Peter Lederman in Second Bout With COVID-19

I for one would not object if the moderator would delete this thread, now that we are getting into conspiracy theories unrelated to COVID. Not surprisingly, the same guys are on the other side of my fence.

Dover, You live on an island with a huge land mass in comparison to its population, and it is accessible via a very limited number of locations.  Controlling an epidemic infectious disease in that setting is rather simple compared to the issues faced by most other larger countries. One possible reason for the screening system used by your government at the outset of the pandemic, if indeed your depiction is correct, would be that the previous Coronavirus outbreak, caused by the SARS virus at the turn of this century, was characterized by the fact that infected persons were not contagious UNTIL they first developed symptoms.  It was not such a bad notion to screen for symptoms in those days when most medical authorities were thinking that SARS-CoV2 would behave much like SARS.  Although it was far more deadly than SARS-CoV2, the SARS outbreak was largely overcome by quarantining those who became ill, immediately at the onset of symptoms.  This is one reason why a vaccine for SARS was never developed, although several were in the pipeline.  As it turned out, COVID is not like SARS; infected persons are contagious to others long before they become symptomatic. Quarantine is not nearly as effective.

cd318, "diabetes is largely ignored". Really? Having been a physician for 45 years, I was completely unaware that diabetes was being ignored. How could I possibly have missed that? Why don’t you and Iso start your own thread. There will be others to join you. If you think big pharma is making out from the pandemic, the amount of profit made in relation to treating diabetes, every day of the year, would blow you away. Why aren’t you exercised about that? By the way, you don’t "catch" diabetes. Therefore there is no good preventative.

As to your claims about COVID:
Antibodies: Yes, people who recover from COVID do have protective antibodies. But actual data derived by measuring the persistence of those antibodies in blood over time shows that the antibodies derived from the RNA vaccines outlive antibodies derive from natural infection. Furthermore, the initial concentrations of virus neutralizing antibodies are on average higher from the RNA vaccines than they are from natural infection. Moreover, it can only be a good thing for the individual to be vaccinated after natural infection, albeit there is no rush, because the vaccine then can both broaden and enhance the pre-existing immune response. I personally don’t give a darn whether you ever get vaccinated, however.

Masks: The paper masks that most of us have had access to were not believed to protect the wearer from close contact with an infected person who is shedding virus in secretions. The paper mask was thought to protect others from the person wearing the mask. This is why we are or were all better off if all of us wear or wore mask. The crux of the question is whether the virus is excreted as an aerosol or in large particles or droplets. If the latter, the mask is good protection. If the former, not as good but still better than nothing. Were you around about a year or more ago when there was a shortage of N95 masks for frontline workers? An N95 mask, or a mask that conforms to N95 standards, is needed for 2-way protection from the virus. The US never had enough for the general population. Among the unvaccinated, of course, it is still advisable to wear even a paper mask in public. Wearing a mask is an altruistic act, so you probably wouldn’t want to do it. Longer experience with this disease and this virus does suggest that there may be some level of 2-way protection afforded to the person wearing the (paper) mask. It is impossible to say exactly how broad that protection might be. What I don’t get is why you think all of this is sinister. You seem to feel threatened.
Actually, a very few persons did die after having received one of the adenovirus-based vaccines. The cause has nothing whatever to do with the COVID antigens expressed by those vaccines; it is due to a cross-reactive antibody elicited by adenovirus that affects blood platelets. The total deaths are well under 50, but of course that is not acceptable. The cause is now understood and the entity can be prevented or safely treated. There have been a few severe adverse events but no deaths among those who have received either of the two RNA vaccines. Again, the causes are now understood and the problems are very treatable. Hundreds of millions of doses of vaccine have been delivered; the very very low incidence of serious problems could never have been uncovered a priori even in the large scale trials that were performed. (This is evident if you know anything about statistics.) On the other hand, more than 600,000 persons have died from COVID in the US alone. Many tens of thousands more would be dead by now were it not for the vaccines. I am sure you don’t believe that. But THOUSANDS of people have NOT died from the vaccines; that is a lie, and you ought not to be repeating it.

Go away with your crap, Iso.  Or did you want to credit Tony Fauci with his leadership role in developing the combination drug therapies that have in effect allowed persons with HIV infection to live long and productive lives.  I suppose you find that reprehensible.  AZT came from the National Cancer Institute, by the way, not from NIAID.  It was the first anti-HIV therapeutic but not a very effective one, since the virus quickly was able to resist the drug effect by mutation escape.  I suppose that was Tony Fauci's fault, even though he had little to do with AZT.

