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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A significant mutation of SARS-CoV-2 appears to have occurred. "He told MPs in the House of Commons that over the last week, there had been sharp, exponential rises in coronavirus infections across London, Kent, parts of Essex and Hertfordshire.
"We've currently identified over 1,000 cases with this variant predominantly in the South of England although cases have been identified in nearly 60 different local authority areas.
"We do not know the extent to which this is because of the new variant but no matter its cause we have to take swift and decisive action which unfortunately is absolutely essential to control this deadly disease while the vaccine is rolled out."
Prof Alan McNally, an expert at the University of Birmingham, said UK testing labs had picked up on this new variant in the last few weeks.
He told the BBC: "Let's not be hysterical. It doesn't mean it's more transmissible or more infectious or dangerous.
"It is something to keep an eye on.
"Huge efforts are ongoing at characterising the variant and understanding its emergence. It is important to keep a calm and rational perspective on the strain as this is normal virus evolution and we expect new variants to come and go and emerge over time.""
Source: https://www.bbc.com/news/health-55308211
Source:
Commentary: One of the most critical reasons to slow the spread of a virus through whatever measures available is that every new case of a virus has the small but non-zero chance to be the spawn point of a new mutation. The D614G mutation in Europe accelerated the spread of COVID-19, and early speculation from Sky News is that this new strain may be spreading still faster.
We will need to wait for genomics labs to fully sequence the new SN501 mutation and better understand if it has increased infectivity or other characteristics, but the most important thing you can do with this information is to stop the spread. Wear a mask. Watch your distance. Wash your hands. Walk out of indoor spaces that aren't your home as soon as possible. The fewer cases, the fewer chances for mutation that leads to significant, adverse outcomes.
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Should pregnant/lactating women receive the vaccine? "Should pregnant people vaccinate? It is a complicated question, but fortunately the new vaccine technology being utilized by Pfizer/BioNTech and Moderna may offer specific benefits for such women. Of course, the underlying context to this question is our knowledge that pregnant women have fared worse with covid-19. This fact must be taken into account.
The race for vaccine distribution is now on. The Pfizer/BioNTech vaccine has already received Emergency Use Authorization (EUA) and Moderna's candidate is likely not far behind. Unfortunately, neither trial (which included 30,000 participants in each) was designed or intended to be conducted with pregnant women. Such exclusions are standard practice for obviously reasons. However, in the Pfizer trial, 12 participants who received the vaccine became pregnant between the first and second doses. So far, no adverse events have been reported. Incidentally, two of the 11 women in the placebo arm who became pregnant had miscarriages. However, the follow-up time is still too short to determine outcomes of the pregnancies or the fetuses themselves. This will be watched closely in the coming months.
Nevertheless, what sets these two vaccines apart is that they use messenger RNA (mRNA), which is a "novel" vaccine approach. While science and medicine have never used this particular method of vaccine delivery before (i.e. there are no vaccines for other diseases that work on the same biological principles), this technology has distinct advantages; they actually mimic how our bodies' own biochemical machinery works. In essence, the mRNA in the vaccine acts as a recipe card of sorts, telling our cells to manufacture a small part of the virus (the spike protein), to which the body then develops its own immune response. By comparison, some of our traditional vaccines are called "live" vaccines, meaning that a weakened version of a virus is injected into a patient to create the immune response. Unfortunately, these vaccines are specifically contraindicated for pregnant patients due to the theoretical risk of infecting the fetus. With mRNA delivery this shouldn't be a problem. That means that the mRNA technology is also a potential breakthrough for a slew of other viruses that pregnant women may want to take in the future, if and when such options become available.
In fact, The Society of Maternal and Fetal Medicine (SMFM) issued a statement reporting that the risk of the mRNA vaccine appears low. Furthermore, the statement even mentions that the mechanism used in AstraZeneca's vaccine is similar to that of an Ebola vaccine (not mRNA, but rather a "viral vector," as described above), which also has thus far had an, "acceptable safety profile" during pregnancy.
It should also be noted that for lactating women, mRNA is likely too fragile to reach the breastmilk. If any of the resulting protein were to be ingested by a child, it would simply be digested like any other protein. As a result of this, the SMFM recommends individuals be offered the SARS-CoV-2 vaccine and the decision to receive the vaccine should be guided by an individual's risk of contracting covid-19 and other individual factors."
Source: https://brief19.com/2020/12/14/brief
Commentary: The analysis by Dr. Westafer makes sense. mRNA isn't a live virus. It isn't even a dead virus. An mRNA vaccine is like teaching the body to recognize a car by showing it the body of a car without the motor, wheels, seats, etc. You can tell a lot from the body, the shell of the car but it can't operate.
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Dr. Scott Gottlieb on delays in vaccine distribution to the elderly:
"Interviewer: I understand it's big undertaking, but there are vaccine doses being made available before that. Why I mean, this seems like a costly delay since the elderly are so vulnerable.
Dr. Gottlieb: Look, it's a very costly delay. There's 50,000 new infections in nursing homes every week, right now, probably more than that we know 20% of people in nursing homes who are infected will succumb to the infection. So there's a lot of death happening in these nursing homes. I think the critical issue is that the consents weren't in place, you have to consent the patients, they want to get the consent in place before they go into the nursing homes. Why? Because they didn't do it in advance, I think they could have they could have provided a fact sheet, they could have cleared a fact sheet with the FDA maybe provided a limited emergency use authorization just for the nursing homes to get that information cleared. So they could have properly consented patients that wasn't done. We are where we are right now. But that needs to be done this week. They need to consent those patients. And in some cases, they'll have to go to family members, because they'll be dealing with patients, unfortunately, who will have capacity to give consent for themselves. So not an easy task, but probably something should have been done in advance."
Source:
Commentary: A lot of the preparatory work to distribute vaccines should have been done by now, including advanced obtaining of consent from assisted living facilities and long term care facilities. The fact that they are now working out those logistics is absurd and will kill more people unnecessarily.
To avoid delays, make sure your own healthcare paperwork is all squared away, that you have all your insurance settled, etc. so that when the time comes, you can obtain your vaccination with as little difficulty as possible.
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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. If you come in physical contact with others, wash your clothing upon returning home.
2. Always wear a mask when out of your home and if going to a high-risk area, wear goggles. Respirators are back in stock at online retailers, too. When going indoors to a place that isn't your home, wear the best protective mask available to you.
3. 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.
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.
6. 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).
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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.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.