bxDuo8jv0AWKLcY3Odfkb9zXVVFYch29P5pXfk8we-5fdDtU8FwzTnG6Awo/w640-h202/Ron%20Johnson,%20Juli%20Mazi.jpg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Ron Johnson, Juli Mazi</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Senator Ron Johnson is <a href="https://twitter.com/HeartlandSignal/status/1598041753206067213">still running on</a> about vaccines doing no good and lots of harm. As Grudgie the Whale <a href="https://twitter.com/grudging1/status/1598113883516174343?">points out</a>, “Lies like this are why Republicans died at like a 3 to 1 rate from COVID since the vaccines came out.” (True! The ratio is <a href="https://www.nber.org/papers/w30512">2.5 to 1</a>, due primarily to differences in vaccine uptake and masking behavior.) A <a href="https://www.sciencedirect.com/science/article/pii/S2667193X22002010">fascinating study</a> finds that the voting records of members of Congress correlate with COVID-19 death rates in their home districts – the more conservative, the worse the outcomes (taking into account race, income, health, and even vaccination rates).<o:p></o:p></p><p class="1obc" style="font-size: medium;">Naturopathic “physician” Juli A. Mazi has been sentenced to <a href="https://apnews.com/article/health-california-covid-san-francisco-immunizations-a2654cad5153d7ddf3edda3cff0b2674">33 months in prison</a> for selling fake vaccine cards. Her main defense – I kid you not – is that “as a Native American she is ‘immune to legal action.’”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Conspiracy theorist <a href="https://www.respectfulinsolence.com/tag/stew-peters/">Stew Peters</a> has released an antivaccine pseudodocumentary under the title of Died Suddenly, which was viewed <a href="https://twitter.com/caulfieldtim/status/1595476226894073858">5 million times</a> in 2 days. Science-Based Medicine <a href="https://sciencebasedmedicine.org/died-suddenly-a-tsunami-of-antivax-misinformation-and-conspiracy-theories/">calls it</a> “A tsunami of antivax misinformation and conspiracy theories,” and a health law professor <a href="https://twitter.com/caulfieldtim/status/1595476226894073858">says</a> it’s “so scientifically absurd it feels like satire.” Peters’s <a href="https://www.factcheck.org/2022/04/scicheck-covid-19-is-caused-by-a-virus-not-snake-venom/">previous video</a> claimed that the disease known as COVID-19 was caused by “snake venom secretly injected into the water supply by the Catholic Church and government agencies.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Conservative media proclaim: “<a href="https://web.archive.org/web/20221218140502/https:/www.theepochtimes.com/health/pfizers-covid-19-vaccine-linked-to-blood-clotting-fda_4930377.html">Pfizer’s COVID-19 Vaccine Linked to Blood Clotting: FDA</a>” and “<a href="https://www.youtube.com/watch?v=h5m5LnRuOdM">The FDA Drops BOMBSHELL over Pfizer Vaccine</a>” The raw data in the FDA <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9712075/">study</a> they’re talking about did find small increases in several clotting problems among older people following Pfizer vaccination. But most of those associations disappeared after further evaluation, with only pulmonary embolism retaining a significant linkage. Since the authors did not adjust for preexisting conditions, even that limited finding is questionable. Then there were the headlines saying <a href="https://www.bloomberg.com/news/articles/2023-01-13/pfizer-bivalent-vaccine-linked-to-stroke-in-preliminary-data#xj4y7vzkg">bivalent boosters caused strokes</a>. That was unlikely <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/us-says-pfizers-bivalent-covid-shot-may-be-linked-stroke-older-adults-2023-01-13/">from the start</a>, and was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9712075/">ruled out</a> by a deeper look at the data.<b><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Yet another new <a href="https://twitter.com/PeterSweden7/status/1604949511494701056">antivax conspiracy theory</a> holds that vaccines cause miscarriages and stillbirths, based on the true fact that both increased greatly in 2021-22. The reality is just the opposite: pregnant women who are vaccinated have a <a href="https://www.bmj.com/content/378/bmj-2022-071416">one-third lower</a> rate of stillbirths and a <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2114466">one-fifth lower</a> rate of miscarriages than those who are unvaccinated. Having COVID-19, on the contrary, increases the risk of <a href="https://www.ucl.ac.uk/news/2022/jun/catching-covid-19-early-pregnancy-could-increase-risk-miscarriage">miscarriage</a> and doubles the risk of <a href="https://www.ajog.org/article/S0002-9378(21)00565-2/fulltext">stillbirth</a>. The spikes in both these bad pregnancy outcomes during the pandemic are due to disease, not to vaccination.<o:p></o:p></p></div><p></p><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p></p>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com8tag:blogger.com,1999:blog-6211405954943098401.post-44012263956768289322023-01-07T17:43:00.000+01:002023-01-07T17:43:02.780+01:00Pills, Pivots, and Pronouns<p> <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBnA-gnuZeXaYdjDATl0D79whrLVkC_J7jJ5gErEiGzrXD8IDYbxT8fYmlja1jD_Df5ZFdtsWr1XH9KPbbvmLkWhXMkjHy_cwixnSShT09aSFrULyjyqLE1dheFIOCtz0SFY-uUkxRjyORfefi4wBJWb1wKhI05AB22-9ZFFxnW3kWNZBU_MG4KneD/s2048/covid%20pts%20lobby%20china.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1365" data-original-width="2048" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBnA-gnuZeXaYdjDATl0D79whrLVkC_J7jJ5gErEiGzrXD8IDYbxT8fYmlja1jD_Df5ZFdtsWr1XH9KPbbvmLkWhXMkjHy_cwixnSShT09aSFrULyjyqLE1dheFIOCtz0SFY-uUkxRjyORfefi4wBJWb1wKhI05AB22-9ZFFxnW3kWNZBU_MG4KneD/w400-h266/covid%20pts%20lobby%20china.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">COVID beds in a Chinese hospital lobby</td></tr></tbody></table><style class="WebKit-mso-list-quirks-style">
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</style></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">New oral COVID-19 meds, mask wars, Floridian science, social media screwing up, countries collide, medium COVID, and a fab new conspiracy theory.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Treatment<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f"><v:stroke joinstyle="miter"><v:formulas><v:f eqn="if lineDrawn pixelLineWidth 0"><v:f eqn="sum @0 1 0"><v:f eqn="sum 0 0 @1"><v:f eqn="prod @2 1 2"><v:f eqn="prod @3 21600 pixelWidth"><v:f eqn="prod @3 21600 pixelHeight"><v:f eqn="sum @0 0 1"><v:f eqn="prod @6 1 2"><v:f eqn="prod @7 21600 pixelWidth"><v:f eqn="sum @8 21600 0"><v:f eqn="prod @7 21600 pixelHeight"><v:f eqn="sum @10 21600 0"></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:formulas><v:path gradientshapeok="t" o:connecttype="rect" o:extrusionok="f"><o:lock aspectratio="t" v:ext="edit"></o:lock></v:path></v:stroke></v:shapetype><v:shape id="Picture_x0020_18" o:spid="_x0000_i1037" style="height: 248pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image001.png"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBtpOhE_oYYgLT7-SB28PXhxEIVnvMCJLqo9u1sh16uHGusRY4929c6cc06VLnGgagLp5kmHOHsEX7XoOzr-Y6fmrZf_LG6hYaglN_tU-UbVdgM8vCldBmLc56NIuTE4QBNyB95D5bnQzbclguGK0kwsObsBH9panXHLl_eftKg1JTtqvH3QidQDtR/s520/Chinese%20Paxlovid.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="284" data-original-width="520" height="175" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBtpOhE_oYYgLT7-SB28PXhxEIVnvMCJLqo9u1sh16uHGusRY4929c6cc06VLnGgagLp5kmHOHsEX7XoOzr-Y6fmrZf_LG6hYaglN_tU-UbVdgM8vCldBmLc56NIuTE4QBNyB95D5bnQzbclguGK0kwsObsBH9panXHLl_eftKg1JTtqvH3QidQDtR/s320/Chinese%20Paxlovid.png" width="320" /></a></div><br /><u><br /></u><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Molnupiravir</u>: A PANORAMIC study manuscript I’ve discussed in <a href="https://deliverypdf.ssrn.com/delivery.php?ID=417031103127071022126066117120095095046013081059031002110086124120082126109002090081002029062028015025012120096108100121099089000008036054039018108001064096023102064095080073100006091072096102104090000000064103064123086069088093100077073074008125031100&EXT=pdf&INDEX=TRUE">preprint form</a> has now been <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02597-1/fulltext">published</a>, reiterating both that the drug does nothing to prevent hospitalization or death, and that it shortens the duration of symptoms from 15 days to 10. The symptom results are suspicious because of the combination of self-reported symptoms and an open-label study design: people randomized to molnupiravir knew they were taking it, and people who were randomized to usual care knew they were in a drug study and weren’t getting the drug. A virology substudy is reported in more detail than in the preprint, with viral loads significantly <i>lower</i> in the molnupiravir group at 5 and 7 days, but significantly <i>higher</i> at 14 days. Make of that what you will.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Zinc</u>: In September CDC <a href="https://www.covid19treatmentguidelines.nih.gov/therapies/supplements/zinc/">recommended against</a> using zinc to treat COVID-19, based on two negative trials. A <a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciac807/6795268?login=false">new randomized, controlled Tunisian study</a> is more promising, though to be taken with a grain of salt. At 30 days, 10.4% of zinc recipients and 16.7% of placebo recipients were dead or or in the ICU. Seems a bit too good to be true, and the placebo group included more diabetics and fewer received anticoagulants, creating bias. But I guess zinc is at least unlikely to cause serious harm.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Paxlovid in China</u>: Until recently Paxlovid was available in China <a href="https://www.ft.com/content/0687def9-585f-41e4-922b-aabdee7d77bb">only for VIPs</a> who obtained it through back channels, but now Pfizer has <a href="https://www.fiercepharma.com/manufacturing/paxlovid-production-pfizer-partners-chinese-company-huahai-which-coming-fda-ban">authorized</a> Zhejiang Huahai to produce it in and for mainland China. The drug could already be accessed through selected hospitals, and <a href="https://edition.cnn.com/2022/12/26/china/china-covid-beijing-paxlovid-distribution-intl-hnk/index.html">should now be widely available</a>. In one ill-advised early distribution effort the drug was offered online to anyone with a positive COVID-19 test – it <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/chinas-111inc-app-starts-retail-sales-pfizers-paxlovid-covid-treatment-2022-12-13/">sold out</a> in 30 minutes.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Paxlovid in the West</u>: It’s still <a href="https://www.nature.com/articles/d41586-022-04576-6">enormously underused</a> even though <a href="https://www.statista.com/statistics/1191568/reported-deaths-from-covid-by-age-us/">well over 90%</a> of recent COVID-19 deaths, at least in the US, occur among people over 50, in whom Paxlovid has been shown to prevent deterioration.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Azvudine</u>: This anti-HIV drug has now been <a href="https://www.nature.com/articles/d41586-022-02050-x">authorized in China</a> based on <a href="https://www.cell.com/the-innovation/pdf/S2666-6758(22)00117-5.pdf">a report</a> that it hastened symptom resolution in 10 (ten!) COVID-19 patients, and on a <a href="https://www.medthority.com/news/2022/7/npma-china-conditionally--approves-azvudine-first-oral-antiviral-made-in-china-to-treat-covid-19--genuine-biotech/">larger supposed study</a> that I haven’t been able to track down. <a href="https://clinicaltrials.gov/ct2/show/NCT05642910">Another trial</a> is still enrolling patients. The efficacy claim has been <a href="https://equalocean.com/analysis/2022080818665">disputed</a>, and there are <a href="https://www.nature.com/articles/d41586-022-02050-x">no data</a> regarding disease progression. China’s huge current surge in COVID-19 may reveal rapidly how this drug works in the real world.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>VV116</u>: Chinese researchers have also developed a second anti-COVID-19 pill, <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/china-junshis-potential-covid-drug-shows-promise-small-trial-2022-05-18/">a derivative of</a> the intravenous antiviral remdesivir. In <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2208822?query=TOC">a noninferiority study</a> performed <a href="https://clinicaltrials.gov/ct2/show/NCT05341609">during the Omicron era</a> it prevented disease progression just as effectively as Paxlovid, with none of the nearly 400 high-risk outpatients in either group becoming severely ill within 28 days. VV116 also seemed to provide some symptom relief, though that finding is flawed by an odd single-blind design: patients but not researchers knew which drug they were taking. Paxlovid gave somewhat more side effects overall, perhaps in part because some patients were taking incompatible medications. But VV116 only rarely gave the taste disturbances so common with Paxlovid, and caused less insomnia; muscle pain was rare in both groups. Strangely, the same Chinese authorities who approved azvudine have not yet authorized VV116, despite stronger evidence in its favor.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Upamostat</u>: It’s a big month for oral antivirals. A randomized, placebo-controlled <a href="https://www.ijidonline.com/article/S1201-9712(22)00638-5/fulltext">pilot study</a> on upamostat, a protease inhibitor like Paxlovid, found patients on active drug to get well faster and go downhill less often. The study predated Omicron, however, so the larger trial the authors promise will be particularly crucial.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Omicron subvariants</u>: In a <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2214302?">laboratory study</a>, Japanese researchers found that molnupiravir may work against BQ1.1 but not XBB, with remdesivir and current monoclonal antibodies good against neither. Paxlovid should work against both newcomers, though. That’s a relief. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Long COVID</u>: Researchers from Yale <a href="https://www.sciencedirect.com/science/article/pii/S2667257X22001000">have reported</a> that out of 12 long COVID patients with cognitive problems given a combination of one new drug, guanfacine, and one old one, N-acetylcysteine, 8 improved. Two of the 8 had to stop because of dizziness. Fatigue and confusion are described as other <a href="https://www.mayoclinic.org/drugs-supplements/guanfacine-oral-route/side-effects/drg-20064131?p=1">common guanfacine side effects</a>, with chest pain and shortness of breath only somewhat less common. I wouldn’t prescribe this cocktail to anyone for brain fog on the basis of this anecdotal evidence, especially not when it may well <i>worsen</i> other long COVID symptoms.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Long COVID again</u>: British researchers have performed a double-blind, placebo-controlled <a href="https://www.mdpi.com/2673-8112/2/4/31">trial</a> finding more improvement in fatigue and general well-being among long COVID patients who took an <a href="https://yourgutplus.com/product-info/">herbal concoction</a> plus a probiotic than among patients who took the probiotic alone, without significant side effects. Only 112 patients had had symptoms for longer than 30 days, and I’m not fully convinced, but what the hell – these herbs look pretty harmless, and I’ve already written two prescriptions. Thanks to Mayah Kadish for the tip.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Prevention<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_22" o:spid="_x0000_i1036" style="height: 225pt; visibility: visible; width: 400pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image002.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFEwmq5Va6l6D640n5IHWgGqI-J4jMaZz1MkHp8J5atZLIHTYzb53ABI3Vjc59Q06S3qltZIU-qd7Ae_lxSlY0132zGPZ7Gk5JkNH1PzcWB5v-bv9XAKlkobZcGoawnzN_VJKKRmY6jFPvYD_v-wQOyfP0RWCSwdrZUWmrKi7Tggf_cMFMseNU-4dw/s800/corpse%20covid+.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="450" data-original-width="800" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFEwmq5Va6l6D640n5IHWgGqI-J4jMaZz1MkHp8J5atZLIHTYzb53ABI3Vjc59Q06S3qltZIU-qd7Ae_lxSlY0132zGPZ7Gk5JkNH1PzcWB5v-bv9XAKlkobZcGoawnzN_VJKKRmY6jFPvYD_v-wQOyfP0RWCSwdrZUWmrKi7Tggf_cMFMseNU-4dw/w400-h225/corpse%20covid+.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">A death from COVID-19</td></tr></tbody></table><br /><u><br /></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Mask don’t mask</u>: With US hospitalizations for respiratory infections <a href="https://www.nytimes.com/interactive/2022/12/16/us/covid-flu-rsv-tripledemic-data.html">soaring</a>, the CDC is <a href="https://www.cnbc.com/2022/12/05/cdc-encourages-people-to-wear-masks-to-prevent-spread-of-covid-flu-rsv.html">again suggesting</a> people wear masks, effective against all 3 viruses, in public indoor spaces. Los Angeles and Sacramento may soon <a href="https://www.washingtonpost.com/wellness/2022/12/07/face-masks-tripledemic-flu-covid-rsv/">reinstitute a mandate</a>. New York City health authorities are <a href="https://www.nyc.gov/assets/doh/downloads/pdf/covid/coh-advisory-respiratory-viruses-masking.pdf">strongly urging</a> New Yorkers to wear high-quality masks in indoor public spaces and crowded outdoor settings, but have <a href="https://www.nytimes.com/2022/12/09/nyregion/nyc-covid-indoor-masks.html">stopped short of a mandate</a> except in healthcare facilities. I think Italy should have reinstituted a mask mandate <a href="https://www.today.it/attualita/mascherine-al-chiuso-novembre-2022.html">months ago</a>, but at least now the existing mandate in medical facilities and nursing homes, which was set to expire at the end of 2022, has been extended through April; more generalized mask mandates <a href="https://www.ilsole24ore.com/art/covid-arrivo-obbligo-mascherine-ffp2-tutti-positivi-anche-asintomatici-AEkvHrSC">may be revived</a> if cases and deaths continue to rise.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Mask versus mask</u>: A <a href="https://www.acpjournals.org/doi/full/10.7326/M22-1966">randomized trial</a> in 4 countries found fairly similar rates of COVID-19 among healthcare workers treating COVID-19 patients whether they used surgical masks or N95/KN95 masks at work. Does this mean both kinds of masks are just as good. Nope!!! The catch, as Leana Wen <a href="https://www.washingtonpost.com/opinions/2022/12/08/n95-masks-work-study-misinterpreted/">points out</a> in the Washington Post, is that most of those healthcare workers were enrolled when rates of Omicron were very high in their communities. If both mask groups were highly exposed to the virus when they were <i>off</i> work, their rates of infection would be expected to be similar whatever masks they wore on the job. In Canada, the one country where community rates were low in the study period, infections were <i>3 times higher</i> for surgical masks.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Flu shots</u>: This year’s influenza vaccine, unlike last year’s, is a good match for the viral strains that are circulating. Get yours!<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Zombies</u>: According to one <a href="https://www.medrxiv.org/content/10.1101/2022.10.11.22280868v1.full">preprinted manuscript</a> cited in the <a href="https://www.nytimes.com/2022/12/15/health/covid-dead-bodies.html">New York Times</a>, the SARS-CoV-2 virus can stay alive in dead bodies for as long as 13 days. That phenomenon is unlikely to cause many COVID-19 cases but families, medical examiners, and funeral parlors should be aware.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Vaccines <o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_32" o:spid="_x0000_i1035" style="height: 147pt; visibility: visible; width: 217pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image003.jpg"></v:imagedata></v:shape><u><o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXBQqgXM-5WRwaP4wtcumPGswxMa5c42ht4C6lo4V39FrnjZzNGcG9DYkCeHEr-xVstprtc5094aHOidMWIxUarHy3Znok4Xm5f83Q4Uz6h01LfbZqY6VINvbEW9tN7T9ihWrtj33LqSCTsmYJJNv4MlNeg6fucQDLR7CHc-ta-YcILOx4lV1xEDFd/s434/myocarditis-review%20copy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="294" data-original-width="434" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXBQqgXM-5WRwaP4wtcumPGswxMa5c42ht4C6lo4V39FrnjZzNGcG9DYkCeHEr-xVstprtc5094aHOidMWIxUarHy3Znok4Xm5f83Q4Uz6h01LfbZqY6VINvbEW9tN7T9ihWrtj33LqSCTsmYJJNv4MlNeg6fucQDLR7CHc-ta-YcILOx4lV1xEDFd/s320/myocarditis-review%20copy.jpg" width="320" /></a></div><br /><u><br /></u><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Floridian science</u>: Ron DeSantis and his sidekick Joseph Ladapo have officially declared war on mRNA COVID-19 vaccines, launching a <a href="https://edition.cnn.com/2022/12/13/politics/desantis-covid-vaccine-manufacturers/index.html">so-called study</a> of vaccine <a href="https://floridahealthcovid19.gov/wp-content/uploads/2022/10/20221007-guidance-mrna-covid19-vaccines-analysis.pdf">side effects</a>, <a href="https://www.orlandosentinel.com/coronavirus/os-ne-coronavirus-florida-surgeon-general-ladapo-myocarditis-covid-deaths-study-20221216-qg2vq7zoongordil6jceobm3j4-story.html">especially myocarditis</a>, and even calling for a grand jury to investigate “the development, promotion, and distribution of vaccines purported to prevent COVID-19 infection, symptoms, and transmission.” “Purported”? It is easy to calculate, between <a href="https://www.npr.org/sections/health-shots/2022/05/13/1098071284/this-is-how-many-lives-could-have-been-saved-with-covid-vaccinations-in-each-sta">earlier estimates</a> and <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=Cumulative&Relative+to+Population=false&Color+by+test+positivity=false&country=~USA">recent</a> figures, that 350,000 Americans have died unnecessarily by remaining unvaccinated, with perhaps as many as <a href="https://www.commonwealthfund.org/blog/2022/two-years-covid-vaccines-prevented-millions-deaths-hospitalizations">3 million</a> lives saved by vaccines in the US alone.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Real science</u>: But the way to <a href="https://twitter.com/kmpanthagani/status/1578921567534297090">refute disinformation</a> from the right is not with misinformation from the left. On the December 14<sup>th</sup> <a href="https://www.msnbc.com/alex-wagner-tonight/watch/desantis-doubles-down-on-covid-paranoia-vaccine-rejecting-gop-suffers-higher-death-rate-157526085701">Alex Wagner show</a> Dr. Vin Gupta rightly criticized DeSantis for politicizing vaccines. But when he said post-vaccine myocarditis is both extremely rare and always mild he was unfortunately wrong. Among male vaccinees between about 15 and 25 the incidence after a second dose of an mRNA vaccine, especially Moderna’s, may be as high as one in 5,000 or even 2,500. For this reason many countries are giving them only one dose or postponing the second one. Most myocarditis cases are mild, but some require intensive care and a handful of <a href="https://covid19.govt.nz/news-and-data/latest-news/statement-from-the-covid-19-vaccine-independent-safety-monitoring-board/">deaths</a> have been reported. Careful analysis of one <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2109730?">Israeli study</a>, which also reported a death, suggests that teenaged boys may run more risk of being hospitalized due to vaccines than they do from COVID-19. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Bivalents</u>: The latest <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm715152e1.htm?">study</a> from the CDC finds that updated vaccines decrease the risk of hospitalization for COVID-19 by 38% in people whose latest booster was 5-7 months earlier, and by 45% if it was 11+ months earlier. To be honest, these numbers seem more plausible than those of a <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7148e1.htm?s_cid=mm7148e1_w#T3_down">previous CDC study</a>, which claimed increased protection against <i>infection</i> of about 50% over the protection from previous boosters. I say “more plausible” partly because in all previous studies COVID-19 vaccines have done much better against severe outcomes than they do against infection. Another encouraging report says the bivalent Moderna booster <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2212772?">will likely work</a> against the BA.2.75 subvariant, even without including its spike protein.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Blame vaccines?</u> An opinion piece in the Wall Street Journal asks “Are Vaccines Fueling New Covid Variants?” As far as I can tell – the article is behind a paywall but I’ve gotten more information from <a href="https://matzav.com/vaccines-fueling-new-covid-variants/">one</a> that isn’t – it’s all about <a href="https://www.nature.com/articles/s41586-022-05644-7">an article</a> rushed into Nature in pre-final form. The complexity of its science goes a bit over my head, but Peer Reviewer 2 <a href="https://static-content.springer.com/esm/art%3A10.1038%2Fs41586-022-05644-7/MediaObjects/41586_2022_5644_MOESM2_ESM.pdf">seems skeptical</a> of the vaccines-fuel-variants interpretation. This study does further document the extreme resistance of recent Omicron subvariants to neutralization by existing antibodies. It also suggests prioritizing development of a pan-coronavirus vaccine, long the Holy Grail of COVID-19 vaccines; such efforts have thus far gotten nowhere.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The state of the pandemic<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_41" o:spid="_x0000_i1034" style="height: 265pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image004.png"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjE9p1TMrdAT5FstJa6Rh7Dmc8htI2ASBUTe5vlI56m4mdiu4mUt9nF-FTpcOS63MJd3xVR66Hz4MyY1sUtvTvyFW-rFOwajoGDKWTZ0wk_gY1oxbe9L4ub-cYZDGxzICmT3aKR_9IsLj_ngYH0t2KqCc5DFqecGRg2JYY9P0LSRPG3ab2ny25Lq6OR/s709/Wastewater-Surveillance%201.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="415" data-original-width="709" height="374" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjE9p1TMrdAT5FstJa6Rh7Dmc8htI2ASBUTe5vlI56m4mdiu4mUt9nF-FTpcOS63MJd3xVR66Hz4MyY1sUtvTvyFW-rFOwajoGDKWTZ0wk_gY1oxbe9L4ub-cYZDGxzICmT3aKR_9IsLj_ngYH0t2KqCc5DFqecGRg2JYY9P0LSRPG3ab2ny25Lq6OR/w640-h374/Wastewater-Surveillance%201.png" width="640" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The winter surge that <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2022-02-10..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Hospital+admissions&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=USA~FRA~DEU~ITA">started in Europe</a> has now hit the US, with <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2022-02-10..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Hospital+admissions&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=USA~FRA~DEU~ITA">hospital admissions doubling</a> in two months despite most Americans’ relative protection from severe illness by vaccines and/or previous infections. The apparent decline in Italy is not because severe cases have fallen but because COVID-19 wards <a href="https://www.repubblica.it/cronaca/2022/12/13/news/pronto_soccorso_caos_affollamento_influenza_covid-378918833/">are saturated</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://covid.cdc.gov/covid-data-tracker/#wastewater-surveillance">Wastewater surveillance</a> in the US suggested a huge surge dipped around mid-December, but lags in reporting make the apparent improvement suspect. Italy is so far behind on this metric that its <a href="https://www.iss.it/documents/20126/0/Bollettino_30_09_22_un%20anno%20sorveglianza_20_11_22_21%20(1).pdf">December 22<sup>nd</sup> bulletin</a> only reached September.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The Biden administration is <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/12/15/fact-sheet-biden-administration-announces-covid-19-winter-preparedness-plan/">finding ways to combat</a> the pandemic despite the lack of funding from Congress, by making testing, vaccines, and treatments more readily available. <a href="https://www.nytimes.com/interactive/2021/us/new-york-city-new-york-covid-cases.html">In New York City</a>, where cases have been rising for months and 6 times as many people are hospitalized as <a href="https://www.nyc.gov/site/doh/covid/covid-19-data-totals.page">in the spring</a>, elderly or disabled residents can now be <a href="https://vax4nyc.nyc.gov/patient/s/">vaccinated</a> at home, and <a href="https://abc7ny.com/covid-paxlovid-how-to-get-treatment-walgreens/12544628/">Walgreens</a> will home-deliver Paxlovid free of charge.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Then there’s China, which like Italy has quietly <a href="https://www.npr.org/2022/12/25/1145472905/china-stops-publishing-daily-covid-data?sc=18&f=1001">stopped publishing</a> daily pandemic updates. The statistics they do report are if anything even <a href="https://www.nytimes.com/2022/12/14/business/china-economy-covid.html?">less credible</a> than earlier in the pandemic, with only 12 (twelve!) deaths reported between December 1<sup>st</sup> and 29<sup>th</sup>, while funeral homes and crematoria were <a href="https://www.washingtonpost.com/world/2022/12/20/china-covid-coronavirus-low-numbers/">working overtime</a>. <i>Half the passengers</i> on a recent China-to-Milan flight <a href="https://www.washingtonpost.com/world/2022/12/29/china-covid-travel-restrictions/">tested positive</a> on arrival! As we know street demonstrations forced China to scrap its no-COVID policy. Disaster will follow if it does not start vaccinating its elderly – ideally with mRNA vaccines, but at least with Sinovac and Sinopharm. <a href="https://www.nytimes.com/2022/12/12/business/china-covid-zero-vaccines.html">Only 60%</a> of older Chinese have received even one booster, though those home-grown vaccines are near-useless without them. Chinese authorities have <a href="https://www.nytimes.com/2022/12/08/world/asia/china-covid-rollback.html?">pivoted</a> from exaggerating the dangers of COVID-19 to underrating them, for instance claiming 90% of Omicron cases are asymptomatic or nearly so. This makes it less likely they will undertake the vitally necessary vaccination campaign. China’s pandemic surge is <a href="https://www.nytimes.com/2022/12/27/world/asia/china-covid-hospital-crisis.html?">decimating hospital staffs</a> and bringing shortages of ventilators, oxygen tanks, and intensive care beds. Note that in China a death <a href="https://www.npr.org/2022/12/21/1144631144/china-limits-how-it-defines-covid-deaths-in-official-count?sc=18&f=1001">is counted</a> as COVID-19-related only if it involves respiratory failure, with <a href="https://www.nytimes.com/2022/12/29/health/china-covid-outbreak-predictions.html?">doctors being pressured</a> not to report even those. Modeling studies <a href="https://www.washingtonpost.com/world/2022/12/18/china-covid-model-deaths/">are predicting</a> one to two million COVID-19 deaths in China in 2023, and on the ground it’s total confusion. Here’s one joke <a href="https://www.nytimes.com/2022/12/22/business/china-covid-censorship-propaganda.html">said to be</a> viral on Chinese social media: <o:p></o:p></p><p class="1obc" style="font-size: medium; margin: 5pt 6pt 5pt 0.5in;">“<i>Three men who don’t know one another sit in a prison cell. Each explains why he was arrested:</i><br /><i>“I opposed Covid testing.”</i><br /><i>“I supported Covid testing.”</i><br /><i>“I conducted Covid testing.”</i><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p><b>Crow for breakfast</b></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_24" o:spid="_x0000_i1033" style="height: 176pt; visibility: visible; width: 279pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image005.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizmn-bgNV74iguvFvMlpGIB0kBSZyMFenpiv2vB3QxX0EzxoyfUvRu2-UDEkP-Y4IbXmJQBdowvUR2iiZta0Y4Wdg3P1PY9nXVZ27gbbUIMJRyC0jkj2Lng9wAU608yTtEJ7CJFiL8SLEFQPHSK0x4u74LNE72Shs5yVWD12WVtJ2-of4McmHwGe1w/s558/crow%20from%20Footnotes.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="352" data-original-width="558" height="202" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizmn-bgNV74iguvFvMlpGIB0kBSZyMFenpiv2vB3QxX0EzxoyfUvRu2-UDEkP-Y4IbXmJQBdowvUR2iiZta0Y4Wdg3P1PY9nXVZ27gbbUIMJRyC0jkj2Lng9wAU608yTtEJ7CJFiL8SLEFQPHSK0x4u74LNE72Shs5yVWD12WVtJ2-of4McmHwGe1w/s320/crow%20from%20Footnotes.jpg" width="320" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I need to eat some crow. After I’ve said repeatedly that Palovid had been proven ineffective in people under 65, an<a href="https://www.medrxiv.org/content/10.1101/2022.06.14.22276393v2.full.pdf">American study</a> during the winter-spring Omicron wave may have proved me wrong. In adjusted analyses Paxlovid cut the hospitalization rate over 2 weeks by 45% among patients over 50. And, in stark contrast with that <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2204919">Israeli study</a>I’ve cited, results were if anything marginally <i>better</i> among patients ages 50-65 than among the elderly, a discrepancy the authors never mention. Two subgroups responded better to the drug: the few who were not fully vaccinated and the many who were obese. People of color were less than half as likely to have received Paxlovid as white patients, reflecting systemic racism in the US healthcare system.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Pick your model<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_33" o:spid="_x0000_i1032" style="height: 420pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image006.jpg"></v:imagedata></v:shape><u><o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg701G8gIQ8tf6P4EW6Emk0lqH3JD2VcDGAGT2c-LrkSdU5uHHSbUOmj8ntu-O45EH9jRk2NP5IUF1aTH3uqjg3_TzDalsmf5YqNg5iY0N9EArLPGUQTxxNTy6g1GNyvjTFu07DV1KX9o0QCkR3H23IXiSZz605zpJTkbU3rnQTXMKIPeemnxItd53e/s1285/car%20models%202.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1190" data-original-width="1285" height="371" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg701G8gIQ8tf6P4EW6Emk0lqH3JD2VcDGAGT2c-LrkSdU5uHHSbUOmj8ntu-O45EH9jRk2NP5IUF1aTH3uqjg3_TzDalsmf5YqNg5iY0N9EArLPGUQTxxNTy6g1GNyvjTFu07DV1KX9o0QCkR3H23IXiSZz605zpJTkbU3rnQTXMKIPeemnxItd53e/w400-h371/car%20models%202.jpg" width="400" /></a></div><br /><u><br /></u><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>American</u>: The House Select Subcommittee on the Coronavirus Crisis’s <a href="https://coronavirus.house.gov/sites/democrats.coronavirus.house.gov/files/2022.12.09%20Preparing%20for%20and%20Preventing%20the%20Next%20Public%20Health%20Emergency.pdf">final report</a> highlighted the poor outcomes in the US during the first two years of the pandemic, rightly slamming both the <a href="https://medicine.yale.edu/news-article/yale-study-more-than-335000-lives-could-have-been-saved-during-pandemic-if-us-had-universal-health-care/">inadequacies</a> of the American healthcare nonsystem and the <a href="https://www.washingtonpost.com/national-security/2022/12/15/trump-covid-intelligence/?">criminal mishandling</a> by the Trump administration. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>British</u>: The UK, which dropped all COVID-19 restrictions last spring, has been running somewhat <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&pickerSort=asc&pickerMetric=location&Metric=Excess+mortality+%28%25%29&Interval=Cumulative&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~USA~GBR">lower excess mortality</a> than Italy or the US. But it’s had <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+cases&Interval=Cumulative&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~USA~GBR">rather more cases</a> lately than the US, though fewer than Italy. Cumulative COVID-19 deaths are <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=Cumulative&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~USA~GBR">remarkably similar</a> in all 3 countries. They’d surely be lower if everybody were masking in indoor public spaces and getting regular boosters. I'm a bit shocked to see that both the US and the UK seem to have <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&pickerSort=asc&pickerMetric=location&Metric=Vaccine+booster+doses&Interval=Cumulative&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~USA~GBR">stopped reporting</a> booster administrations just when the updated shots came out.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Swedish</u>: A retired historian called David T. Beito <a href="https://www.facebook.com/dbeito">claims</a> research proves that Sweden did great during the pandemic despite never shutting down: “We have new compelling evidence that Sweden's covid policy (no lockdowns, no mask mandates, no school closures) was right all along. According to a new OECD study, Sweden had the lowest rate of cumulative excess deaths for all the countries surveyed, lower than much touted New Zealand, and lower than its Scandinavian neighbors, each of which briefly locked down.” I can’t find that OECD study, but I do see 3 problems with Beito’s statement: one is that though the government never called for a formal lockdown the Swedes, no fools, largely <a href="https://journals.humankinetics.com/view/journals/jcsp/15/1/article-p80.xml">invented one</a> for <a href="https://www.folkhalsomyndigheten.se/nyheter-och-press/nyhetsarkiv/2020/juni/stor-majoritet-har-anpassat-sitt-beteende-under-pandemin/">themselves</a>. The second is that the cumulative number of confirmed COVID-19 <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=Cumulative&Relative+to+Population=true&Color+by+test+positivity=false&country=SWE~NOR~DNK">deaths per million</a> as of January 4<sup>th</sup> was 878 in Norway, 1337 in Denmark, 1432 in Finland, and 2069 in Sweden. None hold a candle to the USA (3238) or Italy (3128), and all are much worse off than New Zealand (450). The third is that excess mortality was <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&pickerSort=asc&pickerMetric=location&Metric=Excess+mortality+%28%25%29&Interval=Cumulative&Relative+to+Population=true&Color+by+test+positivity=false&country=SWE~NOR~DNK">vastly higher</a> in Sweden than in its neighbors until a year ago, when high infection and vaccination rates <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&pickerSort=asc&pickerMetric=location&Metric=Excess+mortality+%28%25%29&Interval=Cumulative&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~SWE~NOR~FIN~DNK~USA~NZL">began flattening out</a> the difference. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>After the ball is over<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_40" o:spid="_x0000_i1031" style="height: 256pt; visibility: visible; width: 303pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image007.png"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjELBSLOKn9wIPt1LGFLF_KfPeBM2NK7FXkskZf3dULRPIx7csjqoH4HCyTVp6VKHw9eiK755MQoeie1zvBCmtr9vX7DXxLFbH43MjlnNQpk9K9g4C5WMsTw6ySmAEnJpY1I9b_S2H3hYRt7B8JPIEZnv-THR80wOnY8ng4dTka2uv5nerGWig41bq/s900/long-covid-sintomi-orig.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="760" data-original-width="900" height="270" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjELBSLOKn9wIPt1LGFLF_KfPeBM2NK7FXkskZf3dULRPIx7csjqoH4HCyTVp6VKHw9eiK755MQoeie1zvBCmtr9vX7DXxLFbH43MjlnNQpk9K9g4C5WMsTw6ySmAEnJpY1I9b_S2H3hYRt7B8JPIEZnv-THR80wOnY8ng4dTka2uv5nerGWig41bq/s320/long-covid-sintomi-orig.jpeg" width="320" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">A giant US <a href="https://www.nature.com/articles/s41591-022-01689-3">Veterans Administration study</a> shows a striking increase in new vascular disease during the year after acute COVID-19, among patients who survive the first 30 days. As compared with VA patients without COVID-19, the increased risk of stroke was 52%, atrial fibrillation 71%, myocarditis 438%, myocardial infarction 63%, heart failure 72%, cardiac arrest 145%, and pulmonary embolism 193%. All were much more common among patients sick enough to need hospitalization. <a href="https://www.nature.com/articles/s41591-022-02051-3">An earlier VA study</a> was severely marred by being limited to people who had sought medical assistance; I can’t figure out whether that’s true of this one as well.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Anyone on Twitter can check out an excellent <a href="https://twitter.com/raffyflynnart/status/1602033509568225280?">compendium of articles</a> documenting various kinds of immune dysfunction during the months after COVID-19.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">A year ago I described an autopsy study that found SARS-CoV-2 virus scattered throughout the body even 7 months after death. It has now been <a href="https://www.nature.com/articles/s41586-022-05542-y">published in Nature</a>, with added emphasis on the presence of viral RNA in the brain in 10 of the 11 cases where it was sought. In one case the researchers actually succeeded in culturing the virus from the brain. This might help explain the cognitive aspects of long COVID.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">An <a href="https://www.theatlantic.com/health/archive/2022/10/covid-symptoms-medium-term-post-infection-complications/671684/">excellent article</a> by Benjamin Mazer, MD, maintains (rightly, in my opinion) that the biggest reason to avoid catching COVID-19 is the “medium COVID” affecting one of every ten COVID-19 patients, with symptoms like fatigue, headache, and brain fog dragging on for 4-12 weeks. It does usually blow over eventually, with only a small percentage developing devastating forms of long COVID. But 4-12 weeks is a good chunk out of anyone’s life.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The sour smell of musk<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_34" o:spid="_x0000_i1030" style="height: 211pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image008.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj31NjVPZAerb5VPcxbgUKZqM_xb6KGpEZ2-EgOqmiQ4obGmxXxmPiDjovMr6kLXjdwFtpKITv6TdhUdWdoABz505Eltvg-I8vQZcEMUCfFyY-wwMtbtvdK0bnWjUvM0_GF1RlhsmgLPIbSUIQRVp3FCKYNixKoBR8l6cM4EzQl6NIBfGrQ7jYCXR6v/s1400/elon%20musk%205+.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="653" data-original-width="1400" height="298" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj31NjVPZAerb5VPcxbgUKZqM_xb6KGpEZ2-EgOqmiQ4obGmxXxmPiDjovMr6kLXjdwFtpKITv6TdhUdWdoABz505Eltvg-I8vQZcEMUCfFyY-wwMtbtvdK0bnWjUvM0_GF1RlhsmgLPIbSUIQRVp3FCKYNixKoBR8l6cM4EzQl6NIBfGrQ7jYCXR6v/w640-h298/elon%20musk%205+.jpg" width="640" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I wouldn’t ordinarily offer the new owner of Twitter any publicity, but here goes: “Effective November 23, 2022, Twitter is no longer enforcing the COVID-19 <a href="https://apnews.com/article/twitter-vaccine-misinformation-crackdown-3190793914e7d6aded43c19521954cde">misleading information policy</a>.” Apparently <a href="https://twitter.com/donie/status/1597556029419843584?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1597556029419843584%7Ctwgr%5Eee3910fc7b05908003ad57b30e0dd7caa7c836f3%7Ctwcon%5Es1_&ref_url=https%3A%2F%2Fballoon-juice.com%2F2022%2F12%2F02%2Fcovid-19-coronavirus-updates-thursday-friday-dec-1-2%2F">11,000 accounts</a> had been <a href="https://twitter.com/donie/status/1597556466336288768/photo/1">suspended</a> based on that policy. What’s your bet as to how many Mr. M. will bring back? Check <a href="https://www.nytimes.com/2022/12/22/technology/musk-twitter-bans.html?">here</a>. He’s already <a href="https://www.dailywire.com/news/twitter-reinstates-dr-robert-malone-and-dr-peter-mccullough">reactivated the Twitter accounts</a> of two prominent antivax physicians, while temporarily <a href="https://www.nytimes.com/2022/12/15/technology/twitter-suspends-journalist-accounts-elon-musk.html?">cancelling the accounts</a> of journalists from such dubious publications as the New York Times, the Washington Post, and CNN. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">On December 11 Musk took it one step further. Dig the gratuitous transphobia and the 1.2 million “Likes”:<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_15" o:spid="_x0000_i1029" style="height: 160pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image009.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHN5nB55R6T3Hf7ZxS6vlTrGxHUP0xdT_GE_bqgtmVfUnHTAAKwl6G45JcfNxIU9Ksb0r4B5bG0rbDVm5HbwaBKkOQDZ1VDtpaFjyteB16vFPqqGQLmirj1rZ07yUEyXTnSvazeuGZVvIOwsq7u0z4O-2hHQzBTA2n_mriZ-Z3VLlkviEpzB0wkIpf/s1184/musk%20prosecute%20fauci.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="418" data-original-width="1184" height="141" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHN5nB55R6T3Hf7ZxS6vlTrGxHUP0xdT_GE_bqgtmVfUnHTAAKwl6G45JcfNxIU9Ksb0r4B5bG0rbDVm5HbwaBKkOQDZ1VDtpaFjyteB16vFPqqGQLmirj1rZ07yUEyXTnSvazeuGZVvIOwsq7u0z4O-2hHQzBTA2n_mriZ-Z3VLlkviEpzB0wkIpf/w400-h141/musk%20prosecute%20fauci.jpg" width="400" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Other social media don’t necessarily do any better despite trying harder. TikTok claims to have removed more than <a href="https://www.tiktok.com/safety/en-us/covid-19/">250,000 videos</a> for COVID-19 disinformation, but <a href="https://www.nytimes.com/2022/12/28/technology/covid-misinformation-online.html">researchers have found</a> that <a href="https://www.newsguardtech.com/misinformation-monitor/september-2022/">if you search</a> TikTok for “hydroxychloroquine” the second result claims to tell you how to cook it up in your kitchen. If you search on “covid vaccine,” TikTok thinks you probably want “covid vaccine injury” or “covid vaccine warning.” <a href="https://en.wikipedia.org/wiki/Don%27t_be_evil">Don’t Be Evil</a> Google at least suggests “walk-in covid vaccine” and “types of covid vaccines.”And typing “mRNA vaccine” into TikTok brings up 5 videos with false claims in the first 10 results. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Triple whammy<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_37" o:spid="_x0000_i1028" style="height: 250pt; visibility: visible; width: 347pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image010.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_38" o:spid="_x0000_i1027" style="height: 258pt; visibility: visible; width: 357pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image011.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLSrr9UF7frOFsgcxZo7WTBVBDgCVxAhaBKymrEcDQ0NBtaZrvHOLT0zOXcAl7U0d2uFxQ_z77aggLzUIYcHwuuCA15a48LLOr1m8J1r5U6bKCeXlLARZJ-mzq46oTdDli7ZLz0fdW7DaYDft3PKRJTw4R3C9waai4RGVzK5Ifi4AHM3FOjmZcxpFK/s1456/flu%20vs.%20covid%20admissions.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1052" data-original-width="1456" height="290" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLSrr9UF7frOFsgcxZo7WTBVBDgCVxAhaBKymrEcDQ0NBtaZrvHOLT0zOXcAl7U0d2uFxQ_z77aggLzUIYcHwuuCA15a48LLOr1m8J1r5U6bKCeXlLARZJ-mzq46oTdDli7ZLz0fdW7DaYDft3PKRJTw4R3C9waai4RGVzK5Ifi4AHM3FOjmZcxpFK/w400-h290/flu%20vs.%20covid%20admissions.jpg" width="400" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeDR1--VQEEzYkGFnR_DNzc-gM32mReVaJrTFnz0uWGcLCYlIsXc7nG0ZMcx5Ke_e88HftmryOii5z7lwxzMfvD3L_coNC0o5fguyrd8OfWSXr53vRrljLVdQNecu3GIuI5tX2H_ZKwFFYi4ZFfy7RtkUwNWMUTze_Wo9IFD7vO5zqyMnWylKL4ndv/s1456/covid%20vs.%20flu%20deaths.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1052" data-original-width="1456" height="290" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeDR1--VQEEzYkGFnR_DNzc-gM32mReVaJrTFnz0uWGcLCYlIsXc7nG0ZMcx5Ke_e88HftmryOii5z7lwxzMfvD3L_coNC0o5fguyrd8OfWSXr53vRrljLVdQNecu3GIuI5tX2H_ZKwFFYi4ZFfy7RtkUwNWMUTze_Wo9IFD7vO5zqyMnWylKL4ndv/w400-h290/covid%20vs.%20flu%20deaths.jpg" width="400" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">For the first time since the pandemic began, hospitalizations for influenza in the US are matching, or even overtaking, hospitalizations for COVID-19. This is due to an early arrival of the flu season combined with a particularly virulent viral strain. If you add in respiratory syncytial virus (RSV), which mostly affects children, you have a <a href="https://www.washingtonpost.com/health/2022/12/15/tripledemic-covid-rsv-flu-surge/">triple threat</a>. So should we be worrying as much about the flu as we do about COVID-19? I don’t think so. For one thing, though hospitalizations are about even, with COVID-19 you’re much more likely to wind up in the intensive care unit or dead. For another, influenza is a seasonal disease. So the rise in hospital admissions is unlikely to continue with the same vertiginous slope, and the admissions will fade away in 2 or 3 months. COVID-19, on the contrary, may just be beginning a long roll.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Here comes the crunch<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_39" o:spid="_x0000_i1026" style="height: 176pt; visibility: visible; width: 312pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image012.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLfe7AOdauqzCGd8Gj5nnG-1p7C1zG_Tidoe9Z0-Dhs2m1q4nNocVZYga2zuZ_ddtwIEY8v8XNtGWBFSE54Jj2MkZIIbN3GjOmBHdOGUVBmZ3d92tsfZpheH4_fUWiTx4sJB3J4BIYYrp7r_uacPJVcco5ajDOlp6bnORe9-mO2hiwyphL4xgbCkWJ/s567/gun%20rights%201.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="319" data-original-width="567" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLfe7AOdauqzCGd8Gj5nnG-1p7C1zG_Tidoe9Z0-Dhs2m1q4nNocVZYga2zuZ_ddtwIEY8v8XNtGWBFSE54Jj2MkZIIbN3GjOmBHdOGUVBmZ3d92tsfZpheH4_fUWiTx4sJB3J4BIYYrp7r_uacPJVcco5ajDOlp6bnORe9-mO2hiwyphL4xgbCkWJ/w640-h360/gun%20rights%201.jpeg" width="640" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I’ve warned about terrible consequences of the failure of Congressional Republicans to extend pandemic funding, and <a href="https://www.nytimes.com/2022/12/06/us/politics/covid-testing-treatment-uninsured.html?">now they may be landing</a>. The 30 million Americans who are still uninsured despite the Affordable Care Act will start having to pay out of pocket for COVID-19-related medical visits, tests, vaccines, and treatment. For the time being Paxlovid remains distributed gratis, but to get a prescription you need to pay for a doctor’s visit, and that free supply is set to run out. The situation is particularly dire in the 12 <a href="https://www.urban.org/research/publication/3-7-million-people-would-gain-health-coverage-2023-if-remaining-12-states-were">mostly red states</a> that still refuse to expand Medicaid. The poor are already much more likely to die from COVID-19, not just <a href="https://www.reuters.com/world/us/us-poor-died-much-higher-rate-covid-than-rich-report-2022-04-04/">in the US</a> but even <a href="https://www.bmj.com/content/374/bmj.n1728">in the UK</a> despite its universal National Health Service. When impoverished uninsured people start having to pay for vaccines, they’re not going to get vaccinated. And if they get sick and need Paxlovid they’re not going to get it. Let’s not even talk about what happens if they get so sick they need to be hospitalized. So the pandemic gap between rich and poor is about to get a lot worse. <b>When the hell is the United States going to join the rest of the civilized world and make access to health care as much a human right as access to weapons of war?</b><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>My new favorite conspiracy theory<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_2" o:spid="_x0000_i1025" style="height: 273pt; visibility: visible; width: 240pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image013.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNVGAXbDePYw3RIGfdnu9qn6Ydgx01c8-6iMBkFc4O6Sqh5H-oR2MV2fUaWm5PZW0YLmBRTB0ur5jkNKhD7bYptkofoZA2gOVT8VwR3vL2PGgiL-1gO2Xh8lyxePuL7dP2wQMCG6GOwlpW-pcskHZFe7MlcqkcX0xqDeUlBkL97oduvS_ADtN6Gq7_/s863/master%20and%20slave.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="863" data-original-width="760" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNVGAXbDePYw3RIGfdnu9qn6Ydgx01c8-6iMBkFc4O6Sqh5H-oR2MV2fUaWm5PZW0YLmBRTB0ur5jkNKhD7bYptkofoZA2gOVT8VwR3vL2PGgiL-1gO2Xh8lyxePuL7dP2wQMCG6GOwlpW-pcskHZFe7MlcqkcX0xqDeUlBkL97oduvS_ADtN6Gq7_/w353-h400/master%20and%20slave.jpg" width="353" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Love this one. A September 5<sup>th</sup> 2022 <a href="https://www.facebook.com/photo/?fbid=10224465156308814&set=a.3498325729226">Facebook post</a> that accumulated 650 likes and 254 shares <a href="https://eu.usatoday.com/story/news/factcheck/2022/09/20/fact-check-false-claim-masks-do-not-make-people-more-obedient-slave-like/8026835001/">claims</a> science has proven that wearing a face mask makes you more “slave like” and obedient. The idea is that masks block your breathing and tell you that “a powerful and master force must already be in play.... threatening you,” which triggers the nervous system to assume a mode of obedience and compliance. Thusly, “our world misleaders psychologically manipulate the public into the darkest era this world will ever know.”<o:p></o:p></p>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com5tag:blogger.com,1999:blog-6211405954943098401.post-14369729501216057692022-12-03T18:38:00.005+01:002022-12-04T14:39:17.413+01:00Next Time ‘Round<div class="separator"><br /></div><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4v5B44QoXZKtBO_DuxABzC12IeA8r_NzGlEcqTQsM3Z0SMx6GkcpoBaC0Obr3dc5HMYQlT-hNOMBCTpee1WsyM36E6XZzGM9M1BDvQ6wcK9uOivRECvSWDDcrpS3hfMG1yc1b-iBx5cJIjiXlaPXRphgw7o7IEe0VrX655WgcMciAcJ2ZsGCjZtWK/s900/Omicron%20subvariants.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="510" data-original-width="900" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4v5B44QoXZKtBO_DuxABzC12IeA8r_NzGlEcqTQsM3Z0SMx6GkcpoBaC0Obr3dc5HMYQlT-hNOMBCTpee1WsyM36E6XZzGM9M1BDvQ6wcK9uOivRECvSWDDcrpS3hfMG1yc1b-iBx5cJIjiXlaPXRphgw7o7IEe0VrX655WgcMciAcJ2ZsGCjZtWK/w400-h226/Omicron%20subvariants.png" width="400" /></a></div><br /><br /><p></p><p><span style="font-size: medium;">No, COVID-19 is</span><span style="font-size: medium;"> </span><b><i>not</i></b><span style="font-size: medium;"> </span><span style="font-size: medium;">worse if you get it twice! Also lots about vaccines and long COVID, quick updates on variants and the state of the pandemic, plus extras on masks, Paxlovid, Rochelle Walensky, and one small but egregious conspiracy theory.</span></p><p><span style="font-size: medium;"><br /></span></p><style class="WebKit-mso-list-quirks-style">
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{mso-style-noshow:yes;
mso-style-priority:9;
mso-style-qformat:yes;
mso-style-link:"Heading 4 Char";
mso-style-next:Normal;
margin-top:2.0pt;
margin-right:0in;
margin-bottom:0in;
margin-left:0in;
mso-pagination:widow-orphan lines-together;
page-break-after:avoid;
mso-outline-level:4;
font-size:12.0pt;
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Yu Gothic Light";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;
font-weight:normal;
font-style:italic;}
h5
{mso-style-noshow:yes;
mso-style-priority:9;
mso-style-qformat:yes;
mso-style-link:"Heading 5 Char";
mso-style-next:Normal;
margin-top:2.0pt;
margin-right:0in;
margin-bottom:0in;
margin-left:0in;
mso-pagination:widow-orphan lines-together;
page-break-after:avoid;
mso-outline-level:5;
font-size:12.0pt;
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Yu Gothic Light";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;
font-weight:normal;}
p.MsoCommentText, li.MsoCommentText, div.MsoCommentText
{mso-style-priority:99;
mso-style-link:"Comment Text Char";
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.MsoHeader, li.MsoHeader, div.MsoHeader
{mso-style-priority:99;
mso-style-link:"Header Char";
margin:0in;
mso-pagination:widow-orphan;
tab-stops:center 3.25in right 6.5in;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.MsoFooter, li.MsoFooter, div.MsoFooter
{mso-style-priority:99;
mso-style-link:"Footer Char";
margin:0in;
mso-pagination:widow-orphan;
tab-stops:center 3.25in right 6.5in;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.MsoCommentReference
{mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-ansi-font-size:9.0pt;
mso-bidi-font-size:9.0pt;}
p.MsoListBullet, li.MsoListBullet, div.MsoListBullet
{mso-style-priority:99;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.25in;
mso-add-space:auto;
text-indent:-.25in;
mso-pagination:widow-orphan;
mso-list:l0 level1 lfo2;
tab-stops:list .25in;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;}
p.MsoListBulletCxSpFirst, li.MsoListBulletCxSpFirst, div.MsoListBulletCxSpFirst
{mso-style-priority:99;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.25in;
mso-add-space:auto;
text-indent:-.25in;
mso-pagination:widow-orphan;
mso-list:l0 level1 lfo2;
tab-stops:list .25in;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;}
p.MsoListBulletCxSpMiddle, li.MsoListBulletCxSpMiddle, div.MsoListBulletCxSpMiddle
{mso-style-priority:99;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.25in;
mso-add-space:auto;
text-indent:-.25in;
mso-pagination:widow-orphan;
mso-list:l0 level1 lfo2;
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mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;}
p.MsoListBulletCxSpLast, li.MsoListBulletCxSpLast, div.MsoListBulletCxSpLast
{mso-style-priority:99;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.25in;
mso-add-space:auto;
text-indent:-.25in;
mso-pagination:widow-orphan;
mso-list:l0 level1 lfo2;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;}
a:link, span.MsoHyperlink
{mso-style-priority:99;
color:#0563C1;
mso-themecolor:hyperlink;
text-decoration:underline;
text-underline:single;}
a:visited, span.MsoHyperlinkFollowed
{mso-style-noshow:yes;
mso-style-priority:99;
color:#954F72;
mso-themecolor:followedhyperlink;
text-decoration:underline;
text-underline:single;}
p.MsoPlainText, li.MsoPlainText, div.MsoPlainText
{mso-style-link:"Plain Text Char";
margin:0in;
mso-pagination:widow-orphan;
font-size:10.5pt;
font-family:Courier;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;
mso-bidi-font-family:"Times New Roman";}
p
{mso-style-priority:99;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;}
p.MsoAcetate, li.MsoAcetate, div.MsoAcetate
{mso-style-noshow:yes;
mso-style-priority:99;
mso-style-link:"Balloon Text Char";
margin:0in;
mso-pagination:widow-orphan;
font-size:9.0pt;
font-family:"Lucida Grande",sans-serif;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;}
p.MsoRMPane, li.MsoRMPane, div.MsoRMPane
{mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-parent:"";
margin:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.MsoListParagraph, li.MsoListParagraph, div.MsoListParagraph
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;}
p.MsoListParagraphCxSpFirst, li.MsoListParagraphCxSpFirst, div.MsoListParagraphCxSpFirst
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;}
p.MsoListParagraphCxSpMiddle, li.MsoListParagraphCxSpMiddle, div.MsoListParagraphCxSpMiddle
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;}
p.MsoListParagraphCxSpLast, li.MsoListParagraphCxSpLast, div.MsoListParagraphCxSpLast
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;}
span.Heading1Char
{mso-style-name:"Heading 1 Char";
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 1";
mso-ansi-font-size:14.0pt;
mso-bidi-font-size:16.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Arial;
mso-bidi-font-family:"Times New Roman";
mso-font-kerning:16.0pt;
font-weight:bold;
mso-bidi-font-weight:normal;}
span.Heading2Char
{mso-style-name:"Heading 2 Char";
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 2";
mso-ansi-font-size:13.0pt;
mso-bidi-font-size:13.0pt;
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Yu Gothic Light";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;}
span.Heading3Char
{mso-style-name:"Heading 3 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 3";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Yu Gothic Light";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#4472C4;
mso-themecolor:accent1;
font-weight:bold;}
span.Heading4Char
{mso-style-name:"Heading 4 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 4";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Yu Gothic Light";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;
font-style:italic;}
span.Heading5Char
{mso-style-name:"Heading 5 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 5";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Yu Gothic Light";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;}
p.text, li.text, div.text
{mso-style-name:text;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Plain Text";
margin-top:0in;
margin-right:0in;
margin-bottom:10.0pt;
margin-left:0in;
line-height:150%;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
span.PlainTextChar
{mso-style-name:"Plain Text Char";
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Plain Text";
mso-ansi-font-size:10.5pt;
mso-bidi-font-size:10.5pt;
font-family:Courier;
mso-ascii-font-family:Courier;
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Courier;
mso-bidi-font-family:"Times New Roman";}
p.Heading, li.Heading, div.Heading
{mso-style-name:Heading;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Heading 1";
margin-top:12.0pt;
margin-right:0in;
margin-bottom:12.0pt;
margin-left:0in;
mso-pagination:widow-orphan;
page-break-after:avoid;
mso-outline-level:1;
font-size:12.0pt;
font-family:"Arial",sans-serif;
mso-fareast-font-family:"MS Mincho";
mso-bidi-font-family:"Times New Roman";
mso-font-kerning:16.0pt;
font-weight:bold;
mso-bidi-font-weight:normal;}
p.quotes, li.quotes, div.quotes
{mso-style-name:quotes;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Plain Text";
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
span.BalloonTextChar
{mso-style-name:"Balloon Text Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Balloon Text";
mso-ansi-font-size:9.0pt;
mso-bidi-font-size:9.0pt;
font-family:"Lucida Grande",sans-serif;
mso-ascii-font-family:"Lucida Grande";
mso-fareast-font-family:"Yu Mincho";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:"Lucida Grande";
mso-bidi-font-family:"Lucida Grande";}
p.quotesheadline, li.quotesheadline, div.quotesheadline
{mso-style-name:"quotes headline";
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:quotes;
mso-style-next:quotes;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Arial",sans-serif;
mso-fareast-font-family:"MS Mincho";
font-weight:bold;
mso-bidi-font-weight:normal;}
span.exldetailsdisplayval
{mso-style-name:exldetailsdisplayval;
mso-style-unhide:no;}
span.CommentTextChar
{mso-style-name:"Comment Text Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Comment Text";
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.UnresolvedMention1
{mso-style-name:"Unresolved Mention1";
mso-style-noshow:yes;
mso-style-priority:99;
color:#605E5C;
background:#E1DFDD;}
span.apple-converted-space
{mso-style-name:apple-converted-space;
mso-style-unhide:no;}
p.css-exrw3m, li.css-exrw3m, div.css-exrw3m
{mso-style-name:css-exrw3m;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.3m6-
{mso-style-name:_3m6-;
mso-style-unhide:no;}
span.3l3x
{mso-style-name:_3l3x;
mso-style-unhide:no;}
span.1lh7
{mso-style-name:_1lh7;
mso-style-unhide:no;}
span.1lld
{mso-style-name:_1lld;
mso-style-unhide:no;}
p.6coj, li.6coj, div.6coj
{mso-style-name:_6coj;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.6cok
{mso-style-name:_6cok;
mso-style-unhide:no;}
span.timestampcontent
{mso-style-name:timestampcontent;
mso-style-unhide:no;}
span.mbtext
{mso-style-name:mb_text;
mso-style-unhide:no;}
span.HeaderChar
{mso-style-name:"Header Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Header;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.FooterChar
{mso-style-name:"Footer Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Footer;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.5uzb
{mso-style-name:_5uzb;
mso-style-unhide:no;}
span.accessibleelem
{mso-style-name:accessible_elem;
mso-style-unhide:no;}
span.z-TopofFormChar
{mso-style-name:"z-Top of Form Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"z-Top of Form";
mso-ansi-font-size:8.0pt;
mso-bidi-font-size:8.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:Arial;
mso-bidi-font-family:Arial;
display:none;
mso-hide:all;}
p.1obc, li.1obc, div.1obc
{mso-style-name:_1obc;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.z-BottomofFormChar
{mso-style-name:"z-Bottom of Form Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"z-Bottom of Form";
mso-ansi-font-size:8.0pt;
mso-bidi-font-size:8.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:Arial;
mso-bidi-font-family:Arial;
display:none;
mso-hide:all;}
p.css-axufdj, li.css-axufdj, div.css-axufdj
{mso-style-name:css-axufdj;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.style-scope
{mso-style-name:style-scope;
mso-style-unhide:no;}
p.generic-articlesummary--li, li.generic-articlesummary--li, div.generic-articlesummary--li
{mso-style-name:generic-article__summary--li;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.diamond-blt, li.diamond-blt, div.diamond-blt
{mso-style-name:diamond-blt;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
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</style><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Treatment news<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPfIwkhLwhsp4d2B-FVqw0prXG-OssZY-5eDzg7Z1XYRwSWE2bhyyDaT-wt6tvQYdOsEOln5HkJhY_xEBW8NsB6FNF31fJvMNYBDjty04IFe-VZXDJGqd2lguvV1OU9O46nyvenp0rBtiiwnlPbuZBLBhOfR2p_MgH5-9UmDfEHZU3hFdOd4_5F9qn/s900/molnupiravir-copertina_900x760.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="760" data-original-width="900" height="169" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPfIwkhLwhsp4d2B-FVqw0prXG-OssZY-5eDzg7Z1XYRwSWE2bhyyDaT-wt6tvQYdOsEOln5HkJhY_xEBW8NsB6FNF31fJvMNYBDjty04IFe-VZXDJGqd2lguvV1OU9O46nyvenp0rBtiiwnlPbuZBLBhOfR2p_MgH5-9UmDfEHZU3hFdOd4_5F9qn/w200-h169/molnupiravir-copertina_900x760.jpg" width="200" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Monoclonal antibodies</u>: The CDC has thrown cold water on the modest optimism I expressed in my last post, by <a href="https://www.covid19treatmentguidelines.nih.gov/therapies/statement-on-omicron-subvariants/">saying</a> BQ.1 and BQ.1.1 are likely resistant to bebtelovimab, and also, with BA.4.6, BA.2.75.2, and BF.7, to Evusheld. Arggggggh! In mid-November BQ.1 and BQ.1.1 <a href="https://www.npr.org/sections/health-shots/2022/11/11/1136039817/new-omicron-subvariants-now-dominant-in-the-u-s-raising-fears-of-a-winter-surge?sc=18&f=1001">officially overtook</a> BA.5 in the US. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Paxlovid triumphs</u>: We’ve long hoped that antiviral treatment might reduce the risk of long COVID. Now a large study from the US Veterans Administration, available as a <a href="https://www.medrxiv.org/content/10.1101/2022.11.03.22281783v1.full.pdf">preprint</a>, says yes, reporting that antiviral treatment reduced by 26% the risk of still having symptoms at 90 days. Two caveats. One: VA patients are mostly elderly men, whereas long COVID mostly strikes middle-aged women. The other: diagnoses were made by chart review, without interviews or even questionnaires. Charts are great at detecting heart disease, pulmonary embolism, etc., but they’re unlikely to record such core long COVID symptoms as fatigue, shortness of breath, and brain fog. Nonetheless, I will change my clinical practice on the basis of this study. Until now I have advised older patients with mild, rapidly-improving COVID-19 symptoms that they can skip Paxlovid. Now I will start saying take it.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Molnupiravir hits the skids</u>: Remember Merck’s antiviral? The one that (as per my own <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2201612">Letter to the Editor</a>) didn’t even work on Delta, much less Omicron? People feared its use might breed new, resistant variants. Now it seems that is probably <a href="https://twitter.com/LongDesertTrain/status/1597353291868155906">starting to happen</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Second acts<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjspD_-OCypVFbeOcbb6rog4D9PBoeF10fAUxtMwL1RtAvQVaYGNgZLmGwBEFvLtaGqi4c23QZMKUcKrCv3dWEEVNfe4JNyx6td01Ctg8kx4GW7KrSDo4fVTulCr1q9RGuq11xr8h3uWKEqf2RMwpkhIqV9tpIUOGb6toXW_xFV1uBea86pPQnAWJbc/s441/repeat%20performance%201.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="441" data-original-width="318" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjspD_-OCypVFbeOcbb6rog4D9PBoeF10fAUxtMwL1RtAvQVaYGNgZLmGwBEFvLtaGqi4c23QZMKUcKrCv3dWEEVNfe4JNyx6td01Ctg8kx4GW7KrSDo4fVTulCr1q9RGuq11xr8h3uWKEqf2RMwpkhIqV9tpIUOGb6toXW_xFV1uBea86pPQnAWJbc/s320/repeat%20performance%201.jpg" width="231" /></a></div><br /><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;">We’ve seen ample evidence that COVID-19 is milder the second time around, as summarized in a pre-Omicron <a href="https://pubmed.ncbi.nlm.nih.gov/34682746/">literature review</a>. An <a href="https://www.researchsquare.com/article/rs-2082030/v1">Italian study</a> before variants emerged and a slightly later <a href="https://www.nejm.org/doi/10.1056/NEJMc2108120">Qatari study</a> both found repeat infections fully <b>90% less likely</b> to result in hospitalization or death. And an <a href="https://academic.oup.com/cid/article/74/2/294/6251701?login=false">American study</a> of Emergency Room patients said second bouts entailed lower risks of pneumonia, heart failure, and kidney damage. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">But now a <a href="https://www.nature.com/articles/s41591-022-02051-3">massive study</a> from the US Veterans Administration seems to say exactly the opposite: repeat attacks of COVID-19 are <i>more</i> severe, for both acute outcomes and long COVID. Particularly puzzling since the study extends well into the period of dominance of the <a href="https://www.nytimes.com/2021/12/22/health/covid-omicron-delta-hospitalizations.html">milder</a> Omicron variant. News outlets immediately blasted headlines such as “<a href="https://www.reuters.com/business/healthcare-pharmaceuticals/repeat-covid-is-riskier-than-first-infection-study-finds-2022-11-10/">Repeat COVID is riskier than first infection</a>, study finds” and “Each SARS-CoV-2 reinfection <a href="https://www.news-medical.net/news/20220620/Each-SARS-CoV-2-reinfection-causes-more-severe-disease.aspx">causes more severe disease</a>.” The authors themselves have <a href="https://medicine.wustl.edu/news/repeat-covid-19-infections-increase-risk-of-organ-failure-death/">fed the flames</a>. <b>HOWEVER</b>: they’re all dead wrong, and the contradiction with earlier studies is only apparent. That’s because the VA paper did <b><i>not</i></b> compare people with reinfection to those without reinfection. It was based on a database of medical records, so it could include only people sick enough to have required medical attention, which especially in the Omicron era is a small minority. As Jeremy Faust <a href="https://insidemedicine.substack.com/p/are-repeat-coronavirus-infections">points out</a>, the only lesson to draw is “repeat coronavirus infections are not good, especially for older people who are likely to have existing medical problems (i.e., Veterans Administration patients). This is not exactly breaking news.” <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Vaccine and prevention news<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOiTXydBNvQ8TNAzRhFC-1n9dSLhtxU3XBq64Q6v-W61Ii_Rz8-11IsXa_MRN6ZtLai9bkjSbwSI1cl3uHitpPqDPhYUrIhazFJgRGQ1dEZUqlUE9faNcu3ppvGCW1VAZQZKJ6sb0FDKkL7eoyw_QB5zRt_weU5e8fYBDlFLlukPqmpD5aCX1fKuWw/s1098/inhaled%20cansino.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="732" data-original-width="1098" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOiTXydBNvQ8TNAzRhFC-1n9dSLhtxU3XBq64Q6v-W61Ii_Rz8-11IsXa_MRN6ZtLai9bkjSbwSI1cl3uHitpPqDPhYUrIhazFJgRGQ1dEZUqlUE9faNcu3ppvGCW1VAZQZKJ6sb0FDKkL7eoyw_QB5zRt_weU5e8fYBDlFLlukPqmpD5aCX1fKuWw/s320/inhaled%20cansino.jpg" width="320" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Bivalents in the lab</u>: Research results are mixed. One New York group <a href="https://www.biorxiv.org/content/10.1101/2022.10.22.513349v1.full.pdf">reported</a> that the bivalent BA.4/5 Pfizer and Moderna boosters induced no more neutralizing antibodies against Omicron BA.5 than a 4<sup>th</sup> dose of the original monovalent vaccine. Researchers from Boston <a href="https://www.biorxiv.org/content/10.1101/2022.10.24.513619v1.full.pdf">did find</a> modest antibody superiority for bivalent BA.5 boosters, but no better than for bivalent BA.1 vaccines. <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2208343">Moderna</a> says its BA.1 bivalent booster induced 75% more anti-Omicron neutralizing antibodies than the original monovalent booster, but this advantage did not translate into protection against infection or clinical COVID-19. <a href="https://investors.modernatx.com/news/news-details/2022/Modernas-BA.4BA.5-Targeting-Bivalent-Booster-mRNA-1273.222-Meets-Primary-Endpoint-of-Superiority-Against-Omicron-Variants-Compared-to-Booster-Dose-of-mRNA-1273-in-Phase-23-Clinical-Trial/default.aspx">Moderna also claims</a> its bivalent boosters induce a “robust” neutralizing antibody response against BQ.1.1, but the titres they report look minimal to me. Pfizer and BioNTech <a href="https://www.businesswire.com/news/home/20221103006400/en/">now say</a> anti-BA.4/5 neutralizing antibodies rose 4 times higher after the BA.4/5 bivalent vaccine than after their monovalent booster, without reporting real-world outcomes. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Bivalents vs. monovalents in the real world</u>: Among Israeli healthcare workers, a fourth dose of the original monovalent Pfizer vaccine <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2211283?">boosted protection</a> against Omicron infection substantially, but only for 3 months. And we finally have some concrete evidence in favor of bivalent vaccines, in the form of a very recent <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7148e1.htm?s_cid=mm7148e1_w">CDC study</a>. Twenty-four percent of people with positive PCR swabs were unvaccinated, 72% had received 2-4 doses of monovalent vaccines, and 5% had received a bivalent booster. Among vaccinated patients, the added protection from the bivalent booster varied according the time since a person’s latest monovalent dose. When the last monovalent dose was just 2-3 months earlier, the bivalent booster increased protection against infection by about 30%. But when it had been 8 months earlier and had likely worn off, the added protection was 43%-56%. This does show that bivalent boosters increase protection against COVID-19 above and beyond the effect of previous vaccination. It does not tell us whether another dose of the original monovalent vaccine might have done the same, or what the effect is on <a href="https://rollcall.com/2022/11/22/new-booster-shots-cut-risk-of-symptomatic-covid-19/">new-entry variants</a>such as BQ.1 and XBB, or how long the boost will last, given that the bivalent boosters – given an average of 4 weeks earlier – were at their peak.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Brass tacks</u>: As of mid-October the World Health Organization was agnostic, saying the data did <a href="https://reliefweb.int/report/world/good-practice-statement-use-variant-containing-covid-19-vaccines">not support</a> using bivalent vaccine boosters rather than ancestral-virus-only boosters. <b>Bottom line</b>: if you’re at increased risk, because of age or otherwise, get a booster <i>now</i>, ahead of any winter surge. It probably makes little difference which one. <u><o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Beta boosters</u>: European makers Sanofi-GSK have <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2206711">thrown their hat in the ring</a> with a monovalent booster, “VidPrevtyn Beta,” based on the Beta (South African) spike protein. It produced <a href="https://www.sanofi.com/en/media-room/press-releases/2022/2022-11-10-15-36-50-2553486">2.5 times more</a> Omicron BA.1 and BA.4/5 neutralizing antibodies than did a third dose of Pfizer, and has already been approved by the European Medicines Agency. We’ll see whether it catches on.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Sniffed</u>: People <a href="https://www.nature.com/articles/s41577-021-00583-2">have dreamed</a> of alternative vaccine routes for a long time now, thinking that oral or nasal vaccines could be more effective than injections, by increasing IgA “mucosal” antibodies and possibly better stimulating T-cell immunity. Now an intranasal vaccine booster using the spike protein has been <a href="https://www.science.org/doi/10.1126/science.abo2523">shown to be effective</a> – in mice – against multiple SARS-CoV-2 strains. <a href="https://twitter.com/EricTopol">Eric Topol</a> goes so far as to say, “This is the variant-proof booster we need now to help prevent infections & spread.” Lets hope so, with the caveat that mice aren’t men. Unfortunately the resistance of congressional Republicans to authorizing further pandemic spending <a href="https://www.nytimes.com/2022/11/18/health/covid-nasal-vaccines-warp-speed.html?">means</a> work on American mucosal vaccines is likely to proceed not at warp speed but at a snail’s pace. And in a bizarre twist, Pfizer <a href="https://www.nytimes.com/2022/11/18/health/covid-nasal-vaccines-warp-speed.html?">seems to prefer</a> to throw tens of millions of leftover doses down the drain rather than allow a few of them to be used for research; Moderna has been marginally more cooperative.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Puffed</u>: The Chinese company CanSino created an <a href="https://www.who.int/news-room/feature-stories/detail/the--cansino-biologics-ad5-ncov-s--recombinant---covid-19-vaccine--what-you-need-to-know">injectable viral vector COVID-19 vaccine</a> barely efficacious enough to meet World Health Organization criteria. Now it’s <a href="https://www.ft.com/content/9ba584a6-4d99-41be-8c43-7ef57b6af8bb">developed an inhaled version</a> that will soon be offered as a booster in several Chinese cities, <a href="https://edition.cnn.com/2022/09/06/china/china-covid-19-vaccine-cansino-intl-hnk/index.html">delivered</a> using a device vaguely resembling an overgrown asthma inhaler. It is <a href="https://www.scmp.com/news/china/science/article/3187034/cansinos-inhaled-booster-stronger-against-covid-19-subvariant">said to elicit</a> somewhat more Omicron BA.1 neutralizing antibodies than Sinovac – a low bar – but in the absence of even a preprinted manuscript it’s not clear whether the antibodies <a href="https://www.scmp.com/news/china/science/article/3187034/cansinos-inhaled-booster-stronger-against-covid-19-subvariant">fade rapidly</a> or <a href="https://www.scmp.com/news/china/science/article/3187034/cansinos-inhaled-booster-stronger-against-covid-19-subvariant">persist</a> for more than 6 months.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Mix-and-match immunity</u>: <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2207082?">A study</a> of California state prison inmates has found that Delta-variant infection and three-dose vaccination each gave approximately 40% protection against infection (or reinfection) in the early Omicron period – with a combination of infection <i>plus</i> triple vaccination lowering risk by nearly 85%. Pre-Delta infections were somewhat less protective, and mere double vaccination much less protective. The researchers also present results among prison staff, but I find them uninterpretable.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Children</u>: A <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2210058?">study from Qatar</a> confirms that 2 doses of a Pfizer vaccine do very little to prevent Omicron infection. In school-age children a peak of 50% effectiveness fell to practically nil by 3 months, with even less protection in older, larger kids (Pfizer for kids is a fixed low dose). The primary series worked a bit better in adolescents, who received the 30-mcg adult dose, and lasted somewhat longer. The modest, brief effect against Omicron is confirmed by an <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2209371?">American study</a> – which did find that one Omicron infection was very protective against a second one, and that, as usual, vaccination plus infection is even better.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>The global South</u>: The World Health Organization has chosen to <a href="https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing--14-september-2022">see the glass half-full</a>, emphasizing the progress that’s been made against the pandemic. But only <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=People+fully+vaccinated&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=Low+income~High+income">20% of peopl</a>e in low-income countries have received a primary vaccine course, versus 75% in high-income countries. That’s triple where we were at the beginning of March, but still. Note that this February South African scientists announced that they <a href="https://www.nature.com/articles/d41586-022-00293-2">had succeeded</a> in replicating Moderna’s COVID-19 vaccine. But 9 months later, they’re saying it will be yet <a href="https://www.devex.com/news/south-africa-s-mrna-hub-confronts-old-problems-and-new-directions-104398">another 18 months</a> before their product becomes commercially available. What value will it have then? Moderna <a href="https://www.bmj.com/content/bmj/376/bmj.o304.full.pdf">immediately sued</a> to block the project and, it seems, is <a href="https://www.theguardian.com/global-development/2022/oct/05/covid-vaccine-inequity-south-africa-afrigen-mrna">still trying</a>. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Exercise</u>: A <a href="https://bjsm.bmj.com/content/bjsports/56/20/1188.full.pdf">review article</a> concludes that regular physical activity reduces the risk of SARS-CoV-2 infection slightly, the risk of severe disease by a third, and the risk of death by an astonishing 43%. Eyeballing their Figure 3, I’d guess those benefits only kick in at around 2 hours a week of moderate-intensity aerobic exercise.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Iron men, iron women<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZuQkTlZlNFSwqLdklBvR-ZnQJd7NPYlEmRLM1cYye0xqh7M6PCv3y6dGlhjcldDf6nAjekIjDwQjbAma8KDjsuviEAiDzcNAbdtcCtD_p0ucI_krM1in8c3ZG2WFYHSywgJLzCodGzOjb97TwAvRSbkXYp_i1MTjX8qh6LJJiT0LJ5Cd-JkHoE-HE/s1200/TransmissionWithinHouseholds.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="675" data-original-width="1200" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZuQkTlZlNFSwqLdklBvR-ZnQJd7NPYlEmRLM1cYye0xqh7M6PCv3y6dGlhjcldDf6nAjekIjDwQjbAma8KDjsuviEAiDzcNAbdtcCtD_p0ucI_krM1in8c3ZG2WFYHSywgJLzCodGzOjb97TwAvRSbkXYp_i1MTjX8qh6LJJiT0LJ5Cd-JkHoE-HE/w400-h225/TransmissionWithinHouseholds.jpg" width="400" /></a></div><br /><div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;">Some people intensely exposed to COVID-19 never catch it themselves. They seem to be rare birds in the Omicron era, with my friends and patients generally saying not “I got COVID,” but “We got COVID.” But a <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7109e1.htm">CDC study</a> from this spring showed that only half of people living in the same home as a COVID-19 case ever caught the infection, and that even in households where the patient wasn’t isolated and didn’t wear a mask that rate only reached two-thirds. As you see from the graphic, the CDC emphasized the downside of those findings. But what I find amazing is on the contrary how many of those intimate contacts stayed well.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The state of the pandemic<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhI8yFQp94N2XJnOvzY0MDV5p_bXJwIr-xXlJgw28cq8qEAZV_POzqgpmyADGpoa6UxsCC5lN6iGWe210DXpGz51LjDWBKXg2lJErrwlDphmaVsk20BDMjF_D8X3hQzF36CANNYgKzHQFF4Ib1wEzHXxwXFWvujtQhhltI6tYq4G4tlp0wgQHfDuY2y/s555/Novax%201924%201.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="555" data-original-width="425" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhI8yFQp94N2XJnOvzY0MDV5p_bXJwIr-xXlJgw28cq8qEAZV_POzqgpmyADGpoa6UxsCC5lN6iGWe210DXpGz51LjDWBKXg2lJErrwlDphmaVsk20BDMjF_D8X3hQzF36CANNYgKzHQFF4Ib1wEzHXxwXFWvujtQhhltI6tYq4G4tlp0wgQHfDuY2y/w308-h400/Novax%201924%201.png" width="308" /></a></div><br /> <p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Just while the term “post-pandemic” is being bandied about, <a href="https://www.nature.com/articles/d41586-022-03157-x">most</a> experts (though <a href="https://www.nytimes.com/2022/11/22/us/politics/fauci-covid-winter-surge.html">not all</a>) are asking not whether we’re in store for a winter surge, but just how bad it will be. It’s already hit in Italy, where the number of confirmed cases <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+cases&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~USA">has quadrupled</a> in the last month, and the number of deaths has nearly <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=false&Color+by+test+positivity=false&country=ITA~USA">doubled</a>, with <a href="https://www.epicentro.iss.it/coronavirus/bollettino/Bollettino-sorveglianza-integrata-COVID-19_23-novembre-2022.pdf">one in 5 cases</a> a reinfection. <a href="https://www.epicentro.iss.it/coronavirus/bollettino/Bollettino-sorveglianza-integrata-COVID-19_23-novembre-2022.pdf">Here</a>, for Italian speakers, is a detailed report.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">In the US the official number of new cases has remained <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+cases&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~USA">stable</a>, at around one-fifth Italy’s rate per capita. Deaths, however, are running neck and neck. What that suggests is that most infected Americans aren’t reporting their positive home tests to the authorities. As of this week <a href="https://covid.cdc.gov/covid-data-tracker/#variant-proportions">more than 60%</a> of US cases are caused by BQ.1 and BQ.1.1, but <a href="https://www.ilgiorno.it/cronaca/cerberus-covid-1.8257384">in Italy</a>, the latest stats say 2/3 of cases are still BA.5, 1/3 BQ.1.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Black Americans used to die disproportionately from COVID-19, but now the <a href="https://www.washingtonpost.com/health/2022/10/19/covid-deaths-us-race/">tide has turned</a>, with whites 40% <i>more</i>likely to die. The reason? Vaccine hesitancy. Though once higher percentages were found among blacks, diehard novaxxers are now much more likely to be Trumpy whites. And though <a href="https://www.washingtonpost.com/politics/2022/11/23/vaccinated-people-now-make-up-majority-covid-deaths/">most deaths</a> now occur among the vaccinated, vaccine holdouts are <a href="https://www.washingtonpost.com/health/2022/10/19/covid-deaths-us-race/">5 times as likely</a> to die of COVID-19 as someone who’s fully vaccinated, and 10 times as likely as someone with two boosters. (Thanks to Lisa Paglin and Marianna Brilla for the 1924 cartoon.)<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The United States saw <a href="https://www.nytimes.com/interactive/2022/02/01/science/covid-deaths-united-states.html">more deaths per capita</a> last winter than any other large wealthy country: twice as many as Italy, 3 times as many as Canada, more than 10 times as many as Japan. Mortality was lowest in states with high vaccination rates, but even there it surpassed other countries.’ The reason is probably that the US has <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2021-09-28..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Vaccine+booster+doses&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~USA~DEU~FRA~ESP~GBR~JPN~CAN">lagged in giving the boosters</a>so crucial for combatting Omicron.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Back to basics<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfgzzd99vYe-fk7GBEQR9aWFwseP2N-n2wXs4R041s6UpsfphydGPbXr8eQnW-j7T-j8EYsqWR_GUqdstdybqNav8FitwB7EOVmaNROSW0BSUSNgbydgnqnqT9EEv-FHPxWvow1sDEoexSTxpe40ubistD-WgBBEn2vrutglQ5Wy1eHNI77BxW0VX6/s567/face%20masks.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="425" data-original-width="567" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfgzzd99vYe-fk7GBEQR9aWFwseP2N-n2wXs4R041s6UpsfphydGPbXr8eQnW-j7T-j8EYsqWR_GUqdstdybqNav8FitwB7EOVmaNROSW0BSUSNgbydgnqnqT9EEv-FHPxWvow1sDEoexSTxpe40ubistD-WgBBEn2vrutglQ5Wy1eHNI77BxW0VX6/s320/face%20masks.jpg" width="320" /></a></div><br /><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;">Hard evidence about masking is scarce, and now that everybody has been going barefaced a new New England Journal of Medicine <a href="https://www.nejm.org/doi/10.1056/NEJMoa2211029">article</a> is very timely. Lifting of mask mandates in some but not all Massachusetts school districts provided a neat natural experiment, with clear results. Districts where masking was made optional had 44.9 more cases per 1000 students and staff than districts where it remained obligatory, which nearly doubled the case rate, even though schools that kept mandates had worse physical condition, more low-income students, and more crowded classrooms. Students had 39.9 excess cases per 1000, while staff, who as adults risked more, had 81.7. Though I strongly favor indoor masking I was somewhat surprised at these results, since data have suggested that kids with COVID-19 usually catch the infection not in the classroom but at friends’ homes.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Variant watch<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjizVhQ_uqBLGcW29U2gdu8F7mqhnNsKiCgDFAEErP3dwzR_rWmzQOL0-WjZ2M50FkfdxSBOoLnhi8CrGsJ0OF4nDSfj-q5aoH5xTN_fKIuTd7WcZi2AzAMm7Qp-kFM8G9Gz0LdjW_uhDzAssg8U0rWXWOMZHE16aeRS3gpv21_L1kp4i1TUjyfU5-P/s1024/omicron%20subvariants%20around%20the%20world.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="856" data-original-width="1024" height="335" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjizVhQ_uqBLGcW29U2gdu8F7mqhnNsKiCgDFAEErP3dwzR_rWmzQOL0-WjZ2M50FkfdxSBOoLnhi8CrGsJ0OF4nDSfj-q5aoH5xTN_fKIuTd7WcZi2AzAMm7Qp-kFM8G9Gz0LdjW_uhDzAssg8U0rWXWOMZHE16aeRS3gpv21_L1kp4i1TUjyfU5-P/w400-h335/omicron%20subvariants%20around%20the%20world.png" width="400" /></a></div><br /><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;">Twelve months into the Omicron era its descendants are <a href="https://www.nytimes.com/2022/11/26/science/omicron-birthday-variant-evolution.html">breeding like rabbits</a>. No sooner had BQ.1 and BQ.1.1 appeared on the scene when XBB popped up, apparently even more transmissible and resistant to antibodies. It’s a chimeric blend of BA.2.10.1 and BA.2.75, whose latest subsubvariants include CH.1 and CH.1.1. In early October XBB was only causing about <a href="https://www.who.int/news/item/27-10-2022-tag-ve-statement-on-omicron-sublineages-bq.1-and-xbb">1.3% of new cases</a> globally. Despite <a href="https://www.reuters.com/article/factcheck-covid-xbb-idUSL1N3271RH">claims</a> on social media, there is no evidence it is more severe than other Omicron subvariants. For everything there is to know about Aeterna, Gryphon, Mimas, Pisces, and more see one <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9528072/">review article</a> from October 3<sup>rd</sup>, and <a href="https://healthpolicy-watch.news/omicron-subvariants-race-for-dominance/">another</a> from October 31<sup>st</sup> that claimed 390 Omicron subvariants and 48 “recombinants.” Five weeks later, even that second article is likely outdated.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Dragging on<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2zSN-yLFUNLEp9uRc_PaOahhfdqJDvIc2UyZOsD7szqy3VOU-q7ZSM7Puw7d90R4dUNzoiweMRR2uSKhSjgTSHFYfd58HS773u73d01-xIaoi7C7WrZmxUS4h83DPSq9Idj8fevBZkY3RomvHNdi1M8FTU75tb6H6ThnPZduA-IBSVTCqCrtTUPmj/s800/dragging%203.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="419" data-original-width="800" height="210" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2zSN-yLFUNLEp9uRc_PaOahhfdqJDvIc2UyZOsD7szqy3VOU-q7ZSM7Puw7d90R4dUNzoiweMRR2uSKhSjgTSHFYfd58HS773u73d01-xIaoi7C7WrZmxUS4h83DPSq9Idj8fevBZkY3RomvHNdi1M8FTU75tb6H6ThnPZduA-IBSVTCqCrtTUPmj/w400-h210/dragging%203.jpg" width="400" /></a></div><br /><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Numbers<o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Estimates of the rate of long COVID vary wildly. One pooled analysis <a href="https://jamanetwork.com/journals/jama/fullarticle/2797443">said</a> 6.2% of COVID-19 patients still had symptoms at 3 months, using a relatively narrow definition. A modelling study from the World Health Organization similarly estimated 17 million long COVID cases in <a href="https://www.who.int/europe/news/item/13-09-2022-at-least-17-million-people-in-the-who-european-region-experienced-long-covid-in-the-first-two-years-of-the-pandemic--millions-may-have-to-live-with-it-for-years-to-come">Europe</a> in 2020-21, <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+cases&Interval=Cumulative&Relative+to+Population=false&Color+by+test+positivity=false&country=~Europe">about 7.1%</a>. The US <a href="https://www.gao.gov/products/gao-22-105666">government calculated</a> that <a href="https://www.washingtonpost.com/health/2022/10/12/long-covid-study-scotland/">7.7-23 million</a> Americans had long COVID in February 2022.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">A <a href="https://www.nature.com/articles/s41467-022-33415-5">large Scottish study</a>, however, reported that 42% of COVID-19 patients still had symptoms 6-18 months after their bout. And in a <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2798446">smaller study</a> by Spanish researchers who got a particularly high number of invitees to cooperate, 59.7% of hospitalized patients and a shocking 67.5% of outpatients had at least one residual symptom 2 years after their acute infection, primarily pain, fatigue, and cognitive impairment. Similar to a <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00126-6/fulltext">Chinese study</a> finding that 55% were still not completely well after 2 years. One major caveat: most of the patients in all 3 studies were infected with the original Wuhan strain of SARS-CoV-2, before the arrival of vaccines, antivirals, or Omicron.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">We’ve hoped Omicron patients would be much less prone to long COVID. But according to official UK <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/selfreportedlongcovidafterinfectionwiththeomicronvariant/18july2022">government analyses</a> the percentage of people with persistent symptoms 12 weeks after Omicron is only <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/selfreportedlongcovidafterinfectionwiththeomicronvariant/18july2022">10-15% lower</a> than after Delta, among people who are triple-vaccinated. The rate was halved, though, among people who’d had only two doses of vaccine. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Symptoms<o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The manifestations of long COVID can apparently include both <a href="https://onlinelibrary.wiley.com/doi/10.1002/jmv.27971">low semen quality</a> and <a href="https://www.nytimes.com/2022/05/05/health/covid-impotence-erectile-dysfunction.html">erectile dysfunction</a>. I believe it, partly because so many women have told me they lost their libido when they had COVID-19.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">In older people, COVID-19 increases the risk of both <a href="https://content.iospress.com/download/journal-of-alzheimers-disease/jad220717?id=journal-of-alzheimers-disease%2Fjad220717">dementia</a> and <a href="https://www.frontiersin.org/articles/10.3389/fneur.2022.904796/full">Parkinson’s</a>, with a 69% increase in new diagnoses of Alzheimer’s disease during the year after infection. The Alzheimer article’s co-author Dr. Pamela Davis <a href="https://www.medpagetoday.com/opinion/what-we-heard/100764">hypothesizes</a> at a physicians-only website that “persons who already had declining cognitive function were tipped over into frank Alzheimer's disease.” Another reason for us older people to do everything we can to avoid catching COVID-19 (we <i>all</i> have some degree of declining cognitive function). A <a href="https://alz-journals.onlinelibrary.wiley.com/doi/full/10.1002/trc2.12348">giant study</a> by the Alzheimer's Association Global Consortium should eventually shed more light. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Causes<o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The South African researcher Etheresia Pretorius has <a href="https://cardiab.biomedcentral.com/articles/10.1186/s12933-022-01579-5">published a paper</a> confirming her previous observations of abnormal clotting phenomena in the blood of long COVID patients, in the form of hyperactivated platelets and microclots of fibrin/amyloid. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I’m a believer, given the evidence of impaired circulation in the lungs, hearts, and brains of long COVID patients. But, with <a href="https://www.healthrising.org/blog/2022/10/29/coagulation-controversy-long-covid-chronic-fatigue-syndrome/">others</a>, I confess to finding it odd that nobody except Dr. Pretorius ever seems to detect those microclots, and slightly suspicious that she’s apparently hypothesized the same underlying mechanism for diseases from diabetes to lupus and Parkinson’s. And I’d like to see better evidence that treatment attacking the clots works than the <a href="https://www.researchgate.net/publication/357384617_Combined_triple_treatment_of_fibrin_amyloid_microclots_and_platelet_pathology_in_individuals_with_Long_COVID_Post-Acute_Sequelae_of_COVID-19_PASC_can_resolve_their_persistent_symptoms">pilot study</a>Dr. Pretorius reported a year ago. Fortunately that evidence may arrive soon: the British STIMULATE-ICP trial testing other treatments the anticoagulant rivaroxaban (that might dissolve microclots) finally <a href="https://www.nature.com/articles/d41586-022-02140-w">began enrolling</a> patients this summer.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">MRI brain scans on 15 post-COVID-19 patients <a href="https://www.ajronline.org/doi/full/10.2214/AJR.22.28267">showed mild abnormalities</a> that could have been vascular, though there was little difference between patients with and without fatigue or brain fog. More to the point is a study that using a “susceptibility-weighted” MRI demonstrated post-COVID-19 abnormalities in the frontal lobe and brain stem, brain regions linked with fatigue, insomnia, anxiety, depression, headaches and cognitive problems. The researchers’ <a href="https://press.rsna.org/timssnet/media/pressreleases/14_pr_target.cfm?id=2381">press release</a> hinted that some of their subjects had long COVID but unfortunately didn’t compare that subgroup with others. Other post-COVID changes include <a href="https://www.jacc.org/doi/abs/10.1016/j.jcmg.2022.07.006">poor circulation</a> to the heart muscle and <a href="https://link.springer.com/article/10.1007/s00134-022-06877-w">fibrotic scarring</a> of the lungs (especially relevant to patients from early in the pandemic).<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Prevention<o:p></o:p></u></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1FZGAdntJOSkPDtww-NzPcpyfmPIctHGWuS-hCUN-CJlWTZMBIs0mDmXH1QT_v6Vwf1z-wK3nbcAk8CaNu5doddV0_YNqkYQ61x_rdsDRgTd5vuOtKHWWogm-HcJVGwVlfQjI770lrsXj8STj3dOKoLOCdRton3lW8Sw9n0pa5WDzsYp35pPgYHbJ/s964/BMI-chart-woman-view++.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="649" data-original-width="964" height="269" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1FZGAdntJOSkPDtww-NzPcpyfmPIctHGWuS-hCUN-CJlWTZMBIs0mDmXH1QT_v6Vwf1z-wK3nbcAk8CaNu5doddV0_YNqkYQ61x_rdsDRgTd5vuOtKHWWogm-HcJVGwVlfQjI770lrsXj8STj3dOKoLOCdRton3lW8Sw9n0pa5WDzsYp35pPgYHbJ/w400-h269/BMI-chart-woman-view++.jpg" width="400" /></a></div><br /><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;">Vaccination may help protect against long COVID when people get breakthrough infections. Studies among general populations have given vaccinees variously a <a href="https://www.nature.com/articles/d41586-022-01453-0">15%</a> (US), <a href="https://www.nature.com/articles/s41467-022-33415-5">28%</a> (Scotland), and <a href="https://www.nature.com/articles/d41586-022-01453-0">50%</a> (UK) advantage over the unvaccinated. The authors of one <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00354-6/fulltext">systematic review</a> concluded that vaccination helps but declined to quantify how much. <a href="https://www.medrxiv.org/content/10.1101/2022.10.06.22280798v1.full.pdf">A preprinted study</a> of 280 chronic rheumatological disease patients, however, has found those who were fully vaccinated to be only <b>one-tenth as likely</b> to have persistent symptoms 3 months after a breakthrough infection. Since no previous study has found such a strong protective effect, it might be specific to patients with autoimmune conditions. But, as always, the best way to avoid getting long COVID is to avoid getting COVID-19 in the first place, so keep up to date with your boosters.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">…As I’ve said treatment with Paxlovid <a href="https://www.medrxiv.org/content/10.1101/2022.11.03.22281783v1.full.pdf">seems to cut</a> risk somewhat.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">And so may – surprisingly – weight loss. A <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0001188">new British study</a> found that every additional point of Body Mass Index (weight squared in kilograms divided by height in centimeters), increases the risk of long COVID by 2.7%. That means that all other things being equal someone who barely qualifies as obese (BMI = 30), is 22% more likely to develop long COVID than someone in the middle of the normal range (BMI = 22), and someone morbidly obese (BMI = 40), like <a href="https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity">11.5% of American women</a>, runs a 50% higher risk.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Treatment<o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">No news. The Washington Post <a href="https://www.washingtonpost.com/health/2022/11/25/long-covid-treatments-unproven-brain-fog/">describes</a> desperate long COVID sufferers turning to charlatans who peddle everything from ivermectin to earthworm extract. Unfortunately when it came to hyperbaric oxygen treatment this otherwise excellent article got it wrong. They linked to a year-old <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8806311/">pilot study</a> – 10 patients who said they felt better after treatment than before – but ignored the <a href="https://www.nature.com/articles/s41598-022-15565-0">excellent research</a> published this summer that demonstrated marked improvement with HBOT as compared with a sham control treatment.