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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COVID-19's impact amplified by diabetes. "People with diabetes with COVID-19 are at a greater risk of worse prognosis and mortality. Given the high worldwide prevalence of diabetes, these individuals represent a large vulnerable segment of the COVID-19 population. The poorer prognosis of people with diabetes is the likely consequence of the syndromic nature of the disease (figure): hyperglycaemia, older age, comorbidities, and in particular hypertension, obesity, and cardiovascular disease all contribute to increase the risk in these individuals. The picture, however, is more complicated as it requires factoring in societal factors such as deprivation and ethnicity as well as factors that become relevant at the time that a patient with severe COVID-19 needs to be managed. Here, a physician has to account for not only the health status of the person with diabetes but also to balance carefully glucose-lowering treatments with specific treatments for the viral infection.
Once again, diabetes management in patients with COVID-19 poses a great clinical challenge, one that requires a much-integrated team approach, as this is an indispensable strategy to reduce the risk of medical complications and death as much as possible. Careful assessment of the many components that contribute to poor prognosis with COVID-19 in patients with diabetes might represent the best, if not the only way to overcome the current situation and enable our health systems to be ready to face any future challenges in a prompt and effective manner.
Finally, the inter-relationship between diabetes and COVID-19 should trigger more research to understand the extent to which specific mechanisms of the virus (eg, its tropism for the pancreatic β-cell) might contribute to worsening of glycaemic control and, in some cases, to the striking development of diabetic ketoacidosis or hyperglycaemic hyperosmolar syndrome, and possibly the development of new-onset diabetes."
Source: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30238-2/fulltext
Commentary: COVID-19 appears to be causing issues with glycemic control. This is a complex virus that is attacking on many fronts. For now, if someone has diabetes, obesity, or cardiac issues, they are at substantially greater risk of negative outcomes.
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Children may be greater disease vectors. "Can children carry the coronavirus and spread it?
“I think the answer is conclusively, without a doubt – yes,” said Dr. Lara Shekerdemian, chief of critical care at Texas Children’s Hospital.
Surveillance screening, which is testing all children admitted to a hospital, revealed a higher percentage of them carrying the virus and not showing any symptoms, she said.
The trend is consistent with data from Florida. About one-third of children tested in the state for COVID-19 returned positive results, which is higher than the overall statewide positivity rate of 11%, according to state data.
“There’s no doubt they can be asymptomatic. Do they carry (the virus) more often than adults?” she said. “That’s a hard one to answer. There isn’t enough surveillance going on in the community.”
Megan Culler Freeman, a pediatric infectious disease specialist at UPMC Children’s Hospital of Pittsburgh, said nose swab studies have shown children have the same amount of viral load in their noses as adults.
Children are more likely to have only mild symptoms, which may not be noticeable to child or parent. Shekerdemian said that by being healthier, children can actually be more dangerous as they're less likely to stay at home sick and more likely to go out into the world, unknowingly spreading the virus. "
Source: https://www.usatoday.com/story/news/health/2020/07/17/coronavirus-can-kids-spread-covid-19-spreadquestions-answered/5450062002/
Commentary: Kids are just as dangerous for spreading COVID-19 as adults. We should design policy accordingly and as much as practical, prevent schools from reopening without aggressive, comprehensive testing and isolation.
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"Smoking gun" proof that COVID-19 is an aerosol disease. "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission causing coronavirus disease 2019 (COVID-19) may occur through multiple routes. We collected aerosol samples around six patients admitted into mixed acuity wards in April of 2020 to identify the risk of airborne SARS-CoV-2. Measurements were made to characterize the size distribution of aerosol particles, and size-fractionated, aerosol samples were collected to assess the presence of infectious virus in particles sizes of >4.1 µm, 1-4 µm, and <1 µm in the patient environment. Samples were analyzed by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR), cell culture, western blot, and transmission electron microscopy (TEM). SARS-CoV-2 RNA was detected in all six rooms in all particle size fractions (>4.1 µm, 1-4 µm, and <1 µm). Increases in viral RNA during cell culture of the virus from recovered aerosol samples demonstrated the presence of infectious, replicating virions in three <1 µm aerosol samples (P<0.05). Viral replication of aerosol was also observed in the 1-4 µm stage but did not reach statistical significance (0.05<P<0.10). Western blot and TEM analysis of these samples also showed evidence of viral proteins and intact virions. The infectious nature of aerosol collected in this study further suggests that airborne transmission of COVID-19 is possible, and that aerosol prevention measures are necessary to effectively stem the spread of SARS-CoV-2. "
Source: https://www.medrxiv.org/content/10.1101/2020.07.13.20041632v1.full.pdf
Source:
Commentary: An aerosol disease is an indoor disease. It's a disease that spreads in an enclosed space regardless of distance - if you're indoors (not in your home) you must wear a mask to protect yourself and others no matter how close or far apart someone is.
