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

Also as a reminder:

Ebola:

–Still at 11 confirmed cases with 8 total deaths. The last confirmed case remains the one right before Halloween, so coming up on three weeks with no new confirmed cases. On the down side, at least 10% of the known contacts have not been followed up, so there remains some risk for active transmission in the community if one or two of those missing contacts has active Ebola and is spreading it. If we don’t see that in a week or two though, odds are good we won’t see it from this particular outbreak.

Monkeypox:

–A patient in Maryland returning from Nigeria has been diagnosed with active monkeypox. We have covered monkeypox before, so I won’t re-hash the virology and pathology here. Yes, this is a similar story to that case in Texas in July. The CDC is involved, and they are tracing everyone who may have been exposed on the flights. Unlikely to trigger a significant outbreak.

Coronavirus:

–Where we are once again the victims of optimism bias…

So we said last week that if there is a seasonal, particularly cold weather component to SARS-CoV-2 transmission hinted in the geographic concentration of cases in the US among the northernmost states, we should start to see stabilizing to rising new case numbers in the Midwest in short order as colder weather moved in before Thanksgiving.

I think we can call this now, based on new case numbers in those states (approximately parallel to Indiana). As the weather has gotten colder here the last couple of weeks, sure enough, new case numbers have stopped falling and are starting to rise a bit.

That said, given the periodicity SARS-CoV-2 has established to its waves, I suspect cases will rise in this band of the Midwest to crest around New Year’s and start falling through January. You can adjust your own local wave based on the number of weeks from the start of your own state’s rise and fall.

Unless you are the Four Corners region states, which have just seen a slow steady rise. I hesitate to attach too much to climate here, because this time of year, some of the states are very diverse. For example, take Arizona. In the south of Arizona, where there is definitely a multi-county band of COVID activity, it’s the classic cactus desert and baking temperatures you generally think of. However, Arizona’s north is a huge mountainous plateau up into the Grand Canyon, and one of the most active counties (on a population adjusted basis) in the state right now is Navajo county, where the weather has been in the usual seasonal band of mid-60s in the day, and right around freezing at night. New Mexico also shows greatest per capita activity along its southern border, and then right up in the Four Corners region. Utah is hot in the Four Corners, and to a lesser extent the parts of Utah where people actually live. Colorado is hot at the four corners, all along the southern border, and now starting to spill into Kansas. But again, much like Arizona, all of these are counties that are relatively sparsely populated. One is tempted to speculate that this may just be virus penetration into isolated pockets where there are still susceptible people. But it’s all speculation here.

What I can tell you is that so far, no indication this is due to some new variant evading the vaccine. With the stabilize-then-rise in new cases in Indiana, at least, Delta is still far and away the most common variant. A plethora of minor variants (none of particular concern) are increasing, but none are taking off suggesting a major new resistant branch so far.

–The bad news is the implications for a herd immunity that snuffs transmission of the virus out entirely, where SARS-CoV-2 goes away completely.

I understand the sentiment, but that is not what I am saying, Getting Ahead of Me Hypothetical Reader.

From a medical standpoint, here is what I think is going on and happens going forward. SARS-CoV-2 will settle into a seasonal pattern. This will be over and above it’s approximately-every-four-months-crest-to-trough in new cases that it has shown since the pandemic began. We will see the highest transmission in colder months, very similar to the flu. The current evidence of seasonal spread, despite high levels of recovered natural immunity and vaccine uptake is why the CDC made headlines transitioning from talk of “herd immunity.” I don’t believe that is nefariousness on the part of CDC. Same for Bill Gates, rambling semi-coherently about medicine he sort of understands that made the internets this week as a “gotcha!” when he said something something need newer vaccines that stop transmission.

I don’t think you will get those vaccines.

Because we will not get a herd immunity that stops SARS-CoV-2 transmission altogether around the world, eradication is unlikely at this point. That’s what Bill is talking about and what we hoped for from natural immunity and vaccination. However, biology has had a different plan.

