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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Oxford/AstraZeneca data coming out on their vaccine. Solid efficacy across many groups. "Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs 71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation.
ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials."
Source: https://marlin-prod.literatumonline.com/pb-assets/Lancet/pdfs/S0140673620326611.pdf
Commentary: The Oxford vaccine is the most promising candidate thus far because of its lower logistical requirements and cost. Seeing data that shows its effectiveness across many different groups of people is heartening.
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Pfizer's vaccine also showing more good data. "The coronavirus vaccine made by Pfizer and BioNTech provides strong protection against Covid-19 within about 10 days of the first dose, according to documents published on Tuesday by the Food and Drug Administration before a meeting of its vaccine advisory group.
The finding is one of several significant new results featured in the briefing materials, which include more than 100 pages of data analyses from the agency and from Pfizer. Last month, Pfizer and BioNTech announced that their two-dose vaccine had an efficacy rate of 95 percent after two doses administered three weeks apart. The new analyses show that the protection starts kicking in far earlier.
What’s more, the vaccine worked well regardless of a volunteer’s race, weight or age. While the trial did not find any serious adverse events caused by the vaccine, many participants did experience aches, fevers and other side effects.
“This is what an A+ report card looks like for a vaccine,” said Akiko Iwasaki, an immunologist at Yale University.
New coronavirus cases quickly tapered off in the vaccinated group of volunteers about 10 days after the first dose, according to one graph in the briefing materials. In the placebo group, cases kept steadily increasing."
Source: https://www.nytimes.com/2020/12/08/health/covid-vaccine-pfizer.html
Commentary: More good news on the vaccine front. One of the great dangers now is the belief that the existence of the vaccine confers benefit. It does not. Vaccines are only as good as the population that takes them. Until then, the disease remains a serious risk. Don't let your guard down.
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Face shields ineffective against sneezing. "A flow analysis around a face shield was performed to examine the risk of virus infection when a medical worker wearing a face shield is exposed to a patient’s sneeze from the front. We ensured a space between the shield surface and the face of the human model to imitate the most popularly used face shields. In the present simulation, a large eddy simulation was conducted to simulate the vortex structure generated by the sneezing flow near the face shield. It was confirmed that the airflow in the space between the face shield and the face was observed to vary with human respiration. The high-velocity flow created by sneezing or coughing generates vortex ring structures, which gradually become unstable and deform in three dimensions. Vortex rings reach the top and bottom edges of the shield and form a high-velocity entrainment flow. It is suggested that vortex rings capture small-sized particles, i.e., sneezing droplets and aerosols, and transport them to the top and bottom edges of the face shield because vortex rings have the ability to transport microparticles. It was also confirmed that some particles (in this simulation, 4.4% of the released droplets) entered the inside of the face shield and reached the vicinity of the nose. This indicates that a medical worker wearing a face shield may inhale the transported droplets or aerosol if the time when the vortex rings reach the face shield is synchronized with the inhalation period of breathing."
Source: https://aip.scitation.org/doi/10.1063/5.0031150
Commentary: This is no surprise; a face shield would not stop you from inhaling a smoker's smoke. Keep them around if you bought some - they do come in handy for stuff like yardwork, but don't expect any benefit to them for COVID-19. A mask is the only way to go.
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"The COVID-19 pandemic, in the words of Tedros Adhanom Ghebreyesus, the director general of the World Health Organization (WHO), “is a once-in-a-century health crisis.” Indeed, the last public health emergency to wreak such havoc was the great influenza pandemic that began in 1918, which sickened about a third of the world’s population and killed at least 50 million people. But because global conditions are becoming increasingly hospitable to viral spread, the current pandemic is unlikely to be the last one the world faces this century. It may not even be the worst.
The novel coronavirus hit a world that was singularly unprepared for it. Lacking the capacity to stop the spread of the virus through targeted measures—namely, testing and tracing—countries were left with few options but to shut down their economies and order people to stay at home. Those policies worked well enough to slow the growth of cases by late spring. But over the summer and into the fall, governments faced pressure to relax those restrictions, and cases rose. On November 4, more than 685,000 new cases worldwide were reported in a single day—then an all-time high. By that point, more than 48 million people had been infected with COVID-19, and more than 1.2 million had died.
The economic and societal effects of the pandemic will linger for decades. Worldwide productivity is expected to have contracted by five percent in 2020. The United States alone has suffered an estimated $16 trillion cost from lost productivity, premature deaths, and sickness. More than one billion children around the world have had their schooling interrupted. The World Bank has warned that some 150 million additional people will enter the ranks of extreme poverty as a result of the pandemic.
This staggering toll reveals the severe inadequacy of the global systems in place to protect against pandemics. Today’s public health architecture was built for outbreaks and epidemics, but pandemics require a different approach. In outbreaks and epidemics, the spread of disease is geographically limited, so the unaffected countries can, in theory at least, help the affected ones. In a pandemic, however, nearly everyone is hit at once, which means that there is far greater demand on the limited resources of the WHO, the World Bank, and other international organizations. This means that countries have to rely on themselves to stop the spread.
The United States and other countries are rightly focused on recovering from the current crisis, but they need to look past it and focus on preparing for the next one, too. That requires a fundamental change in the way that countries think about global health security. They have to give the WHO and other international institutions the resources and mandate they need to identify emerging threats and incentivize countries to develop the capacities to contain them. And they have to strike agreements to share data and conduct joint trials, so as to enable a truly global response to a pandemic. Otherwise, the world’s response will once again prove to be too little, too late."
Source: https://www.foreignaffairs.com/articles/china/2020-12-08/stop-pandemic
Commentary: I've said this for a while. Given COVID-19's relatively low fatality rate, it is the practice drill for the world to deal with a substantial pandemic, and we have shown, as a species, our inability to deal with it. The next pandemic might have SARS-like fatality - in the 10% range - which would leave hundreds of millions dead.
On a global level, we need a plan as a species to get through the next pandemic before it strikes. On an individual level, we should look at how different nations responded to the pandemic and who successfully dealt with it best, and consider relocating to those nations over the coming years and decades.
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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. If you come in physical contact with others, wash your clothing upon returning home.
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. When going indoors to a place that isn't your home, wear the best protective mask available to you.
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. 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).
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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.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.