The mRNA coronavirus vaccine: a testament to human ingenuity and the power of science

December 27, 2020 • 9:45 am

The Pfizer and Moderna vaccines are a triumph of both technology and of drug testing and distribution. But to me, the most amazing thing about them is how they were designed. Unlike most vaccines, which are based on either weakened or killed viruses or bacteria, these use the naked genetic material itself—specifically, messenger RNA (mRNA). Viral mRNA serves normally to make more viruses using the host’s own protein-making machinery, and the virus’s genome codes for the most dangerous (and vulnerable) part of the virus: its spike protein. This is the protein that, sticking out all over the virus, recognizes and binds to the host cell—our cells. That allows the virus to inject its entire genome into our cells, commandeering our metabolic processes to make more viruses, which then burst out of the cell and start the cycle all over again.

The spike protein is the dangerous bit of the virus; without it, the virus is harmless. If we could somehow get our immune system to recognize the spike protein, it could then glom onto and destroy the viruses before they start reproducing in our cells. And that’s what the Pfizer and Moderna vaccines do.

The vaccine is in fact composed not of spike protein itself, but of artificially synthesized instructions for making the spike protein. Those instructions, coded in mRNA, are packed in lipid nanoparticles and injected into our arms.  The mRNA, engineered to evade our body’s many defenses against foreign genetic material, goes into our cells and instructs our own protein-synthesizing material to make many copies of the spike protein itself.  Since these copies aren’t attached to a virus, they aren’t dangerous, but they prime the immune system to destroy any later-attacking viruses by zeroing in on the spike proteins on the viral surface.

Thus the vaccine uses our own bodies in several ways: to make copies of just the spike protein, and then to provoke our immune system to recognize them, which the body “remembers” by storing the instructions to fabricate antibodies against real viral spike proteins.  The part of this story that amazes me is the years of molecular-genetic studies that went into our ability to design an injectable mRNA, studies that weren’t done to help make vaccines, but simply to understand how the genetic material makes proteins. In other words, pure research undergirded this whole enterprise.

You can read a longish but fascinating account of how the mRNA vaccine was made at the link below at science maven and engineer Bert Hubert’s website (click on the screenshot). Hubert doesn’t go into the details about packaging the engineered mRNA into lipid nanoparticles, which is a tale in itself, so there’s a lot more to learn. At the end, I’ll link to a story about how quickly this vaccine was made—less than a week to both sequence the virus’s RNA, including the spike protein, and then use that sequence to design a vaccine based on the spike protein.  What I’ll do here is try to condense Hubert’s narrative even more. 

Before China even admitted that the viral infection was dangerous and spreading, Yong-Zhen Zhang, a professor in Shanghai, had already sequenced its RNA (the genetic material of this virus is RNA, not DNA), and then deposited the sequence on a public website (a dangerous thing to do in China). The entire viral genome is about 29,000 bases long (four “bases”, G, A, C, and U, are the components of RNA), and makes 6-10 proteins, including the spike protein.

Within only two days after that sequence was published, researchers already knew which bit coded for the spike protein (this was known from previous work on coronaviruses) and then, tweaking that sequence, designed mRNA that could serve as the basis of a vaccine. Once you’ve designed a sequence, it’s child’s play these days to turn it into actual RNA.

The final mRNA used in the Pfizer vaccine is 4282 bases long (if you remember your biology, each three bases code for a single amino acid, and a string of amino acids is known as a protein). But the vaccine mRNA does a lot more than just code for a protein. Here are the first 500 bases of the Pfizer mRNA as given by Bert Hubert, and below you’ll see a diagram of the whole mRNA used in the vaccine:


If you remember your genetics, this sequence looks odd, for mRNA sequences usually contain the bases A, G, C, and U (uracil). Where are the Us? In this vaccine, the Us have been changed into a slightly different base denoted by Ψ (psi), which stands for 1-methyl-3′-pseudouridylyl. I’ll give the reason they did this in a second.

But what you see above is less than one-eighth of the whole mRNA used in the vaccine. I won’t give the whole sequence, as it’s not important here, but the structure of the mRNA is. Remember, this was engineered by people using previous knowledge and their brains, and then entering the sequence into a “DNA printer” that can fabricate DNA that itself can be turned into virus-like RNA. Isn’t that cool? Here’s a picture of the Codex DNA BioXp3200 DNA printer used to make the DNA corresponding to the vaccine’s RNA (photo from Hubert’s site):

And here’s the heart of this post: the structure of the 4282-nucleotide string of RNA that is the nuts and bolts of the vaccine (also from Hubert):

You can see that it’s complicated. The heart of this is the “S protein__mut”, which is the engineered code for the spike protein. But all that other stuff is needed to get that bit into the cell without it being destroyed by the body, get it to start making lots of spike protein to act as a stimulus (antigen) to our immune system, and to get the spike protein made quickly and copiously. The more innocuous spike protein we can get into our body, the greater the subsequent immune response when the virus attacks. Each bit of the mRNA shown in the diagram above has been engineered to optimize the vaccine. I’ll take it bit by bit:

Cap: Underlined in the diagram above, this is a two nucleotide sequence (GA) that tells the cell that the mRNA comes from the nucleus, where it’s normally made as a transcript from our DNA. These bases protect the engineered RNA from being attacked and destroyed by our body, as it makes it look like “normal” RNA.

Five prime (5′) untranslated region (“5′-UTR”) in the diagram.  This 51-base bit isn’t made into spike protein, but is essential in helping the mRNA attach to the small bodies called ribosomes where it is turned into proteins—three-base “codon” by three-base “codon”—with the help of smaller RNA molecules called “transfer RNAs” (tRNAs). Without the 5′-UTR, the protein won’t get made. Besides helping get the engineered mRNA to the ribosomes, this region has been further engineered. First, the Us have been engineered into Ψs, which keeps the immune system from attacking the mRNA without impairing its ability to attach to the ribosomes and make protein. And the sequence has been further tweaked to give it information for making a LOT of protein. To do this, the designers used sequence from our alpha-globin gene’s UTR, for that region makes a lot of protein. (Alpha globin is one half of our hemoglobin molecules, one of the most copious and quickly made proteins in the body.)