Dover, You are too smart to be that legitimately confused. What is your ulterior motive? Aren’t you in New Zealand anyway, where the disease was controlled and is controlled perhaps better than anywhere else in the world? And yet I think you were once complaining about the permissiveness in New Zealand. Yes, both African-Americans and right wing Americans have been relatively resistant to the vaccine, but for different reasons. Anyway, as you suggest, the two groups do not overlap very much. And your mis- use of statistics in formulating your question is beneath you.

Up above, where I contradicted rpeluso on the composition of the mRNA in the Pfizer and Moderna vaccines, he was correct, and I was wrong.  I apologize for any confusion.  I had in mind a candidate vaccine still under development.

Hello.....The two mRNA vaccines and the adenovirus-vectored vaccines are all more or less effective against all the variants so far, including the delta variant. This information is all over the news and even on Youtube. Try again. Furthermore, it is a simple matter for the two RNA vaccines to be re-derived so as to cope with any variant down the road that may prove resistant to the antibodies induced by the present formulae. As far as I am concerned, you are not disliked. You are misinformed and very verbal about your bad information. You are salvageable, my son. At least as far as your COVID beliefs are concerned.


One school of thought is that the variants recur because of the large numbers of people who are NOT vaccinated. The vaccines seem to prevent any significant virus replication in persons who have been vaccinated. This is actually an unusually good result, as vaccines go. If the virus cannot replicate, it cannot mutate. There is another reason for you to get vaccinated, if there is a soupcon of altruism in your bones.

Johnny, So far as I know, Peter is out of the hospital weeks ago and back to work.  He seems to be doing fine.  The vaccine thing has a life of its own.  I am sorry for the trend, but I hate to let ignorance have its way when I see it right in front of me here.

Devil boy, the truth is actually far more interesting than is the garbage in which you apparently believe. I hope you can open your mind sooner or later. Stay well and don’t lick any doorknobs for now.

The mRNA in the Moderna and Pfizer vaccines actually encode only a few hundred or fewer amino acids of one specific region of the surface glycoprotein, S, which is overall about 900 amino acids in length. That region being the Receptor Binding Domain. Thus they both elicit a panoply of antibodies directed only at that domain. Given the absolute dependence of the SARS-CoV2 virus on the ACE2 receptor for entry into cells, that is likely to be why the two vaccines work more or less on every variant so far known; there is only so much genetic variability in that domain that will still permit efficient receptor binding. In effect, the capacity of the virus to evade the immune response elicited by the vaccines without a reduction in its binding affinity for ACE2 is very limited. Woe unto us if the virus ever "learns" to use some other cellular surface protein as its ticket to cell entry. Most other human pathogenic viruses are not so limited as is SARS-CoV2.

Iso, Wrong. Total BS.
Flembo, The molecular biology required to produce either of the two RNA vaccines is not a big secret. It's not even new technology.  However, manufacturing a vaccine is not a trivial pursuit, if you want consistency of manufacture, safety, and purity.  Getting the RNA and the lipids that form an envelope for the RNA together is a sophisticated process that not just anyone can do with a cookbook.  In my opinion, abrogation of the patents might not get us anywhere except into more hot water, where a plethora of new less sophisticated manufacturers are making vaccines without strict controls and supervision by regulatory authorities, in part because there might be too many of them to oversee adequately.  The FDA has a limited number of persons with the scientific skills required to review and regulate all these efforts; such individuals have been working their butts off for the past 18 months.  We already see how difficult it is to get acceptance by the public (and certain persons on this thread).  All we need is a bad batch made by an inexperienced company to legitimately alienate the public, but more importantly a bad batch could result in hundreds of thousands or millions of persons who think they are protected but in fact are not, because they received a bad product. The major issue in producing sufficient doses of the vaccines hinges on the very fact that so many hundreds of millions of doses are needed.  The potential need is unprecedented in history. Yet there is not an unlimited supply of the many "ingredients" (enzymes, ribonucleotides that are the building blocks of RNA, various chromatography supplies needed to purify the RNA, etc) that are required to synthesize huge amounts of RNA or of the very specific lipids needed to package them.  This also affects companies, other than Pfizer and Moderna, who are still in development of new RNA-based COVID vaccines.  Many of them are stymied because the supply of the raw materials to make RNA and the supply of lipids and agents needed for purification, such as it is, is funneled to Moderna and Pfizer preferentially, because they are the ones with the EUAs.  In order to get on the preferred list, a company needs to make it all the way to a phase 3 trial.  Such legitimate efforts are caught right now in a Catch-22, until the supply chain is beefed up.  So even if there were no patents, I doubt the supply of vaccine(s) could be rapidly increased. I also think this problem (lack of doses) now mostly applies to the rest of the world.  By now in the US it seems that anyone who wants to be vaccinated can get vaccinated.  We are down to those who don't want to be vaccinated, at this point.

