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:

Coronavirus:

–This will be a short update due to exigent circumstances. I will fill you all in next week.

–Going around the horn, most places in the world are coming down off of omicron/BA.2 peaks. This includes the UK, despite the headline consternation over variant XE we mentioned last week. That said, China is obviously continuing to have new cases. Chairman Xi has vowed to continue Zero COVID policies until COVID is defeated, thus ensuring that he will live in interesting times, as the old Chinese proverb goes. A few new cities are under lockdown. Images from Shanghai continue to be quite dystopian and there is still debate over how effectively food is reaching Shanghai at present. The US ordered the withdrawal of non-essential personnel from the consulate in Shanghai this week, and may have even achieved that in a small window.

In the US, you are seeing headlines of clinical cases threatening to catch up to wastewater numbers from several weeks ago now. New York and DC are both seeing definite, if small rises, but those are capable of igniting a larger wave. The dominant strain is BA.2 everywhere in the US now, and there remains a great deal of questions over how large the increase in case numbers actually is, as testing volumes remain low. One of the arguments is that the large amount of at home testing now available is leading to a large number of cases going unreported. However, as we mentioned last week, hospitalization rates continue to drop, if anything. “Well, it’s a combination of less testing and less severe BA.2 then!” is the argument from the “numbers are higher than we think” crowd. While conceding that hospitalization is a lagging indicator, as we mentioned last week, if the rise is what some of this crowd believes to be, or even a significant incipient wave, it should be showing up in hospitals.

It hasn’t yet.

So, I stand by the base case of “if there is a BA.2 wave, it will be small and alpha-ish.”

I would also argue that if a rise in COVID cases is NOT accompanied by a rise in hospitalization rate, there is no pandemic threat from that variant. Again, the MAIN pandemic threat is the ability to overwhelm hospitals. If BA.2 infects everyone, but puts hardly anyone in the hospital, well, sorry about everyone’s inconvenient cold, but that’s not a major public health concern.

Out of preponderance of caution, though, you have seen Philly re-institute its indoor mask mandate this week. Frankly, we attribute this to the reader who was recently at an in-person conference in Philly–you know who you are.

The US government also extended mask requirements for air travel for another three weeks.

So for the US, at least, we’ll be watching for how many more of these mini-bumps we start to see, as the BA.2 in New York and DC especially starts to spread out among the country a bit, and how steep the rise in new cases in New York and DC gets.

–Fall bellweather South Africa has more problems with flooding than COVID at the moment, so other than the weather, still good news there.

–Had a question from a reader about necessity and timing of a second booster shot (4th shot total). The best available data is from Israel, which was published in the New England Journal of Medicine last week. Israel uses the Pfizer shot, and looked at the rate of hospitalization (severe disease) and breakthrough in three groups of patients: those who were eligible for a fourth shot, but didn’t get it (3 doses total), those who got a fourth shot 3-7 days before (so before the fourth shot had a chance to fully work), and then those who got a fourth shot.

Importantly, these patients were all over 60 or otherwise high risk. Not real great data for anyone else yet.

We won’t sciencepalooza this too much, since the study is straight forward and pretty well done. Patient characteristics were all pretty well matched. However, they did not control for what variant of SARS-CoV-2 were infecting patients; this is unlikely to be a significant confounder though. The main findings were that a 4th shot reduced the rate of hospitalization by ~3 fold versus those who only had 3 total shots. This protection against hospitalization lasted for the 6 weeks of follow up they had on the 4 shot patients. However, the breakthrough rate (measured by positive PCR test for COVID) was starting to catch up by the end of six weeks.

So, based on this data, if you are high risk by age or underlying conditions, this does seem to be solid evidence that a 4th booster may be of benefit, at least in preventing hospitalization. Which, again, is the main pandemic threat of the virus. That benefit versus hospitalization is durable for at least 6 weeks, but we don’t know yet how much longer. There’s simply no data on that yet. So timing becomes a tricky question and one to discuss with your doctor if you are a high risk category patient for COVID. Do you wait until another wave starts? Do you get a shot now, but if you do, will the protection wane by the fall when we still don’t know for sure if there will be another fall wave? I don’t have real great answers to either question (although at least for the latter, again, the Southern Hemisphere is looking promising for no to mild COVID wave this fall). Talk with your physician.

And if it helps your piece of mind, we DO still have a number of available therapies for acute COVID if you do catch it.

As for everyone who is -NOT- a high risk category patient for COVID, which is many on this list, we don’t have good data yet on if a fourth shot is necessary, particularly in terms of prevention of hospitalization.

–We also have an economics paper, which made some waves. This was from the National Board of Economic Research, which, from everything I can tell, is rated as being pretty factual and even keel. If anything, its editorials are thought to lead counter to some of what you would expect its conclusions to be if in this study, if politics were causing the NBER to goal-seek these results. They evaluated the performance of the individual United States on COVID mortality (adjusted for average age and metabolic health as much as possible; REALLY tough for a state level look), all cause excess deaths, unemployment, GDP (industry adjusted), economy average, and in person school percentage. Their idea was to try to measure how the different durations and intensity of COVID “lockdowns” impacted these metrics. The results may surprise you; you can find the report here.

