Category: Science

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2021 COVID-19 Science Testing Vaccine

COVID Serology

The immune system is a big complex machine.  Medicine tries to simplify the machine to make it understandable and to manipulate it to our advantage.  That’s why we measure antibody levels in the blood.  The measurement of antibody levels in the blood is called serology.  Serology doesn’t measure the whole immune system, but we do it because it’s easy, and it gives us an idea of what’s going on.  

Your immune system is stimulated by molecular structures that are not native to you.  You could say that your immune system is xenophobic, reacting against foreigners. And your immune system has a long memory.  Once stimulated, these memories allow your immune system to mount a defense quickly should that foreigner ever be encountered again. For many infectious agents, including SARS-CoV-2, this means the formation of antibodies which can be measured in your blood.

When you are infected by the virus, your immune system is exposed to all the molecules that make up that virus.  Your immune system can respond to any of those molecules, including one special molecule: the spike protein.  We need to understand what makes spike protein so special.

Contact between the spike protein on the SARS-CoV-2 virus and a cell inside the nose is the first step in the infection of our bodies by these tiny invaders.  The spike protein is like a key that unlocks the vault, giving the virus access the interior of the cell.  Once inside, the virus hijacks the cell machinery, converting it into a virus manufacturing plant.  Thousands of copies of the virus are pumped out which infect neighboring cells, and the process repeats.

Antibodies to spike protein are special because they are neutralizing antibodies.  Neutralizing antibodies get between the viral key and the cellular portals, acting like putty gumming up the keyholes.  That’s why code for spike protein is the active ingredient in mRNA vaccines, and that’s why we should be able to measure vaccine response with spike protein antibodies.  Other parts of the immune system are activated too, but these work after the virus has entered the body.  At least that’s the theory.

How well does all this work?  Imperfectly.

While vaccination may reduce the risk of future infection, it does not prevent it.  Breakthrough infections occur.  Maybe that’s because neutralization only happens when antibody levels are high enough.  Or maybe neutralizing antibody levels fade within months of vaccination.  Or maybe the small alterations in spike proteins of variants make vaccine-induced neutralizing antibodies less effective.  Or maybe it’s a combination of all these ideas.  We really don’t know.

And there’s the point.  We really don’t know.  We certainly don’t know enough to make universal vaccination the sole objective of our pandemic response.  Vaccination is a tool that can be used to keep people alive, but it should not become the primary goal.  Other theories need to be investigated to identify our best hope for survival.

For example, here’s a theory that should be investigated.  Based on what we know about the immune response, natural immunity from COVID-19 should be more durable, more protective, and better for our communities than vaccine.  Why?  Natural immunity exposes the immune system to many different molecules, not just spike protein, making it more likely to sustain emergence of new variants.  More durable immunity generates longer lasting herd immunity, reducing the size of subsequent disease spikes.  At least that’s the theory.

How well does it work?  We don’t really know.  

Although other nations have found wisdom in this theory, the CDC has not permitted us to try it.  Instead, the CDC stubbornly holds on to the universal vaccination idea, even vaccinating COVID survivors regardless of their antibody levels.

So how do we get out of this?  We need data.  We need answers to questions like what antibody levels indicate protective immunity?  How long does natural immunity last?  Is vaccine-induced immunity as protective natural immunity against variants?  Can antibody levels be too high?  What are the optimal antibody levels?  

That’s why I’m excited about the Texas CARES Survey.  This study sponsored by the UT Health Science Center at Houston, with testing by my friends and colleagues at Clinical Pathology Laboratories (CPL), promises to give us large cohort retrospective data on durability and magnitude of antibody responses after disease and/or vaccination, with matching outcomes.  Although the study has met its initial enrollment goals, check back for results and more opportunities to participate.

Why has it taken so long to ask these questions?

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2021 COVID-19 Ethics Science Vaccine

When We Lose Trust

There is a crisis of trust in America.  One manifestation is in healthcare.  For a century, the trust among Americans, their physicians, and institutions of public health built the most reliable healthcare system in history.  Today that trust is being undermined, and the entire system is in danger of collapse.  If we do not restore trust, we will suffer the reversal of a century’s gains in medicine. 

