As reminders…

Alpha–Variant first identified in the UK

Beta–Variant first identified in South Africa

Gamma–Variant first identified in Brazil

Delta–Variant first identified in India

Also as a reminder:

–This is purely anecdotal, but running the usual kid activities and errands this weekend, there was absolutely no discernible uptick in people masking following the CDC’s new recommendations last week, and no change in businesses requiring masks again. A total unscientific straw poll of a few people I asked about it revealed that yes, indeed, the CDC may have completely obliterated their credibility this past week. To which the NIH said “hold my beer” this week, trotting out their leader to recommend that parents of unvaccinated children mask at home.

No, I’m not even going to bother discussing that one, and yes, that guy is, indeed, a Nobel Prize winner.

Perhaps sensing some skepticism about their decision-making process for the new mask recommendations, the CDC was gracious enough to update the data that “heavily influenced” their initial discussion, and published it in their MMWR. Why they did not lead with it alongside the Indian pre-print study (no longer available on the pre-print site) remains a tad mysterious.

Regardless, this is data the CDC had available for at least a month before acting on it last week. You can find the paper itself here. We’ll go through this one a little bit.

First, the main points. Massachusetts health officials monitored for new SARS-CoV-2 cases in one particular county (69% vaccination rate) following a number of large, well attended public social gatherings around the 4th of July. Mask and social distancing requirements had been released, but delta was on the move, so this was the best real world test of the vaccine in terms of preventing hospitalization or death, because this was optimal conditions for spread of delta. They found 469 new positive tests. Of those, 346 had symptoms of a cold or flu, attributed to SARS-CoV-2 (we’ll get to that attribution in a second). Of note, a majority of the positive cases occurred in vaccinated people (74%), but this is not terribly different than the total vaccination rate (69%), especially when you assume that vaccinated people were more likely to be at these social events and they would be a little enriched for the previously vaccinated. There was no significant difference in the PCR Ct values between the vaccinated and unvaccinated.

Of the vaccinated PCR positives, 79% reported at least one cold/flu symptom. 4 were hospitalized. Of the unvaccinated PCR positives, we don’t know what percentage had a symptom (the authors somehow fail to report this), only 1 was hospitalized.

That’s ~1% total hospitalization rate, between the two groups, for those keeping score at home (two of which had significant underlying medical conditions). Although not statistically significant, more vaccinated patients than unvaccinated were hospitalized.

There were no deaths in either group.

The only virus they tested for, per their method, was SARS-CoV-2. 90% of the samples they were able to sequence for SARS-CoV-2 were the delta variant.

“OMG–the vaccines don’t work! They’re no better than placebo–the unvaccinated patients were even LESS likely to be hospitalized!” I hear you, near freak out, Hypothetical Reader.

Let me say first, and with no disrespect whatsoever to the authors of this study in Massachusetts (and their co-authors, the CDC response team they called in to help with this), who have made a fine start here…

…but I have no idea how this got published. It’s half-baked.

Here’s the problem with this study, and it’s a huge one: they tested for only SARS-CoV-2.

So I’m going to toss a hypothesis out to you about this data.

Let’s imagine, for a second, that there were other viruses that can cause cold/flu symptoms. Easy to do, because there are quite literally hundreds of them across several families of virus. They also transmit, by and large, through respiratory routes similar to SARS-CoV-2. A setting ideal for transmission of SARS-CoV-2 is equally good for them–like dense social gatherings without masks or social distancing. We know these viruses circulate at the same time. Indeed, the CDC was warning just a few months ago about an off season uptick in RSV (respiratory syncytial virus), which in kids can be a cough severe enough to put them in the hospital, but in adults is usually no more than a cold. Let’s say, hypothetically, that one or even several of these hundreds of other viruses that also cause cold/flu symptoms were circulating in this area at the time this study was done. Can you “catch” more than one virus at a time? Absolutely! 10.4% of the time using a multiplex respiratory virus panel of the exact type the CDC recommended (in -last week’s- update) be used in place of its SARS-CoV-2 only assay–and that was grabbing just the top hit on Google Scholar. Moral of the story is that you see co-infections of viruses at a pretty good clip using those multiplex PCR panels–because they can be spreading at the same time, in the same populations.

No, Hypothethical Reader, before you ask the authors did –not- use one of those multiplex panels in this study–and therein lies the problem.

