Lunchtime Pandemic Reading, 26-February-2021
You're in greater danger from getting TO the vaccine
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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Food for thought on a Friday afternoon, especially for event planners. While you might not be able to, or want to completely prohibit unvaccinated people from attending events, nothing says you can't charge different prices, because unvaccinated people pose a legitimate insurance risk to the event when a countermeasure is available. Once vaccine waiting lists are over - and that's coming sooner rather than later - and everyone who wants a COVID-19 vaccination can easily get one, then you could have pricing that says something like:
- Fully-vaccinated ticket (must show proof of vaccination at time of purchase) : $499
- Non-vaccinated ticket : $2,499
That way you respect that some people may not want to make that choice, but you pass on the additional insurance costs to those individuals who are willingly taking higher risks.
Again, not something that can be done until vaccines are so available that you get asked if you want one for free while you're checking out at CVS or the grocery store, but once it's so plentiful, it's an option.
This could apply to many different venues and places, too. Restaurants could add a non-vaccinated fee to the tab, as well as offering bonus incentives to patrons - free appetizer with your vaccine card! - along with bars, gatherings, etc. There are lots of ways to subtly or not so subtly encourage public health compliance, with the goal of getting as many people vaccinated as possible.
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We are beginning to see the B.1.1.7 bounce. "⚠️Global case decline has reversed—#COVID19 is once again surging overall worldwide / no longer dropping. Especially in Europe where the more contagious #B117 variant is driving faster spread & helping launch another wave (as I’ve been shouting at the rooftops for last month). 🧵
2) Denmark is the perfect example — they knew it was coming with the #B117 dominance. They knew it was inevitable but nobody listened.
3) Denmark CDC warned us in January to not be complacent
4) Others have also tried to warn. Models by @GosiaGasperoPhD also warned of the impending menace of #B117 in triggering a new wave if it replaces the old slower common type.
5) With #B117 more contagious, what used to work to contain the old may not work anymore. Denmark has been having trouble now too once #B117 has surpassed old strain and become dominant. Vaccine rollout not fast enough in most places.
6) #B117 in Florida is one of my biggest worries. It will likely dominate by late March across the US, but possibly sooner in Florida
Source:
Commentary: This is alarming but unsurprising. B.1.1.7 and other strains are not only supplanting the existing wildtypes, but are beginning to gain leverage. Despite all the news about them thus far, they haven't really gotten going (such is the nature of exponential growth) in a way that attracts attention. Their growth has been masked by the decline of the wildtypes thanks to improved NPIs and the rollout of vaccines - but many nations still haven't vaccinated more than a tiny minority of their population. We may or may not be on the verge of another big surge - it all depends on compliance with things like mask-wearing (and wearing them PROPERLY) and vaccine rollout.
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Shit happens. "The authors found multiple SARS-CoV-2 genotypes in sewage known to be present in local communities. Assembled whole genomes from wastewater samples matched published genomes from clinical samples. In addition, the majority of individual variants (even those at low frequencies) detected within wastewater samples were also observed in patient-derived genomes from California, and that variants found in two or more samples were 2.3 times more likely to be observed in California or US patient-derived genomes than variants observed only once. This suggests that the variation observed in wastewater samples is representative of the SARS-CoV-2 variation circulating in the sampled population — individuals in Alameda and Marin counties, California. The authors also found evidence of new variants not yet found in patient-derived samples from California and suggested that these variants may be detected in clinical patient samples in the near future. On a technical side, the authors addressed the difficulties inherent to isolating virus in wastewater samples, and reported that both the RNA extraction method and the initial concentration of SARS-CoV-2 in the sample have a significant effect on genome recovery and coverage."
Source: https://ncrc.jhsph.edu/research/genome-sequencing-of-sewage-detects-regionally-prevalent-sars-cov-2-variants/
Commentary: This is an important finding - that sewage wastewater can be used to detect previously unknown variants of SARS-CoV-2. By focusing on areas with high caseloads, scientists may be able to detect new strains of the virus without needing to sequence every test out there. Sewage is a good, albeit gross, representative sample of a population's infections.
I'm hopeful that this is one of the dividends of this pandemic - wastewater analysis could be used to detect a number of different things, from viruses like SARS-CoV-2 to drug usage within a community. Because it's aggregated, it's not personally identifying - you'd know, for example, a general idea of how much cocaine usage was in a community, but you'd protect the privacy of individuals in a general wastewater analysis. That would give plenty of public health insights about the overall state of a community. If this technology gets rolled out wider, we could see rich data insights without worrying about compromising individuals' sensitive healthcare data.
