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.
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Situation report. 45 million cumulative cases globally. 9 million cumulative cases in the United States, 8 million in India, 5.5 million in Brazil. 1.18 million dead globally, 229,000 in the United States, 159,000 in Brazil, 121,000 in India.
The pandemic has shifted into high gear with explosive growth, especially in Europe and North America. Anyone talking about it being 'over' or 'turning the corner' is either outright lying or completely delusional. We are entering a substantial new wave and new chapter of COVID-19.
Stay vigilant. Wear a mask. Watch your distance. Wash your hands. Walk out of crowded places and indoor spaces as fast as you can.
For my American friends, there are signs that the coming week may be more disruptive than usual with the election. Now is the time to replenish any stocked foods and household goods, before this weekend is over, so that if you have to go on lockdown for pandemic or civil unrest, you are well prepared. Take the time this weekend to stock up (without going crazy and hoarding).
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No evidence of Regeneron efficacy. "Late yesterday, Regeneron issued a press release (largely for investors) with some data about its monoclonal antibody against SARS-CoV-2. The data are scant. The company says that its antibody, REGN-CoV-2, decreased the viral load in some patients and that subsequent medical visits were lower. But there is no data suggesting a change in rates of hospitalization or death so far. We will follow this closely but remind readers that lowering viral loads is not enough; patients must have better outcomes overall for a therapy to be meaningful."
Source: https://brief19.com/2020/10/29/brief
Commentary: As more therapeutics are tested, we're finding out that few are as robust as claimed. Beware anything that doesn't come with a well-structured, robust clinical trial and full, open data.
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Why death rates have fallen and why they may go up again. "Doctors also weren’t aware at first that the Covid-19 illness caused by the new virus caused life-threatening blood clots. Now patients are put on blood thinners early on in treatment when necessary.
But the other problem in the spring was that hospitals in hard-hit areas like New York City were overwhelmed. Doctors who hadn’t worked in critical care for many years were being drafted to care for seriously ill patients, nurses were short-staffed, and equipment was in short supply. “There was a sheer overwhelming tidal wave that overtook the health care system,” Dr. Lisker said. “You had critical care units run by doctors who hadn’t done critical care in 10 years, or even ever.”
She added, “There is no question that whether you lived or died in April, some of it had to do with what unit you landed in.”
Indeed, she said, “The whole idea of flattening the curve was to avoid overwhelming the health care system.”
Medical experts are worrying that the surges in cases around the country could reverse or roll back those gains. The number of hospitalized Covid patients has increased by 40 percent over the last month, and more than 41,000 patients are now hospitalized in the United States. Hospital administrators in Idaho, Utah and Kansas City, Mo., have warned they are already close to capacity. Some have turned ambulances away, and others are drawing up plans to ration care if they run out of beds and have said they may be forced to transfer patients to facilities in other states.
“If you compare the number of people who are dying from every 100 cases diagnosed in the U.S., it’s obviously substantially lower than it was in the summertime, and a lot lower than it was in the springtime,” said Tom Inglesby, the director of the Center for Health Security at Johns Hopkins University.
But, he added that the lessening death rate was not assured to remain steady, given the resurgence in higher caseloads. “If hospitals that aren’t prepared for large numbers of people have to deal with a large influx of Covid patients, or small hospitals get pulled into it, we should expect that mortality could change unfortunately,” he said. “That’s a warning.”
Though some have speculated that the virus is less virulent than it once was, experts say there is no evidence that is the case. The improvements in survival are “a testament to modern medical care,” said Dr. Howard Markel, a physician and medical historian at the University of Michigan.
“The virus is still just as stealthy and dangerous as it was,” Dr. Markel said. “We’re just getting better at managing it.”"
Source: https://www.nytimes.com/2020/10/29/health/Covid-survival-rates.html
Commentary: We are at the overload point now. On COVID Exit Strategy, more than 30 states are in the red for hospital capacity. Expect death rates to increase in the next 4-6 weeks. No matter how valiant doctors and healthcare workers try, once you hit a point of rationing care, deaths WILL increase.
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Kids are catching COVID-19 way more than we think. "Dual-antibody positivity was detected in none of 3887 children in 2019 (100% specificity) and 73 of 75 SARS-CoV-2 positive individuals (97.3% sensitivity). Antibody surveillance in children during 2020 resulted in frequencies of 0.08% in January to March, 0.61% in April, 0.74% in May, 1.13% in June and 0.91% in July. Antibody prevalence from April 2020 was six-fold higher than the incidence of authority-reported cases (156 per 100,000 children), showed marked variation between the seven Bavarian regions (P<0.0001), and was not associated with age or sex. Transmission in children with virus-positive family members was 35%; 47% of positive children were asymptomatic. No association with type 1 diabetes autoimmunity was observed. Antibody frequency in newborns was 0.47%.
SARS-CoV-2 dual antibody strategy yielded 100% specificity and >95% sensitivity
Childhood surveillance finds 6-fold higher antibody prevalence than reported cases
Half of the antibody positive children were asymptomatic"
Source: https://www.cell.com/med/fulltext/S2666-6340(20)30020-9
Commentary: 6x more kids having been exposed to COVID-19 is really, really bad. That tells us several things. First, tests aren't sensitive enough to find them. Second, we may not be testing kids enough. Third, activities kids are involved with may be superspreader events - from school to sports to play dates, that 'bubble' may have a bunch of holes in it if kids are involved.
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Will normal return? Dr. Fauci on an NIH livestream. "Somebody is asking about what's going to happen as far as masking and social distancing. So if we have a vaccine that's been proven safe and effective, and we start distributing it, like you're saying late December, January, does that mean everybody can go back to life as they have enjoyed it in 2019? Put away the masks, go to the bars, whatever?
Dr. Fauci: Well, there's a short answer and the longer. The short answer is absolutely not. The longer answer is that what we likely will have, as the efficacy of the vaccine is shown at the population level, we will have a gradual relaxation of some of the stringent public health measures never to be abandoned, I can foresee that even with a really good vaccine, that mask wearing will continue well into the third or fourth quarter of 2021. Then what likely will happen when you talk about normality, there will be a graded, gradual progression towards normality. Some examples, I believe restaurants might be able to do indoor at moderate, if not full capacity, theaters will then be able to seat people, maybe not initially at full capacity, but working your way to that sports events will then have spectators very likely in graded amounts with regard to capacity. So that ultimately, when we get this under control, not only at the domestic but at the global level, we will start to approach what we call normal, I don't think Francis that it's going to be at a level where people are going to feel like there are no public health measures to be implemented until we get to the end of 2021. At least."
Source: https://www.facebook.com/nih.gov/videos/2780624382193426
Commentary: Use this for planning. Expect that we will be maintaining status quo for at least the first half of 2021, if not longer. It's theoretically possible that countries around the world could accelerate progress towards the vaccine above and beyond what they're currently doing, but there's not much juice left to squeeze. We're throwing an awful lot at the virus. Plan accordingly.
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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.
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.
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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.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.