Category: Covid-19

Natural Immunity Is Stronger and Lasts Longer Than Immunity from Covid Vaccines

(p. A17) Public-health officials ruined many lives by insisting that workers with natural immunity to Covid-19 be fired if they weren’t fully vaccinated. But after two years of accruing data, the superiority of natural immunity over vaccinated immunity is clear. By firing staff with natural immunity, employers got rid of those least likely to infect others. It’s time to reinstate those employees with an apology.

For most of last year, many of us called for the Centers for Disease Control and Prevention to release its data on reinfection rates, but the agency refused. Finally last week, the CDC released data from New York and California, which demonstrated natural immunity was 2.8 times as effective in preventing hospitalization and 3.3 to 4.7 times as effective in preventing Covid infection compared with vaccination.

Yet the CDC spun the report to fit its narrative, bannering the conclusion “vaccination remains the safest strategy.” It based this conclusion on the finding that hybrid immunity—the combination of prior infection and vaccination—was associated with a slightly lower risk of testing positive for Covid. But those with hybrid immunity had a similar low rate of hospitalization (3 per 10,000) to those with natural immunity alone. In other words, vaccinating people who had already had Covid didn’t significantly reduce the risk of hospitalization.

Similarly, the National Institutes of Health repeatedly has dismissed natural immunity by arguing that its duration is unknown—then failing to conduct studies to answer the question. Because of the NIH’s inaction, my Johns Hopkins colleagues and I conducted the study. We found that among 295 unvaccinated people who previously had Covid, antibodies were present in 99% of them up to nearly two years after infection. We also found that natural immunity developed from prior variants reduced the risk of infection with the Omicron variant. Meanwhile, the effectiveness of the two-dose Moderna vaccine against infection (not severe disease) declines to 61% against Delta and 16% against Omicron at six months, according to a recent Kaiser Southern California study. In general, Pfizer’s Covid vaccines have been less effective than Moderna’s.

The CDC study and ours confirm what more than 100 other studies on natural immunity have found: The immune system works. The largest of these studies, from Israel, found that natural immunity was 27 times as effective as vaccinated immunity in preventing symptomatic illness.

None of this should surprise us. For years, studies have shown that infection with the other coronaviruses that cause severe illness, SARS and MERS, confers lasting immunity.

For the full commentary, see:

Marty Makary. “The High Cost of Disparaging Natural Immunity.” The Wall Street Journal (Thursday, January 27, 2022): A17.

(Note: the online version of the commentary has the date January 26, 2022, and has the title “The High Cost of Disparaging Natural Immunity to Covid.”)

The Israeli preprint study mentioned above is:

Gazit, Sivan, Roei Shlezinger, Galit Perez, Roni Lotan, Asaf Peretz, Amir Ben-Tov, Dani Cohen, Khitam Muhsen, Gabriel Chodick, and Tal Patalon. “Comparing Sars-Cov-2 Natural Immunity to Vaccine-Induced Immunity: Reinfections Versus Breakthrough Infections.” medRxiv (2021): doi: https://doi.org/10.1101/2021.08.24.21262415.

Democrat-Praised “Whistleblower” Rick Bright, Not Trump Admin, Delayed Molnupiravir by Months at Peak of Pandemic

(p. A17) When Merck and Ridgeback Biotherapeutics announced on Oct. 1 [2021]that their new antiviral pill reduced Covid hospitalizations by roughly half, some in the media blamed Donald Trump. An Axios headline: “Before Merck backed COVID antiviral, Trump admin turned it down.” In fact, Trump officials pushed for government funding to accelerate the development of the drug, molnupiravir. They were opposed by a career official, Rick Bright, whom Democrats praised as a “whistleblower.”

Mr. Bright joined the Biomedical Advanced Research and Development Authority in 2010 and became Barda’s director in 2016.

. . .

Emory had licensed molnupiravir to Ridgeback, which in April 2020 requested $100 million from the government to fast-track studies in humans. Mr. Bright says Trump officials ordered Barda officials “to fund the Ridgeback proposal as quickly as possible, and preferably within 24 hours.” But he said “Ridgeback had not followed the proper procedure for receiving BARDA funding.” Barda declined the request, and Ridgeback collaborated with Merck, which put its own capital at risk.

