The Democrats Go Full Götterdämmerung as Manchin Makes DOA of BBB Official; Omicron Undermines Scapegoating the Unvaxxed

In case you managed not to notice, Team Dem is in a very bad spot. It’s evident that the Obama-era strategy of treating better propaganda as the solution to every problem has run out of runway. Intra-party rifts and a global pandemic have made a mockery of grandiose Biden Administration incoming spin, like evocations of a Rooseveltian first one hundred days. The Democrats were already looking at a possible wipeout at the mid-terms. The odds of that have risen considerably in the last two weeks.

Mind you, we’ve said for quite a while that the fact that Joe Manchin hadn’t voted for Biden’s ineptly branded Build Back Better bill after several attempts to get it across the line meant he wasn’t going to vote for it. The only thing that was surprising about Manchin’s statement on Fox Sunday that he would not support the bill now was that he apparently felt the need to Say Something…when he’d said a month ago that “I cannot vote to continue with this piece of legislation.”

Oddly, only progressives called Manchin and Sinema out when they reneged on their earlier commitment to pass a then-bigger bill under reconciliation. And progressives were scolded for even mild efforts to move Manchin:

And recall how Kamala Harris (and her minder) first bobbed and weaved when Charlemagnethagod tried to pin her down on Manchin’s roadblocking, and then point blank asked her about President Manchin, came off looking petty and defensive and looks even worse now in light of Manchin’s throat-clearing:

But as we said repeatedly, Manchin’s body language has been clear for some time. Nevertheless, many press outlets took up the Administration theme that Manchin had acted in bad faith. Even though true, politics ain’t beanbag. For instance, from the Financial Times:

But on Sunday morning, Manchin plunged a knife into Biden’s economic agenda — and his presidency — by spurning the legislation with a hastily scheduled Fox interview and a sneering statement about its shortcomings.

“My concerns have only increased as the pandemic surges on, inflation rises and geopolitical uncertainty increases around the world,” Manchin said. “I have always said: ‘If I can’t go back home and explain it, I can’t vote for it’.”

Manchin’s stand means the bill, which includes new social investments in areas such as childcare, measures to fight climate change, and a number of tax increases on the wealthy and large companies, is at serious risk of never passing Congress.

This would be a huge blow to the domestic agenda of Biden and Democrats heading into next year’s midterm elections, and members of the president’s party from across its ideological spectrum were united in denouncing the coal-state senator.

Or as reader Wukchumni put it:

BBB going down in flames while student loan repayment will be soon reinforced is tantamount to a 14 point swing in a football game.

You almost get the feeling the Donkey Show not only wants to be beaten to a pulp in November, but is hoping to get tarred & feathered too.

Career advice

Then: ‘Learn to code’

Now: ‘Learn to cope’

Irate Democrats seem to think that Manchin is playing them…when as far as the headline number for the bill is concerned, Manchin is digging in over concerns about inflation, which are hitting lower and middle income voters hard. Never mind that he didn’t get the memo that these price increases are largely due to Covid whipsawing of suppliers like oil producers and chip makers, workers not keen about risking getting Covid, plus other supply chain issues. The Chicago School has done a great job of indoctrinating pols that too much government spending causes inflation….and don’t worry your heads about other things that might generate it.

And it isn’t the mere fact of not getting the BBB done, and the resulting appearance of Administration impotence, that will further damage the Democrats’ already not wonderful 2022 and 2024 prospects. The BBB also represented incremental fiscal spending.

A smaller or no deal means less demand in the economy than if the BBB had passed. We already saw a pretty limp Black Friday due to not so hot third and fourth quarter incomes. Ongoing pump priming has helped offset Covid disruptions and concerns. Consumer confidence has already taken a serious dive, so large that it’s at recession-warning levels. A smaller or no BBB further increases the odds of an economic stallout in 2022. From Bloomberg:

Goldman Sachs Group Inc. lowered its forecast for U.S. economic growth after Senator Joe Manchin said Sunday he won’t support the $2 trillion tax-and-spending plan that’s the heart of President Joe Biden’s economic agenda.

The bank’s economic research team cut next year’s real GDP forecast to:

2% from 3% in first quarter
3% from 3.5% in second quarter
2.75% from 3% in third quarter

The Administration is looking awfully lame-duck-y awfully early. And Biden having the temerity to hew to the Trump timetable for leaving Afghanistan and worse executing that badly, already produced a barrage of press criticism. Mind you, I don’t think much of condemnation stuck with the American public, who have some sense of what we’ve spent in lives and treasure in the Middle East. But it does mean that a significant swathe of the punditocracy will no longer give Biden the benefit of the doubt.

And that’s before we turn to the Administration’s and the nation’s biggest problem, Covid. The lead story in Wall Street Journal is about how investors in the US and abroad are getting rattled that a resurgence of Covid could whack growth and worsen inflation. And they continue to perform badly, to the degree that the great unwashed American public is starting to wake up.

Despite the Democrats’ fondness for blaming everything bad on Trump and Trump voters, Hair Furore left the Biden Administration in a good position. He’d supported Operation Warp Speed, and the vaccines were just starting to be administered as Trump was leaving office, meaning Biden would benefit from their initial success (recall they were developed based on the wild type of Covid, and did somewhat reduce contagion as well as disease severity).

Despite promising that the new Administration represented “adults in the room” and would “follow the science”, in practice they’ve squandered a year and fallen back on HR-style scolding in lieu of policy. Rochelle Walensky has been a complete train wreck at the CDC, failing to address the agency’s poor performance at data gathering and not bothering to build bridges to state public health agencies, who constitutionally are the lead actors. Our IM Doc has excoriated the CDC for failing at another core mission, keeping practitioners abreast on treatments and evolving/emerging symptoms. Admittedly I haven’t surveyed the medical/science tweets and news exhaustively, but I have yet to see anyone make a short list of presumed Omicron symptoms as IM Doc did yesterday in comments:

For the majority, it is a bad head cold. But for those who are really ill, the respiratory symptoms that used to predominate are now replaced with intense nausea-inducing headaches at times leading to severe vomiting, intense fever, chills, and now I have been seeing a few patients with intense diarrhea. Interestingly, the muscle cramps and pain seem to all of a sudden be really bad.

As an aside, a friend in North Carolina reported having just those symptoms for two weeks, said the “two week flu” was going around, but she’d tested negative. However, three of the CDC-authorized Covid tests don’t pick up Omicron. So on top of home test results not being captured in the CDC, there’s also evidence of probably Omicron cases getting false negatives.

Not surprisingly, Walensky has been less and less of a presence at official briefing or on the Sunday talk show circuit.

And the Administration’s vax only approach, and its corollary of blaming everything bad on the unvaxxed, is going to wear thin as more and more of the vaxxed and boosted like Elizabeth Warren get Omicron. Note that Warren is still waving the vaccine flag by saying that her symptoms are mild thanks to having been jabbed, when as someone who has just gotten sick, it’s early to call how her case will progress.

And as more and more of the vaccinated and boosted fall ill, the Administration is set to lose credit for having oversold the vaccines. Do not forget that in popularity polls, the subcategory in which Biden has gotten the best marks is managing Covid. What happens when that starts to erode? For instance:

But Fauci is still putting all blame on the unvaxxed. Biomedical professor KLG read a Financial Times interview with him and despaired. For instance:

“We have so many people in this country who are eligible to be vaccinated who have not yet been vaccinated. And that’s going to be a real problem for stress on the hospital system,” he added.

And the White House is putting out slides even more dumbed down than the ones for CalPERS’ board, an accomplishment of sorts:

By contrast, IM Doc, who is in a hospital system that is already stressed by Covid, mainly due to staff-burnout-generated attrition, reports that cases requiring hospital attention (which included outpatient, they monitor patients at home more aggressively than the overwhelming majority of practices) are proportional to vaccination levels in the community:1

How have things changed? – Way way more vaccinated and boostered patients are now becoming positive. Many of them quite ill. Indeed, as OUTPATIENTS, I would say our vaccinated ill is basically on par with the vaccinated population at large. The same is true of the boosters. So, basically, just like Denmark, we seem to be at complete par. Ergo, the vaccines are basically worthless for transmission of the virus. So far, it remains about 60-40 unvaccinated-vaccinated in the hospital. However, the vaccinated are becoming more and more ill.

IM Doc is hardly alone in that view. GM says that Florian Krammer is a really serious scientist, not a random doomer:

Yet we see, as we also warned, despite the fact that it was evident the vaccines would not confer durable immunity, that they would not halt transmission, and that starting in December 2020, experts started seeing mutations that could affect disease behavior, the officialdom is also attempting the intelligence-insulting “Whocoulddanode” defense, made worse by the nod to Rumsfeld:

In fact, from the very outset of Covid, KLG expected treatments to be the main line of defense, not vaccines, and he put monoclonal antibodies top of the list. And recall that the Trump Operation Warp Speed process was to create demand by having the government place large orders early on. That included for monoclonal antibodies. 55,000 doses for a country of 330 million is a joke.

Part of why the US is “out” is apparent widespread betting on the wrong horses. Most of the current monoclonal antibody treatments don’t work on Omicron, as Thomas Peacock and others noted as soon as its sequence was published. As GM pointed out:

This wasn’t an unknown unknown.

Sotrovimab was loudly touted as “resistant to all variants”/pan-CoV mAb from the start. It’s not even derived from a SARS-CoV-2 serum, but from a SARS-CoV-1 one.

It was always known it will be the last line of defense.

But the monoclonal antibody fail may cause Team Dem more trouble among top donors than its Covid tsuris generally. There was already ample demand for them. Look at just Birmingham, a city of 200,000 people in a state of just under 5 million. From September:

Health leaders said the demand for monoclonal antibody treatment continues to be in high demand in Alabama. State Health Officer Dr. Scott Harris has said if you get this treatment early on in a COVID infection it can keep you out of the hospital.

This week Alabama received about 6,600 doses of monoclonal antibodies. The cost of the drug is covered, but you can expect to pay some administrative costs if you seek this valuable treatment.

At MainStreet Family Care they have seen the demand for monoclonal antibody treatments skyrocket. Betsey Stewart with MainStreet said,“ Companywide we were doing between 60-80 IV treatments a day. Keep in mind that treatment takes two hours per patient.”

The monoclonal drug is expensive but the federal government is covering the cost. “The drug itself is provided free to the sites. That is significant because the drug normally costs between $3,000 to $5,000 a dose,” Dr. Michael Saag, UAB Infectious Diseases, said.

But the treatments aren’t free. They are intravenous and we’ve read of patient charges of $1,200 and higher….with 36% of Americans reporting that they’d have difficulty meeting a $400 emergency expense.

Moreover, monoclonal antibodies need to be administered in a tight time window to be effective, shortly after symptoms strike.

With supplies this short, even some of rich might be unable to cut into the line. From IM Doc, who recall has patients that skew disproportionately towards squillionaries and centimillionaries:

Furthermore, these treatments are being heavily restricted and patients must now meet strict criteria to get them. I have been told there is quite a supply problem….It is alarming to me that intense preparation was not done on these anti-virals by our officials …it is clear that further variants were not even on the radar of our officials this year. Omicron came out of nowhere, don’t you know. Who could have expected this to happen? And it was also crystal clear that this antibody therapy was not on Dr. Fauci’s or Biden’s list of things to take care of. If you live in certain states like Texas or Florida and others, your governor and health officials had the foresight to secure your own supply, limited as it may be. Everywhere else – well – good luck.

In other words, the “vax vax vax” policy appears to have included deliberate neglect of treatments as well as non-pharmaceutical interventions, not just the much demonized horse paste but even medically recognized monoclonal antibodies. After all, only the morally remiss unvaccinated could possibly need them, right?