The Youngest Science, a collection of essays by Dr. Lewis Thomas, traces medicine’s journey from pre-twentieth century practices into the evidence-based practices of today.  Before this transformation, medicine was an unreliable mixture of traditional treatments like blood-letting and fanciful concoctions like snake oil tonic.  Transparency, empirical evidence, and patient collaboration were absent.  

Although there were many well intentioned physicians before the twentieth century, greedy hucksters and evil-doers thrived in this environment.  Quacks with phony credentials wagoned into town hawking the one-and-only genuine medicinal potion that promised to cure whatever ailed you, often accompanied by craftily staged demonstrations.  After selling as many worthless “cures” as possible, these predators escaped at night, leaving townsfolk poorer but in no better health.   People naturally feared being duped again.  Medicine could not progress in this environment.

In the twentieth century, trust changed all this.  Beginning in 1906 with the Pure Food and Drug Act, the federal government developed institutions like the FDA, CDC and NIH to assure the safety and effectiveness of drugs and treatments.  State governments licensed physicians and established standards of medical practice.  Physicians organized, creating boards to prevent frauds from entering their ranks and abusing the trust of their profession.  By the end of the last century, healthcare providers were among the most trusted professions in the nation.  So much so that people were willing share intimate personal details with a stranger, as long as that stranger was a doctor or a nurse. 

Now we see an erosion in the trust at the foundation of the youngest science.  When trusted institutions like the CDC and FDA give incomplete or misleading statements, physicians lose a resource for reliable information.  This quickly translates to a loss of the trust that bonds patients and physicians.  As employers and political leaders displace physicians by claiming to be health experts, people are unsure who to believe.  We’re back in the nineteenth century again.

It didn’t have to be this way.  We could have leveraged medicine’s abundance of trust to lead us to recovery.   Our trusted institutions could have given physicians the tools needed to make meaningful risk-benefit calculations for patients.  But this would have required the acknowledgement that natural immunity is at least as good as vaccination in some COVID survivors, that vaccination is harmful to some individuals, and that vaccination does not prevent the spread of disease.  We could have determined which groups receive the greatest benefit from vaccination, and which groups are most likely to suffer adverse effects.  We could have guidance on measurable markers of immunity—what are the minimum protective antibody concentrations, and what levels are toxic—so that those at greatest risk of death from COVID-19 can determine whether they will benefit from vaccination or booster.  We could have real data on adverse effects of vaccines by age and health status, and we could have balancing data on risk of death by SARS-CoV-2 infections.  We are 18 months into the pandemic; we should have this information by now.  Instead, our public health institutions have adopted an incredulously monolithic policy, saying universal vaccination is our only way out, even though we know this policy violates the oath of my profession: Do no harm.

Our trusted health institutions, like our trusted political institutions, have failed to communicate a clear, achievable objective for the pandemic.  They have failed to demonstrate a connection between their policies and the achievement of this goal.  As a result, we’ve lost trust.  This crisis of trust has created a crisis of healthcare.

We must restore trust, together.  The health of our nation is at stake.

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2021 Philosophy Science

Is It Science?

How do you carve a statue of an elephant?  Start with a block of stone and chip away everything that is not elephant.  Science is like that.  The elephant is truth; science is the chipping away.  Scientists are the carvers, chiseling different parts of the stone block at once, testing and repeating each other’s findings, remodeling as new evidence emerges, and accepting the image that finally appears.  Science is more verb than noun.  It’s not the science; it’s just science.

You can’t predict what science will reveal hidden in the stone block.  Even after the block is partially carved, you can’t be certain about important details that are still hidden from view.  Science doesn’t reveal truth until scientists have finished their work, and that work cannot be rushed.

True science is open source.  It invites questions, dissent, and transparency.  True science is not condescending.  True science can be understood by people with common intelligence.  More than anything, true science is honest.  When you identify misstatements, half-truths, or “believe me because I know better than you,” it doesn’t necessarily mean someone is trying to rob you, but it does necessarily mean you are not dealing with science. 

And this is the point.  Today’s intemperate rhetoric claiming to be science isn’t science at all.

