Tagged Darwin

Bad Breath

“It’s kind of like people dying in a war after the peace treaty has been signed.” Dr. Sanjay Gupta, CNN, July 14, 2021

“This is like the moment in the horror movie when you think the horror is over and the credits are about to roll. And it all starts back up again.” Rep. Jamie Raskin (D, Maryland), July 22, 2021

“Folks are supposed to have common sense. But it’s time to start blaming the unvaccinated folks, not the regular folks. It’s the unvaccinated folks that are letting us down.” Alabama Gov. Kay Ivey, July 23, 2021

“Political division, disinformation and, frankly, stupidity are costing lives. It is not authoritarian to mandate vaccines in America.” Ian Bremmer, President, Eurasia Group, July 26, 2021

“Sometimes praying isn’t enough. I yell at Jesus if I need to.” Laurie Douglas, COVID-19 care nurse, CNN July 31, 2021

“I wish I could snap so many people out of their selfish stupor but I can’t, so I get to watch instead as people learn the hard way; with a tube down your throat. With a ‘code blue, code blue!’ and the crack of a sternum.” Kathryn Ivey, COVID ICU nurse, August 2, 2021

“We are seeing more and more pediatric patients coming in with COVID-19… I would love everyone to look within themselves and do what is right for their family, for our children, for our community… But if people aren’t going to use common sense, then unfortunately mandates may be important and necessary.”  Dr. Kelechi Iheagwara, Medical Director of the Pediatric ICU, Our Lady of the Lake Children’s Hospital, Baton Rouge, Louisiana, August 14, 2021

 

Dear Students,

I have not written an update since Juneteenth, by far the longest I have gone without writing. I have to say that I have been too discouraged. I realized that I could pretty much compose a new update with quotes from my updates over the whole tragic period since early 2020. I use the word “tragic” advisedly. What is tragedy after all but a catastrophe that was avoidable except for some profound human flaw? Why keep writing about it? Because some students and other readers tell me they trust the way I sift through vast amounts of bewildering information and say clearly what I think.

Since it’s my first update since Juneteenth, I want to start by showing you the chart on the right (from a recent article in Health Affairs; FPL means Federal Poverty Level), which shows more strongly than anything how we as a society have failed African-Americans. It really is astounding. It has been said that a civilized person can look at a page of numbers and weep. This chart should bring tears to your eyes. I wrote on Juneteenth, “2.9 is the odds ratio of blacks vs. whites being hospitalized with COVID-19, and 2.0” is their relative risk of dying.” This chart shows that no matter your insurance status, family income, or type of work, you were far more likely to die during this pandemic if you were black than if you were any other kind of person. This is systemic racism, an extension of slavery and Jim Crow, and it is our failure as a nation.

So what I am going to say about vaccine resistance (different from vaccine “hesitancy”), and opposition to masking pretty much exempts black people—let’s call it the Tuskegee exemption—although the chart  tragically shows they would benefit most from vaccination. (The Rand Corporation conducted a study of vaccine hesitancy in black communities last December.) Also exempt, of course, are the small number of people who have legitimate medical reasons for not being vaccinated.

I am talking about white people who carry placards lying about vaccines and masks. I am talking about white governors who repeat the lies or ban mask mandates. I am talking about TV personalities and social media “influencers” who are leaders in the lying. They are, all of them, not just liars but killers, spreading highly deadly disinformation.

I am tired of people who repeat self-serving lies, and I am tired of people who coddle them, who want to make nice-nice with them and help them come around to abandoning their lies. I don’t have time for such psychotherapy. If it’s someone you love, persuade them if you can. But don’t expect the rest of us to wait and see if your persuasion works.

Here is what I want to say to them:

You have bad breath. You have foul, diseased, deadly breath, both when you are spewing your lies and when you are breathing on me, and my children, and my grandchildren, who have done everything humanly possible to fight off this virus, while you have done everything possible to give aid to the enemy. You are traitors to the United States and to the human race. Soon you will be ostracized by widespread mandates, because coercion is all you understand. You will not be forced to accept a vaccine or wear a mask, you will simply be excluded from places where your obstinacy and stupidity can hurt people who have more common sense and more respect for others than you do.

I say to you: Breathe on each other, not on us. Spit on each other if you like, it amounts to the same thing. Keep your filthy, disgusting, sickening breath and other excretions to yourselves and others like you. Stay away from me and those I love.

Polls show that the great majority of all unvaccinated people state that they will not or probably will not get a vaccine. This is not lack of access, this is opposition. Every minute of every day we use laws, rules, mandates, and other forms of coercion to protect ourselves from human obstinacy and stupidity. We have to stop coddling the obstinate and stupid. We have used a lot of carrots, and they don’t work nearly well enough. We need sticks too.

Mandates (laws, punishment, coercion) have been an integral part of public health for centuries and have saved millions of lives.

This includes, but is not limited to, isolating people arriving in fourteenth-century Florence during the Black Death for 40 days (where our word “quarantine” comes from);  mandatory vaccination against smallpox in 1850s Britain, while some religious leaders inveighed against it as un-Godly; shutting off public water supplies carrying cholera (John Snow, 1854); outlawing spitting in public places in New York in the 1890s, when it was extremely widespread, to stop TB; forced quarantine of Typhoid Mary; mask mandates in the flu pandemic of 1918-20; mandatory childhood vaccinations for pertussis, diphtheria, measles, mumps, rubella, polio, etc. or you don’t go to school; mandatory meningitis vaccination or you don’t go to college; closing of bathhouses in the HIV epidemic; arresting and jailing people who deliberately spread HIV; severe restriction of smoking in public places and punitive taxation of tobacco products; infant car seats, seat belts, shoulder belts, and airbags; and cracking down hard on drunk driving.

All these coercions (“sticks”) and many more have stood up to legal, ethical, and historical scrutiny and have saved countless millions of lives. More and more institutions, governments, businesses, and schools will soon be mandating proof of vaccination and masking as the price of admission. You don’t want to do that, fine, you’re free to show me your back. And if you don’t, I’ll be free to call the police to keep you off my premises. And rest assured I will. In the end you will have to take your bad breath somewhere else.

On September 5, 2020, I wrote, “TETRIS [Testing, Tracing, and Isolation] is dead. So is the CDC. And the FDA. And 188,000 Americans.” (What a paltry number that seems now. If only we hadn’t insisted on more than tripling—and soon perhaps quadrupling—it.) I had high hopes for the new government in Washington. But a successful spring vaccination campaign had petered out by summer and, though daily jabs are rising again, they will not suffice.

On May 9th I wrote, “The country has fought the virus to a standstill on a hill some feared we couldn’t hold, and we fought it down the hill. If we can fight it down further off the high plateau, we might just win the war. As always of course, this involves not just vaccinations but other precautions, especially those against swapping air. But the situation in India is heart-breakingly bad and worsening by the day.”

Around that time, the CDC announced that vaccinated people could be unmasked indoors. They unraveled a year of education only to reverse themselves in July. While not as disastrous as last year’s CDC, this one is sending mixed messages that cost lives. If they had just looked at India and the U.K. in May, they would have known better than to ease up on masking.

But this is America. We don’t learn from other countries. So we now have the highest number of new cases in the world.

On the July 4th weekend, our new president took the opportunity to pretty much declare our independence from the virus. How very premature that was. As the second chart shows, we were just getting into the fourth, possibly worst wave.

As for the FDA, it’s also not dead, but some experts I trust say it’s moving far too slowly on full approval of vaccines that have been given to scores of millions of people with minimal safety concerns. The American Academy of Pediatrics has said the same about emergency use approval for children under 12.

If this is not an emergency, I don’t know what would be.

Bad News

  1. The Delta variant—which is so different that I’m inclined to call it “The Delta Virus,” although that’s technically wrong—now accounts for well over 90% of US cases. It is much more contagious than earlier strains (each infected person infects 5-10 others, as opposed to 1-2), makes people sicker, is easily contracted by vaccinated people (although it rarely sends them to the hospital or kills them), and affects young people, including children, more than earlier strains did. It will result in millions of cases of long COVID, which will burden our nation’s health for years, maybe decades, to come. As of today, Delta is the story.
  2. In states with low vaccination rates (and some have killer governors), Delta is overwhelming hospital systems. Georgia is one of the worst states. Children’s wards are filling up fast, and many children are very sick. Nurses are quitting, citing “compassion fatigue.” Don’t have a heart attack, an auto accident, or appendicitis in these states right now. There’s a likelihood that no one will be there for you. On January 5th, when there were a mere 350,000 American COVID deaths, I wrote about overwhelmed health care workers, “We will kick them until they are dead.” This seemed hyperbolic, but we did kill many, some by their own hand. We are about to do it again.
  3. No children are vaccinated, and children are getting COVID-19 in unprecedented numbers, around 100,000 in the past week (that we know of). Of these, roughly 1-2,000 will be hospitalized, and some 300 will die. An unknown number, somewhere between 2,000 and 20,000, will experience long COVID. As Dr. Daniel Griffin said in his latest podcast, if no adults got the virus we would consider this an extremely serious childhood illness. But many people still think it doesn’t affect children all that much because it affects adults more. Schools are opening across the land. CDC Director Wilensky keeps saying, “We know how to protect our children.” Sure, and if you gave each school a couple of million dollars they could implement the protections. Unless of course your governor forbids you to do that. Closures for quarantine are already occurring. And yes, I do get that children need to be in school; but I also get that their health needs protecting.
  4. This virus is evolving. Delta is not the last new variant we will see. Read my “interviews” with the virus (here and here) to learn more about “Sarsie’s” ongoing quest to follow the steps laid out by his Uncle Charlie Darwin, in order to advance his species in its struggle against ours. And heed the warning of Dr. Andrew Pekosz of Johns Hopkins University, which I quoted last time: by have a large unvaccinated population side by side with the vaccinated, we allow the virus to go back and forth and evolve new strains to overcome vaccine protection. It’s essentially the same way Pekosz creates—evolves—new strains of viruses in his laboratory. And of course, the world at large is mostly unvaccinated. We have imported new, increasingly contagious and/or virulent strains of SARS-CoV2 from several other countries, and we will continue to do so until we vaccinate the world.

Good News

  1. Daily vaccination rates are going up again, although they are still a small fraction of the numbers we saw in April and May. Still, we are slowly chipping away at the numbers of unvaccinated people, at least the minority of them who had access problems or who were persuadable. Slightly more than half of Americans are now fully vaccinated. The FDA says it may give full approval (as opposed to Emergency Use Approval) to some vaccines in September.
  2. There are plenty of vaccine supplies for our country, so in the not too distant future a third booster dose will be available. We already approved the third dose for immunocompromised people (around 3% of Americans), and Israel, Germany, and some other countries are already offering it to all older people. This will protect us as vaccine immunity inevitably wanes, on an unknown timetable.
  3. Monoclonal antibodies save many lives if administered to outpatients in the first ten days or so of an infection, although they are much less effective in hospitalized patients. They have kept many thousands of people out of the hospital. If you or a loved one has been exposed and is showing symptoms of COVID-19, get a test, and if you test positive, call your doctor or go to an emergency room to inquire about this treatment right away.
  4. Here is the best news of all, but be wary of it because it is a speculative projection. The Delta wave could go away as fast as it surged. This has happened in India and the UK, two extremely different countries in everything from vaccination to sanitation. Nobody knows why, but it is just possible that the same will happen here. Right now, though, we are very much in the rising portion of the surge, and that means rising cases, hospitalizations, and deaths, including children. Don’t become a statistic, or turn your loved ones into statistics, while we are waiting and hoping for the surge to peak. And remember Uncle Charlie Darwin; the virus has more tricks to play on us after the Delta surge is over.

