Category Archives: Guest Posts

America’s Obesity Epidemic Threatens Effectiveness of Any COVID Vaccine

By Sarah Varney, Kaiser Health News August 6, 2020; Photos: Chokniti Khongchum

For a world crippled by the coronavirus, salvation hinges on a vaccine.

But in the United States, where at least 4.6 million people have been infected and nearly 155,000 have died, the promise of that vaccine is hampered by a vexing epidemic that long preceded COVID-19: obesity.

Scientists know that vaccines engineered to protect the public from influenza, hepatitis B, tetanus and rabies can be less effective in obese adults than in the general population, leaving them more vulnerable to infection and illness. There is little reason to believe, obesity researchers say, that COVID-19 vaccines will be any different.

“Will we have a COVID vaccine next year tailored to the obese? No way,” said Raz Shaikh, an associate professor of nutrition at the University of North Carolina-Chapel Hill.

“Will it still work in the obese? Our prediction is no.”

More than 107 million American adults are obese, and their ability to return safely to work, care for their families and resume daily life could be curtailed if the coronavirus vaccine delivers weak immunity for them.

In March, still early in the global pandemic, a little-noticed study from China found that heavier Chinese patients afflicted with COVID-19 were more likely to die than leaner ones, suggesting a perilous future awaited the U.S., whose population is among the heaviest in the world.

And then that future arrived.

As intensive care units in New York, New Jersey and elsewhere filled with patients, the federal Centers for Disease Control and Prevention warned that obese people with a body mass index of 40 or more — known as morbid obesity or about 100 pounds overweight — were among the groups at highest risk of becoming severely ill with COVID-19. About 9% of American adults are in that category.

As weeks passed and a clearer picture of who was being hospitalized came into focus, federal health officials expanded their warning to include people with a body mass index of 30 or more. That vastly expanded the ranks of those considered vulnerable to the most severe cases of infection, to 42.4% of American adults.

Obesity has long been known to be a significant risk factor for death from cardiovascular disease and cancer. But scientists in the emerging field of immunometabolism are finding obesity also interferes with the body’s immune response, putting obese people at greater risk of infection from pathogens such as influenza and the novel coronavirus. In the case of influenza, obesity has emerged as a factor making it more difficult to vaccinate adults against infection. The question is whether that will hold true for COVID-19.

A healthy immune system turns inflammation on and off as needed, calling on white blood cells and sending out proteins to fight infection. Vaccines harness that inflammatory response. But blood tests show that obese people and people with related metabolic risk factors such as high blood pressure and elevated blood sugar levels experience a state of chronic mild inflammation; the inflammation turns on and stays on.

Adipose tissue — or fat — in the belly, the liver and other organs is not inert; it contains specialized cells that send out molecules, like the hormone leptin, that scientists suspect induces this chronic state of inflammation. While the exact biological mechanisms are still being investigated, chronic inflammation seems to interfere with the immune response to vaccines, possibly subjecting obese people to preventable illnesses even after vaccination.

An effective vaccine fuels a controlled burn inside the body, searing into cellular memory a mock invasion that never truly happened.

Evidence that obese people have a blunted response to common vaccines was first observed in 1985 when obese hospital employees who received the hepatitis B vaccine showed a significant decline in protection 11 months later that was not observed in non-obese employees. The finding was replicated in a follow-up study that used longer needles to ensure the vaccine was injected into muscle and not fat.

Researchers found similar problems with the hepatitis A vaccine, and other studies have found significant declines in the antibody protection induced by tetanus and rabies vaccines in obese people.

“Obesity is a serious global problem, and the suboptimal vaccine-induced immune responses observed in the obese population cannot be ignored,” pleaded researchers from the Mayo Clinic’s Vaccine Research Group in a 2015 study published in the journal Vaccine.

Vaccines also are known to be less effective in older adults, which is why those 65 and older receive a supercharged annual influenza vaccine that contains far more flu virus antigens to help juice up their immune response.

By contrast, the diminished protection of the obese population — both adults and children — has been largely ignored.

“I’m not entirely sure why vaccine efficacy in this population hasn’t been more well reported,” said Catherine Andersen, an assistant professor of biology at Fairfield University who studies obesity and metabolic diseases. “It’s a missed opportunity for greater public health intervention.”

