H5N1 The Other Pandemic Rages On
The Trust-to-Bust Cycle of American Politics
This week we will get a look at a number of items in the world of infectious diseases and Public Health, but first a brief return to the other pandemic engulfing the world of the animals. H5N1 Avian Influenza A, which first appeared in China, in 1996 is spreading rapidly again following the migratory pathways of avians around the world. Some time ago I described the H5N1 deaths of sea-lions along the Peruvian and Chilean coasts. More recently published data from these countries demonstrates the magnitude of these mass death events. Peru has now reported that during a 3-4 month period over 5000 sea-lions died along it’s coast—estimated to be at least 5% of the South American coastal population. So far this virus hasn’t been a big deal for humans, other than decimating their domestic bird flocks and raising the price of eggs. Over the last 20 years only about 900 people have been infected, mostly through contact with birds, but with a mortality rate of 50%. The virus took its time arriving to the Pacific coast of South America, only in December 2022, but in the first few months was responsible for the deaths of an estimated 200,000 Peruvian birds. For more information you could have a look at several of my prior posts with H5N1 in the title. There has been debate whether the virus is being passed from mammal to mammal in the typical manner of a respiratory virus, or whether infection is the result of consuming infected birds. That’s an important distinction for assessing its contagion and pattern of spread among susceptible wild and domestic animals; also the ability to spread through the respiratory route in mammals is a necessary requisite for this virus to become a potential pandemic problem for us. Within the past month Argentinian authorities have reported an H5N1 mass death event of newborn elephant seal pups, with 500 dead pups (felt to be near complete destruction) at one major breeding colony. These are unweaned pups, not eating seabirds, so I think it provides increased evidence of a respiratory pattern of spread.
If you can suppress the collective yawns briefly, here is the up to date COVID status in the US. Test positivity, which had been steadily declining, has now leveled off at 9%. Hospitalizations per week, which had declined over the last 6 weeks from 20,000 to the 15,000 range also appear to have leveled off. Deaths continue in the unaltered pattern of recent months, which is both unexpected and sad.
Waste water data from my home state of Colorado, and the nation overall, shows a remarkably steady, persistent amount of COVID in the community. This is not the usual pattern at all for acute respiratory viruses, which typically show major seasonal variations, and nearly disappear after causing their usual surges, only to recur with the next cycle. It makes me question the notion of COVID having settled down into a nice manageable endemic pathogen. Granted, we were never before able to observe and quantify the evolution of a novel pandemic respiratory pathogen as it transitioned to an endemic state. You all are familiar with the following waste water graph from CDC—COVID is the gift that keeps on giving.
There is nothing surprising on the variant front as HV.1 (first discussed in my post of October 13) has continued to outpace any of the others, and is now the most prevalent variant in the US, representing 25% of sequences. Uptake of the new monovalent vaccine remains extremely slow, with various experts describing it as, “dismal and atrocious”. That’s it for the COVID stuff today, we are in a holding pattern, waiting for the holiday special delivery.
What exactly drives vaccine hesitancy and refusal? It seems to be quite complicated to me, but if you were tuned into the US media over the last two and a half years you may have come away with the notion that it’s caused by being Republican or having voted for Donald Trump. Falling back on the well accepted scientific precept that correlation is not causation; and recognizing both the facts that there is tremendous vaccine hesitancy around the world, and also that a large number of people in the US of very different political persuasions are currently avoiding the CDC’s call to take the newest COVID vaccine, it’s clear deeper issues are at work.
You may know that when China finally backed away from its draconian, and doomed, zero COVID policy, Hong Kong suffered one of the highest per capita death rates in the world. What drove this was an aging population, but more importantly, an incredibly low vaccination rate in the elderly. This wasn’t a question of access to vaccines, China was awash in their homegrown version, with the government pushing very hard for universal vaccination. Despite this, an astonishing 84% of people over the age of 80 in Hong Kong refused vaccination. A new study comparing attitudes of people in Hong Kong compared to Singapore and New Zealand shows that the biggest determinant was trust in the government. Pro-establisment sentiments versus anti-government feelings was the biggest driver of vaccine choice.
