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:

–Cases in the US remain muted this week. Elsewhere in the world is not so lucky. China has obviously been making headlines, but much of southeast Asia is still seeing sky high activity. You are also getting leveling or increasing peaks in much of Europe. While this has not slowed the pace of social distancing roll backs, this may be a slight underestimate of how much SARS-CoV-2 is still circulating, as testing numbers have dropped slightly around the world too.

–That all dovetails into our major themes this week. In Europe, you are seeing new, albeit smaller peaks, pop in Switzerland, Netherlands and Germany. Austria looks to have expanded its initial omicron peak, and the UK has seen a slight rise in new cases. All of this appears to be the BA.2 variant, the close cousin of omicron that got a scare study out of Japan in petri dishes not that long ago. The BA.2 variant is a little more contagious than omicron, but still no suggestion the disease it causes is more severe. However, it does appear to be a burning ember on the back of the omicron wave, increasing cases in places that already have good vaccine penetration AND a previous omicron wave.

There are already cases of BA.2 in the US, as we reported when BA.2 was first making a few scare headlines. If you look at CDC’s wastewater surveillance data (which they are now, finally, making publicly available on their website), there are pretty substantial increases in COVID detection in wastewater sites around Philadelphia as well as Cleveland, Columbus and Dayton OH, and what looks like the broader Chicago-Milwaukee axis. Central and Southern Illinois is seeing a jump, as are isolated sites from Maine down to Orlando and Miami, plus Seattle and -maybe- San Jose. The Midwest and Florida are certainly -well- past their main omicron activity. Now we line that up with the CDC’s genomic surveillance data. We’ll kind of ignore their projected data, which cover this week and last week based on the actual measured rise in % of variants detected from two weeks ago–remember, it takes 1-2 weeks to turnaround sequencing results to figure out which variant was causing a positive test. But even in the weeks where we have solid known data, BA.2 is definitely increasing its percentage of variants detected, suggesting it is outcompeting its omicron cousin. The CDC’s projected BA.2 is at least -directionally- accurate, even if your actual percentage may vary a few points.

Based on the wastewater data lined up with the variant breakdown, I strongly suspect we will see a BA.2 wave within the next few weeks, one month tops in the US as well.

Given the European experience with BA.2 so far, it will be similar to the omicron wave in contagiousness and severity, but likely to top out as a much smaller peak, looking closer to the alpha wave that hit about this time last year.

–As we mentioned, Asia is getting slammered, in particular those countries that have been MOST strict with social distancing measures. South Korea, New Zealand are getting crushed. Australia is seeing a second wave, and it’s not immediately obvious to me if that is a BA.2 wave starting in Australia, or an “interrupted” omicron wave now restarting from close economic contacts with most of southeast Asia where omicron is rampant right now.

But of course the BIG news is China, where the “Zero COVID” policy is inevitably failing in the face of omicron. China has now locked down regions totally 51 million people as of the time I am typing this, including the province where most of Apple’s iPhones are made (Foxconn has temporarily closed those plants), and yes, MAJOR ports there too. A city on the outskirts of Beijing has also been closed. Deaths via sheer force of numbers are on the rise in Hong Kong as well.

To briefly spoil the socioeconomic thunder with the obvious, global supply chains that were already juuuuust maybe kinda’ on the mend from cascading disruption and now getting chaotic for geopolitical reasons (thanks Putin, you utter douche), are going to get another test as it seems increasingly unlikely that China will be able to contain omicron, let alone BA.2, even with its draconian lockdown policies. China is going to get hammer timed over the next couple months, and the timing could not be worse for global supply chains.

I know this surprises none of you by now, so we’ll keep this part short and here.

From a virus perspective, there’s a lot of people in China, and if this is the wave where things get truly rampant there, the virus gets a LOT more hosts. Those are, indeed, more chances to mutate, and thus the possibility of another variant emerging is increased.

Remember, the general trend is still more contagious, less severe over time though. If one does pop, it’s most likely to be the most contagious bad cold evah. But the virus is probably also near the end where it can come up with new ways to still be more contagious.

Regardless, it does appear that I am doomed to be updating COVID for at least a good portion of this year…

–The real test on whether the world has truly turned the corner on the pandemic remains the fall of this year. If we do see another major wave, certainly one that would suggest an annual or fall booster dose of a vaccine (more on -that- in a second), it will be the fall. Our lead indicator remains those places in the southern hemisphere heading into their fall as we speak. Places like South Africa and Argentina remain very quiet still. Really, the only data point of possible concern is that uptick in Australia as far as a fall seasonal wave of COVID goes right now.

–I see the CEOs of Pfizer and Moderna are in the news this week suggesting 4th dose of their vaccines will be “necessary” this fall, and may become an annual booster, and Pfizer’s CEO touted data they are turning into the FDA (and “other external experts”) that they believe supports this assertion.

I look forward to that data. Although I suspect it will be similar to the data Pfizer used to support its booster the first time around. You can find our review of it here, and I recommend you read it again. Because it was cheap and easy for Pfizer to provide that -extremely- limited “evidence” of booster efficacy the first time around, and it got them the result they wanted. Most likely, they have done something similar again.

