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.
You are welcome to share this.
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We have reached a new, horrifying peak in the United States. For the first time, every state in the Union is in uncontrolled spread.
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AstraZeneca vaccine showing efficacy. "AstraZeneca said on Monday its COVID-19 vaccine could be around 90% effective, giving the world’s fight against the global pandemic a new weapon, cheaper to make, easier to distribute and faster to scale-up than rivals.
The British drugmaker said it will have as many as 200 million doses by the end of 2020, around four times as many as U.S. competitor Pfizer.
Seven hundred million doses could be ready globally as soon as the end of the first quarter of 2021.
“This means we have a vaccine for the world,” said Andrew Pollard, director of the Oxford University vaccine group that developed the drug.
The vaccine was 90% effective in preventing COVID-19 when it was administered as a half dose followed by a full dose at least a month later, according to data from late-stage trials in Britain and Brazil. No serious safety events were confirmed, the company said.
The vaccine’s cost to governments works out at just a few dollars a shot, a fraction of the price of shots from Pfizer and Moderna, which use a more unconventional technology.
It can also be transported and stored at normal fridge temperatures, which proponents say would make it easier to distribute, especially in poor countries, than Pfizer’s, which needs to be shipped and stored at -70C."
Source: https://uk.reuters.com/article/uk-health-coronavirus-astrazeneca-idUKKBN2830HH
Commentary: This is the third vaccine candidate showing efficacy, and is excellent news for the world. Based on how quickly AstraZeneca can produce it, we may be able to get clear of COVID-19 by the autumn of 2021 and do things like eat in restaurants safely by then.
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Dr. Fauci on vaccines and the current situation. "But there were there are a couple of things that go into the effectiveness of a vaccine program, a highly efficacious vaccine, and we're there we have two of them that have a 95% efficacy. The other part of the equation is how many people get vaccinated. So if you have a highly efficacious vaccine, and only a relatively small 40 50% of the people get vaccinated, you're not going to get the herd immunity you need what we do need is we need to get as many people as possible, vaccinated. And that's why we want to be very transparent for people to understand the independent and transparent process. that got us to the point of saying which the FDA will examine it very carefully now, together with advisory committees that are completely independent, and declare with an EU way and ultimately a license that the vaccines are safe and effective. When the American public hears that, you should be assured that that is the case. And if you get an overwhelming majority of the people vaccinated with a highly efficacious vaccine, we can reasonably quickly get to the herd immunity that would be a blanket of protection for the country.
One of the things we're really concerned about is that as we get into This Thanksgiving season, you're not going to see an increase until weeks later things lag. So what you don't want to see is another spike in cases as we get colder and colder into the December, and then you start dealing with the Christmas holiday, we can really be in a very difficult situation. So you want to tell people to please seriously consider decisions that you make. And it also means Margaret, another important thing, it's one of the things that we didn't fully realize that one of the spots, if you want to call them, where you have a risk is seemingly innocent family friends get together indoors, I mean, seems like the most natural thing. So that's the reason why when we tell people consider that people that you want to get into your own family unit, you want to bring a large number of people with a big dinner party social event. And when you're eating and drinking, obviously, you have to take your mask off. We know now that those are the kinds of situations that are leading to outbreaks"
Source:
Commentary: Here will be the biggest obstacle to ending COVID-19: getting people to take the vaccine. What you don't want is the Kitty Genovese effect where everyone assumes someone else is doing their part and you don't have to. There's a real possibility of that.
In the meantime, plan on canceling Christmas travel/in person interactions. It's going to be bad this winter.
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CVS CEO Larry Marlowe on vaccine rollout. "And, you know, our first involvement in terms of administering the vaccine will be in long term care facilities. That is not anything that is new for us, our pharmacists, our nursing professionals have gone to skilled nursing facilities, assisted living facilities for several years now conducting seasonal flu clinics. So we have the systems we have the processes, we have built the logistics directly for the COVID vaccine. And we just received information within the last few days that more than 25,000 long term care facilities have selected CVS to be their COVID vaccine provider. So we're in the final step of matching our staffing plan to our logistics plan. And, to your point, operation warp speed has said 24 hours after approval, those vaccines will be on the road and 48 hours after we receive that vaccine, we'll be in those facilities, providing that vaccine into the arms of our elderly, our most vulnerable population."
Source:
Commentary: This is excellent news for those in long term care facilities, one of the most vulnerable populations.
