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:

South Sudan Illness:

–Finally got some clinical detail in the news wires after we went to “press” last week. The mysterious illness has now killed just 100 people in a flood stricken region of South Sudan. The WHO team sent to investigate had to helicopter in just to get there (all the roads are out), and has left. Per available media reports, they left without telling the South Sudanese what they were thinking, and WHO has not commented publicly on it yet. The first I find difficult to believe, and is probably just a reporting issue. The latter suggests they are still ruling some suspects out. There is even one report (but only one) that the WHO team had trouble confirming the deaths attributed to the mystery new disease.

The symptoms are described as diarrhea with loss of appetite, fever, and cough, chest pain, joint pain, headache and body weakness. My guess is that the diarrhea is the dominant symptom, as they tried to rule out cholera first (which makes sense in a flooded region with a sudden diarrheal outbreak). Fever and loss of appetite go along with that. Joint pain, headache and body weakness are all easily explainable from dehydration due to severe diarrhea.

All of the deaths have been elderly or under the age of 14, exactly where you would expect for dehydration to be doing the deed. The cough and chest pain is odd given that symptom spectrum, and probably why they went to a WHO mystery illness team. There are some parasites that spend their life cycle between the gut and the lungs, but this doesn’t fit for these, at least classically.

I think it is most likely that you have more than one disease going on here, one that is respiratory occurring at the same time as the GI thing. Or malaria plus one or more of these. Explains fever, joint pain, and mortality pattern–but I would expect the South Sudan to be pretty familiar with malaria. Less likely is a new pathogen. And if it’s not two different things, the most likely explanation is a known disease with a slightly odd new clinical picture for some reason. We’ll continue to monitor, but no major concerns that it is spreading out of these region of South Sudan, or even spreading like wildfire there.

Coronavirus:

–Omicron updates… Unsurprisingly, given the wide reach and contagiousness of omicron already, coupled with holidays in many countries, total case numbers around the world have been going up. That said, the CDC revised the percentage of new cases last week due to omicron down a bit. As of Christmas, omicron is merely accounting for 58% of new COVID cases across the nation, and not 73% as previously reported. You can bet it will be 73% or higher this week.

Anecdotally, I have heard from far more friends who either know people who have, or themselves, have popped for COVID (presumably omicron) in the last week than at any point in the pandemic. It bears mention that, again anecdotally, most of them are using at home tests, and will NOT be showing up in the official statistics. I am sure the current disease activity is underestimated by the official numbers.

On the plus side, they were all using at home testing because the symptoms were mild at best. Fever and/or cold like symptoms are most common, and the typical reaction has been lamentation of the inconvenience of it all, in terms of cancelling or changing holiday plans, or work required quarantine periods for a positive result. Symptoms have been resolving very quickly and there are no hospitalizations, let alone near hospitalizations. The vast majority have been vaccinated in that circle (so far as I know), but even the one guy I know who has not gotten vaccinated (but recently popped positive) has recovered quickly. Given age and physical condition, his odds were good too though–the fact that he was likely positive for omicron was good for his outcome chances as well.

All of this is anecdote, but this is all very consistent with reports from South Africa early in the omicron wave, as well as hospitalization trends in countries further along in omicron waves. I think at home testing as well as holidays will delay the current case counts a bit, but at least in Indiana, hospital census for COVID patients is actually declining, and there is no delay on that data like there is for COVID test results. I think that is accurate, and if that trend continues, again, supports South Africa and other’s early data for omicron mildness.

We do have new data from the UK–summary available here. The “N” is small and focused on patients in London, but the most significant findings are that, indeed, omicron positives are 50-70% less likely to be admitted to the hospital than delta positives. There are 14 deaths within 28 days of omicron diagnosis in that group, all ages 52-96, and that definition suggests some of those are dying with, not of, omicron–so I am hesitant to toss a mortality out there on it. Suffice to say, omicron appears dangerous only to the high risk categories yet again.

Perhaps the most interesting finding is that patients have been popping with omicron despite getting a booster shot, and that the effectiveness of a booster in stopping clinical symptoms of omicron drops by 15-25% within 10 weeks. In the words of the report itself:

“There are insufficient severe cases of Omicron as yet to analyse vaccine effectiveness against hospitalisation, but this is more likely to be sustained“

I would tend to agree with that, and suspect that it will take a LOT of patients to show a difference between booster or not in terms of hospitalization rates–since I suspect that difference will be pretty small.

