(CNN) Johnson & Johnson pauses Covid-19 vaccine trial after ‘unexplained illness’.

The J&J vaccine is described here: Ad26.COV2-S (JNJ-78436735) Vaccine Description. Quoting,

The JNJ-78436735 vaccine leverages Janssen’s AdVac and PER.C6® technologies. These are the same technologies Janssen used to develop and manufacture the Company’s Ebola vaccine, Ad26.ZEBOV.

AD26 is the specific strain of adenovirus. Quoting from AdVac ,

ADVAC® VIRAL VECTOR TECHNOLOGY

Adenoviruses are a group of viruses that cause the common cold – so they’re good for transporting things into humans.

(The “goodness” of the above has insufficient support for mass vaccination.)

Janssen’s AdVac^® vectors are based on a specific type of adenovirus, which has been genetically modified so that it can no longer replicate in humans and cause disease.

While the details of manufacture are different, this shares the supposed “good idea” of the AstraZeneca and Russian vaccines, the use of a modified adenovirus to insert genetic material into cells at the injection site. The J&J vaccine now shares the distinction, with AstraZeneca, of trial halted by unexplained illness. See

• Why I Would Not Take the Russian or Oxford – AstraZeneca Vaccines – Part 2
• (CNN) AstraZeneca pauses coronavirus vaccine trial after unexplained illness in volunteer
• (CNN)NIH ‘very concerned’ about serious side effect in AstraZeneca coronavirus vaccine trial

With the halts of AstraZeneca and J&J trials, there is almost a pattern. An actual pattern is distinguished by one or both of:

• Frequency of occurrence.
• Specificity of syndrome.

 

 

We continue from COVID Second Wave; Of Hares and Foxes; Primer for Policy Makers, Part 4. The second question on our list is:

• What drives virulence, and what holds it back?

We noted that even though viruses don’t have brains, they appear to have intelligent strategies. It comes from randomness at the molecular level, resulting in mutations. We see only the successes.

Since a virus is very small and simple compared to a living cell, the possibilities of change, of becoming a “better virus”, have limits. The limits can be roughly estimated from the structure of the virus.  But more weight is given to “reputation”. For example,

• Baculoviruses infect insects, and are so specific that they typically  infect a single species of insect. Because they are made of double strand DNA, which is durable stuff, the chance for a baculovirus to find a new game is thought to be small.
• Pox viruses, which include smallpox, manage to mutate even though their structures should be stable.
• Different species of rhabdoviruses infect an incredible range: tomatoes, potatoes, and all kinds of vertebrate animals. The rabies virus is a rhabdovirus. These viruses are made of unstable RNA,  enabling rapid evolution. They have a highly adaptable plan, more so than a coronavirus.
• Adenoviruses, used in gene therapy and in some COVID vaccines, were thought to be stable for the same reason as baculoviruses. But because stability is critical., the assumption has been studied, and found to be unjustified, and possibly false. See Why I Would Not Take the Russian or Oxford – AstraZeneca Vaccines – Part 2, and (CNN) AstraZeneca pauses coronavirus vaccine trial after unexplained illness in volunteer.
• Rarely, radical mutation of viruses occurs. Could COVID become radically different, lose its trademark halo, become something radically different? When the measles virus infects the brain, it undergoes radical mutation. So all things are possible, but mostly rare. Our focus is on mutations that occur all the time.

SARS-CoV-2 is a single strand RNA coronavirus. The instability of RNA means it undergoes frequent mutation and recombination. Nothing in the natural history suggests coronaviruses are anywhere near as versatile as rhabdoviruses. But the way a coronavirus attacks a cell can, by rapid mutation, quickly change virulence.

The surface of a cell is studded with hormone receptors. Mimicking the angiotensin-2 hormone, COVID-19 attaches to and enters the cell via the angiotensin-2 receptor. When angiotensin-2 attaches to and/or enters some cells,  it causes blood vessels to constrict, blood volume to increase, and a bundle known as the fight-or-flight response, which may be why anomalous blood clotting is also observed.

It does not benefit COVID-19 to kill the patient. It uses the angiotensin-2 receptor without considering the consequences. But it may be found that the more strongly COVID mimics angiotensin-2, the more lethal it is. 

People with hypertension are at risk for severe COVID.  Hypertension is treated with angiotensin blockers. But as of 9/1, interrelationships of these factors is unknown:  (AJMC) Patients With COVID-19 Should Stay on ACE Inhibitors, ARBs, Study Finds.

