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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Bill asked yesterday about recommendation 6 on the list attached to the bottom of every email:
6. Get your personal finances in order now. Cut all unnecessary costs.
This is a holdover from the start of the pandemic when we had no idea what was going to happen to the economy. It's probably safe to retire from the list, but the advice is pretty much evergreen. I would still recommend having 3-6 months of living expenses banked for any emergency circumstances, from layoffs to pandemics to an asteroid destroying your place of work. When the pandemic started, my family turtled and we banked almost a year's worth of living expenses by cutting everything non-essential. Since then, we've throttled back to 9 months on hand, which is solid peace-of-mind when literally anything can happen these days.
I'll upgrade this to:
6. Aim to have 3-6 months of living expenses on hand in case the pandemic gives another crazy plot twist to the economy.
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Thoughts on transmission by Dr. Tom Frieden: "If the Covid surge in the US follows the pattern of the UK and India, we’ll see cases top 200,000 in the coming weeks—but we may also see a sharp and sudden decrease soon after.
Why do explosive surges caused by Delta seem to burn out so quickly? A theory...
1/thread
No one knows for sure why cases have plunged so precipitously in countries where the Delta variant has become dominant. But understanding this trend could help us gain control of the pandemic. 2/
There’s been a lot of focus on one epidemiological term: the basic reproductive number, or “Ro,” which is the average number of people infected by one case without vaccination or control measures. Delta is at least two times as infectious as other strains, with an Ro of 5-6. 3/
But there’s another parameter, “kappa,” or k, which ALSO relates to the infectiousness of a disease. Kappa tells us about the patterns of transmission: whether the disease spreads in a uniform pattern or in explosive clusters. 4/
In other words, do most infected people usually spread a disease to the same number of people? Or do only a small proportion of people do most of the spreading? Even with the original strain, it was clear that a small proportion of patients accounted for most transmission. 5/
When k is small, transmission isn’t uniform, and a large proportion of infections are linked to a relatively small number of cases via superspreading events. We don’t have a great sense of the factors that shape k or why it varies from disease to disease. 6/
We’ve learned that k for Covid is small—that is, as few as 10% of infections contribute to as much as 80% of spread, and many cases don’t infect anyone at all. 7/
Along with Dr. Christopher Lee, I wrote about the importance of superspreading to Covid in March 2020 as the pandemic unfolded, and about why identifying and interrupting superspreader events should be a priority in disease control. bit.ly/37BY35X 8/
This is different from flu, which appears to be more homogeneous in its transmission. Superspreading is quite important to the epidemiology of Covid, but not, as far as we know now, to flu. 9/
The extent to which superspreading contributes to spread likely influences the shape of Covid epi curves. If superspreading is a significant driver of spread, the increase may be quite steep. And if superspreading is interrupted, the decrease may also be quite steep. 10/
So k could at least partially explain the sudden plummet in the epi curves observed in India and the U.K. 11/
But what’s going on in countries hit hard by Covid that haven’t seen similarly steep drops, such as Brazil and some other Latin American countries? Their epi curves look different. What explains this difference? 12/
In this graph, look at the difference between North America, the blue steep roller-coaster line, and the green line from Latin America and the Caribbean, with a gradual increase and a gradual decrease. bit.ly/3s4SvKI 13/
In some Latin American countries, Delta isn’t the dominant strain (yet). P1 (Gamma) is. Maybe the Delta and Gamma variants have different dispersion rates, different kappa.
Thanks to Dr. Shama Cash-Goldwasser, of @ResolveTSL, for honing this theory. 14/
That would mean Gamma is less prone to individual variation in infectiousness, or superspreading, than other variants. This is just a theory, and could certainly be wrong. 15/
Not only could this explain the difference in epi curves, but it could also explain why Gamma—even though it’s also more transmissible than the original strain—has spread contiguously to neighboring countries but not around the world in the same way Delta has. 16/
Many factors influence spread, such as levels of population immunity, contact and travel patterns and protection measures, so it can be challenging to compare countries. But kappa may be a key factor, and we must study its impact. 17/
This new piece in @TheLancet appropriately proposes that we must seek to better understand the features of viruses that determine their kappas if we are to most effectively control disease spread during this and future pandemics. bit.ly/3fMzuIj 18/
If superspreading is more important to the spread of Delta than other strains of Covid, this could have major implications for public health action. 19/
For instance, we may need to interrupt superspreading by more strictly limiting mass gatherings, enforcing masks & distancing in high-capacity indoor spaces and layering protections in schools rather than focusing on spread at places such as local grocery stores/small shops. 20/
If big events in the US such as Sturgis or the recent Lollapalooza music festival lead to a large spike in new cases, it will provide more evidence that we may need to rethink large events in light of Delta. n.pr/37uCpRp 21/
If the k for Gamma is higher (i.e. less explosive), that means in places where it’s spreading widely, communities must focus on controlling transmission in households, at work, and in other settings where each case may infect a few close contacts and fuel generalized spread. 22/
The virus has adapted quickly, and could continue to adapt into even more dangerous forms. We must adapt also—including by learning more about how Covid spreads. With infectious diseases, what goes down can go back up. 23/end"
Source:
Commentary: This is fascinating and concerning because of the methods of transmission. Delta probably needs those superspreading events - larger gatherings - to succeed. Gamma may not. So what happens when a strain evolves that has the best of both, the ability to superspread or the ability to spread like flu, more normally? You have a hypercontagious variant.