Because let’s say we hypothetically have a population that is highly vaccinated (69% or so) with a highly effective vaccine to SARS-CoV-2, but also have circulating another cold/flu virus. Pick one–adenovirus, rhinovirus, even another coronavirus. The PCR test just tells you the virus was present, remember. It takes clinical discernment, if not additional functional testing like viral culture, to figure out which virus is causing the cold/flu symptoms in the patient. After all, a SARS-CoV-2 vaccinated patient might be exposed to SARS-CoV-2, but their immune system quash it, at the same time they are exposed to another cold/flu virus they have no immunity to yet–which then causes mild cold/flu symptoms. Is that a vaccine “breakthrough”–or did they just catch a cold from an adenovirus, while being exposed to a virus they had a successful vaccine to?

Remembering that SARS-CoV-2 PCR just tells you the virus is present in the patient, and nothing more, what would you expect to see in the data if another cold/flu virus was moving in that population at the same time?

You would expect to see no significant difference in the percentage of people with cold/flu symptoms based on vaccination status. After all, the vaccine is NOT to the virus doing the symptom damage, right? Meanwhile, the testing for SARS-CoV-2 itself should be positive in a % of patients close to the total vaccination status for the county. Again, because the PCR just proves the presence of the virus, and if everyone was exposed at the about the same time, with the same “dose” or viral load of virus, Ct values should be close as well between vaccinated and unvaccinated patients. Basically, everyone got an equal chance of SARS-CoV-2 exposure, and everyone who did got close to the same “dose.” If another virus was along for the ride though, we would expect that symptoms will be seen in a high percentage of those who were vaccinated–and an approximately equal percentage of unvaccinated patients. Maybe even a little higher in the unvaccinated, as SARS-CoV-2 might account for some of their cold/flu symptoms too–but we have NO idea how many of the unvaccinated had previously had and recovered from SARS-CoV-2 and might be immune already too.

The authors forgot to ask THAT important question as well.

So yes, Hypothetical Reader, the results you would expect if you had a second cold/flu virus (at least) to which many people were susceptible circulating during these 4th of July gatherings alongside SARS-CoV-2 are pretty much -exactly- what the authors got and published.

So, I would argue that the data they show fits for either high symptomatic breakthrough of delta in this group of vaccinated patients as the authors conclude (which has NOT been seen in multiple other studies internationally at NEARLY this rate) or the equally likely, if not more probable (especially as vaccination rates to SARS-CoV-2 go up), idea that another cold/flu virus was there and infecting people.

Since the authors Did. Not. Test. for any other virus, we have no way to know.

Now, to be clear, they may be right and most, if not all, of the symptomatic infections they found are due to SARS-CoV-2. Even then, despite a high rate of symptomatic cold/flu symptoms in the vaccinated, the vaccine is still consistent with previous numbers for hospitalization and death rates–although with fewer hospitalizations and no deaths among the unvaccinated, tough to say it beat “placebo” here. For the record though, performance versus the group of patients without vaccination in this report is NOT interpretable in this study because we don’t know how many unvaccinated had NOT got SARS-CoV-2 before and thus were truly susceptible. Unvaccinated without prior SARS-CoV-2 exposure is the true “placebo” and we don’t know how many of them there are here.

Regardless, the conclusion that this is all SARS-CoV-2 “breakthrough” is simply not supported by the data until they have ruled out a co-infecting cold/flu virus. This paper needs SERIOUS additional work.

–So that’s problematic enough. Here is my brain ‘asplode issue with this.

The authors got SARS-CoV-2 myopia. The reviewers let them get away with it–no one insisted on re-testing these with a multiplex panel to see if other causative agents might be circulating. The CDC now touts this data as the driver for their recent mask recommendations–but also apparently gave -no- thought to the possibility that -another- virus might be there.

Especially since hospitalization rates and mortality rates look close to expected for an average cold/flu bug–and the attack rate on the SARS-CoV-2 vaccinated in their data fits the hypothesis another cold/flu bug was circulating too.

One of, if not “the”, primary objectives and tasks of the Centers for Disease Control and Prevention is the investigation of infectious agents in outbreak settings. To do this, they must be constantly vigilant to the possibility of a novel, or co-infecting, agent.

