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:

–No, the title of this week’s update is NOT an error! Instead, a lab test in the Ivory Coast was. So remember that 18 year old who got symptoms of a hemorrhagic fever that we reported last week? On re-testing samples to confirm Ebola, the reference laboratory in France could NOT confirm the original diagnosis. The WHO seems to believe the French lab; Ivory Coast authorities are also going with the French lab, so “Ebola? Mais non, mes amis.” On the other hand, they’re not quite sure what the 18 year old actually has now. But it hasn’t spread to anyone else yet that we know of, so there’s that. We’ll update as events warrant, following pending identification/additional cases of whatever it is.

–In other filoviridae miraculously content with a one patient outbreak, the one case of Marburg in Guinea remains the only case of Marburg in Guinea this week. Still a few weeks until the incubation period for more runs out and the “outbreak” becomes just one spectacularly unlucky dude.

–In the wild, wild world of Coronavirus…

First off, we are going to do some science here. That’s right–you are going to be part of the experiment! I will explain why a little further down. My hope is that this helps me illustrate a key point about the world around you.

Alright, ready? We’re going to start the experiment here. First, you need to click this link to read the first article. Just go until it hits you in the feels (I don’t know anyone who has finished that article in their first try).

Got it? Still in the feels it gave you?

Good. Now you have a choice to make. You have to pull the lever on one of two slot machines. You get one pull. The slot machine called “YOLO” has only a 20% chance of winning–but if it hits, will pay you $1,000. The slot machine called “Safety” will win 90% of the time, but it only pays $20 when it hits. If it hits, you get that (hypothetical) money. If it misses, you get nothing. So choose now. Are you making your one pull on YOLO or Safety?

Write down your choice. Keep the paper handy, we’ll come back to it near the end.

–Now, let’s cleanse the emotional palette with this short video. Or just pick your favorite funny dog/cat video off the internet. There are billions to choose from.

–Alright, with the start of our experiment out of the way, let’s do a TL;DR summary of what we have covered over the last several weeks. There is still a lot of confusion out there. I’m getting a number of reader questions, especially on boosters.

So, in summary of our Sciencepalooza the last four weeks:

“Do the vaccines even work?”

Yes, they do. The best evidence for this is the effectiveness against hospitalization–the only metric that really matters. If the article ain’t talking hospitalization or death rate, it ain’t worth your time.

The vaccines will reduce your chances of hospitalization, even on breakthrough, by at least 10 fold. More than 90% of those in the hospital in the US right now with COVID are unvaccinated. The most consistent finding of all the papers we covered the last four weeks was that efficacy was still 90%+ for the vaccines in terms of keeping you out of the hospital.

Yes, the vaccines work.

“So why does breakthrough happen?”

For the same reason the flu shot will often, but not always, prevent you from getting the flu. The virus can change just enough that it takes an extra day or two to figure out that it knows the virus, and has B- and T-cells that work with just a little tweaking. While that is going on, you get flu like symptoms. Flu like symptoms are your body fighting the virus. That is “breakthrough.” Again, vast majority of the time, your body figures it out before you are remotely close to needing the hospital. And keeping people out of the hospital is what ends the main threat of COVID.

“But I keep reading that the vaccines suck at stopping infection!”

That’s because there is a terrible definition of infection going on out there. It’s why I keep posting Princess Bride memes, because “infection” is being used for any positive test. Including people who have no symptoms. They’ve been exposed to the virus, sure. The virus is there in their nose–that’s what the positive test says. But are they infected if they have no symptoms? I would argue no. They aren’t even sick. And cavalier use of this “infected” term is unnecessarily worrying folks like you. Which is why I have been taking apart some of these papers in detail to highlight they are screwing this up.

At the end of the day, the vaccine won’t stop SARS-CoV-2 from getting in your nose. What the vaccine WILL doing keep the virus in your nose from replicating a whole bunch in your cells–and THAT is what keeps you out of the hospital. Again, the vaccines have been really good at that part.

