Freedom during the Covid-19 pandemic

While humans debate their personal freedom, viruses are free to mutate into more dangerous variants. Various societies have their own fashions and concepts of freedom. These play crucial roles in a pandemic. In western societies, only outlaws wear masks. People greet each other by shaking hands and kissing. By insisting on these behaviors, people continue to spread the SARS-CoV-2 virus as it infects people and kills many of them in this pandemic of the unvaccinated¹. At the same time, the virus has no consciousness or concept of freedom, yet it is free to mutate into variants that are more transmissible. One of them, the Omicron variant, has emerged and is replacing the Delta variant that has dominated the pandemic for months². So, the first goal of this article is to compare and contrast stereotypical western and Asian concepts of individual freedom and duty to sacrifice oneself for the good of society and that of future generations. The second goal is to describe the Omicron variant of concern. The third goal is to give examples of how science and medicine continue to produce amazing results. For example, new vaccines are being developed to cure not just viral infections, but cancer and other diseases. In addition, stem cell technology has produced pancreas cells that were able to cure type-1 diabetes for the first time.

In many Asian countries, everyone wears a mask and bows without physical contact when greeting people. They avoid shaking hands or giving a hug. People in China, Japan, South Korea, Singapore, Vietnam and other Asian countries tend to be well-educated in math and science, so they trust scientists and doctors. More importantly, most of them feel that it is their honor to make personal sacrifices and compromise when necessary for the good of the whole society. Japanese over 65years of age are 92% vaccinated. Many Asian societies tend to dislike actions that bring glory to a few while endangering many others. There is also a strong tendency to recognize the wholeness of life and the need for balance. Their traditional plants and medicines have provided many effective treatments and cures for diseases. Natural products and/ or synthetic variations of them were used to develop most of the currently approved prescription drugs for many diseases³. For example, 64.9% of the drugs used to treat and cure cancer fall into this category³. Still, they understand the science of immunology. Natural immunity is not better than immunity obtained from a vaccine made by humans that some westerners claim is dangerous because it is not natural. In fact, nobody has a natural immunity to a virus that they have never been exposed to.

Last summer, many Japanese protested against the Tokyo Olympics because they were an unnecessary risk to public health. At the same time, western societies ended previous rules requiring masks to be worn and allowed people to meet in large groups. Now, Asia is opening up while Europe is shutting down, partially. The Japanese, Australians and many East Asian nations are able to relax previous restrictions as their people become almost fully vaccinated. In Europe, Germany and Austria had lockdowns. In Switzerland, 62% of voters approved their government’s existing policy. People need to have a Covid certificate that shows either proof of vaccination or recovery from the illness and is required to enter public spaces like restaurants or museums. In the European Union, there is a digital Covid-19 vaccine certificate. Many EU countries also have a green pass, which was first introduced in Israel. It is a paper document or app that proves the holder has been fully vaccinated or recovered from Covid. It grants them access to indoor restaurants, bars, cafes and other indoor venues.

This has led to violent protests even though medical systems are strained to the limit with the surge in Covid-19 cases. In the USA, some states have passed laws that ban vaccine passports and prohibit businesses from requiring their employees to be vaccinated. The right to remain unvaccinated and risk a horrible death is a key issue for the Republican Party.

At the same time, we are immersed in a society that strongly encourages consumption and the accumulation of personal wealth. The wealthy elite tends to think that they can’t afford to pay higher taxes that would pay for educating other people’s children. They tend to think that healthcare should only be available to those who have money. Some people believe that being wealthy is a sign that God is on your side. This leads them to believe that poor people are being punished and deserve their fate. Life can become all about power and wealth, ignoring the importance of sacrificing and compromising for the better good. This leads to imbalance, misinformation, diseases, deaths and avoidable pandemics⁴.

Wealthy countries must be concerned about others. No nation will reach herd immunity until all nations do. This can’t be done until wealthy nations contribute trillions of dollars to create badly needed infrastructure and improve communications with less fortunate people. Even though 57% of the world population has received at least one dose of a Covid-19 vaccine, only 7.5% of people in low-income countries have received at least one dose⁵.

Australia and many Asian countries have much fewer deaths per capita than western countries. The following are the number of deaths per one million population in several nations: Peru (5990), Bosnia & Herzegovina (3941), Montenegro (3715), USA (2428), Brazil (2868), France (1826), Germany (1238), United Kingdom (2132), Austria (1423), Serbia (1381), Switzerland (1335), Philippines (444), Thailand (300), Japan (146), Vietnam (271), Cambodia (174), Australia (80), South Korea (77), China (3). Also, 46.55% of the world has been fully vaccinated. The percent fully vaccinated in several countries are: Australia (75.3%), Austria (69.1%), Brazil (65.8%), Cambodia (80.1%), China (74.5%), France (71.4%), Germany (69.3%), Japan (77.9%), Montenegro (42.2%), Peru (60.2%), Philippines (33.6%), Serbia (46.2%), South Korea (81.6%), Spain (80.8%), Switzerland (66.2%), Thailand (62.4%), USA (60.6%), Vietnam (54.2%).

