A Third Vaccine Also Shows Success!

Two RNA vaccines developed and produced by Pfizer/BioNTech and Moderna/NIH have already reported highly significant protection against SARS-CoV-2 with negligible side effects. The Pfizer vaccine has been submitted to the FDA for approval, which should be quickly forthcoming. Moderna will soon submit its vaccine for FDA approval.

Now, a third and different type of two-shot vaccine developed by the UK’s AstraZeneca and the University of Oxford also reports 90% efficacy. It also showed minimal adverse effects that are expected from the immune reaction to any vaccine. Unlike the RNA vaccines, this one is a crippled adenovirus engineered to express the CoV-2 spike protein and offers some advantages over the RNA vaccines. First, it can be produced and marketed at a fraction of the cost of the RNA vaccines. Second, it only needs refrigeration storage, not a freezer like the Moderna vaccine, and not an ultracold freezer like the Pfizer vaccine requires. These advantages mean that this vaccine will be more readily available for third-world countries that do not have freezer storage capability. Also, AstraZeneca plans to produce its vaccine in multiple countries, from India to Brazil to Japan and to Australia, and beyond which will facilitate its international distribution.  

Getting a vaccine out to the several billion people around the world is a daunting challenge. Having multiple vaccines produced in various sites around the world should facilitate the distribution to all countries. A global program called Covax has an ambitious effort to deploy vaccines around the world, getting dozens of countries to join and securing deals for 700 million doses so far. AstraZeneca has agreed to supply the initiative, while a collaboration including the Serum Institute of India agreed to accelerate the production of the AstraZeneca or, soon to come, Novavax shots for low- and middle-income nations, priced at only $3 per dose. Another Covax pact with pharma companies Sanofi and GlaxoSmithKline Plc, which are developing their own vaccines, followed last month. The program, led by the World Health Organization, the Coalition for Epidemic Preparedness Innovations, and Gavi, the Vaccine Alliance, expects more deals in the coming weeks. Pfizer/BioNTech, along with Moderna/NIH, are also in talks with Covax.

AstraZeneca/Oxford has easily been the most active company in reaching supply accords around the world. It has assembled an unprecedented global network of manufacturing and distribution partners, and has promised to provide 3.2 billion doses of its vax. More than 50 lower- and middle-income countries in regions including Latin America, Africa, the Middle East, Asia and Eastern Europe would receive AstraZeneca/Oxford’s shot, which will be provided at cost during the current pandemic. The company is poised to be the dominant vaccine supplier to the developing world and it is forgoing any profit to do so.

Trial results for other vaccines produced by Novavax Inc. and Johnson and Johnson are expected soon. The Milken Institute tracks a total of 199 vaccines in development around the world. That means we can soon expect results from 194 more vaccines.

A final note: Some folks with a conspiratorial mindset have pointed out that these positive vaccine results presented just after the November 3rd US election is evidence that the election was rigged. They assume that the vaccine results were delayed in order to prevent giving Trump a bump. But, these folks have to explain why and how German and British pharma and biotech companies, and universities, which had no input from the US, were involved in that conspiracy.

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Refusing To Treat COVID Patients Based On “Quality Of Life” Determinations

FYI: While your humble blogger earned a PhD in viral immunology from the University of Texas, and spent most of his career investigating the causes and cures of leukemia at UCLA and the University of Wisconsin, he also was trained in ethics at Indiana University, the University of Montana, and Calvin College. He taught bioethics and research ethics at the U of W. His closet hooks are full of different hats.

Biomedicine is rife with ethical conundrums, a few of which already have been mentioned in these pages about the coronavirus pandemic, to wit: Should we wave inspection of vaccine manufacturing facilities and risk production mistakes in order to speed release of a CoV-2 vaccine, which will save lives? Or, whose rights do we ignore during a pandemic—the freedom to live as we choose vs the freedom to remain free of infection? Or, do we abandon all social restrictions in attempt to achieve herd immunity via natural infection, realizing that we would be sacrificing many to the disease? All, conundrums, indeed.

Ethical dilemmas entail at least two conflicting choices, neither of which is perfectly good nor perfectly bad. That is why these problems are often referred to as “horns of a dilemma.” Which horn should we embrace, and which should we avoid, knowing that both can stick us?

An ethical dilemma has arisen in healthcare circles, but for which the popular press has largely been silent. This issue is about how “quality of life” factors into health care decisions for COVID-19 patients. The following example of how this ethical conundrum can play out is excerpted and modified from the journal, First Things.

