Category: Medical Science

Since I wrote about the Pfizer vaccine being shown to be effective against COVID-19, people have asked me whether or not those who were previously infected should also get the vaccine. While I tell everyone to talk with a physician who is familiar with their medical history, as a scientist, I didn’t think vaccination after infection was beneficial. That’s certainly true for the vast majority of pathogenic viruses, so it made sense that it was true for the virus that causes COVID-19. In addition, two studies (here and here) indicated that immunity from infection was slightly more effective than immunity from the vaccine. However, a new study has just been published that has changed my mind on the issue.

The study looked at 246 patients who had been infected by COVID-19 in 2020 and then had a laboratory-confirmed reinfection in May or June of this year. It then matched them with 492 people who were roughly the same gender, roughly the same age, had been infected with COVID-19 at roughly the same time in 2020, and had not been reinfected with the disease. It compared the vaccination status of the 246 participants and the 492 controls. It found that those who had been infected but had not been vaccinated were 2.34 times (that number is poorly known, see below) more likely to be reinfected with COVID-19 than those who had been infected and were fully vaccinated (either two doses of the mRNA vaccine or one dose of Johnson & Johnson). Thus, the study indicates that vaccination after infection provides more protection than infection alone.

Why does this study contradict the two previous studies? Most likely, it’s because of the variants that have appeared. The earlier studies looked at reinfections that occurred before the variants had become prevalent in the U.S. The reinfections in this new study were more recent, so they probably contained more variants than the previous studies. Indeed, both of the previous studies list variants as an issue that they don’t address well. This interpretation is supported by another study that indicates vaccine-produced antibodies are significantly more effective against variants of the virus than those produced from infection.

Now I do have to include a couple of important caveats. First, this is a pretty small study, as a result, the statistical error is large. The study says people who were infected and not fully vaccinated were 2.34 times more likely to get reinfected. However, when the small nature of the study is taken into account, that number has a 95% chance of being as low as 1.58 or as high as 3.47. That’s a pretty wide range, indicating that the risk is not well known. However, despite the wide range, the conclusion that the vaccine offers more protection to those who had been previously infected is reasonable.

The study lists five limitations, each of which needs to be considered as additional caveats. However, I will highlight only one of them:

…persons who have been vaccinated are possibly less likely to get tested. Therefore, the association of reinfection and lack of vaccination might be overestimated.

I agree with that. I know many people (my wife included) who got tested for COVID-19 before being vaccinated, but have not been tested since being vaccinated. Since the study is small, it is possible that this issue could radically change the result. Thus, more studies need to be done.

Based on the information that exists right now, however, I do think that those who were infected with COVID-19 would probably be better protected if they got vaccinated. We don’t know that for sure, but the data are certainly leaning in that direction. Of course, no one should get any medical treatment (vaccine or otherwise) without getting the advice of a physician who is familiar with his or her medical history. Everything you put in your body (including food) comes with a risk, and your medical history helps a physician determine that risk.

A new study was recently posted on Medrxiv, a preprint server that allows you to post research articles that are currently being reviewed for publication. This particular study focused on using a very common inhaled medication, budesonide, as a treatment for COVID-19. It was conducted in a single community in the UK and used 146 subjects, all of which were over the age of 18 and had experienced symptoms suggestive of COVID-19 for 7 days or less. All were given the standard treatments for COVID-19, but half were also given an inhaler that contained budesonide and were told to use it twice per day. The authors wanted to see if this medication, which is known to reduce exacerbations related to COPD and asthma, would be effective in reducing the severity of COVID-19.

The study indicates that it is very effective. The authors found that 10 people in the group getting the normal treatment had a COVID-19-related urgent care visit, emergency department assessment, or hospitalization. Only 1 person in the group that got the usual treatment plus budesonide had that kind of outcome. In addition, the group that got budesonide recovered, on average, a full day earlier than those who did not get it. Finally, fewer patients in the budesonide group had persistent symptoms after 14 and 28 days. Thus, it seems that budesonide does aid in the treatment of COVID-19.

What prompted the study? As the authors state:

In early reports describing COVID-19 infection from China, Italy and the United States, there was a significant under representation of patients with asthma and chronic obstructive pulmonary disease (COPD) in patients hospitalised with COVID-19. We hypothesized that this may be due to the widespread use of inhaled [chemicals like budesonide] in these patients. (reference marks removed by me)

It looks like their hunch turned out to be right. Now, of course, there are limitations to the study. The sample size is reasonable, but not as large as that of a full-scale clinical trial. Also, it was conducted in a single community, which would provide a more homogenized group of people than a study conducted over a large geographic range. Nevertheless, the results are so dramatic that it is hard to understand how these limitations could invalidate the results.

