Tag Archives: SARS Virus

Bottom-Line Booster Shots

17 Saturday Apr 2021

Posted by in Coronavirus, Public Health, Vaccinations

≈ Leave a comment

Tags

, , , , , , , , , , , , , , ,

The barrage of precautionary COVID missives continues, and with a familiar “follow-the-money” twist. The CEOs of both Pfizer and Moderna say that booster shots are likely to be needed a year after initial administration of their COVID vaccines, and almost certainly every year thereafter. Of course, this message is for those who felt compelled to be vaccinated in the first place, whether out of concern for their own health, high-minded community spirit, fear of social ostracism, or fear of possible vaccine passport requirements. It’s probably also intended for those who acquired immunity through infection.

There are reasons to believe, however, that such a booster is unnecessary. This case was made a few days ago in a series of tweets by Dr. Monica Ghandi, an infectious disease expert and Professor of Medicine at UCSF. Ghandi says immunity from an infection or a vaccine can be expected to last much longer than a year, despite the diminished presence of antibodies. That’s because the immune system relies on other mechanisms to signal and produce new antibodies against specific pathogens when called upon.

So-called B cells actually produce antibodies. Another cell-type known as T cells act to signal or instruct B cells to do so, but so-called “killer” T cells destroy cells in the body that have already been infected. Dr. Ghandi’s point is that both B and T cells tend to have very long memories and are capable of conferring immunity for many years.

While our experience with COVID-19 is short, long-lasting immunity has been proven against measles for up to 34 years, and for other SARS-type viruses for at least 17 years. Dr. Ghandi links to research showing that survivors of the 1918 flu pandemic were found to have active B cells against the virus 90 years later! The COVID vaccines cause the body to produce both B and T cells, and the T cells are protective against COVID variants.

A last point made by Dr. Ghandi is intended to dispel doubts some might harbor due to the relatively ineffectual nature of annual flu vaccines. The flu mutates much more aggressively than COVID, so the design of each year’s flu vaccine involves a limited and uncertain choice among recent strains. COVID mutates, but in a more stable way, so that vaccines and adaptive immunity tend to retain their effectiveness.

While I’m sure the pharmaceutical companies believe in the benefits of their vaccines, there are undoubtedly other motives behind the push for boosters. There is money to be made, and much of that money will be paid by governments eager to jump on the precautionary bandwagon, and who are likely to be very insensitive to price. In fact, the vaccine producers might well have encouraged those pushing vaccine passports to include annual booster requirements. This would be another unwelcome imposition. The very discussion of boosters gives government officials more running room for other draconian but ultimately ineffective mandates on behavior. And the booster recommendation gives additional cover to public health “experts” who refuse to acknowledge real tradeoffs between the stringency of non-pharmaceutical interventions, economic well being, and other dimensions of public health.

Blow Me Down: Obesity, Age, and Aerosol-Borne Particles

09 Friday Apr 2021

Posted by in Coronavirus, Lockdowns, Public Health

≈ 1 Comment

Tags

, , , , , , , , , , , , ,

Super-spreading events are gatherings at which one or more attendees are already harboring an infection and manage to transmit it to a number of others. These people, in turn, spread it to their close contacts, possibly at the same event. Super-spreading has dominated the transmission of COVID-19. These transmissions have almost always taken place indoors in spaces with limited ventilation, and they have usually involved close or prolonged contact. In addition, super-spreading originates with a small subset of infected individuals. That’s essentially what the chart above shows. It ranks individual subjects by their exhaled quantity of aerosolized particles per liter of air.