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How safe are vaccines? "Since routine vaccination began, there have been rare reports of anaphylaxis, a type of severe allergic reaction, associated with injection of the vaccines. From data collected in the USA, where both the Pfizer-BioNTech and Moderna vaccines are used, we know that an anaphylactic reaction occurs after about 1 in 213,000 doses of the Pfizer-BioNTech vaccine and about 1 in 400,000 doses of the Moderna vaccine. These rates of anaphylaxis are higher than the 1.3 per million seen with flu vaccination, but considerably lower than the 1 per 5000 associated with the common antibiotic penicillin. Many of the people who had anaphylactic reactions had a history of allergy, and they are reported to have recovered after treatment. In the UK, through the MHRA Yellow Card reporting system, which monitors adverse reactions potentially related to vaccination, there have been 101 reports of anaphylaxis after giving about 6 million doses of the Pfizer-BioNTech vaccine (about 1 in 60,000), and 13 reports of anaphylaxis after about 1.5 million doses of the Oxford-AZ vaccine (about 1 in 115,000). All UK vaccine recipients who experienced anaphylaxis have recovered. As a precaution against a rare anaphylactic reaction, you might be asked to wait for 15 mins after being vaccinated before leaving the clinic."
Source: https://sdgresources.relx.com/features/how-safe-are-vaccines-against-covid-19-insights-john-mcconnell-editor-lancet-infectious
Commentary: To put this in context, the chances of you having some kind of severe adverse reaction to the vaccines is about 1 in 60,000. The chances of you getting into a car accident of some kind on the way to get the vaccine is about 1 in 6533 for any given day. You are 10 times more likely to incur harm from getting TO getting your vaccine than you are from getting the vaccine itself. They are among the safest things you'll do on any given day.
(the traffic stat is that the average driver gets into an accident once every 18 years, or once every 6,533 days. source: https://coverhound.com/insurance-learning-center/how-often-are-people-filing-insurance-claims-and-for-how-much )
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What can you do in a partially vaccinated world? "This leaves us in an awkward situation. Getting vaccinated means that your choices no longer endanger you much, but they still might make you a risk to everyone else. To put this in more concrete terms: If a vaccinated person goes out to eat, they can’t yet be sure that they’re not carrying the virus and spreading it to their unvaccinated fellow diners and the restaurant staff, or that they won’t pick up the virus at the restaurant and bring it home to their unvaccinated family.
So, first, a very broad guideline for navigating a world in which vaccinations are rising and infections are dropping: Whether you’re vaccinated or not, how much you can safely branch out in your activities and social life depends on the baseline level of virus in your community. You can imagine that, in pandemic life, each of us has been dealt a certain number of risk points that we can spend on seeing friends outside, going to work, sending the kids to day care, and so on. If you or someone you live with is especially vulnerable to the virus, you might choose to spend fewer points by getting groceries delivered; if you live alone in an area where very few people are sick, you might choose to spend more points by forming a bubble with friends. The vaccine delivers you a huge number of bonus points, if you’re lucky enough to get one. And when spread of the virus is low, everyone gets more points.
Saskia Popescu, an infectious-disease epidemiologist at George Mason University, told me that everyone, vaccinated or not, should try to keep track of three metrics in your area: The number of new daily cases per 100,000 people, the rate at which people transmit the virus to one another, and the rate at which people test positive for the virus. Popescu said that there are no magic numbers that would immediately bring the country back to pre-COVID life, but she’ll feel better about reopening when we hit daily case rates of just one to two per 100,000, transmission rates of .5 or less, and test-positivity rates at or below 2 percent. (As of last week, no U.S. state had reached the trifecta, and the country as a whole is still far from it.) Many local public-health departments regularly provide these numbers.
That doesn’t mean that any loosening up is off the table for the vaccinated. Far from it—plenty of public-health experts have argued that vaccinated people safely seeing relatives or returning to the office can benefit everyone, because seeing how much the shot improves life will persuade more people to take it. Downplaying the vaccines’ success could discourage people from getting them, because if it won’t change their lives, they have no incentive.
