| WPCNR NEWS AND COMMENT. From Your Local Epidemiologist. Jun 22, 2022: The newest Omicron variant, BA.4/5, is gaining traction, causing case, hospitalization, and death curves to trend upwards in many countries. This variant was first detected in South Africa in early 2022 and caught our attention because it had several mutations on the spike protein. Two mutations in particular, called L452R and F486V, caught our attention because we had seen them on previous variants of concern. Recent lab and epidemiological data show BA.4/5 to be driving this wave, in part due to reinfections and infections after vaccination. Infections. In the lab, we see that Omicron is getting better at escaping our first line of defense—neutralizing antibodies. The figure below displays the step-wise function of losing neutralizing antibody protection more and more with each subsequent Omicron variant. Note that among recently boosted, BA.4/5 does not fully escape immunity. This means, in the short-term, boosters help prevent infection and thus transmission.Wang et al., preprint; Source here. Other lab studies show Omicron escapes infection-induced immunity, too. We are particularly worried about recent BA.1/2 infections (first Omicron waves). Data from South Africa found immune escape more pronounced among unvaccinated compared to vaccinated (not boosted) people (5-fold difference). Another study found BA.1 or BA.2 infection among unvaccinated people induced very low levels of antibodies against BA.4/5. Those who were infected and vaccinated did have meaningful protection, albeit at lower levels than before. Kimura et al preprint. Source here. Weakening our first line of defense—neutralizing antibodies— will mean more (re)infections. Lab data compliments what we are seeing in the “real world”. BA.4/5 drove a substantial case wave in South Africa regardless of their high level of immunity. Case waves across Europe are now well on their way, too. In the U.K., reinfections are on the rise, even among 60+ year olds. We don’t have epidemiological data on duration of booster effectiveness against BA.4/5. Data from the U.K. showed that boosters provided strong initial protection against BA.1 or BA.2 infection but quickly diminished to 0% five months later. We expect BA.4/5 to shorten this timeline even more. I’m not confident that our boosters will be able to keep up in protecting against infection with the rate of Omicron mutating. (Protection against severe disease is much higher and wanes slower: 90% effectiveness against hospitalization 2-4 weeks after a booster → 70% 6 months after a booster.)(UK Health Security Agency: Source Here) Severe disease There are a whole host of reasons why infections are not great, but reducing severe disease is one of our main priorities. In South Africa, the BA.4/5 wave contributed to excess deaths, but the rate diminishes with every wave since winter 2021. In Europe, Portugal is the BA.4/5 leader, with 70% of COVID-19 cases accounting for this new variant. With one of the highest vaccination rates in the world, they largely escaped death from Delta. However, now, after recently reaching their BA.4/5 case peak, excess mortality hit the highest level since their vaccination campaign began. In Portugal, increase in hospitalizations is occurring mainly in people over 60 years old. In fact, in a recent analysis, unvaccinated people over 80 had a case fatality rate (CFR) of 9.5% (see figure below). Among those with only the primary vaccine series, CFR is 5%; among those with a booster, it is 1.7%.(Source Here) This is likely due to two things: Waning immunity. While Portugal does have a higher booster rate than the U.S., it isn’t perfect. Some people’s protection against severe disease could be waning, especially among those who are not up to date with COVID-19 vaccine. Transmissibility. Vaccines are not perfect, and if we have a virus burning through a population, it can still cause high levels of death among vulnerable pockets, like the elderly.The verdict is still out as to whether BA.4/5 is more severe. A recent preprint found that BA.4/5 was more severe for hamsters. In fact, their data suggested that BA.4/5 was going into the lungs more. (Initially, Omicron largely moved disease out of the lungs, which helped it become less severe). Importantly, though, this wasn’t the case using human sera. More research is certainly needed. BA.4/5 hospitalizations are now making headway in other European countries. The figure from Financial Times clearly shows the global upswing in hospitalizations as BA.4/5 entered the scene. But, so far, remains much lower than previous peaks. United States So where does this leave us in the U.S.? BA.4/5 makes up 35% of new infections and is growing quickly. Unfortunately, patterns in South Africa and Europe won’t tell us much about how things will unfold in the U.S. because we just had a very infectious variant moving through (BA.2.12.1). Other countries did not experience this. We know BA.4/5 is more transmissible than BA.2.12.1, but the epidemiological impact of that difference is not yet known. This is why disease modelers are providing case projections for worse case (below left) and best case scenarios (below right) for cases.(Twitter JP Weiland) On a population level, we expect our complex history of infection- and vaccination-induced immunity to continue to protect against severe disease. In fact, it’s reassuring that all-cause mortality in the U.S. reached pre-pandemic levels from March-May 2022. Death certificates are lagged, so I’ll be curious to see if and how excess deaths changed in the past two months during our latest wave. It will also be important to track this by age, particularly among elderly, to ensure we don’t leave people behind in the wake of highly transmissible variants.(CDC) Bottom line This virus continues to mutate to escape our first line of defense causing (re)infections. If you don’t want to get sick, it’s time to leverage other layers of protection, like masking. Thankfully, other immune system mechanisms continue to work to reduce severe disease. The transmissibility of the virus is causing upswings of hospitalizations and deaths among the most vulnerable of our populations. We aren’t out of the woods yet but we are inching closer and closer to a manageable virus. “Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, biostatistician, wife, and mom of two little girls. During the day she works at a nonpartisan health policy think tank, and at night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health science so that people will be well equipped to make evidence-based decisions. |
POMP AND CIRCUMSTANCE WILL BE DIFFERENT
WPCNR NEWS & COMMENT. By John F. Bailey. June 21, 2022:
Good morning from White Plains New York USA where it’s 59 wpcnr degrees.
