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IM Doc pt 19
Oct. 26th, 2021 03:40 pmAn Indictment of US Covid Policy
Reader GM, who has an aura-of-burning-rubber resume (membership of several elite scientific institutions) and hangs with scientists who have published dozens of cutting-edge immunology papers, including on topics directly relevant to the intricacies of Covid pathogenesis, has provided, through a series of e-mails, a damning critique of US Covid policy. Thanks to America’s status in the global economy, it is well nigh impossible for other countries to pursue a markedly different path. As he described in a recent e-mail:
The question that I have no answer to is when exactly was it decided to not contain it. If you remember, some information came out about early and mid-February 2020 closed Senate meetings, after which senators were selling their shares in hotels and airlines, i.e. what was going to happen in late March was known at that time. But it was not in fact too late to contain it in early February, it could have been done with test-trace-isolate. So maybe it was perceived at the time that it could not be, assuming the decision was made as late as possible within that timeline. But the earlier that decision happened, the more nefarious motivations one would have to suspect were involved, because why would you not at least try to contain it when it was eminently doable? After all SARS-1 was contained even though it reached hundreds of cases in Canada and the US. And then what followed was the outright sabotage of testing and detection by the CDC,1 the CDC allowing strongly suspected to be infected people to just get off their flight and walk right back into the community, and a rather long list of other such absurd actions. Maybe one day internal information will leak and we will learn the truth, who knows…
Also, this all becomes even more gruesome when one realizes that the decision of the US to allow it to become endemic meant the same decision was imposed on most of the rest of the world, as the US controls it. As I said above, Eastern Europe (except for Belarus and Russia) took it very seriously early on and locked down before it had gotten out of hand, and was in fact very close to elimination. Montenegro, which eventually ended up being one of the worst affected countries, actually did eliminate it in May 2020.
But once it became clear the US will not eliminate and the EU will not eliminate, those countries had no choice, although they could have at least held out for vaccines instead of letting it rip. There was never going to be a world in which the EU and Latin America have indefinitely banned travel out of the US, not with US military bases stationed all over Europe. And there was never going to be a world in which Bulgaria and Romania ban travel from Germany.
The really sad part is that a country like Russia supposedly does have that independence, and could have gone for elimination and closed borders and a bubble with China. But modern Russia is not the USSR, it’s just as, if not more neoliberal than the US, so they let it rip too, for the same reasons as in the US…
And now some the countries that did the right thing — Taiwan, Vietnam, and Laos — are encircled and battling their worst outbreaks since the start, which is heartbreaking to watch.
Even this site, early on, inferred that both the Trump and Biden Administrations were relying on magic Covid vaccines as pretty much their only Covid strategy. Policy-makers and public health officials were unwilling and/or unable to pursue a path of eradication, which in practice is aggressive minimization: hard lockdowns, followed up by opening only areas where new infections are effectively nil, testing at-risk populations often, and engaging in contact tracing and quarantines. Our rejection of quarantines was a tell that the chosen path instead was simply to keep hospitalizations to a manageable level.2 And bugger any consideration of morbidity.
Quite a few of those who are neither in the Biden-aligned PMC bubble nor anti-vaxxers/anti-maskers, like the biggest nurses unions in America, are upset and confused by the Biden Administration’s Covid “Mission Accomplished” directive of “ditch masks and social distancing if you are among the fully vaccinated ‘cool kids’ group.”3 Even if you buy the proposition vaccines alone can vanquish Covid, this was utterly irresponsible messaging. Where was the warning that the vaccinated will need another shot by early-mid fall?
So far, the main propagator of the notion that boosters are coming has been the drug companies themselves, rather than public health officials. But my impression is that even then, no one has been willing to suggest more than an annual shot.
By contrast, former Harvard Medical School/Harvard School of Public Health professor William Haseltine in Forbes warned that booster jabs for mRNA vaccines to combat variants were probably needed six months after the second shot .
Haseltine recaps new research from Moderna, whose vaccine confers the best immunity. It shows that immunity to new variants, as shown by antibody levels, is likely to last only 6 months from the initial shots, and for The Original Covid, eight months. Some researchers argue that T cell and memory B cell immunity could last longer; Haseltine isn’t willing to bet the farm on that.
This finding is consistent with our uninformed layperson best guess. We repeatedly pointed out that experts estimated that immunity after having contracted Covid lasts six to eight months. Even though we accepted the notion that vaccine-conferred immunity would be more robust (as in would enable the recipient to combat higher viral loads and might also offer more protection against variants), that didn’t amount to proof that vaccine-conferred immunity was longer-lived.4
The majority of new infections in the US, Europe, and most other countries are now driven by variants….
