Delta Blues, or how I spent my summer not being able to take a vacation

We still need all of these layers.

When I started writing this post, I was planning on a straightforward update on the current situation with the delta variant (sorry, I couldn’t resist the obvious title). And then a 13-year-old killed a classmate at a local middle school for no discernible reason. And then the Taliban took back Afghanistan.

The murdered boy was trying to talk his killer out of continuing to bully his friends. He stood up to him with words, doing exactly what most of us would teach our kids to do, what my daughter would do, what I would do. The right thing.

Going into Afghanistan was never the right thing. I remember writing “Can you say ‘quagmire’?” back then. Three quarters of Americans thought this war was a great idea. I was part of the other quarter. I take no pleasure in being right in this case. Afghanistan continues its reputation as the “graveyard of empires.”

In order to avenge the deaths of 3000 Americans, we killed or maimed tens of thousands more, plus tens of thousands of Afghans and then Iraqis, naturally including myriad children. We spent 20 years and a couple of trillion dollars and we accomplished what looks right now to be little or nothing.

And to begin with, the perpetrators of 9/11 were Saudis, and we never gave Saudi Arabia the slightest grief over that. We always fought the wrong battles for the wrong reasons. For so many years we, that is, our leaders knew we were failing and we just kept on going, perhaps in the belief that whenever we left things would be exactly as bad as they are now. And things were always worse than we realized.
https://www.washingtonpost.com/investigations/2021/08/10/afghanistan-papers-book-dick-cheney-attack/

I suppose I should not be surprised that instead of effectively fighting this pandemic and its wide-ranging ills, we spend so much of our energy fighting each other.

Pulling the Fangs Back

Anger at the unvaccinated and the irresponsible among us is real. While a more-transmissible strain like delta was bound to come along, wider uptake of vaccines and more stringent adherence to public health common sense would have helped limit the damage, and would still damp down the development of newer variants. Our US deniers and anti-vaxxers are only one aspect of this; many governments have been too poor or too inefficient to get vaccines out to the majority of their people. But seeing Americans die or cause others to get sick because they haven’t taken the most obvious steps to avoid it is maddening.

Dr. John Lapook said, on the Stephen Colbert show on 8/16, “We come into these conversations coiled.” He suggested “pulling the fangs back” when trying to convince someone that getting vaccinated would be a good idea. I didn’t realize how “coiled” I was until I ran into a certain friend at an outdoor event in July. She announced that she wasn’t hugging anyone because she wasn’t vaccinated, which she said was because of her health condition. She really does have a condition in which it’s reasonable to be extremely cautious about medications, but it could just as easily be said that she needs the vaccine all the more because of it— her situation is honestly a bit fuzzy and it’s not crazy that she has hesitated. She has also fallen for a lot of the misinformation, though, and that has been frustrating to deal with. Anyway, I lit into her. Without knowing I was going to do it, I snapped at her. That is, I snapped. She reacted just as badly. Not a productive exchange.

A doctor in Alabama has even refused to see patients who are not vaccinated. ‘“If they asked why, I told them covid is a miserable way to die and I can’t watch them die like that,” wrote Valentine, who has specialized in family medicine with Diagnostic and Medical Clinic since 2008.’ Alabama has the lowest vaccination rate in the US and a high number of residents hospitalized with COVID.


Summer Non-Vacation— Why Is This Happening?

What did you want to do this summer? I wanted to have the party I didn’t get for my 60th birthday last year. (Oh, well— at least I was alive to have another birthday!) It’s very unclear what to do now. Nothing involving a large group of people, certainly. Is it OK to have a small outdoor gathering with vaccinated family and friends? And should we stop attending any non-crucial indoor events of any kind, even with masks and good ventilation? How much have things changed now that delta has taken over?

Amanda Mull wrote a compassionate piece about where we stand with these questions, “Delta Has Changed the Pandemic Risk Calculus.”
‘Assessing risk pre-vaccination was often bleak, but at least the variables at play were somewhat limited: ventilation, masks, crowds, local spread. Now the number of additional, usually hyper-specific questions that people must ask themselves is itself a barrier to good decision making, says Jennifer Taber, a psychologist at Kent State University who studies health risk assessment. “When people feel like things are uncertain, they engage in avoidance,” Taber told me. That can manifest in disparate ways. An unwillingness to acknowledge that many new things are safe for the average vaccinated person is avoidance. So is a refusal to continue taking even minor precautions for the benefit of others.’
https://www.theatlantic.com/health/archive/2021/08/delta-variant-pandemic-risk-safety/619798/

A big part of my job as a clinician is helping patients to sort through all the available information to answer health questions like this, and it’s not easy these days. Just as we’ve been through the entire pandemic, we’re still flying by the seat of our pants, trying to keep up with ever-changing conditions and advice. The rise of delta has been a predictable but chaotic and confusing development that hit us with a bait and switch just when we thought we were getting our lives back. It’s still new and we’re still figuring it out.

What I mean by predictable is that this is normal virus behavior. A more transmissible variant will obviously outcompete others, and it would have been a surprise had we not seen a variant like this eventually. Viruses “want” to produce as many copies of themselves as possible, and any mutation that leads to more chances to replicate is great for them.

In general, causing less illness and death is also good for viruses, because having hosts walking around spreading viral particles results in far more replication than having hosts lying isolated in hospital beds, or in graves. So over time a viral species is likely to become more transmissible but less deadly. Sadly, delta seems to cause at least as much and as severe disease as earlier forms of COVID, maybe more.
https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html

We had some small hope of getting enough people vaccinated quickly enough, as a planet, to limit the possibility of worse new variants popping up. We didn’t make it, and that too was predictable. Viruses can adapt much faster than we can. We can still hope to escape without a far more dangerous variant coming along, but time is not on our side. The more humans there are who cannot access or will not accept vaccines, and the more who refuse to take other precautions, the more opportunities the virus has to mutate.

Here’s a good way of putting it:
‘You might think of viral replication as buying lottery tickets, in which the virus accumulates random mutations that very occasionally help it spread. And the fewer lottery tickets the virus has, the less likely it is to hit the mutation jackpot. The appearance of troubling new variants may slow down.’*

The now-famous Provincetown outbreak around the 4th of July has taught us a great deal.
https://www.washingtonpost.com/health/2021/08/05/provincetown-covid-outbreak/
The area population was so highly vaccinated that the tens of thousands of visitors who descended on the place didn’t worry about getting sick. They even packed cheek by jowl into indoor venues, without a mask in sight. No one expected to need them. Here you can get a sense of just how packed together the revelers got:
https://theboatslip.com/tea-dance
Then some folks noticed they were feeling unwell or had lost their sense of smell. By that time it was dawning on us all that delta was different and that we had been wrenched into a yet another new reality where we had to learn the rules all over again.

The misinformation mill has seized on Provincetown’s experience as an example of vaccines not working. That’s not remotely the case. Yes, 74% of the infections were in vaccinated people, but with over 900 infections, there were only 7 hospitalizations and zero deaths. An unvaccinated population would have a very, very different outcome. This article explains everything you need to know about the outbreak and what it means for the rest of us:
https://www.factcheck.org/2021/08/scicheck-posts-misinterpret-cdcs-provincetown-covid-19-outbreak-report/

You could just read the article, and you should, but I’m going to summarize some key points:

— Imagine a population that was 100% vaccinated. Vaccines are not perfect, so there would be some infections, and 100% of them would occur in vaccinated people.
— Infections in vaccinated people are rare, but since the vaccinated population consists of hundreds of millions of people, a significant number of people do get infected.
— The most important thing: With current strains of the virus, even if one does become infected, vaccination means essentially no chance of dying and very little chance of becoming severely ill.
— It looks like vaccinated people may harbor as much viral material in their noses as unvaccinated ones if they get infected, but infection doesn’t get as far into the body and the viral load goes down quickly as the immune system responds.

Research is ongoing to try to determine how likely an infected vaccinated person is to transmit the virus. That may be less than some studies suggest. From the same article:
‘For one, these sorts of PCR tests are good at identifying viral RNA, but they can’t tell whether that genetic material is in an intact, infectious virus particle or not. That becomes especially relevant for vaccinated people, Deepta Bhattacharya, an immunologist at the University of Arizona College of Medicine, said.
‘“Antibodies from a vaccinated person can coat the released virus and keep it from infecting other cells,” he told us. “And T cells can kill infected cells, releasing viral genetic material but not infectious particles.”
‘Second, the tests are only looking for RNA present in the nose and throat, not the lungs — even though vaccines are likely to have more of an impact there, according to previous research.
‘“Though it isn’t entirely clear how much of transmission comes from the lungs vs. the nose and throat,” Bhattacharya said in an email, “it is almost certainly some.” That would also suggest a vaccinated person with a similar cycle threshold as an unvaccinated person would be less infectious.
‘Vaccinated people also likely aren’t infected as long, since their immune systems are quicker to respond to the virus, which would also make them less likely to infect as many people as an unimmunized person.’

Here is a similar explainer, with data from the UK, where delta has run rampant:
https://theconversation.com/covid-the-reason-cases-are-rising-among-the-double-vaccinated-its-not-because-vaccines-arent-working-164797

Another highly vaccinated place that’s weathered a recent surge is Iceland.
‘Iceland, the experts say, is providing valuable information about breakthrough infections in the fully inoculated. Yet it also remains a vaccine success story.’
https://www.msn.com/en-us/news/world/iceland-has-been-a-vaccination-success-why-is-it-seeing-a-coronavirus-surge/ar-AANl2dx +

As with the surge in England, soccer was involved. ‘The country’s top health officials linked most of the cases to nightclubs and to residents who traveled to London to attend Euro 2020 soccer matches that some warned would be “a recipe for disaster.”’

Epidemiologist Brandon Guthrie gave some perspective in the Iceland article:
‘“We’ve handicapped ourselves in what the definition of success is,” he said. Scientists originally hoped for vaccines that were 50 percent effective, he said, and the goal was to prevent death and severe disease — not to provide blanket protection against any chance of infection.’
That is, the current reduced effectiveness of the vaccines is about as good as we hoped vaccines would be in the first place. Keep that in mind whenever you feel like despairing.

Even if it’s been quite a while since you were vaccinated, and you don’t have a lot of antibodies circulating in your blood, your T and B cells still remember how to recognize and fight SARS-CoV-2. Infection won’t get into your lungs because it will have been fought off by that time. It may take as much as 5-6 days for the body to marshal a good crop of antibodies, but generally it would take 10 or more days for a COVID infection to get as far as the lungs.

But meanwhile, kids are getting sick and being hospitalized, and some of them are dying of this disease that too many adults insist is no big deal for them. Vaccines for the under-12 cohort are on the way, but at this point the behavior of adults is the only real protection younger kids have, and in too many places adults are doing a crappy job.

“This new variant is a major contributor, but a major issue is that people’s behavior has changed,” said Gigi Gronvall, a senior scholar at the Johns Hopkins Center for Health Security. “I don’t think we can absolve people and leaders of responsibility for this because it gives them a pass. The reason kids are getting infected is because we don’t have those precautions and parents and households are getting infected.”
https://www.nbcnews.com/news/us-news/kids-sick-covid-are-filling-children-s-hospitals-areas-seeing-n1276238

‘Kline said it is unclear what kind of long-term effects babies and children will face.
‘Specifically, Kline referenced the brain fog adults see after contracting the virus.
‘”How does that affect a baby who is still having a developing brain? We just don’t know.”
‘Kline said another concern is cardiac issues in children.
‘”It worries me a lot that people say sure, kids can get COVID-19 but most of them recover uneventfully,” said Kline. “We know almost nothing about what those infections could produce down the line. I think there is a real risk that a proportion of these kids will have some long-term effects.”’
https://www.wdsu.com/article/new-orleans-louisiana-children-sick-covid-19-unvaccianted-adults-responsible/37259391

And all this is before school starts in a lot of the country.

