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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Commentary:
We're in quite the situation at the moment in the United States, what with one of the strongest storms ever to make landfall hitting the Gulf Coast, wildfires raging in the West Coast, and police and vigilantes shooting citizens without just cause - all during a pandemic that, as one virologist said yesterday, is something we talk about in the present tense, not past tense.
This underscores the urgency of ensuring you are well-prepared. For those in North America, top off your gas tanks. We don't know the extent, if any, of damage done to the largest oil refining region in the continent. Though the infrastructure in the impacted area is geared to deal with hurricanes, "strongest ever" will become a normal phrase, just as "warmest ever" has become - and infrastructure designed to solve the problems of yesteryear may prove inadequate for today and tomorrow.
If you're dealing with wildfires and particulates, make sure your masks are regularly cleaned and if they have filters, that you're checking the filters for decreased efficiency. Make sure you have replacements on hand - a smoky environment will clog an N95/P100 filter within days even with light usage.
And as always, be prepared to deal with whatever else 2020 wants to throw at us. Onto the news.
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Additional testing of masks and face coverings. "As illustrated in Figures 1 and 2, there were significant differences in particle emissions between breathing, talking and singing (Friedman test for emitted aerosol particle mass, p < 0.0001). Soft singing generated significantly more aerosol particles than normal talking (p = 0.002). Loud singing produced more particles than soft singing (p = 0.002). Figure 1 illustrates mass emission rates. Median (range) aerosol particle number emission rates were: 270 (120-1380) particles/s for normal talking, 570 (180-1760) particles/s for loud talking, 690 (320-2870) particles/s for normal singing, 980 (390-2870) particles/s for loud singing, and 1480 (500-2820) particles/s for loud singing with exaggerated diction. For loud singing with a facemask, the emission rate was 410 (200-1150) particles/s. Hence, a simple facemask reduced the amount of generated aerosol particles from singing to a level similar to normal talking (no significant difference, p = 0.08).
Singing generated more respiratory aerosol particles and droplets than talking. Exhaled aerosol particles and droplets increased with song loudness. The data also indicated that emissions might increase at high pitch. Wearing an ordinary surgical facemask reduced the amount of measured exhaled aerosol particles and droplets to levels comparable with normal talking. However, as surgical masks have a loose fit, some particles may have exited on the sides where we did not measure. Based on these results, singing in groups is likely to be an activity at risk of transmitting infection if not appropriate control and prevention measures are applied, such as distancing, hygiene, ventilation and shielding."
Source: https://www.tandfonline.com/doi/full/10.1080/02786826.2020.1812502
Commentary: Remember that masks reduce, but do not eliminate, the chance of infection. If you have to be in a space with loud talking and singing, wear the best mask you can, and withdraw from that space as soon as possible.
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Asymptomatic transmission on an airplane. "This study was one of the earliest to assess asymptomatic transmission of COVID-19 on an aircraft. Previous studies of inflight transmission of other respiratory infectious diseases, such as influenza and severe acute respiratory syndrome, revealed that sitting near a person with a respiratory infectious disease is a major risk factor for transmission (6,7), similar to our own findings. Considering the difficulty of airborne infection transmission inflight because of high-efficiency particulate-arresting filters used in aircraft ventilation systems, contact with contaminated surfaces or infected persons when boarding, moving, or disembarking from the aircraft may play a critical role in inflight transmission of infectious diseases (6,7).
Previous studies reported that viral shedding can begin before the appearance of COVID-19 symptoms (8,9), and evidence of transmission from presymptomatic and asymptomatic persons has been reported in epidemiologic studies of SARS-CoV-2 (5,10,11). Because KCDC performed strong infection control procedures during boarding; the medical staff and crew members were trained in infection control; all passengers, medical staff, and crew members were tested twice for SARS-CoV-2; and a precise epidemiologic investigation was conducted, the most plausible explanation for the transmission of SARS-CoV-2 to a passenger on the aircraft is that she became infected by an asymptomatic but infected passenger while using an onboard toilet. Other, less likely, explanations for the transmission are previous SARS-CoV-2 exposure, longer incubation period, and other unevaluated situations."
Source: https://wwwnc.cdc.gov/eid/article/26/11/20-3353_article
Commentary: This is the key sentence. "the most plausible explanation for the transmission of SARS-CoV-2 to a passenger on the aircraft is that she became infected by an asymptomatic but infected passenger while using an onboard toilet". Toilets are giant germ warheads. Every time you flush one, you release a cloud of aerosol particles into the air, what is effectively a giant, massive sneeze. COVID-19 spreads through a variety of means including fecal matter, so if you have to use a public restroom, wear the best mask available and sanitize yourself entirely after doing so as soon as possible with a thorough shower using lots of soap and water.
