By Kevin Roche
Here is the latest big picture on the coronavirus pandemic, which I do every now and then because there are new readers and there are occasional developments.
- The Pathogen. It is really hard to figure out how dangerous this virus is. Yes it has “infected” a lot of people, but an astonishing number develop no “illness” and even those who are “ill” have very mild illness for the most part. It is understandable that the frail elderly are easily overwhelmed; their immune systems tend to be weak and CV-19 may have specific immune evasion capabilities. One thing that is clear, but maybe all coronaviruses are like this, just haven’t been studied that much til now despite the original SARS and MERS, this is a very transmissible and infectious pathogen, but really in what appears to be a limited set of environmental conditions. As best I can tell from the research, this is most likely due to characteristics of the lipid envelope around the virus. That envelope may be easily destroyed in most temperature, humidity and sunlight combinations.
- What it means to be “infected” and “infectious”. These are two critical concepts that I find people have trouble grasping. You really have to understand the micro level of when virus meets human tissue. To be infected means to me that the virus has succeeded in entering into a number of the infected person’s cells and is actively replicating and emerging from cells. And a person is only infectious if they are emitting sufficient numbers of viable virus particles to cause an infection in another person. Emitting fragments does nothing. Emitting small numbers does nothing in most situations, although some people, especially the frail elderly, may be capable of being infected by a very small number of virions or virus particles. What we care about most from an epidemiological perspective is the number of people who are infectious at any one time and the trend in that number. Many people are exposed, and could even test positive if their upper respiratory tract is swabbed at the right time, but are never infected by this definition, and never infectious. This is largely due to immune defenses that clear the virus before it gets going. And it is a weakness of PCR testing.
- Adaptive immunity. Another hard to grasp concept. Again, think of a rapid reaction force. You are exposed to a pathogen again, and your body very quickly recognizes it and responds by killing the virus before any infection gets going. And again, it is possible that a person could test positive if they are swabbed at the right time, but as above, would never be truly infected or infectious. The vast majority of the research is finding that almost everyone, and I really mean with very rare exceptions, after being infected develops a strong and lasting B cell and/or T cell defense. Antibody assessment isn’t the critical item, presence of memory B and T cells is. If this weren’t true, it is unlikely that a vaccine would perform very well.
- Vaccines and vaccination. I assume the vaccines will work to some extent to promote or enhance adaptive immunity. I am cautious because my work in drug development taught me that clinical trials are done in a manner to maximize apparent effectiveness and minimize adverse events. Real world use can be and often is different. Respiratory viruses, including coronaviruses, tend to have a large number of mutations and variations, and some of these can assist in avoiding antibodies and T cell responses prompted by vaccine-aided immune defenses. So I worry that the vaccines won’t appear to be as effective as people are imagining, but are as effective as they realistically could be, which should make a big difference in transmission and seriousness of illness. And it would be foolish not to be very watchful about adverse events. I am a big believer in vaccines, they are one of the examples of human intelligence and ingenuity at work to truly improve quality of life. Before vaccines, infectious diseases routinely killed very large numbers of people. But see above, about adaptive immunity; they aren’t going to make the virus disappear. We have to have the will to accept this and adapt to the presence of the virus without changing “normal” life patterns. The cost of doing otherwise is too high.
- Government response. This is the item that drives me. We really have indulged in coronamonomania. We have ignored the consequences of the response as it has attempted to mitigate spread. Governments have collected and reported data in ways that exaggerates the spread and risk posed by CV-19. Governments have failed to collect and analyze or have hidden data that is extremely important to understand the actual risk, and the actual shape of the epidemic. Governments have almost completely failed to acknowledge the extreme harms caused by the various mitigation of spread orders. These are serious, widespread, long-lasting, in many cases irreparable, and far more harmful to society than CV-19.
- Population Response. At least in America, we have revealed ourselves to be a nation of meek followers, incapable of looking for, analyzing and coming to logical conclusions based on real data and science, blindly following the pap fed to us by governments without question, submitting to all manner of totalitarian orders and allowing ourselves to be whipped into a hysterical terror by the media. Our democracy has been revealed to be far more fragile than I would have imagined possible if people are this willing to give up freedom and to see democratic processes subverted for an extended period of time when normal legislative action was available.
- The actual epidemic. Lots of apparent “infections”. Not that much serious illness. Over-attribution of deaths, generally to very frail elderly persons. Excessive hospitalizations, many not actually due to CV-19, and many solely for remdesivir treatment. Inability to find an effective solution to the issue of the frail elderly. Terrorization of the population despite extremely low risk to the general population. The latest wave will subside, just as the others have, and is already subsiding in many places. In a year or so, when the data is assessed accurately and over a sufficient period of time, we will find that there were no excess deaths to CV-19, just a lot of pull-forward deaths, but there were a lot of excess deaths due to the government responses, and ironically, many of those deaths will also be among the frail elderly.