This isn’t going to be “over” for at least a year. Probably longer. Long enough that all of us must focus not on preparing for the end of the pandemic, but adapting to it and accepting that tomorrow will look just like today.

Allow me to make the case.

The only thing that will bring back “normal” life is “vaccinating” all of us. Period. That will happen – either by herd immunity (at least 2/3rds of us get infected and survive, so the virus can’t find enough carriers to keep the pandemic going) or by development, production, and use of a vaccine.

But…”Immunity” isn’t binary – think of it as a continuum rather than an on/off switch. Many vaccines reduce the severity of an illness rather than preventing it entirely. This means that COVID19 may well be with us for a long time, although its impact will be reduced.

Here are the issues. (caveat – there’s much we don’t know for certain, the following is culled from the most credible sources I could locate)

Stopping COVID19’s spread requires enough of us to have immunity that the virus can’t find hosts.  That immunity can come from antibodies created by our immune system reacting to an infection, or a vaccine. Antibodies are blood proteins produced in response to and counteracting a specific antigen – in this case COVID19.

Herd immunity

For myriad reasons, few countries have been able to stop COVID19’s spread. (New Zealand is an outlier, Taiwan and Vietnam have had notable success).  At the other end of the spectrum are Russia, the US and Brazil where the disease continues to spread rapidly.

There’s some research that suggests people who have had relatively mild cases of COVID19 don’t produce a lot of antibodies, thus may be vulnerable to future infections. Other research suggests antibodies may be pretty effective.

Another study found COVID19 patients’ antibody levels remained stable two months post-infection (that was when they were tested, it is possible levels remain high over a longer period).

Eventually, herd immunity will reduce the ability of COVID19 to spread, and likely reduce the severity of the illness – or prevent it entirely – among those who’ve been previously infected

Vaccines

There’s been much wildly optimistic and wholly unrealistic happy talk about a vaccine this fall. Is this possible?

Sure – about as possible that my beloved Chicago White Sox go undefeated and win the World Series.

• The average development time for vaccines is about ten years. Lots of vaccines take even longer.
• The fastest vaccine development  – for mumps – took four years (but that was way back in 1967, and we’ve got a lot smarter since then and technology is a gazillion times better) But, humans are still humans, and biology moves at its own pace, so there are inherent limits in the testing process
• Despite 17 years of effort, we’ve never successfully developed a vaccine for a coronavirus.
• If we don’t have a vaccine by this time next year, it won’t make much difference as COVID19’s spread will push us closer to herd immunity.
• Once a vaccine is developed, hundreds of millions of doses and needles must be manufactured and an entire delivery infrastructure implemented. Good news here, the Feds are investing hundreds of millions in manufacturing potential vaccines, the idea being they will be ready to go IF they are found to be effective and safe.

If you want to track vaccine development, this link is pretty useful.

Takeaway

One of my favorite movie quotes is from Shawshank Redemption;  just after he learns his release from prison is not going to happen, Andy tells Red “I guess it comes down to a simple choice…get busy living, or get busy dying.”

Some will rail against the unfairness of it all, accuse others of all manner of sins, pine for the “old days”, and otherwise waste precious time and energy uselessly bemoaning our fate.

Which will keep them imprisoned behind walls of their own making. Others will accept the new reality, not resigning themselves to it but rather adapting, creating, building and eventually thriving.

I’ve stayed away from most of the COVID stuff because Tom Lynch at WorkersCompInsider has been… as the kids say…crushing it.

Yesterday’s news that Moderna, a new company in Massachusetts reported very early results from tests of a potential vaccine was welcome indeed. The experimental vaccine appeared to help increase resistance** to COVID19 in a handful of people without undue harm.

It was also extremely preliminary.

The trial actually involved 45 people, but the press reports were based on results from 8. That’s less than a fifth of those involved…as one wag put it, “The drug trial sample size seems to be as big as 2 #Uber full of people.”

The double asterisk after “resistance” is because the experiment involved taking a blood sample from those 8 people, putting it in petri dishes with the virus, and measuring the antibodies ability to “kill” the virus. That is waaaaaay different from conveying immunity in the human body.

Perhaps coincidentally, the person charged with leading Operation Warp Speed, the White House initiative to develop a vaccine, has 156,000 shares of stock in Moderna, the vaccine research firm in question. And the company had just been awarded almost a half billion dollars in taxpayer money to help fund research.

