Tagged evolution

“Baby, There’s COVID Outside”

            “Dr Chris Murray from the IHME told Anderson this earlier tonight, they’re expecting over 100,000 additional deaths between now and June … they don’t think that the US will reach herd immunity before next winter. I mean that’s a pretty scary proposition—what do you think?” 

            “I think that Dr. Murray and his colleagues are probably right… It’s going to take us quite some time to get…enough supply. Hopefully we’ll reach that by by mid-summer but…we really need the vast majority of adult Americans to take the vaccine, and I’m afraid that because of the pandemic of disinformation, it’s going to be really difficult to do that, and so I’m hopeful that we can do this by winter and have a normal Christmas and New Year’s, but it’s going to take a lot of hard work for us to get there, and the variants can really throw a wrench into the works… I really do worry about the variants, because if you have something that’s a lot more transmissible then it’s not just a matter of linear spread; so something that’s 50% more transmissible, you’re not going to get 50% more infections, you’ll get many many many times more infections… I also worry about variants that potentially could be less effective with the vaccines that we have and we may always be happy to play catch-up so we vaccinate everyone, but then there are variants, and then we have to get boosters to target those variants. So we could always be trying to play catch-up here, and that is a big problem.” Dr Leana Wen, with Don Lemon, CNN, 2-19-21

            “The virus and the pandemic as we know it is not the virus and the pandemic that we face right now… This virus is changing and it is changing rapidly. There about 4000 different variants… To find a variant you have to genetically sequence, it requires skill, immense computing power, and frankly not many countries are doing that… Those three main strains [UK, South Africa, Brazil/Japan] are out there and they are improvements from the original virus, because that’s the way evolution works. When there is even a tiny advantage that advantage is pushed along through natural selection at an enormously rapid rate because evolution in viruses happens very very quickly… I’ve been following the story of one particular intensive care nurse who was quite optimistic because she had gotten her vaccine and then her COVID ward suddenly changed when these mutant strains arrived:”

            “We’ve seen patients now with absolutely no past medical history, not overweight, runners, people who go to the gym, people in their 40s, and these patients are dying.”

            “What would you say to Americans who might not have woken up yet to the fact that this is coming?” 

            “If you love your family, if you love the people you know, wear a mask, stay indoors, wash your hands, be careful, just realize that this will kill.” Richard Engel with a UK intensive care nurse, MSNBC, 2-21-21

Dear Students:

This is much my favorite of several parodies of the old song, “Baby It’s Cold Outside,” making the cloud rounds since Christmas. I know, it’s cold outside too. Colder than it has ever been in, for instance, Texas, where due to the incompetence of state leadership, at least 32 people have died from the winter storm—of at least 69 nationally—as of yesterday.

My heart goes out to the victims, their families, and the millions of others who suffered from no heat in freezing cold—some made fires from their furniture—and no water due to ice-burst pipes. But consider.

The 7-day moving average of daily deaths in Texas from COVID-19 was 119 on Saturday. So, despite the lowest death rates since November, during the week of the storm the virus killed over 800 people, or around 25 times as many as the cold did. But the storm news thoroughly dominated the air waves all week, with virus stories and analyses relegated to short segments late in the hour.

Nationwide we are under 2,000 deaths a day, down from 4,000 in mid-January (see the chart). This is terrifically good news. But we are still far above the summer peak and only around the immensely disturbing first peak of last spring. That’s with all the advances in treatment and two months of vaccine roll-outs.

Hospitalizations have dropped similarly, a tremendous boon to our frontline healthcare heroes, and cases have dropped even more. But all are still at or above previous peaks. We just crossed the nauseating milestone of half a million deaths.

Baby, it’s COVID outside.

Good News

  1. New cases in the US have dropped 70 percent from the winter peak, hospitalizations and deaths have been halved. This is most likely due overwhelmingly to the pass-through of the holiday-period recklessness and the resulting unprecedented surge. Improved behavior, partial immunity due to prior infection and (to a very small extent) vaccination have probably helped.
  2. The vaccine roll-out continues with great fanfare but at a slow pace. We have reached over 60 million vaccinations, mostly first dose, and that is increasing at 1.6 million a day. So far this is overwhelmingly the Pfizer and Moderna mRNA vaccines, but the Johnson & Johnson single-dose one is on the verge of Emergency Use Approval, with more to come.
  3. A study in Israel, where vaccination rates beat the world, shows that a first dose of Pfizer vaccine affords 85 percent protection between 15 and 28 days out. This is far better than anyone expected. Another Israeli study showed that a double dose prevents transmission as well as disease, at a rate of 89 percent; this was a big question mark until now.
  4. Treatment advances continue, including monoclonal antibodies for early-stage patients to keep them out of the hospital, and late stage tocilizumab, an interleukin-6 (IL-6) inhibitor, given after or with the steroid dexamethasone. Immune system interventions like these, science fiction a few decades ago, are working. Early anticoagulant (blood thinner) treatments and vitamin D supplements also make a difference.
  5. The new administration in Washington has set a new tone. Masks are cool and people from the top down are modeling their use. Social distancing, handwashing, and other preventive measures are mentioned frequently. The stupid culture wars over prevention are not done, but the federal government is on the side of science.

