Our IM Doc sputtered early on in the Omicron wave about not only continued lack of guidance about treatment but also clues as to how Omicron symptoms and progress might differ from earlier variants, particularly given the lack of sequencing in many hospitals (including his) and now even test shortages. As we’ll discuss, there is yet more confirmation that Omicron is much less likely to produce debilitating and often deadly viral pneumonia than early variants. However, the ongoing claim that it is mild may be overdone.
We are not alone in wondering if the apparent higher frequency of less debilitating cases is a statistical anomaly due to incomplete data. We aren’t alone; Yaneer Bar-Yam has expressed similar concerns.
Take two populations of 1000 people.
Assume 200 of one group got symptomatic Delta and 350 of the second group got symptomatic Omicron. That’s hardly nuts in terms of relative penetration of the two variants, given the massive Omicron spike.
Assume 10 of the Delta group wind up being hospitalized and two die. Assume 13 of the Omicron group become hospitalized and two die.
On a population-wide level, Omicron is as deadly and leads to a higher rate of hospitalizations.
But that is not what clinicians will observe. They will look at the level of severe cases among the patients they see or know about. That will of course only be symptomatic cases.
Using the illustrative numbers above, Omicron looks less bad. Delta has a 5% hospitalization rate among symptomatic cases versus 3.7% for Omicron, and a death rate/symptomatic cases of 1% for Delta versus 0.6% for Omicron.
Another factor that may be giving doctors some relief is the shift away from viral pneumonia means that hospitalized patients are likely to have their cases resolve faster. In earlier Covid waves, the severely ill often spent 2 to 3 weeks in a hospital, which is far longer than for most ailments. That meant Covid cases would quickly consume hospital capacity.
However, an offset with Delta is that bad Covid cases, if caught early enough, could be treated with monoclonal antibodies. That’s largely out with Omicron. Most monoclonal antibodies are ineffective against Omicron and the few that work are in very short supply.
And consider:
New York City
Hospitalizations per day from 40 to 1000, i.e. 25X in the past 3 weeks.
Current (total) hospitalizations went from 360 to 4,500, 12X in past 3 weeks.
Not looking mild now. When will action be taken?https://t.co/EKPIkV0Ucd pic.twitter.com/WcfuZ6VkHN
— Yaneer Bar-Yam (@yaneerbaryam) January 3, 2022
30 more stories of children severely ill from COVID https://t.co/L4UGiIYFzh
— Cleavon MD ? (@Cleavon_MD) January 5, 2022
And we’ve repeatedly pointed out from the very get go in South Africa that Omicron is putting an unprecedented level of babies to nine year olds in the hospital. The current vaccines do not produce an adequate antibody response in children under five to justify their use. So when the press demonizes the unvaxxed, that includes toddlers as well as young school age children not yet vaccinated either due to lack of availability or parental concern about limited safety testing on the young.
To have a solid handle on Omicron severity, we need large scale, population-wide surveys, and a ton of sequencing to identify Omicron versus Delta cases. That means we may have to wait for the UK to do the work, since they conduct periodic tests of 100,000 and lots of sequencing.
In the meantime, US testing is a shambles. Readers were describing the difficulty of getting a test in comments. From IM Doc yesterday:
The testing supplies and kits are simply non-available – except in the health department and the hospital.
So so many people are calling in – and we are just assuming they have COVID. There are not enough tests to even begin to appropriately deal with this problem.
The ones I am screening and are of a concern – we also check for RSV or the FLU – but by the time most people hear there is no COVID testing – they are not interested in anything – and it will likely be expensive. Never dreamed that 2 years into this – THE TESTING REGIME WOULD BE WORSE THAN IT WAS IN APRIL 2020. JUST SIMPLY UNBELIEVABLE.
The rage is palpable and getting worse by the minute.
IM Doc is also seeing Covid, presumably Omicron-induced diabetic ketoacidosis, as well as some other disturbing symptoms:
2 very distinctive things happening in this current COVID wave –
1). I have now had 2 DKA [diabetic ketoacidosis]’s in young healthy people who are COVID positive. This is just in the past week – I maybe see them 3-5 times a year – 2 in the last week is very different. I have also admitted 4 TYPE II DM – not in DKA – but they are in hyperosmolar coma with very elevated blood sugars – the lowest in the group was 683. All 6 of these patients are COVID positive – 4 with very mild cases – And I cannot tell you how unusual it is to see even 1 of these in 6 months. Almost exclusively type 2 DM who have fallen off the truck and gone on a Ding Dong binge or some such.
