COVID Transmissions for 10-6-2021

A large percentage of NY healthcare workers accept a vaccine mandate

Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions.

It has been 689 days since the first documented human case of COVID-19. In 689, Pippin of Herstal, a Frankish leader, defeated the Frisian King Radbod. I am sharing this fact purely because the name “Radbod” is hilarious to me, but it also marks a moment in time when what is today the Netherlands again became Frankish territory.

Today in COVID-19:

While the US has reached another grim milestone, the Delta wave is starting to subside. This and a story about vaccine mandates. Also, a reader discussion about molnupiravir. It’s a bit of a short one today.

Bolded terms are linked to the running newsletter glossary.

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Now, let’s talk COVID.

Northwell Health lays off <2% of its workforce for refusing vaccine mandate

This has bee reported widely in places local to me, but today, Northwell Health, the largest private healthcare employer in New York State, laid off those employees who were unwilling to safeguard patients by complying with a vaccine mandate:

Why am I mentioning this in this newsletter? Because I have seen it widely reported in a misleading fashion, emphasizing the number of employees who were laid off (about 1400) rather than what it represents as a share of the Northwell workforce, which is to say, a tiny amount.

The fact is that healthcare workers do have faith in the COVID-19 vaccines and in this large sample more than 98% of them were willing to comply with a vaccination mandate. This keeps patients and society safe. It’s also encouraging as a vote of confidence in the vaccines.

US death toll surpasses 700,000

It was bound to happen:

Buried in there, however, is that the Delta wave is ebbing in the US. There are still some states that are at crisis levels of hospital utilization, but things are starting to improve again. I hope that trend continues, and that it is reinforced by improved vaccination rates.

What am I doing to cope with the pandemic? This:

Feeding a newborn reminds me of the Battlestar Galactica episode 33

As we’ve been adjusting to having a new baby, I am struck by how scheduled everything has become despite having relatively few outside obligations. It’s important to feed a newborn every 2 to 4 hours (ideally every 2 to 3 hours), something the parents who read this will be well aware of. You may notice that this is not compatible with getting 8 hours of sleep each night, something that pretty much everyone knows about being a new parent.

However, it doesn’t mean it’s impossible to get sleep. It just means that sleep is constantly interrupted by a need to take action. The feeling of it reminds of a landmark episode of the 2000s reboot of Battlestar Galactica, an episode called “33.” In this episode, enemies of the main characters are able to track the main fleet and attack it every 33 minutes, before the heroes can jump away at faster than light speeds and start the clock again. The crews of the hero ships are left exhausted and unable to react, always on the run, and trying to catch whatever amount of sleep they possibly can so that they can keep running.

While our baby is far from a malevolent force, the atmosphere of tension in the episode reminds me of the scheduled mental interruptions that come with this phase of her life.

Despite this, I am loving every minute of it. She is incredible, and I am so far so glad we decided to become parents.

Carl Fink had the following comment regarding molnupiravir:

Hi, John.

FYI, your name came up at the Winnipeg in 2023 party at CapClave, as one of the organizers' personal virology expert.

As a nucleoside analog, I assume that molnupiravir will (like monoclonal antibodies) be useful mainly early in the course of disease, because once COVID-19 is severe the actual viral load is typically low and dropping. As I understand it, at that point you're dealing with the sequelae of the infection, especially the inflammatory response and collateral damage to otherwise-healthy tissues.

Merck has also said that the drug will be investigated for other RNA-viral diseases, which could be super-useful if it works.

Carl is as usual on the mark here. Here’s my reply:

Huh, glad to hear that my messages are making it out into the world. Thanks for letting me know. I wonder who it was, though I think I can guess.

On to the more COVID-19 related part of this: yes, I would suspect that molnupiravir will be at its most useful early in infection. This is true of most antiviral agents, for the reasons that you state--by the time you reach a few days into *most* viral infections, the virus has run its course and it's the immune response and tissue damage that you're really dealing with.

There are some notable exceptions, but they are mainly chronic infections, such as herpes virus infections, Hepatitis C virus infections, and HIV infections. In these cases the antiviral agents are able to control outbreaks, overcome sustained virus replication, or force other actions that help manage or even cure disease. In each of these cases, however, we have viruses that are *not* typically reined in by the action of the immune system.

I'm surprised, therefore, that molnupiravir works at all, really. I'm used to the model of influenza virus, where administration of antiviral agents later than a day or two into infection means they can do very little to control disease. But, SARS-CoV-2 is different, and so is molnupiravir. Coronaviruses do not have a high mutation rate per base of RNA copied, and perhaps they are less able to tolerate, even a bit later in infection, the errors that molnupiravir introduces. Perhaps molnupiravir introduces so many errors that it can effectively control virus infections to greater degree that older-generation antivirals. Either way, I am impressed that it works and so well.

I hope it does work for other virus infections. I can think of quite a few where it would be nice to be able to see these sorts of effects, but I'm hesitant to speculate without seeing more experimental data.

You might have some questions or comments! Send them in. As several folks have figured out, you can also email me if you have a comment that you don’t want to share with the whole group.

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