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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The United States has reached the grim toll of 300,000 dead from COVID-19. For perspective, in one year, COVID-19 has killed more Americans than 8 years of the flu. (source: https://www.cdc.gov/flu/about/burden/past-seasons.html ) That is more than the number of combat deaths in all of World War II for Americans (291,557), the deadliest war the United States has ever been involved in. That is 101 times the death toll of 9/11 and 125 times the death toll of Pearl Harbor.
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More data on the Moderna vaccine. "The Food and Drug Administration released a detailed analysis Tuesday morning of the COVID-19 vaccine from drugmaker Moderna that supports the authorization of the company's vaccine for emergency use.
The FDA's briefing document along with one from Moderna were posted two days before a group of experts will convene to advise the agency on whether to grant the vaccine emergency authorization for use, or EUA, during the pandemic.
The agency's analysis finds the vaccine has a "favorable safety profile" and that there are "no specific safety concerns identified that would preclude issuance of an EUA." Serious reactions were rare. Side effects are common, however, with a majority of study volunteers experiencing pain at the site of injection, fatigue and headaches.
The agency's analysis also affirms the effectiveness of the vaccine. It is 94% overall, assessed at least two weeks after the second dose of vaccine, in the final analysis. An interim analysis put it at 95%. The vaccine shots are given 28 days apart.
The vaccine is less effective in older people, the FDA analysis finds. For people ages 18 to less than 65, the effectiveness is 96%, compared with 86% for people 65 and older."
Source: https://www.npr.org/sections/health-shots/2020/12/15/946554638/fda-analysis-of-moderna-covid-19-vaccine-finds-it-effective-and-safe
Source: https://www.fda.gov/media/144434/download
Commentary: It's not terribly surprising to see that the efficacy drops off; that had been hinted at in many discussions prior to the release of the data. It's still substantially higher than it could have been and the minimum standard for efficacy.
There's also a tremendous amount of false or just outright made up information about vaccines continuing to float around on social media. I saw one this morning claiming that the vaccine was loaded with mercury. You'll get the same amount of mercury from a tuna fish sandwich than you will get from any vaccine, and the mercury in a fish sandwich is methylmercury, which is more dangerous than ethylmercury/thimerosal in vaccines. (source: https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/thimerosal-and-vaccines )
That said, MIT did an analysis of the new vaccines and there's no mercury of any kind in them at all. None. In fact, it sounds closer to snack food than anything else. It's got mRNA, fats, salt, and sugar.
Source: https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
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Beware rest stops. "As the coronavirus surge continues, Anthony S. Fauci, the country’s leading infectious-disease expert, warns that Christmas travel may create more spread than Thanksgiving. However, AAA estimates that while holiday travel will be down this winter compared to years past, even more people are expected to travel for Christmas than they did for Thanksgiving.
The Centers for Disease Control and Prevention is urging all Americans stay home. For those that do venture out, some health experts say that traveling by car may be the safest option — but road trips still come with risks. Particularly: rest stops. This is where travelers are going to encounter other people, touch things touched by other people and have more chances for coronavirus exposure.
That may sound extreme, but Eric Feigl-Ding, an epidemiologist and senior fellow at the Federation of American Scientists, says public restrooms are one of the biggest concerns of stopping on a road trip.
It’s not just the surface-level cleanliness to be wary of; it’s also the invisible danger of so-called toilet plumes. Because a flush can release a plume of aerosolized droplets up to three feet in the air — and we now know the coronavirus can be spread in fecal matter — encountering toilet plumes from others may put you at risk for the coronavirus in a public bathroom.
“Oftentimes people get a false sense of security because if they go into a bathroom and they don’t see anyone else, they think they’re safe,” Feigl-Ding says. “But the way we know aerosols act is they can stay in the room for anywhere from 20 minutes to four hours. It depends on the ventilation, and often bathrooms have poor ventilation.”
With those aerosols in mind, Feigl-Ding recommends wearing a premium mask or doubling up on face masks, when going into a public restroom. And Braunstein says to create as much social distance as possible. Avoid using a stall next to others and choose paper towels over hand dryers."
Source: https://www.washingtonpost.com/travel/tips/road-trip-rest-stop-covid/
Commentary: Fecal plumes is not a phrase I would have thought I'd known prior to 2020. But here we are. Stay home for Christmas.
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Attacking ourselves. "Across the United States, state and local public health officials such as Coleman have found themselves at the center of a political storm as they combat the worst pandemic in a century. Amid a fractured federal response, the usually invisible army of workers charged with preventing the spread of infectious diseases has become a public punching bag. Their expertise on how to fight the coronavirus is often disregarded.
Some have become the target of far-right activists, conservative groups and anti-vaccination extremists who have coalesced around common goals: fighting mask orders, quarantines and contact tracing with protests, threats and personal attacks.
The backlash has moved beyond the angry fringe. In the courts, public health powers are being undermined. Lawmakers in at least 24 states have crafted legislation to weaken public health powers, which could make it more difficult for communities to respond to other health emergencies in the future.