Like I said, addressing the dozens of uninformed but fervently held opinions is like playing whack-a-mole. It’s hopeless. First, it would be nice to stop hating each other.

Thank you, Herman.  Go away, Isochronism.

thankful, Sorry for my feeble attempt at humor.  If you will take the time to access the information that is publicly available, perhaps you will ameliorate your fears, if I am correct in assuming that you are "cautious" about getting vaccinated. 


This particular thread started out with COVID as its subject in the first place.  I apologize to anyone who is offended by the persistent theme perhaps abetted by me. Like Michael Corleone, I tried to get out of it in order to honor the expressed wishes of PL, but they kept pulling me back in.
Meantime, tomic that is a terrible story.  My condolences.

What do you mean by "hum"?  Do you need help with your phono stage?

I have 45 years experience as an MD/scientist with a research interest in  certain human pathogenic viruses and vaccine development, both on the developer side and on the reviewer side.  I retired 2 years too early to have been involved in the fight against COVID. Based on the past 20+ year history of using RNA in a vaccine, all unsuccessful, and on what was known a priori about Coronavirus immunology, I was very skeptical about the eventual utility of an RNA vaccine in preventing COVID and particularly about the longevity of the immune response one might expect from an RNA vaccine, even if there were short term protection. So I view the success of the Moderna and Pfizer vaccines as nothing short of a miracle.  But it is not magic; there is solid science behind the unprecedented success of these particular RNAs. Most lay people cannot and do not appreciate how lucky we are that advanced thinking bore such fruit.  Only a very few licensed vaccines achieve 95% or better efficacy in preventing disease. Think where we would be now and for the indefinite future, if the current vaccines were failing. That is why I am continually dismayed by the doubters and conspiracy theorists, although I do understand that some may be put off by the reports of side effects.  What is almost never mentioned in the press is the rarity and transitory nature of these events and the fact that there are treatments and preventatives available.

MC, Your life must be very tense.  If you take some time and check the source material available at the CDC website that is re-interpreted and incorrectly reported by ZeroHedge, you might be less angry at CDC and the "establishment" and more grateful for the vaccines.  I and others cannot do it for you, because it is exhausting work, like playing whack-a-mole.  If you have a specific question, I would be happy to answer it to the best of my knowledge and vast experience as an MD and a molecular virologist.  But you are buried in a blizzard of lies and half-truths.  To take on only this last report from ZeroHedge, the CDC has developed a new reporting system as of May, specifically targeted at detecting vaccine breakthrough cases, because they recognize that monitoring the rate of such an event is critical for predicting the emergence of resistant virus variants, if that should occur.  Surely there are partially resistant strains extant even now, as you know.  That is not a sinister or evil act on the part of CDC.  Also, while it appears to be true that some sources count a positive RT-PCR in an asymptomatic person as a "case" (and I myself have been railing against that practice), that is not the formal definition of a case from either the FDA or the CDC point of view.  See the CDC case definition from August, 2020.  In the phase 3 clinical trials to determine vaccine efficacy, there were (and are for any ongoing studies) strict CLINICAL criteria which in addition to a positive RT-PCR were part of the case definition.  Applying those criteria, the efficacy of the two mRNA vaccines was determined to be ~95% for the study groups.  That is not 100%. That means one can still get COVID even after vaccination, but with a hugely diminished risk that that will happen.  There is some good reason to criticize CDC for its behavior during the first 2 months or so of 2020 as regards the RT-PCR tests used in the US, because there were perfectly good test kits available from China and Germany, yet the CDC insisted on relying upon US-based kit developers, and yes some of those kits were crap.  Did the CDC decision to refuse test kits from China or Germany have something to do with politics, ya think? It's not about what Ct value is taken as positive; it's about the formal process of validating any test kit.  The validation process, which is arduous, determines what Ct value for that particular kit can be used as a cut-off for positivity.  And yes, a Ct value of 40 or higher can almost never be taken seriously.  There were a lot of governmental blunders in the early months, for sure.  But in the end, you and those like you need to make up your mind what you believe.  Is the virus a fraud? Is the virus real and an evil Chinese plot? Is the idea it caused a pandemic a fraud?  Are the vaccines a corporate plot to make money and kill people willy nilly, or are they merely a fraud because after all there was no pandemic?  And so on and so forth.  It's very tiring.

MC, in your eyes, I am the enemy. So be it. But on the subject of covid, I know more than you. Deal with it.