If you end up experiencing COVID-19 symptoms, ask your physician about this study and whether or not budesonide might be a viable treatment option for you. Please note that like all medications (and foods), this medication has potential side effects in some people, so you shouldn’t take it without consulting a physician who knows your medical history.

As I have said countless times before, social media is a horrible source for information. Someone can post a lie, and people who are too lazy to investigate issues for themselves will simply share that lie. Pretty soon, lots of people have been fooled. This is especially true when it comes to the COVID-19 pandemic. Consider, for example, the image on the left. It claims that with just two weeks left in 2020, the total number of deaths in the United States was lower than the total number of deaths in 2019. This, of course, is meant to support the conspiracy theory that the COVID-19 pandemic isn’t real. The problem, of course, is that the post is simply false, and anyone who spends even a short amount of time investigating it will see that.

Back in September, I posted a graph that was widely available on the internet. I checked it with the data that were known at the time and found it to be accurate. Even back then, we knew that 2020 was lining up to be the deadliest year in history. In July, several news outlets (like this one) ran a story on a medical study that showed deaths in the U.S. had spiked by 18%. In October, more stories (like this one) reported that there were 300,000 excess deaths in 2020 compared to the same time frame in 2019. In late December, several stories (like this one) reported that 2020 was on track to be the deadliest year in U.S. history.

If you don’t believe these reports, you can check the data for yourself. I downloaded the file yesterday, and it indicated that there were 3,128,646 deaths in the U.S. from 1/1/2020 to the week ending 12/19/2020 (the last week available at that time). In 2019, the total death count was 2,852,610. Now please note that these numbers are still not final; they will both increase. The 2020 numbers will increase more with the final weeks being included and with new information coming in from very rural areas. Nevertheless, it is quite clear that 2020 was significantly more deadly than 2019. In fact, in terms of total numbers, it is the deadliest year on record. Even when you look at the increase in deaths between 2019 and 2020 as a percentage of the population, you find that it is second only to what happened between 1917 and 1918, when deaths as a percentage of the population rose by 46% because of World War I and the Spanish influenza pandemic.

There are many reasons to distrust the government. Indeed, there are many things that I think the government is lying about. In each case, however, I have come to that conclusion because I think the data demonstrate that the government is promoting falsehoods. In the case of the COVID-19 pandemic, however, the data are clear and easily found by anyone willing to invest even a modicum of effort investigating the issue. It is real, and it turned 2020 into the deadliest year in U.S. history.

Not long ago, I wrote a post about the COVID-19 vaccine produced by Pfizer. At that time, I only had access to the results of the small clinical trial, but those results were very encouraging. Now, the initial results of the large clinical trial are available, and they are even more encouraging. In short, the vaccine is 95% effective at preventing symptomatic cases of COVID-19 in the group that was being tested. While there were side effects, they were generally mild. Of course, not all kinds of people were tested. People under 16 years of age were not included in the clinical trial. Neither were pregnant women nor those who are immunocompromised. Thus, the results don’t apply to people in those groups.

Like most clinical trials used for licensure of a medication, this was a large-scale, placebo-controlled, double-blind study. That means a large number of people (43,538) were randomly assigned to receive either two doses of a placebo (an injection of saltwater) or two doses of the vaccine. The doses were separated by 21 days. Neither the people getting the injections nor the researchers directly involved in the study were aware of which injection each person got (that’s what “double blind” means). Once there were enough COVID-19 cases among all the participants to make a reasonable conclusion about the results, the researchers learned which injection each participant got. At that point, they could compare the two groups.

When they made the comparison, they found that starting seven days after the second dose, there were only 8 cases of COVID-19 in the group that got the vaccine doses, while there were 162 among those who got the saltwater injections. Thus, the vaccine clearly provides strong protection against COVID-19, at least among people like those who were in the study. Now please understand that people in the study were only tested for COVID-19 if they exhibited symptoms, so this says nothing about whether or not the vaccine protects against asymptomatic COVID-19 infections.

