Lunchtime Pandemic Reading, 29-October-2020
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.
You are welcome to share this.
---
Keep highest-risk people away from everyone. "In The Lancet Healthy Longevity, Maria Brandén and colleagues4 use compelling data from a population-based observational cohort to report COVID-19 deaths among older adults during the first epidemic wave in Stockholm, Sweden. The authors categorise all deaths among individuals aged 70 years and older in Stockholm from March 12 to May 8, 2020, using administrative data to link deaths to detailed household characteristics, geographic location, and household size. Older adults living in care homes had the greatest increase in risk of death among all categories of household. Older adults who lived with an adult of working age (<66 years) also had higher risk of COVID-19 mortality compared with those who lived with other older adults. Furthermore, older adults living alone had a similar risk to those living with younger adults. This could be due to a lack of social support for necessary activities, including pharmacy and food shopping, which prevent older adults living alone from physical distancing. Older adults in crowded housing and those in population-dense neighbourhoods also had increased COVID-19-related mortality compared with those living in less crowded or less densely populated settings, respectively. The authors conclude that contact with working-age adults, whether in a household, a care home, or in a neighbourhood with high population density, was associated with higher mortality from COVID-19 among older adults.
Households and neighbourhoods are both important units in social mixing across age groups, which is associated with a greater risk of dying for older adults. Measures designed to protect older adults must consider community spread as well as individual vectors of transmission, such as family members and care-home employees."
Source: https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(20)30035-0/fulltext
Commentary: Sweden, through its herd mentality strategy early on, inadvertently provided a perfect environment for scientific study of what happens when you just let a disease run unchecked through your population. Though the loss of life and health is deeply regrettable, those lost lives might not have been in vain if the lessons and data from them can be used to inform policy. For our elders, keep them away from the rest of the population to the greatest extent possible.
---
A case of ischemic stroke in a 9-year old child. "A 9-year-old girl was admitted to the paediatric intensive care unit (PICU) with a history of high-grade fever for 14 days, throbbing frontal headache, vomiting, and progressive weakness on the right side of her body for 5 days. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA was detected on nasopharyngeal swab by RT-PCR on presentation. On admission to the PICU (day 1), she had bilateral non-purulent conjunctivitis, high-grade fever (axillary temperature using digital thermometer of 39·4°C), blood oxygen saturation of 98%, a heart rate of 64 bpm, tachypnoea, and hypertension (132/102 mm Hg). The patient had a Glasgow Coma Score (GCS) of 11 (E3, V2, M6), upper motor neuron type right-sided seventh cranial-nerve palsy, complete hemiplegia, brisk deep tendon reflexes, and extensor plantar response on the right. Her pupils were normal and she had no signs of meningeal irritation. Her paediatric quick sequential organ function assessment (qSOFA) score was 2 (of 3) on admission.1 The suspected causes for her neurological signs included COVID-19 associated encephalitis or stroke. She received tier 1 and tier 2 management for raised intracranial pressure—ie, mechanical ventilation, thermoregulation, sedation, and head-elevation to 30° (tier 1) and osmotherapy (glycerol, 3% hypertonic saline, and intermittent mannitol) and intermittent hyperventilation (tier 2), and other supportive care (eg, optimisation of intravascular volume, maintenance of normoxemia, and prevention and treatment of fever and seizures).2 Empirical antibiotics included ceftriaxone, vancomycin, and azithromycin. She had normal blood counts and renal function, mild transaminitis, high CRP, high ESR, high D-dimer, and increased triglyceride and ferritin concentrations, suggestive of a hyperinflammatory response (table). Chest x-ray showed bilateral ground-glass opacification and reticulonodular opacity.
MIS-C is rare; of 662 cases reported so far, only the case in this report has presented with acute ischaemic stroke. Considering the emerging evidence of this disease, clinicians should include SARS-CoV-2 in their differential diagnosis for children presenting with new neurological symptoms, positive inflammatory markers, and suggestive imaging findings while exploring other possible causes. Aggressive therapy to halt the cytokine storm and relevant supportive care while considering differential diagnoses is crucial for reaching positive outcomes in children. Further studies are required to understand the pathogenesis of ischaemic stroke and assess the neurological and cognitive outcomes in children with COVID-19."
Source: https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30314-X/fulltext
Commentary: Acute ischemic stroke is the most common form of stroke, when a blood clot forms int he brain and starts to destroy brain tissue by depriving it of oxygen.
