Lunchtime pandemic reading.
Standard disclaimer: this is a roundup of informative pieces I've read that interest me on the severity of the crises and how to manage them. I am not a qualified medical expert in ANY sense; at best I am reasonably well-read laity. ALWAYS prioritize advice from a qualified healthcare provider who knows your specific medical situation over advice from people on the Internet.
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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Commentary: I'm back after a week in Serbia. One of the more unusual things, as an American, in a city like Belgrade is that not only is the air quality fairly dangerous (my travel health insurance app gave me multiple warnings while I was there that the AQI levels were wildfire-level hazardous), but smoking is permitted inside restaurants and businesses - including hotels.
Vaccines are great. They are amazing. They work. But they are only a piece of our defense against airborne threats. Vaccines do nothing for PM2.5 pollution. Vaccines do nothing for unwanted cigarette smoke. Vaccines do nothing against diseases they aren't calibrated for - my COVID vaccine has no impact on RSV or influenza (though an influenza booster does against regular influenza).
Masks? Masks stop that stuff. And if your mask is comfortable, you'll wear it more. I wore my GVS P100 door to door, including sleeping in it on the plane ride over. Now, I have to change the filters on my masks - they're so clogged from the air pollution and smoke that they're passing noticeably less air through, but they did the job of protecting me against airborne threats.
Vax up. Mask up. Stay safe. And you can still enjoy all life has to offer while taking sensible precautions.
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A massive, vitally important thread on COVID consequences for everyone.
"COVID-19: Real world example of the impact of infection
Everyone should watch and listen to Dr. Rae Duncan's presentation about what she has seen COVID-19 do to the body ( ). This is not a cold or the flu despite how it may initially feel. š§µ1/
I will try to summarize her talk here. Dr. Duncan is a cardiology consultant, has a degree in infectious diseases, and is involved in cardiovascular research. She has been working on Long COVID and the cardiovascular complications of COVID since the beginning of the pandemic. 2/
Dr. Duncan set up one of the first cardiovascular complications clinics and is now doing research trials looking at host response to infection and how to develop therapeutic targets to help treat and reduce suffering from Long COVID. 3/
With permission she provided a real world example of what is commonly being seen in the clinics. One of her patients is a young man in his 30s who was fit and healthy, ex-military, running his own business and engaged to be married and then he was infected with COVID. 4/
He didn't die from COVID but he was impacted. He had a heart attack in his 30s. Since then he has had ongoing symptoms and went from running his own business to being housebound and largely bedbound and had to move back in with his parents. 5/
He now has no home, no fiancƩe, and no business. To make things worse, there is a lack of understanding in the medical community of how to investigate this condition and manage it properly. 6/
One of the big issues is that a lot of the standard imaging and blood tests come back negative (or normal). It is not because the patient is ok or the problem is only in the patient's head, but Long COVID is predominantly a vascular disease, not a respiratory illness. 7/
COVID is predominantly a disease of the microvasculature as well. The virus enters through the respiratory tract but in the blood vessels you are getting a chronically stimulated immune response and maladaptive innate immune response. 8/
There are chronically stimulated T-cell lymphocytes that are releasing a lot of cytokines in response to the viral antigen (spike protein). Immune exhaustion sets in from the chronic stimulation so you are probably at increased risk for further infections. 9/
Cytokines are also inflaming the inner lining of the blood vessels (endothelium) which triggers another response where you get platelet activation (molecules involved in blood clotting) which triggers a coagulation cascade where you end up with a cytokine and blood clot soup. 10/
In Long COVID these clots are very small (micro clots) and are not "normal" clots. In the presence of the spike protein, the clotting protein (fibrin) misfolds which ends up trapping other molecules inside it which makes it difficult for the body to break down. 11/
If you make too many of these clots it is believed they are getting stuck in the capillary vascular beds. If you have enough of these clots it obstructs the flow of oxygen to every single organ in your body which causes the symptoms of Long COVID. 12/
The blood clots themselves are likely triggering an immune response so inflammation at the site of the clots in the capillary which cause a disruption in capillary integrity where you get leakage of the inflammatory molecules into the other organs, causing organ damage. 13/
There is lots of evidence now showing neuroinflammatory damage in the brains and the hearts of individuals with Long COVID. This also leads to heart attacks, strokes and various other issues. 14/
Although the death rates from COVID infection may be going down (but actually higher absolute numbers in 2022 for many locations because of the increased # of infections), the disability rates are going up. There are 148 million people with this condition now. 15/
In the USA, the Census Bureau estimates 16 million working age Americans suffer from it with the economic cost of Long COVID in the trillions 16/
There has been an increase in around 1.7 million disabled persons in the USA since the pandemic began and close to 1 million newly disabled workers. 17/
Dr. Duncan states, "There is very clear evidence from the published literature that reinfection increases your risk of Long COVID substantially. So we have to have some sensible public health mitigations." 18/
