TL;DR

• Effective contact tracing combined with quarantining individuals at risk is highly effective with the least impact to most people’s lives.
• COVID vaccines are highly effective. If you over 30 you should get one. For healthy people under 30, COVID has had very low mortality rate which has lead some people to recommend skipping it. Most medical professionals recommend getting a vaccine for the under 30, and I think it’s wise.
• Masking slows the spread of COVID, but there are social costs to masking. Mask, or don’t mask to achieve desired impact, not as a way to signal political identity (for or against).
• There are bad actors who are spreading misinformation, unless there is a peer reviewed paper from experts, don’t believe it.
• Just because people are sharing  misinformation doesn’t mean those people are bad actors. They could have been taken in. Take the time to understand and assume good intent.

The best COVID response I have see is in Taiwan, an island nation of 21 million people (about the same as the state of Florida). Early in the pandemic Taiwan required people entering the country quarantine for 14 days. Any break out cases were contact traced with people possibly impacted quarantined. When the number of infections started to climb Taiwan instituted a 2-week lock down and mask wearing. Other than those 2-weeks people have been completely free to move around, large public gatherings have continued, masks not required. There was excellent government support. Taiwan has a national health care system which is accessible to all. Financial support was provided to people who were quarantined. Quarantines were “enforced” with Geo-Fencing of people’s phones and large fine if people violated their 14 day quarantine. The results? Taiwan had 2 deaths and 40 infections in the same period that Florida had 150 deaths and 12,000 infections, even though the vaccination rate is similar.

I have growing increasingly frustrated by the politicalization in the USA when it comes to COVID. Vaccines and masking have become tools to signal political identity rather than tools whose use is driven by good science. Worse yet, it seems like conversations about this topic is dripping with contempt. Can we move this back to a discussion of public health like when we were battling polio?

There is strong evidence of the following:

• Vaccines are an effective means of limit the spread and lessen the impact of infections.  Before vaccines, most children did not live into their teen years. The history of vaccines in western culture dates back to 1700s (Asia the 1500s?). Famous successes include the elimination of smallpox (Catherine the Great an early advocate); diphtheria, cholera and typhoid control; and the near elimination of polio.
• The COVID vaccine is a vaccine developed by scientists, just as the previous vaccines that most of us have trusted in the past. People are not being injected with poison or micro chips. The development process was accelerated and the testing before use was streamlined compared to the past, but at this point we have far more data about safety and efficacy in the field after a year than testing would have produced.  BTW: A Brief History of mRNA vaccines is fascinating.  Katalin Karik is a real hero in the story!
• In very rare cases vaccines cause severe reactions which can impact people’s health. First of all, there are allergic reactions which can lead to shock.  This is why you are asked to sit for 20 minutes after your shot.  If you have a reaction like that a shot of adrenalin will stop the reaction and with a dose of Benadryl no damage is done.  Other reactions are myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the lining outside the heart) which is usually mild and goes away on its own.  Finally, there are blood clots, a condition called thrombosis with thrombocytopenia syndrome which happens to women younger than 50 on the J&J vaccine.   (Just avoid this vaccine!) Since 100’s of million people have had the vaccines, these serious side effects are very rare.  Statistically, the “average” person will have better health outcomes by taking a vaccine, but these with the serious side effects still have a benefit from the vaccines.  If they do not have the vaccine, Covid19 tends to cause these same serious effects in these people and can lead to hospitalization.
• All of “evidence” that vaccines are responsible for diseases like autism has been discredited.  The sample size of the original study was 8 with no controls or determination when the autism symptoms started!  There is a big difference between causation and coincidence. There was a good paper that evaluates the original study link between vaccines and autism. There is the attempt explain the increase in autism over the past decades by blaming factors like vaccines, but in fact autism is a genetic disorder which seems to be caused by the increasing age of fathers like down syndrone is related to the age of mothers.
• Physical distancing and wearing masks slow the transmission of viruses in general, and covid in particular. Masks preventing the spread of respiratory infections have been common doctrine for more than 100 years. Masks have been demonstrated to be effective with COVID in a randomly assigned trial. [Full paper].  Paper about mask impacting upper bound on one-to-one exposure to infectious human respiratory particles. N95 at the best, surgical masks are more effective than double layer cloth masks. Single layer cloth masks are more a fashion statement than an effective tool. A common issue with most masks is that they don’t seal very well. Aaron Collins, aka mask nerd, a mechanical engineer who specializes in nano materials has produced a number of documents and videos reviewing and ranking masks. Projectn95 is a clearing house for informational about PPE and COVID tests.

