Thank you, Eric. Sadly, we have the tools to get it done, but not the will. And “Cancer Moonshot” sounds better than putting money into fighting something most of the public and the politicians who make the funding decisions think is over, or perhaps no worse than seasonal URIs.
As I’ve said before, I’m afraid it’s going to take another high level event to get everyone’s attention, as horrible as that would be.
Thanks for this update, Dr. Topol. It is dispiriting that so little progress (if any) has been made with mucosal vaccines in the U.S. I had high hopes for NextGen, but it has not panned out, and it might never. And precautions for most of the population are out the window. What are we to do?
I have been in nearly continuous quarantine since the start of the pandemic, as I am the primary caretaker of my "old-old" father, who has most of the risk factors of dying from Covid. I must say, I am tempted to follow the lead of that group that tried developing their own nasal vaccine on the "kitchen counter." With the known sequences, peptide synthesizing companies, and simple adjuvants, it could be done, I suppose, although without any way to test efficacy. Or perhaps nanobodies, those wonderfully small camelid antibodies and their even smaller derivatives, that can now be developed in vitro, without need for a herd of llamas or alpacas and months of immunization and screening. There must be some that can provide IgA efficacy mucosally, supplementing the role of the mRNA vaccines.
Perhaps there are other solutions out there. But without the commitment of the US government or the vaccine makers, people like me and my father are given "Sophie's Choice" -- sacrifice our at-risk elders so we can rejoin society, or try to maintain a modicum of a social life through Zoom and Skype calls, texts and letters, and occasional outdoor meet-ups with like minded folks in "Still Coviding" groups.
There are other ways, but they don't get to mucous immunity of the upper airway. Inhaled interferon would help, but we don't have that. The other choices you mention could help protect but getting true nasal/oral mucous immunity should be the goal. So sorry for what you are going. through.
Sorry for what you're going through and your dad is lucky to have you. Our culture doesn't appreciate its elders the way Eastern cultures do, which might explain why they are ahead of us in both vaccines and using mitigation strategies. Hang in there!
I seem to have missed checking out the comments on this column but better late than never.
We are also in a similar situation to yours. We (my wife and I) are the "old-old" people. We remodeled our house in 2017-2019 so we could enjoy hosting local university students in our retirement. Music students. For six months we had hours of beautiful music in our house every day. Since Spring 2020 we have had no one staying in our house and since the Rapid Antigen tests failed us last Fall no one even comes in the door without a mask. There is no way to compute the cost of the stupid policies we are forced to live with. This is like some dystopian sci-fi movie.
As usual being proactive still isn't the USA way. It's inconceivable an effective nasal vaccine is created in the US and not even trialed/approved here; yet the vaccine is being used in India.
Hi Sara. The WashU nasal vaccine was licensed to American company Ocugen, who then partnered with NIAID for NIAID (NIH) to conduct clinical studies. The company stated they anticipate the government starting the study this year for the first human trial. https://finance.yahoo.com/news/ocugen-mucosal-vaccine-candidate-ocu500-103000780.html
Public Health has abdicated their responsibilities. Thank you, Dr Topal for continuing to keep the public informed and for not being shy about calling out our elected leaders and public health officials who appear to be ignoring the fact that Covid is not a benign virus.
I am tired of being the lone masker/ fresh air advocate. This virus will only continue to mutate , infect and cause many to become permanently disabled.
Once again Eric, you give us a roadmap of what needs to be done to deal with the SARS-CoV-2 pandemic and PASC (Long Covid), but denial at multiple levels of society prevents the application of the most effective measures. Basic research has already shown us how to implement better vaccines, and the CDC and FDA need to adopt measures to stop the spread of new variants with public health measures such as masking, and rapid vaccine development and implementation. Epidemiology and PASC phenotyping have shown us we are dealing complex set of diseases where the common thread is an inflammatory process that targets multiple organs and alters the body's innate and adaptive immune system, and many hormonal systems. Current clinical trials for PASC are too simplistic, underpowered, and not up to the task. Our funding priority needs to be on: 1) vaccines that prevent infections 2) more basic research on the etiology of PASC to find better targets for PASC clinical trials, 3) Public Health measures that have teeth. Social isolation is hard on humans of all ages, but with waves of new SARS-CoV-2 variants, we cannot ignore the threat of acute illness and PASC, which is often swept under the rug as psychogenic.