What of infectivity, the ability to propagate from one infected person to another? It’s not a completely separate issue. Besides attachment to a cell, where it entangles with virulence, infectivity involves:

• Concentration. How much virus is present in exhaled air.
• Aerodynamics. how easily it forms an aerosol.
• Durability. How long it survives outside the body.
• Stealth. how obvious it is that a person is infectious.

These are 5 adjustments subject to random mutation. They are not likely to be independent, but the details will come in coming years.  We’ve done the groundwork for:

• What drives virulence, and what holds it back?

With 5 knobs twisted by random mutation, and the Houston Astrodome (see COVID Resurgent: Of Hares and Foxes; Primer for Policy Makers, Part 3), we’re poised to see Darwin’s Natural Selection in action.  See if you can get a skybox.

I’ll try and dig up Howard Cosell.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

We continue from COVID Resurgent: Of Hares and Foxes; Primer for Policy Makers, Part 3., which poses a list of questions.  With our Houston Astrodome experiment, we explored the natural balance between the predator (virus) and the prey (host, you.) We saw that in the extreme, mutual extinction could occur.  While this may have happened unobserved, the closest known example is a transmissible cancer that affects the Tasmanian Devil, an Australian marsupial.

The first question of our list is:

• How can a virus appear to have an intelligent strategy, when it isn’t even alive? Does Darwin’s theory of natural selection play a role?

If you think the mind has a monopoly on thinking, try to put this notion aside temporarily. When you think about a problem, you try to imagine all the ways it could turn out. At the level of atoms, molecules, viruses, and heredity, Nature tries combinations at incredible speed. The result appears thoughtful. Maybe it is.

So Nature rolls the dice constantly. The processes by which a virus or cell or any form of life reproduces has the chance of error. We call this error mutation.  The result of constantly occurring mutation is genetic diversity.

Genetic diversity is key to the survival of a species. Without it, the human species would already be extinct, killed off by something like COVID. This diversity prevents a virus from knowing its prey too well. It’s the difference between a burglar who has cased the joint, and one who hasn’t.

Genetic diversity saves us from one outcome of the Astrodome experiment. If the foxes are super-efficient at hunting rabbits, they kill off their food supply.  Both go extinct. But rabbits are wily and evasive. The foxes can’t catch all of them.

Genetic diversity is responsible for an axiom of infectious disease: No disease is 100% fatal. Rabies was thought to be. A few years ago, a young woman walked into a Texas hospital with rabies. With no specific treatment, she walked out three weeks later.

Likewise, if a virus did not mutate, the prey would develop universal immunity, so the virus would go extinct.  Mutation comes easily to RNA viruses like COVID, because RNA is fragile.  DNA is so tough you could make golf club shafts out of it. Yet mutation is so important, even DNA viruses roll the dice. (Science Daily) How poxviruses such as smallpox evolve rapidly, despite low mutation rates.

The viral mutations we see are the ones that enable one strain of COVID-19 to out-compete other strains; this is Darwin’s natural selection. Selection works on humans too, but we want to prevent it with medicine and public health policy.

We have addressed the first question of our list:  Even though they cannot think, viruses and immune systems have strategies that appear thoughtful.

The human race will survive COVID. But we want to prevent a Darwinian outcome.  And you’ve got some personal skin in the game.

Our next question: What drives virulence, and what holds it back?

 

 

 

 

With countless plaudits honoring the work of Ruth Bader Ginsburg, what can I add?

There is a folk expression to the effect that with every passing year, the personality is more deeply etched upon the face. By age 87, her personality was in clear display.

She was kindly, yet fiercely determined.

So many strivers are driven by  ambition. Hers was a calling, a vision of principles.

Like cellist Pablo Casals, who improved every year before he died,  Ruth Bader Ginsburg was born a mortal, and died a giant.

We need her still. Who will champion “Be all you can be”?

Although the opinions of a Supreme Court justice, even in dissent, tend to be monumental, I can’t think of her by other than her first name.

Thank you, Ruth.

Let’s see if we can find a smoking gun. To follow this, you need to read (CNN) AstraZeneca pauses coronavirus vaccine trial after unexplained illness in volunteer. Follow the links back.

