2023 wasn't exactly the best of years, but at least we didn't slip back into pandemic circumstances. I fear we will see some "old" infections become new again in 2024. General immunization rates are falling; even before that, we saw plenty of pertussis and even some tetanus, but now we may become reacquainted with measles and varicella, among other vaccine-preventable diseases. Time for some of those younger pediatric healthcare providers who have never seen children with these infections to hit the textbooks again - how's that for a New Year's resolution!
Still, we have lots of reasons to hope for improvements in 2024. Maybe AI won't take over the world but instead will help us practice more effectively.
Short Course Therapy for Febrile UTI in Children
The literature just got a bit muddier with regard to treatment duration for pediatric UTI with a new study from Italy. Investigators in 8 pediatric emergency departments randomized 142 children ages 3 months to 5 years with fever and UTI to receive either 5 or 10 days of oral amoxicillin/clavulanate. The study wasn't blinded, and the randomization occurred on day 4 of therapy when urine culture results were available. UTI was defined as a single organism growing at >100,000 cfu/ml in clean catch urine or > 10,000 cfu/ml in catheterized urine, and subjects were followed for 30 days after completion of antibiotic. After a planned interim analysis the study was stopped early due to finding of noninferiority of the short course therapy.
As you can see, the short course group had numerically lower rates of UTI recurrences during this time period. However, this study's results contradict another study, with a somewhat more reliable study design and definitions, that showed short course therapy to be inferior. I reviewed this earlier study in my July 2, 2023 post. The editorial accompanying the new study is an excellent discussion of weighing the relative merits of the 2 studies. Suffice to say, the jury is still out, and I would stick with 10 days of therapy for febrile UTI in most children.
More Evidence for Using Nirsevimab to Ameliorate Bad Outcomes from RSV
Investigators in 3 European countries conducted a randomized trial of the long-acting monoclonal antibody nirsevimab showing benefits in preventing RSV-associated hospitalization, especially in younger infants. Note that subjects for this study were not eligible for receiving nirsevimab currently in these countries; they were all healthy infants less than 12 months of age, born at > 29 weeks gestation, who were entering their first RSV season.
This was a pragmatic trial, meaning that it was carried out under more "real-world" practice situations rather than within the strict confines of "explanatory" trials used with most therapeutic research studies. It lends more evidence to benefits of nirsevimab for young children.
WRIS (Winter Respiratory Illness Season)
Most pediatric healthcare providers across the country know that we are in the midst of a busy WRIS. This also is a time when data are least reliable due to the extended holiday season - reporting lags a bit, so trends seen now are more likely to be revised in the next few weeks. Still, it's worth a look.
Researchers in Stockholm, Sweden, looked at pediatric hospitalization rates for the 3 "tripledemic" viruses during the period 8/1/21 to 9/15/22 and found that rates were higher for RSV than for omicron covid (the time period was entirely omicron in Sweden) or influenza; note especially the numbers for younger children. I'll be interested to see if this pattern is seen in the US this winter.
CDC has a new (to me) section charting epidemic growth status for covid and influenza, i.e. it depicts, by locale, the growth rates but not the absolute numbers of these pathogens. Another interesting tidbit.
Along the same lines is a monthly crystal ball page from CDC, a bit of sticking their necks out to predict what's in our future for respiratory illnesses. The last report is from November 29:
Lots of uncertainties here, but I appreciate the attempt.
Covid wastewater is increasing, and several healthcare facilities across the country have reinstituted masking and other mitigation practices due to high rates in their communities.
RSV is the one "tripledemic" component that seems to be decreasing in most areas.
So, WRIS this year seems to be a double-whammy rather than a tripledemic, still more than enough to strain healthcare resources. I can only dream how much better people's health would be with widespread vaccine acceptance.
We're Still Safe from the AI Bots
I tried to use an AI program, Microsoft Copilot's Suno, to compose a song about this blog. Specifically, I asked it to create a song about the Pediatric Infection Connection blog using the blues genre. Here's what I got.
