The three co-chairs, according to Washington Post November 9: Vivek H. Murthy, surgeon general during the Obama administration; David Kessler, Food and Drug Administration commissioner under Presidents George H.W. Bush and Bill Clinton; and Marcella Nunez-Smith, associate dean for health equity research at the Yale School of Medicine.
Here are some others, according to WaPo:
The group includes several other prominent doctors:
· Ezekiel Emanuel, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania.
· Atul Gawande, a surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School who is a prolific author.
· Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
· Eric Goosby, global AIDS coordinator under President Barack Obama and professor of medicine at the University of California at San Francisco School of Medicine.
· Celine R. Gounder, clinical assistant professor of medicine and infectious diseases at New York University’s Grossman School of Medicine.
· Julie Morita, executive vice president of the Robert Wood Johnson Foundation, a philanthropy focused on health issues.
· Loyce Pace, president and executive director of the Global Health Council, a U.S.-based nonprofit organization dedicated to global health issues.
· Robert Rodriguez, professor of emergency medicine at the UCSF School of Medicine.
Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University Medical Center, and Beth Cameron, director for global health security and biodefense on the White House National Security Council during the Obama administration, are serving as advisers to the transition task force.
https://www.washingtonpost.com/health/2020/11/09/biden-coronavirus-task-force/
Everyone mentioned for the task force is an expert in epidemiology or public health or has executive experience as an administrator as well as being an MD. All of these people bring experience and education to the table.
Deborah Birx has said she has not been contacted by Biden’s transition team, and we hope that she will not be an integral part of the response– based on her track record of causing anguish among the present task force’s members. Anthony Fauci has refused to say whether he will be involved, but insists that he will continue in his job (which has continued through multiple administrations of both parties.)
Robert Redfield has apparently not been mentioned in relation to Biden’s task force. It should be noted that both Redfield and Birx have publicly stated their disagreement with the current favorite on the current task force, Scott Atlas. Redfield was overheard on a plane saying, “Everything he says is false” with reference to Atlas.
Unfortunately, both Redfield and Birx have serious shortcomings in their organizational abilities. We hope that they will be returned to less visible work, not leading any major groups in the anti-virus effort. Both are expert scientists, but neither is able to lead.
According to the Washington Post, Redfield has stated that he plans to “step down” in January. They seem to imply that [redacted] may try to fire him during the lame-duck period, along with Health and Human Services Secretary Alex Azar and FDA Commissioner Stephen Hahn. In fact, a number of people may be forced out, including the FBI director, the heads of the CIA and NSA, and the Director of National Intelligence, decapitating our national security apparatus at a critical time of transition.
There are two news items here: first, Joe Biden plans to hit the ground running to fight the novel coronavirus pandemic. Second, [redacted] intends to burn his government to the ground before he leaves on January 20.
This woman is Emily W. Murphy. She was appointed to be the head administrator at the General Services Administration by [redacted] on September 2, 2017 and approved by the Senate by “unanimous consent.”
Yesterday, the Washington Post reported that she had no plans to sign a letter that would authorize the Biden administration to officially begin work on a transition that would take final effect on January 20, 2021.
Her excuse, apparently, is that the Electoral College will not certify an official winner to the presidential election until December 14, when the Electors actually vote. Of course, she could wait all the way until January 6 of next year, when the House and Senate meet to count the Electoral votes.
Her refusal ties up millions of dollars in revenue ($9.9 million) for the transition as well as office space, computer time, equipment, and access to officials in the current administration. In addition, agency heads will probably be told not to talk to Biden administration people.
This is all a result of the current president’s refusal to read the handwriting on the wall. Even the legal challenges that have been filed over various voting issues don’t have the potential to change the vote totals enough to overturn the results announced by all the news agencies and acknowledged by even some (four so far) Republican senators.
These senators do not include McConnell, who has announced a position that accepts the results of the election that are positive for the Republicans: retention of Senate seats by his friends and picking up House seats as well. Those very same ballots, however, were not accepted as showing that Biden had won the election. This makes one wonder which parts of the self-same ballots are unacceptable to McConnell? The ones he likes or the ones he doesn’t like?
