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‘Forever Plague’: Nikiforuk Responds to Critics

On Monday The Tyee writer published a detailed caution against COVID minimizing that went viral and sparked fierce debate. Here’s his response.

Andrew Nikiforuk 8 Jul

Tyee contributing editor Andrew Nikiforuk is an award-winning journalist whose books and articles focus on epidemics, the energy industry, nature and more.

As a journalist my job is not to sugar-coat reality, cheerlead for the status quo or defend the powerful. My responsibility is to put emerging trends on everyone’s radar particularly during a novel pandemic that disproportionately affects the poor.

My latest article on COVID — “Get Ready for the Forever Plague: Public health officials’ COVID complacency has opened the door to new illnesses and devastating long-term damage” — did just that.

It warned people that variants of Omicron are evolving at record speed. Moreover these new variants are experts at immune evasion and rapid transmission.

My article added that reinfections are a rising phenomenon and changing in scale. It warned that reinfections come with higher risks of worst health outcomes. It added that our vaccines, so far, are waning in the protection they provide against infection.

And it warned that infection, whether producing symptoms mild or severe, can destabilize the immune system.

The piece ended by reminding readers that our best protections remain N95 masks, avoiding crowds, improved ventilation and filtration of the air (the virus is airborne), testing, tracing and transparent data collection and reporting. I added that vaccines are critically important but they can’t stop the pandemic alone without the layered support of other public health measures such as masks and better ventilation.

But many jurisdictions throughout North America have abandoned or minimized these important tools. Many have all but given up on fighting the COVID fire through public health measures beyond providing vaccines. Unfortunately, personal responsibility is not an effective substitute for shared action during a pandemic.

What I thought was a basic heads-up about the next wave, unexpectedly struck a nerve. The story went as viral as an Omicron subvariant. It sparked enormous and often rancorous debate in social media. Some praised the piece for outlining new risks and for not minimizing the threat of COVID.

Others disagreed. They denounced the article as scaremongering and inaccurate. Slate magazine, for example, trashed the article yet postulated: “The 'Forever Plague' article resonated with many because it successfully conveyed the urgency of the pandemic when the zeitgeist is maddeningly blasé.”

The article’s popularity probably does reflect growing concerns about the evolution of the pandemic and conflicting narratives about how to deal with it. Minimizers say we don’t have anything to worry about. Realists, like myself, beg to differ.

I want to emphasize that people, scientists, journalists and medical doctors, can look at the available data and reach different conclusions.

The appropriate response is not to be dismissive or attack or call the work lies, but to critique and offer an alternative analysis.

COVID has, for some reason, created a situation where any deviation from the official public health view brings a response that seems intended to silence those advocating for appropriate health protections.

Angela Rasmussen, a well-known virologist, particularly took umbrage with the article even though she agreed with many of its central points. Typical of many detractors she characterized the piece as “hyperbolic” and poorly sourced. She also accused me of “doomsaying.” Clearly, she did not like the tone or the wording.

Organ damage

Okay. Let’s parse some important points raised by Rasmussen, Slate and others. The virologist began by claiming that it is hyperbole to say COVID can “wreak havoc” on any organ in the body. “Virologists would say this virus has broad tissue tropism. SARS-CoV-2 does. It infects many tissues,” tweeted the virologist.

Rasmussen then pointed out an obvious mistake. A link in my article meant for a reference to evolving variants was mistakenly attached to “wreak havoc.” She correctly wondered where the supporting evidence for “wreak havoc” went. The Tyee made an error, and we stand corrected. We’ve also changed the phrase “any organ in the body” to “vital organs in the body” to be more precise.

So here are a few links on the multi-organ havoc COVID can do: A recent Scottish study found “persistent multisystem abnormalities” among 159 COVID patients released from hospital. These abnormalities included “cardio-renal inflammation, diminished lung function” and other poor outcomes.

Even mild COVID is linked to brain damage. And yes, even mild COVID can increase the risk of heart problems or lasting damage to airways.

For a longer discussion of “broad tissue tropism” or organ havoc I’d recommend this Science article.

Rasmussen then claims that I said there’s “a growing body of science” showing “reinfections are going to kill us all with multiple organ failure.” That’s hyperbole and I never wrote that. I did say that infections and reinfections will increase the number of people suffering from poor health outcomes including long COVID. If you are going to seriously criticize a writer for hyperbole, it’s probably best to refrain from the practice yourself.

