After Omicron emerged as a highly contagious variant of concern, the majority of the world accepted a harm reduction strategy: get vaccines in as many arms as possible, then slowly open up. In many countries, this turned out to be a good public health strategy to reduce death, minimize stress on healthcare systems, improve quality of life, improve the economy, etc. However, China continues to attempt a zero-COVID strategy—very, very tight restrictions—in an attempt to stop
Thank you as always for your thoughtful newsletters! Question: you talk about an immunity wall and the primacy of hybrid immunity. But I’m starting to see a lot of studies (or, at least interpretations of studies) that imply Covid infection begets Covid infection (I.e., you are MORE likely to get reinfected if you’ve had it once), which would mean an “immunity wall” is basically impossible. Am I misunderstanding these studies? Am I being gaslit with them by people with an agenda? Are these studies flawed to begin with? I want to believe my kids can live long, healthy lives even if they eventually stop masking. 😬
Your concluding point is important: China may be half-way round the world from the U.S., but we are still all interconnected. Whatever variants evolve in China aren't guaranteed to stay there.
Really nicely organized - and especially appreciate how you frame the potential for global consequences. You mentioned "second generation vaccines that stop transmission" - intriguing! Are there such vaccines currently in clinical trials? Biologically, how does 'stopping transmission' work? (It would have to engage some fundamental difference from the way the current vaccines work correct?) What vaccines (against any pathogen) do we have that stop transmission?
Is it evident how the 1918 epidemic evolved into an endemic virus? Would a more ladder-like evolution also imply a transition to a lower level endemic phase?
Very interesting update, tragic for the Chinese people, and geopolitically quite messy. Accepting or purchasing antiviral help from democratic sources like the United States/Pfizer/Paxlovid or Japan/Shionogi/Xocova both sound like nonstarters for the Chinese state?
The FT graph you shared shows a spike of Covid deaths in South Korea but fails to capture just how much all-cause mortality blew up this past Spring. **Crude death doubled**, which if you compare across nations is unprecedented at any phase of the pandemic, in any country.
As I noted last week, be careful with South Korea data. One of two things is happening:
1) they are undercounting Covid deaths by a significant number
-OR-
2) Something else is causing excess deaths to skyrocket.
(There may be a 3rd thing, I haven't thought of?)
Skeptics of the vaccine believe it was the vaccine which caused the excess deaths, as they aren't being attributed to Covid.
I think just as likely that they were Covid deaths, but due to their limited testing and different classification (perhaps the US is more generous of dying "with" covid?) we aren't seeing apples to apples comparison.
If it is the latter, then this may indicate boosters aren't enough - they had high update and even added a second booster last April.
If you are relying on Our World In Data to measure excess deaths, you miss this signal as they are doing something strange with their projections which undercounts excess deaths. [1]
Source:
Mortality.org the easiest to use (Data > STMF > STMF output file)
(basically in September of 2021 they stopped using the 4 year average and switched to a model which certainly is undercounting excess mortality now in several countries including South Korea)
Hospitalizations in the US up 20% over last week. It's still too early to say that was a result of Thanksgiving. New clades identified frequently but as you note, with so many new variants, we'll lose the attention of the labs to identify something with a real serious potential for virulence until too late. And surveillance testing is so low as to approach where we were in early March 2020. I think it's time to declare this pandemic over? Oh, wait. A lot of people already did and are about to be caught flat-footed.
KJ-"It could also impact viral evolution. If COVID-19 takes hold in China, there will be little to stop the virus from jumping person-to-person in a network of 1.4 billion people—about 20% of the global population. Some mutations arise from persistent infection with immunocompromised people (we think this is how Omicron developed), but the more a virus jumps, the more opportunity it has to randomly mutate. This is how we got Delta, for example."
Africa has just as many people and seems like zero interest in vaccinating as Covid is largely ignored (it seems - skimming through African news it seems to be regarded as a Western problem).
Any potential problem China poses as far as being a vector was already present in Africa, no?
Since the Covid vaccines don't stop transmission, I don't see how this hypothesis holds up. Covid blows in vaccinated populations as easily as unvaccinated ones (see, Denmark, Israel, South Korea, Vermont, California, Australia, Germany, etc.)
Obviously, China's "zero Covid" strategy didn't work. I'm wondering if there's any long-term data now on Sweden, given they took more of a hands-off approach early on. I think it's important to compare different approaches and everything in between so we get a better sense of how to handle the next pandemic.
What is the recommendation for when a person (healthy, in 50’s and children 9+ and healthy) should get bivalent vaccine after infection? We are current in our vaccines. I’ve heard 60 days but also 90 days. Thank you!
