Unprecedented
UPDATE 12/8/21: Precisely as I have outlined below, it seems the pandemic is evolving as expected. The latest scare, OMICRON, appears to be somewhat more infectious than Delta, but causes milder symptoms. There is also serious discussion in media sources on the potential need for annual vaccination. Science triumphs again and, remember, you heard it first right here! 😉
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UPDATE 9/18/21: See below at end of blog, before comments.
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Preface: I have been thinking a lot about the science and sociology of the current pandemic for a while. I was hesitant to write about it because I wasn’t sure it would help the public discussion and I am not a social media enthusiast. Nevertheless, given my background, friends and family have been asking me questions about what’s so and what isn’t. The following is my attempt to pull these thoughts and questions together. If I have made unintentional mistakes, I look forward to new information. By the way, if you check history, we have always identified pathogens causing epidemics, whether ebola or influenza, with their place of origin; coronaviruses should not be treated differently due to some misplaced sense of propriety or dislike of the person naming truth. Consistent with this tradition, I have used Wuhan virus to be clear and when I discuss variants, I am referring to those stemming from the original strain. However, I was convinced the Wuhan lab was responsible from early on; this can be corroborated by friends and family. I am also aware that standards for biomedical research and medicine in China leave a lot to be desired (eg, the blood services scandal) compared to the US. I know many colleagues working with Chinese institutions to raise standards and improve levels of health care (eg, transplantation and donor selection). But I don’t believe outside influences were responsible for the pandemic. It is my opinion that something truly sinister, bolstered by incompetence, and covered over by embarrassed officials, was at work in the Wuhan laboratory. This is my attempt to explain in words that anyone can understand what I think was going on. It is broken down into specific questions if you like to skip around or think I am too long winded. I hope you find it helpful. If it does not fit your personal narrative, I apologize, but science is often like that.
We are at war. We have always been at war. For as long as humans have existed, microbial disease (that caused by viruses, bacteria, and fungi) has sought to destroy us; all other species, too. They are trying to adapt us to their “purposes.” To them, we are merely food and their number is Legion. Our only defense is our wits. That and the gift of our immune response and how it adapts to threats new and old. It has ever been so.
The last almost two years have been exceedingly difficult for many. Some faced serious illness, viral and otherwise. Others died. Lost loved ones and friends can never be replaced. Social changes as well have been damaging, almost Kafkaesque. Those that have been taken, diminish all of us. This time, my blog is not about photography per se. It is about the pandemic of the past two years, seen through my own lens as a clinical and viral immunologist for nearly forty years. I have felt a responsibility to explain a few things about this pandemic and indeed every preceding one and every scourge to come.
Nema Virus
What qualifies me to write this?
“First, I am not a journalist!” So goes one of my best loved quips in recent months. I am also not a radio, TV, or YouTube doctor 😉 I was an undergraduate at University of California, Santa Barbara, in Biological Sciences; I was not a distinguished student, largely because I wanted to understand things, not learn them. I think this has been a guiding principle of my life. My bachelor’s degree was followed by an MA in Microbiology and a PhD in Immunology at University of California, Davis. It was there I began to understand how things work under the tutelage of M. Eric Gershwin, MD, a rheumatologist (immunologist) and scientist descended from George and Ira Gershwin of musical fame.
What was my academic career about?
I started out at as an Instructor and then Assistant Professor at Georgetown University where I was doing research on human genetics and human immune responses to influenza virus, the latter introduced to me by Jonathan Lamb, PhD, BDS, a terrific scientist from the UK. It was also where I was introduced to Anthony Fauci, MD, of pandemic fame. Tony has been brilliant, articulate, and hardworking at the National Institutes of Health pursuing interests overlapping with my own for a long time. He is one of the smartest people I know and I was excited when he was appointed to lead NIAID (Allergy and Infectious Disease), which he has done with great energy and distinction for forty years. This is relevant because my grant funding for thirty years came from NIAID and NIDDK (Diabetes, Digestive, and Kidney Diseases) to fund my studies on genetics of human immune responses to transplanted tissue, influenza virus, and Hepatitis C Virus (HCV). I was a Professor at the Medical College of Wisconsin and Senior Investigator at The Blood Research Institute. I finished my career as Professor of Pathology at University of Utah. Suffice it to say, I am qualified to share the following with you even though, as I pointed out previously, I am not a journalist or YouTube doctor 😉
What exactly is science?
