What Dennis discusses with Dr Apple: How she became interested in writing. Her first two novels, and why she decided to write a nonfiction book. Her path to medical school and pathology, and why she chose breast pathology.
What “the Unseen Doctors” means to her. Why communication between pathologists and other doctors is so important. Why she wanted to help educate patients with this book. How she got into teaching, and why it is rewarding for her.
Viruses are efficient creatures that borrow human cells to reproduce themselves without our consent.
From the perspective of the virus, its function and purpose are to replicate and infect the host as much as they can and fast as they can.
Image of Coronavirus from CDC/Dr. Fred Murphy
Mutations in the virus’s genome are normal and guaranteed as it is copied over and over. The GISAID database identified thousands of changes along the genome. Viruses are clever and naturally select mutations that can result in a strain to be more transmissible or impervious to proposed vaccines. University College of London Genetics Institute researcher Lucy van Dorp is a co-author of a study that identified more than 12,700 mutations in the SARS-CoV-2 virus.
The naming of these variants is done by WHO, in collaboration with partners, expert networks, national authorities, institutions and researchers in the established nomenclature systems for naming and tracking SARS-CoV-2 genetic lineages by GISAID, Nexstrain and Pango. The letters of the Greek Alphabet, i.e., Alpha, Beta, Gamma, Delta is chosen to be more practical for discussion by non-scientific audiences.
The working definition of Variant of Concern (VOC)
VOC of SARS-CoV-2 are Alpha, Beta, Gamma and Delta variants which meets the definition of a Variant of Interest (VOI) and one or more of the following changes:
Increase in transmissibility or detrimental change in COVID-19 epidemiology,
Increase in virulence or change in clinical disease presentation,
Decrease in effectiveness of public health and social measures or available diagnostics, vaccines, therapeutics.
The working definition of Variants of Interest (VOI)
VOI of SARS-CoV-2 variants have genetic changes that are predicted or known to affect virus characteristics such as transmissibility, disease severity, immune escape, diagnostic or therapeutic escape and to cause significant community transmission or multiple COVID-19 clusters to suggest emerging risk to global public health. VOI includes Eta (B1.525), Iota (B1.526), Kappa (B.617.1), and Lambda (C37) from various countries. Recently the Lambda variant has met the definition of VOC.
So far seven VOC have surfaced throughout the globe:
B.1.1.7, (Alpha) first detected in the U.K. is known to be 50% more transmissible and found in Florida, Michigan and Colorado.
P.1, (Gamma), firstdetected in Brazil and Japan, and the U.S. has reported 323 cases of this variant.
B.1.351, (Beta) first detected in South Africa, again 50% more transmissible and the U.S. has reported 224 cases of this variant.
B.1.427, first detected in California, 20% more transmissible, and
B.1.429, another variant first detected in California, 20% more transmissible.
All these variants do not have clear information whether the various vaccines are capable of protectinginfection or have significant effect on neutralization by antibodies.
The trend appears that the states which had successful vaccine delivery seem to have decrease in death rate by COVID.
B.1.617 (Delta variant), originated from India.
C.37 (Lambda variant), originated from South America, particularly Peru.
The coronavirus is composed of five different components: envelope small membrane protein (E), membrane protein (N), spike glycoprotein (S), nucleoprotein (N) and genomic RNA.
The virus’ genomic RNA is a complete set of genetic instructions that is written in 30,000 “letters” of code composed of A, T, G and C.
Within the genome are various parts: see the diagram below.
Below is the process of how the virus enters into the host cell, which in this case is humans. Schematic of the SARS-CoV-2 S protein and the mechanisms how virus enters into human cells to replicate themselves using human engines. a. The schematic structure of the S protein. b. The S protein binds to the receptor ACE2. c. The binding and virus–cell fusion process mediated by the S protein. d. The life cycle of SARS-CoV-2 in host cells. By Y. Huang et al Acta Pharmacologica Sinica (2020) 41:1141–1149; https://doi.org/10.1038/s41401-020-0485-4
Pfizer and Moderna vaccines are made from mRNA in the different spike protein area, a new type of vaccine to protect against infectious diseases by triggering an immune response unlike many vaccines which is made from weakened or inactivated viruses. Vaccines trigger immune response, which produces antibodies, which protects us from getting infected if the real virus enters our bodies. Before releasing these vaccines, both companies conducted rigorous studies and the vaccine effectiveness is proven to be 95% from the original coronavirus before mutations when tested among 30,000 people ages older than 18. This means 5% or less still can have a chance to get COVID-19 infection. While the vaccine is not effective in 100%, it is still excellent in preventing infection and at least subsiding its significant symptoms and deaths.
