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

Also as a reminder:

Ebola:

–Outbreak is officially over as it has been more than 42 days without a new confirmed case. And now we wait for the next fruit bat migration or reactivation in an Ebola Jane.

South Sudan Illness:

–I got nothing. There has literally been nothing on this that I can find, either through the WHO or by news media, in the last week. When there is anything more, we will update.

Coronavirus:

–The omicron news continues to be very bipolar. There are equal parts scare headlines and “mostly just a cold” headlines out there. We’ll try to parse this out a bit.

First, is the “OMG! YOUR VACCINES ARE USELESS AGAINST THEM!” headlines, mostly over the weekend. These are all about in vitro (petri dish) testing of antibody responses in the serum of people who have received various vaccines +/- a booster. So, for example, you are seeing headlines screaming that vaccines like Pfizer and Moderna show little, or significantly reduced, inactivation of omicron. They go on to suggest that the adenovirus based delivery vaccines like J&J, AZ and several of the Chinese vaccines show no significant protection at all. There are also suggestions that patients with recovered natural infection show a similar drop in neutralization titer versus omicron.

But, if you act now, a booster can restore the vaccines to effectiveness! Yes, with an amazing booster, omicron neutralizing antibodies are restored to the range that neutralized delta or beta in 70-75% of patients!

Alright, the main problem here is extrapolating what the virus neutralization assays, in petri dishes, are actually telling you. What they are emphasizing is the amount of antibody present to prevent infection of healthy cells in petri dishes.

In the real world, of course, neutralization assays did not correlate tightly with vaccine effectiveness at preventing infection and transmission. After all, I think we are well aware that vaccination reduces, but does not appear to eliminate, the chance of breakthrough symptoms. Again, what the vaccines do well is keep you out of the hospital if you do run into SARS-CoV-2, and that is the main pandemic risk of the virus.

So I want to stress that the vaccines are –NOT- losing their effectiveness in preventing severe disease. Even the most dire headline articles have conceded that point. They’ve just done their level best to bury that fact in the actual article somewhere below the scare headline.

There is every reason to expect, even in spite of the dire epidemiology headlines on speed of omicron spread, that the vaccines will continue to be highly effective against severe disease.

What the “OMG YOUR VACCINES ARE USELESS AGAINST THEM BECAUSE OVERINTERPRETATION OF NEUTRALIZATION ASSAYS SAYS SO AND THAT IS SCIENCE” headlines really say is that the vaccines might be losing effectiveness in preventing breakthrough symptoms. You may be more likely to get the symptoms if vaccinated if you run into COVID–but while more probable (not inevitable), the breakthrough is likely to be more mild and self-limited disease.

Here’s why.

What they are doing in these assays is taking serum from patients who have been vaccinated and testing it against live (in South African studies) omicron or a lentivirus with an omicron spike protein on it, and counting the relative amount of antibodies already present in the patient serum that can lock up the virus and prevent it from infecting new cells.

So to simplify a bit, what these studies are all saying is that if we have 1000 antibodies to SARS-CoV-2 spike proteins in a patient’s sample after vaccination or previous infection, we might find that 600 of them can bind to, say, delta and inactivate it. But we find that only 150 of them bind to omicron.

Oh noes! Two doses of the vaccine are 4 fold less effective against omicron than delta!

That is the headline you are reading–X fold or X percentage less effective. Technically, that’s true.

Here’s the important clinical fact though in our simplified example: you still have 150 antibodies that worked against omicron.

If you get a big dose of omicron, and/or omicron can dip, dodge, duck and weave past those 150 antibodies (more likely than if it was having to dodge 600) to get into cells and cause productive infection, that 150 may not be enough to stop a “breakthrough” infection.

But, here’s how the immune system works.

Those 150 antibodies that ARE working on omicron? It takes your immune system about a day, two tops, to recognize those are the antibodies that are working. Your immune system will selectively grow the B-cells making those antibodies. You’ll grow an army of omicron-bustin’ B-cells from the ones making those 150 antibodies, and they will flood the zone with the best anti-omicron antibodies you had available. They will also start tweaking those antibodies to see if they work even better, because omicron showed up, f***ed around, is now about to find out. And this is why all bacteria, fungi, viruses–any pathogen really–view your immune system as a giant psychotic whirling ball of death and destruction. Because to them, it is. You may have started with 150 antibodies–within 48-72 hours, that’s 1500-15,000 or more as the new, f*** omicron specifically B-cell army cranks up. And that level of antibody will quickly restore the wall and overwhelm the virus.

