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:

–Marburg: Still no new cases reported, and we are getting a little long into the incubation period. The coup that happened on the 5th has been pretty widely panned internationally, with calls for return to constitutional order. The new military junta that still has the president captive started a four day conference to plan transition back to civilian rule. So, as far as we know, no new cases of Marburg. But tough to say how accurately that is being recorded given the governmental uncertainty in Guinea right now.

–Nipah: Of the 274 known contacts of the boy who died of Nipah virus in Kerala, India, 94 have symptoms suggestive of Nipah, and of those, 88 have tested negative for Nipah virus. Unclear if the other 6 are pending, or if there are at least 6 new confirmed cases of Nipah. The area has been pretty much locked down and teams are going door to door in the area looking for fevers or suspicious deaths recently to try and contain the outbreak as quickly as possible.

–Coronavirus…again, plenty to cover here.

–First off, welcome to our sudden influx of Australian “readers” this past week! Based on the “site scraping”-like activity, and the fact that last week we discussed the awfully draconian app the Australian government is rolling out (and linked to a much more popular Atlantic article saying the same thing), I think our readers “down unda'” are -very- likely to be employed by the Australian government. Just want to reassure you that I am not a citizen of Australia (you know, since your government has been doing things like this–when not shooting dogs)!

But just so you know, my new Aussie government friends, the only other geography that has had your exact pattern of site visits after I have discussed totalitarian behavior (or direct violations of human rights) is China.

Hopefully I’ve hit enough keywords again to re-engage your interest, because if the sudden Australian web hits really are the Aussie government, I would like those dedicated employees to ask yourself one very important question:

Is China really the example to emulate?

Otherwise, welcome to the site, and be sure to check out our previous updates in the Coronavirus Archive section!

I also know you have some extra free time at home these days in many parts of Australia. I cannot recommend the linked movie highly enough for you!

–Secondly, the big news this week is a pre-publication paper from the Boston VA. They looked at confirmed SARS-CoV-2 positive patients in the hospital from March 20, 2020 through the end of June, 2021 to see what percentage of those patients qualified as NIH defined moderate to severe COVID (requiring supplemental oxygen and/or blood oxygenation <94%).

Rather than Sciencepalooza, we’ll focus on the high points.

1. In aggregate, 74.6% of cases in the VA with a positive COVID test result met the definition of moderate to severe COVID over the year. The other 25% were admitted for something else, and just happened to have a positive SARS-CoV-2 PCR result, and so had mild to asymptomatic disease at worst.
2. The authors isolated two time points as “pre-vaccine” and “post-vaccine.” The pre-vaccine period had only 62% of COVID PCR positive hospital admissions with the respiratory signs and symptoms of COVID. Post-vaccine, that fell to 52%. That difference was statistically significant.
3. Disease severity in the vaccinated period fell for both vaccinated and unvaccinated patients. Disease severity fell more in the vaccinated group, but they did not identify previously infected patients among the unvaccinated, so comparison is a little tough.

–This is similar to findings in the UK, where there was a minor scandal a few months back that about half of the COVID positive patients in the NHS hospitals were admitted for something else, and only found to be SARS-CoV-2 positive when mandatory screening PCR was done. They were all counted as positive COVID hospitalizations in the official data though.

–This is also similar to a couple pediatric reports from May that found about half of kids in both studies admitted to the hospital and had a positive SARS-CoV-2 PCR test did not have a diagnosis that was likely due to COVID. For example, several kids were admitted for appendicitis or severe allergic reaction. They got screened for COVID because everyone getting admitted has to–low and behold, popped positive. Even though they had no signs or symptoms of COVID. And yes, these were counted as positive COVID cases too.

–Now, there are a couple limitations to the VA study. First, it’s a VA study, and their patient population (mostly male and all at least previously healthy enough to serve in the US Armed Forces) is unique. But this is mostly a classification issue, and is almost certainly happening everywhere else too. For example, breaking just this morning is a leaked Zoom call of a North Carolina hospital’s executive committee meeting, where administrators and doctors paved the road to hell with their good intentions. They were openly discussing how to count more patients who were clearly NOT experiencing COVID symptoms, but had tested positive, as COVID positive cases to make their burden of “COVID positive cases” look higher. Their intent (to “scare”, in their words, more of the public into getting a vaccine they felt their patient population would benefit from) was noble, which turned out to be the problem. Because yet again, just like our ivermectin kerfluffle doctor in Oklahoma last week, the desire to “scare” the public into an action got them over their skiis, seeking to actively change the data and misrepresent the truth.

