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.
You are welcome to share this.
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If you're eligible, get it done.
"I just admitted 3 patients to the ICU in 30 mins. All of them had qualified for the vaccine over a month ago but never got it. Sadly, all of them now have severe Covid. Please DON’T HESITATE when it’s your chance. It may be your last."
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People who have had COVID-19 should get vaccinated. "Novel mRNA vaccines for SARS-CoV-2 have been authorized for emergency use. Despite their efficacy in clinical trials, data on mRNA vaccine-induced immune responses are mostly limited to serological analyses. Here, we interrogated antibody and antigen-specific memory B cells over time in 33 SARS-CoV-2 naïve and 11 SARS-CoV-2 recovered subjects. SARS-CoV-2 naïve individuals required both vaccine doses for optimal increases in antibodies, particularly for neutralizing titers against the B.1.351 variant. Memory B cells specific for full-length spike protein and the spike receptor binding domain (RBD) were also efficiently primed by mRNA vaccination and detectable in all SARS-CoV-2 naive subjects after the second vaccine dose, though the memory B cell response declined slightly with age. In SARS-CoV-2 recovered individuals, antibody and memory B cell responses were significantly boosted after the first vaccine dose; however, there was no increase in circulating antibodies, neutralizing titers, or antigen-specific memory B cells after the second dose. This robust boosting after the first vaccine dose strongly correlated with levels of pre-existing memory B cells in recovered individuals, identifying a key role for memory B cells in mounting recall responses to SARS-CoV-2 antigens. Together, our data demonstrated robust serological and cellular priming by mRNA vaccines and revealed distinct responses based on prior SARS-CoV-2 exposure, whereby COVID-19 recovered subjects may only require a single vaccine dose to achieve peak antibody and memory B cell responses. These findings also highlight the utility of defining cellular responses in addition to serologies and may inform SARS-CoV-2 vaccine distribution in a resource-limited setting."
Source: https://immunology.sciencemag.org/content/6/58/eabi6950.full
Commentary: Because not every COVID-19 infection is the same, nor does it have the same viral load, the only way to ensure a maximum immune response is to also be vaccinated. Get your shot, COVID or not.
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Aiming for a pancoronavirus vaccine. "In 2017, three leading vaccine researchers submitted a grant application with an ambitious goal. At the time, no one had proved a vaccine could stop even a single beta coronavirus—the notorious viral group then known to include the lethal agents of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), as well as several causes of the common cold and many bat viruses. But these researchers wanted to develop a vaccine against them all.
Grant reviewers at the National Institute of Allergy and Infectious Diseases (NIAID) deemed the plan “outstanding.” But they gave the proposal a low priority score, dooming its bid for funding. “The significance for developing a pan-coronavirus vaccine may not be high,” they wrote, apparently unconvinced that the viruses pose a global threat.
How things have changed.
As the world nears 3 million deaths from the latest coronavirus in the spotlight, SARS-CoV-2, NIAID and other funders have had a major change of heart. In November 2020, the agency solicited applications for “emergency awards” to pursue pancoronavirus vaccine development. And in March, the Coalition for Epidemic Preparedness Innovations (CEPI), an international nonprofit launched in 2017, announced it would spend up to $200 million on a new program to accelerate the creation of vaccines against beta coronaviruses, a family that now includes SARS-CoV-2.
The threat of another coronavirus pandemic now seems very real. Beyond bats, coronaviruses infect camels, birds, cats, horses, mink, pigs, rabbits, pangolins, and other animals from which they could jump into human populations with little to no immunity, as most researchers suspect SARS-CoV-2 did. “Chances are, in the next 10 to 50 years, we may have another outbreak like SARS-CoV-2,” says structural biologist Andrew Ward of Scripps Research, one of the scientists who submitted the 2017 proposal NIAID rejected.
The agency has not given out any of its new awards yet, but Ward’s lab is already pursuing a vaccine targeting a subset of beta coronaviruses. Some two dozen other research groups around the world have similar pancoronavirus vaccine projects underway. Their approaches include novel nanocages arrayed with viral particles, the cutting-edge messenger RNA (mRNA) technique at the heart of proven COVID-19 vaccines, and cocktails of inactivated viruses, the mainstay of past vaccines. A few teams have even published promising results from animal tests of early candidates."