Pfizer and BioNTech today (November 9) announced early Phase III trial results that showed their mRNA vaccine is more than 90% effective against COVID-19, with no serious side effects (yet.) The Pfizer vaccine was developed without direct support from the US government, although they have pre-sold 50 million doses for delivery by the end of this year.
The vaccine will be delivered in over 1 billion doses next year. Unfortunately, prior to administration, it must be stored at -100 degrees Fahrenheit. This will make it much more cumbersome to distribute than some other vaccines.
The Emergency Use Approval (EUA) from the Food and Drug Administration (FDA) will soon be forthcoming. We also hold out hope that easier-to-store vaccines will be approved, especially because widespread distribution in poor countries worldwide will depend on less cumbersome material.
You can peruse this New York Times article for further information. Here is an article from Stat news as well. Here is Pfizer’s press release. Finally, here is an Associated Press item.
MSNBC has also stated on television, with a graph to illustrate, that we are in the third wave of infections. The first wave was in April. The second wave, twice the height of the first, was in July. The third wave, heading up now, is already triple the height of the first. Here is an article from Vox.com explaining the “third wave” or “surge.”
The Biden administration has announced today that it has appointed a coronavirus committee consisting of twelve experts in health and epidemiology. The new administration plans to hit the ground running. According to CNN, the coronavirus team will include Rick Bright, who was sidelined by the previous administration and has been designated a whistleblower.
This paper, published on November 2, 2020 in Science magazine, describes autoantibodies found in 172 patients in hospital with severe COVID-19.
From the abstract:
Here, we measured eight types of aPL antibodies in serum samples from 172 patients hospitalized with COVID-19. These aPL antibodies included anticardiolipin IgG, IgM and IgA; anti-β2 glycoprotein I IgG, IgM, and IgA; and anti-phosphatidylserine/ prothrombin (aPS/PT) IgG and IgM. We detected aPS/PT IgG in 24% of serum samples, anticardiolipin IgM in 23% of samples, and aPS/PT IgM in 18% of samples. Antiphospholipid autoantibodies were present in 52% of serum samples using the manufacturer’s threshold and in 30% using a more stringent cutoff (≥40 ELISA-specific units). Higher titers of aPL antibodies were associated with neutrophil hyperactivity including the release of neutrophil extracellular traps (NETs), higher platelet counts, more severe respiratory disease, and lower clinical estimated glomerular filtration rate.
https://stm.sciencemag.org/content/early/2020/11/02/scitranslmed.abd3876
Thus, about half of patients with severe COVID-19 had at least short-term presence of auto-antibodies (antibodies that are aimed at normal parts of the patient’s own body) that promote blood clotting.
These auto-antibodies are the source of the widespread blood clots that form in severe virus disease: clots in veins and arteries that block blood flow to vital parts of the lungs, brain, kidneys, and other body regions.
Patients with severe infection are often killed or rendered permanently disabled by blood clots in the brain, lungs, and kidneys. Strokes (cerebrovascular accidents or CVA) appear suddenly in patients who are in the intensive care unit and cause permanent paralysis. Lung infarctions (due to blood clots in the pulmonary arteries) cause further lowering of blood oxygen levels in patients already suffering from pneumonia.
This explains why the patients with severe COVID-19 benefit from routine administration of anticoagulants (drugs that prevent blood clotting.) Cheap and effective anticoagulants are widely available: warfarin, coumadin, and the like. Newer anticoagulants are also readily available. Further study will probably reveal anticoagulant drugs that are more effective against auto-antibody-mediated blood clots.
This blog is primarily scientific, published by a trio of “academic ecologists”, including Jeremy Fox, who has a PhD from Rutgers and does research in population dynamics (etc.)– his grant was just renewed and expanded in September (congratulations to Jeremy Fox!)
