Ebola:

Coronavirus:

–Vaccines. Moderna seems likely to be approved. Both Moderna and Pfizer’s vaccines work the same way. Vaccination has started, and is favoring frontline health care workers in ERs, urgent cares, and ICUs, followed by hospital staff in general, and rolling out from there. I have NOT received a vaccine yet–the state department of health is managing roll out for everyone, and when your turn in line is called, you get a link to register and go to one of the designated hospitals doing the vaccination. I suspect in many states it is working quite the same.

There is no Phase 3 published data on the Moderna vaccine just yet. As per last week’s addendum, the Pfizer data looks very comparable to a seasonal flu shot. The key safety data from their paper is this figure:

Fatigue, headache, muscle and joint pain are your major adverse events in the study. Again, there are two reports of severe allergic reaction in the UK still being worked up, and reports today of one in Alaska (this one with no history of previous severe acute allergy). Note that these events don’t start to really separate from placebo until the second dose though. Fever is the other major side effect; again, shows up primarily in the second dose. Younger patients were slightly more likely to have an adverse event, but the difference is negligible.

Considering these studies were in ~22,000 patients per arm, a few hundred cases of fatigue is not a particularly high rate. Also considering tens of thousands have now been dosed around the world so far this week, and a few allergic reactions do not make an especially high rate, although this will need to continue to be followed.

Efficacy is somewhere between 88-95%; this is mostly due to just the few hundred patients total who caught COVID while on study. With a total sample size that small, the efficacy is at least very good if not excellent.

Again, I plan on getting the Pfizer vaccine if and when offered.

–That said, if you have already been diagnosed with SARS-CoV-2 and recovered, you can probably wait on getting a vaccine giving data on durability of immunity after infection and recovery. I am quite certain I have been exposed to an infectious dose, but I never got symptoms, thus never got tested, and am well past the window where antibody testing would be likely to be useful. So I plan on taking advantage of the vaccine, even though I will still have to maintain social distancing and a mask for a bit until the population as a whole is closer to herd immunity.

–Given case numbers, that day gets closer. Speaking of which, the wave in the upper Midwest and Big Sky appears to have crested and new case rates are falling. So are admissions and hospital census of COVID-19 patients. That said, this is the lowest available number of ICU beds I have seen in 2020 this week from our state’s tracker, and suggests that at least some local areas are either full up or very, very, very close to. So continue to be prudent.

–I am cautiously optimistic that Christmas and the New Year will result in pretty manageable spikes, if any–at least in most US states.

–On the downside for “close to herd immunity”, cases in Arizona and California continue to rise. Arizona is most disturbing, considering they already had a pretty big waver earlier this year. Again, I think California’s turn for the big wave has finally come–despite the most restrictive lockdowns and public health measures in the country. On the flip side of -that- coin though, cases in Sweden are also getting worryingly high and Stockholm was restricting non-emergent cases in its hospitals to try to triage the large “force of numbers” flood of COVID patients.

So again, if you are arguing one extreme of lockdown yes/no or the other, or encountering someone on the internet tempting you to engage in this kind of modeling, there really isn’t a great argument to be made on either side of it.

–Flu season has been unusually mild, as coronavirus precautions disrupt flu spread as well. A twin disaster of epidemic flu and SARS-CoV-2 pandemic seems much less likely than not, although the season continues to develop.

–In “reasons to root for the mRNA vaccines”, part of the excitement around them is the speed and ease with which they can be designed and manufactured., This is the reason the vaccine makers as a whole have been trying to shift this way (never got a proof of concept running until now, because, well, obviously). If efficacy against SARS-CoV-2 holds up, other infections, particularly viruses (where, as we mentioned, this strategy mimics their actual biology well) may see new, faster and better vaccines against them. That may include a flu vaccine that requires less guesswork and can adjust a little more “on the fly” to contain the actively spreading strains and contain its high mutation rate better.

