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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Well, that happened in my country. The belief system that created yesterday's incident is the same belief system that denies wearing a mask or any of the other preventative measures we need to stop the pandemic, so we collectively have our work cut out for us. Thank you for believing in science, data, and facts.
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The Surgeon General says to go faster if you can. "Meeting with @CDCDirector
@HHS_ASH and Tony Fauci. We want to reiterate that ACIP guidance are recommendations- not mandates. States not only can, but SHOULD aggressively expand vaccinations to other phases if current supply exceeds demand in phase 1a!"
Source:
Commentary: The American vaccine rollout has been a textbook case of how not to roll out a vaccine. No one is in charge. No one is coordinating an effective national strategy. I'm hopeful that will change in the coming months, because if it doesn't, America will be ground zero for a vaccine-resistant strain to emerge. You put out a fire by pouring a hefty amount of water on it all at once, not by flicking water a teaspoon at a time at a fire.
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Mutation, variant, strain. "Although the terms mutation, variant, and strain are often used interchangeably in describing the epidemiology of SARS-CoV-2, the distinctions are important. Mutation refers to the actual change in sequence: D614G is an aspartic acid-to-glycine substitution at position 614 of the spike glycoprotein. Genomes that differ in sequence are often called variants. This term is somewhat less precise because 2 variants can differ by 1 mutation or many. Strictly speaking, a variant is a strain when it has a demonstrably different phenotype (eg, a difference in antigenicity, transmissibility, or virulence).
Evaluation of a new SARS-CoV-2 variant should include assessment of the following questions: Did the variant achieve prominence through natural selection or chance events? If the evidence suggests natural selection, which mutation(s) are being selected? What is the adaptive benefit of these mutations? What effect do these mutations have on transmissibility and spread, antigenicity, or virulence?"
Source: https://jamanetwork.com/journals/jama/fullarticle/2775006
Commentary: A mutation is automatically a variant, but a variant can encompass several mutations. A strain is a variant that behaves differently, for better or worse.
So what's happening now with B.1.1.7 and 501Y.V2 - these are showing functional differences (as also happened with D614G), which means the correct term is that these are new strains of SARS-CoV-2. Both B.1.1.7 and 501Y.V2 are more transmissible than the more or less current D614G strain that is the current standard.
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Sinovac's vaccine showing 78% efficacy. "Brazilian officials said Thursday that a coronavirus vaccine made by a Chinese company was effective, bolstering the chances of approval for a second Chinese inoculation that could be rolled out in much of the developing world.
Officials in the state of São Paulo, where a prominent medical research institute carried out a large study of the vaccine made by the Beijing-based Sinovac, said the inoculation had an efficacy rate of 78 percent.
The vaccine prevented all participants from developing serious and mild complications from the virus, officials said, calling it a highly effective preventive tool.
In anticipation of approval, the vaccine, called CoronaVac, has already been shipped around the world as countries prepare for mass inoculation campaigns. Sinovac has sold more than 300 million doses, mostly to low- and middle-income countries, accounting for about half of the total doses that China says vaccine makers were capable of producing in 2020, based on an analysis of company statements and media reports.
China has set its sights on supplying the developing world with a Covid-19 vaccine, in a push to position itself as a leader in health diplomacy after its failures in the early days of the outbreak. It also wants to burnish its credentials in science by becoming a major player in the global vaccine business.
Even without the regulatory greenlight, China has embarked on an aggressive vaccination drive at home, with the goal of inoculating 50 million people by the middle of next month. Beijing has also developed an overseas distribution plan for exports, directing airlines to stock up on refrigerators and dry ice.
China is filling a void in poorer nations left by Western competitors. The United States is mainly focused on working through the chaos of distributing its vaccines at home. The European Union and other rich countries have bought many of the doses supplied by the American drugmakers Pfizer and Moderna.
“The Chinese have been eager to get out in front, aware of the gap and the hoarding and pre-purchase of so many billions of doses by the Western governments that is leaving so many countries high and dry,” said J. Stephen Morrison, director of the global health policy center at the Center for Strategic and International Studies.
“It will become a tool in their diplomatic alliances, and it will give them some measure of prestige and standing with countries that choose to make use of them,” he added."
Source: https://www.nytimes.com/2021/01/07/business/china-coronavirus-vaccine-sinovac.html
Commentary: While there are certainly diplomatic and political implications to China's strategy, the public health benefits can't be ignored. Good for China if they are helping to stamp out reservoirs of COVID-19 in nations that cannot afford the mRNA vaccines or don't have the logistics to administer them. Someone from Brazil is just as contagious as someone from Germany. The virus doesn't care who you are or what flag you fly, and our vaccine efforts shouldn't, either - if we want this thing to go away.
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The new B.1.1.7 strain is showing up in more places. "Harrisburg, PA – Secretary of Health Dr. Rachel Levine today announced the first confirmed case of the COVID-19 variant, SARS-CoV-2 B.1.1.7, in Pennsylvania. The confirmed case is in Dauphin County. This variant is the same one that was first discovered in England in December.
This individual tested positive after known international exposure. A case investigation and contact tracing were performed to identify, inform and monitor anyone who was in close contact with this individual. The individual had mild symptoms, which have since been resolved while they completed their isolation at home.
“Pennsylvania has been preparing for this variant by working closely with the Centers for Disease Control and Prevention (CDC) and has been sending 10-35 random samples biweekly to the CDC since November to study sequencing and detect any potential cases for this new COVID-19 variant,” Dr. Levine said. “Public health experts are in the early stages of working to better understand this new variant, how it spreads and how it affects people who are infected with it."
Source: https://www.media.pa.gov/Pages/Health-Details.aspx?newsid=1235
Commentary: As we see more cases show up with the B.1.1.7 strain, the urgency to vaccinate grows. Harrisburg is the state capital of Pennsylvania and one of the larger cities. The B.1.1.7 strain is more transmissible, which means that America's probably got a much bigger problem than is generally thought.
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An E484K strain reinfects. "To date, uncertainty remains about how long the protective immune responses against SARSCoV-2 persists and the first reports of suspected reinfection began to be described in recovered patients months after the first episode.1 Viral evolution may favor reinfections, and the recently described spike mutations, particularly in the receptor binding domain (RBD) in SARS-CoV2 lineages circulating in the UK, South Africa, and most recently in Brazil, have raised concern on their potential impact in infectivity and immune escape.2,3,4 We report the first case of reinfection from genetically distinct SARS-CoV-2 lineage presenting the E484K spike mutation in Brazil, a variant associated with escape from neutralizing antibodies."
Source: https://www.preprints.org/manuscript/202101.0132/v1
Commentary: The usual caution that this is a pre-print study that has not been peer reviewed yet. That said, previous studies have indicated that E484K can reduce the effectiveness of antibody responses, and this is a first paper documenting reinfection with it.
I am concerned that with yesterday's news about 8-month duration antibodies that we are starting to see selection pressure - mutation - to evade antibodies naturally as COVID-19 starts running into people who have had it. We have a very narrow window of time to get the vaccine out into the population at large before selection pressure and uneven vaccine distribution make it easier for the virus to mutate out of our grasp. Wherever you live, pressure your public officials to do everything within their power to accelerate the vaccination timetables as supply permits. There shouldn't be a single dose sitting in a warehouse unallocated.
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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.