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.
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)
I also wonder about the US deaths at this point. I think it's around 300/day now, mostly among the elderly. But I haven't seen whether they are still "excess"--do you know?
We only have good number on total deaths up through around week 38 (mid September) in the US.
Excess deaths were near zero this past spring, but became elevated again (roughly +700/day) through summer if using 2016-2019 baseline.
The problem is that in the US, non Covid mortality has increased for several areas not related to Covid including accidental deaths (suicide, murder, accidents), heart attacks, strokes, cancer so the baselines is muddied.
Full data on this won't be available in the WONDER database for quite a bit.
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.)
I had a problem with this too. Is the proposed solution to indefinitely lock down 20% of the population (China) to protect the other 80% from a possible mutation? That doesn’t seem like a justifiable reason to suppress human rights.
Exactly KB - the animal reservoirs alone eliminate any chance we can eradicate Covid and prevent further viral evolution. At best I suspect we play whack-a-mole.
Even in the highly vaccinated countries we would always have the pockets of children serving as reservoirs. For some countries, that is a small group (< 6 months), other countries it is < 12 yr, others < 30 yr, others < 65. I believe many Nordic countries not encouraging vaccination for various age groups, correct?
Back to my original "elephant in the room" - Africa.
The statista chart you bring up visually appears to show a decent vaccine uptake, but that is only because they are presenting doses per population without weighting the population.
Seychelles has an impressive 200 doses per 100 resident and is placed at the top, but the country is under 100,000 people, a drop in the bucket in the continents' population of 1.3 billion. Meanwhile the countries at less than 40 doses per 100 residents total 830 million people, though it isn't intuitive looking at the statista chart.
As an aside, I wonder how much the average African's quality of life would improve if we simply gave them $150 cash to spend on whatever they wanted (or we converted it to $150 of food/clean water). Average salary in Nigeria something like $700 USD/year. With so many people dying of avoidable deaths (hunger, lack of water, hygiene) it honestly feels silly to be allocating our fortune in the west to "cure" them of something which poses near zero risk to anyone under the age of 50 to a continent where 90% of the country is under 50. I can't fathom what it is like to live in Africa, but I suspect I would much rather get $150 worth of food than a vaccine which doesn't halt transmission for an illness that has near zero impacting me. That is a lengthy philosophical and ethical consideration, so I digress for now, but worth thinking about in the future.
And finally, to close out this lengthy comment - you note "When the vaccines first came out, we did get a bonus of reduced transmission".
Did we though?
We assumed the drop in cases in early 2021 after we rolled out vaccinations was due to the vaccine, but now that we have 2 years of data it was likely a mirage - we just happened to start vaccinating at the end of the Covid season, so we attributed the receding cases to our intervention. Correlation in this case didn't equal causation. States like Missouri originally chided [1] for having lower vaccination rates than Illinois saw identical curves in cases and all-cause mortality.
_______________
[1] Unvaccinated Missourians fuel COVID: ‘We will be the canary’
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.
Sweden has the second lowest excess deaths in the world, beaten only by Norway (though Norway seeing 10% year over year increase in all-cause mortality in 2022 so may drop to #2). All of the Nordic countries had fantastic outcomes relative to the rest of the world, and all of the Nordic countries returned to their children to school Spring 2020 and had among the shortest restrictions worldwide.
Public Health needs to acknowledge they got this wrong.
Obviously, there are other differences at play, too. I believe the Nordics are generally healthier, and have better social supports in general. But that is VERY interesting (and frankly, kinda what I thought would happen).
Sweden - Not offering to under 50 without doctor recomendation
Denmark - Anyone over 12 can get it, but they stopped providing it for free to people under 65
Finland - Not offered to "working age" people (I assume < 65?) This is sketchy though as I can only find one source and it is a tabloid paper (Iltalehti) so may not be reliable
Google not helping to clarify any of the above, trying to push articles from 2021. I might go to reddit and ask each country subreddit what's going on as I would like to know (same with India, they seem to have little interest in booster based on data). I even subscribe to TheLocal which is nordic newspaper and can't find much on it.
