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 a qualified healthcare provider who knows your specific medical situation over advice from people on the Internet.
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Delta version 4 showing up. "UK reported its biggest one-day Covid case increase in 3 months just as the new delta variant AY.4 with the S:Y145H mutation in the spike reaches 8% of UK sequenced cases. We need urgent research to figure out if this delta plus is more transmissible, has partial immune evasion?
The variant has been in the UK since about July, but it has been slowly increasing in prevalence. There’s no clear indication that it’s considerably more transmissible, but we should work to more quickly characterize these and other new variants. We have the tools.
The variant has been in the UK since about July, but it has been slowly increasing in prevalence. There’s no clear indication that it’s considerably more transmissible, but we should work to more quickly characterize these and other new variants. We have the tools."
Source:
Commentary: The Delta variant overall has shown incredible fitness thus far; it's unsurprising new mutations of it will result in greater potential infectivity. By being so infectious, it simply has more chances at bat to evolve a new variation with even greater survival fitness.
No variant has successfully evaded NPIs like masking when used properly and are of the best quality you can get ahold of. Combined with vaccines, masks + vaccines + good ventilation continue to offer the knockout combo that keeps you safe.
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Long discussion on European and UK data. "NEW: there’s been a lot of chatter about why cases, hospitalisations and deaths are much higher in the UK than elsewhere in Western Europe.
I think a lot of the commentary has been overly simplistic, politicised and at-times flat-out wrong.
Let’s see if we can do better:
Yesterday we published a story comparing the situation in the UK vs a selection of Western Europe peers: ft.com/content/345825…
Here are the top-line stats:
• Cases among older people are 7x higher in UK
• Hospital admissions are 6x higher
• Deaths are 3x higher
Not great!
Why so much higher in UK?
Here’s a look at what those countries are doing differently to reduce transmission:
• % of people never wearing masks has rocketed in UK but stayed very low elsewhere
• % of people attending large gatherings in UK is surging way ahead of elsewhere
Important: this is not about blaming individuals, it’s showing how measures/guidance differ from country to country.
Masks are no longer required in indoor spaces in England. But they are in Western Europe, which also still has some curfews and has cancelled some mass events.
Now, lots of people looked at those charts and said:
"Aha, so clearly if masks were still required in England, everything would be fine. Masks are still required in Scotland. So the UK’s bad Covid numbers are the English government’s fault. Simples."
Well, let’s dig deeper:
Here’s that first set of charts again, but this time separating out England and Scotland:
• Elderly case rates have been much higher in Scotland
• Admissions much higher too, and stuck there for now
• Deaths also a lot higher
So if anything, Scotland seems to be faring worse
And here’s the second set of charts, again separating Eng + Scot:
• It’s true: Scottish government’s mask guidance means no-masking remains much less common there 😷👍
• But when it comes to mixing in large groups and crowded spaces, Eng & Scot are almost exactly the same
So straight away, we see that of the two behavioural factors, [indoor] mixing is more likely to be playing a big role.
Masks are great! But if you’re encouraging (or at least not discouraging) lots of big, crowded indoor mixing, you’ll get more transmission, masks or no masks.
To be clear, we know masks reduce transmission (I really shouldn’t have to say this), and requiring them in crowded indoor spaces is a very low-cost policy. In my view the English government should do it, at least over winter
Unroll available on Thread Reader
But just because masks are the most visible thing and the most easy for identifying "bad people" to make ourselves feel a little better, they’re not the only factor or even the most important.
And indeed, some things we’ve not discussed yet may be *much* more important:
First and foremost, vaccines. And more specifically, the timing thereof.
The UK took an early lead on vaccine rollout in Europe. This was good! But now it might not be...
Let’s remind ourselves what we know about waning immunity.
After around 5 months, you start to observe some waning of protection against severe disease. Especially in a) people who had AZ, b) people with underlying conditions
(and remember, the best way to think about this is not
"well efficacy only wanes from 96% to 92%, that’s hardly any drop-off"
it’s
"ah, instead of having 4% as much risk, it’s now 8%. chance of a breakthrough has doubled")
Well, what if I told you that while around 35% of older people in Italy & France are 5 months since 2nd jab, *75%* are at that point in UK.
Of course it’s not as simple as a binary +/- 5 month split, but in short, waning is a more immediate problem for UK than rest of Europe
And we really shouldn’t be surprised by this. In July we saw cases in Israel among double-vaxxed rise at the same rate as unvaxxed, and severe cases climb too.
Israel was about 3 months ahead of UK in vax rollout, and we’re now about 3 months on from July.
(plus the UK’s waning problem could also be exacerbated by its greater use of AstraZeneca, since most studies suggest it may wane slightly faster than Pfizer)
All of this means that nailing booster rollout in the UK is especially critical. And this is certainly something the UK’s governments have full control over. So how does it look?
Not good. A far higher share of the UK population is in the "waning but not yet boosted" bracket.
I’m showing both 5 and 6 month versions because waning happens over a range of time, not overnight at x months. But whichever version you look at, UK has ~2x as many people in the "uh-oh" range as rest of Western Europe. UK needs to boost faster and earlier, and it isn’t.
So I hope we can now see that:
• Yes, mask-wearing has plummeted in England and reversing that would help
• But higher rates of crowded indoor mixing are likely a bigger issue
• And both are almost certainly dwarfed by UK’s much more acute waning problem (as seen in Israel)
Oh, and two brief related additions as a reminder that we shouldn’t forget about structural issues either:
UK has far worse sick pay than other Western European countries, making it much harder for people who do get sick to stay home and protect others
Older people are far more likely to be in poverty in the UK than elsewhere, which can increase their risk of both catching and dying from the disease.
Whoops, missed country labels off the most important chart 😅
Couple more bits based on common feedback:
• UK — and in particular England — late vaccination of children definitely a factor too (we addressed this in the story FWIW). Not so much because of direct risk to kids, but kids spread to older groups ft.com/content/345825…
• Some saying weather/climate could be a factor if it leads to more time indoors in UK (and esp Scotland) than FR/ES/DE/IT. Agreed.
• ...and to pre-empt the "if it’s weather/climate, then why no surge in Nordics?"
a) I don’t know
b) but my guess would be that the same structural factors that have kept most of the Nordics relatively low-Covid for 18 months are still doing their thing"
Source:
Commentary: The further out you are from your second shot, the more you should be masking up. If you're in a high risk group, your mask should never have come off in the first place.
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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.