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.
You are welcome to share this.
---
Rapid tests are still challenged by accuracy. "Independent evaluation of different Ag-RDTs has shown that their sensitivity ranges between 70% and 90% (lower confidence limits 50–80%) in symptomatic individuals,2 but it deteriorates remarkably (<50%) in asymptomatic close contacts,3 in those with low nasopharyngeal viral loads,2 and in paediatric patients.4 By contrast, the NPV is excellent (>97%) in all instances,2, 3, 4 which has led most investigators to conclude that a negative Ag-RDT might reliably rule out the infection in low-prevalence settings.1, 4
Current mathematical models suggest that the SARS-CoV-2 pandemic is driven by early and asymptomatic viral transmission and that prompt identification of low-risk and asymptomatic individuals has the strongest effect in controlling viral spread.5 Thus, if our goal is to ensure SARS-CoV-2-free environments (eg, workplaces, schools, gatherings) by allowing those who test negative to resume their usual activities, false-negative results should not be tolerable; to achieve this goal, screening tools with the highest possible sensitivity are required, since sensitivity is the only parameter that reflects the rate of cases who erroneously test negative, irrespective of the disease prevalence.
Because most of the currently available Ag-RDTs have a considerable false-negative rate,2, 3, 4 health-care professionals should be aware that a single negative test cannot conclusively rule out SARS-CoV-2 infection; this is particularly true in low-prevalence settings, where the typically excellent NPV of Ag-RDTs is misleading."
Source: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00206-1/fulltext
Commentary: To ensure someone is truly COVID-negative, use more than one rapid test, or use the RT-PCR test. A single negative test isn't enough to validate that they are actually COVID-free.
---
India's pandemic response challenging the world response. "In the early days of the pandemic, as multiple vaccines were being rushed into clinical trials, intellectual property laws and patents were being viewed as big barriers that would prevent low-income countries from accessing lifesaving vaccines. That hasn’t come to pass. Instead, the real problems stem from the abject lack of procurement planning by a country that has immense vaccine manufacturing capacity and its shoddy regulatory oversight.
Of the five of vaccines developed so far in the Global West, at least three companies — Johnson & Johnson, AstraZeneca, and Novavax — licensed their technologies to Indian manufacturers as far back as last year. The Russian Direct Investment Fund (RDIF) licensed its technology for the Sputnik V vaccine to Hyderabad-based Dr. Reddy’s. And the Indian government, in partnership with Bharat Biotech, another Hyderabad-based company, has developed a vaccine called Covaxin. There is no shortage of vaccine candidates for the low-income countries.
But when the full force of the second wave of the pandemic hit India, its government reacted in a knee-jerk manner by imposing a de facto ban on all vaccine exports, including to COVAX, and redirected all supplies from SII to India. Although the Indian government has officially denied the imposition of any such ban, and there does not appear to be any legal order to that effect, COVAX has announced to intended recipients in low-income countries that orders will be delayed by a few months due to delays at SII, largely due to an increased demand for vaccines in India.
In an interview with the Associated Press on April 7, Adar Poonawalla, the Serum Institute of India’s CEO, all but confirmed the ban, saying he hoped to resume exports in two months. But given the disaster unfolding in India and the pressure on its government to meet a huge domestic demand for vaccines, it is unlikely that SII will be allowed to export any doses until a majority of Indians are vaccinated.
This sudden ban on exports has surely come as a rude shock to COVAX, which arranged for the “at-risk funding” and which is owed at least another 180 million doses by SII, at the very minimum. It is also a blow to countries that may have had their own contracts with SII."
Source: https://www.statnews.com/2021/05/05/india-vaccine-heist-shoddy-regulatory-oversight-imperil-global-vaccine-access/
Commentary: Nationalism of all kinds has been one of the biggest preventable causes of pandemic cases, from restricting vaccine exports to intellectual property to outright denial of the problem.
The key here is to encourage all nations to not outsource so much of their health technology to other nations, so that each nation has some reserve capacity in case supply chains are disrupted. And this isn't limited to pandemics; a boat poorly steered in the Suez Canal can stop up world trade for weeks. Having capacity at home is always a good thing.
---
CDC in America projecting substantial decline. "Increases in COVID-19 cases in March and early April occurred despite a large-scale vaccination program. Increases coincided with the spread of SARS-CoV-2 variants and relaxation of nonpharmaceutical interventions (NPIs).
Data from six models indicate that with high vaccination coverage and moderate NPI adherence, hospitalizations and deaths will likely remain low nationally, with a sharp decline in cases projected by July 2021. Lower NPI adherence could lead to substantial increases in severe COVID-19 outcomes, even with improved vaccination coverage.
