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.
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Seroprevalence continues to suggest undercounting by 10x. "Seroprevalence data (antibodies to the SARS-CoV-2 spike protein) estimate that there may be 10 times more SARS-CoV-2 infections than the number of reported cases. Thus, it is possible that 40 million to 50 million (12% to 15% of the US population) to date may have been infected with a detectable serological response to SARS-CoV-2. However, relying on population-based natural immunity, especially for populations at risk of greater disease severity, is not wise. Boosting specific neutralizing antibodies and TH1 immunity to high levels with an effective vaccine regardless of prior immune status may further protect these individuals.
COVID-19 vaccines in development designed to prevent clinical infection, disease severity, or both show the induction of an anamnestic immune response to the spike protein with a second dose7 and can generate high levels of neutralizing antibodies comparable with or greater than those seen in sera samples from patients. The induction of sufficient CD4+ follicular helper T cells and inclusion of vaccine boosts, employed for several other vaccines where circulating antibody levels are critical for protection, may be needed to maintain levels of anti–SARS-CoV-2 neutralizing antibodies. Boosting antiviral CD8+ and TH1 CD4+ T cells recognizing spike and epitopes from other conserved regions of the proteome may also be crucial in limiting replication and disease severity. SARS-COV-2 may well follow the path of previous coronaviruses and become endemic in the population as another common cold virus."
Source: https://jamanetwork.com/journals/jama/fullarticle/2770758
Commentary: Even with 12-15% of the population potentially having been infected, we are a long, long way off from herd immunity. The only way out of this in the long run is a vaccine.
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Medicaid could be one vehicle for addressing hunger. "Survey data from the US Census Bureau reveals that during the week ending July 21, 12.1% of adults reported that their households sometimes or often experienced food insufficiency in the previous week, up from 9.8% in early May 2020. Those figures are considerably higher in lower-income households, with 21% of those earning less than $50 000 per year and 29% of those earning less than $25 000 going hungry at times.
Although food banks and food pantries have scrambled to meet this growing need, 1 program that appears to be well positioned to help families with low incomes is Medicaid, according to an analysis from the Kaiser Family Foundation (KFF). The KFF analysis is based on data from the 2018 National Health Interview Survey, as well as data from the US Census Bureau’s Household Pulse Survey. “As the health insurance program for low-income children and many adults, Medicaid reaches many people who may be facing food insecurity and could be a potential vehicle to address this growing problem, especially because of the strong association between food security and health,” the authors noted.
In the Census Bureau survey, approximately 23% of adults enrolled in Medicaid reported that their household faced food insufficiency in the week ending July 21, up from 20% in the week ending March 13. Black and Hispanic Medicaid enrollees had higher rates of food insufficiency (25% and 27%, respectively) compared with White Medicaid enrollees (21%). In addition, difficulty accessing food has persisted for many, with 65% of Medicaid recipients who reported food insufficiency in March doing so in July as well.
To help address these unmet food needs, some Medicaid programs are helping to coordinate their eligibility and enrollment systems and processes with those of food assistance programs. In some states, for example, people can apply for Medicaid and SNAP through a single online application process.
Some Medicaid programs are also building on established programs to screen enrollees for food insecurity and refer them to resources in the community. For example, some states have used Medicaid managed care organizations to work with community-based groups to link enrollees with social services.
“Given the strong association between food security and health, Medicaid can play a role in helping to connect people to food assistance during this time of growing need by building on initiatives that were in place prior to the pandemic,” the KFF authors said. However, they noted, although such efforts may help address the problem, the need may outstrip current resources, and some families with low incomes are not covered by Medicaid. For example, in the 12 states that have not adopted the Medicaid expansion, many families with low income remain shut out of the program. Some immigrants are ineligible for nutrition assistance programs and Medicaid."
Source: https://jamanetwork.com/channels/health-forum/fullarticle/2770754
Commentary: The pandemic is having such wide-ranging consequences, but none so vicious as making the lives of at-risk people worse. Whatever your point of view, if you have the means to help others, please do so as best as you can while continuing to protect yourself and your loved ones. A helping hand can go a long way.
