Yes, we should all get boosters! Eventually.

The hubbub for the past few weeks in the U.S. has been all about whether or not the government should recommend that people get booster shots for Covid-19. Conflicting messages have emerged, with some officials saying boosters will be recommended, and others saying boosters are unnecessary or premature.

Just this past Friday, an expert panel at the FDA recommended boosters for people over 65 and for immunocompromised people, but not for anyone else.

But here’s the thing: boosters obviously help to fight Covid-19. In all the objections I’ve read, I can’t find any credible scientific or medical reason not to get a booster. All else being equal, you should get a booster vaccine, probably around 6-8 months after your second shot (if you had a 2-shot vaccine).

The confusion–and the arguments–derive from that little phrase I threw in there, “all else being equal.” You see, it’s really not controversial that a booster vaccine provides better immunity against an infection. We already have boosters for other vaccines, and there’s a wealth of very strong evidence showing that they work. For the Pfizer/BioNTech and Moderna Covid-19 vaccines, we have some early data showing that they, too, provide an excellent boost in antibody levels, which means (almost certainly) that the recipients of the boosters have better protection against Covid-19.

Indeed, a just-published Israeli study shows that in people over 60, the risk of severe disease drops nearly 20-fold and the rate of infection drops by a factor of 11 after a booster shot. (The study only looked at people over 60 because they were the only ones who got boosters.)

So yes, boosters work. The best arguments against them, scientifically, are that we don’t yet know exactly how well they work. That’s merely because these vaccines have only existed for a short time, so of course we haven’t had time to collect much data. But all the data that we do have is positive. So I’d be willing to bet a large sum of money that the evidence in favor of boosters is only going to get stronger.

But all else is not equal. What’s not equal is access to the vaccines. In the U.S., we have an excess supply, so much that pretty much anyone can get a vaccine by simply walking into one of several national-chain pharmacies, without even making an appointment. And that includes those who want a third shot (an unauthorized booster).

Meanwhile, though, many countries still face a severe shortage of vaccines. In most of Africa, for example, only 1-2% of people have received even one dose of any vaccine. Just this week, President Biden authorized a purchase of 500 million Pfizer vaccines that the U.S. will ship to other countries, and we’re going to need more. The pandemic is a worldwide crisis, and as long as the virus is circulating widely in any country, it is a threat to everyone.

Thus the argument against boosters is not a scientific one. The argument is really about where to ship the vaccines that we have. For example, as several vaccine experts wrote in this Lancet article last week, “even if some gain can ultimately be obtained from boosting, it will not outweigh the benefits of providing initial protection to the unvaccinated.”

The only problem with that statement is the use of “even if”: we already know that boosting almost definitely provides a benefit, so they should have acknowledged that fact.

So the question about boosting really should be a different one: what should the U.S. do with its abundant vaccine supply? Should it allow people to get a booster shot, which is clearly beneficial? Or should we make sure those shots go to people who haven’t yet been vaccinated at all?

It’s perfectly reasonable to argue, as some have, that we should get first shots into people’s arms before we start administering 3rd shots. If the choice is 1st shot versus booster, then yes, we need people to get their first shot. But that doesn’t justify any statements playing down the benefits of booster shots.

And is that really the choice? Well, no. At the moment, the U.S. is wasting millions of shots per month, most of them in retail pharmacies that aren’t using their full supply. The vaccines expire quickly, and it’s simply impossible to manage the supply so that all doses are used. At a minimum, we could offer the extra doses (at the end of each day, say) as 3rd shots to anyone who wants them. The alternative is to throw them away.

So to the public health authorities who are saying “no” or “not yet” to boosters: cut it out! You know very well that boosters almost certainly work, and you also know that in a year or two, we’ll likely be recommending boosters for everyone. When that time rolls around–and it will–people will be asking, quite reasonably, why you are contradicting yourself? And you can be sure that the anti-vax crowd will queue up every quote they can find in which government officials expressed any doubt about boosters.

