Lunchtime Pandemic Reading, 7-July-2021
Vax that thang
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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A sex-specific metabolic pathway may explain why males are hit harder by COVID-19. "Coronavirus disease 2019 (COVID-19) has poorer clinical outcomes in males than in females, and immune responses underlie these sex-related differences. Because immune responses are, in part, regulated by metabolites, we examined the serum metabolomes of COVID-19 patients. In male patients, kynurenic acid (KA) and a high KA–to–kynurenine (K) ratio (KA:K) positively correlated with age and with inflammatory cytokines and chemokines and negatively correlated with T cell responses. Males that clinically deteriorated had a higher KA:K than those that stabilized. KA inhibits glutamate release, and glutamate abundance was lower in patients that clinically deteriorated and correlated with immune responses. Analysis of data from the Genotype-Tissue Expression (GTEx) project revealed that the expression of the gene encoding the enzyme that produces KA, kynurenine aminotransferase, correlated with cytokine abundance and activation of immune responses in older males. This study reveals that KA has a sex-specific link to immune responses and clinical outcomes in COVID-19, suggesting a positive feedback between metabolites and immune responses in males."
Source: https://stke.sciencemag.org/content/14/690/eabf8483
Commentary: Once we know sex-specific differences, we can start to build treatments that target those differences and may have therapeutic outcomes that are improvements. Despite the terrible nature of the disease, the discoveries we're making as part of our fight against COVID-19 may yield substantial benefits down the road.
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AR and MO. "The US epicenter for Delta is Arkansas and Missouri. They both have very low vaccination rates, test positivity >15%, rapid case growth, increases in hospitalizations & deaths. It's still early. We should do everything possible to help these states achieve rapid covid containment."
Source:
Commentary: Low vaccination, rapid case growth, and a variant that is 2-4x more contagious than the original wildtype - a recipe for disaster for the unvaccinated. We still do not have a good answer about the Delta variant specifically and whether vaccinated individuals can transmit it effectively; we know and have good clinical data that vaccinated individuals substantially transmit less for the original wildtype and earlier variants, up to 93% less. We don't have data yet for Delta, but it's becoming quite apparent that Delta spreads like wildfire.
At this point, the vaccine has to go to people, rather than people going to get vaccinated. Door to door service in at-risk neighborhoods is the way to go, particularly in population-dense areas.
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Pfizer stops spread of Alpha and Beta. "Prioritizing vaccine rollout, and achievement of herd immunity depend on reduced SARS-CoV-2 viral circulation. The vaccine's effect on infectivity is thus a critical priority. Here, we assess the vaccine effectiveness in reducing infectiousness via two routes: through preventing infection, and through reducing viral shedding, in those who become infected despite vaccination. This is the first study, to the best of our knowledge to estimate the prevalence of infection among exposed individuals, providing an estimate of the vaccine impact on susceptibility to infection, independent of its impact on symptoms. This effect, along with reduced shedding, is a key determinant of the vaccine's ability to reduce transmission. We show that BNT162b2 was 65% effective in preventing infections following exposures, and 83% effective in preventing never-symptomatic, infectious (N-gene Ct value<30) infections, and that viral load, was significantly lower in vaccinated vs. unvaccinated infected HCW."
Source: https://www.sciencedirect.com/science/article/pii/S2666776221001277
Commentary: I had to go look at NextStrain to see what variants were active in Israel during the study period:
https://nextstrain.org/ncov/global?dmax=2021-03-24&dmin=2020-12-19&f_country=Israel
Alpha was the dominant strain by far, followed by Beta. Thus, the results shown indicate that the Pfizer vaccine is 65% effective at stopping any spread of COVID-19, and 83% effective at stopping symptomatic spread. That's excellentnews, good numbers, and yet another reason for people to go get vaccinated.
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New Zealand declares the UK's policy unacceptable. "New Zealand has dismissed suggestions it should follow in Britain’s footsteps to “live with” Covid-19, saying the level of death proposed by Boris Johnson would be “unacceptable”.