Remember, a drop in vaccine effectiveness mostly against symptoms from ~90% to 75-80% in those >50 to 60 years old was what prompted BoosterFest 2021.

The UK researchers compiling the linked report above did not analyze patients who were previously positive for COVID in terms of breakthrough and hospitalization rates. However, South Africa has a lower vaccination rate, but a previous infection rate that is at least as high as other nations like the UK and US. New COVID cases in South Africa are already plunging; in fact, Guateng, where omicron was first sequenced, currently has one of the lowest Rt values I have seen in the pandemic. Those observations lend themselves to relatively robust protection from previous infection as well.

–Omicron is more infectious, less severe, will hit fast and disappear and very possibly steal the oxygen from the more dangerous variants is pulling into a significant lead as the base case.

–That has not stopped our need for this image:

–Early this week we had protests in Germany for new anti-COVID measures about to go into effect. France has locked down, with millions about to be working from home again as omicron rolls through. China has shut down the sizeable city of Xi’an for going on several weeks now due to a persistent omicron surge, now reportedly in the hundreds (likely higher). Samsung has a big plant there, and is already shifting to be “flexible” with its production from the facility. I haz some doubts that China will be able to continue its “Zero COVID” policy in the face of omicron, and if it continues the shock and awe shutdown approach every time, supply chain disruptions from these policies are likely to persist.

At this point, not anything terrible new, but also means the weird ripples in the supply chain will continue to some degree into 2022.

Dr. Fauci has suggested that masks may now be a permanent part of air travel and discussions were taking place about vaccine mandates for domestic air travel. This is <glances at calendar> ohhhhh… about two weeks since two CEOs of the largest US airlines suggested that masks “don’t add much” and HEPA filters in planes removed most airborne pathogens. It’s also easily a year since we discussed in these updates a CDC study of 14,000 air travelers at the height of pandemic before vaccines and treatments were available that could not link a single case of spread of SARS-CoV-2 to air travel. However, that was with masks.

The CDC then came out on Wednesday and said there was no consideration of vaccine mandates for domestic air travel.

So if you had any concerns about the ability of institutions and those who somehow come to lead them in their ability to come together and mobilize against any of the complex and serious issues facing the world still, ranging from AI to climate to response to climate (i.e. electrifying the grid) to supply chain snarls to the raging uncontrolled psychology experiment of modern internet and social media, among others, take heart. We’re coming up on two years into the pandemic, and the CDC and Dr. Fauci not only don’t have clarity on vaccination for domestic air travel (let alone what counts as full vaccination), they can’t even agree on whether discussions about that are even happening. In the same week.

As we head into 2022, the dial is still cranked to Maximum Stupid.

–Around the horn in brief, then, cases are blowing up around the world. This is driven mostly by omicron, but delta remains quite active as well. For example, it is -just- starting to get pushed out in many states. The current wave has hit equally hard regardless of vaccine/booster penetration. New York and much of the Northeast have relatively strict mandates in place, mask rules, and high vaccination rates, yet omicron in particular is very active there right now. Same in much of Europe. I think we can expect the peak incidence of new cases within the next couple weeks, followed by a rapid fall into February. Something like 89 cruise ships on the seas right now have active omicron, so expect cruises to halt until the spring at the earliest. And with high numbers of cold symptoms (and/or positive rapid tests) for omicron, expect an official slowdown (if not shutdown) due to relatively high numbers of sick call offs. I saw some estimates this week that in the US, just the approximate number of work call offs mean “unemployment” (number of workers not at work this week) jumped 1.4% between close contact quarantines and actual positives.

So far, this is not translating into higher numbers of hospitalizations, as everyone is slowly acknowledging that omicron has a much lower severe disease rate versus the previous variants. Again, sheer force of omicron numbers may be threatening, probably more on a local or regional level, but I remain cautiously optimistic here too. Just a reminder though, hospitalizations and deaths are a lagging indicator. If they remain low late this week and through next, despite high new case volume, things will be looking optimistic.