Also worth noting this is by design. Your immune system by nature keeps some “wiggle” in the available antibody wall to catch as many variants as you can in the antibody net, see what you catch, and then focus new production on the most effective antibodies to defeat an active infection by one of those variants.

Meanwhile, while the B-cell army is hulking up to make a wall of the right antibodies, T-cell responses have remained uniformly effective. So while the antibody wall is being strengthened, the T-cells from the vaccines, near as we can tell so far, are still very effective at finding the omicron that got through.

If your immune system had NEVER seen SARS-CoV-2 before (because no vaccine and no prior exposure), this whole process might take 7-10 days. And that will risk your immune system panicking that it’s not working fast enough, setting off the Ah-nold reaction that is the main pathology of severe COVID. When your immune system has seen SARS-CoV-2 before by vaccine or prior infection, having any antibodies from that prior exposure that cross react at all with the current variant shortens the time of immune response and severity of symptoms.

This is probably why the real world data from South Africa, updated again this past weekend, does NOT support the most dire interpretations of in vitro vaccine data in all the headlines.

In South Africa, the omicron wave in the most heavily hit region has already peaked and is falling. This would NOT be expected if omicron were cutting through both vaccination and prior infection in the manner that the headlines on this in vitro data suggest. Further, the hospitalization rate of omicron cases in South Africa has been about 1.6-1.9% of all confirmed infections with omicron–versus ~19% in all previous variant waves in South Africa. Realize many omicron cases may still be asymptomatic and underreported. In fact, I have seen articles using that as an excuse for why to still be concerned about omicron despite the optimism for “much more mild” that South Africa clinical data suggests. They say “well, South Africa has a younger population, and while vaccination rates are low, up to 90% of South Africans may have been previously infected with coronavirus”.

Yes, I hear you Hypothetical Reader, and yes, I know heads are going all ‘aspoldy over the cognitive dissonance of that, because you have been told that prior infection is not sufficient protection from COVID and you still need vaccines and boosters anyways. Yet here, a high prior infection rate is a reason the hospitalization rate from omicron is so… disappointingly? (I mean, that is the angle these explanations are taking, right?)… low in South Africa. Meanwhile, the US, based on antibody prevalence studies is close to South Africa in terms of vaccination plus prior confirmed exposure, suggesting South Africa’s clinical experience may very well replicate here for omicron.

“But wait, Africa is the youngest continent on Earth by far. The the median age in the US is 38, 40 for the UK, and 27 for South Africa. Maybe that argument explains the hospitalization rate for omicron there?” I hear you say, Population Stats Enthusiast Hypothetical Reader.

Good point! Turns out South Africa also did the world a huge scientific solid this weekend and looked at hospitalization versus age with omicron. There is no significant difference in age groups for that “1.6-1.9%” hospitalization rate they reported. Much lower, across the board. Further, the South Africans have stressed of the hospitalized cases, they are MUCH more mild than in previous waves.

Lastly, South Africa is hotly debated as a “developing” versus a “developed” country. The economy is very developed. Their sequencing work throughout the pandemic has been world class. They do have some socioeconomic issues that developed nations don’t have, and therein lies the debate. For our purposes, though, does South Africa’s population look similar enough in terms of known risk factors for severe COVID where we should -expect- its experience to carry over?

Well, you be the judge. Obesity and age are the biggest risk factors. For obesity, 28.3% of South Africa’s population is obese, versus 36% of the US versus 27.8% UK. For diabetes, South Africa has a higher percentage of the population with diabetes than the US or the UK. Age is the only major variance. I’m not sure that age is enough, by itself, to expect a radically different omicron experience from what South Africa has seen so far.

–The next best source of omicron severity data is the UK, where there are tens of thousands of known cases of omicron (just over 25,000 as I start typing this section early this week), with dire warnings that there are likely thousands more of unreported infections. Of those, an estimated 85 are in the hospital. Not 85%.

85. Total. In the hospital with omicron.

That’s out of 25,000 confirmed omicron positives.

Thus, that is a 0.3% gross hospitalization rate out of the gate for those keeping score at home. There are “thought” to be a handful of deaths, and I use that quote deliberately because that is BBC’s wording and did not seem to be all that certain either. What I can tell you is late last week I saw the UK Health Minister correct an interviewer twice about the first reported omicron death in the UK to say “died with” and not the “died of” that the interviewer kept using. That distinction is important, because UK guidelines on COVID death certificates are to list “died of” if COVID was the only, or clearly direct cause of death, and with if there were significant co-morbidities that COVID may have exacerbated. Maybe.

