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.
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At current trend, the world just crossed 1.5 million dead; the United States will cross 300,000 deaths within days.
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The EU issues more stimulus. "The European Central Bank administered another dose of stimulus to the eurozone economy on Thursday, a sign that policymakers expect the impact of the pandemic to linger even as the rollout of vaccines begins.
The bank’s Governing Council, which met on Wednesday and Thursday, said it would increase pandemic-related bond buying — essentially a money-printing program — by 500 million euros, to a total of €1.85 trillion euros, or $2.2 trillion. The central bank also extended by a year an initiative that allows commercial banks to borrow money at negative interest rates, provided the banks pass the credit on to their customers."
Source: https://www.nytimes.com/live/2020/12/10/business/us-economy-coronavirus#european-central-bank-increases-stimulus-to-eurozone-economy
Commentary: This is excellent news for the EU as the region tries to keep its economy moving ahead. Unlike the United States, the EU's member states have been taking extraordinary measures for the last 9 months to keep citizens safe, including measures like isolation wards in hotels and paying people to remain quarantined.
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Pfizer's vaccine data has passed peer review. "We are publishing today in the Journal the results of a phase 3, double-blind, randomized, controlled trial of a new RNA vaccine.1 In this trial, 21,720 participants received BNT162b2 and 21,728 received placebo. Both groups received two injections spaced 21 days apart. Persons with obesity or other coexisting conditions were well represented, and more than 40% of participants were older than 55 years of age. Participants notified trial sites if they had symptoms that were consistent with Covid-19, and they were tested to diagnose infection. They recorded in daily diaries any adverse events they were experiencing. The primary outcomes were safety and the incidence of symptomatic Covid-19 with onset occurring at least a week after the second dose of vaccine or placebo, although all symptomatic infections are reported. The findings in this report include the first 170 cases of Covid-19 detected in the primary population and cover a median of 2 months of safety data. The investigators plan to continue to follow the participants, although once the vaccine becomes freely available, maintaining randomization may be a challenge.
The results were impressive. In the primary analysis, only 8 cases of Covid-19 were seen in the vaccine group, as compared with 162 in the placebo group, for an overall efficacy of 95% (with a 95% credible interval of 90.3 to 97.6%). Although the trial does not have the statistical power to assess subgroups, efficacy appeared to be similar in low-risk and high-risk persons, including some from communities that have been disproportionately affected by disease, and in participants older than 55 years of age and those younger than 55. Adverse events were largely consistent with vaccine reactogenicity, with mostly transient and mild local reactions such as injection-site pain and erythema; systemic reactions such as fever, fatigue, and adenopathy were uncommon. This pattern appears to be similar to that of other viral vaccines and, at least with this number of participants and this follow-up period, does not arouse specific concern.
The logistic challenges of manufacturing and delivering a vaccine remain daunting. This vaccine, in particular, requires storage at −70°C, a factor that may limit its deployment in some areas. Nevertheless, the remarkable level of safety and efficacy the vaccine has demonstrated thus far make this a problem that we should welcome solving. What appears to be a dramatic success for vaccination holds the promise of saving uncounted lives and giving us a pathway out of what has been a global disaster."
Source: https://www.nejm.org/doi/full/10.1056/NEJMe2034717
Commentary: One of the early - and valid - criticisms of the various vaccine candidates was that news releases were how the data was communicated to the public. While that's not a practice that should be encouraged, at least in this case it all worked out - the vaccine is solid.
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First evidence that COVID-19 was spreading earlier than known.
"Coronavirus disease (COVID-19) symptoms can encompass a Kawasaki disease–like multisystem inflammatory syndrome and skin manifestations that accompany common viral infections such as chickenpox and measles (1,2). Some of the earliest reports of COVID-19 cutaneous manifestations came from dermatologists in Italy. In fact, Italy was the first Western country severely hit by the COVID-19 epidemic. The first known COVID-19 case in Italy was reported in the town of Codogno in the Lombardy region on February 21, 2020. However, some evidence suggests that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had been circulating unnoticed for several weeks in Lombardy before the first official detection (3). Phylogenetic studies highlighted an early circulation of SARS-CoV-2 in Italy and suggest multiple introductions of the virus from China and Germany, followed by an autochthonous transmission (4,5). Furthermore, environmental surveillance has unequivocally demonstrated the presence of the virus, at concentrations comparable to those obtained from samples collected at later stages of the pandemic, in the untreated wastewater of the Milan area as early as mid-December 2019 (6).
We describe the earliest evidence of SARS-CoV-2 RNA in a patient in Italy, ≈3 months before Italy’s first reported COVID-19 case. These findings, in agreement with other evidence of early COVID-19 spread in Europe, advance the beginning of the outbreak to late autumn 2019 (6,8–10). However, earlier strains also might have been occasionally imported to Italy and other countries in Europe during this period, manifesting with sporadic cases or small self-limiting clusters. These importations could have been different from the strain that became widespread in Italy during the first months of 2020. Unfortunately, the swab specimen, which was collected for measles diagnosis, was not optimal for SARS-CoV-2 detection because it was an oropharyngeal rather than a nasopharyngeal swab specimen and it was collected 14 days after the onset of symptoms, when viral shedding is reduced. In addition, thawing might have partially degraded the RNA, preventing the sequencing of longer genomic regions that could have been helpful in determining the origin of the strain.