The subjects covered in the blog are eclectic and philosophical. Some are interesting and controversial. The one which caught my eye posed the question “What’s the ‘greatest’ scientific fraud of all time?” published November 2, 2020, and referenced on “Retraction Watch” (another scientific blog, which has mushroomed over the last few years.) Sorry, comments were closed fairly quickly on that particular blog post– due to some controversy over the definition of “fraud”, “scientific”, and other basic words.
A personal note
I have been sick. No, it’s not the novel coronavirus, it’s one of the older ones– at least I have partial immunity to it. But I did have diarrhea, then a sore throat, followed by a runny nose and a cough. I also felt very tired and sleepy. This has been going on for two weeks now.
I don’t know, maybe it is the novel coronavirus and I just have a mild case. It’s not bad enough to bother any of our healthcare workers other than my wife. She told me to rest, take ibuprofen, and take an antibiotic. So I did, and I am. I’m starting to feel better, but I still have that persistent cough and runny nose.
Since I have had chronic sinusitis in the past, I have been particularly cautious about avoiding complications. Besides, I don’t feel like doing anything anyway.
Why am I even saying this? Because I was feeling much better this afternoon as the major news services have forecasted a Biden/Harris win in the election currently being contested. That makes me feel better, and it should make you feel better too. Especially if you are not a non-college-educated, male, conservative, narcissist, with a European background– if you are NOT identified with these things, then you should be especially feeling good. Even if you are most of those things, you should still feel good.
I’ll say it again: no matter who you are, he-who-must-not-be-named is better forgotten forever. If that person happens to be indicted by State of New York or even a federal Attorney General, then you can feel vindicated.
If you somehow identify with that person, you shouldn’t be reading this because it won’t suit you. This blog insists upon being fact-oriented, non-religious, appropriately skeptical, and other things like that. There might even be a slight whiff of socialism adjacent to this text.
So I admit it: I have been sick, and I’m feeling better because the Democrat appears to have won the election. I’m not happy because the Senate is not flipping to the Democrats, but we can deal with that later.
Lancet, on Nov 3, 2020, published an autopsy report with 41 patients who died of COVID-19 pneumonia. This is a highly technical pathology report that describes new findings in virus-infected tissues.
The autopsies showed lungs with thromboses and a few infarctions, viral RNA in pneumocytes and endotheliocytes, and “a large number of dysmorphic pneumocytes, often forming syncytial elements”– besides extensive scarring. Examination of non-lung tissues showed little or no virus infection in most cases.
The presence of thromboses has been widely reported. Scarring and widespread destruction of alveoli were also universally seen. These features have come to be expected in COVID-19. The severe scarring could account for symptoms of persistent shortness of breath in people who appear to have recovered from the infection.
Dysmorphism and syncytia have not been noted, however. The presence of neovascularization and similar signs of new growth was reported previously, but syncytia are a new and troubling finding. This suggests that the reactive process that occurs in virus-infected tissue includes new growth and abnormal cells.
Another troubling finding is the persistence of viral RNA in the lungs, long after the infection has come under attack by the immune system. Continued production of intact virus and shedding into the airways could mean these patients are still contagious even as they have been ill for weeks and are on the point of expiration.
Here is the “findings” section of the abstract:
COVID-19 is characterized by extensive alveolar damage (41/41 of patients) and thrombosis of the lung micro- and macro-vasculature (29/41, 71%). Thrombi were in different stages of organization, consistent with their local origin. Pneumocytes and endothelial cells contained viral RNA even at the later stages of the disease. An additional feature was the common presence of a large number of dysmorphic pneumocytes, often forming syncytial elements (36/41, 87%). Despite occasional detection of virus-positive cells, no overt signs of viral infection were detected in other organs, which showed non-specific alterations.
https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(20)30480-1/fulltext
In the body of the paper, the authors state that: “They [the findings] support the concept that, different from other forms of interstitial pneumonia and ARDS, the clinical features of COVID-19 patients are not [solely] attributable to extensive DAD, but rather derive from the persistence of infected and dysfunctional cells in the lung.”
