Saturday, April 20, 2024

CDC Covid Background Review

“Covid is not the same [as other respiratory viruses] due to its cardiovascular and thromboembolic effects leading to stroke, MI’s [heart attack], long Covid.” – Dr. Peter Hotez on X.

This is about the the CDC’s Background for CDC’s Updated Respiratory Virus Guidance as it relates to covid-19. In short, the CDC has decided that they are going to treat SARS-2, the virus which causes covid, as a seasonal respiratory virus, similar to flu and RSV. As Dr. Hotez, says, it is not.

The document is, generally, a fine piece of deceptive writing. It contains no obvious falsehoods, and yet it ends up by making a disease causing 7,000 excess deaths a month since July 20221 sound like something minor and under control.

The Executive Summary

The Background starts with an executive summary; it then goes on to provide data that is supposed to buttress that summary but in fact contradicts it. Busy policymakers who do not read past the summary will end up believing that covid has become a mild respiratory virus. The summary makes the following three points:

  • “Due to the effectiveness of protective tools and high degree of population immunity, there are now fewer hospitalizations and deaths due to COVID-19.”

  • “Protective tools, like vaccines and treatments, that decrease risk of COVID-19 disease (particularly severe disease) are now widely available.”

  • “There is a high degree of population immunity against COVID-19.”

It concludes: “As the threat from COVID-19 becomes more similar to that of other common respiratory viruses, CDC is issuing Respiratory Virus Guidance, rather than additional virus-specific guidance.”

These points are all true but important facts are omitted, and if one reads down into the document, one finds they paint a deceptive picture.

The Picture in the Data

A Major Omission: the Infectiousness of Covid

Covid is no longer a virgin soil epidemic. SARS-2 is nonetheless an airborne pathogen easily transmitted by simply being indoors in the presence an infected person for several hours2. It is thus easily transmitted in homes, schools, workplaces, and health care facilities. None of this is mentioned in the document.

Frequency of Hospitalization and Death

At the peaks, the respiratory virus seasons of 2020-21, and 2021-22, covid led to about 10 times the hospitalizations than flu in 2019-2020 and 2022-23 (in the peak covid years, flu was much reduced due to respiratory virus precautions.) Indeed, there are fewer hospitalizations directly related to covid in 2022-23, but there are still five times more hospitalizations due to covid than to flu. Similarly, the death rate for the 2023-4 season, as of February 17, 2024 was 5.6 times that of flu. The Background points out that “influenza and likely RSV are often underreported as causes of death” but this is also true of covid, and that is not mentioned. Likewise deaths due to sequelae are not at all discussed, yet as Dr. Eric Ding and Greg Travis observe covid significantly increases the risk of death from non-respiratory disease.

Covid is Only Partly Seasonal

Continuing to read down into the presented data, one finds that, unlike flu and RSV, covid has a significant out-of-season hospitalization rate. It is especially dangerous to people over age 65, with the risk beginning to increase at age 50. The hospitalizations are also those directly attributable to acute infection; the long-term vascular risks are not addressed.

The Efficacy of Immunity

It is true that vaccination and infection acquired immunity have become widespread in the population, but there is a literal survivor bias in the data; the people who have infection-acquired immunity survived covid. This is glossed over, as are the hundreds of thousands additional deaths3 resulting from the refusal to vaccinate. Equally significant, the limitations of immunity are not discussed. Immunity is most effective at preventing death and hospitalization from acute covid. It roughly halves viral loads in infected patients, reducing but not eliminating transmission. Unfortunately, immunity is much less effective at preventing sequelae, with estimates of efficacy ranging from 10% to 50%.

The Efficacy of Protective Tools

“Protective tools, like vaccines and treatments, that decrease risk of COVID-19 disease (particularly severe disease) are now widely available.” This glosses over several things:

  1. Vaccination is not 100% effective, as mentioned above.

  2. Vaccination is beyond the means of large numbers of people in states that have not expanded Medicaid, and beyond the means of undocumented aliens who are outside the US health care system. All of these people can nonetheless catch and spread covid.

  3. Treatment is often late and hard to get. Antivirals are most effective early in infection, but tests are costly and not widely available, prescriptions are hard to come by, and medication is often expensive, sometimes not even available from pharmacies.

  4. Antivirals, also, are not that effective; they reduce but do not eliminate the impact of infection.

  5. There are no reliable treatment protocols for covid sequelae. Because it is a multi-system disease, covid sequelae have multiple etiologies. Each case is individual and the efficacy of treatment is unpredictable.

Measures to Control Spread

Moving on to contagion, the “Respiratory Virus Guidance” states that infected individuals can, once they are feeling better, go back to regular activity, but take additional precautions for five days. Yet the “SARS-CoV-2 shedding and transmission dynamics” section of the Background says, “most individuals [are] no longer infectious after 8-10 days.” This again is an instance of policy in contradiction with data.

