Discussing the C-Word

Number of TB notifications to UK Health Security Agency in England, 2021 Q1 to 2023 Q2

Read on to see what TB has to do with a C-word.

Cancer

When I was growing up, the C-word nobody wanted to mention was cancer.

Grandma didn’t hide her cancer. After her mastectomy, she was fitted with a prosthetic to stuff into one side of her bra. Breast reconstruction wasn’t offered. In steamy southeast Texas, the prosthetic was sweaty and uncomfortable. Grandma quit wearing it. If anybody got upset about her looking lopsided, as far as she was concerned that was their problem, not hers. To say this was not a commonplace attitude is an understatement.

Being hush-hush about cancer was more typical. The mother of one of my classmates got cancer when the kids in the family were small. She and her husband went to the other end of the spectrum from the one Grandma chose. They kept it secret even from their children.

Grandma bumped into my classmate’s mother at the cancer treatment center, who asked Grandma to keep her secret. Both of them had low odds of survival. Both defied the odds, although after decades cancer did eventually kill my classmate’s mother.

My classmate and her sisters understood that the way their family lived was strange. Their house was a major renovation project frozen at the point where demolition had been done but almost none of the envisioned rebuild ever started. Their walls were sheets of plywood temporarily set up. They always went to a local cafeteria for dinner instead of having meals cooked at home. They didn’t know why.

In elementary school, this classmate and I ate lunch together. Occasionally I visited her house. We grew apart as we got into junior high and high school, but I kept bumping into her or her sisters into early adulthood. Their parents didn’t tell them until they grew up.

Cancer has become more common since then. Treatments for it have become far more sophisticated. Odds of survival vary widely from place to place, but in developed countries treatment now often kicks it or at least provides more years with a reasonable quality of life.

Now the C-word is COVID, but in weirder ways than cancer was.

COVID

It’s especially weird in the UK where I live. People who still use protections against the spread of the virus are few. We are not very visible because with the vast majority spreading it as much as they can, we don’t mingle in public much.

Sickness is rife but testing is increasingly rare. People often say what they have is not-COVID, although they can’t be sure. Doctors throw antibiotics into patients with chest infections without testing to see whether the infection is bacterial. Hospitals admonish staff not to test themselves because if they test positive, they’ll have to be off work for a few days. (Written notice to that effect from the NHS region where I live flew around Twitter/X a few days ago. It was quickly followed by similar notices from other parts of the NHS.) Staff should report to work when sick if they are able to drag themselves in. Face masks are discouraged. It’s important for patients to see them smile.

Policies are very virus-friendly. Patient-protecting? Not so much.

On Sunday the BBC published an article claiming COVID is becoming just another seasonal illness akin to flu. Aside from admitting it is killing far more people than flu, the rest of the article was packed with misinformation and outright falsehoods. Don’t bother looking for it. The article is garbage.

However, not everyone is willing to go along with turning this pandemic into another C-word that must not be named. On Monday, George Monbiot’s column in the Guardian was as good as the BBC’s was bad. He’s facing reality.

He isn’t the only one. People who know me are aware that I read scientific material and try to keep up with the status of this pandemic. In the past couple of weeks I’ve had a flurry of conversations where friends wanted an update from me. I’ve also given away more FFP3 face masks in the past couple of weeks than I did all summer.

Talking About the New C-Word

Here are some of the points we’ve talked about. Some bits of reason for optimism are toward the end.

• We misnamed this virus. Severe Acute Respiratory Syndrome (SARS) is inaccurate. Its use of the ACE2 receptor to get into our cells allows it to attack far more than the respiratory system.

• Handwashing and sanitizing surfaces are good, but they only work against pathogens you pick up by touching a contaminated surface. This virus is airborne. My family and friends are too smart to think sanitized hands and surfaces protect against inhaling airborne virus.

• Although it can go after a wide array of organ systems, this virus has favorites. It distorts the immune system, in particular killing off some T-cells and reprogramming some T-cells. It loves the cardiovascular system (causing microclots, heart attacks, strokes, myocarditis, etc.). It also loves the brain and central nervous system (cognitive impairment, memory loss, dementia, skewed decision making, personality changes, disrupted autonomic processes).

• Initial acute infection is not the worst stage of the disease. Most people survive that stage, but the months and years afterward are when the worst trouble occurs. Focusing on rates of hospitalization and death in the initial acute stage made sense in early 2020, but as soon as Long COVID began to be noticed (mid-2020), we should have changed the way we assess impact.

• Post-COVID sequelae (translation: aftereffects of infection with the virus) happen even when the initial infection is mild or asymptomatic. This is often silent. It’s tough to choose the most worrying aspect. My pick? Immune system damage, which allows SARS to establish long term reservoirs inside the body, leaves people more vulnerable to everything else that can infect them and/or turns the immune system against their own bodies. If not for that, the rest of the trouble might not occur.