I don’t have all the answers, but I recognize the absence of science in statements of leaders who say, “This is a pandemic of the unvaccinated.”  The wisdom of universal vaccination, the benefits of vaccine mandates, the rejection of natural immunity have not been established scientifically.  The use of ivermectin and hydroxychloroquine as prophylactics and early treatments have not been disproven scientifically.  Yet there is an unrestrained rush to incorporate these ideas into the dogma of previously unimpeachable institutions and into our public health policies.  It makes me sad.  It makes me fearful for our future.

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2021 COVID-19 Science Vaccine

How We Got Here

It was a scary time.  When the first wave of COVID-19 swept through the nation in the spring of 2020, infection rates, hospitalization rates, and death rates climbed rapidly, and we didn’t know how high they would go.  Nursing homes were especially ravaged.  Once infected, more than 40% of people over 75 years old died.  We were focused on keeping people alive, and we were committed to making sure that the sick had the resources for their best chance at survival.  As hospitals filled up, our greatest fear was that people would die waiting for a ventilator.  We determined to decrease the height of the wave by stretching out the time it would take to pass over us.  Whether you agreed with the policy then, whether you agree with it now, that’s why we locked down, masked, and social distanced.  We thought it was the best way to accomplish our objective of keeping people alive.

As the first wave passed, we relaxed a bit and found ways to feel normal again.  We all stocked up on toilet paper.  We tested small gatherings on Memorial Day and Independence Day.  Those of us who survived (regrettably not all of us did) became convinced we could survive again.  As the second wave of COVID-19 swept over us in the summer, we had new tools—tests, convalescent plasma, and drugs.  And we had the promise of vaccines.  If we could just hold on until the vaccines arrived, we would have a lifeboat that would save us from the virus and make things normal again.  We all wished it would be so; it was not to be.

The second wave was devastating, infecting more people, and lasting longer than the first.  Again, the elderly, the obese, and the diabetics were hardest hit, but more people survived infection this time.  Mortality rates for those over 75 years old were cut in half—still too high, but better than before.  

As the second wave passed and we entered the calm of fall, we began to see our vaccine saviors on the horizon.  Applications were submitted to the FDA.  But by now, the virus had mutated, and the more infectious alpha variant headed our way.  This third wave, the largest and broadest of the three, proved that we had learned how to handle the virus.  Death rates for infected individuals older than 75 dropped to 15%, about the same as Russian roulette.  Still, more Americans died in the third wave than in the previous two combined.  

As the alpha wave headed towards its crest, Pfizer-BioNTech received an EUA for its vaccine.  People clambered for vaccination, especially the elderly and front-line health care workers.  Moderna was authorized, then Janssen.  Local health departments organized waiting lists, and people skipped work when they got the call for their turn.  Operation Warp Speed put vaccines into arms in record time.  And the alpha wave began to subside.  There seemed to be an inverse correlation between vaccination rates and infection rates.  

It was about this time, as lifeboats appeared on the horizon, that we lost our way.  We stopped focusing on helping people survive, and we put our energy into pulling people into the lifeboats.  We didn’t recognize that the boats were leaky, and that some people were better off where they were.  We believed that vaccination would lead to eradication which would lead to freedom and our pre-pandemic lives again, but it wasn’t true.  Even as the alpha wave receded, it became clear that the virus would be here to stay.  

Yet we clung to the fantasy.  We abandoned our initial objective of helping people live.  Instead, we believed in the make-believe of universal vaccination—if we could just vaccinate everybody, the virus would leave earth.  Nevermind that the vaccinated can pass the virus to others; at least they won’t be infectious for as long.  Nevermind that the vaccinated get sick; at least they won’t die.  Nevermind that some vaccinated died; their deaths are clearly the fault of the unvaccinated.  Nevermind that vaccination doesn’t last very long, doesn’t prevent severe disease, and isn’t as good as natural immunity.  Vaccinate!  Vaccinate!  And vaccinate again, with unauthorized boosters!  Afterall, it’s a pandemic of the unvaccinated.

As the delta wave washes over us now, we must have the courage to believe what we see.  Our vaccines are leaky, and they will not eradicate the virus.  We cannot vaccinate our way back to our pre-pandemic lives.  It’s time to change the paradigm.

