2019 Novel Coronavirus (CoVID-19): Part XXXI
2019 Novel Coronavirus (2019-nCoV (first named); COVID-2019 (later named
disease); SARS-CoV-2 (final name of the virus causing COVID-2019), COVID-2019
Pandemic:
April 17, 2022 update Part 31
Paul Herscu ND, MPH
Herscu Laboratory
The last phase of the COVID-2019 Pandemic:
The End of Science
Hello and welcome. This piece concludes any new discussions on Covid-19 pandemic, and follows update #30 from the end of December 2021, as well as the notice to public health officials on the last day of 2021, posted earlier.
First A Prelude Note:
For the people who do not think that this virus exists, or the people who think this virus exists but is harmless, or the people who do not think this virus was widespread, this blog is really not geared for you.
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I have not written formally on this blog for 4 months because, oddly, or predictably, nothing new has occurred in regards to COVID-19. I know it sounded very odd when in the Fall of 2021 I mentioned that, while the virus remains, the pandemic will end by and large by May, then shortened it to April, and that most if not all large scale restrictions will end, and that only local ones will be in place. I know it sounded odd to folks since friends, colleagues, and strangers were mad at me for saying such foolishness. But in fact, it happened just as we described. Separately, we described the high likelihood that the Omicron variant would cause tremendous havoc in healthcare and society, yet have a fraction of the mortality, and that wound up being also how it played out. At the time we offered along with that prediction a way to prevent the clogging of the health care system but it was not widely implemented and thus we had the winter we had. If you go back to the news at the time in September, October, November, December you will see that there is nothing new from what we described would be the situation now, in April, 2022. So, I did not have a need to write. As the pandemic is now for all intents and purposes over, it is replaced by local, regional, and in some areas national epidemics and outbreaks. We talked about this before. (Think about how you live your life now as compared to October. A big change. Yes. But not unpredicted.) So, with that, this is going to be the last planned update on the pandemic, with Update #32 being a sort of time capsule for the future. And then I can rest.
One place that has been particularly challenging is the limited breadth of discussions on how to protect people. From the start, we offered several methods to protect folks. We discussed that if we do not pick up on all of these, then vaccines would be the main way forward. I know in the middle of a pandemic people are not at their best, but thought I would try to discuss this once more, since these topics do not go away, but rather need to be understood so that you too can both understand the past and predict the future news.
Barrier Methods
A small story first. Here I am keeping the story focused on one facet of prevention, i.e., barriers, though there are many other facets involved in protecting people.
I have a problem with deer. They constantly devour our planted garden and small trees. Eventually I put up a tall wooden fence. But then I found out that while the deer do not get in any longer, it turned out that the groundhogs still do. So I replaced the wooden fence with a metal fence. But then it turned out that small critters, bunnies were getting in still, so I replaced that metal fence with a smaller meshed fence. But then the really small critters, they must be mole/vole size, were getting in still, so I got a really small mesh fence and that did the trick. So, I can’t say that the fences did not work. They worked well for the animal size I was considering. In other words, they were not a failure, they did what they were supposed to do, for the animal size considered.
It is the same with small germs. It really is. You can develop different forms of barriers that work well for one type or one size and it works well there, but does not do much for the complete prevention of other types of germs or smaller/larger germs. With this in mind, let’s talk about points that we have made since 2000, then again, 2014, and again during this pandemic. One very early question relates to the nature of this virus and whether it is a droplet or aerosolized. We spent a long time discussing that issue so will not do so here again, but you could read about some of that discussion here on ebolavirus 2014, and related to COVID-19 here or here or here or here starting in early 2020. (Just search for the words airborne or droplet or transmission.) Transmission mode tells you what you have to do from the public health perspective. It matters a lot, as we discussed. If the germ is large enough, then this sort of mask works great, and if germ is too small then that sort of mask does not work as intended. If a large molecule, then it drops quickly enough and if small enough it lingers in the air for a very long time. Again, we spoke of this and the import of getting this right, in every epidemic, not just this one. It becomes one of the first things we try to understand, which is why it is so often highlighted. As we talked about COVID-19 early on, it seemed to be a droplet behavior but it also had airborne transmission behaviors in certain circumstances, and the question was just how transmissible is it if via aerosolize method. We have documented that over time it seems to be more and more aerosolized in behavior, and now finally after more than 2 years it is agreed that this is the case. Aerosolized is becoming the predominant form of transmission. Which is highly significant to us.
