Ian Welsh

The horizon is not so far as we can see, but as far as we can imagine

Category: health care Page 3 of 34

Every Covid Infection Does More Damage & Makes You Less Healthy and More Likely to Die

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On November 14, 2022

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Okay. From very early on in the plague, I’ve been saying getting infected multiple times was a terrible idea, and a worse plan.

The key to being right in advance is being willing to run before things are completely proven, but when they are obvious. It was obvious that reinfections were terrible for people. Now the firm data is coming in. (Read the entire thing here.

“Compared to those with no reinfection, those who had reinfection exhibited an increased risk of all-cause mortality” of over 2x those with no reinfection. Three times for hospitalization, heart problems, and blood clotting. There was also increased incidence of diabetes, fatigue, kidney problems, mental health disorders, musculoskeletal problems, neurologic disorders, and lung problems.

I mean, one might be tempted to just say, “Reinfection makes you more likely to have all health problems,” and not be too far wrong. It may be that things get better, but this study found increased risks right out to six months, which is as far as it studied.

Bonus! As I’ve said almost right from the start, each reinfection makes things worse.

Every time you get infected by Covid, it has a chance to do even more damage, and if that damage heals after the acute phase, it’s damn slow — if.

Now, let’s talk about “immunity debt.” The way the immune system works isn’t like going to the gym, and slowly getting stronger by lifting heavier weights. Instead, it’s like cops or customs agents with mug shots. “If you see this guy, shoot him.” One thing Covid does to evade immunity is mess up the mug shots so that they aren’t recognized. This means that you get other diseases after Covid, to which you were previously immune — because it’s messed up the recognition system. This is probably a big part of why there are so many auto-immune disorders popping up in Covid survivors; mess up the mug shots enough, and the immune system will start going after innocent civilians, i.e., parts of your own body. (Having had  ulcerative colitis when I was young, I can tell you this can be more not-fun than most of you can imagine.)

Getting Covid is very likely to make your immune system worse, not better, and the above is only one mechanism by which this is true.

Too much of the Covid debate has centered on vaccines, which were not, and are not, a silver-bullet. The best results have been in countries that took public health measure approaches, of which vaccines are only a small part.

But for you individually, the “takeaway” is simple: don’t get multiple infections. Don’t let your kids get multiple infections. No matter how strong the social pressure, short of “lose your job” (and maybe not even then, if you can easily get another), do not stop protecting yourself, whatever level you consider appropriate. (I don’t wear masks outside unless it’s a crowded locale, for example, and I keep my tiny apartment ventilated all times. Most people should have a HEPA air purifier running all the time where they live, and your employer should be doing something similar if you work inside.)

Covid is already causing a permanent reduction in lifespans and an increase in illness. It’s not just Covid infections clogging up hospitals, it’s people with other illnesses getting them at increased rates. Keep protecting yourself.

And remember, with proper public health measures, we probably could have ended this plague in the first four months or so. Our lords and masters chose not to. Stupid? Evil? Why not both? I have suspicions (Covid made them a lot richer), but at the end of the day, they were okay with you and the people you care about dying or having serious health problems, likely for the rest of your lives.

Remember how much they were and are willing to hurt and kill you. Remember, also, this goes for all parties in power or near power in most countries. This certainly isn’t significantly different between Democrats and Republicans in the US.

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The Adderall Shortage Is Just the First Major Shortage

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On October 20, 2022

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People who have read me for a while know that for years I’ve been warning of prescription drug shortages or even stoppages. Well, now we have one that’s large enough to have made headlines:

A national shortage of Adderall has left patients who rely on the pills for attention-deficit/hyperactivity disorder scrambling to find alternative treatments and uncertain whether they will be able to refill their medication.

The Food and Drug Administration announced the shortage last week, saying that one of the largest producers is experiencing “intermittent manufacturing delays” and that other makers cannot keep up with demand.

Some patients say the announcement was a belated acknowledgment of a reality they have faced for months — pharmacies unable to fill their orders and anxiety about whether they will run out of a medication needed to manage their daily lives.

Experts say it is often difficult for patients to access Adderall, a stimulant that is tightly regulated as a controlled substance because of high potential for abuse. Medication management generally requires monthly doctor visits. There have been other shortages in recent years.

