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.
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A really long thread, reprinted in full, that's worth reading. "Throughout the pandemic, we've gotten used to the idea that most #COVID cases are "mild." The CDC says mild cases account for 80% of symptomatic infections.
Some people hear this and think it's not worth worrying about. Are they right?
A thread on what "mild" really means. (1)
In common language, the word mild usually describes something of minor importance. For example: health and medical websites often describe the cold as a "mild viral illness."
The implication is that while you may feel crummy, it really isn't a big deal 🍪 (2)
In the case of #COVID, this isn't quite right. Here the common definition of mild and the medical definition differ significantly.
Their confusion is a failure of communication. People are quick to underestimate the disease. They've taken "mild" as a synonym for unimportant. (3)
It was never meant to be. The term came from the first outbreak in China where #COVID emerged 😷
Doctors, effectively in a public health triage situation, defined as "mild" all cases that did not require hospitalization | pubmed.ncbi.nlm.nih.gov/32064853/ (4)
This reduced the vast majority of cases to a single word.
The label was created before we knew much about the disease. In fact, it came months before the CDC even finalized its list of symptoms.
You can imagine why it's current use, knowing as much as we do, is misleading. (5)
But it was used poorly then too. After all, mild is an adjective and cannot be read on its own.
The disease SARS-CoV-2 starts with "Severe Acute" 😱
When you say someone has mild #COVID, you are literally saying they have mild SEVERE ACUTE disease. It's an oxymoron. (6)
The full phrase is more honest, if inconvenient. Technically anything can be mild. For instance...
You can get MILD ebola | cidrap.umn.edu/news-perspecti…
You can have a MILD heart attack | health.clevelandclinic.org/what-is-a-mild…
And mild covid includes "MILD pneumonia" 😮💨 (7)
My point in saying this is: doctors don't use mild the same way we do.
Unfortunately, the science-free definition is now in circulation and people think it's not worth getting vaccinated.
Especially young people who are told as a demographic: "for you, the disease is mild!" (8)
When someone tells you that, they are technically saying: "For you, the disease will lie anywhere on a broad spectrum short of hospitalization and death 😊"
This is why it is important to critically examine language. Some words obscure FAR more than they reveal. (9)
The way to counteract this is to return to the data. What exactly is included in the term mild #COVID?
Here are FOUR True Facts about the condition. (10)
1⃣ Mild actually means Mild + Moderate.
Like any disease, symptomatic #COVID19 is a spectrum. Our language divides it imprecisely: 81% mild, 15% severe, and 4% critical.
As you can imagine, that 81% contains contains a lot of variety. One thing missing are "moderate" cases (11)
Mild and moderate #COVID aren't the same thing. Just look. Here are the typical symptoms of mild COVID: cough, low fever, lost taste or smell, fatigue and aches, feeling down.
Here are common symptoms of MODERATE #COVID19: breathlessness, sore throat + persistent cough that keeps you up, diarrhea (for days), bronchiolitis, fatigue to the point of neglecting self-care, not wanting to eat or get out of bed. Lasts 1-2 weeks | patient.info/news-and-featu… (13)
Whilst the majority of people experience a mild or asymptomatic coronavirus infection, some people will have far more serious and even life-threatening symptoms and complications.
Again, these are clearly not the same thing. But because people say mild and not moderate our impression is skewed towards the former.
What proportion are actually moderate? The truth is that there isn't a fine distinction. Many people will have symptoms in both categories. (14)
I emphasize how miserable moderate #COVID can be. Here is just one symptom of note...
In a sample of mild cases w/ digestive symptoms, 57% had diarrhea that lasted for an average of 5.4 days with 4 bowel movements per day. Many had ongoing fever 🧻 | ncbi.nlm.nih.gov/pmc/articles/P… (15)
The symptoms alone, however, are not the only thing that can make life suck. This bring us to our next fact.
2⃣ Mild #COVID is often a lengthy disease.
In February 2020, WHO director @DrTedros announced in a speech that the average recovery time for mild cases is two weeks (16)
This has held up over time. If anything changed, it's that we now know how long #COVID19 can impact the body.
Even after 2 week, many people struggle to recover.
That's because the illness has two parts:
1) lowering your viral load and 📉
2) recovering from immune response (17)
Part one takes about a week, and packs a nasty punch.
#SARSCoV2 acts on the ACE2, a receptor found in lung, gut, heart, and other tissue. This means the virus can cause damage to multiple organ systems.
We'll soon see that even one week of this may cause lasting damage 💥 (18)
Part two also takes about one week, but many cases go longer.
This is because the inflammation caused by the immune response can be severe. Pneumonia is a common outcome 🫁
Yet even the wear and tear of mild disease has been shown to sometimes cause months of suffering (19).
Two studies from the CDC illustrate this well.
1) Researchers surveyed 292 people. Among adults aged 18-34 without prior health conditions, those who had become ill still felt unwell after 2-3 weeks | cdc.gov/mmwr/volumes/6…
Mild illness seems to have hurt the body (20)
2) Researchers reviewed 3171 mild cases. 66% of patients saw a doctor and received a new diagnosis within 6 months, often related to #COVID (eg cough). 33% of patients saw a new specialist in the same period | cdc.gov/mmwr/volumes/7…
This suggests health problems may linger (21)
If this is surprising, we are still thinking mild. Mild illness seems at worst unpleasant.
Viruses are worse than that. Novel viruses can and do maim human bodies. That's why outbreaks of acute illness are followed by outbreaks of chronic illness. | science.org/news/2020/07/b… (22)
People fail to anticipate this, for two reasons. The first is that we assume disease is natural and so something the body can overcome.