We must return to our original objective of keeping people alive, and we must measure our actions, our public health policies, and our pandemic response against this objective.  When we stop following the fairytale of universal vaccination, we can use vaccination as a tool to further our true objective of survival.  We must develop other tools, prophylactics, and early treatments, and we must see whether any old tools can be repurposed to accomplish our objective.

We can defeat this pandemic if we change course, but the window of opportunity is closing.  We must change course now.

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2021 COVID-19 Science Testing Vaccine

Vaccination Card Folly

Do Vaccination Cards Keep Us Safe?

Before I answer that question, I’d like to tell a personal story.  I took a single dose Janssen vaccine March 15, 2021.  I measured my spike protein antibodies on May 20 to make sure that the vaccine worked; my test was positive with an index level of 1.4.  Last Thursday, August 12, I measured my antibodies again.  They were negative.  I have a vaccination card that I can use to sit in a New York City restaurant, attend a concert at SFJAZZ, live on a university campus, or work at a hospital that has mandated vaccines.  Even if H.R. 4980 becomes law, I will be able to travel on an airplane in the United States.  Yet not even five months since my vaccination, there is no longer evidence of antibody-based immunity in my blood.

My story is another example of the folly of making universal vaccination the primary objective of the pandemic response.  Vaccine mandates by restaurants, employers, airlines, colleges, and entertainment venues are based on the flawed assumption that vaccinated people are safe, clean, and not dangerous to others.  There is undeniable evidence that breakthrough infections occur, that the vaccinated can spread the disease, and that vaccinated individuals can die of the disease.  It’s becoming clear that eradication is no longer possible.  

There is also mounting evidence that vaccines are associated with significant side effects that affect the health and wellbeing of individuals.  Expect more evidence to emerge.  We do not yet know the whole story.

I don’t have all the answers—nobody does.  Our understanding of both the virus and the vaccines are so far from complete that it’s impossible for anyone to make sweeping recommendations, no matter their position, no matter their intelligence.  But there is one thing we know for sure.  Clear objectives drive sound decisions.  Before we can win this war, we must agree on a sensible objective.

Our desired outcome should be keeping as many people alive as possible.  The life, health, and wellbeing of all individuals are paramount.  When we give primacy to vaccination status, we lose sight of our noble objective, and we divide people into uncooperating groups.   To the extent that vaccines further our objective, we should use them.  To the extent that early treatments further this objective, we should use them.  To the extent that therapies and treatment protocols have not been fully studied by science, we should fund studies publicly.  Although we can count on the free market to sponsor research when there’s the prospect of a large profit, wouldn’t it be a shame to overlook regimens that can keep people alive just because there’s no money to be made?  But we should never confuse any of these tools with our primary objective. We must allow people to make choices, and we must allow doctors to make personalized decisions in the best interest of individual patients.

Eradication is no longer possible, but survival is.  We must learn to live with the virus.  Have faith.  Have courage.

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2021 COVID-19 Science Vaccine

A Pandemic of the Unvaccinated?

During a White House press briefing last week, Dr. Rochelle Walensky, the director of the CDC, declared, “This is becoming a pandemic of the unvaccinated.”  She continued, “And our biggest concern is that we are going to continue to see preventable cases, hospitalizations, and, sadly, deaths among the unvaccinated.”  Is there a rational basis to allow our war against the pandemic to devolve into a fight between vaccinated and unvaccinated citizens?  In this blog, I will use data found at the CDC’s website to outline what we know and what we don’t about vaccinations, infections, disease, and death.

