I have often written about Santayana’s comments about history. He said that those who cannot learn from history are doomed to repeat it.
During the COVID-19 pandemic, we have heard references to the Swine Flu epidemic. Of course, most people don’t even remember that epidemic. The primary reason is that it never really occurred.
It began in early 1976. In January 1976 several soldiers at Fort Dix had a flu-like illness. In February one of the soldiers was ill. He participated in a five-mile forced march. He collapsed and died.
The New Jersey Department of Health tested samples from the soldiers. Most were of the Victoria Type A flu. Two were not. They were sent to the CDC. They were identified as Swine Flu. It was similar to the flu strain that caused the 1918 epidemic.
President Ford and Congress acted quickly to set up an immunization program. While that was happening there was an outbreak of what appeared to be severe flu in Philadelphia. Concern was that the epidemic was starting. It turned out to be an outbreak of what would later be called Legionnaire’s disease.
Two researchers publicly expressed doubt about the safety of the vaccines being developed. One was fired for insubordination. Some manufacturers stopped their testing.
Further tests of patients with flu-like symptoms around the world showed no evidence of Swine Flu. Thus there was no pandemic and vaccine safety was in question. That makes the situation very different than the one we are facing with COVID-19.
The main sticking point at the time was that the vaccine manufacturers said that they would only go forward if Congress would pass a law saying they would not be sued for any reactions to the vaccine. That law was passed in August primarily at President Ford’s urging.
Vaccine distribution began on September 22nd. The vaccine program got underway. Ultimately about 45 million doses of vaccine were given.
Of that group approximately 450 individuals developed something called Guillain-Barre Syndrome. This is a disease of muscle paralysis. That 450 was about one in 100,000 individuals who received the vaccine. That number was far too low to be detected in a few thousand patients to undergo Phase III trials. Of those 450 patients about 30 died.
The end result was that there was 1 death from Swine Flu at Fort Dix and 30 deaths from the vaccine nationwide. The Swine Flu epidemic never materialized.
The danger from COVID-19 is far greater than what we faced with the Swine Flu. We have already had well over 200,000 deaths.
However, the lesson about rare side effects from vaccines used on a mass scale basis means that we will need to carefully monitor the upcoming vaccine program. We don’t want that particular part of history to repeat itself.
The national numbers continue to be on the high side. For example for the first 19 days of October there were about 936,000 new cases. For the same period in September there were 716,000 cases. However, over a similar period in July we saw 1,156,000 new cases. So we are somewhere in between right now.
The level continues to be one that the medical care system is able to handle. There are pockets of infection that are stressing the medical care system in those areas. That is why I suggested a nationalized computer system of resources to help cover those situations. It never happened.
Locally, in Sussex County we are seeing a similar thing. For the October period there were 753 new cases. That compares to 243 new cases for the same period in September. It is not as high as the 1,645 cases for a similar period in May.
Dr. Scott Atlas has pretty much replaced Drs. Fauci and Birx as the medical advisor to President Trump on the pandemic. His background is neuroradiology. That means he is an expert on reading brain CT scans and MRIs. He is not an infectious disease expert. Recently a group of epidemiologists (people who study population statistics in disease) met in Great Barrington, Massachusetts.
They put the Great Barrington Declaration on October 4th. I listened to the 2-hour podcast that they gave when they presented their findings. Dr. Atlas backs the Declaration. What it says is that you cannot stop a pandemic. It will spread through the population until it no longer has new patients to infect. That is a correct statement.
The suggestion was that we should allow it to spread at will to low-risk individuals until it burns itself out. High-risk individuals should be protected. However, those individuals have the right to be exposed if they desire to do so.
The sponsor of the declaration was the American Institute for Economic Research. This proposal was aimed at having the lowest economic impact. Sweden tried an approach that was similar. Their death rate is 12th highest in the world compared to the U.S. at 8th. Most pandemics do not have as high a mortality as COVID-19 so this strategy would make more sense if the mortality was lower like with the flu virus.
The biggest problem with this proposal is that it comes far too late to implement. With a vaccine on the horizon, that will become the fastest way to make the virus burn out. So changing course at this late point will likely needlessly increase the number of deaths that we will ultimately have. Perhaps the Declaration can be put aside for now. If there is another pandemic in the future, it could be an early approach that is chosen.
That is especially true if mortality rates are lower than they are for COVID-19.
An interesting sidelight to the vaccine ramp up is related to government funding. Some companies like Moderna and AstraZeneca have had government funding for their research. They need approval from government scientists (including Dr. Fauci among others) before the FDA can approve their vaccines. Pfizer had not accepted government funding for their research. Therefore, they can go directly to the FDA for approval. Thus they are likely to be approved first. It will be interesting to see how their data compares to the Coronavac which I still think is going to be the best vaccine.
Last week the World Health Organization reported that a study showed that Remdesivir (one of the medications used for President Trump) did not lower mortality in hospitalized patients.
I looked at the details of the study. Remdesivir was only part of the study. They looked at four different medications and a control group with no medication.
As expected hydroxychloroquine increased the death rate (expected 84/actual 104). Interferon (which some people thought might decrease mortality) also increased the death rate (expected 216/actual 243). Remdesivir (expected 303/actual 301) showed no real difference. Lopinovir (expected 146/actual 148) also showed no real difference.
The one problem that I had with the study was that it had a total of 11,266 patients. The largest group was the Remdesivir group with 2750 patients. Higher numbers might have shown bigger differences. That being said, there clearly was no huge benefit to any of the regimens.
Different countries have had a variety approaches. Some of the approaches have not been good. You might remember that Peru has the highest COVID-19 mortality rate in the world. They have over 1,000 deaths per million people. Belgium is second at under 900. Peru’s primary mode of treatment was to use hydroxychloroquine and azithromycin for hospitalized patients.
As we have seen that is not a very effective approach. A new study was published by the Peru government’s medical research agency, IETSI. It found that patients given the two drugs together after being admitted to hospital had a 49 percent higher risk of ending up in intensive care, a 70 percent higher risk of needing oxygen and an 84 percent higher risk of dying. The government’s response to the statistical report was to fire the head of IETSI.