Ebola

–A lot more suspected cases this week (15 currently hospitalized in Epidemic Diseases Hospital treatment centers), but none confirmed. Note that “suspected” cases tick just enough boxes that Ebola is somewhere on the differential diagnosis–maybe not high, but it needs to be ruled out just in case. The countdown to “official” end of the Guinea outbreak continues.

Coronavirus

–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

–Whomever invented copy/paste, you the real All-Star.

–Around the horn, Russia is in the midst of the current biggest blow out. South Africa and the UK both seeing climbing cases. The UK rates are climbing again after a slight dip earlier this week, with 90% of new cases now attributable to the delta variant. This is probably a race between maintained restrictions (assuming they are being followed) and additional complete vaccinations in the UK, at least for the next couple weeks until the new “Freedom Day” for the UK.

Wait, wait, wait, wait…. Is that right? Did the United Kingdom really decide to call official re-opening from COVID “Freedom Day“?!?!?!

To our UK-based ex-pat US readers, you know what you must do now. On July 19th, assuming the new “Freedom Day” launches as the UK plans, you can play it cool if you want–remind everyone that you celebrated freedom 15 days ago with a smirk and a sip. Or, you can choose to be a little less subtle:

Moving on to countries that are -not- own goaling their own history, South Africa cases continue to climb a bit as well. Again, this seems to be mostly a function of the winter weather and vaccination status, as cases are still concentrated among the unvaccinated there. Did not help South Africa that a bunch of their designated vaccines were lots that had to be destroyed this week due to a manufacturing contamination issue at one manufacturer’s plant.

I would not sleep on the “weather” part of South Africa’s current climb, either, as per the UK’s NHS data, the Delta variant is particularly adept at household transmission. So as families are indoors together more frequently, one unvaccinated (or under vaccinated) person catching the Delta variant is enough to spread to the rest of the family relatively easily.

–Speaking of Delta, the NHS data also suggest that the most common symptoms of COVID may be shifting. Cough and fever are still very common, but Delta appears less likely than its cousins to cause the classic “loss of or change in smell” symptoms. This may be making it a little more sneaky, as it more closely resembles a nasty cold. Muscle aches are still reasonably common.

So again, for the interim, if you do get cold/flu symptoms, try to self-isolate. And yes, I know we are trying to be over masks, but if you recall from pre-COVID days from visits to, or pictures of people in, Asia (Japan especially), the folks walking around in masks were wearing them because they had cold/flu symptoms and were using the mask to protect you from them. That tradition is worth considering adopting, especially if you have been reluctant to get the vaccine and suddenly develop cold/flu symptoms.

If you are around someone with cold/flu symptoms, wash your hands a little more religiously.

–That said, data continues to suggest that Delta infection in the vaccinated, if and when it does happen, still tends to be mild disease and the mRNA and AZ/J&J vaccines (and now including Novavax’s latest entry this week) have been very effective at keeping people out of the hospital. Again, cannot stress enough, that keeping people OUT of the hospital takes the biggest threat of SARS-CoV-2 away.

–Speaking of infection rates and vaccination, county level study here in the US suggests a bifurcation in the places where the increasingly rarer new infections in the US are happening. Counties with high rates of immunization have LOWER rates of new infection.

I will pause to let you recover your vision, after that blinding bolt of obviousness.

I would still like to see similar county level data correlated with % of population with known, PCR proven prior SARS-CoV-2 infection as well. My guess is that new cases are concentrating in the obvious places–low vaccine uptake and were NOT hit quite as hard by previous infections, and thus are pockets where the virus can still find susceptible hosts.

I do expect delta to become a major player strain in the US, and do expect it to find those pockets though, at least based on early reports about it.

–In vaccine news, the CDC is still working on collecting and investigating cases of myocarditis/pericarditis with the mRNA vaccines. Again, this appears to be more common in young men (16-24 years old), and more likely with the second shot. The cause is a little less clear, although we can recall the debate about myocarditis with COVID in college age athletes that hit the headlines last year when the Big Ten, especially, reported seeing a few cases in kids with COVID. If I were a betting man, I would say that what is happening is an exuberant immune system responding either to active infection of SARS-CoV-2 (which may be in endothelial cells in the heart) in those cases associated with active COVID or the 2nd dose of vaccine, a massive dose of spike protein, which, as we mentioned, causes an already primed immune system to react strongly–the Pfizer Flu or Moderna Malaise of hangover-like symptoms after the second shot. In these still rare cases, that inflammation is getting to the heart a little bit. All cases have responded to standard of care therapy, with no major complications reported that I am aware of. Right now, there are a little over 200 cases of myocarditis/pericarditis after the mRNA vaccines that the CDC is working on, with 130 million doses of those vaccines out already. So again, you are talking about 1 in a million odds. But, that denominator is a little misleading, since those 130 million doses are not out in JUST the at risk population of younger males. I have not been able to find the count of doses out in that age group for a better denominator.

