The CDC gets an Intervention

Is disinformation ever justified?

After 2 1/2 years of embarrassing performance, the Director of the CDC finally admitted what has been obvious to anyone watching the circus—the CDC failed miserably at the one moment when we needed it most. Illusions were shattered (for me personally), trust in public health authority and government in general was undermined. Of course, there is a learning curve that accompanies a brand new infectious disease; but gross errors in judgement, the dismissal of critical data on the mode of the virus’ transmission, impossibly inept communications, and even worse timing in critical mitigation decisions, have even the faithful shaking their heads and wondering if the institution can ever regain, or deserve, the confidence and esteem it once commanded. From her earliest pronouncements at CDC I had my doubts about Rachel Walensky and she continued to confirm them. Her comments this week described a CDC too mired in academic pursuits, the pre-occupation with studying rare diseases, the slow methodical massaging of data for career enhancing publications; and not a quickly responsive public service organization, organized to rapidly respond to emergent situations with a strong Public Health focus. In my estimate, she exactly described the institution from which she came and spend her entire career, the Harvard/MassGeneral complex. My intervention for CDC would include a limo ride back to Boston.

Last week the CDC gave everyone the green light for the COVID highway exit ramp. It’s now up to everyone to assess their own risk and behave as they wish. We have gone from the ethos of we are trying to protect the more vulnerable to, “It’s all up to you.” It wasn’t very long ago that the portion of the population which made that same decision was roundly castigated for their selfishness and presumed ignorance. Along with your exit ramp pass the government is issuing rose colored glasses so you won’t notice the 5700 new COVID hospitalizations every day, the 35,000 people in hospital on any given day, the persistent 400 daily deaths, and the approach of cooler weather when the Corona Virus Season ramps up.

Let’s get on to the science now that the bellyaching section is over. We just received very bad news about Monkeypox (yes Virginia you can still call it that for this week). This comes in the form of a brief research report from French investigators in the Annals of Internal Medicine. The study population were people attending a sexual health clinic, both for routine surveillance and treatment.

Of the 706 men who have sex with men (MSM), 323 had no monkeypox virus symptoms, and 213 had anal swabs collected which were negative for Neisseria gonorrhoeae and Chlamydia trachomatis. Among these 213 men, monkeypox virus PCR was successfully performed on 200 anal swabs and was positive in 13 (6.5%). We contacted all 13 monkeypox virus-positive participants who were initially asymptomatic to assess symptom status and advised them to limit sexual activity for 21 days after the test date and to notify their recent sexual partners,” the authors wrote. “None reported symptoms suggestive of monkeypox infection, but 2 subsequently presented to our clinic with symptoms.”

Finding 6.5% of asymptomatic men carrying Monkeypox in the rectum adds a whole new dimension to the potential for forward transmission of this disease, and further ups the ante for it becoming an endemic problem. While the finding of PCR recoverable DNA doesn’t prove the transmissibility of infectious virus in this setting, I am betting that the human race’s run of extraordinarily bad luck with viruses will hold up here. Up to this point we have presumed that it was relatively easy, within limits of course, to identify people who were actively contagious, and those who had been exposed. If transmission from completely asymptomatic carriers is possible then the success of quarantine and ring vaccination of contacts will fail to end the cycle of disease.

We are quickly approaching the time when newly formulated boosters of the COVID mRNA vaccines will be rolling out and you will be making a decision again. Although there is a plethora of vaccine misinformation whizzing about the Internet and social media, I think we should expect the government to avoid this. We have had the following data from investigators at Stanford, published in Cell back in January, that the mRNA and spike protein of the vaccines persist in what are called germinal centers of recipients lymph nodes for much longer than in people infected with the virus, and for up to the 8 weeks that they conducted their study. https://www.cell.com/cell/fulltext/S0092-8674(22)00076-9?rss=yes#relatedArticles. Until last week, the CDC information page on understanding the mRNA vaccines stated that the mRNA would be broken down and disappear from the body in a few days. Although they have now removed this statement, they still link to page published by Nebraska Medicine which contains the same misinformation.

Perhaps more importantly we have been, and continued to be reassured by the CDC, and an army of diligent fact checkers, that there is no way the mRNA of the vaccines could enter the nucleus of our cells, let alone have any possibility of directly interacting with our DNA. People who suggest this must be crazy disinformation spouting anti-vaxers. Yet the evidence is clear that there is two way traffic through the nuclear pore apparatus of the nuclear membrane. An article appearing in 2021, and referenced for you, demonstrated that during SARS2-Cov19 infection of human cells the RNA of the virus was reverse transcribed within human cells and found to be integrated into the nuclear DNA. This was observed in tissue samples of patients as well as an in vitro model. Zhang, L.; Richards, A.; Barrasa, M.I.; Hughes, S.H.; Young, R.A.; Jaenisch, R. Reverse-transcribed SARS-CoV-2 RNA can integrate into the genome of cultured human cells and can be expressed in patient-derived tissues. https://doi.org/10.1073/pnas.2105968118 Taking it to the next logical step, one would wonder: if during infection with the virus its RNA is taken into the nucleus, reversed transcribed into DNA and integrated into the genome, does this happen when we introduce the mRNA into cells by giving the vaccine? The answer appears to be yes, and I will give you the reference for an article from January 2022, demonstrating that human liver cells given a dose of the Pfizer mRNA rapidly transport it into their nucleus; where it up regulates the expression of a naturally occurring human reverse transcriptase enzyme (translates RNA into DNA) and this gets integrated into the genome. Intracellular Reverse Transcription of Pfizer BioNTech COVID-19 mRNA Vaccine BNT162b2 In Vitro in Human Liver Cell Line

Curr. Issues Mol. Biol. 2022, 44(3), 1115-1126; https://doi.org/10.3390/cimb44030073

Why am I pointing out these studies? Is it because I think there was some nefarious conspiracy from the beginning to poison everyone with mRNA vaccines? Of course not. Without the vaccines we ALL would have gotten COVID and been drenched in viral RNA, and those of us that didn’t die would have had the same interaction of our cells and the virus that I just described. What I believe is important is the mistrust which is engendered by the government through this kind of misinformation or paternalistic disinformation. Either the scientists at the CDC are woefully ignorant of the scientific facts (misinformation), or the bureaucrats are making sure you don’t get information which they think you are not equipped to understand, and might lead you to make a choice they don’t favor (disinformation). Neither one is a good look, and at this point in time you might think they would have learned the lesson.

I suggest that you make an individualized assessment of your future vaccination needs based on a good understanding of the science (which undoubtedly is a bit complicated), a clear picture of your risk based on all the factors we have discussed at length in these blogs, and in consultation with your physician. Medicine is at its best a highly individualized endeavor, and one size fits all rarely works well.

One last tidbit: If you have any history of liver disease or significant immune compromise, skip the raw, warm water oysters from the Gulf this summer. Vibrio vulnificus is a nasty warm water bacteria which recently claimed the lives of two raw bar enthusiasts in Florida. Turns out that recent data strongly suggests our ancestors may have been following the old saying to only eat oysters in months with an R in the name for at least 4000 years. Seems like sage advice. Thanks for your interest and enjoy those hamburgers, hotdogs and other cooked delicacies this Labor Day weekend.