Tuesday, July 27, 2021

Prophets Of Doom?


A particularly disgusting image of an American hero

I’m slipping in this brief post practically on my way out the door, in hopes of being able to resist keeping up with COVID-19 news while Alvin and I are on vacation. Topics: Delta, Italy, origin stories, testing curiosities, bioweapons, and the Right's obsession with Anthony Fauci. See you in September!


Treatment updates

Inhaled budesonide: Results of the STOIC trial in high-risk outpatients were very promising, but interim results of the PRINCIPLE trial on a much larger number of patients (1779 rather than 139), available thus far only in the form of a non-peer-reviewed preprint, are considerably less so. Symptoms were 3 days shorter in treated patients, but the one-month risk of hospitalization or death was only reduced by 22%, which was not statistically significant. The authors say they’ll go forward with publication only when all the patients will have had full one-month follow-up.

Opaganib: Israel has been the birthplace – and the graveyard – of numerous potential COVID-19 treatments. There were stem cells from Pluristem, recycling of the cholesterol-busting fenofibrate, the new drugs Allocetra and EXO-CD24 for critically ill patients, not to speak of a promised oral vaccine. All of these have come to naught thus far, and my cynical mind suspects that opaganib, a new pill intended to help hospitalized people on oxygen therapy from progressing to ventilators, will meet the same fate.


Vaccine updates

Not everyone knows satire when they see it

Pfizer: Their application for full FDA approval is under review, and the agency legally has until January 2022 to finish up. They’ve put it on a priority track, though, aiming for a decision by the end of September. Unfortunate that “priority” is so slow – even a 2-month wait will cause many deaths among novaxers convinced by the “it’s still experimental” argument.

Moderna: Moderna’s application, unlike Pfizer’s, has not yet been accepted for review by the FDA, apparently because of incomplete documentation. Too bad.

Locked up and hesitant: In one California prison 33.5% of inmates – and 45.1% of African-American inmates – offered vaccination turned it down. Fortunately 84% of older inmates, who are more at risk for severe illness, had the sense to take the shot.

Vaccines work: More about how well mRNA vaccines work against both SARS-CoV-2 infection and symptomatic COVID-19 comes from the latest update of a study in 3975 American health care workers. But data collection ended in April, so a Delta caveat applies. The UK study of vaccines against Delta-variant disease has now been published, confirming 88% effectiveness in people fully vaccinated with Pfizer, 67% with those who had AstraZeneca – but a mere 31% effectiveness after a single dose of either vaccine. I sure hope it’s the Brits who have it right, and not the . . .


. . . Jewish Cassandras

Cassandra, who warned in vain against the Trojan Horse, hanging onto a statue of Athena for dear life

Very scary claims have been coming out of Israel, where the Delta variant has taken over entirely. The Health Ministry says that protection from the Pfizer vaccine is now only 40.5% against symptomatic COVID-19 and 80% against serious infection (with even that dropping to 50% among the elderly). Even worse, it claims people who were vaccinated with Pfizer in January were only 16% protected against infection recently, compared to 44% for those vaccinated in February, 67% for March, and 75% for April.

A chorus of Israeli experts has rejected the whole idea. They have variously pointed out that most of the early vaccinees were very elderly and/or medically fragile, that there are grave problems with the definition of serious illness, that a tiny number of cases is involved, and that people who refuse vaccines are also less likely to choose to get tested for SARS-CoV-2, therefore appearing falsely to have lower infection rates. As usual, we need a proper manuscript. But still those of us who, like me, were lucky enough to get vaccinated early on have to feel a tad worried.


Vaccination figures Italian style

Good news about the vaccination campaign in Italy: it turns out to be doing even better than it seemed. I learned only last week that when the Sole 24 Ore webpage whose words I’ve taken for months as holy writ says "FIRST DOSES (TOTAL)," that number does not, contrary to what I have always thought, indicate how many Italians have had at least one dose of vaccine. For some bizarre reason that figure only includes people who have had the first dose of a two-dose vaccine cycle, leaving out everybody vaccinated with the one-dose Johnson & Johnson vaccine and all the COVID-19 survivors who correctly had only one dose. So the real number is 2 million higher than I thought, and Italy has already at least partially vaccinated 73.7% of people over 16, 69.1% of people over 12, and 61.9% of the entire population (leaving the US, at 56.2%, in the dust). Isn't that great? 