–Yes, Hypothetical Reader, I too saw the headlines screaming that the Imperial College in London analyzed hospitalization rates for the first 11,000 cases of omicron and OMG IT’S AS BAD AS ANY OTHER VARIANT BUT NOW OUR VACCINES ARE USELESS.

A few points. First, the Imperial College in London was analyzing the first 11,000 known or suspected to have omicron. The latter is rather important, because I suspect it includes a lot of non-omicron disease. It would have to, since omicron was not dominant enough to have enough time for meaningful analysis of lagging indicators like hospitalization and deaths. So I don’t think it’s a completely clean data set. Second, it is impossible to reconcile that estimate with the live and updated confirmed numbers of omicron and omicron hospitalizations in the UK. One of these is wrong. And only one happens to match South Africa’s experience thus far. Lastly, Scotland did an independent analysis of omicron in its 5.4 million citizens, as omicron hit Scotland first in the UK. They found the risk of hospitalization is 2/3rds less with omicron than with other previous variants.

Also similar to South Africa is an early sign that new cases may be peaking in the UK, especially in omicron heavy areas. We’ll keep an eye on that over the next couple of weeks.

Germany did report its first confirmed death of a patient who was positive for omicron. They have about 3200 confirmed cases of omicron so far (but likely many more than that in the population–they only count sequencing confirmed cases).

–Given the headlines, some of the reactions are perhaps predictable.

The Netherlands has already decided to lock down again for a month. That saber seems to be starting to rattle stateside, with anecdotal reports that banks and other major employers in NYC are requesting employees to stay at home until early January. The NFL shuffled a few games this weekend because of high COVID positives on some teams (still haven’t heard about hospitalizations among any of them, which, given the age, vaccination status, and health of the players, hospitalizations would be very unlikely). The NHL has paused their season due to rising numbers of COVID positives.

The UK has been a weekend and early week full of dire epidemiology predictions as cases are A) rising fast and B) driven increasingly by omicron spreading like wild fire. A UK reader found and sent this website tracking the success of previous epidemiology estimates for COVID by SAGE (their epidemiologists) throughout the pandemic here, to help you put the appropriate context to the headline and article language. Also seems, from what the UK reader has found, that SAGE biases towards scenarios that would require government action in its projections. While that makes sense as the government may not be interested in scenarios where it does not need to do anything, it’s not clear if the communication is that these are all and always worst projections and not “what is the most likely” scenario. Basically, not clear if SAGE is telling them these are worst case, or if government either does not know they are worst case (and not asking for most likely) or merely thinks they are most likely. The UK press may be catching on, as JP Morgan pointed out that SAGE’s recent round of projections models omicron severity like delta severity, and this may not necessarily be the case.

And in case you are wondering, flights to and from South Africa to the US: still cancelled.

Flights to and from the UK? All good, bro.

Also, just as an aside, you’ll need a negative PCR test within 1 day of travel to fly into the US now, no matter where you are coming from. Details here.

–And no details from anyone, as confusingly and tragically usual, about treatment for these omicron patients and how effective that has been.

–Meanwhile, 73% of all new cases in US are omicron! Oh noes!

A couple clarifications on that too. That makes it sound like 73% of all COVID cases right now are omicron. This is not the case. Across the country, omicron represents 13% of ALL confirmed COVID as of the end of last week, which includes new cases and cases reported recently, and/or still in the hospital. Now, that’s a huge jump from its relative percentage a week before that, and another leap a week before that. It’s the same omicron velocity every other country has had so far. Of the new cases of COVID, yes, the majority of them are omicron. This is especially true in New York, New Jersey and New England (despite very high vaccination rates, and boosters, in these states). Among what is now tens of thousands of cases in the US, there has been one death due to omicron (reportedly an unvaccinated man in Texas).

–In response to these dynamics, the President has threatened the unvaccinated with doom and gloom yet again. To be frank, the way omicron has been moving, if you didn’t start your vaccine series last month, you may be too late. You have a good probability of encountering omicron before two doses are down.

On the booster question, I still expect omicron to be relatively mild based largely on early UK returns and South Africa’s experience. That is relative, and there is still a non-zero chance it is as severe as or nearly as severe as previous strains. A booster will NOT guarantee that you will NOT get symptoms. They do come with the small known risks of the boosters (and I have heard more reports of autoimmune things and Pfizer flus with the boosters anecdotally). However, a booster does maximize your antibodies right during what will be a growing peak of omicron spread. So if you want to bottom out your omicron risks, there is no time like the present to booster if you have not done so already. If you already have, no worries, you’re fine with that third shot already. As for me personally, I am comfortable with my antibody level and am not planning on a booster right now (I’m still already in boosted antibody titer range). Again, entirely how much you want to personally de-risk. I will not eat your lunch either way for booster/no-booster decisions.

