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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Overnight, the United States hit two million cumulative infections and 113,000 deaths. "Dr. Ashish Jha, director of the Harvard Global Health Institute, told CNN’s Chris Cuomo on Wednesday that at the moment, the country sees between 800 and 1,000 deaths every day from COVID-19 and the models he’s seen suggest that there will be increases in the coming months. “But even if we assume that it’s going to be flat all summer, that nothing is going to get worse, we’re going to stay flat all summer — even if we pick that low number, 800 a day — that’s 25,000 a month,” Jha pointed out. “In three and a half months, we’re going to add another 87-, 88,000 people, and we will hit 200,000 sometime in September.”"
Source: https://www.boston.com/news/coronavirus/2020/06/11/harvard-ashish-jha-covid-19-death-toll-september
Commentary: Another 100,000 dead by September. Opening too soon. People not doing the basics. And triple-digit growth in cases in Utah, Arkansas, Arizona, Oregon, Vermont, and Alaska. Beware anyone talking about "post-pandemic". We're probably in the second inning at best.
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A counter-argument that we should not wait for perfect antibody testing. "The risks of reopening workplaces and the economy to individuals and communities are real; steps in that direction should be taken cautiously. Antibody testing, made available to those in the workforce, will soon offer a scientifically valid way to better determine workplace access and mitigation strategies based on the risk that individuals may transmit the virus to or acquire the virus from coworkers. But the costs of delaying any reopening until we are certain that no one returning to work will transmit Covid-19 are also real. There is no such thing as a 100% safe bet. Let’s not permit an unattainable ideal to be the enemy of a very good option that we currently have."
Source: https://www.nejm.org/doi/full/10.1056/NEJMp2017739?query=TOC
Commentary: Perfect is the enemy of good. If antibody tests work well enough to guide us in the correct direction, then let's start using them in the workplace. Think of it like a car. Which would you rather have, absolutely no view out the front window as you're driving, or a blurry, muddy view? Given two terrible choices, we'd logically choose the less-bad choice.
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What about increased numbers? "Are increased case counts partially attributable to increased testing? Probably in part. But in places where hospitalizations and the % of tests that come back positive is high or rising, those are sure signs of trouble."
Source:
Commentary: Dr. Rivers is completely correct here. When hospitalizations are going up, you have a problem. That's the number to watch.
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FT has an excellent roundup of where we are right now. "While there is no such thing as a safe way to come into contact with potentially infected people or environments, research points to some general principles to bear in mind.
Three key factors determine risk of exposure: proximity to people; duration of exposure; and how confined the environment is. The greatest peril lies where the three overlap.
“The biggest risk is being in close proximity to someone in an indoor space for any extended period of time,” said Jeremy Rossman, honorary senior lecturer in virology at the University of Kent."
Source: https://www.ft.com/content/2418ff87-1d41-41b5-b638-38f5164a2e94
Commentary: Time. Space. Distance. Those are the keys to avoiding spreading or catching COVID-19. Stay out of indoor spaces. Stay away from people. Limit the amount of time you're around people not in your household.
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SARS-CoV-2 can be detected in semen. "In this cohort study, we found that SARS-CoV-2 can be present in the semen of patients with COVID-19, and SARS-CoV-2 may still be detected in the semen of recovering patients. Owing to the imperfect blood-testes/deferens/epididymis barriers, SARS-CoV-2 might be seeded to the male reproductive tract, especially in the presence of systemic local inflammation. Even if the virus cannot replicate in the male reproductive system, it may persist, possibly resulting from the privileged immunity of testes. So far, researchers have found 27 viruses associated with viremia in human semen. But the presence of viruses in semen may be more common than currently understood, and traditional non–sexually transmitted viruses should not be assumed to be totally absent in genital secretions.5,6 Studies on viral detection and semen persistence are beneficial to clinical practice and public health, especially concerning viruses that could cause high mortality or morbidity, such as SARS-CoV-2.
If it could be proved that SARS-CoV-2 can be transmitted sexually in future studies, sexual transmission might be a critical part of the prevention of transmission, especially considering the fact that SARS-CoV-2 was detected in the semen of recovering patients. Abstinence or condom use might be considered as preventive means for these patients. "
Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2765654
Commentary: As the study points out, presence does not equal transmissibility. Until further studies confirm it, however, anyone exposed to semen (and other bodily fluids in general) should be taking reasonable precautions including the cleaning and/or disposal of contaminated surfaces.
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Dr. Scott Gottlieb on antibody cocktail efforts. "Regeneron starts first clinical trials of antibody cocktail for #COVID19, planning 4 study programs spanning treatment and prevention. These antibody programs are on pace to potentially have a product for the Fall for emergency use. The challenge will be supply. The manufacturers will have limited doses unless the feds can help crash manufacturing capacity. This is where the government can play an important role"
Source:
Commentary: Therein lies the challenge. Only the federal government can build that manufacturing capacity quickly and mitigate the risk for manufacturers. Given the lack of leadership thus far, I would expect that will not be the case.
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"When you get a call from NYS Contact Tracing — Answer your phone! Our Contact Tracing force is working every day to help stop the spread."
Source:
Commentary: I applaud the levity in this tweet, encouraging New York State citizens to respond to contact tracing efforts. Click/copy the link above to see it.
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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.
2. Wear gloves and a mask when out of your home. Consider wearing a face shield.
3. Stay home as much as possible. Minimize your contact with others and maintain physical distance of at LEAST 6 feet / 2 meters. Avoid indoor places as much as you can.
4. Get your personal finances in order now. Cut all unnecessary costs.
5. Donate any PPE you can. https://getusppe.org/give/
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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.