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.
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Christine wrote in with this question:
Hi! My immuno-compromised sister has just accepted a job as a music teacher in a public high school. I’d love your advice on those portable particle-counter thingies and portable air purification systems you’ve used at conferences—she’d love to set up some safety measures in her classroom (beyond her own N95, of course), especially since as a choir teacher she’ll have people’s air flying at her nonstop!
The best advice from all my reading is that she needs a multi-spectrum approach. First, if the room has good access to outside air, ventilate with outside air as much as possible. If it does not, she should be looking at constructing Corsi Rosenthal boxes for the room.
These are 20" box fans with MERV13 or better (MERV13+, so MERV14 is better than MERV13) filters strapped to them so that they're scrubbing the air as much as possible. Filters should be changed every 2-4 weeks.
For someone immune compromised, she will want a lot of these - at least 3-4, in this layout:
1 fan on either side of her, blowing towards her.
2 fans BEHIND her, blowing towards her.
What this does, at least according to my brother (who is far more expert in fluid dynamics and airflow than I am, being an aerospace engineer) is it creates essentially an air bubble around her and that clean air is always blowing towards her.
She obviously will want to wear her N95+ mask at all times, taking eating and drinking breaks either outside away from others or literally sitting right in front of one of the fans so that she’s breathing in relatively clean air for the few moments she’s unmasked. If she has the ability to use an N99 instead of an N95, or even better a P100 and can still do her job, the better the mask, the safer she is.
To test the efficacy of the ventilation, she should bring something like incense or a cigarette with her one day before class, light it in the empty room, and see how long before the odor is significantly less noticeable in the place where she stands.
The definition of good ventilation is that the smell is substantially gone in 2 minutes or less.
It almost goes without saying that she should be vaccinated and boosted to the maximum her healthcare provider recommends/allows.
Vaccines prevented more than 3 million deaths in the USA in the last two years. "From December 2020 through November 2022, we estimate that the COVID-19 vaccination program in the U.S. prevented more than 18.5 million additional hospitalizations and 3.2 million additional deaths. Without vaccination, there would have been nearly 120 million more COVID-19 infections. The vaccination program also saved the U.S. $1.15 trillion (Credible Interval: $1.10 trillion–$1.19 trillion) (data not shown) in medical costs that would otherwise have been incurred."
Commentary: The anti-science/anti-vax crowd seems to have gotten louder the last few weeks, so it's worth reiterating that the vaccines we have in market now are safe and effective at preventing death and hospitalization. That said, they are far less effective at preventing spread, which is why we should still be masking and pushing for our homes and workplaces to have great ventilation.
COVID causes depression long after it's "gone". "The neuropsychiatric sequelae of long COVID are multifactorial. The development of depression and other psychiatric symptoms of long COVID may involve several different mechanisms, including direct brain infection and neuro-injury by SARS-CoV-2, unresolved systemic inflammation and ensuing increased inflammation in the brain through compromised blood-brain barrier (BBB), and oxidative stress [7,35,37,38]. They may operate alone or together, leading to the development of depression, cognitive impairments, and other psychiatric sequelae (sleep disturbances, fatigue) in COVID-19 survivors.
The inflammation theory of depression has proposed inflammation as a key pathogenic mechanism for MDD. Evidence supporting the inflammation theory of depression comes from (a) The association between systemic peripheral inflammation and depression is well documented with the blood level of inflammatory biomarkers, particularly pro-inflammatory cytokines (e.g., interleukin [IL]-6) and C-reactive protein (CRP), positively associated with severity of depression [39-44]. (b) Infection, like psychosocial stress, can activate systemic inflammation, and then induced “sickness behaviors” – cognitive-affective behavioral changes like the core symptoms of depression [45,46]. (c) Increased neuroinflammation in patients with MDD, evidenced by increased cytokines found in cerebrospinal fluid and positron emission tomography brain imaging studies showing upregulation of trans-locator protein by active microglia, in patients with MDD [47-50].
Nutrition science provides another intervention option that can alleviate depression by reducing systemic inflammatory status. Long-chain omega-3 polyunsaturated fatty acids (omega-3 PUFAs) are a promising choice with solid empirical evidence established for their effects on improving major depressive disorder, anxiety, and antenatal and postnatal depression [63-67]. In addition, there is emerging evidence on the effect of omega-3 PUFAs in addressing immune dysregulation induced by SARS-CoV- 2 infection as well as post-COVID depression, anxiety, and other psychological distress [38,68]. Further research is needed using an experimental design (randomized controlled trial) to test the effect of nutrition interventions with omega-3 PUFAs on post-COVID depression as well as to test decreased inflammation as the mediating mechanism of the intervention effect. Beyond omega-3 PUFAs, potential nutrition interventions for long COVID include a nutrition supply with vitamin C, polyphenols, probiotics, and vitamin D and keeping a healthy diet to reduce inflammation and oxidative stress [69-71]. However, these nutrition interventions generally lack solid empirical evidence to support their effects on improving post-COVID depression as well as inflammatory dysregulation."
Source: https://www.cpn.or.kr/journal/view.html?uid=1447&vmd=Full&
Commentary: This is a really important paper because it addresses the mechanics of clinical depression. Clinical depression has long been believed to be influenced by inflammation of certain chemicals in the body, notably cytokines. What else provokes cytokine storms? Yup, COVID. It was always logical to assume that COVID's inflammatory capabilities would also have substantial mental health effects, and now there's good literature beginning to address it.
A couple of important things here. First, if you've had COVID, do your best to avoid getting it again. Every exposure to it increases cytokine activity and if you are predisposed to clinical depression, each exposure of COVID raises the risk of a major depressive phase substantially.
Second, COVID has infected billions of people. Billions. While not everyone who gets COVID experiences long COVID, there is no question that it provokes a cytokine response in the body. How severe and how long depends on the individual but it's not unreasonable to believe we have a massive, unaddressed mental health crisis brewing underneath the surface of every society in the world.
Third, there are already nutrition and behavioral treatments to reduce inflammation. As the article cites, Omega-3 fatty acids - namely, fish oil supplements - have been shown in clinical studies to help reduce oxidative stress and inflammation, as well as other foods like ginger, turmeric, and garlic. Combined with exercise, sleep, and potentially therapy, we already have an arsenal of tools at our disposal to reduce inflammation. We can and should be deploying these across our entire society.
Here's the best part: if we're wrong, nothing bad happens. Telling people to get more sunlight, more exercise, better nutrition, and better sleep is ALWAYS a good idea. There's no downside to that advice. Just like telling people to wear masks in public - there's no downside. Breathing in cleaner air is inherently a good thing. For supplements, obviously consult your qualified healthcare provider first, especially if you have allergies (there are vegan plant-based omega-3 supplements as well).
Keep an eye on your friends and family, especially those who have had COVID, and help them consult the appropriate medical professionals if they exhibit signs of major depression where they previously did not have any. The sooner they're treated, the better off they'll be.
A reminder of the simple daily habits we should all be taking.
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.
Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
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.
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.
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.
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.
Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
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).
Masks must fit properly to work. Here's how to properly fit a mask:
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.
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
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.
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.
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