What can we do to help get things going with the new technologies (universal and nasal vaccines)that are so close and yet so far? Why the complacency with the technologies we have at this moment. What is it in human nature that allows so much denial?
I know this sounds pollyannaish- But couldn't private citizens underwrite the research with a school or Laboratory? If a group of well off, like minded people got together to underwrite it- What would it take? (If you would like to take it off this post), I would love to hear- I will bet it could be done- If it is about raising money- Not meaning to sound grandiose- but I am a film producer and an artist and have never seen obstacles as anything but a challenge. I was married to a scientist in a Laboratory, and it was about grants to do certain research...
Thank you Dr Topol: This is the bad news that I was expecting-and dreading. I am very often the only person in the room wearing a mask-whether it be an disposable N95 or an elastomeric. I also bring a portable battery powered HEPA filter with me when in a work environment-or when I visit a healthcare facility. People will acknowledge that there is a surge going on and then continue to carry on bare-faced-as if somehow pretending that it does not apply to them in a given situation is actually a strategy. When this is done by medical practitioners, I feel like, somehow, people, who are among the most highly educated professionals we have, are somehow participating in this charade as well. This aspect IMHO of the current state of affairs is complete and utter LUNACY. I supported President Biden in 2020 and will support Harris in 2024. Many great achievements are to their credit. Declaring the emergency over was not one of them. I stated when this happened that this decision would come back to bite Biden in the ass in the long run-and it did. I would have been so happy to have been wrong about this. Again, pretending is not a strategy.....I am glad that Bernie Sanders is staying with the issue of Long Covid-I am hoping that something comes of it. The United States has shown repeatedly that when there is a concerted effort, shared by the government, the experts in their chosen fields, manufacturers and the public, there is little that this country cannot accomplish. And yet, in the fifth year of this pandemic-it is still commonplace to hear "masks don't work", the "jab is killing hundreds of thousands of people", "it's an experimental shot", "it's just a cold", "it's just a flu".....and that somehow Long Covid does not exist. I, as of yet and to my knowledge have never been infected. Frequent testing (in intervals since the infection is a "moving target") still seems to be the best strategy. And of course keeping up with vaccinations, when available. (I am glad that there are going to vaccines within the month.) I am saddened when I hear from pundits who should know better that Covid is a "seasonal" virus-when in point of fact it is a virus for all seasons as is being demonstrated at present. I call this obfuscation by inclusion-naming cold, flu and Covid as seasonal respiratory conditions doesn't make a reality-and yet these thing hang on. This imperviousness to facts if it were to be translated into an acquired immunity against the virus would free us all.....Thank you for taking the time and energy to keep us informed.
I can only add to what others have said to thank you for this excellent, information-filled, and clear-eyed report. It is truly dismaying to learn how little investment has been made in developing more effective vaccines, all the more so as they hold such huge promise to be more effective. Also dismaying to learn about the lack of recognition and progress, accompanied by hugely expensive wrong turns, in addressing Long Covid. All that you report as yet undone should absolutely be priorities. Woeful that this is not the case. Thank you for being a consistent, and consistently intelligent, voice to keep these issues in our sights.