For the love of…. I’m not done, Hypothetical Reader. Let me finish the thought here!

What I think happens instead is what I hope we will see on the current fall/winter wave–a different degree of herd “immunity”, probably better termed herd resistance. As I suspect that with high levels of natural and vaccine immunity we will see reductions in per capita severe disease from SARS-CoV-2.

As SARS-CoV-2 mutates slower and less drastically than the flu, there is less chance of a more virulent break out. The trend will be for SARS-CoV-2 to get more contagious, but less severe over time. Meanwhile, between vaccination and natural immunity, a huge percentage of the population will eventually have some exposure of their immune system to SARS-CoV-2, with memory T- and B-cell responses primed for its spike protein. The immune systems of more humans will react better and more strongly to SARS-CoV-2 over time, making COVID (the cold/flu like disease caused by SARS-CoV-2) less and less likely to put you in the hospital should you happen to get clinical symptoms the next time you run into SARS-CoV-2 out there.

I think this is happening because while there is immunity generated, SARS-CoV-2 is spreading in higher concentrations per exposure in cold weather. We can only guess why, and it’s likely multiple reasons, but easy candidates are droplet and aerosol spread aided by denser, wet cold air and concentration of viable hosts indoors during cold weather. I suspect this “higher viral load per exposure” in the winter lets SARS-CoV-2 get a head start, even in immunized hosts, where enough virus particles get past the antibody wall to start replicating. The immune response to that is the flu/cold symptoms, as the immune system catches up. Because more immune systems now can catch up quickly because of memory SARS-CoV-2 specific B- and T-cell responses, duration and severity of clinical symptoms, should you get them, should be down versus the previous waves of pandemic.

All of that that means I expect this wave to be less severe, on a per capita/per infection basis, than last winter. More cases will be “breakthrough” of vaccine or natural immunity, and thus 10x or better less likely to result in severe disease requiring the hospital. On top of that, we have drugs for acute COVID to reduce the risk of hospitalization even more (and no one seems to be pointing it out, so I will–their recent publications show juuuuuust under vaccine-like efficacy in preventing severe disease or death in the acute setting). Even the unvaccinated can be bailed out by treatment to massively reduce the risk of hospitalization or death from COVID–which is not something we had in March of 2020, and were only just starting get this time last year.

Remember too–the main pandemic risk of SARS-CoV-2 is its hospitalization rate, and ability to occupy ICUs.

Its ability to do that has already taken a huge hit, and will continue to fall over time, due to a combination of prior immunity (making disease more likely to be “flu-like”–self limited and not requiring hospitalization in the vast majority of patients) and effective acute treatments.

So the metrics to pay close attention to as the next winter wave begins (in the US as well as Europe, where rising cases discussed last week continue to rise) will be hospitalization rates and death rates. These are lagging indicators, so expect scare headlines on new case numbers alone for a little bit. When hospitalization and death rates do catch up, they should be muted versus the previous waves, and get smaller and smaller over the years to come.

If they don’t, yeah, we’ll have to re-think this meme:

Full caveats about my optimism bias, but I don’t think that is a bridge we will wind up crossing.

The best argument against this as the base case is that the winter lift off is starting from a higher base, as the delta wave had not completely subsided yet. So there is a chance that the sheer numbers get pushed higher than last year’s wave, especially if immunity really has been waning. I -doubt- that immunity has been falling off a cliff based on what we do know from the studies published so far–but it is still possible. Further, if there inefficient distribution and/or use of acute COVID treatments into a higher wave, and we may not see the expected per capita/per infection drops in severe COVID. Those possibilities aside, though, I think it’s most likely that hospitalization and deaths per capita/per infection are muted.

–So in a perfect world, there is broad recognition, especially among political leadership, that the virus’ ability to overwhelm hospital systems is severely diminished between vaccine/natural immunity and effective treatments, and we can return to whatever the new normal is.

