COVID – winter of discontent?

It’s a strange winter already. I have a pear tree that has flowered in late October, a wasps nest that seems, in mid November, to be busier than ever, and plants still flowering that should have been in the compost heap long ago. During the November heatwave I was gardening in a T shirt and await a frost more in hope than expectation. Winters should not be so easy, or weird.

I also have memories of many winters past with waiting rooms and hospital wards packed with the those suffering from acute infections. Given our health system is by many metrics is falling way short of its potential to save lives, treat or prevent illness, (in other words, failing) this winter will be worse still for of my former colleagues and patients with (fingers crossed I’m wrong) further COVID waves almost certain and, if the southern hemisphere is anything to go by, a more severe dose of seasonal influenza on the way to boot.

So what to do?

Stay well of course. Do all those things that improve health, and less of the things that destroy it. Yet, the mantra of the wellness industry sometimes falls a little flat when so many determinants of health are being driven in the wrong direction and are beyond the reach of huge swathes of society.

I have always been a keen proponent of healthy living and remain so, yet have to admit that population health has not greatly improved in this age of information and knowledge, leaving millions vulnerable to whatever risks are built into our polluted, unequal, fragile, and creaking society. This is not helped by a the torrent of misinformation and outright nonsense which inform not only discourse on the pandemic, but also voting patterns around the globe. COVID has exposed our failings and till we arrive at that ever receding wellness utopia, vaccination remains an important, life saving response.

Heading towards the third year of the pandemic, COVID is forever changing and vaccination is now focused now on a smaller group of at risk people. I for one will be having a booster. Why? One reason is the embarrassment I would feel if I turned up at my GP or A+E department with COVID symptoms without having being vaccinated. More objectively, a recent energy sapping protracted LFT negative cough was another reminder of the effect of age on how we respond to and recover from infection more slowly. More objectively still is the overwhelming evidence that for me, a vaccination carries way less risk than the infection. So I will be having a booster; and the bivalent vaccine makes sense. At 67 the benefits of avoiding or reducing illness in increasing.

Given that even mild COVID infection causes an increase in heart problems for at least a year, it stands to reason that anyone at increase risk of heart disease would be well advised to consider boosting this winter and indeed, continue boosting until longer term vaccines become available or the virus mutates into something less harmful than Omicron and its many sub-varieties.

For many others who are in the younger age groups and not at risk, have already had vaccination or infection (ie almost everyone) the booster will probably not be offered or taken up, and that is also easy.

So for many people boosting is a simple decision.

As ever, there will be others who will make their minds up due to social media amplifying professionally created scams about vaccines, and trivialising the risks of infection. Not for the first time, anti-vaccination organisations have been busy elevating mere opinion into fact, lies into biblical truths and seek to undermine science at every attempt. So let’s have a look at a couple of recent internet ‘outrages’ on which decisions certainly should not be made.

Do COVID vaccinations cause heart disease?

Very rarely. I have touched on this before after a poorly conducted and suspicious abstract from the USA claimed that markers of risk of future heart problems were increased from 11 to 25% after the Pfizer vaccine. The significance of the markers are dubious to say the least and the author had a glaring conflict of interest – running a cardiac clinic offering services to predict heart disease to those who can afford it.

There are lots of issues with the methodology and the power of the predictions in any case, so the paper didn’t make much of a ripple until it was picked up be celebrity doctors and sensationalist media outlets like Mercola and more lately, the right wing “anti woke” (presumably pro-sleep) GB News, who according to the Press Gazette, is viewed by about 250,000 people a week.

The immediate conflict of interest of the media outlets themselves is the first thing to note. Any sensible analysis of the dubious findings would hardly make a headline. The main story is indeed how such crap spreads so far. Like so much social media coverage, GB news and others look to harness and manipulate outrage – the invented, so called ‘global scandal’ that the vaccine is causing death is news, that it is quietly saving lives, sadly, is not.

So the ultimate conflict of interest is being the purveyor of newsworthy sensation. Even appearing on outlets like GB news is a conflict because to be there you have to create outrage with Neil Oliver most notable, but there others on that gravy train. For example, Dr Aseem Malhotra was previously a well respected campaigner for a healthier diet, but has in my and others opinion, gone seriously overboard in amplifying the weak and unsupported claims in this paper.

Celebrity doctors can dig themselves into holes which soon become too deep to escape from and of course, the ‘Woozle effect’ kicks in, amplified by anti vaccination businesses and sensation seeking social media and thus leading millions to believe something that is just not supported by any rational analysis.

If you are worried about heart disease, and many should be, it makes sense to get vaccinated.

