Des Moines Register. july 31, 2020.

Can you give us the lowdown for the layman on how vaccines work?

Vaccines are cheat codes for the immune system. If you don’t know what a cheat code is, stop right now and look it up.

The human body is designed to have certain events occur at certain times. Growth/height and reproduction are examples. The immune system has a certain time during which it can be taught what is “foreign.”

What’s fun about the immune system is the way it learns. One of the most important teachers of the immune system are tiny worms in the soil, 1 to 3 millimeters in length. Thus, children who grow up exposed to dirt have stronger immune systems (hygiene hypothesis). The immune system is working out (lifting weights) during a crucial time. Therefore, it is important children get certain diseases early in life. Their immune systems will learn how to fight them off.

Of course, there are variations: poor immune systems (boy in the bubble) and hyperactive (allergy/asthma).

The immune system can recognize and process thousands of substances. When it recognizes something as foreign, the body creates a tag for it. With this tag attached, another part of the immune system recognizes and destroys it.

There are different ways this teaching can be done. One can get the disease, making one vulnerable to the effects of the disease itself. Or you can get part of the disease, which is what vaccines deliver.

With vaccines, the offending organism is chopped up, pickled or immobilized. The immune system recognizes it as “foreign.” It still figures out a recipe for putting a tag on this fragment.

The next time you meet this substance, whether it be in a vaccine or the real thing, your body knows how to fight it.

An example of this is tetanus. For the vaccine, tetanus is ground up and injected. (The organism causing tetanus, Clostridium tetani, is found everywhere in the environment, not just on rusty nails.)

If your body gets infected with tetanus and the tetanus produces its poison, the immune system knows what that poison looks like is and able to fight it off. This has been a tremendous success.

In 35 years of practicing medicine, I’ve seen two cases of “lockjaw.” One person had not received their tetanus immunizations. The other, being elderly, had lost immune protection.

This mechanism sure beats getting a deadly disease.

Someone asked the newspaper to explain why “T-cell activation” is important in vaccines.

The immune system has defenses against outside invaders.

The B-cells make chemicals called antibodies. These chemicals can attach to invading substances, antigens. These antibodies act as markers or bar codes. When these now-marked substances get to the spleen or a similar place in the body, they’re pulled out of circulation.

If you’re into trivia, look up the bursa of Fabricius. This is where B-cells were discovered.

T-cells are another type of artillery. Once a cell has been tagged, by antibodies from B-cells or from the memory the T-cells generated early in life, the T-cell recognizes an infected cell.

The T-cell destroys the cell-factory making viruses.

Interesting fact: The thymus is a gland found in the neck. It is the origin of T-cells and it degenerates over time.

Childhood is the time to build up your immune system. This helps explain why it’s more difficult for adults to fight off new infections (cue coronavirus).

With a properly trained immune system early on (exposure to lots of antigens, including their routine vaccinations), a child’s “library” of T-, B- and memory cells gives a much better immune system as they go through adulthood.

So how would the ideal coronavirus vaccine work?

The ideal vaccine is given once, is painless, and has no side effects. One dose is effective for everybody, everybody takes it and immunity lasts forever. We won’t get there.

Well, what can we reasonably hope for?

Let’s review herd immunity. If everyone is partly immune or most people are completely immune, the virus can’t spread.

Let’s use measles as a model because that’s very well established. The measles virus is the classical example of the aerosol spread. For there to be enough resistance to spreading measles, 95% of the population must have had the measles shot or disease. This is herd immunity. With 5% or less of the population susceptible, the measles virus can’t find enough people to infect.

It is important to note that the measles shot is very effective at getting immunity started.

The coronavirus immunizations being tested are unlikely to be as effective as measles. It is unlikely that one shot will give near lifelong immunity; this is just a feature of the coronavirus. … Thus, you need 100% uptake by the population.

If people refuse to take the shot, there’s plenty of “fuel” left for the virus to spread.

If people can get this infection more than once, we have a long, slow disaster in the making.

Waterloo-Cedar Falls Courier. July 28, 2020.

The right call on absentee voting

Taking their cue from President Donald Trump’s fact-challenged assault on absentee voting, Iowa Republicans tried to scuttle the secretary of state’s voter outreach effort, then put it on pause, affirmed their opposition, but finally restored it.