IM Doc has taken to pointing out that Nemesis inevitably follows Hubris, and she seems to be showing up right on schedule. But the self-destructiveness of our leaders is so apparent to anyone who is not part of the problem that this looks more like Götterdämmerung to me. And in that story, even though their war burns down the world, it also produces its renewal. Will that be the Democrats, or a wider conflagration?

____

1 IM Doc’s county has a very high vax rate, but the neighboring counties are pretty low, and his hospital pulls in patients from them too.

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171 comments

  1. DJG, Reality Czar

    “In other words, the “vax vax vax” policy appears to have included deliberate neglect of treatments as well as non-pharmaceutical interventions, not just the much demonized horse paste but even medically recognized monoclonal antibodies. After all, only the morally remiss unvaccinated could possibly need them, right?”

    An excellent summing-up paragraph, given the many dire facts in the article that have to be addressed.

    To translate into neoliberalese, the main language spoken by the U.S. elites:

    Monetizing everything, the elites have learned the value of nothing.

    1. Mikel

      You bring up Ivermectin. Then think about this:

      “the respiratory symptoms that used to predominate are now replaced with intense nausea-inducing headaches at times leading to severe vomiting, intense fever, chills, and now I have been seeing a few patients with intense diarrhea. Interestingly, the muscle cramps and pain seem to all of a sudden be really bad…”

      Someone who has been taking Ivermectin or knows its use might want to talk me down, but with this description of the symptoms, doesn’t it sound like Ivermectin is tailor-made for the Omicron variant?
      Th symptoms that have intensified remind me of a parasite in the gut or food poisoning.

      1. Yves Smith Post author

        I hope GM comments but my first reaction is *sigh*.

        The parasite that Ivermectin is most used to treat is the worm that causes river blindness, which attacks the eye, not the gut.

        The reason that Ivermectin is believed to be effective v. Covid is its antiviral properties. As I have stated repeatedly, it’s in the advanced stages of several clinical outside the US as an HIV med and doing well in all of them.

        See here for more on its antiviral activity:

        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539925/

        Data from Wuhan showed 40% of those who got Covid had digestive symptoms. They often assumed it was food poisoning and not Covid. That may be just as true in the US given how spotty our testing is.

        1. Mikel

          I’m now just chilled to the bone by the idea of worm that attacks the eye and causes blindness.
          Can’t even think about Covid right now…

          1. Susan the other

            ….”Climate change is painless, it brings on many changes, but you can to learn to love it if you try.”

        2. Kris Alman

          As an endocrinologist, I’ve been very interested in the role of the ACE2 receptor in the pathology of Covid since it is the primary portal for the virus spike to enter the cell. A Trojan horse.

          When I was in fellowship training decades ago, the ACE2 receptor and angiotensin-(1-7) (Asp-Arg-Val-Tyr-Ile-His-Pro) were just babes in benchwork research.
          https://europepmc.org/article/med/1342241

          We have had a much better understanding of angiotensinogen, an inactive precursor peptide cleaved by renin to form angiotensin 1 and further processed by angiotensin converting enzyme 1 (ACE1) to angiotensin 2 in the Renin-Angiotensin System (RAS). ARBs (Angiotensin-II receptor blockers) and ACE inhibitors have been widely used to manage hypertension, congestive heart failure and kidney disease (including diabetic nephropathy).

          Covid-19 has created a surge of interest in these parallel pathways that intersect with our complex immune system and our body’s response to stress/inflammation (including the role of glucocorticoids and gender differences).

          Here’s a dense review with its abstract and one paragraph on diarrhea:
          Functional ACE2 deficiency leading to angiotensin imbalance in the pathophysiology of COVID-19
          Reviews in Endocrine and Metabolic Disorders (2021)
          https://link.springer.com/article/10.1007/s11154-021-09663-z

          Abstract
          SARS-CoV-2, the virus responsible for COVID-19, uses angiotensin converting enzyme 2 (ACE2) as its primary cell-surface receptor. ACE2 is a key enzyme in the counter-regulatory pathway of the broader renin-angiotensin system (RAS) that has been implicated in a broad array of human pathology. The RAS is composed of two competing pathways that work in opposition to each other: the “conventional” arm involving angiotensin converting enzyme (ACE) generating angiotensin-2 and the more recently identified ACE2 pathway that generates angiotensin (1–7). Following the original SARS pandemic, additional studies suggested that coronaviral binding to ACE2 resulted in downregulation of the membrane-bound enzyme. Given the similarities between the two viruses, many have posited a similar process with SARS-CoV-2. Proponents of this ACE2 deficiency model argue that downregulation of ACE2 limits its enzymatic function, thereby skewing the delicate balance between the two competing arms of the RAS. In this review we critically examine this model. The available data remain incomplete but are consistent with the possibility that the broad multisystem dysfunction of COVID-19 is due in large part to functional ACE2 deficiency leading to angiotensin imbalance with consequent immune dysregulation and endothelial cell dysfunction.

          Gastrointestinal system
          The small intestine hosts the body’s highest tissue concentration of both ACE and ACE2 [73]. High doses of exogenous AT2 administered enterally to rats impair jejunal sodium-water reabsorption – potentially explaining the increased risk of diarrhea in COVID-19 – while ACE inhibitors and angiotensin receptor blockers (ARBs) reduce intestinal inflammation in rodent models [73, 74]. The effects of ACE2 in the gut are less well recognized but it appears to act in a non-catalytic manner to regulate tryptophan transport and the expression of antimicrobial peptides [4, 7, 73]. It has been more broadly hypothesized that ACE2’s impact on cardiovascular and pulmonary physiology may also proceed in part through alteration of the gut microbiome [4, 7].

          Also see:
          The pivotal link between ACE2 deficiency and SARS-CoV-2 infection: One year later
          https://www.ejinme.com/article/S0953-6205(21)00307-1/fulltext
          It has been recently suggested that free-floating Spike proteins released by the destroyed cells previously targeted by vaccines may interact with ACE2 of other cells, thereby promoting ACE2 internalization and degradation [[80],[81]]. This mechanism may enhances the imbalance between Ang II overactivity and Ang1-7 deficiency through the loss of ACE2 receptor activity, which may contribute to trigger inflammation, thrombosis, and other adverse reactions [[82],[83]].
          Of note, spike proteins produced upon vaccination have the native-like mimicry of SARS-CoV-2 Spike protein’s receptor binding functionality and prefusion structure [[84]].

          All very concerning if vaccines and boosters are down-regulating ACE2 since…

          It appears that spike protein is also important for cell-to-cell transmission. In other words, viral-infected cell to viral-infected cell.

          This June 2021 pre-print, “SARS-CoV-2 Spreads through Cell-to-Cell Transmission”, shows evidence that the spike glycoprotein mediates the spread of SARS-CoV-2 in cell-to-cell transmission in the absence of ACE2 (angiotensin-converting enzyme 2) receptor expression in target cells.
          https://www.biorxiv.org/content/biorxiv/early/2021/06/01/2021.06.01.446579.full.pdf bioRxiv. 2021 Jun 1

          The authors (primarily from Ohio State University) point out that, “Cell-to-cell transmission is considered to be an effective means by which viruses evade host immunity, especially antibody-mediated responses.”

          Moreover, “(w)hile not statistically significant, some of the COVID-19 sera (2 out of 5) even enhanced cell-to-cell transmission of SARS-CoV-2 (Figure 6D), although the underlying mechanisms are currently not known.”

          These in vitro studies with a small number of samples were using older variants of concern (B.1.351, “Beta” first detected in South Africa and and B.1.1.7, aka British variant).

          One has to wonder why this NIH funded study has not been peer reviewed and published in any journal yet.

          These studies should be replicated with the omicron variant and with sera from vaccinated and delta-infected individuals to see if cell-to-cell transmission is further enhanced through down-regulation of ACE2 receptors.

      2. Kris Alman

        As an endocrinologist, I’ve been very interested in the role of the ACE2 receptor in the pathology of Covid since it is the primary portal for the virus spike to enter the cell. A Trojan horse.

        When I was in fellowship training decades ago, the ACE2 receptor and angiotensin-(1-7) (Asp-Arg-Val-Tyr-Ile-His-Pro) were just babes in benchwork research.
        https://europepmc.org/article/med/1342241

        We have had a much better understanding of angiotensinogen, an inactive precursor peptide cleaved by renin to form angiotensin 1 and further processed by angiotensin converting enzyme 1 (ACE1) to angiotensin 2 in the Renin-Angiotensin System (RAS). ARBs (Angiotensin-II receptor blockers) and ACE inhibitors have been widely used to manage hypertension, congestive heart failure and kidney disease (including diabetic nephropathy).

        Covid-19 has created a surge of interest in these parallel pathways that intersect with our complex immune system and our body’s response to stress/inflammation (including the role of glucocorticoids and gender differences).

        Here’s a dense review with its abstract and one paragraph on diarrhea:
        Functional ACE2 deficiency leading to angiotensin imbalance in the pathophysiology of COVID-19
        Reviews in Endocrine and Metabolic Disorders (2021)
        https://link.springer.com/article/10.1007/s11154-021-09663-z

        Abstract
        SARS-CoV-2, the virus responsible for COVID-19, uses angiotensin converting enzyme 2 (ACE2) as its primary cell-surface receptor. ACE2 is a key enzyme in the counter-regulatory pathway of the broader renin-angiotensin system (RAS) that has been implicated in a broad array of human pathology. The RAS is composed of two competing pathways that work in opposition to each other: the “conventional” arm involving angiotensin converting enzyme (ACE) generating angiotensin-2 and the more recently identified ACE2 pathway that generates angiotensin (1–7). Following the original SARS pandemic, additional studies suggested that coronaviral binding to ACE2 resulted in downregulation of the membrane-bound enzyme. Given the similarities between the two viruses, many have posited a similar process with SARS-CoV-2. Proponents of this ACE2 deficiency model argue that downregulation of ACE2 limits its enzymatic function, thereby skewing the delicate balance between the two competing arms of the RAS. In this review we critically examine this model. The available data remain incomplete but are consistent with the possibility that the broad multisystem dysfunction of COVID-19 is due in large part to functional ACE2 deficiency leading to angiotensin imbalance with consequent immune dysregulation and endothelial cell dysfunction.

        Gastrointestinal system
        The small intestine hosts the body’s highest tissue concentration of both ACE and ACE2 [73]. High doses of exogenous AT2 administered enterally to rats impair jejunal sodium-water reabsorption – potentially explaining the increased risk of diarrhea in COVID-19 – while ACE inhibitors and angiotensin receptor blockers (ARBs) reduce intestinal inflammation in rodent models [73, 74]. The effects of ACE2 in the gut are less well recognized but it appears to act in a non-catalytic manner to regulate tryptophan transport and the expression of antimicrobial peptides [4, 7, 73]. It has been more broadly hypothesized that ACE2’s impact on cardiovascular and pulmonary physiology may also proceed in part through alteration of the gut microbiome [4, 7].

      3. Kris Alman

        As an endocrinologist, I’ve been very interested in the role of the ACE2 receptor in the pathology of Covid since it is the primary portal for the virus spike to enter the cell. A Trojan horse.

        When I was in fellowship training in the early 1990s, the ACE2 receptor and angiotensin-(1-7) were just babes in benchwork research.

        We have had a much better understanding of angiotensinogen, an inactive precursor peptide cleaved by renin to form angiotensin 1 and further processed by angiotensin converting enzyme 1 (ACE1) to angiotensin 2 in the Renin-Angiotensin System (RAS). ARBs (Angiotensin-II receptor blockers) and ACE inhibitors have been widely used to manage hypertension, congestive heart failure and kidney disease (including diabetic nephropathy).