“But Israel is super vaccinated, and their cases are rising! And most of their positive cases have been vaccinated!”

What you are most often seeing is the same “infection” confusion. Israel is reporting all positives, including screen positives (they do a lot screening there too) in vaccinated patients who have no symptoms. In terms of preventing hospitalization, the vaccines are doing well there too. While 59% of hospitalizations are vaccinated, this is far less than the overall vaccination rate in Israel–meaning it is proportionately MORE COMMON to be hospitalized if unvaccinated, even there! Of those hospitalized AND vaccinated, just like here in the US, they are MUCH more likely to be elderly or immunocompromised. That’s why Israel is pushing a booster, starting with those patient populations. Which brings us to…

“Should I get a booster?”

The best US based data on this was covered here. The trend, both in vitro and in real world studies like that one has been for greater chance of hospitalization on vaccine breakthrough if you were >65 years old or immunocompromised. That’s because the vaccine is a little less likely to take in these patient groups, and may be less durable. For why that is among the elderly, this is a reader submitted article that talks about why the immune system gets less adaptive with age (and avenues for future ways to change that).

Now, the Biden administration announced a plan, along with the CDC, for booster shots starting this month. They wanted them for everyone starting 8 months after your first vaccination completed. The data for that is still under review at FDA–including data on boosters from Moderna and Pfizer. That data has been press released as available, but has not been made public anywhere I am aware of yet.

Yes, two senior leaders with 40+ years of vaccine experience have resigned from FDA this week citing undue political pressure on their process to support that decision that the Biden administration has already made. More troubling to me is that they also cited pressure on the decision to expand the vaccine labels to children under 12. I really want to see that safety data on the kids now.

Regardless, if you thought changing politicians and political parties changed political behavior and only “the other side” pressured science to fit its pre-determined goals, well, now you know better.

It is also worth mentioning that the European version of the FDA has not seen sufficient evidence yet for it to endorse boosters.

In my opinion, there is sufficient data out there that if –I– were >65 years old, and/or had known risk factors for severe COVID (especially immunocompromise), I would get a booster. The expectation of benefit is higher than the expected risks.

Important point though: That is my personal opinion, and I am not your doctor!

Talk through your decision with your actual healthcare provider and come to a decision that works best for you. As always, all drugs and therapies should be used according to their label and under the supervision of your licensed healthcare provider.

“But you are NOT >65 years old, and have no risk factors for severe COVID. Are you, personally, getting a booster?”

I am not going to be first in line, no. While there is a strong suggestion that those over 65 and/or immunocompromised may benefit from a booster shot, I have seen nothing yet that convinces me that patients NOT in those groups need a booster right now. I’m not alone. We linked articles last week to other infectious disease experts being interviewed saying the same thing–there is just not sufficient evidence for everyone to get a booster.

I’m fortunate to have access to my antibody levels. They are quite high. There is also reason to believe from in vitro studies that they will stay high enough to handle variants like delta.

–That should cover the main conclusions from Sciencepalooza. If I have missed one, of course, reach out.

–Not quite to part two yet of our experiment, so keep reading…

–This isn’t a reader question, per se, but is worth hammering home again. There is very good evidence that the risk of hospitalization is even less (maybe even up to 13 fold less) than those with just a vaccine if you have been previously infected by SARS-CoV-2.

This makes vaccine mandates that do not also count prior COVID, and vaccine “passports” that do not also count prior COVID, well… untenable to say the least. I am not the only to opine that.

If you did not have COVID symptoms AND a positive PCR test before though, do NOT count yourself as “prior COVID”! I would err on the side of caution and get the vaccine as well.

–Thanks to our South African correspondent for the early tip on the second variant of concern to be initially identified by South Africa. I am going to call this “beta beta” until it gets an official name. There have been the usual “mutations associated with resistance” and “your vaccines may be useless” “doom! dooooooooooooom!” headlines about this already.

