![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
temporaryreality) wrote2021-11-18 01:15 pm
IM Doc pt 24
CDC Reversal on Masks, Vaccinated as Covid Spreaders, While Boosters Look to Be Coming Late and Not Hugely Effective
The Covid situation has developed not necessarily to the CDC’s advantage. Let us count some of the ways before we turn to a new failure in the making, the vaccine boosters.
The CDC and the WHO were late to take Covid seriously despite China having to build new facilities on an emergency basis to house the afflicted and implementing hard shutdown on 70% of its economy. Part of that was discouraging the public from masking (even making home-made face covers), later justified as a Noble Lie to preserve supplies for medical workers
The CDC left public health officials in the dark during the crucial early months by botching its Covid test and then having trouble with assuring adequate supplies, and stonewalling its own responsibility (the first story was that contractors were to blame, but after months of reporting, it turned out that CDC scientists were)
The CDC refused to recommend putting teeth in quarantines
CDC chief Rochelle Walensky said “Vaccinated people do not carry the virus,” as did some public service commercials
The VAERS database is not only weeks behind in reporting cases of vaccine incidents, but multiple clinicians have submitted adverse events that are almost impossible to attribute to anything else that have not been included in VAERS
The CDC doggedly refusing to acknowledge aerosol transmission and continuing to recommend surface cleaning theater long after the careful and paradigm-shifting work of epidemiologists and aerosol scientists came up with a more convincing and complete theory
Walensky made a fool of herself by crying about how awful things were going to get, and later saying before Congress that her son wasn’t going to camp as the CDC had already finished its “Mission accomplished! Throw off your masks” guidance.
Now the CDC has done yet another flip-flop which only further undermines its and the medical establishment’s credibility. The lead item on national TV news this evening was conceding that vaccinated people could (as in are) spreading Covid and they should therefore mask indoors. Oh, but only where the horse has left the barn and is in the next county. As Lambert said in Water Cooler, quoting a Reuters recap:
“The recommendations to wear masks in some indoor settings will apply in areas with surging COVID-19 cases, they said.” • Awesome. Let’s mask up only after it’s too late. As I keep asking: What business is the CDC in, anyhow?
Biden had to rouse himself to apply porcine maquillage:
Pres. Biden: "Today’s announcement by the CDC…is another step on our journey to defeating this virus. I hope all Americans who live in the areas covered by the CDC guidance will follow it; I certainly will when I travel to these areas." https://t.co/ikgSPZoN0n pic.twitter.com/tGDfoB8SH2
— ABC News (@ABC) July 28, 2021
The CDC’s inability to get its new story straight isn’t encouraging:
CDC is super sloppy on the question of do vaccinated people need to test if exposed. In several areas they say yes, in others they say the opposite.
This is from the *same* guidance document, separated by just a few lines (?!) pic.twitter.com/gBM3mUyzWt
— Joseph Allen (@j_g_allen) July 28, 2021
The only goal we can fathom was that Biden was determined to have his July 4 “Freedom Day” whether or not that made any sense in light of vaccination levels and and variant infectiousness. And as Lambert and I have repeatedly bemoaned, treating unmasking as a reward doubled down on right wing messaging that masking was a horrible imposition. Help me. Bathing daily is much more hassle. Do you hear people whine about that?
This isn’t “Follow the science.” This is “Sell the hopium.” Encourage the masses to get out of the house and spend on travel and entertainment. Act like MBAs and make the data fit the PR, which in the CDC’s case meant the absolutely irresponsible act of not collecting data on breakthrough cases among the vaccinated unless they wound up hospitalized, and using that fabrication to maintain that of course nobody vaccinated was getting infected, and its was only crazy right wing anti-vaxxers who dared suggest otherwise.
Mind you, it was predictable that the “Mission accomplished” would blow up because we and others predicted it, starting with the two biggest nurses unions in the US, both of which condemned the CDC for telling the vaccinated to toss their masks.
Just as the implications of the original Covid infection in China were obvious if you weren’t invested in denialism, so too was the significance of new, nastier “variants of concern”. As of late last year, Delta was exploding in India and variants in South Africa and Brazil also were worrisome. It didn’t take long to establish that Delta was vastly more infectious than “wild type” Covid and was spreading rapidly in the UK and then in the US.