Conspiracy Theory Roundup

For the sake of readers who live in a bright future where this craziness is forgotten: Droves of parents are currently following right-wing leaders and fighting requirements to wear masks in schools, sometimes with physical violence against teachers, principles, health care providers, and other parents.

As far as I’m concerned, there is no excuse for willful failure to protect children; I suppose it relates to that tendency toward avoidance when things feel uncertain. Yet, even the parents who give the most insane reasons for refusing to let their kids wear masks believe they are doing their best for them. Some may have thought things through and come up with vaguely rational justifications, but most have surely spent too much time in the conspiracy-verse, where they find an endlessly creative cornucopia of crap being produced every day.

The funniest example going around is the claim that vaccinated people will grow tails. My first reaction to that was Cool!  Unlike the claim that we become magnetic, this one cleverly avoids being immediately disproven by saying that the tails will grow at some point in the future. At least that’s how I heard it. I hope it doesn’t take too long….

For a while we were hearing that women would become infertile if they were vaccinated. Now the same scary disinformation is being aimed at men.
https://www.factcheck.org/2021/06/scicheck-research-rebuts-baseless-claims-linking-covid-19-vaccines-to-male-infertility/

Oddly enough, sperm counts have actually been found to increase after vaccination! The reason is unclear, but it’s been a consistent effect.
https://jamanetwork.com/journals/jama/fullarticle/2781360
“Sperm Parameters Before and After COVID-19 mRNA Vaccination”

President Former Guy rejected masks and publicly visible vaccinations as making him look less manly, but hey, maybe vaccines make for more manliness. I think we should really hammer on this selling point!

(Stephen Colbert pointed out that the conspiracy theory that vaccines cause a drop in fertility must be true— all those elderly people were vaccinated first, and sure enough none of them have had kids since.)

A more insidious claim is the one that COVID is being brought in by people coming over the border from Mexico; this is in line with centuries of blaming “foreigners” for disease. And of course it neatly deflects blame from the GOP fearmongers and unvaccinated Americans who are actually driving the high case counts. But this too is easily disprovable. We know that the bulk of transmission is coming from people within the US, not those coming from elsewhere, because we can track the genomes of various strains of the virus and see who is carrying which and where those strains are prevalent.

The lieutenant governor of Texas, Dan Patrick, added further venom to this trope by disgustingly blaming Black Texans for the state’s horrific rise in COVID illness and deaths. Patrick is the same guy who last year said people over 70, like him, should be willing to sacrifice their lives in order to keep the economy going. And he’s only doubled down in the face of criticism of his racist statements, which again are easily disproven.
‘Patrick acknowledged Texas’ public-health crisis — rising cases, hospitalizations, and fatalities — and said he’s aware of the criticisms of the state’s Republican leadership. But the lieutenant governor insisted the blame be directed at unvaccinated African Americans, not the GOP officials who remain passive toward the pandemic.
‘”The Democrats like to blame Republicans,” Patrick said. “Well, the biggest groups in most states is African Americans who are not vaccinated. Last time I checked, over 90 percent of them vote for Democrats in their major cities and major counties.”’
‘…In fact, the latest data suggests unvaccinated White Texans outnumber unvaccinated Black Texans by a roughly three-to-one margin.’
https://www.msnbc.com/rachel-maddow-show/dan-patrick-falsely-blames-covid-surge-unvaccinated-black-texans-n1277307

Meanwhile, Patrick’s cohort Governor Greg Abbott continues to interfere with requirements for masks around the state in the name of “freedom.” He’s getting plenty of pushback, but why should anyone have to use up their energy— or money— fighting for the right to protect their or their children’s health? Meanwhile taxpayers’ funds are drained away in court battles the state need never have started, instead of meeting real human needs. If only we could immunize against stupidity and self-serving political posturing.

One way out of the mess is to make masking voluntary, but as pediatrician Dr. Danny Benjamin said, a voluntary masking policy is “like having a no-peeing section in a pool.”

Onward with Delta Force

A major development just occurred: the FDA approved the Pfizer vaccine, so it is no longer being given under an Emergency Use Authorization. Moderna was later to submit data but its approval will be coming along soon. Many of the vaccine-hesitant have said this would make a difference in their acceptance of the shots.

The biggest question among my patients right now is when and where boosters will be available. I’m in the camp that wonders whether large numbers of us privileged sorts should be getting a third dose when so much of the world hasn’t even had a first one. We’re told that there are plenty of doses to go around in the US and that we can both give extra protection to Americans and send vaccines to poorer countries, but I personally don’t feel great about using a dose someone else may desperately need, and I recognize that the only way to protect everyone is to protect everyone.**

Giving a third dose to organ transplant recipients on immunosuppressants and others who have not been able to mount a strong response to their original vaccination is a different matter and a clear benefit as far as we know. For the rest of us, we’re told that we should probably get a booster about 8 months after our second shot. For me and a lot of health care workers, that’s early October, so we’ll need to decide pretty soon.

Surprisingly, it appears that flu shots give some protective effect against a range of severe symptoms of COVID. I was figuring that since I would likely stay masked this winter, and that if pandemic limitations continued we might have little or no flu season last year, a flu shot would be pretty worthless. The risk/benefit calculation has changed again. The authors suggest that for populations that have not had access to COVID vaccines, flu vaccine might be better than nothing.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255541
“Examining the potential benefits of the influenza vaccine against SARS-CoV-2: A retrospective cohort analysis of 74,754 patients”

What about those who have already had COVID? Aren’t they immune? They do have some protection, though we aren’t sure how long it lasts. However, since the virus has ways to evade the immune system as part of its normal strategy, natural infection doesn’t confer immunity as well as the vaccine. If you have both a history of natural infection and the vaccine, you have the highest possible level of immune response. For you, a vaccine is essentially a booster. (Similarly, if you become infected despite being vaccinated, the disease has a booster effect.)
https://www.cidrap.umn.edu/news-perspective/2021/03/covid-19-survivors-may-be-able-skip-2nd-vaccine-dose

Last year when vaccines were being developed, there were breezy assurances that we would be able to tweak them to take new variants into account. Can’t we do that for delta? Well, yes, but no. The practical problem with creating vaccines against specific variants is that by the time studies are done and the product approved, that variant may be gone and another may be ascendant. If a variant comes along that completely evades current vaccines, though, we will need to meet that challenge.

Intranasal vaccines are being developed. Injecting a vaccine into the arm doesn’t teach the body to be on the lookout specifically for a respiratory virus. That is, giving a vaccine in the nose tells the body that the virus involved is going to enter through the nose and that’s where defenses need to be placed, so it’s a more efficient strategy. It should also be a bit easier on the needle-squeamish.

‘Charneau and a group of scientists in Paris have shown that natural SARS-CoV-2 infections trigger both systemic and mucosal immunity. But our current crop of COVID-19 vaccines offer only systemic protection. Developing vaccines that are sprayed up the nose, rather than injected into the arm, could change that, Charneau says. Mucosal immunity in our noses could be like a guard at the door, potentially helping stop even small infections of SARS-CoV-2 right where they start.’
https://cen.acs.org/pharmaceuticals/vaccines/Intranasal-nose-vaccines-stop-COVID/99/i21

I’ll leave you with another hopeful note, a story about former pastor Curtis Chang, who has been working within the vaccine-resistant evangelical community to dispel common myths.
https://www.motherjones.com/politics/2021/08/this-former-pastor-is-changing-evangelicals-minds-on-covid-vaccines/

‘Historically, the evangelical movement has baked into it a certain wariness of dominant secular institutions. And this can be captured in the saying that Jesus called us to be in the world, not of the world. We’re not of the world in the sense of just conforming automatically to the assumptions and beliefs the world. But what’s happened is that this orientation of being wary has gotten weaponized.

‘‘There’s been three main forces that I think have done that. One is that you can actually gain a lot of ratings by playing up those fears of what Washington is doing or what the left is doing. Christians are being bombarded by so much conservative media that they automatically just assume they’re out to get us. Another one is that conservative politicians have realized that you can gain a lot of votes by playing up these fears. And then the third is sort of outside conspiracy movements. QAnon, the anti-vaxxer movement—they have realized that evangelicals are fertile hunting grounds for their theories, because they are already primed to be distrustful of institutions, and so they can be easily kind of recruited into their deep conspiracies of distrust.’

Pastors, Chang says, are in a difficult position. Most of them are in favor of vaccination, but they risk backlash from their congregations if they speak too strongly about it— same problem GOP politicians have. (I would argue that both have helped create this problem.)

‘I understand that people are frustrated, that they’re losing patience, that they just want to make things via mandate, and give up trying to persuade these people. I think that’s short-sighted, for a couple of reasons. One, if you just resort to sheer coercion, it just confirms the narrative that they’re out to get us, that they are shoving things down our throat. You’re just laying the groundwork for a deepening divide. The second reason is that you have to realize that we’re still in the first or second inning of vaccine outreach, globally. You have to realize that parts of Africa and Asia are heavily influenced by Christian culture. A country like Uganda is like 90 percent Christian. Those churches, those places in Africa, they actually take their cultural cues to a great extent from American evangelicals, especially leading white evangelical voices. So America is—unfortunately, through evangelical culture—exporting its vaccine hesitancy. A lot of the same conspiracy theories and doubts and fears that we’ve been battling here, we are definitely seeing emerge and being replicated in the rest of the world. Changing American culture is not just about getting more American evangelicals to take the vaccine, it’s going to be critical to getting the rest of the world vaccinated. And ultimately, for all of us, if we don’t get the entire world vaccinated, we’re all at risk. ’

‘…What’s going to be really important is for Christians to convey to other Christians is that it’s okay to change your mind. The Christian virtues of grace and acceptance are going to be paramount here because people are going to be even more resistant if they think that in changing their mind they are going to be shamed.’

Grace and acceptance… those sure sound good right now.

***************************************************************
TAKEAWAYS for the Delta Era:
— You can still get infected even if you’re vaccinated, though most likely you won’t.
— Remember the Swiss cheese layer concept and take multiple precautions as reasonable and available.
— Be good to yourself and others and acknowledge the effects of the unrelenting pain and uncertainty of our time.
— WEAR THE DAMN MASK!

************************************************************

Original source: https://www.washingtonpost.com/world/europe/iceland-covid-surge-vaccines/2021/08/14/bdd88d04-fabd-11eb-911c-524bc8b68f17_story.html

Data from the UK, May to July 2021: 
https://spiral.imperial.ac.uk/bitstream/10044/1/90800/2/react1_r13_final_preprint_final.pdf

*https://www.theatlantic.com/science/archive/2021/08/how-we-live-coronavirus-forever/619783/
“The Coronavirus Is Here Forever. This Is How We Live With It.”

***https://www.npr.org/sections/goatsandsoda/2021/08/04/1019780576/why-who-is-calling-for-a-moratorium-on-covid-vaccine-boosters
Meanwhile, Israel is not waiting and has already given third doses to around 600,000 of their citizens— while Palestinians next door in Gaza and the West Bank have had so much trouble even getting a first dose. Here’s part of that sad tale, in which they were offered nearly-expired doses, for which Israel would have received fresh replacements:
 https://mondoweiss.net/2021/06/we-returned-them-palestinians-axe-1-million-pfizer-dose-deal-with-israel/

A new examination of the possible origins of COVID-19:
https://science.sciencemag.org/content/early/2021/08/16/science.abh0117
“The animal origin of SARS-CoV-2”

2 Comments

Filed under health and healing, history, nature, psychology, science

I Don’t Know How the Pandemic Started, But I Do Know These Things

I got to thinking about what we do know for sure about this and other pandemics, trying to clarify it all in my mind. Here is the list I made for myself.

— New diseases arise all the time; most of them don’t spread far so most people don’t pay much attention.
— The warming climate has pushed disease-carrying insects and other creatures farther north. 
— The growth of the human population has pushed humans into new territories with more contact with animals in their habitats, and pushed the animals to migrate. Both of these movements make transmission of diseases more likely.
— It’s crucial that we study zoonotic diseases and their vectors, and do everything we can to prepare for the next ones that will come along.
— Tick-borne diseases are emerging as an issue of huge importance, again exacerbated by climate change.