For example, the entire University of Michigan football team got boosters on Wednesday, and as a fan, I’m lowkey all for that, because it maximizes the chances that all our players will NOT be on COVID protocols for their college football playoff game next week. Meanwhile, at least one quarterback for Georgia is rumored to have tested positive, a WR too, and Alabama is rumored to have some positives. Oh, look at that… the playoff committee ruled this week that you can win a national championship by forfeit if the other teams don’t have enough players to field a team. Interesting, that…

But back to the US President’s new plan for our US readers. The planned deployment of 1,000 military medical personnel may help, but again, depends on how severe omicron is and how hard it hits, where and when. 500 million rapid tests which you can order shipped to your house for free is nice and all, but we don’t have those 500 million right now, and I expect omicron to be rocking and rolling before most of those can be sourced and shipped. Frankly, we’re probably too late for that to be effective, but hey, perception is just as good in politics. Making more vaccines and boosters available… well, again, the boosters may help prevent symptoms of any kind. Unlikely to stop the omicron wave. Vaccines…also, again, getting one dose on board some will help reduce the risk of severe disease if you catch it some, but not as much as getting the full two dose series on. And I very much doubt unless you get that vaccine started this week you’ll be able to have both doses on board with robust immune response to both before omicron activity is everywhere. But it’s something.

–What’s not mentioned, surprisingly enough, is treatment. Both Merck and Pfizer’s medication got approval this week.

Yeah, I know. Just amazingly coincidental timing with the other announcements this week.

Regardless, I’m more surprised these were not through review for EUA even quicker given their pivotal trial results.

We covered Pfizer’s mechanism of action here. We covered Merck’s mechanism of action here. With the latter in particular there have been questions of theoretical risks of side effects. You can find why I cannot comment much on them, but a link to someone who did here.

If you do get acute COVID, and are thinking of these medications, discuss risks and benefits of each with your healthcare provider.

Again, the mutations in the spike protein that define omicron are -not- expected to interfere with these medications. They should work just fine on omicron. The biggest difference is you can take these at home (the monoclonal antibody cocktails have to be taken at an infusion center, so you’ll be there until the entire bag is in). Both, in their pivotal trials, were highly effective at preventing severe COVID if taken when you first get sick.

This is an excellent addition to our COVID treatment armaments, which include the monoclonal antibodies already. Even if omicron is worse than the data suggests at the moment, we will still have options to blunt the impact.

Further, treatments like this can help keep the winter from being one of death and darkness even for the unvaccinated, as it does not need a vaccine to work.

–So, the million dollar questions. Will we lock down again?

That’s going to be to your local politicians and their level of omicron freak out. In terms of need for lockdown, well, that’s a very debatable question. You can look at the boom in new COVID cases from omicron and model some scenarios where you might want to think about it. But, again, every model is wrong–some are useful. The real risk is how much your local politicians prefer to look effective, especially by pulling out a lock down playbook that has already been played (again, debatable how much “consent of the governed” there will be to renewed efforts), and err on the side of caution–assuming that omicron, like every other wave of COVID thus far, including the original ones, will not get by vaccines/lockdowns/social distancing and continue to spread.

Can omicron crush a healthcare system?

Well, Hypothetical Reader, are we talking crush a healthcare system by itself or in conjunction with delta cases already sitting in the hospital? Because that distinction does matter.

I mean, in theory, even with the low hospitalization rate reported by South Africa it could by itself. But only by spreading nearly instantaneously (in epidemiologic terms) through millions of people at once. While omicron has been a fast mover, it has not been quite fast enough for that. If omicron is as or even a little less severe than other strains, then yes, it’s a significant risk for “bed’s taken.” So far, South Africa suggests that these scenarios are unlikely.

That said, there are healthcare systems I worry about. Indiana, for example, has already called up National Guard to help out healthcare systems in the state because a relatively high number of delta COVID cases from Thanksgiving are still in the hospital, and even through last week, more delta was coming through the hospital doors–albeit slower this week. Same for Cleveland. Same for a few other places around the nation. Even if omicron is mild, if it sweeps into some of these places that just don’t have much spare capacity around (because of healthcare staffing issues, both with holidays and COVID isolation/vaccination requirements) slamming a whole bunch of people at once, that “1.6% hospitalization rate” of a giant number could easily be the straw that breaks a local healthcare system’s back.

