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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At the end of June, at the end of the quarter, midway through 2020. 10 million infections. Half a million deaths. And per the WHO, the worst is yet to come. Are you ready? Have you restocked the supplies you've used? Have you prepared? Are you prepared for what's next?
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CDC Deputy Director, Rear Admiral (ret.), and Doctor Anne Schuchat on the current situation in the United States. " I think there was a lot of wishful thinking around the country that, hey, summer, everything's gonna be fine. We're over this and we are not even beginning to be over this. There's a lot of worrisome factors about the last week or so, you know, these increases are in many places. It's not just New York City, right geographic area, it's so many geographic areas. And while the initial deaths are not as high as what we saw in New York City, or the New York State area, the initial cases are younger people. And so just how far it's going to spread from them is, you know, we know that fatality, the risk of dying or risk of serious disease increases, the older you are, the more underlying conditions you have. So this is really that beginning. And what we hope is that we can take it seriously and slow the transmission in these places. But what I think is very discouraging is you're clearly not at a point where there's so little virus being spread, that it's going to be easy to snap out. We're not in the situation of New Zealand or Singapore, Korea, where they have their, their, you know, a new case is rapidly identified and all the contacts are traced and people are isolated, who are sick and people who were exposed or quarantine and they can they can keep things under control. We have way too much virus across the country for that right now.
I think we're all struggling with ways to understand And then ways to explain and with with influenza, and with influenza pandemics, we saw waves, but this is not influenza. And what we have in the United States, it's hard to describe because it's so many different outbreaks, right? You know, the the, there was a wave, you know, incredible acceleration, intense interventions and control measures that have brought things down to a much lower level of circulation in the New York City, Connecticut, New Jersey area, New York State, but in much of the rest of the country, there's still a lot of virus and in lots of places, there's more virus circulating than there was.
So whether, you know, the things that contribute to waves are both congregation like school, you know, it's usually that the school season comes starts and people are crowded together in some other respiratory viruses and we see more spread or there's the holiday season. People are close together as they, you know, get to their travel locations. But I think with a totally new virus like this and population immunity so low, we just need to expect this virus to continue to circulate. It can be modified by our behavior, you know, if we physically distance if we were the face coverings, if we're washing our hands if we, you know, if we've been exposed, we completely stay at home or quarantine, you know, we can we can affect it. But in terms of the weather or the season or the helping us, I don't think we can count on that. I think we really need to do the Behavior Interventions of social distancing, and the contact tracing and isolation and quarantine and follow that to keep the spread to as low level as possible."
Source:
Commentary: "We have way too much virus across the country right now". That is the first tacit admission by the CDC that there's not really a way to put the genie back in the bottle without massive efforts by everyone to do the 3 Ws.
A reminder, the 3Ws:
- Watch your distance
- Wear a mask
- Wash your hands
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OSHA dropping the ball on unprotected healthcare workers. "More than 4,100 COVID-related complaints about health care facilities have poured into OSHA.
At least 35 health care workers died.
Yet the agency quietly closed almost all of those complaints. None led to a citation or a fine.
The hospital’s problems with personal protective equipment (PPE) were well documented. In mid-March, the state office of the Occupational Safety and Health Administration (OSHA) received five complaints, which described employees receiving “zero PPE.” The cases were closed April 21, after the hospital presented paperwork saying problems had been resolved. There was no onsite inspection, and the hospital’s written response was deemed sufficient to close the complaints, a local OSHA spokesperson confirmed."
Source:
Source: https://khn.org/news/osha-investigations-workers-filed-nearly-4000-complaints-about-protective-gear-some-still-died/
Commentary: I am unsurprised that OSHA was ineffective at helping healthcare workers process complaints, but this strategy is incredibly short sighted. In a pandemic, we need as many hands on deck as possible, and anything we do that runs counter to that objective is harmful in the long run.
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New Jersey's uptick due to restaurants. "We saw the cases tick up a little bit in New Jersey," says @ScottGottliebMD on why NJ is halting indoor dining. "We now have a number of credible reports from public health authorities where we've seen outbreaks and clusters of infections that were forged inside restaurants."
Source:
Commentary: COVID is an indoor disease first and foremost. Remember that. It's not safe to be indoors without protective equipment beyond your home. It's certainly not safe to eat indoors where you can't wear a mask for substantial periods of time.
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42.5% of COVID-19 cases in Italy were asymptomatic. "A study in Nature found 42.5% of the confirmed SARS-CoV-2 infections in Vo', Italy, were asymptomatic. The study also finds no statistically significant difference in the viral load of symptomatic versus asymptomatic infections."
Source:
Source: https://www.nature.com/articles/s41586-020-2488-1
Commentary: It's no surprise now how infectious and stealthy this virus is. The 3Ws are the only reliable ways we have to protect ourselves right now.
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More on the D614G mutation. Heads up, this is a pre-print and is not peer-reviewed. "SARS coronavirus 2 (SARS-CoV-2) isolates encoding a D614G mutation in the viral spike (S) protein predominate over time in locales where it is found, implying that this change enhances viral transmission. We therefore compared the functional properties of the S proteins with aspartic acid (SD614) and glycine (SG614) at residue 614. We observed that retroviruses pseudotyped with SG614 infected ACE2-expressing cells markedly more efficiently than those with SD614. This greater infectivity was correlated with less S1 shedding and greater incorporation of the S protein into the pseudovirion. Similar results were obtained using the virus-like particles produced with SARS-CoV-2 M, N, E, and S proteins. However, SG614 did not bind ACE2 more efficiently than SD614, and the pseudoviruses containing these S proteins were neutralized with comparable efficiencies by convalescent plasma. These results show SG614 is more stable than SD614, consistent with epidemiological data suggesting that viruses with SG614 transmit more efficiently."
Source: https://www.biorxiv.org/content/10.1101/2020.06.12.148726v1
Commentary: Geneticists and virologists are carefully studying the mutations that always occur in any kind of virus, and this particular mutation appears to have hit an open reading frame (a protein) and made COVID-19 more infectious. We will need more study to validate this finding, as well as peer review, but the takeaway is that a more infectious virus means greater precautions with our protective gear.
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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.
2. Wear gloves and a mask when out of your home. Consider wearing a face shield if you can't breathe at all through a mask.
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.
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.