Yet the CDC played head in the sand. It acted as if these new developments were of no consequence and the US vaccine strategy would solve all problems. And the Democratic party and its media allies had already pre-positioned the blame cannons squarely at those horrible deplorables if anything did go amiss.
The CDC’s position became untenable as Israel, which had achieved high levels of vaccination early, was reporting lower and lower efficacy levels for the Pfizer vaccine, most recently admitting to only 39% against Delta. That level is too low for the Pfizer vaccine to have been approved had Delta then been the predominant variant.
So now we have the CDC in the middle of another embarrassing about face, doing a poor imitation of financial regulators’ “Whocoulddanode?” in 2008.
The CDC appears to believe it’s a reasonable defense to say they had no idea Delta was way more contagious. Huh? First, medicine is not financial markets. The precautionary principle, as well as having already observed in the first wave what exponential spread looks like, means that public health officials need to err on the side of caution, particularly after having been too slow to act before. Second, the CDC has no excuse based on extensive evidence that
Delta was much more contagious than the “wild type”. Very early estimates pointed to Delta contagion rates at least 40% higher, which should have sent the CDC back to the drawing board. More refined studies had dire findings, like a fresh article concluding viral loads in Delta patients were 1000 times higher than for “wild type” Covid.
The CDC appears constitutionally unwilling to exercise leadership. Admittedly, with a fragmented US health care system, its formal authority is less than ideal, but it has, or more accurately had, a powerful bully pulpit. Instead, the CDC looks unwilling to stick its neck out and will take a position only when it’s safe, which in disease and disaster management, is pathetically useless. As Taleb has warned, preventing ruin is the paramount concern, and pandemics have nasty downsides. With Covid, that may well include a high level of disability due to lasting damage suffered by survivors.
But the CDC, hewing to the bad values of the American professional-managerial classes, think that image and their feelers count for more than real world outcomes, even actual large-scale damage like the opioid debacle. They seem to believe that it’s better not to take grief for averting a crisis, since some will insist the bad results never would have occurred. They’d rather try to play fireman and run into burning buildings. Or more accurately, get others to run into burning buildings but take credit for having dispatched them.
But as the Wall Street Journal pointed out in a very long article and well-researched piece yesterday, Covid treatments are pretty much nowhere, so the alternatives are to do the equivalent of condemn dangerous-looking buildings or let neighborhoods and maybe even entire cities burn.
Now let’s turn to the next CDC train wreck in the making: the vaccine boosters. Remember that the CDC, and in fact the Biden Administration, has put all its eggs in the Covid vaccine basket. Yes, if we see hospitals on overload again, you will see lockdowns. It’s not acceptable for heart attack and stroke victims not to be able to get treated because Covid patients have taken up pretty much all the hospital and ICU beds. But the Biden Administration and the business community generally is so fixated on having Covid be over that that is deemed to be impossible except in places that are being punished for being vaccine apostates.
Having vaccines as the first line of defense requires having reasonably effective boosters and distributing them on a timely basis, as in when the vaccines wear off.
The CDC appears to be totally asleep at the switch on this issue. First, as we pointed out very early on, immunity to coronaviruses doesn’t last all that long. It ranges from six months for the common cold to 34 months for the very deadly MERS. Results from regular large-scale blood tests in the UK indicated that immunity to getting a case of Covid would last somewhere in the six to eight month range. Better data points to the shorter end of the range:
That is plainly wrong – people die on re infection with variants different to the original infecting virus. Immunity from natural infection decays within 6 months and often earlier
— Gupta Lab, Cambridge (@GuptaR_lab) July 11, 2021
Experts thought vaccine-inferred immunity might last longer because the antibody levels started out higher, but no one really knew. As GM explained, the vaccines are way less effective against the variants, which translates into much shorter protection:
There may be “antibodies” but that’s just a signature of infection, not protective on its own. What matters is neutralizing antibodies, and those decay with a half life of 60-150 days. But that’s against the original variant, add an order of magnitude effective reduction in vivo due to the appearance of the newer variants, and all of a sudden 6-9 months after vaccination you are below the threshold (and with a natural infection it’s a lot sooner than that — vaccine-induced antibodies are 10 times higher and the vaccine does not lead to profound immune dysregulation the way infection does). To their credit, Moderna have been very open about this, but their papers on the subject have not received the publicity that the “lifetime immunity” headlines do.
