Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Book Bans Keep Exposing Censorship to Ridicule

Welcome to Banned Books Week, which ends today, but can be celebrated all of the time – not celebrating that books are banned to punish thought crime, but to read something we might not otherwise read – to expand our awareness of what other people think – to be independent.

Some politicians claim that censorship is wrong, while using the government to prevent citizens from reading unapproved books. These politicians claim that they are protecting citizens from harm, because those citizens are students and too young to think for themselves in the schools that are supposed to teach these students to think for themselves.

The book banning politicians do not want the students to grow up to be voters who think for themselves, but want to control the information that is allowed to students, so that when they are adults, these citizens will do as they are told without questioning what they are told.

This is not new. Banning books has been around for hundreds of years and has always failed.

What is it about Toni Morrison that must be kept from students?

In 1616 the Catholic Church banned Galileo from even thinking about the Copernican hypothesis, because the Copernican hypothesis is a thought crime. In 1632 Galileo took a creative approach to the ban. Galileo wrote a dialogue discussing the superiority of the geocentric system and the heliocentric system, in spite of the evidence.

The evidence that the Earth does not move was that, if the Earth moved, we would feel it and we would be able to observe stellar parallax (when a star is viewed from one extreme of the Earth’s orbit to another, it will appear to have moved). These are common sense arguments, but common sense also tells us that the Earth is flat.

The evidence that must be ignored centered on a book written by Copernicus in 1543, later work by Johannes Kepler, and on evidence produced by Galileo with his telescopes beginning in 1609. Galileo had not invented the telescope, but had improved on it so much that he had the best telescopes in the world at that time. Using the telescope Galileo was able to show that the Earth was not the center of everything in the universe, since the moons of Jupiter revolve around Jupiter, not Earth. The existence and movement of Sun spots supported the Copernican system. The strongest argument was that Venus has phases, just like our Moon, but not consistent with revolution around Earth. Galileo was wrong about the tides, and should have known that he was wrong, but that was not an essential part of heliocentric theory.

After being threatened with torture and execution 69 year old Galileo recanted what he wrote and was sentenced to house arrest for the rest of his life. Giordano Bruno had been tortured for 7 years before being burned alive in public as an example to those who would think for themselves. Bruno was convicted of the same charge as Galileo – Heresy, which is thought crime.

The Church banned On the Revolutions of the Celestial Spheres by Copernicus (unless edited to mean the opposite of what Copernicus meant), and the books of Galileo, Kepler, and other books that provide evidence that the Earth revolves around the Sun. Some of those prohibitions lasted until 1835.

Only 45 years after the death of Galileo, long before there was evidence of stellar parallax, Isaac Newton ignored the prohibition on thought crime in his explanation of gravity. The theory of gravity requires the Earth to revolve around the Sun. If someone can show that the Sun revolves around the Earth, they can disprove gravity. Those who ban books would be ecstatic.

In 1992 Pope John Paul II gave a partial apology for the actions of the Church to punish thought crimes, but was criticized for going too far. The Catholic Education Resource Center still promotes disingenuous arguments to support the actions of the Church. Ironically, the Catholic Church does not oppose evolution (perhaps because their treatment of Galileo was so pathetically bad), but some Protestants, especially Evangelicals, do. Maybe they view evolution denial as their chance to grab their own science denial award – a Darwin Award, given to people who kill themselves through extreme stupidity.

In history, there are also books that are banned, because the evidence presented in the books may make the reader feel bad. This is not out of concern that the reader will feel bad about being lied to by their parents, teachers, and politicians. This is of a desire to protect the lies told by parents, teachers, and politicians.

The American Civil War was started by parts of America deciding to take all of their people and their land and all of the federal government land in their states and declare themselves a separate country, in order to protect slavery from the not yet elected Abraham Lincoln. This was when the Republicans were the radical progressive party and the Democrats were the unapologetic white supremacist party promoting slavery.

The dishonest historical claim is that the Civil War was fought over states’ rights, but before the war the slave states insisted that the Fugitive Slave Act be enforced everywhere in America, even though it completely violated the rights of the states that prohibited slavery. Why would they lie about something that is so easy to show to be false? Because if you are taught that thinking is a crime, you won’t check the facts. If you do check the facts, you are easier to target as a thought criminal.