We saw a near-identical version of this scenario play out very early in the pandemic, only then it was over masks. In early 2020, few prominent public health officials in the U.S. made ill-advised statements that people shouldn’t wear masks. They were worried that we didn’t have an adequate supply of masks, but they knew perfectly well that masks helped prevent transmission of the virus. Even so, they made statements casting doubt on masks, thinking that this would help preserve the very limited (at that time) supply. Those statements were truly damaging, and they contributed to the toxic anti-mask movement in the U.S. today.

The same thing seems to be happening again. The public health experts speaking out against boosters are worried about the supply of vaccines. So they are making statements casting doubt on the efficacy of boosters, statements that are potentially very damaging. For example, the recent Lancet piece states that “currently available evidence does not show the need for widespread use of booster vaccination.” But in the same article they admit that widespread boosting “might ultimately be needed because of waning immunity.”

Vaccine booster shots work, and the experts know it. To fight this pandemic, we need more vaccines, including boosters. We don’t need more misinformation.

Ivermectin doesn't work for treating or preventing Covid-19, even if your favorite FoxNews host says it does

Recently the world has been treated to a flood of misinformation about ivermectin, an anti-parasitic drug that some people thinks can treat or prevent the Covid-19 virus.

It can’t, but that hasn’t stopped a variety of Fox News hosts, including Sean Hannity, Tucker Carlson, and Laura Ingraham, from pushing it for months. As a result, prescriptions for ivermectin have increased like crazy. Here’s a chart just released by the CDC, showing the weekly number of prescriptions over the past two years:

As you can see, the numbers shot up at the beginning of this year, to 40,000 prescriptions per week, and this past month they shot up again, to over 80,000 per week. All this ivermectin has had no effect at all on Covid-19 infections, which have continued to rise, but that hasn’t stopped people from desperately trying to get ivermectin.

Ivermectin doesn’t work. It doesn’t prevent Covid-19, nor does it treat it. Unfortunately, the official government response to this misinformation has once again failed to be blunt enough, with a few exceptions. More on that below, but first let’s review what the heck ivermectin is.

Ivermectin is used to treat two relatively rare (in the U.S.) parasites: a nematode called Onchocerca volvulus that causes river blindness, and an intestinal nematode called Strongyloides stercoralis. (Both of these are sometimes called worms, but they are microscopic in size, and unrelated to the worms that most people are familiar with.) Nematodes are not even remotely similar to viruses, and there’s no reason to think that a treatment for nematode infections will cure a virus–unless, apparently, a popular talk show host claims that it will.

Ivermectin also used for de-worming livestock such as cows and horses, which means that veterinarians carry supplies of ivermectin, often in very large doses. The veterinary form is available in a paste that you can feed to animals. This has resulted in a number of people buying and consuming large amounts of ivermectin–or, as one person put it, “eating horse goo from the tractor store.” This does not usually end well.

Here’s an example from the CDC’s latest health advisory:

An adult drank an injectable ivermectin formulation intended for use in cattle in an attempt to prevent COVID-19 infection. This patient presented to a hospital with confusion, drowsiness, visual hallucinations, tachypnea [abnormally rapid breathing], and tremors. The patient recovered after being hospitalized for nine days.

So: not good. This case and others prompted the FDA to tweet, in a rare instance of bluntness: “You are not a horse. You are not a cow. Seriously, y'all. Stop it.”

The FDA also issued a news release explaining why people should not use ivermectin to treat or prevent Covid-19, and especially not to use doses designed for large animals. It’s dangerous, as the case cited by the CDC illustrates.

Where did this interest in ivermectin begin? Just a couple of days ago, NBC News reporter Ben Collins put together an excellent Twitter thread explaining some of the recent history. One of the main sources was a sketchy group called America’s Frontline Doctors, which was founded by an anti-vaxxer named Simone Gold, who as Collins explained “spent the last year barnstorming churches and schools, insisting COVID vaccines cannot be trusted.”