Bad News

  1. SARS-CoV-2 is evolving fast. The 4,000 variants mentioned above are of uncertain importance, but some could change the game, and not enough people in government or news outlets are talking about them. The UK variant spread like wildfire there and doubled hospitalizations almost overnight. Cases of it are doubling every 10 days here and it will be the dominant US strain by March. Cases of the South African and Brazil/Japan strains are here. The first is resistant to some vaccines and the second is implicated in a new epidemic that engulfed Manaus, an Amazonian city of 2 million.
  2. Dr. Peter Hotez, probably the nation’s leading expert on vaccine development, says we need 3 million doses in arms per day, almost twice what we have now, and there are no plans announced to get to that number. Dr. Michael Osterholm gave up his own second dose because he believes triage requires that we (like the UK) choose to vaccinate twice as many people once before we give second doses (see #3 above).
  3. President Biden has promised to “level” with us, and, like FDR, to give it to us “straight from the shoulder.” But if he did that, he would not talk about 600 million doses by mid-summer as if it were adequate. He would apologize and pledge more. And he would certainly not, as I have heard him, blame his predecessor, which is uncomfortably reminiscent of what his predecessor did.
  4. Israel, the UK, and even the United Arab Emirates show that vaccinations can move much faster than they are moving here now. The UK has been on lockdown for many weeks and will reopen only slowly as conditions allow in March. Bhutan, Rwanda, and Senegal have done far better than we have in controlling this pandemic. Are we still too proud to learn the lessons all those countries and more have to teach us?
  5. The issue of school reopenings has been handled by the new CDC Director, Dr. Rochelle Walensky, almost as bumblingly as by her predecessor. On Sunday the 14th CNN’s Jake Tapper asked her to defend her new guidelines. She tripped all over herself. She said (for example) that community transmission has to be controlled where the school is. Tapper pointed out that 99 percent of US schoolkids live in red zones. No answer. This was without noting that thousands of schools would go bankrupt if they met the guidelines for cleaning, ventilation, and so on. Biden’s White House did not back her up. Of course kids need school, but the new CDC is still being disingenuous. Vaccinate the teachers, janitors, and food workers.

Speaking of kids, I reached the two-week anniversary of my second Pfizer dose on Friday, and on Saturday I snuggled with my grandkids while reading to them for the first time in almost a year. We were outside and I was still masked, but it was a great feeling. One of the new studies mentioned above told me I would be unlikely to carry it asymptomatically to them

As I said to some of you yesterday, I wish I could tell you to party. You have as much right to party as I have to hug my grandchildren. But if you do it now, you will join the ranks of the foolish who infect themselves and others.

This is not over. Not all 4,000 viral mutants are “variants of concern,” most are biologically silent, but some make the disease more likely to transmit, more deadly, or more resistant to vaccines and our own immunity. I was happy to hear cable news talk about natural selection, but I am not happy with the results of that selection. And we are underestimating it because we do so pathetically little viral genome sequencing.

Dr. Michael Osterholm said Friday on PBS that we are in the calm before the storm, and that a new surge caused by the UK variant (B.1.1.7, which current vaccines do prevent) is inevitable. Based on the UK’s own experience, we could see 195,000 hospitalizations a day, compared to the 130,000 a day that overwhelmed our hospitals in January—the surge that among other things required a fleet of refrigerated trucks to store the bodies.

Dr. Fauci said yesterday we may still be wearing masks in 2022—some degree of normality by the end of ’21, but not without masks and other precautions between now and then. Today he said, “This is a common enemy. We’ve all got to pitch in. We’re in some good shape now with the vaccines, but it’s going to be a race against the infections that keep coming.”

Dr. Tom Gillespie, of Emory’s Environmental Sciences Department, was quoted in yesterday’s New York Times (“And Then the Gorillas Started Coughing”), commenting on two San Diego Zoo gorillas that contracted SARS-CoV-2—which they could only have gotten from humans—warning that apes and other infectable species could become a reservoir that preserves the virus after the pandemic and circulates it back to us. Viruses of many kinds are a long-term threat.

Mohamed El-Arian, financial advisor and president of Queen’s College, Cambridge, said today we were in a two-horse race, vaccines against the virus, but that now it’s a three-horse race, with the third horse being the new variants, and if that horse comes up fast, we could be in bad trouble again. We only beat the third horse with the precautionary measures we have been advised to take all along.

As you know, Emory itself, which has done very well all along, has had an unprecedented burst of cases among students in just the past week, for unknown reasons.

Parts of the country are in the deep freeze, but baby it’s covid outside. Stay safe,

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

 

“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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Is Misogyny Maladaptive?

islamic_womenPart of my friend’s question that I didn’t answer last time was about misogyny, which he hopefully speculated is now maladaptive. I deferred this because from an evolutionary viewpoint it is in a different category from xenophobia, racism, and anti-Semitism. Let me state clearly at the outset, as I did about the other categories of prejudice: I think we are gradually creating conditions in which misogyny is maladaptive, and we must continue to do that.

However, it has to be recognized that for the long span of human evolution Read more

Is Genocide Now Maladaptive?

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David Blumenthal, a good and wise friend who is a Jewish studies professor and a rabbi wrote me recently asking about the former adaptiveness and present maladaptiveness of xenophobia. The operative passage in his letter was, “In the global world, however, survival requires the cooperation of varying and different groups. Humanity, in its groups, cannot survive without the quintessential other. Xenophobia has ceased to be adaptive. So has antisemitism, racism, orientalism, and misogyny.”

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The “New Biology” and “The Self”

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I told a very smart neurobiology graduate student named Monica yesterday that I’d been asked to speak on “The New Biology and the Self.” She said, “What’s the new biology?” I said, “I don’t know, but that’s the least of my problems. What’s the self?” Read more

Darwinian News, Hot Off the Press

In the Darwin bicentennial, new insights into fossils, genes, birdsong, and cancer.

google-logo-fossil1The latest issue of Nature to land in my mailbox-the May 28th one-was not a tribute to Darwin in honor of his 200th birthday and the 150th of The Origin of Species; Nature has been there, done that. But it might as well have been another celebration for him, Read more