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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Misinformation is having deadly consequences all over the world. "Walking door to door through the crowded streets of a slum neighborhood in Port-au-Prince, Haitian community leader Reynald Jean is on the front line of efforts to bust entrenched and lethal myths about the coronavirus.
One is that hospital patients are being given a deadly injection to increase the number of COVID-19 deaths so that the government can attract more international aid.
Another myth is that hospitals are testing a vaccine for the coronavirus on patients without their knowledge.
"In the community, people think of COVID-19 as a political matter," said Jean, 45, who heads a local youth group.
False rumours about COVID-19 injections have also had a knock-on effect on other routine vaccinations, Lamarque said.
Vaccination rates among children and newborn babies in public hospitals across Haiti were 50% lower in May than they were last year, she said.
"This is extremely worrying because we may have a gap in vaccination and ... we really risk having another outbreak in the country - measles, diphtheria," said Lamarque.
"This potentially is a time bomb."
Fears about the coronavirus fuelled by misinformation have also led to more pregnant women choosing to give birth at home.
There has been a 75% decline in the number of women giving birth in public hospitals across Haiti in May this year compared with the same month last year, Lamarque said.
"We know this could have an impact on maternal mortality deaths," she said."
Source: https://www.weforum.org/agenda/2020/08/in-haiti-community-leaders-go-door-to-door-to-bust-deadly-coronavirus-myths/
Commentary: Misinformation has been identified by WHO as just as big a problem as the disease itself. We all have an obligation to fight misinformation wherever we find it. When you're on various social networks, if you see a piece of content that is promoting obviously false information, report it. Don't assume an algorithm or another user will do it - take a stand against false information and report, report, report.
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Suppression of case counts in prison. "Inmates at the Yuma prison say they were threatened with violence and ordered by prison officials to refuse COVID-19 testing to keep outbreak numbers artificially low.
The Arizona Department of Corrections recently began conducting mass testing of all inmates across the entire state prison system, resulting in a rapid increase of COVID-19 positive cases being reported.
But before testing was scheduled to begin at the Yuma prison, inmates there say prison administrators and staff, working with informal inmate leaders called “Heads,” led a campaign of threats and intimidation to keep the rest of the inmates from submitting to the mandatory nasal swabs.
Stephanie Hale-Perry’s husband is incarcerated at the Yuma prison. She says he called her with concerns when the testing was first announced.
“The inmate leaders in his yard said that all inmates were to refuse the test, otherwise they were going to get a beat-down,” Hale-Perry said. She said the threats came after inmate Heads met with the deputy warden, correctional officers, and members of the special services investigation unit at the Yuma prison.
Two correctional officers who work at Yuma confirmed to KJZZ the meeting took place. Neither would identify themselves publicly out of fear of retaliation. One of the officers said they believed the administration was encouraging the inmate Heads to get the rest of the inmates to refuse testing, so there would be fewer positive results, and the prison yards could be reopened sooner.
“The prison administrators told the Heads ‘make sure the people in your building or in your run don’t get tested,’” Hale-Perry said. “They were threatened with getting beat up. They used violence and other threats as the scare tactic to prevent the testing from happening.”"
Source: https://kjzz.org/content/1611602/yuma-inmates-allege-prison-officials-ordered-them-refuse-covid-19-testing-keep
Commentary: Suppression of case numbers doesn't change the disease - and the impact will be seen in excess death numbers anyway. Those officials falsifying data or suppressing it should lose their jobs at a minimum and face criminal charges for willful neglect and dereliction of duty. Even if you don't care about the health of incarcerated people, the communities surrounding them are made more vulnerable anytime you have a reservoir of disease, like burning embers ready to begin a new blaze.
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Don't drink bleach. "Gov. Brian Kemp’s office said Monday that the state Department of Public Health has received reports that people are using diluted chlorine dioxide to “treat” COVID-19.
“Chlorine dioxide is a bleach-like cleaning agent and, if ingested, can have severe, adverse health effects, including death,” Kemp’s office said in a press release.
Chlorine dioxide products have not been shown to be safe and effective for any use. The governor’s office said products are being marketed under various names: Aqueous Chlorine Dioxide, CDS, Master Mineral Solution, Miracle Mineral Solution, MSS, Water Purification Solution and others."
Source: https://www.ajc.com/politics/georgia-public-health-officials-say-some-are-drinking-bleach-like-cleaners-to-fight-covid-19/URQAM7I6JZDWRCZYI3NMJCSFZI/
Source: https://dfw.cbslocal.com/2020/08/24/almost-50-north-texans-drank-bleach-this-month-poison-center-warns-stop-it-wont-cure-covid/
Commentary: I still can't believe six months into this pandemic we're having to tell people not to drink bleach or bleach-like products. After a certain point I have to question whether it's worth the effort or not.
Don't drink any cleaners, period. Ever.
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A potentially useful test to identify patients early on at high risk. "A subset of patients with severe COVID-19 develop a hyperinflammatory syndrome, which might contribute to morbidity and mortality. This study explores a specific phenotype of COVID-19-associated hyperinflammation (COV-HI), and its associations with escalation of respiratory support and survival.