Integrity is a funny virtue, in that it is so demanding, and so exact. One compromise, one breach, no matter how well intentioned destroys it forever.

This discussion and decision will ultimately be counterproductive to their goal. They are dead to a large swath of their patient population now, because they have conclusively shown they cannot be completely trusted.

All they have done in the end, despite their noble ends, is add their hospital to the Bonfire of the Institutional Credibilities.

Back to the VA study, which is at least doing God’s work in airing out this discrepancy in their data. For the record, there is no indication the classification issue they are reporting was driven by decision, and is far more probable to be rules for COVID classification that have not been changed from the beginning of the pandemic when most COVID positives were reliably COVID symptomatic. Never attribute to malice that which is better explained by bureaucratic inertia, or something like that. The other main limitation of this study, though, is that their data collection stopped just as delta was getting started. While this is evidence that alpha, at least, was less severe and more contagious, it’s not giving us a great look at delta, and its relative hospitalization rate for bona fide COVID symptoms.

—All of that said, coupled with at least some form of previous exposure or vaccination resistance in 83% of the US as of the same approximate end date of the VA data, we can safely anticipate that a decent chunk of delta hospitalizations are also incidental. Patients are in for something else and are screening positive, especially if previously vaccinated or exposed before.

–“I knew it!!!! PLANDEMIC!!! FAKE VIRUS!!!!” I hear you say Hypothetical Conspiracy Theorist Reader.

Not so fast there, chief. The stories of people asphyxiating or crashing from the Ah-nold like sepsis and dying over the delta are months are still very true. Absolutely happening, even as we speak. There is still plenty of real, serious COVID going around with the more contagious delta variant.

But, it does mean that hospitalization comparisons are now tricky. And, as I strain my arm patting my own back here (ouch!), means that all my screaming about how paper after paper kept defining “infection” by a positive PCR or antigen test without any regard to patient symptoms, and how incredibly wrong it was to do that, was dead on. I had -hoped- that would not also apply to hospitalized cases, and at least those were being kept “pure”, but that is likely not the case.

–What does this mean in the broader scheme of things though?

1. If anything, the vaccines are probably more effective against moderate to severe COVID than we think. That is currently being measure by effectiveness versus hospitalization. It is likely that some portion, even a majority, of hospitalized, vaccinated, SARS-CoV-2 positive cases are mild to asymptomatic for COVID, and have been admitted for something else entirely. Yes, same for previous COVID infections too.
2. Researchers are going to need to be a lot more granular on the symptom data to be doing meaningful comparisons among the three key groups: vaccinated, unvaccinated and no prior infection, and unvaccinated with prior infection.
3. We are closer to herd immunity than we think. And when assigning cause to current hospital strains, we can weight “staffing issues” much higher now, rather than just “delta wave, dude.”

–Also making headline splash was this article in the Lancet. There are also early rumblings from FDA that they are underwhelmed by data for the boosters, and their AdComm (advisory committee) meeting next week will be closely watched. That’s not in this Lancet article though; now is just a convenient spot for me to throw that in!

The linked Lancet article is yet another group of physicians and scientists stating that boosters for the broad population are not necessary, and not supported by the current evidence.  They go so far as to say that even subpopulations need additional specific studies—and may be able to get sufficient protection at a reduced booster dose.  I agree on the potential for a reduced dose part (and that requiring a study–for now, just boost with what we got if you are going to do a booster). I think the steady drum beat of studies so far has been consistent that risks still remain for the over 65 set and immunocompromised. 

That said, the authors correctly point out that the over 65 and immunocompromised may be having higher hospitalizations on breakthrough because they were already high risk for complications from COVID.  However, the original phase 3 studies and evaluations of vaccine efficacy early into the roll out were skewed towards the over 65 and other at risk cohorts, and showed better efficacy at those times than they are showing for these same groups in more recent studies. So while the argument that we may be seeing lower efficacy now because we would always perceive lower efficacy in groups already at higher risk may be part of the explanation, I don’t think it is the whole explanation. After all, over 65 and immunocompromised at a minimum are groups with different immune function and duration versus younger and more immunocompetent patients. So this is not only the cohorts we would expect to see reduced efficacy, but also reduced duration of efficacy first. Lastly, based on the VA results above, would be nice to deep dive as well into how COVID-specific symptomatic the vaccine breakthrough cases actually are.

