Well, I was very much enjoying my holiday but COVID continues to do its COVID thing. It’s time for an update. China: A humanitarian disaster As expected, the COVID-19 situation in China is out of hand. In an interesting turn of events, China went from a “zero COVID” policy to a “let it rip” policy by dropping all mitigation measures without fully vaccinating the highest of risk or strengthening their healthcare system.
Thank you for helping us think this through (as you so frequently do!) It just seems this action is falsely reassuring. If it takes around 3 days for an infected person's PCR to turn positive, and their PCR was 48 hours ago, then (assuming the PCR is always correct) doesn't a negative test just mean they weren't infected 5 days ago? Even if not infected now, they'd be at risk of picking up the virus on 15-20+ hours of flying where most passengers were unmasked. At least the sequencing might help (detect new variants). Meanwhile I believe a large % of people in the US aren't worried about transmission anyway. Plus waiting a week to implement the policy doesn't exactly signal urgent concern. I hope I'm missing something science-based about the rationale, and I realize the importance of reassuring the public - but false reassurance usually backfires eventually.
@David Bate: Hopes and dreams are being dashed worldwide. We all have some degree of pandemic fatigue and restrictions with masking and 30% of us decry or decline vaccines and/or boosters. Having to avoid congregating and travel is not what we humans appreciate. Nevertheless, if you are fully informed about dealing with death and dying from a deadly virus that keeps evolving and now capable of escaping a protective immune response, it forces one to re-order our priorities. If the Taiwan trip is worth the risk of getting ill or succumbing to the virus and its multisystems acute and chronic effects then only you can decide if it's worth the risk. For me, in a survivor mode, I would stay with our status quo - masking, boosters when appropriate/available, distancing and limiting any congregate activities even fully vaccinated as we are. Also, I am mindful that the latest CDC/NIH/FDA pronouncement that the last of 6 monoclonal antibody treatments has now lost its EUA status. This 1 hr infusion of the Lilly product Bebtelovimab (~$720M for 600,000 doses paid by US Taxpayers) "was not expected to neutralize omicron subvariants BQ.1 and BQ.1.1.......because they don't bind to the virus anymore" (Arturo Casadevall, MD Prof of Medicine JHH Baltimore, MD). Antibody cocktails may have a better profile than these MCAbs (Me). Paxlovid is a singular approach presently. Another protocol that has had significant outcomes is based on a repurposed drug hydroxyurea/hydroxycarbamide (HU). My colleague and I have entered >400 case reports from the nearly 2,000 COVID19 pos outpatients and some inpatients that were prescribed this unique protocol since mid-2020. It's only needed for 5 days, has demonstrated a prompt response evident within a matter of hours (a few up to 72 hrs), has shown NO Adverse Drug Reactions, appears safe and has FDA-approval that dates back decades for its continuous or discontinuous use in the congenital hemoglobinopathy sickle cell disease for young children to adults of all ages. The recovery stories are almost too incredible to believe and that is the conundrum. How can a 5-day regimen anchored by pills readily accessible for <USD$10.00 have such a profound effect on the SARS-Cov2 virus and its variants at any stage of infection. This drug needs an immediate RCT for comparison to current therapy of which there is NO approved protocol, only EUA protocols. Review the case reports thus far submitted in the CURE ID website devised by the NIH/CDC/FDA/C-Path after funding by the AHCA of 2012 specifically to address and solicit real world treatments by Clinicians worldwide using repurposed drugs. These governmental agencies recognize the enormous task of bringing new drugs into the armamentarium of COVD19 treatments as well as the expenses to the taxpayers, hence this initiative that has thus far attracted very few credible treatments as the list of top 10 drug protocols notes on the Website. The greatest number of reports came from hydroxychloroquine that has garnered the lion's share of publicity, politicization, and found to have zero benefits for any stage of COVD19 from multiple trials as recorded at ClinicalTrials.gov. The 2nd drug on the list is now HU with the >400 case reports described via the protocol responses my colleague and I have utilized in capturing several hundred cases. The entries are ongoing with the hope of displacing HCQ that is undeserving of any further attention in our opinion. Ivermectin never made the list but it. too was a "darling" that has been studied ad nauseum and found to be ineffective.
Check it out: <http://cure.ncats.io> (National Center for Advancing Translational Sciences is the source for the url)
Thank you for keeping us informed, and sacrificing time with your family by doing so. Please try to enjoy what's left of your holiday and keep making memories with your twins! Children grow up so fast and statistically you actually spend the majority of time with them for only the first 18 years or so. 💜
I assumed masking in China would temper this “let it rip” response to political instability and protests. Does anyone know if this wave is occurring in the context of people masking?