Mask up, get vaccinated. The only way we stave off a variant like that is by reducing the number of chances the virus has to mutate and evolve.
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Keep kids safe. "The family’s predicament is a microcosm of the dangerous and uncertain moment so many Americans face as the pandemic once again changes course. The COVID-19 vaccines have done an extraordinary job of stamping out disease and death. But as the hypertransmissible Delta variant hammers the United States, the greatest hardships are being taken on by the unvaccinated, a population that includes some 50 million children younger than age 12. Across the country, pediatric cases of COVID-19 are skyrocketing alongside cases among unimmunized adults; child hospitalizations have now reached an all-time pandemic high. In the last week of July, nearly 72,000 new coronavirus cases were reported in kids—almost a fifth of all total known infections in the U.S., and a rough doubling of the previous week’s stats. “It’s the biggest jump in the pandemic so far” among children, Lee Beers, the president of the American Academy of Pediatrics, told me. Last week, that same statistic climbed to nearly 94,000.
The most serious pediatric cases are among the pandemic’s worst to date. In the South, where communities have struggled to get shots into arms and enthusiasm for masks has been spotty, intensive-care units in children’s hospitals are filling to capacity. In several states, health workers say that kids—many of them previously completely healthy—are coming in sicker and deteriorating faster than ever before, with no obvious end in sight.
Kids remain, as they have been throughout the pandemic, at much lower risk of getting seriously sick with the coronavirus, especially compared with unvaccinated adults. But the recent rash of illnesses among the nation’s youngest is a sobering reminder of the COVID-19 adage that lower risk is not no risk. With so many children unable to access vaccines and their health contingent on those around them, parents and guardians must now navigate the reality that Delta represents a more serious danger to everyone—which means it’s a more serious danger to kids as well."
Source: https://www.theatlantic.com/health/archive/2021/08/delta-variant-covid-children/619712/
Commentary: If there were onerous, difficult challenges in protecting kids, I could understand parental reluctance. But it's as simple as keeping unvaccinated kids away from unvaccinated people - which is easier to do now, when school is not in session - and making them wear masks. That's it. If a kid is eligible for vaccination, get them vaxxed up. It doesn't have to be like this.
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Delta breaking through AstraZeneca and spreading among vaccinated. "Methods: We studied breakthrough infections among healthcare workers of a major infectious diseases hospital in Vietnam. We collected demographics, vaccination history and results of PCR diagnosis alongside clinical data. We measured SARS-CoV-2 (neutralizing) antibodies at diagnosis, and at week 1, 2 and 3 after diagnosis. We sequenced the viruses using ARTIC protocol.
Findings: Between 11th–25th June 2021 (week 7–8 after dose 2), 69 healthcare workers were tested positive for SARS-CoV-2. 62 participated in the clinical study. 49 were (pre)symptomatic with one requiring oxygen supplementation. All recovered uneventfully. 23 complete-genome sequences were obtained. They all belonged to the Delta variant, and were phylogenetically distinct from the contemporary Delta variant sequences obtained from community transmission cases, suggestive of ongoing transmission between the workers. Viral loads of breakthrough Delta variant infection cases were 251 times higher than those of cases infected with old strains detected between March-April 2020. Time from diagnosis to PCR negative was 8–33 days (median: 21). Neutralizing antibody levels after vaccination and at diagnosis of the cases were lower than those in the matched uninfected controls. There was no correlation between vaccine-induced neutralizing antibody levels and viral loads or the development of symptoms.
Interpretation: Breakthrough Delta variant infections are associated with high viral loads, prolonged PCR positivity, and low levels of vaccine-induced neutralizing antibodies, explaining the transmission between the vaccinated people. Physical distancing measures remain critical to reduce SARS-CoV-2 Delta variant transmission."
Source: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3897733
Commentary: This study is specific to the AstraZeneca vaccine, which is an adenovirus platform. If you got a Pfizer or Moderna shot, you are less likely to have breakthrough events than if you got an AstraZeneca shot. Presumably, the J&J vaccine has about the same level of effectiveness.
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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. 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 permitted.
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.