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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COVID-19 causes 8x as much CVT as any of the vaccines including AstraZeneca. "Using an electronic health records network we estimated the absolute incidence of cerebral venous thrombosis (CVT) in the two weeks following COVID-19 diagnosis(N=513,284),or influenza (N=172,742),or receipt of the BNT162b2 or mRNA-1273 COVID-19 vaccines(N=489,871).Theincidence of portal vein thrombosis (PVT) was also assessed in these groups, as well asthe baselineCVTincidence over a two-week period. The incidence of CVT after COVID-19 diagnosis was 39.0 per million people (95% CI, 25.2–60.2). This washigher thanthe CVT incidenceafter influenza (0.0 per million people, 95% CI 0.0–22.2, adjusted RR=6.73, P=.003) or after receiving BNT162b2 or mRNA-1273 vaccine (4.1 per million people, 95% CI 1.1–14.9, adjusted RR=6.36, P<.001). The relative risks were similar if a broader definition of CVT was used. For PVT, the incidence was 436.4 per million people (382.9-497.4) after COVID-19, 98.4 (61.4-157.6) after influenza, and 44.9 (29.7-68.0) after BNT162b2 or mRNA-1273. The incidence of CVT following COVID-19 was higher than the incidence observed across the entire health records network (0.41 per million people over any 2-week period). Laboratory test results, availablein a subsetof the COVID-19 patients,provide preliminary evidence suggestive of raised D-dimer, lowered fibrinogen, and an increased rate of thrombocytopenia in the CVT and PVT groups. Mortality was 20% and 18.8% respectively. These data show that the incidence of CVT issignificantly increased after COVID-19,andgreater than that observed with BNT162b2 and mRNA-1273 COVID-19 vaccines. The risk of CVT following COVID-19 is alsohigher than the latest estimate from the European Medicines Agency for theincidence associated withChAdOx1 nCoV-19 vaccine (5.0 per million people, 95% CI 4.3–5.8). Although requiring replication and corroboration, the present data highlight the risk of serious thrombotic events in COVID-19, and can help contextualizethe risks and benefits of vaccinationin this regard."
Source: https://osf.io/a9jdq/
Commentary: While more research is needed, early findings in this preprint paper strongly suggest that fears of CVT from any of the vaccines, including the AstraZeneca vaccine, are disproportionate to the same exact deadly outcome from the disease itself - and COVID-19 makes it happen at least 8x as often. Given the choice, take whatever vaccine is available for the most part.
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Sputnik V cannot neutralize B.1.351. "Despite the unprecedented pace of vaccine development, with six vaccines already in use worldwide, the emergence of SARS-CoV-2 ‘variants of concern’ (VOC) across diverse geographic locales suggests herd immunity may fail to eliminate the virus. All three officially designated VOC carry Spike (S) polymorphisms thought to enable escape from neutralizing antibodies elicited during initial waves of the pandemic. Here, we characterize the biological consequences of the ensemble of S mutations present in VOC lineages B.1.1.7 (501Y.V1) and B.1.351 (501Y.V2). Using a replication-competent EGFP-reporter vesicular stomatitis virus (VSV) system, rcVSV-CoV2-S, which encodes S from SARS coronavirus 2 in place of VSV-G, and coupled with a clonal HEK-293T ACE2 TMPRSS2 cell line optimized for highly efficient S-mediated infection, we determined that 8 out of 12 (67%) serum samples from a cohort of recipients of the Gamaleya Sputnik V Ad26 / Ad5 vaccine showed dose response curve slopes indicative of failure to neutralize rcVSV-CoV2-S: B.1.351. The same set of sera efficiently neutralized S from B.1.1.7 and showed only moderately reduced activity against S carrying the E484K substitution alone. Taken together, our data suggest that control of emergent SARS-CoV-2 variants may benefit from updated vaccines."
Source: https://www.medrxiv.org/content/10.1101/2021.03.31.21254660v2
Commentary: The Russian Sputnik V vaccine neutralizes the wild type and B.1.1.7, but was defeated by B.1.351. This is one of the reasons why vaccination is all or nothing for the entire planet - the virus is evolving along with us, and the longer we let it go unchecked by keeping vaccines only to wealthier people and nations, the more chances the virus has to learn how to defeat it.
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Vaccines are piling up. "Many U.S. states and cities have a growing surplus of Covid-19 vaccines, a sign that in some places demand is slowing before a large percentage of the population has been inoculated, according to an analysis by Bloomberg News.
The data indicate as many as one in three doses are unused in some states. Appointments for shots often go untaken, with few people signing up.
Bloomberg analyzed state and U.S. data from Monday, providing a snapshot of vaccine use before Johnson & Johnson shelved millions of shots pending federal health officials’ investigation into rare cases of blood clots. That pause will likely cause the number of unused shots to fluctuate, but will little change the comparisons of states.
Overall, demand remains strong. In the U.S., 37% of people have gotten at least one dose, and the country is one of the world leaders in vaccinations. But even some states that are doing well are struggling with stubborn pockets where uptake is low.
Now there are warning signs that vaccines are going unused. That’s a concern for epidemiologists who maintain that at least 75% of the nation’s population must be protected before the virus can be truly contained.
Federal officials are in the early stages of rethinking distribution. Vaccines have so far been doled out based on population.
“We're going to go through stages, as we vaccinate higher and higher portions of populations, where it will make sense for us to continue to watch where vaccines are needed, how vaccines are distributed, the best way to reach more people,” Andy Slavitt, senior adviser for the White House’s Covid Response team, said at the end of March.
Meanwhile, doses pile up. West Virginia — lauded for its rollout of shots early on — has gone from using all but a tiny percentage of its supply in mid-February to 26% of doses unused, a daily average of 352,000 unused doses over the last week. Some states have never gotten their vaccination strategy in gear. Alabama, Georgia and Mississippi represent a band of southern states that have struggled to work through their supplies."
Source: https://www.bloomberg.com/news/articles/2021-04-15/unused-vaccines-are-piling-up-across-u-s-as-some-regions-resist
Commentary: Just as it was with masks and other interventions, populations around the world will react differently to vaccination. The key however is preventing mutation, and that means that the virus needs fewer hosts. I hope that we can apply more incentives to encourage people to take the vaccine; barring that, I hope at least in the US that we start shipping vaccine to areas where it's need and once demand really falls, start shipping it to other nations. No one is safe until everyone is safe.
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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. 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:
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Common misinformation debunked!
There is no mercury or other heavy metals in the Pfizer mRNA vaccine. https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
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.