I’ve been quite comfortable doing public stuff with an N95 on (seeing patients, watching Avatar 2 with my daughter similarly masked- the only people in the theater doing so 😔)
If people are still masking, then are surgical type masks failing with these freakishly contagious variants?
If X.B.B.1.5 is a B.A.2 descendant, does that mean there’s a chance some of the monoclonal antibody treatments ( and/or Evushield) might become useful once more? That would be very good news. Will testing this idea out be a priority for the companies who’ve lost their EUAs?
Once again, thank you so much, Dr. Jetalina, for keeping us updated, especially during the holiday season. Forewarned is forearmed! I also had hoped that 2023 would be quieter on the Covid front, but with China’s abrupt swerve away from their Zero Covid strategy to what at least some in China are dubbing “Zero Negative,” quiet is probably not going to be the case for Covid next year. I hope that despite all this, you can resume your break and spend more time with your family.
I'd be very interested in your thoughts about the article in Wall Street Journal on January 1 by Allysia Finley entitled "Are Vaccines Fueling New Covid Variants?" The article suggests that high rates of repeated vaccination are fueling the emergence of new immune-evading variants, with specific reference to xxb. Some of the reasoning seems strained -- both Singapore and New York metro area have high vaccination rates and are sites of xxb emergence, ergo there's a relationship! Uh, they are also crowded places with extensive connections to the world. And there's an aside about "disinformation" that suggests political motivation. But she cites some studies that seem to point to concerns. What's your take on this question?
I’m curious about airplanes from China where half the passengers have Covid. Are these half-infected planes outliers? Does this mean roughly half the people in China have Covid right now (suggesting some type of peak, hopefully)? Or are these people who already knew they had Covid and are leaving China in the hopes of seeking medical treatment, perhaps because they have a comorbidity? Or maybe they are fleeing because they fear future civil unrest as the country becomes unglued? It seems logical that people flying from China to other countries are likely a wealthier segment and/or the elite class.
I don’t think Xi is embracing a “let it rip” policy so much as he finally realized that his government can no longer control and suppress the virus, so his best political move was to give the appearance that he is finally acquiescing to the pleas from his people and increasing personal freedom.
COVID in China, the U.S., and everything in-between
Thank you for helping us think this through (as you so frequently do!) It just seems this action is falsely reassuring. If it takes around 3 days for an infected person's PCR to turn positive, and their PCR was 48 hours ago, then (assuming the PCR is always correct) doesn't a negative test just mean they weren't infected 5 days ago? Even if not infected now, they'd be at risk of picking up the virus on 15-20+ hours of flying where most passengers were unmasked. At least the sequencing might help (detect new variants). Meanwhile I believe a large % of people in the US aren't worried about transmission anyway. Plus waiting a week to implement the policy doesn't exactly signal urgent concern. I hope I'm missing something science-based about the rationale, and I realize the importance of reassuring the public - but false reassurance usually backfires eventually.
Thank you. Any word on the effectiveness of the fall booster against the new strain offshoots on the horizon that you spoke of?
@David Bate: Hopes and dreams are being dashed worldwide. We all have some degree of pandemic fatigue and restrictions with masking and 30% of us decry or decline vaccines and/or boosters. Having to avoid congregating and travel is not what we humans appreciate. Nevertheless, if you are fully informed about dealing with death and dying from a deadly virus that keeps evolving and now capable of escaping a protective immune response, it forces one to re-order our priorities. If the Taiwan trip is worth the risk of getting ill or succumbing to the virus and its multisystems acute and chronic effects then only you can decide if it's worth the risk. For me, in a survivor mode, I would stay with our status quo - masking, boosters when appropriate/available, distancing and limiting any congregate activities even fully vaccinated as we are. Also, I am mindful that the latest CDC/NIH/FDA pronouncement that the last of 6 monoclonal antibody treatments has now lost its EUA status. This 1 hr infusion of the Lilly product Bebtelovimab (~$720M for 600,000 doses paid by US Taxpayers) "was not expected to neutralize omicron subvariants BQ.1 and BQ.1.1.......because they don't bind to the virus anymore" (Arturo Casadevall, MD Prof of Medicine JHH Baltimore, MD). Antibody cocktails may have a better profile than these MCAbs (Me). Paxlovid is a singular approach presently. Another protocol that has had significant outcomes is based on a repurposed drug hydroxyurea/hydroxycarbamide (HU). My colleague and I have entered >400 case reports from the nearly 2,000 COVID19 pos outpatients and some inpatients that were prescribed this unique protocol since mid-2020. It's only needed for 5 days, has demonstrated a prompt response evident within a matter of hours (a few up to 72 hrs), has shown NO Adverse Drug Reactions, appears safe and has FDA-approval that dates back decades for its continuous or discontinuous use in the congenital hemoglobinopathy sickle cell disease for young children to adults of all ages. The recovery stories are almost too incredible to believe and that is the conundrum. How can a 5-day regimen anchored by pills readily accessible for <USD$10.00 have such a profound effect on the SARS-Cov2 virus and its variants at any stage of infection. This drug needs an immediate RCT for comparison to current therapy of which there is NO approved protocol, only EUA protocols. Review the case reports thus far submitted in the CURE ID website devised by the NIH/CDC/FDA/C-Path after funding by the AHCA of 2012 specifically to address and solicit real world treatments by Clinicians worldwide using repurposed drugs. These governmental agencies recognize the enormous task of bringing new drugs into the armamentarium of COVD19 treatments as well as the expenses to the taxpayers, hence this initiative that has thus far attracted very few credible treatments as the list of top 10 drug protocols notes on the Website. The greatest number of reports came from hydroxychloroquine that has garnered the lion's share of publicity, politicization, and found to have zero benefits for any stage of COVD19 from multiple trials as recorded at ClinicalTrials.gov. The 2nd drug on the list is now HU with the >400 case reports described via the protocol responses my colleague and I have utilized in capturing several hundred cases. The entries are ongoing with the hope of displacing HCQ that is undeserving of any further attention in our opinion. Ivermectin never made the list but it. too was a "darling" that has been studied ad nauseum and found to be ineffective.