Will the virus escape vaccines?
If the virus changes by mutation substantially, particularly the spike proteins, then it might escape a vaccine. The race against the virus mutations is on. As the entire population gets vaccinated, we seek herd immunity; likely ~70% of population vaccinated. The goal is to slow transmission globally and slow the clock. If people do not get vaccinations, the COVID-19 pandemic prolongs. We do not have to see any more additional deaths beyond 609,000 people. When the virus mutates increasingly, more vaccinated people will be susceptible to infection because the vaccines were not made from the variants. Time is of the essence to race against virus mutations by vaccinating most people. This is the only way to win over the war against the coronavirus.
God was with the science and scientists who developed these effective and great vaccines in the US. Both mRNA vaccines are superior to any other vaccines known from other countries including China and Russia. We can celebrate superior vaccine science in America and be thankful to live in such a great country.
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Read Dr. Apple’s fictional novel based on real events at:
Ms. Apple is a practicing pathologist…she brings a perspective to the effect of the pandemic that unfortunately is seldom seen, and millions would be enriched and informed by her unique vision…The story begins with a woman intern pathologist arriving on Hart Island to an unimaginable scene of mass burials. The web of relationships and events expands to an international scope. This is a medical but personal story, not a political one. I hope everyone can read and share this book, whose proceeds are going to charity. – Amazon book review
Everyone knows someone in their lives who died from COVID-19, and everyone knows someone in their lives who is not willing to get vaccinated. Yet the relationship between these is not necessarily correlated.
As a physician, it is sad to see the public losing confidence in our medical doctors, CDC, WHO and public health care professionals in general. One reason for this loss of confidence is that people are becoming more skeptical and critical to believe in medicine, and even the medical field’s mass recommendation for vaccination. Perhaps this is due to a preponderance of incorrect information in social media, and particularly, unknown sources. Even traditional media generates stories by reporters who do not have a medical degree or scientific understanding often misrepresent or poorly cover stories.
Here are the primary reasons I hear from people who do not want to receive vaccines:
Vaccines are not safe. Many have a suspicion for everything that goes inside the body. The media inadvertently exacerbates this belief by accentuating side effects after vaccinations, such as “a nurse passed out after getting m-RNA vaccine” before the outlet obtained the scientific evidence and facts. Humans are primed to pay attention to threats or negative information. The subsequent beliefs are hard to change because they are initially based on fear, not logic or evidence-based medicine. Even the sunshine is an external element which enters our body to produce vitamin D, but if too much, free radicals can cause skin cancers. What’s not taking things in? Chemotherapy and radiation therapy are taking things in, helping to kill cancer cells. Nearly every person in the US takes over the counter medications, and even these alter the natural mechanisms of our bodies. Food is taking things inside of our body. Everything can be beneficial or harmful at the same time. Vaccines help alleviate infection and avoid death.
Even the sunshine is an external element which enters our body to produce vitamin D, but if too much, free radicals can cause skin cancers.
2. COVID-19 vaccine went through an unprecedently rapid process with shortcuts, no proper vetting or concern for the safety of humans.
“FDA’s speedy decision for emergency usage of the vaccines was coerced. It was a rapid decision by the federal government with pressure from the big pharma companies without observations of short and long term side effects.” (This is a perfect storm for a conspiracy to evolve by asking questions which will use the scare tactic in general population). “What about the other substances or ingredients such as fatty component aside from m-RNA genetic codes in the vaccine? What if there is an access genetic code or other substances that can trace people who received the injection? What if that code can detect the privacy of the people?”
“Social media was created to help consumer’s needs. Later, businesses began using social media to detect and trace almost everything about us. What if the vaccine substances were also initially created to stop the spread of coronavirus, but later have everlasting negative impact on a person?”
What if the vaccine saves lives? First, let us have life to even worry about “what ifs.”
