What We Learned From Sweden’s Response To COVID

Sometimes I wonder whether the world is being run by smart people who are putting us on or by imbeciles who really mean it.
― Laurence J. Peter, The Peter Principle

Many people have asked why we didn't let the virus hit us like a big wave and get it over with. The Great Barrington Declaration (GBD), a letter penned by three physicians, favored such an approach and called it “focused protection.” It recommended quarantining the highly vulnerable, i.e., the elderly and those with high risk factors like diabetes, heart and lung disease, etc., and letting the virus run amok through the rest of the population to quickly build natural herd immunity across the country. They said we should do away with non-pharmaceutical interventions that prevent infections, such as masks, sanitation, personal distancing, quarantines, closings, etc. The recommendation was published as a letter on October 5, 2020 because no medical journal would accept it as an article. Vaccines were still considered to be months away at that time, but actually began to roll out in mid-December of that year. Admittedly, the letter’s authors did not have a crystal ball.

We didn’t accept that recommendation, but Sweden did something very similar on their own and kept their country open and had considerably less morbidity and mortality than the US. Armchair health experts who learned their subjects at Google and Facebook Universities have been clucking their tongues and scolding the CDC and public health professionals ever since. Should we have responded like Sweden did? Would it have been better if we had followed the recommendations made in the GBD?

When the declaration came out, it was widely panned as being ridiculous by health experts and organizations around the world. A Yale epidemiologist pointed out that almost half the US population would be considered to have an underlying risk factor for COVID meaning that half the population would have to be quarantined from the other half, not much different from the protective measures already underway at that point. It also would have meant that people at less risk would be exposed to a rather nasty virus. They essentially would be sacrificed to a disease more lethal than any flu we have encountered since 1918. And then there is the problem with long COVID and other morbidities such as an uptick in new onset diabetes in many COVID survivors. Even though kids have a very low level of mortality from COVID, the disease was still much worse than any flu for them and too many of them were hospitalized in serious shape with a malady called multisystem inflammatory syndrome or MIS. This was the sacrifice the folks who proposed the GBD were willing to impose on half the population.

Anyway, this post is supposed to be about Sweden, not the US. Did Sweden’s experiment turn out as positive as many people believe? It depends on which countries you compare it to. Comparing the Swedish experience to that of the US, it seems they did pretty well. They did not shut down and had much less mortality than we did. But is that an accurate apples-to-apples comparison? Sweden is a country of just over 10 million people. Its demographic is much more homogenous than that in the US and it has much less poverty. In the US, COVID hit impoverished and minority populations especially hard. They have fewer medical resources to deal with the disease. In contrast, Sweden does not have such a large minority or poor population and it has cradle to grave social welfare for everyone, including medical care. It does not at all resemble the US.

It is more accurate to compare Sweden to its neighboring Nordic countries with similar populations, demographics, and social welfare, but that also enacted more stringent social controls in response to the pandemic like the US did.

It turns out that compared to other Nordic countries, Sweden fared quite poorly with the highest mortality rate. Sweden had four times the number of COVID deaths compared to many of its neighbors. In particular, it had ten times the COVID death rate of Norway.

What about the economy? Of course the Nordic countries that enforced public and commercial shutdowns suffered significant economic hits like the rest of the world. Importantly, so did Sweden, which kept its economy open. Nevertheless, the country suffered as much economic downturn as its neighboring countries that enforced stricter shutdowns. In fact, the Organization for Economic Cooperation and Development and Development (OECD), of which Sweden is a member, reported that the country actually did markedly worse than Denmark, Norway and Finland. It seems that economic health is not only related to open commerce, but also to the public health of the country. Sick people do not work or venture out to buy things. It seems that public health affects economic health. That was not considered in the GBD, which was concerned about the economic impact of closing down commerce via fiat. They did not consider the economic impact of closing down commerce by hospitalizing so many people.

As these effects of its open policies became clear, Sweden eventually began to enforce greater social restrictions later in the pandemic, but the damage had already been done. The architect behind its initial open policies eventually admitted that things did not work out as planned. And in December 2020, Sweden’s King Gustav publically declared that the government’s approach had failed.

The real lesson from Sweden is that if you keep things open and people get sick, the economy still suffers in a pandemic. As far as the economy goes, it is a case of “damned if you do and damned if you don’t” enforce public restrictions.

And if you don’t, people still get sick and die and dead people stop buying things.

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Gain-Of-Function Viral Research: What’s The Big Deal?

Senator Rand Paul and many others have raked Dr. Anthony Fauci, long-time director of the National Institute for Allergy and Infectious Diseases (NIAID), over the coals for supporting research at the Wuhan Institute of Virology, and especially for supporting “gain-of-function” (GoF) research at that facility.

This needs some ‘splaining.

