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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Today in the United States, we reach the grim milestone of 150,000 deaths attributed to COVID-19. If you think about it, that's like a 9/11 every day for 50 days. For those of you who have lost a loved one, I am sorry. For those of you taking the disease as seriously as you did when this all started, I thank you.
Wear a mask. Watch your distance. Wash your hands. Withdraw from indoor spaces.
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Misinformation is just as deadly as the disease. "As scientists begin to clear a path to a potential coronavirus vaccine, researchers and advocates are increasingly sounding the alarm over what they see as a looming threat: Facebook’s apparent inability to police dangerous falsehoods about vaccines.
Since the outset of the pandemic, vaccine-related falsehoods have ballooned on the platform — and recent research suggests some of those inaccurate posts are gaining traction among people who weren’t previously opposed to vaccinations. Part of the problem appears to be the way Facebook’s algorithms capitalize on divisive or extremist content.
Compounding the issue is Facebook’s history of hesitating to address misinformation until a particular subject has snowballed into an urgent problem. In the middle of a global measles outbreak last year spurred by low vaccination rates, Facebook rolled out a series of policies to curb vaccine misinformation. But the changes did little to prevent the problem from resurfacing again amid the Covid-19 pandemic.
Concerned that Facebook’s failure to crack down on vaccine falsehoods will backfire at the worst possible time, advocates and scientists have called on Facebook co-founder Mark Zuckerberg to take action.
“Covid-19 misinformation is the equivalent of an ideological dirty bomb: It has the capacity to hurt tens of thousands of people when it detonates in the moment that vaccines are available,” said Imran Ahmed, founder and chief executive officer of the U.K.-based nonprofit Center for Countering Digital Hate, which recently assessed the growing influence of anti-vaccination content on social media platforms including Facebook since the outset of the pandemic."
Source: https://www.statnews.com/2020/07/28/facebook-vaccine-misinformation-antivaxx-coronavirus-covid/
Commentary: Fundamentally, medical disinformation is an act of war against a population. It's no different, from an outcome perspective, than blocking people from receiving vaccines. We should be treating it as such. If Facebook were a company manufacturing, say, automobiles, and those cars started exploding and killing thousands of people, the call for an immediate recall and even shuttering the company would be instantaneous. Their product is doing the same thing, and needs to be addressed as such.
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Not just a respiratory virus. "In late January, when hospitals in the United States confirmed the presence of the novel coronavirus, health workers knew to watch for precisely three symptoms: fever, cough, and shortness of breath. But as the number of infections climbed, the symptom list began to grow. Some patients lost their sense of smell and taste. Some had nausea or diarrhea. Some had arrhythmias or even heart attacks. Some had damaged kidneys or livers. Some had headaches, blood clots, rashes, swelling, or strokes. Many had no symptoms at all.
By June, clinicians were swapping journal papers, news stories, and tweets describing more than three dozen ways that COVID-19, the disease the coronavirus causes, appears to manifest itself. Now researchers at UC San Francisco and around the world have begun taking a closer look at this dizzying array of symptoms to get at the disease’s root causes. They are learning from people inside the hospital and out; people on the brink of death and only mildly sick; people newly exposed and recovered; people young and old, Black, brown, and white. And they are beginning to piece together the story of a virus unlike any known before.
“One of the weirder things about this new coronavirus is it doesn’t seem to be incredibly cytopathic, by which we mean cell-killing,” Krummel says. “Flu is really cytopathic; if you add it to human cells in a petri dish, the cells burst within 18 hours.” But when UCSF researchers subjected human cells to SARS-CoV-2, many of the infected cells never perished. “It’s pretty compelling data that maybe we’re not dealing with a hugely aggressive virus,” Krummel says.
Especially disconcerting, Kattah says, is how long the virus seems to persist in the gut. About 50% of patients with COVID-19 have virus particles in their stools, often for weeks after their nose swabs test negative, he points out. Laboratory studies show that these particles are often still alive and can infect cells in a petri dish. Whether fecal transmission occurs between people, however, is an open question. If the answer is yes, people recovering from COVID-19 may need to stay quarantined even after they feel well, and the rest of us will need to be as meticulous about bathroom hygiene as we’ve become about handwashing and mask-wearing."
Source: https://www.ucsf.edu/magazine/covid-body?fbclid=IwAR1Q9-nfRavcrgVtmls-Ov-d10MXf0pzYp9CM9-D7zyOz67YF1Y4VW6cSkU
Commentary: This entire piece is an excellent, thorough read about how complex this disease is. The really interesting twist is the commentary on cytopathy. The fact that SARS-CoV-2 doesn't kill cells nearly as aggressively gives it a significant survival advantage - the more hosts who have it and carry it around, the better it does. Dying from it too quickly would prevent it from surviving and spreading.
