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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In the United States, hospitalizations continue to reach all-time highs.
Source: https://covidtracking.com/data/charts/us-all-key-metrics
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On the mouthwash story. "The ability of widely-available mouthwashes to inactivate SARS-CoV-2 in vitro was tested using a protocol capable of detecting a 5-log10 reduction in infectivity, under conditions mimicking the naso/oropharynx. During a 30 second exposure, two rinses containing cetylpyridinium chloride and a third with ethanol/ethyl lauroyl arginate eliminated live virus to EN14476 standards (>4-log10 reduction), while others with ethanol/essential oils and povidone-iodine (PVP-I) eliminated virus by 2-3-log10. Chlorhexidine or ethanol alone had little or no ability to inactivate virus in this assay. Studies are warranted to determine whether these formulations can inactivate virus in the human oropharynx in vivo, and whether this might impact transmission."
Source: https://www.biorxiv.org/content/10.1101/2020.11.13.381079v1.abstract
Commentary: A warning, of course, that this study is not peer-reviewed, nor has this finding been validated in living tissue - namely, someone's mouth. In a laboratory setting, it does seem to work. Giving the paper a read-through, I'm not surprised that ethanol was shown to be less effective; in many mouthwashes, it's only 20-25% strength, which is far below the 60% that is typically needed to be virucidal. Most hand sanitizers are distributed at 60-70% ethanol, which, if you put that in your mouth, really burns. (the equivalent of 120 proof shots of alcohol)
What was not in the study was any kind of mouthwash that incorporated hydrogen peroxide, which has been shown to be effective against the virus at concentrations as low as 0.5%.
The bigger problem with the story is the use case. In no way does mouthwash protect you against inhaled SARS-CoV-2, particularly in your nasal cavities. The only practical use case for this is if you accidentally put your hands in your mouth before sterilizing them, say after unpacking your groceries. The danger is people might think they can swish some mouthwash and then go out and not need a mask. (the other danger is people drinking mouthwash)
Bottom line: you still must wear a mask outside your home, always.
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SARS-COV-2 sneaks in. "We investigated SARS-CoV-2 infections among U.S. Marine Corps recruits who underwent a 2-week quarantine at home followed by a second supervised 2-week quarantine at a closed college campus that involved mask wearing, social distancing, and daily temperature and symptom monitoring. Study volunteers were tested for SARS-CoV-2 by means of quantitative polymerase-chain-reaction (qPCR) assay of nares swab specimens obtained between the time of arrival and the second day of supervised quarantine and on days 7 and 14. Recruits who did not volunteer for the study underwent qPCR testing only on day 14, at the end of the quarantine period. We performed phylogenetic analysis of viral genomes obtained from infected study volunteers to identify clusters and to assess the epidemiologic features of infections.
A total of 1848 recruits volunteered to participate in the study; within 2 days after arrival on campus, 16 (0.9%) tested positive for SARS-CoV-2, 15 of whom were asymptomatic. An additional 35 participants (1.9%) tested positive on day 7 or on day 14. Five of the 51 participants (9.8%) who tested positive at any time had symptoms in the week before a positive qPCR test. Of the recruits who declined to participate in the study, 26 (1.7%) of the 1554 recruits with available qPCR results tested positive on day 14. No SARS-CoV-2 infections were identified through clinical qPCR testing performed as a result of daily symptom monitoring. Analysis of 36 SARS-CoV-2 genomes obtained from 32 participants revealed six transmission clusters among 18 participants. Epidemiologic analysis supported multiple local transmission events, including transmission between roommates and among recruits within the same platoon.
Among Marine Corps recruits, approximately 2% who had previously had negative results for SARS-CoV-2 at the beginning of supervised quarantine, and less than 2% of recruits with unknown previous status, tested positive by day 14. Most recruits who tested positive were asymptomatic, and no infections were detected through daily symptom monitoring. Transmission clusters occurred within platoons. (Funded by the Defense Health Agency and others.)"