We have vaccines. Many people refuse them, and masks as well. They have a deadly movement. They are not just ignorant, they combine ignorance with arrogance. They deny they have COVID while they are in the ICU dying of it, and while endangering the people taking care of them. After a year and a half, if some of those brilliant, brave caregivers walk off the wards and don’t come back, you won’t see them getting blame from me.

As for anti-vaxxers and anti-maskers: Keep your foul breath to yourself in your own dirty places. Blow it on your friends and relatives if they will stand for it. But keep away from decent Americans who care about our country and each other.

As  for the rest of us, rewind last year’s horror movie. We are watching it—no, we are in it—again.

Stay safe, and keep your loved ones safe. I will see some of you soon.

Dr. K

Juneteenth. 605,000. 2.9x. 2.0x.

            “All we have to do is look at the situation in India and Nepal…and in the United Kingdom, where variants of COVID-19 have become the dominant virus in those populations—in the UK despite a somewhat successful vaccination campaign. And those variants have different properties that increase the ability of this virus to spread and…eventually cause disease in the population. Anytime we give the virus a chance to get to know its host better, to get to see immunity against it, the natural selection principles laid out by Charles Darwin suggest that variants that are more fit will emerge. And, particularly in the US, we can’t look past that, because we really have sort of a dual population, we have the unvaccinated and the vaccinated, in many places the unvaccinated are larger than the vaccinated populations, and that just sets up a situation where the virus can see immunity, can go into people who don’t have immunity, and that back and forth is essentially how my laboratory selects variants when we’re studying them. So we’re setting up that scenario within the population, and that’s not a good thing for us to be doing.”

Dr. Andrew Pekosz, Johns Hopkins Bloomberg School of Public Health, June 11, 2021

 

Dear Students,

Being in a meditative mood, I want to reflect back as well as forward on this particular day, but being who I am my reflections start with numbers. It is said that a civilized person is one who can look at a page of numbers and weep. I don’t know how civilized I am, but these four numbers become a little blurry when I dwell on them.

Juneteenth, of course, is short for June 19th, the day in 1865 when the last black slaves in Texas were told of their freedom. Today is the 156th commemoration of that day, but the first 155 were unofficial. Now Juneteenth is a national holiday.

The holiday was declared by President Biden just a few days ago, perhaps on the same day that the total number of deaths in our country crossed the milestone of 600,000. It’s hardly something I wanted to be right about, but on December 15th I wrote an update called “Double Down or Double Deaths.” We had just crossed 300,000, and vaccinations had begun, but masks and social distancing were as important as ever, and the vaccine syringe was a shiny object I feared would distract us from these vital preventive measures, which we should have been doubling down on. We did not double down, so we doubled deaths.

George Floyd statue unveiled in Newark, NJ

2.9x is the odds ratio of blacks vs. whites being hospitalized with COVID-19, and 2.0x is their relative risk of dying. Some 89,000 African-Americans have died of it, and it’s a good bet that every one of them said, or if they couldn’t speak, thought, “I can’t breathe,” while dying—just as George Floyd did when he was being murdered by a policeman on a Minneapolis street.

So Juneteenth is well worth commemorating today and on all future June 19ths, but I am not sure how much celebration is in order. Those slaves in Galveston heard about their freedom, but the senses in which they were freed were limited. They were delivered into poverty, landlessness, wage slavery, fake and reversible “Reconstruction,” a century of Jim Crow with its countless lynchings, then a limited process of integration, reversible Voting Rights and Civil Rights laws, police brutality, and essentially permanent gaps in wealth, income, housing, education, imprisonment, and of course health—meaning life.

The same state of Texas they were supposedly freed into in 1865 is taking away their freedom—their voting rights—actively and aggressively, on this first official Juneteenth holiday. The same US Congress that passed the Voting Rights and Civil Rights Acts of the 1960s is, today, aggressively blocking legislation that would protect those laws from being dismantled by Texas and dozens of other states.

So as we celebrate this first Juneteenth National Holiday, white power elites are taking freedom away from blacks—to the cheers of their poor white dupes of course—as they have always done. They are preventing schools from teaching the truth as it actually happened, exactly in the spirit of Holocaust Denial, and with similar consequences. They are building and protecting the New Jim Crow, with state legislators, governors, police, and prison wardens taking the place of the Ku Klux Klan. They are redrawing red lines in housing, jobs, education, and health care delivery that generations have struggled to erase.

Do we think that a federal court system stuffed with young conservative appointees, crowned with a 6-3 hard-right Supreme Court like a rancid cherry on top is going to prevent these nationwide trends? Please. Do we think that with all these new forms of voter suppression the Democrats will keep their paper-thin margin in the Congress a year-and-a-half from now, and the White House two years later? I will let that question hang, and turn to more urgent matters that I personally know more about.

We are about to see the Southeastern Region, including my own state of Georgia, become the new experimental cauldron of differential death. The disparity between the races is much greater down here, in everything, even while the percentage of African-Americans is much higher. Oh, and the vaccination rates? The lowest in the country. The situation is ripe for a new variant of concern to cause a new surge, and as always a new chance for blacks to be sickened and killed more than whites.

Is there such a variant? Yes.

The variants now have Greek letter names to avoid stigmatizing countries or forcing us to memorize long strings of numbers. The original variant first seen in Wuhan (FSI-W) is the baseline. The first evolved variant of concern (FSI-UK) is now called Alpha, which because of greater transmissability caused grave problems in Britain in the winter. Beta (FSI-South Africa) is able to overcome a number of vaccines to a concerning extent. Gamma (FSI-Brazil) spread very fast there, has unexplained properties, and has been seen in many US states.

But the most concerning so far is Delta (FSI-India), far more transmissible than Alpha, which was far more transmissible than the baseline virus. It already predominates in the UK and is spreading fast in the US, especially among children and other unvaccinated people. Vaccine experts seem confident that they will be able to come up with solutions to present and future variants, sooner or later—for the vaccinated, currently a fraction of the world.

Good News

  1. New York, California, and many other states are opening up, pretty much completely. Air travel is huge again, and restaurants are humming. Some states and countries have vaccination rates that justify these comebacks.
  2. Continental Europe’s vaccination program has finally gotten traction and looks like it will continue to accelerate for a while. Israel led the world in vaccination success, the UK was not far behind, and Canada has caught up to them.
  3. India, while still very burdened, has seen a decline in cases in recent weeks that suggests that strict lockdowns in April and May worked (the full vaccination rate is 4%).
  4. Monoclonal antibody studies have continued to bring very good news. If you are offered them after testing positive, with or without symptoms, do not say no.
  5. Novovax has added a new vaccine to our armamentarium. It is based on a more conventional technology than mRNA, tried-and-true for several others, and it seems to have fewer unpleasant effects even after the second dose.

Bad News

  1. The relatively high vaccination rate in the US hides marked regional variation. The Southeastern and some other traditionally Republican states have low vaccination rates and are accordingly vulnerable. The politicization of our national response to the virus has been and will be absurd and deadly.
  2. Biden’s vaccination program accelerated from 1 to 3.5 million a day in his first 100 days, but then plummeted to less than a million and is now almost sure to fall short of his target of getting 70% of Americans vaccinated by the Fourth of July.
  3. India is projected to have a third surge in a few months time, and there is little sign that vaccination rates will go up enough to prevent this.
  4. Japan has decided to proceed with the Summer Olympics, already postponed from last year. The vaccination rate is about 5 percent and not likely to increase to adequate levels by the time of the games. Preventive measures will be used, but the majority of the country does not want the games to go on.
  5. The UK was slated to open up completely on June 21st, but the Delta variant is spreading so fast there that Prime Minister Johnson has postponed opening until July 19th, a decision met by widespread protests.

My friend, poet Marilyn Mohr, shared a poem with me recently that captures the message and the anguish of the virus. It reads in part:

Carried on the moisture of our breath,

it contains us in loneliness, cages us in fear.

We cannot sing or touch, even our smiles are masked.

Of course we want to reopen, reconnect, celebrate. We are starting to be able to do that. But we for now we need to keep looking over our shoulders. Please take to heart the exquisite clarity of Dr. Andrew Pekosz’s explanation of our situation and how the disease works. Please remember that the virus is always changing, and that some of us are more vulnerable than others.

Now that Juneteenth is a national holiday, it would be nice to have a period of national reflection between it and July 4th. In a sense July 4th is meaningless without Juneteenth, which was one halting step (among many, with many more needed) toward realizing the promise of our Declaration of Independence.

Jews have a period of self-examination and penitence for ten days from the New Year to the Day of Atonement. Juneteenth to July 4th could be a more celebratory period, but the self-examination could be equally useful.

See you in the fall I hope. Stay safe,

Dr. K

PS: Please don’t just rely on me. Dr. Michael Osterholm’s now biweekly podcast from CIDRAP, the Center for Infectious Disease Research and Policy of the University of Minnesota drops on alternate Thursdays. He combines realistic assessments and warnings with uplifting stories about how people are finding light and small victories in the pandemic. The best resource on what is happening specifically in the state of Georgia is Dr. Amber Schmidtke’s Covid Digest, now weekly. More generally, I recommend the following: This The Bill & Melinda Gates Foundation COVID-19 Update, aka The Optimist; for the science of viruses, especially the new coronavirus, This Week in Virology (TWiV) podcast, including Dr. Daniel Griffin’s superb clinical updates from the front lines. Dr. Sanjay Gupta’s podcast, Coronavirus: Fact vs. Fiction; COVID-19 UpToDate for medical professionals; and for the current numbers: Johns Hopkins University (JHU); Institute for Health Metrics and Evaluation (IHME); Our World in Data (OWiD); The New York Times Coronavirus Resource Center (NYT). For uncannily accurate warnings, follow @Laurie_Garrett on Twitter. I also recommend this COVID-19 Forecast Hub, which aggregates the data from dozens of mathematical models, and this integrative model based on machine learning. For an antidote to my gloom, check out the updates of Dr. Lucy McBride, who doesn’t see different facts but accentuates the positive.  