A man, Michael, was refused treatment for COVID-19 because the hospital he was admitted to and State bureaucrats believed that he did not enjoy sufficient quality of life to warrant curative treatment for the disease. In 2017, Michael had a heart attack that caused brain damage leaving him a quadriplegic and suffering frequent seizures. But he was conscious, able to do simple math calculations, answer trivia questions, and interact with his family. Then, in late Spring of 2020, he caught COVID-19 and was hospitalized. The hospital decided to withhold his tube feeding despite the objections of his wife, and the fact that he had a fair chance of surviving if provided with appropriate COVID treatment and sustenance care. He died on June 11.

He was denied care because his doctors determined that he did not have a sufficient “quality of life” to justify treatment. Because of his disabilities, saving his life was deemed “futile.” The medical team and the “State,” through a court appointed guardian, reasoned that treatment for COVID-19 would not improve the quality of his life (meaning, he would remain quadriplegic and cognitively disabled if he survived the disease); therefore, they decided to end all treatment care except hospice comfort care.

His wife, Melissa, had been appointed Michael’s temporary guardian, but she was in a legal struggle with Michael’s sister over his custody, a dispute that predated Michael’s hospitalization. Family Eldercare, a nonprofit agency, was then appointed interim guardian until a final decision could be made about permanent guardianship. Hospital doctors convinced Family Eldercare to approve Michael’s transfer to hospice care where he would only receive palliative care and not curative or sustenance care. Michael died of pneumonia after six days on hospice; the withdrawal of nutrition and hydration having no doubt weakened his body’s ability to fight disease. Even without pneumonia, Michael would have soon died of dehydration.

Melissa recorded her conversation with an unnamed physician and posted it on YouTube so we can all hear for ourselves.  Here’s the substance of the conversation from the YouTube transcript, with my commentary.

Doctor: At this point, the decision is, do we want to be extremely aggressive with his care or do we feel like this will be futile? And the big question of futility is one that we always question. The issue is: Will this help him improve the quality of life, will this help him improve anything, will it ultimately change the outcome? And the thought is the answer is no to all of those.

Melissa: What would make you say no to all of those?

Doctor: As of right now the quality of life, he doesn’t have much of one.

Melissa: What do you mean? Because he was paralyzed with a brain injury, he doesn’t have a quality of life?

Doctor: Correct

My Comment: The doctor did not base his decision about Michal’s medical care on the illness for which he was hospitalized, but on his unrelated disability. This is a classic example of applying the invidious “quality of life” ethic, which deems people with disabilities, the elderly, the chronically ill, and the dying to have a lower worth than the healthy, able-bodied, and young. Back to the conversation…

Melissa: Who gets to make that decision whether somebody’s quality of life, if they have a disability that their quality of life is not good?

Doctor: Well, it’s definitely not me. I don’t make that decision. However, will it affect his quality, will it improve his quality of life, and the answer is no.

My Comment: After denying that he had any part in determining Michael’s quality of life, the Doctor then admits that he believes that Michael’s quality of life is negligible. By doing so, he is being duplicitous regarding his role in the decision, and he is not acting as Michael’s doctor, beholden to the Hippocratic Oath he took. Rather, he is acting as an agent for the hospital and State bureaucracies rather than acting in Michael’s interest, a dramatic violation of the Oath he took. Back to the conversation…

Melissa: Why wouldn’t it? Being able to live isn’t improving the quality of life?

Doctor: There’s no improvement with being intubated, with a bunch of lines and tubes in your body and being on a ventilator for more than two weeks. Each of our people here have COVID and they are in respiratory failure. They’ve been here for more than two weeks.

Comment: The Doctor again makes a statement of his opinion of Michael’s quality of life. He admits that many of their OOVID patients are in respiratory failure and on ventilators, but implies that they are more valuable than Michael and deserve such therapy, while Michael does not.

 Melissa: So the fact that you are killing someone doesn’t make sense in your mind?

Doctor: We don’t think it’s killing. Because I don’t know when or not if he will die. But at this point I don’t think it would be humane or compassionate to put a breathing tube in this man and do the lines and the tubes and all that stuff because I don’t think it will benefit him.

Melissa: And I totally agree with you on the intubation part of it. I don’t want him intubated. But I also don’t think you should just sit him somewhere to be comfortable until he finally just drifts away. That to me is futile too. That’s saying you’re not trying to save someone’s life. You’re just watching them go. The ship is sailing. I mean that just doesn’t make any sense to me to not try. I don’t get that part. I don’t like that part.