Despite its name, America’s Frontline Doctors is most definitely not working on the “front lines” treating patients, but instead is a right-wing political organization known primarily for spreading Covid-19 misinformation. Last year they promoted hydroxychloroquine as a Covid-19 treatment, which didn’t work. More recently, they have been offering online consultations to people who wanted ivermectin. The consultations cost $90, which didn’t include the cost of the medicine, but they’d connect you to a pharmacy that would deliver it.

(Aside: in an interesting twist, Simone Gold has been indicted and is now awaiting trial for her role in the January 6 insurrection at the U.S. Capitol in Washington, D.C.)

So here we are: 80,000 prescriptions per week for a drug that doesn’t work for treating or preventing Covid-19. Above, I wrote that the government isn’t responding clearly enough to this misinformation: here’s what I mean by that.

Scientists and doctors are trained to speak very carefully and precisely to one another. So rather than saying “X is false” or “Y doesn’t work,” we say “we don’t have evidence that X is true,” or “the evidence doesn’t support the effectiveness of Y.” That’s all well and good when you’re speaking to another scientist, but the general public hears these statements as something more like “X might work but we are still looking at the evidence.”

Uh uh. Not a good way to talk to the public.

Now, there actually have been several studies of ivermectin as a treatment for Covid-19, and here’s where the story might get confusing–but I’m going to try to keep it really clear. Virtually all of the studies showed that ivermectin simply doesn’t work, but one study out of Egypt (by Elgazzar et al.) seemed to show that it worked quite well. That was really surprising, but the story collapsed pretty quickly: it turned out the data was falsified, and parts of the paper were plagiarised. About a month ago, the study–which was still an un-reviewed preprint, was retracted by the publisher, Research Square.

Making things more confusing, several meta-analyses have already been published that relied on the flawed Egyptian study, and some of those papers report that ivermectin is effective. But a meta-analysis doesn’t contain any original data; instead, it’s an analysis that combines the results from a bunch of other studies. Those positive findings from meta-analysis papers rely heavily on the falsified Egyptian study, and (it turns out) on another very flawed study. For a deeper dive into those, see this excellent breakdown by the epidemiologist (and journalist) Gideon Meyerowitz-Katz (@GidMK, aka HealthNerd), who posted a long Twitter thread detailing the reasons why these meta-analyses, and some of the studies they include, cannot be trusted.

So the scientific picture is already clear: multiple studies show that ivermectin does not work. But rather than saying that in simple, direct English, here’s what the CDC states in their August 26 Health Advisory:

“there are currently insufficient data to recommend ivermectin for treatment of COVID-19”

“Clinical trials and observational studies to evaluate the use of ivermectin to prevent and treat COVID-19 in humans have yielded insufficient evidence for the NIH COVID-19 Treatment Guidelines Panel to recommend its use”

“Be aware that currently, ivermectin has not been proven as a way to prevent or treat COVID-19.”

The FDA isn’t much better (except for that one tweet). In a consumer advisory with the title “Why You Should Not Use Ivermectin to Treat or Prevent COVID-19”, they write:

“The FDA has not reviewed data to support use of ivermectin in COVID-19 patients to treat or to prevent COVID-19; however, some initial research is underway.”

See what I mean? This is how you’d explain things to another scientist, but the general public needs much more direct language.

So I’m saying it here: ivermectin doesn’t work in any way for Covid-19. It doesn’t prevent infection, it doesn’t cure the disease, and it doesn’t reduce your risk of anything.

Or, as the FDA’s Twitter account so eloquently put it, “You are not a horse. You are not a cow. Seriously, y'all. Stop it.”

The FDA needs to approve the COVID-19 vaccines. Right now.

I’ve spent untold hours fighting bureaucracy during the course of my life. Sometimes the issues are big, sometimes small, but I often get incredibly frustrated when I see organizations–and the people who work for them–enforcing rules without thinking, often to the detriment of everyone involved.