THERE IS NO INDICATION, IN THIS STUDY OR BY THEIR PUBLIC STATEMENTS AROUND IT, THAT “THERE MIGHT BE MORE THAN ONE COLD/FLU VIRUS CIRCULATING” EVEN CROSSED THEIR MINDS–AND THEY ARE CO-AUTHORS ON THIS STUDY!

You know, going back to the meme at the top, this past year plus has been simultaneously among the most professionally rewarding to be a physician scientist and among the most embarrassing as institutions we hold and expect to be dispassionate, competent pinnacles of science-based medicine have not met those expectations. Let alone the MDs getting on TV or the internet and either outright lying (from Plandemic through Fauci on masks), or being by many degrees either too hysterical or too conspiratorial/denier. It is to the point that I feel, like after the Middle Ages Black Death, the implicit trust in doctors to soberly and truthfully guide on matters of trust is broken in the minds of our average patient. At least they could blame a flawed “humor theory” of disease in the 15th century.

We have no excuse. We have the tools of science.

But here we have the CDC, which should be leading the way in science done right, clearly failing to consider alternative explanations of the data. Let alone investigate them. Those alternative explanations also happen to include hypotheses that are in their main institutional duties.

This is terrible science. Forget anything about mask recommendations. This is -WAY- beyond that. If this paper is truly the driver of some of CDC’s recent pandemic policy making, then that is terrifying–because they are not considering alternatives, and have become so SARS-CoV-2 focused that their ability to recognize, let alone investigate, possible novel infectious agents appears compromised based on their work and thinking about this study.

This paper alone should be cause for the director of the CDC to resign. And I don’t say that lightly.

–But because the dial is cranked to maximum stupid, that won’t happen. Instead, 10 Congressional Republicans pissed about mask recommendations launched an inquiry this week into the CDC’s decision making process about last week’s mask policy change. While there is a solid chance they are right, the look and feel is utterly partisan politics. It will be treated as such. And so will go absolutely nowhere.

Which means even if they are right, and this paper’s disturbing flaws are indicative of limitations in the CDC’s thinking and scientific process that need to be corrected fast, they won’t get fixed. And if there is another pandemic, particularly a worse one than SARS-CoV-2 (unlikely in our lifetime, for the record, but not zero), we may have a problem…

–No, I’m not going to discuss the CDC’s foray into property eviction law. We’ll leave that beyond the scope of these updates.

–Alright, moving on to vaccine efficacy data that’s worth a damn, we have Chile out in the scientific presses this week with “product comparison” paper of the different vaccines Chile has had access to. The Chinese made Sinovac vaccine was the worst performing in preventing any symptomatic disease among vaccinated but PCR positive patients, with 58.5% efficacy in preventing symptoms following the vaccine. AstraZeneca came in at 68.7% effective at preventing symptoms, while Pfizer came in at 87.7%. That said, the Sinovac vaccine was 86% effective in preventing hospitalization and death (even in the face of delta variant), while Pfizer and AZ were 98% effective in preventing ICU admission and 100% effective against death.

–Again, the vast preponderance of evidence is that the vaccines provide adequate protection against hospitalization or worse.

–Also on the subject of vaccines, and what does a positive PCR in a vaccinated patient even mean, we have Israel doing the study we said would be important last week when talking about the CDC’s new mask recommendations.

Specifically, they traced around the vaccinated-but-SARS-CoV-2 PCR positive cases to see how many new cases could be traced to contact with the vaccinated-but-PCR-positive case.

In 80% of these vaccinated-but-PCR-positive cases, there were NO additional cases found. Basically, the vast majority of the PCR positive vaccinated cases were NOT spreading the virus–consistent with the theory, and prior data from non-delta strains, that all you are detecting is the presence of a virus that has been thoroughly handled by the trained immune system.

In 10% of cases, only ONE additional case could be attributed to the PCR-positive-but-vaccinated person. In 10% of cases, more than one additional case was found.

However, the Isrealis did NOT differentiate among symptomatic vs asymptomatic in the PCR-positive-but-vaccinated. If I were a betting man, given the evidence we discussed last week about likelihood of spread from asymptomatic vs symptomatic patients, I would bet that the cases where there was spread are heavily concentrated in those few vaccinated patients who get at least some symptoms of COVID.

–A pre-peer review paper out from Singapore this week also shows that vaccinated delta positives are MUCH less likely to require supplemental oxygen or hospitalization than unvaccinated patients. Further, they may clear the virus quicker, and the authors opine that this may reduce the infective window and make vaccinated patients less likely to spread SARS-CoV-2, even if positive themselves, but this would require additional studies.