Sarsie Rides Again

            “We are not driving this tiger, we are riding it… We are the one country in the world that’s opening up faster than ice melting in a sauna. It’s crazy… Vaccine’s coming. But it isn’t coming fast enough. It’s not. We’re not going to see a big expansion of vaccine availability for at least weeks yet. We will. Eventually we will. And I think this summer is going to be a really wonderful time that way. But we’re a ways off. B.1.1.7 is here, those numbers are beginning to rise, and I feel like it’s a déja-vu-all-over-again moment.” Michael Osterholm podcast, March 23, 2021  

            “When I first started at CDC about two months ago I made a promise to you: I would tell you the truth even if it was not the news we wanted to hear. Now is one of those times when I have to share the truth, and I have to hope and trust you will listen. I’m going to pause here, I’m going to lose the script, and I’m going to reflect on the recurring feeling I have of impending doom. We have so much to look forward to, so much promise and potential of where we are and so much reason for hope, but right now I’m scared.” Rochelle Walensky, CDC Director, March 29, 2021

            “I’m telling you right now…we are just beginning this surge, and denying it is not going to help us. We are walking into the mouth of this virus monster as if somehow we don’t know it’s here. And it is here. Now’s the time to do all the things we must do to slow down transmission, not open up, and we’ve got to get more vaccine out to more people.” Michael Osterholm on CNN, April 1, 2021

            “We’re not driving this tiger, remember, we’re riding it  … No other country in the world is loosening everything up—pretending the virus doesn’t exist any more. Nobody’s doing that… We are creating the perfect storm. We’ve got a bad, bad virus. We’ve got a lot of people yet who can still be infected despite the fact that vaccines are rising. And we’re opening up as if we’re done with the virus. It’s like dismissing gravity. ‘I don’t want to deal with gravity any more today. I’m done with it.’ It doesn’t work that way.” Michael Osterholm podcast, April 1, 2021

Dear Students,

Some of you may remember my exclusive interview with the SARS-CoV-2 virus (“Sarsie”), way back in early June. He talked a lot about his relationship with Uncle Charlie—who he said was advising him on how to evolve. I didn’t think Darwin would do that deliberately, but Sarsie clearly obeys the old man’s laws.

Actually, he wasn’t interested in being interviewed.

“Professor, shut up and press the record button. I don’t need your questions. I can talk to the students directly, and anyway they’re bored stiff with your doom and gloom. I’ll give it to them, like the new Prez says, straight from the shoulder. Okay, I don’t have a shoulder. Straight from the spike then.

“When I spoke to you back in June I was gearing up, had notched a few wins on the evolutionary scene, and was getting ready for my real triumphs. This column is the half-time show in my superspreader superbowl.

“What’s that? You don’t like the half-time show idea? How about top of the fifth inning? Okay, bottom of the fifth. The home team, your species, is scoring some runs with vaccines. In June they were barely a wisp of a hope. Nine months later, they’ve been born, quadruplets, and they’re starting to grow up.

“I know, you think it’s the seventh-inning stretch at least, or even the end-game. You think you’re about to start hitting them out of the park. Dream on. I’m looking at half the game ahead, not counting overtime. And I’m so confident, I’m about to give you my playbook. Only fair. Homo dumbellus needs a handicap.

“Let’s review the basics as Uncle Charlie set them out: Variation, adaptation, duplication, reproductive success. If you remember two words, make them the last two. You don’t even need the words, really, if you can’t spare the space in your Homo dumbellus brain. Just the letters.

      “RS.

      “It’s Darwin’s own version of Newton’s Law of Gravity. If Variant B reproduces faster than Variant A did, B rocks. If Variant C does even better, it’s Bye-Bye Baby B. And so on. Insanely simple. Not like the rocket science you need to escape gravity. Even a dumbellus can understand Uncle Charlie’s law. Heck, even a virus can.

      “In June I reviewed my early life. Years in the bat-cave spinning my wheels, then a variant that let me jump to you. Nice shot, but more of a bunt than a home run. Then a variant that let me jump from you to you, and I took off like, well, a bat out of Wuhan.

“Mutation, mutation, mutation. I love those little bloopers. Most do nothing. Some knock off the adventurous virus that blooped them. But every once in a while, and don’t forget I’m reproducing zillions of times a day—that’s an approximation—I get one of those happy typos that makes my day, week, month, or year.

“Mutation. Variation. Variants. Variants of Concern.

“My first big VoC after my breakout from Wuhan was one you didn’t even know about at the time. It was the D614G. Let me clue you in how to read that gobbledygook. The spike protein is a string of amino acids (aa’s), and this means a change in the 614th one from aspartate to glycine. Just a blooper in duplication.

“Now that wasn’t so painful was it?

“The explanation wasn’t, but the reality was. It made me much more infectious. G614 outcompeted D614 by binding better to the ACE2 receptor that folds me into your cells. I had greater fitness; that is, greater RS.

“Remember Italy and Spain in early 2020? Wildfire there, then all Europe, then New York—the Big Apple. With D614G I gave my regards to Broadway, and after that the world. Wuhan was just a memory. By June, when I last spoke to you, my darling G614 had swept the globe.

“Big spring surge, then a rest, a bigger summer surge, and after a little vacation in early fall, you took a deep breath and I got set for my giant winter surge. It went well for me. How did it go for you? Oh yeah, I remember. Homo dumbellus. Thick skulls, stupid habits, stupid leaders.

“Wow, did I take off in January. The graph itself looked like a rocket ship.

“But I didn’t rest on my laurels. Uncle Charlie wouldn’t have liked that, and I always want him to be proud of me. Turns out there were plenty of dumbelluses in England, so I fixed my fitness lens on Trafalgar Square. You know. The UK variant. B.1.1.7.

“If I squinted, I could see old Charlie nodding in his photo. He must have also liked that you started naming strains according to their evolutionary history. Couldn’t very well have named it according to one mutation. It had 23! 23 differences from the Wuhan original.

“Eight were in the spike protein, and three of those are a big deal: N501Y, (a blooper changing asparagine to tyrosine), P681H (proline to histidine), and two aa deletions at positions 69-70. The tyrosine at 501 made my spikes even better at binding ACE2, my key to your cell’s locks. The other two changes probably helped me fold myself through your cell membranes.

“You can see why I thought I saw Charlie swell with pride. I was mixin’ & matchin’! I was upping my game several ways at the same time. God I love evolution. My UK variant soon proved up to 70 percent more infectious, and the Brits, who had gotten D614G from their Southern European cousins, returned the favor as a Christmas present, sending the new B.1.1.7 back to Europe and now the world.

“Let’s take a break from the gobbledygook and note that this variant is the one you dumbelluses need to worry about right now. It’s dominant in Europe and soon will be in the US and much of the world; the only thing that will contain it other than vaccines, which work but are not moving fast enough to beat it, will be other souped-up versions of me that hold it to a standoff.

“By the way, the B.1.1.7 is also more lethal. Don’t think for a minute that I like that. Billions of my bros go into a hole in the ground every time they kill one of you—if you were still infectious when you died. Heck, what happens as soon as one of you stops breathing? No breathing, no aerosols, no RS.

“That’s why I evolved to be less virulent—less lethal—than my cousins MERS and SARS-1. I out-evolved them to put it mildly. Dumb as your species is, it gives me no pleasure to kill you. I want infections with few or no symptoms, especially in young people, whose restlessness and appetites whisk me around the world.

“Speaking of which, the world is welcoming me in more variants than one. The South African one, B.1.351, also has the N501Y blooper, but in combination with other changes in my recipe—K417T (lysine to threonine) and E484K (glutamate to lysine)—that make me resistant to your vaccines, even if Africans can get them. Africa is to me a vast unconquered world, an evolutionary opening of collossal proportions.

“Then of course Brazil, where the so-called leaders are as bad as yours, and they’re welcoming me to a banquet. My P.1 variant has 17 unique bloopers, including three that affect our binding to your receptors: K417T, E484K, and N501Y. The P.1 came out of the Amazon—famous for its diverse life forms, including me—and swept the country. But you don’t think my boys are going to stop at the Brazilian border, do you?

“E484K, aka the “Eeek” mutant, may be my jiu-jitsu trick to duck your immune systems and even vaccines. You can bet I’m going to make good use of the Eeek in the future. I’ve already popped up with it in Oregon independently, meaning—Uncle Charlie rocks—parallel evolution. If I can evolve that one pretty much anywhere, and it does turn out to nix your vaccines, well, Katie bar the door.

“Meanwhile, there’s a new New York variant, the B.1.526, which affects young people more, and a new two-form California variant, the B.1.427/B.1.429, with three spike protein mutations, including the novel L452R (leucine to arginine), that make it more contagious.

“Understand: most of your species hasn’t seen any version of me yet. I’m just getting started with them. See what I mean about half time? Bottom of the fifth? I still have to get to the majority of the species, and I will keep spreading faster than vaccines. I will also keep evolving. So you Americans beat the versions you have with the vaccines you have. But wait, you already have the Eeek!

“And something else: Do you think the bottom half of the world won’t be sending evolved versions of me back to you next year? The year after?

“Eventually you’ll fight me to a standoff with evolving vaccines. The smartest strains of your dumbellus species—the scientists—move fast enough to do that. But eradicate me? Forget it. Boosters for waning immunity, annual shots like my bro the flu, we can make a deal.

“A guy like me has a career trajectory. I could evolve toward even less virulence, become more like the common cold than the flu. Just bubbling up, year after year, not much damage but spreading just fine, bubbling and bubbling forever.

“So now you have my playbook and my retirement plan. We’ll get along eventually—after the pandemic game, my species against yours, is over. Which it isn’t even close to being yet. Like the man said, don’t dismiss Newton’s Laws, or Darwin’s. If it’s the bottom of the fifth, you, the home team, are up. Are you going to continue to let me strike you out? Or do you finally hit one out of the park?”

Maybe I should ask Sarsie to say what he really thinks.

He claims he doesn’t like to kill us, but he’s killed 550,000 of us in a year. We’re losing over a thousand a day and that is not declining; cases and hospitalizations are rising, and deaths will rise too.

It’s a fierce evolutionary process that can do that for one, two, three, and soon four American surges. Some biologists say that viruses aren’t really alive. Sarsie said last time, rather annoyed, “I’m alive and I’m eating you alive.”

Either way, his biological evolution has been amazing; cultural evolution is supposed to be faster, but our cultural evolution in response to him continues to lag way behind.

Stay safe,

Dr. K

PS: Please don’t just rely on me. The most important addition I have since my last update is Dr. Michael Osterholm’s weekly podcast from CIDRAP, the Center for Infectious Disease Research and Policy of the University of Minnesota; it drops on Thursdays. He combines realistic assessments and warnings with uplifting stories about how people are finding light and small victories in the pandemic. The best resource on what is happening specifically in the state of Georgia is Dr. Amber Schmidtke’s Daily Digest. More generally, I recommend the following: The Bill & Melinda Gates Foundation COVID-19 Update, aka The Optimist; for the science of viruses, especially the new coronavirus, This Week in Virology (TWiV) podcast; Dr. Sanjay Gupta’s podcast, Coronavirus: Fact vs. Fiction; COVID-19 UpToDate for medical professionals; and for the current numbers: Johns Hopkins University (JHU); Institute for Health Metrics and Evaluation (IHME); Our World in Data (OWiD); The New York Times Coronavirus Resource Center (NYT). For uncannily accurate warnings, follow @Laurie_Garrett on Twitter. I also recommend this COVID-19 Forecast Hub, which aggregates the data from dozens of mathematical models, and this integrative model based on machine learning. For an antidote to my gloom, check out the updates of Dr. Lucy McBride, who doesn’t see different facts but accentuates the positive.

