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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Still not the flu.
Source:
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Vitamin D not proven to have any impact. "NICE’s summary, which looked specifically at emerging evidence on the role of vitamin D in relation to covid-19, concluded that there is currently no evidence to support supplements reducing the risk or severity of covid-19.2 The Scientific Advisory Commission on Nutrition also studied whether vitamin D supplementation could reduce the risk of acute respiratory tract infections other than covid-19, and concluded that the jury was still out.3"
Source: https://doi.org/10.1136/bmj.m3872
Commentary: The general consensus in the medical community is that supplements are useful if you have a deficiency. If you don't, then they provide no added benefit and at extremely high excessive doses, provide documented harm. Anything more than the recommended daily allowances just makes for expensive urine.
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German autopsy results indicate no direct CNS damage from COVID-19. "Prominent clinical symptoms of COVID-19 include CNS manifestations. However, it is unclear whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, gains access to the CNS and whether it causes neuropathological changes. We investigated the brain tissue of patients who died from COVID-19 for glial responses, inflammatory changes, and the presence of SARS-CoV-2 in the CNS.
The emerging evidence, including the current study, shows that neuropathological alterations in the brains of patients who die from COVID-19 are relatively mild, although the virus is able to gain access to the brain. The neuropathological alterations are most likely to be immune-mediated, and there does not seem to be fulminant virus-induced encephalitis nor direct evidence for SARS-CoV-2-caused CNS damage. Further studies are needed to define how SARS-CoV-2 gains access to the brain, to define the neuroimmune activation, and to describe the distribution of SARS-CoV-2 in the brain.""
Source: https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30308-2/fulltext
Commentary: Thankfully SARS-CoV-2 doesn't go on a bender in our brains, but the fact that it shows up in our brain tissues is still concerning. Keep this bug out of your body by wearing a mask at all times outside your home when you might be around other people.
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Another therapeutic fails to show results. "Between March 19, 2020, and June 29, 2020, 1616 patients were randomly allocated to receive lopinavir–ritonavir and 3424 patients to receive usual care. Overall, 374 (23%) patients allocated to lopinavir–ritonavir and 767 (22%) patients allocated to usual care died within 28 days (rate ratio 1·03, 95% CI 0·91–1·17; p=0·60). Results were consistent across all prespecified subgroups of patients. We observed no significant difference in time until discharge alive from hospital (median 11 days [IQR 5 to >28] in both groups) or the proportion of patients discharged from hospital alive within 28 days (rate ratio 0·98, 95% CI 0·91–1·05; p=0·53). Among patients not on invasive mechanical ventilation at baseline, there was no significant difference in the proportion who met the composite endpoint of invasive mechanical ventilation or death (risk ratio 1·09, 95% CI 0·99–1·20; p=0·092).
In patients admitted to hospital with COVID-19, lopinavir–ritonavir was not associated with reductions in 28-day mortality, duration of hospital stay, or risk of progressing to invasive mechanical ventilation or death. These findings do not support the use of lopinavir–ritonavir for treatment of patients admitted to hospital with COVID-19."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32013-4/fulltext
Commentary: Despite not showing results, these days it's almost as important to document what has been proven NOT to work as it is to prove what does work. Plenty of people with no medical background are bandying about everything from hydroxychloroquine to healing crystals as tools against COVID-19, but very few things have actually passed muster. Keep these names in mind for things that don't work.
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Telemedicine delivers less care, but shows no evidence of a digital divide. "While the COVID-19 pandemic has impacted health care delivery in many ways, little is known regarding how the volume, site, and content of primary care in the US has changed. We used a nationally representative audit of outpatient care to characterize primary care delivery in the US between 2018 and Q2 of 2020. The pandemic has been associated with a more than 25% decrease in primary care volume, which has been offset in part by increases in the delivery of telemedicine, which accounted for 35.28% of encounters during the second quarter of 2020. Despite the increased use of telemedicine, its uptake has varied across the continental US and has not been correlated, at a regional level, with COVID-19 burden. Overall, the pandemic has been associated with marked reductions in the primary care assessment of cardiovascular risk factors such as blood pressure and cholesterol levels, owing to decreased total visit volume and less frequent assessment during telemedicine visits than during office-based visits. These findings are notable because little is known about the association between primary care delivery and the COVID-19 pandemic and because the pandemic has generated interest in telemedicine as a means to safely deliver primary care.
If substantial primary care volume continues to be delivered using telemedicine, a focus on the content and quality of such encounters is inevitable.28 Despite findings in a systematic review of 86 articles demonstrating the feasibility and acceptance of telemedicine for use in primary care, to our knowledge, relatively few rigorous comparisons of clinical outcomes in office-based vs telemedicine encounters have been performed.29 Our finding that such visits were less likely to include blood pressure or cholesterol assessments underscores the limitation of telemedicine, at least in its current form, for an important component of primary care prevention and chronic disease management.
Middle-aged individuals and those who were commercially insured were more likely to adopt telemedicine during the pandemic than their counterparts with other or no insurance. This difference may be due in part to the perceived elective or deferrable nature of visits among children30 and greater familiarity with telemedicine technology among middle-aged than among older adults.31 We did not find substantial differences in telemedicine use by payer type, and, contrary to our expectations and evidence of a digital divide,32 we did not find evidence of a racial disparity in telemedicine use when examining the frequency of telemedicine encounters as a proportion of a patient visits among Black versus White individuals."
Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2771191
Commentary: Telemedicine unsurprisingly delivers lower quality care because many people don't have the equipment or skill at home to do self-assessments of things like blood pressure, pulse, SpO2, and other critical measurements for specific conditions. To the extent that telemedicine becomes part of our lives, distributing medically-accurate equipment to people will be a vital component of the process.
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Air travel is moderately risky and precautions work. "Air enters the cabin from overhead inlets and flows downwards toward floor-level outlets. Air enters and leaves the cabin at the same seat row or nearby rows. There is relatively little airflow forward and backward between rows, making it less likely to spread respiratory particles between rows.
The airflow in current jet airliners is much faster than normal indoor buildings. Half of it is fresh air from outside, the other half is recycled through HEPA filters of the same type used in operating rooms. Any remaining risk to be managed is from contact with other passengers who might be infectious. Seat backs provide a partial physical barrier, and most people remain relatively still, with little face-to-face contact.
Despite substantial numbers of travelers, the number of suspected and confirmed cases of in-flight COVID-19 transmission between passengers around the world appears small (approximately 42 in total). In comparison, a study of COVID-19 transmission aboard high-speed trains in China among contacts of more than 2300 known cases showed an overall rate of 0.3% among all passengers. Onboard risk can be further reduced with face coverings, as in other settings where physical distancing cannot be maintained.
Wear a mask, don’t travel if you feel unwell, and limit carry-on baggage. Keep distance from others wherever possible; report to staff if someone is clearly unwell. If there is an overhead air nozzle, adjust it to point straight at your head and keep it on full. Stay seated if possible, and follow crew instructions. Wash or sanitize hands frequently and avoid touching your face."
Source: https://jamanetwork.com/journals/jama/fullarticle/2771435
Commentary: Don't travel if you can avoid it, but if you must, follow the steps in the last paragraph. Crank up the air full blast on your head and face to keep it moving and fresh. Wear the best mask available to you. Don't eat or drink if you can avoid it.
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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.
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.
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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
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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.