Green pass Italian style

Post at the Facebook page of a Rome city police group

As of August 6th you won’t be allowed to walk into an Italian restaurant, concert, gym, spa, conference, bingo parlors, stadium, theater, or museum, or apply for a government job, without a Green Pass (I call it Green Pass Lite, because a single dose of vaccine will do). When no-vax France did something similar a couple of weeks it gave a huge boost to the vaccination drive, but vaccine-friendly Italy doesn’t really need the boost. The decree already has restauranteurs complaining about having to scan customers’ QR codes at the door, and Rome city police threatening to refuse to enforce it. Not to speak of nightclub owners, who aren’t being allowed to reopen at all and who are screaming bloody murder. 

There’s growing evidence that this kind of stuff does increase vaccination rates. And that between Delta and surging cases, some vaccine-hesitant Americans are finally sitting up and taking notice. Others, though, are only hardening their opposition.


On beyond swabs

Are there simpler methods for winnowing out the infected than sticking giant Q-tips up noses? I’ve already mentioned sniffer dogs, trained to sit when their sensitive noses pick up SARS-CoV-2-infected body fluids. They’re already at work patrolling airports in Finland, Lebanon, and the United Arab Emirates, and a county sheriff in Massachusetts is about to unleash two “K-9’s” in schools and nursing homes. Dogs can supposedly detect 96% of infections in controlled settings, though they’ll inevitably do less well in crowds.

There may be an even better living COVID detector: trained honeybees. When I first read about this I imagined them buzzing around the room and dive-bombing on infected heads. But no, it turns out they’re tied down and exposed to individual samples of saliva, sticking their tongues out for a sweet reward when they encounter one that contains SARS-CoV-2. It seems sniffer bees are actually old news, and have been used to detect everything from bombs to tuberculosis. Who knew? Slick brochures claim they’re quicker to train than dogs, with even more sensitive odor sensors.

A no-nose sniffer

But why not bypass the animal kingdom altogether? Cleaner than dogs, less apt to sting than bees, there’s a sniffer gadget being developed by a company in the UK. Nail it to the wall, flip the switch, and in 15-20 minutes it will tell you whether anyone in a large room is carrying the SARS-CoV-2 virus. It’s up to you to figure out which one, possibly by walking around with a handheld model.


Origin stories

Fort Detrick laboratory

I nominate this offering from George Koo for the Most Unlikely prize: “some of the other speculations besides the Wuhan lab theory deserve to be included in the investigation [of the origins of COVID-19]. For instance, the biological laboratories at Fort Detrick in Maryland were shut down by the US Centers for Disease Control and Prevention for violations of safe practices more than six months before the outbreak in Wuhan. Around that time there were unexplained deaths caused by respiratory failures. A full account was never made public, but the issue was swept under the carpet by blaming the fatalities on excessive vaping.” 

The Fort Detrick tale is being pushed by official Chinese government news outlets and purple-prosed spokespeople:“How many secrets are hidden in the US’ Fort Detrick lab and other biolabs overseas from the rest of the world? What is the truth of the outbreaks of respiratory disease in northern Virginia in July 2019 and the e-cigarette, or vaping, associated lung injury (EVALI) outbreak in Wisconsin? The US owes the world an explanation.” 

Fact: the U.S. Army Medical Research Institute of Infectious Diseases at Fort Detrick was indeed shut down over safety issues in mid-2019, and it did indeed work with awful agents such as plague, Ebola, and ricin – not with coronaviruses, though, because they’d make lousy bioweapons (see below). 

More from Koo, to give you an idea what passes for investigative reporting in his corner: “There were also reports in cyberspace that there was evidence of the coronavirus being found in European sewage systems, again months before the Wuhan outbreak. What happened to all those rumors?” 

I do have to say that Italian researchers have thrown a plausible spanner in the origin story works by finding the SARS-CoV-2 virus in a skin biopsy sample taken from a rash on a Milan woman’s arm in November 2019, a month before COVID-19 was first described. They published their case in January 2021, but I didn’t notice it until after the Wall Street Journal picked it up. The woman’s identity is known (the WSJ article got that wrong), her rash lasted 5 months, and in June 2020 she tested positive for SARS-CoV-2 antibodies. This case is consistent with the Chinese origin of the novel coronavirus, given Northern Italy’s intense China connections – especially to Wuhan, with Chinese workers and Italian fashion executives traveling back and forth. It does seem to push the start of the pandemic back a few weeks, though, and in my opinion makes the lab leak theory even less likely.