–The chief physician for the NFL created some stir this past weekend merely by observing that they have not confirmed spread of COVID from asymptomatic positives in the NFL. Symptomatic players and coaches are apparently the ones successfully spreading COVID to teammates. Worth mentioning that asymptomatic or symptomatic, in the latest delta tail/omicron wave, I have not read reports of any player or coach hospitalized for COVID complications. That got lost in some of the pearl clutching about the NFL physician merely stating the observed facts.

Those facts are also consistent with the literature on asymptomatic spread, a topic we have touched on before. This announcement should not surprise our readers–just means SARS-CoV-2, in the NFL at least, is “reading” its own literature and staying consistent with what we know about it. Asymptomatic spread is really quite rare.

–In fact, overlapping a bit with socioeconomic effects, following thousands of cancelled flights due to staff shortages caused in no small part by quarantine requirements after known positive results or exposure during the omicron wave, the CDC has announced changes to its recommended quarantine periods. This reflects a growing awareness that asymptomatic “infection” (better read as “presence of virus sufficient to pop a test positive, whether that virus is ‘alive’ and infectious or not”) is much less likely to spread COVID. I have copy/pasted CDC’s new recommendations here:

“Given what we currently know about COVID-19 and the Omicron variant, CDC is shortening the recommended time for isolation from 10 days for people with COVID-19 to 5 days, if asymptomatic, followed by 5 days of wearing a mask when around others. The change is motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after. Therefore, people who test positive should isolate for 5 days and, if asymptomatic at that time, they may leave isolation if they can continue to mask for 5 days to minimize the risk of infecting others.

Additionally, CDC is updating the recommended quarantine period for those exposed to COVID-19. For people who are unvaccinated or are more than six months out from their second mRNA dose (or more than 2 months after the J&J vaccine) and not yet boosted, CDC now recommends quarantine for 5 days followed by strict mask use for an additional 5 days. Alternatively, if a 5-day quarantine is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure. Individuals who have received their booster shot do not need to quarantine following an exposure, but should wear a mask for 10 days after the exposure.“

You may have noticed that CDC now recommends that those who have received a booster shot do NOT need to quarantine after a COVID exposure. “But wait… the UK just showed that omicron can infect even boosted people, and that effectiveness against symptoms, and thus, presumably risk to spread to others, drops 10 weeks after a booster shot. Did I miss the part where CDC accounted for that in this recommendation?” I hear you ask Hypothetical Reader.

No, you didn’t miss it. CDC cares only about how many shots you had, and the only timing that matters is if your vaccination series was more than 6 months ago. Not about your actual titer of antibodies after those shots (even though in vitro data on those drives their recommendations for things like boosters to begin with). And this change appears to have been made without reference to the UK data, which, in fairness, the CDC may not have had on hand when drafting these new recommendations.

The CDC does not cite or offer any population based clinical data for this difference between booster or not for quarantine/isolation after exposure that I can find.

–The CDC also lifted the requirement for a negative PCR test after quarantine to officially exit quarantine. There has been much consternation about this, because everyone feels more reassured after a negative test. The problem, as we have covered, is that PCR and antigen tests merely prove the presence of virus, not its infectivity, and can detect what are likely just the bits and pieces of virus spit out by the immune system up to 12 weeks after symptoms have resolved in some patients. We have previously discussed the scientific publications to that effect, including experiments that showed the complete inability to grow live, infectious coronavirus from PCR positive patients after their symptoms have resolved.

So is there a chance that people come back too early and potentially infect others? Even if they have had a booster (perhaps especially those with a booster who don’t need to quarantine at all, despite the UK tracking infections of omicron in those who have received a booster)?

Yeah, there is a chance. I think that mostly ties to symptoms as spread from the asymptomatic is rare.

The question really goes back to the tradeoff we discussed when they first instituted mass lockdowns. There are social costs to lockdowns, and we have seen them, ranging from higher rates of other diseases, mental disorders, addictions, and impact to kids. Quarantine does come with a cost. The question is how to balance the cost of the quarantine with the risk of the virus itself. Clearly, CDC has some new thoughts on the balance of that.

To be fair to CDC, the policy is reasonable based on the known science and known consequences of lockdown. The omicron wave is going to continue–difficult to say if it will be higher than it would have been had they kept quarantine rules the same. The biggest key is if you have been exposed, and especially if you have cold/flu symptoms (even in the absence of COVID testing), stay away from others until the symptoms resolve. That seems simple enough to work. Will there be those who just take some Robitussin and power through, and potential infect others? Yeah, probably. That’s human nature too.

