Covid: It ain’t over till it’s over…

…as the endlessly quotable Yogi Berra may or may not have said.

But forget Berra. The World Health Organization, a.k.a. WHO, isn’t as much fun to quote but it knows how to do footnotes, and that makes it more impressive. In its opinion, the pandemic isn’t over. Between the beginning of 2022 and late August, at least a million people around the world died of Covid. 

Or if you want to start counting at the beginning of the pandemic, that’s 6.45 million. Both numbers undercount the damage, but never mind that. Let’s work with what we’ve got.

”We have the tools that can actually prevent these deaths,” said Maria Van Kerkhove, WHO’s technical lead on Covid. “A lot of people are talking about living with COVID. But we need to live with this responsibly. A million deaths this year is not living with COVID. Having 15,000 deaths per week is not living with COVID-19 responsibly.”

In one recent week, more than 5.3 million new cases were reported worldwide, a number that doesn’t include people who registered positive only on a home test. Or who never tested.

“These are huge numbers, and that’s an underestimate,” said Van Kerkhove. “We do see this virus circulating really intensely around the world.”

Irrelevant photo: an orchid

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That brings me to the question of why I keep banging on about Covid. Apologies if I’ve gotten boring–Notes isn’t supposed to be mindless, but it is supposed to be a fun read. The problem is that scientists keep coming up with new information. What I’m saying here is, Blame the scientists. If they weren’t so damn good at this, it wouldn’t end up in your inbox.

And if that isn’t a good enough reason, it’s because it still matters. Living with Covid doesn’t have to mean pretending it’s no danger.

 

Long Covid 

Let’s talk about long Covid. Again. Sorry to keep coming back to it, but not long ago someone challenged me on the extent of the problem (my thanks; it was an interesting discussion) and since long Covid’s hard to define and at least as hard to measure, I didn’t have great statistics to offer. But I have started to see some lately, so let’s play with numbers. They all involve money, since it can be counted, and when you’re dealing with something as hazy as long Covid that’s useful. Besides, as we all know, money matters more than life itself.

So let’s talk money: A report from the US estimates that 4 million people are out of work with long Covid, which could mean $170 billion in lost wages. In a year. The report’s author,  Katie Bach, said, “If this looks like other post-viral illnesses, some people will recover, but there will be this big stock of people who don’t, and it will just continue to grow over time.”

She called it “a shocking number.” 

In mid-2021, the Federal Reserve Bank of Minneapolis estimated that 26% of people with long Covid were out of work or had cut their working hoursAn international survey found that 22% of people with long Covid weren’t working and 45% had cut their hours, and a U.K. survey found 16% had reduced their hours and 20% were on paid sick leave. That was between April and May 2021.

Australia’s treasury reports that the country’s lost 3 million working days to long Covid. Or to put that another way, 31,000 people have missed work every day because of it. 

 

So how many people have long Covid? I’m not sure anybody has a reliable count, but the U.S. Centers for Disease Control estimate that 19% of people who’ve had Covid get long Covid symptoms. Unfortunately, the number’s less helpful number than it sounds like, because long Covid’s symptoms range from relatively mild to completely hair-raising and the duration ranges from weeks to the possibility of a life sentence.  

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Are we having fun yet?

Evidence is growing that people who’ve had Covid face an increased risk of neurological and psychiatric problems as much as two years after their infection. That’s not the final word on the subject, but it comes from a study that followed 1.28 million cases over two years. It does seem to be a strong hint. 

The good news? Depression and anxiety are generally gone after two months and are no more common after Covid than after other respiratory infections. And kids are at the lowest risk for kids for later complications. 

End of good news.

Adults 64 and under showed an increased risk of brain fog–640 cases per 10,000 people vs 550 cases per. Over 65s? The number went up to 1,540 per compared to 1,230. For dementia (we’re still talking about the over 65s here) it was 450 instead of 330. Psychiatric disorders? That’s 85 instead of 60. 

Is there anything can we do about it? Hell yes. I’m going to petition the courts to lower my age.

Does the risk end after two years? We haven’t had enough time for anyone to find that out. 

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A theory that’s loose on social media holds microclots responsible for long Covid, and some evidence does back that up, but (as one article says) hematologists worry that enthusiasm for the theory has gotten ahead of the data.

Danny Altmann, an immunologist at Imperial College London, said, “We’ve now got little scattered of bits of evidence. We’re all scuttling to try and put it together in some kind of consensus. We’re so far away from that. It’s very unsatisfying.”