A new preprint study conducted by Moderna describes both the hope and challenge of booster vaccines as an approach to the solution to the problem of variants. Their booster shots appear to be effective at neutralizing at least two of the new variants, B.1.351 and P.1. But importantly, their preprint study also revealed the first-generation Moderna vaccine doesn’t protect against the variants for as long as we initially hoped…
When tested for its ability to neutralize the P.1 and B.1.351 strains, the antibodies generated by the Moderna vaccine against the original strain dropped to low or undetectable levels six to eight months after the second dose…If two doses of the Moderna vaccine amount to six months of protection against the variants, other vaccines are likely to guarantee less.
So not only is the Biden Administration failing to prepare the public that those who’ve gotten their shots will need to take another in a few months, they’ve also effectively trash-talked what proved to be pretty effective public health strategies of masking and social distancing. Look at how New York City went from being a Covid disaster area to a good performer before vaccinations were readily available. Yet Team Biden has effectively endorsed the Covid-denier line that wearing masks is oppressive.
GM warned where the combination of infection level and vaccine effectiveness lead:
Unfortunately, with many respected scientists jumping on board of the optimism hype train (it was quite noticeable how the mood shifted on purely scientific matters that had absolutely nothing to do with politics a few months ago), the wrong message has already been once again sent to the public, and we can expect disaster in the future.
Non-sterilizing vaccines mean the virus will not only get the chance to evolve complete escape but will be channeled in that direction. But it also may be channeled in the direction of being much more virulent as a side effect of its fight with the vaccines (this can get quite detailed on a molecular level so I will not go into it right now).
The math does not look good — the unmitigated-spread R_0 in February 2020 was much closer to 6.0 than to the usually cited 2.0. But the current variants have undergone adaptation and are much more contagious. Let’s say we have R_0 = 6. And let’s say we reach 70% vaccination (it’s hard to see how we will get higher), and that transmission is cut by 80% (this, however, is simplistic — it is quite likely that transmission is cut by 80% in the first couple months after vaccination, but then the first thing that will wear off is protection from infection, with protection from severe disease going away last). That’s 56% effective vaccination. But the herd immunity threshold for R_0=6 is 85%, a lot higher, i.e. it will continue to spread. It might in fact continue to spread even with 100% vaccination with a full return to 2019 in terms of lack of social distancing.
So we should absolutely never have gone down the path of “solving” this crisis with vaccines and not doing anything to stop transmission. The vaccines should have been used as one of the tools to eliminate the virus, but in combination with NPIs.
If evolution featured in the thinking of our overlords, they would not have settled on this as the “solution” to the problem. But either it does not, or they just don’t care.
P.S. Some more sobering simple math. Let’s say the vaccine is 90% protective against severe disease over a period of two years. Then one can expect to have on average three serious COVID episodes by the time he is 60 even if he is always up-to-date with his biannual vaccinations (and there is no knowing how much more virulent to young people it will have become in the future with all the serial passaging). We now see what round #1 of mass reinfections looks like in India. So that is the “solution” being offered right now. However, it will probably not happen as one giant apocalyptic wave so it can be pushed to the background as a non-problem.
Mind you (and GM has discussed these on other threads), there is a promising nasal vaccine under development that should be able to achieve sterilizing immunity, and that could even start being distributed if everything goes right by end of 2022. That sort of vaccine could be a game-changer. The current ones are enablers of “life with Covid” and not “life after Covid”.
IM Doc has pointed out that past great pandemics had a first wave, then a more acute second wave, and somehow the virus and humans reached an accommodation. So it’s possible Mother Nature will bail us out after we go through some more collective pain.
Another avenue the US has not taken all that seriously is treatments. We reported yesterday, for instance, of a retroviral treatment developed in Queensland that reduced Covid viral loads in mice by 99.9%. IM Doc is a bit leery since he’s seen retroviral based treatments go spectacularly south in some cancer and autoimmune disease patients. But biomedical professor KLG had speculated earlier that ivermectin and another (one or two) antivirals that attack other parts of the viral replication pathway will be one answer to COVID-19, each given at a relatively low dose and working synergistically: “This is how AIDS was turned into a manageable chronic infection in most HIV/AIDS patients.”
So there is hope of eventually getting off the inertial path, but make no mistake, the one our putative leaders have put us on is not pretty. GM made this call on May 8, the week before the “Mission Accomplished” reversal:
GM made this call on May 8:
….the path forward …. “personal choice” on how much you can protect yourself, but nothing will be done to stop transmission aside from vaccination. The US will easily tolerate 100-200K deaths a year, probably even more, as long as hospitals do not collapse. And the truth is that while they were close to collapsing on several occasions, at no point did it become an India-like situation.
