Lunchtime pandemic reading.
Standard disclaimer: this is a roundup of informative pieces I've read that interest me on the severity of the crises and how to manage them. I am not a qualified medical expert in ANY sense; at best I am reasonably well-read laity. ALWAYS prioritize advice from a qualified healthcare provider who knows your specific medical situation over advice from people on the Internet.
You are welcome to share this.
Why are new variants so powerful? Because they're REALLY different.
"Novel SARS-CoV-2 omicron variants, including BM.1.1.1, BQ.1.1, and XBB.1, continue to emerge at an unprecedented rate, evading pre-existing immunity from vaccination and previous infection. Quantifying the antigenic diversity of variants might assist in selecting future vaccine strains. To determine the antigenic relationships between emerging SARS-CoV-2 omicron variants, we and others1, 2, 3, 4 used antigenic cartography, whereby multidimensional scaling is used to generate antigenic maps in which the positions of antigens and antiserum samples directly correspond to neutralising titres. This method allows for the quantification and visualisation of antigenic properties of different variants simultaneously.
Our data reveal substantial cross-neutralisation of BA.5 antiserum samples against BQ.1.1 but little cross-neutralisation against XBB.1 and BM.1.1.1. Dzespite the antigenic similarities between BA.5 and BQ.1.1, thus far there is little evidence for increased neutralisation of BQ.1.1 by BA.5 bivalent vaccines, potentially due to immunological imprinting.5, 6, 7 In addition, these newly emerging variants do not cluster close to each other, therefore a vaccine based on any of these variants might poorly cross-neutralise new, emerging variants, which could be equally antigenically distant. Continuous mapping of new variants and a greater understanding of the evolutionary trajectory of SARS-CoV-2 could indicate potential vaccine candidates."
Commentary: When we look at the graphic of the antigenic landscape, it's clear that the Omicron family has the most diversity, and is continuing to diverge widely from the original SARS-CoV-2 of three years ago. This is why vaccines and other pharmaceutical interventions have such a hard time keeping up with COVID - and why masks and great ventilation are our first, best defense.
A massive review of Long COVID. "Studies looking at immune dysregulation in individuals with long COVID who had mild acute COVID-19 have found T cell alterations, including exhausted T cells18, reduced CD4+ and CD8+ effector memory cell numbers18,19 and elevated PD1 expression on central memory cells, persisting for at least 13 months19. Studies have also reported highly activated innate immune cells, a lack of naive T and B cells and elevated expression of type I and type III interferons (interferon-β (IFNβ) and IFNλ1), persisting for at least 8 months20. A comprehensive study comparing patients with long COVID with uninfected individuals and infected individuals without long COVID found increases in the numbers of non-classical monocytes, activated B cells, double-negative B cells, and IL-4- and IL-6-secreting CD4+ T cells and decreases in the numbers of conventional dendritic cells and exhausted T cells and low cortisol levels in individuals with long COVID at a median of 14 months after infection18. The expansion of cytotoxic T cells has been found to be associated with the gastrointestinal presentation of long COVID27. Additional studies have found elevated levels of cytokines, particularly IL-1β, IL-6, TNF and IP10 (refs. 40,41), and a recent preprint has reported persistent elevation of the level of CCL11, which is associated with cognitive dysfunction42. It remains to be seen whether the pattern of cytokines in ME/CFS, where the levels of certain cytokines are elevated in the first 2–3 years of illness but decrease over time without a corresponding decrease in symptoms43, is similar in long COVID. Multiple studies have found elevated levels of autoantibodies in long COVID27, including autoantibodies to ACE2 (ref. 28) (the receptor for SARS-CoV-2 entry), β2-adrenoceptor, muscarinic M2 receptor, angiotensin II AT1 receptor and the angiotensin 1–7 MAS receptor26. High levels of other autoantibodies have been found in some patients with COVID-19 more generally, including autoantibodies that target the tissue (such as connective tissue, extracellular matrix components, vascular endothelium, coagulation factors and platelets), organ systems (including the lung, central nervous system, skin and gastrointestinal tract), immunomodulatory proteins (cytokines, chemokines, complement components and cell-surface proteins)44. A major comprehensive study, however, did not find autoantibodies to be a major component of long COVID18. Reactivated viruses, including EBV and HHV-6, have been found in patients with long COVID18,21,22,27 (and have been identified in ME/CFS45), and lead to mitochondrial fragmentation and severely affect energy metabolism46. A recent preprint has reported that EBV reactivation is associated with fatigue and neurocognitive dysfunction in patients with long COVID22. Several studies have shown low or no SARS-CoV-2 antibody production and other insufficient immune responses in the acute stage of COVID-19 to be predictive of long COVID at 6–7 months, in both hospitalized patients and non-hospitalized patients47,48. These insufficient immune responses include a low baseline level of IgG48, low levels of receptor-binding domain and spike-specific memory B cells, low levels of nucleocapsid IgG49 and low peaks of spike-specific IgG47."