I get that we are all looking for any hint of good news, and we all desperately hope Moderna’s vaccine:

• is effective and preventing COVID;
• is safe for humans;
• can be manufactured in huge quantities quickly and cheaply.

But vaccine development is full of fits and starts, blind alleys and dead ends, promising early results leading to disappointing failures.

Fewer than one in ten vaccine candidates reach production. Vaccines typically take 10 – 15 years to develop. “And while biotechnology underlying this drug has existed for nearly 30 years, it has never yielded a working vaccine for any human disease” (quote from NatGeo).

Yet we’ve never seen the might of the entire world’s vaccine expertise focused on a single problem, an unprecedented level of effort that – hopefully – will produce an unprecedented result.

Meanwhile, the virus has killed over 90,000 of our friends, parents, neighbors and grandparents so far, while infecting over 1.5 million of us. Thousands more will die, even if the vaccine is everything we hope it is.

People and organizations who focus on what they can control – reducing the risk of infection – will come out of this far better off than those who ignore the risks that remain real and deadly.

What does this mean for you?

Hope for the best and plan for the worst.

A useful discussion of how some companies are handling this crisis is here.

Social distancing works.  Hydroxychloroquine doesn’t. Remdesivir might.  A lot of “tests” may be wrong…Just because you’ve had COVID you may not be immune to future infection.  And COVID19 may lead to long term health problems.

Social distancing works. 

A study showed social distancing significantly reduces infection risk:

estimated that current social distancing measures will reduce the average contact rate among individuals by 38% “Social distancing saves lives but comes at large costs to society due to reduced economic activity… the economic benefits of lives saved substantially outweigh the value of the projected losses to the U.S. economy.”

Hydroxychloroquine and variations thereof are no cure.

It’s becoming increasingly clear that Hydroxychloroquine and its various versions are no COVID19 cure. One study (that has NOT been peer-reviewed) showed more veterans with COVID19 that took the drug died than those that didn’t. Another study found no difference in outcomes for patients that took the drug and those that didn’t. The drug can have deadly side effects. [my March 27 post has a lengthy and citation-filled discussion of the drug and the faulty “research” used to promote it]

Remdesivir

Preliminary data from an analysis of multiple studies shows 2/3rds of patients with severe COVID19 treated with anti-viral drug Remdesivir had “promising” outcomes.

One study in Chicago had positive results as researchers saw “high fevers fall “quite quickly” in remdesivir-treated patients and patients weaning “off ventilators a day after starting therapy.”

This is PRELIMINARY; much work still needs to be done. Additional clinical trials are underway, with one posting results by the end of this month.

Remdesivir is an injectable and to date has only been administered in hospitals.

If you’ve had COVID, are you immune?

We do NOT know. There is no evidence that those who have contracted the disease have immunity from a subsequent infection.  Serology tests look for antibodies in the blood, proteins whose function is to find and kill coronaviruses.

Usually those who have had a disease gain some immunity; that’s the idea behind vaccines. However, there is a report out of China that some patients previously infected tested positive after they were ostensibly “cured”.

There are concerns that tests are inaccurate, that they may show false positives (you aren’t infected but the test results say you are) and false negatives (you are infected, but the test results show you aren’t).

One theory is the antibody tests are hitting on non-COVID19 viruses (like those that cause the common cold) and thus giving false results.

Long term health issues associated with COVID19

There’s growing evidence that people with severe cases of COVID19 may have long-term pulmonary deficits due to compromised lungs.  The most vulnerable are – as you’d expect – older folks, those with pre-existing conditions, and compromised immune systems

A study out of China found about a third of patients that had recovered from severe COVID19 had brain stem issues that manifested as dizziness, headache, seizures and other issues.

Another study found that a fifth of severe COVID19 patients had significant heart issues. Blood clots are also a common problem, one that can be deadly.

PTSD and other mental health problems are also reported – no surprise there.

There have been reports of significant kidney problems, however an earlier study in China found no acute (short term) kidney damage.

What’s clear is we are just starting to grasp the potential long-term health effects of COVID19 – and we will learn a lot more in the coming months.