First, Senator Paul and the anti-Fauci crowd need to give us their definition of GoF research and then explain why it is bad. If they mean research that gives viruses new capabilities, then most labs seeking to learn how a virus functions is guilty. For example, University of Wisconsin flu researcher, Yoshi Kawaoka, did research that exchanged genes from the 1918 H1N1 Spanish flu virus with less virulent H1N1 viruses in order to learn why the Spanish flu caused so much death back then. That is classical gain-of-function research and it was done under strict quarantine and safety conditions (disclaimer, your blogger was on the safety review committee that vetted and approved Kawaoka’s Spanish flu research). It is legitimate and important research.

The Wuhan Institute of Virology had a small bit of indirect funding from Fauci’s NIAID to support a genetic registry of coronavirus sequences that is freely available to all researchers around the world. As new coronaviruses were discovered and their genomes sequenced, the lab investigators cataloged them. They also inserted the new spike protein genetic sequences into incipient, harmless viruses to see how well the new spike proteins allowed a virus to infect mammalian cells in tissue culture. This was done to help assess how much of a risk a new coronavirus was for spreading among mammals. Strictly defined, this research gave the engineered test viruses new capabilities—they acquired new spike proteins and gained the new functions that came with that. This is legitimate research and not some nefarious plot to weaponize coronaviruses that Rand Paul, et al., dishonestly allude to in their allegations.

Furthermore, there are the thousands of other labs around the world, including mine at UCLA and the University of Wisconsin that use viruses as tools for gene transfer in order to study the activity of newly discovered genes. For example, my lab discovered an aberrant gene that was associated with a particular human leukemia that used to be untreatable. We wanted to learn how the abnormal gene affected blood cells, so we cloned it and inserted it into a virus that could infect mouse cells. We then gave mice leukemia by infecting them with a virus that expressed a human cancer gene. That recombinant virus gained the function of the human cancer gene. Rand Paul, et al., would call that sinister gain-of-function virus research. However, from that and other research, that incurable leukemia now is 95% curable. Sinister?

Sure, using modern molecular technology, a minacious actor could help a pathogen gain super-lethal function and develop a super-pathogen, or a weaponized bug, like antibiotic resistant anthrax or super-spreading Ebola virus. It would be pretty easy to do. But, by far, the GoF research routinely done in labs around the world is done for learning not for killing.

When Paul accuses Fauci of supporting GoF research, that accusation is attached, without evidence, to an implicit accusation that the Wuhan labs are creating more virulent pathogens for nefarious reasons. So, why does Paul not go after Kawaoka or me for using NIH money to create viruses that might be able to kill people (Kawaoka’s flu construct) or that could cause cancer (my virus expressing a human cancer gene)?  

Could it be for political reasons?

The History Of Vaccine Mandates In The US

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As employers and the President are pushing vaccine mandates because too many have refused them, voices are crying out for their perceived rights saying “my body my choice.” They do not like their bosses or the government telling them to get vaccinated. This is a clash between individual rights and public health measures designed to save lives and to protect the larger community. Who gets to make the key decisions? How far can the government and employers go? Do individual rights trump community safety?

On Sept. 9, Biden announced the most sweeping vaccine requirements in American history, ordering that businesses with 100 or more employees ensure that all their workers are either vaccinated or get tested weekly for the coronavirus. The new rules also require vaccinations for federal workers and for federal contractors, as well as for workers at healthcare facilities that receive funding from Medicare and Medicaid. This will affect about 100 million people.

The authority for these government mandates, claims Biden, is a 1970 federal statute that gives the Secretary of Labor authority to issue a six month Emergency Temporary Standard (ETS) to protect workers from “grave danger from exposure to substances or agents determined to be toxic or physically harmful.” His move has triggered a political and legal battle, with many Republican governors vowing to fight the mandates in court. The mandates raise several new questions regarding this vague statute: Is a virus a “…toxic or physically harmful substance?” Does COVID-19 present a “grave danger?” Has the executive branch exceeded its authority in offering a solution to a problem previously reserved to the states? Do these mandates violate the 14th Amendment by depriving workers of their personal liberties? It is important to note that Biden’s mandates do not actually make vaccines compulsory: The government may levy a fine or forbid a child from attending school, but no American will be forced to get an unwanted jab. This has not always been the case.

There are historical precedents for vaccine mandates and even for forced vaccination.

In February 1991, five Philadelphia children died from measles, a disease that was mostly eradicated in the US, due to vaccination. Measles once sickened millions of kids, each year hospitalizing ~50,000 and killing close to 500 before a successful vaccine was developed in 1963. After that, cases dropped dramatically as all states mandated measles shots for school children. Vaccine hesitancy and resistance were rare because people saw the tangible success of the measles vaccine.

But, in Philadelphia that winter of 1991, the serious cases of measles came from a single source, a church cult that rejected “…all means of healing apart from God’s way.” Church members took no medicines, owned no thermometers, and saw no doctors. Rejecting all birth control, they raised large families in close quarters, a recipe for the measles epidemic, which they cooked. Trying to contain the threat to the rest of the city, officials worked through the courts to gain access to the homes of the congregants and received the authority to vaccinate the children against the wishes of their parents. In this public health emergency, defending the parents’ anti-vax actions was close to impossible. Even the ACLU took a pass.

