Long COVID, which is sometimes caused by vaccines, can be effectively treated – Glenn Chan’s Random Notes on Investing

Information about ivermectin and vaccine injury is being censored, so here’s what you should know:

• Long COVID can be treated with drugs and avoiding too much exercise.  Prompt treatment of COVID with ivermectin likely decreases the risk of developing long COVID.
• Vaccines seem to cause a version of long COVID that responds to long COVID treatment.
• It will eventually become clear that the current COVID-19 vaccines aren’t quite as safe as we originally thought. 

While I have been very bullish about mRNA vaccine stocks in the past, it would be a good idea to dial back that optimism (especially because the stocks have doubled lately).  For most people who have low COVID risk, booster shots likely cause more harm than good.  The various safety issues will greatly reduce vaccine usage.

The obsession with vaccines will eventually die down.  My interest is shifting towards the underappreciated early treatment market.  As most of the world will be forced to live with COVID, a massive market for early treatment will emerge.  Regeneron (REGN) is the most promising beneficiary.

What long COVID is

*Long COVID is also called post-acute sequelae of COVID-19 (PASC) and long-haul COVID.

Long COVID sufferers, or long haulers, experience a wide range of symptoms like brain fog and fatigue.  It can affect many different organs and manifests itself differently from person to person, making long COVID difficult to pin down as a medical condition.

In some cases, long COVID is essentially a disability because it prevents people from working.  If left untreated, it often goes away after a few to several months.  However, long COVID can come back so the high prevalence of coronavirus in the world is a huge issue for those who’ve already had long COVID.

Linking vaccine injuries to vaccines

The body uses different signaling molecules to co-ordinate the actions of the immune system.  Bruce Patterson of IncellDx has measured the levels of these molecules in patients with long COVID.  This data is analyzed by his company’s software to produce a ‘long hauler index score’.  This score can be used to help doctors figure out whether their treatment plan is working and headed in the right direction (because symptoms can seemingly stay the same while progress is being made).  This long hauler index provides evidence that long COVID is real.  It also provides evidence that vaccines cause a ‘post vaccination syndrome’ that looks a lot like long COVID.

Another piece of evidence is the presence of spike protein in monocyte cells.  Bruce Patterson has pioneered ways of objectively measuring unusual phenomena in long COVID patients.

The treatment for both versions of long COVID is the same.  The FLCCC website lists their I-RECOVER protocol for treating long COVID and post vaccine inflammatory syndromes.  The doctors associated with the FLCCC report that most patients recover, though there are a few patients whose symptoms do not go away.

The diagnostic tools and effective treatments contribute to a growing body of evidence that the spike protein (from COVID-19 vaccines or from natural infection) causes health problems.

The ivermectin wars will change our views on vaccine safety

Currently, the science establishment is waging a war on ivermectin.  Tech companies like Youtube/Google and Facebook censor information relating to ivermectin such as Dr. Pierre Kory’s testimony to the US senate.  Ivermectin happens to be the drug of choice for treating long COVID.  While ivermectin doesn’t always work and other drugs may be needed, ivermectin has the best safety profile so it’s a good idea to start treatment with ivermectin first.

There is going to be plenty of controversy over ivermectin and vaccine safety:

1. Many health authorities suppressed information about vaccines causing long COVID.
2. People are being disabled by long COVID.  Many of those people did not get treated because politically-driven censorship suppressed legitimate medical information.  The medical establishment has also made it unnecessarily difficult to get ivermectin in many countries.

The “vaccines are completely safe” narrative will likely break because there will be enough people pushing for the reality-based narrative.  The anti-woke side of the culture wars will fight for ivermectin because censorship and public health policy has been weaponized against them.  While a few anti-woke commentators like Ben Shapiro and Claire Lehmann currently support the narrative that vaccines are safe and that anti-vaxxing is irresponsible, their positions will likely change because they have an incentive to vilify Big Tech censorship.  They have good reasons to fear others attacking them with censorship and de-platforming.  The idea that censorship literally causes death and disability is a politically attractive narrative for people harmed by censorship.

The pro-ivermectin side will likely win the battle for public opinion because they will help heal the people hurt by vaccines, censorship, and medical misinformation.  Once the pro-censorship woke activists realize that they will lose this particular battle, they will move onto some other political battleground and try to win the culture wars that way.  I anticipate that the ivermectin wars will explode into the mainstream and raise awareness about vaccine safety.  The attention put on vaccine safety will have a negative effect on vaccinations rates and vaccine profits.

My own experience is that my post-vaccination health problems went down a lot after I started taking ivermectin.  (However, I did not get my inflammatory markers measured so I can’t be 110% sure if I was injured by my second Pfizer shot.)