The other distortion of the truth is about memory cells. Yes, memory cells are present and they can make antibodies, but they need to wake up, multiply and ramp up production, which takes time. But the virus has several layers of mechanisms for silencing the immune system, meaning that by the time those memory cells are alerted and have started waking up, runaway exponential viral replication may have already advanced beyond the point of containment.
Same thing for T cells.
Admittedly, earlier this month, both Scott Gottlieb and Fauci were discussing boosters. But do some simple math. Israel used Pfizer, the supposed best in breed. Most of its vaccinations were in January and February. Between natural decay and reduced effectiveness against Delta, efficacy five to six months in is down to 39%. It’s only going to get worse, as reduced protection (lower antibody levels) will translate into not just more contagion, but also more severe cases.
Recall also that the drug companies themselves have been saying the same thing. Pfizer cheekily reported its vaccine offered protection of “up to six months” at the start of April. As GM indicated,
Our high period of vaccinations was January to end of April. Given that how long vaccine conferred immunity would last was an open question, and that variants looked likely to shorten it, I was expecting boosters to be made available as of early fall, at a minimum to health care workers. Instead, the officialdom appeared to have convinced itself, with no factual foundation, that Covid boosters would be annual…just like the flu…because habit. You cannot make this stuff up. Although a toad did hop out of Scott Gottlieb’s mouth in the form of recently saying “annual or biannual vaccinations.”
However, given profit potential, one would also assume that the drug makers would be on top of the plot and would be taking the steps necessary to launch boosters soon. But that isn’t happening on what appears to be the required schedule either.
I hope regulatory experts will pipe up with any corrections or amplification, but the drug-makers are hostage to the EUA process. If the vaccines had gone through full regulatory approval, they could be prescribed for acne. Using them as boosters would be simply a matter of sending out more doses.
But for Pfizer and Moderna, the vaccines were approved because they showed high enough efficacy against the type then circulating. Recall that one defense of J&J was its lower apparent efficacy was at least in part due to being tested later and as a result against some additional variants. But the EUA regime requires that boosters get a new approval. We posted this section from a Reuters story yesterday:
Pfizer said it will be creating a booster shot to target the Delta variant. Trials for the booster shot began in Nashville on Monday. Moderna also announced it will be developing a booster shot, with trial results expected by September.
Studies by Moderna and AstraZeneca showed significantly diminished efficacy of a third shot against earlier variants; it’s not hard to imagine that results against Delta would be similar or worse.1 IM Doc had also heard about trials for Pfizer using the old vaccine from local investigators weeks ago. It’s not clear if the supposed Delta trial mentioned in the story is the same “material” but a different dose, or a new formulation. IM Doc had believed that Pfizer was attempting another two-shot regime, but that may have been unpopular with participants and with officials that heard about it too.
Nevertheless, the supposed advantage of mRNA vaccines was the ability to develop new ones in just a week or two in a lab. Delta has been raging in the UK and India, so why weren’t the trials in progress already, and with a targeted new formulation?
Regardless of what each company is up to, if you make simple-minded assumptions, starting with the Pfizer trial just having started, it’s hard to see how a vaccine is approved before the end of September.2 And even though Pfizer had its vaccines all prepositioned in regional warehouses to be released immediately upon getting the green light, we know from the first go-round that getting patients injected takes time. It’s possible to implement what amounts to bulk distribution at nursing homes, to workers at medical centers, and at drive in sites, but those were in effect only in the early months. Will state and local governments gear up again, or will they just hand the process over to drugstores? Planning should be starting by mid-late August at the latest. What do you think the odds are of that happening outside at most a few places very hard hit in previous waves, like New York City?
And just as important, what will the demand be? It would take a full bore campaign to create an appetite for boosters. But that would require telling those who’ve been vaccinated early in 2021 in no uncertain terms that they are or will soon be at risk again. That messaging, particularly in the late summer, would throw a damp squib on Labor Day vacationers. And again, it’s such a big change from the recent happy talk that it won’t make the CDC or the Biden Administration look very good either.