3. Refusal to see COVID-19 as a serious threat.
“The former president’s experience was not serious, and his claims that the coronavirus was not a big deal were ridiculed by many democrats, who also exaggerated the death rates and its risk.”This thinking has resulted in making the vaccine effort more of a political view instead of a scientific view.To some, COVID-19 is like a mild cold and to some others, it is deadly. As a physician and pathologist, the 609,000 death rates in the US are most likely an underrepresentation. Why take risk of hospitalization, long- haul symptoms and death, when one can have definite benefit of preventing infection and death in a vast percentage of people?
4. Previously infected people with COVID-19 will have natural immunity to protect them. Even President Trump received two doses of vaccines after he contracted COVID-19. He was never against vaccines. He pushed for vaccine discovery. Some research indicates that the vaccine provides stronger immunity than infection via T-cell activations.
5. Concern for side effects that we do not know about are not told. Mostly I hear, “I saw somewhere that Covid may cause…” Doctors have documented injection site pain, muscle and joint aches, low fever, fatigue, or in extreme rare cases, blood clots. Unknown, undocumented, and unproven long term health risks like “infertility” are flooding social media and drowning out medical facts and scientific documentation. Why trust unknown sources of science, medicine, and news? Why trust in hearsay? It is like midwives’ myths from old.
6. No trust in vaccines, institutions, companies, government or even the health care system in general.
The public has lost trust in CDC, WHO and even their own medical doctors. The social media growth is exponential, spreading misinformation and hearsay theories and conspiracy so easily. A good dosage of skepticism is healthy. The CDC has indeed conducted themselves poorly at times and wavered on decisions of masks, for instance. Medicine is never a doctrine but a practice. We call it medical practice, and our practice improves as data grows on open source scientific websites. Research and medicine are more transparent than ever. The coronavirus which caused the pandemic is a novel virus, and initially induced medical and scientific findings as scientific discovery and experimental groundwork. CDC and others are trying their best to figure out the virus as we go and recommending guidelines during current circumstances and new findings. The vaccine is not just an experiment. Look at the results and read the scientific findings instead of believing hearsay news that is intentionally and often anonymously fed into each person’s social media feeds and online search results.
We believe these true stories shown on the left. Why can’t we believe true stories from a vast majority of our medical experts?
7. Younger people trust their own immune system to fight back against the coronavirus, and often believe healthy diets, regular exercise, and healthy lifestyles protect them.
Younger people do have better immune systems in general. In 2019, COVID-19 killed older patients with pre-existing conditions but recently, younger people are also dying; 4,535 deaths occurring from March through July in younger adults ages 25 to 44, or 38% of all excess deaths in that group. Not knowing which groups of younger adults may be more susceptible for death, trusting your own immune system blindly is not wise. “Smart” people are those who prevent a mistake by learning how not to fall into a trap, but “wise” people are those who prevent a mistake by observing how others live and learn from those who fell into a trap. Nearly all victims of serious COVID-19 complications regret not taking a vaccine.
A real electron microscopic image of coronavirus image; look how many viruses are attacking respiratory ciliated human cells. Image produced by US researchers shows SARS-CoV-2 virus particles (red), covering human bronchial cilia (blue), and mucus (yellow). (Ehre Lab, UNC School of Medicine)
University College of London Genetics Institute researcher Lucy van Dorp is a co-author of a study that identified more than 12,700 mutations in the SARS-CoV-2 virus.
8. Poor access to get a vaccine.
This is very unfortunate and still quite common. Door-dash vaccine programs and easier access to vaccine sites is urgently required. Millions of elderly and poor community folks may not have access to a computer or technical savvy to register on sites like MyTurn.com. Many people have no transportation even an appointment can be made.
When will this pandemic pass? It is entirely up to you by getting in line for vaccination. If the virus changes by mutation substantially, particularly the spike proteins, it leads to a distinct possibility it will escape current vaccines. If that occurs, vaccine development begins again, and likelihood of more lockdowns.
We are in a race against mutations. It is necessary we all come to a sense of protecting others and protecting the more vulnerable members of society and becoming socially responsible; benefit the whole community rather than arguing for individual or selfish interests. Part of the decision to reject a vaccine should include this fact: Decisions not to get vaccinations is resulting in other people dying—for whose sake?
America suffers from a deficit of imagining the lives of other people.
The unseen doctor 