        Covid-19 has created a surge of interest in these parallel pathways that intersect with our complex immune system and our body’s response to stress/inflammation (including the role of glucocorticoids and gender differences).

        Here’s a dense review with its abstract and one paragraph on diarrhea:
        Functional ACE2 deficiency leading to angiotensin imbalance in the pathophysiology of COVID-19
        Reviews in Endocrine and Metabolic Disorders (2021)
        https://link.springer.com/article/10.1007/s11154-021-09663-z

        Abstract
        SARS-CoV-2, the virus responsible for COVID-19, uses angiotensin converting enzyme 2 (ACE2) as its primary cell-surface receptor. ACE2 is a key enzyme in the counter-regulatory pathway of the broader renin-angiotensin system (RAS) that has been implicated in a broad array of human pathology. The RAS is composed of two competing pathways that work in opposition to each other: the “conventional” arm involving angiotensin converting enzyme (ACE) generating angiotensin-2 and the more recently identified ACE2 pathway that generates angiotensin (1–7). Following the original SARS pandemic, additional studies suggested that coronaviral binding to ACE2 resulted in downregulation of the membrane-bound enzyme. Given the similarities between the two viruses, many have posited a similar process with SARS-CoV-2. Proponents of this ACE2 deficiency model argue that downregulation of ACE2 limits its enzymatic function, thereby skewing the delicate balance between the two competing arms of the RAS. In this review we critically examine this model. The available data remain incomplete but are consistent with the possibility that the broad multisystem dysfunction of COVID-19 is due in large part to functional ACE2 deficiency leading to angiotensin imbalance with consequent immune dysregulation and endothelial cell dysfunction.

        Gastrointestinal system
        The small intestine hosts the body’s highest tissue concentration of both ACE and ACE2 [73]. High doses of exogenous AT2 administered enterally to rats impair jejunal sodium-water reabsorption – potentially explaining the increased risk of diarrhea in COVID-19 – while ACE inhibitors and angiotensin receptor blockers (ARBs) reduce intestinal inflammation in rodent models [73, 74]. The effects of ACE2 in the gut are less well recognized but it appears to act in a non-catalytic manner to regulate tryptophan transport and the expression of antimicrobial peptides [4, 7, 73]. It has been more broadly hypothesized that ACE2’s impact on cardiovascular and pulmonary physiology may also proceed in part through alteration of the gut microbiome [4, 7]

  2. The Historian

    I can’t say I am surprised or even disappointed by Manchin’s latest utterances. Only idiots would have given control of what was in BBB to a person who was never going to vote for it, yet that is exactly what the progressives did. My disappointment happened months before this when the Progressive Caucus allowed Joe Manchin to dictate what was in the bill.

    To paraphrase Frank Herbert, ala Lambert: “Manchin had one weapon left and both (were the Progressives really that asleep?) knew it: treachery.”

    And in keeping with the musical terms, all the Sturm and Drang by the White House is meaningless – as it always has been. Could they really not see what Manchin was doing? Maybe not! – seeing as how everything that happens these days, including the emergence of new variants, surprises them.

    1. James E Keenan

      “… the Progressive Caucus allowed Joe Manchin to dictate what was in the bill.”

      What is the evidence for this? You seem to imply that the Progressive Caucus was a majority within the House and/or the Senate — when they’re not.

      1. The Historian

        You are forgetting one thing – how closely divided the Congress is. The Democrats only hold a slim majority in the House and a 1 vote majority (Harris) in the Senate, meaning, given the levels of exteme partisanship that exists today, to get bills passed, the Democrats needed every Democratic vote. The Progressive Caucus had enough votes to block any legislation they wanted. They didn’t have to compromise much nor give away their basic planks in the BBB bill nor cow down to Manchin. Sure, they would have taken a lot of heat and criticism, and no doubt there would have been a lot of unpleasantness, but if they had stood fast and refused to vote for the infrastructure bill without their original BBB bill, they could have shown Manchin and Sinema where the real power was. But they caved instead.

      2. Michael Ismoe

        The bill passed with a three-vote majority. The Progressive (HAHA) Caucus in the House agreed to pass the bill and count on Joey B to “use his interpersonal relationships” with the senators to get the thing done. Jaypal’s strategy and it blew up in her face. She trusted the wrong people and it shows. Bad judgement does not get you into Democratic Party leadership – although by the end of the midterms there could be so few Democrats left in Congress that the whole speaker thing is moot for a decade or so.

        1. lance ringquist

          agreed. to actually trust a nafta democrat again after all of the betrayals since 1993, is just setting you up to be the public boob you deserve to be.

          you have no power unless you exercise it.

      3. Brooklin Bridge

        Um, was Manchin a majority? One single lone vote? And yet he got what he wanted. The progressives could have played the same game, demanded that BBB stay intact or they would not allow either bill, and thus the corporate giveaway (infrastruc) that Manchin DID want, would fail. But the mean ol’ press said, “Boo” to the progs and they spluttered out like candles on Manchin’s victory cake.

        These progs drop trow faster than their shadows.

          1. Brooklin Bridge

            Thanks Historian, I was too busy going (grrrr) to think of doing a refresh on my browser, so I didn’t see your comment until I posted mine.
            They work together, detail and rant.

        1. MK

          Don’t forget – it still took 13 Rs in the house to get the infrastructure bill to pass.

          The Progressives never had the numbers to stop the infrastructure bill because there was always enough Rs to vote it through even if the progressive caucus had held together 100% and voted no.

            1. Expat2uruguay

              I think the composition of “the progressives” is closer to “the squad” than the progressive caucus. The progressive caucus is full of a lot of people who would otherwise never be called progressives

              1. Jonathan King

                Indeed. It’s an easy conflation for those who think Ilhan Omar and Hakeem Jeffries must be in cahoots.

          1. Brooklin Bridge

            As I understood it, this was a game of chicken. The trick was for the progs to keep the two bills together as all or nothing and to hold Pelosi’s feet (and her promise) to the fire. In terms of embarrassment, if nothing else, It would have been almost impossible for Pelosi to gather enough Dem_wits to agree to separating the two bills without the prog’s duplicity, I mean agreement. And if the progs had held firm anyway, and still been steamrolled, they could now be making that painfully clear every step of the way. As it is, quite honestly, they are pretty much just slime; fast on their way to being exactly like the rest of the Dems, bought and paid for.

          2. tegnost

            because there was always enough Rs to vote it through even if the progressive caucus had held together 100% and voted no.
            and they would now have had their “I told you so…” moment.
            Instead the get nothing.

      4. Susan the other

        I’d like to get an instruction manual on how to indict Congress for crimes against humanity and crimes against the state; and lesser crimes like total legislative incompetence and bribe taking.

    2. Andrew

      Odd that Manchin, as you say, “was never going to vote for it” in a 50/50 Senate, but somehow this is the fault of progressives.

      1. The Historian

        We are never going to know what the Senate would have done if the two bills were tied together because we weren’t given the chance to find out, were we? And yes, I blame the Progressive Caucus for that!

        I saw this on Common Dreams:
        https://www.commondreams.org/news/2021/12/20/progressives-demand-floor-vote-spotlight-manchins-contempt-his-constituents

        The feckless Progressive Caucus is going to make sure the barn door is tightly locked…..after the horse has escaped! I wonder if they can even accomplish that! I wonder also if they really think ‘shaming’ Manchin by holding a vote on BBB in the Senate matters one whit.

      2. lance ringquist

        if you do not exercise your power. you have none. manchins daughter was a very big easy target.

        1. Yves Smith Post author

          Yes, I’ve been saying that in code: “If Biden could have had Manchin’s vote by means he was willing to use, he would have had it months ago.” Pretty obvious that Biden hasn’t used all the means of inflicting pain to which he has access….or bribes either. He could sponsor some sort of coal transition program to pay off mine shuttering (as a personal bribe to Manchin) and sponsor other businesses in the state (if nothing else government call centers).

  3. Roger Blakely

    My vote goes to Rochelle Walensky’s beauty and wardrobe team. She was cute as a Harvard public health professor. Now they have her looking fetching on the screen.

  4. SomeGuyinAZ

    I’d say “clowns to the left of me, jokers to the right, here we are stuck in the middle” would have made a fair musical interlude/summation, but I think it’s better to put this down to greedy malevolence rather than foolishness by our “leaders”.

  5. ScoFri

    About Vaccine Effectiveness, can someone who knows more about this answer a question I have been asking but cannot seem to get answered?

    In the first vaccines to my understanding, they did not use the mRNA for the whole viral envelope, only the Spike Protein.

    Why did they not use the mRNA for the envelope and matrix protein as well? Is it possible they play a role in infection as well? It looks like it from this image:

    https://www.echelon-inc.com/wp-content/uploads/2020/04/SARS-CoV-2-graphic@2x.png

    The cynic in me thinks that this was part of Big Pharma’s plan…

    1. KLG

      Short answer that GM could do better. The viral envelope is composed of a phospholipid/cholesterol membrane that is similar in composition to the plasma membrane (often mistakenly called the cell wall) of all of our cells. These phospholipids are generally not antigenic. Viral proteins such as spike are “swimming” in two dimensions in the correct orientation (outside out, inside in) in that viral envelope. Proteins from “the other” are antigenic. Spike is essential for viral binding to ACE2 and entry into in our cells, so that is why it was used: Prevent binding and stop infection, disease, and transmission. Only, it didn’t work very well. But that is no surprise. Vaccines against coronaviruses have had significant unicorn character since, well, forever. People who have recovered from COVID-19 typically do have antibodies to non-envelope viral proteins, but it is not clear the antibodies do much to fight disease.

      1. Susan the other

        Are you aware of any new studies on ace blockers for BP? I talked to one doc who told me there was an ongoing debate about their usefulness for covid and I surfed and found just one study that showed a small beneficial effect at prevention (sorry can’t cite – can barely read actually). And another thing from way back in 2019 – there was a lot of info early about covid being a “blood disease” as it was said to attack red blood cells and gobble up the hemoglobin molecule, leaving the rest of the cell detritus to clog up the alveoli, etc. This was followed some months later (I think a link here on NC) by studies involving mice wherein there were “resilient” mice, resilient to viruses that were deadly to other mice – and the reason for their good health seems to have been high levels of iron in their blood – enough for both the mouse and the virus, buying the mouse’s immune system enough time to survive without much harm. Anything on that one and covid? And do doctors recommend B-complex for anemia still – ages ago it was prescribed for me and it worked like a charm. It’s been a stand-by ever since, for just about every incipient little misery.

        1. Kris Alman

          I will try to tackle this one. The short answer is that it’s unclear because ACE inhibitors and ARB blockers affect the ACE1 receptor.

          As an endocrinologist, I’ve been very interested in the role of the ACE2 receptor in the pathology of Covid since it is the primary portal for the virus spike to enter the cell. A Trojan horse.

          When I was in fellowship training in the early 1990s, the ACE2 receptor and angiotensin-(1-7) (Asp-Arg-Val-Tyr-Ile-His-Pro) were just babes in benchwork research.

          We have had a much better understanding of angiotensinogen, an inactive precursor peptide cleaved by renin to form angiotensin I and further processed by angiotensin converting enzyme I (ACE1) to angiotensin II in the Renin-Angiotensin System (RAS). ARBs (Angiotensin- receptor blockers) and ACE 1 inhibitors have been widely used to manage hypertension, congestive heart failure and kidney disease (including diabetic nephropathy).

