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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"The Rio Grande Valley has seen a surge in coronavirus cases, and the patients arrive daily. At least 10 were brought here from the emergency room Wednesday. More than a dozen the day before that. Some nurses tend to three patients each, instead of the usual two, and pick up extra hours. A lead nurse who clocked in at 6:45 a.m. Tuesday was still working past 10:30 p.m. Another, on her fourth 12-hour shift, said she’d seen things she will “never unsee.”"
"We need national media on hospitals in Hidalgo County, TX.
ICU patients covered in ants
No oxygen
Pts coding in the parking lots
No PPE
Outdoor tents in 100 deg. weather
Staff quitting en masse
Heart attack/stroke/trauma delays"
Source:
Source: https://www.texastribune.org/2020/07/02/texas-coronavirus-hospital-rio-grande-valley/
Commentary: What's happening in other states is what happened in New York City, in Bergamo, in Wuhan. COVID-19 strikes fast and overwhelms hospital systems. That's what kills most, when the healthcare infrastructure collapses under the strain.
Every state, every country should have taken the last few months to scale up capacity, to procure supplies, to train staff, to build talent pipelines, to be ready for the inevitable surge that has come or may come yet. With no immunity, COVID spreads quickly and swamps the medical system.
Urge your elected officials, wherever you live, to fund and prepare for a COVID outbreak - even if your community has already had one. You wouldn't disband your army after a temporary victory in a war. Don't disband or defund your medical army because the enemy hasn't reached you yet, or has temporarily moved on.
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Positive news on the vaccine front. "A Covid-19 vaccine being developed by Oxford University and the drug giant AstraZeneca generated an immune response in a study of roughly 1,000 patients, according to interim results published Monday.
The data, published in the medical journal the Lancet, also show that the vaccine caused side effects, including fever, headaches, muscle aches, and injection site reactions, in about 60% of patients. All of the side effects were deemed mild or moderate, and all resolved themselves over the course of the study.
While the Oxford-AstraZeneca vaccine, known as AZD1222, has moved most rapidly into larger-scale studies of any major contender — and AstraZeneca has said that billions of doses could be manufactured — the new data represent the first glimpse researchers have gotten at its efficacy. They show a relatively safe vaccine, though side effects were greater than for a meningitis vaccine, to which it was compared, that engages the immune system to fight the virus. "
Source: https://marlin-prod.literatumonline.com/pb-assets/Lancet/pdfs/S0140673620316044.pdf
Source: https://www.statnews.com/2020/07/20/study-provides-first-glimpse-of-efficacy-of-oxford-astrazeneca-covid-19-vaccine/
Commentary: AZD1222 has, by this read, cleared Phase 2 clinical trials. As a reminder, the phases of a clinical trial are typically:
- Phase 1: does it cause harm?
- Phase 2: does it work at all?
- Phase 3: does it work better than the standard of care?
- Phase 4: does it work at scale?
Since there is no current COVID-19 vaccine, Phases 3 and 4 sound like they'll be lumped together, to prove that this thing works in larger, less homogenous populations.
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From the weekend circuit, Dr. Scott Gottlieb. "Well, I think the apex in the Epidemics states right now the center of the epidemic, which is California, Texas, Arizona, and Florida could be two to three weeks away. There you are seeing some slowing in the new cases, it's not clear whether or not the new cases are actually slowing, or these states are just hitting the upper limit of the testing capacity. Arizona certainly seems to be hitting the upper limit of its testing capacity. The challenge though, is that as the states start to peak and I think they're going to have an extended plateau, I don't think this is a sharp up and a sharp down, but as they start to peak, we're seeing other epicenters of epidemic spreads start to emerge. So you have to be very worried right now about Georgia, about Tennessee about Missouri About Kentucky. We're seeing record numbers of cases with Rising hospitalizations and really a shifting of the center of the epidemic potentially in the United States. And it's just pretends more trouble for the fall in the winter that we're going to be taking a lot of infection to the fall, that we're never going to really be able to come down.
I think it might be wishful thinking that everyone was gonna wear a mask that is a hardened percentage of the population that just feel that the masks are some infringement on their liberty. We've been unable to find some kind of acceptable medium in this country between hapless spread and strict lockdowns. If we can come to a consensus about some reasonable measures that we all agree to take. We could potentially get this under control and keep it under control masks are an important first step. But I just don't see enough for the population agreeing to wear masks and 30% of the population won't wear masks any anytime. And then then you only have maybe 75% compliance among the other portion to populate Because nobody is going to do everything all the time, that might not be enough mask wearing to really get this fully under control.
