Summary In the Midst of Delta

The interview just put up by Mark Halloran over at Quillette is almost six months old now, and I almost just shrugged and ignored it. On Darkhorse, Ivermectin, and Vaccine Hesitancy. As i thought we did not have much new information about the Ivermectin since then, however, and I wanted to understand what the difficulty was between a meta-analysis that showed effectiveness but a quick consensus shortly after that declared it of inconclusive effect, unlikely to be much help. When things don't go together like that and everyone is shouting about them, I like to get an idea what's going wrong.  They are clearly working from different information sets.

I'm glad I went forward with it, as it provides a very good explanation for that and other points of contention. It was in the middle of Delta, and Eric Topol provides a good explanation for why Israel looked great in contain covid, then looked terrible, and then brought it under control again. That isn't his main point, just one of those things he touches on along the way. The interview is longish, but let me find an interesting paragraph. Or six.

ET: Now, we knew that the vaccines weren’t going to stay effective for years, we knew there would be a third shot needed, likely maybe at one year, or two years, at some point. We didn't know it’d be six months. That was the big Israeli realization, when they first came out with that and said: “Oh my gosh, protection has dropped from 95 percent to 40 percent against symptomatic infections.” At first there was denial among the medical community. Nobody wanted to see that. So, the double whammy was both that they had gotten off to a very fast start, they had a lot of people then who were at the six-month waned immunity period, and they also had Delta. If we never had Delta, if they just had Alpha, these breakthrough infections would have probably still been much lower. It’s this combination of a very contagious form of the virus with the waning of immunity that was expected. It really basically was like a perfect storm.

And you add into that, that in Israel they gave Pfizer, at three weeks spacing, which led to a not optimal response of the Beta; the B and T cell immune response. So that now has been largely squashed by the boosters. They used boosters of the Pfizer—the same dose, the same original vaccine in millions of people. And they’re well on their way to getting back to that one case per million people, which is the ultimate—we can’t do much better than that. And I think what we’ve learned already, people over 60 need to get a third shot, that probably applies to all vaccines, or with Johnson & Johnson, that would be the second dose. But an additional dose is going to be needed around six months for people over 60. If we want to suppress symptomatic infections, instead of just hospitalizations and deaths, then we have to go down to much lower ages, possibly as low as age 20 or 18. That’s the big question: how aggressive do you want to suppress symptomatic infections because they’re going to crop up with more exposure to Delta, if we don’t give a third shot.

MH: It seems that that’s a balance then because even though there’s a decrease in approximately 39 percent for the ability to stop infection, there’s still an 89 to 93 percent protection against hospitalization and death.

ET: It’s really a little lower than that. But if you zoom in on the people over age 65, then it drops down, and for the people in their 70s it dropped from 95 to 85, which is substantial. So, the point I am getting at is that most of the hospitalizations and deaths occur in people over age 60. So that's where you see the big bang of the booster.

MH: Because the immune response is just not going to be as good with older people, even with a good vaccine, they’re just not going to be able to produce antibodies the same way.

ET: Exactly. So then with the younger age group it’s two things going on. One, they make better antibody and cellular responses; B and T cells, and they don’t have as much of a risk to wind up in hospital or die...

He discusses the balance points in booster vaccines in various ages and the underlying reasons, both in the immune systems of the individuals and in the general immunity of a community, and thus notes why it might be important for American children to get vaccinated but not such a big deal in Spain.  He talks about hybrid immunity, and why getting covid then getting a vaccine does is "unbeatable" - not that he recommends getting covid. The two discuss the rocketing amount of Parkinson's in the infected.  Ugh. The information about any pandemic, including long covid, and neurological symptoms is pretty distressing

The interview is published as part of a larger academic work by Halloran Iconoclast: Ideas That Have Shaped The Culture Wars that came out in February 2022. So by publishing standards this actually came out pretty quickly. 

Topol is quite understanding of how people get things wrong and why they might go down wrong paths following conflicting data from varying sources.  A lot of the discussion is about the culture war part and how that has impacted treatment and vaccination. Yet when he thinks someone is not merely wrong, but a professional acting in bad faith he doesn't mince words.

MH: I wanted to address some of the claims that were made in Bret Weinstein’s DarkHorse podcast with Dr. Robert Malone and Steve Kirsch. So, the first one is that the spike protein that’s produced by the mRNA vaccine is cytotoxic. And then, the claim is that the transmembrane domain that is supposed to anchor the spike protein to a localized spot fails, or can fail to some extent, and that the spike protein then cleaves, and then Steve Kirsch talks about a Japanese study that shows the distribution of the spike protein throughout the body, bloodstream, the ovaries and in bone marrow. Tell me what do we make of this? What evidence is there for this?

