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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J&J gets stronger over time. "UNDERRATED BENEFITS of J&J vaccine on severe illness— lost in efficacy comparisons is how the J&J vaccine efficacy actually may **get better over time** for severe #COVID19–as high as 90-95% at 56 days—trend is very strong. And makes J&J on par w/ Pfizer-BioNTech & NIH-Moderna.
And do we see that in the table? Yes... in all countries, the efficacy of J&J vaccine against severe #COVID19 was always higher after 28 days than after 14 days: Rising from 70’s to mid-upper 80’s%.
3) Let’s look at the Pfizer-BioNTech vaccine for 14-27 days & severe #COVID19 outcome... it was just 62-80% for severe in Israel, on par if not lower than J&J. And for >35 days with 2nd shot? 92% against severe, on par with J&J that only used 1 shot without any booster.
4) Do we see J&J performing strong on hospitalization, ICU, mechanical ventilation? Yes. In fact, 28 days after vaccination with J&J, zero events, which means de facto 100% efficacy.
5) Also keep in mind the large number of variants during the more recent era of the J&J vaccine. 46-59% of all cases were variants. And 96% of the South Africa Flag of South Africa trial’s 59% cases that were variants - was the infamous #B1351 variant!
6) But wait, didn’t we just see the J&J vaccine being 64% efficacious overall and 81.7% efficacious against severe #COVID19 in South Africa Flag of South Africa after 28 days? YES!!! That means the J&J vaccine is quite good even for the #B1351 variant that was 56% of all cases in SA!
7) Also, if we truly compare apples to apples on days since first shot, while the Pfizer vaccine showed 92% after 35 days (7 after 2nd booster)—yet J&J efficacy matched that range if average all of its efficacy range after its 35 days (with only 1 shot!)"
Source:
Commentary: At the end of the day, any authorized vaccine is going to do its job. For lower risk people, the J&J vaccine may even be better because of the cumulative effects over time. I could also foresee a time in a few months when people who are exceptionally high risk get both an mRNA vaccine and the J&J vaccine to ensure maximum protection, once supply is plentiful.
And... I'm going to be completely immature and comment that the graph shown wasn't a Pfizer graph, but it sure looks like it could have been at first glance. ;-)
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Should we pursue mandatory vaccination? "The best comparison to the massive global vaccination effort that is now starting might be the smallpox vaccination campaigns that culminated in the eradication of the disease, as detailed by Richard Horton.1 With smallpox, vaccine mandates played a pivotal role in reducing mortality and case rates.
By the mid-19th century in Europe, regions with mandatory vaccination proved to have substantially fewer deaths from smallpox than those that relied on voluntary vaccination. In 1853, smallpox vaccination became compulsory in England. In the years before mandatory vaccination in England and Wales, there were more than ten times as many deaths per person than there were in the regions of Italy and Sweden where vaccination was mandatory.2 In German states, mandatory vaccination was introduced in 1874. In the 5 years before the mandate, smallpox mortality rates were more than 30 times higher than in the 5 years following the mandatory vaccination law. These results stood in contrast to neighboring countries with persistent mortality rates.3
Perhaps the clearest experiment with mandatory vaccination was in the USA, informed by the European experience with vaccine mandates decades earlier. The results were notable. Between 1919 and 1928, the ten states with mandatory vaccination laws had 6·6 cases per 10 000, the six states with local options for laws on vaccination had 51·3 cases per 10 000, the 28 states with no laws on vaccination had 66·7 cases per 10 000, and the four states where mandatory vaccination was prohibited had 115·2 cases per 10 000.3 Between the extremes of policy on vaccine mandates, there was a 20-times difference in smallpox case rates."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00267-1/fulltext
Commentary: This says to me that mandatory vaccination works. A 20x gap between the most and least strict vaccination requirements is a massive delta.
I doubt, in the United States, we will ever reach a point where vaccination is mandatory for adults uniformly, but I would encourage all businesses to give some thought as to how to encourage vaccination, from mandates (you must be vaccinated to enter, such as health clubs and gyms) to incentives (free appetizer with your vaccine card), we should be pursuing all reasonable avenues to encourage vaccination, especially once supply is plentiful and getting a vaccine is as easy as grabbing a pack of Twinkies off the counter at CVS.
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Why do women have stronger immune systems? "Among the many health disparities characterizing the COVID-19 pandemic, one that’s received particular attention is the difference in outcomes between men and women. As early as February last year, researchers observed that, although men and women were contracting COVID-19 at similar rates, men seemed far more likely to die from the disease.
Evidence of the gap has continued to emerge as COVID-19 datasets have expanded. For instance, data aggregated by The Sex, Gender and COVID-19 Project indicate that, although statistics vary substantially among countries around the world, men with the disease are around 20 percent more likely to be hospitalized than women. Once hospitalized, men are more likely to require intensive care, and once there, they’re more likely to die.
One person unsurprised by these differences is Sabra Klein, a biologist at Johns Hopkins Bloomberg School of Public Health. Klein has been studying immune responses to viral infections for more than two decades, and says that COVID-19 is helping to shine a spotlight on an important truth in infectious disease biology: that viruses and other pathogens don’t equally affect women and men (for the purposes of this article, people with two X chromosomes and those with one X and one Y, respectively). And at least some of that difference can’t simply be explained by differences in exposure or risk-related behavior between women and men—it comes down to biology.
Klein says that the stronger immune responses illustrated by these and similar studies are likely a double-edged sword from a health perspective. On the one hand, females’ heightened immune activation could help limit the amount of virus in the body—an effect observed in people with HIV, for example, as women tend to have much lower viral loads than men do in the first few years following infection. Additionally, females seem to generate better protective antibody responses than do males following vaccination against influenza, yellow fever, dengue, and several other viruses. On the other hand, that same biology likely also predisposes females to diseases stemming from overactive immune responses, Klein notes. “The downside of this robust immunity is that 80 percent of all autoimmune disease patients are women,” she says. “We are so much more likely to have autoimmune diseases; we are significantly more likely to have multiple autoimmune diseases.”
Researchers who spoke to The Scientist also noted early research on other mechanisms involved in shaping male and female immune responses, including the regulation of certain genes on the Y chromosome, or even sex-specific biases in the composition of the microbiome. The picture that’s emerging, says Klein, is one of a suite of biological mechanisms that provide females with stronger immune responses to viruses at the cost of a higher risk of autoimmune conditions, often later in life—a trade-off likely driven by natural selection.
“Many of us [in the field] hypothesize that this is tied to reproductive success,” says Klein. “One of the things a mother can give her baby during pregnancy is antibodies, some of the immunity that we have. This is likely involved as a mechanism of protection of young, when they’re most vulnerable to severe outcomes.”"
Source: https://www.the-scientist.com/features/sex-differences-in-immune-responses-to-viral-infection-68466
Commentary: People with two X chromosomes mount more substantial immune responses, but at the risk of having greater and more severe autoimmune diseases. But at least for the pandemic, women are generally at lower risk, which is noteworthy.
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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.