Vaccines have their limitations as you have so thoroughly covered. Preventive measures are important, but it’s “inconvenient“ for a lot of people. There are a lot of susceptible hosts for the virus to mutate further. What is lacking, besides a collective will, is a therapeutic. Dr. Topol has touched on the strategy to identify repurposed drugs, but there has not been a single study from any federal agency in any country, of which we are aware, that has identified what we have identified as a consistently effective and safe therapeutic for every variant over the past five years. This specific drug addresses critical neuroreceptors, critical targets for the virus in every variant . Clinical observations coupled with the unique collaborative research from the Palladin Institute has defined that hydroxycarbamide is a multifunctional drug that has been overlooked by the NIH and other federal and private clinical research and translational science facilities. Clinicians and basic science collaborators have provided a credible framework for further study. Unlike pure antivirals, monoclonals and inhibitors, a multi functional drug such as hydroxycarbamide, should be among the top repurposed drugs for further inclusion in that triad necessary for control of this SARS-Cov2 viral pandemic. Is there anyone with any expertise capable of stating emphatically that hydroxycarbamide/hydroxyurea cannot be used in the setting and what is their evidence? We have evidence that it can be used safely. It’s been used around the world for over four decades and declared an essential drug by the WHO. Sickle cell patients from the age of nine months are eligible to take his drug for life to prevent systemic inflammation, including endotheliitis to prevent clots, strokes and a life of pain and misery. The number of sickle cell patients on hydroxyurea that are victims of COVID19 leading to a fatal outcome is almost nil. A five day course of this safe repurposed drug would cost the US public only pennies. Such a novel disease deserves a look at all therapeutic possibilities. Why must we spend millions and billions doing molecular research when there are therapeutic possibilities within our grasp?
We’ve tried and tried and tried to at least get another updated booster but they’re nowhere to be found. It’s so frustrating. We’ve been watching The Decameron and wondering how it started and how long it lasted. Nobody is sure how it started but most historians feel it was the witch trials of the 14th Century & dramatic decrease of women, who typically kept cats, which in turn controlled the rat population. I’ll leave that statement to be made of whatever one sees in it. The plague lasted seven years. Who survived? Those who stayed home. (It still pops up here and there.). It’s astonishing that with all we have available that this plague is entering its 5th year when there is so much that can be done. Even our PCP, who now believes in Long Covid after his son developed life threatening tachycardia that required immediate intervention, has stopped telemed. I send him most of your excellent posts, and I’ll send him this excellent information, but he won’t see it. His nurse is a denier and deletes my portal messages.
So we wait. Stay at home. Exercise. Read. Have meals home delivered. And hope.
This may seem a bit crazy, but I think the near absence of public interest in the current state of the pandemic is at least partially related to the naming scheme for the virus. It’s practically impossible for people not highly familiar with the nomenclature to keep up with the alphabet soup of variants.
That a new variant of concern hasn’t been designated by the WHO has also contributed. The last VOC, Omicron, was first identified in November 2021! The organization’s criteria for naming a new VOC seem to offer some leeway. While I don’t know how much further change is needed by their definitions, it seems we’re not that far off from Pi from a public health perspective. The messaging has and continues to be poor.
Thank you so much for this timely, very informative, and sobering update. I'm glad that my wife and I decided to get a booster of last fall's monovalent vaccine just a couple of weeks ago. Not a silver bullet, but much better than nothing.
Thanks as usual. Just took a look at Congress' funding and aligned with the misinformation about the flu virus vs Covid is misinformation about spending vs taxes. Taxes at the federal level are not a funding mechanism and holding on to such misinformation just keeps us underfunded in key areas. Whenever I get depressed I think of the dedicated researchers trying to find a solution despite the ambivalence of elected officials. Likewise, I think of the core group of economists trying to educate the populace re what is possible. Here is one - https://www.barnesandnoble.com/w/making-money-work-for-us-l-randall-wray/1141351145
Thank you, Eric. Sadly, we have the tools to get it done, but not the will. And “Cancer Moonshot” sounds better than putting money into fighting something most of the public and the politicians who make the funding decisions think is over, or perhaps no worse than seasonal URIs.
As I’ve said before, I’m afraid it’s going to take another high level event to get everyone’s attention, as horrible as that would be.
Thanks. In full agreement
Thanks for this update, Dr. Topol. It is dispiriting that so little progress (if any) has been made with mucosal vaccines in the U.S. I had high hopes for NextGen, but it has not panned out, and it might never. And precautions for most of the population are out the window. What are we to do?