For more than a year, we’ve also known that obesity and age are associated with more severe COVID infections. Now, it’s startling to learn that obese and/or older, infected individuals are more prone to transmitting virus: this study found that a high body mass index (BMI) is associated with significantly greater quantities of exhaled aerosol, and that age has a similarly strong association. So called BMI-years, or age x BMI, has an extremely powerful association with the exhalation of aerosol-borne particles. The authors, David A. Edwards, et al, believe this is a consequence of the properties of mucus produced by different individuals in response to infections and how their lungs and airways handle it. The authors say:

“Our findings indicate that the capacity of airway lining mucus to resist breakup on breathing varies significantly between individuals, with a trend to increasing with the advance of COVID-19 infection and body mass index multiplied by age (i.e., BMI-years). Understanding the source and variance of respiratory droplet generation, and controlling it via the stabilization of airway lining mucus surfaces, may lead to effective approaches to reducing COVID-19 infection and transmission. … ”

“Surfactant and mucin compositional and structural changes, driven, in part, by physiological alterations of the human condition—including diet (10), aging (11), and COVID-19 infection itself (12)—may therefore be anticipated to alter droplet generation and droplet size (7) during acts of breathing.”

So there is substantial variation in the exhalation of aerosol-borne particles across individuals. In the study, less than 20% of healthy subjects produced more than 156 particles per liter of air, accounting for 80% of the exhaled particles. This defined their so-called “super-spreader” cohort. The association of BMI-years and exhaled particles was less pronounced but still positive within the “low-spreader” cohort.

Edwards, et al speculate that these fine droplets might help explain the greater severity of COVID infections among the elderly and obese. Not only does the breakup of mucus into tiny droplets cause these individuals to exhale aerosols more profusely, it probably also leads to deep penetration into their lung tissue.

This knowledge might be broadly applicable to infectious diseases, and SARS viruses in particular. The elderly know they are vulnerable. It’s not clear that the obese have viewed themselves as vulnerable, but they should, even in the age of “body positivity“. And not only are they vulnerable: they appear to pose an elevated hazard to others. I came across a couple of sardonic comments that got right to the apparent elephant in the room: “Instead of a mask mandate, how about a push-up mandate?”; and “Instead of a vaccine passport, how about a BMI passport?”

The debate about how to care for the most vulnerable is ongoing, but the mere mention of regularities like those identified by the study might lead to proposals for coercive policies. But first, a few practical points to bear in mind: 1) while the study identifies a major risk factor for transmission, it must be replicated by others, and there must be research into the underlying reasons for the phenomenon; 2) while the obese and seniors may be more likely to super-spread, not all of them are super-spreaders; and 3) as a matter of policy, how would “super-spreaders” be defined? What would be the cutoff BMIs at various ages? No matter what was decided, restrictive policies predicated on mere statistical associations would involve gross injustices to a large number of individuals.

With the degree of acquired immunity already in the population and fairly widespread voluntary vaccination (since alarmists have scared the bejeezus out of everyone), the whole issue might seem moot. It’s not, however, because COVID-19 is likely to become endemic, the immunities of some individuals might erode more quickly than expected, new and more dangerous variants might arise, and new SARS viruses are likely to emerge with time.

In a pandemic, however, and even without knowing who is infected, it is ethically barbaric to probabilistically isolate classes of individuals, whether based on age, BMI, or anything other than contagious status. The social cost is simply unacceptable. Instead, public health authorities should provide information to those at high risk, facilitate vaccination for those who desire it, and promote rapid, at-home tests. This is essentially a deregulatory agenda relative to the mindless lockdown approaches favored by so many public health experts.

Everyone must balance their own personal risks and rewards. Based on the study of exhaled particles discussed above, some might shun the obese and seniors until the threat has passed. Some of the obese and elderly might shun each other. That might be another regrettable dimension of the costs of a pandemic. On the other hand, perhaps more of us will respond to the unquestionably positive incentives for weight loss, of which we’re almost all aware.

COVID, Trump, and Tyrants

11 Sunday Oct 2020

Posted by in Pandemic, Public Health, Trump Administration

≈ Leave a comment

Tags

, , , , , , , , , , , , , , , ,

I’ve said this before, but it bears repeating: allegations of the White House’s “poor leadership” and preparedness for COVID-19 (C19) are a matter of selective memory. At the link above, I “graded” Trump’s pandemic job performance through May. Among other things, I said:

“Many have criticized the Trump Administration for not being ‘ready’ for a pandemic. I assign no grade on that basis because absolutely no one was ready, at least not in the West, so there is no sound premise for judgement. I also view the very general charge that Trump did not provide “leadership” as code for either ‘I don’t like him’, or ‘he refused to impose more authoritarian measures’, like a full-scale nationwide lockdown. Such is the over-prescriptive instinct of the Left.”

