The Path Forward on COVID-19 Immunizations,

WM, Health,  The Path Forward on COVID-19 Immunizations, February 26, 2021 

As I write these comments, the reported cases and deaths are dropping rapidly. The question of the day is whether there will be a fourth wave, even as deaths are edging closer to half a million. This is 100,000 more than I predicted last year. If there is a fourth wave, expect another 100,000 deaths in those states with below 180 deaths per 100,00. 

California is one of those states. We should know shortly.

It could also be that deaths are underreported. The new variant, which likely first emerged in the Midwest rather than the United Kingdom, may not be as lethal. If that is the case, more people are getting sick and getting well without medical attetion

The natural history of the virus is still not understood by the Center for Disease Control. As I have been repeating as a virus survivor myself, the disease begins with what is confused with seasonal allergies or colds. The distinguishing feature is very heavy mucous. The notorious asymptotic spread follows these symptoms and lasts a week. Then symptoms return. 

Some get seriously ill, but because their symptoms ended, they believe that they can ride them out. Given the news coverage of serious cases, no one wants to believe they have a fatal disease. Often, these patients wait until it is too late to get treatment. These cases often lead to poor outcomes. Those who do survive have a long period of recovery, from being out of breath to general weakness as the body generates anti-bodies.

Most get moderately ill. Those who do are getting younger in the second and third waves. Moderate illness is marked by more manageable respiratory symptoms. Indeed, those who have had asthma know exactly how to respond and probably have the medicines to do so. This was my experience in March of last year. 

The main feature of moderate illness is serious fatigue for the first week and manageable fatigue the second. At the end of this period, the mucous build-up wants up. This is not pleasant, but can be treated by drugs with guaifenesin, such as Mucinex and Robitussin. Young people who were spared in the first wave are not escaping now.

Recent studies have shown that those who have had the disease (not simply those who tested positive for COVID) retain immunity for a longer period of time. In other words, even if their measurable antibodies are undetectable, they have memory cells that turn the next infection into a cold. 

In July, I tested positive (testing was not widely available in March) and had a cold with minor chest congestion. Of course, feeling such congestion never feels mild.

What does this have to do with vaccinations. Simply put, those who have had moderate or severe infections probably do not need to be vaccinated. This leaves plenty for those who have not, especially in areas which have not been hit as hard to date. 

Like California.

If there is no fourth wave in the next month, former President Trump may have been right. The virus will have disappeared, almost like magic. That magic has come at the cost of a half a million dead Americans. 

While I am no fan of the foreign president and believe his future is not bright, these deaths have more to do with the CDC and the medical community following the party line rather than investigating the natural history of the virus in depth. Dying patients are not in the position to give a good medical history. 

What should be done with the large number of surplus doses? Many countries, particularly in the global south, have not yet gotten sick or had our death rates. Cold and flu season is coming to that part of the world. Sending them our excess supply will save millions of lives.

The Bill and Melinda Gates Foundation is good at this kind of thing. I suggest you call them.