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 a qualified healthcare provider who knows your specific medical situation over advice from people on the Internet.
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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Merck treatment reduces risk of death by up to 50%. "Merck announced Friday that an experimental pill it developed to treat covid-19 reduced the risk of hospitalization and death by nearly half in a clinical trial.
An independent board of experts monitoring the trial recommended the study be stopped early because of the positive results, a significant and telling step in a pharmaceutical study.
Merck and partner Ridgeback Biotherapeutics said in a news release they would apply for emergency use authorization for the drug, molnupiravir, in the United States as soon as possible. It would be the first antiviral pill for covid-19.
A simple, easy-to-prescribe pill that prevents mild and moderate cases of covid-19, the illness caused by the coronavirus, from turning into dire episodes has been one of the missing pieces of the medical armamentarium to fight the virus.
Merck has already begun producing molnupiravir. The small brown capsules must be taken twice a day for five days. The company predicts it will make 10 million courses of treatment by the end of the year. The U.S. government made an advance purchase of 1.7 million treatment courses of the drug at a cost of $1.2 billion.
The biggest impact of the drug might be in the rest of the world, where vaccine availability is low and monoclonal antibody treatments may be impractical or unavailable. Merck has licensed its drug to five Indian generic drug manufacturers to speed up availability in low- and middle-income countries, many of which have had limited access to vaccines."
Source: https://www.washingtonpost.com/health/2021/10/01/pill-to-treat-covid/
Commentary: Between vaccines and drugs like this, we might be able to reduce COVID-19 to something that really is no more dangerous than influenza. When we reach that point, the pandemic will truly be over.
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Insights into hesitancy. "Two JAMA Network Open studies yesterday that looked at COVID-19 vaccine acceptance in minority groups and opinions around less-preferred vaccines provide clues for how officials might better encourage immunization.
The first study, involving 13 focus groups, reaffirmed a lack of communication and trust among racially and ethnically diverse communities in the United States.
The second study examined the effect of emphasizing different data around the Johnson & Johnson and AstraZeneca/Oxford COVID-19 vaccines: People were more interested in uptake when they were presented with the vaccines' effectiveness against death versus their effectiveness against symptomatic infection.
The researchers noted that gender and age also appeared to influence the connection between death prevention and vaccine intention. Women and those who were 35 to 54 years old scored 7% and 8% higher, respectively, in their likelihood of vaccination after receiving death prevention information compared with those of other age-groups (95% CIs, 0.04 to 0.11, P < 0.001; 0.04 to 0.12, P < 0.001, respectively).
When stratifying data by vaccine brand, age—but not gender—was significant for those evaluating AstraZeneca, the researchers note. No other subgroup differences were found when analyzing the relationship between receiving all possible VE information and vaccination likelihood.
"These results can inform public health communication strategies to reduce hesitancy toward specific COVID-19 vaccines," write the researchers. "Considering the importance of the Johnson & Johnson and AstraZeneca COVID-19 vaccines to global supply, identifying ways to mitigate hesitancy toward these specific vaccines is vitally important.""
Source: https://www.cidrap.umn.edu/news-perspective/2021/10/studies-provide-insights-covid-vaccine-hesitancy
Commentary: Messaging about avoiding illness didn't work nearly as well as messaging about preventing death.
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Why COVID data in the USA is so messy. "Multiple factors underlie this data deficit. First and foremost: The United States does not have a national health system such as Israel’s or Britain’s, and in a pandemic, U.S. authorities must rely on a vast and decentralized public health infrastructure that is notoriously underfunded and full of holes. As a result, there is no simple way to track infections or outcomes across the population.
Another obstacle to data aggregation may be the siloed computer systems and the self-interest of medical institutions. Some hospital systems want to hang onto their data, said Michael Kurilla, director of the division of clinical innovation at the National Institutes of Health’s National Center for Advancing Translational Sciences.
“They don’t necessarily want to give up all that data because they see that as a potential future revenue stream,” Kurilla said.
“We’re still operating on a largely 19th-century system,” Kurilla said. “Who exactly is to blame is really hard to point a finger at. There are systems where things are done on paper, some information is being faxed, so it’s being transcribed. There isn’t any way to seamlessly upload information.”"