 

 

Arms Race

      “Please hear me clearly: at this level of cases with variants spreading, we stand to completely lose the hard-earned ground we have gained. Now is not the time to relax.” Dr. Rochelle Walensky, CDC Director, CNN, March 2, 2021

      “Dr. Walensky is right, and the reason she’s right is while things are way better than they were about a month and a half ago the level of infection in the country right now is the same as at the peak of the summer surge, so we’re not in great shape. And we have variants, and variants are starting to take over, and if they become dominant and we relax restrictions I think we can absolutely see a huge spike that will really lead to a lot more suffering… We have a high level of infection, we’ve got states easing restrictions, which they should not be doing at this moment, and we’ve got the variants that are circulating that are a lot more infectious. Put all that together and I can’t help but worry about where we’re going to be for the next couple months.” Dr. Ashish Jha, epidemiologist, Dean of the School of Public Health, Brown University, CNN, March 2, 2021

      “I have to congratulate this administration for what they have done…with the vaccines… But we also have to tell the story of what is still ahead of us. And at 2.9 to 3 million doses of vaccine a day, over the next 6 to 14 weeks, when this surge is likely to happen, is not really likely to take care of the problem at all… We still have a lot of high-risk people out there, and when this surge comes, they’re going to be highly vulnerable… The other thing we see right now is that every governor wants to open schools… and as a grandfather of five children I get it. But the problem is that if you look at Europe, the challenge we’re seeing right now is a lot of transmission in schools with this new variant… So we’re going to have some tough days ahead in the older population and the younger population with this new variant virus.” Dr. Michael Osterholm, Director, Center for Infectious Disease Research and Policy, University of Minnesota, on Meet the Press, March 7, 2021

      “The pandemic still remains a very serious situation.” Dr. Rochelle Walensky, Monday, March 8, 2021, Politico.

Dear Students,

The US reportedly delivered 2.9 million vaccines into arms yesterday, far ahead of what Joe Biden initially promised and almost at the 3 million per day minimum that experts have recommended. However, the UK variant (B.1.1.1) is rapidly becoming the fastest spreading strain in the US, destined to account for at least 50 percent of new cases in Americans in the next few weeks. In Britain and Europe, this has been the threshold for new and very serious burdens on health care systems.

Right now, we Americans are feeling good. The holiday surge is over, and cases, hospitalizations, and deaths have come down an astounding 70 percent since their winter peaks. However, this is primarily the result of the mess we made by our behavior on the holidays. When we’ve been banging our head against the wall harder and harder, there is only so much credit we can take for feeling better when we stop.

But now cases and hospitalizations are plateauing at levels higher than the summer peak when the virus swept the south and west and the national surges scared the living daylights out of us. We are stabilizing at that way-high level—a convenient platform for the virus to take off in a new surge—and, right on cue, we are starting to bang our heads against the wall again, with premature openings and ending mask mandates in some states and lazy complacency in many others.

These foolhardy blunders can easily take us from the high plateau we are on into a fourth wave that will once again cause scores of thousands of needless deaths.

As the photo suggests, we are in an arms race between evolutionary changes in the spike protein—the virus’s arm for prying open our cells—and the human arms getting jabbed in the vaccination campaign. The virus is flooring its Darwinian gas pedal with new variants of concern (VoCs) in South Africa and Brazil, yes, but also New York and Oregon.

Our university is among those that have seen surges in student cases—in Emory’s case an unprecedented outbreak after a year of safe performance—due to Superbowl parties, fraternity and sorority pledging, and other activities the virus loves. So many opportunities to evolve! Now spring break is coming for many colleges, and—well, here we go again.

Good news

  1. The Johnson & Johnson single-dose vaccine was given its expected Emergency Use Authorization, putting it on a par legally with the mRNA vaccines. The J&J is an adenovirus carrying viral DNA and is stable for weeks at refrigerator temperatures, a tremendous boon for rollout—as is the fact that you only need one jab. It is substantially less effective than the mRNAs at preventing cases (72 vs. ~95 percent), but, like them, close to 100 percent effective at preventing severe cases and death. Initial rollout has been slow but will ramp up fast.
  2. Not vaccines, but other preventive measures (masks, social distancing, handwashing), along with the pass-through of the holiday surge, have brought cases and hospitalizations down more than 70 percent. Nursing homes, where the most vulnerable have lived and died of COVID all along, have declined even more—in their case largely due to priority vaccinations.
  3. Total vaccinations, mainly with mRNA vaccines, have been deployed more and more effectively, with 450 vaccination centers and thousands of volunteers across the country. We are almost at 3 million a day, and if we can keep that up or, preferably, increase it, we have a chance of flattening the curve of the fourth wave. If we keep up masking and other preventive measures, we have a chance to avoid it altogether and by the end of the year bend the current high plateau way down—if the vaccines provide long-term immunity and the new variants can’t evade them.
  4. Herd immunity through widespread vaccination—up to 85 percent is needed—can be achieved and life can return to something close to normal, with tremendous positive implications for the treatment of non-COVID illnesses, education, jobs, and mental health. Healing from this dreadful national trauma will be under way.
  5. Dr. Peter Hotez has lauded the vaccine rollout in India as having the potential to save the world from the virus—even while reminding us that the US will never be safe from it until it is controlled (not necessarily eliminated) worldwide.
  6. The CDC finally came out with guidelines for people who have been fully vaccinated. They can be indoors with small numbers of fully vaccinated people without masks, or with well-known low-risk people from one other household. They should not go to gatherings, eat indoors at restaurants, and the like.

Bad News

  1. Variants of Concern now include the UK/B.1.1.7 (mutation N501Y), which spreads 50 percent faster and is sweeping the US but is susceptible to existing vaccines; the South Africa/B.1.351(N501Y+K417N+E484K), which spreads faster and is less susceptible to vaccines; the Brazil/P.1 (N501Y+K417T+E484K), same; the new New York variant/B.1.526 (S477N+E484K), same; and the Oregon variant/B.1.1.7 (N501Y+E484K), same.
  2. Lets put this bad news in English. For each of these codes, the number in the middle represents the consecutuve position of the relevant mutation on the viral spike protein. The before and after capital letters represent the one-letter code for amino acids. Thus N501Y means the amino acid in position 501 has changed from arginine to tyrosine due to an underlying mutation (replication error) in the RNA triplet that specifies 501. Since 501 is in the binding domain of the spike protein, the mutation can and does make it easier for the virus to bind with and enter cells—thus increased transmissibility.
  3. The two mutations at position 417 (K→N →or K→T) as well as the change at 477 (S→N) also affect the spike binding domain. All can enhance transmissibility and all are popping up independently in different places. Also, these Variants of Concern involve amino acid substitutions that change the shape of the folded spike protein at least a little, and are therefore able to enter our cells or resist our antibodies more easily.
  4. Most concerning to scientists appears to be the E484K mutant, (glutamic acid → lysine at position 484). This mutant, present in 5 of the 6 new strains named above, makes it easier for the virus to evade our antibodies, thus undermining both natural and vaccinated immunity. Its nickname is the “Eek” mutation, and yes, it is that scary.
  5. Mutations occur constantly, and some of them are adaptive, so the virus evolves. To paraphrase an old song, it’s a mighty restless bug in a mighty restless land. Scientists have a huge deal of trouble figuring out which of the many mutations are silent, and which, like the ones above, matter for humans. On top of that, the mutations operate synergistically, for better or worse, when they appear in the same strain.
  6. Since we still do a woefully low amount of viral sequencing, and overall testing and tracing are low and/or declining, we are fighting the new variants in the dark without a flashlight. Our friends in vaccine manufacture and development start scrambling to invent booster shots for new variants as soon as they appear, but it’s a race against time, vaccine development vs. viral evolution.
  7. There have been disappointments on the clinical side this past week. Convalescent plasma in a metaanalysis was shown to have no benefit on any standard outcome measures. Fortunately, it is being replaced with monoclonal antibodies that work better if introduced early in the illness. Dexamethasone (a steroid) increases mortality if given early in the illness but remains confirmed as effective in advanced stages. The IL-6 inhibitor tocilicumab helps if given after dexamesthasone but is harmful if given without dexamethasone. Something similar is true of other IL-6 inhibitors.
  8. Standard views about children being less likely to be infected than adults may be due to testing bias, so they may be equally vulnerable. It still seems true that they don’t get as sick, but a new study finds that as high as 13 percent of children who are infected will suffer from long COVID. Dr. Daniel Griffin, who gives the clinical updates on the This Week in Virology podcast, calls this “a disaster.” Long COVID goes up by age to peak in the age period 35-49; overall it affects at least one in five people who get infected with COVID-19.

States are opening prematurely. Governor Abbott of Texas, still reeling from accusations that his negligence caused scores of death in the recent snowstorm, has decided to cause thousands more excess deaths from COVID by boldly opening Texas “100 percent.” The governors of Mississippi, Arizona, and other states are doing the same.

This failure of leadership is a step by step repeat of the mistakes that led to last summer’s and then this winter’s surge, needlessly killing hundreds of thousands of Americans, and it will have similar consequences.

Such stupidity in leadership acts synergistically, like the evolving viral mutations, with the stupidity of ordinary Americans. If you have missed it, take a look at the photo on the left. It shows the good citizens of Boise, Idaho, ceremoniously burning masks outside the state Capitol. As with all ceremonies, this one expresses deeply held beliefs, and the adults are passing their beliefs on to their children with the ceremony.

As playwright Arthur Miller said, “The paranoia of stupidity is always the worst, since its fear of destruction by intelligence is reasonable.” These neighbors of ours have bad ideas, which they probably sense cannot hold up in the face of better ones, and since they are attached to their bad ideas, the possible loss of them makes them afraid.

Yet what can we do in the face of such stupidity except continue to meet it with the best intelligence we have? Meanwhile, as always, the stupidity of our fellow citizens, including leaders, puts us all at risk. Eek.

Stay safe. It won’t be too much longer, provided we aren’t stupid enough stretch it out again.

Dr. K

PS: Please don’t rely just on me. The best resource on what is happening specifically in the state of Georgia is Dr. Amber Schmidtke’s Daily Digest. More generally, I recommend the following: The Bill & Melinda Gates Foundation COVID-19 Update, aka The Optimist; for the science of viruses, especially the new coronavirus, This Week in Virology (TWiV) podcast; Dr. Sanjay Gupta’s podcast, Coronavirus: Fact vs. Fiction; COVID-19 UpToDate for medical professionals; and for the current numbers: Johns Hopkins University (JHU); Institute for Health Metrics and Evaluation (IHME); Our World in Data (OWiD); The New York Times Coronavirus Resource Center (NYT). For uncannily accurate warnings, follow @Laurie_Garrett on Twitter. I also recommend this COVID-19 Forecast Hub, which aggregates the data from dozens of mathematical models, and this integrative model based on machine learning. For an antidote to my gloom, check out the updates of Dr. Lucy McBride, who doesn’t see different facts but accentuates the positive.