Even in these places though, omicron moves so quickly, and is probably moving so quickly, that most of the playbook to contain spread is probably going to be too late. Plus, paradoxically, if omicron is more mild, and just consumes all the delta oxygen to drive delta out entirely, you may see stabilizing rates of hospitalization, and then a fall, avoiding disaster entirely. I think that is the best case option for some of the most stretched systems at the moment. The good news is that scenario is not at all impossible, and has some decent odds to it.

–And while we are still hovering around booster issues… couple readers have picked up on various news reports suggesting that a fourth jab for the over 60s is imminent in some countries, and being run up the flag pole here.

They will beat the drum for it, I’m sure. 

There is zero data behind that idea right now though.  Zero. 

Which isn’t to say that it’s not forthcoming. I am sure the omicron rate in those with boosters versus those without will be parsed. Barring that, we’ll see “studies” like Pfizer’s 23 person study that found, to no one’s surprise, that giving a booster shot raises antibody titers.  Thus, all should have boosters because Science!^TM.  Antibody titers simultaneously are -proof- that boosters are needed and enough to publish on (when they wane after X months, even though vaccination is still strongly protective against severe disease)– but according to Very Serious Public Health officials and institutions, those same antibody titers should -not- be used to guide who needs boosters because merely looking at the antibody titer alone does not indicate anything about sufficient immunity. So (and I am not making this up–this is the implicit and explicit policy and rational of august public policy experts and institutions you see on TV)… so to get your antibody titers high, you need a booster, but if they are already high and in a boosted range before you ever get the booster (or have natural immunity from prior infection), that totally doesn’t count, you guys. Only the right number of vaccination dates and lot numbers on your vaccine booster prove that you have sufficient antibody protection. Even though antibody titer doesn’t count towards immunity, until it does.

Try not to let the cognitive dissonance of that explode your head as often as it does mine.

But these are the underpowered studies focusing on lab measures that only matter when they support one specific therapeutic idea that apparently cause no less than CDC and FDA to about face on boosters for everyone (and not just the high risk where the data was robust and clearly showed benefit) two months later. Do I think they can get to a “case” that convinces themselves of a fourth booster for some many everyone (in about that order)?

Absolutely they can! These public health bodies have unequivocally demonstrated their ability to do exactly that.

In fairness to them though,  I can see a legitimate argument for a fourth shot for some if the titer was falling and they were at high risk of severe COVID–IF they can show me a robust enough set of data showing that falling titer correlates to higher risk of severe COVID and hospitalizations and that the booster restores sufficient clinical protection from severe disease.

I’m sorry–I just don’t care about your breakthrough sniffle. I do care about keeping you out of my hospital if you get COVID though.

I think it’s a good idea right now for anyone already vaccinated and over 55 (since they are most likely to have lost titers by 6-8 months post vaccination per the available literature and are at the edge of direct risk from COVID) and anyone who worries enough that they really want those extra couple percentage points as omicron rolls in to get a booster.  Again, will not eat your lunch for that decision. A booster now will maximize your antibody wall size right when omicron is getting rampant. 

But, as we have seen thus far, you’re not going to budge overall vaccination rates by jabbing the same people over and over again.  All you are going to booster is the people who have already been getting shots. You’re also not stopping the spread of the virus around the globe. You’re not. Data is clear on that.

What you are absolutely doing, though, is taking shots from the developing nations, and for all the finger wagging, Australian internment camps and Austrian unvaxxed hunter squads (also now a thing) at the unvaxxed in the developed world claiming “it’s the unvaxxed that are creating these variants”, the last two major variants (delta and omicron) have come from developing countries whose vaccines you are stealing to jab the developed world citizens over and over and over.

The fixation on vaccines as the sole way out, with little mention of effective treatments, is increasingly sounding more and more like this: 

Rational Decision Making and The Sunk Cost Fallacy

The sunk cost fallacy is most dangerous when we have invested a lot of time, money, energy, or love in something. This investment becomes a reason to carry on, even if we are dealing with a lost cause. The more we invest, the greater the sunk costs are, and the greater the urge to continue becomes. … Rational decision making requires you to forget about the costs incurred to date. No matter how much you have already invested, only your assessment of the future costs and benefits counts.

https://fs.blog/the-art-of-thinking-clearly/ (entire post is well worth your time)

–Alright, around the horn quickly… In the US, cases are, despite the headlines, largely flat across the country as a whole. But I think this is a duel between an early end to a delta heavy winter wave (again, HIGHLY optimistic for high levels of vaccine/natural infection immunity) and the nascent start of omicron waves here. You are getting more activity in the northeast and portions of the midwest in particular, as mentioned already, and that will likely start to spread.

