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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LA is running out of oxygen. "Imagine having cardiac arrest and getting picked up by an ambulance that won't take you to a hospital.
Or having a medical emergency and languishing outside an emergency room for hours.
This is what Los Angeles County faces as the onslaught of Covid-19 devastates the community -- including those without coronavirus.
"Hospitals are declaring internal disasters and having to open church gyms to serve as hospital units," County Supervisor Hilda Solis said. "Our health care workers are physically and mentally exhausted and sick." Solis called the situation a "human disaster."
Almost 7,900 people are hospitalized with Covid-19 in just Los Angeles County. And 21% of them are in intensive care units, officials said Tuesday. The number of hospital patients grew by more than 200 from Monday.
On Tuesday, another 224 deaths were announced, bringing the total in the county to more than 11,000.
Now, ambulance crews in LA County have been told not to take patients with little chance of survival to hospitals.
"This order that was issued by the county emergency medical services really is very specific to patients who suffered from a cardiac arrest and are unable to be revived in the field," said Dr. Jeffrey Smith, chief operating officer of Cedars-Sinai Medical Center.
The Covid-19 surge has also led to a shortage of supplemental oxygen, meaning some patients treated by EMS will go without.
"Given the acute need to conserve oxygen, effective immediately, EMS should only administer supplemental oxygen to patients with oxygen saturation below 90%," Los Angeles County EMS said in its memo.
EMS said an oxygen saturation of at least 90% is sufficient to maintain normal circulation of blood to organs and tissues.
The oxygen shortage in the county and San Joaquin Valley prompted the formation of a "task force on oxygen" last week, Gov. Gavin Newsom said.
The task force has been working with local and state partners to try to refill oxygen tanks and get them to the hospitals and facilities most in need."
Source: https://www.msn.com/en-us/news/us/los-angeles-county-ambulance-crews-told-not-to-transport-covid-19-patients-with-little-chance-of-survival-amid-a-devastating-surge/ar-BB1ctP5H
Commentary: I am confused on two things. First, don't hospitals have oxygen generators? Second, why hasn't any health authority made an emergency use authorization to supplement medical oxygen with welding oxygen?
Welding oxygen is chemically the same element, with about the same level of purity - medical oxygen has to be 99.5% purity, whereas welding oxygen has to be 99.2% purity. I just called the welding gases supply store near me and they have plenty of oxygen tanks in stock, from 20 cubic foot to 330 cubic foot tanks.
If I were in the hospital with a choice between slightly less pure oxygen and no oxygen, I'd call that an easy choice. Ask your public health and elected officials to make an emergency use authorization for welding oxygen to be used in cases where hospitals have run out, and provide a waiver of liability to medical institutions who use it for lifesaving purposes.
If I had a loved one in the hospital and the institution was out of oxygen, bet your backside I'd be driving over there with a 330 cubic foot tank of welding oxygen that day and signing as many waivers of liability as possible to get my loved one the oxygen they needed to survive.
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Stick to the plan, urge some doctors. "The Covid-19 pandemic has been fraught with uncertainty and missteps, and for every scientific advancement that has moved us forward, failures to appreciate and clearly communicate the nuances have set us back. This month, we received the welcome news that mRNA vaccines are safe and protective against symptomatic Covid-19. As part of their submissions to the United States FDA for emergency use authorisation, both Pfizer/BioNTech and Moderna included a compelling finding: that the vaccines provided some protection just 14 days after the first shot.
Based on these observations, academics and lawmakers have been seduced by the idea of reducing the two-dose schedule for mRNA vaccines to just one dose, delaying the second dose until more people receive the initial immunisation, or even decreasing the dose of vaccine by half, all with the goal of getting more shots into more arms as quickly as possible. The notion of maximising the number of vaccinated people by these methods has rapidly gained support. In a time of crisis, regulators might be justified in making a decision such as this with little data in order to make the most of limited vaccine supplies and protect as many people as possible. However, in this case, they are not, both because it’s not supported by the data that we do have, and because it doesn’t address the actual problem currently facing the UK, the US, and Canada, which is the distribution of existing supplies.
In the UK, the Joint Committee on Vaccination and Immunisation has expanded the timeframe for a second dose of the Pfizer/BioNTech mRNA vaccine from three weeks – the spacing used in the clinical trials that showed 95% efficacy in protecting against Covid-19 – to up to 12 weeks. (A second dose of the AstraZeneca vaccine, which is the other jab authorized in the UK, can also be administered up to 12 weeks after the first, a practice with some support from clinical trial data.) In the US, Ron DeSantis, the governor of Florida, is reported to have suggested that one dose could be enough. In Ontario, Rick Hillier, who has been charged with vaccine distribution in Canada’s most populous province, has asked regulators to look into allowing the Moderna vaccine to be administered as a single dose. And Dr Moncef Slaoui, the scientific adviser for the US’s vaccination program Operation Warp Speed has proposed decreasing the dose of Moderna vaccine by half. In these and other instances, the thinking goes: if we could vaccinate more people, that would save more lives and bring the pandemic to a close more quickly, right?
