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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Another clue about why men are hit harder by COVID-19 than women. "A growing body of evidence indicates sex differences in the clinical outcomes of coronavirus disease 2019 (COVID-19)1–5. However, whether immune responses against SARS-CoV-2 differ between sexes, and whether such differences explain male susceptibility to COVID-19, is currently unknown. In this study, we examined sex differences in viral loads, SARS-CoV-2-specific antibody titers, plasma cytokines, as well as blood cell phenotyping in COVID-19 patients. By focusing our analysis on patients with moderate disease who had not received immunomodulatory medications, our results revealed that male patients had higher plasma levels of innate immune cytokines such as IL-8 and IL-18 along with more robust induction of non-classical monocytes. In contrast, female patients mounted significantly more robust T cell activation than male patients during SARS-CoV-2 infection, which was sustained in old age. Importantly, we found that a poor T cell response negatively correlated with patients’ age and was associated with worse disease outcome in male patients, but not in female patients. Conversely, higher innate immune cytokines in female patients associated with worse disease progression, but not in male patients. These findings reveal a possible explanation underlying observed sex biases in COVID-19, and provide an important basis for the development of a sex-based approach to the treatment and care of men and women with COVID-19."
Source: https://www.nature.com/articles/s41586-020-2700-3
Commentary: Male ability to generate T-cell immune responses declines with age, whereas it happens much less to women. That in turn means that COVID-19 (and other diseases mitigated by T-cell responses) hit men harder.
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Self-reported data collected from an app yields predictive insights. "Despite the widespread implementation of public health measures, coronavirus disease 2019 (COVID-19) continues to spread in the United States. To facilitate an agile response to the pandemic, we developed How We Feel, a web and mobile application that collects longitudinal self-reported survey responses on health, behaviour and demographics. Here, we report results from over 500,000 users in the United States from 2 April 2020 to 12 May 2020. We show that self-reported surveys can be used to build predictive models to identify likely COVID-19-positive individuals. We find evidence among our users for asymptomatic or presymptomatic presentation; show a variety of exposure, occupational and demographic risk factors for COVID-19 beyond symptoms; reveal factors for which users have been SARS-CoV-2 PCR tested; and highlight the temporal dynamics of symptoms and self-isolation behaviour. These results highlight the utility of collecting a diverse set of symptomatic, demographic, exposure and behavioural self-reported data to fight the COVID-19 pandemic.
Using individual-level data collected from the HWF app, we showed that incorporating information beyond symptoms—in particular, household and community exposure—is vital for identifying infected individuals from self-reported data. This finding is particularly important for risk assessment at the early stage of transmission (for example, during the latent and presymptomatic periods when subjects have not developed symptoms yet), so that high-risk subjects can have priorities for being tested and quarantined and close contacts can be traced, to block the transmission chain early on. Our results show that vulnerable groups include subjects with household and community exposure, healthcare workers and essential workers, and African-American and Hispanic/Latinx users. They are at higher risk of infection and should have priorities for being tested and protected. Our findings also show statistically significant racial disparity after adjusting for the effects of pre-existing medical conditions, which needs to be addressed.
We find evidence among our users for several factors that could contribute to continued COVID-19 spread despite widespread implementation of public health measures. These include a substantial fraction of users leaving their homes on a daily basis across the United States; users who claim to not socially isolate or return to work after receiving a PCR test (+) result; self-reports of asymptomatic, mildly symptomatic or presymptomatic presentation; and a much higher risk of infection for people with within-household exposure."
Source: https://www.nature.com/articles/s41562-020-00944-2
Commentary: Even if a subset of a population uses an app like the one described in the research, the benefits to detecting outbreaks could be substantial, especially in places like the United States which have failed at conducting large-scale, population-level testing. With good data and appropriate algorithms, the researchers demonstrated that even self-reported data has potential predictive power.