A near-origin story…

Preparing vaccines in a Rome hospital

Three students at the California State University, Chico, are suing their school and Anthony Fauci over CSUC’s vaccine mandate, claiming they had COVID-19 in January 2020 so getting vaccinated would put them “at substantial risk of serious illness, including death.”  Couldn’t they have found some more plausible plaintiffs? Leaving aside the anti-vax nonsense, in January 2020 exactly 43 Americans contracted COVID-19 – none of them in California.


Weaponize it

Preparing the headless corpse of a plague victim for launching into a besieged city

Remember the still-unsquelched theory that the novel coronavirus was concocted in a Chinese lab (the Chinese say in an American lab) for use as a biological weapon? Many Americans and two-thirds of Russians believe it. Well I hate to be a party pooper but in fact SARS-CoV-2 would make a lousy bioweapon because it can’t kill or disable maximal numbers of people in minimal time. I get this from pre-COVID-19 review articles by a top microbiologist and US Army bioterrorism experts, and a pandemic article by a US biodefense expert

SARS-CoV-2 does have a couple of points in its favor as a bioweapon, being:

-       easy to access

-       fairly infectious (though not in the league of smallpox or plague)

But it lacks all the other crucial characteristics that are shared by the classic bioterrorism diseases anthrax, smallpox, plague, botulism, Ebola, and tularemia:

-       it’s not easy to manufacture 

-       a low percentage of the exposed become ill 

-       it’s only infrequently deadly or disabling

-       it’s not stable in the atmosphere 

-       it has a relatively long incubation period

-       there’s no guaranteed way to protect the people who deploy it


The mysteries of Fauci-bashing


T-shirt from Florida governor Ron DeSantis

In June 2020, 76% of Americans approved of what Anthony Fauci was doing. Just before the November election that had slipped to 72% of likely voters. By February his approval rating had slipped to 60% and by April to 54%, though it seems to have held steady since then. The American right’s relentless targetting of Fauci for everything up to and including the coronavirus itself does seem to be working, but I’ve never been able to understand why him? Why pick on a calm, balanced scientist who can probably btake credit for saving millions of lives over his half-century pre-pandemic career. Now the conservative polling website, RealClear Politics, may have provided the best explanation, which lies precisely in his calm and his balance. What those guys resent is not that Fauci declined to back up some of Trump’s farfetched notions, it’s that he refused to play the President’s game. In their words, “What surely riles the right even more than Fauci's refusal to cave is that he didn't care. Fauci saw Trump as a politician to manage rather than to fear. The lack of abject submission punched a few holes in the Trumpian myth centered on an all-powerful authority. Fauci met the attacks on him with sighs. He responded to nutty declarations on science with patient correction. The right wants angry conflict, and Fauci never delivered on his end.”

Wednesday, July 21, 2021

Sitting In Limbo


Features Sitting In Limbo

Treatment news

Natural immunity: A rare bright spot in the gloomy recent COVID-19 news. Laboratory research in France examining neutralizing antibodies against the Wuhan original and the Alpha variant suggests survivors stay immune for a solid 12 months. And one-year followup of Italians infected early in the pandemic says immunity is long-lasting in the real world as well as in the lab: of 1,579 people with positive SARS-CoV-2 swabs last spring – a third of them asymptomatic – only 5 were reinfected over the course of the following year. Control had 15 times more infections. Both studies were pre-Delta, though, making them less relevant nowadays.

Azithromycin: A recently published UK trial says this antibiotic does nothing to help COVID-19 outpatients. I’m puzzled that anybody bothered to study it.

Heparin: In a Canadian study among 465 moderately ill hospitalized patients, anticoagulation reduced the risk of reaching a composite primary endpoint from 21.9% to 16.2% and the risk of death from 7.6% to 1.8%, but neither effect reached statistical significance. I doubt anyone will stop anticoagulating hospitalized patients on the basis of these results.

