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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"Multiple COVID-19 vaccines are currently in phase 3 trials with efficacy assessed as prevention of virologically confirmed disease.4 WHO recommends that successful vaccines should show disease risk reduction of at least 50%, with 95% CI that true vaccine efficacy exceeds 30%.5 However, the impact of these COVID-19 vaccines on infection and thus transmission is not being assessed. Even if vaccines were able to confer protection from disease, they might not reduce transmission similarly.
Challenge studies in vaccinated primates showed reductions in pathology, symptoms, and viral load in the lower respiratory tract,6, 7 but failed to elicit sterilising immunity in the upper airways. Sterilising immunity in the upper airways has been claimed for one vaccine, but peer-reviewed publication of these data are awaited.8 There have been reports of virologically confirmed SARS-CoV-2 re-infection of previously infected individuals, but the extent of such re-infection is unclear.9 Whether re-infection is associated with secondary spread is unknown.
These observations suggest that we cannot assume COVID-19 vaccines, even if shown to be effective in reducing severity of disease, will reduce virus transmission to a comparable degree. The notion that COVID-19-vaccine-induced population immunity will allow a return to pre-COVID-19 “normalcy” might be based on illusory assumptions.
Policy makers must be vigilant of the possible impact of vaccine hesitancy.21 In the COVID-19 response, the activities of some politicians have been incompatible with science and risk further eroding vaccine confidence among the general public. The potential disruption of a proportion of people declining vaccine uptake could be substantial. The likely heterogeneity of such abreactions to vaccination roll-outs between countries and across partisan divides within nations should not be underestimated. Finally, if international travel were to fully recommence, vaccine allocation to different countries with varying means of access will require careful deliberation, based on moral grounds and because no country will be truly protected from COVID-19 until virtually the entire world is."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31976-0/fulltext
Commentary: It is likely that vaccination will be mandatory in order to travel internationally. It is also likely that the vaccine will not be a magical silver bullet; the fact that we are unsure of its efficacy against stopping transmission means that "wear a mask" may need to be a perpetual cultural phenomenon from now on - especially if there's a chance that vaccinated individuals can still transmit.
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Malaria risks double. "Using an established set of spatiotemporal Bayesian geostatistical models, we generated geospatial estimates across malaria-endemic African countries of the clinical case incidence and mortality of malaria, incorporating an updated database of parasite rate surveys, insecticide-treated net (ITN) coverage, and effective treatment rates. We established a baseline estimate for the anticipated malaria burden in Africa in the absence of COVID-19-related disruptions, and repeated the analysis for nine hypothetical scenarios in which effective treatment with an antimalarial drug and distribution of ITNs (both through routine channels and mass campaigns) were reduced to varying extents.
Under pessimistic scenarios, COVID-19-related disruption to malaria control in Africa could almost double malaria mortality in 2020, and potentially lead to even greater increases in subsequent years. To avoid a reversal of two decades of progress against malaria, averting this public health disaster must remain an integrated priority alongside the response to COVID-19."
Source: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30700-3/fulltext
Commentary: Many medical conditions have received less attention and less effort during the pandemic. While this was understandable in the first six months, as we got our feet under us, the reality is that we need to begin rebalancing so that other diseases do not resurge.
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A study of antibodies. "Anti–SARS-CoV-2 antibodies to the spike protein, which have correlated with neutralizing antibodies,5 decreased over 60 days in health care personnel, with 58% of seropositive individuals becoming seronegative. The consistency in decline in the signal-to-threshold ratio regardless of the baseline ratio and a higher proportion of asymptomatic participants becoming seronegative support the interpretation as a true decline over a 2-month period rather than an artifact of assay performance. If replicated, these results suggest that cross-sectional seroprevalence studies to evaluate population immunity may underestimate rates of prior infections because antibodies may only be transiently detectable following infection.
The window after recovering from SARS-CoV-2 infection when people could donate serum that has sufficiently high antibody levels may be limited. Implications for health care personnel with antibodies assigned to care for infected patients depend on whether decline in these antibodies increases risk of reinfection and disease, which remains unknown, especially given the lack of data on memory B-cell and T-cell responses.6 Limitations of this study include its single-center setting, small sample size, convenience sampling, and lack of information on timing of infection to evaluate antibody kinetics."
Source: https://jamanetwork.com/journals/jama/fullarticle/2770928
Commentary: The fact that 58% of individuals testing no longer had detectable antibodies is concerning; it might be a major contributor to why convalescent plasma has been shown to be ineffective. More important, it keeps open the question of just how long immunity to COVID-19 lasts. We're not sure. Based on this study, it is POSSIBLE that it doesn't mast very long - not even two months. But without further clinical studies, no one can provably say for sure.
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An interesting in vitro study of povidone-iodine. " In this controlled in vitro laboratory research study, test media infected with SARS-CoV-2 demonstrated complete inactivation of SARS-CoV-2 by concentrations of PVP-I nasal antiseptic as low as 0.5% after 15 seconds of contact, as measured by a log reduction value of greater than 3 log10 of the 50% cell culture infectious dose of the virus.
Intranasal PVP-I rapidly inactivates SARS-CoV-2 and may play an adjunctive role in mitigating viral transmission beyond personal protective equipment.
Povidone-iodine nasal antiseptics at concentrations (0.5%, 1.25%, and 2.5%) completely inactivated SARS-CoV-2 within 15 seconds of contact as measured by log reduction value of greater than 3 log10 of the 50% cell culture infectious dose of the virus. The ethanol, 70%, positive control did not completely inactivate SARS-CoV-2 after 15 seconds of contact. The nasal antiseptics tested performed better than the standard positive control routinely used for in vitro assessment of anti–SARS-CoV-2 agents at a contact time of 15 seconds. No cytotoxic effects on cells were observed after contact with each of the nasal antiseptics tested.
Povidone-iodine nasal antiseptic solutions at concentrations as low as 0.5% rapidly inactivate SARS-CoV-2 at contact times as short as 15 seconds. Intranasal use of PVP-I has demonstrated safety at concentrations of 1.25% and below and may play an adjunctive role in mitigating viral transmission beyond personal protective equipment."
Source: https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2770785
Commentary: For patients and healthcare providers in high-risk situations, spraying povidone-iodine intranasally may reduce risk of contracting COVID-19 further. Note that the study has not been testing on actual people, only in a laboratory, and is specifically indicated for medical care. That said, I'd wait for an actual clinical trial before running out and getting a whole bunch, though having a bottle on hand in the house isn't a bad thing. It's useful in many other circumstances, like scraped knees.
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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 or injected.
2. Always wear a mask when out of your home and if going to a high risk area, wear goggles. Respirators are back in stock at online retailers, too.
3. 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.
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.