The dominant feeling or mood in the country is very, very clearly a desire to be done with the epidemic, or more properly, the restrictions imposed by governments and others as a result of the epidemic. We continue to see the tension between favorable transmission factors and vaccination in case, hospitalization and death rates. I believe there are good indicators to suggest that vaccination is winning. Despite much greater levels of contact, we are not seeing a massive case surge, but more of a bump. As full adaptive immunity kicks in, we should expect even more resistance to rapid transmission. We just have to force our political leaders to recognize reality and remove restrictions.
Here is a fascinating study from the CDC on CV-19 deaths. I am not completely sure what to make of it and it raises at least as many questions as it answers. (CDC Study) The study was done to address concerns that deaths may be inappropriately attributed to CV-19. The agency did a full review of the 2020 death certificates. These authors note, as I have before, that the best way to assess accuracy of death attribution is by a full review of medical records. There is substantial variation and inaccuracy in the content of death certificates. Now, we learned from Minnesota’s Department of Health that CDC actually assigns ICD-10 codes, which seems inconsistent with the study. Nonetheless, the study finds that there were 378,048 certificates listing the CV-19 death code. 94.5% of these had at least one other code, which is what you would expect. It would be unusual to find a certificate that didn’t have chain of event codes or some significant comorbidities. CV-19 doesn’t kill directly; most commonly it causes various lung complications and leads to acute respiratory distress which leads to death. So certificates with only CV-19 on them are suspect. 92% of all certificates had a plausible chain of events or a contributing diagnosis code in addition to CV-19 code, and 70% to 80% had both a chain of events and contributing cause codes or a chain of events only code. This is very confusingly stated and I can’t figure out why it is stated as a range, so you have to parse through it to understand that as many as 30% of death certificates with CV-19 codes on them don’t have a clear chain of events code.
Pneumonia and acute respiratory distress were the most common chain of events codes, as you would expect. Diabetes and hypertension were the most common contributing causes. There was some interaction between place of death and likelihood of coding a chain of events cause or a contributing cause. Many deaths at home or in a LTC facility had only contributing cause, no chain of event codes. This is a clear indication that these deaths were not caused by CV-19, but the people merely had a positive test at some point. If you die of a heart attack at home and had a positive CV-19 test sometime, you didn’t die because of CV-19, you probably didn’t even die with it. And we see again in this study that several thousand deaths from accidents, homicides, overdoses, etc. are listed as CV-19 deaths. I have no clue how the agency does that with a straight face. Over a third of deaths in the age 17 and under group, and there are only 182 of these across the whole country, had contributing or chain of event codes that are inconsistent with a CV-19 caused death. It is frustrating as hell to read these studies and have no clear idea of how or why deaths are being attributed to CV-19.
Here is another study that looked at death calculations and how they varied across countries. (Medrxiv Paper) The authors compared total rates of death in 2020, deaths attributed to CV-19 and the average number of deaths for the prior five years. They found that if CV-19 were disregarded, half the countries had excess deaths and half had fewer deaths than the average would suggest, with very high variation. The researchers believe that the results suggest that there is such variability in death reporting across countries that you can’t easily make comparisons. One finding, however, was that more severe lockdowns were associated with greater levels of non-CV-19 excess deaths.
Readers know I am partial to gloomy stories probably because they confirm my belief in the stupidity of politicians and the harms their actions cause. This study shows a significant drop in use of the ER for children in Quebec, Canada, during the epidemic, resulting in conditions becoming worse and eventually needing hospitalization. The terror campaign worked exactly as designed. (Medrxiv Paper)
Another category of research I am especially fascinated by is anything that helps explain the actual physical processes of infection and why risks of infection may vary. This research examined differences in the airway cells of older and younger persons. (Medrxiv Paper) Compared to young adults and children, older adults have significantly lower expression of interferons, which are critical molecules in the immune system defensive armory, but stronger inflammatory responses, which often lead to more severe disease. Interestingly, older adults also seemed to have lower viral loads, which was attributed to lesser expression of proteins that facilitate CV-19’s hijacking of protein-making machinery in cells. Other studies, however, have tended to find higher viral loads by age.
This study examined viral loads and variants. (Medrxiv Paper) The study comes from Wales and used cycle numbers to determine that the B117 variant is associated with higher average viral loads, which would likely explain any greater transmissibility. While somewhat unclear, in looking at the tables and figures, it appears that the difference is actually rather slight.
Research from Italy looked at relative proportion of variants and original strain. The B117 variant was found to have become the majority of infections, but that really oh so scary variant from Brazil had obtained only a limited foothold in the country, suggesting it does not outcompete B117. (Medrxiv Paper)
But here is a study that is a bit of an antidote to the variant terrorism. It looked at the progress of B117 in the UK, adjusting for a variety of other factors which may affect transmission, primarily meteorological ones and lockdown stringency. (Medrxiv Paper) According to their model, these factors dominated in controlling the course of the epidemic and the introduction of the variant had little effect on transmission rates.