Usually, though, bureaucratic rules are little more than annoying time-wasters. They don’t usually cause actual harm to people. Right now, though, the FDA’s failure to fully approve the Covid-19 vaccines, and its rigid adherence to its own rules, is not just wasting time. It’s killing people, albeit indirectly.

The FDA needs to approve the Covid-19 vaccines, and they need to do it now. They claim to be working hard on doing just that. The vaccines have already been administered to hundreds of millions of people, and the ones used in the U.S. and Europe have proven to be remarkably safe and amazingly effective. So what is the FDA waiting for? Well, according to them, they have to wade through the paperwork.

As nearly everyone knows, here in the U.S. we have three approved vaccines against SARS-CoV-2, from Pfizer-BioNTech, Moderna, and Johnson & Johnson. The first two are messenger RNA (mRNA) vaccines, an innovative design that is strikingly effective, reducing the chance of infection by over 90%.

The U.S. now has an ample supply of vaccines, but we are struggling to get everyone vaccinated, in large part because so many people are either hesitant to get the vaccine or downright opposed. Let’s leave aside the blatant anti-vaxxers for today, many of whom are so deeply misinformed that changing their minds is probably impossible.

A much bigger problem, and one that we can fix, is the far larger number of people who are waiting for the vaccines to get full FDA approval. Not only are many individuals waiting, but many large institutions, including the U.S. Defense Department, have announced that they will mandate vaccines for their personnel once the FDA formally approves them.

Right now, the 3 vaccines in the U.S. are only conditionally approved, under the FDA’s Emergency Use Authorization (EUA). The fact sheet that the FDA provides with these vaccines includes a number of caveats, and states that “there is no FDA approved vaccine to prevent Covid-19.” That statement is not, to put it mildly, very convincing.

Full approval requires the FDA to review “hundreds of thousands of pages of documents,” a process that usually takes 10 months, or maybe six months for a “priority” application. Pfizer only submitted its paperwork on May 7, and Moderna on June 1, so even the FDA’s priority process would leave us without an approved vaccine until the end of 2021. That’s just too long.

I’ve heard the FDA’s excuses. The FDA’s Director of Biologics, Peter Marks, explained in a letter to the NY Times that

“any vaccine approval without completion of the high-quality review and evaluation that Americans expect the agency to perform would undermine the F.D.A.’s statutory responsibilities, affect public trust in the agency and do little to help combat vaccine hesitancy.”

Sorry, Dr. Marks, but these excuses are nonsense. The Covid-19 vaccines have been rolled out with unprecedented speed, it’s true, but we’re now seeing the results of a real-time, real-world experiment on hundreds of millions of people, and–luckily–the results are great! Have you and your colleagues at the FDA not noticed this?

Furthermore, everyone knows that the vaccines will be fully approved in the next few months, and multiple government officials, including the President, have said so quite openly. So why not approve them today? Because you have to follow a set of bureaucratic rules that were not designed for a pandemic?

The virus doesn’t care about the rules. Infections in the U.S. are skyrocketing again, because of the Delta variant, and the only way to end this pandemic is to get nearly everyone vaccinated. Until we have full approval of the vaccines, we’re simply not going to get there. By relying exclusively on the paperwork provided by the vaccine manufacturers, and ignoring the enormous amount of real-world data that everyone can see, the FDA is prioritizing process over results.

The FDA says that it’s now in a “sprint” to approve the vaccines, but with every day that passes, more people get sick, and the virus has more time to mutate and become more deadly.

Listen, FDA: rules are created for a reason. In case you haven’t noticed, the pandemic is a worldwide emergency that cries out for you to bend or break the rules if doing so will save lives. We all want a safe and effective vaccine, but there’s an overwhelming amount of evidence that we already have at least 3 of them (and probably 6 or 7). You can approve the Pfizer-BioNTech and Moderna vaccines today, and if new data emerges, or if you discover something startling and unexpected in those millions of pages of paperwork, you can withdraw approval. There’s nothing preventing this except bureaucracy.

