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.
---
2021 is half over. In contrast to 2020, where every day felt like March 1 for months, it feels like this year is flying by.
---
"Understanding the effects of the COVID-19 pandemic on the population means knowing more than just the total number of infections and deaths. As with many diseases, after the acute infection has passed, a constellation of symptoms known as sequelae can still linger. And while the end of the pandemic is finally coming into view, we’re still in the early stages of comprehending post-acute sequelae of SARS-CoV-2 infection, also referred to as “PASC” or “long COVID.”
But COVID is far from the only infectious disease to result in long-term symptoms. Understanding this newly identified chronic illness and its associated symptoms could be guided by, and inform our knowledge of, other instances of post-infectious sequelae.
There are myriad ways that infectious agents — viruses, bacteria, parasites, fungi and prions — can do long-term damage to the host, directly or indirectly. For instance, damage from the initial infection may cause a cascade of host responses that result in pathology even after the acute infection has resolved. This is sometimes referred to as a “hit-and-run” mechanism of disease, as the infectious agent is often gone by the time any post-infectious damage appears. Alternatively, microbes can infect us and then linger in our bodies for months or years as either a persistent active infection or a persistent nonreplicating (latent) infection. These infections can cause long-term damage via several different means, including inducing inflammation that leads to tissue destruction, or reactivation of a latent pathogen that begins reproducing again in times of stress.
We are still working to develop a specific case definition of PASC, but most studies describe patients with symptoms including fatigue, headaches, joint pain, muscle aches and shortness of breath lasting months or longer after resolution of the acute infection. Some patients also seem to have long-term damage to the heart, lungs or other organs, which can lead to cognitive issues such as “brain fog,” depression, anxiety and issues with sleep. Up to one-third of COVID patients may still suffer from symptoms months after their initial infection, even if their symptoms were mild.
Currently there are numerous competing theories for how the SARS-CoV-2 virus may cause long-term symptoms. PASC may be a hit-and-run infection, potentially triggering inflammation that could do damage, or it could cause direct damage to tissues due to replication of the virus in targeted organs. It’s possible the virus may linger in reservoirs within the body, but there has been no prior documentation of persistent infection of the host by human coronaviruses, so this remains unproven."
Source: https://www.quantamagazine.org/long-covid-how-it-keeps-us-sick-20210701/
Commentary: We've got a long way to go for understanding what COVID will do to us down the road, but it's already abundantly clear you don't want to get it if you can avoid it. Keep those masks on, and keep pushing for vaccination of everyone you know.
---
WHO says keep those masks on. "The World Health Organization is urging people to continue wearing a mask and social distancing—even if they are fully vaccinated against COVID—amid the spread of a concerning new variant and high levels of community transmission in many places. While most COVID vaccines are thought to largely protect against all known variants, none is 100 percent effective.
The WHO also advises vaccinated people to keep taking precautions such as staying in well-ventilated areas and avoiding crowds. “This still continues to be extremely important, even if you are vaccinated, when you have a community transmission ongoing,” said Mariângela Simão, the WHO’s assistant director general of access to medicines and health products, in a recent news briefing.
“What we’re saying is once you’ve been fully vaccinated, continue to play it safe because you could end up as part of a transmission chain,” added Bruce Aylward, senior advisor on organizational change to the WHO’s director general.
The CDC’s guidance that vaccinated people do not need to wear a mask or socially distance in most situations was issued in mid-May, before the highly transmissible Delta variant was widely circulating in the U.S. That variant, which was first identified in India, is thought to be 40 to 60 percent more contagious than the previously dominant Alpha variant, and it poses a risk to unvaccinated and partially vaccinated people. “Breakthrough” infections in fully vaccinated people can occur, though they are rare and usually less severe."
Source: https://www.scientificamerican.com/article/who-urges-vaccinated-people-to-wear-masks-cdc-still-says-no-need/
Commentary: With Delta now the dominant strain in many places, it doesn't hurt to keep your mask on, regardless of vaccination status but especially if you are or live with someone who is at higher risk, like an unvaccinated child.
---
Long COVID motivates vaccination. "Long-hauler stories prompt greater concern among 64% of Americans. After learning more about long COVID, particularly from people suffering from it, about 40% of unvaccinated people say they likely will consider getting the COVID-19 vaccine, including nearly a third of people who are vaccine hesitant."