Another example of the dishonesty of the claim that the Civil War was not fought to expand Christian slavery. Christian slavery does not mean slavery of Christians, although some did convert enslaved people, but slavery by Christians. Christians were the first people to enslave people based on the color of their skin. Slavery has been around probably as long as people have been around, but it was only when Europeans started exploring other parts of the world, that the business of slavery of people for looking different became established. Greece, Rome, the Ottoman Empire, . . . had slavery, but they did not have the racial slavery that Christianity created in the Age of Exploration, justified by the Bible.

Article I, Sec. 9, “(4) No bill of attainder, ex post facto law, or law denying or impairing the right of property in negro slaves shall be passed.” – Constitution of the Confederate States; March 11, 1861

Article IV, Sec. 3, “(3) The Confederate States may acquire new territory; and Congress shall have power to legislate and provide governments for the inhabitants of all territory belonging to the Confederate States, lying without the limits of the several Sates; and may permit them, at such times, and in such manner as it may by law provide, to form States to be admitted into the Confederacy. In all such territory the institution of negro slavery, as it now exists in the Confederate States, shall be recognized and protected be Congress and by the Territorial government; and the inhabitants of the several Confederate States and Territories shall have the right to take to such Territory any slaves lawfully held by them in any of the States or Territories of the Confederate States.” – Constitution of the Confederate States; March 11, 1861

The states also give their reasons for their insurrection:

A Declaration of the Immediate Causes which Induce and Justify the Secession of the State of Mississippi from the Federal Union.

“In the momentous step which our State has taken of dissolving its connection with the government of which we so long formed a part, it is but just that we should declare the prominent reasons which have induced our course.

Our position is thoroughly identified with the institution of slavery– the greatest material interest of the world.”

Confederate States of America – Declaration of the Immediate Causes Which Induce and Justify the Secession of South Carolina from the Federal Union

“We affirm that these ends for which this Government was instituted have been defeated, and the Government itself has been made destructive of them by the action of the non-slaveholding States. Those States have assume the right of deciding upon the propriety of our domestic institutions; and have denied the rights of property established in fifteen of the States and recognized by the Constitution; they have denounced as sinful the institution of slavery; they have permitted open establishment among them of societies, whose avowed object is to disturb the peace and to eloign the property of the citizens of other States. They have encouraged and assisted thousands of our slaves to leave their homes; and those who remain, have been incited by emissaries, books and pictures to servile insurrection.

For twenty-five years this agitation has been steadily increasing, until it has now secured to its aid the power of the common Government. Observing the forms of the Constitution, a sectional party has found within that Article establishing the Executive Department, the means of subverting the Constitution itself. A geographical line has been drawn across the Union, and all the States north of that line have united in the election of a man to the high office of President of the United States, whose opinions and purposes are hostile to slavery. He is to be entrusted with the administration of the common Government, because he has declared that that “Government cannot endure permanently half slave, half free,” and that the public mind must rest in the belief that slavery is in the course of ultimate extinction.

This sectional combination for the submersion of the Constitution, has been aided in some of the States by elevating to citizenship, persons who, by the supreme law of the land, are incapable of becoming citizens; and their votes have been used to inaugurate a new policy, hostile to the South, and destructive of its beliefs and safety.

On the 4th day of March next, this party will take possession of the Government. It has announced that the South shall be excluded from the common territory, that the judicial tribunals shall be made sectional, and that a war must be waged against slavery until it shall cease throughout the United States.”

Most of the Confederate states declared that they were not American before Lincoln was president. South Carolina, in the statement of their reasons does not sound much different from those claiming that Obama was going to close all of the churches and take everyone’s guns. President Obama never tried to do either one, in spite of the promises of his enemies. That is one of the reasons for banning books – to keep people from knowing the truth.

As with the memory holes in 1984, “The Party told you to reject the evidence of your eyes and ears. It was their final, most essential command.” George Orwell condemned authoritarians on the left and on the right. An important part of that condemnation is the way they try to prevent citizens from having access to information, as we see in so many states with book bans.


Management Killed the Patient, But the Nurse is Prosecuted as a Criminal

I wrote about this in 2019 and the only thing that has changed is that the prosecution continues. Is the title misleading? No.

The management of Vanderbilt University Medical Center created the system that killed the patient and the Nashville District Attorney’s Office is an accomplice after the fact.

Yes, the nurse, RaDonda Vaught, is was dangerous as a nurse, but that was fixed by taking away the license to work as a nurse. That doesn’t come close to bringing back the patient killed, but the patient was killed by a system that teaches incompetence. Vanderbilt University Medical Center, which should have prevented this death, rather than causing this death.

