The Bakersfield Doctor Fiasco
Two emergency medicine trained doctors in Bakersfield, CA held a press conference last week that garnered a ton of attention. They had ~5 million Youtube views and ended up on a major Fox news program. They were advocating for an end to "lockdowns" based on a flawed interpretation of their Covid-19 testing data, which was obtained from their own urgent care centers. They also made appeals to authority and misrepresented their level of expertise in epidemiology, immunology and microbiology. They made several very suspect statements that, if followed, could theoretically lead to individuals increasing their risk of infection.
Despite these issues, I think given the context of the current information environment, with speculation coming from every direction (government, experts, and amateurs), these guys shouldn’t have been condemned in total, only in partial. They should have been celebrated for their efforts to support freedom and business, including their own. They should have been condemned for any fraud they may have committed.
Zdogg MD Coverage: https://zdoggmd.com/covid-politics/ Zdogg is pretty hard on these guys, but I think overall gives a fair representation and analysis.
Here is the joint statement from AAEM and ACEP on physician misinformation that I reference in the video.
Immunity and Antibody Dependent Enhancement (ADE)
The take home message here is that I think the preponderance of the evidence suggests most people will develop some degree of immunity against SARS-CoV-2. However, there is an issue of antibody dependent enhancement, which under certain circumstances could cause some people with non-neutralizing antibodies to actually develop worse disease as a result. This situation could arise from ineffective vaccinations, viral mutations, or cross-immunity from exposure to viruses with similar antigens. (Disclaimer: I am not an expert on this topic).
Preprint demonstrating neutralizing antibodies in patients recovered from Covid-19.
"We found that most COVID-19 patients developed SARS-CoV-2-specific NAbs at the 286 convalescent phase of infection. The titers of NAbs reached their peak at 10 to 15 days 287 after disease onset and remained stable thereafter in patients. Antibodies targeting on 288 different domains of S protein, including S1, RBD, and S2, may all contribute to the 289 neutralization."
- Article on Covid-19 and ADE.
- Cell Paper on Antibody Dependent Enhancement (ADE) in Ebola.
- This paper on ADE in SaRS-CoV shows "evidence of a detrimental role of anti–S-IgG in ALI during SARS-CoV infection."
Most of the evidence presented on the transmission of SARS-CoV-2 is flavored in the direction of pointing out how unbelievably easily the virus is transmitted. Well, I think we should consider all evidence, which is why I found this article to be remarkable.
Here’s an excerpt:
"Among 121 HCP exposed to a patient with unrecognized COVID-19, 43 became symptomatic and were tested for SARS-CoV-2, of whom three had positive test results; all three had unprotected patient contact. Exposures while performing physical examinations or during nebulizer treatments were more common among HCP with COVID-19."
Only 3 out of 121 health care personnel exposed to this patient became infected (tested positive). Out of the 121, 37 had exposure to aerosol generating procedures. Only 3 out of these 37 became infected. See excerpted table below:
~11:30 – I talk about "antibodies killing a virus." This is very loose language and really misrepresents viruses and the functioning of antibodies. Firstly, viruses are not living, so they cannot be killed. I should have used a different term such as "neutralizing."
~12:00 – Antibodies do not neutralize viruses on their own. Antibodies are involved in the immune response to bacteria and viruses, but they are just one of many components of an immune response. See this really cool video which gives a great lesson on the workings of the human immune system.