S glycoprotein signal peptide (“sig”) in the diagram. This 48-base bit, which does become part of the protein, is crucial in telling the cell where to send the protein after it’s made. In this case, it tells it to leave the cell via the “endoplasmic reticulum”, a network of small tubules that pervades the cell. Even this short bit was engineered by the vaccine designers, who changed 13 of the 48 bases. Why did they do this? Well, they changed the bases that don’t make a difference in the sequence of the protein (these are usually bases in the third position, whose nature isn’t important in protein sequence). But these bases do affect the speed at which a protein is made. Hubert doesn’t explain why this happens, but I suspect that the engineered changes were designed to fit with more common transfer-RNA molecules (tRNAs), which are the small bits of RNA that attach to amino acids in the cytoplasm and then carry them to the mRNA to be assembled into proteins. While there are 64 three-base sequences (4³), there are only 20 amino acids that normally go into proteins. That means that some tRNAs code for the same amino acids. Since these “redundant” tRNAs are not present in equal quantities in the cell, you can make proteins faster if you design an mRNA sequence that matches with the most common tRNAs. I’m guessing that this is what these 13 changes were about.

Spike protein (“S protein__mut”) in the diagram. This is the heart of the mRNA, containing 3777 bases that code for the spike protein. In this code, too, they’ve “optimized” it by changing the “redundant” bases to allow protein to be made faster. The Ψs are now gone, as they’re not needed to evade the body’s defenses.  But there’s one bit that puzzled me until I read Hubert’s explanation. The spike protein made by the body after vaccination differs from the viral spike protein in just two of the 1259 amino acids. The engineered sequence substitutes two amino acids—both prolines—for amino acids in the viral spikes. Why? Because it was known from previous work that these prolines stabilize the spike protein, keeping it from folding up. It thus retains the same shape it has in the native virus. A folded-up spike protein may induce antibodies, but they won’t readily go after the virus’s own spike proteins because their shape is different.  This is just one of the many bits of prior knowledge that came to bear on the vaccine’s design.

The 3′ untranslated region (“3′-UTR”) in the diagram: mRNA’s have these, but we’re not quite sure what they do, except, as Hubert says, the region is “very successful at promoting protein expression.” How this happens is as yet unclear. This bit, too, was engineered by the vaccine designers to make the mRNA more stable and boost protein expression.

The poly-A tail (“poly[A]” in the diagram). This is the 140-base end of the message. All mRNAs made into proteins contain a repeat of the adenine base at the butt (3′) end, so we get an AAAAAAAAAAAAA. . . sequence. It turns out that these A’s are used up when an mRNA molecule makes protein over and over again (they’re like telomeres that get shorter as we age!). When all the As are gone, the mRNA is useless and falls off the ribosomes. Again, previous knowledge told the designers how many As to put at the end of the sequence.  It was known that around 120 As gave the best result in terms of protein production; the designers used 100 As split up with a 10-base “linker” sequence. Hubert doesn’t explain the linker, and I don’t know why it’s there.

Nevertheless, you can see the complexity of this vaccine, whose design rests on an exact knowledge of the spike protein’s sequence (recent mutations in the sequence don’t seem to affect the efficacy of the vaccine, as they probably don’t affect the spike’s shape), as well as on previous research about stuff like the Ψ bases helping evade mRNA destruction, the optimum sequences for high production of protein, the number of As at the end that are most efficacious, and then those two proline substitutions in the vaccine’s spike protein. It’s all marvelous, a combination of new and old, and a testament to the value of pure research, which sometimes comes in mighty handy.

This prior knowledge, combined with fast sequencing of RNA and the development of machines to turn code into RNA, help explain why the vaccine was designed so quickly. Of course it had to be tested and distributed as well, and this Guardian article tells you ten additional reasons why it took only ten months to go from the onset of the pandemic to a usable vaccine.

Finally, a bit of history of science is recounted by “zeynep” at Substack, showing additional reasons why the vaccine came out so quickly (click on screenshot). It’s largely about Yong-Zhen Zhang, the Chinese scientist who published the genetic code of the Covid-19 virus. Zeynep sees him as a hero who took risks with that publication. What’s clear is that without that code (and of course sequencing of DNA and RNA has been done for a long time—another benefit of pure research), we wouldn’t be near as far along as we are in battling the pandemic.

When you think about all this, and realize that only one species has both the brains and the means to make a designer vaccine to battle a devastating virus, and then think about the many scientists whose work contributed over many years to the knowledge involved in designing these vaccines, it should make you proud of humanity—and of the human enterprise of science. Yeah, we screw up all the time, and are xenophobic and selfish, but this time we overcame all that and used the best in us to help all of us.

Thanks to Bert Hubert for helping me understand the complexity of these vaccines.

Guest post: The New Yorker suggests that “other ways of knowing” can cure Covid-19

December 17, 2020 • 9:15 am

A few years ago I got an email from a colleague who was disturbed about the anti-science attitudes of the New Yorker, which include an emphasis on “other ways of knowing” —often through the arts and literature. But first I’ll repeat my colleague’s analysis:

The New Yorker is fine with science that either serves a literary purpose (doctors’ portraits of interesting patients) or a political purpose (environmental writing with its implicit critique of modern technology and capitalism). But the subtext of most of its coverage (there are exceptions) is that scientists are just a self-interested tribe with their own narrative and no claim to finding the truth, and that science must concede the supremacy of literary culture when it comes to anything human, and never try to submit human affairs to quantification or consilience with biology. Because the magazine is undoubtedly sophisticated in its writing and editing they don’t flaunt their postmodernism or their literary-intellectual proprietariness, but once you notice it you can make sense of a lot of their material.

. . . Obviously there are exceptions – Atul Gawande is consistently superb – but as soon as you notice it, their guild war on behalf of cultural critics and literary intellectuals against scientists, technologists, and analytic scholars becomes apparent.

Today’s topic, though, is “other ways of knowing through folk wisdom“. In particular: ways of healing used by indigenous people. Now this shouldn’t be rejected out of hand; after all, many modern remedies, like quinine, derive from plants used by locals. But that doesn’t imply a wholesale endorsement of “the collective lived experience” touted in this video about plant-based healing. For the “collective lived experience”, after all, sometimes includes shamanism and, in the example below, “spiritual elements” as a way of curing disease. And here the disease that “lived experience” tackles is something the Siekipai of Ecuador have never experienced: Covid-19.

Reader Jeff Gawthorpe saw a New Yorker video at the link below; I’m not sure whether you’ll have free access, but you will using the yahoo! finance link at the bottom, where the video was republished.

Jeff is about as distressed as I by the fulminating wokeness of the magazine and delivered his critical “review” of the video, which I asked if I could put up in full, including his name. (I don’t like paraphrasing other people’s words, especially when they’re as good as the analysis below). Jeff said that was fine, and so here is his take, indented. I have to say that I agree with it, and have a few comments of my own at the bottom.

