In Anticipation of a Highly Virulent SARS-CoV-2 Variant:

What can we do to prepare for a highly virulent variant?

Physicians and scientists may disagree as to how likely it is that a highly virulent, greatly threatening SARS-CoV-2 variant will emerge. Based on his extensive experience in the field of vaccinology and his deep understanding of immunology, virology, and laws of Nature, Dr. Vanden Bossche thinks it is extremely likely that a highly virulent and threatening variant will emerge.^1-3 Others may agree that emergence of such a variant is possible, but not probable or highly likely. Others may deny that emergence of such variant is even possible.

¹See Dr. Vanden Bossche’s book: The Inescapable Immune Escape Pandemic

²See Dr. Vanden Bossche’s educational website: www.voiceforscienceandsolidarity.org

³See the video-presentation: Respecting the Immune Ecosystem—Concerns of an Immune System Ecologist, which is posted on my educational website: www.notesfromthesocialclinic.org

My personal conclusion is that the likelihood of such a variant emerging is definitely sufficiently great to warrant the immediate development of proactive plans to meet that challenge if/when it occurs. In my view, participation in the development of such proactive planning is the pragmatic and responsible thing to do—scientifically, medically, and ethically. In my opinion, it is also the socially responsible thing to do.

I strongly disagree with the attitude that Dr. Vanden Bossche’s concern should be dismissed and ignored, not even discussed, and that no anticipatory planning for such an eventuality is needed. Such an attitude violates one of the most fundamental and important principles of medicine and science—namely, that all plausible hypotheses (not just one narrative) should be welcomed and evaluated via careful, respectful, scientific dialogue. I feel strongly that such an attitude is scientifically, medically, ethically, and socially irresponsible.

I strongly believe in the concepts of thorough patient education, informed consent, and practice of anticipatory medicine. Accordingly, I believe that patients, physicians, and the general public need and deserve to know about Dr. Vanden Bossche’s concerns and deserve a chance to prepare in advance for the possibility that a highly virulent variant might appear—because there are many things that can be done proactively, individually and collectively, to try to protect individuals and populations if/when such a variant arrives on the scene.

That preparation starts with explaining (to individual patients, health care professionals, and the public in general) why that possibility is real, how it has come about, and why it needs to be taken seriously. If/when a virulent variant does appear, I would not want people to be caught by surprise, ill-prepared, unable to promptly access optimal care, and panicked as a result. I would want them, instead, to be fully informed in advance and able to promptly implement a detailed plan that they, their physicians, and their hospitals had proactively developed to promptly and optimally deal with such a situation. In this article I have outlined what anticipatory steps could be taken now by individuals, their physicians, their hospitals, and national health agencies to prepare for a highly virulent variant.

Steps that can be taken now to prepare for a highly virulent variant:

