Lunchtime pandemic reading.
Standard disclaimer: this is a roundup of informative pieces I've read that interest me on the severity of the crises and how to manage them. 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: It should be common sense but it deserves reiteration. If you are feeling ill for ANY reason, COVID or not, put an N95 or better mask on and stay away from other people until your symptoms resolve. Even if you don't have COVID, there are millions of people who have diminished immune systems that will be sicker if exposed to the other bugs floating around now.
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USA friends, free COVID tests are back in stock with the government. Order yours for FREE now. "Get free at-home COVID-19 tests this winter
Every U.S. household is eligible to order 4 free at-home COVID-19 tests."
Source: https://www.covid.gov/tests
Commentary: Get them while they last.
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"The BQ and XBB subvariants of SARS-CoV-2 Omicron are now rapidly expanding, possibly due to altered antibody evasion properties deriving from their additional spike mutations. Here, we report that neutralization of BQ.1, BQ.1.1, XBB, and XBB.1 by sera from vaccinees and infected persons was markedly impaired, including sera from individuals boosted with a WA1/BA.5 bivalent mRNA vaccine. Titers against BQ and XBB subvariants were lower by 13-81-fold and 66-155-fold, respectively, far beyond what had been observed to date. Monoclonal antibodies capable of neutralizing the original Omicron variant were largely inactive against these new subvariants, and the responsible individual spike mutations were identified. These subvariants were found to have similar ACE2-binding affinities as their predecessors. Together, our findings indicate that BQ and XBB subvariants present serious threats to current COVID-19 vaccines, render inactive all authorized antibodies, and may have gained dominance in the population because of their advantage in evading antibodies."
Source: https://www.cell.com/cell/fulltext/S0092-8674(22)01531-8
Commentary: The new variants basically render useless previous immunity if you had COVID more than 6 months ago, or your last vaccine/booster was more than 6 months ago. Get boosted if you have not, and put a mask on.
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The following is a processed transcript from Dr. Rae Duncan:
"I am a cardiologist and consultant by trade, with a degree in infectious diseases and an interest in cardiovascular research. I have been involved with Long COVID and the cardiovascular complications of COVID since the pandemic began. I was assigned to run an acute COVID ward at the Royal Victoria Infirmary (RVI) in Newcastle, one of the two big city hospitals. I set up one of the first cardiovascular Long COVID complications clinics, which I ran for a year. I then moved into research, being part of an international research collaborative. I am involved in a series of research trials that are looking at the pathophysiology, the body’s response to the infection, and how to develop therapeutic targets to treat that, to reduce the level of disease and disability in patients suffering from Long COVID.
I would like to talk about the clinical side of Long COVID, as Claire Taylor, who is dealing with another emergency, cannot be here. I will start by saying something slightly controversial: I cried today. The reason I cried was because I was on the phone to a patient. This patient is someone Claire and I have mutual involvement with. I have permission to explain why I was so emotional.
The patient is a young male in his 30s. I will call him Ben, although that is not his real name. He is a perfect example of what we are seeing in the clinics. He was fit and healthy, ex-military, running his own business, and engaged to be married. Then, COVID hit. He did not die from the virus, but it affected him. He suffered a heart attack in his 30s, and has had a rollercoaster of what could have been a complete nightmare ever since. He has had ongoing symptoms and has gone from running his own business and being engaged to being housebound and largely bedbound. He has had to move back in with his parents, and has lost his fiancé and his business.
What makes it worse is that there is still a lack of understanding in the medical community about how to investigate this condition properly, and how to manage it properly. Many of the standard imaging tests and blood tests come back negative – not because the patient is okay, but because Long COVID is predominantly a vascular disease, not a respiratory illness. It enters through the respiratory tract, but what we are seeing is a chronically stimulated immune response. There is an increased level of pro-inflammatory cytokines, which inflames the inner linings of the blood vessels, called the endothelium. This then triggers platelet activation, which are molecules involved in blood clotting, and it triggers the coagulation cascade. You end up with a ‘cytokine and clot soup’, where the clots are very small and amyloid micro clots. These clots are resistant to fibrinolysis, meaning the body is struggling to break them down. If too many of these clots are made, they get stuck in the capillary vascular beds and obstruct the flow of oxygen to every organ in the body, causing the symptoms of Long COVID. In addition, the clots themselves are immunogenic and cause inflammation and damage to the capillaries. This, in turn, causes leakage of the inflammatory molecules into other organs, resulting in organ damage.
