Open Thread: Here's Hoping We Don't Need Luck As Much in 2022, 1/5/2022 edition.
It’s a new year! Let’s start with the good news!
There are now seven independent lab studies showing that Omicron is less infective in the lower lungs. Here’s a compilation from Eric Topol (who is on substack!).
That’s great news because low lung infectivity is associated with being less able to cause more severe disease. <Edited to add the word “less”! Sorry!>
And while this variant can clearly cause a lot of breakthrough symptoms, immunity from vaccines or prior infection is holding up very well, too. (This is something we’d expect, but we could have gotten really unlucky and had severity escape as well—so far, no such sign).
And in other good news, my Doctors Without Borders fundraiser supporting their work especially in places like Yemen and in Burundi managed to raise more than half a million dollars! So much gratitude to everyone who participated, but especially to healthcare workers around the world working so hard, often with too little, to help others.
Now the bad news.
First, we still need Doctors Without Borders fundraisers to deliver basic health-care and food-aid during a famine. I believe in fundraising because we must, but I yearn for a day this is seen as a quaint, weird hobby.
Second, we are still relying on getting lucky with variants to skate through the pandemic.
I examine all this in my column today in The New York Times, especially in the context of CDC’s zigzag around the rapid tests and N95s, where we see my least favorite friends from the first-year-of-pandemic make an appearance: namely, denigrating of usefulness of tools simply because we don’t have enough even though we should have, and waving around claims of false sense of security to justify not empowering the public.
Consider below comparing statements of CDC director Dr. Walensky made recently with those of the scientist and public health advocate Dr. Walensky of 2020:
“We opted not to have the rapid test for isolation because we actually don’t know how our rapid tests perform and how well they predict whether you’re transmissible during the end of disease,” Walensky said on Dec. 29. “The F.D.A. has not authorized them for that use.”
Dr. Anthony Fauci, the president’s chief medical adviser, argued the same, also on Dec. 29. Referring to antigen tests, he said, “If it’s positive, we don’t know what that means for transmissibility” and that these antigen tests aren’t as sensitive as P.C.R. tests.
Might the real reason be that rapid tests are hard to find and expensive here (while they are easily available and relatively cheap in other countries)?
Is it possible that rapid tests are a good way to see who is infectious and who can return to public life — and their lack of sensitivity to minute amounts of virus is actually a good thing? Let’s ask a brilliant scientist and public health advocate — Rochelle Walensky, circa 2020.
Walensky, who was then on the faculty of the Harvard Medical School and chief of the division of infectious diseases at Massachusetts General Hospital, was a co-author of a paper in September 2020 that declared that the “P.C.R.-based nasal swab your caregiver uses in the hospital does a great job determining if you are infected but it does a rotten job of zooming in on whether you are infectious.”
She was so on the money with every aspect of this that I can’t resist quoting even more from her 2020 article on all this:
That’s right, the key question is who is infectious, who can pass on the virus, not whether someone is still harboring some small amount of virus, or even fragments of it. P.C.R. tests can detect such tiny amounts of the virus that they can “return positives for as many as 6-12 weeks,” she pointed out. That’s “long after a person has ceased to pose any real risk of transmission to others.” P.C.R. tests are a bit like being able to find a thief’s fingerprints after he’s left the house.
So what did 2020 Walensky recommend? “The antigen test is ideally suited to yield positive results precisely when the infected individual is maximally infectious,” she and her co-author concluded.
The reason is that antigen tests respond to the viral load in the sample without biologically amplifying the amount and being able to detect even viral fragments, as P.C.R. tests do. So a rapid test turns positive if a sample contains high levels of virus, not nonviable bits or minute amounts — and it’s high viral loads that correlate to higher infectiousness.
What about the objection that rapid antigen tests don’t always detect infections as well as P.C.R. tests can?