We've had now five months since we first identified a shortcoming in the testing United States, what we don't have is excess capacity, we can surge into these epidemic cities. And so when you have epidemics in Texas and California and Florida and the testing companies, a big commercial labs like labcorp, and quest, try to prioritize tests in those regions. Not only do they fall behind in those regions, but now they're pulling testing out of other regions. You've seen delays there. So once a test is delayed more than 48 hours, it becomes not very useful for clinical decision making. We're seeing delays of up to six or seven days right now."
Source:
Commentary: Fundamentally, the stage is set for a terrible autumn and winter. We haven't gained any measure of control in the months when control should be easiest; we're not competing with influenza right now, and schools are out for the summer. When fall begins, and we see a huge push for schools to open, the United States is likely going to be in a world of hurt.
Prepare accordingly. Keep your supplies replenished. Make sure you have plenty of masks, etc. available for yourself and the people you care about. Right now, supplies are more plentiful - respirators etc. are available on big sites like Amazon as well as local places like your local welding and trades supply stores.
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Speaking of schools... "In the heated debate over reopening schools, one burning question has been whether and how efficiently children can spread the virus to others.
A large new study from South Korea offers an answer: Children younger than 10 transmit to others much less often than adults do, but the risk is not zero. And those between the ages of 10 and 19 can spread the virus at least as well as adults do.
The findings suggest that as schools reopen, communities will see clusters of infection take root that include children of all ages, several experts cautioned.
“I fear that there has been this sense that kids just won’t get infected or don’t get infected in the same way as adults and that, therefore, they’re almost like a bubbled population,” said Michael Osterholm, an infectious diseases expert at the University of Minnesota.
“There will be transmission,” Dr. Osterholm said. “What we have to do is accept that now and include that in our plans.”
Several studies from Europe and Asia have suggested that young children are less likely to get infected and to spread the virus. But most of those studies were small and flawed, said Dr. Ashish Jha, director of the Harvard Global Health Institute.
The new study “is very carefully done, it’s systematic and looks at a very large population,” Dr. Jha said. “It’s one of the best studies we’ve had to date on this issue.”
Children under 10 were roughly half as likely as adults to spread the virus to others, consistent with other studies. That may be because children generally exhale less air — and therefore less virus-laden air — or because they exhale that air closer to the ground, making it less likely that adults would breathe it in.
The study is more worrisome for children in middle and high school. This group was even more likely to infect others than adults were, the study found. But some experts said that finding may be a fluke or may stem from the children’s behaviors.
These older children are frequently as big as adults, and yet may have some of the same unhygienic habits as young children do. They may also have been more likely than the younger children to socialize with their peers within the high-rise complexes in South Korea.
“We can speculate all day about this, but we just don’t know,” Dr. Osterholm said. “The bottom line message is: There’s going to be transmission.”"
Source: https://www.nytimes.com/2020/07/18/health/coronavirus-children-schools.html
Commentary: The latter part is the concern. Kids 10-19 spread the disease more easily than adults? That's grades 4-12 here in the United States - in order words, the vast majority of school students. If schools reopen - and there will be many municipalities that have shown a clear willingness to disregard science - it's likely going to create a massive wave of infections that we haven't seen yet.
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You can ask someone why they're not wearing a mask. It's legal to do so. "“The protection of health information afforded by HIPAA’s Privacy Rule applies only to health information that is in the possession of what the law refers to as ‘covered entities,’” Meisel wrote in an email to USA TODAY. Covered entities include health plans, health care clearinghouses and health care providers that conduct transactions electronically, per the U.S. Department of Health and Human Services.
“HIPAA prescribes rules as to how health care providers, insurers and business associates must protect the privacy of health information about patients and prevents them from disclosing information except in limited circumstances,” Meisel said. “It simply does not apply to anything else.”
There are no legal prohibitions on what people can say to one another about their health.
“For example, if someone tells me that they have tested positive for COVID-19, there is no legal prohibition on my telling someone else,” Meisel wrote. “It might be unfriendly or unkind, but it is not illegal.”"
Source: https://www.usatoday.com/story/news/factcheck/2020/07/19/fact-check-asking-face-masks-wont-violate-hipaa-4th-amendment/5430339002/
Commentary: The whole article is worth reading. In short, asking someone why they're not wearing a mask doesn't violate anyone's rights and is not illegal. Feel free to share that with businesses that are struggling with non-compliant patrons.
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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. 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.