I am 42, healthy as far as I know. I have not received the bivalent booster. We have masked and avoided and gotten the other shots as soon as possible. But, Moderna 2 and 3 rendered me incapacitated with the worst headache of my life and vomiting for 48 hours. I was unable to care for my children (and myself) and wondered if I was having an aneurysm. It was nothing like a flu shot. Or even any other vaccine I have received. I am hoping Paul Offitt’s assessment that I am still protected from the worst is correct. I fear Covid, but the thought of another booster like that is terrifying. My PCM has no guidance other than- maybe try NovaVax.
ADWH - I'm about a year older than you, reasonably healthy, though a penchant for nice cigars and whiskey are my downfall... Your experience with the vaccine is why I kept putting it off. My wife (vascular surgeon) was knocked out 48 hours Dec 2020 and had to cancel surgeries which is unheard of for her. That gave me pause.
Then my social media started filling up with posts recycling the same theme - the vaccine side effects are harsh, but better than getting Covid. I chickened out and kept delaying as I didn't want to be sick for 48 hours, especially since our family had lived our life normally throughout the pandemic and still hadn't gotten Covid (our kids were in school, took vacations, dined out frequently, had parties, etc - zero change for us which seemed to be what most our other physician friends were doing out here in Cleveland "rules for thee but not for me").
Despite my wife having such a terrible reaction to this first (and only) dose she took of Moderna, she still wanted me to get it, but she was so busy with work she acknowledged she wouldn't be able to take care of the kids if I got as sick as her from vaccine.
By the summer of 2021 when it became apparent Israel (Pfizer test country) was overwhelmed with Covid at rates surpassing previous waves, my wife and I tabled vaccine talk for me.
My daughter wound up getting Covid a week before her 12th birthday fall 2021 (I doubt we would have vaccinated at that point anyway as everyone vaccinated was now getting Covid), which consisted of her having a 99 degree fever for 24 hours and having to miss 2 weeks of school. I took care of my daughter, no mask, didn't get Covid. I thought I was one of the lucky people immune.
Flashforward to summer 2022 and I got an unbelievable headache, as bad as the migraine headaches I used to suffer in adolescence, completely knocked me out. For 24 hours. Then I was right back to normal.
I mainly shared this because until your comment I hadn't seen anyone mention headache like that being primary symptom from vaccines so found it odd that was my only symptom to Covid (I felt close to throwing up but never did).
Note my children and myself are all current on vaccines that "work" (i.e. keep you from catching the thing you are vaccinating against), so don't mistake my candor for antivaxx rhetoric - a group I used to troll online for sport back in the day. I just am not in the habit of taking a medication that makes my friends and family feel like shit for little benefit outside of observational cohort studies.
PS - I noticed you are paid subscriber to Unbiased Science Podcast - do you participate in their private facebook group by chance?
I am not really active in the group. I wish the experts I have relied on through all of this would address the side effects. I also see so many sick after the bivalent booster. There seems to be no rhyme or reason.
1) Not sure you are aware, but the primary author of the nature article you linked below, Nele Brusselaers, has been a staunch critic of the Swedish approach from the start of the pandemic. [1][2] I argue this may cloud her judgement and make her biased in how she interprets and selects data to make her case.
When she started her crusade, the early data somewhat backed her, now it does not. It appears she refuses to alter her hypothesis and accept new data. This makes me skeptical she can approach this with disinterestedness - a foundation of science.
2) The all-cause mortality between Nordic countries now places Sweden at the best outcome (previously I had noted it was slightly behind Norway, now it has briefly passed them).
Total excess deaths, per 1 million people, total of 2020-first 40 weeks of 2022, against 4 year historical average [3]:
Norway - 947
Sweden - 926
Finland - 2,179
Denmark - 1,522
This is impressive considering Sweden is the only country in the world which entered 2020 with a sizable mortality deficit - notably in 2019 they had roughly 4,000 fewer deaths than expected which likely meant they see that much of an increase the following year (and this also skews their forecasts lower than probably should). Even with this starting handicap they still outperformed their neighbors (for now, data can and will change, at which point we can update our hypothesis).
I see the Johns Hopkins graph noted in the abc article, and that is weaker evidence than all-cause mortality.
3) Why is it that they only ever compare Sweden to her direct neighbors? Why is it fair to compare California to Florida, the US to South Korea, or Germany to Japan, but the only places Sweden is ever compared in outcome to are 3 very small countries which lack a major international hub like Stockholm (can debate Oslo).
