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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Time to revise close contact? "The delta variant has forced a quick pivot on key pandemic public health recommendations, including the return of universal indoor masking and the green light for vaccine booster shots.
There’s another long-standing core guideline, however, that experts say could use new scrutiny: the definition of “close contact” with an infected person, which dictates at what point someone exposed to the coronavirus should get tested or self-isolate.
For most of the pandemic, the standard has been “6 feet for 15 minutes,” but experts say that since the highly transmissible delta upended the pandemic picture, a new understanding is needed as people make choices about their behaviors and risks.
“The idea of criteria for what is a close contact has been a moving target throughout the pandemic,” said UC Berkeley infectious disease expert John Swartzberg. “I think we need to rethink what it really means to have a close contact, given a virus that is twice as transmissible.”
The Centers for Disease Control and Prevention defines “close contact” as exposure within 6 feet of an infected person, indoors, for more than a cumulative total of 15 minutes over a 24-hour period. The definition applies regardless of vaccination status.
But the CDC also says that those infected with the delta variant can carry a much higher viral load — up to 1,000 times more of the virus compared to the original coronavirus strain, according to at least one study from China.
Scientists have speculated that delta’s higher potency could greatly reduce the time it takes the virus to cause infection to as little as a few minutes or even seconds in an enclosed place. But the science is still developing, Swartzberg said.
“If someone’s got a thousandfold more virus in their throat and nose than somebody else with an ancestral strain, one would think they’d be more likely to spread it,” he said. However, the complexities of transmission make “one-size-fits-all” conclusions difficult, he added."
Source: https://www.sfchronicle.com/health/article/Is-close-contact-still-6-feet-for-15-16409850.php
Commentary: Delta is more contagious. That's not in dispute. And from Australia we have video evidence that fleeting contact can be as little as 10 seconds. So I'd say the criteria is less important than the action - and the action is universal masking.
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Sturgis repeats history. "n western South Dakota’s Meade County, more than one in three COVID-19 tests are currently returning positive, and over the last three weeks, seven-day average case counts have increased by 3,400 percent. This exponential growth in cases is likely attributable to the 81st Sturgis Motorcycle Rally, which drew an estimated half a million visitors to Meade County and its environs from Aug. 6 through 15, potentially acting as a superspreader event.
The pandemic is surging nationally, not just proximal to biker chaos in South Dakota. Defined in large part by the emergence of the highly transmissible Delta variant, the United States is experiencing its fourth surge of COVID-19 right now, and our nationwide case counts have increased by 64.4 percent over the last 21 days. (For more on our methodology, see our note at the bottom of this column.)
But while Southern states have been the main drivers of this surge thus far, the recent spike in cases in South Dakota warrants special concern.
The state more broadly has witnessed a 686.8 percent increase in daily case counts over the past three weeks, currently more than 10 times the nationwide rate. Meade County’s post-Sturgis uptick is certainly a contributor to this state-level increase, but neighboring counties have experienced a sharp incline in cases, too—ranging from a 1,900 percent increase in the past three weeks in Butte to a 1,050 percent increase in Lawrence.
Those two counties are also key focal points for the rally, which is not, in reality, confined to Sturgis. And because the rally is widely attended by residents all across South Dakota, it’s not surprising that counties further away—like Charles Mix County, which saw a 1,500 percent increase—are experiencing an incline in cases, too.
The Sturgis Motorcycle Rally represents the perfect storm for a superspreader event across this region: a large gathering with no testing, no masks, and no vaccination requirements. Though many (but not all) of the goings-on occurred outdoors and thus offered more protection against SARS-CoV-2 transmission than if they hadn’t been, the South Dakota Department of Transportation reported that 525,768 vehicles entered Sturgis over the 10 days of the rally. The sheer number of people in attendance paired with a lack of additional precautions presented prime conditions for viral transmission.
Dr. Shankar Kurra, vice president of medical affairs at Monument Health in Rapid City, told The Daily Beast he was living through a nightmare on repeat.
“We knew this was going to happen,” Dr. Kurra said. “It happened last year. It was just playing a reboot of last year pretty much.”
Kurra added that hospitals in the area had 58 patients battling COVID-19 as of early this week. Before the rally, they had “a handful, five to 10,” he said."