But you keep reading about the “45% jump in hospitalizations in the last week!” Yes, I know you are. These are still overwhelmingly delta cases in the US, and hospitalizations are a -lagging- indicator. This is still the tail end of heavy delta activity following Thanksgiving, and is not unexpected given the post Thanksgiving bump.

–Speaking of vaccines, a few safety and regulatory updates. The clotting disorders rarely seen with the J&J vaccine got additional review since the last update. There have been 1700 cases of thrombosis with thrombocytopenia syndrome (TTS), a clotting disorder that has low platelet count associated with it on a blood draw. This is also known as vaccine induced thrombotic thrombocytopenia (VITT). On a “shots out” basis, this is 500 times higher than the incidence of this syndrome with a competing mRNA vaccine. The risk is highest with women aged 30-39. Previous history of TTS/VITT is now a contraindication to getting the J&J vaccine.

In a related note, a CDC advisory panel looking at boosters recommended the mRNA vaccines (Moderna and Pfizer) as boosters, and did NOT recommend a booster with the J&J vaccine. This was due to the mRNA vaccines effectiveness and safety profile as a booster.

Recent studies suggest that myocarditis may be more common with the Moderna vaccine than the Pfizer vaccine, although still pretty rare. A large study in Denmark found 1.4 cases of myocarditis per 100,000 people with the Pfizer vaccine, versus 4.2 cases per 100,000 with the Moderna vaccine–all within 28 days of vaccination. The vast majority of cases were mild. For reference, young males (the highest risk of mRNA vaccine associated myocarditis) have about 45 cases of myocarditis (also often mild) per 100,000. Or about 10 times higher than the risk of myocarditis from the Moderna vaccine.

–There have been 8 cases of mild, self-limited myocarditis thus far in the US in the 5-12 cohort out of 7.1 million doses out so far (5.1 million first doses, 2 million second doses). Right now, literally a ~1 in a million risk for kids this age.

–All the myocarditis talk brings us to continued consideration of the case of the collapsing European soccer players. If you have not seen the headlines, or previous mention of this in earlier reports, there has been an unusual trend for European soccer players (and a few basketball, maybe a rugby player?) across all the leagues to collapse during games with chest pain. Some with cardiac arrhythmia or even heart attack.

Although there have been a number of publicized COVID cases among professional athletes across US based sports with similar age ranges and cardiac load, like the NFL, the NBA and MLS, there have NOT been players collapsing with sudden chest pain. If you recall, though, there were reports of myocarditis (mild and apparently largely self-limited) among college football players early in the pandemic, which were likely being picked up because of increased COVID surveillance on campus and more frequent physicals for the athletes. But again, no reports of college players keeling over like the European soccer players have been–granted, there were far fewer college football games played total in 2020, when the myocarditis reports were hitting and a number of players were voluntarily not participating in the season.

The underlying insinuation to the reports of the mysterious increased rate of cardiac collapse in otherwise young, healthy male European soccer players is that this is vaccine related, and being brushed under the carpet be eeeevil devious forces to deflect attention from the vaccines. After all, the vaccination status of the players is never reported.

But, in a bit of a back and forth on the topic with a UK reader, I was sent an awfully interesting article. While the NHL, NFL, NBA and MLS all required vaccination, and are by report, >95% vaccinated in those sports (high profile NFL cases of faked vaccinations aside), the European soccer leagues were apparently less strict. The English Premier League, for example, has some teams as low as 50% vaccinated as recently as October, and only just got to the mid-80s across the entire league this week.

So, taking the myocarditis risks we just covered in the vaccine section with the difference in rates of collapse versus vaccination rates in US leagues versus European soccer, I wonder if the -reverse- is true. We know there is a 10x greater risk of myocarditis due to the virus itself. I am really curious now to know the vaccination status of the players, the date and result of their last COVID test, and if they were tested after the collapse incident for COVID and/or COVID antibodies. “Wait, wouldn’t they announce the players collapsing were unvaccinated as cautionary tales to shame the rest of us?” I can hear you ask, Hypothetical Cynical Reader. Maybe. You can make a case for them NOT doing this because they -don’t- want to draw attention to relatively low vaccination uptake among the players–which might encourage impressionable young fans, already a tough group to convince to vaccinate, to vaccinate.