Even if we were to discard that all-cause mortality favors Sweden among her neighbors, Sweden still "beat" every single other country in the world by a considerable margin. It seems unfair that we can hold the US to the standard of Japan, but not Germany to Sweden.
4) In the same vein - why are excuses (euphemized as confounders) made for the poor outcomes in New York, California, citing demographics, population density, being international hubs, but those same confounders aren't applied comparing Sweden to Norway?
If we accept that New York had a catastrophe and can't be blamed for having the highest per capita mortality in 2020 because of NYC, why doesn't Sweden get a pass for having the largest city in Scandinavia? It always seems like the confounders are one directional, allowed when they support the lockdown/mask toddler faction, but disallowed when pointing out relaxed measures had similar outcome
5) And finally, suppose we accept that we can only compare Sweden to her neighbors and not to the rest of Europe or Asia. Suppose we exclude confounders like population density, age, and obesity discrepancies among the Nordic countries. And further suppose we ignore the all-cause mortality and accept Nele Brusselaers hypothesis.
We are left with the fact that all of the Nordic countries had the *lowest* mask usage (and mostly didn't mask their kids throughout the pandemic relative to the rest of the world) [4] The *earliest* return to school (may 2020). [5] The *shortest* lockdowns (varies by country and region).
It seems to me the gap between "laxness" of Sweden to Denmark is smaller than the gap between Denmark and US/South Korea/Germany/etc
This doesn't seem to support the stringent measure hypothesis.
But that's from October 2020. As Michael noted, over time, their strategy seems to have proved correct (albeit, perhaps only for a nation with a healthier, better supported population).
So this is critical of Sweden's communication (or lack thereof) and politicization of the process. That's fair. But it nevertheless seems like their approach, in the end, got better results. Sounds like they could have done even better had they encouraged the use of masks, better care techniques (oxygen etc.) and better protection for vulnerable populations.
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.
On the other hand, Coronaviruses have had 600 million years coexisting with mammals. 50 million years coexisting with bats. 3 million years with our earliest hominid ancestors who (often) lived in caves with bats.
The premise that Coronaviruses waited 600 million years to evolve and strike out to become some highly infectious, highly lethal variant, *JUST IN TIME* for us to also have discovered electron microscopes to see them and PCR tests to detect them feels no different than the doomsday cultists who predict the end of the world *Just so happens* to occur not only within their lifetime, but soon! (see Koresh for example)
The stronger the case we make for natural origin, the more likely this is nothing different than what we have had on the planet for close to a billion years, it's just that this is the first time in history we had the tools to measure them and decided to apply them.
To argue that this is something unlike anything to ever face us I think ticks needle closer to lab made virus we were making in order to develop vaccines for "just in case". That is acknowledged now as something we have been doing for roughly 10 years - you don't need to read Alina Chan "Viral" book, it is also confirmed and acknowledged in Dan Werb's "The Invisible Siege" where he interviews Ralph Baric extensively who casually talks about to make more transmissible coronaviruses so we can find out how to stop more transmissible coronaviruses should they ever arrive.
Good points all, Michael. I looked at your subscription list to see if there were newsletters I should subscribe to, since we often agree
I was amazed! You are neither carnivore, herbivore or omnivore- you are an info-vore! How can you absorb such a flood! I'm getting old and can no longer keep up nor remember what few subscriptions I have 🙁 I may soon have to do a lot of unsubscribing unfortunately.
What do you think are the true origins of covid19? There are so many theories out there.
I had to make a spreadsheet to track all my paid subscriptions. Many of them fizzled out (a few posts and they moved on to something else), but I like to support as many writers as I can - even if I don't agree with them, if they are putting in effort and open to feedback, I subscribe.
I retired young so have a lot of time, and Covid has replaced nearly all my other hobbies. Got a stack of novels collecting dust, millions of hours of Netflix Queue ignored... Covid is just so fascinating.
Origins of Covid? Accidental lab leak. Almost certainly at this point.
It has happened several times before in similar labs, it was bound to happen again.
The problem is that it takes quite a bit of reading to understand how and why this is the most likely cause (beyond Jon Stewarts joke) and the natural origin has appeal of simplicity even though the premise defies common sense.
I thought 100% it was conspiracy theory in 2020, but I try to remain neutral following Carl Sagan tenets of scientific thinking and came around mid 2021 lab leak was possible. The more journalists and investigative reporters dig through, the farther natural origin seems possible.