Avoid the temptation to read too much into this though–and fergodsakes avoid some of the schismogenesis headlines that accompanied some takes on this report. To me, the takeaway is that the pandemic measures imposed did indeed have a cost, ranging from economic to educational and social, to all cause mortality. As we said they would wayyyyyy back when. Those choices would always be political, and would always be difficult. How much extra all cause mortality do you justifiably risk from a prolonged slowdown or even shutdown to stall the spread of a fast moving respiratory virus that might flood your hospital and acutely raise all cause mortality? Tough to say, and even tougher to say how you get enough good, rich data, particularly early in a pandemic when the virus is so new, to make those calls well. If there is a lesson for posterity here, it’s that those decisions come with trade-offs, and we, at least, in the time of coronavirus did not solve the problem of getting complete, or at least sufficiently rich, information to make those decisions clear, obvious and timely. And really can only tell, at the end, that we are dissatisfied with the results.

The other critical question this report should ask, but doesn’t, and is important for response to future pandemics? “Why wasn’t it worse?” What was working, in all those states, that those metrics were not MORE disastrous?

Tangentially related science:

Long long ago, in the before time, in the early days of pandemics and murder hornets, we rambled about the Verroa destructor mite and then recent efforts to combat honeybee colony collapse that the mite has been causing.

While the rambles were eventually sidelined by COVID, the battle between mite and bee has continued.

Amazingly, we actually have news on that front! And yes, all of this is tangentially relevant, Skeptical Hypothetical Reader, because honeybees are needed pollinators for a huge amount of agriculture. Lose the bees, we lose crops, and as we have been discussing, we cannot afford to lose crops this year. Bee collapse was so severe as of 2019, if you click through that ramble link above, you’ll find an article raising the alarm that bee loss due to this mite might “cause a food price increase.”

Yes, we chuckle at our naivety now. As I said, we were all sweet summer children in the days of yore…

Regardless, a bee breeding program marched through lockdowns, shutdowns, riots and all to successfully breed Apis mellifera that are resistant to the destructor mite at scale, based on those wild colonies that had already found ways to cope in pockets here and there by random mutation. That breeding program published the results last week, and resistant commercial pollinatin’ bees at scale are a real possibility now.

With so much else in agriculture under threat, the bees, at least, gonna’ be alright.

Socioeconomic:

–Sri Lanka suspended debt payments in order to use the money to try and secure fuel and food; protestors remain out in legions. The Pakistani prime minister was ousted after a no confidence vote this past week; unsurprisingly, high inflation and a tottering economy were blamed as the final deciding factors. There were rumors that Lebanon’s latest wheat delivery was received damaged and unusable, and Lebanon is out of reserves with little money available to buy more. And on and on.

–Of course, the main focus remains on China, where lockdowns are spreading and now involve cities responsible for about 40% of China’s GDP. This has led to some… extraordinary… moments, a couple of which you should read about here (read the tweet underneath the main one too) and here, on top of many of the videos of treatment of Shanghai which have leaked out.

May Chairman Xi and the entire CCP continue to live in interesting times.

Considering the supply chain snarl they are exacerbating for themselves and the world, one expects they will.

–Warnings are being issued in India and Japan if high demand continues to meet low energy supplies in the summer and mid-winter (January/February 2023), respectively.

–The White House is allowing more ethanol in gas to help slow the rise of prices at the pump–which will come from the millions of acres of LESS corn planted this year, somehow, rather than using that for food much of the world will need. For the politician, perception of effectiveness is just as good as actually being effective–we mentioned that during COVID, but its application does not stop there.

–Goes almost without saying that high cost and less predictability of energy is bad for our globalized, just in time inventory world, where fewer people than ever actually grow their own food. Instead, you have more people than ever, per capita, fed by fewer and fewer farmers–all because of the industrial farming methods which, as we have said, under serious pressure this year and likely next. At a minimum. Projects to supply more energy, whether it be nuclear, renewables, new natural gas or oil projects, all take years to come online. Same to replace fertilizer instability and losses from the Ukraine-Russia war (at a minimum).

As we have also mentioned, starvation has a way of generating abrupt geopolitical changes.

At some point, energy constraints, “zero COVID” lockdowns, and/or starvation +/- protests and revolutions, will disrupt production, transport and thus supply of mission critical widgets in various chains of needed goods. Cascading disruption, again, is baked into the cards. This is a global problem given our global supply chains.

In the best of times, it could be managed successfully by thoughtful, serious leadership acting in close, trusting co-operation. Contrast that to our increasingly divided and fractious globe.

There is a non-zero, and increasing, probability that cascading disruption will become cascading failure at some point, and that is when times will get interesting for everyone.

I would continue the first wave of cascading disruption to hit in earnest this fall.

You may wish to review our previous discussion of energy, of both predictable cost and availability, and our agricultural fragility compared to previous epochs, in the context of the Bronze Age Collapse here.

–This is another classic whose lyrics are starting to hit different–because they are touching sentiments increasingly familiar… So crank the volume, because Merry Clayton just kills her part of this one: https://www.youtube.com/watch?v=QeglgSWKSIY

–Your chances of catching COVID this week, in many places in the world, continue to decline, but are still equivalent to the chances that next week’s update is as long, or even a little longer, than this one.

<Paladin>