Not sure what to make of this – but the timing is concerning.
2). All 3 of these guys are COVID positive – 2 under 30 – 1 much older – all 3 came in the past few days – with massively swollen testicles. All I can say is I certainly do not see this problem very often at all – to have 3 in the span of just a few days is really different. ALL 3 Sonos were orchitis. I cannot tell you how unusual this is.
It must be noted that everyone of these patients is vaccinated.
Maybe nothing – but maybe that Omicron is playing games with the endocrine organs.
Dr. Craig Spencer, Director of Global Health in Emergency Medicine at Columbia Medical School, also reported seeing apparent Covid-induced diabetic ketoacidosis:
Today it seemed like everyone had COVID. Like, so many.
And yes, like before, there were some really short of breath and needing oxygen.
But for most, COVID seemed to topple a delicate balance of an underlying illness.
It’s making people really sick in a different way.
— Craig Spencer MD MPH (@Craig_A_Spencer) January 4, 2022
But still so many needed hospitalization.
Right now NYC has over 5,000 Covid hospitalizations.
More than last winter’s peak.
Higher than any point since May 2020.
3 times higher than only two weeks ago.
And still climbing higher everyday. pic.twitter.com/xZyKIpwCKT
— Craig Spencer MD MPH (@Craig_A_Spencer) January 4, 2022
What’s also different now is those COVID cases are often in beds next to patients who’ve done everything to avoid the virus, and for whom an infection might have a dramatic toll.
The cancer patient on chemotherapy.
Those immunocompromised or severely sick with something else.
— Craig Spencer MD MPH (@Craig_A_Spencer) January 4, 2022
The reason we keep emphasizing the risk of Covid is that the precautionary principle argues for conservatism when uncertainty meets serious outcomes. And it is simply maddening to see the “We must keep the economy open” forces seizing on preliminary data, particularly of the cheery sort, and treating it as dispositive. The sound course is to continue to be cautious until we have better information or better remedies.
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Diabetes is disproportionately present in low income populations – at least in NYC. It’s often rooted in years of food insecurity and the poor eating patterns that result (skipping meals, scrounging for food of lower quality, drinking soda for a pick-me-up, and subsequent over-eating the wrong foods). These reports suggest that once again we’re likely to see inequity in serious illness and hospitalization and death from omicron.
While I don’t pay much attention to the MSM I wonder if they aren’t downplaying the link between the Covid epidemic and America’s obesity epidemic. IM Doc has talked about it here and a neighbor was told by her physician that the non elderly cases are overwhelmingly overweight. I don’t see so much of this in my middle class neighborhood of joggers but when I go to Walmart or the library–another poor people hangout–it’s unavoidably obvious. Those Walmart electric carts seem to be used more by those too overweight to walk than the old and infirm. Given the variation in Covid incidence across regions and countries you wonder if diet might have a lot to do with it.
I knew that diabetes was one of the major risk factors for serious illness and mortality due to Covid but I had no idea how prevalent the condition is in the U.S. From Diabetes.org
“Overall numbers
Prevalence: In 2018, 34.2 million Americans, or 10.5% of the population, had diabetes.
Nearly 1.6 million Americans have type 1 diabetes, including about 187,000 children and adolescents
Undiagnosed: Of the 34.2 million adults with diabetes, 26.8 million were diagnosed, and 7.3 million were undiagnosed.
Prevalence in seniors: The percentage of Americans age 65 and older remains high, at 26.8%, or 14.3 million seniors (diagnosed and undiagnosed).
New cases: 1.5 million Americans are diagnosed with diabetes every year.
Prediabetes: In 2015, 88 million Americans age 18 and older had prediabetes.”
Is that true for type 1 diabetes?
If those 30 kids survived Covid what’s the BFD?
(heavy /s)
Were they all cousins of Nicki Minaj?
flippancy and heavy sarcasm is all I’ve got at the moment friends, sorry. I get that I’m in something of a doomy echo chamber but it’s hard not to conclude that even if Omicron is the mildest strain evah, the totality of the knock-on effects constitutes really fucking bad news, particularly in the anglophone west which is really just doing spectacularly and unnecessarily badly when it comes to handling this problem. And this is going to happen another, what, two more times this year? To say nothing of future variants. Wild stuff.
