Ebola:

No new cases in either of the current outbreaks right now. The biggest news is a case report this week in the New England Journal of Medicine. The report describes a 25 year old man in the Democratic Republic of the Congo during the 2018-2020 North Kivu outbreak of Ebola. As a close contact of a known Ebola patient, he received the Merck vaccine in late 2018.

6 months later, he develops symptoms of Ebola. He was treated with standard supportive care and received a monoclonal antibody against Ebola (mAb114), and was discharged in about two weeks.

149 days after that, he develops Ebola again. This time, it doesn’t respond to treatment and he dies. But this recurrence of Ebola infected a chain of 91 other people.

The authors demonstrate that this does appear to be recurrence of acute Ebola in an “Ebola John”, as the second, ultimately fatal case, had only two additional mutations on top of the first time this poor guy caught Ebola.

The key points in the paper from the discussion:

“To investigate why the patient was not protected from infection after his vaccination in December 2018, we tested a serum sample obtained during his initial EVD episode in June 2019 for anti-EBOV glycoprotein IgG titers, but we detected none. Given that we found no signs of immune deficiencies, this probably was an incidence of temporal or complete vaccine failure. This finding is in line with those of other studies showing that up to 10% of patients with EVD had been fully vaccinated for at least 10 days before admission to the ETU. In addition, serologic data from the Partnership for Research on Ebola Virus in Liberia (PREVAIL) trials involving more than 700 participants who had received rVSV-ZEBOV showed that in approximately 20% of vaccinated persons, positive Ebola IgG binding titers did not develop 1 month after vaccination. Combined, these findings arouse concern about the true effectiveness of the rVSV-ZEBOV, which has been estimated to be 100% in the Guinean “Ebola ca suffit!” trial and 97.5% in the preliminary report by the World Health Organization on the use of this vaccine in the DRC.

An alternative hypothesis for the patient’s lack of protection during relapse, despite his anamnestic response, is potential viral escape during persistence. The E280G glycoprotein mutation that developed during EBV persistence may have allowed a replication advantage or immune escape, but our data show that the mutated glycoproteins retained sensitivity to the treatment antibody mAb114. Alternatively, the mutation may simply be coincidental, and viral persistence may have arisen with infection of an immune-privileged compartment.”

Since that is a product on the market from another pharmaceutical company, I am not going to comment further. I think the discussion above by the authors of this peer reviewed paper is excellent and stands on its own merits.

Coronavirus:

—First, in other news I cannot comment on:

https://investor.lilly.com/news-releases/news-release-details/lilly-vir-biotechnology-and-gsk-announce-positive-topline-data
Thank you for your understanding.

—Second, around the horn… Cases in the US are indeed ticking up. We were closely watching Indiana, hosting the NCAA tournament these past couple weeks. The week to see a bump that might be attributable to the Big Dance is this week. Sure enough, you have seen just a bit of an uptake in new cases and percent of tests positive. This hasn’t hit hospitalizations yet, but that tends to be a slightly lagging indicator.

Interestingly, the counties with the big state schools that were hosting tournament games have seen a spike in new cases in the same time frame as March Madness. However, Indianapolis has not, despite having 4 of the 6 locations for tournament games.

So we’ll see how this develops.

As Indiana goes, so goes a fair bit of the nation. Florida cases are up a little bit (no surprise given Spring Break), and much of the national uptick is centered in the midwest and upper east coast. Which is likely traveling to all of the Spring Break locations and returning to those states.

Coming as no surprise, the new cases are largely coming from variants like the recently described New York variant (B.1.526) and the UK variant. Again, these are more contagious variants of SARS-CoV-2, and are being selected for as the virus -has- to capitalize on increasingly rare meetings with non-immune people.

—So is this a new “fourth wave,” and we should be losing as much sleep as the CDC director this week?

Maybe. We’ll have to see how the trend develops over the next couple of weeks.

But I -really- wish the CDC director would read her institution’s own projections. This bump, happening right now, driven by slightly more contagious variants, is -exactly- what has been predicted for months now.

You can find our discussion of these projections back in January here.

With vaccination now available in many states to everyone 16 and up (and Pfizer publishing safety data showing their vaccine is safe ages 12 and up this week), the virus still has a significant headwind to launching a serious fourth wave.

—The most -likely- scenario is that new cases remain a little elevated for a few weeks, level off quickly, and start inexorably dropping into July as the combination of vaccination and previous exposure forces the virus into a race it cannot win. It runs out of time and ability to find new hosts it can infect, and we have sufficient herd immunity to justify a return to whatever normal looks like going forward.

—The dread “fourth wave” will only look like the big wave from the fall if, and only if, one or more of these new variants can indeed get past the vaccines and cause a significant amount of reinfections.

That is not likely.

