Addressing Dr. Daniel Stock’s Claims
A surprisingly large number of people have sent me a video that is inundated with disinformation about COVID-19 and its reach seems considerable so I have deemed it significant enough to address. In the video, one Dr. Dan Stock from Indiana at a school board meeting opines at length about all the things we’re supposedly doing wrong with COVID-19 (by the way, the FSMB has now stated that spreading misinformation about COVID-19 vaccination may put medical licenses at risk, though state medical boards have final say it seems; rest assured I will be examining the rules in Indiana quite closely). The speech is little more than a verbal gish gallop: a tactic used by science denialists usually over written forums wherein they post a bunch of links that they claim to support their points but in reality most of the citations are unsupportive or even unrelated to their claim- but this serves the appearance of evidence (this is a famous example). He is doing this verbally- he is making a series of incorrect arguments (that are self-contradictory) and essentially seeking to overwhelm opposition with the volume of arguments he makes. The thing is, as I’ll discuss, he discredits himself very early on, so you don’t have to subject yourself to listening to his nonsense because I did it for you.
To begin, the speaker describes himself as a “functional family medicine physician,” which per him “means [he] is specially trained in immunology and inflammation regulation.” Firstly, this isn’t even how most sources define functional medicine. The Cleveland Clinic Center for Functional Medicine defines functional medicine as
a personalized, systems-oriented model that empowers patients and practitioners to achieve the highest expression of health by working in collaboration to address the underlying causes of disease.
A visual aid to explain how masks work. Source
This definition, admittedly, is completely meaningless because the foundation of literally all medicine is built on understanding the pathophysiology of conditions and addressing their underlying cause whenever that is possible (which unfortunately isn’t always feasible) and the implication that other clinician specialties do not do this is on its face pretty offensive. It also tells you nothing about the actual scope of a functional medicine physician’s expertise as far as the ailments they address or which aspects of the human body they specialize in. Perhaps most importantly though, it is not what Stock describes, which most closely seems to describe an allergist/immunologist (which he is not). The title of “functional medicine physician” is usually a red flag for quackery, and he’s already misrepresented his own expertise, so this isn’t off to a great start. An explanation of the problems with functional medicine generally may be found here. Also functional medicine is not a specialty recognized by the American Board of Medical Specialties nor the American Medical Association.
Next he claims that coronaviruses and all respiratory viruses are spread by aerosol particles which are small enough to go through your mask, which is a misleading in several ways. Aerosols refer specifically to very small droplets which in general can linger in the air for prolonged periods of time (and they are blocked by masks). While there is evidence that during certain medical procedures like intubation, SARS-CoV-2 can become aerosolized, most contact tracing studies do find that prolonged close contact with individuals is needed for transmission to occur (but obviously there are exceptions). There is definitely a role for aerosol transmission in COVID-19 but precisely how much is not well-defined. He then argues that masks don’t work because viruses are small enough to pass through them. The problem with this reasoning is viruses do not travel as individual viral particles- they are inside the aerosols and droplets. That’s what the masks block. The IDSA has graciously compiled the multitudinous, surfeit evidence demonstrating the effectiveness of masking here which anyone is free to peruse at their leisure.
The seasonality of various respiratory viruses. Source
He then states that all respiratory viruses wait for the “immune system to get sick in the winter” which is baseless. The seasonality of respiratory viruses is a complex matter dependent on many factors, many of which have nothing to do directly with immunity. For instance, when it’s cold, people gather indoors for prolonged periods close together in poorly ventilated spaces. Humidity is lower which also affects virus transmission as it allows aerosols to remain suspended for longer and mucociliary clearance may be impaired. Additionally, not all respiratory viruses peak in the winter. Vitamin D levels in the winter may also play a role but it’s probably not that important in higher income nations because true vitamin D deficiency is relatively rare. I discussed vitamin D at length here. He goes back to this point several times but there’s still no evidence for the value of vitamin D as therapy or prevention in COVID-19. Having adequate vitamin D levels is critical for optimization of one’s health, absolutely, but there is no evidence that vitamin D alone is protective from COVID-19 (and in fact there are Mendelian randomization studies suggesting in fact that vitamin D does not affect risk for COVID-19 as well as a randomized controlled trial).
Stock then makes a meaningless and unfalsifiable remark that sounds scary by saying that the vaccines make your immune system become “deranged.” He provides no evidence or reference for this most extraordinary claim even though the burden of proof lies with him for making it. This comment is vague and meaningless and he does not clarify what constitutes immunological derangement. What specific pathologies are the vaccines causing indicative of immunological derangement? We have near real-time safety data on them and the risks (which are themselves exceptionally rare) are: anaphylaxis 2.5-4.7 per million doses, thrombosis with thrombocytopenia syndrome (TTS) with the JJJ vaccine at 3 per million doses, Guillain-Barre syndrome at 7.8 per million doses of JJJ, and the rare cases of myocarditis whose rate is hard to define generally but goes up to ~7 per 100,000 second doses of the vaccine in younger males and is far lower for everyone else. COVID-19 patients on the other hand may have substantial immunological challenges. They develop functional autoantibodies that worsen disease and people who recover from COVID regularly have new autoimmune diseases, including diabetes. Some evidence demonstrates prolonged disruption of normal peripheral immune system function following COVID-19 in some patients. I discussed the differences in disease-acquired immunity and vaccine-acquired immunity here for those seeking additional details.