A wake-up call about political ramifications prompted the reversal.

Secretary of State Paul Pate, also a Republican, had anticipated voters and elections workers would be reluctant to show up at polls for the June primary amid the coronavirus when he mailed out en masse absentee ballot request forms.

His initiative was an overwhelming success. More than 530,000 votes were cast — 420,000 absentee. That obliterated the 450,000 primary turnout set in 1994. In Polk County alone, 256 poll workers stayed home

Pate wrote in the Des Moines Register, “Iowans are amazing. The level of civic engagement among our citizens is unrivaled.”

But fellow Republicans sought to curb his adventure in democracy, starting in the Iowa Senate with legislation citing unsubstantiated security risks.

“This legislation does not ban or limit voters to cast an absentee ballot,” said Sen. Roby Smith, R-Davenport. “This bill is about security. This bill is to make sure someone’s vote is not erased by someone that is not legally allowed to vote. More people will vote under this bill.”

In the House, a successful amendment by Reps. Bobby Kaufmann, R-Wilton, and Bruce Hunter, D-Des Moines, shifted responsibility to the Iowa Legislative Council to act on any plan by the secretary of state, propose an alternative or decline to take action.

Otherwise, absentee ballot requests remained in the domain of county auditors.

The Republicans were taking their cue from Trump’s tirades that he lost the 2016 popular vote by 3 million because of irregularities ranging from immigrants fraudulently casting ballots to absentee shenanigans.

He appointed a commission led by then-Kansas Secretary of State Kris Kobach and Vice President Mike Pence that quickly disbanded. Kobach’s claims of 1,000 convictions for voter fraud since 2000 and 8,400 instances of double voting in 2016 were refuted by a commission report of 1,000 convictions for misconduct since 1948.

Trump told “Fox and Friends” this spring that a Democratic proposal for mail-in ballots during the pandemic would result in “levels of voting that, if you ever agreed to it, you’d never have a Republican elected in this country again.”

He castigated Michigan for sending out “illegal” absentee ballot applications when they were pursuant to a 2018 constitutional amendment expanding access to absentee voting. He criticized Nevada for emphasizing mailed ballots promoted by its Republican secretary of state.

The Republicans on the Iowa Legislative Council had a sudden change of heart. It seems Democratic auditors in urban counties were leaving their conflicted rural Republican counterparts in the dust regarding sending absentee ballot requests.

The Register reported Scott County Auditor Roxanna Moritz, a Democrat and president of the Iowa State Association of County Auditors, thought 18 counties — Black Hawk, Polk, Linn, Johnson and Scott among them — were preparing to send ballot request forms to voters.

Consequently, Pate’s request was unanimously approved.

But political differences remained. Linn and Johnson auditors will mail absentee ballot request forms with personal information numbers from state databases. Pate will send out blank forms.

Republicans had passed legislation denying use of the state’s voter registration database to fill in missing information on request forms, including a missing name, address, driver’s license number or a voter’s PIN.

“Any auditor who sends out a pre-populated form with the voter ID PIN is ignoring the law. Auditors and voters should be on notice that this action shows clear disregard for the law and could easily lead to election fraud,” said Sen. Jack Whitver, R-Ankeny.

The county auditor’s office also must call, email or mail a voter about incomplete or incorrect information on a submitted request rather than relying on the voter database.

Left-leaning groups are suing over the law, but face an uphill battle.

In 2019, Judge Joseph Seidlin upheld provisions of the 2017 voter reform law that “the verification of a voter’s identity is necessary before a voter is permitted to receive and cast a ballot.”

Republicans rightly rejected a Democratic request to extend the early voting from 29 to 40 days. Given last-minute campaign revelations, casting a ballot more than a month before an election could produce voter’s remorse.

Republican concerns about absentee voting are ironic considering the GOP began the push for its widespread use in the South to assist elderly voters — among its base constituencies.

Mail-in voting has displaced polling places in Washington, Oregon, Colorado and Hawaii with numerous safeguards, including bar codes.Conservative Utah is nearly there.