In other words, diffuse alveolar damage (DAD) doesn’t explain all the clinical features of COVID-19 pneumonia. Rather, infected, dysfunctional endothelial cells (that form the lung’s inner lining) are causing additional symptoms that account for long-term complications.
The authors say that the dysfunctional cells may explain the development of localized thrombi (blood clots) within the lungs. They blame the syncytial cells on the influence of the “fusogenic S-protein”– that is, the spike protein may cause cells to fuse together.
The paper states that virus-infected or altered cells are largely absent from the rest of the body, despite the findings of studies that showed gastrointestinal (GI) and kidney involvement with at least transient presence of viral RNA in stool and urine.
They propose that the highly inflammatory response that continues in severe infection may be due to the persistence for several weeks of virus-infected, dysfunctional cells in the lungs alone.
The picture that they describe in autopsies suggests that persistence of infection and severe alterations in the lungs, by themselves, can cause the persistence of inflammation and systemic dysfunction through-out the body.
This report is another advance in our understanding of the pathological features of infection with SARS-COV-2 that helps to explain the prolonged nature of the disease in severe cases.
Deborah Birx, MD: a White House coronavirus pandemic response coordinator who doesn’t coordinate
This post is about Dr. Deborah Birx, who was installed as the White House coronavirus pandemic response team’s coordinator. The team is led by Vice President Mike Pence. There are problems with the team, with Dr. Birx, and with the leader, Mr. Pence. The worst problem, though, is the head of government.
This head has failed to provide over-all leadership and has not taken charge of the federal government’s response. He has effectively turned over responsibility for government response to the state governors, but has failed to provide them with funding or direction. The most prominent result has been a free-for-all among states trying to obtain personal protective equipment (PPE) against the virus: masks, face shields, gowns, gloves, respirators, and the like. Individual states have been forced to compete with the federal government for PPE, frequently being outbid or having their shipments hijacked by federal authorities.
The emphasis of this post will be on the personalities of Dr. Birx and Dr. Redfield. There are so many failures in the federal response that it would take an entire book just to give an overview of them all. I focus this post on Dr. Birx because of an article in Science magazine. This article is titled “The inside story of how [redacted] COVID-19 coordinator undermined the world’s top health agency” and it was published October 14, 2020.
I begin with some direct quotes from the article which describe the effect that Dr. Birx’s personality has had on the CDC. The article starts with a meeting held on July 13, in which a top aide to Dr. Birx announced that the CDC would be relieved of its responsibility for data gathering:
Irum Zaidi, a top aide to White House Coronavirus Task Force Coordinator Deborah Birx, chaired the meeting. Zaidi lifted her mask slightly to be heard and delivered a fait accompli: Birx, who was not present, had pulled the plug on the Centers for Disease Control and Prevention’s (CDC’s) system for collecting hospital data and turned much of the responsibility over to a private contractor, Pittsburgh-based TeleTracking Technologies Inc., a hospital data management company. The reason: CDC had not met Birx’s demand that hospitals report 100% of their COVID-19 data every day.
According to two officials in the meeting, one CDC staffer left and immediately began to sob, saying, “I refuse to do this. I cannot work with people like this. It is so toxic.” That person soon resigned from the pandemic data team, sources say.
Other CDC staffers considered the decision arbitrary and destructive. “Anyone who knows the data supply chain in the U.S. knows [getting all the data daily] is impossible” during a pandemic, says one high-level expert at CDC. And they considered Birx’s imperative unnecessary because staffers with decades of experience could confidently estimate missing numbers from partial data.
“Why are they not listening to us?” a CDC official at the meeting recalls thinking. Several CDC staffers predicted the new data system would fail, with ominous implications. “Birx has been on a monthslong rampage against our data,” one texted to a colleague shortly afterward. “Good f—[uck]ing luck getting the hospitals to clean up their data and update daily.”