The word “science” very simply means knowledge. Scientists go about acquiring knowledge through an organized and, at its best, highly prioritized process ultimately grounded in demonstration of facts by experimentation. An important philosophical aphorism (a saying) is, “Nothing can be proven, only dis-proven.” That may sound esoteric, but it is critical if we are to know what is so versus what is not so. Keep this point in mind as we move through the discussion.
Why is this time unprecedented?
We live in unprecedented circumstances. Not because of the pandemic; they come and go and always will. They are Nature’s way of saying the human species has gotten too large or too careless. Not because of the political climate, national or global; humans have always disagreed, sometimes violently, about ways to organize themselves guided by motivations ranging from altruism to lust. This too shall always be so. Sadly, at least, it seems to me.
But what about this time is unprecedented?
It is not because the future is always and by definition unprecedented. Not because of uncertainty, because the future is largely unknown. Not because of progress, which can be very fluid and disruptive. The real reason is because of our access to unprecedented, almost magical, technology. Technology that can detect the presence of a single virus in unimaginably minuscule samples of human fluid. Also, technology that can be used to transmit electronically even ridiculous (mostly?) ideas almost instantly, shaping (or mis-shaping? un-shaping?) our world. Both technologies are not understood, but can be exploited, by our political leaders for good or ill. Technology and human interactions cannot be separated, never could, and therefore cannot escape politics. In this context, it is important to understand that we are experiencing a technological/sociological sea change, scientists might say paradigmatic shift, as demonstrated by a couple of key facts selected from among many:
We can now follow new cases of so-called viral “infection” like we follow the box scores of ball games.
We can now, almost instantly, drive public opinion and make decisions based on electronically disseminated information that may or may not be correct or complete.
However, the ultimate question we face as a national and global population is significance: What is accurate, meaningful, and therefore useful?
What does this have to do with Wuhan?
First, let me start with a necessary digression. The Polymerase Chain Reaction (PCR) was invented in 1983 and resulted in a Noble Prize for Kary Mullis at Cetus Corporation. Without getting too technical, the PCR enables the detection of minute quantities (sequences) of DNA or, with modification, RNA; the Wuhan virus genetic material is RNA. Importantly, the starting material need not be derived from a living or functional organism. Minute, how minute? Again, the complete answer is technically complicated, but it is possible that a single copy of a target (a piece of) nucleic acid sequence may be detected after a billion-fold (or higher) amplification process. The PCR is critical to the success of the Wuhan strategy and to those seeking to understand what is going on. It is also the basis for much of the epidemiological tracking.
How is this (PCR) test used?
The PCR can be adapted to determine the amount of starting material, but is more often used qualitatively, positive or negative, starting material present or “absent”. The word absent is in quotes because I really mean undetectable. The PCR or its derivatives is being used to define Wuhan virus cases. This now includes Delta and other variants. According to the Centers for Disease Control (CDC) as of 10 September 2021, about 40 million cases have been recorded in the US alone and deaths are topping 650 thousand. Significantly, over 75% of adult Americans have been given at least one vaccination. I got both of mine over 6 months ago. Data can be verified at this CDC webpage. Even with these encouraging data, the numbers probably underestimate exposure because most real cases are asymptomatic and go unreported.
Why is this important?
We have never before been capable of watching, literally on TV, in real time, a pandemic spread through a population. Panic spreads as each new case is newsworthy, then tallied by the hundreds, then thousands, and finally they are reduced to percentages, statistics. In the past, with influenza for example, the CDC would report in Morbidity and Mortality, clinically significant disease and death. And many of you with the sniffles, or your kids, have seen your doctor and you hear, “Yes, there’s something going around.” End of story. Infection and disease are part of the human condition; they should not be entertainment. Like following the results of a football game, journalists, crackpots, and even medical doctors appear as talking heads commenting on the latest lurid news. Having taught in medical schools for a long time I can say, yes, your average medical doctor is not qualified to address epidemiology, immunology, or virology other than to report only what they can personally verify. In the “echo chamber” of today's world, untrained, they merely contribute to hysteria.
What, in fact, is a case?
A case is not a positive PCR test. A positive PCR test can be obtained from a toilet seat! If positive, does the toilet seat have an infection? A case, as in the influenza example above, is an exposure that results in clinically significant disease along with confirming lab tests. Think of a “case file” opened in a hospital or clinic. A self-inflicted gun shot wound to the head of a person found to be PCR-positive for the virus may or may not be a legitimate Wuhan case. A case requires follow up. A positive PCR test is evidence of exposure, but in the absence of symptoms, I don’t consider it a case. If an individual has antibodies to Wuhan, then they were infected. Even if they had no clinical symptoms. I would consider that a case. Nobody in the media, expert or otherwise, has made this distinction crystal clear.