Doctor: But what I’m going to tell you is that this is the decision between the medical community and the State.

Melissa: And the State. Forget about his wife and his family and his five kids.

Doctor: I have nothing to do with that.

The recording ends there. 

At first blush, it might seem like a reasonable decision to withhold essential care from someone as damaged as Michael was, but what if we change the selection criteria from “quality of life” to “preciousness of life?” Wasn’t his life as precious as everybody else’s, especially to his family? It was not, according to Michael's doctors and faceless bureaucrats in his State who had never met him, all of whom believed that they could better judge Michael’s worth better than his family could. And, what about Michael’s wishes? The article did not indicate whether, after his hospitalization, he was able to express his desires in the matter, but I will assume he was incapable of doing so. In which case, the medical ethicist must look at Michael’s family as well as his life near the time he was hospitalized. Before catching COVID-19, were his actions consistent with someone who wanted to live, even with his disabilities? Even if a hospitalized patient cannot communicate, it is still possible to divine his wishes from the period before he became, possibly temporarily, non-communicative due to the disease. That divination is more relevant than faceless bureaucrats when making life and death decisions for him.

This is the great ethical problem of quality of life decisions being made by impersonal, anonymous administrators who can overrule the wishes of a patient’s immediate family and even the demonstrated wishes of the patient. The bottom line is to make sure you have your final wishes legally documented and use power of attorney to put your fate in the hands of highly trusted family or friends.

Even then, you still might encounter faceless bureaucrats making life and death decisions for you based on how they judge the quality of your life.

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SARS-CoV-2 vs Hepatitis C: SpaceX vs NASA: New vs Old

What does hepatitis C have to do with the coronavirus subject of this blog? More to the point, why in the world bring up SpaceX and NASA in a blog on the coronavirus? Let me make a couple of seemingly disparate points and then try to tie them together.

First point: American scientists Harvey J. Alter and Charles M. Rice, and British scientist Michael Houghton were just awarded the Nobel Prize for Medicine or Physiology for the discovery of the hepatitis C virus (HCV). Their work led to new diagnostic and treatment developments for HCV that have saved millions of lives. That research took almost four decades.


Second point: Let’s compare the NASA space shuttle to the SpaceX rocket that just took astronauts to the International Space Station.

  • Flight control:
    • Shuttle--human drivers
    • SpaceX--totally autonomous. Humans not needed at all.
  • Reusability:
    • Shuttle--only the shuttle was reusable. The launch vehicle was not.
    • SpaceX--totally reusable.
  • Cost to launch each human passenger:
    • Shuttle--$170 million
    • SpaceX--$60-70 million
  • Cost per kilogram of cargo:
    • Shuttle--$54,500
    • SpaceX--$2,720
  • Development cost:
    • Shuttle--$27.4 billion
    • SpaceX--$1.7 billion

Bringing it all together: The science around the CoV-2 virus and SpaceX represent the new science world that contrasts to the old science world of hepatitis C and NASA, respectively. Make no mistake; the old science was very successful; it led to the Nobel Prize for discovering HCV, and to putting men on the moon and the Hubble space telescope. Those old science accomplishments took decades to achieve and cost billions of dollars. The second point above, comparing SpaceX to NASA, points out how far technology has come in a few years regarding space flight. Just a few weeks ago, many of us saw a SpaceX rocket launch astronauts to the space station. Rather than just letting the rocket that propelled the astronauts’ craft to burn up, it was designed to reenter the atmosphere and land upright in the middle of a bulls-eye, on a small barge just off the coast of Ireland. The great increase in technical capability, along with the great decrease in cost of developing SpaceX is a great testimony to our modern science and technology.

Similarly, new bioscience technology that has led to the rapid identification and treatment of the virus that causes COVID-19 represents our modern “BioX” vs the old standard of molecular biology. The “old biology” (it greatly pains me to describe it that way) was highly successful. It illuminated great things about our microscopic world that have been critical in learning how to deal with our macroscopic world. But the old molecular biology is the “biological NASA” that is being usurped by “BioX.”

Consider the great and significant accomplishments of the three scientists who just won the Nobel Prize for discovering HCV. Decades ago, we knew that two types of viruses caused hepatitis in people exposed to bodily fluids of infected people. The viruses were designated hepatitis viruses A and B. Yet, when blood products destined for patients were screened for both of these viruses, people still contracted hepatitis. It was then well accepted that there was yet another blood-borne pathogen that caused non-A, non-B type hepatitis. And the search for the bug was on.