Source: https://www.thedailybeast.com/sturgis-rally-is-what-a-vaccine-era-coronavirus-superspreader-event-looks-like
Commentary: Who would have thought putting half a million mostly unvaccinated people together in one spot would have caused issues again? My sympathies go out to all the healthcare personnel who have to deal with this again.
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About 30% of the USA population had COVID by EOY 2020. "The COVID-19 pandemic disrupted health systems and economies throughout the world during 2020 and was particularly devastating for the United States, which experienced the highest numbers of reported cases and deaths during 20201–3. Many of the epidemiological features responsible for observed rates of morbidity and mortality have been reported4–8; however, the overall burden and characteristics of COVID-19 in the United States have not been comprehensively quantified. Here we use a data-driven model-inference approach to simulate the pandemic at county-scale in the United States during 2020 and estimate critical, time-varying epidemiological properties underpinning the dynamics of the virus. The pandemic in the US during 2020 was characterized by national ascertainment rates that increased from 11.3% (95% credible interval (CI):8.3 – 15.9%) during March to 24.5% (18.6 – 32.3%) during December. Population susceptibility at year’s end was 69.0% (63.6 – 75.4%), indicating that roughly one third of the US population had been infected. Community infectious rates, the percentage of people harbouring a contagious infection, rose above 0.8% (0.6 – 1.0%) before the end of the year, and were as high as 2.4% in some major metropolitan areas. In contrast, the infection fatality rate fell to 0.3% by year’s end."
Source: https://www.nature.com/articles/s41586-021-03914-4
Commentary: These numbers could indicate that reinfection might be a bigger problem than we think. If you have a population that's had the disease, and add in the 51.6% of people fully vaccinated, and assume maybe half overlap, you'd be somewhere in the 65% range of people who should have immunity. Yet the Delta variant is running rampant now. So either the model is incorrect - which is possible - or Delta is also reinfecting people who had the wildtype variant in early and mid 2020. We'll find out as time goes on. In the meantime, mask up.
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A reminder of the simple daily habits we should all be taking.
1. Wear the best mask available to you when you'll be around people you don't live with, even after you've been vaccinated. Respirators are back in stock at online retailers, too. Wear an N95/FFP2/KN95 that's NIOSH-approved or better mask if you can obtain it. If you can't get an N95 mask, wear a surgical mask with a cloth mask over it.
2. Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
3. Get vaccinated as soon as you're able to, and fulfill the full vaccine regimen. Remember that you are not vaccinated until everyone you live with is vaccinated. If you received an adenovirus vaccine (J&J/AstraZeneca), consider getting an mRNA single shot booster (Pfizer/Moderna) if permitted.
4. Wash/sanitize your hands every time you are in or out of your home.
5. Stay out of indoor spaces that aren't your home and away from people you don't live with as much as practical. Minimize your contact with others and avoid indoor places as much as you can; indoor spaces spread the disease through aerosols and distance is less effective at mitigating your risks.
6. Aim to have 3-6 months of living expenses on hand in case the pandemic gives another crazy plot twist to the economy.
7. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
8. 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).
9. Masks must fit properly to work. Here's how to properly fit a mask:
10. If you think you may have been exposed to COVID-19, purchase a rapid antigen test. This will detect COVID-19 only when you're contagious, so follow the directions clearly. https://amzn.to/3fLAoor
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Common misinformation debunked!
There is no basis in fact that COVID-19 vaccines can shed or otherwise harm people around you.
Source: https://www.reuters.com/article/factcheck-covid19vaccine-reproductivepro-idUSL1N2MG256
There is no mercury or other heavy metals in the Pfizer mRNA vaccine.
Source: https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
There is no basis in fact that COVID-19 vaccines pose additional risks to pregnant women.
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2104983
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/
Source: https://www.smh.com.au/national/are-we-ignoring-the-hard-truths-about-the-most-likely-cause-of-covid-19-20210601-p57x4r.html
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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Disclosures and Disclaimers
I declare no competing interests on anything I share related to COVID-19. I am employed by and am a co-owner in TrustInsights.ai, an analytics and management consulting firm. I have no clients and no business interests in anything related to COVID-19, nor do I financially benefit in any way from sharing information about COVID-19.
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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.