And if it is natural, we may have overreacted to something that was always happening we just never looked for it before. Must consider that possibility. This is common in medicine. Overdiagnosis.
I thought from the beginning that a lab leak was possible, perhaps even probable. We know something like that happened to the Russians when they were working on weaponizing anthrax in a lab near Sverdlovsk and there is good evidence they were still running a bioweapons effort until at least the nineties. And so likely, were we. So it wouldn't shock if the Chinese were working on similar projects at their facility in Wuhan. But I would think it wasnt an intentional act; they had to shut down in early 2020 almost 25% of their industrial capacity. They were likely as dismayed as we were. We know they hid their true losses: satellite data showed they were running crematoria non-stop.
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?
Heinz' question has important implications. Now 75, I've had mRNA vaccine x5. Other than 2 hours of very mild sore arm on the first shot have had zero 'side' effects. I seem to have a well-functioning immune system and no chronic conditions. My primary care doc said lessened reactivity is common as one ages but not to worry - I'm as protected as I 'should' be. How does this make sense?? Are the vaccine short-term side-effects indicators of innate immune response robustness but not correlated with generating adaptive immunity? Thank you!
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)
I also wonder about the US deaths at this point. I think it's around 300/day now, mostly among the elderly. But I haven't seen whether they are still "excess"--do you know?
We only have good number on total deaths up through around week 38 (mid September) in the US.
Excess deaths were near zero this past spring, but became elevated again (roughly +700/day) through summer if using 2016-2019 baseline.
The problem is that in the US, non Covid mortality has increased for several areas not related to Covid including accidental deaths (suicide, murder, accidents), heart attacks, strokes, cancer so the baselines is muddied.
Full data on this won't be available in the WONDER database for quite a bit.
Thank you!
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.)
I had a problem with this too. Is the proposed solution to indefinitely lock down 20% of the population (China) to protect the other 80% from a possible mutation? That doesn’t seem like a justifiable reason to suppress human rights.
Exactly KB - the animal reservoirs alone eliminate any chance we can eradicate Covid and prevent further viral evolution. At best I suspect we play whack-a-mole.
Even in the highly vaccinated countries we would always have the pockets of children serving as reservoirs. For some countries, that is a small group (< 6 months), other countries it is < 12 yr, others < 30 yr, others < 65. I believe many Nordic countries not encouraging vaccination for various age groups, correct?
Back to my original "elephant in the room" - Africa.
The statista chart you bring up visually appears to show a decent vaccine uptake, but that is only because they are presenting doses per population without weighting the population.
Seychelles has an impressive 200 doses per 100 resident and is placed at the top, but the country is under 100,000 people, a drop in the bucket in the continents' population of 1.3 billion. Meanwhile the countries at less than 40 doses per 100 residents total 830 million people, though it isn't intuitive looking at the statista chart.
As an aside, I wonder how much the average African's quality of life would improve if we simply gave them $150 cash to spend on whatever they wanted (or we converted it to $150 of food/clean water). Average salary in Nigeria something like $700 USD/year. With so many people dying of avoidable deaths (hunger, lack of water, hygiene) it honestly feels silly to be allocating our fortune in the west to "cure" them of something which poses near zero risk to anyone under the age of 50 to a continent where 90% of the country is under 50. I can't fathom what it is like to live in Africa, but I suspect I would much rather get $150 worth of food than a vaccine which doesn't halt transmission for an illness that has near zero impacting me. That is a lengthy philosophical and ethical consideration, so I digress for now, but worth thinking about in the future.
And finally, to close out this lengthy comment - you note "When the vaccines first came out, we did get a bonus of reduced transmission".
Did we though?
We assumed the drop in cases in early 2021 after we rolled out vaccinations was due to the vaccine, but now that we have 2 years of data it was likely a mirage - we just happened to start vaccinating at the end of the Covid season, so we attributed the receding cases to our intervention. Correlation in this case didn't equal causation. States like Missouri originally chided [1] for having lower vaccination rates than Illinois saw identical curves in cases and all-cause mortality.
