Wednesday, August 30, 2023

Don't Look Up

 


I need to apologise for the time that’s passed – 2 1/2  months – since my last post. This lengthy gap was due first to a snorkeling vacation in Bali – see https://www.youtube.com/watch?v=6kWmJu2t3BU and https://www.youtube.com/watch?v=yqLwZLoQQY0 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.


  

Prevention



Bivalent boosters: A study of Cleveland Clinic employees has been widely misinterpreted in social media as saying that boosters increase the likelihood of COVID-19, e.g. “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 chose to get more doses. A post at FactCheck.org discusses in detail the issues raised by this interesting and controversial study.

Monovalent vaccines: Following the recommendations of the World Health Organization, both Moderna and Pfizerhave 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 September, and a month later in Italy. Novavax has promiseda protein-based booster aimed at XBB.1.5. That might get a little traction with people who mistrust mRNA technology.

Novavax: Speaking of Novavax, a study 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 lower 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.

HLA types: The human leukocyte antigen (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), Beh├žet’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, may help protect people infected with SARS-CoV-2 from developing clinical COVID-19, helping to explain why at least one in 5 infected individuals never develop symptoms.

Schnozzes: Do you pick your nose? Odds are you do, given that when Dutch researchers asked a sample of health care workers, 85% said yes. They found that nose-picking nearly tripled 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 not increase the risk of infection.

Masking: When St. Louis University eliminated distancing requirements in classrooms but continued to mandate universal masking and up-to-date vaccinations, COVID-19 cases did not increase. This makes sense, because most transmission in colleges likely takes place not in classrooms but in locker rooms and social settings.

Antibiotics: Here’s an odd one: having multiple courses of antibiotics in the last few years apparently puts you at increased risk 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.

 

Testing

A COVID-19-detecting breathalyzer


Even back when Delta and the original Omicron variants were dominant, a single rapid antigen test only detected 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.

Washington University St. Louis researchers have developed an ultra-rapid breath test 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 article 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 plenty of COVID-19 around in St. Louis I can see no excuse for doing such limited validation.

The very same Washington U. research team has invented a cubic-foot-sized gadget that can supposedly test indoor airfor 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.

 

State of the pandemic

 


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 virtually all over the country.



COVID-19 hospitalizations, too, are on the rise nationwide. And the New York Times reports various local outbreaks.



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 now pushing 500.  

In Italy absolute numbers of hospitalizations and deaths remain low, but  there are hints of a new wavelet (ricoverati = hospitalized, terapie intensive = ICU). 


COVID-19 deaths in Italy have more than doubled since mid-July, hospitalizations are up by more than 60%, and the transmissibility index has crept back above one, the “epidemic” cutoff. But the Health Minister has chosen nonetheless to join AustraliaFrance, and the UK in scrapping obligatory self-isolation for people with COVID-19, in favor of mere recommendation.

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 to calculate 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 one to two millionwhile greatly exceeding official Chinese government estimates of 60,000. 

 

Long COVID


There are now about 4 million more disabled Americans than just before the pandemic – the numbers on the graph are in thousands – a surge reasonably attributable to long COVID. Fortunately, fewer American adults are suffering from long COVID now (6.0%) than there were a year ago (7.5%), probably due to a lower risk with Omicron.

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 systematic review 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.

We already knew from research in China and elsewhere that long COVID can drag on for two years and more. Now a study from the US Veterans Administration says the same. And Spanish researchers report 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.

Another VA study reports that the well-known increased risk of dying after COVID-19 is limited to the first six months after infection, and to patients sick enough to require hospitalization – in agreement with some but not allother research. From months 7 through 24, COVID-19 patients had if anything a lower 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.

According to the head of the American Academy of Neurology, long COVID is now the third most commonneurological disorder in the United States, after tension headaches and migraine. And 36 million Europeans, one in 30 inhabitants, are estimated to be currently affected. The best estimates of persistent symptoms nowadays are 6.2% after COVID-19 treated as an outpatient, and perhaps as high as 34% 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.

Some have compared 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.

After futzing around for well over two years, the NIH has finally started a study of prolonged courses of Paxlovid for long COVID (“RECOVER-vital”) under the RECOVER umbrella. Or has it? The Stanford STOP-PASC study using Paxlovid, which infamously allowed its researchers to be unmasked in patients’ presence, has apparently stopped enrolling subjects because of unpromising interim analyses. I haven’t managed to track down details.

Other RECOVER studies are “still under review.” “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 electrical brain stimulation device 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 STIMULATE ICP trial.

Some patients say they have had symptom relief from probiotics aimed at regenerating the gut microbiome. And a few posts back I described a controlled study saying much the same.

Then there’s a pilot study 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 “common side effects” include sleepiness, dizziness, fatigue, impotence, low blood pressure, lethargy, mood swings, and irritability, all symptoms typical of long COVID.

The makers of a “photobiomodulation (PBM) device” delivering intensive light to either the whole body or just the skull, also claim 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.