However, we live in an imperfect world, and I expect political recognition of that to be slow and uneven. Indeed, Europe is guiding the way here, as some countries are already re-instituting severe lockdowns to curtail rising cases despite high vaccination rates. Austria, for example, just made it all but a crime to be out and about for anything if unvaccinated and over age 12. No, this does not take into account natural immunity from recovered COVID, and makes this approach scientifically questionable if the aim is to “protect” the unvaccinated from themselves, no matter what. The recovered, especially if strongly antibody positive, are likely protected similar to vaccination. However, it seems “Austria” is spelled close enough to “Australia” for there to be policy confusion as well. Germany is also apparently debating the Austrian approach too. Gibaltrar, which has the highest vaccination rate on the planet, just cancelled all Christmas activities and gatherings because of their rapid rise in new COVID cases. Gibaltrar is definitely worth mentioning in light of draconian restrictions on the unvaccinated in countries like Austria, as the spread of the virus there very much includes an awful lot of vaccinated people with breakthrough cases. That said, other European countries are largely keeping calm and carrying on. State-level reactions in the US could be equally varied this winter as cases appear poised to rise again.

So in summary, once more:

–I think it’s also important to point out that the Great College Football Experiment is NOT temporally correlated to this rise. While “super spreader” events are possible, these too should become rarer, as clusters of highly susceptible people become less likely over time.

–Still on the COVID beat, thanks to a reader for an apparent rising number of “vaxx than detox” videos on Tik Tok. I have not been able to find them, though, and suspect that the search engines may be protecting me from vaccine disinformation for my own good. But that’s only a suspicion–after all, I am not about to click on “page 2” of search results like some sort weird psychopath, so if the “vaxx than detox” are merely not popular enough on their own right to hit the top search engine results, that could explain why I am missing them.

Regardless, not being able to link them directly or review them in full myself limits my ability to mock some of these as they might deserve.

Tragedy, I know.

But my understanding from the reader who mentioned them is that gist of them is you get one of the COVID vaccines and then do one of several dubious options to “detox” from the vaccine. Up to and including baths in borax, or your favorite woo woo heavy metal detoxification regimen.

The mRNA vaccines, and so far as I am aware, the modified adenovirus vaccines (like J&J’s), do not include any heavy metals. I have no idea what surface application of borax in a bath is supposed to be doing.

It’s not obvious what these “detox” procedures are detoxifying, let alone how.

They even, according to my reader source, include “anti-vaccination”, where you take a syringe, inject the same place as the vaccine went in, except instead of injecting anything, somehow draw the “toxins” or “Illuminati nanobot mind control chips” or whatever back out through the syringe. This way, you get your card signed, but Bill Gates does not control your destiny any more than he did already in a society where money can be converted to power over others.

In the medical world, though, we call that “anti-vaccination” procedure a “blood draw”. Do them frequently. Not for anti-vaccination purposes, or to draw back out the actual vaccine. Because I don’t think that would really work. The lipid particles will have fused with cells in your body and the mRNA delivered long before you could get the “anti-vaccine” injection in to suck the conspiracy out.

Suffice to say, if you have any questions about the vaccines, I strongly recommend you speak to your doctor, rather than get advice on health routines from Tik Tok.

–And yes, stories like “Doc, I was watching this video on the internet from one of my favorite follows, SunnyDayUnicorns420Lolz, and they said to detox from the COVID vaccine I got 8 months ago. So I did what they said and took a bath in concentrated borax, and now I have this rash everywhere….”? They are exactly why I will never be unemployed as an MD.

–Tik Tok crazy aside, Taiwan is the latest to restrict some of the mRNA vaccines in younger patients. This time, however, it is limiting the use of the Pfizer vaccine in 12-17 year olds. As a reminder, that is the full adult dose for that age group, and is not the same dose level as currently available for the under 12s. This is because of concern for myocarditis and pericarditis, which, as we mentioned, has highest incidence in males in this 12-17 demographic.

