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.
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Where's the one place in America masks are mandatory and it works? The military. "Wearing masks, wiping down work spaces and quarantine periods have presented a fringe benefit to military operations, most notably in the basic training environment. Fewer troops are coming down with communicable diseases, which take them out of the fight for days or even weeks.
Keeping in mind that the end of the COVID-19 pandemic is not nearly in sight, and that the promise of a vaccine is months away at best, military medicine is learning in real time how best to keep troops safe for now, and perhaps into the future.
“One of the things that, I will tell you, we definitely believe has made a difference is the masks, particularly in close quarters,” Rear Adm. Louis Tripoli, U.S. Indo-Pacific Command’s top doctor, told reporters Aug. 31.
Infectious disease has always been a threat to readiness, from cholera in the 19th century to COVID-19 now. What can’t be vaccinated for has to be mitigated, or at least accepted as part of the risk of deploying troops ― like the infamous “crud,” a cold that seems to sweep through units soon after deployment.
But the coronavirus pandemic has forced the services to up their game when it comes to preventing disease transmission, and in the mean time, they’ve learned some things.
“I think that we’ve learned a lot from this particular outbreak about what we just we as a medical community ... really didn’t understand about how a pathogen like this can be transmitted, and the value of masks,” Tripoli said."
To date, just over 40,000 troops have contracted COVID-19, including 592 hospitalizations and seven deaths, per the latest Defense Department numbers."
Source: https://www.militarytimes.com/news/your-military/2020/09/10/wearing-masks-could-become-part-of-troops-standard-operating-procedure/
Commentary: To put those numbers in perspective, the US military has approximately 1.3 million service members, many of whom live and work in tight proximity. That the military has kept case loads so low is a clear indicator that basic health protocols like wearing masks work. You couldn't ask for a better case study of what mandatory mask usage looks like.
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Will a vaccine be trustworthy? An interesting poll by Kaiser: "Recently, the Centers for Disease Control and Prevention (CDC) issued a notice to states to start preparing to distribute a coronavirus vaccine by November 1st, 2 days before the 2020 election. Most adults (81%), including majorities across partisans, do not think a vaccine for coronavirus will be widely available in the U.S. before the presidential election in November.
Many (62%) are worried that the political pressure from the Trump administration will lead the FDA to rush to approve a coronavirus vaccine without making sure that it is safe and effective – including 85% of Democrats and 61% of independents. Fewer Republicans (35%) express this level of concern. About four in ten adults overall say both the FDA (39%) and the CDC (42%) are paying “too much attention” to politics when it comes to reviewing and approving treatments for coronavirus or issuing guidelines and recommendations.
The latest KFF Health Tracking Poll finds a shift in the public’s attitudes on the coronavirus outbreak. More than six months into the pandemic, about four in ten (38%) now say “the worst is yet to come” (down nearly half from 74% in early April), while an equal 38% say “the worst is behind us” (up from 13% in April).
Nearly half of adults hold at least one misconception about coronavirus prevention and treatment, including one in five who say wearing a face mask is harmful to your health and one in four who say hydroxychloroquine is an effective treatment for coronavirus. Three in four Republicans have at least one misconception, compared to 46% of independents and one in four Democrats. At the same time, trust in some official sources of information on coronavirus has declined since April, including a particularly steep drop in Republicans’ trust of Dr. Anthony Fauci and the CDC."
Source: https://www.kff.org/coronavirus-covid-19/report/kff-health-tracking-poll-september-2020/
Commentary: The startling stat in there to me is the third one, on the worst being over. We have seen approximately 6.3 million infections in the United States. Out of a population of 330 million, with no immunity. That's 2% of the population. Even if we miscounted by an order of magnitude, that would still be 20% of the population - well below herd immunity numbers. The worst is yet to come, without a doubt, especially heading into the fall and winter, when respiratory diseases spread more easily.
