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.
---
The nose knows. "It is noteworthy that IgA antibody responses have been recorded in nasal fluids of volunteers infected with the common cold coronavirus 229E, and were associated with shortened periods of viral shedding (34). Serum and salivary IgA antibody responses to SARS-Cov-2 spike antigens have now been reported (35), and salivary IgA antibodies persisted for at least 3 months. Interestingly, while good correlations were found between serum and salivary IgM and IgG antibody levels, there was much weaker correlation between serum and salivary IgA antibodies, as expected given that salivary IgM and IgG are largely derived from the circulation, whereas salivary IgA is mostly generated locally in the salivary glands as SIgA (19). Two recent preprints report that IgA antibodies against SARS-CoV-2 were elevated in nasal fluids, tears, and saliva of infected subjects (36, 37), and that IgA-secreting plasmablasts expressing the mucosal chemokine receptor CCR10 were elevated in the peripheral blood of SARS-CoV-2-infected subjects (37). These findings support the concept that mucosal IgA antibody responses are induced by SARS-CoV-2. Further studies aimed at relating these responses to the course of infection in subjects of different age-groups and with different disease outcomes are awaited with great interest.
Finally we expect that efforts in vaccine development aimed at inducing mucosal immune responses and memory cells, especially in the URT, would yield benefits not seen with conventional parenteral routes of vaccine administration. Intranasal vaccines are already available against influenza and others are under development (30, 38). The advantages, in addition to needle-free administration, include the generation of both mucosal (SIgA) and circulating (IgG and IgA) antibodies, as well as T-cell responses. As discussed above, such responses might achieve desirable results not obtained with systemic immunization routes.
In summary, based on the route whereby SARS-CoV-2 infection is acquired and the independence of mucosal and systemic responses, there must be a mucosal immune dimension to COVID-19. Whether it makes a significant contribution to the outcome of SARS-CoV-2 infection, or can be exploited to good effect for diagnostic purposes or for therapy and prophylaxis, can only be determined by carrying out appropriate investigations. Table 2 lists some potentially important studies that should be undertaken to elucidate mucosal immune responses in SARS-CoV-2 infection."
Source: https://www.frontiersin.org/articles/10.3389/fimmu.2020.611337/full
Commentary: Transmission is the big question that we haven't tackled yet from a therapeutics perspective. We know vaccines will cut down on infection. How about shutting down the transmission chain? This paper talks about the need to study mucosal responses and see if we can close that door even a little, to reduce SARS-CoV-2's transmissibility potential.
---
Speaking of blocking... "Containment of the COVID-19 pandemic requires reducing viral transmission. SARS-CoV-2 infection is initiated by membrane fusion between the viral and host cell membranes, mediated by the viral spike protein. We have designed lipopeptide fusion inhibitors that block this critical first step of infection, and based on in vitro efficacy and in vivo biodistribution selected a dimeric form for evaluation in an animal model. Daily intranasal administration to ferrets completely prevented SARS-CoV-2 direct-contact transmission during 24-hour co-housing with infected animals, under stringent conditions that resulted in infection of 100% of untreated animals. These lipopeptides are highly stable and thus may readily translate into safe and effective intranasal prophylaxis to reduce transmission of SARS-CoV-2.
The [SARSHRC-PEG4]2-chol peptide has a long shelf life, does not require refrigeration and can easily be administered, making it particularly suited to treating hard-to-reach populations. This is key in the context of COVID-19, which has reached every community with the burden falling disproportionately on low-income and otherwise marginalized communities. This HRC lipopeptide fusion inhibitor is feasible for advancement to human use and should readily translate into a safe and effective nasal spray or inhalation administered fusion inhibitor for SARS-CoV-2 prophylaxis, supporting containment of the ongoing COVID-19 pandemic."
Source: https://science.sciencemag.org/content/early/2021/02/16/science.abf4896
Commentary: This is an experimental approach to blocking transmission in the nose using a nose spray. If this works in humans as it did in ferrets, it would certainly be a powerful weapon against COVID-19. It's a 24-hour spray designed to block SARS-CoV-2 from attaching to the upper respiratory tract when you know you're going to be exposed to it, and in laboratory settings it stopped 100% of transmission.
Initially this would be gold for healthcare workers to supplement PPE, and as it became more available, it would be usable by anyone; want to eat indoors at a restaurant? Spray up. Want to go to the nightclub? Spray up. Let's hope that further tests and trials confirm its effectiveness - this could be an exciting tool in the toolkit for stopping the pandemic.
---
Vaccination may reduce tranmission. "Data from researchers in Israel, which has inoculated swathes of its population, suggests the Pfizer/BioNTech vaccine is reducing viral load, a key signal that the intervention could diminish the spread of Covid-19.
Evidence that the coronavirus vaccines being deployed globally are dramatically effective in reducing severe disease and death in symptomatic Covid-19 is abundant. But a big question remains unanswered: can they thwart transmission, in other words stop people from passing on the virus?
Preventing the spread of infection is key to reducing the risk of more variants emerging and to achieving herd immunity, scientists say. People with higher viral load tend to be more infectious and are more likely to suffer from severe disease.
To evaluate the impact of the vaccine on transmission, researchers compared data from people over 60 years old and those aged 40 to 60, evaluating data from 16,297 people who had tested positive for coronavirus between 1 December and 30 January.
Israel’s vaccine programme began on 20 December. By the time of analysis, more than 75% of those in the older group were likely to have received their first dose, as had about 25% of the younger group.
As expected, in the last two weeks of January the researchers noted a statistically significant fall in the viral load for the individuals aged over 60, compared with the 40-to-60 group, said the study author, Yaniv Erlich, the chief scientific officer of MyHeritage, a company that runs a large coronavirus testing laboratory in Israel.
The researchers used available demographic data and vaccination rates to estimate the effect of the first dose on viral load reduction, calculating that the vaccine reduced the viral load by 1.6 to 20 times in individuals who tested positive for the virus."
Source: https://www.theguardian.com/science/2021/feb/09/pfizerbiontech-covid-vaccine-reducing-viral-load-data-israel-suggests
Commentary: This has been an ongoing question - we know vaccines shut down the virus from causing severe infection and death. But the vaccines also help to slow transmission by up to 20x? That's huge.
---
A reminder of the simple daily habits we should all be taking.
1. Always wear the best mask available to you when out of your home and you'll be around other people. 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. Get vaccinated as soon as you're able to.
3. Wash/sanitize your hands every time you are in or out of your home for any reason.
4. 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.
5. Get your personal finances in order now. Cut all unnecessary costs.
6. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
7. 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).
8. Masks must fit properly to work. Here's how to properly fit a mask:
---
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
---
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.