— Plagues and pandemics of many kinds have happened commonly throughout history.
— The origins of most pandemics, including the 1918 flu, have never been definitively determined.
— More pandemics will arise in the future. This is the one fact of which we can be absolutely certain.

— Accidents happen, mistakes are made, and anything that can go wrong eventually will.
— Humans are tremendously creative and awfully smart in terms of developing things like new technologies, but also incredibly stupid in many important ways, and common sense is not common.
— Facilities such as microbiology labs are run by humans.
— More humans and more facilities mean more possibilities for error.

— People don’t like to be wrong, and they like admitting it even less.
— Mother Nature always has the last laugh.

***********************************************************************

Meanwhile, I was involved in discussions with a colleague who outlined some questions about the effects of the SARS-CoV-2 spike protein, both the natural version and the inactivated version coded for by the mRNA vaccines.  I tried to chase down some solid information and found a lot of fascinating stuff, which I’ve collected for you here:

 

https://www.theatlantic.com/science/archive/2021/05/spike-protein-vaccines-covid/618954/
“COVID-19 Vaccine Makers Are Looking Beyond the Spike Protein”

 

https://www.snopes.com/fact-check/vaccine-lung-damage/
“Will mRNA COVID-19 Vaccines Wreak ‘Havoc on The Lungs’ in 4 to 14 Months?” [Spoiler: NO.]

 

https://healthfeedback.org/claimreview/byram-bridles-claim-that-covid-19-vaccines-are-toxic-fails-to-account-for-key-differences-between-the-spike-protein-produced-during-infection-and-vaccination-misrepresents-studies/
“Byram Bridle’s claim that COVID-19 vaccines are toxic fails to account for key differences between the spike protein produced during infection and vaccination, misrepresents studies”
[Worth reading carefully.]
‘Ogata et al. found extremely low levels of the spike protein compared to the harmful levels reported in animal studies, as Uri Manor, one of the authors of the study in hamsters, pointed out on Twitter. The blog Deplatform Disease calculated that the amount of spike protein that the authors found in vaccinated people was about 100,000 times lower than the levels of viral spike protein shown to cause harm. This is “a situation that could hypothetically occur in severe COVID-19 patients, pending studies confirming it, but not achievable in vaccinated people, at least for those who received the Moderna vaccine, and unlikely to occur for the other vaccines”, explained Al-Ahmad.

‘While some of the vaccine might end up in the bloodstream, the body breaks it down over time. The European Medicines Agency (EMA) explained in a 23 March 2021 letter that the proportion of vaccine that enters the bloodstream is very small and almost all of that ends up in the liver:’

‘…I have personally discussed these biodistribution data (as obtained by Bridle and colleagues) on my blog, as I teach pharmacokinetics to pharmacy students. The data is pretty clear: the number of vaccines needed to be injected in a 12-year old to reproduce the findings observed in rats and reported as “terrifying” would be equivalent to 60,000 doses given at once, to reproduce the number of nanoparticles used in that study.’


https://www.sciencedaily.com/releases/2020/10/201029141941.htm
“SARS-CoV-2 spike proteins disrupt the blood-brain barrier, new research shows”  [Can this explain some or all of the neurological symptoms?]


https://www.sciencedirect.com/science/article/pii/S2211124720302928
“Route of Vaccine Administration Alters Antigen Trafficking but Not Innate or Adaptive Immunity”  [Where the vaccine goes after injection]
‘The transport of vaccine antigen to the local LNs [lymph nodes] is crucial for priming of T and B cell responses (Liang et al., 2017b). We and others have shown, using both flow cytometry and positron emission tomography (PET)/computed tomography (CT), that vaccine transport after i.m. injection is restricted to the local LNs and is not disseminated systemically (Liang et al., 2017a, Liang et al., 2017b, Lindsay et al., 2019).’


https://www.science20.com/w_glen_pyle/the_thorny_problem_of_covid19_vaccines_and_spike_proteins-254373
“The Thorny Problem Of COVID-19 Vaccines And Spike Proteins”
‘In addition to engineering the spike protein so it can not be fully activated, the protein is tagged with an extra piece called a “transmembrane anchor”. The transmembrane anchor allows the spike protein to appear on the surface – or membrane – of the cell, but it is held in place by the anchor. This prevents the spike protein from drifting away and creates a fixed target for the immune system to recognize the foreign protein.’
‘…Lei and colleagues conclude their paper by noting that their study “suggests that vaccination-generated antibody and/or exogenous antibody against [spike] protein not only protects the host from SARS-CoV-2 infectivity but also inhibits [spike] protein imposed endothelial injury.” In other words, the spike proteins used by currently available vaccines actually offer a double layer of protection.’


https://cen.acs.org/pharmaceuticals/vaccines/tiny-tweak-behind-COVID-19/98/i38
“The tiny tweak behind COVID-19 vaccines
Prepandemic coronavirus research by Jason McLellan and Barney Graham led to a trick for stabilizing the prefusion form of spike proteins”
[This one, linked in the article above, has drawings of the molecular structures of the natural and inactivated spike proteins to help us understand what was changed and why– good to nerd out on]


https://magazine.ucsf.edu/what-covid-doing-our-hearts
“What Is COVID Doing to Our Hearts?”
‘Healthy heart muscle (left) created from adult stem cells has long fibers that allow them to contract. SARS-CoV-2 infection causes these fibers to break apart into small pieces (right), which can cut off the cells’ ability to beat and may explain lasting cardiac defects in COVID-19 patients.’

 

 

 

2 Comments

Filed under health and healing, nature, science

My New Old Lute Albums, Available Again

The universe has decided that I’m supposed to be a lutenist again, which was pretty much a surprise to me. As part of my lute activities, I’ve put my 1993 and 2010 albums up on Bandcamp where they’re easy for you to find.

The 2010 album, A Sampler of Polish Lute Music, was one of my projects for Chopin’s 200th birthday year. The cover and liner are photos from Kraków, where my daughter and I visited after a stay in Warsaw to take in the Chopin piano competition.

It’s here:  https://elenegusch.bandcamp.com/album/a-sampler-of-polish-lute-music

My first album, Risurrectione, comes from 1993, so long ago that it was recorded on cassette. My very patient husband recently remastered it into electronic form so it could enter the modern world. I reworked the cover art, my take on the famous Fiorentino cherub lutenist, into a CD cover format.

You can find that one here: https://elenegusch.bandcamp.com/album/risurrectione

 

Photos from Kraków here:  https://elenedom.wordpress.com/2010/12/06/trippy-journal-part-ii-krakow/

Leave a comment

Filed under music, travel

Don’t “Panic,” But We’re Not Done with This Yet. Not Even Close.

 

Best New Mexican conspiracy theory. The booster has microguacamole.

 

Last week we got the news that a little girl, under 10 years of age, died of COVID-19 in our state. Because of privacy concerns, all we know is that she had underlying conditions and was hospitalized. Kids her age are of course not being vaccinated as yet, one more reason we still need to be careful. This is not over, not by a long shot.

I started writing this post in early April, then ended up working on other matters and putting it off for an unconscionably long time. Many things about the pandemic have become clearer since then, while others have become muddier still.

At that time a few months ago, COVID-19 was doing its maximum damage in India, and Brazil was not far behind. There were still influential voices referring to the pandemic as a “panic,” implying that it is overblown and not really so bad. One of these voices belonged to someone I respect a great deal; you could actually hear the quotation marks when he said “panic,” and I was deeply disappointed to witness that. (Anyway, if you lived in India, wasn’t panic a pretty reasonable response?) That was what got me stirred up to write about the current state of play, and how things look from the perspective of a holistic health care provider.

That is, how things look from my own perspective. Quite a few people in my profession and other areas of “alternative” medicine have been caught up in conspirituality thinking. In general, these people are sincere, and they are promoting some empowering ideas: that the human body has the capability of fighting any disease on its own, and that what appears to be illness in the material world is not really what it seems and has causes quite different from the pathogens we (sort of) understand.

They’re not wrong.

However, I submit that they are impractical and that material-world measures still need to be taken at this point. Humanity as a whole is nowhere near a time when we can all throw off disease with a thought, and this pandemic is a very, very large field of reality-stuff, a huge mass to contend with. I note that some very aware and enlightened health-care gurus have themselves become infected, some with long-term consequences. Yes, I know that the material world isn’t what it seems*, but in consensus reality, if you jump off a cliff you are going to go splat. And in consensus reality, a pathogen your body has never learned to recognize has an excellent chance of making you very sick.

The V Word

I spend a lot of time somewhere other than consensus reality, myself, and don’t put a lot of stock in it for the most part. I’m so alternative that I often treat people from a distance, essentially by just thinking about them. Yet I am still saying that as things stand, our best chance of reducing transmission of this virus and the rise of worse variants is… the dreaded V word.

My best take on the whole situation is that whether we are infected ourselves, dealing with the illness or death of loved ones, affected by the biological challenges of vaccines, or “only” experiencing the heavy pall lowered over the planet by the pandemic and its economic fallout, we WILL be affected. To an extent you can choose your response, but you will necessarily respond in some way. You can’t isolate yourself from it.

As I write this, I’m doing something that until recently was a forbidden pleasure, sitting inside at Michael Thomas Coffee, nibbling a piece of spinach quiche and sipping some nice fair-trade light roast, with other humans in the same room. I owe this enjoyable hour first and foremost to the people who developed the Pfizer vaccine.

When I last wrote about pandemic issues and those who refuse to see reason, around Halloween 2020, COVID vaccines were still only theoretical. We did not expect the degree of efficacy that we’ve had, and for a while there was more room to debate about whether it was worthwhile for any given person to get their “Fauci ouchie.” Now there’s no more question. Cases among vaccinated Americans are practically nil, while among others the virus rages on at similar levels to what it was doing months ago.

A news story that went by as I was working on this concerned an outbreak with deaths and hospitalizations, all of unvaxxed folk, at a government office building in Florida. The vaccinated guy who was exposed didn’t get it.

https://www.cnn.com/2021/06/23/us/manatee-county-outbreak-spread/index.html

The wife of one of the deceased said she and her husband had considered the vaccine, but “we just wasn’t ready yet.” The virus refused to wait for them. So sad, so frustrating, so unnecessary!

And meanwhile, more transmissible variants take over. At this moment, the winner in the evolutionary race is the delta variant, the one that’s given India so much grief. It has even caused an outbreak in Australia, where the virus had seemed to be beaten— and where only a few percent of the population are fully vaccinated.

I wasn’t totally crazy about being among the first wave of vaccinees myself, both because I might have liked to see more about how the side effects played out and because a lot of other people were at higher risk than I. But as a health care provider, I was given the opportunity early on, in January, and I felt that I’d better take it while I could, for my patients’ sake as well as mine.

After I received my first shot, I experienced a major psychological boost, a sense of greater safety and freedom— along with a very sore arm that felt heavy and was difficult to use for a day or so. Since then I’ve treated some pretty significant vaccine side effects among my patients. With my patient population being small, I must conclude that they are common. Most of my patients reported no ill effects at all, though, and most of those who did got over them very quickly. Two who already had skin issues had increased inflammation and itching, which also resolved, but more slowly. Two others who had longer-lasting effects appeared to have lurking underlying illnesses which were brought to the surface. That was uncomfortable but not necessarily a bad thing, as those conditions could then be treated.

What bothers me most is that the majority people who do have significant ill effects will be left without meaningful treatment on the energetic level or even the deeper physical levels, as mainstream medicine may only apply band-aids like steroids. It’s been heartening to see that mainstream medicine has taken the matter very seriously, especially in the rare but quite dangerous cases of odd blood clots associated with the Astra-Zeneca vaccine. (For those who pointed out that birth control pills are more likely to cause clots than these vaccines, meaning it’s no big deal: these are very unusual clots and in more dangerous locations.)