Vaccines as a treatment for long COVID?  Probably a bad idea.

Many long COVID sufferers and doctors believe that it is a good idea for long COVID patients to get vaccinated.  It is the dominant narrative at the moment.

Based on anecdotes from doctors who’ve treated many patients, it seems that vaccines are more likely to make long COVID worse rather than better.  Eventually people will figure out that ivermectin and other drugs should be used to treat long COVID rather than vaccines.  However, it’s not clear why some long haulers actually get better after a vaccine shot.

Data on risk/benefit of vaccines

I haven’t come across great data yet.  The best data would come from large randomized controlled trials like the clinical trials for vaccines.  However, incomplete reporting of data makes it difficult to figure out the balance of benefit and harm.

Pfizer has released data on six month safety and efficacy of the Pfizer/Biontech vaccine BNT162b2 (Comirnaty).  The supplementary appendix shows:

• Deaths were pretty much equal in both groups- 15 in the vaccine group and 14 in the placebo group.  The vaccine group had 1 COVID-related death while the placebo group had 2 COVID-related deaths.  If less healthy people were being studied, the data likely would have favoured the vaccine group because there would be more deaths in the placebo group.  While the trials included elderly people above 65, these people were much healthier than the average population given how few people died.  The mortality benefit is unclear because healthy people rarely die from COVID.
• No data on hospitalization was reported (!).
• Higher adverse effects in the vaccine group.  30.2% of the vaccine group reported an adverse event versus 13.9% in the placebo group.  (This likely includes minor issues such as soreness at the injection site.)  1.2% of the vaccine group had a severe adverse event versus 0.7% in the placebo.  However, life-threatening adverse events were higher in the placebo group (26 events versus 21).
• It is not clear how many people were disabled by long COVID or post vaccination syndrome in both groups.  This is an important scientific question because it’s theoretically possible that vaccines, on average, reduce the prevalence of long COVID.

While I’m willing to believe that the trial itself was conducted properly, the selective reporting of outcomes makes it difficult to figure out which group is healthier.

Ultimately, we already know that COVID risk rises dramatically with age.  The high-risk groups will see more benefit from vaccines than others.  What matters is the cross-over point where vaccines cause more harm than good.  I don’t believe we have performed enough research to pin down where that cross-over point is.  Unfortunately, that point will move around because the new variants won’t be the same as the old ones.

Because risk rises dramatically with age, the risk/reward breakeven point is probably somewhere around 30-60 years of age.  Mortality data from Ontario Canada shows dramatic increases in case fatality rates with age, going from 0.2% in the 40-49 age group to 19.6% for those 80 and older.  See the fourth column below:

Data from the United States CDC and Qatar (see page 30) tell a similar story in terms of risk increasing with age.

In terms of safety issues caused by vaccines, under-recognition of long COVID is a data problem.  Many doctors have denied the existence of long COVID in their patients because they didn’t know how to diagnose or treat it.  The prevalence of long COVID caused by vaccines is almost certainly underreported.

We might also see better reporting of vaccine injuries other than long COVID because there are now diagnostic tests that would draw a connection between injuries and vaccines.  In blood clotting disorders, patients can be tested for auto-antibodies against platelet factor 4 (described in this scientific paper).  In these patients, the spike protein causes the body to produce antibodies that engage in “friendly fire” and attack platelet factor 4 in addition to attacking the coronavirus spike protein.  The collateral damage leads to blood clots.  There are also scientific papers describing how the spike protein can lead to auto-antibodies against various immune system cells and G-protein coupled receptors.  The wide range of auto-antibody targets could explain why long COVID varies so much from patient to patient.

The wide range of auto-antibody targets may be normal for an autoimmune condition.  Our current understanding of antibodies is that they go through a controlled mutation process until the body stumbles across an antibody that is effective at attacking a foreign antigen/protein and ineffective against the body.  Our bodies will iterate and produce novel antibodies until it finds something that works.  Auto-immunity occurs when an antibody turns out to be effective against some host antigen/protein.  The randomness of mutation would explain why autoimmunity is so different from patient to patient.  It might also explain why certain drugs used to treat autoimmune conditions – prednisone, dexamethasone, corticosteroids, tocilizumab – also seem to be effective in treating long COVID.

Vaccine usage

I would divide the population into three segments:

1. High risk individuals who should take vaccines.
2. Medium risk individuals who are at risk of developing long COVID but have very low chances of dying from COVID.  There is an economic incentive for the scientific establishment to push the idea that vaccines help prevent long COVID.
3. Low risk individuals who should not take vaccines.  The scientific establishment currently pushes the idea that children can get long COVID, which would justify yet more medical spending on vaccines and treatments.  I don’t know how long these narratives will last.

