Part the First: Retrospective Notes on a Pandemic.<\/strong>\u00a0 BMJ<\/em>, formerly known as the British Medical Journal,<\/em> has recently published two interesting pieces on COVID-19.\u00a0 The first is an analysis by Anthony Costello, who was previously Director of Maternal, Child, and Adolescent Health at the World Heath Organization: UK decision not to suppress covid raises questions about medical and scientific advice.<\/a>\u00a0 Dr. Costello focuses on the United Kingdom, but his analysis applies to all countries that had the means to suppress the pandemic but did not.\u00a0 In the aftermath of a deadly pandemic, reasoned discussion of what was done and more importantly, not done, has been rare.\u00a0 I am not an infectious disease expert or an epidemiologist, but I have been adjacent to both disciplines for my entire career in biomedical science.\u00a0 I was asked in the spring of 2020 how long I thought COVID-19 would last.\u00a0 My answer was \u201cthree years, if we suppress spread of SARS-CoV-2.\u201d\u00a0 I was dead wrong, but suppression might have worked.\u00a0 As Costello begins:<\/p>\n Early in the covid pandemic, evidence emerged from several East Asian countries that suppression could lead to successful control.<\/strong> \u00a0Yet the UK did not adopt the approach. \u00a0Suppression aims to avoid national lockdowns and maintain economic activity for most of the population by introducing surveillance systems to bring new outbreaks under control quickly<\/strong>, thus reducing the reproductive rate of infection (R0<\/sub>) to below 1 and causing the epidemic to wither. \u00a0In May 2020, Jeremy Hunt, then chair of the health and social care select committee, criticised UK government advisers for failing to recommend a response focused on suppression of the SARS-CoV-2 virus from early in the pandemic, calling it \u201cOne of the biggest failures of scientific advice to ministers in our lifetimes.\u201d \u00a0Why was suppression not recommended, and what can be done to improve advice in future?<\/strong> (emphasis added here and below)<\/p>\n<\/blockquote>\n In my view, which is similar to the conclusion here, the response to COVID-19 failed to recognize SARS-CoV-2 as something \u201cnew,\u201d although SARS<\/a> and MERS<\/a> were clear messages from 2002 and 2012, respectively (and as noted in Links yesterday, nine cases of MERS have recently appeared<\/a>, with two deaths).\u00a0 In the UK strategy followed what might be done during an influenza epidemic (as we whistle past the graveyard about bird flu<\/a>).\u00a0 From the article:<\/p>\n All pandemics are different, but SARS CoV-2 had an R0<\/sub> value more similar to the coronavirus SARS-CoV-1 than to influenza. Influenza spreads too fast to be controlled by testing and contact tracing, but coronaviruses have longer incubation periods and potentially can be suppressed, as evidence from early in the pandemic showed. \u00a0Several East Asian states avoided prolonged national lockdowns with responses focused on suppression initiated early in the pandemic.<\/p>\n Experts had dealt with two previous coronavirus epidemics: severe acute respiratory syndrome (SARS) in 2002-04 and Middle East respiratory syndrome (MERS), first reported in 2012. Two papers after the SARS outbreak showed that coronavirus infections, with slower transmission rates and longer incubation periods than influenza, could be suppressed.<\/p>\n One paper\u2026 showed that isolation and contact tracing could bring about control even if asymptomatic transmission was as high as 40% of all transmission. \u00a0At the start of the epidemic in Wuhan, R0<\/sub> for SARs-CoV-2 was estimated to be close to 3, similar to that seen in the SARS<\/strong> outbreak, indicating that similar suppression measures might have worked. \u00a0(Another) paper, concluded that coronavirus epidemics require a different approach (using isolation and quarantine measures) to control than pandemic influenza<\/strong>.<\/p>\n<\/blockquote>\n In the early days of COVID-19, community health workers, including physicians, were called upon to respond in China, Japan, and Korea.\u00a0 They held the line for as long as they could in a world where most of the \u201cGlobal North\u201d thought of other things.\u00a0 This was also a teachable moment for the medical students in my tutorial groups in February and March of 2020.\u00a0 They learned very quickly they had signed up to be those who run toward a pandemic instead of away.\u00a0 A few were recalcitrant, which is worrying.\u00a0 According to this article, in the UK \u201c750,000 people, many with health skills, responded to a call for volunteers. \u00a0Most were never used in any capacity and none to support case finding. The government could have redeployed environmental health officers, sexual health contact tracers, or medical students to case finding and contact tracing but did not do so.