If cases in Britain explode as a result of the lifted regulations, New Zealand may also consider putting the country on a no-fly list.
On Monday, Johnson announced plans to scrap regulations including on face masks and social distancing by 19 July, saying that Britain must “learn to live with” the virus. He said Covid cases would likely reach 50,000 a day within a fortnight, and “we must reconcile ourselves, sadly, to more deaths from Covid”.
“That’s not something that we have been willing to accept in New Zealand,” the country’s Covid-19 response minister, Chris Hipkins, said at a press conference alongside the prime minister, Jacinda Ardern, on Tuesday.
Ardern, asked whether the country would accept deaths from Covid, said: “Different countries are taking different choices.
“The priority for me is how do we continue to preserve what New Zealand has managed to gain and give ourselves options, because this virus is not done with the world yet.”
Director-general of health, Ashley Bloomfield, said on Wednesday that New Zealand would be “watching closely” and could place the UK on a no-fly list if cases grew out of control."
Source: https://www.theguardian.com/world/2021/jul/07/new-zealand-not-willing-to-risk-uk-style-live-with-covid-policy-says-jacinda-ardern
Commentary: The UK's position of simply giving up on containing COVID-19 is madness with the vaccination rate of only 50.8% of the population. That's like saying you've just given up on half of your country's population. The NZ approach I think is clearly the correct one - the pandemic is not over, and we still have an obligation to protect the unvaccinated, the majority of which are now children under 12.
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Vax that thang. (click the source link to watch the music video)
Source:
Commentary: I love the analogy of throwing mattresses - that is, everyone has a door into their mind. Each door is a different shape and orientation. If you fling a mattress at the door only one way, only a small percentage of the time will it get through the door. If you change how you do it and offer many different ways, you get the mattress through the door much more often. The same is true with communications. Everyone learns and takes in information differently. If a really fun rap song persuades people to get vaccinated, great. Let's share the heck out of it, because every vaccination is potentially a life saved and a life improved by preventing long COVID. Vax that thang.
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A reminder of the simple daily habits we should all be taking.
1. Wear the best mask available to you when you'll be around other people, even after you've been vaccinated. Respirators are back in stock at online retailers, too. Wear an N95/FFP2/KN95 that's NIOSH-approved or better mask if you can obtain it. If you can't get an N95 mask, wear a surgical mask with a cloth mask over it.
2. Get vaccinated as soon as you're able to, and fulfill the full vaccine regimen. Remember that you are not vaccinated until everyone you live with is vaccinated. If you received an adenovirus vaccine (J&J/AstraZeneca), consider gettings an mRNA single shot booster (Pfizer/Moderna).
3. Wash/sanitize your hands every time you are in or out of your home.
4. Stay home as much as practical. Minimize your contact with others and avoid indoor places as much as you can; indoor spaces spread the disease through aerosols and distance is less effective at mitigating your risks.
5. Get your personal finances in order now. Cut all unnecessary costs.
6. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
7. 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).
8. Masks must fit properly to work. Here's how to properly fit a mask:
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Common misinformation debunked!
There is no basis in fact that COVID-19 vaccines can shed or otherwise harm people around you.
Source: https://www.reuters.com/article/factcheck-covid19vaccine-reproductivepro-idUSL1N2MG256
There is no mercury or other heavy metals in the Pfizer mRNA vaccine.
Source: https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
There is no basis in fact that COVID-19 vaccines pose additional risks to pregnant women.
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2104983
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/
Source: https://www.smh.com.au/national/are-we-ignoring-the-hard-truths-about-the-most-likely-cause-of-covid-19-20210601-p57x4r.html
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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Disclosures and Disclaimers
I declare no competing interests on anything I share related to COVID-19. I am employed by and am a co-owner in TrustInsights.ai, an analytics and management consulting firm. I have no clients and no business interests in anything related to COVID-19, nor do I financially benefit in any way from sharing information about COVID-19.
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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.