‘In the new study, his team found that 15 weeks after the first vaccination, immune cells in the body were still organizing — becoming increasingly sophisticated and learning to recognize a growing set of viral genetic sequences.
“The longer these cells have to practice, the more likely they are to thwart variants of the coronavirus that may emerge. The results suggest that the vast majority of vaccinated people will be protected over the long term — at least, against the existing coronavirus variants.”
https://www.nytimes.com/2021/06/28/health/coronavirus-vaccine-immunity.html

An area of great interest is the interaction between immunity after infection and that after vaccination. It looks like people who have had both get the most robust and long-lasting immunity.

There has been a surprising and wonderful development in which COVID vaccination actually becomes a treatment. A significant percentage of people with “long COVID”— the ones who never get better— are improved or even cured after receiving a vaccine. And fascinatingly enough, the vaccine put a lymphoma patient into remission (which can also happen with a viral infection). I have seen reports of Lyme disease, lupus and other conditions improving as well.

https://www.forbes.com/sites/victoriaforster/2021/02/08/did-covid-19-cure-this-persons-cancer/?sh=7d18df674217

At the same time, people with autoimmune conditions and others who are on immunosuppressant drugs may not mount a sufficient immune reaction to a vaccine. Giving an extra dose to those people is an option currently being studied, and it looks like it helps.

Myocarditis has been seen, rarely but enough to worry, in young men after vaccination. So far we have been seeing it resolve and not cause a long-term problem. Myocarditis is also caused by COVID itself, so the vaccine is not causing an increased risk of it as far as I know.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2780548
Note that this study concerned healthy college athletes, not a population whose health had already been compromised.  Heart damage from the virus is a real risk.

It should go without saying that vaccines aren’t 100% safe for every person every single time. No effective form of medicine is without problems when applied to millions of people. My guiding star is always the risk/benefit ratio. In the case of COVID vaccines, for most people, the benefits far, far outweigh the risks. I would contrast this with the annual flu shot, which I usually avoid on the basis of: its relatively poor efficacy, the existence of at least some immunity to these viruses and the ability to treat the illness, the small but nonzero risk of Guillain-Barre syndrome, and the fact that it has to be given over and over, putting more toxic crap in the system each time. I’m not laughing off flu in the least— I’ve had some really nasty cases. From what I know, and that’s always changing, I simply want to limit vaccines to those that make a serious difference.

In any case, we can’t vaccinate our way out of every conceivable epidemic. New pathogens come along all the time, as their nature is to evolve quickly and to evolve toward more transmissibility. It’s still crucial to continue all our basic public health measures such as tracking and isolating cases of outbreaks; that was how Ebola was contained, well before a vaccine was developed. Vigilance is still needed, all around the world. And that’s why those who demonize or laugh at laboratories that study potentially devastating viruses, like the one in Wuhan (I’m talking to YOU, Jon Stewart!) are doing great damage.

Disinformation (and some honest confusion)

A British gentleman, Chris Woollams, who publishes a very useful website that aggregates current information about cancer treatments is among those who fell into the current fashion of vilifying these efforts and Dr. Anthony Fauci personally. He was easily taken in by the right-wing campaign that paints Dr. Fauci as a liar who is somehow responsible for all we’ve been through in the past year and a half, which nicely deflects attention from the failures of the administration that was in power at the time. He even quoted Rand Paul as a reliable source of information in his article about this. (I’ll wait while you finish laughing. Take your time.) When I attempted to inject some facts into the discussion, he email-yelled at me, “Dr. Fauci is endangering me and my family!” Sadly, I can no longer consider him to be a reliable source himself, as he’s shown that his BS detector is malfunctioning.

The other day Woollams also insinuated on his website that some new research on DNA repair in human cells means that the mRNA in vaccines can become part of your DNA. That’s extremely irresponsible at best. Here’s where he got the idea:
 https://advances.sciencemag.org/content/7/24/eabf1771

The human genome is full of sections derived from viral RNA anyway; HIV famously uses its reverse transcriptase to write itself into our DNA. That’s normal biology. The question being explored recently is whether this mechanism might help explain why some people continue to test positive for COVID after recovery. So far, no.

Some researchers thought they did see evidence of SARS-CoV-2 integrating into the human genome:
https://www.pnas.org/content/118/21/e2105968118
“Reverse-transcribed SARS-CoV-2 RNA can integrate into the genome of cultured human cells and can be expressed in patient-derived tissues”
However that appears to be incorrect: https://journals.asm.org/doi/abs/10.1128/JVI.00294-21
“Host-virus chimeric events in SARS-CoV-2 infected cells are infrequent and artifactual”

From this last article: ‘”If the virus was able to integrate its genetic material into the human genome, that could have meant that any other mRNA could do the same. But because we have shown that this is not supported by current data, this should allay any concerns about the safety of mRNA vaccines,” he said.
‘It is possible for the genetic material of some viruses to be incorporated into the DNA of humans and other animals, resulting in what scientists call “chimeric events.” Human DNA contains approximately 100,000 pieces of DNA from viruses that our species have accumulated over millions of years of evolution. In total, this lost-and-found DNA from viruses makes up a bit less than 10% of the genetic material in our cells.’

So although research continues, you don’t have to worry about the mRNA in vaccines becoming part of your DNA. (If you really want to keep worrying about that, just get a different type of vaccine.)

At least Woollams’ contention is based in some sort of reality, and the underlying biology is important and fascinating, as well as confusing to the non-virologist. That can’t be said of the wacked-out statements we’ve heard from some other internet pundits.

I don’t know if anyone will ever exceed the, um, whimsy of Dr. Sherri Tenpenny’s insistence that vaccines make you magnetic, nor if any anti-vaccine concept will ever be easier to disprove. (I’m sitting on a chair made of ferrous metal right now. Nothing.) Yet, this got as far as testimony before the Ohio state legislature. Think about that for a moment. Lord, I’m glad I don’t live in Ohio anymore.

Second prize goes to the person who dreamed up the idea that the viral spike protein in the vaccine penetrates the uterine wall, thus explaining increased menstrual bleeding. Just how big do they think viruses are?

Sadly, a lot of the worst misleading statements, aka lies, about vaccines are coming from real health care providers who used to be trustworthy sources of solid medical information. I grieve particularly to see Christiane Northrup, MD in this group; I used to recommend her women’s health books to my patients. Some of these were called out by the Center for Countering Digital Hate under the title “The Disinformation Dozen,” in a presentation calling for more policing of misinformation by social media corporations. Some might find CCDH a little strident, but a number of the memes they collected are truly eye-popping and nearly at the level of the “magnetic” claim. Tenpenny, a DO, is included.
https://252f2edd-1c8b-49f5-9bb2-cb57bb47e4ba.filesusr.com/ugd/f4d9b9_b7cedc0553604720b7137f8663366ee5.pdf

There is not a hint here of sober consideration of potential side effects or of the risks of the disease itself. Instead there is idiocy like “masks make you get sick” and “vaccines have killed more people than the disease itself” and even “if you are getting tested you are part of the problem.” Huh? And if you sift through crap like this long enough, eventually you get to the hoary old “it’s the Rothschilds.”

I want to emphasize again that their claims are easily disprovable.

 

 

Just plain not true. 

 

Some of these folks, like Sayer Ji, have promulgated solid information about nutrition and other aspects of health in the past, before they went so far off the deep end. On the other hand, the Bollingers, of “The Truth about Cancer” fame, not only put out statements about cancer that don’t hold water, but now they also promote Mr. 45’s election fraud lies. Anyone who believes T. won the 2020 election has some obvious issues with critical thinking, and “truth” is not their strong suit.

Still, a lot of people have been burned by the medical establishment in one way or another, and they have reasons to be leery. They have trouble trusting anybody who tries to advise them about their health. So I was heartened to see that one’s personal doctor does still get named as a trustworthy source:

 

 

 

And trust is slowly ticking up.

 

 

These graphics come from the Zoom updates the UNM infectious disease department holds every week. The kind and supportive community of doctors and other health care personnel helps me stay on top of the latest developments in COVID prevention and treatment— including aspects like nutrition and exercise— and answer the many questions my patients bring up. It also helps me keep some semblance of sanity. The presenters put in a lot of effort to do this on top of their very demanding jobs. It’s clear to me that all these providers are doing everything they can to understand and act upon the best information they can get. When people talk trash about doctors, these are the people I think of, and it hurts my heart.

Unnecessary Deaths and Long-Term Debility

Those who refuse to take the pandemic seriously, and there still are plenty of those, often state that “only” 1% of those who are infected die. Leaving aside the question of whether that percentage is accurate, who would they like to choose for those unnecessary deaths? For a thought experiment, let’s take Albuquerque Public Schools, which has about 4000 employees. That’s a population you can probably imagine, and an appropriate one since schools have always been great places to pass diseases around. Now imagine them as 4000 people who get COVID. Imagine that 40 will die— 40 moms, dads, sisters, brothers, friends. And they’ll die miserably.

Are you OK with that? I’m not, not if we can prevent it.

But while relatively few may die, a great many who contract COVID will have long-term consequences. You know about the devastation of “long COVID,” but you may not have heard that an increased incidence of a variety of health problems and even a greater likelihood of death are seen in the months after infection, even in those who appear to recover normally.

“We show that beyond the first 30 days of illness, people with COVID-19 exhibit a higher risk of death and use of health resources. Our high-dimensional approach identifies incident sequelae in the respiratory system, as well as several other sequelae that include nervous system and neurocognitive disorders, mental health disorders, metabolic disorders, cardiovascular disorders, gastrointestinal disorders, malaise, fatigue, musculoskeletal pain and anaemia. We show increased incident use of several therapeutic agents—including pain medications (opioids and non-opioids) as well as antidepressant, anxiolytic, antihypertensive and oral hypoglycaemic agents—as well as evidence of laboratory abnormalities in several organ systems. Our analysis of an array of prespecified outcomes reveals a risk gradient that increases according to the severity of the acute COVID-19 infection (that is, whether patients were not hospitalized, hospitalized or admitted to intensive care). Our findings show that a substantial burden of health loss that spans pulmonary and several extrapulmonary organ systems is experienced by patients who survive after the acute phase of COVID-19.”
https://www.nature.com/articles/s41586-021-03553-9

Long COVID is something you do not want. It’s still poorly understood, it’s difficult to treat, and it can completely disable you. It often follows mild cases that had seemed to be of little consequence, and it happens even to young, athletic people with no previous health issues. Take it seriously!

The best article I have seen about long COVID is not from a medical journal, but in The Atlantic. I hope you can read it and not be paywalled away. (The Atlantic is superb and worth subscribing to in any case.) The gist is that long COVID involves a derangement of the autonomic nervous system that doesn’t fix itself, but that the brain and body can be retrained with measures as simple as breathing exercises. The cases described are terrifying, but the conclusion is hopeful. I am confident that studying long COVID is helping us to better understand other post-infection syndromes like chronic fatigue syndrome/myalgic encephalitis, something else you definitely do not want.
https://www.theatlantic.com/magazine/archive/2021/04/unlocking-the-mysteries-of-long-covid/618076/

Panic may not be helpful, but a certain degree of alarm is still appropriate. This is no time for complacency. Though a lot of us in the more-vaxxed parts of the USA are sitting pretty right now, with transmission still so high in so much of the world, the virus has millions upon millions of chances to mutate, and we have literally no idea what may happen. At this writing, the delta variant is taking over and causing havoc in a number of countries. Reducing the rate of transmission is the only way to prevent the development of variants that could resist our best efforts and prevention and treatment. And we are a long, long way off from knocking transmission down to a low level in a lot of places. Even Australia has started lockdowns again. Until everyone is safe, no one is really safe.

 

*”How I Know the Material World Isn’t”  https://elenedom.wordpress.com/2010/05/16/how-i-know-the-material-world

Related: “Sorting Medical Fact from Fiction, Part IV: Vaccination, Variolation, and What Doctors Do Tell You”  https://elenedom.wordpress.com/2020/11/01/sorting-medical-fact-from-fiction-part-iv-vaccination-variolation-and-what-doctors-do-tell-you/

 

10 Comments

Filed under health and healing, science

Mask Confusion, Mask Destruction?