_______________
[1] Unvaccinated Missourians fuel COVID: ‘We will be the canary’
https://apnews.com/article/mo-state-wire-michael-brown-coronavirus-pandemic-health-89fa995c59397228d8d56e1ab45890ab
https://www.nytimes.com/interactive/2021/us/missouri-covid-cases.html
Yet compare to highly vaccinated neighbor Illinois
https://www.nytimes.com/interactive/2021/us/illinois-covid-cases.html
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.
Sweden has the second lowest excess deaths in the world, beaten only by Norway (though Norway seeing 10% year over year increase in all-cause mortality in 2022 so may drop to #2). All of the Nordic countries had fantastic outcomes relative to the rest of the world, and all of the Nordic countries returned to their children to school Spring 2020 and had among the shortest restrictions worldwide.
Public Health needs to acknowledge they got this wrong.
Obviously, there are other differences at play, too. I believe the Nordics are generally healthier, and have better social supports in general. But that is VERY interesting (and frankly, kinda what I thought would happen).
Michael DAmbrosio, isn’t their vaccination strategy different too? They are not pushing boosters for those under 50?
From what I gather:
Sweden - Not offering to under 50 without doctor recomendation
Denmark - Anyone over 12 can get it, but they stopped providing it for free to people under 65
Finland - Not offered to "working age" people (I assume < 65?) This is sketchy though as I can only find one source and it is a tabloid paper (Iltalehti) so may not be reliable
Google not helping to clarify any of the above, trying to push articles from 2021. I might go to reddit and ask each country subreddit what's going on as I would like to know (same with India, they seem to have little interest in booster based on data). I even subscribe to TheLocal which is nordic newspaper and can't find much on it.
I am 42, healthy as far as I know. I have not received the bivalent booster. We have masked and avoided and gotten the other shots as soon as possible. But, Moderna 2 and 3 rendered me incapacitated with the worst headache of my life and vomiting for 48 hours. I was unable to care for my children (and myself) and wondered if I was having an aneurysm. It was nothing like a flu shot. Or even any other vaccine I have received. I am hoping Paul Offitt’s assessment that I am still protected from the worst is correct. I fear Covid, but the thought of another booster like that is terrifying. My PCM has no guidance other than- maybe try NovaVax.
ADWH - I'm about a year older than you, reasonably healthy, though a penchant for nice cigars and whiskey are my downfall... Your experience with the vaccine is why I kept putting it off. My wife (vascular surgeon) was knocked out 48 hours Dec 2020 and had to cancel surgeries which is unheard of for her. That gave me pause.
Then my social media started filling up with posts recycling the same theme - the vaccine side effects are harsh, but better than getting Covid. I chickened out and kept delaying as I didn't want to be sick for 48 hours, especially since our family had lived our life normally throughout the pandemic and still hadn't gotten Covid (our kids were in school, took vacations, dined out frequently, had parties, etc - zero change for us which seemed to be what most our other physician friends were doing out here in Cleveland "rules for thee but not for me").
Despite my wife having such a terrible reaction to this first (and only) dose she took of Moderna, she still wanted me to get it, but she was so busy with work she acknowledged she wouldn't be able to take care of the kids if I got as sick as her from vaccine.
By the summer of 2021 when it became apparent Israel (Pfizer test country) was overwhelmed with Covid at rates surpassing previous waves, my wife and I tabled vaccine talk for me.
My daughter wound up getting Covid a week before her 12th birthday fall 2021 (I doubt we would have vaccinated at that point anyway as everyone vaccinated was now getting Covid), which consisted of her having a 99 degree fever for 24 hours and having to miss 2 weeks of school. I took care of my daughter, no mask, didn't get Covid. I thought I was one of the lucky people immune.
Flashforward to summer 2022 and I got an unbelievable headache, as bad as the migraine headaches I used to suffer in adolescence, completely knocked me out. For 24 hours. Then I was right back to normal.
I mainly shared this because until your comment I hadn't seen anyone mention headache like that being primary symptom from vaccines so found it odd that was my only symptom to Covid (I felt close to throwing up but never did).
Note my children and myself are all current on vaccines that "work" (i.e. keep you from catching the thing you are vaccinating against), so don't mistake my candor for antivaxx rhetoric - a group I used to troll online for sport back in the day. I just am not in the habit of taking a medication that makes my friends and family feel like shit for little benefit outside of observational cohort studies.
PS - I noticed you are paid subscriber to Unbiased Science Podcast - do you participate in their private facebook group by chance?