This is an example of the Dunning-Kruger effect being promoted by the hospital management. The management put a nurse, who does not know enough to safely administer sedation, in the position of teaching new nurses to sedate patients without monitoring the patients and to leave the patients in the care of people possibly even less qualified to monitor sedated patients.

How can anyone be less qualified than a nurse who killed a patient?

It may not be part of the training of the radiology technician to recognize and address (by calling for help, at a minimum) excessive sedation, so less qualified. On the other hand, the technician is working for the same hospital that put the dangerous nurse in the position of training other nurses to be dangerous.

The hospital management is telling patients that they have hired competent people, that the management values the lives of patients, and that the management is taking reasonable steps to provide the best care to patients, but the management is lying.

Accidents do happen, which is why there are rules for the administration of sedatives to protect patients.

Vanderbilt University Medical Center has repeatedly declined to comment on Vaught’s trial or its procedures.

Just as the nurse administered the wrong drug, and did not monitor the patient appropriately even for the drug that was supposed to be given, the Nashville District Attorney’s Office is prosecuting the wrong killer. If anyone should be prosecuted, it should be the people responsible – the management of Vanderbilt University Medical Center.

However, prosecuting doctors, PAs, NPs, nurses, paramedics, technicians, … for medical errors is the kind of abuse of power that harms patients. When medical professionals cannot report medical errors, without fear of being charged with crimes, more patients will die, because the errors will be covered up.

The Nashville District Attorney’s Office is telling medical professionals to cover up errors. If medical professionals do not report errors, we do not learn to avoid errors. We learn to hide errors.


Forcing Nurses Out of Nursing to “Save Money”

There are laws being proposed, and some have passed, to limit the pay for nurses, because the legislators assume that nurses are overpaid. The problem is that healthcare is expensive and that nurses are not treated well by employers – most of whom do not seem to be capable of providing the care that nurses provide.

Who has created this problem? It isn’t the nurses, who are overworked, underpaid, and abused by some of their patients.

But a nurse makes more than a paramedic, so they shouldn’t complain! A nurse generally has more education and more responsibility than a paramedic, so why shouldn’t a nurse make more? Before the pandemic, I told people not to go into EMS, because there are few options in what you do for work and the standards are low.

A quick way of eliminating people, while claiming to be making things better, is to put a pay cap on the people actually doing the work. But which people do we lose with a pay cap?

With a pay cap, we lose the people who hit the pay cap, which means the highest paid people. If pay is supposed to have something to do with ability, we will lose the best employees first – and it is not likely to stop with just a few people, because this is a system that has been failing for a long time.

The increased demands of the pandemic and the attacks from the people who demand that doctors, nurses, paramedics, EMTs, … put up with abuse from the least educated, because of the “Freedom” of the least intelligent, there are not many reasons to stay. We keep telling the best nurses, that it is time to find some other way to make a living, because we don’t want competence – we only want compliance.

The way to make healthcare better is not to cap the pay of the people who do the work.

Why aren’t we limiting at the pay of the people who run things and did a lot to get us into this mess?

If we want to decrease the number of people in beds in the hospitals, we should promote vaccination, masking, and social distancing. The corruption of some politicians, partying without masks, is not a reason to avoid wearing masks, but a reason to enforce the rules without exceptions for the politically powerful.

COVID-19 has killed millions with the help of the anti-vaxers and the anti-maskers. We shouldn’t be part of the group sickening/killing our neighbors, our families, or ourselves.

Vaccines and masks are safe and effective and save lives, if we are smart enough to use them.


Why the Ivermectin Evidence is Pathetic

In a pandemic, which has killed almost a million Americans, you might expect that people would try to figure out the most effective treatment, rather than scam their fellow Americans, but you would be wrong.

There are some doctors, who do not understand the difference between good research and garbage, and are promoting bad research because they really really believe – and they were right lucky about steroids before the evidence was clear. Therefore they must be right about everything.

Except, reality does not care what you believe.

They believed in steroids before there was good evidence that steroids work, but their belief was based on wishful thinking and willful ignorance, not on good science. That they were right was purely coincidence. We have seen doctors kill tens of thousands of patients with antiarrhythmic drugs, because the drugs were widely prescribed without high quality evidence of safety and efficacy.