Of course, the small clinical trials had already shown that the vaccine would be effective at preventing symptomatic cases of COVID-19. This large-scale trial was done to confirm that result and, more importantly, to determine whether or not the vaccine is safe for the majority of people. While it is impossible to know for sure, all indications are that for people over 16 who are not pregnant and not immunocompromised, the vaccine is safe. The vast majority of vaccine recipients reported pain at the injection site, compared to only a small percentage of those who got the placebo. Small percentages of those who got the vaccine also reported redness and swelling at the injection site.

The most commonly-reported side effect after pain at the injection site was fatigue. In people aged 16-55, for example, 59% of those receiving the vaccine reported fatigue after the second dose, compared with 23% of those who got the placebo. The percentages were slightly lower for those over 55. Headache was the next most common side effect, followed by muscle pain, chills, joint pain, fever, diarrhea, and vomiting. Figure 2 from the study gives a good summary. There were a total of four people who had severe reactions to the vaccine. Those reactions were a shoulder injury related to administration of the vaccine, severely swollen lymph nodes, an abnormal heart rhythm, and unexplained severe sensations in the leg. There were two vaccine recipients who died, but there were four placebo recipients who died. None of the deaths were judged to be related to the clinical trial.

Based on these results, I plan to get the vaccine as soon as I am allowed to. My wife is in a high-risk group, and she will as well. My adult daughter and her husband have a business that requires extensive travel throughout the U.S. They will also be getting it. Whether or not you or your family get this vaccine (or one of the others that will no doubt become available over time) is up to you. Medical decisions are deeply personal and should be made in consultation with a physician who knows your medical history. I would never presume to tell anyone how to make such decisions. I simply wanted to communicate to my readers what I think the data say about this vaccine.

I will add one more thing. One of my readers said that she heard the COVID-19 vaccine can make women unable to have babies, because the vaccine is training the body’s immune system to fight a protein that is similar to syncytin-1, a protein important to the formation of a placenta. Thus, it is possible that a woman who gets pregnant after getting the vaccine will be unable to form a placenta. While it is true that the proteins are similar, their similarity is in their function, not their actual structure. Both proteins facilitate connection to a membrane, but they do so in very different ways. As a result, their structures are quite different, and a protein’s structure is what the immune system attacks. Thus, there is no reason to expect that the vaccine will cause the immune system to attack syncytin-1.

In addition, women who contract the actual disease would have the same problem, since the immune system attacks the same protein whether it comes from the instructions given by the vaccine or the virus itself. I don’t know of any reports indicating that women who contracted COVID-19 are unable to form a placenta. Finally, while pregnant women were excluded from the trial, 23 got pregnant during the trial. Twelve of them were in the group that got the vaccine. They are being followed, and as of the December 4th National Vaccine Advisory Committee meeting, no adverse effects have been found.

My previous post discussed two studies that seem to indicate masks have little effect when it comes to stopping the spread of COVID-19. I had several Facebook commenters who disagreed with my interpretation of the studies, which is not surprising. One commenter linked a recent study promoted by the CDC, which makes the remarkable conclusion that in Kansas, counties that adopted a mask mandate saw a 6% decrease in new cases, while those that did not adopt the mandate saw a 100% increase. If true, that indicates masks have a strong effect when it comes to stopping the spread of COVID-19. After reading the study and doing my own analysis of the numbers, I have to say that unfortunately, it is not true.

Once again, let me preface this by saying that I am not anti-mask. I wear a mask whenever I am in public, and I did so even before my state made it mandatory. In addition, I am not telling people to stop wearing masks. As I said in my first post, any mask not made specifically for viruses will be pretty much worthless in protecting the wearer. However, a mask does reduce the number of water droplets that the wearer spews into the air, and since those droplets can contain viruses, it probably does protect the people around the wearer, albeit to a small extent. Thus, you should wear a mask. At the same time, however, you need to have a realistic idea of what kind of protection it provides. So far, the data say it offers only a little protection.

With that out of the way, let’s look at the study. It examined various counties in Kansas that adopted a mask mandate on July 3, 2020 and compared them to the other counties that did not adopt a mask mandate. It developed a seven-day rolling average of new COVID-19 cases for both sets of counties and compared the numbers before July 3 and After July 3. The graph (shown near the bottom of the study) shows that while the 7-day rolling average continued to climb for those counties that did not adopt a mask mandate, it fell a bit for those counties that did. Thus, the mask mandate actually reduced COVID-19 cases, while lack of a mandate resulted in a steady increase in cases.

