Moderna and the National Institutes of Health (NIH) are conducting Phase III clinical trials of its vaccine, based on mRNA (a new technology for vaccines) at 89 sites in the USA. 30,000 volunteers will be recruited. The beginning of Phase III was announced on July 27. On August 11, the federal government announced a further $1.5 billion subsidy to Moderna for the vaccine.
In June, the Food and Drug Administration (FDA) announced its criteria for efficacy: the vaccine would have to protect at least 50% of people to be considered effective. They did not say whether that meant that “protection” meant that people would not be infected with SARS-COV-2 or, alternatively, that they would not have symptoms of COVID-19 even if they did get infected. It is possible that a vaccine could protect against symptoms despite infection– and an average of 40% of infected people do not display symptoms anyway.
BioNTech of Germany, Pfizer, and Fosun Pharma of China have been conducting combined Phase II and Phase III trials on an mRNA vaccine that they call BNT162b2 since July 27. These trials are being conducted in the USA and “other countries including Argentina, Brazil, and Germany.” Again, these trials are recruiting 30,000 volunteers, which seems to be a standard number.
The chief executive at Pfizer stated in September that they would know if the vaccine works as soon as October of this year. The federal government has awarded Pfizer $1.9 billion for 100 million doses to be delivered by December (assuming the vaccine works) and Japan has made a deal for 120 million more doses.
CanSino Biologics is working on Phase III trials of its vaccine, called Ad5, using an adenovirus as a vector. The adenovirus is considered nonpathogenic (does not cause disease symptoms.) The vaccine is being developed in partnership with the Chinese Army’s Institute of Biology in its Academy of Military Medical Sciences and it was approved as a “specially needed drug” temporarily on June 25. It is apparently already being used by the Chinese military. The trials are being conducted, since August 9, in Saudi Arabia and Pakistan.
The Gamaleya Research Institute of the Russian Ministry of Health is working on a vaccine that uses two different adenovirus vectors, called Sputnik V. This vaccine was conditionally approved on August 11, and since then Phase III trials have begun and have been expanded to 40,000 “volunteers.” Phase I/II results were published September 4, and the Phase III trials are apparently all being conducted in Russia.
AstraZeneca and Oxford have been developing a vaccine based on a chimpanzee adenovirus, called ChAdOx1. Phase III trials were temporarily halted a few days ago because a volunteer had an unexpectedly severe reaction; it is still not known whether the reaction was due to the vaccine itself. According to the New York Times, “Phase 2/3 trials [are underway] in England and India, as well as Phase 3 trials in Brazil, South Africa, and the [USA].” Indian facilities have already manufactured millions of doses for use in trials. The European Union has also made a deal to accept 400 million doses if the trials turn out well.
Sinovac Biotech is testing an inactivated vaccine under Phase III protocols in Brazil and Indonesia. The Chinese government has given this vaccine a limited emergency approval as well, although there was no information as to who was actually receiving it. The Indonesian government has made a deal to get 40 million doses by March 2021.
Sinopharm and the Wuhan Institute of Biologic Products are developing an inactivated vaccine which is in Phase III testing in the United Arab Emirates, Peru, and Morocco since July and August. The UAE trials are enrolling 5,000 volunteers for this vaccine.
Sinopharm and the Beijing Institute of Biological Products are testing another inactivated vaccine. Phase III tests are underway in the United Arab Emirates, using 5,000 volunteers.
One of the two Sinopharm vaccines has also gotten limited emergency approval from the Chinese government; it is unclear whether it is the Beijing or the Wuhan product. It is also unclear who is receiving the emergency vaccine, but it may be front-line health workers and/or soldiers.
For completeness, we should also mention an Australian trial of the Bacillus Calmette-Guerin (BCG) vaccine, which was developed to protect against tuberculosis and has been in use since 1921. The BCG product does not fully protect against tuberculosis, although it apparently considerably improves physiological defenses against this disease. BCG also provides variable protection against other mycobacteria (tuberculosis is a mycobacterium), leprosy, and even against overall mortality in low-income countries as well as against type I diabetes mellitus (under study.)
BCG has been evaluated against COVID-19 in Rhode Island (see this study) and is currently under Phase III trials in health-care workers in Australia and Netherlands. It is also being tested in Greece.
Most of the above information comes from the New York Times interactive article on vaccines in development.
The significance of the testing locations for these vaccines is that only trials in the USA qualify for FDA approval under normal circumstances. Certainly, the Russian and Chinese vaccines are unlikely to be considered here in the current political climate. Whether the location of Phase III trials matters for the other vaccines is a matter for debate.
