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 fourth surge is on the way. A long thread from Dr. Eric Feigl-Ding. "TWO DIFFERENT #COVID19 PANDEMICS Many think with cases dropping that pandemic is nearly over. But truth is, there are now 2 different #SARSCoV2 pandemics divergingold strain is waning, while the more contagious #B117 strain is dominating. We will be soon slammed very hard.
2) Here is what is really going to happen... most countries are having a gentle case decline with R(e) currently around 0.9. But this is deceiving. The #B117 is still relatively rare so far, so the R is being influenced mostly by the old common variant. But not for long...
3) Here is what is going to happen... currently R is ~0.9 in many places, but with the more infectious #B117, the R will jump 50% approximately. And it is inevitable (all CDC and Danish models say this) that B117 will take over as the reigning dominant variant soon...
4) and when that happens, what worked before to keep the pandemic contained at R of 0.9 will no longer work. Here is the model for Alberta, by @GosiaGasperoPhD. The B117 dotted red line will soon dominate and drive a new surge in latter half of March and April.
5) And Denmark CDC has found the same thing. I GQR works now for keeping R around 0.9 or even 0.8, will absolutely not work anymore once #B117 variant takes over. Forget about it. We will be hit hard. But there is a wayif we suppress R to 0.7 or less.
6) The solution to defeating the #B117 is to chase a #ZeroCovid approach and slam the R even lower to below 0.7.... but optimally 0.6 or less. So that even when the #B117 arises, it will keep R under 1 (0.6*1.5=0.9). And by keeping R at 0.6 nowwe will have buffer room for B117.
7) And again Denmark CDC agrees with that assessment. Their model for R of 0.8 shows it is insufficient to defeat #B117. But its model for R 0.7 shows it can be enough.
8) The problem is that of the declining states, only 1 state is under R 0.7... which is Wyoming (figure below sorted from lowest to highest R). Every other states R is over 0.7. Thus while they would yield decreases nowthey wont once #B117 takes over.
9) Meanwhile, the replacement thing is happening in England. #B117 is dominating while old common #SARSCoV2 is all but nearly gone. Total cases dropping only because of tight UK lockdown. But can UK sustain & not let up on gas pedal before politics caves to reopen too soon?
10) Here is another @GosiaGasperoPhD model of the same thing. Keeping the R at 0.8 level is not enough to stop the spread once #B117 takes over.
11) Denmark CDC @SSI_dk has been warning about this for over a month. The world hasnt been listening. Aggressive mitigation for keeping R under 0.7 now is the only way.
12) Lets slam this home. suppose we have 1000 cases/day now... with an R=0.86 we could reduce it to 500/day in 2 weeks. But w/ added contagiousness of B117 variant that has ~60% higher R, in 2 weeks, 3000 new cases/day instead.
13) The problem is that to get R low enough, what used to work wont work anymore. When we previously could afford to open schools, it may be that when B117 becomes dominant, we might lose that buffer to keep R<0.7.
14) Denmark CDC is becoming more right contagious #B117 variant is continuing to solidify itself as 12.1% of sequenced #SARSCoV2 samples. 70% increase per week!
15) Denmark officials, despite their lockdown induced case drop, are really panicking. Seriously read the WaPo article or this thread below. They express that without the 100% sequencing, they would have been lulled into complacency.
16) Without this variant, we would be in really good shape, said Camilla Holten Moller, co-leader of the @SSI_dk group modeling the spread of the virus. If you just look at the reproduction number, you just wouldnt see that it was in growth underneath at all,
17) The good news so far is that all the vaccines tested so far perform decently against the main #B117 variants, but maybe less so against the #B1352 and #P1 variants. Pfizer, Moderna, etc mostly good for B117. See thread below to catch up.
18) So here comes the but... there is a new subtype of #B117 emerging... a mutated sublineage of regular main #B117 that had acquired the troublesome E484K mutation. This is the bad mutation that CDC & other studies helps B1351 evade antibodies.
19) So what do we know about the #B117+E484K combo sublineage? Not much except this preprint study showing it is might be more resistant to antibody neutralization (more antibodies needed in lab study to neutralize the pseudovirus) than the common strain and the regular B117.
20) This #B117+E484K isnt for sure resistant to vaccine. We dont know yet. And we dont know if it will still be more contagious like the main B117 is, but we should assume it is& take precautions that it might be the double combo of more contagious & maybe antibody resistant.
21) could #B117+E484K be a fluke? Maybe. But it emerged recently in UK twiceindependently arising in Wales, and arising in England. Just like in and so 4 times means convergent evolution is real. And convergent evolution is usually always greater survival fitness.
22) The other way to win is with mass vaccination like in Israel that has already vaccinated 50 shot per 100 people in the elderly. Hence now look how fast the cases, hospitalizations are diverging for those age 60+ vs 59 or under. That is the effect of **mass** vaccinations.