The key points:

1. It does have mutations similar to the other variants of concern, plus some new ones.
2. Most concerning to me, it appears to be a faster mutating strain of SARS-CoV-2. Not flu fast, but faster than its cousins.
3. It has increased its proportion of cases in South Africa, but is still very much a minority variant there. Total cases of COVID in South Africa are currently in decline, and they are in the prime winter months for coronavirus spread. So, epidemiologically, not too freaked out yet.
4. They have not tested it against antibodies yet, but undoubtedly are as we speak. So no one has any idea at the moment how effective the vaccines will be against this variant. My guess–it will be like delta and beta where it simply takes more antibodies to get the job done, but the vaccines will be able to do it. That’s just a guess though. We’ll see what the data says when they have it.
5. No need to worry until they have the data.

–Other odds and ends… Japan is still working on Moderna vaccine side effects and issues, including investigation of two deaths. This comes as it appears some doses there may have a “metallic” contaminant, which may be part of the needle breaking off in the vial as the dose is drawn, or could be a manufacturing issue. All is still under investigation.

–Around the horn briefly, cases are trending down in most countries involving our regular readership. The US Rt continues to hover around 1, and most of the early hit states are in solid decline. Later to the delta party states are still seeing some increases (South Dakota was the last to see a major delta upward move, and will likely be the last to come down). Indiana, one of the later states, appears to be leveling new cases and admissions this week, and hopefully that trend solidifies.

–Staffing issues in hospitals in the US are complex, with causes from suspension or termination of the unvaccinated staff through burnout and the usual reasons of pay and treatment by management. But they are real. And some of the causes are not unique the pandemic, and likely to persist after.

—“Oh noes…Joe Rogan caught the COVID!”

Yes, I saw that, and his treatment regimen has been in the news. First off, I have no idea if Joe is vaxxed or not. From what I have heard, he has questioned the risk/benefit for younger, healthy people to get the vaccine. He is not in the age groups he was arguing about. Even if he wasn’t, he caught the symptoms quick and pursued treatment options. Those included the EUA approved monoclonal antibodies that are available, a Z-pac, some vitamins and ivermectin.

Since this is Joe Rogan we are talking about, there is a non-zero chance DMT was involved, although maybe not to treat the virus directly.

Because of that regimen, I am very limited in what I can say about it, and thank you for your understanding.

I will re-iterate that the monoclonal antibodies have been studied and approved for the treatment of acute COVID in at risk patients. The US has purchased a large supply of them from the companies who make them. Ivermectin is still undergoing clinical trials, and per the last CDC recommendations I saw, should really only be considered as part of a clinical trial for COVID until its efficacy for acute COVID can be definitively established.

–Also thank you for your understanding if you saw this late last week: https://assets.ctfassets.net/srys4ukjcerm/22VL47iyxCGrI2T5yLgYeJ/5a9044d819a04d9f152f8d7693fe97df/Reopening.pdf

–Still have that piece of paper with YOLO or Safety on it? Good. We’re getting closer to part two…

–So Joe Rogan’s treatment regimen does let me talk some socioeconomic issues around ivermectin! Because I am sure that I am not the only one who noticed that every article and a sizeable number of twitter comments over the last two weeks ONLY refer to ivermectin as a “horse de-wormer.”

That’s an adorable effort, and would be effective persuasion, perhaps, in other circumstances. And let’s be frank–this is all about persuading those poor simpleton straw men in our propagandist’s mind to NOT take ivermectin for COVID. In fairness, this bit of propaganda is well-intentioned, because, as we mentioned, Ivermectin is still undergoing the definitive trials. The people behind this propaganda effort are hoping to keep people from wasting time and money and risking, well, usually pretty mild GI side effects, but side effects, sure, to take Ivermectin when it may not be effective. They wrote the “horse de-wormer” deliberately to get echoed across the twitter sphere by those most likely to read the media companies writing those articles. And that was effective. That happened! So they did that right. Plus, if you knew nothing else about ivermectin, and read it was a horse dewormer, you would probably be less likely to take it as a human drug for COVID. So that is reasonable persuasion too.

