Lunchtime Pandemic Reading, 29-July-2021
You are contagious, vaccinated or not, if Delta hits you
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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Really, really, REALLY important. If you have Delta, you are very probably contagious, vaccinated or not.
"During a briefing yesterday, Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, said something that grabbed my attention. While discussing the Delta variant, she said that when “we examine the rarer breakthrough infections [i.e. infections despite vaccination] and we look at the amount of virus in those people, it is pretty similar to the amount of virus in unvaccinated people.” This strongly implies, though does not prove, that when Delta manages to infect a vaccinated person and cause symptomatic Covid-19, that person remains highly protected from serious disease, but on average they may be just as likely to spread the virus forward as unvaccinated infected people. In scientific terms, the viral load, a very good proxy for contagiousness, among unvaccinated and breakthrough delta infections appear comparable.
This is breaking and important news. It’s the reason why the CDC has now altered its mask guidance in areas with “substantial or high” levels of transmission, advising indoor masking in public even for vaccinated people in these places. Given the threshold of 50 new cases per 100,000 people in a 7-day period, the new guidance applies to large swaths of the country now.
What we learned today, both from Dr. Walensky and other well-sourced observers is that once a vaccinated person is infected with Delta (and at this point, assume all US cases are Delta), may be equally contagious as an unvaccinated person. (For my science colleagues, we are being told that the “cycle threshold” on the PCR tests, a number which indicates viral load, were in the teens and twenties, figures that imply the possibility of transmissible virus.) That said, most infections, hospitalizations, and spread are still occurring among the unvaccinated. The vaccines are still preventing most infections and most disease."
Source: https://insidemedicine.bulletin.com/243910787550177
Commentary: What this means is simple: mask up. Period. Don't worry about whether your area is an area of high spread or not. Just mask up any place you're indoors that isn't your home, whether you're vaccinated or not.
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US government considering a vaccination requirement for federal employees. "President Joe Biden is expected to announce Thursday that the federal government, the nation's largest employer, will require its civilian workers to get COVID-19 shots or follow more stringent protections, a move that could encourage other businesses and local governments to follow suit.
The shift in strategy is already winning praise from public health advocates and raising concerns among some libertarians even before the details are announced. The pending policy has the potential to meaningfully boost vaccination rates, given the government's outsized influence and 2.1 million civilian workforce outside of the Postal Service.
White House Deputy Press Secretary Karine Jean-Pierre referred to the policy Wednesday as a vaccine “attestation” rather than a "mandate."
“While no decision has been finalized, I will say that the attestation of vaccination for federal employees is one option under strong consideration,” she told reporters.
People unwilling to confirm their vaccination status may have to follow other mitigation measures like wearing masks and routine testing, even in places where transmission is relatively low, she said.
The policy would represent a major change in the White House’s vaccination campaign.
“Mandates have to be a last resort. But we’ve tried begging, pleading, cajoling, incentives, and none of that worked,” said Lawrence Gostin, a Georgetown Law School global health law expert.
As of July 28, Centers for Disease Control and Prevention data shows that 69 percent of adult Americans have been partially vaccinated and about 60 percent were fully vaccinated.
Once considered a controversial third rail, many experts have embraced vaccine requirements as the highly infectious and potentially more virulent delta variant has torn through the country, putting vulnerable populations at risk."
Source: https://www.rollcall.com/2021/07/28/biden-bid-for-federal-workers-to-get-covid-19-shots-prompts-debate/
Commentary: Employers, especially private sector employers, are free to make any legal requirement a condition of employment (legal meaning anything that is non-discriminatory). Giving people a choice between masks + testing or vaccine virtually eliminates the argument that people MUST take a single course of action, and both interventions are effective. I see no problem with this approach, and recommend that all employers consider it. Plus, I wouldn't be reopening offices so fast. The more people stay home, the safer they'll be - come into the office wearing a mask, or stay at home without a mask is a fair choice as well for those whose jobs permit them to work remotely.
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Another hint at why kids are hit less hard by COVID-19 on average. "SARS-CoV-2 infection of children leads to a mild illness and the immunological differences with adults are unclear. Here, we report SARS-CoV-2 specific T cell responses in infected adults and children and find that the acute and memory CD4+ T cell responses to structural SARS-CoV-2 proteins increase with age, whereas CD8+ T cell responses increase with time post-infection. Infected children have lower CD4+ and CD8+ T cell responses to SARS-CoV-2 structural and ORF1ab proteins when compared with infected adults, comparable T cell polyfunctionality and reduced CD4+ T cell effector memory. Compared with adults, children have lower levels of antibodies to β-coronaviruses, indicating differing baseline immunity. Total T follicular helper responses are increased, whilst monocyte numbers are reduced, indicating rapid adaptive co-ordination of the T and B cell responses and differing levels of inflammation. Therefore, reduced prior β-coronavirus immunity and reduced T cell activation in children might drive milder COVID-19 pathogenesis."
