Wednesday, September 9, 2020

Rejoinder to Chris

 Here are some brief reactions to your comments.

>>I’m struggling to see any connection between your stated thesis and the attached article.<<

This is probably (partially) my fault since I used the circumlocution “a certain respiratory virus” in an attempt to evade Facebook’s Draconian penchant for “filtering” or presuming to stand in judgment of references to COVID-19.

I may restate my concern (personally, I would have reservations about describing it as a “thesis”) more straightforwardly, as follows.

I am concerned that, for some people, particular COVID prophylactics (such as vaccines) may have worse effects than COVID itself has, had, or would have.

Given that the linked-to article is titled “AstraZeneca puts coronavirus vaccine trials on pause after patient had a serious side effect,” I hope that its connection to my (precisified) statement is now clear to you.

But, in case it still isn’t clear to you, let me further say: In the AstraZeneca case, the contemplated vaccine has seemingly triggered “a potentially unexplained illness” in one human-trial participant and, for all we know, this “unexplained illness” could have worse effects on the affected individual than COVID would have had.

>>(Potentially) lifelong organ damage from COVID-19 has been documented from the outset of the pandemic,[…]<<

My (admittedly untutored) survey of the relevant literature suggests the following to me.

(1.)  Although it appears to be true that there have been reports of damage to the heart, kidneys, and lungs of some COVID patients, …[1]

(2.)  …the jury is still out on the question of whether the relevant damage is “lifelong”; unless…

(3.)  …you count people who suffered organ damage as part of an acute bout of COVID and then promptly died. (In which cases, the pertinent damage would count as “lifelong” only insofar as their lives concluded prematurely – in a matter of days or weeks, for example.)

(4.)  For most people, risk factors for long-term (and not necessarily “lifelong”) complications[2] include advanced age and comorbidities such as cardiovascular disease, diabetes, obesity, and so on. One Healthline article phrases “The Bottom Line” like this: “COVID-19 can be a severe illness, especially in people over 60 years of age or those with chronic diseases like diabetes and cardiovascular issues.”[3]

(5.)  For the marginal cases in which younger people have died or experienced organ (e.g., lung) damage,[4] it’s not clear (to me) whether the damage was due to COVID or to medical interventions such as ventilation (which is also well documented to cause organ damage, such as in cases of “Ventilator-Induced Lung Injury,” or VILI.)[5],[6]

>>[…]whereas vaccine side-effects tend to be auto-immune responses to a novel stimulus.<<

Here, it’s my turn to express some puzzlement. You seem to be drawing a(n implicit) distinction between “organ damage” and “auto-immune responses”[7] in terms of duration.

When I Google “most common auto-immune responses,” Google returns the following Healthline article: “Autoimmune Diseases: Types, Symptoms, Causes, and More.”[8]

The article lists fourteen[9] of the “most common” auto-immune diseases.[10]

In the order presented, the 14 are: Type 1 diabetes; Rheumatoid arthritis (RA); Psoriasis/psoriatic arthritis; Multiple sclerosis (MS); Systemic lupus erythematosus (SLE); Inflammatory bowel disease (IBD); Addison’s disease; Graves’ disease; // Sjögren’s syndrome; Hashimoto’s thyroiditis; Myasthenia gravis; Autoimmune vasculitis; Pernicious anemia; Celiac disease.

We can construct follow-up searches according to the following schema, “is [whatever condition] a lifelong disease,” where we substitute each disease name, in turn, for the bracketed variable. Doing so, I got these top results – that is, Google’s 0-position result on the search page (the so-called “snippets”).

-        “is type 1 diabetes a lifelong disease”: “Type 1 diabetes is a lifelong (chronic) disease in which there is a high level of sugar (glucose) in the blood.”[11]

-        “is Rheumatois arthritis a lifelong disease”: “RA is a lifelong condition,…”[12]

-        “is Psoriatic arthritis a lifelong disease”: “Psoriatic arthritis tends to be lifelong.”[13]

-        “is Multiple sclerosis a lifelong disease”: “Multiple sclerosis …[i]s a lifelong condition …”[14]

-        “is Inflammatory bowel disease a lifelong disease”: “IBD is a lifelong (chronic) condition.”[15]

-        “is Systemic lupus erythematosus a lifelong disease”: “Lupus …is lifelong and can become severe…”[16]

-        “is Addison’s disease a lifelong disease”: “…Addison’s is a life-long condition…”[17]

-        “is Graves’ disease a lifelong disease”: “Graves disease is an ongoing (chronic) condition that needs lifelong treatment.”[18]

-        “is Sjögren’s syndrome a lifelong disease”: “Sjögren’s syndrome is generally a lifelong disease.”[19]

-        “is Hashimoto’s thyroiditis a lifelong disease”: “Most patients with Hashimoto’s thyroiditis will require lifelong treatment…”[20]

