The Pandemic is Over??

We received the exciting news from President Biden this week that the pandemic is over. As proof he offered the evidence, “Look, people aren’t wearing masks anymore.” Biden’s, “Behold I bring you tidings of great joy”, moment was rapidly contradicted by Dr. Anthony Fauci the next day. Perhaps Fauci is influenced by: Americans continuing to die from COVID at a 9/11 event rate every week, which makes this virus still a leading cause of death; 40,000 new cases a day, which of course is a tiny fraction of the true number, tens of millions of Chinese under lockdown while the CCP continues to pursue it’s quixotic, and doomed zero COVID policy. I rechecked the definition of a Pandemic from several sources, just to be sure the last 2 3/4 years hadn’t affected my wiring, and as expected, that definition hasn’t changed.

pandemic, outbreak of infectious disease that occurs over a wide geographical area and that is of high prevalence, generally affecting a significant proportion of the world’s population, usually over the course of several months

The unchecked spread of COVID around the world means the pandemic continues; and the appearance of novel variants, like BA.2.275 with increased antibody evasion, means we will continue to see peaks and troughs in disease activity. Winter waves of COVID have happened every year, and will again this year. This is because immunity from natural infection and from endless boosters is only partial, short lived, and does not prevent the asymptomatic spreading of disease. If we are unlucky —like that hasn’t happened repeatedly— we could see a variant with increased virulence. The definition of a Pandemic has nothing to with how lethal the infection is, and it has even less to do with how people choose to respond psychologically and behaviorally. What’s the harm in boosting spirits with a statement that the Pandemic is over? There is the annoying reality that money for COVID testing, treatment and now vaccines is exhausted. It might not be the best approach to beg a reluctant Congress for more money by telling them the Pandemic is caput. Then there is our unflinching devotion to Truth — I didn’t much like being told, “this is just a bad flu”, and I’ll apply the same standard here.

The WHO just released its updated COVID treatment guidelines. I hope this hasn’t diverted them from the critically important work of renaming the Monkeypox. The most significant change was recommending against the use of two monoclonal antibodies (Sotrovimab and Casirivimab/Imdevimab). That’s all appropriate, we have known for 6 months or more that these monoclonals were not active against the circulating Omicron lineages. What I find inexplicable is the WHO’s failure to recommend potential use of Bebtilovimab, the only clinically available monoclonal that retains activity against all the Omicron variants seen so far. Below is a table from Yamasoba, et al. (doi: https://doi.org/10.1101/2022.07.14.500041) showing the potency of various monoclonals against significant sons of Omicron—the higher the number the less active is the drug. As you can see Bebtilovimab is the only monoclonal with good activity against all variants; it has taken a hit with BA.2.275, but still is in a range where we would expect good clinical activity. The WHO continues to recommend use of Ivermectin only within a clinical trial. Let the talking heads on cable news take issue with the WHO for suggesting it’s ok to use the “horse dewormer” in clinical trials.

Let’s turn now to the vaccine booster data. The government has just spent what was once a boatload of cash on the new bivalent booster preparations, with zero human clinical efficacy data, marginal improvement in antibody response in mice, and plenty of unused original vaccine left on the shelf. Moderna will supply 66 million doses for $1.75 billion, and Pfizer will be supplying 105 million doses for $3.2 billion. With expected vaccine sales of $32 billion in 2022—GO PFIZER! Experts are divided on the necessity, and likely benefit of this change in the vaccine formula. The government will of course make it seem like the New Vaccine is a major advance, but realistically you should view it as just another short term boost in immunity. According to MMWR of September 5, 2022, 49% of eligible people over the age of 5 with a primary vaccination series have had one booster. Of the 59 million eligible for a second booster only 34% have gotten it. That ranks the US at 73rd in the world for booster uptake. In prior posts I have discussed my belief that inept CDC messaging, and a chaotic sequence of booster approvals for various age and other groups was largely responsible for Americans having a lower booster rate than Brazil, Bhutan or Estonia. “The Pandemic is over”, is no doubt part of the well orchestrated plan to convince people to at least take a crucial third dose of vaccine, or further boosters if they are at high risk. In the mean time, over the course of this year a large percentage of the population was “vaccinated” by Omicron, so it wouldn’t be a stretch of the imagination to foresee quite a glut of expensive vaccine sitting on the shelf. While we are on the subject of unused vaccine, the uptake rate in the youngest children is in line with my prediction. As of September 14, only 8% of children 6 mo-4 yo have received one dose of vaccine and only 325,000 are fully vaccinated. It’s hard to spin this through the political lens; in Washington DC, which is the most Democrat demography in the US (with 5.3% registered as Republican) only 7.6% of the kids in this age group are vaccinated. Despite the CDC and the American Academy of Pediatrics telling people they must vaccinate their children, something other than political leaning must be informing parents’ decisions.