Check it out: <http://cure.ncats.io> (National Center for Advancing Translational Sciences is the source for the url)
Ray Sullivan, MD
Thank you for taking the time away from your family to keep your subscribers informed. It’s helpful and very much appreciated.
Thanks always for your insightful thoughts. It seems that the many unexpected turns of COVID-19 have led to more humility in predictions.
Please do focus on your family especially during these precious holidays with your growing daughters
Thank you for keeping us informed, and sacrificing time with your family by doing so. Please try to enjoy what's left of your holiday and keep making memories with your twins! Children grow up so fast and statistically you actually spend the majority of time with them for only the first 18 years or so. 💜
Take care of yourself!
Is there any info about the XBB.1.5 symptomatology and severity? Thanks for the heads-up!
I assumed masking in China would temper this “let it rip” response to political instability and protests. Does anyone know if this wave is occurring in the context of people masking?
I’ve been quite comfortable doing public stuff with an N95 on (seeing patients, watching Avatar 2 with my daughter similarly masked- the only people in the theater doing so 😔)
If people are still masking, then are surgical type masks failing with these freakishly contagious variants?
If X.B.B.1.5 is a B.A.2 descendant, does that mean there’s a chance some of the monoclonal antibody treatments ( and/or Evushield) might become useful once more? That would be very good news. Will testing this idea out be a priority for the companies who’ve lost their EUAs?
Once again, so clearly and expertly explained, THANK YOU.
Once again, thank you so much, Dr. Jetalina, for keeping us updated, especially during the holiday season. Forewarned is forearmed! I also had hoped that 2023 would be quieter on the Covid front, but with China’s abrupt swerve away from their Zero Covid strategy to what at least some in China are dubbing “Zero Negative,” quiet is probably not going to be the case for Covid next year. I hope that despite all this, you can resume your break and spend more time with your family.
As always. Thank you.
I'd be very interested in your thoughts about the article in Wall Street Journal on January 1 by Allysia Finley entitled "Are Vaccines Fueling New Covid Variants?" The article suggests that high rates of repeated vaccination are fueling the emergence of new immune-evading variants, with specific reference to xxb. Some of the reasoning seems strained -- both Singapore and New York metro area have high vaccination rates and are sites of xxb emergence, ergo there's a relationship! Uh, they are also crowded places with extensive connections to the world. And there's an aside about "disinformation" that suggests political motivation. But she cites some studies that seem to point to concerns. What's your take on this question?
We are still better off than we were at this time last year...
That's not saying much, but worth remembering.
And I really don't understand China sitting on its hands while doing the zero Covid thing. After OG Omicron hit, what did they think would happen?
Today's headline: "U.S. to require Covid testing of air passengers arriving from China."
Seems to me that airplane wastewater testing should precede that.
I’m curious about airplanes from China where half the passengers have Covid. Are these half-infected planes outliers? Does this mean roughly half the people in China have Covid right now (suggesting some type of peak, hopefully)? Or are these people who already knew they had Covid and are leaving China in the hopes of seeking medical treatment, perhaps because they have a comorbidity? Or maybe they are fleeing because they fear future civil unrest as the country becomes unglued? It seems logical that people flying from China to other countries are likely a wealthier segment and/or the elite class.
I don’t think Xi is embracing a “let it rip” policy so much as he finally realized that his government can no longer control and suppress the virus, so his best political move was to give the appearance that he is finally acquiescing to the pleas from his people and increasing personal freedom.
Testing airplane wastewater is a brilliant idea!