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.
You are welcome to share this.
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Due to the US Thanksgiving holiday, the next Lunchtime Pandemic newsletter will be Monday, 30-November-2020. For those who observe, happy Thanksgiving. For everyone else, enjoy the rest of the week and stay safe.
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Convalescent plasma has no clinical effect. "We randomly assigned hospitalized adult patients with severe Covid-19 pneumonia in a 2:1 ratio to receive convalescent plasma or placebo. The primary outcome was the patient’s clinical status 30 days after the intervention, as measured on a six-point ordinal scale ranging from total recovery to death.
A total of 228 patients were assigned to receive convalescent plasma and 105 to receive placebo. The median time from the onset of symptoms to enrollment in the trial was 8 days (interquartile range, 5 to 10), and hypoxemia was the most frequent severity criterion for enrollment. The infused convalescent plasma had a median titer of 1:3200 of total SARS-CoV-2 antibodies (interquartile range, 1:800 to 1:3200]. No patients were lost to follow-up. At day 30 day, no significant difference was noted between the convalescent plasma group and the placebo group in the distribution of clinical outcomes according to the ordinal scale (odds ratio, 0.83 (95% confidence interval [CI], 0.52 to 1.35; P=0.46). Overall mortality was 10.96% in the convalescent plasma group and 11.43% in the placebo group, for a risk difference of −0.46 percentage points (95% CI, −7.8 to 6.8). Total SARS-CoV-2 antibody titers tended to be higher in the convalescent plasma group at day 2 after the intervention. Adverse events and serious adverse events were similar in the two groups.
No significant differences were observed in clinical status or overall mortality between patients treated with convalescent plasma and those who received placebo."
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2031304
Commentary: The study goes on to say that because people are radically different, any response is going to be heterogenous; one person's plasma may have no effect in another person, even with the same blood type. As we've discovered, SARS-CoV-2 affects the body in wildly different ways from person to person, so it's not terribly surprising that we find no clinical effect.
Thus, this brings us to another therapeutic eventually shown to not have an effect, adding it to the pile with remdesivir and hydroxychloroquine. The only therapeutic proven to have clinical benefit thus far is dexamethasone, and only for severe cases.
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On vaccines and the population. "Over the past few months, there has been an indisputable decline in the number of people in the US who say they plan to get the vaccine for coronavirus disease 2019 (COVID-19) when one becomes available. A national survey by Pew Research Center in May found that 72% of people in the US said they would get the vaccine if it were available. By September, that number had dropped to 51%. Survey results from CNN showed a similar decline, from 66% who said they would get the vaccine in May to 51% in early October.
What is disputable, however, is why this decline is occurring. The COVID-19 pandemic has become highly politicized, with partisanship affecting attitudes toward wearing a mask and confidence in the accuracy and validity of COVID-19 statistics. Similarly, much has been made about the politicization of the vaccine. And a number of voters believe that politics have influenced the development of the vaccine. A Kaiser Family Foundation survey from early October found that 62% of people in the US are worried that the US Food and Drug Administration (FDA) will rush to approve a COVID-19 vaccine without making sure that it is safe and effective owing to political pressure from the Trump administration. Moreover, the survey found that 55% of people believe that President Trump is intervening with the FDA’s job of reviewing and approving a COVID-19 vaccine.
But while coverage has primarily pinpointed the driver of the decline to be political in nature, there are a number of other factors at hand. First, people in the US have a history of reluctance to accept new vaccines. Shortly after the polio vaccine was made available in 1954, Gallup found that 60% of people said they would get the newly created vaccine, while 31% said they would not get the vaccine and 9% were not sure. We know how history transpired, with near universal adoption of the polio vaccine in the US today; however, a sizable number of people were hesitant at the outset. Similarly, after the attacks of September 11 elevated concerns of biological attacks on people in the US, including the use of smallpox, Gallup found that 55% of people would get a smallpox vaccine, while 35% would not get the vaccine and 10% were unsure."
Source: https://jamanetwork.com/channels/health-forum/fullarticle/2773320
Commentary: The COVID-19 vaccine should be a relatively easy sell if medcomms folks pursue a more basic carrot and stick approach. If we want to do things like go to concerts, eat in restaurants, visit our relatives, and other basic creature comforts, then we need to vaccinate up.
