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.
---
Preterm births declined at the start of the pandemic. "Preliminary evidence suggests that the COVID-19 pandemic and the measures taken by governments to mitigate its impact on population health were followed by reductions in preterm births, particularly those occurring at very low gestational ages.
Our study confirms evidence from earlier preliminary studies indicating that substantial reductions in preterm births occurred following national introduction of COVID-19 mitigation measures. International collaborative efforts are needed to collate evidence from across the globe to further substantiate these findings and to study the underlying mechanisms. Such efforts could help uncover new opportunities for preterm birth prevention with substantial effects on global perinatal and public health.
The aetiology of spontaneous preterm birth, which accounts for roughly two-thirds of all preterm births, is largely obscure and probably multifactorial, hampering effective prevention.33 Many of the known risk factors for preterm birth might be affected by implementation of COVID-19 mitigation measures. These risk factors include asymptomatic maternal infection, which through vertical transmission, can cause intrauterine infection, initiating a cascade resulting in preterm birth.33 Physical distancing and self-isolation, lack of commuting, closing of schools and childcare facilities, and increased awareness of hygiene (eg, hand washing) all reduce contact with pathogens and, accordingly, risk of infection. Timing of the observed preterm birth reductions in our study suggests that hygiene measures and anticipatory behavioural changes might have been instrumental. Additionally, closure of most businesses and obligatory home assignments probably resulted in less physically demanding work, less shift work, less work-related stress, optimisation of sleep duration, uptake of maternal exercise indoors and outdoors, and increased social support, which could all have a positive effect. Substantial reductions in air pollution have also been reported following COVID-19 mitigation measures,34 including in the Netherlands.35 Given the recognised increased risk of delivering preterm when exposed to air pollution,36 this finding could explain part of the observed reductions."
Source: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30223-1/fulltext
Commentary: If I had to bet, I'd bet on improved hygiene. We live in a dirty, dirty world and not a ton of people gave a lot of thought to frequent handwashing, especially since that was the main message early on in the pandemic.
Keep up those habits! Just like you heard in history class about wars advancing technology after the conflict and providing a peace dividend, the same could be true of our handling of the pandemic at a personal level. If you got sick less, if you were clean more, if you reduced the likelihood of different kinds of illnesses, that might be a nice dividend from the pandemic to keep.
---
COVID-19 can infect eye tissue. "This case study analyzed a patient previously infected with COVID-19 who had an acute glaucoma attack during her rehabilitation. Plasma samples and tissue specimens, including ones from the conjunctiva, anterior lens capsular, trabecular meshwork, and iris, were collected during phacoemulsification and trabeculectomy surgery. Specimens from another patient who had glaucoma but not COVID-19 were used as a negative control.
In the patient previously infected with COVID-19, the SARS-CoV-2 NP antigen was found in the conjunctival, trabecular, and iris tissues. This indicated that SARS-CoV-2 may exist intracellularly in the inner ocular tissues as well as on the ocular surface. Based on these results, the eye is also one of the target organs for the viral infection in addition to the lungs. Although the method by which the virus enters the eye is still unclear, it could theoretically enter the inner eye tissues in 2 ways. First, SARS-CoV-2 could enter the inner eye tissue via the ACE2 receptor on the surface of the conjunctiva.10 This study’s results showed that ACE2 receptor proteins are expressed on the conjunctival cell, seemingly supporting this hypothesis. However, this hypothesis can only be confirmed through animal experiments—for example, ones that detect the virus in the intraocular tissue after conjunctiva inoculation. Second, the virus may spread systemically to end organs as a result of the primary respiratory infection. However, when the patient presented at the ophthalmology clinic, the possible viremia was already in the recovery stage, and the SARS-CoV-2 NP antigen test and IgM antibody in the plasma showed negative results. These findings do not seem to support this second transmission-route hypothesis."
Source: https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2771320
Commentary: SARS-CoV-2 gets everywhere. It enters through the respiratory system and then goes to party everywhere else. Keep it out of you.
---
Immune challenges for COVID-19 vaccines. "By August, 2020, multiple phase 3 clinical vaccine trials, each involving tens of thousands of participants, had commenced in various geographical locations (eg, the USA, the UK, the United Arab Emirates, Morocco, Argentina, Peru, Brazil, Indonesia, Russia, China, and South Africa). Interim results from these trials are expected to be available at the end of 2020 and will provide a first indication of the efficacy and safety of COVID-19 vaccines. Notably, some phase 3 trials are designed and statistically powered around the primary outcome of preventing severe COVID-19. This design could be problematic in terms of sufficient numbers of participants. In the USA, the Food and Drug Administration has issued guidance stating that a COVID-19 vaccine would have to protect at least 50% of vaccinated people to be considered efficacious.59 In addition, establishing safety will be limited in statistical power in most trials, particularly for uncommon adverse events. Notably, few trials include people younger than 18 years and are likely to enrol sufficiently large numbers of people older than 55 years (particularly those in congregate living situations), and all trials currently exclude women who are pregnant. Many mutations of SARS-CoV-2 have been identified;60 therefore, vaccine development could be obstructed if the virus later evades immunity to the spike glycoprotein used to construct the vaccine—the so-called Achilles heel of COVID-19 vaccines.
Much remains to be learned regarding coronavirus immunity in general and SARS-CoV-2 immunity in particular, including the protective immunity induced by vaccines and the maintenance of immunity against this virus. Furthermore, multiple vaccine types will probably be needed across different populations (eg, immune-immature infants, children, pregnant women, immunocompromised individuals, and immunosenescent individuals aged ≥65 years). In addition to the adaptive immune response, there are some data suggesting that trained innate immunity might also have a role in protection against COVID-19.88, 89 Multiple clinical trials (eg, NCT04327206, NCT04328441, NCT04414267, and NCT04417335) are examining whether unrelated vaccines, such as the measles, mumps, and rubella vaccine and the Bacillus Calmette–Guérin vaccine, can elicit trained innate immunity and confer protection against COVID-19. It is crucial that research focuses on understanding the genetic drivers of infection and vaccine-induced humoral and cellular immunity to SARS-CoV-2, defining detailed targets of humoral and cellular immune responses at the epitope level, characterising the B-cell receptor and T-cell receptor repertoire elicited by infection or vaccination, and establishing the long-term durability, and maintenance, of protective immunity after infection or vaccination. A safe regulatory pathway leading to licensing must also be defined for use of these vaccines in children, pregnant women, immunocompromised people, and nursing home residents. Some have called for further shortening of the vaccine development process through the use of controlled human challenge models.90 As of Oct 5, 2020, no such studies have occurred, but the UK is considering initiating such trials in early 2021."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32137-1/fulltext
Commentary: Pay attention to the part about multiple vaccine types. Stopping COVID-19 will not be a single silver bullet. It's going to be a toolkit of vaccines to reduce infectivity, vaccines to reduce severity, and therapeutics to minimize damage.
Plan for needing multiple, different kinds of vaccines - and they won't all be available at once. For the foreseeable future, you'll be wearing a mask outside your home.
---
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.
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.
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. Participate in your local political process. For Americans, go to Vote.org and register/verify your vote.
---
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
---
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.