month of roses 2021 – a summer as lived in previous years?

… you better don’t! … The SAJO ticker explains….

June 16, 2021

Started in February 2020, the SAJO blog is providing a thread through the pandemic with up-to-date information and suggestions around SARS-CoV-2.

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Dear readers,

The CURRENT pandemic SITUATION is as follows:

The most COVID-19 afflicted countries are the US, India, Brazil, France, Turkey, Russia, Great Britain, Italy, Argentina, Columbia new on 10^th place, Spain No. 11, and Germany 12^th. Recently, Germany was overtaken by Argentina and Columbia, where incidences are exploding, since they are in the fall season.

Globally, we are counting 176 M infections with more than 3.8 M COVID-19 deaths. In Germany, there are 3.8 M cases with 90,000 deaths. We think the actual numbers are a lot higher, globally, in Europe, and in Germany. Many COVD-19 deaths are not accounted for in official statistics, simply by misdiagnoses of sequelae after a severe disease resulting in death.

One example: Rural areas of the United States are exhibiting a strong excess death rate, which is higher than the official COVID-19 death toll. This indicates a much higher COVID-19 death toll than reported statistically. In these areas, the cause of death is reported by non-medical personnel, such as the sheriff or the justice of the peace (who both are elected officials). Consequently, the actual numbers far exceed the official statistics. At the start of the pandemic, German pathologists also found causes of death to be different from COVID-19. Today, we know that many deaths resulted from follow-up symptoms of COVID-19 such as emboly and stroke. We do not know how far the excess death rate in Germany is correlated to COVID-19. https://www.scientificamerican.com/article/excess-deaths-reveal-the-pandemics-hidden-toll-in-some-u-s-counties

Our BEHAVIOR will define the NEXT wave’s crest

Globally, we have seen that in places that seemingly had the pandemic in check, once protective measures were lifted, the pandemic came back roaring. This, we are expecting for the 2021 fall season in Germany, since politicians are repeating the mistakes made in summer 2020 yet again. The magnitude will depend on several factors, such as the number of fully vaccinated people, what mutants found their way to Germany, and how well protected vaccinated people really are. The delta-variant from India is cruising, with an estimated 40 – 70 % higher transmission rate. It is the individual behavior in summer that has an influence on the wave’s magnitude. It all depends on the people and the measures being upheld.

Most importantly, N95-masks need to be worn in summer whenever distancing is not possible (even in the outdoors). The risk is increasing indoors. Thus, we are advising to wear N95-masks indoors, and to make sure the air is exchanged regularly. In summer, doors and windows may be kept open all the time. Politically motivated suggestions to lift the mask mandate are sending a wrong message, if the spread of a highly contagious variant is on the horizon. These new variants will feed the infection wave of fall 2021. It is depressing to see that politicians are repeating the mistakes of 2020, instead of learning from them. The German government managed to get our country among the countries affected most by this disease. Well, there is room for improvement.

It now is clear that the individual behavior in summer 2020 had a major impact on the distribution of one variant in Europe, as has been published two weeks ago in the renowned journal Nature. https://www.nature.com/articles/s41586-021-03677-y

The POST-COVID SYNDROME phenomenon – a consequence of immune reactions

10 % of infected children (!) and adults are suffering from post-COVID-syndrome, which is resembling an autoimmune disease. These patients are suffering from a number of symptoms, for many months. Medically, these people cannot be treated yet. Scientists are predicting that these patients will suffer for years and will need assistance in daily routines. It is unknown if the vaccines will prevent this. SARS-CoV-2 is like a “nuclear bomb” being dropped into the immune system, inducing inflammation in many parts of the body. This is called “multi-inflammatory syndrome”.

Since the GLOBAL VACCINATION RATE is still very low (see figure below), we just have to hang in there. Every single infection is providing room for the virus to adjust. As virologists, we had pointed this out many times before in this blog. You may see the opinion by other experts in the article link below: https://media.nature.com/original/magazine-assets/d41586-021-01505-x/d41586-021-01505-x.pdf

The following figure we took from ‘Nature’. It is showing the current vaccination rates in several countries – a great feat accomplished in a short time frame. However, we are far from the point to call an all clear on the pandemic as many German politicians now are voicing in their enthusiasm and populism during an election year.