Around 30 minutes ago I happened across a dreadful video on the New Yorker‘s website, which drove my temptation to meet head with keyboard through the roof. This piece of ‘journalism’ was entitled: “Fighting COVID-19 with Ancestral Wisdom in the Amazon”. And yes, It’s as bad as it sounds: unscientific, irresponsible nonsense. Complete tosh.

The message which the piece attempts to convey is that COVID-19 can be dealt with by ‘lived experience’, ancient ‘ways of knowing’, and a few bits of boiled tree bark. Then, if you hadn’t had enough already, Just before the end, a caption pops up saying: “With a new stock of plants, the Siekopai are prepared to address future outbreaks of the virus according to their traditions.” Urrrhhgg.

You’ll notice that they are canny enough to maintain a degree of plausible deniability by making no definite claims. To me this demonstrates the very worst of journalism:

  • Conveying mistruths to support an ideology
  • Lacking the courage to commit to claims by asserting them as supportable facts

That’s bottom of the barrel journalism at the best of times, but now it’s irresponsible, reckless even. It presents a clear message that indigenous knowledge and ancient wisdom are perfectly acceptable ways of dealing with the pandemic. At no point is it mentioned that these ‘remedies’ are not backed by evidence, clinical or otherwise.

As you know, many western societies have huge anti-vax movements which often distrust and denounce mainstream medicine. Unfortunately, this video just adds fuel to the anti-vaxers fire. By failing to mention that these plant ‘remedies’ have zero efficacy, they are providing implicit support to the anti-science, anti-vax groups. Worse still, they are acting like digital snake oil salesmen, imbuing members of the public with false confidence that that they can avoid or fight off this virus with a couple of well chosen tree bark specimens. It’s dangerous, irresponsible nonsense.

Click below to see the video:

My own comments are few. First, it looks like the “remedy” includes cinchona bark, the source of quinine, as a palliative (the remedy seems directed at symptomatic relief rather than a cure).

Second, even “lived experience”, while useful, is no substitute for double-blind clinical trials. Granted, the Siekipai can’t do that, but they sure as hell should take the vaccination when it gets to them.  And, like Jeff, I think it’s totally irresponsible of The New Yorker to present this video without any kind of caveat. After all, when Trump skirts the truth, they don’t hesitate to correct him.  I guess “lived experience of indigenous people” is a different matter—it’s not as if they’re recommending drinking bleach or anything.

My doctor’s new post about the Pfizer vaccine: your questions answered (and you can ask the doc if you have others)

December 14, 2020 • 10:15 am

My GP, Dr. Alex Lickerman, has once again put up a coronavirus post on his practice’s website, and allowed me to reference it here. It’s timely because it’s all about the new Pfizer vaccine. (A ICU nurse in New York may have been the first to get the shot.) How effective is it, and how do we know that? Is it safe? What about kids under 16, who weren’t part of the clinical trials? And pregnant women, who also weren’t tested? Since this is a mRNA rather than a killed-virus vaccine, should we have extra concerns about safety? What adverse reactions have been reported? If you were already infected, does the vaccination also reduce your risk of getting reinfected?  When will “normal” people who aren’t healthcare workers or nursing-home patients be able to get their jabs?

Alex has kindly agreed, as he has before, to answer readers’ questions about the new vaccine, so put your questions in the comments section below and he’ll address them as he has time. Alex has read all the relevant scientific literature, as well as the data from the vaccine trials, so ask away! But do read his 4-page summary beforehand, as it has a lot of information.

I’m not going to put up his whole post; you can go to his site to see it,  which you can do by clicking on the screenshot below:

I’ll just post Alex’s recommendations, followed by his list of “unanswered questions” (indented). The short message: GET THE SHOT AS SOON AS YOU CAN!

CONCLUSIONS

  1. The vaccine is highly effective in preventing symptomatic COVID-19 infection.
  2. The vaccine is safe. Adverse reactions, both local and systemic, are mostly minor. Though the study hasn’t yet gone on long enough to prove there are no serious long-term adverse affects, such adverse affects, if they exist, are likely to be rare and non-life-threatening based on other Phase I and II studies of other RNA vaccines.
  3. We recommend everyone who is eligible to receive the vaccine should receive it when it becomes available to them.
  4. It very well may take all of 2021 to get everyone who’s willing to be vaccinated to receive the shots, which means it likely won’t be until early 2022 that life returns to pre-pandemic normal. In the meantime, continue to wear a mask when indoors with anyone you don’t live with, wash your hands frequently, and refrain from dining indoors at restaurants.

UNANSWERED QUESTIONS

  1. While suggested by the study, still left unproven is whether BNT162b2 [Pfizer’s name for the vaccine] prevents severe COVID-19 infection, whether it prevents COVID-19 infection after just one dose, and whether it prevents COVID-19 infection in subjects who’ve already had COVID-19.
  2. The study didn’t look to see if the vaccine prevents asymptomatic infection. Nor did it assess whether subjects who developed COVID-19 despite vaccination are less likely to transmit the virus. Thus, it’s not yet clear how effective the vaccine will be in containing the spread of the infection.
  3. The study hasn’t gone on long enough to tell if subjects who were vaccinated yet still contracted COVID-19 have a lower risk of long-term effects of COVID-19.
  4. We don’t yet know if the vaccine reduces the risk of dying from COVID-19.
  5. There was insufficient data to draw conclusions about safety and efficacy of the vaccine in children younger than 16, pregnant or lactating women, and patients who are immunocompromised.
  6. We don’t yet know how long immunity lasts and whether or not booster shots will be necessary.

Britain’s High Court restricts medical treatment of teenagers who identify as transsexual

December 2, 2020 • 11:00 am

Lately we’ve been talking about several issues related to transsexual people, in particular the senses in which they can or should be distinguished from people of their biological sex, including their participation in sports; possible effects (or lack thereof) of hormone treatment; and recent books that call for caution in supporting and medically treating gender-dysphoric teenagers who may later regret actions taken when they weren’t capable of informed consent. While I think the discussion has been rational and certainly not “transphobic”, I’ve nevertheless been the recipient of a spate of emails, often nasty ones, excoriating me for promoting an “anti-trans” agenda. I’ve resisted the temptation to respond with recommendations for self-copulation.

