Lunchtime pandemic reading.
Standard disclaimer: this is a roundup of informative pieces I've read that interest me on the severity of the crises and how to manage them. I am not a qualified medical expert in ANY sense; at best I am reasonably well-read laity. ALWAYS prioritize advice from a qualified healthcare provider who knows your specific medical situation over advice from people on the Internet.
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Happy New Year 2024 to you. I wish I had better tidings. Let’s dig in.
Commentary: Let's start with something that's apparently non-obvious. Masking isn't binary. It's a mistake to think that you either have to be masked 100% of the time, or not bother at all. It's not black and white. Infectious diseases are like smoke. You want to breathe as little of it as possible, and your risks go up the more of it you breathe.
If you dine out for 30 minutes, your risk is lower than dining out for 90 minutes in the same restaurant with other people. If you wear a mask at the grocery store but not at a bar (assuming equal numbers of people around you at equal distances), your risk is lower than if you didn't wear a mask at all, but higher than if you wore a mask in both places.
The goal is to breathe as little of the bad stuff as possible while still living your life. Certainly, in places where risk outweighs reward like the grocery store, it just makes good sense to wear a mask. In places where the reward dramatically outweighs the risk, like visiting healthy, not-at-risk relatives, it makes good sense to not mask. But it's not all or nothing, and never has been. Some masking is better than none. Any vaccination is better than none. And the more precautions you take, the lower your risk goes.
Biobot wastewater data shows we are now in the second-highest wave of COVID since January 2022.
Source: https://biobot.io/data/
Commentary: If it feels like lots of people are COVID positive around you, it’s because they are. Mask up, and make sure you're up to date on your boosters.
COVID makes your brain smaller. "There is strong evidence of brain-related abnormalities in COVID-19. However, it remains unknown whether the impact of SARS-CoV-2 infection can be detected in milder cases, and whether this can reveal possible mechanisms contributing to brain pathology. Here we investigated brain changes in 785 participants of UK Biobank (aged 51–81 years) who were imaged twice using magnetic resonance imaging, including 401 cases who tested positive for infection with SARS-CoV-2 between their two scans—with 141 days on average separating their diagnosis and the second scan—as well as 384 controls. The availability of pre-infection imaging data reduces the likelihood of pre-existing risk factors being misinterpreted as disease effects. We identified significant longitudinal effects when comparing the two groups, including (1) a greater reduction in grey matter thickness and tissue contrast in the orbitofrontal cortex and parahippocampal gyrus; (2) greater changes in markers of tissue damage in regions that are functionally connected to the primary olfactory cortex; and (3) a greater reduction in global brain size in the SARS-CoV-2 cases. The participants who were infected with SARS-CoV-2 also showed on average a greater cognitive decline between the two time points. Importantly, these imaging and cognitive longitudinal effects were still observed after excluding the 15 patients who had been hospitalised. These mainly limbic brain imaging results may be the in vivo hallmarks of a degenerative spread of the disease through olfactory pathways, of neuroinflammatory events, or of the loss of sensory input due to anosmia. Whether this deleterious effect can be partially reversed, or whether these effects will persist in the long term, remains to be investigated with additional follow-up."
Source: https://www.nature.com/articles/s41586-022-04569-5
Commentary: The neurological effects of COVID are still not fully understood and won’t be for years, if not decades. This is still a novel disease, and by definition we don’t know what the long-term impacts are, but it’s becoming clear that they are significant. The best thing you can do is continue to protect yourself against it and minimize your exposure to it.
Multiple exposures increase risk, regardless of vaccination status. "The first study of health risks from repeat infections was published last November. A team of researchers led by Ziyad Al-Aly, a clinical epidemiologist at Washington University, in St. Louis, and his colleagues concluded that reinfected people are twice as likely to die and three times as likely to be hospitalized with COVID than those infected only once, regardless of their vaccination status. Al-Aly’s team reviewed data from nearly half a million COVID patients treated by the U.S. Department of Veterans Affairs (VA) between March 2020 and April 2022. Among them, roughly 10 percent had been infected with SARS-CoV-2 between two and four times. Some patients continued to have symptoms during the six months of follow-up, Al-Aly says, and the severity of a patient’s disease typically worsened with each new COVID episode."
