Lunchtime Pandemic Reading, 28-May-2020
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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This one's important. From The Lancet: "Although we only studied healthy volunteers and did not study patients with COVID-19 or virus-laden aerosol droplets directly, our data on droplet size distribution and persistence does have implications on requirements to use face masks to prevent virus transmission. Transmission by aerosols of the small droplets studied here can only be prevented by use of high-performance face masks; a conventional surgical mask only stops 30% of the small aerosol droplets studied here for inhaled breath; for exhaled breath the efficacy is much better.
This study shows that better ventilation of spaces substantially reduces the airborne time of respiratory droplets. This finding is relevant because typically poorly ventilated and populated spaces, like public transport and nursing homes, have been reported as sites of viral transmission despite preventive physical distancing. The persistence of small respiratory droplets in such poorly ventilated spaces could contribute to the spread of SARS-CoV-2. Our findings confirm that improving ventilation of public spaces will dilute and clear out potentially infectious aerosols. To suppress the spread of SARS-CoV-2 we believe health-care authorities should consider the recommendation to avoid poorly ventilated public spaces as much as possible. The implications are also important for hospital settings where aerosolisation by coughing and medical treatments and close contact with COVID-19 patients is very common."
What does this mean? Two things.
First, wearing a mask protects others. As cited, the efficacy of masks for exhaled breath is important. Wearing a mask stops you from infecting others. If you're at-risk, high-performance masks (N95 or better) are the way to go if you can obtain one.
Second, reducing risk from COVID-19 is all about ventilation. Stay out of poorly ventilated places. Do as much as you can outdoors - curbside pickup, etc. - and avoid spending time indoors in places that aren't your household. If you live in a place with shared ventilation, block interior ventilation if you can and keep your windows open.
COVID-19 is an indoor disease. Stay away from people, stay away from indoor places as much as you can, and you reduce your risk.
And wear a mask all the time, for yourself and for others.
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From NEJM: "In a large cohort in Louisiana, 76.9% of the patients who were hospitalized with Covid-19 and 70.6% of those who died were black, whereas blacks comprise only 31% of the Ochsner Health population. Black race was not associated with higher in-hospital mortality than white race, after adjustment for differences in sociodemographic and clinical characteristics on admission."
Source: https://www.nejm.org/doi/10.1056/NEJMsa2011686
This is important for two reasons. First, the burden of COVID-19 is increasingly on lower income and minority citizens for obvious reasons: they form the backbone of essential workers. Ending the pandemic means protecting everyone, regardless of background.
Second, it's heartening to hear that while African-Americans are disproportionately affected, in-hospital mortality in this study was the same regardless of race. That means that our healthcare heroes are working their hardest to help everyone, not just certain segments of the population. Yet another reason they deserve our thanks and support.
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Stopping the spread means keeping infected people isolated - which many cannot do for economic reasons. From NEJM: "Many people will be unable to stop working without additional financial support and protections. Our health care system relies on thousands of low-wage workers, including health care aides and environmental services workers to keep facilities clean and operational. Women and minorities are disproportionately represented in these jobs — nearly half of black female and Latina health care workers earn less than $15 per hour.5 Forgoing income even for a short period would be devastating to such workers’ ability to continue to meet basic needs, including housing, food, and health care. In Massachusetts, being directed to self-quarantine by a medical professional is a qualifying reason to leave work and apply for unemployment insurance (www.masslegalservices.org/covid-19-and-ui). Congressional relief bills could include incentives for employers to provide better options for high-risk workers, including paid leave or voluntary furloughs. The Family and Medical Leave Act could be revised to allow people to take job-protected leave if their clinician determines that they or their family member is at increased risk for poor outcomes from Covid-19."
Source: https://www.nejm.org/doi/full/10.1056/NEJMp2013413
What works in Massachusetts could work around the US - paid sick leave or unemployment insurance while quarantined. Again, it's a no-brainer: to incentivize people to stay home and isolated while infected, they need to know their basic needs will be met. Do that, and you'll have much more success containing an outbreak.
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How far away are we from herd immunity? The NY Times has an outstanding visual.
"Official case counts often substantially underestimate the number of coronavirus infections. But even in results from a new set of studies that test the population more broadly to estimate everyone who has been infected, the percentage of people who have been infected so far is still in the single digits. The numbers are a fraction of the threshold known as herd immunity, at which the virus can no longer spread widely. The precise herd immunity threshold for the novel coronavirus is not yet clear; but several experts said they believed it would be higher than 60 percent."
Source: https://www.nytimes.com/interactive/2020/05/28/upshot/coronavirus-herd-immunity.html
In short, we are nowhere near close to herd immunity and probably won't be until we have a working vaccine.
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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.
2. Wear gloves and a mask when out of your home. Consider wearing a face shield.
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.
4. Get your personal finances in order now. Cut all unnecessary costs.
5. Donate any PPE you can. https://getusppe.org/give/
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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.