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.
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Biomedical research significantly impacted by COVID-19. "The effect of COVID-19 has been enormous, with thousands of trials—around 80% of non-COVID-19 trials—being stopped or interrupted, according to Michael Lauer, deputy director for extramural research at the US National Institutes of Health. But the effect extends beyond just trials. “There have also been tremendous disruptive effects on all biomedical research that is not directly related to COVID”, Lauer told The Lancet. “Laboratories are closed. Communications have been shut down, conferences have been cancelled, supply chains for equipment have been lost, resources have been lost. There have been widespread financial losses within academic medical centres that have had spillover effects on their research operations.” The effect has also been felt by those who conduct research. Many researchers were pulled away from working on clinical trials to work in emergency medical care, especially during the first months of the pandemic in places where the pandemic threatened to overwhelm critical care resources. The slowdown or cancellation of trials will have a disproportionate effect on early career researchers, and even those who can work from home—statisticians and epidemiologists—face the same difficulties that many have in balancing work and home life, which is especially true for those raising children, the effect of which still disproportionately falls on women.
The disruptions to patients, researchers, and institutions have been numerous, and will leave a lasting effect on research that was ongoing before the pandemic. “I think when they're presented in a couple of years from now, virtually every trial will have a footnote that says, well, X percentage of patients were enrolled and followed during this part of the pandemic”, Sheth said, “and that'll be a part of the literature that we all incorporate and read.” What the long-term effects on research will be is unclear. Health Affairs posted a blog that examined ways to maximise the utility of data collected by stopped trials and looked forward to ways to protect trials from similar disruptions in the future, such as decentralising trial locations out of a few major urban centres.
Clinical trials are an essential tool in medical research, but COVID-19 has exposed ways that their design, conduct, and reporting could be improved. The rapid design and launch of clinical trials designed to research COVID-19 has shown that certain aspects and practices of clinical trials could be improved, streamlined, or modernised in ways that would benefit patients, practitioners, and all research. In the future, it will be important for the conduct of research to incorporate those lessons to ensure the highest quality of research."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31787-6/fulltext
Commentary: The disruption of so much clinical research will have implications and setbacks for a number of research projects. Hopefully, scientists will be able to restart work after the pandemic and make up lost time, but if you were following any particular project out of clinical or personal interest, know that the timelines for those projects has been affected adversely.
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Kids may not get COVID-19 badly, but when it's bad, it's bad. "Our case report shows inflammatory changes in the cardiac tissue of a child with MIS-C related to COVID-19, which led to cardiac failure and death. SARS-CoV-2 could be detected in cardiac tissue by RT-PCR and electron microscopy. Despite the evident systemic inflammation and final progression to multiorgan failure, clinical, echocardiographic, and laboratory findings strongly indicated that heart failure was the main determinant of the fatal outcome. Further, the autopsy showed myocarditis, pericarditis, and endocarditis, with intense and diffuse tissue inflammation, and necrosis of cardiomyocytes. Moreover, the finding of SARS-CoV-2 in heart tissue indicates that myocardial inflammation was probably a primary response to the virus-induced injury to cardiac cells. The presence of SARS-CoV-2 in different cell types of cardiac tissue suggests potential mechanisms for heart damage. First, infection of cardiomyocytes probably leads to local inflammation in response to cell injury; both the virus-induced injury and the inflammatory response could lead to necrosis of cardiomyocytes. The finding of viral particles in neutrophils supports the idea of virus-induced inflammation. Also, infection of endothelial cells in the endocardium could result in haematogenous spread of SARS-CoV-2 to other organs and tissues.
In conclusion, our pathological observations support the hypothesis that the direct effect of SARS-CoV-2 infection on cardiac tissue was a major contributor to myocarditis and heart failure in our patient. Hopefully, our findings could help to shed light on the understanding of the complex interaction between SARS-CoV-2 infection, MIS-C, and cardiac dysfunction in children and adolescents with COVID-19."