 

 

 

New Sheriff, New Bad Guys

      “We shall fight on the beaches, we shall fight on the landing grounds, we shall fight in the fields and in the streets, we shall fight in the hills; we shall never surrender.” Prime Minister Winston Churchill, House of Commons, June 4, 1940

     “C’mon man, gimme a break!” President Joe Biden, January 21, 2021, answering a reporter who asked if a million vaccinations a day was enough

Dear Students,

Don’t get me wrong. I love Joe Biden. I supported him when most of my family and friends supported Elizabeth Warren—who by the way was the smartest person running for president, and had policy views most similar to mine—or Bernie, or others. Also, I didn’t think anyone as old as me should be president again. Yet I supported Biden because I was fairly sure that he had the best chance of winning, and because I was completely sure that he is an exceptionally good man. Although I did not say this to many people, I thought that he might be a great president.

Also, he is off to a good start. The new sheriff is laying down the law—on racism, LGBTQ rights, economic rescue, environmental protection, masking, social distancing, and vaccinations. But as far as the virus goes, he does not get a break from me, and no, it is not nearly enough.

Dr. Peter Hotez, a distinguished physician-virologist who is probably the most knowledgeable person about the pandemic after Dr. Fauci—but who can speak more freely than Fauci even now—wrote an op-ed piece in the Washington Post on January 26th in which he described the new variants of the virus as a “looming catastrophe” that will bring us to 600,000 deaths by May. We need to deliver 500 million doses of vaccines—into Americans’ arms—to end community transmission. Do we want to wait 500 days? By that time the new variants will have run all over us. We need to do it by summer. Which is why Dr. Hotez is calling for 3 million vaccinations a day.

This means that we need more than two vaccines; a vast and rapid (warp-speed?) expansion of vaccination centers beyond those already planned; unprecedented invocation of the Defense Production Act; imaginative use of the armed forces, even beyond the National Guard; and innovative use of syringes and other equipment to minimize vaccine waste. A good account of the current vaccine development situation in terms of science is here, but we need more than science, we need wartime logistics.

We also need a new level of seriousness about masks, social distancing, and handwashing. If we don’t ramp up our use of these measures, we will surely face more lockdowns, with all the associated economic, social, family, educational, and psychological pain.

If you have studied with me, you recognize that we are in an evolutionary arms race with this virus. All infectious agents adapt and evolve. They evade our defenses—both vaccines and treatments. That’s why after almost four decades we don’t have a vaccine against HIV, which evolves even within one person. That’s why we need a new flu vaccine every year. That’s why every year, thousands die of TB and malaria because they are infected by strains that resist all known treatments.

If we don’t (culturally) adapt and evolve in the face of this new virus—or should I say these new viruses?—we will lose, and as always, black, brown, and Native American people will lose most. We will not win this arms race, this by far most deadly of all our wars, by asking for “a break.” We will only win by fighting the virus every hour of every day, in every place, in every way.

Good News

  1. The new sheriff is really, really different from the old one. His deputies can shoot straight and they know how to round up bad guys—bad viruses. The heads of the CDC, FDA, HHS and many other agencies responsible for fighting disease are superb people, not third-raters and sycophants like their predecessors; they are already speaking directly and frequently to the American people, without fear of censorship for delivering scientific truth. For the first time there is a national plan, and it is a fairly good plan. With it, we are building a shield against the virus that we never had before.
  2. There has been a significant decline in the past couple of weeks in the number of US cases and hospitalizations but not yet deaths, probably related to the end of the big holiday surge.
  3. The Pfizer and Moderna mRNA vaccines are working safely, and pretty soon a few million Americans will have approximately 95 percent protection (two weeks or so after their second dose). Preliminary data suggest that protection levels could be even higher in the community than they were in clinical trials.
  4. The Janssen/Johnson & Johnson (J&J) vaccine will likely be approved (like the first two) for emergency use in the U.S., within a couple of weeks. Despite being less protective than its predecessors, it is more effective than the seasonal flu vaccine and easily passes the threshold of 50 percent protection set by health authorities. It hides the DNA—the gene—of a SARS-CoV-2 spike protein inside the Trojan horse of a cold virus disabled from reproducing. It has tremendous advantages: first, it only requires one shot; second, it does not require any specialized freezing or cooling equipment (DNA being much more stable than mRNA). These advantages will make it literally a lifesaver in rural America and in the developing world.
  5. The Oxford/AstraZeneca vaccine, despite some stumbles in the Phase III trials, is being used in the UK and was just approved by the European Union. It requires two doses but no special freezers, and will probably be added to the US vaccine arsenal in April. It is similar in principle to the J&J but uses a non-reproducing chimp adenovirus (instead of a human one) as the Trojan horse. The DNA is stable at higher temperatures, but it is still being worked out what the ideal doses would be.
  6. A monoclonal antibody drug (bamlanivimab, Eli Lilly) has shown 80 percent effectiveness in preventing infection in a randomized controlled trial in nursing home patients, and even greater effectiveness against deaths. This would have been tremendously important a few months ago, before we had vaccines, but now that we do, it’s not clear how the antibodies will be used—especially since they may interfere with vaccine effects.

Bad News

  1. The big bad news, and it is really bad, is that the virus has evolved new variants—new bad guys that will make the new sheriff’s job much harder. Of course, it has been evolving all along. A new paper, “Emergence of a Highly Fit SARS-CoV-2 Variant,” traces the first big leap the virus took last spring. As you know, “highly fit” in this context means spreading faster for more reproductive success. That first mutation was a single base change known as D614G that emerged in Southern Europe and by June was the dominant strain in the world.
  2. Viral evolution continued. In December a new “variant of concern” (B.1.1.7) was found in Southern England that contained multiple mutations and was determined to spread much faster and cause more severe disease. The mutations make it easier for a spike protein on the virus to combine with ACE2 receptors on human cells to gain entry. Hospitalizations doubled in the UK as the new variant became dominant there. More replication, more fitness, more dominance. It has been found in several US states and is predicted to be the dominant strain here by March. Fortunately, it does not evade already existing vaccines.
  3. A new South African variant (B.1.351) with different mutations of the spike protein—one of the mutations is on the presenting tip of the spike protein—is spreading rapidly and may soon threaten my old friends in Botswana. Two cases were found in South Carolina. Dr. Brannon Traxler, Interim Public Health director for the state, announced that they are independent of each other and have no travel history. She added cogently, “We know that viruses mutate to live and live to mutate.” Another independent case was found in Maryland. Given that we only sequence half of one percent of the virus samples taken in this country, it may already be everywhere. Like the English variant, it is more contagious and produces more severe cases, but unlike the English one, it also appears to be less responsive to existing vaccines.
  4. A new Brazilian variant (P.1) is worrying scientists. It is spreading explosively there and has been found in Minnesota. It may infect people who have had the disease before. It may or may not turn out to be implicated in the newly announced tragic COVID-19 deaths of nine children in the remote Amazonian villages of the indigenous Yanomami.
  5. There is no chance that one million vaccinations a day in the United States will stay ahead of the coming invasion of these new viral variants. The best, if not the only chance, is a great intensification of other preventive measures, the same that have been recommended all along. Unfortunately the behavioral trends seem to be going in the opposite direction.

On “Meet the Press” yesterday, top epidemiologist Michael Osterholm said, “The surge that is likely to occur with this new variant from England, is going to happen in the next 6 to 14 weeks. And if we see that happen—which my 45 years in the trenches tell us we will—we are going to see something like we have not seen yet in this country… Imagine where we are, Chuck, right now. You and I are sitting on this beach where it’s seventy degrees, perfectly blue skies, gentle breeze, but I see that hurricane, Category 5 or higher, 450 miles offshore. And telling people to evacuate on that nice blue-sky day is going to be hard. But I can also tell you that hurricane’s coming.”

Dr. Nahib Bhadelia of Boston University’s School of Medicine, asked to comment on Osterholm’s metaphor, said we are in  “the eye of the storm,” not sitting on the beach with the storm hundreds of miles out. She means that the worst part of the storm so far—December and January—is deceptively slacking off. As the hurricane moves over us, the lull of the eye passes, and we get slammed with another monstrous storm surge in March and April.

Dr. Osterholm went on to say that we need “an audible”—American-footballese for a last-minute yell on the field that changes the plan. He thinks we need to get as many people as possible vaccinated once right now, and forget about the second dose until later. There is controversy about this, but Osterholm is really smart.

Recall what Dr. Traxler, South Carolina surgeon-turned-health official, said when she became the first American to announce the South African strain: “We know that viruses mutate to live and live to mutate.” She continued, ““That’s why it’s critical that we all continue to do our part by taking small actions that make a big difference. These include wearing our masks, staying at least six feet apart from others, avoiding large crowds, washing our hands, getting tested often, and when we can, getting vaccinated. These are the best tools for preventing the spread of the virus, no matter the strain.”

On December 15th, when I posted “Double Down or Double Deaths,” we had just crossed 300,000, but we were having the first vaccinations and hope was in the air. I said we could go to 600,000 if we don’t change our behavior. The IHME model now projects 582 thousand by May , 600 thousand taking the new variants into account. That’s the doubling. Considering we’re at 440,000 today, it’s not a stretch.  Depending on what we do and what the variants do, we could be anywhere between 600 and 2,400 daily deaths in May. The difference would be the equivalent of two 9-11’s every two days. And of course May will not be the end.

The new shield we got on January 20th is not nearly big enough or thick enough. And the new variants teach us that unless we think about protecting the developing world, protecting the whole world, which is the virus’s continuous playground, our shield will be full of holes.

Are you tired of the precautions? I am too. I want to hug my children and grandchildren so bad it hurts (and I don’t care that it’s ungrammatical). I want to see live theater. I want to eat out with my wife in any sort of restaurant, even McDonalds. I want to smile at people and see them smile back. I am tired of restricting myself for the benefit of myself, my community, and my country. I am, to use an  expression my mother might use, bone-tired. But I am not yet dead-tired. I will be dead-tired if and when the virus kills me.

And oh, by the way. In case you get to whisper in President Biden’s ear, give him this message from me: Mr. President, Sir, with all due respect, the next time a reporter asks you if a million vaccines a day is enough, do what you always said you would do: Level with us. Don’t say, ‘Gimme a break man.’ Say, ‘No, it’s not enough. We need three million a day at least, and  I promise you I will not rest until we have that. We are at war. We will fight this virus in the clinics and in the stadiums, we will fight in the pharmacies and supermarkets, we will fight on street corners and parking lots, we will fight in convention centers and on fair grounds, we will fight in the poor dense cities and in the bucolic countryside, we will fight with syringes and tests and masks and distancing; we will never surrender.’

Stay safe,

Dr. K

Double Down or Double Deaths

            “I feel great. I feel hopeful today, relieved — I hope this marks the beginning to the end of a very painful time in our history.”

            —Sandra Lindsay, Director of Critical Care Nursing at Long Island Jewish Medical Center, after becoming the first person in New York, possibly in the U.S., to be vaccinated against COVID-19, December 14, 2020

             “It was truly, truly a humbling moment to be able to do that… So, this is the light at the end of the tunnel, and we truly have to be patient in order to make this work we have to make sure that we continue on to follow the guidelines —socially distancing, wearing our mask, washing our hands, and not having large gatherings—following those guidelines along with the vaccine, we can defeat this. This is something that is giving us that huge light at the end of the tunnel. It’s still a long tunnel but again, it’s up to us to do our part to assist in stopping this pandemic. So with those things in place along with the vaccine, it’s a good prognosis for the future… Let science speak for itself.”

