September 1, 2020

It was the best of times, it was the worst of times. Somebody else once used that as the opening of their story and it struck me as being the perfect opening of this installment of The Accidental Plague Diaries. I don’t know about anyone else but I keep being whipsawed back and forth between extreme highs and lows with what’s going on in the world today. Something happens to make me think I still live in a country full of generous and compassionate people and then something else comes along an hour later which makes me feel like Thomas Hobbes was not only right, but he’s also busy directing events from the next world. The truth is, as always, somewhere in the middle of extremes but it’s not always easy to see when your brain is being asked to absorb far more than it has the capacity to parse on a daily basis.

On the good news front is a news story out of Tuscaloosa where there was a Black Lives Matter march. BLM marches aren’t uncommon these days (I’ve been in a few myself as I strongly support the concept of racial equity and reassessing social structures that prevent it from happening) but what made this one special is the figure spearheading the march, Alabama football coach Nick Saban. Those not of Alabama may not get the import of that image, but college football is a religion in these parts and Saban is a major deity in the pantheon, ranking only slightly below the legendary Bear Bryant (and a couple of more national championships in the bag and he’ll likely dethrone Bryant from the peak of Olympus). I spend a lot of time in small town and rural Alabama due to the part of my job that runs through the VA where I am medical director for their rural house call program. University of Alabama football fandom is one of the few things that’s common to pretty much every household I enter, no matter where it may fall on the socio-economic scale and what political beliefs the inhabitants may hold. The fervency with which they follow the Crimson Tide is usually inversely proportional to the actual likelihood of having ever attended an institution of higher learning. The sight of this divine being, praised by rural Alabama culture, not just supporting, but leading a group disdained by rural Alabama culture (thanks to a steady diet of Fox News) has set up an enormous cognitive dissonance. It will be interesting to see how it actually plays out. I can’t think of a better way to get the people of this region to actually start considering what BLM actually stands for and means.

Moving on from a high to a low… I have a number of friends on the opposite side of the political spectrum from myself and I make it a point to read things written by people of widely divergent views. I swore off televised news years ago but I try to read a good deal of political news and commentary and try to find the nuggets of fact and truth within the spin. Monday I was greeted by a few of my more conservative friends passing around the ridiculous idea that only 6% of Covid-19 deaths were actually due to Covid-19. In tracking down where that insane idea had come from, I found that it was a gross misinterpretation of some data published by the CDC where they stated that only 6% of the death certificates filed had Covid-19 as the sole cause of death. All the others mentioned things like respiratory failure, heart disease, etc. etc. The people promulgating this idea that those 94% of death certificates are part of some sort of grand conspiracy theory don’t know how death certificates actually work. If the certifying physician is doing them correctly, there should almost always be several contributing causes of death and often a cascade of events documented that leads to death. Very few natural cause deaths are completely cut and dried. Rejecting death certificates with other causes would be akin to saying that someone who was involved in a serious car crash, and died later at the hospital of cardiac arrest solely died of cardiac disease and that the accident had nothing to do with the death. Most of realize that this is a) ridiculous and b) would prevent us from getting good public health data on motor vehicle accidents that can be used to keep us all safer. The need of a certain segment of the population to continue to deny the pandemic for political and economic reasons of their own drives me mad. And in the end, you can believe what you want, but the virus will remain the virus, do what the virus does, and all your philosophical arguments will come to naught for the virus doesn’t care.

I posted an article earlier today from a somewhat obscure source on some work done by a group using a supercomputer to sequence the genome of the virus and therefore reverse engineer what it’s actually up to. They came up with some rather surprising conclusions about how the virus is acting in relationship to the angiotensin renin system and the angiotensin converting enzyme (which seems to be how the virus attaches to human cells and infects them) suggesting that what is happening is an overproduction of the protein bradykinin, an inflammatory product and that this is what ultimately tends to cause the pathologies. If this is true, and there is a lot of work yet to do to prove or disprove this hypothesis, it may help come up with some better targeted therapies.
I’m not sure what to make of the reportage on vaccine development. The FDA and the CDC have been so heavily politicized in recent months that I don’t completely trust the information coming out of them and the FDA seems to be ready to approve anything that will ‘help more than it hurts’ whether there is sound science behind it or not. That strikes me as a recipe for either grand failure (after all, we could construe an injection of normal saline as helping more than it hurts) or utter disaster as something improperly tested is widely distributed and only later found to have a major negative effect. Given my reading of political tea leaves, the FDA is likely to release or at least announce a vaccine the last week of October, just as we head to the voting booths. Even if something is available, I have a feeling that there’s going to be some major distribution issues and I won’t be in the least bit surprised to start reading news stories of corruption and profiteering in the supply chain.

In the meantime, you know the drill. Wash your hands, wear your mask, stay out of crowds.