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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Stay home, stay safe. "Using the daily distance difference metric, we identified a strong correlation between decreased mobility and reduced COVID-19 case growth between March 27 and April 20, 2020 (appendix). The other two metrics showed similarly strong correlations (data not shown). However, when we extended the analysis to later time periods (April 21 to May 24, 2020, and May 25 to July 22, 2020) only a weak correlation between daily distance difference and COVID-19 case growth was identified (appendix). In the first time period, when each metric was decreasing, the correlation across all counties was around 0·6. However, as the metrics increased in later time periods, consistent with reductions in social distancing, the correlation decreased to 0·11 or less for all three metrics."
Source: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30725-8/fulltext
Commentary: It should be no surprise that reduced mobility leads to reduced case counts. As much as people are tired of hearing it - COVID fatigue - the reality is that the disease has not changed, is not less dangerous, is not less contagious, and is still an ongoing threat amidst the many other threats we face right now. Biology is unforgiving - there are no days off, no breaks, no forgiveness for lapses in judgement, just a fight against an organism that may or may not even be alive (like all viruses).
Stay home, stay safe, as much as practicality permits.
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How an epidemiologist is approaching Halloween. "Traditionally, Halloween trick-or-treating is primarily an outdoor event, and we know outdoor events are much less riskier given better ventilation. But the activity also involves going to multiple homes and getting treats. For the purposes of this discussion, I'll focus on fomite transmission, as Halloween activities can involve not only coming into close contact with someone, but also getting a treat (e.g. candy).
If someone is infected with COVID-19, their respiratory secretions can contaminate surfaces or objects, creating fomites. Fomites can potentially transfer the virus to a new person. For example, an infected person with COVID-19 coughs or sneezes into their hands, and then proceeds to touch a bowl of candy to distribute or directly expels droplets into the bowl of candy. A new person touches the contaminated candy, then proceeds to touch their mucous membranes (eyes, nose, or mouth). Sounds scary? Well, this is much easier said than done; let's break it down a bit further.
First, fomite transmission is not the primary mode of COVID-19 spread — respiratory droplets and close-range aerosol transmission are.
Second, fomite transmission can potentially occur if there's enough viable SARS-COV-2 virus that can cause infection – but we still don't know the amount of virus, or viral load that can actually cause infection.
Third, the possibility of someone infected with COVID-19 expelling enough viable respiratory droplets on a treat and trick-or-treater, then touching that same area, followed by touching their mucous membranes is low (but not zero).
And fourth, with all this said and done, there are no specific reports which have shown direct fomite transmission. There's a lot we've learned about COVID-19 over the past eight months, but there's still a lot we still don't know.
For my family, I plan to do a Halloween candy egg hunt around our house. I've purchased multi-colored plastic eggs online. During my most recent grocery store trip I wandered into the holiday aisle where the Halloween spread is ready for the picking. I've purchased bite size candy and plan to hide the eggs around our backyard and inside our home, and have the kids find them in their Halloween costume."
Source: https://www.businessinsider.com/how-epidemiologist-is-preparing-for-halloween-holidays-2020-9
Commentary: If your kids MUST go trick or treating, outfit them with the best masks possible and limit their contact with other kids. Dispose of any candy that isn't wrapped in a watertight (plastic or foil) wrapper, and consider purchasing a simple spray bottle and loading it with drugstore hydrogen peroxide. Liberally spray any candy they receive with peroxide (meaning the candy is dripping wet) and allow to dry. Once dry, it should be free of fomite contamination. Under no circumstances should you have parties or gatherings in your home.
Personally, I like the Halloween scavenger hunt idea a lot.
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Eli Lilly has a proof of concept drug for reducing virus load. "A drug being developed by Eli Lilly helped sick patients rid their systems of the virus that causes Covid-19 sooner and may have prevented them from landing in the hospital, according to newly released data.
The drug is what is known as a monoclonal antibody, which experts view as being among the most likely technologies to help treat Covid-19. It’s a manufactured version of the antibodies that the body uses as part of its response to a virus.
“This is a good start,” said Eric Topol, the director and founder of the Scripps Research Translational Institute. “A lot is pinned not only on Lilly but on the whole family of these [monoclonal antibodies], because even though they’re expensive and they’re not going to make a gajillion doses, they could make a big difference in the whole landscape of the pandemic.”
Lilly, which is developing the drug with the biotechnology firm Abcellera, tested three doses of its antibody against placebo in a trial enrolling about 450 patients recently diagnosed with mild to moderate Covid-19. The middle dose, 2,800 mg, met the trial’s primary goal of significantly reducing patients’ levels of SARS-CoV-2 after 11 days.
