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.
---
Some feedback from reader Kevin: "I really appreciate your concise and accurate synopses of the latest published science regarding the ongoing Covid pandemic. My wife and I have been reading them for almost the entire pandemic and have found your commentary to be the best that we know of. I feel the need to point out, however, that your characterization of the virus as “clever” is somewhat misleading for those who are not familiar with the process of Darwinian evolution. Random mutations which lead to Covid strains that are better at infecting and evading immune response are in no way driven by intelligence, or even conscious intent on the part of the virus. I see this anthropomorphic language used quite frequently in this context, but I expect that you, as a stickler for rational, science based information, would avoid using such misleading terms. Perhaps a better description of Covid-19’s evolution would be “unexpectedly rapid” or “very efficient.” I look forward to a time when there is no need for your emails, and until then I will depend on them to provide the information needed to take the appropriate precautions."
Kevin is correct. Viruses are incapable of any conscious action, period. There's some debate in the scientific community about whether they are even alive or not; modern opinions seem to suggest that they are not living at all. Part of what drives COVID's rapid evolution is that it has so many at-bats - meaning infected people. If COVID had been stopped with, say, the first thousand people, it never would have adapted to become Alpha, Delta, Omicron, etc. But because COVID has had half a billion people in which to mutate, its rate of change has been very high.
---
COVID substantially more dangerous to kids than flu. "Among 66 PICUs in the United States, the number of children admitted each quarter with a primary diagnosis of COVID-19 or MISC during the first 15 months of the pandemic was twice as high as that for influenza during the 2 years before the pandemic. Influenza outcomes were observed during a time with no unusual public health measures in place (2018 to early 2020), while those of SARS-CoV-2 occurred while masking, social distancing, and remote schooling occurred. Those measures were sufficient to markedly decrease critical illness from many respiratory viruses, including nearly eliminating influenza admissions to these PICUs.4 Without these measures in place for this largely unvaccinated population, SARS-CoV-2 would likely have led to a number of critically ill children several-fold higher than seen with prepandemic influenza as well as more deaths.
Our findings are supported by studies showing increased admissions,1 mortality rate,3 and absolute numbers of deaths2 among children with SARS-CoV-2 vs influenza."
Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2793366
Commentary: For irresponsible folks who are downplaying COVID's risk to kids in the interest of economic gains, it has been proven multiple times, including with this new study, that COVID is substantially more dangerous to children than the flu. Get kids vaccinated, and keep them masked wherever practical.
---
COVID causes more immune damage than AIDS. "HIV and SARS-CoV-2 are responsible for two of the most dangerous and life-threatening infectious diseases of our times. To better analyze the difference in the immunological response elicited by the two infections, we compare the alterations in the lymphocyte subpopulations, measured by flow cytometry analysis (FCA) in both AIDS and COVID-19 patients, referred to our University Hospital. A total of 184 HIV infected patients were retrospectively examined and the results of FCA collected and compared to those obtained in 110 SARS-CoV-2 infected patients, examined during the actual outbreak. We observe a comparable reduction in B cells in both diseases and a more severe reduction in the total amount of T cells in COVID-19 as compared to AIDS patients. The analysis of the T cells subpopulations indicates that there is a comparable reduction in the CD4+ cells count. Conversely, a remarkable difference between them is observed in the CD8+ counts. In AIDS patients the CD8+ cells are slightly higher than normal, while in COVID-19 patients the CD8+ cell count is markedly reduced. As a result, the CD4+/CD8+ ratios, is very low in AIDS and higher than normal in COVID-19 patients. The NK cells are reduced in both diseases, but SARS-CoV-2 infection causes a more severe reduction compared to HIV infection. In conclusion, both HIV and SARS-CoV-2 viruses induce major changes in the lymphocytes count, with remarkable similarities and differences between them. The total absolute numbers of T cells and, in particular of the CD8+ subpopulation, are lower in COVID-19 patients compared to AIDS ones, while the CD4+ are reduced in both at similar levels. These results indicate that the host immune system reacts differently to the two infection, but they are responsible of a comparable dropping effect on the serum levels of CD4+ T cell population. The meaning of the similarities and of the differences in terms of T cells activation and serum depletion are discussed. The knowledge on how the immune system reacts to these two infections will be useful to better define their mechanism of action and to design specific preventive and therapeutic approaches."
Source: https://www.researchgate.net/publication/342997179_AIDS_and_COVID-19_are_two_diseases_separated_by_a_common_lymphocytopenia
Commentary: Once peer-reviewed, this finding is going to be critical in the years to come as long COVID persists and the disease continues to adapt and attack us. COVID's attacks on the immune system, if this data holds up in peer-review, would make COVID sufferers vulnerable to other infections.
---
BA.2 does not protect against BA.4/BA.5 variants. "Most people who have been infected with COVID-19 in the U.S. in the past couple of months likely had the BA.2 or BA.2.12.1 variant, both lineages of the original Omicron strain of SARS-CoV-2.
Now, BA.4 and BA.5 are here, and they're starting to make up a larger proportion of U.S. cases.
So if someone was recently infected with a BA.2 lineage, are they mostly protected against reinfection with BA.4 or BA.5?
Probably not, infectious disease experts say.
"It's expected that there's probably not much cross-protection between them," Amesh Adalja, MD, an infectious disease physician at the Johns Hopkins Center for Health Security in Baltimore, told MedPage Today.
Adalja said it essentially comes down to the number and type of mutations in the receptor binding domain of the spike protein. There's an "abundance" of important mutations, he said, which doesn't bode well for protection against reinfection.
"That's what you expect with this viral family," Adalja said. "The virus is going to be able to continue to evolve to reinfect us at will."
Source: https://www.medpagetoday.com/special-reports/exclusives/99281
Commentary: Prior infection may not necessarily protect you from getting COVID again, though as with vaccines (or ideally in addition to vaccines) it will blunt the impact.
---
Long COVID has a new bio-marker. "The diagnosis and management of post-acute sequelae of COVID-19 (PASC) poses an ongoing medical challenge. Identifying biomarkers associated with PASC would immensely improve the classification of PASC patients and provide the means to evaluate treatment strategies. We analyzed plasma samples collected from a cohort of PASC and COVID-19 patients (n = 63) to quantify circulating viral antigens and inflammatory markers. Strikingly, we detect SARS-CoV-2 spike antigen in a majority of PASC patients up to 12 months post-diagnosis, suggesting the presence of an active persistent SARS- CoV-2 viral reservoir. Furthermore, temporal antigen profiles for many patients show the presence of spike at multiple time points over several months, highlighting the potential utility of the SARS-CoV-2 full spike protein as a biomarker for PASC."
Source: https://www.medrxiv.org/content/10.1101/2022.06.14.22276401v1.full.pdf
Commentary: Once past peer review, this finding could be a straightforward blood test to identify whether someone has long COVID or a different disorder, a key diagnostic tool.
---
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, including boosters. 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 available. If it's available, choose Moderna as your first choice for both vaccine and booster, Pfizer as your second choice. However, remember than any vaccine is better than no vaccine.
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, or you know, a global war breaks out.
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.