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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Current situation.
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The big story: Moderna's vaccine candidate shows promise. "The drugmaker Moderna announced on Monday that its coronavirus vaccine was 94.5 percent effective, based on an early look at the results from its large, continuing study.
Researchers said the results were better than they had dared to imagine. But the vaccine will not be widely available for months, probably not until spring.
Moderna is the second company to report preliminary data on an apparently successful vaccine, offering hope in a surging pandemic that has infected more than 53 million people worldwide and killed more than 1.2 million. Pfizer, in collaboration with BioNTech, was the first, reporting one week ago that its vaccine was more than 90 percent effective.
Pfizer and Moderna were the first to announce early data on large studies, but 10 other companies are also conducting big Phase 3 trials in a global race to produce a vaccine, including efforts in Australia, Britain, China, India and Russia. More than 50 other candidates are in earlier stages of testing.
Moderna also reported on Monday that its vaccine has a longer shelf life under refrigeration and at room temperature than previously reported, which should make it easier to store and use.
The 95 cases included 15 people 65 or older and 20 people who were Hispanic, Black, Asian or multiracial. The company said the vaccine appeared equally safe and effective in all the subgroups.
The results were analyzed by an independent data safety monitoring board, appointed by the National Institutes of Health.
Pfizer and Moderna each announced the findings in news releases, not in peer-reviewed scientific journals, and the companies have not yet disclosed the detailed data that would allow outside experts to evaluate their claims. Therefore, the results cannot be considered conclusive. The studies are continuing, and the figures on effectiveness may change.
Moderna, based in Cambridge, Mass., developed its vaccine in collaboration with researchers from the Vaccine Research Center, part of the National Institute of Allergy and Infectious Diseases.
Dr. Anthony S. Fauci, director of the institute, said in an interview: “I had been saying I would be satisfied with a 75 percent effective vaccine. Aspirationally, you would like to see 90, 95 percent, but I wasn’t expecting it. I thought we’d be good, but 94.5 percent is very impressive.”
At a news briefing on Monday, Dr. Fauci and Dr. Francis Collins, director of the National Institutes of Health, emphasized that the hopeful news did not mean people could let down their guard. On the contrary, they implored the public to “double down” on mask-wearing, distancing, hand-washing and avoiding crowds, and to stay that course until vaccine becomes available."
Source: https://www.nytimes.com/2020/11/16/health/Covid-moderna-vaccine.html
Commentary: The latter part is vital. The existence of a vaccine does not mean conferred safety on a population until a significant majority of the population has been vaccinated.
That said, this is the second messenger RNA vaccine that has performed well in trials; while we are waiting on actual data from both companies, this shows promise.
Which means it's time to talk about vaccine distribution. All over the world, but especially in the United States, there are significant portions of the population that have opposed vaccines for a variety of mostly unsound reasons based on incorrect information. This poses an obstacle to achieving herd immunity.
So how will we get to herd immunity if a substantial number of people refuse to take a vaccine? Some governments, more authoritarian ones, can simply impose it on their citizens. This is not realistic for more democratic societies.
The route I suggest we need to take is like membership and licensing. You may not legally drive a car without a license, and the penalties for violation are significant. You may not own a gun without a license. You may not consume alcohol below a certain age.
Critically, in some situations, you may not participate in certain parts of society without vaccination. Schoolchildren are required to be vaccinated for participation in some activities. Pets may not be boarded at daycares without up to date vaccination. This is the sort of system I envision as effective with a free of cost vaccine available to all persons. A simple card or smartphone app that is encrypted, possibly uses the blockchain, and simply tracks a person's vaccine status. No personally identifying information beyond their vaccine status - opted out, expired, or current.
Then, have that be required for certain high risk scenarios. Want to go to a concert or a baseball game? Swipe/scan your vaccine status for admission. Want to eat in a restaurant indoors or go drinking at the bar? Swipe/scan your status with the bouncer. Want food/drink service on your flight? Swipe/scan your status at TSA check-in. You don't want to be vaccinated? That's your right - and with that decision comes consequences.
We cannot force people to take a vaccine. But we can absolutely say that if you opt out, you opt out of activities in daily life as a consequence, and opting back in is as easy as going to the doctor/clinic.
