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.
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A pre-print paper from Sichuan University of Science & Engineering looks at an attack route for SARS-CoV-2 on hemoglobin and concludes: "The results showed the ORF8 and surface glycoprotein could bind to the porphyrin, respectively. At the same time, orf1ab, ORF10, and ORF3a proteins could coordinate attack the heme on the 1-beta chain of hemoglobin to dissociate the iron to form the porphyrin. The attack will cause less and less hemoglobin that can carry oxygen and carbon dioxide. The lung cells have extremely intense poisoning and inflammatory due to the inability to exchange carbon dioxide and oxygen frequently, which eventually results in ground-glass-like lung images."
Source: https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173
This paper sheds some interesting light on the disease's impact, and may clarify some conflicting reports of stroke-like symptoms. Anything that diminishes the blood's ability to carry oxygen can have knock-on effects that create similar damage to strokes.
We know COVID-19 can cause viral hepatitis based on a paper in early March in The Lancet; one of the takeaways from that paper is that existing liver damage may make your outcome more severe.
Source: https://www.thelancet.com/journals/langas/article/PIIS2468-1253(20)30057-1/fulltext
The ultimate summary: get as healthy as you can, so that if you do contract COVID-19, you will have the odds stacked in your favor as best as possible. Reduce or eliminate your consumption of alcohol, get some exercise and fresh air if possible, plenty of rest, and a healthful diet.
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The Imperial College of London is now publishing weekly forecasts of COVID-19 activity. "Based on the central trends in the forecasts, the total number of reported deaths in the coming week is expected to be:
Relatively small in 14 countries (<100 deaths)
(Argentina, China, Czech Republic, Dominican Republic, Egypt, Greece, Iraq, Japan, Luxembourg, Malaysia, Morocco, Norway, Panama, South Korea);
Relatively large in 15 countries (100 to 1000 deaths)
(Austria, Canada, Denmark, Ecuador, India, Indonesia, Ireland, Israel, Mexico, Peru, Philippines, Poland, Portugal, Romania, Sweden),
Large in 8 countries (1,000 to 5,000 deaths)
(Algeria, Belgium, Brazil, Germany, Iran, Netherlands, Switzerland, Turkey),
Very large in 5 countries (> 5,000 deaths)
(France, Italy, Spain, United Kingdom, United States of America)."
Source: https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/covid-19-weekly-forecasts/week-07-04-2020/
Imperial College has done an amazing job thus far of analyzing the pandemic. I'll be adding their weekly forecasts to my required reading.
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Epidemiologist Dr. Jennifer Nuzzo from JHU has an excellent interview with JSTOR on the current situation. "I think vaccines are not going to be a realistic solution for years. The 12-to-18 month timeline that you’ve likely heard assumes that the science works in our favor. But it will take years to get the quantities that we need. I don’t see vaccines being a viable solution for a long time. I think what’s going to happen now is that we will, through these crippling social distancing measures, eventually slow our incidents to a more manageable point. And then we’ll have to think about relaxing the social distancing measures very slowly. But in order to be able to do that, so that we don’t wind up back where we started, we’re going to have to do what Singapore and South Korea did. We have to test widely in order to very rapidly identify cases, and then we will have to isolate those cases as soon as we find them, so they can’t transmit their disease to others. We have to identify their contacts, so that we can figure out if those people too have been infected. And we will have to monitor cases of transmission for a period of time—test and isolate so they don’t transmit. We’re just going to have to keep doing that and doing that and doing that, until either the pandemic has peaked—and hopefully we’ve spared the health system from crashing—or until we have other tools, like maybe therapeutics that could treat people who become infected, so that they don’t require intensive care or ventilators."
Source: https://daily.jstor.org/jennifer-nuzzo-were-definitely-not-overreacting-to-covid-19/
In the end, immunity through infection may be what gets us through this - once 60-70% of the population has had the disease and it runs out of hosts to infect at a large scale. Slowing it down with social distancing is clearly the most effective method right now, so it will be a choice of how fast we want it to move through the population - ideally keeping it to a slow burn that can be managed without overwhelming hospitals.
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The WHO issues revised guidance for use of masks, but changes very little. "WHO stresses that it is critical that medical masks and respirators be prioritized for health care workers. The use of masks made of other materials (e.g., cotton fabric), also known as nonmedical masks, in the community setting has not been well evaluated. There is no current evidence to make a recommendation for or against their use in this setting. WHO is collaborating with research and development partners to better understand the effectiveness and efficiency of nonmedical masks. WHO is also strongly encouraging countries that issue recommendations for the use of masks in healthy people in the community to conduct research on this critical topic. WHO will update its guidance when new evidence becomes available."
Source: https://www.who.int/publications-detail/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak
It's interesting that WHO doesn't advocate for the use of masks in some fashion by everyone, as the asymptomatic transmission aspect is a key part of why this disease is so bad. That said, I can understand their caution, especially since we have no shortage of politicians handing out completely unfounded medical advice with no clinical studies to back up their opinions. In the case of putting a t-shirt over your face when you're out and about, that seems like very low risk and potentially some reward, so it's worth doing.
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Scientific American urges advisory panels and councils for Congress. "As lawmakers in the United States turn their focus to fighting the scourge of COVID-19, they will need to come up to speed quickly on the science behind the virus that causes it; the ongoing challenges around testing; and the dynamics of spread. That is going to be difficult, because lawmakers and their staff tend to be generalists. Out of the 535 lawmakers, only 17 have a background in a field related to science and technology policy. They will resort to Google searches, reading Wikipedia, news articles, and, yes, even social media reports. Then they will make a flurry of cold calls and e-mails to whichever expert they can get on the phone with the desperate hope that someone will provide useful and actionable answers."
Source: https://blogs.scientificamerican.com/observations/congress-needs-more-scientific-expertise-to-fight-covid-19/
This is in part why our response has been so haphazard in the United States. Imagine driving a car with no map, no knowledge of the roads, and very poor visibility. I would recommend you contacting your government officials, no matter what nation you live in, and advocating that they have the best possible counsel and information, rather than relying on what's on TV or on Facebook.
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On a lighter note, pandas in Hong Kong's zoo finally mated after 13 years of living together. Why? Zookeepers suspect the peace and quiet helped the mood.
Source: https://www.nytimes.com/2020/04/07/world/asia/panda-mating-hong-kong.html
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A reminder of the simple daily habits we should all be taking.
1. Wash/sanitize your hands often, and 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.
2. Wear gloves and appropriate protective equipment if you have it when out of your home in any enclosed airspace (stores, etc.).
3. Stay home. Just stay home.
4. Get your personal finances in order now. Cut all unnecessary costs.
5. Donate any PPE you can. https://getusppe.org/give/