Covid-19 Diary : Thursday 22 April, 2021

The lovely Johnson & Johnson vaccine remains “paused” in the US, it now being over a week since the FDA and CDC jointly “recommended” not to use it due to concerns over blood clotting.

While the FDA and CDC are “investigating” the issue – which, based on the passing of time and silence – seems synonymous for “doing nothing”, other people and countries are putting this matter into clear perspective.  I’d already pointed out, last week, that for the high-risk group – essentially fertile women – the risk of getting a blood clot from the vaccine seems to be about 1,000 times less than the risk of getting a blood clot from using oral contraceptives.

The French health minister pointed out that the risk of getting a blood clot, when flying from Paris to New York, is 50 times higher than from a dose of the AstraZeneca vaccine (which in turn seems to have a five times risk of blood clots than the J&J vaccine).

The European Medicines Agency said there may be a link to a rare form of blood clotting, but the vaccine’s benefits outweigh the risks.  As a result, Europe is moving full speed ahead to deploy the J&J vaccine.

There have been studies suggesting the risk of getting a blood clot is ten times greater from the virus than from the vaccine.

But, I’m saving the best until last.

An article in the BMJ (British Medical Journal) quotes clotting risks that might affect 5 people per million with the AstraZeneca vaccines, and 4.1 per million people from either the Pfizer or Moderna vaccines.  The apparent risk of blood clotting with the Johnson & Johnson vaccine is one per million people – four times lower than the Pfizer/Moderna vaccines that are in use without any caution or concern at all in the US at present.

Yes, the US authorities have withdrawn a vaccine that is four times safer than the two they allow without any restrictions.

Also revealed this week was a newly cited risk of getting Herpes Zoster, aka “the shingles” as a result of the Pfizer vaccine.  Neither the FDA or CDC have bothered to comment on this.

Meanwhile the J&J vaccine continues to do well in testing, and is showing to be capable of protection against some of the more concerning virus variants.  It is the vaccine I want to take, but “out of an abundance of caution” by the authorities I’m not allowed or able to do so at present.

Seriously, dear reader, there comes a point where outright blithering incompetence fails to adequately explain what is happening.  Is there some darker motive for blocking our access to the J&J vaccine?

Talking about outright blithering incompetence, here are another couple of Fauci-contradicting-Fauci issues.  It is hard to know who to believe – Fauci, or Fauci?

I could accept his 180° changes in messaging, if he’d just have the decency to say “I was wrong before, and new research now updates our earlier understanding”.  That would be understandable, even if in some cases there actually isn’t “new research”.  It would also help if he would differentiate between high-confidence almost-certainties and low-confidence guesstimates, but everything is stated with the same air of omniscient infallibility.

Fauci formerly told us that in all the history of respiratory viruses, over all time, asymptomatic transmission has never been a material factor or a driver, of virus spread.  Now he tells vaccinated people to still wear a mask, for fear of asymptomatically passing the virus on to other people.

Fauci boasted, last year, about how he was deliberately lying “to encourage us” with his statements about the percentage of people who needed to have herd immunity before the virus would be under control.  He started off at 60%-70% and went up to over 80%, not sure how high.  But now, he seeks to avoid talking about herd immunity at all (something I’ve always been skeptical about).

There is more on unforced errors and incompetence by government departments in the additional material, below.  As I pondered above, and not just because of strange attitudes to vaccines, at what point do we stop creating excuses for inexcusable errors and both seek accountability for such missteps and also consider darker motivations for incomprehensible actions (and non-actions) by the people charged with protecting our health and safety?

Current Numbers

The rate of new virus infections continues to climb worldwide.  We’re over a year into this pandemic, and at times it seems we’ve learned nothing at all about how to control it, and internationally, in total, we are doing worse now than ever before.

A large share of the new cases being reported are coming from one country alone.  India.  Of course, as the second largest country in the world, this isn’t altogether surprising, but there is an underlying cause for concern.

India’s surging new cases seem to be as a result of new more infectious virus variants, and new cases are now running at a rate of over 300,000 new cases a day, and more that three times their previous peak.  The concern is that other countries, notwithstanding their vaccination rates, may soon suffer a similar fate.

There are newspaper headlines marveling at India reporting over 300,000 new cases a day, but let’s not forget that we briefly exceeded 300,000 new cases too, and we’re four times smaller than India.  When India starts reporting over 1.3 million cases a day, then and only then will they be experiencing the same impact we had in early January, and – as you can see – currently, all of Europe has rates worse than India, and countries like Turkey have rates 3 1/2 or more times worse.

India’s new case rate is only slightly higher than Canada’s.

Happily, we in the US have now had eight days in a row of dropping case numbers.  Perhaps that – and the very mild rise for the several weeks prior – might be showing that the vaccine is starting to kick in and moderate the new case rate.

Below, after very unchanging rankings for many weeks, Oregon and Maine swapped paces in the US case table, as did South Dakota and Rhode Island.

There were no changes in the minor country list.  There were several changes in the middle of the major country list, and the UK finally dropped out of the list altogether, being replaced by Italy.

