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.
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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B.1.351 is the variant to be concerned about immune escape. "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the global COVID-19 pandemic. Rapidly spreading SARS-CoV-2 variants may jeopardize newly introduced antibody and vaccine countermeasures. Here, using monoclonal antibodies (mAbs), animal immune sera, human convalescent sera and human sera from recipients of the BNT162b2 mRNA vaccine, we report the impact on antibody neutralization of a panel of authentic SARS-CoV-2 variants including a B.1.1.7 isolate, chimeric strains with South African or Brazilian spike genes and isogenic recombinant viral variants. Many highly neutralizing mAbs engaging the receptor-binding domain or N-terminal domain and most convalescent sera and mRNA vaccine-induced immune sera showed reduced inhibitory activity against viruses containing an E484K spike mutation. As antibodies binding to spike receptor-binding domain and N-terminal domain demonstrate diminished neutralization potency in vitro against some emerging variants, updated mAb cocktails targeting highly conserved regions, enhancement of mAb potency or adjustments to the spike sequences of vaccines may be needed to prevent loss of protection in vivo."
Source: https://www.nature.com/articles/s41591-021-01294-w
Commentary: If there's a strain that is likely to evolve to greater resistance to vaccines, it's likely to be one with the E484K mutation. This is why it's so urgent to get vaccination done as fast as possible now - to shut down the virus before it has a chance to mutate further.
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Schools remain risks. "Schools remain overlooked as sites of risk. For example, the government of the United Kingdom continues to maintain face masks are unnecessary in these settings,1 despite high levels of community transmission. The household contact studies referred to by Munro and colleagues, are overwhelmingly based on the results of polymerase chain reaction (PCR) tests, and are affected by the biases I previously described.2 However, when serology is assessed, similar secondary attack rates in children, adolescents and adults are observed.3
Since publication of the Perspective, further studies have provided evidence children may transmit SARS‐CoV‐2 at similar rates to adults. These comprise a study from India of 84 965 cases and 575 071 close contacts14 and a prospective study of 101 households in Tennessee and Wisconsin conducted by the Centers for Disease Control and Prevention.15 The Victorian data16 referred to by Ryan et al are interesting, but lack precision. While the data indicate children may be less likely to initiate outbreaks in childcare centres than adults (with the caveat that some cases may have gone undetected since not all children may have been tested), no statistically significant difference is observed with regard to primary and secondary schools (Box).
Ryan and colleagues describe asymptomatic infection as not uncommon in children. In fact, their own data show it is very common: in Victoria, 33% of children were asymptomatic compared with 17% of adults.16 This is likely to hinder case‐finding. Indeed, the Victorian report notes that “[a]s children tend to be asymptomatic or develop only mild symptoms, it is harder to detect infection in this age group”.16 The report goes on to state that “[a] surveillance strategy that tests only symptomatic children will fail to identify children who are silently shedding the virus, and who may be infectious”.16 Furthermore, the international data referred to by Ryan et al is a single 4–6 week study conducted at a time of low community transmission, comprising only three active cases.19 In contrast, more recent data from Europe show SARS‐CoV‐2 infections in children are frequent. Random testing of the general community in England shows children (aged 5–12 years) and teenagers (aged 13–17 years) are currently more likely to be infected than any other age group.20 Additionally, compared with persons aged 17 years or over, children (aged < 12 years) and adolescents (aged 12–16 years) are now more likely to be the first case in English households, and are more than twice as likely to infect their household contacts.21"
Source: https://onlinelibrary.wiley.com/doi/10.5694/mja2.50934
Commentary: Of course kids are just as risky as adults for transmission, even if they're experiencing fewer symptoms. Their improved immune systems are offset in schools by crazy closeness, poor ventilation, and relatively poor adherence to things like proper mask wearing.
Schools are risks, and until vaccines are deployed in them, at least for the adult staff, they should remain virtual as much as practical to reduce transmission risks.
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The B.1.1.7 storm is brewing in the US. "We're still averaging >60,000 new covid cases a day and 2,000 deaths.
B.1.1.7 infections are country-wide >12%, in every state, a few >25%, doubling every 10 days, w/ real impact that hits when >50%.
Perfect time to undo mitigation strategies.
If you ignore all the data."
Source:
Commentary: I would struggle to agree more. The new, more infectious strains are problematic, especially in locales around the world where vaccination isn't as fast as it should be. This is not the time to be opening things up. Get the vaccine into the population and then we'll talk.
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Ivermectin doesn't work on COVID-19. "Ivermectin is widely prescribed as a potential treatment for COVID-19 despite uncertainty about its clinical benefit. In this randomized clinical trial that included 476 patients, the duration of symptoms was not significantly different for patients who received a 5-day course of ivermectin compared with placebo (median time to resolution of symptoms, 10 vs 12 days; hazard ratio for resolution of symptoms, 1.07). Among adults with mild COVID-19, a 5-day course of ivermectin, compared with placebo, did not significantly improve the time to resolution of symptoms. The findings do not support the use of ivermectin for treatment of mild COVID-19, although larger trials may be needed to understand the effects of ivermectin on other clinically relevant outcomes."
Source: https://jamanetwork.com/journals/jama/fullarticle/2777389
Commentary: Right now, the only approved therapeutics that seem to show good clinical promise are dexamethasone for inflammation, and some polyclonal antibody cocktails. That's it. The best defense against COVID-19 is not catching it.
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Strain B.1.1.7 not a concern for weakened vaccines. "All current vaccines for COVID-19 utilize ancestral SARS-CoV-2 Spike with the goal of generating protective neutralizing antibodies. The recent emergence and rapid spread of several SARS-CoV-2 variants carrying multiple Spike mutations raise concerns about possible immune escape. One variant, first identified in the United Kingdom (B.1.1.7, also called 501Y.V1 or 20I), contains eight Spike mutations with potential to impact antibody therapy, vaccine efficacy and risk of reinfection. Here we show that B.1.1.7 remains sensitive to neutralization, albeit at moderately reduced levels (∼2-fold), by serum samples from convalescent individuals and recipients of an mRNA vaccine (mRNA-1273, (Moderna) and a protein nanoparticle vaccine (NVX-CoV2373, Novavax). A subset of monoclonal antibodies to the receptor binding domain (RBD) of Spike are less effective against the variant while others are largely unaffected. These findings indicate that variant B.1.1.7 is unlikely to be a major concern for current vaccines or for an increased risk of reinfection."
Source: https://www.cell.com/cell-host-microbe/fulltext/S1931-3128(21)00102-5
Commentary: This is excellent news given that B.1.1.7 is showing strong growth around the world. The race is to vaccinate before someone is exposed to the more transmissible B.1.1.7. The vaccine can shut down the strain, but only if a substantial part of the population has had it.
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A reminder of the simple daily habits we should all be taking.
1. Always wear the best mask available to you when out of your home and you'll be around other people. 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. Get vaccinated as soon as you're able to.
3. Wash/sanitize your hands every time you are in or out of your home for any reason.
4. 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.
5. Get your personal finances in order now. Cut all unnecessary costs.
6. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
7. 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).
8. Masks must fit properly to work. Here's how to properly fit a mask:
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Common misinformation debunked!
There is no mercury or other heavy metals in the Pfizer mRNA vaccine. https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
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.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.