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.
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Delta's attack rate can achieve 90%. "272 soldiers out of the 301 soldiers (90.4%) were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant of concern (VOC) on a single navy ship. This outbreak provides three lessons for the pandemic. This incident clearly demonstrates the transmission characteristics of the SARS-CoV-2 Delta VOC."
Source: https://pubmed.ncbi.nlm.nih.gov/34668534/
Commentary: COVID-19 is an airborne disease; this is no longer in question. But that attack rate is crazy high, which means that either ships have almost no outside air ventilation, or Delta's aggressiveness in enclosed spaces has been understated.
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A deep dive into Delta AY4.2, the variant under investigation. "*~*VARIANT UPDATE*~*
I took a little break from these but back with an important new report
@ukhsa has designated AY4.2 a VUI
VUI-21OCT-01
Let’s break it down 🧵 ⤵️
Technical Briefing 26 - AY.4.2
AY.4.2 is a Delta sub-lineage (meaning it’s Delta but with a few new mutations)
AY.4.2 came to attention *not* because these particular mutations are known to be concerning (they are not)
But because the number of cases observed indicate it can compete with OG Delta
So: what’s the epidemiology?
• 15,120 cases in England
• First seen in July 2021
• Dispersed across the country
• Not associated with travel - either home grown or already had so many incursions from abroad that it’s spreading via community transmission now
Of most interest is that it’s growing
Of Delta cases AY.4.2 is:
• 3.8% in week beginning 19 Sept
• 5.2% in week beginning 26 Sept
• 5.9% in week beginning 3 Oct
It’s a slow burner 🔥
But Delta is already *so* transmissible, it’s notable that AY.4.2 is increasing in that context
• Growth rate estimates: 17% advantage for AY.4.2 over Delta
• Household SAR: 12% (8%-16%) more transmissible
Important to note we await neutralisation studies to better understand why we see this advantage?
Is it biological transmissibility? and/or immune escape? or does it just happen to be found in places/populations where #COVID19 infections are growing fastest anyway (eg children)
From an international perspective, it’s reported in 33 countries
{also the countries that do the most sequencing which means it’s probably even more widespread}
For the real geeks🤓
A new surveillance case definition is proposed:
Delta + any 2 of 3 mutations (orf1ab:A2529V; S:Y145H; S:A222V) where none of the positions are wild-type
This definition is highly specific (>99.9%) & sensitive (91.6%)
Pangolin may slightly over-call AY.4.2
So how worried should we be?
Don’t press the panic button yet🚨
Remember Delta had 60-80% transmission advantage, but that was in a partially vaxxed/unvaxxed population.
Best case scenario it’s no more transmissible than Delta & growth is coincident w/case numbers rising…
I think more likely the next best scenario: a slightly more transmissible version of OG Delta, which replaces Delta slowly over next few months.
Spike mutations A222V and Y145H, not previously known to be antigenic, but are poorly characterised.
Neutralisation studies are key.
Forgot to mention - unadjusted analysis of severity (hospitalisations 🏥 and deaths ☠️ ) show no difference in risk between AY.4.2 and B.617.2
Fully adjusted analysis (including vaccination status) in the pipeline
Good news is Lambda and C.36.3 variants are being de-escalated to “signal in monitoring” as they are outcompeted by Delta (both extinct in England 🏴 since June) and evidence that they do not significantly evade immune response"
Source:
Commentary: A variant that increases Delta's already impressive infectivity by another 10-15% isn't great news. AY4.2 outcompeting the Delta OG variant means we need to continue employing masks and other measures. What it also means is that the pandemic will accelerate among the unvaccinated, so if you know anyone who isn't by choice, there isn't much time left to get them vaccinated.
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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
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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
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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.
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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.