An issue that should be recognized, however, is that the US federal executive department, under presidential orders, has refused to participate in the global alliance of more than 170 countries that is working to develop vaccines against COVID-19. The president claims his reason is that the participation of the World Health Organization (WHO) in this alliance (it is also supported by the Global Vaccine Alliance (GAVI), an organization started by Bill Gates to produce vaccines for poor countries, among others) somehow taints this global alliance. I do not support this “reasoning” and feel that it is more in the nature of a personal vendetta against WHO, which the president accuses of being beholden to China.
The financial support of the US government for the Moderna and Pfizer vaccines suggests that these will be the chosen ones for the US, assuming they get positive results. The AstraZeneca/Oxford vaccine is the only other one that is being tested in the US.
Most of the vaccines used in the US before this pandemic are produced by four companies: Aventis Pasteur, GlaxoSmithKline (GSK), Merck, and Wyeth. Of these, only GSK (in partnership with Sanofi) is anywhere near a vaccine– with US government support for 100 million doses– and their Phase III study will not begin until the end of this year. The vaccine they are working on is a recombinant protein-adjuvant type, a traditional route. GSK is also in preliminary work with Translate Bio to develop an mRNA-based vaccine. See this article for information on GSK, Sanofi, and Translate Bio.
Phase III clinical trials of seven or eight vaccines are in progress. They come from CanSino (Ad5-nCoV, adenovirus-based– actually in limited use in China), Gamaleya (adenoviruses Ad5 and Ad26-based Sputnik V, in limited use in Russia) AstraZeneca/Oxford (AZD 1222, ChAdOx1 chimpanzee adenovirus-based), Moderna/NIH (mRNA-1273, mRNA-based), Pfizer/Fosun/BioNTech (BNT162b2, mRNA-based), SinoVac (CoronaVac, inactivated virus-based), and SinoPharm (two different, inactivated virus-based– one of them already in limited use in China.)
See this New York Times interactive article, updated September 8 and probably daily, for a timely update on the latest vaccine information.
The companies suggest that their final Phase III studies will be finished around the end of this year, but none of them promise anything before the election. The president, by contrast, has virtually promised something before November 3.
A group of five vaccine companies have come together in a statement that they will not release a vaccine until it has been shown to be safe and effective. By “effective”, they have been held to the rather low standard of a 50% reduction in infections.
The real question is whether any company will request an “Emergency Use Authorization” (EUA) before the election– because the FDA can’t offer an EUA unless a company asks for it. At least, I don’t think so. Given that, I don’t see how the president can get to his goal of announcing a vaccine before the election.
If anyone can explain to me how the president can get a vaccine company to ask for an EUA before the election, or force the EUA through without a company request, I wish they would tell me. This question really bothers me because I know the president is desperate to announce a vaccine or at least a breakthrough pharmaceutical (which does not appear to be on the horizon)– so how is he going to do this?
Estimates of Hidden COVID-19, Seattle and Wuhan, January-March 2020: Lancet EClinicalMedicine
This study came out online in Lancet on August 13. It used swabs tested previously for influenza in a surveillance study in the Seattle area early this year. Of 2353 patients tested between February 24 and March 9, 442 were positive for influenza and 25 were positive for SARS-COV-2. A complex analysis led to an estimate of 6635 COVID-19 cases in Seattle for that period. With these methods, the authors were able to estimate that the pandemic started with an introduction to the Seattle area between December 25, 2019 and January 15, 2020 by someone probably infected in Wuhan.
This timing corresponds with another study that found a patient in Europe infected by the novel coronavirus on December 25, 2019, who was retrospectively identified this spring from a stored specimen. His source of infection, unfortunately, remains unknown, but the virus spread to his entire family. [Sorry, I can’t find the reference for that study.]
Clearly, this estimate of 6635 cases is vastly more than the reported number of patients with COVID-19 for that area at that time: a total of 245 confirmed cases were reported before the town was locked down on March 9. It is not that the authorities missed all those cases, just that they were unable to even look for them with the limitations that hindered public health surveillance at that time (some of these hindrances persist to this day.)
In Wuhan, a similar situation held, and the paper estimates that, while 571 patients were officially counted, roughly 15,000 cases of COVID-19 occurred between December 30, 2019 and January 12, 2020. The vast majority of these cases were missed, due to similar limitations of awareness and testing ability. The authors estimated that the infection began with one or a few cases between October 26 and December 13, 2019.