The President of the United States does not have the constitutional authority to impose a national lockdown, though Trump himself seemed confused at times as to whether he had that power. However, on this basis at least, the ad nauseam denigration of his “leadership” is vapid. At this point, the course of the pandemic in the U.S. is less severe than in several other industrialized countries who didn’t even have Andrew Cuomo around to exacerbate the toll, and it’s still not as deadly in per capita terms as the Asian Flu of 1957-58.

Who exactly was “ready” for C19? Perhaps critics are thinking of South Korea, or parts of South Asia. Those countries might have been “ready” to the extent that they had significant prior exposure to SARS viruses. There was already some degree of immunological protection. Those countries also were exposed to an earlier genetic variant of C19 that was much less severe than the strain that hit most of the western world. These are hardly reasons to blame Trump for a lack of “readiness”.

A related charge I hear all the time is that Trump “ignored the advice of medical experts“, or that he “ignored the science“. Presumably, those “experts” include the darling of the Prescriptive Class, Dr. Anthony Fauci. On February 28, Dr Fauci said:

“Right now, at this moment, there’s no need to change anything you’re doing on a day by day basis.“

All-righty then! So this was the advice Trump “should” have followed. Oh, wait… he did! And Fauci, on March 9, said there was no reason for young, healthy people to avoid cruise ships.

Likewise, Dr. Robert Redfield, Director of the Centers for Disease Control, said the following on February 27:

“The risk to the American public is low. We have an aggressive containment strategy that really has worked up to this time, 15 cases in the United States. Until the last case that we just had in Sacramento we hadn’t had a new case in two weeks.”

Then there is the World Health Organization, which downplayed the virus in January and February, and giving a convincing impression that it servied as a mouthpiece for the CCP.

In fact, the American people were badly harmed by wrongheaded decisions made by the “experts” at the CDC in January and February, when the agency insisted that testing could not proceed until a test of their own design was ready. Then, the first version it approved was discovered to be flawed! This set the testing effort back by well over a month, a delay that proved critical. It’s no exaggeration to say this bureaucratic overreach denied the whole country, and Trump, the information needed to properly assess the spread of the virus.

But let’s think about actual policy once it became clear that the virus was getting to be a serious matter in parts of the U.S. Here’s another excerpt from my post in May:

“Trump cannot be accused of ignoring expert advice through the episode. He was obviously on-board with Fauci, Dr. Deborah Birx, Dr. Robert Redfield, and other health care advisors on the ‘15 Days to Slow the Spread‘ guidelines issued on March 16. His messaging wavered during those 15 days, expressing a desire to fully reopen the nation by Easter, which Vice President Michael Pence later described as “aspirational”. Before the end of March, however, Trump went along with a 30-day extension of the guidelines. Finally, by mid-April, the White House released guidelines for ‘Opening Up America Again‘, which was a collaboration between Trump’s health care experts and the economic team. Trump agreed that the timeline for reopening should be governed by ‘the data’.” 

We should give Trump credit for shutting down flights into the U.S. from China, where the virus originated, late in January. That was an undeniably prescient move. Let’s also not forget that the original intent of the “15 Days” was to prevent hospitals and other medical resources from being overwhelmed. Today, the data show a strong seasonal tendency to the spread of the virus, but medical resources are not close to being overwhelmed, our ability to treat the virus has vastly improved, and its consequences are much less deadly than in the spring. That’s good progress, whatever the President’s detractors may say.

More than anything else, what Trump’s COVID critics fail to understand is that the executive leader of a republic is not possessed of monarchical powers. And in the U.S., the Constitution provides an additional layer of sovereignty for member states of the Union, a manifestation of the federalist principals without which the Union would not have been possible. The 15-day guidelines produced by the White House, and the guidelines for reopening, were consistent with this framework. The states have adapted their own policies to actual conditions and, if their leaders haven’t worn out their goodwill among voters, internal political realities. Those adaptations were often bad from my perspective, or even tyrannical, but sometimes good. That is exactly how our federalist system was designed to work.