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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Will other nations learn the UK's lessons the easy way or the hard way? "LONDON — As a new and more contagious variant of the coronavirus pounds Britain’s overstretched National Health Service, health care workers say the government’s failure to anticipate a wintertime crush of infections has left them resorting to ever more desperate measures.
Hundreds of soldiers have been dispatched to move patients and equipment around London hospitals. Organ transplant centers have stopped performing urgent operations. Doctors have trimmed back the level of oxygen being given to patients to save overloaded pipes.
And nurses, frantic to make space for more beds, have had to cart critically ill people to newly converted Covid-19 wards in the middle of the night, despite having barely enough staff members to treat existing patients.
Most vexing to doctors and nurses is that Britain’s government and state health system, hammered by the virus last spring, failed to heed a cascade of warnings in the following months about needing to plan for a wintertime wave of infections, leaving hospitals unprepared as patients began arriving.
For the United States, where cases are falling even as some cities remain swamped by the virus, the harrowing scenes in British hospitals hold a sobering lesson: Health systems that withstood the first wave of the pandemic remain vulnerable to the challenges of a faster-spreading variant."
Source: https://www.nytimes.com/2021/01/21/world/europe/uk-hospitals-covid-variant.html
Commentary: The scenes from the UK and Ireland are greatly concerning, particularly since they've focused on using less invasive ventilation that uses more oxygen, so they're burning through their oxygen supplies as well as overloading systems.
I'd urge your local officials to make emergency use authorization of welding oxygen before it's too late, and if you're a person who relies on oxygen as a therapeutic, be sure you have plenty stocked up; you may also want to investigate if local welding supply stores have it in stock (non-medical) and whether their canisters are compatible with your medical equipment.
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Did the pandemic increase suicide rates? "In this cohort study, we assembled suicide death data for persons aged 10 years and older from the Massachusetts Department of Health Registry of Vital Records and Statistics from January 2015 through May 2020. This study was not subject to institutional review board approval or the requirement for informed consent because it used public data. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline was followed.
We used autoregressive integrated moving average (ARIMA) and seasonal ARIMA models to analyze suicide deaths in Massachusetts, with yearly population as the covariate. We used the Akaike information criterion (AIC) to select the best model. We plotted suicide deaths during each month of 2020 for which adequate data exist (January to May). To be conservative, we plotted an alternative scenario in which the number of deaths pending investigation by the state medical examiner exceeding the corresponding monthly averages from 2015 to 2019 were ascribed to suicide. Incident rates and rate ratios for the stay-at-home period (ie, March to May) and the corresponding period in 2019 were determined. Statistical significance was set at P < .05, and all tests were 2-tailed. Analysis was conducted with R version 4.0.2 (R Project for Statistical Computing) and SAS version 9.4 (SAS Institute).
During the pandemic period, the incident rate for suicide deaths in Massachusetts was 0.67 (95% CI, 0.56-0.79) per 100 000 person-months vs 0.80 (95% CI, 0.68-0.93) per 100 000 person-months during the corresponding period in 2019 (incident rate ratio, 0.84; 95% CI, 0.64-1.00). Because data for 2019 and 2020 are preliminary, a sensitivity analysis including all deaths still pending final cause adjudication as of November 14, 2020, was performed. The addition of the 47 deaths pending cause determination occurring from March through May 2020 and the 32 cases still pending determination from the corresponding period in 2019 did not change these findings. The conservative assumption that all pending investigations for March to May were suicides yielded an incident rate of 0.89 (95% CI, 0.77-1.03) deaths per 100 000 person-months for 2020 and 0.95 (95% CI, 0.83-1.10) deaths per 100 000 person-months for 2019 (incident rate ratio, 0.94; 95% CI, 0.76-1.15).
The number of suicide deaths during the stay-at-home period did not deviate from projected expectations using either preliminary data or an alternate scenario in which deaths pending investigation that exceeded the average remaining number of deaths that occurred during the corresponding period in 2015 to 2019 were ascribed to suicide (Figure). Decedent age and sex demographic characteristics were unchanged during the pandemic period compared with those during 2015 to 2019 (Table)."
Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775359
Commentary: The study notes in its limitations that this was only for the first few months of the pandemic; things like economic crisis tend to increase suicide rates. If you know of someone vulnerable/at-risk of suicide, be sure to check in on them frequently.
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The National Medical Association approved the vaccines. "In September, after the Food and Drug Administration authorized Covid-19 treatments based more on presidential puffery than on clinical data, some physicians decided to take matters into their own hands.
Specifically, the National Medical Association, a professional society of African American doctors, formed its own in-house FDA to vet the data when the official one seemed not to be. At first, the task force was framed as a stand-in — another instance in the long history of Black leaders stepping in where the government had failed. And eventually, its members did review the results and endorse the emergency authorizations for both the Moderna and Pfizer/BioNTech vaccines.
But they’ve moved beyond mere recommendations. They’ve also taken on the slower, more painstaking work of building and maintaining patients’ trust in these vaccines. As Rodney Hood, one of the physicians on the NMA task force, put it, “We realize that Black people are at the highest risk for coronavirus but the least likely to want to take the vaccine, so we’re trying to reverse that.”
Racism in the health care system is part of the reason that the NMA exists. The American Medical Association, which set standards for the profession, repeatedly denied membership to Black doctors — so in 1895, they founded a group of their own, “conceived in no spirit of racial exclusiveness, fostering no ethnic antagonisms, but born out of the exigency of the American environment.”
People have asked whether having certain conditions that disproportionately affect Black patients — sickle cell disease, for instance, and HIV — might affect the vaccine’s safety or efficacy. The task force has reported back, after meetings with Moderna and Pfizer/BioNTech, that the vaccine trials included participants with those illnesses, that no problems have arisen specifically in those subgroups, but that the members will keep following up with the companies as analyses become more and more fine-grained. “We’re having a conversation with the Black community,” McDougle said."
Source: https://www.statnews.com/2021/01/22/for-black-doctors-combatting-covid-19-vaccine-hesitancy-starts-with-listening/
Commentary: This is an important set of endorsements for not just the Black community, but everyone. Having independent verification of the vaccines is always a good thing - especially given a history of medical practitioners not giving equal weight or importance to minorities.
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Mutant strains flourish in areas of poor control. "Many virologists don’t believe it to be a coincidence that these kinds of mutations have arisen in parts of the world that had problems controlling the first wave of the virus – areas like the Eastern Cape of South Africa and Manaus in Brazil, places with poor health care and considerable poverty. "In areas where lots of people have already been infected, the original coronavirus may not have been able to reinfect them," explains Hodcroft, who calls herself a "virus hunter" on Twitter. "In those areas the virus has a lot to gain with a mutation that enables it to do so.”
In Germany, where the first wave was mild, SARS-CoV-2 would be less likely to mutate in that way. But in other places, viral evolution took place in fast-forward.
Given the speed, Tulio de Oliveira, the genetics professor from South Africa, believes that similar mutants have evolved in other places. "I wouldn’t be surprised if this kind of variants keep emerging in countries that haven’t gotten the pandemic under control for a long time,” he says. "Places like the U.S., for example, or Russia, but also Spain or Italy."
If you had asked her a few months ago how likely it was that dangerous SARS-CoV-2 mutants would be created in this way and spread through the population, Hodcraft says, she would have replied that, "this probably isn't one of our biggest concerns" right now. "But when we have so many people infected, we allow the virus to get into these unique, weird scenarios. We are providing it with a playground.”"
Source: https://www.spiegel.de/international/world/can-germany-stop-the-new-supervirus-a-e9ffc207-0015-4330-8361-b306f6053e15
Commentary: Evidence is emerging that the United States may have multiple strains of its own. All this reminds us to double down on our vigilance around protective measures, like the ones listed below.
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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 or better mask if you can obtain 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. 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.