The implication (supported by genetic testing of the virus) is that the jump from animal to humans occurred in October 2019. The exact location of the jump or the species that contributed to this zoonotic spread is still unknown. Bats have been blamed as the original source with considerable evidence, but some scientists believe that an intermediate species was involved.
The article’s “Interpretation” states that:
The spread of COVID-19 in Wuhan and Seattle was far more extensive than initially reported. The virus likely spread for months in Wuhan before the lockdown. Given that COVID-19 appears to be overwhelmingly mild in children, our high estimate for symptomatic pediatric cases in Seattle suggests that there may have been thousands more mild cases at the time.
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30223-6/fulltext#seccesectitle0009
This means that, with the benefit of hindsight, we can see the onset of the novel coronavirus and its hidden spread through the community among undetected patients. The virus is far more widespread than initially thought, and many of its victims are asymptomatic or are thought to have the much more common influenza– which has very similar symptoms, although it is less than half as lethal.
A big difference between COVID-19 and influenza is the fact that the novel coronavirus spreads to the blood vessel walls, the heart, the brain, and other organs as well as the lungs– and leads to blood clots, neovascularization, strokes, and myocarditis (inflammation of the heart muscle.) These things very rarely happen with influenza.
The authors suggest that the analytic technique they used to estimate the prevalence of the novel coronavirus could help assess other novel virus epidemics earlier than has currently been possible. A high index of suspicion is essential to detection of new viruses. Caution and good hygiene are also important when dealing with unknown respiratory infections.
Perhaps the Asian habit of wearing masks in public during flu season should be made fashionable in the US. Universal immunization against influenza and with the new coronavirus vaccination, when it is available, should be on our agendas as well.
This is something I’ve been meaning to post about but never had time until now (things have settled down a little bit.) This article is from “Medscape Family Medicine” on April 28, 2020 and it’s called “COVID-19 Crisis Exposes Resident Abuse”. It describes the “abuse” of medical residents… they are conveniently indentured servants to hospitals during this crisis (and before, and after.)
When the Great Dying hit the hospitals in New York in March and April, the residents were conveniently available to do the grueling and dangerous work of taking care for all the patients sick enough with COVID-19 to be admitted to hospital. The attending physicians, by and large, were in hiding, not available to help when they were supposed to be training the residents.
You’ve never experienced abuse of this kind unless you’ve been a medical resident. I only lasted a year at that, and then I took the easy way out by joining the Public Health Service on an Indian reservation. That wasn’t much more fun, but it was better than being forced to work 80-hour weeks and be on call every third night, up all night, asked to do things I had no training for, etc.
Anyway, this is an article about what happens when understaffed hospitals are faced with too many patients: the residents are forced to take up the slack. Even the nurses have it better: they get paid better and their shifts are limited. Read it and weep.
One of the ER doctors notoriously committed suicide in April after she returned to work too soon when she was recovering from a bout of COVID-19. She had no previous history of mental illness– in fact, no one could understand why she would kill herself. She only took ten days off with the virus. Surprise, surprise.
Then there were the medical student and the psychiatry resident who killed themselves two years ago… there wasn’t even a coronavirus then.
The Late Holocene Meghalayan Age, newly-ratified as the most recent unit of the Geologic Time Scale, began at the time when agricultural societies around the world experienced an abrupt and critical mega-drought and cooling 4,200 years ago. This key decision follows many years of research by Quaternary scientists, scrutinized and tested by the subcommissions of the International Commission on Stratigraphy under the chairmanship of Professor David Harper, Durham University, UK.
Agricultural-based societies that developed in several regions after the end of the last Ice Age were impacted severely by the 200-year climatic event that resulted in the collapse of civilizations and human migrations in Egypt, Greece, Syria, Palestine, Mesopotamia, the Indus Valley, and the Yangtze River Valley. Evidence of the 4.2 kiloyear climatic event has been found on all seven continents.
https://www.wired.com/beyond-the-beyond/2018/08/collapse-civilizations-worldwide-defines-youngest-unit-geologic-time-scale/
This worldwide drought coincided with the collapse of the Harappan civilization, 4,200 years ago, prior to the development of the Vedic period in northern India. The drought lasted roughly 200 years and may have caused the collapse of societies all over the world. The collapse was accompanied by starvation, migration, cannibalism, civil war, and loss of continuity for cultures– the disintegration of many societies with universal suffering and many thousands of premature deaths (there were only a few million people in the world at that time.)