Dr. Duncan has seen the inner linings of people's blood vessels and the torn endothelium after 1 or 2 infections and she has no idea of what their blood is going to look like after 10 infections. 19/
Her patient had seen multiple different doctors, he had an undiagnosed syndrome that had been completely missed, and he is very disabled as a result of it. 20/
This is happening all the time now where some of it is treatable but the proper tests aren't being done because most doctors are not aware of what to look for. 21/
An education campaign is needed: there are tests that can be done to properly identify some of these abnormalities. While there are still lots of treatments being tested, there are already some treatments identified that can help reduce the level of disability. 22/
Dr. Claire Taylor (@drclairetaylor) explains more about the right tests such as VQ scans ( ). 23/
Usually when people go into hospital with shortness of breath or chest pain, a D-Dimer test is performed which looks for D-dimer in the blood that is made when a blood clot dissolves in your body ( medlineplus.gov/lab-tests/d-diā¦ ). 24/
If the patient is negative they are not scanned, if they are positive they do a special CT pulmonary angiogram (CTPA) scan to look for problems with perfusion or a blockage of an artery in the lungs ( en.wikipedia.org/wiki/CT_pulmonā¦ ). 25/
If the CTPA is negative they stop there and assume there are no clots. With Long COVID, Dr. Taylor has found that the D-dimer and CTPA tests usually come back "normal" but when you do a VQ scan ( en.wikipedia.org/wiki/Ventilatiā¦ ) you actually find the clots that way. 26/
VQ scans were very popular about 10 years ago but many places have stopped doing them now. Dr. Taylor believes that VQ scans should urgently be made available across the globe to help find these clots in patients who have been infected with COVID-19. 27/
Dr. Taylor previously wrote about a 14 year old girl who was sick for more than a year where a VQ scan finally identified the issue and found her blood clots 28/
There was also a recent article about VQ scans finding lasting lung damage in children and teens after COVID infection, even those with mild cases and seemed to have recovered ( itnonline.com/content/lastinā¦ ). 29/
Dr. Neeja Bakshi in Canada also wrote about her Long COVID program which has been open for 10 months where she has seen over 150 patients (ages 21-87) and already booking into Feb. 2023 30/
Dr. Bakshi has discovered massive barriers to get the help her patient's need from insurance, pages and pages of forms required and fighting to have claims adjusters understand. 31/"
Source:
Commentary: I can't say this enough - keep this thing out of your body. We don't know what the long term consequences are, but we are starting to see evidence that it's much more that a respiratory disease. It's trashing a lot of systems in the body by attacking the circulatory system. And if you've had it, DON'T GET IT AGAIN.
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Immune response decay. "A short update on how waning immunity and immune evasion by convergent mutants BQ.1.1 and XBB stack together. Data suggest that most serum obtained ~7.5 months after BA.1 breakthrough infection would hardly neutralize BQ.1.1 and XBB. (NT50 of 20 is the lower limit of our assay)"
Source:
Commentary: What the chart shows is alarming for the newest crop of variants (BQ.1, BQ.1.1, and XBB): while current vaccines and BA.1 infections offer high antibody titers 1 month after administration or recovery for older variants, the new variants are already somewhat evasive. Stretch out the timeframe to 7.5 months, and the new variants function as if people have had no vaccines or infections - in other words, they're back to square one for immunity.
This is bad for obvious reasons. If you haven't already gotten your bivalent booster and it's been at least 3 months since a COVID infection or your last booster, go and get one as soon as you can.
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Trouble on the horizon. "The rapid growth rate concerns scientists, including leading U.S. infectious disease expert Dr. Anthony Fauci, who recently called the viral familyās doubling time āpretty troublesome.ā
What concerns Rajnarayanan more though, is that hospitalizations in New York are also on the rise. In mid-September they sat at around 2,000 a day. A month later, theyāre nearing 3,000, according to data from the state.
The stateās current hospitalization wave is āpretty close, if not higher than the Delta peak,ā he said, referring to the deadly COVID wave that rocked the U.S. late last year, right before Omicron hit.
Another sign of rising viral activity: Google searches in New York for ācoughā are five to seven times higher than usual, Rajnarayanan said, citing a dashboard he created with data from Google Trends. And searches for ānasal congestion,ā āheadache,ā and āmigraineā are also up, in addition to those for āsore throatā and ādiarrhea.ā
āSomething is going on there,ā he said. "
Source: https://fortune.com/well/2022/10/22/omicron-bq-bq11-wave-rising-new-york-pandemic-covid-fall-winter-wave-belllwhether-xbb-variant-soup-convergence-recombination-viral-evolution/
Commentary: Hospitals are once again filling up (especially pediatric). This is a great time to get your booster and if you haven't been staying masked, get back in the habit. Consider a P100 mask; these are heavier duty, offer far more protection, and are oddly more comfortable for some users (because there's nothing pressing against your nose or mouth). I've been wearing a P100 mask all along, and I MUCH prefer them to N95 masks.
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A tripledemic may be in progress. "For more than two years, shuttered schools and offices, social distancing and masks granted Americans a reprieve from flu and most other respiratory infections. This winter is likely to be different.