High vaccination coverage and compliance with NPIs are essential to control COVID-19 and prevent surges in hospitalizations and deaths in the coming months."
Source: https://www.cdc.gov/mmwr/volumes/70/wr/mm7019e3.htm?s_cid=mm7019e3_w#F1_down
Commentary: Hopefully, America can achieve the target of 70% of the population vaccinated. How? Incentives.
---
Incentives work. "West Virginia is offering $100 savings bonds to 16- to 35-year-olds who get vaccinated. Maryland will pay fully vaccinated state employees $100. Breweries participating in New Jersey’s “Shot and a Beer” program are giving out free drinks to legal adults who gets vaccinated in May. Connecticut and Washington, D.C., are also running free-drink promotions for the inoculated. The New York Yankees and Mets will reportedly offer free tickets to fans who get vaccinated at ballparks before games. Lawmakers in Harris County, Tex., approved a $250,000 budget for vaccine perks like gift cards and freebies. Detroit is handing out $50 prepaid debit cards to pre-registered individuals who drive a neighbor to a vaccine clinic.
The subtext of these programs is clear: The lifesaving benefits of COVID-19 vaccination have not been enough to convince many people to get their shots. And now, if the U.S. wants to reach herd immunity, it may need to get creative.
But will a free drink or a $100 payment actually convince anyone to get vaccinated?
“It gets at the low-hanging fruit”—people who aren’t actively opposed to vaccination but may have been too busy or apathetic to make an appointment, says Eric Feigl-Ding, an epidemiologist and health economist at the Federation of American Scientists. “The hardcore denialists are not going to budge after being bribed with a beer or a $100 savings bond.”
Still, the “low-hanging fruit” population is a large one. More than half of the U.S. population has not yet received a single COVID-19 vaccine dose, even though they are now available to adults nationwide—but U.S. Census Bureau data show that less than 15% of U.S. adults identify as vaccine hesitant. A recent Axios-Harris poll found that 31% of unvaccinated Americans say they’ll either “get the vaccine whenever they get around to it” or “will wait awhile and see before getting the vaccine.” That suggests a significant number of people fall somewhere between eager for and opposed to vaccination. Incentives could help bring them in the door.
Past studies have shown that financial incentives can get people to change their health behaviors. One 2019 research review found that monetary rewards can help motivate smokers to quit cigarettes. Other studies have found that incentives can encourage participation in employer-sponsored wellness and fitness programs, and convince people to eat fruits and vegetables.
When it comes to COVID-19, that pattern seems to hold. For example, in a recent University of California, Los Angeles survey, about a third of unvaccinated people said cash payments would make them more likely to get a COVID-19 shot. Democrats seemed especially swayed by the promise of a payout, the survey found, while Republicans tended to be more tempted by relaxed safety standards, like the ability to go maskless in public."
Source: https://time.com/6046238/covid-19-vaccine-incentives/
Commentary: In most democracies, citizens cannot be mandated to take any medicine, especially one that is an emergency use authorization. Thus, there are only social and material incentives to encourage people to do it. Given the polarized debate about the effectiveness of things like masks and vaccines, incentives seem to be one of the best ways to overcome hesitancy and get people to take the preferred action.
---
Canada gives the green light for 12-15 year olds. "Canada on Wednesday authorized the use of Pfizer-BioNTech’s coronavirus vaccine for children ages 12 to 15, marking the first time the country has greenlighted a coronavirus vaccine for adolescents.
Pfizer also has sought authorization for adolescents in this age group in the United States, and approval is expected by early next week.
The Canadian adolescents will follow the same two-dose regimen authorized for adults following a trial of more than 2,000 participants that began in April, Supriya Sharma, Health Canada’s chief medical adviser, said at a news conference after Wednesday’s announcement.
Health Canada said it will expedite reviews of other vaccine producers seeking authorization for similarly expanded emergency use.
The Pfizer study found that the vaccine was 100 percent effective in preventing infection among the participants who received two doses, while there were 18 cases of the coronavirus among those who received a placebo, Sharma said. Authorities also tested for antibodies and found strong responses similar to those in inoculated adults among the adolescent group that received the vaccine."
Source: https://www.washingtonpost.com/world/2021/05/05/canada-coronavirus-vaccine-pfizer-adolscents-12-15/
Commentary: Quite surprising, but good for Canada. The data for 12-15 year old outcomes is solid, so there's no reason to not authorize.
---
Source:
Commentary:
---
Source:
Commentary:
---
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, even after you've been vaccinated. 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, and fulfill the full vaccine regimen.
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:
---
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
---
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.