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.
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B.1.1.7 in Montreal. "1) The more transmissible B.1.1.7 variant now appears to be circulating widely in Montreal, the latest data by the public health department suggest. The variant been responsible for at least 22 #COVID19 outbreaks in Montreal since January, mainly in schools and daycare centres.
2) And since last week, the number of #COVID19 outbreaks in schools has jumped by 19 to 117 in the city, with nearly 600 positive cases. In fact, the contagion in schools stands out because clusters have been dropping in nearly every other sector. See the chart below.
3) And three more Montreal schools — Antoine-de-Saint-Exupery, Adélard-Desrosier and Beth Jacob de Rev Hirschsprung — reported four more suspected cases on Wednesday involving the B.1.1.7 variant that originated in the U.K. in December, according to covidecolesquebec.org.
4) Dr. Mylène Drouin, of Montreal public health, implied schools are now B.1.1.7 breeding grounds: “When we look at the distribution of age groups, it’s very much young children and their parents, since the variant returns to the home and there is transmission within the home.”
5) Drouin also urged Montrealers to limit their social contacts, especially given that next week’s March break will “give rise to more time to socialize.” Recall that Montreal quickly became the epicenter of the #pandemic in Canada after last year’s March break.
6) This time around, public health authorities are testing a lot more for #COVID19 and have ramped up vaccinations. On Tuesday, nurses administered first shots to 1,478 Montrealers for a total of 95,164. And a big shipment of vaccines will come next week.
7) However, the B.1.1.7 variant — considered to be at least 50% more contagious than previous strains of #coronavirus — is spreading fast. Quebec on Wednesday posted a cumulative total of 602 presumptive variant cases, up by 118 from the day before.
8) Now we have a much better idea why public health officials have shut schools at the faintest sign of a #COVID19 variant. And it’s also why all pupils in elementary schools in the red zone of Montreal will have to wear masks in class after the March break.
9) The big question — or as Premier François Legault put in on Tuesday, the “big test” — that remains is what will happen with B.1.1.7 transmission in Montreal during the March break. Data on workplace outbreaks might provide an answer.
10) The chart below shows the number of #COVID19 outbreaks in the workplace declined by 13 to 119 since last week. But the number of clusters in large retail or department stores inched up by three to six. Will packed shopping centres next week accelerate the spread of B.1.1.7?
11) And it’s not just shopping centres that will be crowded next week, but public pools, hockey rinks and popcorn-less movie theatres. Under the circumstances, perhaps Quebec should have followed Ontario’s lead in postponing March break until mid-April. End of thread.
Addendum: The following charts could not fit into tonight’s thread, so I’m releasing them here. In an ominous sign, emergency room overcrowding in Montreal and across Quebec is rising, as the chart below indicates. Not a welcome development with B.1.1.7 on the loose.
Addendum 2: It appears the number of new daily #COVID19 cases in Montreal has plateaued in the low 400s in the past few days. Please take a look at the chart below.
Addendum 3: But mercifully, the decline in #COVID19 deaths in Montreal has become more pronounced in the past few days. The total number of #pandemic deaths in the province stands at 10,346, or which 4,489 have occurred in the metropolis."
Source:
Commentary: B.1.1.7 and kids doesn't mix. Until a school's staff has been vaccinated, schools should be remote.
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First booster goes to study. "The evaluation is part of the Phase 1/2/3 trial and will study a third dose of the Pfizer-BioNTech COVID-19 vaccine, BNT162b2, at 30 µg that will be given to Phase 1 participants to evaluate the safety and tolerability of a booster vaccine
Discussions with regulatory authorities are ongoing regarding an additional registration-enabling study using an mRNA vaccine with a variant sequence; this would provide a flexible solution for rapidly adapting the vaccine for use against the B.1.351 lineage or other new strains that may emerge as possible immune escape virus variants
Based on in-vitro studies conducted to date and observations from real world evidence, the Companies have not observed changes to neutralizing antibody levels that would predict a significant reduction in protection provided by two doses of BNT162b2
Separately, in order to be prepared for any potential future strain changes, Pfizer and BioNTech are in ongoing discussions with regulatory authorities, including the U.S. Food and Drug Administration (FDA) and the European Medicines Agency, regarding a registration-enabling clinical study to evaluate a variant-specific vaccine having a modified mRNA sequence. This study would use a new construct of the Pfizer-BioNTech vaccine based on the B.1.351 lineage, first identified in South Africa. This could position the Companies to update the current vaccine quickly if the need arises to protect against COVID-19 from circulating strains. In alignment with the updated guidance issued by the FDA regarding emergency use of vaccines to prevent COVID-19 which provides recommendations for evaluating a modified vaccine to address variants, the Companies are hoping to pursue the validation of future modified mRNA vaccines with a regulatory pathway similar to what is currently in place for flu vaccines."
Source: https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-initiate-study-part-broad-development
Commentary: This is excellent news in the fight against variants, especially the regulatory revision concept. Like an updated flu shot, an updated COVID-19 vaccine should be just as easy - and as fast - to take to market.
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Vaccine hesitancy delays opening up in the UK. "1. Due to eligibility and vaccine hesitancy, vaccination alone will not be sufficient to keep the epidemic under control. NPIs must be lifted slowly and cautiously to minimise the number of deaths and prevent high hospital occupancy, with some baseline NPIs remaining in place (and adhered to) throughout 2021 and beyond. 2. It is critical to achieve and maintain high vaccine uptake and roll out before easing NPIs. 3. Assuming optimistic vaccine efficacy, even if 3.2M vaccine doses/week are given up to 12 July (3.9M thereafter), only 46% of the population will be protected against disease (due to vaccination or recovery from infection) at the date of full NPI lifting in scenario 1 (26 April 2021), 60% in scenario 4 (2 August), and 65% in scenario 5a (16 July) (Fig 1A). 4. Relaxing too quickly (scenario 1) will result in peak hospital occupancy considerably higher than the current wave and substantial additional deaths (Fig 1E-F). This holds regardless of vaccine efficacy, roll out, adherence to baseline NPIs, and impact of seasonality. 5. Scenario 4 will still result in a substantial additional number of deaths (58,200, 95%CrI 31,000 - 95,300) by June 2022 in our main analysis."
Source: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/963440/S1129__Unlocking__Roadmap_Scenarios_for_England_.pdf
Commentary: The critical commentary is the UK's modeling that because of B.1.1.7, the vaccine alone might not be enough to keep the reproduction number below 1.0 because of people being unwilling to take the vaccine.
Keep at it - wear the best mask available to you outside your home, keep away from crowds and indoor spaces as much as you can, and get vaccinated as soon as you're eligible.
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A reminder of the simple daily habits we should all be taking.
1. Always wear the best mask available to you when out of your home and you'll be around other people. 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. Get vaccinated as soon as you're able to.
3. Wash/sanitize your hands every time you are in or out of your home for any reason.
4. 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.
5. Get your personal finances in order now. Cut all unnecessary costs.
6. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
7. 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).
8. Masks must fit properly to work. Here's how to properly fit a mask:
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Common misinformation debunked!
There is no mercury or other heavy metals in the Pfizer mRNA vaccine. https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
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.