I have been in nearly continuous quarantine since the start of the pandemic, as I am the primary caretaker of my "old-old" father, who has most of the risk factors of dying from Covid. I must say, I am tempted to follow the lead of that group that tried developing their own nasal vaccine on the "kitchen counter." With the known sequences, peptide synthesizing companies, and simple adjuvants, it could be done, I suppose, although without any way to test efficacy. Or perhaps nanobodies, those wonderfully small camelid antibodies and their even smaller derivatives, that can now be developed in vitro, without need for a herd of llamas or alpacas and months of immunization and screening. There must be some that can provide IgA efficacy mucosally, supplementing the role of the mRNA vaccines.
Perhaps there are other solutions out there. But without the commitment of the US government or the vaccine makers, people like me and my father are given "Sophie's Choice" -- sacrifice our at-risk elders so we can rejoin society, or try to maintain a modicum of a social life through Zoom and Skype calls, texts and letters, and occasional outdoor meet-ups with like minded folks in "Still Coviding" groups.
There are other ways, but they don't get to mucous immunity of the upper airway. Inhaled interferon would help, but we don't have that. The other choices you mention could help protect but getting true nasal/oral mucous immunity should be the goal. So sorry for what you are going. through.
Sorry for what you're going through and your dad is lucky to have you. Our culture doesn't appreciate its elders the way Eastern cultures do, which might explain why they are ahead of us in both vaccines and using mitigation strategies. Hang in there!
I seem to have missed checking out the comments on this column but better late than never.
We are also in a similar situation to yours. We (my wife and I) are the "old-old" people. We remodeled our house in 2017-2019 so we could enjoy hosting local university students in our retirement. Music students. For six months we had hours of beautiful music in our house every day. Since Spring 2020 we have had no one staying in our house and since the Rapid Antigen tests failed us last Fall no one even comes in the door without a mask. There is no way to compute the cost of the stupid policies we are forced to live with. This is like some dystopian sci-fi movie.
As usual being proactive still isn't the USA way. It's inconceivable an effective nasal vaccine is created in the US and not even trialed/approved here; yet the vaccine is being used in India.
Right, it's incredible!
Any word/data on how the nasal vaccine is performing in India?
Maybe if a group of health economists predicted (with transparent modeling assumptions and making their data sets available for other modelers) how much $$ would be saved by payers, employers, society by preventing X% of cases of long Covid? https://www.chron.com/news/article/mounting-research-shows-that-covid-19-leaves-its-19616337.php.
Hi Sara. The WashU nasal vaccine was licensed to American company Ocugen, who then partnered with NIAID for NIAID (NIH) to conduct clinical studies. The company stated they anticipate the government starting the study this year for the first human trial. https://finance.yahoo.com/news/ocugen-mucosal-vaccine-candidate-ocu500-103000780.html
Public Health has abdicated their responsibilities. Thank you, Dr Topal for continuing to keep the public informed and for not being shy about calling out our elected leaders and public health officials who appear to be ignoring the fact that Covid is not a benign virus.
I am tired of being the lone masker/ fresh air advocate. This virus will only continue to mutate , infect and cause many to become permanently disabled.
Thanks Suzanne
Once again Eric, you give us a roadmap of what needs to be done to deal with the SARS-CoV-2 pandemic and PASC (Long Covid), but denial at multiple levels of society prevents the application of the most effective measures. Basic research has already shown us how to implement better vaccines, and the CDC and FDA need to adopt measures to stop the spread of new variants with public health measures such as masking, and rapid vaccine development and implementation. Epidemiology and PASC phenotyping have shown us we are dealing complex set of diseases where the common thread is an inflammatory process that targets multiple organs and alters the body's innate and adaptive immune system, and many hormonal systems. Current clinical trials for PASC are too simplistic, underpowered, and not up to the task. Our funding priority needs to be on: 1) vaccines that prevent infections 2) more basic research on the etiology of PASC to find better targets for PASC clinical trials, 3) Public Health measures that have teeth. Social isolation is hard on humans of all ages, but with waves of new SARS-CoV-2 variants, we cannot ignore the threat of acute illness and PASC, which is often swept under the rug as psychogenic.
