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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Pediatric hospitalizations of COVID-19 are at their highest point ever. "Pediatric hospitalizations for Covid-19 have rapidly increased over the last month in the United States, with the rate of daily new cases reaching an all-time high in the last few days. It's already far worse than the previous record peak in January. The data visualization below created for Inside Medicine makes it plain to see where we are and where we’ve been. Perhaps more alarming than the raw number of daily hospitalizations in children is the magnitude of the rise in recent weeks. Obviously we cannot predict whether this worrisome trend in pediatric hospitalizations will continue, level off, or drop. But we must not ignore it.
The regions having major pediatric outbreaks should serve as a warning to the rest of us. For example, in Georgia last week, around 7 out of every 100,000 children in the state—not per 100,000 pediatric coronavirus cases, but per living child—were hospitalized for Covid-19. That triples the pediatric hospitalization rate that was observed during the worst weeks of the most recent normal flu season (the winter of 2019-2020), and that’s likely a conservative estimate.†
If we dug into the reporting methodology (which I’ll do with you in the future), we would find that the rate of Covid-19 hospitalizations exceeds the usual rate of influenza hospitalizations by far more than that. Keep in mind that this unprecedented spike in pediatric Covid-19 hospitalizations is occurring in the month of August. Historically, August is the month with the fewest pediatric deaths for respiratory and infectious illnesses."
Source:
Source: https://insidemedicine.bulletin.com/2370680396397133/
Commentary: The reality is that schools for children under 12 should not be opening up in less than a month unless each school has been properly outfitted with the correct ventilation, outdoor dining areas, and N95/KN95 masks for children and staff. If you are a parent of a child under 12 and remote learning is practical, keep them home this coming fall. If you cannot do that, ensure that you communicate the risks to your child, then teach and model the behavior you want by making sure you're always masked up outside your home.
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More clues on vaccine protection. "magine peering into people’s blood and being able to pick up a simple marker of exactly how well protected they are from Covid-19.
It’s a pressing goal for scientists who are still trying to understand what immunity to the coronavirus looks like, how robustly vaccines protect us over time, and how protected people are who’ve had and recovered from Covid-19.
Now, a year and a half into the pandemic, researchers are starting to flesh out exactly what these “correlates of protection” look like, a step that could help track the durability of immunity and speed the development of additional vaccines. In a preprint paper last week, a group of researchers from both academia and U.S. health agencies reported their findings of the immune correlates for Moderna’s Covid-19 vaccine. The study demonstrated the link between the level of antibodies in a person’s system and how protected they are against Covid-19, validating the hypothesis that antibodies could be used as a measure that signifies overall protection.
“We saw a very clear correlation that the higher the level of antibody produced by vaccines, the less likely you were to become sick with Covid-19,” said Christopher Houchens, one of the authors of the paper and a biologist at the U.S. Biomedical Advanced Research and Development Authority.
The team is working on similar studies for the other vaccines that received support from Operation Warp Speed, including Johnson & Johnson’s and AstraZeneca’s, while other research groups are investigating other vaccines used around the world. Additional recent studies have also pointed to using antibody levels as correlates of protection.
A key advantage of knowing the correlates of protection is potentially enabling the approval of future vaccines. The vaccines that are available now went through a slog of clinical trials involving tens of thousands of people. But with vaccines increasingly available, it’s harder to enlist volunteers to participate in a study in which they might receive a placebo. Most people would instead choose to get a shot they know works."
Source: https://www.statnews.com/2021/08/16/scientists-clues-how-safe-vaccinated-people-are-from-covid-19/
Commentary: The critical takeaway here is that not only do vaccines work, but it would appear boosters will work as well, at least for the current crop of strains. Expect to need a booster in the next year or so. In the meantime, mask up! The less work your immune system has to do, the better.
