That’s right–we’re dropping the “as always” section that starts with a run down of the major SARS-CoV-2 variants over the last several years and ends with the Star Trek meme…

…because we are officially switching the schedule of these updates.

We fell into a fairly weekly format during the pandemic, because of course. As there is little evidence that the current waves and variants pose substantial risk to the health care system, that weekly format is probably unnecessary.

As you can no doubt tell, it’s been tough to find enough even remotely interesting in COVID to write about for a little while now.

The powerful play has all but moved on.

So we will be moving to more of an “as events warrant” schedule, and these will likely (“Hopefully,” I hear you say Hypothetical Reader) get shorter too.

Marburg

I got nothing this week. WHO is still a week or two behind on updates on cases on the relevant websites. Scanning Ghana news pages isn’t turning up much on Marburg. If there are new cases, they are not many. Or they are not being detected at the moment. Either way, we will keep a weary on it.

Monkeypox

Headlines for these continue to emphasize the downside, because again, fear tends to focus attention, thus driving clicks and view counts. While it is sometimes news and facts of sufficient importance to you or those you care about that you should pay attention to the news, just remember– it is always in their financial interest that you pay attention to them.

So this week we got news that monkeypox, as we have said, has popped a few cases outside of the current high risk demographic, including some pediatric cases. “Next will be sports, schools, nursery care!” come the headlines. And the reminders that, while mostly transmitted by sexual activity right now, monkeypox is not a pure STD. Hence our unfortunate Google search from a recent update, because the infectious skin lesions can be anywhere.

So is this news with immediate threat to you?

Again, kind of depends on who you are, what you do, and where you live, at the moment.

You are starting to see legitimate exponential growth in the most heavily affected states (California and New York), although Georgia and Illinois are looking brisk too. California and New York have clearly adapted the real time epidemiology reporting from COVID to monkeypox, and actually have good data on current case volumes, locations and demographics. Less is available from Georgia and Illinois, but we can make a few guesses based on New York and Cali.

In New York and Cali, cases are still overwhelmingly male (97% or higher) and overwhelmingly homo- or bisexual (~90-95% or better). You are seeing some demographic creep, but not much. For example, out of 142 new cases outside NYC this week, a grand total of 8 were heterosexual (not clear male versus female or other demographic data on those; these are presented in discrete tables). Within NYC, of 1,989 total cases so far, only 77 are heterosexual. New York, California and Georgia (by report) show that minorities are being disproportionately impacted as well. In New York and California this favors Hispanic populations, with a slighter rise in African American, while in Georgia most cases have been African American. In New York and Cali, the cases are concentrated in the big cities–NYC, LA and San Fran. Presumably most cases in Georgia are in Atlanta, and I bet Chicago is counting for most Illinois’ activity right now too. That’s not exactly a surprise.

However, there is a real risk they will lose contain on this in those cities at the rate of current case growth. Not that there is much a medical threat (still) on the level of “bed’s taken, ICU swarming” with COVID, but again, the chance that this epidemic gets “sticky” and persists is rising. The declarations of health emergency on state and federal level should, in theory, help with resources for vaccine access, distribution and exposure tracing for isolation and “ring vaccination” type efforts.

My concern, though, is the demographics of active cases. These are populations that historically have had healthcare access issues, and some of them have strong (Tuskeegee) reasons to be vaccine hesitant. In fact, these populations were slow to COVID vaccine acceptance, as you’ll recall from our previous COVID coverage.

Now layer on the ghosts of the epically botched COVID vaccination campaign overall, and continued, if not expanded, vaccine mistrust, and you don’t have the best recipe for containment success here. We’ll mention this again in the coronavirus section, but this will merely be the first hint of likely public health failure with its roots in the Bonfire of the Credibilities of COVID.

There will come others, and we are fortunate that this version of monkeypox that is spreading, and I think increasingly likely to stick for awhile, is not more medically severe.

Coronavirus

–Around the horn, most active waves around the world are abating, including the US. Still a bit of activity in parts of South America and South East Asia, but I suspect local crests will hit soon there too.

–So of course this was also a week that saw more headlines warn of unattributed “scientists” worried that complacency will result in vicious spread should a more severe variant appear, especially given the immune escape of the omicron cousins.

Appeal to authority and generalized attribution are warning signs of probably low information content.

So to flog the horse carcass one more time, pandemics tend to converge towards highly contagious, less severe over time. This has unquestionably been the trend over the long pandemic (delta is the only debatable exception). While there is always a chance that SARS-CoV-2 could mutate to a new sweet spot that is virulent and different enough to be contagious to a lot of people, that chance continues to dwindle away.

Increasingly, it looks like SARS-CoV-2 has thoroughly explored its probability space, and found the maximum number of peaks available to it where it can continue to find and thrive in new hosts. Or to put that more simply, SARS-CoV-2 appears to be running out of mutations that “work” for it. That our bellweathers like South Africa are now coming through the fall/winter season without much activity after BA.4/BA.5 months ago is a strong indication. Also that there has been no new highly contagious variant coming off of BA.5, despite some warning headlines about it. Cases in India, where the last possible contender to displace BA.5 was circulating, are muted and falling.

This increases that chance that fall season in this hemisphere will not have as much activity as the previous two years–certainly not with severe disease potential.

–Further, we presented the recent research showing that vaccination PLUS exposure to an omicron variant was the most protective for reduced risk of severe disease, and that this protection was very durable.

You’ll probably still get nudged to a new booster this fall. The formulations corrected for omicron family mutations will probably be out and approved (if they ever will be) in the next few months. How necessary those are if you are already vaccinated AND caught COVID already (especially during one of the several omicron waves) given what is likely to be around in the fall is a little debatable. If there is some actual science about that, we’ll try to cover it.

