Lunchtime pandemic reading.
Standard disclaimer: this is a roundup of informative pieces I've read that interest me on the severity of the crisis and how to manage it. I am not a qualified medical expert in ANY sense; at best I am reasonably well-read laity. ALWAYS prioritize advice from qualified healthcare experts over some person on Facebook.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.
You are welcome to share this.
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Chillblain-like lesions may indicate COVID-19 infection. "In this series of 40 consecutive patients with chilblain-like lesions, none had positive findings on polymerase chain reaction (PCR) tests, and 12 (30%) had positive COVID-19 serologic results. Common findings included increased D-dimers, lymphocytic inflammation, vascular damage on skin biopsy results, and a significant interferon-alpha response compared with patients with PCR-positive, acute COVID-19 infection.
Patients presenting with chilblain-like lesions during the COVID-19 pandemic all had negative PCR results for COVID-19 at the time of the diagnosis and developed antibodies in only 30% of cases, and had histologic and biologic patterns of type I interferonopathy.
In less than 2 weeks, 40 patients presented with chilblains to our dedicated multidisciplinary COVID-19 consultation clinic. This occurrence is unusual in temperate areas, and corresponded with the spread of SARS-CoV-2 in our region.7 One-third of patients met clinical criteria for possible COVID-19 infection prior to presentation. Although no patient had positive rt-PCR results, one-third had positive results on serologic analysis. On the basis of these results, definitive proof of a causal link with chilblains and COVID-19 is not demonstrated. However, it is important to emphasize that decreased test sensitivity has been reported in patients with asymptomatic COVID-19 infection, and an alternative immunologic or infectious etiology for these transient chilblain-like lesions was not identified in this cohort.8,9
The clinical presentation was highly reproducible between patients. Typically, most of these patients were adolescents and young adults without additional medical problems. It is important to stress that the chilblain-like changes resolved in all cases. However, the recovery may be slow because 14 patients (35%) had cold toes or acrocyanosis at a median follow-up of 1 month."
Source: https://jamanetwork.com/journals/jamadermatology/fullarticle/2773121
Commentary: What's concerning in this study is that COVID-19 had infected these patients but was no longer showing up in RT-PCR tests. That means either they had the disease and had recovered, or had a low level of a diease enough to evade a test. Either way, COVID-19 remains difficult to track, which is why universal mask wearing is essential. Even with a test, there's no guarantee someone else isn't infected.
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The United States has hit an all-time high for hospitalizations; the Thanksgiving weekend has created a significant disruption in testing. Case counts and tests declined over the holiday.
Source: https://covidtracking.com/data/charts/us-all-key-metrics
Commentary: What we are likely to find is that Thanksgiving has been a slow-motion disaster for spread of disease.
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Psychological distress up 248% year over year. "We fielded wave 2 of the Johns Hopkins COVID-19 Civic Life and Public Health Survey from July 7 to July 22, 2020, among US adults aged 18 years and older who responded to wave 1, fielded April 7 to April 13, 2020. The sample was drawn from NORC’s AmeriSpeak panel of approximately 35 000 members sourced from NORC’s area probability sample and from a US Postal Service address-based sample covering 97% of US households.2 AmeriSpeak’s panel recruitment rate is 34%. The survey was administered online. The Johns Hopkins Bloomberg School of Public Health institutional review board deemed this study exempt and waived informed consent.
We measured psychological distress in the past 30 days using the Kessler 6 scale. A score of 13 or more on the 0- to 24-point scale indicated the validated measure of serious distress.3 We then asked, “During the past 30 days, have any of the following negatively impacted your mental health?” Respondents selected from a list of potential stressors affecting them or their family members, including concern about contracting COVID-19 or experiencing adverse effects related to COVID-19 on employment, finances, education, health insurance, and ability to obtain health care or childcare.
Reported prevalence of serious psychological distress among US adults was 13.6% in April 2020 and 13% in July 2020. Persistent distress increases risk of psychiatric disorders, which the Kessler 6 scale predicts.3 High prevalence at both time points suggests that the pandemic’s longer-term disruptions are important drivers of distress. More than 60% of adults with serious distress reported that pandemic-related disruptions to education, employment, and finances negatively affected their mental health. These stressors may be particularly salient to young adults, about a quarter of whom reported serious distress in both April and July. Thirty-five percent of adults with serious distress cited inability to obtain health care as a contributing factor, highlighting the need to facilitate safe and affordable health care access during the pandemic and beyond.4,5"
Source: https://jamanetwork.com/journals/jama/fullarticle/2773517
Commentary: Be on the lookout for friends and family who are not coping well with the pandemic and offer what support you can. For those already at risk or have pre-existing mental health conditions, consider adding additional support as practical and as costs permit, including increasing therapy frequency.
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Seroprevalence indicates that most of the population still has not had COVID-19. "Qidespread availability of commercial assays that detect anti–severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies has enabled researchers to examine naturally acquired immunity to coronavirus disease 2019 (COVID-19) at the population level. Several studies have found that the SARS-CoV-2 seroprevalence (the percentage of the population with serum containing antibodies that recognize the virus) has remained below 20% even in the most adversely affected areas globally, such as Spain and Italy.1-3 In this issue of JAMA Internal Medicine, Bajema et al4 contribute new information on the shifting nature of SARS-CoV-2 seroprevalence in the US. The study uses national data to expand on an earlier US Centers for Disease Control and Prevention study of seroprevalence of antibodies to SARS-CoV-2 in 10 US sites.3
Using serum samples from commercial clinical laboratories, the investigators found the highest level of seroprevalence in New York, which surged from 6.9%3 in March to a peak of approximately 25% before mid-August 2020.4 For all but a few states, seroprevalence remained below 10% throughout the study period; New York was the only state where seroprevalence increased above 20%. In several states, seroprevalence stayed below 1%. Seroprevalence tended to wane over time, although in a few states, such as Georgia and Minnesota, rates increased over the study period. Thus, the primary takeaway from this study is that despite the pandemic raging across the US, most people do not have evidence of prior COVID-19 infection by antibodies to SARS-CoV-2.
