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.
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Another vaccine clears phase 2 of clinical trials and is in preparation for phase 3. "After randomization, 83 participants were assigned to receive the vaccine with adjuvant and 25 without adjuvant, and 23 participants were assigned to receive placebo. No serious adverse events were noted. Reactogenicity was absent or mild in the majority of participants, more common with adjuvant, and of short duration (mean, ≤2 days). One participant had mild fever that lasted 1 day. Unsolicited adverse events were mild in most participants; there were no severe adverse events. The addition of adjuvant resulted in enhanced immune responses, was antigen dose–sparing, and induced a T helper 1 (Th1) response. The two-dose 5-μg adjuvanted regimen induced geometric mean anti-spike IgG (63,160 ELISA units) and neutralization (3906) responses that exceeded geometric mean responses in convalescent serum from mostly symptomatic Covid-19 patients (8344 and 983, respectively).
At 35 days, NVX-CoV2373 appeared to be safe, and it elicited immune responses that exceeded levels in Covid-19 convalescent serum. The Matrix-M1 adjuvant induced CD4+ T-cell responses that were biased toward a Th1 phenotype. (Funded by the Coalition for Epidemic Preparedness Innovations; ClinicalTrials.gov number, NCT04368988"
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2026920
Commentary: Phase 3 and 4 trials tend to last the longest - normally 1-4 years each phase - to determine if a vaccine is safe and more effective than other options. In the case of a COVID-19 vaccine, what trials will be looking for are outliers.
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The Mayo Clinic on side effects. "A Phase 3 trial is really the last phase in the development of a vaccine before it goes through licensure. It is designed to measure efficacy and safety. After licensure, then we do so-called phase 4studies, which are really just attempts, once you're giving it now to hundreds of thousands of millions of people, to catch any side effects that you didn't in phase 3.
The phase 3 trials occurring now are designed to determine efficacy and safety. Efficacy meaning does it protect you against infection.
At the end of phase 3, what you'll know, hopefully, is did the vaccine prevent either acquiring the virus, or at least prevent disease or symptoms, and complications from that virus.
You'll know something about safety, but you'll actually only know about significant side effects that occur 1 in 5,000 times or more often. So, for example, a side effect that occurred 1 in 10,000 times won't be detected from this trial. That will await phase 4, when it's more widely used. So these are really important trials.
These trials will involve adults of various ages, but they won't yet be testing pregnant women or children, and that's a problem. As we've seen, children absolutely can transmit this virus and widely so. And for good reason, pregnant women are very concerned in regards to having a child during a pandemic like this. So at the current time, they're not included in these trials. Eventually, they will be."
Source: https://newsnetwork.mayoclinic.org/discussion/phase-3-clinical-trial-of-covid-19-vaccine-underway/
Commentary: The challenge with any new drug is the side effects - and especially with something developed as quickly as this COVID-19 vaccine. That's one of the reasons people reacted with alarm when American officials talked about potentially skipping phase 3 trials if other nations' phase 3 trials were successful. America in particular is a very diverse population, but also a deeply unhealthy one. Any side effect which is amplified by an existing comorbidity like diabetes, obesity, cardiac conditions, etc. will have an outsized impact on Americans that you wouldn't necessarily find in, say, Chinese citizens. Thus, despite politicians' urging, skipping phase 3 and even phase 4 trials in America would be potentially disastrous if there's a side effect that wasn't caught in phases 1 and 2.
Wherever you live, urge your elected officials not to skip steps or rely on data sourced from a population that isn't yours. It's the best avenue to safety, even if it takes a little longer for a vaccine.
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COVID-19 causing depression. "In this survey study that included 1441 respondents from during the COVID-19 pandemic and 5065 respondents from before the pandemic, depression symptom prevalence was more than 3-fold higher during the COVID-19 pandemic than before. Lower income, having less than $5000 in savings, and having exposure to more stressors were associated with greater risk of depression symptoms during COVID-19.
These findings suggest that there is a high burden of depression symptoms in the US associated with the COVID-19 pandemic and that this burden falls disproportionately on individuals who are already at increased risk."
Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770146
Commentary: A 3x increase in depression symptoms isn't something to be taken lightly. Remember when we looked at excess death counts for COVID-19? One of the factors in there is suicide.
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COVID-19 and sports. "Beyond its scientific backing, the notion that a COVID-19 patient might wind up with long-term lung scarring or breathing issues has the ring of truth. After all, we hear the stories, right? The virus can leave survivors explaining how they struggled to breathe, or how it can feel, in the words of actress Alyssa Milano, “like an elephant is sitting on my chest.”
We’ve also known for a while that some COVID-19 patients’ hearts are taking a beating, too—but over the past few weeks, the evidence has strengthened that cardiac damage can happen even among people who have never displayed symptoms of coronavirus infection. And these frightening findings help explain why college and professional sports leagues are proceeding with special caution as they make decisions about whether or not to play.
Experts estimate that half of myocarditis cases resolve without a chronic complication, but several studies suggest that COVID-19 patients show signs of the condition months after contracting the virus. One non–peer reviewed study, involving 139 health care workers who developed coronavirus infection and recovered, found that about 10 weeks after their initial symptoms, 37 percent of them were diagnosed with myocarditis or myopericarditis—and fewer than half of those had showed symptoms at the time of their scans.
Taking on myocarditis is a chore. Thankfully, some acute cases resolve on their own, requiring only hospital monitoring and possibly some heart medications. We’ve learned that steroids and immunoglobulins—useful elsewhere—aren’t effective in acute viral myocarditis, although Samuel said there may be a role for steroids in younger COVID-19 patients who seem to present with more of an autoimmune type of the condition. And, of course, an effective vaccine could help prevent cases in the first place.
Samuel called it “extremely dangerous” for athletes diagnosed with myocarditis to play competitive sports for at least three to six months, because of the risk of serious arrhythmia or sudden death, and several athletes already have made the decision to heed those dire warnings. We’ll likely see more such decisions in the very near future, as each sport enters its peak season."
Source: https://www.scientificamerican.com/article/covid-19-can-wreck-your-heart-even-if-you-havent-had-any-symptoms/
Commentary: When the top athletes in the world endure substantial complications that knock them out of competitive sports, what do you suppose the virus does to the rest of us? I suspect over the comings months and years, we will find there are far more complications and lingering effects to COVID-19 than we've discovered. All our focus has rightfully been on understanding the disease and preventing it; obviously, because it's new, we have no idea what the long-term effects will be, but early indications suggest they will be substantial.
Protect yourself. Don't contract it in the first place if you can avoid it.
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Spain stops smoking outdoors. "The Spanish region of Galicia has effectively banned smoking in public places over concerns it increases the risk of Covid-19 transmission. It issued a blanket ban on smoking in the street and in public places, such as restaurants and bars, if social distancing is not possible. The north-western region is the first to introduce such a measure, but the Canary Islands has since followed suit. It comes as Spain faces the worst infection rate in western Europe. Daily cases have risen from fewer than 150 in June to more than 1,500 throughout August. It recorded 1,690 new cases in the latest daily count on Wednesday, bringing the country's total to almost 330,000.
Galicia's smoking ban was announced in a news conference on Wednesday after experts recommended the measure to the regional government. The move is supported by health ministry research, published last month, that outlined the link between smoking and the increased spread of coronavirus. It said the risk was heightened because people project droplets - and potentially Covid-19 - when they exhale smoke. It also said smokers risked infection in other ways, such as by touching their cigarette before bringing it to their mouth and by handling face masks when taking them on and off."
Source: https://www.bbc.com/news/world-europe-53763267
Commentary: Of course smoking spreads COVID-19. You're literally exhaling a massive cloud of particles that were in your lungs. And because smokers tend to congregate around specific, designated areas, the concentration of particles is that much more dense - even outside. No one should be standing around any kind of public area smoking, period, until a vaccine is available. Smoke in private if you smoke (but also, consider stopping smoking - COVID-19 attacks the lungs fiercely, and you want them to be at 100% if you contract the disease).
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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. 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.
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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.