When Birx, a physician with a background in HIV/AIDS research, was named coordinator of the task force in February, she was widely praised as a tough, indefatigable manager and a voice of data-driven reason. But some of her actions have undermined the effectiveness of the world’s preeminent public health agency, according to a Science investigation. Interviews with nine current CDC employees, several of them senior agency leaders, and 20 former agency leaders and public health experts—as well as a review of more than 100 official emails, memos, and other documents—suggest Birx’s hospital data takeover fits a pattern in which she opposed CDC guidance, sometimes promoting President [redacted] policies or views against scientific consensus.
https://www.sciencemag.org/news/
This behavior typified Dr. Birx’s management style and caused resentment, reduced morale, and resignations among people working on the pandemic response. Dr. Redfield, as head of CDC, was a weak leader. He was unable to stand up to Dr. Birx. No-one provided overall leadership to compensate for these personality clashes.
In some cases, Dr. Birx promoted the president’s views against those of scientific personnel without logical reasons. Most of these cases were based on opinions expressed by the president at random where he noticed and commented on isolated aspects of the program without focussed attention. In most other cases, the president did not notice or direct the rest of the program and allowed Dr. Birx to do what she thought best without interference.
CDC employees with whom Science spoke—who requested anonymity because they fear retaliation—along with other public health leaders, say Birx’s actions, abetted by a chaotic White House command structure and weak leadership from CDC Director Robert Redfield, have contributed to what amounts to an existential crisis for the agency. And her disrespect for CDC has sent morale plummeting, senior officials say. During a May task force meeting, The Washington Post reported, Birx said: “There is nothing from the CDC that I can trust.”
CDC scientists and others say Birx’s record echoes her approach as head of the President’s Emergency Plan for AIDS Relief (PEPFAR) since 2014. Although that program is widely praised, people who worked on it for years say her draconian management and unrealistic data demands damaged morale and disrupted fieldwork and patient services.
…
The interviews and documents obtained by Science show Birx replaced a functional, if imperfect, CDC data system—well understood by hospitals and state health departments—with an error-ridden and unreliable filter on hospital needs that sometimes displays nonsensical data, such as negative numbers of beds. Such problems could hamper effective distribution of federal resources during an anticipated fall and winter spike in COVID-19 and flu cases, CDC officials say.
https://www.sciencemag.org/news/2020/10/
There is only one thing I have to add to the analysis by the Science magazine’s reporters: the issue of religious faith. Both Dr. Birx and Dr. Redfield were selected in part because of their staunch Christian religious faith. This selection is a poor basis for making an appointment to a top management position. Both doctors were highly competent within their fields, but both lacked management abilities needed to hold together teams of people with varied backgrounds.
The leader to whom they looked– Vice President Pence– was also highly religious and authoritarian. He followed the instructions of his leader– our current president– without question because of his own authoritarian personality style. The president’s overall leadership was inconsistent and uninformed.
This would not have mattered as much if there had been a well-organized leader at the top who could keep an eye on the ball. Instead, there was a narcissistic, disorganized, uncaring individual who became president almost by accident. He did not have any experience in leading a team of people towards a common goal that transcended the simple management of a real estate company. Worse, he has no concept of learning from experience, so he makes the same mistakes over and over again. We are all suffering the effects of a president who has no concept of organized leadership.
Today is the end of Election Season, so here is a post about the future that has nothing to do with who wins the election. I haven’t posted about this before because it seemed obvious, but I can’t hold back anymore: records are being set every week now of new COVID-19 positive RT-PCR tests. Hospital cases are following right behind, but deaths so far have not increased as much as before.
One problem not noted in the official new case totals is that, increasingly, cases are being diagnosed by rapid tests. Many of these rapid tests are not being officially recorded, making the record increases even more consequential. Rapid tests are performed onsite or nearby, and they are taking place at urgent care centers and doctor’s offices that are not accustomed to informing the appropriate authorities about positive test results.
The rapid tests are also subject to abuse, in that people without symptoms are being tested– a use not intended by the test makers and likely to be false-negative in cases that have low virus loads. Apparently, asymptomatic individuals can have relatively light infections with fewer viruses being shed– resulting in a lower antigen signal.