“This one is more sustained,” said Timothy Wilens,

Now, it may be possible to move to generics, and a lot of the reason for this is how regulated amphetamines are as part of the war on some drugs. Back in the 60s it was possible to buy pure amphetamines over the counter just as at one time one could buy cocaine, morphine and codeine OTC.

That said, supply lines are under pressure and those pressures, though they will fluctuate, are going to get worse over the next years and decades.

Going off Adderall can be nasty, but there are other drugs where it’s downright hell, including SSRIs and Benzos. I know one guy whose careful titration of Xanax took a year, and when another friend’s was without for two days because of a prescription problem his body started just moving and speaking on its own. (GABA is what allows you to not do things, and benzos crush your bodies natural production.)

Then, of course, there are drugs people need because without them they will die or become seriously ill.

As we go forward, all of these things will be subject to the possibility of supply shocks and shortages. I would say, indeed, that more drug and medicine shortages and supply shocks are inevitable.

It’s hard to say what to do about this, because you can’t build up a supply of your own: doctors can’t let you have a 6 months buffer, say, of benzos (which if you take them every day, is about what I’d guess you’d need to have enough to safely take yourself off them with small reductions over time.)

But be aware of this issue and see if you can figure out a way to protect yourself. And remember, even without shortages, there will be future “insulin situations” — where those who have a drug people must have jack the price up so high many people can’t afford it.

Plan ahead if you can, and be well.

Update: Someone who wants to remain anonymous offers the following suggestions:

Covid Variants Continue Immune, Vaccine and Treatment Resistance Evolution

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On October 13, 2022

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From Salon:

BQ.1 and BQ.1.1 are both spreading extremely fast in parts of Europe. According to Cornelius Roemer, a viral evolution expert at the University of Basel, the number of BQ.1.1 infections has been doubling every week. That kind of exponential growth is sure to drive the variant to becoming dominant globally in short order.

“The degree of immune escape and evasion is amazing right now, crazy,” Yunlong Richard Cao, an immunologist at Peking University in Beijing, told Nature this week. Cao co-authored a paper, which has yet to be peer-reviewed, that seems to show previous infections by BA.5 and antibody drugs, including Evusheld and Bebtelovimab, aren’t enough to stop a BQ.1 infection.

“Such rapid and simultaneous emergence of multiple variants with enormous growth advantages is unprecedented,” Cao and his colleagues warned in the study. “These results suggest that current herd immunity and BA.5 vaccine boosters may not provide sufficiently broad protection against infection.”

Meanwhile, BA.2.75.2, an offshoot of the Centaurus omicron subvariant, also shows stark ability to evade antibodies.

So. Expect a bad winter. Remember that this exponential increase in new variants has always preceeded a new variant becoming dominant, and that given international travel, they always spread. If you get a vaccine, get a bi-valent one, but I’d suggest filtering enclosed areas and that wearing n95 masks is a good idea. Remember that even a mild case of Covid can lead to invisible organ damage, especially to the brain and heart, and that repeated infections have a good chance of giving you long Covid.

This isn’t a game, and it isn’t about ideological talking points or culture war bullshit. This is a disease, which because we refuse to take the steps necessary to eliminate it, that keeps mutating to avoid whatever half-assed steps we are taking, and which can seriously fuck you up.

Be well.

Vaccine And Mask Effectiveness

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On October 4, 2022

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I have mostly avoided the vaccine debate, but let’s take a brief pass.

This isn’t because vaccines don’t work.

This doesn’t mean I’m entirely happy with MRNA vaccines, I’m not and I think there’s some validity to them having negative side-effects. I’m even more unhappy with the uneven way they were applied, which allowed for Covid to gain repeated mutations which made vaccines less effective. I personally would have taken Sputnik-V if it were allowed in my country.

But the vaccines are protective against death and serious illness is indicated by the population studies I’m aware of. This is also true of masks.

Now, I do not favor and never did favor a policy primarily based on vaccines. I have always believed that public health measures like properly done shutdowns (much briefer than we had if you do them early), track and trace, quarantine, paid sick leave, travel bans for anything but absolutely necessary travel (with mandatory quarantine) and so on were the way to go. I wanted all loans frozen for the duration of shutdowns, or paid for by central banks (if they can create trillions for rich people, they could easily have done so for ordinary people.)

