In February of 2020:
- The Diamond Princess cruise ship anchored in Yokohama was a site of Covid superspreading.
- South Korea experienced Covid superspreading in a church, which soon infected a city and province.
Thanks to these superspreader events, Japan and South Korea figured out very early on that the virus must have been airborne and not bound in droplets that contaminate surfaces.
In August of 2020, New Zealand Prime Minister Jacinda Ardern constructed her own homemade face covering out of fabric. The assumption behind this act was the droplet transmission theory, because a face covering will inhibit the transmission of big droplets but not tiny viral particles that linger in the air. New Zealand is today lauded for its rigorous Covid response, but it was very different from that of other western Pacific nations like Taiwan. Economically advanced countries with strong agricultural sectors like Australia and New Zealand are familiar with disease outbreaks among livestock and the need for quarantine. Thus, these countries relied on strict border closures nationally and regionally to halt Covid. But looking at their policies one gets the sense they did not seem to recognize the airborne nature of the virus.
It was not until November 2021 that the World Health Organization changed its website to officially recognize that Covid was being transmitted through the air and not through surface contamination via droplets. In other words, only a year after the vaccines had become available did the world’s foremost health authority admit the obvious.
But many people today are still acting as if Covid is spread via droplets. For instance,
- Studies have shown that quality high-filtration masks like the N95 that are snugly worn are extremely effective at protecting from Covid, yet
- Other studies show that mask mandates do not work because people wear loose cloth masks or surgical masks, and/or wear them wrong (for example, below the nose).
The public then assumes that masks just don’t work.
Yet wearing a mediocre mask and wearing it sloppily does make sense if one assumes as the West did — and perhaps still does — that the virus spreads via droplet transmission. That is, if it is droplet transmission, then loosely covering the mouth will probably do the job to protect others from one’s own droplets.
And so the droplet transmission dogma persists, no longer among Western scientists but semi-consciously among the population. Perhaps it was never adequately explained to Westerners that they can stop washing their hands because the problem is in the air and not on surfaces. That is, they sort of understand that the virus is airborne — but not enough to change their behavior. This might influence how they react to the next major pandemic in 10 to 20 years from now in the current globalized and highly populated “age of pandemics”. In fact, it might affect how they do or do not react to a dangerous new Covid variant a year from now.
https://www.nature.com/articles/d41586-022-00925-7
Why the WHO took two years to say COVID is airborne
Early in the pandemic, the World Health Organization stated that SARS-CoV-2 was not transmitted through the air. That mistake and the prolonged process of correcting it sowed confusion and raises questions about what will happen in the next pandemic.
As 2021 drew to a close, the highly contagious Omicron variant of the pandemic virus was racing around the globe, forcing governments to take drastic actions once again. The Netherlands ordered most businesses to close on 19 December, Ireland set curfews and many countries imposed travel bans in the hope of taming the tsunami of COVID-19 cases filling hospitals. Amid the wave of desperate news around the year-end holidays, one group of researchers hailed a development that had seemed as though it might never arrive. On 23 December, the World Health Organization (WHO) uttered the one word it had previously seemed incapable of applying to the virus SARS-CoV-2: ‘airborne’.
“We’re really talking here about two failures, not one,” says Sandman. “Being reluctant to change your mind, and being reluctant to tell people you changed your mind.” Like other public-health and scientific organizations, the WHO “are afraid of losing credibility by acknowledging that they got something wrong”, he says.
Again, one of the questions raised is how the world will react to the next pandemic judging by the incompetence and dishonesty of public health authorities during the Covid pandemic.
A related question is the issue of “moral hazard”, which is lack of incentive to guard against risk where one is protected from its consequences.
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If Americans have been behaving as though Covid spreads through droplet contamination of surfaces rather through airborne transmission, a similar misconception seems to be rampant in the perception of Covid vaccines.
That is, at some semi-conscious level, many Americans seem to assume that vaccination is actually “variolation” involving exposure to the virus via the vaccine.
Once upon time inoculation meant exposure to an intact virus.
This is known as “variolation” and it was risky indeed.
.https://www.immune.org.nz/vaccines/vaccine-development/brief-history-vaccination
The practice of immunisation dates back hundreds of years. Buddhist monks drank snake venom to confer immunity to snake bite and variolation (smearing of a skin tear with cowpox to confer immunity to smallpox) was practiced in 17th century China. Edward Jenner is considered the founder of vaccinology in the West in 1796, after he inoculated a 13 year-old-boy with vaccinia virus (cowpox), and demonstrated immunity to smallpox. In 1798, the first smallpox vaccine was developed. Over the 18th and 19th centuries, systematic implementation of mass smallpox immunisation culminated in its global eradication in 1979.