(CNN) NIH ‘very concerned’ about serious side effect in AstraZeneca coronavirus vaccine trial. Quoting,

“The highest levels of NIH are very concerned,” said Dr. Avindra Nath, intramural clinical director and a leader of viral research at the National Institute for Neurological Disorders and Stroke, an NIH division. “Everyone’s hopes are on a vaccine, and if you have a major complication the whole thing could get derailed.”

The Oxford- Astrazeneca vaccine belongs to the most aggressively novel class of new vaccines: It transfects cells in the recipient with a vector, a carrier virus, to cause them to make COVID spike protein. For a COVID vaccine, transfection  means:

• Deliberate infection of cells near the injection site with an engineered virus, the vector.
• Transport of spike protein DNA into the cell.
• Modification of the cell machinery to make COVID spike protein.

The virus particles of the Astrazeneca vaccine are active micro-machines. This is not as radical as it sounds. Live-virus vaccines were the first devised. They are still used today. Some, such as the live virus polio vaccine, or yellow fever 17D, have known hazards. But in comparing with live virus vaccines of the past, there are meaningful differences:

• Trials were over a much longer period.
• Trials defined age groups, typically juvenile, when the immune system seems to handle well challenge with live virus.
• These vaccines contain large amounts of virus, easy for the immune system to spot, and weakened by multiple passages through nonhuman tissue, cold adaptation, or chemical degradation. This goes back to Pasteur.

There is no rigorous argument for why weakened live virus is usually safe, but it has 150 years behind it. AstraZeneca’s argument is weak, and they have about 3 months behind it.

Is the Astrazeneca event a random event or a smoking gun? Let’s see if we can smell smoke. Details of the event are important, not to establish fact, but possibly requiring the trial be halted.  Let’s begin with rabies, a virus with a stealth trick:

• Somebody gets bit in the deltoid muscle, where you would get the shot. Most immunizations inject into the deltoid muscle of the upper arm.
• Virus in the animal’s saliva incubates silently in muscle for weeks, months, or years. In perhaps 1/3 of bites, it evades the immune system.
• The deltoid muscle is served by the axillary nerve, which, combined with other nerves, exits the spine at the base of the neck. In the deltoid, the nerve has little bulbs, neuromuscular junctions.
• If the rabies virus has evaded the immune system, it breaks into the junctions. It then travels up the nerve, the spinal cord, and finally the brain, where it causes rapid death.

Besides rabies, any virus which incidentally penetrates a neuromuscular junction, or penetrates the brain in some other way, has a chance of infecting the nervous system. Once inside the nervous system, a virus is partly shielded from the immune system, which is why a virus like West Nile can be innocuous or fatal.

So a virus  that does not normally cause encephalitis can be big trouble if it gets into the brain. In a child who has not been vaccinated, measles can cause subacute sclerosing panencephalitis, invariably fatal, with a timeline unaddressed by COVID clinical trials.

Suppose somebody gets the Astrazeneca shot, and the tip of the needle nicks a neuromuscular junction, and virus gets into the junction. The vaccine contains two viruses. One is the Kamikaze, which carries the payload, spike protein, into the muscle cell target. Traces of the helper virus are also present.  But how does a virus which has no experience with nerves know how to climb the axillary nerve all the way to the cervical vertebrae, where it might cause transverse myelitis?

A virus doesn’t have to know a thing. The axillary nerve contains a conveyor belt, reverse axonal transport. Hooked onto the conveyor, even completely inert particles will reach the brain. This was shown years ago by an experiment with patients who had a few days to live. Colloidal gold was sprayed into their noses. When the patients died three days later,  their brains were sectioned, and the gold was found.

The rumored  adverse event is transverse myelitis. Instead of a lesion extending up, down, and sideways, it mainly goes sideways. It’s like nerve block anesthesia, which affects function below the the block. The lesion extends across the whole spinal cord near a few vertebrae. With the Astrazeneca patient, we would expect to see symptoms of a spinal lesion around C5 and C6, the lower cervical vertebrae, at the base of the neck.

This is the smoking gun. If the lesion is not around C5/C6, it could still be the vaccine, but we don’t smell smoke. We would have to consider more typical causes, such as autoimmunity caused by the vaccine. This too has happened.

Are the symptoms caused by the Kamikaze virus, or the helper virus? This is hard, but important. The Kamikaze cannot reproduce, so it cannot cause a slow virus infection, like subacute sclerosing panencephalitis. The helper virus, though present only  in trace amounts, can reproduce. There is a questionable presumption of safety.