Discussions about the PRIORITIZED VACCINATIONS of certain groups are irrelevant. This should be decided on a situative basis. Of course, it is important first to protect those most vulnerable. But each and every single vaccinee, even the young, is providing a protection. Children are visiting schools and educational facilities, that are driving the pandemic, and are carrying the virus to their homes. Every vaccinee is removing one organism for the virus to mutate in. In the US and other countries, children are being vaccinated. The German board on vaccinations (STIKO) should take a look into these data. Nothing is speaking against a vaccination of children, since they are in close contact to parents and grandparents. One example may be seen in this article: https://www.theguardian.com/world/2021/jun/04/covid-outbreak-at-my-childrens-school-makes-me-fear-were-complacent

The immune system of most children seems to completely eradicate the virus even before it enters cells. This is a sign of a strong and immediate reaction of the innate immune system. The older children get, through adolescence to maturity, the bigger the risk of severe disease. This means a younger immune system is dealing better with the virus than an adult one. With age, the immune system is maturing. In scientific terms this is called acquired immunity. In the case of SARS-CoV-2 this obviously is a drawback. The acquired immune system’s reactions may be so violent that people are dying from the effects or may suffer from long-term damage.

The immune system is divided into two parts, to simplify it. The innate and the acquired defense system. Acquired immunity consists of specialized cells, that produce antibodies f.e. The antibody production usually takes 2 – 3 weeks. Vaccination is aiming for this reaction.

In children, the acquired immune system is not yet fully developed. With SARS-CoV-2 this seems to be an advantage. In children, the main defense is coming from the innate immune system, which seems to be highly active from the start of a SARS-CoV-2 infection.

Here, we are heading into a field that is not yet fully investigated. We at SAJO are specializing in this field. To us, this was THE question bugging us since the year 2000. HIV as a virus, a model virus, is the best-known virus. This is where virology is most advanced. The US had invested heavily in its research. We know this virus inside out. The big question, of how it interacts with the immune system, is the one we were asking at the beginning of the millennium. There won’t be a vaccine against HIV, it just does not work with the classical approaches. This is why we went to the US in 2000, joining the National Institutes of Health, to answer some of these questions. We had to realize that this topic will keep us busy for the rest of our lives.

VIRAL EVOLUTION

SARS-CoV-2 has taught us that the pressure resulting from infection numbers, people’s behavior, and vaccination rate is enabling the virus to mutate. On the one hand, viruses are piggybacked from one place to the other, while on the other hand there is convergent evolution in several places around the world. This is a matter of great concern. To scientists this is a great example of EVOLUTION and the impact of selective pressure upon a pathogen. We are watching viral evolution in the making – at fast-forward.

Our advice to keep up the protective measures is still valid, for summer, fall, and winter, into the year 2022: Keep a distance, wear N95-masks whenever being too close to each other, and all the time when inside buildings. Rooms need to have constant air exchange. In summer, doors and windows may be open all the time.

The RECEPTOR ACE2 the virus uses to enter cells, is a UBIQUITOUS one, thus it is present in many ANIMALS as well. This is enabling the virus to infect numerous organisms. And, it is enabling the virus to infect many organs, such as the blood and nervous systems, including the brain. Animal vaccines are being developed. We want to make clear that this virus is also infecting cats and dogs. Infected animals and humans are shedding the virus through feces, very early after infection.

ENTERTAINMENT: Politics in times of elections and a pandemic

Since politics is following its own rules, we are dedicating an extra paragraph to it. It is difficult to scientifically justify a lot of political decisions. Maybe this is a matter for an “entertainment index”. Here we describe a couple of roses, in dark and in bright color.

Many of us would like to experience this SUMMER as good as possible. Including us. Last week, our regional news outlet pointed out all the ACTIVITIES that are ALLOWED combined to the respective incident rates. We were surprised, since below the politically motivated number of 35 everything is possible, even without negative tests. It was not described however how to get a negative test and for how long such a result is valid. Politics is reaching the country-wide incidence rate of 35, on time. It is a bad sign by politicians – just as last summer – to call for a fun summertime, sneakily lifting the measures. We recall that it was almost impossible to tell people that the pandemic might come back in the fall of 2020, in a wave way bigger than the one in spring 2020. Politicians are repeating the same mistakes. In the end, people will pay the price, which is avoidable. Please, even in summer, keep up the measures. In the outdoors with a 6 ft. distance, you don’t need a face mask. In other situations, however, this is a necessity. Our politicians seem to be resistant to a learning process, although they had sworn an oath to protect the people. The pandemic is a long-distance-run. Our goal should be to get there with as little harm as possible.