Just as one example, let’s look at masks, now that the politics is leaving the topic. If this virus is of unknown transmission does wearing a mask work? I would like to answer this in the same way as with the fence story above. They work in relationship to the germ and the mask. So, the example I gave before, let’s say the mask is made out of something silly, say, a newspaper, it stops blood, and sputum but not much for the virus, so let’s say 99.9% of the virus gets through and only 0.1% gets stuck on the newspaper surface, since objects stick to surfaces. Mostly this is not useful. What about if the mask is made of several layers of paper, and now 90% of the virus gets through but 10% does not. Or a fabric, where 80% gets through but 20% does not. Or a properly fitted mask made of good materials where 5% of the virus gets through but 95% does not. You see what I mean. If no mask then 100% gets through, while the better the mask the less gets through (let me grant that is also impacted by the possibility that the mask is not worn properly). Whatever type of material we are looking at, some percent of the virus gets through and some gets stuck to the surface. Again, this only makes since. (Another story, as I drink a glass of water and turn it over, some of the water sticks to the glass. In other words, things stick to other things, having to do with the properties of both the substance and the surface it contacts.) So, if you forget about the hot political topic of MASKS and just think of them as a porous surface, depending on what the material is made of and how fast you are breathing in or out, a certain percent sticks to the surface and does not get through. Very simple science.
The next question is why does this matter to us? Another story. I love chocolate. Dark chocolate. And actually, it is my main food addiction. Ok, not a big deal, right? Well one time when I was teaching in Greece the doctors gave me a meter stick, made out of solid chocolate, and as the week’s classes continued I noticed how I was nibbling down the meter, eventually ending up in only centimeters. Chocolate? Good. Lots of chocolate? Not so good. It is the same here with SARS-CoV-2. What we knew from the early start of this is that the higher the dose you were exposed to, the more likely you were to develop a bad form of COVID-19. The opposite is also true. In general if you are looking at a group of people, the ones that got a smaller exposure did better than those who had a bigger exposure. There are many studies to this point, but here is one that talks about the above topic, as well that of aerosol transmission, though my interest here is to make the above point.
I would like to give the rationale again though, on why this may be the case. When exposed to a new germ your immune system needs time to get more and more of its resources in place. That time is the crucial phase around so many aspects of immunity. But let me stay focused here. While the immune system is sorting itself out to deal with this virus, well…the virus has more and more time to infect cells, replicate, infect more cells replicate, etc. In a way, we are talking about the virus having a sort of head start before the immune system can rightly deal with it. So, the more of the virus we have to start with, the more cells are attacked, the more replication occurs. But the opposite is also true. The less germs you start with, the easier it is for the first stages of the immune system to deal with it and sort of slow it down until the rest of the troops are in place. OK, that should make sense and is pretty much what is found when we look at various groups at this time. So no big surprises and easy to understand for all of us. The less of the infective dose you get, perhaps the less severely you get sick. And again, this is what we find. So when someone says that masks work or that masks do not work, neither statement is 100% true and neither is completely incorrect either. When masks are worn properly and made from proper materials, the intelligent discussion we should be having is what percent of people are getting sick, what percent are hospitalized, what percent die, and what percent developed severe post acute pathologies? It is not a yes or no statement but a question of percent. The bigger the mismatch between material and virus, the less protection you have since you have a larger infective dose. I hope that makes sense.
Related to the above is sort of one of the most painful chapters in all of this for me. I was thinking that perhaps this virus might be more aerosolized than was being considered to start with. And following the same logic above, of limiting or lessening exposure, I asked myself what are other things we could do to impact this before the virus reaches the person. It seemed to me that removing the virus from the air is one important action we could take. Even if we do not remove all of it, the more we remove, in terms of concentration, the less severe the illness would be. Towards that end I wrote, texted, and videoed a form of air filtration system that is relatively inexpensive and worked pretty well when I tested it looking at overall particulate matter. This was a filtration system against all particles, be it virus, mold, or even smoke, as we had in Western United States at that time. The viruses often attach to other particles in the air and sort of ride around on them, so removing particles in the air, removes the virus as well. You can read about it here. I had thought that this concept would get picked up pretty easily, as air filtration/circulation removes many of the risks by removing or diminishing the virus in the air in an area. I was sadly surprised. I really was, and am. While it is true that I did not think that the government would initially take this up in a primary way I did think that physicians would. And I really thought that those folks in the integrative world would take this message as a whole. And I really, really thought that those folks who did not or could not get vaccinated would want to lessen their risks of a severe form by just removing the virus from the air. Mostly, as a group, that was not the case either. Except for a few organizations, people stayed silent on this.
