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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Commentary: I feel like it's Groundhog Day sometimes. A year ago, we were warning about full ICUs, masks, etc. and... we're having to do it again. Only this time around, at least in the USA, it SHOULD have been unnecessary.
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The Pope recommends vaccination.
Source:
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Delta spreads faster because it sticks easier. "The Delta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has outcompeted previously prevalent variants and become a dominant strain worldwide. We report here structure, function and antigenicity of its full-length spike (S) trimer in comparison with those of other variants, including Gamma, Kappa, and previously characterized Alpha and Beta. Delta S can fuse membranes more efficiently at low levels of cellular receptor ACE2 and its pseudotyped viruses infect target cells substantially faster than all other variants tested, possibly accounting for its heightened transmissibility. Mutations of each variant rearrange the antigenic surface of the N-terminal domain of the S protein in a unique way, but only cause local changes in the receptor-binding domain, consistent with greater resistance particular to neutralizing antibodies. These results advance our molecular understanding of distinct properties of these viruses and may guide intervention strategies."
Source: https://www.biorxiv.org/content/10.1101/2021.08.17.456689v1
Commentary: The Delta variant is just stickier. It finds its way into us faster and sticks easier than previous variants anywhere there are ACE2 receptors in our body - most heavily in places like your nose, lungs, intestines, etc. It's all over. However, COVID-19 is a respiratory disease. It sticks and invades us through our respiratory system. That means most of all, we need to be wearing the best masks available to us all the time.
That said, it doesn't hurt to maintain general cleanliness.
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Vaccines are working. People's understanding of math isn't. "In conclusion, as long as there is a major age disparity in vaccination rates, with older individuals being more highly vaccinated, then the fact that older people have an inherently higher risk of hospitalization when infected with a respiratory virus means that it is always important to stratify results by age; if not the overall efficacy will be biased downwards and a poor representation of how well the vaccine is working in preventing serious disease (the same holds for efficacy vs. death).
Even more fundamentally, it is important to use infection and disease rates (per 100k, e.g.) and not raw counts to compare unvaccinated and vaccinated groups to adjust for the proportion vaccinated. Use of raw counts exaggerates the vaccine efficacy when vaccinated proportion is low and attenuates the vaccine efficacy when, like in Israel, vaccines proportions are high.
This is not just an issue of making vaccines look worse than they are ... any summary computing "proportion of hospitalized that are unvaccinated" that covers a period of time in which the proportion vaccinated was low can be similarly misleading, especially if there was a massive Covid-19 surge during that time periods. For example, computing total proportion of hospitalized covid infections in the USA from unvaccinated individuals while aggregating over the entire 2021 (January to present), a time periods that includes the early months in which virtually all USA residents were unvaccinated and there was a massive winter surge, will be similarly misleading. Thus, these artifacts can be used by some to make the vaccines look better than they in fact are, e.g. any report suggesting things like 99.9% of hospitalizations are from unvaccinated when covering a long period of time like this.
The bottom line is there is very strong evidence that the vaccines have high efficacy protecting against severe disease, even for Delta, and even in these Israeli data that on the surface appear to suggest the Pfizer vaccine might have waning efficacy. This is clearly evident if the data are analyzed carefully, and agrees with all other published results to date from other countries."
Source: https://www.covid-datascience.com/post/israeli-data-how-can-efficacy-vs-severe-disease-be-strong-when-60-of-hospitalized-are-vaccinated
Commentary: This is an EXCELLENT, not too technical read about how vaccination data can be misleading if you don't read it carefully and analyze the data properly. Give this a read, and then share this article.
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Saliva an unreliable testing channel for asymptomatic COVID-19. "While real-time reverse transcriptase–polymerase chain reaction (RT-PCR) on nasopharyngeal swabs is the current standard for SARS-CoV-2 detection, saliva is an attractive alternative for diagnosis and screening due to ease of collection and minimal supply requirements.1,2 Studies on the sensitivity of saliva-based SARS-CoV-2 molecular testing have shown considerable variability.3 We conducted a prospective, longitudinal study to investigate the testing timeframe that optimizes saliva sensitivity for SARS-CoV-2 detection.
Saliva was sensitive for detecting SARS-CoV-2 in symptomatic individuals during initial weeks of infection, but sensitivity in asymptomatic SARS-CoV-2 carriers was less than 60% at all time points. As COVID-19 testing strategies in workplaces, schools, and other shared spaces are optimized, low saliva sensitivity in asymptomatic infections must be considered.5 This study suggests saliva-based RT-PCR should not be used for asymptomatic COVID-19 screening."
Source: https://jamanetwork.com/journals/jama/fullarticle/2783249
Commentary: For RT-PCR testing, we will still need to stick with the Q-tip up your nose.
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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. 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. Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
3. Get vaccinated as soon as you're able to, and fulfill the full vaccine regimen. Remember that you are not vaccinated until everyone you live with is vaccinated. If you received an adenovirus vaccine (J&J/AstraZeneca), consider getting an mRNA single shot booster (Pfizer/Moderna) if permitted.
4. Wash/sanitize your hands every time you are in or out of your home.
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 the 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 pandemic gives another crazy plot twist to the economy.
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 a rapid antigen test. This will detect COVID-19 only when you're contagious, so follow the directions clearly. https://amzn.to/3fLAoor
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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
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Disclosures and Disclaimers
I declare no competing interests on anything I share related to COVID-19. 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, nor do I financially benefit in any way from sharing information about COVID-19.
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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.