In the absence of that, and given the well known risk of mortality COVID really does present to the high risk categories (obese, pregnant, over 65, immunocompromised, etc.), in my humble opinion, potential benefits of a booster still outweigh risks for those people who fit those at risk categories.  You might as well get all the percentage points of reduced risk you can.  But of course, I am not your physician.  This is not medical advice. Discuss your own situation with your healthcare provider, and, as always, use any and all medications according to its indicated use and under the direction of your licensed healthcare provider.

–Reinforcing that “potential for reduced protection” in those over 65, we have several papers from the CDC in their MMWR this week. We’ll hit these quickly on the high points, without the Sciencepalooza break down.

1. First paper. This confirms other papers we have recently discussed showing a 10 fold reduction in deaths and hospitalization among the vaccinated versus the unvaccinated.  However, digging into the Figures, you find that there is less protection for those over 65.  Deaths among the vaccinated (and unvaccinated) are still heavily skewed to older patients.  This is also shows that the vaccines remained protective against hospitalization and death in delta wave.
2. Second paper. Another VA study population, but shows the same difference in hospitalization among vaccinated versus not.  There is no difference in black vs. white patients in terms of vaccination effect.  Among the vaccinated, those older than 65 had a greater chance of hospitalization than those younger than 65.
3. Third paper. Moderna -may- be a little better in preventing hospitalization among the vaccines approved in the US.  However, that is still analyzing relatively small numbers of hospitalizations, and again, based on the VA data above, probably need to clarify COVID symptoms among those hospitalizations.  J&J lags, but not many have received that relatively to Moderna and Pfizer, so there is a wide 95% confidence interval.  The researchers did do a good job adjusting for age, geographic region and other variables.  In terms of plausible explanations, Moderna is a slightly higher dose of spike protein and the 2nd shot comes ~week 4 after the first, versus 3 for Pfizer. So if this difference is real and holds up, those are your front-runners for “why”.

–Moving around the horn, so far so good for the US approaching herd immunity! The Great College Football Experiment of two weeks ago has NOT had a meaningful impact on new case numbers so far. Epiforecasts has had the U.S. Rt in the mid 0.9s and falling all week. Most states in the Union have declining case numbers; the rest generally stabilized this week.

The trend now is delta in retreat. One more week like this should confirm that trend.

It’s worth noting that all of this is occurring long before any increase in vaccination rate in response to new mandates could possibly have been completed.

So when the delta wave continues its biologic extinction in the next few weeks, remember that, because the biologic end will be touted as “proof” a socially divisive politicization of vaccine mandates “worked.”

Because, as always, perception of effectiveness is just as good as actually being effective in politics.

Elsewhere, China has a few regions with jumps in reported case numbers despite their usual draconian shut downs. No new port closures yet, but they have a low threshold there. The more important China story to follow right now (if you have not yet) is the inevitable bankruptcy or back stop of Evergrande, the largest Chinese property lender. Worth Googling if that is news to you.

Denmark has joined Sweden in eliminating a lot of its COVID restrictions. The UK is planning boosters for healthcare workers and those over 50.

–On the socioeconomic front, a couple quick points.

Global food prices were up 33% in August from a year earlier. Food is now more expensive than almost anytime in the past six decades: UN data. https://t.co/7wPRatieES pic.twitter.com/cml9Hlo3LL

— Lisa Abramowicz (@lisaabramowicz1) September 15, 2021

Secondly, China’s economic data, especially as they head into another small wave of COVID restrictions, was…not good. Across the board. And you should Google “Evergrande”, if don’t already know what I mean when I link “Evergrande” and “China”.

https://www.bloomberg.com/news/articles/2021-09-15/china-s-economy-weakens-as-consumers-turn-wary-amid-outbreak

The moral of the story? Everyone’s economy is slowing down.  Inflation is rising everywhere.  There is a non-zero chance of effectively -global- stagflation.

And the Pax Americana is over.

You may safely anticipate the return to history, soon-ish, in many parts of the world.

–Yes, I saw that we actually had fact checks for the swelling of Nicki Minaj’s cousin’s balls. By serious people, who are very serious, about seriously confronting vaccine misinformation about the serious possibility of vaccine associated swelling nuts in the cousin of the serious artist who gave us “Anaconda”–based on her report of said potential side effect on twitter. The dial remains cranked to maximum stupid.

Yes, I saw that Congress and the Post Office (among what will surely be others to follow) are already exempt from the new employer vaccine mandate, despite the President’s loss of patience with the unvaccinated.

Yes, I did see that when questioned about the evidence we have recently discussed here showing equivalent or better protection from COVID among the recovered versus even the vaccinated, Fauci, in an interview had “no good explanation” (his words) for why recovered patients should not be considered immune as well.

