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.
Delta and other strains still knocked out by vaccines. "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to evolve around the world, generating new variants that are of concern based on their potential for altered transmissibility, pathogenicity, and coverage by vaccines and therapeutics1–5. Here we report that 20 human sera, drawn 2 or 4 weeks after two doses of BNT162b2, neutralize engineered SARS-CoV-2 with a USA-WA1/2020 genetic background (a virus strain isolated in January 2020) and spike glycoproteins from the newly emerged B.1.617.1, B.1.617.2, B.1.618 (all first identified in India) or B.1.525 (first identified in Nigeria) lineages. Geometric mean plaque reduction neutralization titers against the variant viruses, particularly the B.1.617.1 variant, appear lower than the titer against USA-WA1/2020 virus, but all sera tested neutralize the variant viruses at titers of at least 40. The susceptibility of these newly emerged variants to BNT162b2 vaccine-elicited neutralization supports mass immunization as a central strategy to end the coronavirus disease 2019 (COVID-19) pandemic across geographies."
Commentary: This is excellent news for the global vaccination efforts - our existing vaccines continue to work, even against the newest variants.
Reopening in USA's New England. "Massachusetts and the rest of New England — the most heavily vaccinated region in the U.S. — are giving the rest of the country a possible glimpse of the future if more Americans get their shots.
COVID-19 cases, hospitalizations and deaths in the region have been steadily dropping as more than 60% of residents in all six states have received at least one dose of the vaccine.
The Deep South states of Alabama, Louisiana and Mississippi, in comparison, are the least vaccinated at around 35%, and new cases relative to the population are generally running higher there than in most of New England. Nationally, about 50% of Americans have received at least one shot.
In Massachusetts, health officials this past week determined that none of the state’s cities and towns are at high risk for the spread of COVID-19 for the first time since they started issuing weekly assessments last August.
In Rhode Island, coronavirus hospitalizations have hit their lowest levels in about eight months. New Hampshire is averaging about a death a week after peaking at about 12 a day during the virus’s winter surge. And Vermont, the most heavily vaccinated state in the U.S. at more than 70%, went more than two weeks without a single reported coronavirus death.
“It’s an incredible change over such a short period of time,” said Dr. Tim Lahey, an infectious disease physician at the University of Vermont Medical Center in Burlington.
Even with cases down dramatically, New England hospitals are in many ways busier than ever, as patients return in droves after postponing medical care for more than a year.
Dr. Katherine Gergen Barnett, head of the family medicine department at Boston Medical Center, said it has been “energizing” to reconnect with regular patients but also taxing, as many have a year’s worth of mental trauma to work through, on top of their neglected physical ailments.
“There’s definitely a little bit of exhale happening,” she said. “We ran that marathon, but now there’s this other long race ahead of us in terms of getting people back to healthy.”"
Commentary: It's no surprise to hear that healthcare is booming once again now that the immediate crisis in certain regions is passing. I suspect we will see a lot of acute problems showing up, the consequence of deferring treatments and regular care for over a year. If you're vaccinated, go make sure the rest of your health is good.
Long COVID in kids looks different. "At the pandemic’s outset, it looked like children might be spared the severe illness striking adults in the first Covid wave, when hospitals were pushed to their limits and older age tracked tightly with worse outcomes. Children seemed at first to show minimal symptoms. Then in a small minority of cases, the rare but mysterious multi-inflammatory syndrome, or MIS-C, began appearing in children (and some adults, too, labeled MIS-A). The Centers for Disease Control and Prevention reports 4,018 cases of MIS-C, including 36 deaths, in which life-threatening inflammation can strike the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs.
Long Covid in children is separate and distinct from MIS-C, for which children are being successfully treated. But like long Covid in adults, there is no way now to predict who might be vulnerable to later difficulties. Among children and adolescents, there are varying degrees of impairment in long Covid. To pick just the neurological, the spectrum of troubles spans headache to brain fog to numbness that leaves children unable to walk.
“We all have a daunting task in front of us to try to understand what these risks are and what the protective factors are in learning about these illnesses, with a lot of multidisciplinary expertise, and a big involvement with the clinician community,” said Bill Kapogiannis, a program director in the maternal and pediatric infectious diseases branch of the National Institute of Child Health and Human Development.
He said there are biological and immunological differences between kids and adults that complicate the task. One challenge comes in imaging and other tests. In adults, they show something. Not so in kids.