The civilizations destroyed included “the Akkadian Empire in Mesopotamia, the Harappan civilization in the Indus Valley, the so-called Old Kingdom in Egypt and the Longshan Culture in East China.” (See reference next paragraph.) No American civilizations are mentioned, perhaps because there are none known that old. The Stonehenge civilization must have been affected, but there are no written records nor surviving artifacts from that period other than the graves and henges (and the ones in western Europe.)
The drought was dated by ice cores from tropical glaciers all over the world. See the article about ice cores from “The Conversation” in this link: “https://theconversation.com/video-how-ancient-ice-cores-show-black-swan-events-in-history-even-pandemics-144784”
(The article linked above describes what would be found in ice cores from the present time: lower carbon dioxide emissions due to pandemic-induced slowing of civilization.)
Prior to the drought, around 7000 BCE, farming and pastoralism (the cultivation of herds of cattle, goats, or sheep) had developed and replaced foraging. This settled life resulted in the growth of urban centers and culminated in the Indus Valley civilization.
The drought roughly corresponds to the end of the urban Indus Valley civilization. After the drought, the redevelopment of urban society in the Ganges plain corresponds to the beginning of the Vedic period. There is some evidence, somewhat controversial, that a migration of Aryan tribes from the northwest occurred after the drought began.
Recovery from the drought began the rebuilding of civilizations worldwide, including the society in northern India which was encompassed by what is now called the Vedic period. Whether migration from other areas or indigenous development stimulated the creation of the Vedas is not clear. What we do know is that early written records collected later on showed a developing society along the Ganges river and the rise of the Kuru kingdom.
The Kuru kingdom was a tribal union in iron-age India that included the modern states of Delhi, Haryana, Punjab and some parts of western part of Uttar Pradesh, It is dated to roughly 1200 BCE and corresponds to the archaeological period known as Painted Grey Ware culture. (Wikipedia)
This kingdom or union was “Brahmanical” and was recorded in Vedic literature. A central feature of Brahmanical society was the concept of Varna, a grouping of people into social classes or castes. Whether this was a pre-existing feature of religious society in the area or introduced by the Indo-Aryans is unclear. We do know that the Vedas were a synthesis of the previous religious culture and the new Indo-Aryan culture. This religious synthesis has lasted to the present day.
At that time, the area of the Ganges plain was deforested and large agricultural regions developed. The region became more and more urban. Towards the end of the Vedic period, roughly around 600 BCE, there was a reaction to the Brahmanical and Hindu culture and religion, and ascetic movements developed.
Asceticism was reflected in the Jain and Buddhist religions. This new asceticism opposed the rituals developed in the Vedas and the social classification of the Varna.
The civilization of the Vedas was disrupted around the time of Alexander the Great when the Nanda empire briefly took over northern India. The Nandas were a short-lived dynasty that supposedly began when a barber became the queen’s lover (by his good looks) and overthrew the king. There was popular resentment of the Nandas because of their “low birth.” Alexander’s men mutinied when they were faced with the prospect of attacking the Nandas, and Alexander was forced to retreat from India.
The Nandas were succeeded by the Maurya empire, a more extensive and longer-lasting dynasty that is said to have been the largest political entity in the Indian subcontinent at its zenith under the ruler Ashoka. The first Mauryan ruler, Chandragupta Maurya, supposedly embraced Jainism. Then Ashoka is said to have converted to Buddhism, and the earliest written records of Buddhism to survive are the Ashokan edicts. These edicts were inscribed on stone pillars, many of which are still standing in the original locations.
The Mauryan empire under Ashoka (around 250 BCE) covered India all the way west to eastern Afghanistan (to the Hindu Kush mountains) and east to Bengal– 1.9 million square miles. Its northern extent was along the south side of the Himalayas and its southern end included Odisha and stopped at Andhra Pradesh.
(All this information is summarized from Wikipedia. It is complementary to what I have described in previous posts, jumping over the descriptions of the Vedas to the following period. The next time I have a chance, I will go over the Mauryan empire.)
This article, from the National Bureau of Economic Research (NBER) in November 2019, is an example from the ancient “before times” (that is, pre-pandemic) of pervasive racism in America. The underlying research for this article demonstrates that there is systemic racism built into our very democracy. This racism is nearly invisible, yet it reduces the participation of Black people in the electoral process by making them wait longer to cast their votes.