The other problem is that the death rates from COVID are going down, but the disability rates are going up. There are 148 million people with this condition. I spoke to Ben on the phone today. He had seen multiple doctors, but Postural Orthostatic Tachycardia Syndrome had been completely missed. He is very disabled as a result. When he was explained to, and the tests that many medics are not doing were done, he cried. I have had a 30 year old man sobbing his heart out on the phone. This is happening all the time, and some of it is treatable.
We are trying to get a better campaign of education, which is what we are trying to do through the World Health Network, to train other doctors and get it accepted that there are tests that can diagnose some of these abnormalities, and that there are treatments that can help reduce the level of disability. We also need to get the message out that there is clear evidence from the published literature that reinfection increases the risk of Long COVID substantially, so we need public health mitigations. I have seen the inner linings of people’s blood vessels, and the torn endothelium, after one or two infections. This is why I was so emotional on the phone to Ben today. We need to get this message out, and help those who are suffering.
One thing that has been concerning us recently is the number of blood clots that have been seen in long COVID patients. These patients are not behaving normally, as we would usually determine if somebody goes to the hospital with shortness of breath or chest pain, we would do a D-dimer test. If that test is negative, we wouldn't do any further scans. However, in the last few months we have found that this can't be the case. When we do a VQ scan, which is a perfusion scan, we find that the patient has a clot. This has been happening so often that many establishments have stopped doing VQ scans, which was a very popular test about 10 years ago.
Recently there was a paper written about a 14 year old girl who had been ill for nearly a year. Her physician read a paper on this and decided to do a VQ scan, which showed that she had a clot. This has led to a lot of people having these clots, and we can't even begin to estimate how many people have them. Just recently, on Twitter, somebody put this out and a GP said it was making them do a lot of work. But then came back on Wednesday to thank them as they had scanned their patients and found clots.
On Wednesday I had a patient in their 60s who was fit and well, but was crumbling under the weight of this problem. Every test they had done had been negative and the routine was to send them for CBT. However, I suggested that we should do a VQ scan, as that might show a clot.
This brings me to my second point about the immune response. This was my third COVID infection this year, and each time it has been worse than the last. My daughter got it in March and apart from everyone else having it, she was the only one who was hospitalized, with high fever, tachycardia, cold hands and feet. This made me think about children's immune systems and what the potential outcomes are if they have multiple infections. Children have a different immune system to adults, with a very strong innate immune system. We need to think about what the potential outcomes of multiple infections could be for them.
Lastly, we don't really know what is going to happen with the variants and where it is going to go. We have loosened all of the protections to the point of almost nothing, and are relying on the vaccine to protect us. This could be our undoing, and it is something that we need to be aware of."
Source:
Commentary: This analysis by doctors from the World Health Organization underscores the absolute seriousness of COVID and how little we know about the long-term consequences - but that we know they have the potential to be severe. The only sure-fire way to avert those consequences is to avoid infection as much as possible.
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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. P100 respirators are back in stock at online retailers, too and start around US$40 for a reusable respirator. 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 eligible to, and fulfill the full vaccine regimen, including boosters. Remember that you are not vaccinated until everyone you live with is vaccinated. For COVID, if you received an adenovirus vaccine (J&J/AstraZeneca), consider getting an mRNA single shot booster (Pfizer/Moderna) if available. If it's available, choose Moderna as your first choice for both vaccine and booster, Pfizer as your second choice. However, remember that any vaccine is better than no vaccine.
4. Wash/sanitize your hands every time you are in or out of your home. Sanitize the bottom of your shoes with a simple peroxide spray using ordinary drugstore/supermarket peroxide in a spray bottle. If you've come in close contact with others (rubbing or brushing up against them, hugging, etc.) consider showering and washing your clothes as well.
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 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 pandemics give another crazy plot twist to the economy, or you know, a global war breaks out.
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 several rapid antigen tests and/or acquire them from your healthcare provider or government. This will detect COVID-19 only when you're contagious, so follow the directions clearly. https://amzn.to/3fLAoor
If you think you may have been exposed to monkeypox, contact your healthcare provider about available testing.
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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 or monkeypox. 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 or monkeypox, nor do I financially benefit in any way from sharing information about COVID-19 or monkeypox.
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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.