Their link doesn't exist, nor is there a pediatric infectious disease specialist Dr. Sarah Jones certified by the American Board of Pediatrics. I did find a Sarah Jones infectious diseases pharmacist at Boston Children's Hospital, but she doesn't appear to have a blog and I don't know if she has children.
I think, for the next year, we'll still be able to keep AI from fooling all of us.
I'm only mildly ashamed to admit that when I saw a recent publication of a randomized controlled trial of symbiotic therapy for post-acute COVID-19 syndrome (PACS), I had no idea what the term meant. Now I know more, and the study brings up some intriguing thoughts but no direct answers.
First, let's talk about a couple other issues.
Winter Respiratory Illness Season
I'm inventing a new acronym, WRIS, just because I can. CDC went so far as to issue a Health Alert Network posting reminding all of us about the low vaccination rates for covid, influenza, and RSV as well as the availability of treatments for the first 2 infections. So far, flu vaccine coverage in the pediatric age range (6 months to 17 years) is about 36%, pretty poor. The post has a lot of good information throughout, but if you're pressed for time please at least take a look at Table 2 with its links for suggestions for discussions with the unimmunized.
Looking at CDC's weekly viral report page, respiratory illnesses continue to increase. Nationally, emergency department visits for WRIS continue to rise, driven largely by influenza. RSV may be past its peak.
Lastly, covid is till out there with high levels in wastewater suggesting we'll see a bigger bump in illness soon.
Although I've presented the national picture, be aware that many of these sites have the ability to display findings by state and other jurisdictions, so you can see what's going on in your area.
Is Pediatric Omicron Infection More Contagious Than We Thought?
That's certainly the implication of a recent study looking at duration of viral shedding in infected children over a 90-day period in early 2022. It's important to note that the study looked only at duration of positivity of PCR at high levels thought to link to infectivity, and also at rapid antigen test (RAT) positivity over time. So, it wasn't a direct measure of whether these children actually transmitted infection at home or in school. With this caveat in mind, they found that 25% of children still had presumed infectious viral loads by day 7 of illness, a bit longer than guidelines recommend for isolation. RAT positivity was a mixed bag as usual (the watermark in the graph just denotes "accepted manuscript" as this paper was published for early online access).
This article shouldn't change practice per se. Looking back at publications of covid spread from children, the results are highly variable with some studies suggesting children have little role in spread. With this much variation in study results, likely the issue is multifactorial, making it difficult to come to any broad generalizations that apply across ages, settings, and time.
Meningococcal B Vaccine and Shared Clinical Decision Making
A few weeks ago I mentioned that healthcare providers don't have enough information at their fingertips to allow parents and patients to truly participate in decisions about vaccination. A new publication about meningococcal serogroup B disease rates helps inform the discussion for meningococcal B vaccine. As you may recall, the ACIP and AAP recently updated meningococcal B vaccination information with the approval of a new pentavalent vaccine. Meningococcal B disease in the US is relatively rare, making risks pretty low overall regardless of vaccination status.
The authors looked at rates of meningococcal disease in persons 18-24 years of age in the years 2014-2017, so not altered by any pandemic considerations. They found 229 confirmed or probable meningococcal disease reports, for an overall rate of 0.18 per 100,000 person years. 120 of the 226 cases for which they had college status were undergraduates, the group at highest risk of meningococcal B infection in the US and the main target for any vaccine intervention. Of those 120 students, 89 had infection with serogroup B.
Students attending 2-year colleges did not have an increased risk of infection compared to non-college students. Only 4-year college attendees had increased risk, and the risk was higher among first-year students and among "Greek life" participants, probably because those groups have a bit more crowding and sharing of beverages, etc.
