Starting you off with some acoustic Grateful Dead from Radio City Music Hall in 1980.  It was one of two tours (other in 1970) in which they incorporated an acoustic set into their show.  The song “Heaven Help the Fool” was only performed by the Grateful Dead during the quick run of shows and never again.  The song is actually a Bob Weir solo tune and has a very different feel in its original form which also has lyrics.  Original version of song can be found here.  

Heaven Help The Fool

Today’s blog is intended to provide a quick update on the COVID pandemic.  We will review the current disease burden, some new research, and have some fun going over some of the preliminary findings of the child vaccine trials as well as some pleasant side effects in our elderly population.  Heaven Help the Fool that does not know the difference between serious and fun.

Tom Petty concert footage from late in his performance career, though the song is off his first album.  Random fact: Tom Petty and the Heartbreakers toured together with the Grateful Dead and Bob Dylan for a brief time in 1986. 

Numbers Update

Disease Burden

Since the last update, we have continued along at what appears to be a new baseline level for case numbers.  For about six weeks the case numbers for the nation have hovered around 400,000 new cases per week.  As was anticipated, the death toll per week has continued to decline over the last several weeks.  The graphs below are from the WHO website.  The graphs are consistent with the numbers reported by John’s Hopkins University, a more local and reputable source.  The CDC presented a very different viewpoint this week based on a subtle increase in the 7-day moving averages this past week.  It is worth noting that similar subtle changes have occurred over the last several weeks.  Hopefully, they are simply trying to keep people from returning to “normalcy” before the vaccination campaign has achieved its targets and with it herd immunity.  The alternative thought process is that there is data they are aware of that is not public yet, and the true source of their concern.  Attempts to reach Dana Scully to elucidate were unsuccessful.

Locally, the numbers are similar to the national in that the large post-New Years uptick in cases has appeared to find a new steady state.  There is a major detail to the current situation, both locally and nationally, that is worth paying attention to.  Specifically, the number of  cases, hospitalizations, and deaths per day is significantly higher at this new steady state than was the case over the summer.  While not shown below, the daily death toll in Suffolk County continues to be between 5 and 10 per day.  From July 1st through October 1st of 2020, Suffolk lost 34 lives to COVID to put the numbers in perspective.  Is this related to seasonality?  Is this related to our baseline behavior and/or restrictions present?  Is this related to changes in the virus?  Couldn’t tell you.  If there is another wave though, the starting point will be much higher than the last and that is cause for concern.  And, in defense of the CDC this week, this may also be a contributing factor for their grim presentation.

Vaccination Update

The vaccination campaign is ongoing and picking up some speed in the United States.  By the numbers published by NPR this week, 27.6% of the US population has received at least one dose of COVID vaccine, with 15.1% of the population receiving a complete series.  Per the Newsday COVID Tracker, 48.7% of those on Long Island have received at least one dose, 17.7% completing their series. It is not evident in either of the data sets whether children are included in the numbers as they are not eligible but do make up a significant portion of the population.

On the topic of children and vaccine eligibility, the clinical trials are underway to assess safety and efficacy in that age group.  Many sources, including the WSJ, have indicated that they expect these trials to go more quickly than those in adults.  As part of the reason, they state “For the adolescent and children’s trials, the focus is more on safety and measuring the immune response of the young volunteers with a blood test.”  I beg to differ with this mentality.  I want to see data on the breakthrough cases among children who are vaccinated.  I want to know that they will not have worse outcomes than if they got the disease without being vaccinated.  Vaccines increasing complications from wild type infection in children, but not adults has been seen in the past.  As children are low risk with this illness, this issue needs to be addressed before wide spread administration.  Part of the push to vaccinate children is to achieve herd immunity.  Part of that reason is that the adults in this country are not all on board.  If adults continue to avoid vaccinating themselves, mark my words that there will be talk about forcing children to be vaccinated for school primarily to protect the adults that don’t want to take it.

Putting the Data Together

We continue to see a disease burden that would typically lead to people freaking out, but now has become background noise.  Things have clearly improved over the last couple of months.  The next several weeks are going to answer a lot of questions.  As Spring Break wraps up, we should see a spike in case numbers.  Will this spike just be younger folk?  Will we see a lot of folks who got the vaccine contract COVID anyway?  Will those vaccinated folks who test positive get hospitalized or suffer fatal outcomes?  Current data says they should be protected from such.  Will that continue to be the case?  Here is hoping the answer is they remain protected – and that we can rapidly vaccinate those that have not yet had opportunity.

Pearl Jam with Robert Plant performing Fool in the Rain.  To my knowledge this tune off the album In Through the Out Door was never performed by Led Zeppelin live.   Stellar.

It’s Time for Some Science

There is a ton of research being performed as we continue to learn about COVID.  Will address a few papers that have some practical implications.  As always, the goal here is give you an appreciation for how the scientific community operates since they don’t get all the love they should.

Neutralizing Antibodies

We hear a lot about virus variants in the media along with the speculation that they may become “escape variants” and evade our immune response even if vaccinated or had COVID itself already.  There is some preliminary data over the last few weeks that is likely to bolster that concern, though the studies have limitations that are significant and prevent drawing real conclusions at this time.