Vaccine mandates even appeared during the Revolutionary War. George Washington mandated that all his troops be immunized against smallpox, even against their will. He described smallpox to Virginia’s Governor Patrick Henry as “more destructive to an Army in a Natural Way, than the Enemy’s Sword.” As I wrote earlier in these pages, smallpox had doomed the Colonial Army’s assault on Quebec in 1775, and it threatened Washington’s main force. Washington’s mandate proved a brilliant gambit and smallpox largely disappeared from the ranks. Some historians point to the mandate as a major factor in winning the war against the Brits.

During that war, smallpox vaccination entailed a primitive vaccination procedure known as variolation. That involved opening a lesion from an infected person and scraping its contents into the arm of a recipient. It was effective, but the vaccinated person became quite ill for a couple of weeks, and about 3% of them died from the pox. Later, in 1796, the English scientist Edward Jenner discovered a much safer method of immunization using cowpox, a virus similar to smallpox that did not cause significant disease in people. But the new smallpox vaccine got a mixed reception in the US as some resisted it for reasons of personal safety based on the variolation experience. They rationalized, “what good could possibly come from polluting the body with dangerous foreign matter?” Or, “Why challenge the plans of the Creator?” Still, Jenner’s vaccine was a clear improvement over variolation and drove a steady decline in smallpox outbreaks throughout the 19th century. States began passing laws mandating smallpox vaccinations for school children, and some forcibly vaccinated prisoners, paupers, and orphans.

In 1905, the issue of vaccine mandates reached the Supreme Court in the seminal case of Jacobson v. Massachusetts. Henning Jacobson, a Lutheran pastor in Cambridge had defied a city ordinance requiring smallpox vaccinations during an outbreak. He refused to pay a $5 fine so he was arrested. Jacobson posited that “healthy and law-abiding” people like himself (even though he was disobeying the law at the time) posed a minimal danger to the community. He argued that even if his refusal to be vaccinated led to him spreading the smallpox virus, the only victims would be others “who failed or refused to be vaccinated.” In other words, he reasoned that it would be ok to not get the vax because the vaxed would be safe, but wholly ignored the rights to safety of those who were not vaxed. 

It is an argument that is repeated today about the CoV-2 vax. Using modern science that was not available in the early 20th century, experts have repeatedly refuted this argument, explaining that many people who want the vax cannot be fully vaccinated because they are immunocompromised, or allergic to the vaccine’s contents, or do not have access to the vaccine. Also, we now know that the more RNA viruses, like the coronavirus, are allowed to spread, the greater the chance more deadly variants can appear. Jacobson’s contention that the decision to vaccinate solely belongs to the individual, not to the state, employers, or to medical authorities remains a central tenant of today's anti-vaxers.

The Supreme Court disagreed with Jacobson. The majority opinion, written by Justice John Marshall Harlan, asserted that “the liberty secured by the Constitution does not import an absolute right in each person to be at all times, and in all circumstances, wholly freed from restraint.” Rather, he argued, the Constitution rests upon “the fundamental principle of the social compact…that all shall be governed by certain laws for the protection, safety, prosperity and happiness of the people, and not for the profit, honor or private interests of any one man, family or class of men.” Jacobson had not only broken the law, the court suggested he also had violated the principle upon which a well-ordered society depends. We are not wholly independent the court ruled. The greater good of the community can trump individual rights.

Using Jacobson as precedent, the Supreme Court in 1922, upheld a local ordinance in San Antonio requiring proof of smallpox vaccination for people entering “public schools or other places of education.”  

Later, during World War II, the US military made vaccines mandatory for a host of diseases, such as typhoid, yellow fever and tetanus, and it still mandates certain vaccines for troops in certain deployments. Soon after the war very successful vaccines were developed against several childhood diseases like polio, measles, mumps and chickenpox. Guided by the Supreme Court’s ruling in Jacobson, all 50 states put laws on the books mandating many of these vaccinations for school children. Even today, many school districts and colleges mandate certain vaccines for students and staff. Hospitals, too, often mandate certain vaccines for their staff. Until lately, vaccine mandates have not generated much angst and anger.

Why is this? Perhaps vaccines have done their job too well: Many of them have erased the tragic evidence of why they were needed in the first place. The world no longer deals with small pox, thanks to the vaccine. Almost no one in this country has seen someone ravaged by polio, or a child hospitalized with measles, or who lost his hearing due to chicken pox, all thanks to vaccines. Yet, now with COVID-19, anti-vaccine anxieties have found their way into the political mainstream, especially among conservatives. An estimated 80 million American adults remain unvaccinated against COVID and represent potential factories for producing the next deadly coronavirus variant, which is very preventable.

