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 a qualified healthcare provider who knows your specific medical situation over advice from people on the Internet.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.
You are welcome to share this.
---
More doses for Africa. "The African Union (AU) intends to buy up to 110 million doses of COVID-19 vaccine from Moderna Inc in an arrangement brokered in part by the White House, which will defer delivery of some doses intended for the United States to facilitate the deal, officials told Reuters.
The AU's doses will be delivered over the coming months, with 15 million arriving before the end of 2021, 35 million in the first quarter of next year and up to 60 million in the second quarter.
"This is important as it allows us to increase the number of vaccines available immediately," AU coronavirus envoy Strive Masiyiwa said in an email. "We urge other vaccine producing countries to follow the lead of the (U.S. government) and give us similar access to buy this and other vaccines."
The Moderna purchase is the second time that the AU has agreed with a pharmaceutical company to buy COVID-19 vaccines. It reached a deal in March with Johnson & Johnson (JNJ.N) for up to 400 million doses.
With the exception of the J&J deal, the AU had not had access to vaccine purchases, Masiyiwa told a virtual news conference."
Source: https://www.reuters.com/world/africa/exclusive-african-union-buy-up-110-million-moderna-covid-19-vaccines-officials-2021-10-26/
Commentary: This is a good start but much more is needed. And no worries in the USA, we're currently floating in excess vaccine stock that people aren't taking.
---
Progress on identifying COVID-19 warning indicators. "The drivers of critical coronavirus disease 2019 (COVID-19) remain unknown. Given major confounding factors such as age and comorbidities, true mediators of this condition have remained elusive. We employed a multi-omics analysis combined with artificial intelligence in a young patient cohort where major comorbidities were excluded at the onset. The cohort included 47 “critical” (in the intensive care unit under mechanical ventilation) and 25 “non-critical” (in a non-critical care ward) patients with COVID-19 and 22 healthy individuals. The analyses included whole-genome sequencing, whole-blood RNA sequencing, plasma and blood mononuclear cells proteomics, cytokine profiling, and high-throughput immunophenotyping. An ensemble of machine learning, deep learning, quantum annealing, and structural causal modeling were employed. Patients with critical COVID-19 were characterized by exacerbated inflammation, perturbed lymphoid and myeloid compartments, increased coagulation, and viral cell biology. Among differentially expressed genes, we observed up-regulation of the metalloprotease ADAM9. This gene signature was validated in a second independent cohort of 81 critical and 73 recovered patients with COVID-19, and were further confirmed at the transcriptional and protein level as well as by proteolytic activity. Ex vivo ADAM9 inhibition decreased severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uptake and replication in human lung epithelial cells. In conclusion, within a young, otherwise healthy, cohort of individuals with COVID-19, we provide the landscape of biological perturbations in vivo where a unique gene signature differentiated critical from non-critical patients. We further identified ADAM9 as a driver of disease severity and a candidate therapeutic target."
Source: https://www.science.org/doi/10.1126/scitranslmed.abj7521
Commentary: Eventually, we'll get to a point where disease severity indicators for a number of diseases become common - something that will help target and refine medicine even further. Someone with the ADAM9 genetic market might need a booster shot sooner, for example, than someone without it from a risk management and triage perspective. Let's hope this level of research continues and expands.
---
Why is Delta so contagious? "The Delta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has outcompeted previously prevalent variants and become a dominant strain worldwide. We report the structure, function, and antigenicity of its full-length spike (S) trimer and those of the Gamma and Kappa variants and compare their characteristics with the G614, Alpha, and Beta variants. Delta S can fuse membranes more efficiently at low levels of cellular receptor ACE2, and its pseudotyped viruses infect target cells substantially faster than the other five variants, possibly accounting for its heightened transmissibility. Each variant shows different rearrangement of the antigenic surface of the N-terminal domain of the S protein, but only causes local changes in the receptor-binding domain (RBD), making the RBD a better target for therapeutic antibodies."
Source: https://www.science.org/doi/10.1126/science.abl9463
Commentary: Basically, Delta is stickier and can attach to us faster, with less effort than other strains. That stickiness means not only easier infection, but also easier transmissibility - it takes less Delta to infect us than other variants.
---
Still no link between vaccination and miscarriage. "A new study published in the New England Journal of Medicine reports that pregnant women who had recently received a Covid-19 vaccine did not have higher odds of a miscarriage compared to unvaccinated controls who were also pregnant at the same time.
Pregnant women are often excluded from clinical trials, including ones that studied the Covid-19 mRNA vaccines by Pfizer and Moderna. Because pregnant women are often not studied in clinical trials, it takes longer for experts to be able to confidently say that a medicine or vaccine is safe for them.
But during the Covid-19 pandemic, many of what scientists call “natural experiments” have occurred. In this case, thousands of women in Norway received a Covid-19 vaccine before they were aware of being pregnant. (Some others were aware of being pregnant but had chosen to be vaccinated because of important risk factors). This gave scientists the opportunity to compare first-trimester miscarriage rates among women who had received a Covid-19 vaccine in the previous 3 or 5 weeks to those who had not been vaccinated during that time. The rates were the same and similar to those normally detected by researchers, which hovers between 10-25%.
Many people are surprised that miscarriage rates are that high in general. But the reality is that many early pregnancies end in miscarriage (or “spontaneous abortion,” another medical term for a miscarriage) that go undetected. Frequently, early pregnancies that end in miscarriage are attributed to a “late period.” The earlier a pregnancy is, the higher the odds of a miscarriage are.
Several previous studies have also found no link between the Covid-19 vaccines and miscarriage rates. But this particular study leveraged Norway’s national databases that report on 1st trimester pregnancies, Covid-19 vaccination status, and other demographic features. This allowed the research scientists to compare pregnant women who had been recently vaccinated to those who had not been vaccinated. This type of study is called a “case-control,” and while it is not quite as informative as a truly randomized trial in which some participants are selected to receive a treatment or vaccine and others are not, it is considered a reliable study design for questions of this nature.
This new research should re-assure women who are pregnant and wondering about whether the Covid-19 vaccines are safe. They are. The last thing a pregnant person wants to do is anything that could be risky to their body or their pregnancy. The good news is that, yet again, scientists have found that vaccinating against Covid-19 is safe (and also, as I’ll discuss in a moment, highly beneficial)."
Source: https://insidemedicine.bulletin.com/607489883740001/
Commentary: If you know someone pregnant who has not been vaccinated yet, get them there if you can.
---
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
---
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
---
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.
---
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.