In an attempt to keep you up to speed, here’s an Omicron update. 1. All U.S. adults should get a booster. Before today, this was CDC’s recommendation for boosters in the US: The CDC changed its recommendations today. Now, all adults should (not may) get a booster. Like I
Going back to your 11/15 post "State of Affairs: Europe", I think it deserves some follow-up in light of recent developments with Omicron.
It's been 19 days since Der Spiegel created the infographic showing how much better Portugal, Spain, Malta, and Denmark were doing than the rest of Europe thanks to their high vaccination rates. What has happened since? Cases spiked in the cited "doing it right" examples.
- Spain is clearly in their 6th wave, which is on track to have surpassed their 1st and 4th waves. Additionally, Omicron is detected, but unlikely the cause of their 6th wave. Restrictions being added back in.
- Portugal cases rose since publication as well, now higher than their 1st and 4th waves. 13 cases of Omicron detected at a fully vaccinated soccer team in Lisbon. Restrictions back in place.
- Denmark is now at an all-time high in cases for the entire pandemic. Omicron detected in a few people as well. Finland, Iceland, and Norway are at all-time highs as well, all having very high vaccine rates - curiously I just noticed that Der Spiegel left off Norway and Iceland when they made their original scatterplot - I surmise because it didn't help the correlation they were framing as their rates were already skyrocketing in the Nov 1- Nov 7 snapshot they chose to make their argument.
- Malta, same story as the others.
- Vermont, already at its highest level of infection throughout the entire pandemic when this piece was published, has soared even higher. Excess deaths continue to be elevated by 20% throughout the state, though that data lags by 6 weeks, so our insight ends late October.
Experts appear to be pivoting, and now we are getting (in my opinion) disingenuous stories proclaiming "this isn't surprising", or "this is what we have been saying all along".
Example:
"There’s another factor at play that could help explain why Vermont, in particular, has seen such high case counts in recent weeks: Only a small proportion of residents have had a COVID infection. That’s not the case across the country."
Which goes against what the CDC has claimed, that the vaccine is 5x more effective at preventing breakthrough infections. Now we need 3 doses and to get the infection anyway?
_________
Where am I going with all this?
Science evolves. I get that. It feels to me that some are sticking by hypotheses that data appears to reject, but we aren't evolving along with that data.
The original hypothesis for the vaccine was that it would end the pandemic. I'm too lazy to dig up quotes, but Dr. Fauci, Dr. Wallensky, et al, repeatedly stated that at 50%, 60%.... 70% vaccination levels we would no longer see cases rise like before. That while there may be the odd breakthrough case here or there, but cases would never reach levels like they did before. That deaths would decline.
It's been a year. Does this hypothesis hold up? Should it be discarded? What updates can be made to salvage the hypothesis without falling into a sunk-cost fallacy?
What are some competing hypotheses to explore?
As a lay person, it looks like the Covid 19 vaccines are about as efficacious as flu vaccines, not nearly the 95% promised. And flu vaccines are notoriously not very good.
And it is perfectly "Ok" that flu vaccines, and possibly Covid vaccines aren't very good. Science can't be rushed. We are barely at 100 years of so many tremendous breakthroughs in medicine, so I dont have unrealistic expectations, but at the same time, I don't want to be bullshitted to either. (which is why I subscribe to you :) )
And I'm skirting with "correlation doesn't equal causation", but it feels like these variants are in answer to our vaccines. Alpha dominates until we rolled out first set of vaccines. Delta bypasses those (I'm aware Delta was around prior to our roll-out, but clearly it was the lineage of all the other ones that seemed to thrive among our vaccinated population). Now we are boostering people, and Omicron, at least very early, looks like the candidate selected to bypass those. If not Omicron, I assume something else will step up, no?
Throughout my life I have been told not to overtake antibiotics because bacteria will create new strains. Does this carry over to respiratory viruses/ILI? Is this why Michael Osterholm responded "It's much more complicated than we thought...I know less about influenza today than I did 10 years ago." When quizzed on why Flu Vaccines fail so frequently in 2017? [1]
Is it possible we are at war with something which can't be out-vaccinated? Are we ready to embark on a multi-year campaign of quarterly vaccines, always a step behind the next greek alphabet letter? Could this potentially make things worse than they are now? I'm getting chills of George Carlin's warning that our obsession with germs is going to create superbugs...
If we haven't stopped the flu after 80 years of vaccines, can we realistically expect this to go differently?
