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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Confirmed airborne disease in a peer-reviewed study. "The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originated in Wuhan, China in late 2019, and its resulting coronavirus disease, COVID-19, was declared a pandemic by the World Health Organization on March 11, 2020. The rapid global spread of COVID-19 represents perhaps the most significant public health emergency in a century. As the pandemic progressed, a continued paucity of evidence on routes of SARS-CoV-2 transmission has resulted in shifting infection prevention and control guidelines between classically-defined airborne and droplet precautions. During the initial isolation of 13 individuals with COVID-19 at the University of Nebraska Medical Center, we collected air and surface samples to examine viral shedding from isolated individuals. We detected viral contamination among all samples, supporting the use of airborne isolation precautions when caring for COVID-19 patients.
Taken together, these data indicate significant environmental contamination in rooms where patients infected with SARS-CoV-2 are housed and cared for, regardless of the degree of symptoms or acuity of illness. Contamination exists in all types of samples: high and low-volume air samples, as well as surface samples including personal items, room surfaces, and toilets. Samples of patient toilets that tested positive for viral RNA are consistent with other reports of viral shedding in stool11. The presence of contamination on personal items is also expected, particularly those items that are routinely handled by individuals in isolation, such as cell phones and remote controls, as well as medical equipment that is in near constant contact with the patient. The observation of viral replication in cell culture for some of the samples confirms the potential infectious nature of the recovered virus."
Source: https://www.nature.com/articles/s41598-020-69286-3
Commentary: This is the first peer-reviewed study to confirm that SARS-CoV-2 is an airborne virus. This is a big deal, because it means there's no longer reasonable doubt about how COVID-19 is transmitted. As a reminder, the number of a mask indicates its level of effectiveness; N95 masks filter 95% of particles. N99 masks filter 99% of particles. N100/P100 masks filter 99.99% of particles. If you are entering an airspace where you know you will be exposed to COVID-19, wear the highest level protection possible.
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On school reopening. "The safest way to open schools fully is to reduce or eliminate community transmission while ramping up testing and surveillance. Adults would need to maintain social distance from each other and engage in other measures to reduce adult-to-adult transmission: for example, wearing personal protective equipment (PPE), closing school buildings to all nonstaff adults, and holding digital faculty meetings. These precautions are especially important insofar as 17.5% of teachers are 55 or older.25 But we believe that schools in low-transmission settings could probably provide pedagogically sound and socioemotionally appropriate instruction to all students, in person, in ways that do not put educators or families at undue risk.26
Any region experiencing moderate, high, or increasing levels of community transmission should do everything possible to lower transmission. The path to low transmission in other countries has included adherence to stringent community control measures — including closure of nonessential indoor work and recreational spaces.11 Such measures along with universal mask wearing must be implemented now in the United States if we are to bring case numbers down to safe levels for elementary schools to reopen this fall nationwide.
Districts and states that refuse to implement these essential public health measures, on the other hand, face a profound social and moral dilemma: namely, how to weigh the known risks to children, families, and society of closing school buildings or operating at reduced capacity against the unknown risks (especially to school personnel and to educators’ and children’s household members) of opening schools when the virus is still circulating at moderate or high levels.27,28 This dilemma is exacerbated by school segregation and racial and class injustice: reopening schools that serve poorer and predominantly minority populations poses the greatest risk to families’ and educators’ safety — but their ongoing closure also imposes the greatest harms on children and families.14
Many families — particularly those with medically vulnerable household members — will choose to keep their children home under these circumstances regardless of whether schools are physically open.29 We understand this risk calculus. Remote teaching and other school services (including meal provision and medical and therapeutic services) should be available to all families who choose this option, with designated educators being responsible solely for remote teaching.
But educators and other school personnel cannot necessarily dictate the place or terms of their employment, even (perhaps especially) when the social compact has broken down. It is tragic that the United States has chosen a path necessitating a trade-off between risks to educators and harms to students, given other countries’ success in reducing transmission and opening schools with routine control measures in place. This dilemma represents a social and policy failure, not a medical or scientific necessity.
Nonetheless, we would argue that primary schools are essential — more like grocery stores, doctors’ offices, and food manufacturers than like retail establishments, movie theaters, and bars. Like all essential workers, teachers and other school personnel deserve substantial protections, as well as hazard pay. Remote working accommodations should be made if possible for staff members who are over 60 or have underlying health conditions.5,18 Adults who work in school buildings (or drive school buses) should be provided with PPE, and both students and staff should participate in routine pooled testing.30
But the fundamental argument that children, families, educators, and society deserve to have safe and reliable primary schools should not be controversial. If we all agree on that principle, then it is inexcusable to open nonessential services for adults this summer if it forces students to remain at home even part-time this fall."
