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.
You are welcome to share this.
---
The US CDC yesterday made the sweeping proclamation that fully-vaccinated people can dispense with masks except as required by federal, state, and local regulations.
"Update that fully vaccinated people no longer need to wear a mask or physically distance in any setting, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance
Update that fully vaccinated people can refrain from testing following a known exposure unless they are residents or employees of a correctional or detention facility or a homeless shelter"
Source: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html
Commentary: Unless people start carrying around their vaccine cards, this might prove to be a bit of a challenge, especially for private businesses.
I will not be dispensing with my mask for a variety of reasons; I think there's some nuance here. Here's why.
First, the vaccines are not 100% effective. They are very close, especially the mRNA vaccines, but still not 100%. Thus, continuing to wear a mask continues to protect.
Second, and I think an important consideration, is that not everyone in my household is vaccinated. My 11-year old child is not, and is not eligible. If 100% of my household were vaccinated, then I'd be willing to be a bit more lax on mask-wearing.
Third, we are still working out efficacy of the vaccines against the many new variants; the one on everyone's mind right now is B.1.617.2, the strain that developed in India.
Fourth, wearing a mask costs me nothing and does me no harm, nor does it harm anyone around me. Given potential upsides and no downside, I see no reason to stop. Of course, I've been wearing masks for years anyway, so it's not much of a change.
Fifth, you have people like this:
The text from some radio host says "All you leftist suckers are gonna see my cheerfully unmasked face and you MUST assume I've been fully vaccinated (even though I'M NOT)".
These people will continue to be vectors of disease, and since you can't tell who is and is not vaccinated, I'll still wear a mask around everyone.
As Dr. Fauci said in the CDC briefing yesterday, you are not REQUIRED to stop wearing a mask. If you feel that your personal tolerance for risk is lower than the CDC guidance, by all means continue wearing a mask. I would strongly urge you, if you have people in your household who are not fully vaccinated (or vaccinated at all) that you operate as though no one were vaccinated.
If, on the other hand, you feel comfortable doing so and everyone in your household is fully vaccinated (including the 14-day waiting period after your last shot), go have fun. You've earned it. Be sure to carry a copy of your vaccination record with you, perhaps as a photo on your smartphone.
---
Cancer patients do not see immune responses as strongly from vaccines. "Her cancer and the treatment she takes to control it blunt her immune system to the point that it doesn’t churn out as many antibodies as the vaccines are designed to stimulate. People who take drugs to prevent rejection of their organ transplants face a similar dismay after vaccination, as do people with certain autoimmune diseases who take medications to dampen the overactive immune response that defines their disorder.
The new Covid-19 vaccines, developed with astonishing speed and marked by stunningly high efficacy, may not work for everyone. But the jury is still out on whether antibody tests are a definitive measure of protection, for two reasons: We still don’t know the minimum level of antibodies required to fend off SARS-Cov-2 in immunocompromised people, nor do we know whether another response, known as cellular immunity, might make up the difference. It’s also too soon to determine if booster shots or monoclonal antibody infusions would help."
Source: https://www.statnews.com/2021/05/14/uncertain-protection-from-covid-vaccines-leaves-cancer-patients-in-limbo/
Commentary: The reality is that the vaccines are inherently tied to our immune systems. If you or someone you know is immune-compromised, the vaccines will not work as well for them and thus they are at greater risk. Continue observing non-vaccine precautions.
---
B.1.617.2 is just the start. "As countries around the world airlift oxygen, vaccines and medical supplies to India, they are also closing their borders to the world’s second most populous country. It may already be too late. The B.1.617 variant of the virus, first detected in India, has now been found in 44 countries on every continent except Antarctica—including Nepal, the U.S. and much of Europe. Scientists say it could be more infectious and better at avoiding humans’ immune systems. On May 10, the World Health Organization declared it a variant of “global concern.” And because only around 0.1% of positive samples in India are being genetically sequenced, “there may well be others that have emerged,” says Amita Gupta, deputy director of the Johns Hopkins University Center for Clinical Global Health Education.
