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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Detailed assessment about multi-organ impact of COVID-19. "COVID-19 (coronavirus disease 2019) caused SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection is a disease affecting several organ systems. A model that captures all clinical symptoms of COVID-19 as well as long-haulers disease is needed. We investigated the host responses associated with infection in several major organ systems including the respiratory tract, the heart, and the kidneys after SARS-CoV-2 infection in Syrian hamsters. We found significant increases in inflammatory cytokines (IL-6, IL-1beta, and TNF) and type II interferons whereas type I interferons were inhibited. Examination of extrapulmonary tissue indicated inflammation in the kidney, liver, and heart which also lacked type I interferon upregulation. Histologically, the heart had evidence of mycarditis and microthrombi while the kidney had tubular inflammation. These results give insight into the multiorgan disease experienced by people with COVID-19 and possibly the prolonged disease in people with post-acute sequelae of SARS-CoV-2 (PASC)."
Source: https://www.biorxiv.org/content/10.1101/2021.04.07.438843v1
Commentary: These lab results are important not only to better understand what the impact of COVID-19 is, but to understand the role these organs may have on long-haul COVID as well - and potentially a way to mitigate it in advance.
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3,600 healthcare workers died in the first 12 months of COVID-19. "More than 3,600 U.S. health care workers perished in the first year of the pandemic, according to “Lost on the Frontline,” a 12-month investigation by The Guardian and KHN to track such deaths.
Lost on the Frontline is the most complete accounting of U.S. health care worker deaths. The federal government has not comprehensively tracked this data. But calls are mounting for the Biden administration to undertake a count as the KHN/Guardian project comes to a close today.
The project, which tracked who died and why, provides a window into the workings — and failings — of the U.S. health system during the covid-19 pandemic. One key finding: Two-thirds of deceased health care workers for whom the project has data identified as people of color, revealing the deep inequities tied to race, ethnicity and economic status in America’s health care workforce. Lower-paid workers who handled everyday patient care, including nurses, support staff and nursing home employees, were far more likely to die in the pandemic than physicians were.
The yearlong series of investigative reports found that many of these deaths could have been prevented. Widespread shortages of masks and other personal protective gear, a lack of covid testing, weak contact tracing, inconsistent mask guidance by politicians, missteps by employers and lax enforcement of workplace safety rules by government regulators all contributed to the increased risk faced by health care workers. Studies show that health care workers were more than three times as likely to contract covid as the general public."
Source: https://khn.org/news/article/us-health-workers-deaths-covid-lost-on-the-frontline/
Commentary: Healthcare workers are the front line soldiers in the pandemic, and in the US, they were woefully underequipped. Can you imagine sending soldiers into a fight without guns or ammunition? That's what happened - and the lesson going forward was that we must never do that again if we want to stop future pandemics.
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Should Michigan receive additional doses? "Amid Michigan’s worst-in-the-nation coronavirus surge, scientists and public health officials are urging the Biden administration to flood the state with additional vaccine doses.
So far, though, their plea has fallen on deaf ears. Instead, the federal government is sticking to a vaccine-allocation strategy that largely awards doses to states and territories based on their population. As a result, most jurisdictions are still receiving similar per-capita vaccine supplies, regardless of how many people there are getting sick — or how many excess vaccine doses they have.
Experts have cast a surge in Michigan’s vaccine supply as a critical tool in combating the state’s most recent Covid-19 crisis. The state is currently recording nearly 7,000 new cases per day, just shy of its all-time peak in December. Hospitalizations and deaths, which tend to lag a few weeks behind increasing case counts, are also on the rise.
“I would be surging a lot of vaccines to Michigan right now,” said Ashish Jha, the dean of the Brown University School of Public Health. “To me, this is a no-brainer policy, and I would be curious to hear why the Biden team hasn’t done this.”
During a media briefing on Wednesday, White House officials acknowledged that Michigan’s situation is dire. They gave no indication, though, that they would send additional vaccines there to help quell the surge, when STAT asked. They argued that it is too early in the national vaccine campaign to begin targeting supply based on case rates.