In 2017, scientists at UNC-Chapel Hill provided a critical clue about the limitations of the influenza vaccine. In a paper published in the International Journal of Obesity, they showed for the first time that vaccinated obese adults were twice as likely as adults of a healthy weight to develop influenza or flu-like illness.

Curiously, they found that adults with obesity did produce a protective level of antibodies to the influenza vaccine, but they still responded poorly.

“That was the mystery,” said Chad Petit, an influenza virologist at the University of Alabama.

One hypothesis, Petit said, is that obesity may trigger a metabolic dysregulation of T cells, white blood cells critical to the immune response. “It’s not insurmountable,” said Petit, who is researching COVID-19 in obese patients. “We can design better vaccines that might overcome this discrepancy.”

Historically, people with high BMIs often have been excluded from drug trials because they frequently have related chronic conditions that might mask the results. The clinical trials underway to test the safety and efficacy of a coronavirus vaccine do not have a BMI exclusion and will include people with obesity, said Dr. Larry Corey, of the Fred Hutchinson Cancer Research Center, who is overseeing the phase 3 trials sponsored by the National Institutes of Health.

Although trial coordinators are not specifically focused on obesity as a potential complication, Corey said, participants’ BMI will be documented and results evaluated.

Dr. Timothy Garvey, an endocrinologist and director of diabetes research at the University of Alabama, was among those who stressed that, despite the lingering questions, it is still safer for obese people to get vaccinated than not.

“The influenza vaccine still works in patients with obesity, but just not as well,” Garvey said. “We still want them to get vaccinated.”

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Language Changes?

James Lincoln Warren.
Photo: Reinhard Kargl

By James Lincoln Warren

I will rarely engage with people who want to argue with me about grammar and diction. They almost always open their salvoes with, “Language changes!”, as if I were utterly ignorant of this. Of course language changes. That is not the point.

Change is not a value, in and of itself.

The question people need to ask when they indulge in adopting certain changes is, “What value is in the change?”

If it is a constructive value, then well and good. If it is a destructive value, then bad.

Which naturally leads to the question, what values are we talking about, anyway?

The first and most obvious value of language is semantic clarity, but that isn’t its only function. It’s also used to promote or suppress emotions, for example. And it’s a very significant contributor to establishing group identity.

The way you talk and write is a lot like what you choose to wear. It projects your self-image. There is a distinct difference between long-lived styles and short-lived fads. It announces your sense of class. It may announce a desired impression: “I am refined”, “I am beautiful”, “I am rich”, “I am a rebel”, and so on. Image is also a value.

The forensic linguistic term for language used to establish a particular group identity is called its “register”. This includes slang, professional lingo, bureaucratese, regional dialect, and so forth. (When I was a student at the Mannes College of Music in New York back in the 70s, there was a student there named Arthur Wood or Woodley or something similar, who was a singer with a rich, sonorous baritone voice. He was from the Virgin Islands. When he talked to the other students, he spoke with a perfectly indistinguishable American accent—but when he talked to the school’s janitor, Wendell, also from the VI, he switched into a mellifluous Caribbean accent and a different syntax. It was like he was two different people—both of them very pleasant, I might add.)

Police are famous for having an international register that may not let you know where they’re from, but will definitely tell you the speaker is a cop. An example of this is the postposed “then”, meaning that “then” follows a noun instead of preceding it as is usually the case, viz., “I then proceeded to the station,” in lieu of “Then I went to the station.” (“Proceeded” is also a register marker, of course.)

This is not standard usage, but I have no problem with it, other than the fact that it lacks grace. It has value to its users.

Likewise with slang, although sometimes it fails when it pretends to be standard—I recently read a short phrase online wherein someone described himself as a “sapiophile”. I had never run across that word before, and couldn’t find it in the Oxford English Dictionary. That’s because it’s actually slang. It’s supposed to mean “a person who likes intelligent people.” I think it’s highfalutin nonsense, used to try to make the speaker sound smart by using a word that seems sophisticated, with the connotation being, “if you don’t know what this words means, it’s because you aren’t as smart as I am, so I won’t like you.”

How is that adding value to the language?

The worst offenses, though, are those that reduce the meanings of words, like the ubiquitous “awesome”. It is now impossible to use that word to describe something that inspires awe. It used to be an age identifier, but that has long since evaporated, too. Now it’s just insipid.