          Covid-19 has created a surge of interest in these parallel pathways that intersect with our complex immune system and our body’s response to stress/inflammation (including the role of glucocorticoids and gender differences).

          Here’s a dense review with its abstract:
          Functional ACE2 deficiency leading to angiotensin imbalance in the pathophysiology of COVID-19

          Reviews in Endocrine and Metabolic Disorders (2021)
          https://link.springer.com/article/10.1007/s11154-021-09663-z

          SARS-CoV-2, the virus responsible for COVID-19, uses angiotensin converting enzyme 2 (ACE2) as its primary cell-surface receptor. ACE2 is a key enzyme in the counter-regulatory pathway of the broader renin-angiotensin system (RAS) that has been implicated in a broad array of human pathology. The RAS is composed of two competing pathways that work in opposition to each other: the “conventional” arm involving angiotensin converting enzyme (ACE) generating angiotensin-2 and the more recently identified ACE2 pathway that generates angiotensin (1–7). Following the original SARS pandemic, additional studies suggested that coronaviral binding to ACE2 resulted in downregulation of the membrane-bound enzyme. Given the similarities between the two viruses, many have posited a similar process with SARS-CoV-2. Proponents of this ACE2 deficiency model argue that downregulation of ACE2 limits its enzymatic function, thereby skewing the delicate balance between the two competing arms of the RAS. In this review we critically examine this model. The available data remain incomplete but are consistent with the possibility that the broad multisystem dysfunction of COVID-19 is due in large part to functional ACE2 deficiency leading to angiotensin imbalance with consequent immune dysregulation and endothelial cell dysfunction.

        2. Kris Alman

          As an endocrinologist who trained in the early 1990s, I have had to learn about the two competing arms of the Renin Angiotensin System (RAS) pathways. Covid-19 enters the cell with its spike via the membrane-bound enzyme ACE2 (Angiotensin Converting Enzyme 2) receptor.

          This is not to be confused with ACE1 which is far better understood.

          Angiotensinogen is an inactive precursor peptide which is cleaved by renin to become Angiotensin I (AT1), which is further cleaved by ACE 1 to be Angiotensin 2 (AT2). These pathways are fundamental to prescribing ACE 1 inhibitors and ARBs (angiotensin receptor blockers) for high blood pressure, congestive heart failure and kidney disease (including that due to diabetic nephropathy).

          Angiotensin (1-7) is a bioactive component of the renin-angiotensin system that promotes vasodilatory, anti-inflammatory, and anti-fibrotic effects. It is formed from either AT I or AT II using membrane-bound enzyme ACE2.

          Activation of this arm is thought to oppose the activity of the conventional ACE/AT2 pathway. Depletion of ACE2 is associated with worse Covid outcomes with less inactivation of A2 and less generation of A(1-7), which may ultimately trigger inflammation, thrombosis, and other severe adverse reactions influencing the outcome of COVID-19. Patients with co-morbidities like diabetes and cardiovascular disease share a variable degree of ACE2 deficiency.

          The pivotal link between ACE2 deficiency and SARS-CoV-2 infection: One year later
          https://www.ejinme.com/article/S0953-6205(21)00307-1/fulltext
          “Thus, it is very likely that is not the ‘excess’, but the deficiency of ACE2 receptor activity that complicates the outcome of COVID-19.”

        3. Kris Alman

          egads! My comments weren’t coming through and then flooded in!

          Here’s an article worthy of your question. Note “might” re ACEIs or ARBs. That helps settle the question, right?:

          Hypertension and its management in COVID-19 patients: The assorted view
          https://www.sciencedirect.com/science/article/pii/S2772487521000234

          Conclusion
          This study concluded that hypertension increases COVID-19 severity due to underlying endothelial dysfunctions and coagulopathy. COVID-19 might augment the hypertensive complications due to down-regulation of ACE2. The use of ACEIs or ARBs might be beneficial in the management of hypertensive patients with COVID-19.

      2. Kris Alman

        Spike is essential for viral binding to ACE2 and entry into in our cells

        But in vitro studies suggest that ACE2 is not necessary for cell-to-cell transmission–meaning infected cell to infected cell. (Cell-free infection is virus into cell via spike/ACE2 receptor.
        https://www.biorxiv.org/content/biorxiv/early/2021/06/01/2021.06.01.446579.full.pdf

        The authors of this study point out, “results indicate that cell-to-cell transmission of SARS305 CoV-2 is mostly refractory to neutralization by neutralizing antibodies against spike relative to cell-free infection.”

        1. Kris Alman

          As for Susan the Other’s question, the short answer is that it’s unclear because ACE inhibitors and ARB blockers affect the ACE 1 (not 2) receptor.

          As an endocrinologist, I’ve been very interested in the role of the ACE2 receptor in the pathology of Covid since it is the primary portal for the virus spike to enter the cell. A Trojan horse.

          When I was in fellowship training in the early 1990s, the ACE2 receptor and angiotensin-(1-7) (Asp-Arg-Val-Tyr-Ile-His-Pro) were just babes in benchwork research.

          We have had a much better understanding of angiotensinogen, an inactive precursor peptide cleaved by renin to form angiotensin I and further processed by angiotensin converting enzyme I (ACE1) to angiotensin II in the Renin-Angiotensin System (RAS). ARBs (Angiotensin- receptor blockers) and ACE 1 inhibitors have been widely used to manage hypertension, congestive heart failure and kidney disease (including diabetic nephropathy).

          Covid-19 has created a surge of interest in these competing pathways that intersect with our complex immune system in our body’s response to stress/inflammation (including the role of glucocorticoids and gender differences).

          Functional ACE2 deficiency leading to angiotensin imbalance in the pathophysiology of COVID-19
          https://link.springer.com/article/10.1007/s11154-021-09663-z

          This dense review suggests that “coronaviral binding to ACE2 resulted in downregulation of the membrane-bound enzyme” and this “limits its enzymatic function, thereby skewing the delicate balance between the two competing arms of the RAS.” Further “available data remain incomplete but are consistent with the possibility that the broad multisystem dysfunction of COVID-19 is due in large part to functional ACE2 deficiency leading to angiotensin imbalance with consequent immune dysregulation and endothelial cell dysfunction.”

          I would further wonder if vaccines and boosters downregulate the ACE2 receptors.

        2. Kris Alman

          “One important feature of the virus cell-to-cell transmission is evasion of host immunity, particularly neutralizing antibody-mediated response.”

          These in vitro studies with a small number of serum samples from older variants of concern (B.1.351, “Beta” first detected in South Africa and B.1.1.7, aka British variant).

          One has to wonder how well Omicron transmits cell-to-cell without ACE2 receptor.

          1. Kris Alman

            Because downregulation of ACE2 receptor seems to be associated with bad outcomes.

            Downregulation of Membrane-bound Angiotensin Converting Enzyme 2 (ACE2) Receptor has a Pivotal Role in COVID-19 Immunopathology
            https://www.ingentaconnect.com/content/ben/cdt/2021/00000022/00000003/art00003

            Results: Several studies have indicated that the downregulation of membrane-bound ACE2 may exert a key role for the impairment of immune functions and for COVID-19 patients’ outcomes. The downregulation may occur by distinct mechanisms, particularly: (1) the shedding process induced by the SARS-CoV-2 fusion pathway, which reduces the amount of membrane-bound ACE2, stimulating more shedding by the high levels of Angiotensin II; (2) the endocytosis of ACE2 receptor with the virus itself and (3) by the interferon inhibition caused by SARS-CoV-2 effects on the immune system, which leads to a reduction of ACE2 receptor expression.

            Conclusion: Recent research provides evidence of a reduction of the components of the alternative RAS axis, including ACE2 and Angiotensin-(1-7). In contrast, increased levels of Angiotensin II can activate the AT1 receptor in several organs. Consequently, increased inflammation, thrombosis and angiogenesis occur in patients infected with SARS-COV-2. Attention should be paid to the interactions of the RAS and COVID-19, mainly in the context of novel vaccines and proposed medications.

          2. Kris Alman

            Because downregulation of ACE 2 receptor is associated with worse outcomes.
            https://www.ingentaconnect.com/content/ben/cdt/2021/00000022/00000003/art00003

            The downregulation may occur by distinct mechanisms, particularly: (1) the shedding process induced by the SARS-CoV-2 fusion pathway, which reduces the amount of membrane-bound ACE2, stimulating more shedding by the high levels of Angiotensin II; (2) the endocytosis of ACE2 receptor with the virus itself and (3) by the interferon inhibition caused by SARS-CoV-2 effects on the immune system, which leads to a reduction of ACE2 receptor expression.

          3. Kris Alman

            As an endocrinologist who trained in the early 1990s, I have had to learn about the two competing arms of the Renin Angiotensin System (RAS) pathways. Covid-19 enters the cell with its spike via the membrane-bound enzyme ACE2 (Angiotensin Converting Enzyme 2) receptor.

            This is not to be confused with ACE1 which is far better understood.

            Angiotensinogen is an inactive precursor peptide which is cleaved by renin to become Angiotensin I (AT1), which is further cleaved by ACE 1 to be Angiotensin 2 (AT2). These pathways are fundamental to prescribing ACE 1 inhibitors and ARBs (angiotensin receptor blockers) for high blood pressure, congestive heart failure and kidney disease (including that due to diabetic nephropathy).

            Angiotensin-(1-7) is a bioactive component of the renin-angiotensin system that promotes vasodilatory, anti-inflammatory, and anti-fibrotic effects. It is formed from either AT I or AT II using membrane-bound enzyme ACE2.

            Activation of this arm is thought to oppose the activity of the conventional ACE/AT2 pathway.

            Depletion of ACE2 receptors is associated with worse Covid outcomes.

            https://www.ejinme.com/article/S0953-6205(21)00307-1/fulltext
            “The interaction between ACE2 and SARS-CoV-2 Spike protein induces a substantial loss of ACE2 receptor activity from the external site of the cellular membrane. This phenomenon leads to less Ang II inactivation and less generation of Ang1-7 (imbalance between Ang II overactivity and Ang1-7 deficiency), which may ultimately trigger inflammation, thrombosis, and other severe adverse reactions influencing the outcome of COVID-19.

            The degree of ACE2 expression and the biological relevance of ACE2 deficiency may vary depending on the presence of specific characteristics and conditions (phenotypes of ACE2 deficiency). Important phenotypes including older age, hypertension, diabetes, cardiovascular disease and COPD share a variable degree of ACE2 deficiency and are associated with more severe forms of COVID-19.

            Thus, it is very likely that is not the ‘excess’, but the deficiency of ACE2 receptor activity that complicates the outcome of COVID-19.
            In the SARS-CoV-2 era, we may assume that ACE2 receptors are not dangerous Trojan horses, but useful defense weapons against the adverse mechanisms associated with the disease.”

        3. KLG

          I looked through that pre-print quickly. I defer to those well versed in the cell biology of coronavirus infection. It is not clear to me how the authors distinguished between cell-cell transmission and syncitium formation, the latter of which is well described for respiratory syncitial virus (RSV) and other similar viruses: Excess viral fusion protein is expressed on the plasma membrane of an infected cell and mediates fusion with an adjacent cell. At least one of the coauthors has worked on RSV. This is also still a preprint according to PubMed, and has not been published after peer review. That does NOT mean the work is incorrect in any way, however! Their experimental system is useful for the measurements they made, and I have used similar, broadly, in my research. But this system is not directly analogous to the environment in an infected animal. All I have time for tonight. Sorry.

