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.
---
Third boost causing menstrual irregularities. "Some 10% of Israeli women experienced irregular menstrual periods after receiving the COVID-19 booster shot, a new Health Ministry study on the side effects of the third vaccine published on Wednesday shows.
The Health Ministry study sought to examine the prevalence of symptoms developed 21 to 30 days after receiving Pfizer's booster vaccine.
Women and young people are more susceptible to experiencing the side effects of the booster shot, the study showed. Additionally, the most common symptom reported in the study is irregular menstruation, with 10% of women up to the age of 54 who participated in the study reporting to have experienced the side effect.
The study found that most side effects reported were extremely mild and passed after three days at the most."
Source: https://www.jpost.com/health-and-wellness/coronavirus/article-695964
Commentary: A couple members of my household experienced this with the Pfizer bivalent booster. It is a real phenomenon and one to be aware of if you're timing your booster around things like travel. If you have a history of uterine or other gynecological issues, be sure to consult with your healthcare provider if you have any concerns.
---
COVID winter? "Will we see a new Omicron strain this autumn?
We might see three or more. As the Omicron sub-variants that drove past waves subside — BA.2, BA.4 and BA.5 — evolutionary descendants of these lineages are gaining mutations that seem to be helping them spread.
SARS-CoV-2-watchers are tracking an unprecedented menagerie of new variants from different branches of the Omicron family tree, says Tom Peacock, a virologist at Imperial College London. Despite these variants’ distinct ancestries, they carry many of the same mutations to the SARS-CoV-2 spike protein (the virus’s bullseye, from immune systems’ perspective). “Clearly, there’s an optimal way for a variant to look going into this season,” says Peacock.
Researchers are keeping a close eye on certain sub-lineages. The United Kingdom and some other European countries, for instance, are seeing the swift assent of BQ.1 (a descendant of BA.5 with several key changes). In India, spawn of the BA.2.75 variant that drove an infection wave several months ago are now outcompeting all others, says microbiologist Rajesh Karyakarte, the Maharashtra State Co-ordinator for SARS-CoV-2 sequencing in Pune. In samples his team sequenced in late September, a sub-variant called BA.2.75.2 was the most common (followed by a close relative). Another BA.2 offshoot, BA.2.3.20, is growing quickly in Singapore, and has turned up in Denmark and Australia.
“I’m fairly confident that at least one of these variants or a combination of them will lead to a new infection wave,” says Wenseleers. And, because they all seem to be behaving similarly, “at the end of the day it’s not that important which of these become the next big thing.”"
Source: https://www.nature.com/articles/d41586-022-03157-x
Commentary: At least where I live, Boston, Massachusetts, we are already seeing a sizable uptick in COVID detected by wastewater surveillance - doubling our usual weekly rates. As the weather turns colder in the northern hemisphere, people go indoors, and that leads to rapid spread. Colder, drier air also accelerates disease spread; aerosols are inherently smaller in dry environments, getting through masks more easily (especially cloth and surgical masks).
---
The Novovax vaccine exhibits strong effect. "The SARS-CoV-2 vaccine NVX-CoV2373 is a protein-based vaccine that might circumvent the difficulties in distributing mRNA vaccines to regions with limited access to cold-chain and refrigeration. However, the NVX-CoV2373–induced T cell and antibody responses remain poorly understood. In this issue of the JCI, Moderbacher et al. characterized SARS-CoV-2–specific CD4+ and CD8+ T cell responses elicited by one or two doses of NVX-CoV2373 in individuals enrolled in a phase I/IIa trial. Substantially increased spike-specific CD4+ and T follicular helper cells were found after the first or second vaccine dose, with some individuals developing a modest spike-specific CD8+ T cell response. Correlation analysis revealed an association between spike-specific CD4+ T cells and neutralizing antibody titers. Notably, preexisting T cell immunity showed negligible effects on NVX-CoV2373–induced T cell responses. These findings indicate that the protein-based vaccine NVX-CoV2373 induces robust T cell immunity capable of recognizing SARS-CoV-2 antigens and supporting humoral immune responses."
Source: https://www.jci.org/articles/view/163614
Commentary: Another tool in the toolkit.
---
Greater booster hesitancy. "Around two-thirds of adults in the United States do not plan to get updated COVID-19 booster shots soon, according to a survey conducted by the Kaiser Family Foundation (KFF), a health policy nonprofit organization.
Only a third of adults polled said they either already received the updated shots or plan to get the booster as soon as possible, the poll found.
The Pfizer /BioNTech (22UAy.DE) and Moderna Inc (MRNA.O) shots, updated to target more recently circulating Omicron subvariants of the coronavirus as well as the original strain, were authorized by the U.S. Food and Drug Administration late last month.
Around 18% said they would wait and see whether they would get the new booster shot, while 10% said they would only get it if it was required. Around 12% of adults surveyed said they would definitely not get the shot, while 27% said they were not eligible because they were not fully vaccinated."
Source: https://www.reuters.com/world/us/two-thirds-us-adults-dont-plan-getting-covid-boosters-soon-poll-2022-09-30/
Commentary: I got mine last week. If you're over 12, you're eligible for the booster as long as you haven't gotten a booster within the last 60 days and you've gotten a full regular vaccine dose. Not included in the requirements but just makes good sense - if you've had COVID in the last 2 months, also hold off until 90 days out.
---
7% of all people with COVID have neurological disorders a year later. "In the post-acute phase, patients with COVID-19 had an increased risk of a wide range of incident neurological disorders, including cerebrovascular disorders, cognition and memory disorders (memory problems and Alzheimer’s disease), peripheral nervous system disorders, episodic disorders, extrapyramidal and movement disorders, musculoskeletal disorders, sensory disorders, other neurological or related disorders, and any neurological outcome (a composite outcome of any of the neurological outcomes we studied) (Fig. 1; see the associated paper for the full list of conditions assessed). Overall, we estimate that patients with COVID-19 have a 42% increased risk of developing a neurological sequela in the year after infection, translating to a burden of 7% of infected people. The risks were evident in subgroups based on age, race, sex, obesity, smoking, measures of socioeconomic deprivation, diabetes, chronic kidney disease, hyperlipidaemia, hypertension and immune dysfunction. The risks were evident even among patients who had mild acute COVID-19 that did not necessitate hospitalization, but were higher among people who were hospitalized and the highest risks were among patients who needed intensive care during the acute phase of COVID-19. The results were consistent in analyses involving the COVID-19 group versus either the contemporary or the historical control cohorts as the referent category."
Source: https://www.nature.com/articles/s41591-022-02018-4
Commentary: 7% sounds small at first, until we consider that COVID is reinfecting people over and over again - and each successive dose of the virus itself is likely to increase the odds of a neurological disorder. This isn't something you want to be stuck with for a year or more. Mask up.
---
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.
---
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
---
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.
---
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.