—Nations trailing a bit in vaccinations may vary a bit. France is entering another lock down this week as cases there are blowing up. Same for a few other European countries. Slight uptick in Japan. Brazil is leveling off another wave—they had some issues with overwhelmed hospitals there too. Much of Central and South America is seeing elevated virus activity right now too.

—South Africa is still very quiet. Again, that is an excellent sign the most worrisome variant for vaccine escape does NOT have a high enough reinfection rate to make a giant fourth wave a high probability event.

—Bolstering the likelihood of our base case above is real world data about the performance of the mRNA vaccines thus far. There have been a lot of them administered world wide, and so far, efficacy in reducing severe COVID cases is about 90%. Even more encouraging (and thanks to the reader who sent this along), the nursing home and long term care facility organizations report that since vaccination started, cases among these MOST vulnerable populations have dropped by 96%. Also today the CDC announced, although full analysis and publication of data is forthcoming, that fully vaccinated people are unlikely to spread SARS-CoV-2.

I will pause to let you recover from the shock of that statement.

—Good? Cool. So once again, you are MOST LIKELY to be somewhere between the chart on the left and the chart on the right over the next couple months (closer to the left based on current numbers):

—Speaking of CDC, now that I have a little time, a bit of an update from last week and their recommendation that even those previously infected and recovered get the vaccine. Again, I think the better argument is a social argument to get vaccinated in the setting of having recovered from PCR proven SARS-CoV-2 infection.

I also think it is far, far easier for CDC to -count- doses out than the individual level tracking of all 50 states of people who have been reported as having a positive COVID test, and gives a more reliable estimate to folks who will be using “percent of population immune” to make back to normal decisions. I don’t know if that is in any way part of their thinking. But I do think that one number is easier to track and less variable than the other.

I also thinking lifting of the mask mandate is closer given the CDC’s data on low probability spread from the vaccinated–which will make it much easier for businesses…

‘ lawyers…

…to remove mask mandates at work, particularly once a certain threshold of vaccination is reached.

—The other “big” COVID news this week is the WHO’s second attempt at a “origin of SARS-CoV-2” report, which was about as conclusive as the first effort. But this time China -really- co-operated, you guys. No. Srsly.

Look, unless finding the origin of SARS-CoV-2 can somehow reverse the clock and give us all 2020 back again, this is irrelevant. It won’t help (that much) in preventing a new coronavirus from doing something similar in the future. That all comes down to a virus finding the “magic mutation” to be a major problem. It won’t help stopping the current one now. It’s mostly feeding the all too human desire that someone, or something, MUST be at fault.

—Yes, the Biden administration was equally strident as the Trump administration in pointing out that accidental lab leak of a coronavirus being studied in China was still possible, and that the WHO mighhhhhhhht not have investigated that as hard as they could have. Not the same “we’re not funding the WHO anymore!” temper tantrum of the previous administration, and better phrasing perhaps of disappointment with the WHO, but the same criticism nonetheless. If that makes you feel better, by all means, feel better.

—In fairness to the WHO, though, no one, and I mean no one, has been able to locate any of the f***s I give about the “lab leak” hypothesis before, or right now, either.

If this shitshow sideshow -ever- becomes relevant to the end of the pandemic and a more normal life after, I’ll let you know.

—Speaking of life after COVID, this week’s “social issues” thought piece comes to us via twitter (click on all the pages in the thread to read the entire document).

Again, I want to stress that linking one of these does NOT mean I endorse -every- idea in it. These are merely other viewpoints, and the best part of this is some of the “then what?” thinking about the decline in institutions, what work at home means (especially as it relates to capital vs labor, and what that may mean for you), and another viewpoint on how the next 5-10 years may be a little wild.

And definitely follow the thought experiment on how, and by how much, stimmies help, well, everyone. From the most ardent socialist to the greatest defender of trickle down economics, as it turns out.

Anyways, you can find it here.

—Your chances of catching Ebola are equivalent to the chances a 256,000+ ton container ship that is twice as long as the Suez Canal is wide gets blown sideways by a random sandstorm, and wedges itself as a giant floating dam of stuff bought on Amazon, closing one of the most vital shipping lanes in the modern globalized world for days on end.

I know right? That container ship would be, no joke, two and a half times the size of this:

That’s like the Shaq to the Nimitz class aircraft carrier’s Rock (6’2”, 262 lbs):

So what are the chances of that happening, really?

Oh.

Oh, I see.

Alright, well, your chances of catching Ebola are equivalent to the chances of what you would have thought those chances were before a 250,000 ton container ship twice the size of a modern aircraft carrier got blown sideways and stuck in the Suez canal…

—Your chances of catching coronavirus increasingly depend on your vaccination and previous infection with SARS-CoV-2 status. If you are still a susceptible host, the virus is, quite literally, dying to meet you right now.

<Paladin>