Again, all I can say is the following:

–I also saw the headlines of consternation over crowds with elective masking at college football games, and their irresponsibility. Juxtaposed, of course, with coverage of the Met Gala, where the invited guests were unmasked. While the staff were required to be masked for the duration. For the record, the Met Gala guests were required to be vaccinated–explaining their lack of masks. Yes, that was despite high COVID transmission in the county where the Gala took place, and CDC guidelines would recommend mask use indoors–even among the vaccinated. Also for the record, all the staff was also required to be vaccinated to work the Gala. Yet, the staff was required to wear masks, while the guests were not.

That was not a great look.

On the plus side, I think it does show a common desire to increasingly accept the risks of COVID as effective vaccination and treatment are available, and more of the population is resistant to hospitalization level disease, and move back to normal. Across the broader political and social class spectrum.

–But first… bit of a palette cleanser.

Check out the video at this link. You only need to watch for about 3 minutes–that’s how long the bit takes.

Surprising, huh? When was the last time the world wasn’t quite what you thought it was?

–Back to it now…

–“The Last Don” is not nearly as famous as Mario Puzo’s other Mafia stories, but it has a couple excellent observational lines in it. So one of the older Italian characters is remarking to another about the gold and marble-bedecked ostentatious room of their Vegas Villa, and how such luxury is not good, because it only invites the envy of the poor. And the other character chides him, and says you do not understand America. For in America, Americans see this luxury and “every man believes in his heart he will in live in just such a place one day.”

Ignore, for a moment, the deep irony of an Italian concerned about the envy of the masses over ostentatious luxury should you consider the still enormous and luxurious palazzos and museums full of art and precious metals from the Italian Renaissance, or the ancient glory of Rome.

Instead, wonder if that same belief that one day, the same will happen for you, is why the world got Kings and Queens, Lords and Ladies, to begin with.

Do we look, and believe in our hearts that we will be Kings and Queens one day, and have the same power, wealth and privilege? Is this why American girls get giggly at the thought of British princes? Why monarchies still exist at all?

Because enough of us believe in our own “nobility”, that it will one day be recognized, and we will ascend to recognition as one of those special few who can “rise above”? Maybe not rise above our fellow humans, no matter how base they may be–for that would be a little too elitist. A little too braggy. But some recognition, and privilege, no matter how small, that we have risen above the lesser demons of humanity’s most ignorant, most brutish attitudes, to self-actualize, self-author. To not only be moral, but acclaimed for it.

Is that the nibble in the apple that grows into the source of tolerance for the pompous nonsense of an aristocracy, or “elite” class?

Is that why we tolerate a different justice for the wealthy and powerful? Don’t we all secretly know ourselves to be the main character in our stories? Don’t we know, deep down, our recognition for overcoming our flaws, failures, and temptations, to be seen as who we -truly- are, exceptional, is merely a matter of time? Why else would we post selfies with celebrities to Instragram if not to show to the world that we are so near, if not finally over to, the other side of the velvet rope? And the trappings, private jets, exclusive parties, the different justice, the different rules because we are the invited, desired, adored guests (and not the help)–well, why shouldn’t we? Aren’t those prerequisites merely symbols that our virtues have finally received their deserved recognition?

I suspect most, if not all, making their authority felt in such a fashion rationalize their exercise of privilege in similar ways. They recall the hardship and sacrifices to earn the right opportunities. The hardships and sacrifices to get to where they are. Why not take a moment to enjoy it? Private jets are permissible, so long as their foundations support green causes. Occasional lapse of mask and gathering rules in times of pandemic are okay, so long as they use their position to advocate the measures that will work for everyone. Are they not tireless in their pursuit of the science, defense of it, and advocacy of the fastest ways back to normal? Tireless? Do they not outweigh their vices with their public virtues?

Did not Mario Puzo’s Last Don, in his own words, “not have a chapel in his own house?“

Are there enough of us that believe in our hearts that we, too, will one day be recognized as a Good Person^TM, bow our heads to be annointed with oil, and rise to our rightful place among others where the spirit of the rules and laws are understood, but the letter need not be enforced? For our obvious virtue, now visible to all in blue check marks, a different set of Facebook rules, the invites to the right events, breezily knowing the right people, attending the right schools, the right jobs, the right attitudes, read the right books, re-tweet the right things, and of course, the trappings of wealth and power, excuses the occasional lapse in those rules. Does it not? After all, clearly -we- can be trusted to violate them in a safe and responsible manner. Such is our sophistication to know when the rules we demand, and so often create, for others can be broken. Such is the weight of our virtues, that our vices can only be seen as airily trivial…

Remember! Remember Varys’ Riddle!

