COVID Transmissions for 5-17-2022

New variants of concern, new death numbers, and new restrictions on the J&J vaccine

May 17, 2022

Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions.

It has been 892 days since the first documented human case of COVID-19. In 892, while Viking longships were sailing up the river Thames, over in the Arab caliphate a golden age of philosophy was going on. This had knock-on effects in the Jewish populations of Arab lands, and many well-known Jewish scholars lived in this period. One, Rabbi Saadia Gaon, was born in 892. He was known for many works on Jewish topics, written in Judeo-Arabic, and also for integrating elements of ancient Greek philosophy into his Jewish writings.

It is interesting how big the world must have felt at a time like that—learning and knowledge could be very different at a distance we would consider short today. By contrast, the COVID-19 pandemic illustrates how interconnected we now all are. There is nowhere that has been left untouched by this.

Today we’ll discuss 2 variants that have been escalated to “variant of concern” status in Europe, a change to the Johnson and Johnson vaccine in the US, and reflect on the recent significant number that the US passed in terms of total deaths.

Bolded terms are linked to the running newsletter glossary.

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Now, let’s talk COVID.

European CDC elevates BA.4 and BA.5 Omicron subvariants to “variant of concern” status

The Omicron variant has continued to spawn sublineages that out-compete their ancestors around the world and cause outbreaks in various countries. Among the latest sub-lineages are BA.4 and BA.5, and both are found in various countries around the world.

IT does appear so far that vaccine-mediated protection against these sublineages is similar to what is seen vs prior Omicron lineages, and that immunity to prior Omicron sublineages will carry forward against these. However, it also looks like these viruses are good at spreading through even highly vaccinated populations, and they will cause deaths among unvaccinated people—including children—if they are not taken seriously.

The ECDC is taking them seriously by classing them as variants of concern. A story on this is available at CIDRAP: https://www.cidrap.umn.edu/news-perspective/2022/05/ecdc-ups-ba4-ba5-variants-concern-warns-case-rises

One million deaths in the US

Recently, the US passed one million deaths due to COVID-19. That grim milestone represents about one sixth of the global total of 6.26 million dead.

Of course, whenever these sorts of thresholds are passed, I have to provide the disclaimer that official totals are almost certainly lower than the real death toll of the pandemic. Deaths due to respiratory illnesses or the many complications of COVID-19 are not always easy to attribute to a specific cause, for a variety of reasons. When one looks at “excess deaths,” the death numbers that exceed what would be seen in years before the pandemic, the numbers indicate that our official counts are low.

What is the point of keeping score like this? Well, for one thing, it helps us to understand the dynamics of COVID-19 as a disease, and this tells us that it is a truly historic one.

It also serves to tell us something about the stakes that we face when a contagious virus kills around 1% of the people who it infects. That percentage sounds a lot less threatening than stating that the total US deaths from COVID-19 have now exceeded US combat deaths in all of the country’s wars (about 666,000 from 1775 to 2019, a period of 244 years). If you think about how seriously the horrors of war are taken, I think it stands in stark contrast to the way that people try to rationalize the scale of COVID-19 deaths we have experienced in just 2 years.

On the other hand, statistics hide the human tragedy that each single death represents. It is hard to contemplate even the death of a single loved one, but all of these deaths were full people. One person you know would have to die every day for 2,740 years to approach the full scale of this official count. There is very little I can write that would carry anything close to the full emotional impact of what that would be like. But if we could pile up all the grief that every person who has lost someone to COVID-19 has ever felt, that would be it. More than 2 and a half millennia of daily funerals.

I’m writing at length about this today because yesterday, I passed a bench in Central Park that looks like it was recently dedicated, in memorial of Dr. Li Wenliang. Dr. Li was one of the first victims of COVID-19, a person who is now part of the 6.26 million people I mentioned earlier. He was also someone who took every effort that he could—at some personal risk in the repressive Chinese state—to warn others of what could happen if this disease were allowed to spread. In a world where his warnings were heeded, he was instead admonished by Chinese authorities for sharing advance warning of the outbreak with fellow Wuhan University alumni on WeChat. He died at the age of 33, on February 7th, 2020, as a result of his continued work to treat patients during the outbreak. The patient from whom he contracted the disease was a shopkeeper at the Huanan Seafood Market that is thought to be the initial point of entry of SARS-CoV-2 into the city of Wuhan.

Here is a picture of the bench I saw, complete with a note and bouquet of flowers left by, I must assume, either the person who dedicated the bench or someone else who was touched by it, like me.

Image shows a park bench with a dedication plaque reading “In memorial of Dr. LI Wenliang, who sounded the alarm on COVID-19,” along with some Chinese characters that I lack the ability to transcribe. A bouquet of white flowers (chrysanthemums, I think) has been left on the bench along with a note that includes an additional note in Chinese characters, then the English text, “In memorial of Dr. Li Wenliang and individuals who died of COVID-19.”

Something I will note is that the bench also makes reference to all of the victims of COVID-19. I am struck by the fact that if not for human limitations that cause us to repress and hide frightening information, Dr. Li’s warnings might have been spread more widely and treated more seriously. Many might still have died in Wuhan, but could we have contained the virus overall? I cannot say. But with the US passing another chilling death number, I have to wonder how many of those could have been prevented if we had leaned in on a policy of containment as early as possible.

Johnson and Johnson vaccine EUA restricted

Following a number of deaths due to a rare clotting syndrome, the US FDA recently elected to further limit the EUA (Emergency Use Authorization) for the J&J COVID-19 vaccine. It is now only authorized for use in patients who cannot receive other brands of COVID-19 vaccine (which in the US means mRNA vaccines, currently), or who would not otherwise get vaccinated.