• Our working hypothesis (not yet proven) is that not every case of COVID results in dire aftereffects. Most people recover enough to feel like they are well, although detailed testing many months later still finds some things awry. But each infection is a roll of the dice, and in each round the dice become a little more loaded. The fewer times we catch it, the better.

• The theory of viral evolution, which HIV validated, is in full swing. We’re letting the virus spread unimpeded, so it has no reason to become less problematic. It is more contagious now. Some of the newest versions of it cause a more intense initial illness. It will take a while to see how bad the long term effects are from the latest flavors, but theory says they are likely to be worse.

• Rapid tests are not as useful as they were early in the pandemic. Tests haven’t kept up with changes in the virus. In the UK, current estimates are that when an actual infection is presented to rapid tests, only about 1 out of 3 will actually show up as a positive test result. The other two present false negatives. Testing before we visit each other is useful, but only because a positive test tells us to cancel the visit. A negative test doesn’t mean we are clear.

• We don’t get better immunity from going through a bout with COVID. Instead, we get very brief resistance to COVID (used to be a couple of months but now it’s only a couple of weeks) and then reduced resistance to everything infectious.

• All sorts of other diseases are having a party now that COVID has weakened so many people. Tuberculosis is up 7% in England in the first half of 2023 compared with the first half of 2022, for example. TB and COVID are both classified as biosafety level 3 pathogens. Strep throat, scarlet fever, pretty much everything we can think of that is infectious is taking advantage… not just in the UK, but globally.

• Dogs can smell whether a person is infected with SARS-CoV-2 (sometimes even without being trained to do it). But dogs, cats and other pets can catch the virus too. It can be as devastating for them as it is for their humans. It would be unethical to use sniffer dogs to screen people for this disease.

• The fact that dogs can smell it means we should be able to develop a breath test to detect infection. The FDA granted authorization to one breath test last year. Although it hasn’t caught on, others are in the development pipeline. We should have access to one eventually, plus air monitors appropriate for public spaces.

• If you can get a COVID booster (most people in the UK are not allowed), it’s worth getting even though it won’t be as effective as previous COVID vaccines. We’re falling farther and farther behind the evolution of the virus. Try to get a vaccine that says XBB (the latest formulation) on the vial, not BA (last year’s formulation). If you have access to NovaVax, a non-mRNA vaccine, and your most recent previous jabs were mRNA, personally I would prefer NovaVax this time to broaden my body’s ways of fighting infection. We don’t have that brand in the UK so I don’t have that option. The USA does. So far it seems to be mainly at some CVS and Costco locations, but it’s becoming more widely available.

• Current vaccines generally don’t prevent infection. They mainly help you fight infection. Vaccines are being developed for delivery as nasal sprays instead of injections. Nasal vaccines have good potential for preventing infection and will be easier to distribute. At least two have moved to human clinical trials. I expect at least one to apply for emergency authorization in a major developed country by sometime in 2025, maybe (if we’re lucky) as early as 2024.

• Protective measures against the pandemic also protect against other diseases that can spread through the air such as influenza, TB and respiratory syncytial virus (RSV). Those include ventilation, air filtration (especially HEPA or Corsi-Rosenthal boxes), UV-C radiation (must be Far-UV at 222nm wavelength if people will be able to see the light source) and high quality N95/FFP2 or better face masks (respirators). If we’re going to share the air we breathe, at the least we should treat and/or filter it. If we aren’t going to do that, we should stay far enough apart with enough ventilation so that we don’t breathe the same air. If we won’t do any of that, face masks are our last line of defense.

• Gradually, I am beginning to see more people wearing face masks in public, even in the UK. We are still very few, but not as few as we were a few months ago.

• People who wear “baggy blue” (disposable surgical) face masks are doing their best with what they know and can obtain. Their masks aren’t nearly as effective as N95/FFP2+, but they do a little to reduce the amount of virus a wearer inhales. The fewer virus particles you breathe in, the better your chances.

In case you missed the bits of good news, tests of your breath, not a swab, are in development. They will be more up to date than what we have now and easier to use. Nasal vaccines are in development. They will be more up to date, easier to use, and likely to be better at preventing infection.

In case you aren’t inclined to read scientific studies but want to keep up with pandemic news, try business journals instead of mainstream mass media. Fortune, Bloomberg, the Financial Times and similar publications have been publishing articles with a better factual grounding. Having so many people sick so much of the time, so many people with aftereffects (especially cognitive and decision-making impairments) and so many people dropping out of the workforce entirely due to long term illness is bad for business and bad for the economy. Some of the serious business journals appear to have decided to start addressing reality. They are easier to read than scientific studies.