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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Probably no school this fall. Dr. Anthony Fauci testified before Congress: "I would tell her, i'm sorry, sir, that in this case the idea of having treatments available or a vaccine to facilitate the re-entry of students into the fall term would be something that would be a bit of a bridge too far. As i mentioned the drug that has shown some degree of efficacy was modest. Not yet or maybe ever to be used either yet as treatment. So if the issue is the young individuals who would be going back to school would like to have some comfort and a treatment probably a thing that would be closest to utilization then would likely be passive transfer of convalescent serum. We're not talking about necessarily treating a student who gets ill but how the student will feel safe in going back to school. If this were a situation where we had a vaccine that would really be the end of that issue in a positive way. But as i mentioned in my opening remarks even at the top speed we're going we don't see a vaccine playing in the ability of individuals to get back to school this term."
Source: https://www.c-span.org/video/?471837-1/white-house-coronavirus-task-force-members-testify-coronavirus-response-reopening-phases&live
No school probably in the fall. The therapeutic he mentioned, Remdesivir, has had modest impact at best on blunting the impact of COVID-19.
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Estimated 1-year mortality rates for COVID-19 are 4.46% for high-risk individuals, substantially higher than the generally assumed death rate of 1-2%, according to a new study from the UK in the Lancet. "1-year mortality in the high-risk population was estimated to be 4·46% (95% CI 4·41–4·51). Age and underlying conditions combined to influence background risk, varying markedly across conditions. We provide policy makers, researchers, and the public a simple model and an online tool for understanding excess mortality over 1 year from the COVID-19 pandemic, based on age, sex, and underlying condition-specific estimates. These results signal the need for sustained stringent suppression measures as well as sustained efforts to target those at highest risk because of underlying conditions with a range of preventive interventions. Countries should assess the overall (direct and indirect) effects of the pandemic on excess mortality."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30854-0/fulltext
This is the first I've seen of studies attempting to look at the longer-term impact of COVID-19. The short summary? The weaker the containment/suppression measures, the more deaths you get. Stay Home will be with us for quite a while in some fashion.
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COVID-19 will also have substantial impacts on maternal and child mortality in low/middle income countries. "Our least severe scenario (coverage reductions of 9·8–18·5% and wasting increase of 10%) over 6 months would result in 253 500 additional child deaths and 12 200 additional maternal deaths. Our most severe scenario (coverage reductions of 39·3–51·9% and wasting increase of 50%) over 6 months would result in 1 157 000 additional child deaths and 56 700 additional maternal deaths. These additional deaths would represent an increase of 9·8–44·7% in under-5 child deaths per month, and an 8·3–38·6% increase in maternal deaths per month, across the 118 countries. Across our three scenarios, the reduced coverage of four childbirth interventions (parenteral administration of uterotonics, antibiotics, and anticonvulsants, and clean birth environments) would account for approximately 60% of additional maternal deaths. The increase in wasting prevalence would account for 18–23% of additional child deaths and reduced coverage of antibiotics for pneumonia and neonatal sepsis and of oral rehydration solution for diarrhoea would together account for around 41% of additional child deaths."
Source: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30229-1/fulltext
To some degree, all healthcare is resource-constrained. Every doctor we task to fighting COVID-19 is a doctor not treating something else. Every nurse in a COVID ward is a nurse who can't be in other wards, especially high-risk wards.
The more we can reduce the strain on healthcare systems, the better.
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COVID-19 is showing up in weird places, like your eyeballs. "Coronavirus disease 2019 (COVID-19) has been shown to affect different parts of the body, and ophthalmological changes have been associated with ocular external diseases such as conjuntivitis. Here we report retinal and OCT changes in 12 adults (six men and six women, aged 25–69 years), examined 11–33 days after COVID-19 symptom onset. All patients showed hyper-reflective lesions at the level of ganglion cell and inner plexiform layers more prominently at the papillomacular bundle in both eyes (figure). Results of OCT-angiography and ganglionar cells complex analysis appeared normal. Furthermore, four patients presented subtle cotton wool spots and microhaemorrhages along the retinal arcade, observed on fundus examination, color fundus photography, and red-free imaging. Visual acuity and pupillary reflexes were normal in all eyes, and we detected no symptoms or signs of intraocular inflammation."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31014-X/fulltext
Yep. COVID-19 damages your eyes in some cases. I'm not an ophthalmologist, so I can't say if these injuries are temporary or permanent, but either way, COVID-19 is more than just a respiratory illness.
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COVID-19 has also substantially dampened the number of organ transplants. "We noted a strong temporal association between the increase in COVID-19 infections and a striking reduction in overall solid-organ transplantation procedures (figure). The effect was seen in France and confirmed in the USA. The overall reduction in deceased donor transplantations since the COVID-19 outbreak was 90·6% in France and 51·1% in the USA, respectively. In both France and the USA, this reduction was mostly driven by kidney transplantation, but a substantial effect was also seen for heart, lung, and liver transplants, all of which provide meaningful improvement in survival probability."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31040-0/fulltext?rss=yes
Vulnerable patient groups appear to not be getting transplants done at nearly the rate before the pandemic. As we shared previously, in critical care, "time is tissue" - meaning the longer you put something off, the more damage your body incurs. If you or someone you know is a donor, be sure to keep your donor status updated in case there's a critical need.
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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:
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/?fbclid=IwAR1BsCnM8EzQkjPCOeyJO00xeOkzBPTlNSNdewV_0WBtDUbRBRizNrgljxg