Source: https://www.nature.com/articles/s41467-021-24938-4
Commentary: When COVID-19 hits hard, it makes our immune system go haywire. Kids have had less exposure to other coronaviruses (other beta coronaviruses make up some of the common cold), which means there's less memory in their immune system to go crazy when they do get COVID-19.
This raises the question of whether they will in turn get more severe common colds later in life if they've had COVID-19. We have no data or research on that yet, for obvious reasons.
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File under things you wouldn't expect from a frozen cheesesteak company, but a worthwhile read. From Steak-Umm:
"ok it's time to talk about societal distrust in experts and institutions, the rise of misinformation, cultural polarization, and how to work toward some semblance of mutually agreed upon information before we splinter into irreconcilable realities
(beefy thread incoming)
science the *term* has been politicized—not the *process* of it. as that process has evolved on issues, both public and private institutions have taken inspiration from it, but those decisions are still driven by economic and political interests which muddy how the term is used
distrust in institutions is complex. it's accelerated by people's access to infinite information, credible sources being paywalled, corruption, honest misteaks, or propaganda, but underneath it all is a cultural polarization dating back decades that won't be solved overnight
in the past year various experts and public figures have changed positions with new findings, made good faith errors, politicized the virus, spread misinformation, and had disagreements across institutions. every possible narrative on these occurrences has been amplified by media
the path to restore trust in institutions must be shared between experts and laypeople alike. it’s an uphill battle. people naturally distrust power. experts have knowledge laypeople don't. polarization, fear, and otherizing sell. there's a bottomless market for misinformation
experts need to earn trust back by acknowledging misteaks and being transparent about their processes, what's known, and what's still being learned. they need to address valid concerns. they need to meat people where they are and deliver tangible benefits to improve their lives
laypeople need to hold both their skepticism and trust of experts in an open hand. they need to acknowledge their limitations in accessing or interpreting fields or resources outside their expertise. they need to keep learning media literacy and grappling with empirical evidence
the shortcomings within experts and institutions don't make fringe sources equally credible or trustworthy. if a doctor gets something wrong, you try another doctor, not a plumber. if a study gets something wrong, you don’t rely on anecdotes for truth, you rely on better studies
the usefulness of skepticism in experts and institutions is strongest within competing experts and institutions, not outsiders. an outsider may have certain insights worth engaging, but they can't be weighed as equally credentialed as a relevant expert or institutional consensus
an institution may have structural biases that need to be acknowledged, but alternative sources in media are littered with their own biases and have little to no accountability, so no matter where you get information from you're still extending a degree of trust in something
one universal goal everyone should prioritize is getting people from across the ideological spectrum closer to the same reality of baseline facts and evidence. it won't be perfect, but that needs to be the trajectory, rather than the current divergent trend into split realities
ideological divides will never go away in society, but they need to be fought over by using mutually understood language and comparable information or else conversations can't get off the ground—people will just continue talking past one another and escalating tension
solutions to societal distrust, media literacy, and polarized realities have to come on both institutional and cultural levels. people need to be inspired. ideas need to be proposed. awareness is easy. everyone sees the problem. mass participation and solutions are the hard part
you can maintain healthy levels of skepticism while also extending trust where it's earned by empirical evidence and expertise. use critical thinking. work toward solutions with one another. and remember, this whole thread was an ad so please buy our frozen meat
steak-umm bless"
Source:
Commentary: Meat puns aside, they're not wrong in that experts are the ones who should be most skeptical of other experts, because they have knowledge parity. I wouldn't know the first thing about criticizing a surgeon or an auto repair expert, and so my opinions about their professions are limited to the outcomes they generate - i.e. they fixed my car or my spleen, or they didn't. Misinformation fills a knowledge gap that lay people have - but with the wrong thing.
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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 other people, even after you've been vaccinated. Respirators are back in stock at online retailers, too. 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 able to, and fulfill the full vaccine regimen. Remember that you are not vaccinated until everyone you live with is vaccinated. If you received an adenovirus vaccine (J&J/AstraZeneca), consider getting an mRNA single shot booster (Pfizer/Moderna) if permitted.
4. Wash/sanitize your hands every time you are in or out of your home.
5. Stay out of indoor spaces that aren't your home as much as practical. Minimize your contact with others and avoid indoor places as much as you can; indoor spaces spread the disease through aerosols and distance is less effective at mitigating your risks.
6. Get your personal finances in order now. Cut all unnecessary costs.
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:
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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. 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, nor do I financially benefit in any way from sharing information about COVID-19.
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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.