MC, If you are talking about "rate of thrombosis" after vaccination, when you say it is "greatly increased", you are misinformed.  First, these odd and often catastrophic thrombotic events have been reported only for persons who received either of the two adenovirus-based vaccines currently in use outside of China (where the Chinese are using their own adenovirus-based vaccine).  Second, there is a finite risk period following vaccination, at around 50 days.  Once you are outside of that time line post-vaccination, apparently the incidence of the problem vanishes.  And third, the incidence is very low, the exact estimate keeps changing but probably around 1:50-100,000 vaccinations.  Severe cases are much rarer. I mentioned this earlier in this thread, but the etiology appears to involve adenovirus-specific antibodies that are cross-reactive with a certain platelet antigen.  Presence of those adenovirus antibodies causes low platelets ("thrombocytopenia").  Since platelets are necessary for normal hemostasis, you would think this would cause bleeding, but it causes clot formation in fact.  Now that the etiology is understood, these cases can be treated.  More important, physicians now know what NOT to do in treating these patients.


For sure, high altitude poses no risk for anyone who was vaccinated with any of the four COVID vaccines.  Persons with Sickle Cell anemia or with Sickle Cell trait are at risk for clotting in any situation that results in even mild hypoxemia, e.g., high altitudes.

Audiotweak, Why do you think it is referred to as a "Cytokine Storm"? Because dozens of different Cytokines are involved, is the answer, and CCR5 is only a minor player.  So far, no single cytokine suppressor or method of suppression has done more than a little good for patients in end stage disease. Some of them work well enough to have received an EUA from FDA.  Such an effect has not been formally shown for Leronlimab. For sure, you have no idea what it means to differentiate anecdotal evidence, including "testimony" from doctors you can find on the internet, from scientific evidence that is sound enough to use as a basis for a regulatory decision.  Your persistence in this matter causes me to wonder whether you have a financial interest in the drug.  Peter recovered, thankfully, without the benefit of Leronlimab.  May I use that as evidence it is not needed? By your standards, I could.

I'm coming out of my cone of silence to say that I somehow made it through that video.  It adds nothing to any evidence that Leronlimab does anything in the severe cytokine storm phase of COVID.  It's a pure anecdote, and as the narrators of the story admit, neither was directly involved in the care of the anecdotal case of Mr Estrada.  So we and they don't know what else was done for the patient that might have effected his favorable outcome, besides also kismet.  I fervently hope that Leronlimab is a good drug in severe COVID, but the proper studies need to be done, or if such a study has been done, it needs to be formally reported in a reputable peer-reviewed journal (not Youtube) before one can draw any conclusion.  Note that one comment on the video states that even the Philippines FDA has not authorized the drug even for emergency use.

Dear Peter, In my opinion, your own rheumatologist did a good job dissecting the issues in your case. Of course, I like what he wrote, by and large, because he agrees with me, (1) even if you’ve had COVID, it is still a good idea to get vaccinated, and (2) ADE is unlikely to play an important role in the genesis of severe COVID, with or without vaccine. When you told us about your recent medical history, I was struck by the fact that, were it not for your telling us you had a positive PCR test for virus in association with your acute illness, I would have doubted that you actually had a second infection, which is to say that it is not necessary to postulate that you had a second infection in order to explain your recent pulmonary emboli. For one thing, what you described are major thromboembolic phenomenon that blocked some of your major vessels. Although that probably can happen in COVID, COVID more typically causes "microthrombi" of the capillary bed that feeds pulmonary alveoli, the air sacs responsible for gas exchange in the lungs. Similarly, small clots can also form in other organs where the ACE2 receptor protein required by the virus for cell entry is expressed (heart, brain, etc), by a similar mechanism. Those are not "embolic"; they don’t come from somewhere else in the body. They are thought to be caused by direct infection of endothelial cells that line the pulmonary capillary wall. Those cells efficiently express ACE2. When they get infected, they release a clotting factor that alone can start the cascade that leads to microthrombi. Having very elevated D-dimers is not proof of COVID per se. Elevation of D-dimers in blood (and fibrin consumption) can occur in several other pathologic states. For another thing, you don’t describe much in the way of other symptoms that characterize COVID, except that you felt lousy for a few days before going to hospital. However, those who took care of you know much more about your case than I ever will, and if they say you had a second illness from COVID, I am in no position to doubt it.
I would take issue with only one point your doctor made: In COVID, absent vaccination, autoantibodies are not implicated in clotting abnormalities. See above for the accepted pathogenesis of "micro" clots in lungs and other organs. Autoantibodies are definitely implicated in the very rare cases of severe and often fatal thrombo-embolic disease in those who received either of the two vaccines that use adenovirus as a vector (AstraZeneca and J&J). The mechanism is very recently described (last week) and seems to be due to the fact that adenoviruses bind to platelets. In rare cases, this results in the generation of antibodies that recognize platelets, and that results in platelet destruction. The resulting very low platelet concentration in blood heralds the clotting problems that ensue. (It’s paradoxial that low platelets leads to clotting, but that is another story.) The incidence is very very low, probably lower than one case per million vaccine doses, but the consequences have been grave for those who contract this problem. When an adverse event is that rare, (and there is no prior basis to suspect it, because there have never been any other adeno-vectored vaccines in widespread use), there is no way to design a clinical trial to detect the problem prior to release of the vaccine. Fortunately, the recent reports also describe effective treatment regimens, if they are implemented promptly.

