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.
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Before we get to the weekend circuit, the big news is a documented case of reinfection. For the details, we turn to Dr. Akiko Iwasaki.
"A first case of #COVID19 reinfection from HKU, with distinct virus genome sequences in 1st and 2nd infection (142 days apart). Kudos to the scientists for this study.
This is no cause for alarm - this is a textbook example of how immunity should work.
1) Second infection was asymptomatic. While immunity was not enough to block reinfection, it protected the person from disease. (2/n)
2) Patient had no detectable antibody at the time of reinfection but developed detectable antibody after reinfection. This is encouraging. (3/n)
3) Since reinfection can occur, herd immunity by natural infection is unlikely to eliminate #SARSCoV2. The only safe and effective way to achieve herd immunity is through vaccination. (4/n)
Lastly, while this is a good example of how primary infection can prevent disease from subsequent infection, more studies are needed to understand the range of outcomes from reinfection. (end)"
Source:
Commentary: Dr. Iwasaki is one of the planet's leading experts on immunobiology, so take it from her that the reinfection itself and how the body's immune system challenged it isn't something to panic about. But do take note of her second to last point: there is no such thing as herd immunity without a vaccine.
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A roundup of colleges. "partying students have inflamed viral outbreaks, fuming administrators and campus anxiety. We also have a lot of older faculty and staff, and we're all vulnerable. Dozens of schools already have reversed plans. They switched undergraduates to all virtual classrooms and offered a course in consequences. Syracuse suspended 23 partiers Purdue 36 St. Olaf in Minnesota 17. North Carolina State University has had multiple COVID clusters. But human nature is always the X Factor, and fingers crossed is a poor Cova defense students have blamed administrators for poor planning Notre Dame 372 people have tested positive. But America's Heartland has more COVID troubles rising cases in 12 states including North Dakota, Wyoming, Kansas and Missouri, South Dakota's average daily case loads are up 58%."
Source:
Commentary: Asking students not to get together and party is like asking the sky not to rain. It's in defiance of basic natural tendencies, coupled with the belief that younger people will have less severe outcomes. The reality is that any kind of indoor gathering poses higher risks to everyone; colleges are slowly figuring this out as case counts spike. Expect many to revert to virtual in the next couple of weeks.
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University of Arizona president Robert Robbins. "I think we all know that we can control things in the classroom and on campus and in the Student Union and not having large gatherings of people on campus and official venues. The problem is, what I've seen is that others, such as Kansas, even Arizona State, other universities, Purdue, have gone aggressively off campus to try to break up large gatherings and parties, and that's where most of the transmission has occurred.
we've got a face covering policy. We're anticipating that Some people who refuse to cover their face because of their expression of their individuality and freedom. But that is going to be that'll go through the Dean of students and code of conduct. And yes, they can be expelled.
When we can't mitigate and handle if we get overwhelmed with cases where we can't don't have enough room for isolation, our hospitals are starting to get a capacity or over capacity where we can't surge into ICU use and if someone were to get really sick, so we're going to be watching the numbers every day. And if we run out of isolation beds and we can't handle it and people are getting really ill, then they will pull the plug."
Source:
Commentary: Only 5,000 of the more than 45,000 students that attend the University of Arizona live on campus. Breaking up large gatherings off campus is a Sisyphean task; I doubt they will be successful.
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An excellent paper on the false dichotomies of the pandemic. "Amid the coronavirus disease 2019 (COVID-19) pandemic, a myriad of logical fallacies and cognitive biases have interfered with the understanding of the nuances and communication of evidence-based guidance. In particular, multiple false dilemmas have run rampant across social media with the pitfalls of black-or-white messaging and reductionist frameworks. In this article, we thoughtfully review the evidence around five COVID-19-related false dichotomies: 1) health and lives vs economy and livelihoods, 2) indefinite lockdown vs unlimited reopening, 3) symptomatic vs asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 4) droplet vsaerosol transmission of SARS-CoV-2, and 5) masks for all vs no masking. While we acknowledge that there is not one unequivocal answer, we make a call for comprehensive messaging and science-informed tailored policies that reckon with gray shades, uncertainties, and social contexts."
Source: https://osf.io/k2d84/
Commentary: The entire paper is a worthwhile, thought-provoking read by experts in the field. There's enough ambiguity in every situation that there are no proven absolutes when it comes to the pandemic. Personally, I would have preferred stronger language on some of the dichotomies in favor of erring on the side of caution, but that's my own opinion.
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Is COVID-19 growing less lethal? In a word, no. "Recent reports have suggested that Covid-19 has become markedly less lethal in the United States. Our analysis of death rates and infection fatality rates from Arizona, the U.S. as a whole, and New York City shows it isn’t, indicating that public health measures to reduce infections should not be relaxed.
Given progress in the diagnosis and treatment of Covid-19, why has there been no apparent improvement in the infection fatality rate? The two main possibilities are that the improvements that have been made in treating Covid-19 are not enough to make a detectable difference in the infection fatality rate, or that a large fraction of those who die of Covid-19 do not get to the hospital in time for successful treatment. We were, unfortunately, unable to find the fatality rate of patients who were hospitalized. Such data would help distinguish between these possibilities.
We recommend that all states implement procedures to track the ratio of deaths to hospitalizations, as well as implement random testing studies to accurately track infection fatality rates. Without this vital information, our ability to improve the health infrastructure to treat Covid-19 is handcuffed and may well lead to deaths that could otherwise have been prevented."
Source: https://www.statnews.com/2020/08/24/infection-fatality-rate-shows-covid-19-isnt-getting-less-deadly/
Commentary:
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Dr. Scott Gottlieb on the FDA: "I served in that agency three times twice under President Bush and once as the commissioner for two years under President Trump. And when it comes to regulatory decision making in that agency, it's a foundational truth that will guide that agency of science. And in deeply see the sense of public health mission that permeates that agency. It's a part of the esprit de corps of the staff of that agency. And I know that they know the urgency of the moment, they put out 60 guidance documents to find new ways to bring products to the market more quickly. There are 750 drugs under mid or late stages of clinical development clinical trials right now. So I firmly reject the idea that they would slow up anything or accelerate anything for that matter, based on any kind of political consideration and any consideration other than what's best for the public health and a real sense of mission to patients.
But I will tell you and I sit on the board of Pfizer, one of the two US companies for this long and developing a vaccine, the vaccine trials have have enrolled very fast Madura and Pfizer, the two us manufacturers who are the furthest ahead and rolled 25,000 patients into those trials in the four weeks that those trials have been stood up and they've really only been enrolling in earnest for three weeks. That's extraordinary. So to say that these products aren't moving at really historic pace, I think is wrong. The there were delays, or perceived delays in bringing plasma. authorizing plasma under an emergency use authorization was reported this week that NIH had misgivings about FDA going forward with that authorization. But there's reasons people have Have some questions about that the trial that that's going to be based on 70,000 patients wasn't a very rigorously done trial. It was an open label study where everyone got treated. So it's hard to draw conclusions. "
Source:
Commentary: Despite ramblings and conspiracy theories from politicians, progress on therapeutics and vaccines continues to proceed at a record-setting pace. The convalescent plasma trial reported recently continues to be investigated, but the benefits, to the extent there are any, are probably weak compared to other interventions like dexamethasone.
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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. 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.