I would expect a wide variety of medical policies across the globe, continuing the pattern of politics trumping sensible medicine.  For example, some countries recognize natural immunity from a SARS-CoV-2 infection while others don’t.  My guess is that the current obsession with overvaccination will die down in a few years when vaccine injuries become too obvious to ignore.

Based on an age cutoff somewhere between 30-60 years of age, about 21-60% of the population would be candidates for vaccination rather than the ‘aim for 100%’ approach that we currently take with measles, polio, etc.

Moderna still looks undervalued

Here’s a quick estimate of what mRNA vaccines would earn.  Assume that 30% of the world’s population receives 2 booster shots every year.  That’s 4.6 billion doses every year.  Assume that mRNA vaccines from Moderna and Pfizer/Biontech account for most of that market with 4 billion doses per year, split 50/50 between the two manufacturers.  If the after-tax profit on each dose is $10 (the actual number may be higher), then each vaccine generates $20B in profit each year.  Assume a 15X multiple.  Moderna, which currently has a market cap of $166B, could eventually grow to a market cap of $300B .  The share price would be around $747 versus $413 currently, an 81% increase.  The stock still seems undervalued to me.

The value of the vaccine franchises depend heavily on usage; I could be underestimating how bad public health policy will be.  There may also be a cultural component that I am underestimating.  If enough people believe that vaccinations reduce transmission, then being vaccinated has a social signaling effect: vaccinated people can present themselves as courteous people who are doing their best not to infect others and to help reduce the economic problems caused by the pandemic.  It’s possible that vaccines will be popular for cultural rather than medical reasons.

There is also the risk of better vaccines taking away market share.  Companies are working hard on vaccines that provide broad cross-protection against variants.

Pharma price inflation

A Financial Times article describes how Pfizer/Biontech and Moderna have been raising their prices.  Because most countries are pursuing a strategy of vaccinating most of their population, demand exceeds supply at the moment.  However, price inflation could happen without a supply/demand imbalance.

Let’s take a look at Merck’s ProQuad/M-M-R II/Varivax vaccine franchise.  The MMR vaccines (mumps measles rubella) were discovered decades ago but Merck holds a monopoly in the US, where the franchise generates most of its revenues.  Since 2007, that franchise has experienced revenue growth at a CAGR of 2.6% (2007 sales were $1,347.1M versus 2020 sales of $1,878M).

The Gardasil / Gardasil 9 vaccine franchise for HPV had a CAGR of 7.8% (2020 sales – $3.938B, 2007 sales – $1,480.6).  The drug was approved in 2009 and has experienced higher growth because of innovation (Gardasil 9) and because its use was expanded to more age groups in 2018.

I believe that price inflation exists largely due to regulatory capture and political lobbying in the United States.  Drugs/vaccines like ProQuad/M-M-R II/Varivax generate most of their revenue in the United States even though most of the world’s developed population does not live in the United States (e.g. there are more people living in the European Union than the US).  If key regulators eliminate competition on behalf of the vaccine manufacturers, then I would expect price inflation to occur.  Some Americans will drive to Canada to buy insulin because the FDA and USPS help maintain American prices that are higher than free market for prescription drugs in Canada.  However, there are instances where regulators do not take action against free market competition such as generics and biosimilars.

The pivot towards early treatment

The original plan, betting it all on vaccines ending the pandemic, is failing because the coronavirus still spreads and people still die as vaccines don’t offer 100% protection.  Once it becomes obvious that the vaccine plan failed, you’ll likely hear more about early treatment for COVID.

Anthony Fauci is currently pushing for early treatments as a solution for the coronavirus pandemic.

Animal studies of monoclonal antibodies, the phase III prophylaxis study on the REGEN-COV monoclonal antibody, and the observations of the doctors behind the FLCCC all point towards early treatment being a sound plan.  Damage is most easily prevented when seemingly-healthy people get treated early before the immune system starts overreacting to viral debris.  You can think of the coronavirus as a mostly mild flu and the debris from dead virus as a dangerous trigger that can cause the immune system to overreact and kill its host.  Before the immune system kills off all of the virus, there is a window of opportunity to kill the virus faster and to greatly reduce the build-up of toxic debris.

The obsession with vaccines will eventually be replaced by an obsession with finding effective early treatments.  A few early treatments already exist.