And that is fine as far as the powers that be are concerned – the only real constraint there ever was was that there should be no people dying on the street outside of hospitals because that is very bad PR and it runs the risk of the public waking up and demanding that an elimination program be implemented (which is fundamentally impossible without the absolutely abominable idea of taking from the rich and giving to the poor). How many people die overall does not matter (especially given that we know very well which people will be doing the dying and which people will be living comfortable secluded from it all lives). BTW, this has a corollary – expanding hospital capacity is something that we do not want in the West, because what it means is a lot more people dying and becoming disabled for life in absolute terms, as it raises that tolerance limit. This is one reason the late-2020 wave was met with a lot less restrictions than the Spring 2020 one. Even though it killed 2-3X as many people. Hospitals were “prepared”. Again, this perverse logic works in the West. In less privileged places people will be left to die on the streets.
This also highlights the more generally perverted logic of Western medicine and healthcare systems – we only care about “treatment”, not about the actual health of people.
Of course nobody wants to listen, so a lot of suffering lies ahead.
Yes, we’ll get through Covid collectively, but many people and families will suffer unnecessarily due to weak and incompetent leadership and lack of concern for the general good. This is yet another product of neoliberal cognitive capture.
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1 From GM in a different thread:
For the record, to those of us in the molecular biology world, what the CDC was doing in January and February 2020, when it simultaneously could not put together a working test for the six to eight long crucial weeks of silent undetected spread, while preventing others from developing their own, looked like deliberate sabotage of containment. It was hard to explain in any other way — I’ve mentored high school students who were successfully doing much more complex designs of molecular biology reagents in 9th grade, it is not rocket science, plus there were already working designs from other countries, and it was quite literally a copy-paste matter to adapt those. And then there is the question of why would you possibly not allow others from working out their own tests and also demanding that samples be sent across the country to Atlanta, when literally every minute was of the utmost importance?
2 Please do not present New York’s quarantine as a counterexample. I went in and out of New York City several times while it was on (to see doctors). It was a joke. I did not have to change a single thing I had planned, for example.
3 The plural of anecdote is not data, but I am seeing even some resistance among my tiny sample here. I saw an older but fit looking woman at the drugstore wearing a serious-looking mask and thanked her for doing so. She said she was fully vaccinated but thought it was way too soon to stop masking. I assume her logic was to model appropriate behavior.
4 Mind you, getting Covid is a really bad idea; we are simply leery of the over-hyping of the vaccines.
Amid a Pandemic, a Health Care Algorithm Shows Promise and Peril
Yves here. Aside from my general allergy to AI and algos (among other things, they are only as good as their training sets, which raises questions of accuracy and consistency of inputs), another reason to be concerned with health care algos is they require collection of patient data to work, which means yet another source of data vulnerability. Our reader IM Doc pointed out:
In the USA – we have multiple large tertiary referral centers that have quite the national reputation – I would include in that list MD Anderson, MAYO, Johns Hopkins, and …… The Scripps Clinic in La Jolla, California. I have innumerable patients that are seen there – they cater to that type of clientele. I first heard about this impending disaster over the weekend – and today things appeared to get immeasurably worse there…… see the following article……
https://www.nbcsandiego.com/news/local/what-we-know-about-scripps-health-cyberattack/2598969/
I know we have a major pipeline down from ransomware now – but this is just as scary if not more so. This is a major medical system in this country – and it has been hobbled. All of my patient’s appointments there have been cancelled until June – they are admitting no one – and no one seems to know if it will be back or not anytime soon. It has already been going on for a week.
ANNNNDDDDD – they use Epic – which has repeatedly touted itself ( I have been in the meetings multiple times in my life) as completely impervious to hacking.
Again – I knew this day was coming at some point. These EMR systems are a complete disaster waiting to happen. The hackers have managed up to this point to take down non-EPIC systems at Bugtussle Memorial Hospital across the country – but nothing like Scripps.
The patient portal was among the systems taken out by hackers..and it was “Epic powered” or some such corporate jargon. While Scripps has been remarkably close-mouthed, available evidence says it’s not a reach to think Epic is implicated.
Is it reasonable to be agnostic on this treatment and say that we don’t yet know for sure?
At this time last year a lot of folks were hot to trot for Hydroxychloroquine, including some of the geniuses of America’s Frontline Doctors. (Remember Dr. Stella?). Now, you don’t hear much about it at all. Maybe because it doesn’t really work. Maybe because one of the more pertinent conclusions of the few clinical studies concluded that Hydroxy actually harmed some patients and there was no definite proof it helped patients. You might also remember that Trump revealed he was taking Hydroxy as a preventative, again with no clinical proof of its efficacy. Not too long after that came out, he stopped taking it on the advice of several doctors who feared it would do much more harm than good. My point is that there’s a lot grasping at straws during a pandemic. Read Defoe on the great plague of 1665.