It took a couple of decades to identify the suspected pathogen as a virus. That happened at the end of 1989. Because of the virus’s peculiarities, we still have not been able to develop a vaccine for it, but a drug cure was approved in 2014. That cure took fifteen years to develop and that was on top of the 20 or so years it took to identify the virus; almost four decades in total.

Compare how long it took to identify the pathogen and develop a treatment for HCV to today’s situation with the novel CoV-2 virus. According to a timeline I posted earlier, in Dec/Jan an unusual flu was discovered in China’s 10th largest city, Wuhan. In just a couple of weeks the virus was isolated and just a few weeks later, we knew its genome sequence. In February, the Chinese began developing the first vaccines. According to the Milken Institute tracker, today 315 treatments for COVID-19 are in development around the world. 199 vaccines also are being developed, 11 of which are in late stage trials and we should have more than one vaccine available in the next 2-5 months. All of this has happened in about a year after the virus was first suspected to exist! That is bioscience working at the speed-of-light, and that is only possible because of what we learned in the “dark ages” of molecular biology.

The age of BioX has turned your humble blogger into a dinosaur.

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An Invitation To Those Who Refuse To Wear Masks

I have been seeing a LOT of resistance to using face masks during this pandemic, mostly from libertarian or anti-authority types who "don't like to be told what to do." For these people I have a question: do you also believe no one should tell people not to  steal your wallet, or drive drunk? After all, preventing people from hurting others is one of the common features of our laws. Masks protect people from others just like drunk driving laws do.

On other forums, and in this blog here and here, I have presented scientific evidence that masks are effective in retarding the spread of infectious diseases, but these nouveau "experts" keep arguing and ignoring the evidence.

So, I have an invitation for those who think masks are ineffective and say that they will never wear one.

Next time you have surgery, tell your surgeon that you don't believe in face masks and insist that he not wear one during the operation.

Tell him that, even though your insides might be open, you are not worried about the spray from his mouth when he utters spray-worthy things like, "scalPel, Please," "sucTion  Please," and "reTracTion Please."

At this point, I am reminded of the Seinfeld episode when Kramer et al., were in a surgical theater overlooking an operation. Kramer brought in a box of Junior Mints like he was just watching a movie, and while leaning over the rail to watch the operation, he popped the candy in his mouth. Just before the surgeons were getting ready to close, he was putting a mint in his mouth, but it dropped into the body cavity of the patient. That would have been prevented if he had been wearing a mask.


Using And Re-Using N95 Face Masks

In these pages, I previously talked about the basics of face masks, and how their wide spread use might have the same, if temporary, effect of attaining herd immunity. Keep in mind that your typical cloth mask or bandana mostly protects others from oral spray from an infected wearer. They are not very effective at protecting the wearer since most of the inhaled air comes in from the edges and is not well filtered by the mask. In order to protect yourself from airborne virus, you need to wear an N95 respirator mask that is fitted to your face. Early on, the masks were hard to find, but, lately I have seen long shelves of them at hardware stores.

Peter Tsai is the Taiwanese/American who invented the synthetic fabric that make N95 masks effective at filtering 95% of particles in the air. Tsai made the fabric using an electrostatic charging method. Put simply, the mask's filter contains both positive and negative charges. Neutral particles, like bacteria and viruses, gain a charge when they contact the fabric, trapping them before they can pass through the mask.

Tsai was retired for two years when the pandemic struck. Because of the early shortage of N95 masks, he heard that healthcare workers were reusing them, so he went back to work at the University of Tennessee, Knoxville’s Research Foundation to research the best way to sterilize the masks for re-use. He tested a variety of methods: He left the masks out in the sun, put them in the oven, washed them with soap and steamed them. The best method, he found, was keeping the masks in 160-degree dry heat for 30 minutes, which can be done by hanging them in an oven.

But that's not his preferred method. Tsai recommends buying seven N95 masks and rotating them, using a new one each day. After using one mask, he hangs it in an isolated spot and doesn't use it again for seven days, so any pathogen it catches becomes inactive over time. Various environmental studies of the CoV-2 virus find that it survives a few hours to a few days, depending on the surface the virus is on. It seems to have a shorter survival time on cloth and fabric, perhaps due to desiccation of the virus particles caused by the absorptive properties of the material.