The situation is improving in Brazil, where 65.3% of the population is now fully vaccinated and 11.7% partly vaccinated, for a total of 77.1%. This is in spite of President Jair Bolsonaro denying the seriousness of the Covid-19 pandemic and the efficacy of vaccines. Sadly, this is consistent with his denial of science in general and global climate change in particular. Fortunately, most Brazilians accept science. There is a long tradition of the Brazilian government educating the public about the importance of vaccines before the Covid-19 pandemic emerged. This has been especially effective in the Brazilian city of Toledo. Pfizer has fully vaccinated everyone in the city over the age of 12 so it can carry out a study of the safety and effectiveness of their vaccine⁶. The company will work with local health officials, a hospital, a university and Brazil’s national vaccination program to monitor the transmission of the SARS-CoV-2 virus after the whole population has been vaccinated. The study will follow participants for up to one year to investigate how long vaccine protection lasts against Covid-19 and new virus variants.

There are already some reports from the Centers for Disease Control (CDC) and several universities in the USA that indicated that Covid-19 vaccination provides better protection than prior infection^7,8. One study was conducted using data from 187 hospitals⁸. Unvaccinated people with prior infection within 3-6 months were 5.49 times more likely to have laboratory-confirmed Covid-19 than those who were fully vaccinated within 3-6 months with mRNA (Pfizer or Moderna) vaccines. Covid-19 vaccines are safe and effective. They prevent severe illness, hospitalization, and death. CDC continues to recommend everyone 12 and older get vaccinated against Covid-19⁸.

Meanwhile, the virus is free to infect billions of unvaccinated people and to mutate into more transmissible variants. The World Health Organization (WHO) and CDC have identified variants of interest (VOI) and variants of concern (VOC)^9,10. The WHO defines a VOI as a variant which, if compared to a reference variant, has important mutations in its genome⁹. These mutations have either established or suspected implications on the phenotype. VOIs have genetic changes that are predicted or known to affect virus characteristics such as transmissibility, disease severity, immune escape, diagnostic or therapeutic escape; and cause significant community transmission or multiple Covid-19 clusters, in multiple countries with increasing relative prevalence alongside an increasing number of cases over time, or other apparent epidemiological impacts to suggest an emerging risk to global public health⁹. After being identified as a VOI, a variant may become a VOC. Not all VOIs become VOCs. The first four that did become VOCs were the Alpha, Beta, Gamma and Delta variants. The next ones that were named epsilon through mu never became VOCs. Then the omicron variant emerged. After more data were collected, it was elevated from a VOI to a VOC. To become a VOC: “A SARS-CoV-2 variant that meets the definition of a VOI (see below) and, through a comparative assessment, has been demonstrated to be associated with one or more of the following changes at a degree of global public health significance: increase in transmissibility or detrimental change in Covid-19 epidemiology, or increase in virulence or change in clinical disease presentation; or decrease in the effectiveness of public health and social measures or available diagnostics, vaccines, therapeutics”⁹.

The CDC has a slightly different definition¹⁰. To them, a VOC is a variant for which there is evidence of an increase in transmissibility, more severe disease (e.g. increased hospitalizations or deaths), a significant reduction in neutralization by antibodies generated during previous infection or vaccination, reduced effectiveness of treatments or vaccines, or diagnostic detection failures.

On 25 November, the African Union and Africa Centres for Disease Control and Prevention released a statement that identified the newest VOC, the omicron variant, also known as the B.1.1.529 variant¹¹. On the next day, the WHO issued its own statement¹². Current SARS-CoV-2 PCR (polymerase chain reaction) diagnostics continue to detect this variant. Several labs have indicated that for one widely used PCR test, one of the three target genes is not detected (called S gene dropout or S gene target failure) and this test can therefore be used as a marker for this variant. Individuals are reminded to take measures to reduce their risk of Covid-19, including proven public health and social measures such as wearing well-fitting masks, hand hygiene, physical distancing, improving the ventilation of indoor spaces, avoiding crowded spaces, and getting vaccinated¹². News agencies published reports that two doses of the Pfizer/BioNTech vaccine provided about 70% protection against hospitalization¹³. This is down from 93% during the wave of infections by the Delta variant.