But that’s not stopping a few medical groups from offering treatment to remove the clots, and some people with long Covid are desperate enough to try anything, which I can understand. But at least some treatments to get rid of clots risk messing with the blood’s ability to clot, and that (she said, indulging in a mild understatement) would not be a good thing.

 

How Covid’s changing

Its incubation period—the time between when a person gets infected and when they’re shedding enough of the virus to infect other people—is getting shorter, and the shorter that time that period is, the harder it is for vaccines to keep the virus from spreading.  

Yeah, that was news to me too. Measles and rubella have a two-week incubation period, which allows time for a vaccinated person’s immune memory cells to crank out antibodies and keep the person from passing the bug to other people. So vaccines for those diseases stop the spread. In contrast, a Covid vaccine, although it protects the wearer, doesn’t protect the wearer’s friends. Or enemies. 

On the bright  side, the shorter incubation time means people who test positive might not have to isolate themselves for as long.

Every cloud has a silver lining, but the problem with that is that silver linings are too heavy to float. Watch out for falling silver linings.

 

Expired tests

You may (or may not) remember that a while back I wrote about the expiration dates on Covid tests. After they pass those dates, I led you to believe (if and only if you read it, of course), they start to call in sick and miss work. Well, I need to update that. The U.S. Food and Drug Administration set the expiration dates in the early days of the pandemic, on the basis of the limited information that was available at the time, but manufacturers are testing aging tests them and some turn out to be good beyond their expiration dates.

How do you know if yours still good?

“To check whether your test kit is still good beyond the printed expiration date, you can search on the FDA’s “At-Home OTC COVID-19 Diagnostic Tests” website.

“Type in the brand name on the FDA site, and a link will appear showing a list of updated expiration dates.

“You may have to check the lot number on your package. For instance, say you’re trying to look up an iHealth COVID-19 test kit with lot number 222CO20208. Scroll down the document to find your lot number, and you’ll find that the original expiration date of Aug. 7 has been extended to Feb. 7, 2023.”

Apologies.

 

An update on Hafiza Qasimi

In early August, I wrote about Hafiza Qasimi, a woman artist fleeing Afghanistan after the Taliban destroyed her paintings and left her unable to work. The campaign to raise the 10,000 euros she needed to apply for a German visa has reached its goal. This allows her to demonstrate that she can support herself for her first year in the country. (The amount will be raised to 11,208 in January.)

In the meantime, Qasimi has reached Tehran. I have no idea how she did that. In Afghanistan, women aren’t allowed to either travel or leave the country unless they’re with their husband or a male a relative. But she managed it, she’s safe, and she’s been offered a three-month residency at a German art gallery is she can get that visa.

The group supporting her is trying to raise more than the 10,000 euro minimum so that she can afford health insurance and other basics. They’re also working with her on a grant application that would allow her to study at art school.

“This,” they say, “will provide her with the space she needs, as a free woman, to renew and develop her artistic work. We are full of confidence and look forward with Hafiza to the future.”

Her brother, who lives in Germany, will be flying to Tehran to see her for the first time in eight years.

If you want to contribute to the fundraising campaign, any amount will be welcome. And if you don’t (or would love to but can’t), that’s okay. Do what you can where you can and wish her joy in her freedom.

Can fermented soybeans destroy Covid?

It’s too early to celebrate this, but from Japan comes the news that an extract made from natto–a sticky food involving fermented soybeans–inactivates Covid’s spike protein by digesting the receptor binding domain.

What’s a receptor binding domain? No idea, but Covid’s spike protein needs it, so anything that digests it has got to be good–at least from our point of view.

The extract of natto works on all the existing variants.

The reason it’s not time to celebrate is that so far it’s only worked in a lab. No one’s gotten the natto and the virus together inside the body. Eating natto won’t help. Neither will sending the virus invitations to a party and serving natto hor d’oeuvres. No matter how much it mutates, the virus will continue to be illiterate, so it won’t show up.

Irrelevant photo: a wild orchid.

The next stage is to isolate the molecular mechanism that’s destroying the–what was that called?–the receptor binding domain. Figure that out and you could well have a treatment for Covid. 

Possibly. At some time in the indistinct future. But c’mon, we need all the hope we can find.

 

England’s world-beating experiment in irresponsible government

On July 19, England took what little common sense it had forgotten in the drawers of 10 Downing Street’s desks and set it on fire. It’s been dry lately, but there wasn’t enough common sense to burn for long, so we didn’t get the second Great Fire of London, just another round of Covid stupidity.