What we know:

  • SARS-CoV-2 infections have increased recently.  It’s easy to see this point from the CDC’s COVID Data Tracker.  Play with the graph a little.  By clicking any of the boxes (sex, age, ethnicity) under “Cases” on the upper left, you’ll see case trends of the entire pandemic.  Pass your cursor along the horizontal axis, and you’ll see the rate of cases each week of the pandemic.  The number of cases bumped up in the first two weeks of July.  But the recent increase is not yet close to levels of the surge last winter.   
  • Deaths from COVID-19 are still going down.  Using the same graph, click on any of the boxes under “Deaths” on the upper right.  The last week deaths increased was May 8, and then only by a little bit.  There has not been a spike in COVID deaths since the winter surge.  Even as infections increased recently, deaths have not.
  • Risk of death from COVID-19 increases with age.  Now look specifically at deaths by age.  Move your cursor along the horizontal axis and pay attention to the death rate as age increases.  It’s the old who die from COVID-19, not the young.   
  • Vaccination rates are highest among those at greatest risk of death from COVID-19.  Now study another chart from the CDC’s COVID Data Tracker.  Notice that in increasing age groups, more and more people are at least partially vaccinated, more than 90% among 65–74 year-olds.  The old, who have the greatest risk of death from COVID-19, also have the highest vaccination rates.  
  • Vaccination does not prevent COVID-19.  Breakthrough cases occur, and vaccinated individuals can spread the disease.  This last point is well known by everyone who follows Texas politics.
  • Community vaccination rates correlate with reduction in COVID-19 spread.  For this point, study the CDC’s vaccination vs. covid heat map, showing lower rates of COVID-19 where vaccination rates are higher and vice versa.  This is the data Dr. Walensky points to when saying “This is becoming a pandemic of the unvaccinated.”  However, unless she has private data not on the website, I do not see a similar correlation between deaths or even hospitalizations.  Death rates continue to decline, even among the unvaccinated.

There are some things we don’t know, and we don’t know them because we don’t yet have good data.  For example, the CDC tracks COVID-19 deaths by sex, age, and ethnicity, but not by vaccination status.  That information would be very helpful to individuals deciding whether to take a vaccine.  So would age-adjusted vaccine complication rates.  The absence of such data makes it difficult-to-impossible for young people to determine their personal risk-benefit ratios for vaccination.  The VAERS website is good for its intended purpose as a reporting site for adverse events, but the data must be mined and analyzed to be meaningful.  

Good data is simply hard to come by.  Last week, Sir Patrick Vallance said in a press conference that 60% of hospitalized COVID-19 patients in the UK are fully vaccinated.  Later, he tweeted a correction, saying exactly the opposite.  The trouble is that it’s impossible to validate either statement with reliable, publicly available data.  

Science is a process, not a product.  For science to work, conventional wisdom must be questioned.  It is always okay to ask, “Why should I believe this?”  Dissent is a natural byproduct of science.  But dogmatism, coercion, ridicule, hyperbole, and fearmongering have no place among real scientists.  Not even the director of the CDC.

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2021 Science Vaccine

More Vaccine Complications

We have warned of the dangers of unforeseen consequences inherent in medical therapies and procedures that have not been thoroughly tested.  All COVID vaccines are in this category since they are only available in the U.S. are under Emergency Use Authorization.  None has been approved by the FDA.  

Information about vaccine complications is slowly emerging.  First, we learned of the 10x higher incidence of anaphylaxis from mRNA vaccines compared to other vaccine types.  Then we learned of a new clotting disorder caused by vaccine called VITT.   Last week, the FDA required a new statement in Pfizer and Moderna Factsheets for Healthcare Providers warning that certain cardiac disorders, including myocarditis and pericarditis, may be caused by mRNA vaccines.  

In the pathology world, adding “-itis” to the end of a word simply means inflammation.  So, myocarditis is inflammation of muscle (“myo-”) of the heart (“card”), and pericarditis is inflammation of the sac around (“peri-”) the heart.  By themselves these words are vague and do not say what that inflammation means to a person.  Myocarditis can be mild and go away on its own, or it can be severe and cause the heart to stop beating.  Similarly, mild pericarditis is a common finding in many disease processes, but pericarditis can become so severe that it restricts the movement of the heart, a condition called “cardiac tamponade” which can be deadly. 

These vaccine complications tend to occur in young people who receive mRNA vaccines (Pfizer and Moderna, but not Janssen), especially when there is an underlying cardiac condition.  The trouble is that this vaccine complication may be the first sign of an underlying cardiac condition, since “in this younger population, coronary events are less likely to be a source of these symptoms.”  Does this make the vaccine unsafe for adolescents and young adults?  The CDC says no; I’m not so sure.  