–Other big news is the UK announcing identification of a new strain of SARS-CoV-2 in the southern part of the country. Details remain a little sketchy on this one, although they have found a cluster of about 1,000 patients with this new strain, which includes a few mutations in the spike protein. It is far too early to speculate on the significance, if any, of this strain. This strain is the first, in some time, to outcompete the D614G strain which we have said is more contagious, but less severe on a case by case basis thus far. Hence the interest. There is not enough data yet to know if this new strain is more contagious, as contagious, less contagious (but broke out in a very tight infection chain), and how severe it might be. Also unknown how it may affect vaccines and current treatment, although odds are against much of an impact, since this is NOT a strain that has emerged from significant exposure to them to have been selected for its resistance.

–And no, there was never any update or details from Denmark about what they saw in the minks that caused them to cull the entire population.

–If you saw the reports, yes, SARS-CoV-2 was found in a wild mink in the US. The mink apparently had a bit of sniffle from it. This is NOT the mutant Denmark strain of COVID, and yes, coronaviruses can hop as colds between species. Nothing unusual or ominous about it.

–Speaking of nothing ominous, readers keep finding scare articles out there, typically alleging nefarious things the vaccines might do and/or the “unproven” vehicle of lipid nanoparticles and PEG.

The good news is that most of these are coming to me because they are pinging your bullshit meter–which is great. That means your bullshit detector is on and active!

The best thing to do when encountering an article describing the mechanism of action of the vaccine, and why it’s radically different, and then making a bunch of scare claims of things that may go awry is to first go back and re-read the immunology and virology explainer from a couple updates ago. If the mechanism the article is describing doesn’t sound like that, i.e. “these new vaccines alter your DNA!”, odds are good their understanding of how they work is a little flawed. If they are making claims that by targeting the virus spike protein like this, terrible autoimmune conditions may result, realize that the burden of proof is now on them because we should have seen those autoimmune diseases in people who got the virus already by now. If they can’t show you the patients, the chances of their autoimmune disease of choice (“infertility risk!”) will be seen with the vaccine is pretty damn low.

In short, the vaccine does not modify your DNA at all. The mRNA it delivers uses the exact same biology as every virus known to man, and in fact works just like an RNA virus. The vaccine mRNA does not last more than 48-96 hours tops. The cells the vaccine “infects” will be killed as usual just like any other virally infected cells. The cell that takes up the vaccine mRNA will not be making viral spike protein forever and ever amen, no matter what. You are not still making the virus proteins or particles of the viruses you have caught over the years and developed immunity towards; in the same way, once your body has an immune response going to the spike protein, the very first thing it will do is ruthlessly hunt down and kill any of your cells still making the protein. Because the way the vaccine works is to make the immune system think the spike protein insert IS the entire virus, and this is how your immune system takes out viruses.

This strategy was selected because yes, traditional attenuated/inactivated strain vaccines or purified viral protein vaccines did not work well in the past for coronaviruses. They are also much slower to produce and more expensive. As we said above, the entire vaccine field has been moving towards mRNA vaccines in the last 5-10 years because mRNA vaccines can be rolled out faster, cheaper and in much greater quantity than traditional vaccines.

Lipid nanoparticles, again, are a 5 dollar word for “tiny fat droplets”. They are also something your own body makes (which is why your cells will dutifully pick them up). When your body makes these, it, too, packages everything from protein to yes, mRNA in it, as a way to send signals from one cell to another. They’re called “exosomes” if you want to Google them. So the delivery vehicle is nothing earth shatteringly new either–we can just do this biology outside of cells, and at manufacturing scale now.

PEG, again, is in everything up to and including toothpaste. Many drugs already use it to improve solubility, particularly for drugs meant to be injections. Here, it is keeping lipid nanoparticles “nano” in size, lest they, like your olive oil, clump together in one big fat blob that becomes hard to inject.

So the risks of the delivery vehicle are minimal as well.

Lastly, the common sense check. If the nefarious goal is sterilize/control/eliminate a large percentage of the population, and you were evil, would you start with the population of people most likely by training and professional experience to recognize what you were doing? Would you really give it to health care workers first?