• Thorough, honest, scientifically sound, understandable, and demystifying patient education about COVID-19 can be made available to the Public—particularly regarding COVID-19 vaccination and Dr. Vanden Bossche’s concerns.
• We must now shift to preparing for optimal outpatient and inpatient management of the threat that a highly virulent variant poses, including an emphasis on accurate diagnosis, early anti-viral therapy (including consideration of prophylaxis for the most vulnerable), careful anticipatory monitoring of a patient’s clinical course, and appropriately aggressive treatment of hospitalized patients.
• Regarding diagnosis, only PCR tests that have been proven by independent honest laboratory experts to be highly specific and sensitive for SARS-CoV-2 should be used, and reports of all positive PCR results should disclose the PCR Ct value at which the test was positive. Furthermore, verification of SARS-CoV-2 by genomic sequencing may be important in selected instances.
• For those who become infected, early (timely) outpatient treatment with safe, effective, widely accessible, and affordable anti-viral therapies may help prevent escalation of disease. Regarding the choice of anti-viral therapies, global experience with ivermectin and other inexpensive anti-viral therapies needs to be honored. Since there has been so much controversy regarding various anti-viral therapies (e.g., ivermectin and hydroxychloroquine); since the safety and efficacy of Paxlovid and Molnupiravir have not been adequately studied and are still unclear; since there are problems with the affordability and accessibility of Paxlovid and Molnupiravir; since there has never been a head-to-head comparison of these four just-mentioned options (which means that we do not know which one has the best benefit/risk ratio); and since the susceptibility of a new highly virulent variant will represent new territory; it would be important to proactively prepare an excellent, scientifically sound, honestly and competently conducted, nation-wide randomized prospective study of early outpatient anti-viral treatment of the virulent variant, focusing on these four therapies. Patients in need of anti-viral therapy could opt to participate in this randomized trial or they (and their physician) could opt to choose their preferred anti-viral therapy. Careful prospective study of each enrolled patient could reveal which anti-viral therapy performs the best for a new highly virulent variant, regarding both efficacy and safety.
• Because the elderly, people with co-morbidities, and people who have received multiple doses of COVID-19 vaccination will be particularly vulnerable to a highly virulent variant (particularly when compared to healthy unvaccinated non-elderly people), the option of placing such people on a prophylactic course of anti-viral therapy should be strongly considered. That is, such people could be placed on prophylactic anti-viral therapy as soon as it becomes evident that a highly virulent variant is circulating in their community. The choice of anti-viral therapy could be as discussed above—namely, people could opt for participation in a proactively prepared randomized trial of prophylactic anti-viral therapy or they (and their physician) could choose their preferred anti-viral therapy for prophylaxis. Careful prospective study of each enrolled patient could reveal which prophylactic approach performs the best for a new highly virulent variant, regarding both efficacy and safety.
• For those who become ill with a highly virulent variant: In addition to promptly starting early outpatient anti-viral treatment, prompt initiation of careful monitoring can be immensely helpful—to document whether the patient is following a reassuring clinical course or is heading into a worrisome hyperimmune phase. It is helpful to follow: serial COVID-19 PCR Ct values to document the extent to which the initial viral load is reassuringly decreasing, or not; serial CBC, blood chemistries, CRP, ESR, serum ferritin, d-Dimers to document the extent to which the patient is or is not developing a hyperimmune reaction and/or hypercoagulable state; and use of a home pulse oximeter to document the extent to which the patient is developing a drop in O2 saturation due to worrisome lung disease.
• For those who develop a hyperimmune/hyperinflammatory reaction (usually during the second and third weeks of illness, but probably much sooner with new more virulent variants), careful anticipatory monitoring and prompt, appropriately aggressive immunosuppression (with, for example, appropriately bold use of corticosteroid and anti-cytokine therapies) and appropriate use of other therapies may be critically important.
• When/if a highly infectious and highly virulent variant appears, particularly in highly vaccinated communities/countries/populations, it may be necessary to treat virtually everyone prophylactically, or at least those who are most vulnerable, with prompt safe, effective, widely accessible, affordable anti-viral therapy (at appropriate doses), perhaps for several weeks, in an effort to thoroughly reduce the viral infectious pressure in these populations/communities and to interrupt the vicious cycle of high infectious pressure causing enhanced immune pressure on the viral life cycle and, hence, driving immune escape.
• Good exercise, good nutrition (including immune-supporting vitamins and other nutraceuticals, fresh air, sunshine, and good emotional health (including reduction of COVID-19-related mystery, confusion, anxiety, and cognitive dissonance) will help optimize people’s immune systems, particularly their innate immune systems. The angst of confusion, mystery, and frustration is counter-therapeutic. De-mystification and “having a specific proactive plan,” well in advance of becoming exposed/infected, are therapeutic.
• When/if the highly infectious and highly virulent variant appears, particularly in highly vaccinated communities/countries/populations, it may be necessary to consider moving elderly folks (particularly those who are most vulnerable) out of nursing homes/retirement homes into single family dwellings, to the extent possible/practical—-or to designated small COVID-19 facilities that are properly staffed and protected.

Summary of specific proactive “plan of action” that individuals could make: Individual citizens, individual physicians, and individual health care institutions could immediately start preparing to optimally practice the anticipatory medicine approach outlined above.

• Citizens can schedule an “anticipatory appointment” with their primary care physician to proactively discuss the information reviewed in this article and Dr. Vanden Bossche’s book and to develop a specific plan of action to be implemented if/when the patient falls ill with COVID-19 or is particularly vulnerable and is exposed to the virulent variant.
• During such a visit, the physician could indicate their willingness to collaboratively develop (with the patient) and implement such a plan. This might include prescription of anti-viral medicines in advance of the COVID-19 illness, so that the patient will have those medications immediately available (in their own medicine cabinets) at the onset of the COVID-19 illness or for prophylactic use in the case of the particularly vulnerable. It might also include making proactive plans for certain specific initial and subsequent lab monitoring that can be started on day 1 or 2 of a threatening COVID-19 illness. It might also include discussion of a specific plan regarding how the patient will be promptly treated if monitoring shows early signs of development of a hyperimmune reaction to SARS-CoV-2.
• It would be ideal if people could be tested now to determine the extent to which they have already developed effective naturally acquired immunity (as opposed to vaccinal immunity) against SARS-CoV-2. Unfortunately, such testing is quite limited.
• Citizens can prepare themselves by purchasing, in advance, a pulse oximeter to monitor their O2 saturation during their upcoming illness. They can also proactively start taking Vit-D and other nutraceuticals well in advance of developing COVID-19. They might also want to purchase and prepare, in advance, diluted povidone iodine nasal spray, to be used promptly once a COVID-19 illness starts.
• Primary care physicians can prepare themselves by being fully informed of the information provided in Dr. Vanden Bossche’s book, in this article, and companion articles. Part of that preparation might include educating their own health care institutions and colleagues and encouraging them to prepare.
• Health care institutions can prepare by becoming fully informed of the information provided in Dr. Vanden Bossche’s book, this article, and companion articles. Part of that preparation might include educating their entire health care staff and encouraging them to prepare in the ways discussed above.
• It will be essential for patients, physicians, and health care institutions to all be on the same page, working collaboratively and respectfully, with a shared awareness of information and understandings about COVID-19.