That said, CDC stated they expected about 100 co-incidental cases of myocarditis/pericarditis in an age matched population (so people who had myocarditis/pericarditis for some other reason AND happened to get a vaccine dose around the same time). This is about double what the CDC would expect by “accident,” and is why this is getting a closer look.

–Speaking of questions about vaccines, review of the Seychelles spike suggests that the Sinopharm vaccine’s real world efficacy was closer to 50% in stopping symptomatic disease. That’s a bit less than the 79% they published with, but the patient populations are a little different. A few other countries, such as Mongolia and Bahrain, have seen rising cases recently despite vaccination programs heavily favoring the Chinese manufactured vaccines. However, like South Africa, most of the new cases appear to be in those who have not gotten a vaccine yet. So, tough to say. Western headlines questioning Chinese vaccine efficacy not entirely unexpected given some of the rhetoric we have been mentioning here lately.

That said, it’s a little telling that China itself has had to quarantine an entire city of about 18 million recently due to new cases–particularly when the official mouthpieces of the government are claiming 1 billion shots out with 80% of Beijing now vaccinated just this week.

And there are also reports of measures other countries which had adopted Chinese vaccines early are now taking due to concerns about efficacy.

–And finally, news on some previous threads in the update…

1. An NIH antibody study using antibody tests for SARS-CoV-2 on old blood samples to see if antibodies to see how early the virus may have arrived in the US were released this week. The samples were originally collected for the “All of Us” project, looking at donations from 24,000 Americans from all 50 states between January 2 and March 18, 2020 for population health projects. They found antibodies to SARS-CoV-2 in 9 of them, with the earliest hits in Illinois and Massachusetts. Since those antibodies take about a week or two to form, this suggests SARS-CoV-2 was circulating stateside by the last week of 2019, and maybe earlier. This confirms a CDC study on leftover Red Cross blood donation samples, suggesting SARS-CoV-2 was in Washington, Cali, and Oregon as early as December 13, 2019–which, if you recall, were among the first states with significant “no history of foreign travel or contact” cases way back last year. But it also suggests that travel was already spreading the virus throughout the country by New Year’s Eve of 2019…
2. Science writer shocked to learn that vaccines (and infection) induce T-cell responses, and these T-cell responses, as the body’s main way of removing viral infection after it has gotten into a cell, allow them to be very effective against SARS-CoV-2 variants–even if the antibody titer is low. Fortunately, you have been reading these updates, and know the function and importance of T-cells, and how the choice of B-cell versus T-cell heavy response to SARS-CoV-2 may be playing a major role in symptoms and immunity to the virus. So you are not shocked by this.

–On the socioeconomic front, falling lumber prices (finally) are now being touted as evidence that inflation will be transitory. The higher prices you are seeing are just the lingering supply chain shocks from the virus, which will iron themselves out over the next couple years. Possible. The counterargument to that is the increasing number of headlines you have been reading of bonuses, incentives, higher hourly wages to fill the record job openings right now and the truly astounding amounts of money flooded into the system as stimmies and PPP loans to lessen the shock of the days the world economy stood still. You can make a much longer, stronger case for either of those arguments right now. In short, you have what our friends at Epsilon Theory would term “dueling narratives” going on right now. Of this I am certain, there is some inflation happening. How long it lasts, how high it goes–no one has any idea. No one. Remember every headline you read about this will be from one side of this debate or the other and is just, like, their opinion man. Anyone who tells you they know, doesn’t–and is probably selling their book.

Just notice though that the debate is not “if” inflation is going on, but “how high and how long” inflation will run. That’s the signal, at the moment.

–Somewhere in this land, a lone computer screen illuminates dimly in the surrounding gloom. The room is quiet, save for the soft clacking of the keyboard. The strobing light gives glimpses of crumpled McDonalds sandwich wrappers and empty cartons of french fries. A silent semicircle of Coca-Cola cans, some standing, some fallen, some finished, some half-drunk, surround the vestiges of the fast food meals gone by. A Stonehenge in aluminum, with all the more austere mysterium granted by the shadows of the flickering screen. The clacking continues through the night. Faster and faster. More and more urgency, a desperation to the typing now. On the screen, images and headlines. Images and headlines. Fauci e-mails. Kamala Harris protestors in Guatamala. The French president, slapped. The Biden-Putin summit, and gifs of Biden speaking gaffes. The Biden speaking gaffe gifs. The same ones. Over and over. So. Much. Material. Finally, the keyboard sounds stop.

It’s too much. Just too much. All calls out, all demands comment. Communication. Participation. Biden. Kamala. The French President slapped fergodsakes…

Then, one last, furious, despairing rush across the keys… but the answer the computer screen returns is known, has been known, and indeed, now shines its mute testimony in the lonely darkness:

There, among his Coke can monolith, before that lonely computer screen, the Donald screams.

And that’s your chances of coronavirus this week.

–Your chances of catching Ebola are equivalent to the chances that the 76ers would NOT hold on to a 26 point lead in the 4th quarter last night.

<Paladin>