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Non-white Americans have died more from COVID-19. "As many as 215,000 more people than usual died in the U.S. during the first seven months of 2020, suggesting that the number of lives lost to the coronavirus is significantly higher than the official toll. And half the dead were people of color—Blacks, Hispanics, Native Americans and, to a marked degree unrecognized until now, Asian Americans.The new figures from the Centers for Disease Control and Prevention highlight a stark disparity: Deaths among people of color during the crisis have risen far more than they have among Whites.As of the end of July, the official death toll in the U.S. from COVID-19 was about 150,000. It has since grown to over 170,000.This story was published in partnership with The Associated Press.
But public health authorities have long known that some coronavirus deaths, especially early on, were mistakenly attributed to other causes, and that the crisis may have led indirectly to the loss of many other lives by preventing or discouraging people with other serious ailments from seeking treatment.A count of deaths from all causes during the seven-month period yields what experts believe is a fuller—and more alarming—picture of the disaster and its racial dimensions.People of color make up just under 40 percent of the U.S. population but accounted for approximately 52 percent of all the “excess deaths” above normal through July, according to an analysis by The Marshall Project and The Associated Press."
Source: https://www.themarshallproject.org/2020/08/21/covid-19-s-toll-on-people-of-color-is-worse-than-we-knew
Commentary: Systemic racism continues to rear its ugly head in all aspects of this pandemic, but none more than in unequal healthcare outcomes. Fixing it will require overhauling substantial parts of the healthcare system to ensure equal access and outcomes at a system level, even when practitioners themselves are living up to their highest ideals.
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The former director of the CDC highlights some problems.
"Recently CDC quietly changed its website. First, they no longer recommend quarantine for travelers from high-prevalence areas. Second, they no longer recommend testing for asymptomatic people, even contacts.
Both changes are highly problematic. If explained openly in a press conference, perhaps defensible, tho hard to see how.
Re quarantine, it's not enough to mask, distance, and wash hands. And you can go outside if not near others, but not to crowded spaces. Masks aren't perfect."
Source:
Source:
Commentary: This change in guidance is alarming, doubly so when the former director has to resort to publicly calling it out. Why these changes have been made, we're not sure about - especially since CDC officials have been prohibited from talking to the media.
Medical professionals stand by the existing (now former) guidance: quarantines for travelers makes sense, especially if travelers are coming from an area with higher caseloads than the area they're traveling to. Testing should be as widespread as possible to detect outbreaks.
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Concerning use of funding in the United States. "A new analysis of funds allocated under the Paycheck Protection Program and Health Care Enhancement Act found that just approximately $121 million of $10.25 billion has been put to use since the Act's passage in April. The intention of this legislation was to bolster testing, contact tracing and surveillance during the covid-19 outbreak in the United States. Additionally, only $1.62 billion of $5.7 billion allocated to federal agencies has been committed, and the majority of an $8 billion allotment to the U.S. Department of Health and Human Services (HHS) likewise remains untouched. There has been frustration among experts asking for more efficient testing, broader testing efforts and more thorough contact tracing. On one hand, it feels to many as if there is a lack of adequate funding for these efforts which are seen as vital in turning the time against covid-19. But that sense has apparently been exacerbated by the knowledge that such funding actually is technically available, but for a variety of logistical reasons remains untouched or inaccessible.
Separately, an email obtained by the New York Times from HHS Secretary Alex Azar indicated that allocation of the $100 billion from the Provider Relief Fund would be tied to healthcare facilities' reporting of covid-19 admissions data to a private contracting firm, TeleTracking Technologies. Critics have raised concerns with this plan for several reasons. Chief among them is that the policy requires hospitals to share public health information with a private firm that has not previously held such contracts, rather than reporting the information directly to federal health entities such as the U.S. Centers for Disease Control and Prevention, which was the initial setup. The new workflow is seen as increasing risks related to transparency and data reliability. Many experts find it particularly problematic that relief funding is essentially being used to coerce hospitals into entrusting important and sensitive data to a private company, while keeping public health experts in the dark."
Source: https://brief19.com/2020/08/26/brief
Commentary: It is disheartening but unsurprising that the United States federal funding response is as lackluster and chaotic as the federal pandemic response overall.
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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. 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.