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.
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.
---
Cancer patients should get Moderna if possible. "Multiple myeloma (MM) patients are at higher risk for severe COVID-19. Their mRNA vaccination response against SARS-CoV-2 is unknown. Thus, we analyzed responses to mRNA vaccination against COVID-19 among these patients. Using an ELISA-based assay that detects IgG antibodies to SARS-CoV-2 spike protein, we determined serum antibody levels prior to immunization and 12–21 and 14–21 days following the first and second vaccinations, respectively, with mRNA-1273 (Moderna) or BNT162b2 (Pfizer/BioNTech) among 103 MM patients (96 and 7 with active and smoldering disease, respectively). We stratified patients into clinically relevant responders (>250 IU/mL), partial responders (50–250 IU/mL, which was above pre-COVID-19 background), and nonresponders (<50 IU/mL). Smoldering MM patients responded better than those with active disease. Only 45% of active MM patients developed an adequate response, while 22% had a partial response. Lower spike antibody levels were associated with older age, impaired renal function, low lymphocyte counts, reduced uninvolved immunoglobulin levels, > second line of treatment, and among those not in complete remission. Patients who received mRNA-1273 vaccine had higher anti-spike antibody levels than those who were vaccinated with BNT162b2. Thus, most MM patients have impaired responses to mRNA vaccination against COVID-19, and specific clinical and myeloma-related characteristics predict vaccine responsiveness."
Source: https://www.nature.com/articles/s41375-021-01354-7
Commentary: I suspect this is true for any immune compromised or high risk individual - the antibody response from the Moderna vaccine is much stronger and more durable, and so should be the first choice.
---
Herd immunity may be a pipe dream. "Let's bust some myths 🧵
1. Herd immunity is coming soon
This is Iran. There are 3 shades of green on this map. Starting at medium green, each person living in this province has been infected on average more than once.
/photo/1
In dark green, the provinces with an overall population attack rate between 150% and 200% during the 5 waves which surged in Iran.
Kurdistan : 155 %
North Khorasan : 157 %
Qazvin : 163 %
So each person living in these provinces has caught it > 1,5 times in 21 months.
One province, Sistan and Baluchistan, in dark blue was hit with a vicious 3rd and 4th wave and has reached an overall population attack rate of 259%. This is a number with a great uncertainty. The attack rate could be as low as 41% or as high as 480% [95% confidence interval].
Which wave was the deadlier. The 5th in all age groups except for the 75 years old and above which had good vaccine coverage unlike the others who had just 3 %.
So what happened in the hardest province Sistan and Baluchistan?
In this graph
/photo/1
⬛️: suspected hospital admission,
🟧: confirmed hospital admission
🟦: excess mortality
per 100,000 persons over time
The peaks become higher even though after the third wave attack rate ~ 121%
Let me repeat this : On average, it was estimated at the end of Jan 2021, the citizens of Sistan and Baluchistan had been infected on average 1.2 times in a year but the combined fourth and fifth wave were still the deadliest and each person had Covid 2.5 times overall on average
The reigning popular models still speak about herd immunity and Covid becoming more and more like a nice manageable flu for the people who have been infected or vaccinated.
The data on vaccination is a 1 billion person strong. We know that it is highly effective at⬇️the severity of the disease. We also know that immunity towards infection wanes in ~ 47 % after 4 months (Lancet). This is a problem that we are not sure how to fix on the long term.
I suggest that we abandon the reigning popular models based on 1918 flu and accept that this is a novel coronavirus with all the uncertainty that it entails.
Let's be humble and act on sound science based on this rapidly evolving coronavirus.
We don't know how it ends yet."
Source:
Commentary: Fundamentally, until we understand the dynamics of the disease, we should continue with as many precautions as practical. Get vaccinated. Get your boosters when eligible, available, and appropriate. Remain masked up, and keep yourself out of unnecessarily risky situations. We will eventually decode the virus and understand more about its nature, how it evolves, and what it means, but for now it's easiest to stay cautious.
---
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
---
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 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.
---
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.