That said, it does appear from headlines at least that they may be limiting the booster data to the 65 year old and up crowd (and presumably other high risk patients).

I would also direct you to recent “about face” coverage in the lay media about the data underlying “booster the world” recommendations covered here, including other expert opinion, which also linked to our Sciencepalooza review of the initial CDC studies around the necessity of boosters and which patients might actually benefit from them.

–Had my own antibodies tested again. As a reminder, I have ONLY received the primary 2 dose series of the Pfizer vaccine (no booster), which finished in January of 2021. I have not caught symptomatic COVID (nor asymptomatic COVID, but I have not tested without symptoms to know for sure) at any point in the pandemic. My antibody titer continues to remain well above the upper limit of quantitation, and requires dilution to come into range. That is the expected finding in someone who just got a booster, for context. There has been no measurable drop in my antibody level in well over a year now.

That said, I do anecdotally know one other person who caught mild symptomatic non-omicron COVID earlier and then mild symptomatic omicron COVID during the omicron wave here whose antibodies for omicron, at least, were in this same approximate range. I also know several of you who got a booster already, and got omicron anyways in the most recent wave. As well as a few people with underlying immune disorders who have caught COVID a few times now, despite vaccine and booster.

All of them have NOT been hospitalized with COVID though, and again, that is the main pandemic health threat of SARS-CoV-2.

Keep all of that in mind as well when Pfizer presents what I suspect will be their “supportive” data for a 2nd booster to their CEO’s annual bonus.

–For reasons that continue to elude me, the fact that we can successfully treat COVID to keep patients who do manage to contract it out of the hospital in the acute phase of the disease, as well as reduce risks of severe COVID in patients out of the early window and hospitalized with disease, is still not emphasized nearly as much as vaccination.

Instead, I continue to hear that it is difficult to find these treatments, including the new Merck and Pfizer pills.

I don’t know why this is. I don’t have a good medical explanation for why these are not more widely available.

–Quick note on the treatment front. There was a poster presentation whose abstract was published in a journal of the obscure that showed in a large retrospective cohort study that Ivermectin had reduced mortality in COVID versus remdesivir. That abstract got a lot of prominent Twitter attention last week.

To the enormous credit of the 4th year medical student first author on that abstract, he hit reply on nearly EVERY one of those tweets that he could find to emphasize that they did NOT go on to publish this paper because their evidence for this was ultimately quite weak.

The reason it is weak is that their ivermectin cohort largely got ivermectin outpatient (and thus with milder COVID symptoms) than remdesivir, which was given to inpatients (or people already in the hospital with COVID). That difference in severity likely explains their findings, and so their abstract is nowhere CLOSE to the definitive study on ivermectin effectiveness against COVID that some on Twitter would like it to be. So pump the brakes on this one if you came across it too.

–Back to vaccines quickly. Apparently there have been rumblings on Chinese social media about an increase in leukemia in kids who were vaccinated with the Chinese vaccines for COVID. To be frank, I am not sure what to make of it, since it is all anecdotal. Not much clarity from other nations that used a lot of Chinese vaccines either, as Brazil, for example (the next largest country to use a lot of Chinese vaccines) is using the Pfizer vaccine for the 5-11 demographic and not the Chinese versions. Same for Madagascar, whose outbreak awhile back we covered as among the first suggesting that the Chinese vaccines were not as effective as advertised. As far as I know, Madagascar used those for adults only. So we’ll see what continues to develop from these rumblings.

–There are also more cases of a fusion variant of COVID reported, where a patient has been unlucky enough to catch delta and omicron at the same time, and they swapped a couple genes. This does happen in viral infections (it’s one of the main ways the flu stays active and gets around vaccines, and one possible natural explanation for how SARS-CoV-2 made the leap into the virus it is). So far there is no indication that the resulting hybrids are more severe or contagious. If anything pops up on this, we’ll of course cover it.

Socioeconomic:

–The WHO is warning of a massive risk of food insecurity, as food prices already exceed those which precipitated the Arab Spring across that region. Other areas of particular concern include North Africa and regions south of the Sahara, which not only import food, but are agriculturally sustained by huge imports of fertilizer. Speaking of which, Brazil is the largest importer of fertilizer in the world, and its top supplier is Russia (~22% of its imports). Russia has frozen fertilizer exports in reaction to the economic sanctions. While Brazil has announced a plan to reduce its need for imported fertilizer, that plan will be a little too slow to help much this year–they want to take an 85% dependency on imported fertilizers to 45% within the next 70 years. The most likely impacted crops are soybeans and corn. Even places like Portugal are already warning that production may limit the quantities and varieties of foods available this year. And of course, the list of places restricting food or cooking oil exports grows a little bit more every week.