Rochelle Walensky, the director of the Centers for Disease Control and Prevention, said the agency was working to expand testing capacity in the state, address outbreaks in Michigan’s jails and prisons, and scale up genomic sequencing. The one strategy she did not bring up was scaling up vaccine supply.
“By and large, we are still allocating vaccines based upon population,” Andy Slavitt, one of President Biden’s top pandemic-response advisers, said during the briefing. “Clearly we will get to a place where more targeted strategies will work, but right now I would commit to you that we’re doing both.”
The administration’s fixed position is at odds with public health experts like former Food and Drug Administration commissioner Scott Gottlieb; the physician-researcher Eric Topol; and the Flint, Mich.-based public health advocate Mona Hanna-Attisha.
Some have attempted to quantify what’s at stake more precisely: One modeler, University of California, Berkeley, research programmer Joshua Schwab, projected recently that doubling Michigan’s vaccine allocation for two weeks could help prevent 10,000 hospitalizations and 1,200 deaths."
Source: https://www.statnews.com/2021/04/08/michigan-covid-surge-biden-officials-no-additional-vaccine-doses/
Commentary: There are at least two, if not more, sides to this issue. Surging vaccines to Michigan would be reasonable assuming the population is willing to take them and the infrastructure can handle it. It would indeed save lives in that case.
The flip side is that B.1.1.7 isn't limited to just Michigan, nor is the United States limiting interstate travel. Keeping vaccine allocations commensurate with population in effect preserves 'fire breaks' that can hopefully keep B.1.1.7 tamped down nationally.
The key question I would ask is what other interventions are being used to complement the vaccine. Is the state - ANY state, not just Michigan - rolling back openings and engaging in more strict adherence to masks, closing schools & restaurants and other known vectors of spread? If so, then the vaccine surge would make a great deal of sense. If, on the other hand, the state is unwilling to use all the tools at its disposal to shut down the surge, I think the case is made that vaccine allocations should remain where they are to ensure fairness across all states.
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Our vaccines are Serena Williams. "For a while, Dr. Jeremy Faust struggled to put into words why he was not worried about COVID-19 variants rendering vaccines obsolete.
Faust, an emergency-medicine physician and instructor at Harvard Medical School, was loath to use data to explain his reasoning to nonscientists. Instead, he had a hunch that sports analogies might help people understand him a little better.
Recently, he came up with one comparison that seemed to resonate: Think of our COVID-19 vaccines as world-class athletes.
Even if Serena Williams or Tom Brady is not performing at their absolute best, even if they face a change in the game, and even if they face a strong opponent, they are still extraordinarily hard to beat.
Pfizer's, Moderna's, and Johnson & Johnson's COVID-19 shots, which were all 100% effective at preventing hospitalizations and deaths in clinical trials of tens of thousands of people around the world, are kind of like the Williams or the Brady of vaccines.
Yes, viral variants are on the rise — some of which can evade virus-neutralizing antibodies. But make no mistake: These vaccines, like elite athletes, can still perform very well against them.
"If Serena Williams all of a sudden was 10% less effective than usual, or 50% less effective than usual, she would still kick everyone's ass," Faust, who is also the editor of Brief19, a daily review of COVID-19 research, recently told Insider on Clubhouse.
"So far, the variants have not rendered any of the vaccines useless," Faust said, adding that like Williams or Brady, "they're still quite impressive," even when slightly less effective. "
Source: https://www.businessinsider.com/why-covid-19-vaccines-work-variants-sports-analogy-2021-4
Commentary: This is a great analogy for the moment. That said, we have to get as much vaccine into the human race as possible, as quickly as possible, so that the virus doesn't have a chance to adapt and level up against our star players. In the meantime, we can each do our part by continuing to mask up and stay out of indoor spaces that aren't our homes and away from large gatherings.
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A reminder of the simple daily habits we should all be taking.
1. Always wear the best mask available to you when out of your home and you'll be around other people. 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.
3. Wash/sanitize your hands every time you are in or out of your home for any reason.
4. 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.
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 mercury or other heavy metals in the Pfizer mRNA vaccine. https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
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.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.