Lunchtime pandemic reading.
Standard disclaimer: this is a roundup of informative pieces I've read that interest me on the severity of the crises and how to manage them. 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.
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This past weekend, I ate inside a restaurant in New York City. Why on earth would I do that? Here was the decision-making process I went through.
First, I carry a portable CO2 meter with me. Inside the restaurant, the CO2 PPM levels were around 750 PPM. Above 800, there's probably a ventilation problem and it's probably not safe to eat in that place.
Second, before I left for NYC, I checked their COVID wastewater data. While COVID is still quite present, it was on a significant downswing from the holidays.
Third, the restaurant was a Korean barbecue. Inside, there were a few other patrons (but not many, about 8 total in a restaurant that can easily seat 60 by my count) with the individual barbecues going at their tables. Why is this context important? Because there was no smoke in the air despite active cooking, which meant the restaurant's ventilation was really good.
And fourth, when I sat down at my table (I specifically requested to be away from other patrons), I noticed something about my paper napkin on the table.
It was fluttering.
After a minute or so, I felt a cold draft from the outside, followed by a blast of warm air; the particular table I was at was next to an air vent. The icy cold air wasn't coming from another part of the restaurant, it was coming from the outdoors.
It was at that moment that I knew the restaurant - at least the table I was at - was reasonably safe to eat at. Good CO2 numbers, obvious visible evidence of ventilation, and ventilation with outside air - that's a winning combination. If you can find similar kinds of restaurants that test just as well, they are reasonably safe to eat in.
And if you're a business owner, one of the best things you can do to make your business safe for both employees and customers is to provide substantial ventilation with outside air. Fresh air has multiple benefits, well beyond COVID mitigation.
More strong evidence of microclots and long COVID.
"COVID-19 infections have been associated with coagulation deficits from the very beginning of the pandemic. It seems to do this by disrupting the endothelium, or the single layer of cells that line all of our blood vessels.
A group of researchers have found miniature blood clots in acute COVID-19 patients, as well as patients with long COVID. The clots are made up of a protein called fibrin that has taken on an anomalous, or amyloid, structure. Essentially, something changed the physical structure of fibrin to make it sticky, and prevent it from being broken down efficiently. These tiny clots aren’t large enough to block blood vessels, but can occlude capillaries, which is the major site of oxygen exchange for our tissues.
Researchers found that the S1 portion of the spike protein is sufficient to induce microclot formation in samples from healthy patients.
While both acute and long COVID patients have microclots, the clots in long COVID patients contained more inflammatory markers that can also contribute to altered coagulation processes.
Preliminary reports indicate 100% of long COVID patients have detectable microclots. Current research is being done to see if microclots can serve as a diagnostic biomarker for long COVID, and whether they correlate with certain symptoms or symptom severity.
Microclots could serve as a type of “underlying mechanism” in long COVID, as it intersects with several other lines of research including:
Metabolic dysfunction: persistent microclots that block capillaries could result in persistent cycles of oxygen deprivation, which eventually results in a state of oxidative stress. Metabolic dysfunction is heavily implicated in myalgic encephalomyelitis (ME), a post-viral condition characterized by severe fatigue and exertional intolerance. Many long COVID patients develop ME, and ME patients with no history of COVID infections also exhibited microclots.
Immune dysregulation: some studies have shown that white blood cells, which regulate immune responses in the blood, have metabolic and functional disruptions in long COVID patients. This would be in line with recent hypotheses that some long COVID cases may be the result of an underactive immune response, in which high viral loads or persistent viral pockets are more likely.
Endothelial disruption: continued metabolic dysfunction as well as dysregulated coagulation cascades can drive vascular damage, including loss of capillary density and resultant nerve damage.
Viral persistence: studies have shown that SARS-CoV-2 virus or antigen can persist in the tissue of some individuals for a long time, including those with long COVID. Persistent exposure to the spike protein could continue to drive microclot-related damage. However, this would also suggest that microclots are not the underlying cause of long COVID.