As I have addressed before in these pages, many factors fuel resistance to the life-saving shots, including doubts about their quick development and their possible long-term effects. But a growing distrust of professional expertise, including medical science, has also played a role, which is unwarranted. Who are you going to believe, a medical scientist like me with nothing to gain in the debate (except the safety of my friends, family, and self), or someone who read a web post from folks who are selling nostrums they claim will protect you, like Dr. Steve Hotze, or from one of America’s Frontline Doctors whose web site claimed that gynecological problems were caused by having sex with demons? Do you jump on the side of those who tout that their individual freedoms have been abridged, but who do not consider the freedoms from disease of the greater community, and whom the courts already have decided against?

Almost 300 years ago, Benjamin Franklin struggled over whether to have his sons variolated against smallpox. In his “Autobiography,” he worried that well-meaning people were tragically misjudging the calculus between the risks and benefits of the procedure, as he had once done, with a tragic result. He wrote, “In 1736, I lost one of my sons, a fine boy of four years old, by the smallpox….I long regretted bitterly and still regret that I had not given it to him by inoculation. This I mention for the sake of the parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.”

HIV And Coronaviruses: A Bad Combo

Africa is the continent least vaccinated for COVID-19 and it also has been where several CoV-2 variants have arisen: Beta in South Africa, most recently C.1.2 (not yet given a Greek letter designation) also from South Africa, and Eta in Nigeria. A possible reason for the appearance of these variants is because Africa is also home to the most immunocompromised people. HIV is common in Africa and tuberculosis is rampant on the continent.

One HIV-positive woman in South Africa was reported to carry active CoV-2 infection for 216 days, during which time it mutated 30 times according to Tulio de Oliveira, who runs gene-sequencing centers at two South African universities. This is concerning since South Africa has the world’s largest HIV epidemic. It is estimated to have 8.2 million people infected with HIV. While most of these take antiretroviral drugs, which keep the virus at bay, many do not. And neighboring countries, Botswana, Zimbabwe, and Eswatini also have very high HIV infection rates. The burden of HIV, TB and other chronic diseases is higher in these countries than in other countries around the world due to extreme poverty and poor health care for millions of Africans. When these people also become infected with CoV-2, they grow and shed the virus longer than someone with a good immune system and good health care. That means that the virus has longer to mutate in an infected, immunocompromised person.

In wealthier countries in the West, a rich debate is ongoing about whether to add another shot (booster) to already vaccinated people. One of the biggest arguments against this is that those booster vaccines are needed much more in poorer, and woefully under-vaccinated countries, such as those in Africa. The concern is that our boosters come at the expense of basic immunization of these impoverished countries, which facilitates the generation of troublesome viral variants. On the other hand, if CoV-2 is running rampant because the health care infrastructure in these countries is not up to delivering those vaccines, maybe it would be better making sure that richer countries are as protected as possible.

These are the proverbial two horns of a dilemma. Which horn would you choose?

Anti-vaxers, Get Over Yourselves--The Vaccine Is Not All About You

As predicted, viral variants are now causing most of the new cases of COVID-19 disease around the world. The Delta variant, formerly known as the “double mutant,” which first arose in India and as earlier discussed in these pages, is extremely transmissible and seems to cause more severe illness. It arose in India because the country was way under-vaccinated and, therefore, a prime incubator for producing more lethal viral variants. As the virus replicates in a person’s cells, then spreads to another person, it accumulates small mutations that, by chance, can make a significant difference in its virulence. The virus replicated over and over and over in unvaccinated India and a more potent strain evolved. It is a matter of time before an even more potent virus emerges that resists the current vaccines, thanks to people who refuse to be vaccinated. That refusal potentially affects all of us, not just the vaccine recipient.

It is one thing to not be vaccinated because of vaccine supply and delivery problems. India, and countries in Africa and South America fall into this category. It is another thing to willfully refuse to be vaccinated when the vax is readily available. The latter is just wrong and inexcusable. There is no rational reason to not be vaccinated!

Anti-vaxers cite a litany of false claims about how the vaccine might be dangerous for them (the evidence refutes that). They say it is experimental (it has been well proven and uses technologies that are decades old!), or that it is not FDA approved (it is!), or that it is ‘gene therapy’ (it is NOT!), or that people have died or become sterile from it (flat wrong!). Anti-vaxers also complain that we do not know the long term effects of the vax (name ONE vax that had long term effects!). After millions have been infected with the virus or have been vaccinated, the evidence clearly shows that the worst thing that can happen to someone is to be infected with the virus, and that the safest thing is to get the shot. Follow the science, not your emotions.

Note that the objections to the vaccine are all self-focused. No thought is given to the reality that if an unvaccinated person is infected and does not practice caution, he will be responsible for spreading the virus to his family, friends and strangers. And, he might very well be the source of the next, more deadly variant. As I wrote earlier, a great example of how vaccines protect others is the Japanese experience with flu vaccines. After Japan mandated that school kids be vaccinated against the flu, elderly flu deaths plummeted. The vaccine clearly did not just benefit the kids, it benefited others with whom they had contact. The same holds true with the coronavirus vaccine.