Reinfection and Long Covid

Reinfection is mentioned once. It is pointed out that so far the most recent booster vaccines protect against currently circulating variants of the virus, but only 22% of adults have received that booster. Nonetheless, SARS-2 is an RNA virus with a high mutation rate and future immune-escaping variants are likely. Long covid is discussed, but only self-reported incidence is used, and those numbers are most likely low – many doctors are unaware of long covid and some even refuse to believe it exists4.

Indoor Air Quality

There is a paragraph on air quality. This is progress. Unfortunately, it is couched in terms of control of relative amounts of clean air rather than the absolute amounts of clean air required to control infection. ASHRAE Standard 241-2023, which addresses this, was published six months before the new CDC Guidance was released; the public health research it is based on is in some cases over 100 years old.

A Better Summary

To begin with, it would be best if covid was not lumped in with flu and RSV; it a multi-system virus whose transmission is usually respiratory, not a respiratory virus, and attempts to treat it as a respiratory virus will lead to increased morbidity and mortality. I might start out with the following points:

  • Covid has become endemic. While it is no longer the scourge it was when it emerged, it remains dangerous, especially to elders and high-risk people.

  • Covid is less dangerous because more than 98% of the U.S. population now has some degree of protective immunity. On the way to acquiring that immunity, over a million people died. It is estimated that 200,000 of the deaths between May 1 and Dec 31 2021 would have been prevented had more people been willing to accept vaccination3. (If this were an actual policy document I would update that number; it would probably end up quite a bit higher, since the 2021-22 respiratory virus season did not end in December 2021.)

  • Covid remains dangerous, with a hospitalization rate five times that of flu. Covid has increased the death rate of Americans aged 18-44 by 7,000 deaths a month since July 20221.

Conclusions

The “Background for CDC’s Updated Respiratory Virus Guidance” is a thoroughly dishonest document which minimizes the reality of a new and dangerous pathogen. There seems to be a combination of a surrender to politics and denial of the enormity of the failure to control a novel pandemic virus, which is likely going to be remembered as one of the great mistakes of human history. There is perhaps a historical model for this in the minimization of the 1918 flu to maintain the morale of soldiers during World War I. In China there was a series of mistakes on the part of local authorities abetted by the central government; a US parallel might be a corrupt state government burying news of an outbreak5. In the United States the failure, was largely a result of Trump administration policies and, especially, the work of Donald Trump’s son-in-law, Jared Kushner6.

I would like to write a long outraged screed about the CDC’s leadership, but I am not at all sure that they could have done much better. The CDC is part of the US Department of Health and Human Services (HHS); the CDC Director is two levels down from the President in the US government. The job is necessarily political. Both Drs. Fauci and Birx had to deal with President Trump, who wanted to hear nothing that contradicted him. Currently, the CDC faces a hostile House of Representatives, heavily influenced by former President Trump, which is likely to cut off funding if sufficiently nettled, and a violently angry reactionary public faction. In that position, if one is competent and dedicated, one works instead to make quiet long-term gains. There are some signs of this: there is a good discussion of masking in the CDC Respiratory Virus Guidance and addressing indoor air quality is offered as a core prevention strategy. ARPA-H has now announced an initiative to develop technologies to monitor and improve air quality. So, the quiet approach offers dividends.

And yet people are dying.

  1. Gregory Travis. USA actual deaths by month and expected deaths by month. Accessed April 9, 2024. http://www.gregorytravis.com/SARS-CoV-2/CoronaGraphs/excess2.php?location=USA&death_cat=deaths_disease_ucd&rpt_type=Months&demo=YAH. The data set ends, so far, in Dec 2023, but there seems no reason to believe the number has fallen. ↩︎ ↩︎

  2. Ferretti L, Wymant C, Petrie J, et al. Digital measurement of SARS-CoV-2 transmission risk from 7 million contacts. Nature. 2024;626(7997):145-150. doi:10.1038/s41586-023-06952-2 ↩︎

  3. Hotez PJ. Summary and Derivation of Approximately 200,000 American Lives Lost. In: The Deadly Rise of Anti-Science: A Scientist’s Warning. Johns Hopkins University Press; 2023:47. The period covered was May 1 to Dec 31 2021; since that time there have undoubtedly been more; the 2021-22 respiratory virus season was the peak of covid mortality. ↩︎ ↩︎

  4. See, for instance, Al-Aly Z, Topol E. Solving the puzzle of Long Covid. Science. 2024;383(6685):830-832. doi:10.1126/science.adl0867 for an overview, but there are many papers in this area. ↩︎

  5. Short interview with Dali Yang, an American political scientist, who has written a book on the failure in Wuhan: Wuhan: How the COVID-19 Outbreak in China Spiraled out of Control. Oxford University Press; 2024. ↩︎

  6. Sherman, Gabriel. In The Shallows.Vanity Fair. 2020;62(6):48. ↩︎

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