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.
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This newsletter marked an anniversary last week. January 27, 2020 was the first issue of the Lunchtime Pandemic newsletter, and the guidance back then was largely the same as it is today. There's no need to wear gloves as long as you're washing/sterilizing your hands every time you return home or touch your face, and N95 or better masks are the baseline now.
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Dr. Scott Gottlieb on the weekend circuit. "MARGARET BRENNAN: I thought it was remarkable there to hear a Republican mayor criticize a Republican governor in saying we- we need to actually be able to control what's happening in our own city and that not being allowed to happen. Are cities like Miami, places where they are seeing B.1.1.7, this strain in the U.K. circulate. Are they really at risk of being overrun?
DR. GOTTLIEB: I think Miami is at the highest risk right now, Miami and southern California. If you look at where B.1.1.7 is right now in the country, about half the cases that we're turning over in southern California and in Florida and the cities are the hot spots, San Diego, Miami. So I think that the possibility is that we're not going to see a national epidemic with B.1.1.7, at least in the spring and the summertime. It's a risk to the fall. But what we're likely to see is regionalized epidemics with this new variant. And the two places in the country right now that are the biggest hotspots are southern Cali- California and southern Florida, Miami. So those cities need to be very mindful of the spread of these variants. Now we know what works. Prior immunity and the vaccines do appear to be as effective against this new variant. So as we immunize more of the population and if people continue to wear masks and be vigilant in these parts of the country, we can keep this at bay. It's not too late, but it's a real risk to those regions of the country right now.
MARGARET BRENNAN: Can you clarify, because Dr. Fauci was on this program last Sunday and said that that U.K. strain does have a certain degree of increase in virulence, meaning it can cause more damage, including death. Is it more deadly?
DR. GOTTLIEB: There's some- there's some evidence right now that does suggest that it is more pathogenic, that it does cause more severe illness. And we do know that it's about 50% more transmissible. But what we also know from the data, at least the data we have so far, both experimental evidence as well as the data that's come out of some of these vaccine trials like the Johnson and Johnson vaccine trial and the one with Novavax is that immunization and prior infection appears to be protective against the B.1.1.7 variant, as protective. That's not the case with the Brazilian the South African variant P.1. and B.1.351, where prior infection, immunity you get from being infected as well as the immunity you get from vaccination, does not appear to be as protective against those variants. So the good news with B.1.1.7, if there is good news is that as we vaccinate more of the population, it should be a backstop against the continued spread of that variant.
MARGARET BRENNAN: So the Biden administration projected this week that another 90,000 people will die in the US over the next four weeks, but the curves seem to be coming down on hospitalizations and infections. Are we getting ahead of ourselves by saying we're turning a corner here? Are you warning us that these new variants are going to dramatically change this trajectory?
DR. GOTTLIEB: I think we have the potential to turn a corner. Things are clearly improving around the country. We can't take our foot off the brake too quickly in terms of the things that people are doing, like wearing masks and being more vigilant. That's really probably what's bringing down infection rates across the country right now. The new variants create a lot of risk. I think that the risk is that what you're going to see over the summertime is whereas the summer should have been very quiet, coronavirus should have really dissipated in part because of the seasonal backstop, in part because we've infected a third of the population and in part because we're immunizing more people. So coronavirus levels should have really come down this summer. You might see higher prevalence than what you would have expected. But what's going to likely happen is that the prevalence is going to be high in certain regional hotspots. So we'll have hotspots of infection and maybe epidemics in parts of Florida, parts of Southern California, because of B.1.1... They'll never really get out of it, but the rest of the country will see prevalence come down. Now, the risk is to the fall when, you know, these new variants are going to want to surge, B.1.1.7, B.1.351, P.1. Now, with respect to the South African and the Brazilian variants, they don't appear right now to be more fit, meaning that they're more transmissible. So, they may not spread as readily. And we have time to get control of those variants and develop new boosters that could protect against them, vaccine boosters."
Source: https://www.cbsnews.com/news/transcript-scott-gottlieb-discusses-coronavirus-on-face-the-nation-january-31-2021/
Commentary: We're racing the clock, as a planet, to get immunizations in place before the virus spreads even faster or develops more resistance. Case counts in the United States and other nations are dropping. The greatest danger now is people ending restrictions too soon. Every time numbers have fallen, people have gotten lax with their precautions, and a new surge has resulted, each worse than the last.
Keep your guard up and your mask on. This is the part of the movie where the hero looks like he's won but the villain pulls out his ace in the hole. This is the part of the game at halftime where our team is ahead just a little, but the score is still close and there's a lot of game left to play. It's much too soon to ease up.