A very exciting move in the death rate list – the US dropped two places, being displaced by both Brazil and Peru.  Poland, which wasn’t on the list at all last week, is now at seventh place.

Our new table showing the most suffering countries over the last week, as predicted, has changed a great deal during those seven days.  I’d asked Worldometers to add a population column to this new data, and they’ve kindly done that, so starting from Sunday, I’ll only show countries with populations greater than one million in that table.  I’ve italicized the three countries that will be removed.

Oh, as for India, it only came 49th on that list (1,416 new cases per million people in the last week).

US Best and Worst States

Top Case Rates Minor Countries (cases per million)

Top Case Rates Major Countries (cases per million)

Top Death Rate Major Countries (deaths per million)

Top Rates in New Cases Reported in the Last Week (new cases per million)

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I Am Not a Doctor, But….

Good news is always good news, even when it is tinged with regret at being tragically a year (and 580,000 deaths) late.  On Monday the National Institutes of Health said it was going to fund a large trial of selected “re-purposed drugs” (ie, drugs like hydroxychloroquine and ivermectin) to see how effective they might be at treating mild and early cases of Covid-19.

This seems to be part of a broader groundswell of advocacy for using cheap anti-viral drugs to treat Covid before it becomes serious and deadly.  It is strange that ordinary MDs and general practitioners are driving this rather than NIH, which is definitely behind the curve.  Normally, front-line doctors look to NIH and the other three-letter-agencies for guidance and advice, but this time around, the process is reversed.

The NIH decision to conduct this trialing is great news.  But, why wasn’t this done a year ago?  Furthermore, don’t confuse Monday’s announcement with actual action – they still haven’t even decided which drugs to test!  With the trial protocol extending as far as 90 days after test subjects are given drugs, and who only knows how long it will take to analyze and report on the trial data, when will we see results in the form of official approvals for drugs to be used for early treatment?

I’ve also a suggestion to NIH that might at first strike you as heretical.  Don’t test ivermectin and hydroxychloroquine.

“Why not?” you might ask.  Yes, it is true I’ve been advocating for both these drugs for almost the entirety of the last year, but wait.  I’ve not finished my suggestion.  Don’t test these two drugs, because IVM has already been written up in 52 trials, involving 17,562 patients, and showing a stunningly positive 81% improvement in early treatment outcomes.  There’s no need to do a 53rd trial.  Just officially bless it, today.

Don’t test HCQ either, because HCQ has already featured in 235 trials involving a massive 358,862 patients.  It shows a weaker but still invaluable improvement of 65% when used as an early treatment.  Approve it as a treatment, too, and today.

Not only is there an enormous number of positive trials already completed on both drugs, there are more underway at present, for example, a new ivermectin trial in the Philippines and a new report on successful HCQ use in Senegal.

It is important to understand there is no law forbidding doctors from prescribing either HCQ or IVM at present.  Both are authorized drugs and on the WHO list of essential (and safe!) medicines, and both are widely prescribed, in the US and everywhere in the world, for other purposes.  Your doctor is allowed to “white label” prescribe both drugs for Covid treatment if he chooses to.

But for unfathomable reasons, many doctors won’t.  There’s something beyond broken when it requires a Court Order to get safe effective ivermectin released to a dying patient – this has happened several times before, and happened again this last week.

Doctors are supposed to be on our side.  They’re supposed to help us get better, and for sure, sitting on their hands, refusing to prescribe anything, and sending people home to get worse, is not help at all.

I’m increasingly of the opinion that this is not about medical science and best treatment practices, but is about money.  For example, Merck, who makes ivermectin, has been very negative about it, while developing and now advocating a new expensive alternate treatment – one which they can patent and profit from, whereas ivermectin’s patent has expired and offers drug companies no clear path to profits.

Yes, massive profits is what it takes.  Rather than advocating ivermectin, Merck is developing another treatment that may or may not end up as effective as ivermectin, but which promises to give them $5+ billion a year in sales, in the US alone.

In France they’re trying to change ivermectin from a cheap generic pill to an expensive injection.  This is clearly “over-engineering” something that couldn’t be simpler or better in the form of “take a pill, once a day”, but which has the promise, in this new form, to the drug company, of ending up as a proprietary and profitable product.

Continuing the subject of “too little, too late” has been the frustrating refusal by the FDA to certify “do it yourself” Covid test kits as indeed “do it yourself” kits.  These kits work a bit like an at-home pregnancy test, although it is interesting to note that the process of an at-home pregnancy kit was developed in 1967 and patented in 1969, but took until 1977 to finally be FDA approved and available for sale.

At last the FDA is accepting reality, and agreeing that it is beyond crazy to require a doctor or other registered “healthcare professional” to administer/interpret whether or not a line appears on a test kit to indicate the presence of a Covid infection.  So, as from this week, at-home test kits, with fast results, will start to become available at CVS, Walgreens, and Wal-Mart.  The price of these kits can be as low as $24 for a pair of tests – $12 each.  We understand the ex-factory price is about $5 each, so there’s still plenty of opportunity for the price to go lower, but at $12 each, that’s no longer an outrageous price, either for at-home testing or for testing in other venues too – at work, for example.