I realize that I may be guilty of taking this thread in a technical, medical science direction, and if that offends anyone, particularly if it offends Peter, I apologize.  Having recognized that I broached these subjects and maybe took us in the wrong direction, I had decided to refrain from further comments of that ilk.  But I must correct some of the ideas planted, for sure with good intentions, by Mijostyn and Viber.
First, Mijo said, "The drive to get as many people vaccinated as possible is highly suspect. Trusting the pharmaceutical industry for advice in this regard is quite frankly, dangerous."  And now Viber quoted Mijo, in agreement. But the statement is false.  And I believe it is potentially damaging to the public health, if such sentiments convince unvaccinated persons to remain so. The pharmaceutical industry for sure is power and money hungry, but the drive to get as many people vaccinated as possible emanates from public health authorities who represent both the government and private research institutions. These are by and large really smart people who are not doing what they do primarily to make millions. Their zeal is justified by the results of the phase 3 trials of the Moderna and Pfizer vaccines.  Those trials showed not only a ~95% efficacy of both vaccines in preventing ANY clinical disease over the first 3 months after dose 2, but also that NONE of the participants developed severe enough disease to merit hospitalization. Nor did any persons vaccinated with either of the RNA vaccines in the course of the two phase 3 trials of those vaccines die of COVID.  In the control group for Moderna (or Pfizer), there were 11 deaths, for comparison.  We don't yet know the long term duration of such complete protection afforded by both of those RNA vaccines, but we also don't know the duration of protection afforded by naturally acquired infection. On that latter subject, however, we do know that there are rare second episodes COVID that were documented before we entered the COVID vaccine era, suggesting that protection afforded by natural infection is not all that durable.  Further, there is some scanty evidence that infection with seasonal coronaviruses that cause the common cold syndrome is also not permanently protective against that group of Coronaviruses.  Second illnesses with those viruses do occur, probably years after the primary exposure.  This is circumstantial evidence that the same may apply to COVID.  Both Mijo and Viber talk about what they perceive based on patients in their respective private practices, that patients who are vaccinated after having recovered from mild disease have the "worst" reactions to vaccine.  Ask yourselves just how severe are these reactions? Are you seeing something worse than the rare severe reactions we know about (which for the RNA vaccines is the very rare immediate hypersensitivity reaction or the common shoulder pain or malaise or fever on days 1-5)?  Are you having these exceptionally severe reactions documented?  Do you have a control group?  Are these post-vaccinal symptoms really worse than the disease itself?  (I very strongly doubt that.)  All the evidence we have in peer-reviewed journals regarding vaccine adverse events and the disease COVID itself suggest that one should get vaccinated (so far preferably with one of the two RNA vaccines, in my opinion), regardless of prior disease history.
Second, Viber brought up the issue of Antibody Dependent Enhancement (ADE).  The term arises from studies of the epidemiology of dengue fever.  It is probably a real phenomenon for dengue, because there are actually four antigenically distinct viruses that cause dengue fever, and ADE can occur after sequential infections with any two of those four, because the infections elicit a plethora of cross-reactive, non-neutralizing antibodies that bind the second infecting virus but don't neutralize it.  Antibody-bound virus can then enter certain cell types that express certain antibody receptors on their surface.  But classical ADE has never convincingly been shown to occur for any other virus, and the fact of those early monkey studies on COVID really is not convincing.  The experiments were artificial.  For one thing, there is only one serotype of SARS-CoV2.  For another thing, SARS-CoV2 apparently does not replicate well in those cell types that do promote ADE in dengue. I doubt that ADE had anything to do with Peter's unusual illness.  I'll stop there.

viber6, I beg to differ with you.  The benefits of maintaining Vit D levels were recognized very early on by the "medical establishment".  You can find videos on Youtube (a public forum) dating back a year or more that were posted by reputable sources that one might identify with the medical establishment, emphasizing the importance of both Vitamin D and C.  Low Vit D was actually identified as a risk factor for severe disease.  However, neither vitamin will "cure" the active disease or prevent it in a statistically detectable way.  (Which is not to say that having normal levels of Vit D might not make the difference between an asymptomatic infection and getting sick.)  Further, there were published papers on the effect of Vit D in peer-reviewed journals.  In the only study I can recall off the top of my head, there was no benefit shown to taking mega-doses of D or C when you actually get sick or even on a chronic basis prior to infection; the benefit was associated with achieving and maintaining at least the accepted normal range of concentrations in blood.  I myself went on Vit D after reading those papers and watching a Youtube video, and because my own Vit D level was low-ish historically.

