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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It's all about ventilation. "A spin studio that public health officials say followed all Covid-19 protocols is now reporting 61 positive cases of Covid-19, and as many as 100 staff, clients and family members may have been exposed.
SPINCO, in Hamilton, Ontario, just reopened in July and had all of the right protocols in place, including screening of staff and attendees, tracking all those in attendance at each class, masking before and after classes, laundering towels and cleaning the rooms within 30 minutes of a complete class, said Dr. Elizabeth Richardson, Hamilton's medical officer of health, in a statement.
Public health officials are very concerned about the number of cases and the size of the outbreak, especially because the city is not currently a hotspot and the facility was not ignoring health protocols, they said in a statement to CNN.
In a post to clients on Instagram, SPINCO exclaimed in frustration, "We took all the measures public health offered, even added a few, and still the pandemic struck us again!'"
SPINCO said it will stay closed pending further investigation by health officials.
City officials say SPINCO was operating at 50% capacity, with a 6-foot radius around each bike, and that this might raise questions about the safety of gyms and fitness studios during the pandemic."
Source: https://www.cnn.com/2020/10/13/world/spinco-canada-covid-19-outbreak-trnd/index.html
Commentary: In the end, the problem is that COVID-19 is an airborne disease, and no amount of distancing in an indoor space is safe without masks being used all the time and high-speed ventilation with fresh, outside air. Not wearing a mask during class is unsafe. Not wearing a mask indoors at all is unsafe.
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The Czech Republic is building field hospitals. "The Czech Republic will start building capacity for COVID-19 patients outside of hospitals, government officials said on Thursday, as the country battles the fastest rate of infections in Europe.
Interior Minister Jan Hamacek told CTK news agency the army would start building an area for 500 hospital beds at a fairground in Prague from Saturday.
Both military and healthcare personnel will staff the makeshift hospital, Hamacek told Czech television.
COVID-19 infections have nearly doubled in October alone to a total so far of 139,290 in a country with a population of 10.7 million. The Health Ministry reported 9,544 new COVID-19 cases on Wednesday, its highest one-day tally so far.
Prime Minister Andrej Babis told reporters it was necessary to start building extra capacity and that the state would purchase 4,000 beds from hospital and nursing bed maker LINET.
"We don't have time, the outlook is not good. These numbers are catastrophic," Babis said.
Earlier this week, the government shuttered bars, restaurants and clubs and shifted schools to distance learning as it imposed new measures to curb the fast spread of new infections."
Source: https://news.trust.org/item/20201015070150-nq7hg
Commentary: Europe is experiencing a massive second wave. On a percentage basis, European nations have higher rates of new infections than badly-infected places like the United States.
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Consensus. "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 35 million people globally, with more than 1 million deaths recorded by WHO as of Oct 12, 2020. As a second wave of COVID-19 affects Europe, and with winter approaching, we need clear communication about the risks posed by COVID-19 and effective strategies to combat them. Here, we share our view of the current evidence-based consensus on COVID-19.
SARS-CoV-2 spreads through contact (via larger droplets and aerosols), and longer-range transmission via aerosols, especially in conditions where ventilation is poor. Its high infectivity,1 combined with the susceptibility of unexposed populations to a new virus, creates conditions for rapid community spread. The infection fatality rate of COVID-19 is several-fold higher than that of seasonal influenza,2 and infection can lead to persisting illness, including in young, previously healthy people (ie, long COVID).3 It is unclear how long protective immunity lasts,4 and, like other seasonal coronaviruses, SARS-CoV-2 is capable of re-infecting people who have already had the disease, but the frequency of re-infection is unknown.5 Transmission of the virus can be mitigated through physical distancing, use of face coverings, hand and respiratory hygiene, and by avoiding crowds and poorly ventilated spaces. Rapid testing, contact tracing, and isolation are also critical to controlling transmission. WHO has been advocating for these measures since early in the pandemic.