In a perfect world, the new T-cell test for immune response to challenge with COVID and antibody testing would inform who really needs boosters this fall due to waning immunity. Certainly high risk demographics should probably consider it. But another horse carcass we have flogged into glue is that politics and tribal signaling especially have seized and strangled vaccinations, and the available lab tests will likely continue to go underused for this purpose.

The COVID vaccination effort, although well intentioned, will be considered one of the greatest public vaccination campaign failures in history, when all is said and done. And the Bonfire of the Credibilities responsible for this debacle will likely echo for future vaccines to other diseases in our lifetimes, with public health consequences we will no doubt be able to measure before long. As early as monkeypox, for example. So too will the damage this has done to the reputation of the medical community writ large, as we are all painted by the policy choices and errors of public health leaders we did not elect.

–Speaking of which, interesting paper here on the origins of SARS-CoV-2 controversy. I have mostly ignored origin debate articles, since, as I have said before, the smoking gun if it exists is in a Chinese lab notebook somewhere, and won’t see the light of day in our lifetimes. However, this article makes a reasonable case for greater transparency on past and current “gain of function” research that the NIH was funding, including US lab collaborations on SARS-CoV variants with China that may have laboratory data and evidence with clues on potential origin. Was it an accidental release of a gain of function strain? Or did they create SARS-CoV viruses with mutations that could then, in a lab like Wuhan working with a LOT of them, meet and exchange genes in a very unfortunate way, and then escape? The US lab notebooks are obviously… okay, theoretically… more accessible.

However, I strongly suspect that these, too, will likely not see the light of day for decades either. Call me cynical. Or maybe just faithful that top people are already looking into this matter closely.

Socioeconomic

All of which takes us to the zeitgeist as well. I was discussing with a reader this week the enormous level of COVID, or maybe just crisis, fatigue. I had mentioned to the reader that I had more people admit to career burnout in just the past few weeks than at any time I could remember, including a few that genuinely caught me by surprise. We talked about how we had both heard that getting nursing staff anywhere is just a nightmare. Early retirements. Sudden career changes we knew about. People planning on selling family businesses built over decades, because everyone just feels over it.

All of it.

I called my regular electrician this morning (one of the largest and oldest electrician companies in the area), and was flat out told they were not taking service calls right now. They don’t have the staff. Fortunately, they were able to recommend another electrician. More places I go to than not have signs announcing new and shorter hours, speaking to similar staffing issues.

There’s a definite malaise that everyone seems to feel, but no one can seem to put a handle on. The shock of the pandemic, the response to it, and the still reverberating socioeconomic challenges, to say nothing to the new geopolitical instability increasingly layered on top, have simply become numbing. I still suspect that the long faces, the fewer smiles, the lack of civility when driving and around town anymore that we mentioned last time as well are just the sudden, sharp releases of this feeling in those around us. I also wonder if the politics, besides the deliberate schismogenesis, is also just an easy, genetically hard-wired displacement strategy. Or put more simply, if the tribalism of politics (and maybe sports, but I don’t think fights in stands have gotten more frequent or intensified noticeably) gives a socially acceptable outlet to vent this malaise. If you’re Team R, it’s okay to vent about Team D. And vice versa.

And except for the die hards, I think even that is losing its value among most. After all, it’s hard to see yourself as a full member of either of the approved teams if A) the most extreme elements in your team are clearly insane, even to you and B) when answering the question “what leader do you take the aliens to if they land?” comes up with no one, even on your own “team.”

I think that sense of rudderlessness, the lack of clear and coherent direction, and just general fatigue of the many contradictions in policy and personal behavior revealed in the Bonfire of the Credibilities is a big part of the malaise.

Maybe it’s just the “COVID Crisis of Confidence” we all sense.

Maybe it’s just me : )

But I think two other things about this malaise.

First, I think it is the sign that sellsword in Varys’ Riddle is starting to reconsider their options. The story they used to listen to, be it priest or king or rich man, is starting to seem more hollow, less authentic. The Bonfire of the Credibilities has seen to that. Tales and promises that once worked are not trusted any more. Hence burnout. Hence career changes, as COVID and crisis and lockdowns viscerally demonstrated where one’s true values lay between career and family, public life and private lives.

Second, because of that, there is enormous potential energy. For while it’s hard to see authentic leadership, or clear vision of who we, as a polity, as people, as humanity are headed right now, it won’t be that way forever. Probably not even all that long. What was before this has passed, and I think we all feel, but do not say, that clearly what is cannot continue this way. Some consensus will emerge, and the malaise will clear as it does. Replaced with whatever our new agreement, our restored relationships with one another will be. A new covenant. Mountains will shift; stars will be driven from their courses when that happens–because a lot of outcomes are now possible.

There will be crises and trials on the way to this new balance, this new equilibrium. This will call for courage and wisdom. Honesty and trust.

May be my optimism bias again, but I believe those virtues still live, and will answer when we call them. We will choose well.

Yes, the world is changing. No, there are parts of it you will not recognize when the changes now happening finish their course. It is easy to mourn what is lost in those changes, or feels lost–that is the creep and fog of the malaise. But change can shift the unbalanced to the balanced, bring justice from injustice. Yes, it is wrenching when it happens. But the end of that which should not be brings relief. The Black Death cleared the obstacles that rebirth, the Renaissance, might flourish.

The end of the Bonfire of the Credibilities will be wrenching, but if we do it right, the result will be the renewal, the rebirth, the new life we all seem to be seeking in our own COVID crises of confidence.

–Your chances of catching coronavirus are dwindling. Your chances of catching monkeypox again depend, but for most remain quite poor.

<Paladin>