\u201d\u00a0 The result was that:<\/p>\n Over the next three years, death rates in China, Japan, and South Korea were five times lower than in the UK (fig 2<\/a>). Demographics seem insufficient to explain these huge differences: Japan and South Korea had similar gross domestic products (GDP), life expectancy, and age profiles to the UK. Had the UK followed the same strategy and achieved the same excess cumulative death rate by March 2024 as South Korea, 69 instead of 344 deaths per 100,000, it might have prevented up to 180,000 UK deaths.<\/p>\n<\/blockquote>\n The US response was different, but not better.\u00a0 The US medical establishment was not particularly useful from the beginning of the pandemic.\u00a0 But in my view the conclusions are inescapable.\u00a0 Suppression of SARS-CoV-2 could have worked, but that very notion has been flushed down the memory hole.\u00a0 Finally:<\/p>\n The UK was once rated the second-best country (after the US) in the world for pandemic preparedness. \u00a0Covid-19 caused over 230,000 civilian deaths, three times the number during the Blitz. \u00a0The root failure of the UK response to covid was a strategy devised in January and February 2020. \u00a0Yet the four chief medical officers in their 2023 technical report for future advisers maintain that their recommendation to \u201ccontain, delay, research, and mitigate\u201d was broadly correct, and the report does not recognise suppression successes that led to much better survival rates and lower economic damage in other states.<\/p>\n Five years on, many of the people who developed the UK\u2019s flawed response are still in post; they have not changed their views on suppression, and little has been done to improve government pandemic advice committees or to introduce detailed governance rules for the UK\u2019s future pandemic response and resilience. \u00a0The covid inquiry and the UK medical establishment should properly critique this public health failure.<\/p>\n<\/blockquote>\n Ditto for the United States.\u00a0 In the US, one of the chief advocates of the \u201cLet \u2018er rip!\u201d strategy, so that in a matter of months herd immunity would be reached and the pandemic would become a thing of the past, is now Director of the National Institutes of Health.\u00a0 Jay Bhattacharya<\/a>, MD-PhD (MD but never a physician and the PhD is in Economics), is a principal author of the Great Barrington Declaration<\/a> (GBD).\u00a0 The GBD still seems to be policy, even though, and I repeat myself to the point of irritation, durable immunity to coronaviruses, either through prior infection or vaccination remains a noble but unattained goal for at least eighty years.\u00a0 Thus, based on the settled science of coronavirus pathobiology, herd immunity to SARS-CoV-2 was an unlikely possibility.\u00a0 One may well wonder if this continuing asininity has deeper political and economic roots.\u00a0 And contrary to what Matt Taibbi seems to believe, Jay Bhattacharya was never \u201ccensored.\u201d<\/a>\u00a0 His \u201cMerchant of Doubt\u201d libertarianism was skewered by scientists paying attention, though.<\/p>\n Part the Second: The People\u2019s Attitudes to Government and Healthcare Administrators Changed During the Pandemic<\/strong>.\u00a0 This report<\/a> (paywall) is also from the UK, but the message travels well:<\/p>\n News reports about politicians and government officials ignoring guidelines during the pandemic was a turning point for many people, the UK covid inquiry heard.<\/p>\n<\/blockquote>\n The underlying document is here<\/a>.\u00a0 The following is a good summary:<\/p>\n The US responses to COVID-19 were different but the results of a US Covid Inquiry<\/strong> would be similar.\u00a0 From the beginning according to our healthcare leaders, COVID-19 was nothing more than a cold from which recovery was just a matter of time.\u00a0 No, not really.\u00a0 I don\u2019t know how many colds I have had in this long life, but I never lost my sense of smell because of one (after the nasal congestion went away).\u00a0 Neither I nor any friends of family ever suffered from \u201cLong Cold\u201d for years after.\u00a0 No one ever died of Long Cold as far as I know, but I had two friends who died of COVID-19 sequelae.\u00a0 I received two COVID-19 shots (Pfizer\/BioNTech) and so far I have not had COVID-19, as far as I know.\u00a0 But I have avoided crowded indoor spaces to the extent possible while remaining perfectly happy.\u00a0 Several coworkers have gotten multiple booster shots and have had COVID-19 multiple times. \u00a0And contrary to President Biden, the COVID-19 vaccines did not work as he said<\/a> they would.<\/p>\n Through all this, scientists, including many friends and colleagues, marvel that they are losing respect they have not already squandered?\u00a0 Can my colleagues and I get it back?\u00a0 Only if we start telling the disinterested \u201ctruth\u201d as we understand it.\u00a0 Stranger things have happened, perhaps.<\/p>\n Part the Third. Pathogenic Bacteria Can Eat Plastic and Form Stronger Biofilms<\/strong>.\u00a0 To which one can only reply, what took them so long?\u00a0 As Ian Malcolm\/Jeff Goldblum put it, \u201cLife, uh, finds a way.<\/a>\u201d\u00a0 As an aside, I generally do not read much science fiction, but Michael Crichton had a way with the biological form of the genre, beginning with The Andromeda Strain<\/em><\/a>.