Flexibility and CREATIVITY were in demand last year to hedge the pandemic. There is a lot of creativity in Germany, indeed. Test centers are being financed that show a fanciful way of accounting. There are loads of forged vaccination passports, and troves of fake N95-masks made in China. Pharmacies are flooded with flat rates for masks, irrespective of the purchase price. The German Robert-Koch-Institute’s calculation of the 7-day incidence is based on a “frozen” number of cases, not including any late reporting. The Robert-Koch Institute (RKI) is under ministry of health and thus, political guidance. Reported case numbers in Germany are dropping at a surprisingly steady pace, unlike in other countries. There is no lack in creativity, in the wrong area, however.

Welcome to an election year: BLAMING and discrediting among parties do not go well with the public. During this pandemic, nature has forced upon us, we are observing a disconnection of politicians with the important issues, even a loss of contact to the people. To us, this is concerning.

Maybe the call for resignation is no longer en vogue, since MISBEHAVIOR seems to be ok in politics. Just as the holding of a position – with lots of responsibility – by persons without any expertise. In the course of the pandemic, we could observe a lot of panic reactions by the Berlin government, due to the pressure and the situation. Mistakes have been made. We recall a proverb, that there are no mistakes to be made if nothing is being done. There we are. It is not necessary to retaliate, for example towards Mr. Spahn. But there is one wish: Learn from the mistakes. They must not be repeated. Try and improve each day. Remember, Germany is among the countries faring worst in this pandemic.

Journalists of the Süddeutsche Zeitung had uncovered a booking scandal with TEST CENTERS, which is also having an impact on the official case numbers. We could not even think about the idea to have people taking swabs after watching a 1-hour video. People without any knowledge of hygiene or sterile working procedures. Politics has refused to give self-testing a chance. What exactly is the difference? We, educated virologists, should LET A LAY PERSON TAKE A SWAB? This needs improvement. It is an indication of disrespect towards the personnel with medical know-how, such as medics, technicians, nurses, caretakers, pharmacists and other professions dealing with hygiene. We won’t let a lay person take a swab. Tests performed by ourselves we trust.

This leads us to another area of DISRESPECT BY POLITICIANS, the one regarding doctorates. We think that any doctorate that is not being earned in full time over a period of several years, but rather in part-time, is not a doctorate at all. In natural sciences, a Ph.D. is being earned in full time over at least three years – in many cases even longer. The way politicians are dealing with doctorates is showing a disrespect for all those doctorates that have been earned through hard work. It is denigrating this degree. A doctorate that has been acquired through fake, plagiarism, or simply by a money transfer is no foundation of a career. Punishment should not only be imposed on the student, but also on the faculty members who supported him/her. In German politics this is a growing problem. Ms. Giffey made a point here. Give back the degree and go on with another office, with responsibility – a role model? It is a matter of character. We personally CANNOT trust liars.

Finally, we want to point out that it is you who are having it in your hands how the pandemic will proceed. It is your behavior that counts. Reports from politics, the german Robert-Koch-Institute, and the Ministry of Health are giving mixed messages.

In the end it is just like in a Western movie: You are facing the virus with your health. This moment will come. Once you know that, you may get prepared and protect yourself – across summer, for fall is coming. The question is just, how it will come.

Yours, Sabine and Jörg

SAJO is consulting all around infectious diseases. We are applying our know-how, that we have acquired in more than 20 years. We do what we can to fight this pandemic.

SAJO – for a healthy world and better future!

This is post No. 180. To our delight our blog is receiving a lot of acceptance, we love to share our know-how and experience. Single posts and contents are being adopted by others, also in media. We have learned how to correctly make a citation; this we would wish from others in return as well. Please feel free to share the link – it is an informative tool to fight this pandemic.

(Note: We are no members of political parties, religious congregations, or societies. We value independence, sovereignty, and freedom. With our blog we are providing purely scientific advice, without conflict of interest, altruistic. We are not being paid for it.)

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