When the first news of the clotting syndrome came out, I emphasized that although the condition was rare, it made sense to have a certain amount of caution about it since there were other effective vaccines. While the idea of a single-dose vaccine was appealing for efficiency reasons at the time, it has since become apparent, through several successive waves of infection and variants, that the mRNA vaccine technologies have held up better, efficacy-wise, against all of these changes.

In that environment, it doesn’t make a lot of sense to make this particular vaccine available to absolutely everyone. The risk of the syndrome that it can—very rarely—cause remains smaller than the risk of COVID-19 related death, including just COVID-19 deaths from blood clotting, but with other, better options available, this vaccine is one that is better used where preferable options are not appropriate.

That means people who refuse mRNA technology out of unfounded fear that it is not safe, but it also includes people with allergies to mRNA vaccine ingredients or manufacturing processes (which can introduce allergens), or people who may have other medical conditions that contraindicate use of the mRNA vaccines.

At this point, I think I am with the FDA on this. The J&J vaccine is not my first choice, but it is an important option for those people who can’t use my first-choice option for whatever reason.

I also want to point out how seriously this situation was taken. It would have been quite easy to dismiss the whole thing by saying there have been only 9 deaths, and the risk of death from COVID-19 is substantially higher. The FDA could have ignored this…and it would have been like throwing gasoline onto the fire of antivaccine hysteria.

Antivaccine grifters rely on the lie that serious safety concerns about vaccines are ignored in order to make profits for big pharmaceutical companies. This is wrong in several ways, but importantly, here we see an obvious counterexample. When an extremely rare but life-threatening condition was identified with a vaccine made by one of the world’s biggest pharmaceutical companies, the FDA was conservative. The company that manufactures the vaccine was also forthcoming and complied with safety monitoring requirements. Decisions were made that used great caution—what some might see as too great—at least in part because it is important for safety issues to be taken seriously.

This is an example of how a real safety issue, rather than an invented one, is taken seriously by regulators, even when it means harm to the profits of the manufacturer. Instead of a coverup, a transparent process has weighed the pros and cons of continued wide availability of this vaccine, and it was clear that a restriction was needed.

Part of science is identifying and correcting errors. If you find a mistake, please tell me about it.

Though I can’t correct the emailed version after it has been sent, I do update the online post of the newsletter every time a mistake is brought to my attention.

No corrections since last issue.

What am I doing to cope with the pandemic? This:

Building a fancier breakfast

My wife and I have become fond of a chain restaurant called Bluestone Lane that offers excellent coffee and some very “clean” brunch and breakfast options that favor salads and healthier-feeling options.

Naturally, I wanted to recreate some of these at home, and I have to admit, in general, it’s almost more trouble than it’s worth. But not quite, because I really like having a salad for breakfast.

This one includes feta cheese, poached egg, boiled farro, sliced grape tomatoes, and greens—and a light acidic dressing, the exact details of which don’t matter. I prefer to use sustainable, vertically-farmed greens if I can. These are grown indoors in facilities that use renewable energy, no pesticides, and are hyperlocal to where I purchase them. Lately I’ve been favoring arugula-sprout microgreens and baby kale.

For eggs, I typically poach one hen’s egg per serving. Recently I was feeling a little indulgent and bought some quail’s eggs instead. Most instructions for poaching them call for trimming the finished poached product with scissors to make it prettier, but I think that’s a waste of perfectly good protein. Those are definitely more trouble than they are worth, but it was fun to try them out. Here’s what all of this looked like, put together:

Image shows a porcelain bowl with a blue decoration pattern; the bowl contains the salad I just described making.

Honestly, I’d skip the quail’s eggs. They’re interesting, and you can have some textural fun with them, but they’re annoying to poach. The rest of the recipe? It’s a great way to start the day.

Reader Patti Rieser had the following feedback on a word choice I made in describing a clinical trial:

Consider using the term "volunteers" instead of "subjects" for clinical trial participants. (from a retired nurse practitioner and science writer with clinical research experience and strong opinions about word choices).

I take this feedback to heart, and welcome it. Patti is right—”subjects” is a poor word choice, and sloppy of me. I don’t prefer volunteers, either, though. Here are my thoughts on the topic (as something of a science writer with clinical research experience and strong word choice opinions, myself):

Frankly I tend to prefer "patients" for clinical trial participants but sometimes I use "subjects" in the case of healthy volunteers. I agree that "subjects" has some uncomfortable connotations. I should probably be diligent in using the word "participants."
I don't prefer "volunteers" because it tends to elide the complicated consent dynamics of clinical trial participation. Many people are in dire situations when they sign up for clinical trials, and while I do consider their consent valid I don't think the word "volunteer" captures the experience that they are having. For a very rough analogy, even if a disaster evacuation is voluntary, I would still call the people who relocate "evacuees" rather than "volunteers." There is a clear and present danger in so many cases of clinical trial participation to where I don't think "volunteer" fully captures the participants' experience.
Of course, in the case of healthy volunteers that whole discussion is a little less applicable, but with a major pandemic going on I do think quite a few participants may feel pressured by circumstances to seek out clinical trial participation.
Anyway, you're right that subjects is a less than ideal word choice, and is one of the word choices I've been less thoughtful about--which is not my typical approach, given that I am also a science writer with extensive clinical trial experience. I'll favor "participants" in the future.

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