Ivermectin: In my last post I blasted a recent so-called meta-analysis, and the papers it was based on, as junk. Now one of its chief sources has been retracted for data fabrication and ethical concerns. The meta-analysis itself was retracted, then unretracted – Open Forum Infectious Diseases has now officially published it after 6 months of hemming and hawing.

Remdesivir: A study in Norway found that neither remdesivir or hydroxychloroquine did any good for patients hospitalized with COVID-19: no effect on symptoms, no effect on viral load. For hydroxychloroquine that’s no surprise, but the dismal remdesivir results suggest the World Health Organization’s thumbs down and the German agnosticism may be smarter than the American and European thumbs up.

Lilly’s monoclonals: It’s been a roller-coaster. Last September good: hospitalizations fell by 72% if high-risk outpatients received bamlanivimab, leading rapidly to authorization for emergency use. April 2021 bad – bamlanivimab had lost its punch against the Alpha variant – then good again when a bamlanivimab-etesevimab combo stepped in. In June bad – the FDA withdrew emergency authorization altogether, over low efficacy against Beta and Gamma. Now good…? The main Phase 3 study has finally been published, reporting the combination decreases hospitalizations by 70% when given early to high-risk outpatients. The study was unfortunately performed long before Delta rode into town – yet another COVID-19 study published too late to be really useful. Laboratory studies, at least, suggest that etesevimab (though not bamlanivimab) may be effective in Delta-infected patients.

Sotrovimab: This new monoclonal antibody, made by GlazoSmithKline-Vir and authorized in the US and Europe just a couple of months ago, is coming up roses. It’s active against Beta, Gamma, and Delta, and may soon be available as a convenient intramuscular injection.

Germany’s bottom line: The German health authorities have brought out updated guidelines for hospitalized COVID-19 patients. Dexamethasone and anticoagulants unequivocally yes. Tocilizumab maybe, in highly selected patients. Monoclonal antibodies maybe, in early disease. Remdesivir no recommendation for or against; baricitinib insufficient evidence; azithromycin, ivermectin, and vitamin D no. This jibes with my own reading of the data and confirms that nothing new and exciting has come along.


Vaccine news

Reithera: This made-in-Italy vaccine dropped out of sight months ago when it had so-so Phase 1 results (details in this blog post) and couldn’t get Phase 3 trials funded. Now it’s trying to make a comeback, claiming better results. (Consider running Enrico Bucci’s excellent commentary through Google Translate.) To be honest, I don't think the world needs another adenovirus vector vaccine. We've had enough trouble with AstraZeneca and Johnson & Johnson, between modest efficacy and rare but serious side effects. Countries who can afford Pfizer and Moderna should stick with them, hopefully retooled to cover variants.

AstraZeneca: Italy is rightly having a hard time convincing people 60-79, the only eligible age group at the moment, to take the Oxford vaccine. The Lazio region announced it won't order any new supplies. The government then raised them one, putting both adenovirus vaccines on hold for a month. Another mess: the AstraZeneca original, Vaxzevria, is approved in the EU but the Indian knockoff, Covishield, the chief source for the Covax initiative, is not. Which means many people from poorer countries are being blocked from entering the EU or obtaining the coveted Green Pass

Clotting problems: AstraZeneca and Johnson & Johnson think they might be able to come up with a fix. I frankly doubt they’ll succeed – and given the rarity of this dread complication I don’t see how they could possibly tell whether the retrofit worked without giving millions more shots. Probably only developing countries desperate for doses will let their people be guinea pigs.

Johnson & Johnson: A study of antibody titers and cellular immune responses in a handful of Phase 3 trial volunteers 8 months after vaccination revealed that immunity had hardly faded at all. But, as usual, that’s immunity against early strains only.

Mix-n-match: Findings of heightened antibody responses, including against the vaccine-resistent Beta variant, when Pfizer or Moderna are given on top of AstraZeneca, have now been published. The top World Health Organization scientist has nonetheless taken a strong stand against this approach, calling it a “dangerous trend.” Given that neither France nor Germany, where they’ve been mixing and matching for months, have experienced explosions of breakthrough cases, I can’t agree.