But events may create the sense of urgency all on their own. A fresh e-mail from GM:
The increase overall in hosptializations in the US is truly frightening. This is most definitely not the UK situation where they got a lot of cases but it was mostly young people so hospitals did not get slammed as before (of course, it remains to be seen what will happen there when schools restart).
Yesterday, to the extent that the data can be believed given how it is no longer being properly collected and reported, hospitalizations jumped by almost 4,000 in a single day.
I went through the data from the previous waves and it looks like there was only one day in mid-November 2020 when they rose by more than that.
In total it is still at 40,000 compared to the 120,000 at the peak. But we know it will keep rising because people are still out there unmasked and the exponential phase of case growth shows no signs of slowing.
So this looks like how B.1.617.2 has been behaving in India, Nepal, Russia, Indonesia, etc., and most definitely not like the UK situation.
Worst of all, we have all these derivatives of B.1.617.2 that are now spreading in the US and a massive rise in hospitalizations in an otherwise fairly highly vaccinated population, which has not really been observed so far — every massive B.1.617.2 surge elsewhere has been in a largely unvaccinated population — so is it because in the US a lot of older people did not get vaccinated while in other countries nearly everyone vulnerable did get vaccinated, is it because vaccines are fading, or is it because these derivatives are even worse than OG vanilla B.1.617.2? Well, we will have to wait for these variants to spread in Europe to figure it out, because in the US nobody is tracking or looking at this question…
How did we get to this sorry state? No one seems willing to make decisions, particularly the really important ones that entail saying “no” to those who don’t want to hear it. The Republicans’ excuse is that they want to fob everything off to the private sector. The Democrats sold themselves as paragons of managerial competence and sound decision-making. They are coming off like actors whose telepromoter has frozen.
Lambert’s take:
The CDC has proved utterly incapable of assessing and communicating risk to public health during a pandemic. And that assumes “genocidal elites” theory has been ruled out, which I’m coming to think in fact parsimonious.
GM also has to concede that malevolent intent by our better can’t be entirely ruled out, but he sees hubris and incompetence as the drivers:
The part about the willing self-deception of the elites is also very important. I too have come to the conclusion that either there is some absurdly nefarious grand conspiracy behind this (not really likely) or it is just stupidity and shortsightedness all around. COVID has shown, again and again and again, that you can ignore it for some time, but eventually you will pay for it. Wuhan CCP officials, Trump, the Tanzanian president, and many others learned that lesson the hard way. And it’s been 18 months of that. And it’s not like it was not known there is antigenic drift with these viruses, or that they have all sorts of tricks up their sleeve yet to be played, or that the vaccine was not going to last (was talked about from the start), or that we were never going to vaccinate enough people to reach herd immunity, etc.. So why would you possibly spend half a year blatantly lying when it was crystal clear from the start that it will backfire eventually? Unless you are indeed that deluded and unable to think rationally about the long term.
After the financial crisis, I took to saying that Washington DC had a Versailles circa 1788 air about it. That’s now looking charitable. Lambert’s been studying the last years of imperial Russia, and finds it a much closer parallel to our rot at the top. That isn’t at all encouraging, since the Romanovs made the Bourbons look good.
____
1 From GM via e-mail:
https://www.medrxiv.org/content/10.1101/2021.05.05.21256716v1
There were two concerning observations there:
1. No neutralization activity left against P.1 and B.1.351 after 6-8 months
2. The booster worked, but only increased the neutralizing titers to ~40% of what they were originally against the Wuhan variant and what they are against it when boosted.Based on the fact that the booster “worked”, OAS was dismissed by most, but this would in fact consistent with an OAS effect — nAbs only got boosted to less than half of the previous level.
But then the AZ booster preprint came out:
https://www.biorxiv.org/content/10.1101/2021.06.08.447308v1
They saw the same <50% boosting against B.1.351, and they also analyzed neutralization against B.1.617.2 and saw that it was even worse against it (B.1.617.2 is antigenically more different from B.1.351 than it is from the wild type). But they also did several more important experiments: 1. They immunized naive mice with a WT and with a B.1.351 vaccine, single dose 2. They immunized naive mice with a mixture of the two And the neutralization against B.1.351 was still half of what it is against the WT [wild type]
2 Back of the envelope:
Two weeks after vaccination to reach peak efficacy (Pfizer and Moderna did not include information on infections before that time frame last time).
