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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Keep it moist. "In the temperate regions, seasonal influenza virus outbreaks correlate closely with decreases in humidity. While low ambient humidity is known to enhance viral transmission, its impact on host response to influenza virus infection and disease outcome remains unclear. Here, we showed that housing Mx1 congenic mice in low relative humidity makes mice more susceptible to severe disease following respiratory challenge with influenza A virus. We find that inhalation of dry air impairs mucociliary clearance, innate antiviral defense, and tissue repair. Moreover, disease exacerbated by low relative humidity was ameliorated in caspase-1/11–deficient Mx1 mice, independent of viral burden. Single-cell RNA sequencing revealed that induction of IFN-stimulated genes in response to viral infection was diminished in multiple cell types in the lung of mice housed in low humidity condition. These results indicate that exposure to dry air impairs host defense against influenza infection, reduces tissue repair, and inflicts caspase-dependent disease pathology."
Source: https://www.pnas.org/content/116/22/10905
Source: https://40to60rh.com/
Commentary: This study, originally performed on the influenza virus, is now part of a petition by scientists for the WHO to adopt requirements for indoor humidity during the winter to reduce COVID-19 spread. Low humidity - below 40% - makes us more susceptible to airborne viruses by drying up our mucus in our nasal passages, letting more stuff stick to us and getting us sick. Dry air also makes virus capsules smaller, letting them stay airborne longer.
In any place you live or work, consider adding a humidifier to maintain indoor humidity above 40%. If your employer has you in the workplace, do the same. I remember working in an office where humidity levels dropped to 15-20% in the winter - making offices even more dangerous to work in.
On airplanes, wear the best mask possible. Almost every airplane has extremely low humidity in the cabin to reduce corrosion to the airframe. That's a prime environment for spread.
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Antibody decay in the UK. "Led by Imperial College London, analysis of finger-prick tests carried out at home between 20 June and 28 September found that the number of people testing positive dropped by 26.5% across the study period, from almost 6% to 4.4%.
The downward trend was observed in all areas of the country and age groups, but not in health workers, which could indicate repeated or higher initial exposure to the virus, the authors suggest. The decline was largest in people aged 75 and above compared to younger people, and also in people with suspected rather than confirmed infection, indicating that the antibody response varies by age and with the severity of illness.
These findings suggest that there may be a decline in the level of immunity in the population in the months following the first wave of the epidemic.
Professor Helen Ward, one of the lead authors of the report said: “This very large study has shown that the proportion of people with detectable antibodies is falling over time. We don’t yet know whether this will leave these people at risk of reinfection with the virus that causes COVID-19, but it is essential that everyone continues to follow guidance to reduce the risk to themselves and others.”"
Source: https://www.imperial.ac.uk/news/207333/coronavirus-antibody-prevalence-falling-england-react/
Commentary: The associated study is still a pre-print, but ICL is a very reputable research institution. The key takeaway is that immunity to COVID-19 is not assured in the long term, and people who have contracted COVID-19 may not be protected against reinfection as antibodies decay over time. This also thoroughly debunks any notion of a natural herd immunity strategy; only a thoroughly-administered vaccine will accomplish herd immunity, nothing less.
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Utah at care rationing. "With new coronavirus cases shattering records on a daily basis, Utah’s hospitals are expected to begin rationing care in a week or two.
That’s the prediction of Greg Bell, president of the Utah Hospital Association, who said administrators of the state’s hospitals confronted Gov. Gary Herbert on Thursday with a grim list: Criteria they propose doctors should use if they are forced to decide which patients can stay in overcrowded intensive care units.
Under the criteria, which would require Herbert’s approval, patients who are getting worse despite receiving intensive care would be moved out first. In the event that two patients' conditions are equal, the young get priority over the old, since older patients are more likely to die.
‘We told him, ‘It looks like we’re going to have to request those be activated if this trend continues,’" Bell recounted, “'and we see no reason why it won’t.'"
Hospitalizations normally rise after the number of new cases increases, and Utah repeatedly set new records for daily case totals last week. At least two Utah hospitals have opened overflow ICUs this month.
The state’s hospitals can shift patients around to free up bed space, Bell said, and the state has long planned to open a field hospital at the Mountain America Expo Center in Sandy if necessary.
But one of the defining features of intensive care is access to doctors and nurses with specialty training — and opening new beds does not mean those health care workers can staff them.
Bell said it’s now all but inevitable that hospitals will need to enact their triage protocols, known as “crisis standards of care.”
“I haven’t said, ‘It’s gonna happen’ — until [Thursday] night,” Bell said. “I told the governor, ‘It’s gonna happen. We’re going to be back here asking for crisis standards.’ ”"
Source: https://www.sltrib.com/news/2020/10/25/with-coronavirus-cases/
Commentary: One of the COVID-deniers' popular claims is that COVID-19 is getting less deadly. That's untrue. The disease has remained remarkably consistent and stable. What changes is access to care. For the last few months, caseloads have been manageable compared to the "first wave" in March and April, when a few dense hotspots like Milan, New York City, and Wuhan had their healthcare systems overwhelmed. Death rates were much higher because care had to be rationed. Over the summer, caseloads were manageable enough that ICUs and hospitals could treat every patient, and we saw mortality fall to a baseline.