The 2020 Walensky wrote that the F.D.A. shouldn’t worry about “false negatives” on rapid tests because “those are true negatives for disease transmission” — meaning that people are unlikely to spread the virus even if they have a bit of virus lingering. In other words, the fact that rapid tests are less likely to turn positive if the viral load isn’t high is a benefit, not a problem.
And here’s more on the false sense of security playing a role on all this—the idea that will not go away even if there is no evidence for it.
The threat of a “false sense of security” has been used against everything from seatbelts to teaching young kids how to swim (because that would supposedly encourage parents to stop watching their children in the water!). Research and common sense shows what one would expect: Safety measures make people safer and people who choose to use them are looking to be safer — if anything, they do more of everything. (Parents should watch their young children in the water, but kids who learn to swim are less likely to drown.)
That’s why it was extra disappointing to hear Walensky argue recently that “if you got a rapid test at five days and it was negative, we weren’t convinced that you weren’t still transmissible. We didn’t want to leave a false sense of security. We still wanted you to wear the mask.”
Ugh. All of this is so reminiscent of public health officials and health journalists claiming wearing masks would “cause” a false sense of security (and make people ignore washing their hands!) in 2020.
Aesop’s fable on the Fox and the Grapes has entered the chat, too!
Aesop's Fables: Phaedrus
Book IV - III. De Vulpe et Vua (Perry 15)
Fame coacta uulpes alta in uinea
uuam adpetebat, summis saliens uiribus.
Quam tangere ut non potuit, discedens ait:
"Nondum matura es; nolo acerbam sumere."
Qui, facere quae non possunt, uerbis eleuant,
adscribere hoc debebunt exemplum sibi.
The Fox and the Grapes (trans. C. Smart)
An hungry Fox with fierce attack
Sprang on a Vine, but tumbled back,
Nor could attain the point in view,
So near the sky the bunches grew.
As he went off, "They're scurvy stuff,"
Says he, "and not half ripe enough--
And I 've more rev'rence for my tripes
Than to torment them with the gripes."
For those this tale is very pat
Who lessen what they can't come at.
The masks that we didn’t have enough of weren’t useful for the public anyway in 2020, and now it’s the tests we don’t have enough of which are suddenly sour and not that ripe!
I also want to highlight this bit from Katherine Eban’s excellent article in the Vanity Fair on why the White House rejected the proposal to acquire a large number of rapid tests in time for the holiday season, where a version of “false sense of security” rears its head again:
Three experts who interacted with the White House came to believe that the Biden administration had deprioritized rapid testing, partly out of concern that people would opt for that instead of getting vaccinated. As one expert put it, “It was clear they felt that people who didn’t want to get vaccinated might like no-strings-attached rapid testing.”
I have to say, this is more than a bit disappointing. We don’t have enough tests because someone bought into baseless pop-psychology on how better is worse?
Those who are looking for an excuse to avoid vaccination do exist, but there’s no reason to think they just won’t find yet another reason if rapid tests weren’t available to them, and absolutely no reason to deny the rest of us useful tools based on this kind of theorizing—I see no evidence to think this is even true.
So, here are my two proposed laws, going forward.
Treat the public like adults and partners, and work to empower them—even if some portion isn’t listening to the advice, or even if some are actively hostile. Seems straightforward enough, and yet we still struggle with it.
If anything, the existence of that hostile portion makes it even more important to empower and respect those of us looking to public health authorities for guidance, tools and infrastructure.
Here’s to hoping we will need less luck in 2022.
It is hard to overestimate how much damage the pronouncements of experts like Walensky and Fauci have done to the idea that we should respect expertise. What they have demonstrated, repeatedly, is that everything is political. Nothing said can be taken at face value for everything is tinged with so e form of political maneuvering. This is very bad. Very bad. And we can now see the problem was not Trump. It is endemic to the system and it will be very hard to extirpate.
The good news: Topol's studies do indeed show how to reduce lung damage.
The bad news: first you have to get the Syrian hamsters down into your lungs.