Ask any Public Health Official
Ask any public health official in central Europe this week how the Pandemic, which “is over”, is going and they will tell you they have entered the next winter wave, and a bit earlier than expected. New cases in France are up 55% compared to the last week in September, and daily cases are now at 17,000. The highest surge in cases as reported by the European CDC are occurring in France, Germany, Austria, Belgium, and Lichtenstein. Apparently the new Omicron bivalent boosters are a hard sell in Europe, just like the US, with uptake running between 10-15% of the rate compared to when last year’s boosters became available. And it’s not just the, “oh so mild Omicron” cases—Italy is experiencing a sudden increase in COVID hospitalizations and ICU admissions, similar to the UK. At this point in the Pandemic it is very difficult to determine whether a given variant is intrinsically much less virulent, or whether the accumulated population immunity is making it appear thus. Think back to the beginning of the Omicron wave late last autumn,\ when we were instructed by the talking heads that Omicron was much milder, and really not going to be such a problem. Milder or not, the shear mass of infections it caused pushed up the death toll to the second highest tally of the Pandemic. We aren’t in for a repeat of that, given our hard won immunity, but the Winter Wave will be on it’s way to the US, so you might want to dust of the old surfboard. Here are some visuals.
The following chart makes it clear that many places in the world which were highly effective in avoiding COVID for quite a long time, are now the locations where the disease is spreading most rapidly. This just goes to show that given a world wide Pandemic with one of the most contagious viruses ever seen, you can run but you can’t avoid COVID forever. It would be nice if Mr. Xi and the CCP internalized this fact, and ceased with their contribution to screwing up the world economy. (There are sufficient inputs from other players right now.)
The last graph today is from the CDC and shows US COVID deaths. Suffice it to say that I fully expect the current slight downslope to reverse about 3 weeks after the first ripples arrive from Europe. We are facing waning immunity to all the current Omicron variants, increased indoor exposure, removal of all mandatory social mitigation means, and people failing to test when exposed or sick. If you are in a high risk group for serious illness, then please consider getting a booster soon. After all, the government spent many billions of your dollars to purchase 117 million doses of the new bivalent boosters, so let’s go try them out, and report back.
While I am on the subject of reporting back, Pfizer just provided a press release today giving us the first peek at actual human data on the antibody response to the new bivalent Omicron boosters. Details are slim, and no quantified data are provided. Unsurprisingly, one week post injection, antibody levels against BA.4/.5 are “higher” with the bivalent vaccine compared to a test group who received the original Wuhan version. Also unsurprisingly, Pfizer extrapolates that to say that better protection against BA.5 is expected with the new formulation. The expected hard sell on the new boosters is beginning—the government may pretend they are not worried about the low uptake so far, 4.5% of eligible folks over the age of 12—but the fact is that they are out on a limb to some extent here, with 117 million doses that can’t be allowed to collect dust for too long. The risk of course is in over promising results, and then quickly finding that the vaccine does not live up to the stated benefits. As we learned in early 2020, claims trumpeting that the RNA vaccines prevented 95% of cases of COVID, turned out to be completely wrong, and that only fed into skepticism, distrust and anti-vaccine sentiment. No less a vaccine enthusiast than Professor Paul Offit, director of the Vaccine Education Center at CHOP, has stated that we should have known upfront that the vaccines would have a dramatically lower effectiveness in the real world, and clearly communicated this. This should have been obvious based on everything that we knew about rapidly waning immunity against other Corona viruses and respiratory pathogens. The realistic expectation is that you will get an increase in partially protective immunity that will last several months. For high risk people, even for healthy people over the age of 70, vaccine and natural immune protection from severe disease are slipping, and a booster can temporarily restore it. The Pfizer announcement comes hot on the heels of the FDA’s Wednesday approval of the bivalent boosters for everyone over age 5.
Next we get another look at the Law of Unintended Consequences, brought to you by the people who always know better. Data just released show that the most recent college ACT test scores are the lowest in more than 30 years. The average score of the class of 2022 was 19 out of a possible 36. 42% of the kids met NONE of the subject benchmarks set by ACT as indicative of college level preparation. Remember these are the kids who are planning to be college bound, let’s not even try to imagine what the other kids have managed to learn in zoom high school. It’s actually hard for me to comprehend what you have to do to score that low. If we look at the ramifications of what we collectively allowed educators and politicians to do to in-person learning during the Pandemic, it extends beyond a catastrophic decline in American competitiveness on the world stage. Of course, the most prestigious Universities will still have their pick of the very brightest, most motivated students (or the ones with celebrity parents paying to have the kids’ test scores “revised”, or making large contributions to the old alma mater). Colleges just a little further down the food chain aren’t going to close up shop because they don’t get applicants up to their standards—no sir, those standards will be ratcheted down to meet the available pool of tuition payers. Will more of those poorly prepared students graduate with degrees which do not make them competitive for jobs paying more than the minimum wage? Will someone come along and bail them out; forgiving loans they promised to pay back, and shifting the cost to other people? Time will tell.
Other respiratory viruses are back with a vengeance in children this season, after a relative lull the prior two years. Pediatric hospitals around the country are currently inundated with cases of RSV, Rhinovirus and Enterovirus. Multiple states are reporting filled to capacity Pediatric ICUs and general inpatient wards. The surge in RSV is occurring earlier than usual. This is highly concerning since we have not yet hit the Flu season and its typical contribution to hospital admissions. Unfortunately, it looks like the Pediatric health system may be in for an extremely stressful period. Below are some statistics from the CDC giving you an idea of just how much RSV disease impacts the hospital system every year. Layer on top of that Rhinovirus, Enterovirus, COVID, Influenza and others for a view of what’s in store. When we finally reach an endemic equilibrium with COVID, we will continue to see peaks and troughs of disease activity. We will simply have added another respiratory pathogen that likes to kill older and compromised individuals. If a bad Influenza season happens to coincide with a new COVID variant driving up case numbers, expect it to push the hospital system to the limit.
CDC Surveillance Findings
Each year in the United States, RSV leads to approximately:
2.1 million outpatient (non-hospitalization) visits among children younger than 5 years old.
177,000 hospitalizations among adults 65 years and older.
14,000 deaths among adults 65 years and older.
100–300 deaths in children younger than 5 years old.
In closing I will share an unhappy study that appeared in the October 10th JAMA Network. I don’t usually veer into the sociology lane, so I will just present their findings. This survey study looked into how often people lied about important things related to COVID: failed to report positive tests when meeting others in social situations, went to work sick, failed to disclose positive COVID results or symptoms while seeking medical care for unrelated issues, failed to adhere to isolation or quarantine recommendations, lied about vaccination status (either way), etc. Perhaps the results will surprise very few, but about 50% of people admitted to these behaviors on one or multiple occasions. Most interesting, was that the only demographic which predicted a significantly lower rate of these behaviors was age; not sex, vaccination status, ethnicity, or stated political affiliation. Only people over the age of 60 were reliably more honest. Is that a hard earned life lesson, or simply that the older folks took the disease much more seriously? Even if you have a coherent, effective, well supported and supplied public health response to a pandemic, it’s likely to be significantly subverted by this level of population cheating.
Misrepresentation and Nonadherence Regarding COVID-19 Public Health Measures | Public Health | JAMA Network Open | JAMA Network. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797071
Sympathy extended to everyone suffering the terrible effects of Ian. As we get closer to the mid-term election the forces that seek to divide us will be at their loudest, try tuning them out, and look for ways to be kind and generous. Resolve to take a decidedly non-politician approach, and just tell the truth.