You are not singularly alone in that aspect. Two years into this, and with the adult administration now in charge for the past 11+ month this is where we are. A video clip yesterday linked to a brief statement from the Florida surgeon general, and basically he wanted everyone to just chill more and not stress about testing nearly as much.
I never have seen GOT, but what’s the line? We are ruled by the Harkonens.
House Harkonen = Dune
House Lannister = Game of Thrones
Better analogy = We are ruled by sociopaths…
More like the planet “Jackson’s Whole” in the Vorkosigan series by Bujold.
Yes, where you can get anything for a price. There is no law, no justice, and no humanity. Where the only thing sacred, besides your money, is The Deal.
Duly noted, thanks for the correction. I should stick closer to home, regarding works on film and screen that I know much better.
Instead I’ll stick to my Weyland corporation knowledge from the Alien film series. Parasitic organism is priority 1, crew expendable.
Quebec’s hospitalization numbers are climbing non-stop. At this pace, we’ll probably surpass the numbers of the first wave in around 2 days. For example, see yesterday’s 11 AM update here https://montrealgazette.com/news/quebec/covid-19-live-updates-quebec-reports-14494-cases-21-deaths
One week before Christmas the government was saying that it would be OK to celebrate private gatherings of 20 people. They only closed dining rooms last week. Won’t anyone think of The Economy (TM)?!
> They only closed dining rooms last week. Won’t anyone think of The Economy (TM)?!
At least you’re closing them! Everything is open here around Chicago with a case surge three times what it was last year. I suspect the Covid bean counters are OK for now with hospitalization and death numbers.
“Thank goodness The Economy™ is alive!”
It’s getting worse here in Quebec: 39 deaths today, never seen before jam 2021, hospitalizations through the roof.
Also, thank you USA: they just reduced the self-quarantine from 10 to 5 days, no testing required.
And one more thing: they stopped testing except health personnel (and indigenous people and homeless). That’s it. No more testing folks! No bad numbers every day! And the labor minister kindly asked employers to trust employees pretending they have covid, who until today required a positive PCR test. PMC have the trust of their employers, but imagine at McDonald’s.
Source: https://www.ledevoir.com/societe/658095/survol-des-nouvelles-consignes-d-isolement-et-de-depistage
This reminds me of a recent story. I work in Spiritual Care at a high-tech hospital, and I get called in from home to arrive for some Code Blues. Earlier in December, I came in after midnight after a particularly gnarly and bloody Code Blue was completely finished. I was just sitting quietly, and the attending surgeon sat down next to me. He wanted my assistance while he made the death calls: I mean, he wanted moral support. I was somewhat wide-eyed during this – usually we work solely with patients and nurses. He debriefed with me about the Code, and how he didn’t know what went wrong. Of course, I couldn’t really interpret the lab results and everything, but I looked at the screen as he said, “see that?” etc. He and I ran into each other in the hallway about 2 days later. He thanked me for attending to him, and also he said the family declined an autopsy. We were both chagrined about that. I am aware of other perplexing medical outcomes in recent weeks, but this example is the most specific one. The surgeon is a well-regarded doc, affectionately known by his first name, so it wasn’t an issue of physician incompetence as far as I know.
I had a meeting with my boss today because she was concerned about the state of my mental health. During the meeting she brought up that she noticed I had brought a CO2 meter into a meeting with one of my clients yeaterday. In Sweden, only a small percentage of the people wear masks on public transport (almost always surgical masks), and no one wears them inside the office space. A few workers have started masking when meeting with clients. Of course, Omicron is racing through Sweden like a forest fire at the end of a drought. The idea of me using a CO2 meter is as bizarre to Swedes as if I were carrying a magic wand. I had to explain to my boss how a CO2 meter could be useful, but that including explaining that the virus is airborne. The problem is that little fact contradicts Folkhälsomyndigheten’s (Swedish CDC) information. On their website, it states: “Även om covid-19 inte räknas till de så kallade luftburna smittorna, där partiklar hänger kvar i luften under lång tid och där smittan kan färdas långa sträckor, kan det i vissa situationer finnas risk för smittspridning trots att man håller avstånd.” Translation: Although covid-19 is not included in the so-called airborne infections, where particles remain in the air for a long time and where the infection can travel long distances, in some situations there may be a risk of infection spreading despite keeping a distance. Why would I believe “misinformation” about Covid-19 and think that I would need a CO2 meter? This is the state of knowledge in Sweden in the second year of the pandemic. It’s so depressing.