This  scenario pertains to vaccines that use a virus to  penetrate cells in the recipient. It cannot happen with:

• Killed virus vaccines.
• VLP (virus-like particle) vaccines.
• RNA vaccines.
• DNA vaccines.

These vaccines have similarity-to-safe; for what this means, see Why I Defend FDA Commissioner Stephen Hahn. A single live-virus vaccine in use today, 17D for yellow fever, can cause fatal infection. See Moderna Partial Results Part 1.

Whether a vaccination can introduce live virus into neuromuscular junctions was not formerly a troublesome question. Now it is. Rigorous safety demands an answer to: Why did this  adverse event happen? It cannot be well studied in humans, because the spinal cord of a living person is not available. It can be studied in animals in a far more detailed way. The answer will not come quick.

So do the right thing.

 

(CNN) AstraZeneca pauses coronavirus vaccine trial after unexplained illness in volunteer. Quoting,

“In large trials, illnesses will happen by chance but must be independently reviewed to check this carefully. We are working to expedite the review of the single event to minimize any potential impact on the trial timeline. We are committed to the safety of our participants and the highest standards of conduct in our trials.”

Chance is one possibility. For another, see  Why I Defend FDA Commissioner Stephen Hahn. Quoting,

This sounds informative, but it leaves out a crucial safety question, discussed in Why I Would Not Take the Russian or Oxford – AstraZeneca Vaccines – Part 2. Quoting the nut of it,

After a while, we’re ready to harvest the culture medium for the virus we want, the Kamikaze, purifying it of the helper virus. We don’t want the helper virus in our vaccine, because it  does not contain the code for the spike protein, and it can replicate…

Very small quantities of live, helper adenovirus are present in the finished vaccine product.  Supporters of these vaccines make these claims:…

(Reuters) Putin critic Navalny was poisoned with Novichok nerve agent, Merkel says. Quoting,

She said Berlin now expected Moscow to explain itself and that Germany would consult its NATO allies about how to respond, raising the prospect of new Western sanctions on Russia, sending Russian asset prices tumbling.

You read it here first:  Alexei Navalny, Poisoned Again? The Russian Poison Trick. Quoting,

The modern syndrome is near-death, prolonged illness, partial recovery, and prolonged or permanent disability. It is characterized by stealth and extreme precision,  a sub lethal dose of a  substance so poisonous it completely evades standard toxicology. Vil Mirzayanov revealed the existence of the Novichok family of nerve agents in 1992, but hope for a “new Russia” delayed assessment of the threat.

You read it here first, and there isn’t a subscription fee!

But you might have guessed as much if you read (NPR) Navalny Was Poisoned, But His Life Isn’t in Danger, German Hospital Says. Quoting,

Navalny is now being treated with an antidote called atropine; the medical team says there’s the possibility of long-term effects on his health and particularly his nervous system.

Treatment with atropine as the only named substance suggests a partial truth. Atropine is only part of a treatment protocol. Additional chemicals are required to reactivate cholesterinase, and scavenge loose  Novichok. According to the inventors of Novichok, the bond is much harder to break than with VX. The Russians considered Novichok exposure to be untreatable, except for supportive care.

Since Porton Down chose not to disclose the protocol that saved the Skripals, it is reasonable to suspect that Charité Hospital told a little white lie, to protect British innovation.

How did the Germans or Brits determine the poison? The Raman microscope, with the ability to perform spectroscopy on  microscopic quantities, is probably involved.

 

 

Edit: Dr. Fauci’s remarks in KHN interview.

(CBS) COVID-19 vaccine will be made available “on the basis of science and data,” FDA commissioner says.

Suspicion says Hahn is under pressure to approve a vaccine before completion of Phase 3 trials. I have been writing articles about caution with new vaccines. This is about the other side of the coin.

Clinical trials are supposed to safeguard reason with the power of statistics. In the minds of the public, and possibly you, they are a complete replacement for something they have no understanding of. This is natural. It’s also a kind of intellectual poison.  There is no replacement for intellect, except to rely entirely on expert judgment, which you might fear is caving to political pressure.

In a court of law, expert witnesses for the prosecution and defense compete for the minds of the jury. We think this works better than the alternatives. It could work better here.

If you are interested in Hahn’s decision making process, how he thinks, you have to go beyond trials-phase 1,2,3. Plans, procedures, and  statistics cannot replace human reason.   Human intelligence connotes adaptation to circumstances as they evolve. You have to understand Hahn’s intelligence, which requires a little more about vaccines than the media provide.