Commentary: The alarming part of this study is that the risks don't decline with vaccination status. Repeatedly getting COVID is bad for you.
COVID is MUCH worse for you than the flu. "Over 18 months of follow-up, compared to seasonal influenza, the COVID-19 group had an increased risk of death (hazard ratio [HR] 1·51 [95% CI 1·45–1·58]), corresponding to an excess death rate of 8·62 (95% CI 7·55–9·44) per 100 persons in the COVID-19 group versus the influenza group. Comparative analyses of 94 prespecified health outcomes showed that COVID-19 had an increased risk of 68·1% (64 of 94) pre-specified health outcomes; seasonal influenza was associated with an increased risk of 6·4% (six of 94) pre-specified health outcomes, including three out of four pre-specified pulmonary outcomes. Analyses of organ systems showed that COVID-19 had a higher risk across all organ systems except for the pulmonary system, the risk of which was higher in seasonal influenza. The cumulative rates of adverse health outcomes across all organ systems were 615·18 (95% CI 605·17–624·88) per 100 persons in COVID-19 and 536·90 (527·38–544·90) per 100 persons in seasonal influenza, corresponding to an excess rate of 78·72 (95% CI 66·15–91·24) per 100 persons in COVID-19."
Source: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00684-9/fulltext
Commentary: It is astonishing when you read the comparative numbers about just how much more punishing COVID is to your body's systems - for pre-specified health outcomes, it's 10x worse.
A reminder of the simple daily habits we should all be taking.
Wear the best mask available to you when you'll be around people you don't live with, even after you've been vaccinated. P100 respirators are back in stock at online retailers, too and start around US$40 for a reusable respirator. 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.
Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
Get vaccinated as soon as you're eligible to, and fulfill the full vaccine regimen, including boosters. Remember that you are not vaccinated until everyone you live with is vaccinated. There are new vaccines available now in addition to the boosters we already know that may be more efficacious and tolerated better, so talk to your healthcare provider about which vaccine or booster is the best choice for you.
Check COVID dashboards to see how prevalent it is in your region. Focus especially on wastewater reporting. A couple of useful dashboards:
In areas of above-average prevalence, stay out of indoor spaces that aren't your home and away from people you don't live with as much as practical. Minimize your contact with others and avoid indoor places as much as you can; indoor spaces spread disease through aerosols and distance is less effective at mitigating your risks.
Aim to have 3-6 months of living expenses on hand in case the pandemics give another crazy plot twist to the economy, or you know, a global war breaks out.
Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
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).
Masks must fit properly to work. Here's how to properly fit a mask:
If you think you may have been exposed to COVID, purchase several rapid antigen tests and/or acquire them from your healthcare provider or government. This will detect COVID only when you're contagious, so follow the directions clearly. https://amzn.to/3fLAoor
Remember, you are not clear until you take 2 tests that are negative, 24 hours apart.
Common misinformation debunked!
There is no basis in fact that COVID vaccines can shed or otherwise harm people around you.
Source: https://www.reuters.com/article/factcheck-covid19vaccine-reproductivepro-idUSL1N2MG256
There is no mercury or other heavy metals in the Pfizer mRNA vaccine.
Source: https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
There is no basis in fact that COVID vaccines pose additional risks to pregnant women.
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2104983
There is no genomic evidence at all that COVID arrived before 2020 in the United States and therefore no hidden herd immunity:
Source:
https://twitter.com/trvrb/status/1249414291297464321
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/
Source: https://www.smh.com.au/national/are-we-ignoring-the-hard-truths-about-the-most-likely-cause-of-covid-19-20210601-p57x4r.html
There is no evidence a flu shot increases your COVID 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
Disclosures and Disclaimers
I declare no competing interests on anything I share related to COVID or other communicable diseases. I am employed by and am a co-owner in TrustInsights.ai, an analytics and management consulting firm. I have no clients and no business interests in anything related to COVID or other communicable diseases, nor do I financially benefit in any way from sharing information about COVID or other communicable diseases.
I am not a qualified healthcare provider and I do not provide medical advice. Only take medical advice from your qualified healthcare provider who knows your specific details and can provide customized recommendations for you.