      3. Kris Alman

        There’s more attention to the competing pathways of ACE1 and ACE2 in the renin-angiotensin system. ACE1 pathways are better understood in clinical medicine with ACE inhibitors and ARBs (angiotensin receptor blockers) used to treat cardiovascular disease, hypertension and kidney disease (including secondary to diabetes.

        It is very likely that is not the ‘excess’, but the deficiency of ACE2 receptor activity that complicates the outcome of COVID-19.

        Therapeutics like Vitamin D induce ACE2/Ang-(1-7)/MasR axis activity and inhibit the classic renin and the ACE/Ang II/AT1R axis, thereby increasing expression and concentration of ACE2.

        A brief review of interplay between vitamin D and angiotensin-converting enzyme 2: Implications for a potential treatment for COVID-19
        https://onlinelibrary.wiley.com/doi/full/10.1002/rmv.2119

  6. Cocomaan

    I’m wondering what the next spin is, because the democrats do have a pretty effective spin machine.

    Is it war with Ukraine? As an extension of Russia Russia Russia.

    Mandate boosters?

    I have no idea where they can turn but the Dems always intrigue me. What’s certain is that they will not do the right thing.

    1. Michael Ismoe

      January 6th. They are making it the line-in-the-sand. If you do not believe that this was a combination of Shay’s Rebellion and the firing on Fort Sumpter than you are a Deplorable.

      It’s all they got. The problem is that the only people who care are Democrats but it’s good for fundraising and that’s all that matters. “This could be the last free election in America…”

      1. Cocomaan

        Good one. I had thought about how we are coming on the one year anniversary now, so it will be a day of ritual pearl clutching.

      2. Screwball

        I think you are correct. Blame/shame the unvaxxed, and go all in on Jan 6 heading into the midterms. Their base will eat it up.

        I hope they get a historical ass beating come November, and if it is worse than that – good. And they can STFU about Manchin and the whole blame game.

        We are/have been, in the middle of a pandemic. They shouldn’t have 2000 page bills that nobody knows what’s in them, and argue over for months. Create smaller bills that can actually pass, and quickly. You know, like create a bill for X million for mailed at home test kits, money for R&D on a sterilizing vax, a nose/sinus wash, or pill. But no – all they have is the one trick pony – vax, vax, vax.

        And it’s the Trump vaccine to boot. You can’t make this stuff up.

        Carlin was right – they don’t give a **** about you. Vote them all out.

        1. Pavel

          They shouldn’t have 2000 page bills that nobody knows what’s in them, and argue over for months. Create smaller bills that can actually pass, and quickly. You know, like create a bill for X million for mailed at home test kits, money for R&D on a sterilizing vax, a nose/sinus wash, or pill. But no – all they have is the one trick pony – vax, vax, vax.

          Bingo!

          By all means get rid of these ginormous omnibus spending bills stuffed with lobbyist pork and loopholes for the elite.

          Small bills posted on the internet ahead of the vote, and force the critters to read every word aloud on the floor.

          Use GitHub to track the changes and who makes them.

          Is it true the CTC isn’t means-tested? That was one of Manchin’s objections, I believe. I agree with him there.

          Plus that obscene $80K SALT deduction!

          Throw them all out and start over with a randomly selected group of citizens. They couldn’t do any worse.

          1. Michael Ismoe

            The SALT deduction will pass before the midterms. It’s Chuck Schumer’s baby and that baby will get through in time for Schumer’s re-election or Long Island turns against him. And the Hamptons are on the other end of LI and must be defended.

            1. Pavel

              Iron Dome for Israel, SALT for the rich liberal elites… we know where the Senate priorities lie.

              Plus of course $780B for “defense”. (And BTW all those Dems who bleat about how climate change is an existential threat — how then can they vote for Pentagon spending when the US military is the world’s number one polluter?)

              Bur fairly-priced insulin? That can wait.

        2. Grumpy Engineer

          They shouldn’t have 2000 page bills that nobody knows what’s in them, and argue over for months. Create smaller bills that can actually pass, and quickly.

          Oh, wow. It’s difficult to describe how strongly I agree with you here. I HATE the Democrats’ practice of writing enormous bills that are so opaque that even full-time political writers have difficulty summarizing them well. How in the world are ordinary citizens supposed to have meaningful opinions about the merits of such bills?

          Manchin has been accused of lying about his support regarding the BBB, but I doubt he’ll suffer a political price at home. Most Democrats in WV will be mad at him because they think he blocked good benefits, but most Republicans there will be happy because they think he blocked wasteful spending. And sadly, these emotions will be driven primarily by political loyalties rather than hard opinions about the bill itself. Why? Because it’s too large. “Nobody knows what’s in them.

          Asking citizens to parse 2000 pages of legalese is asking too much. So the Democrats are effectively asking people to trust them. Except we don’t.

          1. Another Scott

            Isn’t the 2000 pages the point? Politicians get to include bad stuff without any consequences from their side of the isle because of all of the goodies that they included. Not to mention it allows more opportunities to reward their donors with line items that might otherwise be caught or publicized. And when the bill is inevitably killed, politicians at the end of the spectrum get to grandstand on Twitter and TV

            1. tegnost

              Yes to this. There was a lot of pork in that monstrosity. One might assume that they have had time to actually read this bill…
              I’m happy to see it go down in flames…

          2. George

            What we have lost is our nation but go ahead and choose sides.
            “The taxes involved in the Build Back Better bill were just a small part of Trump’s $4.5 trillion 2018 tax cuts. The Build Back Better bill’s funding involved partially raising Trump’s corporate taxes. But even that was too much for the thousands of corporate lobbyists who descended on Washington in recent months; their single objective has been to ensure corporate interests in the Senate–within the Democrat party as well as the Republican–don’t pass the Build Back Better bill in any form, since paying for it involved to a significant extent clawing back some of Trump’s $4.5T tax cuts for corporations and investors. Their lobbying effort has proved quite successful.”

            Jack Ramus Build back better now DOA

    2. TroyIA

      The next spin will be that total cases aren’t important only severity. In practice we will be like the NFL. They had such a spike in cases they needed to postpone games so they changed their policy to only testing symptomatic unvaccinated players instead of everyone.

      Biden admin eyes a potentially stark shift in messaging around ending the pandemic

      A shift toward focusing on severity instead of case numbers
      Some of Biden’s advisers are encouraging the administration to begin discussing publicly how to live alongside a virus that shows no signs of disappearing, a potentially stark shift in messaging for a White House that once touted “freedom from the virus.”

      Steering public attention away from the total number of infections and toward serious cases only — as some Biden advisers have encouraged — could prove a challenge after nearly two years of intense focus on the pandemic’s every up and down. It is a part of a growing conundrum that Biden faces as the Covid-19 pandemic refuses to abate.

      “We’re getting to the point now where … it’s about severity,” said Xavier Becerra, the secretary of the Department of Health and Human Services, in a meeting with reporters this week. “It’s not about cases. It’s about severity.”

      Becerra said the issue recently arose during a meeting at the White House with Biden’s Covid response team. Other officials also said the issue of how to refocus the public away from total cases toward the severity of illness has been an ongoing subject of discussion within the administration.

      “There’s a degree of difficulty that now comes in trying to decide what means it’s severe and what you have to do to stay out of that threshold of severity,” Becerra said. “But I think that’s where we’re heading, is to try to be able to tell the public that.”

      1. Objective Ace

        > they changed their policy to only testing symptomatic unvaccinated players instead of everyone.

        The CDC set the example and was doing that 6 months prior

    3. fajensen

      … an extension of Russia Russia Russia.

      Sabotage the gas supply to Germany, Publicly blame the Russians for it, While leaving some breadcrumbs leading back to the UK and/or China, for additional shit & giggles, while giving the Nuclear Mob some desperately needed help?

  7. Kengferno

    Here’s some info on omicron symptoms from a super spreader event in London:
    https://twitter.com/chrischirp/status/1471119076244209669?s=21

    And here’s a chart from an Oslo Xmas party omicron event:
    https://twitter.com/ty4on/status/1472289436943667205?s=21
    Not sure where this chart came from however.
    Symptoms are:
    Cough 83%
    Runny nose 78%
    Fatigue/lethargy 74%
    Sore throat 72%
    Headache 68%
    Muscle pain 58%
    Fever 54%
    Sneezing 43%
    Reduced smell 12%
    Reduced appetite 33%

    People in the thread who’ve had covid lately agree with this list

    1. Yves Smith Post author

      Funny they don’t have the digestive symptoms the way IM Doc’s patients do.

      But it’s an average of 3 days from exposure to symptom onset with Omicron. So Dec 3 is only 4 days into their cases. I can’t imagine they’d all be done being sick by then.

      1. Lena

        People I know who had Covid recently (all are “breakthrough cases”) have reported GI problems. Diarrhea, nausea and (less often) vomiting.

        1. redleg

          I can vouch for this based on my own experience plus a score of friends and family in the last few weeks (Delta)- lots of nausea but no vomiting.

          1. SB

            Dr. Tom Yarema, who gives a weekly Zoom webinar, said this week that he’s seeing new symptoms in his COVID patients – less respiratory symptoms and a complex of viral GI disease. This was his Zoom 78, but Youtube has apparently taken it down so I don’t have a link.

      2. Mikel

        Sounds like something an organization like The Who should be on top of: compiling and sharing lists of symptoms from country to country.

        Where they at? They still moonlighting as pharma salesmen?

    2. pxx

      Yep now in day 8 with a pretty gnarly, yet could-be-worse, set of symptoms. These are atypical for me. (male 40s good health): sore throat, impressive nasal mucus, headache for a day, and an intense wet cough. Appearing in that order. Everything but the cough and congestion cleared up by day 4, cough tapering off slowly, still not all the way gone. Girlfriend similar, minus sore throat, plus fatigue for a day or two, and faster to improve. Location has massive 2500-active-case outbreak for a college town. Girlfriend’s immediate relative contact traced as exposed but asymptomatic (and tested negative). I had negative result on home test, G/F and immediate family had negative result on both home tests and PCR, so we didn’t fully isolate, though stayed home for the most part.

      If this thing is registering false-negative on PCR, look out! That should be story number one…

      1. Pate

        “had negative result on home test, G/F and immediate family had negative result on both home tests and PCR”

        Was your illness ever confirmed Covid?

        1. pxx

          No, so likely in the category of a cold/whatever. But with how much confidence? Rearranging holiday plans, concern about older family etc. The Abbott home tests available here were already 85% accuracy per the fine print — with the 15% false-neg in large part as best I can tell from press reports — and that was tested against the original-recipe virus. The item in the article above questioning PCR vs Omicron raises huge concerns.

          1. Objective Ace

            >with the 15% false-neg in large part

            I don’t see how they could calculate this. It will depend on how much covid is in the area at a specific time.. To take it to the extreme if everyone has covid in the area it will have a 100 percent false negative rate

      1. Michael Ismoe

        No offense but the symptoms of Runny nose, Fatigue/lethargy, Sore throat, Headache. Muscle pain,
        Fever and Sneezing sound like a normal day to us allergy sufferers. Could it be that I originated Covid?

        1. lordkoos

          I’ve had bad allergies to certain grasses and trees since I was 14 and I have never had headaches, sore throat, muscle pain or fever from it. I would not consider those to be typical allergy symptoms at all?

  8. TMoney

    Meanwhile inside the PMC Beltway cabal…..
    A: Young and Worried
    B: Older and Wiser

    A: “We get wiped out in the midterms ”
    B: “I know – awesome right ? ”
    A: “what ?? ???”
    B: “Relax, our fund raising numbers go through the roof when we are out of power – how else are you going to pay for your kids college ? ”
    A: “Oh…..”