–Yes, I did see the headlines about lambda variant. This variant was first identified in Peru, and has been a dominant strain there. It is more contagious than alpha or the original SARS-CoV-2, but has not made nearly as much international headway as delta. Unsurprisingly, it takes more antibody to neutralize the virus in a petri dish. Again, successful vaccination, like with delta, is generating enough antibody to overwhelm lambda anyways.

Tragically, this has already proven insufficient to overwhelm the tendency for “NEW VARIANT–WE ALL GONNA DIE–YOUR FIREARMS ARE USELESS AGAINST IT” headlines.

–Which brings us to boosters. Some countries have already announced that they are acquiring vaccine for a third dose (or second for some of the one-dose vaccines) for select, at risk populations. The UK and Israel, among several others (Germany at least, and I think France off the top of my head), have been active in the papers with these plans. Still unclear if this is strictly necessary–on the other hand, in high risk populations, it’s a reasonable thought in the absence of data.

That said, the WHO came out this week AGAINST boosters for the time being, since much of the global population hasn’t even had a first shot yet.

And just today there are rumors the US is going to ignore the WHO and the Biden administration is working on a plan for boosters for at least high risk populations like the elderly and immunocompromised. So stay tuned, I guess.

–Whew. Get all that so far?

Good.

We’ll go quickly around the horn next. Cases in the UK continue to drop. Japan has seen an Olympics co-incident increase in cases (not terribly surprising). In fact, Asia in general looking a little dicey and riding a delta wave as China goes back to pretty significant lockdowns. In fact, the size of some of the China measures is getting lost in the domestic noise a bit. Several million people are now on lockdown across a wide swath of Chinese provinces. They are also requiring mandatory quarantines in ports of ships arriving from India (which is a lot, considering that’s a stop on the way to China before you hop into the strait of Malacca). Other ships arriving from pretty much anywhere else will have to test negative for the entire crew.

In short, expect supply chain funkiness again, and it might not be the worst idea to go a little heavy on the next trip to the supermarket with stuff that will last a little while.

In the US, Epiforecasts has the Rt down to a 1.2 (from 1.4 over the past couple weeks). I think we are still on pace to crest the delta wave in 2-3 weeks, leaning towards 3. Parts of Louisiana and Florida are being pressured on bed count, but hospitalization rates are still comparatively low versus previous waves at this stage. Expect that to catch up though, and I fully expect delta scare headlines to continue so long as the numerical counts continue to climb. Don’t be surprised if they at least jawbone about lockdowns, depending on how hysterical the headlines get.

–I did hear anecdotally that one Florida locale is seeing a cluster of elementary age kids in the hospital with COVID, but this is one location and purely doctor internet rumor right now. Given the widespread geography and numbers at the moment, this is more likely random chance. After all, with every wave, there has been somewhere that has seen, by chance alone, a slightly higher percentage of younger, sicker patients and leapt to tell everyone that “this time it’s hitting younger healthy people!” But this is the first time the rumor mill has been about kids, so we’ll monitor. Keep you updated if this becomes more of a trend.

–On better news for kids, there is a recent publication in the JCI showing that kids with mild or asymptomatic SARS-CoV-2 infection (both the most likely outcomes in kids by far) generate robust antibodies to SARS-CoV-2 following recovery. In fact, they have a stronger response than adults, and the response is at least as durable.

–Had a couple reader requests. One was a video that frankly I have not had time to listen to in depth which was questioning the efficacy numbers of the vaccines. My knee jerk reaction on the first few minutes is that the doctor they were interviewing is, well, aggressively interpreting what constitutes bona fide “breakthrough” infection on the Israeli data, which we mentioned last week had some limitations (like retrograde going back for any respiratory symptom to call a “breakthrough” and all based on pretty small numbers of actual positives picked up by screening in vaccine positive patients). Phase 3 studies of the vaccines and multiple international real world studies of the vaccines consistently show high efficacy in preventing hospitalization and death (just look at Chile and Singapore up above again). Among elderly populations, who are at the highest risk but internationally now at the highest vaccination levels, show this reduction in hospitalizations and deaths most clearly. That said, trend is also for disease to be less severe, more contagious over time–coupled with daily reductions in the number of people unvaccinated (as more people get the shot), which have an unknown number of people who are previously exposed and now naturally resistant, will make the efficacy of the shots appear harder to discern over time. Who you compare to and when will matter a lot–as will the variants, which do indeed seem to require robust response from the vaccinated to control variants like delta. They can do it, but you might have mild symptoms in some cases for a bit before your immune system recalls its training and adjusts to the differences in the spike protein. Hope that makes sense (and addresses what I’m guessing is the direction the rest of that interview went).

