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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Schools need either ventilation or filtration. "Airborne transmission of SARS-CoV-2 through virus-containing aerosol particles has been established as an important pathway for Covid-19 infection. Suitable measures to prevent such infections are imperative, especially in situations when a high number of persons convene in closed rooms. Here we tested the efficiency and practicability of operating four air purifiers equipped with HEPA filters in a high school classroom while regular classes were taking place. We monitored the aerosol number concentration for particles >3 nm at two locations in the room, the aerosol size distribution in the range from 10 nm to 10 µm, PM10 and CO2 concentration. For comparison, we performed similar measurements in a neighboring classroom without purifiers. In times when classes were conducted with windows and door closed, the aerosol concentration was reduced by more than 90% within less than 30 minutes when running the purifiers (air exchange rate 5.5 h − 1). The reduction was homogeneous throughout the room and for all particle sizes. The measurements are supplemented by a calculation estimating the maximum concentration levels of virus-containing aerosol from a highly contagious person speaking in a closed room with and without air purifiers. Measurements and calculation demonstrate that air purifiers potentially represent a well-suited measure to reduce the risks of airborne transmission of SARS-CoV-2 substantially. Staying for two hours in a closed room with a highly infective person, we estimate that the inhaled dose is reduced by a factor of six when using air purifiers with a total air exchange rate of 5.7 h − 1."
Source: https://www.tandfonline.com/doi/full/10.1080/02786826.2021.1877257
Commentary: Masks alone are not enough to stop COVID-19 in high-density settings. They are better than nothing, to be sure, but they are part of a whole solution. Ventilation or filtration is another essential piece - if filtration can cut down aerosol particles by 90% in a classroom, that combined with masks should be enough to permit schools to reopen.
These filters need to be installed and running as long as people are in the room and probably for 30 minutes before and after as well to keep particle concentrations down.
Schools also cannot afford more high-end equipment, but it's possible to MacGyver solutions together with box fans and MERV13-16 filters.
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Important and good: FDA permits amendments to EUAs. "The following describes FDA’s current thinking regarding the chemistry, manufacturing, and controls information (CMC), nonclinical data, and clinical data needed to support an amendment to an EUA under section 564 of the FD&C Act (21 U.S.C. 360bbb-3) for a vaccine for the prevention of COVID-19. These recommendations pertain to modified COVID-19 vaccines for the prevention of COVID-19, where the vaccine is made by the same process and manufacturer, but is modified in order to enhance efficacy against COVID-19 caused by a SARS-CoV-2 variant(s). It should be recognized that FDA’s thinking regarding data needed to authorize a modified COVID-19 vaccine may evolve as additional information is accrued with SARS-CoV-2 variants and corresponding vaccines. Of note, the recommendations detailed below are specifically tailored to pandemic COVID19 vaccines that express the S protein and are made under the assumptions that neutralizing antibody to SARS-CoV-2 S is a major component of the vaccine protective response (or for a given vaccine construct, is likely to vary in proportion to the protective response), that an immune marker predictive of protection has not been established, and that it is not feasible to conduct clinical disease endpoint efficacy studies rapidly enough to respond to the emergence of SARS-CoV-2 variants that may escape immunity conferred by prototype vaccines. Assuming the prototype vaccine has been authorized under an EUA it is expected that the modified COVID-19 vaccine against a SARS-CoV-2 variant made by the same manufacturer and process as the prototype COVID-19 vaccine would be authorized through an EUA amendment to the EUA for the prototype COVID-19 vaccine."
Source: https://www.fda.gov/media/142749/download
Commentary: What this says is that vaccine manufacturers who are providing updates to the COVID-19 vaccines do not need to file for entirely new emergency use authorizations for each vaccine variant designed to deal with new strains of SARS-CoV-2. Instead, they'll file an amendment as long as the process they're using hasn't changed.
Why this matters is that it accelerates how fast vaccine updates can be brought to bear on new strains. Instead of taking weeks or months, vaccine updates could receive authorization extensions in much shorter times - recognizing the importance of speed in dealing with mutations.
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The Pfizer vaccine is effective against B.1.1.7 and also reduces asymptomatic infections.
