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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Distancing works. From the Lancet: "Our analysis revealed that mobility patterns are strongly correlated with decreased COVID-19 case growth rates for the most affected counties in the USA, with Pearson correlation coefficients above 0·7 for 20 of the 25 counties evaluated. Additionally, the effect of changes in mobility patterns, which dropped by 35–63% relative to the normal conditions, on COVID-19 transmission are not likely to be perceptible for 9–12 days, and potentially up to 3 weeks, which is consistent with the incubation time of severe acute respiratory syndrome coronavirus 2 plus additional time for reporting. We also show evidence that behavioural changes were already underway in many US counties days to weeks before state-level or local-level stay-at-home policies were implemented, implying that individuals anticipated public health directives where social distancing was adopted, despite a mixed political message.
This study strongly supports a role of social distancing as an effective way to mitigate COVID-19 transmission in the USA. Until a COVID-19 vaccine is widely available, social distancing will remain one of the primary measures to combat disease spread, and these findings should serve to support more timely policy making around social distancing in the USA in the future."
Source: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30553-3/fulltext
Commentary: With the additional evidence from yesterday's newsletter that indoors, 6 feet may not be enough, getting people to stay home as much as possible is one of the best tools we have available for shutting down the pandemic. Even without large numbers of infected people, a strategy of isolating and containing it in communities that aren't rife with the virus works.
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COVID-19 is showing neurological impacts on a subset of patients. "Careful clinical, diagnostic, and epidemiological studies are needed to help define the manifestations and burden of neurological disease caused by SARS-CoV-2. Precise case definitions must be used to distinguish non-specific complications of severe disease (eg, hypoxic encephalopathy and critical care neuropathy) from those caused directly or indirectly by the virus, including infectious, para-infectious, and post-infectious encephalitis, hypercoagulable states leading to stroke, and acute neuropathies such as Guillain-Barré syndrome. Recognition of neurological disease associated with SARS-CoV-2 in patients whose respiratory infection is mild or asymptomatic might prove challenging, especially if the primary COVID-19 illness occurred weeks earlier. The proportion of infections leading to neurological disease will probably remain small. However, these patients might be left with severe neurological sequelae. With so many people infected, the overall number of neurological patients, and their associated health burden and social and economic costs might be large. Health-care planners and policy makers must prepare for this eventuality, while the many ongoing studies investigating neurological associations increase our knowledge base."
Source: https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30221-0/fulltext
Commentary: We still learn new things about the virus every day. There's still so much unknown, but it's good to see we're getting clinical studies of how it affects neurology. This virus isn't a flu by a long shot.
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Spanish seroprevalence has thus far come out to about 5%. "This is the first nationwide population-based study that presents seroprevalence estimates of antibodies against SARS-CoV-2 at national and regional levels, exploring the landscape of population immunity in Spain. With more than 61 000 participants, this study provides accurate prevalence figures according to sex, age—from babies to nonagenarians—and selected risk factors. Our findings confirm that at least a third of individuals who have developed antibodies against SARS-CoV-2 were asymptomatic. Additionally, our results indicate that children and adolescents have lower seroprevalence than adults and seroprevalence does not vary by sex. Our study confirms that a high-quality point-of-care test could be a good choice for large seroepidemiological studies. The rapid test used here showed good performance compared with a chemiluminescent microparticle immunoassay. Finally, the use of two different assays allowed us to define seroprevalence ranges alternatively favouring specificity (requiring a positive result for both tests) or sensitivity (positive to either test).
The relatively low seroprevalence observed in the context of an intense epidemic in Spain might serve as a reference to other countries. At present, herd immunity is difficult to achieve without accepting the collateral damage of many deaths in the susceptible population and overburdening of health systems. Our results, together with previous evidence, suggest that approximately a third of people with SARS-CoV-2 infection remain asymptomatic, which has important public health implications. Regional seroprevalence data offer valuable information to tailor public health policies against this epidemic."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31483-5/fulltext
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Commentary: Seroprevalence means how many people have been infected and have antibodies. In the hardest hit regions of Spain, that's around 14.4% of people. That's a FAR cry from the levels needed for true herd immunity. How we'll get there is a vaccine, plain and simple - and non-pharmaceutical interventions until then. There's no "herd immunity" naturally yet.
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COVID-19's impact on HIV treatment. "One problem: 73 countries are at risk of stock-outs of antiretrovirals to treat HIV infection. "To mitigate the impact of the #covid19 pandemic on HIV treatment access, WHO recommends all countries prescribe ARVs for longer periods of time”, says @DrTedros ."
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Commentary: Every form of medical treatment has suffered with COVID-19 taking the spotlight and resources. We'll have to find a balance somehow.
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Testing shortages again. "Lines for coronavirus tests have stretched around city blocks and tests ran out altogether in at least one site on Monday, new evidence that the country is still struggling to create a sufficient testing system months into its battle with Covid-19.
In the early months of the nation’s outbreak, testing posed a significant problem, as supplies fell far short and officials raced to understand how to best handle the virus. Since then, the United States has vastly ramped up its testing capability, conducting nearly 15 million tests in June, about three times as many as it had in April. But in recent weeks, as cases have surged in many states, the demand for testing has soared, surpassing capacity and creating a new testing crisis.
In many cities, officials said a combination of factors was now fueling the problem: a shortage of certain supplies, backlogs at laboratories that process the tests, and skyrocketing growth of the virus as cases climb in almost 40 states and the nation approaches a grim new milestone of three million total cases."
Source: https://www.nytimes.com/2020/07/06/us/coronavirus-test-shortage.html
Commentary: Other parts of the United States have had months to prepare, and have not. Just as the US as a whole squandered the lead time we had from China's early warnings, so too have individual states squandered their leads. I hope every major metro that hasn't been hard hit is preparing, because the storm is coming for you. It's just a matter of time.
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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 gloves and a mask when out of your home. Consider wearing a face shield if you can't breathe at all through a mask. 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.
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:
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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.