This part at least is clear!

 

I’m just coming off a session of attempting to de-freakout someone about a misleading vaccine scare article. I’ve had it with the antivaxx disinformation crew, and then I’ve also had it with the “science-based” bunch who poo-poo everything that doesn’t fit their narrow field of vision, like the guy I was reading a few minutes ago who insists that chiropractors aren’t doctors. I’ve had it.

I bet you’ve had it too.

Let’s take a deep breath, get a cup of tea, and survey the current state of play in our pandemic reality.

 

Are you confused about where, when, and whether to wear a mask now, or whether they help at this point? Of course you are. The current guidance is about as confusing as anything in the past 15 months has been, though I don’t know how it could be stated much better under the circumstances. And some people are still getting vicious with each other over their decisions about masking and other precautions.

Emma Green wrote an article in The Atlantic that struck me as lacking in empathy at best, entitled “The Liberals Who Can’t Quit Lockdown.” She took jabs at people who, in her opinion, were refusing to follow science not by denying the need for precautions, but by keeping them in place too long. Yet, all too many times, loosening of restrictions has led to spikes in cases and restrictions being imposed again. Is it any wonder that a lot of people are taking their time in going back to “normal”?

Shayla Love responded to Green with “People Aren’t ‘Addicted’ to Wearing Masks, They’re Traumatized.” I found her thoughts compelling.
https://medium.com/vice/people-arent-addicted-to-wearing-masks-they-re-traumatized-2746308163cc

‘There are other reasons why people may be hanging onto COVID precautions. Some people have unvaccinated children who, though at low risk, don’t have zero risk. Others may be immunocompromised or worried about the uncertainty around variants. Individual risk tolerance varies, and since the pandemic is certainly not over, it’s understandable if people’s tolerances still rest at different levels.

‘But in general, there are two groups of people who are most likely to return to normal life more slowly — and their reasons have to do with mental health and trauma, said Steven Taylor, a psychiatrist at the University of British Columbia. They are people who had mental health concerns before the pandemic, like anxiety or OCD, and those who had highly stressful or traumatic experiences: people who had COVID themselves, have long COVID, or lost someone due to COVID. These groups deserve our compassion, and patience.’

She reminds us that much of the world is still in a far more precarious situation than we are, and a lot of us feel that acutely.
‘Frani also thinks it’s a bit obtuse to zero in on people being “overly cautious” when the pandemic is still causing so much loss around the world. “It’s obnoxious, the sort of glee and readiness of which we’re abandoning masks when we see what’s going on in India,” she said. “Of course we’re all happy that things are going well here. But it’s so cringey to me that in the same breath someone would have the audacity to say, ’You’re being too safe,’ when they [sic] are people praying for anything resembling this sort of safety that we have here in other parts of the world.”’
Frani speaks for me too.

Back at The Atlantic, the kind and gentle Ed Yong also took up the effects of our communal trauma in “What Happens When Americans Can Finally Exhale.”
https://www.theatlantic.com/health/archive/2021/05/pandemic-trauma-summer/618934/

‘But it is also reasonable for people to want to continue wearing masks, to feel anxious that others might now decide not to, or to be dubious that strangers will be honest about their vaccination status. People don’t make decisions about the present in a temporal vacuum. They integrate across their past experiences. They learn. Some have learned that the CDC can be slow in its assessment of evidence, or confusing in its proclamations. They watched their fellow citizens rail against steps that would protect one another from infections at a time when the U.S. had already weathered decades of eroding social trust. They internalized the lessons of a year in which they had to fend for themselves, absent support from a government that repeatedly downplayed a crisis that was evidently unfolding. “We had no other protections all year,” Gold said. “We had masks. No one else protected us. It’s understandable that people would be hesitant about taking them off.”’
…..
‘The pandemic hasn’t been a one-off disaster but “a slow, recurrent onslaught of worsening things,” adds Tamar Rodney, from the Johns Hopkins University School of Nursing, who studies trauma. “We can’t expect people to go through that and for everyone to come out the other side being fine. People suffered in between, and those effects must be addressed, even if we’re walking around maskless.”’


So, with all that, when and where do we wear our masks now, as of early June 2021? The CDC still says we should wear them in health care settings, and virtually all my patients are still preferring to keep them on in my office, even though nearly all are vaccinated and only one of them is in the building at a time. I’m still wearing mine, too. At this point our group opinion is that they aren’t bothering us and we would rather be cautious.

And I am obligated to keep my patients safe in every way I can, so legally and ethically I have to err on the side of caution. I can’t help worrying that I will inadvertently endanger someone.

On the other hand, I recently attended my first “unmasked ball” of the pandemic era, in a large space with plenty of ventilation and a small group of dancers in which all but one person had been fully vaccinated. I felt almost entirely comfortable there. Then I attended a largely-outdoor, mostly-unmasked event that included a lot of people I didn’t know, and felt on the verge of panic and almost bugged out. The fact that we were eating and drinking meant that simply keeping a mask on wasn’t going to be an option.

All the currently available evidence suggests that I was safe in those situations and that others were safe with me as well, but it’s going to take time to get used to throwing caution relatively to the winds. And I’m not naturally reckless, far from it. So, probably just like you, I’m trying to find the sensible happy medium.

No one can say anymore that masks and distancing don’t help prevent infection, though. In addition to all the other evidence built up over the past year, I submit this: We had essentially no flu season last winter. That’s huge. We may even want to do the same to some degree next winter— at least, keep up the hand-washing, and maybe even use masks in some situations.

Some time soon, we’ll likely be able to fling off those masks and forget about them. But don’t throw them away, because with all the unknowns about the viral variants and how long our natural or vaccinated immunity is going to last, we may well have to pull them out again.

Want to have less need to worry about a particularly nasty variant coming to get us? Then keep up sensible precautions. That’s the best advice I can give right now, vague as it is. Everything about this pandemic has been a matter of muddling along, doing our best to figure things out, building the airplane while trying to fly it. I don’t think that will stop anytime soon.

5 Comments

Filed under Uncategorized

WandaVision: Unconscious in Our Episodes

“So long, darling….”

“Our deepest fear is that we are powerful beyond measure.”  — Marianne Williamson

The final episode of WandaVision has been in the past for a while now, so I’m figuring that any of you who were interested in seeing it already managed to do so. If not, I must add:

**SPOILER ALERT!**

I’m a rather vague and desultory fan of the Marvel Cinematic Universe. That is, I’ve seen most of the movies from the past decade, and I was heavily into Agents of S.H.I.E.L.D., mostly because of my crush on Clark Gregg (Agent Phil Coulson), but I don’t have the wide-ranging background knowledge necessary to understand WandaVision with all its cross-references, or the memory to keep track of everything I have seen over the years.

So I wasn’t really expecting to be, but I was immediately enthralled with this oddest addition to the MCU, and now I’m seriously crushing on both Paul Bettany and Elizabeth Olsen.

We see the origins of a whole crew of super beings in this series, and those who knew them from the comics were excited to have them show up on the screen. The superhero tropes weren’t the point, though, and like some of the critics whose work I’ve read, I was a bit jarred and almost annoyed when the final magic-fire-smiting battle of the witches came along, iconic and necessary though it was. We were in it more for the small-screen, intimately emotional story at the core. 

Elizabeth Olsen’s Wanda Maximoff is incandescent even when she’s not throwing red fireballs around the neighborhood. She is catastrophically powerful, exquisitely vulnerable, and most of all profoundly broken. In her short life she has lost her parents, her home, her brother, her husband, and any chance at stability or normality. Unable to bear the latest and sharpest loss, she has retreated into a comforting world constructed from the American sitcoms that she enjoyed as a child, her last memories of happiness with her family.

It’s a perfect story for our reality-warped, grief-soaked, wrenchingly surreal time.

When the story begins, we’re confused and nonplussed. There is no explanation for the sudden appearance of these superhero characters in a ’50s-style sitcom. It doesn’t take long for the characters themselves to begin to realize that they don’t belong there and something is terribly wrong. At some level Wanda realizes that she’s creating this televised reality (including the pithy commercials) but she fights that knowledge with everything she’s got. Messages break through from the outside, but she rejects them. She has to be forced to understand what she has done.

It seems to me that this is pretty much what we’re all doing every day. 

Like Wanda, we are terrified of our own power and of the responsibility that comes with it. Wanda has been told that she is dangerous and will destroy the world. As individuals, we are unlikely to do that, but as a species, we know the destruction we are capable of, even as we protest our innocence.

The sitcom world is enticingly free of such concerns. Vision is the perfect husband, devoted, caring and empathetic, poetic and philosophical with a charming edge of goofiness— not to mention able to fly, walk through walls, and protect his family from sundry technological and supernatural attacks. Yes, he’s a synthezoid, but hey, we’ve made worse choices in romantic partners, right? Don’t judge.

And of course he is perfect; he is Wanda’s creation, everything she wants him to be, and he becomes acutely aware of that. In the series finale, just before the artificial world disintegrates and he is destroyed, he asks Wanda, “What am I?” She explains, ripping our hearts out: “You, Vision, are the piece of the Mind Stone that lives in me. You are a body of wires and blood and bone that I created. You are my sadness and my hope. But mostly, you’re my love.”

We do not, most of us at least, create our lovers’ physical forms. But I will argue that in a sense we create everything else about them. Do we ever know the true nature of anything we perceive, or only what we perceive of it? Demonstrably no. So do we ever know the true nature of the people in our lives, or only our perceptions of them? The answer is obvious.

(When I was a teenager, this truth slammed into me suddenly when I saw it in a play, before I was ready for it. I had a sort of nervous breakdown in response. I remember blubbering uncontrollably while my mother held me and wondered what in the world to do with me. Since then I have made peace with the fact that reality is slippery and undefined and no one quite exists as they appear.)

We all change form over time, and adjust to the programming necessary to live different lives. This is as true within one lifetime as it is across many. As Vision begins to dissolve, he recounts, with wonder, the very different forms he has taken over time. “Who knows what I might be next,” he concludes wistfully.

There is another truth embedded in this scene. Wanda has already stated firmly that “family is forever”— and that does appear to be the case in the real world, whether we like it or not! As Vision’s body dematerializes, the two agree, “We have said goodbye before, so it stands to reason…. we’ll say hello again.” Cheesy? Perhaps, but who cares? We needed it, and it’s true. Relationships don’t end with one lifetime/series/episode.  As for Vision, we know we can expect to see more of him in other stories, and most likely we’ll see the kids as well. 

I don’t know how to tell you what I was feeling as Wanda stood alone in the midst of the desolate lot that was all that was left of her dream home, or why I experienced that specific image with such intensity. It was visceral, a twisting in my chest, as if all the losses and griefs of the past year spun together into a black hole. All that even though I have not personally experienced the great losses that so many others have.  I believe that stories have been crucial to our emotional survival during the pandemic, but sometimes the processing they facilitate can be hard going.

So much more could be said about WandaVision, and so much has been.  Here’s a worthwhile example, an interview with someone at least as enthusiastic as I and way more knowledgeable about the MCU: https://news.yahoo.com/breaking-down-wandavision-thrilling-easter-235442212.html

I can’t end without mentioning everyone’s favorite quote, which we hear the real Vision say in a flashback: “What is grief, if not love persevering?”

Wanda is the heroine of this story, but she is also its primary villain. She has conscripted other living, conscious beings into her fantasy against their will, and that, too, is a fine metaphor for our time. The past year has felt like things just happen randomly, without our knowledge or consent, like we’ve been cast in someone’s movie for which we never auditioned. It’s good to be reminded that we are the writers, directors and producers.

Wanda says that she doesn’t understand her power, but she vows to learn. Let’s do that.

May the reality you create be beautiful and filled with love, and may it harm no one.

**********************************************************************

While looking for the Marianne Williamson quote above, I found some others that seemed relevant:

“Until you make the unconscious conscious, it will direct your life and you will call it fate.”  — Carl Jung

“People have a hard time letting go of their suffering. Out of a fear of the unknown, they prefer suffering that is familiar.”  —Thich Nhat Hanh

“We are the sum of the things we pretend to be, so we must be careful what we pretend to be.” — Kurt Vonnegut Jr.