Source: https://preventepidemics.org/wp-content/uploads/2021/06/Report_Long_COVID_Survey.pdf
Commentary: The odds of dying from COVID-19 remain relatively low; people believe that 1 in 100 chances are apparently pretty good odds. 1 in 3? That's a number you can wrap your brain around. If you're sitting around a table with 4 people, 1 of those people is likely to suffer from long COVID if everyone gets COVID-19. 1 in 3 odds is twice as bad as Russian roulette.
---
Unvaccinated people hit hard. "Vaccinated people are safer than ever despite the variants. But unvaccinated people are in more danger than ever because of the variants. Even though they’ll gain some protection from the immunity of others, they also tend to cluster socially and geographically, seeding outbreaks even within highly vaccinated communities.
The U.K., where half the population is fully vaccinated, “can be a cautionary tale,” Hanage told me. Since Delta’s ascendancy, the country’s cases have increased sixfold. Long-COVID cases will likely follow. Hospitalizations have almost doubled. That’s not a sign that the vaccines are failing. It is a sign that even highly vaccinated countries host plenty of vulnerable people.
Delta’s presence doesn’t mean that unvaccinated people are doomed. When Alpha came to dominate continental Europe, many countries decided not to loosen their restrictions, and the variant didn’t trigger a huge jump in cases. “We do have agency,” Hodcroft said. “The variants make our lives harder, but they don’t dictate everything.”
In the U.S., most states have already fully reopened. Delta is spreading more quickly in counties with lower vaccination rates, whose immunological vulnerability reflects social vulnerability. Black and Hispanic Americans are among the most likely groups to die of COVID-19 but the least likely to be vaccinated. Immunocompromised people may not benefit from the shots. Children under 12 are still ineligible. And unlike in many other wealthy countries, the pace of vaccinations in America is stalling because of lack of access, uncertainty, and distrust. To date, 15 states, most of which are in the South, have yet to fully vaccinate half their adults. “Watch the South in the summer,” Hanage said. “That’ll give us a flavor of what we’re likely to see in the fall and winter.”"
Source: https://www.theatlantic.com/health/archive/2021/07/3-principles-now-define-pandemic/619336/
Commentary: This pandemic is splitting into two different events - the world for the vaccinated, and the world for the unvaccinated. With Delta's increasingly strong capabilities (and subsequent variants that evolve from it), expect conditions to worsen for the unvaccinated, especially those who don't observe other precautions.
---
A reminder of the simple daily habits we should all be taking.
1. Wear the best mask available to you when you'll be around other people, even after you've been vaccinated. Respirators are back in stock at online retailers, too. Wear an N95/FFP2/KN95 that's NIOSH-approved or better mask if you can obtain it. If you can't get an N95 mask, wear a surgical mask with a cloth mask over it.
2. Get vaccinated as soon as you're able to, and fulfill the full vaccine regimen. Remember that you are not vaccinated until everyone you live with is vaccinated. If you received an adenovirus vaccine (J&J/AstraZeneca), consider gettings an mRNA single shot booster (Pfizer/Moderna).
3. Wash/sanitize your hands every time you are in or out of your home.
4. Stay home as much as practical. Minimize your contact with others and 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. Masks must fit properly to work. Here's how to properly fit a mask:
---
Common misinformation debunked!
There is no basis in fact that COVID-19 vaccines can shed or otherwise harm people around you.
Source: https://www.reuters.com/article/factcheck-covid19vaccine-reproductivepro-idUSL1N2MG256
There is no mercury or other heavy metals in the Pfizer mRNA vaccine.
Source: https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
There is no basis in fact that COVID-19 vaccines pose additional risks to pregnant women.
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2104983
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/
Source: https://www.smh.com.au/national/are-we-ignoring-the-hard-truths-about-the-most-likely-cause-of-covid-19-20210601-p57x4r.html
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
---
Disclosures and Disclaimers
I declare no competing interests on anything I share related to COVID-19. I am employed by and am a co-owner in TrustInsights.ai, an analytics and management consulting firm. I have no clients and no business interests in anything related to COVID-19, nor do I financially benefit in any way from sharing information about COVID-19.
---
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.