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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Second dose safer for those allergic to the first dose. "There were 189 patients who participated in this study (mean [SD] age, 43 (14) years; 163 women [86%]) (Table). Of the mRNA COVID-19 vaccine first-dose reactions evaluated, 130 (69%) were to Moderna and 59 (31%) to Pfizer-BioNTech. The most frequently reported first-dose reactions were flushing or erythema (53 [28%]), dizziness or lightheadedness (49 [26%]), tingling (46 [24%]), throat tightness (41 [22%]), hives (39 [21%]), and wheezing or shortness of breath (39 [21%]). Thirty-two (17%) met anaphylaxis criteria.
A total of 159 patients (84%) received a second dose. Antihistamine premedication before the second dose was given in 47 patients (30%). All 159 patients, including 19 individuals with first-dose anaphylaxis, tolerated the second dose. Thirty-two (20%) reported immediate and potentially allergic symptoms that were associated with the second dose that were self-limited, mild, and/or resolved with antihistamines alone.
This multisite US study supports the safety of Pfizer-BioNTech or Moderna vaccine second dose administration in patients who report immediate and potentially allergic reactions after the first dose. Although mild symptoms were reported in 20% of patients with second dose administration, all patients who received a second dose safely completed their vaccination series and could use mRNA COVID-19 vaccines in the future when indicated. Second dose tolerance following reactions to the first dose argues that either many of these initial reactions are not all truly allergic reactions, or supports an allergic, but non–immunoglobulin E–mediated mechanism in which symptoms can typically be abated with premedications.6"
Source: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2782348
Commentary: Good news for anyone who had a reaction to the mRNA first dose. Go and get your second dose if you haven't already.
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Rapid mass vaccination works. "This retrospective observational study examined COVID-19 vaccine effectiveness at the population level in the district of Schwaz, an early VoC hotspot that became one of the first highly vaccinated regions in Europe. Our study design is based on several comparisons. We used a control group of districts highly similar to Schwaz regarding many population characteristics, as well as zoomed in on border municipalities residing just outside of the treated district. We first documented a massive vaccine uptake that raised coverage from around 10% to more than 70% of the adult population within the 5 days of the local mass vaccination campaign in March. Our analysis revealed that this massive rollout of BNT162b2 mRNA vaccine was associated with a significant reduction in new SARS-CoV-2 infections of around 60% relative to the control districts. We find similar, although somewhat lower, significant reductions in
B.1.351 and B.1.1.7/E484K cases. During the time period of our study (up to June 2021), we also observed a small number cases of the B.1.617.2 variant in the control districts but none in Schwaz. Our results suggest that the rapid mass vaccination campaign was successful in curbing the local outbreak of two major VoCs. Our analysis also showed that the drop in cases followed a significant reduction in hospital as well as ICU admissions associated with SARS-CoV-2. Finally, we found the biggest effect of this population-wide vaccine roll-out to occur among younger age cohorts, a mostly unvaccinated demographic group in our control districts (due to the prioritization of older age groups in the national vaccination plan)."
Source: https://assets.researchsquare.com/files/rs-741944/v1_covered.pdf?c=1627148808
Commentary: This is the strategy everyone should be using. At the first sign of trouble, before community spread can get underway, charge in and vaccinate everyone as quickly as possible. Yes, vaccines take time to work. That's why you do it as soon as you have 1 case, not when you have 100. By the time spread accelerates, enough time has passed for the vaccine to put up a firewall.
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The kind of mask matters. "The debate over masks is heating up again, with increasing calls for all Americans, regardless of coronavirus vaccination status, to return to wearing face coverings in indoor public places to help thwart the spread of the highly contagious delta variant. But some experts say the recommendations should specify the kind of masks people should be using.
“Delta is so contagious that when we talk about masks, I don’t think we should just talk about masks,” Scott Gottlieb, former commissioner of the Food and Drug Administration, said during a recent appearance on CBS’s “Face the Nation.” “I think we should be talking about high-quality masks,” such as N95 respirators.
In an interview with The Washington Post, Monica Gandhi, a professor of medicine and an infectious-disease expert at the University of California at San Francisco, expressed a similar sentiment: “We can’t say we’re going back to masks without discussing type of mask.”
Vaccinations, experts emphasized, remain the first line of defense against the coronavirus. “Far and away the best prevention we have are still the vaccines,” said Paul Sax, clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital in Boston. “All of these things pale in comparison to getting the remaining people who are eligible for vaccination vaccinated.”
But amid concerns about the rapid spread of the delta variant, “it’s a fantastic idea at this point in time to move toward higher-quality masks,” especially if you’re unvaccinated or otherwise vulnerable to severe disease, said Chris Cappa, an environmental engineer and professor at the University of California at Davis. And for fully vaccinated individuals who may still be at risk of breakthrough infections, he noted, “the delta variant is a good reminder that we shouldn’t necessarily quit wearing masks when we’re in environments that might be prone to transmission.”
The efficacy of a mask is based on its material and fit. Medical-grade respirators, such as N95 masks, can provide greater protection from infectious coronavirus particles than surgical masks or cloth masks, said Linsey Marr, an aerosol expert at Virginia Tech who studies airborne virus transmission."
Source: https://www.washingtonpost.com/lifestyle/wellness/n95-mask-delta-variant-kn95/2021/07/23/ee849e6c-eafe-11eb-97a0-a09d10181e36_story.html
Commentary: As we've been saying for over a year: wear the best mask available to you, properly. N95 masks or better are back in stock at major retailers.
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mRNA vaccines boost responses. "Currently approved viral vector-based and mRNA-based vaccine approaches against coronavirus disease 2019 (COVID-19) consider only homologous prime-boost vaccination. After reports of thromboembolic events, several European governments recommended using AstraZeneca’s ChAdOx1-nCov-19 (ChAd) only in individuals older than 60 years, leaving millions of already ChAd-primed individuals with the decision to receive either a second shot of ChAd or a heterologous boost with mRNA-based vaccines. However, such combinations have not been tested so far. We used Hannover Medical School’s COVID-19 Contact Study cohort of healthcare professionals to monitor ChAd-primed immune responses before and 3 weeks after booster with ChAd (n = 32) or BioNTech/Pfizer’s BNT162b2 (n = 55). Although both vaccines boosted prime-induced immunity, BNT162b2 induced significantly higher frequencies of spike-specific CD4+ and CD8+ T cells and, in particular, high titers of neutralizing antibodies against the B.1.1.7, B.1.351 and P.1 variants of concern of severe acute respiratory syndrome coronavirus 2."
Source: https://www.nature.com/articles/s41591-021-01449-9
Commentary: It's not surprising that the mRNA vaccine boosted immunity further than the adenovirus vaccine. The mRNA vaccines have proven to be rockstars. If you got an adenovirus vaccine, ask your healthcare provider about an mRNA booster.
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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 other people, 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 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. Get your personal finances in order now. Cut all unnecessary costs.
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:
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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.