We fumbled Covid, probably because it was making the rich rich very very fast, and that lost trust in measures that were somewhat effective, but were sold as silver bullets. They weren’t, absent both public health efforts and a worldwide effort and/or travel banks. This has now morphed into culture war bullshit, where what you think depends not on your actual study of the issues, but on what your politics are.

That’s very sad, and very stupid.

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No The Solution To Ending Mandatory Masking Isn’t “Well YOU can still mask”

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On September 27, 2022

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Few things make more more tired or contemptuous of someone than, when a masking mandate is removed, someone saying “well, you still have the choice to wear a mask, we’re not effecting you” or some variation.

Masking is not primarily about protecting yourself. Only a respirator and a well-fitted N95 offer good protection from Covid if other people aren’t masking.

 

Now that chart may be making you feel safe if you go quickly in and out of businesses, but realize that there are multiple people in those buildings and that in an enclosed space the virus builds up, so even if there’s only one person who is infectious, if they’ve been there for a while, you can walk in and get a huge dose. And if you have multiple exposures in different places, the viral load can build.

Oh, and if you think anything short of a respirator is likely to protect you on a long flight where people don’t have to mask…

Masking is not primarily about protecting yourself, though it helps, it’s about protecting other people, especially since Covid can be asymptomatic and since Covid tests, especially the rapid antigen tests, often give false negatives.

It’s not, thus, just about you. It’s about the people around you.

And hysterics aside and rare conditions, no, masking may be uncomfortable but it doesn’t hurt adults or children. What hurts them is getting Covid, especially repeated exposure leading to organ damage, including brain damage, and to serious long-Covid.

Now I know that most countries have given up and just declared Covid over. Happening where I live, even as emergency departments have to be closed because of not enough nurses and doctors. It’s “over”.

But this marker is still worth placing. Masking is far more effective when it is a communal action. Some things, to work properly, we must do together.

The end result of not doing these things (which go far beyond masking) is going to be a double digit percentage of the population disabled and I doubt, combined with climate change, that our societies can handle that.

Welcome to the future. Deliberately un-handled plague, ecological collapse and climate change, combined with a cyberpunk dystopia without the cool parts of cyberpunk.

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Ontario’s Mass Murdering “Top Doctor”

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On August 31, 2022

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I don’t consider this hyperbole:

Remember that ever since school openings, school infection rates have spiked before general community rates. Schools, as anyone who is a parent or was a child should know, are cesspools of infection even in good times. Kids get sick, pass it along, their families then get sick and in turn pass it along to co-workers and so on.

And letting people who are still infectious go to work is obviously insane. Note that 10 days was the original guideline, then it was dropped to 5, which was absolutely not enough. As for masks, they only partially protect other people, unless you have a respirator or properly fitted n95 and never take it off for the duration of the school or work day. If you’re with other people for hours in a surgical or cloth mask, forget it, you’re exposing them and almost no one wears a properly fitted N95 mask and also never takes it off or breaks the seal.

BA.5 is arguably the most infectious disease we know about, beating measles. It’s certainly in the top 5. If it doesn’t kill someone, it has a good chance of doing permanent damage, and that damage can add up to Long Covid, and be disabling. Every time you get Covid, more damage can be done, until symptoms appear that don’t go away after the infection. People who have had Covid are at more risk for heart disease, diabetes and brain conditions.

Now, some data from the US on Covid:

  • Around 16 million working-age Americans (those aged 18 to 65) have long Covid today. 
  • Of those, 2 to 4 million are out of work due to long Covid. 
  • The annual cost of those lost wages alone is around $170 billion a year (and potentially as high as $230 billion). 

The pandemic isn’t over. Covid keeps mutating into more infectious forms. Our society cannot survive this going on for years and years. Lost wages is the least of it, the economic impact and human cost go far beyond that.

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Sweden’s Relative Performance In Covid

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On August 30, 2022

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Sweden famously chose a herd immunity policy during Covid and deliberately withheld life-saving support from seniors, giving them morphine instead of oxygen when they had plenty of oxygen. It wasn’t triage, it was murder. There are many claims that they did well due to their policy. Did they?

Let’s take per-capita deaths as our proxy. Sweden(196.15) did do better than the US (316.83) and the UK ( 302.59) in deaths per 100,000 population. However, they did worse than all their sister-Scandinavian states: Norway (
72.92) Denmark (118.93) and Finland (100.65).