The US has spent/printed somewhere between 4 - 10 trillion dollars combating this pandemic, and it seems like we have little results to show from an ROI perspective. For perspective, the total amount spent by the govt, pharm industry, and various charities for oncology research is around 60 billion a year. 100 years of potential cancer research spent on Covid.
What is the end game here?
/rant, thanks for all the work you put into to gathering so much info and simplifying it for us
Thanks for all the energy you spend keeping us informed! Much love & respect!
I’m curious about the technology used to detect Covid in wastewater, and how amazing that is at predicting community spread. Is it cost-effective? It seems like it could be used to become an early screening device in households?
I still think even though testing is free, it is under-utilized because it’s uncomfortable, people get concerned about privacy, and sadly the responsibility of knowing. I live in an area that believes the pandemic is over, or is not real. Big sigh.
If we had easy, discreet at home screenings- that might help?
This article is similar to the story of the origin of the Omicron variant.
"Summary (100 words)While most people effectively clear SARS-CoV-2, there are several reports of prolonged infection in immunosuppressed individuals. Here we present a case of prolonged infection of greater than 6 months with shedding of high titter SARS-CoV-2 in an individual with advanced HIV and antiretroviral treatment failure. Through whole genome sequencing at multiple time-points, we demonstrate the early emergence of the E484K substitution associated with escape from neutralizing antibodies, followed by other escape mutations and the N501Y substitution found in most variants of concern.This provides support to the hypothesis of intra-host evolution as one mechanism for the emergence of SARS-CoV-2 variants with immune evasion properties."
Wasn't there some idea that if the virus mutates enough where the spike protein is so different that our vaccines won't recognize it anymore, then the virus wouldn't actually be able to infect our cells anymore either?
Is this the theoretical underpinning of the hope some people have that the virus will be milder?
Thank you for the updates. It cuts through the noise and is timely and in depth.
Your updates are so helpful and clear. Thank you!
Given the filters on planes and mask mandates for air travel, what is your thinking about the risks of air travel?
Katelyn,
Going back to your 11/15 post "State of Affairs: Europe", I think it deserves some follow-up in light of recent developments with Omicron.
It's been 19 days since Der Spiegel created the infographic showing how much better Portugal, Spain, Malta, and Denmark were doing than the rest of Europe thanks to their high vaccination rates. What has happened since? Cases spiked in the cited "doing it right" examples.
- Spain is clearly in their 6th wave, which is on track to have surpassed their 1st and 4th waves. Additionally, Omicron is detected, but unlikely the cause of their 6th wave. Restrictions being added back in.
- Portugal cases rose since publication as well, now higher than their 1st and 4th waves. 13 cases of Omicron detected at a fully vaccinated soccer team in Lisbon. Restrictions back in place.
- Denmark is now at an all-time high in cases for the entire pandemic. Omicron detected in a few people as well. Finland, Iceland, and Norway are at all-time highs as well, all having very high vaccine rates - curiously I just noticed that Der Spiegel left off Norway and Iceland when they made their original scatterplot - I surmise because it didn't help the correlation they were framing as their rates were already skyrocketing in the Nov 1- Nov 7 snapshot they chose to make their argument.
- Malta, same story as the others.
- Vermont, already at its highest level of infection throughout the entire pandemic when this piece was published, has soared even higher. Excess deaths continue to be elevated by 20% throughout the state, though that data lags by 6 weeks, so our insight ends late October.
Experts appear to be pivoting, and now we are getting (in my opinion) disingenuous stories proclaiming "this isn't surprising", or "this is what we have been saying all along".
Example:
"There’s another factor at play that could help explain why Vermont, in particular, has seen such high case counts in recent weeks: Only a small proportion of residents have had a COVID infection. That’s not the case across the country."
From:
https://www.vpr.org/vpr-news/2021-12-01/why-vermonts-covid-surge-isnt-surprising
Which goes against what the CDC has claimed, that the vaccine is 5x more effective at preventing breakthrough infections. Now we need 3 doses and to get the infection anyway?
_________
Where am I going with all this?
Science evolves. I get that. It feels to me that some are sticking by hypotheses that data appears to reject, but we aren't evolving along with that data.
The original hypothesis for the vaccine was that it would end the pandemic. I'm too lazy to dig up quotes, but Dr. Fauci, Dr. Wallensky, et al, repeatedly stated that at 50%, 60%.... 70% vaccination levels we would no longer see cases rise like before. That while there may be the odd breakthrough case here or there, but cases would never reach levels like they did before. That deaths would decline.
It's been a year. Does this hypothesis hold up? Should it be discarded? What updates can be made to salvage the hypothesis without falling into a sunk-cost fallacy?
