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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Enormous parts of Brazil are at 100% ICU capacity. "“Things are desperate,” said Hermeto Paschoalick, the head of critical care unit in the midwestern state of Mato Grosso do Sul where such facilities were this week 93% full.
Paschoalick, who works at a public hospital in the city of Dourados, said he had seen his team members shed tears of exhaustion and despair as they battled to cope with the cascade of patients. On Tuesday his 20-bed unit had one free bed – and requests to admit 22 critically ill Covid patients.
“It’s terrifying,” the doctor said, pointing to an even more dramatic situation in Ponta Porã, a town 75 miles down the road on the Paraguayan border, where a hospital with 30 Covid ICU beds was intubating an average of 10 patients a day.
In the state capital, Campo Grande, things were worse still. “I was told yesterday that there’s a health clinic there with 20 ambulances parked outside. The patients are arriving from small towns in the interior and there’s nowhere to put them – so they just keep them in the ambulances,” Paschoalick said. One private hospital had closed its doors because even its casualty department was packed with Covid patients on ventilators.
Danilo Maksud, a cardiologist from São Paulo, said Brazil’s richest and most populous state – where ICUs were 89% full with more than 11,000 Covid patients – was in similarly dire straits. “It’s not chaos – we’re well beyond chaos,” admitted the 39-year-old physician who said all 20 of his ICU beds were occupied after a month-long surge in admissions.
Maksud suggested a “complete lockdown” was probably the only way to stop the virus’s rampage, although Bolsonaro has resisted that idea, apparently fearful of the impact it might have on the economy and his hopes of re-election next year. With 212 million citizens, Brazil is home to 2.7% of the world’s population but has suffered more than 10% of its Covid deaths."
Source: https://www.theguardian.com/world/2021/mar/19/brazil-coronavirus-intensive-care-unit-capacity
Commentary: With the P.1 variant running rampant, Brazil's only hopes are lockdown and vaccination.
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The AstraZeneca vaccine has 79% efficacy against symptomatic COVID-19, and 100% efficacy against severe COVID-19. "AstraZeneca said Monday that the Covid-19 vaccine it developed with the University of Oxford reduced both mild and serious forms of the disease, paving the way for a likely U.S. authorization of the vaccine.
Doctors, regulators, and government officials the world over are likely to breathe a sigh of relief at the results, which are better than expected and appear materially higher than those in previous studies.
The two-dose vaccine reduced symptomatic disease by 79%, the company said in a press release, and reduced severe Covid-19 and hospitalization by 100%. AstraZeneca said that the vaccine was equally effective in people over 65, where it had 80% efficacy.
The company said the study identified no new safety concerns. A specific review found no risk of blood clots, worries about which led many European nations to pause their vaccine rollouts last week. The European Medicines Agency said last week the vaccine’s benefits outweighed its risks. The study also did not see a specific type of clot in blood vessels near the brain that the EMA said might be associated with the vaccine. However, this type of clot, called a cerebral venous sinus thrombosis, is so rare it might not be expected to occur in even a large clinical trial.
Even before AstraZeneca’s involvement, researchers at Oxford University had an ambitious goal: to create a vaccine that could be available to large swaths of the global population. The shot they designed is less expensive than other vaccines, and easier to manufacture and distribute. Unlike the Pfizer and Moderna shots, which must be kept very cold, it can be stored for six months at between 2 to 8 degrees Celsius and administered without on-site preparation.
The two-dose AstraZeneca vaccine, like the one-dose vaccine developed by Johnson & Johnson, uses a modified common cold virus, known as an adenovirus, to ferry genetic code for a key component of the SARS-CoV-2 virus known as the spike protein into recipients’ cells. The cells make this protein, which is then recognized as foreign by the immune system. The result is that the recipient becomes protected against the virus."
Source: https://www.statnews.com/2021/03/22/astrazenecas-covid-19-vaccine-shows-better-than-expected-efficacy-in-u-s-trial/
Commentary: This is good news, as the AstraZeneca vaccine is the one most likely to be distributed to poorer countries. 100% protection against severe COVID-19 is what the entire world needs, and the mRNA vaccines have too many logistical issues to go to places without as much infrastructure. To summarize, we now have:
- Pfizer mRNA - 2 shots, cold storage required
- Moderna mRNA - 2 shots, cold storage required
- J&J - 1 shot, normal refrigeration
- AstraZeneca - 2 shots, normal refrigeration
- Novovax - 2 shots, normal refrigeration
- Sinovac - 2 shots, normal refrigeration
- Gamaleya - 2 shots, normal refrigeration
Of these, the first three are approved for usage in the US and EU; AstraZeneca is conditionally approved for the EU but paused while they investigate the rare cases of thrombosis.
Lots of vaccines in market is a very good thing, especially since all approved vaccines have high efficacy. Why? If everyone got just one kind of vaccine, a viral mutation could nullify it. With so many different choices, consumers are getting a heterogenous mix of vaccines, and that will make mutating to evade vaccines more difficult for the virus. In time, of course, it will, and our vaccines will adapt as well, but this is generally good news.
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World first: mix and match study underway. "The world’s first COVID-19 vaccine study researching alternating doses of two approved vaccines - alongside different dosing intervals, begins today at eight research sites across England.
The National Institute for Health Research (NIHR) supported study, referred to as the COVID-19 Heterologous Prime Boost study, or ‘Com-Cov’, will determine the effects of using a different approved vaccine for the second dose to the first dose, in addition to examining the efficacy of two different time intervals between doses.
Over 800 volunteers, aged 50-years-old and above, are expected to take part in the study at eight sites across England - including in Oxford, London, Birmingham, Liverpool, Nottingham, Bristol and Southampton.
Professor Andrew Ustianowski, NIHR Clinical Lead for COVID-19 Vaccination Programme and Joint National Infection Specialty Lead, said: “This is another exciting step forward in finding a variety of vaccine options for the UK and globally, for which the NIHR is integral to ensuring the participant recruitment for this study and the gaining of robust data on safety and effectiveness.
"We need people from all backgrounds to take part in this trial, so that we can ensure we have vaccine options suitable for all. Signing up to volunteer for vaccine studies is quick and easy via the NHS COVID-19 Vaccine Research Registry."
Researchers will gather immunological evidence on different intervals between the first and second dose for a mixed-vaccine regimen against control groups when the same vaccine is used for both doses.
A same-dose regimen is currently implemented for the national COVID-19 vaccination programme, and there are no current plans for this to change. Anyone who has received either the Pfizer or AstraZeneca vaccination as part of the UK-wide delivery plan will not be affected by this study. They will receive their second dose from the same source and over the same 12 week interval."
Source: https://www.nihr.ac.uk/news/worlds-first-covid-19-vaccine-alternating-dose-study-launches-in-uk/26773
Commentary: This is a vitally important study, because up until now we've said different vaccines cannot be mixed. This study will hopefully conclude that it's both safe and effective to do so - and that might create even more difficult conditions for the virus to mutate against, because it would have to mutate to evade multiple different kinds of defenses. We'll be watching this study with great interest.
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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.