Over time, vaccines became safer, though in some cases the virus was still intact albeit attenuated.
Louis Pasteur’s experiments spearheaded the development of live attenuated cholera vaccine and inactivated anthrax vaccine in humans (1897 and 1904, respectively). Plague vaccine was also invented in the late 19th Century. Between 1890 and 1950, bacterial vaccine development proliferated, including the Bacillis-Calmette-Guerin (BCG) vaccination, which is still in use today.
In 1923, Alexander Glenny perfected a method to inactivate tetanus toxin with formaldehyde. The same method was used to develop a vaccine against diphtheria in 1926. Pertussis vaccine development took considerably longer, with a whole cell vaccine first licensed for use in the US in 1948.
Viral tissue culture methods developed from 1950-1985, and led to the advent of the Salk (inactivated) polio vaccine and the Sabin (live attenuated oral) polio vaccine. Mass polio immunisation has now eradicated the disease from many regions around the world
This website was last updated in January 2020, and so there is no mention of the mRNA vaccines which were developed over a 20 year period and applied to the Covid virus.
The mRNA vaccines are a whole different deal from the old vaccines in that no virus or bacteria is being introduced into the body.
All vaccines are a way to introduce the body to its new enemies — much like the “America’s Most Wanted” posters at the post office.
The old vaccines can be compared to the captured aliens in the movie “Independence Day”.
- Will Smith’s character brought in a live one they could talk to.
- The military had a few dead aliens in Area 51 they were studying.
In contrast, the new mRNA vaccines are like a 3D printer that produces a lifelike dummy of a space alien.
That is, your body once vaccinated by the mRNA vaccines creates a chunk of harmless flesh that looks like a part of the Covid virus.
It’s a whole new level of safety.
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/mrna.html
To trigger an immune response, many vaccines put a weakened or inactivated germ into our bodies. Not mRNA vaccines. Instead, mRNA vaccines use mRNA created in a laboratory to teach our cells how to make a protein—or even just a piece of a protein—that triggers an immune response inside our bodies. This immune response, which produces antibodies, is what helps protect us from getting sick from that germ in the future.
One issue that contributes to vaccine resistance might be the roots of vaccination in variolation.
The point being made here is that vaccine resistance is not purely irrational but has very rational roots that go back to the very real risks posed by variolation.
https://www.washingtonpost.com/history/2020/12/12/abigail-adams-smallpox-coronavirus-vaccine/
The future first lady feared inoculation, but she feared smallpox more.
It was 1776, and Abigail Adams had decided that she and her four children would seek protection from a deadly epidemic. Her husband, John Adams, was in Philadelphia, where the Declaration of Independence had just been announced.
A smallpox inoculation involved a controversial treatment: infecting the recipient with a mild case of the deadly disease.
“God grant that we may all go comfortably through the Distemper,” Abigail wrote her husband.
Some people still fear vaccines because at some semi-conscious level they think they are being exposed to live pathogens when they are being vaccinated.
The experience of being vaccinated often confirms that false intuition because of its side effects.
The vaccination alerts the body’s defenses to an invasion and this triggers an immune response — which can be a pretty rough ride because your body is now mobilizing for war.
However, the subjective experience of being vaccinated can trigger a misperception.
It feels as if one has been infected by the vaccine — and that the side effects of the vaccine mean that the pathogen is growing within you.
In fact, it could be argued that we all sort of feel that we have been infected after a vaccination when we are in the throes of its side effects — but later we remind ourselves otherwise.
The point here is that there is a need to move away from the dichotomy of rational scientists versus the irrational public.
Everybody is semi-rational.
After all, the prevalence of the droplet transmission dogma among scientists in the West during the first two years of the Covid pandemic illustrates how science is a human endeavor.
(HBO “John Adams”, small pox variolation in 1776)
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There seems to be a distinct difference between the outlook of physicians and scientists.
This distinction might make physicians — in particular, emergent care physicians — better judges of how to deal with a pandemic.
In a nutshell, physicians deal with ambiguity, whereas scientists seek to overcome it.
The ambiguity over how to prescribe Paxlovid illustrates how physicians have to negotiate with uncertainty.Paxlovid (nirmatrelvir/PF-07321332 and ritonavir) is an oral antiviral drug that should be initiated as soon as possible after diagnosis of COVID-19 and within 5 days of symptom onset. Paxlovid is available for patients by prescription only. Prescriptions can be obtained from your healthcare provider or through the Test to Treat program.