Stock then says something about filtering out the virus but the context is no longer masks or any nonpharmaceutical interventions so I’m not sure what he’s talking about and also says the virus can’t ever go away because it has animal reservoirs (zoonotic virus). This is not the whole truth. Certainly, barring a universal coronavirus vaccine that can be given to animals and ideally one that is itself transmissible, SARS-CoV-2 is not a viable candidate for eradication because it has animal reservoirs that can keep introducing it into the population. This does not mean that vaccination cannot alleviate the public health burden of COVID-19. It does it every year for flu, which is another zoonotic disease. Our healthcare system has yet to get close to collapse because of seasonal influenza. COVID vaccines are far more effective, however. We might eventually even be able to eliminate SARS-CoV-2 country-by-country with them like we do for measles and polio, but that is a much more long-term goal and having disinformation like this disseminating widely doesn’t help with it. Stock then goes back to gish galloping by naming a bunch of viruses that we have (not all of which are zoonotic) for which we have no vaccine as evidence that we won’t be able to control this virus by vaccination. He specifically mentions RSV and adenoviruses. We do have effective vaccines for a few adenoviruses (type 4 and 7) but they are given only to the military. Adenoviruses (especially replication-incompetent adenoviruses) also have a role as potential vectors for vaccines, wherein pre-existing immunity creates challenges to generating solid protection with such vaccines. We have yet to make an effective RSV vaccine so suggesting that the eradication campaign has failed for RSV because RSV keeps getting reintroduced into the population by animals (despite it having no known animal reservoirs) is absolutely false. It’s also extraordinarily dishonest to compare the worst pandemic in over a century to the common cold (though RSV is certainly not a cold for several vulnerable groups).
This is not the portrait of an ineffective vaccine. At this point approximately half of the US population is vaccinated. Using these numbers, an 8-fold reduction in the risk of symptomatic infection corresponds to approximately 88% vaccine effectiveness against symptomatic COVID. The 25-fold reduction in hospitalization and death each corresponds to 96% effectiveness. Note that this data goes up to July 24, 2021- well into the time period at which the delta variant had attained high prevalence.
Stock then describes breakthrough cases during the summer and claims that this is proof the vaccine doesn’t work. Firstly, multiple respiratory viruses are having out of season resurgence (e.g. RSV) which significantly weakens the argument. Most probably, this is because we decided to relax every single mitigation measure against COVID which also had the side effect of reducing the spread of any infection spread by the respiratory route. He then chooses to ignore the vaccine effectiveness data we currently have. In the CDC’s own most recent data, the vaccine was shown to be ~88% effective against symptomatic disease during a period when the Delta variant was dominant. As for severe disease, hospitalization, and death, those numbers are very close to 100%. The vaccine works quite well- having a variant that is a beast at spreading means more cases and the vaccine is not 100% effective, so of course some cases happen in the vaccinated. This is basically a long-winded nirvana fallacy (the idea that if it’s not perfect it’s useless) on his part.
At this point, Stock then raises the matter of antibody-dependent enhancement, except he calls it “antibody-mediated viral enhancement.” I wrote a post all about this in December which you can read here and it is only reinforced by the latest data. This is irredeemable and unequivocally disinformation. Firstly, he defines ADE incorrectly by suggesting it is exclusive to vaccines. ADE does not have to be caused by a vaccine to be ADE- in Dengue which is the major infection for which it’s relevant it is almost always because of infection. Secondly he confuses ADE and VAERD (see the ADE post). These are immunologically distinct entities and ADE does not have to be caused by a respiratory infection (Dengue is not respiratory). It also has nothing to do with how pathogenic the virus is; per his claim RSV has low pathogenicity (I wouldn’t agree with that but I digress) but this has also been observed for Ebola which is among the most lethal viruses in existence. If ADE were happening, reinfections would be both common and more severe with COVID-19. It’s the literal exact opposite. We also have data on hundreds of thousands of people at this point who got convalescent plasma and it didn’t make them worse. On top of that animal studies of the vaccines demonstrated protection and not enhanced disease. If the vaccines actually caused ADE it would represent a negative vaccine efficacy/effectiveness. The mRNA vaccines were ~95% efficacious and perform similarly in the real world; JJJ also clearly improves outcomes with about 66% efficacy and very solid protection against severe outcomes. Stop trying to make ADE happen. It’s not happening. By the way- we are at this point only a third through in the video. Take note of how much disinformation has been espoused in a mere 2 minutes.
