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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The situation in the Northern Hemisphere is grim. North America continues to grow its caseloads, while Asia has spiked significantly. Europe has not tamed its massive second wave.
In America, we have achieved new records, with all time highs for hospitalizations and deaths; meanwhile, testing is lagging. America hit 17 million cases - 5 days after hitting 16 million cases.
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We dodged a bullet on the D614G mutation. "In studies in hamsters infected with D614 or G614 variants, Plante et al. showed that the contemporary G614 variant replicated to higher titers in nasal-wash samples early after infection and outcompeted the ancestral D614 variant (Figure 1C); these findings suggest increased fitness in a major upper airway compartment potentially associated with enhanced transmission. The SARS-CoV-2 G614 variant did not cause more severe disease than the ancestral strain in hamsters, a finding that supports current findings in humans. The Covid-19 vaccines that are currently being evaluated in clinical trials are based on the original D614 ancestral spike sequence; therefore, the authors used a panel of serum specimens to test whether the G614 variant is as sensitive to neutralization as the ancestral strain (Figure 1D). Fortunately, the results showed that it is as sensitive to the serum specimens as the D614 strain and thus may allay fears that it could escape vaccine-elicited immunity.
Plante et al. have provided evidence of the genetic and molecular basis for enhanced fitness of the G614 variant over ancestral strains, providing strong support for its role in facilitating global spread. Unlike variants in the SARS-CoV 2003 epidemic strain, those in SARS-CoV-2 may point to new mechanisms that are associated with pandemic spread in human populations. In addition to showing the critical importance of blending genetic epidemiologic studies with empirical molecular virologic studies to understand pandemic virus evolution and spread, the findings raise critical questions regarding the future evolutionary trajectories of the SARS-CoV-2 G614 variant. These questions are especially important at a time when environmental pressures, such as expanding herd immunity, vaccine-induced immunity, antiviral therapies, and public health intervention strategies, may — through selective pressure — promote virus survival and escape. Will these selective pressures drive antigenic variation, promote virus stability and transmissibility, alter virus virulence and pathogenesis, or drive SARS-CoV-2 to extinction or into alternative hosts as reservoirs? Plante et al. articulate a critical need for proactive, rather than reactive, tracking of SARS-CoV-2 and other potential emerging coronaviruses."
Source: https://www.nejm.org/doi/full/10.1056/NEJMcibr2032888
Commentary: The mutation that occurred earlier this year was substantial, enough to change the infectivity of COVID-19. Fortunately, the vaccines currently in production were not affected - this time. One of the reasons to get people vaccinated as quickly as possible is to cut down the number of cases. The fewer cases, the fewer chances for the virus to mutate in a way that evades the vaccine.
Encourage everyone you know to obtain the vaccine once it's available, and until then to remain vigilant in protecting yourself against COVID-19. Beyond the obvious risks to your health, every new case creates the non-zero possibility of a much worse mutation.
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Race causes issues with pulse oximetry. "Thus, in two large cohorts, Black patients had nearly three times the frequency of occult hypoxemia that was not detected by pulse oximetry as White patients. Given the widespread use of pulse oximetry for medical decision making, these findings have some major implications, especially during the current coronavirus disease 2019 (Covid-19) pandemic. Our results suggest that reliance on pulse oximetry to triage patients and adjust supplemental oxygen levels may place Black patients at increased risk for hypoxemia. It is important to note that not all Black patients who had a pulse oximetry value of 92 to 96% had occult hypoxemia. However, the variation in risk according to race necessitates the integration of pulse oximetry with other clinical and patient-reported data.
In device applications, the Food and Drug Administration requires reporting of demographic subgroups to mitigate risk. However, our findings highlight an ongoing need to understand and correct racial bias in pulse oximetry and other forms of medical technology."
Source: https://www.nejm.org/doi/full/10.1056/NEJMc2029240
Commentary: Many pulse oximeters emit a light into the skin and then look to see how that light is refracted. It's no surprise that insufficient testing was done for darker skin, and an urgent call to action for medtech device manufacturers to test against a wide diversity of people.
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Not enough pregnant women in trials. "Inclusion of pregnant women in COVID-19 clinical trials would allow evaluation of effective therapies that might improve maternal health, pregnancy, and birth outcomes, and avoid the delay of developing treatment recommendations for pregnant women. We explored the inclusion of pregnant women in treatment trials of COVID-19 by reviewing ten international clinical trial registries at two timepoints in 2020. We identified 155 COVID-19 treatment studies of non-biological drugs for the April 7–10, 2020 timepoint, of which 124 (80%) specifically excluded pregnant women. The same registry search for the July 10–15, 2020 timepoint, yielded 722 treatment studies, of which 538 (75%) specifically excluded pregnant women. We then focused on studies that included at least one of six drugs (remdesivir, lopinavir–ritonavir, interferon beta, corticosteroids, chloroquine and hydroxychloroquine, and ivermectin) under evaluation for COVID-19. Of 176 such studies, 130 (74%) listed pregnancy as an exclusion criterion. Of 35 studies that evaluated high-dose vitamin treatment for COVID-19, 27 (77%) excluded pregnant women. Despite the surge in treatment studies for COVID-19, the proportion excluding pregnant women remains consistent. Exclusion was not well justified as many of the treatments being evaluated have no or low safety concerns during pregnancy. Inclusion of pregnant women in clinical treatment trials is urgently needed to identify effective COVID-19 treatment for this population."
Source: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30484-8/fulltext
Commentary: Failing to include pregnant women, especially with therapeutics where there's a low probability of adverse outcomes, in clinical trials is a serious omission. If you're pregnant, there's some level of uncertainty about the various COVID-19 therapeutics available, as well as the vaccines themselves. That said, mRNA vaccines aren't conceptually complex; once more data becomes available, it should be straightforward to determine the level of risk.
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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. If you come in physical contact with others, wash your clothing upon returning home.
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. When going indoors to a place that isn't your home, wear the best protective mask available to you.
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. 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).
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Common misinformation debunked!
There is no mercury or other heavy metals in the Pfizer mRNA vaccine. https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
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.