With caseloads exploding in dozens, if not hundreds of hotspots around the world, expect mortality to jump. Not every patient that deserves full care will receive it, especially in rural communities where the number of beds and healthcare workers is limited. That in turn will lead to higher deaths.
The major difference between now and the spring is that in the spring, most systems had ample capacity and resources to move around. Many healthcare workers surged into places like New York City to volunteer and help out. With cases exploding everywhere, no one has surge capacity any more.
What can you do? Continue to press your governments at every level to impose more stringent containment measures. Close down unnecessary vectors of spread like indoor dining, team sports, and other gathering places.
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A COVID breathalyzer? "Independent observational prevalence studies at Edinburgh, UK, and Dortmund, Germany, recruited adult patients with possible COVID-19 at hospital presentation. Participants gave a single breath-sample for VOC analysis by GC-IMS. COVID-19 infection was identified by transcription polymerase chain reaction (RT- qPCR) of oral/nasal swabs together with clinical-review. Following correction for environmental contaminants, potential COVID-19 breath-biomarkers were identified by multi-variate analysis and comparison to GC-IMS databases. A COVID-19 breath-score based on the relative abundance of a panel of volatile organic compounds was proposed and tested against the cohort data.
Ninety-eight patients were recruited, of whom 21/33 (63.6%) and 10/65 (15.4%) had COVID-19 in Edinburgh and Dortmund, respectively. Other diagnoses included asthma, COPD, bacterial pneumonia, and cardiac conditions. Multivariate analysis identified aldehydes (ethanal, octanal), ketones (acetone, butanone), and methanol that discriminated COVID-19 from other conditions. An unidentified-feature with significant predictive power for severity/death was isolated in Edinburgh, while heptanal was identified in Dortmund. Differentiation of patients with definite diagnosis (25 and 65) of COVID-19 from non-COVID-19 was possible with 80% and 81.5% accuracy in Edinburgh and Dortmund respectively (sensitivity/specificity 82.4%/75%; area-under-the-receiver- operator-characteristic [AUROC] 0.87 95% CI 0.67 to 1) and Dortmund (sensitivity / specificity 90%/80%; AUROC 0.91 95% CI 0.87 to 1).
These two studies independently indicate that patients with COVID-19 can be rapidly distinguished from patients with other conditions at first healthcare contact. The identity of the marker compounds is consistent with COVID-19 derangement of breath-biochemistry by ketosis, gastrointestinal effects, and inflammatory processes. Development and validation of this approach may allow rapid diagnosis of COVID-19 in the coming endemic flu seasons."
Source: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30353-9/fulltext
Commentary: Hopefully more resources are poured into extremely rapid tests like this. A COVID-breathalyzer could revolutionize how quickly we can test someone for COVID-19, and gas chromatography machines, while not inexpensive, are a proven technology with many, many laboratories having one. Heck, you can technically buy one on Amazon if you have a few thousand dollars to spend and you know what you're doing with it.
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Healthcare workers hit hard. "Analysis of COVID-19 hospitalization data from 13 sites indicated that 6% of adults hospitalized with COVID-19 were HCP (health care personnel). Among HCP hospitalized with COVID-19, 36% were in nursing-related occupations, and 73% had obesity. Approximately 28% of these patients were admitted to an intensive care unit, 16% required invasive mechanical ventilation, and 4% died.
HCP can have severe COVID-19–associated illness, highlighting the need for continued infection prevention and control in health care settings as well as community mitigation efforts to reduce SARS-CoV-2 transmission."
Source: https://www.cdc.gov/mmwr/volumes/69/wr/mm6943e3.htm
Commentary: One of the reasons healthcare workers are hit so hard by COVID-19 is the duration of exposure. It's been established that the more exposed you are to the virus, generally the more severe your illness. Healthcare workers are in the highest risk category and except for heavy gear like powered air purifying respirators (which can cost close of US$1,000 for a single unit), masks reduce but do not eliminate risk. An N95 mask, by definition, reduces 95% of particles inhaled. For the average civilian, that's more than enough protection to go to the grocery store. For a healthcare worker in a ward where the air is saturated with virus particles, they're still inhaling 5% of them, and over time, that's enough to get you sick. Worse, when they have to reuse equipment, the risk of infection increases.
Right now, stocks of PPE have risen; retailers like Amazon have Chinese KN95 and European FFP2 masks in stock. If you've got a relative or friend working in healthcare or other front line positions that is not being equipped properly, stock up.
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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. Always 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.
6. Participate in your local political process. For Americans, go to Vote.org and register/verify your vote.
7. Ventilate your home as frequently as weather and circumstances permit.
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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.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.