Aside from the ongoing school disaster at the federal level (today apparently the CDC will be designated as a wholly-owned subsidiary of the teachers’ unions, as the White House was on January 20), the state of Minnesota officials responsible (really more like irresponsible) for the epidemic response yesterday held the only briefing we will apparently hear this week. I want to point out again that as you would expect with a highly seasonal respiratory virus, we are in a very low trough of cases which is continuing to further decline. There is no reason why schools should not be fully open, businesses should not be fully open and any restrictions on people’s social activities lifted. Notwithstanding this obvious fact, in the interest of maintaining the illusion (actually a delusion) that there is great danger for the entire population of Minnesota, the fear-mongering was kept up in the briefing. Don’t dare travel to a sane state like Florida, or any place warm. Be afraid of variants, be afraid, be afraid, be afraid. And Big Daddy Walz will protect you. A load of crap. My advice, if you can afford it, get the hell out of this godforsaken state and go to Florida for a little normalcy and restoration of sanity. Flying is pretty much completely safe and Florida is not some nexus of massive transmission, on the contrary, seems about the same or better as other states in its geographic and climatic zone. I am leaving on Monday to go there, but my timing sucks, our deep freeze starts to lighten on Tuesday.
I want to do my part to clear up misconceptions about both the vaccine and variants. We don’t know a lot of things for sure, but people are entitled to the best possible information so they can make their decisions. I gave a talk to a group earlier this week and I got a number of questions that indicated that people were believing some of the garbage floating around there about vaccines. The current vaccines are not gene therapy. I am a founder of a gene therapy company, so I know what that is. These vaccines do have a different way of prompting the body to develop an immune response, but no genes are being modified or replaced in the course of that. While there clearly are adverse events occurring, most are mild–headaches, fever, tiredness–and not unexpected when you are giving tens of millions of people a biologic product. As an older person, I get an enhanced dose of flu vaccine and I feel like crap for a day or so after that. Just because of the large numbers, there can be deaths and other events occurring coincident with administration of the vaccine but that really doesn’t mean causation. I don’t want to minimize the advisability of reading up on the potential risks, and asking questions if you are concerned, but there isn’t evidence of widespread serious issues.
I would be more concerned about effectiveness, although it is too early to really assess this. And because seasonally in the US, transmission is declining on its own and we have large numbers of people with natural adaptive immunity from infections, it is hard to tell what the additive effect of vaccination is on the reduced level of cases. We also should anticipate that it takes a few weeks for vaccination to prompt the full power of adaptive immunity. The real test will be the next time the seasonal factors are lined up for a good case surge. And I wouldn’t be that concerned about variants, there is no evidence demonstrating that they actually cause worse disease, and since transmission is declining in the US notwithstanding the expanded presence of supposedly more infectious variants, I just am not seeing yet that they are a serious cause for concern. And you know I have repeatedly warned that over-zealous attempts to suppress the virus could lead to more aggressive strains, so that could still happen, but so far the mutations seem manageable.
Yes, the terror campaign kills. This was a large study of the impact on hospitalizations for emergency conditions in Germany. (Medrxiv Paper) During the first wave of the epidemic, hospitalizations dropped by over 15% for things like heart attacks, aorta rupture and pulmonary embolism. Following this period there was a continued smaller drop in other emergency hospitalizations, but an increase for those specific categories. The likely explanation was that patients ignored warning signs and had worsening disease leading to more severe outcomes. The researchers indicated that patients missing care may be the explanation for excess deaths in Germany in the summer, because it wasn’t due to CV-19.
Governor Cuomo also kills, nursing home residents especially, and then tries to hide the bodies. So this study is timely. Similar to an earlier piece of research, it focused on any association of mitigation measures and nursing home resident deaths. (Medrxiv Paper) The study covered June to August 2020, so the usual issues about time period selection, and attempted to correlate changes in stringency of certain suppression measures with cases, CV-19 deaths and non-CV-19 deaths in nursing homes in a state. Somehow they divided states into just a low or a high stringency regime, that seems pretty arbitrary and limited. Nonetheless, the primary findings, reporting on only one week of the study period, were that more stringent measures were associated with fewer cases and fewer CV-19 deaths, but more non-CV-19 deaths. Not clear what adjustments were done to avoid confounding.
Yet another encouraging study on adaptive immunity following infection. The researchers found that almost all patients, regardless of disease severity, develop strong memory B and T cell responses that lasted at least 6 to 8 months. (Cell Paper)
And another paper along the same lines examining responses in uninfected persons, active cases and recovered cases. (Cell Paper) Both antibody and T cell responses were included. They found that T cell response appeared to be more prominent over time than antibody ones, and they found that those T cell responses persisted over time in recovered patients. Antibody responses appeared correlated with disease severity and waned over time, although remaining present. They also found a T cell response, but not an antibody one, from uninfected patients who had been infected with seasonal coronavirus, suggesting that those previous infections could aid in fighting off CV-19.
If you are really missing a discussion of modeling studies, read this one. (NBER Paper) The models have been pretty worthless, largely because of inability, or even lack of attempt, to incorporate seasonality. At least the one discussed in this paper tries to do that.
And another study, this one from New York, finds that there likely was significant circulation of the virus before the first cases were reported. The researchers did a test on over 3000 respiratory samples collected in the first ten weeks of 2020 and found that even in January there was virus RNA present in samples. (Medrxiv Paper)