What can we do to help get things going with the new technologies (universal and nasal vaccines)that are so close and yet so far? Why the complacency with the technologies we have at this moment. What is it in human nature that allows so much denial?
Fatigue. Misinformation. Short-sightedness. Many contributing factors.
We did it right in 2020 to get the first gen vaccines, and then just let down.
I know we could rise to the occasion, but no sign there's will to do it now.
I know this sounds pollyannaish- But couldn't private citizens underwrite the research with a school or Laboratory? If a group of well off, like minded people got together to underwrite it- What would it take? (If you would like to take it off this post), I would love to hear- I will bet it could be done- If it is about raising money- Not meaning to sound grandiose- but I am a film producer and an artist and have never seen obstacles as anything but a challenge. I was married to a scientist in a Laboratory, and it was about grants to do certain research...
Thank you Dr Topol: This is the bad news that I was expecting-and dreading. I am very often the only person in the room wearing a mask-whether it be an disposable N95 or an elastomeric. I also bring a portable battery powered HEPA filter with me when in a work environment-or when I visit a healthcare facility. People will acknowledge that there is a surge going on and then continue to carry on bare-faced-as if somehow pretending that it does not apply to them in a given situation is actually a strategy. When this is done by medical practitioners, I feel like, somehow, people, who are among the most highly educated professionals we have, are somehow participating in this charade as well. This aspect IMHO of the current state of affairs is complete and utter LUNACY. I supported President Biden in 2020 and will support Harris in 2024. Many great achievements are to their credit. Declaring the emergency over was not one of them. I stated when this happened that this decision would come back to bite Biden in the ass in the long run-and it did. I would have been so happy to have been wrong about this. Again, pretending is not a strategy.....I am glad that Bernie Sanders is staying with the issue of Long Covid-I am hoping that something comes of it. The United States has shown repeatedly that when there is a concerted effort, shared by the government, the experts in their chosen fields, manufacturers and the public, there is little that this country cannot accomplish. And yet, in the fifth year of this pandemic-it is still commonplace to hear "masks don't work", the "jab is killing hundreds of thousands of people", "it's an experimental shot", "it's just a cold", "it's just a flu".....and that somehow Long Covid does not exist. I, as of yet and to my knowledge have never been infected. Frequent testing (in intervals since the infection is a "moving target") still seems to be the best strategy. And of course keeping up with vaccinations, when available. (I am glad that there are going to vaccines within the month.) I am saddened when I hear from pundits who should know better that Covid is a "seasonal" virus-when in point of fact it is a virus for all seasons as is being demonstrated at present. I call this obfuscation by inclusion-naming cold, flu and Covid as seasonal respiratory conditions doesn't make a reality-and yet these thing hang on. This imperviousness to facts if it were to be translated into an acquired immunity against the virus would free us all.....Thank you for taking the time and energy to keep us informed.
I can only add to what others have said to thank you for this excellent, information-filled, and clear-eyed report. It is truly dismaying to learn how little investment has been made in developing more effective vaccines, all the more so as they hold such huge promise to be more effective. Also dismaying to learn about the lack of recognition and progress, accompanied by hugely expensive wrong turns, in addressing Long Covid. All that you report as yet undone should absolutely be priorities. Woeful that this is not the case. Thank you for being a consistent, and consistently intelligent, voice to keep these issues in our sights.
Thank you, Susan. Always great to get your feedback!