\u00a0 Jurassic Park was a good read and better movie (to me) but required even more suspension of disbelief than The Da Vinci Code<\/a> (I would nevertheless recommend in the illustrated version<\/a>, which I picked up from a Remainder Table).<\/p>\n Actually, it has been known for some time that bacteria will \u201clearn\u201d to eat plastic.\u00a0 They are versatile organisms and given time they will evolve to eat what is available.\u00a0 They like sugar, starch, fat, and protein just like us, but they can get by on little and are very patient. \u00a0A current paper is Cell Reports<\/em> tells us that Pseudomonas aeruginosa<\/em> clinical isolates can encode plastic-degrading enzymes that allow survival on plastic and augment biofilm formation<\/a> (open access but very technical).\u00a0 From the Summary\/Abstract:<\/p>\n Multiple bacteria encoding plastic-degrading enzymes have been isolated from the environment. \u00a0Given the widespread use of plastic in healthcare, we hypothesized that bacterial clinical isolates may also degrade plastic. \u00a0This could render plastic-containing medical devices susceptible to degradation and failure and potentially offer these pathogens a growth-sustaining substrate, enabling them to persist in the hospital-built environment.<\/strong> \u00a0Here, we mined the genomes of prevalent pathogens and identified several species encoding enzymes with homology to known plastic-degrading enzymes. \u00a0We identify a clinical isolate of Pseudomonas aeruginosa<\/em> that encodes an enzyme that enables it to degrade a medically relevant plastic, polycaprolactone (PCL), by 78% in 7 days. \u00a0Furthermore, this degradation enables the bacterium to utilize PCL as its sole carbon source. We also demonstrate that encoding plastic-degrading enzymes can enhance biofilm formation and pathogenicity. <\/em>\u00a0Given the central role of plastic in healthcare, screening nosocomial bacteria for plastic-degrading capacity should be an important future consideration.<\/strong><\/p>\n<\/blockquote>\n Or in bullet points:<\/p>\n Why is this important?\u00a0 P. aeruginosa<\/em> infections typically occur in healthcare settings and are often resistant to antibiotics.\u00a0 From CDC:<\/p>\n Some types are resistant to nearly all antibiotics, including carbapenems, known as multidrug-resistant (MDR) P. aeruginosa<\/em>. \u00a0In 2017, MDR P. aeruginosa<\/em> caused an estimated 32,600 infections among hospitalized patients and 2,700 estimated deaths in the United States<\/strong>.<\/p>\n<\/blockquote>\n Pathogenic bacteria are also very good at building their environment in the form of biofilms, where they can effectively hide from antibiotics.\u00a0 Biofilms form on surgical implants and catheters, making chronic infections difficult to treat.\u00a0 P. aeruginosa<\/em> is often the culprit.<\/p>\n Will these latest \u201csuperbugs\u201d eventually cause widespread problems?\u00a0 Probably not, but it is important that biomedical science stays ahead of them.\u00a0 Sixty years ago, it was generally believed (but not by disinterested microbiologists) that infectious diseases were becoming a thing of the past.\u00a0 Our misuse of antibiotics proved that notion false with the development of antibiotic-resistant bacteria.\u00a0 Sir Alexander Fleming<\/a> predicted this would happen if penicillin were misused, especially as it was in the United States beginning in the 1950s.\u00a0 In the 1960s the standard of care for viral infections of my very good group of family doctors included oral penicillin<\/a>.\u00a0 I went to the library and looked up the pill in the Physician\u2019s Desk Reference, now available online<\/a>.\u00a0 The budding biologist in me was puzzled at this practice.\u00a0 Except for secondary bacterial infections during a viral infection (which may have contributed to the virulence of the 1918 flu pandemic), antibiotics are not recommended for the common cold and similar illnesses.\u00a0 But they were (over)used.\u00a0 Now they are an essential ingredient in animal feed used in CAFO<\/a>s.\u00a0 To the unthinking technologist, can implies ought and often leads to novel problems.<\/p>\n In my view, the likelihood that we will stay ahead of bacteria during the current attack on American science is small.\u00a0 The common answer to the contrary is that Big Pharma will do the work.\u00a0 No, probably not.\u00a0 A good friend and colleague who left academia to work in Biotech eventually took his research to Big Pharma.\u00a0 He was never able to talk to me in detail about his work, but it was on the development of a completely new approach to antibiotics.\u00a0 This was an exciting time for him.\u00a0 He was working with some of the best scientists and scientific workers with no constraints on resources.\u00a0 The Big Pharma corporation that had bought the \u201cintellectual property\u201d and lured him in nevertheless pulled the plug, because they apparently decided there was no upside to their \u201cinvestment.\u201d\u00a0 If the drugs cured intractable bacterial infections, no matter how much they cost per course they would be a financial loss.