To be clearer about this, nightclubs are now open. So are bars, restaurants, and pretty much everything else you can think of. It’s up to you whether to throw your mask away and sit nose to nose, indoors, and sing loudly with six of your favorite strangers and no ventilation. Or with thirty of them if you can get your noses close enough. Crowd limits are out of fashion, along with distancing. 

The first day of that was called Freedom Day. Those of us currently cowering under the covers are free to cower under the covers. Unless of course we have to go to work or in other ways mix with the rest of humanity.

The official justification for this is that vaccination has severed the link between infection and hospitalization. Or weakened it, depending on when you listen to the explanations and who gives it. We have to return to normal life. We have to live with Covid. The economy needs us. And if not now, when? 

Maybe when it’s safe, that’s when. Because the link between infection and hospitalization hasn’t been severed, it’s only been weakened, and that’s not enough. The number of infections is going up, and so is the number of deaths. Not as sharply as it once would have, but more than it would if we kept to a marginally sensible policy.

And the thing about deaths is that once people are dead, they’re gone. It’s kind of irreversible.

The government’s Scientific Advisory Group warns that the combination of a large number of vaccinated people and a high number of infections creates the perfect conditions to create a variant that will escape the vaccines. No one can know whether that will happen–vaccines mutate randomly–but the likelihood increases as the number of infections increases.

And while all this is shoving us in one direction, Boris Johnson says vaccine passports will be required for nightclubs etc.–but not until the end of September. Between now and then, let Covid rip.

What are they thinking? One of the government’s scientific advisors, Robert West, says it’s “a decision by the government to get as many people infected as possible as quickly as possible, while using rhetoric about caution as a way of putting the blame on the public for the consequences.” 

That wave of infections would combine with the number of vaccinated people to push the country toward herd immunity and the virus would no longer spread.

What are the problems with the strategy? Well, in addition to opening the doors to a variant that evades the vaccines, no one knows what level of immunity is needed for herd immunity to Covid. The best guess is 85%. And then there’s long Covid–the long-term damage that some people live with for no one knows how long, after even asymptomatic infections. 

The government says that’s not its strategy. You’re welcome to believe it if you like. 

And a unicorn just pranced down the street outside my window. You’re welcome to believe that as well. It was wearing a tutu and singing a Mozart aria.

Not long ago, the Netherlands opened everything up and Covid infections rose sevenfold. They’ve since closed bars, restaurants, and nightclubs.

England’s reopening has caused the Covid tracing app to warn an annoying number of people that they’ve been exposed to Covid and should self-isolate–more than 600,000 last week–and that in turn has led to a lot of people being off work.

So what’s a responsible government to do about that? 

We don’t have one of those, so who cares? Instead of deciding that too many people are being exposed to Covid because we took all our restrictions out and burned them, the government’s decided that too many people are being notified, so it’s created a list of crucial occupations whose employees can ignore the app if they’re double vaccinated–although they will at least have to test themselves. 

Can people who are doubly vaccinated spread Covid? Why look! It must be time to talk about breakthrough infections! Because buried in that segment somewhere is the news that we don’t have a clear answer to that question yet.

 

Breakthrough infections

First we need a definition of a breakthrough infection, even if you already know it: A breakthrough infection happens when a vaccinated person gets Covid–or (it can happen with any matched pair of disease and vaccination) whatever else they were vaccinated against. When that happens, it doesn’t mean the vaccine isn’t effective. It means the vaccine isn’t 100% effective, much as we wish the Covid ones were. 

That leaves us–or me anyway–wondering why one person will get a breakthrough infection and another won’t. The definitive answer is that it’s hard to say.

Thanks, Ellen. That was really helpful.

Sorry, but I can only pass on what I find. The direct quote is, “It’s difficult to determine why any particular breakthrough case happens.” 

How large a dose of the virus you’re exposed to might make a difference–with the emphasis on might. Our individual immune systems will make a difference. They can be affected by health problems and by medications that make an immune system respond to the vaccine less enthusiastically.

And new variants can make a difference. The vaccines were developed for the Covid 1.0, or 2.0. We’re now onto–

Hang on a minute. I have to go look up the Greek alphabet and figure out where Delta comes. 

We’re now at Covid 4.0.