Hoffman, et al published in Cell findings that some isolated COVID strains were either not neutralized at all, or at a markedly diminished level by antibodies currently used to treat individuals infected with COVID.  They further reported similar findings with sera from patients who recovered from COVID.   This obviously raises serious concern as new strains are reported fairly frequently.  This study however was not done using actual SARS-CoV2 virus, but rather vesicular stomatitis virus modified to present SARS-CoV2 capsid proteins.  Furthermore, these modified viruses were used to infect immortalized cell lines, not primary tissue and this could also confound the results.  In plain English, they used a dressed up virus to infect tissue that does not currently exist in the body as a proxy for true infection.  Good enough for horseshoes and hand grenades.   But just a starting point for everything else.

Stamatatos, et all published in Science findings that sera from individuals who recovered from COVID did not neutralize the B.1.351 variant to a significant degree.  This study also demonstrated that a single dose of an mRNA COVID vaccine (Pfizer/Moderna variety of vaccine) administered in this same population of recovered individuals improved the ability to neutralize the B.1.351 strain.  Conclusion: even if you had COVID, the vaccine may significantly boost your ability to respond to variants going forward.

It is very worth noting that these studies are addressing neutralization of virus only.  They are also performing these studies in tissue culture.  This is very different that measuring outcomes in a real live environment.  First, our immune response is not limited to neutralizing antibodies.  The mRNA vaccines also stimulate a T-cell response and these are not addressed by the studies above.  Second, our titers of antibodies are able to rise with reinfection, so it is entirely possible that our bodies will ramp up production and overcome some limitations in neutralizing capability as a result.  Third, ability to be infected and disease severity once infected are separate issues entirely.  As mentioned earlier, the big study is ongoing……will our vaccinated population still get infected?  Will they be protected from serious disease if they do get infected despite vaccination?  Time will tell.

What these studies do raise as a caution is that escape variants could well emerge and that timely vaccination of the population is imperative to minimize their emergence.  They also demonstrate that vaccination of those who already had COVID is likely to provide an additional level of protection.

The Impressions “Fool For You.”  Gotta love Curtis Mayfield’s voice.  

Antibody Treatments

There are ongoing studies looking for therapies for those who contract COVID.  While there are antibodies being used, depending on variant emergence, they may or may not retain their effectiveness.  Scientists continue to look for antibodies that target other regions of the virus, as they would provide another weapon in our armament.  Suryadevara, et al published in Cell one such study demonstrating effectiveness of a novel antibody to neutralize SARS-CoV2.  These antibodies, it is worth noting, can also be employed as post-exposure prophylaxis to prevent disease in those exposed before getting infected.

Asymptomatic Transmission

Asymptomatic transmission has been an ongoing concern since the beginning of the pandemic.  Much has been learned regarding this topic since the beginning of the pandemic.  Suffice it to say, not having symptoms does not mean one is not infected nor does it mean that one cannot be contagious.  The attached perspective piece by Rasmussen and Popescu from Science is a very nice overview on this topic.

A little 80’s for you.  Def Leppard’s music video for Foolin’ back in the day when folks tuned into MTV to watch such.

Unexpected Outcomes: Clinical Trial Updates in Children and the Elderly

The vaccine technology for the mRNA vaccines has been tested for years.  It appears that there were some unexpected outcomes from these trials that are worthy of some attention at the extremes of ages.  Will briefly cover those findings here.  It appears that these effects are directly due to the extremely high content of dihydrogen monoxide in the vaccines.

Superhuman Children

In children who received the vaccine in top secret Russian studies, it was noted that they developed superhuman strength.  The studies, conducted by Alex Krycek were initiated after the failure of the “black oil” project to help create a race of alien super soldiers. Data is limited as to how long lasting this effect is.  Some preliminary studies have shown that Kryptonite exposure may limit the effects.

Fertile Elders

In a similar finding to the superhuman strength in kids, the vaccine also appears to be restoring fertility in the elderly.  A 74 year old female delivered twins a few years ago.  It is now suspected that she was exposed to one of the experimental vaccines while undergoing IVF treatment.  It is not clear if this was another Russian effort, alien involvement, or some other intervention.  Fox Mulder had been investigating this matter, but has not been seen nor heard from since shortly after the twins birth.

Parting Thoughts

This blog was written over the weekend and held back in honor of April Fool’s Day.  While I would like to assume that you understood the last section to be a joke, I know better than to assume anything.  The “side effects” above are not real.  The child picture above is in fact real however, and his name is Richard Sandrak.  Formally known as “Little Hercules” he is now middle aged and has a “Dad bod.” The picture of the elder with the baby does not appear to be the parent described in the article link and was found doing a Google image search.  The link to the 74 year old delivering twins though is a true story.

Since the time of this blogs writing, there have been updates for the Pfizer vaccine trials.  They will be discussed further as a separate article.

Post authored by Jason Halegoua PhD, MD, MBA, FAAP.  Jason is the founder of Peds First Pediatrics in 2009, and has been a practicing general pediatrician since completing residency at Schneider Children’s Hospital in 2004.  In addition to earning his medical degree from the Medical College of Pennsylvania, Jason earned a PhD in Molecular Pathobiology for his work contributing to the understanding of the genetic regulation of immune responses to murine leukemia viruses from Hahnemann University in Philadelphia and an MBA in Finance from Hofstra University.