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.
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A peer-reviewed article from Nature Magazine highlights testing challenges. Dr. Christian Drosten shows that PCR tests toggle between positive and negative at the end of the disease's course. The claims of COVID-19 reinfecting people may be a testing problem instead.
Source: https://www.nature.com/articles/s41586-020-2196-x_reference.pdf
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We have been saying for quite some time that this is a challenging, slippery bug. That it evades detection at the end of the disease seems perfectly reasonable given how hard it is to detect at the beginning of the disease. Someone who tests negative at the end could again test positive just because the testing cannot reliably find the bug all the time. Keep that in mind when reading panic-inducing articles about how the virus is reinfecting people. It's probably not.
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The Imperial College of London has released a hospital capacity planner in Excel format that allows hospital administrators and governments to forecast and plan hospital capacity. While not for everyone, if you or someone you know works in healthcare, they may find these resources very valuable. "While keeping track of the outbreak, we’ve become aware of how hard this vigilance is for even the most energetic and well-motivated scientists and journalists, given the firehose of available information from both traditional sources (public health authorities, journals) and new ones (preprints, blogs). To help in this effort, we think reporting should distinguish between at least three levels of information: (A) what we know is true; (B) what we think is true—fact-based assessments that also depend on inference, extrapolation or educated interpretation of facts that reflect an individual’s view of what is most likely to be going on; and (C) opinions and speculation."
Source: https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-15-hospital-capacity/
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An excellent article by virologists Bill Hanage and Marc Lipsitch on how publications should responsibly report on COVID-19.
Source: https://blogs.scientificamerican.com/observations/how-to-report-on-the-covid-19-outbreak-responsibly/
These guidelines aren't just for journalists. They're for you and me, for anyone sharing any information on COVID-19. Even how I structure these daily updates - the article and citation comes first, and then any opinion I have to add comes after, to disambiguate what was said versus my perspective on it. We all have to do our part fighting the infovirus, especially in a world where major political leaders benefit from false information willfully spread.
Dr. Caitlin Rivers adds a fourth category: what we definitely don't know.
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STAT News reports that a phase 3 clinical trial of remdesivir is showing promising outcomes. "Remdesivir was one of the first medicines identified as having the potential to impact SARS-CoV-2, the novel coronavirus that causes Covid-19, in lab tests. The entire world has been waiting for results from Gilead’s clinical trials, and positive results would likely lead to fast approvals by the Food and Drug Administration and other regulatory agencies. If safe and effective, it could become the first approved treatment against the disease. The University of Chicago Medicine recruited 125 people with Covid-19 into Gilead’s two Phase 3 clinical trials. Of those people, 113 had severe disease. All the patients have been treated with daily infusions of remdesivir. “The best news is that most of our patients have already been discharged, which is great. We’ve only had two patients perish,” said Kathleen Mullane, the University of Chicago infectious disease specialist overseeing the remdesivir studies for the hospital. Reached by STAT, Mullane confirmed the authenticity of the footage but declined to comment further. In a statement, the University of Chicago Medicine said “drawing any conclusions at this point is premature and scientifically unsound.”"
Source: https://www.statnews.com/2020/04/16/early-peek-at-data-on-gilead-coronavirus-drug-suggests-patients-are-responding-to-treatment/
As a reminder, clinical trials typically go through 4 phases:
- Phase 1: does it cause harm?
- Phase 2: does it work at all?
- Phase 3: does it work better than existing alternatives?
- Phase 4: does it have long term effects? (measured in years)
Hence the University of Chicago's caution not to draw conclusions at this point. That said, this is aligned with the path that many doctors have been saying about the progression of COVID19, that therapeutic, pharmaceutical interventions like remdesivir will be available before a vaccine. (Dr. Anthony Fauci said that as well in Congressional testimony in March). More studies need to be done, including randomized controlled studies, but at least there's progress on the therapeutic front.
In the United States, the FDA will approve or not a drug after Phase 3 is completed. If this trial is successful, remdesivir could be made available for COVID-19 mitigation sooner rather than later, given the urgency of the situation.
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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.
2. Wear gloves and a mask when out of your home.
3. Stay home as much as possible.
4. Get your personal finances in order now. Cut all unnecessary costs.
5. Donate any PPE you can. https://getusppe.org/give/
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Common myths debunked. 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.
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