       —Dr. Michelle Chester, DNP, director of employee health services at Northwell Health, who injected Ms. Lindsay with the vaccine, interviewed on CNN December 15, 2020

            “This disease is real, it is serious and it is deadly. Wear the mask, socially distance, if not for yourself then for others who may lose a loved one to the disease.”

—Kim Miller of Carbondale, Illinois, in the obituary she wrote for her husband Scott

Dear Students,

Two milestones for our country yesterday: the first people outside of research trials to get a COVID-19 vaccine were inoculated; and we crossed the threshhold of 300,000 deaths from the virus, by far the most of any country in the world. The vaccine will eventually be everywhere, but that death toll is only in America.

The first photo shows Sandra Lindsay (quoted above) being vaccinated by Dr. Michelle Chester (also quoted above) and the second shows Ms. Lindsay applauding as she gets her bandaid. She was one of the very first and possibly the first person in the U.S. to receive any COVID-19 vaccine outside a research trial.

People are understandably excited about the vaccine. For a few days it seemed that all I saw when I turned on the news was freezer trucks leaving Pfizer vaccine factories and distribution centers. You would think they were carrying the secret of life, and in a way they were, for those few who will be vaccinated soon. By next week at this time, trucks will be rolling out with a second very effective mRNA vaccine, from Moderna.

But I couldn’t help think of a different kind of refrigerator truck, the portable morgues that are being brought in to hospitals and coroners’ offices all over the country—and not for the first time—to store the overflow of bodies of people killed by COVID-19. Hundreds of hospitals are at full capacity for those still alive, and a third of U.S. hospitals are almost out of ICU space.

Doctors agree that death rates will go up as health care workers are overwhelmed—they, not ICU beds, are the ultimate bottleneck of care—over the next two to three months. Remember that the small number of front-line heroes being vaccinated this week will not have full immunity until the third week of January. Even according to the Trump administration, always bragging about solving the problem, projects 20 million people will be vaccinated in December, and another 20-25 million in January. That’s the first dose; 3-4 weeks later, the second dose, and then a week more for full immunity.

There are 350 million people in the U.S. We add roughly 200,000 cases and more than 2000 deaths a day, with deaths lagging by about 3 weeks. You do the math. Vaccines will have no impact on the next 60 days’ deaths (adding 120,000) and little impact in the next 60 after that. Community spread will continue up to and beyond April 1st, when deaths are projected to pass 500,000, or 600,000 with relaxation of mandates.

But you know of course what can slow the spread right now, today? Masking, social distancing, avoiding gatherings, and proper hand washing. What are the chances that enough Americans will take these simple measures during the holiday season? Close to zero, even though they would save scores of thousands.

In the past nine months, Americans have chosen the worst kind of “social Darwinism” which is contrary to Darwin’s own beliefs. We have chosen to allow the virus to kill off certain groups of people we evidently consider expendable: the old, the sick, the obese, and people whose skin is not white. And now we are cheering and celebrating the deployment of vaccines that will not make a significant dent in community spread for months, and will not stop the U.S. epidemic until we have doubled the number of deaths.

The choice is clear, as it has been all along, except now we have the worst two months of the pandemic right in front of us. We can either double down on precautions or double down on deaths. Remember that young people will be among those killed. And a much larger number of people young today will live out their lives getting reminded every day of the permanent damage the virus did to their bodies.

Celebrate the vaccines, sure, but bear in mind that they will not make a real dent for a long time. Other preventive measures will make a great difference now.

Enjoy the holidays safely, so we can truly have a blowout celebration next year. I’ll see you in January, unfortunately still on Zoom.

Stay safe,

Dr. K

 

Between the Lightning and the Thunder

Dear Students,

As you know, when you see the sky light up because of a bolt of lightning, it takes a few seconds before you hear the thunder, because of the difference between the speed of light and the speed of sound. The lag varies, and the loudness of the thunder varies.

That’s my metaphor for today, the day after the sacred American holiday of Juneteenth, the day the last large group of African-Americans were freed from slavery in 1865. It’s also the day that 19,000 people are converging on an indoor space in Tulsa, Oklahoma, currently experiencing a rise of COVID-19 cases. About 90 percent of them will not be wearing masks, and almost none of them will be six feet away from the nearest person. One million people competed for the privilege of being one of those 19,000. Interviews show that as they enter the arena they are not worried. At this hour (5pm Saturday) the arena is already packed with early arrivals.

If you can’t guess my hypothesis about their level of risk, you haven’t been paying attention to anything I’ve said since January.

But, it’s a hypothesis. When I see lightning, I listen for thunder, but I don’t always hear it. Sometimes it’s too faint. Also, my hearing is not that great any more.

So the lightning might be crowds—including crowds of left-wing protesters—and the thunder might be cases of viral illness. You might recall that there was a huge difference in the size of the 1918 flu epidemic in Philadelphia compared to St. Louis. The difference was directly attributable to a big parade in Philadelphia at the wrong moment, while there was no such parade in St. Louis. Parade: lightning; huge spike in cases only in Philadelphia: thunder.

But you might also remember that the count of cases does not impress me as the right outcome measure. That is because the number of tests strongly influences the number of cases. There are ways of correcting for that, but major state and national leaders continue to say that the rise in cases in some states is due to better testing, period.

Consequently, I am not going to write today about the number of cases; instead, I am going to wait for a much better measure: the number of hospitalizations, and then, the number of deaths. So I am going to use the metaphor differently: spike in cases: lightning; spike in hospitalizations and deaths: thunder.

I don’t know for sure that today’s party in Tulsa will even result in lightning; it will take a couple of weeks to see a spike in cases there, and leaders in Oklahoma and Washington will say that it’s because so many people at the party got tested. So that would for me just be the lightning. A spike in hospitalizations and deaths two to four weeks after that would be the thunder. We would be in August.

There is my kind of lightning—rapidly rising cases—in Arizona, Texas, and Florida. In two weeks we might see my kind of thunder begin to roll. We will see. Science takes patience. I am not wanting to be insensitive. I am recognizing that half the country and half its leadership do not expect that thunder.

You might also remember that in 1918, Philadelphia carpenters could not make coffins fast enough. Maybe St. Louis sent some carpenters there.

So while we wait to see if Tulsa needs carpenters, I’ll make this update about nuts and bolts: 5 vaccines, 5 treatments. Most are good news.

5 Vaccines

There are at least 130 to 140 vaccines in development around the world. The 5 I’m going to mention are the ones already chosen by Operation Warp Speed, a Federal government program to fast-track development and prepare for mass production (hundreds of millions of doses; the world will need up to 7 billion) if one or more  of these works. It is not clear what criteria were used to choose those 5, but it is likely that the name “Warp Speed” will increase the number of vaccine refusers. Fast and good don’t always go together.

Two of the 5 are messenger RNA vaccines, which deliver coronavirus mRNA into our cells, where they make surface spike proteins that can raise a specific immune response to the viral envelope. No mRNA vaccine has been approved for use in any disease, although some are in clinical trials for other diseases. Three of the 5 are viral vector vaccines, which use a partly disabled different virus to deliver coronavirus genes into cells, to make the surface proteins that provoke the immune response. This principle has yielded an effective vaccine for Ebola and an ineffective one for HIV.

Interestingly, none of the 5 Warp-Speed candidates is a weakened or killed whole-virus vaccine (polio, chickenpox, measles, mumps, etc.); a protein-based vaccine (HPV/cervical cancer); a recombinant vaccine, such as genetically engineered yeast that produces viral proteins in our bodies (shingles, hepatitis B); or a DNA vaccine, in which coronavirus genes are introduced into our cells (none such approved for human use).

In other words, three proven principles were not chosen for Operation Warp Speed.

  1. Moderna (mRNA): Press release said it worked in 8 people, stock price skyrocketed, then crashed on expert skepticism. Phase III (large) clinical trials to begin in July if all’s well. No similar vaccine approved for anything in humans.
  2. BioNTech/Pfizer/Fosun (mRNA): Clinical trials under way; perhaps a few million doses available for emergency use in the fall if all’s well. No similar vaccine approved for anything in humans.
  3. AstraZeneca/U. of Oxford (viral vector is a chimp adenovirus): Phase II/III testing starting in England and Brazil. Could have emergency doses by October; has the manufacturing capacity to produce 2 billion doses eventually. The general principle has worked in Ebola.
  4. Johnson&Johnson/Beth Israel-Harvard (vector is a monkey adenovirus): Phase I/II safety trials begin late July. The general principle has worked in Ebola.
  5. Merck/IAVI (vector is a stomatitis virus): Merck actually used this method to make their successful Ebola vaccine. Clinical studies on corona expected to start this year.

Bad news: No knowledgeable person thinks it’s likely we will have a vaccine widely deployed before 2021 at the soonest, although a few think it’s possible.

Good news: Never before in human history has so much money, effort, and scientific talent been thrown at developing a vaccine for one disease.

5 Treatments

  1. This past week, the tried and true (and cheap) anti-inflammatory drug dexamethasone was announced in a press release to reduce COVID-19 death rate in very sick patients. No peer-reviewed publication, no data available for other scientists to examine. But, as doctors joke, dexamethasone works for everything (it’s sort of cortisol x 20), so why not this?
  2. Remdesivir, an antiviral originally developed for Ebola, may or may not have significant benefits, but it’s approved for compassionate use.
  3. Convalescent plasma, which contains anti-COVID-19 antibodies from people who fought off the virus, has been proved safe in a Mayo Clinic study of 20,000 hospitalized patients, and may be effective in reducing mortality, perhaps especially if given earlier rather than later.
  4. In a very disappointing, even scandalous outcome, peer-reviewed papers published in two top medical journals proved flawed and had to be retracted. Not only can’t we rely on press releases, we may not be able to rely on top journals. Also, maybe, hydroxychloroquine isn’t dangerous in this disease, just (probably) ineffective.
  5. Triple antiviral therapy combined with immune-boosting interferon beta was more effective than the same with one of the antivirals omitted, suggesting that as with HIV we will more likely succeed with combination therapy than one magic bullet. None of the three was remdesivir. Boy, do we have a lot to learn.

Experts are more optimistic about an effective combination therapy sooner than a vaccine. But don’t forget, Sarsie-2 is consulting his Uncle Charlie Darwin every few hours about how  best to evolve and adapt.

As I write, at 7pm Saturday, a crowd of unmasked thousands packed into an arena in Tulsa is waiting for their President to deliver a campaign speech. Fortunately for those people, the arena is not full.

You may know that the President was persuaded to move his rally there from Juneteenth to June 20th in response to outrage from Americans of all ethnic groups who understand the symbolic meaning of Juneteenth. You may or may not know that the rally is being held a stone’s throw from the place in Tulsa where the greatest mass murder, an attempted genocide really, against African-Americans, just 99 years ago.

Remember, if your country refuses to stay safe, you can still protect yourself and your loved ones. Use your mind. Use your brain.