The last issue, treatment of young children (mostly girls), is the subject of today’s post. It turns out that yesterday Britain’s High Court ruled that children under 16—and perhaps those between 16 and 18—might have to have a court ruling before they’re allowed to take “puberty blockers”, a somewhat reversible treatment that stops puberty in its tracks. Taking these blockers is usually the first step in further transitioning involving irreversible treatments like cross-sex hormone treatment or surgery. The court ruled that under-16s are largely incapable of giving “informed consent.” You can read about this case in the three article below from the BBC, The Guardian, and The Times of London (click on screenshots to access articles).

From the BBC:

From The Guardian:

From the Times (paywalled):

The High Court decision came in a case brought by two people against the Tavistock and Portman National Heath Service Trust, the clinic in England that counsels and treats those who consider themselves transsexual. One of the cases was brought by Keira Bell, 23, shown in the pictures above. She was treated with puberty blockers at Tavistock after she was referred there at 16, and regrets it. (I’m not implying that most teenagers later regret such treatment, as I have no data on that, but I suspect most of them have no regrets. Nevertheless, if an appreciable number do, that’s a reason for caution.)

The other person bringing the case was “Mrs. A”, the mother of a 15-year-old autistic girl who is awaiting treatment at Tavistock “Mrs. A.” is worried that her daughter will “get it wrong” before she can make a mature decision.

There are a fair number of young girls who have sought and received treatment at Tavistock: the paper reports that, in the last year, 161 children were referred to the Gender Identity Development Services (GIDS), and of these three were 10 or 11 years old and 95—nearly 60%—were under 16. The Times notes that those seeking treatment involve “a disproportionate amount of girls and young women.”  These numbers have been growing rapidly, from 97 children and young people referred to the clinic compared to 2,591 in 2018. Here’s a plot I showed recently:

Here’s a plot from a paper in the Archives of Sexual Behavior showing the number of people referred each year to the UK’s Gender Identity Development Service. It shows the strong rise in referrals of adolescent females compared to males, and some rise in children as well. In the last 7 years it seems to have gone from fewer then 40 to over 1700 in adolescent females—a roughly 43-fold increase!

We don’t know the reason for this rapid increase: among suggested causes are a freer climate that allows children to express their gender identities, or a faddishness that turns troubled or confused children to a form of treatment that is heavily supported and often makes them into a type of hero.

Regardless, here’s the papers’ summary of the High Court ruling (you can read the full ruling here); this is from The Guardian:

In their decision, Dame Victoria Sharp, president of the Queen’s bench division, Lord Justice Lewis and Mrs Justice Lieven, said a child under the age of 16 may only consent to the use of medication intended to suppress puberty “where he or she is competent to understand the nature of the treatment”.

Such an understanding must include “the immediate and long-term consequences of the treatment, the limited evidence available as to its efficacy or purpose, the fact that the vast majority of patients proceed to the use of cross-sex hormones, and its potential life-changing consequences for a child”.

The judges said there would be enormous difficulties for young children weighing up this information and deciding whether to consent to the use of puberty blocking medication.

“It is highly unlikely that a child aged 13 or under would be competent to give consent to the administration of puberty blockers,” the judges added. “It is doubtful that a child aged 14 or 15 could understand and weigh the long-term risks and consequences of the administration of puberty blockers.”

For treatment of those over 16 it is normally presumed that they have the ability to give consent. But in gender reassignment cases where puberty blockers may lead to subsequent surgical operations, the judges said: “Given the long-term consequences of the clinical interventions at issue in this case, and given that the treatment is as yet innovative and experimental, we recognise that clinicians may well regard these as cases where the authorisation of the court should be sought prior to commencing the clinical treatment.”

The NHS, which is appealing the judgement, has immediately stopped the inception of puberty-blocking as well as cross-sex hormone treatment, and issued some statements. From the BBC:

An NHS spokesperson said: “We welcome the clarity which the court’s decision brings. The Tavistock have immediately suspended new referrals for puberty blockers and cross-sex hormones for the under-16s, which in future will only be permitted where a court specifically authorises it.”

In September, the NHS announced an independent review into gender identity services for children and young people.

The Tavistock and Portman NHS Trust said it was “disappointed by today’s judgment and we understand that the outcome is likely to cause anxiety for patients and their families”.

It added: “Our first duty is to our patients, particularly those currently receiving hormone blocking treatment, and we are working with our partners, University College London Hospitals NHS Foundation Trust and Leeds Teaching Hospitals NHS Trust, to provide support for patients concerned about the impact on their care.”

In contrast, groups like the “trans children’s charity Mermaids” decried the decision:

Lui Asquith, from trans children’s charity Mermaids, said the ruling was a “devastating blow” and “a potential catastrophe for trans young people across the country”.

The charity said: “We believe very strongly that every young person has the right to make their own decisions about their body and that should not differ because somebody is trans.”

You can see more about Mermaids’ reaction here. But their last statement skirts the question that the Court was asked to decide: How old must you be before you are capable of making a medical decision that may be irreversible?  And it’s not just trans people to whom this applies: what if a 13-year-old boy wanted his penis removed because he didn’t like it? Should he be able to make “his own decision about his body”?

I think that reasonable people should agree that there is an age below which a child isn’t deemed capable of making a medical decision like this one, even if they feel strongly that they are transsexual.  Surely 6 is too young and 20 sufficiently old to make a “mature” judgement. But it’s also clear that children differ in the level of “maturity”, so there might be some flexibility (though there isn’t in things like drinking ages). The court, in ruling that 16 is a cut-off point, was surely being subjective, and they realized it, for they affirmed that even older teenagers might require a court judgment to begin puberty blockers. For those younger than 16, it seems reasonable to me to wait until they turn 16 until they can give “informed consent,” or be able to bring their case to legal judgement.

Those who think that 10-year-olds should be able to make their own decisions, and take puberty blockers or cross-sex hormone treatment at will (counseling is surely required), seem to me unreasonable. After all, courts have set age limits for other decisions that require “informed consent”, like age limits for statutory rape (in Illinois, 17 is the legal age of consent for sexual acts. If you’re 16, are you too young to consent to sex but old enough to have your sex transformed to another?) It’s a sign of the valorization of all desires to be transsexual that a charity like Mermaids wants anyone, no matter how old, to have their own decisions not just respected, but acted upon.

The dreaded shingles shot

November 22, 2020 • 2:15 pm

I’m not turning this site into a report on my health—which is very good, thank you—but I will post any additional bills I get for my hernia surgery, just so you can see what American healthcare costs. And today I will report that I got the second in the series of two shots designed to prevent shingles (Shingrix). After the first jab, you need to get the second between two and six months later. I had another immunization against shingles a couple of years ago—Zostavax—but that shot is apparently passé. The immunizations for shingles were free.