Mind the gap: Canada’s 16-week gap between vaccine doses, the longest in the world, was promulgated on March 3rd. Three months later most provinces cut that in half, and just 2 weeks ago several started giving their second doses after only 4 weeks. Canada luckily ducked the Delta variant during the months when most vaccinees had only a single dose (one is useless against Delta).

Pfizer: Pregnant women were excluded from clinical trials, but a case-control study among 15,060 pregnant Israelis now allows us to estimate real-world effectiveness at 78% in preventing clinical COVID-19 during pregnancy – perhaps only 45% at preventing hospitalization (too few cases to be sure). Vaccinated and unvaccinated women had identical pregnancy outcomes, from preeclampsia to birth weight. …Also, the Phase 3 trial showing strong immune stimulation and 100% efficacy among adolescents has now been published.

Belfast, Northern Ireland

New frontiers in vaccine hesitancy: Hostility toward COVID-19 vaccination is so intense in some mainly Republican parts of the United States that people don’t dare do it for fear of being ostracized by friends and relations. In Howell County, Missouri, where 81.4% voted Trump vs. 17.3% Biden, only 23% of people have had even one dose and cases are soaring. One local clinic made an astonishing offer, immediately shared on the Health Department’s Facebook page: “Choosing to get vaccinated has been put in a strange light. For some getting a vaccine may mean losing friendships . . . if you are afraid of walking into a public area where you might be seen getting your vaccine, we will work to accommodate even more of a private setting for you to receive your vaccine.” Meanwhile, on the bribe front, we have Canada offering kids ice cream, and lotteries that promise guns in West Virginia, herrings in Holland, cows in Thailand, and gold bars in Hong Kong. Different strokes for different folks. 

On the bright side, even Steve Scalise (influential Republican congressman) and Sean Hannity (influential Fox News personality) have abandoned their anti-vaccine stances and are urging their followers to get the jab.


The state of the virus

US cases county by county last week

Every state in the USA is now seeing an upswing in cases, with hospitals and ICUs starting to fill up in ArkansasMississippi, and Alabama, joining already hard-hit Missouri.

Everybody’s concerned about breakthrough cases of SARS-CoV-2 infections in vaccinated people. Should they be? Not very, I think, at least not so far. In California, 10,430 breakthrough cases were identified between January 1 and July 7 among 20.4 million fully vaccinated individuals. A total of 1,472,970 cases were diagnosed in that half-year, so only 0.7% were in people who had been fully vaccinated. Put another way, as of July 12th only 5,492 of 159 million fully vaccinated Americans had needed to be hospitalized for COVID-19. 

Still more COVID-19 infections among the Yankees. But don’t let that shake our faith in vaccines: some of the cases were unvaccinated, we don’t know whether the vaccinated ones had any symptoms, and all the vaccinated Yanks had the less effective Johnson & Johnson product.

With COVID-19 hospitalizations surging among the unvaccinated, Los Angeles has had to reinstate the indoor mask mandate that had been dropped only weeks earlier. In San Francisco and many other counties it’s merely a recommendation, not a mandate, at least for now. 

Indonesia has now become the pandemic’s global epicenter, with more daily cases than Brazil or India, as the Delta variant sweeps across Java and Bali toward points east. Local experts believe the real number of daily cases is 5 or 6 times the official 60,000. Hospitals are overwhelmed, lacking beds, oxygen, and staffing. Only 15% of the population has received any vaccine, usually the relatively ineffective Sinovac (dozens of fully vaccinated doctors have died).


Delta blues

People infected with the Delta variant seem to have a viral load 1000 times higher than those with the original Wuhan strain, helping to explain why it’s so contagious. But there’s mounting evidence that the effectiveness of mRNA vaccines in preventing it is closer to the 88-89% observed in Canada and the UK than to the 64% hinted at by Israel (see my last post). In Rome’s Lazio region, fewer than 10% of Delta cases had been fully vaccinated. In California, as I just pointed out, virtually all cases are among the unvaccinated. And in Israel itself they are backtracking on lifting pandemic mitigation measures, saying “We may have lifted some of the restrictions much too early” – suggesting that they think the apparent decrease in vaccine effectiveness may be related to over-hasty normalization.

We already knew Delta might be more virulent as well as more contagious; now it seems the vaccine-resistant Beta variant may be as well.

