Lunchtime Pandemic Reading, 25-September-2020
3 months till Christmas, 7 million cases in the US
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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We currently stand at 32 million cumulative cases globally, and nearing 1 million deaths globally. In the United States where I live, we are nearing 7 million cases and now just over 200,000 deaths. More concerning, around the world and in my country, cases are accelerating again. Remain vigilant.
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Another expert using the cigarette analogy, which I love. Dr. Lindsay Maher: "we can think about it like cigarette smoke. So the distancing really keeps you out of range of those big droplets that fly through the air and then will fall to the ground quickly, they don't really fly more than six feet or so. But at the same time, for every one of those that you see, there's hundreds or thousands of the microscopic ones, the ones we call aerosols, and those can stay in the air again, like cigarette smoke. So imagine you're interacting with a smoker, you want to stay as far away as possible from them really to avoid breathing in a smoke, the smoke doesn't stop at six feet. So six feet is a guideline, and it keeps you kind of farther away from the most concentrated part of this smoke, the plume. But it doesn't guarantee that you're not going to be exposed.
The cigarette smoke is a great way to think about different specific scenarios, whether you're indoors, do you want to be indoors with that smoker, will you think about what what affects that is the ventilation in the room, if the room is really well ventilated, and there's lots of outdoor air coming in, then that smoke will be kind of pushed outside. But if the ventilation is poor, that smoke can build up just like the virus can also build up in the air. And as exactly as you've suggested, if you're outdoors, you're really close to someone and you're right downwind of them. And the there's not much wind, you could end up reading and a lot of that smoke. But if you kind of move a little bit and it's really windy out, you you would greatly reduce your exposure to smoke"
Source:
Commentary: In any situation where you'd likely smell cigarette smoke, you must wear the best mask available to you. Use this explanation for people who are having trouble understanding why six feet isn't enough; the video is also excellent.
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Speed matters. "The COVID-19 pandemic has created a public health crisis. Because SARS-CoV-2 can spread from individuals with pre-symptomatic, symptomatic, and asymptomatic infections, the re-opening of societies and the control of virus spread will be facilitated by robust surveillance, for which virus testing will often be central. After infection, individuals undergo a period of incubation during which viral titers are usually too low to detect, followed by an exponential viral growth, leading to a peak viral load and infectiousness, and ending with declining viral levels and clearance. Given the pattern of viral load kinetics, we model surveillance effectiveness considering test sensitivities, frequency, and sample-to-answer reporting time. These results demonstrate that effective surveillance depends largely on frequency of testing and the speed of reporting, and is only marginally improved by high test sensitivity. We therefore conclude that surveillance should prioritize accessibility, frequency, and sample-to-answer time; analytical limits of detection should be secondary."
Source: https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v3
Commentary: A pre-print paper argues that speed and scale of testing matters much more than analytical accuracy after a certain point. Certainly, horrendously inaccurate tests are not helpful, but testing is "good enough" right now. The critical path forward is getting more testing done faster, to find out where the fires are and put them out. Like a fire, it's unhelpful to wait days to find out what's burning. You want to spot the fire as fast as possible and put it out before it spreads.
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UC San Diego sewage. "We're doing it we're doing it at UCSD, UC San Diego, we're doing it at the dorms. So when the kids come back, we can basically look at the dorm sewage of individual dorms, it's actually isolated for each dorm. And we're using that to be able to have sort of it says it they say it predict, you know, comes out and you'll see it in the sewage about seven days before you'll get the outbreak in the building. So it gives you a little bit higher. You know, it's it's much better than having the test individuals and so you can help you sort of isolate that dorm sooner is the idea."
From that same video, a powerful explanation of infection.
"The other thing that makes I should add that makes these aerosols, particularly effective, and, you know, has had I think, played a big role, it turns out that the severity of disease depends on the transmission mode, right. So if you touch a surface and get though mines, or you know, you get you get it on your skin, and you touch your nose, you touch your mouth, and you get it that way. That's one mode, right? That's the other mode. That's the mode we've all focused on. But if you inhale, tiny aerosols, these go deep into your lungs, they can actually, as we described in the paper, that will bypass can bypass your immune system. That's why you don't have symptoms. And so that virus just takes off and your body's under attack, and you don't know it for five days, until it grows up in your upper respiratory tract, then it triggers your immune system, and then you have symptoms, so that it's just found a way to basically spread very silently through people who don't even know they're sick.
The only way you're 100% protected, is not being around other people, you know, but you can knock it back. And again, I think people have shown that you can knock it back significantly with masks, the most extreme major you can do is what you just said, which is lockdown, right? That's the only way you can be 100%. Sure. But these countries that were masks like Taiwan, they never locked down. So that's a super important point. I mean, if you have to, if people won't wear masks, then we have to stay in lockdown. Right. But if people will agree to wear masks, we can get our lives going again, pretty safely, I mean, pretty safely, there's needs to be changes made for indoor air, you know, and quite honestly, I would think twice before going into a restaurant right now. That's one of the places they've calculated, you can get some of the highest exposure, unless they have the windows open and or you eat outside, right. So I just want to get that point across. But I think people have been really upset that we've been forced to be locked down. And that's the only option. And you're right, that's the only option if you want to be 100% sure, you won't get it. Right. But if you want to move on, and we want to get our society going again, then we need to think about, you know, other majors, and that's where the masks come in."
Source:
Commentary: Masks are the key to getting slowly back to normal. The longer people resist wearing them, the longer the pandemic goes on.
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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.
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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.