The authors had some excellent advice in their discussion:
"These findings might be useful for patients, parents, and clinicians when discussing whether to vaccinate adolescents against serogroup B before they go to college. Adolescents planning to live on campus at a 4-year college, particularly ones planning to engage in Greek life or attend schools known for their social life, may benefit more from vaccination. Immunity from MenB vaccines is known to wane quickly, but concentration of risk among first year college students means there is an opportunity to prevent relatively more disease by vaccinating students shortly before they go to college so that the timing of maximum protection overlaps with the highest period of risk."
"Requiring or recommending vaccination against serogroup B disease might not be a tenable policy decision for all colleges, but our findings suggest that 4-year colleges with large numbers of students participating in Greek life or with a high party school ranking might be most likely to benefit from such policies, as these schools were significantly more likely to experience serogroup B cases or outbreaks."
Did you catch that party school mention? Another aid for parents referenced in the study was a ranking of party schools. Those with high rankings presumably represent higher risk for meningococcal B disease. No surprise to me, my undergraduate school didn't make the list.
What I really wanted to know was the Number Needed to Vaccinate (NNV), i.e. how many students would need to be vaccinated to prevent 1 additional case of meningococcal B disease. I knew it would be high because this is such a rare event. It took a little work because I needed a denominator - I knew the number of cases, but I didn't know how many were in the risk group. I had to go to a supplementary table in the article, then look at web links to try to choose a reasonable denominator. I settled on the number of full-time students in undergraduate schools in 2017; it included both 2-year and 4-year colleges. That number, from the National Center for Education Statistics, was 12,085,000. Let's assume the MenB vaccines are 100% effective (they are not, but all are pretty close and I got tired of calculations) and that none of those 89 students in the study were vaccinated (the authors couldn't determine precisely the vaccination rates in their study). NNV is the reciprocal of the absolute risk reduction, which is the rate of infection in the control group (89/12,085,000) minus the rate in the experimental (vaccine) group, which we are assuming to be zero. Crunching those numbers gives us an NNV of 135,786. That is to say, we would need to vaccinate that number of students entering full-time college with a meningococcal B vaccine to prevent 1 additional infection. That NNV number is astronomical and orders of magnitude above NNV for other recommended vaccines. If we were doing a cost-benefit analysis of meningococcal B vaccine, it wouldn't jive at all, but what isn't taken into account is the panic that develops when a case of meningococcal disease occurs on a college campus. Also, I made a lot of assumptions in coming to that number, so it's really just a very rough ballpark. Any decision would need to balance vaccine risks (virtually zero; anaphylaxis from vaccination found 33 cases in 25,173,965 vaccination events in one study, a similar ballpark to the rate of meningococcal B disease above.) This all goes to show that using absolute risk reduction can be more informative than looking at relative risks, which are ratios. For example, in the meningococcal B rates study, participation in Greek life carried a 9.8-fold increase in infection risk compared to other students - a high number that doesn't convey the extremely low infection rates. News stories invariably talk about relative risks rather than absolute risks - bigger numbers sell more papers/advertisements.
So, you can see why those quoted discussion points from the authors are so important. If a parent/potential college student asked me about meningococcal B vaccine, I'd start with saying meningococcal disease is very rare but also very dangerous, with a high fatality rate if one is infected. The risk of getting the infection is very low, about equal to risk of having a life-threatening allergic reaction to any vaccine, both being very rare. [The provider could insert in here if they've ever seen in case of anaphylaxis with a vaccine.] If the plan is to attend a 4-year college, live in a dormitory or fraternity/sorority, and have an active "party" life, the risks for infection are higher though still rare. Some people might value having some more piece of mind and choose to receive vaccination; others may not. Regardless, if at school one hears that you have been exposed to someone with meningococcal infection, you need to follow specific guidance from the local health department or student health team without delay - antibiotic and/or vaccination might be life-saving.