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Rachel, Rachel, I’ve been thinking<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzBgX_XSDzTXEvn9TzKFaB7yNhI5Dd5IsFSBk0KrPCscQ3j59hOlDr-NCxr31QoDY7oN9ucDgm9Yz4PlPyuk_3TOb3UQTn9Vx8kEbsW50N378WRUQLqq_nc4qDL1Et-qTG1T8cqho4QvCi6hb6NMWSNOVfKnD-boh7LYs9nEzs7WALL6AFB8JErU9v/s1628/walensky%20unmasked%20screenshot.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1088" data-original-width="1628" height="268" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzBgX_XSDzTXEvn9TzKFaB7yNhI5Dd5IsFSBk0KrPCscQ3j59hOlDr-NCxr31QoDY7oN9ucDgm9Yz4PlPyuk_3TOb3UQTn9Vx8kEbsW50N378WRUQLqq_nc4qDL1Et-qTG1T8cqho4QvCi6hb6NMWSNOVfKnD-boh7LYs9nEzs7WALL6AFB8JErU9v/w400-h268/walensky%20unmasked%20screenshot.jpg" width="400" /></a></div><br /><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;">OK, so Rochelle Walensky, the head of the CDC, has had COVID-19. No scandal there, though as per the photograph above, she hasn’t always been superprudent. And – like Anthony Fauci and Joe Biden – she had a <a href="https://www.usnews.com/news/health-news/articles/2022-10-31/cdc-director-tests-positive-for-covid-again?src=usn_nl_coronavirus&h_eid=d676e576422b62d91aabbaed723d51be10108f6f131c3d12fd1a13dc8aab8031&utm_source=Sailthru&utm_medium=email&utm_campaign=CB_11/1/22&utm_term=Coronavirus%20Bulletin">relapse</a> of symptoms and test positivity a few days after finishing a course of Paxlovid. Clearly this phenomenon is much more common than Pfizer admits. BUT: unlike Fauci and Biden, she had no business taking Paxlovid in the first place. They are both far over 65, the cutoff after which Palovid definitely helps avoid hospitalization and death. Walensky is in her 50’s, even younger than Kamala Harris who was given Paxlovid even more scandalously, for an asymptomatic infection, where it is <i>never</i> indicated. If I myself know that Paxlovid does <a href="https://www.nejm.org/doi/full/10.1056/nejmoa2118542">little</a> or<a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2204919"> nothing</a> for people under 65, even those at high risk because of chronic disease, I’d expect that Walensky to know so as well. And if I know that Paxlovid, while reducing risk of hospitalization, <a href="https://insidemedicine.bulletin.com/paxlovid-does-not-shorten-the-duration-of-covid-symptoms-data-show-what-about-long-covid">doesn't</a> relieve symptoms, Walensky should be at least as well-informed.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Have they no shame?<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggMeZEX6PpvJokesKMRTosM8FXsmbqnG318jrMg1IwrL0Cihlxtqpuf-Gt0Q8JyR_1TedfHW-OC_4Zo-yQ8-Fx26HsZ6S7s0CQeef0pw2WGuT8MwxXJ6TjP0W1GHwv1qPydSGQ5_W3dk7ijlzEq3YAWsOiZl5eKjmkyx_pGij1ZlWTTMbJPKNllCna/s1746/boy%20dies%20of%20cv%20vaccination.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1182" data-original-width="1746" height="272" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggMeZEX6PpvJokesKMRTosM8FXsmbqnG318jrMg1IwrL0Cihlxtqpuf-Gt0Q8JyR_1TedfHW-OC_4Zo-yQ8-Fx26HsZ6S7s0CQeef0pw2WGuT8MwxXJ6TjP0W1GHwv1qPydSGQ5_W3dk7ijlzEq3YAWsOiZl5eKjmkyx_pGij1ZlWTTMbJPKNllCna/w400-h272/boy%20dies%20of%20cv%20vaccination.jpg" width="400" /></a></div><br /><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;">This unfortunate child was actually not connected with the COVID vaccination campaign in any way, and his death from pneumonia was in no way related to either COVID-19 or COVID-19 vaccines.<o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /></div>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com9tag:blogger.com,1999:blog-6211405954943098401.post-38906770156186498882022-10-20T19:11:00.000+02:002022-10-20T19:11:34.724+02:00Alphabet Soup<div class="separator"> </div><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5OaWz0lfAltmiBoCJc502r8qjqp74Lt935CX3raSwURK8JOwoGnyYUypXngOCD5u2pP43VXklW-Y7wxonjHusnyBgmCnWRaxUsFCqL3MDa0z-hSprDDWvJ9nwxmg-xAOO27fSsCTEfnfD-z2IafreFHcriJQoefre2XQpZ-dDSHVPXnQ54FOA1yPD/s850/alphabet%20soup.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="850" data-original-width="850" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5OaWz0lfAltmiBoCJc502r8qjqp74Lt935CX3raSwURK8JOwoGnyYUypXngOCD5u2pP43VXklW-Y7wxonjHusnyBgmCnWRaxUsFCqL3MDa0z-hSprDDWvJ9nwxmg-xAOO27fSsCTEfnfD-z2IafreFHcriJQoefre2XQpZ-dDSHVPXnQ54FOA1yPD/s320/alphabet%20soup.jpg" width="320" /></a></div><br /><p></p><p><b>Treatment and testing news</b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjC3fgRbdGWYuAbVcqrABn1UpcncfbBqjT2KYCHydIze1FdHFcVj2saxJHvNnrBOjkYNXvGSYmSkYhJCNeN5G5ldz3ZLsyQ7ZUwkM__tuKo-n-jzAaFTscQylNvio27vdkA4HkXRtF1Mw_SqQa-c8O07HVldJnuuis_N2HossPxLAIOiApTMB2FJXHt/s800/LillyChina.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="533" data-original-width="800" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjC3fgRbdGWYuAbVcqrABn1UpcncfbBqjT2KYCHydIze1FdHFcVj2saxJHvNnrBOjkYNXvGSYmSkYhJCNeN5G5ldz3ZLsyQ7ZUwkM__tuKo-n-jzAaFTscQylNvio27vdkA4HkXRtF1Mw_SqQa-c8O07HVldJnuuis_N2HossPxLAIOiApTMB2FJXHt/s320/LillyChina.jpg" width="320" /></a></div><p class="1obc" style="margin-right: 6pt;"><br /></p><p class="1obc" style="margin-right: 6pt;"><u>Monoclonal antibodies</u>: It was starting to seem as though the monoclonal antibody era was over, with the WHO <a href="https://www.bmj.com/content/370/bmj.m3379" style="color: #954f72;">strongly advising</a> against the use of both casirivimab-imdevimab (Regeneron, which we already knew was no good against Omicron) and sotrovimab (it worked against Omicron BA.1 but <a href="https://pubmed.ncbi.nlm.nih.gov/35240676/" style="color: #954f72;">not against BA.2</a> and thus probably not against later subvariants either). But what about Lilly’s latest, bebtelovimab? It does a good job of neutralizing both <a href="https://www.fda.gov/media/156152/download" style="color: #954f72;">BA.4/5</a> and BA.4.6 in the test tube. Yes, its clinical trials in humans were pre-Omicron, but if laboratory evidence is enough to spur a wide rollout of updated vaccine boosters, I’d think it could be enough for Emergency Use Authorization of bebtelovimab in Europe – it already was for the US but the drug is near-unobtainable in practice.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Evusheld</u>: A couple of posts back I wondered why AstraZeneca’s monoclonal antibody combo given by intramuscular injection had been approved only for prevention of COVID-19 in the immunocompromised and not for treatment of high-risk outpatients, given that it was effective in the laboratory against early varieties of Omicron. Well, now the European Medicines Agency is <a href="https://www.fiercepharma.com/pharma/astrazenecas-evusheld-trending-positive-chmp-recommendation" style="color: #954f72;">encouraging just that</a>, so outpatients will have another option besides Paxlovid and remdesivir, assuming AstraZeneca can produce the drug fast enough and doctors catch on about prescribing it. Furthermore, <a href="https://www.medrxiv.org/content/10.1101/2022.09.16.22280034v1.full.pdf" style="color: #954f72;">recent real-world data</a> from San Diego say it is effective in preventing clinical COVID-19 from Omicron BA.1, but that in the BA.4/5 era it only prevents severe disease. So far Evusheld is still being underused for its preventive indication <a href="https://aspr.hhs.gov/COVID-19/Therapeutics/orders/Pages/default.aspx" style="color: #954f72;">even in the US</a>. In Italy <a href="https://tg24.sky.it/cronaca/2022/09/23/covid-oggi-bollettino-23-settembre-live?lbp=3" style="color: #954f72;">only 8000</a> or so doses have been administered and in the UK it is theoretically approved but in practice unavailable to patients.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Molnupiravir</u>: Remember the first anti-COVID-19 pill, the one from Merck? It proved ineffective against Delta, carries various major concerns, and has been entirely eclipsed by Paxlovid. Now <a href="https://deliverypdf.ssrn.com/delivery.php?ID=417031103127071022126066117120095095046013081059031002110086124120082126109002090081002029062028015025012120096108100121099089000008036054039018108001064096023102064095080073100006091072096102104090000000064103064123086069088093100077073074008125031100&EXT=pdf&INDEX=TRUE" style="color: #954f72;">a manuscript</a> from the UK claims it substantially shortens the duration of symptoms, from 14.5 to 10.2 days, while doing nothing to prevent hospitalization or death. I frankly don’t believe a word of it, nor apparently do any experts other than <a href="https://twitter.com/PaulSaxMD/status/1578086975512334337?" style="color: #954f72;">Paul Sax</a>. Why? Because the PANORAMIC study was open-label. People randomized to molnupiravir knew they were taking it, and people who were randomized to usual care knew they were in a drug study and weren’t getting the drug. Patients reported their symptoms themselves, guaranteeing such a powerful placebo effect that in my opinion that aspect of this study is useless.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Ivermectin</u>: Can you believe it’s shown up again? This time in the form of <a href="https://www.cureus.com/articles/111851-regular-use-of-ivermectin-as-prophylaxis-for-covid-19-led-up-to-a-92-reduction-in-covid-19-mortality-rate-in-a-dose-response-manner-results-of-a-prospective-observational-study-of-a-strictly-controlled-population-of-88012-subjects" style="color: #954f72;">a study performed in Brazil,</a> involving the infamous Pierre Kory, published in an obscure medical journal, under a truly amazing title: “Regular Use of Ivermectin as Prophylaxis for COVID-19 Led Up to a 92% Reduction in COVID-19 Mortality Rate in a Dose-Response Manner: Results of a Prospective Observational Study of a Strictly Controlled Population of 88,012 Subjects.” If you believe that one I have a great bridge I’d like to sell you. Other articles by <a href="https://retractionwatch.com/2021/11/09/bad-math-covid-treatment-paper-by-pierre-kory-retracted-for-flawed-results/" style="color: #954f72;">Kory</a> and his <a href="https://retractionwatch.com/2022/06/10/researcher-attacks-journal-for-retracting-his-paper-on-covid-19-drug/" style="color: #954f72;">coauthors</a>have been retracted for fake results, and hopefully this one will be too. If you feel like looking closely at its flaws, start <a href="https://twitter.com/GidMK/status/1566574956628287488" style="color: #954f72;">here</a>. And – please – don’t miss the conflict of interest disclosures. I couldn’t find them in the article itself but you can <a href="https://twitter.com/GidMK/status/1566574961678258176/photo/1" style="color: #954f72;">view them</a> on Twitter.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Home tests</u>: We’ve always thought COVID-19 tests were lousy at detecting Omicron. A Dutch study now confirms, <a href="https://www.bmj.com/content/378/bmj-2022-071215" style="color: #954f72;">reporting</a> that home tests miss up to 50% of symptomatic, PCR-proven cases.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="margin-right: 6pt;"><b>Vaccine news<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj79nppTCUqEWoE-J1WDdnRx3eToZHyNoJNkmE_V_f1NxyLVUtX8AviNvUWlOToEw8FmbTqCCZkbFIul2vCEi213awc8aAGNR3h3qazpQQwKL_jcxEs-4x3nO9aTcTdKCOGNrfZGEBKBm-UeMu7Z7yBVrGYwatOf3fCCTpIcVKzoNpviCKIoCss1XC8/s1200/bivalentbooster.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="683" data-original-width="1200" height="182" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj79nppTCUqEWoE-J1WDdnRx3eToZHyNoJNkmE_V_f1NxyLVUtX8AviNvUWlOToEw8FmbTqCCZkbFIul2vCEi213awc8aAGNR3h3qazpQQwKL_jcxEs-4x3nO9aTcTdKCOGNrfZGEBKBm-UeMu7Z7yBVrGYwatOf3fCCTpIcVKzoNpviCKIoCss1XC8/s320/bivalentbooster.png" width="320" /></a></div><p class="1obc" style="margin-right: 6pt;"><br /></p><p class="1obc" style="margin-right: 6pt;"><u>Bivalent BA.1 boosters</u>: Moderna’s human neutralizing antibody results for their first bivalent updated booster, the one called mRNA-1273.214, which targets the spike protein of the original BA.1 Omicron variant, have now been <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2208343" style="color: #954f72;">properly published</a>. As we already knew from the preprint, it induced somewhat more antibodies against both BA.1 and BA.4/5 – 61% more in both cases – than did Moderna’s original monovalent booster, and did better against all the pre-Omicron variants as well. Please note that this is <b><i>not</i></b> the bivalent booster (mRNA-1273.222) being administered now in the US and soon to arrive in Europe. That one targets the spike protein of BA.4/5 directly. Both Moderna and Pfizer promised the first human data would come through in mid-September, but it ain’t happened yet. <o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Bivalent BA.4/5 boosters</u>: This one is finally available in Italy, 6 weeks after the US. Anyone who’s over 12 and 4 months after their last vaccine dose or last infection is eligible, though people at risk because of age, pathology, or occupational exposure are prioritized. I am still gritting my teeth and waiting for those damned human neutralizing antibody results on BA.4/5-targeting boosters that were due in mid-September. Promising early results for both <a href="https://www.biorxiv.org/content/10.1101/2022.09.21.508818v1.full.pdf" style="color: #954f72;">Pfizer</a>and <a href="https://www.biorxiv.org/content/10.1101/2022.09.12.507614v1.full.pdf" style="color: #954f72;">Moderna</a> were only in mice! …But now, on October 13<sup>th</sup>, Pfizer-BioNTech <a href="https://investors.biontech.de/news-releases/news-release-details/pfizer-and-biontech-announce-positive-early-data-clinical-trial" style="color: #954f72;">announced</a> that a 30-mcg dose of their bivalent vaccine given to adult human beings yields “a substantial increase in the Omicron BA.4/BA.5 neutralizing antibody response above pre-booster levels.” Substantial increase. That’s it. No specifics. We <a href="https://www.fda.gov/media/159496/download" style="color: #954f72;">already knew</a> that a 30-mcg bivalent Pfizer booster with an admixture of <b><i>BA.1</i></b> stimulated neutralizing antibodies at a level of 226, three times as good as the original monovalent booster. Why is Pfizer holding those data so close to its chest?<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Kiddies</u>: Data showing the Moderna vaccine produces lots of antibodies in young children but doesn’t give much concrete protection against illness (50.6% in babies and 36.8% in 2-5-year-olds) has now been <a href="applewebdata://6B49E0AE-93F2-48A3-9820-6FF5869237AD/v" style="color: #954f72;">published</a> in the New England Journal of Medicine.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Symptoms</u>: There’s <a href="https://jamanetwork.com/journals/jama/fullarticle/2797418?" style="color: #954f72;">good new evidence</a> that mRNA vaccination, especially with a booster, makes for milder disease in people who get breakthrough COVID-19, especially if the latest shot was less than 5 months earlier.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Quick fade</u>: We have 2 real-life studies coming down on opposite sides of the vaccine duration question. Down side: researchers from South Africa <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2210093" style="color: #954f72;">report</a> that vaccine protection against hospitalization due to the BA.4/5 subvariants falls to 19.3% by 9 months after a two-dose initial series. Booster data are more limited because of the time frame, but suggest that the dropoff may be similar: effectiveness fell from an initial 68.8% to 46.8% by just 3-4 months. Remember, we’re talking about protection not against infection but against severe disease, which is commonly considered long-lasting. These data call into question the fantasy of an annual booster. <o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Slow fade</u>: Up side: a <a href="https://jamanetwork.com/journals/jama/fullarticle/2796893" style="color: #954f72;">vast study</a> of more than 10 million North Carolina residents, extending well into the Omicron era, suggests on the contrary that COVID-19 vaccines may last more than a year against severe outcomes. Protection against infection with the SARS-CoV-2 virus fell off drastically over time, reaching 17% for Pfizer and 30% for Moderna by 14 months after the first dose. This corresponds to <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2210546?" style="color: #954f72;">the plunge</a> in neutralizing antibodies against all Omicron subvariants by 6 months after any dose of the original mRNA vaccines. But efficacy was still 42% and 68% respectively against hospitalization, and was about 68% against death for both vaccines. Interestingly, the Johnson & Johnson vaccine, whose initial efficacy is much lower, retains that efficacy better over time, still reducing deaths by 80% after 14 months. Third doses provided a further boost. I should say that this study had methodological issues that somewhat limit my optimism. <o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Natural immunity</u>: A <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2209306?" style="color: #954f72;">study from Qatar</a> confirms that having been infected by a pre-Omicron SARS-CoV-2 variant gives little protection (35%) against symptomatic BA.4/5 disease. Infection with earlier Omicron variants, though, gives much more (76%).<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Supply chain</u>: The US has a limited supply of updated boosters – at least of <a href="https://www.boston.com/news/coronavirus/2022/09/16/dph-supply-of-new-moderna-covid-vaccine-booster-is-temporarily-limited/" style="color: #954f72;">Moderna</a>. Nonetheless there should be <a href="https://www.nytimes.com/2022/09/18/us/covid-vaccine.html?" style="color: #954f72;">plenty to go around</a> given that in the 7 weeks since the bivalent shots have been available they’ve drawn only <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-additional-dose-totalpop" style="color: #954f72;">14.8 million</a> customers (tripled in the last month). That’s out of some 105 million Pfizer and 66 million Moderna that are <a href="https://qz.com/the-uss-estimate-for-uptake-of-the-new-covid-booster-wa-1849639093" style="color: #954f72;">on order</a>. As the Washington Post <a href="https://www.washingtonpost.com/opinions/2022/10/01/covid-bivalent-booster-shots/" style="color: #954f72;">points out</a>, this could be the last free booster, so get one while you can. People without health insurance will be particularly badly off, likely having to <a href="https://www.kff.org/coronavirus-covid-19/issue-brief/commercialization-of-covid-19-vaccines-treatments-and-tests-implications-for-access-and-coverage/" style="color: #954f72;">pay out of pocket</a> not only for COVID-19 vaccines but for tests and treatments as well. <o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Clotting issues</u>: Rare cases of serious blood clots, Vaccine-Induced Immune Thrombocytopenia and Thrombosis, can follow Johnson & Johnson’s and AstraZeneca’s vaccines. Now a fatal case <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2210813" style="color: #954f72;">has been reported</a> in Argentina soon after vaccination with Russia’s Sputnik V product. No surprise, since Sputnik V is similarly a viral vector vaccine, but if cases have been happening in Russia, as is likely, the authorities ain’t lettin’ on.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="margin-right: 6pt;"><b>Variant watch<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqVwuzBqD7nUcDhuGKX_PZ3rO_ahRg6u4hQ1wX57cDWkCzDfT16QIipRGwQkw_4F0jUuRtOT2AL_xziJMzBW_lFuU4jWbTDtkbFMhQxOM5ZNzUuulHiA6AbgHC1gGSkisL9fHbAipI3qeSLeVcG_bDzoG99mtwk4DsTuFNMs8cTLdn085MzT1cTtQE/s945/Ontario%20wastewater.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="600" data-original-width="945" height="254" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqVwuzBqD7nUcDhuGKX_PZ3rO_ahRg6u4hQ1wX57cDWkCzDfT16QIipRGwQkw_4F0jUuRtOT2AL_xziJMzBW_lFuU4jWbTDtkbFMhQxOM5ZNzUuulHiA6AbgHC1gGSkisL9fHbAipI3qeSLeVcG_bDzoG99mtwk4DsTuFNMs8cTLdn085MzT1cTtQE/w400-h254/Ontario%20wastewater.png" width="400" /></a></div><div style="text-align: center;"><br /></div><p class="1obc" style="margin-right: 6pt;">The BA.2.75 Omicron subvariant first detected in India has been <a href="https://www.vice.com/en/article/wxn5ay/did-a-random-person-on-twitter-name-the-latest-covid-variant-centaurus" style="color: #954f72;">randomly nicknamed</a> “Centaurus” by some guy on Twitter who thought the name was cute. The WHO <a href="https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/" style="color: #954f72;">disapproves</a>. It’s very contagious, and already accounts for about <a href="https://www.usnews.com/news/articles/2022-09-16/cdc-omicron-subvariant-ba-5-shows-slight-decline-while-ba-4-6-ba-2-75-increase" style="color: #954f72;">1% of cases</a> in the US. Fortunately, <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2210648?" style="color: #954f72;">vaccines may be more effective</a> against it than they are against BA.5, which still accounts for 85% of US cases. Even newer strains such as <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2212117?query=TOC" style="color: #954f72;">BA.4.6</a> and BF.7 (the Mongolian one) are already accounting for <a href="https://www.nbcchicago.com/news/coronavirus/covid-variant-tracker-shows-bf-7-ba-4-6-continuing-to-gain-on-ba-5-as-dominant-strain/2964566/" style="color: #954f72;">more than 15%</a> of US cases. But BA.2.75 already has a daughter, BA.2.75.2, that is said to be <a href="https://www.coronaheadsup.com/coronavirus/ba-2-75-2-exhibits-more-extreme-antibody-escape-than-any-variant-weve-seen-so-far/" style="color: #954f72;">5 times better</a> at escaping previous immunity than even BA.5. Now that, as Anthony Fauci <a href="https://www.politico.com/news/2022/09/19/anthony-fauci-we-are-not-where-we-need-to-be-00057580" style="color: #954f72;">has said</a>, is “suspicious” not to say scary. <o:p></o:p></p><p class="1obc" style="margin-right: 6pt;">Not to speak of BQ.1.1 and <a href="https://www.biorxiv.org/content/10.1101/2022.09.15.507787v3.full.pdf" style="color: #954f72;">especially XBB</a> (lately <a href="https://twitter.com/erictopol/status/1578759773146607617" style="color: #954f72;">driving a nasty surge</a> in Singapore), which have extreme levels of immune evasion and are more able to infect people who are ultravaccinated, even with the bivalent boosters, or have had recent infections.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;">All the ingredients in this alphabet soup are Omicron subvariants, mostly subsubvariants of BA.5.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;">Then there’s a brand-new virus, <a href="https://news.wsu.edu/press-release/2022/09/22/newly-discovered-covidlike-virus-could-infect-humans-resist-vaccines/" style="color: #954f72;">Khosta-2</a>, which has been found in Russian bats and like SARS-CoV-2 is a sarbecovirus. According to researchers at Washington State University it’s capable of infecting human cells and is resistant to all the monoclonal antibodies and vaccines we have. Should we worry?<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;">There are multiple bad aspects of all this. One is is the rapid development of new subvariants which overlap instead of replacing each other, and the other is the failure of BA.5 to fade away the way previous variants did (as per the wastewater tracking in the picture). As evolutionary biologist T. Ryan Gregory <a href="https://twitter.com/TRyanGregory/status/1577617059525140480" style="color: #954f72;">points out</a>, the less we do to stop transmission (dropping mask mandates…) the more these phenomena will occur. And the more likely there will be a <a href="https://www.washingtonpost.com/health/2022/10/18/covid-variants-xbb-bq1-bq11/" style="color: #954f72;">vicious winter surge</a>, just as masks are falling off faces and vaccine uptake is in the cellar.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="margin-right: 6pt;"><b>Ever more CDC blues<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsiUCvN-aeWe_vOiUrRP1wb9FnvMj7kt5g6Lit_eaYfu8VHAn8WHBhgZjNd3miWlhUsockNUsDS9Y5Mz1gmQe-k5co5bzZ13taOkT9Tg-7gsViVOJ1dsfT8rKBY7ipSPwu7vhRDQDmqDM9tRUlogPzYHjg7iDCuJpIRn8QzavZyz53sVAvSWOClCC5/s1920/Walensky.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1920" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsiUCvN-aeWe_vOiUrRP1wb9FnvMj7kt5g6Lit_eaYfu8VHAn8WHBhgZjNd3miWlhUsockNUsDS9Y5Mz1gmQe-k5co5bzZ13taOkT9Tg-7gsViVOJ1dsfT8rKBY7ipSPwu7vhRDQDmqDM9tRUlogPzYHjg7iDCuJpIRn8QzavZyz53sVAvSWOClCC5/s320/Walensky.jpg" width="320" /></a></div><p class="1obc" style="margin-right: 6pt; text-align: center;"><br /></p><p class="1obc" style="margin-right: 6pt;">The Centers for Disease Control have pulled another fast one. Their <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html" style="color: #954f72;">latest guidelines</a>, quietly released in late September, have scrapped masking in healthcare facilities, including nursing homes. They do at least make an exception for areas with high levels of community transmission, which currently means 70% of American counties. But individual facilities can opt out if they want… No more testing before hospital admissions or medical procedures either. And, as in the next-to-last version, no more quarantines.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;">As usual whenever it offers more liberal policies, the CDC is getting pushback, from <a href="https://twitter.com/meganranney/status/1573682891720216578" style="color: #954f72;">physicians</a> whose hospitals are experiencing staff shortages due to COVID-19, from prominent pandemic expert <a href="https://insidemedicine.bulletin.com/cdc-drops-masking-in-many-nursing-homes-we-ve-learned-nothing" style="color: #954f72;">Jeremy Faust</a>, and from at least one <a href="https://twitter.com/JeromeAdamsMD/status/1574005861793529857" style="color: #954f72;">former Surgeon General</a>.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;">At least under the Biden Administration there isn’t the blatant political interference with the CDC that there was under the Former Guy, as documented in shocking detail by the <a href="https://coronavirus.house.gov/news/press-releases/clyburn-trump-cdc-redfield-caputo-report?utm_source=substack&utm_medium=email" style="color: #954f72;">third installment</a> from the House Select Subcommittee on the Coronavirus Crisis.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="margin-right: 6pt;"><b>Boys and girls<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDEs9C4TS_mKMTS_epvOC539BdJ7jXb7aNA_-zQyHRVBKubl11dS7cDxjvkv2CT6ELVOW9WfXmUMjIvitkYiJhb_kEDiz8JAaOolRgmSDLh1NsNDUywh0Wx7w0BPDX0kYrC3VqFeSqTfpOKXpa_U0pSvBk6X-95D-pNbjLjJvM-2d_FqQo5nLpqLqP/s945/testosterone.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="601" data-original-width="945" height="204" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDEs9C4TS_mKMTS_epvOC539BdJ7jXb7aNA_-zQyHRVBKubl11dS7cDxjvkv2CT6ELVOW9WfXmUMjIvitkYiJhb_kEDiz8JAaOolRgmSDLh1NsNDUywh0Wx7w0BPDX0kYrC3VqFeSqTfpOKXpa_U0pSvBk6X-95D-pNbjLjJvM-2d_FqQo5nLpqLqP/s320/testosterone.jpg" width="320" /></a></div><p class="1obc" style="margin-right: 6pt; text-align: center;"><br /></p><p class="1obc" style="margin-right: 6pt;">A <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795874?" style="color: #954f72;">new study</a> from St. Louis claims that having a <b><i>low</i></b> testosterone level puts men at increased risk of hospitalization for COVID-19. Men using testosterone replacement therapy had no increased risk. This seems bizarre at first glance, given that men are more likely than women to get COVID-19 or to become very sick with it. But in fact, as I have learned only now, similar findings have been reported by researchers in both <a href="https://pubmed.ncbi.nlm.nih.gov/34409772/" style="color: #954f72;">Italy</a> and <a href="https://pagepressjournals.org/index.php/aiua/article/view/aiua.2021.4.460" style="color: #954f72;">Turkey</a>.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="margin-right: 6pt;"><b>Leap vs. leak re-re-redux<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-VL-A9Tfva33K7h3cxnwjaCeiqD4OHWuKzPczBZMbV3me-fEwqvvFkuSa9wq_IAyqO0fA-peZHuat7PXBr_JOBjb-bb4aJFGMZ2s-QqenMUcdOW4UXDnac5G5xMQdPhGR2CbqXKAku6YL5LDIqztgbyPqGcpzpO1ZHukT6dd0vMGeFPUsfacO3iRX/s709/lab%20leak%20theory%20gains%20prominence.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="399" data-original-width="709" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-VL-A9Tfva33K7h3cxnwjaCeiqD4OHWuKzPczBZMbV3me-fEwqvvFkuSa9wq_IAyqO0fA-peZHuat7PXBr_JOBjb-bb4aJFGMZ2s-QqenMUcdOW4UXDnac5G5xMQdPhGR2CbqXKAku6YL5LDIqztgbyPqGcpzpO1ZHukT6dd0vMGeFPUsfacO3iRX/s320/lab%20leak%20theory%20gains%20prominence.jpg" width="320" /></a></div><p class="1obc" style="margin-right: 6pt; text-align: center;"><br /></p><p class="1obc" style="margin-right: 6pt;">I thought the final nail in the coffin of the lab leak theory for the origin of the pandemic was hammered in months ago, but it seems another one was still needed. A world expert <a href="https://www.pnas.org/doi/10.1073/pnas.2211107119" style="color: #954f72;">has described</a> in great detail the ways the actual SARS-CoV-2 virus differs from anything that could have been designed in, and thus leaked from, a virology laboratory. He also emphatically refutes economist Jeffrey Sachs’s accusation of an NIH conspiracy to suppress the laboratory leak theory.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="margin-right: 6pt;"><b>The state of the pandemic<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHnlpJAngW6AyccGx9u3gkavhGN7fZa-5dd1E3OPmQZkG5tUWY6FKadkbOXQC2hTd0-9WBHPMYPo12Myvk0eLVp4jJBTZM4U0JDLiPVjuVftFUc_puoyoxa1_ToAwTbRW0Wb-TIb5j5CU4v7REMIkDwcUlpdZljk3X6LwIWGBMkpbm_Us32_rKWSvq/s976/biden%20pandemic%20over.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="549" data-original-width="976" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHnlpJAngW6AyccGx9u3gkavhGN7fZa-5dd1E3OPmQZkG5tUWY6FKadkbOXQC2hTd0-9WBHPMYPo12Myvk0eLVp4jJBTZM4U0JDLiPVjuVftFUc_puoyoxa1_ToAwTbRW0Wb-TIb5j5CU4v7REMIkDwcUlpdZljk3X6LwIWGBMkpbm_Us32_rKWSvq/w400-h225/biden%20pandemic%20over.jpg" width="400" /></a></div><div style="text-align: center;"><br /></div><p class="1obc" style="margin-right: 6pt;">President Biden said in a <a href="https://www.nytimes.com/2022/09/18/us/politics/biden-trump-covid.html?" style="color: #954f72;">interview on 60 Minutes</a>, “The pandemic is over. If you notice, no one’s wearing masks. Everybody seems to be in pretty good shape.” Directly contradicting what his own COVID-19 response coordinator, Ashish Jha, <a href="https://www.whitehouse.gov/briefing-room/press-briefings/2022/09/06/press-briefing-by-white-house-covid-19-response-team-and-public-health-officials-88/" style="color: #954f72;">had said</a> a week earlier. Biden did admit that “We still have a problem with Covid.” Damn right! With COVID-19 killing 400-500 Americans every day, Biden deserves the <a href="https://www.nytimes.com/2022/09/19/us/politics/biden-covid-pandemic-over.html?" style="color: #954f72;">backlash he's getting</a> from the recently bereaved, the Washington Post <a href="https://www.washingtonpost.com/opinions/2022/09/19/biden-pandemic-over-60-minutes-wrong/" style="color: #954f72;">editorial board</a>, and scientists from <a href="https://www.politico.com/news/2022/09/19/anthony-fauci-we-are-not-where-we-need-to-be-00057580" style="color: #954f72;">Anthony Fauci</a> to <a href="https://www.youtube.com/watch?v=mFflqpDFP8s" style="color: #954f72;">Eric Topol</a> to <a href="https://www.newspress.com.ng/boston-doctor-says-covid-pandemic-isnt-over-despite-bidens-comments/" style="color: #954f72;">Paul Sax</a> and <a href="https://www.boston.com/news/coronavirus/2022/09/19/biden-covid-pandemic-is-over-doctors-disagree/" style="color: #954f72;">onward</a> to Michael Mina, who supposedly said “COVID is not over.” Biden has even received a <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/eu-health-regulator-says-covid-pandemic-ongoing-2022-09-20/" style="color: #954f72;">pointed rebuke</a> from the Chief Medical Officer of the European Medicines Agency. As far as I can tell Leana Wen is the only supposed expert who’s <a href="https://www.washingtonpost.com/opinions/2022/09/19/biden-covid-pandemic-over/" style="color: #954f72;">backing him up</a>, though the <a href="https://www.npr.org/2022/09/08/1121706249/new-york-subway-mask-policy-you-do-you" style="color: #954f72;">dropping of mask requirements</a> on New York’s subways suggest other support in high places. And while his foolish words have no direct policy effect, they will surely <a href="https://www.politico.com/news/2022/09/19/biden-pandemic-over-covid-team-response-00057649" style="color: #954f72;">make it less likely</a> that Congress will allocate the $22 billion needed to keep fighting the pandemic, and even less likely that vulnerable Americans will bother to get the updated boosters they need. <o:p></o:p></p><p class="1obc" style="margin-right: 6pt;">Many ordinary Americans are of course ecstatic, with <a href="https://www.ipsos.com/en-us/news-polls/axios-ipsos-coronavirus-index" style="color: #954f72;">nearly half</a> saying they’ve returned to their pre-pandemic life.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;">What Joe Biden thinks about the end of the pandemic actually means nothing. It’s the World Health Organization’s job, and WHO chief Dr. Tedros Ghebreyesus, was <a href="https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing--14-september-2022" style="color: #954f72;">more circumspect</a> in mid-September: “We are not there yet, but the end is in sight.” His reasoning was, “Last week, the number of weekly reported deaths from COVID-19 was the lowest since March 2020.” His perspective is global, not domestic, and surges in Europe can and do coincide with drops elsewhere. It’s wonderful to know that vaccination and immunity from prior infections (antivirals are <a href="https://www.nature.com/articles/d41586-022-02939-7" style="color: #954f72;">not contributing</a>) have reduced deaths so dramatically worldwide, but that doesn’t mean we’re out of the woods.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><o:p> </o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisuwu2nRlTDqA_M-peWuxiAGNlvghyWJ1lW_VVvjzv6-Sepg2_f2bfngpxEVlfED9hCzJIuDKQXJWJaXHeGIu8EmdbIC4e7qY9ZMnFxX8flO_7P1QnKPyXGGAE9IvUtewWjoUr0Bc9llxJQt-xqNEdkV68NRt395bTIvcBSWzFT4hPn9wxRWEVCN74/s1778/cases%20Italy%20US.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1146" data-original-width="1778" height="258" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisuwu2nRlTDqA_M-peWuxiAGNlvghyWJ1lW_VVvjzv6-Sepg2_f2bfngpxEVlfED9hCzJIuDKQXJWJaXHeGIu8EmdbIC4e7qY9ZMnFxX8flO_7P1QnKPyXGGAE9IvUtewWjoUr0Bc9llxJQt-xqNEdkV68NRt395bTIvcBSWzFT4hPn9wxRWEVCN74/w400-h258/cases%20Italy%20US.jpg" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuTi3gEmEwsCGhzuo9gPIg04VOIKOqm7YPJ4Hqh163H2EN58g1jJyq2qxXq4kjUIdxaqMbnW_T3L0C4tIkzBNkhbgPQqTY4kbOhu1U5DsI-nzsT5fX9hQPVfFSTDj037MKL3Gef2RUour5grhnB-TxlT5sme9jyljHV5_U5rGX_jIIw_OZuwITn7il/s1778/deaths%20Italy%20US.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1146" data-original-width="1778" height="258" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuTi3gEmEwsCGhzuo9gPIg04VOIKOqm7YPJ4Hqh163H2EN58g1jJyq2qxXq4kjUIdxaqMbnW_T3L0C4tIkzBNkhbgPQqTY4kbOhu1U5DsI-nzsT5fX9hQPVfFSTDj037MKL3Gef2RUour5grhnB-TxlT5sme9jyljHV5_U5rGX_jIIw_OZuwITn7il/w400-h258/deaths%20Italy%20US.jpg" width="400" /></a></div><br /><br /><p class="1obc" style="margin-right: 6pt;">Let me point out that we’ve been here before. In Italy COVID-19 cases nearly zeroed out in July of 2020 and 2021, with dreadful surges just months later. Cases nearly tripled here this September-October, reaching an official case count 40 times higher than in July 2021, though the peak may now be passing. I – and other colleagues confirm – am now again hearing every day from friends and patients with COVID-19. Absurdly, 2 weeks into this latest surge Italy went through with removing its last remaining mask mandate, which required KN95 masks on public transport. Now, though, they <a href="https://tg24.sky.it/cronaca/2022/10/06/covid-obbligo-mascherina" style="color: #954f72;">may reconsider</a>… <o:p></o:p></p><p class="1obc" style="margin-right: 6pt;">The US was doing pretty well in June 2021 too, with <a href="https://www.washingtonpost.com/outlook/2021/09/21/covid-pandemic-end/" style="color: #954f72;">optimists predicting</a> the coming end of the pandemic, but it’s running triple the new cases and twice the deaths it was then. Nobody knows whether another variant is going to hit hard, or whether the current ones will soar again when people go back indoors in the chilly weather.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;">But even if no winter surge happens, and even if COVID-19 is in fact in the process of going from epidemic from endemic – even if, as some think, COVID-19 is now <a href="https://www.npr.org/sections/health-shots/2022/09/16/1122650502/scientists-debate-how-lethal-covid-is-some-say-its-now-less-risky-than-flu?sc=18&f=1001" style="color: #954f72;">less lethal</a> than flu – I’m still far from reassured. First, there continue to be plenty of new cases. Second, SARS-Co-V-2 is not like the flu. It’s a uniquely insidious virus, particularly capable of causing long-lasting disability itself and triggering downhill slides in chronic medical conditions from heart failure to dementia. <o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="margin-right: 6pt;"><b>The latest vaccine mishegos<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnWLGOXGgmOAHv95DLLHAkBk1UY3WrDjIUKJ-eNwFPJehVHzGn_H7WGWeiizv4BJ-qi9oPJb6Jv1Qce1FaWLI28S4KAcIzlXps9yK9uxjv6pq4PsEoD_Rqv6TWOgpnRb2SaFMUDiPaOP4Yh96wXXeu-nV0OhbigDaN4cb2WJ9u73EcbZXvRRctAtDl/s664/Janine%20Small.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="337" data-original-width="664" height="203" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnWLGOXGgmOAHv95DLLHAkBk1UY3WrDjIUKJ-eNwFPJehVHzGn_H7WGWeiizv4BJ-qi9oPJb6Jv1Qce1FaWLI28S4KAcIzlXps9yK9uxjv6pq4PsEoD_Rqv6TWOgpnRb2SaFMUDiPaOP4Yh96wXXeu-nV0OhbigDaN4cb2WJ9u73EcbZXvRRctAtDl/w400-h203/Janine%20Small.png" width="400" /></a></div><div style="text-align: center;"><br /></div><p class="1obc" style="margin-right: 6pt;"><a href="https://www.wnd.com/2022/10/pfizer-exec-confesses-vaccine-never-even-tested-stopping-transmission/" style="color: #954f72;">This one</a>, which came from <a href="https://www.wnd.com/author/wndnewsservices/" style="color: #954f72;">WND News Services</a> on October 11, is worth quoting in full:<o:p></o:p></p><p class="1obc" style="margin: 5pt 6pt 5pt 0.5in;"><b>“Pfizer executive Janine Small testifies before the European Parliament in Brussels on Monday”<o:p></o:p></b></p><p class="1obc" style="margin: 5pt 6pt 5pt 0.5in;">Undermining the premise for mandates and "passports," a Pfizer executive admitted to the European Parliament on Monday that her company's vaccine was never tested during clinical trials for the ability to prevent transmission of COVID-19. Janine Small, Pfizer's president of international developed markets, was asked by Dutch MEP Rob Roos if the pharmaceutical giant had tested the vaccine “on stopping the transmission of the virus before it entered the market.” <o:p></o:p></p><p class="1obc" style="margin: 5pt 6pt 5pt 0.5in;">No ... you know, we had to really move at the speed of science to really understand what is happening in the market," she confessed.<o:p></o:p></p><p class="1obc" style="margin: 5pt 6pt 5pt 0.5in;">Roos later posted a video on Twitter of Small's response and added his own comment.<o:p></o:p></p><p class="1obc" style="margin: 5pt 6pt 5pt 0.5in;">"This is scandalous!" he said. "Millions of people worldwide felt forced to get vaccinated because of the myth that you do it for others."<o:p></o:p></p><p class="1obc" style="margin: 5pt 6pt 5pt 0.5in;">That claim, he said, has “turned out to be a cheap lie.”<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;">This is obviously total bullshit: aside from anything else, if you prevent infection, which the vaccines do, then by definition you prevent transmission. So it occurred to me to google the website where this appears. I was not entirely shocked to read the first paragraph of its <a href="https://en.wikipedia.org/wiki/WorldNetDaily" style="color: #954f72;">Wikipedia entry</a>:<o:p></o:p></p><p class="1obc" style="margin: 5pt 6pt 5pt 0.5in;"><b><i>WND</i></b> (formerly <b><i>WorldNetDaily</i></b>) is an American far-right<sup> </sup><a href="https://en.wikipedia.org/wiki/Fake_news_website" style="color: #954f72;" title="Fake news website">fake news website</a>. It is known for promoting falsehoods and conspiracy theories, including the false claim that former President Barack Obama was not born in the United States. <o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br />Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com2tag:blogger.com,1999:blog-6211405954943098401.post-53049155738840159442022-09-13T20:36:00.000+02:002022-09-13T20:36:27.652+02:00Boosters, Blues, and Battling Long COVID <p> <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgyFpPD98LsC45aIV0zil4wH0HY95R2AtcHHEWu4fPIc2_squfqKRw8vpiuyUto5rXaTODuX1g1sXSsVLV7UXlMfesmXLiYyp525gIJFWYcaEWxFQ7stLfj181bHtqwUM4W1NKqIgxtt1-aCe-rNs1ruxWmnXgERY412BYSWG1rzThS-bRrZuEz87bg/s783/The_Battle_Between_the_Gods_and_the_Titans_-_WGA25902.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="600" data-original-width="783" height="306" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgyFpPD98LsC45aIV0zil4wH0HY95R2AtcHHEWu4fPIc2_squfqKRw8vpiuyUto5rXaTODuX1g1sXSsVLV7UXlMfesmXLiYyp525gIJFWYcaEWxFQ7stLfj181bHtqwUM4W1NKqIgxtt1-aCe-rNs1ruxWmnXgERY412BYSWG1rzThS-bRrZuEz87bg/w400-h306/The_Battle_Between_the_Gods_and_the_Titans_-_WGA25902.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">J. Wtewael, The Battle Between the Gods and the Titans</td></tr></tbody></table></p><div class="separator" style="clear: both; text-align: center;"><br /></div><br />New Paxlovid studies, the lowdown on bivalent boosters, Titanic battles, the CDC blues, more on lab leaks, vaccine hooey, and for perhaps the first time ever some good news about long COVID.<div><br /><p></p><p><b>Treatment and prevention news</b></p><p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhB3ZuoRGt1Ivsk3vWSvoN9u60mza0Xa0RVK16PXdZFzO83848oa0lvLlOLekHzlg-SMIp9El9SwwX-5o2gJF-wTh2Ipni8DOj4Z6HDROyxtDdIPguHpoWBes84p4iN-Aq5JcVionpIit6K5g0GekdmlHPS7XFU6gqvuLcKu34_3awJ6zlB_NY_7Qta/s1350/exercise.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="900" data-original-width="1350" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhB3ZuoRGt1Ivsk3vWSvoN9u60mza0Xa0RVK16PXdZFzO83848oa0lvLlOLekHzlg-SMIp9El9SwwX-5o2gJF-wTh2Ipni8DOj4Z6HDROyxtDdIPguHpoWBes84p4iN-Aq5JcVionpIit6K5g0GekdmlHPS7XFU6gqvuLcKu34_3awJ6zlB_NY_7Qta/w400-h266/exercise.jpeg" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><u><br /></u><p></p><p><u>Paxlovid efficacy</u>: New examination of old data has <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2206277" target="_blank">cast doubt</a> on the idea that it works better if started within 3 days than on days 4-5 – and <a href="https://www.cnbc.com/2022/07/27/as-more-people-report-covid-rebounds-after-paxlovid-experts-insist-cases-are-rare.html" target="_blank">some even think</a> that very early treatment may increase the risk of post-treatment rebound. </p><p>Symptoms: We do not know whether Paxlovid shortens illness or makes it milder, though the manufacturer <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-reports-additional-data-paxlovidtm-supporting" target="_blank">has hinted </a>it does not. Pfizer has <a href="https://clinicaltrials.gov/ct2/show/NCT05011513" target="_blank">abandoned</a> its trial in average-risk patients, whose main goal was symptom relief, releasing <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-reports-additional-data-paxlovidtm-supporting" target="_blank">very few results</a>. But only now have I learned that in their main trial, about preventing hospitalizations in high-risk patients, they also <a href="https://insidemedicine.bulletin.com/paxlovid-does-not-shorten-the-duration-of-covid-symptoms-data-show-what-about-long-covid" target="_blank">gathered data</a> on symptom duration and severity, but chose not to report those data in the published paper. Not transparent, and not encouraging. And, in case you’ve wondered, we know <a href="https://insidemedicine.bulletin.com/paxlovid-does-not-shorten-the-duration-of-covid-symptoms-data-show-what-about-long-covid" target="_blank">nothing whatsoever</a> about whether Paxlovid reduces the risk of long COVID.</p><p>The large Israeli study showing Paxlovid does little for younger COVID-19 patients has now been <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2204919?query=TOC" target="_blank">properly published</a>. The drug reduced the risk of hospitalization by 73% in people over 65, but by a statistically non-significant 26% in people ages 40-64, even though all those younger patients had multiple risk factors for developing severe disease. Patients who were over 70, incompletely vaccinated, or immunosuppressed were automatically eligible.</p><p>Antivirals are still <a href="https://www.federfarma.it/Edicola/Ansa-Salute-News/VisualizzaNews.aspx?type=Ansa&key=34013" target="_blank">vastly underused</a> in Italy, being given lately to 0.65% of all diagnosed cases. Let me explain: <a href="https://www.epicentro.iss.it/coronavirus/dashboard/30gg.html" target="_blank">19%</a> of recent cases have been in people over 70, of whom approximately <a href="https://www.epicentro.iss.it/coronavirus/dashboard/30gg.html" target="_blank">20%</a> are mildly to moderately symptomatic, so at least 3.8% of diagnosed cases were eligible for antiviral treatment – add in patients 65-69 plus younger ones with high-risk medical conditions and I’m sure you’ll reach 5%, meaning only about 1 in 8 eligible patients gets treated. (Though, as above, younger patients get little benefit from Paxlovid even if they are at high risk.)</p><p><u>Fluvoxamine</u>: Is my go-to prescription for high-risk patients who can’t get their hands on Paxlovid ineffective after all? That’s what a New England Journal of Medicine <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2201662?" target="_blank">study</a> has found, looking at outpatients whose only risk factor was being overweight or obese. The study was enough to convince both a NEJM <a href="https://www.nejm.org/doi/full/10.1056/NEJMe2209017?" target="_blank">editorialist</a> and the writers of <a href="https://app.magicapp.org/#/guideline/nBkO1E/rec/jmYxpV" target="_blank">WHO guidelines</a>. I’m not entire sure, because in two smaller randomized trials among truly high-risk patients fluvoxamine seemed <a href="https://pubmed.ncbi.nlm.nih.gov/35383578/" target="_blank">surprisingly effective</a> at reducing hospitalizations (74%) and mortality (33%), though so few patients reached those endpoints that the results were not statistically significant. But I confess I’ll be relieved to have an excuse to stop prescribing fluvoxamine, since few people tolerate its side effects at the recommended dose.</p><p><u>Convalescent plasma</u>: In a 416-patient <a href="https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(22)00421-9/fulltext" target="_blank">randomized trial</a> in the Netherlands convalescent plasma failed to meet statistical criteria for success. But there are two important caveats. One is that it did cut the hospitalization rate by a hefty 39%, which fell short of statistical significance only because so few people became very sick. Secondly, the authors admit that the antibody titer of the plasma they administered was probably far too low. So we still don’t know whether this low-tech, low-cost intervention works.</p><p><u>Folic acid</u>: Here’s a strange one: according to a <a href="https://bmjopen.bmj.com/content/12/8/e062945" target="_blank">large observational study</a> from the UK, people taking folic acid, a B vitamin, were 51% more likely to get sick with COVID-19, and more than twice as likely to die if they caught it. </p><p><u>Exercise</u>: Might regular exercise help keep you from getting COVID-19, and help prevent severe disease if you get it anyway? That’s what’s hinted by a <a href="https://bjsm.bmj.com/content/56/16/901?" target="_blank">study from South Korea</a>, confirming a recent <a href="https://bjsm.bmj.com/content/early/2022/07/07/bjsports-2022-105733" target="_blank">meta-analysis</a>. </p><p><u>Vitamin D</u>: New large clinical trials from the <a href="https://www.bmj.com/content/378/bmj-2022-071230" target="_blank">UK</a> and <a href="https://www.bmj.com/content/378/bmj-2022-071245" target="_blank">Norway</a> have found that, as I’ve always suspected, vitamin D supplements do nothing to prevent or mitigate COVID-19. An editorialist <a href="https://www.bmj.com/content/378/bmj.o1822" target="_blank">points out</a> some caveats, of which in my opinion the most significant is that fully half the subjects in the UK placebo group were taking vitamin D supplements on their own.</p><p><br /></p><p><b>Vaccine news</b></p><p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEowiEn9J-lSZkfi8ehCcnmZPXb3psUz7XTHpWfkh3VN7s6G3rnNPmF8NGMR9GiGepIhHb3WjISyeCqeU0HagTV-HcVnZGRDLsyK68b2i4Il6RoygMrpSv26UmLMXIloOUTQlqcJhAaIX1710TxfvEo2fPpFUTT0mUIrSifsVOug03VKPC_9LUISON/s1280/bootstraps%202.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEowiEn9J-lSZkfi8ehCcnmZPXb3psUz7XTHpWfkh3VN7s6G3rnNPmF8NGMR9GiGepIhHb3WjISyeCqeU0HagTV-HcVnZGRDLsyK68b2i4Il6RoygMrpSv26UmLMXIloOUTQlqcJhAaIX1710TxfvEo2fPpFUTT0mUIrSifsVOug03VKPC_9LUISON/w400-h225/bootstraps%202.jpeg" width="400" /></a></div><br /><p></p><p><u>Bivalent vaccines</u>: They’re hot news but, as they say on Facebook, it’s complicated. Even old-fashioned monovalent boosters <a href="https://www.science.org/doi/10.1126/science.abq0203" target="_blank">have some activity</a> against the Omicron BA.4 and 5 subvariants, but the next mRNA vaccine boosters against COVID-19 used in the USA and in Europe will for the first time all include two kinds of mRNA rather than one. A half-dose of the original vaccine, which targeted the spike protein of the original Wuhan wild strain, will be combined with a half-dose targeting the spike protein of an Omicron variant. Two that take direct aim at the twin BA.4-BA.5 subvariants, from Moderna and Pfizer, have not only <a href="https://www.nytimes.com/2022/08/31/us/politics/covid-booster-shots-variants.html?" target="_blank">been approved</a> for emergency use by the FDA, but are <a href="https://www.cvshealth.com/news-and-insights/press-releases/cvs-health-statement-on-availability-of-bivalent-covid-19-boosters" target="_blank">already available</a> in American and UK pharmacies and will <a href="https://www.bloomberg.com/news/articles/2022-08-31/europe-set-to-approve-moderna-pfizer-omicron-tailored-shots" target="_blank">soon reach Europe</a>. </p><p>Some have expressed <a href="https://www.science.org/content/article/omicron-booster-shots-are-coming-lots-questions" target="_blank">doubts</a> because of the lack of human Phase 3 trials. I’d remind them that yearly flu shots aren’t tested that way either, but are formulated according to experts’ best guess as to the next season’s dominant influenza strains. Usually the experts do OK, but sometimes (as in the <a href="https://www.cdc.gov/flu/vaccines-work/past-seasons-estimates.html" target="_blank">2021-22 season</a>) their predictions are so far off that the vaccine is practically useless.</p><p><a href="https://jamanetwork.com/journals/jama/fullarticle/2794259?guestAccessKey=665c48d6-26fd-4be3-adbd-02265f7d84c8&utm_source=silverchair&utm_campaign=jama_network&utm_content=covid_weekly_highlights&utm_medium=email" target="_blank">Others wonder</a> whether targeting Omicron 4/5 is really necessary, given evidence that retooling against the original BA.1 Omicron variant might work pretty well too. Both <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/moderna-booster-candidate-produces-strong-antibodies-against-omicron-subvariants-2022-06-22/" target="_blank">Moderna</a> and <a href="https://www.fda.gov/media/159496/download" target="_blank">Pfizer</a> mRNA vaccines with an Omicron BA.1 component have been shown to induce neutralizing antibodies against the BA.4 and BA.5 variants. But for the vaccines now on American pharmacy shelves, whose Omicron portion comes directly from the spike sequences of BA.4-5, we won’t even have antibody data until at least mid-September, weeks before the new vaccines are likely to arrive in Italy or elsewhere in Europe. So we folks on the far side of the pond will be better poised to decide which vaccine to get, and will have a broader choice than Americans. <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/eu-regulator-backs-omicron-adapted-covid-shots-2022-09-01/" target="_blank">EU regulators</a> and <a href="http://direnl.dire.it/odm/anno/2022/settembre/08/?news=C04" target="_blank">Italian authorities</a> have already approved BA.1-spiked boosters from both Moderna and Pfizer-BioNTech. My bottom-line advice for Europeans is wait until those data come in before deciding which booster to choose.</p><p>As far as I know only <a href="https://www.timesofisrael.com/modernas-new-variant-busting-covid-vaccine-starting-trial-in-israel/" target="_blank">one group</a>, in Israel, is studying the real-life efficacy of any of these vaccines (specifically, the Moderna version with a BA.1 component). That study began during the dreadful BA.4-5 summer spike, so it has a chance of encountering enough cases to be able to assess vaccine effectiveness. But the impact of the bivalent vaccines will mostly need to be estimated post-hoc, months after the vaccines are rolled out.</p><p>In any case, with the pandemic showing no sign of disappearing and with all boosters somewhat protecting against severe disease and death, older or medically vulnerable people should definitely get a fall booster if they’re 2 or more months after their last booster or 3 months after a breakthrough infection. That will definitely include my husband and me. We’ve managed to escape infection for 2 ½ years now, and we plan to do everything we can to maintain that record, from masking and distancing to ventilation, HEPA filters, and vaccine boosters. As Eric Topol emphasizes in a <a href="https://erictopol.substack.com/p/some-light-on-long-covid" target="_blank">review article</a> on long COVID, “There’s only one surefire way to prevent Long Covid: not to get Covid.”</p><p>Various <a href="https://www.pbs.org/newshour/health/updated-covid-19-booster-shots-are-now-available-heres-what-you-need-to-know" target="_blank">experts</a>, including <a href="https://www.nejm.org/doi/full/10.1056/NEJMra2206573?query=TOC&cid=NEJM%20eToc,%20September%201,%202022%20DM1402792_NEJM_Subscriber&bid=1141551427" target="_blank">one featured</a> in the New England Journal of Medicine and the <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-moderna-pfizer-biontech-bivalent-covid-19-vaccines-use" target="_blank">FDA itself</a>, avoid speculating as to how well the updated boosters will ward off infection, emphasizing their ability to prevent severe outcomes. I hope that’s just a case of deliberately <a href="https://www.supportiv.com/tools/lower-your-expectations-avoid-disappointment" target="_blank">setting low expectations</a>.</p><p>Should I mention that the American <a href="https://www.investorsobserver.com/news/featured/what-next-for-covid-19-vaccine-stocks-pfizer-pfe-and-moderna-mrna" target="_blank">government is paying</a> $26.36 for every dose of the updated Moderna booster and $30.48 for Pfizer-BioNTech, compared with $15.75 and $24 for the original versions. So it can only afford 66 million doses of Moderna and 105 million of Pfizer, enough to cover half the population, again for lack of funding. But to be honest the supply is unlikely to ever run out, given that only <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?facet=none&Metric=Vaccine+booster+doses&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=USA~ITA~GBR">40% of Americans</a> have gotten any boosters at all (compared to 73% of Italians and 60% of Brits).</p><p>Self-boosting vaccines: This concept has <a href="https://www.europeanpharmaceuticalreview.com/news/173366/microparticles-could-form-self-boosting-vaccines/" target="_blank">generated some enthusiasm</a>, but I don’t get it. What the technology seems designed to do is to release vaccines in dribs and drabs – perhaps allowing a vaccine that usually needs two shots 3-4 weeks apart to be given as a single dose instead. That’s not my idea of self-boosting.</p><p><u>Heterologous boosters</u>: Starting with one vaccine and boosting with a different one isn’t a new idea but has been getting a bit more traction. Originally the concept was to top up mRNA vaccines with viral vector boosters, but the latter have been largely abandoned because of those pesky blood clots. Spike protein vaccines, specifically the Sanofi-GSK version, are now being tested as boosters to mRNA vaccines, <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2206711" target="_blank">with reports</a> that they hoist neutralizing antibodies not just to wild strain and Delta variants but also to Omicron. We’ll see how this story unfolds.</p><p><u>Novavax</u>: both <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/eu-regulator-says-novavax-covid-vaccine-should-carry-side-effect-warning-2022-08-03/" target="_blank">EU regulators</a> and <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-emergency-use-novavax-covid-19-vaccine-adjuvanted#:~:text=The%20Fact%20Sheet%20for%20Healthcare,heart)%20following%20administration%20of%20Novavax" target="_blank">the FDA</a> have decided this vaccine must carry a warning about myocarditis and pericarditis as possible side effects. This is particularly unfortunate because it will be even less likely that no-vaxxers will flock to this vaccine because of its more traditional technology. </p><p><u>School-age kids</u>: In <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2203209?query=TOC" target="_blank">Singaporean children</a>, the Pfizer vaccine was less than 40% effective for preventing Omicron infections, but more than 80% effective against hospitalizations. I wish they had tested Moderna, whose higher dose may work better.</p><p><u>Valneva</u>: This whole-virus inactivated vaccine, made by a French company, has <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/who-recommends-valnevas-covid-vaccine-2022-08-18/" target="_blank">received the nod</a> from the WHO on the basis of immunobridging studies showing it stimulates a somewhat stronger antibody response than the notoriously ineffective Astrazeneca vaccine, which isn’t saying much. Only people 18 to 50 were examined, heaven only knows why, so the vaccine is being recommended <a href="https://www.who.int/news-room/feature-stories/detail/the-valneva-vla2001-covid-19-vaccine--what-you-need-to-know" target="_blank">only in that age group</a>. And the antibodies were against the original Wuhan wild strain, to boot! With no Phase 3 trials, no data on older people, and no data about any variants much less Omicron, this vaccine probably deserves a miss worldwide.</p><p><br /></p><p><b>Leap or leak, redux</b></p><p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIlpB8yyeisiSlQ-cXMMwWsurfd8JHnVfn-ENM4-0D32HgPAMoJFon30nvG-dZNzMyQYcYLftOHOv0uwrY68uKiEgzQ8EFte6mXiVjMDjd6NFu82ZuQIiy-Gv-vrZFt-sUFlvT3_-BhPQwVi7SiQYTF19hLbgwRx9GoeE3xjuLFpKxcyZ6abA8w8Bq/s714/huanan%20market%20map.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="650" data-original-width="714" height="582" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIlpB8yyeisiSlQ-cXMMwWsurfd8JHnVfn-ENM4-0D32HgPAMoJFon30nvG-dZNzMyQYcYLftOHOv0uwrY68uKiEgzQ8EFte6mXiVjMDjd6NFu82ZuQIiy-Gv-vrZFt-sUFlvT3_-BhPQwVi7SiQYTF19hLbgwRx9GoeE3xjuLFpKxcyZ6abA8w8Bq/w640-h582/huanan%20market%20map.png" width="640" /></a></div><br /><p></p><p>For me the lab leak theory was killed by the recent <a href="https://www.science.org/doi/10.1126/science.abp8715" target="_blank">Science paper</a> whose chief graphic I’ve pasted again here.</p><p>But now we have Columbia University economist Jeffrey Sachs to the contrary. He is not just 100% convinced the virus was created in a laboratory but thinks it’s not the Chinese but Americans who are chiefly responsible for covering up the evidence. In a <a href="https://www.jeffsachs.org/interviewsandmedia/64rtmykxdl56ehbjwy37m5hfahwnm5" target="_blank">Current Affairs interview</a> laying all this out he also claims the NIH won’t release material about its bat coronavirus research. Isn’t it weird that Sachs, who is not a physician, epidemiologist, or virologist, came to be named as the head of The Lancet COVID-19 Pandemic Commission’s origins task force? For me the origin question has been settled, the NIH has been <a href="https://www.niaid.nih.gov/diseases-conditions/coronavirus-bat-research" target="_blank">transparent</a>, and the whole business about a furin cleavage site that’s supposedly key to the lab leak argument is <a href="https://pubmed.ncbi.nlm.nih.gov/33493182/" target="_blank">less than meets the eye</a>, but if you feel like taking a deeper dive into the whole controversy you might consider starting <a href="https://www.science.org/content/article/fights-over-confidentiality-pledge-and-conflicts-interest-tore-apart-covid-19-origin-probe" target="_blank">here</a>.</p><p><br /></p><p><b>Long COVID</b> </p><p> <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSnvUxSt7vF00nBrhGXelnm6Ss9R5kmZywDnxRN4VQ15ufAfiZ8NgSaQTx0-Z4ap2p-zzhxEeAisvMV9IcjwrBjHvQGuwiwnNWRPtvykJkD_-f6_BEkljmUOmG8gWC03he_fMMk5jSv6LXujXnkKN9kXRX1juf8MsfYTl3AKqEvSgzeKUUQ8bgjer3/s1024/Hyperbaric_chamber_featured.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="683" data-original-width="1024" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSnvUxSt7vF00nBrhGXelnm6Ss9R5kmZywDnxRN4VQ15ufAfiZ8NgSaQTx0-Z4ap2p-zzhxEeAisvMV9IcjwrBjHvQGuwiwnNWRPtvykJkD_-f6_BEkljmUOmG8gWC03he_fMMk5jSv6LXujXnkKN9kXRX1juf8MsfYTl3AKqEvSgzeKUUQ8bgjer3/w400-h266/Hyperbaric_chamber_featured.jpeg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">A hyperbaric chamber</td></tr></tbody></table><br /></p><p><u>Impact</u>: “Long COVID-19 is keeping between 2 million to 4 million Americans out of work, according to an Aug. 24 <a href="https://www.brookings.edu/research/new-data-shows-long-covid-is-keeping-as-many-as-4-million-people-out-of-work/?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top" target="_blank">report</a> from the Brookings Institute.” Since about 16 million working-age Americans have long COVID and a <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00299-6/fulltext" target="_blank">high percentage</a> of sufferers who are able to work have to reduce their hours, those depressing figures clearly underestimate the overall impact. Omicron probably entails a lower rate than Delta, but there have been so many cases that a long COVID epidemic may end up being its long-term <a href="https://www.reliasmedia.com/articles/149072-an-epidemic-of-long-covid-may-be-the-legacy-of-omicron" target="_blank">legacy</a>.</p><p><u>Hyperbaric oxygen therapy</u>: I’ve already mentioned that HBOT sounded reasonable, and cited a promising <a href="https://www.rcpjournals.org/content/clinmedicine/21/6/e629" target="_blank">pilot study</a>. Now an <a href="https://www.nature.com/articles/s41598-022-15565-0" target="_blank">excellent randomized study</a> reports that it really does work. Patients who had been suffering for an average of 5-6 months improved in terms of brain fog, fatigue, sleep, and pain after 40 sessions of HBOT, 90 minutes each on 5 days a week, as compared with patients who received a sham procedure. Brain scans even showed improved blood flow to the brain. This is the most exciting long COVID news I’ve read for a long time if ever. Only problem for my own patients is that whereas in the US it’s not hard to get HBOT privately and off-label – for <a href="https://www.hyperbaricmedicalsolutions.com/blog/how-much-does-hyperbaric-oxygen-therapy-cost#:~:text=Off%2Dlabel%20conditions%20will%20most,sessions%20and%20location%20of%20services." target="_blank">several hundred dollars</a> per session – in Italy that’s not possible.</p><p><u>Autologous mesenchymal stem cell therapy</u>: Harvested from a patient’s own fat or bone marrow and then replaced either into the nose or by intravenous infusion, stem cells are being touted as a treatment for long COVID in <a href="https://www.sechenovmedj.com/jour/article/view/396" target="_blank">Russia</a>, <a href="https://www.labiotech.eu/trends-news/panacell-biotech-stem-cell-used-for-treatment-long-covid/" target="_blank">South Korea</a>, and at least one, somewhat dubious-looking <a href="https://www.boulderbiologics.com/stem-cell-therapy" target="_blank">American center</a>, in Colorado. Some theoretical mechanisms <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8625432/" target="_blank">have been proposed</a>, but there is zero published, preprinted, or even promised evidence in actual patients. <a href="https://clinicaltrials.gov/ct2/show/NCT04992247" target="_blank">One clinical trial</a> promised by Sorrento Therapeutics was subsequently <a href="https://clinicaltrials.gov/ct2/show/NCT04909892?term=stem+cell&cond=long+covid&draw=2&rank=1" target="_blank">withdrawn</a> and replaced by another protocol that had <a href="https://clinicaltrials.gov/ct2/show/NCT04992247?term=stem+cell&cond=long+covid&draw=1&rank=2" target="_blank">not started recruiting</a> as of August 8th. Another trial is “<a href="https://clinicaltrials.gov/ct2/show/NCT04798066?term=stem+cell&cond=long+covid&draw=1&rank=2" target="_blank">no longer available</a>.” A third was supposedly <a href="https://www.bloomberg.com/press-releases/2021-11-30/american-cryostem-completes-clinical-protocol-design-for-long-covid-study" target="_blank">being planned</a> last year by the American Cryostem Corporation, but is nowhere to be found in the Clinicaltrials.gov database. The Colorado center <a href="https://www.boulderbiologics.com/stem-cell-therapy" target="_blank">simply claims</a>, “Our preliminary clinical evidence shows that our stem cell therapy has been effective for some of our long hauler patients. Those who saw benefits no longer experienced shortness of breath, heart palpitations, brain fog, or chronic fatigue.” How many is “some”? 80%? 10%? Their failure to provide even that basic number is suspicious.</p><p><u>Kids</u>: I’ve ignored long COVID in children, partly because it’s so rare, but it’s worth mentioning that it seems to behave quite differently from long COVID in adults, with the most common pathology being <a href="file:///doi/10.1001:jamapediatrics.2022.2800" target="_blank">myocarditis</a>, inflammation of the heart muscle.</p><p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUZMOc_eDnjHaZvr0Y08tIBr447I7ISY2hmTzZtphoYK_JP4yT3bJLTO18nPtVj_HFGwUk0N1yCyuEJoJHFmtnHcCiJE2qWxThemSPvjgukQ_D7qq2FrQJzolOI9eWMtjKFskfPAU00o_yrgikgAbU5BmY5B8pToaIPxWsxapT9RCUzPALyIUfNlzo/s1200/anosmia-covid-smell-loss-og.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="630" data-original-width="1200" height="168" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUZMOc_eDnjHaZvr0Y08tIBr447I7ISY2hmTzZtphoYK_JP4yT3bJLTO18nPtVj_HFGwUk0N1yCyuEJoJHFmtnHcCiJE2qWxThemSPvjgukQ_D7qq2FrQJzolOI9eWMtjKFskfPAU00o_yrgikgAbU5BmY5B8pToaIPxWsxapT9RCUzPALyIUfNlzo/s320/anosmia-covid-smell-loss-og.jpeg" width="320" /></a></div><br /><p></p><p>A <a href="https://www.medpagetoday.com/infectiousdisease/covid19/100068#:~:text=%E2%80%94%20Cross%2Dsectional%20survey%20showed%2088,at%202%2Dyear%20follow%2Dup&text=Most%20patients%20with%20smell%20or,sectional%20survey%20conducted%20in%20Italy." target="_blank">depressing headline</a> at the doctors-only website Medpage Today: “Most COVID-Related Smell, Taste Dysfunction Resolved at 2 Years.” Only most? Alas, yes. Italian researchers <a href="https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2794937" target="_blank">report</a> that more than 1 in 10 patients who lost their sense of smell when they had mild COVID-19 hadn’t fully gotten it back two years later.</p><p><br /></p><p><b>Legal battle of the Titans</b></p><p> <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjctIZgQ1OOteU22cadqBL-DpLpBshQjUxEweHrqBDLB8ugmfl9NAjOS-38gnVu-cJQm68L5IQ12cjpWXKYtMAn9QhhhAdRlcnLdbZ3O2strjz5GjwNLR3CFuO3dEmXotvkxYT1ULeXDa5s9rKlySXGKzx58jJinHtPL7pJanAcZe1vjPHID7a8zf4N/s800/fall%20of%20the%20titans.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="621" data-original-width="800" height="496" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjctIZgQ1OOteU22cadqBL-DpLpBshQjUxEweHrqBDLB8ugmfl9NAjOS-38gnVu-cJQm68L5IQ12cjpWXKYtMAn9QhhhAdRlcnLdbZ3O2strjz5GjwNLR3CFuO3dEmXotvkxYT1ULeXDa5s9rKlySXGKzx58jJinHtPL7pJanAcZe1vjPHID7a8zf4N/w640-h496/fall%20of%20the%20titans.jpg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">C. van Haarlem, The Fall Of The Titans</td></tr></tbody></table><br /></p><p>The competition between Moderna and Pfizer/BioNTech is now adding a monetary plane to the scientific one, as the former <a href="https://www.nytimes.com/2022/08/26/business/moderna-covid-vaccine-lawsuit.html" target="_blank">sues the latter</a> for patent infringement. CureVac is <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/pfizer-biontech-seek-revoke-curevacs-patent-infringement-claims-2022-09-02/" target="_blank">doing the same</a>, while Moderna fights off <a href="https://www.pharmaceutical-technology.com/news/arbutus-lawsuit-moderna-vaccine/" target="_blank">similar suits</a> in turn. The Moderna suit is apparently <a href="https://www.natlawreview.com/article/moderna-to-pfizer-pandemic-over" target="_blank">legally questionable</a> because of Moderna’s pledge not to enforce its patents during the pandemic, and it looks <a href="https://endpts.com/moderna-sues-pfizer-and-biontech-for-infringing-on-mrna-vaccine-patents-used-in-blockbuster-covid-shots/" target="_blank">scientifically questionable</a> to me as well, since <a href="https://ec.europa.eu/research-and-innovation/en/horizon-magazine/qa-biontech-vaccine-only-mrna-10-just-beginning-say-co-founders" target="_blank">BioNTech claims </a>it’s been working on mRNA vaccines for 20 years, but what do I know? Any damages assessed are considered likely to be <a href="https://www.nytimes.com/2022/08/26/business/moderna-covid-vaccine-lawsuit.html" target="_blank">tens of millions</a> of dollars – an amount Pfizer can brush off as a rounding error after raking in <a href="https://www.theguardian.com/business/2022/feb/08/pfizer-covid-vaccine-pill-profits-sales" target="_blank">$36.8 billion</a> for its vaccine in 2021 alone.</p><p><br /></p><p><b>CDC blues</b></p><p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioNFz6Bq5FIDAVopyJCnlCfC41Zp0NUfbJV99gNfhP234gWkx6aBwpKrIPXHdSs5d5ZUatZC0saXYlCHYqVXqAzpelGw9K68Vm0TTRe3KX2DobOOj9cF4uSvp_jubjqv2crayr13XhP06MLF5KxbIrK1IR74gxZER1ZQaw5WHP6bQhhgmFAiHoX1u2/s1024/CDC.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="700" data-original-width="1024" height="274" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioNFz6Bq5FIDAVopyJCnlCfC41Zp0NUfbJV99gNfhP234gWkx6aBwpKrIPXHdSs5d5ZUatZC0saXYlCHYqVXqAzpelGw9K68Vm0TTRe3KX2DobOOj9cF4uSvp_jubjqv2crayr13XhP06MLF5KxbIrK1IR74gxZER1ZQaw5WHP6bQhhgmFAiHoX1u2/w400-h274/CDC.jpeg" width="400" /></a></div><br /><p></p><p>The <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7133e1.htm?s_cid=mm7133e1_w" target="_blank">latest guidelines</a> from the Centers for Disease Control, updated in mid-August, practically eliminate contact tracing, quarantines, workplace screening, and physical distancing, and lean more heavily than ever on the <a href="https://twitter.com/drericding/status/1497319120567742464?s=11" target="_blank">flawed</a> COVID-19 community levels, saying that people – except those at highest risk – don’t need to wear face masks in any settings unless their local hospitals are overwhelmed. This while COVID-19 is killing around <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?facet=none&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=false&Color+by+test+positivity=false&country=~USA" target="_blank">400 Americans</a> every day, with about <a href=" https://ourworldindata.org/explorers/coronavirus-data-explorer?facet=none&Metric=Hospital+patients&Interval=7-day+rolling+average&Relative+to+Population=false&Color+by+test+positivity=false&country=~USA" target="_blank">30,000 patients</a> in the hospital for it. The CDC continues to say infected people can go out into the world after 5 days without even an antigen swab, though most patients are still swab-positive on day 6 and many until day 14, with <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794884?guestAccessKey=cbdbd993-8149-4810-a404-3775468c8b97&utm_source=silverchair&utm_campaign=jama_network&utm_content=covid_weekly_highlights&utm_medium=email" target="_blank">at least half</a> of swab-positives carrying culturable, infectious virus. <a href="https://www.infectioncontroltoday.com/view/cdc-radically-cuts-covid-19-guidelines-right-school-year-begins-not-all-experts-approve" target="_blank">Deborah Birx</a> is among those blasting the new guidelines. </p><p>Rochelle Walensky herself <a href="https://www.nytimes.com/2022/08/17/us/politics/cdc-rochelle-walensky-covid.html?campaign_id=2&emc=edit_th_20220817&instance_id=69598&nl=todaysheadlines&regi_id=19728476&segment_id=101693&user_id=d89c7002526915cc9287fae06e27a284" target="_blank">now admits</a> that the agency she leads has done miserably in handling the pandemic and is recommending a major <a href="https://www.statnews.com/2022/08/17/cdc-ambitious-overhaul-covid-missteps/" target="_blank">overhaul</a>. Experts <a href="https://www.nytimes.com/2022/08/24/opinion/cdc-reorganization-covid-monkeypox.html?campaign_id=2&emc=edit_th_20220824&instance_id=70176&nl=todaysheadlines&regi_id=19728476&segment_id=102303&user_id=d89c7002526915cc9287fae06e27a284" target="_blank">approve</a>. I’ve always thought she wasn’t up to the task. </p><p><br /></p><p><b>After the ball is over?</b></p><p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjq8WKgRgjmHQrsx4rW3K30HgPmc_PEGjqFHMvUnbSpXDE1b9_1JajAg-4Cu21l0afHZet2NDkTo90VxFNxtpjAgsVtOp2rQEZMUyPWPpNmSduTPTosps6L4eG0ETfqFGwUCdznsJf1MwwtlcKL_ywIwW-b_6ydrR0Mt4dRP_W374bmj5jfoeM2egku/s1024/home%20test.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="667" data-original-width="1024" height="260" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjq8WKgRgjmHQrsx4rW3K30HgPmc_PEGjqFHMvUnbSpXDE1b9_1JajAg-4Cu21l0afHZet2NDkTo90VxFNxtpjAgsVtOp2rQEZMUyPWPpNmSduTPTosps6L4eG0ETfqFGwUCdznsJf1MwwtlcKL_ywIwW-b_6ydrR0Mt4dRP_W374bmj5jfoeM2egku/w400-h260/home%20test.jpeg" width="400" /></a></div><br /><p></p><p>Just as the FDA is telling people it’s crucial to do <a href="https://www.npr.org/2022/08/11/1117060962/covid-19-home-tests-fda" target="_blank">lots of home testing</a>, the US government program that sends everybody 16 free tests a month <a href="https://www.covid.gov/tests" target="_blank">is ending</a> because Congress isn’t willing to allocate the funds.</p><p>Speaking of testing, a study finding that more than half of people who’ve had Omicron <a href="https://www.newscientist.com/article/2334227-more-than-half-of-people-infected-with-omicron-may-not-know-it/" target="_blank">didn’t know</a> they had COVID-19 has gotten lots of press. They supposedly thought they just had a cold. But come on already, don’t people know by now that a “cold” can be COVID-19 and that they should test whenever they get upper respiratory symptoms? Failure to test – which is often done to avoid seeing a positive result – means failure to protect others. COVID-19, even with mild symptoms that last only a few days, can be transmitted to people who may get much sicker or develop long COVID.</p><p>Was there really a period in late August when <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?facet=none&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=false&Color+by+test+positivity=false&country=~GBR" target="_blank">nobody in the UK</a> was dying of COVID-19? That’s what the official stats said for a few days. Now, though, I see they’ve <a href="https://www.google.com/search?q=uk+covid&rlz=1C5CHFA_enIT906IT906&oq=uk+covid&aqs=chrome..69i57j0i512l9.3083j0j4&sourceid=chrome&ie=UTF-8" target="_blank">taken it back</a> and admitted the numbers were far from zero. What I suspect is that the authorities were momentarily and perhaps deliberately misattributing this summer’s <a href="https://theconversation.com/summer-2022-saw-thousands-of-excess-deaths-in-england-and-wales-heres-why-that-might-be-189351" target="_blank">huge excess mortality</a> to other causes.</p><p><br /></p><p><b>Vaccine hooey</b></p><p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjChKcI8Ht2jY4sL4qavE-sD2Q1o13KUUi0o1Y8jCW7xGzFdr1SXyMu5TnitVSb0fWXbUweiw669FvoLGMlDViQD4VwAaTpljb9_XcYo3iRRWa0Bby4UC5kWEp8gOPuTAz0uF2CfwKTL_R3MoWd64LQAc6lldR-Ct39dozbYWPDnZnO7p4rvkiNpc9x/s1680/Tucker%20Carlson.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="954" data-original-width="1680" height="228" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjChKcI8Ht2jY4sL4qavE-sD2Q1o13KUUi0o1Y8jCW7xGzFdr1SXyMu5TnitVSb0fWXbUweiw669FvoLGMlDViQD4VwAaTpljb9_XcYo3iRRWa0Bby4UC5kWEp8gOPuTAz0uF2CfwKTL_R3MoWd64LQAc6lldR-Ct39dozbYWPDnZnO7p4rvkiNpc9x/w400-h228/Tucker%20Carlson.png" width="400" /></a></div><br /><p></p><p>In April 2022 the journal Food and Chemical Toxicology – <a href="https://retractionwatch.com/2013/11/28/controversial-seralini-gmo-rats-paper-to-be-retracted/" target="_blank">already known</a> for publishing fake research – brought out an article by known COVID-19 <a href="https://forbetterscience.com/2022/04/20/elsevier-pandemic-profiteering-again/" target="_blank">misinformation-mongers</a> with the (deliberately obfuscating?) title, “Innate immune suppression by SARS-CoV-2 mRNA vaccinations: The role of G-quadruplexes, exosomes, and MicroRNAs.” Its conclusion? “Billions of lives are potentially at risk” from mRNA vaccines. The article, which has been <a href="https://plu.mx/plum/a/?doi=10.1016/j.fct.2022.113008&theme=plum-sciencedirect-theme&hideUsage=true" target="_blank">shared 45,000 times</a> on social media, is <a href="https://forbetterscience.com/2022/04/20/elsevier-pandemic-profiteering-again/" target="_blank">complete nonsense</a>, as carefully documented by a group of scientists who asked in a <a href="https://osf.io/m58yh/" target="_blank">Letter to the Editor</a> that the article be retracted. FCT refused to publish the scientists’ letter, and the article didn’t just remain in that obscure journal but got publicized by none other than <a href="https://archive.ph/Rlbom" target="_blank">Tucker Carlson</a>.</p><p>More: Texas state Senator Bob Hall <a href="https://apnews.com/article/fact-check-covid-vaccines-animal-studies-947974839488" target="_blank">claimed last year</a> that “they actually started the animal tests and because the animals were dying, they stopped the tests.” Sorry I missed this pearl at the time!</p><p>Still more: According to widely-circulated conspiracy theories, between <a href="https://www.clarkcountytoday.com/news/fda-knew-huge-percentage-of-women-in-pfizer-trial-suffered-miscarriages/" target="_blank">44%</a> and <a href="https://apnews.com/article/fact-checking-950821598874" target="_blank">97%</a> of pregnant women who received the Pfizer vaccine had miscarriages. The number is actually <a href="https://apnews.com/article/fact-checking-950821598874" target="_blank">about 10%</a>, if anything <i>less</i> than <a href="https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298" target="_blank">what’s expected</a> for all pregnancies.</p><p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2OMkg-zdbPTRQ_RsXUcP6m5byG_HSEc0mVEzzrV6nhRTdBJGC0KBJHAciIzvC3q-Loux21jrRSWd7O-b8qMBFHHUgCvXJqYXSMFC_5SKNoJ3E6nZRKqKIq3Z70h2G5oYtDgzWEb-iOv2McRj-xfc0NCpUWUwfbzQSJXvLXXYRl2zPa89AYvMA4wwI/s432/paul%20marik.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="244" data-original-width="432" height="181" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2OMkg-zdbPTRQ_RsXUcP6m5byG_HSEc0mVEzzrV6nhRTdBJGC0KBJHAciIzvC3q-Loux21jrRSWd7O-b8qMBFHHUgCvXJqYXSMFC_5SKNoJ3E6nZRKqKIq3Z70h2G5oYtDgzWEb-iOv2McRj-xfc0NCpUWUwfbzQSJXvLXXYRl2zPa89AYvMA4wwI/s320/paul%20marik.png" width="320" /></a></div><br /><p></p><p>Obsessive readers of this blog may remember the notorious <a href="https://covid19criticalcare.com/covid-19-protocols/i-mask-plus-protocol/" target="_blank">ivermectin-mongering</a> physician Paul Marik, whose chief research paper was withdrawn after it turned out he’d faked the statistics. Some months ago he prudently <a href="https://covid19criticalcare.com/wp-content/uploads/2022/01/FLCCC-Statement-Marik-EVMS-FINAL-1-4-22.pdf" target="_blank">resigned</a> from his teaching position at the East Virginia Medical School before getting the inevitable boot, and now there’s even better news: he’s <a href="https://www.medpagetoday.com/special-reports/exclusives/99592?xid=nl_mpt_DHE_2022-07-06&eun=g1849131d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Evening%202022-07-06&utm_term=NL_Daily_DHE_dual-gmail-definition" target="_blank">no longer licensed</a> to practice medicine.</p><div><br /></div><p><br /><br /></p></div>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com0tag:blogger.com,1999:blog-6211405954943098401.post-19780862479425772722022-07-31T18:00:00.001+02:002022-07-31T18:50:13.684+02:00Vaccines And Coffin Nails<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdPeLJNX1rqUXrVD32DLMpOSq4DS1WNURuPpwuSOsUDA1xVyRlkqeHoVQtgjkZgF2Ijj_rKjo60mzyQaYxqpo_-gNLyoOzjZJOKqk0_Z_Nt4d0YTWemS8B3OFRZze1Ypd5NjDMCVgx-n2jpl2IwEa504k-iHgDarmrNsOtbYffZKdkMqa1Zn8_oCIs/s568/nails%20in%20coffin.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="568" data-original-width="340" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdPeLJNX1rqUXrVD32DLMpOSq4DS1WNURuPpwuSOsUDA1xVyRlkqeHoVQtgjkZgF2Ijj_rKjo60mzyQaYxqpo_-gNLyoOzjZJOKqk0_Z_Nt4d0YTWemS8B3OFRZze1Ypd5NjDMCVgx-n2jpl2IwEa504k-iHgDarmrNsOtbYffZKdkMqa1Zn8_oCIs/w241-h400/nails%20in%20coffin.jpg" width="241" /></a></div><style class="WebKit-mso-list-quirks-style">
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mso-bidi-theme-font:major-bidi;
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mso-themecolor:accent1;
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mso-bidi-theme-font:major-bidi;
color:#4472C4;
mso-themecolor:accent1;
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span.Heading4Char
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mso-fareast-theme-font:major-fareast;
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mso-bidi-theme-font:major-bidi;
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mso-themecolor:accent1;
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font-style:italic;}
span.Heading5Char
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mso-style-locked:yes;
mso-style-link:"Heading 5";
font-family:"Calibri Light",sans-serif;
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mso-fareast-theme-font:major-fareast;
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mso-hansi-theme-font:major-latin;
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mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
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{mso-style-name:text;
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mso-style-qformat:yes;
mso-style-parent:"Plain Text";
margin-top:0in;
margin-right:0in;
margin-bottom:10.0pt;
margin-left:0in;
line-height:150%;
mso-pagination:widow-orphan;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
span.PlainTextChar
{mso-style-name:"Plain Text Char";
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Plain Text";
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mso-fareast-theme-font:minor-fareast;
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{mso-style-name:Heading;
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mso-style-qformat:yes;
mso-style-parent:"Heading 1";
margin-top:12.0pt;
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margin-bottom:12.0pt;
margin-left:0in;
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{mso-style-name:quotes;
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mso-style-parent:"Plain Text";
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
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span.BalloonTextChar
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mso-style-priority:99;
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{mso-style-name:"quotes headline";
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mso-style-qformat:yes;
mso-style-parent:quotes;
mso-style-next:quotes;
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margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
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span.exldetailsdisplayval
{mso-style-name:exldetailsdisplayval;
mso-style-unhide:no;}
span.CommentTextChar
{mso-style-name:"Comment Text Char";
mso-style-priority:99;
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mso-style-locked:yes;
mso-style-link:"Comment Text";
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mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.apple-converted-space
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mso-style-unhide:no;}
p.css-exrw3m, li.css-exrw3m, div.css-exrw3m
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mso-style-unhide:no;
mso-margin-top-alt:auto;
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margin-left:0in;
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span.3m6-
{mso-style-name:_3m6-;
mso-style-unhide:no;}
span.3l3x
{mso-style-name:_3l3x;
mso-style-unhide:no;}
span.1lh7
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mso-style-unhide:no;}
span.1lld
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mso-style-unhide:no;}
p.6coj, li.6coj, div.6coj
{mso-style-name:_6coj;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.6cok
{mso-style-name:_6cok;
mso-style-unhide:no;}
span.timestampcontent
{mso-style-name:timestampcontent;
mso-style-unhide:no;}
span.mbtext
{mso-style-name:mb_text;
mso-style-unhide:no;}
span.HeaderChar
{mso-style-name:"Header Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Header;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.FooterChar
{mso-style-name:"Footer Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Footer;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.5uzb
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span.accessibleelem
{mso-style-name:accessible_elem;
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span.z-TopofFormChar
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mso-style-link:"z-Top of Form";
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display:none;
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margin-left:0in;
mso-pagination:widow-orphan;
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span.z-BottomofFormChar
{mso-style-name:"z-Bottom of Form Char";
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mso-hide:all;}
p.css-axufdj, li.css-axufdj, div.css-axufdj
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mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.style-scope
{mso-style-name:style-scope;
mso-style-unhide:no;}
p.generic-articlesummary--li, li.generic-articlesummary--li, div.generic-articlesummary--li
{mso-style-name:generic-article__summary--li;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.diamond-blt, li.diamond-blt, div.diamond-blt
{mso-style-name:diamond-blt;
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mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.font-copy, li.font-copy, div.font-copy
{mso-style-name:font-copy;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.dogb1923
{mso-style-name:dogb1923;
mso-style-unhide:no;}
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{mso-style-type:export-only;
mso-default-props:yes;
font-family:"Calibri",sans-serif;
mso-ascii-font-family:Calibri;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:Calibri;
mso-fareast-theme-font:minor-latin;
mso-hansi-font-family:Calibri;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;
mso-header-margin:.5in;
mso-footer-margin:.5in;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
/* List Definitions */
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text-indent:-.25in;
font-family:Symbol;}
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font-family:"Courier New";
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{mso-level-number-format:bullet;
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{mso-level-number-format:bullet;
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{mso-level-number-format:bullet;
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{mso-level-number-format:bullet;
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{mso-level-number-format:bullet;
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{mso-level-number-format:bullet;
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{mso-level-number-format:bullet;
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{mso-level-number-format:bullet;
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font-family:Symbol;}
@list l3
{mso-list-id:180240054;
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mso-list-template-ids:-406915396 1833337546 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
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text-indent:-.25in;}
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text-indent:-9.0pt;}
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text-indent:-.25in;}
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{mso-level-number-format:alpha-lower;