Continue reading “Kansas Confirms Mask Mandates Don’t Do Much To Prevent the Spread of COVID-19”

In the midst of this pandemic, most governments are requiring people to wear mask in public. I will start this by saying that I began wearing a mask early on in the pandemic, long before any mandates were made. I didn’t wear one because I thought it would be effective. Even a basic understanding of science tells us that standard masks provide little protection against the spread of a virus. Protecting yourself against a virus using a mask that is not made specifically for viruses is roughly equivalent to protecting your yard against mosquitoes by installing a chain-link fence.

However, a mask does reduce how many water droplets you spew into the air, and since those droplets can carry viruses, there is probably some small protective effect for those with whom you come into contact. I wore a mask early on simply to put others at ease. Now I wear one because I think people must follow a society’s rules (unless they are immoral) in order to be a functional member of that society. If the mandates were lifted, however, I would still wear a mask in public until the pandemic dies out, simply because some people think it protects them, and I want to put such people at ease.

Having said that, there has been one study that concluded mask mandates reduced the rise of COVID-19 infections by a tiny amount. However, the study couldn’t conclude that the masks were the cause of the tiny decline. Most likely, when a mask mandate is instituted, people become naturally more cautious, limiting their social interactions, being more aware of social distancing, etc. Thus, it’s possible that the masks had nothing to do with the small reduction in COVID-19 cases.

My publisher sent me a recent study that tries to address the question a bit more effectively than the study linked above. It didn’t test masks directly, because it would be impractical to follow people around making sure they were wearing their masks. However, the study gave 3,030 people a set of recommendations for protecting themselves against COVID-19. They included things like social distancing, etc., as well as the recommendation to wear a mask, 50 surgical masks, and instructions on how to use them. The study also gave 2,994 people the same set of recommenstions, minus the mask recommendation, the masks, and their instructions. After 1 month, they tested people for COVID-19 antiboides. This was all during a time when their communites did not issue any mask recommendations or mandates.

The results showed that slighly fewer people in the mask group contracted COVID-19 than those in the no-mask group. However, because the number of people who contracted COVID-19 during the study was small, the difference between the groups could have been the result of random chance. In the end, the authors use basic statistics to conclude that the mask group was somewhere between 46% less likely to get the disease and 23% more likely to get the disease. As they say:

The recommendation to wear surgical masks to supplement other public health measures did not reduce the SARS-CoV-2 infection rate among wearers by more than 50% in a community with modest infection rates, some degree of social distancing, and uncommon general mask use. The data were compatible with lesser degrees of self-protection.

Now, of course, we have no idea what percentage of the people in the mask group actually followed the recommendation, but the study made it pretty easy to do so. Combined with the study I linked at the beginning of the post, I think we can conclusively say that if the typically-used masks provide protection against COVID-19, it is small. Thus, when “experts” say nonsense like this:

If we could get everybody to wear a mask right now, I really think in the next four, six, eight weeks, we could bring this epidemic under control.

We know they are not using science to inform their opinion.

On Saturday, I received the image on the left from a well-meaning individual. She wanted me to see that we have been fooled regarding the severity of the virus that causes COVID-19. By Sunday, this image (or one like it) was all over my Facebook feed. Please understand that the statement starts out as completely false and then uses true statements to imply something else that is completely false. Unfortunately, it tends to resonate with people who do not understand medical science and who have not been personally affected by the pandemic. As I watched this lie literally spread around the world, I couldn’t help but think of Jonathan Swift’s famous statement¹

Falsehood flies, and the Truth comes limping after it.

Here is my attempt to get the truth to come limping after this falsehood.

Let’s start with the first lie. The CDC has not “quietly updated” the numbers to “admit” something. The CDC has been regularly updating the numbers in the same place since the pandemic began. In addition, they have been saying that 94% of COVID-19 deaths were in patients with underlying conditions since at least April 3rd. That’s nothing new to anyone who has done even a little investigation into the matter.

More importantly, this image is meant to imply that COVID-19 is not dangerous because the vast majority of people who die from it have some other illness. Once again, that is simply 100% false. If you look at the underlying conditions that are included in the 94% (table 3 in the link above), you find things like high blood pressure (hypertensive diseases), diabetes, obesity, etc. The image tries to categorize them as “serious illnesses,” and depending on the person, they might be. However, they are present in a large percentage of the population. 45 percent of adults in the U.S. have a hypertensive disease, 10 percent of the U.S. population have diabetes, and 42 percent have obesity. Thus, a huge number of people in the U.S. have at least one of the “serious illnesses” that make you likely to die from COVID-19. In other words, there are many, many people at risk of death from COVID-19.