With apologies to Reuters, look at Scientists see downsides to top COVID-19 vaccines from Russia, China. Quoting,

Researchers have experimented with Ad5-based vaccines against a variety of infections for decades, but none are widely used. They employ harmless viruses as “vectors” to ferry genes from the target virus – in this case the novel coronavirus – into human cells, prompting an immune response to fight the actual virus.

This sounds informative, but it leaves out a crucial safety question, discussed in Why I Would Not Take the Russian or Oxford – AstraZeneca Vaccines – Part 2. Quoting the nut of it,

After a while, we’re ready to harvest the culture medium for the virus we want, the Kamikaze, purifying it of the helper virus. We don’t want the helper virus in our vaccine, because it  does not contain the code for the spike protein, and it can replicate…

Very small quantities of live, helper, adenovirus are present in the finished vaccine product.  Supporters of these vaccines make these claims:…

Don’t trust me. Read the abstract of (PubMed) Evidence of frequent recombination among human adenoviruses. With elisions so you can see the point:

Genome stability is a prerequisite for the production and use of adenoviruses for therapy of genetic diseases and cancer….Our results suggest that recombination among circulating adenoviruses is very frequent and plays an important role in shaping the phylogenetic relationships of adenovirus genomes.

This line of reasoning now presents:

• For adenoviruses to be used, they must be stable.
• Adenoviruses frequently recombine. Hence they are not stable.
• Adenoviruses must not be used.

This is similar to unsafe. Maybe this makes you uncomfortable; you’d like to disengage. It’s not your specialty, you don’t know anything about it, so you’d rather rely on experts, who you don’t trust either. But you can’t disengage, because you are a juror in the court of public opinion.  With or without you, there will be a verdict, You may as well help it be a good one.

So how do you use the above? It’s  an argument, not a fact. You can show it around to prospective “experts”. And like a juror, you might see something in a face, a tone, or a gesture that inclines you to doubt. Or you might find their reasons  unconvincing.

A while back, I’m embarrassed to say, I cited the Thorotrast debacle as preventable by thorough clinical trials. It is actually exactly the opposite. It’s an example of a disaster that could have been prevented only by human reason, because the cancers produced by Thorotrast take 20+ years to develop.

The only way the Thorotrast disaster could have been prevented is by recognition, in radioactivity introduced into the body, of similarity to unsafe. In this phrase, we stumble on what a court would call professional expertise. An expert should have the ability to recognize  two basic similarities:

• Similarity to unsafe. “It looks dangerous.”
• Similarity to safe. “It looks safe to me.”

Similar to unsafe should require extensive, prolonged, exacting investigation in every avenue of potential hazard. Novelty enhances this similarity. Familiarity, or precedence of use, reduces it.

Some novelties remain similar to unsafe, because the current state of knowledge does not resolve the difference. (PubMed) Evidence of frequent recombination among human adenoviruses offers no more foundation than quicksand.

Similar to safe requires another faculty embedded in professional expertise, using what we call good judgment to abbreviate investigation. Influenza strains mutate yearly. But vaccines manufactured by established processes do not repeat clinical trials. They are accepted as similar to safe.

By now, you should have one  takeaway: Vaccine safety is not served by a mechanical process, 1,2,3.  That process is a theme with variations, working in concert with expertise, which unlike the scientific method, still resists bottling.

What are Commissioner Hahn’s choices? The nearest term options are controversial ones, to approve a vaccine that has completed:

• Phase 2 or 3, but highly novel, with a similarity to unsafe.
• Phase 2,  but less novel, with less or no similarity to unsafe, with high immunogenicity.
• Phase 2 or 3, which appears inherently safe, but less immunogenic, and hard to store and transport.

Hahn knows that within 6 months of the above, more and probably superior options, free of traces of live virus, will have completed phase 3. During the wait, people will die.

Dr. Fauci has another criteria. (Kaiser Health News) There’s a legitimate way to end coronavirus vaccine trials early, Fauci says. Quoting,

The Data and Safety Monitoring Board could say, “‘The data is so good right now that you can say it’s safe and effective,'” Fauci said.

Yet  numbers do not replace  judgment and ethics.  A vaccine could reduce fatalities, with unapparent change in average severity. What of  the risk that the trace helper virus of an adenovirus vaccine does something horrible long after clinical trials? Are ethics served by immediate need or unknown risk?