The first Shingrix shot I got, three months ago, gave me flu-like symptoms, and I was out of it for a day (but I still went to work!). This morning’s is already taking effect, with my poor arm hurting like I was punched hard, and the bodily languor starting to set it. I’m going to take some Tylenol and lie down.

But my doc recommended the shots highly, as does the CDC. From what I hear from those who have had shingles, it’s a dreadful and painful malady—far worse than a couple of malaise-inducing jabs. If you’re over 50, get the series. Don’t let my kvetching put you off.

And. . . there’s another series of two shots coming up, perhaps in the Spring, that I’m really looking forward to!

Thanks to an American Catholic bishop, the pandemic gets a boost

November 20, 2020 • 9:00 am

I was going to say “the Catholic Church gives the pandemic a shot in the arm,” but that would have been confusing. Reader Bill sent me this link to the Los Angeles Times about a faith-soaked Catholic bishop (click on screenshot) who’s bad-mouthing coronavirus vaccines because they’re supposedly made using embryonic tissue from aborted fetuses or from surplus embryos used during in vitro fertilization (IVF) that are eventually discarded.

An excerpt:

Citing ethical concerns about the use of fetal cells in vaccine development, Bishop Joseph Brennan of the Diocese of Fresno is urging Catholics not to “jump on the COVID-19 vaccine bandwagon.”

In a video shared by the diocese this week, Brennan said that some of the researchers racing to produce a coronavirus vaccine have made use of cells derived from an aborted fetus, and perhaps other “morally objectionable” materials.

“I try to maintain a joyful spirit, so I don’t like to rain on anyone’s parade,” Brennan said. “But I’m going to rain on a parade today: the vaccine parade.”

In his message, Brennan said the use of fetal cells at any stage of a vaccine’s development means Catholics cannot avail themselves of its scientific results.

“I won’t be able to take a vaccine, brothers and sisters, and I encourage you not to, if it was developed with material from stem cells that were derived from a baby that was aborted, or material that was cast off from artificial insemination of a human embryo,” he said. “That’s morally unacceptable for us.”

. . . Brennan said he is not opposed to vaccines in general, and noted that he has received vaccines for the flu and pneumonia, but said he is specifically opposed to vaccines derived from babies “whose lives were taken.”

This is one example of the hypocrisy of Catholicism. Even if vaccines were made using fetal or embryonic tissue, that tissue would eventually be discarded. Why not use it to save lives? Further, even if you think that discarding unused IVF embryos, or aborting fetuses, is “murder,” there is no evidence that women will undergo these procedures in order to help create vaccines.  Bishop Brennan has a bizarre kind of calculus in which tissue already available cannot be used to save other lives. Note that he is in general expressing the position of the Catholic church, though I don’t think the Pope has yet weighed in on this.

But are the vaccines really made using this kind of tissue? Nope—not one mentioned by Brennan during his video homily:

He cited the Pfizer vaccine by name, which — along with another vaccine from Moderna — has been roundly celebrated as a breakthrough in the fight against the coronavirus.

Brennan did not explain why he singled out Pfizer’s COVID-19 vaccine for criticism. There is no indication that it was developed using either fetal cells or human embryonic stem cells.

“Not a single stage has had it,” Pfizer spokeswoman Jerica Pitts said Thursday.

The Pfizer and Moderna vaccine candidates are made with a snippet of the coronavirus’ genetic code, and both are estimated to be roughly 95% effective.

You think the good bishop would have done his homework, for how many Catholics that heard his homily are going to check for themselves?

It is true that some vaccines are made using fetal tissue:

The Charlotte Lozier Institute, an antiabortion organization, has flagged five COVID-19 vaccine candidates that were developed with the help of fetal cells. One of them, developed by Oxford University and AstraZeneca, is in late-stage testing. So is another developed by Johnson & Johnson.

If Catholics are worried about burning in hell if they take a vaccine developed this way, all they have to do is take the Pfizer or Moderna vaccine. But I repeat: even if you equate abortion or unused IVF embryos as “murder”, what is the moral objection to using that tissue to save further lives? It’s not as if women get IVF and abortions for the purpose of creating vaccines, or get paid to do so. Those abortions or IVF procedures would take place with or without a vaccine being developed.

All I can say is that it’s a good thing that at least some vaccines are being developed without use of fetal or embryonic material, because otherwise pious Catholics wouldn’t be able to get vaccinated, and more people would die in the name of a senseless “morality”.

The erasure of a book that describes problems with adolescent and teenage girls transitioning to males

November 13, 2020 • 12:45 pm

I was amazed to read, in the Qullette article below, this sentence:

Between 2016 and 2017, the number of females seeking gender surgery quadrupled in the United States.

But the reference cited did indeed show this (the actual increase was 3.88-fold), while the number of males seeking gender reassignment surgery was not only absolutely lower, but increased much less (41%) over a year. If you go back further, the rise is even more dramatic (graph below):

Here’s a plot from a paper in the Archives of Sexual Behavior showing the number of people referred each year to the UK’s Gender Identity Development Service. It shows the strong rise in referrals of adolescent females compared to males, and some rise in children as well. In the last 7 years it seems to have gone from fewer then 40 to over 1700 in adolescent females—a roughly 43-fold increase! Clearly, some phenomenon is happening that needs an explanation.

 

 

These kinds of surgeries are manifestations of gender dysphoria: the distress caused when one’s felt gender identity conflicts with one’s sex at birth. The rate of this dysphoria in adolescent and teenage women has risen to the extent that it could be considered an epidemic, which is what some people  think it is: a manifestation of cultural influence that drives many young girls to not only identify as males, but to undergo medical treatment to become hormonally and physically more like males. Shrier’s thesis is that many of these woman would have become lesbians, or reversed their desires, had not gender dysphoria constituted a sort of fad, one seen as a heroic syndrome supported by all kinds of medical and psychological professionals.

In the new book below, which has just entered the Amazon top 100 list, Abigal Shrier, a writer for the Wall Street Journal who also has degrees from Columbia and Oxford and a law degree from Yale, is raising the alarm not about adults who are transgender and undergo medical treatment—Shrier’s fine with that—but about adolescent and teenage girls who claim a different gender identity and then are universally “affirmed” by psychologists, sociologists, and doctors, many undergoing transitions before or while they’re in their teens. It’s undeniable that many of these who transitioned later have second thoughts or regrets about the process, but many of the medical procedures, including hormonal treatments, cause irreversible and injurious changes in the body.