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India facing an oxygen shortage. "Only two of the four tanks of liquid oxygen at Mr Sethia's SS Hospital and Research Centre in Bhiwandi were full. Forty-four of the hospital's 50 beds were occupied by Covid-19 patients, many of whom needed piped oxygen from the tanks to breathe.
Each small tank was getting exhausted in six hours instead of the usual nine hours, because of the surge of patients. Both Mr Sethia's dealers had run out of supplies.
Through the night, he called 10 dealers and four hospitals in and around Mumbai to ask for oxygen. None could help. Around 2am, he finally managed to get 20 large cylinders from another hospital, some 18 miles (30km) away. There were no vehicles available, so his ambulances did five trips through the night to get the cylinders. Four people now work round the clock at the hospital to procure supplies from any maker who can send a truck of liquid oxygen for the tanks or any dealer who can spare a cylinder.
"Now I have enough oxygen for the next 12 hours," Mr Sethia said on Sunday evening. "We are firefighting every day. The battle is to get some oxygen anyhow."
Some 15% of Covid-19 patients require help with breathing, according to the World Health Organization (WHO). Some people appear in no evident respiratory distress, but are found to have dangerously low oxygen levels - a condition called silent hypoxia. A fraction of the critically ill patients require a ventilator.
Around 500 factories spread across India extract and purify oxygen from the air. Oxygen for medical use typically accounts for 15% of overall supplies. The rest - industrial oxygen - is mainly supplied to steel and automobile industries for running blast furnaces."
Source: https://www.bbc.com/news/world-asia-india-54139112
Commentary: Oxygen was a concern I had when the pandemic kicked off in the United States, but fortunately we didn't run out. India's in much tougher straits right now; hopefully they can use their considerable scientific and industrial capacity to ramp up.
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How serious is vaccination? "@ASlavitt to @donlemon on #coronavirus vaccination: "We did some analysis that showed that for every 10% of the population that doesn't take the vaccine, that's another 100,000 lives we'll lose. That's what's at stake in the @US_FDA making sure we have a trusted process."
Source:
Commentary: A trustworthy vaccine is the only viable exit strategy for the pandemic. We are seeing the process work as intended so far with stoppages for unusual events in Phase 3 trials. Let's hope we continue to see rigorous adherence to protocols.
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The 9 CEOs of major pharmas have all pledged not to skip steps on vaccines. "We, the undersigned biopharmaceutical companies, want to make clear our on-going commitment to developing and testing potential vaccines for COVID-19 in accordance with high ethical standards and sound scientific principles.
The safety and efficacy of vaccines, including any potential vaccine for COVID-19, is reviewed and determined by expert regulatory agencies around the world, such as the United States Food and Drug Administration (FDA). FDA has established clear guidance for the development of COVID-19 vaccines and clear criteria for their potential authorization or approval in the US. FDA’s guidance and criteria are based on the scientific and medical principles necessary to clearly demonstrate the safety and efficacy of potential COVID-19 vaccines. More specifically, the agency requires that scientific evidence for regulatory approval must come from large, high quality clinical trials that are randomized and observer-blinded, with an expectation of appropriately designed studies with significant numbers of participants across diverse populations.
Following guidance from expert regulatory authorities such as FDA regarding the development of COVID-19 vaccines, consistent with existing standards and practices, and in the interest of public health, we pledge to:
Always make the safety and well-being of vaccinated individuals our top priority.
Continue to adhere to high scientific and ethical standards regarding the conduct of clinical trials and the rigor of manufacturing processes.
Only submit for approval or emergency use authorization after demonstrating safety and efficacy through a Phase 3 clinical study that is designed and conducted to meet requirements of expert regulatory authorities such as FDA.
Work to ensure a sufficient supply and range of vaccine options, including those suitable for global access.
We believe this pledge will help ensure public confidence in the rigorous scientific and regulatory process by which COVID-19 vaccines are evaluated and may ultimately be approved."
Source: https://www.businesswire.com/news/home/20200908005282/en/Biopharma-Leaders-Unite-Stand-Science
Commentary: This is important, not because it's just a public statement, but it's now on record that these brands and their key executives have made a statement that can be upheld in a court of law. Any one of these companies that now did the opposite could be sued for damages and any number of other reasons, so I'm glad to see they've drawn a line in the stand and said what they are willing to commit to, in a way that has consequences if they don't do what they say.
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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.
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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.