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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Remdesivir performs poorly in a proper, randomized, double-blind, placebo-controlled trial in China. "In this study of adult patients admitted to hospital for severe COVID-19, remdesivir was not associated with statistically significant clinical benefits. However, the numerical reduction in time to clinical improvement in those treated earlier requires confirmation in larger studies. Between Feb 6, 2020, and March 12, 2020, 237 patients were enrolled and randomly assigned to a treatment group (158 to remdesivir and 79 to placebo); one patient in the placebo group who withdrew after randomisation was not included in the ITT population. Remdesivir use was not associated with a difference in time to clinical improvement (hazard ratio 1·23 [95% CI 0·87–1·75]). Although not statistically significant, patients receiving remdesivir had a numerically faster time to clinical improvement than those receiving placebo among patients with symptom duration of 10 days or less (hazard ratio 1·52 [0·95–2·43]). Adverse events were reported in 102 (66%) of 155 remdesivir recipients versus 50 (64%) of 78 placebo recipients. Remdesivir was stopped early because of adverse events in 18 (12%) patients versus four (5%) patients who stopped placebo early."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31022-9/fulltext
Bad news for those pinning their hopes on remdesivir as a therapeutic. This is the first published study using all the proper methods to ensure statistical validity.
There's another study just completed by NIAID of remdesivir, but the data itself has not been published yet.
Source: https://www.statnews.com/2020/04/29/gilead-says-critical-study-of-covid-19-drug-shows-patients-are-responding-to-treatment/
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The Lancet indicates that some research is cutting corners and potentially putting patients at risk for mental health problems. "Mental health research, including self-harm and suicide, is a vital part of the response to the pandemic, but we are concerned about the ethical robustness of some studies already recruiting. We have seen studies that do not provide sufficient information to enable fully informed consent, do not measure mood before or after participation, do not provide any signposting other than to potentially anxiety-provoking messages about COVID-19, and do not attempt any kind of mood mitigation or debrief to help to stabilise anyone that does become distressed after participation. We would recommend that researchers be mindful that general research into the impacts of COVID-19, even if this does not evaluate mental health, self-harm, or suicide, should be viewed as a highly sensitive topic, with similar attention to safeguards needed to protect the wellbeing of participants."
Source: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30150-4/fulltext
The article goes on to re-emphasize that in everything we do, we should be obeying the Hippocratic oath: first, do no harm. Expediency is important, but cutting corners leads to flawed outcomes at best and substantially negative outcomes at worst.
This extends beyond just the medical field; it extends to what you and I share and talk about on digital channels like social media. You don't have to be the first to post a link, especially if you haven't personally vetted it. Be the best, not the first, especially if you are in no way compensated as a journalist to attract page views.
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Summer weather won't stop COVID-19. "High levels of heat, UV light, and humidity can help prevent more widespread infections of the flu or colds in the summer, along with medical treatments and vaccines (when available). But the Covid-19 coronavirus is still new to humans, so we don’t have as much immune protection built up against it — so the virus seems able to overcome summer-like weather and still cause big outbreaks. “For the novel coronavirus SARS-CoV-2, we have reason to expect that like other betacoronaviruses, it may transmit somewhat more efficiently in winter than summer, though we don’t know the mechanism(s) responsible,” Marc Lipsitch, an epidemiologist at Harvard, wrote. “The size of the change is expected to be modest, and not enough to stop transmission on its own.” Still, the studies on heat, light, and humidity, plus the fact coronavirus has a harder time spreading in open-air areas, suggest that the outdoors may be a safe target for a slow reopening as transmission of the virus slows, as long as precautions like physical distancing and mask-wearing are followed. So outdoor activities could offer a respite to lockdowns and quarantines — one that’s also, potentially, good for physical and mental health."
Source: https://www.vox.com/2020/4/29/21231906/coronavirus-pandemic-summer-weather-heat-humidity-uv-light
Outdoors + distancing + masks is what any vacation will likely resemble. Plan accordingly; JetBlue has already made the change to make masks mandatory for everyone on a plane, from check-in to destination. Expect any outdoor spots like beach rentals, etc. to be swamped; if you plan on traveling anywhere, expect crowds.
That said, the world is a big place. A remote cabin in the woods for a week, with no other human contact, will be safer than living in an apartment in the city. It might not be the hottest or most scenic destination, but it might be what you have available. Plan ahead (and plan to drive, it'll be safer than any form of mass transit) if you do vacation this year.
Source: https://www.npr.org/sections/coronavirus-live-updates/2020/04/28/846966739/the-new-flying-etiquette-jetblue-mandates-face-masks-for-all-passengers
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NEJM has first clinical data for patients under age 50 experiencing large-vessel stroke associated with COVID-19. "Over a 2-week period from March 23 to April 7, 2020, a total of five patients (including the aforementioned patient) who were younger than 50 years of age presented with new-onset symptoms of large-vessel ischemic stroke. All five patients tested positive for Covid-19. By comparison, every 2 weeks over the previous 12 months, our service has treated, on average, 0.73 patients younger than 50 years of age with large-vessel stroke. On admission of the five patients, the mean NIHSS score was 17, consistent with severe large-vessel stroke."
Source: https://www.nejm.org/doi/full/10.1056/NEJMc2009787
A key point made in the disclosures of the data is that strokes may have been made worse by patients waiting to seek medical attention. As with any severe medical problem, the longer you wait, the worse it gets. If you or someone you care about is experiencing symptoms consistent with things like stroke, cardiac events, or other severe health problems, do not wait to get them help.
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US GDP falls 4.8% in the first quarter. "Gross domestic product fell 4.8% in the first quarter, according to government numbers released Wednesday that provide the first detailed glimpse into the deep damage the coronavirus wreaked on the U.S. economy. The biggest drags on the economy were consumer spending, nonresidential fixed investment, exports and inventories. Residential fixed investment, which jumped 21%, along with spending from both the federal and state governments helped offset some of the damage. Federal spending was up 1.7%. Consumer expenditures, which comprise 67% of total GDP, plunged 7.6% in the quarter as all nonessential stores were closed and the cornerstone of the U.S. economy was taken almost completely out of commission. Durable goods spending tumbled 16.1% while expenditures on services were down 10.2%."
Source: https://www.cnbc.com/2020/04/29/us-gdp-q1-2020-first-reading.html
The remainder of the report discusses the fact that the first quarter numbers are not a good indicator of the severity of the pandemic's economic impact. For all intents and purposes, the pandemic began inflicting serious financial harm around March 15, two weeks before the end of the quarter.
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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.
2. Wear gloves and a mask when out of your home.
3. Stay home as much as possible.
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.
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