Nine year olds aren't supposed to have strokes. Keep COVID-19 away from your kids by following all safety protocols and keeping them home as much as possible.
---
Long term care facilities workers need prioritization for vaccines. "A key struggle in rolling out coronavirus disease 2019 (COVID-19) vaccines could be getting several million initial doses to the nation’s massive and far-flung long-term care workforce.
Vaccinating those workers, who can unknowingly spread the virus to fragile residents, is considered an important step in controlling the pandemic. Long-term care facilities in the US have been ravaged by the virus, accounting for 8% of cases but 40% of deaths as of October 8, according to the Kaiser Family Foundation.
Early in the fall some experts in long-term care and immunization predicted significant hurdles in vaccinating long-term care workers. After all, staff turnover at nursing homes has been high for decades, and long-term care facilities typically possess fewer resources than hospitals for staff education about vaccine risks and benefits.
“The only way to keep older adults healthy and safe in this pandemic is through a coordinated federal response,” Katie Smith Sloan, president and chief executive officer of LeadingAge, which represents nonprofit nursing homes and other aging services, said in a statement. “The vaccine is still months away, so there is time to get this right.”
Even with the federal effort, however, significant obstacles remain. Inadequate vaccine safety is a widespread concern, and the vaccines themselves pose some unique logistical challenges. For example, the 2 leading candidates, both made with new gene-based messenger RNA (mRNA) technology, require ultracold storage.
Although CVS and Walgreens will maintain the cold chain for the vaccines they administer through the new partnership, long-term care facilities have to opt in to participate and choose a pharmacy to give vaccines on site. Facilities that don’t participate may not have the equipment necessary to properly store vaccines."
Source: https://jamanetwork.com/journals/jama/fullarticle/2772581
Commentary:
---
Charlie Baker, governor of Massachusetts, in a recent briefing. "DPH oversaw the investigation of multiple positive cases that are linked to youth hockey. More than 30 clusters discovered more than 110 positive cases, another 22 probable cases and more than 220 contacts, close contacts across 20 ranks all over the state. The cases impact at least 66 cities and towns. We also know the cases related to hockey and ranks are not isolated to Massachusetts this is happening in other states as well. And it's likely these confirmed hockey cases lead to dozens of additional cases as well. The data is real and probably undercounted due to the lack of cooperation by some of the adults who our contact tracing team reached out to and to the fact that most teams wouldn't make rosters available so that we could follow up with the kids and the families on the team and not cooperating with case investigations generally. That's among others. The reason why we took the immediate action and shut down all the rinks in Massachusetts for two weeks.
As we head into this holiday season, as we move indoors, as our cases, as we said almost three weeks ago, have continued to climb, use your head and think about how your actions will affect those around you. Now speaking of social gatherings, that I might spend a minute talking about Thanksgiving. I think we all know the last nine months have been tough on everybody. And the holidays are usually a time when we all get together to celebrate the spirit of the season.
But there's just no way around it. The holidays have to look and feel different this year. If we're going to keep up the fight against COVID. I know that's hard to say and in some respects it will be even harder to do. But the science on this one's pretty clear. Gathering in groups indoors for an extended period of time with family and friends is likely the worst possible scenario for spreading the virus. Today the Department of Public Health has released tips on how families should think about and plan for a safe Thanksgiving. The lowest risk for spreading COVID-19 is to celebrate with only members of your household or to host a virtual gathering with other members of your family that can't be there. This is the best way to avoid bringing this terrible virus to your parents, your grandparents or other loved ones. The Department of Public Health recommends limiting guests as much as possible.
And as I said before, this virus, especially for people in those kinds of [high-risk] categories, has no mercy. COVID won't take a vacation. It certainly won't respect the holiday. And we need to respect that when we make decisions about how we plan to spend that weekend. "
Source:
Commentary: There frankly should be criminal penalties - a fine, at least - for failure to comply with contact tracers during a public health emergency.
As for Thanksgiving and other holidays, Governor Baker is correct: the science is clear that spending time indoors for long periods of time, eating, drinking, and socializing is the most dangerous possible way to spend the holidays with anyone outside your household.
---
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. Always wear a mask when out of your home and if going to a high risk area, wear goggles. 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, 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.
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.
6. Participate in your local political process. For Americans, go to Vote.org and register/verify your vote.
7. Ventilate your home as frequently as weather and circumstances permit.
---
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
---
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.