Lunchtime pandemic reading.
Standard disclaimer: this is a roundup of informative pieces I've read that interest me on the severity of the crises and how to manage them. 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.
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Long COVID is the next big emergency. "Long COVID is a multifaceted condition that can follow SARS-CoV-2 (COVID-19) infection and affects the neurologic, cardiovascular, pulmonary, hematologic and endocrine systems, leading to anything from mild to debilitating disease. From a public health perspective, the effects of long COVID are massive; a recent review published in Nature estimated that at least 65 million people worldwide have already experienced it.
In August 2022, the Brookings Institution estimated that Long COVID is keeping the equivalent of two million to four million full-time workers out of the American labor force, resulting in about $170 billion of lost earnings per year. Economist David Cutler drew similar conclusions and, moreover, estimated the U.S. health costs of long COVID to be on the order of $100 billion per year. These combined estimates imply a real cost of more than $1 trillion over a five-year period, even before accounting for lost quality of life, increased disability costs and the burden on caregivers and the health care system. In our roles observing the health and economic toll of long COVID, these accumulating effects are breathtaking and extremely concerning.
And yet, unlike our earliest responses to acute COVID, there is no “Operation Warp Speed” for long COVID.
Because each new COVID infection carries with it the potential to lead to long COVID, the best way to avoid it is to avoid getting infected with COVID in the first place. However, we have largely abandoned societywide measures to prevent disease transmission, making infections difficult to avoid. This means we are forced to fall back on preventing and treating long COVID—but at this point, we can’t. Even as caseloads and the suffering of the people who care for those with long COVID continue to mount, science around this aspect of disease lacks transformative investment and activity.
The resources mustered by federal agencies, private companies and philanthropists to combat long COVID pale in comparison to those dedicated to the development of acute COVID vaccines, tests and treatments. To gain perspective, we searched the NIH’s research repository using the terms “Long COVID,” “Post-acute sequelae of SARS-CoV-2,” “PACS,” “Post-COVID syndrome,” or “Long haul” (access date March 23, 2023). We found $740.8 million of federal funding for long COVID studies across 218 projects, most of which ($509 million) was allocated in 2021. This reflects only 6% percent of the $11.6 billion in funding and only 2.7 percent of the 8,042 projects dedicated to COVID research overall. Compared to 2021, the percentage of funds devoted to studying long COVID in 2022 was cut by nearly half (from 11 percent to 6 percent)—representing an even bigger drop than it might seem because total COVID research funding decreased over that time period as well."
Source: https://www.scientificamerican.com/article/we-need-an-operation-warp-speed-for-long-covid/
Commentary: The ugly truth is that we've basically given up on COVID and are treating it like the flu. Except that it's not the flu, it's a different creature that requires different mitigation strategies. If we don't develop new treatments, effective treatments for long COVID, we will have an ever-increasingly heavy anchor tied to our ankles as more people contract it.
"The World Health Organization (WHO) is monitoring a new COVID-19 subvariant called XBB.1.16, which has been circulating throughout India for a few months and is causing a new surge of cases there. The Times of India reported on Apr. 3 that more than 3,600 new COVID cases had been recorded in the country since the previous day, marking India’s largest single-day jump in case numbers in more than six months. “In India, XBB.1.16 has replaced the other variants that are in circulation,” said Maria Van Kerkhove, WHO’s COVID-19 technical lead, during a Mar. 29 press conference. “So this is one to watch.”
XBB.1.16 is one of more than 600 Omicron subvariants that are currently circulating, according to WHO. It’s similar to the XBB.1.5 variant that has dominated the U.S. throughout 2023 but is distinguished by a mutation in the spike protein that “may give it some additional growth advantages,” says Dr. Peter Hotez, co-director of the Texas Children’s Hospital Center for Vaccine Development. In lab studies, this additional mutation “shows increased infectivity, as well as potential increased pathogenicity,” Van Kerkhove said. “It has potential changes that we need to keep a good eye out on.”
So far, XBB.1.16 has been found primarily in India and Nepal, where at least 10 cases were confirmed on Apr. 3. But, as we’ve seen with past variants, things can change quickly, Hotez says. Take XBB.1.5, which accounted for less than a quarter of COVID-19 cases in the U.S. going into late December last year. “Over the ensuing week, XBB.1.5 became the dominant variant,” says Hotez. If the new variant reaches the U.S., “the question is whether XBB.1.16 is going to do the same, or whether the two are [closely related] enough.”"