Regardless, without more clinical detail on vaccination status and COVID test results around these players, it’s just an interesting hypothesis…

–Pivoting to socioeconomic issues…

–Germany is set to take 4 nuclear reactors off line next week, part of a planned pivot to reduce environmental impacts. France has multiple nuclear plants off line for maintenance and strikes, the latter the most French reason possible. All of this comes at wretched timing, as the price for energy has hit new record highs in Europe all week long. Natural gas prices are 6 times what they typically are, and are in ranges reported to be “uneconomic for heavy, energy intensive industries.” Basically, to try to operate the business right now would bankrupt a number of them. The governments are left in the unenviable position of deciding to help private citizens avoid the sudden sticker shock of sharply higher energy prices or help those businesses out. So far, the Germans appear to be full speed ahead on continuing to remove the nuclear reactors from service.

Liquid natural gas prices have gotten so high in Europe, in fact, that the market is taking over and there are reports of tankers on their way to Asia turning around mid-trip because the gas they are transporting has just sold for a premium back in Europe. There are also at least 20 tankers full of LNG from the US now on their way to Europe.

On the plus side, this does mean that a top will be found for European energy prices–but it also means that a non-zero chance of prices starting to shoot up in Asia (and elsewhere) exists as well. Especially if supply is inelastic. After all, China is still just barely meeting energy needs as even as its property sector continues to implode–that’s just pushed to page 2 of the business section by the energy crisis in Europe right now. If the problem is really that there are only X barrels-of-oil-equivalent energy available in the world, but the world really needs Y, you have a bidding war for the X available (which will land somewhere in the difference between Europe’s sky high cost and everyone else’s lower cost) and someone is going to be left holding the proverbial short stick.

Who that is, where they are, and what sneakily critical global supply chain widget they may be the sole or dominant producer of, is yet to be determined.

That long story short is if Europe cannot produce, or cannot produce as much, of the widgets its industries make, additional supply chain ripples will be felt. I guarantee you Europe writ large produces a lot of necessary widgets, which may not be able to be produced elsewhere soon enough.

2022 may shift from the pandemic and pandemic response risks of 2020/2021 to mostly economic risks as the choices over the past two years ripple over the world.

–Europe has also been protesting in its thousands for some of the existing pandemic measures. Throw in major inflationary pressure, risk of recession or depression from a still emerging and slow moving energy crisis, all while Putin is wielding the whip hand of natural gas supply to the continent while maneuvering to keep Ukraine out of NATO and NATO of the Ukraine, and some of the European readership has suggested the natives may grow restless.

–Net inflationary pressure remains strong. You can read a Bloomberg article here on the global impact of higher food prices, making some items flatly unavailable or forcing changes in holiday traditions and menus. The longer and deeper this goes, the greater the chance for political instability.

Deus impeditio esuritori nullus.

–Not directly pandemic related, but because we discussed it during the pandemic in these updates, we have some bonfire of the credibilities updates. We learned this week in the Ghislaine Maxwell trial that all of the evidence from Epstein’s safe has been lost by the FBI. This was obtained after the FBI raids on his properties in the days after his death.

So to recap, the one guy who you could not let die in custody without creating an enormous cloud of corruption and suspicion given the nature of the crimes and those either implicated directly by the underage female victims or as close associates with great wealth and power… you let that guy die in custody.

Then you get all the evidence that might be critical to see those wealthy and powerful who may have abused underage women face justice for those heinous crimes (if they had committed them). All the evidence you would need to restore the public’s confidence that all are, indeed, equal before the law and this isn’t some kind of banana republic. All collected by the federal law enforcement agency with a reputation for being the best, smartest and toughest investigators in the world. The guys who broke the mob with operations like “Donnie Brasco,” for instance. And now they have the dream shot to protect our daughters from marauders who would hide behind political and financial power.

And you…lose…all of that evidence. All of it.

And we only learn about these Adventures in Basic Crimefighting Competence the same week as the bombshell Buzzfeed story detailing all the FBI informants and officers in the Michigan governor abduction case who were fired for lying, other crimes, and/or may have done an enormous amount of entrapment in that plot. And how that may call into question similar investigations of Muslims in the US in the years after 9/11.

What is the FBI even doing? Other than adding to the bonfire of credibility?

–“Hevel,” said Qoheleth in Ecclesiastes. “All things are hevel.”

The politicization of medical events shows we are more limited in our ability to influence anything that goes on in the world than we think.  More Americans have died since Biden took office than during the Trump Administration. That number was used to score points against Trump, and now, predictably and exhaustingly, it is resurfacing as a “gotcha'” from the other team as the trend now goes against Biden. Here’s the secret though–there has been no significant difference in policies. They have included prophylactic travel bans, heavy emphasis on vaccines and accelerating them, various forms of, and ability to enforce, social distancing measures.  You might say that Trump oversaw the lockdowns, but the criticism from the other side was that the lockdowns were ending too soon.