“Not everything that is faced can be changed, but nothing can be changed until it is faced.” — James Baldwin

And the rest of the quote from A Return to Love:  “Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that most frightens us. We ask ourselves, who am I to be brilliant, gorgeous, talented and fabulous? Actually, who are you not to be? You are a child of God. Your playing small doesn’t serve the world. We were born to make manifest the glory of God that is within us. It’s not just in some of us; it’s in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others.”

4 Comments

Filed under art, mythology and metaphor, psychology, spirituality

Sorting Medical Fact from Fiction, Part IV: Vaccination, Variolation, and What Doctors Do Tell You

encased in plastic bubbles

Will we see more of this?

I wrote most of this on 10/27, and the HHS update I’m referring to below happened on that date. By a couple of days later things looked massively worse, with a record one-day case count of 1082 and a real threat to our health care system and its exhausted workers. We knew fall was likely to be difficult, and it is, here and in so many places.

As I write on this scariest 10/31, I’m thinking of the Berlin Philharmonic’s concert earlier today. The full orchestra was on stage together for the first time in all these months; they had been using smaller ensembles only. More amazingly, the seats were packed with audience members, whereas last week they had been separated by empty seats in between. I was boggled and a bit jealous that they had managed this. Weren’t things a lot worse in Germany too? Then came the announcement at the end of the show telling us that the orchestra’s hall would be closed Nov. 2-30. It was fun while it lasted….

Last time I talked about the epic stupidity of the Great Barrington Declaration.  Then, a couple of days ago, I saw that someone I had long admired and followed, Lynne McTaggart, had endorsed it and was telling people to sign it.  I guess I should have expected that, but I was still in shock.

The reason I should have expected it is that Lynne’s long-term brand is What Doctors Don’t Tell You.  So when Doctors Do Tell You and what they say is actually true, if you have the point of view that doctors are always trying to deceive you, you can’t hear them.

I’m trying to come to terms with this and with the gigantic number of people who STILL, despite the catastrophic spike in COVID-19 cases across the country, refuse to understand that they need to change their behavior if we are ever to get through this.  It’s gotten to where we seem to be unintentionally running the experiment the Great Barrington people were advocating. And it’s not going well.

Something occurred to me this morning: Maybe the deniers and anti-maskers and open-everythingers are unwilling to believe the virus is really so bad because the truth is just too painful and hard to face.* I mean, every day at least once I experience a moment of shock when it hits me again that this is really happening. It’s been like a bad dream all along. Do you have that feeling, too, that you’re going to wake up any minute now, but then you never do?

If someone has that persistent feeling of unreality, and then they are bombarded with messages that the pandemic isn’t real, perhaps they can be forgiven— just a little— for trying to find refuge in the belief that it’s all a hoax, or at least the danger has been overblown, so that there’s no problem with their usual habits. Nothing having a beer with their friends in a crowded bar can’t solve.

Today [10/27] I attended the weekly web update from Dr. David Scrase, the head of the New Mexico Department of Health and Human Services. Dr. Scrase manages to inject some gentle humor into the march of facts, even when the numbers are looking as dire as they have lately, and he always speaks with compassion as well as honesty. I get to these meetings most Tuesdays, and whenever possible I also hang out with a bunch of infectious disease and public health experts on Mondays at a UNM ECHO session. These are good people, doing their best to navigate rough and uncharted seas. They are Doctors Who Do Tell Us— to the extent that anyone knows anything for sure.

I hope HHS won’t mind that I’ve grabbed a couple of today’s slides to show you. This one illustrates the dizzying rise in cases in the past couple of weeks. What I’d like you to look at here is the sharp upward swoop of the purple line, the one that shows cases in people ages 35-64. The green line showing those 18-34 is less dramatic, but it’s pretty substantial. And you can see that cases are also notably up in kids and teens as well. If you’re still thinking that only older people are vulnerable to this disease, well, you are wrong.

In some parts of the country the virus is considered to be out of control, including places like the Dakotas who hardly had it at all for so long. I hope New Mexico’s case counts don’t reach that level. I hope they haven’t already. But getting back to a better situation requires a population that is united in doing all the right things, and we aren’t seeing that.

Now for another denier contention, the idea that if you do get COVID you’ll just get over it and everything will be fine, no big deal. Uh-uh. The following slide makes it clear that long-term symptoms are not just happening to an unlucky few, but are actually very common even in “mild” cases.

Here’s more about the brain damage that can accompany all this unpleasantness:
https://www.reuters.com/article/health-coronavirus-brains-int/covids-cognitive-costs-some-patients-brains-may-age-10-years-idUSKBN27C1RN

Deniers also like to believe that if against all odds they somehow come down with the illness, it will be like the president told them, they’ll get the latest greatest treatments, which are miraculously effective. While I hope every patient will get the best possible treatments at the earliest possible time, the more patients need them at once, the less likely that becomes. The main limiting factor at this point is not so much hospital beds as skilled personnel to staff them. And one of the limitations on health care professionals being available is that some of them are getting COVID themselves.

Dr. Scrase told us that the health care personnel who get sick are usually not getting infected at work, but rather at social gatherings in the community— the same way that most of the laypeople are getting infected. The people who should know better are apparently doing the same dumb things as the rest.

At this point please imagine that I am shaking you and screaming that you don’t need to have a birthday party and invite 50 of your closest friends!

But pretty soon there is going to be a vaccine, you say, and we’re all going to be able to live our lives any way we want to again. Yes, in the next few months there is likely to be at least one vaccine that will be available to at least a few people, most likely front-line health care workers to begin with. That will start to help a little. But as you’ve probably heard, even in a best-case scenario of a very effective vaccine, it’s going to take ages to get shots to everybody who wants them. Not to mention the fact that many people will not want them. No matter how this goes, all that masking and distancing stuff that we hate is likely to be necessary for a very long time.

Now we’re going to look at how good a vaccine has to be in order to be useful, and how we can tell whether a vaccine candidate will meet that standard. What percentage of the time does a vaccine have to work in order to be considered effective? What percentage of the population needs to be vaccinated in order to create herd immunity (which is purely a vaccine-related concept, by the way)? There are formulas that can inform these decisions.

The following article is a month old, and that’s ages in COVID time. I’m including it because it gives a layperson-friendly explanation of how researchers decide whether a vaccine is working and whether it’s ready to be given to the public at large. Pfizer was supposed to have big news about its trial around the end of October, but that hasn’t happened as yet. Whether Pfizer’s effort pans out or not, this clarifies how to think about the process and what it all means.
https://www.propublica.org/article/a-real-vaccine-before-the-election-itd-take-a-miracle

I was surprised to see how few cases these momentous decisions may be based on. Especially with this unprecedentedly rushed research program, it’s hard to feel confident that we’re seeing real effectiveness, and even harder to feel confident about safety. About the same time that I read the ProPublica piece, I came across a September interview of Dr. Paul Offit by Dr. Eric Topol on Medscape, in which he expressed his own doubts. That really caught my eye. Dr. Offit has been a huge cheerleader of vaccines in general, very publicly gung-ho about them. If he is feeling cautious about COVID vaccines, I thought, there must really be something to be cautious about. He expressed some skepticism about both the drug companies’ promises and the politically compromised FDA.

“So you have this difficult-to-characterize, elusive virus that you are now about to meet with a handful of vaccine strategies for which you have no commercial experience,” he said. “I think you can assume that there may be a learning curve here.”

There are so many important points I wanted to quote in this interview that I have to ask you to go and read it for yourself. Honestly, you should. It’s a little unnerving, but it should also leave you with the feeling that there are some reasonable safeguards in place. Since it’s necessary to sign up with the Medscape site to read articles (although it is a free service), for your convenience I’ve parked a copy where you can get it easily:
https://app.box.com/s/rpammbltgrp4fbi9tmon1dzn1p6yhte0
‘Paul Offit’s Biggest Concern About COVID Vaccines’

If you don’t feel like going over to Box to grab that copy, this excerpt will give you some of the main points:

“[Offit:] We have two ways of stopping this virus: One is hygienic measures — face masks, social distancing, hand-washing — and the other is the vaccine. With those two, we will be able to bring this virus under control. But it will take both. What worries me is that if you had to pick which is the stronger of the two, I would go with hygienic measures. I mean, if I wear a mask and stand 6 feet away from you, and you wear a mask and stand 6 feet away from me, the chances that I’m going to get the virus from you or you from me is about zero. You have two things going for you. One, you have a mask, which is going to prohibit the virus’ small droplets from traveling very far. And two, even if I didn’t wear a mask and stand 6 feet away, the odds are also that you wouldn’t get it.

Topol: And by the way, if you do get it, you get a lower dose of virus, which is important.

Offit: That’s right. You might get more mild disease. On the other hand, if we have a vaccine and it’s 75% effective against moderate to severe disease, that means 1 out of every 4 people can still get sick, including very sick. It also means probably a larger percentage than that 25% could get mild infection, or asymptomatic infection, which they could still shed, even to the point of contagiousness. We’ve been asking these trials to look not only at whether they’re protecting against moderate to severe disease, but to what extent they are protecting against shed. I think that is important to know.
But people have such an unrealistic expectation of these vaccines that they see it as the panacea, as the magic bullet to make it all go away. [emphasis mine] If people have unrealistic expectations, such that they think “I’ve gotten the vaccine, I’m good. I don’t need to wear a mask. I don’t need to social distance. I can engage in high-risk activities,” then we’ve lost one of the important arms to bring this virus under control, arguably a more important arm. If, when we bring the vaccine up in terms of users, we move social distancing and masking down, we could end up having a sort of break-even effect.

Topol: Well, you’re bringing up a critical point and that is, the vaccine effect could actually increase the number of people who are asymptomatic carriers. Because they basically have protection from beyond their mucosa. But they still have the virus in their nose and their upper respiratory tract to spread. And that’s why this coupling of continued hygiene— masks, distance, and these other measures — is going to be important all the way through until we get a very dense immunity of the population, right?

Offit: There is a formula for this, actually. If you have a 75% effective vaccine against significant shedding, then you would need to immunize about two thirds of the American population to get the R0 to less than 1, meaning to stop spread, which is what you want.”

It may well be that a vaccine with 50% effectiveness will be the best we can do. It may be that there will be multiple vaccines available, with some being best for people of one age group or health status and others for other categories. Right now we don’t know much, so again I ask that everyone keep an open mind. No knee-jerk reactions, please! Whether you take every shot available or scrupulously avoid vaccinations, at this point you don’t have enough data to weigh risks against benefits. We have to have data, and we have to have clear messaging about it from the people in charge. That might be a tougher challenge than creating a vaccine to begin with.

In other sobering news this week, more evidence came in to show that immunity to COVID-19 does not appear to last very long— another blow against the Great Barrington mindset.
https://www.reuters.com/article/uk-health-coronavirus-britain-antibody-idUSKBN27C005
‘Antibodies against the novel coronavirus declined rapidly in the British population during the summer, a study found on Tuesday, suggesting protection after infection may not be long lasting and raising the prospect of waning immunity in the community.’

But all is not lost. Antibodies are not the entirety of the immune response. And with masking and distancing, those of us who don’t get sick may still be getting small doses of the virus as we go about our business, enough to teach the body how to recognize this pathogen and fight it to at least some degree. There is evidence that people who are exposed in this way tend to get infections that stay asymptomatic. Even if no really robust long-term immunity exists, some memory will develop in their immune systems, and they should be better off than they would be without any exposure. The author likens this to variolation, the strategy used to prevent smallpox before the vaccine was invented. The key would be small doses of the virus, not the uncontrolled onslaught of a big group event with no masks.
https://www.nejm.org/doi/full/10.1056/NEJMp2026913
‘Facial Masking for Covid-19 — Potential for “Variolation” as We Await a Vaccine’

So even if we have an effective vaccine, we’ll still need to do all this other stuff that we’re getting so tired of, and there’s no end to it in the near term. I’m sorry. I would like to be able to give you better news. We just have to keep muddling along as best we can. I implore you not to make the situation any worse! Don’t travel. Don’t get together with a bunch of people indoors, and be careful outdoors. No big Thanksgiving dinner with family from far and near. Wear the damn mask. Just do it. The more effort we make now, the sooner we can be done with all this.