I will give just a few simple examples of how things are still not dealt with here, today:
1. Essentially allowing people to get infected, especially within a household where one person is sick with it and could pass it along to others in the household, without encouraging an air filtration system.
2. Arguing about whether we should wear masks or not at a large crowded indoor event but not placing high filtration systems in place.
3. Arguing whether we should be allowed to have indoor restaurant eating without masks, and having today indoor restaurant eating without masks and not making inexpensive air filtration systems available. I have been in numerous crowded restaurants where there was no air filtration system. This is still the case in the town where I live.
4. While some medical clinics placed air filtration systems in some rooms, many did not and many medical schools did not.
5. School dormitories still did not place these. And what is sad is that this solution works well for old dorm rooms that have mold present.
6. Some doctors offices as well as other office placed some air circulating systems or air filtration system in their offices but the system was not geared to remove viruses, so they simply moved air around.
I think you can see in the areas of the world where there are substantial rates of unvaccinated people who have not been ill with COVID-19 previously, any of the above situations would allow for aerosolized viruses to transmit easily. This is what we considered in the fall when we said to expect a most intense spike of infections during omicron.
There are many many more examples of this, where easy changes, even today, could limit infection rates. And even if you did not want to limit overall infection rates for the general population, you could still do these things to protect the most vulnerable amongst us. Even if you do not agree with this or that policy, it seems like protecting the vulnerable should be of utmost import to all.
Honestly,
I still do not understand this. I can see why someone who only wants to focus
on vaccines, for or against, might not wish to publicize this, but really for
those who choose not to vaccinate to stay silent on this partial solution makes
the rest of their comments about their concern for the health of themselves and
other people ring hollow for me. I am heartened that now, more than 2 years
into the pandemic, both the governments and public health authorities are starting to really look
at this solution and really shift the public messaging to focus on this. Note
that this CNN
article follows my recommendations. For
example school systems have just recently implemented air filtration devices to remove viruses, and
I would add mold, from the classrooms as a way to be able to not just circulate
air but remove viruses from the air. What can I say. Please consider highlighting
and implementing this solution. And if you do not feel comfortable saying that
this is a partial solution to removing SARS-CoV-2 from the air, you can still
advocate for this by just highlighting how this removes mold from the air, or
smoke, or pollens. Put another way, if you do not want children to get
vaccinated or wear masks, why not highlight and fund partial solutions that
remove some of the virus from the air.
The reason I picked this specific topic of barriers and filtration is that while these discussions were previously at the periphery, they are becoming central all at once, now that SARS-CoV-2 has been acknowledged to be aerosolized. This forces these solutions to come to the fore. Notice that somewhere around omicron, the government shifted their focus towards this as a partial large scale solution. Which I am glad for.
The last point regarding barriers is that there are numerous products that may be useful if inhaled through the nose. We spoke of this last year and in 2020 before there were vaccines that at some point the vaccines and treatments would move towards nasal inhalation. Well, in the drug world, that is being developed. In the vaccine world that is being worked on. However, these products already exist and are currently being sold in the OTC/nonprescription market which may potentially lessen to overall viral load, with the same outcomes as we spoke above. I am not saying that these will keep you from getting sick, but perhaps they may lessen the amount of the overall viral load, which is what really matters here. These are made from different active ingredients that are either supposed to coat the mucus membrane or else kill viruses. These need to be better funded and tested. I use these. Thus far I have been lucky, even in highly contagious area, with a fair amount of viruses around me. I have been lucky, thus far, perhaps because of these. The government and industry and medical institutions really should test these in earnest so that they can be distributed, and if not for everyone, at least the vulnerable amongst us. Alternately, if this works then perhaps sections of the population can take these at one time to limit the speed of the spread, and not overflow the medical system.
In short, while the rest of the world has focused on ONE solution, vaccines (while others focused their energies against them), there is/was a better way to think about this whole topic by asking a simple question of what are all the different ways we can actually effectively and easily lessen someone’s viral exposure. And honestly, I am still not sure why the integrative world has not and still does not systematically focus on this one well founded and largely uncontested variable but rather as a group has remained mostly silent. For me, this is just one of the critical factors to consider when dealing with any bug, not just this one.
