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 a qualified healthcare provider who knows your specific medical situation over advice from people on the Internet.
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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Perspective. "More Americans died of Covid in the past 2 weeks than died of influenza in the past 3 years."
Source:
Commentary: It's not the flu. It does have similar risk levels once you are vaccinated and boosted as the flu, which means as long as you continue to keep up with boosters etc. to ensure strong immune response, it is about as risky as the flu. If you're not keeping up, or you're not vaccinated, your risk levels are substantially higher than the flu.
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Omicron reinfects. "Merchants of herd death oversold immunity. People are being reinfected immediately again after Omicron infection.
We have the data: Both laboratory experiments and actual cases.
1/ Evidence from a study showing immunity based upon “mild" Omicron infection is weak for Omicron reinfection, and limited for cross immunity to Delta infection.
2/ medrxiv.org/content/10.110…
Overall, immunity from Omicron infection is much lower than the immunity from Delta infection, correlated with the severity of infection. So unless you get a severe infection with all of its consequences you also don’t get immunity from having another infection.
3/ And recall even immunity from severe infection wanes rapidly in a few months.
4/ Summary: "Neutralizing immunity...from Omicron and Delta"
"We found a significantly smaller rise of neutralization titers associated with milder Omicron breakthrough infection in vaccinated individuals, to only approximately one-third of the rise associated with boosting.
5/ "We also identified limited cross-variant immunity to Delta."
6/ "Thus, breakthrough infection from Omicron may enhance cross-protection against Delta, and vice-versa, [only] inasmuch as there is a sufficiently large increase in baseline neutralizing immunity, which appears to be related to the clinical severity of the infection.
7/ "Our findings parallel those from another study from our group that demonstrated limited cross-variant immunity after milder Omicron variant infection in unvaccinated individuals in a mouse model and in human patients.
8/ "Taken together, our results suggest that Omicron-induced immunity may not be sufficient to prevent infection from another, more pathogenic variant, should it emerge in the future.
9/ Actual cases of reinfection by Omicron are so widespread they are manifest to anyone who is not closing their eyes:
10/ (See comments in that thread)
11/ Important addition:
Anthony Leonardi @fitterhappierAJ has shown that the immune system T-cells are damaged by covid (shades of HIV), potentially undermining not just Covid immunity but immunity to other diseases, and part of Autoimmune dysfunction after covid."
Source: https://www.medrxiv.org/content/10.1101/2022.01.25.22269794v1.full.pdf
Source:
Commentary: Omicron's trick is that it doesn't protect against future infection. In other words, without vaccination, Omicron can just keep punching you over and over again because the body doesn't mount enough of an immune response without the broad spectrum response from vaccines. If you want to keep yourself safe from Omicron - and repeated infections - you must get vaccinated and boosted. And wear a mask to keep Omicron out in the first place.
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A key reminder. "Guys! When I write about frontlines, I don't do it to push for empathy towards me or HCWs. All i want is for you to understand YOU HAVE NO HEALTHCARE NOW in this country. Its not about feeling sorry for us. Its about all of you having NO ACCESS TO CARE NOW.
I have experience w low resource HC when ppl need to bring own supply to hospitals. This is why Spring 2020 in NY didnt shock me. Always open crash carts & supply cabinets provided us meds & tools we needed. We used all we could find & repurposed a lot of tools.
2 years into the pandemic we are still running out of tools. Now we are running out of very BASIC tool like nasal cannula! A very basic tube between O2 tank & patient's nose. We ran out. We ran out of BIPAPs. Its not about covid only, if you have COPD or CHF > 🤷🏻♀️
We ran out of syringes filled with glucose water or salty water. This is basic! When we give any medicine in the vein, then we flush it so medicine doesnt stay in the tubing. We ran out of these flushes.
One floor charge nurse took 1L bag of saline & filled 100 10-cc syringes. The other floor RN pinned a 1L bag to the wall & nurses come and draw a 10-cc syringe as they need.
How more basic this can be. Salt in water or sugar in water! We dont have it.
People are coming from out of states bc no beds in their states. People are coming super sick bc they wait hoping sickness will improve & it doesn't.
3 healthcare forms are offered now - rapid response, code blue & palliative care. You are either super sick, or near-dead, or too advanced that nothing else we can do. No prevention, no ability to have quality primary care or quality outpatient specialty care.
Your missed stress test, colonoscopy, pap smear, lipid test may become an emergency. 3 perforated bowels in 2 days, 2 out of 3 from out of state, uterine bleeds, stomach bleeds, lung bleeds. Ppl were unable to make appts w specialists or PCP. Telemed doesn't fix any of this.
I repeat once again you have no healthcare now. Nothing is available. No elective procedures, no elective surgeries. Until your problem becomes an emergency, you have no healthcare. Once it is an emergency, we do bandaid care or CPR or palliation. How do we get out of this? "
Source:
Commentary: Until the Omicron wave recedes, expect healthcare options to be severely restricted. Do what you can to minimize risk to yourself and your loved ones.
