I am intensely interested in public policy, but I try to avoid politics although the two are unfortunately inseparable. A couple of recent events should clarify to everyone that we have a group in this country, the woefully misnamed progressive movement, that views our children just like the Chinese, the Nazis, the Stalinists, the North Koreans, the Islamic extremists and every other authoritarian group viewed children in their countries. To these people, children are mere tools to be molded to the image ideologues desire. We see Terry McAuliffe, that execrable excuse for a human being, saying in the Virgina Governor’s race that parents have no right to determine what their children are taught, in the context of critical race theory and gender identity nonsense. We are talking about very young children here. And then in a hearing our national Secretary of Education says the same thing. This is horrifying–these whackos in the universities have brainwashed future teachers and are counting on those graduates to brainwash the students in public, and even private, schools. These teachers are encouraged to hide what they are doing from parents in the process. If you are a parent of a school-aged child, you must support school choice, get a school board that supports parent’s control over what their children learn and do everything you can to eliminate the power of teachers’ unions. You must assume that your children’s minds are being filled with garbage. For the sake of your children, you must fight this with every fiber of your being. Children have a right to be children, and parents have every right to control what is taught to their children when it is political, social, sexual, cultural or otherwise of any controversial nature. I am completely outraged about what is happening to our children in most schools today. And we wonder why childhood mental illness is up so dramatically.
Now to the epidemic, where public policy is equally horrifying and inept. One thing to keep in mind as the proportion of cases among the vaxed rises, is that this means that right now today, the proportion of vaxed among active cases, those people who are infectious, has also risen. I believe that at this moment we are experiencing at least a 50/50 split of cases among the vaxed and unvaxed in Minnesota. But are the vaxed as infectious? One explanation for the odd plateauing, instead of a rise, we are seeing in cases in Minnesota could be that it is the result of a lot of vaxed cases, and these vaxed cases aren’t as infectious, so the average number of people they are infecting has dropped. I think R(t), or the reproduction rate at any given time in any given population, is a worthless number and impossible for anyone to accurately calculate. But it looks to me like on average, even with the dread pirate Delta, each infected person in Minnesota is maybe infecting one other person. That is interesting.
I would further note that if you really want to understand the percent of current cases in Minnesota that are among the vaxed population, you have to ignore children under 12, who are not eligible for vaccination. Taking those cases out of the calculation would lead to an even higher percent of vaxed cases, especially now that we are back to school testing insanity.
I want to caution again that what I say about breakthrough cases is not designed to cast doubt on the vaccines or discourage people from getting vaccinated. The durability against infection appears a little lower than I might have expected, but this is confounded by our very problematic testing methods and weird determinations that a person is positive. Effectiveness against hospitalization and death appears good for most age groups. What is really striking to me is that the frail elderly are going to die, period, in the near future, CV-19 or no CV-19, vaccine or no vaccine. To imagine that a vaccine was going to protect this group, which still accounts for most deaths, was unrealistic. The flu vaccine doesn’t protect them either. We really are where we were in the early stages of the epidemic where one group overwhelmingly accounts for severe illness and death.
This paper is getting a lot of attention from all sides and I don’t know why. It is poorly designed. Like other similar studies it is an attempt to ascertain whether vaccinated people who become infected have less serious illness and are less infectious, as measured by cycle numbers, in this case in the context of the Delta variant. The study is sponsored in part by the Zuckerberg foundation and has authors with an agenda, and unfortunately today you always have to ascertain this for any study. Their bottom line is that the vaxed are dangerous too so we have to be masked forever. When you see the conclusion, you know the study is just being designed to get there. And the conclusion is that vaxed cases have viral loads as high as do unvaxed ones. But how do they get there. Maybe by prospectively monitoring a large cohort of people? No, by examing samples from people who walked in voluntarily to get a test. So you have serious selection confounding right off the bat, because if in fact vax people have lower viral loads at the same stage of infection, and have more asymptomatic infections, then you are testing and mis-sampling the entire population and your average viral load is going to look much higher than it actually is. Viral loads also vary substantially over the course of an infection, so if the samples weren’t derived either daily from the start of the infection or all drawn at the same point in the person’s infection, you also have confounded your findings. And here is an interesting quibble, there were two collection sites and different sequencing equipment was used at the sites, so not necessarily consistent cycle number identification. Also bizarrely, no where can I find the actual breakdown of the number of vaccinated and unvaccinated people involved in the study, so there is no way to compute relative infection rates. There are other methodological issues, but the authors interestingly don’t note any of them, which is a sign of the weakness of the paper. (Medrxiv Paper)
This is a large study from the VA health system attempting to compare adaptive immunity from infection versus that from mRNA vaccination. It is a fascinating study, obviously heavily male population that skews old. About 37,500 fully vaxed persons and 9500 people with prior infection were included. The vaccinations and the infections all occurred in January and February of 2021. Then infections among these groups in June through August 21 of this year were compared. There was a subgroup of about 3900 persons who had been infected and were subsequently vaccinated and this group was excluded from the main analysis and will be reported on later. I want to note importantly that no antibody testing was done to identify infections that went undetected prior to February 2021, or frankly, after February 2021. So there is a substantial possibility that were a number of persons in both groups who actually had been infected at some point. Be that as it may, the results are fascinating. For adults under the age of 65, there was no difference in infection, hospitalization or death rates, in fact prior infection may have been more protective. For those over 65, the two mRNA vaccines had a roughly 67% additional protection from subsequent infection compared to prior infection alone, Moderna offered a 61% and Pfizer a 45% additional protection against hospitalization and Moderna a 95% and Pfizer a 99% additional protection against death. So according to this study for the oldest cohort, the vaccines were more protective than prior infection. Something is wrong or at least unexplained. What is the possible clinical explanation for such a stark difference? Would have been helpful to see a broader description of events by smaller age brackets. And part of the problem may be that the absolute number of infections in the study period–June through August–was very small, only 110. That makes comparisons iffy. In addition, the strength of the protection was lower toward the end of the study period, so by a year, even among the elderly a prior infection might be as protective. (Medrxiv Paper)
Long-term care residents and staff have had a bad epidemic. This study examined antibody rates among these groups in over 200 facilities. The prevalence was 35% in residents and 26% for staff. The assay used was not looking for spike protein antibodies but nucleocapsid ones, so these are infected persons, with no attempt to ascertain vax status. The antibody level declined below detection in about a year, indicating that more sensitive assays will be needed to be able to identify persons with prior infection. (Medrxiv Paper)
Another of my favorite studies about where the rubber meets the road, in the upper respiratory tract. Studying child and adult patients, the researchers found that mucosal tract antibodies tended to be higher in children than adults and in asymptomatic or mild cases than in severe ones, suggesting that early and robust building of antibodies helps limit disease. (Medrxiv Paper)
Another paper assessing the durability of antibodies following actual infection. At six and 12 months follow-up, detectable antibodies remained. These were stronger in those who had a severe illness. There was some lessening of protection against variants of concern. Always important to remember in these papers that the memory B cell response is not being assessed, nor is any of the T cell arm of adaptive immunity. (Medrxiv Paper)
Most European countries have tried to keep real school going. This research is from the Czech Republic and purports to examine whether schools being open contributed to greater spread. Part of the analysis is modeling based and it isn’t clear to why how well community prevalence was adjusted for, but in contrast to some other studies, this one found that closed schools were associated with fewer cases in school aged children. (Medrxiv Paper)