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 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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Monkeypox does live for a long time. "Viral aerosols can have a major impact on public health and on the dynamics of infection. Once aerosolized, viruses are subjected to various stress factors and their integrity and potential of infectivity can be altered. Empirical characterization is needed in order to predict more accurately the fate of these bioaerosols both for short term and long term suspension in the air. Here the susceptibility to aerosolization of the monkeypox virus (MPXV), associated with emerging zoonotic diseases, was studied using a 10.7 liter rotating chamber. This chamber was built to fit inside a Class three biological safety cabinet, specifically for studying airborne biosafety level three (BSL3) microorganisms. Airborne viruses were detected by culture and quantitative polymerase chain reaction (qPCR) after up to 90 hours of aging. Viral concentrations detected dropped by two logs for culture analysis and by one log for qPCR analysis within the first 18 hours of aging; viral concentrations were stable between 18 and 90 hours, suggesting a potential for the MPXV to retain infectivity in aerosols for more than 90 hours. The rotating chamber used in this study maintained viral particles airborne successfully for prolonged periods and could be used to study the susceptibility of other BSL3 microorganisms."
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556235/
Commentary: Let's have a quick discussion about monkeypox since it's in the news, even though it's totally unrelated to SARS-CoV-2. First, a few facts. Pox viruses tend to transmit by fomites - particles you pick up on your skin and then introduce into mucosal membranes - i.e. putting your hands in your nose or mouth. Even though the article above was an aerosol test, that's not how diseases like monkeypox and smallpox transmit most of the time. It's not out of the question, but it’s not as bad as COVID.
Monkeypox and related viruses are substantially more deadly than COVID, about 5-10x deadlier.
Now, here's the good news. Everything you're already doing to control COVID from a non-pharmaceutical perspective also controls monkeypox. In fact, it's even more effective. As a virus, SARS-CoV-2 is between 60-140 nanometers in size, under 1 micron. It's why you have to wear an N95 or better mask - it's tiny and can sneak through cloth masks really well. Monkeypox is between 200-300 nanometers. It's a much larger particle, so masks trap it even better. And in general it's substantially less infectious. SARS-CoV-2, especially the new Omicron strains, are WILDLY infectious. They are and should be your primary concern, and the threat you should be actively countering.
So between wearing an N95 or better mask indoors in places other than your home and washing your hands (and keeping them out of your nose and mouth), you're pretty much covered for both COVID and monkeypox. No need to panic - just carry on the great habits you're already doing.
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More Long COVID evidence. " I wanted to share a story of a patient I saw this week. Very fit man aged 52, previous marathon runner, suspected mild #COVID19 March 2020. Extensively investigated by cardiology in 2020 for symptoms of chest pain, dizziness and struggling to exercise 1/
Cardiac MR showed some fibrosis suggestive of previous myocarditis, but all other Ix were normal. By November 2021 he was back to running 15km, but very slow improvement. Dec 2021 had booster followed by COVID re-infection over a couple of weeks (again mild symptoms) 2/
After this he developed similar symptoms to 2020, dizziness on walking up stairs, chest pain (anginal sounding). We did his spirometry and gas transfer - completely normal. On the 1 minute sit-to-stand he desaturated to 92%, HR increased from 49 to 110 and he became quite SOB 3/
Put him through the CT scanner, CTPA was negative for PEs but showed some possible right heart strain. I discussed this with some colleagues and given the desaturation we decided to perform a VQ scan. This showed extensive clots 4/
He had been referred to Resp as non-urgent. It was a chance discussion that the appointment was expedited. He was walking around with PEs and RH strain! I am really concerned about the number of people with 'mild COVID' out there who may have undiagnosed thromboembolic disease 5/
causing non-specific chest pain and SOB. This chap's symptoms were not alarming, in fact he thought it was all a bit of a fuss about nothing 6/
This paper is a multi-national report of over 900,000 people indicating propensity of risk for arterial and venous thrombi is in men, with increasing age, and association with fatalities (4-fold in non-hospitalized) https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00223-7/fulltext 7/
We also know that beyond the first 30d after infection, individuals with COVID-19 are at increased risk of cardiovascular disease spanning several categories, even in the non-hospitalised 8/
There is mounting evidence that COVID19 is a pro-thrombotic, vascular/endothelial disease. The question is, are the tests we are currently doing in #LongCOVID clinics good enough? If CTPA and lung function are normal, should we be looking harder? Do people have access to VQ? 9/
On a microvascular level there is evidence of abnormal clotting and platelet hyperactivation. Why is it that the 'knowns' are not translating into treatment options? We know that dual anti platelet therapy & anticoagulation are effective in preventing vascular events 10/
In the absence of any other treatment, why are we not prescribing these drugs to people with #LongCOVID? With monitoring / risk benefit discussion of course. RCTs are not the only type of evidence. Real-world studies could be set up quickly via LC clinics 11/
Surely we should be thinking about primary prevention of 'known' vascular and thrombotic complications? I worry for the people out there with #LongCOVID. The lucky ones will have access to the best care and treatment, but how many others don't? END/
(Everything shared in this thread is with express permission from the patient.)"
Source:
Commentary: Long COVID is shaping up to be a much bigger, more serious public health issue as time goes on and we find out more about what the disease does to us. Keep it out of your body as much as you can.
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Nasal boosters could be a nice bolster. "Vaccines are a cornerstone in COVID-19 pandemic management. Here, we compare immune responses to and preclinical efficacy of the mRNA vaccine BNT162b2, an adenovirus-vectored spike vaccine, and the live-attenuated-virus vaccine candidate sCPD9 after single and double vaccination in Syrian hamsters. All regimens containing sCPD9 showed superior efficacy. The robust immunity elicited by sCPD9 was evident in a wide range of immune parameters after challenge with heterologous SARS-CoV-2 including rapid viral clearance, reduced tissue damage, fast differentiation of pre-plasmablasts, strong systemic and mucosal humoral responses, and rapid recall of memory T cells from lung tissue. Our results demonstrate that use of live-attenuated vaccines may offer advantages over available COVID-19 vaccines, specifically when applied as booster, and may provide a solution for containment of the COVID-19 pandemic."
Source: https://www.biorxiv.org/content/10.1101/2022.05.16.492138v1
Commentary: It makes sense now to be looking at inactivated virus versions of COVID vaccines. The virus is evolving quickly and the mRNA vaccines do a great job of shutting down death and serious illness. But they're not stopping transmission and they haven't been updated in 2 years.
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Omicron's excess mortality is bigger than Delta's. "More all-cause excess mortality occurred in Massachusetts during the first 8 weeks of the Omicron period than during the entire 23-week Delta period. Although numerically there were more excess deaths in older age groups, there was excess mortality in all adult age groups, as recorded in earlier waves, including in younger age groups.5,6 Moreover, the ratio of observed to expected all-cause deaths was similar in all age groups, and increased during the Omicron period compared with the Delta period."
Source: https://jamanetwork.com/journals/jama/article-abstract/2792738
Commentary: This article introduces the concept of the mortality product - severity of illness times transmissibility. Even if Omicron were "milder", because it's so much more transmissible, it puts more people in hospitals or worse.
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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. 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. Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
3. Get vaccinated as soon as you're able to, and fulfill the full vaccine regimen, including boosters. Remember that you are not vaccinated until everyone you live with is vaccinated. 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 than any vaccine is better than no vaccine.
4. Wash/sanitize your hands every time you are in or out of your home.
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 the 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 pandemic gives 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 a rapid antigen test. This will detect COVID-19 only when you're contagious, so follow the directions clearly. https://amzn.to/3fLAoor
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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.