If the answer is that power resides where we believe it to reside–is power truly born of the power we believe that –we– will one day ascend to? Does the sellsword merely choose whose powers and privileges the sellsword would most like to have for themselves? And that is the side, be it king, or rich man, or priest, the sellsword tolerates and allows to go on?

What then to make of the advice of a well known teacher and his half brother in Israel during the Roman occupation? The teacher who said that the rulers of the time lord it over them, and “their great ones make their authority over them felt”? Felt, with every “for me, not for thee” rule and privilege? He said it should -not- be that way among you. His half brother Iakobos (in the Greek), wrote in a letter that making distinctions between how you treat people based on their power and privilege was shallow judgement that, if it became habit, would lead to poor judgement, and eventually evil. The slow corruption of the Tolkien’s One Ring.

We do not love our neighbor as ourselves when we do that, or in the more modern version of the Golden Rule, are not doing unto others as we would do unto ourselves.

Right? We may be imprecise there. When we tolerate different sets of COVID rules, when we tolerate different justice for the rich (again, where are the prosecutions of Epstein’s co-conspirators and enablers? Or any FBI prosecution of abuse of underage girls, it seems?), when we tolerate different violations of terms of service on social media based on who is making them or how right their opinion might be, when we ignore the hypocrisy of those demanding sacrifices by others they don’t appear to be making as often… are we really violating the Golden Rule?

Or again, are we tolerating hypocrisy and injustice because we would want to be atop Olympus with the rules there for ourselves?

The desire, and the act, both seem morally culpable.

Yet, one could argue, that we actually are doing to others as we would have done for ourselves. What a terrible condemnation that is…

But, at the very least it’s a violation of the unwritten Silver Rule: don’t do to others what you would not want done to you. You know, the part that doesn’t get translated as often from “love your neighbor” as yourself. We wouldn’t want to be outside the velvet rope, where the rules always apply. We would want to be inside it. If we wouldn’t want the outside of the rope foisted on us, the flaw is to do it to others. Or allow others to do it to others.

The desire and the act to make authority felt, well, these too add to the Bonfire of Credibilities.

I know, I know. Easier said than done when life inside the rope looks soooooo much cooler, so much easier, and is what we deserve. As Jay-Z put it:

So we’re living life like a video
Where the sun is always out and you never get old
And the champagne’s always cold and the music’s always good
And the pretty girls just happen to stop by in the hood

And they hop their pretty ass up on the hood of that pretty ass car
Without a wrinkle in today, ’cause there’s no tomorrow
Just a picture-perfect day that last a whole lifetime
And it never ends ’cause all we have to do is hit “Rewind”

To be clear, there is nothing wrong in enjoying success, particularly when earned and hard fought. You should. For as Seneca the Younger said, “Fortune is never to be so mistrusted as when she has been good to you” and Herodotus quoted Solon “Count no man happy until the end is known,” and as Job learned too well, the good times can be rare. So smoke ’em while you got ’em, laissez les bon temps rouler. With Goyen your co-conspirator, steal joy like a thief from despair.

No, the problem is your intention in those times in your life when things work out for you. If you are making, or ignoring, rules to elevate yourself, and to make your authority felt as a triumph for your virtuous success and proof you have made it, or merely because you can (and are special, because other can not), well, that is the danger. When the staff must be masked to give a nod to virtue, while the guests can frolic without, the sole difference between them being who is chosen and who is there to make the chosen feel chosen, that is the problem. That is the sin.

If the devil’s greatest trick was to convince the world he didn’t exist (hat tip to The Usual Suspects), then his second greatest trick is to see to it you –get– exactly what you want. For sometimes, we will use it wrong, with poor intention, or it corrupts us. What we thought would be our fulfillment becomes instead the delight of hell, and the source of our greatest moral failures.

Maybe the order of those tricks is reversed, no?

–Think piece this week? Good one here.

–Just as an update to last week, on the time probability risks of AI development and gain of function biological research…

You can find more, including poems you could not tell were written completely by computer algorithm, at this link.

–Your chances are of catching coronavirus are equivalent to the chances the last 20 seconds of this would have been vastly improved by cutting in “The Sound of Silence”:

https://mobile.twitter.com/stoolpresidente/status/1436780321450643458?s=21

–Your chances of catching Nipah or Marburg are equivalent to the chances that this would -not- get linked this week. Because given where the AI is above, we should celebrate human artistic mastery as well whenever we see it…

To our many Buckeye readers, better luck this weekend : )

<Paladin>