But other doses of the drug did not meet that goal, including a higher dose of 7,000 mg and a lower one of 700 mg. That could raise the risk that the benefit was due to chance, because normally one expects a medicine to become more effective as the dose increases, known as a dose response.
In a more tantalizing finding, the medicine also appeared to reduce patients’ odds of ending up in the hospital. Just 1.7% of patients who received the drug, called LY-CoV555, eventually went to the emergency room or were hospitalized, compared with 6% of those who took placebo. That amounts to 72% relative reduction in risk."
Source: https://www.statnews.com/2020/09/16/lilly-covid-19-antibody-helps-patients-rid-their-systems-of-virus-sooner/
Commentary: It's still in testing, so this is by no means a cure of any kind or generally available, but it's a promising drug that could be added to the therapeutic arsenal, along with remdesivir and dexamethasone. Slowly but surely, we're building up our toolkits to fight the virus as we wait for a vaccine.
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Wildfire smoke is adding a complication. "Although scientists haven’t yet examined the effect of wildfire smoke on the transmission of the coronavirus, studies have already found that areas with high levels of air pollution tend to have higher rates of COVID-19 cases and deaths — even after accounting for factors like race and poverty known to be linked to higher death rates from COVID-19.
“The air quality on the West Coast is terrible,” Yifang Zhu, an environmental health sciences professor at UCLA’s Fielding School of Public Health, told BuzzFeed News. “It’s one public health crisis on top of another public health crisis.”
The Oregon Health Authority has already said that about one in 10 ER visits across the state right now is for asthma-like symptoms, according to Portland TV station KATU. Several studies have shown that wildfire smoke can trigger surges in hospital admissions from asthma. In one, researchers at Colorado State University found that a rise in PM2.5 concentrations of just 10 micrograms per cubic meter from wildfire smoke was associated with an 8% increase in asthma-related hospital admissions. Concentrations surged by more than 200 micrograms per cubic meter in Portland over the course of just a few hours on Sept. 10.
There is already evidence that exposure to wildfire smoke can make people more susceptible to the seasonal flu, another respiratory virus. In Montana, higher daily PM2.5 concentrations during the summer wildfire season have been linked to higher rates of influenza in the following flu season.
It makes sense that wildfire smoke would make people more vulnerable to infection by respiratory viruses because PM2.5 particles damage cells called alveolar macrophages, which are an important line of immune defense in air sacs deep in the lungs. “If the alveolar macrophages are overloaded with toxic particles, whether those particles are from tobacco smoke, marijuana smoke, vaping, or wildfire smoke, they don’t function as well,” Balmes said.
One glimmer of hope is that both the pandemic and the wildfire smoke are making people stay at home, which should decrease both exposure to PM2.5 and the likelihood of spreading the coronavirus. For those who need to venture outside in order to work, the best protection is N95 masks, not the cloth masks worn to reduce transmission of the virus."
Source: https://www.buzzfeednews.com/article/peteraldhous/west-coast-wildfires-air-quality-health-crisis
Commentary: Remember that NIOSH ratings are based on effectiveness. An N95 mask reduces particulate intake by 95%. If you can, if you can afford to, consider buying an N100/P100 mask from an online retailer. Many are still in stock, like the 3M 6502 mask series with the 2091/2097 P100 filters.
3M 6502: https://amzn.to/3hC66m3
3M 2091: https://amzn.to/3motSFT
Disclosure: if you buy through these links, my company earns a small referral fee.
Indoors, a simple 20" box fan with a HEPA MERV 13 strapped to it or better filter reduces pathogens in the air as well as smoke and other pollutants. For commercial establishments looking to add air cleaning for COVID-19, buy MERV 16 filters.
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A soft read for kids about the pandemic, Mason and the Pandemic. ""Mason and The Pandemic," written and illustrated by a Grandmother/Granddaughter duo, takes readers through the emotions of six-year-old Mason as he relearns what his world means to him in the midst of what he likes to call, "The Corona." Author Pamella Fine writes as her Grandson Mason and describes all of the activities he enjoyed before "The Corona," how his world has changed, and how it all makes him feel. This unique children's book helps kids and adults alike to understand that even though a serious virus has changed our world, that even though we all have lots of unanswered questions, our world is not reduced to its' scariest parts and we can still find the good amidst it all."
Source: https://amzn.to/3hCKIgg
Commentary: This was sent to me by a friend; their mother is the author.
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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.