CAST – The Cardiac Arrhythmia Suppression Trial (the high quality evidence that was agreed to in order to prove which drug saved more lives) showed that the doctors fooled themselves, and killed their patients, by believing in something that only appeared to be an improvement in outcomes. Tens of thousands of deaths were not an improvement in outcomes.

If we have a story that seems to make sense, it is much easier to convince ourselves that we are not killing patients. After all, we mean well. At least some of us do. This is an example of misleading ourselves with a narrative fallacy. C A S T and Narrative Fallacy. Rudyard Kipling called these Just So Stories.

Dr. Pierre Kory (president of the Frontline COVID-19 Critical Care Alliance – FLCCC, which is different from the extreme quackery of America’s Frontline Doctors) may be a true believer, but if Dr. Kory really believes ivermectin works, he should be demanding large scale randomized double blinded placebo controlled research, rather than making excuses for low quality research.

Dr. Kory’s claims are so bad that even PolitiFact can’t find any truth in Dr. Kory’s claim – and PolitiFact tries to be as fair to every claim as possible.

What about the science? The promoters of ivermectin have claimed that the odds are over 2 trillion to 1 that the results of the latest meta-analysis are due to chance low quality research methods. Their research methods are almost as bad as their math.

Dr. David Gorski has written a long article that goes into detail about the problems with this latest paper. Ivermectin is the new hydroxychloroquine, take 2. Read the whole article, but here is a sample:

In fairness, the authors don’t actually say that meta-analyses of crappy studies do make good evidence, at least not in the paper. However, ivermectin advocates touting the study fans are certainly making that claim, and Dr. Kory sure did seem to me to imply the same in his interview with Bret Weinstein. In any event, one large, well-designed rigorous double-blind clinical trial for prevention, along with one large, well-designed rigorous clinical trial for treatment, could trump this entire meta-analysis.

Indeed, Gideon Meyerowitz-Katz did a reanalysis of the studies analyzed by the BIRD Group that shows that if you leave out the two studies that are as yet only preprints, are very small, and actually appear to have been miscategorized as higher quality than they are, the results are very different:

This basically shows that without those two studies, the analysis demonstrates no benefit for ivermectin at all compared to placebo, with a confidence interval that includes everything from a big benefit to a large harm from the drug.

If the study really had a 2 trillion to 1 chance of the results being by chance alone, it would not rely of such low quality research (preprints, tiny studies, studies without placebos, studies that are not double blinded, . . .).

There is no good reason to look at any research on treatment for COVID-19 that is not randomized placebo controlled and double blinded.

There are millions of patients to study, so the only reasons to avoid using the highest quality of research is a lack of confidence in the treatment.

As with promoters of alternative medicine, the actions of the promoters of ivermectin do not demonstrate confidence that what they are selling will survive high quality research.


Happy Darwin and Lincoln Day 2021


Where would we be without these two revolutionary thinkers? Both Charles Darwin and Abraham Lincoln were born on the same day – February 12, 1809.

We are in a pandemic, which is starting to look much less ominous, in large part, due to the genetic modification of mRNA (messenger RiboNucleic Acid), which was completely unknown to Darwin and Lincoln. So why bring it up?

This is going to be more about Darwin, than Lincoln, but both are just introductions to the topic of genetics. Darwin’s explanation of the way evolution works, along with the repeatedly overlooked Gregor Mendel’s explanation of the way inheritance works, led to the field of genetics. Genetics allowed scientists to take the genome of SARS-CoV-2 (Severe Acute Respiratory Syndrome – CoronaVirus – 2 [the first SARS was in 2003 – 2004]), provided by researchers in China, and design a safe and effective vaccine in 2 days.

Only two days? It must be cheap. Right?

Moderna, the company that created one of these vaccines, has been working on mRNA vaccines for a decade, so there is much more than two days that went into the creation of this vaccine. Pfizer/BioNTech makes the other mRNA vaccine.

It is important to understand the speed, because the virus (SARS-CoV-2) appears to be mutating to variants that might not be protected against by the current vaccines. Both vaccines are currently used under EUA (Emergency Use Authorization) from the FDA (Food and Drug Administration), but both vaccines should be able to receive regular approval from the FDA in the next few months. Once the vaccines have full approval, modifications for variants should be similar to approval for influenza variants, which happen every year, because influenza also mutates frequently. This does not mean that the vaccines will be less safe, because the process of protecting the body is what requires approval and we already have evidence from millions of vaccinated people that this process is safe and effective.

