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.
You are welcome to share this.
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COVID-19 is not endemic yet. "I keep getting asked if SARS-CoV-2 is endemic yet.
Record-busting case counts are not endemicity.
This isn’t “living with” the virus. That’s not what endemicity means anyway. Endemic means that there is a steady state level of virus circulating. This is explosive exponential, epidemic growth, not a stable level of endemic transmission.
Endemic doesn’t mean that the virus is “milder” and that it just rips through the population at periodic intervals. It doesn’t mean “living with” hospitals becoming overwhelmed. It doesn’t mean complacency or surrender.
And lest the White House thinks that more finger wagging and responsibility shaming is the solution rather than addressing the much more complex & challenging structural reasons why people resist public health measures such as masks and vaccines, I’ll wag my finger right back.
We are here because of repeated, intentional, catastrophically bad policy decisions that emphasize the economy over public health, when these interests are not even fundamentally opposed. These include:
-Exclusive reliance on voluntary vaccine/booster uptake with minimal outreach to the recalcitrant unvaccinated
-No policies that improve vaccine access (paid sick leave, child care, transportation)
-No policies that offer meaningful financial relief for isolation/quarantine
-No efforts to improve access to health care or support those with huge bills from COVID
-No sustained support for people with chronic illness at higher risk and/or because of COVID
-No mask mandate, much less providing quality masks to people at low or no cost
-No rapid tests because of refusal to invest in them more than a year after their approval & despite promising them in early 2020
-Not enough testing, period
-No urgency to get global vaccination rates up
-Not enough vaccine doses exported & no will to improve
-No vaccination requirement for entry to US
-Minimal testing at the border
-No vaccination requirements for domestic travel
-No clear guidance and lack of candor from officials who claim to want to build trust
It’s untrue that endemicity means “living with” a never ending, preventable clusterfuck. The solutions have always been in front of us:
-Mass immunization to achieve *global* population immunity
-NPIs and policy to drive down transmission while everyone gets vaccinated
Until that sinks in for our leadership, we’re going to continue this vicious cycle of surges. Everyone is sick to death of it. In some cases, literally.
This isn’t endemic yet. We must demand more from our leadership than lip service and failed policy."
Source:
Commentary: To be clear, this is not just one government or presidential administration. We are repeating the same mistakes of the last two years to some degree in the USA and if we want this thing defeated, we have to go on a wartime footing and treat it as such, not ineffective half measures.
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Omicron isn't less severe. " The mechanism behind Omicron's increased transmissibility is not just immune escape. Fitness also plays a major role : in addition to immune evasion properties, it’s also a too overpowering variant.
Omicron is also easier to spread because of insanely high viral loads and shorter generation time (ppl test positive more quickly following exposure, suggesting a more rapid viral growth) : there's a lot more virus, more quickly after exposure.
Individuals infected with Omicron are shedding a lot more 🦠 , which increases the likelihood of exposing their community a to an infectious dose.
Shorter generation time also means you become infectious more quickly after exposure, which gives even more opportunity to spread
Considering that viral load exposure is also known to be associated with *increased* severity (increased not reduced !), it’s difficult to affirm that Omicron is intrinsically less virulent than older variants.
Because of substantial immune escape, neutralizing antibodies won’t be able to prevent newly synthesized 🦠 from being shed AND from infecting other cells in the *same* host. This is not driving attenuation.
(It doesn’t mean vaccines are useless, they ⬇️ disease severity)
Omicron infects triple vaccinated ppl who wouldn’t get infected w/ Delta.
Omicron’s immune escape and high VL overcome vaccine elicited Abs, enough to cause a symptomatic infection, but not enough to cause severe disease in most cases.
As a result we see a higher number of *mild to moderate* forms w/ Omicron. By Simpson paradox it seems less severe but is more.
Viruses don’t always evolve to become less virulent. When they do, it’s because an evolutionary pressure is driving attenuation.
Such pressure exists if the 🦠 meets two criteria:
➡️ its virulence must depend mostly on viral strain (1)
➡️ the most virulent variants must kill their host before getting the opportunity to be spread to a new one: they won’t be passed on but less virulent variants will (2)
No such pressure exists for SARS-CoV-2 which doesn’t meet any of the criteria (1) and (2) above : asymptomatic ppl can spread and even those who die from covid were most contagious before developing severe disease.
Let’s not forget that even if Omi turned out to be milder - which is unlikely - it’s spreading and mutating so fast that sublineages harboring mutations conferring increased virulence (and full immune escape) could pop out very soon. Viral evolution is uncertain"
Source:
Commentary: In short, defense against Omicron means multiple techniques. Vaccination is the last line of defense and it's REALLY good - but don't just leave it there. Wear a mask. Take precautions.
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Long COVID resembles chemo's impact. "Survivors of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection frequently experience lingering neurological symptoms, including impairment in attention, concentration, speed of information processing and memory. This long-COVID cognitive syndrome shares many features with the syndrome of cancer therapy-related cognitive impairment (CRCI). Neuroinflammation, particularly microglial reactivity and consequent dysregulation of hippocampal neurogenesis and oligodendrocyte lineage cells, is central to CRCI. We hypothesized that similar cellular mechanisms may contribute to the persistent neurological symptoms associated with even mild SARS-CoV-2 respiratory infection. Here, we explored neuroinflammation caused by mild respiratory SARS-CoV-2 infection, without neuroinvasion, and effects on hippocampal neurogenesis and the oligodendroglial lineage. Using a mouse model of mild respiratory SARS-CoV-2 infection induced by intranasal SARS-CoV-2 delivery, we found white matter-selective microglial reactivity, a pattern observed in CRCI. Human brain tissue from 9 individuals with COVID-19 or SARS-CoV-2 infection exhibits the same pattern of prominent white matter-selective microglial reactivity. In mice, pro-inflammatory CSF cytokines/chemokines were elevated for at least 7-weeks post-infection; among the chemokines demonstrating persistent elevation is CCL11, which is associated with impairments in neurogenesis and cognitive function. Humans experiencing long-COVID with cognitive symptoms (48 subjects) similarly demonstrate elevated CCL11 levels compared to those with long-COVID who lack cognitive symptoms (15 subjects). Impaired hippocampal neurogenesis, decreased oligodendrocytes and myelin loss in subcortical white matter were evident at 1 week, and persisted until at least 7 weeks, following mild respiratory SARS-CoV-2 infection in mice. Taken together, the findings presented here illustrate striking similarities between neuropathophysiology after cancer therapy and after SARS-CoV-2 infection, and elucidate cellular deficits that may contribute to lasting neurological symptoms following even mild SARS-CoV-2 infection."
Source: https://www.biorxiv.org/content/10.1101/2022.01.07.475453v1
Commentary: This is why "just let Omicron run rampant" is a bad idea. We will create an entire generation of people with substantial long-term, if not permanent, impairments that will dramatically increase healthcare costs and strain on our healthcare systems. An ounce of vaccine is worth ten thousand pounds of long COVID disability treatment.
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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. If it's available, choose Moderna as your first choice for both vaccine and booster, Pfizer as your second choice. However, remember than any vaccine is better than no vaccine.
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.