Paxlovid is intended for high-risk groups.
https://aspr.hhs.gov/COVID-19/Therapeutics/Products/Paxlovid/Pages/default.aspx
Paxlovid is authorized for the treatment of mild to moderate COVID-19 in adult and pediatric patients age 12 years and older weighing at least 40 kg, with a positive SARS-CoV-2 test, who are at high risk for progressing to severe COVID-19, including hospitalization or death.
How do I know if I am a candidate for PAXLOVID?
Your healthcare provider will determine if you are a candidate for PAXLOVID. If you are immunocompromised or not up to date on your COVID-19 vaccine you should consider this therapy. Those with the following conditions are at increased risk of COVID-19 severe symptoms:
- Older age (for example ≥65 years of age)
- Obesity or being overweight (e.g., BMI >25 kg/m2), or BMI ≥85th percentile pediatrics
- Pregnancy
- Chronic kidney disease
- Diabetes
- Immunosuppressive disease or immunosuppressive treatment
- Cardiovascular disease (including congenital heart disease) or hypertension
- Chronic lung diseases (e.g., COPD, moderate to severe asthma, etc.)
- Sickle cell disease
- Neurodevelopmental disorders (e.g., cerebral palsy) or other complexity conditions
- Medical-related technological dependence (e.g., tracheostomy, gastrostomy)
- Other conditions identified by the CDC for the person at risk for disease severity
Is there anything I need to tell my healthcare provider before PAXLOVID is prescribed?
Please let your health care provider know if any of the following apply:
- Allergies.
- Liver or kidney disease.
- If you are pregnant or plan to become pregnant.
- Are breastfeeding.
- Have any serious illness or medical history.
- If you are taking oral contraceptives.
- Provide your provider with a list of all your current medications.
Like all antivirals, Paxlovid works best early in the course of an illness—in this case, within the first five days of symptom onset.
https://www.yalemedicine.org/news/13-things-to-know-paxlovid-covid-19
You take three Paxlovid pills twice daily for five days for a full course that adds up to 30 pills. It helps that the pills are packaged in a “dose card,” basically a medication blister pack that allows you to punch out the pills as needed.
When it applied for FDA authorization, Pfizer presented data from a clinical trial conducted between mid-July and early December in 2021. The data showed that participants (all of whom were unvaccinated) who were given Paxlovid were 89% less likely to develop severe illness and death compared to trial participants who received a placebo.
Physicians are dealing with the uncertainty of prescribing Paxlovid.
https://www.statnews.com/2022/07/07/paxlovid-prescribing-covid19-rebounds-data/
Physicians generally agree that certain high-risk patients — including people who are unvaccinated or those over 65 with multiple comorbidities — should always be prescribed the drug. But the broader eligibility makes it difficult for some physicians to decide who should or should not receive Paxlovid. A child is not likely to need it, but what about a healthy 50-year-old man? A 65-year-old woman? The experts STAT spoke with didn’t agree.
Some physicians are more conservative when recommending Paxlovid, though they still encourage older patients with one or more comorbidities to accept it.
For them, it’s the borderline cases — like patients who are older, but otherwise in good health — that are tricky. The disease can manifest in many different ways in different patients, and Paxlovid, like any drug, does come with potential side effects.
Differences have also emerged in the timing of prescribing. Myron Cohen, an infectious diseases specialist and prominent HIV researcher at the University of North Carolina at Chapel Hill, advocates starting on Paxlovid immediately. “The conversation’s a pretty short conversation,” said Cohen. “The data that’s available suggests that if you want to have the maximum benefit of this drug and you want to try to reduce long Covid, that the sooner you take it after you test positive, the smarter you probably are.”
Smith, the UCSD professor, said he’s seen physicians prescribe the drug after a patient is exposed but before they test positive, “even though the study is fairly clear it didn’t have a benefit as prophylaxis.”
Conversely, Robert Wachter, chair of the Department of Medicine at the University of California, San Francisco, speculated that giving Paxlovid early may not give the immune system enough time to ramp up and prepare itself for when the drug tapers off, which he worries may increase the risk of a rebound. (There is no research yet to demonstrate this is the case.) “For someone that I think of as being a borderline candidate, I would say the majority outcome is — if it’s on day one or two — is let’s wait three. … We have till day five to take this,” said Wachter. “Let’s wait until day four and see how you’re doing and if you’re feeling well, don’t take it. If you’re still feeling really bad, then it’s reasonable to take it.” Of Wachter’s patients who followed his advice, some did end up taking the drug. But for “the majority of people,” symptoms were minimal by day three and Paxlovid was not necessary.