But I’m not going to argue with anybody about it, one on one. Use of language absolutely is tied in with identity, and confronting someone with a consistent misusage is like rapping their knuckles everytime they make a mistake, punishing them for being stupid or slow.

Margaret corrects me everytime I make an error, but since part of MY identity is wrapped up in ensuring standard usage, I am grateful for the corrections. Plus, I usually know better than to argue with my wife.

So—please don’t justify using a barbarism on the grounds that language changes. I know it does. I am not trying to arrest changes. I’m only trying to weed out the bad ones.

[Guest post courtesy of James Lincoln Warren]

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A New Year’s Toast To Pope Gregory XIII

by Tim Thompson

Today, most of the world celebrates New Year. But that has been the case only since the adoption of the Gregorian calendar, which began to replace the older Julian calendar in 1582. The process lasted from 1582 until 1929, when the Soviet Union became the last country to abandon the Julian calendar (Greece switched in 1923). Most of the Catholic countries reformed their calendars quickly, in 1582-1583, while the non-Catholic countries followed rather slowly.

The British Empire and its colonies did not switch until 1752, well after most of the Founding Fathers of the USA were born, so it is necessary to distinguish between “old style” (Julian) and “new style” (Gregorian) dates in American history. For instance, we recognize George Washington’s birthday as 22 February 1732, but he was born on 11 February 1732, when the Julian calendar was in place; 22 February is the translation of the Julian date into the Gregorian date, pretending that the Gregorian calendar had been in force even in 1732.

Gregory_XIII

The Gregorian calendar was adopted on the authority of Pope Gregory XIII [1502-1585], in order to fix the date for Easter, and return it to a date near the spring equinox (northern hemisphere), as it had been set in the First Council of Nicaea (20 May – 19 June, 325). The need to move Easter back to the right place in the calendar meant that when the new Gregorian calendar was adopted, 11 days were dropped, so that the day after Julian Thursday 4 October 1582 was Gregorian 15 october 1582 (5-14 October vanished).

Another big change was that the beginning of the new year moved from 1 March to 1 January. Leap day at the end of February was the last day of the year on the Julian calendar; leap day remained at the end of February, but now it seems incongruous, since there is nothing otherwise special about the end of February in the Gregorian calendar.

First page of the papal bull Inter Gravissimas. Click to enlarge.

First page of the papal bull Inter Gravissimas. Click to enlarge.

The old Julian calendar had been established in 46 BC under the authority of legendary Roman Emperor Julius Caesar [100-44 BC]. It was a modification of the older (and already many times reformed) Roman calendar. In even older, ancient civil calendars, the seasons were not fixed (i.e., the equinox and solstice dates drifted from year to year). The Roman calendar had already fixed that problem, but in a very cumbersome way. The old Roman calendar had 12 months, but only 355 days, so the Romans adopted leap months instead of leap days, and some years were as long as 378 days, just to keep the seasons in line. The Julian calendar fixed that, and fixed the length of the average year at 365.25 days.

But the real year is about 365.2425 days (a fact already known to ancient Greeks, but ignored by Caesar). So the seasons slowly slipped, and by 1582, had drifted about 11 days out of sync. Hence, the adoption of the Gregorian calendar included slipping the calendar back to compensate. Also, the Gregorian calendar changes the rule for leap years, so that century years are leap years only if they are evenly divisible by 400. So, 1700, 1800 and 1900 are not leap years, but 2000 is (and 2100 will not be). This small difference is enough to keep the civil calendar in sync with the seasons for about 10,000 years.

The Julian calendar and the older Roman calendars all started the new year in 1 January beginning about 153 BC. But in post-Roman Europe, the new year was usually moved to a date of Christian importance, such as Easter, the date of Annunciation (25 March) or the Nativity (25 December).

In post-Roman Anglo-Saxon England, the new year commonly began on 25 December, to align with both the pagan Winter Solstice and the Christian Nativity. When the Normans took over, they moved the new year to 1 January (1087-1155), then moved it to 25 March (1155-1751). In 1752, when the British Empire finally adopted the Gregorian calendar, New Year once again moved to 1 January.

So you can thank Pope Gregory XIII (and the British Empire) for today being New Year.

http://en.wikipedia.org/wiki/Gregorian_calendar
http://en.wikipedia.org/wiki/Julian_calendar
http://en.wikipedia.org/wiki/Roman_calendar
http://en.wikipedia.org/wiki/Calendar

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