In summary, a robust and well-designed seroprevalence study using residual serum samples from across the US has found that herd immunity to SARS-Cov-2 is nowhere in sight, even as the COVID-19 pandemic has raged on for a year. The good news is that the limited number of reinfections of SARS-CoV-2 to date, and the experience with natural infections with other viruses, suggests that protective immunity to COVID-19 should result, a harbinger for the success of vaccines. The bad news is that, like the 1918 influenza pandemic, achieving herd immunity through natural infections will take years of painful sacrifice that are tallied in numerous deaths, severe long-term health sequelae, and widespread economic disruption and hardship. Let us hope that safe and effective vaccines help avoid the consequences of naturally developing herd immunity to COVID-19, as they have reliably done for so many other respiratory viruses."
Source: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2773575
Commentary: More fuel for debunking herd immunity through methods other than vaccines. Vaccination will be the only viable way to end COVID-19 that doesn't result in millions of deaths and hundreds of millions of long-term disabilities.
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Wash your hands, guys. "An internet survey conducted in late June included about 4800 US adults who said they had been out in public during the previous week. Overall, 85% of the participants said they always or often washed their hands or used hand sanitizer after coming in contact with high-touch surfaces in public places.
However, men and younger adults were less likely than women and older adults to practice proper hand hygiene after touching common objects while out to shop or for other reasons. About 72% of adults younger than 24 years used hand sanitizer or washed their hands compared with approximately 89% of adults aged 65 years or older.
Men were 35% less likely than women to frequently wash their hands; non-Hispanic Asian adults were 66% more likely than White adults to wash their hands often.
People who were extremely concerned about contracting severe acute respiratory syndrome coronavirus 2 infection were twice as likely to frequently wash their hands as those who weren’t uneasy about becoming infected. Adults who made less than $25 000 a year were less likely than wealthier individuals to use hand sanitizer, perhaps because of the product’s cost, the authors suggested.
A second survey of about 4000 US adults found that less than 75% said they were likely to remember to wash their hands after having respiratory symptoms or before eating at home or in a restaurant during 2020. Men, young adults, and White people were less likely than other groups to wash their hands in those situations."
Source: https://jamanetwork.com/journals/jama/fullarticle/2773286
Commentary: Dudes, wash your hands. It's not that hard. I carry peroxide and alcohol-based sanitizer, and it's fast and convenient.
And when things do reopen eventually... give some serious thought as to whether you even want to resume shaking hands with people. I don't plan to.
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A reminder of the simple daily habits we should all be taking.
1. Wash/sanitize your hands every time you are in or out of your home for any reason. Consider also spraying the bottoms of your shoes with a general disinfectant (alcohol/bleach/peroxide) when you return home. Remember that cleaners are NEVER to be ingested or injected. If you come in physical contact with others, wash your clothing upon returning home.
2. Always wear a mask when out of your home and if going to a high-risk area, wear goggles. Respirators are back in stock at online retailers, too. When going indoors to a place that isn't your home, wear the best protective mask available to you.
3. Stay home as much as possible. Minimize your contact with others and maintain physical distance of at LEAST 6 feet / 2 meters, preferably more. Avoid indoor places as much as you can; indoor spaces spread the disease through aerosols and distance is less effective at mitigating your risks.
4. Get your personal finances in order now. Cut all unnecessary costs.
5. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
6. Ventilate your home as frequently as weather and circumstances permit, except when you share close airspaces with other residences (like a window less than a meter away from a neighboring window).
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Common misinformation debunked!
There is no genomic evidence at all that COVID-19 arrived before 2020 in the United States and therefore no hidden herd immunity:
Source:
There is no evidence SARS-CoV-2 was engineered, nor that it escaped a lab somewhere.
Source: https://www.washingtonpost.com/world/2020/01/29/experts-debunk-fringe-theory-linking-chinas-coronavirus-weapons-research/
Source: https://www.nature.com/articles/s41591-020-0820-9
Source: https://www.nationalgeographic.com/science/2020/05/anthony-fauci-no-scientific-evidence-the-coronavirus-was-made-in-a-chinese-lab-cvd/
There is no evidence a flu shot increases your COVID-19 risk.
Source: https://www.factcheck.org/2020/04/no-evidence-that-flu-shot-increases-risk-of-covid-19/
Source: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa626/5842161
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A common request I'm asked is who I follow. Here's a public Twitter list of many of the sources I read.
https://twitter.com/i/lists/1260956929205112834
This list is biased by design. It is limited to authors who predominantly post in the English language. It is heavily biased towards individual researchers and away from institutions. It is biased towards those who publish or share research, data, papers, etc. I have made an attempt to follow researchers from different countries, and also to make the list reasonably gender-balanced, because multiple, diverse perspectives on research data are essential.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.