With a little effort, and a little help from the media, you can think along with Hahn. And maybe, when he makes a decision, you won’t have to cry “foul!” The jury is still out, and you’re on it.

Will the media step up? These are tough times for the inquiring mind.

 

 

 

 

 

 

This is a continuation of Russia’s COVID-19 Vaccine Part 1, in the form of a brief note which  will be followed up in depth.

Traditional vaccines inject antigen into the body to  cause an immune response. The Russian and Oxford-AstraZeneca vaccines belong to a new breed, which harness your own cells, at the site of the injection, to make antigen.

This requires that cells at the injection site, most likely your arm, are fooled or forced to take in foreign DNA or RNA, and convinced to make the antigen you want, in this case the spike protein of COVID-19. Of all the schemes to do this, the one employed by the Russian and Oxford-AstraZeneca contains the most novel hazards. From Russia’s COVID-19 Vaccine Part 1,

• Both the Russian and Oxford vaccines contain novelties.
• Novelties can contain surprises.
• Surprises can be bad.

The method these vaccines use to penetrate your cells is an adenovirus vector, engineered in the lab to carry a payload of DNA for the COVID spike protein. Most of the genetic code of this carrier virus has been ripped out. It cannot replicate. Like a Kamikaze pilot, it has one mission, to crash into the side of one of your cells, penetrate the cell membrane, and release the payload. Since that’s all it does before it is destroyed, it must be harmless, right?

To understand the hazard, we have to go back to the lab, where we grow the stuff.  All viruses require live medium to grow. Since this special carrier adenovirus cannot replicate, it won’t  grow even  in the warmest, juiciest cell culture medium.

The trick is to use a helper virus, also an adenovirus, which co-infects the cells of the culture medium. Unlike our kamikaze, the helper virus can replicate, and while it does, it also makes copies of the Kamikaze vector.

After a while, we’re ready to harvest the culture medium for the virus we want, the Kamikaze, purifying it of the helper virus. We don’t want the helper virus in our vaccine, because it  does not contain the code for the spike protein, and it can replicate..

The various but related methods of purification are all called chromatography. It has nothing to do with color. The problem with it is that the result is not 100% pure Kamikaze-vector-adenovirus. Because the Kamikaze and the helper are so similar in size, shape, and weight, the helper can’t be completely purified out. Try as you might, you can only make it more pure, not completely pure.

Very small quantities of live, helper, adenovirus are present in the finished vaccine product.  Supporters of these vaccines make these claims:

• The helper virus has been chosen to be harmless.
• The helper virus will stay harmless. The theoretical basis for this has recently been shown to be false. There is an absence of fact, pro or con.
• Safety can be proven with trials over periods short relative to the human lifespan.
• The impurity of helper virus is very small. (With something that can grow, what’s small?)
• Clinical experience with adenovirus vectors  in therapies for several thousand of the severely ill has been positive.

If you get a shot of the Russian or Oxford-AstraZeneca, you’re also getting a little bit of live, helper virus along with it. Will it grow? Will it remain harmless? There is absence of fact, practical or theoretical.

Should you get this shot? Life is a gamble to which there are no sure answers. Guidance is hard to come by.  If the approval process is allowed to complete without political interference, consider your own situation. Only 24.5% of Russian doctors would accept it. (Reuters) Russian doctors wary of rapidly approved COVID-19 vaccine, survey shows. Quoting,

A survey of 3,040 doctors and health specialists, conducted by the “Doctor’s Handbook” mobile application and quoted on Friday by the RBC daily, showed 52% were not ready to be vaccinated, while 24.5% said they would agree to be given the vaccine.

I am waiting for a better vaccine. Although I myself would not receive these vaccines, personal risk factors tilt the balance of risk/reward. The CDC page on risk factors lacks authority that is years down the road.

Since medical advice that embodies meaningful professional knowledge is not yet available, these are my personal opinions:

• Diabetic, take it. The consequences of COVID are too severe.
• Obese, BMI>30, maybe you should take it.
• Uncontrolled hypertension, maybe. Or maybe you should have it treated.
• First responder or infectious disease healthcare worker, maybe.
• If you’re one of the 2.8 million in the U.S. who are Immunocompromised, run the other way. The helper virus might grow in you.

For the rest of us, it’s a great big unknown-unknown.