While wearing N95 masks will greatly reduce respiratory exposure to the virus, they are not perfect. You can still pick it up from surfaces and you can even be infected by airborne virus through your eyes. Also, the masks can be quite uncomfortable, and if worn for hours at a time, cause bruising and skin irritation where it fits to the face as shown in the selfie below. Also, be aware that extended use of the respirators can lead to reduced oxygen levels in the blood. One report a few weeks ago told of a nurse who passed out after wearing her mask for several hours. Therefore, only wear them when you are in a crowded situation or in a room, like an elevator that has been recently occupied by many people where virus could remain in the air. Do not wear them in your home, car or outside when you are well separated from others.

Finally, remember these recommendations apply only to the N95 respirator masks. They do not apply to regular masks that are not very effective at protecting the wearer. They are much better at protecting others from an infected wearer.


Some People Say That A COVID-19 Vaccine Will Never Happen

It is amazing how many new “expert” virologists, immunologists and vaccinologists have popped up since the COVID-19 pandemic began. Over the last few weeks I have repeatedly seen claims from such “experts” that since we don’t have a vaccine for the coronavirus that causes the common cold, we will never have one for the coronavirus that causes COVID-19. Therefore, they conclude that the current efforts and expense to make such a vaccine simply waste time and resources. That syllogism assumes that someone has tried and failed to make a vaccine to prevent the common cold.

These are the facts: Only ~30% of colds are caused by a coronavirus; rhinoviruses and adenoviruses also cause what we call a cold. Therefore, we would have to develop several vaccines against several different viruses in order to prevent colds. Since colds do not cause serious morbidity or mortality, there has been little interest in developing several different cold vaccines. Thus, the first point in the “expert” syllogism falls apart.

Second, coronavirus vaccines that effectively prevent certain diseases in animals do, in fact, exist. Therefore, it is quite possible to develop a vaccine to a novel coronavirus. This defeats the second point in the “expert” syllogism.

I am pretty certain that in a couple of years, there will be several successful CoV-2 vaccines. In fact, there is a very good chance that by the end of this year, we might very well have one or two effective vaccines. This humble blogger predicts that the biggest problem we face is not in developing an effective vaccine, but getting enough people quickly vaccinated.

On May 18, this blog reported that 133 vaccine candidates were under development around the world. Today, the Milken Institute reports that 172 vaccines are under development.

120,000 Deaths And Counting....

The US just passed 120,000 deaths due to COVID-19. That happened in just five months and WITH quarantine measures in place. That is 3-4 times the number of deaths we see in an entire typical 18 month flu season WITHOUT quarantine measures. So, to those who try to brush this off as just another flu, I wish a pox on you (pun intended).

It is true, as many COVID-19 skeptics point out, that >97% of infected people survive the virus. But that was also true of the Spanish flu in 1918, which, in just 24 weeks, killed more people than were killed in the 10 total years of WWI and WWII combined. It is wise to view all the statistics rather than just cherry pick the ones you like.

At this time, COVID-19 is increasing in several Southern US states, so we are not out of the woods. It also is exploding in Central and South America, and India. Your humble blogger believes that Africa is not far behind.

Recent reports indicate that large cities in India, such as its modern financial capital of Mumbai, have been hammered by the virus. News reports talk of overwhelmed hospitals in Mumbai where the ICU beds stretch into hallways and new patients sleep on the floor while waiting a bed. It also appears that new hotspots are emerging in rural areas across India as people leave the big cities and head to their homes in the hinterland where there is less access to basic health care, let alone ICU beds and ventilators.

Brazil has passed the US in the disease rate and Peru and Mexico are not far behind. So much for hoping that the warm summer would retard the virus spread. Below is an aerial image of mass graves recently dug in Brazil to deal with COVID-19 fatalities.


And as the virus hammers these countries, its victims are younger than those in the US and Europe where ~70% of the people who die from the virus are over 75 years old. In contrast, just 12% of COVID-19 deaths in India, and 17% in Mexico have been people over 75.  In these countries, it is mostly people in their 40s and 50s who are dying from the disease.

There are many possible reasons for the change in these mortality statistics, including different demographics and health care availability. But, it also raises the scary specter that the virulence of the virus could be changing. The bottom line is that younger people cannot be complacent about it.

The virus is an opportunist. It will have its will with whoever is most available.

Where Did This Coronavirus Come From? An Update.

On 5/21 I posted a blog, “Where Did This Coronavirus Come From?” This post is to update some of that information. However, the conclusion remains the same, we do not know.