In the US, nitrogen fertilizer supplies are particularly tight. Natural gas, now being diverted for fuel, is also the primary source of nitrogen fertilizers worldwide. You can DuckDuckGo “US farmers fertilizers” to find all the stories you want to read about this. Fortunately for US farmers, this is more an issue of trade offs in what crops to plant. Potash, for example, still comes from Canada, so near and friendly supplies for farmers in North America are plentiful. The crops most likely to be planted less heavily than prices might otherwise indicate are corn and wheat, which need those nitrogen fertilizers. There may be relative increases in soybeans (animal feed and biofuel mostly) and legumes in general. These are peas and beans, which are nitrogen fixing plants and thus bring their own nitrogen to the party (also a good natural way to put more nitrogen into the ground for next year’s planting). Oats, barley and canola may also see attractive prices bring more acres of those online in the Midwest. The US Department of Agriculture announced a $250 million plan this year to help offset costs of fertilizer.

The USDA releases its survey on estimated crop production for the US at the end of March, and may be worth keeping an eye on. If there is less corn and wheat planted, know there will likely be less supply of those internationally this year to make up for shortfalls (for reasons already discussed). Don’t forget most beef cattle are either corn fed or corn finished (to increase marbling), so corn prices may hit unexpected places. And of course wheat is the main flour for most baked goods. If you’re the bake at home type, this may be a good year to try out those barley and rye recipes. I would also not be surprised to see a little more seasonality return to supermarket shelves this year. Frankly, it’s only since the dawn of refrigerated transport that you have year round availability of some foods. Blackberries, for instance, don’t really grow in the winter, and if you’re buying them now in the US, it’s because they’re being shipped from someplace else (almost certainly Mexico).

–Ford is delivering some new Ford Explorers without rear climate control due to a lack of microchips. Buyers get a discount now, and a free install of the controls when parts become available. I would also expect similar adaptations to supply chain disruptions to increase this year.

–Also simmering on the backburner has been the absolute immolation of the Chinese stock market these past weeks. And while their real estate crisis, which we mentioned before, has drifted off the front page of the news, it has not stopped. Indeed, the next four largest real estate developers in China have all been plunging over the past several weeks as well.

–Between COVID, geopolitics, supply chain snarls, commodity spikes especially in food with real chance of starvation in many places globally, and a (probable) Chinese real estate crisis which may spill over into their banks, there is a non-zero chance for convergent social and economic crises this year.

–If you picked up on the news this week that Saudi Arabia and China were finding a way to settle sales of oil in yuan (and NOT dollars, which yes, IS unusual), as well as understanding what else may be secretly driving a lot of the wild commodities moves this year, and this decade, this podcast is a must listen. One of the rare ones moved out from behind the paywall, because the feedback on it was that positive. Just a macroeconomics tour de force, and you can find it here.

–Finally, your chances of catching coronavirus this week are equivalent to the chances that a few months from now, in the northern hemisphere at least, the weather will finally have turned to spring. In most places, that will mean flowers and the start of long, sunny days in a pleasant temperature range, as the trees fill out in green splendor.

There you will be, beneath a blue sky in the warm sun, suddenly miles away from these long last two years. The global chaos and rancor has melted away, like the ice and snows of winter. Lost in that moment, you close your eyes and remember that humans do not exist for desk jobs, spreadsheets and zoom calls, but as part of the unity of life, in their tiny corner of a wondrous and unimaginably large universe. For a moment, you remember that all this crude matter that makes up your physical form was quite literally born of the stars themselves.

A light breeze touches your skin, carrying the faint whispers of a familiar tune.

Oh… oh no…. Your heart seizes. Reality returns, and in your mind you see the camera suddenly zoom in on you, like a reaction shot in a movie where the plot is about to turn.

The song… it’s… the song...

You open your eyes. Sure enough, still distant, but unmistakable on the summer breeze, floats a cloud of yellow spiders. They lean forward on their ballooning “parachutes”, clicking their forelegs together in eager anticipation as they descend to the fearful screams of their human foes. You thought this was something only the charming little spider babies did as they were leaving Wilbur at the end of “Charlotte’s Web.” No… other spiders, worse spiders do this too. As you, and the world, have learned to your horror.

This is no children’s tale.

This is really happening.

Really happening now.

And the screaming… my God the screaming…

One young woman runs into your field of vision and just stops, the Joro spiders already dangling from her hair and face like hideous yellow earrings and matching necklace. She shrieks, the kind of lingering, high pitched horror movie freeze and scream from every B-movie “Attack of the ____” you have ever seen. Behind her, in the distance, screaming crowds of people run in every direction. It’s the kind of panic reserved for crowds in Godzilla movies, or fleeing Gamera. Buildings burn, punctuated by occasional random mushroom cloud explosions. No, the fires and explosions make no sense, because these are just parachuting spiders. But still, somehow, it’s happening. In fact, the carnage and chaos is so complete that you can’t help it. You quickly scan the fourth wall expecting to see the silhouettes of Joel or Mike and two robot friends in an otherwise empty theater row.

But this is no third rate 50s horror film. You’re not in the middle of a lazy Sunday rerun of MST3K.

No. You’re in 2022, my friend.

And this is your chances of catching coronavirus most places in the world this week.

(obligatory)

<Paladin>