Unvaccinated people in India led to the emergence of the Delta virus variant that has overwhelmed health care systems in India. Even younger, healthier people are getting sick. Delta is now spreading in unvaccinated people in at least 62 countries, including the US where it now accounts for 20 percent of new cases, up from just 2 percent a couple of weeks ago. You do not have to be a scientist to see where that trend is leading.

Delta also is now the dominant strain in the UK accounting for three quarters of new cases there. It has forced a four-week pause in the UK’s reopening plans. The variant could also affect reopening in the US as well, thanks to the anti-vaxers.

The good news is that people who are fully vaccinated are well-protected against the Delta and other variants—so far. Again, it is just a matter of time that a vaccine-resistant variant emerges. Again, there is no rational reason to not be vaccinated, but there are billions of reasons to get vaccinated. It is not all about you, but also about your fellow humans on the planet. Get the shot!

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The Origin Of The Virus, Redux: Did It Really Come From The Wuhan Lab?

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Back story: In May 2020, I posted here on the origin of the SARS-CoV-2 virus that causes COVID-19. I wrote how many scientists who examined the genome sequence of the novel virus concluded in a letter to Nature in March, that “…the genetic data irrefutably shows that [CoV-2] is not derived from any previously used virus backbone.” That means that in its genetic sequence, there is zero evidence it was engineered in a lab.

On the other hand, I also mentioned, that a 2018 report by several diplomats who visited the Wuhan Institute for Virology (WIV) months before the pandemic broke concluded that the lab’s security and safety measures were lax. If true, it means that an accidental leak from the lab is plausible. However, note that these were not scientists, but diplomats. Later, James Le Duc, PhD and head of the Galveston National Laboratory, which is the biggest biocontainment facility on a US academic campus, also visited the lab and stated that it had safety and quality measures comparable to the best Western labs. Other Western scientists who have visited WIV also highly rated the facility and concluded that an accidental release was “implausible.” And in February, 2020, 27 scientists published a letter in The Lancet that roundly rejected the lab-leak hypothesis. One of the major responsibilities of the lab is to isolate novel coronaviruses from bats from all corners of China, sequence their genomes, and post the sequences into a repository that is freely available to researchers around the world. This was partly paid for with a modest sub-grant from the NIH. The genome sequence of the SARS-CoV-2 virus does not match the sequence of any coronavirus posted in the repository suggesting, but not proving, that they never worked on it.

I also reported last September that in December 2019, the world first became aware of a mysterious respiratory illness that popped up in November of 2019 in Wuhan, China. Wuhan is home to both a wet animal market and the WIV. Soon after detecting the unusual disease, Chinese scientists reported that it was caused by a previously unknown coronavirus. Suspicion immediately was placed on an animal in the wet market as the source of the outbreak, since the SARS-CoV-1 virus had been traced to an animal in a wet market. Later, the MERS coronavirus was also traced to animals, in this case camels, that passed the virus to humans. Indeed, the CoV-2 virus was found in the wet market, but it remains unknown how it got there and the animal host that is postulated to have transferred the new CoV-2 virus to humans has not been found. Without a “smoking bat,” the source of the CoV-2 virus that causes COVID-19 remains elusive. That lack of certitude regarding the source of the virus led some to speculate that it came from the WIV, either by design or by incompetence. That hypothesis was downplayed by a WHO expert team that spent a month in Wuhan investigating the source of the outbreak. They reported that it was much more likely that the virus had an animal origin. But, that report was woefully incomplete due to Chinese stonewalling.

The first confirmed cases of COVID-19 appeared in Wuhan in December 2019. But, last February, I reported that in October 2019, weeks before the Wuhan disease was reported, several clusters totaling 90 people with a COVID-like respiratory disease were hospitalized in different parts of China, miles from Wuhan. I also commented that shortly after the Wuhan disease was recognized, the UCLA medical center reported an unusual 50% increase in respiratory illness. Finally, there is the Italian child who was treated for respiratory and gastrointestinal problems, also before the disease was first reported. Recent analysis of samples that were saved from the kid showed he was infected with CoV-2. How did he catch the virus half a world away and before it was recognized in Wuhan?

Fast forward a few months to now, and we find people increasingly exercised over the possibility that the virus came from the WIV—and they do so with the slimmest of evidence, but with an abundance of conjecture.