I dread the idea of a nation of 1.4 billion people acting, in effect, as a giant petri dish for the continuing evolution of this virus. Sooner or later it is going to randomly generate a variant that will combine long asymptomatic infection, immune escape, high infectivity, and high lethality. The luck has been with us that the virus didn't start out in 2019 with this nightmare form. As things worked out, we've had the time to develop our biotechnology, surveillance systems and medical infrastructure to deal with future outbreaks of the zoonotic. But at what a cost.
QUESTION: Do you know if/when the FDA would officially approve any of those full head, plastic "mask/hood/respirators" for non-medical personnel (the average citizen on the street)? I found one called "Micro Climate Mask"/$300 -- (Would these prototype "Hood/Masks" be worth the $300 that it costs, even if it was just further mitigation & not 100% prevention?)
Huge thank-you for this clear and informative essay.
I have a question....
I'm 81, have the full complement of available vaccinations. I was very sick for two days after the Bivalent shot. Mainly 'heavy duty' body aches, unable to sleep - no fever. Found out that my Primary Care physician had similar experience. Is this at all common? Is this a 'good' immune response?
China has now given up the "No COVID" policies after protests by very brave people started growing larger and larger. So what will happen now ? A huge wave of infections, deaths, and hospitalizations?
I bet that does not happen, despite all the dire predictions seen here. Anybody here want to take that bet?
Take a look at highly vaccianted Denmark. They had a daily peak in vaccinations given in December 2021 - 80% of the population was vaccinated by then. Their biggest daily spike in deaths occurred in March 2022, 3 months later. After that Denmark banned COVID shots for almost everybody under 50 years of age. After April 2022 almost nobody was given COVID shots. Apparently they have rejected the latest bivalent booster shot. And their death rate now is far lower than it was in March.
Are nations that vaccinated a very large percentage of their populations with mRNA COVID vaccines and have continued with all the boosters now doing better than nations that never adopted mRNA vaccines? That's something for epidemiologists to look at, right? I've not seen any analysis like that done by epidemiologists or U.S. government agencies.
It's a mystery as to why China never adopted mRNA vaccines after they have been in development for a long time now.
Can you recap the stats on those over 65 dying from covid? I read a report that threw out a few stats as to their vaccination status, but the stats were not complete. I'd appreciate it, thanks!
Thank you as always for your thoughtful newsletters! Question: you talk about an immunity wall and the primacy of hybrid immunity. But I’m starting to see a lot of studies (or, at least interpretations of studies) that imply Covid infection begets Covid infection (I.e., you are MORE likely to get reinfected if you’ve had it once), which would mean an “immunity wall” is basically impossible. Am I misunderstanding these studies? Am I being gaslit with them by people with an agenda? Are these studies flawed to begin with? I want to believe my kids can live long, healthy lives even if they eventually stop masking. 😬
Your concluding point is important: China may be half-way round the world from the U.S., but we are still all interconnected. Whatever variants evolve in China aren't guaranteed to stay there.
It’s not a coincidence that respect for human rights and freedom generally leads to the best longterm outcome - even during a pandemic.
Really nicely organized - and especially appreciate how you frame the potential for global consequences. You mentioned "second generation vaccines that stop transmission" - intriguing! Are there such vaccines currently in clinical trials? Biologically, how does 'stopping transmission' work? (It would have to engage some fundamental difference from the way the current vaccines work correct?) What vaccines (against any pathogen) do we have that stop transmission?
Is it evident how the 1918 epidemic evolved into an endemic virus? Would a more ladder-like evolution also imply a transition to a lower level endemic phase?
Very interesting update, tragic for the Chinese people, and geopolitically quite messy. Accepting or purchasing antiviral help from democratic sources like the United States/Pfizer/Paxlovid or Japan/Shionogi/Xocova both sound like nonstarters for the Chinese state?
The FT graph you shared shows a spike of Covid deaths in South Korea but fails to capture just how much all-cause mortality blew up this past Spring. **Crude death doubled**, which if you compare across nations is unprecedented at any phase of the pandemic, in any country.
As I noted last week, be careful with South Korea data. One of two things is happening:
1) they are undercounting Covid deaths by a significant number
-OR-
2) Something else is causing excess deaths to skyrocket.
(There may be a 3rd thing, I haven't thought of?)
Skeptics of the vaccine believe it was the vaccine which caused the excess deaths, as they aren't being attributed to Covid.
I think just as likely that they were Covid deaths, but due to their limited testing and different classification (perhaps the US is more generous of dying "with" covid?) we aren't seeing apples to apples comparison.
If it is the latter, then this may indicate boosters aren't enough - they had high update and even added a second booster last April.
