Cause -> Effect or Serendipity ?


Oftentimes in the practice of medicine the question arises as to whether or not A led to B or whether B occurred coincidentally after A, but not in a cause-effect relationship. This A-B juxtaposition question came into my mind today because of something that occurred to me about six weeks ago in conjunction with something I just read.

On December 17 my wife and I both received our Moderna booster shots. Although I was not an enthusiastic fan of boosters, we did this because we were going to an out of state wedding in early January and would be commingling with some senior citizens who were at high risk for Covid. Exactly fifteen days after my booster, I came down with Covid confirmed by a PCR test. At that point we cancelled our wedding trip, and after my ten days of isolation, and then quarantine, I was back to normal. I thought that the relationship between my booster and my Covid was serendipity  … that is until I read about the present situation with Covid in Israel. For those not aware, Israel had a very high percent of their population vaccinated early, and is not only one of the most boosted countries, but has also started to administer second boosters.

The perplexing part of the Israeli story is that as of Feb. 1-2, both the new Covid ICU admissions and the new confirmed Covid deaths have skyrocketed. However, perhaps not really so perplexing if the relationship between the boosters and the dramatic increase in the number of sick Covid patients in Israel is not mere serindipity, but rather a cause-effect relationship. In other words could the increase in the number of Israelites now with boosters be the cause of the proliferation of new Covid ICU patients and new Covid deaths? 

“Impossible,” you say! To that I would respond, “Not so fast, Lefty!”

While it is true that Israel, with its younger population and lower obesity rate, has fared better than many other Western countries throughout the pandemic, why is it experiencing its own worst wave now – much worse than before any of the shots were administered?

This would be disturbing enough if we were still dealing with the Delta variant, but presumably almost all the cases in Israel are from Omicron. How in the world is the most vaccinated country on earth worse off than ever before in the pandemic with the mildest variant? After all, a study from the Kaiser Permanente Southern California hospital system found that Omicron had a 74% lower ICU admission rate and a 91% lower mortality rate than Delta.

According to professor Yaakov Jerris, director of Ichilov Hospital’s coronavirus ward in Tel Aviv, “most of our severe cases are vaccinated.” “They had at least three injections,” Jerris said in describing the typical COVID patient. “Between seventy and eighty percent of the serious cases are vaccinated. So, the vaccine has no significance regarding severe illness, which is why just twenty to twenty-five percent of our patients are unvaccinated.”

Could the reason be ADE? “What is ADE?” I asked myself, as I was unfamiliar with the term.

What follows is a simplified explanation from Dr. Dan Stock (Dr. Stock coauthored a more in-depth article explaining the concerns of original antigenic sin at Trial Site News several months ago.)

“ADE (antibody dependent disease enhancement) is characterized by much higher levels of antibody production than is seen with natural infection, and a much lower Tc response. Thus, the more the virus changes, not only will this particular vaccine lose its efficacy, but it will go negative because the body won’t produce as many T cells in the parts of the body that are infected.”

So in essence it appears that due to ADE, boosters can actually lead to increased susceptibility to different Covid variants. Also infection with a different variant can be more deadly because as the virus changes, the boosters cause a diminutive T-cell response.

Ergo, in actuality, my coming down with Covid fifteen days after my booster could have been cause->effect due to ADE, rather than serendipity. 

2/7/22

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