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</style><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Vaccines new and old, bicontinental journalistic flops, this “post-pandemic?” world, long COVID, vaccine profits, Presidential COVID-19, and a touch of madness.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Treatment news<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f"><v:stroke joinstyle="miter"><v:formulas><v:f eqn="if lineDrawn pixelLineWidth 0"><v:f eqn="sum @0 1 0"><v:f eqn="sum 0 0 @1"><v:f eqn="prod @2 1 2"><v:f eqn="prod @3 21600 pixelWidth"><v:f eqn="prod @3 21600 pixelHeight"><v:f eqn="sum @0 0 1"><v:f eqn="prod @6 1 2"><v:f eqn="prod @7 21600 pixelWidth"><v:f eqn="sum @8 21600 0"><v:f eqn="prod @7 21600 pixelHeight"><v:f eqn="sum @10 21600 0"></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:formulas><v:path gradientshapeok="t" o:connecttype="rect" o:extrusionok="f"><o:lock aspectratio="t" v:ext="edit"></o:lock></v:path></v:stroke></v:shapetype><v:shape id="Picture_x0020_668" o:spid="_x0000_i1034" style="height: 178pt; visibility: visible; width: 178pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image001.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzqdvCyi3pzPutwmg15sB-UBrOKRa1n_zl9vI3ndKKQcbZu4VNVxM7zHKV88rSlHM_4K1ZUI2ueHtPDB7ZXNdBi4akSwiVARDPIpKSKxU_7_LpbXHHd2NdRboW5CNJbfFiEx-DQ4nN64KPmlMshi8A06kaxHWmnKD03OhUYOL7HnASZ5UnIQwc_PPD/s1000/fluimucil.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1000" data-original-width="1000" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzqdvCyi3pzPutwmg15sB-UBrOKRa1n_zl9vI3ndKKQcbZu4VNVxM7zHKV88rSlHM_4K1ZUI2ueHtPDB7ZXNdBi4akSwiVARDPIpKSKxU_7_LpbXHHd2NdRboW5CNJbfFiEx-DQ4nN64KPmlMshi8A06kaxHWmnKD03OhUYOL7HnASZ5UnIQwc_PPD/w200-h200/fluimucil.jpg" width="200" /></a></div><u><br /></u><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>N-acetylcysteine</u>: The armamentarium of medications to treat severe COVID-19 continues to expand. After sabizabulin, mentioned in my last post, now we have a high-tech version of acetylcysteine, a decades-old expectorant that in the US is mostly squirted down the tubes of patients on respirators but elsewhere is commonly ingested in liquid form – in Italy one brand name is Fluimucil – for cough. Acetylcysteine can also be lifesaving for paracetamol (acetaminophen) overdose. People have been <a href="https://www.futuremedicine.com/doi/10.2217/fmb-2020-0074">proposing it</a> as a possible COVID-19 treatment since early in the pandemic, and now there is some concrete support from a tiny but placebo-controlled and randomized <a href="https://www.science.org/doi/10.1126/scitranslmed.abo2652">study</a> in severely ill hospitalized patients, accepted for publication in a high-level journal. Patients were given a single intravenous infusion of either placebo or an acetylcysteine/dendrimer compound specially designed to bind to activated macrophages (inflammatory white blood cells). Inflammatory markers in the blood of drug-treated patients began to fall within days, and 2 months later 3 out of 17 of them were dead, compared with 4 out of 7 placebo patients. This was only a Phase 2 pilot study; hopefully the results will hold up in a larger Phase 3 trial.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Natural immunity</u>: According to a <a href="https://www.medrxiv.org/content/10.1101/2022.07.11.22277448v1.full.pdf">prepublished study</a> from Qatar, having been infected with Delta or earlier variants gives virtually no protection (we’re talking 15%) from symptomatic infection with the Omicron BA.4 and BA.5 subvariants. Having had earlier versions of Omicron did provide some immunity against 4 and 5, but only 76%, meaning that plenty of people infected during the giant winter surge are susceptible to reinfection. Too few cases were involved to analyze how long natural immunity lasted or how effective it was against severe disease or death.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Post-Paxlovid rebound</u>: I recommend an <a href="https://insidemedicine.bulletin.com/president-biden-has-paxlovid-rebound-here-s-what-you-need-to-know">excellent article</a> by Jeremy Faust, where he guesstimates from personal observation that it’s occurring in not 1-2%, not even 5-6%, but 15-35% of people who take Paxlovid. In his opinion the main reason is that the drug may function differently in people who have been vaccinated (the original trials were done in unvaccinated patients), while also suggesting the recent variants may have better comeback abilities and we may be treating people too early. He emphasizes the risk of spreading contagion, and the need to extend the patient’s isolation period. He says young healthy patients have been taking Paxlovid in the US. I didn’t know this, and it’s a bad thing – we have <a href="https://www.researchsquare.com/article/rs-1705061/v1">evidence</a> that the drug gives people under 60 virtually no benefit. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Vaccine news<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_701" o:spid="_x0000_i1033" style="height: 307pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image002.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-29JVBMzE7X4_o_JkOJI7Z01yypfv-mwE7Nc2R7Hrsfja93WHopJfpPEwaErsSxlkPr9gkS19gBegf0ubfDe1qgObDfNH6OgefzhEw0pPp5DYamC0qxLZK68oO1aaVM7ufchIpUwuoB18P3AclkHH6n4nW7bugXAS-mLI9IVmAnEz4bYitb7VV-3Z/s1200/Patricia%20Neves%20and%20Ana%20Paula%20Ano.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="812" data-original-width="1200" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-29JVBMzE7X4_o_JkOJI7Z01yypfv-mwE7Nc2R7Hrsfja93WHopJfpPEwaErsSxlkPr9gkS19gBegf0ubfDe1qgObDfNH6OgefzhEw0pPp5DYamC0qxLZK68oO1aaVM7ufchIpUwuoB18P3AclkHH6n4nW7bugXAS-mLI9IVmAnEz4bYitb7VV-3Z/s320/Patricia%20Neves%20and%20Ana%20Paula%20Ano.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Patricia Neves and Ana Paula Ano</td></tr></tbody></table><br /><u><br /></u><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Girl stuff</u>: A pair of 40-something female Brazilian scientists who happen to be best friends <a href="https://www.npr.org/sections/goatsandsoda/2022/07/13/1111137152/these-brazilian-besties-are-inventing-an-mrna-vaccine-as-a-gift-to-the-world?sc=18&f=1001">are working on</a> a new kind of mRNA vaccine that will be self-amplifying, thus requiring only a minuscule amount of raw material and making the vaccine cheap and convenient for the developing world. Even cheaper because the team plans to provide the recipe to the world free of charge – something the big players, Moderna and Pfizer, have steadfastly refused to do. Human trials won’t even reach Phase 1 for months, though, and this vaccine will likely face the same storage and distribution barriers as its competitors. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Novavax</u>: After what seemed like an endless gestation, Novavax is born, achieving <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-emergency-use-novavax-covid-19-vaccine-adjuvanted">FDA authorization</a> for emergency use in the USA as a two-dose primary series based on 90% efficacy against the wild strain of SARS-CoV-2. <a href="https://www.forbes.com/sites/brianbushard/2022/07/11/us-secures-32-million-novavax-covid-vaccines---offering-alternative-to-mrna-shots-as-new-variant-spreads/?sh=2c828113593d">Some fantasize</a> that its conventional technology will win over many of that <a href="https://www.apmresearchlab.org/covid/vaccine-progress">10% of American adults</a> who are hard-core antivaxxers. As I’ve said before, I doubt it – <a href="https://www.cnbc.com/2022/07/15/why-new-novavax-covid-vaccine-wont-win-over-unvaccinated-americans.html">with others</a> – and suspect its chief value may be as a booster to mRNA vaccines. The good news is that a third dose of Novavax given to some trial participants 8 months after the second one <a href="https://newatlas.com/science/novavax-covid19-vaccine-omicron-booster/">seems to have induced</a> neutralizing antibodies against Omicron BA.5. The bad news is that, like the mRNA vaccines, Novavax can probably cause both <a href="https://www.cidrap.umn.edu/news-perspective/2022/06/fda-novavax-covid-vaccine-effective-cardiac-questions-remain">myocarditis and pericarditis</a>, though the company plays down the risk. According to the <a href="https://www.fda.gov/media/158912/download">FDA’s briefing document</a>, 4 of the 5 cases within 10 days of a dose were in male volunteers younger than 30, though no denominator is provided. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>A double bill from Moderna</u>: I said last time that Pfizer has a fall 2022 booster in either hand. Now <a href="https://www.medscape.com/viewarticle/976900?">Moderna does too</a>. Both are bivalent and are composed of spike protein mRNA half from the wild strain and half from Omicron. The first is their original candidate, now called mRNA-1273.214, which is made with with Omicron BA.1 but also spurs neutralizing antibodies against BA.4 and BA.5. The other, mRNA 1273.222, uses BA.4-5-strain mRNA instead and hasn’t yet been fully tested.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Pfizer dose 4</u>: In 48 healthy older Israelis, anti-spike IgG <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794465">antibody levels soared</a> after a second booster, going from 3775 to 28,708, about the same peak level as after the first booster 5 months earlier. The researchers didn’t measure neutralizing antibodies. We don’t know how quickly those levels fall, though we do know that protection against infection only lasts 4-6 weeks.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Schoolkids</u>: A <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2203209?query=featured_home">study from Singapore</a> confirms good protection from vaccination with Pfizer in 5-11-year-olds. But, as in Israel, it waned fast. The vaccine was 70% effective against PCR-confirmed infection 7-14 days after the second dose, but by 30-59 days its effect had already fallen to 60%, and 60+ days after dose two it was just 43%. Protection against hospitalization was over 80% for 2 months, with no longer-term data. About 40% of American children in this age group have been vaccinated – for once <a href="https://lab24.ilsole24ore.com/numeri-vaccini-italia-mondo/">similar to Italy</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Little kids</u>: The vaccination campaign for children under 5 continues to lag far behind expectations in the US, with only <a href="https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-july-2022/">17% of parents</a> of children under 5 saying they’ve either vaccinated their kid already or intend to soon – down from 31% in January. And 43% say they definitely never will. No vaccines have been approved for this age group in Italy.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Boost now or wait?</u>: Everybody’s asking me whether to get a second booster now or wait until the fall when Omicron-specific ones will come out. Neither I <a href="https://www.medicalnewstoday.com/articles/should-i-get-a-covid-19-booster-now-or-wait-experts-answer-key-questions">nor anyone else</a> has had definitive answers, but since by now we’re only two months away from the arrival of the anti-Omicron boosters in <a href="https://www.ema.europa.eu/en/news/ecdc-ema-update-recommendations-additional-booster-doses-mrna-covid-19-vaccines">Europe</a>, including <a href="https://tg24.sky.it/salute-e-benessere/2022/07/12/covid-nuovo-vaccino-omicron#07">Italy</a>, even less in the <a href="https://www.washingtonpost.com/health/2022/07/22/booster-shots-coronavirus-under-50/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F377439f%2F62dbc6cacfe8a2160100858c%2F599d6acbae7e8a3d46e1400f%2F16%2F59%2F62dbc6cacfe8a2160100858c&wp_cu=24fe7fdaf3a5ae7a2be4e63a62e47d7a%7Ca33d67be-fe27-11e0-b478-12313d08a5d6">US</a>, I’ve changed my mind and just say no… What <b><i>is</i></b> clear is that the <a href="https://www.nytimes.com/interactive/2020/us/covid-19-vaccine-doses.html">two-thirds of Americans</a> 18-64, the third of Americans over 65, and the <a href="https://lab24.ilsole24ore.com/numeri-vaccini-italia-mondo/">third of Italians</a> 20-50 who haven’t gotten <b><i>any</i></b> booster should go grab one now, since without it even the “fully vaccinated” are unprotected against Omicron of whatever flavor. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Worst headline of the month, as </b><a href="https://twitter.com/drericding/status/1547398772191334402?s=11&t=whqEZ42DKwUSPZR4tTCsKA"><b>tweeted</b></a><b> by Eric Feigl-Ding <o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_702" o:spid="_x0000_i1032" style="height: 435pt; visibility: visible; width: 292pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image003.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh73GE2GB9Dk80uqTeS9BegUI6LsVam2hJysIh8_jm21lN5yNQ0AvWtHmg2xBuO7SRCGgmacN6fWY9kRoZ_RRAb2RdvgtPN34qIQECq_aePVjK3Aj2UHu72odDkPH_cjsAwB6rW2w4XPKoi-1LFOcKld9m5WE-iLuqHScSik3X2Yk1lPel9D_REUdZH/s1482/brain%20fog%20a%20mercy.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1482" data-original-width="996" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh73GE2GB9Dk80uqTeS9BegUI6LsVam2hJysIh8_jm21lN5yNQ0AvWtHmg2xBuO7SRCGgmacN6fWY9kRoZ_RRAb2RdvgtPN34qIQECq_aePVjK3Aj2UHu72odDkPH_cjsAwB6rW2w4XPKoi-1LFOcKld9m5WE-iLuqHScSik3X2Yk1lPel9D_REUdZH/w269-h400/brain%20fog%20a%20mercy.jpg" width="269" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">What was the LA Times thinking when they plastered this headline on Mary McNamara’s piece? Fortunately they changed it within days to “Covid was my vacation souvenir. <a href="https://www.latimes.com/entertainment-arts/story/2022-07-12/column-covid-brain-fog-is-real-and-its-a-mercy">The brain fog is all too real</a>.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Post-pandemic<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_703" o:spid="_x0000_i1031" style="height: 233pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image004.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnA5xMvHMHYqSjHw9TAY4c_KkxaLp20dfLdCmGmK99SQK1eWygTjHWwidDH2Wpv7GFizkC-tVFNgWpun1BbZ9iuDaYKyn8Bi3MGma0oDP-HarEa9W3fU17w0Z8o0FutDwczzMop06xETrI7JLihl4scuYHxr3PYLTudfpWCTFh_pxyhqQTSzeDoCcs/s1016/tweet%20on%20covid%20patients%20in%20stores.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="522" data-original-width="1016" height="164" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnA5xMvHMHYqSjHw9TAY4c_KkxaLp20dfLdCmGmK99SQK1eWygTjHWwidDH2Wpv7GFizkC-tVFNgWpun1BbZ9iuDaYKyn8Bi3MGma0oDP-HarEa9W3fU17w0Z8o0FutDwczzMop06xETrI7JLihl4scuYHxr3PYLTudfpWCTFh_pxyhqQTSzeDoCcs/s320/tweet%20on%20covid%20patients%20in%20stores.jpg" width="320" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">While much of the Western world is making like it’s 2019, the coronavirus has other ideas. To the point that WHO chief Tedros Adhanom Ghebreyesus has felt it necessary to scream danger from the rooftops, <a href="https://www.washingtonpost.com/health/2022/07/13/covid-pandemic-wave-who-ba5-variants/">warning people</a> that “The virus is running freely,” “covid-19 is nowhere near over,” and urging expansion of testing, vaccination (especially boosters), and treatment.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Expansion ain’t happening, though, on the contrary. Dedicated COVID-19 funding is in the process of running out in the US, Italian emergency services are long past the crisis point, one out of 17 people in the UK had COVID-19 during the week ending July 7<sup>th</sup>, and <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?time=2022-01-14..latest&facet=none&uniformYAxis=0&Metric=Hospital+patients&Interval=Cumulative&Relative+to+Population=true&Color+by+test+positivity=false&country=USA~ITA~GBR~FRA~AUT~AUS">hospitalizations are soaring</a> in virtually all countries that provide data. In Italy, a leader in vaccinations, the booster campaign has <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?time=2021-10-02..2022-07-11&facet=none&uniformYAxis=0&Metric=Vaccine+booster+doses&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=~ITA">slowed down dramatically</a> in the last 4 months even though more than a third of adults still haven’t had one. The message doesn’t seem to have sunk in that Omicron brushes off two doses like flies.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">In the US, I consider Rochelle Walensky’s CDC <a href="https://twitter.com/erictopol/status/1545449245028716544?s=11&t=DGnKPwCVF5pf2xZae3jaiQ">missing in action</a> in the face of <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?time=2022-03-07..latest&uniformYAxis=0&Metric=Cases%2C+hospital+admissions%2C+ICU+patients%2C+and+deaths&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=~USA">surging</a> COVID-19 cases, hospital admissions, ICU occupancy, and now deaths. Somebody in the Biden administration must agree, if they’re reorganizing the Department of Health and Human Services to elevate the <a href="https://www.washingtonpost.com/health/2022/07/20/biden-administration-aspr-independent-division/">Administration of Strategic Preparedness and Response</a> to an independent agency at the level of the CDC and the FDA and having it lead America’s battle against the pandemic.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I must say that Italy isn’t doing any better, with <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?time=2022-03-07..latest&uniformYAxis=0&Metric=Cases%2C+hospital+admissions%2C+ICU+patients%2C+and+deaths&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~USA">just as many deaths</a> per capita as the US even though nearly <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?time=2022-01-14..latest&facet=none&uniformYAxis=0&Metric=Vaccine+booster+doses&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~USA">twice as many people</a> have had vaccine boosters; wider use of antivirals in the US may be what’s saving those lives. And the situation in Italy’s hospitals is dire. I’m damned if I can understand how official figures can claim that on July 19<sup>th</sup>only 16.7% of available COVID-19 beds and 7.5% of available COVID-19 ICU beds in the Lazio region were <a href="https://lab.gedidigital.it/gedi-visual/2020/coronavirus-in-italia/">occupied</a>, when on the very same day La Repubblica reported (Cronaca di Roma, p. 4) that more than 70 patients were parked in the Emergency Room of each of Rome’s largest hospitals waiting for a bed, and that <b><i>all</i></b> 850 of the COVID-19 beds that have been opened up in the last 2 weeks were occupied. A week earlier, according to the same newspaper, 55 ambulances were sitting outside ER doors and more than 100 emergency calls for ambulances were being totally ignored every day. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Long COVID updates<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_708" o:spid="_x0000_i1030" style="height: 170pt; visibility: visible; width: 301pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image005.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNpl98tI464DQvq1AcW8T8eYEbN9qhYfaHmD6xEVf8fCu2HyuNqU5-dsZe-KoBUTswhlGOXmnT_VqHKa508jPgRoQU6uAuLyB6F1m-_-a3YKEKVPk0KeKgLfTzusNcE_SLvA6JUkgAGScXL85zamlTC0qiBXNZmNWzifeIYk30oLdG7IQ0ablWennp/s1280/apheresis%20machine.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNpl98tI464DQvq1AcW8T8eYEbN9qhYfaHmD6xEVf8fCu2HyuNqU5-dsZe-KoBUTswhlGOXmnT_VqHKa508jPgRoQU6uAuLyB6F1m-_-a3YKEKVPk0KeKgLfTzusNcE_SLvA6JUkgAGScXL85zamlTC0qiBXNZmNWzifeIYk30oLdG7IQ0ablWennp/w400-h225/apheresis%20machine.jpg" width="400" /></a></div><br /><u><br /></u><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Prevalence</u>: An <a href="https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(22)00321-4/fulltext">American study</a> following 173 patients after COVID-19 they contracted during the first wave found that half of them still had at least one symptom a year later, most commonly fatigue and/or shortness of breath, and one in 4 still had symptoms 2 years later. Patients who had been hospitalized were only slightly more likely to have persistent symptoms at 12 months (53% vs. 48%). These figures seem dire, but there’s a catch: 500 patients were invited to participate, but two-thirds declined. The researchers don’t specify exactly what they told the patients, or how the participant and non-participant groups compared, but it seems to me likely that people would be more likely to agree to be interviewed if they had long COVID. It is also unclear how relevant a study of patients from the pre-vaccine, pre-variant era is to the current phase of the pandemic.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://www.nature.com/articles/s41591-022-01837-9">UK researchers</a> using in-depth cardiac evaluations found that more than half of patients hospitalized for COVID-19 had evidence of myocarditis one-two months after discharge, one in 5 had scarring of the heart muscle, and many had persistent kidney malfunction and signs of inflammation. The brief follow-up in this study is a major limitation, as are two characteristics shared with the American one: difficulty recruiting participants and completion relatively early in the pandemic.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Origins</u>: According to an interesting <a href="https://www.medrxiv.org/content/10.1101/2022.06.14.22276401v1.full.pdf">new preprint,</a> intact spike protein could be detected in the blood of 60% of 37 COVID-19 patients who continued to have symptoms 3 to 12 months later, but in none of 26 patients whose acute disease resolved within weeks. A few patients were carrying other bits of virus in their blood as well. The researchers think their findings support the hypothesis that persistent live virus is at the root of at least some cases of long COVID. They also thought the spike protein itself might be directly causing symptoms, by overstimulating the immune system, but were unable to document this when they measured proinflammatory cytokines in the blood. The <a href="https://academic.oup.com/brain/advance-article/doi/10.1093/brain/awac151/6621999?searchresult=1&login=false">finding of immune complexes</a> in the autopsied brains of 9 people who died in the first COVID-19 wave may support the immune overstimulation theory.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Treatment</u>: Centers in <a href="https://beatejaeger.com/en/research/">Germany</a> and elsewhere have been offering long COVID sufferers apheresis, a form of blood cleansing intended to filter out microclots from the circulation, under the theory that small vessels clogged with tiny clots are at the root of long COVID symptoms. The leading practitioner, <a href="https://beatejaeger.com/en/research/">Dr. Beate Jaeger</a>, promises that “The good therapy results so far will soon be available as a study.” I find the microclot hypothesis convincing, and don’t rule out that her treatment may work, though certainly <a href="https://www.theguardian.com/society/2022/jul/12/thousands-seeking-unproven-long-covid-blood-treatments-abroad">not on everyone</a>. But I am concerned that Dr. Jaeger apparently <a href="https://www.bmj.com/content/378/bmj.o1671">told the BMJ</a> she had treated “thousands of patients,” while her website says “<a href="https://beatejaeger.com/en/research/">more than 100</a>.” And even more concerned that she isn’t testing her treatment in a controlled trial, claiming variously that it’s <a href="https://www.bmj.com/content/378/bmj.o1671">too expensive</a> and <a href="https://www.news-medical.net/news/20220713/Long-covid-patients-travel-abroad-seeking-for-unproven-blood-washing-treatment.aspx">that</a> “Trials take too long when the pandemic has left patients desperately ill.” But if it is true that, <a href="https://www.youtube.com/watch?v=h_LZSh9k-zU">as she claims</a>, her patients can go “From wheelchair to walking in just a few weeks” then a proper trial would only take a few months to complete. And I don’t honestly see why randomizing half her patients to a sham procedure would be so expensive. Some other apheresis centers are <a href="https://www.bmj.com/content/378/bmj.o1671">ethically questionable</a> – scientifically, too, since they <i>still</i> prescribe hydroxychloroquine for COVID-19!<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Vaccine effects</u>: Veterans Administration researchers have published <a href="https://www.nature.com/articles/s41591-022-01840-0">the latest study</a> finding that “breakthrough infections” in fully vaccinated people are only a bit likely to cause long COVID than infections in the unvaccinated. Six months after their infection, vaccinated patients were 25% less likely to have fatigue, 15% less likely to have cardiovascular problems, and 15% less likely to have <i>any</i> long COVID symptom. The only complications at substantially lower risk were pulmonary problems and clotting disorders. This study was done in January-October 2021, before Omicron, booster doses, or outpatient antiviral therapy, so it has limited relevance to the present phase of the pandemic. I was puzzled to see the first author of the study featuring in a misleading <a href="https://twitter.com/zalaly/status/1529494830820335617?s=12">Twitter thread</a> not the comparisons with unvaccinated COVID-19 patients but comparisons with a healthy uninfected population.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The vaccines that laid the golden eggs<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_709" o:spid="_x0000_i1029" style="height: 132pt; visibility: visible; width: 204pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image006.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjK4f16McZCpnQ31TGinIhQgYgpKJUsg7Adps7_rzIY7gnPuZhU8Ii-khsAtFAEcWmhgCUayJjD67yzC-keyaBKGF1p5dutj5xVDQkfx5y0I7RpCs61Refq013ctQv-61L7u2ctHSRiivon-nsm_xC-Fp7qZnRpsUk4Me3CSGLQPGuKJhG-ZAp4mYIw/s427/golden%20eggs.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="275" data-original-width="427" height="206" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjK4f16McZCpnQ31TGinIhQgYgpKJUsg7Adps7_rzIY7gnPuZhU8Ii-khsAtFAEcWmhgCUayJjD67yzC-keyaBKGF1p5dutj5xVDQkfx5y0I7RpCs61Refq013ctQv-61L7u2ctHSRiivon-nsm_xC-Fp7qZnRpsUk4Me3CSGLQPGuKJhG-ZAp4mYIw/s320/golden%20eggs.png" width="320" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Curious how much the vaccine-sellers have made off the pandemic? This will give you an idea: Pfizer, the company that gave us not only the first effective vaccine but also the first effective treatment, doubled their income in 2021 over 2020: <a href="https://www.pfizer.com/sites/default/files/investors/financial_reports/annual_reports/2021/performance/">$81<b> </b>vs. $41 billion gross, $22 vs. $9 billion net</a>. And that’s before Paxlovid came out – just imagine the prospects for 2022. Moderna closed 2021 with <a href="https://www.aljazeera.com/opinions/2022/3/16/modernas-profits-show-why-big-pharma-cant-meet-our-health-needs">similar profits</a> despite selling only <a href="https://www.amnesty.org/en/latest/news/2022/02/covid-19-pharmaceutical-companies-failure-on-equal-vaccine-access-contributed-human-rights-catastrophe-in-2021/">673 million doses to Pfizer’s 2.4 billion</a>, by charging higher prices and taking a 70% profit margin. <u><span style="color: #0563c1;"><o:p></o:p></span></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Science journalism Italian style<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_711" o:spid="_x0000_i1028" style="height: 361pt; visibility: visible; width: 271pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image007.png"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivsWR3QLrW47V06DhLGQn3Fi9gdFyhSNJinYL50cYcT_YtFGZeiF4azRIKFg4YDCDewS11wdj_ivUY9tVVNaigA9vZYOTBAhKx5973MVJwkwzffmbzMR9nTqkHSLCK04OY6aG05XD2zMxdhY6zV0MYVI3lZ1vfQqPnLbup7oDol6s_YqFD66e8sTbU/s791/giornalismo%20scientifico%20tabloid.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="791" data-original-width="594" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivsWR3QLrW47V06DhLGQn3Fi9gdFyhSNJinYL50cYcT_YtFGZeiF4azRIKFg4YDCDewS11wdj_ivUY9tVVNaigA9vZYOTBAhKx5973MVJwkwzffmbzMR9nTqkHSLCK04OY6aG05XD2zMxdhY6zV0MYVI3lZ1vfQqPnLbup7oDol6s_YqFD66e8sTbU/s320/giornalismo%20scientifico%20tabloid.png" width="240" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I was delighted the other day to see a <a href="https://www.ilmessaggero.it/salute/focus/omicron_5_cura_antivirali_funziona_cosa_sappiamo_dove_li_prescrivono-6805345.html">headline in Il Messaggero</a> about oral antivirals: “COVID, the antiviral weapon against the summer boom, ‘But they don’t prescribe it.’” The failure public system GPs to prescribe Paxlovid happens to be my current pet peeve. But reading further down I got even more peeved, at the journalist. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">She correctly points out that only 21,000 of the 600,000 available courses of Paxlovid have gone into patients. And she correctly blames the government for not telling GPs last April they could now prescribe the drug themselves instead of sending patients to the hospital. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">But she herself seems to be unaware of a vitally important <i>later</i> change in antiviral use: a vast <a href="https://www.aifa.gov.it/documents/20142/1269602/IT_Raccomandazioni_AIFA_gestione_domiciliare_COVID-19_Vers9_31.05.2022.pdf">expansion of eligibility</a>. From February to May, only people who were immunosuppressed or otherwise gravely ill could get antiviral treatment. As of June 1<sup>st</sup>, though, everybody who is at increased risk because of asthma, obesity (not “morbid obesity” as she writes), or other chronic illnesses, has a right to Paxlovid. Most crucially, the increased risk category now includes everybody 65 years and up!!! The government’s failure to inform GPs of this change is even deadlier than their omission back in April. The journalist had the opportunity to let older COVID-19 patients know they now have a right to effective treatment, and I consider her failure to do so criminal. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I have always said that science journalism is an unknown concept in Italy – with one knowledgeable local even <a href="https://www.coelum.com/articoli/sette-motivi-per-cui-il-giornalismo-scientifico-italiano-e-scadente">listing</a>“Seven reasons why Italian science journalism is poor.” This is the umpteenth proof.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">*<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Still talking lab leaks?<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_716" o:spid="_x0000_i1027" style="height: 326pt; visibility: visible; width: 357pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image008.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhI_BHIFgPwxkr8C7gOE2yXUh5K-mDQZKC_Pdb0iBn4mwSrREq32HhJg1y6GEJ095DEooH1enbjreDbzkL4mzyodzqkIBGMSxqEBoSyU9NSH9G_Di-vOS7ddlIVZyZTsJTSeoH87kFBNOlmb0v2vqUYHcpjoLZEmil4VtGNHW8WIAE2HiQjeilrcQiD/s1048/links%20to%20market.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="956" data-original-width="1048" height="366" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhI_BHIFgPwxkr8C7gOE2yXUh5K-mDQZKC_Pdb0iBn4mwSrREq32HhJg1y6GEJ095DEooH1enbjreDbzkL4mzyodzqkIBGMSxqEBoSyU9NSH9G_Di-vOS7ddlIVZyZTsJTSeoH87kFBNOlmb0v2vqUYHcpjoLZEmil4VtGNHW8WIAE2HiQjeilrcQiD/w400-h366/links%20to%20market.jpg" width="400" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">A pair of papers in Science, one based on analysis of the <a href="https://www.science.org/doi/10.1126/science.abp8337">SARS-CoV-2 genome</a> and the other on <a href="https://www.science.org/doi/10.1126/science.abp8715">analysis of cases and animals</a> at and around the Huanan Seafood Wholesale Market in Hunan, claim to have proven that the market was the source of the pandemic. This should be the final nail in the coffin of the theory that the pandemic originated in a virus that leaked from a Chinese laboratory. But given the insane politicization that pollutes everything related to the pandemic, <a href="https://www.washingtonpost.com/science/2022/07/26/coronavirus-origin-wuhan-market/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F377cb89%2F62e10cd8cfe8a2160109bceb%2F599d6acbae7e8a3d46e1400f%2F15%2F62%2F62e10cd8cfe8a2160109bceb&wp_cu=24fe7fdaf3a5ae7a2be4e63a62e47d7a%7Ca33d67be-fe27-11e0-b478-12313d08a5d6">that theory is unlikely to go away</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>A tale of two COVIDs<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_714" o:spid="_x0000_i1026" style="height: 151pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image009.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhypktAdu5HYAa-6lWYEg1I9Ov5f1sWLs4Nw1PaWmxpj4svlkETeo9HS6d9jpmAHj4dqHm70r6S3Dn07x_Hoe_xBPnmUOMDhhsi-SZEepjMpyJMqwvmNkT-hNOIyhtFer3PMSM0nd1XlnZal6pTlnZOU3VW_xP0w2Jp-nLoOjZJxKH57KAefB8woRm0/s1282/maskless%20Preses.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="426" data-original-width="1282" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhypktAdu5HYAa-6lWYEg1I9Ov5f1sWLs4Nw1PaWmxpj4svlkETeo9HS6d9jpmAHj4dqHm70r6S3Dn07x_Hoe_xBPnmUOMDhhsi-SZEepjMpyJMqwvmNkT-hNOIyhtFer3PMSM0nd1XlnZal6pTlnZOU3VW_xP0w2Jp-nLoOjZJxKH57KAefB8woRm0/w640-h213/maskless%20Preses.jpg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Trump tearing off mask, Biden in April</td></tr></tbody></table><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Both pandemic-era American Presidents have had COVID-19, and some of the <a href="https://insidemedicine.bulletin.com/a-tale-of-two-covids-president-biden-s-illness-means-something-very-different-than-trump-s-did">contrasts</a> in their cases are <a href="https://www.washingtonpost.com/politics/2022/07/21/bidens-covid-diagnosis-shows-benefits-avoiding-infection/">interesting</a>. The most obvious is the difference in severity, with Trump barely avoiding the ventilator and Biden sailing through with mild symptoms, at least at first – as I write his post-Paxlovid “rebound” has just been announced. It supposedly consists in just a positive antigen test, without any symptoms, but there’s no guarantee that will hold. Anthony Fauci, for instance, was sicker with “rebound” than he had been when he first fell ill, though he did escape hospitalization. Assuming Biden won’t follow in Fauci’s footsteps, one can only say thank you vaccines, thank you boosters, and thank you antivirals. Trump’s life may have been saved by monoclonal antibodies, but he would likely never gotten anywhere near as sick if Paxlovid pills had been available at the time.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The emphasis on how mild Biden’s symptoms are, how he’s <a href="https://apnews.com/article/biden-covid-teachable-moment-a3013aa63e6efa4d8130881f0f1b2329?user_email=d676e576422b62d91aabbaed723d51be10108f6f131c3d12fd1a13dc8aab8031&utm_source=Sailthru&utm_medium=email&utm_campaign=July22_MorningWire&utm_term=Morning%20Wire%20Subscribers">working long hours</a> despite his illness, etc., is a political choice, and it doesn’t necessarily send the best message. People should know that COVID-19, even of the Omicron variety, can make people quite sick, can cause long COVID, and should be avoided if possible. Far from being “just a flu,” Omicron has killed <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?time=earliest..2022-07-11&facet=none&uniformYAxis=0&Metric=Confirmed+deaths&Interval=Cumulative&Relative+to+Population=false&Color+by+test+positivity=false&country=~USA">about 200,000 Americans</a> thus far.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The poor guidance being provided by the CDC is also rightly <a href="https://www.washingtonpost.com/health/2022/07/21/biden-covid-return-to-normal-strategy/">being highlighted</a> by many experts. “For instance, the White House said Biden would remain in isolation until he tested negative for the virus, going beyond CDC guidance.” My own advice to patients goes even further: isolate for 10 days even if you’ve gone negative on an antigen swab. Antigen tests are notoriously poor at detecting Omicron, live virus has been detected in Omicron patients as long as 14 days after symptom onset, and rebound cases risk infecting others even if asymptomatic. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Much has also been made of the <a href="https://www.washingtonpost.com/politics/2022/07/21/bidens-covid-diagnosis-shows-benefits-avoiding-infection/">care Biden took</a> to avoid infection, in contrast with the notoriously mask-adverse Donald – particularly that anybody coming in contact with him had to test negative (including Mohammed Bin Salman?). But those tests are notoriously lousy, asymptomatic infections can be highly transmissible, and Biden himself has gotten sloppy about masks these days, not just <a href="https://www.washingtonpost.com/politics/2022/04/08/biden-pandemic-masks/">before his diagnosis</a> but also when he was supposed to still be <a href="https://www.bloomberg.com/news/articles/2022-07-28/biden-ditches-mask-at-meeting-despite-doctor-s-assurances">wearing one afterward</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Pandemic madness<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgot__xpCIdVsyl8qt4TmGIzFs5JuWGxWag6U942yjvRvwWaUa0Liv1XwaNadmDs2W5BKKkHyvgriUchm4nyoLtTqzAK0-o4tX-rIf9__oeSjvetCR5Yq06Q4kvKMxRzGc8kM7EulaEL2i_Orin9lqQa2Rd5VYuFaIdOzBVMsThgRM6LoNi-jOB9ZFq/s850/peedrinker.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="567" data-original-width="850" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgot__xpCIdVsyl8qt4TmGIzFs5JuWGxWag6U942yjvRvwWaUa0Liv1XwaNadmDs2W5BKKkHyvgriUchm4nyoLtTqzAK0-o4tX-rIf9__oeSjvetCR5Yq06Q4kvKMxRzGc8kM7EulaEL2i_Orin9lqQa2Rd5VYuFaIdOzBVMsThgRM6LoNi-jOB9ZFq/s320/peedrinker.jpg" width="320" /></a></div><br /><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_384" o:spid="_x0000_i1025" style="height: 228pt; visibility: visible; width: 341pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image010.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://viralproductsexchange.com/z-stack-develop-by-dr-zelenko-vsl?gclid=CjwKCAjw_b6WBhAQEiwAp4HyIJoIipZ2fozzj6UruoO4ygjOkJKrFCBijKn0eF23UMgNlzJd54qJWBoCz1gQAvD_BwE">Kosher vitamins</a> can prevent and cure COVID-19, including “Delta, as well as Omicron strains.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://www.reuters.com/article/factcheck-urine-covid/fact-check-no-evidence-that-urine-therapy-cures-covid-19-idUSL1N2TS215">Drinking your own urine</a> is just as effective.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">One company that received a <a href="applewebdata://34248E35-1E91-482D-9919-E030354CD397/DESTROYS%20SARS%20CoV-2%20and%20other%20COLD%20&%20FLU%20viruses%20in%2015%20seconds">warning letter</a> from the FDA still hasn’t taken down the claim that its iodine-based CofixRX nasal spray “<a href="https://cofixrx.com/faq/">reduces viral load</a> of Sars-CoV-2, the virus that causes Covid-19, by 99.9% in under 45 seconds.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">And the outfit selling a nasal spray containing Iota-Carrageenan, derived from seaweed, still <a href="https://nasitrol.com/science/">hasn’t quit claiming</a> their product can prevent COVID-19.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">But other FDA <a href="https://www.fda.gov/consumers/health-fraud-scams/fraudulent-coronavirus-disease-2019-covid-19-products">warning letters</a> have worked:<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Multiple sites promoting CBD to prevent or treat COVID-19 have removed those claims.<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->So have the manufacturers of a <a href="https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/sensory-cloud-inc-628897-04062022">salt water mist product</a> who had claimed that “A Harvard study demonstrates it may have a protective effect against airborne viruses like COVID-19.” <o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->And the <a href="https://sodapharmlife.com/product/cold-flu-covid-pack/%20Don%E2%80%99t%20just%20wait%20until%20you%E2%80%99re%20bad%20enough%20to%20go%20to%20the%20ER!!%20Get%20better%20instead!">makers of mullein leaf tea</a>, who once <a href="https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/soda-pharm-626261-03102022">advertised</a> “everything you need for cold/flu or COVID management at home in one click,” adding “Don’t just wait until you’re bad enough to go to the ER!! Get better instead!”<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->The FDA has even gotten some <a href="https://pushmycart.com/">Indian websites</a> to stop <a href="https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/mahita-llc-dba-pushmycart-616541-08192021">claiming</a>, for instance, that “Ayurvedic medicines obstruct the replication process of the Coronavirus and mitigate its infection by increasing the body’s fighter immune cells.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Coincidentally, two scientists have just <a href="https://jamanetwork.com/journals/jama/fullarticle/2794578?guestAccessKey=69969eab-09a8-4bba-a3e2-8cf2d51ab927&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=072622">reported</a> that even products containing banned ingredients are often not removed from the market after warning letters from the FDA.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I’ll close with a zinger that drew a <a href="https://twitter.com/denise_dewald/status/1551709508430430213">nice comment</a> on Twitter: “This genius eugenicist thinks that diseases don’t actually exist. The only problem is weak people.”<o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGlfH8bffWTjc9Ooi9lT1tLgSX1k6nfC3LByIEFoFWwzxA6VW8p8IJhpE-k03ulSHNemEv0cfrBx4sBT9s_7b2whAnZrP9AhJPjPOuyQ9C1Q2GkhpVv5LMOV8U8RP09m8YgU9ZiUYBJ0GCJL2R9D5Lm4eoPSthBJ8qoiN5iWJHWhiVmyV8OoKXVj8V/s1125/Dr.%20Gino%20nongenius%20tweet.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="801" data-original-width="1125" height="228" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGlfH8bffWTjc9Ooi9lT1tLgSX1k6nfC3LByIEFoFWwzxA6VW8p8IJhpE-k03ulSHNemEv0cfrBx4sBT9s_7b2whAnZrP9AhJPjPOuyQ9C1Q2GkhpVv5LMOV8U8RP09m8YgU9ZiUYBJ0GCJL2R9D5Lm4eoPSthBJ8qoiN5iWJHWhiVmyV8OoKXVj8V/s320/Dr.%20Gino%20nongenius%20tweet.jpg" width="320" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com2tag:blogger.com,1999:blog-6211405954943098401.post-45047435799367926122022-07-13T15:37:00.004+02:002022-07-13T16:12:31.795+02:00Moderna Meets Pfizer At The OK Corral <p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4CKPx10Rkb4necft5B87zuqTXB4JkKlWeljiEchORzz10hMVP3jbPa8dzgQxb1Pe_0Rrh_s10J3_ZlAz1Wd0XgZCONJO2dVZSh8O0pEp55LY6zEVFf5xrO_J1P0kx2cbz4ot22NnYM78kM611gGwPZ86NpUuThkea58QSLUY-oFRwjAK4nFnHEbmh/s1920/rna%20vaccines%20cause%20monkeypox.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1920" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4CKPx10Rkb4necft5B87zuqTXB4JkKlWeljiEchORzz10hMVP3jbPa8dzgQxb1Pe_0Rrh_s10J3_ZlAz1Wd0XgZCONJO2dVZSh8O0pEp55LY6zEVFf5xrO_J1P0kx2cbz4ot22NnYM78kM611gGwPZ86NpUuThkea58QSLUY-oFRwjAK4nFnHEbmh/w400-h225/rna%20vaccines%20cause%20monkeypox.jpg" width="400" /></a></div><style class="WebKit-mso-list-quirks-style">
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span.timestampcontent
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div.WordSection1
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</style><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Discouraging treatment news, so-so vaccine news, BA.5 triumphant, Anthony Fauci, Eric Adams, long COVID, the mirage of single-payer, and hot new conspiracy theories.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"> <v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f"><v:stroke joinstyle="miter"><v:formulas><v:f eqn="if lineDrawn pixelLineWidth 0"><v:f eqn="sum @0 1 0"><v:f eqn="sum 0 0 @1"><v:f eqn="prod @2 1 2"><v:f eqn="prod @3 21600 pixelWidth"><v:f eqn="prod @3 21600 pixelHeight"><v:f eqn="sum @0 0 1"><v:f eqn="prod @6 1 2"><v:f eqn="prod @7 21600 pixelWidth"><v:f eqn="sum @8 21600 0"><v:f eqn="prod @7 21600 pixelHeight"><v:f eqn="sum @10 21600 0"></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:formulas><v:path gradientshapeok="t" o:connecttype="rect" o:extrusionok="f"><o:lock aspectratio="t" v:ext="edit"></o:lock></v:path></v:stroke></v:shapetype><v:shape id="Picture_x0020_697" o:spid="_x0000_i1033" style="height: 183pt; visibility: visible; width: 326pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image001.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Treatment news<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4SGFiiDYw6vgXkK9dvXbhpPx1k2KRsASl5l5X-yN0tET4OAf5c2kSyAIXgkclLRUyrrZFH376gMaAFoCtCFyVYvOKezGAYzaVMjEHYy5CWGCS-GFdM65Pq5qqbRbbpu_75bce0-6bP5MyLC5tNu9r3C4t9RSn_RuSBPlnqFgHWQ9RlENPHT4s38j-/s900/paxlovid.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="600" data-original-width="900" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4SGFiiDYw6vgXkK9dvXbhpPx1k2KRsASl5l5X-yN0tET4OAf5c2kSyAIXgkclLRUyrrZFH376gMaAFoCtCFyVYvOKezGAYzaVMjEHYy5CWGCS-GFdM65Pq5qqbRbbpu_75bce0-6bP5MyLC5tNu9r3C4t9RSn_RuSBPlnqFgHWQ9RlENPHT4s38j-/s320/paxlovid.png" width="320" /></a></div><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_692" o:spid="_x0000_i1032" style="height: 2in; visibility: visible; width: 3in;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image002.png"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Whistling a happy Paxlovid tune</u>: The FDA has now <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-pharmacists-prescribe-paxlovid-certain-limitations">authorized American pharmacists</a> to prescribe Paxlovid themselves, if they can’t reach a patient’s physician but the patient brings enough health records to demonstrate they can take it safely. In Italy, which claims to have one of the highest prescription rates in the world, only <a href="http://www.quotidianosanita.it/scienza-e-farmaci/articolo.php?articolo_id=106179">28,000 courses</a>of treatment had been distributed as of July 5th, a mere 0.4% of the 7,822,349 COVID-19 cases reported since the drug first arrived; I can’t find US statistics, but in Israel during early months Paxlovid was prescribed in <a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciac443/6599020">0.8%</a> of all adult cases, and only 2.6% of eligible cases. Also, contrary to the suspicion that vaccination might invalidate Paxlovid, it did lower hospitalization rates among older, vaccinated Israelis during the Omicron era – by <a href="https://assets.researchsquare.com/files/rs-1705061/v1/ed7100f4-9dba-4cd5-8581-3548721bfa0d.pdf?c=1654110344">60% in one study</a>, but only <a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciac443/6599020">38% in another</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Singing the Paxlovid blues</u>: A <a href="https://www.medrxiv.org/content/10.1101/2022.06.21.22276724v1">large-scale study</a>, available only as a preprint, reveals that post-treatment relapses are more frequent and more severe than previously thought. Nearly 6% of treated people had recurrent symptoms, as vs. 1% in Phase 3 trials, while 0.8% went on to require hospitalization. Though the FDA continues to advise against restarting Paxlovid, Anthony Fauci himself chose to <a href="https://thehill.com/policy/healthcare/3541329-fauci-says-he-is-experiencing-rebound-of-covid-symptoms-after-paxlovid-treatment/">take a second course</a> when he experienced a rebound worse than his initial illness. Here’s a possible reason relapses have increased: the SARS-CoV-2 virus has been <a href="https://www.science.org/content/article/bad-news-paxlovid-coronavirus-can-find-multiple-ways-evade-covid-19-drug">mutating to escape</a> from Paxlovid. <b><u>This is the worst COVID-19 news I’ve heard for months</u></b>. Though perhaps I should emphasize that if I became ill with COVID-19 myself I would certainly take Paxlovid. If the virus becomes resistant to Paxlovid (not confirmed in one <a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciac496/6611663?">case report</a>) then we’re left with remdesivir, whose multiple intravenous infusions can’t possibly be provided to masses of patients. There is an oral version of remdesivir, but frankly it’s <a href="https://www.genengnews.com/virology/coronavirus/oral-formulation-of-remdesivir-protective-against-sars-cov-2-in-mice/">not very promising</a>. More bad news for Paxlovid: Pfizer has <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-reports-additional-data-paxlovidtm-supporting#:~:text=Additional%20analyses%20of%20secondary%20endpoint,placebo%20(p%3D0.0228)">scrapped a study</a> in <i>average</i>-risk patients, after early results were a wash.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Sabizabulin</u>: There’s little news lately about drugs for inpatients – particularly unfortunate when hospitalizations and ICU admissions are rising in the US (<a href="https://www.nytimes.com/2022/07/12/us/politics/ba5-omicron-variant-white-house.html?campaign_id=2&emc=edit_th_20220712&instance_id=66497&nl=todaysheadlines&regi_id=19728476&segment_id=98355&user_id=d89c7002526915cc9287fae06e27a284">more than doubling</a> since new variants arrived, and much of Europe). <a href="https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200145">Early results</a> of a Phase 3 trial suggest this oral antiviral may be lifesaving, but there are several important caveats: 1) the results are preliminary; 2) the number of patients enrolled is small; and 3) the death rate in the placebo group was <a href="https://twitter.com/boulware_dr/status/1545057096005079042">higher</a> than expected, which could make the drug look better than it really is.<o:p></o:p></p><p style="font-size: medium; margin-bottom: 0.25in; margin-top: 1.5pt;"><o:p> </o:p></p><p style="font-size: medium; margin-bottom: 0.25in; margin-top: 1.5pt;"><b>Vaccine news<o:p></o:p></b></p><p style="font-size: medium; margin-bottom: 0.25in; margin-top: 1.5pt;"><b><v:shape id="Picture_x0020_693" o:spid="_x0000_i1031" style="height: 179pt; visibility: visible; width: 318pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image003.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p style="font-size: medium; margin-bottom: 0.25in; margin-top: 1.5pt;"><u></u></p><div class="separator" style="clear: both; text-align: center;"><u><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCSErat6qNZllebCXcYn7_VHU0h8coe2tv8k4-atzgQzpvuecf7XVRsShWTeZ6pu4fs7RTyVzRZVhvrYUQhwjoA7cCqL2796tNgzflJEp5pkEfGd7diR5LNIz6j9Xib6oq-qwBqUIID9FecVNZsDAC_tpHflzFkURS_vluaq3bQliM4Jk_S3RnRs_F/s1600/moderna%20vs.%20pfizer.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="900" data-original-width="1600" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCSErat6qNZllebCXcYn7_VHU0h8coe2tv8k4-atzgQzpvuecf7XVRsShWTeZ6pu4fs7RTyVzRZVhvrYUQhwjoA7cCqL2796tNgzflJEp5pkEfGd7diR5LNIz6j9Xib6oq-qwBqUIID9FecVNZsDAC_tpHflzFkURS_vluaq3bQliM4Jk_S3RnRs_F/w400-h225/moderna%20vs.%20pfizer.jpg" width="400" /></a></u></div><u><br /></u><o:p></o:p><p></p><p style="font-size: medium; margin-bottom: 0.25in; margin-top: 1.5pt;"><o:p></o:p></p><p style="font-size: medium; margin-bottom: 0.25in; margin-top: 1.5pt;"><u>Toddlers</u>: One issue parents will face when choosing between Pfizer and Moderna vaccines is how <a href="https://www.statnews.com/2022/06/20/comparing-the-pfizer-and-moderna-covid-vaccines-for-young-children/?utm_campaign=rss">sick the shot will make their kid</a>. Moderna’s 25 mcg of mRNA gives, unsurprisingly, more side effects than Pfizer’s 3 mcg. Among toddlers in the Pfizer studies, more placebo recipients than vaccine recipients (5.2% vs. 4.9%) developed a fever, while for Moderna it was the other way around (10.6% vs. 18.9%). Ummmm… how come all those kids got fevers after getting shot up with salt water? In any case, the preschool vaccination campaign is fizzling. Despite endorsement from <a href="https://www.aap.org/en/news-room/news-releases/aap/2022/american-academy-of-pediatrics-applauds-cdc-approval-of-safe-effective-covid-19-vaccines-for-children-ages-6-months-and-older/">pediatric societies</a> and <a href="https://www.washingtonpost.com/opinions/2022/06/15/fda-vote-coronavirus-covid-vaccines-children-5-and-younger-no-longer-left-behind/">pandemic pundits</a>, only <a href="https://www.nytimes.com/2022/06/25/opinion/covid-vaccines-children.html?campaign_id=2&emc=edit_th_20220626&instance_id=65070&nl=todaysheadlines&regi_id=19728476&segment_id=96836&user_id=d89c7002526915cc9287fae06e27a284">one in 5</a> American parents of little kids are rushing to get them vaccinated. I’m still not sure where I stand personally, but I was shocked to see a Florida pediatrician <a href="https://twitter.com/LisaGwynn/status/1542583448761688064">being punished</a> for advocating the CDC’s position.<o:p></o:p></p><p style="font-size: medium; margin-bottom: 0.25in; margin-top: 1.5pt;"><v:shape id="Picture_x0020_698" o:spid="_x0000_i1030" style="height: 250pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image004.jpg"></v:imagedata></v:shape><u><o:p></o:p></u></p><p style="font-size: medium; margin-bottom: 0.25in; margin-top: 1.5pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh70CM5kam8rPLCxsfBZCwhJFrqAMlLSFZoc8OoiEJO8wSGA2D_s5MHvr4n2Gp4d1QhhD50JKZhifUdEQ76qKXORGLO08t5S_Rhtr7SXDMmyDwd4O-lsdL5djjzTO3V1gVNoMRW-YNNkRELtaOwdKSGTV5Nm7y5hF3-XTpyS5Fq-Ib3v-7tAkyXnWL3/s2210/CDC%20data%20on%20second%20booster.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1220" data-original-width="2210" height="357" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh70CM5kam8rPLCxsfBZCwhJFrqAMlLSFZoc8OoiEJO8wSGA2D_s5MHvr4n2Gp4d1QhhD50JKZhifUdEQ76qKXORGLO08t5S_Rhtr7SXDMmyDwd4O-lsdL5djjzTO3V1gVNoMRW-YNNkRELtaOwdKSGTV5Nm7y5hF3-XTpyS5Fq-Ib3v-7tAkyXnWL3/w640-h357/CDC%20data%20on%20second%20booster.jpg" width="640" /></a></div><br /><u><br /></u><p></p><p style="font-size: medium; margin-bottom: 0.25in; margin-top: 1.5pt;"><u>Second boosters, data</u>: One <a href="https://www.nature.com/articles/s41467-022-30884-6">new Israeli study</a> documents that the first booster’s benefit is nearly gone after 3 months, contrary to hopes it would last longer than the primary series. <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2793699">Another</a>, among elderly nursing home residents, found the second booster to protect well against even moderate COVID-19 and cuts mortality by 72%, with no waning over 11 weeks; this study has substantial methodological weaknesses, however. It seems the older and frailer the population the better the 4<sup>th</sup> shot works and the longer it lasts. A <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4107709">Swedish study</a> among people over 80 reports that the second booster decreased <i>total, all-cause</i> mortality by 42%; the benefit against COVID-19 mortality was undoubtedly higher. There are some <a href="https://www.fda.gov/media/159494/download">data from the CDC</a> as well (slide 29 is above), suggesting that a second booster decreases the short-term risk of death from COVID-19 by 75% in people 50+. Italy is just about to open up eligibility to everybody over 60, and so many doses are lying around unused that they may let even younger people get a second booster if they want – <a href="https://www.washingtonpost.com/health/2022/07/11/biden-officials-second-booster-shots-all-adults/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F3759540%2F62cd4637cfe8a21601e69947%2F599d6acbae7e8a3d46e1400f%2F37%2F58%2F62cd4637cfe8a21601e69947&wp_cu=24fe7fdaf3a5ae7a2be4e63a62e47d7a%7Ca33d67be-fe27-11e0-b478-12313d08a5d6">as may the US</a>.<o:p></o:p></p><p style="font-size: medium; margin-bottom: 0.25in; margin-top: 1.5pt;"><u>Second boosters, upshot</u>: Since we know that fourth dose only wards off infection for a month or so, and don’t know how long protection lasts against severe disease, I’ve been recommending people get it only if they’re facing a high-risk situation. But with cases and hospitalizations soaring over the last few weeks I'm starting to soften up. Maybe older people should in fact consider getting a booster now, anticipating yet another one in the fall. I’m still ambivalent, in part because a booster now will likely disqualify you from getting a bivalent booster soon after it arrives.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Pericarditis again</u>: Moderna has been thought to cause about twice as much pericarditis as Pfizer in young men, with one case in about 10,000 second doses. Now a <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2793551?">study from Ontario</a> suggests both numbers are overoptimistic. With about 20 million vaccine doses and 300 cases of pericarditis to examine, they found Moderna’s risk to be <i>five times </i>higher. One in 3300 men 18 to 25 years old developed pericarditis following the second dose of Moderna, compared with one in 17,000 after Pfizer. The risk was lower if the second dose was delayed, so an 8-week interval might make sense in that demographic. A <a href="https://www.nature.com/articles/s41467-022-31401-5">French study</a> found slightly less dire numbers: one in 5900 second doses for Moderna, one in 21,100 for Pfizer.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Sanofi-GlaxoSmithKline</u>: Their first stab at a protein-based vaccine flunked Phase 2, but now they’ve come up with a new two-dose one, adjuvated to be more potent. It’s bivalent, like Moderna’s latest, but mixes in the Beta rather than the Omicron variant. <a href="https://www.sanofi.com/en/media-room/press-releases/2022/2022-06-24-05-29-02-2468538">The companies summarize</a> early top-line results of a Phase 3 trial as 63% efficacy against all symptomatic COVID-19 and, surprisingly, <i>higher</i> (72%) efficacy against Omicron. Not bad, but not as good as the similar Novavax. They don’t say how many Omicron cases were involved or, of course, how long protection lasts. I’m eager for a proper manuscript.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Valneva</u>: I was shocked to see the European Medicines Agency <a href="https://www.ema.europa.eu/en/news/ema-recommends-valnevas-covid-19-vaccine-authorisation-eu">authorize</a> emergency use of this French company’s whole-virus inactivated vaccine for people between 18 and 50 without any Phase 3 trials, on the basis of “immunobridging studies” showing it stimulates more antibodies against the original Wuhan wild strain of SARS-CoV-2 than the AstraZeneca vaccine. Considering how mediocre the AstraZeneca vaccine is, that’s not saying much. And there’s no information regarding <i>any</i> Variant of Concern, much less Omicron. The EMA announcement mentions “limited data” but it doesn’t provide them.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Corbevax</u>: India has given its <a href="https://www.business-standard.com/article/current-affairs/biological-e-s-corbevax-gets-dcgi-nod-as-a-heterologous-covid-booster-dose-122060400572_1.html">definitive OK</a> to a locally produced version of this famously inexpensive vegan/halal vaccine as a booster following two doses of Covishield (=AstraZeneca) or Covaxin (the vaccine developed in India). This is on the basis of Phase 2 studies, mislabled Phase 3, that show an unspecified increase in neutralizing antibodies against earlier variants and neutralizing antibodies in “most vaccinees” against Omicron. It’s a mystery to me why the American developers don’t do <i>real</i> Phase 3 trials – they shouldn’t be too difficult given how cases are soaring in many countries.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Omicron-busters face off</u>: With Moderna on the verge of getting an Emergency Use Authorization for its anti-Omicron vaccine Pfizer is, predictably, on its tail. The economic stakes are high, now that both an <a href="https://www.statnews.com/2022/06/28/tracking-an-fda-advisory-panel-meeting-on-updating-covid-vaccines/">FDA advisory panel</a> and the <a href="https://www.who.int/news/item/17-06-2022-interim-statement-on--the-composition-of-current-COVID-19-vaccines">World Health Organization</a> are saying all future boosters should aim at Omicron (though one panel member has <a href="https://www.statnews.com/2022/06/29/fda-dont-rush-to-change-covid-19-vaccine-composition/">gone public</a> with his skepticism). The FDA <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-recommends-inclusion-omicron-ba45-component-covid-19-vaccine-booster">has even said</a> that new boosters should directly target Omicron 4 or 5. It will be several months before those versions are available, though, so vaccines targeting the original Omicron spike protein might be rolled out first; the bivalent Moderna product actually <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/moderna-booster-candidate-produces-strong-antibodies-against-omicron-subvariants-2022-06-22/">induces a fairly good supply</a> of antibodies against BA.4 and BA.5. Pfizer has one new vaccine in either hand: a monovalent one targeting only the Omicron BA.1 spike protein, and a bivalent one mixing in some of the original wild strain vaccine. According to <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-omicron-adapted-covid-19">Pfizer’s press release</a> the monovalent version is better at inducing anti-Omicron antibodies, but unfortunately both are much less potent against BA.4 and BA.5. If given the chance I’ll grab whichever one comes around first, though it would be nice to see 1) some effectiveness data rather than just lab tests, 2) real manuscripts rather than press releases, and 3) a head-to-head comparison between Moderna and Pfizer.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>AstraZeneca</u>: A French group <a href="https://bmjmedicine.bmj.com/content/bmjmed/1/1/e000104.full.pdf?">reports</a> that the AstraZeneca vaccine was as effective as Pfizer and nearly as effective as Moderna in preventing hospitalization from the Alpha and Delta variants (91%, 91%, and 95% respectively). But <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00146-3/fulltext">we already know</a> that AstraZeneca wears off even faster than the mRNA vaccines, particularly in older people. And, of course, Omicron is a whole new ball game.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>CoronaVac</u>: We had already had hints that Sinovac’s inactivated whole-virus vaccine loses its meagre punch quickly. That’s now confirmed by a <a href="https://www.bmj.com/content/377/bmj-2022-070102">Brazilian study</a>: the effect wanes sharply by 3 months, especially in the elderly.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Lives saved</u>: Imperial College London researchers <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00320-6/fulltext">have calculated</a> that vaccines saved 20 million lives worldwide during the first year they were available. American research groups have variously estimated the number of lives saved by vaccines in the United States as <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2793913">225,000</a> as of the end of September 2021 and <a href="https://www.commonwealthfund.org/publications/issue-briefs/2021/dec/us-covid-19-vaccination-program-one-year-how-many-deaths-and">1,100,000</a> by the end of November – I have no idea why those figures are so different.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>The Holy Grail</u>: A British group is working on a <a href="https://mft.nhs.uk/2022/01/06/early-data-for-multivariant-covid-19-vaccine-booster-shows-promise/">new vaccine candidate</a> that targets both spike and non-spike proteins and is specifically engineered to maximize T-cell immunity as well as antibodies. They don’t provide much in the way of details, and have only tested it as a booster in a handful of people previously vaccinated with AstraZeneca. <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/biontech-pfizer-starting-testing-universal-coronavirus-vaccine-h2-2022-06-29/">According to Reuters</a>, Pfizer-BioNTech is working on its own version of a universal anti-coronavirus vaccine, and maybe on another intended to block only serious disease, with plans to start human testing in just a few months. I looked through the <a href="https://investors.biontech.de/static-files/edee73bd-1620-4f51-a419-7ce7782ffa0f">Powerpoint</a> the Reuters article seems to be referring to and couldn’t find discussion of these vaccines, but maybe I scrolled too fast through the 153 slides. In any case, hope springs eternal.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Tony the Great<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_666" o:spid="_x0000_i1029" style="height: 215pt; visibility: visible; width: 381pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image005.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhis-U_9HfxVaKiI-njY_XsKfw-XEy1bcyNDXdoLsQgN1VLSrsbGXg1lBhazD6TB22OLrnWdWs5INg0w5VtPNMoCngpfvTP-XAuVnoG7yzcEMWYD5ajso1jkOgXAP-ce3U8j5lzMbm0F1GkxsHoUNMjZedOAQ9QeWbPEDPE17ecnoxdj2FV53xrAQJK/s700/trump-fauci.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="394" data-original-width="700" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhis-U_9HfxVaKiI-njY_XsKfw-XEy1bcyNDXdoLsQgN1VLSrsbGXg1lBhazD6TB22OLrnWdWs5INg0w5VtPNMoCngpfvTP-XAuVnoG7yzcEMWYD5ajso1jkOgXAP-ce3U8j5lzMbm0F1GkxsHoUNMjZedOAQ9QeWbPEDPE17ecnoxdj2FV53xrAQJK/w400-h225/trump-fauci.jpg" width="400" /></a></div> <p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="margin-right: 6pt;">If you’re curious about what Anthony Fauci has to say about on his history, the history of the pandemic, and what it was like to work with Donald Trump, <a href="https://www.washingtonpost.com/magazine/2022/06/27/anthony-fauci-post-pandemic-interview/">click here</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p><br /></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Variant watch<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_691" o:spid="_x0000_i1028" style="height: 213pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image006.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglKyXW7MfeUdYhpB0E-jBXXZegPigrN9jFTXSb3O2b4gY1VX94GWHkIIhCmhDhhm12m0nEcbF0a2wVLPEUy2ikDcHY5UDDbfCnxgMFRPuf8IdwY-pVAGNdIsbvVqfehxdIu9s4625nlDXIzq-FjjJ_zDBbn_SPXpp0uI68l9LhPWlGhHhwnld4DjDk/s1034/BA.5%20vs.%20BA.2.75.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="486" data-original-width="1034" height="302" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglKyXW7MfeUdYhpB0E-jBXXZegPigrN9jFTXSb3O2b4gY1VX94GWHkIIhCmhDhhm12m0nEcbF0a2wVLPEUy2ikDcHY5UDDbfCnxgMFRPuf8IdwY-pVAGNdIsbvVqfehxdIu9s4625nlDXIzq-FjjJ_zDBbn_SPXpp0uI68l9LhPWlGhHhwnld4DjDk/w640-h302/BA.5%20vs.%20BA.2.75.jpg" width="640" /></a></div><span style="font-size: 12pt;"> </span><p></p><p class="1obc" style="margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="margin-right: 6pt;">It’s been long suspected that immunosuppressed people, in whom the virus can live on for many months, might be a breeding ground for variants. Now <a href="https://www.nature.com/articles/d41586-022-01613-2">more evidence is piling up</a>, including tying the Alpha variant to one specific person in England… <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The hyper-contagious and <a href="https://twitter.com/erictopol?s=11">hyper-immunity-escaping</a> subvariants, <a href="https://www.theatlantic.com/health/archive/2022/07/ba5-omicron-variant-covid-surge-immunity-reinfection/670485/">BA.4-BA.5</a>, are now officially dominant in both the United States (<a href="https://www.nytimes.com/interactive/2022/07/07/us/ba5-covid-omicron-subvariant.html">about 80% of new cases</a>) and Italy (71% at last call). Even the official, lowball, Italian case count has <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?facet=none&Metric=Confirmed+cases&Interval=7-day+rolling+average&Relative+to+Population=false&Color+by+test+positivity=false&country=~ITA">more</a><span class="MsoHyperlink"> than quintupled</span> in the last month. Rome hospitals are so overloaded that ambulances show up, if at all, <b><i><u>as long as 6 hours</u></i></b> after you call the emergency number.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://www.rainews.it/articoli/2022/07/omicron-ba5-aumentano-i-casi-di-polmonite-lo-dice-il-118-a6e8b3b6-6b13-4c34-aca3-0da37843d3a8.html">Anecdotal Italian reports</a> that rates of COVID-19 pneumonia are increasing, combined with a near doubling of ICU occupancy and deaths in the past month, suggest that Omicron 5 may be more aggressive than previous Omicrons. BA.5 certainly is even better at evading immunity, attacking many people who are triple-vaccinated and/or COVID-19 survivors.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Out of 169,233 COVID deaths in Italy since the beginning of the pandemic, 31,720 have been due to Omicron. “It's just a bad cold”???? Italy has already reinstated a mask requirement on public transport, and regions may be allowed to reimpose indoor masking. Rome’s Lazio region said 2 weeks ago it <a href="https://www.quotidianosanita.it/governo-e-parlamento/articolo.php?articolo_id=105987">wants to</a>, but for some reason it hasn’t yet.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Not only is Omicron good at escaping prior immunity, but it turns out that catching it after previous infections or triple vaccination leaves you with <a href="https://www.science.org/doi/10.1126/science.abq1841">hardly any immune boost</a>, via either antibodies or cellular (T cell) immunity. That’s one reason so many people are getting Omicron twice, and why the hope is vain that having a mild case now will protect you forever. And don’t forget about long COVID: “Not having got long Covid after a prior infection in the earlier waves <a href="https://www.theguardian.com/commentisfree/2022/jul/01/herd-immunity-covid-virus-vaccine">offers no guarantee</a> against getting it this time” – in fact, reinfection <a href="https://assets.researchsquare.com/files/rs-1749502/v1/499445df-ebaf-4ab3-b30f-3028dff81fca.pdf?c=1655499468">makes it more likely</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">…Those new subvariants are coming ever faster and more furious. BA.2.75, thus far largely been <a href="https://www.livemint.com/news/world/new-omicron-subvariant-ba-2-75-looks-different-who-chief-scientist-explains-severity-11657116605710.html">confined to India</a>, has additional mutations that make <a href="https://twitter.com/erictopol?s=11">Eric Topol</a> think it might surpass even BA.5 at infecting triple-vaccinated or recently-infected people. Then there’s <a href="https://github.com/cov-lineages/pango-designation/issues/771#issuecomment-1178854885">BA.5.1 recombinant</a>, detected in Europe and the US, still basically an unknown.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Worms in the Big Apple<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_685" o:spid="_x0000_i1027" style="height: 157pt; visibility: visible; width: 236pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image007.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0LGYU-y1xI09fZDf69PgvvW1r8HvmpHQSAj-LAUSP2v6eNZH-6o8GCpkk6KGIJUCLfYzsPTWwX9Wi65tEwoZ8dWLeZz8Jogx5gYojcmKBVKiNuLu2K7aPVxhVRLuN_Flx0b-DV4zGnKun_6AwAYx0GC3CeC5fyvoN5cucojhdbFqKHmfxBq8F5Tcr/s275/Eric%20Adams.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="183" data-original-width="275" height="183" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0LGYU-y1xI09fZDf69PgvvW1r8HvmpHQSAj-LAUSP2v6eNZH-6o8GCpkk6KGIJUCLfYzsPTWwX9Wi65tEwoZ8dWLeZz8Jogx5gYojcmKBVKiNuLu2K7aPVxhVRLuN_Flx0b-DV4zGnKun_6AwAYx0GC3CeC5fyvoN5cucojhdbFqKHmfxBq8F5Tcr/s1600/Eric%20Adams.jpg" width="275" /></a></div><br /><p></p><p class="1obc" style="margin-right: 6pt;">I’ve thought for a while that New York City Mayor Eric Adams has <a href="https://english.stackexchange.com/questions/413583/is-there-a-more-polite-or-less-vulgar-but-still-rude-way-to-say-head-up-his">cranial rectal uppitis</a> when it comes to COVID-19, and now I’m sure. He already disregarded CDC advice back in May by <a href="https://www.nytimes.com/2022/05/18/nyregion/adams-mask-mandate-covid.html">refusing to reimpose</a> indoor mask mandates in the face of Red Alert levels. Now city cases and swab positivity rates are soaring, hospitalizations have <a href="https://coronavirus.health.ny.gov/daily-hospitalization-summary">more than quadrupled</a> since the end of March (<a href="https://coronavirus.health.ny.gov/daily-hospitalization-summary">rising by 61%</a> in the last month), and all 5 boroughs are classified as High Transmission even according to the CDC’s lenient standards, which is supposed to make <a href="https://covid.cdc.gov/covid-data-tracker/#county-view?null=36061&data-type=Risk&list_select_state=New+York&list_select_county=36061">indoor masking imperative</a>. So <b><i>now</i></b> has Adams ordered masking? Nope, he’s doubled down instead, <a href="https://www.nytimes.com/2022/07/01/nyregion/nyc-covid-alert-risks.html?campaign_id=2&emc=edit_th_20220701&instance_id=65673&nl=todaysheadlines&regi_id=19728476&segment_id=97464&user_id=d89c7002526915cc9287fae06e27a284">quietly dismantling</a> the entire color-coding alert system he himself had introduced in March, and <a href="https://gothamist.com/news/nyc-high-covid-level-mayor-adams-administration-pcr-test-site-closures">closing down half</a> of the city’s PCR testing centers. Astonishing!<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"> </p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Long COVID updates<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_695" o:spid="_x0000_i1026" style="height: 208pt; visibility: visible; width: 312pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image008.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u></u></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4RwUi1OYdsyb0v9QJoBW3NQOd8oGjBV4-QbzXiTcr8lKPQg1ZYFQWmT_QCDI7l5dkayUm5tWgxytnBTTjqbyiTGBxSOovYs6wtOUO3D4QEbyHp6SfppDs7b_8AS8oocjyd_NgxgBoLBDGMz0jpJYqCUDktJS-KM2j5Ck4a_IiuPm4tCw4T4jjua9o/s1200/vagal%20stimulation%20for%20long%20covid.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="800" data-original-width="1200" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4RwUi1OYdsyb0v9QJoBW3NQOd8oGjBV4-QbzXiTcr8lKPQg1ZYFQWmT_QCDI7l5dkayUm5tWgxytnBTTjqbyiTGBxSOovYs6wtOUO3D4QEbyHp6SfppDs7b_8AS8oocjyd_NgxgBoLBDGMz0jpJYqCUDktJS-KM2j5Ck4a_IiuPm4tCw4T4jjua9o/w400-h266/vagal%20stimulation%20for%20long%20covid.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Vagal stimulation via the ear</td></tr></tbody></table> <o:p></o:p><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Numbers</u>:</p><p class="1obc" style="font-size: medium; margin-right: 6pt;">According to a one recent CDC study, COVID-19 <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7121e1.htm?s_cid=mm7121e1_e&ACSTrackingID=USCDC_921-DM82414&ACSTrackingLabel=MMWR%20Early%20Release%20-%20Vol.%2071%2C%20May%2024%2C%202022&deliveryName=USCDC_921-DM82414#contribAff">more than doubles</a> the risk of developing a new health condition over the next year. Another even worse one found that about <a href="https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220622.htm#:~:text=NCHS%20Home-,Nearly%20One%20in%20Five%20American%20Adults%20Who%20Have%20Had,19%20Still%20Have%20">one in 5 Americans</a> who has <b><i>ever</i></b> had COVID-19 still has symptoms to this day. In an <a href="https://www.nature.com/articles/s41467-022-29521-z">English study</a> of 76,155 community residents with self-reported COVID-19, 38% still had symptoms 12 weeks after their diagnosis (and 22% after 6 months).<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Of <a href="https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/Patients%20Diagnosed%20with%20Post-COVID%20Conditions%20-%20A%20FAIR%20Health%20White%20Paper.pdf">78,252 Americans</a> who filed private insurance claims for long COVID during the first 4 months after it was recognized as a medical condition, more than 3/4 had never been hospitalized, and about 1 in 3 had previously been perfectly healthy.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">In the Omicron subvariant era, when many people who survived previous bouts of COVID-19 are getting sick again, it’s particularly discouraging to learn that, as I’ve mentioned, repeat infections <a href="https://assets.researchsquare.com/files/rs-1749502/v1/499445df-ebaf-4ab3-b30f-3028dff81fca.pdf?c=1655499468">increase the risk</a> of long COVID.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Hospitalized patients: In one <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00127-8/fulltext">British study</a>, only 29% had returned to their previous state of health a year later. <a href="https://pubmed.ncbi.nlm.nih.gov/35314503/">Half of American patients</a> without previous cognitive difficulties had them a year later. And a frightening Chinese <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00126-6/fulltext">study of 2469 hospitalized patients</a> found that 55% still had symptoms <b><i>two</i></b> <b><i>years</i></b> later. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Special cases</u>: <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Omicron: Everybody is itching to know whether the milder Omicron variant carries less risk of long COVID. According to <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00941-2/fulltext">the only available study</a>, from the UK, the risk is in fact 25%-50% what it was from Delta. Oddly, they define long COVID as persistent symptoms after 4 weeks – longer follow-up is needed. Even more oddly, they included people who tested positive but were entirely asymptomatic. This makes the very low 4.5% rate after Omicron much less believable, since people without symptoms rarely develop long COVID.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Breakthrough infections: Do vaccinated patients have a lower risk of post-COVID-19 sequelae? The answer seems to be yes, but not by much. A large-scale <a href="https://www.nature.com/articles/s41591-022-01840-0">Veterans Administration study</a> found that fully vaccinated patients were 34% less likely to die during the months following their acute illness – sounds good – but only 15% less likely to develop long COVID. In a <a href="https://ukhsa.koha-ptfs.co.uk/cgi-bin/koha/opac-retrieve-file.pl?id=fe4f10cd3cd509fe045ad4f72ae0dfff">British systematic review</a> 2 out of 8 studies found previous vaccination to give no benefit at all.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Patterns</u>: <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">British researchers <a href="https://www.bmj.com/content/377/bmj-2022-070230">have developed</a> a Symptom Burden Questionnaire (SBQ-LC) to assess how much various symptoms affect patients. Hopefully this will be useful in gauging progress over time, with or without treatment. I found the <a href="https://www.bmj.com/content/bmj/suppl/2022/04/27/bmj-2022-070230.DC1/hugs070230.ww.pdf">Appendix</a> including the actual items and some patient reactions to them to be the most interesting part of the article.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The risk of developing Alzheimer’s disease or Parkinson’s disease has been found to <a href="https://www.frontiersin.org/articles/10.3389/fneur.2022.904796/full">double or even triple</a> following a bout of COVID-19. Other infections can increase those risks too, but with COVID-19 being so extremely common its impact will be far greater.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">American researchers who <a href="https://www.sciencedirect.com/science/article/pii/S2667296022000039?via%3Dihub">carefully assessed 60 outpatients</a> an average of 7 months after acute COVID-19 found that 27% scored “extremely low” on tests of cognitive function, including many who didn’t complain of brain fog or memory problems. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">An Australian team studying patients who had cognitive symptoms a year after COVID-19 claims to have <a href="https://www.medrxiv.org/content/10.1101/2022.06.07.22276020v1.full.pdf">identified a blood test</a> (“kynurenine pathway metabolites”) that predicts brain dysfunction. They go even farther, hypothesizing that these metabolites might actually <i>cause</i> the thinking problems, and that treatment targeting the kynurenine pathway could be useful. I confess it’s all Greek to me.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Causes</u>: <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The <a href="https://www.science.org/content/article/what-causes-long-covid-three-leading-theories">three dominant theories</a> remain: microclots clogging up small blood vessels, persistent live virus, or an immune system in overdrive. All probably contribute, though to different extents in different patients.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Microclots: one <a href="https://journal.chestnet.org/article/S0012-3692(21)03635-7/fulltext#relatedArticles">key study</a> that I’ve mentioned but didn’t link to showed that patients with long-lived exercise intolerance have poor oxygenation of their muscle tissues, not because the lungs fail to get oxygen into the blood but because the muscles themselves fail to extract it. This was documented by performing a special stress test while patients had a catheter threaded into their hearts. And since poor circulation causes organs to shrink, the finding that the brain <a href="https://www.nature.com/articles/s41586-022-04569-5.pdf">loses 2% of its substance</a> following COVID-19 also supports the microclotting hypothesis.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Live virus: viral RNA <a href="https://www.cell.com/med/fulltext/S2666-6340(22)00167-2?">has been found</a> in the stool of 4% of COVID-19 survivors 7 months after their initial illness, indicating ongoing infection of the gastrointestinal tract. There is no reason to think that the virus doesn’t persist in other organs as well, suggesting, as I have said before, that antiviral drugs might have a role in treating long COVID. Now <a href="https://www.researchsquare.com/article/rs-1617822/v2">case reports</a> of 3 long COVID sufferers hint at some possible benefit. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Immune system: An Australian group <a href="https://www.nature.com/articles/s41590-021-01113-x"><span style="text-decoration: none;">has shown</span></a> that immune system overactivity persists for 8 months following mild-to-moderate SARS-CoV-2 infection. Another relevant study in mice, found that even mild COVID-19 infection<a href="https://www.cell.com/cell/fulltext/S0092-8674(22)00713-9">leads to immune hyperactivation</a> involving the brain.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Treatment</u>: <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The <a href="https://www.stimulate-icp.org/faq">STIMULATE ICP trial</a> just now getting under way in the UK will assess 3 pharmacological approaches: the antigout and antiinflammatory drug colchicine, the anticoagulant rivaroxaban, and the paired H<sub>1</sub>- and H<sub>2</sub>-antihistamines loratidine and famotidine; those last two are more promising.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Two treatments have been proposed to help patients regain their sense of smell. One, the old-fashioned asthma drug theophylline added to saline nasal irrigations, <a href="https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2793987">has been tested</a> in only a few patients. The other, an Italian package of “olfactory training” plus two dietary supplements, palmitoylethanolamide and luteolin, <a href="https://pubmed.ncbi.nlm.nih.gov/35450527/">may actually help</a>, though there’s no evidence yet that it impacts “brain fog,” as <a href="http://direnl.dire.it/odm/anno/2022/luglio/07/?news=N05">boasted by</a> the Lazio medical association.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Does a dose of vaccine ease the symptoms of long COVID, as some early surveys reported? A large <a href="https://www.bmj.com/content/377/bmj-2021-069676">UK community study</a> and a corresponding <a href="https://www.bmj.com/content/377/bmj.o988">BMJ editorial</a> basically conclude “sometimes, but don’t count on it.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The English National Opera has come up with <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00125-4/fulltext">an intervention</a> that supplements standard breathing exercises with singing! I love the idea, but their package seems if anything to help only psychological well-being, not exercise tolerance or shortness of breath.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Another cute one: American researchers have <a href="https://www.researchsquare.com/article/rs-1716096/v1">prepublished a pilot study</a> claiming that 6 long COVID sufferers had fewer symptoms, especially “mental fatigue,” after 4 weeks of stimulating their vagus nerve through electrodes on the left ear. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Universal health care</b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://www.pnas.org/doi/full/10.1073/pnas.2200536119?utm="></a></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjW7A9m1kNoOpB0rJE7WNuAbEYViV_teM5cAM27BDoSIIRGRZQ_o7u2rjXZOYkIRSTCPIGwf30POSlIo-6DXefuWU62XCqIs3qHCtajAjvlfqwG8p2PzyYwxjOGdxCRpr_8_JBOLD5Kz_NyQVC1x5fEjF-30RtZgkcmA_sRRds7lEeDv7FdFGNMyO4U/s1516/world%20healthcare%20map.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="804" data-original-width="1516" height="342" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjW7A9m1kNoOpB0rJE7WNuAbEYViV_teM5cAM27BDoSIIRGRZQ_o7u2rjXZOYkIRSTCPIGwf30POSlIo-6DXefuWU62XCqIs3qHCtajAjvlfqwG8p2PzyYwxjOGdxCRpr_8_JBOLD5Kz_NyQVC1x5fEjF-30RtZgkcmA_sRRds7lEeDv7FdFGNMyO4U/w640-h342/world%20healthcare%20map.jpg" width="640" /></a></div><br /><br /><o:p></o:p><p></p><p class="1obc" style="margin-right: 6pt;"><a href="https://www.pnas.org/doi/full/10.1073/pnas.2200536119?utm=">Yale researchers have calculated</a> that if the US had a single-payer healthcare system one in 3 deaths from COVID-19 would have been averted: 338,594 out of the 984,287 clocked as of the end of March 2022, with hundreds of billions of dollars in costs avoided. I and many <a href="https://www.apha.org/Policies-and-Advocacy/Public-Health-Policy-Statements/Policy-Database/2021/01/14/The-Importance-of-Universal-Health-Care-in-Improving-Response-to-Pandemics-and-Health-Disparities">others</a> had hoped the pandemic would push the USA toward joining the rest of the civilized world and introducing a universal healthcare system, but, alas, it ain't happening.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">In Italy, as in most other European countries,<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l27 level1 lfo19; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Nobody lost medical insurance along with their job (<a href="https://www.ebri.org/docs/default-source/ebri-issue-brief/ebri_ib_esicovidloss-8oct20.pdf?sfvrsn=f0763a2f_6">7.7 million Americans</a> did in March-June 2020, along with 6.9 million of their dependents)<o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Nobody paid a penny for COVID-19 testing or treatment (<a href="https://www.affordablehealthinsurance.com/1-in-4-americans-with-medical-debt-owe-more-than-10000/">50 million Americans</a> have medical debt related to COVID-19)<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-bottom: 0in; mso-add-space: auto; mso-list: l27 level1 lfo19; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Nobody had to put their coworkers at risk by going in to work sick (<a href="https://www.bls.gov/opub/ted/2021/paid-sick-leave-was-available-to-79-percent-of-civilian-workers-in-march-2021.htm">21% of American workers</a> have no sick leave)<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">For many months paid sick leave in Italy covered not only anyone home with COVID-19 but also their contacts who quarantined for 14 days. But the money ran out at the end of 2020 and KN95 masking has unfortunately replaced quarantine.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>My favorite new conspiracy theories<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitiLr9buukuLEaP7ZwtW0vVxqcexz8BA2IW6gUwcRQkOiWCXWRDYyoXw_EzB6Tn8FxiV2QO6GDsBHm8mbeREFKfRGGJtMQ1E1afLgTWVkW45BLStVuPN94b6i8y8SP1G_F2w4r4fhfcGete7seE3f9tfyGSkRqJQ03h-vSKDFlAdTh91KxPwDFOsyu/s1194/Steve%20Gates%20vaccine%202.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="673" data-original-width="1194" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitiLr9buukuLEaP7ZwtW0vVxqcexz8BA2IW6gUwcRQkOiWCXWRDYyoXw_EzB6Tn8FxiV2QO6GDsBHm8mbeREFKfRGGJtMQ1E1afLgTWVkW45BLStVuPN94b6i8y8SP1G_F2w4r4fhfcGete7seE3f9tfyGSkRqJQ03h-vSKDFlAdTh91KxPwDFOsyu/w400-h225/Steve%20Gates%20vaccine%202.jpg" width="400" /></a></div><b><br /></b><p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->COVID-19 <a href="https://healthfeedback.org/claimreview/monkeypox-outbreak-conspiracy-theories-claiming-it-was-planned-linking-with-covid-19-vaccines/">vaccines cause monkeypox</a><o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->World Health Organization pandemic plans will <a href="https://khn.org/morning-breakout/new-conspiracy-theory-who-pandemic-plans-will-steal-government-power/">steal power from governments</a><o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Bird flu, a current problem for poultry farmers, is <a href="https://www.cbsnews.com/news/bird-flu-outbreak-2022-conspiracy-theories/">chicken COVID</a><o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Bill Gates has been trying to <a href="https://www.snopes.com/fact-check/bill-gates-brief-cia-in-2005/?collection-id=254522">vaccinate</a> people against religion since 2005<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->COVID-19 is actually <a href="https://khn.org/morning-breakout/conspiracies-show-no-sign-of-slowing-film-claims-covid-is-venom-not-virus/">snake venom</a><o:p></o:p></p>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com0tag:blogger.com,1999:blog-6211405954943098401.post-13344795280021945822022-06-21T14:21:00.001+02:002022-06-21T15:59:04.780+02:00Gimme That Wee Arm!<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMBmFBu6Ue_19OBZy-hgwjChuRBE_nOp24ydrU-Y3Sq96XZixx-62hXQXMu_yMvogxCoaPggP9ZKKnQkrD_NbGCDjjvYL5O-0fNJLsO2Kvgsf0LIuxdVjpgUcFqHht_M3OJK-vHLlqXGP7JvM6pQs2A6R2DY6Zr3lunfz4ppaldSHsDnmLChV-E3Uz/s5760/baby%20gets%20vaccine.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="3840" data-original-width="5760" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMBmFBu6Ue_19OBZy-hgwjChuRBE_nOp24ydrU-Y3Sq96XZixx-62hXQXMu_yMvogxCoaPggP9ZKKnQkrD_NbGCDjjvYL5O-0fNJLsO2Kvgsf0LIuxdVjpgUcFqHht_M3OJK-vHLlqXGP7JvM6pQs2A6R2DY6Zr3lunfz4ppaldSHsDnmLChV-E3Uz/w400-h266/baby%20gets%20vaccine.jpg" width="400" /></a></div><p style="text-align: center;"><br /></p><p> <span style="font-size: medium;">Vaccines hit the headlines, while Paxlovid keeps scoring points. Surges, guidelines, Omicron tidbits, herd immunity, excess mortality, and proof that conspiracy theories are harder to kill than zombies.</span></p><style class="WebKit-mso-list-quirks-style">
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margin:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.MsoListParagraph, li.MsoListParagraph, div.MsoListParagraph
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;}
p.MsoListParagraphCxSpFirst, li.MsoListParagraphCxSpFirst, div.MsoListParagraphCxSpFirst
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;}
p.MsoListParagraphCxSpMiddle, li.MsoListParagraphCxSpMiddle, div.MsoListParagraphCxSpMiddle
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;}
p.MsoListParagraphCxSpLast, li.MsoListParagraphCxSpLast, div.MsoListParagraphCxSpLast
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;}
span.Heading1Char
{mso-style-name:"Heading 1 Char";
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 1";
mso-ansi-font-size:14.0pt;
mso-bidi-font-size:16.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Arial;
mso-bidi-font-family:"Times New Roman";
mso-font-kerning:16.0pt;
font-weight:bold;
mso-bidi-font-weight:normal;}
span.Heading2Char
{mso-style-name:"Heading 2 Char";
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 2";
mso-ansi-font-size:13.0pt;
mso-bidi-font-size:13.0pt;
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;}
span.Heading3Char
{mso-style-name:"Heading 3 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 3";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#4472C4;
mso-themecolor:accent1;
font-weight:bold;}
span.Heading4Char
{mso-style-name:"Heading 4 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 4";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;
font-style:italic;}
span.Heading5Char
{mso-style-name:"Heading 5 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 5";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;}
p.text, li.text, div.text
{mso-style-name:text;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Plain Text";
margin-top:0in;
margin-right:0in;
margin-bottom:10.0pt;
margin-left:0in;
line-height:150%;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
span.PlainTextChar
{mso-style-name:"Plain Text Char";
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Plain Text";
mso-ansi-font-size:10.5pt;
mso-bidi-font-size:10.5pt;
font-family:Courier;
mso-ascii-font-family:Courier;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Courier;
mso-bidi-font-family:"Times New Roman";}
p.Heading, li.Heading, div.Heading
{mso-style-name:Heading;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Heading 1";
margin-top:12.0pt;
margin-right:0in;
margin-bottom:12.0pt;
margin-left:0in;
mso-pagination:widow-orphan;
page-break-after:avoid;
mso-outline-level:1;
font-size:12.0pt;
font-family:"Arial",sans-serif;
mso-fareast-font-family:"MS Mincho";
mso-bidi-font-family:"Times New Roman";
mso-font-kerning:16.0pt;
font-weight:bold;
mso-bidi-font-weight:normal;}
p.quotes, li.quotes, div.quotes
{mso-style-name:quotes;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Plain Text";
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
span.BalloonTextChar
{mso-style-name:"Balloon Text Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Balloon Text";
mso-ansi-font-size:9.0pt;
mso-bidi-font-size:9.0pt;
font-family:"Lucida Grande",sans-serif;
mso-ascii-font-family:"Lucida Grande";
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:"Lucida Grande";
mso-bidi-font-family:"Lucida Grande";}
p.quotesheadline, li.quotesheadline, div.quotesheadline
{mso-style-name:"quotes headline";
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:quotes;
mso-style-next:quotes;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Arial",sans-serif;
mso-fareast-font-family:"MS Mincho";
font-weight:bold;
mso-bidi-font-weight:normal;}
span.exldetailsdisplayval
{mso-style-name:exldetailsdisplayval;
mso-style-unhide:no;}
span.CommentTextChar
{mso-style-name:"Comment Text Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Comment Text";
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.apple-converted-space
{mso-style-name:apple-converted-space;
mso-style-unhide:no;}
p.css-exrw3m, li.css-exrw3m, div.css-exrw3m
{mso-style-name:css-exrw3m;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.3m6-
{mso-style-name:_3m6-;
mso-style-unhide:no;}
span.3l3x
{mso-style-name:_3l3x;
mso-style-unhide:no;}
span.1lh7
{mso-style-name:_1lh7;
mso-style-unhide:no;}
span.1lld
{mso-style-name:_1lld;
mso-style-unhide:no;}
p.6coj, li.6coj, div.6coj
{mso-style-name:_6coj;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.6cok
{mso-style-name:_6cok;
mso-style-unhide:no;}
span.timestampcontent
{mso-style-name:timestampcontent;
mso-style-unhide:no;}
span.mbtext
{mso-style-name:mb_text;
mso-style-unhide:no;}
span.HeaderChar
{mso-style-name:"Header Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Header;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.FooterChar
{mso-style-name:"Footer Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Footer;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.5uzb
{mso-style-name:_5uzb;
mso-style-unhide:no;}
span.accessibleelem
{mso-style-name:accessible_elem;
mso-style-unhide:no;}
span.z-TopofFormChar
{mso-style-name:"z-Top of Form Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"z-Top of Form";
mso-ansi-font-size:8.0pt;
mso-bidi-font-size:8.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:Arial;
mso-bidi-font-family:Arial;
display:none;
mso-hide:all;}
p.1obc, li.1obc, div.1obc
{mso-style-name:_1obc;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.z-BottomofFormChar
{mso-style-name:"z-Bottom of Form Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"z-Bottom of Form";
mso-ansi-font-size:8.0pt;
mso-bidi-font-size:8.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:Arial;
mso-bidi-font-family:Arial;
display:none;
mso-hide:all;}
p.css-axufdj, li.css-axufdj, div.css-axufdj
{mso-style-name:css-axufdj;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.style-scope
{mso-style-name:style-scope;
mso-style-unhide:no;}
p.generic-articlesummary--li, li.generic-articlesummary--li, div.generic-articlesummary--li
{mso-style-name:generic-article__summary--li;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.diamond-blt, li.diamond-blt, div.diamond-blt
{mso-style-name:diamond-blt;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.font-copy, li.font-copy, div.font-copy
{mso-style-name:font-copy;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:"Calibri",sans-serif;
mso-ascii-font-family:Calibri;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:Calibri;
mso-fareast-theme-font:minor-latin;
mso-hansi-font-family:Calibri;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;
mso-header-margin:.5in;
mso-footer-margin:.5in;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
/* List Definitions */
@list l0
{mso-list-id:-119;
mso-list-type:simple;
mso-list-template-ids:-1888465356;}
@list l0:level1
{mso-level-number-format:bullet;
mso-level-style-link:"List Bullet";
mso-level-text:;
mso-level-tab-stop:.25in;
mso-level-number-position:left;
margin-left:.25in;
text-indent:-.25in;
font-family:Symbol;}
@list l1
{mso-list-id:125974259;
mso-list-template-ids:-1612801510;}
@list l1:level1
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l1:level2
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:1.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:"Courier New";
mso-bidi-font-family:"Times New Roman";}
@list l1:level3
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:1.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level4
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:2.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level5
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:2.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level6
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:3.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level7
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:3.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level8
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:4.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level9
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:4.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l2
{mso-list-id:150560276;
mso-list-template-ids:-944067816;}
@list l2:level1
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level2
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:1.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level3
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:1.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level4
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:2.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level5
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:2.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level6
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:3.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level7
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:3.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level8
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:4.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level9
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:4.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l3
{mso-list-id:180240054;
mso-list-type:hybrid;
mso-list-template-ids:-406915396 1833337546 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l3:level1
{mso-level-start-at:84;
mso-level-text:"%1\)";
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l3:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l3:level3
{mso-level-number-format:roman-lower;
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" o:spid="_x0000_i1035" style="height: 185pt; visibility: visible; width: 303pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image002.png"><o:lock aspectratio="f" v:ext="edit"></o:lock></v:imagedata></v:shape><u><o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Paxlovid</u>: <o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnEJYMacnhuyjfsY7GG7YFAYQr6sMfFWvx2ZJ0VgTByDIcAFodg3qVEBU7KjSmA0nc59qraskTH2MgSxGq0QbCgEQn26VVEgRsO8SXPl1Pj_y7zyxtKqGCV1Edlk_Ad6349l2tBI1bxVBKjHFFt3Soo9cJFN0uT5x1LCH3gQ7ABdEUpUET_BasMPV5/s754/Paxlovid%20with%20prior%20immunity.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="489" data-original-width="754" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnEJYMacnhuyjfsY7GG7YFAYQr6sMfFWvx2ZJ0VgTByDIcAFodg3qVEBU7KjSmA0nc59qraskTH2MgSxGq0QbCgEQn26VVEgRsO8SXPl1Pj_y7zyxtKqGCV1Edlk_Ad6349l2tBI1bxVBKjHFFt3Soo9cJFN0uT5x1LCH3gQ7ABdEUpUET_BasMPV5/s320/Paxlovid%20with%20prior%20immunity.png" width="320" /></a></div><p class="1obc" style="font-size: medium; margin-right: 6pt;">Efficacy: A preprinted <a href="https://www.researchsquare.com/article/rs-1705061/v1">Israeli study</a> answers two important hitherto open questions: Is Paxlovid effective against Omicron? Does it work in people who are vaccinated? Yes, and yes. In people over 65 its efficacy against Omicron was 67% overall, not far from the 85-88% against Delta. It was 60% in older patients previously vaccinated or infected, 82% in those with no prior immunity. It didn’t help younger high-risk patients, especially those with some prior immunity; the apparent value in those without it is based on few cases and is statistically non-significant.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Symptom issues: Should people who test positive without symptoms take Paxlovid? I’ve heard that some of my colleagues suggest it, though the Phase 3 <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2118542">trials</a> enrolled only people with clinical covid. <a href="https://www.cdc.gov/coronavirus/2019-ncov/your-health/treatments-for-severe-illness.html">CDC guidelines</a> are slightly ambiguous. On the one hand: “If you test positive and are more likely to get very sick from COVID-19, treatments are available that can reduce your chances of being hospitalized or dying,” as though maybe that includes the asymptomatic …on the other hand: “It should be started as soon as possible and must begin within 5 days of when your symptoms start.” The FDA says firmly that Paxlovid is authorized “<a href="https://www.fda.gov/drugs/news-events-human-drugs/cder-conversations">For the treatment of mild-to-moderate COVID-19</a>.” I stand with the FDA, and <a href="https://www.mountsinai.org/files/MSHealth/Assets/HS/About/Coronavirus/Mount-Sinai-Health-System-Treatment-Guidelines-for-COVID-Updated.pdf">others</a>: don’t use Paxlovid or remdesivir unless you are ill. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Average-risk patients: Early reports from Pfizer suggested that Paxlovid was 70% effective in patients <i>without</i> major risk factors. But now the <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-reports-additional-data-paxlovidtm-supporting">company admits</a> that those results have failed to hold up. Standard-risk patients don’t heal faster, and their risk of hospitalization falls only by 50%, non-significant because so few low-risk patients went south (5 vs. 10).<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">“Rebound”: <a href="https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciac481/6607746?login=false">A study</a> of 483 high-risk patients treated with Paxlovid seems to have found that the treatment failed in 2 patients who went on to require hospitalization, and that 4 others, all boosted, had milder relapses. I say “seems” because contrary to the usual pandemic practice this article is hidden behind a firewall. <a href="https://www.medpagetoday.com/infectiousdisease/covid19/99224?xid=nl_mpt_DHE_2022-06-14&eun=g1849131d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=DailyHeadlinesEveningManual_061422&utm_term=NL_Daily_DHE_dual-gmail-definition">The summary</a> at the physicians-only MedPage Today website is unhelpful – I can’t even figure out whether there were 4 relapses or 6. And the summary specifies oddly and somewhat ominously: “Patients who failed to complete the 5-day course, lacked significant improvement in symptoms, or had persistent symptoms indicating long COVID were excluded.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Treatment eligibility</u>: Criteria for outpatient antivirals and sotrovimab are <a href="https://www.nhs.uk/conditions/coronavirus-covid-19/self-care-and-treatments-for-coronavirus/treatments-for-coronavirus/">extremely restrictive in the UK</a>(immunosuppression or very severe comorbidities). In the US, on the contrary, almost everybody over 50 is eligible (though the drug is really only useful in the elderly). In practice well-off, well-educated Americans are much more likely to receive treatment, though <a href="https://www.nytimes.com/2022/05/26/us/politics/paxlovid-white-house-covid-deaths.html">steps are being taken</a> to improve access for the masses. In Italy those criteria were until recently as rigid as in the UK. So as of late May only 12,000 outpatients had received Paxlovid and 10,000 remdesivir, though about 2.5 million people over 65 had contracted COVID-19 since those antivirals were approved. The much less desirable molnupiravir had gone to 25,000 patients, and the anti-Omicron monoclonal antibody sotrovimab to zero. But I’m pleased to report that as of June 1<sup>st</sup> Italy has <a href="https://www.aifa.gov.it/documents/20142/1269602/IT_Raccomandazioni_AIFA_gestione_domiciliare_COVID-19_Vers9_31.05.2022.pdf">broadened those criteria</a> considerably, making anyone over 65, and younger people with obesity, uncontrolled diabetes, chronic lung disease, etc., eligible for Paxlovid and remdesivir. And National Health Service GPs can now prescribe Paxlovid, though not all pharmacies carry it.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Convalescent plasma</u>: Immunocompromised patients respond poorly to remdesivir and are often taking medications incompatible with Paxlovid, but they’re giving convalescent plasma something of a comeback. Not only has test tube research shown that its polyclonal antibodies <a href="https://pubmed.ncbi.nlm.nih.gov/35443020/">can neutralize</a> even the variants that didn’t infect the donor, but there is <a href="https://pubmed.ncbi.nlm.nih.gov/34137799/">direct evidence</a> that high-dose plasma saves lives in hospitalized immunodepressed patients.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Monoclonal antibodies</u>: I’ve never understood why Evusheld, AstraZeneca’s combination of tixagevimab and cilgavimab, was being pushed solely for prevention, not treatment. Now <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00180-1/fulltext">researchers report having tested it</a> in unvaccinated patients with early mild-to-moderate COVID-19. It was only modestly effective, cutting progression by 50%. And that was against early strains of SARS-CoV-2, long before Omicron or even Delta. In vitro, though, it seems both bebtelovimab and cilgavimab <a href="https://www.nature.com/articles/s41586-022-04980-y_reference.pdf">can effectively neutralize</a> all the Omicron subvariants, including BA.4 and BA.5. Hope they hit the market soon.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Multivalent glycoclusters</u>: Say what? It’s the <a href="https://cdn.uclouvain.be/groups/cms-editors-presse/cp-mai-2022/41467_2022_30313_Author.pdf">latest nasal spray</a> hoped to block the SARS-CoV-2 virus from sticking to the lining of the nose and getting people sick. So far it’s only been studied in test tubes – next up: mice.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>I-SPY COVID</u>: This multifaceted Phase 2 trial in hospitalized patients has now presented its <a href="https://www.medpagetoday.com/meetingcoverage/ats/98870?xid=nl_mpt_confroundup_2022-05-24&eun=g5640205d41r">final results</a> in preliminary form. All 6 tested treatments flunked out: Cenicriviroc, icatibant (Firazyr), apremilast (Otezla), <a href="https://www.nih.gov/news-events/news-releases/nih-trial-anti-cd14-antibody-treat-covid-19-respiratory-disease-begins">IC14</a>, inhaled dornase (Pulmozyme), and celecoxib (Celebrex) plus famotidine (Pepcid).<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Vaccines<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOnsCdXMJfYZjmE7MedHxluhiLFqXx9S8LwiSrHsteqCKqIEh2aAvia3z4bsHoTIs6aSE5bVUA-qKb1gyg1dvICKj6OrTwFz9Y-e3k-pph1o5EWBfA8GYp_AOc-SSwgyJFhxzkoRwL6CAuVO1XxCnIG4IZF2BVcbRiS2GsGUSWQ8WRpd5Y4NBxOvdQ/s3500/Pfizer%20vs.%20Moderna%20for%20kids.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2265" data-original-width="3500" height="207" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOnsCdXMJfYZjmE7MedHxluhiLFqXx9S8LwiSrHsteqCKqIEh2aAvia3z4bsHoTIs6aSE5bVUA-qKb1gyg1dvICKj6OrTwFz9Y-e3k-pph1o5EWBfA8GYp_AOc-SSwgyJFhxzkoRwL6CAuVO1XxCnIG4IZF2BVcbRiS2GsGUSWQ8WRpd5Y4NBxOvdQ/s320/Pfizer%20vs.%20Moderna%20for%20kids.jpg" width="320" /></a></div><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_689" o:spid="_x0000_i1034" style="height: 158pt; visibility: visible; width: 244pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image003.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Children and teens</u>: Moderna’s trial in 5-to-11-year-olds, using two 50 mcg doses of vaccine, <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2203315?">has now been published</a>. Vaccination elicited a strong immune response, and efficacy against clinical COVID-19 during the Delta wave was a very respectable 88% even just 2 weeks after the <b><i>first</i></b> dose. It was also 63% effective in preventing asymptomatic infection, with virtually no sign of waning at 3 months. Unfortunately this trial was pre-Omicron, thus less relevant nowadays. Until recently Pfizer has been the only option for anyone under 18, but now the <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-moderna-and-pfizer-biontech-covid-19-vaccines-children">FDA has conceded</a> an Emergency Use Authorization for Moderna in the 5-17 age group, with 12-to-17-year-olds getting the adult 100 µg dose.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Babies and toddlers</u>: Both Pfizer and Moderna <a href="https://www.nytimes.com/2022/06/17/us/politics/pfizer-moderna-vaccines-kids-fda.html">now have</a> Emergency Use Authorizations for their vaccines for little kids, and the CDC quickly <a href="https://www.nytimes.com/2022/06/18/health/covid-vaccines-children.html?campaign_id=2&emc=edit_th_20220618&instance_id=64499&nl=todaysheadlines&regi_id=19728476&segment_id=96211&user_id=d89c7002526915cc9287fae06e27a284">gave its stamp of approval</a>, so parents of small children will soon have major decisions to make. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">First, should they vaccinate their kiddies? Hard to say, since few small children get COVID-19 at all and they rarely become severely ill. A few helpful figures: as of May 11<sup>th</sup>, <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2022-06-17-18/02-COVID-Fleming-Dutra-508.pdf">202 Americans</a> between 6 months and 5 years old have died from COVID-19; other sources make it roughly as many as from <a href="https://www.medrxiv.org/content/10.1101/2022.05.23.22275458v2.full.pdf">influenza and pneumonia</a>. Parents whose kids have already had COVID-19 need to note that previous infection, especially during the Omicron era, does not give reliable future protection. I can’t give a strong recommendation for or against.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Second, which vaccine should they prefer, if offered the choice? Pfizer said that 3 doses of its hyper-low dose (3 µg) vaccine had <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-biontech-covid-19-vaccine-demonstrates-strong-immune">80% efficacy</a> against Omicron. But that’s absurd, because the so-called efficacy was based on just 10 cases. Moderna’s heftier version using two 25 µg doses <a href="https://www.fda.gov/media/159189/download">has proven</a> only 51% effective against Omicron in children between 6 months and 2 years old, and 37% in 2 to 5-year-olds – more plausible, about what we see in adults. Well over 100 cases had occurred in each age group, making Moderna’s figures much more reliable. Pfizer also has a timing problem: the first two doses don’t even stimulate antibody formation, so kids would be completely unprotected for 3 months after their first shot. I’d personally go for Moderna.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>COVID-19 survivors</u>: <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2118946?query=TOC">Israeli research</a> further confirms that hybrid immunity, the combination of SARS-CoV-2 infection and vaccination, gives stronger and longer-lasting protection than either on their own. But Omicron infection in unvaccinated individuals (<a href="https://www.nature.com/articles/s41586-022-04865-0_reference.pdf">mice, in this study</a>) seems to protect only against the same subvariant that caused the initial infection, though in vaccinated individuals it intensifies the protection against <b><i>all</i></b> variants. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>AstraZeneca</u>: A <a href="https://edition.cnn.com/2022/05/20/health/mrna-vaccine-technology-covid-19-durability/index.html?">recent CNN piece</a> claimed a New England Journal of Medicine article had shown AstraZeneca protected longer against COVID-19 than Pfizer. Yes and no. AstraZeneca’s effectiveness against infection <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2118691">putatively rose</a> from 58% early on to 70% after 134 days, but those numbers were based on such scanty data that the authors themselves minimized their significance. And <span class="MsoHyperlink">we already knew</span> that after 6 months AstraZeneca is utterly useless against Omicron, with Pfizer not much better. I wouldn’t rehabilitate the AstraZeneca vaccine on the basis of this latest study.<o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZqN-_tzwiLqfIdf2-vwt6mEVA9iSySupmhmnXsPj5oxeSWN6v7z2RM8Wli684sd1lJO1h_h6K85ZAQ8DP8LFkktcJcucUpOrCT5pnn3qn4qyZtxbsU39X6V0k2gpeoC0GB_gREel4S_NgiEXjSRgT3U2-SvxSpZzKMeSneMtRb6Ye32SETrfhtLVE/s840/a%20covifenz%20plantation.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="496" data-original-width="840" height="236" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZqN-_tzwiLqfIdf2-vwt6mEVA9iSySupmhmnXsPj5oxeSWN6v7z2RM8Wli684sd1lJO1h_h6K85ZAQ8DP8LFkktcJcucUpOrCT5pnn3qn4qyZtxbsU39X6V0k2gpeoC0GB_gREel4S_NgiEXjSRgT3U2-SvxSpZzKMeSneMtRb6Ye32SETrfhtLVE/w400-h236/a%20covifenz%20plantation.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">A Covifenz plantation</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_690" o:spid="_x0000_i1033" style="height: 268pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image004.jpg"></v:imagedata></v:shape><u><o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Covifenz</u>: The more I think about it, the more puzzled I am that the world’s top medical publication, the New England Journal of Medicine, chose to publish the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2201300?">Phase 3 trial</a> of the Canadian “plant-based” vaccine. I already mentioned the trial’s major weaknesses – enrolling almost nobody over 65 or with comorbidities, and completion before the Omicron surge. But I didn’t notice how much less effective it is not only as compared to the mRNA vaccines but also as compared with the very similar Novavax, until the French expert Benjamin Davido <a href="https://techyinsight.com/a-plant-primarily-based-covid-vaccine-which-sufferers-would-profit/">pointed it out</a> (in an interview whose execrable English screams Google Translate). Novavax has 90% overall efficacy, Covifenz just 70%; efficacy against severe disease 100% vs. 78%. And, remember, that’s in working-age adults, usually the group <b><i>best</i></b> protected by COVID-19 vaccines. