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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You know, I was earnestly hoping that I could have retired this newsletter by now because we would have contained this thing.
Let's hit the circuit.
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Dr. Scott Gottlieb: "Well, look, I think things are going to get worse before they get better. There's some private modeling floating around that shows that this is possibly going to peak in the next two or three weeks. You see Google mobility data and Open Table reservation starting to decline in the southern states with these dense epidemics are happening, which is an indication that consumers are pulling back and that's going to create somewhat of a backstop but I think what you're likely to see in the south, which is different than New York, New York really followed the pattern of Italy where it was a sharp up a huge epidemic, but it came down rapidly. I think in the south you likely to see an extent Did plateau we really don't have a national approach here, what we have is state approaches that are creating regional effects. And so those regional effects are different than New York experience mirrored Italy, I think the southern experience is more likely to mirror Brazil, where you're likely to see more of an extended plateau once we reach that Apex and you could reach the apex in the next two or three weeks.
I think that they felt they were out of the woods after that first wave pass, but this has really been a regional experience the United States and what happened was they reopened against the backdrop of what was a lot of spread. They had Really crushed. No states. And people became too early in my view and people became complacent, especially younger people, they were going out not taking precautions. Older people were taking precautions. They were protecting the nursing homes in the vulnerable. But inevitably, what happens is that the younger people go out and get infected, because they're not taking those precautions, it's going to get back into a more vulnerable population. That's what we're seeing right now. You're seeing rising cases in nursing homes positivity in the states is actually declining in the younger population, but rising in the older population, and if you want sort of a proxy for that experience, you look at Iran. Iran had a major epidemic, it came way down. They had a second peak, it was mostly in younger people. They said, Don't worry, it's younger people. So we're not going to see the same level of deaths. But eventually the infection seeped into an older population. That's what's happening. Now you're starting to see more outbreaks in nursing homes. So tragically, we're going to see deaths start to rise and that's why I said two to three weeks until you see deaths get back above 1000.
I think this is something they should look at remember, it's not binary. It's not either airborne or droplet transmission. This could be spread primarily through droplet transmission, but in certain settings that are very conducive to respiratory spread, you get something that approximates airborne transmission and what what are those conditions it's enclosed spaces spaces with recirculating air air conditioned spaces where it's cooler and it's more conducive to spread. So in optimal conditions indoors, you might get the kind of spread patterns that approximate airborne transmission and in those settings, we should be thinking about trying to improve conditions putting in heppa filters putting in UV light and air conditioning systems. I think these are things you should be looking at. And in fact, many businesses are doing that they are looking at retrofitting. You know, air conditioning systems, it's in some cases, it's not very expensive to do that in other cases. might be more expensive?
And what we've learned from this virus is it surprised us as both we both underestimated and overestimated at the same time. So we need to be prudent. I think it's important to give discretion to local districts to take steps to try to densify schools and protect kids so we don't have outbreaks. Everyone should be working to reopen schools. It's critical. When I talk to Republican and Democratic governors, they're in fact doing that. But I think districts need discretion to try to put in place measures to keep kids safe. No other country with the exception maybe of Sweden reopened their schools are kept their schools open against the backdrop of so much spread that we're attempting to do in this country. So we do face unique risks. And while the balance of the data shows that kids are less susceptible to infection and less likely transmitted, less susceptible doesn't mean they're not susceptible and sometimes in some of the studies show that they can compensate for their decline in susceptibility by their propensity to spread infection by their behaviors that are more likely to propagate infection. And one final point here, you know, if we look at the 2018 2019 flu season, 11.3 million kids became symptomatic from flu that season, there were 480 tragic deaths. We have not seen 11.3 million kids get symptomatic COVID yet, because we've largely sheltered the children and we don't want to see it. We've got to take measures to make sure it doesn't become epidemic in children in the same way that flu becomes epidemic in children because we don't know what the impact is going to be on kids right now. The kids have been sheltered, I would guess that the infection rates among children has been relatively low in this country."