It’s noteworthy that none of these complications—not anaphylaxis, not VITT, and not inflammatory heart conditions—were included in data submitted to FDA for initial authorization.  We are learning as we go. Quite literally, if you take a COVID vaccine, you are part of a study of the long-term effects of that vaccine on humans.  There may be compelling reasons for a person to take a vaccine, ranging from personal health benefits to scientific altruism.  But just as compelling may be the reasons a person chooses not to take a vaccine.  We should not coerce these decisions, we should not ridicule these decisions, and we should not penalize individuals for these decisions.  

We simply don’t know all the long-term consequences of the COVID vaccines.  But if history is any guide, there will be unintended consequences that may make the “smart people” of today look foolish in the future.

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2021 COVID-19 Science

The Delta Variant

The Delta Variant is one of several new strains of SARS-CoV-2 recently added the variant zoo.  Why has this new variant received so much attention lately, and why are we referring to variants with Greek letters now?  

The CDC still groups variants into categories of High Consequence, Concern, and Interest.  Thankfully, there are still no Variants of High Consequence.  The WHO has assigned Greek letters to certain variants to aid in communication.  The Delta Variant, B.1.671.2, is a new entry on the list of Variants of Concern.  Three cousins of the Delta Variant, B.1.671, B.1.671.1 and B.1.671.3 are now on the Variants of Interest list.  All these new strains originated in India.

What makes Delta different? It’s the first addition to the Variant of Concern list since April, and it’s prevalence in the U.S.is increasing.  Although it’s not nearly as prevalent as the Alpha Variant, aka the U.K. Variant, B.1.1.7 which we first learned about last December, some reports suggest that the Delta Variant is even more easily transmitted, meaning that it may soon replace the Alpha Variant as the most common form in the U.S.  The Delta Variant shows some resistance to treatments, although not more than other variants.  It does not escape detection by tests, and S-antibodies, either from disease or vaccine, seem to provide immune protection.  The Delta Variant is just the ‘new kid on the block’; we need to take this in stride.

I’ve updated variant reference tables, sorted by U.S. prevalence.

Variants of Concern
VariantWHO LabelFirst DetectionCurrent U.S. PrevalenceIncreased TransmissionIncreased SeverityReduced Detection by TestsResistance to Treatment
B.1.1.7AlphaUK69.7%50%●  
P.1GammaJapan/Brasil8.4%   ●
B.1.617.2DeltaIndia2.7%140%  ●
B.1.351BetaSouth Africa0.7%50%  ●
B.1.429EpsilonCalifornia0.6%20%  ●
B.1.427EpsilonCalifornia0.4%20%  ●
Variants of Interest
VariantWHO LabelFirst DetectionCurrent U.S. PrevalenceIncreased TransmissionIncreased SeverityReduced Detection by TestsResistance to Treatment
B.1.526IotaNew York5.0%   ●
B.1.526.1 New York2.5%   ●
B.1.525EtaUK/Nigeria0.1%   ●
B.1.617.1KappaIndia0.1%   ●
P.2ZetaBrazil0.0%   ●
B.1.617 India0.0%   ●
B.1.617.3 India0.0%   ●
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2021 COVID-19 Science Testing Vaccine

Vaccinate the Previously Infected? A Risk without Benefit

Vaccination of the previously infected is a risk without benefit because there’s no significant difference between S-antibody levels stimulated by SARS-CoV-2 infection when compared with vaccine.  

Using the same group of volunteers from our study to determine antibody types stimulated by vaccine and/or COVID, we measured the level of S-antibodies in the people who had them.  To make the comparison fair we did not consider the people who were both vaccinated and infected; instead, we only counted people who were vaccinated but had no evidence of disease, and we compared them to unvaccinated people with evidence of infection.  Here’s what we found:

IndividualsLowHighAverage
Vaccine171.49.16.6
COVID81.28.34.2

There were 17 people vaccinated without disease.  Their S-antibody levels ranged from 1.4 to 9.1 with an average of 6.6.  There were 8 unvaccinated individuals with evidence of infection.  That evidence could with be a positive SARS-CoV-2 test sometime during the pandemic, a positive N-antibody test, or both.  Their S-antibody levels ranged from 1.2 to 8.3 with an average of 4.2.  Any level above 1 is considered positive.