I present the abstract here:
Equal access to voting is a core feature of democratic government. Using data from millions of smartphone users, we quantify a racial disparity in voting wait times across a nationwide sample of polling places during the 2016 U.S. presidential election. Relative to entirely-white neighborhoods, residents of entirely-black neighborhoods waited 29% longer to vote and were 74% more likely to spend more than 30 minutes at their polling place. This disparity holds when comparing predominantly white and black polling places within the same states and counties, and survives numerous robustness and placebo tests. We shed light on the mechanism for these results and discuss how geospatial data can be an effective tool to both measure and monitor these disparities going forward.
https://www.nber.org/papers/w26487
Overt racism, supported by poll taxes or literacy tests, has been outlawed since 1965, when the Voting Rights Act was passed over the objections of 19 Senators, all from Southern States. The Act was gutted by the Supreme Court in 2013. In that year, the Court handed down a decision that cut out an important part of the Act (4b, the preclearance provision)– as described by the Guardian on June 25, 2020:
… the Supreme Court issued one of the most consequential rulings in a generation in a case called Shelby county v Holder. In a 5-4 vote, the court struck down a formula at the heart of the Voting Rights Act, the landmark 1965 law that required certain states and localities with a history of discrimination against minority voters to get changes cleared by the federal government before they went into effect.
It’s hard to overstate the significance of this decision. The power of the Voting Rights Act was in the design that the supreme court gutted – discriminatory voting policies could be blocked before they harmed voters. The law placed the burden of proof on government officials to prove why the changes they were seeking were not discriminatory. Now, voters who are discriminated against now bear the burden of proving they are disenfranchised.
Immediately after the decision, Republican lawmakers in Texas and North Carolina – two states previously covered by the law – moved to enact new voter ID laws and other restrictions. A federal court would later strike down the North Carolina law, writing it was designed to target African Americans “with almost surgical precision”.
… While statewide voting changes get a lot of attention, most of the voting changes the justice department reviewed were submitted by local jurisdictions. Now it’s much harder to even hear about those local changes – which include polling place closures or changing the way candidates are elected – let alone stop them
https://www.theguardian.com/us-news/2020/jun/25/shelby-county-anniversary-voting-rights-act-consequences
The Justices who voted to strike down the preclearance provision (Section 4b) were: Roberts, Scalia, Thomas, Kennedy, and Alito. Since that decision, Scalia and Kennedy have been replaced by Kavanaugh and Gorsuch. In order to restore preclearance, the Congress would have to pass (and the President would have to sign) a new provision 4b that would, presumably, take into account any changes that have taken place in the last 40 years.
The Court’s reasoning for striking down 4b was that “the coverage formula violates the constitutional principles of “equal sovereignty of the states” and federalism because its disparate treatment of the states is “based on 40 year-old facts having no logical relationship to the present day”, which makes the formula unresponsive to current needs.” (The Court failed to do any digging into the facts on the ground as to whether there had been any changes in government proclivities in the last 40 years– and, apparently, there have been no changes, as the experiences of the past seven years have made plain.)
Notwithstanding this reasoning, “Research has shown that the coverage formula and the requirement of preclearance substantially increased turnout among racial minorities, even as far as the year before Shelby County. Some jurisdictions that had previously been covered by the coverage formula massively increased the rate of voter registration purges after Shelby County.” (Quotes are from Wikipedia’s article, “Voting Rights Act of 1965“)
The fact is that local jurisdictions have felt free to eliminate polling places and allocate outdated or malfunctioning voting machines in areas where Black people are over-represented, while areas where White people predominate have enjoyed updated voting machines and additional polling places.
Systemic racism is alive and well all over America. This is only one example of the invidious discrimination that people of color face in this country. The current administration has rolled back or eliminated all attempts to make progress against systemic racism. If re-elected, they will redouble their efforts to “comfort the comfortable and afflict the afflicted.”
Propagandists from authoritarian countries like China and Russia will again be encouraged to engage in “whataboutism” by highlighting the many examples of systemic racism in this country to make us look bad and distract attention from their complete lack of democratic representation. We need to practice what we preach and eliminate these racist practices.
This long tale in RawStory.com, published August 31, is the third installment in a series on QAnon, that notorious conspiracy theory of theories. It describes the ancient origins of many of the theories within QAnon, going back to the 1970s and even before. The author describes attempts by his “friend” to convince him of conspiracy theories supporting the Republican Presidential candidate:
According to my friend, initiates of the Illuminati had teamed up with subterranean demons to torture, rape and eat kidnapped children in underground military bases ruled by [redacted]’s mortal enemies.
