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.
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My one and only non-COVID piece. If you haven't watched this piece with Trevor Noah (host of the Daily Show) yet, please do so in its entirety. It's worth your time.
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From this weekend, Dr. Scott Gottlieb: "Black Americans and Hispanic and Latino Americans have been disproportionately impacted by COVID. I think it's a symptom of broader racial inequities in our country that we need to work to resolve it really you have to look at it across two dimensions, the first wire the higher rates of COVID among these communities. And second, when people in these communities do get COVID disease, why are they dying at a higher rate and the first has to do with a lot of issues of socio economic factors, low income, issues related to overcrowded housing where people work the fact that they have to take crowded Transportation, that they work in essential jobs that they've had to continue to work and didn't have good PP at work. We've seen black communities and Hispanic and Latino communities disproportionately in these kinds of circumstances. The second has to do with poor access to health care, mistrusted a health care system, some discrimination in health care. And also back to the first factors the the economic factors, you see a higher burden of chronic disease in black communities and Hispanic communities in this country, often related to income inequities. And stopping the pandemic is going to depend on our ability to take care of our most medically and socially vulnerable, we absolutely need to resolve these underlying problems to eliminate the risk of pandemic spreading of the epidemic.
As it's taking resources and trying to get it into communities that you know, being disproportionately impacted by the disease, you think of people from communities that that are disadvantaged, they already lack access to health care, they lack access to testing. So they're not only at higher risk, they don't have the same health care opportunities. And so you try to bring the testing into those communities into work sites. The other thing we need to do is make sure that COVID doesn't become punitive that having a diagnosis of COVID disease doesn't mean you lose your job, you lose your wages. And so we need to support people through the illness, we need to encourage them to get tested and self identify. And so you really need to focus the resources on the medically vulnerable communities where this virus is going to spread more actively. So it's not just, you know, black and Hispanic communities, it's also institutions like nursing home places with those vulnerable Americans, but you need to be focusing the resources on those settings."
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Stopping the pandemic means eliminating reservoirs of the disease. When you have huge concentrations - farm workers, warehouse workers, etc. - the disease will continue to spread. Dr. Gottlieb says we're testing about 500,000 people a day - but are they the people at the center of potential chains of transmission, like agricultural workers? If not, we need to reallocate those tests to rooting out the disease. A person like me who sits in their home office and only once a week goes to the grocery store doesn't need to be tested first. A person who sits elbow to elbow with a hundred other people needs that test first.
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On the impact of protests and COVID-19 spread. "But others were more concerned about the risk posed by the marches. Dr. Howard Markel, a medical historian who studies pandemics, likened the protest crowds to the bond parades held in American cities like Philadelphia and Detroit in the midst of the 1918 influenza pandemic, which were often followed by spikes in influenza cases.
“Yes, the protests are outside, but they are all really close to each other, and in those cases, being outside doesn’t protect you nearly as much,” Dr. Markel said. “Public gatherings are public gatherings — it doesn’t matter what you’re protesting or cheering. That’s one reason we’re not having large baseball games and may not have college football this fall.”
Though many protesters were wearing masks, others were not. SARS-CoV-2, the virus that causes the Covid-19 disease, is mainly transmitted through respiratory droplets spread when people talk, cough or sneeze; screaming and shouting slogans during a protest can accelerate the spread, Dr. Markel said.
Tear gas and pepper spray, which police have used to disperse crowds, cause people to tear up and cough, and increase respiratory secretions from the eyes, nose and mouth, further enhancing the possibility of transmission. Police efforts to move crowds through tight urban areas can result in corralling people closer together, or end up penning people into tight spaces.
Arresting, transporting or jailing protesters increases the potential for spreading the virus."
Source: https://www.nytimes.com/2020/05/31/health/protests-coronavirus.html
If you look at the global stats on dashboards like the COVID-19 dashboard from JHU, you'll see that after two months of flat cases, in May we began ticking upwards. Expect that trend to continue.
Source: https://coronavirus.jhu.edu/map.html
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Via Dr. Eric Ding, isopropyl alcohol has tripled in price.
Source:
If you're unable to get hold of alcohol for hand sanitization, you can use ethanol as well, as long as it's a 61% concentration or stronger. In terms of cost and efficacy, hydrogen peroxide is also good at concentrations of 0.5% or greater; standard drug store peroxide is a 3% solution.
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Dr. Fauci on the progress of vaccine efforts. "What I like about the whole thing is that there are multiple candidates that we’re involved with. It just feels good to be directly or indirectly involved in four or five candidates, to do it in a way that I refer to as sort of harmonized, where you come to an agreement, which we did, that we’re going to do things where the trial protocols will be quite similar, where the laboratory tests that we’re going to ask for are going to be quite similar, so that you can extrapolate results from one study to another.
Now, why is that important? If one vaccine proves efficacy in a clinical trial and another vaccine is behind it but it’s getting the same correlate of immunity you could bridge data and facilitate the approval of the second and the third one based on the efficacy of the first one.
So when you design a clinical trial, there are a certain number of events that will give you a definitive answer as to whether or not your vaccine is effective. That is set in stone. So we’re not going to declare efficacy or even begin to think about efficacy or not until we reach that predetermine statistically sound number of infections that either occurred and/or were prevented. I mean, whether we do the trial over 10 years, or we do it over four months, the endpoint is still the same. It’s certainly statistically significant difference. So I don’t worry about that.
On durability, you’re absolutely correct. We’re not going to know what the durability is. But we’re going to have to live with that. The first thing we’re interested in is: If we vaccinate you in the late summer, early fall, are you protected through that fall, that winter and then going into the spring? If the answer is yes, wonderful. Then we’ll worry about durability."
Source: https://www.statnews.com/2020/06/01/anthony-fauci-on-covid-19-reopenings-vaccines-and-moving-at-warp-speed/
Glad to hear that companies are not cutting corners on the requirements for clinical trials.
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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.
2. Wear gloves and a mask when out of your home. Consider wearing a face shield.
3. Stay home as much as possible. Minimize your contact with others and maintain physical distance of at LEAST 6 feet / 2 meters. Avoid indoor places as much as you can.
4. Get your personal finances in order now. Cut all unnecessary costs.
5. Donate any PPE you can. https://getusppe.org/give/
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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.