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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More American veterans have died from COVID-19 than from the Iraq and Afghanistan wars combined. "On Monday morning, Department of Veterans Affairs officials reported 6,772 patient deaths died from complications related to the virus in the last 10 months. Defense Department officials list 6,756 military casualties in Operation Iraqi Freedom (which lasted more than seven years, from 2003 to 2010) and Operation Enduring Freedom (which lasted from 2001 to 2014).
VA’s death total does not include another 95 employees who have contracted coronavirus and died in recent months. Department officials have declined to release information on their jobs and contact with patients and visitors to VA medical facilities.
The department death total reflects many of the 9 million veterans connected to VA health services, but not all veterans in America. It is roughly equal to 23 deaths a day since the first month of the pandemic, making it even more of a threat to the veteran population than suicide (roughly 17 deaths a day among all U.S. veterans).
About 40 percent of the VA coronavirus deaths have occurred among department inpatients. The others are veterans being cared for at home or in other medical centers but still connected to the VA health system."
Source: https://www.militarytimes.com/news/pentagon-congress/2021/01/04/vas-coronavirus-deaths-have-now-surpassed-totals-from-iraq-afghanistan-wars/
Commentary: It is damning that veterans, people who put their lives on the line for their country, are finding their nation doesn't have their back. The nation owes them the same or better standard of care after their service as it did when they were serving the nation on active duty.
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An important new pre-print shared by Dr. Akiko Iwasaki. "The pathogenesis of severe COVID-19 remains poorly understood. While several studies suggest that immune dysregulation plays a central role, the key mediators of this process are yet to be defined. Here, we demonstrate that plasma from a high proportion (77%) of critically ill COVID-19 patients, but not healthy controls, contains broadly auto-reactive immunoglobulin M (IgM), and only infrequently auto-reactive IgG or IgA. Importantly, these auto-IgM preferentially recognize primary human lung cells in vitro, including pulmonary endothelial and epithelial cells. By using a combination of flow cytometry, LDH-release assays, and analytical proteome microarray technology, we identified high-affinity, complement-fixing, auto-reactive IgM directed against 263 candidate auto-antigens, including numerous molecules preferentially expressed on cellular membranes in pulmonary, vascular, gastrointestinal, and renal tissues. These findings suggest that broad IgM-mediated autoimmune reactivity may be involved in the pathogenesis of severe COVID-19, thereby identifying a potential target for novel therapeutic interventions."
Source: https://www.researchsquare.com/article/rs-128348/v1
Commentary: Auto-reactive IgM is a very broad immune response. I am going to drastically oversimplify and undoubtedly get it wrong in the finer details, but if IgA and IgG are like snipers and infantry, IgM is like an air strike. COVID-19 appears to be provoking the body into delivering an air strike rather than sending in snipers in its immune reaction, which means that a lot of collateral damage - to the heart, lungs, kidneys, and liver - comes along with that response. In effect, COVID-19 convinces the body, in severe cases, to kill itself, like someone just shooting blindly in every direction rather than aiming at the specific problem.
The net of the paper is that by understanding how COVID-19 causes harm in a very specific way, we might better be able to moderate its impact, tell the body to call off the air strike before the damage is too severe.
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COVID-19 underreporting is improving. " Adjusting reported COVID-19 infections using underreporting multipliers derived from CDC seroprevalence studies in April (n = 16 596), May (n = 14 291), June (n = 14 159), July (n = 12 367), and August (n = 38 355), there were estimated medians of 46 910 006 (interquartile range [IQR], 38 192 705-60 814 748) SARS-CoV-2 infections, 28 122 752 (IQR, 23 014 957–36 438 592) symptomatic infections, 956 174 (IQR, 782 509–1 238 912) hospitalizations, and 304 915 (IQR, 248 253–395 296) deaths in the US through November 15, 2020. An estimated 14.3% (IQR, 11.6%-18.5%) of the US population were infected by SARS-CoV-2 as of mid-November 2020.
The SARS-CoV-2 disease burden may be much larger than reported COVID-19 cases owing to underreporting. Even after adjusting for underreporting, a substantial gap remains between the estimated proportion of the population infected and the proportion infected required to reach herd immunity. Additional seroprevalence surveys are needed to monitor the pandemic, including after the introduction of safe and efficacious vaccines."
Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774584
Commentary: With only 14% of America having had COVID-19, we are not anywhere close to herd immunity. The vaccines are the only way to shut this thing down.
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A stunning system failure in Egypt. "All coronavirus patients in an intensive care unit in Egypt have died after the oxygen supply to the ward failed.
Footage captured by one of the patient's relatives taken at El Husseineya Central Hospital in Ash Sharqia province has gone viral online.
The cameraman's aunt, Fatima Al-Sayed Mohamed Ibrahim, 66, was among the patients being treated at the quarantine centre.
The incident happened after the oxygen level was almost below two per cent and there was neither enough pressure nor enough oxygen to save the patients' lives.
It is the second such incident to occur after patients in the ICU at Zefta General Hospital suffered the same fate.
The tragedy has underscored the corruption and negligence at the heart of Egypt's ruling government."
Content warning: the video contains scenes of death.
Source: https://www.middleeastmonitor.com/20210104-egypt-entire-icu-ward-dies-after-oxygen-supply-fails/
Commentary: This is not isolated; hospitals and healthcare facilities around the world are under severe strain from caseloads.
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New vaccines are astonishingly safe. "Per CDC, COVID vaccines looking impressively safe.
Through Dec 22, after nearly 1 million doses, only 307 ED visits, almost all of them for minor symptoms."
Source: https://wonder.cdc.gov/controller/datarequest/D8;jsessionid=2C5DF9F944A2AEE971DE2FD2EA71?stage=results&action=shiftm&measure=D8.M2&direction=left
Commentary: 307 adverse events requiring an emergency department visit for 1 million doses is an insanely safe product, especially since the #1 reason for the visit was dizziness, felt by 31% of patients, along with nausea and shortness of breath. Honestly, you could hand out glasses of water and probably get similar results.
To give you a sense of probability, that's a 0.0307% chance of an adverse reaction. Put another way, you are 99.97% likely not to have a severe reaction to the vaccine.
Those are amazing odds. When you become eligible, get it.
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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. If you come in physical contact with others, wash your clothing upon returning home.
2. 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.
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.
6. 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).
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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.