Stock then brings up the Barnstable County outbreak and he gets applauded for some stupid reason, again ignoring context and misrepresenting data. We have no idea what the denominator for the outbreak described here was (i.e. how many people were exposed to the virus). There is no way to make a conclusion about vaccine effectiveness from that study, despite him trying to imply it shows the vaccine doesn’t work. Here’s a thought experiment for you to understand why this isn’t useful. Suppose I take 100 fully vaccinated people and put them in a room where I introduce aerosolized measles virus. We might expect a few of them to get sick because vaccines aren’t 100% effective (2 doses of MMR-II are 97-99% effective against measles). 100% of the cases will be in people who were fully vaccinated. Does that mean the vaccines don’t work? Secular trends in the incidence of measles would suggest otherwise. See this excellent animation by Dr. Kristen Panthagani in this post from Dr. Jeremy Faust’s Inside Medicine Bulletin showing how breakthrough cases and disease prevalence change with vaccination rates. Provincetown has a 95% vaccination rate. If 74% of the cases were in vaccinated people, that gives vaccines (and this is across all 3 available in the US) 84% effectiveness (assuming everyone in Provincetown had equal likelihood of exposure) against symptomatic COVID-19 under conditions that would really stress test them. In short, this case series does not impugn the effectiveness of vaccines for COVID-19 and anyone claiming that it does either doesn’t understand how vaccine effectiveness works or has an agenda.
Stock then claims no vaccine ever stops infection as though this is some smoking gun. Firstly, that’s not true. HPV vaccines do prevent infection (and depending on the capsule group some pneumococcal and meningococcal vaccines are also considered to confer sterilizing immunity). Secondly, in general, no vaccine needs to stop infection for it to have massive public health benefits or stop transmission. Here’s a thread I made all about that going through the data rebutting it. He goes back to this more than once because he argues that vaccines don’t stop spread, which is demonstrably false. Also as some will inevitably raise the issue, despite the Provincetown data, evidence that infectiousness of breakthrough and naive COVID-19 cases is equivalent is lacking. While Ct values taken at a single time point at the time of diagnosis are similar, data from Singapore indicates in vaccinees infected with the delta variant, they rise more quickly suggesting a shorter duration of infectiousness. Furthermore, we have data showing that breakthrough cases in general are milder and shorter lived. Additionally, simply comparing Ct values of vaccinees and unvaccinated patients is not sufficient to make judgments about relative infectiousness. A vaccinated person’s immune system is extremely well primed against SARS-CoV-2. Thus it is not clear how much of the RNA noted via PCR corresponds to virus that is actually capable of infection, as much of the virus in a vaccinated person may be neutralized by antibodies relative to that of the unvaccinated person. Plaque assays would be needed to quantify that difference and we don’t currently have these. Certainly, the data merit masking for the vaccinated out of an abundance of caution (frankly in the face of a surge it shouldn’t take much to recommend universal masking), and we should avail ourselves of every tool we have to reduce incidence in the face of a surge by the delta variant, but no data presently exists giving a death knell for vaccines’ ability to reduce transmission of SARS-CoV-2. Remember- you still have to be infected in the first place to spread SARS-CoV-2, which is already less likely by virtue of vaccination.
Stock then references a mumps outbreak and claims that the outbreak was caused by vaccinated people shedding the mumps virus on the unvaccinated. He may be disappointed to learn that there has never been a well-documented case of secondary transmission of vaccine strain mumps in the history of its use (in this case I am referring to the Jeryl-Lynn strain used in the US- there has been a case of Urabe strain and some cases of the Leningrad-Zagreb strains doing it; the Urabe strain is no longer used).
Stock then claims the trifecta of vitamin D (addressed earlier), ivermectin, and zinc to treat a whole 15 COVID patients. The issue is that given any representative sample of 15 people in the US population the most probable outcome of COVID-19 is recovery so these data are not meaningful (beyond the fact that this is anecdote). Furthermore, recent data has emerged to indicate that much of the positive data regarding ivermectin may be the result of fraud. I could find no data of reasonable quality on the value of zinc as a therapy in COVID-19. For details about vitamin D, see the post I linked earlier. Stock also says that vaccination is appropriate only if there is no treatment- there is no such condition recognized anywhere. Furthermore vaccination is a preventive measure, not a treatment.
Stock then asserts very confidently again that patients who recover from COVID-19 have no benefit from vaccination at all. This was explicitly demonstrated to be false in the recent CDC MMWR then which found the exact opposite- a significantly reduced risk of reinfection among those who got 2 doses after recovery by 2.34 times. There is no quantitative data I have seen on the relative burden of “side effects” for recovered patients following vaccination; it is known that the first dose of vaccine after recovery is analogous to people’s second dose if they did not have COVID before but the effect goes away with the second dose in those patients per the most recent Pfizer clinical trial data. I reviewed the benefits of vaccination of the recovered more generally here.
I can honestly say that I don’t think there was any part of the 6 minutes and 30 seconds of that entire video that was completely truthful or accurate which is quite unsettling.