There have been tens of millions of vaccinations and the most serious adverse event has been anaphylaxis (a treatable allergic reaction that can rarely cause a fatal drop in blood pressure and/or a fatal airway obstruction). There is good research on about 6 million of the first people vaccinated, showing that the rate of anaphylaxis is 11.1 cases per million doses for the Pfizer/BioNTech vaccine and 2.5 cases per millions doses for the Moderna vaccine.

Everybody who developed anaphylaxis appears to have been discharged to home, following treatment for anaphylaxis, so there do not appear to have been any cases of long term adverse effects from any of these vaccinations. For comparison, the disease, COVID-19 (COronaVIrus Disease first identified in 2019) has a fatality rate of somewhere around 1%, which is millions of times more deadly than a vaccine that is not deadly. If you are worried that the vaccine is deadly, the disease is millions of times worse.

Maybe you are not worried about death, but about living with side effects. Then the case for getting vaccinated is even stronger. About 15% of people who get COVID-19 have significant and long term complications. Again, this is millions of times more of a problem with infection than with vaccination.

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine — United States, December 14–23, 2020

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Moderna COVID-19 Vaccine — United States, December 21, 2020–January 10, 2021

The second shot is reported to cause flu like symptoms (fever, muscle aches, et cetera) beginning about half a day after the vaccination, but treatable with ibuprofen. Plan on not doing anything the day after your second vaccination shot. This is also reported to be much worse in younger people, than in older people, so an 80 year old may not have any side effects, while the healthy 30 year old may feel miserable that night or the next day.

This should not be a difficult decision. These vaccines are safe – especially when compared to the infection they protect against. These vaccines are both over 90% effective at preventing illness (development of symptoms).

While anti-vaxers, anti-maskers, and other conspiracy theorists have been trying to discourage vaccination, there are a few things to consider:

Vaccines save millions of lives every year. Most of those are the lives of children. If the anti-vaxers get their way, millions more children will die every year.

Vaccines are probably the safest and the most effective medical intervention available.

Why do anti-vaxers claim that vaccines are not safe? Why do anti-vaxers claim that vaccines don’t work? There is no research supporting their claims.

At anti-vax events, the sale of dangerous chemicals to “treat” autism is common. These chemicals are not approved by the FDA for this purpose. These “treatments” are dangerous scams. Why are anti-vaxers so comfortable with poisoning children?

Anti-vaxers failed to stop worldwide vaccination against smallpox. The success of vaccines means we no longer vaccinate our children against smallpox. Success for vaccines is eradicating disease, so that vaccines are not needed. They put themselves out of business.

Success for anti-vaxers is a lot of dead children, a lot more disabled children, a lot of disabled adults, and a lot of dead adults – COVID-19 does produce a lot of dead/disabled adults.


US Rep. Stephen Lynch tests postive for COVID despite receiving two doses of vaccine

The increase in the number of cases of disease remains the same for 10 days after the first vaccine shot, then things dramatically change for the better for those who received the vaccine.

If the mRNA (messenger RiboNucleic Acid) vaccines really work, how is it possible for someone to get COVID-19 after receiving both the first and second shot of the Pfizer/BioNTech vaccine?

The results of the research submitted to the FDA (Food and Drug Administration) for an EUA (Emergency Use Authorization) show that the vaccine is much more effective than was expected. Originally, the efficacy goal for a vaccine was to prevent at least 50% of disease. The Pfizer/BioNTech vaccine research shows that it prevents 95%.

For participants without evidence of SARS-CoV-2 infection prior to 7 days after Dose 2, VE [Vaccine Efficacy] against confirmed COVID-19 occurring at least 7 days after Dose 2 was 95.0%. The case split was 8 COVID-19 cases in the BNT162b2 group compared to 162 COVID-19 cases in the placebo group (Table 6).

Link to research – Efficacy Results – Primary Endpoint (Evaluable Efficacy Population)

95.0% is more precise than anyone should be using, even if it is mathematically correct to calculate it that way. The paper does admit this: “The 95% credible interval for the vaccine efficacy was 90.3% to 97.6%, . . .” As more people are vaccinated, the numbers reported will more accurately represent the true protection from disease.

