COVID Transmissions for 1-24-2022
COVID-19 vaccines do not cause infertility; also, COVID-19 is not endemic
Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions.
It has been 769 days since the first documented human case of COVID-19. 769 was a BIG year in European history. It was the first year that King Charlemagne ruled the Franks, and he began military campaigns that would eventually lead to him becoming an Emperor. Also in 769, a Lateran Council was called by Pope Stephen III to deal with, among other things, papal election procedure problems that led to the creation of competing antipopes.
Speaking of schisms, I want to discuss today the issue of endemicity—and specifically why we are not at the point of endemic COVID-19.
In perhaps less controversial news, I share a study that shows COVID-19 vaccines don’t cause infertility, but COVID-19 the disease can. Also, I highlight a program in San Francisco that I think is good common sense for keeping infected people at home where they won’t spread COVID-19.
Have a great week!
Bolded terms are linked to the running newsletter glossary.
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Now, let’s talk COVID.
COVID-19 vaccines do not impact fertility; COVID-19 the disease might
A large study of COVID-19 vaccination in couples looking to conceive has revealed that COVID-19 vaccination does not impact fertility—this is regardless of whether the vaccinated person is supplying an egg or sperm.
Interestingly, the same study also established that there is a risk of reduced fertility if the “male”1 partner has been infected with SARS-CoV-2 in the previous 60 days.
I’ve heard a lot of people concerned that the vaccines will affect fertility; this is an old antivaccine accusation that comes up with every vaccine, and so far no vaccine has had an impact on fertility. For COVID-19 vaccines specifically, several studies have now shown this. But the accusations continue.
Meanwhile, the risk of fertility impacts from SARS-CoV-2 itself looks to be very real. Full study here: https://academic.oup.com/aje/advance-article/doi/10.1093/aje/kwac011/6511811
San Francisco program pays people to stay home if they are positive with COVID-19
This program has existed for some time already, but apparently it recently got an additional $5.4 million in funding. Basically, this is a program that ensures that people who are sick with COVID-19 can stay home by giving them $1000 to remain at home for 10 days—for people who do not have paid sick time or access to other income during their recovery.
I know that this may generate very political feelings, but the bottom line is this: in most societies around the world, money is used to incentivize behavior. If we want to control the spread of COVID-19, people who are sick with it will need to stay home, and it makes sense to incentivize their doing so. The damage that continued, unrestrained spread does costs a lot more than $1000/case.
You can read more about the program here: https://www.kron4.com/news/bay-area/san-francisco-extends-recovery-program-to-financially-assist-people-impacted-by-covid/
Also here’s a flyer for it:
COVID-19 is NOT endemic
I’ve been seeing more and more news stories like the following, where a personality of some kind will claim that SARS-CoV-2 is “endemic”: https://www.kron4.com/health/coronavirus/covid-is-now-an-endemic-not-a-pandemic-san-francisco-doctors-say/
One person noted in that article is Dr. Vinay Prasad, a physician who has no experience in pediatrics or infectious disease but has spent much of the pandemic calling for extremely unethical trials where the chief question is to see whether or not more children get COVID-19 if this-or-that protective protocol (such as masking) is eliminated. If you’re questioning why this might be unethical, let me be clear: if your study’s question is “will we have more of [something bad] happen if we try out my idea?” then you’re not doing an ethical study. The goal of health research is to ask questions about why bad things happen, or whether a planned intervention can make them happen less. We do not generally conduct studies on just how bad it would be to let more people, especially kids, get a disease.
Anyway, folks like Dr. Prasad have a vested interest, given their ideological view, in declaring the pandemic over as soon as possible. To forward this goal—one which has attracted a lot of fame to Dr. Prasad with those who would like to just ignore COVID-19—some of these folks have begun to say that COVID-19 is “endemic.”
Endemicity for an infectious disease refers to a situation where a constant background level of disease is observed and generally tolerated by society. Eventually, COVID-19 might be an endemic disease. This will require many things to happen that have not happened yet, including widespread immunization of close to 100% of the population early in life. It will be many decades before our relationship with this disease settles into an endemic pattern—if we ever reach that point.
The massive waves of cases that continue to happen with SARS-CoV-2 variants as they emerge do not at all represent an endemic situation. It is just false to portray this as an “endemic” disease. There are still billions of people in the world who have not even been exposed or immunized to this virus in any way. We’re just not there, and as long as we keep seeing huge spikes in cases, we will continue to have proof we are not there.
It is possible for us to have a controlled relationship with a disease without it being endemic, however. It is debatable, for example, whether influenza is “endemic” or whether each influenza pandemic is followed by years of new variants producing global waves of disease. We call these seasonal influenza and we immunize against them every year. People who don’t get the vaccines let the rest of society down by allowing the virus to spread through the population unimpeded, and around the world quite a lot of people die—but not as many as would die if we did not have immunizations and past experience of infection with the virus.