Why the new focus on the idea that the virus came from the lab? The theory that the virus came from a Wuhan lab began to gain traction amid criticism of the international WHO probe into the virus’ origin earlier this Spring that concluded the virus likely came from nature. That probe was admittedly inadequate due to the Chinese government’s lack of cooperation. They denied the team full access to necessary lab data that might prove or disprove that the virus came from the lab. That lack of transparency added fuel to the conspiratorial fires that Trump and others have been spreading about the virus originating in the WIV. On top of that, a recently released US intelligence report claimed that three researchers in the lab became ill and sought hospitalization in November 2019, just weeks before the disease and virus were identified, and about the time that the Italian child became ill. Beijing denied that report. The information in the report came from an unnamed “international partner,” and remains uncorroborated. The report also stated that the lab workers had “…symptoms consistent with either Covid-19 or common seasonal illness (emphasis mine).” Marion Koopmans, a Dutch virologist on the WHO team that investigated the WIV told NBC News in March that she attributed the illnesses to regular seasonal sickness. Unlike the Italian child, these lab workers were never diagnosed with or without COVID-19. It is not even known if they were exposed to any coronavirus or even got ill from the lab—remember, others in Wuhan and elsewhere around China, and even in Italy and California, also were coming down with similar symptoms at the same time. The head of the WIV also claimed that all staff had tested negative for Covid-19 antibodies and that there had been no turnover of staff on the coronavirus team, suggesting no hospitalizations. It would be very helpful if the Chinese government released records to substantiate these claims.

If we are going to focus on the Wuhan lab illnesses as almost being a smoking gun, on what basis do we ignore these similar, and in the case of the Italian child, confirmed, far-flung cases? All this is makes it far from convincing that we know where the virus came from, and even casts reasonable doubt that it originated in Wuhan, let alone in the WIV.

Then, there is this: Twenty-seven of the first 41 COVID-19 patients identified in Wuhan had contact with the wet market in Wuhan, where China’s CDC found traces of the novel virus, and none of these 41 cases were clearly linked to the WIV—according to the Chinese government.

Adding fuel to the lab-origin-of-the-virus fire is a recent Fox News interview by Tucker Carlson with an exiled Chinese scientist who did some work with animal coronaviruses as a post-doctoral fellow at the University of Hong Kong. The scientist, Dr. Li-Meng Yang, claimed in the interview that she could present solid scientific evidence that the virus is not from nature, but man-made in a lab. She also claimed that she was among the first scientists to study the coronavirus outbreak in Wuhan. But the University of Hong Kong said in a July statement that Yang never conducted any research on human-to-human transmission of the novel coronavirus at HKU. More recently, Yang co-published an article that suggests there was "sophisticated laboratory modification" of the coronavirus. The study was uploaded Sept. 14 to a website called Zenodo, an open-source repository of research that is not peer-reviewed.

The research behind that article was backed by the Rule of Law Society and the Rule of Law Foundation, sister nonprofit organizations that are connected to Steve Bannon, a former chief strategist for the Trump administration, and Guo Wengui, a billionaire political activist who fled China in 2014 to avoid corruption charges. Neither organization has published scientific reports before. Also, a website linked to Bannon and Wengui has a history of making inaccurate claims about the coronavirus pandemic. Yang’s charade eventually collapsed as her utter lack of expertise was exposed.

Finally, scientists worldwide have publicly shared the genetic makeup of the coronavirus and its variants thousands of times. If the virus had been altered, there would be evidence in its genome data. Experts in viral genome evolution determined that such evidence is lacking. It almost certainly was not engineered because it has several naturally occurring features and is closely related to a 2014 coronavirus that came from a bat in a cave in China that was collected and sequenced by the WIV and reported in its database. In March, several microbiology, infectious disease and evolutionary biology experts wrote in the journal Nature that the genetic makeup of the coronavirus does not indicate it was altered. 

Bottom line: At this point, there is zero compelling evidence that the virus came from the lab. The so-called evidence that the lab was the source of the virus has, so far, been either circumstantial or debunked. Admittedly, it remains possible that the virus did come from the lab, but that remains an hypothesis, not proven fact. China bears responsibility for obstructing investigators. Whether it did so out of sheer authoritarian habit or because it had a lab leak to hide is, and may always be, unknown.

China’s lack of transparency in all this does not constitute solid evidence that the virus came from the lab. Evolutionary biologist, Dr. Joel Wertheim, cautions that we should not default to conspiracy theories when we do not have immediate answers to important question. He reminds us that it took scientists decades of research to find the chimpanzee population that passed the HIV virus to humans, causing the AIDS pandemic. During that time, some cranks posited, with no evidence, only fervor, that the US government created it. It is a maxim of science that extraordinary claims require extraordinary evidence. The extraordinary claims made by some regarding the WIV origin of the virus have not been supported by any, let alone extraordinary evidence.

We will see. Maybe….

Why It Is Necessary To Vaccinate Kids

Vaccine makers are applying to the FDA for approval to give the COVID-19 vaccines to children. Some people have questioned the need for this since kids seldom get sick, let alone die from COVID-19. But, there is a very good reason to vaccinate them, which is to protect them, as well as the rest of us from the emerging new viral variants that are more infectious and more potent and that I discussed earlier.