This finding is of epidemiologic importance because it expands our knowledge on timing and mapping of the SARS-CoV-2 transmission pathways. Long-term, unrecognized spread of SARS-CoV-2 in northern Italy would help explain, at least in part, the devastating impact and rapid course of the first wave of COVID-19 in Lombardy. Full exploitation of existing virologic surveillance systems to promptly identify emerging pathogens is therefore a priority to more precisely clarify the course of outbreaks in a population. Further studies aimed at detecting SARS-CoV-2 RNA in archived samples suitable for whole-genome sequencing will be crucial at determining exactly the timeline of the COVID-19 epidemic in Italy and will be helpful for the preparedness against future epidemics."
Source: https://wwwnc.cdc.gov/eid/article/27/2/20-4632_article
Commentary: There has been a lot of discussion (and more than a few unbaked, unhinged conspiracy theories) that SARS-CoV-2 existed and was spreading before detection in late December/early January 2020. Until now, no evidence existed that confirmed speculation. This is the first clinical evidence that the disease had been spreading before it had been detected.
It will be interesting to see how sites like Nextstrain incorporate this data, as well as whether it affects our known maps of the virus genome. This is a really big deal - and to the extent we can find other evidence, we should be looking for it.
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More on the Abbott fast test. "Testing and subsequent isolation and contact tracing is crucial for the global efforts to halt the ongoing SARS-CoV-2 pandemic. Rapid diagnostic tests have the potential to benefit testing strategies as they have short turnaround times, are cheap, and can be used in decentralized testing. Their potential hinges on their diagnostic performance, which has not been sufficiently determined to date. Our findings show that the Panbio™ COVID-19 Ag rapid test reliably identifies SARS-CoV-2 infected individuals with high viral load in nasopharyngeal samples, in a cohort of community-dwelling subjects with mild symptoms of respiratory tract infection. Specificity of this test was 100%. Although the sensitivity is lower than the RT-qPCR, false negative rapid test results were all due to low viral loads in nasopharyngeal samples.
Due to the lower sensitivity of the Panbio™ COVID-19 Ag rapid test, RT-qPCR would be the preferred diagnostic test of choice for clinical purposes in a hospital setting. However, for surveillance of SARS-CoV-2 within the community, this rapid antigen test reliably and rapidly identifies individuals with high potential of further transmission, and could therefore be an essential new tool in our testing strategies to control transmission of SARS-CoV-2."
Source: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30421-1/fulltext
Commentary: The cheap Abbott test ($5-$7) is less sensitive than the RT-PCR tests. It misses more infections. But in terms of being able to find pockets of disease, it would be a powerful tool to deploy in any population. Unfortunately, some locales - like the United States - have not authorized its use, which is crippling our disaster response. Knowing where the hotspots are with greater reliability is vital, and as a population-level sampling tool, the Abbott test needs to be authorized and pressed into service as quickly as possible for any nation where testing is falling short of goals.
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On economics. "“The rich get richer” doesn’t even begin to truly capture what’s been happening across the United States during the coronavirus pandemic.
According to Americans for Tax Fairness and the Institute for Policy Studies, the 651 U.S. billionaires have seen their collective wealth grow by more than $1 trillion over the past nine months, while the less fortunate struggle to keep their jobs and put food on the table.
If the ultra-rich were to share their “pandemic profits,” research shows, they could give everybody in the country a one-time $3,000 stimulus check and still be wealthier than they were back in March.
“As tens of millions of Americans suffer from the health and economic ravages of this pandemic, a few hundred billionaires add to their massive fortunes,” ATF’s Frank Clemente said in a statement. “Their pandemic profits are so immense that America’s billionaires could pay for a major COVID relief bill and still not lose a dime of their pre-virus riches.”
At this point, the exploding net worth of the billionaires has surpassed $4 trillion, in total — that’s almost double the combined wealth of the bottom half of the U.S. population."
Source: https://www.marketwatch.com/story/heres-the-case-for-elon-musk-warren-buffet-and-the-rest-of-americas-billionaires-sending-3-000-stimulus-checks-to-everybody-11607613932
Commentary: Income inequality has been in the spotlight since the pandemic began, but seeing these results (and in an otherwise moderately conservative publication like Marketwatch) is eye-opening. The irony is that given where people are spending their money, the mega-rich would not only not lose money by cutting everyone a $3,000 check, they'd likely just get the majority of it back again in a few months.
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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 or injected. If you come in physical contact with others, wash your clothing upon returning home.
2. Always wear a mask when out of your home and if going to a high-risk area, wear goggles. Respirators are back in stock at online retailers, too. When going indoors to a place that isn't your home, wear the best protective mask available to you.
3. 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.
4. Get your personal finances in order now. Cut all unnecessary costs.
5. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
6. 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).
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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.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.