-        “is Myasthenia gravis a lifelong disease”: “Myasthenia gravis is a lifelong health condition.”[21]

-        “is Autoimmune vasculitis a lifelong disease”: “There are many types of vasculitis, and most of them are rare. Vasculitis might affect just one organ, or several. The condition can be short term (acute) or long lasting (chronic).”[22]

-        “is pernicious anemia a lifelong disease”: “People who have pernicious anemia may need lifelong treatment.”[23]

-        “is celiac disease a lifelong disease”: “Individuals with celiac disease cannot outgrow the disease since it is a lifelong autoimmune disorder like diabetes and rheumatoid arthritis.”[24]

With the possible exceptions of Autoimmune Vasculitis and Pernicious Anemia, which could be acute or chronic, the other twelve of the “most common autoimmune diseases” are manifestly lifelong conditions.

>>Are you saying that handwashing and other general precautions to avoid a cold/flu/virus infection will cause a coronavirus to react differently within an exposed body?<<

What I actually typed was: “Some people who may otherwise have recovered from a certain respiratory virus without lasting ill effects will possibly be stricken with lifelong debilities in a misguided attempt (imo) to shield themselves from it.”

The final word, “it” was intended to refer back the aforementioned circumlocution, “a certain respiratory virus.”

So, the first alteration I would make to your paraphrase would be this.

Translated into your phraseology, what I was talking about was (something like):

How “…handwashing and other general precautions to avoid a [certain respiratory] infection [a.k.a., coronavirus]” relate to how an exposed body” will “react” to coronavirus.

This emendation having been performed, I would also take exception to the causal claim embedded in your paraphrase.

No, I don’t think that “general precautions”[25] taken by an individual “will cause a coronavirus [in an of itself] to…” do anything whatever.

However, I think that something (again, translated partially into your verbiage) in the vicinity is true, namely:

Some interventions (such as vaccinations[26]), designed to avoid a COVID infection, will cause exposed bodies to react differently to COVID than those bodies would have reacted without the intervention.

And, sometimes, “react differently” will unfortunately mean than the intervention will make things worse.

>>Does HIV, herpes, etc react differently because someone has avoided it until the moment they catch it?

Just a bit of a worry… “catch it” is not a little vague.

Presumably, firstly, a person could be “exposed” to a pathogen without that pathogen taking up residence (so to speak) within a person’s body.

Secondly, a pathogen could take up residence a person’s body and begin to replicate without that person ever displaying symptoms – being asymptomatic, in other words.

Thirdly, even where the pathogen takes up residence and replicates sufficiently to produce symptoms of clinical infection, such a disease is usually said to evolve along a roughly five-stage trajectory.

-        The “incubation” stage is that period after an organism is exposed to a pathogen during which the pathogen is replicating.

-        Although the point of demarcation is hazy, at some time, this incubation period gives away to a “prodromal” stage in which some “low-level” symptoms may appear, but before “higher-level” symptoms – perhaps those most characteristic of the disease in question – appear.

-        Once replication has advanced far enough, presumably, the individual segues into the full-blown “illness” stage, which (we’ll suppose) presents in such a way as one would typically read about in a clinical, diagnostic manual.

-        If the afflicted person doesn’t die, then the immune system eventually puts the pathogen into “decline.”

-        And, once the decline has proceeded adequately, the person begins his or her period of recovery, or “convalescence.”

Given all of these niceties, it isn’t at all clear to me what “catch it” means.

Does it designate exposure only? Or exposure + incubation – whether or not the person remains asymptomatic? Or does it only apply in cases where exposure evolves all the way to some symptomatic stage – whether prodromal or full, clinical illness?

I’m sure questions like these could be multiplied.

But, leaving this concern aside, your main question was about whether a virus (you name HIV and herpes[27]) “react[s] differently” upon “catch[ing] it… because someone ha[d theretofore] avoided it”.

To echo my previous remarks, I don’t think there’s much of a reason to think that, for some random person (let’s call her Zhang Xiu Ying), her avoidance of Pathogen x causally affects Pathogen x in and of itself.

Let me give an illustration, using the phrase in vitro.

Suppose that we have a specimen of Pathogen x in vitro and that, as of 7:00pm central time 9/9/2020, Zhang Xiu Ying “avoided” any exposure to x, whereupon she unfortunately shatters the specimen’s container and exposes herself.

That Zhang Xiu Ying successfully avoided x up to the specified time plausibly had no causal effect on x (in and of itself, in this case emphasized in virtue of being in vitro) up to 7:00pm central 9/9/2020.

However, once Zhang Xiu Ying is exposed, then whether she becomes an incubation chamber for x or manifests symptoms of clinical illness will, equally plausibly, be the result of a complex interaction.

Relevant factors might include any or all the following (and probably more besides).

