Lunchtime pandemic reading.
Standard disclaimer: this is a roundup of informative pieces I've read that interest me on the severity of the crises and how to manage them. 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.
You are welcome to share this.
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Masks PLUS ventilation. "Healthcare workers (HCWs) are at risk from aerosol transmission of severe acute respiratory syndrome coronavirus 2. The aims of this study were to (1) quantify the protection provided by masks (surgical, fit-testFAILED N95, fit-testPASSED N95) and personal protective equipment (PPE), and (2) determine if a portable high-efficiency particulate air (HEPA) filter can enhance the benefit of PPE.
Significant virus counts were detected on the face while the participants were wearing either surgical or N95 masks. Only the fit-testPASSED N95 resulted in lower virus counts compared to control (P = .007). Nasal swabs demonstrated high virus exposure, which was not mitigated by the surgical/fit-testFAILED N95 masks, although there was a trend for the fit-testPASSED N95 mask to reduce virus counts (P = .058). HEPA filtration reduced virus to near-zero levels when combined with fit-testPASSED N95 mask, gloves, gown, and face shield."
Source: https://academic.oup.com/jid/article/226/2/199/6582941
Commentary: This is a critical study for high-risk areas. Essentially, if your N95 mask fails a fit-test - meaning you didn't put it on right - you're still at substantial risk when in a high-risk environment. A properly-fit mask works. But when you combine masks with HEPA filtration? You squash the virus to near-zero levels.
If we want to make COVID a thing of the past, we need to dramatically upgrade our ventilation in all high-risk places. Grocery stores. Offices. Concert venues. Movie theaters. Conference centers. Apartment buildings. The good news is, better ventilation isn't rocket science. You literally just add HEPA filtration and high-volume air circulation everywhere. It DOES add cost to operating a facility, which will be the main sticking point for most venues - but ventilation and filtration will fight more than just COVID. It'll also squash colds, flu, and allergens. For workplaces, it should be a no-brainer - you'll dramatically lower ALL employee sick time and the cost savings will more than pay for the ventilation.
How much does it cost to ventilate a single schoolroom, for example? Around $100 initially plus monthly costs of about $30 a month per room to put two cheap box fans with HEPA MERV13 filters strapped to them, with monthly filter changes. You don't need a million-dollar HVAC rip and replace.
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"1/5 Many thanks @EricaRHill for hosting me @CNNnewsroom about the new original lineage-BA.5 booster proposed by the FDA, which will be taken up by CDC ACIP later this week. A few things to discuss, but trigger warning: some nuance and uncertainty…
2/5 I feel it’s important that we receive another boost this fall, for those over the age of 50 - a third boost (5th Covid immunization overall, and adults <50 - a second boost. Doing so would ramp up virus neutralizing antibodies for the current BA.5 in circulation and help vs
3/5 vs a future variant that might come along as we head toward winter. The question is whether boosting with both lineages is warranted at this point? Ideally yes since BA.5 is going down but slowly and a long tail + possibility that any future variant might look more like BA.5
4/5 the issue is do we do this without human testing given that we roll out annual influenza vaccines on this basis? My issue there is we have decades of experience with flu vaccines, far less with mRNA so it’s a bit audacious making that same analogy. Therefore I would have..
5/5 preferred some human safety/immunogenicity data particularly since Americans are not knocking down the door to get their boosters - only 30% or less for each so far. I will take it, because I’m curious and have confidence in the mRNA technology, but I might be an exception"
Source:
Commentary: This is the big question everyone's asking - the Omicron boosters haven't been human tested yet. Should you get one when it's available? The layperson's answer - my answer - is a qualified yes. Here's why - the difference between a 2019 OG COVID strain vaccine and the proposed new vaccines is like the difference between a 2019 Ford F-150 and a 2022 F-150. If you owned and drove a 2019 F-150, how comfortable would you be behind the wheel of a 2022 F-150? Chances are it would be almost identical with a few little changes here and there, but nothing that would make you stop and wonder how the heck the 2022 model operated.
The difference between OG COVID and today's strains in terms of functionality, from a vaccine perspective, aren't enough that the vaccine would function differently or cause dramatically different side effects. Will there be different side effects? Probably. The COVID strains themselves cause different symptoms, so it's not unreasonable to think there will be different side effects from the mRNA vaccine updates.
This is a case where a more open-source approach to vaccines would be helpful. If the exact formulation, contents, and nanoparticle designs were made public, independent experts could validate that in fact, there are no showstopping changes that should reduce confidence in the updates.