–Finally in related scientific news, the flu, having been hammer timed last year, is back like the U of M football team this season. Possibly infecting the U of M football team as well, as the state of Michigan called for an official CDC investigation of a surprisingly rapid jump in influenza cases on the U of M campus the past few weeks. This is all H3N2 flu, which is part of this year’s seasonal vaccine. The vast majority of cases had not received a flu vaccine yet. Flu activity remains low in most states (New Mexico an exception at the moment too), but CDC’s data on this is 10 days old as I type. So good idea to consider the flu vaccine if you have not already got one, because ’tis the season for flu and influenza may not decide to sit this one out.

–On the socioeconomic front…

–OSHA announced that it will be suspending enforcement of President Biden’s executive order to fine the bejeezus out of employers that do not require, and confirm compliance with, COVID vaccine mandates after the 5th Circuit Court of Appeals held that the mandate was “staggeringly overbroad” and ordered suspension of enforcement. Meanwhile, the administration encouraged companies to go forward with the mandate pending continued legal challenges. I suspect the courtroom tennis will be ongoing on this one all the way up to the Supreme Court at some point.

–Back on inflation, been thinking a bit more on the ability of social media to amplify and affect the zeitgeist. Part of inflation is supply/demand balance, but part too is the expectation that prices will continue to rise. As everyone takes pictures of rising prices at the pump and grocery stories, comments on the real estate market, goes on Tik Tok or Insta rants about inability to find, let alone get delivered, appliances, does posting all of them amplify and intensify that expectation of inflation?

Especially when you go to the pumps and stores and see the same things in your area, confirming what is suddenly everywhere online. Thus, expectation of inflation gets confirmed for you as well. And since social media can spread “common knowledge” like this further and faster than ever, the “expectation” variable may be more important than previous historical bouts of rising prices from supply/demand mismatches. I’m sure this will be some economist’s PhD thesis at some point when writing the history of this era down the road…

–Anecdotally, I have seen posts and pictures online of fake items making it look like shelves are still full. I have not seen fake items on display at the stores here yet, making me think those posts are either staged or very, very rare still. What I have seen a lot of in real life though is the odd gap in shelves with shipments of things that clearly did not come in. The soda and pre-bottled tea aisles in particular have been suddenly sparse everywhere around here.

–So I think we are still in the “cascading disruption” phase of the supply chain crisis, and I doubt we exit it as COVID proves itself seasonal in the next coming months. Politicians will be tempted to look effective again, and the lockdowns in Europe are likely to spread. With them will come additional supply chain ripples. “Cascading failure” still seems unlikely, but is -not- impossible.

–And that’s not counting for non-COVID disasters to severely impact supply chains. Vancouver has been completely cut off from rail supply (and possibly road) after Biblical flooding and landslides took out a number of bridges. Those bridges will take months to repair. Meanwhile, Vancouver is Canada’s largest port, and the third largest in North America, now with no effective way to move cargo to or from it.

Poor timing on the flooding, to say the least…

–Before we leave inflation coverage, Bloomberg Opinion is the latest to try to put a rosy spin on rising prices for all the stuff you need…

Ryan has better ideas on constructive ways to be more European this side of the pond. Walkable cities and classical public art, especially.

Regarding Bloomberg’s argument that high inflation can make us all more European… well, there’s a chance that could be true! Just perhaps not in the way that op-ed anticipates though…

–Two good think pieces this week.

But first–video break! All you need to watch is the segment queued up here.

Make sure to check it out before we go on–you deserve the break!

Back? Cool.

Now, let’s talk schismogenesis.

“Schismo-what?“, I hear you ask, Hypothetical Reader. Especially since I spelled that right, yet even the spell checker on this program did not recognize it!