Source: https://www.nature.com/articles/s41579-022-00846-2.epdf
Commentary: If you can, give this article a full read. It's an incredible summary of what COVID does in the body. The short version: anything with an ACE2 receptor is fair game, which is most of your internal organs and nervous system.
Keep this out of your body. The people treating it like a seasonal cold and blithely accepting multiple reinfections are substantially damaging themselves.
Which booster is better? "In my view, Dr. Topol is not wrong about the fact that bivalent boosters help high-risk populations. The problem I’m having is that most of the graphs and data shown in his essay simply indicate that high-risk people need to stay up-to-date on their vaccines. That’s not the same thing as proof that bivalent boosters are superior.
I also tend to agree with Dr. Gounder and Dr. John Moore, who published a piece in MedPage Today (Disclosure: I am medical editor-in-chief of that publication, though I did not have involvement in that piece). Researchers should have tested a full-on Omicron-only booster, instead of playing cute with half doses of the old and half doses of the new variants. (Dr. Offit feels the same way).
All of this said, whether or not the bivalent booster is similar or better than the monovalent one it replaced is not terribly important for any decisions you might have to make right now. If you’re at risk of a bad outcome from Covid-19, boosting will decrease the short-term chances of an infection, and with it the odds of hospitalization."
Source:
Commentary: if you're at risk, keep up to date with your boosters. But the best measure by far you can take right now and for the foreseeable future is to mask up indoors anyplace that isn't your home.
A reminder of the simple daily habits we should all be taking.
Wear the best mask available to you when you'll be around people you don't live with, even after you've been vaccinated. P100 respirators are back in stock at online retailers, too and start around US$40 for a reusable respirator. 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.
Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
Get vaccinated as soon as you're eligible to, and fulfill the full vaccine regimen, including boosters. Remember that you are not vaccinated until everyone you live with is vaccinated. For COVID, if you received an adenovirus vaccine (J&J/AstraZeneca), consider getting an mRNA single shot booster (Pfizer/Moderna) if available. If it's available, choose Moderna as your first choice for both vaccine and booster, Pfizer as your second choice. However, remember that any vaccine is better than no vaccine.
Wash/sanitize your hands every time you are in or out of your home. Sanitize the bottom of your shoes with a simple peroxide spray using ordinary drugstore/supermarket peroxide in a spray bottle. If you've come in close contact with others (rubbing or brushing up against them, hugging, etc.) consider showering and washing your clothes as well.
Stay out of indoor spaces that aren't your home and away from people you don't live with as much as practical. Minimize your contact with others and avoid indoor places as much as you can; indoor spaces spread disease through aerosols and distance is less effective at mitigating your risks.
Aim to have 3-6 months of living expenses on hand in case the pandemics give another crazy plot twist to the economy, or you know, a global war breaks out.
Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
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).
Masks must fit properly to work. Here's how to properly fit a mask:
If you think you may have been exposed to COVID-19, purchase several rapid antigen tests and/or acquire them from your healthcare provider or government. This will detect COVID-19 only when you're contagious, so follow the directions clearly. https://amzn.to/3fLAoor
If you think you may have been exposed to monkeypox, contact your healthcare provider about available testing.
Common misinformation debunked!
There is no basis in fact that COVID-19 vaccines can shed or otherwise harm people around you.
Source: https://www.reuters.com/article/factcheck-covid19vaccine-reproductivepro-idUSL1N2MG256
There is no mercury or other heavy metals in the Pfizer mRNA vaccine.
Source: https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
There is no basis in fact that COVID-19 vaccines pose additional risks to pregnant women.
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2104983
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/
Source: https://www.smh.com.au/national/are-we-ignoring-the-hard-truths-about-the-most-likely-cause-of-covid-19-20210601-p57x4r.html
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
Disclosures and Disclaimers
I declare no competing interests on anything I share related to COVID-19 or monkeypox. I am employed by and am a co-owner in TrustInsights.ai, an analytics and management consulting firm. I have no clients and no business interests in anything related to COVID-19 or monkeypox, nor do I financially benefit in any way from sharing information about COVID-19 or monkeypox.
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.
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