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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It is with a sense of relief that I am scheduled to receive the Moderna vaccine this coming Sunday, according to the state I live in.
Even after being vaccinated - and in late May, after I've received both doses and had the appropriate time for immune response - I will still continue to wear a mask in public and avoid large gatherings. Why? The vaccines are good - very, very, VERY good - but nothing is foolproof, and at this point, there's no compelling reason to STOP countermeasures.
It is possible to catch COVID-19 after vaccination. What the vaccines do is substantially change the odds of severe illness or death to nearly zero. It is possible to transmit COVID-19 to others after vaccination. What the vaccines do is cut that risk by as much as 90%.
Wearing a mask and avoiding large gatherings costs me nothing, so there's slight risk but zero reward for stopping countermeasures. Plus, I really like my mask.
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On new strains. "Great thread. There are 2 problems with much of the variant coverage.
On one side, we have:
***OMG MUTATION***
On the other, we have:
Nothing to worry about here, because (T cells/herd immunity/scientists are being negative again)
Neither side is 100% wrong or right
Unroll available on Thread Reader
Here's what we know:
Yes, variants have emerged. Yes, they are a problem.
Some, like B.1.1.7 are more transmissible and more virulent.
Some, like B.1.351 and P.1, may have *some* capacity to *partially* evade adaptive immunity (B cells/T cells).
But we can address both of these threats:
-Continuing to take precautions (masks, distancing, ventilation, etc) to reduce exposure risk
-Getting vaccinated ASAP. No variant has shown the ability to *completely* evade adaptive immunity. Vaccines still work against the variants.
Neutralizing antibodies, which are most the commonly measured metric, are not the totality of the immune response. A variant with the ability to evade some antibody neutralization in the lab does not mean that it's capable of evading protective immune responses.
Data from clinical trials shows that, in fact, all the vaccines retain the ability to protect against severe disease caused by all the known variants. We should be concerned about the variants, but we can do something about them.
Take precautions.
Get vaccinated.
At the same time, don't discount the importance of the variants or the possibility that other variants could emerge. When the virus replicates, it acquires mutations. "Double mutants" aren't surprising. What we need to watch out for are mutations that give the virus an advantage.
Advantages include:
-Increased capacity to evade immunity
-Increased fitness (ability to replicate)
-Increased infectivity (ability to cause an infection)
-Increased pathogenicity (more virulent)
Variants with mutations that offer any of the above advantages *could* emerge...IF THE VIRUS KEEPS HAVING OPPORTUNITIES TO REPLICATE.
If we can get transmission down, it won't have those opportunities.
So don't respond with fear or panic to every hyperbolic OMG MUTATIONS headline or tweet that you see.
And don't have a false sense of security when someone tells you to chill out because we have T cells or we've already reached herd immunity or it's all media hype.
What you should do is somewhere in between.
New variants will emerge if we don't take action now. So do this:
-Take precautions to reduce your exposure risk. Risk reduction is additive, so apply as many as you can (see chart from me & @syramadad).
-Get vaccinated ASAP."
Source:
Commentary: The key to slowing down future mutations is reducing infections, and the key to reducing infections is vaccinations. This is why, much as I would sometimes like to leave the science-denying crowd to endure the consequences of their beliefs, it's counterproductive to our overall health as a species. Every host of the virus offers the virus a chance to mutate in its favor. This is also why vaccines MUST get to poorer nations. A rich nation with its population vaccinated is still vulnerable to a poor nation's mutations if the virus runs unchecked in that nation - especially if there's a mishmash of vaccinated and unvaccinated people. That's practically a training ground for the virus to learn how to defeat the current vaccines.