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Novavax</u>: This spike protein vaccine is finally <a href="https://www.nytimes.com/2022/06/07/health/novavax-covid-vaccine.html?campaign_id=2&emc=edit_th_20220607&instance_id=63479&nl=todaysheadlines&regi_id=19728476&segment_id=94515&user_id=d89c7002526915cc9287fae06e27a284">nearing Emergency Use Authorization</a> by the FDA, a mere 15 months after interim Phase 3 results began to trickle in, 10 months after the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2107659">first article was published</a>, and 6 months since the best trial <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2116185?query=TOC">published results</a>. Apparently the snail’s pace is due to <a href="https://www.nytimes.com/2022/06/07/health/novavax-covid-vaccine.html">slow vaccine production</a>. Only a handful of doses have been given in the European Union despite authorization, and none of the 1.1 billion doses promised to COVAX have come through. And the <a href="https://www.fda.gov/media/158912/download#page=10">FDA briefing document</a> contains other discouraging surprises: Novavax may cause even more myocarditis than the mRNA vaccines, and manufacturing processes vary so much from plant to plant as to <a href="https://www.fiercepharma.com/manufacturing/novavax-struggling-to-make-covid-19-vax-to-meet-global-demand-report">raise concerns</a> about safety and efficacy.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Covaxin</u>: After Novavax the next vaccine in the pipeline seems to be this home-grown Indian vaccine, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02000-6/fulltext">which claimed</a>an overall efficacy of 78% against any COVID-19 and 93% against severe disease. But as I wrote at the time, efficacy was only 66% in people over 60 or otherwise vulnerable, and only 65% against the Delta variant even in the young – all pre-Omicron. Covaxin is an inactivated whole virus vaccine, like Sinopharm and Sinovac, but a more powerful adjuvant supposedly makes it work better. The FDA is making the company do <a href="https://clinicaltrials.gov/ct2/show/NCT05258669?term=Covaxin&draw=2&rank=3">another trial</a> to see whether the vaccine induces as strong an immune response in an American population as it did in the original Indian trials, and apparently plans to award an Emergency Use Authorization if those results come through. Some think a vaccine based on the whole virus rather than just on the spike protein might be better at neutralizing new variants, but given the poor real-life performance of the Chinese whole-virus vaccines I wouldn’t count on it.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Moderna’s new booster</u>: Moderna <a href="https://www.nytimes.com/2022/04/19/us/politics/moderna-vaccine-beta-variant.html">didn’t do well</a> with a previous attempt at a multivariant vaccine, but now it’s tried again, with a half “regular” and half Omicron-specific booster. According to <a href="https://www.nytimes.com/2022/06/08/us/politics/moderna-vaccine-booster-omicron-variant.html">media reports</a> Moderna has been <a href="https://investors.modernatx.com/news/news-details/2022/Moderna-Announces-Omicron-Containing-Bivalent-Booster-Candidate-mRNA-1273.214-Demonstrates-Superior-Antibody-Response-Against-Omicron/default.aspx">touting</a>a 75% improvement in anti-Omicron antibodies over the ordinary Moderna booster as a brilliant result. A leading virologist called this “<a href="https://www.nytimes.com/2022/06/08/us/politics/moderna-vaccine-booster-omicron-variant.html">only a modest benefit</a>,” and questioned whether a broad fall rollout of the new booster would be worthwhile. After reading the <a href="https://assets.researchsquare.com/files/rs-1555201/v1_covered.pdf?c=1650045900">detailed preprint</a>, though, I see that the results were actually better than that, with Omicron antibodies more than doubling after 4 weeks, and remaining up there for 6 months. Promising. But antibody levels don’t necessarily translate into real-world protection, and those antibodies were against the original Omicron variant, not against the BA.2 and later subvariants now dominating new infections. With new strains popping up practically every month, who knows how relevant those antibodies are even now, much less this fall? <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>How to keep efficacy from waning</u>: An immunologist who studies prolonging immunity has penned a <a href="https://www.nytimes.com/2022/06/13/opinion/covid-immunity.html?campaign_id=2&emc=edit_th_20220613&instance_id=63982&nl=todaysheadlines&regi_id=19728476&segment_id=95062&user_id=d89c7002526915cc9287fae06e27a284">New York Times Op-Ed</a> describing what he considers possible approaches: 1) boost with the <a href="https://www.sciencedirect.com/science/article/pii/S0163445322002006">Johnson & Johnson vaccine</a>, whose protective effect, while relatively low, is relatively steady over time; 2) boost with vaccines like Moderna’s latest, engineered to cover current variants; 3) develop nasal spray vaccines aimed to keep the virus from invading the body; 4) go for universal, all-variant vaccines. The latter option is of course the best, and I was excited to see the author saying universal vaccines have “shown great promise” in animal studies. But the excitement faded when I clicked through and saw he was citing a <a href="https://www.nytimes.com/2021/02/09/health/universal-coronavirus-vaccine.html">Times article</a> from February 2021 and, even worse, that the <a href="https://www.vbivaccines.com/press-releases/preclinical-coronavirus-data-candidate-selection/">data it featured</a> went back all the way to August 2020. A scientist working actively to develop a universal vaccine <a href="https://www.france24.com/en/live-news/20220425-the-quest-for-a-universal-coronavirus-vaccine">estimates</a> a time scale of 2 or 3 years.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Omicron woes<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_677" o:spid="_x0000_i1032" style="height: 197pt; visibility: visible; width: 350pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image005.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrw3P2zNbwa-ZPA1MGRFb-ns-4XGnUggpYCEkOw-DmQPuV0swimg3vFna-0rLyOAqk8YrXieabRHhxg6sRaRYZO6bYTeYCpxb9PIhyY89ZIZA2BGrPI_miv1Ba94U5YRYiysMpewp_QceKXj0qOCNnsGZrFao1exs2Q0O0-j3SN9MJ7k2H4V9TUdyz/s700/Omikron.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="394" data-original-width="700" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrw3P2zNbwa-ZPA1MGRFb-ns-4XGnUggpYCEkOw-DmQPuV0swimg3vFna-0rLyOAqk8YrXieabRHhxg6sRaRYZO6bYTeYCpxb9PIhyY89ZIZA2BGrPI_miv1Ba94U5YRYiysMpewp_QceKXj0qOCNnsGZrFao1exs2Q0O0-j3SN9MJ7k2H4V9TUdyz/s320/Omikron.jpg" width="320" /></a></div><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Yes, the Omicron variant usually causes milder disease, but nonetheless it’s already killed <a href="https://www.nytimes.com/2022/05/31/health/omicron-deaths-age-65-elderly.html?campaign_id=2&emc=edit_th_20220601&instance_id=62861&nl=todaysheadlines&regi_id=19728476&segment_id=93867&user_id=d89c7002526915cc9287fae06e27a284">as many older Americans</a> as Delta!<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The BA.4 and BA.5 subvariants will soon dominate in the US and Europe. They already account for <a href="http://www.quotidianosanita.it/studi-e-analisi/articolo.php?articolo_id=105625">34%</a> of new cases in Italy and <a href="https://covid.cdc.gov/covid-data-tracker/#variant-proportions">22%</a> in the USA and are spreading fast, with the vast majority of the rest the very similar BA.2.12.1. Should we worry? No, because there’s no evidence they cause more severe disease. Yes, because they <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2206725?query=TOC">escape preexisting immunity</a> even better than the highly infectious original, infecting even people who’ve had vaccine boosters or have recovered from earlier strains of Omicron. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_667" o:spid="_x0000_i1031" style="height: 172pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image006.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-Qd1g0oRpeuBVhhTKpqc6hDuPO0FSpQHclvDfdWBl68A5GABPCEbXKKQix4Fk_O9AS0pOvDSwtPnZZ-f5FpqmH7yUF-0kP3F-x8GcPBzTj0GtFPJ7r0_ZOsTae5vzQQ5KGqztNwrgh-emK-NFR5zqH98nfgEo108MCNWpQhgVqu1kMzl9g-GmsIDg/s1560/community%20levels%20vs.%20transmission.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="594" data-original-width="1560" height="244" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-Qd1g0oRpeuBVhhTKpqc6hDuPO0FSpQHclvDfdWBl68A5GABPCEbXKKQix4Fk_O9AS0pOvDSwtPnZZ-f5FpqmH7yUF-0kP3F-x8GcPBzTj0GtFPJ7r0_ZOsTae5vzQQ5KGqztNwrgh-emK-NFR5zqH98nfgEo108MCNWpQhgVqu1kMzl9g-GmsIDg/w640-h244/community%20levels%20vs.%20transmission.jpg" width="640" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">You may remember that in February the CDC stopped tracking the pandemic with the Community Levels of Transmission that showed how many <a href="https://edition.cnn.com/2021/07/28/health/substantial-or-high-covid-19-transmission-wellness/index.html">people were getting sick</a>. The new “Community Levels” sound similar but reflect a very different reality, <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/community-levels.html">the percentage of COVID-19 beds occupied in local hospitals</a>. <a href="https://twitter.com/drericding/status/1497319120567742464?s=11">Waving that magic wand</a>artificially slashed the number of Americans living in high-risk counties. A site calling itself the <a href="https://peoplescdc.org/2022/06/06/peoples-cdc-covid-19-weather-report-7/">People’s CDC</a> did, however keep following the older, more valid measure and constantly updates an <a href="https://peoplescdc.org/2022/06/06/peoples-cdc-covid-19-weather-report-7/">animation</a> tracking the situation. At some point the CDC threw in the towel, <a href="https://covid.cdc.gov/covid-data-tracker/#county-view?list_select_state=all_states&list_select_county=all_counties&data-type=CommunityTransmission&null=Risk">adding back maps</a> using the old parameter. Look at how great the US is doing if you just look at hospital capacity (left) and how poorly it’s actually doing (right). <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">And Congress <b><i>still</i></b> hasn’t approved continued pandemic funding. Dr. Ashish Jha, the White House coronavirus response coordinator, <a href="https://www.thefiscaltimes.com/2022/06/09/White-House-Issues-New-Warning-Covid-Funding">told reporters</a> he’s worried about what could happen later this year. “<a name="OLE_LINK4">What keeps me awake at night</a>, it is that we are going to run out of vaccines,” he said. “We’re not going to be able to have enough of the next generation of vaccines. We’re going to run out of treatments. And we’re going to run out of diagnostic tests, probably in the late fall into winter, if we end up having a significant surge of infections.”<o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHCQigrwAQHDRIm8IY0XDOftKH5ikIz-WDiBQ_ViJI5e-X1J7-I9IFkKGihHv4nmR5eIZvDVMbyxKapVJkNWudqIISx7D85oUxzvg7IPtydqGF2uX4oR8vDw_zE4ehp0fu6l2OlrujhCKvpV8NQZsEtQrOeW-q-S7C_d7KpDFV16M0IP0z-v9KNxrl/s904/new%20cases%20May%2015-29.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="722" data-original-width="904" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHCQigrwAQHDRIm8IY0XDOftKH5ikIz-WDiBQ_ViJI5e-X1J7-I9IFkKGihHv4nmR5eIZvDVMbyxKapVJkNWudqIISx7D85oUxzvg7IPtydqGF2uX4oR8vDw_zE4ehp0fu6l2OlrujhCKvpV8NQZsEtQrOeW-q-S7C_d7KpDFV16M0IP0z-v9KNxrl/w400-h320/new%20cases%20May%2015-29.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">New cases May 15-29</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://www.epicentro.iss.it/coronavirus/bollettino/Bollettino-sorveglianza-integrata-COVID-19_31-maggio-2022.pdf">Italy’s map</a> looks like the US one, though it covers two weeks rather than one:<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_670" o:spid="_x0000_i1030" style="height: 128pt; visibility: visible; width: 161pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image007.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">But since deep red means 250+ weekly cases per 100,000 in Italy and only 100+ in the US, Italy is likely doing worse. We can’t know for sure given the increasing dependence in both countries on do-it-yourself tests, but I can tell you that not a day goes by without someone consulting me about a positive test, and that my secretaries tell me patients are cancelling appointments left and right because they have COVID.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The latest CDC guidelines let COVID-19 patients go back to work after 5 days and get on a plane after 10 days, with nary a swab. I’ve always had serious doubts about such leniency, and <a href="https://heromag.net/covid-19-can-leave-you-infectious-after-five-or-even-10-days">they're only increasing</a>. We’ve known for months that <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7108a3.htm">more than half</a> of Omicron patients still <a href="https://www.medrxiv.org/content/10.1101/2022.02.01.22269931v1.full.pdf">test positive</a> after the 5-day mark, with somewhere between <a href="https://www.medrxiv.org/content/10.1101/2022.04.04.22273429v1.full.pdf">17%</a>and <a href="https://www.medrxiv.org/content/10.1101/2022.03.01.22271582v1.full.pdf">60%</a> still shedding live virus. Now it turns out that some patients remain positive on antigen tests for more than 10 days, some as long as <a href="https://www.medrxiv.org/content/10.1101/2022.05.19.22274968v1.full.pdf">14 days</a>, a <a href="https://www.nytimes.com/2022/05/29/health/coronavirus-testing-positive.html?">reasonable</a> sign that they’re still infectious… The 10-day contagious period was with earlier variants; if Omicron sticks around longer that helps explain why it spreads like wildfire.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Italy was poised to eliminate all mask mandates on June 16<sup>th</sup>, but faced with huge case numbers they’ve had the good sense to back off a mite, requiring KN-95 masks on buses, subways, and trains through September. Not on planes, because ventilation in the air has been markedly improved. But unfortunately they’re <a href="https://www.italia.it/en/covid19">insisting on</a> letting audiences at indoor shows and sporting events sit for hours unmasked and undistanced.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Herd immunity: fantasy and reality<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_640" o:spid="_x0000_i1029" style="height: 219pt; visibility: visible; width: 390pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image008.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYJ_bETVrzGaOyMWbZYYc_vqEnagrkWiWPYCMeKFh4SekE0X_E6AK4_hLu_2htcNyAb1s-_5FzuQZRRhGVLVZVL56K2jB5k01mQpShgHe14Z8NQoOOuQSox6zM7MuODElSg7tY0wdxkM_6OulpXH4Yk7B_YHRiEyy6NgfTaAzrmKaK28nBIFh0Je1m/s963/GBD%20authors%20with%20Azar.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="541" data-original-width="963" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYJ_bETVrzGaOyMWbZYYc_vqEnagrkWiWPYCMeKFh4SekE0X_E6AK4_hLu_2htcNyAb1s-_5FzuQZRRhGVLVZVL56K2jB5k01mQpShgHe14Z8NQoOOuQSox6zM7MuODElSg7tY0wdxkM_6OulpXH4Yk7B_YHRiEyy6NgfTaAzrmKaK28nBIFh0Je1m/w400-h225/GBD%20authors%20with%20Azar.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Great Barrington Declaration authors meeting with Trump's HHS Secretary Alex Azar</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The let-her-rip mirage of herd immunity from natural infection turns out to have been even more deeply embedded in the Trump White House than we knew. Remember the Great Barrington Declaration? The one saying everybody except the aged and the frail should go out and get COVID-19 on purpose? <a href="https://twitter.com/malar0ne/status/1494736249692643328">It's been revealed</a> that its authors met twice with the Trump pandemic team in the White House while the President was critically ill in the hospital. And that they had a meeting with the Man himself in August 2020, kept secret for more than a year. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">But how about real herd immunity, the kind that comes when so many people are immune that a germ can’t find anybody to infect? Anthony Fauci suggested early in the pandemic that we might reach that point when 70% of the population had been vaccinated. He admitted later this was a deliberately overoptimistic underestimate, updated that estimate to 80%, and hinted that 90% might be even more realistic. Now, though, he and two colleagues <a href="https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiac109/6561438">are arguing</a>that the herd immunity concept might never apply to COVID-19. Human populations can have herd immunity against polio, smallpox, and measles because those viruses meet two criteria: only one form of the virus exists stably over time, and both vaccination and natural infection give long-lasting or even lifelong immunity. SARS-CoV-2, alas, flunks (or wins) on both counts. It’s been mutating like mad starting a year after it first appeared, vaccine efficacy starts falling off within a few months, and infection is less protective than had been hoped – especially against different variants. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Wonking out about excess mortality<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjaklTL9BIcJuvez3IdNncx1_fJrZ6tOpgLCSVGwcTDpMVkOUznGJpnZtNX4GTz_Gb8h7p2_pZzKyUOtYm5hWmX4kF3JgumgkpmONQUQUz49pLAK8Z-114vJWvJAbI5zCxiqx5d1V2GxJGOmRoV8-qTICS7BnfvFd8SdacBxg9lxcuwic0_ls9e4Itt/s1728/excess%20mortality%20Our%20World%20In%20Data.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1022" data-original-width="1728" height="378" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjaklTL9BIcJuvez3IdNncx1_fJrZ6tOpgLCSVGwcTDpMVkOUznGJpnZtNX4GTz_Gb8h7p2_pZzKyUOtYm5hWmX4kF3JgumgkpmONQUQUz49pLAK8Z-114vJWvJAbI5zCxiqx5d1V2GxJGOmRoV8-qTICS7BnfvFd8SdacBxg9lxcuwic0_ls9e4Itt/w640-h378/excess%20mortality%20Our%20World%20In%20Data.jpg" width="640" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_659" o:spid="_x0000_i1028" style="height: 268pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image009.jpg"></v:imagedata></v:shape>I told you a couple of posts back that a distinguished group of scientists had <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02796-3/fulltext">estimated</a> the true number of worldwide deaths due to the pandemic in 2020-2021 as around 18 million. Now a different group, convened by the World Health Organization, has come up with the very similar <a href="https://www.who.int/data/stories/global-excess-deaths-associated-with-covid-19-january-2020-december-2021">14.9 million</a>. Nearly a <a href="https://www.nytimes.com/2022/05/05/health/covid-global-deaths.html?campaign_id=2&emc=edit_th_20220506&instance_id=60580&nl=todaysheadlines&regi_id=19728476&segment_id=91436&user_id=d89c7002526915cc9287fae06e27a284">third of those deaths</a> were in India, making the real human cost of the pandemic 10 times what that country claimed.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">But there is an oddity buried in the WHO figures: Germany’s excess mortality is estimated as higher than the UK’s, much higher than the French, and nearly at Italian and American levels. This is very different from <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Metric=Deaths+and+excess+mortality&Interval=Cumulative&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~USA~DEU~GBR">the figures</a> – above – at the Our World In Data website that is my pandemic Bible.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">There is an explanation, as a kindly OWID statistician informed me:<o:p></o:p></p><p class="1obc" style="font-size: medium; margin: 5pt 6pt 5pt 0.5in;">“The WHO estimates <i>higher</i> excess mortality in Germany because they estimate a <i>lower</i> baseline number of expected deaths for 2020–2021 (had the pandemic not occurred). This gives higher excess deaths, even when using the same numbers for reported (actual) deaths, because excess deaths = reported deaths – expected deaths. <a href="https://twitter.com/paulmainwood/status/1522482273085440000?s=21&t=y0_Axi1TUo-yAwvOLCwaKg" target="_blank">This Twitter thread</a> explains a bit more what I mean.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">That fascinating Twitter thread features these very different-looking curves:<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_660" o:spid="_x0000_i1027" style="height: 211pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image010.jpg"></v:imagedata></v:shape><v:shape id="Picture_x0020_664" o:spid="_x0000_i1026" style="height: 197pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image011.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKLOAd4BrfWGWynpDRz9I1W5xUW6BvfPdekNF2VBg5OcQWbBIkd303WyDqOo_sPVOupYFa2REtaMEn_92c6eEjy1bQTrPSNgkW5uZ5llD6DY5N8S3ENTJx6wRKwd0fSPRVEfTab8pEWPT014zFt4OvIWiQiBAHx3WBir_feQ4iWGBMvf79CyLNuWbJ/s2260/UK%20excess%20mortality.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1054" data-original-width="2260" height="186" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKLOAd4BrfWGWynpDRz9I1W5xUW6BvfPdekNF2VBg5OcQWbBIkd303WyDqOo_sPVOupYFa2REtaMEn_92c6eEjy1bQTrPSNgkW5uZ5llD6DY5N8S3ENTJx6wRKwd0fSPRVEfTab8pEWPT014zFt4OvIWiQiBAHx3WBir_feQ4iWGBMvf79CyLNuWbJ/w400-h186/UK%20excess%20mortality.jpg" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNnOGasTYEgxRgxPUGKPWhKG_8we-2gwtWNLjWYy4PJ-i7GPgVdq2MAtpP2LkvVuHQfYOEWQIbrTEnwnPFezyAB3RO3_iLYUhHrMcxw_SF9sE2aaj4I2CeWOIsulW3aRpjMoDT0MwqKJykoTmgoR8sxDdD-MJhebyKX11u3FVMydrl4PcEORZduxsy/s2264/Germany%20excess%20mortality.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="982" data-original-width="2264" height="175" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNnOGasTYEgxRgxPUGKPWhKG_8we-2gwtWNLjWYy4PJ-i7GPgVdq2MAtpP2LkvVuHQfYOEWQIbrTEnwnPFezyAB3RO3_iLYUhHrMcxw_SF9sE2aaj4I2CeWOIsulW3aRpjMoDT0MwqKJykoTmgoR8sxDdD-MJhebyKX11u3FVMydrl4PcEORZduxsy/w400-h175/Germany%20excess%20mortality.jpg" width="400" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><p class="1obc" style="font-size: medium; margin-right: 6pt;">The German one sure looks suspicious, as though OWID was cheating when it gave Germany a good report card. But Germany has reported very few COVID-19 deaths despite using <a href="https://newseu.cgtn.com/news/2020-04-18/How-do-different-countries-calculate-their-COVID-19-death-rates--PM3ur6PEtO/index.html">explicitly inclusive criteria</a>: “Germany's case numbers include those who died ‘of’ COVID-19, and those who died ‘with’ the disease.” This suggested to me that the WHO might be wrong after all, with Germany really having low excess mortality during the pandemic.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">In fact!!! The WHO received so much flak about their German numbers that it has had to eat humble pie, recalculate, and <a href="https://www.nature.com/articles/d41586-022-01526-0">admit it messed up</a>. Its new estimate for excess mortality in Germany is a whopping 37% lower than the original one.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Editorial chicanery<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_665" o:spid="_x0000_i1025" style="height: 177pt; visibility: visible; width: 282pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image012.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGPNPkRYKgsbomSeA7lvcHmNZ9A4qDY7YMCt23AsM9grxeqarfChBmxAquNJlqHaNObumAHCFKdrY8fF7ua-J68D4q9h3CngnaW9ZABIve0KkbTfBcqch2BEZ5QO_h-RzoViJdGnMWuyhK7D0JKgnuNvQA3Tmptgt5IQYCGVEX9dg6DvBLimikU14_/s1020/Blaylock%20and%20his%20book.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="640" data-original-width="1020" height="201" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGPNPkRYKgsbomSeA7lvcHmNZ9A4qDY7YMCt23AsM9grxeqarfChBmxAquNJlqHaNObumAHCFKdrY8fF7ua-J68D4q9h3CngnaW9ZABIve0KkbTfBcqch2BEZ5QO_h-RzoViJdGnMWuyhK7D0JKgnuNvQA3Tmptgt5IQYCGVEX9dg6DvBLimikU14_/s320/Blaylock%20and%20his%20book.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Russell Blaylock and his kooky book</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">In what in medical publishing amounts to an astonishing abuse of power, the <a href="https://www.mcgill.ca/oss/article/controversial-science-health-news-supplements/seems-neurosurgeons-are-not-immune-neuroses">notorious</a> retired neurosurgeon <a href="https://en.wikipedia.org/wiki/Russell_Blaylock">Russell L. Blaylock</a>, Assistant Editor-In-Chief of a <a href="https://www.discovermagazine.com/mind/right-wing-brain-surgeons-the-case-of-surgical-neurology-international">weird</a> journal called Surgical Neurology International, has published <a href="https://surgicalneurologyint.com/wp-content/uploads/2022/04/11548/SNI-13-167.pdf">a bizarre rant</a> about COVID-19 as an editorial in his journal, often citing papers that directly contradict his conclusions (see this withering <a href="https://twitter.com/gidmk/status/1527438419193868288?">Twitter thread</a>). Here goes:<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->The virus was “engineered” to “deliberately kill and cripple millions.” <o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Natural immunity is lifelong<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->The media is under the control of those benefitting from this “pandemic”<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->“Federal medical bureaucracies (CDC, FDA, NIAID, NIH, etc) did all in their power to prevent life- saving early treatments” because “Letting patients deteriorate to the point they needed hospitalization, meant big money for all hospitals”<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Masking, lockdowns, even testing, are “of little or no use”<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Hydroxychloroquine and ivermectin are “life-saving”<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->mRNA vaccines are “essentially untested”<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Vaccines cause cancer<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Vaccines alter your DNA<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Vaccines have killed hundreds of thousands<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Vaccines spread “deadly nano-lipid carriers” throughout the body<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l35 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->“Special deadly lots (batches) of these vaccines are mixed with the mass of other Covid-19 vaccines”<o:p></o:p></p>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com2tag:blogger.com,1999:blog-6211405954943098401.post-90963299445953158422022-05-22T19:39:00.002+02:002022-05-22T19:39:24.805+02:00Doubter Docs, Fauci Ouchies<p style="text-align: center;"> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5v6mMeGy3c9vuKtMIrRvWLBXblJnlevNpesbz1mUPt8JPMz79ocbjATRWUg02zxHS-GHrwS5M9l1NDYVLzOlQ3sAfOoq8qhBFDPoEjHM4TcZFddqJYAXg9C1ZQNlK_nS81gcuHl7lk1ExVhklp7aTT8lZPUCyjicaW0OG57voBtuWGQ2H2lO2VWUn/s1600/novax%20doctor+++.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="900" data-original-width="1600" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5v6mMeGy3c9vuKtMIrRvWLBXblJnlevNpesbz1mUPt8JPMz79ocbjATRWUg02zxHS-GHrwS5M9l1NDYVLzOlQ3sAfOoq8qhBFDPoEjHM4TcZFddqJYAXg9C1ZQNlK_nS81gcuHl7lk1ExVhklp7aTT8lZPUCyjicaW0OG57voBtuWGQ2H2lO2VWUn/w400-h225/novax%20doctor+++.jpg" width="400" /></a></div><br /><p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Lots on vaccines and treatments. Doubter docs and illustrious superspreaders. Mysteries of New York mayors, Delta Airlines, and Italy. A rare Fauci slip-up... plus the inevitable extras.</p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b><o:p> </o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>Treatment news<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxekfwW-ELFLor1fbB_DTFDCN7wst-sdn3myym9zZLUvS2qUE1C00umKwJftSJvVddCKizws0sVj1yVUu0KJd46RxsLcjcqn9SS5K6xETgx0Tobdfwx8qne6BI9FPNlps5Y0ffGgE4hyKfFYJb7CirnuCk55QSKMKpBdBEh2ZWQAk4Hw2zIqY9pA-n/s800/Paxlovid%20on%20pharmacy%20shelf.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="608" data-original-width="800" height="304" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxekfwW-ELFLor1fbB_DTFDCN7wst-sdn3myym9zZLUvS2qUE1C00umKwJftSJvVddCKizws0sVj1yVUu0KJd46RxsLcjcqn9SS5K6xETgx0Tobdfwx8qne6BI9FPNlps5Y0ffGgE4hyKfFYJb7CirnuCk55QSKMKpBdBEh2ZWQAk4Hw2zIqY9pA-n/w400-h304/Paxlovid%20on%20pharmacy%20shelf.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Fetching a box of Paxlovid</td></tr></tbody></table><b><br /></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b><span><v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f"><v:stroke joinstyle="miter"><v:formulas><v:f eqn="if lineDrawn pixelLineWidth 0"><v:f eqn="sum @0 1 0"><v:f eqn="sum 0 0 @1"><v:f eqn="prod @2 1 2"><v:f eqn="prod @3 21600 pixelWidth"><v:f eqn="prod @3 21600 pixelHeight"><v:f eqn="sum @0 0 1"><v:f eqn="prod @6 1 2"><v:f eqn="prod @7 21600 pixelWidth"><v:f eqn="sum @8 21600 0"><v:f eqn="prod @7 21600 pixelHeight"><v:f eqn="sum @10 21600 0"></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:formulas><v:path gradientshapeok="t" o:connecttype="rect" o:extrusionok="f"><o:lock aspectratio="t" v:ext="edit"></o:lock></v:path></v:stroke></v:shapetype><v:shape id="Picture_x0020_676" o:spid="_x0000_i1043" style="height: 304pt; visibility: visible; width: 400pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image001.jpg"></v:imagedata></v:shape></span><span><o:p></o:p></span></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Paxlovid</u>: Even in the United States, where there’s plenty available, most Paxlovid doses are remaining on pharmacy shelves even while those <a href="https://www.washingtonpost.com/health/2022/04/26/paxlovid-availability-expansion/" style="color: #954f72; text-decoration: underline;">most in need</a> are often <a href="https://khn.org/news/article/paxlovid-covid-pill-antiviral-access-data/" style="color: #954f72; text-decoration: underline;">unable to access it</a>. Unless, of course, they’re wealthy and well-connected – take Kamala Harris. She was given a course after testing positive for SARS-CoV-2, despite being young, healthy, and asymptomatic. <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">On the positive side, use is picking up now, with prescription rates in the US <a href="https://eu.usatoday.com/story/news/2022/04/26/administration-pledges-provide-more-life-saving-covid-antivirals/7444064001/" style="color: #954f72; text-decoration: underline;">more than doubling</a> month by month and more than 500,000 antiviral courses used by April 25<sup>th</sup>. By now the drug has been taken by about 0.6% of all patients with confirmed cases.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Italy is no longer making potential users go to a hospital to consult an infectious disease specialist and pick up the box of pills, but instead trusts primary care physicians to prescribe it correctly and have ordinary pharmacies stock it. This may or not be a wise choice given the <a href="https://www.amazon.com/Dottoressa-American-Doctor-Susan-Levenstein/dp/1589881397" style="color: #954f72; text-decoration: underline;">limited training</a> of Italian GPs. As of a month ago only <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/demand-pfizers-covid-pills-lags-around-world-2022-04-19/" style="color: #954f72; text-decoration: underline;">8300 Italians</a> had received Paxlovid, 0.15% of confirmed cases. So we can roughly estimate that if the drug is being underused in the USA, the underuse is 4 times worse in Italy.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">On the negative side: To start with, when given to healthy people living in the same household with COVID-19 cases, Paxlovid <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-shares-top-line-results-phase-23-epic-pep-study" style="color: #954f72; text-decoration: underline;">doesn’t keep them</a> from getting sick – I don’t see why anybody would have thought it could. Also, if the drug is used very widely it could push the SARS-CoV-2 virus to evolve into <a href="https://www.bmj.com/content/377/bmj.o1037.short?rss=1" style="color: #954f72; text-decoration: underline;">drug-resistant strains</a>, as happens with antibiotics. Furthermore, the studies showing brilliant results for antivirals were performed in unvaccinated COVID-19-naïve patients, so we really don’t know how effective these drugs are in preventing patients who have some immunity from vaccination or previous infections, who by now are most people in the Western world – as <a href="https://www.statnews.com/2022/05/18/does-paxlovid-help-people-who-have-been-vaccinated-against-covid-19/?utm_campaign=rss" style="color: #954f72; text-decoration: underline;">one commentator wrote</a>, “Show Us The Data!”<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Finally, about 2% of patients have some degree of <a href="https://blogs.jwatch.org/hiv-id-observations/index.php/more-on-relapses-after-paxlovid-treatment-for-covid-19/2022/05/04/?cid=DM1028702_Subscriber&bid=970788495" style="color: #954f72; text-decoration: underline;">relapse</a> after completing a course of Paxlovid. Most of the time that just means antigen tests returning positive, but in other cases the person actually becomes ill again. <a href="https://blogs.jwatch.org/hiv-id-observations/index.php/yes-relapses-after-paxlovid-happen-now-what/2022/04/25/" style="color: #954f72; text-decoration: underline;">What to do</a>? Ignore the relapses, given that they are almost never severe and that the patient’s own immune system is likely to kick in and knock out the virus? Prolong the standard treatment from 5 days to 6 or 7? Or offer symptomatic relapsers a second 5-day course? <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Convalescent plasma</u>: If you’re confused about whether infusions of convalescent plasma help COVID-19 patients, you’re not alone. Two experts think we still don’t know, and try to make sense of various discrepant results in a New England Journal of Medicine <a href="https://www.nejm.org/doi/full/10.1056/NEJMe2204332?query=TOC&cid=NEJM%20eToc,%20May%205,%202022%20DM1008104_NEJM_Subscriber&bid=961507844" style="color: #954f72; text-decoration: underline;">editorial</a>. Probably locally-sourced plasma could decrease deterioration in high-risk patients by 25%-50%, and could find appropriate use in developing countries lacking easy access to antivirals.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Remdesivir</u>: The <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00519-0/fulltext" style="color: #954f72; text-decoration: underline;">final results</a> from the World Health Organization’s large Solidarity trial clarify its role in hospitalized patients: useless for patients already on ventilators, but capable of slightly decreasing the risk of winding up on one. This borderline effect is far inferior to its <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2116846" style="color: #954f72; text-decoration: underline;">splendid performance</a> in outpatients.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Inhaled interferon beta</u>: After good results in a <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30511-7/fulltext" style="color: #954f72; text-decoration: underline;">Phase 2 trial</a> among hospitalized patients, Synairgen’s innovative product has <a href="https://www.biospace.com/article/bms-synairgen-clinical-trials-fail-to-perform-as-expected/" style="color: #954f72; text-decoration: underline;">cratered in Phase 3</a>, not getting patients discharged faster or preventing mechanical ventilation or death. Some subgroups of patients did seem to benefit, so the company hasn’t yet thrown in the sponge.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>S-217622</u>: A new oral antiviral developed in Japan <a href="https://www.biorxiv.org/content/10.1101/2022.02.14.480338v1" style="color: #954f72; text-decoration: underline;">hastens recovery</a> from COVID-19 . . . if you’re a hamster. In a small <a href="https://www.contagionlive.com/view/shionogi-s-oral-antiviral-s-217622-rapidly-clears-covid-19-virus" style="color: #954f72; text-decoration: underline;">Phase 1-2 trial</a> in human patients, it helped clear the virus more quickly but did little or nothing in the way of symptom relief. A multinational <a href="https://www.businesswire.com/news/home/20220316005123/en/ACTG-and-Shionogi-Announce-Progress-on-Global-Phase-3-Trial-of-Novel-COVID-19-Oral-Antiviral-Agent-S%E2%80%91217622" style="color: #954f72; text-decoration: underline;">Phase 3 trial</a> could conceivably come up with better results.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Ensovibep</u>: This Swiss intravenous antiviral is new to me, though <a href="https://investors.molecularpartners.com/news-releases/news-release-details/molecular-partners-and-novartis-report-positive-topline-data" style="color: #954f72; text-decoration: underline;">Novartis announced</a> promising Phase 2 results (78% reduction in clinical worsening) back in January. It had already flunked out in hospitalized patients, and the company says it <a href="https://www.evaluate.com/vantage/articles/news/deals/bad-day-molecular-partners" style="color: #954f72; text-decoration: underline;">may not be willing</a> to go forward with the Phase 3 trials that would be needed for authorization in the US or the EU.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>Vaccine news<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b><span><v:shape id="Picture_x0020_675" o:spid="_x0000_i1042" style="height: 245pt; visibility: visible; width: 327pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image002.jpg"></v:imagedata></v:shape></span><span><o:p></o:p></span></b></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4hFwbFM82Fb_z4ezICBhcZ1jV5rOOYX3_GvxwxHWwYxWcHH4CR868f66WGrviiD2oxRIsYhD2wrBpMRiLDWxPtscHpD_qvHuInT2R86T72Zi6ZTVWN2FXkyDWIhYxGrXWNZx95tWs4PSVBHhMgbXXa9RUzNDFn_DHhArCz-S9PwxaAeFefMIbnIAX/s1600/developers%20of%20corbevax.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1200" data-original-width="1600" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4hFwbFM82Fb_z4ezICBhcZ1jV5rOOYX3_GvxwxHWwYxWcHH4CR868f66WGrviiD2oxRIsYhD2wrBpMRiLDWxPtscHpD_qvHuInT2R86T72Zi6ZTVWN2FXkyDWIhYxGrXWNZx95tWs4PSVBHhMgbXXa9RUzNDFn_DHhArCz-S9PwxaAeFefMIbnIAX/s320/developers%20of%20corbevax.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Peter Hotez and Maria Elena Bottazzi, the developers of Corbevax </td></tr></tbody></table><p class="1obc" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Second boosters</u>: The World Health Organization is <a href="https://www.who.int/news/item/17-05-2022-interim-statement-on-the-use-of-additional-booster-doses-of-emergency-use-listed-mrna-vaccines-against-covid-19">now saying</a> they are probably beneficial for “highest risk groups,” especially the immunosuppressed, while emphasizing how little we know. The CDC, on the other hand, is expanding its recommendations, advising <a href="https://www.nytimes.com/2022/05/20/us/politics/cdc-second-booster.html?smid=url-share">everybody 50 and over</a> to get a second booster 4 months after their first one. We now have some important new data on real-world effectiveness from 3 Israeli studies performed during the Omicron surge. </p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPJd3FnkcKujwNm_6hkzmO3HVUPfminDrqMwlSZO1ZMFGA18BZm_OrT6rZRQFQ1RSLFbs2LU_ew67qr7rXaJ7SdUkLbM69XjZRYoOX4ohmrQ_2b7LPxkgUaObbFSoB23MgKLZIR8LvfCQ4HZk0Qdsuh4WHatqeq7sDN_mUOjzENM-DXWCBq-W7Nj6y/s1800/Israel%202nd%20booster%20%3E60.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1070" data-original-width="1800" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPJd3FnkcKujwNm_6hkzmO3HVUPfminDrqMwlSZO1ZMFGA18BZm_OrT6rZRQFQ1RSLFbs2LU_ew67qr7rXaJ7SdUkLbM69XjZRYoOX4ohmrQ_2b7LPxkgUaObbFSoB23MgKLZIR8LvfCQ4HZk0Qdsuh4WHatqeq7sDN_mUOjzENM-DXWCBq-W7Nj6y/w400-h239/Israel%202nd%20booster%20%3E60.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Israeli study #1</td></tr></tbody></table><p class="1obc" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_672" o:spid="_x0000_i1041" style="height: 176pt; visibility: visible; width: 297pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image003.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2201570" style="color: #954f72; text-decoration: underline;">The first</a> looked at all 1,252,331 citizens over 60 who had received a first Pfizer booster dose 4 or more months earlier and were eligible for a second one. Those who got it were half as likely to become infected with SARS-CoV-2 than those who had not, but the benefit wore off by 7 weeks. They were also a quarter as likely to develop severe COVID-19, at least for 6 weeks. This was not a randomized study, though, and people who chose to get their 4<sup>th</sup> shot were older, and probably sicker, than those who didn’t. <o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoFTyNxorfVuia2XwnsPc0frVLK4QmXW0dWplc2lVkHkjeXyJSaxGu91fGlo-kWEw0pxAg2vodcwrLAW9vINdUlVsG8Mjrb4rt6YxlK0UR5eZVStSkKk7BBVaSu2n3Ggk1Un7HMV3eJ18CpGTEqphHZ7EDEzaRV6AAnhN3dklVU14GfAxouR559Qh8/s2090/israeli%20insurance%20co%20no.%202.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="902" data-original-width="2090" height="174" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoFTyNxorfVuia2XwnsPc0frVLK4QmXW0dWplc2lVkHkjeXyJSaxGu91fGlo-kWEw0pxAg2vodcwrLAW9vINdUlVsG8Mjrb4rt6YxlK0UR5eZVStSkKk7BBVaSu2n3Ggk1Un7HMV3eJ18CpGTEqphHZ7EDEzaRV6AAnhN3dklVU14GfAxouR559Qh8/w400-h174/israeli%20insurance%20co%20no.%202.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Israeli study #2</td></tr></tbody></table><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_674" o:spid="_x0000_i1040" style="height: 196pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image004.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><a href="https://www.medrxiv.org/content/10.1101/2022.03.24.22272835v1.full.pdf" style="color: #954f72; text-decoration: underline;">The second</a>, from a large insurance company, had a relatively long 10-week follow-up on 97,499 people over 60, of whom about 1/3 received a second booster. The 4<sup>th</sup> dose gave an additional 64% protection against infection, which began to wane a month after the shot and by 10 weeks had fallen to 29%. Protection against severe COVID-19 and death, however, if anything strengthened over the course of the study, rising from 73% at one week to 86% at 7 weeks. This study did have health information, and confirmed my suspicion that individuals who chose to receive a second booster had more chronic conditions than those who did not. <o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKWDbrB716zym-sv2OOiIa0DvSyXjD3YxQXo23xHftMKAsjeWCuQYyvJ2vbV_0RzhPAmwOFFT7RpELGhjlrEIW9D1r0R7GeDj6AJUa-OY4Y94EAP_0SY1o4IIbFriVDEjxHviGlIAm0QZ0VvagX_5TSiaoEslvuPPLqWWmQBbRTiKGVnIX22-arFvI/s1798/Israel%20insurance%20co%20%3E60.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="764" data-original-width="1798" height="170" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKWDbrB716zym-sv2OOiIa0DvSyXjD3YxQXo23xHftMKAsjeWCuQYyvJ2vbV_0RzhPAmwOFFT7RpELGhjlrEIW9D1r0R7GeDj6AJUa-OY4Y94EAP_0SY1o4IIbFriVDEjxHviGlIAm0QZ0VvagX_5TSiaoEslvuPPLqWWmQBbRTiKGVnIX22-arFvI/w400-h170/Israel%20insurance%20co%20%3E60.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Israeli study #3</td></tr></tbody></table><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_673" o:spid="_x0000_i1039" style="height: 193pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image005.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><a href="https://www.nature.com/articles/s41591-022-01832-0_reference.pdf" style="color: #954f72; text-decoration: underline;">The third</a><span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"> study</span>, from a different insurance company, had similar findings, though only over 40 days, on 563,465 older people, of whom 58% had received that second booster. The 4<sup>th</sup> dose lowered hospitalizations by 64% and deaths by 78% as compared with 3 doses.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Having had a 4<sup>th</sup> shot myself last month I find these studies somewhat reassuring, in that the 10-week boost in preventing severe disease is less fleeting than I’d feared. But the second booster seems to wane sooner than the first one, the first one waned sooner than the original course of vaccines, and I fear this pattern will continue with future boosters of the same mRNA vaccines. We can’t be going back for boosters every month or two. So I still think that until we have boosters that give multivariant immunity individuals who are neither elderly, immunocompromised, or chronically ill should hold off on those second boosters unless they’re about to travel, attend a conference with unmasked people, or otherwise be put at particularly high risk.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Johnson & Johnson</u>: The news is mixed. Good: two doses were <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2202061?query=TOC&ssotoken=U2FsdGVkX18mfjK6ovh1sfnU8d68jOe%2FqCtxlRt1%2BzBhKlw9KVQQhOry2X3lcfKfOa6wesdZEU8VQnzHKLBqanDOXl2%2FmVM3cWCz%2BrEwGPFS6S3xFTkgbj5tbBXmFuzG11RIl%2BXCEYSI3TGnbd%2FETM2hoE5MWht%2FTQLCkspKJ9S5dodbCVGTidJbUaxq1RHr1pux2JO0jZpuCsBpwjamZg%3D%3D&cid=NEJM%20eToc,%20May%205,%202022%20DM1008104_NEJM_Subscriber&bid=961507844" style="color: #954f72; text-decoration: underline;">just as effective</a> as 2 doses of Pfizer against severe disease during the Omicron surge in South Africa. J&J should probably have been two-dose all along. Bad: the US Food and Drug Administration has <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-limits-use-janssen-covid-19-vaccine-certain-individuals" style="color: #954f72; text-decoration: underline;">further limited</a> its use, citing the risk of thrombosis with thrombocytopenia syndrome (blood clots), which have been documented in 60 Americans and killed 9. Now the FDA recommends it be given only to adults who are ineligible for mRNA vaccines, cannot obtain them, or say J&J is the only vaccine they would accept.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Valneva</u>: The makers of this French whole-virus vaccine already got my goat by <a href="https://valneva.com/press-release/valneva-reports-positive-phase-3-results-for-inactivated-adjuvanted-covid-19-vaccine-candidate-vla2001/" style="color: #954f72; text-decoration: underline;">palming off</a> Phase 1-2 trial results as “Phase 3.” There is <b><i>still</i></b> no true Phase 3 trial in the works and the European Union <a href="https://www.fiercepharma.com/pharma/valneva-covid-19-vaccine-faces-uncertain-future-after-europe-cancels-supply-contract" style="color: #954f72; text-decoration: underline;">has cancelled its contract</a>, though the United Arab Emirates and perhaps the UK will <a href="https://valneva.com/press-release/valneva-receives-emergency-use-authorization-from-the-united-arab-emirates-for-its-inactivated-covid-19-vaccine/" style="color: #954f72; text-decoration: underline;">give it a try</a>.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Convidecia (CanSino)</u>: The World Health Organization has <a href="https://www.who.int/news/item/19-05-2022-who-validates-11th-vaccine-for-covid-19" style="color: #954f72; text-decoration: underline;">green lighted</a> emergency use of this one-dose Chinese viral vector vaccine on the basis of Phase 3 trials showing 58% efficacy against symptomatic wild-strain COVID-19; unfortunately only 7.9% of trial volunteers were over 60. It’s the <a href="https://covid19.trackvaccines.org/agency/who/" style="color: #954f72; text-decoration: underline;">11<sup>th</sup> COVID-19 vaccine</a> to get the WHO nod.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Novavax</u>: Unbeknownst to me, this vaccine <a href="https://www.bbc.com/news/health-61045810" style="color: #954f72; text-decoration: underline;">arrived in Europe</a>, including Italy, toward the end of February. It hasn’t exactly caught on, rarely hitting 300 doses a day in Italy (vs. Pfizer’s 30,000+). It may <a href="https://fortune.com/2022/03/07/fourth-covid-vaccine-novavax-anti-vax-protein-mrna/" style="color: #954f72; text-decoration: underline;">soon get</a> an Emergency Use Authorization in the United States as well.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Covifenz</u>: The new Canadian vaccine I mentioned a few posts back, touted as “plant-based” because it uses tobacco plants to produce the spike protein, has now been confirmed in a <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2201300?" style="color: #954f72; text-decoration: underline;">Phase 3 study</a> to be 70% effective against symptomatic COVID-19 from variants up to and including Delta, with no vaccine recipients developing severe disease. Virtually all the subjects were healthy adults under 65, so we know nothing about this vaccine’s performance against Omicron, in older people, or in the chronically ill. It’s already been approved for use in <a href="https://www.livemint.com/science/health/worlds-first-plant-derived-covid-vaccine-approved-11645762395846.html" style="color: #954f72; text-decoration: underline;">its home country</a>, but I’m not sure anybody else will bite.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>ZF2001</u>: Still another new entry, from China, is a protein subunit vaccine like Novavax. In <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2202261?query=TOC&cid=NEJM%20eToc,%20May%205,%202022%20DM1008104_NEJM_Subscriber&bid=961507844" style="color: #954f72; text-decoration: underline;">Phase 3 trials</a> it’s 76% protective against COVID-19 for 6 months, and more than 85% against severe outcomes and death. Like Covifenz, it’s only been tested in working-age populations and not at all against Omicron.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Corbevax</u>: This is the open-source, inexpensive, vegan, halal Texas-made protein subunit vaccine. In India it’s been approved in India even for kids – though not without <a href="https://www.science.org/content/article/india-s-speedy-approvals-covid-19-vaccines-come-under-fire" style="color: #954f72; text-decoration: underline;">backlash</a> – and also in <a href="https://www.voanews.com/a/botswana-approves-texas-made-covid-vaccine-manufacturing-plant/6506456.html" style="color: #954f72; text-decoration: underline;">some African countries</a>, despite the lack of <b><i>any</i></b> Phase 3 trial data. <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Too much of a good thing?</u> That makes 4 new COVID-19 vaccines hitting markets within months. Does the world really need them? Two New England Journal of Medicine editorialists <a href="https://www.nejm.org/doi/full/10.1056/NEJMe2204695?query=TOC&cid=NEJM%20eToc,%20May%205,%202022%20DM1008104_NEJM_Subscriber&bid=961507844" style="color: #954f72; text-decoration: underline;">argue</a> that the answer is yes, largely because mRNA vaccines are complicated to store and deliver, whereas these new ones are both convenient and cheap.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Dream on</u>: Eric Topol, one of the most intelligent commentators around, has written a <a href="https://www.theguardian.com/commentisfree/2022/may/16/covid-19-pandemic-exit-roadmap?CMP=share_btn_link" style="color: #954f72; text-decoration: underline;">Guardian piece</a> calling for something very simple: variant-proof nasal vaccines. But the simplicity is only apparent, because all attempts thus far to develop any vaccine that’s even slightly variant-proof have been dead in the water.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Kids</u>: COVID-19 vaccines are relatively ineffective in children, both the ones from <a href="https://www.nature.com/articles/d41586-022-01239-4" style="color: #954f72; text-decoration: underline;">China</a> and the hyper-low-dose one from Pfizer whose benefit is also <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/pfizerbiontech-covid-vaccine-less-effective-ages-5-11-new-york-study-2022-02-28/" style="color: #954f72; text-decoration: underline;">particularly short-lived</a>. Moderna has now performed a Phase 3 trial of a half-dose vaccine – identical to the adult booster dose – in about 3000 children between 6 and 11, and <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2203315?query=featured_home" style="color: #954f72; text-decoration: underline;">early results</a> are very promising: efficacy of 73% against SARS-CoV-2 infection (Delta variant) and about 90% against symptomatic COVID-19, without substantial side effects. Protection began 2 weeks after the first dose and showed no sign of waning over 3 months of follow-up; since the Moderna product contains 50 mcg of mRNA vs. Pfizer’s 10, we can guess it will be longer-lasting. <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>Variant watch<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLGPqBHLVBpzwphAMpgQ0S7ujpwbZwSikYcfKUcGeutZRpQ4qFgHXbcBSpfZF-unDTTNZReCmuUxAfyvzYUpUyvOBCJTfDsfAuG-5wkQZKz33tW9lKb3LJeBzspyv3lE1Xz_c4NW4agXtYFOEN7RixqCbSJHBBRppJNgUZx_LKQJ_gOUli_2S_LPJT/s1198/Omicron%20subvariants%20US.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="734" data-original-width="1198" height="245" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLGPqBHLVBpzwphAMpgQ0S7ujpwbZwSikYcfKUcGeutZRpQ4qFgHXbcBSpfZF-unDTTNZReCmuUxAfyvzYUpUyvOBCJTfDsfAuG-5wkQZKz33tW9lKb3LJeBzspyv3lE1Xz_c4NW4agXtYFOEN7RixqCbSJHBBRppJNgUZx_LKQJ_gOUli_2S_LPJT/w400-h245/Omicron%20subvariants%20US.png" width="400" /></a></div><b><br /></b><p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_681" o:spid="_x0000_i1038" style="height: 202pt; visibility: visible; width: 330pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image006.png"></v:imagedata></v:shape></span><b><o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Transmissibility</u>: An interesting <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2791601" style="color: #954f72; text-decoration: underline;">review and meta-analysis</a> shows that after a very rapid rise early in the pandemic when we knew little about COVID-19, the rate of transmission from patients to family members has continued to climb, especially after the more infectious Delta and Omicron variants hit town.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Omicron subvariants BA.2.12 and BA.2.12.1</u>: The <a href="https://www.washingtonpost.com/health/2022/04/15/new-omicron-variants/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F36990a0%2F625a93c864253a7f34354e77%2F599d6acbae7e8a3d46e1400f%2F42%2F59%2F625a93c864253a7f34354e77" style="color: #954f72; text-decoration: underline;">latest twists</a> on the Omicron variant are <a href="https://www.cnn.com/2022/05/03/health/fitter-omicron-descendants-covid-variants/index.html" style="color: #954f72; text-decoration: underline;">coming ‘round the</a>mountain. They are even more transmissible than BA.2, and ever more capable of infecting people who’ve been triple- or perhaps even quadruple-vaccinated, and <span> </span>who have recovered from previous bouts of COVID-19. The latest variants <a href="https://www.biorxiv.org/content/10.1101/2022.04.30.489997v1" style="color: #954f72; text-decoration: underline;">can even attack</a> people who’ve had previous versions of Omicron. BA.2.12.1 now accounts for 1 in 3 new cases in the United States, with virtually all the rest BA.2, and for two-thirds of cases in New York City. Then there’s the even newer BA.4 and BA.5 subvariants – they are <a href="https://www.cnn.com/2022/05/03/health/fitter-omicron-descendants-covid-variants/index.html" style="color: #954f72; text-decoration: underline;">already dominant</a> in South Africa and present in more than a dozen other countries. Remember the <a href="https://www.washingtonpost.com/health/2022/05/01/coronavirus-more-mutations/" style="color: #954f72; text-decoration: underline;">optimistic predictions</a> early on that SARS-CoV-2 wouldn’t mutate as fast as, say, the flu virus, so vaccines would last for years? If only!<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Omicron XE</u>: Another hypertransmissible variant, combining bits of the genetic material of both BA.1 and BA.2. There are handfuls of cases in the <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1067672/Technical-Briefing-40-8April2022.pdf" style="color: #954f72; text-decoration: underline;">UK</a> and Japan. But other chimera variants such as Deltacron never got anywhere, so I suspect this one won’t either.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b><o:p> </o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>A Fauci ouchie<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b><o:p> <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjITHHl85mtBuiFnjvwSEb6Q3AhBaoZC8jawDBXk5drtw7MHKcI-OY2GbI2iFoGZNRCMO2D_bMheSJSoYwT_hHWWbmLrFjr2BnAxkKadOcVLFk9XTalEPYwKyI8k0FqBKPgcVCEOgQ5ouKs09GdV7pPeS0JiDq4gkeyUf8GY0H_y9vSrYG3FvvqoP7A/s1024/fauci%20on%20pbs.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="683" data-original-width="1024" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjITHHl85mtBuiFnjvwSEb6Q3AhBaoZC8jawDBXk5drtw7MHKcI-OY2GbI2iFoGZNRCMO2D_bMheSJSoYwT_hHWWbmLrFjr2BnAxkKadOcVLFk9XTalEPYwKyI8k0FqBKPgcVCEOgQ5ouKs09GdV7pPeS0JiDq4gkeyUf8GY0H_y9vSrYG3FvvqoP7A/s320/fauci%20on%20pbs.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Anthony Fauci on PBS</td></tr></tbody></table><br /></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_669" o:spid="_x0000_i1037" style="height: 163pt; visibility: visible; width: 245pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image007.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Anthony Fauci told an interviewer on the PBS Newshour on April 26<sup>th</sup>,“We are certainly right now in this country out of the pandemic phase” of COVID-19. The very next day he had to backtrack, <a href="https://www.npr.org/2022/04/26/1094791782/why-are-masks-such-a-big-deal-for-so-many-psychologists-have-thoughts" style="color: #954f72; text-decoration: underline;">telling NPR</a>, “I probably should have said 'the acute component of the pandemic phase.'” And telling the <a href="https://www.washingtonpost.com/health/2022/04/27/pandemic-phase-over-fauci-covid/" style="color: #954f72; text-decoration: underline;">Washington Post</a>: “out of the full-blown explosive pandemic phase” and into “a transitional phase, from a deceleration of the numbers into hopefully a more controlled phase and endemicity.” <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">My own spectacles are less rose-tinged than Fauci’s. For one thing, the running average of COVID-19 deaths in the USA, while on its way down, is currently <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=false&Color+by+test+positivity=false&country=~USA" style="color: #954f72; text-decoration: underline;">339 per day</a>. On a yearly basis that would be more than quadruple<b> </b>the death rate from influenza, often considered an appropriate criterion for when COVID-19 can be considered a “normal” and merely endemic, infectious disease. This is far from “controlled.” <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Plus the Omicron subvariants are getting more and more contagious, and as long as the developing world remains unvaccinated – only <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Metric=People+fully+vaccinated&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=~Africa" style="color: #954f72; text-decoration: underline;">17% of Africans</a> are “fully vaccinated” – new and possibly more virulent variants are sure to pop up.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>Superspreading<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_654" o:spid="_x0000_i1036" style="height: 153pt; visibility: visible; width: 272pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image008.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjz3c6x5JXPlD1YYbm0hH2QGBIWVjDtcXjmya6rsBvFY27CSj9C53AHGn38wCsvEczRJsO07DG7SOMX4e8v8Ra2_mE3KvCbguG5EBVZr5c6LjO9wI5rRGw1wFABMtv-qBhggh-211t0tOw6_VxcszizjmQKNye3Sp053l5Oq0PNzoPwUxXgS6bchKnh/s1920/Gridiron%20Club%20dinner%20-%2072+%20cases.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1920" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjz3c6x5JXPlD1YYbm0hH2QGBIWVjDtcXjmya6rsBvFY27CSj9C53AHGn38wCsvEczRJsO07DG7SOMX4e8v8Ra2_mE3KvCbguG5EBVZr5c6LjO9wI5rRGw1wFABMtv-qBhggh-211t0tOw6_VxcszizjmQKNye3Sp053l5Oq0PNzoPwUxXgS6bchKnh/s320/Gridiron%20Club%20dinner%20-%2072+%20cases.jpg" width="320" /></a></div><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Nancy Pelosi picked up the SARS-CoV-2 virus at this White House event celebrating the Affordable Care Act; <a href="https://people.com/politics/nancy-pelosi-covid-quarantine-watching-hoops-bridgerton-fundraising/" style="color: #954f72; text-decoration: underline;">she says</a> she never felt sick. Obama had had <a href="https://www.npr.org/2022/03/13/1086362826/obama-has-tested-positive-for-covid" style="color: #954f72; text-decoration: underline;">a mildly symptomatic case</a> 3 weeks earlier.<o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEii4sJXHUQ1jI95TPbwWoE-QCw6fDG6Q59uINDYOl0CmKlICLb4WQKhKVooSG7NUUzoND8lLu0O7EBxoUTJ44pq3c2p5UuxVXQofmcJ0B4BpZsOlhpmb-W5MbIGWZfnCL8cRq5NNQ9RM9DJcPsBIvsN7g-T2AKplAz-LQdUkCQL7RLCao73fhxirrrb/s1244/White%20House%20Correspondents%20Dinner.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="704" data-original-width="1244" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEii4sJXHUQ1jI95TPbwWoE-QCw6fDG6Q59uINDYOl0CmKlICLb4WQKhKVooSG7NUUzoND8lLu0O7EBxoUTJ44pq3c2p5UuxVXQofmcJ0B4BpZsOlhpmb-W5MbIGWZfnCL8cRq5NNQ9RM9DJcPsBIvsN7g-T2AKplAz-LQdUkCQL7RLCao73fhxirrrb/w400-h226/White%20House%20Correspondents%20Dinner.jpg" width="400" /></a></div><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_658" o:spid="_x0000_i1035" style="height: 200pt; visibility: visible; width: 354pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image009.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><a href="https://nypost.com/2022/04/11/covid-hits-more-than-70-attendees-of-dc-gridiron-dinner/" style="color: #954f72; text-decoration: underline;">More than 70 people</a>, from Merrick Garland, Susan Collins, and Eric Adams on down, tested positive for COVID-19 days after attending this year’s white-tie Gridiron Club dinner.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_682" o:spid="_x0000_i1034" style="height: 231pt; visibility: visible; width: 310pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image010.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5gnMfLezWUfIUATR9CYD6MiMkAnfk-9XmY2p2rd6qd2efApdTD-Rv0yeQI6Xl5QNPJHF2sEO_0SRTCp9-K39y6dbGGqwUpfbhwXOhSySbsqxeDhUyHl5qK5NgWvgsGyUQpqKQpGewUuuzc6FFSpZ54QDJIwflso2kao144c20QUnQVM8giY_x9Sfd/s849/unmasked%20at%20STT.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="632" data-original-width="849" height="299" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5gnMfLezWUfIUATR9CYD6MiMkAnfk-9XmY2p2rd6qd2efApdTD-Rv0yeQI6Xl5QNPJHF2sEO_0SRTCp9-K39y6dbGGqwUpfbhwXOhSySbsqxeDhUyHl5qK5NgWvgsGyUQpqKQpGewUuuzc6FFSpZ54QDJIwflso2kao144c20QUnQVM8giY_x9Sfd/w400-h299/unmasked%20at%20STT.jpg" width="400" /></a></div><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">I caught my husband (in the purple cap) and almost everybody else with their masks down in front of the “A Mask Is Still Required” sign at the airport in St. Thomas.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Even smart people are sometimes dumb. <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>Doubter docs<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_678" o:spid="_x0000_i1033" style="height: 215pt; visibility: visible; width: 382pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image011.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoCsGCFHDfaTBm3r0SxdDpad5rZ5V20dlUKPUeSxVmb6sC9yFieB02r_V-6JKVWYhSWXaXLyrszlawOE--W9YJNRksEVx9JR7otrgDBht65jv0ziY-OnjVDszl30GUkh_qLCaSGRGY-azNjYJmDmLZfXUg4U6NpUMVXHkP-8B2rikjGtFlJ-Ls4hTv/s1362/Bruce%20Boros.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="766" data-original-width="1362" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoCsGCFHDfaTBm3r0SxdDpad5rZ5V20dlUKPUeSxVmb6sC9yFieB02r_V-6JKVWYhSWXaXLyrszlawOE--W9YJNRksEVx9JR7otrgDBht65jv0ziY-OnjVDszl30GUkh_qLCaSGRGY-azNjYJmDmLZfXUg4U6NpUMVXHkP-8B2rikjGtFlJ-Ls4hTv/s320/Bruce%20Boros.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Dr. Bruce Boros, who <a href="https://www.thedailybeast.com/dr-bruce-boros-and-six-others-from-florida-covid-summit-fall-sick" target="_blank">fell seriously ill</a> with COVID-19 after a novax medical conference</td></tr></tbody></table><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">A <a href="https://www.sciencedirect.com/science/article/pii/S0264410X22003024" style="color: #954f72; text-decoration: underline;">shocking poll</a> of American primary care physicians found that 10.1% didn’t agree that COVID-19 vaccines are safe and 9.3% didn’t agree they are effective. That’s fewer doubters than in the US population as a whole, but still it’s pretty scary, especially since PCPs are supposed to be the backbone of the US vaccination campaign. Unsurprisingly, docs who identify as politically conservative were more likely to be skeptics. But so were Hispanic docs – go figure.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>Delta Airlines interprets the CDC<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b><span><v:shape id="Picture_x0020_671" o:spid="_x0000_i1032" style="height: 185pt; visibility: visible; width: 280pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image012.jpg"></v:imagedata></v:shape></span><span><o:p></o:p></span></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhTH4oaGuWP2du4A-m0PyCWp6wSfIWAxPzfE3y60B6iCzYIF0Nlfdpo2lCLGFSfbbt2QHDDO8AjDkKpgNrV-R3E8hwBg45rF9HgG7WQ3HEjtr7Gh55_SE3eExIImmM0ZbrY96bnhVbPrQ31oN-hfp72e0eL56lKzlViTKXRWiUkhWWrDIgkHeZ-L4K/s1417/delta%20airplane.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="937" data-original-width="1417" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhTH4oaGuWP2du4A-m0PyCWp6wSfIWAxPzfE3y60B6iCzYIF0Nlfdpo2lCLGFSfbbt2QHDDO8AjDkKpgNrV-R3E8hwBg45rF9HgG7WQ3HEjtr7Gh55_SE3eExIImmM0ZbrY96bnhVbPrQ31oN-hfp72e0eL56lKzlViTKXRWiUkhWWrDIgkHeZ-L4K/s320/delta%20airplane.jpg" width="320" /></a></div><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Checking in for a flight, here’s what Delta forced us to “Acknowledge”:<o:p></o:p></p><h2 style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: white; background-position: initial initial; background-repeat: initial initial; break-after: avoid; color: #2f5496; font-family: "Calibri Light", sans-serif; font-size: 13pt; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 60.6pt 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; vertical-align: baseline; white-space: normal; widows: auto; word-spacing: 0px;"><span style="color: #191919; font-family: "Open Sans", sans-serif; font-size: 15.5pt; text-transform: uppercase;">THE STANDARD FOR SAFER TRAVEL<o:p></o:p></span></h2><form style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"></form><h3 style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: white; background-position: initial initial; background-repeat: initial initial; break-after: avoid; color: #4472c4; font-family: "Calibri Light", sans-serif; font-size: 12pt; font-style: normal; font-variant-caps: normal; font-weight: bold; letter-spacing: normal; line-height: 15pt; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; vertical-align: baseline; white-space: normal; widows: auto; word-spacing: 0px;"><span style="color: #191919; font-family: "Open Sans", sans-serif; font-size: 11.5pt;">DELTA'S COMMITMENT TO YOU<o:p></o:p></span></h3><p style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: white; background-position: initial initial; background-repeat: initial initial; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0in 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; vertical-align: baseline; white-space: normal; widows: auto; word-spacing: 0px;"><span style="color: #191919; font-family: "Open Sans", sans-serif; font-size: 9pt;">The Delta CareStandard℠ focuses on creating a safer experience for everyone.<o:p></o:p></span></p><h3 style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: white; background-position: initial initial; background-repeat: initial initial; break-after: avoid; color: #4472c4; font-family: "Calibri Light", sans-serif; font-size: 12pt; font-style: normal; font-variant-caps: normal; font-weight: bold; letter-spacing: normal; line-height: 15pt; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; vertical-align: baseline; white-space: normal; widows: auto; word-spacing: 0px;"><span style="color: #191919; font-family: "Open Sans", sans-serif; font-size: 11.5pt;">YOUR COMMITMENT TO SAFETY<o:p></o:p></span></h3><p style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: white; background-position: initial initial; background-repeat: initial initial; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0in 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; vertical-align: baseline; white-space: normal; widows: auto; word-spacing: 0px;"><span style="color: #191919; font-family: "Open Sans", sans-serif; font-size: 9pt;">If traveling within the United States, I/we confirm that I/we are not currently required to isolate or quarantine due to COVID-19 exposure, symptoms or a positive diagnosis under the current CDC COVID-19 guidelines.<o:p></o:p></span></p><p style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0in 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; vertical-align: baseline; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-family: "Open Sans", sans-serif; font-size: 9pt;">If traveling internationally, I/we confirm that I/we are not required to isolate or quarantine due to COVID-19 exposure, symptoms or a positive diagnosis under the current public health regulations at the origin and destination. <o:p></o:p></span></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Here are the actual current <a href="https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html?" style="color: #954f72; text-decoration: underline;">CDC Guidelines</a>:<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_657" o:spid="_x0000_i1031" style="height: 114pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image013.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrhhtqsxpmPF_1q0zrLlS3H9-f8L4IYeOq3dbl8LrEVg0r_yDUdZJ-XCXHFMlgAG6FAou3eCKZbdDYXcJNnhHxQT3sk9gzwvGsyzW7RcwvEbPu2jSLSLS7AAiGzNR7Y2YioDFwf39Ri1i-1COLxAevykSxyz9aVrOLiVz1Gtf_eL4mvRItvTGSt6Am/s1752/cdc%20guidelines.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="442" data-original-width="1752" height="162" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrhhtqsxpmPF_1q0zrLlS3H9-f8L4IYeOq3dbl8LrEVg0r_yDUdZJ-XCXHFMlgAG6FAou3eCKZbdDYXcJNnhHxQT3sk9gzwvGsyzW7RcwvEbPu2jSLSLS7AAiGzNR7Y2YioDFwf39Ri1i-1COLxAevykSxyz9aVrOLiVz1Gtf_eL4mvRItvTGSt6Am/w640-h162/cdc%20guidelines.jpg" width="640" /></a></div><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Then there’s the “trip details” sent 3 days before our flight from St. Thomas, which included<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_680" o:spid="_x0000_i1030" style="height: 102pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image014.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQ4xjwRu7bWkHqV2RGPlj53TNnvg2YQyD6MiP91EC76-zW9ZYje4YEMjzN3Rkk6w3SPrLmi0ad1s-hhfe1jqJVkFdCW8AtY8bpB-KPfbjd7_wf23Fbb3rid5KWZpEVeCFeAi6KrupKqPUrcgz3blSbUV-0ljSAoS6m4El0ckwv5E9M0Qi4EjfPSiz_/s1166/Delta%20masks%20optional.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="262" data-original-width="1166" height="147" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQ4xjwRu7bWkHqV2RGPlj53TNnvg2YQyD6MiP91EC76-zW9ZYje4YEMjzN3Rkk6w3SPrLmi0ad1s-hhfe1jqJVkFdCW8AtY8bpB-KPfbjd7_wf23Fbb3rid5KWZpEVeCFeAi6KrupKqPUrcgz3blSbUV-0ljSAoS6m4El0ckwv5E9M0Qi4EjfPSiz_/w640-h147/Delta%20masks%20optional.jpg" width="640" /></a></div><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">In fact, as per the huge sign in the St. Thomas airport and Gov. Hochul’s continuing masking requirement in all New York State transportation hubs, all that’s true is the “On Board” part.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Fire that fact checker!<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>COVID eats the Big Apple<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b><span><v:shape id="Picture_x0020_663" o:spid="_x0000_i1029" style="height: 214pt; visibility: visible; width: 322pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image015.jpg"></v:imagedata></v:shape></span><span><o:p></o:p></span></b></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGQ-tzFprwZWvoXRcUEfaH6W_uCaFfT4DduLOCYRFqSX88wg-CScmOeAmiMxHwS6JCylfB-xLMCMtbF9-Zl0GWZlyzLBEk-YAZhmT9b2xNMTclYsCU0iNoUgzCtWFaXi3oCpKakjeKOXi-sezl_Fp3k5mBcb3LAzpYQJHOdpwlvJwcDk_t2OssK_P5/s1535/eric-adams-mask-covid-01.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1023" data-original-width="1535" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGQ-tzFprwZWvoXRcUEfaH6W_uCaFfT4DduLOCYRFqSX88wg-CScmOeAmiMxHwS6JCylfB-xLMCMtbF9-Zl0GWZlyzLBEk-YAZhmT9b2xNMTclYsCU0iNoUgzCtWFaXi3oCpKakjeKOXi-sezl_Fp3k5mBcb3LAzpYQJHOdpwlvJwcDk_t2OssK_P5/w400-h266/eric-adams-mask-covid-01.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">New York Mayor Eric Adams vowing not to reinstate mask mandates</td></tr></tbody></table><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">With <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=~Africa&Metric=People+fully+vaccinated">6 times as many cases</a> being officially reported as in March and <a href="https://projects.thecity.nyc/2020_03_covid-19-tracker/?_ga=2.253860040.179573086.1627913114-1505564498.1582832400">3 times as many hospitalized</a>, New York City has <a href="https://www.nytimes.com/2022/05/17/nyregion/nyc-covid-high-alert.html?campaign_id=2&emc=edit_th_20220518&instance_id=61642&nl=todaysheadlines&regi_id=19728476&segment_id=92569&user_id=d89c7002526915cc9287fae06e27a284">already entered</a> the Orange or high COVID risk zone, even though cases are vastly underestimated because few home tests get reported. Under the older, better, CDC criteria, New York would have been “high-risk” months ago. Theaters are again having to <a href="https://deadline.com/2022/05/broadway-covid-cancelations-moulin-rouge-skin-of-our-teeth-1235024731/">cancel performances</a>. Mayor Adams’ reaction? Mask mandates in preschools, of all things, and some vaccination checks. He and his health commissioner stubbornly <a href="https://www.nytimes.com/2022/05/19/nyregion/adams-mask-mandate-covid-new-york.html?campaign_id=2&emc=edit_th_20220520&instance_id=61868&nl=todaysheadlines&regi_id=19728476&segment_id=92819&user_id=d89c7002526915cc9287fae06e27a284">refuse to take</a> the <b><i>really</i></b> vital step of mandating masking in all public indoor settings, even though that mandate is <a href="https://www1.nyc.gov/assets/doh/downloads/pdf/covid/covid-19-alert-levels-definitions-actions.pdf">official New York City policy</a> and <a href="https://twitter.com/oni_blackstock/status/1526364942231916545?s=20&t=l2eazbAIZO7CBWTE0QqoeA">health experts</a> are asking “<a href="https://twitter.com/oni_blackstock/status/1526364942231916545?s=20&t=l2eazbAIZO7CBWTE0QqoeA">How does this make any sense, @NYCMayor?</a>” and “<a href="https://www.otdowntown.com/news/a-concern-over-covid-collective-amnesia-FD2063061">Wow, when are we going to learn</a>.” At least Adams can’t contravene Governor Hochul’s statewide mandate for masking on public transport, which – eyeballing it in late April – is being obeyed by about 90% of subway riders.</p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">On a personal note: I attended an <a href="https://www.alexandregallery.com/" style="color: #954f72; text-decoration: underline;">art opening</a> on April 30<sup>th</sup><span> </span>at the Alexandre Gallery downtown. A door sign says masks are obligatory, but none of the staff and almost nobody else were wearing them. The artist, the late Edith Schloss, was an intimate friend and I had been looking forward enormously to the show, but it felt so unsafe that I walked out after 5 minutes. I was unsurprised to hear a few days later that multiple attendees had come down with COVID-19.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">The rest of the country isn’t doing any better. Even according to those new CDC guidelines that vastly underestimate how much virus is around, <a href="https://twitter.com/CDCDirector/status/1527715083446636546" style="color: #954f72; text-decoration: underline;">45% of Americans</a> are now in counties rated medium- or high-risk, so should probably be wearing masks indoors, <a href="https://www.nytimes.com/2022/05/18/us/politics/white-house-covid-briefing.html?campaign_id=2&emc=edit_th_20220519&instance_id=61785&nl=todaysheadlines&regi_id=19728476&segment_id=92714&user_id=d89c7002526915cc9287fae06e27a284" style="color: #954f72; text-decoration: underline;">up from 32%</a> just 4 days ago and <a href="https://www.usnews.com/news/health-news/articles/2022-03-18/cdc-virtually-every-american-can-stop-wearing-masks-indoors" style="color: #954f72; text-decoration: underline;">1% in mid-March</a>. If the older, better guidelines were still in use <a href="https://twitter.com/thisladyvicki/status/1527717183094026240" style="color: #954f72; text-decoration: underline;">73% of counties</a> would be counted as high-risk rather than just 24%. And the CDC is predicting both <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/forecasting/hospitalizations-forecasts.html" style="color: #954f72; text-decoration: underline;">hospitalizations</a> and <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/forecasting/forecasting-us.html" style="color: #954f72; text-decoration: underline;">deaths</a> will keep rising at least through the middle of June, even though Omicron is usually mild. (They’ve now officially <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/forecasting/forecasts-cases.html" style="color: #954f72; text-decoration: underline;">given up</a> on trying to forecast case numbers.)<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b><o:p> </o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>The Italian mystery<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_661" o:spid="_x0000_i1028" style="height: 270pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image016.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOdk4bCrqtYCudA1JiSMF8NntWbKmGCt3k5xatn1KCmYqKrQpNeBt7H8gFTok-E5jV9EUj0fYE3y_MEji96TqguX_8K9F69RAo9TfhmOFKntdJbxyA6KA7NaVOv-5c65juG-TVxDCdrO651YS80VlwTRWKH5jxaPaiGqUSEowWtoYP_DKNJHnyKD1P/s1736/total%20death%20rates.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1034" data-original-width="1736" height="384" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOdk4bCrqtYCudA1JiSMF8NntWbKmGCt3k5xatn1KCmYqKrQpNeBt7H8gFTok-E5jV9EUj0fYE3y_MEji96TqguX_8K9F69RAo9TfhmOFKntdJbxyA6KA7NaVOv-5c65juG-TVxDCdrO651YS80VlwTRWKH5jxaPaiGqUSEowWtoYP_DKNJHnyKD1P/w640-h384/total%20death%20rates.jpg" width="640" /></a></div><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">In Italy more than 90% of everyone over 12 is fully vaccinated, everybody masks indoors, and Green Passes were essential until May 1<sup>st</sup>, and yet the country has had higher total per capita death rates than any other Western country except Belgium (neck-and-neck) and the USA (alas). One reason is surely the horrific early epidemic in Northern Italy, which overwhelmed hospitals at a time when virtually nothing was known about the disease, including how it was transmitted.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_662" o:spid="_x0000_i1027" style="height: 270pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image017.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitlj5Iw1aIuhmK_-SXFOpO6bXjNCOxPCXI3a6q8gIeotwRkPyP1B5m3xiszhpdE1meHGVvtaaj3ecSHDs1ThhpOaWU9nJ3Aye1U7ekjEmmo7V4QiUxrVm3n1BBtDRpufnrzxX3s6sW5xe2IhubkyvGUdPxUxy32jUKQxHE5x7_4XUGg9XZBmqLpulu/s1736/recent%20death%20rates.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1034" data-original-width="1736" height="384" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitlj5Iw1aIuhmK_-SXFOpO6bXjNCOxPCXI3a6q8gIeotwRkPyP1B5m3xiszhpdE1meHGVvtaaj3ecSHDs1ThhpOaWU9nJ3Aye1U7ekjEmmo7V4QiUxrVm3n1BBtDRpufnrzxX3s6sW5xe2IhubkyvGUdPxUxy32jUKQxHE5x7_4XUGg9XZBmqLpulu/w640-h384/recent%20death%20rates.jpg" width="640" /></a></div><br /><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">But the death rate is <b><i>still</i></b> worse than other major EU countries’ and is now running double the rate in the US. In large part this may be because Italy is barely making any use of antiviral drugs such as Paxlovid and remdesivir. But I fear it’s partly due to medical incompetence – as per <a href="https://www.ilsole24ore.com/art/covid-perche-italia-ci-sono-ancora-cosi-tante-vittime-AE4vdQCB" style="color: #954f72; text-decoration: underline;">a recent article</a> in the Sole 24 Ore newspaper. I have <a href="https://www.pauldrybooks.com/products/dottoressa" style="color: #954f72; text-decoration: underline;">long considered</a> the care in many Italian Emergency Rooms and intensive care units to be subpar. Some try to put the blame on Italy’s relatively elderly population, but Germany has seen 43% fewer deaths despite a similar age distribution.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>When do breakthrough infections go sour?<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b><span><v:shape id="Picture_x0020_679" o:spid="_x0000_i1026" style="height: 224pt; visibility: visible; width: 319pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image018.png"></v:imagedata></v:shape></span><span><o:p></o:p></span></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWwRDhSA7f8PIRURZoNM_We8yfRaIhcVTei3wyotlkSMujFfhsmS2_Wcx885hTdcrOwB3FeuG1eV3PosBg1seFVOPvXTzuL8E8nBiK-ReucLIChT3Pm1WYdFJJvrtin5rKgvY1WrqIaA3E8qXHovWj8BWp_WxDSi8g4tNvtFxtSgXid-YsZO6jnT8P/s2666/deaths%20vaccinated%20vs.%20not.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1875" data-original-width="2666" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWwRDhSA7f8PIRURZoNM_We8yfRaIhcVTei3wyotlkSMujFfhsmS2_Wcx885hTdcrOwB3FeuG1eV3PosBg1seFVOPvXTzuL8E8nBiK-ReucLIChT3Pm1WYdFJJvrtin5rKgvY1WrqIaA3E8qXHovWj8BWp_WxDSi8g4tNvtFxtSgXid-YsZO6jnT8P/s320/deaths%20vaccinated%20vs.%20not.png" width="320" /></a></div><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">COVID-19 in fully vaccinated people is usually mild, but not always. Who does well, and who gets very sick or dies? A <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7101a4.htm?s_cid=mm7101a4_w" style="color: #954f72; text-decoration: underline;">Morbidity and Mortality Weekly Report</a> examined that question among 2246 fully vaccinated individuals with breakthrough infections, and identified 8 risk factors: age over 65, immunosuppression, diabetes, and lung, liver, kidney, neurological, or heart disease. Every patient with a severe case had at least one of those risk factors, and 78% of those who died had 4 or more. Sex, race, and time since vaccination had no impact. Being a COVID-19 survivor, monoclonal antibody treatment, and booster shots were all protective factors, and Moderna worked better than Pfizer or J&J. But never forget, the most important risk factor for getting severely ill or dying from COVID-19 is being unvaccinated.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>My new favorite conspiracy theory<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_656" o:spid="_x0000_i1025" style="height: 213pt; visibility: visible; width: 5in;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image019.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><p style="text-align: left;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0c_IlILEtaUi3Dghyn8NzfOnrjBscfIDXcWzT_Q8S9pYYjeIrzXNmUykG4S2bDKdN8XfV87o_Gixvz3evRuWeff7_aM1AsQPkGu5ljgjOXJLngQmRMHd0s18bLXbS39QQMfXSxWFUeitO9zzbMh0XJ8p6G5U5f1UcQau7X4zDYaUDkZsuupsJcern/s750/montagnier%20vaccines%20aids.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="445" data-original-width="750" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0c_IlILEtaUi3Dghyn8NzfOnrjBscfIDXcWzT_Q8S9pYYjeIrzXNmUykG4S2bDKdN8XfV87o_Gixvz3evRuWeff7_aM1AsQPkGu5ljgjOXJLngQmRMHd0s18bLXbS39QQMfXSxWFUeitO9zzbMh0XJ8p6G5U5f1UcQau7X4zDYaUDkZsuupsJcern/w400-h239/montagnier%20vaccines%20aids.png" width="400" /></a></div><span style="font-size: 12pt;"><br /></span><p></p><p style="text-align: left;"><style class="WebKit-mso-list-quirks-style">
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p.MsoListParagraphCxSpMiddle, li.MsoListParagraphCxSpMiddle, div.MsoListParagraphCxSpMiddle
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;}
p.MsoListParagraphCxSpLast, li.MsoListParagraphCxSpLast, div.MsoListParagraphCxSpLast
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;}
span.Heading1Char
{mso-style-name:"Heading 1 Char";
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 1";
mso-ansi-font-size:14.0pt;
mso-bidi-font-size:16.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Arial;
mso-bidi-font-family:"Times New Roman";
mso-font-kerning:16.0pt;
font-weight:bold;
mso-bidi-font-weight:normal;}
span.Heading2Char
{mso-style-name:"Heading 2 Char";
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 2";
mso-ansi-font-size:13.0pt;
mso-bidi-font-size:13.0pt;
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;}
span.Heading3Char
{mso-style-name:"Heading 3 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 3";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#4472C4;
mso-themecolor:accent1;
font-weight:bold;}
span.Heading4Char
{mso-style-name:"Heading 4 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 4";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;
font-style:italic;}
span.Heading5Char
{mso-style-name:"Heading 5 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 5";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;}
p.text, li.text, div.text
{mso-style-name:text;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Plain Text";
margin-top:0in;
margin-right:0in;
margin-bottom:10.0pt;
margin-left:0in;
line-height:150%;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
span.PlainTextChar
{mso-style-name:"Plain Text Char";
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Plain Text";
mso-ansi-font-size:10.5pt;
mso-bidi-font-size:10.5pt;
font-family:Courier;
mso-ascii-font-family:Courier;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Courier;
mso-bidi-font-family:"Times New Roman";}
p.Heading, li.Heading, div.Heading
{mso-style-name:Heading;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Heading 1";
margin-top:12.0pt;
margin-right:0in;
margin-bottom:12.0pt;
margin-left:0in;
mso-pagination:widow-orphan;
page-break-after:avoid;
mso-outline-level:1;
font-size:12.0pt;
font-family:"Arial",sans-serif;
mso-fareast-font-family:"MS Mincho";
mso-bidi-font-family:"Times New Roman";
mso-font-kerning:16.0pt;
font-weight:bold;
mso-bidi-font-weight:normal;}
p.quotes, li.quotes, div.quotes
{mso-style-name:quotes;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Plain Text";
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
span.BalloonTextChar
{mso-style-name:"Balloon Text Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Balloon Text";
mso-ansi-font-size:9.0pt;
mso-bidi-font-size:9.0pt;
font-family:"Lucida Grande",sans-serif;
mso-ascii-font-family:"Lucida Grande";
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:"Lucida Grande";
mso-bidi-font-family:"Lucida Grande";}
p.quotesheadline, li.quotesheadline, div.quotesheadline
{mso-style-name:"quotes headline";
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:quotes;
mso-style-next:quotes;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Arial",sans-serif;
mso-fareast-font-family:"MS Mincho";
font-weight:bold;
mso-bidi-font-weight:normal;}
span.exldetailsdisplayval
{mso-style-name:exldetailsdisplayval;
mso-style-unhide:no;}
span.CommentTextChar
{mso-style-name:"Comment Text Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Comment Text";
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.apple-converted-space
{mso-style-name:apple-converted-space;
mso-style-unhide:no;}
p.css-exrw3m, li.css-exrw3m, div.css-exrw3m
{mso-style-name:css-exrw3m;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.3m6-
{mso-style-name:_3m6-;
mso-style-unhide:no;}
span.3l3x
{mso-style-name:_3l3x;
mso-style-unhide:no;}
span.1lh7
{mso-style-name:_1lh7;
mso-style-unhide:no;}
span.1lld
{mso-style-name:_1lld;
mso-style-unhide:no;}
p.6coj, li.6coj, div.6coj
{mso-style-name:_6coj;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.6cok
{mso-style-name:_6cok;
mso-style-unhide:no;}
span.timestampcontent
{mso-style-name:timestampcontent;
mso-style-unhide:no;}
span.mbtext
{mso-style-name:mb_text;
mso-style-unhide:no;}
span.HeaderChar
{mso-style-name:"Header Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Header;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.FooterChar
{mso-style-name:"Footer Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Footer;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.5uzb
{mso-style-name:_5uzb;
mso-style-unhide:no;}
span.accessibleelem
{mso-style-name:accessible_elem;
mso-style-unhide:no;}
span.z-TopofFormChar
{mso-style-name:"z-Top of Form Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"z-Top of Form";
mso-ansi-font-size:8.0pt;
mso-bidi-font-size:8.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:Arial;
mso-bidi-font-family:Arial;
display:none;
mso-hide:all;}
p.1obc, li.1obc, div.1obc
{mso-style-name:_1obc;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.z-BottomofFormChar
{mso-style-name:"z-Bottom of Form Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"z-Bottom of Form";
mso-ansi-font-size:8.0pt;
mso-bidi-font-size:8.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:Arial;
mso-bidi-font-family:Arial;
display:none;
mso-hide:all;}
p.css-axufdj, li.css-axufdj, div.css-axufdj
{mso-style-name:css-axufdj;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.style-scope
{mso-style-name:style-scope;
mso-style-unhide:no;}
p.generic-articlesummary--li, li.generic-articlesummary--li, div.generic-articlesummary--li
{mso-style-name:generic-article__summary--li;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.diamond-blt, li.diamond-blt, div.diamond-blt
{mso-style-name:diamond-blt;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.font-copy, li.font-copy, div.font-copy
{mso-style-name:font-copy;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:"Calibri",sans-serif;
mso-ascii-font-family:Calibri;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:Calibri;
mso-fareast-theme-font:minor-latin;
mso-hansi-font-family:Calibri;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;
mso-header-margin:.5in;
mso-footer-margin:.5in;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
/* List Definitions */
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{mso-list-id:-119;
mso-list-type:simple;
mso-list-template-ids:-1888465356;}
@list l0:level1
{mso-level-number-format:bullet;
mso-level-style-link:"List Bullet";
mso-level-text:;
mso-level-tab-stop:.25in;
mso-level-number-position:left;
margin-left:.25in;
text-indent:-.25in;
font-family:Symbol;}
@list l1
{mso-list-id:125974259;
mso-list-template-ids:-1612801510;}
@list l1:level1
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l1:level2
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:1.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:"Courier New";
mso-bidi-font-family:"Times New Roman";}
@list l1:level3
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:1.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level4
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:2.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level5
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:2.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level6
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:3.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level7
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:3.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level8
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:4.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l1:level9
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:4.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Wingdings;}
@list l2
{mso-list-id:180240054;
mso-list-type:hybrid;
mso-list-template-ids:-406915396 1833337546 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l2:level1
{mso-level-start-at:84;
mso-level-text:"%1\)";
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l2:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l2:level3
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l2:level4
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l2:level5
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l2:level6
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l2:level7
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l2:level8
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l2:level9
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l3
{mso-list-id:197426527;
mso-list-type:hybrid;
mso-list-template-ids:267133896 67698705 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l3:level1
{mso-level-text:"%1\)";
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l3:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l3:level3
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l3:level4
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l3:level5
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l3:level6
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l3:level7
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l3:level8
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l3:level9
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l4
{mso-list-id:338582796;
mso-list-template-ids:-1806528500;}
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{mso-list-id:367686160;
mso-list-type:hybrid;
mso-list-template-ids:8276860 1843136710 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l5:level1
{mso-level-start-at:13;
mso-level-number-format:bullet;
mso-level-text:-;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
@list l5:level2
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:"Courier New";}
@list l5:level3
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
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</style><span style="font-size: 12pt;">Nobel laureate Luc Montagnier, who died in February, said lots of nutty things about <a href="https://www.science.org/content/blog-post/has-luc-montagnier-lost">lots of subjects</a> including COVID-19 </span><span style="font-size: 12pt;">(the virus was </span><span style="font-size: 12pt;"><a href="https://www.connexionfrance.com/French-news/Disputed-French-Nobel-winner-Luc-Montagnier-says-Covid-19-was-made-in-a-lab-laboratory">created in a laboratory</a></span><span style="font-size: 12pt;">, it </span><span style="font-size: 12pt;"><a href="https://www.francesoir.fr/opinions-tribunes/le-defi-de-la-verite-luc-montagnier-prix-nobel-de-medecine">incorporated genetic material</a></span><span style="font-size: 12pt;"> from HIV</span><span style="font-size: 12pt;">, etc.) but there is <a href="https://www.reuters.com/article/factcheck-boosters-hiv/fact-check-covid-19-boosters-do-not-cause-positive-hiv-tests-idUSL1N2UM1Q0">no evidence</a> that this is one of them. The claim is of course B.S.: vaccine boosters <a href="https://www.reuters.com/article/factcheck-boosters-hiv/fact-check-covid-19-boosters-do-not-cause-positive-hiv-tests-idUSL1N2UM1Q0">can't</a> give you AIDS. </span><span style="font-family: -webkit-standard; font-size: medium;"></span></p>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com0tag:blogger.com,1999:blog-6211405954943098401.post-31127426540309176552022-04-27T21:52:00.000+02:002022-04-27T21:52:08.046+02:00To Boost Or Not To Boost, That Is The Question<p style="text-align: center;"> <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisf9ja8umwiqrqDbEskd3vImYwDvHv5ja_iwkJZ7c-f87CcpWaMfO2AoKjiGppdOd2PeRvbQOhnnQvEHVg8uK7GANrq6L25yalIeZTW0ohDoSPIDj3x5xsYdo2sW9TJM3ssMqkfToCjYJH4DxNBa6wZq-QkrTNEB_6PtyRDYPiLOBE8b8y6yWj1ag8/s962/Passengers_whooped_and_cheered_as_they_whipped_off_their_masks.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="537" data-original-width="962" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisf9ja8umwiqrqDbEskd3vImYwDvHv5ja_iwkJZ7c-f87CcpWaMfO2AoKjiGppdOd2PeRvbQOhnnQvEHVg8uK7GANrq6L25yalIeZTW0ohDoSPIDj3x5xsYdo2sW9TJM3ssMqkfToCjYJH4DxNBa6wZq-QkrTNEB_6PtyRDYPiLOBE8b8y6yWj1ag8/w400-h225/Passengers_whooped_and_cheered_as_they_whipped_off_their_masks.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Airplane passengers ripping off their masks mid-flight</td></tr></tbody></table><br /></p><p>I’m on vacation but I thought the masking and second booster controversies deserved comment, and the Shkreli Awards deserved publicity, so I’ve dashed off a quick post.</p><style class="WebKit-mso-list-quirks-style">
