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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Encouraging early vaccine results. "Jackson et al. now report in the Journal preliminary findings from a phase 1 trial to evaluate the safety and immunogenicity of an mRNA SARS-CoV-2 vaccine.3 Phase 1 involves 45 healthy adults, 18 to 55 years of age, who were assigned to receive the candidate vaccine at one of three dose levels (25 μg, 100 μg, or 250 μg) given as two vaccinations 28 days apart. These preliminary findings represent the first of three reports of data from a phase 1 study of this candidate vaccine; a second report including similar data from adults older than 55 years of age and a final report summarizing the safety and durability of immunity for both study cohorts are also planned.
The speed with which this vaccine has been developed is remarkable — from publication of the first SARS-CoV-2 sequences through phase 1 in 6 months, as compared with a typical timeline of 3 to 9 years (Figure 1). The rapid pace of development of vaccines against Covid-19 is enabled by several factors: prior knowledge of the role of the spike protein in coronavirus pathogenesis and evidence that neutralizing antibody against the spike protein is important for immunity4,5; the evolution of nucleic acid vaccine technology platforms that allow creation of vaccines and prompt manufacture of thousands of doses once a genetic sequence is known6; and development activities that can be conducted in parallel, rather than sequentially, without increasing risks for study participants."
Source: https://www.nejm.org/doi/full/10.1056/NEJMe2025111
Commentary: A reminder that vaccines typically go through 4 phases:
- Phase 1: prove it does not harm
- Phase 2: prove it works at all
- Phase 3: prove it works better than the standard of care
- Phase 4: prove it works at scale
This vaccine development is showing positive results in Phase 1, so there's still a long road ahead, but at least it appears to be clearing this first hurdle.
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A newborn affected through transplacental transmission. "SARS-CoV-2 outbreak is the first pandemic of the century. SARS-CoV-2 infection is transmitted through droplets; other transmission routes are hypothesized but not confirmed. So far, it is unclear whether and how SARS-CoV-2 can be transmitted from the mother to the fetus. We demonstrate the transplacental transmission of SARS-CoV-2 in a neonate born to a mother infected in the last trimester and presenting with neurological compromise. The transmission is confirmed by comprehensive virological and pathological investigations. In detail, SARS-CoV-2 causes: (1) maternal viremia, (2) placental infection demonstrated by immunohistochemistry and very high viral load; placental inflammation, as shown by histological examination and immunohistochemistry, and (3) neonatal viremia following placental infection. The neonate is studied clinically, through imaging, and followed up. The neonate presented with neurological manifestations, similar to those described in adult patients."
Source: https://www.nature.com/articles/s41467-020-17436-6
Commentary: Earlier studies had suggested fetuses were safe from COVID-19, but this case study indicates the virus successfully crossed the placental barrier AND impacted the fetus neurologically. Pregnant women should continue to take extra precautions and treat themselves as high-risk patients to ensure maximum safety, including avoiding exposure to other people as much as practical.
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"The number of people with confirmed COVID-19 has rapidly increased over the last five months with no sign of decline in the near future. The fight against COVID-19 will be long, until vaccines and other effective therapies are developed. To facilitate rapid therapeutic development, clinicopathological, genomic and other societal information must be shared with researchers, physicians and public health officials. Given the evolving nature of the SARS-CoV-2 genome, drug and vaccine developers should continue to be vigilant for emergence of new variants or sub-strains of the virus."
Source: https://www.who.int/bulletin/volumes/98/7/20-253591/en/
Commentary: The genomic analysis in this paper demonstrates just how many mutations have occurred in SARS-CoV-2, including some on open reading frames (which have a higher chance of causing impactful effects) like the D614G mutation that appears to have caused increased transmissibility. Some of the implications for the documented mutations are concerning.
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Masks on. "The two hair stylists in Springfield, Mo., broke the cardinal rule of infection control: Despite having respiratory symptoms, one went to work and saw clients for eight days, when she learned she had tested positive for Covid-19. Her colleague also developed symptoms, three days after her co-worker, and also kept working until she tested positive, two days after the first stylist. Together, they saw 139 clients, with appointments for haircuts, shaves, and perms lasting 15 to 45 minutes.
Yet when the local health department identified and contacted the 139 clients, asking them to self-quarantine for 14 days and checking in daily about whether they had developed Covid-19 symptoms, not a single one (of the 104 who agreed to be interviewed) did. Of the 67 who consented to a swab test, every one tested negative. There was one other notable fact about the case: Both stylists and every client had worn a face covering.
The stark case, described on Tuesday in Morbidity and Mortality Weekly Report, adds to the near-universal scientific consensus that, more than any of single action short of everyone entering solitary confinement, face coverings can prevent the transmission of the coronavirus that causes Covid-19.
“Like herd immunity with vaccines, the more individuals wear cloth face coverings in public places where they may be close together, the more the entire community is protected,” Robert Redfield, director of the Centers for Disease Control and Prevention, and two colleagues wrote in an editorial in the Journal of the American Medical Association, also published on Tuesday. Because cloth face coverings can also allow states to more safely ease stay-at-home orders and business closings, Redfield told a JAMA Live webcast Tuesday, “If we could get everybody to wear a mask right now, I really think in the next four, six, eight weeks, we could bring this epidemic under control.”"
Source: https://www.statnews.com/2020/07/14/if-everyone-wore-mask-covid19-could-be-controlled-cdc-director-urges/
Commentary: Universal mask usage is the way forward. That's all there is to it for now.
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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.
2. Wear gloves and a mask when out of your home. Consider wearing a face shield if you can't breathe at all through a mask. 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. Avoid indoor places as much as you can.
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.
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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.