It’s also possible for a person to have gotten a vaccine dose that wasn’t administered correctly, although that’s a lot less likely. And no, I’m not sure how you administer a vaccine the wrong way either. Maybe you let the stuff get too warm. Maybe you let it expire. Maybe you miss the arm entirely and inject it into the hat. That last one is the reason they don’t let me do vaccinations anymore.

People who are (fortunately) better than I am at figuring this stuff out are tracking the number of breakthrough infections, looking for evidence that the vaccines’ are wearing thin and booster shots are needed. So far, they haven’t seen it. 

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We can break breakthrough infections into a few categories, and in order of decreasing likelihood they are: 1, testing positive, 2, having a mild infection, 3, having a serious infection, and 4, dying.

Patients are strongly advised to keep themselves out of category 4. 

If you’ve absorbed that advice–and it is important–we’ll move on to the question of whether fully vaccinated people who’ve been exposed to the virus should have to go into isolation. In the US, the Centers for Disease Control (citing “limited evidence” according to the article I found) says they not only don’t need to go into isolation, they don’t need to get tested unless they develop symptoms. The theory is that they’re less likely to infect other people than unvaccinated people with asymptomatic infections.

Other countries are making different rules.The evidence is limited, the lights are off, and we’re all bumping into the furniture. 

What percentage of fully vaccinated people test positive after being exposed to Covid? If anyone has numbers on that, I haven’t found them.

What does seem to be well established is that breakthrough infections are rare, and we do have statistics (sort of) for categories 3 and 4–the one you want to stay out of and the other one you want to stay out of. In the US, 5,492 vaccinated people were either hospitalized or died and also tested positive for coronavirus. That doesn’t exactly say they were hospitalized for or died of Covid, but it’s as close as we’re going to get. That’s 5,492 out of the 159 million people who’ve been fully vaccinated. I’ll leave someone else to figure out what percent that is and just say it’s small.

Most breakthrough infections are mild, and the number of mild or asymptomatic infections will be larger, but again if numbers are available for that I haven’t found them.

 

A different way to live with Covid

Is it possible to return to normal life in some sane and safe way? A study from Barcelona points us toward a possibility. It followed the 5,000 people who attended a carefully controlled indoor concert. 

People were screened on the way into the concert, using an antigen-detecting rapid diagnostic test (it’s called an Ag-RDT if you want to sound like you know what you’re talking about), and the test was done by nurses. At least with other rapid Covid tests, that makes it more reliable than when people do it themselves, probably because they maneuver those nasty swabs into the right spots.

Everyone wore masks–specifically, filtering facepiece 2 masks–the whole time. Presumably over their noses and mouths, not their chins or back pockets. They look like this.  (I’m conducting a one-person boycott of Amazon, but I’m not above using them as a link if I don’t have to give them money.) They’re a kind of mask that offers more protection than your average cloth mask, but they’re disposable, which if everyone used them everywhere would create its own set of problems. Especially since a few of us out there hate throwing things away when they still look usable. 

But enough of that. Let’s move on.

The event’s described as a concert but people danced. People sang (presumably along with the music but it shouldn’t really matter from a medical point of view.) No one was asked to keep 6 feet away from anyone, at least by the organizers, although some predictable number of individuals will have told some predictable other number of individuals to back off. 

I don’t have details on the ventilation except for a passing mention of improved ventilation. Ventilation’s probably the most overlooked way to make work and public spaces safe. 

The event was held in an area that at the time had a moderate rate of Covid and a low number of vaccinated people. 

What happened? The followup found 6 cases of Covid two weeks after the event. Three of those were traced to sources other than the concert. Another person may have been in the incubation stage when she attended the event and could’ve been missed by the test. No one’s figured out where the other two cases came from. 

Which isn’t bad for 5,000 people. So it can be done if we have the will to do it.

 

. . . and in the schools

In the US, the American Academy of Pediatrics is calling for all students, teachers, and staff to wear masks in school, whether they’ve been vaccinated or not. That runs counter to Centers for Disease Control advice, which exempts the vaccinated and says the unvaccinated should wear masks in school to protect themselves.

Even though–apologies, CDC–your average mask is better at protecting people around the wearer than at protecting the person sporting one.

The article I got this from has the first statistics I’ve seen on how many kids get multi-system inflammatory condition (called MIS-C, in case you have any need to address it directly): It’s 1 out of every 600 infected children and teenagers. That’s not the same as 1 out of every 600 kids, only out of the ones who get infected.

MIS-C is seriously serious and more often than not will land a kid in intensive care. It comes several weeks after the primary infection.