I thought I could utilize basic tools such as N95, CO2 meter, vitD, K2, vit C, Zinc, etc. combined with natural immunity to avoid a second infection…at least until a proper vaccine was distributed. I’m realizing that this will never happen. This pandemic will be with us until Covid becomes the avian influenza for humans. Western governments are making sure of it. I’m finally considering getting the vaccine because I’ve become convinced that people will keep spreading this virus until it mutates and kills all unvaccinated and 50% of the vaccinated. Only then, will governments possibly consider taking any action… maybe.
I could suggest you move to China, which appears to be a nation which is treating this pandemic with the seriousness it deserves. The amount of disinformation being spread by the media about China’s highly successful health and safety measures against Covid-19 is quite disheartening. For example, in the allegedly left-leaning Guardian this morning was a piece delighted to report on problems caused by strict measures in the Chinese cities of Xi’an and Yuzhou, problems vastly less than those caused here in the UK by our capitalist regime’s insistence that protecting corporate profits always trumps keeping people living. But then, as in Nineteen Eighty-Four, China is the UK’s Official Enemy for now, so everything its government does is evil.
The officials know it’s airborne. They don’t put it in official state guidelines because with some regulatory systems it would force business to comply with air quality rules.
And as long as aerosol transmission isn’t emphasized in guidelines, the businesses that have you in poorly ventilated spaces think they can avoid blame.
As obvious as it is that this is an airborne disease, they will still look at you with that blank stare and lie until they believe it themselves.
And if they are anything like US corporations, if you die while employed there, they are going to get paid through their life insurance policy on you.
@Mikel
January 5, 2022 at 9:33 am
——-
Your last sentence is incorrect. In the US employers are not allowed to own life insurance policies on their employees, other than top executives and keypersons, whose death could materially impact operations or earnings.
Employers do not have an insurable interest in most of their employees because the death of any single workers doesn’t have a measurable impact on the company.
Due to changes in the law back in 2006 (to prevent “dead peasant” insurance policies), businesses are allowed to take out insurance on the top earning 35% of their workforce and those employees most be notified of the corp. insurance policy and agree to it.
That’s good to hear. I thought that the dead peon insurance was still legal.
About “dead peasant” insurance: yes, there’s no direct material interest in a clerk. I had assumed that it was a tax scam that allows profitable businesses to park extra cash for multiple years.
From Yaneer Bar-Yam:
: a very casual discussion with Nassim Nicholas Taleb on COVID with some healthy disagreements.
https://twitter.com/yaneerbaryam/status/1477661460415266816
Bar-Yam worked with Benjamin Allen (pubmed.ncbi.nlm.nih.gov/19548837/), which is a green flag for me (bread crumb, hint^2).
Taleb is one of a half-dozen or so who keep being right. Note: being right when they stay in their lane. All of them have been wrong, but usually correct their course. Taleb lately has been triggered into dancing a hoppity; after he dumped/wised up about crypto, he got attacked (duh), including by Snowden, who was a big enough name that Taleb predictably won’t let go of the chewtoy. Fine, except now he’s starting to tweet about Russia. Out of his lane. So far, yellow flag, but be aware.
Regarding the “statistical anomaly”, there is also much anecdata about not-at-risk individuals suffering strokes and other neurovascular events after even relatively mild covid infections.
This makes perfect sense as covid is NOT a respiratory disease, but a disease of the epithelium, the type of tissue that lines blood vessels. There just happen to be lots of blood vessels in the lungs to facilitate oxygen exchange. Inflammation of blood vessels, even if subclinical, might well explain strokes, etc.
This! My healthy 23 year old son had what appeared to be a focal seizure on Christmas Day. The docs found nothing and even assumed it might be psychological. The one thing they didn’t do (oddly) is test for COVID. He came up positive two days later. (Though the ER was slammed, and at the time he didn’t know he’d been exposed at work.) My 15 year old nephew tested positive, and the same day exhibited stroke like symptoms–couldn’t remember his name or spell birthday–again, docs found nothing overt and it resolved in a few hours. His physician recommended daily aspirin for a week due to micro clots that scans won’t pick up. A family member who is a nurse seconded the idea because she’d seen it in the hospital where she works.
The news that the symptoms are different needs to get out because who knows what damage is being done by this “mild” virus?