Peter, no, the ( much more than 6) women (and men but mostly women) who had clotting problems after the JJ (and the AZ) vaccine were not virus-infected. They had a very rare auto-immune reaction to their own platelets due to the fact that adenovirus binds to platelets. What you seem to have had is exceedingly bad luck plus possibly a second infection with a virus that escapes the immunizing effect of the Pfizer vaccine, which is typically very protective even after only one dose. The ongoing data for the vaccines otherwise suggests that vaccinees constitute way way less than 1% of those developing clinical illness, let alone the severe disease you suffered. Which is why I’m wondering about an escape mutant virus. Most if not all of the “variants” that you read about every day are not fully resistant to the vaccine effect.  Which is to say vaccinated persons are most likely protected from them. (We don’t yet have a surrogate test for efficacy which is why I’m not making absolute statements. The surrogate will probably be some level of neutralizing antibody in blood.)

To be more emphatic than glupson. No, the mRNA vaccines, namely the Pfizer and Moderna vaccines, cannot and do not cause clots.  The adenovirus-based vaccines do have that potential, but despite the hysteria in the press, it is a very rare adverse event, which of course is no comfort if you happen to be one of the rare cases.  One diagnostic sign of the adeno-vaccine induced clotting is elevated D-dimers (a degradation product of the clotting factor fibrinogen), which Peter does report, but that also happens with COVID-induced clotting.  However, the vaccine-induced mechanism starts with a marked reduction in platelet count by an auto-immune mechanism, which separates it from the COVID-induced phenomenon. The adeno-vaccine induced clotting mechanism has now been defined in the context of several reports that occurred in the New England Journal of Medicine in the last two weeks.  Turns out, it can be successfully treated if recognized early enough, but that's the trick.  It's so rare that routine screening is not (yet) done.  Look for that in future, because it will be hard to do completely without the J&J vaccine.  The AstraZeneca adeno vaccine has many other problems, as well.

Peter, Did anyone bother to isolate your infecting virus?  If anyone else of lesser credibility had told me your story (serious clinical disease after both prior infection AND the first dose of Pfizer vaccine), I would have been skeptical; the odds are so heavily against that sequence of events.  It raises the question whether your second illness was caused by an antigenic variant virus that eludes antibodies induced by the vaccine and by prior infection with the wildtype strain, which is why I ask whether anyone took a sample of your secretions during the acute phase.  It is vitally important that antigenic variants are verified and documented. I would go so far as to say that yours is a reportable case, if the data were available on which to base a report.  Was your first case proven by a positive PCR also?

What's most important is that you are in recovery.  Take your time. And obviously we are all so happy to know it, including me.

You are operating under a false assumption. The FDA doesn’t design the clinical trial. The sponsor is responsible for that. Then the sponsor submits the proposal to FDA for approval of the study plan before the trial can commence. In the phase 3 trial the dose and the number of doses and the amount of drug per dose would have already been established based on phase 1 and 2 results. The algorithm for making those decisions is also work done by sponsor, usually starting with animal studies before phase 1. Sounds to me like the sponsor simply wants to take another shot at showing an effect, using 4 doses instead of 2. If 2 doses was at least “safe” for the participants, FDA might allow it, but it requires a whole new proposal. And some new evidence to suggest 4 doses would be both safe and any better than 2. With a view to protecting the safety of participants, doesn’t that make sense? That’s the job of FDA.

Theaudiotweak, why do you assume the paranoid view? Maybe the truth is that this drug is not effective in severe covid, and the FDA would be doing the right thing based on real data not to grant it an EUA, much less a bona fide  license. Seems to me like the sponsor is just grasping at straws, trying to find some use for this drug that was originally developed to treat HIV, and apparently didn’t make much of a mark in that area either. Their idea is only to make money.

The FDA calls this “data dredging”. If the drug or vaccine doesn’t meet the stated criteria for success, you find another way to make it sound good by sifting the data. It is a regulatory no-no, but may work for the lay press. Maybe it helps the stock price. 