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Mass testing in prisons reveals a 12x worse problem than originally thought. "SARS-CoV-2 outbreaks in correctional and detention facilities are difficult to contain because of population-dense housing and limited space for medical isolation and quarantine. Testing in these settings has often been limited to symptomatic persons.
Mass testing in 16 U.S. prisons and jails found SARS-CoV-2 prevalence ranging from 0%–86.8%, a median 12.1-fold increase over the number of cases identified by earlier symptom-based testing alone. Median prevalence was three times higher in dormitory-based than in cell-based housing.
In correctional and detention facilities, broad-based SARS-CoV-2 testing provides a more accurate assessment of disease prevalence than does symptom-based testing and generates data that can potentially help control transmission."
Source: https://www.cdc.gov/mmwr/volumes/69/wr/mm6933a3.htm?s_cid=mm6933a3_w
Commentary: Note this sentence: "Median prevalence was three times higher in dormitory-based than in cell-based housing." Who else lives in dormitories?
College students.
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How well did herd immunity work? Sweden records the highest death tally in 150 years. "Sweden, which has stood out among European countries for its low-key approach to fighting the coronavirus pandemic, has recorded its highest tally of deaths in the first half of 2020 for 150 years, the Statistics Office said.
Covid-19 claimed about 4,500 lives in the period to the end of June – a number that has now risen to 5,800 – a much higher percentage of the population than in other Nordic nations, though lower than in some others, including Britain and Spain.
In total, 51,405 Swedes died in the six-month period, a higher number than in any year since 1869, when 55,431 people died, partly as a result of a famine. The population of Sweden was about 4.1 million then, compared with 10.3 million now.
Covid-19 meant that deaths were about 10% higher than the average for the period over the last five years, the office said on Wednesday. In April the number of deaths was almost 40% higher than average due to a surge in Covid-related fatalities.
Sweden has taken a different approach to most European countries in dealing with the pandemic, relying to a greater extent on voluntary measures focused on social distancing and opting against a strict lockdown.
Most schools have remained open and many businesses have continued to operate to some extent, meaning the economy has fared better than many others.
However, the death toll has been higher than in its Nordic neighbours, which opted for tougher lockdown measures. Norway, with about half Sweden’s population, has had only about 260 Covid deaths in total.
The economy of Finland also outperformed its larger neighbour in the second quarter, despite a tougher lockdown. Finland’s gross domestic product shrank by 5% against an 8.6% contraction in Sweden from the previous three-month period."
Source: https://www.theguardian.com/world/2020/aug/19/sweden-records-highest-death-tally-in-150-years-in-first-half-of-2020
Commentary: Sweden's approach was the worst of both worlds. More citizens became ill and died than their neighbors, and their economy took a bigger hit than their neighbors, demonstrating that you cannot simply "open up" to save the economy. Lives lost and disabled have a significant impact on the economy; the two are intertwined. Save lives, save the economy.
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The CDC guidance for reducing asymptomatic testing did not come from the CDC. "The day after the Centers for Disease Control and Prevention issued the revised guidance, there were conflicting reports on who was responsible.
Two federal health officials said the shift came as a directive to the C.D.C. from higher-ups at the White House and the Department of Health and Human Services.
Adm. Brett P. Giroir, the administration’s coronavirus testing czar, called it a “C.D.C. action,” but he acknowledged that the revision came after a vigorous debate among members of the White House coronavirus task force — including its newest member, Dr. Scott W. Atlas, a frequent Fox News guest and a special adviser to President Trump.
Regardless of who was responsible, the shift is highly significant, running counter to scientific evidence that people without symptoms may be the most prolific spreaders of the virus."
Source: https://www.nytimes.com/2020/08/26/world/covid-19-coronavirus.html
Commentary: Scientific evidence has not changed. Asymptomatic, pre-symptomatic, and symptomatic people all spread COVID-19. Testing needs to continue and increase to identify
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A reminder from May 21 that FEMA will have reduced operational capacity in disaster areas due to the pandemic. "While COVID-19 morbidity and mortality persist, FEMA will generally minimize the number of personnel deploying to disaster-impacted areas and minimize the number of new field deployments by using personnel already deployed to the impacted region, including FEMA Integration Team (FIT) members or other FEMA personnel already working at EOCs, deploying locally-available personnel, and leveraging remote disaster support. FEMA Regional Administrators, in partnership with FEMA Headquarters (HQ), will evaluate risk in their regions and determine the most appropriate approach to deployments while considering the guidance and direction of public health officials and the factors established in the White House Guidelines."
Source: https://www.fema.gov/media-library-data/1589997234798-adb5ce5cb98a7a89e3e1800becf0eb65/2020_Hurricane_Pandemic_Plan.pdf
Commentary: Expect already anemic responses from the US federal government to be even more so. Evaluate what natural disasters the region you live in is prone to, and prepare for them under the assumption that no one will come to help you. How would you prepare, knowing you're on your own? What choices and plans will you make?
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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.