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.
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WHO to crack Moderna. "Fans of the television series The Great British Bake Off have long marveled at the skill contestants show during the dreaded "technical challenge" — for which they are given a basket with all the ingredients needed to make a highly unusual dish but a set of instructions that are often as vague as, "Bake until ready." Now a team of scientists at a pharmaceutical startup in South Africa is essentially confronting the same type of test — except the stakes are life and death.
The World Health Organization has hired the company, called Afrigen Biologics and Vaccines, as part of a $100 million plan to figure out how to make an mRNA vaccine against COVID that is as close as possible to the version produced by Moderna.
Until recently, Afrigen specialized in developing veterinary vaccines using fairly traditional methods. Now, says Afrigen's managing director, Petro Treblanche, the company's labs are a hive of research into the cutting-edge technology behind mRNA vaccines.
"You will see scientists in white coats and some with full personal protective equipment [suits] operating a bioreactor to make the actual DNA," says Treblanche. "You will see microbiology clean rooms where testing is taking place. You will see stability chambers where some of the products are put in to understand how stable they are in different environments of humidity and temperature."
Once Afrigen has sorted out all the complicated steps to make Moderna's shot on an industrial scale, WHO and other partners plan to pay Afrigen to become a teaching center.
"We call it a 'technology transfer hub,' " says Martin Friede, the WHO official in charge of this effort. "Manufacturers from around the world will be invited to come and learn the entire process. So this will accelerate the availability of the technology, not to one manufacturer but to many manufacturers."
Specifically manufacturers in low- and middle-income countries. Friede says the pandemic has shown they're sorely needed.
"There are regions on earth — the whole of Africa, for example, the whole of the Middle East — that really suffer because they've got no vaccine production capacity," says Friede."
Source: https://www.npr.org/sections/goatsandsoda/2021/10/19/1047411856/the-great-vaccine-bake-off-has-begun
Commentary: Given that Moderna received a large infusion of taxpayer funds for the development of the vaccine, much of its development should be considered public property. Here's hoping that the technology transfer hub is not only able to replicate it, but improve upon it. More open science is better for humanity as a whole.
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New study data on boosters. "A booster shot of the BioNTech/Pfizer vaccine is 95.6 per cent effective against Covid-19 compared with two shots and a placebo, the companies said on Thursday, citing preliminary results from the first randomised, controlled trial on boosters.
Ugur Sahin, the head of BioNTech, said the “important data” added to the body of evidence suggesting that a booster dose could help “protect a broad population of people from this virus and its variants”.
“Based on these findings, we believe that, in addition to broad global access to vaccines for everyone, booster vaccinations could play an important role in sustaining pandemic containment and a return to normalcy,” he said.
In a trial with 10,000 participants who had all completed a two-shot Pfizer regimen, half were randomised to receive a further equal-strength dose of the shot, and half a placebo. Five cases of Covid were registered in patients receiving the booster compared with 109 who were given a placebo.
The trial took place during a period when the Delta coronavirus variant was prevalent, and the median time between second and third doses was about 11 months, with a median follow-up time of two-and-a-half months.
Andy Hill, a senior visiting research fellow in pharmacology at the University of Liverpool, said the trial was “very important” because it provided a “much stronger” level of evidence.
“It is randomised and measures effects on new infections. This is a big step forwards from previous studies of other vaccines which only measured effects on antibody levels,” Hill said. “This new trial is much more reliable.”"
Source: https://www.ft.com/content/d4e58d38-37d6-40cd-9d72-6b9bfd0a3683
Commentary: Solid evidence that boosters deliver a significant impact; chances are if your area already has enough vaccine, boosters will be available to you shortly. Once they are, talk to your healthcare provider about when you're eligible, and go get it. Boosters reduce not only severity of illness, but reduce transmission as well.
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Lockdowns resuming in Europe. "Latvia has announced a month-long Covid-19 lockdown after an unprecedented surge in infections, becoming the first country in Europe to reimpose far-reaching restrictions amid a new wave of cases in countries across the continent.
The Baltic country has one of the highest rates of new Covid cases relative to population in the world, according to the US Centres for Disease Control and Prevention (CDC), after successfully keeping the virus at bay for months.
“Our health system is in danger … The only way out of this crisis is to get vaccinated,” the prime minister, Krišjānis Kariņš, said on Monday evening at an emergency government meeting. He said the country’s low vaccination rate was to blame for the surge in hospital admissions.
Only 57% of the 1.9 million Latvians are fully vaccinated, well below the EU average of 74%. The government imposed a month-long night-time curfew, from 8pm to 5am, this week and closed schools and all non-essential shops."
Source: https://www.theguardian.com/world/2021/oct/20/latvia-enters-month-long-covid-lockdown-as-fourth-wave-breaks
Commentary: Central and Eastern Europe are seeing cases spike; the big question before everyone in the Northern Hemisphere is whether this is the start of a winter wave. Mask up to protect yourself.
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Mix and match is more effective. "Following severe adverse reactions to the AstraZeneca ChAdOx1-S-nCoV-19 vaccine1,2, European health authorities have recommended that patients under the age of 55 who received one dose of ChAdOx1-S-nCoV-19 vaccine receive a second dose of Pfizer BNT162b2 vaccine as a booster. However, the effectiveness and the immunogenicity of this vaccination regimen have not been formally tested. Here, we show that the heterologous ChAdOx1-S-nCoV-19/BNT162b2 combination confers better protection against Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection than the homologous BNT162b2/BNT162b2 combination in a real-world observational study of healthcare workers (n=13121). To understand the underlying mechanism, we conducted a longitudinal survey of the anti-spike immunity conferred by each vaccine combination. Both combinations induced strong anti-spike antibody (Ab) responses but sera from heterologous vaccinated individuals displayed a stronger neutralizing activity, regardless of the SARS-CoV-2 variant. This enhanced neutralizing potential was correlated with increased frequencies of switched and activated memory B cells recognizing the SARS-CoV-2 Receptor Binding Domain (RBD). The ChAdOx1-S-nCoV-19 vaccine induced a weaker IgG response but a stronger T cell response than the BNT162b2 vaccine after the priming dose, which could explain the complementarity of both vaccines when used in combination. The heterologous vaccination regimen could therefore be particularly suitable for immune compromised individuals."
Source: https://www.nature.com/articles/s41586-021-04120-y
Commentary: This is particularly useful and important. For those who received adenovirus vaccines (AstraZeneca and J&J), an mRNA booster may deliver an even more potent protective effect. Talk to your healthcare provider about which is right for you, but if given a choice, consider mix and match for your booster shot.
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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. 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 permitted.
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.
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
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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
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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.
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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.