Lunchtime Pandemic Reading, 18-August-2022
Long COVID affects 20% of kids
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.
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.
---
A succinct situation report for the USA:
"COVID-19 still kills around 400 people a day in the U.S., and around 100,000 new cases are still being reported each day. The virus is likely never going away.
Meanwhile, experts are losing hope that monkeypox can be contained, at least in the short term, after the U.S. fumbled its initial response.
A polio case was recently detected in New York, the first reported case since 2013 and only the second identified instance of community transmission of polio in the U.S. since 1979, per the CDC. Wastewater samples indicate the virus may have been circulating since as early as April.
Vaccine rates for other diseases plummeted during the pandemic, anti-vaccine sentiment is on the rise and less than half of eligible Americans have received a even one COVID booster dose.
On top of all that, the country's public health workforce is short-staffed and burned out."
Source: https://www.axios.com/2022/08/18/cdc-public-health-covid-pandemic-monkeypox-polio
Commentary: If it hasn't been clear for the last 2 years, this report card of the current status should make it clear. At least in the USA, public health government bodies and organizations have largely surrendered to the pandemics (plural) and public health problems. That means that keeping ourselves safe - despite the actions of others - is a burden we have to carry that's heavier than it should be. Is it fair? No. But that's life - and we can, with modern tools, with data, with good news sources, and with relatively inexpensive gear, continue to keep ourselves safe.
The best things you can do right now against all these public health challenges? A simple list.
1. Mask up. Monkeypox, measles, COVID, influenza... they're all stopped by great masks. Get a P100/FFP3/P3 if you can - they're reusable (less waste) and personally, I find them more comfortable. This is the one I recommend now: https://amzn.to/3wepAr1
2. Wash up. Simple and easy. The moment you get in your car or home after being out in public, sanitize. A little alcohol hand sanitizer or my personal favorite mix, alcohol + hydrogen peroxide, and you'll keep yourself safe.
3. Power up. Today is the best day to start getting healthier, no matter where you are in life. There's something you can do to improve your fitness, your nutrition, etc. As diseases continue to ravage the general population, folks committed to being healthy will want a higher baseline to start from, so get healthier any way you can.
---
Long COVID affects 20% of kids. "Speaking on Commercial Radio on Wednesday morning, Mike Kwan, a consultant paediatrician at the Princess Margaret Hospital, said around 50 children of 288 cases he treated had experienced symptoms of the long-term post-Covid condition.
These children, aged between eight and 13, contracted the coronavirus during Hong Kong’s fifth-wave when they were unvaccinated, Kwan said.
The doctor said a patient is considered to have long Covid if they develop symptoms that last for more than two months and which cannot be explained by other diseases, more than three months after their initial infection.
Kwan said the long Covid symptoms of children infected during the fifth were different from those in previous outbreaks.
Those affected by post Covid-19 conditions after earlier infections lost their sense of smell and taste, Kwan said. But for fifth-wave cases, they observed long-term effects on different parts of their body.
Their symptoms included a deterioration of memory and a decline in cognitive abilities, as well as fatigue, insomnia and headache. As an example, Kwan said he met a boy who used to excel in mathematics but now struggled to solve math problems after recovering from Covid-19.
In a rare case, Kwan said a girl would lose her eyesight for short periods of time each day.
“This is what really makes us worry that the Omicron strains are actually attacking different organs,” Kwan said."
Source: https://hongkongfp.com/2022/08/17/almost-20-of-hong-kong-children-infected-during-fifth-wave-suffered-from-long-covid-hospital-finds/
Commentary: If your kids are back at in-person schools, encourage them to remain masked and of course, make sure they're fully vaccinated and boosted.
---
Monkeypox can spread through the air in contaminated environments. "We identified widespread surface contamination (66 positive out of 73 samples) in occupied patient rooms (MPXV DNA Ct values 24·7-38·6), on healthcare worker personal protective equipment after use, and in doffing areas (Ct 26·3-34·3). Five out of fifteen air samples taken were positive. Significantly, three of four air samples collected during a bed linen change in one patient’s room were positive (Ct 32·7-35·8). Replication-competent virus was identified in two of four samples selected for viral isolation, including from air samples collected during the bed linen change."
