Lunchtime Pandemic Reading, 4-June-2024
Bird flu edition
Lunchtime pandemic reading.
Standard disclaimer: this is a roundup of informative pieces I've read that interest me on the severity of the crises and how to manage them. 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.
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So... things are not going well on the H5N1 front (bird flu). Let's talk about it.
"Widespread reluctance on the part of farmers to allow scientists — government or otherwise — onto their premises to study spread of the virus among infected cows has created a frustrating lack of understanding of the dynamics of this outbreak. U.S. Department of Agriculture incentives aimed at getting farmers to test their cows and take preventive measures to protect both animals and farmworkers do not seem to have solved the impasse, even as the outbreak has affected 82 herds in nine states.
It’s not lost on many scientists, here and abroad, that the paucity of data coming out of the U.S. is not dissimilar to the limited information flow out of China in the early days of the Covid-19 pandemic — a situation the U.S and other governments complained about loudly at the time. With the shoe on the other foot, however, there is no overt effort to make farmers cooperate.
“A lot of criticism was leveled at China for their early response to Covid-19 — some of it reasonable, a lot of it extremely ignorant. Are we currently making some of those mistakes ourselves?” wondered Kristian Andersen, an evolutionary biologist and a professor of immunology and microbiology at Scripps Research Institute in La Jolla, Calif."
Source: https://www.statnews.com/2024/06/05/bird-flu-h5n1-in-cows-scientists-top-questions/
Commentary: The reality is that there are strong, strong economic incentives to conceal H5N1 outbreaks among animals and humans. Farms don't want to be shut down. Food manufacturers don't want shortages in the supply chain. Grocery stores don't want empty shelves or much higher prices due to supply shortfalls.
And that means strong incentives to not report illness in any way.
What does that mean for us? It means we won't know if H5N1 mutates in a meaningful way until you start seeing a lot of illness all of the sudden - and H5N1 is particularly nasty. It has, according to past studies, a mortality rate up to 60%.
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10389235/
That's the bad news. Here's the good news. Preventing illness is very, very straightforward. Unlike COVID, influenza is a well-known (albeit very dangerous) adversary. We have some level of vaccination for this strain, but more important, wearing an N95 mask defeats it completely. We saw this in the winter of 2020 and early 2021 when influenza basically vanished from the world because people were masking due to COVID.
So here's what you should do. Start masking in public places if you stopped, using N95 masks, especially in low-value places. An N95 mask doesn't restrict conversation, and wearing it at the grocery store, post office, etc. is easy.
Mask up. Take the usual other precautions that we talked about back in 2020 and that appear at the bottom of this newsletter. In the northern hemisphere, I would doubt it'll get much traction until the fall, but be prepared anyway.
You MIGHT want to consider purchasing multi-tests. I got a pack of 40 recently from Germany (because they're not broadly available in the USA) for about $125 (disclosure: Amazon affiliate link), which made them about $3 per test. H5N1 falls in the influenza A family, which these tests can detect. As with regular COVID tests, they are rapid antigen tests, which means they detect contagiousness, not whether you have the disease or not. You may be ill but not ill enough to be shedding germs.
CO2 may be more than just a proxy for ventilation:
"For decades, that’s how aerosol scientists and ventilation engineers have mostly thought about CO2 — as a sort of indicator for the health of indoor environments. But over the last three years, researchers in the U.K. working with next-generation bioaerosol technologies have discovered that CO2 is more than a useful bystander. In fact, it plays a critical role in determining how long viruses can stay alive in the air: The more CO2 there is, the more virus-friendly the air becomes."
Source: https://www.statnews.com/2024/06/04/co2-ventilation-research-virus-airborne-life-haddrell-celebs/
Commentary: This is a fascinating report and associated study. The implications are huge; first, in a room where the air is filtered but not vented, it would mean persistently high CO2 levels would continue to make viral persistence in the air a problem. Existing viruses in the air would eventually get filtered, but newly introduced ones by people in the room breathing would last longer.
Second, and this is a macro picture thing, the amount of atmospheric CO2 is something around 425 ppm. Prior to the Industrial Revolution, it was 280 ppm. That means, if this research holds up under further review, climate change is making the entire planet's atmosphere more friendly to viruses.
The key takeaway here is that if you're in a room with other people, filtration or not, if the air is being recirculated you really want to be wearing a mask.
N95 masks almost perfectly stop COVID when worn correctly.
"“The research shows that any mask is much better than no mask, and an N95 is significantly better than the other options. That’s the number one message,” says the study’s senior author, Dr. Donald Milton. Milton is a UMD SPH professor of environmental health and a global expert on how viruses spread through the air.
“Data from our study suggests that a mildly symptomatic person with COVID-19 who is not wearing a mask exhales a little over two infectious doses per hour,” says first author Dr. Jianyu Lai, a postdoctoral researcher at the PHAB Lab. “But when wearing an N95 mask, the risk goes down exponentially.”"
Source: https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(24)00192-0/fulltext
Source: https://sph.umd.edu/news/study-shows-n95-masks-near-perfect-blocking-escape-airborne-covid-19
Commentary: N95 masks stop 98% of exhaled particles, which dramatically lowers the risk of infection around you. As always, the trick is to wear them properly. This is generally good news and impressive - given the 95 in N95 means stopping 95% of particles.
COVID makes everything worse - including making you more susceptible to other diseases by 2-8x.