Vaccine injury: the S1 spike protein alone appears sufficient to induce microclot formation, at least in vitro. This indicates that encountering spike protein, whether through infection or vaccination, can drive vascular pathology. Some individuals may be predisposed to this effect and have adverse reactions to the high levels of spike protein induced in the mRNA vaccine. Importantly, COVID-19 infection remains a much higher risk factor for developing long COVID than vaccination."
Source:
Commentary: I have been wondering for a while whether the portion of the spike protein in the mRNA vaccine can still trigger an inflammatory reaction the way the actual SARS-CoV-2 virus can. The answer, it appears, is yes, though in substantially smaller volumes than actual COVID does. What does that mean?
My take on this is that repeated exposure to the spike protein probably isn't super for our health. If you're at high risk, or going into high-risk situations, get a booster, but this - to my LAYMAN brain because I am not a qualified medical practitioner - would seem to indicate that if you don't need a booster after you've gotten a couple, and you are diligently masking with N95 masks or better in places that are not your home, you should time your boosters with periods of higher risk (i.e. travel around the holidays, periods when you will be indoors with others) as opposed to just going out and getting a booster like clockwork because it's been X months since your last one.
The diligently masking piece is essential. With a good enough mask (N95 or better), you have a formidable defense in place. With great ventilation, even better.
There is still no credible evidence of a "lab leak". Dr. Angela Rasmussen:
"So...the DOE decided that SARS-CoV-2 originated with a "lab leak."
The available evidence shows overwhelmingly that the pandemic started at Huanan market via zoonosis.
But affirmative evidence of lab origin could change my view. What kind of evidence? 🧵
First of all, I have no idea what this evidence that DOE has is. All I know that it is "weak" and resulted in a conclusion of "low confidence". It reportedly comes from the DOE's own network of national labs rather than through spying.
But I do know that to be consistent with the available scientific evidence, the DOE has to explain how the virus emerged twice over 2 wks in humans at the same market the size of a tennis court, over 8 km & across a river from the only lab in Wuhan working on SARSr-CoVs.
For more on that you can see my thread on what my co-authors and I showed. By the way, today is the year anniversary from when we dropped these preprints (eventually published in @ScienceMagazine). No challenge to our work has yet survived peer review.
But that said, I'm always prepared for the possibility that new evidence can falsify a hypothesis. No hypothesis is too precious for evidence to trash.
One piece of evidence that could change my mind would be conclusive proof that WIV possessed a progenitor of SARS-CoV-2.
We don't have pandemics all the time, despite spillover being pretty common, because most spillovers are dead ends with no onward human transmission.
Pandemic-ready viruses are themselves exceedingly rare. Emergence in a situation that allows a pandemic to start is rarer still.
If WIV was doing experiments with a virus that could have evolved into SARS-CoV-2, that would dramatically change the likelihood that this virus would coincidentally emerge somewhere in Wuhan naturally, especially if it was collected years earlier in a far-off location.
Indeed, many lab leak proponents have floated a myriad versions of this possibility. We're always just a random out-of-context FOIA email or one deleted database away from uncovering THE TRUTH about what really happened in Wuhan.
So if this is the kind of evidence that would change my mind, why do I still think the pandemic started with zoonosis at or immediately upstream from Huanan market?
Simple. This evidence doesn't exist. Claims of a progenitor at WIV are pure speculation & unsupported by evidence.
Viruses aren't imagined or computed into existence. No serial passage, gain-of-function, humanized (transgenic) mouse studies or whatever else has been proposed to be the laboratory origin of SARS2 can happen without a progenitor.
And ZERO evidence suggests WIV had one.
No progenitor virus = no reverse genetics or isolation
No reverse genetics or isolation = no virus in culture
No virus in culture = no infectious virus at all
No infectious virus = no lab leak.
Despite 3 years of a global search for this evidence, it has not materialized, while evidence supporting zoonosis associated with Huanan has continued to stack up.
At some point, an absence of evidence might just be evidence of absence.
As I said before, I am willing to reconsider my hypothesis if presented with verifiable, affirmative evidence of a progenitor virus at WIV.
I don't know what the new evidence is, but if it was obtained from the DOE's labs, I doubt it will point to a WIV progenitor.