Against this are some observations that I don’t have randomized controlled experiments but I believe to be true:

• Wearing mask is causing significant stress for all people, but especially children because it makes it much harder to connect with others.  This does not seem to be true in Asian populations where mask wearing is a common practice out in public.
• Lockdowns and other restrictions disproportionally impact the most vulnerable people because they have not been able to work remotely, often lost jobs, and when working are at elevated risk due to their regular contact with others.
• Schools being closed has been very hard on the children, and extremely difficult for parents, especially single parents, and have been extremely difficult for teachers to teach.  Germany has been able to keep their schools open by using better ventilation and masks, unlike many US school districts.

Was Covid a lab leak?

• An number of reputable journalists reported that there were saftey issues at the Wuhan lab just weeks before the first cases of Co
• The scientists I know believe the evidence we have today favors a natural process bring COVID to humans.  There are several scientists who have questions this conclusion.  Several of the papers by these scientists have been built on faulty data or assumption. Most have not been written by people who specialize in this field. Likewise, they have not gone through the peer review process, rather have been released as positional papers, editorials, or letters to the editor. Examples of some questionable reasoning:
  • We should have found it animals.  It took 15 years after SARS to find these links. There are some close  relatives of Covid19 have been already been found in nature.
  • There should be multiple animal to human transmissions (preliminary evidence of at least two jumps). With SARS it took many years to discover this.
  • the Wuhan lab has very poor protocols and controls. The lab in question was built by the French at BioHazard Level 4, is reported by visiting researchers to use excellent safety protocols. The director is well regarded by all of the leaders in the field. Counter-point is that there are entrenched interests which are inclined to cover-up mistakes and we should continue to be open minded about the origin.

Mis-Information

• Covid has killed more people who have received the vaccine than who haven’t received the vaccine is simply not true. Since less than 50% of the world’s population has been vaccinated this is preposterous at a world level, since the vaccines are widely known to reduce the death rate from COVID.  In Israel where 85% of the population (9.3 million) has been vaccinated, there are more vaccinated people than unvaccinated.  But of course more people unvaccinated are dying than vaccinated even in absolute numbers.  On October 1, 2021 the number of serious Covid cases in Israel was 644, with 472 unvaccinated, 123 with two shots and 49 boosted.  In the week previous to October 1, 129 people died of Covid, 65% unvaccinated (84), 26%  one or two shots (34) and 8% with booster (1).  So even in Israel with 85% vaccinated, more unvaccinated die than vaccinated. This shows that the hypothesis that more vaccinated people die of Covid than unvaccinated is wrong, even in a population where 85% of the people are vaccinated.  (Israeli data is more reliable than US data because they have universal healthcare and good record keeping.)

Questionable Position

• Great Barrington Declaration signed by folks who are bucking against the common narrative of the larger medical community. I find myself sympathetic to their position, but have some concerns about their reasoning. First, we have evidence of re-infection which suggest herd immunity will never be achieved.

Things I want to followup on

• Historical analysis of pass attempts of containment. One classic comparison was Saint Louis vs Philly during the Spanish flu.
• Some of the countries which did early masking / lockdowns has worse outcomes than countries that were looser. Of course there are many factors which impacted both infection rates and mortality rates. Any way to understand which factors have what prepositional impact?
• At the end of 2020 models suggested risk of death from COVID vs flu was lower under 14, higher above 14, growing significantly the higher the age. How has another year of data plus better treatment changed these numbers?

To Deepen understanding of science method (and frequent failures) in the medical space

• Studying Studies by Dr. Peter Attia
• Bad Science by Ben Goldacre

Miscellaneous Information

• Dry Heat Sterilization of N95 Masks: 30minutes in dry 100C deactivates covid while preserving the structure of the mask