Here is where things start to get complicated. Protection from “disease”, in the case of vaccine approval, means not developing symptoms. Symptoms are what the person experiences – cough, shortness of breath, weakness, aches, et cetera. Signs are things that the person might not feel, such as an elevated heart rate or hypoxia (hypoxia is a low oxygen saturation). Hypoxia is a particular problem with COVID-19, since many patients have been hypoxic, but have not experienced any difficulty breathing or other respiratory symptoms. It is easy to miss hypoxia in COVID-19 patients, if we are not measuring oxygen saturation.

If the person does not have any symptoms, does that mean that the person is not infected? No.

Is that a problem? Probably not. It would be best, if the vaccines provide sterilizing immunity – immunity that prevents the transmission of infection. Often an infection is asymptomatic, so the person is not aware of being infected. Measuring the rate of infection requires frequently testing everyone, but that was not the goal of this research. The goal was for the vaccine to decrease the spread of disease (an infection that is causing symptoms), when compared with placebo. We do not yet know if any COVID-19 vaccines prevent transmission of infection. The Pfizer/BioNTech vaccines, which is what US Rep. Stephen Lynch received two doses of, prevents development of symptoms 95% better than placebo (not receiving any active vaccine doses). That also means that a small percentage (5%) of the people who are vaccinated will be expected to become symptomatic.

A statement from the South Boson congressman’s office says Lynch isn’t displaying any symptoms of COVID-19.

Link to article in MassLive

Since he is not reported to be experiencing any symptoms, Rep. Lynch is still considered to be asymptomatic, therefore probably in the 95% protected from disease (symptoms). It is possible that Rep. Lynch would have developed an asymptomatic infection, if he were not vaccinated, but we do not know. At 65 years old, Rep. Lynch is not expected to develop an asymptomatic infection. That is much more likely to occur in much younger people, but there are no guarantees.

Why did the researchers only look at symptoms? Because it would be a lot more work, and money, and could discourage people from volunteering for the study, since participants would have to get tested for COVID-19 every few days to determine if they had infection, rather than only getting tested after developing symptoms. Is it possible that more people became infected in the vaccine group, than in the placebo group? Yes, but it is unlikely and more infections in the vaccine group, with 95% less disease, would not indicate that vaccination is a problem. Why?

In the final analysis of the evaluable efficacy population (7 days), four participants had severe COVID-19 disease at least 7 days after Dose 2 (one subject who received BNT162b2 and three participants who received placebo). The vaccine recipient who had severe COVID-19 disease met the severe case definition because oxygen saturation at the COVID-19 illness visit was 93% on room air. The subject was not hospitalized, did not seek further medical care, and did not have risk factors for severe disease. The three placebo recipients who had severe COVID19 disease met the severe case definition for the following reasons: one subject had an oxygen saturation of 92% on room air without other severe disease criteria, one subject was hospitalized for noninvasive positive pressure ventilation with bilateral pneumonia, and one subject had an oxygen saturation of 92% and ICU admission for heart block. One of these placebo recipients with severe disease also had a body mass index > 30 kg/m2 as a risk factor, while the other two participants did not have any risk factors for severe disease. The vaccine efficacy of this secondary efficacy endpoint is shown in Table 11.

The worst outcome, among those vaccinated, was an oxygen saturation that dropped to 93%. It does not describe if symptoms resulted in testing, or if it was due to an exposure, or something else, but the reason this person is categorized as severe disease is an oxygen saturation of 93%. One of the three patients in the placebo group was also considered to have severe disease is for a similar oxygen saturation (92%), which is essentially the same as 93% for treatment purposes.

Has the protection provided by vaccine decreased since the EUA approval for the vaccine? No. There have not been any reports of decreasing efficacy of either mRNA vaccine. Any reasonable person, who does not have a medical reason for not getting vaccinated (severe allergies seems to be the only consideration), should receive both shots of vaccine.

You can develop immunity naturally, with about a 1% chance of death and about a 15% chance of severe disease (depending on age, co-morbidities, …), or you can obtain immunity by vaccination, with the possibility of some side effects, which are reported to be less severe for older people.

The only reason Rep. Lynch found out that he was infected was testing after a member of his staff tested positive for COVID-19. He is not reporting any symptoms. A vaccine that prevents symptoms, even if it allows infection, is still a successful vaccine. Preventing disease and preventing death are both very important benefits of vaccines.


What to Look for in Today’s Pfizer/BioNTech FDA Advisory Committee Meeting

The 9 AM December 10 meeting is available by video conference at this link. Since we are seeing record rates of infection, there should be a lot more cases of infection, with the same difference in numbers between the placebo group and the vaccine candidate group. There are two important questions.