"Considering the significant burden of post-acute COVID-19 conditions among patients infected with SARS-CoV-2, we aimed to identify the risk of acute respiratory complications or post-acute respiratory sequelae. A binational population-based cohort study was conducted to analyze the risk of acute respiratory complications or post-acute respiratory sequelae after SARS-CoV-2 infection. We used a Korean nationwide claim-based cohort (K-COV-N; n = 2,312,748; main cohort) and a Japanese claim-based cohort (JMDC; n = 3,115,606; replication cohort) after multi-to-one propensity score matching. Among 2,312,748 Korean participants (mean age, 47.2 years [SD, 15.6]; 1,109,708 [48.0%] female), 17.1% (394,598/2,312,748) were infected with SARS-CoV-2. The risk of acute respiratory complications or post-acute respiratory sequelae is significantly increased in people with SARS-CoV-2 infection compared to the general population (acute respiratory complications: HR, 8.06 [95% CI, 6.92- 9.38]; post-acute respiratory sequelae: 1.68 [1.62-1.75]), and the risk increased with increasing COVID-19 severity. We identified COVID-19 vaccination as an attenuating factor, showing a protective association against acute or post-acute respiratory conditions. Furthermore, while the excess post-acute risk dimin- ished with time following SARS-CoV-2 infection, it persisted beyond 6 months post-infection. The replication cohort showed a similar pattern in the associa- tion. Our study comprehensively evaluates respiratory complications in post- COVID-19 conditions, considering attenuating factors such as vaccination status, post-infection duration, COVID-19 severity, and specific respiratory conditions."
Source: https://www.nature.com/articles/s41467-024-48825-w
Commentary: This study was frankly shocking. Contracting COVID makes you vulnerable to other respiratory diseases and complications, which we generally knew. This is the first study of a large cohort that has quantified that risk, and that risk is GIGANTIC - up to 8x more likely to have respiratory complications.
For people STILl saying COVID wasn't that bad... yes, it was. And it's the gift that keeps on giving.
If you or someone you know is suffering from Long COVID or what you suspect is Long COVID, ensure that your healthcare provider has the latest clinical practice guidelines.
""Long COVID" is a term used to describe a condition when the symptoms and signs associated with coronavirus disease 2019 (COVID-19) persist for more than three months among patients infected with COVID-19; this condition has been reported globally and poses a serious public health issue. Long COVID can manifest in various forms, highlighting the need for appropriate evaluation and management by experts from various fields. However, due to the lack of clear clinical definitions, knowledge of pathophysiology, diagnostic methods, and treatment protocols, it is necessary to develop the best standard clinical guidelines based on the scientific evidence reported to date. We developed this clinical guideline for diagnosing and treating long COVID by analyzing the latest research data collected from the start of the COVID-19 pandemic until June 2023, along with the consensus of expert opinions. This guideline provides recommendations for diagnosis and treatment that can be applied in clinical practice, based on a total of 32 key questions related to patients with long COVID. The evaluation of patients with long COVID should be comprehensive, including medical history, physical examination, blood tests, imaging studies, and functional tests. To reduce the risk of developing long COVID, vaccination and antiviral treatment during the acute phase are recommended. This guideline will be revised when there is a reasonable need for updates based on the availability of new knowledge on the diagnosis and treatment of long COVID."
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10990882/
Commentary: I saw someone on Threads the other day talking about how local clinics still have no idea how to manage COVID. This guidance is thorough and helpful. Provide it to your healthcare practitioner to get them up to speed on the latest mitigation methods for Long COVID.
A reminder of the simple daily habits we should all be taking.
Wear the best mask available to you when you'll be around people you don't live with, even after you've been vaccinated. P100 respirators are back in stock at online retailers, too and start around US$40 for a reusable respirator (disclosure: Amazon affiliate link). 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.
Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
Get vaccinated as soon as you're eligible to for COVID and flu, and fulfill the full vaccine regimen, including boosters. Remember that you are not vaccinated until everyone you live with is vaccinated. There are new vaccines available now in addition to the boosters we already know that may be more efficacious and tolerated better, so talk to your healthcare provider about which vaccine or booster is the best choice for you.
Check COVID and flu dashboards to see how prevalent it is in your region. Focus especially on wastewater reporting. A couple of useful dashboards:
In areas of above-average prevalence, 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 disease through aerosols and distance is less effective at mitigating your risks.
Aim to have 3-6 months of living expenses on hand in case the pandemics give another crazy plot twist to the economy, or you know, a global war breaks out.
Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
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).
Masks must fit properly to work. Here's how to properly fit a mask:
If you think you may have been exposed to COVID or influenza, purchase several rapid antigen tests and/or acquire them from your healthcare provider or government. This will detect diseases only when you're contagious, so follow the directions clearly. This multi-test from the EU does COVID, influenza, and RSV (disclosure: Amazon affiliate link).
Remember, you are not clear until you take 2 tests that are negative, 24 hours apart.
Common misinformation debunked!
There is no basis in fact that COVID 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 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 arrived before 2020 in the United States and therefore no hidden herd immunity:
Source:
https://twitter.com/trvrb/status/1249414291297464321
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 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
Disclosures and Disclaimers
I declare a competing interest on Amazon affiliate links for products shared in this newsletter, for which I earn approximately 1% of the purchase price of anything purchased through those links. I am employed by and am a co-owner in TrustInsights.ai, an analytics and AI consulting firm. I have no clients in anything related to COVID or other communicable diseases.
I am not a qualified healthcare provider and I do not provide medical advice. Only take medical advice from your qualified healthcare provider who knows your specific details and can provide customized recommendations for you.