What I Learned About Synbiotics
I'm exhausted after too much number crunching, let's look at a new study that certainly is food (pun intended) for thought. A few definitions first:
Prebiotic - a nondigestible food ingredient that promotes the growth of beneficial microorganisms in the gut
Probiotic - live microorganisms ingested to improve the gut microbiome
Synbiotic - a combination of prebiotic and probiotic substances
The randomized, double-blind, placebo-controlled study looked at 463 adult patients in Hong Kong who were previously diagnosed with covid and fulfilled a standard definition of PACS. The experimental group received twice daily oral doses ("sachets") consisting of 3 probiotic bacteria and 3 prebiotic compounds; the control group received vitamin C with inert additives such that the packets of oral doses were identical in appearance, smell, and weight. The choice of synbiotic elements was based specifically on prior Hong Kong microbiome studies that suggested beneficial elements. The main outcome of interest was change in PACS symptoms at 6 months.
Although there was no difference in quality of life or physical activity between the 2 groups, the treatment did seem to have a beneficial effect on several symptoms and was correlated with favorable microbiome changes.
Maybe some progress, we'll need to see more studies on synbiotic therapy for long covid, hopefully expanded to many different populations. I think I'll go get some yogurt for lunch.
I've been thinking for a while about taking a break to reassess this blog. First, I'm not sure if the focus is optimal and whether this blog serves any unique function that isn't available elsewhere on the web. Second, I've not been happy with the design of the web site for some time, plus I've heard about problems with the subscription sign up widget not working now. I don't know that there is any good time for a pause, but now seems pretty good both from my schedule and from covid's (unpredictable) schedule.
I expect this may take at least a month or so - I want to work within the GWU system where my site is housed to look at tracking data and fixes available there, as well as to think about an entirely new site if I do decide to continue. I will provide an update post when I have a better idea of timing.
At the time I am writing this, we are all waiting for expected FDA approval of this fall's covid vaccines directed against the XBB lineage. ACIP has a meeting set for September 12 to discuss this, so I expect FDA's notice any second now! Also watch for the ACIP meeting on maternal RSV vaccination on September 22.
Nothing strikingly new on the variant front. Press releases from Pfizer and Moderna state their fall vaccines offer some immunity against BA.2.86 in addition to XBB lineages, and investigators have announced (on social media!) similar good news from in vitro studies. As usual, I'm waiting for actual data that I can assess myself.
Here is a quick update on noteworthy items from this week:
Covid variant BA.2.86 caused an outbreak in a nursing home in the East of England region of the UK - in the link, scroll down about 1/3 of the way. The attack rate was 86.6% (33 of 38 residents); so far 22 of the 33 positives have been sequenced and are BA.2.86. 29 of the 33 had received a spring covid vaccine booster. Only 1 resident required hospitalization. From the limited data presented, it appears that this very high risk population had relatively mild courses of illness.
During my hiatus, you may want to look at a few of those gazillion sites that I've found useful.
Remember that comparing covid numbers now to those from last winter or prior years can be very misleading because of dismantling of some tracking systems as well as unreported home testing and lack of testing in general. Even covid tracking for ED visits, hospitalizations, and deaths all are significantly changed. Probably only the wastewater methodology has remained similar over the few years, so I'm watching those trends more closely.
And one final optimistic note I picked up from David Brooks of the NY Times in his August 31 opinion piece (subscription required). The title was "People are More Generous Than You Think" and he referred to a scientific publication in a psychology journal that I found pretty surprising. For all I know he cherry-picked this article to come up with a heartening message, I didn't take the time to do a formal lit search and I certainly don't keep up with this subject matter.
In the study, almost 200 people in total, from 3 low-income and 4 high-income countries, were selected to receive $10,000 for whatever they wanted to use if for. The only strings attached were that they must report to the investigators how they used the money and they agreed to be randomized to either share their use of the money on Twitter or keep quiet about what they used it for. The investigators figured that the group publicizing this on Twitter would spend less of the money on themselves. That wasn't the case however. On average the individuals spent $6400 of the total on others, including $1700 on charitable donations. By and large, spending of those from lower income countries didn't differ that much from the higher income group, though the latter had slightly higher gifts to charity. The article really brightened my day, take a peek at it.