All that said, will I get the booster? Yeah, probably a month after it comes out. As long as there aren't headlines in reputable medical journals calling for an immediate cessation, I'll go with that as a guideline for safety.
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A deep dive into Long COVID:
"1/🧵 The Haunting Brain Science of Long COVID 🧠
@washingtonpost Aug 25
📍Brain shrinking
📍Corona ghosts
📍Autoimmunity
📍Clinical clusters
“The good news is that in some pts #LongCovid #BrainFog may not be permanent.”
Link👇 but paywall so see 🧵
2/ Mild Covid is biologically dangerous long after initial viral infection.
81 mild COVID pts:
Study revealed:
✔️Astrocytes (🧠 support cells for neurons) get infected
✔️Neurotransmitters are altered
✔️Neurons die indirectly
✔️Then we lose brain power
https://bit.ly/3pcqbFV
3/ Epidemiology💥
Long COVID is tightening its grip on society.
We’re still losing >600 people a day to death from COVID in US alone
Over 100,000 new infections per day (Johns Hopkins data).
This is an epic global 🌍#PublicHealth catastrophe.
4/ New @TheLancet study says 12.5% of those infected get LongCOVID:
bit.ly/3Aiyi9W
Yet they didn’t ask about brainfog or mental health, which 1 in 3 pts have.
CDC study of 63M says 20% have LC:
bit.ly/3AmPHhM
So…
~15% x 600M = 90 MILLION
SO what is LCovid?
5/ Fascinating new study from @VirusesImmunity team on LongCOVID…
🔸Other dormant viruses like VZV and EBV are reactivated
🔸Also, low cortisol is a Biomarker of severity
🔸It’s an example of how our body is taken advantage of by our own immune system
https://bit.ly/3QUgebZ
6/ CoronaVirus Ghosts: 👻
Antibody patterns over time indicate prolonged antigenic stimulation long after COVID infection.
We find virus in the GI system of some patients mos later.
One theory about #LongCOVID is that COVID has figured out how to…
go.nature.com/3w1jnhZ
7/…#COVID virus rents space in our gut mucosa wreaking havoc on some people’s immune system.
📌N=113. Ongoing viral “ghosts” (& not friendly Casper)
📌Fecal shedding in 50% initially & still present in 12.5% pts at 4 mos
📌GI symptoms 1 yr later
📌Ugh
https://bit.ly/3BYVThj
8/ This study of 46 patients with Inflammatory Bowel Disease (IBD) >200 dys after COVID showed viral RNA in a whopping 70% of them 7 months later.
Most patients w ongoing COVID antigen persistence got #LongCOVID.
That’s not proof of cause & effect…yet.
bit.ly/3vT7dYz
9/ We learned in @Nature that patterns of B cell response (antibody production) continued to evolve 6 mos after initial infection.
This supports that ongoing Ag stimulation of our immune systems by COVID ghosts in GI tract is a source of Long COVID.
go.nature.com/3bQgHNo
10/ Ongoing inflammation is also supported by this study of N=2,320 pts in which systemic high levels of IL-6 & LC symptoms support ongoing tissue damage that translated into disability & low quality of life 1 year later.
bit.ly/3LUsHu9
11/ Three different profiles of #LongCOVID were found in N=1,500 patients:
🧨 brain predominant
🧨 heart/lung predominant
🧨 multi-system (including joints & GI).
Which profile do you or your loved ones suffer?
bit.ly/3QjM5mq
12/ It is estimated by large datasets using ICD-10 codes that ~75% of #longCOVID patients were never hospitalized.
📍third <50 y/o (4% kids <12)
📍third between 51-66 y/o
📍third >65 y/o
bit.ly/3djfkqN
13/ BRAIN FOG: Early autopsy studies of COVID pts showed lack of virus in neurons & made us think the brain wasn’t involved.
We know lots more now...
UK Biobank MRI study N=401 pts(most mild COVID) found ⬇️ brain SIZE vs 384 controls & slower brains 😩
https://go.nature.com/3ILTN4Z
14/ Other neuroimaging, PET & cognitive testing data support abnormalities in the hippocampus & frontal cortex.
PET studies showing metabolic slowing help explain profound anxiety, loss of memory & neurocognitive deficits in long COVID pts.
https://bit.ly/3axWlaN
15/ The virus infects not only endothelial cells but also astrocytes, both of which indirectly affect longevity and overall health of our neurons.
