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

Omicron–Variant first identified in South Africa

Updating the chart above:

Ancestral: B.1.1.529 Omicron

Transmissibility: All the +

Immune Evasiveness: All the +

Vaccine Effectiveness: Check (for hospitalization)

Also as a reminder:

Pediatric Hepatitis of Unknown Origin:

–The CDC joined the WHO last week to ask for increased physician vigilance for severe hepatitis (inflammation of the liver) in children. The CDC has been investigating a cluster of 9 kids in Alabama dating back to October 2021, where a cluster of 5 kids were hospitalized with elevated liver enzymes (including some with acute liver failure). The usual suspects of Hepatitis virus A, B and C were ruled out. All of them were positive for adenovirus, though. Review of records found an additional four cases that were similar, a couple of whom were positive for adenovirus 41.

Adenovirus is a DNA virus, and there at least 88 known subtypes that can infect humans. Adenovirus is a major cause of the common cold, as well as viral pink eye. Type 41 was mentioned by CDC specifically because it is one of a handful of adenoviruses that can cause gastroenteritis, better known as diarrhea and vomiting. None of them are terribly common causes of hepatitis though. That said, adenovirus can get to the liver, and there are rare case reports of fulminant hepatic failure from adenovirus infection of the liver in patients with severe immunocompromise.

The WHO is similarly tracking a cluster of similar cases in the UK, most of which also are positive for adenovirus, and like Alabama, all in kids under age 6. Most of these kids have NOT been vaccinated for COVID, and so there is NO reason to suspect a side effect of vaccination. The US cases were all COVID negative, as were most of the tracked cases in the UK, so SARS-CoV-2 is not likely involved either.

In general, adenovirus is not treated at all unless the disease is very severe, usually in an immunocompromised host. Although there are no controlled trials demonstrating benefit of antiviral therapy in adenovirus infection, there are a couple that are mostly investigational, with case reports or lab data suggesting efficacy (my employer–at least for this week–does not make any of these drugs).

–Because many of the readers have kids in this approximate age range, I want to stress that while CDC and WHO are monitoring, this is very rare when you think of the number of kids who are walking around with an adenovirus infection right now. If I had to handicap, my guess is this is a new or variant adenovirus strain that, for some reason, is a little more likely to get to the liver in young kids, but even this is a RARE complication. Other than being aware of it and specifically testing for adenovirus in a kid in this age with elevated liver enzymes (which would not normally be done) there is not much more for doctors to be doing about it right now.

Flu:

–China announced the first human case of H3N8 influenza, a strain most commonly found in birds. Patient zero is a 4 year old kid whose family has some poultry, and China stressed there is little evidence that it spreads human to human well, and looks mostly like some bird flus rearranged themselves and got a lucky jump into a kid. The kid by all reports is doing fine, aside from, you know, the flu.

To keep this simple, the “H” part is the hemagglutinin gene of influenza and the “N” is the neuraminidase gene of the virus. These are the two parts of flu that your immune system prefers to attack to clear the virus, much like the “spike” protein of SARS-CoV-2. The number just refers to the version of those genes a specific flu virus is carrying.

H3N8 is notable largely only because antibody testing on samples from exhumed bodies from those who died during the 1889 “Russian flu” pandemic suggest that a strain of flu carrying an H3 version of the hemagglutinin was responsible. The N8 part, as near as I can put together in 15 whole minutes of PubMed and Google searching, is due entirely to a conjecture that H3 was paired with “possibly” the N8 version of the influenza neuraminidase based on serological and epidemiological data that was not cited or published. But as an extra fun fact for you, none other than Anthony Fauci (yes, that Anthony Fauci) is a co-author on that paper that said Russian flu was H3, with maybe an N8. Everyone else cites that paper for “previous studies have shown that Russian flu was H3N8” statements in their later work–which is odd, since the Fauci paper was just A) hypothesizing about B) data they did not claim nor cite. If I had to guess, and I do, sometime after the Fauci publication, someone got lazy in the “throw away” section of their scientific paper discussing prior flu epidemics, did not read the Fauci paper closely, and just cited it as “studies showing H3N8 caused the Russian flu.” And everyone after that was even lazier, citing that citation of the Fauci paper without actually reading it either.

“Chart worms” are so much fun like that.

Regardless, the Russian flu of 1889 is a lesser known pandemic flu that spread around the world in ~4 months. Papers published within the last year have looked at the symptoms, which overlap COVID somewhat, and the mortality curve, which killed mostly the elderly versus other flu epidemics that killed mostly the very young and very old, to suggest that a coronavirus really caused the 1889 Russian flu, and not an H3 influenza strain. Considering the best studied flu pandemic of the past, the 1918 Spanish flu, was unusually lethal in the young and healthy compared to other flu pandemics, I’m not entirely convinced by the epidemiologic evidence for the coronavirus hypothesis. But they do prove that if you throw “coronavirus” and “pandemic” into just about anything, even now, some journal, somewhere, is going to take it.