• Ivermectin and other repurposed drugs.  See the FLCCC’s protocols for outpatient (at-home) treatment and hospital treatment for a list of drugs that they currently recommend.  While repurposed drugs could have a huge impact on the pandemic, usage is low at the moment due to the war on ivermectin.
• Monoclonal antibodies made by Regeneron, Eli Lilly, and GlavoSmithKline.  Regeneron has a smaller market cap so it is more of a pure play on monoclonal antibodies than  the other pharma giants.  REGEN-COV has an emergency use authorization for post-exposure prophylaxis (prevention), where the drug is given to high-risk individuals who have been exposed to the virus and might become SARS-CoV-2 positive.  Regeneron’s phase III trial supported the drug’s use for early treatment.  In its latest quarter, Regeneron’s antibody treatment REGEN-COV became its best-selling drug (see section “2. Product Sales”).
• Remdesivir (owned by Gilead).  This will likely sell well only in the United States because the drug may cause more harm than good.  A Veterans Health Administration study found that the drug increased duration of hospitalization rather than the opposite.  The World Health Organization does not recommend remdesivir for treatment.  Gilead is no longer pursuing this antiviral drug as an early treatment (even though antivirals should be used for early treatment when there is still virus to kill).
• Avodart / dutasteride (owned by GSK).  While this drug is available as a generic, its sales were £574M in 2019.  Its antiandrogen effect affects TMPRSS2 expression which is required for priming of the spike protein for cell fusion.  Bicalutamide is another off-patent antiandrogen drug that can be repurposed for COVID treatment..
• Proxalutamide (owned by 9939.HK) is an antiandrogen like dutasteride.  While this drug is promising, it is still in clinical trials.  Antiandrogen drugs may not necessarily turn into an effective treatment.  Suzhou Kintor Pharmaceuticals is based in China so shareholders may end up owning nothing.

Regeneron is probably the best way to play the early treatment market.  REGEN-COV was the best-selling COVID treatment drug last quarter with $2.6B in sales during Regeneron’s latest quarter.  It is currently the most competitive drug in the early treatment market.

GlaxoSmithKline (GSK) and Cytodyn (CYDY)

CCR5 inhibitors seem to be useful in the treatment of long COVID.  Doctors associated with Bruce Patterson and Ram Yogendra tend to use maraviroc to treat long COVID.  CCR5 inhibitors are not on page 1 of the FLCCC’s protocol for treating long COVID; its usage is not widespread.  GSK owns rights to maraviroc / Selzentry / Celsentri.  Pfizer and Shionogi / 4507.T also own small parts of the rights.

I don’t foresee the long COVID market becoming so large that it would meaningfully impact a pharma company with a market cap of US$102B.  My current guess is that long COVID is rare and will be a much smaller market than early treatment for COVID.  GSK may very well make more money on its monoclonal antibody than maraviroc.  Expensive drugs will also lose market share to cheap drugs like ivermectin, statins, fluvoxamine, corticosteroids, prednisone, and melatonin.  Ivermectin and melatonin are the safest COVID-related treatment drugs and are sold over the counter in some/many countries.

Cytodyn owns the rights to leronlimab, a monoclonal antibody that targets the CCR5 receptor and acts as a CCR5 inhibitor.  Cytodyn’s market cap is $835M and its most promising drug candidate is leronlimab.  Cytodyn is heavily shorted by short sellers- see the Buyersstrike blog and this post on leronlimab as a long hauler treatment.  If you read certain blog posts of mine, you can probably figure out why I shorted CYDY in the past and mentioned CYDY in a 2019 post.  I haven’t done enough research into Cytodyn in 2021 to figure out if it’s a good or bad stock.

Politics and tribalism create opportunity

I understand that vaccine safety is a controversial topic.  Some people want to create a medical apartheid system between the vaxxed and unvaxxed, presumably paving a path to a future system where there is a social hierarchy between the woke and non-woke.  The culture wars have been getting more intense.  This has resulted in a sea of misinformation from both sides of the culture wars, each pushing their own political agendas.  A lot of people are afraid of taking action against their own “tribe” because they don’t want to be socially ostracized.  Because of this, many people are misinformed about the pandemic and/or invest with fear of what their peers will think of them.  It’s normal for human beings to get caught up in politically-driven narratives regardless of how wrong they are.  That is why opportunity exists.

It seems fairly obvious to me that most of the world will live with COVID and create a massive market for COVID-related treatments and vaccines.  Vaccines will take a slice of that pie but it seems like monoclonal antibodies will dominate that market.

*Disclosure:  Long GILD and REGN calls (and REGN stock).  Long MRNA and BNTX stock.  No position in Google, Twitter, and Thomson Reuters (which implement woke pro-censorship policies).  Long FB calls despite its censorship.  I own a put option on MSFT, whose LinkedIn subsidiary engages in censorship.