–While we’re still in the science/epidemiology portion, had a reader request a compare/contrast between the coronavirus vaccines and the flu vaccines of old. We have covered some of this before, so I will try to keep this brief, and without as detailed a description of the mRNA vaccine mechanism and biology as you can find in that link.

Alright, first let’s talk about our goals in vaccination. Vaccines are a preventative measure, where we try to safely introduce the agent causing a disease, without giving you that disease, in a way that trains your immune system to recognize it. If your immune system is trained and prepared for that agent, there is a much greater chance that it will curb stomp the agent if/when you are exposed to it. I say agent because you can (and we do) vaccinate against bacteria and viruses, and there are even trials for vaccines to specific high incidence cancer mutations (none of the cancer vaccines are approved yet anywhere, so far as I am aware).

For our purposes though, we will talk about viral vaccines.

Vaccines of ye olden dayes come in a couple of flavors. For some, what you are injecting is the dead, inactivated virus itself. The way these train the immune system is having macrophages, your body’s “clean up crew” cells, called to the injection site where they hoover up all the dead virus particles that have been injected. The macrophages will chop them up into pieces and “by law” will present those pieces on the surface of the cell. There, T- and B-cells look over the pieces and “train” to fight them by recognizing them as foreign things that are not you. In these kinds of vaccines, the dead virus is not replicating in your cells. But specific T- and B-cells learn to recognize and fight those pieces, and will be “stored” in case you run into them later. Specifically, B-cells will start making antibodies to those pieces, and T-cells will be on standby to immediately recognize a virus hijacked cell suddenly making those specific viral proteins to take out any virus that got past the wall of antibodies to infect cells.

Flu vaccines are, by and large, dead virus vaccines like this. The dominant strains of flu are grown, then executed, and packaged into vaccines. Because the flu mutates so quickly though, and it takes awhile for the virus to grow, flu vaccine manufacturers have to “guess” every year which of the circulating strains will be the dominant ones. Sometimes they guess wrong, or the virus simply evolves as it moves, to slip around the vaccine some.

Thus, the effectiveness of the flu vaccine changes from year to year. It may stop you from getting sick altogether. Or it may just reduce the duration of the symptoms if the virus has mutated enough that your immune system is trained to something “close but not quite” the mutant that actually got to you, and has to spend a few days catching up to the changes. Getting the flu vaccine annually is a good idea though, because even if guessing “wrong”, it will typically take the edge off the flu and significantly reduce your chances of hospitalization with flu pneumonia and/or death.

Does that sound like a familiar scenario? It should…

Other olden tymey viral vaccines use what’s called an “attenuated strain.” This is a -live- virus, but it’s been defanged. In this case, it’s close enough to the dangerous version that your immune system will recognize the dangerous version and stop it. The way these work is that the attenuated virus actively infects your cells.

That’s right–you basically get the most mild case ever of the virus itself. Just enough to train your immune system.

This is because the attenuated virus is defective–it can infect your cells and replicate in them, and does, but it sucks at it. It can’t get to enough of your cells quickly enough to actually cause the associated disease. So in this case, your immune system gets its first warning of the attenuated viral strain when T-cells doing random “ID checks” start seeing pieces of viral protein on the surface of your cells–all part of the “quality control” system for your dumb ribosomes discussed in detail in the link above. The T-cells get triggered, alert the B-cells, and again, you’ll get combined B- and T-cell mediated immunity. Yes, the main risk of this is the attenuated strain mutates back to a fully disease capable live one, and this does happen in rare cases (outbreaks of measles in Africa most recently, from back mutated virus as big vaccination campaigns with an attenuated strain vaccine were used).