The story goes into great detail to describe the ancestors of the conspiracy theories that are now prevalent on the alt-Right. It seems that many of these theories can be traced back to such documents as the book “Fear and Loathing in Las Vegas” by the late Dr. Hunter Thompson (allegedly a work of fiction.)
That book described the fictional “adrenochrome” which was extracted from young children (who were then killed) and used by fictional wealthy and elderly individuals to fictionally rejuvenate themselves. In the modern version of the conspiracy theory, however, “adrenochrome” is a real substance and their “proof” that it exists is the reference to it in that book.
Back then (in the late sixties), left-wing conspiracy theorists held that the CIA, through projects like MK ULTRA, was experimenting with mind control through drugs and other means. Ideas (or “memes”) like this are now part and parcel of modern conspiracy theories, which use them without attribution and probably without realizing their ancient origin. The difference from past versions of these theories is that they are used by those on the far right to make their case for such falsehoods as “cannibalistic pedophiles who use Comet Ping Pong (a real pizza joint in Washington DC) as a base.”
This long and involved story piece is a fascinating read if you can tolerate the bizarre, involved, and nauseating ideas involved and understand that they are pure figments of the imagination. It seems that the new conspiracists can’t tell the difference between truth and fiction.
One of the techniques used by practitioners of “Big Lie” propaganda is to repeat false statements over and over again until they become more reasonable-sounding because of their familiarity. You should beware of people who repeat the same statement twice or three times, as if for emphasis, but really to make the statement seem more reasonable by repetition. The technique is dangerous because experiments have shown that it really works. It is known by logicians as the “argumentum ad nauseam.”
Other logical fallacies found in modern propaganda include ad hominem (“against the man”) which includes personal insults like “weak”, “loonies”, “losers”, and the like. Another is the appeal to fear, which uses images or words designed to cause fear in the listener– this is very popular with modern rightists. Other popular fallacies include the “black and white fallacy“, the “cult of personality“, the “thought-terminating cliche” (“it is what it is”), and “whataboutism.” Look these up in Wikipedia under “Propaganda techniques” so that you can become familiar with them and be on your guard when they are used on you (mainly by Republicans but even by some Democrats as well.)
Saliva specimens for SARS-COV-2 detection: 2 studies show parallel positivity and sensitivity
A letter to the editor in the New England Journal of Medicine on August 28 describes higher virus counts in saliva specimens than in nasopharyngeal swab specimens taken from the same patients.
From the letter:
We therefore screened 495 asymptomatic health care workers who provided written informed consent to participate in our prospective study, and we used RT-qPCR to test both saliva and nasopharyngeal samples obtained from these persons. We detected SARS-CoV-2 RNA in saliva specimens obtained from 13 persons who did not report any symptoms at or before the time of sample collection. Of these 13 health care workers, 9 had collected matched nasopharyngeal swab specimens by themselves on the same day, and 7 of these specimens tested negative …. The diagnosis in the 13 health care workers with positive saliva specimens was later confirmed in diagnostic testing of additional nasopharyngeal samples by a CLIA (Clinical Laboratory Improvement Amendments of 1988)–certified laboratory.
https://www.nejm.org/doi/full/10.1056/NEJMc2016359
A letter to the Annals of Internal Medicine, also on August 28, found similarly discordant test results: (in this study both nasopharyngeal and oropharyngeal swabs were used in separate cases)
Of the 1939 paired swab and saliva samples analyzed (Figure), SARS-CoV-2 E gene was detected in 70 samples (Table), 80.0% with swabs and 68.6% with saliva. Thirty-four participants (48.6%) tested positive for SARS-CoV-2 on both swab and saliva samples. Discordant test results were seen in 22 participants (31.4%) who tested positive with swab alone and in 14 (20%) who tested positive with saliva alone. Swabs were obtained from the nasopharynx in 35.7% of participants who tested positive with saliva alone, compared with 9.1% of participants who tested positive with swab alone.
https://www.acpjournals.org/doi/10.7326/M20-4738
The second study used a preservative fluid for the saliva specimen to prevent degradation of the RNA during room-temperature storage and transport of the specimen: “This study is unique in that it used a novel collection kit containing a preservative and viricidal [sic] fluid, allowing for safe and stable storage and transport of the samples.”
The first study was much smaller than the second, so the finding of somewhat greater sensitivity for saliva specimens may have been a fluke. Nonetheless, it is clear that saliva specimens are similarly sensitive as nasopharyngeal specimens.
