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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More details on inflammatory syndrome from COVID-19. "Although most children have mild or no illness from SARS-CoV-2 infection, MIS-C may follow Covid-19 or asymptomatic SARS-CoV-2 infection. Recognition of the syndrome and early identification of children with MIS-C, including early monitoring of blood pressure and electrocardiographic and echocardiographic evaluation, could inform appropriate supportive care and other potential therapeutic options.10,11
Because children often present with mild symptoms of Covid-19 and are less frequently tested than adults,4,7 the incidence of MIS-C among children infected with SARS-CoV-2 is unclear. It is crucial to establish surveillance for MIS-C cases,14 particularly in communities with higher levels of SARS-CoV-2 transmission.
The emergence of multisystem inflammatory syndrome in children in New York State coincided with widespread SARS-CoV-2 transmission; this hyperinflammatory syndrome with dermatologic, mucocutaneous, and gastrointestinal manifestations was associated with cardiac dysfunction."
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2021756?query=featured_home
Commentary: Kids are at risk from COVID-19 inflammatory illness - and unlike diseases like KAwasaki's disease, it applies to every ethnicity. This should be concerning to anyone rushing to re-open schools; the inflammation attacks the respiratory system, skin, GI tract, and heart in young children.
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Contact tracing works when the community trusts you. "More than 1600 cases of Covid-19 have been diagnosed on the reservation served by our hospital, with only one of these patients being intubated in our emergency department. Of some 400 patients who needed hospitalization, nearly half have been transported to facilities that provide higher-level care. Our community’s case fatality rate so far is 1.1%, less than half the rate reported for the rest of Arizona.
Running this kind of operation is difficult. It is staff-intensive and requires clinicians to spend long days in the hot sun. But we believe that our process has yielded positive outcomes.
Any success is due in large part to strong partnerships with tribal leaders who have acted decisively to curb the spread of infection, supporting social-distancing measures despite obvious challenges. In addition, our hospital and clinicians have built a level of trust with the community that we do not take for granted. Recent data suggest we have successfully flattened the curve in our community, but our situation remains precarious, given rising case counts statewide.
Covid-19 is a novel disease in need of novel approaches. But our experience has shown that there is no substitute for providing services according to the most basic principles of medicine and public health. In our current health care system, knocking on doors and talking to patients may be the most novel approach of all."
Source: https://www.nejm.org/doi/full/10.1056/NEJMc2023540?query=featured_home
Commentary: Very positive results from contact tracing among Native Americans in Arizona - with community trust, they've halved the death rates compared to the rest of the state. this is contact tracing done well and correctly - the rest of the state (and nation) would do well to follow.
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Are hospitals recession-proof? "Our estimates are independent of any short-term loss of revenue from the care of patients with coronavirus, restrictions aimed at preventing the spread of the virus, and lost investment income. Many more patients will delay obtaining care, fearing that hospitals will be sites of exposure. In addition, hospitals may have to compete for patients who have become accustomed to telemedicine for certain services and may lose associated revenue from facility fees and ancillary services. This new price sensitivity may require hospitals to adopt new practices in the short term, such as eliminating cost sharing or providing coupons to restore revenue from insured patients.
Though the current crisis is unprecedented in terms of its scale and cause, the underlying economic issues would have surfaced with any substantial perturbation of the economy. We are not entering this crisis with the same health care system we had during the Great Recession. Even with more people insured today, the increasing prevalence of high–cost-sharing plans and the widening gap between private and public payers each threaten access and create cracks in a previously recession-proof industry. As the financial crisis grows throughout the health care system, policymakers will have to grapple with the question of whether it’s in the public interest to bail out organizations that adopted anticompetitive strategies that put hospitals in this financial situation in the first place. It’s hard to imagine creating the conditions for thoughtful policy analysis in the middle of this crisis, but that will be essential to achieving a sustainable health care system in the post-Covid world."
Source: https://www.nejm.org/doi/full/10.1056/NEJMp2018846?query=featured_home
Commentary: Fundamentally, the reliance on private health insurance through employers is the biggest crack in the armor for the United States compared to the rest of the developed world. Like the student loan industry, it creates perverse incentives for ever-increasing costs across the board because someone else is always paying, and in a massive recession/depression, people without employer health insurance can't pay their bills. I hope, and urge you to urge your elected officials, to help move America to a universal, single-payer healthcare model like the rest of the planet. This crisis has made that need desperately apparent - and will be strongly opposed by the insurance industrry.