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</style><p class="1obc" style="margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="margin-right: 6pt;"><b>Treatment and prevention news<o:p></o:p></b></p><p class="1obc" style="margin-right: 6pt; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitHh1zH37JOSn93KdAOg6ayNR-XPiRdnCE8trgqWb7eiKd9Lkh5OVqCcIv03s1arcTuA7_3CX_pzYVhGlr2XBDWwhNywHWljbWuvYPCONqgD4XApfEDIviu006tVv0d-_f0m4GrMoqU-JQCi33tI8VZX7aMKq9wOtLALi6bDQBrd4cvJYfYY8RlHxm/s1630/I%20have%20covid.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="504" data-original-width="1630" height="125" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitHh1zH37JOSn93KdAOg6ayNR-XPiRdnCE8trgqWb7eiKd9Lkh5OVqCcIv03s1arcTuA7_3CX_pzYVhGlr2XBDWwhNywHWljbWuvYPCONqgD4XApfEDIviu006tVv0d-_f0m4GrMoqU-JQCi33tI8VZX7aMKq9wOtLALi6bDQBrd4cvJYfYY8RlHxm/w400-h125/I%20have%20covid.jpg" width="400" /></a></div><b><br /></b><p></p><p class="1obc" style="margin-right: 6pt;"><b><v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f"><v:stroke joinstyle="miter"><v:formulas><v:f eqn="if lineDrawn pixelLineWidth 0"><v:f eqn="sum @0 1 0"><v:f eqn="sum 0 0 @1"><v:f eqn="prod @2 1 2"><v:f eqn="prod @3 21600 pixelWidth"><v:f eqn="prod @3 21600 pixelHeight"><v:f eqn="sum @0 0 1"><v:f eqn="prod @6 1 2"><v:f eqn="prod @7 21600 pixelWidth"><v:f eqn="sum @8 21600 0"><v:f eqn="prod @7 21600 pixelHeight"><v:f eqn="sum @10 21600 0"></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:formulas><v:path gradientshapeok="t" o:connecttype="rect" o:extrusionok="f"><o:lock aspectratio="t" v:ext="edit"></o:lock></v:path></v:stroke></v:shapetype><v:shape id="Picture_x0020_655" o:spid="_x0000_i1029" style="height: 140pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image001.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="margin-right: 6pt;"><u>Mask mandates</u>: As you all know by now, a Florida judge has <a href="https://www.nytimes.com/2022/04/18/us/politics/federal-mask-mandate-airplanes.html?campaign_id=2&emc=edit_th_20220419&instance_id=58838&nl=todaysheadlines&regi_id=19728476&segment_id=89602&user_id=d89c7002526915cc9287fae06e27a284">struck down</a> the Biden administration’s requirement that people wear face masks on interstate transportation and in airports and other hubs. Airlines, Amtrak, and Uber jumped to say both passengers and staff could leave their masks home. Despite the jubilation pictured above, <a href="https://morningconsult.com/2022/04/20/cdc-mask-mandate-federal-transportation-survey/">60% of Americans</a> disagree. Call it one small step for the 35-year-old who has been characterized as Trump’s <a href="https://www.thedailybeast.com/roseanne-barr-whines-about-witch-burning-cancel-culture-in-new-documentary?ref=scroll">worst judicial appointment</a> and considered by the American Bar Association <a href="https://www.vanityfair.com/news/2022/04/this-trump-judge-was-found-not-qualified-then-she-axed-the-mask-mandate">not qualified</a> to do the job, and one giant leap in favor of the coronavirus. Top legal scholar Laurence Tribe <a href="https://www.newsweek.com/judge-kathryn-mizelle-mask-mandate-ruling-shambles-1698901">called her opinion</a>, “A shambles, filled with unsupported medical claims as though she were an expert in fields about which she knows even less than about law!” The administration is appealing the order but unfortunately not requesting a stay. My husband and I – currently in the US – opted in the end to get second boosters to cover us for a series of 4 flights and 5 airports. Thank heavens we did!<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;">In the meantime, Italy is backing off from its scheduled May 1 end to masking. High-quality face masks will remain required for at least an additional month in public transport, theaters, concerts, indoor sports venues, gyms, and discotheques; for the rest of the school year in classrooms; and until the end of 2022 in healthcare facilities. They can be left off in restaurants, bars, and museums, with offices still to be decided. It remains a mystery to me why Italy is still having so many cases, and especially so many <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=USA~ITA">deaths</a>, even though more than 90% of adults have been vaccinated and <i>everyone</i> wears masks.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Sabizabulin</u>: The <a href="https://verupharma.com/news/verus-novel-covid-19-drug-candidate-reduces-deaths-by-55-in-hospitalized-patients-in-interim-analysis-of-phase-3-study-independent-data-monitoring-committee-halts-study-early-for-overwhelmin/">manufacturer</a> of this experimental drug for critically ill COVID-19 patients says it slashed the death rate so drastically in a Phase 3 trial, from 45% to 20%, that independent monitors recommended the trial be halted and that an application for Emergency Use Authorization be filed with the FDA. The <a href="https://www.nytimes.com/2022/04/11/health/covid-sabizabulin-veru.html?campaign_id=2&emc=edit_th_20220412&instance_id=58215&nl=todaysheadlines&regi_id=19728476&segment_id=88185&user_id=d89c7002526915cc9287fae06e27a28">New York Times article</a> is wrong to say it’s the first drug to cut the death rate in hospitalized patients – that trophy belongs to the old drug <a href="https://www.nejm.org/doi/full/10.1056/nejmoa2021436">dexamethasone</a>– but it is certainly the first to claim such a powerful effect. We’ll see whether the findings hold up after peer review of a complete manuscript.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Evusheld (AZD7442)</u>: The AstraZeneca antibody cocktail seems less effective against plain old Omicron than was first hoped, leading the FDA to <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-authorizes-revisions-evusheld-dosing">double the recommended dosage</a>, but it is apparently more effective against the BA.2 subvariant. A <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2116620?query=TOC">6-month trial</a> involving thousands of volunteers during the Alpha and Delta waves found a single dose of Evusheld to cut the rate of symptomatic COVID-19 by 82.8%, and all cases of severe disease were in the placebo group. This trial predated Omicron, but laboratory analyses confirmed potency against BA.2.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Remdesivir</u>: Rushed through the approval process despite benefits to hospitalized patients that were meagre at best, this drug will probably get knocked out of clinical use altogether by a large negative <a href="https://www.medrxiv.org/content/10.1101/2022.03.30.22273206v2">European study</a>. Fortunately it’s getting wider use now for outpatients, in whom it works much better.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Camostat mesilate</u>: Another <a href="https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(21)00048-7/fulltext">once-promising</a> drug for hospitalized patients has now <a href="https://www.medrxiv.org/content/10.1101/2022.03.27.22271988v2">flunked out</a>. <o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Paxlovid</u>: Previously in short supply, it’s now <a href="https://techilive.in/biden-administration-beefs-up-access-to-covid-antiviral-pills/">readily available</a> all around the United States, but still not reaching the people who most need it. Patients and doctors <a href="https://www.medpagetoday.com/special-reports/exclusives/98402">aren't familiar enough</a> with the pill, and many Americans don’t even have doctors. I often disagree with Zeynep Tufekci, but she’s written an <a href="https://www.nytimes.com/2022/04/22/opinion/covid-pandemic-drugs-treatment.html?campaign_id=2&emc=edit_th_20220423&instance_id=59293&nl=todaysheadlines&regi_id=19728476&segment_id=90065&user_id=d89c7002526915cc9287fae06e27a284">excellent piece</a> describing how the American health non-system is making it difficult for the well-connected, near-impossible for everybody else, to get treated effectively for COVID-19.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="margin-right: 6pt;"><b>Vaccine news<o:p></o:p></b></p><p class="1obc" style="margin-right: 6pt; text-align: center;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgF8dLCOBwFczxH0qB_BBhxJSqoIGMpauW-q5A1hEj9YGicweBDCdQdsgcTzsB4ijpswcECh18BWqZmyo_SAvAB-oCnSXClHxd4UIsfjjJot4EvbZcCJtruZIjOqx4Y54_5_5dIuUvKLmAYzy-G0RSRWHE_bgp7Xi2AuIr8TptxmaO-xN0kTU27U1ed/s2404/Moderna%20bivalent%20vaccine.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1570" data-original-width="2404" height="262" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgF8dLCOBwFczxH0qB_BBhxJSqoIGMpauW-q5A1hEj9YGicweBDCdQdsgcTzsB4ijpswcECh18BWqZmyo_SAvAB-oCnSXClHxd4UIsfjjJot4EvbZcCJtruZIjOqx4Y54_5_5dIuUvKLmAYzy-G0RSRWHE_bgp7Xi2AuIr8TptxmaO-xN0kTU27U1ed/w400-h262/Moderna%20bivalent%20vaccine.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Moderna's <a href="https://assets.researchsquare.com/files/rs-1555201/v1_covered.pdf?c=1650045900" target="_blank">bivalent vaccine</a></td></tr></tbody></table></p><p class="1obc" style="margin-right: 6pt;"><b><v:shape id="Picture_x0020_645" o:spid="_x0000_i1028" style="height: 226pt; visibility: visible; width: 346pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image002.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="margin-right: 6pt;"><u>Second mRNA boosters</u>: Two important new second booster studies have come out of Israel, the first country to start offering that 4<sup>th</sup> dose.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;">The first is a <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2202542?query=TOC">small study</a> among Israeli healthcare workers, in which for the first time to my knowledge Pfizer beat Moderna. Over and above the efficacy of 3 doses, a 4<sup>th</sup> dose of Moderna added just 11% to prevent infection with SARS-CoV-2, whereas Pfizer added 30% while giving fewer side effects. Both added a little more protection against <i>symptomatic</i> infections (31% and 43% respectively). But it’s all small potatoes in these relatively young and healthy individuals.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;">The <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2201688?query=featured_home">second Israeli study</a>, however, suggests that a 4<sup>th</sup> dose likely has more to offer to people who are more at risk. During the Omicron surge, among 182,122 people over 60 who had a 4<sup>th</sup> Pfizer dose as compared with matched individuals who only had 3 doses, the extra booster reduced infections by about 50%, symptomatic infections by 60%, severe disease by 70%, and deaths by 75%. The effect didn’t wane, but researchers report only 30 days’ follow-up.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Omicron-zappers</u>: After Pfizer’s and Moderna’s attempts at an Omicron-specific vaccine stalled at the <a href="https://www.biorxiv.org/content/10.1101/2022.02.03.479037v1">animal-testing stage</a>, the Chinese companies Sinopharm and Sinovac, whose original vaccines were pretty ineffective, are now <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/omicron-specific-sinopharm-covid-vaccine-candidates-cleared-clinical-trial-2022-04-16/">trying their hands</a>. We’ll see. <o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Moderna tries again</u>: <a href="https://assets.researchsquare.com/files/rs-1555201/v1_covered.pdf?c=1650045900">This time</a> it’s a booster they call mRNA-1273.211, which is half aimed at the wild strain and half at Beta (the first relatively vaccine-resistant variant). It managed to induce a hefty load of neutralizing antibodies not only against Beta and the wild strain but also against Omicron. So far it’s only been tested in mice, and only looked at antibodies rather than actual protective ability, but still I’d call these results promising.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Myocarditis, again</u>: Norwegian researchers have reported <a href="https://jamanetwork.com/journals/jamacardiology/fullarticle/2791253">follow-up</a> on 20 million vaccinees. One in 18,000 men and boys between 16 and 24 developed myocarditis after a second dose of Pfizer, and one in 5400 after a second dose of Moderna. Young males should probably get just one dose.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><u>Appendicitis</u>: I’ve heard about lots of strange reactions after mRNA vaccines, from shingles to Guillain-Barre, but I didn’t know appendicitis was <a href="https://www.fiercepharma.com/pharma/pfizer-s-covid-vaccine-data-raise-some-questions-but-shouldn-t-scuttle-fda-nod-analysts">claimed</a> to be among them. And, in fact, an analysis of more than 4 million Danish vaccinees has proven that <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2791667?guestAccessKey=96531e15-b2a5-4584-b2e0-11c802252fc8&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=042522">it's not</a>, that the apparent increased risk was just coincidence.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="margin-right: 6pt;"><b>Are we all infected?<o:p></o:p></b></p><p class="1obc" style="margin-right: 6pt;"><v:shape id="Picture_x0020_653" o:spid="_x0000_i1027" style="height: 163pt; visibility: visible; width: 290pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image003.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEij5G0HZ4psnQsCuoFQQyQ0JWT1UBn5pAiJS1NUDDpG4HBCIJB5cHE9nID27V-MR7TAl9xFvMXm49vU2HkYRCrnHO4S8ouUGfJrQYlR_zR7u992ALUuNMy6Fd5yI_DBKzK-UpnqLKGLk7Pw-uDaqYb02Ob7Pbo0Ryyl2mGR2cEKYt_57J0vBFrlqF0E/s1199/blood%20draw.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="674" data-original-width="1199" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEij5G0HZ4psnQsCuoFQQyQ0JWT1UBn5pAiJS1NUDDpG4HBCIJB5cHE9nID27V-MR7TAl9xFvMXm49vU2HkYRCrnHO4S8ouUGfJrQYlR_zR7u992ALUuNMy6Fd5yI_DBKzK-UpnqLKGLk7Pw-uDaqYb02Ob7Pbo0Ryyl2mGR2cEKYt_57J0vBFrlqF0E/s320/blood%20draw.jpg" width="320" /></a></div><p class="1obc" style="margin-right: 6pt;">New York Times <a href="https://www.nytimes.com/live/2022/04/26/world/mandates-cases-vaccine-covid-19/cdc-covid-infections#cdc-covid-infections">headline</a>: “More than half of Americans have been infected with the coronavirus at least once, the C.D.C. says.” The Times article, and the <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7117e3.htm?s_cid=mm7117e3_w">scientific report</a> it’s based on, specify that “more than half” means 60% of all Americans and 75% of children. <o:p></o:p></p><p class="1obc" style="margin-right: 6pt;">In my opinion this is nonsense. As I pointed out just in my last post, those percentages were obtained from what is described as “a convenience sample of blood specimens submitted for clinical testing.” But, hey, who gets their blood drawn for clinical testing? People who are acutely ill, having checkups for chronic medical conditions, etc., certainly individuals likely to be older and sicker than the general population, and possibly with differing risks of exposure to COVID-19. It’s absurd to generalize their infection rates to the rest of us.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="margin-right: 6pt;"><b>2021 Lown Institute </b><a href="https://lowninstitute.org/projects/shkreli-awards/2021-shkreli-awards/"><b>Shkreli Award Winners</b></a><span class="MsoHyperlink"><b><o:p></o:p></b></span></p><p class="1obc" style="margin-right: 6pt;"><v:shape id="Picture_x0020_646" o:spid="_x0000_i1026" style="height: 254pt; visibility: visible; width: 392pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image004.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZo4JXem_sVnTlDCDF-RBlI6NBST3xpR3ZESlQc4mr0ENNQDJVI396MT6EmG8iU8aLYWINCy9T8XyTZ8ohvmw6nds8Vh2CJIujqvgO0bccP4iXAs78uyBh88CyJ1-0Kea98woc5QK5gC52_6JAT86M3EywgvdQoazH6ZLA84YQ2I9HbPQJQMt64cYM/s962/sackler%20family.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="622" data-original-width="962" height="259" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZo4JXem_sVnTlDCDF-RBlI6NBST3xpR3ZESlQc4mr0ENNQDJVI396MT6EmG8iU8aLYWINCy9T8XyTZ8ohvmw6nds8Vh2CJIujqvgO0bccP4iXAs78uyBh88CyJ1-0Kea98woc5QK5gC52_6JAT86M3EywgvdQoazH6ZLA84YQ2I9HbPQJQMt64cYM/w400-h259/sackler%20family.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">The Sackler family, likely to be worth a <a href="https://www.bloomberg.com/news/features/2021-09-01/sackler-family-exits-bankruptcy-trial-over-purdue-pharma-s-oxycontin" target="_blank">mere $14.6 billion</a> after paying off their settlement</td></tr></tbody></table><p class="1obc" style="margin-right: 6pt;">As in past years, The <a href="https://lowninstitute.org/">Lown Institute</a> picked out 10 of the worst medical profiteers for their 2021 “<a href="https://www.nationalgeographic.com/magazine/article/and-the-shkreli-award-goes-to">Shkreli Awards</a>,” named after the guy who raised the price of an antiparasitic drug costing pennies to make from $13.50 a pill to $750.</p><p class="1obc" style="margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l1 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;"><!--[if !supportLists]-->1.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->FDA fast-tracks unproven Alzheimer’s drug Aduhelm, defying its own advisory committee and putting millions of older Americans at risk<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l1 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;"><!--[if !supportLists]-->2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Sackler family at heart of opioid crisis offered immunity despite harm to millions and deaths of hundreds of thousands <o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l1 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;"><!--[if !supportLists]-->3.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Catholic hospital system, Ascension, with mission to serve the “poor and vulnerable,” creates billion dollar private equity fund while cutting services at safety nets<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l1 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;"><!--[if !supportLists]-->4.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Drug manufacturer Merck prices a course of molnupiravir, a Covid-19 pill developed with federal funds, at 40 times its production cost, $712 instead of $18<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l1 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;"><!--[if !supportLists]-->5.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Community Health Hospital system files 19,000 lawsuits for unpaid medical bills, while receiving $700 million in Covid bailout funds<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l1 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;"><!--[if !supportLists]-->6.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Several hospital systems, including Parkview Regional Medical Center in Fort Wayne, Indiana, claim Medicaid doesn’t count as insurance, raid accident victims’settlements instead<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l1 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;"><!--[if !supportLists]-->7.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Woman leaves Atlanta’s Emory Decatur Hospital<b> </b>ER after waiting seven hours without being seen, hospital charges $700<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l1 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;"><!--[if !supportLists]-->8.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Lenox Hill Hospital steers patients to ER for Covid-19 testing, inflating bill as much as 30 times, from $100 to $3000<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l1 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;"><!--[if !supportLists]-->9.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Pharma companies Biogen and Teva use “charitable giving” to increase sales of their overpriced drugs<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l1 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;"><!--[if !supportLists]-->10.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Suppository users experience discomfort of 5000% price increase – since 2008, under successive patent-holders, most recently Assertio, Indocin suppositories have gone up from $6 to $345 each<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;">Shkreli Award <a href="https://lowninstitute.org/shkreli-awards-dishonorable-mentions-21/">Dishonorable Mentions</a><span class="MsoHyperlink"><o:p></o:p></span></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhAx9zlkBhlljJeT682_kEFf2tk56mx51f20T1GYuH5g3P6fL5N1F9TztaWVWcwn9g4i46S5SQxefEiRiHrwpU2Ms_kzVMJWwzJoP2sPLB-pz5fyCUDQk-ImcFHmcczBTzSHbNvpiFmnAqrhRvjHSdh6gT4xC8h3RF4ZO1HO44F0eZZcUMiDTwf2Pw/s920/America's%20Frontliine%20Doctors.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="517" data-original-width="920" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhAx9zlkBhlljJeT682_kEFf2tk56mx51f20T1GYuH5g3P6fL5N1F9TztaWVWcwn9g4i46S5SQxefEiRiHrwpU2Ms_kzVMJWwzJoP2sPLB-pz5fyCUDQk-ImcFHmcczBTzSHbNvpiFmnAqrhRvjHSdh6gT4xC8h3RF4ZO1HO44F0eZZcUMiDTwf2Pw/w400-h225/America's%20Frontliine%20Doctors.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Stella Immanuel of "America's Frontline Doctors" and sex-with-demons fame</td></tr></tbody></table><p class="1obc" style="margin-right: 6pt;"><v:shape id="Picture_x0020_647" o:spid="_x0000_i1025" style="height: 182pt; visibility: visible; width: 325pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image005.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l0 level1 lfo2; tab-stops: list .5in; text-indent: -.25in;"><!--[if !supportLists]-->1.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Half of US hospitals refuse to comply with price transparency rule designed to help consumers<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l0 level1 lfo2; tab-stops: list .5in; text-indent: -.25in;"><!--[if !supportLists]-->2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Health systems in Palm Beach, Chicago, and elsewhere allow big donors, board members, and executives to cut the line for Covid-19 vaccines<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l0 level1 lfo2; tab-stops: list .5in; text-indent: -.25in;"><!--[if !supportLists]-->3.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Doctor Francisco Patino (Michigan) trades opioid prescriptions for unnecessary spinal injections<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l0 level1 lfo2; tab-stops: list .5in; text-indent: -.25in;"><!--[if !supportLists]-->4.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->U. of Texas Anderson Cancer Center fails to report results of clinical trial for over 15 years<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l0 level1 lfo2; tab-stops: list .5in; text-indent: -.25in;"><!--[if !supportLists]-->5.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Florida’s program to cover medical expenses for brain-damaged children denied claims for necessary therapies<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l0 level1 lfo2; tab-stops: list .5in; text-indent: -.25in;"><!--[if !supportLists]-->6.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->“America’s Frontline Doctors” make millions pushing unproven and harmful medications such as hydroxychloroquine and ivermectin for Covid-19<o:p></o:p></p>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com0tag:blogger.com,1999:blog-6211405954943098401.post-36687889584442185402022-04-07T13:50:00.002+02:002022-04-07T20:42:59.813+02:00America’s Chickens Come Home To Roost<p></p><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;"><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiesLajBhrNiwyau-v48zAokjRLzesB9CocIDdPwb13A52jv9Dx_CtT85gSdVnb1l-dS1P_s3sS2xsNH1IqJrSPcNnFw8njRW8FGlScxyp29WXkaoy41dHLjpjaXxMtxdNXQJdkXTjtuU6oWzbsUMxgG11qv_Uc3oFzN7Sd8F-9k3wucCQakS0negnY/s470/back%20in%20the%20usa.png" style="font-family: -webkit-standard; margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="470" data-original-width="470" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiesLajBhrNiwyau-v48zAokjRLzesB9CocIDdPwb13A52jv9Dx_CtT85gSdVnb1l-dS1P_s3sS2xsNH1IqJrSPcNnFw8njRW8FGlScxyp29WXkaoy41dHLjpjaXxMtxdNXQJdkXTjtuU6oWzbsUMxgG11qv_Uc3oFzN7Sd8F-9k3wucCQakS0negnY/s320/back%20in%20the%20usa.png" width="320" /></a></p><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: left;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">A wide-ranging post: from convalescent plasma to boosters, American healthcare, CDC guidelines, long COVID, excess mortality, leak vs. leap, and global mishegos.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Treatment and prevention news<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjtQ9_lEUReVzAxlOkP7kxSgJClG3Qu3x7gZWjjNBp0ZiuEGiwML7lp968SloFf8eBrQXOxRuU36j4c3tNJh--_OWesC0ug3YJT_Djos7uXKE9V2nBzMr3F0svL18yz_qf-FTp4iFPzA_Sf9ludsMmKjrfW9iwOQ4fuqktaP84W__-GzLw62Yw2wa5/s1734/aula%203+.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1301" data-original-width="1734" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjtQ9_lEUReVzAxlOkP7kxSgJClG3Qu3x7gZWjjNBp0ZiuEGiwML7lp968SloFf8eBrQXOxRuU36j4c3tNJh--_OWesC0ug3YJT_Djos7uXKE9V2nBzMr3F0svL18yz_qf-FTp4iFPzA_Sf9ludsMmKjrfW9iwOQ4fuqktaP84W__-GzLw62Yw2wa5/w400-h300/aula%203+.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">An Italian classroom</td></tr></tbody></table><br /><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Convalescent plasma (serum)</u>: A treatment that rises continually from its ashes. In a new <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2119657?query=TOC&ssotoken=U2FsdGVkX1%2FfGwF2yh7mLVA8%2FSuUcoTBZSaP0WPpwU1MGiaXW0voMyltk4pCOfbdgZ1VfI%2Fu9SeSdwZjbuKBMs2LQn5QuzDho0oXDBH7LEyeydrlimVfaFA0Q2l0KIz7cmmXh7te6mMxYF5zTN00FSdm5aafErQtjp0D0YlF0ffDGMQ%2BZSgR2VlXXMig7R6ywRWmQOt1IjCOmpe11E02Pw%3D%3D&cid=NEJM%20eToc,%20March%2031,%202022%20DM883979_NEJM_Subscriber&bid=905747566">large American study</a>, recent-onset patients who received high-antibody plasma saw their risk of hospitalization slashed in half. Even though most plasma donors had had the Wuhan wild strain, their sera protected against Delta. If donor and recipient strains had matched, the treatment might have done even better. The researchers point out that unlike monoclonal antibody products, convalescent serum contains a broad range of antibodies, adding that plasma sourced <b><i>locally</i></b> from recent survivors might be particularly effective.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Ventilation</u>: <a href="https://www.reuters.com/world/europe/italian-study-shows-ventilation-can-cut-school-covid-cases-by-82-2022-03-22/">A study</a> in one <a href="https://www.regione.marche.it/News-ed-Eventi/Post/83541/Covid-19-la-ventilazione-meccanica-controllata-Vcm-abbatte-il-rischio-contagio-oltre-l-80-Primo-studio-pilota-nelle-Marche-unica-regione-in-Italia-ad-aver-investito-per-contrastare-la-diffusione-della-pandemia-nelle-scuole">Italian region</a> says controlled mechanical ventilation in classrooms can cut kids’ infections by <a href="https://www.regione.marche.it/News-ed-Eventi/Post/83541/Covid-19-la-ventilazione-meccanica-controllata-Vcm-abbatte-il-rischio-contagio-oltre-l-80-Primo-studio-pilota-nelle-Marche-unica-regione-in-Italia-ad-aver-investito-per-contrastare-la-diffusione-della-pandemia-nelle-scuole">as much as 82.5%</a>, pretty amazing. I need to see more details, because the classroom isn’t where most children get infected. Ventilation systems might be most valuable in adult venues such as theaters and medical conferences. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Lockdowns</u>: A <a href="https://theconversation.com/did-the-covid-lockdowns-work-heres-what-we-know-two-years-on-176623">nice piece</a> in The Conversation demonstrates that lockdowns are extremely effective when instituted early, while pointing out that they represent a failure of more gradual policies. Its data should silence the few remaining doubters.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Vitamin D</u>: People with low vitamin D levels have a high risk for severe COVID-19. Yes. There’s even a self-styled <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8541492/">meta-analysis</a> claiming that a “Mortality Rate Close to Zero Could Theoretically Be Achieved at 50 ng/mL 25(OH)D3 [a high blood level of vitamin D].” I’ve always been convinced the association was due to confounding: people in poor health have low levels. Now there’s proof. In a <a href="https://www.medrxiv.org/content/10.1101/2022.03.22.22271707v1.full.pdf">gigantic British study</a>, adults with lowish vitamin D levels who were randomized to receive high-dose supplements were if anything <i>more</i> likely to fall ill with COVID-19, be hospitalized, or develop long COVID. These results held even when people randomized to supplements but didn’t take them and people randomized to no supplements took vitamin D outside the study setting were excluded from the analyses.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Ivermectin</u>: The large-scale Brazilian study that put the final nail into its coffin has now been <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2115869?query=TOC&ssotoken=U2FsdGVkX1%2FfGwF2yh7mLVA8%2FSuUcoTBZSaP0WPpwU1MGiaXW0voMyltk4pCOfbdgZ1VfI%2Fu9SeSdwZjbuKBMs2LQn5QuzDho0oXDBH7LEyeydrlimVfaFA0Q2l0KIz7cmmXh7te6mMxYF5zTN00FSdm5aafErQtjp0D0YlF0ffDGMQ%2BZSgR2VlXXMig7R6ywRWmQOt1IjCOmpe11E02Pw%3D%3D&cid=NEJM%20eToc,%20March%2031,%202022%20DM883979_NEJM_Subscriber&bid=905747566">published</a>. But I doubt that will <a href="https://www.nbcnews.com/think/opinion/ivermectin-myths-make-covid-vaccine-test-psas-harder-sell-rcna22901">stop ‘mectinmania</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Sotrovimab</u>: Bad news. The only monoclonal antibody product that worked well against the original Omicron variant turns out <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2201933">not to work</a> against BA.2, which <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/omicron-stealth-covid-variant-ba2-now-dominant-globally-2022-03-29/">has taken over</a> much of the world, so the FDA has <a href="https://www.statnews.com/2022/03/25/fda-limits-therapy-ineffective-against-ba2-variant-omicron/">stopped shipments</a> to areas of the US where it’s dominant. Next up to the plate is the new arrival, bebtelovimab.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Antivirals</u>: What’s with Italy? Though more than 11,000 doses of Paxlovid touched down by February 3<sup>rd</sup>, and many more since, <a href="https://www.quotidianosanita.it/governo-e-parlamento/articolo.php?articolo_id=103387">only 2,072 patients</a> had been treated as of March 22<sup>nd</sup>. The less effective Lagrevio (molnupiravir) had gone to more than <a href="https://sport.sky.it/calcio/2022/03/14/coronavirus-italia-dati-covid-oggi-14-marzo?lbp=2">4 times as many</a>, and I’m unable to find how many have had infusions of remdesivir. About 384,000 people over 70 were diagnosed with COVID-19 during that time frame, most of whom would have been eligible for antivirals. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Vaccine news<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRJxf6TOXOlh-i0EwpAgdeRs0vJbpNieGhONhWt5BVuwwt7YZAPar7kG8CaJVa0oUB4ne_025AGWgvPM-HDliHsvDUV0OkzCTNrYiUDcBMquv-HN2TB6BsbyOV8zfRqSfL5iD5FRi69z8SaQ0EtjrCmbHSOjDvbLjzAh_cGHpLO1fnjBwTVD8btYY8/s1240/vaccine%20for%20babies.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="845" data-original-width="1240" height="218" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRJxf6TOXOlh-i0EwpAgdeRs0vJbpNieGhONhWt5BVuwwt7YZAPar7kG8CaJVa0oUB4ne_025AGWgvPM-HDliHsvDUV0OkzCTNrYiUDcBMquv-HN2TB6BsbyOV8zfRqSfL5iD5FRi69z8SaQ0EtjrCmbHSOjDvbLjzAh_cGHpLO1fnjBwTVD8btYY8/s320/vaccine%20for%20babies.jpg" width="320" /></a></div><br /><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u><v:shape id="Picture_x0020_651" o:spid="_x0000_i1038" style="height: 202pt; visibility: visible; width: 297pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image002.jpg"></v:imagedata></v:shape><o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Booster #1</u>: Yet <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2200674?query=TOC&ssotoken=U2FsdGVkX1%2Fnq%2BofrPKv%2FR2hD%2FfKeSklveroruTmEliLE0o3im8G%2BR9oQWT75pY50sk7Vvl3qO4fWtu1bqSlh57QCZqOoJMk82PGmBJg8VpmzPH%2B8gJfMttJg15J9myXev9iYhKHMsUtD1wjN81BwBuF01y58gKEr%2BOjhFslxOmx228gWBR4bA68AWd5IlEfpj8wZTBLUsJCKd%2BXCT50vA%3D%3D&cid=NEJM%20eToc,%20March%2024,%202022%20DM858995_NEJM_Subscriber&bid=892001150">another study</a>, analyzing Pfizer Phase 3 follow-up data during the Delta wave, has confirmed that a third dose heps up effectiveness to well over 90%. But we know it’s less effective against Omicron, and that it doesn’t last long. There is now laboratory <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2119912?">evidence</a> that the Moderna booster would be much more effective against Omicron if it contained 100 µg of mRNA instead of 50.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Booster #2</u>: This is what everybody’s asking me about, and I don’t always know what to say. Along with Israel and several European countries, the US is <a href="https://www.nytimes.com/2022/03/25/us/politics/biden-second-booster-shot-older-americans.html">plunging ahead</a> with 4<sup>th</sup> shots to older people. But their value has <a href="https://www.ft.com/content/3963f1fa-64d7-4c68-9afb-bfba02c26971">still not</a> been definitively demonstrated. An <a href="https://www.medrxiv.org/content/10.1101/2022.02.15.22270948v1.full.pdf">Israeli study</a> of healthcare workers, using age-matched controls, found vaccinated subjects to have only 11-30% fewer infections and 31-43% lower rate of symptomatic COVID-19. <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2201570?">Another study</a>, in the general Israeli population, found substantially increased protection against <i>infection</i>, but it had vanished just 8 weeks after the 4<sup>th</sup> dose; enhanced protection against <i>severe</i> disease lasted at least 6 weeks. Now <a href="https://www.medrxiv.org/content/10.1101/2022.02.15.22270948v1.full.pdf">a third Israeli study</a>, from an insurance company, reports that <i>deaths</i> from COVID-19 were 78% lower for 40 days following a second booster. But before leaping to conclusions, note that this study was not a prospective trial but a retrospective comparison between people who chose to get a 4<sup>th</sup> dose and those who did not. This weaker methodology leaves the results more susceptible to confounding, less trustworthy. Fifteen percent of Americans over 50 still haven’t even gotten a primary course of vaccine, much less <a href="https://www.kff.org/coronavirus-covid-19/dashboard/kff-covid-19-vaccine-monitor-dashboard/#boosters">boosters</a>, and with the US about to face a <a href="https://www.nytimes.com/2022/03/29/opinion/covid-funding-america.html?campaign_id=2&emc=edit_th_20220330&instance_id=57086&nl=todaysheadlines&regi_id=19728476&segment_id=86951&user_id=d89c7002526915cc9287fae06e27a284">shortage of doses</a> for the first time priority should be given to the unvaccinated and unboosted. Italy is <a href="https://www.reuters.com/world/europe/italy-recommends-fourth-covid-vaccine-dose-immunocompromised-2022-02-20/">still offering</a> dose 4 only to the immunosuppressed, which at this point makes sense to me and to at least <a href="https://abcnews.go.com/Health/4th-covid-19-vaccine-doses-looming-experts-fast/story?id=83578268">some others</a>, though I would add the very elderly and those with multiple preexisting conditions.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>AstraZeneca</u>: Though it’s been dismissed by now in the US and Europe for low efficacy, questionable research, and serious (though rare) side effects, the company <a href="https://www.theguardian.com/society/2022/mar/20/oxford-covid-jab-vaccine-astrazeneca">is back to defending</a> its cheap and convenient vaccine, saying it’s already saved more than a million lives and will save many millions more in developing countries. Maybe so.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>The mRNA derby</u>: Why is Moderna’s vaccine consistently more effective than Pfizer’s? Partly, it is thought, the dose: Moderna’s 100 µg original dose, and even its 50 µg booster, are heftier than Pfizer’s 30 µg. But a <a href="https://www.science.org/doi/10.1126/scitranslmed.abm2311">recent study</a>has revealed another reason: Moderna stimulates parts of the immune system that Pfizer doesn’t, including but not limited to inducing IgA “mucosal” antibodies believed key in preventing infection.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Little kids</u>: Pfizer’s <b><u>3 microgram</u><i> </i></b>vaccine for under-5’s flunked out – it didn’t even stimulate toddlers’ immune system. A 2-dose cycle of Moderna’s <b><u>25 microgram</u></b> version for children 6 months to 6 years old, on the other hand, <a href="https://investors.modernatx.com/news/news-details/2022/Moderna-Announces-its-COVID-19-Vaccine-Phase-23-Study-in-Children-6-Months-to-Under-6-Years-Has-Successfully-Met-Its-Primary-Endpoint/default.aspx">works</a> even in the real world. Efficacy was only around 40%, but against Omicron that’s par for the course. No kids developed severe disease, so we can’t say anything about that endpoint.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>School-age kids</u>: Parents get widely <a href="https://www.nytimes.com/2022/03/23/nyregion/nyc-schools-vaccine-clinics.html?campaign_id=2&emc=edit_th_20220324&instance_id=56553&nl=todaysheadlines&regi_id=19728476&segment_id=86412&user_id=d89c7002526915cc9287fae06e27a284">castigated</a> for not getting their kids vaccinated, giant campaigns are being instituted, and some even propose the shot be added to the obligatory list for attending school. But only 27% of 5-11-year-olds are vaccinated nationally, 45% in vaccine-friendly New York City. Given that those low-dose Pfizer jabs turn out to work not for months but <a href="https://www.medrxiv.org/content/10.1101/2022.02.25.22271454v1">for weeks</a>, I tend to be with those hesitant parents. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Adolescents</u>: Teenagers, unlike kids, seem to remain more than 90% protected – at least against hospitalization for the Delta variant – for <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2202826?query=TOC">close to a year</a> after their second dose. Against Omicron only 40%, in line with results among adults.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Two doses against Omicron</u>: I mentioned a large <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2119451?query=TOC&ssotoken=U2FsdGVkX18aU6LDj94kO9M2aATsM97e7w%2FLAnsgTIIwS4eoqsYEqSLpW9xIRB4ZyfPD3aH5MTSRnSiNH7JTAI%2BSDuDPFgBeM%2FWMSk%2BYcjEsmXQDJd37pkzeW7DWT0hiAc8rC4ZpsLdTz0VO%2F25VIM%2BlS4gZ%2FGvmqf55d%2Fyfd0UIF3uetSxH6vv%2BzZiHImpHokXIPiu4HLhBUUcm3%2F%2BRZg%3D%3D&cid=NEJM%20eToc,%20March%203,%202022%20DM784500_NEJM_Subscriber&bid=854847704">British study</a> last time but I skipped past what may have been its most important finding: a mere 3 months after your second dose of Pfizer, when you’re still eligible for the Italian Super Green Pass, your protection against Omicron is only 25%.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>One dose in survivors</u>: Yet more evidence, <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2119497?query=TOC">this time from Israel</a>, that people who have recovered from COVID-19 need only a single dose of vaccine. Pfizer was 82% effective in preventing reinfection in patients ages 16-64, and 60% in those over 65, whether they received one dose or two – pre-Omicron. I.e. Italy has it right, the US has it wrong.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Omicron specials</u>: One of the plusses of mRNA vaccines was supposed to be the ability to adapt them easily to new variants, and as late as January <a href="https://www.cnbc.com/2022/01/10/covid-vaccine-pfizer-ceo-says-omicron-vaccine-will-be-ready-in-march.html">Pfizer was promising</a> it would have an anti-Omicron vaccine ready to roll in March. Now that deadline has come and gone, and who’s gotten the vaccine? Animals, mainly, and it <a href="https://www.nature.com/articles/d41586-022-00003-y">hasn’t done them much good</a>. Even a tailored Moderna vaccine is flunking out in <a href="https://www.biorxiv.org/content/10.1101/2022.02.03.479037v1">monkeys</a> and <a href="https://www.biorxiv.org/content/10.1101/2022.02.07.479419v1">mice</a>. Even worse, the antibody patterns suggest the new vaccines leave the animals <b><i>less</i></b> protected against previous strains of the virus. Early human studies are underway from both <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-initiate-study-evaluate-omicron-based">Pfizer</a> and <a href="https://www.clinicaltrialsarena.com/news/moderna-omicron-specific-booster/">Moderna</a>, but I suspect it’s back to the drawing board.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Vaccinated/contagious</u>: People with breakthrough infections have a lower <a href="https://www.medrxiv.org/content/10.1101/2022.01.10.22269010v1">infectious viral load</a> than the unvaccinated and clear the virus <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00648-4/fulltext">more rapidly</a>. And researchers in <a href="https://www.medrxiv.org/content/10.1101/2021.09.28.21264260v2.full">the UK</a> and <a href="https://www.medrxiv.org/content/10.1101/2021.10.14.21264959v1.full.pdf">the Netherlands</a> found people with “breakthrough” infections transmitted the Delta variant to about half as many contacts. But when it comes to household members, who are more intensely exposed, that <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00648-4/fulltext">advantage disappears</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>About them chickens…<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPw6tlvT5eKlaDaNbgT6VAoIdUZoDf6IUn8EAybDfIgj2J9jkGfZgcjigRfVIzWi7X0GMxYyKcZ2X8RjjoifuoQdDnFtQbMx_Q_GzS9GPdhh7xxEfQcd_n39tLGEsi8BEHKlhqPCVue_MsbgChySucuOqEWRJENk2mS8ABFd6kQffc3ekFMaCqa6wz/s960/animals-chickens_come_home_to_roost-chickens-regrets-regretful-idiom-mcan1494_low.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="800" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPw6tlvT5eKlaDaNbgT6VAoIdUZoDf6IUn8EAybDfIgj2J9jkGfZgcjigRfVIzWi7X0GMxYyKcZ2X8RjjoifuoQdDnFtQbMx_Q_GzS9GPdhh7xxEfQcd_n39tLGEsi8BEHKlhqPCVue_MsbgChySucuOqEWRJENk2mS8ABFd6kQffc3ekFMaCqa6wz/w334-h400/animals-chickens_come_home_to_roost-chickens-regrets-regretful-idiom-mcan1494_low.jpeg" width="334" /></a></div><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_631" o:spid="_x0000_i1037" style="height: 217pt; visibility: visible; width: 180pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image003.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Currently 31.2 million Americans are uninsured, and that number may swell to <a href="https://www.washingtonpost.com/health/2022/03/14/medicaid-loss-of-coverage/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F3652c6e%2F623063ba9d2fda34e7d287ee%2F599d6acbae7e8a3d46e1400f%2F22%2F68%2F623063ba9d2fda34e7d287ee">47 million</a> when the Medicaid rolls get slashed due to the end of the state of emergency later this year. Many are theoretically eligible for other forms of insurance, but in practice there are <a href="https://apnews.com/article/covid-health-business-coronavirus-vaccine-medicaid-fbb66b72937f3517a5d3d1ba8840f339">many barriers</a>. As I reluctantly predicted in my last post, the refusal of Congress to fund the battle against COVID-19, for which <a href="https://www.nytimes.com/2022/04/05/us/politics/coronavirus-pandemic-aid-immigration.html?campaign_id=2&emc=edit_th_20220406&instance_id=57671&nl=todaysheadlines&regi_id=19728476&segment_id=87607&user_id=d89c7002526915cc9287fae06e27a284">Democrats are as responsible as Republicans</a>, means those 47 million will likely <a href="https://www.nytimes.com/live/2022/03/28/world/covid-19-mandates-cases-vaccine#concerns-rise-as-a-us-reimbursement-fund-for-testing-and-treating-the-uninsured-for-the-virus-stops-taking-claims">have to pay</a> for services that had been free: each test will set them back <a href="https://thecenterforurgentcare.com/covid-19-testing/">$125-$195</a>, each vaccine dose <a href="https://www.cms.gov/medicare/covid-19/medicare-covid-19-vaccine-shot-payment">at least $40</a>, and if they get sick they’ll be <a href="https://www.washingtonpost.com/health/2022/03/28/federal-aid-hospitals-clinics-runs-out/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F367025d%2F6242d8d83e6ed13ade43d3aa%2F599d6acbae7e8a3d46e1400f%2F56%2F75%2F6242d8d83e6ed13ade43d3aa">liable for treatment costs</a>. Already <a href="https://www.statnews.com/2022/03/29/covid-19-pandemic-isnt-over-for-black-americans-report-warns/?utm_campaign=KHN%3A%20Daily%20Health%20Policy%20Report&utm_medium=email&_hsmi=208440038&_hsenc=p2ANqtz-8EwWTyyEe75xGMtGV19Vnw8t7v73-7b8uuSUnMrL0XVzl2lQ9vy_IBS5AMVkdIr2doTnOxxMRyq7SbI2e6oFaMGzFrew&utm_content=208440038&utm_source=hs_email">black</a> or <a href="https://www.usnews.com/news/top-news/articles/2022-04-04/u-s-poor-died-at-much-higher-rate-from-covid-than-rich-report?src=usn_nl_coronavirus&utm_source=Sailthru&utm_medium=email&utm_campaign=CB_4/5/22&utm_term=Coronavirus%20Bulletin">impoverished</a> Americans are being hospitalized at twice the national rate, even before cutbacks kick in. <a href="https://www.nytimes.com/2022/03/29/opinion/covid-funding-america.html?campaign_id=2&emc=edit_th_20220330&instance_id=57086&nl=todaysheadlines&regi_id=19728476&segment_id=86951&user_id=d89c7002526915cc9287fae06e27a284">Insured Americans will suffer</a> too, since supplies of vaccines and treatments will dry up, traditional Medicare will <a href="https://apnews.com/article/covid-health-business-coronavirus-vaccine-medicaid-fbb66b72937f3517a5d3d1ba8840f339">no longer cover</a> telemedicine, and the ability to detect and protect against new variants will be damaged. The criminal American health system – or should I say death system – strikes again. When the hell is the US going to join the rest of the civilized world and offer health care to everybody?<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The state of the States<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTQI8K7ZiBPUsWRVwaYk2tDUuAzxmfVUZ4ACVtQz5UfQSC57yyM9DMwfRJ8I84n6Crf5fWnj_-WTYLjhkZzOv-LeS0KEmQR1iMjcrHb6Pj3gEulPZl4tuCfRFH4NKHQjQvw8ZYOFG9wrQj_lOpGOfWGYwKVo0XXkFoj5yH6XNx_W12J3XMQgPB8QHy/s1190/Leana%20Wen%202022-03-23.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="576" data-original-width="1190" height="194" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTQI8K7ZiBPUsWRVwaYk2tDUuAzxmfVUZ4ACVtQz5UfQSC57yyM9DMwfRJ8I84n6Crf5fWnj_-WTYLjhkZzOv-LeS0KEmQR1iMjcrHb6Pj3gEulPZl4tuCfRFH4NKHQjQvw8ZYOFG9wrQj_lOpGOfWGYwKVo0XXkFoj5yH6XNx_W12J3XMQgPB8QHy/w400-h194/Leana%20Wen%202022-03-23.jpg" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWPYTmfYMWBTcA9Gwy-QSLY5Jf2Ljxrl5lfid0zVIFv0JgejAiKCrTqUyB4W0FlJY0XJ35HPzwzJSwb2TFDJYgAHRCk7g1vUbg4U6QSoTuLf0-HEkSv_-xSxDi-XWH-eHlUemltmirSJjFhrPEclupsovTBIAoiGc2O49garUjplJaBshuyI3H1myE/s1126/reply%20to%20Wen%202022-03-23.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="299" data-original-width="1126" height="108" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWPYTmfYMWBTcA9Gwy-QSLY5Jf2Ljxrl5lfid0zVIFv0JgejAiKCrTqUyB4W0FlJY0XJ35HPzwzJSwb2TFDJYgAHRCk7g1vUbg4U6QSoTuLf0-HEkSv_-xSxDi-XWH-eHlUemltmirSJjFhrPEclupsovTBIAoiGc2O49garUjplJaBshuyI3H1myE/w400-h108/reply%20to%20Wen%202022-03-23.jpg" width="400" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_633" o:spid="_x0000_i1036" style="height: 154pt; visibility: visible; width: 317pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image004.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_635" o:spid="_x0000_i1035" style="height: 82pt; visibility: visible; width: 309pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image005.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">New <a href="https://www.washingtonpost.com/health/2022/02/28/covid-cases-nationwide/">CDC data</a> suggest that <a href="https://covid.cdc.gov/covid-data-tracker/#national-lab">43% of Americans</a>, including more than half of children under 18, have already been exposed to SARS-CoV-2, doubling the official number of cases. But those figures come from analyses of blood samples drawn during January for <a href="https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/commercial-lab-surveys.html">other reasons</a> – a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686880/">questionable methodology</a>, given that people who are getting blood tests are older and sicker than the general population, and may also have differing risks of exposure to COVID-19. Only age could be adjusted for statistically. Alas, these findings can and will be misinterpreted as meaning that 43% of Americans not only have had COVID-19 but have permanent future protection due to natural immunity.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The lenient new CDC guidelines continue to be <a href="https://www.nytimes.com/2022/03/19/health/covid-ba2-surge-variant.html?campaign_id=2&emc=edit_th_20220320&instance_id=56235&nl=todaysheadlines&regi_id=19728476&segment_id=86037&user_id=d89c7002526915cc9287fae06e27a284">hotly debated</a>, partly related to the agency’s <a href="https://multiracialunity.org/2022/02/10/cdc-prioritizes-a-healthy-public-or-a-healthy-economy/">gradual corruption</a> by economic and business interests, with immunosuppressed <a href="https://www.washingtonpost.com/health/2022/03/21/biden-pandemic-plan-ba2-surge/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F36607b2%2F62399e4b3e6ed13ade34301e%2F599d6acbae7e8a3d46e1400f%2F55%2F82%2F62399e4b3e6ed13ade34301e">justifiably fearful</a>. The Italian Medical Association <a href="http://direnl.dire.it/odm/anno/2022/marzo/31/?news=C01">strongly recommends</a> everybody keep wearing masks inside public spaces even if the government goes through with dropping the requirement at the end of April.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">In addition to thinking the US should return to normal, Leana Wen thinks an Omicron BA.2 surge is coming but we <a href="https://www.washingtonpost.com/opinions/2022/03/21/ba2-covid-wave-concerns-restrictions/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F36607a5%2F62399e4b3e6ed13ade34301e%2F599d6acbae7e8a3d46e1400f%2F40%2F82%2F62399e4b3e6ed13ade34301e">shouldn’t worry</a>. Her reasoning is that most Americans are protected from severe disease and death by recent infections or boosters. But protection from milder forms is less, and my mantra – <a href="https://www.theguardian.com/society/2022/mar/23/long-covid-could-create-a-generation-affected-by-disability-expert-warns">shared by experts</a> such as <a href="https://en.wikipedia.org/wiki/Danny_Altmann">Danny Altmann</a> – is as always, “What about long COVID?”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Another fellow-Cassandra is <a href="https://www.nytimes.com/2022/03/22/opinion/covid-surge-prep.html">Tom Frieden</a>, Director of the CDC in better days, who particularly emphasizes how urgent it is get more shots into American arms given that a mind-boggling 60% of Americans are not up-to-date with their vaccines and therefore at particularly high risk for severe disease and death. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXO360YNCddYXgEbYP6wwamKBUiUmkaMdPIn-EcRtquaOzmo35hRAlw0x-8aN-bDK56X6kSnobICeMR9cELKgbc3QOb2Pp8IqPitMhl2FjlnioCemy2KaH_WTb57tA4zTrDKUN0XbqN9Lmtih5DxX9GgicqjuhXgs8xMhnnMCcneYMRMbLXgH4Y7Ey/s1084/Wallace%20re%20lack%20of%20urgency.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="460" data-original-width="1084" height="170" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXO360YNCddYXgEbYP6wwamKBUiUmkaMdPIn-EcRtquaOzmo35hRAlw0x-8aN-bDK56X6kSnobICeMR9cELKgbc3QOb2Pp8IqPitMhl2FjlnioCemy2KaH_WTb57tA4zTrDKUN0XbqN9Lmtih5DxX9GgicqjuhXgs8xMhnnMCcneYMRMbLXgH4Y7Ey/w400-h170/Wallace%20re%20lack%20of%20urgency.jpg" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8srDhhuIScP0A8G4KI59SNnfTy29I5fbByjZJQA1jp_VLSP1oXmwIgHkZ4g8W-7NCt5EVkZM3K6ib7xUZFezyDnfYTXg0HvZAq0um-6QJFOcYgSk0t1CGLVza-jH5pwXduaraqSCxSvVJY0D8iJa3IXWcHweE3Xh3ljRJmjA0qo3GbkbwLpJLa9FD/s1104/Wu%20re%20lack%20of%20urgency.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="502" data-original-width="1104" height="183" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8srDhhuIScP0A8G4KI59SNnfTy29I5fbByjZJQA1jp_VLSP1oXmwIgHkZ4g8W-7NCt5EVkZM3K6ib7xUZFezyDnfYTXg0HvZAq0um-6QJFOcYgSk0t1CGLVza-jH5pwXduaraqSCxSvVJY0D8iJa3IXWcHweE3Xh3ljRJmjA0qo3GbkbwLpJLa9FD/w400-h183/Wu%20re%20lack%20of%20urgency.jpg" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><v:shape id="Picture_x0020_643" o:spid="_x0000_i1034" style="height: 112pt; visibility: visible; width: 264pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image006.jpg"></v:imagedata></v:shape><o:p></o:p><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_641" o:spid="_x0000_i1033" style="height: 97pt; visibility: visible; width: 260pt;" type="#_x0000_t75"><v:imagedata cropbottom="11571f" o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image007.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Here's that <a href="https://www.theatlantic.com/health/archive/2022/03/next-covid-variant-surge-strategy/627597/">good piece</a> of hers. </p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Long COVID news (this </b><a href="https://www.nytimes.com/interactive/2022/02/19/science/long-covid-causes.html?campaign_id=2&emc=edit_th_20220220&instance_id=53782&nl=todaysheadlines&regi_id=19728476&segment_id=83373&user_id=d89c7002526915cc9287fae06e27a284"><b>Times article</b></a><b> and this <a href="https://www.aljazeera.com/program/the-stream/2022/2/8/whats-needed-to-defeat-long-covid">Al Jazeera video</a> recommended)</b><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_626" o:spid="_x0000_i1032" style="height: 200pt; visibility: visible; width: 357pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image008.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgF4DpV5DH6IcvTGz5mAtQotacnnBN37hqjvp68o6CHsHW-eSgQpvd1BUHOzQ2RMrTp1KcHfSPniKZFFrJVd21sSRoyupffFuBGaP7sUJX7XYO6IvKyiN6IJc_WEeNCCZpLviLU5G2o1Y7jS4lh0Es1Vb8Nm707gFWRSNhQTufqCCKCmNpeLjymu82E/s976/Xenon%20scan%20long%20covid.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="549" data-original-width="976" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgF4DpV5DH6IcvTGz5mAtQotacnnBN37hqjvp68o6CHsHW-eSgQpvd1BUHOzQ2RMrTp1KcHfSPniKZFFrJVd21sSRoyupffFuBGaP7sUJX7XYO6IvKyiN6IJc_WEeNCCZpLviLU5G2o1Y7jS4lh0Es1Vb8Nm707gFWRSNhQTufqCCKCmNpeLjymu82E/w400-h225/Xenon%20scan%20long%20covid.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Xenon gas MRIs showing poor oxygen transport in long COVID</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Prevalence</u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://www.medrxiv.org/content/10.1101/2022.03.18.22272607v1?fbclid=IwAR1e3C5x2hnR2hMmolEdRyTWTU39C-5KBRnCFdc03DlM_Bg-0pnPO4E17t8">Half</a> the patients with mild-moderate COVID-19 still aren’t well after 6 months, and sicker ones do even worse: a <b><i>year</i></b>after being discharged from the ICU <a href="https://jamanetwork.com/journals/jama/fullarticle/2788504">74%</a> had persistent symptoms, and only 42% of those previously working full-time were back on the job. And countless outpatients have “<a href="https://www.npr.org/sections/health-shots/2022/03/17/1083040162/long-covid-symptoms?sc=18&f=1001">medium COVID</a>” that drags on for many weeks.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Most long COVID patients simply continue with the same symptoms they had to start with, but new organ damage can also appear. In one <a href="https://www.nature.com/articles/s41591-022-01689-3">study</a>, COVID-19 survivors were more likely than controls to develop atrial fibrillation, heart failure, heart attacks, and strokes. Other <a href="https://www.bmj.com/content/376/bmj-2021-068414">late consequences</a> can include <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00044-4/fulltext#fig2">diabetes</a>, <a href="https://www.bmj.com/content/376/bmj-2021-068414">kidney damage, hypertension</a>, and <a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/2789919">dementia</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Fortunately <a href="https://link.springer.com/article/10.1007/s00431-021-04345-z">fewer than 1%</a> of pediatric COVID-19 patients develop long COVID and those who do, mostly adolescents, are usually OK by 5 months.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">One international research group that followed 309 COVID-19 patients <a href="https://www.cell.com/cell/pdf/S0092-8674(22)00072-1.pdf?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867422000721%3Fshowall%3Dtrue">found</a> that 4 patient characteristics predicted prolonged symptoms: type 2 diabetes, high blood levels of SARS-CoV-2, Barr-Epstein virus reactivation, and autoantibodies. Swiss researchers <a href="https://www.nature.com/articles/s41467-021-27797-1">reported</a> 4 <i>different</i> predictors: more symptoms, advanced age, history of asthma, and low levels of IgG3 and IgM antibodies. What to make of the discrepancies?<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Diagnosis<o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">“Brain fog” has been considered purely subjective, but that is changing. In-depth neurocognitive testing <a href="https://www.bmj.com/content/376/bmj-2021-068414">reveals</a> that even young people with no complaints often have impaired memory and concentration 6 months after mild COVID-19. Structural <a href="https://www.nature.com/articles/s41586-022-04569-5">brain changes</a> have been documented after recovery, <a href="https://link.springer.com/article/10.1007/s00259-022-05753-5">impaired brain metabolism</a> demonstrated by <sup>18</sup>F-FDG PET scans in patients with cognitive difficulties, and <a href="https://techilive.in/what-drives-post-covid-cognitive-changes/">inflammatory markers</a> found in patients’ <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/acn3.51498">cerebrospinal fluid</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Many long COVID patients have shortness of breath despite normal x-rays, CT scans, and pulmonary function tests. But one small <a href="https://oxfordbrc.nihr.ac.uk/preprint_explain_study/">study</a> from Oxford University documented <a href="https://www.bbc.com/news/health-60154398">ineffective oxygen transfer</a><span class="MsoHyperlink"> </span>by having patients inhale xenon gas while inside the MRI machine. <a href="https://journal.chestnet.org/article/S0012-3692(21)03635-7/fulltext">Another very interesting study</a>, using an invasive form of exercise <a href="https://www.sciencedirect.com/science/article/pii/S0012369221036357">stress testing</a>, showed that patients who were still short of breath a year after mild COVID-19 had normal oxygen levels in the blood but poor delivery of that oxygen to tissues.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Etiology and treatment</u><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Live SARS-CoV-2 virus may persist in long COVID, as per a <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2022.848886/full?s=03">Spanish study</a> finding high levels of immune cells with antiviral properties. Only one of their 30 subjects had detectable virus in his blood, but the authors hypothesize that virus persists in bodily tissues, continuing to overstimulate the immune system. Nine of their patients had preexisting autoimmune diseases such as rheumatoid arthritis or psoriasis, suggesting an underlying hyperimmune tendency. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I’d like to see a placebo-controlled trial of antiviral drugs for long COVID. But remdesivir is currently in short supply in both <a href="https://www.fiercepharma.com/manufacturing/despite-pledge-to-meet-demand-gilead-sciences-faces-remdesivir-shortages-european">Europe</a> and the <a href="https://www.fiercepharma.com/manufacturing/pfizer-signs-up-to-help-manufacture-gilead-s-covid-antiviral-remdesivir">USA</a>, and Paxlovid is practically impossible to obtain even for patients supposedly eligible, so no such trial is likely to happen soon. And it’s possible that fragments of viral RNA are what’s stimulating the immune system, not whole viruses that would be susceptible to antivirals.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">A <a href="https://www.nature.com/articles/s41467-022-29440-z">controlled study</a> in non-human primates has shown that even relatively mild COVID-19 can infect cerebral blood vessels, bringing inflammation and hemorrhaging, with impaired blood flow reminiscent of the <a href="https://orbi.uliege.be/bitstream/2268/288290/1/Long_Covid_Letter_JABFM_Jamoulle_20220311.pdf">brain scans</a> of long COVID patients with “brain fog.” <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Many long COVID symptoms likely reflect poor tissue oxygenation, whether because of clots clogging the arteries or inefficient extraction of oxygen from the blood (possibly with a role for <a href="https://www.atsjournals.org/doi/10.1164/rccm.202108-1903LE">mitochondrial dysfunction</a>). So concentrated forms of oxygen might be therapeutic. Hyperbaric oxygen seemed in fact to help the core symptoms of fatigue and brain fog in one <a href="https://www.rcpjournals.org/content/clinmedicine/21/6/e629">pilot study</a> from the UK, with some patients finding it <a href="https://www.bbc.com/news/uk-scotland-north-east-orkney-shetland-58724980">transformative</a>. This approach is undergoing controlled trials in <a href="https://clinicaltrials.gov/ct2/show/NCT04905888?cond=long+covid&draw=3&rank=16">California</a>, targetting pulmonary symptoms, and in <a href="https://clinicaltrials.gov/ct2/show/NCT04842448?cond=long+covid&draw=5&rank=32">Sweden</a>, targetting fatigue and cognition.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">But even if hyperbaric oxygen helps symptoms, it will remain a stopgap unless we attack the root cause, perhaps using anticoagulants to dissolve microclots. Following promising <a href="https://assets.researchsquare.com/files/rs-1205453/v1_covered.pdf?c=1640805028">South African data</a>, a large-scale study, <a href="https://pharmaceutical-journal.com/article/feature/opening-the-black-box-the-researchers-trying-to-find-treatments-for-long-covid">STIMULATE-ISP</a>, is going forward in the UK: this consortium will enroll 4,500 long COVID patients, with 1500 receiving the anticoagulant rivaroxaban. I can’t wait to see their results.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">A different approach to treating microclots is to filter them out of the circulation using <a href="https://meassociation.org.uk/2021/10/a-new-treatment-for-long-covid/">apheresis</a>. One center in Germany has tried this complex and costly method on <a href="https://beatejaeger.com/en/research/">more than 100</a> long COVID patients, including a physician who says it <a href="https://www.youtube.com/watch?v=h_LZSh9k-zU">cured him</a> – in combination, though, with cheap(ish) and simple <a href="https://www.tlcsessions.net/episodes/dr-asad-khan-help-apheresis">anticoagulants</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Farther-out treatments include non-invasive <a href="https://content.iospress.com/articles/restorative-neurology-and-neuroscience/rnn211249">electrical brain stimulation</a>, claimed to have cleared the brain fog of <b><i>one</i></b>long COVID patient, and – undergoing controlled trials –PureTech’s <a href="https://www.clinicaltrialsarena.com/news/puretech-trial-oral-molecule/">LYT-100</a> (deupirfenidone) for respiratory symptoms, <a href="https://clinicaltrials.gov/ct2/show/NCT05212688?cond=long+covid&draw=6">acupuncture</a> for fatigue, Roche’s Pirfenidone for lung fibrosis, an <a href="https://clinicaltrials.gov/ct2/show/NCT05047952?cond=long+covid&draw=10&rank=90">antidepressant</a> for brain fog, and Resolve Therapeutics’s <a href="https://clinicaltrials.gov/ct2/show/NCT04944121">RSLV-132</a> for fatigue and brain fog. Also <a href="https://clinicaltrials.gov/ct2/show/NCT04997395?cond=long+covid&draw=2&rank=2">cannabis</a>, the opioid blocker <a href="https://clinicaltrials.gov/ct2/show/NCT04604704?cond=long+covid&draw=3&rank=19">naltrexone</a>, the cholesterol drug <a href="https://www.businesswire.com/news/home/20211118006240/en/IncellDx%E2%80%99s-Chronic-COVID-Treatment-Center-Partners-with-ARISE-MD-Integrative-Medicine-Surgery-to-Evaluate-Novel-Therapeutic-Approach-to-Chronic-COVID">atorvastatin</a>, and a whole range of <a href="https://clinicaltrials.gov/ct2/results?cond=long+covid&age_v=&gndr=&type=Intr&rslt=&Search=Apply">dietary supplements</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Then there’s the <a href="https://covidlonghaulers.com/">IncellDX</a> company, which has already gotten 14,000 long COVID patients to shell out thousands of dollars for atorvastatin and the AIDS drug maraviroc. Its bona fides have been sharply questioned in an <a href="https://www.motherjones.com/politics/2022/01/desperate-patients-are-shelling-out-thousands-for-a-long-covid-cure-is-it-for-real/">investigatory piece</a> in Mother Jones, noting that its founder and CEO, Dr. Bruce Patterson, has been associated with the notorious <a href="https://en.wikipedia.org/wiki/Front_Line_COVID-19_Critical_Care_Alliance">Front Line COVID-19 Critical Care Alliance</a>, and that he used to promote leronlimab, a failed COVID-19 treatmentwhose publicity earned its company an unusual public <a href="https://www.fda.gov/drugs/drug-safety-and-availability/statement-leronlimab">reprimand</a> from the FDA. IncellDX now offers its package <a href="https://letstalkwellnessnow.com/2021/11/15/episode-141-what-do-fibromyalgia-cfs-lyme-and-long-haulers-have-in-common-with-dr-bruce-patterson/">not only</a> to “chronic Lyme disease” and “myalgic encephalomyelitis” patients but also, ominously, to people who believe <a href="https://twitter.com/yodoctoryo/status/1399490980445839361">COVID-19 vaccines</a> made them chronically ill.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>How bad is bad?<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_608" o:spid="_x0000_i1031" style="height: 222pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image009.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEip9s9fDRTzUtQiKuqgvTucgQ0qSYn0j1om2NWHMlIPKQ-m1eChCxC3uQvoznbO8lNQUL80ZLoHaa8FlemW9lDOtyzDMnVHGPyWBVrnxMjzDwzDyVCzXid9zWYtC8kO-L0C5ZL8dWt5fbV0jQWZgBvL4GesYoLUrePEQcD05lxCOCGazPmumTvc6NkV/s4155/excess%20mortality%20worldwide.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="2038" data-original-width="4155" height="316" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEip9s9fDRTzUtQiKuqgvTucgQ0qSYn0j1om2NWHMlIPKQ-m1eChCxC3uQvoznbO8lNQUL80ZLoHaa8FlemW9lDOtyzDMnVHGPyWBVrnxMjzDwzDyVCzXid9zWYtC8kO-L0C5ZL8dWt5fbV0jQWZgBvL4GesYoLUrePEQcD05lxCOCGazPmumTvc6NkV/w640-h316/excess%20mortality%20worldwide.jpg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Estimated <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02796-3/fulltext?" target="_blank">excess mortality</a> due to the COVID-19 pandemic, 2020-21</td></tr></tbody></table><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The best measure of the human toll of the COVID-19 pandemic is excess mortality, the number of total deaths over what would be predicted from earlier years. For countries with reliable all-cause death records, such as the US and Italy, that calculation is easy (the excess is about 20% in both, of which 90% is due directly to COVID-19). But in low- and middle-income countries many deaths go unreported, and the wish to downplay COVID-19 has increased that proportion. A giant international group of researchers examined the real human costs of the pandemic and <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02796-3/fulltext">concluded</a> that the true pandemic death toll is <b>18.2 million</b>, triple the official statistic. As you can see from the map, the worst-off countries are in Latin America, southern Africa, and Eastern Europe. </p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="font-size: medium;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Leak vs. leap<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjATUk9ba1FvIshtbHdy_xNVG64jfCQlfcEbz6mXei0kme0i1tQrlVmOJj5xwLnbQ2WRsCu1UtA6i8OwD_NP_NJbiBlwRbLNlN9UkC8JIqgORxTbi_0BL6x629uPXAm87HKbXGVR2b8vvRYd-2aB4MVPzwKy26yJNs_kDoHjxLuSU0jVeYnla5DBsQP/s1459/the%20Huanan%20market.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1095" data-original-width="1459" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjATUk9ba1FvIshtbHdy_xNVG64jfCQlfcEbz6mXei0kme0i1tQrlVmOJj5xwLnbQ2WRsCu1UtA6i8OwD_NP_NJbiBlwRbLNlN9UkC8JIqgORxTbi_0BL6x629uPXAm87HKbXGVR2b8vvRYd-2aB4MVPzwKy26yJNs_kDoHjxLuSU0jVeYnla5DBsQP/w400-h300/the%20Huanan%20market.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">The Huanan Market</td></tr></tbody></table><br /><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_649" o:spid="_x0000_i1030" style="height: 208pt; visibility: visible; width: 278pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image010.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">In case anyone still thinks SARS-CoV-2 leaked from a laboratory, the evidence that it was instead passed from animals to humans at Wuhan’s Huanan Seafood Market is <a href="https://www.science.org/doi/10.1126/science.abm4454">increasingly solid</a> – see summaries in the <a href="https://www.nytimes.com/interactive/2022/02/26/science/covid-virus-wuhan-origins.html?campaign_id=2&emc=edit_th_20220227&instance_id=54407&nl=todaysheadlines&regi_id=19728476&segment_id=84095&user_id=d89c7002526915cc9287fae06e27a284">New York Times</a>, <a href="https://www.forbes.com/sites/brucelee/2022/03/05/3-new-studies-further-support-wuhan-market-as-origin-of-covid-19-pandemic/?sh=79b3f18462d4">Forbes</a>, and <a href="https://www.nature.com/articles/d41586-022-00584-8">Nature</a><span class="MsoHyperlink">.</span><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>American mishegos<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyG98gqzLB3ss9twlR9cdlQ54ffEdywdaeM1kbvHDXnSxyCAT1RW8h_YGuLDMCWSVx5IOPW4YLLMbugYb5WEco4sp6PbXf45HPos3Y1g-jh3aOr5F4T07tiibyembTMhbZiepHvrNpEbf4QpfqUu4u3Y-cnz0BbldgqSUjoaPOKUJrfk_Cd0JJz4Ma/s2048/Ladapo%20Desantis.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1365" data-original-width="2048" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyG98gqzLB3ss9twlR9cdlQ54ffEdywdaeM1kbvHDXnSxyCAT1RW8h_YGuLDMCWSVx5IOPW4YLLMbugYb5WEco4sp6PbXf45HPos3Y1g-jh3aOr5F4T07tiibyembTMhbZiepHvrNpEbf4QpfqUu4u3Y-cnz0BbldgqSUjoaPOKUJrfk_Cd0JJz4Ma/s320/Ladapo%20Desantis.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Joseph Ladapo with Ron DeSantis</td></tr></tbody></table><br /><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_648" o:spid="_x0000_i1029" style="height: 209pt; visibility: visible; width: 314pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image011.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">• Florida governor DeSantis gets the Pandemic Politician booby prize. He’s still <a href="https://www.beckershospitalreview.com/legal-regulatory-issues/desantis-casts-aside-cms-vaccine-rule-for-hospitals.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=8153B8946823F6C">refusing to enforce</a> the federal vaccine mandate for healthcare workers after it was upheld by the Supreme Court, leaving Florida hospitals <a href="https://floridapolitics.com/archives/486432-scotus-ruling-puts-florida-health-care-providers-in-a-bind/">between a rock and a hard place</a>. And the latest antic of Joseph Ladapo, they guy he hired as Florida’s top physician, is telling parents <a href="https://www.washingtonpost.com/health/2022/03/07/florida-surgeon-general-opposes-childrens-covid-vaccines/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F3642497%2F622737599d2fda34e7c302dd%2F599d6acbae7e8a3d46e1400f%2F54%2F67%2F622737599d2fda34e7c302dd">not to vaccinate</a> their kids?</p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">• Tennessee Republican lawmakers are not far behind. Last September their Board of Medical Examiners <a href="https://www.tn.gov/content/dam/tn/health/healthprofboards/medicalexaminers/Covid19.pdf">declared</a> that doctors spreading COVID-19 misinformation – vaccines contain microchips, etc. – could jeopardize their medical license. State lawmakers promptly threatened to disband the Board, and in December the Board <a href="https://www.rollingstone.com/politics/politics-news/tennessee-medical-board-policy-covid-misinformation-1268517/">caved</a>. They did <a href="https://www.tn.gov/content/dam/tn/health/healthprofboards/medicalexaminers/ME092121.pdf">eventually repost</a> a wishy-washy version, but zero <a href="https://khn.org/news/article/medical-boards-pressured-to-let-it-slide-when-doctors-spread-covid-misinformation/">Tennessee</a> docs have faced <a href="https://www.postandcourier.com/health/covid19/scs-doctor-discipline-board-silent-as-covid-19-misinformation-debate-rages/article_fb828894-90d6-11ec-9a3b-97fa1a547a5c.html">disciplinary action</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">• An Oklahoma City hospital had to <a href="https://www.healthcareitnews.com/news/baseless-attacks-online-trigger-lockdown-oklahoma-hospital-icu">close down a COVID-19 ICU</a> because of online threats <a href="https://www.facebook.com/daniel.navejas/posts/4768857416485123">accusing doctors</a> of making patients receive “Fauci's death protocol” and being “Wicked Marxist” who “murder God's people.” One Facebook post provided a physician’s home address, superimposing the word MURDERER over his photograph.<o:p></o:p></p><p class="1obc" style="font-size: medium;">• Should novaxxers be allowed get organ transplants? For me that’s a no-brainer, the sacrifice someone made to give that organ is in vain if the organ is destroyed by COVID-19. Many major institutions agree, but I’m shocked to see a majority <a href="https://www.healio.com/news/nephrology/20220310/survey-most-transplant-centers-not-requiring-covid19-vaccinations-before-surgery">do not</a>…. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b> </b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>International mishegos<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjm5LqWGe0SnQkkl0Dj4MNDvfaXUoY3A_nQoB7uBicDERjDijR3zQFX0dZ0eGgf9dOKiaJIZ6r3C8zRX6-2wDF6CBfLG_MXwx-K9wVZ1olgDvjEGwWeACplIxkXOJYHPM9Z1wW08X4c16ivsclwAN1qW5la7xcagYsbtjx3_-Nmi5FFyc_0KbvCviBB/s2048/pro-djokovic%20demo%20in%20Serbia.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1365" data-original-width="2048" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjm5LqWGe0SnQkkl0Dj4MNDvfaXUoY3A_nQoB7uBicDERjDijR3zQFX0dZ0eGgf9dOKiaJIZ6r3C8zRX6-2wDF6CBfLG_MXwx-K9wVZ1olgDvjEGwWeACplIxkXOJYHPM9Z1wW08X4c16ivsclwAN1qW5la7xcagYsbtjx3_-Nmi5FFyc_0KbvCviBB/w400-h266/pro-djokovic%20demo%20in%20Serbia.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">A pro-Djokovic demonstration in Serbia</td></tr></tbody></table><br /><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_590" o:spid="_x0000_i1028" style="height: 206pt; visibility: visible; width: 309pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image012.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">When Australia barred entry to tennis superstar and proud novaxxer Novak Djokovic early this year<b><i> </i></b>the dominant global reaction was <a href="https://www.nytimes.com/2022/01/06/sports/djokovic-rodgers-irving-coronavirus.html?campaign_id=2&emc=edit_th_20220108&instance_id=49813&nl=todaysheadlines&regi_id=19728476&segment_id=79071&user_id=d89c7002526915cc9287fae06e27a284">outrage at his arrogance</a>, but in Djokovic’s native Serbia, where <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=earliest..2022-03-21&facet=none&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Metric=People+vaccinated&Interval=Cumulative&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~USA~SRB~BGR">only 48%</a> of the population has had even one vaccine dose, he’s a <a href="https://www.washingtonpost.com/world/2022/01/07/novak-djokovic-covid-vaccine-serbia-australia/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F35b4979%2F61d96eb79d2fda14d7e3ead4%2F599d6acbae7e8a3d46e1400f%2F40%2F59%2F61d96eb79d2fda14d7e3ead4">national hero</a> (but, hey, Serbia beats Bulgaria’s 30%!).<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I mentioned last time that vaccine coverage of the elderly was low in China. But I didn’t realize just how low until I read in a Hong Kong <a href="https://www.medrxiv.org/content/10.1101/2022.03.22.22272769v2.full.pdf">manuscript</a> that as of January, “two-dose vaccine coverage had only reached 46% in older adults 70-79 years of age and <b><i><u>18% in those aged 80 years</u></i></b>.” No wonder they’ve had to lock down Hong Kong and Shanghai.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Italy gave fair warning back in January that all novaxxers over age 50 would be punished with a fine: €100 ($110). Now 2 million notices are <a href="https://www.tgcom24.mediaset.it/cronaca/covid-in-arrivo-le-multe-per-gli-over-50-no-vax-sono-quasi-due-milioni-da-sanzionare_48178210-202202k.shtml">in the mail</a>. That’ll learn ‘em!<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>English mishegos<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtnkPBY3SCPLuoXJ-8BlOKXiVHAvgr0hucto5FivDvx-ayfmTyjPRHJfGOU7aP_eXLDSB_F-xJQnGC0eg_roWgQfE08TW8rCjfUiszB9feYQhYOiG32aYXpP9D3yU8kE7DFUS7lbwK473CK8Uo5ulL0lX-nkh-DHHDC0RtYZegup3chacXXaHsjgbg/s1280/london%20tube%20masking.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="362" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtnkPBY3SCPLuoXJ-8BlOKXiVHAvgr0hucto5FivDvx-ayfmTyjPRHJfGOU7aP_eXLDSB_F-xJQnGC0eg_roWgQfE08TW8rCjfUiszB9feYQhYOiG32aYXpP9D3yU8kE7DFUS7lbwK473CK8Uo5ulL0lX-nkh-DHHDC0RtYZegup3chacXXaHsjgbg/w640-h362/london%20tube%20masking.jpg" width="640" /></a></div><br /><b><br /></b><p></p><p class="1obc" style="font-size: medium;"><v:shape id="Picture_x0020_639" o:spid="_x0000_i1027" style="height: 201pt; visibility: visible; width: 358pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image013.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium;"><u>Human challenge studies</u>: Who knew? The Brits <a href="https://www.nature.com/articles/s41591-022-01780-9">began quietly infecting</a> unvaccinated, non-immune people with wild-strain SARS-CoV-2 six months ago. Of 36 young healthy volunteers who had a very low dose of virus shot into their nose, 18 were successfully infected and 16 became ill after 2-4 days. Contrary to the researchers’ early promises, just a few were given remdesivir, the only antiviral available at the time. No volunteers became severely ill but 7 became feverish, many had muscle aches and fatigue, and 12 lost their sense of smell, some for as long as 6 months. Subjects were infectious by 2 days after inoculation and remained so for up to 12 days. <a href="https://edition.cnn.com/2022/03/31/health/first-challenge-study-covid-19/index.html">CNN generously titled its article</a>, “First human challenge study of Covid-19 yields valuable insights about how we get sick.” <a href="https://www.nature.com/articles/d41586-022-00319-9">What valuable insights</a> exactly? None that I could see.</p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Head counts</u>: The AstraZeneca vaccine is not the only aspect of the UK’s epidemic surrounded by weirdness and lies. It also fudges its <a href="https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2021/07/COVID-19-Daily-Deaths-FAQ-Jul2021.docx">death statistics</a>: “<span lang="EN-GB">A death can only be recorded as a COVID-19 death where a positive test was received if this positive test was received within 28 days of their death.” </span>They devised this brilliant trick in <a href="https://www.bbc.com/news/health-53722711">August 2020</a>, thereby slashing their official death toll by 12% in one fell swoop. These shenanigans are medically absurd – COVID-19 patients notoriously can hang on life support for weeks, even months. <span lang="EN-GB"><o:p></o:p></span></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>In the trash</u>: But the greatest mishegos of all is Boris Johnson <a href="https://www.euronews.com/2022/02/23/covid-19-in-europe-italy-to-end-state-of-emergency-and-ease-restrictions-in-april">scrapping all</a> pandemic restrictions in England on February 24<sup>th</sup>, including self-isolation. He did get <a href="https://openletter.earth/open-letter-from-uk-scientists-and-medics-re-early-end-to-englands-isolation-rules-14a731a1">blowback</a>, and the UK government’s scientific advisory board predicted large increases in community transmission. In fact, the BA.2 subvariant arrived in time to send the 7-day average of new cases in the UK from 37,214 on February 27<sup>th</sup> to 123,451 on March 24<sup>th</sup> before falling off slightly. Hospitalized cases rose from 10,561 to 18,809 [update on March 30<sup>th</sup>). And hundreds of flights have been cancelled because crews are out with COVID-19 – as <a href="https://twitter.com/drericding/status/1511121777463803909?">Eric Ding says</a>, wasn’t “let it rip” supposed to be good for the economy?<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Old conspiracy theories never die, they don’t even fade away<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0cx-QC2r_Oqg9X1WE8IXX6wX1JT_vhrwk6lnd3vCSWK9MP0PKs2JYJ4wdJQP4TAYspFyM5cKp25F2sZ95r1IITlGjX-9QMDaWmQj2DIh8TjowQ3ER5UNO1zHOC_rgqW1fcErNOwe20gWh6Atvl8c74Qg1KjphRzjtmUbRvQ1f07IygJHX2HYoO7An/s3849/covid%20hoax%20graffiti.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2566" data-original-width="3849" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0cx-QC2r_Oqg9X1WE8IXX6wX1JT_vhrwk6lnd3vCSWK9MP0PKs2JYJ4wdJQP4TAYspFyM5cKp25F2sZ95r1IITlGjX-9QMDaWmQj2DIh8TjowQ3ER5UNO1zHOC_rgqW1fcErNOwe20gWh6Atvl8c74Qg1KjphRzjtmUbRvQ1f07IygJHX2HYoO7An/w400-h266/covid%20hoax%20graffiti.jpg" width="400" /></a></div><br /><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_652" o:spid="_x0000_i1026" style="height: 190pt; visibility: visible; width: 286pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image014.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Think the hoax theory died out long ago? So did I, but <a href="https://twitter.com/TheMarcitect/status/1472949182574981121">we’re wrong</a><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">• <a href="applewebdata://8A5B5447-E1F7-4647-9019-68ABF7F00F07/MIT%20Scientist%20Warns%20Parents%20NOT%20TO%20GIVE%20CHILDREN%20Vaccine,%20Could%20Cause%20%E2%80%98Crippling%E2%80%99%20Neurodegenerative%20Disease%20In%20Young%20People">Headline</a> from The Geller Report: “MIT Scientist Warns Parents NOT TO GIVE CHILDREN Vaccine, Could Cause ‘Crippling’ Neurodegenerative Disease In Young People.” Yes, <a href="https://www.csail.mit.edu/person/stephanie-seneff">Stephanie Seneff</a> is really an MIT computer scientist. She’s also <a href="https://archive.ph/yoP8e#selection-441.0-441.5">convinced</a> COVID-19 vaccines cause <a href="https://eu.usatoday.com/story/news/factcheck/2021/03/31/fact-check-covid-19-vaccine-not-associated-prion-disease/7053007002/">mad cow disease</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">• Then there’s the osteopath who calls COVID-19 vaccines <a href="https://archive.vn/PU2fH">deadly bioweapons</a> or “depopulation vaccines,” saying depopulation would start by last August. Haven’t you noticed people disappearing?<o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8M1PF7q2R3XgQk3h3M-WF0wrR2T9noNQZxepExUTPHYOOVNin6qW1XGChS1RjcvfIzAcprmO-VYiG8GLFh-1UGqrBuwuW3zrXBJhlh1rjYZtD26Aa-f_UfqcdRUpOwoioBbmgp37Jki4lFP24ZVcLlkK3QuY1TqZTpntgmTSmd2yHYM54WX83IYff/s356/share%20this.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="266" data-original-width="356" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8M1PF7q2R3XgQk3h3M-WF0wrR2T9noNQZxepExUTPHYOOVNin6qW1XGChS1RjcvfIzAcprmO-VYiG8GLFh-1UGqrBuwuW3zrXBJhlh1rjYZtD26Aa-f_UfqcdRUpOwoioBbmgp37Jki4lFP24ZVcLlkK3QuY1TqZTpntgmTSmd2yHYM54WX83IYff/s320/share%20this.png" width="320" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_605" o:spid="_x0000_i1025" style="height: 128pt; visibility: visible; width: 171pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image015.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b> </b></p></div><br /><p></p><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><style class="WebKit-mso-list-quirks-style">
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</style>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com2tag:blogger.com,1999:blog-6211405954943098401.post-77635570920606767052022-03-22T21:59:00.001+01:002022-03-22T22:04:19.058+01:00Is The End Nigh?<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyHNkcq359j3_D9Z2pDwloh7B3DS9Cgu-FdcBN2NKU59n5-5FIb-xQuG_sroc5Sdgp349Nb4t9RXMtkeSq3gCC18PSX0a2eHN7H161brlzfw9j-gA2pdStRVkcAHo5_IJQammcYj80HSqKNJb_QeUksqEI1L6FcKgTwukMTchffom5A0_GtEY48clT/s2121/mask%20in%20bin%204+.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1414" data-original-width="2121" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyHNkcq359j3_D9Z2pDwloh7B3DS9Cgu-FdcBN2NKU59n5-5FIb-xQuG_sroc5Sdgp349Nb4t9RXMtkeSq3gCC18PSX0a2eHN7H161brlzfw9j-gA2pdStRVkcAHo5_IJQammcYj80HSqKNJb_QeUksqEI1L6FcKgTwukMTchffom5A0_GtEY48clT/s320/mask%20in%20bin%204+.jpg" width="320" /></a></div><br /><p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">There was lots I wanted to write about, but with so much treatment, vaccine, and variant news, and such urgency to discuss post-pandemic dreams, nothing else would fit.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>Treatment and containment news<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB3xVg9kog4NxyDNE0_Fo40c0iL36BzYWbr3C_orOFCtBgo7BKGfHudx6brF4cjojQGPYtVijhSeHIYoursE7O0lbBtTd1Rfer1gzPZon9ViImP3x3JDALTNm_IxMmNuJdW8kl-4g1hOHGSzp0NvrYEYDxuw_zaDZpyAJiuw-MzILFmCwmsofY6FMl/s1414/ivermectin%20placebo%20effect.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="710" data-original-width="1414" height="161" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB3xVg9kog4NxyDNE0_Fo40c0iL36BzYWbr3C_orOFCtBgo7BKGfHudx6brF4cjojQGPYtVijhSeHIYoursE7O0lbBtTd1Rfer1gzPZon9ViImP3x3JDALTNm_IxMmNuJdW8kl-4g1hOHGSzp0NvrYEYDxuw_zaDZpyAJiuw-MzILFmCwmsofY6FMl/s320/ivermectin%20placebo%20effect.jpg" width="320" /></a></div><br /><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Ivermectin</u>: A few alert readers may remember my mentioning a year ago that Dr. Paul Sax, a deep-thinking infectious disease specialist, had <a href="https://blogs.jwatch.org/hiv-id-observations/index.php/ivermectin-for-covid-19-breakthrough-treatment-or-hydroxychloroquine-redux/2021/01/04/" style="color: #954f72; text-decoration: underline;">mysteriously embraced</a> ivermectin as a treatment for COVID-19. Having seen the evidence of data faking, he’s now made an <a href="https://blogs.jwatch.org/hiv-id-observations/index.php/the-rise-and-fall-of-ivermectin-1-year-later/2022/02/12/" style="color: #954f72; text-decoration: underline;">about-face</a>, with apologies. And Andrew Hill, the reputable scientist who published a pro-ivermectin meta-analysis, has <a href="https://academic.oup.com/ofid/article/9/2/ofab645/6509922?login=false" style="color: #954f72; text-decoration: underline;">published a revised version</a> as, “Ivermectin for COVID-19: Addressing Potential Bias and Medical Fraud.” If anyone still harbored any hopes for ivermectin, a new, <a href="https://www.beckershospitalreview.com/pharmacy/ivermectin-didn-t-curb-covid-19-hospitalizations-in-largest-study-to-date.html" style="color: #954f72; text-decoration: underline;">huge, randomized, placebo-controlled study</a> should kill them. When given to high-risk outpatients the drug didn’t affect viral load, symptoms, hospitalization rates, or mortality. There’s no persuading the conspiracy theorists, though.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Molnupiravir</u>: Merck’s pill is almost entirely ineffective against the Delta variant, as I pointed out in a <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2201612" style="color: #954f72; text-decoration: underline;">Letter</a> I’ve proudly seen published in the New England Journal of Medicine. <a href="https://www.nature.com/articles/s41422-022-00618-w" style="color: #954f72; text-decoration: underline;">Laboratory studies</a> say it might do better against Omicron, but they’re mediocre predictors of real-world efficacy.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Paxlovid</u>: I warned in my last post that the few available doses of Pfizer’s miracle COVID-19 pill might go to the influential, the well-educated, and the pushy rather than to the most deserving. In fact, we’re already seeing clinics that serve low-income populations having to turn away a shocking <a href="https://www.progresswest.org/Health-Library/View-Content?contentTypeId=6&contentId=1656251161" style="color: #954f72; text-decoration: underline;">90%</a> of eligible patients.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Test to Treat</u>: …and that nefarious Paxlovid scenario is now even <a href="https://www.statnews.com/2022/01/19/pharmacies-shouldnt-be-only-place-to-get-paxlovid/" style="color: #954f72; text-decoration: underline;">more likely</a><span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;">.</span> In his State of the Union address President Biden showcased a pilot “<a href="https://thehill.com/policy/healthcare/596449-biden-announces-test-to-treat-initiative-free-covid-19-antiviral-treatment" style="color: #954f72; text-decoration: underline;">Test to Treat</a>” initiative that would authorize pharmacists to hand a packet of Paxlovid pills (or, unfortunately, molnupiravir) to a patient at the same time as a positive test result. The plan is brilliant in concept but, in my opinion, profoundly misguided in practice. Two reasons. First, very few doses will be available in the coming months, far fewer than would be needed to treat everybody meeting the criteria, so strict rationing is necessary. Pharmacists are in no position to make those decisions. Second, even with an infinite supply of pills, many otherwise eligible patients shouldn’t take Paxlovid. Pharmacists, and even random physicians, can’t be sure whether the individual has a medical contraindication or is taking one of the <a href="https://www.ema.europa.eu/en/documents/referral/paxlovid-pf-07321332-ritonavir-covid-19-article-53-procedure-conditions-use-conditions-distribution_en.pdf" style="color: #954f72; text-decoration: underline;">scores of medications</a> that risk serious interactions; as a practicing doc I can testify that even well-educated patients often don’t know exactly what drugs they’re on.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Pharmacists are begging that the program <a href="https://www.beckershospitalreview.com/pharmacy/test-to-treat-program-too-narrow-pharmacists-say.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=8153B8946823F6C" style="color: #954f72; text-decoration: underline;">be expanded</a>, and pundit <a href="https://www.boston.com/news/coronavirus/2022/03/03/this-local-doc-says-president-bidens-test-to-treat-plan-is-a-major-milestone-heres-why/" style="color: #954f72; text-decoration: underline;">Michael Mina</a> thinks it’s the cat’s pyjamas. But the <a href="https://www.ama-assn.org/press-center/press-releases/ama-statement-administration-s-test-treat-covid-19-plan" style="color: #954f72; text-decoration: underline;">American Medical Association</a>, <a href="https://sports.yahoo.com/doctors-praise-bidens-test-treat-175948139.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAABoW21L_Cpsw-ybMYj6mEPbU5A-Xvi0mDN9PKFVWrm7Qj3X4P4N_n0a-YzrMVetyJdpBZBv3efNnIPfxcldvv2_23G-fGYNjiM8J_RiROQteBhWYObXGzOOCGS3ZxOvDR2XvqhypGwlmS71YrasEwHn27-nnxOxNRY7J2NDvoTdc" style="color: #954f72; text-decoration: underline;">Eric Topol</a>, and <a href="https://abc7news.com/test-to-treat-initiative-biden-covid-dr-peter-chin-hong/11615369/" style="color: #954f72; text-decoration: underline;">others</a> share my doubts. As the AMA points out, “Leaving prescribing decisions this complex in the hands of people without knowledge of a patient’s medical history is dangerous in practice and precedent.” And a <a href="https://www.kff.org/other/slide/one-fourth-of-adults-and-nearly-half-of-adults-under-30-dont-have-a-primary-care-doctor/" style="color: #954f72; text-decoration: underline;">quarter of Americans</a>, skewed toward <a href="https://www.fiercehealthcare.com/practices/many-americans-don-t-have-a-primary-care-doctor" style="color: #954f72; text-decoration: underline;">minorities</a> and the uninsured, don’t have a primary care provider to provide a reliable medical history. So as usual, the white, well off, and well-educated will win out.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Beyond Test to Treat</u>: The rest of Biden’s <a href="https://www.beckershospitalreview.com/hospital-management-administration/white-house-to-roll-out-next-covid-19-plan.html?origin=BHRSUN&utm_source=BHRSUN&utm_medium=email&utm_content=newsletter&oly_enc_id=8153B8946823F6C" style="color: #954f72; text-decoration: underline;">COVID-19 plan</a> – here’s the <a href="https://www.whitehouse.gov/covidplan/" style="color: #954f72; text-decoration: underline;">detail</a> – sounds great: distribute high-quality masks, improve tracking, study universal vaccines and long COVID, prepare for new variants, avoid lockdowns, and vaccinate both the US and the world. <a href="https://www.covidroadmap.org/" style="color: #954f72; text-decoration: underline;">Some experts</a> express quibbles, saying it’s weak on ventilation and health equity. But now it looks like the entire package will go <a href="https://www.nytimes.com/2022/03/09/us/politics/house-spending-bill.html?campaign_id=2&emc=edit_th_20220310&instance_id=55322&nl=todaysheadlines&regi_id=19728476&segment_id=85143&user_id=d89c7002526915cc9287fae06e27a284" style="color: #954f72; text-decoration: underline;">down the drain</a> for lack of funding. What this means, <a href="https://www.beckershospitalreview.com/finance/the-meltdown-of-covid-19-relief-funds-6-things-to-know.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=8153B8946823F6C" style="color: #954f72; text-decoration: underline;">tragically</a><span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;">,</span> is that monoclonal antibody treatment will be less and less available, the US will be less able to detect and prepare for new variants, and the <a href="https://fortunly.com/statistics/uninsured-americans/#gref" style="color: #954f72; text-decoration: underline;">31 million Americans</a> with no health insurance – a number unfortunately soon to <a href="https://www.washingtonpost.com/health/2022/03/14/medicaid-loss-of-coverage/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F3652c6e%2F623063ba9d2fda34e7d287ee%2F599d6acbae7e8a3d46e1400f%2F22%2F68%2F623063ba9d2fda34e7d287ee" style="color: #954f72; text-decoration: underline;">rise sharply</a> – will have little access to testing or treatment.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Sotrovimab</u>: Under yesterday sotrovimab was the queen of monoclonal antibodies, the sole Omicron-killer. Its primacy has now been <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-new-monoclonal-antibody-treatment-covid-19-retains" style="color: #954f72; text-decoration: underline;">challenged</a> by the peculiar <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-new-monoclonal-antibody-treatment-covid-19-retains" style="color: #954f72; text-decoration: underline;">Emergency Use Authorization</a> awarded to bebtelovimab, which I discussed in my last post.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Inhaled corticosteroids</u>: I’ve been prescribing high-dose inhaled steroids for months to COVID-19 outpatients who have either high risk for progression or prominent respiratory symptoms. A new <a href="https://www.medrxiv.org/content/10.1101/2021.11.04.21265945v2.full.pdf" style="color: #954f72; text-decoration: underline;">meta-analysis</a> confirms they can both prevent hospitalization and shorten illness, and the authoritative <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015125/full?contentLanguage=en" style="color: #954f72; text-decoration: underline;">Cochrane Library</a> now calls them also possibly effective for decreasing mortality.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Baricitinib</u>: Following mixed results in hospitalized COVID-19 patients, the <a href="https://www.ox.ac.uk/news/2022-03-03-recovery-trial-shows-baricitinib-reduces-deaths-patients-hospitalised-covid-19" style="color: #954f72; text-decoration: underline;">latest study</a> says it decreases mortality by 13%.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Face masks again</u>: A study of US <a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2021.01072?" style="color: #954f72; text-decoration: underline;">mask mandates</a> during 2020 reports they cut infections by as much as 33%, even though at the time the masks nearly everyone was using were the relatively ineffective cloth sort.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Weed</u>: According to the industry website <a href="https://www.ganjapreneur.com/cannabis-company-seeking-colombias-approval-to-study-covid-19-prevention-drug/?utm_source=newsletter&utm_medium=email&utm_campaign=us_house_passes_safe_banking_act_california_fish_wildlife_agents_destroyed_26m_lbs_of_illegal_cannabis_plants_and_more&utm_term=2022-02-07" style="color: #954f72; text-decoration: underline;">Ganjapreneur</a>, Flora Pharma has approached the Colombian government about testing a cannabis product for preventing and treating COVID-19. The company’s <a href="https://www.businesswire.com/news/home/20220202005408/en/Flora-Growth-Announces-Patent-Pending-Cannabinoid-Based-Product-Seeks-INVIMA-Colombian-FDA-Emergency-Use-Authorization-Under-COVID-19-Protocols" style="color: #954f72; text-decoration: underline;">press release</a> seemed a bit coy about the details.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Evusheld</u>: This monoclonal antibody combo, intended to replace vaccines to prevent COVID-19 in immunosuppressed patients, was initially lauded for its efficacy against the Omicron variant. But it turns out that <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-authorizes-revisions-evusheld-dosing" style="color: #954f72; text-decoration: underline;">efficacy is less</a> than originally thought, and probably doesn’t last the 6 months initially promised. So the recommended dose has been <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-authorizes-revisions-evusheld-dosing" style="color: #954f72; text-decoration: underline;">doubled</a>, and everyone who’s already received a dose has been told to come back for more. There’s also been a <a href="https://www.nytimes.com/2022/03/06/us/politics/evusheld-covid-treatment.html?campaign_id=2&emc=edit_th_20220306&instance_id=55020&nl=todaysheadlines&regi_id=19728476&segment_id=84788&user_id=d89c7002526915cc9287fae06e27a284" style="color: #954f72; text-decoration: underline;">striking mismatch</a> between who’s eligible for the drug and who’s getting it, with many doses going unused in the confusion.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>Vaccine news<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgtymqOYrs6a29brdOY3upuVikZciMZiluja493nUshNlJV0NNVOlz9ndbW5g0322y5OI_wx0d5cQEeA1dguv0Sd32hqkx6XjIahJ32MV0TVtLXHK1SaXqyYpRinRfpelX3KQcNkBkdExeih7Ui2sYyhUbAyPlXLkQ3T3dHRgTWXAD4ePTh4-VNrbC/s1300/125431094-dry-tobacco-leaf-drying-of-tobacco-leaves-tobacco-growing.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="866" data-original-width="1300" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgtymqOYrs6a29brdOY3upuVikZciMZiluja493nUshNlJV0NNVOlz9ndbW5g0322y5OI_wx0d5cQEeA1dguv0Sd32hqkx6XjIahJ32MV0TVtLXHK1SaXqyYpRinRfpelX3KQcNkBkdExeih7Ui2sYyhUbAyPlXLkQ3T3dHRgTWXAD4ePTh4-VNrbC/s320/125431094-dry-tobacco-leaf-drying-of-tobacco-leaves-tobacco-growing.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Tobacco leaves drying</td></tr></tbody></table><u><br /></u><p></p><p class="1obc" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-weight: normal; text-decoration: none;">Covifenz</span>: Who expected a <a href="https://www.cbc.ca/news/health/medicago-s-homegrown-plant-based-covid-19-vaccine-approved-by-health-canada-1.6362745" style="font-weight: normal; text-decoration: none;">new vaccine</a> now? Not me. It’s a two-dose product from the Canadian company Medicago, already <a href="https://covid-vaccine.canada.ca/info/regulatory-decision-summary-detail.html?linkID=RDS00921" style="font-weight: normal; text-decoration: none;">approved by Canadian regulators</a> for adults under 65 <span style="font-size: 12pt; font-weight: normal; text-decoration: none;">but probably about to be</span><span style="font-size: 12pt; font-weight: normal; text-decoration: none;"> </span><a href="https://globalnews.ca/news/8689655/medicago-covid19-vaccine-who-rejection/" style="font-size: 12pt; font-weight: normal; text-decoration: none;">nixed by the World Health Organization</a><span style="font-size: 12pt; font-weight: normal; text-decoration: none;"> </span><span style="font-size: 12pt; font-weight: normal; text-decoration: none;">due to ties with Philip Morris</span>. It’s hip for supposed green bona fides – it’s based on “plant-derived, <a href="https://newsinteractives.cbc.ca/coronavirusvaccinetracker/#virus-like-particles" style="font-weight: normal; text-decoration: none;">virus-like particles</a>, which resemble the coronavirus behind COVID-19 but don't contain its genetic material.” I was slightly disappointed to learn <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/drugs-vaccines-treatments/vaccines/medicago.html" style="font-weight: normal; text-decoration: none;">at canada.ca</a> that the role of plants (tobacco) is only to manufacture the spike protein – from wild strain SARS-CoV-2, which has by now mutated far away. Here’s a <a href="https://www.nature.com/articles/d42473-020-00253-2" style="font-weight: normal; text-decoration: none;">description of the process</a>. Overall efficacy was supposedly a respectable <a href="applewebdata://C34C744A-D4EB-4874-8B01-CE4FA09C7ACC/SARS-CoV-2%20spike%20protein%20from%20the%20original%20strain,%20using%20a%20plant-based%20system" style="font-weight: normal; text-decoration: none;">71%</a>, and 75% against Delta, though there’s no proper manuscript yet. <u style="font-weight: normal; text-decoration: none;">Sanofi-GSK</u>: These European pharmaceutical giants’ first vaccine <a href="https://www.sanofi.com/en/media-room/press-releases/2020/2020-12-11-07-00-00" style="font-weight: normal; text-decoration: none;">did so poorly</a> at stimulating the immune system of people over 50 that the company didn’t bother to go forward with Phase 3 trials. A new version, which is protein-based like Novavax, did get older people to produce <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/sanofigsk-report-positive-interim-results-their-covid-19-shot-2021-05-17/" style="font-weight: normal; text-decoration: none;">antibodies and memory T cells</a> – but only against the long-gone wild strain of SARS-CoV-2. A Phase 3 trial is said in a <a href="https://www.sanofi.com/en/media-room/press-releases/2022/2022-02-23-11-15-00-2390091" style="font-weight: normal; text-decoration: none;">press release</a> and announced in <a href="https://www.nytimes.com/live/2022/02/23/world/covid-19-tests-cases-vaccine#a-new-covid-vaccine-shows-100-percent-efficacy-against-severe-disease-and-hospitalizations-its-makers-say" style="font-weight: normal; text-decoration: none;">the press</a> to show an efficacy of 58% against any COVID-19 and 75% against “moderate-to-severe” disease. If the trial was very recent those numbers aren’t bad, since <i style="font-weight: normal; text-decoration: none;">all</i> vaccines are less effective against Delta and even less against Omicron. The company’s hinted its best use might be as a heterologous booster.</p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Pfizer</u>: Hearing loss has been reported as a rare complication <a href="https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2789497" style="color: #954f72; text-decoration: underline;">in Israel</a>, though not <a href="https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2789496" style="color: #954f72; text-decoration: underline;">in the USA</a>.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Immunosuppression</u>: It’s been debated whether antiinflammatory drugs might interfere with the immune response to COVID-19 vaccination; some physicians advise patients to avoid even aspirin and ibuprofen on the day of and days after each dose. There’s now some <a href="https://ard.bmj.com/content/early/2022/02/21/annrheumdis-2021-221916" style="color: #954f72; text-decoration: underline;">concrete evidence</a> that methotrexate (a much more powerful antiinflammatory drug) does in fact interfere with the Sinovac vaccine. Not really relevant to aspirin and ibuprofen… <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>AstraZeneca</u>: A giant <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003926" style="color: #954f72; text-decoration: underline;">British study</a> confirms that thrombotic complications occur only in people under 70. Oddly, despite having data on tens of millions of people, the researchers didn’t separate out the under-40’s considered at highest risk.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Patents</u>: I thought Moderna had thrown in the sponge in its patent battle against the National Institutes of Health scientists who collaborated on their COVID-19 vaccine, but I <a href="https://www.washingtonpost.com/health/2022/02/28/moderna-arbutus-patent-infringement-lawsuit/" style="color: #954f72; text-decoration: underline;">was wrong</a>... <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Preventing Omicron</u>: A <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2119451?query=TOC&ssotoken=U2FsdGVkX18aU6LDj94kO9M2aATsM97e7w%2FLAnsgTIIwS4eoqsYEqSLpW9xIRB4ZyfPD3aH5MTSRnSiNH7JTAI%2BSDuDPFgBeM%2FWMSk%2BYcjEsmXQDJd37pkzeW7DWT0hiAc8rC4ZpsLdTz0VO%2F25VIM%2BlS4gZ%2FGvmqf55d%2Fyfd0UIF3uetSxH6vv%2BzZiHImpHokXIPiu4HLhBUUcm3%2F%2BRZg%3D%3D&cid=NEJM%20eToc,%20March%203,%202022%20DM784500_NEJM_Subscriber&bid=854847704" style="color: #954f72; text-decoration: underline;">British study</a> has filled in some of the blanks. Two doses of AstraZeneca did nothing much, and boosters faded fast. As usual, Moderna beat Pfizer.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Fourth dose</u>: According to <a href="https://www.medrxiv.org/content/10.1101/2022.02.15.22270948v1" style="color: #954f72; text-decoration: underline;">a new study</a> among Israeli health care workers, a second mRNA booster increases antibody levels and (Moderna only) T-cell immunity but gives little real-world protection against Omicron disease (11-30%), and breakthrough infections have a high viral load. The authors conclude, appropriately, that “next-generation vaccines” rather than dose after dose of the same ones are needed to protect against future variants. Who’s pushing a 4<sup>th</sup> dose? <a href="https://www.cbsnews.com/news/face-the-nation-full-transcript-03-13-2022/" style="color: #954f72; text-decoration: underline;">Albert Bourla</a>, Pfizer’s CEO, of course. With <a href="https://www.cnet.com/health/medical/moderna-asks-fda-to-authorize-second-covid-booster-for-all-adults/" style="color: #954f72; text-decoration: underline;">Moderna now chiming in</a>. I personally suggesting dose 4 only to people at extremely high risk.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Durable J&J</u>: I’ve mentioned that a <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2115596" style="color: #954f72; text-decoration: underline;">laboratory study</a> in a handful of individuals suggested that antibodies faded more slowly with Johnson & Johnson than with Moderna or Pfizer. That’s now been confirmed in a <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790204" style="color: #954f72; text-decoration: underline;">real-world study</a>. A single dose remained effective against both COVID-19 (66%) and hospitalization (72%) for over 6 months, including during Delta. The authors gave even higher rates, but those depend on a statistical adjustment procedure that doesn’t convince me. <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Durable mRNA vaccines</u>: One <a href="https://www.biorxiv.org/content/10.1101/2022.02.14.480394v1" style="color: #954f72; text-decoration: underline;">laboratory study</a> has suggested that the antibody boost from a third dose of fades fast, and with it the protection against infection and milder COVID-19, but that memory T cells persist and prevent severe disease. Real-world confirmation: A <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7112e1.htm?s_cid=mm7112e1_e&ACSTrackingID=USCDC_921-DM78104&ACSTrackingLabel=MMWR%20Early%20Release%20-%20Vol.