Last spring, to coincide with Passover and Easter, I did a post called The Four Anti-Vaxxers: How to Discuss COVID-19 Vaccination with your Vaccine-Hesitant Relatives, defining different categories of vaccine-hesitant people, paralleling the metaphorical four sons (or four children), discussed in the traditional Passover seder. In the course of the discussion, we learned how there is really a spectrum of vaccine hesitancy, and people being hesitant for different reasons. We discussed how the full-blown anti-vaccine, the likes of anti-vaccine activist leader Robert Kennedy Jr., who compares vaccination programs to the Holocaust and things like that is the far extreme. We decided not to waste our energy on that extreme fringe, but to work educating the middle people. On the other hand, it has been useful occasionally to quote claims by the extreme fringe in order to demonstrate the fallacies, the faulty ideas and such. We did this when we debunked claims about COVID-19 vaccines causing infertility and abruptio placentae (detachment of the placenta from the inner wall of the uterus). We also did it by discussing an individual, about whom I heard from others, common friends, although I have not had any contact with this person since childhood, an individual who apparently is a far into the anti-vaccine category as one can be. So I referred to a couple of his social media posts as examples of the sort of nonsense that the anti-vaccine movement is circulating, so that I would debunk them for you. I did this first in a post about masks, and then in a post about COVID-19 in which I quoted a very misinformed meme that the individual was circulating on Facebook, built around the following rhetorical question:
“And yet, in 1 year, we have a vaccine for Covid-19 [sic] and you want me to take it?” The meme did this after saying that there is no vaccine for human immunodeficiency virus (HIV) nor for the common cold, that “the flu vaccine is a joke, and that, “At least 100 years of research and there’s no vaccine for cancer.”
Then, I went on to debunk the whole thing, explaining how the influenza vaccine saves lives, how there are cancer vaccines, and so on, which you can read here.
The individual went on for the entire year spreading numerous myths about COVID-19 and vaccines, making a range of conspiratorial claims. His claims included that the vaccines contained tracking devices and that the omicron variant was an invention, or not a real disease, or something of that sort. He continuously called people “sheeple” for yielding to what he believed to be conspiracy involving governments and pharmaceutical corporations. Naturally, he finally became infected with SARS-CoV2 (the virus that causes COVID-19). Apparently, this happened just recently, because of the highly contagious Omicron variant, and apparently he developed a case severe enough for him to be hospitalized for eight days. This is no surprise, given that he is unvaccinated, middle aged, and (based on what I have heard) overweight, possibly into the obese category. Based on the social media post, included here with his name hidden, it sounds as if he should consider himself lucky that his personal encounter with COVID-19 came, not two years ago, but now (or just recently), when we have a much better understanding of how to manage people afflicted with this pandemic virus. But it’s a close call that you should avoid particularly during pregnancy, which is also a risk factor for the development of severe COVID-19 disease.
I think that it is useful to unpack his post, and add a pregnancy perspective along the way. First, however, notice his post previous to the one about being hospitalized in which he talks about returning from an absence from Facebook. He calls it a “7-day jail sentence” and attributes it to his being suspended for an old post that had been flagged by fact checkers. Well, maybe, but his post before that one has a date much more than 7 days earlier, so maybe the “jail sentence” overlapped to some extent with his hospitalization. This, after all is an individual who for some time had been telling his followers that the virus either wasn’t real, or was being exaggerated by the powers that be, or was “just a flu”, and things of that nature.
Anyway, on to his post about his hospitalization, which he begins by referring to his doctors as “these greedy criminals”. He writes this in reference to the drug remdesivir, which he received during his hospitalization and in reference to which he posts a video making some conspiratorial claim about the drug. He calls it a toxic drug and claims that it kills people. He seems to think that if a certain percentage of people died after receiving the drug (don’t take the 26% number that he writes seriously) then it means that the drug is what killed them. He doesn’t say anything about the fact that he apparently did not die. So let’s see what we can deduce from this.
Now, we have discussed remdesivir before, although we discussed it fairly early in the pandemic. This is actually a pro-drug, meaning that it does its job in the body after the body transforms it into a slightly different chemical. Remdesivir actually turns into a chemical compound that looks very similar to one of the four building blocks of RNA, the molecule that carries genetic information for the virus. To make little baby virus particles and spread the infection, the virus needs to get its RNA copied after it invades a body cell. But by masquerading as as an RNA building block, the drug messes up the process, thus interfering with the virus’ ability to reproduce and spread.
Remdesivir was not created specifically for COVID-19, but doctors started testing it out early in the pandemic. The testing revealed that remdesivir is not a magic bullet against SARS-CoV2, but it can help when administered in combination with other drugs and other measures against the disease. By the way, remdesivir is one of the COVID-19 medications that is approved for use in pregnant women, when appropriate. Remdesivir is administered by intravenous (IV) infusion, once per day, over a period of 30-120 minutes. Usually, this is done for five days, with double the amount of the drug infused on day 1 (loading dose) compared with the other days. In some cases, the treatment can be extended up to a total of ten days.
If this individual received remdesivir, we can deduce that his case was severe enough that he needed to receive supplemental oxygen, which was something that we could have concluded anyway based on the fact that he was hospitalized for eight days. If he needed to be admitted to the hospital and received oxygen, it is also very likely that he suffered dyspnea, breathing difficulty prior to his hospitalization. Along with fever and other symptoms, this likely served as a rude awakening to the fact the COVID-19 is a very serious disease that does not strike only the elderly. As for the kind of oxygen therapy that he received, which is related to the severity of the disease, he could have been on low flow oxygen through a tube in the nose (nasal cannula) or a mask. Remdesivir would be appropriate in such a circumstance, as would dexamethasone, which he likely also received, with a very good chance that it saved his life. Remdesivir also would be appropriate, if his oxygen needs, on admission to the hospital, or later reached a point that he needed what doctors call high flow oxygen, which can be given through a variety of devices. Such devices include non-rebreather masks, high flow nasal cannulae, and continuous positive airway pressure (CPAP) machines. This spectrum of oxygen delivery overlaps with scenarios on which he could have required treatment in the intensive care unit (ICU). Now, based on the fact that he was given remdesivir and that he was discharged from the hospital after eight days, I suspect that, probably he did not become so severe as to require mechanical (invasive) ventilation, or what doctors call extracorporeal membrane oxygenation (ECMO). Given that he probably avoided mechanical ventilation, he was aware and able to make his own decisions, which means that the medication that he calls toxic and deadly is a treatment that he accepted. Other medications that he could have received include tocilizumab to confront cytokine release syndrome, a condition in which the immune system goes crazy with excessive inflammation. Time will tell as to whether or not he’ll start posting conspiratorial claims about the other medications that he received. Either way, though, I think that this illustrates the extreme mindsets with which we are dealing in confronting the misinformation that circulates through society in connection with this devastating disease.