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The D614G mutation of SARS-CoV-2 is getting some notice. "A SARS-CoV-2 variant carrying the Spike protein amino acid change D614G has become the most prevalent form in the global pandemic. Dynamic tracking of variant frequencies revealed a recurrent pattern of G614 increase at multiple geographic levels: national, regional and municipal. The shift occurred even in local epidemics where the original D614 form was well established prior to the introduction of the G614 variant. The consistency of this pattern was highly statistically significant, suggesting that the G614 variant may have a fitness advantage. We found that the G614 variant grows to higher titer as pseudotyped virions. In infected individuals G614 is associated with lower RT-PCR cycle thresholds, suggestive of higher upper respiratory tract viral loads, although not with increased disease severity. These findings illuminate changes important for a mechanistic understanding of the virus, and support continuing surveillance of Spike mutations to aid in the development of immunological interventions."
Source: https://www.cell.com/cell/fulltext/S0092-8674(20)30820-5
Commentary: This is a mutation on the active part of the virus' RNA, a protein spike that controls how the virus infects us. This mutation apparently shows that it makes SARS-CoV-2 a better, more robust virus, able to infect us more easily. This mutation began in Europe and is now the majority of COVID-19 infections. While it doesn't appear to have had any change in the severity of illness, the fact that it's increased infectiousness is bad news. The full paper goes on to say that the mutation may negate any seasonal influence (i.e. summer slowing down the virus).
What does this mean for us? A more infectious virus means we have to take our precautions more seriously. It doesn't seem to have changed the vectors - it's still a respiratory virus, but it means taking the 3Ws even more seriously. Wash your hands. Wear a mask. Watch your distance. The fact that this mutation is now the dominant form of SARS-CoV-2 means that it was a mutation that worked in the virus' favor - and against us.
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These people are idiots. "Alabama college students threw ‘COVID parties’ — and offered cash prizes to see who’d get sick first. Several Alabama college students continued attending parties despite knowing they’d been infected with coronavirus.
The students were aware they had tested positive for COVID-19, but officials confirmed rumors about college students attending parties around Tuscaloosa for the past few weeks as coronavirus as the number of cases continued to climb in the state, reported WBMA-TV.
“We had seen over the last few weeks parties going on in the county, or throughout the city and county in several locations where students or kids would come in with known positives,” said fire chief Randy Smith. “We thought that was kind of a rumor at first [but] we did some additional research [and] not only did the doctor’s offices help confirm it, but the state confirmed they also had the same information.”"
Source: https://www.rawstory.com/2020/07/alabama-college-students-threw-covid-parties-and-offered-cash-prizes-to-see-whod-get-sick-first/
Commentary: Honestly, whoever these students are, I hope they're last in line to receive medical services. They intentionally did this to themselves and should be treated accordingly.
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Testing is at capacity. "The United States is once again at risk of outstripping its COVID-19 testing capacity, an ominous development that would deny the country a crucial tool to understand its pandemic in real time.
The American testing supply chain is stretched to the limit, and the ongoing outbreak in the South and West could overwhelm it, according to epidemiologists and testing-company executives. While the country’s laboratories have added tremendous capacity in the past few months—the U.S. now tests about 550,000 people each day, a fivefold increase from early April—demand for viral tests is again outpacing supply.
If demand continues to accelerate and shortages are not resolved, then turnaround times for test results will rise, tests will effectively be rationed, and the number of infections that are never counted in official statistics will grow. Any plan to contain the virus will depend on fast and accurate testing, which can identify newly infectious people before they set off new outbreaks. Without it, the U.S. is in the dark.
The delays have already started. Yesterday, Quest Diagnostics, one of the country’s largest medical-testing companies, said that its systems were overwhelmed and that it would now be able to deliver COVID-19 test results in one day only for hospitalized patients, patients facing emergency surgery, and symptomatic health-care workers. Everyone else now must wait three to five days for a test result.
“Despite the rapid expansion of our testing capacity, demand for testing has been growing faster,” Quest said in a statement last week warning of such a possibility. The company then said that orders for COVID-19 testing had grown by 50 percent in three weeks."
Source: https://www.theatlantic.com/science/archive/2020/06/us-coronavirus-testing-could-fail-again/613675/
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Commentary: If we don't test effectively, we can't stop the virus. Period. We need a coordinated national response to shut this thing down.
And we're probably not going to get it.
So, the onus of responsibility is on you and me to stay home as much as practical and adhere to the 3Ws religiously. We know we're not testing enough. Arizona has a positivity rate of 28.3% - and it should be around 5%. Anything more than 5% means not enough testing.
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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.
2. Wear gloves and a mask when out of your home. Consider wearing a face shield if you can't breathe at all through a mask. 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. Avoid indoor places as much as you can.
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.
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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.