So don’t tell us that you (FDA) have to “complet[e] the high-quality review” or you’ll somehow be shirking your responsibility. That response is equivalent to saying “we can’t look at the overwhelming evidence from the real world, we can only look at the paperwork that the vaccine companies provided to us.” In other words, “nanner nanner we can’t hear you” rather than considering the fact that hundreds of millions of people have taken the vaccine and that it’s working.

And about that comment from the FDA about maintaining public trust? As Dr. Eric Topol pointed out in a recent op-ed, somehow the FDA managed to approve, in the midst of the pandemic, an incredibly expensive new Alzheimer’s drug (aducanumab) for which the evidence of effectiveness is very thin, and the risks of harm are very real. The FDA’s own advisors resigned in protest, and now the FDA’s inspector general is going to take another look at how this happened. And yet the FDA is worried about “public trust in the agency”? Give me a break. Meanwhile, the FDA can’t seem to find the time to approve the mRNA vaccines “despite massive evidence of their benefits.”

The FDA needs to stop hiding behind the mountain of paperwork. Millions of people will remain unvaccinated while the FDA reviews documents that merely tell us what we already know: the vaccines work, and they are safe. Give them full approval, today, and continue to monitor their safety carefully, and many lives will be saved.

It's time to shut down the Disinformation Dozen

I’ve been writing about anti-vaxxers for a dozen years now, warning of the threat to public health that they represent. Today, though, the threat is far greater than it was in the past, because we're in the midst of a deadly pandemic, and vaccines are our only tool out of it. Merely educating the public on the benefits of vaccines isn’t working in the face of a deluge of misinformation from anti-vaxxers. It’s time to take away their platforms.

A new report from the nonprofit Center for Countering Digital Hate (CCDH) reveals that 65% of the anti-vaccine disinformation online can be traced to just twelve people. This offers hope that we can actually do something: by removing a tiny number of accounts, millions of lives can be saved. The social media platforms have the power to do this, and they could do it virtually overnight.

(No, I’m not calling for censorship, and no, they don’t have any 1st amendment rights to spread their lies. I’ll get to that below.)

A bit of background: the modern anti-vax movement started in the late 1990s, focusing primarily on childhood vaccines, especially the vaccines against measles, mumps, and rubella, and using (initially) a fraudulent study published in The Lancet to scare people about a non-existent link between vaccines and autism. That study was eventually retracted, and the lead author, Andrew Wakefield, lost his medical license after his fraud came to light.

But the damage was done. Anti-vaxxers and the misinformation they spread on social media caused vaccination rates to drop in the US and the UK, and in other countries, and diseases such as measles, which we had essentially eliminated in the US, started to re-emerge. Tragically, some people died of completely preventable diseases. One thing we’ve learned from the past 20 years is that once anti-vaxxers start spreading their misinformation, it’s incredibly difficult to correct the falsehoods.

Anti-vaxxers today have turned their social media efforts towards attacking the Covid-19 vaccines. (They actually started attacking the vaccines before the vaccines even existed, a kind of reality-twisting that would be funny if it weren’t so tragic.)

Covid-19 has already killed millions, and millions more may die before we get it under control. The only realistic way to end the pandemic is through vaccination. Fortunately, we now have multiple highly effective vaccines, as I’ve written about several times in the past year. Unfortunately, a large segment of the population has been grievously misled, and many people say they will never get vaccinated. The pandemic might persist for years, hurting all of us, if these people continue to refuse vaccines.

The anti-vax movement constantly spreads lies, rumors, and misinformation in an effort to scare people away from vaccination. I won’t repeat the lies here, because merely stating them gives them more credibility than they deserve. But the anti-vaxxers and the social media platforms that spread their messages must be stopped. As President Biden said this past Friday, “they’re killing people.”