“The adults have myocardial fibrosis and they’ve got changes on their CT scans and they’ve got thromboembolism and organic pathology that’s easy to see,” Johnston of Boston Children’s said. “And they have abnormal labs. The kids that we are seeing have normal white blood cell counts in general, normal inflammatory markers, normal pulmonary function tests, normal EKGs, normal X-rays, normal echocardiogram. And yet they’re clearly impaired.”
Age seems to make a difference. More patients with long Covid are over 12 and some are college-age, so at least they are able to tell doctors what distressing symptoms they feel. Younger children with lingering symptoms after Covid infections will be watched closely.
“You can get Covid at 18 months of age,” Audrey John, chief of pediatric infectious diseases at the Children’s Hospital of Philadelphia, pointed out. “Maybe you can’t tell us that you have a little brain fog. Maybe you can’t tell us that you just don’t feel great. But whether those kids grow like they’re supposed to, develop language like they’re supposed to, go on to be successful in school like they’re supposed to — we’re not going to learn for a long time.”
Doctors see similarities between long Covid and what can happen after mononucleosis or in other post-viral syndromes. Among teens, high-achieving athletes and successful students sometimes don’t get back right away to where they were before mono. They can’t get off the sofa, they can’t go to the mailbox — like their post-Covid peers. That similarity argues for developing an integrated medical approach to take care of all these patients better, including treatment for the anxiety and depression that have been exacerbated by the pandemic. “There’s a lot of overlapping Venn diagrams of what’s going on with those kids right now and all of the [therapeutic] pieces that are needed there,” John said. "
Commentary: this is why it's so vital to get your kids vaccinated, and until they are, keep them safe from COVID-19. MIS-C is relatively rare. In adults, long COVID is distressingly common. A 1-in-3 chance of a diminished quality of life for weeks or months, possibly years is not something you want for your kids. Take the cautious approach; keep unvaccinated kids away from others as much as possible, and masked up when it's unavoidable.
"In the federal government’s previous pandemic playbook, the initial actions taken by President Donald Trump’s administration, and advice given by experts, there was a common theme: that America would come together against a major national threat, helping put it down collectively.
Over the past year and a half, we’ve learned how wrong that was. While the US did manage to lock down at first, those lockdowns soon gave way to protests. Not long after the Centers for Disease Control and Prevention recommended masking and most states adopted the advice into mask mandates, masks became political symbols as many Americans rejected wearing one often, if at all. Even after the country built up its coronavirus testing capacity, translating that into collective action through, say, contact tracing, centralized isolation, or genomic sequencing (to track variants) just didn’t happen in most of the US.
Case and death rates have gotten much better recently, thanks to the vaccines. But that’s largely due to a lot of individuals acting in their own interest and getting the shot. The policy proposals to make a more collective push for vaccines — through, for example, vaccine passports — have been widely rejected, including by the White House.
Whenever collective action is called for, Americans don’t do it — or, at the very least, don’t do it sufficiently. America is too politicized, fractured, and, above all, individualistic for a collective move to save it.
“It’s a facet of the United States before Covid, during Covid, and I’m not sure it’s going to change after Covid,” Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, told me. “That’s one of the challenges the US has faced throughout the Covid pandemic.”
When the US writes its next pandemic playbook, it can’t ignore this reality. Going forward, tackling a pandemic or collective public health threat will require a more individualistic approach to public health — one more focused on clear guidance, risk communication, harm reduction, and making the safest choice the easiest.
The research suggests collectivistic places handled at least some aspects of the pandemic better. But in a highly individualistic society like the US, maybe such approaches are simply unrealistic. After suffering one of the highest Covid-19 death tolls among developed nations and in the world, America may have to find its own individualized alternative."
Commentary: This was a fascinating post-mortem on how the USA reacted to the pandemic and the assumptions we have to question for all future crises.
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 other people, 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. 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.
3. Wash/sanitize your hands every time you are in or out of your home.
4. Stay home 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.
5. Get your personal finances in order now. Cut all unnecessary costs.
6. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
7. 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).
8. Masks must fit properly to work. Here's how to properly fit a mask:
Common misinformation debunked!
There is no basis in fact that COVID-19 vaccines can shed or otherwise harm people around you.
There is no mercury or other heavy metals in the Pfizer mRNA vaccine.
There is no basis in fact that COVID-19 vaccines pose additional risks to pregnant women.
There is no genomic evidence at all that COVID-19 arrived before 2020 in the United States and therefore no hidden herd immunity:
There is no evidence SARS-CoV-2 was engineered, nor that it escaped a lab somewhere.
There is no evidence a flu shot increases your COVID-19 risk.
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.
A common request I'm asked is who I follow. Here's a public Twitter list of many of the sources I read.
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.