And why the Black Death will always reach England.

–On the vaccine beat, the UK tabled a decision on vaccines for healthy 5-11 year olds, although does recommend vaccination for kids in that age group with high risk conditions. I want to be clear about “tabled” because some reports have been “rejected.” Their vaccination authority has really just deferred a final decision on the non-high risk kids pending additional details about the number of children in the UK in that age group who have already had COVID and additional safety data from “international use” of the vaccine in this age group.

In other words, they want more clarity on the risk/benefit ratio, since the risk/benefit in healthy 5-11 year olds is much more narrow than the elderly, for example.

I mention this mostly to illustrate how different expert observers of the risk/benefit here can come to different decisions based on how much risk they are willing to tolerate for what degree of benefit.

–Also on the vaccine beat, some school districts (New Orleans the largest I am aware of) are mandating COVID vaccines for kids 5+ for public education. Given some vaccines are already mandatory for this age group (like polio, for example, and the MMR), this is not a huge surprise. Adoption will likely be contentious, and done school board by school board and state by state across the US.

–And lastly on the vaccine beat, a reader sent a case report in South Korea about a young, otherwise healthy military recruit who died of a cardiac arrhythmia in the few days after his second mRNA vaccination. Autopsy did show a myocarditis. Although the immune infiltrate was not classic for autoimmune myocarditis, that may be more related to the timing of the autopsy relative to when we usually get biopsies for autoimmune myocarditis. Regardless, the authors concluded (reasonably, in my opinion) that it was probably related to the vaccination. In some patients, there is either enough overlap of the spike protein with something in the heart or enough immune freakout that the immune system whacks the heart by accident too. With the vaccine it’s rare, but it happens, and yes, if it interferes with the “circuitry” of the heart, a cardiac arrhythmia can happen. And yes, rare. Remember, we have billions upon billions of shots out right now, and these events are still publishable as case reports (which are news of the rare, but interesting in medical journals).

For what it’s worth, recall the myocarditis is much more common with SARS-CoV-2 itself than the vaccine. It’s not super common, but it happens. I know via two degrees of separation of an otherwise healthy young woman with new onset cardiac failure after symptomatic COVID.

Yes, I suppose, it does raise risk/benefit questions. After all, with the young South Korean, were his chances of dying from COVID enough to justify the risks of a COVID vaccine? As a younger male, his chances of myocarditis from the vaccine were higher. On the flip side of that argument, based on available data, his chances of myocarditis from COVID were about 5-10 times higher than the chance of this from the vaccine. Is the chance of one really rare outcome enough to justify the risk of another really rare outcome? Without the hindsight bias of knowing what his outcome from vaccination was already?

What about the medical ethics of blanket mandatory vaccination, with social, and sometimes severe social, consequences for non-compliance? If you already have cardiac arrhythmia, or autoimmune disease, or other conditions that might increase your risks of some complications of vaccination, is it just to load a gun full of “no job, no freedom of movement, restricted social participation and social stigma” at you and say you have to get the needle anyways?

But I feel like I have flogged the “worst mass vaccination strategy” and “why politicizing vaccination was incredibly stupid” horses enough already…

–On the new treatments beat, some scare headlines about drug-drug interaction and other risks of the new anti-COVID meds. Why the scare headlines, I’m not sure. Are we rooting against these as a way to reduce hospitalizations, protect the unvaccinated and get back to a world with less political risk and fear of COVID?

At any rate, a couple key points. The Merck drug, as we mentioned, works by increasing the mutation rate in the virus because mutations are more likely to make a hopelessly broken and ineffective virus. Because it works by increasing the mutation rate, as a precaution, the Merck drug has been limited to adults, and ideally non-pregnant ones. Because obviously. You are taking this drug for 5 total days, and risks given that short duration of treatment may be worth the benefit.

Again, as always, use any medication as indicated under the supervision of your healthcare provider and with a complete discussion of the risks and benefits of such medication. Thank you for your understanding.

