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.
---
Dr. Scott Gottlieb on the DC situation. "The Abbott test is a very good test, when used appropriately, you have to fit the right test to the right purpose, the White House was relying almost solely on testing as a way to protect the president they needed a zero fail any precautions beyond testing people who are going to be in contact president, and that requires multiple layers of testing, if you want to something close to a zero fail testing protocol, and you're never going to be able to achieve 100%, you would probably be needing to use a PCR based test at the point of entry at the White House. So the stephie gene expert probably would be more fit the purpose, but frankly, you need double layers of testing, you'd probably want to test people before they depart for the White House, and then test them again when they arrive. And even that wouldn't be 100%. But it would get you closer using these kinds of tests and and now using the binax as well the antigen based tests and and the Abbott ID now using that to screen an asymptomatic population to try to detect virus, you might only have 50% sensitivity perhaps a little bit better than that.
Anyone who is with the President on Tuesday, Wednesday, is not in the clear. I mean, anyone who is with any of the people who are currently infected earlier this week, they were probably at their peak contagion at that point. So typically, you're most contagious about 24 hours before the onset of symptoms. So the debate prep on Tuesday, is a source of potential third generation spread. The meeting of the GOP, the Senate GOP on Wednesday is a source of third generation spread, will likely see more cases emerge, unfortunately, early this week from people who are currently infected, who went on to infect other people. So this is still very much an evolving situation. Now, look, we hope not. And there are situations where there is no further propagation, but it's more than likely that you will see additional cases of third generation spread."
Source:
Commentary: It will be several weeks before any proclamation of anyone "being out of the woods" can be made that's medically sound. Keep that in mind as you consume news media.
How did the President of the United States get infected, the one person in the world who should have been safest? What happened in DC is an example of using the right technologies in the wrong ways. The RT-PCR test us a highly sensitive test that takes a long time to deliver a result, but the result is reasonably accurate. The Abbott rapid test is a test that takes a very short time to deliver a result, but is much less accurate.
The rapid test is best used for assessing a population - you want to know roughly how many people in a city test positive. Even if you miss 25% of cases, you have a much better picture broadly of what's going on.
The RT-PCR test is best used for assessing individuals, especially in high-risk situations where you can't afford to let even one person slip by who might be infected - and even with the test, you should maintain safe procedures. That didn't happen.
CNN has more on that:
"Seven people who attended the Barrett event, including Trump, have since tested positive for the virus. A number of them can be seen on video chatting before and after, all without masks. University of Notre Dame President Fr. John Jenkins, who flew in for the event and has since tested positive, said entrants were checked with rapid-response tests and told it was safe to take off their masks when their results came back negative."
Source: https://www.cnn.com/2020/10/03/politics/coronavirus-outbreak-supreme-court-ceremony-capitol-hill/index.html
What happened is that the wrong test was used for screening; instead of the rapid test, the White House should have been using the RT-PCR test which requires at least an hour (sometimes substantially more) to deliver a result.
The equivalent of these two tests is the difference between asking someone if they have a gun versus sending everyone through full body scanners. The survey will tell you a broad result but won't help you find just one person with a gun. The scanner will tell you who has a gun. If your goal is understanding how many guns there are, the less accurate survey is the way to go. If your goal is to stop an assassin, the scanner is the way to go.
The White House let the assassin loose by using the technology incorrectly.
---
Systems and data matter. "An Excel bungle that led to thousands of cases being lost in government systems masked daily cases in the UK hitting 11,000.
A clearer picture of the country's outbreak has emerged after some 16,000 confirmed infections had to be added to the daily totals running back more than a week.
Counted by the date specimens were collected, rather than the date the government published them, the UK had 11,404 cases on September 30, almost as many as were reported in the next two days combined.
The daily number has not been below 6,000 since September 21 on the alternative measure - although the government has reported lower figures on several days in that period.
The extraordinary meltdown was caused by an Excel spreadsheet containing lab results reaching its maximum size, and failing to update. Some 15,841 cases between September 25 and October 2 were not uploaded to the government dashboard.
As well as underestimating the scale of the outbreak in the UK, critically the details were not passed to contact tracers, meaning people exposed to the virus were not tracked down. "
Source: https://www.dailymail.co.uk/news/article-8805697/Furious-blame-game-16-000-Covid-cases-missed-Excel-glitch.html
Commentary: Using Excel to manage a system of critical national importance is like sending your soldiers to war with rubber band guns. In the beginning of the pandemic, it was absolutely excusable - speed mattered, and standing up ANY kind of system was better than nothing. But 7 months in, those hacks should have been replaced by enterprise-grade systems equipped to do the job.
---
A caution on the use of dexamethasone and why drugs like it should always bee administered with care. "Studies have convincingly shown that corticosteroids like dexamethasone, which broadly dampen the immune response, can save some people who have severe disease. Crotty cautions that if clinicians give steroids too early, “you could really shoot yourself in the foot because this might be somebody whose adaptive immune response is just getting going.”
In theory, the type of analyses done in this study may help clinicians better determine when to use these drugs. “You can assess patients based on their adaptive immunity profile,” Farber says. “This is really important.” But she also cautions that the blood may not reflect the immune responses in tissues such as the lungs, which is a key site of attack by the virus. “I don’t know if monitoring the blood is going to tell us what is going to prevent a mild case from becoming severe,” says Farber, who studies lung and airway immunity."
Source: https://www.sciencemag.org/news/2020/09/uncoordinated-immune-response-may-explain-why-covid-19-strikes-some-hard-particularly
Commentary: The timing of administering any of the COVID-19 therapeutics matters, because what they're intended to avert is the cytokine storm - the immune response where the body attacks itself. Using dexamethasone too soon could suppress the immune system too much - making it easier for the virus to replicate. It's a delicate balancing act.
---
Dr. Fauci on the Daily Show. "I think the 200,000 deaths that you're talking about, Trevor
are a good reflection of people that likely would not have died. If they didn't have this infection. The thing that I think we need to be careful and humble about in that we don't know everything about this infection. But we're starting to see right now or a couple of things that are troubling to me.
And that is that first of all, more and more young people you see when you look at it are getting into some significant trouble. Not a lot, not a high percentage. That's true.
The other thing is that when people get infected, we're seeing more and more of lingering signs and symptoms, so that when you clear the virus, you may have weeks or months or so in which you are just not quite right.
And the final thing is that they've recently done a study that was published in the Journal of the American Medical Association cardiology with people who recovered even from disease that wasn't that severe. When you do MRI, or imaging sensitive imaging, you can see things like inflammation of the heart. Now they may not be symptomatic, but we want to make sure that six months or a year from now, they don't wind up with unexplained arrhythmies, premature heart attacks, or other cardiomyopathies. So the situation is not wrapped up about what is the full impact of this, which means we have to take it very seriously, even among people who are obviously in trouble and die. There's other people that we need to be concerned about."
Source:
Commentary: The greatest danger of celebrities and politicians recovering from COVID-19 is communicating in some way that the disease is not as dangerous as it actually is. Treat it as such. Stay vigilant.
---
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.
6. Participate in your local political process. For Americans, go to Vote.org and register/verify your vote.
---
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
---
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.