I'll keep an open mind when and if we ever get more information about what has caused the DOE to change their assessment (as well as toward other emerging evidence about the origin of SARS-CoV-2).
But for now, I see no evidence that suggests the current scientific evidence base is incorrect. And that evidence base continues to suggest the pandemic originated via zoonotic spillover at the Huanan market, in association with the live animal trade."
Source:
Commentary: The conspiracy nuts have been out in force lately, most recently with a report from the Department of Energy about COVID being leaked from a lab. Dr. Rasmussen's Twitter thread is an excellent, evidence-based summary of why this is still highly improbable.
More evidence to switch up booster brands.
"The emergence of the SARS-CoV-2 Omicron sublineages resulted in increased transmission rates and reduced protection from vaccines. To counteract these effects, multiple booster strategies were used in different countries, although data comparing their efficiency in improving protective immunity remain sparse, especially among vulnerable populations, including older adults. The inactivated CoronaVac vaccine was among the most widely distributed vaccine worldwide and was essential in the early control of SARS-CoV-2–related hospitalizations and deaths. However, it is not well understood whether homologous versus heterologous booster doses in those fully vaccinated with CoronaVac induce distinct humoral responses or whether these responses vary across age groups. We analyzed plasma antibody responses from CoronaVac-vaccinated younger or older individuals who received a homologous CoronaVac or heterologous BNT162b2 or ChAdOx1 booster vaccine. All three evaluated boosters resulted in increased virus-specific IgG titers 28 days after the booster dose. However, we found that both IgG titers against SARS-CoV-2 Spike or RBD and neutralization titers against Omicron sublineages were substantially reduced in participants who received homologous CoronaVac compared with the heterologous BNT162b2 or ChAdOx1 booster. This effect was specifically prominent in recipients >50 years of age. In this group, the CoronaVac booster induced low virus-specific IgG titers and failed to elevate neutralization titers against any Omicron sublineage. Our results point to the notable inefficiency of CoronaVac immunization and boosting in mounting protective antiviral humoral immunity, particularly among older adults, during the Omicron wave. These observations also point to benefits of heterologous regimens in high-risk populations fully vaccinated with CoronaVac."
Source: https://www.science.org/doi/10.1126/scitranslmed.ade6023
Commentary: especially for older folks and those at risk, getting vaccines and boosters from different brands/types seems to be the way to go to maximize immune response. Switch it up!
A reminder of the simple daily habits we should all be taking.
Wear the best mask available to you when you'll be around people you don't live with, even after you've been vaccinated. P100 respirators are back in stock at online retailers, too and start around US$40 for a reusable respirator. 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.
Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
Get vaccinated as soon as you're eligible to, and fulfill the full vaccine regimen, including boosters. Remember that you are not vaccinated until everyone you live with is vaccinated. For COVID, if you received an adenovirus vaccine (J&J/AstraZeneca), consider getting an mRNA single shot booster (Pfizer/Moderna) if available. If it's available, choose Moderna as your first choice for both vaccine and booster, Pfizer as your second choice. However, remember that any vaccine is better than no vaccine.
Wash/sanitize your hands every time you are in or out of your home. Sanitize the bottom of your shoes with a simple peroxide spray using ordinary drugstore/supermarket peroxide in a spray bottle. If you've come in close contact with others (rubbing or brushing up against them, hugging, etc.) consider showering and washing your clothes as well.
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 disease through aerosols and distance is less effective at mitigating your risks.
Aim to have 3-6 months of living expenses on hand in case the pandemics give another crazy plot twist to the economy, or you know, a global war breaks out.
Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
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).
Masks must fit properly to work. Here's how to properly fit a mask:
If you think you may have been exposed to COVID-19, purchase several rapid antigen tests and/or acquire them from your healthcare provider or government. This will detect COVID-19 only when you're contagious, so follow the directions clearly. https://amzn.to/3fLAoor
If you think you may have been exposed to monkeypox, contact your healthcare provider about available testing.
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 or monkeypox. 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 or monkeypox, nor do I financially benefit in any way from sharing information about COVID-19 or monkeypox.
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
if you prefer the update in your inbox.