COVID-19 Vaccination Willingness and Reasons for Vaccine Refusal
Phyllis Lun, MA1; Ke Ning, PhD1; Yishan Wang, MSc1; et al JAMA Netw Open. 2023;6(10):e2337909. doi:10.1001/jamanetworkopen.2023.37909
I think these findings are very likely translatable to many countries around the world, certainly the US. Consider the mercurial speed with which Americans change their level of trust in the government. It doesn’t matter whether you are a Republican or Democrat, it seems as soon as the other party comes into power all trust in the motives of the government vanish, and that extends unfortunately to the scientific organs of government, the CDC, NIH and others. Let’s try the following thought experiment to see if I’m correct. (Einstein’s greatest discoveries started as simple—well for him simple—thought experiments, but he was dealing with physical reality not human nature so go easy on me!) Let’s take for a starting parameter Kamala Harris saying publicly in September 2020 that if the COVID vaccine was available before the election, it would not have received adequate testing and would be unsafe. Now imagine for a moment that in fact this timing had occurred, and further that Trump had won the election. With the consequent bully pulpit of the Presidency to brag about HIS vaccine and take credit as the situation, at least temporarily improved, (and what politician today wouldn’t do that)—do you think demographic vaccine uptake patterns around the country might have been different? Personally I think the media bears enormous responsibility for this near total trust-to-bust cycle.
For another example of how governments eroded public trust during the Pandemic, we can look at the disaster that was wide spread, long lasting lockdowns. These were enacted without any scientific proof that they worked (they didn’t), and were enforced with severity leading to enormous economic damage and personal misery. In NYC alone by the end of 2021, employment in the restaurant sector had cratered 25% with the loss of 78,000 jobs. Over the same period the national loss of jobs in the same sector was 1.6%. Yet the lockdowns were constantly presented as “following the Science”, and people opposing them vilified as dangerous no-nothings. The following article in New York Magazine has a detailed look at where these ideas originated and came to be implemented.
COVID Lockdowns Were a Giant Experiment. It Was a Failure. A key lesson of the pandemic.
https://apple.news/A5UPLfcBYSlO3_UIu6zpX-A
What about the growing distrust in Science more generally? We all know the unfortunate situation with the instantaneous spread of the most ridiculous disinformation and misinformation on the internet via social media. We are in the midst of a culture war (so I’m told) and as Aeschylus said, “The first casualty of war is truth”. All this is a given, but what about the representatives of Science, how have they acquitted themselves during the Pandemic—have they done their best to convince the wider public what is scientific fact versus nonsense? Poor communication and faulty judgement have marred the performance of the CDC over and over; from Redfield to Walensky, the leadership of the institution stumbled and contributed to a sense of uncertainty and outright mistrust. One of the biggest easily avoided errors from the beginning was conflating current theory, received wisdom, and opinion with proven fact, and presenting these to the public as “The Science”. No amount of back-peddling and excuse making will soften peoples’ judgement when you have seriously impacted their lives, and subsequently appear to have either lied, or been just plain arrogantly wrong. On Friday the CDC’s panel on infection control voted to adopt the finalized version of their new Infection Control Guidelines. The guidelines recommend the use of surgical masks instead of N95 masks for health car workers (HCW) in the majority of patient care scenarios. I won’t go into details, (please read the guidelines for yourself if interested) but I believe the interpretation of study data which they considered is seriously flawed and illogical. I’ll sum up my impression of these guidelines in two sentences. Studies showing equivalence of surgical masks and N95 for prevention of viral respiratory infection in HCWs do not discriminate whether the individual caught the infection in the clinic or in the outside world. We should use all available simple methods to prevent our nurses and doctors from acquiring infection on the job. There was immediate backlash from multiple professional groups including National Nurses United, CAL/OSHA, and others who feel these guidelines will put HCWs at unnecessary increased risk. (draft infection control guidelinesopens in a new tab or window,) It doesn’t look like the CDC is moving in the direction of repairing trust just yet.