It is a further erosion of the nation’s already fragile public health infrastructure. At least 181 state and local public health leaders in 38 states have resigned, retired or been fired since April 1, according to an ongoing investigation by The Associated Press and KHN. According to experts, this is the largest exodus of public health leaders in American history. An untold number of lower-level staffers have also left.
One in 8 Americans — 40 million people — lives in a community that has lost its local public health department leader during the pandemic. Top public health officials in 20 states have left state-level departments, including in North Dakota, which has lost three state health officers since May, one after another.
Collectively, the loss of expertise and experience has created a leadership vacuum in the profession, public health experts say. Many health departments are in flux as the nation rolls out the largest vaccination campaign in its history and faces what are expected to be the worst months of the pandemic.
“We don’t have a long line of people outside of the door who want those jobs,” said Dr. Gianfranco Pezzino, health officer in Shawnee County, Kansas, who is retiring from his job earlier than planned because, he said, he’s burned out. “It’s a huge loss that will be felt probably for generations to come.”"
Source: https://apnews.com/article/pandemics-public-health-michael-brown-kansas-coronavirus-pandemic-5aa548a2e5b46f38fb1b884554acf590
Commentary: Public health is a thankless field to begin with, because so many people already resist information about health that runs counter to their desires. The current environment has made things substantially worse. Get educated about public health and do your part to support science-based messaging.
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More evidence masks work. "Considering that the nasal epithelium is one of three sites in the human body binding with the SARS-CoV-2 virus,46,47 wearing a 65%-filtration mask can reduce the nasal deposition (viral load) by half for 3 µm–10 µm aerosols and by four to five times for 15-µm aerosols (Fig. 13).
In summary, the effects of wearing a three-layer surgical mask on airflow and aerosol dynamics were examined in a mask–face-airway model in comparison to without a mask. A better understanding of the factors involved in determining the dosimetry of ambient aerosols on the face and in the respiratory tract was obtained. Specific findings are as follows:
1. Wearing a mask significantly slows down inspiratory flows and extends respiration zones, which favors the inhalability of ambient aerosols into noses.
2. High flow speed and elevated particle concentrations are observed in the mask pleats.
3. Wearing a mask significantly reduces particle penetration into the lungs, regardless of the filtration efficiency of the mask. Wearing a 65%-filtration mask can reduce lung deposition by three folds for particles of size 1 µm–10 µm.
4. With a 65% mask filtration efficiency that is typical for a three-layer surgical mask, deposition is reduced by wearing a mask for all particle sizes considered, except 1 µm–3 µm, for which equivalent dosimetry in the upper airway was predicted.
5. Wearing a mask protects the upper airway (particularly the nose and larynx) best from particles larger than 10 µm, while it protects the face and lungs best from particles less than 10 µm (PM10).
6. The mask protection of the nasal airway, whose goblet secretory cells are binding sites for SARS-CoV-2, decreases at lower inhalation flow rates (15 l/min or less)."
Source: https://aip.scitation.org/doi/10.1063/5.0034580
Commentary: That's quite something - a regular three layer mask cuts risk by half for COVID-19 in laboratory simulations. That's not an N95 (which cuts risk by 95%) or an N100/P100 (which cuts risk by 99.97%). Wear a mask. It works.
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In-depth research into 7 major mutations of SARS-CoV-2, including the new UK version. "Defining mutations:
Has appeared multiple times independently: each can be associated with different accompanying mutations
Amino-acid changes are N501Y (nucleotide mutation A23063T), N501T (nucleotide mutation A23064C), and N501S (nucleotide mutation A23064G)
S:N501
Mutation is in the receptor binding domain (RDB), important to ACE2 binding and antibody recognition
Associated with a recently reported 'new variant' announced in the South East of England on 14 Dec 2020 (COG-UK Report)
This particular variant is associated with multiple mutations in Spike, including: N501Y, a deletion at 69/70 (as seen in S:N439K & S:Y453F), and P681H
Clusters also seen in USA, South Africa, & Australia
May be associated with adaptation to rodents and mustelids: N501T in ferrets (Richard et al. Nature Comm.); N501Y in mice (Gu et al. Science)
Some have speculated of risk of a persistent reservoir in wild rodents/mustelids
May increase ACE2 binding: Bloom Lab ACE2 binding website
N501Y was found in longitudinally-collected samples from an immunocompromised patient (Choi et al. NEJM)"
Source: https://github.com/emmahodcroft/cluster_scripts/blob/master/README.md
Source:
Commentary: These new mutations are still relatively benign because COVID-19 doesn't have any serious opposition yet. As more people are vaccinated, you'll see more mutations as the virus adapts. This is why it's important to get the vaccine out fast, in large numbers, so that the virus has far fewer chances to spread, mutate, and adapt. The worst possible outcome would be a slow, incoherent, and patchy rollout that leaves huge reservoirs of virus to continue replicating and mutating.
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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. If you come in physical contact with others, wash your clothing upon returning home.
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. When going indoors to a place that isn't your home, wear the best protective mask available to you.
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. 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).
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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
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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.