Glial cells are the glue that holds the brain together and provide the environment for neurons to thrive.
https://bit.ly/3SIWiKC
16/👇Frere showed glial cells are activated by COVID & sustain inflammation, which in turn, sadly sets into motion a pathway toward overall brain atrophy (shrinking), long-term cognitive disability & mental health disorders seen in your friends w LC.
https://bit.ly/3zB7gLk
17/ We have solid data across mammals (e.g. humans and mice) that COVID infection causes increases of neurotoxins and neuronal cell death similar to that seen in the brains of patients with cancer after receiving chemotherapy.
https://bit.ly/3JM0fdE
18/ Neuropsychological testing we do as part of our @CIBScenter’s NIH studies indicates many of our long COVID patients have deficits equivalent to acquired dementia.
Clinical trials are being designed, including therapies to prevent/heal dementia.
go.nature.com/3Qx6XXe
19/ Science makes it so clear that #Covid turns on inflammation & alters our nervous system even when the virus seems long gone.
Listen & validate your friends & patients.
It helps them simply to know they are heard.
TY @VirusesImmunity👇
go.nature.com/3zQqVFB
20/ LC pts describe over 200 symptoms‼️
Yet we have no cures…yet
At times, I must have seemed upset & perhaps sent the message to patients they’re a burden.
If I have, I am sorry.
It is in no small part because I'm grappling for answers, too.
https://bit.ly/3JLGNO5
21/ I remind myself that patients are not difficult. It’s the situation that is difficult.
New data in 1.28M COVID pts found mood & anxiety disorders improved BUT Acquired #BrainFog (dementia), psychosis & seizures persist at 2 YEARS.
https://bit.ly/3PBsOvw
22/ Too many people are losing #hope.
A study of 150,000 COVID survivors, both hospitalized & not, showed they had 10-15 times ⬆️ risk of considering suicide at 1 year versus 11M control patients.
Our daily zoom support groups are part of recovery ❤️🩹
bit.ly/3HnHZpB
23/ In 20 years of studying long-term ICU outcomes, we’ve learned that acquired dementia is often partially correctable.
#PICS patients can benefit from brain exercises even years after ICU care.
There will be overlap w #LongCOVID & we must study this.
https://bit.ly/3vCMTtc
24/ Patients with cancer who suffer #ChemoBrain may benefit from cognitive rehabilitation.
Some use sudoku, wordle & online games to help. The brain wants exercise & can often rebuild and sharpen.
We are conducting more clinical trials.
H/T @tmprowell
https://bit.ly/3KimRCG
25/fin
#LongCOVID patients, please don’t lose hope. Your brain is packed w powers of neuroplasticity.
Caregivers serving patients during difficult times, harness empathy & compassion to aid patients’ recovery.
Neuroscience is real & patients must be heard to start healing ❤️🩹"
Source:
Commentary: This is perhaps the most detailed analysis of Long COVID yet. And it's a shitshow in terms of what it does to the body - like literally shrinking your brain. The reality is we don't fully understand what COVID does to the body, but Long COVID is incredibly common AND incredibly bad. Keep the virus out of your body. The people calling for precautions to end are gambling on a virus they don't understand, and 1 in 3 odds... suck.
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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. P100 respirators are back in stock at online retailers, too and start around US$40 for a reusable respirator. 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 eligible to, and fulfill the full vaccine regimen, including boosters. Remember that you are not vaccinated until everyone you live with is vaccinated. For COVID, if you received an adenovirus vaccine (J&J/AstraZeneca), consider getting an mRNA single shot booster (Pfizer/Moderna) if available. If it's available, choose Moderna as your first choice for both vaccine and booster, Pfizer as your second choice. However, remember that any vaccine is better than no vaccine.
4. Wash/sanitize your hands every time you are in or out of your home. Sanitize the bottom of your shoes with a simple peroxide spray using ordinary drugstore/supermarket peroxide in a spray bottle. If you've come in close contact with others (rubbing or brushing up against them, hugging, etc.) consider showering and washing your clothes as well.
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 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 pandemics give another crazy plot twist to the economy, or you know, a global war breaks out.
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 several rapid antigen tests and/or acquire them from your healthcare provider or government. This will detect COVID-19 only when you're contagious, so follow the directions clearly. https://amzn.to/3fLAoor
If you think you may have been exposed to monkeypox, contact your healthcare provider about available testing.
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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 or monkeypox. 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 or monkeypox, nor do I financially benefit in any way from sharing information about COVID-19 or monkeypox.
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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.