    1. Michael Ismoe

      The amazing part to me is that these very same people who are going to master strategize for the Dems and lose 75 House seats and 5 senate seats are going to be in high demand because 2024 is right around the corner. Falling upwards is a Democratic Party tradition. Look at the commander in chief. The Speaker. The Majority Leader.

  9. michael

    When I was a kid growing up in the 70’s, my dad told me about the yellow dog Democrats. Yellow dog Democrats would vote for a yellow dog running as a Democrat over any Republican. Has anyone here thought about what it would take to create yellow dog Republicans? I think threatening people with loss of their job so that they can’t feed, clothe, or provide shelter for themselves and their family would be an excellent place to start. I think that allowing crime to run rampant is a close second. I still remember the congressional Democrats kneeling to the altar of BLM as protestors rioted, destroyed and looted businesses, started fires with the express intent to hurt people, and attacked police and national guardsmen on duty to protect government buildings and police stations. Today, we have Democrat DA’s deliberately not prosecuting criminals. These criminals then go out and commit more crimes that they aren’t prosecuted for. This doesn’t even factor in the illegal immigrant invasion or the “whiteness bad” cults that seem to have taken over the schools, universities, and major multinational corporations. I know that a lot of the people upset by the above are already Republicans but how many are now former Democrats? How many yellow dog Republicans have these policies created? A small permanent shift of even 2 to 3% could make the Democratic party the minority party for years to come.

    1. marym

      While it’s very generous of people all across the country who don’t live in or travel to troubled big cities run by Democrats, to be concerned about them, they should vote for or against candidates based on issues like jobs, healthcare, social services, local infrastructure, school budgets, natural disasters made worse by climate change, local pollution by corporate industries, the opioid epidemic, debt relief, etc. that have an impact on their own lives. Perhaps this would make corrupt and anti-working class politicians a minority in both parties.

      1. coboarts

        In the clown show to which I have referred before, the recent recall election of our next president, Gavin Newsom, those are exactly the types of issues that were demanded and nowhere found.

        1. Jeff

          Newsom is an excellent representation of a California Democrat. He failed as the mayor of SF and was rewarded by the dim population to be governor.

          Ignore the crime, homelessness, bad schools, unaffordability and business hostile approach to governance. As I’ve said ad nauseam, California is a basket case, and it’s best personified by Newsom himself.

          Remember, he’s the guy helping PG&E fight off those entitled, pesky homeowners who lost their homes in the Wolsey fire and who are suing PG&E for restitution.

    2. Phil in KC

      You only need to visit rural USA and you will find all the “yellow dog” Republicans you want. Some of my in-laws from the high plains view Satan more favorably than the Democratic Party. If you confine discussions to policy and philosophy only, a lot of these folks will express a preference for Democratic and even some progressive proposals. I mean, come one, who is FOR child poverty? Or more expensive treatments for diabetes? No one, but once the “D” label is applied, the idea becomes radioactive. The GOP has effectively branded the Democratic Party. Dems seem unable to get out of GOP framing.

    3. LY

      The yellow dog Republicans are the DAs refusing to prosecute criminals (polluters, wage theft, fraud, affluenza), those causing the illegal immigrant invasion (i.e. those employing them), etc. Of course, Islamaphobes, the “Lost Cause”, and slavery apologists are part of the base, so that’s not going to change.

      Biden and Obama get stick for illegal immigration as they deport record numbers, while Republicans get a utter free pass on hypocrisy (farm labor, Trump, Inc. with Costa Ricans and Poles). And heaven forbid BLM get the same treatment as the Bundy’s, KKK, frat boys celebrating a sports championship victory/loss, or Jan. 6th rioters.

        1. TMoney

          Not lost. He just accidentally found his way to a more enlightened comments section.

          Warning! Continual Exposure to NC may cause thinking.

        2. Jeff

          Hmm, much of what he said about cities not prosecuting criminals is indeed happening in Los Angeles and SF.

    4. WobblyTelomeres

      Yellow dog Democrats (YDD) and yellow dog Republicans (YDR) are the exact same people. YDD were Democrats only because they refused to vote for the party of Lincoln, who freed the slaves. They slowly began turning into YDR following LBJ’s civil rights act, which became a stampede when told they didn’t have to be ashamed of their rascism, that they were patriots, builders, moral even.

      1. JBird4049

        Dixiecrats in the South. Once President Richard “Tricky Dick” Nixon’s Southern Strategy got going, it gave an excuse for all those crypto-racists an excuse to go Republican.

        Don’t forget that the Democratic Party is what the conservative Republican Party used to be; the Republican Party today, if not insane, is very reactionary being the American version of the French Ultras, but perhaps worse; they look like they want to rule as the American version of the Latin American or Brazilian varieties of reactionary oligarchies. Especially, the Southern wing.

      2. Duke of Prunes

        Maybe I’m an optimist or incredibly naive (or, perhaps, a closet racist in denial of such), but I believe there’s often more to these things than racism. Then again, blaming everything on racism is neat and easy.

        1. Jeff

          The racism trope is tired nonsense. The woke mob would accuse the sun of racism for not rising in the west and likely accused the Earth’s rotation as just another example of white privilege.

          Oh, and math is racist.

  10. Gregory Etchason

    Post Holiday is likely be an historic WTF moment. When many return to work and find 30% of co-workers out sick. The 2021 story won’t be body bags and refrigerated trailer morgues. But the economy will likely end up crtically ill.

      1. Gregory Etchason

        I agree that Omicron may be just as lethal as Delta in the immunologically naive( no prior infection or vaccination). I would guess at least 100 million immunologically naive in the US right now. My sense the intact T cell immunity in everyone else is keeping Omicron out of the lungs. If so, an historic Red State die off is coming

  11. IM Doc

    .About the Gottlieb tweet.

    Is it just me misremembering, or was there a time this summer, when the National media were all aghast that deSantis was obtaining monoclonal for Florida outside of the federal process?

    It was a big right wing conspiracy theory there in our national media. Meanwhile, in academic medical departments everywhere, the Abs were recognized as a really good tool.

    It seems to me that part of this fiasco is also the complete and total failure of our media and their social media censors and fact checkers.

    We must not forget that as well when the blame is being assessed.

    1. Shonde

      Also, I recently read that the Florida health department is promoting use of D, C and zinc whereas my northern state with supposedly an excellent health department (Minnesota) has not said a thing.

      Shouldn’t we have walk in D testing stations free of charge? Had my D tested in May and even while taking 5000 IU’s a day, it was still at the minimum of 40.

      1. endeavor

        I’ve read repeatedly from trusted practitioners that Vit D needs magnesium and quercuitan to be really effective. Plus a heavier person needs a larger dose of D as it is fat soluble.

      2. Louis Fyne

        Long-term supplements of zinc should be accompanied by copper (but I have no idea how upping copper and zinc affects covid).

        Mega-dosing of zinc is really meant for very brief periods, around the time one feels an infection developing.

        Tread carefully with zinc! get knowledgeable advice.

        Mega-dosing with zinc is not as fool-proof as mega-dosing with Vitamin C or D.

        just saying

      3. KLG

        That is not the minimum. I recently had a complete metabolic panel done. Anything above “40” is good IIRC (the current Endocrine Society recommendation is 40-60 ng/mL for both children and adults, which accounts for vagaries in assays). It is not clear that excess helps, and it may hurt. Vitamin D3 is fat soluble and excess is not excreted as with water-soluble vitamins (such as B vitamins). Toxicity caused by too much vitamin D can be a thing: “Vitamin D, when ingested in large amounts, is one of the most likely of all vitamins to cause overt toxicity” (Advanced Nutrition and Human Metabolism, 6th edition, S.S. Gropper and J.L. Smith, 2013). The key is not to be deficient, while maintaining good health. Our bodies do homeostasis very well, and if enough of a vitamin is present, more is not necessarily good. This applies to all nutritional supplements. It is also good to remember that the “supplement business” is not regulated by the FDA, which among our alphabet agencies has not yet been tainted by the rampant stupidity associated with this pandemic AFAIK. You never really know what is in those pills…

        1. Amfortas the hippie

          yeah. i keep the Zinc and D on the shelf until there’s a syptom or relatively certain exposure.
          we’re all outside a lot….like, really a lot,lol…and eat like old time farmer people.
          so i know that our D is pretty decent, compared to other folks…and i expect the rest of the vitamin and mineral profiles to be good as well(picked the last vine ripened tomatoes last week….and wrapped 30# of green toms in newsprint and stuck them in a ventilated cooler in the living room, in a dark-ish corner…we’ll be eating lots of tomatoes through january, at least…plus peppers and green onions in the greenhouse)
          i push vitamin C on everyone…because, as you say, water soluble=can’t OD on it. and i’ve been taking B Complex forever(due to grandma’s advice, long ago), because why not? for the same reason….can’t OD.
          touch wood, but i very rarely get sick…even with all the time i’ve spent with wife in hospitals and such in the last 3 years.
          of course, i have always avoided crowds and close contact with people out in the world…so i’m sure that has an effect, as well—i’ve been “social distancing’ my whole derned life.
          (if only this method could do something about whole body arthritis, Fibro and Cedar Fever!)

        2. Yves Smith Post author

          20 minutes of full body sun at the equator = 20,000 IU of Vitamin D. It’s very hard to get to toxic levels. No one is recommending 100,000 IU.

          1. Amfortas the hippie

            i’ll take your word for it.
            thanks.
            a tickle in my mind remembered something about too much D being bad, so i erred on the side of caution…and, like i said, we get lots and lots of sun around here(especially me).
            (and all that milks we drink has D added, too.)
            too much to keep up with, i suppose….i may have been thinking of zinc.
            box in my closet has all the preps for covid exposure.
            …and to their credit, local clinic recommended D, zinc and even melatonin when wife and boys had it last january.

            where i’m at, the general consensus is that the pandemic is over…even that it never happened/was a hoax(in spite of the local deaths and sickness).
            so omicron should be interesting.
            i haven’t seen a single at-home test on any shelf, anywhere, here.
            clinic only does them for folks with symptoms(and cancer patients)
            luckily, wife is taking january off(FMLA), since she’ll be tied up with the clinical trial for so much of the month anyway(and retiring in May)…and youngest, sophomore, feels like mask wearing in school is akin to letting his whiskers or hair grow out: an act of defiance.(local school is sticking to their role as hair police)
            (eldest works outside, and refuses vax(fwiw))

      4. Kris Alman

        There’s more attention to the competing pathways of ACE1 and ACE2 in the renin-angiotensin system. ACE1 pathways are better understood in clinical medicine with ACE inhibitors and ARBs (angiotensin receptor blockers) used to treat cardiovascular disease, hypertension and kidney disease (including secondary to diabetes.

        It is very likely that it is not the ‘excess’, but the deficiency of ACE2 receptor activity that complicates the outcome of COVID-19.

        Therapeutics like Vitamin D induce ACE2/Ang-(1-7)/MasR axis activity and inhibit the classic renin and the ACE/Ang II/AT1R axis, thereby increasing expression and concentration of ACE2.

        A brief review of interplay between vitamin D and angiotensin-converting enzyme 2: Implications for a potential treatment for COVID-19
        https://onlinelibrary.wiley.com/doi/full/10.1002/rmv.2119

    2. coboarts

      Going out on a limb IM D, and, obviously only my delusional, conspiratorial predilections at work, plus several well documented counter-narrative sites that are beyond the gates kept (The Last American Vagabond & Corbett Report are the best), I might suggest that there is a long planned agenda to… well, one would have to go there… And, if so, and if there are enough remaining with the vigor, then the entire PMC class: Academics, Media, Corporates, Politicians will be tried and condemned for crimes against humanity – and all who acquiesced on the way.