I'd love to see a standardized, verified proof of vaccination and let some of the market help with messaging, like restaurants offering discounts with vaccine certifications, or barring entrance for people who have not been vaccinated. Combine that with ample, free distribution, and we could see the necessary uptake needed to stop COVID-19.
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Mask up for yourself, too. "However, last week, as cases of coronavirus disease 2019 (COVID-19) were surging across the US and threatening to overwhelm hospitals in some states, the CDC cited emerging evidence that the person who wears a mask also garners some protection against infection. “The prevention benefit of masking is derived from the combination of source control and personal protection for the mask wearer,” the brief says.
With respect to protecting other people, wearing a multilayer cloth mask can block up to 70% of fine droplets and aerosol particles and limit the spread of those that do penetrate the mask. In human experiments, masks have blocked the passage of “upwards of 80%” of all respiratory droplets, the brief notes, and some studies found that cloth masks performed as well as surgical masks as barriers to protect others.
As the updated brief highlights, wearing a mask thus offers potential benefits to persons who wear masks. “Studies demonstrate that cloth mask materials can also reduce wearers’ exposure to infectious droplets through filtration, including filtration of fine droplets and particles less than 10 microns,” the agency wrote.
The agency cites a number of real-world observational and epidemiologic human studies that have found a link between wearing of masks and reduced spread of SARS-CoV-2. In 1 case, reported in May, 139 clients at a Springfield, Missouri, salon were exposed to 2 hair stylists with symptoms and confirmed COVID-19 while both the stylists and the clients wore face masks; none of the 67 clients tested for SARS-CoV-2 developed the infection. Similarly, a report on 124 households in China with at least 1 person with COVID-19 each found that when everyone in the household wore masks as a preventive measure before the family member with the infection developed symptoms, further household spread was reduced by 79%."
Source: https://jamanetwork.com/channels/health-forum/fullarticle/2773247
Commentary: It's nice to see the CDC updating with new findings and research. I suspect that as the transition to a new administration begins, we'll see a lot more data be released.
Wear a mask. It protects you, and it protects others.
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An interesting piece in the BMJ about intimate relations during lockdown. "Of the 1187 who commenced the survey, 965 (81.3%) completed it. Overall, 70% were female and 66.3% were aged 18–29 years. Most (53.5%) reported less sex during lockdown than in 2019. Compared with 2019, participants were more likely to report sex with a spouse (35.3% vs 41.7%; diff=6.4%; 95% CI 3.6 to 9.2) and less likely to report sex with a girl/boyfriend (45.1% vs 41.8%; diff=−3.3%; 95% CI −7.0 to -0.4) or with casual hook-up (31.4% vs 7.8%; 95% CI −26.9 to -19.8). Solo sex activities increased; 14.6% (123/840) reported using sex toys more often and 26.0% (218/838) reported masturbating more often. Dating app use decreased during lockdown compared with 2019 (42.1% vs 27.3%; diff= −14.8%; 95% CI −17.6 to -11.9). Using dating apps for chatting/texting (89.8% vs 94.5%; diff=4.7%; 95% CI 1.0 to 8.5) and for setting up virtual dates (2.6% vs 17.2%; diff=14.6%; 95% CI 10.1 to 19.2) increased during lockdown.
Although significant declines in sexual activity during lockdown were reported, people did not completely stop engaging in sexual activities, highlighting the importance of ensuring availability of normal sexual and reproductive health services during global emergencies."
Source: https://sti.bmj.com/content/early/2020/10/29/sextrans-2020-054688
Commentary: It's no surprise to find out that intimate relations among individuals changed during lockdowns. If the pandemic has done one good thing, the massive disruption to all aspects of life has generated enormous amounts of research data on every conceivable topic, research that could never be ethically conducted at scale in any other circumstance. With luck and time, we will see "pandemic dividends" of all kinds as that research leads to improvements in the quality of life for everyone.
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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. Always 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.
6. Participate in your local political process. For Americans, go to Vote.org and register/verify your vote.
7. Ventilate your home as frequently as weather and circumstances permit.
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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.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.