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Omicron BA.2 has a 34% higher attack rate in households; it's more infectious than Omicron BA.1. "The Omicron SARS-CoV-2 variant of concern (VOC lineage B.1.1.529), which became dominant in many countries during early 2022, includes several subvariants with strikingly different genetic characteristics. Several countries, including Denmark, have observed the two Omicron subvariants: BA.1 and BA.2. In Denmark the latter has rapidly replaced the former as the dominant subvariant. Based on nationwide Danish data, we estimate the transmission dynamics of BA.1 and BA.2 following the spread of Omicron VOC within Danish households in late December 2021 and early January 2022. Among 8,541 primary household cases, of which 2,122 were BA.2, we identified a total of 5,702 secondary infections among 17,945 potential secondary cases during a 1-7 day follow-up period. The secondary attack rate (SAR) was estimated as 29% and 39% in households infected with Omicron BA.1 and BA.2, respectively. We found BA.2 to be associated with an increased susceptibility of infection for unvaccinated individuals (Odds Ratio (OR) 2.19; 95%-CI 1.58-3.04), fully vaccinated individuals (OR 2.45; 95%-CI 1.77-3.40) and booster-vaccinated individuals (OR 2.99; 95%-CI 2.11-4.24), compared to BA.1. We also found an increased transmissibility from unvaccinated primary cases in BA.2 households when compared to BA.1 households, with an OR of 2.62 (95%-CI 1.96-3.52). The pattern of increased transmissibility in BA.2 households was not observed for fully vaccinated and booster-vaccinated primary cases, where the OR of transmission was below 1 for BA.2 compared to BA.1. We conclude that Omicron BA.2 is inherently substantially more transmissible than BA.1, and that it also possesses immune-evasive properties that further reduce the protective effect of vaccination against infection, but do not increase its transmissibility from vaccinated individuals with breakthrough infections."
Source: https://www.medrxiv.org/content/10.1101/2022.01.28.22270044v1
Commentary: Short version: if someone in your household has Omicron, unless you're strictly isolating them, chances are you're getting Omicron too. The only way to prevent it is with solid masking, reducing contact to the outside world (especially large groups), and vaccination.
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A reminder of the simple daily habits we should all be taking.
1. Wear the best mask available to you when you'll be around people you don't live with, even after you've been vaccinated. Respirators are back in stock at online retailers, too. Wear an N95/FFP2/KN95 that's NIOSH-approved or better mask if you can obtain it. If you can't get an N95 mask, wear a surgical mask with a cloth mask over it.
2. Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
3. Get vaccinated as soon as you're able to, and fulfill the full vaccine regimen, including boosters. Remember that you are not vaccinated until everyone you live with is vaccinated. If you received an adenovirus vaccine (J&J/AstraZeneca), consider getting an mRNA single shot booster (Pfizer/Moderna) if available. If it's available, choose Moderna as your first choice for both vaccine and booster, Pfizer as your second choice. However, remember than any vaccine is better than no vaccine.
4. Wash/sanitize your hands every time you are in or out of your home.
5. Stay out of indoor spaces that aren't your home and away from people you don't live with as much as practical. Minimize your contact with others and avoid indoor places as much as you can; indoor spaces spread the disease through aerosols and distance is less effective at mitigating your risks.
6. Aim to have 3-6 months of living expenses on hand in case the pandemic gives another crazy plot twist to the economy.
7. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
8. Ventilate your home as frequently as weather and circumstances permit, except when you share close airspaces with other residences (like a window less than a meter away from a neighboring window).
9. Masks must fit properly to work. Here's how to properly fit a mask:
10. If you think you may have been exposed to COVID-19, purchase a rapid antigen test. This will detect COVID-19 only when you're contagious, so follow the directions clearly. https://amzn.to/3fLAoor
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Common misinformation debunked!
There is no basis in fact that COVID-19 vaccines can shed or otherwise harm people around you.
Source: https://www.reuters.com/article/factcheck-covid19vaccine-reproductivepro-idUSL1N2MG256
There is no mercury or other heavy metals in the Pfizer mRNA vaccine.
Source: https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
There is no basis in fact that COVID-19 vaccines pose additional risks to pregnant women.
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2104983
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/
Source: https://www.smh.com.au/national/are-we-ignoring-the-hard-truths-about-the-most-likely-cause-of-covid-19-20210601-p57x4r.html
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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Disclosures and Disclaimers
I declare no competing interests on anything I share related to COVID-19. I am employed by and am a co-owner in TrustInsights.ai, an analytics and management consulting firm. I have no clients and no business interests in anything related to COVID-19, nor do I financially benefit in any way from sharing information about COVID-19.
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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.