Their death toll was almost 3x Norway’s, the best performer, and somewhat over half again as much as Denmark’s, the worst performer among the other Scandinavian countries. They did worse than Germany (176.90) but slightly better than France (237.39).

All of these countries are, however, pathetic compared to good performers. Japan (30.87), South Korea (51.92), Vietnam (44.29) and China (1.06).

All of these numbers come from the John Hopkins chart. I have to say that I don’t believe some of the statistics. Russia and India had much higher mortality than the chart indicates, for example. Some will suspect that China falls into the same camp, but the people I know in China support the idea that China’s zero Covid has largely worked. The rare exceptions, Hong Kong and Shanghai, did not follow the same policies as other cities. But even if one were to assume that fatalities were 10X as large as stated, China would still have massively outperformed.

The truth is that most countries completely cocked up Covid. They shutdown way too late in each wave, they didn’t quarantine properly, they didn’t put filtration into buildings and they didn’t massively limit international travelers and make quarantine for those travelers who remain mandatory, supervised and supported.

If we had just properly shut down early (and stayed shut down a bit longer), tracked and traced and quarantined we could possibly have ended Covid early. If we had not been told Covid vaccines were a silver bullet, rather than like weaker flu vaccines (have to take them multiple times, they aren’t that effective) and used proper public health policy, a hell of a lot less people would have died.

As for Sweden. Solidly middle of the pack, worse than their peer Scandinavian countries and deliberately murdered old people. Sweden’s GDP growth was nothing spectacular in 2021: middle of the pack. Inflation was solidly middle of the pack, though better than their peer Scandinavian countries.

It’s fair to say that Sweden’s Covid performance wansn’t terrible among developed nations and not as disastrous as many (including myself) thought it would be. But Sweden is nowhere near best in class, or among its Scandinavian peers. The sad truth is that virtually all Western countries blew it and Sweden is among that group.

It’s not that shutdowns don’t work, contra the propaganda, it’s that for them to work you have to do them early, keep them on long enough (though by doing them early virtually all of China’s shutdowns have lasted less time than Western ones) and support people at home with food deliveries and so on so they can actually stay at home. Paid sick days of essential workers were needed, and people going out to grocery shop and so on probably did a great deal of danger. Once schools were opened up, Covid numbers surged first in schools, then to the general population.

Sweden’s no great victory, but it does show that most of what the West did was ineffective. Effective public health measures, where they were done, reduced mortality and cases significantly, but in the West we did everything half-assed, and that’s what our numbers show. Sweden had the grace to mostly not even bother.

People don’t support shutdowns and other public health measures because they didn’t work well because they were done badly. If they had worked they would have wide support.

So the lesson of Sweden (minus their deliberate murder of seniors) is simply do it properly.

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BA.5 Covid Is Incredibly Virulent and MonkeyPox Is in Exponential Growth

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On July 28, 2022

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Yeah…

Remember that even a mild case of Covid can cause organ damage without you knowing, or can give you Long Covid with symptoms, sometimes extremely severe symptoms and that damage can accumulate each time you get Covid.

Meanwhile, two days ago, from WHO:

 

Don’t assume that because you aren’t gay or don’t have a lot of partners you won’t get monkeypox; plenty of people who aren’t having anal sex are getting it. Most of the guidance I’ve read says “direct contact,” but…

While experts believe monkeypox spreads primarily in close contact through skin lesions, evidence suggests the virus can also be airborne, at least over short distances. For example, during Nigeria’s monkeypox outbreak in 2017, scientists recorded cases of airborne transmission within a prison and in health care workers who did not have direct contact with patients. However, it is not clear how much airborne transmission contributes to the overall spread of the virus.

What I suspect is that monkeypox can spread through droplets, which is not the same as Covid, which is fully airborne. Droplets is how most scientists originally thought Covid spread, which is why “social distancing” was emphasized so much at the start of the pandemic.

Generally vaccines are not available unless you’re queer and have multiple partners, but check locally. I suspect the directions at the start of Covid should be relatively effective vs. monkeypox: distance, use 70 percent ethanol or dettold, and wear a mask. (Soap alone will not do it – correction.)

This stuff is nasty, takes a month to clear, and can leave permanent disfiguring scars. So keep an eye on it and take it seriously if it’s spreading where you are.

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