What's next with Covid?
We were told in mid-November by the experts to cancel all family gatherings or expect a surge of cases with the Thanksgiving and Christmas holidays coming up.
A number of states took extreme actions in imposing further lockdown orders.
Governor Gavin Newsom of California earlier this month announced draconian orders in some regions of the state that included closing all restaurants for dining (inside and outside) and is requiring masks to be worn inside and outside.
It is not going well for the Governor. Almost one million California voters have already signed a recall petition that if it gets to the required 1.5 million signatures by March would require Newsom to face a statewide recall vote before his normal term ends at the end of 2022. This is actually the sixth recall petition effort against Newsom since he was elected. The others all failed to gain the required signatures so it is far from certain this effort will succeed either.
However, we may discover that even in liberal California there is a limit on what people are willing to have done to them by government.
As I wrote earlier in BeeLine, it appears that not many people took the advice of the experts and cancelled Thanksgiving travel and family gatherings.
Surprisingly, more people actually travelled this year for Thanksgiving than last year according to Liz Ann Sonders of Schwab.
Most of that travel was undoubtedly not done through the air. However, even TSA statistics show that four days during the Thanksgiving travel period had more than 1 million air travelers. Those are the first days that TSA has reported more than 1 million air travelers on any day this year since March 16!
|TSA checkpoint numbers for 2020 (left column) and 2019 (right column)|
For additional context, on April 14, 2020 the total TSA checkpoint number was 87,534!
We have a long way to go but we have come a long way from April.
What do the case trends look like since mid-November?
There is no evidence of an overall post-Thanksgiving surge. In fact, the Great Plains and Rocky Mountain areas have seen a major decrease in positive test results in the last month. There is evidence of increasing cases in the South and Northeast post-Thanksgiving. However, there is nothing to suggest that the travel and gatherings over Thanksgiving resulted in a dramatic surge of cases that were predicted by the experts.
Let's look at the three key states of California, Florida and New York.
I am always looking at trends in the these large states. I am particularly interested in California and New York as they have had the strongest lockdown and mask mandates since the beginning of the pandemic. Florida is known to have been more open and has not had a mask mandate in place for several months so that gives us a state that acts more of a control group.
You would think that if the lockdown and mask mandate measures were effective it would be apparent in looking at a comparison of these three states.
Can you see it?
Here is one additional chart comparison that includes those three states as well as New Jersey measuring deaths per capita since the pandemic began.
New Jersey is another state that has been stricter on lockdowns and masks than many other states.
California clearly has done a good job in avoiding a spike in deaths despite the explosion of cases.
However, this might be due to the fact that the California has the lowest median age of these states.
California 36.8 median age
New York 39.0
New Jersey 40.0
This fact makes Florida's record in managing Covid look even better.
The narrative is that lockdowns and mandatory mask orders are the keys to managing Covid. It used to be that you would look at the data above and conclude that Florida's experience suggests that public health guidance might not be correct. That is not the world we live in right now.
Will we ever see a clear-eyed look at the data in developing further public health responses to managing Covid? That is a big question when we try to discern what is next with Covid.
The biggest factor in what's next with Covid will be how effective the various vaccines are going to be that are now being deployed?
The most important question I see is whether the benefit of the vaccines will outweigh the risk of being injected with the vaccine?
Make no mistake that everything in medicine involves a trade-off between risks and benefits. There is nothing that is risk-free when you intervene with some type of medical procedure with the human body.
Medical intervention saves and extends many lives. However, each intervention carries risk. That is why in every instance around the world in which doctors have gone on strike that the death rate has actually decreased or remained the same while the doctors were not practicing.
The benefits of intervention usually greatly exceed the risks. However, there are risks in all medical interventions.
I wrote about this subject last year in a blog post "Being A Smart Patient".
There is a reason that we often hear that a doctor's most basic responsibility is to "first do no harm".
Smallpox had a death rate of 20%-60% of those infected. It was over 80% with small children.
There is little question that the benefits of a smallpox vaccine outweighed the risks of receiving it.
You can easily say the same thing when you look at polio and the fact that 1 in 200 infections resulted in irreversible paralysis and among those as many as 10% died when breathing muscles became immobilized.
Here is the most recent data on Covid infection survival rates based on data from 40 countries around the world.
Here is another interesting data set on Covid case fatality and infection fatality rates (far right column) from Minnesota.
What is particularly interesting about the Minnesota data is it breaks down the CFR and IFR between those in long-term care facilities and others.
The Minnesota data indicates a 99.90% survival rate if infected with Covid outside of an LTC facility.
The survival rate from the infection is 89.46% with Covid even if you are in an LTC facility in the state.
The potential benefits of the Covid vaccine are just not as apparent as the smallpox and polio vaccine looking at the numbers. This is especially true right now as we don't fully know all the potential side effects.
The FDA says that the side effects from the Pfizer and Moderna vaccines are manageable but it must be remembered that testing involves a limited number of subjects. Those subjects were also generally not the very young or very old. They also were individuals who were generally healthy. These vaccines were also not generally tested on those with two or more comorbidities. Of course, these are the people who are at the greatest risk of Covid.
