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Letter from San Francisco

Last year in the late spring, San Francisco seemed to have fallen to a post-apocalyptic nadir. A rudderless, soulless White House could not come to terms with the disaster unfolding before it, and seemed bent on sowing discord and division at a time of unprecedented national crisis. The mayor here had already begun a heroic effort to sidestep the epic failures at the federal level. She had long ordered San Franciscans to observe a curfew and to shelter in place. Restaurants had been shuttered, conventions cancelled, the entire world’s economy had come to a dead stop. The skies had grown quiet, the highways were deserted, and it were as if the Rapture had come and gone. The streets had been unswept for nearly two months. Wind blown trash and plastic and paper piled up against buildings. The sidewalks were littered with piles of excrement, animal and human. Coyotes and wolves patrolled the city at will. Beyond a certain hour, except for the endless shuffle of the homeless roaming the sidewalks, those streets were eerily quiet. The city could have been a set for the “Walking Dead”, and for a time I was hard pressed to tell the difference between the formerly haughty and shiny San Francisco, and the most barren blocks of East Baltimore. The situation was dire. To counter my own sense of hopelessness amidst the overwhelming reach of this pandemic, I embarked on my own personal mobilization campaign. On my own time in July of 2020, I enrolled in the randomized, controlled, double-blinded (at the outset) human subject study protocol AZD1222, in which a consortium comprised of AstraZeneca & Oxford University had created a vaccine targeting the SARS-CoV-2 coronavirus spike protein. The University of California at San Francisco Medical Center had dedicated it’s entire Vaccine Research Center at 100 Van Ness St to the phase III clinical trial of this live vector nonpathogenic adenovirus vaccine, and there I hopped on with a swelling sense of optimism. It gave me immediate relief and strength to enroll, knowing how few times black people are included in these studies. They are the industry standard used to verify the capacity of medications that, once approved, are judged safe for all. It felt like the most empowering thing I could possibly do at that moment to counter the unmitigated disaster that this pandemic had become for every single one of us. I had resolved that it would be with my very own body that I would personally answer the last question on this pop quiz, for all humanity, and stop these metaphoric gears from crushing us all. “And you’ve got to put your bodies upon the gears and upon the wheels, upon the levers, upon all the apparatus, and you’ve got to make it stop!”Mario Savio..And then some participant in England got a fever and had a vigorous leukemoid reaction, and meningismus, and that shut the whole study down. In England, and Brazil, and all of the United States, as abruptly as the world’s economy had crashed – AZD1222 came to a dead stop for 3 months worldwide. After usual due diligence and observation, and probably countless lumbar punctures and bone marrow aspirates for that poor sop (his iliac crest must look like Swiss Cheese by now), US regulators finally authorized re-commencement of the protocol. Brimming with a sense of excitement, more so than hope, I first presented for inoculation on November 12. I returned on December 15, and was again inoculated, per protocol.Two days prior to that second inoculation, Pfizer had breathlessly released their first summary of results 3 months in electronically through the New England Journal of Medicine. They were astounding.Two points of clarification are offered at this point. Firstly, that discovery did not happen in a vacuum, nor even in a month’s time, as I may have suggested. It builds on work that started in 2005, when the severe acute respiratory syndrome-related coronavirus (SARS-CoV-1) threatened to encircle the globe from Hong Kong. That work resumed again in earnest in 2012, when it was found that the Middle East respiratory syndrome was in fact due to a coronavirus (MERS-CoV) acquired from camels. Both had spike proteins nearly identical to that of SARS-CoV-2, which were acquired presumptively from bats somewhere near Wuhan. Both SARS-CoV-1 and MERS-CoV disappeared from the globe before they could first encircle it. Their silver lining was that these vaccines from Pfizer and Moderna were not weeks in the making at all. More than a decade of grunt work was necessary to leave us positioned to swiftly capitalize on that past, as we did. Secondly, for clarification, the childhood vaccines endorsed by the CDC generally have an efficacy of 90% or greater in preventing clinically significant disease. No vaccine intends to prevent infection. Only an infallible mechanical bubble, and various other nefarious constructs, could tentatively accomplish that. The point of vaccination, what we measure in the term “efficacy” is the capacity to prevent clinically significant disease in the infected person, and to limit propagation to others. After 60 years of work, we have laboriously arrived at a slate of childhood vaccines, almost all with 90+% efficacy. Consider then how marvelous it is indeed that this brand new, never before used mRNA based technology of Pfizer and Moderna now posts 95% efficacy. Both trials started just 1 month after we had sequenced the SARS-CoV-2 genome. If you don’t know to be astounded, be now astounded and observe. Making that vaccine is one of the seminal achievements of humankind across all of our recorded history. It’s right up there with Prometheus, running out of a cave with that lit branch. It is a peer to Alexander Fleming’s bread mold called penicillium. It is no less than Gregor Mendel’s cowpeas. Legions of scientists descended upon the work of taking those prior experiments from SARS and MERS from bench to bedside. They worked 24/7, across the globe, every man and woman to his task. They fell asleep at their microscopes. They ate ramen in their labs in preference to home cooked food, until it was done. Regard, and observe.“Lux eternae!”ElgarPraiseworthy though they are, it’s not their studies that I am enrolled in. For AstraZeneca, my study, now that a vaccine claiming 95% efficacy was out, it was immediately unethical to continue without offering to participants the chance to know whether they had received vaccine or placebo. Nobody was gonna Tuskegee me. Ongoing participants had to be offered the chance to take an effective remedy, were it authorized and offered earlier than AstraZeneca’s own. One could elect to continue unawares, but the choice to be unblinded had to be offered to all 19 000 of us. That is what Pfizer’s breathless, hot-off-the-presses New England Journal article meant. As a physician I understood this, and demanded to know as soon as I had taken my second jab.Two days later, I received a new consent for participation in the study, this time with a 4 page addendum detailing the process for unblinding of participants in the event of an efficacious alternative treatment successfully obtaining emergency authorization for use. The consent was now well over 200 pages long. That’s life in America: lawyers, everywhere. I went in later that day, signed, and was told that I had received vaccine on both inoculation visits, and should consider myself vaccinated as of December 15, 2020. “Dulce et decorum est….”Wilfred OwenThe relief I felt has been tempered of late by a deep sadness. 2.69 million people worldwide have died in this pandemic. Even more galling was bearing witness to the greatest display of official incompetence and executive malpractice ever put on by an elected leader. Incredibly, that leader was President of the United States at the time. That man hobbled his own federal government agencies and bridled their response to covid. 539 000 Americans have died of covid thus far. That’s more Americans dead of covid than died in combat in World War I AND World War II, combined. It bothers me to no end that that putrid orange beast still draws breath. I’m saddened to see how many continued to believe covid a hoax until the body count passed half a million. It takes a special kind of vulgar self absorption to demand your fellow countrymen give themselves as human sacrifices before you agree to wear a mask, or take a vaccine. That’s disgusting. But in honor of those who lost their lives to covid, I soldier on. Dulce et decorum est pro patria mori.