In very early January, Chinese authorities took hundreds of samples from animals and from the Wuhan market. As I reported, they found several samples of the virus in drains and sewers in and around the market, but they had inexplicably refused to release the results of animal testing. The Chinese authorities have now confirmed that no animal samples from the market were infected. This suggests that a single person brought a virus that was already adept at human transmission to the market and infected others. This just confirms what was already known; the virus passed through the market, but this says little about where it originated. It, however, does, increase the doubt that it came from an animal in the market.

Recent work published in March by Andrew Rambaut of Edinburgh University, analyzing viral genomic sequences, calculates that the most recent common ancestor of the virus infected someone in late November or early December, though that comes with a “confidence range” stretching back into October. So it presumably fine-tuned its ability to infect humans sometime before this and likely somewhere other than the market in Wuhan, since Wuhan is not a home for the bat species that carries the ancestor virus.

The closest animal version of the virus remains a bat sample collected by scientists in 2013 a thousand miles away in Yunnan. A new paper by two scientists from the Agharkar Research Institute in Pune, India, show that it is the same as a published sample that was collected from an abandoned mineshaft in southern Yunnan in 2013, following an outbreak of pneumonia-like illness that killed three miners there the year before.

So what did happen? At present, the evidence points tentatively to a chain of person-to-person infections occurring somewhere outside the city before somebody brought the virus to Wuhan, where the market acted as an amplifier. The first case could have been a rural farmer or possibly a bat researcher collecting samples for virologists. Or it is possible that another animal was involved in some way, with the virus bouncing between a farmer and his animals, or a wildlife smuggler and his poor prey.

As I concluded in my previous article, “It seems clear that the ancestral virus came from a bat, but there is little certainty about what happened after that. At this point, the only thing certain about the virus is its uncertainty.” Except, a bit more data seems to support the notion that the virus originated outside Wuhan. That is speculative at this point, but it seems more possible.

What If A Vaccine Becomes Available?

There has been a lot of talk about “herd-immunity” to this coronavirus. The hope is that this will enable a return to more normal, less cautious times. Sweden has tried to achieve “natural” herd immunity by sacrificing many of its citizens to a nasty pathogen. Their approach is rather experimental; almost like a clinical trial in which the subjects are never given full disclosure of risks vs benefits and never have the chance to volunteer or decline to participate. The Swedish government declared by fiat that all its population would be guinea pigs. It hasn’t gone well there. Stay tuned for a soon-to-come blog on the Swedish experiment.

As I have written before in these pages, with a new pathogen it is not at all guaranteed that herd immunity will be effective or beneficial. It remains to be seen. Given that, it seems unethical to expose people to a potentially deadly pathogen in order to achieve something that is uncertain. This highlights the value of vaccines. Simply stated, a vaccine is a way to trick the body into thinking it has a virus infection without undergoing the risk of actually encountering the virus. That way, we can try to develop herd immunity at low health risk. If a vaccine can effectively stimulate a protective immune response, without risking viral disease, that is the ethical way to try to achieve herd immunity. The Milken Institute tracker now lists 145 candidate vaccines under development around the world.

In this blogger’s opinion, there is a pretty good chance that an effective and safe vaccine will be found and made available to not only protect individuals, but also to potentially protect the entire population for years to come by achieving herd immunity. However, finding that vaccine is just the first hurdle in developing herd immunity; getting the vax to sufficient numbers of people is the second hurdle. There already is a small, but nasty and persistent anti-vaccine strain in the US and European populations. I am concerned that this will prove to be a major impediment for using a vaccine to achieve herd immunity. A recent poll supports this concern.

A recent Associated Press-NORC Center for Public Affairs Research poll shows that only about half of Americans would get a CoV-2 vaccine if available. A population needs about 70% to carry protective immunity in order for herd immunity to be effective. Among those who said that they would not get vaccinated, 70% said that they were worried about vaccine safety. This is despite the demonstrable fact that vaccines have proven extremely safe, especially when compared to the risks of the diseases they prevent.

40% of the non-vaxers also said that they were concerned about catching COVID-19 from the vaccine. That statistic reveals how lack of information and emotion informs many health decisions in lay people. Catching the virus from the vaccine is impossible. Most of the lead vaccines in development do not even use the CoV-2 virus. They take pieces of the virus that researchers believe can tickle the immune system, and put them into inert or crippled vectors that are not infectious. They can enter human cells, but cannot exit. They do not spread. Many of the vaccines under development don’t even use an inert or crippled vector. Some are just using potential immune-provoking genetic elements without the rest of the virus or its genome. Fear of being infected with a virus from a vaccine is unwarranted.

