Day 452: An End to the Crazy

Our governor has finally relented on the COVID-theater outdoor mask mandate, which comes to a well-deserved end this Friday, possibly due to the CDC's strange statement about the vaccinated not needing masks outdoors.

Massachusetts cases were up a seventh of a percentage point today.

P.S. The New York Times reported recently on how no one ever needed masks outdoors (except in the long-term face-to-face situations we've known about for a year now).

Day 450: Long COVID Fatigue

At Quillette, a brave and soon-to-be-cancelled writer compares "long COVID" to predecessors like chronic fatigue syndrome, and, surprisingly, transgenderism in "The Search to Explain Our Anxiety and Depression: Will ‘Long COVID’ Become the Next Gender Ideology?"

It’s important, as always, to emphasize that gender dysphoria has long been recognized as a real condition that afflicts a small portion of the population. What I’m describing here is an act of extrapolation, not of pure invention, whereby the existence of a legitimate diagnosis is co-opted by larger and larger portions of society. The same kind of trend has been going on in regard to homosexuality (which, to state the obvious, is also a very real phenomenon): To be gay (or bisexual) once had a fairly specific meaning in regard to one’s sexual tastes and behaviour. But teenagers now are encouraged to sort themselves into an ever-expanding typology of (often gauzily described) queer sub-variants—from allosexual (meaning non-asexual) to skoliosexual (“a sexual orientation that describes those who are sexually attracted to people with non-cisgender gender identities, such as people who are non-binary, genderqueer, or trans”). As in the latter case, these sexual identities sometimes mesh in complicated ways with gender identity—even though, as Angus Fox has described in his ongoing When Sons Become Daughters series for Quillette, many self-identified trans youth retreat to gender ideology precisely as a means of escaping (or at least delaying) the sexual changes and impulses associated with post-pubescent development.

One could even extend this pattern to the question of race. Every reasonable person will acknowledge that racism is a real phenomenon, and that the distinction between white and non-white can have concrete (and sometimes tragic) consequences for people who are victims of bigotry in Western societies. But out of this fact has sprung fanciful lexicons and hierarchies that purport to rank and encode fine racial distinctions, often (some might say, especially) in the case of privileged individuals who can’t explain how racism has affected their lives except by reference to abstract (and unfalsifiable) theories that cast the problem as an invisible, systemic malignancy generated by white people.

Another interesting point of comparison is the subclass of medical ailments known as “contested illnesses”—conditions such as chronic fatigue syndrome (CFS), multiple chemical sensitivities, and chronic Lyme disease, which don’t seem to exist except as a sort of crowdsourced belief system among individuals who claim to be afflicted. While none of these movements have attained anything close to the political and academic prominence of gender theory, their most politically engaged proponents echo the now-familiar idea that their problems can be traced to an outwardly undetectable condition whose denial generates its own separate form of suffering.

In the case of COVID-19, much attention has been focused on conspiracy theorists and lay quacks who claim the disease is a fraud. But there is also a pseudo-scientific movement that seeks to present its adherents as sufferers of a condition they call “Long COVID.”

As McMaster University psychiatrist Jeremy Devine recently wrote in The Wall Street Journal, some COVID-19 patients really do experience long-term effects that linger after the infection has left their body. But he adds that “such symptoms can also be psychologically generated or caused by a physical illness unrelated to the prior infection.” Moreover, he notes that a survey produced by Body Politic Covid-19 Support Group, a prominent driver of the Long COVID idea, indicates that “many of the survey respondents who attributed their symptoms to the aftermath of a COVID-19 infection likely never had the virus in the first place. Of those who self-identified as having persistent symptoms attributed to COVID and responded to the first survey, not even a quarter had tested positive for the virus. Nearly half (47.8%) never had testing and 27.5% tested negative for COVID-19. Body Politic publicized the results of a larger, second survey in December 2020. Of the 3,762 respondents, a mere 600, or 15.9%, had tested positive for the virus at any time.”

Echoing the idea of “self-identification” as the gold standard of gender identity, the Long COVID survey authors brushed aside these facts, arguing that “future research must consider the experience of all people with COVID-19 symptoms, regardless of testing status.” In this way, Long COVID also sounds a lot like chronic fatigue syndrome. In 2016, Devine himself, then a medical student, reported on a chronic-Lyme-disease group whose members, in many cases, “never had a Lyme infection in the first place. Those who explained away a negative Canadian test result often did so with a positive one from for-profit U.S. labs—so-called ‘Lyme specialty laboratories’—that offer testing with very high false positive rates.”

Massachusetts cases were up about a sixth of a percentage point today.

Day 448: The Most Compliant

The Boston Globe reports that Massachusetts has the lowest rate of "vaccine hesitancy" in the US at 7%. The only other state in the single digits (also 7%) was Vermont, while Wyoming is the most hesitant state.

Massachusetts cases were up a quarter of a percentage point today.

Day 441: Even the Queen

Female researchers at a couple of US universities have launched a formal study of COVID vaccines' unexpected effects on women's periods. (Women of childbearing age can participate in the research here.) Not surprisingly, platelets may be a factor:

There isn’t much research on how vaccination affects menstruation. But vaccines do stress the immune system, and the menstrual cycle sometimes responds to those types of changes. “The menstrual cycle is really dynamic, and it responds to tons of things,” Lee says.

There’s also a potential relationship between the nanoparticles used in the COVID-19 vaccines and changes in bleeding patterns. In some people, the nanoparticles end up creating a temporary immune reaction that kills off platelets, a type of blood cell involved in clotting, Clancy says. They regenerate quickly, but if someone has a bleeding event like a period just after they get a shot, it could make it heavier. She’ll be collaborating with Anirban Sen Gupta, a platelet researcher at Case Western Reserve University, to try to understand that potential mechanism.

Of course the real question is how such a pervasive side effect failed to come up in the initial trials considering that, apparently, women have been "regularly included in clinical trials [since] the 90's." Such glaring oversights don't exactly inspire confidence in the vaccines.

Massachusetts cases were up three-tenths of a percentage point yesterday, on what would have been tax day were we back to normal. Instead, the Commonwealth has followed the federal government in moving tax day to May 17th this year.

Day 438: No More Tears

The feds are recommending no more Johnson & Johnson vaccine after six cases of a rare clotting condition not unlike the one that sickened Vaxevria recipients in Europe. The suspension is temporary, but PlagueBlog hardly expects much uptake if they resume. Risk aversion seems to be at an all time high in the US.

Massachusetts cases are up a quarter of a percentage point today.

Day 436: Vaxzevria to Blame for VITT

Science reports on the causal connection between AstraZeneca's COVID-19 vaccine "Vaxzevria" and a rare clotting disorder scientists have dubbed vaccine-induced immune thrombotic thrombocytopenia (VITT). VITT has affected at least 222 European vaccine recipients and killed more than 30 of them (a rate of about one in a million).

While the disorder is similar to heparin-induced thrombocytopenia (HIT), the mechanism is only partly understood. The mRNA-based vaccines (Moderna's and Pfizer's) don't appear to prompt VITT, but suspicious clotting has already been reported for another viral vector vaccine, Johnson & Johnson's.

One in a million is a very small risk, possibly even smaller than the risk of a child under 10 dying of COVID, but several European countries have reacted by restricting the vaccine to the elderly. The article offers a glimmer of hope for Vaxzevria in lowering the doseage:

In AstraZeneca's phase III trial in the United Kingdom, a small number of people accidentally received a lower dose and had fewer side effects in general; perhaps the lower dose is less likely to trigger the kind of strong inflammation that boosts PF4 antibodies as well, the researchers say. And unexpectedly, those people were slightly better protected, perhaps because high levels of inflammation can actually block the formation of antibodies, Marschalek says. “Part of the problem might be that they just overdose” the vaccine, Greinacher says.

In local news, Massachusetts' cases have been holding around a third of a percentage point for the past week. (Today's numbers are not up yet.)

Day 432: The Brazilian Variant

The world is at 133 million total COVID-19 cases, with 31.5 million in the US, slightly over 13 million in Brazil, and slightly under 13 million in India. The rest of the top 10 countries have between 3 and 5 million cases each. China is currently #92, between Ghana, a nation of 31.6 million souls, and Kyrgyzstan, a nation of 6.6 million souls.

Massachusetts is at #15 among the states and is approaching 650,000 total cases. Despite ongoing hand-wringing over minor fluctuations in our case counts, the daily increase has remained well under half a percent since the holiday peak died down in early February. Yesterday, for example, was up only a quarter of a percent.

We do continue to lag in vaccination of young people (having only started the 55+ cohort this week) but our coverage in absolute doses is good, probably due to a combination of an older population and high uptake. We're also getting a bonus batch of vaccine this week. Barnstable County leads the Commonwealth in vaccinations, and it's a good thing because the P.1 variant on the Cape has given us the dubious title of the state with the most cases of the Brazilian variant.

P.S. More on P.1 from the Virological forum:

The detection of over 50 cases of the P.1 variant, a VoC that has been associated with increased transmissibility and reinfection, in less than a month in MA is concerning.

That many of these genomes appear to reflect multiple independent introductions of P.1 into New England, and transportation of this variant between several US states, points to likely widespread circulation of this VoC across the country. While our understanding of the increased transmissibility of the P.1 variant is still unfolding, the large cluster of identical and nearly identical genomes–a pattern of genetic diversity consistent with superspreading-- highlights the ongoing risk of rapid spread of SARS-CoV-2, and in particular for more transmissible lineages. The extent of community transmission of P.1 in Massachusetts and across the US is currently unknown, however, it is likely that the P.1 variant is already or will soon be circulating in communities and ongoing surveillance will be critical to understanding the trajectory and impact of the P.1 variant.

P.P.S. Massachusetts cases were up two fifths of a percentage point today.