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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Moderna's vaccine continues to work against B.1.1.7 and B.1.351 strains. "results from in vitro neutralization studies of sera from individuals vaccinated with Moderna COVID-19 Vaccine showing activity against emerging strains of SARS-CoV-2. Vaccination with the Moderna COVID-19 Vaccine produced neutralizing titers against all key emerging variants tested, including B.1.1.7 and B.1.351, first identified in the UK and Republic of South Africa, respectively. The study showed no significant impact on neutralizing titers against the B.1.1.7 variant relative to prior variants. A six-fold reduction in neutralizing titers was observed with the B.1.351 variant relative to prior variants. Despite this reduction, neutralizing titer levels with B.1.351 remain above levels that are expected to be protective. This study was conducted in collaboration with the Vaccine Research Center (VRC) at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH). The manuscript has been submitted as a preprint to bioRxiv and will be submitted for peer-reviewed publication.
“As we seek to defeat the COVID-19 virus, which has created a worldwide pandemic, we believe it is imperative to be proactive as the virus evolves. We are encouraged by these new data, which reinforce our confidence that the Moderna COVID-19 Vaccine should be protective against these newly detected variants,” said Stéphane Bancel, Chief Executive Officer of Moderna. “Out of an abundance of caution and leveraging the flexibility of our mRNA platform, we are advancing an emerging variant booster candidate against the variant first identified in the Republic of South Africa into the clinic to determine if it will be more effective to boost titers against this and potentially future variants.”
For the B.1.1.7 variant, neutralizing antibody titers remained high and were generally consistent with neutralizing titers relative to prior variants. No significant impact on neutralization was observed from either the full set of mutations found in the B.1.1.7 variant or from specific key mutations of concern. Although these mutations have been reported to lessen neutralization from convalescent sera and to increase infectivity, sera from the Phase 1 participants and NHPs immunized with mRNA-1273 were able to neutralize the B.1.1.7 variant to the same level as prior variants.
For the B.1.351 variant, vaccination with the Moderna COVID-19 Vaccine produces neutralizing antibody titers that remain above the neutralizing titers that were shown to protect NHPs against wildtype viral challenge. While the Company expects these levels of neutralizing antibodies to be protective, pseudovirus neutralizing antibody titers were approximately 6-fold lower relative to prior variants. These lower titers may suggest a potential risk of earlier waning of immunity to the new B.1.351 strains."
Source: https://investors.modernatx.com/news-releases/news-release-details/moderna-covid-19-vaccine-retains-neutralizing-activity-against
Source: https://www.biorxiv.org/content/10.1101/2021.01.25.427948v1.full.pdf
Commentary: This is good news for dealing with the B.1.1.7 strain, that the existing vaccine works fine. It's concerning against the B.1.351 strain because it's less effective. Still effective, but less effective. What we talked about in previous issues of the newsletter appears to be coming to pass - as strains evolve, companies using mRNA vaccines will need to develop new boosters, as Moderna indicated in their press release. We'll need these boosters each year, like flu shots.
That also means that you should probably plan on wearing a mask for the indefinite future, and wear the best mask available to you outside your home in indoor spaces like grocery stores.
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Growing evidence that B.1.1.7 may be more dangerous.
"1. The variant of concern (VOC) B.1.1.7 appears to have substantially increased
transmissibility compared to other variants and has grown quickly to become the
dominant variant in much of the UK.
2. Initial assessment by PHE of disease severity through a matched case-control study
reported no significant difference in the risk of hospitalisation or death in people
infected with confirmed B.1.1.7 infection versus infection with other variants. [1]
3. Several new analyses are however consistent in reporting increased disease severity
in people infected with VOC B.1.1.7 compared to people infected with non-VOC virus
variants.
4. There have been several independent analyses of SGTF and non-SGTF cases
identified through Pillar 2 testing linked to the PHE COVID-19 deaths line list:
a. LSHTM: reported that the relative hazard of death within 28 days of test for
VOC-infected individuals compared to non-VOC was 1.35 (95%CI 1.08-1.68).
b. Imperial College London: mean ratio of CFR for VOC-infected individuals
compared to non-VOC was 1.36 (95%CI 1.18-1.56) by a case-control
weighting method, 1.29 (95%CI 1.07-1.54) by a standardised CFR method.
c. University of Exeter: mortality hazard ratio for VOC-infected individuals
compared to non-VOC was 1.91 (1.35 - 2.71).
d. These analyses were all adjusted in various ways for age, location, time and
other variables.
5. An updated PHE matched cohort analysis has reported a death risk ratio for VOCinfected individuals compared to non-VOC of 1.65 (95%CI 1.21-2.25).
6. There are several limitations to these datasets including representativeness of death
data (<10% of all deaths are included in some datasets), power, potential biases in
case ascertainment and transmission setting.
7. Based on these analyses, there is a realistic possibility that infection with VOC
B.1.1.7 is associated with an increased risk of death compared to infection with
non-VOC viruses.
8. It should be noted that the absolute risk of death per infection remains low.
9. An analysis of CO-CIN data has not identified an increased risk of death in
hospitalised VOC B.1.1.7 cases. However, increased severity may not necessarily be
reflected by increased in-hospital death risk."
