The COVID Slow Burn

Watching Children Play is Good Therapy.

I was going to skip an update this week, recognizing that we all need a break from COVID, but a few significant items crossed my path, and here is the quick summary. This week Dr. Anthony Fauci came down with COVID, an event of no real significance in the course of the Pandemic cataclysm; however, one could choose to see it in a symbolic sense, as the certain sign that we are all indeed destined to get COVID, whether we know it or not. After all, when the high priest of vaccines and double masking—who passed up a free steak dinner at the Democratic fundraiser in DC just to avoid the tainted air—comes down with the virus, it seems like game up. That is basically one way of looking at an endemic respiratory virus; you don’t need to do anything other than breath to catch it, so almost all of us do sooner or later. Right now, here in Colorado, the Sons of Omicron wave is beginning it’s slow burn crest right on schedule. Twenty four out of sixty counties have moved into the CDC’s highest level of community transmission, compared to almost none at the beginning of May. Nationwide, identified but grossly undercounted, cases are basically plateaued at 100,000/day for a month now. New daily hospitalizations continue on a steady upslope, currently at 4,300/day. That contrasts with an all time pandemic high of 21,500/day in early January during the first Omicron wave, but markedly above where we were last June when there were very few hospitalizations. BA.4/.5 are right on schedule as well, doubling in frequency every 8-9 days and now up to 23% of viral sequences nationwide. They will replace BA.2.12.1 and BA.2 in July, and as discussed in recent prior posts, it is likely they will cause a significant round of new infections in people who previously recovered from earlier Omicron lineage variants.

This week, as expected, the FDA approved EUA’s for both Pfizer and Moderna vaccines in the 6 mo to 5 yo age group. If that is significant for your personal situation, my post of June 5th has some some data that I think it would be wise to review before discussing with your pediatrician. The FDA also approved the first clinical test that has the potential to make it possible to easily measure a person’s T cell immunity against COVID. While measuring B cell, or antibody based immunity, is relatively easily done, assays for T cell, or cellular immunity, have been very complicated and laboratory intensive until now. To put into perspective how this information might eventually be used, let’s consider the following. Neutralizing antibodies (B cell derived) have a great influence on whether you get infected. T cell immunity has a profound influence on how sick you eventually get once infected. The current vaccines have been lapped in the race with the virus and are now providing only modest reductions in your risk of infection, and only for short periods of time after boosters. However, these vaccines have provided longer lasting T cell immunity against a wide array of the COVID variants. That’s one important reason that the death rate has remained relatively low in the face of uncontrolled transmission of COVID. Having a clinical test that could accurately determine whether the person still has good protection from serious COVID disease would be a nice advantage in assessing the need for and timing of further vaccination, or the need for antiviral or monoclonal therapy in the case of infection.

Social scientists of all flavors will be dissecting the Pandemic playbook from around the world for many years. A whole generation of graduate dissertations are waiting to be written, and books, perhaps less steeped in politics than the current crop, and with the benefit of accumulating data, will eventually add to our understanding of the whole event. This weekend at the Telluride Bluegrass Festival I was struck by the hundreds of young children, from toddlers up to pre-teens, running, playing, laughing, dancing, with painted faces and costumes, and no masks. I marveled at not seeing any child crying or acting out, and I thought—isn’t that great, they are back to normal without missing a beat. But are they? Data coming out of San Paulo Brazil, where schools were shut down for a year and a half in some cases, show fourth and fifth graders up to two years behind in learning, and with a great deal of increased behavioral problems and aggressive behavior. Here in the US, we had huge numbers of children denied access to in person learning, sometimes for over a year. In many cases this occurred in large cities on either coast, and affected children from families without the circumstances or means to even attempt to make up for this loss. Was this a good idea? What was it predicated on? Who is to blame if it was a very bad idea, so it is not repeated in the future?

The guiding principle behind much of public health policy here in the US seems to have been Utilitarianism, the philosophical construct that dictates the only moral course is the one which maximizes the well being and happiness of the maximum number of people. Several problems arise out of that approach. When there are no other first principles to guide, utilitarian policy decisions are always a shot in the dark as to whether they will achieve the only goal that matters under this framework. You can never say that you are acting morally until the game is played out and all the consequences are known. This approach also values the health and happiness of all individuals equally, which I find very problematic. Should the health and happiness of an infirm, elderly nursing home resident— with limited life expectancy and zero possibility of contributing anything in their remaining life span which could potentially increase the total world utility—be equal to that of a young child? Well that is the valuation which we accepted in many areas of the country, and it will take quite a long time to take stock of the consequences. Perhaps the approach was not so surprising given the preponderance of octogenarians in our governing leadership, and the fact that nursing home residents, and other free living elderly with impaired cognition, freely vote, while children do not.

The Monkey Pox cases currently number 2662 world wide with no deaths, and no indication that the pattern of spread has changed. What is concerning is that the slope of the case curve is accelerating. The UK continues to top the leaders board with 576 cases, while the US has recorded 113 cases. If people would just stop having sex for 21 days this would be quickly extinguished. I suppose you could say the same thing about a brief pause in the act of breathing for a few days being a way out of COVID, and equally likely to happen. The WHO made the news again this week with the notification that they will be doing the important work of finding a new name for Monkey Pox. Some socially conscious scientists apparently complained about the terrible stigma associated with the name, and in a repeat of the Wuhan saga, the Pox will get a new name. The WHO haven’t said if they will be holding focus groups to decide between the leading candidates of MPO. 1.01.1X or the equally useful, DonTouchame 6.0 virus. Leading progressive simians have already signaled their support. Meanwhile, I’d like to point out that after a short period of time where calling it Wuhan virus would get you cancelled and excoriated on social media, I see many scientific papers now referring to it as such. I suppose there may be insufficient woke censors perusing scientific papers given the demands and greater rewards of policing social media. I can only assume that the Germans and the Chickens have particularly ineffective lobbies for the renaming of their eponymous measles and pox. That goes for people living along the Ebola river, in Marburg Germany, in Lassa Nigeria and in the Crimea. That concludes the Pet Peeves.