How might reimbursement policies contributed to misinformation?
In order to bolster overloaded hospitals, HHS and Medicare decided to supplement several thousand dollars for every incidence of Wuhan exposure resulting in hospitalization. I can’t say how extensive gaming of this supplement occurred, but I can say with conviction that such definitely did occur and thus incidence reporting is distorted to some extent. Follow the money. This kind of supplementation is likely to confuse understanding the extent of viral spread. I expect it will take years to sort it all out. Political machinations have interfered with proper epidemiological follow up. My view is politicians should stay out of the laboratory.
What are viral variants?
Continuing the warfare analogy, variants are the way the enemy tries to evade our defenses. They can be quite effective depending on the pathogen’s unique characteristics. Viral pathogens “seek” to replicate; killing the host stops replication. Therefore, it is in a virus’ “self interest” to adapt to the host in favor of spreading more efficiently so more virus progeny can be made. There are many epidemiological examples of pathogens that have adapted in such ways and the same is happening with Wuhan. What have you heard about the Delta variant? Spreads easier; less significant disease. As Wuhan virus continues to adapt, like the Influenza Virus, there will continue to be new variants. I do not mean variants are not of serious concern. Ultimately, essentially everyone will have exposure to Wuhan; it is inevitable, either by vaccination or by natural infection.
OMG is this thing never going away?
We really don’t know. But so what? Influenza has not gone away; it is sometimes called, “the old man’s friend.” If Wuhan or it’s variants don’t disappear, we’ll handle it through vaccination programs like we do for Influenza Virus.
What about risk of dying from Wuhan virus or its variants?
I do believe the Wuhan pandemic is serious. But it is not as serious as the 1918 Spanish flu that may have killed more than 0.6% (600 per 100,000) of the American population. Likely due to modernization of medical technology, the current death rate in our country is running around 0.15%, 150 per 100,000. The major difference between these scourges is that the flu killed young and old alike. We’ve known some coronaviruses were a frequently lethal risk since the early 2000s. I believe people have died from nothing more than an infection. I believe that the elderly and those with “pre-existing conditions” to be at highly elevated serious risk. The question is how to respond or defend against it. Coronaviruses have been around and infecting people and animals for millennia. This will continue. Especially if idiots and criminals deliberately tamper with these pathogens. If our Public Health System, and I trust Tony Fauci on this, truly believes they are a significant threat for whatever reason, we should combat them with a regular national vaccine campaign similar to that for Influenza Virus. As a scientist, this is the only rational response.
Why haven’t credible scientists addressed these questions?
I will concede most scientists are terrible when it comes to communicating with non-scientists. The public funds our research through tax dollars and donation and therefore deserves lucid transparency. Even as an expert, I would spend a day listening to Tony Fauci make a subtle point about very complex science and such is the Wuhan pandemic. But how to explain all of its moving parts? Imagine a 1 minute sound bite to explain why Kansas City lost the Super Bowl and you’ll have some idea of what it is like. On one point, I would criticize Dr Fauci, which is that our understanding evolves as we gather more facts. He hasn’t changed his mind so much as that he has become aware of new facts that require updated interpretations. I don’t believe he has lied, technically and legally; the NIH did not directly fund bio-weapons research at Wuhan. This will be sorted out in court, hopefully not the court of public opinion. Tony could have done a better job of explaining the evolution of his thinking, but another aspect of this is the Public Health Service is essentially a branch of the military. PHS officers are subject to the UCMJ. There are things that can be talked about, others not, and I bet the intelligence people are limiting our access to information behind the scenes. Don’t be naive. There are severe penalties for divulging classified information. I believe such considerations and political maneuvering are distorting the actual picture of who knew what when.
What about our government funding the Wuhan lab?
Here we go into politics. In their infinite wisdom, members of Congress pass laws, mostly without thinking too deeply. Even when those laws may impact national security. For example, the edict against “gain of function” research, doesn’t stop a bad actor (eg, the Chinese Communist Party) from pursuing such studies. However, it is within our strategic interest to prepare potential defenses against such enemies. Ergo, offload the research to a third party who can make sure the research gets done, but it is kept at arm’s length, and we can stay in the loop. That being said, I’d rather have this research done in our own domestic labs, not outsourced to an enemy. Seems logical. It is possible that this logical necessity is what gave Tony Fauci pause, what scared him, and which he was bound by law not to reveal. We may never know. The bottom line, elect smarter more ethical representatives!