Immunity and reinfection

Rasmussen, like many critics, then professed ignorance about experts downplaying COVID infections as inevitable and even beneficial. Skeptical critics implied there was no evidence of this. Let me provide two links to articles in the Wall Street Journal representing this kind of harmful thinking. One article promised a good chance of herd immunity by April.

Another said taking measures to speed the spread of Omicron would produce the best long term outcomes.

Now let’s deal with various issues concerning immunity and reinfection. Slate magazine claimed my article was full of untruths. It said that it is not true that COVID infection can destabilize and age your immune system. It said it is not true that new infections don’t confer immunity. And it also contested my statement that “it is now possible to be reinfected with one of Omicron’s variants every two to three weeks.”

Here’s why I wrote what I did.

In 2021 the researcher Niharika Duggal of the University of Birmingham reported at a conference that COVID patients discharged from hospital showed “the age-related decline in the body's ability to form a defence against viruses and other illnesses.” The New Scientist, too, wrote about premature immune system aging in COVID patients.

A study published in March concluded that COVID infection “may lead to T-cell dysfunction, depletion and eventually lymphopenia in patients.” In plain English an infection can cause direct damage to the immune system.

The immunologist Anthony Leonardi has long argued these points. He thinks that the virus is well designed to serially challenge and insidiously age the immune system. Here is an excellent interview with him.

Leonardi, by the way, was one of the first researchers to theorize that one COVID infection could make individuals more susceptible to bad outcomes from a second infection — due to immune dysregulation. As with many emerging parts of the COVID puzzle, a lot of health experts found this idea unpalatable and dumped on Leonardi the same way they have now dumped on The Tyee.

Yet important new research, which my article highlighted, compared people with reinfections to those with one infection. Reinfections doubled all-cause mortality and adverse heart and lung troubles. They also increased the risk of hospitalization three fold.

Eric Topol, a reliable U.S. physician and science writer, noted another worrying finding: “with additional episodes of COVID, for every outcome there was a stepwise increased risk.”

So Leonardi has been more right than wrong. Slate just might want to profile this very credible and controversial scientist and ask what he is seeing that so many others are ignoring.

Pace of reinfection

Now let’s deal with the contentious subject of repeated reinfections over short periods of time. For some reason this issue bugged a lot of critics.

Remember, I wrote that “it is now possible to be reinfected with one of Omicron’s variants every two to three weeks.” Slate, however, committed its own hyperbole on the matter by saying that “A viral article paints a picture where we’re constantly sick.” That’s not what I said. I merely warned that it was a distinct possibility for some of us if we don’t stop transmission. I didn’t say it was our reality yet or that at any point all of us would be constantly sick with COVID.

So what is the reality?

Last April the U.S. Centers for Disease Control and Prevention issued a field report on reinfections. It documented ten cases of reinfection — all during the Omicron wave — the majority among children and health-care workers. The shortest interval between one infection and a subsequent reinfection with a different lineage of COVID was 23 days — hence the basis for my sentence.

The researchers added that “antigen tests are increasingly performed at home, resulting in specimens being unavailable for strain testing. Thus, most early reinfections are likely not identified.” So the actual numbers of people having reinfections within 30 or 90 days is unknown but probably much greater than what the CDC picked up. (It is important to note that reinfections may also represent relapses whereby persistent infections reappear.)

The CDC isn’t the only group that has reported on reinfection intervals. The European Congress of Clinical Microbiology and Infectious Diseases recently reported on a case of a fully vaccinated Spanish health-care worker who caught Delta. Twenty days later she was reinfected with Omicron. The congress ended its account with this advisory:

“This case highlights the potential of the Omicron variant to evade the previous immunity acquired either from a natural infection with other variants or from vaccines. In other words, people who have had COVID-19 cannot assume they are protected against reinfection, even if they have been fully vaccinated.”

Given this evidence and anecdotal reports from health-care workers with a history of reinfections, public health authorities should be keeping a registry of reinfections and tracking the biological consequences over time.

Alright. Let’s fast forward to the reality in Australia where two Omicron variants BA4 and BA5 are raging. Here’s what Andrew Robertson, Western Australia’s chief medical officer of health, recently said to citizens about reinfections.

“What we are seeing is an increasing number of people who have been infected with BA2 and then becoming infected (again) after four weeks,” he said. “So maybe six to eight weeks (later) they are developing a second infection and that’s almost certainly either BA4 or BA5.”

And now the Australian Health Protection Principal Committee has announced that it has reduced reinfection intervals from 12 weeks to 28 days.