I am just down the road near Akron.
I am not really active in the group. I wish the experts I have relied on through all of this would address the side effects. I also see so many sick after the bivalent booster. There seems to be no rhyme or reason.
KB - Many points to consider:
1) Not sure you are aware, but the primary author of the nature article you linked below, Nele Brusselaers, has been a staunch critic of the Swedish approach from the start of the pandemic. [1][2] I argue this may cloud her judgement and make her biased in how she interprets and selects data to make her case.
When she started her crusade, the early data somewhat backed her, now it does not. It appears she refuses to alter her hypothesis and accept new data. This makes me skeptical she can approach this with disinterestedness - a foundation of science.
2) The all-cause mortality between Nordic countries now places Sweden at the best outcome (previously I had noted it was slightly behind Norway, now it has briefly passed them).
Total excess deaths, per 1 million people, total of 2020-first 40 weeks of 2022, against 4 year historical average [3]:
Norway - 947
Sweden - 926
Finland - 2,179
Denmark - 1,522
This is impressive considering Sweden is the only country in the world which entered 2020 with a sizable mortality deficit - notably in 2019 they had roughly 4,000 fewer deaths than expected which likely meant they see that much of an increase the following year (and this also skews their forecasts lower than probably should). Even with this starting handicap they still outperformed their neighbors (for now, data can and will change, at which point we can update our hypothesis).
I see the Johns Hopkins graph noted in the abc article, and that is weaker evidence than all-cause mortality.
3) Why is it that they only ever compare Sweden to her direct neighbors? Why is it fair to compare California to Florida, the US to South Korea, or Germany to Japan, but the only places Sweden is ever compared in outcome to are 3 very small countries which lack a major international hub like Stockholm (can debate Oslo).
Even if we were to discard that all-cause mortality favors Sweden among her neighbors, Sweden still "beat" every single other country in the world by a considerable margin. It seems unfair that we can hold the US to the standard of Japan, but not Germany to Sweden.
4) In the same vein - why are excuses (euphemized as confounders) made for the poor outcomes in New York, California, citing demographics, population density, being international hubs, but those same confounders aren't applied comparing Sweden to Norway?
If we accept that New York had a catastrophe and can't be blamed for having the highest per capita mortality in 2020 because of NYC, why doesn't Sweden get a pass for having the largest city in Scandinavia? It always seems like the confounders are one directional, allowed when they support the lockdown/mask toddler faction, but disallowed when pointing out relaxed measures had similar outcome
5) And finally, suppose we accept that we can only compare Sweden to her neighbors and not to the rest of Europe or Asia. Suppose we exclude confounders like population density, age, and obesity discrepancies among the Nordic countries. And further suppose we ignore the all-cause mortality and accept Nele Brusselaers hypothesis.
We are left with the fact that all of the Nordic countries had the *lowest* mask usage (and mostly didn't mask their kids throughout the pandemic relative to the rest of the world) [4] The *earliest* return to school (may 2020). [5] The *shortest* lockdowns (varies by country and region).
It seems to me the gap between "laxness" of Sweden to Denmark is smaller than the gap between Denmark and US/South Korea/Germany/etc
This doesn't seem to support the stringent measure hypothesis.
__________________________
[1] Aug 2020 on Twitter
https://twitter.com/nelebrusselaers/status/1293819093213224961
[2] Dec 2020
"‘We Were Told Those in Charge are Right So Don’t Question It’
Researcher who Quit Sweden Lifts the Lid on Its Controversial COVID-19 Response"
https://bylinetimes.com/2020/12/24/we-were-told-those-in-charge-are-right-so-dont-question-it-researcher-who-quit-sweden-lifts-the-lid-on-its-controversial-covid-19-response/
[3] Complete breakdown by country and year:
https://imgur.com/a/k0GHA1X
[4] https://imgur.com/a/kRJkjVL
via https://yougov.co.uk/topics/international/articles-reports/2020/03/17/personal-measures-taken-avoid-covid-19
(don't be fooled by date in URL, it is continuously update)
[5] Example, but true of all nordic countries: https://www.helsinkitimes.fi/columns/columns/viewpoint/17632-sending-finnish-children-back-to-school-for-two-weeks-is-irresponsible-useless-and-wrongly-motivated.html
[6] https://newseu.cgtn.com/news/2020-04-16/Finland-to-lift-coronavirus-lockdown-in-region-around-capital--PIiAE4MM36/index.html
But that's from October 2020. As Michael noted, over time, their strategy seems to have proved correct (albeit, perhaps only for a nation with a healthier, better supported population).