Conspiracy Theories
If I take all my recent personal experiences of death threats, hate mail, DOS attacks, what they have in common is conspiracy theories. Mostly they follow the same sort of format somewhere on this continuum. “You (Paul) are wrong about this or that. There is no virus, or there is a virus but it is mostly harmless, or it is only harmful to very few people, that only a few people died from it and they had other problems, that this propaganda is to control people (for a variety of reasons), that we have a great solution that is being stifled, that the drug companies are controlling the world (or others are controlling the world), etc.” And then they offer this or that proof, and when you answer those proofs, they just move on to the next one, and do not address the fact that there was a very good answer to their prior theory. Everyone has their own favorite conspiracy. I had tried to answer all of them, one at a time, but was too busy, and so stopped. But I thought I could just pick one, since I received so many emails on this one, and use this one as an example of how sometimes what you see is really just what there is and nothing more, and that not knowing the past just makes you vulnerable to misunderstanding. All of which may then lead to conspiracy theories. Here goes.
A few weeks ago, I started getting emails about the ‘proof’ that there was a conspiracy in the numbers that were officially reported as ill or died. The proof was that CDC removed 70,000 from the COVID mortality numbers, and that the reason they were there in the first place was that CDC was trying to artificially inflate them. A clear conspiracy, they claim, since CDC is itself dropped the number by 70,000. (By the way, if you want to see the numbers, via CDC, please find them here.) The way I usually answer this is the same way I have answered this for the past 30 years. We originally have provisional numbers to start with, and then as the ‘fog of war’ lifts we get better numbers, and as we get better clearer numbers we adjust by raising some of them and lowering others. It’s an epidemic with imprecise tools for gathering information. The data is not clean and only gets more and more clear after the fact. Think of when you first hear of a tragedy, a shooting, a large accident, there are numbers and facts that are generally correct but also inaccurate, it could be that there were 35 people in the accident not 30, or 35 people not 50.
For the most part you are following trends. The best example of this correction process, which I have spoken about, is the Ebolavirus epidemic in West Africa in 2014. I usually show the following slide of Ebolavirus cases in 2014. Note the third from the end in Sierra Leone.
We have a negative number there. Meaning that those number of people ‘undied’ on that day. This is one way we show a correction. In other words, upon closer examination, they realized that there was an error in the counting of cases and on that day they undid that error by removing numbers which made the cases go negative for the day. Typically, when I show this slide, people both laugh and ask what is the point of showing this to us. And I usually say that errors occur in counting every time. You try to limit this but they occur each time. And what is important is to correct them, but also to expect this to happen each time in one form or another. This does not mean that there is a conspiracy, this does not mean that people are cheating somehow. It happens, most of the time. It is just that now, here, in the midst of this pandemic people see this as a conspiracy. From my point of view there is a sort of conspiracy, well really more of a complacency, in not educating enough people in public health. Which means that people in general are subject to misunderstanding this or that fact, taking it out of historical context. I titled this post as the end of science because of this. There are general rules to science. But as conspiracy theories take hold, science begins to unravel as people begin to cherry pick their favorite observations and disregard others, even when presented by proofs, proofs of the past, and even better proofs that predict the future that come true.
Where We Are Now?
AS MENTIONED IN OTHER BLOG POSTS DO NOT TRY THIS AT HOME BY YOURSELF.
Regarding rates. In terms of vaccinations, we thought that only about 1/3-1/4 of folks would take the booster which is how it has turned out, and that hardly anyone would have the stomach to get a 4th shot or a second booster, which is also how it is turning out to be. And we also thought that the mortality rate of Omicron would be a small fraction of the prior Delta variant which is how that turned out to be as well. And as we discussed for a year it may be that those who had the vaccine AND had COVID-19 would end up having the best immune defense as compared to those who got just the vaccine or all those who just got COVID-19. In other words, this hybrid situation might be the best protection.