Lastly, for vaccines like Hepatitis B, the vaccine injection is just a key surface protein for the virus. Similar to a dead virus vaccine, macrophages hoover up the injected protein, break into pieces, and show those pieces to the T- and B-cells. They then learn to fight Hepatitis B virus–but only its spike protein. That’s enough to keep you from getting ACTUAL Hepatitis B virus if you run into in the future though–but you don’t make responses to all the parts of the virus. Just the surface protein. In fact, you can tell based on the antibodies they make who has been infected by Hepatitis B before (full virus) and who got the vaccine. The former will have responses to other proteins, like Hepatitis B core protein AND surface protein. Those with just the vaccine will have responses to only the surface protein. There are drawbacks to this approach. First, at least for Hep B, the target surface protein is “slippery”–there are some people whose cells, genetically, cannot hold onto the most important pieces well enough for the immune system to train against them. In Japan, the Hep B vaccine failure rate can be up to 30%. Second, because it is slippery, it is not especially immunogenic, and you need to get several Hep B vaccines spaced several months apart for most people to respond (if they will at all). That said though, when it works, it works, and chronic Hep B rates have been significantly reduced by vaccination in at risk populations (like healthcare workers from accidental needle sticks).

Alright. So that is ye olde timey vaccines. What’s new about these SARS-CoV-2 vaccines?

For some of them, not much. The SinoPharm vaccine from China is an inactivated viral vaccine–so similar to an old school vaccine, this is just dead SARS-CoV-2 loaded up as a vaccine injection. It does NOT actively infect the cells, and relies on macrophage clean up, followed by presentation of its pieces to the immune system for “training.”

The Novavax vaccine is a SARS-CoV-2 spike protein ONLY vaccine–similar to the Hep B vaccine, it will inject ONLY the spike protein. Macrophages will pick it up, chop it up, and show the pieces to the immune system to train it. There is NO active infection of your cells with this vaccine either.

Others are variations on an old theme. The J&J vaccine is a “viral vector” vaccine. This is a new style, but the idea is similar to an “attenuated virus” vaccine, with a couple key differences. For example, the attenuated virus in this case is really just an empty viral shell from another family of viruses called adenoviruses. Some adenoviruses can cause the common cold–they are a big family of viruses. Importantly, we learned decades ago how to make “empty” adenoviruses. In short, we get the adenovirus “shell”, which includes the proteins it uses to invade a cell, but we remove all its genetic material from the inside. So the “shell” will still get inside target cells, but without the adenovirus genetic material, no new virus gets made. It’s a defective “infection.” We can also put different genetic material into that adenovirus shell. Now the adenovirus shell takes the genetic material we want to send to the cell, “infects” it, and the cell will now make the new gene we put in. Again, importantly, since this gene does not include instructions on how to make new adenovirus shells, this is still a defective “infection.” The shell and the new gene go into the cell–but no new adenoviruses (or coronaviruses for that matter) come out. It mimics actual virus infection, but there is nowhere for our new gene to go.

So for SARS-CoV-2, what they have done is take empty adenovirus shells and pack them with the gene for the SARS-CoV-2 spike protein. And just the SARS-CoV-2 spike protein. The adenovirus shell carries the SARS-CoV-2 spike protein gene to your cells and “infects” them. But again, there is no way to create new adenovirus shells, and no way to create new full SARS-CoV-2 viruses either.

So no, Virginia, despite what you read on the internet, vaccinated people are NOT “shedding” and infecting non-vaccinated people. Only the spike gene is there; only the spike protein gets made. That’s NOT a full SARS-CoV-2 virus and cannot infect new cells or replicate on its own.

ONLY the SARS-CoV-2 spike protein, carried to the cell by our adenovirus vector, gets made. This more closely mimics actual infection though. As discussed in our link for the mRNA vaccines, the cell that picked up our adenovirus shell makes the SARS-CoV-2 spike protein from the gene we sent it in the shell. Ribosome quality control kicks in, and that protein is chopped into pieces and shown to passing T-cells. They recognize it as foreign, freak out, and train themselves and the B-cells to fight the SARS-CoV-2 spike protein. This results in immunity, as your immune system will now take out the SARS-CoV-2 full virus from now on by being “trained” to recognize and shoot it on sight by “remembering” what the spike protein looks like. Of note, the T-cells will ALSO ruthlessly hunt down and kill all of your cells that picked up an adenovirus shell, so your cells will not be making SARS-CoV-2 spike protein from those shells for more than a few days.

So that’s the “viral vector” vaccines.