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If you have a strong reaction after the first shot of an mRNA vaccine, you probably had COVID-19 at some point. "A questionnaire and serum sample were collected 14 or more days following dose 2 for 954 HWs. Clinically significant symptoms were reported by 52 of the 954 (5%) after dose 1 and 407 (43%) after dose 2. After adjusting for prior SARS-CoV-2 infection, age, and sex, the odds of clinically significant symptoms following either dose were higher among participants who received the Moderna vs the Pfizer vaccine (dose 1: odds ratio [OR], 1.83; 95% CI, 0.96-3.50; dose 2: OR, 2.43; 95% CI, 1.73-3.40) (Table). Prior SARS-CoV-2 exposure was associated with increased odds of clinically significant symptoms following dose 1 (OR, 4.38; 95% CI, 2.25-8.55) but not dose 2 (OR, 0.60; 95% CI, 0.36-0.99), after controlling for vaccine type, age, and sex.
Regardless of symptoms, the vast majority of participants (953 of 954, greater than 99.9%) developed spike IgG antibodies 14 or more days following dose 2; 1 participant who was taking immunosuppressant medication did not develop IgG antibodies (Figure). Reporting clinically significant symptoms, age younger than 60 years, female sex, receipt of Moderna vaccine, and prior SARS-CoV-2 exposure were independently associated with higher median IgG measurements, after adjusting for time after dose 2.
Nearly 100% of HWs in this study mounted a strong antibody response to the spike protein after dose 2 of the SARS-CoV-2 mRNA vaccine independent of vaccine-induced reactions. Clinically significant symptoms following dose 1 were associated with prior SARS-CoV-2 infection, confirming prior reports.4 Clinically significant symptoms following vaccination were more frequent following dose 2 and receipt of the Moderna vaccine.3"
Source: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2782821
Commentary: Previous exposure to COVID-19 tends to create a really vigorous immune response, similar to what non-exposed people get after the second shot. If your first shot reaction is bad and you get very little reaction on the second shot, you probably already had COVID-19.
That said, remind folks that they should get both shots regardless.
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A reminder of the simple daily habits we should all be taking.
1. Wear the best mask available to you when you'll be around people you don't live with, even after you've been vaccinated. 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. Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
3. Get vaccinated as soon as you're able to, and fulfill the full vaccine regimen. Remember that you are not vaccinated until everyone you live with is vaccinated. If you received an adenovirus vaccine (J&J/AstraZeneca), consider getting an mRNA single shot booster (Pfizer/Moderna) if permitted.
4. Wash/sanitize your hands every time you are in or out of your home.
5. Stay out of indoor spaces that aren't your home and away from people you don't live with as much as practical. Minimize your contact with others and avoid indoor places as much as you can; indoor spaces spread the disease through aerosols and distance is less effective at mitigating your risks.
6. Aim to have 3-6 months of living expenses on hand in case the pandemic gives another crazy plot twist to the economy.
7. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
8. 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).
9. Masks must fit properly to work. Here's how to properly fit a mask:
10. If you think you may have been exposed to COVID-19, purchase a rapid antigen test. This will detect COVID-19 only when you're contagious, so follow the directions clearly. https://amzn.to/3fLAoor
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Common misinformation debunked!
There is no basis in fact that COVID-19 vaccines can shed or otherwise harm people around you.
Source: https://www.reuters.com/article/factcheck-covid19vaccine-reproductivepro-idUSL1N2MG256
There is no mercury or other heavy metals in the Pfizer mRNA vaccine.
Source: https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
There is no basis in fact that COVID-19 vaccines pose additional risks to pregnant women.
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2104983
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/
Source: https://www.smh.com.au/national/are-we-ignoring-the-hard-truths-about-the-most-likely-cause-of-covid-19-20210601-p57x4r.html
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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Disclosures and Disclaimers
I declare no competing interests on anything I share related to COVID-19. I am employed by and am a co-owner in TrustInsights.ai, an analytics and management consulting firm. I have no clients and no business interests in anything related to COVID-19, nor do I financially benefit in any way from sharing information about COVID-19.
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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.