%2071%2C%20March%2018%2C%202022&deliveryName=USCDC_921-DM78104" style="color: #954f72; text-decoration: underline;">CDC study</a> found that fully vaccinated American adults were 92% less likely to wind up intubated or dead for 5 months after dose 2, 84% less likely for even more months, and 94% after a booster. That contrasts with much lower protection against mild COVID-19. And for lucky folk with normal immune systems and no chronic medical conditions, even 2 doses gave 98% protection. <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Combined immunity</u>: A South African <a href="https://www.medrxiv.org/content/10.1101/2022.02.10.22270789v1.full.pdf" style="color: #954f72; text-decoration: underline;">study</a> finds that people <b><i>vaccinated</i></b> against COVID-19 with breakthrough Omicron infections emerged with increased protection not just against Omicron, but Delta and Beta as well. But <b><i>unvaccinated</i></b> people who contracted Omicron mounted immunity only to Omicron.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Vaccinating survivors</u>: I’m glad to see that Dr. Eric Topol has <a href="https://www.theguardian.com/commentisfree/2022/feb/20/its-time-to-consider-natural-immunity-to-covid-19-as-equal-to-one-shot-of-the-vaccine" style="color: #954f72; text-decoration: underline;">publically endorsed</a> Italy’s policy of giving a single vaccine dose in people who’ve recovered from COVID-19. <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Adolescents</u>: In an <a href="https://publications.aap.org/pediatrics/article/doi/10.1542/peds.2022-056230/184855/COVID-19-Incidence-Among-6th-12th-Grade-Students" style="color: #954f72; text-decoration: underline;">American study</a>, 6<sup>th</sup> to 12<sup>th</sup> grade students were 9 times as likely to come down with symptomatic COVID-19 if they were unvaccinated. Nothing new there. What <i>is</i> new is that after looking into the sources of infection the researchers concluded that only 2 out of the 27 infections occurred in school. I take this to support my agnosticism about school mask mandates: kids pick up COVID-19 not in the classroom, but at home or hanging with pals.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Gaps:</u> The CDC <a href="https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#primary-series" style="color: #954f72; text-decoration: underline;">now recommends</a> that otherwise healthy men and boys between 12 and 39 years old be vaccinated with a 8-week gap between doses, as I’ve long advised for males under 30. An even stricter policy may be advisable for the youngest age group, as per a <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2789584" style="color: #954f72; text-decoration: underline;">study of vaccine-induced myocarditis</a> from Hong Kong, showing the highest rate yet reported: one in 2563 boys ages 12-17 following a second Pfizer dose. After Hong Kong joined Norway, Taiwan, and the UK in a one-dose policy for adolescents, there were no new cases. It seems myocarditis may be <a href="https://jamanetwork.com/journals/jama/fullarticle/2790421" style="color: #954f72; text-decoration: underline;">rarer after a booster</a> than after a second dose, but not by much.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Kids</u>: The efficacy of minidoses of Pfizer in children 5-11 years old seemed too good to be true, and it was. Protection from COVID-19 peaks a week after the second dose but <a href="https://www.medrxiv.org/content/10.1101/2022.02.25.22271454v1" style="color: #954f72; text-decoration: underline;">plummets</a> to 12% just 3 weeks later. Effectiveness against hospitalization holds up somewhat better, falling only from 100% to 48%.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Slowing down</u>: In Italy the rate of penitent novaxxers coming in to get a shot has dropped dramatically, from 78,600 a day during the week of January 9<sup>th</sup> to 3000 a day during the week of March 13<sup>th</sup>. So have the number of boosters, falling from 537,000 a day to 44,000. But this is likely because people who get COVID-19 are told to wait 3 months before getting any vaccine, and <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2021-02-03..2022-03-21&facet=none&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Metric=Confirmed+cases&Interval=Cumulative&Relative+to+Population=false&Color+by+test+positivity=false&country=~ITA" style="color: #954f72; text-decoration: underline;">nearly 15%</a> of the entire population has tested positive since Christmas. So vaccinations might pick up again next month.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>Variant watch<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiigi1aEN29xAmmxSJhiJghAIYYmVD6PRmVMypJ2o7qWbZvxdis-GyIEc4L6eTURZTbeuTibX_Ssv7RbZ8tt_KBdyFldqfq4fO2jgSnoCln1_X7mdNszUNcQxAIfBJjEMPfGtR9zDTr1u2BC_Hca_ekrjac33iHKFtcGwUtfLZ3P4KRTox9FcquzJkA/s1280/deltacron_covid_nuova_variante.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="702" data-original-width="1280" height="220" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiigi1aEN29xAmmxSJhiJghAIYYmVD6PRmVMypJ2o7qWbZvxdis-GyIEc4L6eTURZTbeuTibX_Ssv7RbZ8tt_KBdyFldqfq4fO2jgSnoCln1_X7mdNszUNcQxAIfBJjEMPfGtR9zDTr1u2BC_Hca_ekrjac33iHKFtcGwUtfLZ3P4KRTox9FcquzJkA/w400-h220/deltacron_covid_nuova_variante.jpg" width="400" /></a></div><br /><b><br /></b><p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b><span><v:shape id="Picture_x0020_613" o:spid="_x0000_i1029" style="height: 212pt; visibility: visible; width: 387pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image002.jpg"></v:imagedata></v:shape></span><span><o:p></o:p></span></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>BA.2</u>: The up-and-coming Omicron subvariant is <a href="https://www.statnews.com/2022/02/02/omicron-sister-variant-ba2-spreads-faster/" style="color: #954f72; text-decoration: underline;">even more transmissible</a> than the original and is harder to distinguish from Delta on PCR tests, bringing the moniker “<a href="https://www.ama-assn.org/delivering-care/public-health/what-ba2-or-stealth-omicron-subvariant" style="color: #954f72; text-decoration: underline;">stealth variant.</a>” It’s similar to the original Omicron, in its ability to escape vaccine- and infection-induced immunity, and fortunately seems to cause <a href="https://www.itv.com/news/2022-03-10/what-is-the-stealth-omicron-ba2-variant-and-should-we-be-worried" style="color: #954f72; text-decoration: underline;">similarly mild disease</a>. BA.2 is now up to <a href="https://www.cbsnews.com/news/covid-ba2-omicron-sub-variant-cases-cdc/" style="color: #954f72; text-decoration: underline;">1 in 4</a> new cases in the US, <a href="https://www.itv.com/news/2022-03-10/what-is-the-stealth-omicron-ba2-variant-and-should-we-be-worried" style="color: #954f72; text-decoration: underline;">contributes</a> to the <a href="https://coronavirus.data.gov.uk/details/cases" style="color: #954f72; text-decoration: underline;">surge England has experienced</a> after stupidly tossing all restrictions in the trash, and is <a href="https://www.statnews.com/2022/02/10/conflicting-reports-raise-questions-about-whether-any-monoclonals-work-against-omicrons-sister-variant/" style="color: #954f72; text-decoration: underline;">already dominant</a> in South Africa and elsewhere. One <a href="https://www.biorxiv.org/content/10.1101/2022.02.07.479306v1" style="color: #954f72; text-decoration: underline;">laboratory study</a> has suggested that sotrovimab, the Omicron-killing monoclonal antibody, won’t work against BA.2. The manufacturer disagrees, but the manuscript promised in its <a href="https://investors.vir.bio/news-releases/news-release-details/data-suggest-sotrovimab-retains-neutralizing-activity-against" style="color: #954f72; text-decoration: underline;">press release</a> hasn’t come through yet. BA.2 probably does remain susceptible to <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2201933?query=TOC&ssotoken=U2FsdGVkX18QFYeu9gJodHjUGhEOoRIR0m64fg2xMkU8cn9fIytpCIHPZGR945RCxiaTDUhCs%2B6Yv9%2Fx%2Fo%2FPUGAFyw1d7u1CKX4jRRYCmSlDV%2BLoHU5PnVy%2B46swYpqBp8mqd8UxTumulT0YETv5mrXZfDOON1iN8jTDQPC8ANBANr8Yd6jutNUdW6XNXU8P3qT8uPe2XzyGB83qZcNxAg%3D%3D&cid=NEJM%20eToc,%20March%2010,%202022%20DM809401_NEJM_Subscriber&bid=866525968" style="color: #954f72; text-decoration: underline;">antiviral drugs</a>.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>BA.1.1, BA.2.H78Y and BA.3</u>: Still more Omicron subvariants. I’m unable to find much on them beyond a rather opaque <a href="https://www.forbes.com/sites/williamhaseltine/2022/02/23/whither-the-omicron-family-ba1-ba11-ba2-ba2h78y-ba3/?sh=6fdf52d4862e" style="color: #954f72; text-decoration: underline;">article in Forbes</a>.<u><o:p></o:p></u></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Deltacron/Deltamicron</u>: After having supposedly been debunked as <a href="https://www.nature.com/articles/d41586-022-00149-9" style="color: #954f72; text-decoration: underline;">laboratory contamination</a>, a variant combining Delta bits with Omicron bits does now <a href="https://www.medrxiv.org/content/10.1101/2022.03.03.22271812v1.full" style="color: #954f72; text-decoration: underline;">seem to exist</a>, though the relation with the <a href="https://7news.com.au/travel/coronavirus/omicron-and-delta-covid-variant-reportedly-discovered-with-dozens-infected-so-far--c-5247343" style="color: #954f72; text-decoration: underline;">original report</a> from Cyprus is unclear. The number of cases it’s known to have caused thus far can be <a href="https://www.beckershospitalreview.com/public-health/deltacron-5-things-to-know-about-the-newest-coronavirus-variant.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=8153B8946823F6C" style="color: #954f72; text-decoration: underline;">counted on your fingers</a>, and there’s no evidence it’s particularly virulent or transmissible, so why worry?<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">P<b>ost-pandemic antics: USA<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLA-WenpX3sLsKZiM1aHtJoRPswQvsk_IL1qTycohrCE6Ze6fHi5INjjMeX-TYnIQTmk_qhOO7Q0tf3rePZIT0bmKLuI_kl8UYzIja3QJLwcpzPIZBo8Ssd1GECemanXNbUWaSTTQNqevbxxs-J51H7MxXxAMk-qrqrDPvb2uT5tKPTTQ9H5xI4oXV/s1766/CDC%20risk%20maps%2025-26%20feb.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="504" data-original-width="1766" height="184" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLA-WenpX3sLsKZiM1aHtJoRPswQvsk_IL1qTycohrCE6Ze6fHi5INjjMeX-TYnIQTmk_qhOO7Q0tf3rePZIT0bmKLuI_kl8UYzIja3QJLwcpzPIZBo8Ssd1GECemanXNbUWaSTTQNqevbxxs-J51H7MxXxAMk-qrqrDPvb2uT5tKPTTQ9H5xI4oXV/w640-h184/CDC%20risk%20maps%2025-26%20feb.jpg" width="640" /></a></div>COVID levels according to the CDC on February 25<sup>th</sup> (left), February 26<sup>th</sup> (right)<p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_625" o:spid="_x0000_i1027" style="height: 119pt; visibility: visible; width: 196pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image004.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfHLBDojeMh8SjE013Xiwyfrj62HItJyCZ3qP9I_w4m5t3mve8su6xHTYo-Lxh-9d_BoiGjGyPVaRM_Tja40xqtETIrKLGAcjBhOnQsm97tSxXwN0bgd6ulS4rSUHIRNfEyw53sASi5dA28VSWuTa2y5uxUHTN9Ftd150FGqIwvJ9zWTwtL4JCD5ec/s1524/community%20levels%20CDC%2017-3.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="922" data-original-width="1524" height="194" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfHLBDojeMh8SjE013Xiwyfrj62HItJyCZ3qP9I_w4m5t3mve8su6xHTYo-Lxh-9d_BoiGjGyPVaRM_Tja40xqtETIrKLGAcjBhOnQsm97tSxXwN0bgd6ulS4rSUHIRNfEyw53sASi5dA28VSWuTa2y5uxUHTN9Ftd150FGqIwvJ9zWTwtL4JCD5ec/s320/community%20levels%20CDC%2017-3.jpg" width="320" /></a></div><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">…and on March 17<sup>th</sup></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">For once a CDC guideline that’s perfectly clear. Clear – but inaccurate. The CDC <a href="https://www.cdc.gov/coronavirus/2019-ncov/your-health/covid-by-county.html" style="color: #954f72; text-decoration: underline;">web page</a> explaining its new mask recommendations is straightforward: in all counties where “community levels” are low, housing <a href="https://www.beckershospitalreview.com/public-health/90-of-population-now-in-communities-where-masks-not-needed-cdc.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=8153B8946823F6C" style="color: #954f72; text-decoration: underline;">94% of Americans</a>, nobody needs to wear a mask anywhere unless they have COVID-19-like symptoms, a positive test, or a recent exposure. <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">As the first 2 maps show, county risk levels went <b><i>in one day </i></b>– “<a href="https://www.washingtonpost.com/video/politics/40-times-trump-said-the-coronavirus-would-go-away/2020/04/30/d2593312-9593-4ec2-aff7-72c1438fca0e_video.html" style="color: #954f72; text-decoration: underline;">like a miracle</a>” as Donald Trump was widely mocked for saying in March 2020 – from almost uniformly high to mostly low-medium. And two weeks later to almost uniformly low!<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">How did CDC Director Rochelle Walensky <a href="https://twitter.com/drericding/status/1497319120567742464?s=11" style="color: #954f72; text-decoration: underline;">make this magic happen</a>? Not with improved prevention or treatment, but by revising her definitions. The wording of the new reigning criterion, “COVID-19 community levels,” looks a lot like the old “levels of community transmission,” but there’s a crucial difference: “community transmission” was based on how many <a href="https://edition.cnn.com/2021/07/28/health/substantial-or-high-covid-19-transmission-wellness/index.html" style="color: #954f72; text-decoration: underline;">people were getting sick</a>, whereas “community levels” depend on <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/community-levels.html" style="color: #954f72; text-decoration: underline;">how full local hospitals</a> are.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">OK, so that’s clear. Questionable sleight of hand, but clear. So why do I say inaccurate? Because the CDC page <b><i>fails to mention</i></b> that <a href="https://www.washingtonpost.com/transportation/2022/02/25/mask-mandate-transportation-airlines/" style="color: #954f72; text-decoration: underline;">masks are still required</a> on interstate trains, buses, and airplanes and in all transportation hubs. This omission is not just ill-considered but risks further fueling the epidemic of “<a href="https://www.washingtonpost.com/transportation/2022/02/14/unruly-passengers-american-airlines-flight-kansas-city/" style="color: #954f72; text-decoration: underline;">unruly passengers</a>.” Similarly dumb, though perhaps less dangerous, is the <b><i>failure to specify </i></b>that patients, staff, and visitors in hospitals and nursing homes are supposed to <a href="https://www.cbsnews.com/news/cdc-guidelines-mask-indoors-covid-19/" style="color: #954f72; text-decoration: underline;">continue following</a> the old “levels of community transmission” standards, which would currently require masks inside medical settings <a href="https://covid.cdc.gov/covid-data-tracker/#county-view?list_select_state=all_states&list_select_county=all_counties&data-type=Cases" style="color: #954f72; text-decoration: underline;">in the majority</a> of US counties.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">And how about explicit CDC criteria for reversing gear and and reintroducing masking, distancing, and other limitations if a new surge arrives? They may exist, but I haven’t been able to find them.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">States are free to impose their own indoor mask mandates, and Hawaii, Illinois, Oregon and Washington are keeping theirs. <a href="https://www.nytimes.com/2022/02/25/health/cdc-mask-guidance.html?campaign_id=2&emc=edit_th_20220226&instance_id=54362&nl=todaysheadlines&regi_id=19728476&segment_id=84038&user_id=d89c7002526915cc9287fae06e27a284" style="color: #954f72; text-decoration: underline;">Several blue states</a> have <a href="https://www.cnet.com/health/medical/states-without-mask-mandates-covid-19/" style="color: #954f72; text-decoration: underline;">instituted</a> an honor system, saying you can only stop wearing masks indoors if you’re vaccinated. Dream on! In January <a href="https://www.tampabay.com/news/health/2022/01/27/will-covid-ever-be-over-most-americans-think-not-poll-shows/" style="color: #954f72; text-decoration: underline;">37%</a> of unvaccinated Americans, versus 75% of the vaccinated, said they “frequently” wore masks. Connecticut and California also still require masks in schools, health care facilities, nursing homes, jails and prisons, homeless and emergency shelters, and on public transit.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">The CDC’s switcheroo may seem sensible to experts including <a href="applewebdata://C34C744A-D4EB-4874-8B01-CE4FA09C7ACC/protect%20vulnerable%20populations" style="color: #954f72; text-decoration: underline;">Leana Wen</a> and <a href="https://www.nytimes.com/2022/02/25/opinion/cdc-covid-guidelines.html?campaign_id=2&emc=edit_th_20220226&instance_id=54362&nl=todaysheadlines&regi_id=19728476&segment_id=84038&user_id=d89c7002526915cc9287fae06e27a284" style="color: #954f72; text-decoration: underline;">Ashish Jha</a> – and to the American public. In a <a href="https://docs.cdn.yougov.com/9yefy3kct2/20220124_yahoo_tabs.pdf" style="color: #954f72; text-decoration: underline;">Yahoo poll</a> as far back as January only 33% of Trump voters were at all worried about COVID-19, 89% of currently unvaccinated elderly people intended to stay that way, and 46% of all adults thought we needed to “get back to normal.” <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">In my opinion, though, the redefinition boils down to saying infections don’t matter, only severe disease. This amounts to flirting with the notorious herd immunity concept that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557300/" style="color: #954f72; text-decoration: underline;">Dr. Walensky herself vigorously opposed</a> in late 2020. Some American experts have <a href="https://www.nytimes.com/2022/02/28/nyregion/nyc-vaccine-mask-mandates.html?campaign_id=2&emc=edit_th_20220301&instance_id=54529&nl=todaysheadlines&regi_id=19728476&segment_id=84260&user_id=d89c7002526915cc9287fae06e27a284" style="color: #954f72; text-decoration: underline;">publically dissented</a> from the new guidelines, notably top doc Eric Topol, whose <a href="https://www.theguardian.com/commentisfree/2022/mar/16/once-again-america-is-in-denial-about-signs-of-a-fresh-covid-wave" style="color: #954f72; text-decoration: underline;">latest article</a> is titled “Once again, America is in denial about signs of a fresh Covid wave.” Dr. Eric Feigl-Ding <a href="https://twitter.com/drericding/status/1497319120567742464?s=11" style="color: #954f72; text-decoration: underline;">tweeted</a>:<b> </b>“MAGIC— we go from left map to right map in just 1 day!!! Hallelujah? ‘One day COVID will just disappear’ — never thought <a href="https://twitter.com/CDCgov" style="color: #954f72; text-decoration: underline;">@CDCgov</a> will gaslight us light this. <a href="https://twitter.com/CDCDirector" style="color: #954f72; text-decoration: underline;">@CDCDirector</a> — what the heck are you doing?” <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Concentrating on hospital capacity also means <a href="https://www.nature.com/articles/d41586-022-00414-x?fbclid=IwAR16aoK1P7NPhM_we9t29EwcLX3QvHIUSsxsAr1OIG0BblcUd77KgJowV6E" style="color: #954f72; text-decoration: underline;">ignoring</a> two crucial words: long COVID. We still don’t know how many Omicron patients will have prolonged symptoms, but I worry, along with some <a href="https://apnews.com/article/coronavirus-pandemic-health-lifestyle-f87fd7ec5680e1833006b6016357b367?user_email=d676e576422b62d91aabbaed723d51be10108f6f131c3d12fd1a13dc8aab8031&utm_source=Sailthru&utm_medium=email&utm_campaign=MorningWire_Feb9&utm_term=Morning%20Wire%20Subscribers" style="color: #954f72; text-decoration: underline;">prominent scientists</a> and clinicians. Especially having seen young patients of my own who are still tired and short of breath months after presumed Omicron.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">In other CDC news, it was startling to learn that the CDC has been deliberately <a href="https://www.nytimes.com/2022/02/20/health/covid-cdc-data.html" style="color: #954f72; text-decoration: underline;">withholding vital pandemic information</a> from the public. It’s been tracking the age, vaccination status, and race of COVID-19 patients and fatalities for more than a year, but keeping the data to itself, and also preferred not to reveal some key booster data. One <a href="https://www.nytimes.com/2022/02/20/health/covid-cdc-data.html" style="color: #954f72; text-decoration: underline;">expert commented</a>, “The CDC is a political organization as much as it is a public health organization.”<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">No wonder the proportion of Americans who trust the CDC has <a href="https://www.nytimes.com/2022/03/12/opinion/public-health-trust.html?campaign_id=2&emc=edit_th_20220313&instance_id=55688&nl=todaysheadlines&regi_id=19728476&segment_id=85453&user_id=d89c7002526915cc9287fae06e27a284" style="color: #954f72; text-decoration: underline;">fallen</a> from 69% at the start of the pandemic to 44% now.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">The word “<a href="https://www.washingtonpost.com/opinions/2022/02/26/cdc-ease-mask-mandates-pandemic-shift-but-not-over/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F362c9a2%2F621b59ca9d2fda34e7ae5911%2F599d6acbae7e8a3d46e1400f%2F24%2F55%2F621b59ca9d2fda34e7ae5911" style="color: #954f72; text-decoration: underline;">endemic</a>” gets tossed around a lot nowadays, with <a href="https://www.nytimes.com/2022/02/08/us/politics/covid-restrictions-americans.html?campaign_id=2&emc=edit_th_20220209&instance_id=52534&nl=todaysheadlines&regi_id=19728476&segment_id=82081&user_id=d89c7002526915cc9287fae06e27a284" style="color: #954f72; text-decoration: underline;">55% of US voters</a> thinking COVID-19 should be “treated as an endemic disease that will never fully go away,” like influenza. I agree that the flu is a good measure: the time to consider COVID-19 an endemic disease like any other, when we can let down our guard, will be when it’s killing more or less as many people as influenza, which in the US means 28,000 deaths per year, about 2000 a month. But even with the Omicron surge supposedly over, that many are <a href="https://www.worldometers.info/coronavirus/country/us/" style="color: #954f72; text-decoration: underline;">still dying</a> <b><i>every</i></b> <b><i>couple of days</i></b>. Until the endemic phase arrives we need to keep protecting people by encouraging vaccination, mandating masks in public indoor settings, and isolating infectious individuals. As I mentioned above, I lean negative on the hot button issue of masking children in schools, since <a href="https://consumer.healthday.com/vaccination-reduces-incidence-of-sars-cov-2-among-adolescents-2656775519.html" style="color: #954f72; text-decoration: underline;">classrooms are not</a> where kids mostly get infected. If Paxlovid or other highly effective antivirals and medical consultants were easily, quickly, and universally available at your corner drug store, my mind could change. <o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">COVID-19 <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+cases&Interval=7-day+rolling+average&Relative+to+Population=false&Color+by+test+positivity=false&country=~USA" style="color: #954f72; text-decoration: underline;">cases</a>, <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&pickerSort=asc&pickerMetric=location&Metric=Hospital+patients&Interval=7-day+rolling+average&Relative+to+Population=false&Color+by+test+positivity=false&country=~USA" style="color: #954f72; text-decoration: underline;">hospitalizations</a>, and <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=false&Color+by+test+positivity=false&country=~USA" style="color: #954f72; text-decoration: underline;">deaths</a> have all been falling precipitously in the US, but Anthony Fauci <a href="https://www.nytimes.com/2022/03/20/health/fauci-us-cases-ba2.html" style="color: #954f72; text-decoration: underline;">predicts</a> cases will soon rise again, though severe disease may remain low. An uptick makes sense, with the simultaneous arrival of BA.2, scrapping of mitigation measures, waning vaccine immunity, and low booster rates. But note: case numbers have always been unreliable in the US, and are <a href="https://www.mlive.com/public-interest/2022/02/with-at-home-testing-on-the-rise-do-we-really-know-covid-cases-are-going-down-in-michigan-yes-experts-say.html" style="color: #954f72; text-decoration: underline;">increasingly useless</a> as more and more patients get diagnosed only with unreported home tests. Instead, follow hospitalizations and deaths.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>Post-pandemic antics abroad<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinNLAjJlQ9CmODAyr2TOjwwipCD3g5uah_sbfBgqLmJDLbS4HPSy1GPBy6erlI82rh94s4ow9qlCee27boWSE7QNYGLYR62nMM_QVKTPxbcHAwbQJScDtCJg7jmY6f3VFIvWbKxSG0GnZPCJpJQEzMhrXG--I6hGtTm6ssXrbCsVy0YC-LnYioXyRs/s1328/Italy%20cases%20to%2021-3-22.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="644" data-original-width="1328" height="194" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinNLAjJlQ9CmODAyr2TOjwwipCD3g5uah_sbfBgqLmJDLbS4HPSy1GPBy6erlI82rh94s4ow9qlCee27boWSE7QNYGLYR62nMM_QVKTPxbcHAwbQJScDtCJg7jmY6f3VFIvWbKxSG0GnZPCJpJQEzMhrXG--I6hGtTm6ssXrbCsVy0YC-LnYioXyRs/w400-h194/Italy%20cases%20to%2021-3-22.jpg" width="400" /></a></div><u>Italy</u>: My adoptive country declined to join the mad dash toward a post-pandemic world during January and February, continuing a strict Green Pass policy and insisting people wear not just face masks but KN95s inside buses and movie theaters. In February it even <a href="https://www.spazio50.org/verso-la-fine-dello-stato-di-emergenza-ma-l-obbligo-vaccinale-per-gli-over-50-e-legge/">reaffirmed</a> a vaccine mandate for everybody over 50, though letting them off with a silly €100 fine. In late March, though, Italy surrendered to the “endemic” temptation. As of April 1<sup>st</sup> regions will no longer be classified weekly by risk, Green Pass requirements will loosen, and face masks will <a href="https://startup.info/it/addio-alla-pandemia-covid-novita-dal-1-aprile/">only be required</a> inside stores, theaters, transport, and sport venues. One month later the whole structure dissolves: no more Green Passes, face masks, or physical distancing. The sole vestiges: until June 15<sup>th</sup> older workers who want to work in person must be vaccinated or recovered, and until the end of the year workers in health settings and nursing homes must be vaccinated (as of <a href="https://www.ilgiorno.it/cronaca/covid-medici-non-vaccinati-sospesi-1.7327078">early February</a> 29,972 physicians were known to be unvaccinated, but only 2,254 had been suspended without pay as the law demands – many, though, were exonerated for having recently had COVID-19). <p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Some Italian experts <a href="https://www.thelocal.it/20220321/italys-covid-reopening-timeline-what-do-the-experts-think/?tpcc=nl_converter&utm_source=newsletter&utm_medium=email&utm_campaign=italys_tax_on_energy_profits_and_how_to_claim_the_sismabonus&utm_term=2022-03-21" style="color: #954f72; text-decoration: underline;">approve</a> of the plan, but I’m predictably with the <a href="https://www.thelocal.it/20220321/italys-covid-reopening-timeline-what-do-the-experts-think/?tpcc=nl_converter&utm_source=newsletter&utm_medium=email&utm_campaign=italys_tax_on_energy_profits_and_how_to_claim_the_sismabonus&utm_term=2022-03-21" style="color: #954f72; text-decoration: underline;">many</a>, from the country’s infectious disease guru to the Health Minister’s scientific advisor for the coronavirus, who think it’s a mistake. Retiring the Green Pass is fairly reasonable – it’s already been so successful at its task of incentivizing vaccination that only <a href="https://lab24.ilsole24ore.com/numeri-vaccini-italia-mondo/?" style="color: #954f72; text-decoration: underline;">8.7% of people over 12</a> haven’t had a shot. But scrapping face masks??? Cases of COVID-19 in Italy have <b><i>doubled</i></b> during March, and <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~GBR~FRA~DEU" style="color: #954f72; text-decoration: underline;">more Italians are dying</a> per capita than Germans, French, or Brits. This is not the moment to stop masking. The president of Italy’s evidence-based medicine foundation, Gimbe, calls the idea “<a href="https://www.thelocal.it/20220321/italys-covid-reopening-timeline-what-do-the-experts-think/?tpcc=nl_converter&utm_source=newsletter&utm_medium=email&utm_campaign=italys_tax_on_energy_profits_and_how_to_claim_the_sismabonus&utm_term=2022-03-21" style="color: #954f72; text-decoration: underline;">madness</a>.” The government does say it will re-introduce the indoor requirement if a real surge threatens. I’d bet that moment will come before the de-masking decree goes into effect. And don’t expect to see my own bare face inside any stores or theaters for good while to come.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>England</u>: When Boris Johnson <a href="https://www.theguardian.com/world/2022/feb/09/boris-johnson-says-he-plans-to-lift-all-englands-covid-rules-a-month-earl" style="color: #954f72; text-decoration: underline;">trashed COVID restrictions</a> in late February, including self-isolation for infectious patients, a political motivation was clear – he’s hanging on to power with his fingernails amid myriad scandals and gaffes, <a href="https://www.bbc.com/news/uk-politics-60809454" style="color: #954f72; text-decoration: underline;">including</a> an idiotic comparison of Ukrainians to Brexiteers. Since then the number of UK cases has more than tripled, though hospitalizations and deaths (always lagging indicators) hold pretty steady.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>China</u>: Their famed zero-COVID policy fell apart a few weeks ago when surges occurred in multiple cities, most notably Hong Kong which since February 19<sup>th</sup> has seen more than a million cases and nearly 4000 deaths, out of only 7.5 million people. The underlying reason is that China pushed its workforce to the front of the vaccination queue, rather than giving precedence to older people. And though it’s vaccinated as many people per capita as Italy, it’s given <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&pickerSort=asc&pickerMetric=location&Metric=Vaccine+booster+doses&Interval=Cumulative&Relative+to+Population=true&Color+by+test+positivity=false&country=CHN~ITA" style="color: #954f72; text-decoration: underline;">40% fewer boosters</a>.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><u>Israel</u>: All those vaccine doses haven’t kept the BA.2 subvariant from spreading and <a href="https://www.haaretz.com/israel-news/israel-s-expert-covid-team-to-meet-as-infection-rate-surges-1.10690165?utm_source=mailchimp&utm_medium=email&utm_content=author-alert&utm_campaign=Ido%20Efrati&utm_term=20220322-12:36" style="color: #954f72; text-decoration: underline;">now dominating</a> in Israel, and haven’t kept cases from increasing since Green Passes have been largely abandoned. But the country has sensibly decided to nip a possible new surge in the bud by keeping an <a href="https://www.timesofisrael.com/israel-to-keep-indoor-mask-mandate-as-it-warily-watches-covid-resurgence-elsewhere/" style="color: #954f72; text-decoration: underline;">indoor mask mandate</a> in place longer than planned.<o:p></o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>My favorite new conspiracy theory<o:p></o:p></b></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjt7Fkl4pWwWwH54Z-juZLessldIH0VSuzNjuqbw3LS5Jzg2cijf0A-Vr0vVEt-9ASCSMhRlR2TzFSnkTl4Fa9OSKAu7wZxd29XgEaCEidm0X4-SoB04J4ZUKOeFurebIHlwkd7Gex5xySyvwWK7BdDo51nM30IMLIOaz0Hbw4dI_ge9pwGGv1ye4IY/s640/Hydravulgaris.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="614" data-original-width="640" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjt7Fkl4pWwWwH54Z-juZLessldIH0VSuzNjuqbw3LS5Jzg2cijf0A-Vr0vVEt-9ASCSMhRlR2TzFSnkTl4Fa9OSKAu7wZxd29XgEaCEidm0X4-SoB04J4ZUKOeFurebIHlwkd7Gex5xySyvwWK7BdDo51nM30IMLIOaz0Hbw4dI_ge9pwGGv1ye4IY/w200-h192/Hydravulgaris.jpg" width="200" /></a></div><b><br /></b><p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><v:shape id="Picture_x0020_642" o:spid="_x0000_i1025" style="height: 176pt; visibility: visible; width: 184pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image006.jpg"></v:imagedata></v:shape></span><o:p></o:p></p><p><style class="WebKit-mso-list-quirks-style">
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</style></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Meet Hydra vulgaris, a parasitic organism rumored to be found, live and wriggling, <a href="https://eu.usatoday.com/story/news/factcheck/2021/11/12/fact-check-false-claim-hydra-vulgaris-covid-19-vaccine/6356471001/">in COVID-19 vaccines</a>. Read <a href="https://www.mcgill.ca/oss/article/covid-19-pseudoscience/madej-madness">here</a> about the osteopathic physician peddling <a href="https://www.reuters.com/article/factcheck-coronavirus-vaccines/fact-check-covid-19-vaccines-do-not-contain-live-immortal-creatures-experts-say-idUSL1N2RM2F3">this crap</a>.<o:p></o:p></p>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com2tag:blogger.com,1999:blog-6211405954943098401.post-65912173474738048422022-02-21T19:13:00.002+01:002022-02-21T19:15:18.741+01:00Something Rotten in the State of Denmark?<p> </p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEi7VapIt5Gs0XFqcGzuOSFL9s5xPhL1ArnOGzNgacS727Yjv5FBhPWGEuZv0ebrRdaq4ylbEknUNuQm6IhBpLgd8-iaQlQNrYNWgTpqJB9DcvwIqPqw_K4a7_WwcUIre2Ou-eI5c6SbXU9dKoqX3qTjEmVyWEy6Ry4Qc_Ys3b-rUu-aDgWNLihxRlNa=s745" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="745" data-original-width="701" height="320" src="https://blogger.googleusercontent.com/img/a/AVvXsEi7VapIt5Gs0XFqcGzuOSFL9s5xPhL1ArnOGzNgacS727Yjv5FBhPWGEuZv0ebrRdaq4ylbEknUNuQm6IhBpLgd8-iaQlQNrYNWgTpqJB9DcvwIqPqw_K4a7_WwcUIre2Ou-eI5c6SbXU9dKoqX3qTjEmVyWEy6Ry4Qc_Ys3b-rUu-aDgWNLihxRlNa=s320" width="301" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">I saw Richard Burton play Hamlet on Broadway!</td></tr></tbody></table><style class="WebKit-mso-list-quirks-style">
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</style><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Lots on masks, treatments, vaccines, and guidelines, my take on hospitalized with versus hospitalized for, and detours about what's going on in Italy and Denmark.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Treatment and prevention news<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiBkDPDVp0-K3KAHImNJ5B6dGJlGibvqedN-_IfmJ6Xa0m7tns7H3JrmrhvH-VVZ80EWTomq5URKqXM7GfH9C4uFD1rsBdnkTsS-JmtL2CSELUMgnf59GwaaM3Y4VB4jQglfI0ugv0-xKOb2YnV-_oSQAYFDOFDwtSRpAJ05_kyo4C6dj7dm2yBKZ9G=s862" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="575" data-original-width="862" height="266" src="https://blogger.googleusercontent.com/img/a/AVvXsEiBkDPDVp0-K3KAHImNJ5B6dGJlGibvqedN-_IfmJ6Xa0m7tns7H3JrmrhvH-VVZ80EWTomq5URKqXM7GfH9C4uFD1rsBdnkTsS-JmtL2CSELUMgnf59GwaaM3Y4VB4jQglfI0ugv0-xKOb2YnV-_oSQAYFDOFDwtSRpAJ05_kyo4C6dj7dm2yBKZ9G=w400-h266" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Indians lined up to refill oxygen canisters.</td></tr></tbody></table><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f"><v:stroke joinstyle="miter"><v:formulas><v:f eqn="if lineDrawn pixelLineWidth 0"><v:f eqn="sum @0 1 0"><v:f eqn="sum 0 0 @1"><v:f eqn="prod @2 1 2"><v:f eqn="prod @3 21600 pixelWidth"><v:f eqn="prod @3 21600 pixelHeight"><v:f eqn="sum @0 0 1"><v:f eqn="prod @6 1 2"><v:f eqn="prod @7 21600 pixelWidth"><v:f eqn="sum @8 21600 0"><v:f eqn="prod @7 21600 pixelHeight"><v:f eqn="sum @10 21600 0"></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:formulas><v:path gradientshapeok="t" o:connecttype="rect" o:extrusionok="f"><o:lock aspectratio="t" v:ext="edit"></o:lock></v:path></v:stroke></v:shapetype><v:shape id="Picture_x0020_614" o:spid="_x0000_i1034" style="height: 193pt; visibility: visible; width: 290pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image001.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Face masks 1</u>: Finally, some real data on whether face masks protect the person who wears one. First, an <a href="https://www.ajpmonline.org/article/S0749-3797(21)00557-2/fulltext">international study</a> found that mask mandates lowered death rates. Then a <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7106e1.htm?">case-control study</a> by the CDC, which found protection against SARS-CoV-2 infection to be minimal for cloth masks, 66% for surgical masks, and 83% for N95 or KN95 masks. Despite <a href="https://vinayprasadmdmph.substack.com/p/mask-studies-reach-a-new-scientific">methodological weaknesses</a>, I think this study disproves the earlier theory that masks keep infected wearers from spreading the virus but don’t protect uninfected wearers. Importantly, all the subjects said they wore masks consistently whenever they were in indoor public spaces.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Face masks 2</u>: If COVID-19 is raging (97% of US counties are currently high-transmission areas), and if good masks protect, then everybody should be wearing them in indoor public spaces. For once <a href="https://www.nytimes.com/2022/02/09/health/mask-rules-cdc.html?campaign_id=2&emc=edit_th_20220210&instance_id=52675&nl=todaysheadlines&regi_id=19728476&segment_id=82234&user_id=d89c7002526915cc9287fae06e27a284">the CDC</a> and I agree. But states – <i>especially</i> blue states – are instead <a href="https://www.nytimes.com/2022/02/09/us/mask-mandates-by-state.html?campaign_id=2&emc=edit_th_20220210&instance_id=52675&nl=todaysheadlines&regi_id=19728476&segment_id=82234&user_id=d89c7002526915cc9287fae06e27a284">falling all over each other</a> to revoke mask mandates. Since my husband and I will be visiting two of those states in April, California and New York, I’m scared. Of course you can only leave your mask off if you’re vaccinated. Yeah. Anyone who believes unvaccinated people are going to “keep” masking up, please raise your hand.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Bye bye lockdowns</u>? Three economists made a huge splash on <a href="https://www.foxnews.com/health/covid-lockdowns-johns-hopkins-study-debate">right-wing American media</a> with a <a href="https://sites.krieger.jhu.edu/iae/files/2022/01/A-Literature-Review-and-Meta-Analysis-of-the-Effects-of-Lockdowns-on-COVID-19-Mortality.pdf">"working paper"</a>claiming to prove that lockdowns did no good whatsoever. It gets widely described as a “Johns Hopkins study” though only one of the authors, who has no epidemiology or public health expertise, is from JHU. Are the trio right? Nope. Start with their definition of a lockdown: “The imposition of at least one compulsory, non-pharmaceutical intervention.” So school closures and international travel bans, whose benefits are indeed questionable, are just as much lockdowns as are stay-at-home orders? And it’s only downhill from there, as shown in excruciating detail by the research methodology expert <a href="https://www.methodsman.com/blog/did-covid-lockdowns-work">F. Perry Wilson</a> and <a href="https://healthfeedback.org/claimreview/claims-johns-hopkins-study-showed-lockdowns-ineffective-reducing-covid-19-mortality-based-working-paper-questionable-methods-fox-news-daily-mail/">others</a>, and <a href="https://www.chicagotribune.com/suburbs/post-tribune/opinion/ct-ptb-davich-johns-hopkins-lockdown-study-st-0209-20220208-cy6o27a6bzh7xeucopecqbbsjq-story.html">others</a>, and <a href="https://www.politifact.com/article/2022/feb/07/what-know-about-study-lockdowns-and-covid-19-death/">still others</a>. The paper depends on a <a href="https://www.mdpi.com/2071-1050/13/6/3042/htm">single article</a> whose findings were actually so contradictory to the “working paper’s” thesis that its author <a href="https://twitter.com/whippletom/status/1489229847973015565">disavowed the citation</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Natural immunity</u>: According to <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2200133?query=TOC">analyses in Qatar</a>, having been infected with SARS-CoV-2 an average of 10 months earlier protected only 56% against reinfection with Omicron, as compared to 90% for previous variants. But that figure puts previous infection at least on a par with 2-dose vaccination. And protection against <i>severe</i> Omicron disease was an excellent 88%. But there’s zero evidence so far that simply having mild Omicron will protect you against other strains even short-term, much less forever.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Evusheld</u>: This monoclonal antibody combo from AstraZeneca is being marketed as preventive treatment for immunosuppressed individuals, a concept I’ve long advocated. A single dose of RegenCov gave <a href="https://investor.regeneron.com/news-releases/news-release-details/new-phase-3-analyses-show-single-dose-regen-covr-casirivimab-and">81.6% protection</a>against COVID-19 for up to 8 months, but at this point an anti-Omicron product such as Evusheld or sotrovimab would obviously be a wiser choice.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Sotrovimab</u>: Now this monoclonal antibody has <a href="https://www.healio.com/news/infectious-disease/20220217/intramuscular-sotrovimab-noninferior-to-iv-administration-for-covid19">been shown effective</a> by intramuscular injection, much more convenient than intravenous infusion. But twice as many patients required hospitalization with intramuscular administration, even if the formal criteria the researchers laid out for “noninferiority” were not met. Me, I’d go for the IV version.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Bebtelovimab</u>: This new single-dose intravenous monoclonal antibody product is Lilly’s latest offering. It’s predicted to be active against Omicron and the BA.2 subvariant. It’s already scored an <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-new-monoclonal-antibody-treatment-covid-19-retains">Emergency Use Authorization</a> for use in high-risk patients with early disease, and half a million doses or so should soon be available in the USA. But I the supportive evidence described in the <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-new-monoclonal-antibody-treatment-covid-19-retains">FDA’s press release</a> is strangely underwhelming. A placebo-controlled study that showed briefer illness was only in <b><i>low-risk</i></b> patients, not the <b><i>high-risk</i></b> patients for whom the drug is authorized. Neither of two trials in high-risk patients had placebo controls, and all the FDA can say is that the rates of bad outcomes were “Generally lower than the placebo rate reported in prior trials of other monoclonal antibodies in high risk patients.” It links to a <a href="https://clinicaltrials.gov/ct2/show/study/NCT04634409">clinical trial</a> with no results posted. Very weird.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Paxlovid</u>: At last Pfizer’s <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2118542?query=TOC">magic pill</a> is hitting the street. But Italy is expecting only 600,000 courses of treatment in 2022, <b><u>1 for every 100 Italians</u></b>. <a href="https://www.epicentro.iss.it/coronavirus/bollettino/Bollettino-sorveglianza-integrata-COVID-19_12-gennaio-2022.pdf">About 700,000</a> Italians over 60 had COVID-19 last month. Taking that very roughly as the number eligible for Paxlovid treatment (some older people will be too healthy to be eligible and some younger people will be eligible because of comorbidities), 600,000 is a drop in the bucket. There will be <a href="https://www.fiercepharma.com/pharma/pfizer-to-double-order-covid-19-pill-paxlovid-us-report"><b>one course for every 16 Americans</b></a>, and <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-provide-united-kingdom-additional-25-million"><b>one for every 24 Brits</b></a>, much more adequate. The New York Times ran a <a href="https://www.nytimes.com/2022/01/19/business/covid-pill-treatment-pfizer.html">story</a> describing the hoops one of its reporters jumped through to obtain Pavlovid for her mother. The tale was touching, and the reporter’s efforts impressive, but I confess some ethical qualms. The mother was already well protected by a vaccine booster, so one could argue the treatment would have been better given to someone else…<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">…a propos of who else, the head of Pfizer is <a href="applewebdata://075A2C18-AFD5-494A-AD34-35E1ABB12E2B/for%20the%20lower-income%20countries,%20we%20are%20going%20to%20provide%20it%20at%20cost.">now saying</a> that not only will he allow generic companies to manufacture Paxlovid, but that Pfizer itself will provide the pill to low-income countries “at cost.” Since we know from <a href="https://www.statnews.com/pharmalot/2021/11/16/pfizer-covid19-bourla-pill-paxlovid-fda/">other sources</a> that manufacturing costs are estimated at $20 for a 5-day course, this is fantastic news.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">…in Italy as of February 10<sup>th</sup> a grand total of <a href="https://it.style.yahoo.com/aifa-pillola-merck-5-348-081434228.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAABoW21L_Cpsw-ybMYj6mEPbU5A-Xvi0mDN9PKFVWrm7Qj3X4P4N_n0a-YzrMVetyJdpBZBv3efNnIPfxcldvv2_23G-fGYNjiM8J_RiROQteBhWYObXGzOOCGS3ZxOvDR2XvqhypGwlmS71YrasEwHn27-nnxOxNRY7J2NDvoTdc">41 patients</a> had received Paxlovid. Here the patient must <a href="https://tg24.sky.it/salute-e-benessere/2022/02/05/pillola-covid-pfizer-paxlovid#06">go to a hospital</a>in person to be evaluated by an infectious disease specialist and be given the pills. For medically advanced countries this seems nuts: patient contacts physician, doc calls in prescription, family member picks up pills. Though in the mess that passes for an American health system even that <a href="https://www.nytimes.com/2022/02/13/opinion/covid-drugs.html?campaign_id=2&emc=edit_th_20220214&instance_id=53086&nl=todaysheadlines&regi_id=19728476&segment_id=82657&user_id=d89c7002526915cc9287fae06e27a284">is iffy</a>. But a deep dive into the reasoning of the Italian authorities reveals a different issue: they <a href="https://www.lanazione.it/pisa/cronaca/pillola-covid-paxlovid-1.7304358">don’t trust General Practitioners</a> to know whether a patient’s disease or medication regime is incompatible with the pill. And from what I know of that category of docs, they’re right.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Corticosteroids</u>: Italian madness: steroids, which are known to make outpatients <i>worse</i>, are now <a href="https://www.quotidianosanita.it/allegati/allegato3418644.pdf">officially recommended</a> for outpatients if they are sick enough to need hospitalization but no beds are available. Remember those families in India lined up to refill oxygen cylinders for their relatives? What an admission of defeat.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Remdesivir</u>: After multiple well-conducted trials finding virtually no benefit in hospitalized patients, and with the World Health Organization recommending <a href="https://www.who.int/news-room/feature-stories/detail/who-recommends-against-the-use-of-remdesivir-in-covid-19-patients">against its use</a>, now a pair of studies have according to the NEJM’s highly-respected <a href="https://www.jwatch.org/na54603/2022/02/11/remdesivir-adults-hospitalized-with-covid-19?query=etoc_jwgenmed&jwd=000000851154&jspc=IM&cid=DM729804_Subscriber&bid=829921559">Journal Watch</a>, provided “strong evidence that adding remdesivir to standard care improves outcomes among hospitalized adult patients with COVID-19.” I was shocked to look at the articles themselves. The first, a randomized open-label <a href="https://www.cmaj.ca/content/cmaj/early/2022/01/19/cmaj.211698.full.pdf">study from Canada</a>, found no significant effect on mortality even though the comparison patients were slightly healthier. The second, an <a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciac014/6515763?login=false">Italian trial</a> that <b><i>did</i></b> report decreased mortality, wasn’t even randomized much less placebo-controlled. It seems absurd to me that these researchers didn’t bother to do a proper trial, and that Journal Watch’s commentator would consider their results convincing.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Vaccine news<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"><b> </b></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhGswHbwgOjPa4gYne2nnFaODBbIBWEVDvkmdBGWhB26Pa654NWJIx41EVkY6E7TO2Ie2PDXmPMmTgH_GaKHnmywaPJz_bH0XeUgBEG6955WCVP1lXbyvYAMh4h2HsAq4l6FyQXTM4hIzWV9YZQgESG6cCBczB2T9s8NGmj-KW8ZRLKG2OQbrAHuwMn=s600" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="400" data-original-width="600" height="266" src="https://blogger.googleusercontent.com/img/a/AVvXsEhGswHbwgOjPa4gYne2nnFaODBbIBWEVDvkmdBGWhB26Pa654NWJIx41EVkY6E7TO2Ie2PDXmPMmTgH_GaKHnmywaPJz_bH0XeUgBEG6955WCVP1lXbyvYAMh4h2HsAq4l6FyQXTM4hIzWV9YZQgESG6cCBczB2T9s8NGmj-KW8ZRLKG2OQbrAHuwMn=w400-h266" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Johnson & John's Leiden plant, no longer making COVID-19 vaccine</td></tr></tbody></table><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_638" o:spid="_x0000_i1033" style="height: 175pt; visibility: visible; width: 263pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image002.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Novavax</u>: The company <a href="https://www.cbsnews.com/news/covid-vaccine-novavax-seeking-fda-authorization/?utm_campaign=KHN%3A%20Daily%20Health%20Policy%20Report&utm_medium=email&_hsmi=202566362&_hsenc=p2ANqtz-97Y364yIvQaHx6UgTE3mxyrxW6P2DvFefPzItqHLu5c9XMBfSQ9KCADn_UZWKOM00NT0ZmR-JeB-3Y_-f0bhsaxMDxhQ&utm_content=202566362&utm_source=hs_email">finally requested</a> Emergency Use Authorization from the FDA on February 1<sup>st</sup>, 3 months after beginning the process and a year after their first trial results came in. I think hoping this vaccine’s old-fashioned technology will persuade American novaxxers to repent is pie in the sky. And, of course, the trials are long outdated by now.</p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Vaccinating survivors</u>: A <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2119497?">giant Israeli study</a> has shown that Pfizer vaccination cut the risk of reinfection among patients who had recovered from COVID-19 by 76% overall, though people over 65 did worse. A single dose of vaccine was just as effective as a double one, suggesting the Italian policy of giving COVID-19 survivors only one shot makes at least as much sense as the American approach. And a <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2118691?query=featured_home">UK study</a> among regularly-tested healthcare workers showed vaccination left survivors more than 90% protected against reinfection, with no waning over a full year. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Bye bye booster</u>: A <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7107e2.htm?s_cid=mm7107e2_w#T2_down">CDC study</a> found the protection against hospitalization from Omicron provided by mRNA boosters to <a href="https://www.washingtonpost.com/health/2022/02/11/covid-boosters-omicron-protection/">drop</a> over 4 months from <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7107e2.htm?s_cid=mm7107e2_w">91% to 78%</a>. That’s not terrible, but it’s a far cry from the efficacy against earlier strains – for Delta, 97% and 89% respectively. And effectiveness against milder COVID-19 is likely to be still lower. These results are of particular concern for countries like Italy, Denmark, and the UK, which had intense early booster campaigns: a month from now about a third of older Brits will run up against the 4-month wall, as will 20% of older people in Italy including my husband and me. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Fourth doses</u>: The big question is whether we should plunge ahead giving ever more boosters of the same vaccines, or wait for revised versions. Maybe fourth doses make sense for the <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00593-3/fulltext">immunocompromised</a>, but I think monoclonal antibody products such as sotrovimab and Evusheld every few months is a better idea. For the rest of us, Israeli data remain <a href="https://www.reuters.com/world/middle-east/israel-sticks-with-4th-vaccine-shot-sees-omicron-waning-week-2022-01-18/">uncertain</a>. Antibodies <a href="https://www.nytimes.com/2022/01/25/world/europe/israel-fourth-covid-dose.html">skyrocket</a>, but protection against symptomatic COVID-19 is at best <a href="https://www.medrxiv.org/content/10.1101/2022.02.01.22270232v1.full.pdf">halved</a>. Dose 4 protects better against <i>severe</i> disease, but with only 23 days’ follow-up we have no idea how long it lasts.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Universals</u>: Better than a whack-a-mole approach would be a single vaccine that could counter present and future SARS-CoV-2 variants, as discussed in a recent <a href="https://www.washingtonpost.com/health/2022/02/14/universal-covid-vaccine/">Washington Post article</a>. The <a href="https://www.sciencedirect.com/science/article/pii/S2211124721016399">US Army vaccine</a> that showed promise in animals should soon see results from a Phase 1-2 <a href="https://clinicaltrials.gov/ct2/show/NCT04784767">human trial</a>, and groups at the <a href="https://www.washingtonpost.com/health/2022/02/14/universal-covid-vaccine/">University of Pennsylvania</a>, <a href="https://rupress.org/jem/article/218/12/e20211003/212688/Glycan-engineering-of-the-SARS-CoV-2-receptor">Osaka University</a>, and the <a href="https://www.nature.com/articles/d41586-021-02561-z">University of Washington</a> are working on others. Last May Duke researchers <a href="https://www.nature.com/articles/s41586-021-03594-0">described</a> a vaccine that neutralized several early variants in monkeys, but they still haven’t gotten around to human trials. Many “universal” vaccines actual involve bits of the spike protein taken from <i>previous</i> variants, which seems unlikely to yield protection from <i>future</i> ones. A <a href="https://www.mdpi.com/1999-4915/14/2/329/htm">group of researchers</a> from the Italian central research institute, the Istituto Superiore di Sanità, are trying a vaccine that targets the N protein, a portion of the SARS-CoV-2 virus they seem to think is unlikely to mutate. So far they’ve only gotten as far as studies in mice. <a href="https://www.adnkronos.com/covid-e-vaccino-universale-cosa-dicono-gismondo-pregliasco-e-salmaso_5CpxcJjXOnFFqBLLSIxMzG?refresh_ce">Some commentators think</a> it may be good at preventing severe COVID-19, but poor against milder disease.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Kids</u>: in Israel, 2-dose vaccination <a href="https://www.timesofisrael.com/vaccinated-kids-half-as-likely-to-get-omicron-but-protection-fades-fast-study/">cut Omicron illness</a> in kids by half but wore off in a few months – as did the booster… Twelve cases of <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2022-01-05/02-covid-su-508.pdf">post-vaccine myocarditis</a> had been reported in American children ages 5-11 by December 17, 2021 – 4.3 per million in boys after the second dose. That’s less than a tenth of the rate in teenagers, but may be far enough from zero to make some parents uneasy.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Johnson & Johnson</u>: The <a href="https://www.nejm.org/doi/pdf/10.1056/NEJMoa2117608?articleTools=true">final results</a> of their Phase 3 single-dose trial are very mediocre, only 53% efficacy overall. It peaked at 62% a month after vaccination but immediately started to drop, falling off a cliff around 6 months. Protection was stronger against severe disease (75%) and death (83%), so there should still be a role for this convenient, inexpensive vaccine in the developing world. But… J&J <a href="https://www.nytimes.com/2022/02/08/business/johnson-johnson-covid-vaccine.html?campaign_id=2&emc=edit_th_20220209&instance_id=52534&nl=todaysheadlines&regi_id=19728476&segment_id=82081&user_id=d89c7002526915cc9287fae06e27a284">quietly paused production</a> of its vaccine months ago, and won’t start up again until late spring.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Moderna</u>: The World Health Organization may <a href="https://www.nature.com/articles/d41586-022-00293-2">enable South Africa</a> to produce this vaccine, with no help from the company itself.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Pfizer vs. Moderna</u>: We already knew two doses of vaccine did very little to prevent Omicron disease, and <a href="https://www.gov.uk/government/news/boosters-provide-high-level-of-protection-against-death-with-omicron">the latest British data</a> confirm that even boosters wear off disturbingly fast. Protection against hospitalization from a Pfizer booster dropped over 10 weeks from 90% to 75% – but Moderna won out as usual, remaining 90-95% effective.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>CoronaVac</u>: How about the tens of millions of people who got Sinovac’s vaccine in early 2021? It was mediocre to start with and <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00094-0/fulltext">becomes entirely ineffective</a> by 6 months. A British group has tried <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00094-0/fulltext">giving various boosters</a> to Brazilian Sinovac vaccinees 6 months after their second dose, and examined the antibody response. Additional doses of the original vaccine, AstraZeneca, and Johnson & Johnson did little to raise antibodies, but Pfizer hoisted them to levels that <i>might</i> be protective. Follow-up of the same research subjects should be able to tell both whether the antibodies translate into real-world protection and how long either lasts.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>ARCoV</u>: The two main Chinese vaccines used so far, from Sinovac and Sinopharm, aren’t very effective. Now they’re doing Phase 3 trials of an <a href="https://theconversation.com/covid-china-is-developing-its-own-mrna-vaccine-and-its-showing-early-promise-176319">mRNA vaccine</a>. In <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(21)00280-9/fulltext">Phase 1-2 trials</a> it wasn’t as good at stimulating the immune system as Moderna or Pfizer, and gave more side effects, but – who knows? – it could perform well enough in the real world to let China continue to avoid buying foreign products.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Gaping gaps</u>: The <a href="https://www.nbcnews.com/health/health-news/covid-vaccine-cdc-advisers-weigh-delaying-second-shot-eight-weeks-rcna14905">CDC is considering</a> increasing the standard interval between the first two doses of mRNA vaccines from 3 or 4 weeks to 8 weeks, on grounds of greater efficacy and lower risk. I’ve been advocating for some time lengthening the dose gap for males under 30, to lower the risk of myocarditis. After reviewing the <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2022-02-04/09-covid-tunis-508.pdf">Canadian efficacy data</a> that were presented to the CDC on February 4<sup>th</sup> I can’t agree with broadening that advice, especially for Pfizer. By 2 weeks after the first dose the Moderna vaccine gave more than 80% protection against pre-Omicron variants, and it is relatively long-lasting. A single dose of Pfizer <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2022-02-04/09-covid-tunis-508.pdf">doesn’t even reach 60%</a> efficacy pre-Delta and only 33% against Delta, versus 90%-plus for two doses. And its efficacy will start fading before the second dose kicks in – probably why Pfizer was so ineffective among the elderly in the UK, where the gap was 12 weeks. I find the <a href="https://www.medrxiv.org/content/10.1101/2021.10.26.21265397v1.full.pdf">manuscript from Canada</a> itself unconvincing. It does show improved effectiveness following a second dose given after an 8-week interval, but does not report the crucial data, 2-10 weeks following the <b><i>first</i></b> dose. A longer gap should be less of a problem with young people with robust immune systems, so I stick with my position: increase the gap to 8 weeks for younger males, but otherwise leave it unchanged.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>What’s up with the Danes?<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_634" o:spid="_x0000_i1032" style="height: 133pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image003.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgsz56yI8_s1PeJAFFfZXVPefMyEZ32bv5VmJ8HiiwfEa-iLoLuF1w45-VKEUKkIEfs3Vu22qMIXHX0R9byvO03cvL4aFwciTMHtRRgecj9LE6vp8uP94qR0TE9vfyG8CGeWribNx_0IgJ78Lik0efipYqvtKiXVKiKR0oGJsyyQMD53QHV_ib_wCU9=s1538" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="453" data-original-width="1538" height="190" src="https://blogger.googleusercontent.com/img/a/AVvXsEgsz56yI8_s1PeJAFFfZXVPefMyEZ32bv5VmJ8HiiwfEa-iLoLuF1w45-VKEUKkIEfs3Vu22qMIXHX0R9byvO03cvL4aFwciTMHtRRgecj9LE6vp8uP94qR0TE9vfyG8CGeWribNx_0IgJ78Lik0efipYqvtKiXVKiKR0oGJsyyQMD53QHV_ib_wCU9=w640-h190" width="640" /></a></div><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Let’s say you’re a national health authority and you’ve been watching your country’s COVID-19 cases, hospitalizations, and deaths climb steadily for 4 months. What do you do? <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">If you’re Danish, you <a href="https://edition.cnn.com/2022/02/01/europe/denmark-lifts-covid-restrictions-intl/index.html">scrap all mitigation measures</a> and make like it’s 2019. No more masks, no more Green Passes, no more self-isolation if you’re sick. WOW!!! I’m not impressed with <a href="https://www.theatlantic.com/ideas/archive/2022/02/denmark-covid-restrictions/621482/">their justifications</a>, nor is epidemiologist Dr. Eric Feigl-Ding, who tweets: “<a href="https://twitter.com/drericding/status/1493465973952757760?s=11">Danish <span style="font-family: "Apple Color Emoji";">🇩🇰</span> political leaders have completely lost their frigging minds</a>.” Maybe, just maybe, it’s all about putting economics (ski tourism) over public health. And surprise, surprise! After a mere two weeks there were <a href="https://www.webmd.com/lung/news/20220217/covid-rates-jump-denmark-no-restrictions">already surges </a>in cases (up <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Metric=Confirmed+cases&Interval=Cumulative&Relative+to+Population=true&Color+by+test+positivity=false&country=~DNK">43%</a>), hospitalizations (up <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Metric=Hospital+admissions&Interval=Cumulative&Relative+to+Population=true&Color+by+test+positivity=false&country=~DNK">30%</a>), and even deaths (up <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=Cumulative&Relative+to+Population=true&Color+by+test+positivity=false&country=~DNK">14%</a>), though deaths ordinarily lag behind other indicators by weeks.<o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhBvhbuNgMm7E1_o3zFAizuT6kIFmW00z8OPvBTB9YnnQrEU93iPbmfbmEBYdwX_wpgQlYeCCl4uZvpoE3ITWafOhXRO_osUF7iqnZnEQm69tBESL7LPHV6dbSbY_j3HFJNdLwTzjCZtPaHnp0IHOnnCoutEP3CCt7Mtv9wPhFJDdzS9gPl4kFOfjnl=s1538" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="474" data-original-width="1538" height="200" src="https://blogger.googleusercontent.com/img/a/AVvXsEhBvhbuNgMm7E1_o3zFAizuT6kIFmW00z8OPvBTB9YnnQrEU93iPbmfbmEBYdwX_wpgQlYeCCl4uZvpoE3ITWafOhXRO_osUF7iqnZnEQm69tBESL7LPHV6dbSbY_j3HFJNdLwTzjCZtPaHnp0IHOnnCoutEP3CCt7Mtv9wPhFJDdzS9gPl4kFOfjnl=w640-h200" width="640" /></a></div><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_632" o:spid="_x0000_i1031" style="height: 140pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image004.jpg"></v:imagedata></v:shape><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">True, case numbers can be inflated by high testing rates, but Denmark does only twice as many tests as Italy, and finds 7 times as many cases. Deaths, too, are inflated by Denmark’s <a href="https://en.ssi.dk/news/news/2022/mortality-is-declining-in-denmark">peculiar definition</a> (which it may soon scrap): any death within 30 days of a positive swab is attributed to COVID-19 even if it’s in a car crash. But the death rate is on its way up rather than – as elsewhere in Europe – sharply down. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Guidelines…<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_606" o:spid="_x0000_i1030" style="height: 193pt; visibility: visible; width: 296pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image005.jpg"></v:imagedata></v:shape><o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhsMgSLnyUVEitIxCz6TorZJRWLamBgS6QYzF4ZegDrFLzA3p3VvBhdzcF6bmbGbDg9xzyeqYXjUVrB-ZL0dJzmfBHkoh8Ffcd86ve4M-Vi6hVfoUF6oBcfe8RojzTI57Dv4jnKkwV3dfGu0w2pnG8ov-g8aYs84gRF7qWTENcfyidh3-mDtUS2BP8U=s320" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="227" data-original-width="320" height="284" src="https://blogger.googleusercontent.com/img/a/AVvXsEhsMgSLnyUVEitIxCz6TorZJRWLamBgS6QYzF4ZegDrFLzA3p3VvBhdzcF6bmbGbDg9xzyeqYXjUVrB-ZL0dJzmfBHkoh8Ffcd86ve4M-Vi6hVfoUF6oBcfe8RojzTI57Dv4jnKkwV3dfGu0w2pnG8ov-g8aYs84gRF7qWTENcfyidh3-mDtUS2BP8U=w400-h284" width="400" /></a></div><p class="1obc" style="font-size: medium; text-align: center;"><br /></p><p class="1obc" style="font-size: medium;">Exactly how confusing are US guidelines? Now we know. <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2788656?">Researchers presented</a> 338 well-educated American adults with several hypothetical testing scenarios and randomized them to receive either: 1) official FDA-authorized instructions for how to act on the results, 2) experimental instructions designed by the researchers, or 3) no instructions at all. Those who received the authorized instructions were the <i>least</i> likely to behave according to CDC guidelines, which in any case the researchers found inconsistent and hard to follow. Even the best policies won’t have any impact unless the target audience understands them; communicators must carefully design and test messages whenever stakes are high.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">As for how off-base those CDC guidelines are, take the one allowing COVID-19 patients to be <a href="https://www.cdc.gov/media/releases/2021/s1227-isolation-quarantine-guidance.html">out and about</a> after 5 days. <a href="https://www.medrxiv.org/content/10.1101/2022.02.01.22269931v1">It turns out</a> that more than 40% of vaccinated health care workers who feel enough to work after breakthrough infections still have positive antigen tests after day 5.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Italian tidbits<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_636" o:spid="_x0000_i1029" style="height: 255pt; visibility: visible; width: 453pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image006.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEji4ErsST7FRRXS7YaxRp2MaVc7xvVuXUxhjJuratPJiIdKEdbNJN0McBkNhQatPo4352UGftQX9_eI_-ye2BwtNzIJPPfHxP3fj-Y81LlklIV-f5dx7d2-MHe3nvVFyCPSxX4Oznouqm1C00whbyCeUPjgB0USlNsgUEh_Ajx9Wd0BIYAVGyb4aK1n=s1320" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="742" data-original-width="1320" height="225" src="https://blogger.googleusercontent.com/img/a/AVvXsEji4ErsST7FRRXS7YaxRp2MaVc7xvVuXUxhjJuratPJiIdKEdbNJN0McBkNhQatPo4352UGftQX9_eI_-ye2BwtNzIJPPfHxP3fj-Y81LlklIV-f5dx7d2-MHe3nvVFyCPSxX4Oznouqm1C00whbyCeUPjgB0USlNsgUEh_Ajx9Wd0BIYAVGyb4aK1n=w400-h225" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Pharmacy rapid-test tent</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">We expats were charmed to see the Washington Post run an <a href="https://www.washingtonpost.com/world/2021/12/31/covid-testing-pharmacies/?fbclid=IwAR0KTZJBfwoad4wIoNcn8x5OwruI8ymlpbIgDpobFGOs31pgc2H_QQyFtgM">article</a> about the rapid testing tents that have sprouted outside Italian pharmacies. But the journalists fail to mention that much of what they describe is illegal – all those people “coughing, sniffling…” Sidewalk tents and private laboratories can screen people who feel fine, but are strictly forbidden to test anyone with possible COVID-19 symptoms. Symptomatic people must either get tested on the public system or have a private lab make an expensive house call. Yes, the nurses taking swabs at those pharmacy tents often neglect to ask, and patients often lie, but it would have been nice if the journalists had done their homework.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Only 7% of the Italian population over age 12 are unvaccinated, but they accounted for <a href="https://tg24.sky.it/cronaca/2022/01/11/covid-non-vaccinati-terapia-intensiva-ricoveri">56% of ICU patients</a> at last call.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b><v:shape id="Picture_x0020_585" o:spid="_x0000_i1028" style="height: 166pt; visibility: visible; width: 315pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image007.png"></v:imagedata></v:shape></b><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Several Italian intellectuals, featuring philosopher Massimo Cacciari, have <a href="https://www.fanpage.it/politica/cacciari-agamben-freccero-e-mattei-ora-nasce-anche-la-commissione-dubbio-e-precauzione/">constituted</a> “The Dupre Commission.” The group started out gently, as befits a bunch of eggheads, saying they’re not no-vaxers but different-vaxers: the mRNA vaccines lose effectiveness so fast that Italy should switch to the one from Sinovac, which “Has a lower initial efficacy but lasts longer.” False! Chinese researchers found that 6 months after a second dose of Sinovac neutralizing antibodies were <a href="https://www.medrxiv.org/content/10.1101/2021.07.23.21261026v1.full.pdf">practically gone</a>, and only 20% of vaccinees still had <i>any</i> kind of antibodies. Contrast with Pfizer, which after six months is still at least 50% protective, the highest level Sinovac <i>ever</i> <a href="http://www.sinovac.com/?optionid=754&auto_id=922">attains</a>. After softening us up, the Dupre bunch moved on to minimizing vaccines’ benefits, exaggerating their risks, disparaging Green Passes, and finally arriving at <a href="https://www.liberoquotidiano.it/news/personaggi/29727171/giulio-agamben-filosofo-cacciari-ora-passare-azione-no-vax.html">true nutcase stuff</a>: the pandemic was pre-planned by Big Pharma, vaccines will only make it worse, etc., etc.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Mystery: a month ago Italy was running as many COVID-19 deaths per capita as the United States (now they’re doing somewhat better) despite more Italians being vaccinated, <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Metric=Vaccine+booster+doses&Interval=Weekly&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~USA">twice as many</a> boosted, strong vaccine passports, a slimmer and healthier population, and universal indoor masking. <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Metric=ICU+patients&Interval=Weekly&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~USA">Fewer than half</a> as many Italian patients per capita were in ICUs, but they were much more likely to die. In Germany there are <i><a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Metric=ICU+patients&Interval=Weekly&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~DEU">more<span style="font-style: normal;"> ICU patients</span></a></i> but far <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=Weekly&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~DEU"><i>fewer</i> deaths</a>. Here are a few hypotheses for why (Italian experts <a href="https://tg24.sky.it/salute-e-benessere/2022/02/03/covid-rasi-verso-normalita-morti">share my suspicions</a>):<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .75in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.75in; mso-list: l23 level1 lfo31; text-indent: -0.25in;"><!--[if !supportLists]-->1)<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Twice as many Americans per capita <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Metric=Confirmed+cases&Interval=Cumulative&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~USA">had had COVID-19</a> in the previous year. <o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .75in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.75in; mso-list: l23 level1 lfo31; text-indent: -0.25in;"><!--[if !supportLists]-->2)<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->In late January more Italian cases were due to the <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Metric=Delta+variant+%28share%29&Interval=Weekly&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~DEU~USA">deadlier Delta variant</a> (7.6% vs. 1.4% in the US as of January 24<sup>th</sup>). But that proportion was still higher in Germany (11.6%), where they’re doing fine.<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .75in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.75in; mso-list: l23 level1 lfo31; text-indent: -0.25in;"><!--[if !supportLists]-->3)<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->23% of Italians vs. 16% of Americans are over 65, and age is the biggest risk factor for severity. But, again, look at Germany, where 22% are elderly… <o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .75in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.75in; mso-list: l23 level1 lfo31; text-indent: -0.25in;"><!--[if !supportLists]-->4)<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Then there’s those <a href="https://eu.usatoday.com/in-depth/news/nation/2021/12/22/covid-deaths-obscured-inaccurate-death-certificates/8899157002/">red zones in the US</a> where families insist COVID-19 be left off death certificates, and coroners play along.<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .75in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.75in; mso-list: l23 level1 lfo31; text-indent: -0.25in;"><!--[if !supportLists]-->5)<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Non-COVID-19 patients can spend days parked in Italian ERs, risking <a href="https://www.rainews.it/tgr/toscana/articoli/2021/12/tos-livorno-contagio-covid-focolaio-ospedali-riuniti-positivi-pronto-soccorso-indagine-asl-toscana-sud-ovest-e9a1306e-cc48-485c-a1be-778ad3e54b23.html">catching the virus</a>. But even in the US, <a href="https://www.beckershospitalreview.com/public-health/record-number-of-patients-caught-covid-19-in-hospital-last-month.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=8153B8946823F6C">more than 2%</a> of non-COVID-19 patients get infected with SARS-CoV-2 during their hospitalization.<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .75in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.75in; mso-list: l23 level1 lfo31; text-indent: -0.25in;"><!--[if !supportLists]-->6)<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Patients can <a href="https://www.fanpage.it/attualita/quattro-pazienti-covid-morti-al-pronto-soccorso-di-oristano-lasl-apre-uninchiesta/">die</a> in Emergency Rooms waiting for an ICU bed.<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .75in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.75in; mso-list: l23 level1 lfo31; text-indent: -0.25in;"><!--[if !supportLists]-->7)<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Italian ICUs are not always world-class, in my experience.<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .75in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.75in; mso-list: l23 level1 lfo31; text-indent: -0.25in;"><!--[if !supportLists]-->8)<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Some Emergency Room staff are <a href="https://www.ansa.it/sicilia/notizie/sanita_sicilia/2022/01/24/covid-direttore-pronto-soccorso-troppi-anziani-non-vaccinati_c98e73f8-29e9-4e64-a64d-398f5ae4453a.html">triaging</a> selected fragile patients straight to nursing homes, where they’re more likely to die.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><span lang="EN"> </span></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Hospitalized with, hospitalized for?<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_637" o:spid="_x0000_i1027" style="height: 340pt; visibility: visible; width: 454pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image008.jpg"></v:imagedata></v:shape><o:p></o:p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhG8ugwJ1sKmISNjxFGeWCLYNj3wsl1UTjCguXBrtsb8ZX4GlV6-2XLqZTiE-CZd9XvQitJheRJL-AbDhPNaiV-vvbhxfoA85eibgO3VWJEdUSpxoi4siwgm193q5x9rs5vHgyBM3B7pt-KOQbaPgs0_-qzOMBv578aW5kXkRnDJJ5NLTsPmRZf9qLo=s1600" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1200" data-original-width="1600" height="240" src="https://blogger.googleusercontent.com/img/a/AVvXsEhG8ugwJ1sKmISNjxFGeWCLYNj3wsl1UTjCguXBrtsb8ZX4GlV6-2XLqZTiE-CZd9XvQitJheRJL-AbDhPNaiV-vvbhxfoA85eibgO3VWJEdUSpxoi4siwgm193q5x9rs5vHgyBM3B7pt-KOQbaPgs0_-qzOMBv578aW5kXkRnDJJ5NLTsPmRZf9qLo=s320" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">An Italian COVID-19 ward</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">There’s a raging debate everywhere over how many SARS-CoV-2-positive inpatients should be counted as COVID-19 hospitalizations. See this excellent <a href="https://www.washingtonpost.com/outlook/2022/01/07/hospitalization-covid-statistics-incidental/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F35b6aef%2F61dac0469d2fda14d7e66875%2F599d6acbae7e8a3d46e1400f%2F30%2F57%2F61dac0469d2fda14d7e66875">Washington Post article</a>, where 3 California clinicians describe their personal experiences. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">People who come to Italian hospitals for other reasons but test positive in the ER are counted as cases and sent to COVID-19 wards, but – as in <a href="https://www.beckershospitalreview.com/public-health/where-people-go-wrong-with-incidental-covid-19-hospitalizations.html?origin=BHRSUN&utm_source=BHRSUN&utm_medium=email&utm_content=newsletter&oly_enc_id=8153B8946823F6C">some US states</a> – they are no longer counted as “COVID-19 hospitalizations” unless their condition deteriorates while they’re in the hospital. Assuming their hospital course will be adequately monitored…<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">ICU occupancy may be artificially high if a patient with, say, a heart attack tests positive incidentally. But most infected individuals do eventually develop symptoms, and those sick enough to be in the ICU for sepsis, strokes, etc. are at <a href="https://www.aamc.org/news-insights/how-are-covid-19-deaths-counted-it-s-complicated">extremely high risk</a> of COVID-19 complications or death.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">…Death, though, is a very reliable parameter. <a href="https://www.iss.it/it/web/guest/-/come-si-calcola-la-mortalita-associata-al-covid-19">Italian authorities</a>, for example, list 4 clear and sensible criteria for listing COVID-19 on a death certificate:<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l30 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->A positive PCR swab for SARS-CoV-2<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l30 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->A clinical picture compatible with COVID-19<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l30 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Absence of any other obvious cause of death<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l30 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->No period of remission between illness and death<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Variant watch<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_615" o:spid="_x0000_i1026" style="height: 305pt; visibility: visible; width: 214pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image009.jpg"></v:imagedata></v:shape><b><o:p></o:p></b></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhKip-01ufyt8ob0wqFLJi23yhlk0DAlyJQpEHvwT9_iKPG6D9R3jSKPAZ7P3G8AT654ajADAwOye6Q7CsTFrqVE0fOzx64GzYsq0gkEpm_1saZYYjqwF5oIpwOcXx5v58clL8nR7Ye6MWHEZR5P1gklw5NCs3nua6NN78DD_OC37jZNRwCQmBCZFXt=s1330" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1330" data-original-width="933" height="640" src="https://blogger.googleusercontent.com/img/a/AVvXsEhKip-01ufyt8ob0wqFLJi23yhlk0DAlyJQpEHvwT9_iKPG6D9R3jSKPAZ7P3G8AT654ajADAwOye6Q7CsTFrqVE0fOzx64GzYsq0gkEpm_1saZYYjqwF5oIpwOcXx5v58clL8nR7Ye6MWHEZR5P1gklw5NCs3nua6NN78DD_OC37jZNRwCQmBCZFXt=w450-h640" width="450" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="https://twitter.com/toshiakima/status/1493954047359201282?s=11" target="_blank">Tweeted</a> by Dr. Satoshi Akima</td></tr></tbody></table><br /><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Deltacron</u>: As suspected, it <a href="https://www.nature.com/articles/d41586-022-00149-9">doesn’t exist</a>.</p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>BA.2</u>: This Omicron subvariant is <a href="https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---15-february-2022">now dominant</a> in Denmark, South Africa, and several Asian countries. It’s harder to detect and may be a <a href="https://www.cnbc.com/2022/01/31/the-new-omicron-subvariant-is-more-contagious-but-vaccinated-people-are-less-likely-to-spread-it-study-finds.html">bit more transmissible</a>, though perhaps only from unvaccinated patients. It unfortunately <a href="https://www.biorxiv.org/content/10.1101/2022.02.07.479306v1.full.pdf">resists</a>the anti-Omicron monoclonal antibody sotrovimab, though it remains susceptible to Lilly’s bebtelovimab (Evusheld wasn’t tested). We have no real-world evidence it causes worse illness, better evades vaccines, or reinfects Omicron survivors. Overall it looks more like Alpha than like Delta or Omicron, so even if it does take over the world it may not cause much damage. If the <a href="https://www.livemint.com/science/health/are-we-looking-at-another-omicron-surge-who-on-severity-transmissibility-of-covid-subvariant-ba2-11645089028705.html">WHO isn’t yet worrying</a>, neither am I. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Cloaca minima</u>: People have described “<a href="https://www.nytimes.com/2022/02/03/health/coronavirus-wastewater-new-york.html?campaign_id=2&emc=edit_th_20220204&instance_id=52095&nl=todaysheadlines&regi_id=19728476&segment_id=81604&user_id=d89c7002526915cc9287fae06e27a284">Cryptic lineages</a>” in New York City <a href="https://www.nature.com/articles/s41467-022-28246-3">wastewater</a> never yet found in human beings.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Omicron</u>: Is it really milder? Yup. <a href="https://jamanetwork.com/journals/jama/fullarticle/2789408?">Canadian researchers</a> matched 9087 Omicron patients one-to-one with 9087 Delta patients on sex, age, vaccination status, time since most recent vaccine dose, and onset date; Omicron patients turned out to be 43% less likely to need hospitalization, 81% less likely to wind up in an ICU, and 88% less likely to die. Guess that settles it.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Unfunny hah-hah<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><v:shape id="Picture_x0020_629" o:spid="_x0000_i1025" style="height: 209pt; visibility: visible; width: 200pt;" type="#_x0000_t75"><v:imagedata o:title="" src="file:////Users/susanlevenstein/Library/Group%20Containers/UBF8T346G9.Office/TemporaryItems/msohtmlclip/clip_image010.jpg"></v:imagedata></v:shape><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhUXhvH--fZqzQkiklmOAx2R0a-938S7Rgi3gfU-SKuh_FhdLKbEzFF0_CermXZieZbUvRhg9phgh1nefEHmoci0DA0q0sRcpUyyJgKZc_-eUpVVD212yOW0xgXyiKBm1Mk37cO-EyZbipBvAEDJ5VQcAyBByGTtqmG9WmvReqvZG1tn3q4d0Ex_IUy=s1148" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1148" data-original-width="1098" height="320" src="https://blogger.googleusercontent.com/img/a/AVvXsEhUXhvH--fZqzQkiklmOAx2R0a-938S7Rgi3gfU-SKuh_FhdLKbEzFF0_CermXZieZbUvRhg9phgh1nefEHmoci0DA0q0sRcpUyyJgKZc_-eUpVVD212yOW0xgXyiKBm1Mk37cO-EyZbipBvAEDJ5VQcAyBByGTtqmG9WmvReqvZG1tn3q4d0Ex_IUy=s320" width="306" /></a></div><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">A Washington State bar <a href="https://www.thenewstribune.com/news/coronavirus/article257863643.html">advertised an event</a> on Facebook specifically aimed at spreading COVID-19: “Come see the show, maybe catch the virus, or just stay home and whine. Tickets 10 bucks or 6 with proof of omicron positive test.” <a href="https://www.businessinsider.com/staff-and-bands-quit-bar-that-promoted-catch-covid-event-2022-2?r=US&IR=T">Four staff quit</a>, 3 bands cancelled their engagements, and attempts to pass the post off as a joke <a href="https://www.facebook.com/atrocitygirl/photos/a.573007443517328/1144870009664399/">fell flat</a>.<o:p></o:p></p>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com4tag:blogger.com,1999:blog-6211405954943098401.post-72863172031403844532022-02-01T15:00:00.000+01:002022-02-01T15:00:28.029+01:00The New Normal?<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhZ5gzO9oR1y75fGA4p7cKIxAzBGO1s3WRqF40OTfBtuN-uX6XhvgzzJ1lHZgHDScbEt_HBuGpCv3HTm3zMrxYzOvYAhYprpZJutdvR6epqzDwSogba-QxCNXkEZ17FKTr6STfGdEbpWm-xW5rxQD2znruR4bZ3iGUabfQb4q0cet-BOyhSu1F5vblD=s1570" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1570" data-original-width="1272" height="400" src="https://blogger.googleusercontent.com/img/a/AVvXsEhZ5gzO9oR1y75fGA4p7cKIxAzBGO1s3WRqF40OTfBtuN-uX6XhvgzzJ1lHZgHDScbEt_HBuGpCv3HTm3zMrxYzOvYAhYprpZJutdvR6epqzDwSogba-QxCNXkEZ17FKTr6STfGdEbpWm-xW5rxQD2znruR4bZ3iGUabfQb4q0cet-BOyhSu1F5vblD=w325-h400" width="325" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">A <a href="https://www.nationalgeographic.com/science/article/worlds-brightest-x-rays-reveal-covid-19-damage-to-the-body" target="_blank">COVID-19 patient's lung</a>, scanned using Hierarchical Phase-Contrast Tomography</td></tr></tbody></table><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"></td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt;">Should high schools cancel wrestling? Does Sputnik beat Pfizer? What’s the best antigen test? Is the pandemic over? Is health care a right or a privilege? My take on all that, plus mandate madness, Omicron updates, and treatment and vaccine news.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Treatment and prevention news<o:p></o:p></b></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhAwS4ywAtr4nB9opIxd6eSwiaJqGnNjpg9h7ZwVhCaBKA2MVhXxuDQk-gR3qdiHStGx5WSZG6lNtvf3smCMIc5_S8qHzbhFB5u4l-BqrEjcJ9RL9Lm-7X5iT0e4t5aBF_hDpdEl0V5c-W8aQv-w3j1RWCbe560pRAi6NZHtwXqfuHWLL7xeFrHUF1Z=s1488" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="991" data-original-width="1488" height="266" src="https://blogger.googleusercontent.com/img/a/AVvXsEhAwS4ywAtr4nB9opIxd6eSwiaJqGnNjpg9h7ZwVhCaBKA2MVhXxuDQk-gR3qdiHStGx5WSZG6lNtvf3smCMIc5_S8qHzbhFB5u4l-BqrEjcJ9RL9Lm-7X5iT0e4t5aBF_hDpdEl0V5c-W8aQv-w3j1RWCbe560pRAi6NZHtwXqfuHWLL7xeFrHUF1Z=w400-h266" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Band rehearsal at Wenatchee High, Washington State</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Antivirals</u>: It seemed likely that, unlike monoclonal antibodies, antiviral drugs such as remdesivir, molnupiravir, and Paxlovid would work fine against Omicron. Now we have a little <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2119407">supportive evidence</a>. Reassuring, even if it’s only in the test tube, not in patients.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Immunoglobulin</u>: After convalescent plasma and monoclonal antibodies a third type of immune therapy <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00101-5/fulltext">has now been tested</a> in a proper trial on 579 patients hospitalized with wild-strain COVID-19: hyperimmune intravenous immunoglobulin containing a broad array of antibodies from the pooled blood of multiple recovered donors. Clever idea, too bad the treatment bombed.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Natural immunity</u>: The CDC has <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/vaccine-induced-immunity.html#anchor_1635540449320">nicely summarized</a> what we know about immunity following infection versus immunity following vaccination: <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7044e1.htm">Americans</a> who had COVID-19 3-6 months earlier were 5.5 times more likely to get hospitalized for COVID-19 than people who were fully vaccinated with Pfizer or Moderna 3-6 months earlier. And the superiority of vaccines was even greater during the Delta wave. One <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19infectionsurveytechnicalarticleimpactofvaccinationontestingpositiveintheuk/october2021">UK government study</a> reported previous infection (timing not specified) to be as good as vaccination for preventing Delta, but not Omicron; other <a href="https://www.imperial.ac.uk/media/imperial-college/medicine/mrc-gida/2021-12-16-COVID19-Report-49.pdf">UK data</a>indicate that the protection from Omicron from having had previous COVID-19 may be as low as 19%. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Brown’s Dr. Ashish Jha <a href="https://twitter.com/ashishkjha/status/1487868684412628996?s=11">tweeted</a>: “You all know the data demonstrating dramatically higher hospitalization rates for unvaccinated folks But one key point often not discussed? Around 60%-70% of unvaccinated adults have already been previously infected Which tells us a lot about infection-induced immunity.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Ivermectin</u>: Inmates of the Washington County Detention Center in Arkansas are <a href="https://www.nytimes.com/2022/01/17/us/ivermectin-covid-arkansas-jail.html?campaign_id=2&emc=edit_th_20220118&instance_id=50587&nl=todaysheadlines&regi_id=19728476&segment_id=79987&user_id=d89c7002526915cc9287fae06e27a284">suing the prison</a> and its doctor for lying when they were sick with COVID-19, hiding the fact that the treatment they were getting was high-dose ivermectin.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Paxlovid</u>: Its chief ingredient now has a name: nirmatrelvir. Israel, the first country to try introducing it widely, has encountered substantial <a href="https://www.haaretz.com/israel-news/in-israel-pfizer-s-covid-drug-paxlovid-faces-critical-obstacle-1.10548212">logistical problems</a>, but the drug is working as promised for the few patients who’ve received it – 75% improve, mostly within 24 hours. Since many of the high-risk patients who are Paxlovid’s intended target are taking incompatible medications for chronic medical problems (see <a href="https://www.covid19treatmentguidelines.nih.gov/therapies/statement-on-paxlovid-drug-drug-interactions/">this list</a>), complicating its use.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Cancel band?</u> The latest <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/k-12-guidance.html">CDC guidelines</a> says schools in high-transmission areas – meaning virtualy everywhere – should cancel after-school activities including band, choir, football, and wrestling… They’ve gotten a lot of <a href="https://edition.cnn.com/2022/01/17/health/cdc-guidance-out-of-touch/index.html?utm_campaign=KHN%3A%20Daily%20Health%20Policy%20Report&utm_medium=email&_hsmi=201174519&_hsenc=p2ANqtz-_z-QVAclP5gMhqIFP0jWqtoUuxf-6sqsrXUGD7AefeyqKBp63ZgZL0bDJX6_fmKVrs94KXg_QCNOo758uiO1XDdYy73g&utm_content=201174519&utm_source=hs_email">flak</a> for this, but for once I happen to agree. Kids shouldn’t be wrestling, singing collectively, or spewing viruses out their band instruments, at least not indoors, unless Wenatchee High’s band pods catch on big. About football, I’m agnostic. As with other outdoor team sports, the problem may be less what happens on the field than what happens in the locker rooms.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Return to the world?</u> A <a href="https://www.ijidonline.com/article/S1201-9712(21)01206-6/fulltext">British study</a> using stored samples from the early phases of the pandemic has suggested that a few people with mild-moderate disease may remain infectious beyond the canonical 10 days. Their criterion for infectivity is less than sure-fire, and the study is extremely small, so I take this one with a grain of salt and continue to tell patients they can leave self-isolation after 10 days.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Vaccine news<o:p></o:p></b></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgpTpbm7mF2zypnScHOm5lprXdlQoEKfT8axxFxUcU0smox7UzwsmcMt8BJ9yaKpJu7VfRh39IhwWDPD7hOzDkSd9Gpl7f-NDOYXPoBGBkm8lWJ22HlFvOhZpSGEsZXEYqpPGsifD_4ai65zxvAHl1-kUQbYV-AEQJNY3i-0DmYBFr0iHZewRl2l52l=s1562" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="634" data-original-width="1562" height="262" src="https://blogger.googleusercontent.com/img/a/AVvXsEgpTpbm7mF2zypnScHOm5lprXdlQoEKfT8axxFxUcU0smox7UzwsmcMt8BJ9yaKpJu7VfRh39IhwWDPD7hOzDkSd9Gpl7f-NDOYXPoBGBkm8lWJ22HlFvOhZpSGEsZXEYqpPGsifD_4ai65zxvAHl1-kUQbYV-AEQJNY3i-0DmYBFr0iHZewRl2l52l=w640-h262" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">The Spallanzani Infectious Disease Hospital in Rome, vials of Sputnik V</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Johnson & Johnson</u>: In <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2116747?query=TOC">a study</a> among 461 healthcare workers who had received a single dose of the J&J vaccine, booster doses of <i>any</i> vaccine raised spike protein antibodies well, and neutralizing antibodies less well. Moderna did the best as usual, followed by Pfizer, with J&J itself being the worst. But since antibodies were measured only 4 weeks after the additional dose, this study cannot answer the crucial question, which is how long those antibodies – and the presumed real-life protection – will last. We already know that effectiveness <a href="https://deliverypdf.ssrn.com/delivery.php?ID=479004100026075009089021123124127090024069085080028027023053103048040115124127079117099075120069089123028035050082103111009019022127122054101023031075126105092023006043089018023060024115087125034020023110005040037002121100115112006020021122125101086090080025087113107001023075026101083005115&EXT=pdf&INDEX=TRUE">fades faster</a> for primary J&J vaccination than for either of the mRNA vaccines, so I suspect mRNA boosters will hold up longer as well. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Omicron</u>: After UK studies suggested triple-vaxed adults protected 76% against symptomatic Omicron, <a href="https://jamanetwork.com/journals/jama/fullarticle/2788485">US researchers</a> have come up with a quite similar 66%. Alas, that protection <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1050236/technical-briefing-34-14-january-2022.pdf">fell to about 50%</a> by 10 weeks after the booster, though protection against hospitalization remained a decent 83%. Interestingly, in a <a href="https://www.medrxiv.org/content/10.1101/2021.12.02.21267198v2.full.pdf">small American study</a> of Pfizer vaccinees, a Johnson & Johnson booster induced more and longer-lasting neutralizing antibodies to Omicron than did a third Pfizer shot. Unfortunately Moderna wasn’t tested. The value of a vaccine tailored to Omicron is <a href="https://www.nature.com/articles/d41586-022-00199-z">still under debate</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Moderna rules</u>: In <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2117933?query=TOC">Qatar</a> Moderna shone once again, doing >30% better than Pfizer over a period of 6 months.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Waning efficacy</u>: The numbers are pretty consistent. According to a <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2115481?query=TOC">British study</a> 5 months after the second dose, Pfizer protected only 66% against symptomatic Delta, AstraZeneca by 44%, though both vaccines still worked against severe disease. Effectiveness was even lower in the elderly or chronically ill. A <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2119432?query=TOC">Qatari study</a> found effectiveness against all Beta and Delta variant COVID-19 to fall over 7 months from 90% to just under 50%, while remaining over 90% against more severe outcomes.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Sputnik V</u>: Is Sputnik, not Moderna, <a href="https://healthpolicy-watch.news/93195-2/">the cat’s pyjamas</a>? According to the Russians, yes. First they said <a href="https://www.medrxiv.org/content/10.1101/2021.08.22.21262186v2.full.pdf">neutralizing antibodies</a> against pre-Omicron variants persist after 4 months (true for mRNA vaccines as well). Then they <a href="https://healthpolicy-watch.news/russia-sputnik-v-vaccine-effective-mrna/">claimed</a>(by press release) that Sputnik remained 80% effective in San Marino after 7 months when Pfizer’s protection fades more (the Russians claim it falls to 23%, misreading a <a href="https://deliverypdf.ssrn.com/delivery.php?ID=767068083087006022018102091072000103054050034080045061126006093094001095113120093124011002034032054015113002115115071074071114107041047029074101005084064101099029104051055083096084007015113109088013087117075109009030097104021093080103028066068081122102&EXT=pdf&INDEX=TRUE">Swedish study</a>. Now they’re saying that a <a href="https://rdif.ru/Eng_fullNews/7282/">laboratory study</a> from Rome’s Spallanzani Hospital predicts their vaccine will be better against Omicron than Pfizer, inducing twice the number of neutralizing antibodies, and suggest Sputnik be used as a booster after mRNA vaccines. Hmmm… First, this study had <a href="https://cattiviscienziati.com/2022/01/24/sputnik-v-new-pre-print-new-concerns/">serious methodological weaknesses</a>, especially a longer time period after Pfizer vaccination than after Sputnik and lack of adjustment for age and comorbidities. Second, mixing-and-matching experience has been with <a href="https://www.who.int/publications/i/item/WHO-2019-nCoV-vaccines-SAGE-recommendation-heterologous-schedules">mRNA boosters</a> after viral vector vaccines, not vice-versa. Third, I continue to harbor doubts about Sputnik’s original efficacy study, whose authors still refuse to provide raw data. Finally, there are sticky quality control issues in Gamaleya’s factories – the WHO is <a href="https://tass.com/society/1390437">dispatching yet another team</a> to check them out.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Adolescents</u>: A <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2117995">case-control study</a> using the Pfizer vaccine shows it reduced hospitalizations by 94% and ICU admissions by 98% in 12-18-year-olds.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Kids</u>: Pfizer has had <a href="applewebdata://CD0A7338-221B-46B0-80A5-F73D6D8EBCF0/its%20trial%20of%20an%20ultra-low-dose%20vaccine%20(3%20%C2%B5g)">a setback</a> in its trial of an ultra-low-dose vaccine (3 µg) for kids under 5: so many toddlers failed to develop a proper antibody response after 2 doses that they are going to try an extra dose. Pfizer <a href="https://www.washingtonpost.com/health/2022/01/31/coronavirus-vaccine-children-under-5/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F35ea400%2F61f912cb9d2fda14d716e4d5%2F599d6acbae7e8a3d46e1400f%2F8%2F73%2F61f912cb9d2fda14d716e4d5">somehow thinks</a> it can get Emergency Use Authorization even before the preliminary 3-dose results arrive in March. <a href="https://investors.modernatx.com/Statements--Perspectives/Statements--Perspectives-Details/2022/Statement-on-COVID-19-Vaccine-Clinical-Studies-in-Children--Adolescents/default.aspx">Moderna</a> is not expecting to see any results from its own kiddie trial until March.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Boosteritis</u>: The Israeli decision to go forward with a 4<sup>th</sup> dose without testing it first seems to have been an error – <a href="https://abcnews.go.com/Health/wireStory/israel-study-4th-vaccine-shows-limited-results-omicron-82312196">preliminary results</a> say that neither Pfizer nor Moderna gave any additional protection to at-risk healthcare workers. Probably the 500,000 4<sup>th</sup> doses that have already gone to elderly Israelis would have better been donated to COVAX. Giving dose after dose of the same mRNA vaccine just doesn’t seem to do the trick.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Incidentally, the World Health Organization seems, at a press conference, to have <a href="https://healthpolicy-watch.news/93223-2/">dropped its ethical objections</a> to vaccine booster campaigns, saying there now are enough doses to cover vulnerable populations in poor countries. Should we read anything into the fact that Tedros Adhahom Ghebreyesus, Mike Ryan, and Soumya Swaminathan, its most prominent officials, were all absent from that particular press conference?<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Next generation</u>: Pfizer and BioNTech have <a href="https://www.statnews.com/2022/01/25/pfizer-biontech-begin-trial-omicron-based-vaccine/?utm_campaign=rss">begun Phase 1-2 trials</a> of a vaccine aimed at the Omicron variant, with Moderna <a href="https://edition.cnn.com/2022/01/26/health/moderna-omicron-antibodies-booster/index.html">not far behind</a>. And the same NIAID group that made a plea for universal vaccines <a href="https://www.nejm.org/doi/pdf/10.1056/NEJMp2118468">last month</a> has already published <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2118468?query=TOC">another one</a>. Once again they set out in detail what they want out of such a vaccine, and once again they say little about how to achieve it.