You can get the book, which I’m doing, from Amazon, despite their refusal to take paid ads for it (more on that below).  And its popularity, and overall positive customer reviews, come despite the refusal of mainstream media to advertise or even review this book, which seems to me an important one.

 

Shrier, as I said, deals only with gender dysphoria in young girls and teenage girls, and only one form: “Rapid onset gender dysphoria” (ROGD). Her thesis, as laid out in the Quillette article below (click on screenshot), is this:

What I aim to do, as a journalist, is to investigate cultural phenomena, and here was one worth investigating: Between 2016 and 2017, the number of females seeking gender surgery quadrupled in the United States. Thousands of teen girls across the Western world are not only self-diagnosing with a real dysphoric condition they likely do not have; in many cases, they are obtaining hormones and surgeries following the most cursory diagnostic processes. Schoolteachers, therapists, doctors, surgeons, and medical-accreditation organizations are all rubber-stamping these transitions, often out of fear that doing otherwise will be reported as a sign of “transphobia”—despite growing evidence that most young people who present as trans will eventually desist, and so these interventions will do more harm than good.

The notion that this sudden wave of transitioning among teens is a worrying, ideologically driven phenomenon is hardly a fringe view. Indeed, outside of Twitter, Reddit, Tumblr, and college campuses, it is a view held by a majority of Americans. There is nothing hateful in suggesting that most teenagers are not in a good position to approve irreversible alterations to their bodies, particularly if they are suffering from trauma, OCD, depression, or any of the other mental-health problems that are comorbid with expressions of dysphoria. And yet, here we are.

As I said, Shrier has no issue with adults who, after deciding they’re transgender, decide to have surgery and assume the non-birth gender. She’s solely concerned with the young: why is this suddenly happening, who is supporting it among adults, and what harms can it cause?

Because even raising these questions is considered taboo in today’s political climate, there has been a concerted effort to “erase” Shrier’s book—to pretend it never existed by refusing to advertise or review it. It came to public attention largely because Shrier was interviewed by Joe Rogan on his wildly popular podcast. Even Spotify, which hosts those podcasts, called the interview (as well as Rogan and Shrier) transphobic and threatened to walk out. (See the Rogan-show video here; I recommend it as a substitute for the book if you want to hear about the controversy).

I was able to find only one long-form review of Shrier’s book—one by a feminist writing in Feminist Current, who, despite a few quibbles, praises the book highly. Click on the screenshot to read Megan Mackin’s review:

Between Mackin’s and Shrier’s pieces, you can read about all the attempts by the media (and others) to pretend Shrier’s book doesn’t exist. They include these:

  1. Amazon refuses to host paid ads for the book on its site, though it allows paid ads for books praising medical transitions for teenage girls.
  2. The book wasn’t even reviewed by Publisher’s Weekly and Kirkus, two of the most important pre-publication venues for calling attention to books.
  3. As I mentioned, Spotify employees, calling both Rogan and Shrier “transphobes”, threatened to walk out. Fortunately, the Rogan show episode is still up.
  4. The National Association of Science Writers removed Sean Scott from their discussion group because he had said, without having read the book, that it “should hopefully shed some overdue light on a very sensitive, politically charged topic that potentially carries lifelong medical consequences.” Really offensive and transphobic, right?
  5. Parents started a GoFundMe account to support Shrier, but GoFundMe closed the account twice, though they’re happy to host fundraisers for teenage girls who want transition surgery.
  6. As Mackin notes, “Shrier contributes frequently to the Wall Street Journal, and among her degrees is a Juris Doctor from Yale University. She is a skilled writer who offers complex ideas with accessible delivery. It is possible the media would have covered her work had she resorted to obfuscating postmodernist jargon. Shrier has received no reviews from the established liberal press — not from the New York TimesThe Atlantic, the Kirkus Review, nor any other mainstream online publications. Amazon, which still sells and thus profits from Irreversible Damage — garnering rave reviews there — has refused to allow sponsored ads to promote the book.

And, finally, this just happened. Someone beefed to Target that they were carrying Shrier’s book, and Target removed it.

Here’s the beefer, who apparently removed the tweet:

And some pushback:

At any rate, despite the lack of media support for Shrier’s bestselling book, she is not casting herself as a victim; in fact, her ending of the Quillette piece is measured and rational, but passionate as well:

I want to be clear about something. I don’t believe that I’ve been harmed by these suppression efforts. I am not entitled to book reviews by any media outlet. I sold plenty of books without Amazon’s “sponsored ads.” Joe Rogan (and Megyn Kelly, who also had me on) have much larger platforms than the outlets that pretended this book doesn’t exist. And while this topic has become a fascination of mine, I am no activist. I will pursue other subjects and write other books.

But there is a victim here—the public. A network of activists and their journalistic enablers have largely succeeded in suppressing a real discussion of the over-diagnosis of gender dysphoria among vulnerable girls. As you read this, there are parents everywhere being lectured to by authority figures about how they have to affirm their daughter’s sudden interest in becoming a boy—no questions asked. From Amazon to I Am Jazz, everyone is telling them that transition is the path to happiness, and those who question this narrative are bigots. So they stare at their shoes and let the conversion therapy take its toll.

This is what censorship looks like in 21st-century America. It isn’t the government sending police to your home. It’s Silicon Valley oligopolists implementing blackouts and appeasing social-justice mobs, while sending disfavored ideas down memory holes. And the forces of censorship are winning. Not only because their efforts to censor leave almost no trace. They are winning because, thus far, most Americans have been content to surrender virtually every liberty in exchange for the luxury of having products delivered to their door. Most would happily submit to the rule of Big Tech, so long as their Netflix isn’t disrupted.

At some point, it will cross each of our minds to question an item on the ever-growing list of unsayables. We will find ourselves smeared, or blocked, or the target of a woke campaign. And we will look for support from those with only a dim recollection of why they once cared about free speech. Those who will note tyranny’s advance with the pitiless smile of a low-level bureaucrat already anticipating the door-delivered Cherry Garcia and hours of uninterrupted streaming: “You brought this on yourself, didn’t you?”