You can be sure that there were not very many nursing homes residents that were in the testing phase either.
I found this headline interesting as I saw that the Secretary of HHS Alex Azar said that we have the resources and capability to vaccinate every nursing home resident in the nation by Christmas.
Considering the risk profile it makes a lot of sense to provide the vaccine to nursing home residents first.
However, how safe will the vaccine prove to be with this population when it really has not been tested that thoroughly on people who are older and far less healthy than those in the trials?
The efficacy reported in the trials looks promising and I am rooting for the vaccine to be successful.
However, I also know that there are a lot of people with big bets on this working including Big Pharma, the FDA, the CDC, Dr. Fauci and President Trump.
People with this much to lose usually will go to great lengths to make sure they don't lose. However, that outlook also blinds them from things that they should see.
Most people in that position don't look into the fine print or want to consider negative information.
For example, the Pfizer study indicated that four subjects who took the vaccine ended up with Bell's Palsy as a side effect. This is a paralysis of one side of the face.
This was considered acceptable because it was explained that number was similar to what one would expect in the general population. However, when I saw that I checked the study to see how many in the control group had a case of Bell's Palsy during the trial. If four was expected in the general population for that size group you would expect that there would be four cases in the control group as well.
How many cases of Bell's Palsy were in the control group?
Is that a normal positive deviation or is there something there to be concerned about?
I couldn't help thinking about the cases of Guillain-Barre syndrome that cropped up shortly after the 1976 national swine flu vaccination program that ended up scuttling those vaccines.
The good news is that we should know a lot more about any short-term side effects soon since so many doses of the vaccine are to be administered before year-end. We should know fairly quickly if there are any immediate problems from that nursing home population.
That still leaves open the question of what about longer term side effects?
This is probably not as much a concern for those nursing home residents as it is to the health care workers and others who are scheduled for the first doses.
The biggest concern I hear voiced about the Pfizer and Moderna vaccines is the fact they were developed using new mRNA technology. This is the first time it has ever been used in a human vaccine.
Some are concerned that it could potentially cause a problem named "Antibody Dependent Enhancement" in which the vaccine actually results in a worse situation for the person who received it if exposed to a future virus in the coronavirus family. This is a major reason that previous efforts to develop a vaccine other coronaviruses were not successful.
This usually did not allow the vaccines to get past animal trials. It should be noted that few animal trials were conducted with the Covid vaccine trials due to the compressed testing schedule.
I have also seen questions about the long-term effects the Covid vaccine might have on fertility. The concern is that the antibodies for the spike proteins of the SARS viruses might also work to cause infertility in females since there are genetic similarities in the spike proteins of Covid and those necessary for the development of the placenta in humans and mammals.
In fact, the question about the effects on fertility is clearly left open in the leaflet that is being given to health professionals in the UK who are administering the Pfizer shots. It also makes clear that no animal studies on this issue have been done.
If I was a young woman in the health care field I would certainly not be first in line for the Pfizer or Moderna vaccines in light of this information when I balanced the benefits and risks of receiving these vaccines.
The research I have done also indicates that the side effects are a bigger concern with the Moderna vaccine than with the Pfizer type.
One in five people in the test phase who took the Moderna vaccine suffered Grade 3 or 4 side effects after the second dose.
For many these side effects may be worse than the effects from the actual virus.
You have to also ask if this vaccine is going to be the game changer that many believe it will be why are we being told that masks will still be required and people should not travel?
At this point it is now known if the vaccine actually will stop the spread of the virus. All that is known from the trials is that people will not get as sick from Covid as they would without the vaccine.
How does that affect the risk/benefit analysis of the vaccine for you?
If you are interested in reviewing the FDA's Brief Document on the Pfizer vaccine you can read it here.
As history is written Covid will be the defining event of the Trump presidency.
If these vaccines are successful Trump should get credit for leading one of the greatest medical accomplishments in human history.
This is a tweet from President Trump on May 14
There was almost no one that believed it was possible. Most everyone in the media said that Trump would need a miracle to do it.
This is a headline from NBC News from the day after Trump's tweet. This narrative was repeated often by the media over the course of the year.
I was skeptical myself about whether it could be done as I wrote in "Warp Speed or Wish and a Prayer" in May.
I am happy to admit I was wrong. What about the others?
Will Trump get the credit he deserves if these vaccines work?
The odds are probably no better than 50/50 he will and that tells you all you need to know about our country right now.
This guy who has over 21,000 followers on Twitter says we need to thank Joe Biden. He is not the only one saying this.
What exactly has Joe Biden had to do with any of this?
I can assure you that if things don't work out that 100% of the blame will be placed on Donald Trump.
That is an easy prediction from a guy who does not like making predictions.
What's next with Covid in other respects?
We have found that normal and traditional rules no longer apply when it comes to the policy and public responses to Covid.
Facts, data and true science don't seem to matter much compared to the narrative.
That makes it difficult to predict what is next.
What's next depends more on the narrative than the facts.
That has been true for the last ten months. I do not see anything changing that right now.