Where are we now? Good question. At the end of December, we wrote about the situation as we saw it then and the government decisions at that time. The best term we could use was ‘permissible infection.’ It appeared to us that once it became clear that the mortality rate of Omicron was not as high, and given that so many people were vaccinated, that the government decided to sort of let people get sick. In other words, what it looked like to us was that with vaccine in hand, letting people get sick at that time would allow them to get the virus while still being protected, survive it, and at the same time develop longer lasting natural immunity. The same hybrid solution we discussed in the summer/fall! And towards that end they shortened the isolation period to 5 days, and then sort of quickly got rid of many of the mandates. The result was not unpredicted. A LOT of people got sick, though percent wise not as many people died. And the result is that a large proportion of the country now likely have natural immunity building up. This I think explains why so many countries are letting go of their mandates even in the midst of severe and increasing rates of infection and illness. They are attempting to build up natural immunity while people are still under the protection of the first wave of vaccines. Hopefully this makes sense, even if you agree or disagree with the strategy.
Our comment in December was, since you are letting this happen, letting people get sick while protected by the vaccine, perhaps there are natural therapies that should be stressed that we could do to either potentially lessen the viral infective dose or improve immune response, so that there is less overall risk. Really we are in that place now and continue to advocate for this approach. Soon most countries, even ones that have rising rates, will have their infections rates drop and their mortality rates drop still further, as this process continues.
AS MENTIONED IN OTHER BLOG POSTS DO NOT TRY THIS AT HOME BY YOURSELF.
The Chronic State
In September 2020 I wrote this, “As I mentioned before, while we are in the midst of the scary times, what bothers me most is the long-term effect of having gotten this virus.”
And regarding the long (bad) arm of disease prevention I also wrote, “Decades from now, we will find that there is an uptick in the percent of people with osteopenia and osteoporosis, and heart disease, and depression. And there will be many reasons that will be rightfully attributed to COVID-19. HOWEVER, I believe one such reason, is the panic that this epidemic has caused has led to the lockdown, that has led to less activity, less outdoor time, less sunshine, and all of this will lead to these increases in lifestyle-preventable diseases. This is my way to plead with you, one more time to make sure that you get some exercise, get fresh air, especially get some sun on your face or body. This is just for proper bodily functioning.”
Additionally, I wrote regarding the long arm of disease, “One of the most common and important observations I made, as well as almost everyone else, is that the vast majority of people that develop COVID-19 do not experience it as a true acute situation but rather as part of their chronic picture. Which means, to me, since January 2020, that unlike common respiratory tract infections, which usually last for a bit and leave, this one will leave many people chronically ill….”
I think we are in that time now. As the panic over death is leaving us, the chronic effects or post-acute effects are becoming very clear. This part is again not unpredicted from 18 months ago, but at this time, this issue is too complex to write about in a general blog. I teach this extensively to my students and hopefully they expand it outward. I just wanted to say that in general, for the most part, there is a very clear path here as well and it makes sense that the nature of these “Long Haul” symptoms is more individuated.
I want to end this by saying that in the next blog I will encapsulate all the blogs into one document, for future researchers who are not in the midst of this pandemic, to highlight that while the virus was new there was nothing new here, in terms of both public health and the public response at large. Rules of the game are the rules of the game. I believe anyone can understanding them, and that they should not only be presented as part of basic education in general, but also be highlighted and taught in-depth in medical schools. In that way, it becomes easy to both discuss the issues at hand and correctly predict the potential future of an epidemic. This sort of education does not take long. There are only so many variables each time. They are not difficult to comprehend, and with those in hand it becomes less complicated to understand epidemics, and you will be less likely to be manipulated by this group or that group.
Separately, there are numerous folks reading this who only have a partial understanding of the pandemic because they only began treating folks or personally knowing folks who were ill during omicron, once the mortality rates dropped dramatically. That does not wholly reflect the reality of the past two plus years. This post is based on our long view of treating innumerable COVID patients, a lot of them since the very beginning of the pandemic. I have aged a decade during this time, seeing folks through the worst part of the mortality stage, and have to step back from these posts to recover my own health.
In the meantime, I do not think there will be anything new in the short term. Things will continue in the general direction. It will be about 6 months from now when I’ll next write anything ‘new’ on this topic, and at that time the topic will be about the confusion of where the end of math and the end of science coalesce to create what I call “The Great Regret”. Last time I made a 6-month prediction which turned out to be spot on, I got a great deal of grief. I would like now instead to just share the title, skip the negatively, and just explain in 6 months why things are as they are at that time. So…The Great Regret.
Until next time,
Kindest regards,
Paul Herscu ND, MPH