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2029717
Commentary: This is fairly incredible. Despite rigorous precautions including a mandatory 14 day quarantine and testing, 2% of recruits still tested positive at the US Marine Corps facilities. In ideal conditions, SARS-CoV-2 snuck by. This is why universal prevention measures need to be in place. If the virus can sneak by Marines, it can sneak by lesser attempts to tame it unless everyone rigorously does their part - and keeps doing it.
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Universal masking works. "From March 15, 2020 to June 6, 2020 we assessed all HCWs who tested positive for SARS-CoV-2. Based on the panel adjudication, 38% cases were community-acquired, 22% were healthcare-associated, and 40% did not have a clear source of acquisition. Of note, 80% of HCWs did not work on COVID-19 units.
Of the healthcare-associated cases, 70% were related to unmasked exposure to another HCW for more than 10 minutes less than 6 feet apart and 30% were thought to be secondary to direct care of SARS-CoV-2 positive patients.
One week following the implementation of universal masking on March 31, 2020, we observed a significant decrease in the cumulative incidence rate of healthcare-acquired SARS-CoV-2 infections among HCWs (Figure 1) (LRT 4.38, p-value 0.03). The cumulative incidence rates in community-acquired cases and cases with no clear source of acquisition did not significantly change, however, and continued to mirror the cumulative incidence rates of SARS-CoV-2 in the communities surrounding Duke Health.
Universal masking of all HCWs significantly reduced the rate of healthcare-acquisition of SARS-CoV-2, thereby flattening the healthcare-associated SARS-CoV-2 epidemiologic curve in our healthcare system. HCWs with community-acquired SARS-CoV-2 or who had an unknown route of acquisition SARS-CoV-2 at the same incidence rate as other community members. We attribute the lower rate of healthcare-acquired infections in part to providing universal source control via masking, thereby mitigating the spread from asymptomatically infected or minimally symptomatic individuals. Mask etiquette, defined as wearing a mask at all times when physical distancing is not possible around anyone outside of your household contacts, limiting unmasked exposures indoors, and performing hand hygiene before and after touching the face mask, needs to be reinforced both inside and outside the workplace to help preserve the HCW workforce. Mask etiquette must also be performed alongside other infection prevention measures including following standard and transmission-based precautions, hand hygiene, physical distancing, and self-isolation coupled with immediate testing and contact notification when symptomatic. Finally, the recent changes to the CDC guidance that call for masking all inpatients and outpatients while direct care is provided and the addition of a face shield to our pandemic PPE outfit will hopefully lead to further reduction in healthcare-acquired SARS-CoV-2. HCWs will need ongoing reminders to follow recommended public health guidance to protect themselves from community acquisition of SARS-CoV-2 as the pandemic continues."
Source: https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/universal-masking-is-an-effective-strategy-to-flatten-the-severe-acute-respiratory-coronavirus-virus-2-sarscov2-healthcare-worker-epidemiologic-curve/9301E77612122039190A29CB7223F9C4/core-reader
Commentary: In the most dangerous, high-risk setting - namely, hospitals - COVID-19 was slowed substantially to almost no growth the moment hospitals began implementing universal mask mandates with surgical masks for patients and healthcare workers. If wearing a mask substantially reduces infections in an extremely high-risk environment, imagine what it will do in normal environments.
It would kneecap the pandemic.
Going forward, if we want to shut down COVID-19, it's pretty simple. Everyone wears a mask at all times outside their home. That's it. That would literally stop the pandemic in its tracks and some things could be reopened, like movie theaters and concerts and such - as long as no food or drink was served, because removing your mask is the problem.
If we want things like conferences and events to come back, then expect to attend them wearing a mask at all times. If we want things like malls and stores to fully reopen, expect to be wearing a mask at all times.
The industries that will need substantial aid will be any in which you have to remove a mask - bars, restaurants, etc. While cases are increasing, those need to be closed to any form of public dining. Take the food and drink home and consume it there - no exceptions to removing your mask in public.
We won't need lockdowns if everyone wears a mask and never removes it outside their home.
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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.
6. Participate in your local political process. For Americans, go to Vote.org and register/verify your vote.
7. Ventilate your home as frequently as weather and circumstances permit.
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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.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.