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COVID-19 causing cancer death increases due to delays in treatment. "Substantial increases in the number of avoidable cancer deaths in England are to be expected as a result of diagnostic delays due to the COVID-19 pandemic in the UK. Urgent policy interventions are necessary, particularly the need to manage the backlog within routine diagnostic services to mitigate the expected impact of the COVID-19 pandemic on patients with cancer.
Our results are conservative estimates of the number of additional deaths and years of life lost because we do not consider the effect of suboptimal or delayed cancer treatment. These data are essential for policy makers to drive changes in national lockdown and stay-at-home messaging, and to urgently reduce diagnostic delays, particularly for routine investigations, through outreach and accessibility programmes. Our model can also be used by other countries in their unique health-care settings to understand the impact of delays in diagnosis on cancer outcomes."
Source: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30388-0/fulltext
Commentary: Health has to be holistic. Think of health like a basketball game. Do you just guard the player with the ball? Or do you also guard the rest of the players? Right now, understandably, we're fighting the COVID-19 pandemic with everything we have. But that's leaving other dangers unguarded - and they are gaining traction in our absence.
Do not delay care if you are in a region which is not overwhelmed. Contact your medical care professional about anything that you would normally seek care about and get their qualified opinion first, before making a decision about whether you will seek care or not. Masks and other countermeasures are effective at keeping COVID-19 lower risk even in hospitals and medical facilities when properly worn - more than enough to get care for higher-risk conditions. Don't wait.
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More details on the Chinese vaccine candidate. "This study provides more evidence for the immunogenicity and safety of the Ad5-vectored COVID-19 vaccine in a larger population. To assess the vaccine in a more diverse population, we removed the age cap for the recruitment of participants for this phase 2 trial. Older individuals (ie, aged ≥55 years), many of whom often have chronic illness, have a high risk of serious illness and death associated with SARS-CoV-2 infection; thus, they are an important target population for a COVID-19 vaccine. Our results suggest a single-dose immunisation schedule of Ad5-vectored COVID-19 vaccine at 5 × 1010 viral particles is an appropriate regimen for healthy adults. Compared with the younger population, we found older people to have a significantly lower immune response, but higher tolerability, to the Ad5-vectored COVID-19 vaccine. Therefore, an additional dose might be needed to induce a better immune response in the older population, and this will be evaluated in a phase 2b trial."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31605-6/fulltext
Commentary: Compared to the Oxford candidate, the Chinese candidate appears to be less effective in those over 55 years old. Further research is ongoing to determine what could be done to boost its effectiveness.
That said, if we develop multiple, viable vaccines for COVID-19, that's a good thing. One vaccine may eventually show as being less effective or with greater side effects than another, and having an arsenal of options will be the best way to combat the disease. Plus, we're learning as a species how to make a vaccine on never-before-seen timetables - lessons that we might be able to apply to other diseases in the future. As always, I salute the researchers who are burning the candle at both ends to create a vaccine solution for the pandemic. Imagine being told you have a year to do ten years' work.
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CO2 as a measure of ventilation. "Fresh outdoor air has a CO2 concentration of 350-450 ppm. The closer one can get to those values while using a room, the better (33). According to expert Atze Boerstra, the minimum flow rate of 60 m3/h per person roughly corresponds to a CO2 concentration of 800 ppm (29). Rooms where CO2 values rise above 800 ppm should therefore be additionally ventilated or aired. If that proves impossible, it is an indication that the maximum number of people has to decrease or that the room is not suitable for the ongoing activity."
Source: https://documentcloud.adobe.com/link/review?uri=urn%3Aaaid%3Ascds%3AUS%3Af2f0a4e1-6939-43e6-af86-e0af71dbd756#pageNum=3
Commentary: This is a smart, simple measure for indoor spaces like malls, etc. I hope to see every business deploying these to measure their ventilation and provide that information to customers, letting them see that they're doing what's required to keep them safe.
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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. 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; 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.