After Mr. Bright’s reassignment, Barda funding for trials, manufacturing and advance purchases of monoclonal antibodies proved critical in accelerating their development. Molnupiravir would likely have been available much sooner had Barda provided funding as Trump officials urged last spring.

For the full commentary, see:

Allysia Finley. “Who Slowed Merck’s Covid Remedy?” The Wall Street Journal (Monday, October 11, 2021): A17.

(Note: ellipsis, an bracketed year, added.)

(Note: the online version of the commentary has the date October 10, 2021, and has the same title as the print version.)

Large Retailers Chartered Ships to Avoid the Most Crowded Ports

(p. A1) Global supply-chain delays are so severe that some of the biggest U.S. retailers have resorted to an extreme—and expensive—tactic to try to stock shelves this holiday season: They are chartering their own cargo ships to import goods.

Port delays, Covid-19 outbreaks and worker shortages have snarled the flow of products between Asia and North America, threatening the supplies of everything from holiday decorations and toys to appliances and furniture. It is taking roughly 80 days to transport goods across the Pacific, or twice as long as before the pandemic, retail and shipping executives said.

Walmart Inc., Home Depot Inc., Costco Wholesale Corp. and Target Corp. —some of the biggest U.S. retailers by revenue—are among the companies that are paying for their own chartered ships as part of wider plans to mitigate the disruptions, a costly and unattainable option for most companies.

For the full story, see:

Sarah Nassauer and Costas Paris. “Retailers Charter Ships to Ensure Supplies.” The Wall Street Journal (Monday, October 11, 2021): A1 & A6.

(Note: the online version of the story has the date October 10, 2021, and has the title “Big U.S. Retailers Charter Private Cargo Ships Amid Port Delays.”)

To Get “Free” Covid Pills from 60 Miles Away You Pay Private Uber to Deliver

(p. 1) Just after 1 p.m. on Tuesday last week, my phone buzzed with a text message from my mother: “Well, came down with cold, aches, cough etc over wknd.” She had taken an at-home coronavirus test. It was positive.

Having spent the past year writing about Covid-19 vaccines and treatments for The New York Times, I knew a lot about the options available to people like my mother. Yet I was about to go on a seven-hour odyssey that would show me there was a lot I didn’t grasp.

. . .

(p. 3) In the end, my scramble to find a prescriber turned out to be unnecessary. In the early evening, my mother got an unexpected call from a doctor with her primary care provider. She told the doctor about her symptoms and about the Rite Aid I had found with Paxlovid in stock.

The doctor told her that he was surprised that we had been able to track down Paxlovid. He phoned in a prescription to the Rite Aid.

Now we just needed to pick up the pills before the pharmacy closed in about an hour.

Uber came to the rescue. I requested a pickup at the Rite Aid and listed the destination as my mother’s home, some 60 miles away.

Once a driver accepted the ride, I called him and explained my unusual request: He’d need to get the prescription at the pharmacy window and then drive it to my mother’s. I told him I’d give him a 100 percent tip.

The driver, who asked me not to use his name in this article, was game. He delivered the precious cargo just after 8 p.m. My mother swallowed the first three pills — the beginning of a five-day, 30-pill regimen — within minutes of the driver’s arrival.

. . .

. . . the fact that the process was so hard for a journalist whose job it is to understand how Paxlovid gets delivered is not encouraging. I worry that many patients or their family would give up when told “no” as many times as I was.

I was also reminded that even a “free” treatment can come with significant costs.

The federal government has bought enough Paxlovid for 20 million Americans, at a cost of about $530 per person, to be distributed free of charge. But I spent $256.54 getting the pills for my mother. I paid $39 for the telemedicine visit with the provider who told my mother that she would need to visit in person. The rest was the Uber fare and tip. Many patients and their families can’t afford that.

President Biden recently called the Pfizer pills a “game changer.” My experience suggests it won’t be quite so simple.

For the full story, see:

Rebecca Robbins. “A 7-Hour Odyssey to Get My Mom Covid Pills.” The New York Times, SundayBusiness Section (Sunday, January 23, 2022): 1 & 3.

