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.
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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Winter is coming. "Concerns about a possible new surge arise from a combination of three factors: human behavior, the evolution of the virus and overall waning immunity protection from vaccines and prior infection, said UCSF infectious disease expert Dr. Peter Chin-Hong.
And a recent rise in cases and hospitalizations in Europe, which has often been a COVID bellwether for the U.S., is heightening the unease.
“The question is not whether we will see an increase in cases and hospitalizations — we will — but by how much,” Chin-Hong wrote in an email.
Here are the omicron offshoots experts are monitoring closely, and why:
BA.2.75.2
Share of U.S. cases: 1.4%
What we know: This offshoot of BA.2.75, which caused a surge in India several months ago, is the best among the crop of new variants at evading immunity due to mutations in the spike protein, Chin-Hong said.
It’s uncertain how long boosters will protect against even mild infections with this variant, Chin-Hong said, but he added that the shots “will likely continue to perform extremely well at preventing hospitalizations and deaths.”
A study published earlier last month found this variant had “profound antibody escape” and suggests that it can escape current immunity in the population. The study also found that the variant could reduce the effectiveness of Evusheld, the monoclonal antibody treatment for immunocompromised individuals.
BF.7
Share of U.S. cases: 3.4%
What we know: Also known as BA.5.2.1.7, BF.7 is a relative of BA.5 and has a “few more mutations on the spike protein,” Chin-Hong said. It could reduce the effectiveness of Evusheld as well as another treatment called bebtelovimab that is used to treat mild and moderate COVID in adults, he said.
BA.2.3.20
Share of U.S. cases: Has not yet appeared in CDC variant tracker.
What we know: This offshoot of BA.2 is an emerging variant in Singapore and some European countries, Chin-Hong said. It has a growth rate advantage of about 15% compared with BA.5, he said, which may fuel more infections and reinfections.
BQ.1.1
Share of U.S. cases: 0% on CDC variant tracker.
What we know: This variant is “extremely immune evasive” like BA.2.75.2, but does not have the “high growth advantage” of BF.7 so far, Chin-Hong said.
While cases from BQ.1.1 are still a small fraction, its rates “have been growing rapidly,” according to Stacia Wyman, senior genomics scientist at the Innovative Genomics Institute at UC Berkeley.
“We still have sublineages of BA.2.75 to keep an eye on as well, but if they exceed the apparent growth advantage of BQ.1.1, that would not be good, as BQ.1.1. is already worrisome,” she said. “It is estimated that BQ.1.1 has a growth advantage of 14% over BA.5. This is less than omicron had over delta, but more than BA.2 had over BA.1.”
But she added that because BQ.1.1 stems from BA.5, we would have good protection against it with the new omicron-targeting bivalent boosters.
XBB
Share of U.S. cases: Not yet listed on CDC variant tracker.
What we know: Little has been published about XBB, but this descendant of BA.2 is “one of the main BA.2 new variants to be concerned about,” according to Dr. Eric Topol, executive vice president of Scripps Research in San Diego. Citing a preprint article in bioRxiv, Topol said Tuesday on Twitter that XBB has surpassed BA.2.75.2 as “the most immune evasive variant seen to date and replicated” — so much so that it could outcompete BA.5 and challenge protection from the new bivalent vaccine."
Source: https://www.sfchronicle.com/health/article/COVID-variants-surge-17487479.php
Commentary: Given that so few people have gotten the updated booster, it's shaping up to be another long winter. As always, your best bets are to do what you've been doing: get your booster if you're eligible, mask up, and avoid indoor spaces that aren't your home unless you're wearing really good masks (N95 or better).
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It's been a few years since we've seen a flu. "1/ What should you know about influenza heading into flu season?
with @CBSMornings @CBSNews' @nateburleson
Only ~1/2 of adults in the US plan to get a flu shot.
Here's why this has infectious disease specialists like me worried.
2/ Masks😷 & social distancing during the pandemic haven't just curbed COVID.
They crushed the flu.
But that means there's a lot less immunity in the population against flu this year.
Most of us haven't encountered the flu in a couple of years.
3/ Influenza doesn't just cause fever, chills, runny/stuffy nose, cough, pneumonia & diarrhea.
The flu triggers a heart attack🫀 & worsening of congestive heart failure.
3/ The flu also causes asthma or COPD🫁 exacerbations.