The San Francisco Chronicle just reported that so called “hybrid immunity” (vaccine combined with previous infection) isn’t working either. “Vaccinated and boosted people who were infected as recently as January’s Omicron surge are finding themselves testing positive for the coronavirus a second or even third time.” And so on.

A recent New York Times piece looked at reinfection data from South Africa (it is a big issue there) and speculated about the future as I did in my piece.

The article quoted Kristian Andersen, a virologist at the Scripps Research Institute in San Diego. He made this statement: “If we manage it [the pandemic] the way that we manage it now, then most people will get infected with it at least a couple of times a year. I would be very surprised if that’s not how it’s going to play out.” So I don’t think I was scaremongering. A more apt characterization of my intent would be the urging, in the strongest terms, that public health officials and citizens employ the precautionary principle in the face of fast evolving and highly contagious variants.

Reinfections are happening everywhere and will lead to more cases of long COVID. Robert Wachter, a medical professor at the University of California recently noted in the Washington Post that “the best-protected person still likely has at least a 1-in-20 chance of lingering symptoms” if they get infected.

The truth is this: infections are not giving us reliable protection against reinfections and our immune system is worse off. Even the World Health Organization warned about this possibility in 2020. With few public health measures at play, society has chosen a path of long-standing vulnerability to this virus and its variants.

Last month a really important study published in the journal Science shed more light on this critical issue. It warned that Omicron variants were poor boosters of immunity against future infection.

Rosemary Boyton, an immunologist at the Imperial College London, found that “Getting infected with Omicron does not provide a potent boost to immunity against reinfection with Omicron in the future." Indeed, even the triple-vaccinated “had 20 times less neutralizing antibody response against Omicron than against the initial 'Wuhan' strain.”

When experts talk about “immunity” from COVID infections people assume they have some kind of lasting protection and shield from further harm. Boyton’s work indicates that would not be the case.

In this uncivil age of reckless tweeting, I hope nobody accused Boyton of scaremongering or hyperbole. I strongly recommend that concerned citizens listen to her careful account of the Science findings to an independent science advisory group in England last week. It is sobering.

British immunologist Danny Altmann added another important point. Not only can Omicron "break through vaccine defences, it looks to leave very few of the hallmarks we’d expect on the immune system — it’s more stealthy than previous variants and flies under the radar, so the immune system is unable to remember it.”

And that’s why I bluntly wrote in my piece that new infections confer no immunity. But to be accurate (and avoid semantic disputes) I should have said that new infections confer so little immunity — because the immune system is unable to remember them — that we must seek every other protection available. The Tyee has made that correction to the original story.

Charges of 'fear mongering'

Lastly, many critics disparaged the article as fear mongering and doomsaying. Some even called for its removal. I, and The Tyee's editors, strongly disagree. Unlike many of our public health officials the article pointedly communicated new research as well as growing concern about the evolution of this pandemic and its complexity.

As such the article (like some responsible health experts) challenged wishfully optimistic narratives among the status quo.

Many officials have minimized Omicron as “mild” and forecast that “harmless endemicity” will arrive any day or is here now. They also promised widespread immunity, hybrid immunity and herd immunity. They claimed the variants would evolve to a benign state. Reinfections and immune evading variants have punched big holes in this narrative. The idea that there is some benefit from getting infected has now been shown to be false. And now "the worst variant" has arrived.

Downplaying the pandemic is not recipe for ending it but compounding it.

Yaneer Bar-Yam, a complexity expert and founder of World Health Network, has long warned about the trajectory of the pandemic and the need to reduce transmission with a combination of tools including widespread testing. Bar-Yam recognizes that complex things like pandemics often lead to unforeseen and non-linear outcomes.

He, too, has rejected the notion that future variants will be kinder and milder.

“In the context of uncertainty, you really want to act according to things that might hurt you the most rather than the things that might turn out for the best,” Bar-Yam noted in a 2021 interview. “If you’re walking along a cliff that might crumble, you change your course. You don’t continue along the cliff edge saying ‘Well, it might not crumble.’ But that’s exactly what we’re doing.”

The great novelist Albert Camus observed in The Plague that a doctor’s job during a pandemic is difficult. It is not glorious or biased towards optimism. It “is a matter of lucidly recognizing what had to be recognized; of dispelling extraneous shadows and doing what needed to be done.”

That too is a reporter’s job, and what I will continue doing here at The Tyee.  [Tyee]

Read more: Coronavirus, Media

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