\u00a0 My friend retired to a house with a view in the mountains.\u00a0 Is this a true story?\u00a0 Undoubtedly.\u00a0 Granted, it is only one story.\u00a0 But has it happened before, and will it happen again?\u00a0 Undoubtedly.<\/p>\n Part the Fourth.\u00a0 The Secretary of Health and Human Services Speaks.\u00a0 <\/strong>Or as STAT+ puts it, In combative hearings, Kennedy defends HHS cuts, backtracks \u2013 and lashes out<\/a> (paywall, but you can get the photograph at the link; I do not know if it was taken during the May 14 hearing).\u00a0 The gist:<\/p>\n In hours of combative congressional hearings Wednesday, health secretary Robert F. Kennedy Jr. swung between defending sweeping changes at his agency and backtracking on aspects of a reorganization he nevertheless said would be \u201cpainful.\u201d<\/p>\n He repeatedly cast doubts on reports about negative impacts of the changes, often calling them a \u201ccanard.\u201d \u00a0For instance, he claimed that amid sweeping cuts to his agency, \u201cwe did not fire any working scientists.\u201d<\/p>\n His statement before the Senate HELP Committee seems to contradict news reports and former agency staff, who say deep funding cuts have halted scientific research and clinical trials across the country.<\/p>\n One employee at the National Institutes of Health told STAT they were \u201c100% sure\u201d Kennedy\u2019s assertion was false. Another person recently employed at the agency said they knew of \u201cplenty of scientific staff\u201d who had been among the nearly 20,000 employees HHS is shedding<\/a>. FDA food scientists were fired<\/a>, though some were later rehired, and support staff let go. Scientists who relied<\/a> on nearly $2 billion in NIH grants<\/a> have lost that money.<\/p>\n<\/blockquote>\n I would point out here that \u201cworking scientists\u201d do not get much done when those who staff their laboratories and provide institutional and administrative support that make research possible go missing.<\/p>\n Senator Tim Scott<\/a> (R-South Carolina) asked the Secretary about the \u201ccontinuation of minority health programs (and) Kennedy pointed to a program that was terminated because it had elements of DEI \u2014 though he committed to supporting other kinds of minority health programs.\u201d\u00a0 As they say in these parts, \u201cYeah, right.\u201d\u00a0 The largest blemishes on American healthcare are the wide disparities in outcomes depending on socioeconomic factors.\u00a0 If noticing the obvious is \u201cDEI,\u201d then there is no dealing with these people.<\/p>\n Regarding Senator Bill Cassidy<\/a> (R-Louisiana), the former practicing physician who clinched the nomination<\/a> of RFKJr as Secretary of Health and Human Services:<\/p>\n And after Kennedy misrepresented vaccine safety testing standards, Cassidy fact-checked him, pointing out that rotavirus, measles and HPV vaccines were evaluated against placebos, and others were tested against previous versions of the vaccine.<\/p>\n<\/blockquote>\n And:<\/p>\n In some cases, Kennedy told lawmakers that what appeared to be cuts were actually shifts of agency functions into the new Administration for a Healthy America<\/a> \u2014 an explanation several Democrats found unsatisfying. (HHS hasn\u2019t laid out official plans for AHA, and its funding level isn\u2019t yet clear.)<\/p>\n For instance, he told senators that the CDC branch that worked on Alzheimer\u2019s disease would be folded into the AHA. \u201cA lot of the reports that whole divisions have been liquidated were just wrong,\u201d Kennedy said.<\/p>\n<\/blockquote>\n Will the Administration for a Healthy America<\/strong> become another very powerful but faux government department like DOGE?\u00a0 If so, perhaps they can use the book<\/a> written by our future Surgeon General<\/a> as a guide to make America healthy again, while recommending glucose monitors from Levels<\/a>, the company founded by her and her brother, and cookbooks that require organic radishes and certified free-range, pasture-raised chicken and wild Atlantic salmon.\u00a0 It will be difficult to find and pay for these in the food deserts<\/a> of America, where health outcomes are \u201cproblematic.\u201d<\/p>\n Anyway, regarding the Secretary\u2019s dissembling, a 50% budget cut forced on the largest and most productive biomedical science organization in the world, albeit one that could use several improvements, necessarily pushes thousands of our scientists into the outer darkness.\u00a0 Mostly, it seems, because their research does not align with Administration \u201cpriorities.\u201d\u00a0 This is a new thing in American biomedical science.\u00a0 The same thing is happening to the National Science Foundation, the other crown jewel of American science.\u00a0 Trofim Lysenko<\/a> has been mentioned here before and in Links<\/a> on Wednesday, May 14th<\/sup>.\u00a0 History rhymes yet again?\u00a0 It would seem so.<\/p>\n See you next week, with good things about current science, if all goes according to plan.<\/p>\n\n
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