  12. Louis Fyne

    —- And in that story, even though their war burns down the world, it also produces its renewal. Will that be the Democrats, or a wider conflagration?—

    Then throw in….for whatever reason, DC decides that the midst of a pandemic, and generation-high inflation, is precisely when the US should turn up the diplomatic heat on Russia and PRC—but of course, the Beltway turns up the diplomatic heat by using meaningless gestures that make no practical difference (diplomatic boycott to the ’22 Olympicis, sending light arms to Ukraine) but absolutely infuriates the other sides and tips the US’s intrasigent hand.

    For hating POTUS #45, the DC Dems are literally doing everything that they can to given him 300+ electoral college votes.

    The results of incompetence truly look no difference than the results of malice.

    1. NotTimothyGeithner

      Failed domestic Presidents go shopping for foreign policy wins, so former Vice President Biden is looking for a win. Africa doesn’t get headlines, and he’s run out of small countries. Pervasive propaganda about Russia has likely been internalized. He might think they will fold and the Russians will make a deal, but Biden doest realize he’s not a new President but a continuation of now three mad men. He’s too aligned with Obama to be treated with in good faith.

      Again, former Vice President Biden is very stupid.

  13. Tom Stone

    Step back for a moment and consider how pervasive the incompetence is.
    This took talent of a kind. and an impressive amount of effort or there would,if only by accident,someone doing a good job.

    1. Mantid

      I agree. However, when all sorts of agencies, universities, politicians, medical publications, and even a large variety of countries are incompetent, perhaps they are really exhibiting competence. Their efforts, what they want to achieve, are successful.
      Why hasn’t Harvard Medical School, Emory Univ., USC Med. Ctr. come out with simple Covid avoidance measures? Well, who signs their pay check? Who offers them grants? Why did Andrew Hill, who was initially all in for Ivm (and other cheap treatments) and then did an about face in Jan. of 2021, receive a $40,000,000 check for his institution? Also, why are the people who suggest preventatives being fired (Dr.s Korey, Meric, etc.). Vaxifornia, uber alles!

      1. coboarts

        what’s this… synchronicity.. my comment above, under IM Doc, is not so different:
        coboarts
        December 20, 2021 at 5:18 pm

  14. Wukchumni

    48 double vaxed came down with Covid on a cruise ship in Miami yesterday, so its a matter of time before hospitals are overwhelmed, with the worst part being that those vaccinated were told they were in the clear, nothing much to worry about.

    So, we’ll have the non-vaxed and vaxed getting sick simultaneously, I knew we could bring this country back together somehow!

      1. ChrisFromGeorgia

        What is the proverb, “as a dog returns to his own vomit, so a fool returns to his own folly?”

  15. Arizona Slim

    Was chatting with three friends yesterday evening. Two of them are sisters and the third is the husband of one of the sisters.

    There were glum faces all around, and the truth soon emerged. Two of the three had to be vaxxed so they could keep their jobs.

    The wife of that couple said, in essence, that she knew that being vaccinated wouldn’t do her any good, but she had to do it. And she experienced some pretty scary side effects — hallucinations, trouble moving her legs, and tinnitus. Suffice it to say that she wants no part of any booster.

    Meanwhile, the husband sailed right through his vaxx experience.

    The other sister had you-know-what last year and does not want the vaccine. She may lose her job, but so be it. She saw what just happened to her sister and she’s frightened.

      1. Arizona Slim

        I can’t tell you how grateful I am for your comment, Louis. I sent this information on to my friends.

        The NC Commentariat is truly the BEST!

        1. cocomaan

          Yeah this is interesting. At the very least, if you have side effects, document that you had them! Never know what may come of it.

          1. Anonymous 2

            I had tinnitus after my first vaccine dose. The good news is that in many cases it seems to disappear gradually if, as in my case, it was probably an off-target inflammatory response.

    1. Pavel

      I have had constant tinnitus since my second vax (never had it previously). One result is that I can’t get to sleep until exhausted at five AM or so. Thankfully I am on work sabbatical.

      I can only hope it will resolve over time. I read of one chap who killed himself because it was so unbearable.

      No way I will get a booster.

      1. Anonymous 2

        There is a tinnitus support group on Facebook. You might find it helpful to join. In my case it has got better with time – but it does take months (I am 10 months on, now much better).

        1. Pavel

          Hello…

          thanks for the encouraging words (which I had heard elsewhere). I have no wish to be on FB but I’ll do some research elsewhere!

          Mine is high-pitched and comes-and-goes (right now at full blast) and is worst of course at 3AM or 4AM and destroys my sleep. I might try some white noise recordings instead of the podcasts I listen to now — interesting and/or amusing but no good for my sleep!

          Thanks again.

          1. Amfortas the hippie

            i’ve had it off and on for a long time.
            music in my head helps…and whiteish noise…like a box fan…really helps me to sleep(exhaustion is my friend, as well,lol)
            i chalk mine up to loud amplifiers back in my guitar god days, as well as the likely constant inflammation from the arthritis.
            it’s worse in winter.
            wouldn’t wish it on…very many people….

      2. Anon

        I am still suffering with GBS after getting my J&J vaccine in the Spring. It is unsafe for me to get a booster of any of the vaccines. At this point, I am essentially unvaccinated.

      3. johnnyme

        I’ve had bad tinnitus all my adult life. Something that generates soft white noise (like having a fan nearby) helps immensely with sleep.

  16. Carolinian

    Don’t forget hospitals being short handed because Biden forced them to fire their staff. Since Biden likes to play doctor someone should tell him about “first do no harm.”

    But of course it’s not just him as hospitals around the country insist on following the Fauci party line re ivermectin and other non vax treatments. We are living in a repressive environment where doctors are attacked if they challenge a failed consensus. The entire establishment seems more focused on protecting their position than in solving problems.

    Still, isn’t it possible that Omicron could turn out to be a ray of light if it changes Covid into a less deadly disease? The Spanish Flu did fade after a couple of years and early on some epidemiologists said this would happen with Covid. Perhaps now’s the time….

  17. Tom Stone

    A friend of mine and his wife held their annual Christmas party yesterday, 30 odd attendees.
    Inside because the weather is cold.
    No worries because everyone was vaxxed.
    He’s mostly apolitical, she’s a lifelong Dem and vice principal of a private High School.
    BA and Master’s degrees.
    Really nice people and I hope they are lucky.

    We are only weeks away from a tsunami of new cases, and an obviously corrupt and incompetent leadership guarantees a clusterfuck of historic proportions.
    When Governments lose legitimacy the only tools they have left are lies and violence.

  18. Louis Fyne

    Icing on top of the incompetence cake—-my hunch is that behind-the-scenes West Wing staffers called Manchin’s constituents something a bit more nasty than Deplorable.

    ****
    —On statewide WV radio, explaining his decision to buck BBB, Manchin says Biden staffers alienated him.

    “They drove some things, and they put some things out that were absolutely inexcusable. They know what it is, and that’s it,” he says on @HoppyKercheval’s MetroNews program.—

    https://twitter.com/stevenportnoy/status/1472951145362567170? (CBS News reporter)

    1. marym

      If we’re proposing that Manchin decided to vote against things his constituents need and want – having already “negotiated” those things downward – because some elite Dem said something mean about his constituents, we would have to ask who else besides Democrats is showing contempt for those constituents in this scenario.

    2. Pat

      I may despise Manchin, and though this story reeks of entitlement along the lines of “don’t they know who I am, I also have to give him some props. He has read the situation, played the key entities, “negotiated” hard and gotten everything he wanted while denying any wins for those key entities. He might not have made out so well with an LBJ or even a Reagan/Bush 1 administration (they would have used the tools Biden forgot he had) but this is possibly the best hardball play by a Democrat in over a decade. Too bad it was all about self serving greed.

        1. NotTimothyGeithner

          Manchin is whining about WH staffers. I think Obama could squeeze Manchin. Manchin if he’s ever read a book would probably curl up into a fetal position and piss himself if he read on Caro’s LBJ books.

          1. Pat

            No drama Obama! Nah I don’t think so. Michelle would just appear on some talk show talking about going high. What I will give Obama in this is there never would have been the President Manchin meme as he would make sure Jaypal would never have been able to pin the failure on him, he would have arranged it to be all about the squad’s overstep and incompetence.

  19. Matthew G. Saroff

    This was why Pelosi should have held off passing the infraxtructure (glorified highway) bill before the BBB bill made it through the Senate.

    DINOs never keep their promises.

  20. Hepativore

    Of course when the Democratic wipeouts happen in 2022 and 2024, the Democrats will use this as a sign that they should move further right and become even more Republican-Lite.

    If Joe Biden really wanted Manchin to fall in line he could have threatened to have his daughter investigated for all of the various illegal financial misdeeds that the Manchin family has been involved in. The same thing goes for Sinema. Biden could have told her to either play ball or he could make a few calls to ensure that she loses those cushy lobbyist jobs she has lined up after her political career.

    This is why I do not think that Biden ever actually wanted to stop Manchin or Sinema in the fist place.

    1. NotTimothyGeithner

      After 2024. Manchin et all will be held in gallows set up your Trump and his supporters. He voted to convict Trump twice.

    2. Dr. John Carpenter

      Agreed with this 100%. And I would add, if one vote is all that’s standing in the way, howcome Biden didn’t go after a Republican? We heard so much about how he was beloved by them and was going to reach across the isle, etc. And yes, I know. Republicans evil. It would have been a long shot. But did he even try?
      This was supposed to be his signature accomplishment. He’s either the laziest man in politics or he really didn’t care if it passed.

    3. Duke of Prunes

      Perhaps Biden is hesitant to go after family because of his family? That lovable scamp Hunter has been out of the news for while…

      1. polar donkey

        For real. Biden threatens Manchin, Manchin flips to republican party and then 24/7 Senate investigation and hearings.

  21. drb48

    In all, most monoclonal antibodies were completely ineffective against the Omicron variant. Some, such as sotrovimab, S2K146, and S2X324 retained neutralizing activity, but at a significant reduction. This points to the immune escape capabilities of Omicron via its distinctly mutated S protein and genome.

    Conclusion

    Many seem surprised at the ability of SARS-CoV-2 to mutate to increase resistance against convalescent sera, most vaccines, and most monoclonal antibodies. However, the surprise was unwarranted for those who realized that coronaviruses have evolved over many millions of years to reinfect hosts over time. Those previously infected with earlier strains of the virus, contrary to our assumptions earlier in the pandemic, are able to be reinfected with Omicron and strains to come.

    We previously predicted that SARS-CoV-2 would persist, continue to vary, and evade our natural and adaptive immune responses. We have also learned that SARS-CoV-2 has the potential to become far more lethal than it is today. We reiterate that the sister of this virus, SARS-CoV, and its cousin, MERS-CoV, ranged between 10% and 30% lethality. This is presumably due to slight variations in the structural, nonstructural, and accessory proteins. We must be ever alert now and for many years in the future of the possibility of such changes and their consequences.

    https://www.forbes.com/sites/williamhaseltine/2021/12/17/how-omicron-evades-natural-immunity-vaccination-and-monoclonal-antibody-treatments/?sh=808bb7f60e08

    1. MT_Wild

      “The rise and fall of Omicron” is but Act III of the Shakesperean tragedy we are living through. The variant with a 10% CFR does not arrive untill midway through Act IV.

    2. Objective Ace

      >We reiterate that the sister of this virus, SARS-CoV, and its cousin, MERS-CoV, ranged between 10% and 30% lethality.