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Dr. Scott Gottlieb. "Well, look, this supply is going to be limited in 2020. As we get into 2021, there'll be much more supply and I think by the second quarter of 2021, maybe into the third quarter, we'll have a vaccine that hopefully will be licensed for general use if everything goes well. And the data continues to support the safety and effectiveness of that vaccine. And we'll be able to vaccinate the public or a good portion of the public heading into the fall of 2021. I think 2021 is going to be a much different year with COVID. With the combination the vaccine and other therapeutics, the therapeutic antibodies that will be in wider supply in 2021, what we really need to get through is the next two or three months. And what I would say the American people is there's light at the end of the tunnel right now. Try not to be the person who gets infected in the last two or three months of the acute phase of this pandemic, we've protected ourselves for nine months, we have two or three months to go before we have technological solutions are going to dramatically lower the risk, we need to just get through a very difficult period right now.
Well, the problem is that the progress isn't going to be widely accessible over the course of time that we're going to be getting through the acute phase of this pandemic. And really, the worst phase of this pandemic, what's going to happen over the next four, six weeks is largely baked in and this spread is going to be so diffused around the country that the federal government's not going to be able to backstop local regions who are going to be facing very unprecedented situations, you know, there will be therapeutics available and vaccination available, probably to help on the tail end of what we're going to go through. But we're going to have to go through this the old fashioned way, we're going to have to, you know, hunker down, reduce our interactions wear masks more aggressively higher quality masks, right now to contextualize this for the individual. The prevalence is about 1.5%. That means if you're in a restaurant with 50 people, there's a 50% chance nationally that someone has COVID in that restaurant. In North Dakota, where infection rates are higher. If you're in a group of 10 people, there's a 50% chance is somewhere in that group of 10 people has COVID. That's the kind of risk we're facing individually right now. And that's only going to get worse.""
Source:
Commentary: Instead of a multi-year war, we could be done with COVID-19 by this time next year, as long as everyone does their part between now and then. Stay home, stay safe, and know that you can probably pencil in Thanksgiving and Christmas 2021 in person as long as we all do our part between now and then.
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Why the death rate will be worse in the third surge.
"A full hospital means that everyone waits. COVID-19 patients who are going downhill must wait to enter a packed intensive-care unit. Patients who cannot breathe must wait for the many minutes it takes for a nurse elsewhere in the hospital to remove cumbersome protective gear, run over, and don the gear again. On Tuesday, one rapidly deteriorating patient needed to be intubated, but the assembled doctors had to wait, because the anesthesiologists were all busy intubating four other patients in an ICU and a few more in an emergency room.
None of the people I spoke with would predict when UNMC will finally hit its capacity ceiling, partly because they’re doing everything to avoid that scenario, and partly because it’s so grim as to be almost unthinkable. But “we’re rapidly approaching that point,” Hewlett said.
When it arrives, people with COVID-19 will die not just because of the virus, but because the hospital will have nowhere to put them and no one to help them. Doctors will have to decide who to put on a ventilator or a dialysis machine. They’ll have to choose whether to abandon entire groups of patients who can’t get help elsewhere. While cities like New York and Boston have many big hospitals that can care for advanced strokes, failing hearts that need mechanical support, and transplanted organs, “in this region, we’re it,” Johnson says. “We provide care that can’t be provided at any other hospital for a 200-mile radius. We’re going to need to decide if we continue to offer that care, or if we admit every single COVID-19 patient who comes through our door.”
But COVID-19 works slowly. It takes several days for infected people to show symptoms, a dozen more for newly diagnosed cases to wend their way to hospitals, and even more for the sickest of patients to die. These lags mean that the pandemic’s near-term future is always set, baked in by the choices of the past. It means that Ricketts is already too late to stop whatever UNMC will face in the coming weeks (but not too late to spare the hospital further grief next month). It means that some of the people who get infected over Thanksgiving will struggle to enter packed hospitals by the middle of December, and be in the ground by Christmas."
Source: https://www.theatlantic.com/health/archive/2020/11/americas-best-prepared-hospital-nearly-overwhelmed/617156/
Commentary: This is the common refrain: a hospital can add more beds, but it cannot add more staff. The fact that one of the leading hospitals in the nation for infectious diseases has reached a point of care rationing should be greatly concerning to everyone.
Here's what you must do for the next 8 weeks: avoid anything risky that could put you in the hospital - because wherever you live, there may not be space.
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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.
6. Participate in your local political process. For Americans, go to Vote.org and register/verify your vote.
7. Ventilate your home as frequently as weather and circumstances permit.
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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.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.