WHO recommends using Ivermectin for Covid in clinical trial settings only at this time. Could there be another reason for not touting this treatment while trials are ongoing? Say, not wishing to raise false hopes? And also to remove yet another rationale for not getting vaccinated? (“Why get the shot when there’s a simple remedy available?”).
Not trolling here, being very sincere. We’ve only been dealing with this disease for 16 months or so. How long did it take us to figure out AIDS, for example? I want to follow science, but at the same time I don’t want to breathe down their necks.
As for the profit motive, someone has figured out how to charge thousands of dollars to insurance companies and their customers for insulin and it’s legal, so why would you expect anything different? On that front, I am cynical.
A final thought: if Dr. Campbell finds Ivermectin promising, then I’m impressed as he has been quite reliable during this pandemic.
Further:
I understand what you are saying about not raising false hopes.
As a veteran of the AIDS pandemic – I would suggest that your concerns are very understandable – but quite frankly, now like then, we just simply do not have the time.
A very similar analogue to what is happening now with Ivermectin was Bactrim back in the 1980s – it was absolutely shat all over as a therapy for PCP in AIDS patient by the medical establishment including Dr. Fauci himself. The medical establishment dictated that we had to use Inhaled pentamidine and other toxic therapies – ( with the similar issue that these therapies were also very toxic to the wallet). Bactrim was and is a very cheap antibiotic. I remember one lecture with an NIH speaker back then that laughed out loud – “We cannot treat the plague of the century with little old lady urine pills”.. Not unlike modern times – “Ivermectin – that is just dog flea pills you morons!”. It was only the networking of frontline docs all over the country that eventually changed the course. Today, we do not have nearly the patients with PCP that we did then – but no one would dream of using pentamidine and Bactrim is now the front line agent.
There are too many patients dying in these hot-spots like India. The safety profile of Ivermectin is so positive that it should be used without delay in these situations. All we are getting from the USA and the EU is stonewalling and deception – not unlike what happened in the 1980s with our medical leaders.
Go and read “And the Band Played On” – little has changed.
From the British Medical Journal
Misleading clinical evidence and systematic reviews on ivermectin for COVID-19
https://ebm.bmj.com/content/early/2021/04/21/bmjebm-2021-111678
“Up to February 2021, the (Pan American Health Organization) identified twenty two ivermectin randomised clinical trials through a rapid review of current available literature.34 There is considerable heterogeneity in the population receiving ivermectin, with studies administering it to family contacts of confirmed COVID-19 cases as a prophylactic measure and other studies using ivermectin for treatment of mild and moderate infected cases28 or even severe hospitalised patients. Applied dosis (sic) and outcomes of interest were also highly variable. Additionally, patients also received various cointerventions, and control groups received different kinds of comparators ranging from placebo or no intervention to standard care or even hydroxychloroquine. The authors claim that pooled estimates suggest beneficial effects with ivermectin, but the certainty of the evidence was very low due to high risk of bias and small number of events throughout the included studies. Most study results have been made publicly available as preprints or unpublished, with no peer review or formal editorial process. Others incorporated their results only in the clinical trial register, but nearly half of these randomised clinical trials had not been registered.”
“Concluding, research related to ivermectin in COVID-19 has serious methodological limitations resulting in very low certainty of the evidence, and continues to grow. The use of ivermectin, among others repurposed drugs for prophylaxis or treatment for COVID-19, should be done based on trustable evidence, without conflicts of interest, with proven safety and efficacy in patient-consented, ethically approved, randomised clinical trials.”
In India – right now – you are seeing a gigantic trial taking place for all of humanity to see. I cannot wait to see how the medical establishment tries to play those data.
This is so so familiar to those of us in the early days of AIDS.
Almost all the trial data is from tropical, third world areas. Places where there is a huge problem with untreated parasitic infestation because of the lack of clean water and poor sewage systems.
It stands to reason that if you treat a patient’s parasites with ivermectin, they will become healthier, and more able to fight other infections, such as covid 19.
It doesn’t, however, stand to reason that the vast numbers reportedly seeing a benefit from ivermectin treatment in these ‘tropical, third world areas’ are only doing so because they all had latent parasitic infections. Come on.
Please don’t Make Shit Up. About 2/3 of the population in Africa DOES take ivermectin regularly as a prophylactic. From IM Doc: