May 24th, 2021
The United States continues on a great trajectory overall.
Latest numbers google/CDC show that cases peaked in early January. Death numbers continue to decline on a 7 day moving average. The United States is now past 61% of its over 18 year old population having been vaccinated with at least one dose.
The number of vaccinated and or previously infected Americans is now a very large number heading towards a herd immunity possibility.
130 million Americans are fully vaccinated with most being higher risk. 163 million have had at least one dose. The vaccines continue to drastically reduce the risk of death and hospitalization.
North Carolina now has 76% of individuals over 65 years of age fully vaccinated. It also appears to be stalled here.
The vaccines continue to be effective against the variants.
COVID continues to be a minor nuisance for almost all children.
As it stands today, the United States has had 33.1 million cases and almost 589,000 deaths.
There is still no change in the knowledge that more than 80% of deaths are skewed toward the over 55 age group and 94% of all deaths occurred in a person with a co-morbid chronic health disease. More biological antibody medicines are on the horizon that may along with a mixture of vitamin A , D, zinc, quercetin and melatonin be employed for a safe resolution to COVID19. If you did not read the newsletter about an Integrative approach to health in the COVID era, read this link and this link.
As with the first newsletter on this topic, keep solace with the fact that there is a 99+% chance of survival for all of us.
Mathematically, you now have a 99.9998% chance of survival once vaccinated.
Free Thoughts
The beginning of a new adventure in an audio format is at hand. After many years of toying with the idea, I am embarking on a dual role as an audio caster. I will audio record these newsletters for your listening pleasure and also begin a more formal podcast on specific heath care topics with the help of Dr. Paul Smolen.
The first installment is the recorded version of Coronavirus #35 (Last newsletter) which can be found at this link.
Dr. M
Coronavirus Update 36
If you would like to share some silver linings from COVID 2020 for us all to reflect on, please send them to
We must have discourse regarding experimental vaccinations to be a moral society. For this reason, I will take on this controversial topic.
Are we all ok with an emergency use authorization for the COVID19 vaccine for children under age 16 years old? That is a loaded question. In the British Medical Journal we see a piece written by Drs. Pegden, Prasad and Baral this week. They state: "For adults, the benefits of covid-19 vaccination are enormous, while for children they are relatively minor. Rare side effects from adult covid-19 vaccination are unlikely to lead to future vaccine hesitancy whose public health impact could be comparable to the benefits of the adult covid-19 vaccination program itself. But accelerated mass child vaccination under emergency use authorization—perhaps even spurred by school mandates and “vaccine passports”—presents a different balance of risks and benefits. The possibility that rare adverse events could emerge as the more durable public health legacy of an emergency use authorization for child covid-19 vaccines is much greater." (Pegden et. al. 2021)
"Young people have been largely spared from severe covid-19 so far, and the value of childhood vaccination against respiratory viruses in general remains an open question for three reasons: the limited benefits of protection in age groups that experience only mild disease; the limited effects on transmission because of the range of antigenic types and waning vaccine induced immunity; and the possibility of unintended consequences related to differences in vaccine induced and infection induced immunity." (Lavine et. al. 2021)
As I have discussed in the past, vaccines do cause rare but serious side effects that take years to ferret out. An EUA for COVID19 makes little sense to me as children have no significant increased mortality risk from COVID than they do from the annual influenza. EUA is necessary under specific conditions as was met for the adult death risk. Furthermore, we do not mandate influenza vaccination despite its incredible safety. To mandate vaccination for children to go to any school including college while not mandating the at risk adult individuals is like treating the adult swimming pool for stool leakage from diapers and not touching the kiddie pool. We should be treating the risk pool where it lies. This is not like mandatory measles for children which has a high morbidity and insane R0.
Our priority should be vaccinating the at risk population which is the adult population and allowing children to receive the vaccine based on each persons comfort with the scientific data as it stands. Even, in this situation, it may be better served for us to send our potential childhood use vaccines overseas to hotspots like India where people are succumbing to COVID19 in record number. Morally, this makes complete sense to me.
I am pro vaccine, but I am more pro safety and an EUA at this point as pointed out is jumping the safety gun for kids. Couple this to a much greater need over seas and you have a path forward.
This is not to say that each individual family cannot choose to get the vaccine if and when it is made available as the acute safety data is very strong. Every person must choose, as these events unfold, based on the risk of COVID in children which is minimal (not zero) versus the theoretical risk of a long term vaccine side effect as yet to be determined.
According to the CDC, there were 654 deaths from COVID19 in the age group 0-24 years old. In 2020, from 0-17 years of age, there were 178 COVID deaths from unvaccinated children and 179 influenza deaths in the 2020/21 season. Remember that the 179 deaths is from a partially influenza vaccinated youth population not a naive COVID population. (CDC) Putting this into perspective, when measles was rampant in the United States, 500 deaths and 1000 damaged brains occurred yearly in an unvaccinated population. This is a factor of 6X worse for outcomes and coupled to robust vaccine safety data. I have never seen a live case of measles in clinic in 25 years of medicine. Thus, vaccination works well for measles with no significant side effects.
For a counter argument that vaccination is necessary for children's mask removal in public see this piece by Wamsley from NPR.
Regardless of which side of this debate you find yourself on, the discourse is important while the judgement of viewpoints is not. Read the data and viewpoints over the ensuing weeks and be informed for your choice.
Quick hits
1) Poor quality messaging is eroding our confidence in the CDC. As noted in previous newsletters and a recent NYTimes article, the messaging, among others, was that less than 10% of the Covid cases occur outdoors when the actual number is between 0.1% and 1%. They are misleading the public by a factor of 10 to 100. Not good for trust.
"Saying that less than 10 percent of Covid transmission occurs outdoors is akin to saying that sharks attack fewer than 20,000 swimmers a year. (The actual worldwide number is around 150.) It’s both true and deceiving." (Leonhardt 2021)
We need to demand transparency and truth from our scientific leaders and health care policy makers. This kind of messaging erodes the public trust making mask mandates and vaccination requests less complied with as fear rises. They should state exact numbers and truth as known by today's data. That can change and that is ok as we always plan to change our behavior based on the evidence at hand and not the fear based altered data sets.
2) In a new Nature Medicine article, we see modeling data showing us that the human vaccine induced neutralizing antibody titer will wane over the first 250 days after immunization predicting some loss in protection to SARS2 infection. However, protection against severe COVID19 disease should be largely preserved. (Khoury et al. 2021)
This is consistent with what we are witnessing in post vaccination surveillance nationally from a morbidity perspective. Immunity may wane, yet, morbidity and mortality remain low even if a reinfection occurs. However, so far infection post vaccination remains rare. More time is needed to answer this type of modeling data.
3) SARS2 origins in the news again. This time in the Wall Street Journal, Mr. Freeman has written a piece on the origins of SARS2 very similar to the work of Nicholas Baker in the NYT Intelligencer back in January. (Freeman 2021)
4) The rare clotting events seen with the COVID Johnson and Johnson vaccines may be an autoimmune overreaction leading to a disease called vaccine induce thrombotic thrombocytopenia or VITT. A group led by blood disorder specialist Dr. Greinacher, has found that the preservative EDTA causes some of the proteins in the vaccine to leak into the blood and develop autoantibodies. It seems that platelet factor 4 may be targeted by the immune system for antibody production leading to autoimmune damage in the clotting cascade presenting clinically as serious venous clots in the brain, lungs or other location. (Pancevski et. al. 2021)(Greinacher et. al. 2021)
Because these events are exceedingly rare, it is highly likely that certain women have a genetic risk for autoimmune activation following exposure to the preservative EDTA in conjunction with vaccine related proteins. A rare but very bad event ensues that is deadly in a large percentage of affected individuals.
This again begs the question of vaccinating young individuals with low COVID risk who could develop a serious vaccine reaction to one of the adenoviral vector vaccines.
5) Sometimes human non compliance or a needed reason to delay a second vaccine falls into the land of serendipity. Such is the case with new data from the Journal Nature regarding the Pfizer vaccine effectiveness and dose timing. "To determine whether the delay paid off, Amirthalingam and her colleagues studied 175 vaccine recipients older than 80 who received their second dose of the Pfizer vaccine either 3 weeks or 11–12 weeks after the first dose. The team measured recipients’ levels of antibodies against the SARS-CoV-2 spike protein and assessed how immune cells called T cells, which can help to maintain antibody levels over time, responded to vaccination. Peak antibody levels were 3.5 times higher in those who waited 12 weeks for their booster shot than were those in people who waited only 3 weeks. Peak T-cell response was lower in those with the extended interval. But this did not cause antibody levels to decline more quickly over the nine weeks after the booster shot." (Ledford H. 2021)
This data set yet again gives us pause to continue to iterate our trials and knowledge on the most effective route to long term vaccine induced immunity for the at risk populations.
6) Researchers from Stanford University looked at a 9 month period last year (May 2020 to February 2021) during the pandemic to analyze the truth of pediatric COVID disease and found a surprising overshoot diagnosis rate by 45% meaning that a full 45% of the defined COVID cases were not actually caused by COVID. (Kushner et. al. 2021) The demographics of the 117 patients in the study included a 50% split male to female, 71% Hispanic, 11% Caucasian, 9% Asian, 2% African American, 16% immunocompromised.
It is important for us to understand that this disease is very very mild in children.
Perspective: 178 children died from coronavirus last year between 0 and 17 years of age of which 27% had a known underlying medical condition. (CDC Table) In 2018, 4,074 children under 19 years of age died in a motor vehicle accident and 3,143 from firearms. (Cunningham et. al. 2018) Driving in a car or owning a firearm is 20x more dangerous than being unvaccinated against SARS2 as a child/adolescent.
Keep reading, keep thinking,
Dr. M
Pegden BMJ
Lavine BMJ
Hoeg Atlantic
Leonhardt NYT
Khoury Nature Medicine
Freeman Wall Street Journal
Pancevski Wall Street Journal
Greinacher NEJM
Ledford Nature
Kushner Hospital Pediatrics
Cunningham NEJM
