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.
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The COVID-19 pandemic in America is the worst it's ever been.
"New record highs for 17 consecutive days
- Midwest and West regions set new highs
- 49 US States are in the Red/Orange Zones for cases
- 49 states are up
- 3 of 4 Regions up over 40% for the week"
Source:
Commentary: America hit a new all-time high today, with 147,274 new cases reported today. This is what exponential growth looks like, and at this pace, 200,000 new cases per day could be very soon. Deaths are on the rise; 1,432 new deaths today.
America will need to make some tough choices very soon. Keep going the way things are going, or change course with substantially restrictive measures.
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The key is hospital utilization. "North Dakota's hospitals have reached their limit, and the coming weeks could push them past their capabilities, Gov. Doug Burgum said at a news conference on Monday, Nov. 9.
Due to a major shortage of health care staffing, the state's hospitals have a severe lack of available beds. Rising COVID-19 hospitalizations and high noncoronavirus admissions, some resulting from residents who deferred health care earlier in the pandemic, have caused the crunch on medical centers.
Burgum said hospitals are implementing their "surge" plans, and some will be voluntarily stopping elective surgeries to free up staff. He added that the state will coordinate with hospitals to move nurses to medical centers in most dire need of staff.
In an attempt to alleviate some of the staffing concerns, Burgum announced that interim State Health Officer Dirk Wilke has amended an order that will allow health care workers with asymptomatic cases of COVID-19 to continue working in COVID-19 units at hospitals and nursing homes.
The move aligns with "crisis" guidelines from the Centers for Disease Control and Prevention. Since only patients with COVID-19 could receive care from doctors and nurses with the virus, Burgum said he believes there will be little risk of more spread. He added that health care workers in COVID-19 units already wear protective gear to prevent them from contracting the virus."
Source: https://www.grandforksherald.com/newsmd/coronavirus/6753876-With-North-Dakota-hospitals-at-100-capacity-Burgum-announces-COVID-positive-nurses-can-stay-at-work
Commentary: What causes COVID-19 mortality rates to jump is insufficient healthcare resources. What causes resource depletion is case loads. America was at a manageable point a few months ago - not great, but manageable - in summertime. Now that colder weather has settled in and gatherings indoors are increasing, we are seeing substantially more cases, especially in places that don't have a ton of healthcare excess capacity. This is what will cause death rates to spike in the coming weeks.
What you can do is what you have been doing. Stay home. Stay safe. Wear a mask, always outside of your home, no exceptions. Stay out of indoor places that aren't your home.
And encourage everyone you know to do the same.
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A new and painful twist: people refusing testing. "At a September webinar entitled, โUntil We Have a COVID-19 Vaccine,โ epidemiologist Michael Osterholm, PhD, MPH, expressed concerns about insufficient testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the US.
The problem has morphed from inadequate testing capacity to inadequate numbers of people agreeing to be tested, said Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
In the pandemicโs early weeks, when a shortage of tests meant that mainly hospitalized patients were being tested, the demand was greater than the supply. Months later, laboratories have greater testing capacity, but in some states, testing rates have dropped as cases have increased.
Test avoidance appears to be a growing problem, at least anecdotally. Many of the same people who dismiss the need to test feel the same way about wearing a mask, in part because they think no one has the right to tell them to do either.
โThere are challenges with the messaging, from the top to the bottom,โ said Charity Menefee, MA, director of communicable and environmental disease and emergency preparedness at the Knox County Health Department in Tennessee. โThe [pandemic] fatigue has set in; the politics have gotten more intense.โ
Testing is a key component of contact tracing, and only testing can reveal whether flulike symptoms are due to influenza or to the much more contagious and deadly SARS-CoV-2.
But most states arenโt performing enough tests, as evidenced by their 7-day average positivity rates, according to the Johns Hopkins Testing Tracker. As of October 23, only 16 states and the District of Columbia had a positivity rate of 5% or lower, which the World Health Organization has said jurisdictions should achieve for at least 14 days before reopening.
Not only does a positivity rate of more than 5% suggest greater community transmission, it also โindicates a state may only be testing the sickest patients who seek out medical care and is not casting a wide enough net to identify milder cases and track outbreaks,โ the trackerโs website notes.
Apparently, thatโs a difficult concept to grasp for some people, including the governor of Missouri. Missouriโs 7-day average positivity rate reached an all-time high of 18.3% on October 16, a record that Republican Governor Mike Parson mistakenly attributed to increased testing, echoing similar assertions by President Donald Trump and Vice President Mike Pence."
Source: https://jamanetwork.com/journals/jama/fullarticle/2772860
Commentary: This is an unsurprising and disheartening extension of the concept of personal liberty above all else, including communal good. Testing helps not only yourself, but those around you. However, failure to achieve testing goals means that businesses and other services will remain shuttered for longer, as the 5% positivity rate is an important benchmark.
Imagine trying to put together a jigsaw puzzle, but one player is intentionally withholding half the pieces. How well will that effort go?
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Healthcare consumption overall on the decline. "This cross-sectional study with a claims-based analysis of 6.8 million commercially insured individuals found that during the initial phase of the COVID-19 epidemic in March and April of 2020, patients significantly reduced use of preventive and elective care and increased use of telemedicine but not enough to offset reductions in in-person care. Racial/ethnic and income disparities were seen in changes in use of in-person care and telemedicine.
In this study, the initial 2 months of the COVID-19 pandemic were associated with large reductions in use of health services; future policy initiatives should ensure that these reductions do not adversely affect patient health.
This cross-sectional study analyzed health insurance claims for patients from all 50 US states who receive health insurance through their employers. Changes in use of preventive services, nonelective care, elective procedures, prescription drugs, in-person office visits, and telemedicine visits were examined during the first 2 months of the COVID-19 pandemic in 2020 relative to existing trends in 2019 and 2018. Disparities in the association of the pandemic with health care use based on patientโs zip codeโlevel race and income were also examined.
In this cross-sectional study of a large US population with employer-sponsored insurance, the first 2 months of the COVID-19 pandemic were associated with dramatic reductions in the use of preventive and elective care. Use of telemedicine increased rapidly but not enough to account for reductions in in-person primary care visits. Race and income disparities at the zip code level exist in use of telemedicine."
Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772537
Commentary: Consumption of elective healthcare and healthcare maintenance declined, and that's no surprise. What we should be on the lookout for is whether that trend has continued, because it can create substantially worse outcomes later on.
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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.
6. Participate in your local political process. For Americans, go to Vote.org and register/verify your vote.
7. Ventilate your home as frequently as weather and circumstances permit.
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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.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.