A French group has done careful evaluation of neutralizing antibodies against various SARS-CoV-2 variants. People who had had COVID-19 a year earlier still had plenty against Alpha, but few against Beta or Delta. Blood samples from people fully vaccinated with either Pfizer or AstraZeneca were similarly worse at knocking out those two variants; we already knew a single dose was useless. Another laboratory study found both Pfizer and Moderna to score high against Delta, Delta plus, and Lambda, while Johnson & Johnson flunked out against all 3 variants. A third group claims the opposite – we’ll see what happens in the real world… Fortunately some monoclonal antibody products are still effective against Delta: etesivimab (part of the Lilly cocktail), GlazoSmithKline-Vir’s sotrovimab, and both casirivimab and imdevimab (the two elements of Regeneron’s REGEN-COV).

On beyond Delta we now have Kappa (similarly born in India) and Lambda (which first showed up in Peru). Neither of them seems particularly contagious, vicious, or resistant to vaccines and therapies, though, so the World Health Organization is still calling them Variants of Interest rather than Variants of Concern.


Green Pass skulduggery

Phony Green Pass

The EU Digital COVID Certificate (“European Green Pass”) is a reality – I’ve proudly carried mine in wallet and cellphone for 3 weeks. They’re needed to travel within Europe, to go to a soccer game in Italy – and, in France, to enter a restaurant, cafĂ©, intercity train, hospital, or movie theater. The day after this last stroke of brilliance was announced, 1.3 million vaccine-shy citoyens and citoyennes signed up for the shot. Italy is about to follow suit for nightclubs, restaurants, and concerts. Supposedly in September you’ll need a Green Pass even to get on a Rome bus – how the hell do they think they can enforce that?

What happens when you require a Green Pass to eat indoors...

There are 3 ways to qualify for a Green Pass: get vaccinated (good for 9 months), get COVID-19 (good for 6 months), or have a negative swab (good for 3 days). But, as the Italians say, “fatta la legge, trovato l’inganno,” as soon as they pass a law someone will find a way around it. For a mere $150 in cryptocurrency you can get a fake Green Pass whose QR code will pass muster at the airport. And it’s not only those anarchic Italians, the dutiful Germans are at it too. The Italian police are busily shutting down the “dark web” sites that deal in conterfeit passes, threatening buyers and sellers alike with 6 years in prison. Knowing how widespread the phenomenon is in the US, I was surprised to read a few days ago that a homeopathic “doctor” was the very first American charged with distributing false vaccination cards.

But the heartland of bogus vaccination certificates is Russia, where the irresistible force of vaccine mandates – for everyone from teachers to barflies to women needing Pap smears – is about to slam up against the immovable object of baked-in vaccine refusal. One month ago there were 500 domain names selling fake vaccination certificates… a mere 18.5% of Russians have had even one dose.


Scandal variations 

Yangon, Myanmar, hoping to refill oxygen cannisters

An outbreak at the US Embassy in Kabul supposedly reached 159 people, causing deaths and medical evacuations, even though the embassy had received its vaccine supply two months earlier. How many people are there at that embassy, anyway? 

There’s a raging surge in Myanmar, fueled by its common border with India – the Delta variant’s home town – and a stumbling vaccination campaign. The military leaders who seized power in February have been doing what they can to make things worse: denying oxygen to private clinics and charities while stockpiling it in army hospitals, firing live ammunition into crowds lined up to buy oxygen, vaccinating soldiers before the elderly.

Until now Australia has done a great job in keeping the spread of the virus down, by tracing contacts and by sealing its borders at the drop of a hat. At this moment some 34,000 citizens are trapped abroad by closed borders. But its vaccination campaign still hasn’t taken off. Between supply shortages, no-vaxxism, and old-fashioned inefficiency, only 6% of its population was fully vaccinated as of July 2nd (compare 32% in Italy, 47% in the US…). I start to suspect an ideological component to the failure, that deep down the Australian authorities believed they had the pandemic so well under control that they didn’t need vaccinations. 

Brazilian President Jair Bolsenaro is accused of making irregular deals to acquire tens of millions of doses of India’s unproven Covaxin vaccine. As Brazil’s Supreme Court authorizes a criminal investigation into his conduct, some think the scandal will bring down his government (here’s hoping!). Brazilians have an astonishingly original array of nutty beliefs about COVID-19: they’re still enthusiastic about hydroxychloroquine, especially inhaled. Some think face masks cause cancer, people are being buried alive to inflate COVID-19 statistics, and vaccination breeds homosexuality. And here I thought the kings of conspiracy theory lived in North America.