Schismogenesis is an anthropology term, first coined by Gregory Bateson back in the 1930s. Being an anthropologist, he was studying group dynamics in various cultures, and noticed that certain specific behaviors or rituals in those cultures could either inhibit or accelerate schisms between factions within them. Schismogenesis, then, was the coin he termed for how schisms were created. He thought these were self-destructive to both parties, and encouraged research on how to recognize and prevent them.

The specific form of schismogenesis that will be most relevant here is “complementary schismogenesis.” Here, we imagine there are two factions, and they are complementary in the sense that if Faction 1 does A, Faction 2 will do B. It helps them self-identify how they are different from the other Faction, and humans tending to act/think first and rationalize later, they will then create a mythology for why what they did/thought was better.

Narrator: It was not necessarily better.

Hence, the self-destructive part. Even more interesting is that research showed that members of the different Factions would gradually over time take and defend more extreme positions in arguments/discussions with a perceived member of the other Faction than they otherwise normally would. The more of these “one does/thinks A while the other does/thinks B” that happened, the more exaggerated, the more rapid, and more severe the split.

Yes, this should sound familiar to US readers in particular.

Yes, there are technologies and forces that certainly appear to be amplifying schismogenesis.

Yes, this was coined in the 1930s, so no, there really is nothing new under the sun.

And yes, I did throw a base jumping video in before this to prime you for closer attention to the section on schismogenesis. Not sorry, I thought it necessary, and you are welcome for the improvement in your Scrabble score.

But keep “schismogenesis” in mind and how it is happening (and even how we may be participating in our own self-defeating schismogenesis) as we come to the first think piece.

Why?

Because our first think piece came from a reader, and is another rundown of how the corporate media has added logs to the bonfire of its own credibility. With receipts. Get as lost in those as you like, but the key ideas to consider are the three paragraphs at the end. When you read them, keep this KEY THOUGHT in mind: this is a knife that cuts both ways. The author is castigating the media of one faction (mostly because he believed it more trustworthy than the other once), but this very much applies to corporate media writ large, or media that is clearly devoted to politics, and thus one Faction or the other. Read it, but when you do, mentally substitute media of both political tribes when you read the last three paragraphs.

Because this is how they contributed to schismogenesis. And how they are lighting the fires to their own credibility.

And if you still burned with partisan zeal reading it, well, that just shows now is the time to start thinking about how we reverse the schismogenesis that has been taking place. Otherwise, post-COVID world and society outcomes NO ONE wants become more likely.

The second think piece is a little off topic, but worth your time. It’s one of the most recent Hidden Forces podcasts, were they got Eric Schmidt, the former CEO and co-founder of Google on to talk about a book co-authored with Henry Kissinger on the importance of AI technology. Great promise, great danger, and it is just getting started. The second hour is also worthy if you are willing to make a Patreon donation to Hidden Forces for access, where they discuss the geopolitical importance of AI technology. Basically, do you want AI with the CCP’s values and priorities, or with the West’s values and priorities? Worth considering their discussion on the need to moonshot AI technology like the Space Race of old, given the current new Cold War we live in…

And because “schismogenesis” is the Word of The Update this week, highlights just one of several good reasons for society to get its headspace cleared, get back on the same page, and find a way to work together, rather than letting the extremes at either end continue to drag us into their self-defeat.

Otherwise, we have no chance of uniting for that moonshot.  Or any of the other necessary moonshots.

As these guys lay out, that may be disastrous.

–Your chances of catching Ebola are equivalent to the chances the Detroit Lions win their Thanksgiving day game next week. Yes, I am willing to lay those odds despite Detroit breaking its season long losing streak with a “non-loss” (but not even a win!) recently.

–Your chances of catching coronavirus are equivalent to the chances next week’s update will be super short, because Thanksgiving. Which, yes, also makes those odds equivalent to the chances that next week’s update will rival the “Lord of the Rings” complete series in length, invented languages, and mentions of schismogenesis, because that’s what seems to happen to me every time I think “next week’s should be on the shorter side…” There shall be no in between though!

<Paladin>