Vaccines do two things; 1) they protect the vaccinated from the disease, and 2) they prevent the further spread of the pathogen and disease. A good example of the latter point is Japan and flu vaccines. A number of years ago, Japan mandated that all school kids be vaccinated against the flu. A major result was a sharp drop in flu deaths in the elderly. Kids are walking incubators for respiratory viruses and carry them home for their families to enjoy. Thus, Japan's flu vaccination program meant that fewer kids were catching the flu and carrying it home to infect their parents and grandparents. Hence, flu mortality dropped.

That is why we need to vaccinate kids against CoV-2 even though they seldom get seriously ill from it. Related to that point is the fact that the more CoV-2 spreads, the greater the chance that the virus will mutate into variants that are increasingly infectious, more deadly, and that can evade the immune response to the current vaccines. If that happened, we would be starting all over again. Hundreds of thousands, if not millions around the world would die, countless more would suffer long term consequences from COVID-19, and the disease could very well become more serious in young people. We already are seeing increases in infections and hospitalizations in younger, healthier people from the viral variants that already have arisen in the UK, South Africa, Brazil, and India.

We need to vaccinate kids in order to slow as much as possible transmission of this virus in order to minimize the development of potentially more deadly variants.

Some People Worry About The Vaccines Because They Were Developed So Quickly

A poll published by Gallup in early August found that 35% of surveyed Americans would decline a Covid-19 shot offered to them at no cost. I have seen other studies that say 50% of Americans will not get the vaccine. And on social media sites I have seen discussion and comments about why folks are so reticent to get the vaccine. Let me address the concerns.

1) Problem: People will not take a vaccine pushed out by Trump. Nancy Pelosi and Chuck Schumer are the more prominent members of this cadre. Answer: Well, Trump has had nothing to do with the vaccine development. The two leading vaccines now available are based on RNA vaccine technology that is a decade old. In other words, the technology was being developed way before Trump had presidential aspirations. Also, the Pfizer vaccine was developed in the UK using technology from a German biotech company and was developed without any US dollars. Trump did set up Operation Warp Speed to produce and disseminate a vaccine quickly, but the Pfizer vaccine’s share of that initiative is only a four star Army general, Gus Parna, who is overseeing the enormous logistics of getting a few hundred million people vaccinated. Trump’s fingerprint on all that is negligible.

2) Problem: The vaccine was rolled out too fast for comfort. Answer: As I wrote above, the RNA vaccines are based on technology platforms that are at least a decade old. All the companies needed to do was take a short CoV-2 genome sequence and add it to that well developed platform then test it. With a raging pandemic, the vax testing went quickly—when several thousands of people get infected every day, the results of a test vaccine come quickly. Similar vaccines were being developed for the earlier coronaviruses, SARS and MERS, but both of those pandemics fizzled out before enough data about the vaccines could be collected. Those platforms were repurposed to accommodate the SARS-CoV-2  virus. During the several months of testing, tens of thousands of people were given the vaccines and adequate efficacy and safety data were rapidly gathered. Since the vaccines were approved, a few million people around the world have been vaccinated and that larger sample simply confirms the data from the clinical trials. The vaccines are safe and effective.

Keep in mind, every year we roll out new flu vaccines in just a few months and they are safe. This vaccine has been adequately tested.

3) Problem: The RNA vaccines can alter your cellular DNA. Answer: Total bull scat. There is no way that the short stretch of the virus’ RNA genome that is used in the two leading vaccines can interfere with cell DNA. That is biologically impossible. Having said that, let me elaborate. There is a family of RNA viruses, called lentivirus, that can mess with your DNA. The lentivirus family includes HIV, human T cell leukemia virus, and several animal viruses that cause cancer. However, the unique thing about lentiviruses is that their genome carries a gene that encodes the enzyme, reverse transcriptase, which copies RNA into DNA allowing it to insert randomly into cellular genomes. Two of my science mentors and friends, David Baltimore and Howard Temin, shared the Nobel Prize for discovering reverse transcriptase. Most RNA viruses, like flu and coronaviruses do not express reverse transcriptase, so they do not affect cellular genomes. It is biologically impossible for the Pfizer and Moderna vaccines to alter your cells’ DNA.

4) Problem: The vaccines will infect you with the virus. Answer: Balderdash! The RNA vaccines are not produced using any living microorganism. A short stretch of DNA is tethered to insoluble beads and used to produce copies of a short RNA sequence that will produce the viral spike protein. The insoluble DNA templates are easily separated from the RNA that remains in solution, and the RNA is then encapsulated in lipid nanoparticles. That is what is injected. After injection, the lipid nanoparticles fuse with lipid cell membranes to empty the encapsulated RNA into the cells. Then normal cell machinery takes over producing the spike protein, which generates an immune response and immune memory that protects you from subsequent infection. The vaccine RNA is gone in about two days.