Excess deaths

Much has also been made about the recent increase in excess deaths which some try to pin on vaccines. Polished websites as well as Mercola have gone big on this in an effort to get people to see that the vaccination campaign is, at its extreme, an effort to depopulate the planet, make money for drug companies (mixing fair points with fantasy is a technique) and generally doing everything they can to make believe public health agencies are there to persecute them.

When this is taken into account, 2022 year-to-date deaths are generally lower than all other years since 2001, see here for further analysis

Inevitably, Mercola leads the way. It’s interesting how he has changed his website so you cant look at previous nonsense such as his opposition to HPV vaccine for teenagers which is now preventing thousands of deaths from cervical cancer. (At least without paying $50 a year). Looking back, the antivaccine rhetoric was just the same as with the COVID vaccines, even more blatantly wrong, and just as likely to cause harm. Right now death from cervical cancer is almost totally avoidable, unless you are taken in by antivaccine rhetoric.

What will lawyers make of a woman with an invasive cervical cancer suing Mercola and others for their terrible advice to avoid reducing their risk of HPV infection and thus risk of cervical cancer by 90%?

Back to the excess deaths. Using logic and the data the whole thing is a lot less sensational if equally unsettling. There are many other reasons for this sad uptick, in particular and tragically unsurprisingly, that COVID19 infection leads to problems with the circulation and heart for many months way after the acute infection is over. In a way, this means that Long Covid, already a big problem, has a very sharp end which reveals itself in death statistics.

Antivaccine dogma seem intent on ignoring the multifaceted problems we face which are also having an impact. Heatwaves, increasing wealth and poverty, a failing health sector, increasing housing and energy costs, the reducing prospects for the young, increasing alcohol use, the need for cheap food, to name but a few. I rest my case.

Vitamin D again.

Im always interested in Vitamin D, not least as Ive been taking it for years, as anyone with MS should – for us it makes sense in many ways. There is debate as to whether lack of Vitamin D is more a marker of wider risk as it is reduced in many illnesses and lower in those who are housebound or immobile. In other words, those with lower levels are more likely to get COVID for other reasons. A recent RCT called the CORONAVIT trial was a disappointing in that it showed no benefit from Vitamin D supplementation for those with low levels when it came to risk of infection.

Another showed that supplementation failed to reduce the risk of heart disease or cancer. It did however, show that Vitamin D supplements did reduce the risk of auto-immune disease by 22%. I’ll continue to take it on this basis alone.

Now a retrospective study of veterans in the US has revealed an association between taking Vitamin D and reductions in risk of infection with Sars-Cov2 by 20-28% and a 30% lower risk of dying of COVID19. The word association is really important, because that is what the study shows.

Too much can be made of this. The study acknowledges in its important limitations section that those taking Vitamin D supplements might be more interested in their own health and thus more likely to be healthier than those who didn’t which is a big confounder and there are plenty of others.

I have looked at this before and still think Vitamin D is no panacea. Supplementation makes sense for those who live an indoor life, those with dark skin in temperate climates, those with or with a family history of auto-immune condition amongst others – this will include a big chunk of the population. The inverse care law apples and those who need them most will be the least likely to take them. What it certain is that it cannot replace the need for vaccination or anti virals for those who need them.

Unfortunate too is that those who are opposed to vaccination will manipulate the study as proving that a another simple ‘natural’ cure which is suppressed by nefarious public health organisations, Big Pharma and governments can cure COVID19. The truth is actually a lot more nuanced and interesting.

Predicting severe COVID

It has been clear from the onset of the pandemic that some people are more at risk than others. Much of this is explained by risk factors such as age, diabetes, high blood pressure, obesity and pre-existing lung disease, but not all. It would be so helpful to have a way of determining our own risk so that antivirals and vaccinations could be prioritised for those who need them most.

This study hints at one possibility – a certain gene which has been noted to affect how cancers spread has also been shown in animal studies to affect severity of COVID19. By looking at the gene in the blood of UK Biobank members and their risk of COVID the researchers found there is a link between certain types of the a gene called apolioprotein E (APOE) gene and not only severity of COVID, but also its neurological complications and indeed, development of Alzheimers disease. The gene associated with severity of COVID is present in 3% of the population, in other words 240 million people worldwide.

It’s a cheap and easy test and is now set for larger studies to explore this interesting link and its predictive possibilities. That is really important as there is a plethora of interesting findings in small studies which fail when looked at in more powerful studies and are then consigned to history. Yet the ability to pick out and protect those most vulnerable to COVID would save life, suffering and expense. That would be wonderful.

In the meantime, COVID boosters this winter will be a personal choice based on a balance of reason and emotion, the former driven by science and the latter too frequently driven by the outrage which is the staple diet of so much online misinformation, a phenomenon which will not be going away any time soon.

Thanks for getting this far with the blog. If you have any comments of questions then do leave them in the box below and I’ll get back to you as soon as I can.

Have a good winter!