Yes, I know this blog always deals with bugs, but this time I'm referring to the slightly larger bug forms. I think I saw my first Phoebis sennae in Maryland on Friday. My wife and I had taken advantage of the unusually delightful weather to make a dash to the West River in Maryland for some kayaking. I wasn't expecting to see a butterfly haven but happened on a flutter of butterflies right beside a public boat launch area.
First I guess I should mention the other creatures you expect to hear about in these pages, recognizing that viruses aren't considered life forms so maybe are not analogous to butterflies.
Pediatric Mpox
A new article nicely describes Mpox in the pediatric population. Multiple investigators from the WHO focused on the 1.3% of Mpox cases globally that occurred in individuals under 18 years of age. Only 1 ICU admission and 0 deaths were reported. Mode of acquisition below shows that contact with infected individuals and contaminated material predominated in younger children, while sexual encounters were most common in adolescents. Some of the analysis was limited by lack of complete data such as sexual history and, to a lesser extent, clinical findings. I don't think this study included US patients, but they have been reported separately a year ago.
Vaccination Against Disease X
No, this isn't something Elon Musk (he of the bizarre fascination with the 24th letter of the alphabet) came up with. Here, Disease X refers to unknown pathogens with the potential to cause pandemics. The University of Oxford just announced US$80 million in funding to continue research on the ChAdOx technology used for the Oxford - AstraZeneca covid vaccine marketed as Novavax in the US. This vaccine was associated with rare thromboembolic events and is no longer available in the US and UK. Let's hope future pandemic preparation continues to receive funding.
COVID Variant Hand-Wringing
I still see a lot of attention to covid variants, which is appropriate, but it must be tempered by the observation that the numbers are very low. Of course, any interpretation of these numbers must be made with the recognition that cases, hospitalizations, and even deaths are not being tracked in the same way as at the height of the pandemic and thus difficult to compare to prior numbers.
The BA.2.86 variant is a major focus in spite of its very small numbers. As I've mentioned before, this attention is due to the large number of mutations that could improve its ability to escape immunity from vaccines and prior infection. The latest CDC assessment again states that there is no evidence it causes more severe disease, and the main question is still immune escape and "fitness" qualities, i.e. how well it can outcompete other variants to become predominant.
The UK has a more detailed analysis (I think I'm becoming favorably biased towards the UK reports). Here's a timeline of the current 27 BA.2.86 cases identified worldwide so far. Note that for a BA.2.86 case to be identified, the infected individual would first need to undergo testing and then have that sample sequenced, so just the tip of the iceberg here.
BA.2.86 also has been seen in wastewater samples all over the world for some time. Here is an assessment from the UK: "...the variant is present in multiple countries on multiple continents, detected at a low prevalence amongst clinical cases or in wastewater. Although an increasing number of countries are reporting detection, there is as yet no clear signal of growth within any of these individual countries...No conclusions can be drawn about the fitness of the variant based on this data, and a full range of options – from less fit than other circulating variants, to a large jump in fitness – are still possible, given the available data."
As always, stay tuned.
Number Needed to Vaccinate for Covid Vaccine
To continue in my Anglophilic vein, the UK also provided a wonderful analysis of NNV. I copied one of their tables here (IS denotes immunosuppression):
The NNV reflects the number of individuals in those categories that would need to be vaccinated to prevent one additional hospitalization. The NNV is lower in the immunosuppressed and elderly populations. The estimates don't go below age 15; as you may be aware, vaccination of children in the UK is less of a priority than in the US, so it's hard to get NNV in young children in the UK.
In general, if one looks at covid vaccination at the individual level, at every age the benefit/risk ratio of the vaccine outweigh those of natural covid infection. From a population health perspective, the cost of vaccination to society increases when younger age groups are included in the analysis.
Vibrio vulnificus
CDC issued a health alert advisory this past week. If you are unfamiliar with severe infection related to V. vulnificus, please read this. Most notable and perhaps underemphasized in the lay press are the risk factors for severe, life-threatening disease: diabetes, immunocompromised states, and liver disease. Make sure your patients with these risk factors are aware of steps to avoid this infection and what to do if early signs develop. The infection can move very rapidly in these high-risk patients.