Yesterday school maintenance workers were setting up the long rows of white chairs on beautiful Loucks Field in preparation for the middle school and high school graduations this week.
The perfect rows of over 550 seats shown spectacularly in late afternoon sun. Just as the graduates hold the future of this country and the hope it has held aloft to the world for the last 246 years.
It crosses my mind that in our town and towns big and small across the land this week perhaps today’s graduates are the most important graduates in many years. Arguably, they are one of the toughest classes of graduates in a long time.
As Pomp and Circumstance, the march that opens every graduation, starts I hope this graduation will send a different message deliver a different theme not of pursuing dreams and success and you can do everything. This week’s speakers need to give them a mission like no other.
The graduates have come through three years of at-home remote learning, the isolation of not seeing their friends, the alienation of mask-wearing and negative vibes from persons not wearing masks and persons wearing them feel towards each other.
They have not been able to enjoy class learning in the traditional way socially distanced in class rooms. Imagine not being able to pass notes in class – not being able to sit next to your friends in study hall trying to crack up your old buddy Chuck Cannizzaro—a great old friend of mine –with jokes to get him thrown out of study hall – singing songs in the hall… and of course seeing a teacher with a mask on… that was not the typical school experience.
One student at a recent library event described this was were first year back in high school and how traumatic it was getting reacquainted in a real high school environment for the first time. These graduates of 2022 have had to be tougher then the millions of graduates before them. and they face a big challenge in the state of this county, state and every state in this country all at odds with one another..
I cannot stress how important it is that the graduation addresses of the Valedictorians and student leaders and academic speech makers be different. The well-wishes and laudatories should address the need these graduates have to be coached to a different level of qualities as they head into colleges, jobs in the community and a cruel environment their wages cannot handle.
The message need to deliver not just the need to do well and follow their dreams. (For many their dreams are harder than ever to achieve.)
The sages on the stage need to raise the level of challenge: emphasize to the Classes of 2022 to spread the message of respect for working together with one another to heal and advance the legacy america has in world history.
This nation saved the world three times in the last century with the blood of graduates no older than those graduating this week.
This nation found a vaccine for the greatest plague since the Black Death and the influenza of 1918. Discovered the polio vaccine. The smallpox vaccine. Revolutionized medicine. Advanced communications exponentially to bring the world closer together, and sadly provided the means to tear the world apart.
Today’s messages to graduates and the hearts of parents in the stands I hope will find the inspiration and realism to lay out the path for these graduates who must follow for the sake of lives throughout the world and have the courage to follow — a path of respect, doing what is right in the eyes of God that Voice in your Head you always hear that always shows you what to do, and tells you when you are doing wrong.
If the graduates do not hear that message the mission they have: bringing not the attitude of selfishness and person success but being big brave responsible persons very very quickly to bring healing, health hope and direction to make us all united and respectful of one another as Americans first together.
The Graduates of 2022 have a huge burden on their shoulders.
They are the last hope as are the Graduates of 2023, 2024, 2025 and beyond.
Looking at the past, but learning from it.
Building back the nation one person at a time until America the Beautiful is Beautiful once more.
E pluribus unum
OUT OF ONE, MANY.
And when they have finished their never-ending mission to build us back one person at a time they can look back with pride.
One significant effect of Pomp and Circumstance is its sound of always marching foreward as its strains wash across the field, filling parrents with tears and the sounds of their children leaving them taking new steps without them, hoping for the best, but worrying, always worrying about them. Will they be happy? Will they do better than I have?
For the graduates, the cadence and relentless crescendos and refrains of Pomp and Circumstance beckon and present the challenge of the unknown life ahead, intimidating and commending just the same.
These graduates of 2022 if the messages are right will know what their mission is in their behavior, their challenges and know what must be done. Kids always see the truth.
If the new generation of graduates succeeds, there will be a different nastalgia, a looking back that will be filled with pride and new hope and achievement.
As we salute the graduates and bade you our prayers we know you have to do the job we have failed to do.
Please pick up the pieces for us. When they do, the graduates of today and future will look back at the job they did with a melancholy and a sense of achievement
Chuck Berry captured this melancholy in his record Oh Baby Doll.
Oh baby doll, when bells ring out the summer free
Oh baby doll, will it end for you and me?
We’ll sing the old alma mater
And think of things that used to be
