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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COVID-19 fatality rate may be higher than previously thought. "As the COVID-19 pandemic continues to unfold, the infection-fatality risk (ie, risk of death among all infected individuals including those with asymptomatic and mild infections) is crucial for gauging the burden of death due to COVID-19 in the coming months or years. Here, we estimate the infection-fatality risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in New York City, NY, USA, the first epidemic centre in the USA, where the infection-fatality risk remains unclear.
Using a comprehensive epidemic model-inference system and detailed population data of weekly cases, deaths, and mobility, we estimated the infection-fatality risk of severe acute respiratory syndrome coronavirus 2 for all ages overall and by age group in New York City, NY, USA, during the 2020 spring pandemic (March 1, to June 6, 2020). We also estimated the fluctuations in infection-fatality risk over the course of the pandemic. Our estimates addressed three main challenges in estimating the infection-fatality risk of COVID-19: age differences, under-ascertainment of deaths, and under-detection of infections.
We estimated that the overall infection-fatality risk was approximately double previous estimates for elsewhere during earlier or similar periods. Our results are based on more complete ascertainment of COVID-19-associated deaths in New York City than are those from previous studies, and thus probably reflect the true, higher burden of death due to COVID-19 than previously reported elsewhere. Given this high infection-fatality risk, governments must account for and closely monitor the infection rate and population health outcomes and enact prompt public health responses accordingly as the COVID-19 pandemic unfolds.""
Source: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30769-6/fulltext
Commentary: This new research highlights what many have suspected about the pandemic - that the numbers overall are underreported badly (especially in America), and that the pandemic is worse than generally reported due to incomplete data. An infection-fatality rate that's double what's been previously reported is a big deal.
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The pandemic has not led to global suicide increases. "Suicide, a leading cause of death with devastating emotional and societal costs, is a generally preventable cause of death and a critical global public health issue. The coronavirus disease 2019 (COVID-19) pandemic may increase the risk of population suicide through its effects on a number of well-established suicide risk factors.
Prior to the pandemic, many countries were engaging in suicide prevention strategies, and although the overall global burden of suicide deaths has increased, some national efforts were beginning to see positive results. Additionally, the gap between mental health needs and services has been increasing in many nations. With the added physical and mental health, social, and economic burdens imposed by the pandemic, many populations worldwide may experience increased suicide risk. Data and recent events during the first 6 months of the pandemic reveal specific effects on suicide risk. However, increases in suicide rates are not a foregone conclusion even with the negative effects of the pandemic. In fact, emerging suicide data from several countries show no evidence of an increase in suicide during the pandemic thus far. There are actionable steps that policy makers, health care leaders, and organizational leaders can take to mitigate suicide risk during and after the pandemic.
Based on the growing body of science informing our understanding of suicide, there are several risk factors linked to the pandemic and ensuing public health measures, which suicide expert consensus views as threats that could increase population suicide risk without significant efforts to mitigate these risks. These threats to population suicide risk include the pandemic’s potential to lead to deterioration in mental and/or physical health; social disconnectedness, loneliness, or diminished social support; fears about or realized job or financial losses; remote work or school and the related disruption in social, academic, and basic structure to daily life; loss of loved ones or anticipated milestones; increased alcohol consumption in some regions of the world; and increased availability of lethal means such as firearms, opioids, and other toxic substances, especially with more time spent at home sheltering in place. Of particular concern in the US, firearms purchases increased by 85% during March 2020 at the start of COVID-19, compared with previous years during March."
Source: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2772135
Commentary: Check in frequently on your friends, especially now that we're entering a dangerous new phase in the pandemic, with uncontrolled spread in many nations. Someone losing their life from COVID-19 is just as bad as someone losing their life by their own hand, and both are preventable with appropriate countermeasures. Check in on the people you care about.
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Obesity and risk in detail. "Not a single country in the world has less than 20% overweight or obese individuals. Many of the poorest nations are now facing overweight and obesity levels of 30%, 40%, 50%, or more. So this is a problem not only for the countries we think about first, like the US, UK, and Australia, which are leaders in obesity levels among the high-income countries, but also across the globe.