Source: https://www.medrxiv.org/content/10.1101/2022.07.21.22277864v1.full.pdf
Commentary: Think about it. Where do you shed skin cells a lot? In a bed. Shake out that bed? You've now launched all those particles as dust in the air. If you're in a situation where you're exposed to clouds of skin cells - like working in hotel/hospitality - be SURE you are masked up.
---
Long COVID still going in some patients 2 years later. "To our knowledge, this is the first study with a comparator cohort that assesses the risks of a range of neurological and psychiatric outcomes of COVID-19 up to 2 years after the index SARS-CoV-2 infection. We found that the risks of post-COVID neurological and psychiatric outcomes follow different trajectories: the risk of cognitive deficit, dementia, psychotic disorder, and epilepsy or seizures remain elevated 2 years after SARS-CoV-2 infection, while the risks of other diagnoses (notably, mood and anxiety disorders) subside after 1–2 months and show no overall excess over the whole 2-year follow-up. We also found that risk trajectories differ somewhat in children: they are not at an increased risk of mood or anxiety disorders (even over the first 6 months) and their risk of cognitive deficit is transient, but they share adults’ risk of several other diagnoses and are notably at risk of epilepsy or seizures. Finally, we found that the risks of neurological and psychiatric outcomes remain similar after the emergence of the omicron (B.1.1.529) variant as with the delta (B.1.617.2) variant, but are offset by a significantly lower death rate."
Source: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00260-7/fulltext
Commentary: A few critical findings in this paper. First, the brain fog and other neurological effects continue LONG after the COVID infection. That's bad. Second, Omicron is as bad as Delta in terms of long COVID and its impact.
---
A potential indicator for long COVID: low cortisol. "SARS-CoV-2 infection can result in the development of a constellation of persistent sequelae following acute disease called post-acute sequelae of COVID-19 (PASC) or Long COVID1–3. Individuals diagnosed with Long COVID frequently report unremitting fatigue, post-exertional malaise, and a variety of cognitive and autonomic dysfunctions1–3; however, the basic biological mechanisms responsible for these debilitating symptoms are unclear. Here, 215 individuals were included in an exploratory, cross-sectional study to perform multi-dimensional immune phenotyping in conjunction with machine learning methods to identify key immunological features distinguishing Long COVID. Marked differences were noted in specific circulating myeloid and lymphocyte populations relative to matched control groups, as well as evidence of elevated humoral responses directed against SARS-CoV-2 among participants with Long COVID. Further, unexpected increases were observed in antibody responses directed against non-SARS-CoV-2 viral pathogens, particularly Epstein-Barr virus. Analysis of circulating immune mediators and various hormones also revealed pronounced differences, with levels of cortisol being uniformly lower among participants with Long COVID relative to matched control groups. Integration of immune phenotyping data into unbiased machine learning models identified significant distinguishing features critical in accurate classification of Long COVID, with decreased levels of cortisol being the most significant individual predictor. These findings will help guide additional studies into the pathobiology of Long COVID and may aid in the future development of objective biomarkers for Long COVID."
Source: https://www.medrxiv.org/content/10.1101/2022.08.09.22278592v1
Commentary: More evidence that COVID is a wrecking ball in all kinds of ways in the body. The fact that cortisol can be an effective diagnostic indicator is also a good way for clinicians to help understand if someone has long COVID or not.
---
A reminder of the simple daily habits we should all be taking.
1. 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 (I recommend this one: https://amzn.to/3wepAr1 ). 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. Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
3. 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.
4. 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.
5. 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.
6. 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.
7. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
8. 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).
9. Masks must fit properly to work. Here's how to properly fit a mask:
10. 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 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. I declare a competing interest on affiliate links to Amazon; I receive a small financial benefit if you purchase something through that link, on average 1-3% of the purchase price.
---
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.
Facebook has decided that sharing this post of yours (to covid specific groups) is spam. Super annoying because you write excellent roundups that are worth sharing.