At any rate, if more H3N8 actually infects more than one unlucky 4 year old in China who is doing well, we will start to worry. The only reason this is news is because, you know, pandemics on the mind and influenza is still far and away the most likely agent to cause the next major pandemic (if we get another in our lifetimes–odds of which are not likely).

Coronavirus:

— Speaking of Dr. Fauci, he gave an interview this week with PBS Newshour where he noted continued low rates of new cases and hospitalizations. Then he gave this direct quote:

“So, if you’re saying, are we out of the pandemic phase in this country, we are.”

Yes, Hypothetical Reader, I have the exact same question right now! Are we like, finally here?

Has the political decision finally been made?

Of course not, Hypothetical Reader.

Of course not!

Less than 24 hours later and following what I am presuming was a phone call reminding Dr. Fauci that the DOJ just filed an appeal after the CDC said the mask mandate on planes, removed by a federal judge, was still necessary and people might wonder why the DOJ would file or continue that appeal, or why the CDC thought their mask mandate was still necessary, if “we are out of the pandemic phase” and those musings by the citizens might be super politically awkward Dr. Fauci amended those comments on NPR by saying:

“I probably should have said the ‘acute component of the pandemic phase.'”

And the bonfire of the credibilities remains undefeated.

–Around the horn, waves continue to subside in most countries. In the US, there is a barely noticeable blip of BA.2 cases. Given the contagiousness of BA.2 is higher than omicron, the rate of new case accumulation is not concerning. The base case is that this won’t even be an alpha sized wave, and the scare headlines that are out there are really having to pump the percentage increase or speak nebulously of “thousands” of new cases because the raw numbers are just not that impressive.

Meanwhile, China continues its ambitious “Zero COVID” policy, and although workplaces are open again in parts of Shanghai, you’re still getting videos of residences getting welded shut and claims of starvation in the city. We’ll talk more about China in the socioeconomic portion, but suffice to say they are still battling omicron/BA.2.

–There was new prevalence data for antibodies to SARS-CoV-2 released in the US this past week, covering the fall of 2021 through February 2022, and thus the entire omicron wave. I’ll spare you the citation and just hit the high points. As of February, roughly 75% of teenagers and under had antibodies indicating previous SARS-CoV-2 infection, with approximately 1/3rd of that catching COVID during the omicron wave. If 25% of the kids, in the nation, caught omicron then, reasonable to expect that your experience with omicron this past winter was the norm, with everyone and their brother seeming to get it. Total vaccination in the US is over 90% of the over 65 age group and over 80% for the over 50%. Unsurprisingly, given risk categories for severe COVID, vaccination rates drop as you go younger. But between vaccination and prior infection now there is an awful lot of what should be strong resistance to SARS-CoV-2, and I think the lack of a significant BA.2 wave thus far bears that out.

–EU health authorities reported they believe, based on similar studies, that 80% of Europe has antibodies to SARS-CoV-2 right now.

–Again, bellweathers in the Southern Hemisphere continue to look good, with no new variant whammies obvious yet. The BA.2 “wave” still takes a lot of this:

…to even see it in the current data. So what we continue to watch is the Southern hemisphere going into their winter in June/July–if no rise, then there is likely no new variant of concern–and for BA.2 to continue to be very muted in the US. If those trends continue, the hurdle is going to be VERY high for a SARS-CoV-2 variant to find a working mutation that gets around what is now quite high levels of natural and vaccine immunity in the US this fall.

That will be, in my humble opinion, definitive evidence that the pandemic is truly over, and in a way politics can no longer deny.

Arguably, when you had enough vaccine/treatment to prevent “bed’s taken” scenarios and were actually using them to prevent “bed’s taken” scenarios, you had medically controlled the pandemic threat. But argue amongst yourselves if vaccination and treatment campaigns were ever rolled out effectively when we needed them during this global health crisis.

–Will they still try to convince you to get a booster? Yes. 100%, yes they will. Moderna and Pfizer have entirely too much money on the table for them to not at least try a seasonal booster. And who knows–they might even have some data for that (still waiting to hear on what Pfizer recently turned in to FDA). Me throwing all the shade aside though, if you are a high risk category, a booster is not a bad idea. Less clear and talk to your actual doctor if you are not high risk though.

–And again, a multitude of treatments for acute COVID are now available if it does break through on ya’.

Socioeconomic:

—

You had Russia invade Ukraine precipitating wrenching moves in commodities, an almost certain global food shortage by Q3 this year, uncertain energy supplies to major European and Asian economies, the Yen in absolute free fall, Fed rate hikes to combat runaway inflation, the Shanghai lockdown causing already disrupted supply chains to become even MORE disrupted… all either Q1 or early Q2.

And the effect of all that on US GDP was unexpected?