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Quick takes on the variants and duration. "The pathway out of the coronavirus pandemic is looking somewhat bumpier than it did one month ago.
Three more transmissible strains are threatening to prolong the United States’s struggle with the virus. These mutations are tempering hopes that life might start feeling more normal by the summer – even as the daily pace of immunizations accelerates.
“The road to herd immunity from the coronavirus suddenly looks longer,” our colleagues Joel Achenbach and Ariana Eunjung Cha report. “The emergence of more transmissible, potentially vaccine-evading variants threatens to extend the global health disaster and make 2021 feel too much like 2020.”
“A complicated mix of good news and bad news makes any forecast for the coming months fuzzy,” they add. “But scientists have one clear and sobering message: The pandemic is a long way from over.”
Health 202: Do the variants mean it will be even longer before life in the U.S. starts feeling normal again?
Topol: “Yes, it means it will likely take longer. Instead of midyear to see marked containment of the virus, it’s going to be at least a few months delayed.”
Lipsitch: “Admittedly there is preliminary evidence that the U.K. variant may be more lethal than the prior strains (in unvaccinated people), but this effect, while important to understand, is not huge. More importantly, even in South Africa with the variant, as well as elsewhere, all existing vaccines show very good effects against severe disease and death.”
“Therefore, if we can achieve high coverage in the groups that are at high risk of dying if infected, the toll of the virus will be dramatically reduced, and we will be able to tolerate more cases while having fewer severe cases and deaths, and while returning our health-care systems to normal functions. The evidence so far does not make me think our ability to do that is fundamentally different because of the variants.” "
Source: https://www.washingtonpost.com/politics/2021/02/01/health-202-how-bad-are-these-coronavirus-variants-here-what-experts-say/
Commentary: I'm not sure of the models prolonging the pandemic into the fall. A lot will depend on whether the virus can evade vaccines; the new strains now are more infectious for the most part, which would speed up the progress towards herd immunity (at the cost of many more deaths). Given how many people I see on a day to day basis wearing masks incorrectly, I suspect the new federal mandates for mask usage will be a bit of a wash; the UK and Denmark have shown that even with strict lockdowns, the new strains spread much more effectively.
Hint: if you wear glasses and your glasses fog up when you're wearing a mask, it's not on right. A mask should be filtering the flow of air in and out of you. It should snugly fit over your nose and mouth - air escaping should be through the mask, not around it.
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The CDC issues a long-overdue order requiring masks on all public transportation. Private transportation (i.e. your car) is exempt. "The policy sets a minimum standard that all individuals using transportation–defined as any "conveyance" (ie. vehicle) directly operated by United States local, state, territorial, or tribal government authorities. Masks will also be required wear for any persons inside of transportation hubs defined as "any airport, bus terminal, marina, seaport or other port, subway station, terminal, ..., train station, U.S. port of entry, or any other location that provides transportation and is subject to the jurisdiction of the United States." People must wear a mask over their nose and mouth for the duration of travel or occupancy of a hub. States, localities, or tribal territories are exempt from the stipulations of the order, but only in cases where those jurisdictions have requirements that are at least as stringent."
Source: https://www.cdc.gov/quarantine/pdf/Mask-Order-CDC_GMTF_01-29-21-p.pdf
Source: https://brief19.com/2021/02/01/brief#national-mask-requirement-for-public-transit-goes-into-effect-tonight-cdcs-previous-guidance-now-a-mandate-1
Commentary: Long, long overdue. I'm glad to see the CDC under the new administration is using its powers under federal law to enforce public health measures.
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Pregnant mothers transfer antibodies to newborns. "In this cohort study, maternal IgG antibodies to SARS-CoV-2 were transferred across the placenta after asymptomatic as well as symptomatic infection during pregnancy. Cord blood antibody concentrations correlated with maternal antibody concentrations and with duration between onset of infection and delivery. Our findings demonstrate the potential for maternally derived SARS-CoV-2 specific antibodies to provide neonatal protection from coronavirus disease 2019."
Source: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2775945
Commentary: This is excellent news for anyone pregnant. If you're pregnant with COVID-19, your child may be born with some immunity transferred.
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A reminder of the simple daily habits we should all be taking.
1. Always wear the best mask available to you when out of your home and you'll be around other people. Respirators are back in stock at online retailers, too. Wear an N95/FFP2/KN95 or better mask if you can obtain it.
2. Get vaccinated as soon as you're able to.
3. Wash/sanitize your hands every time you are in or out of your home for any reason.
4. 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.
5. Get your personal finances in order now. Cut all unnecessary costs.
6. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
7. 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).
8. How to properly fit a mask:
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Common misinformation debunked!
There is no mercury or other heavy metals in the Pfizer mRNA vaccine. https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
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.