One particularly unfortunate development in the US is that the anti-vax position has become hyper-political. Even though Trump has claimed credit for developing the vaccines, and even though he and his family were vaccinated as soon as the vaccines became available, many leaders of the Republican party and on right-wing media such as Fox News have embraced anti-vaccine positions, and have told their millions of followers to refuse vaccination. Logically, it makes no sense that vaccine refusal has become a political issue, but it has.

The good news is that we might actually be able to stop the anti-vaxxers. The CCDH report on the Disinformation Dozen shows that these 12 people, who collectively have 59 million followers, are responsible for 73% of the anti-vax content on Facebook and 65% of anti-vaccine messages on other major platforms, including Twitter, Instagram, and YouTube. This in turn means that if the social media platforms will simply shut down their accounts (and other sites that they control, such as the misleadingly-named Children’s Health Defense and National Vaccine Information Center), we will see a dramatic reduction in false vaccine information, virtually overnight.

So who are the Disinformation Dozen? Here they are:

  1. Joseph Mercola
  2. Robert F. Kennedy, Jr.
  3. Ty and Charlene Bollinger
  4. Sherri Tenpenny
  5. Rizza Islam
  6. Rashid Buttar
  7. Erin Elizabeth
  8. Sayer Ji
  9. Kelly Brogan
  10. Christiane Northrup
  11. Ben Tapper
  12. Kevin Jenkins

I’ve written about Mercola and RFK Jr. before, multiple times, but not the others. I’m intentionally not providing links to their anti-vax accounts, which include Facebook, Instagram, Twitter, YouTube, and dedicated websites, because any links simply add to their influence. Mercola, for example, has become wealthy by selling dietary supplements with unproven and often bogus health claims, and by pushing anti-vaccine myths, as I wrote all the way back in 2010. Perhaps if people realized this, they wouldn’t be so quick to believe him.

It’s time to de-platform the anti-vaccine Disinformation Dozen. In our current world, this can only happen if the companies themselves–Facebook, Instagram, Twitter, and Google–delete their accounts. One might expect that these companies would have already done this, based on their own policies, but as the CCDH report states:

“Despite repeatedly violating Facebook, Instagram and Twitter’s terms of service agreements, nine of the Disinformation Dozen remain on all three platforms, while just three have been comprehensively removed from just one platform.”

This isn’t a free speech or First Amendment issue; private companies aren’t required to provide a platform for anyone. And I’m not calling for the Disinformation Dozen to be arrested or legally punished for spreading misinformation, even though it is harmful, and even though they are indirectly killing people by their actions. But private companies can kick anyone off their platforms, whenever they want, and if these companies care at all about public health, and about the health of their own customers, they’ll delete all the accounts associated with these 12 people.

Finally, let me get a bit philosophical. It’s astonishing that we’ve created a society where we appear to be powerless to stop the spread of lies and distortions that are actually killing people. Our technology allows anti-vaxxers to reach millions of people and to convince those people to take actions that harm not only themselves, but all of us, because they’re allowing the virus to spread and mutate. It appears that our governments simply don’t have the power to force Facebook, Twitter, YouTube, Google, and Instagram to shut down these accounts, so instead we rely on the whims of a tiny number of people who run those companies.

Should governments step in here and force the companies to take action? I don’t know, but so far the companies themselves have failed to take action on their own. Germany and France seem to have the best solution so far: by requiring vaccines in order to eat at restaurants and travel on planes and trains, they’ve convinced large swaths of their populations, including formerly vaccine-hesitant people, to get vaccinated. The US, by contrast, has 50 different policies for 50 states, including some policies that are straight-up anti-vaccine. There must be a better way.

Does drinking coffee reduce the risk of atrial fibrillation? Maybe just a little.

Atrial fibrillation is the most common type of heart arrhythmia in the U.S. and Europe, affecting millions of people every day. A-fib is a condition where your heart beats irregularly and less efficiently than normal. Some people experience a-fib without even being aware of it, but it is a serious condition that leads to an estimated 750,000 hospitalizations per year in the U.S. alone.