Source:
Commentary: The situation as it stands right now is that our nation's children largely have not been infected yet. That will change if schools are reopened before we have the disease under control. Many people point out that mortality rates and other adverse consequences are lower for younger people, and thus far that has been true. The challenge is that we still have a big unknown to tackle: comorbidities. We know obesity is a substantial comorbidity with COVID-19. We also know, according to CDC data, that American children are suffering from obesity.
For children and adolescents aged 2-19 years1:
The prevalence of obesity was 18.5% and affected about 13.7 million children and adolescents.
Obesity prevalence was 13.9% among 2- to 5-year-olds, 18.4% among 6- to 11-year-olds, and 20.6% among 12- to 19-year-olds. Childhood obesity is also more common among certain populations.
Source: https://www.cdc.gov/obesity/data/childhood.html
What happens when the children of America get exposed to COVID-19 en masse and have these substantial comorbidities?
If we open too soon, we'll find out.
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Mayor Kate Gallego, Phoenix. "It continues to be a very difficult situation in the Greater Phoenix area. We are seeing positivity rates above 20%. We continue to have a real challenge with testing although there was some very good news this week about additional resources that are coming. We are setting records of the type you don't want to set for the use of ventilators by COVID patients, acute care beds or healthcare workers are telling us they are already tired and they are worried that there could be an additional growth. After the Fourth of July, there was a little bit of flattening in the rate of growth. So maybe too early to celebrate and we don't have a firm trend yet, but I'm looking for positive news.
We have separately elected school boards. And we're now seeing many of those elected leaders say we can't open until at least October. With the levels of the virus so pronounced in our community, they just don't feel like it's a safe environment for teachers to go in. And they're concerned about our students as well as spread of the virus. I hope there'll be full financial support for those school districts, including digital programming.
The best advice that public health professionals give is to stay home but that's difficult if you don't have a home are about to be evicted from it. I'm deeply worried about the expiration of the eviction order. What we're hearing is particularly renters are at risk. Many mortgage companies have been willing to say we have a 30 year mortgage, we'll add a few months at the end. But if you were in month six of a year lease, you're you're at huge risk of being evicted. And I feel for our landlords, landlords, we have many retired couples who own a duplex and that's a big part of their retirement. So we need to think about landlords as well. Okay, what we're hearing is that our communities of color who are already so hard hit are likely to be among the highest levels of evictions, so it's, it's concerning from many levels."
Source:
Commentary: Mayor Gallego highlights an important point: you can't stay home if you're evicted from it. Hopefully city and state governments can work to resolve the issue before it becomes a massive problem during the pandemic.
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The US Surgeon General on complications with reopening schools. "Well, thank you for that question. I have a 16, a 14 and a 10 year old and I want them back in school. We know that kids who are not in school, they're more likely to be obese to misuse substances. There's less reporting of Sexual Abuse and Child Abuse. There are real health implications to not being in school, but it has to be done safely. And I think it's the headlines that are out, talk about best case scenarios. And I'll give you a very specific example. They say that every kid should bring in their own lunch. So you asked for a specific example. We know that in some school districts in many school districts, over 50% of kids are eating lunch at school and don't have the ability to bring their own lunch. So that's one case where we need to work directly with local school districts and help them figure out okay if you can't do what is The Gold Standard best case scenario, can you do something that's a compromise to safely reopen?"
Source:
Commentary: For good or ill, in the United States, schools are also childcare centers, many of which feed their charges. If schools are reopening without meal service, 50% of kids who cannot bring their own lunch due to economic reasons is a major problem that needs to be solved.
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COVID Exit Strategy has needed to add a new color: bruised red. "As a country we've reached a record number of cases. We've added a new color to the scale: "Bruised Red". There were extremes that were not captured in our original scale. Our scale also has been adjusted to put more weight on "new cases per million" and "positivity"."
Source: https://www.covidexitstrategy.org/definitions-and-criteria
Commentary: With this status update, it becomes abundantly clear how bad the problem is within America, and why American's won't be able to travel many places until we've gotten the pandemic under control.
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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. Wear gloves and a mask when out of your home. Consider wearing a face shield if you can't breathe at all through a mask. 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. Avoid indoor places as much as you can.
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.
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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.