Here’s the end of Mackin’s review, the only thoughtful and longish review I could find anywhere (there are, of course, short reviews on Amazon and GoodReads):

Shrier — not a radical feminist — understands the need for a transfer of feminist ideas, which may encourage other women to take a deeper look. Girls’ lives matter. I give Shrier credit for authoring this necessary book. It is the first to put the many pieces together clearly and accessibly. Read Irreversible Damage and share it with others — it is a brave and daring book that ought to be part of the public discussion.

(Mackin also discusses the many people who profit financially and professionally from affirming, both psychologically and medically, the self-diagnoses of girls as gender dysphoric.)

It’s shameful that a book like Shrier’s is publicly erased by mainstream media and stores like Target because it somehow is seen as “transphobic”.  No matter what your preconceptions are, or what you’ve read about girls transitioning before or as teenagers, this book seems like a must-read. It’s a dereliction of duty that major journalistic outlets haven’t reviewed it and that medical associations so readily affirm medical treatment of gender dysphoria in the young. This is how deeply cowed we have become by wokeness, part of which is the universal glorification of gender dysphoria, whose sufferers are seen as heroes. (That may, in fact, partly account for its rapid spread.) When those sufferers are in their teens, though, society should be moving a lot more carefully than it’s doing now.

All too often our Cancel Culture tries to eliminate discussion of issues that are vital in deciding how we should think and act as social beings. The attempts of many to pretend that this book doesn’t exist, and therefore avoid Shrier’s difficult questions, is a reprehensible example of that culture.

 

My surgery bill, and the implications for American healthcare

November 10, 2020 • 9:45 am

I’m not a doctor, of course, nor do I play one on television, but I know that there are physicians among the readers here. They, as well as non-doctors, particularly those in countries with government medical care, might be interested in the itemized statement I got for my hernia surgery exactly a week ago.  The total bill was $64,476.34.  $513.00 of that was for the curbside COVID testing required before I went into surgery during a pandemic, and the remainder, totaling $63,963.34, was for the surgery itself —including all the supplies and drugs.

Here are the bills; I’ve removed personal information. I won’t of course have to pay more than a small fraction of these costs, as I have a good medical plan through the University (as well as Medicare), but those without insurance and Medicare would have to pay it all.

The COVID testing:

And the surgery bill (below). What impressed me was the high cost of anesthesia—nearly ten thousand dollars—as well as the mesh that’s in my belly to hold my guts in ($2,421.37 for a 10 x 15 cm piece), and also “robotic supply,” which I take to be whatever stuff they had to attach to the robot to operate on me ($9,657.00).

I also didn’t know that the operating room is billed in 15- or 30-minute increments, at $2,284 per fifteen minutes after the first half hour (nearly $12,000 for 30 minutes). Presumably that covers the costs of the surgeon, anesthesiologist, and other personnel in attendance—and, of course, profit to the University of Chicago Hospital.

Look at all the drugs I got: 24 of them! I think the Propofol is what put me to sleep, but as for the function of the rest, well, as I said, I’m not a doctor. I have to say that even a dollar for two acetaminophin (Tylenol) is way too expensive given that I can buy then for a bit more than 1 cent per tablet at Walgreen’s.

At the end is the superglue they used to close me up (“Adhesive Dermabond mini”). They didn’t use any stitches on the outside, so there’s still a veneer of glue over each of my three robotic punctures that will wear off. That glue cost $118.23.

TOTAL AGAIN: $63,963.34

I could look up all the drugs, but I’m not sure that would be good for me.  I did look up Sugammadex, the most expensive one ($691.16), which Wikipedia describes as “a medication for the reversal of neuromuscular blockade induced by rocuronium and vecuronium.  in general anaesthesia. It is the first selective relaxant binding agent (SRBA).”

And of course I had to look up “neuromuscular blocking drugs”, which are these:

In clinical use, neuromuscular block is used adjunctively to anesthesia to produce paralysis, firstly to paralyze the vocal cords, and permit intubation of the trachea, and secondly to optimize the surgical field by inhibiting spontaneous ventilation, and causing relaxation of skeletal muscles. Because the appropriate dose of neuromuscular-blocking drug may paralyze muscles required for breathing (i.e., the diaphragm), mechanical ventilation should be available to maintain adequate respiration.

I guess I was intubated, though I don’t see any charge for tubes.

Now, can you know these prices in advance so you can comparison shop among hospitals? The answer is NO. While hospitals differ drastically in their costs, it would be nearly impossible to get a figure for the entire operation in advance. Some hospitals, like the Surgery Center of Oklahoma, will quote you a flat price (and for them, my redo surgery would have been free), and that price, for hernia surgery similar to mine is, I’m told, about $4,500: only 7% of what the bill was above. Nor are these cheaper hospitals worse at what they do: there seems to be little correlation (or even a negative correlation) between the price of a procedure and the quality of the facility and the doctor. (My doctor at the U of C, by the way, was excellent and has a superb record, but more on doctor-shopping later.)

What about the costs above? Are those the sticker costs that then get discounted when billed to the insurance companies (i.e. are they they the so-called “Chargemaster list prices” for each item), or are they the already-discounted costs given to my insurance company?  I have no idea.  It’s as if you went to the grocery store and there were no prices on the food items, and then after a month you get a bill saying, “This is what you have to pay for groceries.”  After talking to my doctor, who will answer your questions below, I’m convinced that the entire medical system is set up not only to make profit, but to prevent patients from exercising discretionary pricing and comparison shopping.

Why are prices so high? Because there is no incentive for doctors and hospitals not to raise prices given that most patients have insurance, don’t know what they’re going to pay, and because hospitals negotiate a flat percentage rate for reimbursement, which differs among insurance companies—a rate that applies regardless of what a procedure costs. So, for example, if the insurance company negotiates having to pay 50% of the “Chargemaster price” used by the hospital (these rates are secret, of course), then the hospital can simply raise the price of its procedure, so it will get more money from the insurance company and the patient’s co-payment.

Things aren’t made better, I’m told, by the Affordable Care Act, which sets a roughly 20% maximum on what each insurance company can keep for profits, salaries, and operating expenses, with the rest going for their customers’ healthcare. That leads to an inexorable raising of premiums and doctor/hospital prices, which go up in tandem. There is no brake to this system.

Can you at least comparison shop among doctors and hospitals to see who has the best record of surgical or medical outcomes? The answer is also a big NO. Those records are required to be kept by law, but patients have no access to them. You have to either find a doctor who has access to these records (they have to pay for such access), or rely on word of mouth.

What’s the solution? Government insurance may help, but isn’t a panacea. In Canada, I’m also told, prices are lower, but the country is hemorrhaging doctors because of the low salaries, resulting in a severe doctor shortage and interminable waits for medical care except in emergency situations.