But how can we say that these people died of COVID-19 when they had some other condition? Because most of these conditions are completely treatable and will not generally kill a person. However, when that person gets an infection, the underlying condition makes it harder for his or her body to fight off the infection, leading to death. The more serious the infection, the more likely the person is to die. In fact, the majority of people who die of an infection like influenza, pneumonia, tuberculosis, etc. have an underlying condition that makes it more difficult for them to fight off the infection. Thus, it is not even remotely unusual that 94% of people who die from COVID-19 had one or more underlying conditions. It is common for many serious infectious diseases, especially in the developed world.

There is one more issue in the image above that I must address. It says that the overwhelming majority of people who died from COVID-19 were of advanced age. That’s true, but it’s true for all deaths in the developed world, not just COVID-19 deaths. Indeed, a recent study compared the ages of people who died from COVID-19 to those who died from all causes. Guess what? They were quite similar:

In fact, the age distribution of deaths attributed to COVID-19 is quite similar to that of all-cause mortality, which tends to increase by about 10% every year of age after age 30 y.

We don’t know a lot about COVID-19, and there is no way to scientifically state the best cause of action against the disease at this time. However, we do know that it is a very serious disease, and it is being downplayed by some using falsehoods like the image above. Please stop the misinformation! If you want to share something about COVID-19, at least make sure it doesn’t communicate something blatantly false, like the image above does.

ADDENDUM (added 9/4/2020): Someone on a friend’s Facebook feed wrote an incredibly insightful comment that I must share. She said that if you really think that the only COVID-19 deaths are the ones that had COVID-19 as the sole cause, then you must think that AIDS has a mortality rate of zero!

REFERENCES

1. The Examiner, Number 15 November 2 to November 9, 1710, (Article by Jonathan Swift), Page 2, Column 1, Printed for John Morphew, near Stationers-Hall, London.
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In a previous post, I compared COVID-19 cases and deaths in Sweden and Denmark. As I said then, it’s because they are very similar countries in the same basic region of the world, but they have remarkably different responses to the disease. Sweden has avoided lockdowns and tried to target their social restrictions, while Denmark has followed the practices of most other countries, strongly limiting what their citizens can do during the pandemic. While no comparison of two different countries is conclusive, I think the results are very interesting. The data come from the European Centre for Disease Prevention and Control, and while it may very well be a biased source of data, at least it is equally biased for both countries.

The graph on the left shows the cumulative COVID-19 cases per million. That means each day on the graph shows the total cases that were reported by that date, divided by the population in millions. Initially, Denmark had more cases (probably because initially they were testing more), but as you can see, Sweden quickly surpassed Denmark in cases per million, and the difference between the two countries has continued to grow. Since the death rate of COVID-19 is low (but higher than most infectious respiratory diseases), many people (including myself) think that death rate is a better indicator of the severity of the pandemic. Thus, the graph on the right shows the cumulative deaths per million. Notice that Sweden has more than 5 times the deaths per million as Denmark.

If the comparison between these two countries is legitimate, then, government restrictions did reduce the number of COVID-19 deaths per million in Denmark. However, there are those who suggest that this might be okay, since Sweden will reach herd immunity faster than Denmark. In the long term, then, Sweden will have fewer COVID-19 deaths because the spread of the disease will stop sooner.

Based on my evaluation of the data, I don’t think Sweden is significantly closer to herd immunity than Denmark. Take a look at the graph below, which records cases per day per million. Rather than adding all the cases reported by a given date (as is done in the graph on the left above), this shows the daily reports of COVID-19 cases per million.

If Sweden were closer to herd immunity than Denmark, the recent cases per million per day in Sweden should be lower than the cases per million per day in Denmark. However, they are not. For most of August, Sweden and Denmark have roughly equivalent cases per million per day. That tells me the disease is spreading roughly the same in the two countries right now, but Sweden has lost five times the people (per capita) as Denmark. As a result, my analysis indicates that Denmark’s restrictions kept a lot of people from dying of COVID-19, and that will continue to be the case in the long run.

Now please understand that this analysis considers only deaths from COVID-19. We know that government restrictions have also caused deaths. There are those who say that the government restrictions will cause more deaths than the ones that were saved from COVID-19. Others say that overall, the restrictions have saved lives. I think the data are insufficient to make that determination, but I do agree that most countries are ignoring the devastating death toll caused by the restrictions themselves. Nevertheless, I think the data are now clear that Sweden’s strategy has not accomplished what the country had hoped it would.