The mRNA vaccines are also new. Again, for full details, link above. The main difference for these is that we use lipid particles (tiny fat droplets–the same kind of fat that makes up the cell membrane of ALL of your cells) to carry the SARS-CoV-2 spike protein RNA to your cells–instead of an empty adenovirus shell. Since the lipid particles carrying the SARS-CoV-2 spike protein RNA are the same kind of lipid as your cell membranes, they merge and fuse as the particles bounce into your cells as they push the plunger on the syringe in your arm. When the lipid particles merge with your cells, the SARS-CoV-2 spike protein instructions they carry inside is dumped inside your cells.

So like the viral vector, this also mimics infection–but again NO full SARS-CoV-2 is made. The only difference between these and the viral vector vaccines is that J&J used an adenovirus shell; these use a lipid only shell. Old timey attenuated virus strains were just using a wussified defective virus to dump the ENTIRE instruction sheet for new viruses into your cells. HOWEVER, for the mRNA and viral vector vaccines, UNLIKE THE ATTENUATED VIRUS STRATEGY, only the instructions for the spike protein are in the SARS-CoV-2 mRNA and viral vector vaccines, and only that gets into your cells.

So now that the lipid particles have delivered the instructions for the SARS-CoV-2 spike protein inside your cells, once again, your ribosomes are morons and dutifully make new SARS-CoV-2 spike protein. Because your cells know the ribosomes are morons, ribosome QC happens, and the spike protein they just made is chopped up and shown to passing T-cells. The T-cells freak out, alert the B-cells, and everybody trains against the SARS-CoV-2 spike proteins. That SARS-CoV-2 spike protein instruction sheet (mRNA) won’t last in your cells for more than 48 hours anyways; but regardless, your T-cells will again ruthlessly hunt down all of your cells that picked up a lipid droplet with the SARS-CoV-2 spike protein RNA in it, and kill them. The message will not persist. The spike protein will not persist in you.

The training will though! Your immune system will be ready to rock and roll with a full range of B-cell (antibody) and T-cell responses–but will be spike protein specific. So if the spike protein shifts enough, similar to a flu virus shifting around the “best guess” vaccine, you may get mild symptoms lasting a little bit as your immune system remembers its training, recognizes the virus, but takes a second to figure out that it’s SARS-CoV-2 in a new mustache disguise.

In terms of side effects, as we mentioned above, old timey vaccines use dead or attenuated viruses can accidentally give mild or even full versions of the disease they are vaccinating against. For a dead virus vaccine, this happens when they did not quite kill the virus hard enough, and it’s really only mostly dead.

That is almost always a manufacturing issue.

Attenuated viruses will back mutate, as we mentioned, to become the fully functioning version and cause the actual disease being vaccinated against. This is rare, but it does happen.

This is basically impossible for the viral vector or mRNA vaccines, because unlike the dead or attenuated old skool vaccine types, there is NOT a full copy of the virus being vaccinated against involved. Similar to the vaccines that inject just a specific target protein, only one tiny piece of the final virus is involved with the viral vector/mRNA vaccines. In fact, the only difference between the viral vector/mRNA vaccines and the old skool vaccine types where you inject just a protein is where that protein gets made. For the old skool protein only vaccines, we make the protein ourselves in a vat, and load that into shots. For viral vector/mRNA vaccines, we mimic viral infection to get your cells to make the target protein. Your cells become the vat!

While old skool dead/attenutated viruses can -rarely- lead to mild or even full cases of the disease being vaccinated (because the full virus is still involved), and this is unique side effects to these classes of vaccines, there are more universal side effects.

All of the vaccine types, including the new mRNA and viral vector SARS-CoV-2 vaccines, have a similar range and mechanism of those side effects. For example, Guillen Barre Syndrome, and even rare myocarditis, has followed olde tymey vaccines too. The Pfizer Flu and Moderna Malaise of aches/pains/fever/generally feeling hungover are common complaints after other old timey vaccines as well.

In all cases, these “side effects” are because your immune system has been provoked by the vaccine, and is training. That hung over feeling (and really ALL the symptoms of cold/flu when you actually have a cold/flu) is your immune system fighting the infection. Or in this case, the “infection”–the part of the vaccine that makes your immune system THINK a real infection is happening! The more rare, but more severe, side effects like GBS, clotting, myocarditis etc. are just your immune system, while training, getting off target. It starts thinking that it sees the vaccine protein in places where it’s not, and starts “shooting” normal cells by accident.

