Lunchtime Pandemic Reading, 22-June-2021

Mix and match

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.

You are welcome to share this.

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When it comes to rolling out treatments in a new situation, what's the best strategy? "Vaccine allocation decisions during the ongoing COVID-19 pandemic have proven to be challenging due to competing ethical, practical, and political considerations. Complicating decision making, policy makers need to consider vaccine allocation strategies that balance needs both within and between populations. Due to limited vaccine stockpiles, vaccine doses should be allocated in locations where their impact will be maximized. Using a susceptible-exposed-infectious-recovered (SEIR) model we examine optimal SARS-CoV-2 vaccine allocation decisions across two populations considering the impact of population size, underlying immunity, continuous vaccine roll-out, and heterogeneous population risk structure. We find that in the context of an emerging pathogen, where many epidemiologic characteristics might not be known, equal vaccine allocation between populations performs optimally in most scenarios. In the specific case considering heterogeneous population risk structure, first targeting individuals at higher risk of transmission or death due to infection leads to equitable resource allocation across populations."

Source: https://www.medrxiv.org/content/10.1101/2021.06.18.21259137v1

Commentary: This is an interesting pre-print paper, done by credible researchers, about what strategy to puruse when you have a bucket of unknowns. Their paper shows that equally distributing vaccines, instead of specific distributions to subgroups, creates an overall better outcome. This makes logical sense; in a situation where you have a lot of unknowns, unequal distributions may be like putting out the fire in the wrong locations.

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More evidence for mix and match. "“Two different vaccines may be more potent than either vaccine alone,” says Dan Barouch of Beth Israel Deaconess Medical Center, who helped develop the one-dose COVID-19 vaccine made by Johnson & Johnson. It and the two-dose AstraZeneca vaccine use a nonreplicating adenovirus as a “vector” to introduce DNA coding for the spike protein of SARS-CoV-2 into the recipient’s cells. Vaccines from Pfizer-BioNTech and Moderna instead use messenger RNA (mRNA) coding for spike, which cells take up and use to make the protein.

Mixing the two types of vaccine may give the immune system multiple ways to recognize a pathogen. “The mRNA vaccines are really, really good at inducing antibody responses, and the vector-based vaccines are better at triggering T cell responses,” Sander says. Matthew Snape, a vaccine expert at the University of Oxford, agrees the combination vaccine results so far are promising but cautions they don’t resolve whether any improvement in T cell response results from longer dose intervals rather than the mixing."

Source: https://www.sciencemag.org/news/2021/06/mixing-covid-19-vaccines-appears-boost-immune-responses

Commentary: If we can continue to generate strong immune responses from mix and match, that may be the needed booster strategy to bring into the fall, while virologists formulate the next generation of vaccines. If we can maintain enough supply, it may make it harder for variants like Delta to gain a foothold.

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Delta is growing rapidly in unvaccinated areas. "Some states — particularly those in the South — are at much higher risk for bad coronavirus outbreaks not only due to low vaccination rates, but also because their populations were more vulnerable to begin with.

"The Delta variant accounts for a rapidly rising proportion of US cases, and that proportion will continue to grow and could cause clusters and outbreaks, particularly in areas of the country and in demographic groups that have lower vaccination rates," tweeted former CDC director Tom Frieden.

Arguably, people who live in these areas would benefit most from vaccination, as they're at highest risk.

But that's not what's happening. Instead, some of the most vulnerable states in the country — like Alabama, Mississippi and Georgia — have some of the country's lowest vaccination rates, according to an analysis by Surgo Ventures."

Source: https://www.axios.com/coronavirus-vaccines-vulnerability-states-outbreaks-variants-b418fe6d-31f6-4790-9d79-bd7c4d747dd3.html

Commentary: Remember where we were this time last year? In the USA, we were just headed into our second wave, and mainstream media pundits were saying that summer weather would suppress the virus. We know now that it didn't. Only vaccination suppresses the virus.

If regions go into fall and winter weather with a significant part of their population unvaccinated, those regions will have serious outbreaks. AS new variants evolve, those regions will be hotspots, and it's not inconceivable to think that we will see further segregation of rich and poor regions because of their ability to inability to manage the virus going forward.

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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 other people, 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. 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 gettings an mRNA single shot booster (Pfizer/Moderna).

3. Wash/sanitize your hands every time you are in or out of your home.

4. Stay home 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.

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 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.