And would you even use a vaccine to do it? There is already such an anti-vaccination movement for existing vaccines that have been around for decades that diseases once controlled in much of the developed world have been re-emerging. You think Jenny McCarthy is going to line up for a shot to fall victim to your eeeeeevil plan? How do you get to your target number with that much resistance to your clever scheme already? And what would be your endgame there? You take out a bunch of people with your vaccine–BUT the ones you KNOW, going in, that you are not going to get are the ones already most attuned to your evil plot. Those who have been standing wary vigil for the rest of us, keeping their steady watch through the dark night in the flickering light of their computer screen. Arguably the ones your evil would want to eliminate first, since these are the presumably clever, willful and good who will oppose your rule once your crime has been committed and is now manifest to all?

If you were evil, is this how you would do it?

Or should we instead be somewhat comforted that evil has such an obviously terrible plan to eliminate/control the population?

–Speaking of conspiracy gone haywire, have you seen Bill Gates “CAUGHT ON VIDEO!” admitting, admitting!!!!! that the vaccine will “alter your DNA forever”?!?!?!

Have you seen it? Caught red handed! Evil really does have an obviously terrible plan!

Look, I get it. It’s Bill Gates. He’s a smart guy with enormous amounts of money, so he gets to do a lot of videos. His Gates Foundation also supports a lot of work on preventative care in developing countries, particularly vaccine access. Some of their initiatives have worked well; some have not.

Bill is also on record with some certifiably crazy ideas that human population needs to reduce about 90% to be sustainable, and it is urgent that we do so.

Because Bill has “Bond Villain” money, and “Bond Villain” ideas (and a history of flights on Epstein’s Lolita Express), he’s an easy target for the internet to make into its very own Bond villain.

Also, because of the halo effect (a known cognitive bias), many people often assume Bill Gates knows what he’s talking about–no matter what he is talking about.

I think Bill knows what he’s talking about when it comes to computers, computer science, software, entrepreneurship and business administration. He has clearly demonstrated competencies there. He is also one of those rare individuals capable of leading and succeeding at both the small start up level and at a massive multinational corporation level. However, it’s worth noting that Bill’s successes in business were all in a business he had intimate, tacit knowledge of–since he built computers and did his own software out of his garage when building Microsoft.

Bill also dropped out of Harvard in the 70s, before the biology underpinning these mRNA vaccines was even really in the Biology 101 classes he almost certainly was not taking. Bill does not have deep and tacit knowledge of medicine, molecular biology or biotechnology. He has a lot of money and a heart in the right place for preventative medicine, and I am sure has read a lot. He also has access to lots of people who do know. So he probably knows enough to ask reasonable questions at their presentations, and knows enough to generally follow along.

But, I also doubt many of his hired experts correct him when he makes obvious errors in understanding the biology. First, they likely depend on him for the paycheck. Second, while he does not present as the most egotistical guy, there is a non-zero chance he could have at least a bit of the ol’ “I’m Chevy Chase–and you’re not” to him, where such correction would be unwelcome to say the least. Lastly, he doesn’t need to know all the details. He has hired people who do, and what he needs from them is to show him they are doing good in the places he wants to do good with his money. I doubt they would make the mistake about mRNA vaccines permanently altering DNA (they can’t). But Bill might slide off the rails in interviews when going into details and nuances he doesn’t remember exactly right from the slideshow they gave him as an update two weeks ago in a pretty busy schedule. AND, he’s being interviewed by someone who almost certainly does not know the details either to catch the error in real time with a follow up question so that Bill can correct the error he made.

Even if THAT had happened, there is still the miracle of video editing to make Bill at least sound like the Bond Villain the internet wants him to be.

I listen to Bill Gates about Windows updates. When he makes obvious errors on the biology of vaccines his Foundation had nothing to do with (trust me, neither Pfizer nor Moderna needed his money to do this), I tend to discount his opinion. He is NOT an expert on vaccines or biotechnology or molecular biology to where this is the “gotcha'” moment some on the internet apparently believe it to be.

So remember–halo effect. And if it sounds wrong, it might be wrong and is worth checking out.

Your chances of catching Ebola are equivalent to the chances Bill slept at a Holiday Inn before making his comments.

Your chances of catching coronavirus are equivalent to the chances you should have yourselves some Happy Holidays in case next week’s update is a little brief. Or absent.

<Paladin>