Also this week, in addition to learning the Pandemic is over, we got the news that we will now be transitioning to once a year COVID shots. This of course has nothing to do with any scientific data that suggests this is the correct schedule, it is simply a matter of convenience and practicality. A recent NEJM paper from Israeli shows that the protection from hospitalization from a third shot in the BA.4/.5 era fades rapidly to <50% by 4 months. We can certainly expect new variants to schedule their arrival to line up with the yearly fall shots, so that will be covered. Let’s not forget that the free COVID shots are very soon to be a thing of the past—that gravy train is going the way of 1.5% inflation and $2 gas. The likely scenario is people who might be inclined to take a booster will weigh various factors such as: their perceived demographic/medical risk, how long it’s been since they had a virtually inevitable COVID infection boosting their immunity, the degree of side effects from previous shots, and importantly for many, how much it will cost out of pocket. The government can and does print money ad nauseam, but it looks like a lot of it will be going to Ukraine for the time being to help kill Russians.

In contrast to the blink of the eye development of the COVID vaccines, the development of an effective malaria vaccine has taken more than a century since the causative organism was first identified. Malaria continues to kill about 400,000 people per year, and in contrast to COVID, the parasite primarily kills children and babies. On a bright note, a team of vaccinologists from Oxford recently published in Lancet Infectious Diseases, results of a study demonstrating that in babies 5-17mo, a 3 dose series of their vaccine with a booster at a year was 80% effective in preventing clinical malaria during the subsequent year. The vaccine is reported to be relatively cheap and easy to scale production into the hundreds of millions of doses. This is potentially world changing, and if approved, I doubt we will see this vaccine languishing on shelves.

Efficacy and immunogenicity of R21/Matrix-M vaccine against clinical malaria after 2 years' follow-up in children in Burkina Faso: a phase 1/2b randomized controlled trial

Finally I will leave you with some words to ponder from the brilliant American physicist and Nobel Prize winner Richard Feynman.

Science alone of all the subjects contains within itself the lesson of the danger of belief in the infallibility of the greatest teachers in the preceding generation (…) When someone says, “Science teaches such and such,” he is using the word incorrectly. Science doesn’t teach anything; experience teaches it. If they say to you, “Science has shown such and such,” you might ask, “How does science show it? How did the scientists find out? How? What? Where?” It should not be “science has shown” but “this experiment, this effect, has shown.” And you have as much right as anyone else, upon hearing about the experiments–but be patient and listen to all the evidence–to judge whether a sensible conclusion has been arrived at. (…) The experts who are leading you may be wrong… Science is the belief in the ignorance of experts.

A healthy dose of humility and sympathy for our fellow travelers through the stresses of the Pandemic would be an excellent lesson to be taken from the events of the last 3 years. Use your own clear and present thinking to evaluate information, and always be skeptical of conclusions which are presented as dogma that may not be questioned.

Thanks as always for your attention and comments, which are most appreciated. Please subscribe, forward to friends and colleagues, and indicate your interest in the subject material with the appropriate button. Happy equinox.