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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Schools reopening are contingent on effective testing. "With increased levels of testing (between 59% and 87% of symptomatic people tested at some point during an active SARS-CoV-2 infection, depending on the scenario), and effective contact tracing and isolation, an epidemic rebound might be prevented. Assuming 68% of contacts could be traced, we estimate that 75% of individuals with symptomatic infection would need to be tested and positive cases isolated if schools return full-time in September, or 65% if a part-time rota system were used. If only 40% of contacts could be traced, these figures would increase to 87% and 75%, respectively. However, without these levels of testing and contact tracing, reopening of schools together with gradual relaxing of the lockdown measures are likely to induce a second wave that would peak in December, 2020, if schools open full-time in September, and in February, 2021, if a part-time rota system were adopted. In either case, the second wave would result in R rising above 1 and a resulting second wave of infections 2·0–2·3 times the size of the original COVID-19 wave. When infectiousness of children and young adults was varied from 100% to 50% of that of older ages, we still found that a comprehensive and effective test–trace–isolate strategy would be required to avoid a second COVID-19 wave."
Source: https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30250-9/fulltext
Commentary: Without effective testing and contact tracing, a second wave of infections twice as large as the original is what the UK projects. That fate awaits any nation with poor or insufficient testing.
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Vitamin D at normal, nutritive doses could potentially help and is unlikely to hurt. "Pending results of such trials, it would seem uncontroversial to enthusiastically promote efforts to achieve reference nutrient intakes of vitamin D, which range from 400 IU/day in the UK to 600–800 IU/day in the USA. These are predicated on benefits of vitamin D for bone and muscle health, but there is a chance that their implementation might also reduce the impact of COVID-19 in populations where vitamin D deficiency is prevalent; there is nothing to lose from their implementation, and potentially much to gain."
Source: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30268-0/fulltext
Commentary: There is no clinical evidence that vitamin D provides therapeutic value, but The Lancet concludes that there is no harm in getting individuals to the recommended daily allowance of vitamin D, and it could potentially help. Take special note that they are advocating for reference intakes - that means normal dietary intakes.
That specifically does NOT mean go out and buy a bottle of vitamin D supplements and start eating them like Mentos. MORE IS NOT BETTER. You can absolutely get vitamin D toxicity which can cause bone and kidney problems, like kidney stones - and the last place you want to be right now is in a surgery ward getting stones removed. Take the recommended daily allowance and no more.
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Not just a respiratory disease. "In this follow-up stage, neurological symptoms were presented in 55% COVID-19 patients. COVID-19 patients had statistically significantly higher bilateral gray matter volumes (GMV) in olfactory cortices, hippocampi, insulas, left Rolandic operculum, left Heschl's gyrus and right cingulate gyrus and a general decline of MD, AD, RD accompanied with an increase of FA in white matter, especially AD in the right CR, EC and SFF, and MD in SFF compared with non-COVID-19 volunteers (corrected p value <0.05). Global GMV, GMVs in left Rolandic operculum, right cingulate, bilateral hippocampi, left Heschl's gyrus, and Global MD of WM were found to correlate with memory loss (p value <0.05). GMVs in the right cingulate gyrus and left hippocampus were related to smell loss (p value <0.05). MD-GM score, global GMV, and GMV in right cingulate gyrus were correlated with LDH level (p value <0.05).
Study findings revealed possible disruption to micro-structural and functional brain integrity in the recovery stages of COVID-19, suggesting the long-term consequences of SARS-CoV-2."
Source: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30228-5/fulltext
Commentary: Additional evidence this virus impacts many systems in the body. For those already at risk from other neurological problems, consider talking to your healthcare provider if you've had COVID-19 about its potential impact on you. For everyone else, if you have existing neurological problems, you are in the high-risk category. Protect yourself accordingly.
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Should universities reopen? "At the start of the semester, the hypothetical cohort of 5000 students included 4990 (99.8%) with no SARS-CoV-2 infection and 10 (0.2%) with SARS-CoV-2 infection. Assuming an Rt of 2.5 and daily screening with 70% sensitivity, a test with 98% specificity yielded 162 cumulative student infections and a mean isolation dormitory daily census of 116, with 21 students (18%) with true-positive results. Screening every 2 days resulted in 243 cumulative infections and a mean daily isolation census of 76, with 28 students (37%) with true-positive results. Screening every 7 days resulted in 1840 cumulative infections and a mean daily isolation census of 121 students, with 108 students (90%) with true-positive results. Across all scenarios, test frequency was more strongly associated with cumulative infection than test sensitivity. This model did not identify symptom-based screening alone as sufficient to contain an outbreak under any of the scenarios we considered. Cost-effectiveness analysis selected screening with a test with 70% sensitivity every 2, 1, or 7 days as the preferred strategy for an Rt of 2.5, 3.5, or 1.5, respectively, implying screening costs of $470, $910, or $120, respectively, per student per semester.
In this analytic modeling study, screening every 2 days using a rapid, inexpensive, and even poorly sensitive (>70%) test, coupled with strict behavioral interventions to keep Rt less than 2.5, is estimated to maintain a controllable number of COVID-19 infections and permit the safe return of students to campus."
Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2768923
Commentary: To reopen colleges, every student would need to be tested every 2 days. What's the likelihood of compliance on that?
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Indiana makes not wearing a mask punishable by jail. "The Governor of Indiana has announced all residents and visitors in the state will be required to wear face coverings such as masks in public or risk facing a criminal charge.
Governor Eric Holcomb is due to sign an Executive Order which will mean a statewide mask requirement would take effect in Indiana on July 27.
Those who don't follow the new order could be charged with a Class B misdemeanor, which is punishable by a fine and up to six months in jail.
Holcomb said that by "masking up, we can and will save lives and slow the spread of COVID-19" in the state.
The mandate will require everyone over the age of 8-years-old to cover their faces at all indoor spaces, public transport and vehicle services such as taxis, as well as outdoor public spaces when you can't socially distance from those who you do not live with.
Face coverings will be required in schools for students in third grade and above, as well as all teachers, other school staff and visitors."
Source: https://www.newsweek.com/indiana-face-masks-misdemeanor-eric-holcomb-1519982
Commentary: This may be what is necessary to bring the pandemic under control in the United States.
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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. 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.