In the US, we have 43% of adults who are obese and another 25% to 30% in the overweight category. We are by far the largest country with large numbers of obese individuals. Even if you move to levels of really serious obesity, BMIs [body mass indexes] of 35 or 40 or even 50, we lead the world in the proportions who are in the most severe categories.
JAMA:Your analysis found heightened COVID-19 risks for people with obesity. Can you tell us about those risks?
Dr Popkin:We looked at all stages, from risk of getting COVID, to the risk of hospitalization, going into an intensive care unit, being put on a ventilator, and, finally, dying. What surprised me the most was that obese adults had an additional 113% risk, over normal-weight [and overweight] adults, of going into the hospital. That’s more than double the likelihood, if you’re obese, that you will be hospitalized if you test positive for COVID. Then we found that an additional 74% went into the intensive care unit if they had COVID. But even more scary was that people who were obese had an additional [48%] risk [of death] over the others. For obesity, people had talked about a small effect but hadn’t really shown the size of it in the way we have.
JAMA:Can you tell us more about some of the potential drivers of these increased risks among people with obesity?
Dr Popkin:We’ve known for some time that obese individuals’ immune systems are impaired. We also know that there’s a lot of metabolic dysfunction that goes on with obesity, and that the adipose tissues become inflamed quite readily. So those 3 things we’ve had some sense of. They’re very much linked to the [underlying COVID-19] risks of diabetes, hypertension, hyperlipidemia, and kidney and liver disease. So those are known pathways.
We know that visceral adiposity has an effect on impairing the lungs, and since the lungs are so impacted by COVID, this has become another major factor. We’ve learned that putting people on their stomachs helps with that.
JAMA:What are the concerns about vaccine effectiveness among individuals with obesity?
Dr Popkin:My coauthor Melinda [Beck] has published a number of really important studies that then were followed up by other scholars that showed that the flu vaccine really didn’t work as well among the obese. Obviously, there’s benefits from it. In the last couple years in the US some individuals are given 2 [flu] vaccine shots because they need more of the vaccine before it will impact their immune system as much as it does for normal-weight individuals."
Source: https://jamanetwork.com/journals/jama/fullarticle/2772071
Commentary: This is why we need a working vaccine and strong countermeasures like distancing and universal mask wearing. When 43% of the population of a nation is at risk, you've got a serious threat to public health in general, and from the pandemic specifically.
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The hardest hit group in the US? 25-44 year olds. "The coronavirus pandemic has left about 299,000 more people dead in the United States than would be expected in a typical year, two-thirds of them from covid-19 and the rest from other causes, the Centers for Disease Control and Prevention reported Tuesday.
The CDC said the novel coronavirus, which causes covid-19, has taken a disproportionate toll on Latinos and Blacks, as previous analyses have noted. But the CDC also found, surprisingly, that it has struck 25- to 44-year-olds very hard: Their “excess death” rate is up 26.5 percent over previous years, the largest change for any age group.
It is not clear whether that spike is caused by the shift in covid-19 deaths toward younger people between May and August or deaths from other causes, the CDC said.
“The number of people dying from this pandemic is higher than we think,” said Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University, who has conducted independent analyses of excess mortality. “This study shows it. Others have, as well.”
The United States is in the midst of another sharp increase in coronavirus infections, this one centered in the upper Midwest and Plains states. The seven-day rolling average of cases, considered the most accurate barometer, is near 60,000 per day. At least 220,000 people have died of covid-19 so far, according to data kept by The Washington Post.
The new CDC data covers Feb. 1 to Oct. 3. Woolf said the total is likely to reach 400,000 by the end of the year. The numbers were assembled by the National Center for Health Statistics, a unit of the CDC."
Source: https://www.washingtonpost.com/health/coronavirus-excess-deaths/2020/10/20/1e1d77c6-12e1-11eb-ba42-ec6a580836ed_story.html
Commentary: Food for thought: by the end of the year, by these models, COVID-19 deaths will eclipse in less than one year the total number of deaths from World War II - a four year war.
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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.