In reality, viral evolution in a global world can be random, cruel, and deadly. Its effects are as "natural" as natural disasters 🌪️ (23)
Even flu can have severe side-effects: myocarditis, encephalitis, multi-organ inflammation, and sepsis, among others.
We know #COVID19 engages more of the body, and more thoroughly than influenza. This increases the chance of such effects | open.spotify.com/episode/4eFb5W… (24)
The second reason we see #COVID as an event and not a process is that we are too focused on mortality (death) and not morbidity, or living with illness.
This is a point which deserves its own consideration. It is the single largest failing of the word mild. (25)
3⃣ Mild COVID can cause long-term disability.
From the start of the pandemic, it would have been reasonable to ask whether #SARSCoV2 would lead to disability.
We have evidence to suggest that the original SARS lead not only to physical but terrible psychiatric problems. (26)
One study of 233 survivors found 40% were suffering from mental illness 3.5 years later | jamanetwork.com/journals/jamai…
27% of them the CDC's criteria for Chronic Fatigue Syndrome: a deadening disease where even basic activities can cause extreme fatigue 😨 (27)
While #COVID19 seems to cause less extreme energy problems, we are seeing a similar kind of syndrome known as #LongCovid (LC)
The most common long-term effect of #COVID in adults is fatigue. People also report brain fog and issues with attention | nature.com/articles/s4159… (28)
These problems cause disability, which is a robust indicator of unhappiness.
Princeton Economists Anne Case and Angus Deaton put it simply: “Not being able to spend time with friends, go out for a meal, go to a ballgame, or just hang out all shrink and impoverish lives.” (29)
I can attest. As someone who lives with pulmonary disability, specifically pulmonary hypertension, I've found my own world has shrunk ⬇️
Last month I left a great job early because I was so tired and at-capacity. That's just one example of how it has affected me (30)
Mind you, I am an endurance athlete (3X 50-Mile Runner). But it doesn't matter: illness isn't always about how tough you are.
I wouldn't wish this kind of disability on anyone. And while I mean LC, #COVID19 may also cause pulmonary hypertension | ncbi.nlm.nih.gov/pmc/articles/P… (31)
The sad fact is that #LongCovid is relatively common. The UK government says that one million of their citizens are living with it | ons.gov.uk/peoplepopulati…
A striking study from Norway also found that 52% of adults 16-30 had issues 6 mo. later | nature.com/articles/s4159… (32)
Why is this happening to people, even after mild illness? We don't know which means we can't predict who is vulnerable.
Remember: #COVID19 is unpredictable because it is a NOVEL virus. We cannot just assume it is something the body will naturally and completely overcome. (33)
Our incomplete understanding provides the final reason to avoid mild #COVID.
4⃣ We don't know the long-term effects of the disease.
One reason people refuse to get #vaccinated is because they fear the "long-term effects." It seems no one told them about the virus itself... (34)
Take concerns over myocarditis. Myocarditis from the disease is a phenomenon of unknown scale. Surveys have often found high rates.
In one study of 1597 Big Ten athletes, .3% had symptomatic myocarditis after infection and 2.3% had it asymptomatic | jamanetwork.com/journals/jamac… (35)
We have not done enough research to know the actual prevalence, but this rate appear to be many times higher than from the mRNA vaccine.
It's concerning because viral myocarditis is a cause of sudden death in young athletes and servicemen | jamanetwork.com/journals/jamac… (36)
For #COVID19 the significance of myocarditis is unknown. Doctors called it a "gray-zone cardiac finding."
Dr. Eike Nagel, an expert in experimental heart imaging, says we may "see an increased incidence of heart failure in a couple of years" 💔 (37)
He continues "But we don't have the data."
This point is 🗝️: to learn about the natural course of a disease, you have to monitor it over time. Effects can occur years later.
We detect them through careful study, and the cumulative operation of multiple reporting systems. (38)
For #COVID19 (new) we have no idea what they might be.
Maybe it will be ⬆️ rates of dementia. We are now finding changes to brain tissue | med.stanford.edu/news/all-news/…
Maybe it will be ⬆️ rates of IBS. Viral RNA often shows up in stool 1+ month later | ncbi.nlm.nih.gov/pmc/articles/P… (39)
Maybe it will be more heart attacks. Maybe nothing! No one can say for sure.
The point is: if you are concerned about long-term effects, focus on the virus. The mRNA vaccine - which contains only the code for a small portion of said virus - is clearly a better option ⚖️ (40).
Even if you get a breakthrough infection, the symptoms pass more quickly and are less severe.
You are 1/2 as likely to have a fever, less likely to cough, and will on average spend 60% fewer days in bed | npr.org/sections/healt…
That all suggests less potential for harm 🛡️ (41)
Better to protect yourself now than wait. The delta variant has been a global game-changer. We know it is MUCH more infectious, shedding 1000x viral particles.
Some data published in the Lancet also suggest it doubles hospitalization rates 🏥 | thelancet.com/journals/lanin… (42)
When you get it, you RISK 2 weeks of uncomfortable illness, disability, and potential long-term side effects.
Will these things happen to you? Probably not! Maybe you'll be asymptomatic.
The question is: why would you even take that chance when millions have fallen victim? (43)
For many people, the answer is that they aren't afraid of mild disease. Yet we come to believe #COVID is mild by relying on rhetoric, not science.
Let's do better. Strength comes not in downplaying threats, but in using evidence to avert their impact (44)
Those whose only concern is hospitalization and death are missing the big picture.
I am of the belief, one thoroughly grounded in evidence, that epidemic illness is itself worth avoiding.
We will never achieve this goal if we consistently underestimate the disease (45 - END)."
Source:
Commentary: The bottom line is that a vaccine makes the disease sometimes avoidable and almost always less serious. Get it done, and get everyone around you vaccinated.
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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. 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 permitted.
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.
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.