The SARS-CoV-2 vaccines, particularly the mRNA and viral vector vaccines, are only “new” in the way that part of the protein we WANT the immune system to train against and target is being delivered to your cells in a slightly different way. However, ALL vaccines, even the old ones, are just variations on “how to get the part of the virus we want the immune system to hammer” into your cells (either macrophages or others) to get your immune system to train against them. The side effects we have seen from them are the same, often immune mediated, ones we have seen with old timey vaccines too–just a slight difference in the rates. That’s it.

And that’s your compare/contrast between previous vaccine delivery technologies, and the couple that moved along quicker than these strategies to get new SARS-CoV-2 vaccines available…

–Finally, on the socioeconomic impacts front…

“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair”

–C. Dickens

They also trotted out Dr. Fauci to state that he believes a return to the lockdowns of 2020 are “unlikely” as the White House walked back statements from a White House spokeswoman on the 29th that lockdowns and school closures, if recommended by agencies like the CDC, would be considered.

Followed by last night, when Dr. Fauci made headlines musing about the possibility that a “worse variant to come” than delta is a risk that keeps him up at night.

Meanwhile, you have op-eds like this, claiming vaccine mandates are not enough and you need to punish those who choose to not get vaccinated. You have Federal worker mandates where you lose your job if you don’t get vaccinated (unless you are in the postal service–and apparently the teacher’s union is exempt as well). And of course, you have Mayor De Blasio in New York, too afraid to issue a vaccine mandate from his office for fear of political blowback, instead forcing restaurants, gyms, bars and events to ensure vaccination status of anyone trying to enter and deny entry to anyone who has not been vaccinated or is not vaccine eligible. More and more employers are either electing, or being “encouraged” (so the blowback falls on eeeeeevil business and not our precious political leaders) to issue vaccine mandates for employment.

The CDC reported this week that only 28.4% of African Americans have been vaccinated. Hispanic numbers are not appreciably different. I doubt Native American vaccination is particularly high, just to name a few.

Again, what message does this send to already marginalized demographics? That they must comply, or they will be more marginalized? That we must make it more difficult for them to live and participate in society if they do not get a shot from a government they have good reasons to not trust? And we are justified for doing so, as these op-eds claim, because they are endangering the rest of us?

The following quote is from a monologue about an election, so I’m going to cut the election specific part of it. But I think the rest is very relevant as food for thought as the “make life intolerable for the unvaccinated until they damn well do what we tell them” drive is clearly growing in popularity among government and business leaders:

“I love this country even though at times it doesn’t love me back. For my whole life my parents, my grandparents, me, for most black people, this system has never worked for us. But we still play ball, tried to do our best to live by the rules even though we knew they would never work out in our favor, had to live in neighborhoods that you wouldn’t drive through, send our kids to schools with books so beat up you couldn’t read them, work jobs that you wouldn’t consider in your nightmares.

Black people wake up every day believing our lives are gonna change even though everything around us says it’s not. Truth be told, you ask most black people and they tell you no matter who won the election, they don’t expect the hood to get better. But they still voted because that’s what you’re supposed to do. . . I love this country as much–if not more–than you do. And don’t you ever forget that.”

–“Black-ish”, episode “Lemon”

Again, what message are mandates sending? Is it one we want to send?

You want to increase vaccination rates? Meet the unvaccinated where they are, and work with them to convince them. Ask them what it will take to convince them, and give them that proof.

Mandates may create, or extend, more problems than they will fix.

–Speaking of the Bonfire of the Institutional Credibilities, I doubt my anecdotal experience above, out and about this past weekend, seeing little compliance to the new CDC mask guidelines, was unique across the country.

Remember when we mentioned Varys’ Riddle in previous updates? When we asked rhetorically what happens when governments, no matter how construed, lose the consent of the governed?

That’s what it looks like, especially at first. And it builds from there.

Two other great reads for examples this week. These are not provided for agreement, nor to persuade you to agree. Take an anthropologist’s view of it. What does the Bonfire of the Institutional Credibilities look like? How does it happen?

Read this entire thread. Also note the like and re-tweet metrics for it…

Secondly, the Nudge. Who is saying this, based on some of the previous pandemic writing they have done, is also significant.

–Finally, your chances of catching coronavirus in most places in the world this week are equivalent to the chances you need this break after this update…

<Paladin>