      The more this drama unfolds, I’ve been wondering if China–who are actually getting their public health response correct–may actually be kicking themselves down the road. Everyone in the west will have been exposed many times over the next 5 to 10 years. Will China be sitting there like the America’s were when Christopher Columbus landed and brought a bunch of viruses they had never encountered anything the likes of before

  22. Russel Allinson

    I am so sick of all the commentary about the impact of the BBB failure on the democrats and the president. How about the impact on children of the poor , low income families, the climate, and those who depend on Medicare? Failure of this bill leaves all the problems unresolved and worsening. That is the tragedy in a country of enormous wealth and criminal inequality

    1. Mark Sites

      And, of course, there will be no tax increases on the richest. That was the whole game for Manchin, and he delivered BIGLY to every one that matters to him.

    2. Amfortas the hippie

      Hear, hear!

      …but we’re by now rather acclimated to having no help, i suppose.
      i know i sure am…
      i’m not eligible for medicaid, for instance, because wife makes too much money teaching(!)…(she’s eligible, because it’s Cancer, which apparently puts her in a different, not-lazy category.)

      i allowed myself a tiny sliver of hope, up until the Progs caved on the highway bill.
      if i vote at all, going forward, it will be in the GOP primary so i can screw with them.
      and local things like the sheriff, that have an actual effect on me…and that, due to polity size, i can actually have an effect on.
      i vow to never vote for a democrat again.
      if i do deign to vote in the General, it will be only for greens.
      a pox on them all.

      1. coboarts

        What if those who care for the Earth and dwell in cities decide that each privately owned quarter of an acre, anywhere, should be taxed – a lot – to bring equity and justice to the land?

    3. Michael Ismoe

      It’s the children of the wealthy I’m most concerned about. Their parents were expecting a SALT increase and didn’t get it. The dues at the country club went up, the leases on the Lexuses are due and will they have to hire another maid so Courtney can get private Spanish lessons?

      Burn the whole thing down. I gladly sacrifice my voucher for a free hearing test that was carefully crafted to make one happy Medicare recipient (damn entitlement mentality).

  23. Samuel Conner

    Stimulated by an alternative spelling, “Hybris”, in comments yesterday, I’m wondering if the “u” in “Hubris” is properly pronounced the same as the “u” in “nu”.

    —-

    If “yes”, I cannot resist the temptation to paraphrase Gandalf as he fell into the abyss at the bridge of Khazad-Dum:

    “Flu’, you fools!”

    1. ddt

      Ypsilon “υ” in Greek is an ee sound, like the word ‘Greek’. The capital is “Y”. So the word in the language, ύβρις, is pronounced eevrees (“h” is silent) with the accent on the first syllable. There endeth your Greek lesson for the day.

  24. LAS

    From within the NYC DOHMH, we are being encouraged from City Hall and leadership to believe that Pfizer and Moderna shots stop Omicron, where other makers’ shots do not. They are relying on the fact that Moderna says its booster significantly raised the level of antibodies which could combat Omicron and the rest of the world does not have access to Pfizer/Moderna used in the USA. It is not clear to me how these claims can be reliable at so early a stage of Omicron. Nonetheless, these are the talking points by an outgoing DiBlasio administration and commissioner of health.

  25. Kris Alman

    As an endocrinologist, I’ve been very interested in the role of the ACE2 receptor in the pathology of Covid since it is the primary portal for the virus spike to enter the cell. A Trojan horse.

    When I was in fellowship training decades ago, the ACE2 receptor and angiotensin-(1-7) (Asp-Arg-Val-Tyr-Ile-His-Pro) were just babes in benchwork research.
    https://europepmc.org/article/med/1342241

    We have had a much better understanding of angiotensinogen, an inactive precursor peptide cleaved by renin to form angiotensin 1 and further processed by angiotensin converting enzyme 1 (ACE1) to angiotensin 2 in the Renin-Angiotensin System (RAS). ARBs (Angiotensin-II receptor blockers) and ACE inhibitors have been widely used to manage hypertension, congestive heart failure and kidney disease (including diabetic nephropathy).

    Covid-19 has created a surge of interest in these parallel pathways that intersect with our complex immune system and our body’s response to stress/inflammation (including the role of glucocorticoids and gender differences).

    Here’s a dense review with its abstract and one paragraph on diarrhea:
    Functional ACE2 deficiency leading to angiotensin imbalance in the pathophysiology of COVID-19
    Reviews in Endocrine and Metabolic Disorders (2021)
    https://link.springer.com/article/10.1007/s11154-021-09663-z

    Abstract
    SARS-CoV-2, the virus responsible for COVID-19, uses angiotensin converting enzyme 2 (ACE2) as its primary cell-surface receptor. ACE2 is a key enzyme in the counter-regulatory pathway of the broader renin-angiotensin system (RAS) that has been implicated in a broad array of human pathology. The RAS is composed of two competing pathways that work in opposition to each other: the “conventional” arm involving angiotensin converting enzyme (ACE) generating angiotensin-2 and the more recently identified ACE2 pathway that generates angiotensin (1–7). Following the original SARS pandemic, additional studies suggested that coronaviral binding to ACE2 resulted in downregulation of the membrane-bound enzyme. Given the similarities between the two viruses, many have posited a similar process with SARS-CoV-2. Proponents of this ACE2 deficiency model argue that downregulation of ACE2 limits its enzymatic function, thereby skewing the delicate balance between the two competing arms of the RAS. In this review we critically examine this model. The available data remain incomplete but are consistent with the possibility that the broad multisystem dysfunction of COVID-19 is due in large part to functional ACE2 deficiency leading to angiotensin imbalance with consequent immune dysregulation and endothelial cell dysfunction.

    Gastrointestinal system
    The small intestine hosts the body’s highest tissue concentration of both ACE and ACE2 [73]. High doses of exogenous AT2 administered enterally to rats impair jejunal sodium-water reabsorption – potentially explaining the increased risk of diarrhea in COVID-19 – while ACE inhibitors and angiotensin receptor blockers (ARBs) reduce intestinal inflammation in rodent models [73, 74]. The effects of ACE2 in the gut are less well recognized but it appears to act in a non-catalytic manner to regulate tryptophan transport and the expression of antimicrobial peptides [4, 7, 73]. It has been more broadly hypothesized that ACE2’s impact on cardiovascular and pulmonary physiology may also proceed in part through alteration of the gut microbiome [4, 7].

    Also see:
    The pivotal link between ACE2 deficiency and SARS-CoV-2 infection: One year later
    https://www.ejinme.com/article/S0953-6205(21)00307-1/fulltext
    It has been recently suggested that free-floating Spike proteins released by the destroyed cells previously targeted by vaccines may interact with ACE2 of other cells, thereby promoting ACE2 internalization and degradation [[80],[81]]. This mechanism may enhances the imbalance between Ang II overactivity and Ang1-7 deficiency through the loss of ACE2 receptor activity, which may contribute to trigger inflammation, thrombosis, and other adverse reactions [[82],[83]].
    Of note, spike proteins produced upon vaccination have the native-like mimicry of SARS-CoV-2 Spike protein’s receptor binding functionality and prefusion structure [[84]].

    All very concerning if vaccines and boosters are down-regulating ACE2 since…

    It appears that spike protein is also important for cell-to-cell transmission. In other words, viral-infected cell to viral-infected cell.

    This June 2021 pre-print, “SARS-CoV-2 Spreads through Cell-to-Cell Transmission”, shows evidence that the spike glycoprotein mediates the spread of SARS-CoV-2 in cell-to-cell transmission in the absence of ACE2 (angiotensin-converting enzyme 2) receptor expression in target cells.
    https://www.biorxiv.org/content/biorxiv/early/2021/06/01/2021.06.01.446579.full.pdf bioRxiv. 2021 Jun 1

    The authors (primarily from Ohio State University) point out that, “Cell-to-cell transmission is considered to be an effective means by which viruses evade host immunity, especially antibody-mediated responses.”

    Moreover, “(w)hile not statistically significant, some of the COVID-19 sera (2 out of 5) even enhanced cell-to-cell transmission of SARS-CoV-2 (Figure 6D), although the underlying mechanisms are currently not known.”

    These in vitro studies with a small number of samples were using older variants of concern (B.1.351, “Beta” first detected in South Africa and and B.1.1.7, aka British variant).

    One has to wonder why this NIH funded study has not been peer reviewed and published in any journal yet.

    These studies should be replicated with the omicron variant and with sera from vaccinated and delta-infected individuals to see if cell-to-cell transmission is further enhanced through down-regulation of ACE2 receptors.

  26. skippy

    @Lambert …. per mention of Chicago School indoctrination.

    This is the most important factor above all others in assessing Manchin moves, corner stone to his entire world view[.]

    When I recently saw him quoted as saying the nations debt was his driving concern I stopped all other further introspection on what environmental conditions might be influencing his views/agenda – personal interests or otherwise. He is a vassal filled and no amount of wrangling will ever change his beliefs, probably thinks the private sector creates all the wealth for the nation of which the government relies upon to function – you know people like him and his.

    Its this perspective that mentally allows him the hall pass for letting the unwashed take the brunt of all the bad decisions pre and post GFC and now Covid. Might actually think he is fighting for some higher purpose, would explain his intractability in allowing any social good which might threaten his perspective.

    That’s not to say all the looters in the rest of the Dem or Rep parties would make BBB resemble 3rd world aid or Afghan school building.

  27. Kris Alman

    As an endocrinologist who trained in the early 1990s, I have had to learn about the two competing arms of the Renin Angiotensin System (RAS) pathways. Covid-19 enters the cell with its spike via the membrane-bound enzyme ACE2 (Angiotensin Converting Enzyme 2) receptor.

    This is not to be confused with ACE1 which is far better understood.

    Angiotensinogen is an inactive precursor peptide which is cleaved by renin to become Angiotensin I (AT1), which is further cleaved by ACE 1 to be Angiotensin 2 (AT2). These pathways are fundamental to prescribing ACE 1 inhibitors and ARBs (angiotensin receptor blockers) for high blood pressure, congestive heart failure and kidney disease (including that due to diabetic nephropathy).

    Angiotensin-(1-7) is a bioactive component of the renin-angiotensin system that promotes vasodilatory, anti-inflammatory, and anti-fibrotic effects. It is formed from either AT I or AT II using membrane-bound enzyme ACE2.

    Activation of this arm is thought to oppose the activity of the conventional ACE/AT2 pathway.

    Depletion of ACE2 receptors is associated with worse Covid outcomes.

    https://www.ejinme.com/article/S0953-6205(21)00307-1/fulltext
    “The interaction between ACE2 and SARS-CoV-2 Spike protein induces a substantial loss of ACE2 receptor activity from the external site of the cellular membrane. This phenomenon leads to less Ang II inactivation and less generation of Ang1-7 (imbalance between Ang II overactivity and Ang1-7 deficiency), which may ultimately trigger inflammation, thrombosis, and other severe adverse reactions influencing the outcome of COVID-19.

    The degree of ACE2 expression and the biological relevance of ACE2 deficiency may vary depending on the presence of specific characteristics and conditions (phenotypes of ACE2 deficiency). Important phenotypes including older age, hypertension, diabetes, cardiovascular disease and COPD share a variable degree of ACE2 deficiency and are associated with more severe forms of COVID-19.

    Thus, it is very likely that is not the ‘excess’, but the deficiency of ACE2 receptor activity that complicates the outcome of COVID-19.
    In the SARS-CoV-2 era, we may assume that ACE2 receptors are not dangerous Trojan horses, but useful defense weapons against the adverse mechanisms associated with the disease.”

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