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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Someone asked me privately how I'll evaluate the various vaccines when they come out, especially given the challenges of misinformation floating around. The answer is the same as for all other pandemic data I evaluate: when the top experts in virology and immunology look at the data, the research, the findings and say, "Yep, that's likely to work". People like Dr. Akiko Iwasaki, head of the immunobiology lab at Yale University. I will believe them and trust in their expertise.
Who will I not believe about the quality of a vaccine? Politicians and appointed officials under duress. Karen from Facebook and her conspiracy theorist friends. Politico and most mainstream media news sites (unless an article is penned solely by a scientific expert). Why? Because these folks aren't the scientific experts, and at best their news is going to be watered-down interpretations of expertise, as opposed to expertise from the sources.
What's a sign a vaccine is not credible? Lack of transparency. Given the publicly-funded nature of the crisis, the urgency, and the global importance, I will not trust any vaccine that isn't accompanied by all the data and research. Beware any vaccine - or any therapeutic, really - that comes without conclusive, peer-reviewed evidence. Remember hydroxychloroquine? Despite lots of noise, peer-reviewed clinical data showed without doubt it was ineffective at best and harmful at worst. We will need to hold any vaccine to the same standard - no matter what non-scientists have to say about it, we should be looking at the data, the research, and what peer scientists have to say in their reviews.
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2 meters/6 feet isn't enough. "Physical distancing is an important part of measures to control covid-19, but exactly how far away and for how long contact is safe in different contexts is unclear. Rules that stipulate a single specific physical distance (1 or 2 metres) between individuals to reduce transmission of SARS-CoV-2, the virus causing covid-19, are based on an outdated, dichotomous notion of respiratory droplet size. This overlooks the physics of respiratory emissions, where droplets of all sizes are trapped and moved by the exhaled moist and hot turbulent gas cloud that keeps them concentrated as it carries them over metres in a few seconds.12 After the cloud slows sufficiently, ventilation, specific patterns of airflow, and type of activity become important. Viral load of the emitter, duration of exposure, and susceptibility of an individual to infection are also important.
Instead of single, fixed physical distance rules, we propose graded recommendations that better reflect the multiple factors that combine to determine risk. This would provide greater protection in the highest risk settings but also greater freedom in lower risk settings, potentially enabling a return towards normality in some aspects of social and economic life."
Source: https://www.bmj.com/content/370/bmj.m3223
Commentary: Treat COVID-19 (and any airborne disease, including influenza) like smoking. If someone lit a cigarette in any space, in any context, what's the likelihood you'd smell it? If you'd be likely to smell it, then you're breathing air that was just inside someone else's respiratory system - and thus your risks are higher.
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A draft report shows COVID-19 activity in Florida schools. "The Florida Department of Health accidentally released a report on COVID-19 outbreaks at schools across the state — from daycare centers to colleges — and found that nearly 900 students and staffers had tested positive during a two-week period in August as schools had just begun or readied to reopen.
State officials published the six-page draft online on Monday, but then quickly wiped it away a day later. The Herald obtained a copy before it disappeared.
Florida International University infectious disease epidemiologist Dr. Mary Jo Trepka said the detailed data was one of the most valuable reports the DOH has produced because it assesses how the virus is affecting the state’s children as they return to the classroom."
Source: https://news.yahoo.com/state-report-shows-hundreds-test-191328708.html
Commentary: More data, rather than less, will help solve the pandemic. Given the sudden backlash and retraction of the report, you have to question the quality of the data being shared by the Florida state government.
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From the weekend circuit, Dr. Scott Gottlieb: "Well, I think it's concerning August should have been a slow month we should have seen infection levels come down in July and August they didn't. We saw an epidemic cross over the Sunbelt. We saw infections actually increase. They're coming down now. So that's a good sign. hospitalizations are coming down. And I think that's the most important thing to be looking at because it's the most objective near term measure. And what the state of the epidemic really is. So hospitalizations are about 36,000 down from their peak. Hopefully they'll continue to come down but as we head into September and October, kids return to school people are starting to return to work we're likely to see infection start to go back up again. And we know that hospitalizations, lag infections and so we could see hospitalizations rise as well. The most concerning trend Right now is that as we see the cases fall on the Sunbelt. They're picking up in other parts of the country, particularly across the Midwest and the med West, and particularly in rural parts of the country. And that's a big concern, because those parts of the country probably have less healthcare resources to keep up with the epidemic. They don't have the same kinds of hospitals and same kinds of resources to deal with an epidemic like this.