There is a lot of mis- and dis-information out there, from “cures” to the assertion that 5G towers cause COVID19 to Chinese claims that COVID is a U.S.-caused disease to “evidence” that the virus escaped from a Chinese bio-research lab to ridiculous claims by “scientists’ that all the health problems are caused by an overactive immune system.

This is exactly why one needs to be very careful when reading about drugs, cures, tests, results, and infection rates...almost no one had heard of COVID just 120 days ago, all research is just getting started, and we are all learning as we go. And fear-mongers and charlatans love a crisis and get off on scaring people while they get their 15 minutes of fame.

Oh, and YouTube is NOT a reliable or credible primary source for scientific information.

As of this morning 23,459 US deaths have been attributed to COVID19.

That number is almost certainly too low.

The words “have been attributed” were carefully chosen – note I did NOT write “COVID19 killed 23,459 people” or “23,459 people died of COVID19 or “there were 23,459 COVID19 deaths.”

Briefly, that’s because:

a) patients presenting at a hospital with breathing problems, a fever, and a bad headache are often not tested as COVID19 is assumed;

b) severe COVID cases typically lead to heart attack, Acute or Severe Respiratory Distress Syndrome or other problems, and the cause of death [more on this below] may be attributed to a heart attack/ARDS/SRDS and not to COVID;

c) many hospitalized victims also have other health problems; diabetes, high blood pressure, asthma, COPD, cardiac issues.  These co-morbidities greatly increase the risk of death and, absent a positive test for COVID19, may be given as the cause of death; and

d) cause of death (COD) can be a judgment call, and multiple CODs can be reported on the “death certificate”.

Here are the facts.

The CDC finally published guidelines for assigning cause of death for COVID19 earlier this month. Needless to say, a lot of people had died from COVID19 before these guidelines came out, so that’s issue One; Issue Two – as noted above, there can be multiple “causes of death”.

For physicians confronted with a deceased patient, determining and assigning a  cause or causes of death is often complicated and uncertain. For example, COVID19 leads to much greater stress on the heart as it tries to pump more blood to get more oxygen out of damaged lungs. According to the CDC, when that old, tired, sick heart gives out:

The immediate cause of death [in this case the heart attack], which is the disease or condition that directly preceded death and is not necessarily the underlying cause of death (UCOD) [in this case COVID19], should be reported on line a.  The conditions that led to the immediate cause of death  should be reported in a logical sequence in terms of time and etiology below it [on the cause of death statement]. [italics added]

Last week, CDC spokesman Scott Pauley said, “It’s likely that COVID-19 related deaths may not be included on a death certificate [italics added] or COVID-19 might be a factor related to an individual’s death but not the main cause.”

Issue Three – no test, no diagnosis (in some cases) From ABCNews last week

“There is no swabbing of deceased individuals anymore and unless the medical examiner has knowledge of a confirmed coronavirus test, then they aren’t being marked down as having coronavirus,” said [New York City Councilman Mark] Levine, whose committee has oversight for the Office of the Chief Medical Examiner.

Issue Four – A related issue is most of the victims of COVID19 are elderly; older people who contract COVID19 are much more likely to die than younger folk.

Of course, older people have more health problems than younger folks, so there are more “potential” causes of death – cancer, heart disease, stroke, hypertension, COPD, kidney failure and the like. Thus there are more opportunities for the pathologist to attribute non-COVID causes as one of the causes of death – which would further skew the numbers.

There are compelling data from New York City indicating COVID19 may be involved in many more deaths than have been attributed to the virus;

The FDNY reported a nearly 400 percent increase in “cardiac arrest” home deaths in late March and early April, [emphasis added] a spike that officials say is almost certainly driven by COVID-19, whether they were formally diagnosed or not.

Between March 20 and April 5, the department recorded nearly 2,200 such deaths, versus 450 in the same period last year,

Then there’s the issue (Five, to those still counting) that there are a LOT of “extra” deaths that can’t be directly tied to COVID19 as that specific cause of death, however these “extra deaths” happened during the COVID19 crisis.

This from Judy Melinek M.D., a forensic pathologist:

To quote Dr. Ed Donoghue, a forensic pathology colleague at the Georgia Bureau of Investigation, “No matter how these deaths are currently being attributed, after this pandemic terminates, an excellent approximation of the true fatality rate of COVID-19 deaths can be made by the calculation of the excess mortality for the period. This calculation was very helpful during the 1995 Chicago heat wave. Almost certainly, because of the scarcity of testing and other reasons, we will find that the number of COVID-19 deaths has been grossly underestimated.”