ET: It’s all false. It’s all unacceptable lying; making things up. For example, Bret Weinstein on one of his podcasts said that the reason people get headaches post vaccination is because the mRNA from the vaccine crosses the blood brain barrier, and that’s what’s causing it. That’s ridiculous...

I found it interesting that even though the prediction that Delta would be tough to supersede did not hold up, one can get a good sense from the reasoning why that is the case with an Omicron variant that is even more contagious, though less deadly. 

I have never pretended to be someone who can explain the medical data to you, though I do have some experience from the psych side of the limitations of small sample sizes and the craze for meta-analyses that involve divergent protocols, different doses, and evaluations of efficacy that don't match up at all. The only value-added I provide is looking at the arguers themselves and what they seem to be doing: who is fighting fair and who isn't. I not only have a mind that seeks immediately for this information (since teen years and maybe before) I also have a great deal of experience with people who want a particular answer to be true and the type of responses they engage in when the evidence seems to go against them, versus the responses of the straight shooters when the evidence seems to go against them. Note in the interview comment by Topol the line "At first there was denial among the medical community. Nobody wanted to see that." But what did they do next?  That's what's key. They went looking for the real answer.

In the Ivermectin discussion it rapidly became apparent to me that there was a group that decided they wanted it to work long before there was any helpful data, only a couple of stories. Some of that makes sense. It's cheap, fairly available, and we have a good safety profile on it at some dosing rates. What's not to like? But as the evidence mounted that it was only going to be a little help at best, all of a sudden people started doubling down, tripling down, quadrupling down. No, it really works, it's not being given a chance.  No, they're covering up the good results because they want to make money. No, they are just lying because they don't want to admit they are wrong. (You will note, BTW, that all three of those arguments could apply to the skeptics.) It became clear to me, not from the medical data, but from the discussions themselves, that a lot of people really wanted Ivermectin to prove out for another reason: they wanted to stick it in the eye of "the so-called experts." 

Think about that for a moment. The people who have the best chance of saving your life, but you get obsessed with the idea of proving them wrong.  You want them to be wrong. No amount of evidence convinces you otherwise. You don't rejoice that we find some things that work at least somewhat and taken together reduce death, and that some things aren't worth the time. Because the Wrong People came up with those answers. That those wrong people had to go through hoops of regulators who would love to trip them up - there is competition and resentment in that ecosystem as in any other - and the amount of dishonesty required for a coverup basically extends to the entire medical system. Who would willingly choose to believe that doctors and coroners everywhere are intentionally fudging data about vaccine side effects?  I have worked with enough doctors to know that a lot of those guys would love to make Merck look bad, or Pfizer.  It would be the crowning moment of their career. Oh, but hospitals get paid $3000 for every covid patient. (Look at the overall budgets and what insurance companies pay for each inpatient stay) A lot of them are under pressure from their administrations to gloss over vaccine problems. (I am imagining the MSO meeting at my hospital where that discussion comes up.) Please.  Get real.

Being a moderate skeptic myself - I am certainly aware of treatments advocated by mental health professionals I thought were crap and have been pleased to watch fall out of favor - I have tried to be more sympathetic to the moderate covid skeptics of all stripes. A lot of the contrary arguments that get floated do look very plausible at first look - and sometimes at the second. But there comes a point where you recognise that even those are pulling out studies, data, and claims from less and less reliable sources. I have websites I used to like that I simply don't go to anymore, because they have too often published crap.  I think I can get by generally good sources that just get a bee in their bonnet about an issue or two. That seems like normal stuff, even if they really go off a deep end on those few topics. It's why I stuck with Ron Unz for awhile, until it became clear that he is now psychotic. (I had someone who knew describe his deteriorated self-care and personal behavior a few years ago, but it gives me no insight into what exactly is going on there.) John Derbyshire gets a few things badly wrong but I generally still like him.  Theodore Dalrymple has been so reliable that when I disagree I immediately question myself instead of him - but even he misses the mark at times.  That's fine. I'm worse. But may abandonment of some disputants goes deeper.  I eventually get enough data that I conclude "Okay, it's clear what answer you want to be true, and nothing budges you.  I'm done.  I haven't got the time."