What are some competing hypotheses to explore?
As a lay person, it looks like the Covid 19 vaccines are about as efficacious as flu vaccines, not nearly the 95% promised. And flu vaccines are notoriously not very good.
And it is perfectly "Ok" that flu vaccines, and possibly Covid vaccines aren't very good. Science can't be rushed. We are barely at 100 years of so many tremendous breakthroughs in medicine, so I dont have unrealistic expectations, but at the same time, I don't want to be bullshitted to either. (which is why I subscribe to you :) )
And I'm skirting with "correlation doesn't equal causation", but it feels like these variants are in answer to our vaccines. Alpha dominates until we rolled out first set of vaccines. Delta bypasses those (I'm aware Delta was around prior to our roll-out, but clearly it was the lineage of all the other ones that seemed to thrive among our vaccinated population). Now we are boostering people, and Omicron, at least very early, looks like the candidate selected to bypass those. If not Omicron, I assume something else will step up, no?
Throughout my life I have been told not to overtake antibiotics because bacteria will create new strains. Does this carry over to respiratory viruses/ILI? Is this why Michael Osterholm responded "It's much more complicated than we thought...I know less about influenza today than I did 10 years ago." When quizzed on why Flu Vaccines fail so frequently in 2017? [1]
Is it possible we are at war with something which can't be out-vaccinated? Are we ready to embark on a multi-year campaign of quarterly vaccines, always a step behind the next greek alphabet letter? Could this potentially make things worse than they are now? I'm getting chills of George Carlin's warning that our obsession with germs is going to create superbugs...
If we haven't stopped the flu after 80 years of vaccines, can we realistically expect this to go differently?
The US has spent/printed somewhere between 4 - 10 trillion dollars combating this pandemic, and it seems like we have little results to show from an ROI perspective. For perspective, the total amount spent by the govt, pharm industry, and various charities for oncology research is around 60 billion a year. 100 years of potential cancer research spent on Covid.
What is the end game here?
/rant, thanks for all the work you put into to gathering so much info and simplifying it for us
[1] https://www.sciencemag.org/news/2017/09/why-flu-vaccines-so-often-fail
Boosters for 16+ coming soon.
https://www.washingtonpost.com/health/2021/11/29/covid-vaccine-16-17-year-olds/?fbclid=IwAR1qnAdfDzwqLHdAymtUdRcH2jhMzq_tWT4hDgISxWcSj9gmzdcJmjJZkuo
Thanks for all the energy you spend keeping us informed! Much love & respect!
I’m curious about the technology used to detect Covid in wastewater, and how amazing that is at predicting community spread. Is it cost-effective? It seems like it could be used to become an early screening device in households?
I still think even though testing is free, it is under-utilized because it’s uncomfortable, people get concerned about privacy, and sadly the responsibility of knowing. I live in an area that believes the pandemic is over, or is not real. Big sigh.
If we had easy, discreet at home screenings- that might help?
This article is similar to the story of the origin of the Omicron variant.
"Summary (100 words)While most people effectively clear SARS-CoV-2, there are several reports of prolonged infection in immunosuppressed individuals. Here we present a case of prolonged infection of greater than 6 months with shedding of high titter SARS-CoV-2 in an individual with advanced HIV and antiretroviral treatment failure. Through whole genome sequencing at multiple time-points, we demonstrate the early emergence of the E484K substitution associated with escape from neutralizing antibodies, followed by other escape mutations and the N501Y substitution found in most variants of concern.This provides support to the hypothesis of intra-host evolution as one mechanism for the emergence of SARS-CoV-2 variants with immune evasion properties."
Article from the University of South Africa
https://www.krisp.org.za/manuscripts/MEDRXIV-2021-258228v1-deOliveira.pdf
also thanks for the previous post about boosters bc the CDC isn't even trying to explain why boosters are helpful (bc they'd have to admit a likely efficacy drop). i mean what is this? https://www.cdc.gov/media/releases/2021/s1129-booster-recommendations.html#:~:text=Today%2C%20CDC%20is%20strengthening%20its,after%20their%20initial%20J%26J%20vaccine.
Wasn't there some idea that if the virus mutates enough where the spike protein is so different that our vaccines won't recognize it anymore, then the virus wouldn't actually be able to infect our cells anymore either?
Is this the theoretical underpinning of the hope some people have that the virus will be milder?
https://www.nytimes.com/live/2021/11/29/world/omicron-variant-covid/pfizer-booster-shots-16-17-year-olds