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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Harvard's Chan Public School of Health on disparities in COVID outcomes: "Key findings are that the surge in excess death rates, both relative and absolute, was evident starting in early April, and was greater in city/towns and ZCTAs with higher poverty, higher household crowding, higher percentage of populations of color, and higher racialized economic segregation."
Source: https://cdn1.sph.harvard.edu/wp-content/uploads/sites/1266/2020/05/20_jtc_pdw_nk_COVID19_MA-excess-mortality_text_tables_figures_final_0509_with-cover-1.pdf
From the Boston Globe article: "The results were unambiguous: As the death rate increased across the state in early April, it surged nearly 40 percent higher in cities and towns with the largest concentrations of people of color compared to those with the least. The mortality rate increased nearly 14 percent more in municipalities with the most crowded housing compared to those with the least. And in cities and towns with the most poverty, the death rate increased 9 percent more than those with the least poverty."
Source: https://www.bostonglobe.com/2020/05/09/nation/disparities-push-coronavirus-death-rates-higher/
As with many universalities like disease, COVID-19 doesn't discriminate, but people do. COVID-19 has illuminated the sharp disparities between haves and have-nots around the world, in every community. More important, having populations who are at greater risk increases the risk for everyone. All it takes is one infected person of any background to be in the wild to start an outbreak again.
The cliche "we're in this together" is actually true, and would go a long way towards solving the pandemic if we did what we said and treated each other equally, as if we were all in this together.
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Peer-reviewed research from the CDC estimates the native, uncontained reproduction number of SARS-CoV-2 is 5.7. "Severe acute respiratory syndrome coronavirus 2 is the causative agent of the 2019 novel coronavirus disease pandemic. Initial estimates of the early dynamics of the outbreak in Wuhan, China, suggested a doubling time of the number of infected persons of 6–7 days and a basic reproductive number (R0) of 2.2–2.7. We collected extensive individual case reports across China and estimated key epidemiologic parameters, including the incubation period. We then designed 2 mathematical modeling approaches to infer the outbreak dynamics in Wuhan by using high-resolution domestic travel and infection data. Results show that the doubling time early in the epidemic in Wuhan was 2.3–3.3 days. Assuming a serial interval of 6–9 days, we calculated a median R0 value of 5.7 (95% CI 3.8–8.9). We further show that active surveillance, contact tracing, quarantine, and early strong social distancing efforts are needed to stop transmission of the virus."
Source: https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article
5.7 is substantially higher than early estimates of a 2.4-3.0 reproduction number. This bug is crazy contagious in the right settings.
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Dr. Muge Cevik has an excellent thread worth reading. "While the infectious inoculum required for infection is unknown, these studies indicate that close & prolonged contact is required for #COVID19 transmission. The risk is highest in enclosed environments; household, long-term care facilities and public transport."
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"High infection rates seen in household, friend & family gatherings, transport suggest that closed contacts in congregation is likely the key driver of productive transmission. Casual, short interactions are not the main driver of the epidemic though keep social distancing!"
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"Increased rates of infection seen in enclosed & connected environments is in keeping with high infection rates seen in megacities, deprived areas, shelters. A recent preprint demonstrates that #COVID19 epidemic intensity is strongly shaped by crowding"
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"While we have limited data, similar high risk transmission pattern could be seen in other crowded & connected indoor environments such as crowded office spaces, other workplace environment, packed restaurants/cafes, cramped apartment buildings etc."
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"we need to redesign our living/working spaces & rethink how to provide better, ventilated living/working environment for those who live in deprived & cramped areas; (b) avoid close, sustained contact indoors & in public transport, & maintain personal hygiene."
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Crowds and indoors. These are the two things our societies will need to avoid until we have a working vaccine. Open office floor plans? Toast. Conferences and tradeshows? Not for a long while. Movies? At the drive-in, where everyone has to distance because there's only so close you can get while in a vehicle.
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Debunking herd immunity, from the folks at Johns Hopkins. "To reach herd immunity for COVID-19, likely 70% or more of the population would need to be immune. Without a vaccine, over 200 million Americans would have to get infected before we reach this threshold. Put another way, even if the current pace of the COVID-19 pandemic continues in the United States – with over 25,000 confirmed cases a day – it will be well into 2021 before we reach herd immunity. If current daily death rates continue, over half a million Americans would be dead from COVID-19 by that time."
Source: https://coronavirus.jhu.edu/from-our-experts/early-herd-immunity-against-covid-19-a-dangerous-misconception
Read the article in full, it's worth it. There is no herd immunity anywhere on planet Earth yet, and there won't be for quite some time. In five years, with or without a vaccine? Probably. But certainly not in the next year or two. Anyone saying otherwise has no understanding of the science or the math.
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Dr. Scott Gottlieb showcases data about states which are outliers in opening up - in a bad way. "Comparison of U.S. reopen states with European nations also reopening. Many reopen states are in line with European countries in terms of reduction in spread, epidemic density, positivity. Some reopen states are outliers, don't meet same criteria (TN, AL, GA, TX, CO, SD, ME, IN)"
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Getting to and keeping the reproduction number under 1.0 is the only way we contain COVID-19. Any place with higher than 1.0 reproduction numbers have no business opening up anything. If your municipality is opening up and it's on the risk list with a higher than 1.0 reproduction number, stay home and contact your elected officials urging them to keep things contained until that number falls below 1.0.
Here's the challenge: until your location meets its testing quotas, any reproduction number is effectively useless. Not enough testing? Don't open up.
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Another study out of Harvard looks at mobility. "Results: The estimated population prevalence of SARS-CoV-2 ranged from 11.3% (95% credible interval 8.9%, 13.9%) in Manhattan to 26.0% (95% credible interval 15.3%, 38.9%) in South Queens, with an estimated city-wide prevalence of 15.6% (95% credible interval 13.9%, 17.4%). The peak city-wide prevalence was during the week of March 30th, though temporal trends in prevalence varied substantially between boroughs. Population revalence was lowest in boroughs with the greatest reductions in morning commutes out of and evening commutes into the borough (Pearson R = –0.88, 95% credible interval –0.52, –0.99). Conclusions and relevance: Reductions in between-borough mobility predict geographic differences in the prevalence of SARS-CoV-2 infection in New York City. Large parts of the city may remain at risk for substantial SARS-CoV-2 outbreaks. Widespread testing should be conducted to identify geographic disparities in prevalence and assess the risk of future outbreaks."
Source: https://dash.harvard.edu/handle/1/42665370
This one's pretty easy to understand. Mobility - people moving around - creates outbreaks. Keep people at home, outbreaks fizzle out.
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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.
2. Wear gloves and a mask when out of your home.
3. Stay home as much as possible.
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:
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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/?fbclid=IwAR1BsCnM8EzQkjPCOeyJO00xeOkzBPTlNSNdewV_0WBtDUbRBRizNrgljxg