The true scale of the COVID-19 outbreak in India is impossible to accurately quantify. Officially, confirmed daily cases are plateauing just under 400,000 but remain higher than any other country has seen during the pandemic. Experts warn that the real numbers are far bigger, and may still be rising fast as the virus rips through rural India, where two-thirds of the population lives and where testing infrastructure is frail. The University of Washington’s Institute for Health Metrics and Evaluation (IHME) estimates the true number of new daily infections is around 8 million—the equivalent of the entire population of New York City being infected every day. Official reports say 254,000 people have died in India since the start of the pandemic, but the IHME estimates the true toll is more than 750,000—a number researchers predict will double by the end of August. Since the beginning of May, dozens of bodies have washed up on the banks of the river Ganges, with some villagers saying they were forced to leave the dead in the water amid soaring funeral costs and shortages of wood for cremation.
India’s first wave, which peaked last September, was severe: by the time it started to dissipate, nearly 100,000 people had died across the country, according to official statistics. But in a country with a population of nearly 1.4 billion, it also sent another message: that India may have avoided the most damaging effects of the pandemic. Now, India’s brutal second COVID-19 wave is sparking worries that the worst is still ahead. Especially concerning are densely populated African countries, many of which have yet to experience large outbreaks. Versions of the B.1.617 variant have already been reported in Angola, Rwanda and Morocco. Many of the vaccines that could curb outbreaks in such countries were meant to come from factories in India—which has now ordered that most of its vaccine production be used to meet domestic needs."
Source: https://time.com/6047957/india-covid-19-global-crisis-variant/
Commentary: This is why it is urgent we get vaccines to as much of the world as possible. Yes, there are humanitarian reasons. But there are also enlightened self-interest reasons: we don't want even more new strains developing.
---
B.1.617.2, the new variant of concern from India, is a speed racer. "For those who would like to see a graph of the distribution of the Indian variant B.1.617.2 in addition to my garden - it looks like this based on the (relatively limited) GISAID data. Indian variety has an estimated growth advantage over UK variety B.1.1.7 of 10% / day.
Or based on the Sanger Institute data from the UK, we get this (data from travelers and cluster outbreaks have been filtered out). A growth advantage of 10% per day over the UK variant would amount to about 60% more contagious. See if this is confirmed by further research.
Indian variant 1.6x more contagious than UK variant, which in turn was 1.6x more contagious than original type would make that Indian variant (1.6)^2 x = Could be 2.6x more contagious than original type. Although benefit mschn is also partly linked to immune evasion."
Source:
Source:
Commentary: The new variant of concern is REALLY fast, has some immune evasion, and is part of the reason (along with absolutely awful federal government management) India is in such bad shape right now - and why its variant is spreading so fast.
---
Mix and match may be valid. "COVID-19 vaccines emerging from different platforms differ in efficacy, duration of protection, and side effects. To maximize the benefits of vaccination, we explored the utility of employing a heterologous prime-boost strategy in which different combinations of the four types of leading COVID-19 vaccine candidates that are undergoing clinical trials in China were tested in a mouse model. Our results showed that sequential immunization with adenovirus vectored vaccine followed by inactivated/recombinant subunit/mRNA vaccine administration specifically increased levels of neutralizing antibodies and promoted the modulation of antibody responses to predominantly neutralizing antibodies. Moreover, a heterologous prime-boost regimen with an adenovirus vector vaccine also improved Th1-biased T cell responses. Our results provide new ideas for the development and application of COVID-19 vaccines to control the SARS-CoV-2 pandemic."
Source: https://pubmed.ncbi.nlm.nih.gov/33691606/
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01115-6/fulltext
Commentary: What this report says is simple: mixing and matching vaccines may make up for some of the vaccines, especially the adenovirus platform vaccines like AstraZeneca and J&J, being partially evaded by the new variants. So depending on what vaccine you received, there may be an advantage later this year in receiving a different vaccine as a booster.
To be clear: right now, this is not approved for usage by ordinary people, so don't go booking another vaccine appointment if you're already fully vaccinated. But our existing arsenal might down the road be what's needed to combat the new variants more effectively without needing entirely new vaccines.
---
A reminder of the simple daily habits we should all be taking.
1. Always wear the best mask available to you when out of your home and 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.
3. Wash/sanitize your hands every time you are in or out of your home for any reason.
4. 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.
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:
---
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/
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
---
Disclosures and Disclaimers
To be clear, 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.
---
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.