Nature Holds Most of the Cards

What’s the fasting spreading virus on the planet?

There were several important developments on the COVID front this week. Before we review them let’s take note that the slowly declining winter surge has now led to a drop in weekly deaths to 2400. That is certainly an improvement over the 4000 weekly deaths we were experiencing in December. It is also substantially above the 1600 death rate in July of 2021 and the 2100 of June 2022— points in time when we did not choose to say the Pandemic is over, relax all mitigation efforts and decide life is back to normal. Normal seems to be a pretty subjective term these days, an important concept to keep in mind for the future. The most reassuring aspect of the following graph is that this years winter disease peak fell in line with predictions, and was nothing like the initial Omicron surge of last winter, or the disastrous winter of 2021. The combination of vaccinations and repeated infections is clearly inching us toward a new equilibrium with the Omicron lineage of COVID.

XBB.1.5 is now 87% of all circulating virus in the US. It has been steadily growing in percentage since it was first identified in NYC in October. Perhaps more importantly it is the only Omicron derivative which is increasing, there are no new challengers on the horizon. That may be significant, since we have not had a break in the new variant parade of this duration since the Omicron era started. The virus continues to mutate at a steady pace, but the absence of new variants means that the current mutations are failing to create advantageous changes to the virus which would allow a new mutant to begin spreading and compete with XBB.1.5. I think this is a very positive sign which may indicate that Omicron has nearly maxed out its potential in the face of our accumulated immunity. As XBB.1.5 continues to infect and reinfect the population that immunologic barrier is ever increasing. Now that COVID has firmly established itself as an endemic respiratory pathogen, we can expect an endless succession of variants, similar to Influenza, but it looks to me like we truly passed a milestone this winter. Of course that doesn’t mean that another novel Greek Letter COVID, able to evade a great deal of our immunity, will not happen even in the near future. When we speak of a once in a hundred year Pandemic, that means the risk is 1% /year, and there is 10% chance it happens in the next decade. Right now we have no idea what the odds are with COVID, and Mother Nature is a tough dealer.

This week the US Department of Energy weighed in on the origin of the Pandemic saying that new information has led their scientists to decide that the the most likely cause was the accidental leak of a virus from the Chinese lab in Wuhan. Why would we care what the Department of Energy thinks about this compared to say Kanye West, Donald Trump or Joe Biden? The Energy Department is in charge of some of our most sophisticated biological research laboratories, and those other folks, not so much. All this means is that another group of specialists, qualified by their professional training, has rendered an educated guess. This is not a situation where the last group to speak up or change their mind must be correct. I did find it a little unusual that Christopher Wray, the FBI director, gave an interview this week in which he reiterated the fact that the FBI had previously come to a similar conclusion. When President Biden gave 90 days for the US intelligence community to investigate the origin of the Pandemic, the National Intelligence Committee reported that the FBI had favored a lab leak, the CIA did not render an opinion, and that four other branches of the intelligence community (IC) decided on a natural origin of the virus crossing to humans from an animal source. We were never told what those four departments or branches of the IC were. That struck me as odd at the time, and still does. Why can’t we know which branches of the IC voted in favor of a natural origin? Various people are weighing in now on the Energy Department’s qualifications to have an opinion, so let’s have an equal playing field. It seems that some other people are interested in this as well. Yesterday the US senate just passed the COVID Origins Information Act (S.619) with a unanimous vote. When is the last time you remember the Senate acting unanimously, especially about something which is certainly controversial? This bill will compel the Biden administration to release essentially all the information they possess regarding the origin of the Pandemic. Including the arguments made by the various IC members justifying their previous assessments. I’m assuming it will pass the House, despite significant Democratic opposition (not found in the Senate for some reason), and despite plenty of redactions, should make some interesting bedtime reading.

In any event, this latest assessment by the Energy Department does nothing to prove the question, and as time goes on, given China’s unwillingness to cooperate, it seems unlikely we will ever have a definitive answer. Rather than argue how many angels can dance on the head of a pin, there is an important lesson to be taken from this. Early on a number of prominent American scientists categorically dismissed the possibility of a lab leak. Worse than that, they suggested publicly that anyone stating that a lab leak was a POTENTIAL explanation, were no-nothing, Sinophobic, conspiracy theory imbeciles. Some of these scientists have subsequently, quietly, recanted that position as the general consensus has emerged that there are indeed two viable competing theories. Why would these intelligent individuals trained in the scientific method behave this way? The answer seems clear that it was because the guy who was the head of the “other tribe”, (whom they hate) had stated he believed, based on classified evidence, that the virus had leaked from the Wuhan Lab. It is completely fine to look at the available incomplete data, and form an opinion that perhaps strongly favors one obvious option over the other. It is outstanding to marshal your facts and try to refute the other position with logical argument. However, it is frightening and embarrassing when scientists feel they need to demonstrate their bona fides as good warriors against some politician, by making a mockery of the scientific method. Scientists rightfully bemoan the loss of public trust. Failing to call out and challenge this sort of behavior, does nothing to further the cause.

The second notable event this week was the ACIP (the CDC’s outside group of vaccine experts) meeting to advise the CDC on COVID vaccine policy going forward. This group of leading experts stated that, “There is insufficient evidence to recommend multiple COVID vaccine boosters per year—even in individuals at high risk of more severe infection”. They did equivocate with regard to people at the very highest risk due to profound immune suppression. This is an important development and seems again to be firmly pointing to a once a year COVID vaccine in the fall. It’s anybody’s guess how high it will rank on the equity and inclusivity index of different variants. I have previously discussed the evidence that natural immunity after infection is effective and relatively durable, on a par with vaccination; and that multiple studies have shown hybrid immunity to be the most effective. I’ve also been clear about my opinion that failing to consider natural immunity in the, now largely discredited, vaccine mandates was unscientific and dumb. Equally lame was the failure of the CDC to consider infection arising after vaccination in recommendations for subsequent booster doses. It appears that has finally changed with the following now appearing on the CDC vaccination pages.

‘If you become ill with COVID-19 after you received all COVID-19 vaccine doses recommended for you, you are also considered up to date. You do not need to be revaccinated or receive an additional booster.”

As usual for the the current CDC—I would say this is predictably ambiguous. I had received all the COVID vaccine doses recommended for me when I came down with Omicron last winter. Based on a pretty good attention to and understanding of the science involved, plus my own particular risk strata and previous vaccine experiences, I decided not to take the bivalent fall booster. But is that what the CDC really meant to communicate to the vast number of people who have been infected after receiving some prior recommended vaccination schedule? Does the CDC even know? I don’t doubt that the interested reader may be able to find another declaration on some CDC page contradicting this statement, but that’s basically the problem. To misquote Bob Dylan’s My Back Pages, “My CDC, led by confusion boats mutineed from stern to bow”.

The final item today takes us back to Avian Influenza. It seems there was a mis-communication between the Cambodian Public Health Authorities and sources reporting the initial information. Follow up from Cambodia indicates that so far, only the youngster who died and her father tested positive for H5N1, so the likelihood of human to human transmission is very low. Also, the particular clade of virus they were infected with is a local strain present for some time in the region, and not the clade of H5N1 which is spreading around the world, and now infecting mammals as well as birds. On the mammalian front, the Chilean government just reported the death of a sea lion found to be positive for H5N1. This virus is experimenting with an extremely wide range of mammals now, and further adaptation to their physiology with the potential for intra-species spread should not be ruled out. Of course we naturally focus on human epidemics—but make no mistake H5N1 is the fastest spreading virus on the planet now with a death toll eclipsing our COVID experience by several orders of magnitude.

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