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.
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Remember the news about blood types and COVID-19? "Blood type is not associated with a severe worsening of symptoms in people who have tested positive for COVID-19, report Harvard Medical School researchers based at Massachusetts General Hospital.
Their findings, published in the Annals of Hematology, dispel previous reports that suggested a correlation between certain blood types and COVID-19.
The study did find, however, that symptomatic individuals with blood types B and AB who were Rh positive were more likely to test positive for COVID-19, while those with blood type O were less likely to test positive.
“We showed through a multi-institutional study that there is no reason to believe being a certain ABO blood type will lead to increased disease severity, which we defined as requiring intubation or leading to death,” said senior study author Anahita Dua, HMS assistant professor of surgery at Mass General.
“This evidence should help put to rest previous reports of a possible association between blood type A and a higher risk for COVID-19 infection and mortality,” Dua said."
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354354/
Source: https://hms.harvard.edu/news/covid-19-blood-type
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Commentary: Excellent news for folks worried about the previous findings. This underscores the importance of peer review in data; so much data has been released so fast that traditional peer review processes are struggling to keep up. However, once reviewed, we may find significant early conclusions were incorrect or misleading.
Keep reading, keep researching, keep studying.
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A fascinating study on SARS-CoV-2 and immunity. "Memory T cells induced by previous pathogens can shape the susceptibility to, and clinical severity of, subsequent infections1. Little is known about the presence of pre-existing memory T cells in humans with the potential to recognize SARS-CoV-2. Here, we first studied T cell responses to structural (nucleocapsid protein, NP) and non-structural (NSP-7 and NSP13 of ORF1) regions of SARS-CoV-2 in COVID-19 convalescents (n=36). In all of them we demonstrated the presence of CD4 and CD8 T cells recognizing multiple regions of the NP protein. We then showed that SARS-recovered patients (n=23) still possess long-lasting memory T cells reactive to SARS-NP 17 years after the 2003 outbreak, which displayed robust cross-reactivity to SARS-CoV-2 NP. Surprisingly, we also frequently detected SARS-CoV-2 specific T cells in individuals with no history of SARS, COVID-19 or contact with SARS/COVID-19 patients (n=37). SARS-CoV-2 T cells in uninfected donors exhibited a different pattern of immunodominance, frequently targeting the ORF-1-coded proteins NSP7 and 13 as well as the NP structural protein. Epitope characterization of NSP7-specific T cells showed recognition of protein fragments with low homology to “common cold” human coronaviruses but conserved amongst animal betacoranaviruses. Thus, infection with betacoronaviruses induces multispecific and long-lasting T cell immunity to the structural protein NP. Understanding how pre-existing NP- and ORF-1-specific T cells present in the general population impact susceptibility and pathogenesis of SARS-CoV-2 infection is of paramount importance for the management of the current COVID-19 pandemic"
Source: https://www.nature.com/articles/s41586-020-2550-z?flip=true
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Commentary: What a fascinating plot twist. This underscores the importance of continued research. No answer is carved in stone in a disease this new, and research like this may confer long-lasting benefits to other diseases in the future. What if other related but not identical diseases create antigens to things like HIV, for example? That's an exciting prospect to consider.
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Surgeon General Jerome Adams on the weekly talk show circuit. "Because there is so much focus on whether or not we should force people to do something. And I think not enough focus on the need to educate people about why they should do it. Strictly from a public health, motivational and behavior change perspective. It's important Know that we don't have much luck when it comes to trying to force people to do something if we don't couple that with the the Why? We know that if you force people to do it, they'll do it when you're watching. But then when you when you aren't watching, they'll stop doing it. We also know that shame doesn't work. And that's true for opioids. That's true for for STDs. That's true for HIV testing. What I'm focused on a surgeon general is helping people understand a couple of things. Number one, COVID-19 has really humbled us in terms of its asymptomatic spread. Really quickly, what that means is that previous diseases like COVID-19 other Coronavirus is really weren't spread by people who didn't have symptoms. You knew if you were sick, and if you were sick, then you were one of those people who was more likely to spread the disease. But up to 50%. In many cases of people who are spreading COVID are spreading it before they have symptoms without ever even knowing they have it That's why our recommendations change to tell people to wear masks or face coverings. The other important thing I want people to know is that mask actually don't inhibit your freedom. They don't inhibit your choice. They enable freedom and enable more choices. Because we know that if we can get 90% of people to wear face coverings, and get people to practice at least six feet of social distancing from their neighbors, and practice good hand hygiene, that we can reopen, and then we can stay open and we can get back to schools to worship, to college football in the fall, and to the other things that people want to do. You'll have more choices if you wear a face covering."
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Commentary: The one factor Dr. Adams doesn't address is that education is of limited use when running into an opposing belief system. In a person who has no strong opinion or belief system, education is a great way to persuade a person. In a person who has married their beliefs to a point of view, persuading them through education may prove very difficult. The benefit presentation is more likely to work - if you want X, do Y.
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Dr. Scott Gottlieb, also from the talkshow circuit, on positivity rates and schools. "I think somewhere in five to 10% is starting to get iffy above 10%. I think that's a threshold where you really want to think carefully about closing the school districts because That is a sign that there's an epidemic underway inside that community. So those are the kinds of things you're looking at. I'm in Connecticut right now we've gotten the infection under control, I think we're going to have the opportunity to open the schools here. But when you look at states like Florida or Southern California, I mean, California has already made the decision not to open the schools, I think it's gonna be very hard parts of Florida, to open schools on time because of the outbreaks. And you're also seeing a lot of parents make proactive decisions to keep their kids home. So districts in Maryland, for example, that were giving an option to parents of flexible option parents, they surveyed those parents and they enough parents said we're not going to be sending our kids that the districts just made the decision to close the schools. And that shows that in the in the setting of uncertainty and and the lack of specific guidance about how to keep schools open, I think more parents are going to earn a side of caution. That's why it's very important to get specificity out and what the hard metrics are that CDC didn't do in this guidance is still time to do it. But I think we need to think about things like positivity rate, what is the local spread, what is the testing capacity in place in a local community, those metrics. What are we looking at?"
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Commentary: This is a very useful and powerful piece of information. When you look at sites like COVID Exit Strategy, they publish positivity levels for testing by state. If your state is above 10%, Dr. Gottlieb is recommending that schools question whether opening is the right move. Personally, and this is pure opinion, I'd be much more inclined to look at sub-5% rates.
That said, that positivity rate is also contingent on timely testing, which is a whole other ball of worms. Keep your eyes open and on the best data sources available.
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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 gloves and a mask when out of your home. 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. 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:
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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.