(Note: ellipses added.)

(Note: the online version of the story has the date Jan. 19, 2022, and has the title “When My Mom Got Covid, I Went Searching for Pfizer’s Pills.”)

Less-Ventilated Energy-Efficient Buildings Reduce Indoor Air Quality, Harming Cognitive Performance

(p. D6) A new study shows that poor indoor air quality is associated with subtle impairments in a number of cognitive functions, including our ability to concentrate and process information. The study tracked 302 office workers in commercial buildings in six countries — the United States, Britain, China, India, Mexico and Thailand — for 12 months.

The scientists used monitors to measure ventilation and indoor air quality in the buildings, including levels of fine particulate matter, which includes dust and minuscule particles from smoking, cleaning products and outdoor air pollution that seeps into the building. The workers were asked to use an app to take regular cognitive tests during the workday. The tests included simple math problems, as well as a tricky color and word brain teaser called the Stroop test, in which a word like “blue” or “purple” is printed in green or red ink.  . . .

The study found that the office workers in buildings with the poorest indoor air quality tended to perform worse on the brain teasers. While the effect wasn’t dramatic, the findings add to a growing body of evidence suggesting that the air we breathe affects brain health.

. . .

“This study looked at how several factors in the indoor environment have an immediate impact on our cognitive function and performance,” said Joseph G. Allen, the director of the Harvard Healthy Buildings program and the study’s senior author. “This study shows that the air you’re breathing at your desk at that moment has an impact on how well you think.”

In the past, air quality control in buildings has been mostly focused on energy efficiency and comfort, with little consideration given to infection control or overall worker health.

. . .

Dr. Allen is the co-author of a new book, “Healthy Buildings: How Indoor Spaces Drive Performance and Productivity.” He said he’s been encouraged to see more businesses and individuals taking indoor air quality more seriously as a result of the pandemic. Recently he saw a job posting at a major company advertising for a “head of healthy buildings” in the company’s global real estate division.

“It tells you that serious companies are changing how they approach their buildings, and they’re not thinking about this as a one-off during Covid,” said Dr. Allen.

. . .

“The pressure is coming from employees, parents of kids in school, teachers — there’s a heightened level of awareness and expertise,” said Dr. Allen. “How many people were talking about MERV 13 filters prior to the pandemic? This knowledge that our indoor spaces have been underperforming is not going away. I think people are rightly frustrated and fed up with it.”

For the full story, see:

Tara Parker-Pope. “What Bad Indoor Air Could Do to Your Brain.” The New York Times (Tuesday, September 28, 2021): D6.

(Note: ellipses added.)

(Note: the online version of the story was updated Sept. 28, 2021, and has the title “Is Bad Indoor Air Dulling Your Brain?”)

The book co-authored by Allen, and mentioned above, is:

Allen, Joseph G., and John D. Macomber. Healthy Buildings: How Indoor Spaces Drive Performance and Productivity. Cambridge, MA: Harvard University Press, 2020.

Pandemic Increased Population Shift to the Exurbs

(p. A1) MURFREESBORO, Tenn.—This bucolic town 30 miles southeast of Nashville, Tenn., was once best known for its nearby Civil War battlefield and state college. Now it is one of the fastest-growing places in the country.

Surging housing costs and remote work are sending droves of people to live in new, fast-growing exurbs of metropolitan areas in the Southeast where suburban living has long been concentrated closer to the city.

Nashville, Charlotte, N.C., Charleston, S.C., and Jacksonville, Fla., are among the places getting the type of outer-ring residential development once found only around the country’s largest cities.

In 2020, net migration into a large group of exurban counties rose 37%, according to an analysis of U.S. Postal Service permanent change-of-address data by The Wall Street Journal. Nearly two-thirds of the flow came from large cities and their close-in suburbs.

Exurban areas, which include 240 counties as defined by the Brookings Institution, grew at almost twice the national rate over the past decade, a shift that began before the pandemic. There are signs it is accelerating this year as Americans prepare for an expected post-pandemic landscape where increased working from home reduces the need to commute.