Now this is a very complex process, but American healthcare appears to be broken in ways that very few of us know about. I may have made a few errors in this post, and will strive to fix them.

Also, my physician, Alex Lickerman, who’s a private primary-care doctor and deeply concerned with the rising costs of American medical care, has consented to answer readers’ questions in the comments below as he has time. You can ask him about how to comparison shop, why American healthcare is a big rip-off, what he sees as the fix for American healthcare, and why the Canadian system, at least, isn’t working very well. (Much of the information above I got from him.) Or ask anything else.

This started out as a simple presentation of my medical bill, but may wind up as a discussion of the outrageous costs of American healthcare, and whether there’s a good fix. Have at it, and do pose questions for Dr. Lickerman.

 

We interrupt our usual program for a pandemic update: Pfizer claims its coronavirus vaccine is 90% effective

November 9, 2020 • 7:00 am

If this is true, it’s excellent news. Click on screenshot to read the CNN report (see also the Washington Post report here):

An excerpt:

Drugmaker Pfizer said Monday an early look at data from its coronavirus vaccine shows it is more than 90% effective — a much better than expected efficacy if the trend continues.

The so-called interim analysis looked at the first 94 confirmed cases of Covid-19 among the more than 43,000 volunteers who got either two doses of the vaccine or a placebo. It found that fewer than 10% of infections were in participants who had been given the vaccine. More than 90% of the cases were in people who had been given a placebo.

Pfizer said that the vaccine provided protection seven days after the second dose and 28 days after the initial dose of the vaccine. The final goal of the trial is to reach 164 confirmed cases of coronavirus infection.

In a news release, the pharmaceutical giant said it plans to seek emergency use authorization from the US Food and Drug Administration soon after volunteers have been monitored for two months after getting their second dose of vaccine, as requested by the FDA.

I believe that 50% effectiveness is the threshold for FDA approval. And, of course, this is early days; but you can’t deny that this looks good so far.

New article: coronavirus lingers on surfaces longer than we thought

October 14, 2020 • 9:45 am

While most cases of Covid-19 are surely contracted via interperson contact (hugging, respiratory droplets, talking next to someone, handshakes, and so on), this new article from Virology Journal, produced by five Australian researchers, suggests that the virus can linger on various surfaces substantially longer than we suspected, and those infection-bearing surfaces (called “fomites”) can carry a viral load large enough to cause infection. Remember when you thought that paper and cardboard could be “disinfected” by leaving it untouched for 24 hours, so that the virus would all die? That doesn’t seem to be the case, at least according to this paper.

Click below to read the screenshot; the pdf is here , and the reference is at the bottom.

The results can be conveyed briefly. The researchers inoculated live virus onto six types of surfaces that might be encountered by people on a daily basis: Stainless steel (cookware, etc.), polymer currency (used in Australia), paper currency (no longer used in Australia but used in many other places), a glass surface (cellphones, touchscreens, etc.), vinyl, and cotton fabric.  The materials were incubated at three temperatures (20, 30, and 40 Celsius, corresponding respectively to 68, 86, and 104 degrees Fahrenheit, respectively), and incubation was in the dark, as UV light kills the virus more quickly (hint, put your envelopes and packages in the light when disinfecting them).  The relative humidity was 50%, though higher humidity also decreases viral survival.

The virus titer is said by the researchers to “represent a plausible amount of virus that may be deposited on a surface”. Samples were taken over 28 days, and the amount of living (i.e., infectious) virus measured by standard methods.

The attrition of the virus due to death over time was measured in three ways: the D value (time at which only 10% of the original sample remained), the half life (time at which half the original sample remained), and Z values (the increase in temperature required to reduce the D value by 90%, in other words to kill 99% of the inoculate).

The table below tells you everything you need to know: the D values and half lives (latter in parentheses) for all six materials at three temperatures, as well as the Z values:

Now what we don’t know about these values, and what is really important, is how much virus has to remain on the surface before it loses its ability to infect you (remember, probability of getting infected is proportional to the amount of virus you pick up and transfer to your nose, mouth, or eyes). This isn’t discussed in the paper, but I’d say a reasonable precaution is the D value: 90% loss of titer.  Perhaps readers in the know can tell us after they’ve read the paper.

But even if you use the half life, at 20°C, two days is a minimum for any surface save cotton (1.7 days). Paper loses half its virus load in three days, and glass in two. But remember, this is in the dark, and half-lives will be shorter in sunlight. Half-lives and Z values decrease dramatically at higher temperatures, though I think 20°C is what we should pay attention to because it’s close to room temperature.  If 10% of the original titer is not enough to infect you, you’ll have to wait 10 days for paper and 6 days for glass. Surprisingly, cotton cloth was the material that retained viable virus for the shortest amount of time.

The Z values show that an increase in temperature of about 15°C is enough to kill 99% of the virus existing at a given temperature.

The researchers also found that except for cotton, viable virus was still found on all surfaces after 28 days.

What’s the lesson for us? Well I can’t say (nor do I wish to purvey public-health advice!), because the crucial information—the amount of virus normally deposited on a surface, and how much of that must remain to give you an appreciable chance of getting infected if you pick it up—is missing. What the authors conclude is this:

The data presented in this study demonstrates that infectious SARS-CoV-2 can be recovered from non-porous surfaces for at least 28 days at ambient temperature and humidity (20 °C and 50% RH). Increasing the temperature while maintaining humidity drastically reduced the survivability of the virus to as little as 24 h at 40 °C. The persistence of SARS-CoV-2 demonstrated in this study is pertinent to the public health and transport sectors. This data should be considered in strategies designed to mitigate the risk of fomite transmission during the current pandemic response.

I guess we’ll have to leave it to the “considerers”, i.e., medical researchers and public health experts, to translate these results into recommended behaviors. But I think it’s smart to disinfect paper for two days instead of one after getting it, and use as little currency as possible (currency is like a circulating Petri dish, carrying E. coli as well as coronavirus. Use your credit card instead, and wipe it off with ethanol or wash it with soap and water after you use it. Put it in the machine, and don’t hand it to anyone unless you have to. Oh, and don’t let anybody use your cellphone.

___________________

Riddell, S., Goldie, S., Hill, A. et al. The effect of temperature on persistence of SARS-CoV-2 on common surfacesVirol J 17, 145 (2020). https://doi.org/10.1186/s12985-020-01418-7