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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To reopen the economy, shut down the virus. "Country-level comparisons soundly support this hypothesis. Countries that controlled the virus effectively have tended to experience far smaller economic shocks than those where the curve has yet to be flattened. Compare Sweden, which has attempted to minimize lockdowns as much as possible, with its Scandinavian neighbors that took a health-first approach. In the second quarter of 2020, Sweden experienced an 8.5% decline in GDP, while Finland and Norway each saw GDP shrink by only about 5%. A difference of about three percentage points may not sound like much, but in the context of a high-income country’s GDP, that difference amounts to tens of billions of dollars.
The same trend holds in the U.S. Despite the Trump administration’s efforts to reopen the economy as quickly as possible, the country experienced a 9.5% drop in GDP in the second quarter of 2020 as COVID cases and deaths continued largely unabated. Compare this to South Korea, which saw a massive, centralized government response to the pandemic, testing about 20,000 people per day, quarantining infected people in dedicated facilities, and mobilizing thousands of healthcare workers for contact tracing. As a result, lockdowns were brief, and the country has seen one of the smallest economic downturns of any country in the world — just a 3% decrease in GDP in the second quarter this year."
Source: https://medium.com/@healthfininst/in-pandemic-response-health-and-wealth-go-hand-in-hand-af534490b5fd
Commentary: A key point is that a substantial number of consumers don't feel safe with "normal" activities even in the absence of government intervention, so trying to force reopening won't have the desired economic outcome until shopppers feel safe. I'm not sure why the connection between safety and spending is so opaque to politicians.
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Even RT-PCR tests have substantial variance. "Over the 4 days of infection before the typical time of symptom onset (day 5), the probability of a false-negative result in an infected person decreases from 100% (95% CI, 100% to 100%) on day 1 to 67% (CI, 27% to 94%) on day 4. On the day of symptom onset, the median false-negative rate was 38% (CI, 18% to 65%). This decreased to 20% (CI, 12% to 30%) on day 8 (3 days after symptom onset) then began to increase again, from 21% (CI, 13% to 31%) on day 9 to 66% (CI, 54% to 77%) on day 21.
Care must be taken in interpreting RT-PCR tests for SARS-CoV-2 infection—particularly early in the course of infection—when using these results as a basis for removing precautions intended to prevent onward transmission. If clinical suspicion is high, infection should not be ruled out on the basis of RT-PCR alone, and the clinical and epidemiologic situation should be carefully considered."
Source: https://www.acpjournals.org/doi/10.7326/M20-1495
Commentary: False negatives are worse than false positives when it comes to disease. You'd rather someone quarantine unnecessarily than someone be actively spreading. The fact that the RT-PCR test has such variance is concerning, and why even if you test negative, you MUST continue wearing a mask, distancing, and practicing other elements of hygiene. There is a sizeable possibility you are not negative.
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Daily vapers 5 times more likely to contract COVID-19. "The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has made differential diagnosis of EVALI even more challenging due to the high rate of SARS-CoV-2 diagnosis in e-cigarette smokers (5 times more likely among daily users8) and large overlap of clinical and radiological features of the two conditions.9 Adding another level of difficulty is the recent emergence of multisystem inflammatory syndrome in children (MIS-C) with COVID-19. Similar to EVALI, MIS-C is clinically characterised by non-specific systemic symptoms and high concentrations of inflammatory markers. At least 18% of children with MIS-C present with shortness of breath and other respiratory symptoms,10 not unlike those of EVALI. Unfortunately, BAL characteristics and lung pathology of MIS-C are not well described and diagnosis relies heavily on a history of recent SARS-CoV-2 infection or exposure, which is common for children and young adults residing in COVID-19 hotspots, and more common still in those who use vape products.8 The overlap of similar clinical features, use of vape products, and probable SARS-CoV-2 exposure make distinguishing the differential diagnosis of EVALI from MIS-C challenging in both children and adults, particularly when MIS-C presents with respiratory symptoms."
Source: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30450-1/fulltext
Commentary: With the understanding that for some, it's a necessary stress relief mechanism in the most stressful times in recent memory, putting anything harmful into your lungs during a respiratory disease pandemic is a bad idea. To the extent you can, wean off any inhalation-based product documented to cause harm to your lungs until the pandemic is over.