Okay, counterclaims.  There are any number of specious claims about rampant over-counting of deaths as COVID; I have yet to see any from any credible source backed by credible data. This is perhaps the best overall discussion of claims that COVID deaths are overcounted; it is thorough and detailed.

Here are just a couple debunked claims…

• “Requirements” that death certificates indicate COVID unless it is a car accident or gunshot.
• Deaths that were “sped up” or “hastened along” – as if all of us aren’t going to die die some day, and anything that kills us isn’t “hastening it along”. Oh, and that’s completely inconsistent with accepted standards for reporting COD.
• Specious and unfounded claims that “if you die of heart disease your death is marked as COVID”

For those interested – The international picture

From the BBC – “it might seem simple enough: if a patient dies while infected with Covid-19, they died of Covid-19.” Perhaps – but they may have died from a car accident, or might have an underlying health condition such as COPD or asthma or heart disease. The UK counts ANYONE who dies and has tested positive for COVID as a COVID death. Even if they died in a car accident.

A related issue – reports from Italy indicate there are a lot more people dying of all causes than usual, and many of those “extra” deaths aren’t attributed to COVID. “Only 12 per cent of death certificates have shown a direct causality from coronavirus,” said the scientific adviser to Italy’s minister of health last week. [source here]

What does this mean for you?

Two things:

We do not KNOW how many deaths are directly or indirectly due to COVID19.  But medical experts, physicians, epidemiologists, and medical examiners believe it is significantly higher than the published total.

There are truckloads of BS on the interwebs about COVID; ignore anything not based on solid research from credible people with scientific and/or clinical training and experience.

Ten days ago I wrote:

Ignore anyone who says there will be this many infections and this many deaths – their “models” are based on data that is likely wildly inaccurate and [based on] assumptions that differ wildly.

Not much has changed.

Today we’ll dive into “official” infection rates and why they may be way less than the actual infection rates. (for those wanting a lot more detail, try this.)

How many of us are infected?

According to testing results, in the US about 550,000 people have tested positive for coronavirus.  However, some researchers suggest as many of 12 million may have been infected, with the vast majority showing no or mild symptoms. (original source is Reason magazine, an avowedly libertarian publication)

DO NOT take that as gospel or dismiss it outright; the researchers relied on data from testing from China as well as other sources; some have questioned the reliability of data and testing kits from China. Other scientists have employed mathematical modeling to calculate actual infection rates; their findings indicate we’re identifying about 2/3rds of COVID19 cases.

Remember, all projections rely on data that are woefully inadequate. Reality is we do NOT know how many of us are infected, because here in the US (and in many other countries) the rollout and ramp up of testing has been far too slow. As you can see, after an initial increase, in the US we’ve been averaging less than 150,000 tests per day for more than two weeks.

data from CovidTracking project; source here (btw, this is a highly credible entity with full transparency re data sources)

From the research reported by Reason:

Credible research indicates Insufficient and delayed testing may explain…Germany, which has detected an estimated 15.6% of infections compared to only 3.5% in Italy or 1.7% in Spain. Detection rates [the percentage of people who are actually infected that are tested and counted as infected] are even lower in the United States (1.6%) and the United Kingdom (1.2%)…As of March 31, [research article authors] Vollmer and Bommer calculate confirmed cases represented just 3.5 percent of infections in Italy, 2.6 percent in France, 1.7 percent in Spain, 1.6 percent in the United States, and 1.2 percent in the U.K. [emphasis added]

In other words, the true number of infections was between 29 and 83 times as high as the official tallies in those countries [emphasis added]

The countries with the highest estimated detection rates were South Korea (nearly 50 percent), Norway (38 percent), Japan (25 percent), and Germany (16 percent)…The estimated prevalence of infection ranged from 0.1 percent in India and Japan to more than 13 percent in Turkey; it was 3.6 percent in the United States.[emphasis added]

To be clear, the researchers made several assumptions, some based on other researchers’ work. And, Vollmer and Bommer’s findings are quite different from Rao and Krantz’s.

What does this mean for you?

Net – we do not KNOW how Americans are infected…but it is definitely more than a half-million.

We will not KNOW until testing using a statistically-credible sample size and methodology has been done and reported.