If you are relying on Our World In Data to measure excess deaths, you miss this signal as they are doing something strange with their projections which undercounts excess deaths. [1]
Source:
Mortality.org the easiest to use (Data > STMF > STMF output file)
It ties out to Korean CDC data which is clunkier:
https://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1B8000G&conn_path=I2&language=en
If you don't have time to recreate the pivot tables here is a screenshot, you be the judge:
https://imgur.com/a/WugvPkl
[1] https://ourworldindata.org/excess-mortality-covid#how-is-excess-mortality-measured
(basically in September of 2021 they stopped using the 4 year average and switched to a model which certainly is undercounting excess mortality now in several countries including South Korea)
Hospitalizations in the US up 20% over last week. It's still too early to say that was a result of Thanksgiving. New clades identified frequently but as you note, with so many new variants, we'll lose the attention of the labs to identify something with a real serious potential for virulence until too late. And surveillance testing is so low as to approach where we were in early March 2020. I think it's time to declare this pandemic over? Oh, wait. A lot of people already did and are about to be caught flat-footed.
Another point would like clarified:
KJ-"It could also impact viral evolution. If COVID-19 takes hold in China, there will be little to stop the virus from jumping person-to-person in a network of 1.4 billion people—about 20% of the global population. Some mutations arise from persistent infection with immunocompromised people (we think this is how Omicron developed), but the more a virus jumps, the more opportunity it has to randomly mutate. This is how we got Delta, for example."
Africa has just as many people and seems like zero interest in vaccinating as Covid is largely ignored (it seems - skimming through African news it seems to be regarded as a Western problem).
Any potential problem China poses as far as being a vector was already present in Africa, no?
Since the Covid vaccines don't stop transmission, I don't see how this hypothesis holds up. Covid blows in vaccinated populations as easily as unvaccinated ones (see, Denmark, Israel, South Korea, Vermont, California, Australia, Germany, etc.)
Obviously, China's "zero Covid" strategy didn't work. I'm wondering if there's any long-term data now on Sweden, given they took more of a hands-off approach early on. I think it's important to compare different approaches and everything in between so we get a better sense of how to handle the next pandemic.
What is the recommendation for when a person (healthy, in 50’s and children 9+ and healthy) should get bivalent vaccine after infection? We are current in our vaccines. I’ve heard 60 days but also 90 days. Thank you!
I dread the idea of a nation of 1.4 billion people acting, in effect, as a giant petri dish for the continuing evolution of this virus. Sooner or later it is going to randomly generate a variant that will combine long asymptomatic infection, immune escape, high infectivity, and high lethality. The luck has been with us that the virus didn't start out in 2019 with this nightmare form. As things worked out, we've had the time to develop our biotechnology, surveillance systems and medical infrastructure to deal with future outbreaks of the zoonotic. But at what a cost.
QUESTION: Do you know if/when the FDA would officially approve any of those full head, plastic "mask/hood/respirators" for non-medical personnel (the average citizen on the street)? I found one called "Micro Climate Mask"/$300 -- (Would these prototype "Hood/Masks" be worth the $300 that it costs, even if it was just further mitigation & not 100% prevention?)
Huge thank-you for this clear and informative essay.
I have a question....
I'm 81, have the full complement of available vaccinations. I was very sick for two days after the Bivalent shot. Mainly 'heavy duty' body aches, unable to sleep - no fever. Found out that my Primary Care physician had similar experience. Is this at all common? Is this a 'good' immune response?
Thank you
Heinz
China has now given up the "No COVID" policies after protests by very brave people started growing larger and larger. So what will happen now ? A huge wave of infections, deaths, and hospitalizations?
I bet that does not happen, despite all the dire predictions seen here. Anybody here want to take that bet?
Take a look at highly vaccianted Denmark. They had a daily peak in vaccinations given in December 2021 - 80% of the population was vaccinated by then. Their biggest daily spike in deaths occurred in March 2022, 3 months later. After that Denmark banned COVID shots for almost everybody under 50 years of age. After April 2022 almost nobody was given COVID shots. Apparently they have rejected the latest bivalent booster shot. And their death rate now is far lower than it was in March.
Are nations that vaccinated a very large percentage of their populations with mRNA COVID vaccines and have continued with all the boosters now doing better than nations that never adopted mRNA vaccines? That's something for epidemiologists to look at, right? I've not seen any analysis like that done by epidemiologists or U.S. government agencies.
It's a mystery as to why China never adopted mRNA vaccines after they have been in development for a long time now.
Can you recap the stats on those over 65 dying from covid? I read a report that threw out a few stats as to their vaccination status, but the stats were not complete. I'd appreciate it, thanks!