Researchers differ in defining exurbs, but they gen-(p. A10)erally include the fast-growing outer fringes of large metro areas where single-family homes mix with farms and many workers have traditionally commuted a significant distance to the core of the metro area.”

For the full story, see:

Cameron McWhirter and Paul Overberg. “Pandemic Changes Swell Exurbs.” The Wall Street Journal (Monday, August 30, 2021): A1 & A10.

(Note: ellipsis added.)

(Note: the online version of the story has the date August 29, 2021, and has the title “New Life and Work Choices Revitalize Exurbs, Bringing New Strains.” The online version says that the title of the (New York?) print version was “Pandemic Stokes Exurbs Boom.” But my (National?) print version had the title “Pandemic Changes Swell Exurbs.”)

30,000 Tourists Find the Longest Queue at Shanghai Disney Is for Covid-19 Test

(p. A1) More than 30,000 visitors to the Shanghai Disneyland theme park were kept within the park’s gates on Sunday [October 31, 2021] and forced to undergo Covid-19 testing after a customer tested positive for the virus, a move that underscores China’s eradication efforts.

With fireworks exploding above them as they awaited nasal swabs, the Disney visitors became the latest Chinese residents to experience life under a “zero tolerance” policy for the virus enforced by their country’s government. Leaders there have taken stringent measures to contain pockets of the coronavirus in the country, despite criticism from business groups and a close to 80% vaccination rate.

“I never thought that the longest queue in Disneyland would be for a nucleic acid test,” one visitor said on social media.

(p. A6) Disney’s gargantuan mainland park—home to a Tomorrowland, Gardens of Imagination and Mickey Avenue—turned into a giant testing site late into Sunday evening, with guests required to be tested before being allowed to leave. The last visitor walked out at 10:30 p.m., said a Walt Disney Co. spokesman. Disney, which is a minority owner in the resort and has seen a spectrum of responses to Covid-19 at its parks around the world, had to comply with China’s local protocols, said the spokesman.

The shutdown on Sunday illustrates the lack of control Disney and other Western firms have in China, especially as officials work to clamp down Covid-19 outbreaks. The world’s largest entertainment company has yet to see park attendance return to pre-pandemic levels, and Sunday’s shutdown highlights the difficulties of reopening the global tourism economy while the threat of outbreaks still looms.

. . .

The mass testing proved a surreal scene. Videos shared by guests on social media showed swarms of people—many dressed up in Halloween costumes—queuing up for tests before they could leave. One showed the Disney evening fireworks erupting behind workers in hazmat suits conducting tests for park visitors.

For the full story, see:

Natasha Khan and Erich Schwartzel. “China Pens 30,000 Visitors In Park After Covid-19 Case.” The Wall Street Journal (Tuesday, November 2, 2021): A1 & A6.

(Note: ellipsis, and bracketed date, added.)

(Note: the online version of the story was updated Nov. 1, 2021, and has the title “China Locks 30,000 Visitors Inside Shanghai Disneyland After Covid-19 Case.”)

“People Are Now Coming to Their Own Conclusions About Covid”

(p. 3) Lauren Terry, 23, thought she would know what to do if she contracted Covid-19. After all, she manages a lab in Tucson that processes Covid tests.

But when she developed symptoms on Christmas Eve, she quickly realized she had no inside information.

“I first tried to take whatever rapid tests I could get my hands on,” Ms. Terry said. “I bought some over the counter. I got a free kit from my county library. A friend gave me a box. I think I tried five different brands.” When they all turned up negative, she took a P.C.R. test, but that too, was negative.

With clear symptoms, she didn’t believe the results. So she turned to Twitter. “I was searching for the Omicron rapid test efficacy and trying to figure out what brand works on this variant and what doesn’t and how long they take to produce results,” she said. (The Food and Drug Administration has said that rapid antigen tests may be less sensitive to the Omicron variant but has not identified any specific tests that outright fail to detect it.) “I started seeing people on Twitter say they were having symptoms and only testing positive days later. I decided not to see anybody for the holidays when I read that.”

She kept testing, and a few days after Christmas she received the result she had expected all along.

