I’m getting tired of people, governments, and news stories being alarmed every time a new variant arises. This is exactly what smart people have been predicting. It’s what viruses do, especially this one. Expect more of it, adjust your thinking, and take sensible actions!
I don’t know everything but I’ve studied this enough that no recent virus news surprises me, so it appears things have become predictable enough to be manageable if you’re willing to think. If you’re not, then move along … there’s nothing for you here. :-)
Here’s a dump of everything actionable I’ve learned in recent months, for people who want to understand what actions makes sense.
… specifically his weekly podcast from the U of Minnesota. This epidemiologist, a quirky loving grandpa of a scientist, has been correctly predicting what we can anticipate since the beginning. (Strange how 40 years in a scientific field can make you know what to expect!)
Lots of people didn’t like it last April when he said “The worst of this virus is yet to come – watch out for variants.” And what’s happened since then? Did he know what he’s talking about?
— 2020: 20.3 million cases, 354k deaths
— 2021: 48.8 million cases, 786k deaths (1/1/21-12/2)
So, do you want to keep getting shocked, or would you like to know what to anticipate for a change, so you can plan?
How did he know this? He’s been around epidemics his whole life.
He’s not always right in all details – often says there’s mud on his crystal ball – but Osterholm is the main reason I don’t get surprised or alarmed anymore, because he knows what we can anticipate.
Watch the numbers on hospitalizations and deaths, not infections
“Mild” cases should not be reported in the same breath as hospitalizations. They are not the same threat to you or the healthcare system or the economy! All infections are not equal, not even coronavirus infections. When you get an ordinary cold, that too is an infection, but it’s no cause for alarm.
It will be a great moment if we get to where COVID is like that – where lots of people catch it but it’s no worse than a cold or a headache. It would mean we don’t need lockdowns … and guess what: there’s something right now that’s moving in that direction (read on):
Vaccines protect against hospitalizations, ICU cases, and death, even if you get the bug
Getting vaccinated doesn’t keep you from getting exposed to the virus – you’ll still get exposed to whatever risks you encounter. But it minimizes your risk of infections – and your loved ones’ – and of getting hospitalized and dying.
Look: in the latest CDC data (September) unvaccinated people were 5.8x more likely to get infected and 14 times more likely to die. Make your choice.
At that link you can push buttons to look at other numbers too.
What to do? Read on:
Get vaccinated and “boosted.”
And make others around you do so too.
I put “boosted” in quotes because months ago Osterholm said he wasn’t sure two doses make you fully vaccinated – this vaccine may need a third “prime,” he said, before its full protection takes effect. (Weeks later people like Fauci started saying it.)
“Adverse reactions” to COVID vaccines happen but they’re very rare.
They do happen but they’re infinitely less likely to happen than the number who actually are getting sick or dying. Here’s the best available info I have:
- 28.5 million new infections this year in the US, out of 258 million over-18 population. That’s 110,000 COVID cases per million US adults this year alone (so far, through December 2)
- 432,000 COVID deaths this year in the US, out of 258 million. That’s 1,674 deaths per million people (so far, through December 2)
- Severe vaccine reactions (anaphylactic shock or myocarditis): 11.4 per million doses.
Variants will keep happening until the whole world is vaccinated. Don’t be surprised.
Viruses mutate. Osterholm’s said for a year that as long as there’s “dry wood” for this “wildfire” to burn, it will keep happening … and as the virus wanders around the world, it will inevitably stumble into places with low vaccination rates, and have a field day. And every new infection is another chance for it to mutate. It’s going to keep happening.
Importantly, the New York Times podcast “The Daily” said this week that there’s greater risk in countries where immune systems are weaker, which is true of southern Africa, because in populations where lots of people have weakened immune systems, a virus can hide and “simmer” for a long time without noticeable outbreaks, piling mutation on top of mutation, because people with low-grade infections aren’t strong enough to just kill it. (Omicron has 50 mutations.)
Until the world is vaccinated, this will keep happening. Plan for it. And support proposals to get the whole world vaccinated!
Understand “variants of concern.”
Variants are random and most aren’t important, but one in a zillion has some of these important features that make it a variant of concern (another term I first heard from Osterholm long ago)
- more transmissible (more infections, more contagious), and/or
- more serious illness, and/or
- more deadly, and/or
- more likely to escape detection in tests, and/or
- more able to evade immunity & vaccines.
Notice: when a variant of concern arises, by definition, it will spread quickly. Right now in the US, news people are urgently announcing every new state where omicron shows up – well, duh! This is not news! (Some observers are pointing out that travel restrictions are relatively pointless because within a few weeks it’ll be everywhere no matter what we do.)
What will be news is whether omicron turns out to create severe illness and death, or just a lot more mild cases.
Avoid 15 minutes of an infected person’s air.
A year ago we thought the danger threshold was spending 15 minutes sharing an infected person’s air all at once. The National Football League put sensors on all players to track their actual movements and connections and learned it’s actually 15 minutes over 24 hours.
Of course in any give room if you don’t know who might be infected, don’t stay in the same confined space with anyone for long. Especially if you don’t know how good the ventilation is. (See below about CO2 monitors.)
You don’t have to put up with people who endanger.
We banned a relative from sharing our Thanksgiving table because s/he insists that vaccines are bogus or risky, and even with family, we are serious about defending ourselves. S/he was puzzled and saddened when all other relatives did the same.
This person had already given one elder a breakthrough case of COVID, and when confronted with the news said, “Stop bullying me.”