Source: https://www.nejm.org/doi/full/10.1056/NEJMms2024920?query=TOC
Commentary: The whole piece is well thought out and science-driven. Fundamentally, if educators are to work in person, they should be provided with the same level of safety equipment we would expect any essential service to have. Other nations are accomplishing this. The United States should be able to as well. If citizens are unwilling to do what is necessary to cut community transmission, then schools in that community should not reopen.
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Johns Hopkins University advocates for a reset of the US COVID-19 strategy. "Summary of Recommendations
1. Encourage and, where appropriate, mandate nonpharmaceutical interventions.
2. Close higher risk activities and settings in jurisdictions where the epidemic is worsening and reinstitute stay-at-home orders where healthcare systems are in crisis.
3. Bolster PPE supply chains and stockpiles and make information about the PPE manufacturing base and supply chain publicly available, with the goal of expanding PPE availability.
4. Bolster test supply chains, plan for shortages, and collaborate with states and commercial laboratories to expand capacity and improve test turnaround times.
5. Conduct and make public detailed analyses of epidemiologic data collected during case investigations and contact tracing.
6. Curate and fund a rapid research agenda to cope with major challenges that have arisen.
7. Scale up contact tracing and continue to improve performance.
8. Identify and disseminate best practices for improving the public health response.
9. Plan for a vaccine, including production, allocation, distribution, and community engagement, to ensure a successful rollout.
10. Develop policies and best practices to better protect group institutions."
Source: https://www.centerforhealthsecurity.org/our-work/pubs_archive/pubs-pdfs/2020/200729-resetting-our-response.pdf
Commentary: That's a very straightforward list. Will the United States have the will to do it?
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A study on trains. "COVID-19 has a high transmission risk among train passengers, but this risk shows significant differences with co-travel time and seat location. During disease outbreaks, when travelling on public transportation in confined spaces such as trains, measures should be taken to reduce the risk of transmission, including increasing seat distance, reducing passenger density, and use of personal hygiene protection."
Source: https://academic.oup.com/cid/article/doi/10.1093/cid/ciaa1057/5877944
Commentary: Public transportation is a place where you should be wearing the best protection you have available to you. If you have to ride a train, boat, or plane, be geared up to maximum safety levels available to you.
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The pandemic that never should have happened. "The US National Academy of Medicine warned in 2016 that “the underlying rate of emergence of infectious diseases appears to be increasing”. In recognising then that there is more to come, the challenge is to find a middle path between rose-tinted and gloom-laden views—much as it is, I would argue, for the deepening climate crisis. MacKenzie pulls no punches about the dangers. Dreadful though it has been, the COVID-19 pandemic could have been worse. There's no law that says a virus this contagious could not be more lethal; the disease could have been caused by a less familiar type of virus (SARS has helped to create some existing understanding of coronaviruses that could speed up development of a vaccine); and many countries have managed the crisis fairly well. But she explodes the complacent view that viruses will get milder as they spread—there's no reason why the opposite could not be true—and mutation to more virulent forms might be encouraged by “leaky” vaccines that do not confer full immunity on all who take them. Besides, these terrible events won't in any way exempt us from the next serious influenza pandemic, and even a usual winter influenza season could be much worse with COVID-19 still circulating. A worst-case scenario is that complex feedbacks in human society—mass unemployment, economic crashes, depletion of the work force, and disruption of production and supply for food, energy, and medicines—could threaten to rend the entire social fabric. It wouldn't be the first time that a disease will have brought civilisation to its knees.
But there are opportunities to avoid the worst, and the COVID-19 pandemic is an urgent wake-up call. There can be no excuses now for a lack of national transparency when new diseases emerge, or for a failure to better prepare health and social care systems in advance of that. There is no doubt about the need for global surveillance systems, for preparedness plans for quarantine and contact tracing, more investment in virology and in capacity for distributed, large-scale vaccine and antiviral production, and for making our health, social care, and socioeconomic systems more robust."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31594-4/fulltext
Commentary: This is a summary of a new book that looks like it will be excellent and required reading. I agree that COVID-19 is a dress rehearsal for a more serious pandemic, and there's a non-zero chance that the combination of COVID-19 and a regular or stronger than average flu season could be disastrous.
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Understanding data lags, a useful primer on COVID-19 data reporting.
Source:
Commentary: Watch the video so that you can watch COVID-19 stats with a more critical eye.
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Dark humor about the reopening of schools. "As we prepare for the start of our school year, I wanted to alert you to a recent addition to your classroom learning environment. As per the order of the State Department of Education, each classroom will now be equipped with a lion.
The following information is designed to help you achieve your learning targets as you manage your lion. Please note: Due to the fact that we have never had lions in our classrooms and we’re figuring this out as we go, these recommendations could change at any moment."
Source: https://www.cmstevensmary.com/post/note-from-the-principal-this-fall-your-classroom-will-be-equipped-with-a-lion
Commentary: In case it wasn't clear, the analogy is that COVID-19 is the lion, and schools may be sending children and faculty in ill-prepared to deal with said lion.
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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.