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.
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Commentary: As you may have noticed, I've slowed publication of the newsletter from being a "daily no matter what" to "daily when there is news to share". More often than not these days, the news is on things like anti-vax movements, politicians doing their thing, etc. and not on new information that benefits us or that we can act on. There's only so many times I can write "go get vaccinated".
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Europe has started its 2021 winter wave, with Belgium, Denmark, Germany, Russia, and the Netherlands showing record one-day increases.
Source:
Commentary: As Europe goes, so does North America, typically with about a 3-4 week lag. Expect to see cases increase sharply in the USA, Canada, and Mexico as we head into the holiday season. Be safe, wear a mask.
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More on the winter wave. "It’s deja vu, yet again. The pandemic first hit Europe in March 2020, and Americans were in denial, thinking it wouldn’t happen here. Then, later in the year, the Alpha variant wave took hold in the United Kingdom and the United States was unprepared. This recurred with Delta in the summer of 2021. Now, in the fall of 2021, Europe is the outlier continent on the rise with Covid, with approximately 350 cases per 100,000 people and many countries are soaring to new records. This not only involves eastern and central Europe, where there are some countries with low vaccination rates (such as Georgia, only 24% fully vaccinated) and caseloads as high as 160/100,000 (Slovenia), but also western Europe, such as Austria, Belgium, Ireland and several others. Indeed, in Germany, leading virologist Christian Drosten recently warned their death toll could be doubled if more aggressive mitigation and vaccination strategies were not quickly adopted.
Why is this happening again in Europe after the Delta wave passed through and high rates of vaccination were achieved? There are a few important reasons. First, there are a large proportion of unvaccinated individuals in each country, and only countries such as Spain at 80% and Portugal at 88% that fully vaccinated their total populations have set a high bar and have thus far withstood the continental trend of rise in cases. Noteworthy is Belgium with 74% fully vaccinated and one of the hardest-hit countries in the world, now at 79/100,000, currently 10th highest caseload globally. That alone tells us 74% isn’t enough, and that prior Covid (without vaccination, what some refer to as “natural immunity”) is unreliable for representing a solid immunity wall against the Delta variant. In fact, it has been projected for Delta that any country needs to achieve 90-95% of its total population fully vaccinated (or with recent Covid) in order to have population-level immunity that covers, providing relative protection, for the others.
Key among the unvaccinated are teenagers and children. For European countries, the UK was slower in starting their vaccination program for teens and that has been suggested as one of the reasons their cases started rising again. There is compelling data from both the UK and United States that children and teens have been a key driver of spread in recent months.
It is noteworthy that we are not dealing with just cases or a “casedemic”. For example, Greece’s cases have now quickly soared to 650/100,000 people and so has their death rate increased. While many countries have “uncoupled” their rise in cases from hospitalizations and deaths, that is incomplete at best, and many infected individuals are getting seriously ill, no less the risk of long Covid which remains under-recognized as to its importance and potential of durable disabling effects.
Second, there is evidence of waning of immunity on top of the hyper-contagious Delta strain. Even though much of Europe got a later start in vaccination, a recent study showed that with the Astra Zeneca vaccine the decline in anti-spike antibody occurred quite early and there was a clear relationship between antibody levels and breakthrough infections. Decline below the anti-spike antibody threshold of 500 U/ml was reached at 96 days for AstraZeneca’s vaccine compared with 257 days for Pfizer’s. The impact of waning, and the opportunity to restore very high (~95%) effectiveness of mRNA vaccines (specifically Pfizer/BioNtech) with booster (third) shots has been unequivocally proven from the Israeli data. Yet the adoption of boosters, even in the highest-risk groups such as age 60 plus, has been very slow.
Third, there has been relaxation or abandonment of mitigation measures. Countries such as Denmark and Norway completely reopened and have seen resurgence of cases since that occurred. Throughout the world, the profound pandemic fatigue has led to the irresistible notion that the pandemic end is nigh, that masks, distancing, and other measures have run their course, essentially that enough is enough. It is hard to imagine fighting a foe as formidable as Delta that a vaccine-only strategy can be effective. We’ve seen a dramatic improvement in Japan, with full return to baseline after their worst outbreak, by the combination of high level of vaccination and the continued use of masks and mitigation measures.
That brings us to the United States, sitting in the zone of denial for the fourth time during the pandemic, thinking that in some way we will be “immune” to what is happening in Europe. That somehow the magical combination of mRNA vaccines with only 58% of the population fully vaccinated, a relatively low proportion of booster shot uptake, a start to vaccinating teens and children, and a lot of prior Covid, and little in the way of mitigation, will spare us. That’s no magic. Add to that the complete lack of availability of cheap, rapid home tests to screen for infectiousness. Unlike Europe, the US was not capable of uncoupling cases from hospitalizations and deaths during its initial Delta wave – fully 75% of hospitalizations and 66% of deaths occurred compared to its third wave peak before vaccinations were available"
Source: https://www.theguardian.com/commentisfree/2021/nov/12/covid-cases-surging-europe-america-denial
Commentary: The message should be clear to everyone: it's mask season. And not just any mask, but the best mask available to you, ideally an N95 or better that fits properly.
Cloth masks are not good enough against Delta and newer variants. That's all there is to say.
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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. 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 permitted.
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.