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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How long will we be at war against SARS-CoV-2? Give this some thought:
- The 1918 pandemic lasted until the end of 1920, about 3 years
- World War 1 lasted from 1914-1918, about 4 years
- World War 2 lasted from 1939-1945, about 5 years
Worldwide efforts to win against a major foe last years. There will be ebbs and flows in the battle, but no one should be fooled into thinking this will last a month, or even a year. To win, we have to get to a mass-produced, mass-available vaccine, and that's likely to be a couple of years at least - 12-18 months to find a working vaccine, and then potentially months to mass produce it affordably. Until then, we'll need to keep some kind of social distancing to keep our healthcare systems functioning.
That said, we may slowly be turning a corner. Many of the world's nations are showing that social distancing and other mitigation methods are slowly turning the tide of battle in our favor, for now.
Here's the catch: we have to keep doing it. Like a boxer in the ring, the moment we let our guard down, we get punched in the face again.
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A new paper from the CDC computes a substantially higher R0 (infectiousness) number than previous studies. "Severe acute respiratory syndrome coronavirus 2 is the causative agent of the 2019 novel coronavirus disease pandemic. Initial estimates of the early dynamics of the outbreak in Wuhan, China, suggested a doubling time of the number of infected persons of 6–7 days and a basic reproductive number (R0) of 2.2–2.7. We collected extensive individual case reports across China and estimated key epidemiologic parameters, including the incubation period. We then designed 2 mathematical modeling approaches to infer the outbreak dynamics in Wuhan by using high-resolution domestic travel and infection data. Results show that the doubling time early in the epidemic in Wuhan was 2.3–3.3 days. Assuming a serial interval of 6–9 days, we calculated a median R0 value of 5.7 (95% CI 3.8–8.9). We further show that active surveillance, contact tracing, quarantine, and early strong social distancing efforts are needed to stop transmission of the virus."
Source: https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article
An R0 that high seems like it should be an error; time will tell if additional studies and newer data disprove it. For now, that means the guidance for "masks on, all the time outside the home" is quite correct. If SARS-CoV-2 is really that infectious, you should never be without protection outside your home. Masks on, stay 10-12 feet away from others.
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SCMP raises a flag about COVID-19 antibodies: "Researchers in Shanghai hope to determine whether some recovered coronavirus patients have a higher risk of reinfection after finding surprisingly low levels of Covid-19 antibodies in a number of people discharged from hospital. “Whether these patients were at high risk of rebound or reinfection should be explored in further studies,” the team wrote in preliminary research released on Monday on Medrxiv.org, an online platform for preprint papers. Although the study was preliminary and not peer-reviewed, it was the world’s first systematic examination of antibody levels in patients who had recovered from Covid-19, the disease caused by the coronavirus, the researchers said. The team also found that antibody levels rose with age, with people in the 60-85 age group displaying more than three times the amount of antibodies as people in the 15-39 age group. The low amounts of antibodies could affect herd immunity, resistance to the disease among the general population to stop its spread."
Source: https://www.scmp.com/news/china/science/article/3078840/coronavirus-low-antibody-levels-raise-questions-about
Source: https://www.medrxiv.org/content/10.1101/2020.03.30.20047365v1
The implications of this finding are concerning, once the paper has been peer-reviewed and vetted. If SARS-CoV-2 doesn't stimulate a strong immune response, it may mean vaccines will have a tougher time creating immunity, and also means we may be potentially open to reinfection sooner. Hopefully scientists will be able to review the paper and conduct additional research.
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Black Americans are suffering higher death rates than the rest of the population. "African Americans’ higher rates of diabetes, heart disease and lung disease are well-documented, and Louisiana Gov. John Bel Edwards (D) noted those that health problems make people more vulnerable to the new respiratory disease. But there never has been a pandemic that brought the disparities so vividly into focus.
“I’ve shared myself personally that I have high blood pressure,” said Surgeon General Jerome Adams, who is 45, “that I have heart disease and spent a week in the [intensive care unit] due to a heart condition, that I actually have asthma and I’m prediabetic, and so I represent that legacy of growing up poor and black in America.”"