Let’s cast a look at the other representatives of Science, the academic world; how have they fared as generators of public trust? There has been a torrent of retractions of published peer reviewed scientific papers during the Pandemic. In all fairness there was a firehose of published studies over the last three years, but the rate of retractions has exceeded historic norms. Forget about the non-peer reviewed preprints posted to various servers (which I have frequently quoted), there it’s clearly caveat emptor. But what about our most prestigious scientific journals? This week Nature issued a retraction of a highly visible paper claiming superconductivity at room temperature and pressure. If correct that would be an enormous discovery in physics and for the world, the kind of monumental finding that peer reviewers should be dissecting very closely. But the problem is, the paper was basically garbage, quickly called out by physicists in the field, and this is the THIRD time that a paper by this same group of researchers has been retracted by a journal after publication. Beyond just being incorrect, there are serious accusations of intentional hanky-panky with data manipulation. Almost nobody in the real world would know about this except it filters into the news stream, and it’s just one more example of a science confidence builder. Some quick factoids of interest follow here in no particular order, without references—you can google them if you choose.
Paxlovid appears to have no significant ability to prevent Long COVID (PSCS) complications in a large population of veterans. Perhaps it might work a bit better in younger healthier people, as most things do, but my firm prediction is it will be found to be useless as a treatment for established Long COVID by the ongoing studies. Also double blinded trials will be impossible because of the frequent altered taste side effect—so placebo effect may dominate.
We still have zero idea what are the fundamental causes of Long COVID, despite excitement every week or so about some likely epiphenomena, such as low serotonin levels or abnormalities on PET-MRI of the brain. Finding truly effective treatments is always hard when you don’t have a firm understanding of pathophysiology. That doesn’t prevent unscrupulous purveyors of proverbial snake oil from taking advantage of the situation, which is compounded by the lack of regulation by the FDA, and marketing nonsense treatments to the unwary. A recent study identified 38 businesses marketing stem cell therapy as a cure for acute or Long COVID— caveat emptor. Ok this one deserves a direct link. DOI:https://doi.org/10.1016/j.stemcr.2023.09.015
A mass outbreak of conjunctivitis in Pakistan led to the closure of 56,000 schools for 4 days recently, with hundreds of thousands of cases. This is coming just at the time of publication of an interesting study using full genome sequencing to really understand what are the most common causes of conjunctivitis. Turns out it varies quite a bit from place to place, and viruses are the most common cause by far, (adenoviruses and one of the endemic corona cold viruses). The study also demonstrated that our ability to differentiate accurately between viral and bacterial cases based on the clinical appearance was a myth. Like quite a bit of what I learned as received wisdom in medical school and post graduate training, it was current opinion, with no real factual basis, but nearly always presented as the “Science”.
Finally, it does appear that money talks (like we didn’t know that) as the University of Pennsylvania reacts to the backlash from mega-donors and other alumni critical of the University’s initial indifferent comments about the Hamas attack on Israel, and to the institution’s tolerance of anti-semitic hate speech and threats on campus. The University had hosted a Palestinian Writers conference just a few weeks before the Hamas attack, featuring several writers of hateful anti-semitic and anti-Israel diatribes, and the administration had blatantly ignored calls to cancel this event. The school is suddenly taking protection of their Jewish students seriously, vigorously denouncing hate speech directed at Jews (they were already vehemently against hate speech directed at any other demographic you can think of), and have pledged to “re-examine the process by which outside speakers are invited to campus”. It remains to be seen if institutions like Harvard, Yale, or Stanford, sitting on giant endowment fortunes greater than the wealth of many nations can be shamed or intimidated into behaving in a civilized manner. For those of you wondering how this reprehensible state of affairs came into being at our formerly honorable Universities I recommend Bari Weiss’ brilliant piece, “Buying and Brainwashing Academia”, on Substack. The essay could have been titled, “Follow the Money”, for she examines how dark, illegally unreported millions have flowed into our top Universities from state actors around the Muslim world with an agenda to demonize and destroy the Jewish nation. To my Jewish readers and friends—how much do you respect and trust these institutions, when it requires public shamming, and the threat of fiscal hurt, for them to treat you with a modicum of decency? I would hope that our FBI and DOJ will look into the issue this foreign, dark, illegal money flowing into the country and having a pernicious influence on institutions and people—but then I’m also hopeful to see one of the famous flying pigs of Kansas before they all succumb to H5N1.
Thank you for spending a few minutes on these pages. Referrals to your friends and colleagues are most appreciated. The like button will help to protect those cute seal pups from viral destruction so be generous. Looking forward to summer vacation, my editor just showed me an all inclusive 12 day trip to Uzbekistan, with a brief stop in Dagestan for the festival of Jewish and American Culture. It’s an old tradition there, recently enhanced by an exuberant airport greeting and passport review.