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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In the USA, 16-17 year olds can now get Pfizer boosters. "The Food and Drug Administration on Thursday expanded the emergency use authorization for Pfizer and BioNTech’s Covid-19 booster shot to cover 16- and 17-year-olds, making it the only booster shot currently available in the United States for teenagers in this age group.
Within hours, Rochelle Walensky, director of the Centers for Disease Control and Prevention, signed off on the expanded authorization, clearing the way for 16- and 17-year olds to book booster shot appointments.
“Today, CDC is strengthening its booster recommendations and encouraging everyone 16 and older to receive a booster shot,” Walensky said in a statement. “We know that Covid-19 vaccines are safe and effective, and I strongly encourage adolescents ages 16 and 17 to get their booster if they are at least 6 months post their initial Pfizer vaccination series.”"
Source: https://www.statnews.com/2021/12/09/fda-expands-authorization-for-pfizers-covid-19-booster-to-cover-16-and-17-year-olds/
Commentary: Do it. If you or your child is eligible, do it. You will need all the ammunition you can against the coming Omicron wave.
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Omicron presenting in the triple-vaxxed. "Based on its genetic profile and preliminary in vitro and epidemiological data, the recently emerged SARS-CoV-2 Omicron variant is predicted to evade immune responses to some extent. We report a cluster of Omicron variant infections in individuals who had received full primary vaccination series and booster doses with mRNA vaccines. All patients experienced symptomatic COVID-19 but clinical manifestations were mild to moderate. Their SARS-CoV-2 viral RNA loads and anti-spike antibody levels were determined. This series proves that even three doses of mRNA vaccines may not be sufficient to prevent infection and symptomatic disease with the Omicron variant."
Source: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3981711
Commentary: Caveat lector, as always, this is a pre-print (as is pretty much anything with Omicron because it's so new). The study shows that Omicron's evasiveness means even fully vaccinated people can contract it, albeit with mild to moderate symptoms. The fundamental takeaway is to get vaccinated and mask up, because we can live with mild to moderate symptoms - but if we're in contact with anyone at risk, we could cause them substantial harm. Mask up with the best mask available to you, ideally N95/KN94/FFP2 or better.
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Updates from the UK. "NEW: Omicron Variant report from UKHSA
Firstly, the context of England epi:
Omicron case are rising rapidly.
Latest official count is 696, though the true number of infections is likely to be much higher, as we know Omicron is now ciruclating in many areas.
Omicron cases are rising faster than earlier variants
A vanishingly small number of Omicron cases are in people who recently travelled abroad (any country) or had a known contact with a traveller.
Evidence of 2 things:
1) ongoing community transmission
2) we have effectively interrupted infections entering the country
Right, onto the data...
1. VACCINE EFFECTIVENESS (symptomatic infection)
*caveat: early estimates*
Real-world surveillance data shows a significant reduction in VE for Omicron vs Delta
* 2x AZ, VE is ZERO
* 2x Pfizer, VE is ~30%
BUT! Boosters increase VE to 70-75% (Pfizer, in the 1st month)
Interpret VE data with caution due to low numbers & some residual uncontrolled biases.
It is too early to measure protection against severe disease, but with earlier variants protection against hospitalisation & death has been largely preserved. All hoping this holds true 🤞
The VE drop off is much greater than we saw with Delta, and suggests a level of immune evasion that could result in a surge in 'breakthrough' infections.
Good news is that boosters appear to mitigate much of that loss in VE, taking VE back to pre-booster levels
2. REINFECTIONS
Likewise, with an immune evading virus you expect to see an increase in re-infections. And we do.
7% (25/361) Omicron cases were re-infections, vs
0.4% (336/85,460) Delta
After adjustment, this equals a 3- to 8-fold increased risk of re-infection with Omicron
3. LABORATORY NEUTRALISATION STUDIES
Capping off the mounting evidence for Omicron's immune evasion, 2 UK & 3 international live virus studies were reviewed (UK papers coming!)
Omicron gives 20- to 40-fold reduction in nAbs compared to the viruses used to develop vaccines
Both UK studies show more than 20-fold reduction in neutralising antibodies for Omicron vs Delta
2-dose AZ showed the greatest reduction: in most cases no detectable neutralising activity🙄
BUT! Boosters significantly improved nAbs, regardless of the vaccine in first course
Taken together, this paints a very consistent picture for Omicron being immune evading.
This is reassuring scientifically, but also pretty depressing.
Let's move on to transmissibility studies.
🚨WARNING: also fairly depressing
4. HOUSEHOLD TRANSMISSION
(caveat: early data)
Analysis of transmission in residential households (121 Omicron, 72,882 Delta)
19% of Omicron cases resulted in household outbreaks vs 8.5% of Delta cases
Adjusted odds of household transmission for Omicron:
3.2 (95%CI 2.0-5.0)
For comparison the adjusted odds was 1.7 when this analysis was done for Delta vs Alpha. pubmed.ncbi.nlm.nih.gov/34729548/
This preliminary analysis will be repeated with more cases next week.
We cannot determine how much increased transmission is immune evasion vs infectiousness
5. SECONDARY ATTACK RATES (SAR)
Analysis using NHS T&T contact tracing data
Household SAR 2-fold higher for Omicron (21.6%) vs Delta (10.7%)
The risk of a close contact becoming a secondary case (adjusted odds ratio 2.1 (95% CI: 1.5-2.8)
Again, small numbers of Omicron limit the analysis and lead to wide confidence intervals so this analysis must be repeated.
However, these 2 analyses use different datasets and methods to estimate household transmission so is compelling to get such similar results.
6. GROWTH ESTIMATES
Taken together, it is no surprise that we are seeing exponential growth in Omicron cases (using SGTF as proxy)
3 day doubling time (0.35/day)
Rt= 3.7 (3.3-4.2)
So let's recap.
Omicron has a large growth advantage over Delta.
At least part (if not all) is due to it's ability to evade our existing immunity acquired through either vaccination or previous infection.
Left unchecked, this will result in exponential growth of infections.
But will in result in more hospitalisations and deaths?
Well good news so far is there are no hospitalisations or deaths associated with Omicron.
This is encouraging news, probably largely due to vaccines and high levels of immunity.
But also, its very early days.
There are very few cases in high risk groups, including the elderly
And so Omicron would have to be very much milder than Delta, in order to avoid an increase in hospitalisations and deaths.
Remember, a small percentage of a big number is still a bigger number than we would like to see..."
Source:
Commentary:
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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, including boosters. 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 available.
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.