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 a qualified healthcare provider who knows your specific medical situation over advice from people on the Internet.
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Situation in the USA, part 1. "The US test positivity rate for Covid has ticked up to almost 10%, which indicates increased transmission. Make sure you're up-to-date with vaccination and mask up with N95s to avoid infection, especially if you're older or immunosuppressed or around someone who is."
Source:
Commentary: So things are kind of a mess in the USA - and lots of other places, too. People are done with the pandemic. The pandemic is not done with them.
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Situation in the USA, part 2. "A painful and foreboding reality is setting in for the White House as it enters a potentially dangerous stretch of the Covid fight: It may soon need to run its sprawling pandemic response on a shoestring budget.
Just two months after the administration unveiled a nearly 100-page roadmap out of the crisis, doubts are growing about Congress’ willingness to fund the nation’s fight. It has forced Biden officials to debate deep cuts to their Covid operation and game out ways to keep the federal effort afloat on a month-by-month basis.
Among the sacrifices being weighed are limiting access to its next generation of vaccines to only the highest-risk Americans — a rationing that would have been unthinkable just a year ago, when the White House touted the development and widespread availability of vaccines as the clearest way out of the pandemic.
But as the government’s cash reserves dwindle, officials are increasingly concluding that these types of difficult choices will soon have to be made. And they are quietly preparing to shift responsibility for other key parts of the pandemic response to the private sector as early as 2023.
“There’s a great deal of concern that we’re going to be caught shorthanded,” said one person familiar with the discussions. “On the face of it, it’s absurd.”
The contingency planning is aimed at preserving the bare-minimum tools needed to protect against the virus this year, federal officials and others familiar with the discussions said. But many of those decisions still hinge on Congress authorizing $10 billion in new Covid spending, a prospect that remains uncertain in the face of GOP opposition."
Source: https://www.politico.com/news/2022/05/13/white-house-vaccines-covid-funding-impasse-00032319
Commentary: The key takeaway here is that if you've been waiting to get a booster or even vaccinated, and you're eligible, DO IT NOW. Do it before funding runs out.
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Unusual hepatitis cases may be SARS-CoV-2 reservoirs in kids. "Acute hepatitis has been reported in children with multisystem inflammatory syndrome, but co-infection of other viruses was not investigated.8 We hypothesise that the recently reported cases of severe acute hepatitis in children could be a consequence of adenovirus infection with intestinal trophism in children previously infected by SARS-CoV-2 and carrying viral reservoirs (appendix). In mice, adenovirus infection sensitises to subsequent Staphylococcal-enterotoxin-B-mediated toxic shock, leading to liver failure and death.9 This outcome was explained by adenovirus-induced type-1 immune skewing, which, upon subsequent Staphylococcal enterotoxin B administration, led to excessive IFN-γ production and IFN-γ-mediated apoptosis of hepatocytes.9 Translated to the current situation, we suggest that children with acute hepatitis be investigated for SARS-CoV-2 persistence in stool, T-cell receptor skewing, and IFN-γ upregulation, because this could provide evidence of a SARS-CoV-2 superantigen mechanism in an adenovirus-41F-sensitised host. If evidence of superantigen-mediated immune activation is found, immunomodulatory therapies should be considered in children with severe acute hepatitis."
Source: https://www.thelancet.com/journals/langas/article/PIIS2468-1253(22)00166-2/fulltext
Commentary: More evidence that COVID-19 is in fact harmful to children in a multitude of ways and we should be doing all we can to protect them until we have updated vaccines that are effective against it.
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Long COVID is a big unknown. "Long COVID may already affect between 7 million and 23 million Americans who previously had the virus, or up to 7% of the U.S. population, according to the U.S. Government Accountability Office.
Different estimates of how many people are affected with long COVID vary widely—from 10% to 80% of COVID survivors. More than half of COVID survivors report symptoms that persist after six months, Penn State College of Medicine researchers reported last year.
It’s a poorly understood condition that could disable over a billion worldwide in just a few years, says Arijit Chakravarty, a COVID researcher and CEO of Fractal Therapeutics, a drug development firm. Experts say that it’s quickly growing into a major public health concern already overwhelming primary-care physicians.
Chakravarty and his research team have developed simulations throughout the pandemic and have a record for predicting uncomfortable truths, like how rebound waves of COVID were possible even after wide distribution of the vaccine. His team’s modeling shows that those who are vaccinated but don’t take precautions against the virus can expect to get COVID once or twice a year, going forward.
Those who are fully vaccinated reduce their risk of long COVID by about half. Assuming the entire world is vaccinated and doesn’t take precautions, and that the risk of getting long COVID each time one gets COVID is 10%, “to be conservative,” everyone has a 5% chance of getting long COVID each year, Chakravarty says.
Over three years, then, the chance of coming down with long COVID is 14%. If 14% of the world’s population, nearly 8 billion, comes down with long COVID—the math isn’t pretty, Chakravarty says.
“If the whole world was vaccinated tomorrow and we spent just three years ‘learning to live with COVID’ under the current [U.S. public health] strategy, we could have well over a billion people living with long COVID.”"