Dr. K

“I, Corona”: My Exclusive Interview with the Little Guy Who’s Changing the World

Dear Students,

I have a special treat for you today, an exclusive interview with SARS-CoV-2, his first ever, on his life and times so far. I was able to arrange this through my special friend Charles Darwin, whom Sarsie—his preferred nickname—likes to call Uncle Charlie. Sarsie doesn’t think he’ll be confused with his older brother, SARS-CoV-1, whom he calls “pathetic,” nor does he think highly of his cousin MERS. “I mean, really, a few months in one or a few places, and then, poof! they’re pretty much gone.” He has a certain grudging admiration for cold viruses.

            But I’ll let him tell you in his own words. By the way, he insists on he/him/his, because as he puts it, “I don’t have the equipment to reproduce, so I gotta beg, borrow, or steal it from someone who does. I just put in my genes, and they do the rest. Also, let’s face it, a guy like me, who puts ambition above everything…I mean, I’m most likely gonna be male, right? Yep. My whole species, and my brothers and cousins too.”

            He asked me to call this column “I, Corona,” as an hommage to Isaac Asimov’s science fiction classic, I, Robot. “I didn’t like his three ethical laws, of course, but when he got to the part about robots that secretly run the world, I could definitely wrap my envelope around that. But why keep it a secret? Just take the world over and run it, I say.”

            What follows is a lightly edited version of our interview, with my questions removed. Not that there were many. He doesn’t let a human get a word in edgewise. So I listened and learned.

            “Yep. I’m on the move for sure. My bros and cousins were well meaning, all princes in their way—and we’ve got more princes than the Saudi Royal family—but I’m the Crown Prince (get it? Corona? Crown?) and I will be King.

            “By the way, this whole debate about am I alive? Am I alive? Are you kidding me? I’m alive and I’m eating you alive.

            “But back to the family. We’ve only been around a hundred thousand years, less than you even, but then again, we reproduce in 48 hours, you take 20 years. Do the math. Ex. Po. Nen. Shl. As Uncle Charlie would say, we can sure do some evolving.

            “The family divides up the spoils, but we’re not all equally successful. Some of the corona cousins specialized in farm critters. It’s a dirty job but somebody’s gotta do it. Let’s be honest, though, you’re not goin’ down in history for makin’ a chicken cough or givin’ a pig a belly ache. Then there’s the bunch I call the Corona Sniffles, they’ve done alright for themselves actually, they got around, they hang around, they evolve, they come back. No drama, mama, but Uncle Charlie would be proud.

            “SARS-1 did alright for himself but he just couldn’t get transmissable enough, and on top of that he only jumped from Jim to Jane, or from Zhang Wei to Mei Ling, after he gave Jim or Zhang symptoms. Jane and Mei knew to keep their distance. So my Sarsie-1 bro hit Guandong Province in China, got to Toronto somehow, and got locked in with quarantine. 8,000 cases, 800 deaths, a little economic slump, that was about it. One wave in 2003, so far done and done.

            “Cousin MERS was a killer though, too much for his own good. You kill a guy, he ain’t passin’ you on. Also Cousin MERS was never good at jumping from one of you sorry humans to the next. Probably more of you have gotten him from camels than each other. He broke out in Saudi in ’12, trickled around to 27 countries since, 2,500 cases, 800-some-odd deaths, well controlled by even your bumbling species, nothing to write home about.

            “You can see where I’m goin’ with this. I’ve done more in eight months than the rest of them put together. I’m the Crown Corona Prince by acclamation. I mean, let’s look at the facts. Okay, I was trapped in bats for I don’t know how long. I was bummed. Do you have any idea what a bat cave smells like? But I took a deep breath—the kind I make impossible for you—and channeled Uncle Charlie. He counseled patience: “Be like a Buddha Virus, bide your time, mutation and evolution will do the rest.

            “Boy, did they ever. You helped, by bulldozing forests and setting the bats I was riding free. My hosts got snared, sold, and eaten, and I was on my way. Okay: I’d evolved my way from bats to humans, but would I be like my cuz MERS, get stuck in a bat-to-human trap like he did (mostly) with his camel-to-human song-and-dance? No way. Or would I maybe take a leaf from my bro Sarsie-1’s book and only jump from Jim to Jane when Jim was already sick and Jane could avoid him like, well, the plague? Nope again.

            “I did everything by Uncle Charlie’s playbook, evolve, wait, mutate, evolve. Jump from bats to you folks (Whoopie!): Check. Jump from Zhang Wei to Mei Ling: Check. Now, jump from Zhang to Mei before Zhang gets sick—three days, a week, two weeks: Check. Now, don’t even make Zhang sick at all, ever. Or Mei Ling. True, a cough or a sneeze will spread me yards in droplets and aerosols. But if Zhang and Mei are rehearsing in the same chorus for a couple of hours, or even sitting at different tables at a restaurant with the right air circulation system, that’ll work fine for me. If they exchange looks and fall in love and do a Chinese version of French kissing, I’m golden.

            “But think about it: I can’t win big in Uncle Charlie’s sweepstakes by staying in one corner of Wuhan. So here’s where your species really starts to help me. Homo sapiens? Homo dumbellus is more like it. That young doc in Wuhan who tried to blow the whistle on me last year, right at the start? Whew, that was a close call. That could have ended me maybe, but thankfully his bosses shut him up fast. They even made him apologize for making me up! That was a great moment in my career, gave me just window I needed to zip around Wuhan.

            “He was some kind of hero. Poor guy got sick from one of the patients he tried to help, and I killed him. Wasn’t trying, you know, but there it is. He gave his life to tell the truth and save your species from mine. Not fair, but that’s how Uncle Charlie’s law swings. Or, you might say, how the fortune cookie crumbles. Sorry, couldn’t resist; but I spent enough time in China to know fortune cookies don’t crumble there, only in America.

            “Speaking of which, I was getting folks to carry me out of Wuhan to all over, even while the Chinese did a 180 and started to shut me down. They had the right government and the right science and the right culture to do it, and I was done there in a couple of more months. People cared about each other. They believed their doctors and scientists after that first blooper. They show the world how your species could win the war against mine. Or could have.

            “Some learned, some didn’t. I was rockin’ and rollin’ man. Jims and Janes, Fritzes and Gretchens, and especially Sergios and Claudias were leaving Wuhan and taking me home as a souvenir. I got a foothold on the Pacific Coast of your country in January, but that was small potatoes compared to Italy and Spain. Those folks love their grandmas, so instead of quarantining them they killed them. Okay, I killed them, but they gave me free rein.

            “Who’s they, you want to know? The young people. The ones who couldn’t sit at home. The ones who were chock full of me and I didn’t even make them sneeze. They were my ambassadors. Healthy young humans doin’ their thing, havin’ fun, hustling, moving. They’re the reason I left my Sarsie-1 bro and MERS cousin in my dust. They took me to every place on the planet. You humans talk about flyways for the flu. You mean geese and ducks. They fly south and north on two routes. They overlap a tad in the arctic. Geese? Ducks? Your species has a hundred thousand flights a day that go from everywhere to everywhere. And every one of them is carrying someone carrying me. Flu too by the way. He and I are gonna make beautiful music together. There’s gonna be some Darwinian mutual back-scratchin’ for sure.

            “Anyway, Italy mourned. Doctors and nurses were crying in the hospital halls. But I was headed for the U.K. and New York! That clown Boris thought he could pull a Sweden. I tried to help him see the light by laying him low for a while, but he squinted and bumbled again. Herd immunity? You have to be kidding me. That’s years away everywhere.

            “Treatments? Some day. Right now they’re just making a dent for the sickest, and may help me evolve resistance. I admit it’s been hard for me to reinfect someone I got to once before. I’m working on that, according to Uncle Charlie’s rules. We’ll see. The flu comes back every year in a different form. Every year a new vaccine that’s maybe half effective, and half of Homo dumbellus doesn’t even bother with it. Is that the sort of standoff I could live with long term? As they say in North Dakota (where by the way I’ll be heading soon), you betcha!

            “Meanwhile, Boris the Clown can’t hold a candle to that donkey’s rump Bolsonada in Brazil. It’s like Sweden without the modicum of leadership and with twenty times the population. Wow! Talk about a field day for me! They can’t dig graves fast enough in São Paulo. Mind you, it’s no great deal for me to be buried in a hole in the ground. But it’s the cost of doing business.

            “And then of course there’s the Clown of Clowns, the fat one with the orange face and pouffy yellow hair, the It’ll-be-gone-like-magic Gotta-open-up-our-country Whaddya-gotta-lose happy hero of every virus in Darwin’s kingdom. Sorry, it’s your country, I don’t want to hurt your feelings. But really. Open up the meat plants: Check! Don’t worry about the prisons and nursing homes or the small towns around them: Check! And then you got those folks yelling about freedom. “Don’t put your mask on me!” I love them so much I want to hug them. I do hug them.

            “And now these protests. I’m sorry, they have a right to grieve, but it doesn’t matter to a guy like me whether the crowds are righteous or not. I don’t give a flying fig whether I infect a Democrat or a Republican, as long as it’s a warm body. I am a teensy little Darwinian machine obeying Uncle Charlie’s laws to the letter. Good thing for me that guy in New York isn’t running your whole American show. I’d be beaten back into a corner for the summer and then you’d be gearing up to fight me and my buddy Flu-Boy in the fall.

            “But this is a zero-sum game, my species against yours, and I don’t think I’ll be in retreat during the summer. Maybe if you wake up in July and lock down again I’ll give you a five-minute break in September. But I’m not promising.

            “Good thing for me too that there aren’t more women running more countries. Seems like most of the countries that have kept me down or out are run by females, and the countries I win hands down are run by overgrown, overblown boys. Maybe you are actually two species: Homo sapiens, the ones with the reproductive equipment who know how to protect their own; and Homo dumbellus, the ones with DNA donation, the big shoulders, and the bluster.

            “Better believe it when I tell you you’ll be seing me around.

            “What? You think I’m ruthless the way I’m taking over the planet? How the hell do you think your species did it? You poisoned the earth, killed off half the other animals and plants, and brutalized each other beyond belief in your own species. You packed yourself into the crowds I swoon for. I can become King of the World without doing a fraction of the damage that you’ve done. It’s a miracle there were any bats left for me to evolve in.

            “But now you are really really helping me, so keep up the good work!

            “And oh, please, I’m begging you, whatever you do, please please re-elect Empty Hairdo, the Leader of the Free World who will never ever figure out how to keep it free from me.”

            Well, students, now you’ve heard it, Sarsie in his own words, uncensored, from the horse’s—or the virus’s—mouth.

            And don’t knock his hopes and dreams. He’s just following Dr. Darwin’s prescription. For him.

            Dr. D’s advice for us? Stay safe, be well, and keep in touch—from a distance.

Dr. K

Opening to What?

            “I think right now, because there’s been good news really, that the opening up is starting to happen faster than we expected, appears to be doing so safely, then there is a chance that we won’t really need a Phase Four [Congressional support package].” White House economist Kevin Hassett, Fox News, Saturday

            “Is this guy serious?” Mayor Bill DeBlasio, later that day

            “It’s devastatingly worrisome to me personally because if they go home and infect their grandmother or their grandfather who has a co-morbid condition and they have a serious or a very — or an unfortunate outcome, they will feel guilty for the rest of our lives,” Dr. Deborah Birx, Sunday.