Source: https://www.washingtonpost.com/nation/2020/04/07/coronavirus-is-infecting-killing-black-americans-an-alarmingly-high-rate-post-analysis-shows/
This pandemic is revealing so much about our societies and amplifying what's already there. Good people become greater, bad people become worse, and injustices become even more sharply visible. Let's hope that one of the consequences from this pandemic, after all is said and done, is that we repair the injustices within our societies.
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Once upon a time, the United States spent 2% of its GDP on publicly funded research. Scientific American argues it's time to go back to that era. "At the height of the space race, America spent almost 2 percent of its GDP on federally funded research and development (R&D). In recent years, that number was orders of magnitude lower, standing at an anemic 0.6 percent of GDP today and the result is unknowable missed opportunities. In the wake of COVID-19, it is imperative that American invest in discovery and basic scientific research—with an eye not just to preparing for future pandemics, but also to solving the most pressing issues of our time, including the climate crisis, extreme weather and antimicrobial resistance, among others."
Source: https://blogs.scientificamerican.com/observations/the-pandemic-shows-why-the-us-must-invest-in-public-research/
Science, properly funded and done, benefits everyone. The reason governmentally-funded science is so important is that the most impactful projects take a very long time, and are often not profitable in any way, which means corporations will not pursue that knowledge. For example, developing prototype vaccine platforms against threats that aren't commercially viable - like coronaviruses - isn't a profitable endeavor... until an emergency strikes us. If we invest in research now, we can be ready for all manner of threats later. Contact your elected representatives in the nation you live in and urge them to continue and increase funding in scientific research.
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One unanticipated side effect of school closures: a reduction in healthcare worker availability due to child care needs, according to The Lancet. "Between January, 2018, and January, 2020, the US Current Population Survey included information on more than 3·1 million individuals across 1·3 million households. We found that the US health-care sector has some of the highest child-care obligations in the USA, with 28·8% (95% CI 28·5–29·1) of the health-care workforce needing to provide care for children aged 3–12 years. Assuming non-working adults or a sibling aged 13 years or older can provide child care, 15·0% (14·8–15·2) of the health-care workforce would still be in need of child care during a school closure. We observed substantial variation within the health-care system. We estimated that, combined with reasonable parameters for COVID-19 such as a 15·0% case reduction from school closings and 2·0% baseline mortality rate, a 15·0% decrease in the health-care labour force would need to decrease the survival probability per percent health-care worker lost by 17·6% for a school closure to increase cumulative mortality. Our model estimates that if the infection mortality rate of COVID-19 increases from 2·00% to 2·35% when the health-care workforce declines by 15·0%, school closures could lead to a greater number of deaths than they prevent. School closures come with many trade-offs, and can create unintended child-care obligations. Our results suggest that the potential contagion prevention from school closures needs to be carefully weighted with the potential loss of health-care workers from the standpoint of reducing cumulative mortality due to COVID-19, in the absence of mitigating measures."
Source: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30082-7/fulltext
In terms of things to open back up first, schools are probably high on the priority list. Optional gatherings like sports events, business conferences, etc. are low on the list, but if we can get kids back in school safely, we may see greater net benefits to both COVID-19 outcomes and the economy.
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An interesting irony: some patients with anxiety and depression are doing better during the pandemic. "Ironically enough, another factor that might be helping some people with depression and anxiety cope during this crisis is a habit that, in normal life, we try to avoid. Many people who experience depression and anxiety find themselves separating from their immediate situations, either intentionally or unintentionally—a mental process called dissociation. A person might, for instance, focus intensely at work before coming home to disappear into a TV show or endlessly scroll through Instagram. “That’s not great when we’re in our lives because that means you’re missing a lot of your life,” Cohen said. “However. Right now... if you’re a master dissociater, you’re going to be in a better place... You have, basically, a toolbox of how not to have to deal with all the scary feelings.”"
Source: https://www.thedailybeast.com/coronavirus-is-making-a-lot-of-people-anxious-and-depressed-but-some-sufferers-actually-feel-better-now
Ask your friends who are master introverts for tips on coping skills as the pandemic battle rages on.
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A reminder of the simple daily habits we should all be taking.
1. Wash/sanitize your hands often, and 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.
2. Wear gloves and appropriate protective equipment if you have it when out of your home in any enclosed airspace (stores, etc.).
3. Stay home. Just stay home.
4. Get your personal finances in order now. Cut all unnecessary costs.
5. Donate any PPE you can. https://getusppe.org/give/