You don’t have to put up with people like this who are more concerned with their own “right” to be irresponsible than with the actual harm they’ve actually caused actual others. In this case the perp even felt it was wrong for other people to make them feel bad about the harm!
Science works, better than ever.
It’s astounding that omicron was first reported nine days ago (November 24) and studies are well under way to understand its behavior and evaluate whether existing vaccines will protect against it. (A podcast I heard this morning said “But that might take weeks.” Weeks?? For something that’s less than two weeks in our world??) Astounding.
Some vaccine skeptics worried at first that the vaccines hadn’t been tested enough; some couldn’t believe that a vaccine could possibly be developed safely so fast. Well, they were out of date – dangerously. These mRNA vaccines are from a different generation.
Go back and look at the graph showing how well the vaccine protects against death (it works), and look at the incidence of deaths per million compared to vaccine reactions. (The virus is 150x more likely to kill you than the vaccine’s risk of severe reaction without death.) Good science bleeping works.
Think. Act rationally to defend your family.
In case it’s not clear by now, it’s entirely possible that any day now (or week or month) a super-deadly super-viral variant might arise. No amount of wishful thinking will prevent this. So, think ahead.
- Get vaccinated and tell everyone around you to.
- Even if a vaccine isn’t perfect, it’s the best way to reduce spread and reduce the worst disease: hospitalization, ICU, death.
- Stay away from people who won’t get vaccinated.
- If you’re forced to be in a room with one, open doors and windows, stay away from their breath stream, and leave when you can. You cannot know whether they’re infected. You can only take action.
- Wear masks when indoors.
- Remember the importance of ventilation (fresh outdoor air), to dilute pollutants including any coronavirus.
Re ventilation, I’ve blogged several times about CO2 meters as a good way to measure ventilation, and I recently upgraded to a pocket-size one (see photo) so I can take it where I want. It’s not cheap ($249) but it’s let me prove important things for myself, like, the air is fresher near the supermarket door than in the back – so I should get what I want back there and leave, not linger. Update 12/12/21: I found a budget alternative, $79.
Most of all, remember that we have no idea when a super-variant may come along. Don’t be surprised. Think ahead, and be prepared.
Bill Reenstra says
Very nice synopsis.
I would point out that antibodies produced in response to Covid infection and to immunization, confer immunity by binding to discreet sites on the spike protein. There are several sites on the spike protein that are bound by anti-Covid antibodies. I have never seen these sites reported in the lay press. For a mutant to escape the immune system it must mutate at these sites so that the structure is altered and antibodies are no longer able to bind. A comparison of known antibody binding sites with mutation sites should allow a biochemist to make a very good estimate of how effective a given mutation will be in evading the immune system. However, it still needs to be confirmed in vivo.
Another point is that viral binding to a receptor is the first of several dozen necessary biochemical steps leading to the release of newly formed virus from the infected cell. New drugs that target some of these key steps are being evaluated by the FDA and may become another line of defense in our war on Covid. However, they will NEVER replace vaccination and social distancing from potentially infected individuals.
e-Patient Dave says
Bill, I’m so happy to hear that you approve of this summary. I well remember that you’re no pushover or cheerleader for air-headed or mistaken assertions :-)
(For those who don’t know, Bill has been a friend since college, a retired Berkeley professor who’s always been quite picky about detecting unscientific thinking.)
Bill, I’m parsing your spike protein remarks. My impression from high-end news reports (i.e. not TV) is that the “few weeks” I mentioned is exactly for that kind of work, though it didn’t mention the issue of specific sites on the spike.
Good post; thanks, Dave.
Unfortunately, those who disbelieve in the virus, take the following illogical routes:
1. If the events DO NOT match the predictions exactly: See? The scientists were all wrong, and they don’t know what they’re talking about.
2. If the events DO match the predictions exactly: Suspicious, isn’t it? These people make a prediction and then it suddenly comes true. (Like, I’m sure that weatherman on TV last night caused the rain today: how else could he have been so accurate?).
e-Patient Dave says
Always good to hear from you, Ken. Thanks for being the e-patient voice in the world of medical continuing education.
Re the topic: in my advocacy work I’ve always asked “What could be said that would make any difference?” It’s a hard question when any audience thinks “It’s all BS. I don’t believe any of it.”
Honestly I won’t be surprised if someday (in the next year, or not) a variant comes along that kills a lot of hard-core skeptics, performing a sort of Darwinian purge. Some will surely blame it on anything other than boring old reality.
But I’ve also started reading Carl Sagan’s 1996 book “The Demon Haunted World,” which recounts how people thought before science made interventions *dependable*. A classic, horrible example is torturing suspected witches: if they didn’t confess it proved they were supernatural and guilty.
Many folks use the book to assail today’s anti-science thinkers, but I’m trying to find a line of thought that those people can perhaps “hear” as a path to rethinking things.
Catherine Rose says
Dave, I have a renewed focus on CO2 with Omicron. Got my monitor for early Christmas present. Been regularly trending between 600-800 and then opening windows/doors to get fresh air into house. I found this article may be useful to others (echoes many of the items you have captured already) — https://ncceh.ca/sites/default/files/FINAL%20-%20Using%20Indoor%20CO2%20Sensors%20for%20COVID%20MAY%2017%202021.pdf
e-Patient Dave says
Catherine, that’s a really interesting article. What do you make of its lengthy exploration of the subject, particularly its warning that CO2 concentration shouldn’t be used as too accurate an assessment of virus risk?
In my first posts on the subject I described it (based on my academic friend’s advice) as a “valid proxy,” since we can’t directly measure the virus itself in the air.