Factors about Pathogen x, like:

-        how x is absorbed into a body,

-        how transmissible x is,

-        how quickly x incubates,

-        how much of x there was for Zhang Xiu Ying to be exposed to,

-        how much of x generally has to be present in order to affect incubation in an organism like the kind that Zhang Xiu Ying is,

-        etc.

Factors about the exposure circumstances, e.g.:

-        how much of x “got on” or “got into” Zhang Xiu Ying,

-        the pathway or exposure route that x traversed,

-        whether there were ancillary factors that tended to amplify or defeat x’s ability to leverage the exposure into an incubation in Zhang Xiu Ying, specifically

-        etc.

Factors about Zhang Xiu Ying herself, such as:

-        how susceptible she is to a pathogen like x, and – and this is my main point of emphasis

-        how healthy Zhang Xiu Ying is, overall, including…

-        whether she has any comorbidities (like cardiovascular disease, diabetes, obesity, etc.), and…

-        how – let me use the word… – robust her immune system is,

-        etc.

Now… “how robust her immune system is” is, I confess, difficult to specify.

But what I am most curious about is a comparative like the following.

Call this, My Fundamental Question:

How robust is Zhang Xiu Ying’s immune system (i.e., how robust is it now, as a matter of fact) compared to and contrasted with how robust it would be[28] (i.e., counterfactually) were it not for some medical intervention or prophylaxis? (Call the intervention or prophylaxis “y.”)

Let me conclude by providing one thought experiment that, in my mind, makes it plausible that a question like My Fundamental Question is worth asking.

Suppose that our intervention/prophylaxis, y, is this:

Per impossibile, we place Zhang Xiu Ying in a hermetically sealed “bubble” suit from birth.

Suppose further that at 7:00pm central 9/9/2020, Zhang Xiu Ying simultaneously ruptures x’s petri dish and tears her suit, compromising her longstanding hermetic seal (and undermining y).

Based on this far-fetched,[29] but still instructive, scenario, I think that the following statement is more plausible than its negation:

Zhang Xiu Ying’s immunity is less robust given her longstanding reliance upon y than it would have been had she lived her life allowing her immune system to interact naturally with pathogens, without y.

If this is the case, though (that the above proposition is more plausible than its negation), then it tends to show (I think) that there is some intervention, some y, such that a person’s immunity is less given y than that person’s immunity would have been without y.

But, if this is the case, then the obvious follow-up questions are: what sort of interventions are the ones that folks have in mind to protect us from COVID: things like vaccinations and, yes, handwashing? Are they immune-enhancing interventions, or are they immune-diminishing ones?

I would argue – although, not here and not now – that these sorts of intervention can probably go either way, depending on how (and how often) they are carried out and other factors. And, as a matter of fact, they are often immune diminishing.

To be continued, presumably…

Peace.



[2] The previously cited Today article reads, in part: “Some patients have been called ‘long haulers’ as they continue to have symptoms for months after being infected with the coronavirus, perhaps because of the inflammation triggered by COVID-19.” (Loc. cit.; boldfacing added for emphasis.) Or, again, this author writes: “While most people recover from pneumonia without any lasting lung damage, the pneumonia associated with COVID-19 may be severe. Even after the disease has passed, lung injury may result in breathing difficulties that might take months to improve.” According to https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/what-coronavirus-does-to-the-lungs. “Months to improve” is not synonymous with “lifelong” unless the afflicted person dies in a matter of months. (And, even then, “months to improve” must mean something else, unless we treat “die” as functionally equivalent to “improve.” …which, hey, one might do, from a Christian point of view.)

[6] For instance, the “woman in her 20s” received numerous, invasive interventions in a hospital. We read: “For two months, she was in the intensive care unit on a ventilator and another machine, known as ECMO, that pumps and oxygenates blood outside of the body.” (Ibid.; boldfacing added.)

[7] “[T]o novel [stimuli]” whatever that is supposed to mean.

[9] Of “more than 80,” by Healthline’s count. Op. cit.

[10] By the way, Google freely substitutes the term “diseases” for your arguably less pointed word, “responses.”

[25] Of course, what I had in view primarily was vaccination, not hand washing.

[26] Incidentally, tho, I think this applies to more pedestrian interventions like handwashing.  

[27] Just what do you imagine that I’ve been doing? Tho, even in the case of herpes: “Everyone who is exposed to the virus does not develop sores…”, according to: https://healthcenter.ucsc.edu/forms/student-handbook/HC-814-Herpes-Testing_FAQ.pdf. This is unfortunate wording, from the perspective of logic. Presumably, the author does not mean “for all people who are exposed to herpes, it is the case, for those people, that all of them do not develop sores”, but rather “it is not the case that: for all people who are exposed to herpes, all of them develop sores.”

[28] Or… would have been, had the intervention never been administered.

[29] Extreme thought experiments are often useful tools. And, anyway, herpes and HIV seem to be extreme examples of viruses, so I can hardly be faulted for returning extreme example for extreme example.

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