Physician Outlook

COVID-19 Pandemic A Rational Vaccine Plan

“A brief history of pandemics, the human endeavor for herd immunity, and a rational plan for vaccination for those at risk.”

2020 is the year medical history, morals, ethics and principles were overrun by politics and power, under the guise of public health policy. Koch’s postulates, principles of Lister, the history of chickenpox, all paved over by the rancor of social media. In order to move society back to normal, we must start by letting individuals be normal. In a time with so many power-hungry and political plans, we must rely on classic Hippocratic, allopathic, and osteopathic principles and practices that are time tested and proven true. 

Mankind has suffered the ignominy of plagues and scourges throughout history. The riddles of these illnesses take time to solve but eventually, the human mind resolves to save itself. Thousands of years ago, smallpox showed itself in the Egyptian Empire in the 3rd century BC - mummies were found with the variola pox. The spread was slow due to the low density of the population and infrequent travel. Smallpox claimed many famous lives including Britain’s 32 year old Queen Mary II and Benjamin Franklin’s 4 year old son. President Abraham Lincoln, after the 1863 Gettysburg Address, contracted smallpox and recovered after 4 weeks of illness. Not until Edward Jenner’s astute observation in 1796 was a vaccine discovered from the milkmaid’s cowpox sore that inoculated 8-year old James Phipps. This recorded the first documented triumph against the disease. On May 8, 1980, the 33rd World Health Assembly officially declared the world free of smallpox. This freedom from smallpox was predicated on the very low mutation rate of this poxvirus and the cowpox vaccine.

 Other scourges have followed including poliomyelitis that maimed President Franklin Delano Roosevelt and claimed many lives only to be tamed by the Salk vaccine. Although prior attempts in 1935 had disastrous results, not until 1941 was the success guaranteed. Other pandemics included measles that required the vaccination of children at a 92% level to achieve success. And we are now faced with COVID19 that has spread terror among the world population. The striking difference between other pandemics and this one, is the rancor, manifested from an unprecedented worldwide collusion between pseudoscience and political ambition. When history is written by non-partisan historians, this will be a tale of idiots, full of sound and fury, signifying nothing: In the scheme of things, a wretched offering from the crucible of time.

 Basic and proven concepts, such as herd immunity, are being redefined or ignored. Prior to the advent of vaccines, the actually infected survivors conferred immunity to themselves as well as to the others - the herd - by creating a firewall against the offending germ. With the advent of an efficacious vaccine, both the surviving infected individuals and the vaccinated ones serve to immunize the herd. Now the World Health Organization (WHO) seems to suggest on their website that only vaccine immunity exists, essentially erasing the long reasoned and understood herd immunity concept. 

Herd immunity was first recognized by A.W. Hedrich in the 1930s, who wrote about the measles epidemic in Baltimore, having found enclaves of children that were immune. The threshold of the herd immunity stems from the transmissibility and replication rate of the virus and is bracketed between 50%-90% of the populace. The 50% target is based on a low mutation rate of the virus and low contagiousness. The higher rates are based on the latter. For instance, the seasonal influenza virus has a high mutation rate but remains seasonal and is thwarted by vaccinating the vulnerable population, the very young and the very old. Even with public education, the seasonal flu takes countless lives in the thousands and at times if extremely virulent, even more.

Vaccines against the flu are predicated on the past season’s infection and have a 50% efficacy at best. Considering mumps, measles, and rubella which remain quiescent mostly because of the 91.7% vaccination rate of the 19 to 36-month-old children, since it mostly affected the young with sequelae lingering in the old. Even polio, a low mutation rate poxvirus, required 100 million Americans between 1962 and 1965  (roughly 56% of the population at that time) to receive the Sabin vaccine that allowed herd immunity to occur and thus the banishment of the virus from the US soil. This virus found in the digestive tract of humans had no predilection for age.

While the herd immunity threshold (HIT) varies with diseases, it is estimated at 33%-44% for influenza and 92%-95% for measles. The transmission, however, has always been due to the population density of the connected networks as evidenced by the COVID19 infection rate in the densely populated skyscrapers of New York City. The more closely packed dense networks suffer from rapid spread, while the opposite is true for thinly populated areas. Other countries offer us clues as to their herd immunity status and population density spreads, issues that are worth understanding.

The R0 (pronounced “R naught”) is considered to be a measure of the number of cases generated by a “typical” infectious person, which depends on how individuals within a network interact with each other. R0 is the lynchpin of the herd immunity threshold calculus. Herd immunity exerts an evolutionary pressure on the virus itself and causes the virus to evolve through a mutation that results in changeable epitope (surface protein/antigens) or antigenic drift. These antigenic drifts can and in many cases lend resistance to the vaccines. The HIT can be calculated based on the basic (viral) reproduction number or R0. A simple equation is Pc = 1- (1/R0) where Pc is the critical population at risk and R0 is the viral reproducible rate. So, an R0 of 2 will require a HIT of 50%. 

The scientists at the pulpit initially claimed that vaccines would be the panacea against COVID19. Unbeknownst to them, the “Operation Warp Speed” created an mRNA vaccine in record time. But as the vaccine was rolled out, the experts claimed that masks would still be necessary in spite of the vaccine as would the need for “social distancing.” With the purported 95% efficacy of the vaccine, one begins to wonder as to the motive behind those requirements. The vaccine itself has some unanswered questions. Some are being answered concurrently as only 6 anaphylactic reactions have occurred while over a million individuals have been vaccinated, and all 6 have safely resolved. Antibody-dependent enhancement (ADE), feared if reinfection occurs, is still a potential hypothesis. The incorporation of the mRNA as an intron into the human DNA also remains a theoretical possibility since this is the first mRNA vaccine approved for humans. Time will hash out these conundrums and potential longer-term side-effects.

 As of December 2020 we do not yet know the HIT for COVID19 because it is a novel virus that has been on the planet for only a year.  There is much left to discover and learn based on scientific evidence.  How then, should we approach the vaccination process?  The populace most vulnerable to COVID has always been the elderly >70 years of age with comorbid conditions, such as diabetes, obesity, hypertension, and those with suppressed immunity.

 Based on what we know today about the virus, the vaccine and herd immunity concepts, we should vaccinate the vulnerable first, followed by those younger but with comorbid conditions, and then those who willingly want to be vaccinated. Children have robust immune systems and thus need little in the way of vaccination, as they can eliminate the virus in a short span of a day or two without sequelae. There is also now proof of high false-positive rates in PCR testing based on high thermal cycle thresholds and a burgeoning proof of lack of transmission from asymptomatic individuals. Keeping all that in mind, a rational mind would use worthwhile strategies rather than fear-mongering and promoting a constant state of alarm for mandatory vaccinations for all. Schools should stay open and the powerful Teachers Unions should not dictate policy through lobbyists, and neither should the grifting wealthy billionaire crowd.

 When an eagle point of view is taken, one finds that the greed for the power of a few has trampled on the lives of the many. These few have manipulated a willing media and used them to their own ends. The vicious nature of the rhetoric and the anger directed at logical scientific skepticism has transformed into words like “deniers of the truth.” As if “truth” is only seen from a single point of view. What has unfolded during this COVID19 debacle is the lechery and grift of the rich and powerful, against the many. It is a sad testimony to human nature and human greed that flows in the veins of some. History is replete with such occurrences in the past. This pandemic and the response to it will also “go down” as another such “humans against humanity” episode in the chronicles of time signifying our turbulent past. 

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