The RT-PCR test is supremely sensitive– so much so that it is being accused of being “false-positive” when tiny amounts of virus are detected. The rapid virus tests are not nearly as sensitive, and can miss infections with small virus loads; this is particularly a problem in asymptomatic people. The rapid test is very helpful, but overall direction of the rapid effort should have included full instructions that it’s use should be limited to symptomatic people. This is increasingly evident: a failure of direction from the top has led to sincere but mis-directed efforts to find cases and failure to follow-up with contact tracing.
One example of official failure that I can’t help mentioning is that of a woman who died on an airplane in flight. She was middle-aged, obese, and had asthma; she did not know that she had COVID-19. She experienced increasing respiratory distress in-flight and had an intensive cardiopulmonary resuscitation attempt by a stewardess. The flight was diverted and the dead patient removed, but the diagnosis of COVID-19 was not made until she was autopsied two days later.
Most of the people exposed to her were not informed, and contact tracing was not done. It took three months for all of the people involved to learn of this case. From July 24 until mid-October, when the case was published in the newspaper, no attempts at full notification were performed. This was a failure of federal government agencies, initiated by a lack of overall direction by the administration from the top.
To return to the present: increases in new cases are being followed by increases in hospital admissions, resulting in record numbers of inpatients. These patients are overloading hospitals in places like Denver, Colorado, Salt Lake City, Utah, Boise, Idaho, and Bismarck, North Dakota. Hospitals are talking about transferring patients to places with greater intensive care unit capacity.
By the end of this year, hospitals may have been overloaded, and temporary field hospitals are being set up to handle the overflow. The hospital crush that was seen in New York City in the spring is being seen now in the rural Midwest, West, and Southwest.
The death rates have fallen far behind the new case rates because it now looks like doctors have gotten much better at treating serious cases. Fewer patients are being put on ventilators; more people are getting dexamethasone, which by itself reduces death rates by a third; patients are being turned to prone positions to improve oxygen exchange; and many refinements have resulted in improved survival rates in hospital.
Another problem which has not received enough attention is the plight of people who were not in critical condition during their acute infection but are left with serious after-effects. The rate of “long COVID” has been estimated at 5 to 10% of symptomatic cases. This represents a huge number of people when you take 8 million total positive test results in the last ten months: 400,000 to 800,000 people with persistent symptoms and at least a hundred thousand of them disabled, for a year or possibly permanently. They look like a new generation of myalgic encephalitis/chronic fatigue syndrome.
The virus is coming back in places that were hard hit last spring, but that experienced a remission in the summer: mostly the Northeast.
Places like Connecticut and Massachusetts that had almost eliminated new cases are seeing dramatic increases, doubling the rates from a month ago– although the rates then were so low that even twice as much is not overwhelming.
Everyone is saying that it looks like it is going to be a hard winter. Even Deborah Birx, MD, coordinator of the administration’s shambolic coronavirus task force, was said to have privately issued a warning about the winter. No public confirmation of the warning has been given, presumably because the White House doesn’t want people to know and would rather have rampant rumors spreading around among those who don’t believe the official lies.
Instead, the current president has threatened to “fire” the most trusted scientist working for the government: Anthony Fauci, MD. Dr. Fauci is said to have a 64% approval rating, versus the president’s 36% rating– so an unpopular president would be firing a popular scientist: not a good look. Of course, it is next to impossible for the president to directly fire him because of his Civil Service protections, but he has been eating away at those protections day by day.
No references today: I’m taking a holiday because today is the end of the Election Season. (Besides, it has all been reported by the big newspapers ad nauseam.) Tomorrow comes the real test of democracy: can the people wait for a full count of all the votes, or will they be sucked under by the violent bloviations of a narcissist completely without scruples?
I’m betting that, despite intensive exclamations of “vote rigging”, “fraud”, and “fake news”, the current president will see the winds blowing against him, including expressions of disgust by a few Republicans, and admit defeat (as he has in the past, in the face of intense public outcries.) Then he will make every effort to destroy the government on his way out the door, even pouring glue into the locks before he slams the front door.