Thousands of unwitting Indians went for COVID-19 vaccinations, paid, and received shots of salt water instead. Fourteen doctors have been arrested. 


Hauling COVID-19 along

study from Norway found that 52% of adults under age 30, especially women, were still suffering symptoms 6 months after mild COVID-19. Thirty percent were still fatigued, 26% sleepy, 13% short of breath; 23% had trouble finding words and 18% had memory problems. Older patients were even worse off, but all these figures far outpace the 10% rate generally cited.

An international survey of nearly 4,000 COVID-19 survivors, mostly under age 60 and almost none hospitalized, was even more troubling. Six months after falling ill 77.7% complained of fatigue, 72.2% of exercise intolerance, and 55.4% said they couldn’t think straight. Most had not returned to a full work schedule, and 22.4% were still off work. A separate sober assessment of the cognitive aspects of long COVID concludes that physicians have little to offer.

A 12-year-old with long COVID

Fortunately this often devastating syndrome, which can occasionally strike children as well as adults, is starting to be recognized as a “public health disaster in the making.” Hopefully the billion dollars being funneled into long COVID research by the National Institutes of Health, along with smaller investments in the UKSwedenGermany, and elsewhere, will eventually yield results.

But there’s also encouraging news: long COVID is virtually unheard of after breakthrough infections in the fully vaccinated. Get your shots, people!



On the one hand we have mass pandemic burnout, the coronavirus conflagration reducing dreams to ashes…

Doctors and nurses are leaving the medical field in droves. In July 2020 12% of American doctors had either already closed their practices or planned to do so by the end of the year, and 72% said their income had dropped. Primary care providers are particularly likely to be fleeing. And 25% of all United States physicians said they were contemplating early retirement, while another 12% hoped to at least stop seeing patients. Even worse in the UK, where 32% of National Health Service doctors are would-be pensioners.

Doctors are unlikely to starve if they retire early. Unfortunately the same can’t be said for millions of others, notably teachersairline employees, and people of color in general. Most of the working-class Americans who retired in 2020 did so involuntarily.

Then there’s dancers and actors, more than half of whom were unemployed in July-September 2020. Gigging musicians were wiped out financially, and even a steady job was little protection – New York Philharmonic players accepted a 25% paycut for two years, and may never get back to their prepandemic salaries. I’ve read articles claiming the pandemic has boosted creativity, that people work better together on Zoom than in person, etc. For managerial types that could be, but for the performing world it’s blather. 

Igor Levit playing one of his daily lockdown concerts

Artists have scrambled to find ways to cope and survive, creatively and financially, with some success. But for one Igor Levit, who broadcast extraordinary piano concerts from his Berlin living room, dozens more feel their worlds have been thrown into disarray, their senses deranged, “past their prime.” In one British study half the composers and writers found themselves unable to do creative work during lockdowns, with a third of arts workers spending no time at all practicing or reflecting; 15% felt a lack of motivation or focus (“everything seems pointless and I feel forgotten,” “hard to feel motivated to do anything”);  many artists in Australia felt “sure the recovery couldn’t heal them,” or “parts of their lives would be damaged forever.” One survey of nearly 3000 musicians found that 35% (!) had sought professional counseling during the pandemic – but most found they couldn’t afford it. 

There’s a flip side, though, people who found the pandemic the perfect moment to trash their careers or transform their lives for the better. Radio host Brian Lehrer invited job quitters to call in when he faced an unexpectedly empty quarter of an hour. Callers included a teacher who’s turning himself into a real estate agent. A non-profit’s CEO going back to school to become a social worker. A working stiff who went over to online trading, and struck gold. A home health aide and assistant librarian who’s become a fulltime actor. And just this week, the Washington Post published a remarkable series of interviews with people who during the pandemic had started an art studio, founded a consulting firm, moved to Paris, built a house with their own hands, run successfully their school board, or gotten gender-affirming top surgery. Even the economic recovery is peppered with cheerful “I quits.” Call it the YOLO principle, You Only Live Once.