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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Masks won't be enough. "Universal masking is most obvious, least intrusive intervention states with large epidemics can take. But it won’t be enough at this stage. Many will also have to consider targeted mitigation steps to limit congregate settings that they identify as the sources of biggest spread."
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Commentary: The only way to stop massive outbreaks is to return to a shutdown state. I don't see elected officials in many places in the US having the level of political will to do what is necessary to save thousands of lives, and we see the consequences of opening too soon in the data:
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This is extremely dangerous. "Now I have seen it all. It infuriates me to see people making fake cards and invoking the ADA act which is meant to protect people with real disabilities. The vitriol, rhetoric, antics and misinformation being spread by #antimaskers is dangerous. This needs to be shutdown."
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Commentary: Share this tweet with your fellow professionals, with elected officials, with everyone to alert them that this is a scam.
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Texas puts bars and pubs over medical procedures. "It is worth noting that Texas chose to suspend elective medical procedures before they took additional strong mitigation actions, like temporarily closing congregate activities in bars which is a venue that they have identified as a source of spread."
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Commentary: This pandemic has shown us more clearly than anything in recent memory what the priorities of our local, state, and national governments are. I'll take this moment for those who are US citizens to remind you to visit Vote.org, verify your voting registration, and then vote in upcoming elections for officials at every level who believe in science and prioritize the good of the citizens over the good of their own interests.
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More support for tocilizumab in the treatment of the most severe COVID-19 cases. "Of 1351 patients admitted, 544 (40%) had severe COVID-19 pneumonia and were included in the study. 57 (16%) of 365 patients in the standard care group needed mechanical ventilation, compared with 33 (18%) of 179 patients treated with tocilizumab (p=0·41; 16 [18%] of 88 patients treated intravenously and 17 [19%] of 91 patients treated subcutaneously). 73 (20%) patients in the standard care group died, compared with 13 (7%; p<0·0001) patients treated with tocilizumab (six [7%] treated intravenously and seven [8%] treated subcutaneously). After adjustment for sex, age, recruiting centre, duration of symptoms, and SOFA score, tocilizumab treatment was associated with a reduced risk of invasive mechanical ventilation or death (adjusted hazard ratio 0·61, 95% CI 0·40–0·92; p=0·020). 24 (13%) of 179 patients treated with tocilizumab were diagnosed with new infections, versus 14 (4%) of 365 patients treated with standard of care alone (p<0·0001).
Treatment with tocilizumab, whether administered intravenously or subcutaneously, might reduce the risk of invasive mechanical ventilation or death in patients with severe COVID-19 pneumonia."
Source: https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30173-9/fulltext
Commentary: Continued good news on the therapeutics front, adding more tools to the toolkit for us to fight off the worst impacts of COVID-19.
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COVID-19 is especially adept at one human weakness: lack of patience. "Researchers have learned a lot about SARS-CoV-2, the novel coronavirus that causes Covid-19, since it emerged in China at the end of 2019. They have learned more about how it spreads, and how to test for it. They have learned that two drugs, remdesivir and dexamethasone, show some benefit in the sickest patients.
But they have also learned that the virus takes advantage of human instinct. Its long course means that it is possible to believe that things aren’t going to get that bad — long after they are actually becoming catastrophic. And many experts fear — though they may not be able to say for certain — that the U.S. is nearing the point of catastrophe again.
The virus “defies intuition,” said Caitlin Rivers, an assistant professor at the Johns Hopkins Bloomberg School of Public Health. “People like to see the impact of changes in the data much sooner than we actually observe.” In reality, it takes three weeks, sometimes even a month, for surges in the number of case counts to show up as increases in deaths, Rivers said."
Source: https://www.statnews.com/2020/06/25/as-covid-19-cases-peak-a-virus-once-again-takes-advantage-of-human-instinct/
Commentary: What you're seeing now in cases will become severe cases and deaths in a few weeks. It's going to be grim. Be prepared, if you live in a country severely afflicted, to see a return in some areas to shutdowns out of necessity, especially once the death counts begin to spike.
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The White House ordered NIH to cancel coronavirus research funding. "The National Institutes of Health abruptly cut off funding to a long-standing, well-regarded research project on bat coronaviruses only after the White House specifically told it to do so, according to Dr. Anthony Fauci, director of the NIH’s National Institute of Allergy and Infectious Diseases.
Fauci made the revelation Tuesday at a Congressional hearing on the federal response to the COVID-19 pandemic, which is caused by a coronavirus that is genetically linked to those found in bats. Rep. Marc Veasey (D-Texas) asked Fauci why the NIH abruptly canceled funding for the project, which specifically worked to understand the risk of bat coronaviruses jumping to humans and causing devastating disease.
After the hearing, Fauci clarified to Politico that it was the White House that told the NIH to cancel the funding. An unnamed White House official told Politico that the White House did encourage the funding cut, but ultimately it was the Department of Health and Human Services—of which the NIH is a part—that made the final decision. An HHS spokesperson said only that the funding was cut because "the grantee was not in compliance with NIH's grant policy.""
Source: https://arstechnica.com/science/2020/06/white-house-ordered-nih-to-cancel-coronavirus-research-funding-fauci-says/
Commentary: All I can say is, regardless of party, make sure the candidates you vote for believe strongly in the use and application of credible, vetted science, and put their trust in credible scientists and experts. Belief in credible science is the only way out of the pandemic that doesn't involve millions of deaths and a return to the ways of thinking that dominated during the Dark Ages.
If your current elected representatives do not operate on scientific and data-driven principles, do not re-elect them for any reason.
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The story of the pandemic's spread.
Source: https://www.nytimes.com/interactive/2020/us/coronavirus-spread.html
Commentary: This is an outstanding way to tell stories with data.
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US public health decisions have consequences. "The European Commission is advising ambassadors only to consider countries that are comparable or better than the EU average when it comes to new infections, the trend in new infections, as well as testing and tracing.
Reports said member states were assessing two different lists. The Politico website said one covered countries with fewer than 16 cases per 100,000 people and the other with up to 20 cases, which would include Canada and Turkey. The New York Times said the list would be revised every two weeks, so the US could be added later."
Source: https://www.bbc.com/news/world-europe-53161447
Commentary: Frankly, I wouldn't let Americans travel to my country if I had the virus under control. The US is out of control, as are the other nations topping the daily charts.
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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.
2. Wear gloves and a mask when out of your home. Consider wearing a face shield if you can't breathe at all through a mask.
3. Stay home as much as possible. Minimize your contact with others and maintain physical distance of at LEAST 6 feet / 2 meters. Avoid indoor places as much as you can.
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:
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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.