I believe that medicine’s potential is much more than the version we see in the world today. A doctor should be an educator with the goal of bringing patients to a place of deeper understanding of who they are in the world. To me, medicine is ultimately about self-empowerment through self-knowledge and growth.
As far as cases go, Massachusetts and the Berkshires continue to cool off this week, with case dropping 35% or so. Country-wide cases are lingering in the same range. What will the summer bring? Massive immunity suggests we will enjoy low case rates. We are keeping an eye on the Omicron sub-variants. See below.
Omicron is 100% of what we have circulating globally. No alpha, no beta, no gamma, no delta. As we know, Omicron is associated with higher transmissibility and more cases but less hospitalizations and death.
New sub-variants of Omicron, BA.4 and BA.5, are increasing in prevalence. This suggests the ability to outcompete the previous strains and suggests even greater transmissibility. Heavily vaccinated Portugal is having a wave made up predominantly of the new subvariants, raising the question in the scientific community of immune evasion.
However, even with the other strains, evidence has been mounting since last year that the vaccines do not meaningfully prevent spread of infection. The data suggests that their main area of impact is now considered personal, really only decreasing the severity of infection. This trend appeared before Omicron and certainly seems to persist with it and its sub variants.
It’s hard to be precise because previous strains had different characteristics and therapeutics have come a long way. In any case, we can be grateful that lower rates of deaths and hospitalizations are graduating us from the emergency of the last years.
New kid on the block
Novavax is a new vaccine for Covid which has been in the pipeline for a long time. It received almost 2 billion dollars from Project Warp-Speed (that name triggers a wave of nausea, doesn’t it?) but had sluggishness with production. It passed an FDA hurdle this week with an advisory board recommending Emergency Use approval.
It is a more traditional type of vaccine, where a protein, in this case the spike protein, (instead of DNA or RNA coding for spike protein) is created in a lab and administered in a shot. Traditional vaccines, such as this one, don’t reliably elicit an immune response on their own, and so they are given with a toxin, called an adjuvant, to alert the immune system to mount a response. Novavax uses this approach.
Mid-week the fate of Novavax was unclear because of reports of myocarditis in a small number of study participants. The spike protein is known to cause cardiovascular inflammation, which is why myocarditis keeps coming up. However, the rates were quite low and the advisory board passed it unanimously.
The main concern that persists is that the vaccine’s studies were against 2020 and 2021 strains. As the world is seeing, Omicron is somewhat of a different scenario.
Shots for Tots?
Approval for the shot in children less than 5 years of age is on the docket currently and expected to go through. However, this group already has exceedingly low rates of case severity, and as above, we can’t say with any confidence that spread will be curtailed. Approval is different than recommendation. Resources are limited. Risk:benefit ratio is not good enough to recommend it for everyone, in my opinion.
Other pipeline news
There is talk of an Omicron specific Moderna shot in the pipeline for the end of the year. That might have been useful this spring. Most of us will have Omicron specific immunity by then.
Wuhan Lab is back
The WHO has come up with a new conclusion, bumping its previous conclusion that the Lab was an extremely unlikely source of the pandemic. Now a panel of scientists at the WHO say all possibilities for the origins of COVID need to be back on the table. Information is lacking and prevents meaningful conclusions at this point. The reports of febrile illness in workers from the lab at the end of 2019 and China’s stonewalling of the investigation as well as the proximity of the lab to the Wuhan market where the outbreak has been traced have long interested observers. Biden’s team is backing the effort to explore this politically tenuous situation.
Why did we take the word of the original investigators even though they weren’t able to acquire any information from the Chinese government? Why was discussion of the topic made taboo?
The shift in thinking times up well with a book release from one of evidence-based medicine’s most prominent proponents, Peter Gøtzsche (co-founder of the world renowned Cochrane Collaboration). He also happens to be wary of the drug industry’s tendency to degrade evidence-based medicine. His new book explores what he perceives is a great cover up around the source of Covid 19. The original investigation was done by insiders, with inherent bias. According to Gøtzsche virologists were all too ready to accept the stonewalling by their Chinese hosts.
“If the public knew that the virus that killed their loved ones, bankrupted their businesses and deprived them of their freedom, had escaped from a virology lab, it would have an impact on the virologic profession,” speculates a review of the book which landed in my inbox this week.
The Wuhan lab as a possible origin of COVID is an example of how scientific thought and healthy dialogue to support the scientific process (including dissent and argument) was one of the early casualties of the pandemic. The era of Big Data and Big Tech has the ability to form conversation like never before. Be wary, says Gøtzsche.
A dutch physician’s review of the book goes on to compare our current approach to another historical period:
In many ways, the debate over COVID-19 resembles the dark period at the end of the Middle Ages when the Spanish Inquisition hunted heretics.
Just as priests during the Inquisition accused individuals of dissent about religion of heresy, social media’s uncrowned kings put the label “anti-vaxxer” on anyone who dared be critical of corona policies and mass vaccinations. Just as the medieval church resisted scientific insights when they contradicted religious doctrines, so editors of scientific journals and the zeitgeist caught up with researchers while refusing to face the facts. Just as medieval universities only taught what the ecclesiastical bureaucracy had approved, most medical journals now only carry the message of the pharmaceutical industry.
It will be clear that under these conditions, which are aimed at forcing a consensus no matter what, science languishes. After all, science is not about consensus. Science is the opposite of consensus. Scientists disagree, and by the grace of that disagreement, science advances. “Without the possibility of an open debate, science simply ceases to exist,” the Belgian doctor Jan Vandenbroucke once remarked.