Bottom line: There is a Great Race around the world to develop a CoV-2 vaccine and it probably will be successful. But, fear of the vaccine that is greater than fear of the disease will, sadly, minimize the immediate impact of the vaccine.

Where Did This Coronavirus Come From?

Inquiring minds, of both honest and conspiratorial sets, have been pondering, speculating, and even authoritatively announcing the origin of the CoV-2 virus that is causing this pandemic. Some say it has a natural origin, others say it came from a lab, either accidentally or on purpose. Some say that the lab of origin is in Wuhan and others say it came from a US military lab and neither provide much evidence for their allegations. What do we believe?

At first, based on previous experience with SARS and MERS, people immediately pointed to bats with some animal intermediate as the source of the human infection. From that, the Wuhan wet market became immediately suspect for being ground zero. Then the silliness began. China shut down release of much information on its testing to find ground zero. Trump, Secretary of State Mike Pompeo and no shortage of shrill conspiracy fans pointed to the fact that Wuhan has an Institute for Virology where labs study coronaviruses; therefore, they announced it had to have come from that lab, either by design or by incompetence. The Chinese unhelpfully, and with just as little evidence and as much shrillness, countered that the virus was introduced to Wuhan by the US military. Other, more irrational tin-hatters claim that Bill Gates created this so he could develop a vaccine with which he can surreptitiously inject us with a microchip thereby turning us all into Stepford Wives or Manchurian Candidates. I even saw a video of an MD who claimed that there is no virus. Rather, he authoritatively asserted that the COVID-19 malaise comes from toxins excreted by our cells in response to 5G technology. It has all been great show, but I don’t know whether to laugh at or fear my fellow travelers who so willingly buy such bunk.

Maybe there are a few of us left who like to look at facts and evidence before reaching conclusions. This post is for you. All others can go back to their tinfoil hat channels.

Some backstory:

Early on, in January, as news about the virus began emerging, China began pointing to animals at the Wuhan market, probably a pangolin or scaly anteater (a delicacy in China) as the likely source of the virus. After a while that story began to break down as they found infected people in Wuhan who had no contact with the market and a large scale surveillance of coronaviruses in pangolins concluded that these animals are not the source of the human virus. Then the Chinese stopped releasing information to the world, while simultaneously totally isolating and Hubei province where Wuhan is found  from all outsiders. US reporters were kicked out of China. Meanwhile, the virus had already escaped and was rapidly racing around the world.

Recently the Wall Street Journal published an expose of what went on in Wuhan during the first few days of the outbreak. In the middle of the night on December 31st, before anyone outside China knew there was a coronavirus on the loose, Wuhan officials began disinfecting its wet market. Officials collected biological samples from the stalls, goods and animals. China’s CDC said that a team from Beijing arrived on Jan. 1 and collected 585 “environment” samples from a garbage truck, drains and sewers in the market. They reported that 33 of the environmental samples tested positive for the virus. 14 of the positive samples were from the area of the market where wildlife was traded.  

Four months later, however, China inexplicably has yet to release data on the animal samples they collected from the Wuhan market. Why? A UN body charged with coordinating research into the origins of the virus has been denied entry by China. The EcoHealth Alliance, a nonprofit organization based in New York, has studied coronaviruses in China for 15 years and helped establish that the SARS virus originated in bats then jumped to humans via an intermediate civet in a market in Southern China. But the Alliance’s partners in China also have been unable to investigate anything about this virus. Why?

Clearly, the virus passed through the market, but how did it get there? Its origin remains unknown and shrouded in mystery, which only fuels speculation.

The virus:

It is well known that bats are an important reservoir for coronaviruses. About 500 different coronaviruses have been isolated from bats around the world. Other animals also carry the virus. In fact there are about 7 (including SARS, MERS and CoV-2) that can be found in humans.

A virus isolated from a species of bat found in Southern China and not found in the Wuhan area has 96% genetic sequence identity to CoV-2. This suggests that this bat carried an ancestor of the Wuhan virus, but how did it make its way to Wuhan where that species of bat is not found? It is eminently plausible that an animal in Southern China picked up the virus, was trapped and shipped to Wuhan. It also is possible that this didn’t happen.

Did the virus come from a lab?