I can’t remember where I saw this:
COMMUNITY
IMMUNITY
I’M UNITY

Unity. Let’s try it.

************************************************************************

* Later I came across this:
 ‘Left to their own devices, people chart their paths based on their personality, how they see the world, and how they relate to risk. According to Geller, many people presented with a barrage of contradictory instructions just grow tired and give up. Others become hypervigilant, their behavior calcifying against new information that might let them ease up and enjoy life a little more. Still others simply choose optimism, no matter how dangerously misguided—such as the belief that “herd immunity” is near, or the assumption that catching the virus will have no long-term consequences for them. “People will gravitate to the positive message because it’s convenient, and it’s not scary, it’s not fearful,” Geller said.’


https://www.theatlantic.com/health/archive/2020/10/pandemic-safety-america/616858/

And still later, an interview update came from Dr. Offit, in which he discusses what may happen with an emergency use authorization, and what distribution of a vaccine may look like:
https://edhub.ama-assn.org/jn-learning/video-player/18555773
He also demolishes the Great Barrington argument:
 ‘So now suddenly herd immunity induced by natural infection has become the plan, right? But the premise is wrong. The premise is that a virus could can affect enough people in the population, that would provide immunity such that that essentially the virus would put itself out of business. That’s never happened. That’s never happened for any virus. So historically there’s no support for it. Secondly, if you had to pick the perfect virus for which it would happen, it would be measles. I mean, measles is 10 times more contagious then this virus and SARS-COVID-2. It has an [inaudible], you know contagiousness index of close to 20, where this is less than two. Two, measles induces lifelong sterilizing immunity. You are protected against all manner of infection, including asymptomatic infection, that’s not going to be this virus. And nonetheless, despite that, before there was a measles vaccine every year there would be about one to two million cases of measles. There would be 50,000 hospitalizations, and there’d be 500 deaths from measles. So there’s no such thing as this Great Barrington declaration. Plus, about 30% to 40% of the population is really at high risk.’


5 Comments

Filed under health and healing, politics, psychology

When We Used to Dance

An eerie interlude with magical music by Kitka.

We will do these things again!

2 Comments

November 1, 2020 · 12:30 am

Sorting Medical Fact from Fiction, Part III: Give Me Liberty AND Give Me Death

Patients have been asking me about “herd mentality,” which they then quickly correct to “herd immunity.” Herd mentality we’ve got plenty of. Herd immunity, not so much. In fact, it’s unclear whether widespread, lasting natural immunity to COVID-19 is even a biological possibility. It may turn out to be only a mirage.

But as the pandemic drags on and we are all getting weary, some of us are worn down enough to entertain some pretty crazy notions– or to take cynical advantage of our weariness.

The Great Barrington Declaration came out on October 4, made a splash, and is still being talked about. This is a letter which calls for letting the virus essentially run wild among the younger and healthier members of the population, in order to bring about a theoretical herd immunity, while in some way protecting those who are at high risk. It’s named for Great Barrington, Massachusetts, where it was written, not because it is actually great in any way.

This declaration amounts to magical thinking. It has irresponsibly injected more confusion into an already uncertain situation. It has made the already impossible jobs of public health workers and health care providers that much harder. And yet, some people have been taken in, even some in my own profession.

Although I wouldn’t usually use Wikipedia as a reference, in this case they have an excellent overview of the document, the responses to it, and the issues involved.
https://en.wikipedia.org/wiki/Great_Barrington_Declaration

If that’s TL;DR, here’s a simpler summary:
https://news.yahoo.com/white-house-backed-great-barrington-142700156.html?guccounter=1

The declaration is such utter balderdash (insert less polite term here) in so many ways that it’s amazing it’s gotten as far as it has. You can read all about the objections to it if you wish. I’ll give you a sketch to save you some time:
— Many younger people are immune-compromised or have conditions like asthma, diabetes or obesity, putting them at higher risk of severe COVID-19. With moderate overweight now added to the list of underlying conditions that matter, it’s been estimated that about 72% of Americans fall into the high-risk category!

— It is unrealistic at best, and likely impossible, to try to separate younger and older people. Even in nursing homes, the staff is largely composed of younger workers, and obviously they must go home to their families and come back. More generally, a great many people live in multigenerational extended families. The latest figures I’ve found, from 2018, put the number at over 20% of the US population, and growing.

— Even if we have sufficient hospital beds to manage out-of-control numbers of cases, we don’t have enough skilled staff to provide care. The avalanche of cases that would be likely to result from the Great Barrington non-strategy would be impossible to care for.

If these points haven’t convinced you, listen to a group of virologists, starting here at about 50 minutes in:

https://www.microbe.tv/twiv/
https://www.youtube.com/watch?v=8IjXzadiNaA&feature=emb_logo

As I write this, New Mexico is reeling from an unprecedented surge in cases, bigger than anything seen last spring at what we thought was the height of the pandemic. Much of the world is in far worse shape than a month ago. No one is sure why this has happened, when only a few short weeks before we seemed well on the way toward beating this thing.

The doctor who was interviewed in the TWiV segment above expressed the theory that having schools open encouraged a premature feeling that everything could go back to normal. He described an 80-year-old woman in his hospital who had caught the virus at her grandson’s birthday party. It was bad enough that 20 kids and their parents got together at all, but then it rained heavily and everyone crowded inside. Without masks.

To the Great Barrington people, that birthday party would have been fine. They wouldn’t have invited Grandma, I suppose, but they would have let the kids and parents infect each other freely. One might wonder what the motivation would be for such shortsighted idiocy. It turns out that the declaration came from a libertarian think tank funded by the Koch brothers. But even if one sympathizes with the libertarian objection to any kind of government control, ending current restrictions makes no practical sense. The longer people go around spreading infection, the longer it will be till the virus is damped down and we can get back to our lives and livelihoods. Which is what libertarians and everyone else would seem to want.

But political philosophies will be moot if it turns out that lasting natural immunity doesn’t happen, and it’s looking like that is the case. Back in the spring, I was thinking more like the libertarians, that it might be ideal to catch a mild case, become immune, and move on. That was before anyone realized the potential for long-term damage— and before we started getting reports of reinfections.

While there are not many known cases so far, there are definitely people who have had COVID-19, recovered, and later been infected with a different strain. We know this because the genomes of various strains have been sequenced, so they can easily be distinguished from each other. Worse, some of the patients became more severely ill the second time, and one died. The previous infection appeared to offer no protection. We don’t know what factors influenced any of this. We aren’t yet sure of the role of innate immunity (not mediated by antibodies). We can’t yet predict how long antibodies to SARS-CoV-2 last. We’re pretty sure it’s not more than a matter of months, though.

This is terrible, vexing news, but it’s not unexpected. The common cold coronaviruses can return to torment us again and again. The same goes for flu. And those are diseases that our bodies already know how to recognize, not a new one that’s hit us out of the blue.

That leaves us in need of a vaccine.

I’m not thrilled to say that, since all vaccines entail some level of risk, and not all are very effective— and a vaccine, even if it’s an especially good one, is not going to solve all our pandemic problems. But I would like to ask you to think clearly about where we are in terms of a potential vaccine and what we are likely to get.

In our current low-trust environment, it’s understandable that a lot of people are leery of accepting a new vaccine that may have God knows what side effects. I don’t want to be among the first to try any kind of medication, myself; I’d rather let some time go by and see if problems crop up. But some people in my profession have been insisting that they aren’t going to take any COVID vaccine, no way no how. Although I’m not gung-ho about vaccines, I don’t see the logic in deciding for or against taking something before one has any information about it. A great many vaccines are in development. They have different characteristics. Some will no doubt prove to be safer than others, and some more effective than others.

More on that next time.

3 Comments

Filed under health and healing, history, politics

Sorting Medical Fact from Fiction, Part II: We Need Therapy

About the time I began writing this, at the annual meeting of our New Mexico Society for Acupuncture and Asian Medicine, we heard a presentation from David Riley, MD about how to write case reports for publication in medical journals. That brought home to me how much goes into each published study that we read and how slow and incremental the scientific process can be.

At the same meeting, one of my senior colleagues went into a passionate rant about how the SARS-CoV-2 virus was engineered as a bioweapon and we are at war, hydroxychloroquine was great, we should all go to Fox News and Newsmax to get The Truth, and most stunning of all, that President Trump was the highest order of doctor because he saved the lives of the people of America by instituting a travel ban.

The rest of us sat there and gazed bemusedly at our Zoom screens. It was deeply disturbing to find one of us, a highly educated and intelligent man of mature years, spouting poisonous bilge like that. In fact, it was almost physically painful.

Then, just a few days later, we got the news that the conspiracizer-in-chief himself had come down with COVID-19. Immediately more conspiracy theories began to fly from both left and right. He was given treatments that sounded reasonable, including an experimental antibody preparation. (I don’t know why they were not adding vitamin C to the vitamin D and zinc.) That is, the treatments sounded reasonable, if we can actually believe what we were being told about them— and we are in the habit of not believing much of anything anymore. The Old Man Who Cried Wolf has trained us that way.

Dexamethasone, a common steroid that is often given in severe cases of COVID, was part of the president’s regimen. Since getting out of the hospital, he’s been even more impulsive, erratic, and incomprehensible, and many observers are assuming he’s still dexamethazoned.

Conspicuously, he was NOT treated with his famously favored hydroxychloroquine. Isn’t that interesting.

I originally started writing this post because there are people I respect, people who are influential writers and teachers, who are still touting hydroxychloroquine and insisting that it is being kept from patients by nefarious forces, just like my colleague. They still believe the persistent myth that HCQ, either by itself or with azithromycin, is a terrific treatment for COVID-19 and can be used for prevention too, but is being suppressed by Big Pharma, the FDA, The Government, etc. in order to market more expensive drugs and/or force everyone to accept a vaccine, take your pick.

Let’s try applying some logic to this. (I know, I know, nobody does that anymore.)

In order for this contention to be valid, first, there would have to BE an expensive and effective drug to market instead, either one already in existence or one being developed. As far as I know there is no such thing. Remdesivir might be what they have in mind, as it has shown itself to be useful and costs over $3000 per course, but it isn’t a “cure” and it doesn’t help with prevention. In fact, it’s still unclear whether it really helps much at all.

“J. Randall Curtis gives remdesivir to his seriously ill coronavirus patients based on statistics, not his own experience. From the bedside, he said, benefits of the drug are undetectable.
“It’s hard when you’re on the front line, knowing whether it makes a difference. People are not jumping out of bed and saying, ‘Thanks, you saved my life,’ ” said Curtis, a doctor at Seattle’s Harborview Medical Center. “We are continuing to use it, because if you look at all the data in total, there probably is some benefit.”

Second, some very inexpensive drugs and substances have come to the forefront. They are still not “cures,” but they are helping quite a lot. Dexamethasone is one. It only helps in advanced cases where a person needs help to breathe, but in those cases dexamethasone and other well-known steroids can damp down the inflammatory reactions that kill people. These are familiar medications, basic medical workhorses with wide applications, being repurposed for the present situation. There’s no new drama to be found in this story— steroids are being used to combat inflammation just like always— and there are no prominent politicians hyping it at rallies, so no one seems to be making up myths about it. Yet it’s one of the more important discoveries that’s been made about treating COVID-19.