Did Tony Fauci lie?
Part of this was addressed in the previous paragraphs. The other part is about the fickle nature of humans. How we love our heroes! How we love to crucify them, too! Tony Fauci was the only person on the public stage in early 2020 that knew what the hell he was talking about; every other person involved, including those from CDC and HHS, has little credibility in my view. Because he stood out, he automatically became a target. Finally, I think it is ironic and hypocritical that politicians seek to crucify Tony Fauci. To wit, if his lips are moving, you know any politician is definitely lying. Tony Fauci is no politician.
So what can we do about it?
What qualifies me to lay this information on you? Besides my above qualifications, I feel I have a serious, perhaps sacred, responsibility to share my expertise, perspective, experience, and even opinions with you. Infectious disease has been part of life for millions and millions of years; it will not be vanquished in a thousand. Coronaviruses, Wuhan is one among many, cause a variety of diseases and have been around for a similarly very long time. They are not going away. Pathogens are Nature’s way of making sure there are not too many of us living too close together under adverse circumstances. As with other chronic public health issues, like the flu, we need to reduce Wuhan virus infection to a rational risk.
What is rational risk?
Rational risk may not sound familiar, but it is something we each deal with every day of our lives. Every time you get in an automobile, you risk death, injury, and legal proceedings. Let’s not even talk about air travel! We could fall down the stairs or slip on the ice. When was the last time you used a public restroom? Yuk!
Have you ever stamped your feet at a flock of pigeons as they swarmed about? It’s great fun, especially for children. If there was a pigeon scientist, he would say, why are you all flying around? The children are just having fun. Yes, they could step on you, but really that is not very likely. Besides, if you fly away, you’ll miss the luscious peanuts there on the ground! Hysteria is unreasonable fear. Fear, especially of the unknown, is a primitive and highly motivating human emotion. Often, it is over done, but not always, of course. Have you never lain awake at night worrying about what coulda, woulda, shoulda, mighta happened, but never did? I am not saying Wuhan virus is in the same category, but it is manageable. It’s not rocket science. Implicit in this is the mandate for Public Health efforts and while these certainly include vaccine and other medicinal strategies to control, prevent, and treat, they also involve social considerations. Yes, we are our brothers’ keepers. But, let’s not be pigeons! Be vigilant, be suspicious whenever you see fear being used to drive political agendas.
My Rx for staying healthy:
How can you achieve rational risk with infectious disease? While these recommendations below are referenced to Wuhan virus, you can generalize them to other pathogens. You cannot eliminate all risk unless you’re dead.
Wash your hands.
Stay away from sick people.
If you are sick stay away from people.
Cover your mouth when you cough or sneeze.
Don’t pick your nose unless your hands are clean.
Don’t rub your eyes unless your hands are clean.
Don’t chew your fingernails unless your hands are clean.
Don’t kiss grandma on the mouth.
Get vaccinated or don’t; YOU are responsible for YOUR own health. If you are a carrier and you spread the virus to another and they die, YOU are responsible. Period.
Wear a mask if you have not had Wuhan or been vaccinated; or you’re not sure and you’re afraid.
Exercise.
Wash your hands for God’s sake!
Do you know what has saved more lives historically than all the vaccines, antibiotics, medical technologies, and public health measures we enjoy? Hand washing. Think about it.
I hope this piece has been a little bit entertaining, but most of all useful. Be mindful of people promulgating irrational fear: sloppy journalists, media experts, any politician. Be wary of numbers that are not well understood or their significance is unclear. Remember, everyone is selling something, even old scientists 😉
I look forward to your comments, below.
UPDATE 9/18/21: I have been thinking about this discussion more deeply and wanted to leave with a last comment. Regarding mandatory vaccination, what does it matter? If you don’t wish to protect yourself because you resent government overreach or you think there are mind-control nano-probes in the injection, go ahead, becoming infected is essentially inevitable. You personally will bear responsibility for the implications of your choice. If you are a vaccine advocate, what do you care? You are protected as best as medical technology can provide today. The new vaccines are incredibly effective against Wuhan and its variants. Period. Why do you feel you have to coerce everyone else into your point of view? For God’s sake, let’s get over the effing hysteria.