Vladimir and Me
I'm speaking of Nabokov, the writer. He is most known (and in some misguided circles, despised) for his novel Lolita, published in 1955 (1958 in the US). Fewer people are aware that he was an accomplished lepidopterist. The September 4 issue of the New Yorker reprinted a 1948 essay where he extolls the delight of butterflies and related creatures. Who knew that a mixture of molasses, beer, and rum applied to tree trunks attracts hungry moths at night? Read the essay if you have a chance, I think limited free access is available to non-subscribers. You'll experience some incredible writing, even if you aren't convinced to love butterflies and moths.
This past week I attended an event that led me to reflect on "good will," not necessarily referring to the "peace on earth ...." quote or to the San Antonio chapter of Goodwill Industries where my mother volunteered countless hours in the last century, but a more basic understanding. Its origins may be in the New Testament or in Middle English, but regardless it is pertinent today. More on that later.
Maternal RSV Vaccine Approved by FDA
The approval finally came through, as it turned out on the last day of FDA's deadline to make a decision based on the fast tracking and other priorities assigned to it by the FDA. The FDA advisory committee did not meet again prior to this decision, they had already reviewed the data at a previous meeting in May, and FDA did not release any updated scientific documents. Perhaps lost in the fine print is the important change in the approval. The original trials looked at vaccine administration to pregnant people at 24-36 weeks gestation, but the FDA approval narrows this to 32-36 weeks. This significant change is because of concerns about the vaccine causing premature delivery; the numbers in the published trials were very low, not enough to establish a cause/effect relationship and only answerable but post-marketing surveillance when a much larger number of pregnant people receive the vaccine. However, more concern than usual was expressed because another pharmaceutical company (GSK; the approved vaccine is from Pfizer) stopped their clinical trials in pregnant people for the same reason. Delaying the vaccine administration to 32 weeks gestation is a safety move; even if the vaccine causes a higher but extremely low risk of precipitating premature birth, the clinical consequences at 32+ weeks is small; infants born at that gestational age generally do very well. The down side is that narrowing the window for vaccination creates more logistic difficulties in ensuring pregnant people have the opportunity to receive the vaccine.
Next up will be an important meeting of ACIP/CDC to put together all the recommendations, including how to manage use of maternal vaccine and the long-acting monoclonal antibody to RSV, nirsevimab. Their next scheduled meeting is September 12, but so far the only current agenda item relates to covid vaccines.
A Curmudgeonly Jab at the Lay Press
At my age, what else do I have to do besides complain? I was annoyed by 2 items percolating through the lay press this past week.
BA.2.86
This new but relatively rare covid sublineage is popping up in every news feed there is. I've mentioned it before. Although it is present in only very low numbers, the pattern of mutations it carries suggests that it will be very effective at evading immunity from prior infection or vaccines, perhaps including the new XBB-derived vaccine to be available soon. Biobot helps put this in perspective. First, wastewater covid levels seem to have plateaued in the US and are still well below what we say in winter 2023.
Second, this variant doesn't even appear in wastewater data, although note the graph only reflects sequencing through the week of August 7.
In addition to following wastewater data, the next likely useful piece of information should be some in vitro data on ability of serum from study volunteers who received the new covid vaccine to neutralize newer variants, including BA.2.86. Given how long the assays take, we should see some information in September. A silver lining for all the publicity is that it could speed up the peer-review process for publication so we won't need to rely on non-peer-reviewed data. Look for a research letter in the New England Journal of Medicine relatively soon (just my prediction).
My second gripe is with the reporting on a supposed tripledemic resulting in school closures in Lee County, Kentucky, alleged to be caused by a combination of covid, influenza, and group A streptococcal infections. What seems to be missing in all the reports is how these etiologies were established. It sounds like it was just what parents or school staff were calling covid, flu, or strep, rather than based on careful testing.