The best way forward for us all is for vaccinated people to spend their extra risk points in ways that don’t put unvaccinated people in danger. As you consider whether you should do things that you wouldn’t have done before the vaccine, think creatively about how you can make those things safer for everyone involved. “Grandparents really want to be able to go hug their grandchildren,” Tara Kirk Sell, a senior scholar at the Johns Hopkins Center for Health Security, told me. “I don’t have a problem with that.” But consider asking Grandma and Grandpa to wear masks during that hug, or meet you outside, or avoid sleeping over. Throughout the pandemic, we’ve developed an arsenal of strategies to make particular settings and activities safer. The vaccine is an extra-strong weapon against transmission that some people can deploy, but that doesn’t mean they need to discard all of the other ones to use it."
Source: https://www.theatlantic.com/health/archive/2021/02/covid-19-vaccine-golden-rule/618140/
Commentary: We are making good progress towards reaching a state of vaccinated people. We just have to keep up our precautions for a few more months. Remember that 2021 is likely to be the mirror of 2020. Rough start to this year, but as long as we keep marching on, a solid second half with a full reopening by year's end. We'll still want to be wearing masks (I really enjoyed not getting the common cold at all this winter) and such, and we'll need COVID boosters like we need flu shots, but there is an end in sight.
For gatherings like families and such, once everyone in the family is vaccinated (and the vaccine is FULLY active, meaning 21 days after the last shot), it's totally safe to have a family gathering any time, as long as it's in a private setting. So that means for sure Christmas, Hanukkah, and Thanksgiving (US and Canadian) will likely be on for 2021, and depending on how fast your region rolls out vaccines, late summer and fall holidays could be on the table, too.
The end is in sight, if we can just maintain our vigilance for a little while longer.
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What about vaccines for kids? "Though Dr. Anthony Fauci, the White House chief medical adviser, predicted a COVID-19 vaccine may not be available for high schoolers until the fall and for younger kids until early next year, scientists and vaccine makers say studies are moving as quickly as possible to ensure the vaccines are safe and effective for the nation's children.
Pfizer and Moderna are in the midst of testing their vaccines in children and teen ages 12 to 15 and 12 to 17, respectively, and both companies expect to have data by June. Next, the companies will start testing their vaccines in progressively younger ages groups. Currently, the Pfizer-BioNTech vaccine is authorized for persons 16 and older, and Moderna's vaccine is authorized for those 18 and older.
Experts say it's crucial to test vaccines in children through carefully designed studies. Children are not simply smaller adults, meaning it's not safe to assume that any drug or vaccine that works well for adults will also be highly safe and effective in children.
However, unlike adult vaccine trials, researchers won't have to enroll tens of thousands of volunteers and wait for some to become infected as they go about their daily lives. Instead, they enroll a few thousand volunteers and analyze their blood to ensure the vaccine is doing its job of provoking an appropriate immune system response.
That means experts predict the trials will progress faster than those for adults. It likely take a few weeks, rather than months, to see results.
"We are looking mostly for safety and immune responses generated, which correlates with vaccine effectiveness over large numbers," said Dr. Todd Ellerin, an ABC News contributor and infectious disease specialist at South Shore Health.
The immune responses in children will be compared to the immune responses generated in adults following vaccination.
"In general, kids have an equal or greater immune response compared to adults," Ellerin said.
The way COVID-19 vaccines are being tested in children mirrors the way other vaccines have been tested in children in the past, with researchers monitoring for any new safety concerns in children.
"Clinical outcome data will still be collected, but these trials are primarily concerned with adverse events and immune (or antibody) responses," said Dr. Michael Chang, a pediatric infectious disease specialist with McGovern Medical School at UTHealth in Houston."
Source: https://abcnews.go.com/Health/covid-19-vaccine-testing-children-scientists/story?id=76049115
Commentary: Given that we have never deployed in production mRNA vaccines before, it's unsurprising that we don't have good reference data for kids. That said, based on how at least the Pfizer and Moderna drugs work - by training the immune system to recognize the components of the virus - it stands to reason kids might even do better than adults with the mRNA vaccines (and probably about the same with non-mRNA vaccines). That could mean they'd need even less of a dose than adults. We'll see what happens, but I would expect encouraging results given how massively safe the mRNA vaccines have been for adults.
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A reminder of the simple daily habits we should all be taking.
1. Always wear the best mask available to you when out of your home and you'll be around other people. 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. Get vaccinated as soon as you're able to.
3. Wash/sanitize your hands every time you are in or out of your home for any reason.
4. 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.
5. Get your personal finances in order now. Cut all unnecessary costs.
6. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
7. 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).
8. Masks must fit properly to work. Here's how to properly fit a mask:
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Common misinformation debunked!
There is no mercury or other heavy metals in the Pfizer mRNA vaccine. https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
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.