Vaccines have their limitations as you have so thoroughly covered. Preventive measures are important, but it’s “inconvenient“ for a lot of people. There are a lot of susceptible hosts for the virus to mutate further. What is lacking, besides a collective will, is a therapeutic. Dr. Topol has touched on the strategy to identify repurposed drugs, but there has not been a single study from any federal agency in any country, of which we are aware, that has identified what we have identified as a consistently effective and safe therapeutic for every variant over the past five years. This specific drug addresses critical neuroreceptors, critical targets for the virus in every variant . Clinical observations coupled with the unique collaborative research from the Palladin Institute has defined that hydroxycarbamide is a multifunctional drug that has been overlooked by the NIH and other federal and private clinical research and translational science facilities. Clinicians and basic science collaborators have provided a credible framework for further study. Unlike pure antivirals, monoclonals and inhibitors, a multi functional drug such as hydroxycarbamide, should be among the top repurposed drugs for further inclusion in that triad necessary for control of this SARS-Cov2 viral pandemic. Is there anyone with any expertise capable of stating emphatically that hydroxycarbamide/hydroxyurea cannot be used in the setting and what is their evidence? We have evidence that it can be used safely. It’s been used around the world for over four decades and declared an essential drug by the WHO. Sickle cell patients from the age of nine months are eligible to take his drug for life to prevent systemic inflammation, including endotheliitis to prevent clots, strokes and a life of pain and misery. The number of sickle cell patients on hydroxyurea that are victims of COVID19 leading to a fatal outcome is almost nil. A five day course of this safe repurposed drug would cost the US public only pennies. Such a novel disease deserves a look at all therapeutic possibilities. Why must we spend millions and billions doing molecular research when there are therapeutic possibilities within our grasp?
Enlightening, encouraging, and depressing all at the same time! Thanks for keeping us informed!
Many thanks for your note!
Appreciate this outstanding review & enjoyed the Shane Crotty podcast. I’d be happy to enroll if any nasal vaccine trials are enrolling in SoCal.
Much appreciated!
We’ve tried and tried and tried to at least get another updated booster but they’re nowhere to be found. It’s so frustrating. We’ve been watching The Decameron and wondering how it started and how long it lasted. Nobody is sure how it started but most historians feel it was the witch trials of the 14th Century & dramatic decrease of women, who typically kept cats, which in turn controlled the rat population. I’ll leave that statement to be made of whatever one sees in it. The plague lasted seven years. Who survived? Those who stayed home. (It still pops up here and there.). It’s astonishing that with all we have available that this plague is entering its 5th year when there is so much that can be done. Even our PCP, who now believes in Long Covid after his son developed life threatening tachycardia that required immediate intervention, has stopped telemed. I send him most of your excellent posts, and I’ll send him this excellent information, but he won’t see it. His nurse is a denier and deletes my portal messages.
So we wait. Stay at home. Exercise. Read. Have meals home delivered. And hope.
Thank you so much.
Sorry to learn you’re unable to access boosters and sad to see denialism among clinicians.
This may seem a bit crazy, but I think the near absence of public interest in the current state of the pandemic is at least partially related to the naming scheme for the virus. It’s practically impossible for people not highly familiar with the nomenclature to keep up with the alphabet soup of variants.
That a new variant of concern hasn’t been designated by the WHO has also contributed. The last VOC, Omicron, was first identified in November 2021! The organization’s criteria for naming a new VOC seem to offer some leeway. While I don’t know how much further change is needed by their definitions, it seems we’re not that far off from Pi from a public health perspective. The messaging has and continues to be poor.
Agree with you! Not crazy at all
Humans seem to have moved on, but the virus hasn't. Thank you Dr. Topol for your continued public service and education.
Much appreciated
Thank you so much for this timely, very informative, and sobering update. I'm glad that my wife and I decided to get a booster of last fall's monovalent vaccine just a couple of weeks ago. Not a silver bullet, but much better than nothing.
Exactly. Thanks!
Thanks as usual. Just took a look at Congress' funding and aligned with the misinformation about the flu virus vs Covid is misinformation about spending vs taxes. Taxes at the federal level are not a funding mechanism and holding on to such misinformation just keeps us underfunded in key areas. Whenever I get depressed I think of the dedicated researchers trying to find a solution despite the ambivalence of elected officials. Likewise, I think of the core group of economists trying to educate the populace re what is possible. Here is one - https://www.barnesandnoble.com/w/making-money-work-for-us-l-randall-wray/1141351145