However, the reason this effort is doomed to utter failure is the horse is already out of the barn on ivermectin.

Pun intended.

Everyone they would be trying to convince has already heard of ivermectin, knows it is a cheap generic, been in use for decades, and has been on the essential medicines list, for humans, since 1987.

Calling it a “horse dewormer”, while an accurate depiction of its veterinary use, is WAY too late in the ball game now. Worse, it’s a demonstrable over-exaggeration when you do even the briefest search on the internet for ivermectin.

On top of that, there is no subtlety here. Ivermectin was just plain ol’ ivermectin for months in the media. Then within two weeks–two weeks!!!!!–it’s “horse dewormer ivermectin” everywhere, all at once, same language.

All this will wind up doing is damaging the reputation for serious, sober and independent reporting and thinking for anyone parroting this particularly obvious propaganda line.

Fergodsake, just let the trial play out guys. This is why we run them.

And to be on the level, ivermectin has not bombed out yet. There is a non-zero chance it shows benefit–and those “horse dewormer proves effective in treatment of acute COVID” are going to be that much more embarrassing if ivermectin pulls ahead at the wire.

–Speaking of other obvious persuasion elements in the news, for the next week or so, just pull up the headlines at whatever your favorite major media source is. I will bet you that you will see at least one tragic story of someone who spoke out against vaccines and just died of COVID, or did not get vaccinated because of otherwise apparent good health and died, or is in the ICU warning others not to do as they did.

The moral is all the same in this steady drip–“learn from this terrible tragedy–get vaccinated today, unvaccinated!”

And again, heart is in the right place. But this is equally obvious nudging.

–Which brings us back to our experiment! No brutal article this time, I promise. Instead, watch this short video.

See? Totally different feels.

Now you have another choice to make. You have to pull the lever on one of two slot machines. You get one pull. The slot machine called “YOLO” has only a 20% chance of winning–but if it hits, will pay you $1,000. The slot machine called “Safety” will win 90% of the time, but it only pays $20 when it hits. If it hits, you get that (hypothetical) money. If it misses, you get nothing. So choose now. Are you making your one pull on YOLO or Safety?

Write down your choice again.

Got it down? Good.

–So the boys at Epsilon Theory (with a great think piece this week by the way) arrived at their analysis of narrative by adopting Ben Hunt’s process for reading headlines.

And Ben’s method involved two questions. For every headline he read, especially the above-the-fold main headlines (since that is the most expensive real estate for attention), he asked himself two questions:

“Why am I reading this?” (or “Why was this story, this narrative, in particular chosen as important enough to write about here?”)

“Why am I reading this now?” (Why is this bit of news now attention worthy? Sometimes, it’s describing trends months or years in the making, after all. What has changed?)

–And this works for Epsilon Theory to identify the Narrative. So well, in fact, that this is their main line of business. A high ticket subscription service for professional investors, as they have a proprietary computerized analysis of those headlines to let those investors know when narratives are shifting. And as GameStop shows, Narrative, not fundamentals, can drive asset prices, especially in the short term.

But, I would argue in the era of social media (and media companies who have to respond to compete with social media) this is inadequate.

–Why? Because of our experiment we did together in this update.

If we were doing this for real, there would be a control group that would not have read the article or watched the video, but chosen between YOLO and Safety. If we could aggregate all of your answers, we would find that more of you picked YOLO after reading the article (which is a brutally sad article) than in the control group who did not read the article. We would also find that more of you picked Saftey after watching the video than in the control group who did not watch the video.

I can say that with confidence because this experiment has been done before, even including material designed to provoke sadness or anxiety before asking the participants to choose between a high-risk/high-reward option and a low-risk/low-reward option.

Don’t get hung up on your specific answers.