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Vaccines at the local Dollar store? "We use geospatial data to examine the unprecedented national program currentlyunderway in the United States to distribute and administer vaccines against COVID-19. We quantify the impact of the proposed federal partnership with the company Dollar General to serve as vaccination sites and compare vaccine access with DollarGeneral to the current Federal Retail Pharmacy Partnership Program. Although dollar stores have been viewed with skepticism and controversy in the policy sector, we show that, relative to the locations of the current federal program, Dollar General stores are disproportionately likely to be located in Census tracts with high social vulnerability; using these stores as vaccination sites would greatly decrease the distance to vaccinesfor both low-income and minority households. We consider a hypothetical alternative partnership with Dollar Tree and show that adding these stores to the vaccination program would be similarly valuable, but impact different geographic areas than the Dollar General partnership. Adding Dollar General to the current pharmacy partners greatly surpasses the goal set by the Biden administration of having 90% of the popu-lation within 5 miles of a vaccine site. We discuss the potential benefits of leveraging these partnerships for other vaccinations, including against influenza."
Source: https://www.medrxiv.org/content/10.1101/2021.04.03.21254847v1
Commentary: This makes a great deal of sense and is 100% how we should be using data to identify ways to shut down chains of transmission and vaccinate vulnerable populations. Again, the virus doesn't see us as rich or poor, Black or white, liberal or conservative. We are just hosts, and it wants to infect us and mutate to survive. Our fight must be equitable so that we shut down reservoirs of infection.
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Moderna shows strong antibodies 6 months after second dose. "The estimated half-life of binding antibodies after day 43 for all the participants was 52 days (95% CI, 46 to 58) calculated with the use of an exponential decay model, which assumes a steady decay rate over time, and 109 days (95% CI, 92 to 136) calculated with the use of a power-law model (at day 119), which assumes that decay rates decrease over time. The neutralizing antibody half-life estimates in the two models were 69 days (95% CI, 61 to 76) and 173 days (95% CI, 144 to 225) for pseudovirus neutralization and 68 days (95% CI, 61 to 75) and 202 days (95% CI, 159 to 272) for live-virus neutralization. As measured by ΔAICc (change in Akaike information criterion, corrected for small sample size), the best fit for binding and neutralization were the exponential decay and power-law models, respectively (see the Supplementary Appendix). These results are consistent with published observations of convalescent patients with Covid-19 through 8 months after symptom onset.5
Although the antibody titers and assays that best correlate with vaccine efficacy are not currently known, antibodies that were elicited by mRNA-1273 persisted through 6 months after the second dose, as detected by three distinct serologic assays. Ongoing studies are monitoring immune responses beyond 6 months as well as determining the effect of a booster dose to extend the duration and breadth of activity against emerging viral variants. Our data show antibody persistence and thus support the use of this vaccine in addressing the Covid-19 pandemic."
Source: https://www.nejm.org/doi/full/10.1056/NEJMc2103916?query=featured_home
Commentary: Excellent continuing news for the mRNA vaccines in general. Immune responses remain strong after 6 months.
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An important piece on the pandemic and personality change. "With the death of her husband, Dr. Steffel’s life would be changing regardless of the pandemic. But other people too have been reassessing their futures in this brutal year. Something about the strangeness and tension of the pandemic seems to have prompted some people to shake up their lives.
After all, the person who emerges from quarantine doesn’t have to be the same old you. Scientists say that people can change their personalities well into adulthood. And what better time for transformation than now, when no one has seen you for a year, and might have forgotten what you were like in the first place?
Modern science, of course, has long since discarded notions of bile and humors. And now, it appears the idea that our personalities are immutable is also not quite true. Researchers have found that adults can change the five traits that make up personality — extroversion, openness to experience, emotional stability, agreeableness and conscientiousness — within just a few months. Much as in Dr. Steffel’s case, the traits are connected, so changing one might lead to changes in another.
Through painful isolation, this past year has, perversely, revealed the value of friendships and social ties. For those who want to renew connections that have atrophied, solidify friendships that have migrated to Zoom, or otherwise live differently, it’s very possible to do so. Remember that your personality is more like a sand dune than a stone."
Source: https://www.nytimes.com/2021/04/06/opinion/covid-personality-change.html
Commentary: This is a great, thoughtful piece. Who have you become in the pandemic? What have you learned about yourself? What would you like to become? This well-researched piece suggests that change is within your grasp, and one of the few times where "fake it till you make it" is backed by research - be the person you want to see by acting like it.
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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 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.
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:
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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.