With few to no restrictions in place and travel and socializing back in full swing, an expected winter rise in Covid cases appears poised to collide with a resurgent influenza season, causing a ātwindemicā ā or even a ātripledemic,ā with a third pathogen, respiratory syncytial virus, or R.S.V., in the mix.
Cases of flu have begun to tick up earlier than usual, and are expected to soar over the coming weeks. Children infected with R.S.V. (which has similar symptoms to flu and Covid), rhinoviruses and enteroviruses are already straining pediatric hospitals in several states.
āWeāre seeing everything come back with a vengeance,ā said Dr. Alpana Waghmare, an infectious diseases expert at Fred Hutchinson Cancer Center and a physician at Seattle Childrenās Hospital.
Most cases of Covid, flu and R.S.V. are likely to be mild, but together they may sicken millions of Americans and swamp hospitals, public health experts warned.
āYouāve got this waning Covid immunity, coinciding with the impact of the flu coming along here, and R.S.V.,ā said Andrew Read, an evolutionary microbiologist at Penn State University. āWeāre in uncharted territory here.ā
The vaccines for Covid and flu, while they may not prevent infection, still offer the best protection against severe illness and death, experts said. They urged everyone, and especially those at high risk, to get their shots as soon as possible.
Older adults, immunocompromised people and pregnant women are most at risk, and young children are highly susceptible to influenza and R.S.V. Many infected children are becoming severely ill because they have little immunity, either because it has waned or because they were not exposed to these viruses before the pandemic."
Source: https://www.nytimes.com/2022/10/23/health/flu-covid-risk.html
Commentary: What stops colds, flu, RSV, and COVID? Great masks.
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The mashup no one asked for. "Interactions between respiratory viruses during infection affect transmission dynamics and clinical outcomes. To identify and characterize virusāvirus interactions at the cellular level, we coinfected human lung cells with influenza A virus (IAV) and respiratory syncytial virus (RSV). Super-resolution microscopy, live-cell imaging, scanning electron microscopy and cryo-electron tomography revealed extracellular and membrane-associated filamentous structures consistent with hybrid viral particles (HVPs). We found that HVPs harbour surface glycoproteins and ribonucleoproteins of IAV and RSV. HVPs use the RSV fusion glycoprotein to evade anti-IAV neutralizing antibodies and infect and spread among cells lacking IAV receptors. Finally, we show that IAV and RSV coinfection in primary cells of the bronchial epithelium results in viral proteins from both viruses co-localizing at the apical cell surface. Our observations define a previously unknown interaction between respiratory viruses that might affect virus pathogenesis by expanding virus tropism and enabling immune evasion."
Source: https://www.nature.com/articles/s41564-022-01242-5
Commentary: What this study shows is that influenza and RSV can have babies - a new flu that uses RSV's protein structure to evade our immune system and our flu shots. Under normal circumstances, this might not be a huge deal but as the previous article cited, we're having a banner year for both. And as we have seen repeatedly with COVID over the past 2.5 years, the more infections there are, the more chances for mutations that are better for the virus and worse for us.
You know what will stop this? Flu shots and great masks. That way influenza A in its regular form can't get a hold of you, and masks will keep out new variants.
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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 people you don't live with, even after you've been vaccinated. P100 respirators are back in stock at online retailers, too and start around US$40 for a reusable respirator. 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. Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
3. Get vaccinated as soon as you're eligible to, and fulfill the full vaccine regimen, including boosters. Remember that you are not vaccinated until everyone you live with is vaccinated. For COVID, if you received an adenovirus vaccine (J&J/AstraZeneca), consider getting an mRNA single shot booster (Pfizer/Moderna) if available. If it's available, choose Moderna as your first choice for both vaccine and booster, Pfizer as your second choice. However, remember that any vaccine is better than no vaccine.
4. Wash/sanitize your hands every time you are in or out of your home. Sanitize the bottom of your shoes with a simple peroxide spray using ordinary drugstore/supermarket peroxide in a spray bottle. If you've come in close contact with others (rubbing or brushing up against them, hugging, etc.) consider showering and washing your clothes as well.
5. Stay out of indoor spaces that aren't your home and away from people you don't live with as much as practical. Minimize your contact with others and avoid indoor places as much as you can; indoor spaces spread disease through aerosols and distance is less effective at mitigating your risks.
6. Aim to have 3-6 months of living expenses on hand in case the pandemics give another crazy plot twist to the economy, or you know, a global war breaks out.
7. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
8. 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).
9. Masks must fit properly to work. Here's how to properly fit a mask:
10. If you think you may have been exposed to COVID-19, purchase several rapid antigen tests and/or acquire them from your healthcare provider or government. This will detect COVID-19 only when you're contagious, so follow the directions clearly. https://amzn.to/3fLAoor
If you think you may have been exposed to monkeypox, contact your healthcare provider about available testing.
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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 or monkeypox. 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 or monkeypox, nor do I financially benefit in any way from sharing information about COVID-19 or monkeypox.
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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.