Lunchtime Pandemic Reading, 14-July-2021
Don't worry about breakthroughs, worry about the unvaccinated
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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Fatality rates unchanged. "The case fatality rate of coronavirus in documented cases in the US is similar to a year ago.
Why?
Because almost all the symptomatic cases are occurring in unvaccinated people right now.
For those folks, the risk of severe illness after infection *has not changed*."
Source:
Commentary: We are bifurcating human society into two camps, the vaccinated and the unvaccinated. This will continue to be a problem, especially globally - so we need vaccines out and in the world everywhere, for everyone who needs one.
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No evidence yet of long COVID from asymptomatic breakthroughs. "People are understandably worried about long COVID resulting from asymptomatic breakthrough, and while we still don't know much about this, I haven't seen any data suggesting that occurs. I'd be surprised if it was common."
Source:
Commentary: I've not seen any data either, but I'm looking for it. The reality is that the priority and concern has to be the massive populations of unvaccinated people, and getting them vaccinated (except for those who actively choose not to be vaccinated and cannot be persuaded).
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Doctors around the world calling for mandatory healthcare worker vaccination. "This consensus statement by the Society for Healthcare Epidemiology of America (SHEA) and The Society for Post-Acute and Long-Term Care Medicine (AMDA), The Association for Professionals in Epidemiology and Infection Control (APIC), the HIV Medicine Association (HIVMA), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP), recommends that COVID-19 vaccination should be a condition of employment for all healthcare personnel. Exemptions from this policy apply to those with medical contraindications to all COVID-19 vaccines available in the United States and other exemptions as specified by federal or state law. The consensus statement also supports COVID-19 vaccination of non-employees functioning at a healthcare facility (for example, students, contract workers, volunteers, etc.)."
Source: https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/multisociety-statement-on-covid19-vaccination-as-a-condition-of-employment-for-healthcare-personnel/690D1804B72FFF89C5FC0AED0043AD62
Commentary: I would add this should be mandatory for anyone who works with an at-risk population - healthcare, education, retail, etc. Basically, if you interact with high volumes of at-risk people, vaccination should be a mandatory condition of employment.
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A good read on what a breakthrough infection means. "The first thing to know about the COVID-19 vaccines is that they’re doing exactly what they were designed and authorized to do. Since the shots first started their rollout late last year, rates of COVID-19 disease have taken an unprecedented plunge among the immunized. We are, as a nation, awash in a glut of spectacularly effective vaccines that can, across populations, geographies, and even SARS-CoV-2 variants, stamp out the most serious symptoms of disease.
The second thing to know about the COVID-19 vaccines is that they’re flame retardants, not impenetrable firewalls, when it comes to the coronavirus. Some vaccinated people are still getting infected, and a small subset of these individuals is still getting sick—and this is completely expected.
We’re really, really bad at communicating that second point, which is all about breakthroughs, a concept that has, not entirely accurately, become synonymous with vaccine failure. It’s a problem that goes far beyond semantics: Bungling the messaging around our shots’ astounding success has made it hard to convey the truly minimal risk that the vaccinated face, and the enormous gamble taken by those who eschew the jabs.
To be clear, breakthroughs of any severity are an entirely expected part of the vaccination process. No vaccines are 100 percent effective at preventing infection or disease. But our current crop of COVID-19 shots comes pretty damn close with regards to stymieing symptoms, especially the severe ones that can signal a deadly case. The Moderna and Pfizer shots have consistently demonstrated very high COVID-prevention rates, often in the 90s; Johnson & Johnson’s, for the most part, isn’t far behind. Symptomatic breakthroughs are the cases that wedge themselves in the gap between excellent effectiveness and perfect effectiveness; in other words, we saw them coming.
Even out in the messiness of the real world, symptomatic breakthrough cases are proving themselves quite rare. The overwhelming majority of the COVID-19 cases we’re seeing are among the unvaccinated. And when the virus does affect the immunized, it seems to accumulate to lower levels, and spread less enthusiastically to new hosts; it’s causing, on average, milder and more transient symptoms.
All of this is a reminder of how vaccines work—by ratcheting up our immunity against the version of SARS-CoV-2 that the shots were formulated to mimic. If humans are wood that fuels a flame, and coronaviruses are the sparks that ignite it, vaccines are the fire suppressants that protect best against the worst of the viral burn: severe disease, hospitalization, and death. Stopping milder cases requires more immune investment, and blocking asymptomatic infections—ones that barely singe the bark—is most difficult of all. It’s part of why the vaccines’ goalposts were at first set so conservatively. “This is not a magic shield that just bounces coronavirus right off you,” McNamara told me.
Considering that we first took aim at stopping disease, it’s great news that the majority of known breakthroughs have actually been asymptomatic infections, not COVID-19 cases. The proportions of silent breakthroughs reported by various studies and federal agencies are certainly undercounts, because vaccinated people aren’t regularly screened for the coronavirus. (On May 1, the CDC controversially switched its reporting strategy to documenting only breakthrough cases involving some form of hospitalization or death, skewing national counts further.) Since the vaccines first deployed, the news has only improved: Researchers didn’t bank on it, but in many people, the shots seem to stop the coronavirus from establishing itself at all. “The vaccines are better than anything we ever dreamed of,” Gounder told me, exceeding our first expectations in more ways than one."
Source: https://www.theatlantic.com/science/archive/2021/07/coronavirus-breakthrough-infections/619416/
Commentary: It has astounded me how much people resist the vaccines, even though we have built quite possibly the best vaccines ever in human history, at effectiveness levels unheard of previous - and on our first try. We need to invest heavily in medical and scientific communications so that we better explain to people what it is they're getting. That will be essential for the rest of this pandemic and for future pandemics.
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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 other people, 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. 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.
3. Wash/sanitize your hands every time you are in or out of your home.
4. Stay out of indoor spaces that aren't your home 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.
5. Get your personal finances in order now. Cut all unnecessary costs.
6. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
7. 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).
8. Masks must fit properly to work. Here's how to properly fit a mask:
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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.