Graphically, the data looks like this:

Give a slight edge to vaccine, but really the difference between the two groups is negligible.  The COVID group includes a couple who previously had asymptomatic infections, implying that even asymptomatic infections cause the formation of S-antibodies just like vaccines.

Which causes us to return to the question we asked in early May.  Why vaccinate COVID survivors?  I still see no evidence for doing so, but there are reasons for not vaccinating previously infected people.  Our study includes two previously infected people who took the first dose of an mRNA vaccine and experienced vaccine complications so severe that they couldn’t take the second dose.  One of the two developed a debilitating condition that has not yet resolved and may persist for life.  Through June 7, 2021, VAERS received 5,208 reports of death associated with vaccine administration in the U.S.  Clearly the vaccine did not cause every reported death, but just as clearly, the vaccine death rate is greater than zero.  Death is the most serious of complications.  There are more common but less serious complications that range from inconvenience to discomfort to debilitation.  If there is no benefit, why take a risk?  That’s why my advice is that previously infected people should not be vaccinated without a compelling personal indication. 

Some researchers are beginning to agree with me.  As early as February, a study subsequently published in Nature suggested that a second dose of mRNA vaccine is unnecessary for people previously infected by SARS-CoV-2.  More recently, a pre-publication report of a study conducted at the Cleveland Clinic concludes that vaccinating individuals who have had SARS-CoV-2 infections has no benefit.

So why does the CDC still adamantly insist that COVID-19 survivors be vaccinated?  The answer lies in perspective.  The vaccination rate in a community is the single greatest factor in controlling the spread of disease and achieving the goal of herd immunity, which has already been reached in many parts of the country.  If you prioritize the good of the population over the good of any individual, then you advocate for universal vaccination even when the vaccine has no benefit, or worse yet, may cause harm to individuals.

That is not my focus as a physician.  My focus is the individual, the patient in front of me.  Health care is not a commodity that can be mass-produced without hurting individuals.  I have urged that vaccine decisions be made individually, not collectively, and I continue to do so.  I believe that the people with greatest risk of unnecessary harm from vaccine are the previously infected and the young.

The suggestion that even asymptomatic infections cause the formation of S-antibodies has implications in the ongoing debate regarding the vaccination of children, the group most likely to have asymptomatic infection.  During this debate, we must first resolve whether our priority is the population as a whole or the individual boys and girls subject to vaccination.  We may reach different conclusions depending on the priority we choose.

Here’s an idea.  Why not check S-antibody levels before vaccination?  Something to think about.

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2021 COVID-19 Science

THE PANDEMIC IS OVER

What gives a Texas pathologist practicing in a suburban community the right to declare THE PANDEMIC IS OVER in screaming headlines?  Shouldn’t such a pronouncement come from an official institution like the NIH or the CDC or the WHO or a prestigious university?   Read on, I’ll tell you.

The graph of the number of positive tests resulted each week by the laboratory where I practice gives you a fair image of the pandemic in my community:

There were two waves, a small one last summer and a bigger one in the winter.  But since the end of February, the number of positive tests has been low and constant.  Positive tests have not disappeared, but the rate of positives is not changing.  Search for rates in your community, and I bet you’ll find a similar graph.

Recall that epidemic means an increasing number of cases in a community, and that pandemic means an epidemic all over the world.  From the graphs it’s obvious that the number of cases is not changing, and it hasn’t been for several months.  If there’s no epidemic in my community and there’s no epidemic in your community, then there’s no more pandemic.  The pandemic is over.

The graphs also tell us that the virus is still here, and probably will be for a long time, maybe forever.  Epidemiologists call this the endemic rate—the rate of disease that is always present in a population.  People will still get sick, and some may even die, but it’s no longer an epidemic.  We reached herd immunity more quickly than many “experts” predicted.   

So now what?  We have to learn to live with the virus. Know your immunity status.  If you are not immune, continue COVID precautions if you wish to avoid contracting the virus.  The pandemic may be over, but the virus and its variants will be with us for a long time.