I can agree with some of your sentiments, but the last paragraph is scurrilous.  The problem with US medicine is the fact that the big medical corporations and the insurance companies DO understand economics, and they have f**ked up the practice of medicine for idealistic doctors who want to do right but are prevented many times by their system from following the course of action they would prefer, because of the almighty dollar.  For example, insurance companies hire medically ignorant persons to make decisions about paying for care. They do this because the first duty of their front line personnel is to say no, and then see how hard they are pushed by the doctors to make the insurance company pay for the procedure in question.  Threats of law suits are often required.  I know you prefer to hate everyone, because no one has the obvious common sense that you believe you alone possess.

Please tell us your plan, Mijo.

Do you think maybe Peter deliberately let it be known that he expects to be on the way to recovery, so as to lessen the anxiety of his many customers and future potential customers?  And also to explain why his business output may be backed up a bit at present?  Anyway, he has nothing but well-wishers here, myself included.

Just to be clear, Tony Fauci is not synonymous with NIH and Tony Fauci does not personally dispense extramural research grants. In fact, he has nothing to do with it. Fauci is Director of the National Institute for Allergy and Infectious Disease. He runs that institute only, which is one of at least 10 different institutes that constitute NIH, albeit NIAID has one of the biggest but not the biggest budget of any of the institutes. He also runs a large and very productive lab (I am sure he has co-authored more than 1000 papers in peer-reviewed journals), and he is ultimately in charge of all the patients admitted to the NIH Clinical Center under the NIAID aegis. Plus, he has become a TV personality, thanks to DJT and the pandemic. I don’t know his work schedule these days, but a decade ago it was common knowledge that he typically put in 12-14 hours in his office, not to mention time spent reading at home. I think that’s enough work and responsibility for any man. NIAID specifically, and each of the other NIH institutes, have large groups of reviewers, who give out extramural grant money. (The NIAID grant review group mainly funds research related to its mission, to combat pathogens like HIV, tuberculosis, malaria-related applications.) I served on the NIAID extramural grant review committees more than once during Fauci’s term as Director; he is nowhere in sight during that process. That myth about "gain of function" is BS meant to discredit Fauci that has been circulating since before the election; it makes no sense to anyone who knows anything. Truthfully, that whole business makes me sick.

My thoughts are the virus is NOT man-made. If it were man-made, it could only have been man-made in the sense that someone took pieces of one or more other Coronavirus genomes and spliced them together. This could be done in a lab, but guess what... No one could concoct such a virus and know in advance what it was going to do. We are just not that good. Hollywood exaggerates. There is not even any lab method to predict the particular pathogenicity of this particular virus, in advance of releasing it into the human population. Further, the Coronaviruses have the capacity to re-combine in nature, which is to say when or if two coronaviruses infect the same cells in an animal, the genomes of the two separate viruses can exchange pieces with each other. These exchanges of genetic information occur at certain known points in the genome; it’s tightly controlled. The resulting chimeric viruses could/can easily be detected by genome sequencing and comparing results to the parent viruses. There are some papers that show a plausible origin of SARS-CoV2 in relation to certain native bat viruses.  I don't know if any particular scenario is yet proven. In general, for any virus, the vast majority of deliberate mutations introduced into the genome by scientists in a lab result in a crippled or attenuated virus that has actually lost some of its virulence properties. It’s much easier to do that than it is to create a Franken-virus that will eat your face. There is absolutely nothing about this virus that makes me think it came out of a lab. (However, it could have come out of a lab by accident if there were a lab that was collecting Coronavirus isolates from bats or other animal hosts for a legitimate scientific purpose, but there is no way it was made in a lab.)
As to your question about mutation. Coronaviruses actually have a lower mutation rate than most viruses, owing to the fact that the virus genome codes for a "proof-reading" protein that eliminates most mutations before transcription is completed. IF there were a man-made "synthetic" Coronavirus, it would still have to obey all the rules by which Coronaviruses operate and proliferate, and I would expect it to mutate at a rate no different from any other Coronavirus. As far as COVID is concerned, the virus is constrained from mutating in such a way as to negatively affect its binding affinity for its cell receptor, ACE2. ACE2 is the receptor in both humans and susceptible animal species. This is good for us, as our vaccines are targeted to produce antibodies to the part of the virus that binds ACE2; the virus will have a hard time escaping antibodies induced by the present vaccines, although we may have that problem in future. Fortunately, it’s very easy to combat an escape mutant when it occurs, using the latest technology.