The causes of a-fib are not completely understood, but one widespread view is that too much caffeine might trigger it. For example, the American Heart Association’s website says that “Avoiding atrial fibrillation and subsequently lowering your stroke risk can be as simple as foregoing your morning cup of coffee.” Although the site goes on to describe more substantial treatments such as beta blockers and calcium channel blockers, the idea of simply cutting out coffee seems very appealing.

As appealing as it sounds, this advice is wrong, at least for men.

In a study published in 2019 in the Journal of the American Heart Association, Vijaykumar Bodar and colleagues at Harvard Medical School looked at data from nearly 19,000 men who participated in the long-term Physicians’ Health Study. They looked at the risk of atrial fibrillation in men drinking anywhere from no coffee at all to 4 or more cups per day.

They found, somewhat surprisingly, that men who drank 1-3 cups of coffee per day had a 15% lower risk of a-fib compared to men who never or almost never drank coffee. They also found a small hint of a “dosage” effect, with the greatest reduction in risk at about 1.5 cups per day, and less benefit as consumption rose to 4 or more cups.

In a commentary published along with the study, Ryan Aleong and Amneet Sandhu point out that coffee contains a number of ingredients that might explain its cardiovascular benefits. They also point out, though, that the benefits are modest at best.

Unfortunately for women, though, coffee doesn’t seem to have the same benefits for them. Back in 2010, the Women’s Health Study reported that higher caffeine consumption did not increase the risk of a-fib in women, but it didn’t decrease it either. In a subgroup of women drinking the highest amount of coffee, they reported a slight increase in the risk of a-fib, but those women also smoked more often.

(Actually, if you look closely at the numbers in Table 2 of the Women’s Health Study report, women in the group who consumed an average amount of caffeine had a 20% lower risk of atrial fibrillation, consistent with the more recent study in men.)

For those of us who like coffee, this seems to be good news. At worst, coffee isn’t bad for heart health, and at best it might slightly reduce the risk of atrial fibrillation.

Some caveats: although these are large studies with thousands of men and women followed for many years, they rely on self-reporting of coffee consumption, which isn’t perfect. That’s probably the best we can do, though, since it’s impractical to measure caffeine consumption precisely over a long period of time.

The best advice, then, appears to be to keep drinking one or two cups of coffee per day, if you enjoy it. For those who have atrial fibrillation, cutting out that morning coffee, as the American Heart Association suggests, is very unlikely to help.

Why the "Lab Leak" Hypothesis Doesn’t Mean the COVID-19 Virus was Engineered

The “lab leak” hypothesis about the origin of Covid-19 has been getting a lot of attention lately, and deservedly so. This is the idea that the SARS-CoV-2 virus accidentally escaped from a laboratory in Wuhan, China, that conducts research on coronaviruses. Just a few weeks ago, a group of highly respected virologists and epidemiologists published a letter in the journal Science calling for a more thorough investigation, stating that the lab leak hypothesis was not taken seriously enough in earlier investigations.

The coincidence of having a major virus research facility, the Wuhan Institute of Virology (WIV), just a short distance from the live animal food market that was originally believed to be the source of the outbreak is too great to ignore. Even more curious is that WIV was actively doing research on coronaviruses in bats, including the bats that carry a strain of SARS-CoV-2 that is the closest known relative to the Covid-19 virus itself.

From the beginning of the outbreak, attention was focused on WIV, and various conspiracy theorists suggested, without any evidence, that the Covid-19 virus was either intentionally engineered, intentionally released, or both. Let me just say right off the bat that I don’t believe either of those claims.

However, I do think the lab leak hypothesis is credible, and it’s also possible that “gain of function” research (more about this below) might be responsible.