These two studies suggest that it may be useful to test patients who have a high index of suspicion for COVID-19 with both nasopharyngeal swabs and saliva tests. Nasopharyngeal swabs have a significant false negative testing rates, a factor which is not widely discussed. The discordance of positive tests with one type of specimen and negative results with the second type supports the idea of using both tests when one is highly suspicious of infection.
The studies indicate that saliva testing is a viable means for detecting SARS-COV-2 RNA. The saliva test has the advantage of dispensing with an invasive nasopharyngeal swab, eliminating one component of the test which may be in short supply. In addition, the saliva test does not require a technician for collection, eliminating the risk of exposure to infection by another person.
The only roadblock to using saliva tests is certification by the Food and Drug Administration for these tests. Emergency Use Authorization should be immediately given for saliva tests.
This paper, a pre-print (not peer-reviewed yet) in Lancet (abstract here), describes a man who had two infections with genetically distinct SARS-COV-2 isolates resulting in two symptomatic episodes of COVID-19. From the paper:
In April, 2020, a twenty-five year old resident of Reno, NV tested positive for SARS-CoV-2 through a community-based testing event held by the Washoe County Health District (collection date: 4/18/2020). The patient indicated symptoms consistent with viral infection (sore throat, cough, headache, nausea, diarrhea; onset: 3/25/20). During isolation, the patient indicated resolution of symptoms (4/27/20).
(from pdf version)
Forty-eight days later (on 5/28/20), only two days after testing negative for the viral antigen, the patient had a recurrence of symptoms. He was hospitalized with hypoxia a few days later. Chest imaging showed pneumonia. This time (on 6/6/20) he had an IgM/IgG positive blood test. The virus responsible was found to be genetically distinct from that isolated during his first episode.
The details of the distinction are complex, but the viruses were in the same clade (strain) but there were several mutations in the second isolate which were not present in the first. In addition, the patient’s parent had symptoms simultaneously with the patient’s second infection and was found to be positive for SARS-COV-2. At the time of publication, the authors were unable to confirm the identity of the second infection with that of the patient’s parent (but they’re working on it.)
This patient had no immunosuppressive conditions and was not on any medication which might have prevented him from resisting the second infection.
This and other, so far isolated, cases of re-infection with different strains of the virus represent confusing, not to say bizarre, facts about this new virus. Speculation would be premature at this juncture.
Suffice it to say that it is possible for young, healthy people to be infected a second time within a few months– and to have significant symptoms and disease (pneumonia in this case.)
(… continued from previous post )
The trick of dividing what should be a unified society into warring classes or ethnicities destroys the solidarity of a free society and makes it easier to subjugate the society. What is needed for this trick is to take the otherwise trivial distinguishing characteristics of two groups within society– for example, green eyes vs. blue eyes– then use them to denigrate one group while setting them against and advantaging the other group.
It is even easier to destroy society by undermining the competence of its government. The con man in the White House has been doing that ever since he came into office: he hires incompetent people who know nothing of the departments they are supposed to run– or worse, these people have publicly declared that they want to dismantle the very agency they are appointed to head.
These incompetents, with no experience in government (or worse, experience in trying to destroy government) are hired because they affirm their loyalty to the con man in chief. They are fired only if their scandals become too flagrant to be ignored, or they disobey their instructions and make statements counter to their con man leader’s lies.
A perfect example of this all-encompassing ignorance and incompetence is Betsy DeVos, the secretary of education. She never held any government position before her appointment. She never had a position as a teacher or an administrator in any branch of education. Her only qualification was that she was a loyal, affluent Republican. Her stated aims in life (and her experience as an organizer) before her appointment were related to the promotion of private, religious schools– about as far from free, secular public schools as could be imagined.
This Ms. DeVos has been part of the administration since the beginning. She has avoided scandal and made few public statements, thus her ability to stay in office. She has quietly dismantled one of the most important efforts made towards equalizing education: the relief of debt incurred by students defrauded by for-profit vocational schools. She has steered government efforts away from providing justice to students victimized by sexual assault in schools. She has done much more to damage schools that is unpublicized and essentially done in the dark, without anyone learning enough to complain, much less to try and stop her.
I am so angry that our society has been divided into polarized camps by the con man in the White House, that I just can’t shut up. He has worked hard to increase the sense of grievance that disadvantaged (or fearful of being dispossessed) White people, especially White Men, are feeling.