We included 269 patients admitted to one of the study hospitals between March 1 and March 31, 2020, among whom 178 (66%) were eligible for escalation of respiratory support and 91 (34%) patients were not eligible. Of the whole cohort, 90 (33%) patients met the COV-HI criteria at admission. Despite having a younger median age and lower median Charlson Comorbidity Index scores, a higher proportion of patients with COV-HI on admission died during follow-up (36 [40%] of 90 patients) compared with the patients without COV-HI on admission (46 [26%] of 179). Among the 178 patients who were eligible for full respiratory support, 65 (37%) met the definition for COV-HI at admission, and 67 (74%) of the 90 patients whose respiratory care was escalated met the criteria by the day of escalation. Meeting the COV-HI criteria was significantly associated with the risk of next-day escalation of respiratory support or death (hazard ratio 2·24 [95% CI 1·62–2·87]) after adjustment for age, sex, and comorbidity.
Associations between elevated inflammatory markers, escalation of respiratory support, and survival in people with COVID-19 indicate the existence of a high-risk inflammatory phenotype. COV-HI might be useful to stratify patient groups in trial design."
Source: https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30275-7/fulltext
Commentary: Testing early on for markers of susceptibility to hyperinflammatory syndrome could be life-saving for patients. Hopefully we can develop rapid testing on patient intake to detect it and provide therapeutics in advance, warding off hyperinflammatory syndrome, rather than reacting to it.
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Contact tracing becomes challenging under lax lockdown conditions. "To support efforts to control COVID-19, contact tracing must be implemented alongside prompt and extensive community case detection, and a high proportion of contacts must be reached. Similar to other models,5,6 our estimates imply that contact tracing could support partial relaxation of physical distancing measures but not a full return to levels of contact before lockdown.
The benefits of contact tracing depend substantially on adherence to isolation and quarantine among individuals who are traced, which could be enhanced through policy measures such as voluntary out-of-home accommodations, income replacement, and social supports. Prompt testing, diagnosis, and notification of individuals with infection are needed to ensure that contacts can be traced and quarantined early enough to prevent transmission. Testing contacts without symptoms could improve program benefits by identifying new cases to trace and potentially improving quarantine adherence."
Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2769618
Commentary: The more locked down an area is, the easier it is to do contact tracing and suppress an outbreak. This remains true; as new cases spread, locking down part of a region is a good strategy if accompanied by strong contact tracing to put out the fire. It's analagous to digging defensive lines around a fire to keep it from spreading while firefighters put out the existing flames.
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The perfect storm. "However, the ensuing 5½ months have shown that coronavirus disease 2019 (COVID-19) is far deadlier and less predictable than seasonal influenza. Unlike influenza, COVID-19 does not appear to be seasonal, given the ever-increasing numbers of US cases this summer.
So beginning this fall, the US for the first time will have to deal with a flu season wrapped in a global pandemic. Or, as the headline on a recent editorial by Edward Belongia, MD, and Michael Osterholm, PhD, MPH, described it, “a perfect storm.”
Many questions remain about how flu season might affect the pandemic, and vice versa. For example, would coinfection with influenza worsen the course of COVID-19? Experts also aren’t certain whether influenza vaccination could help protect against COVID-19 or whether steps taken to mitigate COVID-19 will reduce the burden of the coming flu season.
The corticosteroid dexamethasone, appears to be effective in some patients hospitalized with COVID-19, but it could harm those who instead have influenza. A recent preliminary report found that dexamethasone resulted in a lower 28-day mortality rate among patients hospitalized with COVID-19 who were receiving respiratory support. However, in 2019 clinical practice guidelines, the Infectious Diseases Society of America (IDSA) specifically advised against using corticosteroids to treat seasonal influenza unless clinically indicated for other reasons, such as asthma. Data from randomized controlled trials of corticosteroid treatment of influenza aren’t available, but 2 meta-analyses of observational studies suggested that corticosteroid treatment of patients hospitalized with influenza was associated with increased mortality, according to IDSA.
The best-case explanation for the southern hemisphere’s mild flu season is that COVID-19 mitigation strategies are tamping down the spread of other respiratory viruses, said Brendan Flannery, PhD, coauthor of the letter calling for systematic testing for both influenza and COVID-19. But the worst-case scenario is that COVID-19 has overwhelmed health care systems, so people with the flu are staying home and not being counted or seeking care but getting lost in the crowd of COVID-19 patients, said Flannery, lead investigator from the US Centers for Disease Control and for the US Flu Vaccine Effectiveness Network.
“We’re all going to learn a lot,” Osterholm said of the upcoming flu season. “We can speculate until we’re blue in the face, and I don’t think we know yet what’s going to happen.”"
Source: https://jamanetwork.com/journals/jama/fullarticle/2769835
Commentary: I'm cautiously optimistic that in regions that have maintained vigilance against the disease and have adopted strong countermeasures like masks for everyone will see a mild, perhaps even record low flu season. And as the article states, the mitigations against COVID-19 also work for the common cold and flu. Wear a mask. Wash your hands. Watch your distance. Withdraw from indoor spaces other than your home.
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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.