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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Just one drop. "Exposure to a single nasal droplet is sufficient to become infected with Covid-19, according to a landmark trial in which healthy volunteers were intentionally given a dose of the virus.
The trial, the first to have monitored people during the entire course of infection, also found that people typically develop symptoms very quickly – on average, within two days of encountering the virus – and are most infectious five days into the infection.
The study was carried out using a strain of the virus before the emergence of the Alpha, Delta and Omicron variants.
The trial’s chief investigator, Prof Christopher Chiu, of Imperial College London, said: “Our study reveals some very interesting clinical insights, particularly around the short incubation period of the virus, extremely high viral shedding from the nose, as well as the utility of lateral flow tests, with potential implications for public health.”
The findings, published on Springer Nature’s pre-print server, and which have not yet been peer-reviewed, detail the outcomes in 36 healthy, young participants with no immunity to the virus. The volunteers were monitored at a specialist unit at the Royal Free hospital in London, and experienced no severe symptoms.
The study found that the infection first appears in the throat and that infectious virus peaks about five days into infection, by which point the nose has a much higher viral load than the throat. The study also suggested that lateral flow tests are a reassuringly reliable indicator of whether infectious virus is present. Swabbing the nose and throat makes it more likely to detect infections during the first few days, the work suggests."
Source: https://www.theguardian.com/world/2022/feb/02/exposure-to-one-nasal-droplet-enough-for-covid-infection-study
Commentary: This is useful; we know that the variants since this study have evolved to be much more transmissible, so if a single nasal droplet was sufficient to cause infection with the old D614G lineage, today's Omicron variants require even less to transmit. That's why we've all moved to saying that cloth and surgical masks ARE NOT ENOUGH to stop transmission. Only N95 and better masks will do that, because you need to stop the virus from entering your nose and mouth.
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We might be done with COVID, but it's not done with us - or other species. "Last January, a team of researchers searching for the coronavirus in New York City’s wastewater spotted something strange in their samples. The viral fragments they found had a unique constellation of mutations that had never been reported before in human patients — a potential sign of a new, previously undetected variant.
For the past year, these oddball sequences, or what the scientists call “cryptic lineages,” have continued to pop up in the city’s wastewater.
There is no evidence that the lineages, which have been circulating for at least a year without overtaking Delta or Omicron, pose an elevated health risk to humans. But the researchers, whose findings were published in Nature Communications on Thursday, still have no idea where they came from.
The researchers themselves are torn about the lineages’ origins. Some lean toward the explanation that the virus is coming from people whose infections aren’t being captured by sequencing. But others suspect that the lineages may be coming from virus-infected animals, possibly the city’s enormous population of rats. Even then, the favored theory can change from day-to-day or hour-to-hour.
On the other hand, the lineages have been circulating for long enough now that they should have appeared in at least one sample sequenced from an infected person, some scientists said.
“To have something in a sewershed that you’re detecting, you need a fair bit of it around,” said Dr. Adam Lauring, a virologist at the University of Michigan, who was not involved in the research.
Dr. Johnson, the Missouri virologist, agrees. He favors the hypothesis that the sequences are coming from animals, perhaps a few specific populations with limited territories. In May and June of 2021, when the number of human Covid-19 cases in the city was low, the mysterious lineages made up a greater proportion of the viral RNA in wastewater, suggesting that they may have come from a nonhuman source.
The researchers initially considered a diverse array of potential hosts, from squirrels to skunks. “This is a very promiscuous virus,” Dr. Johnson said. “It can infect all kinds of species.”
To narrow down the possibilities, they went back to the wastewater, assuming that any animal that was shedding virus might be leaving its own genetic material behind, too.
Although a vast majority of the genetic material in the water came from humans, small amounts of RNA from dogs, cats and rats were also present, the scientists found.
Dr. Johnson has been considering rats, which roam the city by the millions. In his lab, he created pseudoviruses — harmless, nonreplicating viruses — with the same mutations present in the cryptic sequences. The pseudoviruses were able to infect both mouse and rat cells, he found. The original version of the virus does not appear able to infect rodents, although some other variants, like Beta, can."
Source: https://www.nature.com/articles/s41467-022-28246-3
Source: https://www.nytimes.com/2022/02/03/health/coronavirus-wastewater-new-york.html
Commentary: One of the reasons stopping transmission was so important was to prevent more species-jumping. SARS-CoV-2 showed early on it could jump to ferrets, mink, and cats; if it's now adapted to infect rats, then we're never, ever fully getting rid of this thing. It will be in animal reservoirs and show up with new variants repeatedly.
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Bullseye. "Chemists at Pfizer’s research facility in Connecticut dusted off some ideas the company had developed during the SARS outbreak in 2003. Even back then, an obvious line of attack had been to block a well-understood component of the virus life cycle involving a key protease, a protein that orchestrates how the virus copies itself. Find a chemical that is able to stick tightly enough to that protein, and it would stop the virus from replicating in the body, lessening the chances that a patient would become seriously ill.
Right away, researchers got a lucky break. When Pfizer checked, it found that none of the thousands of proteins in the human body shared the same bit of molecular structure they planned to interfere with in SARS-CoV-2. That meant they could hit the virus hard and not expect any major side effects. Nature had provided the scientists with a big bull’s-eye. “This is the most solid biological target I have ever worked on,” says Pfizer chemist Dafydd Owen.
By the fall of 2021, Pfizer was ready to declare success. A monitoring board decided to stop the human study because covid-19 patients on Paxlovid weren’t dying—but those given the dummy drug were. “It was an incredible moment,” says Charlotte Allerton, Pfizer’s head of medicine design. Even though it trailed the vaccine development by nearly a year, Allerton believes Paxlovid still set a record—the fastest any drug company has ever moved from a synthesizing a new chemical to proving that it safely treats a disease.
A test in unvaccinated volunteers done by Pfizer had shown that the new pill cut the chance of a serious case of covid by 89%. And the results seemed to come at a perfect time. Infections and deaths were about to reach new heights. The new, fast-spreading omicron variant has infected millions of people each day just in the US. President Joe Biden, whose administration authorized the pill’s sale on December 22, 2021, touted it as “a game changer.” "
Source: https://www.technologyreview.com/2022/02/04/1044714/pfizer-covid-pill-paxlovid-pandemic/
Commentary: This is an incredible story of how the science worked well. Let's hope we're not too far away from a pan-coronavirus vaccine as well. If we develop that, then that will offer protection from almost all future variants.
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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.