Wachter said he’d follow the same advice he gives patients. “I’m 64, I’ve had two boosters — two vaccines and two boosters,” said Wachter. “I think if I got Covid today, I would still take Paxlovid. And would I wait a day or two? I wouldn’t rush to get it on day one. I might wait for day two or three.”
But other physicians disagree about waiting. The first and largest study of Paxlovid treated patients within three days of their experiencing symptoms, so the five days in the emergency authorization already offers leeway, they say, that isn’t as well-supported by the scientific evidence. “Our knowledge is greater about early use than late use. So that kind of ‘let’s see how you do’ doesn’t really make sense to me except in people in whom you don’t think they need Paxlovid,” explained Cohen, the UNC-Chapel Hill physician. Cohen said he and colleagues in his practice prescribe as soon as possible to patients who they believe need Paxlovid.
There is also debate over how long a patient should be prescribed Paxlovid.
In perhaps the highest-profile case of a Covid-19 rebound, Anthony Fauci, the Biden administration’s chief medical adviser, recently experienced rebound after a first course of Paxlovid and received a second regimen of the drug as a result. It’s an unusual move, and one that had experts conflicted. None of the physicians STAT spoke with have prescribed Paxlovid for a patient experiencing rebound, primarily because rebound cases often resolve on their own and rarely progress to a hospitalization or death. But it was unclear to them whether the emergency use authorization allowed a second course, with some physicians stating this was up to each individual state’s medical board and others arguing both sides.
“Some pharmacists have been pretty assiduous,” said Cohen. “When I tried on occasion to give a second course of Paxlovid over a short window of time, they basically argued with me and refused it, which is an unusual thing with a pharmacist.” Li, the Brigham and Women’s Hospital physician, pointed out that the wording of the authorization was unclear as to whether a rebound qualified as a new “day zero” of symptom onset.
There seems to be an emerging general sense that the more Covid risk factors a patient has, the sooner they should begin Paxlovid treatment and that the treatment should last longer.
That sort of “general sense” of what to do seems more like how a physician thinks than how a scientist would think.
For a scientist, there is simply the science and the policy that scientific truth demands, and people must follow it because there is no wiggle room when it comes to physical reality.
Scientists might consequently have a certain rigidity when it comes to public health policy.
Pharmacists are also rigid — for example, when it comes to prescribing Paxlovid — not because of their scientific background but because they strictly follow the directions of the CDC.
For a physician there is all sorts of ambiguity on how the science should be applied.
The results they see don’t always conform to the conclusions of laboratory testing.
There is also the issue of human nature.
If you tell an American teenager not to smoke or drink or take drugs or have sex they will immediately buy some weed and head to the nearest liquor store.
Accepting human nature is built into public health policy, but physicians are probably more likely than scientists to adopt Plan B when doing the right thing just doesn’t fly.
One example might be sending kids to school during the Covid pandemic.
Ideally, students should have been isolated from one another — especially during the early stages of the pandemic when so little was known.
Unfortunately, 70% of Americans were incapable of working from home.
Not going to work would mean losing their homes and winding up in a homeless shelter where they would have contracted Covid.
Moreover, private schools remained open during the pandemic, so even affluent parents who could work from home were often sending their kids to school anyway.
In June 2020,
the American Academy of Pediatrics made headlines by recommending that elementary through high school students return to school this fall — in a move that surprised government officials and parents alike.
https://www.pbs.org/newshour/health/analysis-why-some-schools-stayed-open-during-the-1918-flu-pandemic
Perhaps
one of the symptoms of rigidity in Covid school policy was the lack of
innovation, especially in terms of improving ventilation in schools.
During the 1918 “Spanish flu” influenza pandemic some schools remained open but moved classes outdoors and innovated.
https://www.nytimes.com/2020/07/17/nyregion/coronavirus-nyc-schools-reopening-outdoors.html
The point is that pandemic policy is not primarily based on scientific research — but on action informed by science.
Once upon a time, public health agencies like the CDC were designed to mobilize and coordinate public action during pandemics.
For example, when the Epidemic Intelligence Service within the CDC was created in 1951, it was modeled after the CIA.
https://en.wikipedia.org/wiki/Epidemic_Intelligence_Service
Creation of the Epidemic Intelligence Service was proposed by Dr. Alexander Langmuir, chief of epidemiologic services, communicable disease center at the U.S. Public Health Service on March 30, 1951.[4] Dr. Langmuir said that it was of utmost importance to planning of appropriate defense measures against biological warfare germs, development of new detection devices, and train laboratory workers for rapid recognition of biological warfare germs.[4] It arose from biological warfare concerns relating to the Korean War.