Exactly! I hope both your son and nephew make a full recovery. Unfortunately, their experience will be written off as “anecdata”.
Multiply your family’s experiences by the the size of the non-NC readership to get an idea of the true scope of the problem being completely ignored by the MSM.
The lack of tests, the lack of contact tracing, the failure to sequence, the lack of approved treatment…after 2 years, is not something I can attribute to incompetence.
It is deliberate.
Cui Bono?
In the short term, assuming that TPTB are arrogant enough to believe they won’t be impacted…
I know that the belief that the effort against pandemic has been been deliberately botched for money and perhaps other reasons, but how could anyone assume that they will not be affected or that there will be treatments available that will work? It is an airborne disease prone to mutation, which anyone who was among TPTB could easily find out.
So how is it arrogant playing Russian roulette for profit? Would not insanity be a better description?
The lack of Covid testing in the US is going to bite hard if/when long term effects of Covid infection get singled out for special funding for treatment, such as the already emplaced Covid-victim funeral funding.
I’m not sure if I am stating this clearly, as my morning coffee hasn’t kicked in yet.
Covid testing as means testing?
Special funding available for those who have long Covid but most who have it can’t prove they had Covid at all. “We provided funds but nobody qualified for them, so we ended (or privatized! Yay.) the program”.
Is this looking like one more way to possibly screw people over, or am I thinking too hard?
When I last worked two nights ago I admitted a COVID+ patient who had been intubated immediately on arrival due to being encephalopathic and totally unresponsive. This appeared to be a result of their blood pH of 6.9 and also blood glucose level of 1300+ and resulting DKA, as they did start to arouse somewhat as those values started to be corrected. Other findings I thought were peculiar including their mostly compliant lungs relative to all the other intubated COVID patients I have seen in the last 2 years. Interesting to read this summary and see if some of these things might be connected to some larger trend.
the vitals, wow!
Do current PCR tests detect Omicron?
The PCR tests detect COVID but do not distinguish variant. Further analysis (gene sequencing, I believe) is required to identify the variant.
Some say an “S gene dropout” is diagnostic as to Delta VS Omicron. You can tell that from some PCR tests.
Many of these symptoms sound like antibody-dependent enhancement (a major problem in earlier attempts to create coronavirus vaccines) and lingering adverse effects of the vaccines—some of which compound with the number of doses. Myocarditis being just one example. https://www.medrxiv.org/content/10.1101/2021.12.23.21268276v1.full.pdf. Ketoacidosis being another.
Since the spike protein is toxic (especially to epithelial cells) and the vaccines induce the body to produce said protein, it will be functionally difficult to separate the adverse effects of covid from those of the vaccine. There’s an urgent need to focus attention on early treatments that were suppressed with the goal of forcing everyone to get jabbed.
This is a really important point. Once the entire population is vaccinated there is no longer a control group and at that point everything bad that happens will just be declared as being due to Covid. I may be crazy but I am convinced that this is the main reason that all western governments are massively pushing for 100% vaccination. The number of reported bad reactions to the vaccines is really really high, in Germany we are at something like 1600 suspicious deaths compared to the usual 6 -15 per year (usually around 50million innoculations per year in Germany) . Unbelievably high, and yet no one is interested.
You’re not alone
At this point I am thinking I will not take another mRNA vaccine. Too much is unknown. The fact that Pfizer and the FDA don’t want to release the documentation of the vaccine development is a huge red flag.
With respect, this claim makes no sense in the way it is propounded:
“Take two populations of 1000 people. Assume 200 of one group got symptomatic Delta and 350 of the second group got symptomatic Omicron. That’s hardly nuts in terms of relative penetration of the two variants, given the massive Omicron spike. Assume 10 of the Delta group wind up being hospitalized and two die. Assume 13 of the Omicron group become hospitalized and two die. On a population-wide level, Omicron is as deadly and leads to a higher rate of hospitalizations. But that is not what clinicians will observe.”
Clinicians do not observe omicron being as deadly as delta because, by this example, it just is not true! Absolute mortality may be equal but relative mortality is what counts. Patients who do not get infected cannot due from it! The odds are 2 in 10 get delta, 1 in 20 delta cases go to hospital and 2 in 10 pax die. Whereas omicron is 3.5 in 10 infected, 1 in ~24 hospitalised and 2 in 13 die. Normalise these to 2 vs 3.5 in 10; 6 vs 5 in 120 and 26 vs 20 in 130. It IS less deadly and hospitalisation RATE of cases is lower.