Source: https://www.sciencemag.org/news/2021/04/vaccines-can-protect-against-many-coronaviruses-could-prevent-another-pandemic
Commentary: This is not only necessary, but seriously cool stuff. Let's hope we can develop vaccines for entire families of viruses like this. If we crack, say, retroviruses, that will shut down HIV/AIDS.
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All about that ventilation. "It is now clear that SARS-CoV-2 transmits mostly between people at close range through inhalation. This does not mean that transmission through contact with surfaces or that the longer range airborne route does not occur, but these routes of transmission are less important during brief everyday interactions over the usual 1 m conversational distance. In close range situations, people are much more likely to be exposed to the virus by inhaling it than by having it fly through the air in large droplets to land on their eyes, nostrils, or lips.17 The transmission of SARS-CoV-2 after touching surfaces is now considered to be relatively minimal.181920
Improved indoor air quality through better ventilation will bring other benefits, including reduced sick leave for other respiratory viruses and even environmentally related complaints such as allergies and sick building syndrome.2122 Less absenteeism—with its adverse effect on productivity—could save companies significant costs,23 which would offset the expense of upgrading their ventilation systems. Newer systems, including air cleaning and filtration technologies, are becoming ever more efficient.24
Covid-19 may well become seasonal, and we will have to live with it as we do with influenza.25 So governments and health leaders should heed the science and focus their efforts on airborne transmission. Safer indoor environments are required, not only to protect unvaccinated people and those for whom vaccines fail, but also to deter vaccine resistant variants or novel airborne threats that may appear at any time. Improving indoor ventilation and air quality, particularly in healthcare, work, and educational environments, will help all of us to stay safe, now and in the future."
Source: https://www.bmj.com/content/373/bmj.n913
Commentary: Masks are likely to be a cultural mainstay in many parts of the world for at least a few years, if not longer - and that's a welcome thing, honestly. It will not only suppress COVID-19, but other respiratory diseases like colds and influenza. I know I plan on continuing to wear mine. It literally costs me nothing, inconveniences no one, and cuts down on the crap I inhale into my body. Cigarette smoke? It'll knock out all the particles. Pollen? Blocked. Disease? If it's airborne, it's not getting in. Someone's terrible perfume? It'll knock it down by half.
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Sinovac vaccine underperforming. "THE LATEST results for China’s CoronaVac vaccine, developed by Sinovac Biotech, a Beijing-based pharmaceutical company, were disappointing for the aspiring scientific and technological powerhouse. Phase-three trials, which were conducted on health-care workers in Brazil, yielded an efficacy rate of just 50.7% (with a 95% confidence interval of 35.7% to 62.2%), just barely above the 50% threshold set by the World Health Organisation for covid-19 vaccines (see chart). The results of a real-world trial released a week earlier were even worse: the vaccine was estimated to be just 49.6% effective (11.3% to 71.4%) against symptomatic covid-19 cases; when asymptomatic infections were included, this figure dropped to a dismal 35.1%.
The Chinese authorities’ reaction did little to boost confidence. After news broke of the discouraging results, Gao Fu, head of the Chinese Centre for Disease Control and Prevention, admitted at a conference on April 10th that current vaccines “don't have very high rates of protection”, and suggested that vaccines could be mixed to improve efficacy. Mr Gao later backtracked from the comments, claiming that it was “a complete misunderstanding”.
That the Sinovac trials were conducted in Brazil, which harbours a variant of the virus thought to be particularly nasty, suggests some caution in assessing the outcome is in order. Indeed, preliminary results from the firm’s phase-three trials in Turkey suggest an efficacy rate of 83.5%. Similar phase-three trials are under way in Chile, Indonesia, and the Philippines.
Effective or not, Sinovac has already exported approximately 120m doses to 19 different countries, according to Airfinity, a London-based science analytics company (see chart). So far, the largest shipments have gone to Brazil, Indonesia and Turkey. In China, nearly 180m people have already been vaccinated.
Despite the apparently poor results in stopping infections, the Sinovac vaccine, like its competitors, appears to offer remarkably good protection against severe disease and death. In the Brazil phase-three trials, nearly 4% of the unvaccinated participants who were infected got severely ill; among the vaccinated, none did."
Source: https://www.economist.com/graphic-detail/2021/04/15/in-clinical-and-real-world-trials-chinas-sinovac-underperforms
Commentary: As long as the vaccine is shutting down severe illness and death, that's all we can ask for at this point. These will not be the only, or the last, COVID-19 vaccines we produce. In all likelihood, we will be having them like flu shots for the foreseeable future.
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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:
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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.