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Accelrated evolution. "A 45-year-old man with severe antiphospholipid syndrome complicated by diffuse alveolar hemorrhage,1 who was receiving anticoagulation therapy, glucocorticoids, cyclophosphamide, and intermittent rituximab and eculizumab, was admitted to the hospital with fever (Fig. S1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org). On day 0, Covid-19 was diagnosed by SARS-CoV-2 reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay of a nasopharyngeal swab specimen, and the patient received a 5-day course of remdesivir (Fig. S2). Glucocorticoid doses were increased because of suspected diffuse alveolar hemorrhage. He was discharged on day 5 without a need for supplemental oxygen.
We performed quantitative SARS-CoV-2 viral load assays in respiratory samples (nasopharyngeal and sputum) and in plasma, and the results were concordant with RT-PCR Ct values, peaking at 8.9 log10 copies per milliliter (Fig. S2 and Table S1). Tissue studies showed the highest SARS-CoV-2 RNA levels in the lungs and spleen (Figs. S4 and S5).
Phylogenetic analysis was consistent with persistent infection and accelerated viral evolution (Figures 1A and S6). Amino acid changes were predominantly in the spike gene and the receptor-binding domain, which make up 13% and 2% of the viral genome, respectively, but harbored 57% and 38% of the observed changes (Figure 1B). Viral infectivity studies confirmed infectious virus in nasopharyngeal samples from days 75 and 143 (Fig. S7). Immunophenotyping and SARS-CoV-2–specific B-cell and T-cell responses are shown in Table S2 and Figures S8 through S11.
Although most immunocompromised persons effectively clear SARS-CoV-2 infection, this case highlights the potential for persistent infection5 and accelerated viral evolution associated with an immunocompromised state."
Source: https://www.nejm.org/doi/10.1056/NEJMc2031364
Commentary: This is one of the concerns with SARS-CoV-2 and keeping it away from high risk populations. Not only are they at greater risk of negative outcomes, by having the virus stay in the body longer, fighting a compromised immune system, the virus can learn and adapt much more quickly to our defense mechanisms.
Imagine a boxing match with the virus in one corner and the patient in the other. In a healthy immune system, the body knocks out the virus in the first round. Boom, it's on the canvas. The virus never learns what hit it.
Now imagine the same match with a compromised immune system. The virus gets hit but doesn't go down - and it begins to learn the patient's moves. It learns how the immune system responds to it and evolves, gets smarter, evades the immune system longer.
That's what the virus is doing in someone with a compromised immune system - and if it spreads from that person, we now have a virus that is smarter and better adapted to defeating us. It's evolved, it's learned.
Many of the vaccines coming on the market target the spike protein where the virus attaches to the body's cells. If we have a big reservoir of sick people whose bodies are breeding grounds for mutation, it increases the chance that a mutation will evolve that defeats our current pool of vaccines.
Thus, it is in everyone's best interests to wear a mask, watch your distance, wash your hands, and walk away from indoor spaces as quickly as possible that aren't your home.
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Morgues need prisoners to move bodies. "The morgue in El Paso is so overwhelmed by the number of people dying from COVID-19 that inmates from the county’s detention facility are being brought in to assist with the overflow of bodies awaiting autopsy.
While the work these inmates do in the community typically goes unpaid, Chris Acosta, a spokesperson for the El Paso County Sheriff’s Office, said “trustees refused to work unless they were compensated.” They’re making $2 per hour.
Between four and eight inmates from the detention facility’s trustee program are volunteering daily from 8 a.m. to 4 p.m. The inmates doing the work are misdemeanor offenders and those in minimum custody. The shifts started Monday, Acosta said.
Acosta said she couldn’t speak to the exact nature of the work the inmates are doing at the morgues, but she said that the inmates, one deputy and two detention officers are given personal protective equipment and are required to wear it.
Images and video show the trustees moving bodies to the eight, soon to be 10, mobile morgues set up outside the medical examiner’s office.
It’s a temporary assignment, Acosta said, while the county awaits the arrival of the National Guard."
Source: https://www.texastribune.org/2020/11/15/coronavirus-texas-el-paso-inmates-morgue-deaths/
Commentary: Case counts are up. Hospitals are full. And morgues are overflowing.
This is a critical point: with hospitals full, beds are not available - not only for COVID-19, but for all healthcare. A bed is a bed is a bed. If you contract appendicitis or have a heart attack or other healthcare problem that requires a hospital bed, one may not be available. That's the part everyone who opposes restrictions and masks misses. There's simply no room at the inn, as it were. If you get in a car accident, there's no space in the ICU if it's entirely occupied by COVID-19 cases.
Do everything you can to help. Convince others as best you can. Stay safe, stay home, stay away from people you don't live with except by virtual communication.
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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.
7. Ventilate your home as frequently as weather and circumstances permit.
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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.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.