In arguing against (unsupported) claims that the Chinese released the virus on purpose, a group of virologists published a paper very early in the pandemic, in March 2020, which looked at the genome sequence of the virus and concluded that “SARS-CoV-2 is not a laboratory construct or a purposefully manipulated virus.” Other studies since then have come to similar conclusions: the virus is very similar to naturally-occurring coronaviruses, and it is possible that it simply evolved naturally in the wild, probably in bats.

Even so, the lab leak hypothesis remains highly credible, regardless of whether or not the virus was genetically engineered. Here’s why. First, we know that lab accidents can happen and viruses can escape, even if these accidents are rare. We also know that the Wuhan Institute of Virology had thousands of viruses, including coronaviruses, in its facility. And despite claims that viruses couldn’t possibly have escaped accidentally, a 2017 Nature article describing the then-new Wuhan Institute reported, perhaps prophetically, that “worries surround the [Wuhan Institute of Virology], too. The SARS virus has escaped from high-level containment facilities in Beijing multiple times.”

The secrecy of the Chinese government, which has not yet allowed independent, outside scientists full access to WIV to investigate, hasn’t helped matters. We need to know if any viruses in WIV are similar to the Covid-19 virus, and at this point we can’t trust the Chinese government’s assurances on this question. Of course, even if they allow outsiders to investigate now, we cannot know that they have preserved all the viruses that were present in the lab in the winter of 2019-2020.

Now let’s talk about gain-of-function research. Gain of function, or GoF, refers to research that tries to make viruses or bacteria more harmful, by making them more infectious. This seems crazy, right? And yet it’s been going on for years, despite the efforts of many scientists to stop it. In the past, GoF research focused on the influenza virus, and in particular on a small number of scientists (highly irresponsible ones, in my view) who were trying to give avian influenza–bird flu–the ability to jump from birds into humans. I wrote about this in 2013, and in 2017, and again in 2019, each time calling on the US government to stop funding this extremely dangerous work. The NIH did put a “pause” on gain-of-function research for a few years, but the work resumed in 2019.

Now, let me explain why GoF research does not require artificially engineering a virus. Viruses mutate very rapidly all by themselves, and RNA viruses like influenza and SARS-CoV-2 mutate even more rapidly than DNA viruses. So a GoF experiment doesn’t need to engineer a virus to make it more infectious: instead, scientists can simply grow a few trillion viral particles, which is easy, and design experiments to select the ones that are more infectious. For example, some GoF research on bird flu simply sprays an aerosol mixture of viruses into a ferret’s nose (influenza research often uses ferrets, since you can’t ethically do this with people), and waits to see if the ferret comes down with the flu. If it does (and this has been done, successfully), the strain that succeeds now has a new function, because it can infect mammals. The viruses that are artificially selected (as opposed to natural selection) in these experiments will appear completely natural; no genetic engineering required.

We know that WIV was conducting gain-of-function experiments, and we know that its work included coronaviruses. Was the Wuhan Institute of Virology running GoF experiments on SARS-CoV-2 viruses from bats? Possibly. And if it was, these experiments could easily have produced a strain that infected humans. If a lab employee was accidentally infected with such a strain, that could have started the pandemic. And even if SARS-CoV-2 wasn’t the subject of GoF experiments, a naturally-occurring strain being studied at WIV could still have infected one of their scientists and thereby leaked out into the population.

I’m not saying that any of these events is likely. I am, however, agreeing with the scientists who, in their recent letter to Science, called for a deeper investigation into the cause of the Covid-19 pandemic.

Finally, let me echo a sentiment they expressed in their letter, which is best said by simply quoting them: “in this time of unfortunate anti-Asian sentiment in some countries, we note that at the beginning of the pandemic, it was Chinese doctors, scientists, journalists, and citizens who shared with the world crucial information about the spread of the virus—often at great personal cost.” Rather than seeking to cast blame, we need to uncover the origin of the Covid-19 pandemic, and any behaviors that led to it, as a means to help all societies prevent future pandemics.