It's a little early for influenza in Kentucky, not that it's impossible, but so far CDC data haven't shown it.
I didn't find anything about it on the Kentucky state flu site.
Group A strep infections aren't reliably reported, and the problem with GAS diagnoses is the relatively high carrier rate of the organism, around 10-15% in the pediatric population. So, if someone tests a child with a viral illness (e.g. rhinovirus/enterovirus, which is prominent this time of year), 10-15% will test positive for GAS.
More reliable but less relevant to Kentucky are recent data from England about GAS hospitalizations:
This may reflect changes in epidemiology during and after the pandemic, but I'm still skeptical of the characterization of etiologies for the Kentucky school illnesses. I hope we'll hear more eventually.
Fungus Amongus
I received a COCA Now notice from the CDC nicely summarizing concerning trends in fungal strains causing ringworm and nail infections. It may be that we are in the midst of rising rates of resistance to commonly-used antifungal medications to treat these diseases. A big problem for clinicians is that treatment response may be normally slow, requiring weeks to months of therapy, so it can take a long time to figure out if the infection isn't responding. Keep this in mind if you notice children with poor responses to treatment, and consider culture and susceptibility testing with a qualified lab.
Paxlovid Resistance
No surprise to anyone, but a new report characterizes nirmatrelvir (Paxlovid) resistance in an immunocompromised patient, exactly the sort of setting we'd expect to see for development of resistance. This isn't the first report of Paxlovid resistance, and it won't be the last. I wouldn't worry about it yet, but, like most treatments for infectious diseases, resistance becomes a problem sooner or later.
My Night in a Brewpub
Not one of my usual habitats, but this was for a good cause: a special meeting of the Greater Washington Infectious Diseases Society at a brewpub in Bethesda, MD. You won't find a web link for GWIDS, not because it's a secret society but because no one has gotten around to making one in the few decades of GWIDS' existence. It's a monthly meeting of adult and pediatric infectious diseases training programs in the DC area where fellows in training present challenging and usually obscure infection cases and try to stump the stars in attendance. Basically it is heaven for an infectious diseases nerd.
This meeting was our first in person since the pandemic began. It was special because Dr. Anthony Fauci, an annual speaker usually at the end of the year, was featured in what was supposed to be a fireside chat now transformed into a vatside chat. I moderated the session only because the first 50 or so choices for moderator weren't available. We gathered a list of questions from members prior to the meeting plus opened up for questions from the audience at the end. A good time was had by all, although I myself missed out on the refreshments.
One of the questions I asked, the only one I submitted, was for Dr. Fauci to help us understand the differences between the criticisms he received during the early days of the AIDS pandemic and the terrible threats he now receives from various covid crazies. (Three guys looking very muscular, with receivers in their ears and bulges under their coats, were the only non-GWIDS members present; Fauci came and went in one of those flashing-light black SUVs that disrupt traffic all over the DC area.)
In 1988, Larry Kramer, one of the earliest AIDS activists and a leader in the movement (also an accomplished playwright and author), published letters to Fauci in the Village Voice and the San Francisco Examiner. I read excerpts from those documents, and if you didn't know the context it would be perfectly reasonable to assume they were written recently. Kramer called him a murderer, an idiot, and a liar, among the repeatable epithets. I can't quote Dr. Fauci's response accurately, I wasn't taking notes, but the gist of his reply was that the AIDS and covid personal attacks, while sounding similar, are completely different. The difference boils down to Good Will.
AIDS protesters wanted to work to a solution; they were terribly critical of Fauci as a person as well as of policies of FDA and NIH. The end result was a revamping of the research and approval process for AIDS (and thus other treatments) that resulted in a quicker and more effective benefit to society. According to Fauci, those AIDS activists were motivated by good will and demonstrated willingness to collaborate on a solution. Nothing like that exists in today's Fauci demonization.
Read Tony's NY Times essay on Mr. Kramer and "loving difficult people," and take a little time to practice some good will.