The next step in this process is to get at-home test results broadly accepted.  Except that is probably not a good idea.  There is already a brisk trade in fake vaccine and test certificates, and how can one credibly self-certify an at-home test.

Meanwhile, the more prevalent the virus is at present, the more it can, will, and does mutate.  This article has a great summary table of the major mutated strains and their impacts.

Vaccine News

This headline sets up a puzzle – “Chile has one of the world’s best vaccination rates. Covid is surging there anyway“.

Actually, it’s not really a puzzle at all (and neither is it much of a surge – the last week has seen rates dropping steadily).  The solution is right at the top of the article – Chile is using a very ineffective vaccine, one of the Chinese vaccines with a mere 56% effectiveness rate.

So with 28% of the population fully vaccinated, and a 56% effectiveness, that means in reality, a net 16% of the population is protected.  Compare that to the US with almost as many people fully vaccinated, but with vaccines having a 90%+ effectiveness rate.

Perhaps the headline should read “As expected, Chinese vaccine proves to be not very effective”, but that would probably not sell as many papers.

While we lambasted the FDA and CDC for pausing the distribution of the J&J vaccine above, it seems the unrelated problem of quality control at the contractor in Baltimore that had been making the vaccine for J&J is very real indeed, as this article outlines.

But you’ve got to pause and hum “The Twilight Zone” theme to yourself and wonder what alternate dimension the company’s spokesman is inhabiting when you read their statement praising their “heroic workforce who have stepped up to work 24/7 to ensure vaccines will be produced with the highest quality and quickly available to fight this pandemic”.

Would that be the workforce that caused 15 million doses to be ruined and trashed due to manufacturing problems?  Or have they all now been replaced with “heroes”?

Timings And Numbers

The splendid progress in vaccinating continues in both the US and UK, with the rest of the world still a far way behind, although Canada is now vaccinating at an impressive daily rate too.

I was writing about India above, and pointing out that its new case numbers, when viewed in the context of its 1.39 billion population, are not really all that high.  It also appears to have a very low case fatality rate – 1.15%, compared to a world average of 2.12%.

But this article suggests India might be undercounting its deaths, perhaps by as much as ten-fold.  Maybe so, maybe not.  If India truly is undercounting its deaths ten-fold, that would suggest it is also undercounting its cases by at least a factor of five.

Closings and Openings

Great news – another country is about to open its borders and welcome back passengers – Tahiti and French Polynesia in general.  But they have an interesting requirement – to be allowed in, you have to BOTH be vaccinated AND to have a negative Covid test prior to travel.  I guess that’s the medical equivalent of a belt and braces approach.

The left hand apparently doesn’t know what the right hand is doing?  The CDC and State Department are issuing confusing and conflicting advice about which countries are safe or not safe to travel to (from a virus perspective).

What I find strange is advice to not travel to countries, due to the virus risk, in cases where the countries in question have markedly lower rates of virus cases than the US itself.  How can it possibly be unsafe to travel to a country with fewer virus cases than we have at home?

Oh, in case you’re wondering, the State Dept updated its French Polynesia travel page on Wednesday, giving it a Level 3 “Reconsider Travel” downcheck, and the CDC gives it a Level 3 High Danger downcheck, recommending avoiding all nonessential travel.

Even more extreme, both the CDC and State Dept give Britain their highest “Do Not Travel” Level 4 warnings.

In the last week, the US has had 1,351 new Covid cases every day (per million of population).  The UK has had a rate of 256 cases/day, and French Polynesia has a rate of 131 cases a day.

How can the UK, with five times lower a rate of new Covid cases, be given a maximum level warning when in truth it is five times safer?  And why are we told to avoid Tahiti when it is ten times safer than staying at home?

Shortages

Almost a year ago, there was a great concern that vaccination rates would be limited by the number of syringes and ampoules that could be manufactured.  As it turns out, neither has been a constraint.

But as part of anticipating such a problem, the US government awarded a $1.3 billion contract to a company to make a new type of “pre-loaded” syringe.  It is perhaps just as well the syringe shortage never eventuated, because so too have these new syringes never eventuated either.

The problem that has been blocking their production?  Hard to exactly tell, but I did see in this article references to waiting for FDA approvals…..

Shortages of a different sort are being optimistically projected by the CEO of the Intercontinental Hotel Group – he is predicting a shortage of hotel rooms for vacationers this summer.

He may be in a position to accurately know, better than me; on the other hand, he is also one of his industry’s necessary cheerleaders.  I’d be surprised if there were an overall shortage of hotel rooms, although there might be some regional patches of high demand.

As long as air travel numbers remain low (see our daily tweets and Friday morning’s regular newsletter), and as long as business travel in particular remains depressed, I’m not sure how much pressure there’ll be on hotels.

Medical

Here’s yet another promising new virus treatment – this time oestrogen for women.  Studies suggest it gives a 78% reduction in Covid mortality.  But there’s little official interest in the concept.  Why not?

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