Source: https://time.com/6268467/omicron-subvariant-xbb116-covid-19/
Commentary: What's become apparent so far is that COVID variants don't seem to get more dangerous from a pathogenicity perspective, but they keep getting better and better at spreading. This makes logical sense; all organisms adapt to survive, and COVID is no exception. Keep up with your booster schedule based on your level of risk, and wear a mask in indoor places that aren't your own.
The optimal boosting interval appears to be quarterly. "While the rapid deployment of SARS-CoV-2 vaccines had a significant impact on the ongoing COVID-19 pandemic, rapid viral immune evasion and waning neutralizing antibody titers have degraded vaccine efficacy. Nevertheless, vaccine manufacturers and public health authorities have a number of levers at their disposal to maximize the benefits of vaccination. Here, we use an agent-based modeling framework coupled with the outputs of a population pharmacokinetic model to examine the impact of boosting frequency and durability of vaccinal response on vaccine efficacy. Our work suggests that repeated dosing at frequent intervals (multiple times a year) may offset the degradation of vaccine efficacy, preserving their utility in managing the ongoing pandemic. Our work relies on assumptions about antibody accumulation and the tolerability of repeated vaccine doses. Given the practical significance of potential improvements in vaccinal utility, clinical research to better understand the effects of repeated vaccination would be highly impactful. These findings are particularly relevant as public health authorities worldwide seek to reduce the frequency of boosters to once a year or less. Our work suggests practical recommendations for vaccine manufacturers and public health authorities and draws attention to the possibility that better outcomes for SARS-CoV-2 public health remain within reach."
Source: https://www.medrxiv.org/content/10.1101/2023.01.26.23285076v1.full
Commentary: Obviously, talk to your healthcare provider about what the best schedule is for you, but as a layperson unqualified to give medical advice of any kind, but who can read data and statistics, there's basically an inverse relationship between masking and boosting. The more you mask, the less frequently you probably need to boost - but annually seems to be the bare minimum. The less you mask, the more often you should boost.
A reminder of the simple daily habits we should all be taking.
Wear the best mask available to you when you'll be around people you don't live with, even after you've been vaccinated. P100 respirators are back in stock at online retailers, too and start around US$40 for a reusable respirator. 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.
Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
Get vaccinated as soon as you're eligible to, and fulfill the full vaccine regimen, including boosters. Remember that you are not vaccinated until everyone you live with is vaccinated. There are new vaccines available now in addition to the boosters we already know that may be more efficacious and tolerated better, so talk to your healthcare provider about which vaccine or booster is the best choice for you.
Wash/sanitize your hands every time you are in or out of your home. Sanitize the bottom of your shoes with a simple peroxide spray using ordinary drugstore/supermarket peroxide in a spray bottle. If you've come in close contact with others (rubbing or brushing up against them, hugging, etc.) consider showering and washing your clothes as well.
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 disease through aerosols and distance is less effective at mitigating your risks.
Aim to have 3-6 months of living expenses on hand in case the pandemics give another crazy plot twist to the economy, or you know, a global war breaks out.
Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
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).
Masks must fit properly to work. Here's how to properly fit a mask:
If you think you may have been exposed to COVID, purchase several rapid antigen tests and/or acquire them from your healthcare provider or government. This will detect COVID only when you're contagious, so follow the directions clearly. https://amzn.to/3fLAoor
If you think you may have been exposed to monkeypox, contact your healthcare provider about available testing.
Common misinformation debunked!
There is no basis in fact that COVID 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 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 arrived before 2020 in the United States and therefore no hidden herd immunity:
Source:
https://twitter.com/trvrb/status/1249414291297464321
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 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 or other communicable diseases. 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 or other communicable diseases, nor do I financially benefit in any way from sharing information about COVID or other communicable diseases.
I am not a qualified healthcare provider and I do not provide medical advice. Only take medical advice from your qualified healthcare provider who knows your specific details and can provide customized recommendations for you.
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
if you prefer the update in your inbox.