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Intubation less dangerous for healthcare workers than coughing. "The potential aerosolised transmission of severe acute respiratory syndrome coronavirus‐2 is of global concern. Airborne precaution personal protective equipment and preventative measures are universally mandated for medical procedures deemed to be aerosol‐generating. The implementation of these measures is having a huge impact on healthcare provision. There is currently a lack of quantitative evidence on the number and size of airborne particles produced during aerosol‐generating procedures to inform risk assessments.
To address this evidence gap, we conducted real‐time, high‐resolution environmental monitoring in ultraclean ventilation operating theatres during tracheal intubation and extubation sequences. Continuous sampling with an optical particle sizer allowed characterisation of aerosol generation within the zone between the patient and anaesthetist. Aerosol monitoring showed a very low background particle count (0.4 particles.l‐1) allowing resolution of transient increases in airborne particles associated with airway management. A positive reference control quantitated the aerosol produced in the same setting by a volitional cough (average concentration, 732 (418) particles.l‐1, n = 38). Tracheal intubation including face‐mask ventilation produced very low quantities of aerosolised particles (average concentration, 1.4 (1.4) particles.l‐1, n = 14, p < 0·0001 vs. cough). Tracheal extubation, particularly when the patient coughed, produced a detectable aerosol (21 (18) l‐1, n = 10) which was 15‐fold greater than intubation (p = 0.0004) but 35‐fold less than a volitional cough (p < 0.0001). The study does not support the designation of elective tracheal intubation as an aerosol‐generating procedure.
Extubation generates more detectable aerosol than intubation but falls below the current criterion for designation as a high risk aerosol‐generating procedure. These novel findings from real‐time aerosol detection in a routine healthcare setting provide a quantitative methodology for risk assessment that can be extended to other airway management techniques and clinical settings. They also indicate the need for reappraisal of what constitutes an aerosol‐generating procedure and the associated precautions for routine anaesthetic airway management."
Source: https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/abs/10.1111/anae.15292
Commentary: Good news for healthcare workers who have to intubate patients.
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How much did the President's care cost? About $100,000 if the average person had to pay for it. "President Trump spent three days in the hospital. He arrived and left by helicopter. And he received multiple coronavirus tests, oxygen, steroids and an experimental antibody treatment.
For someone who isn’t president, that would cost more than $100,000 in the American health system. Patients could face significant surprise bills and medical debt even after health insurance paid its share.
The biggest financial risks would come not from the hospital stay but from the services provided elsewhere, including helicopter transit and repeated coronavirus testing.
Across the country, patients have struggled with both the long-term health and financial effects of contracting coronavirus. Nearly half a million have been hospitalized. Routine tests can result in thousands of dollars in uncovered charges; hospitalized patients have received bills upward of $400,000.
Health economists are only starting to understand the full costs of coronavirus treatment, just as scientists are mapping out how the disease works and spreads. They do have some early estimates: The median charge for a coronavirus hospitalization for a patient over 60 is $61,912, according to a claims database, FAIR Health
For insured patients, that price would typically be negotiated lower by their health plan. FAIR Health estimates that the median amount paid is $31,575. That amount, like most things in American health care, varies significantly from one patient to another.
In the FAIR Health data on coronavirus patients over 60, a quarter face charges less than $26,821 for their hospital stay. Another quarter face charges higher than $193,149, in part because of longer stays.
Many, but not all, health insurers have said they will not apply co-payments or deductibles to patients’ coronavirus hospital stays, which could help shield patients from large bills.
The financial consequences of a coronavirus hospitalization could be long-lasting, if a new Supreme Court challenge to the Affordable Care Act is successful. That case argues that all of Obamacare is unconstitutional, including the health law’s protections for pre-existing conditions. The administration filed a brief in June supporting the challenge.
The Supreme Court hears that case on Nov. 10. If the challenge succeeds, Covid-19 could join a long list of pre-existing conditions that would leave patients facing higher premiums or denials of coverage. In that case, coronavirus survivors could face a future in which their hospital stays increase their health costs for years to come."
Source: https://www.nytimes.com/2020/10/07/upshot/trump-hospital-costs-coronavirus.html
Commentary: A reminder that while approximately 1 in 100 people dies from COVID-19, 1 in 20 need an ICU and as many as 1 in 5 may need some level of hospitalization or care. With costs in the tens of thousands of dollars, that's an extremely risky gamble, even if you fully recover and you have good healthcare coverage. If coverage for pre-existing conditions is eliminated, everyone who contracted COVID-19 and has had some after-effects has a pre-existing condition and could face substantial health costs down the road.
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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. Always 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, 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. Participate in your local political process. For Americans, go to Vote.org and register/verify your vote.
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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.