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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An excellent thread by Dr. Muge Cevik:
"Concerns about outdoor transmission risk seem to be trending again. What is the risk of transmission outdoors and should we be more worried about outdoors with the new more-transmissible variant? (1/n)
The risk of transmission is complex and multi-dimensional. It depends on many factors: contact pattern (duration, proximity, activity), individual factors, environment (e.g. outdoor, indoor), socioeconomic factors, and mitigation measures in place. (2/n)(gov.uk/government/pub…\)
Transmission is facilitated by close proximity, prolonged contact, and frequency of contacts. So, the longer the time you spend with an infected person and the larger the gathering, the higher the risk is. (3/n) (academic.oup.com/cid/advance-ar…\)
But what is the likelihood of catching the virus outdoors? Contact tracing studies suggest that transmission risk is 20 times higher in indoor settings compared with outdoor environments. The risk is not zero but significantly lower. (4/n)
And we know that the majority of transmission (>90%) occurs indoors. Sharing the same sleeping space, frequent daily contact, engaging in group activities such as dining are high risk. So, the risk increases with longer & frequent exposure, close proximity, # of contacts. (5/n)
The small number of cases where outdoor transmission might have occurred were associated w/close interactions, particularly extended duration, or settings where people mixed indoors alongside an outdoor setting. (6/n)
Therefore, outdoor risk is negligible unless it involves close interaction or you are in a crowded or semi-outdoor environment. For example, walking on the street with no f2f contact, or passing by a jogger, the risk is very low as the duration of interaction is brief. (7/n)
With the new variant, all interactions are higher-risk, but outdoor risk is still relatively low. Most importantly, given very high community prevalence, you are much more likely to encounter someone infected now than a few months ago. (8/n)
Of course, we still need to show respect to others and their personal space outdoors, even though it’s low risk. But a recurring theme on social media and in the news is shaming people for spending time outside, when really this is one of the safer places. (9/n)
1- These messages are quite harmful because people are confused about where the real risk is. Majority of transmission continues to happen in indoor settings. (10/n)
2- There's a delicate balance between preventing infections and increasing lockdown fatigue. People do not have unlimited energy, so we should ask them to be vigilant where it matters most, which is indoors, while giving them a break outdoors. (11/n)
3- We have to assume that not everyone will be able completely eliminate social interaction for extended periods of time, especially people who live alone, so restricting outdoor activity will likely result in some people gathering indoors, where the risk is higher. (12/n)
4- Focusing on low-risk settings diverts us away from addressing structural factors driving majority of transmission. Higher cumulative infection rates are observed among those working in low paid, public facing jobs & living in crowded households. (13/n)
So, I can’t see how blanket "tougher" measures will help much now. Smarter response is urgently needed; making work places safer, invest in supportive measures for those who are disproportionately affected such as housing, income relief. (14/n)
For example, there is international consensus that those living in crowded households have 2-3x higher risk of infection. Housing in socioeconomically deprived areas is more likely to be overcrowded, increasing the risk of transmission. (15/n) (gov.uk/government/pub…\)
While there's been a lot of emphasis on testing, we haven't emphasised isolation enough. One simple measure, financial & social support for isolation, could make a huge difference. Here I discussed ways to scale up isolation w/ @vcallier (16/n)
Individually, we need to avoid / spend as little time as possible in crowded poorly ventilated indoor settings & wear a mask indoors/transport. Spend time outdoors. Open windows. Maintain distance, wash hands and engage in shorter interactions. (17/n)
Here is a thread based on our article published in CID summarising international data on transmission. (18/n)
In this article, we summarised international and UK contact tracing data, looking at transmission associated with households, occupational settings, transport and social/leisure settings. (19/n)
This is a fantastic article by @B_resnick where we discussed 4 ways to think about Covid-19 risk: Distance, time, activity, environment. (20/n)
In this interview, we discussed the key misunderstandings about transmission - BBC @sciencefocus (21/n)
While blaming rule-breakers is satisfying & easy, "psychologising and individualising the issue of adherence, one disregards the structural factors which underlie the spread of infection." This is a great article by @ProfJohnDrury @ReicherStephen (22/n)
Further thoughts about outdoor risk, why shaming people for spending time outside is counterproductive, where we should be focusing right now. Discussed w/ Evan Davies @EvanHD @BBCRadio4 PM program - you can listen via link @ 5:20pm GMT today. (23/n)
Need to be careful with car share b/c of close proximity of people in a confined space. Recommend avoiding car-share w/non-households, or if you have to take a short ride + open windows + use mask (but not zero risk). Tweet #19 for more details. (24/n)"
Source:
Commentary: Pretty much any mask will do outdoors to cut your risk substantially. Staying outdoors and maintaining distance allows you to interact socially with friends. Get together for a long walk, a bike ride, a game of tennis - any activity that does not require you to remove your mask outdoors is almost completely safe. That's the bottom line right now.