Though it’s been almost two years since the onset of the pandemic, this phase can feel more confusing than its start, in March 2020. Even P.C.R. tests, the gold standard, don’t always detect every case, especially early in the course of infection, and there is some doubt among scientists about whether rapid antigen tests perform as well with Omicron. And, the need for a 10-day isolation period was thrown into question after the Centers for Disease Control and Prevention announced that some people could leave their homes after only five days.

“The information is more confusing because the threat itself is more confusing,” said David Abramson, who directs the Center for Public Health Disaster Science at the N.Y.U. School of Global Public Health. “We used to know there was a hurricane coming at us from 50 miles away. Now we have this storm that is not well defined that could maybe create flood or some wind damage, but there are so many uncertainties, and we just aren’t sure.”

Many people are now coming to their own conclusions about Covid and how they should behave. After not contracting the virus after multiple exposures, they may conclude they can take more risks. Or if they have Covid they may choose to stay in isolation longer than the C.D.C. recommends.

And they aren’t necessarily embracing conspiracy theories. People are forming opinions after reading mainstream news articles and tweets from epidemiologists; they are looking at real-life experiences of people in their networks.

For the full story, see:

Alyson Krueger. “Covid Experts, the Self-Made Kind.” The New York Times, SundayStyles Section (Sunday, January 23, 2022): 3.

(Note: the online version of the story has the date January 21, 2022, and has the title “So You Think You’re a Covid Expert (but Are You?).”)

The Internet of Things Enables Better Indoor Air Measurement and Customization

(p. A1) “Indoor air quality is not a nice-to-have anymore—people have realized it’s essential,” says Arjun Kaicker, an architect at Zaha Hadid Architects, a London-based firm that has designed buildings around the world.

Many of the technologies bringing about this transformation are part of the oft-touted “Internet of Things.” It’s a combination of wireless, internet-connected sensors and automation, tied together by the cloud and millions of lines of code and sold as a service to solve a particular problem—in this case, the spread of communicable diseases and other air pollutants indoors.

As with other applications of the Internet of Things, such as in factories, much of the technology involved is about tying together existing systems so they can respond more dynamically to information their sensors are gathering, says Bobby George, chief digital officer of Carrier, which manufactures heating, ventilation and air-conditioning systems.

The goal is relatively simple: In more than 95% of buildings, air-conditioning systems are set on a schedule that remains largely untouched. Smart-building systems can pump more clean air into parts of an office as occupancy or other factors change throughout the day, adds Mr. George.

Wireless, battery-powered air-quality and occupancy sensors that can handle continuous monitoring are rapidly falling in price. They can be peppered throughout a building and don’t require opening up walls to connect to data and power.

. . .

In a May [2021] letter in the journal Science, 39 researchers and experts in public health, indoor air quality and engineering asserted that our understanding of transmission of respiratory infections, especially Covid-19, has progressed so rapidly that it should spur a “paradigm shift” for those responsible for the health and safety of office workers.

No longer, they continued, should people accept the idea that there is little we can do to prevent the spread of airborne infections at work. Just as we take pains to eliminate the spread of waterborne and foodborne disease, we now have the knowledge and tools to reduce the spread of germs in the air. And we should start demanding employers do something about it, they said.

To make that happen, businesses and schools should follow guidelines like those offered by the American Society of Heating, Refrigerating and Air-Conditioning Engineers, says William Bahnfleth, a professor of architectural engineering at Pennsylvania State University and the head of the committee that created these standards. Those guidelines include ensuring the right mix of fresh outdoor air and filtered indoor air, and using air filters that meet a higher standard of effectiveness.

Employees can use these types of published guidelines to inform their questions when talking to employers about returning to the office, Dr. Bahnfleth says. Similar guidelines are offered by the American Industrial Hygiene Association and the U.S. Centers for Disease Control and Prevention.

For the full story, see:

Christopher Mims. “KEYWORDS; Breath of Fresh Air.” The Wall Street Journal (Saturday, September 4, 2021): B2.

(Note: ellipsis, and bracketed year, added.)

(Note: the online version of the story has the same date as the print version, and has the title “KEYWORDS; The Pandemic Could Help Us Breathe Easier at the Office.”)