The Pfizer drug has drawn headlines for its mechanism of action too. As we mentioned, the Pfizer anti-COVID regimen is a two pill therapy, one of which is well known anti-HIV med ritonavir. Ritonavir is there to inhibit an enzyme called CYP3A in your liver. CYP3A is responsible for clearing the actual anti-SARS-CoV-2 drug in Pfizer’s regimen. When ritonavir blocks CYP3A in your liver, more of the SARS-CoV-2 targeted drug is available for longer.

The headline freakout is over blocking CYP3A though, with dark promises of terrible potential drug-drug interactions, as it will raise the level of other drugs also cleared by CYP3A.

As if we have never dealt with this before in the -25 years- we have been using ritonavir.

HIV patients are on ritonavir for decades at this point. If you get COVID, you’ll be on it for 5 total days. Potential interactions will be very manageable. A list of commonly used drugs affecting the CYP3A pathway is tabled below:

A couple points on that. Yes, grapefruit juice is also a CYP3A inhibitor, just like ritonavir. So if you’re worried about the ability to manage drug-drug interaction over 5 days of ritonavir use in a COVID regimen, just recall the last time you heard about some poor dude keeling over dead from the sudden overdose of Viagra (that’s “sildenafil” on the list above, which is cleared by CYP3A too) when they washed the ol’ blue bomber down with a glass of fresh squeezed grapefruit juice.

And those of you involved in the authoring and publishing businesses on this list, I expect royalties when the 20 something gold digger offs the 80 year old dirty old man oil tycoon by slipping him grapefruit juice before bed on their honeymoon in your next mystery thriller.

–Royalties-.

“So…and just asking for a friend… if this interaction involves Viagra does it also affect Cial-” I hear you ask, Totally Innocent Follow Up Question Asking Hypothetical Reader. Thank you for understanding when I do not comment on tadalafil specifically, for reasons you can likely guess with a quick Google of “tadalafil.” Suffice to say there are case reports suggesting interaction between ritonavir and that medication as well, such as this one. Any questions–please discuss with your healthcare provider or call the manufacturer’s hotline.

Anyways, the other serious potential interactions are on the list above. The calcium channel blockers are used to treat high blood pressure and some cardiac arrhythmias–the main risk there would be blood pressure accidentally bottoming out when used with ritonavir if doses are not monitored closely. The immunosuppressive agents could pop higher to cause more immunosuppression, which would not be ideal during acute COVID. The benzodiazepines above include the famous Xanax (as an example of what they are used for), so dosage during the 5 days of COVID treatment should be watched closely as these may get a little higher than usual as well when used with ritonavir. And lastly the statins, which are cholesterol medications, may also pop higher. Main side effect we worry about with those is severe muscle damage called rhabdomyolysis, which may result in kidney failure if bad enough (the pieces of muscle breaking off clog the kidneys).

But again–we have used ritonavir for 25 years successfully, in complicated patients, with far longer duration of use than in the COVID regimen. Important to know these risks, but realize the drug-drug interaction potential is known, recognized, and can be very effectively managed by your provider. Again, review the risk benefits of ANY medications you are taking, and their potential interactions with your provider, and thank you for your understanding.

–Shifting to socioeconomic issues…

–Gas prices in Europe are dropping from outrageous and bankrupting to merely ridiculously high as the arbitrage we mentioned last week diverts ships and shipments of LNG to Europe. That wasn’t quite quick enough to stop rolling blackouts in Kosovo, as the least wealthy European nations were always more likely to get pinched first by the spike in energy prices. But those blackouts, and “bankruptcy” level energy prices, were temporary–this time. Keys to watch going forward are weather in Europe, which will affect demand and price, and where the actual settlement price lands as the current price spike winds down. Again, if supply is truly inelastic, and there is not enough energy equivalents to go around, the price of gas will land (relatively) high–most likely somewhere between what Asia is currently paying and Europe is currently paying for all of these ships full of natural gas floating on the world’s oceans.

How stable that is for industries and how integral to the global supply web their particular widgets are determine how many, and how big, the ripples from the current energy supply/demand mismatch.

–In other supply chain rumblings, there are articles out there rumoring that China has locked up 50% of the grain crops in the world via futures contracts for delivery through the next year. Some of these had a conspiranoia quality to them–when you look at China’s activity there, their share of global grain prices has been increasing steadily since at least 2016. This probably has more to do with China having an enormous population, despite never being exactly blessed with a robust amount of arable land. In fact, China has only 0.09 hectares of arable land per capita–half the world average. China will always need to import a lot of food. The share of grain crops available for sale that they are soaking up is probably more a reflection of their relative worth and ability to grow enough food at home.