Influenza is under a degree of control. When a new pandemic influenza emerges, we also know how to respond and can fairly rapidly deploy a vaccine.
This is the future that I expect to see with COVID-19, too—not endemicity, but control.
What am I doing to cope with the pandemic? This:
Surprise melon!
For some weeks I have been saving what I thought was a spaghetti squash I got from my farm share. Spaghetti squash keeps pretty well, so I hadn’t gotten around to using it. I had a whole meal plan for it.
And then I cut it open. It was a melon of some kind. I Googled “melon that looks like spaghetti squash” and discovered that what I had was in fact a canary (winter) melon, and a pretty overripe one. It had lost a lot of the promised sweetness, but was still quite edible—wet, bright, a little sweet.
Thinking on my feet, I had to make a new dinner plan, because this was not going to taste very good with oregano and tomato.
Instead, I blanched some broccoli, added salt, pepper, olive oil, and lemon juice, and tossed this along with my unexpected melon (cubed). This turned out to be really good!
There were a few comments about the medical ethics discussion from last issue, but I don’t want to delve too deeply into medical ethics here. However, those are there for you to read if you’re interested.
Instead, I want to focus on this question from reader Sam:
Somewhat related to Carl's question, I was wondering if you had any thoughts on the implications of Delta-Omicron cross-immunity for vaccination. Increasingly, it seems clear that Omicron infection by itself doesn't really yield Delta immunity, just as Delta infection doesn't yield Omicron immunity. But it *does* looks like Omicron infection in *vaccinated* individuals enhances immunity to both Delta and Omicron (see, e.g., https://secureservercdn.net/50.62.198.70/1mx.c5c.myftpupload.com/wp-content/uploads/2022/01/MEDRXIV-2021-268439v2-Sigal.pdf).
My question is: does this imply that an Omicron-specific vaccine might elicit cross-immunity in previously vaccinated people, but not in immunologically naive people? What about unvaccinated people who were infected with an earlier strain, then reinfected with Omicron?
Really interesting! I answered focusing on vaccination—I do not think getting infected with COVID-19 is a very good way to prevent COVID-19, and not just because it requires you to get the very thing you’re trying to prevent. Still, the answer for vaccination will apply (probably to a lesser degree) to recovery from natural infection. If you survive. Perhaps.
Here’s my answer:
Good question. This comes back to the concept of Original Antigenic Sin that we've discussed on here before. It is possible that upon seeing something close enough related to Delta to be vaguely similar (there is clearly cross-reactivity between anti-Delta and anti-Omicron neutralizing antibodies, for example), the immune response will be biased towards the first pathogen seen. Too much bias would be bad, of course, but with a balanced response that is Omicron-specific and new alongside a Delta-specific (or, really, WHN-01 specific) an Omicron-sequence booster could provided expanded protection against this new variant as well as reinforce past responses. I am sure the clinical studies of this new thing will look into neutralization of many past variants.
You might have some questions or comments! Join the conversation, and what you say will impact what I talk about in the next issue. You can also email me if you have a comment that you don’t want to share with the whole group.
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No corrections since last issue.
See you all next time. And don’t forget to share the newsletter if you liked it.
Always,
JS
In quotes because this is the word the study uses.
COVID Transmissions for 1-24-2022
Pfizer just announced that they're starting their Omicron vaccine trial: https://investors.pfizer.com/Investors/News/news-details/2022/Pfizer-and-BioNTech-Initiate-Study-to-Evaluate-Omicron-Based-COVID-19-Vaccine-in-Adults-18-to-55-Years-of-Age/default.aspx. From the press release:
"The study will evaluate up to 1,420 participants across the three cohorts:
"Cohort #1 (n = 615): Received two doses of the current Pfizer-BioNTech COVID-19 vaccine 90-180 days prior to enrollment; in the study, participants will receive one or two doses of the Omicron-based vaccine
"Cohort #2 (n = 600): Received three doses of the current Pfizer-BioNTech COVID-19 vaccine 90-180 days prior to enrollment; in the study, participants will receive one dose of the current Pfizer-BioNTech COVID-19 vaccine or the Omicron-based vaccine
"Cohort #3 (n=205): Vaccine-naïve participants will receive three doses of the Omicron-based vaccine"
I realize that we are dealing with different strains and that coronaviruses never generated much permanent immunity, but the idea that an actual viral infection does not result in immunity as (or more) effective as a vaccine goes against my clinical expectations. I thought that reinfection rates have remained fairly low despite shifts in SARS-CoV-2 strains. Is it possible that, when we study vaccine effectiveness, we are measuring immunity to Delta or Omicron in a fairly specific or limited way, thus missing other ways in which an actual infection might generate immunity? Should we perhaps be calling it "measurable Omicron immunity" instead?