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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The approved Russian vaccine details are out. "Some limitations of the studies by Logunov and colleagues are notable. In the study of the frozen vaccine formulation, the population included young military personnel. Soldiers are likely to be fitter and healthier than the general population. Moreover, in older adults, immune senescence might make vaccines less immunogenic, and this age group was absent from this study. Sex imbalance occurred in the study arms because there was no random allocation. A control arm was conspicuously absent. Two participants were of Asian descent, with the rest of the participants of white European ethnic origin. Clearly, much more remains to be learned from the phase 3 randomised trial planned to include 40 000 civilian volunteers and, hopefully, broadly inclusive of groups at risk.
This COVID-19 vaccine candidate from Russia joins two other adenovirus-vectored COVID-19 vaccine candidates, which have been reported in randomised trials in The Lancet and an mRNA vaccine candidate reported in a non-randomised trial. Similar to these studies before it, Logunov and colleagues’ studies are encouraging but small. The immunogenicity bodes well, although nothing can be inferred on immunogenicity in older age groups, and clinical efficacy for any COVID-19 vaccine has not yet been shown. A wide portfolio of early COVID-19 vaccine candidates will hopefully provide more successful vaccines that are broadly protective across risk groups and that increase the global availability of what will be a precious limited commodity."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31867-5/fulltext
Commentary: The Russian vaccine is what everyone else is hoping to avoid - a vaccine rushed through and given approval while skipping over phase 3 trials. The fact that the trial also had no control arm would immediately invalidate it under any other circumstances - without a placebo, there's no way to know if the effects were just random. There are so many problems with this vaccine, it's difficult to know where to begin, but it's a fantastic object lesson in what not to do to build a vaccine.
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More questions on reinfection. "Historically, the vaccines that have been easiest to make are against diseases in which primary infection leads to lasting immunity, says Richard Malley, a paediatric infectious-disease specialist at Boston Children’s Hospital in Massachusetts. Examples include measles and rubella.
But the capacity for reinfection does not mean that a vaccine against SARS-CoV-2 can’t be effective, he adds. Some vaccines, for example, require ‘booster’ shots to maintain protection. “It shouldn’t scare people,” Malley says. “It shouldn’t imply that a vaccine is not going to be developed or that natural immunity to this virus can’t occur, because we expect this with viruses.”
Learning more about reinfection could help researchers to develop vaccines, says Poovorawan, by teaching them which immune responses are important for maintaining immunity. For example, researchers might find that people become vulnerable to reinfection after antibodies drop below a certain level. They could then design their vaccination strategies to account for that — perhaps by using a booster shot to maintain that antibody level, Poovorawan says.
As public-health officials grapple with the dizzying logistics of vaccinating the world’s population against SARS-CoV-2, a booster shot would hardly be welcome news, but it would not place long-term immunity against SARS-CoV-2 completely out of reach, says Malley.
Still, Malley is concerned about the possibility that vaccines will only reduce symptoms during a second infection, rather than prevent that infection altogether. This provides some benefit, but it could effectively turn vaccinated individuals into asymptomatic carriers of SARS-CoV-2, putting vulnerable populations at risk. The elderly, for example, are among the hardest hit by COVID-19, yet do not tend to respond well to vaccines.
For this reason, Malley is keen to see data on how much virus people ‘shed’ when reinfected with SARS-CoV-2. “They could still serve as an important reservoir of a future spread,” he says. “We need to understand that better following natural infection and vaccination if we want to get out of this mess.”"
Source: https://www.nature.com/articles/d41586-020-02506-y
Commentary: If a vaccine doesn't stop spread, it's not much of a vaccine.
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Florida suppresses more data. "Local health officials are barred from releasing detailed information about new COVID-19 cases in public schools because of privacy rules, a local health official said Thursday.
The number of students and school staff who are infected — or whether infections are being transmitted in classrooms ― will no longer be released by health officials, Dr. Raul Pino, the state’s health officer in Orange County, said at a Thursday briefing.
That’s a departure from earlier this week when Pino released the number of cases associated with schools as well as the number of students and staff under precautionary quarantine and a list of affected schools.
The clampdown on information about schools came as Orange County Comptroller Phil Diamond announced the latest collections of the tourist tax — just $5.2 million for July, a 77% decline over the same month last year, but a marked improvement over June when less than $3 million was collected.
Diamond said the county’s financial well-being is tied to its physical health. The increase from the 6% levy on hotel rooms from June to July reflects the reopening of Walt Disney World, though at a reduced capacity."
Source: https://www.orlandosentinel.com/coronavirus/os-ne-coronavirus-orange-sept3-20200903-wanhmugklvbf7nnfehljb7qdsu-story.html
Commentary: The epidemic of "if we don't measure it, it's no longer a problem" continues to spread. Continue to pressure your elected officials to be as transparent with data as possible; it's the only way we'll ever be able to understand the scope of the problem in order to solve it.
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A reminder on excess deaths. "The death rate is a fact, all else is an inference. It's a FACT that at least 215,000 more Americans have died this year than baseline, including diagnosed and undiagnosed Covid, as well as other causes (such as heart attack) due to the pandemic's impact on health services."
Source:
Commentary: At the end of the day, if it's your loved ones, do you care to split hairs about why they died? Probably not. Preventing unnecessary death is job one for everyone, by continuing to observe countermeasures.
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Vaccine when? "A World Health Organization spokeswoman said on Friday it does not expect widespread vaccinations against COVID-19 until the middle of next year, stressing the importance of rigorous checks on their effectiveness and safety.
“We are not expecting to see widespread vaccination until the middle of next year,” spokeswoman Margaret Harris told journalists at a briefing in Geneva.
“This phase 3 must take longer because we need to see how truly protective the vaccine is and we also need to see how safe it is,” she added referring to vaccine clinical trials."
Source: https://www.reuters.com/article/us-health-coronavirus-who-briefing/widespread-covid-vaccinations-not-expected-until-mid-2021-who-says-idUSKBN25V1B0
Commentary: If you're doing any kind of business planning, this seems like a reasonable estimate. Even if we get a working vaccine by the end of 2020, we need to distribute it across the planet, which would require anywhere from 14 to 16 billion doses. That's an astonishingly large amount of anything to produce - a shot and a booster for the 7 billion people on earth. Even if only 50% get immunized, that's still 7 billion doses and boosters. It's going to be a while. Plan accordingly.
For those who make their livings from large gatherings, mid to late 2021 is when it might be reasonable to expect things like conferences, events, concerts, etc. to resume.
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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. Always 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, 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.
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.