Of course, every contract they buy is another load of grain that someone else, typically a poorer someone else, cannot buy. Which will continue to put pressure on global food prices.

–The long term pressure on food availability and prices comes down to the following charts.

That trend is counterbalanced by this one:

So less hectares per capita, but more efficient production per hectare since 1960. You have agricultural science hard at work coming up with hardier and more productive strains of these crops.

HOWEVER… the real secret of the “Green Revolution” that made all this possible is cheap (or at least stable, known price) energy. That runs the giant combines, does the irrigation. And powers the production of fertilizer.

You can learn here from a source with more detailed knowledge than me that the price of ammonia fertilizer has doubled in the last year, and is 25% higher than the previous record price (2014). Not all of that is tied to higher energy prices (natural gas cost mentioned in the article), and these folks heavily into agriculture suggest that its actually more grain production as higher prices incentivize farmers for maximum production plans this year. The MOAR GRAINZ! price incentive for the farmers is increasing demand for fertilizer to put all those fields into production. Also of interest to me is these agricultural folks impression in that article that overall demand for agriculture products is relatively static.

Overall, that suggests that as long as there are not more weather catastrophes disrupting production, food price inflation will -not- be due to lack of production–which would be the worst case scenario. The biggest factors to what you will be paying at the supermarket will be dominated by distribution costs, not production costs, as we mentioned when shelves were already disturbingly thin early in the pandemic at the beginning of lock downs. The cost of the truck, trucker and fuel for the truck to go from farm to your grocer is the biggest variable for what you will be paying. Unfortunately, those costs are still at risk, as supply chain and energy madness continues. Lots of widgets are bidding for that truck, the trucker (if you can find enough of them), and the fuel next to your shipment of food. That’s a choice and incentive problem, which is a tough problem (and frankly a societal own goal), but less nasty than not being able to produce enough food. There is a quicker solution to the former than the latter.

And all of that is a long way of saying when you see scare articles about China “hoarding” grain, or another one I saw about the rising price of urea (main input for industrial ammonia production), realize there are less conspiracy-and-fear explanations than what you see. They just don’t attract as much attention as the “FEAR! DOOM! ANXIETY!” slant, and remember, capturing and holding your attention is what gets much of the internet paid right now.

–On a semi-related noted, based on reader questions this week–although it touches on several themes we have hit in these updates, I had nothing to do with the writing of “Don’t Look Up” on Netflix. Yes, I know it has an equally dim view of the incentives and competency of political leadership (especially in the modern era). Yes, I know it is critical of social media’s habits and incentives that drive extreme opinion, often in ways that are counterproductive to rallying attention, focus and drive to fix major problems. Yes, it is critical of other institutions, such as “savior genius tech founders” and their real incentives and competencies. Yes, Jennifer Lawrence’s character does have a great quip to some kids with conspiracy theories that the genius tech founders and government elites have special bunkers to survive a planned demolition of the human race to the effect that once you know them up close, you realize they are “too stupid and incompetent to be that evil.” Yes, it despairs of the ability to capture attention to actual data and real-world, scientific truth in a world of enormous distraction–especially where distraction and capture of attention by the inane pays so handsomely. But didn’t write. Didn’t consult for it. And I don’t think they read this update.

I just think we’re not the only ones noticing some of these problems, and maybe starting to talk about them.

–Since it’s New Year’s this week, good time to remind ourselves to start one small change at a time. I’ve heard this quote variably attributed, but it rings true:

“Most people overestimate what can be accomplished in a year, and underestimate what can be accomplished in 5 or 10 years.”

–Happy New Year all.

–Your chances of catching coronavirus are equivalent to the chances that the shove arbiters deserve some respect on their name:

–Your chances of catching South Sudan Illness are equivalent to the chances of correctly predicting the flip of the currency disk many, many times in a row, assuming the currency disk weight is evenly distributed within its volume.

Now go party like reasonable rock stars. “2022–The Law of Averages Has To Kick In At Some Point, Right?”

<Paladin>