Source: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/955239/NERVTAG_paper_on_variant_of_concern__VOC__B.1.1.7.pdf
Commentary: In analysis of the data, the B.1.1.7 strain was shown to be between 28-35% more deadly than the current versions of SARS-CoV-2. Now, bear in mind that COVID-19 has roughly a 1% fatality rate, so this would increase that to 1.35. But that tiny little change makes a big difference in absolute numbers. Globally, we've had 2 million people die of COVID-19 that we know of. A change of 0.35% would mean an additional 70,000 dead with the current situation. That doesn't take into account the fact that B.1.1.7 spreads faster as well.
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Smoking is a risk factor for COVID-19, but not asthma. "Biological plausibility is a fancy way for scientists to say that something "makes sense." But in the real world of research, biological plausibility is not enough. You need data to back up an idea. For example, most people assumed that asthma might be a risk factor for covid-19. It just "seems logical." But so far, the data have not found this to be the case. So while there is compelling biological plausibility that smokers might be at increased risk of severe disease from covid-19 than non-smokers, real data has been lacking. Previously, there has been some evidence that smoking was associated with worse covid-19 outcomes in people with lung cancer. But until today, data assessing any association between smoking and the severity of covid-19 symptoms had not been published.
Enter the Cleveland Clinic, which maintains a covid-19 registry that tracks patients who test positive for SARS-CoV-2 allowing researchers to examine different characteristics and outcomes in all included patients. Smoking is one of those characteristics. Using electronic medical records a team of investigatorsmeasured whether cumulative years of smoking meant worse covid-19 outcomes. The findings were published today in JAMA Internal Medicine.
Heavy smoking was associated with a 2.25 greater rate of hospitalizations among covid-19 patients. These same heavy smokers were 1.89 times more likely to die from covid-19. These findings elevate the idea that smoking could be a risk factor for worse covid-19 outcomes from "biologically plausible" to supported by actual data. "
Source: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2775677?guestAccessKey=53695286-504b-40dd-a2ed-755526312066
Source: https://brief19.com/2021/01/25/brief
Commentary: One of the more controversial points of debate about vaccines right now is around smokers. People who smoke are at higher risk of negative outcomes, but many also point out that unlike age, smoking is a personal choice. The arguments for and against vaccinating smokers before others are complex; the main reason in favor of doing it is to reduce the absolute number of bodies in ICUs. Right now, standards of care are dropping because hospitals are overwhelmed, so anything that keeps a bed free is judged to be a good thing. On the other hand, smoking is absolutely a personal choice that negatively impacts one's health substantially, and vaccine programs for smokers have been likened to liver transplants for alcoholics who haven't stopped drinking.
I can't say there's a right perspective on this. For sure, we need all the bed space in hospitals possible. For sure, the fewer people who contract COVID-19, especially more severe cases, the better, because every new case is a chance for a new mutation that works against us. I would personally be in favor of an approach that identified the risk vectors, the super spreaders, and try to knock those out first, but I'm not sure we have the data to build models like that just yet.
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Israel may be winning the battle. "Vaccines are quickly averting serious cases of COVID-19 among the most vulnerable members of society, an Israeli healthcare provider has indicated.
The full effects of Pfizer’s vaccine are only slated to kick in around a month after the first shot, but data from Israel, home to the world’s fastest vaccination drive, has already shown that there is a stark drop in infections even before this point.
Attracting widespread international interest by sharing early data, Maccabi Healthcare Services reported earlier this month that it has seen a 60 percent reduction in coronavirus infections three weeks after the first shot is administered.
But it wasn’t clear if the benefits were being felt equally by those who have a propensity to mild infection and those who would be likely to take COVID-19 badly.
Now, Maccabi is starting to answer the question that hospitals and health ministers around the world are anxiously asking, amid fears of health service meltdowns: How quickly will COVID-19 wards start to see the benefits of vaccination?
The decrease in hospital admissions is swift after vaccination, Maccabi suggests in its latest data, finding that hospitalizations start to fall sharply from Day 18 after people receive the first shot. Galia Rahav, head of infectious diseases at Israel’s largest hospital, Sheba Medical Center, described the data as “very important.”
By Day 23, which is 2 days after the second shot, there is a 60% drop in hospitalizations among vaccinated people aged 60-plus, Maccabi revealed after monitoring 50,777 patients. It compared their hospitalization rate at that point with their hospitalization rate soon after receiving the vaccine, using 7-day moving averages.
“This is very important data,” Rahav, who is unconnected to the study, told The Times of Israel. “It has an impact because amid high infection rates and the spread of variants it’s hard to see from general figures how vaccination is influencing things.
“By giving an insight into hospitalizations among just those elderly people who were vaccinated, this data is valuable.”
However, she cautioned that some of the drop may be due to a tendency of newly vaccinated people to adhere to lockdown rules, which causes a drop in infection and hospitalization.
The new data also supports Maccabi’s earlier claim of a 60% infection rate drop after three weeks, reporting that it saw the same drop with a new sample comprising only the 60-plus age group.
Maccabi’s graph gives a real picture of infection in Israel, showing that until Day 13, vaccinated over-60s had similar infection rates as the overall 60-plus population. Then, a gap opens, and by Day 23, there were 18 daily infections among the 50,777 overall, but just six among the vaccinated."
Source: https://www.timesofisrael.com/israel-sees-60-drop-in-hospitalizations-for-over-60s-in-weeks-after-vaccination/
Commentary: This is very encouraging news. If you have the chance to get vaccinated, get vaccinated.
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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 or better mask if you can obtain 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. 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.