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Will a vaccine be ready before November? Dr. Paul Offit: "I don't see how it's possible. Moncef Slaoui, who's the head of Warp Speed, has, I think appropriately, said recently on a National Public Radio show that he thought a best-case scenario would be the end of the year, most likely the beginning of next year. I think that's a more accurate representation.
As you said, you have to get 30,000 people to get dose 1 of placebo or vaccine. You have to wait a month, give 30,000 people dose 2 of placebo or vaccine, wait 2 weeks to full immunity, then you have to hope that about 150 or 160 people in your placebo group get sick. Not just infected, but sick. The clinical endpoint in these trials is moderate to severe disease.
Jackie Miller from Moderna presented to the Advisory Committee on Immunization Practices (ACIP) last week and was asked what the attack rate is in the places where they're rolling out these trials. They're getting antibody studies on all of the people when they enroll so they have a sense of what the attack rate has been. It's about 1%.
If that's true, and remembering that 80% of the disease is asymptomatic, you're focused on the 20% that's symptomatic in an area where only about 1% of people have been infected. And you're also telling people to wear a mask and social distance, because one, they may be placebo recipients, and two, no vaccine is going to be 100% effective. In many ways, you don't want them to get sick, but on the other hand, you're only going to know if the vaccine works if a certain number of them get sick. You're not asking them all to go to Sturgis, South Dakota, and hang out with a mess of bikers. You want them to be protected at some level."
Source: https://www.medscape.com/viewarticle/936937#vp_4
Commentary: This was a fascinating interview. The short of it is that no vaccine will be safely ready before end of year, one that has fully passed Phase 3 clinical trials with no truncation. Beware anything that is promised before then.
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There was no flu season in the Southern Hemisphere.
Source: https://www.economist.com/graphic-detail/2020/09/12/2020-has-been-a-year-without-a-flu-season-in-the-southern-hemisphere
Commentary: The headline says it all. Due to COVID-19 precautions, the flu season in the southern hemisphere basically didn't happen. In the northern hemisphere, for places taking COVID-19 precautions seriously, expect the same.
For places that don't, expect a double whammy of flu and COVID-19.
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COVID-19 can invade the brain. "Although COVID-19 is considered to be primarily a respiratory disease, SARS-CoV-2 affects multiple organ systems including the central nervous system (CNS). Yet, there is no consensus whether the virus can infect the brain, or what the consequences of CNS infection are. Here, we used three independent approaches to probe the capacity of SARS-CoV-2 to infect the brain. First, using human brain organoids, we observed clear evidence of infection with accompanying metabolic changes in the infected and neighboring neurons. However, no evidence for the type I interferon responses was detected. We demonstrate that neuronal infection can be prevented either by blocking ACE2 with antibodies or by administering cerebrospinal fluid from a COVID-19 patient. Second, using mice overexpressing human ACE2, we demonstrate in vivo that SARS-CoV-2 neuroinvasion, but not respiratory infection, is associated with mortality. Finally, in brain autopsy from patients who died of COVID-19, we detect SARS-CoV-2 in the cortical neurons, and note pathologic features associated with infection with minimal immune cell infiltrates. These results provide evidence for the neuroinvasive capacity of SARS-CoV2, and an unexpected consequence of direct infection of neurons by SARS-CoV-2."
Source: https://www.biorxiv.org/content/10.1101/2020.06.25.169946v2
Commentary: While a pre-print, it comes from Yale's Iwasaki immunology lab, which is reputable. Neuroinvasion - meaning the virus invades the brain - is linked with mortality. The number of different ways SARS-CoV-2 can kill us is varied. Stay safe - watch your distance, wash your hands, wear a mask, and withdraw from indoor spaces that aren't your home. You don't want to catch this thing.
The concern I have that is not borne out yet in research is what is the impact on survivors? Like the previously documented lung damage, COVID-19 will cause lifelong damage in some people. What will the neurological impact be?
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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.
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.
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.
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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.