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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We continue to learn more about SARS-CoV-2. In this paper on super-spreading events, the more we learn how exactly it spreads, the faster we can come up with countermeasures that are most effective. "While SSEs are fueling this outbreak, we have an opportunity to take advantage of this heterogeneity in transmission, and use it to risk-stratify populations and locations for public health interventions and interrupt future SSEs. Novel methods are needed to quickly predict, identify, or isolate individuals / hotspots with the potential for causing SSEs. It may prove difficult to identify and isolate individuals with the potential for causing SSEs and infectious individuals still transmit. This is compounded with the sizeable proportion of pre-symptomatic, as well as asymptomatic or minimally symptomatic individuals who can actively transmit60–63. If SSE predictors cannot be identified, then every infectious individual has the opportunity to cause a SSE if exposed to sizable susceptible populations. Therefore, it is crucial to understand types of hotspots and patterns of transmission for each type, as interventions might have to focus on all hotspots at high risk for SSEs and limiting gatherings at these places, and/or through rapid-and-extensive testing and contact tracing (both traditional and digital) to identify pre-symptomatic and asymptomatic people64. Contact tracing efforts should have an explicit goal to understand types of transmission and hotspots, so that the characterization of transmission could be used to adapt and prioritize other recommendations such as masks and mass gatherings. Further, it thus remains important to be cautious in reopening populations undergoing cordons sanitaires until transmission routes in different types of hotspots are well understood, or when safe and effective COVID-19 treatments and vaccines are available."
Source: https://covid.idmod.org/data/Stochasticity_heterogeneity_transmission_dynamics_SARS-CoV-2.pdf
This paper does a good job of shedding light on the fact that SARS-CoV-2 does not spread in a linear fashion. That's important - understanding that some people are mega-spreaders and others aren't means that if we can get ill people tested and isolated quickly, we can shut this thing down.
Imagine a campfire throwing sparks randomly. Now imagine that some sparks land in piles of dry leaves while others land on rocks or sand. Right now, we're distancing, which is the equivalent of putting wet towels over everything. It works, right? But it makes it hard to sit around and enjoy the campfire because everything is covered by wet blankets.
If we could catch all the sparks instead, we wouldn't need wet blankets everywhere and the potential for fire would be much lower. That's what vast testing is all about - catching the sparks.
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A first vaccine trial is underway in China in humans. "This first-in-human trial showed that the Ad5 vectored COVID-19 vaccine was tolerable and immunogenic in healthy adults. One dose of the vaccine at all dose concentrations (5 × 1010, 1 × 1011, and 1·5 × 1011 viral particles) tested induced both specific antibody and T-cell responses in most participants. Rapid specific T-cell responses were noted at day 14 and specific humoral responses against severe acute respiratory syndrome coronavirus 2 peaked at day 28 post-vaccination. Although we found that the high dose vaccine tended to be more immunogenic than the middle dose and low dose vaccines, it was also associated with a higher reactogenicity. Severe fever, fatigue, dyspnoea, muscle pain, and joint pain were reported in some of the recipients in the high dose group."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31208-3/fulltext
It's important to note that this appears to be a phase 1 trial, which is "did it harm patients?" So far the answer seems to be no, and now it can move on to the next of 4 phases. In no way is this even close to ready for prime-time, BUT it is a good step forward. Many other vaccine candidates are still in modeling or animal testing.
China appears to be leading the way here, and with their government's commitment to release their research as a public good, if they reach a working vaccine first, then everyone with scientific capabilities will be able to replicate it all over the world. Let's hope their progress continues unabated and unimpeded.
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A brand new study on hydroxychloroquine, the largest ever, also shows that it's harmful and ineffective. "In the absence of reported randomised trials, there is an urgent need to evaluate real-world evidence related to outcomes with the use of hydroxychloroquine or chloroquine (used with or without macrolides) in COVID-19. Using an international, observational registry across six continents, we assessed 96 032 patients with COVID-19, of whom 14 888 were treated with hydroxychloroquine, chloroquine, or their combination with a macrolide. After controlling for age, sex, race or ethnicity, underlying comorbidities, and disease severity at baseline, the use of all four regimens was associated with an increased hazard for de-novo ventricular arrythmia and death in hospital. This study provides real-world evidence on the use of these therapeutic regimens by including a large number of patients from across the world. Thus, to our knowledge, these findings provide the most comprehensive evidence of the use of hydroxychloroquine and chloroquine (with or without a macrolide) for treatment of COVID-19. We found no evidence of benefit of hydroxychloroquine or chloroquine when used either alone or with a macrolide. Previous evidence was derived from either small anecdotal studies or inconclusive small randomised trials. Our study included a large number of patients across multiple geographic regions and provides the most robust real-world evidence to date on the usefulness of these treatment regimens. Although observational studies cannot fully account for unmeasured confounding factors, our findings suggest not only an absence of therapeutic benefit but also potential harm with the use of hydroxychloroquine or chloroquine drug regimens (with or without a macrolide) in hospitalised patients with COVID-19."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext
No benefit and documented harm.
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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.
3. Stay home as much as possible. Minimize your contact with others and maintain physical distance of at LEAST 6 feet / 2 meters.
4. Get your personal finances in order now. Cut all unnecessary costs.
5. Donate any PPE you can. https://getusppe.org/give/
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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/
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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.