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DIY swab? "Unsupervised home midnasal swab collection was comparable to clinician-collected nasopharyngeal swab collection for detection of SARS-CoV-2 in symptomatic patients, particularly those with higher viral loads. During this rapidly evolving pandemic, we enrolled 185 individuals presenting for SARS-CoV-2 testing, including 41 with positive test results. We used novel home-based swab self-collection and rapid delivery services, thus avoiding participant contact with the health care system.
Unsupervised home self-swab collection presents several advantages, including accessibility outside of the health care system and minimizing personal protective equipment use. This approach is safe and scalable in the pandemic setting, permitting widespread testing of symptomatic participants early in illness and the potential for prompt self-isolation and contract tracing. The sensitivity of home self-collection in this study was lower than previously described.1 We observed false-negative results in samples with low initial viral loads.2-4 A home-based strategy should be targeted toward individuals early in illness, when risk of transmission is highest and care seeking less likely."
Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2768535
Commentary: People could conceivably self-administer nasal swabs for COVID-19 testing, based on these results. If we could get the test processing up to speed in the United States in particular, it could do much to stem the outbreaks by identifying where the problems are.
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Long-term damage. "With the COVID-19 pandemic having reached tremendous proportions, post-mortem series are under the limelight to explain many of the peculiar clinical findings. Pathological descriptions of disease are fundamental for understanding pathogenetic features and might inform new treatments. Indeed, the widely discussed identification of thrombosis in patients with COVID-19 has garnered much interest, and has resulted in new treatment strategies, with anticoagulants now part of patient management.
In their Article, Luca Carsana and colleagues1 describe the lung findings of 38 patients who died with COVID-19 and show that early-phase or intermediate-phase diffuse alveolar damage is the main pathological finding, as well as fibrin thrombi in small arterial vessels.1 Other autoptic series, composed of fewer cases, also show thrombotic events to be findings specifically related to COVID-19.2, 3 The fibrotic changes seen in patients who died with COVID-19 who had severe disease of long duration have been, however, only briefly touched upon in published studies, and no complete pathological description of these cases is available.
Presumably, the fibrotic pathological findings are unlikely to regress in patients with severe COVID-19 who survive, although prospective studies are necessary to identify long-term functional impairment.4 Whether the cause of fibrotic findings in the lungs is viral infection, the secondary cytokine cascade, related to treatment or ventilation, or a mixture of all these things is unknown; however, tissue collection must be part of, and indeed become the basis for, more in-depth studies.5"
Source: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30582-X/fulltext#coronavirus-linkback-header
Commentary: The last paragraph is key. The lung damage done by COVID-19 seems unlikely to unwind, leaving victims with permanent, life-long lung damage. Recall that while only 1% of people who contract the disease tend to die, as much as 5% incur serious, severe harm from it - and in a world of 7 billion people, 5% is 350 million people permanently disabled - greater than the population of the United States.
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On metrics. "Experts suggested that the daily case count is better viewed as a rough measure of whether an outbreak is slowing, expanding or stabilizing. A decrease in new confirmed cases could also indicate that testing is not available widely enough, or that there is a backlog of tests that have not yet been processed and delivered to the local health department.
Another frequently cited number is the positivity rate, the percentage of coronavirus tests that have returned with a positive result.
“The positivity number is one of the first places I go to,” said Gov. Mike DeWine of Ohio, who wakes up each morning to a fresh PowerPoint presentation from his staff, which he reads on his iPad before 8 a.m. “That’s what I zero in on.”
A rising positivity rate can point to an uncontrolled outbreak; it can also indicate that not enough testing is occurring.
Mr. DeWine is an avid reader of the daily PowerPoint presentation, which he calls the Situation Update. It started small in the early days of the pandemic. It has grown to at least 31 slides of numbers, charts and graphs — every day.
He said he also focused closely on the number of Ohioans who have been hospitalized for the coronavirus, a data point that is difficult to spin or misinterpret. Last week, the pandemic approached an alarming milestone: About as many people in the United States are now hospitalized with the coronavirus as at any other time in the pandemic, including during an earlier surge in the New York region in the spring.
“Hospitalization is a hard number,” Mr. DeWine said. “There’s no fudge on it.”"
Source: https://www.nytimes.com/2020/07/27/us/coronavirus-data.html
Commentary: The numbers I pay attention to personally are a basket of numbers - new cases per day, new deaths per day, positivity rates per day, testing numbers per day, and doubling time. As the article mentions, no one number tells the whole story, but with a handful of data points, you can quickly get a sense for the situation.
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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 or injected.
2. Wear gloves and a mask when out of your home. Respirators are back in stock at online retailers, too.
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; indoor spaces spread the disease through aerosols and distance is less effective at mitigating your risks.
4. Get your personal finances in order now. Cut all unnecessary costs.
5. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
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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.