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Testing news<o:p></o:p></b></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhLSwk2VwFRl4BCMBWZeJj0mcIETmh5CGCZl-0AqF-sDbhbSos4TtU9eFUz3xRJl9y9-VBrTRAWLPwqlzS-rc-bF2GWa3FbszqXACRCCNytgPNxoEDvQ5cM8NRu9iaukJ-hFSdCPt8_bMJhZky2FOIfD9rymV1INqtZl8xe0sTi4Y_EFMCv3wtPag3_=s1820" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1024" data-original-width="1820" height="225" src="https://blogger.googleusercontent.com/img/a/AVvXsEhLSwk2VwFRl4BCMBWZeJj0mcIETmh5CGCZl-0AqF-sDbhbSos4TtU9eFUz3xRJl9y9-VBrTRAWLPwqlzS-rc-bF2GWa3FbszqXACRCCNytgPNxoEDvQ5cM8NRu9iaukJ-hFSdCPt8_bMJhZky2FOIfD9rymV1INqtZl8xe0sTi4Y_EFMCv3wtPag3_=w400-h225" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Fresh Air Clip</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Wearables</u>: Researchers at Yale have <a href="https://ysph.yale.edu/news-article/wearable-air-sampler-detects-personal-exposure-to-sars-cov-2/?utm_source=YaleToday&utm_medium=Email&utm_campaign=YT_Yale%20Today%20Alum%20no%20Parents_1-21-2022">come up with</a> a miniature virus detector they call the Fresh Air Clip. It’s not a DYI test, but more like the little gadgets radiologists wear to monitor their radiation exposure over time. You clip it to your clothing, leave it on for several days to accumulate viral particles, then send it to a lab for PCR testing. If SARS-CoV-2 is detected, implying there’s virus in the air you breathe, the protective measures in your environment – a restaurant, say – need to be tightened. The results are even semi-quantitative, not just yes-or-no. It hasn’t hit the market yet, but I’d put this in the category of Very Very Cool.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Thumbs down</u>: The chief message of my last regular post was how poorly rapid tests detect Omicron. The very next morning the full-page headline in the Rome section of Il Messaggero was: “School, false negatives peak,” with subhead “Swabs flop, 20% of children who returned to class Monday learned later they were positive.” Meanwhile, in the US, <a href="https://www.medrxiv.org/content/10.1101/2022.01.08.22268954v3">a study</a> at a professional testing center in San Francisco, which reported that the Abbott BinaxNOW antigen test missed more than a third of PCR-positive infections, is being spun as “<u><a href="https://www.nytimes.com/live/2022/01/11/world/omicron-covid-testing-vaccines#abbott-binaxnow-at-home-covid-test">A popular at-home test detects most infectious Omicron cases</a>.</u>” <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Rapid tests vary</u>: A <a href="https://www.medrxiv.org/content/10.1101/2021.12.18.21268018v2.full.pdf">study by Swiss researchers</a> found huge variability among 7 antigen tests with current or pending WHO approval. In 4 cases the sensitivity was much lower for Omicron than for Delta, and 2 out of the 3 that detected Omicron less than 40% of the time were made by Western pharma giants Abbott and Roche. The best test, made-in-USA Flowflex, detects Omicron as well as it does Delta, and gives only 11% false negatives. I’ve bought a few myself. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Caveat emptor</u>: The home test kits being sent out free of charge to American consumers by the Biden administration are from<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; color: #0a0a0a; font-family: Georgia, serif; font-size: 14.5pt;"> </span><a href="https://www.medtechdive.com/news/biden-administration-buy-500m-more-covid-tests/617183/">Abbott, iHealth, and Roche</a>. IHealth is unfamiliar, but for the other two, oy. Is this a case of you get what you pay for?<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The new normal<o:p></o:p></b></p><div style="text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEib0YM_RI1sneJAPRPqpLX1fpW_9xYmfqfL_QaHL00OgMQWHAvbKQkhSK5Hgp3mOWwgmaZJ6fMyUkrXn_hXq3CEFRj9eujwktfn0oDHB0mNsV3JKMDnp6odstWnMszTHXRE0W9iLNkNRIVU0YJc7qtv8qp4-7jdN-DpNul-yexnqWyEV4fDkcPizGN3=s2560" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1920" data-original-width="2560" height="240" src="https://blogger.googleusercontent.com/img/a/AVvXsEib0YM_RI1sneJAPRPqpLX1fpW_9xYmfqfL_QaHL00OgMQWHAvbKQkhSK5Hgp3mOWwgmaZJ6fMyUkrXn_hXq3CEFRj9eujwktfn0oDHB0mNsV3JKMDnp6odstWnMszTHXRE0W9iLNkNRIVU0YJc7qtv8qp4-7jdN-DpNul-yexnqWyEV4fDkcPizGN3=s320" width="320" /></a></div><span style="font-family: "Times New Roman", serif;"><br /></span></div><p class="1obc" style="font-size: medium; margin-right: 6pt;">Is the pandemic nearly over and the SARS-CoV-2 virus about to become endemic and tame, like its cold-causing cousins? If you believe the modelling guru <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00100-3/fulltext">Chris Murray</a> and <a href="https://abc7ny.com/endemic-when-will-the-covid-pandemic-end-omicron-variant-covid-19/11466588/">some other experts</a>, yes. I too was hopeful in early December: “Omicron may turn out to be not the variant from hell but the variant from heaven.” The WHO Europe director, Hans Kluge, <a href="https://www.france24.com/en/europe/20220123-europe-could-be-headed-towards-end-of-pandemic-after-omicron-says-who">agreed</a> on January 22<sup>nd</sup>: "It's plausible that the region is moving towards a kind of pandemic endgame." But his boss backed him up only in part, <a href="https://healthpolicy-watch.news/we-will-be-living-with-covid-for-foreseeable-future-but-we-can-end-acute-phase-this-year-who-director-general/">saying maybe</a> “Countries can end the acute phase of the pandemic this year,” but calling it “<a href="https://www.reuters.com/business/healthcare-pharmaceuticals/who-chief-says-world-critical-juncture-covid-pandemic-2022-01-24/">dangerous</a>” to assume the endgame is near and emphasizing that “Conditions are ideal for more variants to emerge.” Other <a href="https://www.beckershospitalreview.com/public-health/next-variant-could-be-more-transmissible-than-omicron-who-says.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=8153B8946823F6C">WHO scientists think</a> the next variant is likely to be more transmissible than Omicron, even better at escaping prior immunity, and perhaps more rather than less severe. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">With <a href="https://www.nytimes.com/2022/01/27/health/omicron-covid-pandemic.html?campaign_id=2&emc=edit_th_20220127&instance_id=51399&nl=todaysheadlines&regi_id=19728476&segment_id=80882&user_id=d89c7002526915cc9287fae06e27a284">others</a>, more <a href="https://www.medscape.com/viewarticle/966987?">others</a>, and <a href="https://www.theatlantic.com/health/archive/2022/01/omicron-wave-immunity/621324/">still others</a>, I’m no longer as optimistic as I was. Omicron is only heavenly if we assume that 1) nearly everybody is going to get infected, 2) by far most infections will be mild, 3) even asymptomatic or barely-symptomatic infections will protect forever against present and future variants.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><a href="https://www.science.org/doi/10.1126/sciimmunol.abf3698">A major study</a> did once suggest that asymptomatic or mild infections would bring durable immunity, but that was so early in the pandemic that follow-up was less than 5 months and variants of concern didn’t exist. It’s now thought that mild illness gives briefer immunity – <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2025179">anti-spike antibodies</a> fall by half every month, and neutralizing antibodies <a href="https://www.medrxiv.org/content/10.1101/2021.11.08.21266035v1">disappear entirely</a> over a year. One<a href="https://www.nature.com/articles/s41586-021-03647-4"> interesting report</a> found antibody-producing cells in patients’ bone marrow as long as 11 months after mild COVID-19, prompting some to enthuse: “<a href="https://www.reuters.com/article/factcheck-study-covid19-idUSL1N2T71XL">If You’ve Had COVID You’re Likely PROTECTED FOR LIFE…</a>” But that was all wild-strain COVID-19, and both an <a href="https://www.nature.com/articles/d41586-021-01442-9">editorialist</a> and the paper’s <a href="https://apnews.com/article/fact-checking-558851199032">top author</a> have pointed out that those bone marrow antibodies are unlikely to neutralize variants. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">True, most people with mild infections <a href="https://journals.asm.org/doi/10.1128/Spectrum.00087-21">are largely protected</a> against reinfection for 4-6 months, but that’s not very long, and according to CDC research in <a href="https://wwwnc.cdc.gov/eid/article/27/5/20-4912_article">Brazil</a> and <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7008a3.htm?s_cid=mm7008a3_w">Kentucky</a>, some reinfections occur even earlier. I agree with the reporter who called the idea that Omicron will end the pandemic “<a href="https://www.theglobeandmail.com/amp/opinion/article-its-a-delusion-to-think-mass-spread-of-omicron-will-end-the-pandemic/">a mass delusion</a>.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The only Omicron data relevant to reinfection come from <a href="https://secureservercdn.net/50.62.198.70/1mx.c5c.myftpupload.com/wp-content/uploads/2021/12/MEDRXIV-2021-268439v1-Sigal.pdf">one tiny study</a> saying anti-Delta antibodies rose somewhat in people who had caught Omicron after previously having Delta. And there are already real-world hints that Omicron infections <a href="https://www.prevention.com/health/a38758270/omicron-reinfection-covid-19/">don’t even protect</a> completely against re-infection with Omicron, much less against other variants. <a href="https://www.theatlantic.com/science/archive/2022/01/delta-omicron-showdown/621380/">Delta</a>might even <a href="https://www.science.org/content/article/after-omicron-some-scientists-foresee-period-quiet">make a comeback</a> once the Omicron surge blows over.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Anthony Fauci has commented with his usual <a href="https://www.weforum.org/agenda/2022/01/omicron-end-of-covid-19-anthony-fauci-radio-davos/">caution</a>: “It is an open question as to whether or not Omicron is going to be the live virus vaccination that everyone is hoping for.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Six former scientific advisors to Joe Biden made a <a href="https://www.nytimes.com/live/2022/01/06/world/omicron-covid-vaccine-tests/former-biden-advisers-call-on-the-administration-to-change-its-covid-strategy">huge splash</a> by publishing an alternative playbook in a <a href="https://consumer.healthday.com/members-of-biden-s-transition-team-call-for-new-covid-19-plan-2656247316.html">series of opinion pieces</a> in JAMA, suggesting ways to achieve the new normal and relieve stress on the health system. Most of their recommendations are uncontroversial: free and easy access to face masks, testing, and therapies, and of course universal vaccination. They also remind us of crucial but neglected mitigation measures such as ventilation and air filtering. And they particularly emphasize rebuilding the public health infrastructure: centralized reporting of positive swabs, widespread monitoring of wastewater and air, more viral sequencing, better surveillance of vaccine effects, etc.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>MAGA mandate madness <o:p></o:p></b></p><div style="text-align: center;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEguEnJNrWCSWOuiCtrMxcP-RoHiABIFiGPGczLAQMvQw33kE5pKjtEc-qkyj05TeiGiEeLA9-Xn3Pjx7gtwROMMjHGwzcudgoBtNPHU4Gs_w-PSmdr2gzkKYhzSt65_vtqaXAtvEEMan4zWfrTpuBofSzuADppKD5_Em9E9hBlgTTnsOghwjKt6YTmU=s1666" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="564" data-original-width="1666" height="216" src="https://blogger.googleusercontent.com/img/a/AVvXsEguEnJNrWCSWOuiCtrMxcP-RoHiABIFiGPGczLAQMvQw33kE5pKjtEc-qkyj05TeiGiEeLA9-Xn3Pjx7gtwROMMjHGwzcudgoBtNPHU4Gs_w-PSmdr2gzkKYhzSt65_vtqaXAtvEEMan4zWfrTpuBofSzuADppKD5_Em9E9hBlgTTnsOghwjKt6YTmU=w640-h216" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Meatpacking plants, 1906 and 2016</td></tr></tbody></table><span style="font-family: "Times New Roman", serif;"><br /></span></div><p class="1obc" style="font-size: medium; margin-right: 6pt;">In the United States, attempts to mandate vaccination or for that matter any mitigation measure has met fierce resistance. The US Supreme Court has been to some extent a force for good, letting mandates for health workers stand in <a href="https://www.nytimes.com/2021/12/13/us/politics/supreme-court-vaccine-mandate-new-york-healthcare.html?campaign_id=2&emc=edit_th_20211214&instance_id=47742&nl=todaysheadlines&regi_id=19728476&segment_id=76915&user_id=d89c7002526915cc9287fae06e27a284">New York State</a> and <a href="https://www.nytimes.com/2021/10/29/us/politics/maine-coronavirus-vaccine.html">Maine</a> without a religious exemption. Justices Gorsuch, Alito, and Thomas dissented in the New York case, with Gorsuch penning a personal diatribe saying religious exemptions had to be permitted because the vaccines were tested on cells that may have been derived from abortions. At the risk of sounding like a broken record,<a href="https://www.webmd.com/vaccines/covid-19-vaccine/news/20210918/some-medications-also-tied-to-religious-vaccine-exemption">so were</a> Benadryl, Sudafed, Tylenol, Tums, Preparation H, albuterol, aspirin, ibuprofen, Pepto Bismol, Lipitor, Senokot, Maalox, Ex-Lax, Benadryl, Sudafed, Preparation H, Claritin, Prilosec, Zoloft, Humira, and Regeneron’s <a href="https://www.newsweek.com/fact-check-regeneron-derived-fetal-tissue-1625354">RegenCov</a>. I challenge Justice Gorsuch to find an anti-abortion claimant who has rejected any of those medications on religious grounds.<o:p></o:p></p><p class="1obc" style="font-size: medium;">But that pro-mandate run ended when the battleground moved from the state to the federal realm. The Court did <a href="https://www.nytimes.com/2022/01/07/us/politics/biden-vaccine-mandate-supreme-court.html?campaign_id=2&emc=edit_th_20220108&instance_id=49813&nl=todaysheadlines&regi_id=19728476&segment_id=79071&user_id=d89c7002526915cc9287fae06e27a284">approve</a> a vaccine mandate for healthcare workers in settings (the vast majority) that receive Medicare or Medicaid funding. But when 26 Republican-leaning US states, backed by major <a href="https://www.dailyposter.com/the-corporate-campaign-against-pandemic-protections/">corporate lobbyists</a>, <a href="https://apnews.com/article/coronavirus-pandemic-joe-biden-business-lawsuits-health-a57c936f1e6495a71cc2504a4dbfb813">challenged</a> the Occupational Safety and Health Administration “vaccine mandate” for companies with more than 100 employees, SCOTUS ruled in their favor on technical grounds: “although Congress has indisputably given OSHA the power to regulate occupational dangers, it has not given that agency the power to regulate public health more broadly.” Note that the OSHA regulation was <i>not</i> a vaccine mandate but a <a href="https://www.washingtonpost.com/opinions/2021/11/10/vaccine-requirements-come-with-very-real-political-risks-theyre-still-worth-pursuing/">testing and masking mandate</a>, with exemptions for workers who are vaccinated. This decision <a href="https://www.nytimes.com/2022/01/17/opinion/supreme-court-vaccine-osha.html?campaign_id=2&emc=edit_th_20220118&instance_id=50587&nl=todaysheadlines&regi_id=19728476&segment_id=79987&user_id=d89c7002526915cc9287fae06e27a284">hobbles the functioning</a> of a major government agency that’s attempting to fulfill its mission – <a href="https://www.nytimes.com/2021/10/28/world/meatpacking-workers-covid-cases-deaths.html">nearly 300</a>workers have died from COVID-19 in the meatpacking industry alone. The regulation has been <a href="https://www.osha.gov/coronavirus/ets2">withdrawn</a>, but OSHA hopes to create a permanent Healthcare Standard to protect workers against COVID-19 that can pass SCOTUS scrutiny.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Omicron tidbits – see also overviews from the <a href="https://www.who.int/publications/m/item/enhancing-readiness-for-omicron-(b.1.1.529)-technical-brief-and-priority-actions-for-member-states">WHO</a> and <a href="https://erictopol.substack.com/p/where-do-we-stand-with-omicron">Dr. Eric Topol</a><o:p></o:p></b></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjEUH4c4FAAc9VvjIATKfNS0FOMMNVCyoiW0p9jEaVJMQDWB3CR6eI4xLgMEPefDE_VY9L0Q2Kc43-VFY6qMzhAJZzJHcbxetG8bSJctzdlFXi5NvRJ4lLTf62Vmhh4emyZ5TpSll1Mc6GKgSLLMMIg1zVoRn2eI1XuqjIoMI0E6ZjJ63-HhvhfWfLT=s1668" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="492" data-original-width="1668" height="188" src="https://blogger.googleusercontent.com/img/a/AVvXsEjEUH4c4FAAc9VvjIATKfNS0FOMMNVCyoiW0p9jEaVJMQDWB3CR6eI4xLgMEPefDE_VY9L0Q2Kc43-VFY6qMzhAJZzJHcbxetG8bSJctzdlFXi5NvRJ4lLTf62Vmhh4emyZ5TpSll1Mc6GKgSLLMMIg1zVoRn2eI1XuqjIoMI0E6ZjJ63-HhvhfWfLT=w640-h188" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">"COVID parties" in Italy, USA, UK</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>The Age of Omicron</u>: Italy is finally there, <a href="https://www.toscanamedianews.it/roma-omicron-variante-cancellato-delta-95-covid.htm">at 96%</a> of cases, though some regions still have Delta rates as high as 17%. In the United States, <a href="https://covid.cdc.gov/covid-data-tracker/#variant-proportions">virtually all new cases</a> are Omicron.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Covid parties</u>: <a href="https://www.adnkronos.com/covid-party-con-positivi-e-boom-ce-chi-paga-per-contagiarsi_4SMyfJdlpyxYjBtvzwijZ7?fbclid=IwAR3wq7S20d1Cm_CEUDx_b3JXVhknT7mCSXtXYMwkiFlg0Xqty-YRgGVnZT4">Some Italians</a> deliberately try to contract COVID-19 so they can get a Super Green Pass: “Wanted: COVID-19 positive girl to kiss.” One Tuscan restaurant is <a href="https://www.yahoo.com/news/desperate-no-vaxxers-paying-covid-113042643.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cubWVkc2NhcGUuY29tL3ZpZXdhcnRpY2xlLzk2NjUxMD9zcG9uPTM0JnVhYz00MjM1M0JHJmltcElEPTM5NTU1NTMmc3NvPXRydWUmZmFmPTEmc3JjPVdOTF9tZHBsc18yMjAxMThfbXNjcGVkaXRfZm1lZA&guce_referrer_sig=AQAAAM3RUSNF6KsgfSQ63heLe7qb91-SMte_BG-Ub9k-7uIRO1Zl0zR1tLGyGytxD7-YoCDukIFNw1cIn2qrVN7nM87tuLED9NqJIPn6Bznh6vNEmeAMkH57eog-qFd7sJ0LWO95fuVBF3xsvV3IOWJ4LbNiBOvRN8XbxcUtVeOOXtH5">supposedly offering</a> exposure to the virus alongside your truffles, at a price of €150. Dr. Paul Offit says that’s “<a href="https://edition.cnn.com/2022/01/11/health/deliberate-omicron-infection-wellness/index.html?fbclid=IwAR3eYiPU_GntPTZuvdum4MHZHoBemR3pRQRm33jdylR934Hicjf9Ti6H-c0">all the rage</a>” in the US too. Unfortunately some of those suckers are going to wind up dead, especially since most are likely to be unvaccinated – like the <a href="https://twitter.com/ddiamond/status/1281945527563751424?">30-year-old Texan</a> and the 57-year-old <a href="https://www.nytimes.com/2022/01/20/world/hana-horka-covid-czech-singer.html">Czech folksinger</a> who died after deliberately exposing themselves to the virus. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Transmissibility</u>: Omicron spreads more readily than Delta but it’s <a href="https://www.who.int/publications/m/item/enhancing-readiness-for-omicron-(b.1.1.529)-technical-brief-and-priority-actions-for-member-states">not quite as contagious</a> as it seemed at first, <a href="https://www.who.int/publications/m/item/enhancing-readiness-for-omicron-(b.1.1.529)-technical-brief-and-priority-actions-for-member-states">spreading</a> to only 25%-35% (<a href="https://www.medrxiv.org/content/10.1101/2021.12.27.21268278v1.full.pdf">rarely 50%</a>) more vaccinated household contacts than Delta; unvaccinated contacts catch both variants at equal rates. At first that rapid spread was <a href="https://health.ucdavis.edu/chpr/news/index.html">attributed</a> to a higher viral load, but recent data from <a href="https://www.medrxiv.org/content/10.1101/2022.01.10.22269010v2.full.pdf">Switzerland</a> and <a href="https://www.medrxiv.org/content/10.1101/2022.01.13.22269257v1.full.pdf">the US</a> say that if anything it’s Delta patients who carry more virus in the nose. Omicron’s rapid multiplication in <a href="https://www.med.hku.hk/en/news/press/20211215-omicron-sars-cov-2-infection">bronchial tissue</a> may also not be relevant. The heightened transmissibility is <a href="https://www.who.int/publications/m/item/enhancing-readiness-for-omicron-(b.1.1.529)-technical-brief-and-priority-actions-for-member-states">now thought</a> to be due mostly to <a href="https://www.medrxiv.org/content/10.1101/2021.12.27.21268278v1.full.pdf">immune escape</a>: many more people are vulnerable hosts, no longer well protected by previous COVID-19 or vaccination. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Severity</u>: Portuguese researchers <a href="https://www.medrxiv.org/content/10.1101/2022.01.20.22269406v1">say</a> that during December patients diagnosed with Omicron were one-quarter as likely to need hospitalization as those with Delta, and none of 6581 Omicron patients died. But not all reports are that rosy. <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4008930">In Denmark</a> the risk of hospitalization was only a third lower overall with Omicron than with Delta, only half even in people who were boosted. And <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~USA~FRA~GRC">high recent death rates</a> in countries like the US, Italy, France, and Greece confirm that Omicron <a href="https://www.nytimes.com/2022/01/29/health/omicron-chronic-illness.html?campaign_id=2&emc=edit_th_20220130&instance_id=51717&nl=todaysheadlines&regi_id=19728476&segment_id=81163&user_id=d89c7002526915cc9287fae06e27a284">may not be as benign</a> as it was cracked up to be.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Self-isolation</u>: Omicron’s shorter incubation period bred hope that patients would remain infectious more briefly – one of the CDC’s excuses for cutting self-isolation from 10 days to 5, a policy unfortunately being imitated by some Italian regions. It turns out, though, that Omicron infections are <a href="https://www.medrxiv.org/content/10.1101/2022.01.13.22269257v1.full.pdf">barely shorter</a> than Delta (10 vs. 11 days average), with fully a third of Omicron cases remaining infectious for 6-11 days.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Healthcare system? What healthcare system?<o:p></o:p></b></p><div style="text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEih_Ko_d7fMsthcXv4KNjcCR-ouAad4vJmSeSA1WhAyMT0v4O5WyazonH7gwSTS4Nh5QASqWsMko8NdD3YeUfqk0g-5nFyHmAvI6YzfzY82BdQLVIJS2pBiTRw_f6-UkIJ_-ch8P1-jmbUj3GJUoOtOrVeaqZhrmWUY8v2DuLUlLlJ7fjUI20mPVHud=s1030" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1030" data-original-width="1026" height="400" src="https://blogger.googleusercontent.com/img/a/AVvXsEih_Ko_d7fMsthcXv4KNjcCR-ouAad4vJmSeSA1WhAyMT0v4O5WyazonH7gwSTS4Nh5QASqWsMko8NdD3YeUfqk0g-5nFyHmAvI6YzfzY82BdQLVIJS2pBiTRw_f6-UkIJ_-ch8P1-jmbUj3GJUoOtOrVeaqZhrmWUY8v2DuLUlLlJ7fjUI20mPVHud=w400-h400" width="400" /></a></div><span style="font-family: "Times New Roman", serif;"><br /></span></div><p class="1obc" style="font-size: medium; margin-right: 6pt;">As Sarah Kliff <a href="https://twitter.com/sarahkliff/status/1475579315299536904">tweeted</a>, “Only in the United States could the government run a public health campaign centered on fears of large, unexpected medical bills.” The richest country on the planet, with the highest medical spending per capita and some of the world’s best hospitals, notoriously has the <a href="https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019">worst health outcomes</a> of any developed nation. That’s what happens when medical care is run for profit, not for health – check out this excellent <a href="https://multiracialunity.org/2022/01/10/the-us-gets-f-for-covid/">commentary</a> from out in left wing.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Of the 7 nations with <a href="https://www.washingtonpost.com/opinions/2022/01/15/pandemic-shows-why-united-states-should-not-be-one-only-11-nations-without-paid-sick-leave/">no mandated sick leave</a>, only one is a developed country: the United States. Ten percent of all employed Americans, <a href="https://www.bls.gov/ncs/ebs/factsheet/paid-sick-leave.htm">one in 4 who work</a> in the private sector, and <a href="https://www.dol.gov/sites/dolgov/files/OASP/evaluation/pdf/WHD_FMLA_LowWageWorkers_January2021.pdf">half of workers</a> earning less than $15 an hour have no sick leave at all, and those who do have only an average of 7 days. If so many working-age Americans can’t afford to take time off to quarantine, self-isolate, or get vaccinated, workplace exposures are guaranteed.<o:p></o:p></p><div style="text-align: center;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEg90r4-lYCcBf8jT_j5ZnshLyEuLBTMNBx8QCzKRDTw1S8aF4-Au31SHxiDUGIU8ylcCNaVnhrH9Sdxe3nGs8deaSSO3KeEQDB5JcEGy0jl3FrJGde9r9PFeesiD2D9RW_ZcbeLN2CCIqYBBTf2oYOPVDVYMJyubz2gyhDGqU0V173-07-FGheRbYHs=s1636" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="718" data-original-width="1636" height="280" src="https://blogger.googleusercontent.com/img/a/AVvXsEg90r4-lYCcBf8jT_j5ZnshLyEuLBTMNBx8QCzKRDTw1S8aF4-Au31SHxiDUGIU8ylcCNaVnhrH9Sdxe3nGs8deaSSO3KeEQDB5JcEGy0jl3FrJGde9r9PFeesiD2D9RW_ZcbeLN2CCIqYBBTf2oYOPVDVYMJyubz2gyhDGqU0V173-07-FGheRbYHs=w640-h280" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Duration of <a href="https://www.worldpolicycenter.org/sites/default/files/Sick leave policy brief 2021.pdf" target="_blank">paid medical leave</a> around the world</td></tr></tbody></table><span style="font-family: "Times New Roman", serif;"><br /></span></div><p class="1obc" style="font-size: medium; margin-right: 6pt;">Not everybody has suffered from the COVID-19 pandemic. American health insurance companies, for instance, are <a href="https://www.theguardian.com/us-news/2021/aug/06/us-healthcare-insurance-covid-19-coronavirus">making a killing</a>. No sign they’re planning to reduce premiums, though, and they’re not rushing to send customers the rebates required by the Affordable Care Act. </p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Big Pharma’s happy too, with Pfizer + Moderna making <a href="https://reliefweb.int/report/world/pfizer-biontech-and-moderna-making-1000-profit-every-second-while-world-s-poorest">$1000 every second</a>. Yes, I said every <i>second</i>.<o:p></o:p></p><div style="text-align: center;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhuEzTbNVJ7oUd6dfUkz-rVsYjqUWv2bLXtYDICqldP3c-lb99SOoHzVtW_t7c51XZYUpL8OYySlZ0agUr6yEf62VAaidiA1W0pYlxQvbhDc7AGgQ9cXX-H1vibCFOK0Tld65g0g3y_-sBeF32HSjPrhOW4gSQOFD-VB2nOSWp-QLt9Uz8hMQb7QES4=s1616" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="984" data-original-width="1616" height="392" src="https://blogger.googleusercontent.com/img/a/AVvXsEhuEzTbNVJ7oUd6dfUkz-rVsYjqUWv2bLXtYDICqldP3c-lb99SOoHzVtW_t7c51XZYUpL8OYySlZ0agUr6yEf62VAaidiA1W0pYlxQvbhDc7AGgQ9cXX-H1vibCFOK0Tld65g0g3y_-sBeF32HSjPrhOW4gSQOFD-VB2nOSWp-QLt9Uz8hMQb7QES4=w640-h392" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">KFF polling on the Affordable Care Act since its inception</td></tr></tbody></table><span style="font-family: "Times New Roman", serif; font-weight: bold;"><br /></span></div><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">But there are tiny silver linings for the rest of us: Oklahoma, Nebraska, Montana, Missouri, and Arkansas <a href="https://www.vox.com/2020/8/5/21355515/missouri-oklahoma-medicaid-expansion-vote-results-covid-19">expanding Medicaid</a>, more <a href="https://www.kff.org/report-section/kff-health-tracking-poll-july-2020-politics/">approval of the Affordable Care Act</a>, and more support for a <a href="https://morningconsult.com/2021/03/24/medicare-for-all-public-option-polling/">public option</a> in healthcare insurance – though the backing of “Medicare for All” holds steady at 55%.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Will COVID-19 be the straw that finally breaks the back of the already broken American medical non-system and drives it to join the rest of the civilized world in making health care a right as fundamental as water, schools, and highways?<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>What killed 'em?</b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><div style="text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjq5uRIOjAxSy5HX2kB8hLRuUQKGzlaKz4N-K4WRyYJTYp6EsYTw3ignZrD-GaS8vL4HE4_bFA7FsNKWcNaP515KPh_tQvVTvErGlgtGv5Pjx5s1oAJpKzeuqVSHHB4jN2cuih7uGfuNC7TF53YG5F14pE-BaHGrO81CZ0A09Lj5mKd155SToWgJdWm=s1600" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="900" data-original-width="1600" height="180" src="https://blogger.googleusercontent.com/img/a/AVvXsEjq5uRIOjAxSy5HX2kB8hLRuUQKGzlaKz4N-K4WRyYJTYp6EsYTw3ignZrD-GaS8vL4HE4_bFA7FsNKWcNaP515KPh_tQvVTvErGlgtGv5Pjx5s1oAJpKzeuqVSHHB4jN2cuih7uGfuNC7TF53YG5F14pE-BaHGrO81CZ0A09Lj5mKd155SToWgJdWm=s320" width="320" /></a></div><span style="font-family: "Times New Roman", serif;"><br /></span></div><p class="1obc" style="font-size: medium; margin-right: 6pt;">The number of death certificates in the US citing COVID-19 as the cause of death is far less than the real number. Coroners say one reason is that they take the word of families for the cause of death of people who die at home, and <a href="https://eu.usatoday.com/in-depth/news/nation/2021/12/22/covid-deaths-obscured-inaccurate-death-certificates/8899157002/">many such families</a>, especially in red states, prefer to say the person died of Alzheimer’s, heart attack, diabetes, whatever. Admitting their relative had died of COVID-19 would apparently be a personal insult to Donald Trump.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">But then – contrariwise – you have families who try to falsely have COVID-19 added to the death certificate, or obtain a <a href="https://www.politico.com/news/2021/02/25/fema-funeral-aid-coronavirus-471533">forged one</a>, so as to be eligible for the up to $9000 offered by FEMA in <a href="https://www.fema.gov/disaster/coronavirus/economic/funeral-assistance">funeral assistance</a>!<o:p></o:p></p><style class="WebKit-mso-list-quirks-style">
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p.MsoListParagraphCxSpMiddle, li.MsoListParagraphCxSpMiddle, div.MsoListParagraphCxSpMiddle
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;}
p.MsoListParagraphCxSpLast, li.MsoListParagraphCxSpLast, div.MsoListParagraphCxSpLast
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;}
span.Heading1Char
{mso-style-name:"Heading 1 Char";
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 1";
mso-ansi-font-size:14.0pt;
mso-bidi-font-size:16.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Arial;
mso-bidi-font-family:"Times New Roman";
mso-font-kerning:16.0pt;
font-weight:bold;
mso-bidi-font-weight:normal;}
span.Heading2Char
{mso-style-name:"Heading 2 Char";
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 2";
mso-ansi-font-size:13.0pt;
mso-bidi-font-size:13.0pt;
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;}
span.Heading3Char
{mso-style-name:"Heading 3 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 3";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#4472C4;
mso-themecolor:accent1;
font-weight:bold;}
span.Heading4Char
{mso-style-name:"Heading 4 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 4";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;
font-style:italic;}
span.Heading5Char
{mso-style-name:"Heading 5 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 5";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;}
p.text, li.text, div.text
{mso-style-name:text;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Plain Text";
margin-top:0in;
margin-right:0in;
margin-bottom:10.0pt;
margin-left:0in;
line-height:150%;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
span.PlainTextChar
{mso-style-name:"Plain Text Char";
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Plain Text";
mso-ansi-font-size:10.5pt;
mso-bidi-font-size:10.5pt;
font-family:Courier;
mso-ascii-font-family:Courier;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Courier;
mso-bidi-font-family:"Times New Roman";}
p.Heading, li.Heading, div.Heading
{mso-style-name:Heading;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Heading 1";
margin-top:12.0pt;
margin-right:0in;
margin-bottom:12.0pt;
margin-left:0in;
mso-pagination:widow-orphan;
page-break-after:avoid;
mso-outline-level:1;
font-size:12.0pt;
font-family:"Arial",sans-serif;
mso-fareast-font-family:"MS Mincho";
mso-bidi-font-family:"Times New Roman";
mso-font-kerning:16.0pt;
font-weight:bold;
mso-bidi-font-weight:normal;}
p.quotes, li.quotes, div.quotes
{mso-style-name:quotes;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Plain Text";
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
span.BalloonTextChar
{mso-style-name:"Balloon Text Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Balloon Text";
mso-ansi-font-size:9.0pt;
mso-bidi-font-size:9.0pt;
font-family:"Lucida Grande",sans-serif;
mso-ascii-font-family:"Lucida Grande";
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:"Lucida Grande";
mso-bidi-font-family:"Lucida Grande";}
p.quotesheadline, li.quotesheadline, div.quotesheadline
{mso-style-name:"quotes headline";
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:quotes;
mso-style-next:quotes;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Arial",sans-serif;
mso-fareast-font-family:"MS Mincho";
font-weight:bold;
mso-bidi-font-weight:normal;}
span.exldetailsdisplayval
{mso-style-name:exldetailsdisplayval;
mso-style-unhide:no;}
span.CommentTextChar
{mso-style-name:"Comment Text Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Comment Text";
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.apple-converted-space
{mso-style-name:apple-converted-space;
mso-style-unhide:no;}
p.css-exrw3m, li.css-exrw3m, div.css-exrw3m
{mso-style-name:css-exrw3m;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.3m6-
{mso-style-name:_3m6-;
mso-style-unhide:no;}
span.3l3x
{mso-style-name:_3l3x;
mso-style-unhide:no;}
span.1lh7
{mso-style-name:_1lh7;
mso-style-unhide:no;}
span.1lld
{mso-style-name:_1lld;
mso-style-unhide:no;}
p.6coj, li.6coj, div.6coj
{mso-style-name:_6coj;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.6cok
{mso-style-name:_6cok;
mso-style-unhide:no;}
span.timestampcontent
{mso-style-name:timestampcontent;
mso-style-unhide:no;}
span.mbtext
{mso-style-name:mb_text;
mso-style-unhide:no;}
span.HeaderChar
{mso-style-name:"Header Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Header;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.FooterChar
{mso-style-name:"Footer Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Footer;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.5uzb
{mso-style-name:_5uzb;
mso-style-unhide:no;}
span.accessibleelem
{mso-style-name:accessible_elem;
mso-style-unhide:no;}
span.z-TopofFormChar
{mso-style-name:"z-Top of Form Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"z-Top of Form";
mso-ansi-font-size:8.0pt;
mso-bidi-font-size:8.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:Arial;
mso-bidi-font-family:Arial;
display:none;
mso-hide:all;}
p.1obc, li.1obc, div.1obc
{mso-style-name:_1obc;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.z-BottomofFormChar
{mso-style-name:"z-Bottom of Form Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"z-Bottom of Form";
mso-ansi-font-size:8.0pt;
mso-bidi-font-size:8.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:Arial;
mso-bidi-font-family:Arial;
display:none;
mso-hide:all;}
p.css-axufdj, li.css-axufdj, div.css-axufdj
{mso-style-name:css-axufdj;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.style-scope
{mso-style-name:style-scope;
mso-style-unhide:no;}
p.generic-articlesummary--li, li.generic-articlesummary--li, div.generic-articlesummary--li
{mso-style-name:generic-article__summary--li;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.diamond-blt, li.diamond-blt, div.diamond-blt
{mso-style-name:diamond-blt;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.font-copy, li.font-copy, div.font-copy
{mso-style-name:font-copy;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:"Calibri",sans-serif;
mso-ascii-font-family:Calibri;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:Calibri;
mso-fareast-theme-font:minor-latin;
mso-hansi-font-family:Calibri;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;
mso-header-margin:.5in;
mso-footer-margin:.5in;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
/* List Definitions */
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{mso-list-id:-119;
mso-list-type:simple;
mso-list-template-ids:-1888465356;}
@list l0:level1
{mso-level-number-format:bullet;
mso-level-style-link:"List Bullet";
mso-level-text:;
mso-level-tab-stop:.25in;
mso-level-number-position:left;
margin-left:.25in;
text-indent:-.25in;
font-family:Symbol;}
@list l1
{mso-list-id:180240054;
mso-list-type:hybrid;
mso-list-template-ids:-406915396 1833337546 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
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{mso-level-start-at:84;
mso-level-text:"%1\)";
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l1:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l1:level3
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
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{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l1:level5
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l1:level6
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
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{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l1:level8
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l1:level9
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l2
{mso-list-id:197426527;
mso-list-type:hybrid;
mso-list-template-ids:267133896 67698705 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l2:level1
{mso-level-text:"%1\)";
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l2:level2
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l2:level3
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l2:level4
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l2:level5
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l2:level6
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l2:level7
{mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l2:level8
{mso-level-number-format:alpha-lower;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;}
@list l2:level9
{mso-level-number-format:roman-lower;
mso-level-tab-stop:none;
mso-level-number-position:right;
text-indent:-9.0pt;}
@list l3
{mso-list-id:338582796;
mso-list-template-ids:-1806528500;}
@list l3:level1
{mso-level-tab-stop:.5in;
mso-level-number-position:left;
text-indent:-.25in;}
@list l3:level2
{mso-level-tab-stop:1.0in;
mso-level-number-position:left;
text-indent:-.25in;}
@list l3:level3
{mso-level-tab-stop:1.5in;
mso-level-number-position:left;
text-indent:-.25in;}
@list l3:level4
{mso-level-tab-stop:2.0in;
mso-level-number-position:left;
text-indent:-.25in;}
@list l3:level5
{mso-level-tab-stop:2.5in;
mso-level-number-position:left;
text-indent:-.25in;}
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{mso-level-tab-stop:3.0in;
mso-level-number-position:left;
text-indent:-.25in;}
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{mso-level-tab-stop:3.5in;
mso-level-number-position:left;
text-indent:-.25in;}
@list l3:level8
{mso-level-tab-stop:4.0in;
mso-level-number-position:left;
text-indent:-.25in;}
@list l3:level9
{mso-level-tab-stop:4.5in;
mso-level-number-position:left;
text-indent:-.25in;}
@list l4
{mso-list-id:367686160;
mso-list-type:hybrid;
mso-list-template-ids:8276860 1843136710 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l4:level1
{mso-level-start-at:13;
mso-level-number-format:bullet;
mso-level-text:-;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
@list l4:level2
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:"Courier New";}
@list l4:level3
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:Wingdings;
mso-bidi-font-family:Wingdings;}
@list l4:level4
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:Symbol;
mso-bidi-font-family:Symbol;}
@list l4:level5
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:"Courier New";}
@list l4:level6
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:Wingdings;
mso-bidi-font-family:Wingdings;}
@list l4:level7
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:Symbol;
mso-bidi-font-family:Symbol;}
@list l4:level8
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:"Courier New";}
@list l4:level9
{mso-level-number-format:bullet;
mso-level-text:;
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</style>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com0tag:blogger.com,1999:blog-6211405954943098401.post-15277203582752728762022-01-20T17:00:00.002+01:002022-01-22T10:52:40.619+01:00EXTRA: Covid's Long Tail<p> </p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiN6DA4p_2WtT8ue9rqgaQEmTVQL5PmlPJ8N5dnpkJP5FkBq9hiAzd8supN7d9zatLSwoZJHYIHY5o3kA2IGxCFqQy7ekK0Nvr_Lq1YcStF9zkO6rRxl4ca87w3-X29Dn9SQStLA2npUsC_KzU84XkCu9KxBcz4Wm7W_V3yGdw5OV6NnZWQZr_gduEY=s1121" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="699" data-original-width="1121" height="250" src="https://blogger.googleusercontent.com/img/a/AVvXsEiN6DA4p_2WtT8ue9rqgaQEmTVQL5PmlPJ8N5dnpkJP5FkBq9hiAzd8supN7d9zatLSwoZJHYIHY5o3kA2IGxCFqQy7ekK0Nvr_Lq1YcStF9zkO6rRxl4ca87w3-X29Dn9SQStLA2npUsC_KzU84XkCu9KxBcz4Wm7W_V3yGdw5OV6NnZWQZr_gduEY=w400-h250" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Black spider monkey</td></tr></tbody></table><br /><p></p><style class="WebKit-mso-list-quirks-style">
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mso-style-noshow:yes;
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mso-style-link:"Heading 5";
font-family:"Calibri Light",sans-serif;
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mso-ascii-theme-font:major-latin;
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mso-fareast-theme-font:major-fareast;
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mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;}
p.text, li.text, div.text
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mso-style-qformat:yes;
mso-style-parent:"Plain Text";
margin-top:0in;
margin-right:0in;
margin-bottom:10.0pt;
margin-left:0in;
line-height:150%;
mso-pagination:widow-orphan;
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span.PlainTextChar
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mso-style-locked:yes;
mso-style-link:"Plain Text";
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mso-fareast-theme-font:minor-fareast;
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mso-style-qformat:yes;
mso-style-parent:"Heading 1";
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margin-right:0in;
margin-bottom:12.0pt;
margin-left:0in;
mso-pagination:widow-orphan;
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mso-outline-level:1;
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mso-bidi-font-family:"Times New Roman";
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font-weight:bold;
mso-bidi-font-weight:normal;}
p.quotes, li.quotes, div.quotes
{mso-style-name:quotes;
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mso-style-qformat:yes;
mso-style-parent:"Plain Text";
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-pagination:widow-orphan;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
span.BalloonTextChar
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mso-style-link:"Balloon Text";
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mso-hansi-font-family:"Lucida Grande";
mso-bidi-font-family:"Lucida Grande";}
p.quotesheadline, li.quotesheadline, div.quotesheadline
{mso-style-name:"quotes headline";
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:quotes;
mso-style-next:quotes;
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margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-pagination:widow-orphan;
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font-family:"Arial",sans-serif;
mso-fareast-font-family:"MS Mincho";
font-weight:bold;
mso-bidi-font-weight:normal;}
span.exldetailsdisplayval
{mso-style-name:exldetailsdisplayval;
mso-style-unhide:no;}
span.CommentTextChar
{mso-style-name:"Comment Text Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Comment Text";
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.apple-converted-space
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mso-style-unhide:no;}
p.css-exrw3m, li.css-exrw3m, div.css-exrw3m
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mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.3m6-
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mso-style-unhide:no;}
span.3l3x
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mso-style-unhide:no;}
span.1lh7
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mso-style-unhide:no;}
span.1lld
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mso-style-unhide:no;}
p.6coj, li.6coj, div.6coj
{mso-style-name:_6coj;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.6cok
{mso-style-name:_6cok;
mso-style-unhide:no;}
span.timestampcontent
{mso-style-name:timestampcontent;
mso-style-unhide:no;}
span.mbtext
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mso-style-unhide:no;}
span.HeaderChar
{mso-style-name:"Header Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Header;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.FooterChar
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mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Footer;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.5uzb
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span.accessibleelem
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mso-style-unhide:no;}
span.z-TopofFormChar
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mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"z-Top of Form";
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mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:Arial;
mso-bidi-font-family:Arial;
display:none;
mso-hide:all;}
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{mso-style-name:_1obc;
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mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.z-BottomofFormChar
{mso-style-name:"z-Bottom of Form Char";
mso-style-noshow:yes;
mso-style-priority:99;
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mso-style-locked:yes;
mso-style-link:"z-Bottom of Form";
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mso-fareast-font-family:"Times New Roman";
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mso-bidi-font-family:Arial;
display:none;
mso-hide:all;}
p.css-axufdj, li.css-axufdj, div.css-axufdj
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mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.style-scope
{mso-style-name:style-scope;
mso-style-unhide:no;}
p.generic-articlesummary--li, li.generic-articlesummary--li, div.generic-articlesummary--li
{mso-style-name:generic-article__summary--li;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.diamond-blt, li.diamond-blt, div.diamond-blt
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mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.font-copy, li.font-copy, div.font-copy
{mso-style-name:font-copy;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
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mso-default-props:yes;
font-family:"Calibri",sans-serif;
mso-ascii-font-family:Calibri;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:Calibri;
mso-fareast-theme-font:minor-latin;
mso-hansi-font-family:Calibri;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
@page WordSection1
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margin:1.0in 1.0in 1.0in 1.0in;
mso-header-margin:.5in;
mso-footer-margin:.5in;
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div.WordSection1
{page:WordSection1;}
/* List Definitions */
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font-family:Symbol;}
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{mso-level-number-format:roman-lower;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
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</style><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Counting beans<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"></p><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgtIHAI0Gc4IX4zIvGVvkg4G3qA8foiTwoYcGNtVfJd6Ia_zqfJpPsjh9JlsWAgQ5n5-iOLD7jwsyPuQ7PQhU5w5GzvHq9fGDXc2BM8B2Gfn5sMVPJQY-5ugSQq99BImwzUQiFG-AHwHGwOJdKNotTBCZ9DjysyncoKCwfGyVXTQ1y9-nwdR7ihk63z=s1622" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1038" data-original-width="1622" height="258" src="https://blogger.googleusercontent.com/img/a/AVvXsEgtIHAI0Gc4IX4zIvGVvkg4G3qA8foiTwoYcGNtVfJd6Ia_zqfJpPsjh9JlsWAgQ5n5-iOLD7jwsyPuQ7PQhU5w5GzvHq9fGDXc2BM8B2Gfn5sMVPJQY-5ugSQq99BImwzUQiFG-AHwHGwOJdKNotTBCZ9DjysyncoKCwfGyVXTQ1y9-nwdR7ihk63z=w400-h258" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiAC3f8w1LdCQ4RMr8qpPNLf7lHoEBFLt8h81s8NHJc8_GZuAy42XQ6IGv0EAdyKsNAwgHq7fA243SahrVjLU9IFBSlBJekrHUHAQsqLiLP_r4m-zxRa8pQ1bn3N_03un2qSkOmqP93QPcp8uhG8BrtrwSkj9RHLFHMy7hBP-hScl7TodNYnfHgbZ5U=s1622" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1038" data-original-width="1622" height="258" src="https://blogger.googleusercontent.com/img/a/AVvXsEiAC3f8w1LdCQ4RMr8qpPNLf7lHoEBFLt8h81s8NHJc8_GZuAy42XQ6IGv0EAdyKsNAwgHq7fA243SahrVjLU9IFBSlBJekrHUHAQsqLiLP_r4m-zxRa8pQ1bn3N_03un2qSkOmqP93QPcp8uhG8BrtrwSkj9RHLFHMy7hBP-hScl7TodNYnfHgbZ5U=w400-h258" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Remember when Donald Trump said in June 2020, to universal derision, “If we stop testing right now, we'd have very few cases, if any”?<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Joe Biden’s US seems to be following Trump’s advice. Take a look at the first graph above: Italy is running <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Metric=Confirmed+cases&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~USA">35-40% more cases</a> per capita than the United States. When I first saw such a graph I was flummoxed – how could the Italians be doing worse, when far more of them are vaccinated, almost twice as many are boosted, vaccine passports are enforced, and everyone wears masks indoors. Then I looked at the lower graph, and the reason became clear: Italy is doing nearly <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&uniformYAxis=0&pickerSort=asc&pickerMetric=location&Metric=Tests&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~USA">3 times as many</a> tests per capita. <a href="https://en.wikipedia.org/wiki/Matthew_7:7%E2%80%938">Seek and ye shall find</a>. No seek, no find.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I might mention that despite frequent <a href="https://www.pbs.org/newshour/health/why-you-cant-find-cheap-at-home-covid-tests">declarations</a> in the US that testing “in Europe” is free or costs only pennies, Italians shell out €15, about $18, every time they do an antigen test in a pharmacy.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The Biden administration’s current party line can be interpreted as: it doesn’t really matter how many people get sick. As per <a href="https://apnews.com/article/coronavirus-pandemic-science-health-anthony-fauci-9444d63b650b98e235ed2595b0ebe844">Anthony Fauci</a>: “it is much more relevant to focus on the hospitalizations as opposed to the total number of cases.” This while experts such as <a href="https://www.theguardian.com/world/live/2022/jan/04/covid-live-news-chinese-city-puts-13-million-in-strict-lockdown-over-three-asymptomatic-cases?filterKeyEvents=false&page=with:block-61d4de468f082feb30260d59#block-61d4de468f082feb30260d59">Eric Topol</a> emphasize that even the awful official statistics vastly undertimate the true state of the pandemic, with many “colds” and “flus” actually being COVID-19. (By the way, the US has one-third more hospitalized COVID-19 patients per capita than Italy.)<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Scope of the problem<o:p></o:p></b></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEj4EFUxOMyNHZC0CePop_lSpZzNKmuNJtd4rcELVNM4M03zB55-giqrxHPCrowDK3hC1h3HsBdZInC9hSfOYuzhz6FkzMbIrqElfh-zT7DHmUo0YcF45qVnhvZbMtpMU88sMF0tTzip1zO2IGe0mi-tD7iXYuAAU2SSxZeQsEl-Gi6xPF3VCJhJHuqB=s735" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="416" data-original-width="735" height="226" src="https://blogger.googleusercontent.com/img/a/AVvXsEj4EFUxOMyNHZC0CePop_lSpZzNKmuNJtd4rcELVNM4M03zB55-giqrxHPCrowDK3hC1h3HsBdZInC9hSfOYuzhz6FkzMbIrqElfh-zT7DHmUo0YcF45qVnhvZbMtpMU88sMF0tTzip1zO2IGe0mi-tD7iXYuAAU2SSxZeQsEl-Gi6xPF3VCJhJHuqB=w400-h226" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Long COVID clinic Policlinico Gemelli, Rome</td></tr></tbody></table><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">After that prelude, on to my real subject: an update on long COVID. It’s probably the biggest reason case numbers count, and is why I myself do everything within my power to avoid getting infected. If Omicron is sooner or later going to infect “<a href="https://www.washingtonpost.com/nation/2022/01/12/covid-omicron-variant-live-updates/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F35bce12%2F61deb4c69d2fda14d7eca846%2F599d6acbae7e8a3d46e1400f%2F10%2F77%2F61deb4c69d2fda14d7eca846">just about everybody</a>” or even just “<a href="https://unric.org/en/who-50-of-the-population-in-europe-could-be-infected-by-covid-in-next-2-months/">more than 50%</a>,” <b><i>how many will develop long COVID?</i></b> So far, of course, we have no idea, the variant having arrived on the scene less than 2 months ago. We can hope that being milder Omicron will cause fewer cases, but even the mildest cases of COVID-19 <a href="https://www.nature.com/articles/s41591-021-01433-3">can bring prolonged symptoms</a>, so we could be in for an overwhelming secondary pandemic. <o:p></o:p><span style="font-family: "Times New Roman", serif; font-size: 12pt;">The first hint may be a</span><span style="font-family: "Times New Roman", serif; font-size: 12pt;"> </span><a href="https://www.beckershospitalreview.com/workforce/15-of-job-vacancies-are-due-to-long-covid-19-report-finds-6-things-to-know.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=8153B8946823F6C" style="color: #954f72; font-family: "Times New Roman", serif; font-size: 12pt;">very recent report</a><span style="font-family: "Times New Roman", serif; font-size: 12pt;"> </span><span style="font-family: "Times New Roman", serif; font-size: 12pt;">finding that 15% of current job vacancies in the US are due to long COVID.</span><span style="font-family: "Times New Roman", serif; font-size: 12pt;"> </span></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Definitions</u>: The <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00703-9/fulltext">World Health Organization convened</a> 265 experts from more than 30 countries, many of them long-haulers themselvers, to use the “Delphi consensus method” to develop a definition. Here’s the short version: “Post-COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset, with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis.” <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-02115-0">Another careful study</a> laid out various subtypes, using a superb data set the authors continue to mine for more information.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Numbers</u>: If anything they’ve become bleaker as time goes by. One <a href="https://www.sciencedirect.com/science/article/pii/S0889159121006516#t0015">recent review and meta-analysis</a> found that a third of COVID-19 patients still suffered from fatigue 6 months after their illness, with fully half of the women complaining of brain fog. <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2784918?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=101321">Another review</a> concluded that more than half of COVID-19 survivors still had at least one COVID-related symptom 6 months later. <a href="https://www.medrxiv.org/content/10.1101/2021.11.15.21266377v1.full.pdf">A third</a> estimated that 43% of all cases diagnosed worldwide have or have had long COVID, meaning about 100 million long COVID cases when they wrote, and more than 134 million now. Vaccination, contrary to <a href="https://www.nbcnews.com/health/health-news/can-vaccinated-people-get-long-covid-doctors-say-risk-very-n1273970">early optimism</a>, seems to reduce the risk only by half, according to studies of <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2109072">healthcare workers in Israel</a> and <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00460-6/fulltext">app users in the UK</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Severity</u>: The <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00703-9/fulltext">WHO panel</a> said gently that the symptoms “generally have an impact on everyday functioning.” To get an idea of what that really means, I strongly suggest checking out <a href="https://www.aamc.org/news-insights/doctors-long-covid-19-share-their-struggles-heal">this article</a> about physician-patients, and <a href="https://www.washingtonpost.com/business/2021/12/09/long-covid-work-unemployed/">this one</a>about regular folks.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Light at the end of the tunnel?<o:p></o:p></b></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjF5hBhcNUFEdiG6f9-Ds9phEsrs94zchXogH-SWW8rfuBWNTdokYHokqVvIGCAPrZfhneOhLg3zT-UbArTlfxv9f3NrrPZwiFN_EjLY2rxBL6Mm1ekt5q3SMdISOxgulOFKfbPEOU5_lED8XudlQ6_bmh-W3jgbwHaRyLiLa-CFsQVW8h0W9fcGvGO=s1522" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="406" data-original-width="1522" height="172" src="https://blogger.googleusercontent.com/img/a/AVvXsEjF5hBhcNUFEdiG6f9-Ds9phEsrs94zchXogH-SWW8rfuBWNTdokYHokqVvIGCAPrZfhneOhLg3zT-UbArTlfxv9f3NrrPZwiFN_EjLY2rxBL6Mm1ekt5q3SMdISOxgulOFKfbPEOU5_lED8XudlQ6_bmh-W3jgbwHaRyLiLa-CFsQVW8h0W9fcGvGO=w640-h172" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="https://assets.researchsquare.com/files/rs-1205453/v1_covered.pdf?c=1640805028)" target="_blank">Microclots</a> circulating in the blood</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgpfxNmHQjNfp7lFQ2a3eEgZjUCnn-SH-1lvu7CHjJpUXOqAnaqOByz7DldYDCfd0H6TzOOYx8J68pLyQvYonZIWd1UeELO2lM5UBKMtMEap_omnXWY3reNnZ84odLh8Li5wSCzthoQjyzjL-aXdJpjGSR6Homc4WaA9C6S4VpKNOyLHN3NszJpjOIB=s1746" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="426" data-original-width="1746" height="158" src="https://blogger.googleusercontent.com/img/a/AVvXsEgpfxNmHQjNfp7lFQ2a3eEgZjUCnn-SH-1lvu7CHjJpUXOqAnaqOByz7DldYDCfd0H6TzOOYx8J68pLyQvYonZIWd1UeELO2lM5UBKMtMEap_omnXWY3reNnZ84odLh8Li5wSCzthoQjyzjL-aXdJpjGSR6Homc4WaA9C6S4VpKNOyLHN3NszJpjOIB=w640-h158" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">SARS-CoV-2 <a href="https://assets.researchsquare.com/files/rs-1139035/v1_covered.pdf?c=1640020576" target="_blank">viral particles</a> in thyroid, esophagus, spleen, and colon</td></tr></tbody></table><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;">Overviews of long COVID in journals such as <a href="https://www.science.org/doi/full/10.1126/science.abg7113">Science</a> and <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32705-7/fulltext">The Lancet</a> have concluded that the condition is basically untreatable, that all we can offer is analgesics for pain, <a href="https://www.theatlantic.com/magazine/archive/2021/04/unlocking-the-mysteries-of-long-covid/618076/">breathing exercises</a> for faintness, and modest advice for <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/pmrj.12684">fatigue</a> and <a href="https://www.stasis.life/">shortness of breath</a>. The one thing that has led to striking improvement in some patients is a dose of SARS-CoV-2 vaccine, as <a href="https://orbi.uliege.be/bitstream/2268/265876/1/Long_Covid_Research_report_Jamoulle_et_al_20211210.pdf">reported anecdotally</a> and confirmed by one <a href="https://www.theguardian.com/society/2021/may/18/long-covid-symptoms-ease-after-vaccination-survey-finds">large international poll</a>. Vaccination makes some patients worse, though, and we have no way of predicting which way an individual patient will react.</p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">In the last few months, though, there may finally be some progress in understanding both what causes long COVID and how it could be treated. Theories vary but overlap to some extent, and I’ll attempt to present them in a logical order:<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Tissue damage</u>: Severe COVID-19 can damage the lungs and the heart, leading to long-lasting <a href="https://www.bmj.com/content/372/bmj.n693.long">organ dysfunction</a> that would explain some prolonged symptoms. Many long COVID sufferers were never severely ill, though, and a considerable proportion <a href="https://www.bmj.com/content/371/bmj.m4470">have no</a> readily demonstrable organ dysfunction. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Blood clots</u>: The South African scientist Etheresia Pretorius believes <a href="https://www.theguardian.com/commentisfree/2022/jan/05/long-covid-research-microclots?CMP=Share_iOSApp_Other">the secret</a> of long COVID is <a href="https://pubmed.ncbi.nlm.nih.gov/34425843/">tiny inflamed clots</a>that plug up the circulatory system and inhibit the transport of oxygen to tissues. She admits that affected patients have no obvious signs of persistent clotting or inflammation, but thinks their blood is carrying inflammatory molecules and auto-antibodies sequestered inside fibrin amyloid microclots that can be detected only using special, highly refined techniques. In possible support of this theory, <a href="https://orbi.uliege.be/bitstream/2268/265876/1/Long_Covid_Research_report_Jamoulle_et_al_20211210.pdf">one small series</a> found that a majority of long COVID patients with “brain fog” had technitium (Tc-99m) brain scans that appeared to show reduced blood flow. The clot theory would, of course, imply that long COVID could be treated using antiplatelet drugs and/or anticoagulants. Dr. Pretorius and her colleagues tried just such a combination, in a tiny number of cases, producing a <a href="https://assets.researchsquare.com/files/rs-1205453/v1_covered.pdf?c=1640805028">manuscript</a> claiming that 24 out of 24 patients found their symptoms not just improved by <i>cured</i> by such treatment! These were not unselected long COVID patients, though, but a less-than-well-defined subgroup of a 845-patient database. This seems too good to be true, and since anticoagulation is potentially dangerous I wouldn’t leap to try it; we’ll know more if and when a planned large controlled trial comes off. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Inflammation</u>: Ordinary markers of inflammation such as C-reactive protein are <a href="https://www.sciencedirect.com/science/article/pii/S0889159121006516#t0015">sometimes</a> but <a href="https://www.medrxiv.org/content/10.1101/2021.03.08.21253124v1.full.pdf">not always</a> found in the blood of long COVID patients, and such patients often had <a href="https://www.medrxiv.org/content/10.1101/2021.03.08.21253124v1.full.pdf">particularly <i>low</i></a> levels of such markers during their acute phase. Some think nonetheless that inflammation underlies the condition and have turned to the prototypical antiinflammatory drugs, corticosteroids, as treatment. In a <a href="https://www.mdpi.com/2227-9059/9/11/1540/htm">tiny case series</a> in Madrid, 9 out of 9 long COVID patients had shifts in the subpopulations of some white blood cells (lymphocytes and monocytes) in a pro-inflammatory direction. The researchers tried giving these patients an extremely brief course of steroids, lasting only 4 days, and say that nearly all their symptoms resolved. Again, this seems too good to be true, and, again, a proper controlled trial is said to be in the works.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Autoimmunity</u>: Patients with severe COVID-19 <a href="https://www.nature.com/articles/d41586-021-00149-1">frequently develop</a> autoantibodies against normal body tissues, and these often persist in long COVID. <a href="https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-021-03184-8">One study</a> found long-lasting autoantibodies more common in women following asymptomatic infections, and in men after symptomatic COVID-19, with specific patterns of antibodies also varying by gender. Corticosteroids are a mainstay of treatment for autoimmune diseases such as lupus, so this is yet another line of thinking that would suggest steroids might help long COVID. Some long-hauler clinics do prescribe low-dose steroids to patients on empirical grounds, but I’ve been unable to find trials even in a planning phase. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Abnormal immune response</u>: Researchers in London <a href="https://jim.bmj.com/content/jim/early/2021/10/05/jim-2021-002051.full.pdf">identified</a> distinctive patterns of T cells in patients with long COVID that led them to prescribe combined histamine blockade (famotidine plus fexofenadine) to 49 patients, and they have reported that 35 of them improved. Antihistamines have become part of the large-scale <a href="https://www.theguardian.com/commentisfree/2022/jan/12/long-covid-trial-britain-short-term-virus">Stimulate-ICP study</a>from University College London, so we should have some better evidence in a few months. But these drugs are harmless enough that I have already tried prescribing them. Anomalous immune responses – goosing the immune system – might contribute to explaining post-vaccine improvement. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Blunted immune response</u>: Case series in <a href="https://www.medrxiv.org/content/10.1101/2021.03.08.21253124v1.full.pdf">Spain</a> and <a href="https://orbi.uliege.be/bitstream/2268/265876/1/Long_Covid_Research_report_Jamoulle_et_al_20211210.pdf">Belgium</a> have reported that patients destined for long COVID have not just low inflammatory markers but also weak antibody responses at the time of their original infection. I have also heard anecdotally that many long COVID patients produce few antibodies after vaccination. This poor immune response may make it harder to clear the coronavirus from the body, allowing it to continue at length both causing direct damage and stimulating the immune system. The virus does <a href="https://www.medrxiv.org/content/10.1101/2021.03.08.21253124v1.full.pdf">not keep shedding</a> from the nose, though, so long COVID patients are not contagious. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Live virus</u>: …and we now have another, very different kind of evidence that the virus itself may hang around at length. National Institutes of Health researchers <a href="https://thehill.com/policy/healthcare/587391-study-suggests-coronavirus-lingers-in-organs-for-months">performed autopsies</a> on 44 patients who died weeks or months after being diagnosed with COVID-19 by PCR-swabs, looking for viable coronavirus in body tissues. Their <a href="https://assets.researchsquare.com/files/rs-1139035/v1_covered.pdf?c=1640020576">prepublished manuscript</a> says they detected SARS-CoV-2 in all 44 cases, scattered through tissues including not only the lung as expected, but also heart, brain, kidney, lymph node, muscle, thyroid, even testicle and ovary. Most of these patients had died within days from raging COVID-19, and in them the presence of live virus is not surprising. But 7 of them died much later, as many as 7 months after the acute illness. These findings are both novel and surprising, since the virus has always been thought to disappear quickly unless the patient had AIDS or was otherwise immunosuppressed. None of these autopsied patients were known to have long COVID, but to me the findings imply the exciting suggestion that antiviral drugs such as Paxlovid could conceivably be useful in treatment.<o:p></o:p></p>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com0tag:blogger.com,1999:blog-6211405954943098401.post-63382299315835170412022-01-13T20:02:00.003+01:002022-01-13T22:31:39.650+01:00Had Enough Already?<p style="text-align: center;"> </p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjFYqbzBwogu7j8iDkOHXoDd5QrJ8IW_4QdGneUE8eFAPocrE5VEGIYENkywV3ySCyazWB5CGXIZRDIoly15JLBsJkAlp2LDmhxiEm3GY3Vi9qb0c9MW2MZEIeMvmgNR39ZSpRLbNPSosudnxxEWW10LTorxWixIdedB_Qedgx_6cszzI2GX-pEdHiM=s555" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="555" data-original-width="414" height="400" src="https://blogger.googleusercontent.com/img/a/AVvXsEjFYqbzBwogu7j8iDkOHXoDd5QrJ8IW_4QdGneUE8eFAPocrE5VEGIYENkywV3ySCyazWB5CGXIZRDIoly15JLBsJkAlp2LDmhxiEm3GY3Vi9qb0c9MW2MZEIeMvmgNR39ZSpRLbNPSosudnxxEWW10LTorxWixIdedB_Qedgx_6cszzI2GX-pEdHiM=w300-h400" width="300" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Thanks to Arnold Dreyblatt for this image</td></tr></tbody></table><p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Lots of vaccine news, some mandate lessons from Italy, more on those pesky CDC guidelines, plus some Omicron miscellany.<o:p></o:p></p><div class="separator" style="clear: both; text-align: left;"><style class="WebKit-mso-list-quirks-style">
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page-break-after:avoid;
mso-outline-level:4;
font-size:12.0pt;
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;
font-weight:normal;
font-style:italic;}
h5
{mso-style-noshow:yes;
mso-style-priority:9;
mso-style-qformat:yes;
mso-style-link:"Heading 5 Char";
mso-style-next:Normal;
margin-top:2.0pt;
margin-right:0in;
margin-bottom:0in;
margin-left:0in;
mso-pagination:widow-orphan lines-together;
page-break-after:avoid;
mso-outline-level:5;
font-size:12.0pt;
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;
font-weight:normal;}
p.MsoCommentText, li.MsoCommentText, div.MsoCommentText
{mso-style-priority:99;
mso-style-link:"Comment Text Char";
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.MsoHeader, li.MsoHeader, div.MsoHeader
{mso-style-priority:99;
mso-style-link:"Header Char";
margin:0in;
mso-pagination:widow-orphan;
tab-stops:center 3.25in right 6.5in;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.MsoFooter, li.MsoFooter, div.MsoFooter
{mso-style-priority:99;
mso-style-link:"Footer Char";
margin:0in;
mso-pagination:widow-orphan;
tab-stops:center 3.25in right 6.5in;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.MsoCommentReference
{mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-ansi-font-size:9.0pt;
mso-bidi-font-size:9.0pt;}
p.MsoListBullet, li.MsoListBullet, div.MsoListBullet
{mso-style-priority:99;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.25in;
mso-add-space:auto;
text-indent:-.25in;
mso-pagination:widow-orphan;
mso-list:l0 level1 lfo2;
tab-stops:list .25in;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;}
p.MsoListBulletCxSpFirst, li.MsoListBulletCxSpFirst, div.MsoListBulletCxSpFirst
{mso-style-priority:99;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.25in;
mso-add-space:auto;
text-indent:-.25in;
mso-pagination:widow-orphan;
mso-list:l0 level1 lfo2;
tab-stops:list .25in;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;}
p.MsoListBulletCxSpMiddle, li.MsoListBulletCxSpMiddle, div.MsoListBulletCxSpMiddle
{mso-style-priority:99;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.25in;
mso-add-space:auto;
text-indent:-.25in;
mso-pagination:widow-orphan;
mso-list:l0 level1 lfo2;
tab-stops:list .25in;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;}
p.MsoListBulletCxSpLast, li.MsoListBulletCxSpLast, div.MsoListBulletCxSpLast
{mso-style-priority:99;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.25in;
mso-add-space:auto;
text-indent:-.25in;
mso-pagination:widow-orphan;
mso-list:l0 level1 lfo2;
tab-stops:list .25in;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;}
a:link, span.MsoHyperlink
{mso-style-priority:99;
color:#0563C1;
mso-themecolor:hyperlink;
text-decoration:underline;
text-underline:single;}
a:visited, span.MsoHyperlinkFollowed
{mso-style-noshow:yes;
mso-style-priority:99;
color:#954F72;
mso-themecolor:followedhyperlink;
text-decoration:underline;
text-underline:single;}
p.MsoPlainText, li.MsoPlainText, div.MsoPlainText
{mso-style-link:"Plain Text Char";
margin:0in;
mso-pagination:widow-orphan;
font-size:10.5pt;
font-family:Courier;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;
mso-bidi-font-family:"Times New Roman";}
p
{mso-style-priority:99;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;}
p.MsoAcetate, li.MsoAcetate, div.MsoAcetate
{mso-style-noshow:yes;
mso-style-priority:99;
mso-style-link:"Balloon Text Char";
margin:0in;
mso-pagination:widow-orphan;
font-size:9.0pt;
font-family:"Lucida Grande",sans-serif;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;}
p.MsoRMPane, li.MsoRMPane, div.MsoRMPane
{mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-parent:"";
margin:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.MsoListParagraph, li.MsoListParagraph, div.MsoListParagraph
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;}
p.MsoListParagraphCxSpFirst, li.MsoListParagraphCxSpFirst, div.MsoListParagraphCxSpFirst
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;}
p.MsoListParagraphCxSpMiddle, li.MsoListParagraphCxSpMiddle, div.MsoListParagraphCxSpMiddle
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;}
p.MsoListParagraphCxSpLast, li.MsoListParagraphCxSpLast, div.MsoListParagraphCxSpLast
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;}
span.Heading1Char
{mso-style-name:"Heading 1 Char";
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 1";
mso-ansi-font-size:14.0pt;
mso-bidi-font-size:16.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Arial;
mso-bidi-font-family:"Times New Roman";
mso-font-kerning:16.0pt;
font-weight:bold;
mso-bidi-font-weight:normal;}
span.Heading2Char
{mso-style-name:"Heading 2 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 2";
mso-ansi-font-size:13.0pt;
mso-bidi-font-size:13.0pt;
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;}
span.Heading3Char
{mso-style-name:"Heading 3 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 3";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#4472C4;
mso-themecolor:accent1;
font-weight:bold;}
span.Heading4Char
{mso-style-name:"Heading 4 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 4";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;
font-style:italic;}
span.Heading5Char
{mso-style-name:"Heading 5 Char";
mso-style-noshow:yes;
mso-style-priority:9;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Heading 5";
font-family:"Calibri Light",sans-serif;
mso-ascii-font-family:"Calibri Light";
mso-ascii-theme-font:major-latin;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:major-fareast;
mso-hansi-font-family:"Calibri Light";
mso-hansi-theme-font:major-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
mso-themeshade:191;}
p.text, li.text, div.text
{mso-style-name:text;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Plain Text";
margin-top:0in;
margin-right:0in;
margin-bottom:10.0pt;
margin-left:0in;
line-height:150%;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
span.PlainTextChar
{mso-style-name:"Plain Text Char";
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Plain Text";
mso-ansi-font-size:10.5pt;
mso-bidi-font-size:10.5pt;
font-family:Courier;
mso-ascii-font-family:Courier;
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Courier;
mso-bidi-font-family:"Times New Roman";}
p.Heading, li.Heading, div.Heading
{mso-style-name:Heading;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Heading 1";
margin-top:12.0pt;
margin-right:0in;
margin-bottom:12.0pt;
margin-left:0in;
mso-pagination:widow-orphan;
page-break-after:avoid;
mso-outline-level:1;
font-size:12.0pt;
font-family:"Arial",sans-serif;
mso-fareast-font-family:"MS Mincho";
mso-bidi-font-family:"Times New Roman";
mso-font-kerning:16.0pt;
font-weight:bold;
mso-bidi-font-weight:normal;}
p.quotes, li.quotes, div.quotes
{mso-style-name:quotes;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"Plain Text";
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
span.BalloonTextChar
{mso-style-name:"Balloon Text Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Balloon Text";
mso-ansi-font-size:9.0pt;
mso-bidi-font-size:9.0pt;
font-family:"Lucida Grande",sans-serif;
mso-ascii-font-family:"Lucida Grande";
mso-fareast-font-family:"Times New Roman";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:"Lucida Grande";
mso-bidi-font-family:"Lucida Grande";}
p.quotesheadline, li.quotesheadline, div.quotesheadline
{mso-style-name:"quotes headline";
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:quotes;
mso-style-next:quotes;
margin-top:0in;
margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Arial",sans-serif;
mso-fareast-font-family:"MS Mincho";
font-weight:bold;
mso-bidi-font-weight:normal;}
span.exldetailsdisplayval
{mso-style-name:exldetailsdisplayval;
mso-style-unhide:no;}
span.CommentTextChar
{mso-style-name:"Comment Text Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"Comment Text";
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.apple-converted-space
{mso-style-name:apple-converted-space;
mso-style-unhide:no;}
p.css-exrw3m, li.css-exrw3m, div.css-exrw3m
{mso-style-name:css-exrw3m;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.3m6-
{mso-style-name:_3m6-;
mso-style-unhide:no;}
span.3l3x
{mso-style-name:_3l3x;
mso-style-unhide:no;}
span.1lh7
{mso-style-name:_1lh7;
mso-style-unhide:no;}
span.1lld
{mso-style-name:_1lld;
mso-style-unhide:no;}
p.6coj, li.6coj, div.6coj
{mso-style-name:_6coj;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.6cok
{mso-style-name:_6cok;
mso-style-unhide:no;}
span.timestampcontent
{mso-style-name:timestampcontent;
mso-style-unhide:no;}
span.mbtext
{mso-style-name:mb_text;
mso-style-unhide:no;}
span.HeaderChar
{mso-style-name:"Header Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Header;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.FooterChar
{mso-style-name:"Footer Char";
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Footer;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.5uzb
{mso-style-name:_5uzb;
mso-style-unhide:no;}
span.accessibleelem
{mso-style-name:accessible_elem;
mso-style-unhide:no;}
span.z-TopofFormChar
{mso-style-name:"z-Top of Form Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"z-Top of Form";
mso-ansi-font-size:8.0pt;
mso-bidi-font-size:8.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:Arial;
mso-bidi-font-family:Arial;
display:none;
mso-hide:all;}
p.1obc, li.1obc, div.1obc
{mso-style-name:_1obc;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.z-BottomofFormChar
{mso-style-name:"z-Bottom of Form Char";
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:"z-Bottom of Form";
mso-ansi-font-size:8.0pt;
mso-bidi-font-size:8.0pt;
font-family:"Arial",sans-serif;
mso-ascii-font-family:Arial;
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:Arial;
mso-bidi-font-family:Arial;
display:none;
mso-hide:all;}
p.css-axufdj, li.css-axufdj, div.css-axufdj
{mso-style-name:css-axufdj;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.style-scope
{mso-style-name:style-scope;
mso-style-unhide:no;}
p.generic-articlesummary--li, li.generic-articlesummary--li, div.generic-articlesummary--li
{mso-style-name:generic-article__summary--li;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.diamond-blt, li.diamond-blt, div.diamond-blt
{mso-style-name:diamond-blt;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
p.font-copy, li.font-copy, div.font-copy
{mso-style-name:font-copy;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:"Calibri",sans-serif;
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/* List Definitions */
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</style><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Treatment and mitigation</b></p><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEghfoL728bwtkPcTOTu30O6bfCDMzLlEXDiP_B_NeNzRHkXiof-6mNGEHEVyMHT-S2DvYRUYonZsKqr_3SE9qikpXVOOSl1Agrjd5olKja4SXceAQvadaKTBVHM74U_jzyqq7inSy39W-MTsC5BLHr9KrWW5AuD9AXYcc7o4ufkjH6OieP49pUBbhVj=s1000" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="667" data-original-width="1000" height="213" src="https://blogger.googleusercontent.com/img/a/AVvXsEghfoL728bwtkPcTOTu30O6bfCDMzLlEXDiP_B_NeNzRHkXiof-6mNGEHEVyMHT-S2DvYRUYonZsKqr_3SE9qikpXVOOSl1Agrjd5olKja4SXceAQvadaKTBVHM74U_jzyqq7inSy39W-MTsC5BLHr9KrWW5AuD9AXYcc7o4ufkjH6OieP49pUBbhVj=s320" width="320" /></a></div><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>RegenCov</u>: I was surprised that the Phase 3 trial of Regeneron’s monoclonal antibody treatment, from when early variants of SARS-CoV-2 were dominant, was <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2108163?">published</a> only last month. The product <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8662228/">does work</a> against the Delta variant – though likely not against Omicron.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>RegenCov and Lill</u>y: I mentioned in my last post that the federal government stopped distributing both these monoclonal antibody products to the states, based on fallacious figures from the CDC. Now they have <a href="https://www.washingtonpost.com/health/2022/01/09/monoclonal-antibodies-omicron/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F35b87ef%2F61dc11d99d2fda14d7e87780%2F599d6acbae7e8a3d46e1400f%2F14%2F66%2F61dc11d99d2fda14d7e87780">resumed distribution</a>, but are getting flak for it because of the Omicron story. This criticism is misguided, both because there is still a lot of Delta around in the US and because Omicron is less likely to send people to the hospital.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Masking</u>: I was slow to accept that face masks would help curb transmission of the coronavirus, but now I’m a convert. If I hadn’t been, a recent <a href="https://www.ajpmonline.org/article/S0749-3797(21)00557-2/fulltext">comparison</a> of countries with and without mask mandates in the spring of 2020 would have convinced me. The difference in daily per capita COVID-19 mortality was huge: 288.54 per million in countries without face mask policies, 48.40 in countries with face mask policies. The researchers picked a period when all 44 study countries had restricted movements and gatherings, and were able to take other mitigation measures into account. The US and Canada were excluded because the rules varied so much from state to state. Italy, incidentally, is now requiring KN95 masks inside both public transport and cultural events.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Keeping safe</u>: I’ve examined and tested many calculators intended to help people gauge how risky a given activity is, and the best I’ve seen is <a href="https://mycovidrisk.app/">this one</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Ivermectin</u>: The <a href="https://covid19criticalcare.com/covid-19-protocols/i-mask-plus-protocol/">ivermectin-mongering</a> physician Paul Marik, whose chief paper was withdrawn after his hospital revealed he’d faked the statistics, has prudently <a href="https://covid19criticalcare.com/wp-content/uploads/2022/01/FLCCC-Statement-Marik-EVMS-FINAL-1-4-22.pdf">chosen to resign</a> from his teaching position at the East Virginia Medical School before getting the boot. So now he’ll have more time for spreading pandemic lies and conspiracy theories.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Weed</u>? <a href="https://pubs.acs.org/doi/10.1021/acs.jnatprod.1c00946">Research</a> from the Linus Pauling Institute (check out what the institute says about <a href="https://lpi.oregonstate.edu/mic/vitamins/vitamin-C">vitamin C</a>) made a huge splash under headlines such as Bloomberg’s “Cannabis Compounds Prevented Covid Infection in Laboratory Study.” Actually those cannabinoids – which included CBD but not THC – did nothing of the sort. They merely blocked SARS-CoV-2 from entering cells in a testtube, in a study so far behind the times that the its examples of “the most concerning and widespread” variants are Alpha and Beta. Know what other drugs do the same thing? <a href="https://www.sciencedirect.com/science/article/pii/S0968000421001183">Heparin</a>,<a href="applewebdata://5CA6A952-7274-45C0-A832-1E90582A2A68/umifenovir">umifenovir</a>, <a href="https://www.nature.com/articles/s41429-021-00491-6">ivermectin</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7128816/">hydroxychloroquine</a>, all of which flopped as antivirals in human bodies.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Azithromycin (Zitromax, Z-pak)</u>: Despite having been proven a year ago to have no value in treating COVID-19 either <a href="https://www.medrxiv.org/content/10.1101/2020.12.10.20245944v1">inside</a> or <a href="https://www.principletrial.org/news/azithromycin-and-doxycycline-are-not-generally-effective-treatments-for-covid-19-shows-principle-trial">outside</a> the hospital, this antibiotic is being prescribed so much by ignorant Italian doctors that <a href="https://www.ilgiorno.it/cronaca/zitromax-covid-1.7244232">pharmacies have run out</a>. Unfortunately only <a href="https://www.ilgiorno.it/cronaca/zitromax-covid-1.7244232" target="_blank">a few</a> Italian science writers <a href="https://roma.repubblica.it/cronaca/2022/01/12/news/omicron_finito_lo_zitromax_in_tutta_italia_la_medicina_anticovid_e_introvabile-333591917/">have done their homework</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"> <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Vaccine news</b></p><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgnY_V-5tv8ukTYsmBvy4CGFq27lWBjSDE_m8Rs4TKDC7Aixh4NQ1CR2csioTkzxY9STpgbnWbJwhyePCC2R7RRDO4SCCF8M3Ig29D3QYOJgzAs9Q0zNWaywpGimXVUcHBp2E8Wb6DflincgaVIHI9MUUVYnfp-L35hSMWzQjh7jIzlT5eqM-7SVyWv=s1200" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1200" data-original-width="1109" height="640" src="https://blogger.googleusercontent.com/img/a/AVvXsEgnY_V-5tv8ukTYsmBvy4CGFq27lWBjSDE_m8Rs4TKDC7Aixh4NQ1CR2csioTkzxY9STpgbnWbJwhyePCC2R7RRDO4SCCF8M3Ig29D3QYOJgzAs9Q0zNWaywpGimXVUcHBp2E8Wb6DflincgaVIHI9MUUVYnfp-L35hSMWzQjh7jIzlT5eqM-7SVyWv=w594-h640" width="594" /></a></div><br /><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Sinovac’s Coronavac</u>: Already the least effective vaccine around, albeit widely used worldwide. Now <a href="https://www.medrxiv.org/content/10.1101/2021.12.27.21268459v1.full.pdf">a lab study</a> says it’s likely to be completely useless against the Omicron variant.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Boosteritis</u>: Pfizer boosters have <a href="https://jamanetwork.com/journals/jama/fullarticle/2788104">now been shown</a> to reduce infection rates by over 90% as compared with “complete” vaccination, and to be <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2115926?query=TOC&cid=NEJM%20eToc,%20December%2023,%202021%20DM567993_NEJM_Non_Subscriber&bid=749293983">particularly effective</a> in young people ages 16-29. Israel is now moving on to <a href="https://www.timesofisrael.com/over-250000-people-have-received-4-covid-vaccine-doses-ministry/">4<sup>th</sup> doses</a> for healthcare workers, people over 60, and the immunosuppressed. <a href="https://www.reuters.com/world/americas/chile-vaccine-front-runner-launches-fourth-covid-dose-2022-01-10/">Chile is following suit</a>, though only in the immunocompromised. They should probably broaden eligibility, given their dependence on <a href="https://www.gob.cl/en/news/sars-cov-2-vaccines-used-chile-remain-highly-effective-preventing-hospitalization-icu-admission-and-death/">Sinovac</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Johnson & Johnson</u>: Preliminary results from a <a href="https://www.medrxiv.org/content/10.1101/2021.12.28.21268436v1.full.pd">study</a> among South African health workers suggest that a two-dose regimen – with a booster 6-9 months after the first shot – provides 85% protection against hospitalization due to the Omicron variant. That looks at first glance about as good as Pfizer. But the extremely high proportion of South Africans who have had COVID-19 (about 70%), means that population has an additional source of immunity, so this study can’t be generalized elsewhere. The follow-up period was also very brief, and the efficacy of the J&J vaccine tends to wear off fast.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Corbevax</u>: I got the spelling wrong last time but not the lack of evidence in its favor. Let’s root for high efficacy, especially since the Texas group have deliberately and generously created a cheap and easy vaccine <a href="https://www.democracynow.org/2022/1/3/patent_free_vaccine_in_texas?">aimed at the developing world</a> (it’s even vegan and halal!). For one millisecond I thought there actually had been <a href="https://www.precisionvaccinations.com/vaccines/corbevax-covid-19-vaccine">Phase 3 trials</a>, before discovering that the term was being misused: the trials they’re calling Phase 3 were actually only Phase 2, showing the vaccine was “safe, well-tolerated, and immunogenic.” Real Phase 3 trials, looking at real-world efficacy among tens of thousands of volunteers, don’t even seem in the works, just one using Corbevax as a <a href="https://www.business-standard.com/article/current-affairs/biological-e-gets-approval-to-conduct-trials-of-corbevax-as-booster-dose-121122900030_1.html">booster dose</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Novavax</u>: The United States/Mexico Phase 3 trial has <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2116185?query=TOC">now been published</a>, with nothing new since we first saw the preprint of the manuscript: topline efficacy of 90%, long before Delta appeared on the scene. The <a href="https://www.pharmatimes.com/news/astrazeneca_and_novavax_say_their_vaccines_are_effective_against_omicron_1385721%5d">company says</a> the antibodies their vaccine elicits should knock out Omicron, let’s hope.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>CanSino</u>: Hadn’t heard from them for a long time, but now a <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02753-7/fulltext">Phase 3 trial</a> has shown 57.5% efficacy against symptomatic COVID-19 and 90% efficacy against severe disease, after a single dose. But it worked less well in women and in people over 60, and protection began to wane quickly. Though that topline efficacy is less than other viral vector vaccines, Johnson & Johnson and AstraZeneca, CanSino’s could be useful in the developing world given easy storage in the fridge. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Pfizer vs. Moderna</u>: A <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2106599?query=TOC">case-control study</a> among American healthcare personnel, unfortunately pre-Delta, proves once again that Moderna rules the roost. It was more effective than Pfizer both after a single dose (89% vs. 78%) and after a complete two-dose course (96% vs. 89%). Effectiveness decreased slightly overall by 13-14 weeks, but too few subjects had received Moderna to be able to detect differences.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>AstraZeneca</u>: The sole properly-performed Phase 3 trial, the one conducted mostly in the United States, has now been <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2105290?query=TOC">published</a>, 10 months after the company suffered the humiliation of being publically <a href="https://www.nih.gov/news-events/news-releases/niaid-statement-astrazeneca-vaccine">reprimanded</a> by the US Food and Drug Administration for fudging its data. Overall efficacy was 74%, considerably less than the 79-80% that had been announced in the company’s <a href="https://www.astrazeneca.com/content/astraz/media-centre/press-releases/2021/astrazeneca-us-vaccine-trial-met-primary-endpoint.html">original press release</a>, though better than the 64% in AstraZeneca’s crummy original trials. This vaccine has been abandoned in Europe and even (almost entirely) in its native UK due to clotting complications, and will certainly never be used in the US, but it can still be valuable in the developing world. This is yet another study that predated Delta… Against Omicron the best AstraZeneca can <a href="https://www.pharmatimes.com/news/astrazeneca_and_novavax_say_their_vaccines_are_effective_against_omicron_1385721">claim</a> is that a 3-dose series produced as many neutralizing antibodies as 2 doses of Pfizer. Since a 2-dose course of Pfizer gives only 33% protection in the real world, that’s really nothing to brag about.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Universal vaccines</u>: Articles last spring in <a href="https://www.science.org/content/article/vaccines-can-protect-against-many-coronaviruses-could-prevent-another-pandemic?utm_campaign=SciMag&utm_source=Social&utm_medium=Facebook&fbclid=IwAR02keOgQ-4wmUAakGmo4NaOEGTytWztlmWrbRHD4Z02ktWnLSLLXO70HEo">Science</a> and <a href="https://www.theatlantic.com/science/archive/2021/04/finding-universal-coronavirus-vaccine/618701/">The Atlantic</a> described a variety of approaches researchers are taking to create a vaccine that might knock out current and even future variants. One, from biologist Pamela Bjorkman in California, cobbling together spike protein fragments from several coronaviruses, stimulated antibody production in miceeven against some coronaviruses not included in the vaccine. Another approach is illustrated at the top. A recent <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2118468?query=TOC">think piece</a> by Anthony Fauci and colleagues breathed new life into the subject by brilliantly setting out the necessary and desirable properties of such a vaccine. But they had little to say about how to achieve it.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Do vaccines make infected people less contagious?</u> A <a href="https://www.nejm.org/doi/10.1056/NEJMoa2116597">British study</a> says people fully vaccinated with Pfizer are half as likely to transmit infection as those who are unvaccinated, though that advantage falls markedly over 14 weeks. AstraZeneca’s already paltry edge reaches zero by 12 weeks.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Should COVID-19 survivors get vaccinated</u>? <a href="https://www.medrxiv.org/content/10.1101/2021.12.21.21268058v1">Brazil has investigated,</a> and found additional protection from vaccination over natural immunity that ranges from 39% for Sinovac to 65% for Pfizer, with AstraZeneca and J&J in between. Everybody should get vaccinated.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Myocarditis redux, again</u>: A <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2110737?query=TOC">study</a> by an Israeli insurance company, limited to people 16 and over, puts the risk after the <b><i>first vaccine</i></b><i> dose</i> at about 1 in 10,000 male vaccinees between 16 and 29 years old. Since the incidence is known to be higher after the second dose, this is consistent with the 1 in 6273 after <b><i>dose 2</i></b> for boys 12-18 in a US study based on <a href="https://www.medrxiv.org/content/10.1101/2021.08.30.21262866v1.full.pdf">Vaccine Adverse Event Reporting System reports</a>. The authors of the VAERS study are somewhat dubious, with a slight odor of novax, and a <a href="https://www.bmj.com/content/374/bmj.n2251">BMJ article</a> has criticised their results. But even tainted messengers can at times bring a correct message, and I fear this is one of those times. The VAERS results are very close to the 1 in 6637 estimated for Israeli boys ages 16-19 in a <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2109730?">population-wide</a> analysis. They also jibe with a <a href="https://www.medrxiv.org/content/10.1101/2021.12.23.21268276v1.full.pdf">brand-new UK study</a> that found myocarditis during the 4 weeks after dose 2 in one in 9900 males <b><i>under 40</i></b>, a rate 14 times higher than the rate of myocarditis following a positive test for SARS-CoV-2; there were too few adolescent boys to analyze separately. The CDC has <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-06/05-COVID-Wallace-508.pdf">acknowledged</a> the complication, “<a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-06/03-COVID-Shimabukuro-508.pdf">predominantly in male adolescents and young adults</a>,” without providing any statistics of its own.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Omicron</u>: Our best current info comes from the UK’s December 31<sup>st</sup> <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1044481/Technical-Briefing-31-Dec-2021-Omicron_severity_update.pdf">government report</a>. A single dose of Pfizer or Moderna lowered the risk of Omicron hospitalization by 52% as compared with unvaccinated controls, 2 doses by 72%, and 3 doses by 88%. Against <i>any</i> symptomatic Omicron, double-dose AstraZeneca was less than 30% effective and by 20 weeks it was totally useless. Two doses of an mRNA vaccine started out around 60% but by 20 weeks barely beat AstraZeneca. A booster dose of Pfizer raised effectiveness to 60%, though by 5 weeks the improvement was already slipping. Moderna did better, as usual, hitting 70-80% protection lasting at least 9 weeks. At this point the only image that gives me any sense of optimism is of Pfizer’s scientists working like mad to develop an Omicron-specific vaccine. If they succeed I’ll be the first on my block to hold out my arm. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Variant watch</b></p><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEga1BldbNjVIsv0QvCuZ6hjJ6oFKpJec9HlPHuDCX7W99-HybOiiXtWRb6JWwiYJomWs0l8otU8mx0_9TJJqKgxnPwnjtoDksy-hIbSz4xSkW_ULjy1Xcds8bdtnB1B1sZB-rHQCm5Vv9USTjvv6Lm2890kuHNATmyo_wY9vFA-tMfs3nttsBO__htw=s600" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="338" data-original-width="600" height="180" src="https://blogger.googleusercontent.com/img/a/AVvXsEga1BldbNjVIsv0QvCuZ6hjJ6oFKpJec9HlPHuDCX7W99-HybOiiXtWRb6JWwiYJomWs0l8otU8mx0_9TJJqKgxnPwnjtoDksy-hIbSz4xSkW_ULjy1Xcds8bdtnB1B1sZB-rHQCm5Vv9USTjvv6Lm2890kuHNATmyo_wY9vFA-tMfs3nttsBO__htw=s320" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Didier Raoult</td></tr></tbody></table><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>B.1.640.2</u>: Remember Didier Raoult, the French celebrity virologist who caused unmeasurable harm early in the pandemic with fake research that spawned the hydroxychloroquine craze? <a href="https://www.medrxiv.org/content/10.1101/2021.12.24.21268174v1.full-text">He’s resurfaced</a>, describing a dozen cases of a new SARS-CoV-2 variant imported from Cameroon. It doesn’t have a Greek letter yet, and may never get one given the <a href="https://www.nytimes.com/2022/01/05/world/covid-variant-france.html">lack of concern</a> in WHO circles, but Raoult has immodestly dubbed it IHU after his own workplace, the Institut Hospitalo-Universitaire.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Flurona</u>: Don’t be fooled. This is <i>not</i> a new variant, but one unvaccinated pregnant woman in Israel and a few young people <a href="https://www.smithsonianmag.com/smart-news/flurona-cases-of-co-infections-increase-amidst-peak-influenza-season-and-omicron-variant-surge-180979341/">in the US</a> who got <a href="https://world-today-news.com/5-facts-about-florona-influenza-corona-double-infection-that-happened-in-israel/">infected with two viruses</a> at once, influenza and SARS-CoV-2. Double infections like this do happen, and the patients have all recovered quickly.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Deltacron</u>: Researchers in Cyprus <a href="https://7news.com.au/travel/coronavirus/omicron-and-delta-covid-variant-reportedly-discovered-with-dozens-infected-so-far--c-5247343">say</a> they’ve found 25 cases of a novel variant, with Omicron-like genetic signatures within a Delta genome. But <a href="https://www.ctvnews.ca/health/coronavirus/deltacron-variant-discovery-most-likely-lab-error-health-experts-say-1.5734310">many experts think</a> they’re being fooled by cross-contamination in the lab.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Staying home in the USA</b></p><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiGgaQNzG4udWWo19zqaOZ5tyEnHBwa4by0LjTmvxB28PkBuvyoWoIxo3B4WSL4xn6lu5DkiDDHv2OuPntUEvkt0rRCW1k_SZgl0DQfdiPyugS-LELoqX_GMJxgDzsNhWRyVUqvHhySSFQxRo1Wj4-TSA5iJ1uSvy2ufMj6O3Y-yY92bIdJ4JsGEPSM=s1428" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="420" data-original-width="1428" height="190" src="https://blogger.googleusercontent.com/img/a/AVvXsEiGgaQNzG4udWWo19zqaOZ5tyEnHBwa4by0LjTmvxB28PkBuvyoWoIxo3B4WSL4xn6lu5DkiDDHv2OuPntUEvkt0rRCW1k_SZgl0DQfdiPyugS-LELoqX_GMJxgDzsNhWRyVUqvHhySSFQxRo1Wj4-TSA5iJ1uSvy2ufMj6O3Y-yY92bIdJ4JsGEPSM=w640-h190" width="640" /></a></div><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">After widespread shock greeted the CDC announcement of drastically slashed guidelines for quarantine and self-isolation, Anthony Fauci <a href="https://www.washingtonpost.com/health/2022/01/02/fauci-testing-covid-pandemic/">dropped hints</a> that the agency might at least add a testing requirement. But no, they’re <a href="https://www.npr.org/2022/01/04/1070413311/cdc-test-covid-isolation-five-days?sc=18&f=1001">sticking to their guns</a>, allowing people back in the community after 5 days without testing, though saying that if for some reason a person “<a href="https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html">wants to test</a>” it’s permitted. This choice seems to be for the worst possible reason: <a href="https://www.npr.org/2022/01/04/1070413311/cdc-test-covid-isolation-five-days?sc=18&f=1001">nobody follows the rules anyway</a>. According to NPR, “studies suggest” that only 25-30% of Americans with COVID-19 actually stay home for 10 days as they are supposed to. Equally embarassing is how <a href="https://www.washingtonpost.com/business/why-is-it-so-hard-to-get-a-rapid-covid-test-in-the-us/2021/11/23/7070f6f2-4c41-11ec-a7b8-9ed28bf23929_story.html">expensive and scarse</a> antigen tests are in the US. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">And here’s the kicker. Antigen tests are already lousy at detecting Delta, notoriously missing as many as <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06524-7">50% of infections</a>, and they’re turning out to be <b><i>even worse</i></b> at picking up Omicron. <a href="https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/sars-cov-2-viral-mutations-impact-covid-19-tests#omicronvariantimpact">Some tests</a> are completely unable to detect the new variant. Even those that supposedly work, don’t work well. <a href="https://www.medrxiv.org/content/10.1101/2022.01.04.22268770v1.full.pdf">One scrupulous study</a> studied viral loads and traced contacts on 30 vaccinated and boosted patients with PCR-proven Omicron COVID-19, having them test at home daily with Abbott BinaxNOW and/or Quidel QuickVue. Judging from viral loads, most of them were contagious for 3 or more days before the antigen test became positive, during which time 4 transmitted the infection to other people. Previous reassurances about precisely those tests had come not just from the <a href="https://ir.quidel.com/news/news-release-details/2021/Quidels-Antigen-Tests-Detect-the-Omicron-Variant/default.aspx">Quidel</a> and <a href="https://www.abbott.com/corpnewsroom/diagnostics-testing/an-update-on-omicron-and-test-effectiveness.html">Abbott</a> companies, but also from <a href="https://www.nbcchicago.com/news/local/do-rapid-at-home-tests-detect-the-omicron-variant-heres-what-experts-say/2717242/">the FDA</a>. I find this news scary and depressing. It implies that having a negative rapid test doesn’t mean much, whether for protecting your family at gatherings or for getting out of self-isolation. Interestingly, <a href="https://www.medrxiv.org/content/10.1101/2021.12.22.21268246v1.full.pdf">throat or salivary swabs</a> seem better than nasal swabs when it comes to Omicron, unlike earlier viral strains. I wonder whether <a href="https://ir.quidel.com/news/news-release-details/2021/Quidels-Antigen-Tests-Detect-the-Omicron-Variant/default.aspx">Quidel</a> and <a href="https://www.abbott.com/corpnewsroom/diagnostics-testing/an-update-on-omicron-and-test-effectiveness.html">Abbott</a> are the home testing kits soon to be <a href="https://www.washingtonpost.com/nation/2022/01/06/biden-covid-tests-usps/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F35b2409%2F61d81d5a9d2fda14d7e1e7df%2F599d6acbae7e8a3d46e1400f%2F22%2F59%2F61d81d5a9d2fda14d7e1e7df">sent by the Biden administration</a> to American families, supposedly free but <a href="https://apnews.com/article/coronavirus-pandemic-business-health-cb49a8458f33a698c3a4f3b721835270">more likely a pricing nightmare</a>.