23) Actually, Israel has now reached 60 vaccination shots per 100 people: 4x UK and 6x the . Rest of EU is much much lower.
24) Another alarming datapoint: 10% of the village of Corzano has the #B117 variant10% of all residents!!!
25) Moreover, of the 10% of the infected village with #B117 UK variant, 60% of cases are kids from kindergarten and primary school, while other 40% are their parents. Schools in the village have closed now.
26) BOTTOMLINE: unless we can mass vaccinate quickly like Israel (which is still not 1/3 of the way done), we must continue to mitigate with *premium* masks preferably and with airborne virus precautions to ventilate.
No virus = No mutation."
Source:
Source: https://www.sciencemag.org/news/2021/02/danish-scientists-see-tough-times-ahead-they-watch-more-contagious-covid-19-virus-surge
Commentary: Are you prepared for a B.1.1.7 surge in your locale? Are you using the best masks available to you? Are you keeping your supplies stocked up? The UK and Denmark have introduced strict lockdowns and even those aren't able to keep the new strain under control because the reproduction number is much higher. How will places like the United States - which already has massive compliance issues - fare with the new strain? Not well.
The silver lining to a very dark cloud is that the pandemic will be over faster because so many people will contract the disease in a shorter period of time. Deaths will be much, much higher, along with permanent or long-term disabilities as a tradeoff, so "getting it over with" isn't something to aspire to. Hopefully, all nations can pick up the pace on vaccinations.
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Misinformation is another disease. "Widespread acceptance of a vaccine for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will be the next major step in fighting the coronavirus disease 2019 (COVID-19) pandemic, but achieving high uptake will be a challenge and may be impeded by online misinformation. To inform successful vaccination campaigns, we conducted a randomized controlled trial in the UK and the USA to quantify how exposure to online misinformation around COVID-19 vaccines affects intent to vaccinate to protect oneself or others. Here we show that in both countries—as of September 2020—fewer people would ‘definitely’ take a vaccine than is likely required for herd immunity, and that, relative to factual information, recent misinformation induced a decline in intent of 6.2 percentage points (95th percentile interval 3.9 to 8.5) in the UK and 6.4 percentage points (95th percentile interval 4.0 to 8.8) in the USA among those who stated that they would definitely accept a vaccine. We also find that some sociodemographic groups are differentially impacted by exposure to misinformation. Finally, we show that scientific-sounding misinformation is more strongly associated with declines in vaccination intent."
Source: https://www.nature.com/articles/s41562-021-01056-1
Commentary: As a marketer, the idea that something could reduce my conversion rates THAT much is scary. Fighting misinformation, particularly about COVID-19, is challenging and organizations like social networks are disinclined to help (in particular Facebook). Thus, the burden of inoculating others falls on private citizens.
Encourage your friends to play the University of Cambridge's Go Viral. It's a mental vaccination against misinformation.
https://www.goviralgame.com/en
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People who have had COVID-19 might possibly have a stronger reaction to the vaccine. "A new paper on medRxiv.com, a preprint server where non-peer reviewed manuscripts are posted, makes me think that I really might have been infected with SARS-CoV-2 this year. That's because researchers in New York City tested vaccine recipients before receiving their first dose of a coronavirus vaccine in order to detect and quantify the presence of SARS-CoV-2 antibodies. They then tested all participants for antibody levels around every four days or so, to see how the antibody levels changed over time. Persons found to already have had antibodies before the first dose of either a Pfizer/BioNtech or Moderna vaccination mounted an impressive response within a 5-8 days. It took 9-12 days for those without evidence of prior infection ("seronegative") to have any response at all, and when they did, their levels ("titers") were noticeably lower than those who had previously been infected ("seropositive"). As of day 24, not a single person in the seronegative group had levels as high any any single person in the seropositive group. After the second dose, the levels did not change much; both group's levels rose some, but not a lot, albeit it is unclear how long after the 2nd dose these levels were checked. These data alone suggest that at least in the short term, for people who have evidence of a prior infection, a first dose of the vaccine may effectively be functioning as a booster, meaning a 2nd dose may not be needed for quite some time. In order to conclude this safely, we would need to see durability of these findings, which this paper does not present."
Source: https://brief19.com/2021/02/05/brief/is-one-dose-of-the-vaccine-enough-for-people-with-evidence-of-prior-coronavirus-infection-new-impressive-data-sheds-light
Commentary: This is unsurprising; people have reported that the second dose has consistently had stronger side effects. It makes logical sense that if you already have antibodies in your bloodstream from actual COVID-19 that you would in turn have a stronger reaction to the first dose.
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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 or better mask if you can obtain 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. 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.