Like some of the many discussants on the thread you cited, we can agree the case report is interesting, but it is one case. In response to the objection that the report is anecdotal , a few others noted that there were other successful individual case reports as well. Still other contributors implied that FDA is corrupt, because it won’t approve drugs like this with a few scattered reports of success, which by the way we don’t really know were successes. It could as well be the case that those patients who were receiving other treatment modalities would have recovered anyway. That is the problem. The FDA is bound to consider only data that arise from a controlled trial which is conducted according to a study plan that is submitted to FDA and approved by FDA prior to the start of the study. Furthermore there have to be safety precautions in place, and there has to be an independent data monitoring board that reviews adverse events and makes final judgment on clinical outcome. Apparently the company that makes this drug did submit some study data to FDA, and on the basis of those data, FDA did not see fit to issue an EUA. This drug was originally formulated and developed for treatment of HIV, because it blocks the CCR5 receptor on T lymphocytes which is an auxiliary receptor for HIV. I guess it could be useful in Covid because of possible activity in inhibiting cytokine storm via its putative effect on the immune response. Several other drugs with similar rationales for their use have been tried in late stage, severe cases of Covid, and some of them do show a modest benefit. But the operative word is modest. None of them is a magic bullet. None of them is even any better than dexamethasone, which is current standard of care. Certainly the CCR5 receptor has no biological role in the pathogenesis of Covid. So I am dubious that this drug will ever be a major success in this particular application.

Mijo, Just to be clear and as I said the first time, I was not talking about "emboli"; I was talking about "microthrombi", tiny clots that occlude the capillaries that run in the alveolar septal walls and which are needed for oxygenation of blood. Those microthrombi are caused by direct virus infection of the endothelial cell lining of the capillary. Injured cells then release clotting factors locally, resulting in clot formation. This process is rather unique to COVID.  The mode of death in COVID very often involves the generation of these microthrombi on a massive scale throughout the lung, such that the patient does not have the alveolar perfusion necessary to maintain life off a ventilator.  Patients with COVID can certainly have classical pulmonary emboli, as well.

Like you, I also am not "convinced" that the (RNA) vaccines give more solid or longer lasting immunity to disease; I tried to convey the possibility that that "may" prove to be the case. Seasonal coronaviruses do not induce lifelong immunity to seasonal coronavirus diseases, and so it is possible that persons with COVID will not be protected lifelong from COVID. (Note, I am talking about clinical illness, not infection per se.) If the RNA vaccines induce effective memory responses, it is at least possible that long term protection will be as good as or better than natural infection in protecting from future disease. However, there is no way to know at this time. In 5 years, we will know. The reasons I say what I said about the RNA vaccines vs naturally acquired infection are complex, would take a couple of paragraphs to explain.

I do agree it seems that getting COVID twice (over the short history of the disease) is at least very rare. That’s why I wrote earlier that we probably don’t have all the facts straight regarding Peter L. Also, every documented second illness due to COVID that has been reported in the literature was LESS severe than the original disease in that person, except for one report that I can recall. So if PL is having his second illness, and if it’s worse than his first, he is in a very rare category for sure. There is a better chance that we don’t know all the facts.

The pulmonary "emboli" of COVID are not really embolic in the true sense of the word; they are small clots that form in situ in the small vessels and capillaries of the lung, because the endothelial cells of those vessels bear ACE2 receptors that permit virus to directly infect them. This releases local clotting factors that promote the formation of the small clots or microthrombi in the tiny vessels that serve the alveoli or air sacs. Thus those air sacs may be functionally OK but they get no blood supply to pick up oxygen. These clots are very slow to resolve during recovery, which takes months, if indeed they ever go away completely.  I gather Peter is not in hospital (because he was able to respond to someone here) and is not requiring supplemental oxygen (because if he were, he would be in hospital), both of which are good things in his favor. However, if he knows he has clots in his lungs, he may well have a slightly reduced arterial oxygen or at least the characteristic confirmatory chest x-ray findings, which is best if it does not get worse.
I still wonder why he was not vaccinated at least a month or more ago. Maybe because with a prior history of COVID, he felt he did not need vaccination.  Actually, immunity due to vaccination with either of the RNA vaccines is probably superior to natural infection in providing protection against clinical illness.
Leronlimab, the monoclonal antibody recommended above, is probably worthless for COVID, certainly worthless for a person who already has significant pulmonary involvement. It was developed for HIV, which uses the CCR5 receptor.

Being an elderly male with Type A blood constitutes a risk group for severe disease per se.  Don't know about Type AB.

He’s in the age range where he should have been vaccinated at least a month or more ago. Furthermore, second infections are typically less severe than primary infections, so I wonder what is really going on. Anyway I also wish him well, he is a vital part of our hobby. And a nice guy too.