Source: https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30257-1/fulltext
Commentary: The eye opener for this particular case study was an otherwise healthy 11-year old child. SARS-CoV-2 caused cardiac failure in an 11-year old. Think about that for a second - and then weigh the need to reopen schools with the consequences that at least some students will face, students who are otherwise healthy and have no pre-existing conditions. We still don't know what causes some cases to be so bad - and until we do, it's a lottery, gambling with the lives of those we care about.
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Air travel case study. "We discovered 2 likely SARS-CoV-2 transmissions on this flight, with 7 index cases. These transmissions may have also occurred before or after the flight. The risk of transmission of droplet-mediated infections on an aircraft depends on proximity to an index case and on other factors, such as movement of passengers and crew, fomites, and contact among passengers in the departure gate.1 In our study, both passengers with likely onboard transmission were seated within 2 rows of an index case.
The airflow in the cabin from the ceiling to the floor and from the front to the rear may have been associated with a reduced transmission rate.2 It could be speculated that the rate may have been reduced further had the passengers worn masks.
It has previously been observed for SARS and influenza that transmission may also occur among passengers seated beyond the 2-row perimeter,2,3 indicating possible airborne transmission. Our findings do not rule out airborne transmission of SARS-CoV-2 in an airplane cabin."
Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2769383
Commentary: 2 rows within the index case means that skipping the middle seat alone is not likely enough to stop spread on an airplane. Mandatory masks on airplanes is definitely required and justified; passengers who refuse to comply should be prohibited from travel.
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What happens in Vegas doesn't stay in Vegas when it's an airborne infectious disease. "Contact tracing, one of the pillars of stopping the pandemic, is a labor-intensive process where a health official tracks down anyone who’s been in contact with an infected person and takes steps to prevent the disease’s spread. But there is no national system in place for contact tracing, said Joshua Michaud, an epidemiologist and associate director of global health policy for the Kaiser Family Foundation. It’s decentralized and performed by local health agencies that may not communicate with one another, especially given their caseloads. So, if a casino had a “cluster outbreak” or “superspreading event” among visitors, it’s unlikely contact tracing would catch it, Michaud said.
“The way it’s set up right now, contact tracers are not looking for clusters that might identify outbreaks tied to traveling to a casino or other specific locations,” Michaud said. “You’re not actively looking for it, so you might miss that event. Contact tracing is not set up to answer those questions, so you’ll still be in the dark.”
A new analysis of smartphone data, conducted at ProPublica’s request, shows how interconnected the country is with visitors to Las Vegas — which heightens concerns about the limitations of interstate contact tracing. The companies X-Mode and Tectonix analyzed travel to and from Las Vegas during four days, a Friday to Monday, in mid-July. In compliance with privacy laws, X-Mode collects data from smartphone users, mainly those using fitness and weather apps that track their location. The data represents about 5% of the smartphone users in the United States. Tectonix analyzed the data and visualized it on a map.
During the four-day period, about 26,000 devices were identified on the Las Vegas Strip. Some of those same smartphones also showed up in every state on the mainland except Maine in those same four days. About 3,700 of the devices were spotted in Southern California in the same four days; about 2,700 in Arizona, with 740 in Phoenix; around 1,000 in Texas; more than 800 in Milwaukee, Detroit, Chicago and Cleveland; and more than 100 in the New York area.
The cellphone analysis highlights a reason the virus keeps spreading, said Oscar Alleyne, an epidemiologist and chief program officer with the National Association of County and City Health Officials. “People have been highly mobile, and as a result, it makes sense why we see the continuation of the surge.”"
Source: https://www.propublica.org/article/cellphone-data-shows-how-las-vegas-is-gambling-with-lives-across-the-country
Commentary: High mobility equals high spread, especially when you look at the photos of people in these places and there's very little mask wearing. High mobility, low compliance - that's the recipe for a pandemic that never ends.
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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 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.
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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.