Whatever its motivation, the Iowa Legislative Council finally made the right call.

Dubuque Telegraph Herald. August 1, 2020

Governor should tell, not ask, people to wear masks in Iowa

The mask stalemate — to wear or not to wear — has come to a head, and it’s time for Iowa Gov. Kim Reynolds to act.

This week, the Iowa Medical Society requested the governor make masks mandatory. The group, which includes 12,000-plus doctors and health care providers, said with hospitalizations and infections increasing, a stronger statement from the governor is necessary.

While Reynolds has encouraged Iowans to wear masks, she has refused to issue a mandate and insists Iowa cities and counties do not have the authority to make such a mandate on their own. Yet, recently, Reynolds said this about wearing masks, as part of the Iowa Department of Public Health’s “Step Up Mask Up” campaign: “Protecting yourself means you’re protecting your friends, your family members, your co-workers and your fellow Iowans. Each and every one of us has it in our power to slow the spread of COVID-19.”

Her words are exactly right. But the governor is failing to step up when it comes to putting weight behind her statement.

More than 30 states, including Wisconsin and Illinois, have a mandatory mask order in most public places. Dubuque Mayor Roy Buol has pleaded for Reynolds to allow Dubuque to mandate masks, particularly now when the community has been designated a “red zone.” Five Dubuque Community School Board members requested of the county Board of Health that city and county officials issue a mask mandate. Public health leaders across the state, including Dubuque County’s Patrice Lambert, have called on Reynolds to issue a directive.

We’ve long known the virus was easily passed through respiratory droplets. But scientists have learned a great deal more about COVID-19 since March. Early on, the guidelines were that anyone experiencing symptoms should wear a mask. Now we know that many infected people don’t show symptoms immediately or at all. If everyone wears a mask, it will reduce the spread. It’s that simple. The governor embraces the science with her words. Now she must act on it.

Setting aside the compelling health reasons to order Iowans to wear masks, Reynolds should issue the mandate for the state of the economy and in support of small-business owners. The power of her mandate is the boost they need.

If the grim realities of COVID-19 haven’t hit home yet, revisit the story in Tuesday’s TH about Larry Ikonomopoulos, the 51-year-old owner of Skinny Maginny’s, 345 Main St., who was airlifted to UW Health University Hospital in Madison after more than two weeks on a ventilator in a local hospital. Ikonomopoulos closed the Dubuque bar on June 29 when he first felt ill, and it remains closed. Not only is this illness ravaging people, but it’s destroying businesses.

Many businesses have encouraged the wearing of masks, but most stopped short of making it a requirement so as not to alienate customers. One stop at Dubuque Farmers Market makes clear why that might be the case.

Dubuque Main Street put out an impassioned plea for people to wear masks for the safety of others at the market. Yet a recent walk around the marketplace showed a tepid 50% compliance with that request. Who will enforce it? Will the farmer, who picks vegetables at dawn and packs them up, ready to sell wares for a few dollars each? Should the seller refuse to sell ripe tomatoes and kale to the unmasked? Chances are, they’d rather take the money than get into a confrontation.

The same goes for small businesses. Amid this pandemic, as restaurants and retail shops are struggling to stay afloat, will the proprietors turn away customers who aren’t wearing masks? Or will they welcome them in to make a purchase, despite their personal discomfort?

If there is one thing all citizens agree on, it’s the wish to return to normalcy and to see our businesses survive. That only happens if purchasing gains momentum and consumer confidence is revived. There is a big segment of community members who simply aren’t comfortable going into an establishment in which people aren’t wearing masks and social distancing. If everyone wore masks in public, it would be much easier for all people to go to stores, restaurants, car dealerships and other public places. That’s how consumer confidence is rebuilt. That’s how the economic engines begin to rev.

As for the anti-mask contingent, even if you don’t believe you should be compelled to wear a mask, weigh the consequences. If wearing a mask in public — a minor inconvenience — brings more people into stores again and helps revive the economy, won’t that have been a small price to pay?

And, if wearing masks in public became the norm, and things didn’t improve medically, well, you can say, “I told you so.”

But for the sake of the state’s health — both physical and fiscal — we should give mandatory masks a try. Gov. Reynolds must make it so.