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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The situation. "Well, we're seeing a resurgence in the south and southeast, they never really got rid of their epidemics. And now we're seeing significant outbreaks on top of a background rate of spread that was quite high. As they reopened, that spread has continued to increase. And so, you know, challenge that was facing some regions of the country now is facing every region in the country. And the worry is that they're going to tip over into exponential growth coming this week. Because the cases are building quite quickly in Texas, Florida, Alabama, South Carolina, North Carolina, Arizona. And the challenge with exponential growth is everything looks ok until suddenly it doesn't and so this is something that has to be agreed. concern of everyone that's been watching this.
So if you look at places like Arizona, the hospitals now are getting pressed midweek, there was a report out of Arizona that about 40% of the hospital beds were filled with COVID patients, Texas and Florida still reporting a lot of capacity, even though Florida doesn't report the total hospitalizations for COVID patients. But these things can mount very quickly, as we saw in New York, you're always when when the Epidemics expanding, it's always worse than what you're measuring. And so there are a lot more cases in these states that are gonna get turned over this coming week. Given the rate of growth that we've seen, we know that there's community spread now underway in states like Florida, Texas, California, for that matter to Arizona, those are big states that have a lot of cases that have been building and so this is going to be hard to get under control. We're not going to want to shut down businesses, again, we're not going to want to shut down the economy. So there's not many tools we can reach for we can do case based interventions, the trends In the tracing of sick people, to get people isolated, we can go towards universal masking something has been controversial in some of these states, but there's not much else you can do. And so there's no quick intervention that's going to bring this to an end.
I think they're going to have to the masking has become controversial. It shouldn't be. It's a simple intervention. It's a collective action we can all take to help protect our fellow citizens and also protect ourselves and try to reopen the economy safely. I think some people see it as a sort of infringement on their liberty or as a weight as to cast some scorn on a public health establishment that's come in for some questions because people blame the public health establishment for the shutdowns. They blame the public health establishment for some conflicting guidance. I think in other quarters, it's been portrayed as something that you have to Trump supporters don't want to wear masks. It's neither of those things. It's something that we can do collectively to try to reduce the spread. It's really all we have. And it's not it's not a very robust tool at that. But it's a tool that we have. And it's a tool that's been demonstrated to have an impact if everyone does it, or if most people do it.
Some of the cases that we're collecting are because we're testing more, but the positivity rates also going up in states like Texas, where it's about 8%, Florida about 8%, Arizona, almost 20%, we've seen the positivity rates go up. That's a clear indication there's now community spread underway. This isn't just a function of testing more. So some of it is testing we're we're probably capturing right now, somewhere between one and five to one in 10 infections. Before during the epidemic, we were probably measuring one in 10 to one in 20 infections. So we're capturing a higher percentage of the overall infections, but the infections are also going up. So this is an epidemic that's expanding in the States. And the challenges there's not a clear endpoint, we're becoming more and more different. pending upon a therapeutic intervention early in the fall to be our backstop, because we're taking a lot of virus through this summer, we really shouldn't be where we are in June right now, it's not clear what's going to improve the picture in July and August, if we're not going to start to impose additional mitigation, start closing bars and restaurants. And states aren't going to want to do that. They're going to be slow to do that. And so these case counts are going to build."
Source:
Commentary: Increased cases isn't just more testing. The spread of the disease is accelerating in the United States at the same time that compliance for the two things people can do to slow the spread of the disease is falling. The outcome is clear and unambiguous: more lives will be lost or irreparably harmed by COVID-19.
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An excellent writeup in NEJM about how to help employees return to work safely, for those that must. "The current pandemic poses challenges — unprecedented in the modern developed economy of the United States — for a broad range of workplaces, businesses, and institutions. All are struggling in their activities and on their premises to prevent transmission of a dangerous, highly infectious airborne pathogen. The foundations of employer and institutional prevention are relatively inexpensive personal protective equipment whose use is taught and monitored; basic administrative controls such as segmenting the workforce, reducing density, and mandating self-deferral from work for those who feel ill; and environmental controls such as the use of physical barriers and the careful management of air exchange and filtration. Testing, at present, is most effectively used for accurate assessment and follow-up of contacts, whereas the use of contact-tracing apps and mandatory screening by means of molecular, antibody, or antigen tests currently appears to be more complicated, less efficient, and less effective than more traditional public health measures."
Source: https://www.nejm.org/doi/full/10.1056/NEJMsr2019953
Commentary: There are certainly many positions that require a physical presence in order to accomplish work. However, there are just as many positions that do not require physical presence at all. It is the height of irresponsibility to require workers be physically present without absolute need right now. If your company has managers who are uncomfortable managing virtually or need to stuff people in conference rooms for hours at a time to justify their paychecks, you don't have a pandemic problem - you have a bad employee problem. The past four months have demonstrated that for many office jobs, physical presence is unnecessary. Take the opportunity to modernize instead of going backwards. Your company will save money, help climate change, and open up to a global talent pool that isn't location-restricted.
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Tocilizumab also may benefit severe cases of COVID-19. "In this retrospective cohort study, treatment of severe COVID–19 patients with a single intravenous infusion of low–dose tocilizumab (8 mg/kg up to 400 mg) resulted in favorable outcomes such as shorter time to clinical improvement, shorter duration of invasive ventilation, and shorter duration of vasopressor support compared to a control group. These findings require cautious interpretation because a statistically significant difference was seen only for the duration of vasopressor support."
Source: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30162-0/fulltext
Commentary: What's emerging now are the therapeutics that Dr. Fauci told us all about in March, right on the 3-6 month timeframe. Companies are identifying therapeutic drugs that may blunt the impact of COVID-19, and that's a wonderful thing. If we can eventually reduce COVID-19 to that of what it was originally compared to - a severe flu - then we reduce fatalities, burdens on hospital systems, and other obvious side effects. Let's hope we see therapeutics that mitigate some of the lung damage that seems to come with more severe cases as well - if we crack that nut, we can make COVID-19 just another disease we have to live with, like the flu and common cold.
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Concerns about immunity arise from a Chinese study. "Levels of an antibody found in recovered COVID-19 patients fell sharply in 2-3 months after infection for both symptomatic and asymptomatic patients, according to a Chinese study, raising questions about the length of any immunity against the novel coronavirus."
Source: https://www.reuters.com/article/us-health-coronavirus-antibody/antibody-levels-in-recovered-covid-19-patients-decline-quickly-research-idUSKBN23T1CJ
Source: https://www.nature.com/articles/s41591-020-0965-6
Commentary: There's still more we need to learn about the disease; this research underscores the importance of therapeutics. If a vaccine could potentially be rendered less helpful, then an array of therapeutics to mitigate the damage becomes all that more important.
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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.
2. Wear gloves and a mask when out of your home. Consider wearing a face shield if you can't breathe at all through a mask.
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.
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.