Probably not. According to the trial data, vaccine efficacy drops to around 50% after a single shot for both mRNA vaccines. While this estimate includes the 14 days immediately after the primary shot (before the maximum immune response is expected to kick in), it suggests that a single-shot regimen would provide substantially less protection. Even if the first 14 days are excluded, after which efficacy is estimated to be over 90%, the confidence intervals – or what scientists estimate is the range of the true efficacy – indicate that this protection could vary by nearly 30%.
This also is at odds with data obtained from earlier studies with mRNA vaccines against both Sars-CoV-2 (the cause of Covid-19) and its cousin, Mers-CoV. Studies of Sars-CoV-2 infections in monkeys suggest that for a single mRNA vaccine shot to be protective, the dose must be higher. Phase 1 clinical trials designed to assess tolerability and immune responses in healthy volunteers to different doses showed that higher ones were associated with more serious side-effects. It’s questionable whether a single-shot vaccine could be both protective and safe.
The argument that the second (booster) shot of an mRNA vaccine could be delayed is also not supported by the science. Because of the expedited trial process, we don’t yet have information on immune durability, that is, the length of time that protective immunity endures. Typically booster shots are intended to provide the immune system with advanced “training” to make better antibodies, and to hardwire immune memory so that vaccine protection lasts.
Some vaccines don’t require a booster for this to occur, but these typically use vaccine platforms that include harmless replicating viruses, either weakened (so-called live-attenuated vaccines), or used as a vehicle to carry bits of protein from the target virus (viral-vectored vaccines). The Johnson & Johnson vaccine, which is expected to conclude phase 3 clinical trials in January, is a viral-vectored vaccine and is being evaluated as a single shot. These types of vaccines can stimulate the immune system more robustly and for a longer period of time than mRNA vaccines (although this is not always the case, as with the Oxford/AstraZeneca vaccine, which is a viral-vectored vaccine that requires two doses)."
Source: https://www.theguardian.com/commentisfree/2021/jan/06/mrna-vaccines-schedule-covid-19
Commentary: Given that we haven't distributed the doses we have, I strongly agree with Drs. Rasmussen and Schwartz, the authors of the piece. We know from clinical trials that the vaccines work when used as directed. If we had distributed all 50 million doses in the United States and were anxiously awaiting more, I'd agree that yes, let's stretch it as far as we can. But when we've distributed 5 million with 45 million sitting in warehouses and storage because of logistical incompetence, changing the dosing regime is absurd. Fix the logistics first.
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Immunity lasts for up to 8 months. "Understanding immune memory to SARS-CoV-2 is critical for improving diagnostics and vaccines, and for assessing the likely future course of the COVID-19 pandemic. We analyzed multiple compartments of circulating immune memory to SARS-CoV-2 in 254 samples from 188 COVID-19 cases, including 43 samples at ≥ 6 months post-infection. IgG to the Spike protein was relatively stable over 6+ months. Spike-specific memory B cells were more abundant at 6 months than at 1 month post symptom onset. SARS-CoV-2-specific CD4+ T cells and CD8+ T cells declined with a half-life of 3-5 months. By studying antibody, memory B cell, CD4+ T cell, and CD8+ T cell memory to SARS-CoV-2 in an integrated manner, we observed that each component of SARS-CoV-2 immune memory exhibited distinct kinetics."
Source: https://science.sciencemag.org/content/early/2021/01/05/science.abf4063
Commentary: This is good news for the vaccines currently being distributed (because of fears of very short-lived immunity), but potentially also bad news for people who were exposed to COVID-19 early in the first quarter of 2020. With an 8 month window, their immunity clock might be running down by now, making them potentially susceptible to reinfection.
The moral of the story is: whether or not you've had COVID-19, whether or not you've been administered the vaccine, behave as though you haven't. Wear the best mask available to you outside your home. Wash your hands. Watch your distance. Stay out of indoor spaces that aren't your home as much as you can.
Here's the part no one wants to hear. COVID-19 isn't going away. We will eventually get it under control. It will evolve. And like the common cold, we will be fighting it for decades to come in an arms race to deal with it. The things that are part of normal life now, like wearing masks, are probably going to be the norm for years to come - or should be, if you take your health seriously. Eventually, some activities like eating in restaurants will be safe again once you've been vaccinated and your shots are up to date with the current strains, but like the flu and common cold, COVID-19 is a genie that can't be put back in the bottle.
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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.