We may not be be able to answer either one, yet. How long does the vaccine candidate protect recipients. We know there are cases of people developing COVID-19 after recovering from an earlier case. Since there are no coronaviruses that have provided long term immunity, how often will we need to get vaccinated? Every six months? Every year? Every other year?

Usually, reinfection results in a less serious infection, but there is already evidence that this may not be the case with COVID-19.

The patient had two positive tests for SARS-CoV-2, the first on April 18, 2020, and the second on June 5, 2020, separated by two negative tests done during follow-up in May, 2020. Genomic analysis of SARS-CoV-2 showed genetically significant differences between each variant associated with each instance of infection. The second infection was symptomatically more severe than the first.

Genomic evidence for reinfection with SARS-CoV-2: a case study

He was reinfected two months later and the second infection was more severe.

The other important thing that we may not be able to know depends on the amount of information obtained by the study. Did the study require tracking of the close contacts of the participants to see if there is a difference in infection rate?

If there is no difference, that means the vaccine candidate does not prevent transmission, even though it prevents the vaccinated people from becoming noticeably sick. This would still be an effective vaccine, but would require a higher rate of vaccination to control the pandemic.

The higher the rate of vaccination needed, the more likely it is that the anti-vaxers will keep the pandemic from being stopped for years, if not forever. Anti-vaxers have prevented the eradication of polio, so we have to continue to vaccinate our children against polio. Successful vaccines put themselves out of business. Anti-vaxers require vaccination for ever.

Fortunately, anti-vaxers failed to protect smallpox, so we no longer have to vaccinate children against smallpox.

Vaccines are probably the safest and most effective medical intervention available, but anti-vaxers oppose that.

Vaccines save millions of lives every year – mostly the lives of children – but anti-vaxers oppose that.


Update on the Moderna Vaccine Candidate

Today Moderna issued another press release to update the information available on their vaccine candidate. The results are consistent with the previously released results and will be followed by a much more detailed release of information at an FDA advisory panel meeting, expected to be on December 17, 2020.

The new cases are more than double the 95 cases from the November 16 press release. The total is now 196 symptomatic cases – 185 in the placebo group and 11 in the mRNA-1273 group – efficacy of 94.1%. There were 30 severe cases, including 1 death, in the placebo group and no severe cases in the mRNA-1273 group.

We do not know how many asymptomatic cases are in either group, so this route of transmission by vaccinated people is still a possibility.

Another part of the press release raises different questions.

Efficacy was consistent across age, race and ethnicity, and gender demographics. The 196 COVID-19 cases included 33 older adults (ages 65+) and 42 participants identifying as being from diverse communities (including 29 Hispanic or LatinX, 6 Black or African Americans, 4 Asian Americans and 3 multiracial participants).

But . . .

The study includes more than 11,000 participants from communities of color, representing 37% of the study population, which is similar to the diversity of the U.S. at large.

The minority rate in the study is stated to match the 37% minority rate of America, but the symptomatic infection rate among American minorities in the study is 42 out of 196 (21.4%), but according to a meta-analysis of over 18 million patients in the Lancet, the symptomatic infection rate among minorities is significantly higher than 37%:

Patients from ethnic minority groups are disproportionately affected by Coronavirus disease (COVID-19). We performed a systematic review and meta-analysis to explore the relationship between ethnicity and clinical outcomes in COVID-19.

How is this study of randomized volunteers, who are allegedly representative of the American population, producing symptomatic infection rates that are much less than half of what is expected among minorities?

The November 18 Pfizer/BioNTech vaccine candidate press release only states:

Efficacy was consistent across age, gender, race and ethnicity demographics.

I did not find any details of the actual numbers in the press release, nor in any of the links. The Moderna press release has a similar statement, even though the numbers provided disagree with that statement: “Efficacy was consistent across age, race and ethnicity, and gender demographics.” Is the Pfizer/BioNTech statement more trustworthy, because it does not provide any numbers? No, but this is something that needs to be addressed for all of the vaccine candidates.

What are the Pfizer/BioNTech numbers for minorities? The FDA meeting for Pfizer/BioNTech is scheduled for December 10, so we should learn a lot more from that open to the public by video FDA meeting.

Why does the Moderna press release list such disproportionate numbers, but not mention that they are disproportionate? There is no reason to expect that a placebo would provide this kind of disproportionate protection.