Four weeks to have enough infections and results from placebo and controls to determine efficacy
A week to compile and polish findings and send them in
FDA at a bare minimum has to do a statistical review, which takes a minimum of two weeks.
Science/Medicine
Last NSW outbreak we had one #COVID19 positive pediatric patient the entire time, this time we already have over 100
Suggests there’s a LOT more to this than we’re seeing yet
— Dr Greg Kelly (@drgregkelly) July 28, 2021
Pfizer Data Suggest Third Dose of Covid-19 Vaccine ‘Strongly’ Boosts Protection Against Delta Variant CNN. Help me. Based on 23 people when IM Doc says based on intel from local investigators that Pfizer has been running trials on boosters…yet per Reuters its official trial started last Monday. That suggests the earlier trials were likely aborted. So why should we trust this? Smacks of cherry-picking.
Today’s update –
An uptick has occurred – but we are nowhere near overwhelming the hospital.
I admitted 5 patients this AM who had been admitted overnight with COVID related symptoms. 3 of these patients are fully vaccinated. Two of them are unvaccinated. None of them is in critical condition.
With one exception, these are all patients I follow as outpatients so I know them very well. I also know the cT of all these patients that are in the hospital – and will include in the description.
The one vaccinated I do not follow is associated with the group superspreader event I described yesterday. The patient is 27 and very athletic. Had vaccination competely done in May. Is having problems breathing and is analagous to a very severe asthma problem – although never diagnosed with asthma. This individual is a PMC type but at the start of their career. cT 18
Another vaccinated patient was completed Moderna on June 4th. A 68 year old very healthy patient with no known medical issues. I have seen them twice in the past 2 years for physicals. No meds. Very vigorous exerciser. This patient has spoken to me of their political persuasion (many people do whether I want to hear it or not ) and is GOP conservative. cT 16
The other vaccinated patient is a more elderly individual. Age over 70. Only takes 1 med and is otherwise very healthy. I have not seen them often either – just not that problematic medically. This person is definitely in the MAGA group. cT 22
The first unvaccinated patient is a 35 year old man-bun wearing, unabashed Leftist – wearing his political identity in the shirt he had on this AM. Militantly anti-vax for every single vaccine not just COVID. He was a bit SOB with a low pulse ox last night – and got steroids and is already better – He will likely go home later tonight. cT 22
The second unvaccinated patient is a 38 year old whose spouse is a known anti-vaxxer and big Bernie Sanders supporter. Indeed, the spouse is the leader of our local anti-vaxx group. Already doing much better and will likely go home today. cT 24
Again, the crush of patients as outpatients is ongoing – and is actually remaining right at 70%vaccinated/30%unvaccinated. I have no doubt there are many patients not coming to attention. This would be especially true of the unvaccinated who tend to be younger and more healthy. I have now seen 2 patients with COVID today who were just given their first shot in the past 2 weeks. None of these people are very ill. And tend to get better in just a few days. Mostly young.
As I have repeatedly stated, the “deplorable MAGA unvaccinated rhubarb” trope all over the media right now is really overdone. It certainly does not apply in my world. The anti-vaccine patients around me are largely Liberal Leftists often Bernie Sanders supporters – young and militant anti-vaxx and anti-chemicals. There are also plenty of Evangelical anti-vaxxers. But it should come as no surprise that many of the measles outbreaks have occurred in Oregon, Washington, and California in recent decades. There is a reason for that – and the reason is not MAGA deplorables. This anti-vaxx Leftist group is just as militant if not more so than the right wingers.
Thankfully so far other than the deaths we had last week – most of these patients are just in the hospital a day or so – and then DC home. Occasionally someone is really ill. I am hoping it stays that way, but I do worry about the future given the fact that these vaccines are so clearly non-sterilizing and this virus is so profoundly capable of mutation. And the way this virus has operated all year – God only knows what is going to happen tomorrow.
Be safe and take care.
Doc, thanks as always for your comments. But I haven’t been able to figure out what cT or SOB mean in this context.
cT is cycle threshold – it is the PCR threshold for viral particles – in this case COVID – — and indicates the level of positivity –
SOB – means Shortness of breath –
Try as I might – the abbreviations and doctor-speak are just too ingrained in my brain to avoid sometimes – sorry.