Okay, at the request of readers I will go through through my spiel on adaptive immunity and vaccines again. Adaptive immunity is development of an immune response to a specific pathogen. It can happen through infection and/or through vaccination. The immune system is extremely complex but basically you are attempting to train it to identify the chemical sequence of particular pathogens and respond to those sequences by preventing the pathogen from replicating and/or destroying it. Antibodies are one primary mechanism used to do this, and T cells are another. The primary repository of ability to identify a pathogen resides in memory B cells, which produce antibodies, and memory T cells. These cells exist in tissues throughout the body. Adaptive immunity does not keep you from being exposed or even infected, although it should lessen the odds of infection. It is designed to identify a repeat invader and react quickly and strongly. Think of a bouncer at a bar, he sees the troublemaker coming in, and immediately attempts to throw him or her out the door. But people are highly variable, their immune systems are highly variable, and of different strengths, so adaptive immunity isn’t the same for everyone. The vaccines appear to very successful at prompting people to recognize all or some parts of the spike protein. So most, but not all, people are going to kick the virus out before an infection starts. And those who get infected will likely have less serious disease and be less infectious, but there will be infections, especially with our goofy testing programs. Doesn’t mean the vaccines aren’t successful, this is just the way it works.
Cases appear (and that is the right word) to be rising in Minnesota, kind of right on the seasonal schedule. My hesitation is based on what I know about the testing regimen in Minnesota and how likely it is to produce false and low positives. The case rise is said to be occurring disproportionately in adolescents, where schools are doing constant, asymptomatic testing. If you are a high school with 2000 students, and you test them every week, and you find 10 positives, no matter how accurate your test is supposed to be, I assure you that at least half those positives are false and the remainder are likely to be low positives. The state refuses to release cycle numbers and trends in distribution and refuses to randomly test supposedly positive samples with culturing to verify virus viability and correlate viability with cycle number. Any positive test in an asymptomatic testing program should be re-tested with a different test to verify the result. The briefing today was surprisingly light on variant terrorism, probably because the state wanted to highlight the success of getting the LTC population vaccinated. Staff vaccination has been slower. The questions mostly focused on vaccination rollout and priorities. One other note, the state has gotten more and more evasive in answering questions submitted by Powerline’s Scott Johnson. The latest set of answers is posted verbatim by Scott here. (PL Link) These are important questions, especially around deaths, to help understand trends, and the state does nothing but obfuscate.
One other quick note, since this blog is normally about health care data, research and business, let me talk about health care inflation. We are going to see far higher inflation than has been experienced in decades. Because of the goofy formula used by the US government to measure inflation, which is largely designed to minimize how much social security payments go up every year, it will be understated by official measures. But one area I can guarantee you is going to see much higher inflation is health care, and that inflation will show up in health plan premium increases. Those typically go out in the summer for plans renewing in January, which is the biggest renewal month. Gas is way up, housing prices are up, food costs have soared, health care going up, but don’t worry, inflation is only occurring in the necessities of life.
And don’t watch yesterday’s presidential pre-recorded press briefing if you think the president has any capability to do one of the world’s hardest jobs. You might be disabused of your belief. He literally had to refer to note cards to answer questions, only reporters who would ask softball questions were called on, and he still was incoherent and as usual, flat-out lied, but then, as a career politician, that is all he has ever done.
On to the research. I have repeatedly mentioned the issues with test accuracy, low and false positives, false negatives can be an issue as well. This paper discusses those problems, with some suggestions for how to potentially avoid them to some extent. (Medrxiv Paper) The authors are focused on the accuracy of antigen tests and the problem of calibrating them with PCR, which picks up a lot of non-viable virus fragments. They suggest an alternative calibration method. Basically antigen tests are better than PCR at picking up truly infectious cases, so their accuracy in identifying positives should be assessed by that, not whether they pick up the same non-cases as PCR. The authors note the need for ongoing viral culturing of samples, see my comments above.
Want to stay terrorized about variants, don’t read this study from Houston. (Medrxiv Paper) B117 grew rapidly as a percent of all cases during the sampling period. But there was no change in mortality or median length of hospital stay. There was a slight increase in hospitalization rate, but I suspect some of that is a greater likelihood to hospitalize someone because they have that variant and there being slightly more males in the variant group than the “wild” strain group, although viral loads also appeared higher on average, which could lead to more severe disease.
Another variant related paper comes from London. (Medrxiv Paper) They compared outcomes from the two primary waves of the epidemic in London, especially hospitalizations. B117 was becoming the dominant strain during the second wave. One side note is the finding that a number of cases were actually transmitted in the hospitals, despite precautions. There were what I would consider fairly minor differences in the patients making up hospitalized cases in the second wave compared to the first. There was slightly more hypoxia (low oxygen level) on admission in the B117 cases and slightly more obesity. The authors did not provide comparative outcome measures, like length of stay or mortality.
Here is another paper on what happened to other respiratory viruses during the epidemic. (Medrxiv Paper) The study comes from Singapore and tracked virus prevalence during 2020 compared to 2019. Shortly after suppression efforts, influenza basically disappeared and other respiratory viruses gradually severely declined as well. Rhinovirus and adenovirus showed the biggest declines. When the suppression measures were removed, rhinovirus and adenovirus bounced back quickly. Other viruses remained in a suppressed mode.