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.
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I had the interesting experience this morning of an HVAC work crew in my basement and at times during the work, they weren't wearing their face masks appropriately. What do you do when something like that happens? Here's the list of steps I took:
1. Everyone in my house was already wearing masks, so that was a non-issue. In the basement, for the next 12 hours, anyone going into that space wears a mask. Even though it's my home office, I'll be wearing a P100 mask at my desk for the remainder of the day.
2. I've set up a MERV13 HEPA air filter and a high-speed fan to ventilate immediately. It'll change over the air 2-5 times an hour, so within a day, it will have thoroughly cleaned the air of any particles. After ventilation is complete, that filter will get tossed and a new one put on the fan.
3. I sprayed down area where the crew was working with 3% hydrogen peroxide and I'll be mopping the entire floor area with it.
4. The above ground floors had the windows open already; had they not, I'd open them up. Ventilate, ventilate, ventilate.
5. Obviously continued good hygiene.
6. I contacted the vendor immediately and they volunteered to have the workers be tested today with a rapid test to ascertain their safety. Since I live in a city where spread is out of control, it's as much for their safety as ours.
We know that aerosols/airborne spread is likely the primary vector, and a basement is a place where air can be trapped. Ventilation is the primary answer here. If you find yourself in a similar situation, take these steps.
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A look back.
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Dr. Scott Gottlieb from the weekend circuit.
"Probably the most difficult phase of this epidemic, I think the next three months are going to be very challenging. There's really no backstop against the spread that we're seeing. We're probably two or three weeks behind Europe and Europe's in a very difficult position right now to I think as we enter the winter, we're going to see continued spread. There's 42 states where hospitalizations are rising. There's 45 states with a rate of transfer the RT is above one, meaning they have expanding epidemics. And there's really no backstop, there's not going to be an intervention that really thwarts this, short of the the ability to get a vaccine, which is probably an event that happens late next year.
So it begs the question, what is the strategy and I think the strategy is just to endure the spread until we get to that vaccine. And the reason that's problematic is because even if you get companies filing applications at the end of November, which is what they've said, and I'm on the board of Pfizer, one one of the companies developing one of those vaccines, it'll take FDA two to four weeks to turn that application around, then it will take us another two to four weeks to get the initial tranche or people the most vulnerable, who are indicated for the vaccine, vaccinated, then they need to get a second dose, and that happens in the next three to four weeks. And then it takes two weeks for the immunity really to kick in. So you're looking at a situation where the first tranche of people to get vaccinated really won't be protected from the vaccine probably till February, and maybe March. And so that's a long way off, we're going to have to endure this wave of spread right now. And it's probably likely to be the biggest way that we endure without the benefit of a vaccinated population. So we're gonna have to rely on those mitigation steps."
Source:
Commentary: We have a long, difficult winter ahead. Prepare now; one of the things I've noticed at my local grocery store is that shelves are starting to look a little emptier. In particular, the paper products aisle is still a hot mess, but the meats section and the dairy section were looking a little rough this week.
As we all did in the early months, now's a great time to make sure you've got everything you need, especially if you're in an area that can get hit by winter storms and you're housebound for a few days. Make sure you've got a good selection of frozen foods (if you have room) and basic staples like grains. No need to go overboard, just make sure you haven't drawn down on your supplies without replenishing them.
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Dr. Anthony Fauci from the weekend circuit on multiple topics.
The situation:
"As you know, the background baseline number of cases that we were having each day was between 45 and 50,000 a day, that's an unacceptably high level, and then what's happening in some of the Midwest state and the North West, and even now in the upper Northeast Corridor. As the weather gets cooler in the fall, you're seeing people doing things more indoors than outdoors, which is always a bad situation to be in when you're dealing with a respiratory infection. So what we're seeing, unfortunately, is upticks in case, positivity, test positivity ease, that's going to translate as it already is, into in additional hospitalizations, which ultimately going to translate into additional deaths. So we have a high background to begin with. And now we're starting to see, as you said correctly, an uptick in cases in you know, in 37 states. I mean, that is a substantial proportion of the United States of America, that is not a good sign as you're entering into the cooler weather. So what we really have to do is double down on the things that I talk about every single day, the five issues, universal wearing of masks, keeping a distance, avoiding crowds in congregate settings, trying to do things outdoors, preferentially over indoors and washing your hands frequently. They sound very simple. But people are not doing that. And that's the reason why we're seeing the uptick in cases."