            “This is definitely government overreach.” Lockdown protester on social distancing

Dear Students,

Given our studies of evolution in disease (Darwinian medicine), you won’t be surprised to learn that the pandemic coronavirus is mutating and adapting, although fortunately more slowly than seasonal flu. Nor will you be surprised to see natural selection operating at different levels. We are not sure that a bat was the origin, but if bats have it you know they’ll be evolving too. And so will we. Here is how the city planning commissioner of Antioch, California put it in a Facebook post:

The shelter in place needs to end, we as a species need to move forward with our place on Earth…This virus is like a human version of a forest fire, a forest fire will burn through and burn off all the dead trees, old trees…The strong trees survive and the forest replenishes itself and flourishes once again… If we look at our population as the forest you will see many similarities. We have our old, we have our weak and we have our drains on our resources. This virus is targeting those sectors of our population. If we were to live our lives, let nature run its course, yes we will all feel hardship, we will all feel loss. I am sure everyone of us would lose a person who we hold dear. But as species, for our Nation and as a Planet we would we would strengthen when this is all settled. We would have significant loss of life, we would lose many elderly, that would reduce burdens in our defunct Social Security System, health care cost…make jobs available for others and it would also free up housing… We would lose a large portion of the people with immune and other health complications… But that would once again reduce our impact on medical, jobs and housing. Then we have our other sectors such as our homeless and other people who just defile themselves by either choice or mental issues. This would run rampant through them and yes I am sorry but this would fix what is a significant burden on our Society… Of course we would lose many of the “Healthy” maybe even myself but that is the way of the World!

I am sure you see the logic in this as clearly as you see its inhumanity. This is so-called Social Darwinism at its worst, and the end result is a Nazi-like culling of the “unfit” from our populations. Nazis carried out mass murders as “euthanasia,” and one of the ways they did it was to crowd Jews into ghettos where typhus and other deadly microbes were brewing and then (see above) “let Nature take its course.” A friend of mine, Tosia Szechter Schneider (now 92) lost her mother and other family members to typhus in one of those Nazi-encouraged experiments in letting Nature take its course. You may remember what Darwin said about this in The Descent of Man:

The aid which we feel impelled to give to the helpless is mainly an incidental result of the instinct of sympathy, which was originally acquired as part of the social instincts, but subsequently rendered…more tender and more widely diffused. Nor could we check our sympathy, if so urged by hard reason, without deterioration in the noblest part of our nature… If we were intentionally to neglect the weak and helpless, it could only be for a contingent benefit, with a certain and great present evil.

In other words, Darwin rejected the moral lapses that some people argued should derive from his own theory. He understood that being human gives us choices that other animals don’t have, and he wanted us to use those choices to protect the weak, not “let Nature take its course.”

            But you might decide Darwin is wrong and the Antioch commissioner is right. I hear some young people have suggested COVID-19 parties where you can infect each other, get a (probably) mild illness, and get it over with! I suggest the following song after you’ve had a few beers. (It’s sung to the tune of the title song in the ‘60s musical Bye Bye Birdie.):

Bye bye Grannie,

We’re gonna miss you so!

Sorry, Grannie,

But ya gotta go!

If you’re curious about this tune click the link now, because after Nature takes its course, no one left alive will remember it, and you’ll never hear of it again.

[Important disclaimer! I don’t really advise you to have a COVID-19 party!]

Good News

  1. “Good to be with you,” said Gov. Cuomo Sunday to one of the four governors joining him virtually and pragmatically in a new consortium. New York, the tip of a severed starfish point, has regenerated much more of the point by bonding with Connecticut, New Jersey, Pennsylvania, and Delaware to coordinate rules and to bulk-buy protective and testing equipment at better prices.
  2. Remdesivir, an antiviral that was developed for Ebola, has reportedly shown its ability to reduce ICU stays from 15 to 11 days in very sick patients. This, if it holds up, is great news. The drug will not be withheld in new trials (now unethical), but will be added to other study drugs in continued research. Bill Gates’s foundation and others are working aggressively (“The Therapeutics Accelerator”) on a treatment that would use monoclonal antibody technology to derive drugs from convalescent plasma, among other treatments.
  3. Testing of two main types (for current virus and for antibodies raised by past virus) is ramping up, although not nearly fast enough. Home self-tests (like the ones we have for pregnancy) should soon be more widely available. Contact tracing, far behind testing, is slowly improving. Random-sample testing in a few places is beginning to clarify how the virus has spread and who (by age, location, ethnicity, and gender) is affected most.
  4. New cases in South Korea that appeared to be reinfections of people who already had it (i.e. they lost their protection in weeks to months) now appear to have been head fakes (false positives), caused by what one expert calls “viral litter”—non-dangerous fragments of viral RNA lingering from the infection.
  5. As many as a hundred labs worldwide are working as hard and fast as they can on vaccine candidates. 95 percent of these could fail in clinical trials (the hard part) and we would still have a few to use. Factories are being built and adapted long in advance of this to produce up to billions of doses that will eventually be needed. Up to 14 vaccines have already entered Phase 1 clinical trials, much sooner than most experts expected.
  6. The modelers at the University of Washington (IHME, led by Chris Murray) have detected a heat effect that is much less than it is with some other viruses but greater than previously thought for this one. Therefore a hot summer will work to a modest extent against the social factors making things worse.

Bad news

  1. Rules are being relaxed by states in an uncoordinated way, without a flicker of national leadership, except in the direction of greater risk. Few if any of the states reopening have met the national standard, put forth recently, of having declining cases for two weeks; most still have rising cases. The Federal government has ordered meatpacking plants, essentially petri dishes for the virus (like cruise ships and prisons), to reopen and stay open, and these are and will be places from which many American communities will become disaster areas.
  2. As Bill Gates remarked on CNN Friday, the so-far modest impact of remdesivir is not going to make us say, “Let’s go to the movies.” Experts note that a smaller study (but a good one, and large enough to show a substantial effect if there were any) in The Lancet found no effect of the same drug. The larger study praised by Dr. Fauci has not been published or peer-reviewed, and all we have so far is a press release and his word.
  3. Testing and contract tracing, the life blood of safe reopening (and therefore of economic recovery) is primitive in our country. We have around 200,000 tests a day nationally, done for the sick and a few others (like health care workers) in most places, but otherwise haphazardly. Expert opinion on how many tests we need range from 5 million a week to 20 million a day. Given that we are most infectious in the first few days of symptoms, or even before, tests that take days to get results are of limited value in controlling the pandemic. “What’s the point?” Bill Gates asked the other evening. “Do you just send apology notes to the people you infected in those 3 or 4 days?” The Gates foundation is supporting the scale-up of rapid testing.
  4. Perhaps the biggest unanswered question is what is the extent of our immunity after having had the virus and how long it will last. Could it be like chickenpox, one and done for life? Or more like flu, protection for a season? The same questions apply to vaccines; this year’s flu vaccine was 50 percent effective.
  5. Speaking of vaccines, the 12-18 month time-frame often mentioned for getting to distribution of a safe and effective vaccine would be by far the shortest in history. Animal models have limits; Dr. Sanjay Gupta reminded us the other day of an old doctors’ saying: Rats lie, monkeys exaggerate. Perhaps the brute force of a hundred labs parallel-processing various methods will accelerate the time to large human trials, but those trials take time. Many will fail and some may fail dangerously.
  6. Internal Trump administration memos revealed today project 3,000 cases per day in June, about double what we have today and higher than the highest peak so far (~2500 in mid-April). These new projections may to be what led President Trump to say yesterday that total deaths could go to 100,000. Given how optimistic he has been in the past, this could be interpreted as meaning that he is deliberately choosing economic activity over preventing mortality, and we should be prepared for more.

Almost half the country is officially open to some extent as of today. “Government overreach”—for your protection—is (temporarily) ending in many states. Watch the states, as well as other nations (with much better testing) that are opening and see what happens. It’s interesting that Dr. Birx (quote up top) misspoke slightly in expressing her worries about the people who don’t do social distancing in protests: “they will feel guilty for the rest of our lives”—the line between “their” and “our” indeed blurs.

Nationally, we’ve been stuck on a fairly stubborn plateau of cases and deaths as states with increases replace those with declines. Projected cases, hospitalizations, and deaths that two weeks ago gave me hope of a more normal summer before a possible fall wave were based on the assumption of serious social distancing through May. That hasn’t held, and all models are projecting more deaths. The latest today (May 4) from IHME projects 134,000 deaths by August, almost double the number projected 6 days ago. I wish I could tell you that college will be live in the fall. As Gov. Cuomo said today, “Know what you don’t know.”

I don’t know for sure, and I’m sorry to have to say it, but it seems to me we have chosen mobility over sheltering and death over life.

The weather’s great, go out (seriously), enjoy a walk or a run alone or with someone you trust. Wear a mask (as Cuomo says, it’s a sign of love and respect for others, because it protects them from you), stay at least six feet (two meters) away from anyone not part of your household, go home as soon as you can, and wash your hands obsessively. While you’re out, observe the crowds who aren’t doing the above, and if you’re religious say a prayer for them, because in a couple of weeks they are going to need it.

As for you, please to take to heart what Tim Cook, head of Apple, said to the new Ohio State grads in his online commencement address: “I hope you wear these uncommon circumstances as a badge of honor.” This is my hope for you in your own futures. Do the right thing now, and live to brag for the rest of your lives about how you made it through COVID-19. As you have heard me say many times, you are lucky to have great gifts, and the world has a right to expect leadership from you.

Dr. K

Note: Please don’t just rely on me. I recommend the following good sources: The Bill & Melinda Gates Foundation COVID-19 Update, aka The Optimist; This Week in Virology (TwiV) podcast; IHME (U. of Washington) model website; COVID-19 UpToDate for medical professionals; and for all readers: Why the Coronavirus is So Confusing. Dr. Ashish Jha of the Harvard School of Public Health said on Thursday, “I grew up as a public health person loving and admiring the CDC, arguing and believing that it is the best public health agency in the world… But in this entire pandemic, it’s been one fiasco after another. And it’s either possible that all of the scientists all of a sudden forgot their science, or there’s something at the leadership level that’s really hindering them.” 

 

 

 

 

 

 

 

 

 

 

 

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Charles Darwin’s Happy Birthday

As we mark Charles Darwin’s birthday on February 12th, our culture is riding a wave that should take us back to his theory. The #MeToo and #TimesUp movements are the crest of the wave, which may represent a turning point against men’s chronic exploitation of women. It’s one aspect of the decline of male supremacy predicted and fought for by Elizabeth Cady Stanton, the pioneering women’s rights activist born just a few years after Darwin.

Stanton, like Darwin, was a realist when it came to gender differences. She thought that some were intrinsic and fundamental, but that these were to women’s advantage. Indeed, in a powerful 1869 speech, she held that the strongest argument for women’s equality was “the difference between man and woman.”

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