5) Problem: We need several years of data to be assured of the safety of the vaccine. And we do not know how the vaccine will interact with other drugs many people take. Answer: Wrong. Vaccines are not drugs and do not interact with drugs you might take. And since vaccines are just one or two shots, and not taken chronically like drugs, long term problems are not a concern. I challenge any naysayer to name one long term health problem caused by vaccines.

6) Problem: Vaccines cause allergic reactions. Answer: Some do, but that risk is nothing compared to the risk of serious consequences of getting the disease that the vaccine prevents. The FDA and other regulatory agencies weigh these risk factors and the vaccines that are approved come out way on top. Such reactions can occur with any vaccine, but are extremely rare—about one per 1 million doses.

There have been very few allergic problems with the CoV-2 vaccines and that problem has been linked to polyethylene glycol (PEG), a component of the lipid nanoparticles that carry the RNA sequence. PEGs are also used in everyday products such as toothpaste and shampoo as thickeners, solvents, softeners, and moisture carriers, and they have been used as a laxative for decades. So, most of us have been exposed to PEGs, but very few of has have a problem with them.

Endnote: As published in these pages in late October, there are several examples of vaccine production errors that led to tragic consequences. In 1955, the Salk polio vaccine was rushed into production just hours after it was approved. This was an inactivated virus, which means that live virus was grown, then killed, then injected. Some lots from one of the manufacturers, Cutter Laboratories, were not fully inactivated and some patients received injections of live virus leading to tragic results. Similar production errors have led to people being infected with live measles virus, and respiratory syncytial virus. In 1976, an H1N1 flu that was similar to the 1918 Spanish flu reached pandemic stage and we rushed out a vaccine that was associated with a spike in the very rare Guillaume Barre disease (GBD), which is a type of paralysis. It is thought that the rushed vaccine somehow caused the small, but significant spike in the disease in fewer than 500 patients across the country. It is not known how the vaccine was related to GBD.

Note: your humble blogger was a college student and working in a hospital physical therapy department at the time, and worked with two GBD patients.

Those problems using inactivated virus vaccines are very rare and have not arisen in over 40 years. Since the CoV-2 RNA vaccines do not use any live microorganisms, this will not be a problem with the vaccines.

I will willingly get mine as soon as it is offered. How about you?

Don’t Vaccinate Health Workers First

The following is an excerpt of an opinion piece written by Joel Zivot, MD and published December 10 in MedPageToday. Zivot is an ICU doctor and Assistant Professor of Anesthesiology/Critical Care at Emory University School of Medicine.

We are on the verge of a COVID-19 vaccine rollout and the current reality is that the on-hand supply will fall short. Healthcare workers have been put in the CDC's very first priority group, along with nursing home residents. I am puzzled by this. The question is, what is the expected result with this first wave of vaccinations?

From the public perspective, one can imagine the desired result would be to reduce morbidity and mortality as fast as possible...

When one considers the plan to start with vaccinating healthcare workers, the reality is the death rate will likely not slow in any appreciable way. This first wave of vaccinations is actually not configured to have a substantial impact on the current COVID-19 mortality rate….

The best way to reduce mortality is to staunch the flood of hospital admissions. If the hospital had fewer COVID admissions, this would accomplish two things. First, it would ease the burden on the healthcare workers. I speak from experience as an ICU doctor working this from the beginning. So much of what we do is COVID and we have had to expand services in a way that has stretched us very thin…

Second, if we target the high-risk group for serious COVID-19 morbidity and mortality, we will begin to also reduce morbidity and mortality overall...

The idea behind vaccinating healthcare workers is to avoid a crippling level of healthcare worker absenteeism. This sounds reasonable. In my experience, yes, healthcare workers have gotten sick with COVID-19, but on the whole, this group has actually done well in protecting itself and is not the population at the crest of the wave of mortality. Until we target the highest risk groups, we will continue to lose lives to COVID-19…

That's why I respectfully disagree with the CDC that healthcare workers be among the first in line to receive the COVID-19 vaccine.

Recently in the U.K., the National Health Service reconsidered its original plan to vaccinate healthcare workers first, and instead will focus on nursing home residents and staff. It is true that healthcare workers have fallen sick and some have died, yet they make up a very small proportion of patients in ICUs and of deaths.

Vaccinating healthcare workers won't unclog the ICU and thus will not make healthcare workers' jobs any easier…

But what if we started with Medicare and Medicaid recipients, a group that covers the populations at highest risk: the elderly, the disabled and the poor? The vaccine program could be administered by family doctors who can reach out directly to their Medicare/Medicaid patients and ask them to come in to the office or the clinic...

The hospital is clogged with patients and empty of families. This combination is eroding the resolve of the healthcare worker. When the hospital begins to unclog as we target the real priority populations -- those at highest risk of otherwise becoming hospital patients -- the clog will give way and the families will return. When this happens, ICUs will return to something closer to normal for healthcare workers -- to the benefit of all.