A few months ago there was excitement about another cheap and widely available drug, famotidine (Pepcid), because people who had been taking it for heartburn and then got COVID did better than COVID patients who had not been taking it. As far as I know there is still research going on with famotidine, but I couldn’t find any very recent references to studies about it. I did hear that it was given to the president— but he hasn’t even mentioned it.

https://www.healio.com/news/gastroenterology/20200817/famotidine-linked-to-improved-outcomes-in-covid19

https://www.sciencenews.org/article/coronavirus-covid-19-heartburn-medicine-pepcid-does-not-work-antiviral

The concept is that famotidine and other histamine blockers may be able to block the cytokine storms (catastrophically overwhelming immune system reactions) that contribute to deaths from COVID. An intriguing study combined famotidine with the antihistamine cetirizine (Zyrtec):
https://www.sciencedirect.com/science/article/pii/S1094553920301462

Anticoagulants, including the old standby heparin, are important in countering the widespread clotting that often occurs with COVID-19 and can cause strokes and heart attacks. Here is one of many reports about that:
https://www.acc.org/latest-in-cardiology/articles/2020/08/26/12/45/anticoagulants-associated-with-better-survival-lower-risk-of-intubation-in-covid-19-patients

Azithromycin, very often given for sinus infections as a “Z-Pack,” was famously given along with HCQ, and is being studied in other contexts. Since antibiotics in general don’t kill viruses, why is this happening? It seems that azithromycin may actually have a role in fighting certain viral infections.
“Azithromycin is known to have immunomodulating and antiviral properties. In vitro studies have demonstrated the capacity of azithromycin in reducing production of pro-inflammatory cytokines such as IL-8, IL-6, TNF alpha, reduce oxidative stress, and modulate T-helper functions. At the same time there are multiple clinical evidences of the role of azithromycin in acute respiratory distress syndrome and against Middle East Respiratory syndrome (MERS).”

https://www.sciencedirect.com/science/article/pii/S0924857920302235

(Unfortunately, this article adds, “Furthermore, there are some concerns regarding the association of azithromycin and hydroxychloroquine because of potential QT prolongation. In fact, both drugs have this as a potential side effect and evidence regarding the safe use of this combination is controversial.”)

Are any of these drugs being “suppressed”? No. Are right-wing politicians yelling about them? Not that I know of. Maybe they should be, as the public would probably like to know more about them. But they’ve already invented their conspiracy theory, and I guess they don’t need another one.

Not that hydroxychloroquine is useless by any means. I have patients with autoimmune conditions who depend on it. But I also know of someone who died when his employer required him to take it as supposed prevention for COVID. The fact that it isn’t being widely used to combat this pandemic is NOT, I repeat NOT, a sign of a conspiracy to suppress it. It just hasn’t panned out as hoped. Nothing I have found from any credible source has said that it helped a majority of COVID patients. Some, it appeared to make worse. 

You don’t have to take my word for it. Even the most cursory search brings up multiple studies and articles.
https://www.statnews.com/2020/07/16/new-covid-19-study-despite-flaws-adds-to-case-against-hydroxychloroquine/

https://www.washingtonpost.com/business/2020/04/21/anti-malarial-drug-trump-touted-is-linked-higher-rates-death-va-coronavirus-patients-study-says/

https://www.nejm.org/doi/full/10.1056/NEJMoa2019014

https://bgr.com/2020/05/22/coronavirus-drug-hydroxychloroquine-harmfull-side-effects-death-covid-19/

I note that one study that appeared to show benefit from HCQ used it in conjunction with steroids, which may have been the part that actually worked.
https://www.msn.com/en-us/health/health-news/study-finds-hydroxychloroquine-helped-coronavirus-patients-survive-better/ar-BB16hifu

There are still sources I consider very respectable who are recommending hydrochloroquine, such as the following. As far as I can tell, such sources are quoting studies from a number of months ago, which is a lifetime in terms of COVID-19 research. More recent studies are not looking favorable, and those are the ones I’m paying the most attention to.
https://chriswoollamshealthwatch.com/your-illness/general-health/potential-covid-19-treatment-chloroquine/

Has HCQ helped anybody recover from COVID-19? Possibly. People are all biochemically different from each other. A given person might respond to a given treatment that didn’t work for most others. In the search for treatments that help the broadest population of patients, though, HCQ has appeared to be a dead end.

You have to realize that health care professionals, especially those who work in hospitals, have every reason to want effective medications for COVID. They are the ones most directly in the line of fire. If something is seen to work, even the least altruistic doctor one can imagine is going to want to have it available. If hydroxychloroquine, or HCQ plus azithromycin and/or zinc, really knocked down COVID-19 infections, and did it safely, I can’t think of any downside to distributing it everywhere. Who could possibly object? We’d all be a lot closer to resuming our regularly-scheduled lives by now.

It’s reprehensible that this has become a matter of politics. We can’t afford for it to be political.

My impression is that people often think medical authorities or pharma companies have far more information at hand than they really do, and that they must be hiding it from the rest of us. The reality is that we are all figuring this pandemic out as we go along. By the time you read this, there may have been some truly game-changing discovery— one can hope. More likely, we’ll just keep incrementally adding to our understanding. Science is a slow process, one that’s supposed to be careful and rigorous. No one is supposed to make claims before they have solid evidence, and evidence takes time to accumulate. I’ve spent many hours in virtual meetings and webinars with local infectious disease experts and public health workers, and what I see is a bunch of sincere, intelligent people doing their best to make sense of a situation that no one completely understands yet.

There has also been a persistent charge that the authorities must be dishonest because they have changed their recommendations at times. Science, as well as plain common sense, changes our understanding as new information comes in. Holding to the same opinions no matter what facts come along is more like religious belief, and that sort of bullheaded unwillingness to think has no place in a public health crisis, where we must all be willing to adapt to constantly changing knowledge and circumstances.

 

ICAM, vitamin C, and other supplements

What about vitamin C? To the best of my knowledge and googling skills, research on the use of IV vitamin C in hospitalized COVID-19 patients is ongoing and we don’t yet have study results. This summary comes from the Linus Pauling Institute:
https://lpi.oregonstate.edu/COVID19/IV-VitaminC-virus

My colleague Daniel Cobb, DOM wrote this extremely intriguing article which postulates that advanced cases of COVID-19 result in a form of scurvy. The idea is that fighting the virus uses up so much of the body’s store of vitamin C that collagen fibers can’t be replaced, leading to breakdown of tissues in the lungs and blood vessels, with fluid in the lungs and bleeding plus clotting in the vascular system. This can help explain why a patient may appear to be recovering, then suddenly crash.
https://www.faim.org/covid-19-is-really-two-diseases-to-treat-the-second-one-you-have-to-name-it-correctly

If I were hospitalized with COVID-19 or any severe pneumonia or similar illness, I would want to be given IV vitamin C. The evidence looks strong enough to me, and harm looks relatively unlikely.

Vitamin C is a major part of a strategy developed in Florida called ICAM.
https://bgr.com/2020/09/26/coronavirus-cure-icam-protocol-florida/
“ICAM isn’t a new drug, it’s an acronym for a combination of existing medications used simultaneously on patients. It uses Immunosupport drugs (Vitamin C and Zinc), Corticosteroids against inflammation, Anticoagulants against blood clots, and Macrolides to help fight infection.”
“…Norwood-Williams continued, ‘What we found out was that ICAM works as a strategy for super defense for the body. It doesn’t kill coronavirus, but it doesn’t need to. Viruses are self-limiting anyway. They have a very short life cycle. What kills people are the consequences of coronavirus in multiple ways.’”

(Macrolides are a class of antibiotics that includes azithromycin.)

A role has also been suggested for B vitamins in preventing deadly cytokine storms.
https://www.maturitas.org/article/S0378-5122(20)30348-0/fulltext#%20

Of course vitamin D is also important in any problem involving the immune system. It has been shown that low vitamin D levels make people more vulnerable to infection. What hasn’t been shown as yet is that giving vitamin D to a person who is already ill makes a difference. The most important thing we know regarding vitamins is that it’s best to keep your internal shelves well stocked with them at all times.

What should you take away from all that? If you were my patient, I would definitely recommend continuing supplements of C and D as well as a good-quality multivitamin. In general, keep your nutritional status as high as you can, eating a variety of colorful fruits and vegetables, olive oil, nuts, and fish, as tolerated. I would say that under any circumstances, but it’s truer than ever now.

The Linus Pauling Institute has a good summary of general nutrition for immunity too:
https://lpi.oregonstate.edu/COVID19/nutritional-strategies-immune-system

 

Chinese herbs, in China and in the US

It would be easy for us practitioners of herbal medicine to fall into paranoia when thinking about the lack of use of antiviral and other herbs for COVID-19 in the US. Have Chinese herbs been suppressed as a treatment? Well, sort of, because of the way our US regulatory system works. I just don’t think it’s a Nefarious Plot.

Chinese doctors already had experience developing herb formulas to treat SARS in the early 2000s, as well as for epidemics over the centuries. When COVID hit, they had a place to start. They quickly put together herbal strategies that could treat the range of symptoms they were seeing, and the published literature on those looks quite positive. They also ramped up the use of venerable formulas for prevention.

John and Tina Chen at Evergreen Herbs/Lotus Institute have done a great service by translating materials from China about specific herbs and formulas that have been used against COVID. A lot of this is layperson-friendly, and all of it is free to access.
https://www.elotus.org/articles

Herbal pharmacology is a well-established science, and many herbs have been shown to inhibit the reproduction of viruses, prevent them from entering cells, break up thick phlegm, act as anticoagulants, or do other things that are relevant to this disease. John Chen has given webinars that explicated specific mechanisms by which components of herbs can accomplish their actions against coronaviruses, some of which are the same as those of antiviral drugs. It’s fascinating.

I’ve stocked up my clinic’s pharmacy with all the herbs I can get from the Chinese protocols. Since I have not needed to treat any patients with current cases of COVID, thankfully, I haven’t used the formulas for the acute disease, but if I or my family members get sick, we can start treating immediately, and if patients do report symptoms, I can deliver herbs to them. We have been making use of time-honored preventive formulas over the months.

However, in this country, we are not even allowed to say that we can treat COVID with any means outside mainstream medicine. (Note that I am telling you only that certain protocols have been shown to help in China and that certain herbs have been shown objectively to have relevant actions, not claiming that any specific herbs treat or cure the disease.) Colleagues across the country have used herbs successfully against this virus nonetheless. I have yapped as loud as I could about this to any medical person who would listen.

There hasn’t been a big result. Does this mean that They are trying to suppress the use of herbs? Not necessarily. In the US, herbs are regulated more like food and less like drugs; another regulatory category for traditional medicine is clearly needed but has not been created as yet (long story, won’t go into it here). That means that making claims that an herbal product treats a disease is fraught with difficulties.

In China, herbs are prescribed in hospitals, often cooked as water decoctions in the traditional manner. Here there is no way to accomplish that in a hospital. If doctors in American hospitals wanted to give already-prepared herb formulas in pills, I suppose they could, but then there would be no insurance reimbursement, nor pharmacists who knew what to do with those medications. Our system just isn’t set up to use natural substances in hospital settings, or to make them affordable to patients who can’t pay out of pocket. My impression from trying to get the information from China in front of MDs is that they are often very much open to it, but they’re not sure how to make use of it. In practical terms, that means it all falls by the wayside.

In addition, there is some prejudice here about studies done in other countries, very much including China. American regulators and doctors typically want to see evidence from studies done here, or at least done exactly the way they would be done here, whether that makes sense in a given case or not.

I have the most intense hope that medicinal herbs will be employed far more than they have been so far, and that we can tap into the wealth of Asian medical experience to improve our own situation. On a small scale, I’m sure we can. Unfortunately, the same kinds of holes in our healthcare “system” that plague us on other levels make it unlikely that this will happen in a widespread way anytime soon.

Despite all that, we should be making more use of herbs, and I would like to see forces within my own profession advocating more strongly for them. We don’t have a lot of options. MDs complain that we don’t have enough tools in our toolbox, but most of them don’t even know about these important tools that we’ve had for many years.

 

One definite upside to this year of medical horror is that we are being forced to learn so much, knowledge that will help us to cope not only with this pandemic but with the next one and the next.

5 Comments

Filed under health and healing, politics, psychology