The Omicron variant has some mutations that have been detected in previous variants, such as Alpha and Delta, and have been associated with increased transmissibility and immune evasion. There are over 30 mutations in the part of the mRNA that codes for the spike protein. This is the antigen used by Moderna and Pfizer/BioNTech mRNA vaccines to train one’s immune system to recognize and eliminate the SARS-CoV-2 virus^1,14.

The mutations are as follows: V67A, 70del, T95I, G142D, 145del, L212I, R214_insE, G339D, S371L, S373P, S375F, K417N, N440K, G446S, S477N, T478K, E484A, Q493R, G496S, Q498R, N501Y, Y505H, T547K, D614G, H655Y, N679K, P681H, N764K, D796Y, N856K, Q954H, N969K, L981F.

Just one month after its discovery, the Omicron variant has transmitted more efficiently, impacted vaccine effectiveness and evaded immune response in some people. However, it seems to cause less severe symptoms and milder disease. Since vaccines provide the best protection against hospitalization and death due to Covid-19, China, the USA, Russia and other countries are providing billions of doses12. However, it has been difficult to get the doses to many people in regions with inadequate infrastructure. Although the supply of doses to African countries has increased, the Global Vaccine Alliance says donations of vaccines with short shelf lives have been delivered with little advance notice¹⁵. This makes it extremely challenging for countries to plan vaccination campaigns. The Health Ministry in South Africa delayed the delivery of more doses because it had too much stock. The country's deputy director-general of the health department told Reuters news agency that South Africa had 16.8 million doses in stock. About 384 million doses have been delivered to Africa for a population of more than 1.2 billion people. South Africa has had 32.5 million doses delivered, in a population of about 40 million adults. Botswana has had about 2.4 million doses delivered for a population of 2.3 million, and Namibia about one million for 2.5 million people¹⁵. So, it’s noteworthy that China has been developing infrastructure in Africa, Asia, Europe and the Middle East for years in its Belt and Road Initiative¹⁶. Moreover, President Xi Jinping announced that China will donate one billion Covid-19 vaccines to Africa¹⁷. This is in addition to the 300 million that they have already donated. They have also given 2.49 billion shots to their own people while producing more than half of the Covid-19 vaccines made globally.

Fortunately, two new drugs that are taken orally offer hope in decreasing hospitalizations and deaths^18,20. They are Molnupiravir^TM and Paxlovid^TM, also known as Lageviro and Nirmatrelvir, respectively. They inhibit the viral enzymes RNA polymerase and reverse protease, respectively^18,19.

In the meantime, scientists, mathematicians, engineers and healthcare workers around the world are developing testing many new vaccines and cures for deadly diseases. The same mRNA technology that is used in the Pfizer and Moderna vaccines is being tested for preventing and curing many types of cancer^14,18. Other technologies are being used for other cures. For the first time ever, it appears that a cure may have been found for type-1 diabetes²². Stem cells were converted into insulin-producing pancreas cells that are not present in people who have this incurable disease. They came from unused fertilized eggs from a fertility clinic even though former President George W. Bush barred using federal money for research with human embryos. Researchers had to sever their stem cell lab from everything else at Harvard. They received private funding from the Howard Hughes Medical Institute, Harvard and philanthropists to set up a completely separate lab with an accountant who kept all its expenses separate, down to the light bulbs²².

However, Vertex Pharmaceuticals bought the rights to this treatment. It is feared that they will charge as much as possible for it. They will probably charge whatever the market will bear because their goal is to increase corporate profits and the value of their stock. Sadly, they are free to do so.

In contrast, Moderna announced last year that it would not enforce its Covid-19 vaccine patents. Moreover, the lipid nanoparticles that are used in the mRNA vaccines are licensed to Pfizer and Moderna, but other companies have the rights to them. Despite that, there is still no generic Moderna vaccine. The manufacturing process is extremely complex and there is a shortage of raw materials. The ingredients in the Moderna and Pfizer vaccines are well known^23-24. However, there are procedural details that must be followed to make them successful. Waiving intellectual property protections won’t make this information available.

Appendix

Amino acid abbreviations: A – alanine; C – cysteine; D – aspartic acid; E – glutamic acid; F – phenylalanine; G – glycine; H – histidine; I – isoleucine; K – lysine; L – leucine; M – methionine; N – asparagine; P – proline; Q – glutamine; R – arginine; S – serine; T – threonine; V – valine; W – tryptophan; Y – tyrosine.

So, D614G is when a mutation changes an aspartic acid (D) is changed into a glycine (G), N501Y is when a mutation changes an asparagine (N) into a tyrosine (Y); L452R is when a mutation changes a leucine (L) into an arginine (R); K417N is when a mutation changes a lysine (K) into an arginine (R); P681R is when a mutation changes a proline (P) into an arginine (R).