 

Ripoffs

The Fortune Teller, Georges De La Tour

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, looting an estimated $80 billion from the Paycheck Protection Program to buy Lamborghinis, Ferraris, Teslas, mansions, and private jet flights. 

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. More than 1,000 false tax forms fraudulently claimed more than $124 million in Covid-19 employment tax credits for businesses owned by himself and others.

And take Ron DeSantis, who diverted $92 million of Florida’s COVID-19 relief funds to a pet highway construction project of one of his major donors.

The Feds are using a variety of tricks to go after all those fraudsters. Without much success, if only $30 billion (or perhaps only $1.4 billion!) 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 unemployment insurance alone. But now it seems that the Feds may finally be getting off their butts, undertaking 718 cases to recover $836 million in stolen coronavirus funds that were used among other purposes to – get this! – “solicit murder for hire.”

What a shame that plenty of money was allocated legitimately but never used, for instance half a trillion dollarsintended to improve air quality in classrooms. American researchers have reported that better ventilation plus air filtration can cut a school’s COVID-19 cases nearly in half, and an Italian study found even better results.

 

Variant watch



BA.2.86: (“Pirola”): There’s been some alarm in medical venues and in the popular press of the United StatesItaly, and elsewhere, 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 escaping immunity from infections and vaccines. The CDCdoesn’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 shares my concern, and uses BA.2.86 as a springboard for reproposing his “dream vaccine” against all coronaviruses.

Two other recent variants, EU.1.1 and EG.5, on the other hand, are part of the XBB lineage and thus likely to be susceptible to the new monovalent vaccines.

 

Winding and unwinding


As of August 21st more than a third of all Americans on Medicaid – 5.2 million people – had been kicked off the program during the so-called “unwinding” of special pandemic concessions – in 75% of cases for procedural reasons such as not returning paperwork on time, rather than from ineligibility. Texas leads the pack, having already given a shocking 72% of its Medicaid recipients the boot. But pushback is starting. In a lawsuit filed by two expelled Florida families who allege lack of due process, an agent 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 ten more states may follow suit. The Centers for Medicare and Medicaid Services are also offering help, and they’ve opened a special enrollment period under Obamacare to help people find alternative affordable insurance. 

On the positive side, South Dakota is about to become the 41st state (including D.C.) to fully expand Medicaid under the Affordable Care Act, leaving only 10 holdouts. 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 work requirement for anybody newly gaining coverage.

 

The Free State of Florida

DeSantian fantasy of a jolly slave family

During breaks from saying that slavery was often beneficial to the enslaved, claiming African-Americans were perpetrators of violence during notorious massacres of black Americans, and seeking to cut Social Security benefitsfor the next generation, Florida governor Ron DeSantis notoriously backtracked on his early enthusiasm for COVID-19 vaccines. A New York Times investigation 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.

 

Back to origins

The infamous Huanan "wet market"

Fairly plausible new claims that the first 3 people 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 cut off all funding 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. 

Zeynep Tufekci has weighed in with a thoughtful, readable, and ultimately agnostic article, while two other distinguished commentators have taken on the origins issue in a perspective piece 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.

Bottom line: the truth may never be known.

 

The foul smell of musk

Lebron James's son Bronny

Elon is at it again, joined by Ron DeSantis’s novax Surgeon General Joseph Ladapo. This time he’s blaming COVID-19 vaccines – rather than the congenital heart defect likely to have actually been at fault ­– for Bronny James’ cardiac arrest during a recent college basketball practice session. And he made “X” delete a post that fact-checked his own “tweet” or whatever they’re called now. USA Today ran its own fact check if you’re interested. Note that Bronny James did receive a COVID-19 vaccine but it was two years before his cardiac arrest.

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 new Kaiser poll, whose key findings have been summarized 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 wrongwrong, and wrong again.

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 stripped of her medical license, as has – temporarily ­– a hydroxychloroquine-monger in Massachusetts. Wish somebody would do the same with Joseph Mercola and his ilk. Red states are running in the opposite direction, though, with Florida recently passing a law that prevents professional boards from punishing doctors who spread COVID-19 misinformation, and MissouriNorth Dakota and Tennessee following suit. Speaking of Florida, Simone Gold (of America’s Frontline Doctors notoriety) received a state medical license while in prison for participation in the January 6th insurrection, after refusing to complete the “criminal history” section of her application. One Wisconsin physician was reprimanded by his state medical board with a slap on the wrist, while an Idaho pathologist who referred to coronavirus vaccines as “needle rape” isn’t even under investigation.

“I just heard from a reliable source that 98% of SIDS deaths happen within 10 days of vaccination.” Irrelevant to COVID-19 vaccines, of course, since none are approved for babies under 6 months old, the age group suffering 90%of Sudden Infant Deaths. If you have any suspicion that other childhood vaccines might increase the risk of SIDS, look here and here and here and here and you will see that if anything the opposite is true.

“Health Outcomes for Unvaccinated Kids ‘Look Great’ as More Parents Decide to Go Natural” 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 impact factor of 0.00, 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 176, JAMA Neurology at 30. Psychosomatic Medicine, my professional society’s journal, stands at 4.3, considered very respectable.