There is the possibility that public health authorities nowadays neither understand nor approve of this earlier model of pandemic mobilization.
Today, the cultures of these public health institutions reflect the stately deliberative approach of professors in academia who eternally mull over issues central (or not) to their field.
https://www.nytimes.com/2022/07/30/opinion/monkeypox-public-health-failure.html?smid=tw-share
The C.D.C. should lead America’s response to viral exigencies. But the agency isn’t a crisis organization. It lacks the infrastructure to mobilize a rapid response and is too hidebound and process driven to move quickly. Its cultural instinct is to take a deliberative approach, debating each decision. With Covid, the virus gained ground quickly. With monkeypox, which spreads more slowly, typically through very close contact, the shortcomings of C.D.C.’s cultural approach haven’t been as acute yet. But the shortfalls are the same.
Take the scant information available about the domestic outbreak and how it has spread. The C.D.C. has publicly complained that it can’t compel sufficient reporting from states and that it lacks insight into the scope and nature of reported monkeypox cases. That’s true. But the C.D.C. still possesses information from states that do share case reports, which the agency could have used to provide a better clinical mosaic on how the virus was spreading and presenting to physicians.
The political system has tried to work around this paralysis by
creating within itself new institutions — but this might just lead to
more paralysis when there is a crisis.
That leaves it up to the Biden administration. But its late stab at reform also falls short. It has effectively created an agency out of an office inside the Department of Health and Human Services that is charged with coordinating the federal response to bioterrorism, among other things. The reordering puts the new Administration for Strategic Preparedness and Response on equal footing with the C.D.C. It’s a classic Washington response to a problem: create an agency around it. The move will only add to the muddle.The pandemic mission must remain with the C.D.C., which has the requisite tools and expertise to respond to these crises. I know from my time at the F.D.A. that it’s the agencies that have the operational know-how and capabilities. The C.D.C. has the boots on the ground that provide the frontline needs for attacking these kinds of outbreaks, with its sophisticated tools for detection and surveillance. What it lacks is the authority and a national security mind-set.
It’s time to reform the CDC to be the action-oriented institution that it originally was.
The Biden administration needs to get the C.D.C. back to its disease control roots, by transferring some of its disease prevention work to other agencies. The F.D.A. can handle smoking cessation, leveraging its regulatory toolbox. The National Institutes of Health can tackle cancer and heart disease. Focus the C.D.C. more on its core mission of outbreak response. And imbue the agency with the national security mind-set that it had at its origins. If the C.D.C.’s mission were more tightly focused on the elements required for handling contagion, Congress might be more willing to invest it with the robust authority to do that targeted mission well. Congress would need to reprogram budget lines to get it done, but someone needs to start that conversation.
Time is running out. Diseases like Zika, Covid and monkeypox are a dire warning that dangerous pathogens are on the march. The next one could be worse — a deadly strain of flu or something more sinister like Marburg virus. We’ve now had ample notice that the nation continues to be unprepared and that our vulnerabilities are enormous.
The American response to the Covid pandemic brings to mind a couple of movies:
- The American public’s response resembled Netflix’s “Don’t Look Up”.
- The response of public health authorities was like HBO’s “Chernobyl”.
And now it just might happen all over again — for multiple emerging pathogenic threats.
Here’s one pet theory as to the cause:
- Elite American universities are out of touch with reality.
https://www.nytimes.com/2022/08/02/opinion/elite-universities-campus.html
- Elite universities are now the model for other elite institutions because people are compelled to adjust their preexisting values, attitudes, beliefs, ideas, and concepts to their institutional environment — most especially the institutions that they were socialized into.
https://en.wikipedia.org/wiki/How_Institutions_Think
https://www.routledge.com/How-Institutions-Think-Routledge-Revivals/Douglas/p/book/9780415684781
First published in 1986 Mary Douglas’ theory of institutions uses the sociological theories of Emile Durkheim and Ludwig Fleck to determine not only how institutions think, but also the extent to which thinking itself is dependent upon institutions. Different kinds of institutions allow individuals to think different kinds of thoughts and to respond to different emotions. It is just as difficult to explain how individuals come to share the categories of their thought as to explain how they ever manage to sink their private interests for a common good.
Douglas forewarns us that institutions do not think independently, nor do they have purposes, nor do they build themselves. As we construct our institutions, we are squeezing each other’s ideas into a common shape in order to prove their legitimacy by sheer numbers. She admonishes us not to take comfort in the thought that primitives may think through institutions, but moderns decide on important issues individually. Our legitimated institutions make major decisions, and these decisions always involve ethical principles.