4/ The @CDCgov recommends that EVERYONE 6 months of age & older get an annual flu shot.
5/ It’s especially important for these folks to get their flu shots:
👵🏼people 65+
🤰🏾pregnant women
🫁🫀🧠people with chronic medical conditions
👶🏾children under the age of 5
because they’re at the highest risk for hospitalization and death.
6/ High-dose flu vaccines or “adjuvanted” flu vaccines are preferred among people 65 and older.
Adjuvants strengthen the immune response to a vaccine.
7/ Vaccinating pregnant women🤰🏾 doesn't just protect the fetus, it protects the newborn👶🏾.
Vaccinated women will pass antibodies to their babies through the placenta & through breast milk for the first 6 months of life.
8/ While younger people might be at lower risk for severe flu, they can act as vectors for the transmission of influenza to higher-risk persons in the community.
9/ It is safe to get vaccinated for COVID and the flu at the same time, but you might experience more side-effects like fevers, headache, or body aches.
These side-effects can be treated with over-the-counter medications like Tylenol.
10/ Even if you're one of those people who "don't do flu shots," this is an important year in which to get a flu shot, especially if you're in one of those high-risk categories.
11/ Just like COVID vaccinations can't give you COVID, flu shots can't give you the flu.
12/ Flu & COVID vaccinations don't prevent all infections, but they're really good at preventing hospitalization and death.
If you still get the flu (or COVID) after you get your flu (or COVID) shot, this doesn't mean the vaccination didn't work.
13/ If you didn't end up in the hospital or dead from the flu (or COVID), the shot worked!
If your flu & COVID shots prevent you from having pneumonia or a heart attack or a flare of your asthma or COPD, that's a win!
The shots are working!"
Source:
Commentary: Since you're there anyways... talk to your healthcare provider about doing Benadryl in addition to acetaminophen to minimize the side effects of both vaccines.
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Long COVID affects us in 6 different, unpleasant ways:
"COVID-19 may affect the central nervous system in (at least) six main ways (Figure 1).
First, the immune response to SARS-CoV-2 in the respiratory system may cause neuroinflammation - increasing cytokines, chemokines and immune cell trafficking in the brain and inducing reactive states of resident microglia and other immune cells in the brain and brain borders.
Second, SARS-CoV-2 rarely may directly infect the nervous system.
Third, SARS-CoV-2 may evoke an autoimmune response against the nervous system.
Fourth, reactivation of latent herpesviruses like Epstein-Barr virus may trigger neuropathology.
Fifth, cerebrovascular and thrombotic disease may disrupt blood flow, disrupt blood-brain-barrier function, and contribute to further neuroinflammation and/or ischemia of neural cells.
Lastly, pulmonary and multiorgan dysfunction occurring in severe COVID can cause hypoxemia, hypotension and metabolic disturbances that can negatively affect neural cells.
It is important to recognize that these mechanisms of nervous system injury are not mutually exclusive, and a combination of mechanisms may occur in some individuals, with varying frequency and timing. For example, neuroinflammation triggered by the immune response to the respiratory system infection and consequent dysregulation of neural homeostasis and plasticity is likely a more common mechanistic principle that occurs even after mild disease in the acute phase, while direct brain infection is likely an uncommon mechanism associated with severe COVID-19."
Source: https://www.cell.com/action/showPdf?pii=S0896-6273%2822%2900910-2
Commentary: This is a useful, informative paper about the effects of Long COVID. This thing is a vascular and neurological wrecking ball inside the body.
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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. 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.
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 eligible to, and fulfill the full vaccine regimen, including boosters. Remember that you are not vaccinated until everyone you live with is vaccinated. For COVID, if you received an adenovirus vaccine (J&J/AstraZeneca), consider getting an mRNA single shot booster (Pfizer/Moderna) if available. If it's available, choose Moderna as your first choice for both vaccine and booster, Pfizer as your second choice. However, remember that any vaccine is better than no vaccine.
4. 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.
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 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 pandemics give another crazy plot twist to the economy, or you know, a global war breaks out.
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 several rapid antigen tests and/or acquire them from your healthcare provider or government. This will detect COVID-19 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.
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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 or monkeypox. 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 or monkeypox, nor do I financially benefit in any way from sharing information about COVID-19 or monkeypox.
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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.