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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The new J&J vaccine is out and showing some data. "Johnson & Johnson said Friday that its single-dose Covid-19 vaccine reduced rates of moderate and severe disease, but the shot appeared less effective in South Africa, where a new coronavirus variant has become common.
Overall, the vaccine was 66% effective at preventing moderate to severe disease 28 days after vaccination. But efficacy differed depending on geography. The shot was 72% effective among clinical trial volunteers in the U.S, but 66% among those in Latin America, and just 57% among those in South Africa. Though markedly below the levels seen with the first two authorized Covid-19 vaccines, those rates are above the thresholds originally set by the U.S. Food and Drug Administration for a vaccine to be considered useful.
Results from the first two authorized vaccines, one from partners Pfizer and BioNtech and a second from Moderna, were considerably stronger, reducing symptomatic infection by about 95%. But those vaccines require two doses. They also come with distribution challenges since they are required to stay at ultra-cold temperatures.
The new variant of the virus that was first identified in South Africa, B.1.351, throws another monkey wrench into the equation. It appears to make vaccines less effective. Novavax, another vaccine manufacturer, said Thursday that its vaccine was 90% effective in the U.K. but just 49% effective in South Africa. The existence of such a variant raises the possibility that vaccine makers will have to develop booster shots to protect against it. They might even need to do so regularly, as new strains of the coronavirus emerge."
Source: https://www.statnews.com/2021/01/29/jj-one-dose-covid-vaccine-is-66-effective-a-weapon-but-not-a-knockout-punch/
Commentary: What people are missing is something Dr. Akiko Iwasaki pointed out: 100% protection against death, 85% effectiveness against severe disease. You can still get sick with COVID-19 with the J&J shot, but it's no longer going to kill or seriously injure you for the most part. That's not to say there won't be long-term complications, but in terms of emptying out ICUs, this is still an outstanding result.
Source:
What this could mean is we could have a tiered system for vaccines based on risk and need. For people at the highest risk of complications, they should get the Pfizer/Moderna vaccines that are in more limited supply, more expensive, and are harder to transport. For people with lower risk of complications - younger people, people with no comorbidities - the J&J vaccine is the right call. 85% protection against severe disease and 100% protection against death would be amazing, and the J&J shot will be cheaper, easier to transport, faster to scale production, and most important for compliance, requires only a single shot.
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More testing is needed. "Regular and affordable testing, if done right, could not only diagnose people who feel sick, it could stop the spread of the pandemic by letting people know if they are contagious and need to stay home, even if they don't feel sick.
Scientists have been pushing for this kind of testing -- accessible, affordable and ideally, at home -- since the start of the pandemic, but it hasn't happened yet.
"Almost all the infections happen from people who don't know that they're positive, and so what you need is a widespread testing program that helps people identify when they are infectious so they can stop infecting other people," said Dr. Ashish Jha, a professor and dean at the School of Public Health at Brown University who wants more widespread testing. "We never really quite built that out."
Dr. Michael Mina, an assistant professor of epidemiology at the Harvard T.H. Chan School of Public Health, said the country hasn't scaled up the tests yet for a few reasons. One, the Trump administration "didn't want to see positive test results." While that's no longer a problem, he thinks, the "regulated environment" in the US would also need to change.
"We have the FDA that is kind of all controlling in some ways of what tests are available," Mina said. "The FDA, unfortunately, only has a single lens through which to look at a coronavirus test. Their only mandate, when it comes to testing, is to evaluate medical diagnostic tests.
"We don't have the legal framework or the regulatory framework to think of a test in the United States as a public health tool, only as a medical diagnostic tool," Mina said.
"If we actually got these tests into the average American's home and we asked every American to use a test twice a week, it takes 30 seconds to use -- as you brush your teeth, you use a Covid test -- that would be enough to empower people to know their status," Mina said. "And if they are positive, they would be able to essentially know that they're positive and make the appropriate changes.""
Source: https://edition.cnn.com/2021/01/29/health/covid-19-rapid-test-where-are-they/index.html
Commentary: We have long needed, and will continue to need, rapid, widespread testing. Especially as the new strains take hold, we need to identify hotspots much more quickly than we are now.
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You need the second dose. "BNT162b2 vaccines showed high efficacy against COVID-19 in a randomized controlled phase-III trial. A vaccine effectiveness evaluation in real life settings is urgently needed, especially given the global disease surge. Hence, we assessed the short-term effectiveness of the first dose of BNT162b2-vaccine against SARS-CoV-2 infection. Given the BNT162b2 Phase-III results, we hypothesized that the cumulative incidence of SARS-CoV-2 infection among vaccinees will decline after 12 days following immunization compared to the incidence during the preceding days.
We demonstrated an effectiveness of 51% of BNT162b2 vaccine against SARS-CoV-2 infection 13-24 days after immunization with the first dose. Immunization with the second dose should be continued to attain the anticipated protection."
Source: https://www.medrxiv.org/content/10.1101/2021.01.27.21250612v1
Commentary: One shot of the Pfizer vaccine isn't enough, with only 51% effectiveness. If you get the first jab, you MUST get the second to reach the 95% efficacy levels.
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A reminder of the simple daily habits we should all be taking.
1. Always wear the best mask available to you when out of your home and you'll be around other people. Respirators are back in stock at online retailers, too. Wear an N95/FFP2/KN95 or better mask if you can obtain it.
2. Get vaccinated as soon as you're able to.
3. Wash/sanitize your hands every time you are in or out of your home for any reason.
4. 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.
5. Get your personal finances in order now. Cut all unnecessary costs.
6. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
7. 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).
8. How to properly fit a mask:
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Common misinformation debunked!
There is no mercury or other heavy metals in the Pfizer mRNA vaccine. https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
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.