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">As for the supposed science underlying the 5-day limit, the chief research <a href="https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine-isolation-background.html">cited by the CDC</a> is a British <a href="https://www.medrxiv.org/content/10.1101/2021.12.23.21268326v1">modeling study</a> estimating that only 31% of Omicron cases are still infectious 5 days after their positive test. HOWEVER. Firstly, 31% is far from zero. Secondly, booster shots are our best bulwark against Omicron, and <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Vaccine+booster+doses&Interval=Cumulative&Relative+to+Population=true&Color+by+test+positivity=false&country=ITA~USA~GBR">more than twice</a> as many people have received them per capita in the UK (50%) than in the US (22%). Thirdly, on one <a href="https://www.nytimes.com/2022/01/05/opinion/omicron-covid-testing-cdc.html?campaign_id=2&emc=edit_th_20220106&instance_id=49563&nl=todaysheadlines&regi_id=19728476&segment_id=78835&user_id=d89c7002526915cc9287fae06e27a284">informal poll</a> 43% of American Omicron patients still had positive antigen tests more than a week after the first one, and given the tests’ low sensitivity even more were likely still infectious. Italian experts <a href="https://www.adnkronos.com/covid-italia-ricciardi-con-mix-delta-delta-plus-omicron-sara-gennaio-catastrofico_QQiLXDjKAvlzTJuMVfQMh">recommend</a> current antigen tests be scrapped for making any important decisions. Better ones must be developed, manufactured, and distributed, fast.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Then there’s the justification CDC chief <a href="https://www.washingtonpost.com/health/2022/01/02/fauci-testing-covid-pandemic/">Rochelle Walensky gave</a> to the Washington Post for not requiring testing. It’s ridiculously off the point: PCR tests “can yield positive results even when the patient is not infectious.” True, but those false positives occur far later than 5 days and, besides, no one’s proposing PCR tests for getting out of quarantine or self-isolation, especially not in the US, where results can take <a href="https://www.nbcchicago.com/news/local/demand-for-covid-testing-causes-supply-shortages-and-longer-wait-times-for-results/2717558/">6 days</a>. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Remember in May when <a href="https://www.npr.org/2021/05/13/996582891/fully-vaccinated-people-can-stop-wearing-masks-indoors-and-outdoors-cdc-says">Walensky said</a> vaccinated people could stop wearing masks, on the honor system? Remember when she decided to <a href="https://www.propublica.org/article/the-cdc-only-tracks-a-fraction-of-breakthrough-covid-19-infections-even-as-cases-surge">stop tracking</a> breakthrough infections if they didn’t lead to hospitalization or death? Remember her <a href="https://www.npr.org/2021/07/16/1017012853/97-of-people-entering-hospitals-for-covid-19-are-unvaccinated">false reassurance</a> in July: “If you're fully vaccinated, you are protected against severe COVID hospitalization and death and are even protected against the known variants, including the delta variant”?<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">This woman is just not up to the task.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I hear she’s <a href="https://edition.cnn.com/2022/01/07/politics/rochelle-walensky-cdc-communications-covid-19/index.html">hired a media consultant</a> to help her messaging (“<a href="https://www.washingtonpost.com/politics/2022/01/10/rochelle-walensky-is-not-good-this/">Rochelle Walensky Is Not Good At This</a>”) But in my opinion the problem is at least as much with the substance as with the spin.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Staying home in Italy</b></p><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhaxDh6c2wGXIwgzYy4-gNd809WCdeAjDXFnjKoutTxVfH1VSFJpwbuCkgrOOEYoAlJDZK0g9TiGmzt6EaVqPTqox3kACgD9YxxxO7aQ0NVWawAu868qI7eW8VbavGgW1Osj661GGGFjKUY5rvYrWtJEsAo8iyX_2119vZXC-qzmAFa9rLRsBip4_KV=s2560" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1707" data-original-width="2560" height="213" src="https://blogger.googleusercontent.com/img/a/AVvXsEhaxDh6c2wGXIwgzYy4-gNd809WCdeAjDXFnjKoutTxVfH1VSFJpwbuCkgrOOEYoAlJDZK0g9TiGmzt6EaVqPTqox3kACgD9YxxxO7aQ0NVWawAu868qI7eW8VbavGgW1Osj661GGGFjKUY5rvYrWtJEsAo8iyX_2119vZXC-qzmAFa9rLRsBip4_KV=s320" width="320" /></a></div><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Italy is more pandemic-cautious than the US, but it too is somewhat relaxing quarantine and self-isolation guidelines. A December 31<sup>st</sup> <a href="https://www.notiziedellascuola.it/legislazione-e-dottrina/indice-cronologico/2021/dicembre/CIRCOLARE_MS_20211230_60136">decree</a> lets close contacts who are boosted, recently vaccinated, or recently recovered <a href="https://www.notiziedellascuola.it/legislazione-e-dottrina/indice-cronologico/2021/dicembre/CIRCOLARE_MS_20211230_60136">skip quarantine</a>. But that’s only if they remain asymptomatic all week, wear a KN95 mask for 10 days, and test negative 5 days after their last exposure. Anyone who’s not fully vaccinated must still quarantine for 10 days, and people who completed their vaccination more than 4 months ago and haven’t been boosted must quarantine for 5 days followed by a negative test. In my opinion the reduced duration is a mistake, because Delta, still the dominant variant in Italy, has a longer incubation period. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Self-isolation of individuals who test positive but have no symptoms has also been reduced, from 10 days to 7, but that’s only if they are boosted or recently vaccinated, and in any case they must do a swab at the end. For everybody else self-isolation remains 10 days, again closing with a negative swab. For what they’re are worth.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The rules are so confusing that even science journalists get them wrong, <a href="https://www.ilfattoquotidiano.it/2021/12/31/caos-quarantene-dopo-il-silenzio-del-governo-la-circolare-chiarisce-lauto-sorveglianza-dura-5-giorni-da-asintomatici-non-serve-il-tampone/6441924/?">for example</a>: “Self-isolation only lasts 5 days and if there are no symptoms a negative swab is not required.” <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Omicronicles</b></p><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEi4QRySRMb4AlfAX32OZ8Ob9TZBjHbbdlv4NvdNnZ1BrpTt1byB-XoLFAbUJ_p_kPu2dUP6fvWXX2xDp7f6d60XpYSfm8Af4DjlR3pFk6sy3RMAcy66zsMIfq3d24VrDnC6VrMVXubYJr9dD4Z0rA1hEHqk_-u57ywCWcxnomoeXrPpu17qfmn6XoiH=s1280" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="582" data-original-width="1280" height="292" src="https://blogger.googleusercontent.com/img/a/AVvXsEi4QRySRMb4AlfAX32OZ8Ob9TZBjHbbdlv4NvdNnZ1BrpTt1byB-XoLFAbUJ_p_kPu2dUP6fvWXX2xDp7f6d60XpYSfm8Af4DjlR3pFk6sy3RMAcy66zsMIfq3d24VrDnC6VrMVXubYJr9dD4Z0rA1hEHqk_-u57ywCWcxnomoeXrPpu17qfmn6XoiH=w640-h292" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Amount of 3 viral strains growing in hamster tissues</td></tr></tbody></table><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Might the current American surge <a href="https://www.washingtonpost.com/health/2021/12/30/how-long-will-omicron-last/">peak in mid-January</a> and then fade fast? That’s what some <a href="https://www.nytimes.com/2022/01/06/opinion/omicron-covid-us.html?campaign_id=2&emc=edit_th_20220107&instance_id=49649&nl=todaysheadlines&regi_id=19728476&segment_id=78927&user_id=d89c7002526915cc9287fae06e27a284">predict</a>, based on the brevity of the Omicron spikes in <a href="https://www.npr.org/sections/coronavirus-live-updates/2021/12/31/1069476889/omicron-south-africa">South Africa</a> and perhaps in <a href="https://www.dailymail.co.uk/news/article-10387395/UKs-Covid-cases-fall-10-week-142-224-hospitalisations-flatten-out.html">the UK</a>. I’ve been skeptical about extrapolate the Omicron experience of either country to the US or Western Europe, because of South Africa’s young population and sky-high previous infection rate, and the UK’s super booster campaign. But there are some hints that the Pollyannas may be right, with wastewater coronavirus levels <a href="https://www.boston.com/news/coronavirus/2022/01/12/massachusetts-wastewater-data-omicron-peak/">falling in Boston</a> and cases starting to <a href="https://www.washingtonpost.com/health/2022/01/12/covid-omicron-plateau-new-york/">plateau in New York City</a>. As I too often find myself saying, time will tell.</p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I’ve previously described a study of surgical specimens that found Omicron to grow well in upper respiratory tissues but poorly in the lung, explaining lower rates of pneumonia. This has been confirmed now in <a href="https://www.nytimes.com/2021/12/31/health/covid-omicron-lung-cells.html?campaign_id=2&emc=edit_th_20220101&instance_id=49185&nl=todaysheadlines&regi_id=19728476&segment_id=78436&user_id=d89c7002526915cc9287fae06e27a28">laboratory animals</a>, with the above figure showing viral load in <a href="https://www.biorxiv.org/content/10.1101/2022.01.02.474743v1.full.pdf">hamster tissues</a> 4 days after inoculation. The figure is on a logarithmic scale, so the differences are larger than they look: compared with the wild strain Omicron grew 74% <i>less</i> in the lung, 90% <i>more</i>in the nose.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Remember that <a href="https://sciencenorway.no/covid19/at-least-140-people-were-infected-with-covid-19-after-christmas-party-in-oslo/1949790">party</a> in an Oslo restaurant where 150 people came down with COVID-19 within days? <a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2021.26.50.2101147?fbclid=IwAR1FAkPSHHzEMvbJpZQENsBOB-Mel57rX8tYjfdHDZ41D7XsBuEWIE_nl08">Investigators now say</a> that one person, who had returned from South Africa several days earlier, infected all of them in a single evening. Wow.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">We know previous infection with Delta doesn’t protect against reinfection with Omicron. How about vice-versa? A <a href="https://www.ahri.org/wp-content/uploads/2021/12/MEDRXIV-2021-268439v1-Sigal_corr.pdf">South African study</a> found that neutralizing antibodies against Delta increased in 13 patients after they had Omicron infections. However: 1) this is a very tiny study; 2) neutralizing antibodies in the lab do not necessarily translate into real-world protection; 3) we cannot generalize from these patients, all previously infected with Delta, to Delta-naïve people; 4) this would be relevant only in countries where the two strains coexist, currently including the US (<a href="https://covid.cdc.gov/covid-data-tracker/#variant-proportions">41.4%</a> of new cases are Delta) and Italy (<a href="https://www.ilmessaggero.it/salute/focus/omicron_delta_contagi_bambini_brusaferro_rezza_incidenza-6413635.html">79%</a>). Given how quickly Omicron has replaced Delta in the <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1044331/20211230_OS__Omicron_Daily_Overview.pdf">UK</a> and <a href="https://www.ecdc.europa.eu/en/news-events/weekly-epidemiological-update-omicron-variant-concern-voc-week-1-data-7-january-2022">several EU countries</a>, cross-immunity may soon be irrelevant. The World Health Organization has <a href="https://unric.org/en/who-50-of-the-population-in-europe-could-be-infected-by-covid-in-next-2-months/">made the horrifying prediction</a>that more than 50% of Europeans will be infected with Omicron over the next 6-8 weeks, with Anthony Fauci <a href="https://www.washingtonpost.com/nation/2022/01/12/covid-omicron-variant-live-updates/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F35bce12%2F61deb4c69d2fda14d7eca846%2F599d6acbae7e8a3d46e1400f%2F10%2F77%2F61deb4c69d2fda14d7eca846">extending that</a> to “just about everybody.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Evidence that Omicron causes milder disease keeps piling up. <a href="https://www.medrxiv.org/content/10.1101/2021.12.30.21268495v1.full.pdf">A study</a> of nearly 600,000 American patients followed over 3 days found that those diagnosed on December 15<sup>th</sup>-24<sup>th</sup>, when Omicron was spreading rapidly, were 56% less likely to be hospitalized, 67% less likely to wind up in the ICU, and 84% less likely to need a ventilator, than those – all Delta diagnosed (with Delta) during the previous 18 weeks. And in a UK <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1044481/Technical-Briefing-31-Dec-2021-Omicron_severity_update.pdf">government report</a> analyzing a million cases between November 22<sup>nd</sup> and December 26<sup>th</sup>, half Omicron and half Delta, the risk of hospital admission was two-thirds lower with Omicron. <o:p></o:p></p><p class="1obc" style="font-size: medium;"><o:p> </o:p></p><p class="1obc" style="font-size: medium;"><b>Mandate sanity Italian style</b></p><p class="1obc" style="font-size: medium; text-align: center;"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEh4hBb-Pd38ZwN2epFPArPFtx8MnpCWp-_M_4_tAZCHZP7juYSdaWND6XMIKg4O341CElsNKhO2qqLYAWWph-RxEenb3ORVvVm8H-uYslj8lF3Ji6qCVbgNWm2QbEW-o7u1OCFH2rRZ9HtMmUNeQvSH9rBPZy7nbvA8g687NbeYQwvGQwV6KFhaMfoA=s735" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="416" data-original-width="735" height="362" src="https://blogger.googleusercontent.com/img/a/AVvXsEh4hBb-Pd38ZwN2epFPArPFtx8MnpCWp-_M_4_tAZCHZP7juYSdaWND6XMIKg4O341CElsNKhO2qqLYAWWph-RxEenb3ORVvVm8H-uYslj8lF3Ji6qCVbgNWm2QbEW-o7u1OCFH2rRZ9HtMmUNeQvSH9rBPZy7nbvA8g687NbeYQwvGQwV6KFhaMfoA=w640-h362" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Not much distancing at this vaccine hub in Naples</td></tr></tbody></table><p></p><br /><p class="1obc" style="font-size: medium; margin-right: 6pt;">Researchers <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(21)00273-5/fulltext">have studied</a> how effective “Green Passes” are in promoting vaccination, and the bottom line is “very.” Here’s a concrete Italian example. During the first half of November, when unvaccinated people could still get into a restaurant or a movie theater based on an antigen swab, vaccinations were at a standstill – only 270,000 novaxers went for a first dose. In the second half of November a “Super Green Pass” (no test option) was pre-announced, and 340,000 novaxers repented. In December the rules actually tightened, and between the 1<sup>st</sup> and the 15<sup>th</sup>, 490,000 novaxers folded…. Out of 7 million people over 12 unvaccinated on November 1<sup>st</sup>, nearly 2 million had had a dose by December 31<sup>st</sup>. Yippie!<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The latest Italian decree is in my opinion just what the doctor ordered: a <a href="https://www.affaritaliani.it/coronavirus/vaccino-obbligatorio-per-over-50-ma-la-multa-per-i-trasgressori-solo-di-100Euro-773742.html">vaccine mandate</a> for everybody over 50. But if someone refuses to comply all they face is a one-off 100 euro fine (about $114). Is this some kind of joke?<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Italy’s making life so hard on the unvaccinated – now they can’t even get on a city bus – that one novax acquaintance and her mother are planning to move to the United States. <o:p></o:p></p><p class="1obc" style="font-size: medium;">Italy remains laser-focused on vaccines, which though invaluable won’t have any immediate effect. In the meantime COVID-19 infections are soaring, ICU cases creeping ominously upward, and even the daily death toll triple what it was at the beginning of December. At least everybody here wears masks inside public spaces and they’re testing like mad. But sporting and cultural events are cheek-to-jowl, nobody’s working from home, and young people party like it’s 2019. I say fix all that and impose a curfew. Plus why not add a lockdown for novaxers, with cops doing random checks on the streets flanked by out-of-work young people hired for the occasion? The one Austria instituted in December quickly (but alas briefly) slashed its case numbers by 80%. Drastic, but the only way I see to ward off a <i>real</i> lockdown.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Mandate madness Italian style</b></p><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiEUOLQ2J9lvakqNIKVHv3gRIMis04Ysx_a0T5fxsT0Kl0YjWm5a8sqpevFAywe6qRutV219x8jp1a157cViWH5TrsiA8oewWvT870xUriNC_sns-bpeDtnduyr4AQCJ9zmQQizeaXjEVHc-gB6ZyuMEQYNtBBruh6zluODsAmuhaw1x-SBhvFePAXL=s1498" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="674" data-original-width="1498" height="290" src="https://blogger.googleusercontent.com/img/a/AVvXsEiEUOLQ2J9lvakqNIKVHv3gRIMis04Ysx_a0T5fxsT0Kl0YjWm5a8sqpevFAywe6qRutV219x8jp1a157cViWH5TrsiA8oewWvT870xUriNC_sns-bpeDtnduyr4AQCJ9zmQQizeaXjEVHc-gB6ZyuMEQYNtBBruh6zluODsAmuhaw1x-SBhvFePAXL=w640-h290" width="640" /></a></div><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">COVID-19 vaccination for healthcare workers has been obligatory in Italy since this summer, with thousands of unvaccinated doctors, nurses, and hospital personnel already suspended without pay. More are still being ferreted out, as the professional licensing boards gain access to official vaccination data bases they can cross-tabulate with their membership rolls.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">For months the mandate was hailed as essential protection for patients, with nobody made a public peep in opposition. That ended December 19<sup>th</sup>, when 40 or 50 no-vax physicians <a href="https://www.italy24news.com/News/307245.html">screamed their way into a meeting</a> of Rome’s medical organization, shoved their colleagues around, commandeered the mic, and read out a manifesto against being forced to take “experimental” vaccines. I thought that kind of thing only happened in America! But I find it even more shocking that Rome’s medical organization has only suspended a few dozen unvaccinated physicians, when it claims to have evidence that <a href="http://direnl.dire.it/odm/anno/2021/dicembre/10/?news=C01">600 of them</a> are still plying their trade on hospital wards and in General Practitioner offices, 8 months after the mandate and suspension order kicked in.<o:p></o:p></p></div><p style="text-align: center;"><br /></p>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com0tag:blogger.com,1999:blog-6211405954943098401.post-37642878055797948352021-12-31T16:41:00.002+01:002022-01-01T00:20:52.751+01:00The Great Stay-Home Leave-Home Debate<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEinYAJdytlJZVDK0NVE75JO9CUkFkPPL-75aTxWc8jXQtm6tmaBArAQCOygOWcCq42wFGAXArwtYJzWJWyV92ulBy5Z57jttmM1nQI5oimYzfkQU7jC-c-8jXHf_6DdvqKoE0T1ZSA3OZ5GZu9aSq4rRhOA4hl1U3khLhJkydIHTr576QR0XL-TeMmQ=s1401" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="788" data-original-width="1401" height="225" src="https://blogger.googleusercontent.com/img/a/AVvXsEinYAJdytlJZVDK0NVE75JO9CUkFkPPL-75aTxWc8jXQtm6tmaBArAQCOygOWcCq42wFGAXArwtYJzWJWyV92ulBy5Z57jttmM1nQI5oimYzfkQU7jC-c-8jXHf_6DdvqKoE0T1ZSA3OZ5GZu9aSq4rRhOA4hl1U3khLhJkydIHTr576QR0XL-TeMmQ=w400-h225" width="400" /></a></div><style class="WebKit-mso-list-quirks-style">
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</style><p></p><p class="1obc" style="margin-right: 6pt;">The CDC’s new quarantine and isolation rules were what pushed me to publish today. But I'll also offer you big treatment and vaccine news, discouraging Omicron updates, graphic vaccination lessons, and more.<o:p></o:p></p><p class="1obc" style="margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Treatment news<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjt3hlLhB8aplagvjeBwaUo8Zh7L992EdvTA5JzHs-SrQ5WpofBTaa_UoGpveTliK_13TXl_OXA77gMU380LuX10hJIQr-nA3JOsG0UzrkY6GKBBuctmmQQgtwyAM8bzVmKyVJ4irzRMaFpnP3wZCTDEjc5Lfc_rPX8UYmJb4q1P66MhY7K26DkWl5o=s1400" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="840" data-original-width="1400" height="192" src="https://blogger.googleusercontent.com/img/a/AVvXsEjt3hlLhB8aplagvjeBwaUo8Zh7L992EdvTA5JzHs-SrQ5WpofBTaa_UoGpveTliK_13TXl_OXA77gMU380LuX10hJIQr-nA3JOsG0UzrkY6GKBBuctmmQQgtwyAM8bzVmKyVJ4irzRMaFpnP3wZCTDEjc5Lfc_rPX8UYmJb4q1P66MhY7K26DkWl5o=s320" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Convalescent plasma rides again</td></tr></tbody></table><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Paxlovid</u>: The most exciting update is the FDA <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-first-oral-antiviral-treatment-covid-19">authorizing</a> Pfizer’s pill for emergency use in high-risk COVID-19 outpatients, and the <a href="https://www.ns-healthcare.com/news/eu-regulator-recommends-paxlovid/">EMA allowing</a> European Union members to do so if they wish. Paxlovid has been shown to cut the risk of hospitalization and death in this group by nearly 90% if a 5-day course is started within 5 days. Plus – more big news – a trial in standard-risk patients seems to be showing <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-announces-additional-phase-23-study-results">70% fewer</a> bad outcomes. This could transform the shape of the pandemic, but I have several caveats. First, as yet we don’t know for sure it works against Omicron. Second, though it doesn’t have the serious risks associated with molnupiravir, not everyone can take it – not patients with liver or kidney disease, or on <a href="https://www.fda.gov/media/155050/download">medications</a> ranging from the antiinflammatory piroxicam to certain antiarrythmics, sleeping pills, anticonvulsants, even Saint John’s Wort. Many of those drugs can be safely paused for 5 days, though, to allow for Paxlovid trreatment.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Finally, to have a real impact on the pandemic a drug needs to be readily available worldwide. Given <a href="https://www.npr.org/sections/health-shots/2021/12/31/1069323181/covid-antivirals-paxlovid-molnupiravir">major supply shortages</a> the pill may arrive too late to flatten the curve of the Omicron surge – Italy won’t have any before <a href="https://www.adnkronos.com/pillola-covid-merck-e-pfizer-in-italia-da-fine-gennaio-2022_1I28m2r7ua8hBM5cDjQp10">February or even March</a>. And Pfizer must keep its <a href="https://www.pmlive.com/pharma_news/emergency_use_of_paxlovid_allowed_in_europe_1385583">promise</a> to lower prices from the current $529 per course if Paxlovid is to be <a href="https://corporateeurope.org/en/2021/11/bitter-pill">within reach</a> of middle- and low-income countries. Distribution issues can be expected even in some wealthy countries, notably the United States, whose chaotic healthcare non-system makes access to testing and physicians difficult for many people. This may change when Biden’s <a href="https://www.nytimes.com/2021/12/21/us/politics/omicron-covid-biden.html">half-billion</a> free home test kits get – <a href="https://www.nytimes.com/2021/12/22/us/politics/covid-tests-biden-omicron.html?campaign_id=2&emc=edit_th_20211223&instance_id=48395&nl=todaysheadlines&regi_id=19728476&segment_id=77755&user_id=d89c7002526915cc9287fae06e27a284">eventually</a> – into the hands of American families. Paxlovid is arguably the best single reason for home testing. <b>(Assuming those tests can detect Omicron, which is </b><a href="https://www.politico.com/news/2021/12/28/fda-antigen-tests-reduced-sensitivity-omicron-526217"><b>not guaranteed</b></a><b>.) <o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Molnupiravir</u>: Merck’s pill received an Emergency Use Authorization from the FDA the day after Pfizer’s, but I doubt its executives are happy. The FDA has demanded considerable further post-marketing research, and <a href="https://www.fda.gov/media/155053/download">wisely specifies</a>that this drug should be used only if “alternative COVID-19 treatment options authorized by FDA are not accessible or clinically appropriate.” Paxlovid and anti-Omicron monoclonal antibodies should soon arrive, so molnupiravir will likely be used very little… <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">…if at all. The full Phase 3 trial results for molnupiravir have now been <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2116044">published</a>, and the difference between the mediocre interim results and the frankly poor final results stands out like a sore thumb. The authors tried hard to explain it away as due to “imbalances between the analysis samples, shifts in the epidemiology of the Covid-19 pandemic, and regional variation among the enrolled participants.” But the real reason is inefficacy against the Delta variant: buried in a <a href="https://www.nejm.org/doi/suppl/10.1056/NEJMoa2116044/suppl_file/nejmoa2116044_appendix.pdf">supplementary appendix</a> is the crucial information that the drug was only 24% effective against Delta but 60% effective against other strains. Oddly, the New England Journal of Medicine <a href="https://www.nejm.org/doi/full/10.1056/NEJMe2117814">editorialist</a> didn’t pick up on this. Between efficacy that’s poor against Delta and unknown against Omicron this drug is next to useless. I’ve even submitted a letter to the editor, what the hell.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Even worse news for Merck from France: it’s <a href="https://www.reuters.com/world/europe/france-cancels-order-mercks-covid-19-antiviral-drug-2021-12-22/">cancelled its order</a> for 50,000 pills. I wish other countries would do the same, but Italy and Germany have instead confirmed theirs, and a first shipment <a href="https://www.interris.it/attualita/astrazeneca-variante-omicron/">has already arrived</a> on Italian soil. We’ll see what gets done with it.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Monoclonal antibodies</u>: Both the Lilly and Regeneron products have been shown by <a href="https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiab570/6429422">a Mayo Clinic study</a> to be effective against Delta not just in unvaccinated patients, but also in high-risk vaccinated people with <a href="https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiab570/6429422">breakthrough infections</a>, lowering the hospitalization rate by 77%. This was a retrospective study, though, and we can’t be sure without placebo-controlled clinical trials. Sotrovimab, the antibody expected to be most effective against Omicron, wasn’t examined. The US government is now frantically stockpiling sotrovimab, which has been scarse there and practically nonexistent in Europe.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Before Christmas the US Department of Health and Human Services <a href="https://www.forbes.com/sites/zacharysmith/2021/12/23/us-pauses-distribution-of-monoclonal-antibody-treatments-that-proved-ineffective-against-omicron/?sh=4b4386e24c62">stopped distributing</a> monoclonal antibodies from Lilly and Regeneron on grounds of their probable inefficacy against Omicron. But this was based on the umpteenth screwup from the CDC, which had <a href="https://apnews.com/article/omicron-majority-us-cases-833001ef99862bd6ac17935f65c896cf">claimed</a> that 73% of new cases in the US were due to Omicron. The next week it turned out the real figure is <a href="https://www.npr.org/2021/12/28/1068643344/cdc-omicron-covid-19-delta-revise-estimates">not 73% but……23%</a>! This revision, or rather admission of incompetence, means Delta is still by far the dominant strain in the US and Lilly and Regeneron are still invaluable. Hopefully that distribution will restart pronto.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Remdesivir</u>: A study I’ve mentioned showing remdesivir can help outpatients has now been <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2116846">published</a>: 87% efficacy at preventing hospitalization or death at 28 days, among high-risk unvaccinated patients treated within a week. This would be grand, if not that 1) we don’t know whether it works in vaccinated people, and 2) patients have to drag themselves in 3 days in a row for lengthy intravenous infusions. Since monoclonal antibodies can be given in a single dose, and the Paxlovid pill will be even more convenient, outpatient remdesivir will probably be used only in people with contradictions to Paxlovid and no access to monoclonals.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Convalescent plasma</u>: This treatment was discarded months ago but now seems to have risen phoenix-like from its ashes, with a <a href="https://www.medrxiv.org/content/10.1101/2021.12.10.21267485v1.full.pdf">large American study</a> finding a dose of antibody-loaded plasma cut hospitalization rates by 54%, in the Delta era, when given early to unselected COVID-19 patients. The FDA has <a href="https://www.fda.gov/media/141477/download">already acted</a> on these results.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Vaccine news<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgWy1DHEACycyA81u4KOS0jmzMj3i_6kfPZ8lE0u7FOmR4CNA1i0Th2O67kqGgWZU_b2wGCjIGlLZI2ml0IwPy4NGUyGO-MVRe8QtNcqf-LQbpssHjC1bQjhJbcU_SkhagzlyOSMGQxuyEQGrDBz41tczcyI0mK5iFTepxJgnOoXkBITUF9g7BF4ZJM=s780" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="438" data-original-width="780" height="226" src="https://blogger.googleusercontent.com/img/a/AVvXsEgWy1DHEACycyA81u4KOS0jmzMj3i_6kfPZ8lE0u7FOmR4CNA1i0Th2O67kqGgWZU_b2wGCjIGlLZI2ml0IwPy4NGUyGO-MVRe8QtNcqf-LQbpssHjC1bQjhJbcU_SkhagzlyOSMGQxuyEQGrDBz41tczcyI0mK5iFTepxJgnOoXkBITUF9g7BF4ZJM=w400-h226" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Donald Trump gets booed for admitting he had a vaccine booster</td></tr></tbody></table><br /><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Myocarditis, again</u>: New Zealand is investigating the cases of a 13-year-old boy and a 26-year-old man who <a href="https://covid19.govt.nz/news-and-data/latest-news/statement-from-the-covid-19-vaccine-independent-safety-monitoring-board/">died from myocarditis</a> following the Pfizer vaccine. I know of only 2 other such deaths, but the risk of myocarditis is high enough that I continue to advise prudence regarding boosters to males under 30, and in favor of delaying their second doses. In a new <a href="https://www.bmj.com/content/375/bmj-2021-068665">study</a> from Denmark Moderna caused 3 times as much myocarditis as Pfizer, so it’s clearly to be avoided in that age group.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Vaccine politics</u>: “<a href="https://eu.usatoday.com/story/news/nation/2021/12/20/moderna-booster-effective-against-omicron-study-shows-covid-19-news/8963500002/">Trump was appearing</a> on Bill O'Reilly's ‘History Tour’ at the American Airlines Center in Dallas when the host asked if he was boosted. ‘Yes,’ Trump replied.” This confession was <a href="https://theweek.com/donald-trump/1008266/trump-waves-off-boos-after-he-bill-oreilly-reveal-theyve-received-the-covid">met with boos</a>. If Anthony Fauci was “<a href="https://slate.com/news-and-politics/2021/12/fauci-stunned-trump-supporters-booed-booster-covid.html">stunned</a>” that only means he’s out of touch.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Johnson & Johnson</u>: <a href="https://www.medrxiv.org/content/10.1101/2021.12.28.21268436v1.full.pdf">Preliminary evidence</a> from an observational study in South Africa suggests that a second shot protects well against hospitalization due to the Omicron variant. But confirmation from countries with older populations, fewer people exposed to the coronavirus, and higher vaccination rates will be necessary before we start recommending a J&J booster over a Pfizer one.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Corbavax</u>: This <a href="https://www.washingtonpost.com/world/2021/12/30/corbevax-texas-childrens-covid-vaccine/">new entry</a>, inexpensive and easy to produce, was developed by researchers at the Texas Children’s Hospital and is already approved in India. But there’s as yet minimal proof of its efficacy.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Novavax</u>: Double good news for this company’s vaccine, but important caveats. First, it’s been approved by the European Medicines Agency, becoming the 5<sup>th</sup> one available in the EU. Caveat: its Phase 3 studies were all completed before Delta and <i>way </i>before Omicron, and it was ineffective against Beta, so we don’t know how well it will perform in the current phase of the pandemic. Some think the conventional technology of Novavax – similar to our normal hepatitis vaccine – will convince those who think “experimental” vaccines will mess with their DNA and spread spike protein around their body to get vaccinated. I have my doubts. Conspiracy theories mutate even more rapidly than coronaviruses. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Also: <a href="https://www.biospace.com/article/releases/novavax-announces-initiation-of-prevent-19-covid-19-vaccine-phase-3-trial-booster-study/">twin booster trials</a> are now underway. One arm will give a third dose to volunteers in the original Phase 3 trials, while the other will use it as a heterologous booster to other vaccines. Heterologous boosting could be its main use in Italy. Caveat: I hope the booster works better in real life than it <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02717-3/fulltext">did in the lab</a>, when it looked particularly mediocre in people who’d been vaccinated with AstraZeneca or Pfizer. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Moderna meets Omicron</u>: A small company-funded <a href="https://www.medrxiv.org/content/10.1101/2021.12.15.21267805v2">laboratory study</a> has found that two doses of Moderna, like Pfizer, do little against the Omicron variant, but that a third dose gives a big boost to neutralizing antibodies. The <a href="https://www.npr.org/sections/health-shots/2021/12/15/1064202754/omicron-evades-moderna-vaccine-too-study-suggests-but-boosters-help">researchers conclude</a> that there’s no need to make variant-specific versions of the vaccine. If Moderna throws in the towel, I hope Pfizer doesn’t. Given that neutralizing antibodies <a href="https://deliverypdf.ssrn.com/delivery.php?ID=839101122089124078124121006121111081023038005086089069018123119119094026119017102075106041116007045039113100114114089065024111106091030041064028090011010001088015070024041035066089111019113025124072118107025125109099118087073122073112111126069116003091&EXT=pdf&INDEX=TRUE">don’t necessarily translate</a> into real-life efficacy, that Pfizer’s effectiveness against Omicron seems <a href="https://khub.net/documents/135939561/430986542/Effectiveness+of+COVID-19+vaccines+against+Omicron+variant+of+concern.pdf/f423c9f4-91cb-0274-c8c5-70e8fad50074">much less</a> than it was against Delta, and that we have close to zero real-life data for Moderna, am I allowed to say this conclusion pisses me off? <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">…We do now have two morsels of Moderna data: in a superduperspreader event in Norway, people who had been vaccinated with Moderna were <a href="https://sciencenorway.no/covid19-vaccines/oslo-christmas-party-outbreak-most-of-the-non-infected-were-vaccinated-with-moderna/1954619">less likely</a> to get sick than those vaccinated with Pfizer, leading the Norwegian Institute of Public Health director to say that, like me, she’d take a Moderna booster after 2 doses of Pfizer. An English <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1043807/technical-briefing-33.pdf">government report</a> also suggests Moderna boosters are a bit better than Pfizer in preventing Omicron. But there’s bad news from that same <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1043807/technical-briefing-33.pdf">report</a>: boosters’ enhanced protection against Omicron wore off fast, dropping at 10 weeks by 15%-25%.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Pfizer meets Omicron</u>: A <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2119270?fbclid=IwAR2h5Hid2lUSlNVCuKPoDHGoSYlwaT7Z6E39X5rIa-F0lf4doOq6n8z6-yo">study from South Africa</a> suggests that double-dose Pfizer vaccine lowers the risk of hospitalization by 70%, much better than their 33% or so effect on COVID-19 overall. As usual, effectiveness may be different in Western countries.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>The cavalry to the rescue</u>: The United States Army <a href="https://www.defenseone.com/technology/2021/12/us-army-creates-single-vaccine-effective-against-all-covid-sars-variants/360089/">has announced</a> to considerable <a href="https://yourlocalepidemiologist.substack.com/p/pan-coronavirus-super-vaccine?token=eyJ1c2VyX2lkIjo2MzU4MzkxOCwicG9zdF9pZCI6NDU5MTUzNDEsIl8iOiJWSnhCMSIsImlhdCI6MTY0MDU3OTcxNiwiZXhwIjoxNjQwNTgzMzE2LCJpc3MiOiJwdWItMjgxMjE5Iiwic3ViIjoicG9zdC1yZWFjdGlvbiJ9.REFv6NOEdLj1KUMN-UX8M-KNYGBSPA2lqbeLopHRMlc">hype</a> that they’ve developed a vaccine good against <i>all</i> SARS-CoV-2 variants including Omicron. <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2118468">Universal vaccines</a> are one of my favored pipedreams but – hold on – human trials of this candidate vaccine are only at Phase 1. And even those results, about short-term safety and immune system stimulation, haven’t been released yet. Their research in monkeys has mostly looked at <a href="https://www.science.org/doi/10.1126/scitranslmed.abi5735">immune responses</a>, and the <a href="https://www.nature.com/articles/s41541-021-00392-7">one study</a> of protection against disease was in hamsters. Furthermore, the hamsters were given only Alpha and Beta variants, and in monkeys the immune response was particularly weak against Delta. If this vaccine ever hits the market, it will be many months from now.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Infectiousness</u>: A <a href="https://www.mdpi.com/2076-393X/9/11/1267">German study</a> has found that people exposed to a fully vaccinated infected individual were about one-third as likely to become infected themselves than if they were exposed to someone who was not vaccinated. While not surprising, this is reassuring.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>It wanes, it wanes not</u>: We know that protection against severe COVID-19 stays high for many months after vaccination even as protection against mild or asymptomatic infection falls away. <a href="https://www.science.org/doi/10.1126/science.abm0829">One small but careful study</a> helps to understand why: memory B cells and memory T cells persist and even increase over 6 months, while ordinary anti-spike antibodies tank. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Booster nightmares</u>: In Israel they’ve found that antibodies start falling just a few months after the booster, so they were all set to start giving <a href="https://www.bbc.com/news/world-middle-east-59749967">a 4th dose</a> of Pfizer to healthcare workers and elderly people who had their 3<sup>rd</sup> doses back in July and August. But now they’re doing a <a href="https://www.nytimes.com/2021/12/23/world/middleeast/israel-vaccine-4th-dose.html?campaign_id=2&emc=edit_th_20211224&instance_id=48633&nl=todaysheadlines&regi_id=19728476&segment_id=77833&user_id=d89c7002526915cc9287fae06e27a284">clinical trial</a> instead, definitely a better idea. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Staying home<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjsPPa_DwrCdO6eXOirtEIVRcjsfQecK7QeEpKxxDF7xN9X1OgTOPh0LPj68fpgOoT9LJzu3Y_8NaIXTYs2VEpO5q889fLSTcsp_Bwl9xuoXODifx20sQNcaEGmoVkhrXY2zk8rGOH6t3w-gnqyKZNxb-pgm1TcdFR_ljjhRz6m5sZUDMvLOAr9CRKb=s1394" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="928" data-original-width="1394" height="266" src="https://blogger.googleusercontent.com/img/a/AVvXsEjsPPa_DwrCdO6eXOirtEIVRcjsfQecK7QeEpKxxDF7xN9X1OgTOPh0LPj68fpgOoT9LJzu3Y_8NaIXTYs2VEpO5q889fLSTcsp_Bwl9xuoXODifx20sQNcaEGmoVkhrXY2zk8rGOH6t3w-gnqyKZNxb-pgm1TcdFR_ljjhRz6m5sZUDMvLOAr9CRKb=w400-h266" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">The Oslo Christmas party restaurant</td></tr></tbody></table><br /><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Self-isolation</u>: Here’s its death by 1000 cuts. Infected individuals have always been advised to stay home in complete isolation for 10 days. Before Christmas I was scandalized by new English guidelines <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/uk-reduces-covid-19-self-isolation-7-days-most-england-2021-12-22/">cutting self-isolation</a> from 10 days to 7, following two negative antigen swabs. The English authorities themselves didn’t seem fully convinced, if they “strongly advised” those leaving self-isolation early to “limit contact with others in crowded or poorly ventilated spaces, work from home and minimise contact with those most vulnerable to COVID-19.” <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Next the Centers for Disease Control <a href="https://thehill.com/policy/healthcare/public-global-health/587199-asymptomatic-healthcare-workers-with-covid-19-can%5d">approved</a> shortening the self-isolation period to 7 days for healthcare workers. I thought that was a particularly bad idea, since we know people remain infectious for <a href="https://www.ecdc.europa.eu/en/covid-19/latest-evidence/infection">up to 10 days</a>, and hospital patients are the last people we should be exposing to SARS-CoV-2. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Now the CDC has gone <a href="https://www.cdc.gov/media/releases/2021/s1227-isolation-quarantine-guidance.html">one step further</a> in the wrong direction, saying that <i>all</i> swab-positive people whose “symptoms are resolving after 5 days” can be out and around after just 5 days of isolation – merely wearing masks around others for another 5 days. The CDC isn’t even demanding a negative antigen test first, though they do suggest testing “If possible.” And even a negative antigen test is no guarantee a patient is not infectious, especially with Omicron. Good lord. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Of course I understand the <a href="https://www.washingtonpost.com/health/2021/12/28/cdc-isolation-guidelines-rationale/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F35a0cfc%2F61cc3fc89d2fdab56be735d1%2F599d6acbae7e8a3d46e1400f%2F8%2F63%2F61cc3fc89d2fdab56be735d1">motivation</a> for these policy changes. With Omicron on the rampage, previous regulations would have vast numbers of people at home quarantining or self-isolating, risking major personnel shortages in essential workplaces. Lack of staff already has New York City <a href="https://www.nytimes.com/2021/12/27/nyregion/nyc-vaccine-mandate.html?campaign_id=2&emc=edit_th_20211228&instance_id=48836&nl=todaysheadlines&regi_id=19728476&segment_id=78070&user_id=d89c7002526915cc9287fae06e27a284">subways running late</a>, half the shows on Broadway shuttered, thousands of <a href="https://www.nytimes.com/2021/12/27/business/weekend-flights-canceled-omicron.html">flights cancelled</a>, and American hospitals <a href="https://www.theguardian.com/us-news/2021/dec/23/us-hospitals-staffing-shortages-omicron-covid">preparing to call retired workers</a> back into service. The National Hockey League season has evaporated and the Miss World competition was postponed when 23 of the 97 contestants came up positive. Omicron is so contagious that 81 out of 117 Christmas party guests at one <a href="https://sciencenorway.no/covid19/at-least-140-people-were-infected-with-covid-19-after-christmas-party-in-oslo/1949790">Oslo restaurant</a> – all swab-negative and almost all double-vaccinated – came down with COVID-19, <a href="https://sciencenorway.no/covid19-vaccines/oslo-christmas-party-outbreak-most-of-the-non-infected-were-vaccinated-with-moderna/1954619">mostly Omicron</a>, as did 70 unfortunates who happened to be sitting at nearby tables. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I have been able to find zero evidence that Omicron patients are contagious for a briefer period of time. In fact, I suspect the opposite may be the case, that the massive load of virus in the nose could lengthen the period of viral shedding. And numerous reported clusters confirm my clinical impression: Omicron is probably an exception to the rule that vaccinated breakthrough cases are <a href="https://www.washingtonpost.com/health/your-questions-about-covid-19-answered-are-vaccinated-people-who-have-breakthrough-infection-less-contagious/2021/11/26/3c90ff9e-4d68-11ec-b73b-a00d6e559a6e_story.html">less likely to infect</a> their close contacts.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The justification given by Walensky and those toeing her party line – unfortunately Anthony Fauci is among them – is that people with COVID-19 are most infectious early on: “the majority of transmission occurs early in the course of illness, generally in the one to two days prior to onset of symptoms and the two to three days after.” This is true, but <i>“the majority”</i> is by no means <i>all</i>. Sick patients are usually most infectious within a week of becoming ill, but many remain contagious for <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30172-5/fulltext">9-12 days</a> (somewat <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30172-5/fulltext">fewer</a> for asymptomatic infections).<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I find the new CDC advice horrifying, coming while the pandemic is spinning out of control. As do…<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l24 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->A <a href="https://www.npr.org/sections/health-shots/2021/12/28/1068632200/cdc-covid-guidelines-testing?sc=18&f=1001">professor of epidemiology</a>: “I don't know a lot of people that feel super comfortable with this decision.” <o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l24 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->A university health officer who called <a href="https://www.nytimes.com/2021/12/28/opinion/covid-isolation-guidelines.html?campaign_id=2&emc=edit_th_20211229&instance_id=48881&nl=todaysheadlines&regi_id=19728476&segment_id=78137&user_id=d89c7002526915cc9287fae06e27a284">his column</a>, “The CDC has new COVID guidelines. This is what it got wrong.” <o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l24 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><a href="https://www.washingtonpost.com/health/2021/12/28/cdc-isolation-guidelines-rationale/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F35a0cfc%2F61cc3fc89d2fdab56be735d1%2F599d6acbae7e8a3d46e1400f%2F8%2F63%2F61cc3fc89d2fdab56be735d1">A top infectious disease specialist</a>: “It feels to me the wrong time to relax any guidance for the public.” <o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l24 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->A flight attendant <a href="https://www.washingtonpost.com/health/2021/12/28/cdc-isolation-guidelines-rationale/">union president</a>: “No worker should be forced to come to work when they’re still sick.”<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l24 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->A <a href="https://www.washingtonpost.com/health/2021/12/28/cdc-isolation-guidelines-rationale/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F35a0cfc%2F61cc3fc89d2fdab56be735d1%2F599d6acbae7e8a3d46e1400f%2F8%2F63%2F61cc3fc89d2fdab56be735d1">professor</a> of internal medicine: “you are in effect encouraging people to engage in activities that could increase transmission.”<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l24 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->A <a href="https://www.nytimes.com/2021/12/28/health/covid-isolation-period-omicron.html?campaign_id=2&emc=edit_th_20211229&instance_id=48881&nl=todaysheadlines&regi_id=19728476&segment_id=78137&user_id=d89c7002526915cc9287fae06e27a284">professor</a> of immunology and infectious diseases: “this feels honestly more about economics than about the science.”<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l24 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><a href="https://twitter.com/michaelmina_lab/status/1475598522338656266">Michael Mina</a>, Harvard epidemiologist turned rapid-testing apostle: “CDC’s new guidance to drop isolation of positives to 5 days without a negative test is reckless. Some ppl stay infectious 3 days, some 12. I absolutely don’t want to sit next to someone who turned Pos 5 days ago and hasnt tested Neg. Test Neg to leave isolation early is just smart.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The one exception I’d make to the 10-day rule would be to allow swab-positive hospital personnel to work on COVID-19 wards – even without any self-isolation – if they feel up to it.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Quarantine</u>: The CDC has long advised close contacts of infected individuals to quarantine (for 14 days) only if they’re unvaccinated. The <a href="https://www.nytimes.com/2021/12/27/health/omicron-cdc.html?campaign_id=2&emc=edit_th_20211228&instance_id=48836&nl=todaysheadlines&regi_id=19728476&segment_id=78070&user_id=d89c7002526915cc9287fae06e27a284">latest update</a> reduces that period to <a href="https://www.cdc.gov/media/releases/2021/s1227-isolation-quarantine-guidance.html">5 days</a> for the unvaccinated and the vaccinated but unboosted, letting only those who’ve had a booster to forego quarantine altogether. All of them should “Test on day 5, if possible.” Again, good lord – “if possible”? Even worse, everyone who’s unvaccinated or unboosted is told, “If you can’t quarantine you must wear a mask for 10 days.” Huh???? Who exactly falls in that category???? <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Note that 14 days covers the conventional incubation period for COVID-19, while 5 or even 10 days does not. But the quarantine change, as opposed to the self-isolation change, does have a kernal of validity. With early COVID-19 strains, half of patients became ill more than <a href="https://www.ecdc.europa.eu/en/covid-19/latest-evidence/infection">5 days</a> after their exposure. With Delta the halfway point fell to about <a href="https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(21)00264-7/fulltext">4 days</a>. The average incubation period with Omicron is even shorter, about 3 days, judging from clusters in <a href="https://www.biospace.com/article/omicron-variant-has-shorter-incubation-period-and-more-covid-19-news/">Nebraska</a>and <a href="https://sciencenorway.no/covid19/at-least-140-people-were-infected-with-covid-19-after-christmas-party-in-oslo/1949790">Oslo</a>. That means it is not unreasonable to shorten the period of obligatory quarantine. But not to 5 days! If with previous strains the time between exposure and illness was considered to range up to 14 days (though it was occasionally even longer), about triple the average incubation period, until we get better data we can estimate Omicron’s maximum incubation period at 10 days. If quarantine must be truncated to 5 days it is vital that people test before they emerge from home, and that they wear a well-fitting KN95 mask scrupulously until at least 14 days have passed. <b>Remember: 1) antigen tests </b><a href="https://www.politico.com/news/2021/12/28/fda-antigen-tests-reduced-sensitivity-omicron-526217"><b>often don’t pick up</b></a><b> Omicron; 2) Delta, with its longer incubation period, is still the dominant variant in countries including both the </b><a href="https://www.npr.org/2021/12/28/1068643344/cdc-omicron-covid-19-delta-revise-estimates"><b>United States</b></a><b> and </b><a href="https://www.business-standard.com/article/current-affairs/italy-tightens-anti-virus-rules-for-holiday-season-as-omicron-cases-mount-121122400102_1.html"><b>Italy</b></a><b>. </b>(Italy has <a href="https://www.altalex.com/documents/news/2021/12/30/decreto-covid19-quarantena-vaccinati#p3">softened</a> quarantine regulations too, but only slightly.)<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">As the situation deteriorates – daily cases in the US and Italy are now triple what they were 10 days ago – what we need is not masses of infected individuals loosed on our streets, but mask mandates, vaccine mandates, distancing, Green Passes, telework, and strict limits on gatherings. What’s coming instead, at least in Republican-leaning US states, is the <a href="https://www.washingtonpost.com/health/2021/12/25/covid-public-health-laws-restricted/">exact opposite</a>. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">My bottom line, and I’ve said it before: Rochelle Walensky is an intelligent and well-meaning person, but she’s in over her head. She should not be running the CDC. These new policies and the recent snafu over percentages of Omicron cases are just the latest proof.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I confess my personal paranoia is starting to match a <a href="https://twitter.com/tmprowell/status/1475648512348114947">tweet</a> from Dr. Tatiana Prowell: “The American public needs a clear message. It does not appear to be coming, so here's my best attempt. If you are able to, you should: STAY HOME, STARTING NOW.”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Bad Omicron news</b></p><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjJkXWKNw9mxJfsopjsG5yqnOYqSh-hQn0GkunWGV8XjP5Hnq5ZaqcpNtXRhpaRTbkeX-7rZOOKPk0HZ55c-Ffg5porYOAc-r-ND7KuQ8HqFd8lCkdtJb-2VH2GSoChpHkE0Ts5n5JgC9jBdW4o6vVI5eCuxkiGA-ycZkEeSg39PXEY1lbi83_IVadg=s1200" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="936" data-original-width="1200" height="250" src="https://blogger.googleusercontent.com/img/a/AVvXsEjJkXWKNw9mxJfsopjsG5yqnOYqSh-hQn0GkunWGV8XjP5Hnq5ZaqcpNtXRhpaRTbkeX-7rZOOKPk0HZ55c-Ffg5porYOAc-r-ND7KuQ8HqFd8lCkdtJb-2VH2GSoChpHkE0Ts5n5JgC9jBdW4o6vVI5eCuxkiGA-ycZkEeSg39PXEY1lbi83_IVadg=s320" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">A positive antigen test</td></tr></tbody></table><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The <a href="https://www.medrxiv.org/content/10.1101/2021.12.21.21268116v1.full.pdf">latest data</a> from South Africa say that people infected with Omicron are 80% less likely to need hospitalization than those with Delta, and 70% less likely to have severe disease. But other findings in those data seem to contradict the government <a href="https://www.youtube.com/watch?v=e4Y2sXkt-cw">presentation</a> I featured in my last post, which said hospitalized Omicron patients were half as likely as Delta patients to need intensive care or die. In this new manuscript, which looks at both variants simultaneously instead of comparing today’s Omicron with summertime Delta, there was only a non-significant 30% difference in severe disease. The outcome measures are different, so the discrepancy is hard to interpret.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">We’ve been made to believe that Omicron is just a bad cold, largely because of those low hospitalization rates. Unfortunately the story is different if you look <a href="https://www.washingtonpost.com/world/2021/12/24/omicron-coronavirus-south-africa-mild/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F35999a5%2F61c5a8369d2fdab56bdc0110%2F599d6acbae7e8a3d46e1400f%2F10%2F59%2F61c5a8369d2fdab56bdc0110">outside South Africa</a>, a country where the population is young and 70% have already been infected with SARS-CoV-2. As compared with Delta, the hospitalization rate with Omicron is only two-thirds lower in <a href="https://www.research.ed.ac.uk/en/publications/severity-of-omicron-variant-of-concern-and-vaccine-effectiveness-">Scotland</a> and <a href="https://www.ssi.dk/-/media/cdn/files/covid19/omikron/statusrapport/rapport-omikronvarianten-20122021-9j51.pdf?la=da">Denmark</a>, and a mere <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1043807/technical-briefing-33.pdf">40-45%</a> in <a href="https://spiral.imperial.ac.uk/handle/10044/1/93035">England</a>. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Some more discouraging Omicron news that contradicts previous reassurances: a colleague who performs rapid tests here in Rome told me they’ve had to change their reagents, because the ones that were good for detecting Delta weren’t picking up the new variant. An FDA <a href="https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/sars-cov-2-viral-mutations-impact-covid-19-tests#omicronvariantimpact">study</a> has now confirmed her observations for professionally-taken swabs, and home tests likely perform <a href="https://www.politico.com/news/2021/12/28/fda-antigen-tests-reduced-sensitivity-omicron-526217">even worse</a>. Antigen tests were already <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06524-7">lousy enough</a> at picking up previous variants! Alas, now we have hints from both <a href="https://www.medrxiv.org/content/10.1101/2021.12.21.21268116v1.full.pdf">South Africa</a> and the <a href="https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/sars-cov-2-viral-mutations-impact-covid-19-tests#omicronvariantimpact">USA</a> that even PCR tests might be less accurate with Omicron.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Words, wise and otherwise</b></p><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEi6WcyShw1muRcT0exdBFhgPc5bLANC35vHFlMpBIzTmbNx-l_rDdKkqro6anxdHl_T9Y5NYEshbe09dw-WzBqoh6MlQamEvLV8AC0TLSM45udcLvUjM7AVcffMk6XXZOFqzCkKAVW82Xe7BEVP3NujQ6gAzkpK6zdyDtAUipJYuKet0TUt2Fvjmv5R=s1984" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1328" data-original-width="1984" height="214" src="https://blogger.googleusercontent.com/img/a/AVvXsEi6WcyShw1muRcT0exdBFhgPc5bLANC35vHFlMpBIzTmbNx-l_rDdKkqro6anxdHl_T9Y5NYEshbe09dw-WzBqoh6MlQamEvLV8AC0TLSM45udcLvUjM7AVcffMk6XXZOFqzCkKAVW82Xe7BEVP3NujQ6gAzkpK6zdyDtAUipJYuKet0TUt2Fvjmv5R=s320" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Dr. David Kessler</td></tr></tbody></table><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Two Washington Post journalists have written a very sensible <a href="https://www.washingtonpost.com/health/2021/12/22/covid-positive-fully-vaccinated/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F3597947%2F61c456c59d2fdab56bd961e4%2F599d6acbae7e8a3d46e1400f%2F15%2F71%2F61c456c59d2fdab56bd961e4">article</a> on what to do if you test positive. Not much new for my readers, but it’s nice to have the advice set out so clearly.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Unfortunately one authoritative source has in my opinion fallen down on the job. Dr. David Kessler, former FDA head and Biden’s chief science officer for the COVID response, said on the <a href="https://www.msnbc.com/rachel-maddow/watch/omicron-fears-outpacing-real-world-risks-for-people-vaccinated-boosted-masked-129503301758">Rachel Maddow show</a> (just before minute 3) that people with mild symptoms suggestive of COVID-19 should wear a mask but not bother to get tested. I find this advice irresponsible. Masks are less than perfect, and Omicron is extraordinarily contagious. No mask can fully protect the patient’s family members and workplace contacts, some of whom may be at high risk for severe disease. Any person who has symptoms <i>must</i> get a PCR test, and pending the results <i>must</i> not only wear a mask but stay home in complete isolation until the result comes back negative; if the result is positive, they should keep it up for 10 days.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>A tale of three countries<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjEUtIOH2alPK3pvbkL7YEVP-YH0IO2PtIICcSiEkQNXaH9A-ZeVzf8rIKj9vAJf5empXx-GgrVFAf_y1Wxvsi7ptL6zDfqTjURFGH4W3d13lhCVnR3V2yEHRUDggDaRmpHxLs-t5Desuyn6toB4SN4U9wQisJil8eAx2mQzRA5gNY7yGXMzvxvyO2C=s1688" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1042" data-original-width="1688" height="398" src="https://blogger.googleusercontent.com/img/a/AVvXsEjEUtIOH2alPK3pvbkL7YEVP-YH0IO2PtIICcSiEkQNXaH9A-ZeVzf8rIKj9vAJf5empXx-GgrVFAf_y1Wxvsi7ptL6zDfqTjURFGH4W3d13lhCVnR3V2yEHRUDggDaRmpHxLs-t5Desuyn6toB4SN4U9wQisJil8eAx2mQzRA5gNY7yGXMzvxvyO2C=w640-h398" width="640" /></a></div><br /><b><br /></b><p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Italian, UK, and US figures (from <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer">Our World In Data</a>) provide an object lesson in the value of vaccination. The number of new infections <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+cases&Interval=7-day+rolling+average&Relative+to+Population=true&Align+outbreaks=false&country=ITA~USA~GBR">cases per capita</a> is now nearly identical in the US and Italy, and twice as high in the UK. But Italy has about a third as many COVID-19 patients <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=ICU+patients&Interval=7-day+rolling+average&Relative+to+Population=true&Align+outbreaks=false&country=ITA~USA~GBR">in ICUs</a> as the US, and half as many <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=true&Align+outbreaks=false&country=ITA~USA~GBR">deaths</a> – and rates in the UK are much lower yet. That’s the vaccines doing their job. The US has more bad outcomes because so few residents are “<a href="https://www.nytimes.com/2021/12/29/health/covid-vaccinations-boosters.html?campaign_id=2&emc=edit_th_20211230&instance_id=48882&nl=todaysheadlines&regi_id=19728476&segment_id=78251&user_id=d89c7002526915cc9287fae06e27a284">fully vaccinated</a>” (a near-obsolete term): 61%, far below Italy’s 78% and the UK’s 69%. And the UK has kept those bad outcomes down still further by <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Vaccine+booster+doses&Interval=7-day+rolling+average&Relative+to+Population=true&Align+outbreaks=false&country=ITA~USA~GBR">boosting like mad</a>: nearly half of the entire population has already received a booster shot.</p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Like everybody, Italy is struggling with case surges by instituting one set of new policies after another. The main change in its latest set, outdoor masking everywhere, is just silly. But some measures are sensible: reintroducing some capacity limits, making KN95 masks (=N95=Ffp2) obligatory for entertainment venues and city transport, cutting the duration of vaccine Green Passes from 9 months to 6, urging boosters after just 4 months, and closing discotheques until February (though cheating is expected). <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Probably the best recent Italian innovation is the “Super Green Pass” reserved for people who are vaccinated or post-COVID-19, now required for restaurants (even outside), ski lifts, cinemas, gyms, outdoor sports, weddings and other ceremonies, conferences, museums, hotels, even coffee bars and city buses. But the only thing the Super Green Pass can possibly do is to encourage vaccination. It’s working, but vaccination can’t possibly impact case numbers until masses of repentant novaxers are weeks after their second shot, which won’t be true for months, and without a booster shot vaccines do little to stop Omicron. What Italy needs now is tougher measures: curfews, closing restaurants in the evening, remote work, and limits on private gatherings. And if infections keep raging, lockdown.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>The latest COVID-19 papers to hit the dust</b></p><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEi6vG5ED2_4mAgUNgXhL2fIj2eIrA58Yu76e9TTfNReynQ7l25OhP1BsI7EBkaUfXwIWTtlTHBwvms75IFrMGD3LKWhQUMOC1qxSRXQRXQRDAzmVdKO2DYVAJzYXd3tLm6AROYDNNQbY9ajuK09VUkJEGTydG-QJ4n8SYvcO_mJH6P6WatldrtXmmnq=s976" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="549" data-original-width="976" height="225" src="https://blogger.googleusercontent.com/img/a/AVvXsEi6vG5ED2_4mAgUNgXhL2fIj2eIrA58Yu76e9TTfNReynQ7l25OhP1BsI7EBkaUfXwIWTtlTHBwvms75IFrMGD3LKWhQUMOC1qxSRXQRXQRDAzmVdKO2DYVAJzYXd3tLm6AROYDNNQbY9ajuK09VUkJEGTydG-QJ4n8SYvcO_mJH6P6WatldrtXmmnq=w400-h225" width="400" /></a></div><b><br /></b><p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l24 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->An article claiming to prove that <a href="https://retractionwatch.com/2021/12/13/paper-claiming-a-lack-of-evidence-covid-19-lockdowns-work-is-retracted/">lockdowns don’t work</a><o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l24 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->A conference poster claiming vaccines <a href="https://retractionwatch.com/2021/12/03/aha-regrets-any-confusion-and-is-reviewing-meeting-policies-after-outcry-over-covid-19-vaccine-abstract/">damage the heart</a><o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l24 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->An article claiming vaccination caused <a href="https://retractionwatch.com/2021/11/16/co-author-of-paper-claiming-covid-19-vaccines-linked-to-miscarriage-says-hes-retracting-it/">miscarriages</a><o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l24 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->A trumped-up metaanalysis of treatment with <a href="https://journals.sagepub.com/doi/10.1177/20406223211039699">granulocyte-macrophage colony-stimulating factor antibodies </a><o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l24 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Two Egyptian studies of <a href="file:///Users/susanlevenstein/Library/Containers/com.microsoft.Word/Data/Library/Preferences/AutoRecovery/b">favirapir treatment</a> (a hydroxychloroquine study from the same group was pulled earlier)<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l24 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Yet another <a href="https://retractionwatch.com/2021/11/02/ivermectin-covid-19-study-retracted-authors-blame-file-mixup/">ivermectin</a> article<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; margin: 5pt 6pt 5pt 0.5in; mso-list: l24 level1 lfo24; text-indent: -0.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->A paper from notorious anti-vaxers vastly exaggerating the <a href="https://retractionwatch.com/2021/10/25/covid-19-vaccine-myocarditis-paper-to-be-permanently-removed-elsevier/">risk of myocarditis</a> after mRNA vaccines (the <a href="https://www.medrxiv.org/content/10.1101/2021.08.30.21262866v1.full.pdf">real data</a> among adolescents are already worrisome enough)<o:p></o:p></p>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com10tag:blogger.com,1999:blog-6211405954943098401.post-60922962304519462192021-12-20T13:08:00.000+01:002021-12-20T13:08:08.060+01:00Christmas Joy Or Christmas Panic<p style="text-align: center;"> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhpQiRur6-sQg0zLM-HG3g2dFWS9MqmYCoWvtMI3xzTsdcVjfF4NtLQwchbzsfLyyY6lO3zpNNoSf6X8oA9Mao5kkSLKS9L5lSxZM3aVU5Q6QwIwci7BUvQRYpKgWZg7yuZ82JMJW-lSgVJrRQCYUWEkP4xQI5AiPz1MbFJcuwxsHXsk8vNBUmnN4RC=s750" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="504" data-original-width="750" height="269" src="https://blogger.googleusercontent.com/img/a/AVvXsEhpQiRur6-sQg0zLM-HG3g2dFWS9MqmYCoWvtMI3xzTsdcVjfF4NtLQwchbzsfLyyY6lO3zpNNoSf6X8oA9Mao5kkSLKS9L5lSxZM3aVU5Q6QwIwci7BUvQRYpKgWZg7yuZ82JMJW-lSgVJrRQCYUWEkP4xQI5AiPz1MbFJcuwxsHXsk8vNBUmnN4RC=w400-h269" width="400" /></a></div><div style="text-align: left;"><br /></div><p></p><p class="1obc" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: "Times New Roman", serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 6pt 6pt 0in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>Christmas Joy or Christmas Panic?<o:p></o:p></b></p><div style="text-align: left;"><style class="WebKit-mso-list-quirks-style">
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mso-bidi-theme-font:major-bidi;
color:#2F5496;
mso-themecolor:accent1;
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p.text, li.text, div.text
{mso-style-name:text;
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mso-style-parent:"Plain Text";
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margin-right:0in;
margin-bottom:10.0pt;
margin-left:0in;
line-height:150%;
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mso-fareast-theme-font:minor-fareast;
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{mso-style-name:Heading;
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mso-style-parent:"Heading 1";
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margin-bottom:12.0pt;
margin-left:0in;
mso-pagination:widow-orphan;
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mso-font-kerning:16.0pt;
font-weight:bold;
mso-bidi-font-weight:normal;}
p.quotes, li.quotes, div.quotes
{mso-style-name:quotes;
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mso-style-parent:"Plain Text";
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margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
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span.BalloonTextChar
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mso-style-qformat:yes;
mso-style-parent:quotes;
mso-style-next:quotes;
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margin-right:0in;
margin-bottom:6.0pt;
margin-left:.5in;
mso-pagination:widow-orphan;
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mso-fareast-font-family:"MS Mincho";
font-weight:bold;
mso-bidi-font-weight:normal;}
span.exldetailsdisplayval
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span.CommentTextChar
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mso-style-link:"Comment Text";
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mso-style-unhide:no;}
p.css-exrw3m, li.css-exrw3m, div.css-exrw3m
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mso-style-unhide:no;
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margin-left:0in;
mso-pagination:widow-orphan;
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span.3m6-
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span.3l3x
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mso-style-unhide:no;}
span.1lh7
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span.1lld
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mso-margin-bottom-alt:auto;
margin-left:0in;
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span.6cok
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mso-style-unhide:no;}
span.timestampcontent
{mso-style-name:timestampcontent;
mso-style-unhide:no;}
span.mbtext
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mso-style-unhide:no;}
span.HeaderChar
{mso-style-name:"Header Char";
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mso-style-locked:yes;
mso-style-link:Header;
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mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.FooterChar
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mso-style-unhide:no;
mso-style-locked:yes;
mso-style-link:Footer;
font-family:"Times New Roman",serif;
mso-ascii-font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-hansi-font-family:"Times New Roman";
mso-bidi-font-family:"Times New Roman";}
span.5uzb
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span.accessibleelem
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mso-style-unhide:no;}
span.z-TopofFormChar
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margin-left:0in;
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span.z-BottomofFormChar
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mso-style-noshow:yes;
mso-style-priority:99;
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mso-style-link:"z-Bottom of Form";
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mso-hide:all;}
p.css-axufdj, li.css-axufdj, div.css-axufdj
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mso-margin-top-alt:auto;
margin-right:0in;
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margin-left:0in;
mso-pagination:widow-orphan;
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
span.style-scope
{mso-style-name:style-scope;
mso-style-unhide:no;}
p.generic-articlesummary--li, li.generic-articlesummary--li, div.generic-articlesummary--li
{mso-style-name:generic-article__summary--li;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
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margin-left:0in;
mso-pagination:widow-orphan;
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p.diamond-blt, li.diamond-blt, div.diamond-blt
{mso-style-name:diamond-blt;
mso-style-unhide:no;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";}
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mso-default-props:yes;
font-family:"Calibri",sans-serif;
mso-ascii-font-family:Calibri;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:Calibri;
mso-fareast-theme-font:minor-latin;
mso-hansi-font-family:Calibri;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
@page WordSection1
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margin:1.0in 1.0in 1.0in 1.0in;
mso-header-margin:.5in;
mso-footer-margin:.5in;
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div.WordSection1
{page:WordSection1;}
/* List Definitions */
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font-family:"Times New Roman",serif;
mso-fareast-font-family:"MS Mincho";}
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</style><p class="1obc" style="font-size: medium; margin-right: 6pt;">I've rushed to publish this post, mainly to catch you up on Omicron but also to squeeze in some advice on safe celebration while there are still a few days to go before the holidays.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b> </b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Treatment updates<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Molnupiravir</u>: We <a href="https://www.nature.com/articles/d41586-021-03667-0">now know</a> in a word why the efficacy of Merck’s antiviral plummeted from 50% to 30% between the interim and final results of its major Phase 3 trial: Delta. The fairly good interim results were obtained on patients enrolled between May and early August, largely before Delta started rising in July and well before it took over the world. The lousy final results included patients enrolled in the Delta era, between August and October, in whom the drug apparently had <a href="https://www.nature.com/articles/d41586-021-03667-0">virtually no effect</a>. This means we can expect its current efficacy, in what are probably the last weeks of the Delta era, to be not 30% but close to nil. In the Omicron era? Nobody knows.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Paxlovid</u>: Pfizer <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-announces-additional-phase-23-study-results">has announced</a> that final results of their Phase 3 trial in high-risk unvaccinated COVID-19 outpatients are even better than the already excellent interim ones: treatment of high-risk unvaccinated patients within 3 days of symptom onset lowered hospitalization rates by 89%, treatment within 5 days by 88%. Since this trial <a href="https://clinicaltrials.gov/ct2/show/NCT04960202">began in mid-July</a>, we can be sure Paxlovid, unlike molnupiravir, is effective against the Delta variant. Against Omicron? Again, nobody really knows, but <a href="https://www.washingtonpost.com/health/2021/12/14/does-pfizer-covid-pill-paxlovid-work/">Pfizer is optimistic</a> based on laboratory studies. Interim results of a separate trial (<a href="https://clinicaltrials.gov/ct2/show/NCT05011513">EPIC-SR</a>) in standard-risk unvaccinated and high-risk vaccinated outpatients seem promising, but I won’t discuss them before seeing some more definitive results. I’m eager for this excellent drug to be authorized for emergency use, but I <a href="https://www.statnews.com/2021/11/23/covid-antivirals-pandemic-game-changers-americans-struggle-access/">share the concern</a> that this could widen rather than narrow <a href="https://jamanetwork.com/journals/jama/fullarticle/2775687">the chasm</a> in COVID-19 outcomes between marginalized and well-off communities, due to limited access to testing and physicians – <i>especially</i> in the United States.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Vaccine updates<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEi5QTT2GLDuPhjtL5IAQjZ9t3NtNtY0rvWHdaQDLjYAOAT4a1Cg3hOYlxcvpGP-s9PNWaMTWddMQz8ZWJV1mQDqNzl4SjqVL0rZQk2wGSFwMjpL-3CmqKZQD3cNOpzLc1wfEzxyogpl40gU8fYw2DfZadFLKQv4fnF0jfOwbkMwcEKrCwbc--WqXXDv=s4000" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2667" data-original-width="4000" height="213" src="https://blogger.googleusercontent.com/img/a/AVvXsEi5QTT2GLDuPhjtL5IAQjZ9t3NtNtY0rvWHdaQDLjYAOAT4a1Cg3hOYlxcvpGP-s9PNWaMTWddMQz8ZWJV1mQDqNzl4SjqVL0rZQk2wGSFwMjpL-3CmqKZQD3cNOpzLc1wfEzxyogpl40gU8fYw2DfZadFLKQv4fnF0jfOwbkMwcEKrCwbc--WqXXDv=s320" width="320" /></a></div><br /><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Boosters</u>: The Israeli health system were the first to tell us that boosters 5 months after dose 2 restored full efficacy to the Pfizer vaccine in individuals over 60. Now <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2115926?query=featured_home">they provide data</a> saying the same thing for all ages. Out of nearly 5 million individuals 16 and up who had completed their primary cycle 5 months earlier, those who had a booster were 10 times less likely to be infected with SARS-CoV-2 and 18 times less likely to develop severe COVID-19, while those over 60 were 15 times less likely to die of COVID-19. Protection varied little by age, and began to rise just a few days after the shot. Another Israeli study, from a major insurance company, found <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2115624?query=featured_home">death rates</a> to drop by 90%. Both studies were during the Delta wave, so they have nothing to tell us about Omicron.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>The mRNA derby</u>: Moderna wins out yet again. In a <a href="https://www.cell.com/med/fulltext/S2666-6340(21)00382-2">study from the Mayo Clinic</a>, people who had gotten two doses were 40% less likely to have breakthrough infections than those who had had Pfizer, even after age, date of vaccination, and medical history were taken into consideration.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Moderna</u>: But in another arena Moderna’s the loser. They’ve had to <a href="https://www.washingtonpost.com/health/2021/12/17/moderna-vaccine-patent-dispute-nih/?utm_campaign=wp_todays_headlines&utm_medium=email&utm_source=newsletter&wpisrc=nl_headlines&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F358db10%2F61bdbf499d2fdab56bce1d6f%2F599d6acbae7e8a3d46e1400f%2F12%2F59%2F61bdbf499d2fdab56bce1d6f">drop a lawsuit</a> against the federal government over the vaccine patent, yielding co-ownership to the National Institutes of Health. This should be good for the rest of the world, because Moderna has been particularly stingy about contributing to COVAX or otherwise getting vaccines to the developing world. Now the Biden administration can get going, provided it has the will.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Omicron</u>: Judging from the number and type of its mutations, the Omicron variant seemed on the face of it more likely than others to escape the protection from current vaccines. Concrete evidence is arriving fast and furious. In South Africa, for example, a group of 7 young, healthy German visitors <a href="https://deliverypdf.ssrn.com/delivery.php?ID=839101122089124078124121006121111081023038005086089069018123119119094026119017102075106041116007045039113100114114089065024111106091030041064028090011010001088015070024041035066089111019113025124072118107025125109099118087073122073112111126069116003091&EXT=pdf&INDEX=TRUE">all fell ill</a> with Omicron despite being triple vaccinated, 5 with Pfizer-Pfizer-Pfizer, one with AstraZeneca-Pfizer-Pfizer, and one with Pfizer-Pfizer-Moderna (full-dose). A good demonstration that the <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-provide-update-omicron-variant">neutralizing antibodies</a> an mRNA booster can induce against Omicron do not necessarily translate into protection against infection or illness. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">We have particularly valuable data from a <a href="https://khub.net/documents/135939561/430986542/Effectiveness+of+COVID-19+vaccines+against+Omicron+variant+of+concern.pdf/f423c9f4-91cb-0274-c8c5-70e8fad50074">preprint performed in the UK</a>, the country with more documented Omicron cases than any other outside South Africa (581 at the time of this study, more than <a href="https://news.sky.com/story/covid-19-10-059-more-omicron-cases-recorded-in-uk-three-times-as-many-as-yesterday-12499092">10,000 new cases</a> every day now). Vaccine effectiveness against symptomatic Omicron illness could be estimated at 15 or more weeks after a second dose of vaccine: for AstraZeneca, protection was nil, for Pfizer, about 35%. A Pfizer booster increased it to 71% if the initial vaccine had been AstraZeneca, to 76% if it had been Pfizer. There were too few cases at that time to break down effectiveness by age group, but we can expect updates on that question soon now that the epidemic there is spiraling out of control.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">I should mention that in this study Pfizer was actually very effective against Omicron in the short run – 88% during the period between 2 and 9 weeks after the second dose. This figure is a bit distorted because younger people were the ones most recently vaccinated, and the vaccine may be less effective in the elderly, but for the sake of argument let’s take that high effectiveness at face value. Since higher doses of medications <a href="https://www.nps.org.au/australian-prescriber/articles/pharmacokinetics-made-easy-10-pharmacodynamics-the-concentration-effect-relationship">generally last longer</a>, this finding suggests in my mind the possibly crazy idea that simply <a href="https://www.theatlantic.com/health/archive/2021/10/pfizer-moderna-dose-which-vaccine-best/620501/">hiking up</a> Pfizer’s 30 mg dose, either to Moderna’s full-dose 100 mg or even to the 50 mg in a Moderna booster, might make its high efficacy against Omicron last much longer. That’s just my own thought, I’ve never heard or read anybody else saying it. The study also confirms what we already knew about vaccine effectiveness against Delta variant COVID-19 at 6 months after the second dose: it was 42% for AstraZeneca and 64% for Pfizer, hoisted by a booster to around 93%. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Another <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/pfizer-vaccine-protecting-against-hospitalisation-during-omicron-wave-study-2021-12-14/">interesting study</a> comes from a private insurance company in South Africa, that according to a <a href="https://www.discovery.co.za/corporate/news-room">press release</a>found double vaccination with Pfizer to be 70% protective against hospitalization with Omicron disease, lower than the 93% against Delta but still respectable. But at age 70-79 protection was only 60%, and it could be even lower over age 80. Efficacy against all COVID-19 was 33%, very close to the UK figure. Few South Africans have received boosters, so this study couldn’t gauge their effect.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Are new vaccines or new versions of old vaccines necessary? As of December 15<sup>th</sup> Anthony Fauci was <a href="https://www.washingtonpost.com/health/2021/12/15/is-omicron-specific-vaccine-necessary/">still saying no</a>, because “Our booster vaccine regimens work against Omicron.” I’m not so sure of that. A 70% protection after a booster isn’t high enough to be reassuring. I do still believe that in the long run Omicron could be the variant from heaven, but I’m pretty scared of what we may have to expect in the next few months. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>A particularly disgusting hoax<o:p></o:p></b></p><div style="text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjkzo__qfHdYXBfk-dTPUUi6O0mgwOAvpuluBKND4KX3y_uH1Uy7Lscih83mj8stL9_rNVIlK1rMktOsqbFBXSoMdJ9NBjCSHX8yCf71FpNARJFxPtYNxjOcmRO3XvR2WRwrq4f2lo03ijpGanCpcTASvV-i-XSC-ztfnYLdWBQ1WRWxog92D-KrIEt=s1296" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="413" data-original-width="1296" height="204" src="https://blogger.googleusercontent.com/img/a/AVvXsEjkzo__qfHdYXBfk-dTPUUi6O0mgwOAvpuluBKND4KX3y_uH1Uy7Lscih83mj8stL9_rNVIlK1rMktOsqbFBXSoMdJ9NBjCSHX8yCf71FpNARJFxPtYNxjOcmRO3XvR2WRwrq4f2lo03ijpGanCpcTASvV-i-XSC-ztfnYLdWBQ1WRWxog92D-KrIEt=w640-h204" width="640" /></a></div><br /><span style="font-family: "Times New Roman", serif;"><br /></span></div><p class="1obc" style="font-size: medium; margin-right: 6pt;">One can only respond to this craven headline by asking conservativebeaver, as Joseph Welch famously asked Joseph McCarthy in 1954, “Have you no sense of decency, sir?”<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Here are the Bourlas together on November 11, the day after that headline:<o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjLWUvERveh8j3fsX8uZpjg5m9jzrzjZc1ycMsNxtda5CtMkhIvxLz0uptWa17zjc9uEi3jMDSfCF6Uu0TgbEzRrbMjrYFcTUuB3cF-aIp0H3-IblulK9173SnHbpW7r_XPHTOZ7QWpFTtvm0K_qT6Cnns6_NcCOyaOU6Ug894ef22CJ5_zjrh5lFxF=s1128" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="962" data-original-width="1128" height="273" src="https://blogger.googleusercontent.com/img/a/AVvXsEjLWUvERveh8j3fsX8uZpjg5m9jzrzjZc1ycMsNxtda5CtMkhIvxLz0uptWa17zjc9uEi3jMDSfCF6Uu0TgbEzRrbMjrYFcTUuB3cF-aIp0H3-IblulK9173SnHbpW7r_XPHTOZ7QWpFTtvm0K_qT6Cnns6_NcCOyaOU6Ug894ef22CJ5_zjrh5lFxF=s320" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Omicron panic<o:p></o:p></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiwzeJ3UT9zFJF7Mpc1q2JyL0qY_x1HqAySABxXnqqJwB2mufz6xjJNrelHOfDlbQHMB4AHPLVGzZ3FKx9PFldpDU94YrDvKs5I6hzv1Q58QbNP4trxwos6UlW4d50i6a9h61SzIQmi4i_QNSuwoWGYzFWw3qxe9_T7DksE3sIoc_l9kg_I7jxHicQ0=s1658" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="910" data-original-width="1658" height="220" src="https://blogger.googleusercontent.com/img/a/AVvXsEiwzeJ3UT9zFJF7Mpc1q2JyL0qY_x1HqAySABxXnqqJwB2mufz6xjJNrelHOfDlbQHMB4AHPLVGzZ3FKx9PFldpDU94YrDvKs5I6hzv1Q58QbNP4trxwos6UlW4d50i6a9h61SzIQmi4i_QNSuwoWGYzFWw3qxe9_T7DksE3sIoc_l9kg_I7jxHicQ0=w400-h220" width="400" /></a></div><p class="1obc" style="font-size: medium; margin-right: 6pt; text-align: center;"><br /></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Transmissibility<o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">There’s ever more confirmation that it’s highly contagious, and some interesting <a href="https://www.scientificamerican.com/article/why-is-omicron-so-contagious/">speculation</a> as to some societal reasons. According to a South African <a href="https://www.nicd.ac.za/wp-content/uploads/2021/12/The-Daily-COVID-19-Effective-Reproductive-Number-R-in-the-public-sector-of-South-Africa-week-48-of-2021.pdf">government report</a> the R<sub>t, </sub>for COVID-19, a measure of the rate the disease is spreading in the population, rose from 0.8 late in the Delta wave – i.e. the epidemic was shrinking – to well over 2 now that Omicron is taking over. But that’s a young population with considerable prior exposure to SARS-CoV-2, so the rate of spread could be slower than elsewhere. And, in fact, confirmed Omicron cases have been doubling every 3 days in the UK, leading scientists to <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1042046/Technical_Briefing_32.pdf">estimate</a> that the R<sub>t </sub>could be as high as 3.7, meaning every case infects about 4 others.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">A <a href="https://www.med.hku.hk/en/news/press/20211215-omicron-sars-cov-2-infection">laboratory study</a> from Hong Kong has given us the first biological hints of why Omicron is so contagious. The researchers exposed surgical specimens of bronchial and lung tissue to the wild Wuhan strain and the Delta and Omicron versions of SARS-CoV-2 virus and watched what happened over 48 hours. Omicron multiplied much faster in bronchial cells, and much more slowly in the lung, which could explain both its sky-high contagiousness and its low virulence. Curiously, the Delta variant multiplied <i>less</i> quickly in the lung than the wild strain, even though it’s thought to cause more hospitalizations and more deaths per capita.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Severity<o:p></o:p></u></p><div style="text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjeMKChzIhIUbEPVPTRffwVUjHW0AXeWvVFkfwTj3Ch6AnG0wJUjI2pNDnXjnU9YxkW9DgaVAIPrf8dOYCdQiW5wKS7seW59z1nFzBqYObW9tOyA8eBNJQOW68rzCRw7BWeJh1NfFbeKGH-l9_h5_1eI__UISL1yjfbxhevQ6wgO46zwp8HEA4VUVDD=s1706" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="962" data-original-width="1706" height="361" src="https://blogger.googleusercontent.com/img/a/AVvXsEjeMKChzIhIUbEPVPTRffwVUjHW0AXeWvVFkfwTj3Ch6AnG0wJUjI2pNDnXjnU9YxkW9DgaVAIPrf8dOYCdQiW5wKS7seW59z1nFzBqYObW9tOyA8eBNJQOW68rzCRw7BWeJh1NfFbeKGH-l9_h5_1eI__UISL1yjfbxhevQ6wgO46zwp8HEA4VUVDD=w640-h361" width="640" /></a></div><span style="font-family: "Times New Roman", serif;"><br /></span></div><p class="1obc" style="font-size: medium; margin-right: 6pt;">Denmark is up there with the UK in rates of Omicron, with the new variant <a href="https://www.washingtonpost.com/world/2021/12/18/omicron-variant-denmark/?pwapi_token=eyJ0eXAiOiJKV1QiLCJhbGciOiJIUzI1NiJ9.eyJzdWJpZCI6IjI5NjI2OTE5IiwicmVhc29uIjoiZ2lmdCIsIm5iZiI6MTYzOTg1OTk0OCwiaXNzIjoic3Vic2NyaXB0aW9ucyIsImV4cCI6MTY0MTA2OTU0OCwiaWF0IjoxNjM5ODU5OTQ4LCJqdGkiOiJjNGQxZjUzMC01MGNmLTQwOTAtODI2Yi03ZjRhNTcxODkwOTUiLCJ1cmwiOiJodHRwczovL3d3dy53YXNoaW5ndG9ucG9zdC5jb20vd29ybGQvMjAyMS8xMi8xOC9vbWljcm9uLXZhcmlhbnQtZGVubWFyay8ifQ.r_-fB04ohIrjSjJ9X1w2eCHaImva5Ax-o1_TN-CtGtc">already causing</a> at least a third of new cases. As of December 12<sup>th</sup> there had been only <a href="https://files.ssi.dk/covid19/omikron/statusrapport/rapport-omikronvarianten-12122021-k29d">27 hospitalizations</a> in Denmark due to Omicron, out of 2471 cases (about 1%). That’s encouraging, because the ratio of hospitalized patients to new cases in Denmark during this summer’s Delta wave was <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Hospital+patients&Interval=7-day+rolling+average&Relative+to+Population=false&Align+outbreaks=false&country=~DNK">around 10%.</a><span class="MsoHyperlink"> </span>But Danish scientists are concerned nonetheless, for 4 reasons: <o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->The new variant has spread thus far mostly in young people, who rarely get very sick<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->COVID-19 patients often deteriorate a week or more after their symptoms start, and Omicron only arrived recently, so it’s early to judge <o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Denmark is the most highly vaccinated country in Europe, but most Danes have had only two doses of vaccine, leaving them vulnerable to Omicron, and getting everybody boosted will be a logistical nightmare<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->The variant spreads like wildfire, so even if the rate of severe disease is much lower than with Delta, the hospitals could be overwhelmed nonetheless<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Imagine that wildfire burning its way through the US, where only <a href="https://www.nytimes.com/interactive/2020/us/covid-19-vaccine-doses.html">72% of adults</a> have had even two doses of vaccine (the comparable figure in Denmark is 96%, in Italy 87%) and <a href="https://www.nytimes.com/interactive/2020/us/covid-19-vaccine-doses.html">15%</a> of all adults – including 5% of those over 65 – have still not had a single shot.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">We now have some proper severity data from a <a href="https://www.youtube.com/watch?v=e4Y2sXkt-cw">South African presentation</a>, and they show death rates and other bad outcomes that are strikingly lower than in earlier waves of the pandemic despite climbing case numbers and hospitalizations. The graphs at the top are screenshots from the Powerpoint. Note that the denominator is always hospitalized patients, not all symptomatic COVID-19 cases or all infections. One explanation for the better outcomes could be that doctors are hospitalizing people who are not as sick; I think that’s unlikely. More relevant is that most South Africans have already been infected with SARS-CoV-2, judging from a seropositivity rate <a href="https://www.nicd.ac.za/wp-content/uploads/2021/11/SACMC-Fourth-wave-report-17112021-final.pdf">estimated</a> at 60-70%, and that the population is <a href="https://en.wikipedia.org/wiki/List_of_countries_by_median_age">particularly young</a> (median age 28, as vs. 39 in the US and 47 in Italy), two reasons infected individuals are likely to have milder disease whatever the viral strain. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">In the South African <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/pfizer-vaccine-protecting-against-hospitalisation-during-omicron-wave-study-2021-12-14/">private insurer’s study</a>, too, the disease seemed relatively mild, with a <a href="https://businesstech.co.za/news/lifestyle/546940/discovery-has-published-its-first-omicron-data-in-south-africa-here-are-4-of-the-most-important-findings/">29% lower</a> hospitalization rate than in early 2020, and less need for ICU care (no figures provided), though it did seem Omicron might be a bit more aggressive in children than previous variants.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Yet more hints come from that cluster of German visitors <a href="https://deliverypdf.ssrn.com/delivery.php?ID=839101122089124078124121006121111081023038005086089069018123119119094026119017102075106041116007045039113100114114089065024111106091030041064028090011010001088015070024041035066089111019113025124072118107025125109099118087073122073112111126069116003091&EXT=pdf&INDEX=TRUE">to South Africa</a>. Most had only common cold-like symptoms, and oxygen saturations remained normal, but 3 of the 7 did become short of breath despite being young and triple-vaccinated. This suggests that Omicron COVID-19 may not be trivially mild as has been hoped. Eighty-five hospitalizations and <a href="https://news.sky.com/story/covid-19-10-059-more-omicron-cases-recorded-in-uk-three-times-as-many-as-yesterday-12499092">7 deaths</a> from Omicron, mostly in double-vaccinated individuals, have now been reported in the UK.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><u>Predicting the future<o:p></o:p></u></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">The scary headline at the top about 75,000 deaths was only one of many. What’s the reality? If you look at the <a href="https://cmmid.github.io/topics/covid19/reports/omicron_england/report_11_dec_2021.pdf">actual study</a> they’re talking about, a collaboration between English and South African scientists, you’ll see the results are somewhat less dire. The researchers construct various models on the basis of various possible levels of vaccine efficacy and immune escape. Assuming immune escape to be high, as seems to be the case, their model estimates vaccine effectiveness against infection after an mRNA booster at 50%-60%. But on the basis of the real-world evidence from the preprint I just described, effectiveness is actually above 70%. And even more crucially, all their models assume that Omicron is just as virulent as Delta. Since all the evidence points to its being less virulent, all those dire predictions of hospitalizations and deaths will likely be adjusted downward. The authors cautiously call their report not a preprint but a work in progress, to be updated as more data become available. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">However… Tedros Adhanom Ghebreyesus, the smart and non-alarmist Director-General of the World Health Organization, <a href="https://news.un.org/en/story/2021/12/1107932">is warning</a> that even if Omicron does cause less severe disease than Delta it is so contagious that it could still overwhelm health care systems if huge numbers of people get sick all at once – as I said above about Denmark. <o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">Vast numbers of infections could wreak havoc on the economy, our healthcare systems, and our lives even if they are mild and even if countries don’t impose lockdowns, since all the swab-positives and their close contacts will be isolating or quarantining at home and unable to work. A giant pandemic of “long COVID” could also follow, since it can be caused by mild disease – perhaps even by asymptomatic infection, though I find <a href="https://www.medrxiv.org/content/10.1101/2021.03.03.21252086v1.full.pdf">the study</a> that says so somewhat questionable, and it remains unpublished 9 months after being posted as a preprint.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">What to do? What is obvious is that we need to vaccinate the unvaccinated like crazy, boost the vaccinated like crazy, have Pfizer and Moderna work like crazy on developing Omicron-specific vaccines, and intensify measures such as masking, ventilation, and distancing. I personally support even more drastic measures: institute Italian-style Green Passes everywhere (they are in the UK), close down restaurants and other public-facing businesses for several weeks (they are in the Netherlands), tell people to return to working from home if possible, quarantine people entering countries – or even US states – from high-risk areas, and seriously consider brief but stringent lockdowns.<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>Deck the halls<o:p></o:p></b></p><div style="text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiZeW6V8gs_MWPeaH8JSRUCu9w3wcbhXtW7KJHMszgEb5NIyqTK3v2AJ4lKqclxMnjorDsU3fVpN9dRzeJ1oeV72WZIK3H-firig23tAtOtVscrPAe44y6k2QmNkKN0TgDZbM6eBfMSXhVidTsh0nV6PmwmggQGjsTu6_45IDJnJARQWM8FODjRJNks=s2500" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1582" data-original-width="2500" height="253" src="https://blogger.googleusercontent.com/img/a/AVvXsEiZeW6V8gs_MWPeaH8JSRUCu9w3wcbhXtW7KJHMszgEb5NIyqTK3v2AJ4lKqclxMnjorDsU3fVpN9dRzeJ1oeV72WZIK3H-firig23tAtOtVscrPAe44y6k2QmNkKN0TgDZbM6eBfMSXhVidTsh0nV6PmwmggQGjsTu6_45IDJnJARQWM8FODjRJNks=w400-h253" width="400" /></a></div><br /><span style="font-family: "Times New Roman", serif;"><br /></span></div><p class="1obc" style="font-size: medium; margin-right: 6pt;">Plan on getting together with family on Christmas? On shaking a leg with friends on New Year’s Eve? Watch out, the coronavirus may be an uninvited guest. Holiday celebrations aren’t totally out of the question like last year, but caution is essential – Queen Elizabeth <a href="https://www.bbc.com/news/uk-59683343">cancelled</a> hers at the last minute. A few words to the wise I’ve assembled from <a href="https://www.nytimes.com/2021/11/17/opinion/covid-thanksgiving-holiday-risk.html">here</a>, <a href="https://www.vcuhealth.org/news/covid-19/covid-19-and-the-holidays">here</a>, and <a href="https://theconversation.com/planning-a-christmas-get-together-8-tips-to-avoid-a-super-spreader-event-172857">here</a>, plus my own little grey cells:<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->keep the guest list down, so seats can be spaced out at the table<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->make sure everyone is vaccinated (with boosters if they’re 5 months out)<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->everybody should do rapid tests that morning<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->anyone with the slightest symptom should stay home<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->party outdoors if weather permits<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->everybody wash their hands when they come in<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->leave a window at least partly open<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><span style="font-size: medium; text-indent: -0.25in;">consider wearing masks when not actually eating or drinking</span></p><p class="1obc" style="font-size: medium; margin: 5pt 6pt 5pt 0.5in; text-indent: -0.25in;"><o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[endif]-->-<span> </span>consider investing in a <a href="https://www.epa.gov/coronavirus/air-cleaners-hvac-filters-and-coronavirus-covid-19">portable HEPA air purifier</a>: examples <a href="https://www.rollingstone.com/product-recommendations/electronics/best-hepa-air-purifier-reviews-1086229/">in the US</a> and <a href="https://www.migliorpurificatorearia.it/">Italy</a><o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->hugs and kisses: try to resist the temptation<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->separate unvaccinated kids from older adults<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->no Christmas carols! (singing is the best way to spread droplets)<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->be extra careful if anyone is over 65, chronically ill, immunosuppressed, or pregnant <o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->be extra careful if there’s high community transmission<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->coming in by train, bus, or airplane? Wear KN-95 masks when travelling, grab bites quickly, open a window if you can…<o:p></o:p></p><p class="1obc" style="margin-bottom: 5.0pt; margin-left: .5in; margin-right: 6.0pt; margin-top: 5.0pt; mso-list: l49 level1 lfo49; text-indent: -.25in;"><!--[if !supportLists]-->-<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->…and ideally self-isolate for 3-5 days before the event<o:p></o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><o:p> </o:p></p><p class="1obc" style="font-size: medium; margin-right: 6pt;"><b>My new favorite conspiracy theory<o:p></o:p></b></p><p class="1obc" style="font-size: medium; margin-right: 6pt;">It's a total invention, of course.</p><div style="text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgDHlY2OBjhmAR5bDJtALCVf93VrysulFnCIEt1aR7r7V_5QdKE7BS8CvNs0vsuPI5dsi16qUtoc694czXQ85WI4lj9xduUajt7wA6oEMURgHHNNWoq6Ya2JG6YVkCL_W9yhenIACNKktTb3CtZ0WdAh_3s9baVBiU5k-TlEatXp4nYWxFZQUsPRp-v=s1296" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="868" data-original-width="1296" height="428" src="https://blogger.googleusercontent.com/img/a/AVvXsEgDHlY2OBjhmAR5bDJtALCVf93VrysulFnCIEt1aR7r7V_5QdKE7BS8CvNs0vsuPI5dsi16qUtoc694czXQ85WI4lj9xduUajt7wA6oEMURgHHNNWoq6Ya2JG6YVkCL_W9yhenIACNKktTb3CtZ0WdAh_3s9baVBiU5k-TlEatXp4nYWxFZQUsPRp-v=w640-h428" width="640" /></a></div><br /><span style="font-family: "Times New Roman", serif;"><br /></span></div></div>Susan Levenstein, MDhttp://www.blogger.com/profile/04664082134917253721noreply@blogger.com0