Lunchtime pandemic reading.
Standard disclaimer: this is a roundup of informative pieces I've read that interest me on the severity of the crises and how to manage them. I am not a qualified medical expert in ANY sense; at best I am reasonably well-read laity. ALWAYS prioritize advice from a qualified healthcare provider who knows your specific medical situation over advice from people on the Internet.
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 are now dealing with three public health crises: COVID (which hasn't gone away), monkeypox, and now a resurgence of polio. In all cases, preventative measures like washing your hands/using sanitizer, wearing the best mask available to you, and ensuring your vaccinations are up to date will keep you safe at minimal inconvenience.
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Incubation is getting faster. "In this systematic review and meta-analysis of 141 articles, the pooled incubation period was 6.57 days. The incubation periods of COVID-19 caused by the Alpha, Beta, Delta, and Omicron variants were 5.00, 4.50, 4.41, and 3.42 days, respectively.
The findings of this study suggest that SARS-CoV-2 has evolved and mutated continuously throughout the COVID-19 pandemic, producing variants with different enhanced transmission and virulence. Identifying the incubation period of different variants is a key factor in determining the isolation period."
Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795489
Commentary: A faster incubation period means less time for you to detect something's up. This is why rapid testing is so important to do regularly and frequently in any high risk situation. A faster incubation period means you can go from negative to positive (contagious) VERY quickly.
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Polio remains a threat. "The case of a young adult paralyzed by polio in New York is not simply unexpected. It’s shocking. The last time polio was diagnosed in New York State was in 1990. And yet the virus has now also been found in wastewater samples in Rockland County, Orange County and New York City. As surveillance continues, we will learn more, but what we know already is enough. We have circulating poliovirus that can cause paralysis in these communities. Polio in New York today is an imminent threat.
Unlike Covid-19, polio is not a novel disease. Once a source of terror in summer months, the virus seemed headed to the history books. Successful vaccination campaigns in the 1950s meant wild poliovirus was declared eliminated in the United States in 1979 and from the Americas in 1994.
In a conversation, my colleague and friend Jane Cardosa, a Malaysian virologist, calmly noted, “In our part of the world, one case of paralytic polio is an outbreak.” The case in New York State is no fluke, freak accident or government conspiracy. And it’s not surprising that we have had just one person develop paralysis. Many are unaware that about 70 percent of people who contract polio have no symptoms. About 25 percent of people infected experience symptoms that are mild or flu-like — headache, fatigue, fever, stiffness, muscle pain, nausea, a sore throat — all of which could be mistaken for many other illnesses. Fewer than 1 percent of infected individuals develop paralysis. Of those paralyzed, 2 to 10 percent die when their breathing muscles become immobilized. On this virus, we simply cannot play the odds."
Source: https://www.nytimes.com/2022/08/21/opinion/even-a-single-case-of-polio-is-a-threat.html
Commentary: Polio shouldn't be a problem right now, but it is, thanks largely to unvaccinated and anti-vaccine folks. The danger is the same with polio as it has been with COVID: the more chances at bat it has, the more it can mutate to evade our existing vaccines and immunities.
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Long COVID hits different. "The condition of long COVID, also known as post-acute sequelae of SARS CoV-2 infection, is rife with mysteries. While its incidence among adults who have been infected has been estimated at 5% to 40%, a recent study that tracked symptoms before infections and compared participants to controls has given us one of the best snapshots to date. It indicated that 1 in 8 people who have had COVID experience prolonged symptoms over many months.
With vaccinations and different variants, the incidence may be lower, but even if it were half as many (6% of adults who have been infected), and we assume two-thirds of adults have had COVID, that would equate to more than 10 million Americans who have endured persistent symptoms that interfere with their daily life activities, frequently impairing their ability to return to work.
One of the mysteries: As opposed to those most likely to get severe COVID, the vast majority of people affected by long COVID are younger (30 to 50 years old) and previously healthy. The typical symptoms include marked fatigue, exercise intolerance, difficulty breathing, brain fog, muscle pain and weakness, chest pain, headaches and fast heart rate. While the list of troubling symptoms is long, the number of proven therapies is very short — zero."
Source: https://www.latimes.com/opinion/story/2022-08-21/long-covid-treatment-research
Commentary: This is why masking and ventilation are so vital. Long COVID is different than COVID and it's debilitating to many who have it. The only prevention for it right now is keeping COVID out of your body, period.
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Monkeypox risks for schools. "The experts Inverse spoke with were somewhat split about how bad outbreaks in schools could become.
Norman Beatty, an Assistant Professor of Medicine at the University of Florida College of Medicine, and infectious disease specialist, tells Inverse, “Monkeypox could easily spread among children at daycare or within a school system. This is a valid concern.”
Hotez is not currently too worried about outbreaks in schools — yet.
“Transmission occurs through fairly prolonged, close, intimate contact. If kids were going to be a major population affected, I would expect to see more household transmission to kids than we’re currently seeing,” he says. “If the force of infection goes up and we start seeing hundreds of thousands of cases, then weird stuff starts to happen. But right now, I'm not projecting a big impact on the pediatric population.”
Creech says that what we do now will determine how many kids are ultimately affected.
“We are early in the outbreak,” he says. “If we can continue to limit spread among those that appear to be at highest risk, we can reduce the burden of disease in the community. By reducing overall case counts, we protect our kids.”
One measure Creech thinks would be especially useful in this area is “educating individuals about what pox lesions look like…they are distinct from other childhood rashes.”"
Source: https://www.inverse.com/mind-body/kids-monkeypox-schools-what-parents-need-to-know
Commentary: I would argue, having raised kids and watched kids interact, that the risk of monkeypox among children, especially young children, is higher than some folks are probably imagining. When you watch a toddler just walking around licking other people... yeah. That qualifies as prolonged, close contact.
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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 people you don't live with, even after you've been vaccinated. P100 respirators are back in stock at online retailers, too and start around US$40 for a reusable respirator. 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. Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
3. Get vaccinated as soon as you're eligible to, and fulfill the full vaccine regimen, including boosters. Remember that you are not vaccinated until everyone you live with is vaccinated. For COVID, if you received an adenovirus vaccine (J&J/AstraZeneca), consider getting an mRNA single shot booster (Pfizer/Moderna) if available. If it's available, choose Moderna as your first choice for both vaccine and booster, Pfizer as your second choice. However, remember that any vaccine is better than no vaccine.
4. Wash/sanitize your hands every time you are in or out of your home. Sanitize the bottom of your shoes with a simple peroxide spray using ordinary drugstore/supermarket peroxide in a spray bottle. If you've come in close contact with others (rubbing or brushing up against them, hugging, etc.) consider showering and washing your clothes as well.
5. Stay out of indoor spaces that aren't your home and away from people you don't live with as much as practical. Minimize your contact with others and avoid indoor places as much as you can; indoor spaces spread disease through aerosols and distance is less effective at mitigating your risks.
6. Aim to have 3-6 months of living expenses on hand in case the pandemics give another crazy plot twist to the economy, or you know, a global war breaks out.
7. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
8. 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).
9. Masks must fit properly to work. Here's how to properly fit a mask:
10. If you think you may have been exposed to COVID-19, purchase several rapid antigen tests and/or acquire them from your healthcare provider or government. This will detect COVID-19 only when you're contagious, so follow the directions clearly. https://amzn.to/3fLAoor
If you think you may have been exposed to monkeypox, contact your healthcare provider about available testing.
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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 or monkeypox. 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 or monkeypox, nor do I financially benefit in any way from sharing information about COVID-19 or monkeypox.
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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.