Once again, we face rapidly accelerating increase in COVID-19 cases across much of Europe, the USA, and many other countries across the world. It is critical to act decisively and urgently. Effective measures that suppress and control transmission need to be implemented widely, and they must be supported by financial and social programmes that encourage community responses and address the inequities that have been amplified by the pandemic. Continuing restrictions will probably be required in the short term, to reduce transmission and fix ineffective pandemic response systems, in order to prevent future lockdowns. The purpose of these restrictions is to effectively suppress SARS-CoV-2 infections to low levels that allow rapid detection of localised outbreaks and rapid response through efficient and comprehensive find, test, trace, isolate, and support systems so life can return to near-normal without the need for generalised restrictions. Protecting our economies is inextricably tied to controlling COVID-19. We must protect our workforce and avoid long-term uncertainty.
Japan, Vietnam, and New Zealand, to name a few countries, have shown that robust public health responses can control transmission, allowing life to return to near-normal, and there are many such success stories. The evidence is very clear: controlling community spread of COVID-19 is the best way to protect our societies and economies until safe and effective vaccines and therapeutics arrive within the coming months. We cannot afford distractions that undermine an effective response; it is essential that we act urgently based on the evidence."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32153-X/fulltext
Commentary: This is the simple laundry list of what to do to fight COVID-19 with the best scientific information we have available to us at the moment. None of this is a surprise. None of this is new. What is new is greater and greater failure to comply with the basics of keeping COVID-19 under control.
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Antibody responses decline over time. "Neutralizing antibodies develop in asymptomatic persons with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection; however, the initial immune response is not as strong as in patients with more severe disease (1,2). We investigated the kinetics of SARS-CoV-2 neutralizing antibodies during the 5 months after infection in asymptomatic persons and patients with pneumonia caused by SARS-CoV-2.
Two months after infection, all patients had neutralizing antibodies. Antibody titers correlated with disease severity; the geometric mean titer was 105 among symptomatic persons, 161 among patients with subtle pneumonia, and 891 among patients with apparent pneumonia. Five months after infection, all patients still had neutralizing antibodies, but the geometric mean titer decreased significantly (219.4 at 2 months vs. 143.7 at 5 months; p = 0.03). In the linear regression model, the decline was significantly associated with the antibody levels at 2 months as measured by ELISA (r = 0.536, p = 0.02) and the neutralization assay (r = 0.563, p = 0.02) (Appendix Figure). The waning neutralizing antibody response occurred in 2 (40%) of 5 patients with apparent pneumonia and 2 (33%) of 6 with subtle pneumonia, but none of the asymptomatic persons (Figure).
Our findings demonstrate waning humoral immunity in patients with SARS-CoV-2 infection. We documented the decline of neutralizing antibody titers in asymptomatic and symptomatic patients. In this study, the initial neutralizing antibody reaction appeared to correlate with the severity of the disease. However, patients with pneumonia were considerably older than asymptomatic persons, and increasing age is associated with a stronger neutralizing antibody response (10). In this study, neutralizing antibody titer decreased more in symptomatic than asymptomatic patients. Our study reinforces the concern that naturally acquired humoral immunity against SARS-CoV-2 might not be long-lasting."
Source: https://wwwnc.cdc.gov/eid/article/27/1/20-3515_article
Commentary: Immunity against COVID-19 may not be long-lasting, and that also means that any vaccine we develop likely will have trouble providing long-term immunity as well, at least in the initial round of vaccines. Should you get one when it's available? Yes. Should you expect it to provide long-term immunity? No.