What isn't safe? Anything that requires you to be indoors for a prolonged period with a lower quality mask (less than N95), or anything that requires you to remove your mask for any reason (eating, drinking, smoking, etc.)
If you're not sure how to properly fit a mask, watch this short 2 minute video:
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Bavaria has started to require FFP2 (N95 equivalent in the EU) masks. Disclosure: Google-translated.
"Anyone traveling by bus or shopping in the supermarket in Bavaria will have to wear an FFP2 mask from next week. The state government decided that. As the State Chancellery announced , the extended mask requirement will apply from January 18. In addition, a weekly test obligation for cross-border commuters was decided.
Prime Minister Markus Söder (CSU) sees the first successes of the corona restrictions. "The measures are slowly starting to take effect," said Söder after a meeting of the Council of Ministers and spoke of a "cautiously positive trend" in the corona numbers. Within 24 hours there were 1,740 new infections in Bavaria - almost 500 fewer than a week ago. With a seven-day incidence of 158.8, the Free State is in seventh place nationwide.
Söder pointed out that the progress in vaccinations also gave reason for hope. So far, around 140,000 people in Bavaria have been vaccinated against the pathogen.
However, the death rate is still high. It is not yet clear how the holidays will ultimately affect, said Söder. He is also "very concerned" about the virus mutation from Great Britain, which has now also been found in Germany. The CSU boss warned that patience was still needed. "Nobody can say when Corona will end."
Söder spoke of a "race against time". FFP2 masks are now easily available. "The availability in the trade is sufficiently guaranteed, so there is no shortage of FFP2," he said. An obligation to test for cross-border commuters was overturned by the Bavarian Administrative Court last year. Now that the federal government has drawn up a new quarantine ordinance, a weekly test obligation can be introduced again on this basis."
Source: https://www.zeit.de/politik/deutschland/2021-01/bayern-macht-ffp2-masken-in-geschaeften-und-oepnv-zur-pflicht
Commentary: This is a substantial step, and one I think every nation should take. At the very least, every person reading this newsletter - you - should take it for yourself. Masks that are rated N95 or higher (including N99, P99, N100, and P100), KN95 or higher, or FFP2/FFP3 are the masks you should be looking for and wearing any time you'll be around other people. Cloth masks are fine outdoors and in empty places. Indoors in malls, stores, etc. you should be wearing a rated mask. We know the new strains - B.1.1.7 and 501Y.V2 are on average 35% more contagious. Cloth masks were already around 70% effective; the new strains may diminish their effectiveness.
Unlike in the spring of 2020, there's plenty of supply now of N95/KN95/FFP2 masks. I was at my local hydroponics store this weekend and they had crates of rated masks on sale. Be sure to wear one, and wear it properly.
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No herd immunity globally in 2021. "World Health Organization (WHO) chief scientist Soumya Swaminathan said Monday that herd immunity to the coronavirus would not be achieved in 2021, despite the growing availability of vaccines.