In other words, the Black Death got to England because the Black Death will -always- get to England, and no matter your choice, all roads in the Black Death Choose Your Own Adventure lead to the same place.

There is nothing new under the sun. Once it’s out, the virus is going to virus.

Or to paraphrase a quote of a quote from a source I will link shortly, “we have paleo emotions and medieval institutions.” Even though we have “technology with God like power that requires the wisdom and benevolence of God to use.”  

In the Time of Coronavirus, the Era of Maximum Stupid, we do not yet, collectively, have that wisdom.

This is why Tristan Harris’ and Daniel Schmachtenbergerishardtospellbuthisbeardisepic’s talk with Joe Rogan last month is the single most important think piece I have linked for you this year.

Seriously.

Even if you have not clicked through to any other think piece, click through to that and listen to it. I’ve waited until the holidays so you would have time for it.

Because the most powerful technology is that which controls human minds and human decisions. To lockdown, to not lock down. To vaccinate, to not vaccinate. Those are human decisions, made based on the beliefs and values we bring to them, and the information we believe about the world available to us. Even nuclear weapons–they don’t do anything by themselves. It takes humans to decide when, where and who to launch them at. Control those decisions, the beliefs that underlie them, and present or obscure the truth about the world available to the deciders, and you control the world.

And now we are at a crossroads, because the technologies to heavily influence and skew those beliefs and decisions exist. Not only do they exist, they are addictive, and they can be manipulated. Meaning you, and everyone else, can be manipulated.

And you are being manipulated. We think “not me”, it only affects the others, and I am the lone bastion of sanity. Not so.

You’ll hear on this podcast how algorithms deliberately shape your perception of the world. You’ll hear how of the top 20 Christian Facebook pages, 16 are run by bots, all from Macedonia (which is almost certainly a front for someone else). You’ll hear that 2/3rds of the content shown to African Americans are run by bots; almost as high for Native Americans. You’ll hear one of these speakers, who is an expert on these algorithms and silos they form, shocked in real time to learn about some videos of January 6th he never saw before, and how that adjusts his interpretation a little. You’ll hear why one of the speakers is shocked that Tik Tok has not been banned for its deliberate propaganda skew and data collection for a foreign government of dubious reputation. You’ll hear about some things that, God help me for typing this, China is doing right to make this technology work to encourage the upside of their citizen’s potential and control their downside. You’ll hear how Taiwan uses it to fix democracy, and how we might do the same. And you will hear Joe Rogan, for all his faults, rightly suggest over and over again that human nature, and its darker angels of power, money, and sex, and the corruption that entails, is the biggest stumbling block to the changes we need to make. How there is no incentive currently for the major corporate and government players, even in the West, to change this technology for greater transparency and to work for us, rather than simply exploit us. How AI researchers are now looking for the least bad dystopia with their technology, for that kind of reason. And thus, why the change must come from us.

Listen to it.

Especially as we look to the New Year and New Year’s Resolutions and think of how we will get out of the doldrums of 2020 and 2021.

The future is bright; the light still shines in the darkness.  I still believe in us, and hope you do too.  And we need -resolution-, starting this coming year, for many things. We will also need resolve to get there.  I hate to sound glib with “be the change you seek,” but it’s true.  Be the change in diet, both in what you consume as food and what you consume as news and media.  Be the change in exercise, both physically and in how you interact with the world and those around you. How are you contributing to the tribal problem, to schizmogenesis? How will you instead work to unite? 

Just don’t do it all at once. According to the internet, 80% of New Year’s Resolution fail. Pick one thing you are highly motivated to change. Win it one day at a time until it’s a habit. Once it’s a new, positive habit, pick the next thing. Could be swapping soda for water. Could be walking Monday-Wednesday-Friday every week. Could be run a 5K in June, and the training for it. Could be no more Facebook, could be Twitter with a timer, and that’s it for the day.

–Special thanks to the reader who sent a perfect tee up for another addition of the Army of the Bioterrorist Monkeys. It even would have worked in Roasting Weenies Security dogs too. But reading the actual article, it’s pretty brutal and sad, especially for Christmas coming up.

–So, your chances of catching Ebola are equivalent to the chances I’m going to run that write up here this update.

–Your chances of catching South Sudan Illness are equivalent to the chances that next week’s update will be short, long, maybe even get skipped in the swing of things. Who really knows at this point?

–Your chances of catching coronavirus are equivalent to the chances that you should have a Merry Christmas, and if the anxiety of omicron is bringing back all the bad feels and anxieties that we hoped to put behind us this time last year, well, this one’s for you. Alan Watts at his very finest, reminding us that one never sees troughs without crests.

<Paladin>