High Viral Load Increases Odds of Long Covid

(p. 18) It is one of many mysteries about long Covid: Who is more prone to developing it? Are some people more likely than others to experience physical, neurological or cognitive symptoms that can emerge, or linger for, months after their coronavirus infections have cleared?

Now, a team of researchers who followed more than 200 patients for two to three months after their Covid diagnoses report that they have identified biological factors that might help predict if a person will develop long Covid.

The study, published Tuesday [January 25, 2022] by the journal Cell, found four factors that could be identified early in a person’s coronavirus infection that appeared to correlate with increased risk of having lasting symptoms weeks later.

. . .

One of the four factors researchers identified is the level of coronavirus RNA in the blood early in the infection, an indicator of viral load. Another is the presence of certain autoantibodies — antibodies that mistakenly attack tissues in the body as they do in conditions like lupus and rheumatoid arthritis. A third factor is the reactivation of Epstein-Barr virus, a virus that infects most people, often when they are young, and then usually becomes dormant.

The final factor is having Type 2 diabetes, although the researchers and other experts said that in studies involving larger numbers of patients, it might turn out that diabetes is only one of several medical conditions that increase the risk of long Covid.

. . .

One persuasive conclusion, several experts said, was the suggestion that because patients with high viral loads early on often developed long Covid, giving people antivirals soon after diagnosis might help prevent long-term symptoms.

“The quicker one can eliminate the virus, the less likelihood of developing persistent virus or autoimmunity, which may drive long Covid,” Dr. Iwasaki said.

For the full story, see:

Pam Belluck. “New Research Hints at 4 Factors That May Increase Chances of Long Covid.” The New York Times, First Section (Sunday, January 30, 2022): 18.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the story has the date Jan. 25, 2022, and has the same title as the print version.)

The “Gold Standard” of Randomized Clinical Trials “Has Its Own Issues”

(p. R2) . . ., closely held Epic Systems Corp., maker of one of the most widely used electronic health record systems, searched a segment of its database in the spring of 2020 to find that routine breast, colon and cervical cancer screenings in the U.S. had each dropped by more than 85% during the first weeks of the Covid-19 pandemic. The report helped spur efforts to persuade people to make up for missed screenings.

But researchers have a much more ambitious vision for this data: to help guide how doctors treat individual patients in real time.

“The evidence from real-world data is a different and exciting new path,” says Jackie Gerhart, a physician who works with the informatics team at Epic. “You can get a lot of outcomes information from medical records that can help change care for individual patients.”

. . .

To be sure, patient records are observational, and thus subject to confounders and other shortcomings that can undercut their reliability in pointing to treatment options.

But the gold standard has its own issues. Randomized clinical trials, which control for differences in patient health status and other variables, are the preferred evidence to inform patient care. Yet such trials generally exclude an especially common group of patients—those with multiple ailments. Moreover, the elderly, children, women, minority groups and people who live far from medical research centers have long been underrepresented in such studies.

As a result, the highest-quality evidence that medicine produces doesn’t apply to most patients doctors see in daily practice. “There are so many clinical situations where the evidence that is needed does not exist,” says Nigam Shah, professor of medicine and biomedical data science at Stanford University Medical School.

Researchers have believed for at least a half-century that data in patient medical records could help fill the gaps.

. . .

The struggles of International Business Machines Corp.’s Watson raises [a] . . . yellow flag. It had ambitions to develop a tool for cancer doctors that would mine patient health records and thousands of pages of research from the peer-reviewed medical literature for treatment advice. But it hit walls, including accuracy and the complexity of combining data from electronic health records, billing claims and published research to provide a cohesive product. Doctors who used the service rarely changed treatment plans. IBM says it discontinued Watson for Oncology at the end of 2020.

For the full story, see:

Ron Winslow. “Mining the Gold in Patient Records.” The Wall Street Journal (Thursday, December 9, 2021): R2.

(Note: ellipses, and bracketed word, added.)

(Note: the online version of the story has the date December 3, 2021, and has the title “Medical Records Data Offers Doctors Hope of Better Patient Care.” In a couple of passages there are a few extra words in the online version, which is the version quoted above.)