I find myself beginning to doubt economists’ forecasts…

–Speaking of Shanghai, the city opened more factories last week, but a large portion of the population remains in lockdown, with some measures actually increasing in enforcement, despite a fall in official cases. There again are unconfirmed videos on the internet of residencies being welded shut and claims of starvation. Over the weekend, Beijing had a run on grocery stores as positive cases there prompted the rapid and mass testing of 4 million people, and a lockdown seems probable there too. The ripple effects of this on the supply chain are obvious by now given the last two years, but here’s a good thread on what is happening now, and the logistical disaster in Shanghai which is keeping food supply to the public there tenuous at best. Hence grocery stores getting picked clean in Beijing at the merest idea that similar lockdowns happen there.

–The “Zero COVID” policies and some of Xi’s other declared policy goals this week (see below), as reported online, make this a very pertinent question:

–May he and the CCP continue to live in interesting times…

–Although speaking of times getting interesting, to continue to flog the “threat to global food supply” horse, we had Indonesia ban the export of cooking oil over the weekend. They loosened that slightly, but that was enough to cause some European markets to start limiting the amount of cooking oil one could buy at a time. Indonesia counts for a -sizeable- portion of exported seed oils, and there is no one capable of making up their shortfall. And there will be a shortfall, as their new quota on exports is quite low compared to the volume they used to ship overseas.

—This is an excellent, and short, read on the intersection of diesel, biodiesel, renewable diesel, policy, and cooking oil’s chemical structure. Although I would contend that the move to soybeans among US farmers this year is just as motivated by cost and availability of fertilizer, as previously discussed, versus meeting demand for renewable diesel.

–Had a reader send it, but I’m sure you saw it as well–US winter wheat quality is the worst it has been since 2006. The US will not be able to make up any international shortfall in winter wheat. Neither will Latin America, which, as we mentioned is quite fertilizer dependent. Bloomberg was also reporting that it is becoming cost prohibitive for Brazil to export soybeans this year as diesel fuel goes parabolic, making the trucks to get beans on boats too expensive. Fertilizer cost is not reducing the acreage devoted to soy in Brazil this year, similar to choices made in the US per the USDA planting estimates report we covered a few weeks back.

However, MUCH will depend on the yield per acre this fall. If fertilizer price, let alone availability, restricts fertilizer use, those yields will predictably fall. Just look at the chart in the link just above this section on the rise of yield per acre after the chemistry industry figured out how to make nitrogen fertilizers as part of oil processing for how closely yield ties to fertilizer in modern industrial agriculture.

In countries self-sufficient in their caloric needs from their agriculture, you can expect rising prices through the year, and increasingly seasonal availability of some items.

Countries not so calorically self sufficient from their own farms are very likely screwed. There’s just no sugar coating that. And as I say in Latin often, “no God can stop a hungry man.”

There will be consequences to the hunger of the fall of 2022 and especially spring of 2023. Brace yourselves, prepare, and spare what you can.

Your neighbor is going to need you.

–Aside from that, the CEO of Whirpool was suggesting that supply constraints will limit the number of appliances they can produce total this year. On the earnings call this week, Whirlpool also suggested they were already seeing decreasing demand for appliances, likely due to inflation leaving people with less discretionary income for the latest model of washer/dryer. I continue to hear rumors of most if not all major car manufacturers unlikely to produce as many cars as they would prefer to this year due to supply constraints, with dealer lots full only with the used trade ins and NO new cars to sell. I have also heard of dealerships that won’t even put you on a waiting list for a new car at this point, uncertain of when new inventory will arrive and with a list already a few months in length…

–Your chances of catching coronavirus continue to decline, and are roughly equivalent to the chances that Elon’s purchase of Twitter leads to an inevitable remake of “Citizen Kane”. However, the iconic death scene that starts the search to unravel the mystery of Kane’s final words–“Rosebud”–is changed to fit the times and the man. In the original, Kane died holding a snowglobe and thinking of his sled “Rosebud” which he was playing on as a child, the last time he was truly carefree and happy, despite a lifetime of industrial wealth and power, including ownership of major newspaper outlets which he altered to project his own narratives. Of course, there have long been rumors that “Rosebud” was the nickname for William Randolph Hearst’s mistress, and thus a subtle “in” dig at Hearst who was one of the “inspirations” for Kane, and banned the mention of the movie from any of the many newspapers he owned at the time. In the remake, however, Kane has been replaced by “Meelon Usk”, who dies in the opening scene staring into a crystal ball, in which a cloud of greyish smoke is swirling. His cryptic last word… “bud”… sets in motion an equally piercing review of Meelon’s life, from his rise from obscurity to the world’s richest man following industrial success in electric vehicles and space, and later pivot to include social media companies, as well as the multiple divorces along the way. We learn that in many ways, despite the trappings of success, Meelon was deeply unhappy like Kane in the original, causing us to question our definitions of “success” and in his final moment recaptured the memory of the last time in his life that he was truly carefree and happy with the “Bud” of his youth:

And that’s your chances of catching coronavirus this week.

<Paladin>