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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There was no update yesterday due to it being a crazy day. Back on the wagon.
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Evidence of long COVID in kids. "510 children were included (56.3% females) infected between January 2020 and January 2021. At their initial COVID-19 infection, 22 (4.3%) children were hospitalized. Overall, children had persisting COVID-19 for a mean of 8.2 months (SD 3.9). Most frequent symptoms were: Tiredness and weakness (444 patients, 87.1% of sample), Fatigue (410, 80.4%), Headache (401, 78.6%), Abdominal pain (387, 75.9%), Muscle and joint pain (309, 60.6%), Post-exertional malaise (274, 53.7%), rash (267, 52.4%). 484 (94.9%) children had had at least four symptoms. 129 (25.3%) children have suffered constant COVID-19 infection symptoms, 252 (49.4%) have had periods of apparent recovery and then symptoms returning, and 97 (19.0%) had a prolonged period of wellness followed by symptoms. Only 51 (10.0%) children have returned to previous levels of physical activity. Parents reported a significant prevalence of Neuropsychiatric symptoms.
Our study provides further evidence on Long COVID in children. Symptoms like fatigue, headache, muscle and joint pain, rashes and heart palpitations, and mental health issues like lack of concentration and short memory problems, were particularly frequent and confirm previous observations, suggesting that they may characterize this condition. A better comprehension of Long COVID is urgently needed."
Source: https://www.preprints.org/manuscript/202103.0271/v1/download
Commentary: Long COVID isn't limited to adults, and the mean of 8.2 months for symptoms - for a disease we've known about for 14 months - is concerning. Keep your kids away from likely environments of contamination.
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COVID in schools. "Although COVID-19 can and does occur in school settings, the results of these analyses indicate that in Florida, 60% of COVID-19 cases in school-aged children were not school-related, <1% of registered students were identified as having school-related COVID-19, and <11% of K–12 schools reported outbreaks. These findings add to a growing body of evidence suggesting that COVID-19 transmission does not appear to be demonstrably more frequent in schools than in noneducational settings (2). Temporal trends in the United States also indicate that among school-aged children, school-based transmission might be no higher than transmission outside the school setting (3,4); the limited in-school transmission observed in Florida has also been observed in other states (5) and countries (6).
Success in preventing the introduction of SARS-CoV-2 into schools depends upon controlling community transmission and adhering to mitigation measures in schools, particularly masking, physical distancing, testing, and increasing room air ventilation (2,4,7). Where feasible, supporting family choice for remote versus in-person learning likely reduces in-school crowding and facilitates better physical distancing in schools. In Florida, a large proportion of school-related outbreaks was observed among social gatherings and extracurricular sporting activities. Household transmission and social gatherings might pose a higher risk for infection among school-aged children than does school attendance (8). School sports and other extracurricular activities in which masking and physical distancing are difficult or impossible to achieve should be postponed, particularly during periods of high community transmission (2,9)."
Source: https://www.cdc.gov/mmwr/volumes/70/wr/mm7012e2.htm?s_cid=mm7012e2_w
Commentary: The keys to safely opening schools are the countermeasures that we need everywhere. Distancing. Universal, correct mask usage. Ventilation. And monitoring the virus in the community, with testing. Since kids are currently unable to be vaccinated, we have to treat them as we did adults last year, before a vaccine was available, and apply as many countermeasures as possible.
Ventilation is CRITICAL. The air in classrooms needs to be changed out very frequently with fresh air to reduce the probability of infection.
Family choice for remote learning will be important too - letting people stay home reduces the total number of seats needed.
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Opioid abuse accelerated during the pandemic. "People with opioid use disorder (OUD) are vulnerable to disruptions in access to addiction treatment and social supports during the novel coronavirus 19 (COVID-19). While some communities have reported increased opioid overdose rates, the extent and subsequent changes in Emergency Department (ED) utilization following a nonfatal opioid overdose during COVID-19 remains unknown.
Overdose visit counts increased by 10.5% (N=3486, 95CI 4.18%-17.0%) in 2020 compared to 2018-2019 (N=3020 and 3285, respectively) despite a 14% decline in all-cause ED visits. Opioid overdose rates increased 28.5% (95CI 23.3%-34.0%) from 0.25 per 100 ED visits in 2018-2019 to 0.32 per 100 ED visits in 2020. While all 6 health systems had overdose ED visit rates greater than the 95th percentile prediction in 6 or more weeks of 2020 (vs. 2.6 weeks as expected by chance), two health systems experienced sustained outbreaks during the COVID-19 pandemic.
Despite decreases in ED visits for other medical emergencies, the number and rates of opioid overdose-related ED visits in 6 healthcare systems increased during 2020, suggesting a widespread worsening in opioid-related complications during COVID-19. Expanded community and hospital-based interventions are needed to support people with OUD and save lives during COVID-19."
Source: https://www.annemergmed.com/article/S0196-0644(21)00226-2/fulltext
Commentary: It's not surprising to see drug problems increase during the pandemic; one of the consequences we will need to resolve in the coming years is the massive mental health toll the pandemic has had on nearly everyone.
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Reinfection is rare. "LONDON — Most people who have had Covid-19 are protected from catching it again for at least six months, but elderly patients are more prone to reinfection, according to peer-reviewed research published in The Lancet medical journal Wednesday evening.
The first large-scale study on coronavirus reinfection rates was carried out in Denmark in 2020 with the findings confirming that only a small proportion of people (0.65%) returned a positive PCR test twice. PCR tests are seen as the gold standard and tell you if you currently have the virus.
However, while prior infection gave those under the age of 65 around 80% protection against reinfection, for people aged 65 and older it conferred only 47% protection, indicating that they are more likely to catch Covid-19 again.
The authors of the study — which was conducted by researchers from the Staten Serum Institut and the University of Copenhagen in Denmark, and the European Centre for Disease Prevention and Control in Sweden, and received no funding — found no evidence that protection against reinfection declined within a six-month follow-up period.
The Lancet noted that the researchers’ findings validate strategies that have prioritized protecting elderly people during the pandemic, such as enhanced social distancing and prioritization for vaccines, even for those who have recovered from Covid-19."
Source: https://www.cnbc.com/2021/03/17/covid-reinfection-more-common-for-the-over-65s-study-finds.html
Commentary: This is good news, but should remind us that vaccination is the priority. Get as many shots into arms as fast as possible, to shut down variants, especially since the research cited by the Lancet focuses on the original strain of SARS-CoV-2 and not any of the new variants of concern.
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A reminder of the simple daily habits we should all be taking.
1. Always wear the best mask available to you when out of your home and you'll be around other people. 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. Get vaccinated as soon as you're able to.
3. Wash/sanitize your hands every time you are in or out of your home for any reason.
4. 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.
5. Get your personal finances in order now. Cut all unnecessary costs.
6. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
7. 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).
8. Masks must fit properly to work. Here's how to properly fit a mask:
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Common misinformation debunked!
There is no mercury or other heavy metals in the Pfizer mRNA vaccine. https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
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.