 

 

 

 

 

 

 

(RFE) Kremlin Critic Navalny ‘In Coma’ After Suspected Poisoning.

The last time this happened was just a year ago. Alexei Navalny, Poisoned?  noted how remarkable it was he was still alive. This directly translates to the present tense.

In Russia, poisoning politicians is nothing new. The modern syndrome, specifically applied to politicians in post-breakup Russia, may date no further back than 2015, with the first poisoning of Vladimir Kara-Murza. Poisoned again in 2017, he was allowed to seek medical treatment abroad. Forced emigration may have been the poisoners’ objective. See Kim Jong Nam & Vladimir Kara-Murza; All About Poisons; Novichok.

The modern syndrome is near-death, prolonged illness, partial recovery, and prolonged or permanent disability. It is characterized by stealth and extreme precision,  a sub lethal dose of a  substance so poisonous it completely evades standard toxicology. Vil Mirzayanov revealed the existence of the Novichok family of nerve agents in 1992, but hope for a “new Russia” delayed assessment of the threat.

With the poisoning  of Sergei and Yulia Skripal,  Charlie Rowley and the death of Dawn Sturgess, it became apparent that Novichok A-234 is not simply a Russian ace-in-the-hole, but an operational device.

The Russian arsenal also includes agents of embarrassment, such as the dioxin TCDD, used against Viktor Yushchenko in 2004. In July 2019, Navalny asserted he was “poisoned” in his Moscow jail cell.  (Reuters) Kremlin critic Navalny says he may have been poisoned. The nonlethal swelling and skin irritation could have been caused by urushiol, the cause of poison ivy. A subtle warning?

In the case of Kara-Murza, the onset of symptoms occurred in places where the actual exposure was unlikely to have occurred. This implies a time-release preparation, which was first seen in the poisoning of Bulgarian dissident Georgi Markov with ricin in 1978. Time-release can be accomplished with a  carrier pellet, or by the composition of the poison itself. A-234 is not the most potent Novichok; solid forms that dissolve slowly exist that are far more lethal.  A grain a few tens of microns diameter, fired at speed into exposed skin, might suffice.

It’s not hard to kill a man. The gem of the Russian technique is the ability to precisely dose for severe illness without actually killing the victim. In the case of Navalny, we do not yet know the Russian intent, which will become clear only on his death or recovery.

Limited tolerance of political opposition in what is essentially a one-party state  keeps opponents of the regime visible and controllable, and provides an escape valve for dissent. In the best of times, the rein is easy. When the going gets tough, the reins tighten. Navalny currently positions himself as a pro-Western democratic nationalist. At intervals he has expressed an ethnocentric view of Russia, and associated with the extreme right-wing. This is a threat to the  Russian state, which like the Soviet Union,  is multi ethnic. See Alexei Navalny, Poisoned? for details.

But why must Navalny be silenced now? Navalny has recently positioned himself as a pro-Western democrat, but his history includes association with the ultra-right. While his impulsive rants are harmless to the Kremlin, Navalny-the-strategist is the ultimate of danger:

• He  advocates an end of subsidies to the Caucasus, risking a third Chechen war, and worse.
• To a  Russian nationalist, Belarus is part of Russia. A Russian politician has free license to import Belarusian trends for political purpose. In this case, the trend is revolution.
• Navalny’s on-off association with the ultra-right could presage a combination, against Putin, with virulent right-winger Vladimir Zhirinovsky, whose party governs in Khabarovsk Krai.
• Should Navalny appropriate the Khabarovsk protests, which are turning into a lasting feature of Russian politics, a breakdown of authority could result with some features from the Caucasus. This is the greatest danger.

The above is mechanism. Now let’s look to the points of a compass:

• In the west, Belarus threatens the  importation of 9 millions who want to join the West.
• In the south, the Caucasus, part of which is claimed by Iran, could break away. Immune to cultural absorption or genuine pacification, loyalties of Islamic quasi-states are bought with expensive subsidies, considerable autonomy, and the threat of crushing military power. There was nothing civil in the two Chechen wars.
• In the far east, political unrest  is  seeded by Khabarovsk over the entire region. An historical fact has recently come alive, with the first signs of China revanchism: parts are claimed by China, as unjustly ceded by the Unequal Treaties.

Only in the north is Russia secure. Cold comfort for the bear. The Kremlin’s anxiety:

Will the center hold?