Physicians, hospitals, medical schools, health departments, and national health care leaders have an obligation to be excellently informed about the COVID-19 situation:

• It is important for physicians, health care officials, politicians, and citizens to appreciate the great complexity of the COVID-19 situation. Simplistic understandings that are not rooted in a deep appreciation of the complexities of immunology, virology, vaccinology, evolutionary biology, and glycosylation biology are potentially dangerous and should be avoided.
• It is critically important that the scientists and physicians who have been responsible for the prevailing COVID-19 narrative and its policies engage in respectful, healthy scientific dialogue with those scientists and physicians who have challenged the prevailing narrative and its policies. To date there has been very little such dialogue, despite pleas by Dr. Vanden Bossche and others for such dialogue. This must change. More than one narrative must be allowed. That is a fundamental principle of science and medicine. The demonization and persecution of those who have responsibly challenged the prevailing narrative must stop. If Dr. Vanden Bossche is wrong in his understandings and concerns, this needs to be established through thorough, honest, thoughtful scientific dialogue. If the promoters of the prevailing COVID-19 narrative have been wrong, especially regarding their COVID-19 vaccination campaign, this needs to be established through thorough, honest, extensive scientific dialogue.
• I would like to again emphasize that I would much prefer that COVID-19 issues be addressed by a representative international panel of honest, objective, altruistic physicians and scientists with exemplary expertise in immunology, virology, vaccinology, evolutionary biology, glycosylation biology, and epidemiology who would engage in respectful, scientific, video-archived dialogue about these questions. Physicians, including me, need and deserve that help. Citizens and physicians could then view and listen to that dialogue and decide whose explanations make the most sense and whose recommendations seem wisest.
• Unfortunately, the vast majority of physicians (at least in the USA) have either supported the prevailing COVID-19 narrative and obediently executed its policies or, if they have disagreed with the prevailing narrative and its mass vaccination campaign, they have remained silent (often out of fear of reprisal if they challenge the prevailing narrative). It is imperative, now, for physicians to do their homework and speak up—for the sake of science, medicine, their patients, and Humanity. To facilitate that homework, Dr. Vanden Bossche has created a superb educational website: www.voiceforscienceandsolidarity.org I have also created an educational website: www.notesfromthesocialclinic.org
• In addition to promoting respectful, healthy, scientific dialogue among health care professionals, we must also promote such dialogue among citizens. We must promote dialogue and demystifying education that will elevate understanding of the complexity of the COVID-19 situation, create consensus, bring people together, and unite people in positive, constructive efforts to do what is needed to preserve lives. Honest, altruistic, informed media could help with this.
• It is important that the “vaccinated” and “unvaccinated” not be pitted against each other. This has never been a “pandemic of the unvaccinated,” nor is it helpful to view it as a “pandemic of the vaccinated.” It is a pandemic that has been prolonged and made worse by a misguided mass vaccination campaign. Vaccinated and unvaccinated citizens should kindly and sensitively work together to correct the many mistakes that have been made in the management of this pandemic.
• All of us must learn from mistakes made during the COVID-19 pandemic so that we do not repeat those mistakes during future pandemics.
• Finally, it should be realized that the White House COVID-19 Task Force, the CDC, FDA, NIH, WHO, the medical establishment, pharmaceutical companies, and the conventional media (CNN, NY Times, The Atlantic, even NPR, e.g.) may not honestly acknowledge and correct the mistakes they have made. Correction of these mistakes, therefore, may depend on the careful homework and thoughtful advocacy and altruism of ordinary citizens (both the vaccinated and the unvaccinated).
• If citizens, particularly mothers and pediatricians, unite to properly educate the Public and open the eyes and minds of unaware promoters of the COVID-19 mass vaccination campaign, then Humanity, particularly our children and grandchildren, will have a chance for a good outcome.

Rob Rennebohm, MD

June 11, 2023