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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DIY air filters. "THE IDEA SEEMS pretty simple, once someone explains it. The virus that causes the pandemic disease Covid-19 passes from human to human on tiny droplets of spittle, through the air. Masks block some of them. But what if—and I am literally spitballing here—you could clean those particles from the air itself?
Researchers who study aerosols and indoor air quality have (mostly) (finally) convinced the scientific establishment—the World Health Organization, the US Department of Health and Human Services—that Covid-19 transmission has an airborne component. And now some of those same aerosol specialists have begun to think this ventilation approach is a good idea. A big, complicated central air system filled with filters and maybe even germ-busting ultraviolet light, like what a hospital or skyscraper might have, would be great. A $500 air purifier could make a real difference in pulling infectious bits out of a room before they can infect a person. But it’s possible, some of them speculate, that even a store-bought filter stuck onto a $20 box fan might do some good too. It’s cheap, and while it wouldn’t cut the risk of infection to zero, it would still pull virus-laden particles out of the air. “It hadn’t occurred to me until two days ago, until someone pointed it out,” says José-Luis Jiménez, an aerosol scientist at the University of Colorado, Boulder, “but I think it’s a brilliant idea.”"
Source: https://www.wired.com/story/could-a-janky-jury-rigged-air-purifier-help-fight-covid-19/
Commentary: I've been doing this for years. MERV 12-16 air filters run something like $60 for a pack of 6, and a 20" box fan is stupid cheap. Slap a bungie cord on it, put the filter on the intake side, and you've got yourself an air filtration system that works as well or better than most air filtration gadgets at a fraction of the cost.
These are the filters I use: https://amzn.to/3ifK1uj
If you build this for your home or office, remember that you need to be using at least a MERV 14 rated HEPA filter. Bonus: you'll also squash pet allergies from things like floating dander. Remember to change the filter at least monthly, if not more frequently.
It's important to note that this doesn't eliminate the need for a mask or distancing. But in an enclosed environment (say, like a classroom or a daycare) it can help further reduce risk.
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Viral load predicts mortality. "A Cox proportional hazards model adjusting for age, sex, asthma, atrial fibrillation, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, heart failure, hypertension, stroke, and race yielded a significant independent association between viral load and mortality (hazard ratio 1·07 [95% CI 1·03–1·11], p=0·0014; appendix p 3), with a 7% increase in hazard for each log transformed copy per mL. A univariate survival analysis revealed a significant difference in survival probability between those with high viral load (defined as being greater than the overall mean log10 viral load of 5·6 copies per mL) and those with low viral load (p=0·0003; appendix p 4), with a mean follow-up of 13 days (SD 11) and a maximum follow-up of 67 days.
Early risk stratification in COVID-19 remains a challenge. Here, we show an independent relationship between high viral load and mortality. Transforming qualitative testing into a quantitative measurement of viral load will assist clinicians in risk-stratifying patients and choosing among available therapies and trials. Viral load might also affect isolation measures on the basis of infectivity. Future work will address SARS-CoV-2 viral load dynamics and the quantitative relationship with neutralising antibodies, cytokines, pre-existing conditions, and treatments received, among other covariates, as we develop integrative algorithms for risk prediction."
Source: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30354-4/fulltext
Commentary: The more viruses you have in you, the more likely the disease is likely to kill you. That's important by itself, but it also means that if you get tested, ask for a load count if possible. That number has predictive power to how much care you might need.
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"On COVID-19 vaccine: A vaccine is only a vaccine. It's nothing until it's a vaccination. And I think that's where we're going to have to understand how we’re going to deliver this. I worry about supply chains. There are people who will want billions of dose vials right now. Can the glass companies make them? How are we going to deliver it? Right now Operation Warp Speed is talking about the military delivering it. I can tell you from many of my colleagues in public health, that is not seen as a good idea."
Source: https://jamanetwork.com/journals/jama/fullarticle/2769289
Commentary: The logistics of a vaccine have not been even close to remotely worked out. What I'd like to see is for insurance companies to step in as part of the solution. Anything that requires insurance should also either discount or penalize companies, venues, etc. that don't offer the vaccine to employees and participants. There's an expression in political science - you can't legislate morality, but you can tax the hell out of vice. The same is true for science-based policy. You can't force people to take a vaccine, but you sure can incentivize it and make it worth someone's time. Health insurance companies could reduce premiums. Offices could offer perks. Let's get creative.
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COVID-19 could induce psychiatric issues like PTSD. "Infection-triggered perturbation of the immune system could induce psychopathology, and psychiatric sequelae were observed after previous coronavirus outbreaks. The spreading of the Severe Acute Respiratory Syndrome Coronavirus (COVID-19) pandemic could be associated with psychiatric implications. We investigated the psychopathological impact of COVID-19 in survivors, also considering the effect of clinical and inflammatory predictors.
We screened for psychiatric symptoms 402 adults surviving COVID-19 (265 male, mean age 58), at one month follow-up after hospital treatment. A clinical interview and a battery of self-report questionnaires were used to investigate post-traumatic stress disorder (PTSD), depression, anxiety, insomnia, and obsessive-compulsive (OC) symptomatology. We collected sociodemographic information, clinical data, baseline inflammatory markers and follow-up oxygen saturation levels.
PTSD, major depression, and anxiety, are all high-burden non-communicable conditions associated with years of life lived with disability. Considering the alarming impact of COVID-19 infection on mental health, the current insights on inflammation in psychiatry, and the present observation of worse inflammation leading to worse depression, we recommend to assess psychopathology of COVID-19 survivors and to deepen research on inflammatory biomarkers, in order to diagnose and treat emergent psychiatric conditions."
Source: https://www.sciencedirect.com/science/article/pii/S0889159120316068
Commentary: COVID-19 PTSD is a real thing. Two takeaways - we need to ensure we're offering treatment in the long term for people who've had it and suffered psychiatric harm as well as physical harm. Second, we need to flag people with existing psychiatric issues as also at greater risk if they contract COVID-19.
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Still much to learn. "What will determine our future with the virus is how long protective immunity lasts. For severe coronaviruses like MERS and the original SARS, it persists for at least a couple of years. For the milder coronaviruses that cause common colds, it disappears within a year. It’s reasonable to guess that the duration of immunity against SARS-CoV-2 lies within those extremes, and that it would vary a lot, much like everything else about this virus. “Everyone wants to know,” says Nina Le Bert from the Duke-NUS in Singapore. “We don’t have the answer.”
Most people still haven’t been infected a first time, let alone a second. The immediate uncertainty around our pandemic future “doesn’t stem from the immune response,” Cobey says, but from “policies that are enacted, and whether people will distance or wear masks.” But for next year and beyond, modeling studies have shown that the precise details of the immune system’s reactions to the virus, and to a future vaccine, will radically affect our lives. The virus could cause annual outbreaks. It might sweep the world until enough people are vaccinated or infected, and then disappear. It could lie low for years and then suddenly bounce back. All of these scenarios are possible, but the range of possibilities will narrow the more we learn about the immune system."
Source: https://www.theatlantic.com/health/archive/2020/08/covid-19-immunity-is-the-pandemics-central-mystery/614956/
Commentary: The challenging thing for a lot of people is understanding that science is ever growing, ever learning. We don't know what's going to happen. All we can do is our best to prepare for likely scenarios and outcomes.
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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. 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. 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.
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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.