What you are trying to say, I think, is that a less deadly disease with higher incidence can still have higher absolute hospital admissions and mortality, as a small percentage of a very large number is still a large number. And in this, the clinical patient level picture is misleading with respect to the public health implications.
But this is hardly news and nearly every blog has pointed this out. It probably is not in the MSM but then, what is?
I also felt that part maybe needed proofreading. Are the other remaining people in the groups uninfexted, or infected asymptomatically?
I found this part to be a little unclear as well:
“However, an offset with Omicron is that bad Covid cases, if caught early enough, could be treated with monoclonal antibodies. That’s largely out with Omicron. Most monoclonal antibodies are ineffective against Omicron and the few that work are in very short supply.”
I might still be reading it wrong…
That bit does need to be fixed. Should read, “an offset with Delta is that bad Covid cases…”
No, you are really missing the point and proving mine.
I very carefully wrote SYMPTOMATIC cases. You have an unknown number in each sample that are asymptomatic and are not properly counted as also being Covid cases. I could have made the point explicit by assuming a number. But that will never be known in our current “not enough testing” regime, now compounded by home tests with a propensity to false negatives where results are also not reported.
However the thesis is that under Omicron, you have people either who would not get Delta at all (due to having enough protection via vaccines or prior infection) or get only an asymptomatic case who are getting active if “mild” cases of Omicron. That is widely conceded as true.
Someone getting sick from Omicron who did not/would not have gotten visibly sick under Delta is a WORSENING of severity in that example. Having symptoms is worse than no symptoms or not getting any case at all. But those worse but counted as mild cases leads to a larger denominator of observed cases and can create the appearance of lower severity due to not having the right denominator (the hidden matter of how many asymptomatic cases and the relevant total population).
As I said, the UK population-wide samples will provide vastly better measures.
Thanks for the clarification. It’s an excellent point and it’s being studiously ignored by everyone with a platform it seems.
“However, an offset with Omicron is that bad Covid cases” should be “However, an offset with Delta is that bad Covid cases”?
I very much appreciate the reality checks from IMDOC. OTOH, hospitals seem to be adjusting their covid hospitalization numbers downward due to over counting the admissions which were not covid related but which were only covid positive. Here’s one such hospital:
https://www.sfgate.com/coronavirus/article/California-COVID-hospitalizations-overcount-Marin-16748226.php
“maybe that Omicron is playing games with the endocrine organs”
As an endocrinologist, I am convinced that the endocrine system is involved with Covid-19 pathology. This was a suspicion when I first heard of the ACE2 receptor. That’s because the classic renin angiotensin system (RAS) is activated in chronic disease states–which is very much the bailiwick of endocrinologists. The RAS involves the ACE receptor. But the “ACE receptor” (or rather ACE1 or classic RAS receptor) is distinguished from the ACE2 receptor.
Clinicians have long understood the ACE receptor plays a role in chronic disease. Angiotensin II (AT2) plays a role in hypertension, cardiovascular disease, chronic kidney disease and even insulin resistance, which leads to type II diabetes. See: link
And: link
When I first heard about the ACE 2 receptor, I was confused. I had simply not heard of it. That’s because we are early in the leap from bench to bedside when it comes to this alternate pathway pathway of the classic RAS.
See:
Functional ACE2 deficiency leading to angiotensin imbalance in the pathophysiology of COVID-19
It’s like the parasympathetic (rest and digest) and sympathetic nervous systems (fight or flight). These two parallel pathways divert energy at crucial times when needed to allow us to survive.
This. Especially with long covid. At a million new cases a day we are conservatively creating a hundred thousand people with some level of new disability every day. Three million a month. That’s a lot of misery.
But we are told to look on the bright side of life. Really discouraging.
Imbalance of renin angiotensin system (the endocrine angle) has implications for vaccinations:
SARS-CoV-2 vaccines: Lights and shadows
https://www.ejinme.com/article/S0953-6205(21)00142-4/fulltext
“The free-floating Spike proteins synthetized by cells targeted by vaccine and destroyed by the immune response circulate in the blood and systematically interact with angiotensin converting enzyme 2 (ACE2) receptors expressed by a variety of cells including platelets, thereby promoting ACE2 internalization and degradation. These reactions may ultimately lead to platelet aggregation, thrombosis and inflammation mediated by several mechanisms including platelet ACE2 receptors.”