And so as the [vaccine clinical] trials progress, if we start to see lower rates of covid infection in the active group, the group that receives the vaccine versus the placebo group, the group that hasn't received the vaccine, the trials could lead out earlier. If the, if the vaccines are very effective, it's likely that the trials aren't going to read out until October in order to read out in November in in November, they won't wait out until November in order to read out in October, the vaccines would have to be very effective. And so I'm not sure what he means by approving it earlier than when the trials are completed. They're going to wait for these trials to read out before they can make a decision around the efficacy of these vaccines. Now, it's likely going to be the case that the first authorization of these vaccines are going to be an emergency use authorization for select populations that are at higher risk of the infection either because of what they do. People who work in healthcare for example, health care jobs, or because of comorbidities people who are older, maybe nursing home patients So we're likely to see a stepwise progression of authorization of this vaccine for certain select populations that are at higher risk of either contracting it or having a bad outcome before we see a full approval for the general population. I think again, a full approval for the general population where people can go to CVS and get a shot. That's really a 2021 event, maybe the first quarter of 2021, probably more likely the first half."
Source:
Commentary: There is noted concern that in order to have a vaccine by the time of the election, the United States FDA may be taking shortcuts (source : https://www.palmbeachpost.com/story/news/2020/08/27/coronavirus-vaccine-trial-palm-beach-county-paused/5642163002/ ). Dr. Gottlieb's commentary indicates that emergency use authorization may be permitted for select high-risk groups. Hopefully they will adhere to the established process, as well as continue sharing data. If the United States skips clinical trials for phase 3 for a vaccine, we should at least hope that the vaccine manufacturer and sponsoring country (in this case, AstraZeneca and the UK, respectively) provide data at the same level of transparency as expected of a US corporation.
As mentioned at the top, this is why some folks have legitimate concerns about the safety of a vaccine, if political pressure is indeed forcing a product to market before it's truly proven in a clinical trial with no shortcuts taken. I continue to look to experts (especially those outside the FDA) to validate findings being shared.
As for the spread of the disease itself, schools are going to be the launching point for another spike of infections. It's already underway.
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COVID-19 may impair male fertility. "Eighteen semen samples from recovered men were obtained 8–54 days after absence of symptoms, 14 from control subjects, and 2 from patients with an active COVID-19 infection. No RNA was detected by means of RT-PCR in the semen, including semen samples from two patients with an acute COVID-19 infection. Subjects with a moderate infection showed an impairment of sperm quality.
A mild COVID-19 infection is not likely to affect testis and epididymis function, whereas semen parameters did seem impaired after a moderate infection. SARS-CoV-2 RNA could not be detected in semen of recovered and acute COVID-19–positive men. This suggests no viral transmission during sexual contact and assisted reproductive techniques, although further data need to be obtained."
Source: https://www.fertstert.org/article/S0015-0282(20)30519-7/fulltext
Commentary: Yet another outcome of COVID-19 we're just discovering. Reduced fertility has obvious long-term consequences.
There is absolutely no evidence SARS-CoV-2 was in any way engineered (source: https://www.nationalgeographic.com/science/2020/05/anthony-fauci-no-scientific-evidence-the-coronavirus-was-made-in-a-chinese-lab-cvd/ ) but boy, you couldn't ask for a more powerful model for disease. It's like a virus wishlist: highly contagious, affects just about every system in the body, low fatality rate overall (to keep hosts alive), reinfection possible, and impairs those hosts in many ways to make them easier to spread infection.
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Where did the Sturgis rally riders go? Everywhere. "Who attended Sturgis mega bike rally in South Dakota, and where did they come from, and where did they go after? Answer: EVERYWHERE. My god!This is what scares epidemiologists (but excites us with data). Looks like Florida Spring break week too. #COVID19"
Source:
Commentary: Watch the full video embedded in the tweet. It's astonishing to see how one event spreads that many people around a nation.
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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 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.