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20% increase in excess deaths through July 2020. "Previous studies of excess deaths (the gap between observed and expected deaths) during the coronavirus disease 2019 (COVID-19) pandemic found that publicly reported COVID-19 deaths underestimated the full death toll, which includes documented and undocumented deaths from the virus and non–COVID-19 deaths caused by disruptions from the pandemic.1,2 A previous analysis found that COVID-19 was cited in only 65% of excess deaths in the first weeks of the pandemic (March-April 2020); deaths from non–COVID-19 causes (eg, Alzheimer disease, diabetes, heart disease) increased sharply in 5 states with the most COVID-19 deaths.1 This study updates through August 1, 2020, the estimate of excess deaths and explores temporal relationships with state reopenings (lifting of coronavirus restrictions).
Of the 225 530 excess deaths, 150 541 (67%) were attributed to COVID-19. Joinpoint analyses revealed an increase in deaths attributed to causes other than COVID-19, with 2 reaching statistical significance. US mortality rates for heart disease increased between weeks ending March 21 and April 11 (APC, 5.1 [95% CI, 0.2-10.2]), driven by the spring surge in COVID-19 cases. Mortality rates for Alzheimer disease/dementia increased twice, between weeks ending March 21 and April 11 (APC, 7.3 [95% CI, 2.9-11.8]) and between weeks ending June 6 and July 25 (APC, 1.5 [95% CI, 0.8-2.3]), the latter coinciding with the summer surge in sunbelt states.
Although total US death counts are remarkably consistent from year to year, US deaths increased by 20% during March-July 2020. COVID-19 was a documented cause of only 67% of these excess deaths. Some states had greater difficulty than others in containing community spread, causing protracted elevations in excess deaths that extended into the summer. US deaths attributed to some noninfectious causes increased during COVID-19 surges. Excess deaths attributed to causes other than COVID-19 could reflect deaths from unrecognized or undocumented infection with severe acute respiratory syndrome coronavirus 2 or deaths among uninfected patients resulting from disruptions produced by the pandemic. Study limitations include the reliance on provisional data, inaccuracies in death certificates, and assumptions applied to the model."
Source: https://jamanetwork.com/journals/jama/fullarticle/2771761
Commentary: If a third of deaths that are related to COVID-19 are going unreported, then that means while the United States has 215,000 coded deaths, we might have a real death toll of over 300,000 now.
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Advance notice to investors. "On the afternoon of Feb. 24, President Trump declared on Twitter that the coronavirus was “very much under control” in the United States, one of numerous rosy statements that he and his advisers made at the time about the worsening epidemic. He even added an observation for investors: “Stock market starting to look very good to me!”
But hours earlier, senior members of the president’s economic team, privately addressing board members of the conservative Hoover Institution, were less confident. Tomas J. Philipson, a senior economic adviser to the president, told the group he could not yet estimate the effects of the virus on the American economy. To some in the group, the implication was that an outbreak could prove worse than Mr. Philipson and other Trump administration advisers were signaling in public at the time.
Interviews with eight people who either received copies of the memo or were briefed on aspects of it as it spread among investors in New York and elsewhere provide a glimpse of how elite traders had access to information from the administration that helped them gain financial advantage during a chaotic three days when global markets were teetering.
To many of the investors who received or heard about the memo, it was the first significant sign of skepticism among Trump administration officials about their ability to contain the virus. It also provided a hint of the fallout that was to come, said one major investor who was briefed on it: the upending of daily life for the entire country.
“Short everything,” was the reaction of the investor, using the Wall Street term for betting on the idea that the stock prices of companies would soon fall.
That investor, and a second who was briefed on the Hoover meetings, said that aspects of the readout from Washington informed their trading that week, in one case adding to existing short positions in a way that amplified his profits. Other investors, upon reading or hearing about the memo, stocked up on toilet paper and other household essentials."
Source: https://www.nytimes.com/2020/10/14/us/politics/stock-market-coronavirus-trump.html
Commentary: The good news, for those of you reading this newsletter, is that we've been watching this pandemic since late January and calling for everyone to prepare appropriately. We may not have access to the innermost information of governments and wealthy investors, but we're still doing pretty well with publicly available data. Keep your eyes and ears open.
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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. 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.
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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.