Anyone who doubts that this con man is a racist should study his history. He was sued by our federal government for refusing to lease apartments to Black and other non-White people. He signed a consent agreement and then ignored it. He was sued again, and forced to sign a second consent agreement. He made racist comments about his employees who were Black, comments which were so foul that I refuse to dignify them by repeating them.
He made selective and “strategic” alignments with certain Black people, such as the singer Kanye West, who fit his definition of White by being rich and evangelical Christian. He elevated the Black neurosurgeon Ben Carson into Secretary for Housing and Urban Development– a position for which he had neither experience nor expertise– because he was rich and an evangelical Christian.
He made an alliance with Herman Cain, who fit his definition of White by being rich and a conservative Republican (he was instrumental in the defeat of President Clinton’s national health care plan by sponsoring the TV ads that starred “Harry and Louise”.) Then he cooperated in Mr. Cain’s death from the novel coronavirus by inviting him to a mask-optional, non-socially-distanced rally in Tulsa, Oklahoma that resulted in a dramatic surge of new cases.
He has deliberately angered Black people by insulting them, especially those who have had the courage to speak out against his prejudice and injustices. If you doubt this, look up what he said and tweeted about the late John Lewis and his Congressional District.
He has even encouraged agents in the pay of the Russian Secret Service to increase polarization and engender anger and division among both White and Black people in this country.
Before the last presidential election, the Internet Research Agency (a Russian Secret Service organization) created fake accounts that appeared to support Blacks but stoked resentment against Whites– not to change votes (almost all Blacks voted against the Republican Presidential candidate anyway) but to increase Black anger against Whites.
All of this con man’s actions have deliberately fostered anger and division among the American people. He could not have done more harm to America if he had studied the speeches of Hitler. (Oh, wait, one of his biographers claimed that he really did study the speeches of Hitler!)
(I regret and sincerely apologize for using the name of Hitler but I justify it by saying that He-who-must-not-be-named is equally as dangerous as Hitler at this point in history.)
We are in a much worse position to counter the attempts at dominance by the Chinese totalitarians than we were four years ago. Don’t fear dominance by the Russians– they are a minor power that is punching way above their weight. Our real and most dangerous adversaries are the Chinese government’s authoritarian/totalitarian bureaucrats, their censors, and their spies.
By the way, the Chinese and the Iranians are not covertly working to sabotage the elections– but the Russians are. The Chinese and the Iranians are expressing their opinions– they don’t like the con man because he is unstable, xenophobic, and against all foreign governments except those that unfailingly support his every fleeting impulse.
It is true that that the governments of China and Iran are undemocratic, authoritarian, and repressive– but they’re not using unfair, covert means to interfere with our elections yet. The Russians are using all available means, both fair and foul, to press for the re-election of the most dangerous con man ever to fool most of the people, most of the time.
Why do the Russians support this con man? Because they can see that he is weakening and dividing America. That suits their goal– to pull this country down to the point where they can, without our interference, get back their precious Soviet Union (which included all of Ukraine, Georgia, and several other countries that they lost in 1991 and that are nominally independent now.)
We have been conned by a con man who lost the popular vote by nearly 3 millions and only won the Electoral College by strategically picking up 70,000 votes spread over three states. Remember that Hitler only gained 40% of the popular vote in a relatively free and fair election (where he divided the popular vote by setting the Communists against the Socialists… )
Hitler won the chancellorship (similar to today’s American presidency) by picking up the support of the industrialists. They “temporarily” backed him “strategically” because they thought that they could discard him afterwards, when he had controlled the unrest in Germany that was threatening to divide it into civil war.
Hitler had incited that very civil war by dividing the country in just the way that I previously described. He set the Jews apart and divided the country into anti-Semites versus Jews and their supporters. He set the Socialists apart by lumping them together with the Communists and denigrating them all as “anti-German.”
Be warned– He-who-must-not-be-named is following this very same playbook. He is lumping the Democrats together with the Socialists. He is lumping the Blacks together with immigrants. He is lumping Native Americans together with South Asian immigrants. He is playing all non-White peoples off against European White peoples. He is playing up all the divisions that already existed before he came to power– making minor disagreements into major feuds.
Enough geopolitics– this is a problem within America, which only Americans (both White and non-White, American-born and immigrant) can solve. We are being made weaker by this con man. Those of us who are still fooled by his fear-mongering are in for an awful awakening that will inevitably come if he is re-elected. I have never in my 66 years been so fearful for the future of America.
