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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Another day, another set of record highs, at least in the United States. For the folks who like to say "it's because we're testing more", no, record high hospitalizations and rapidly rising deaths have nothing to do with testing. The United States outbreak is out of control.
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Expect a post-holiday surge.
"Based on mid-October forecast models, AAA would have expected up to 50 million Americans to travel for Thanksgiving – a drop from 55 million in 2019. However, as the holiday approaches and Americans monitor the public health landscape, including rising COVID-19 positive case numbers, renewed quarantine restrictions and the Centers for Disease Control and Prevention’s (CDC) travel health notices, AAA expects the actual number of holiday travelers will be even lower.
Those who decide to travel are likely to drive shorter distances and reduce the number of days they are away, making road trips the dominant form of travel this Thanksgiving. Travel by automobile is projected to fall 4.3%, to 47.8 million travelers and account for 95% of all holiday travel."
Source: https://newsroom.aaa.com/2020/11/fewer-americans-traveling-this-thanksgiving-amid-pandemic/
Commentary: Go ahead and cancel those Christmas travel plans and New Year's party plans as well. I did weeks ago, much to my family's great displeasure, but the data is absolute. We are in a massive surge that is not slowing down, and we know that, at least in America, millions of people plan to travel for the holidays anyway.
Disclosure: AAA is a client of my company, but did not offer or request inclusion of their data.
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Remdesivir no longer supported by the World Health Organization. "Thursday evening, a new review from the World Health Organization was published by the British Medical Journal, entitled "A living WHO guideline on drugs for covid-19." This comprehensive document addresses drug interventions in treating covid-19 and this latest version focuses on the use of the anti-viral medication remdesivir. Sure to bring controversary to an already contentious topic is the new stance taken by the WHO which provided a "weak or conditional" recommendation on the use of remdesivir in hospitalized patients. Behind the new WHO stance (in direct opposition to the US FDA) are the results of the WHO Solidarity trial, released as a preprint in October. This over 11,000 patient multi-site multi-national study investigating not only remdesivir but hydroxychloroquine, lopinavir and interferon showed the drug had little or no effect on mortality, decreasing need for mechanical ventilation, or significantly changing hospital duration. Despite previous studies published in the New England Journal of Medicine the panel still felt that the extant available evidence is either low quality or low certainty and there is no current proof that remdesivir improves patient-important outcomes. An important clarification the authors made was this does that imply ineffectiveness. Rather, the sum of all current research shows a small and uncertain benefit that must be weighed against the harms. Consideration must be made of socio-economic factors such as equity, feasibility and resources across all healthcare systems worldwide. An accompanying editorial asks if remdesivir simply "Tamiflu redux"? Tamiflu (Oseltamivir) is an expensive influenza medication with limited benefit. Despite its widespread use, it has no real record of saving of lives."
Source: https://brief19.com/2020/11/20/brief
Commentary: This is no surprise; trial after trial showed no benefit to use of remdesivir when tested properly.
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Do you want to take part in contact tracing? Johns Hopkins University and Coursera have teamed up to offer a free course for people volunteering to be contact tracers.
"In this introductory course, students will learn about the science of SARS-CoV-2 , including the infectious period, the clinical presentation of COVID-19, and the evidence for how SARS-CoV-2 is transmitted from person-to-person and why contact tracing can be such an effective public health intervention. Students will learn about how contact tracing is done, including how to build rapport with cases, identify their contacts, and support both cases and their contacts to stop transmission in their communities. The course will also cover several important ethical considerations around contact tracing, isolation, and quarantine. Finally, the course will identify some of the most common barriers to contact tracing efforts -- along with strategies to overcome them."
Source: https://www.coursera.org/learn/covid-19-contact-tracing
Commentary: Contact tracing is practically an art form, so having a great training to start as a baseline is wonderful. I'm especially glad to see the fees have been waived for this course. Consider joining the fight against COVID-19 and taking the training.
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Be on the lookout for delirium in older COVID-19 patients. "Beyond COVID-19, delirium is known to be a common presenting symptom for older adults with severe disease in the emergency department (ED) but goes undetected in two-thirds of cases.7,8 Delirium is an acute state of confusion, characterized by altered level of consciousness, disorientation, inattention, and other cognitive disturbances, that commonly affects older persons and is associated with adverse outcomes, including prolonged hospitalization and death.9,10 In non–COVID-19 illness, delirium may be the earliest, or only, sign of an infection.11 In older adults infected by SARS-CoV-2, anecdotal evidence and case series have described atypical presentations—namely, patients presenting without the typical signs or symptoms of an illness or with nonspecific signs and symptoms.12 For example, older persons can present with delirium in the absence of typical signs and symptoms of COVID-19, such as fever or cough.13-17 Early COVID-19 studies have estimated rates of delirium at 25% to 33% in hospitalized patients18,19 and 65% in intensive care unit (ICU) patients.20 In one study,21 among 113 patients with COVID-19 who died, 22% presented with altered level of consciousness, compared with 1% of those who recovered. The frequency of and outcomes associated with delirium among older adults with COVID-19 infection in the ED setting, however, have not been well described, to our knowledge. This information is critical to ensure early recognition of COVID-19 by frontline clinicians. The primary objective of this descriptive study was to determine the frequency of delirium as a presenting symptom of COVID-19 infection among older adults in the ED.
Patients with COVID-19 who present with delirium, either as the main symptom or as one of the presenting symptoms or signs, have worse outcomes, including ICU stay and in-hospital death, than those without delirium. Our study demonstrates that it is critical to recognize that older adults with COVID-19 may present with delirium as the primary or sole symptom. In addition, delirium is an important risk marker to identify patients at high risk for poor outcomes, including death. Future studies will be critical to evaluate the preventable nature of delirium in COVID-19 and the effectiveness of tested intervention strategies, such as the Hospital Elder Life Program38 or the ABCDEF bundle,39 to reduce the severity and duration of delirium and the occurrence of associated complications. Adding delirium as a common presenting symptom of COVID-19 will keep important cases from being missed and allow earlier identification and management of vulnerable patients at high risk for poor outcomes."
Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773106
Commentary: Delirium as a primary symptom of COVID-19 in older people is an important marker to be on the lookout for. If you have responsibility for caring for elders, add this to your diagnostic toolkit.
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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. Always wear a mask when out of your home and if going to a high risk area, wear goggles. 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, 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.
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.
6. Participate in your local political process. For Americans, go to Vote.org and register/verify your vote.
7. Ventilate your home as frequently as weather and circumstances permit.
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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.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.