"Background: BNT162b2 mRNA and ChAdOx1 nCOV-19 adenoviral vector vaccines have been rapidly rolled out in the UK. We determined the factors associated with vaccine coverage for both vaccines and documented the vaccine effectiveness of the BNT162b2 mRNA vaccine in our healthcare worker (HCW) cohort study of staff undergoing regular asymptomatic testing.
Methods: The SIREN study is a prospective cohort study among staff working in publicly funded hospitals. Baseline risk factors, vaccination status (from 8/12/2020-5/2/2021), and symptoms are recorded at 2 weekly intervals and all SARS-CoV-2 polymerase chain reaction (PCR) and antibody test results documented. A mixed effect proportional hazards frailty model using a Poisson distribution was used to calculate hazard ratios to compare time to infection in unvaccinated and vaccinated participants to estimate the impact of the BNT162b2 vaccine on all (asymptomatic and symptomatic) infection.
Findings: Vaccine coverage was 89% on 5/2/2021. Significantly lower coverage was associated with prior infection (aOR 0.59 95% confidence interval [CI] 0.54-0.64), female (aOR 0.72, 95% CI 0.63-0.82), aged under 35 years, being from minority ethnic groups (especially Black, aOR 0.26, 95% CI 0.21-0.32), porters/security guards (aOR 0.61, 95% CI 0.42-0.90),or midwife (aOR 0.74, 95% CI 0.57-0.97), and living in more deprived neighbourhoods (IMD 1 (most) vs. 5 (least) (aOR 0.75, 95% CI 0.65-0.87). A single dose of BNT162b2 vaccine demonstrated vaccine effectiveness of 72% (95% CI 58-86) 21 days after first dose and 86% (95% CI 76-97) seven days after two doses in the antibody negative cohort.
Conclusion: Our study demonstrates that the BNT162b2 vaccine effectively prevents both symptomatic and asymptomatic infection in working age adults; this cohort was vaccinated when the dominant variant in circulation was B1.1.7 and demonstrates effectiveness against this variant."
Source: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3790399
Commentary: The study demonstrates effectiveness of reducing infection at 71% after the first dose (21 days), and 85% after the second dose. In turn, it reduces transmission, which is great news for the B.1.1.7 strain. The numbers aren't as high as they were for the OG virus, where in trials it was shown to be 94% after 2 doses, but a loss of 9% efficiency is still more than tolerable, especially against one of the new strains. And it's far more effectiveness than the 0% effectiveness of not getting vaccinated at all.
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If you want to reopen schools, vaccinate the teachers. "In-person learning provides important benefits to children and communities. Understanding SARS-CoV-2 transmission in schools is critical to improving the safety of in-person learning.
An investigation of SARS-CoV-2 transmission in a Georgia school district during December 1, 2020–January 22, 2021, identified nine clusters of COVID-19 cases involving 13 educators and 32 students at six elementary schools. Two clusters involved probable educator-to-educator transmission that was followed by educator-to-student transmission in classrooms and resulted in approximately one half (15 of 31) of school-associated cases.
Educators might play a central role in in-school transmission networks. Preventing SARS-CoV-2 infections through multifaceted school mitigation measures and COVID-19 vaccination of educators is a critical component of preventing in-school transmission."
Source: https://www.cdc.gov/mmwr/volumes/70/wr/mm7008e4.htm?s_cid=mm7008e4_w
Commentary: What, the person standing at the front of the room talking loudly might be a vector for transmission? You don't say. Sarcasm aside, this underscores the importance of vaccinating teachers, not only for their own health, but to cut down on chains of transmission in the classroom. If you want to reopen schools, you must vaccinate the staff.
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A reminder of the simple daily habits we should all be taking.
1. Always wear the best mask available to you when out of your home and you'll be around other people. 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. Get vaccinated as soon as you're able to.
3. Wash/sanitize your hands every time you are in or out of your home for any reason.
4. 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.
5. Get your personal finances in order now. Cut all unnecessary costs.
6. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
7. 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).
8. Masks must fit properly to work. Here's how to properly fit a mask:
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Common misinformation debunked!
There is no mercury or other heavy metals in the Pfizer mRNA vaccine. https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
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.