On the availability of monoclonal therapeutics:
"The number of doses that are currently available is not going to be able to meet that projected benchmark, I think we're talking about hundreds of thousands of doses and not 10s of millions of doses. So right now, given the supply that there is I don't think we'll be able to attain that goal. Ultimately, if it gets approved for use, I would imagine the company is going to mass produce it and make it widely available. But right now, there are not enough doses to do that."
On Thanksgiving:
"And that's really an unfortunate fact, that is going to cause obviously some concern about everyone who looks forward to the holidays and interacting with family members that they haven't seen in a while. That is unfortunately a risk. When you have people coming from out of town gathering together in an indoor setting, you don't know what the status of it is. It is unfortunate, because that's such a sacred part of American tradition, the family gathering around Thanksgiving, but that is a risk.
I think given the fluid and dynamic nature of what's going on right now, in the spread, and the uptick of infections, I think people should be very careful and prudent about social gatherings, particularly when members of the family might be at a risk because of their age, or their underlying condition. Namely, you may have to bite the bullet and sacrifice that social gathering, unless you're pretty certain that the people that you're dealing with are not infected, either they've been very recently tested, or they're living a lifestyle, in which they don't have any interaction with anybody, except you and your family, then it's okay. And it's almost like, like my relationship with my wife, we almost do nothing with anybody else except each other. So I'm not worried about my infecting my wife of my wife infecting me, you take my sister and my brother in law, they the same thing, they almost never go. Anyway, socially, of being in contact with other people, you would say that that kind of a gathering would be really relatively safe. But when you're talking about relatives, that are getting on a plane, being exposed in an airport, being exposed in a plane, then walk in the door and say, Happy Thanksgiving, that you have to be careful about.
My Thanksgiving is going to look very different this year, I would love to have it with my children. But my children are in three separate states, throughout the country. And in order for them to get here, they would all have to go to an airport, get on a plane travel with public transportation, they themselves, because of their concern for me and my age, have decided they're not going to come home for Thanksgiving, even though all three of them want very much to come home for Thanksgiving."
On dealing with the fall:
"You can make sure there's good ventilation. I mean, you may need to expand a little bit more heat energy to keep your house warm, but try and keep windows open. Try and keep things well ventilated. And don't be afraid to wear a mask in your house. If you're not certain of the persons that are in the house, or negative, I think there's them you know that there's an interesting reports that we're getting. Dr. Birx is out in the field now doing an amazing job of traveling to different states trying to get a feel for what's going on, and telling people what to do. And she reports back to me literally yesterday, that what she's seeing is that household transmission now is assuming a greater element of the transmissibility. So people who feel comfortable, they say, Well, I'm in my own house with my own family, I don't need to wear a mask. And I can just be, you know, not be as careful as I would on the outside. And that's where the transmissibility is occurring. So we better be careful, don't assume, because you're in your own home, with your own family, that you're not going to spread infection, because you may feel perfectly well. And when you are outside speaking with someone who felt perfectly well, that they transmitted the virus to you, and then you're in danger of transmitting it to your family."
On safety of voting:
"Well, you know, I have seen in so many stores, Nora, I mean, you can try to get a cup of coffee and Starbucks and they say, stay here, you're six feet away from the next block, you don't move to the next block until that person moves on. Then you see the people in a particular establishment all wearing masks, some wearing gloves. If the voting stations are doing that, I think it's just as safe to vote as it is to go and get a cup of coffee in a Starbucks in which everyone's wearing a mask and doing the things they should be doing. So voting can be safe in person. There are some people clearly who are concerned, the elderly people with underlying conditions, they don't want to get out of the house. They don't want to do that. Then therefore right in voting, and sending in ballots are perfectly fine for them, whatever suits you and your level of risk. Have you voted by mail? I haven't voted yet. What I likely do is either drop something off in the box or walk into the school with a habit and vote in person."
Source:
Commentary: Go ahead and vote, but cancel Thanksgiving. I'd long assumed, once we hit our "second wave" in America, that all the winter holidays will be in isolation because we demonstrated our complete inability to get the pandemic under control.
If you have to travel to see relatives, and that means things like public restrooms or shared air space with others, be prudent. If your relatives are at risk, don't gamble with their health. Stay home, stay safe, and video call them.
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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.
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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.