Source: https://www.washingtonpost.com/health/2021/09/30/inadequate-us-data-pandemic-response/
Commentary: In general, I am in favor of free market solutions. In general, I am in favor of less government intervention over more. However, in cases like wartime and national emergencies - like a pandemic - the government has a responsibility to its people to override normal operating conditions and require institutions - and certainly any that receive any amount of taxpayer funding - to do what's necessary to bring the emergency to an end. The data crisis in healthcare is a potentially life-saving solution that is currently out of reach - but it doesn't have to be.
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Denmark is attempting to transition out of the pandemic. "Life in Denmark now feels so much like it did before the pandemic that it can put visitors on edge, says Lone Simonsen, an epidemiologist at Roskilde University. The country lifted all of its remaining coronavirus restrictions on 10 September. Copenhagen clubs are buzzing, music lovers flock to festivals, and buses are packed with unmasked commuters. The government has given up its power to close schools and shut down the country. “When we have guests now, they feel uncomfortable about how normal everything is,” Simonsen says.
Denmark is a pioneer. As the second coronavirus winter approaches in the Northern Hemisphere, Denmark and a few other countries where vaccines now protect a large percentage of the population from severe disease are entering a momentous transition: from pandemic to endemic COVID-19, when the virus is still there but ceases to be an overriding public health threat. Researchers are closely watching what happens next, because it could yield valuable information about what lies ahead for the rest of the world.
There are many unknowns: how best to manage the transition out of the public health crisis, how it might go wrong, and exactly what endemicity will look like once it arrives. “Going into a pandemic is hard enough, coming out of it is even harder,” says Jeremy Farrar, an infectious disease researcher who leads the Wellcome Trust. “We don’t just go from a no-vaccine state and horror to a status quo. There’s a transition phase, and I think that will be this winter.”
Denmark has fully vaccinated more than 88% of people older than 18 and an astonishing 97% of those over age 60, the group most vulnerable to serious COVID-19. That allows the country to try to treat SARS-CoV-2 like influenza and other infectious diseases instead of a threat to the entire health system. “We’re thinking of this virus now as a sort of defanged version of the original one. It has gotten its teeth pulled out by the vaccine,” Simonsen says. “What’s left is not much worse than diseases that we’re used to and that we don’t close schools for, like seasonal flu or maybe the 2009 influenza pandemic.”"
Source: https://www.science.org/content/article/will-pandemic-fade-ordinary-disease-flu-world-watching-denmark-clues
Commentary: With vaccination rates that high, Denmark is well positioned to be testing this experiment. In a country like the USA, it would be disastrous.
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More data that Pfizer in particular may wane in some protections after 6 months. "The development of the highly efficacious mRNA vaccines in less than a year since the emergence of SARS-CoV-2 represents a landmark in vaccinology. However, reports of waning vaccine efficacy, coupled with the emergence of variants of concern that are resistant to antibody neutralization, have raised concerns about the potential lack of durability of immunity to vaccination. We recently reported findings from a comprehensive analysis of innate and adaptive immune responses in 56 healthy volunteers who received two doses of the BNT162b2 vaccination. Here, we analyzed antibody responses to the homologous Wu strain as well as several variants of concern, including the emerging Mu (B.1.621) variant, and T cell responses in a subset of these volunteers at six months (day 210 post-primary vaccination) after the second dose. Our data demonstrate a substantial waning of antibody responses and T cell immunity to SARS-CoV-2 and its variants, at 6 months following the second immunization with the BNT162b2 vaccine. Notably, a significant proportion of vaccinees have neutralizing titers below the detection limit, and suggest a 3rd booster immunization might be warranted to enhance the antibody titers and T cell responses."
Source: https://www.biorxiv.org/content/10.1101/2021.09.30.462488v1
Commentary: What's important to remember here is that we have two memory cell types in our immune system - T cell and B cell. Waning effectiveness in one kind does not necessarily mean waning effectiveness in both, but it does imply that after a period of time, vaccinated people may be able to spread COVID-19 more easily.
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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 people you don't live with, 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. Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
3. 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 getting an mRNA single shot booster (Pfizer/Moderna) if permitted.
4. Wash/sanitize your hands every time you are in or out of your home.
5. Stay out of indoor spaces that aren't your home and away from people you don't live with 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.
6. Aim to have 3-6 months of living expenses on hand in case the pandemic gives another crazy plot twist to the economy.
7. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
8. 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).
9. Masks must fit properly to work. Here's how to properly fit a mask:
10. If you think you may have been exposed to COVID-19, purchase a rapid antigen test. This will detect COVID-19 only when you're contagious, so follow the directions clearly. https://amzn.to/3fLAoor
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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
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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.
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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.