The key points are these:

1. By emotionally “priming” you prior to a decision, I shift the odds of the decision you will make
2. I cannot guarantee that you, specifically, will make that decision. But I can shift enough of you, in aggregate, to make one decision more likely than the other. All by presenting you the same emotional primer.

Other emotions prime you in different ways, and to really terrify you, this has been studied most in depth in experiments to predict and control consumer behavior.

Why does social media make this even more potent?

You probably remember the headlines a few years back, and part of the reason Zuckerberg got hauled in to Congress to drink water like a robot, where Facebook got in trouble for running a broad but unannounced experiment on its own users. Facebook presented more sad content to some of its users–and lo and behold found they got more sad in the real world, and their decision making was affected.

All of those apps on your phone? Your Google searches (look into Duck Duck Go, folks)? The cookies on your internet browser as you surf the web? The articles you click on? The ads you click on? What you watch on YouTube? Or Netflix? Your likes on Facebook? Who you like? What you like?

There is more aggregated data about you, and what you react to, than ever before.

Anyone with access to that can now start to tailor messaging to you. Advertising, sure. But the emotional content of the headlines and stories you see can be adjusted too–just like Facebook did. If they make you angry with something first, you are more likely to blame others and -take action-. If they make you feel fear, you are more likely to blame the situation, and less likely to take action (more likely to process deeply though, evaluating the situation).

In short, while I was just using general examples of “sad” and “anxiety”, someone with enough of your personal data footprint, the history of interests and choices you have made in front of them, can be even better at it than me.

They can select an article highly likely to make you sad. Or just more sad. Or more anxious.

If they can, their chance of priming you at the subsequent YOLO vs Safety decision goes up.

–It’s not enough to ask “Why am I reading this?” “Why am I reading this now?” Not when they can so specifically weaponize emotion at you in the way they can.

You need to ask “What do I feel after reading this?” “Why might someone want me to feel this way?” as well.

–I bring that up because the reason I am sent an article most often to comment on is because it has tripped a feel. Someone is anxious, or afraid, or angry, or some other emotion–and wants me to offer my expertise on the data and science for them to decide if they should feel that way.

We have also mentioned the steady march of doom, the increasingly extremist slant of Team D and R in the battle for attention, that zeitgeist of waiting for the next world ending shoe to drop. How one of any number of armaggedons may be rising from the sea a giant beast, now ambling inexorably towards our cities.

How much of that is fed by the emotion evoked, deliberately or not, by what you read and see?

“Why am I reading this?”

“Why am I reading this now?”

“What do I feel after reading this?”

“Why might someone want me to feel this way?”

–And I do not say this from arrogance. I am not immune and I know this priming happens to me.

No human being, absent literal brain damage in emotion processing centers (which brings its own set of problems), is immune to this.

You are not immune to this priming and nudging.

But you can teach yourself to recognize more of it, once you know it exists. And if you can, you will be manipulated less often, more grounded, and hopefully, make better decisions.

You can even start to make it work for you, like deliberately choosing music or stories or videos to prime your own emotions they way -you- want them to go.

–Alright, last socioeconomic comments. Shortages are real and getting realer. They will not unwind anytime soon. Expect odd disappearances off the shelves. Expect inflation to be, well, expect it to be.

–Remember New Orleans and Haiti. Give if you can.

–Apologies to the reader with the harrowing, yet inspirational, tale of survival in time of coronavirus crisis. We ran out of time to tell the story again…

–Your chances of catching coronavirus are equivalent to the chances that part of the readership has no idea why this is so funny to the rest of us.

–Your chances of catching Marburg are equivalent to the chances you are NOT now a little disappointed they didn’t layer the modified lyrics over this video of the same aria, just for Pavarotti’s perfectly timed reaction at the end (after what would have been the last powerful exclamation of “low”).

Apologies to the two professional, classically trained musicians on the list, for none of them will get sleep after that.

Especially knowing what I did there ; )

<Paladin>