Source: https://fortune.com/2022/05/08/surviving-pandemic-half-the-battle-long-covid-growing-public-health-crisis-could-affect-a-billion-in-just-a-few-years/
Commentary: Long COVID is going to be a big, big problem in the decades to come. We have no idea what the long-term consequences of the SARS-CoV-2 virus will be in our bodies, but we know viruses can cause problems later in life. Mononucleosis can be a trigger for multiple sclerosis. Shingles comes from chicken pox. What we do know is that there are already large, long-term health consequences from COVID-19, and nations that have done a poor job containing it are going to see explosive long-term healthcare costs from it.
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"BREAKING: The ECDC (European Centre for Disease Prevention and Control) has upgraded Omicron Sub Lineages BA.4 and BA. 5 to Variants of Concern from Variants of Interest, making it the first public health authority to do so."
Source:
Commentary: And that's not even talking about BA2.1.121.1, the variant currently sweeping through the USA and Europe.
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Actual risk is 5-10x higher in the USA. "This is a screenshot from the CDC website of the current Covid *transmission* map - as in the one we used for the majority of the pandemic that measured how bad the cases are in your area. (The new map is based almost entirely off hospital capacity, NOT cases.)
Here is a link to where you can access this map. Please bookmark it, as the map you will most commonly be sent to is the OTHER map - the one that doesn’t actually measure your risk or infection, it just tells you if your hospitals are too full.
https://covid.cdc.gov/covid-data-tracker/#county-view?list_select_state=all_states&list_select_county=all_counties&data-type=Risk&null=Risk
Something important to keep in mind: this map is based on officially recorded tests - NOT home tests, which currently make up the *majority* of tests taken.
Meaning even though this map shows high transmission in most of the US, actual cases are even HIGHER.
Estimates I’ve seen range from saying we’re only catching 1 in 5 cases on the conservative end, to 1 in 10 cases from others.
All this to say, transmission is currently very high in MOST of the US right now, well past the levels that would have previously triggered responses.
“But most people are vaccinated, so it’s not a big deal anymore.”
A few facts.
First, since Omicron and it’s sub- variants took over in the US, over 40% of the Covid deaths have been in FULLY VACCINATED people.
Second, less than 1/3 of children ages 5-11 have been vaxxed for Covid in the US.
And since Omicron & its sub-variants became dominant, the share of pediatric hospitalizations and deaths went way up from past strains. So yes, Covid in kids DOES matter. Don’t believe otherwise.
(Not to mention the whole hepatitis in kids becoming a big problem now thing. The US may be dancing around it, but countless other countries have admitted what we won’t - it’s the Covid y’all.)
Third, we understand now that immunity from these vaccinations wanes within months. If you are more than 4-5 months from your last shot, you are at significant risk. (And since the current boosters are only accessible to certain populations, most people are outside that window.)
Fourth, even IF you are among the small percentage of the population that has had 4 shots? The current variants have a significant degree of immune escape - so you’re still very likely to be INFECTED if exposed, even if your odds of hospitalization/death are decreased.
“Luckily we just had Omicron, so we’re ok for now at least.”
I know this myth is common, but PLEASE know that Omicron was shown to offer even *less* durable immunity than past strains. People who already had Omicron this year are already getting reinfected.
Put all of that together with this map?
You should not be going ANYWHERE without a mask. Period.
If you believed them when they said you could unmask b/c they would bring mandates back if/when risk was high again? Sorry to say, but they lied.
Risk is high NOW. Mask up.
PS: I really did a disservice by not adding that ZERO percent of kids < 5 have been vaccinated. You may not think that matters, but the highest concentration of Covid hospitalizations for kids is in babies & toddlers. If you won’t mask for you, mask for them. #ImmunizeUnder5s "
Source:
Commentary: Wear the best mask available to you. The disease is changing.
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So, COVID-22? "Wang notes, however, that the subjects in the new study were all vaccinated with CoronaVac, a Chinese vaccine made from inactivated virus. Subjects in his study were vaccinated with messenger RNA (mRNA) vaccines, which might provide a more potent response to the new strains, he says. But Wang agrees that Omicron’s knack for immune escape is dramatic. Based on its immunological profile, it “should be called SARS-3,” he says—an entirely distinct virus.
Omicron’s rapid evolution creates difficult decisions for vaccine- and policymakers about whether to shift to a new set of vaccines or stick with the current formulations, which are based on the virus that emerged in Wuhan, China, more than
2 years ago. Moderna has tested two versions of its mRNA vaccine, containing the ancestral strain and either the Beta variant—which spread in South Africa for a while in 2021 but is now gone—or the Omicron BA.1 variant. The company has not yet reported data on how well they might protect against the new subvariants."
Source: https://www.science.org/content/article/new-versions-omicron-are-masters-immune-evasion
Commentary: I suspect the Omicron branch as a whole needs to be designated at least a new disease, COVID-21 or COVID-22.
Here's the ugly truth: pharmaceutical interventions, be they vaccines or Paxlovid, will continue to decline in effectiveness as the virus mutates from uncontrolled spread. Non-pharmaceutical interventions - masks and ventilation - will continue to grow in importance as a result. Stay ahead of the curve, and stay masked up.
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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, including boosters. 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 available. If it's available, choose Moderna as your first choice for both vaccine and booster, Pfizer as your second choice. However, remember than any vaccine is better than no vaccine.
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, or you know, a global war breaks out.
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.