Scientists from around the world who have examined the sequence of CoV-2 are convinced that it has a natural origin. They say it lacks telltale signs that certain sequences were purposefully cut out of the RNA backbone and replaced with other engineered sequences. And as viruses replicate, they make random, infrequent errors in copying the millions of bases in their genomes and these mistakes are passed on to daughter viruses that go on to replicate. These small genome mistakes provide a sort of fingerprint from which forensic analyses can be done and the molecular sleuths all seem to agree that the fingerprints do not point to a guilty verdict. The scientific consensus is almost unanimous in rejecting that the virus was engineered by humans. In a letter to Nature in March, a team in California led by microbiology professor Kristian Andersen said “the genetic data irrefutably shows that [Covid-19] is not derived from any previously used virus backbone” – in other words spliced sections from another known virus.

However, a team of Australian scientists, led by Nikolai Petrovsky, very recently described evidence that the novel coronavirus has an unexpectedly high affinity for receptors on human cells. A virus from another animal would be expected to have primarily adapted to that species and not to have undergone changes that make it more infectious in a different species. From this they jumped to the conclusion that the virus could have been specifically designed by humans to penetrate human cells. This is not based on any experimental data, but on computer models that predict the virus’ ability to bind to receptors in humans and other animals. While this observation is not what one would expect for a naturally evolved virus, it remains eminently possible that the virus really did evolve this human preference by happenstance in other species. Most viruses do tend to prefer the species they are found in, but there are myriad molecular and biological reasons why they sometimes do jump across species. And this virus has shown an unusual propensity to move between species. The genetic sequence that encodes for the region of the viral spike protein that binds to cell receptors is also  known to be the most mutable part of the coronavirus genome, which makes it less surprising that it could spontaneously mutate in animals to a form that could more easily infect other species.

Therefore, in this blogger’s opinion, this computer simulation does little to answer the question regarding the origin of the virus. In the absence of more direct data proving it was engineered, and the reality that the molecular sequence shows no “fingerprint” of such engineering, it remains premature to claim that it was created in the lab.

In a recent interview, Francis Collins, Director of NIH, explained that If you wanted to design a virus weapon, you would not design this one because it looks like viruses we already know about. It is not very novel in its genome sequence. Genome analysis comparing this virus to all of the 500 or so known coronaviruses shows more compelling evidence that nature was the bioterrorist that created it and that its creation has been going on naturally for a long time.

Peter Forster, an archaeological research fellow at Cambridge University, co-invented phylogenetic algorithms that have, since the 1990s, become standard software for mining genetic data to reconstruct evolutionary trees, or networks. His team applied the software to genome samples of the earliest coronavirus sequences from China.  In the Proceedings of the National Academy of Sciences, Forster reported finding three main strains of the virus that he labeled A, B and C. His research determined that A was the founding variant because it was the version most similar to the ancestral Cov-2 found in bats from Southern China.  He also discovered that the A strain wasn't the predominant type in Wuhan. Of 23 Wuhan samples, only three were type A, the rest were type B, a version that was derived from A and that is identified by two point mutations that distinguish it from type A. In other parts of China type A was the predominant strain. In other words, it appears that the type A founding strain frequently appeared in other parts of China very early after it was first found in Wuhan in December. Forster’s research adds to the confusion of the virus origin since it seems possible that the virus could have been introduced into humans in a number of places in China, not necessarily Wuhan. This suggests, but does not prove, that the virus might not have even originated in Wuhan.

The Wuhan Institute of Virology:

The Wuhan Institute of Virology is a world class coronavirus research facility and many have speculated that the virus could have escaped the lab by accident. They point to a Washington Post article from 2018 that reported that US Embassy officials who visited the WIV had  concerns over the security of the lab. However, James Le Duc, the head of the Galveston National Laboratory in the US, the biggest active biocontainment facility on a US academic campus, poured cold water on that suggestion. He also visited and toured the lab and stated that it has safety and quality measures comparable to the best Western labs. Other Western scientists who have visited the lab also believe that an accidental release was “implausible” and highly rate the facility. One of the major responsibilities of the lab is to isolate coronaviruses from bats from all corners of China. They then sequence the viral genomes and post the sequences into a repository that is freely available to any researcher around the world. The genome sequence of the current virus does not match the sequence of coronaviruses posted in the library suggesting, but not proving, that they never worked on it.

Of course, it is possible that Wuhan lab researchers simply have not reported all of their research to the public, but until specific evidence of that omission is presented, that just remains an unproven possibility.

Bottom line:

It seems clear that the ancestral virus came from a bat, but there is little certainty about what happened after that. At this point, the only thing certain about the virus is its uncertainty.