Mitigating factors to herd immunity include limited access to vaccines in developing countries, skepticism about vaccination and the potential for virus mutations, according to health experts.
A growing number of countries around the world — including the United States, the United Kingdom, Singapore, and Germany and other EU countries — are in the first stages of mass-vaccination campaigns.
Herd immunity occurs when enough people in a population have immunity to an infection so that it prevents the disease from spreading.
"We are not going to achieve any levels of population immunity or herd immunity in 2021," Swaminathan told a briefing, while emphasizing that measures such as physical distancing, handwashing and wearing masks continue to be necessary in containing COVID-19's spread for the rest of the year. "
Source: https://www.dw.com/en/covid-herd-immunity-will-not-happen-in-2021-says-who/a-56197701
Commentary: There's likely no going back entirely to the pre-pandemic world. What will change in 2021 for folks who go out and get the vaccine is the ability to do close gatherings. For example, once everyone in my family has been vaccinated (and the correct amount of time has passed to ensure the vaccine is effective), I would feel safe having a private holiday gathering. I would feel comfortable visiting family and having them visit me for birthdays and other celebrations. I would feel comfortable having coffee privately with a vaccinated friend in an airspace I own, like my home. I would feel comfortable allowing vaccinated kids to play together outside or in a home.
I would still not feel comfortable dining out, going to bars, etc. - any activity that required me to remove my mask in the presence of the non-vaccinated, I'd still feel less comfortable doing until we have evidence that the vaccine also suppresses transmission risk.
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Long haul, six months later. "To our knowledge, this study is the largest cohort study (n=1733) with the longest follow-up duration for the consequences of adult patients discharged from hospital recovering from COVID-19. Our findings showed that 76% of patients reported at least one symptom at 6 months after symptom onset, and the proportion was higher in women. The most common symptoms were fatigue or muscle weakness and sleep difficulties. Additionally, 23% of patients reported anxiety or depression at follow-up. The percentage of patients with pulmonary diffusion abnormality during follow-up is higher in patients with more severe disease at acute phase. These patients also have a higher CT score at follow-up. Ground glass opacity and irregular lines are the most common pattern at follow-up. In multivariable analysis, women and participants with severity scale 5–6 have a higher risk of lung diffusion impairment, anxiety or depression, and fatigue or muscle weakness. The seropositivity of the neutralising antibodies, N-IgM, RBD-IgM, and S-IgM, N-IgA, RBD-IgA, and S-IgA antibodies, and RBD-IgG, and neutralising antibody titres at follow-up were significantly lower compared with at acute phase.
At 6 months after symptom onset, patients with COVID-19 had symptoms of fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients with a more severe illness during their hospital stay had increasingly impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and these are the patients who are the main target population for intervention of long-term recovery. The decline of neutralising antibodies raises concern for severe acute respiratory syndrome coronavirus 2 re-infection. The risk of re-infection should be monitored for patients who present with new symptoms of COVID-19."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32656-8/fulltext
Commentary: Interesting that there's greater concern for risk of reinfection for those who have had severe COVID-19.
The bottom line is that you don't want this disease. Yes, it has a relatively small chance of killing you. But it has a reasonably large chance of making your life miserable, possibly for a very long time. Don't take the risk. Wear a mask, protect yourself, get vaccinated when available to you.
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A reminder of the simple daily habits we should all be taking.
1. Always wear the best mask available to you when out of your home and you'll be around other people. Respirators are back in stock at online retailers, too.
2. Get vaccinated as soon as you're able to.
3. Wash/sanitize your hands every time you are in or out of your home for any reason.
4. 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.
5. Get your personal finances in order now. Cut all unnecessary costs.
6. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
7. 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).
8. How to properly fit a mask:
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Common misinformation debunked!
There is no mercury or other heavy metals in the Pfizer mRNA vaccine. https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
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.