So this is critical of Sweden's communication (or lack thereof) and politicization of the process. That's fair. But it nevertheless seems like their approach, in the end, got better results. Sounds like they could have done even better had they encouraged the use of masks, better care techniques (oxygen etc.) and better protection for vulnerable populations.
One of my 1700+ bookmarked articles already KB ;)
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.
On the other hand, Coronaviruses have had 600 million years coexisting with mammals. 50 million years coexisting with bats. 3 million years with our earliest hominid ancestors who (often) lived in caves with bats.
The premise that Coronaviruses waited 600 million years to evolve and strike out to become some highly infectious, highly lethal variant, *JUST IN TIME* for us to also have discovered electron microscopes to see them and PCR tests to detect them feels no different than the doomsday cultists who predict the end of the world *Just so happens* to occur not only within their lifetime, but soon! (see Koresh for example)
The stronger the case we make for natural origin, the more likely this is nothing different than what we have had on the planet for close to a billion years, it's just that this is the first time in history we had the tools to measure them and decided to apply them.
To argue that this is something unlike anything to ever face us I think ticks needle closer to lab made virus we were making in order to develop vaccines for "just in case". That is acknowledged now as something we have been doing for roughly 10 years - you don't need to read Alina Chan "Viral" book, it is also confirmed and acknowledged in Dan Werb's "The Invisible Siege" where he interviews Ralph Baric extensively who casually talks about to make more transmissible coronaviruses so we can find out how to stop more transmissible coronaviruses should they ever arrive.
Good points all, Michael. I looked at your subscription list to see if there were newsletters I should subscribe to, since we often agree
I was amazed! You are neither carnivore, herbivore or omnivore- you are an info-vore! How can you absorb such a flood! I'm getting old and can no longer keep up nor remember what few subscriptions I have 🙁 I may soon have to do a lot of unsubscribing unfortunately.
What do you think are the true origins of covid19? There are so many theories out there.
I had to make a spreadsheet to track all my paid subscriptions. Many of them fizzled out (a few posts and they moved on to something else), but I like to support as many writers as I can - even if I don't agree with them, if they are putting in effort and open to feedback, I subscribe.
I retired young so have a lot of time, and Covid has replaced nearly all my other hobbies. Got a stack of novels collecting dust, millions of hours of Netflix Queue ignored... Covid is just so fascinating.
Origins of Covid? Accidental lab leak. Almost certainly at this point.
It has happened several times before in similar labs, it was bound to happen again.
The problem is that it takes quite a bit of reading to understand how and why this is the most likely cause (beyond Jon Stewarts joke) and the natural origin has appeal of simplicity even though the premise defies common sense.
I thought 100% it was conspiracy theory in 2020, but I try to remain neutral following Carl Sagan tenets of scientific thinking and came around mid 2021 lab leak was possible. The more journalists and investigative reporters dig through, the farther natural origin seems possible.
And if it is natural, we may have overreacted to something that was always happening we just never looked for it before. Must consider that possibility. This is common in medicine. Overdiagnosis.
I thought from the beginning that a lab leak was possible, perhaps even probable. We know something like that happened to the Russians when they were working on weaponizing anthrax in a lab near Sverdlovsk and there is good evidence they were still running a bioweapons effort until at least the nineties. And so likely, were we. So it wouldn't shock if the Chinese were working on similar projects at their facility in Wuhan. But I would think it wasnt an intentional act; they had to shut down in early 2020 almost 25% of their industrial capacity. They were likely as dismayed as we were. We know they hid their true losses: satellite data showed they were running crematoria non-stop.
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
Heinz' question has important implications. Now 75, I've had mRNA vaccine x5. Other than 2 hours of very mild sore arm on the first shot have had zero 'side' effects. I seem to have a well-functioning immune system and no chronic conditions. My primary care doc said lessened reactivity is common as one ages but not to worry - I'm as protected as I 'should' be. How does this make sense?? Are the vaccine short-term side-effects indicators of innate immune response robustness but not correlated with generating adaptive immunity? Thank you!
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!