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 a qualified healthcare provider who knows your specific medical situation over advice from people on the Internet.
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The future. "Given the parade of variants, their varying transmissibility, and continuing concern about antigenic changes affecting vaccine protection, I believe it should now be clear that it is not possible to eliminate this virus from the population and that we should develop long-term plans for dealing with it after the unsupportable surges are fully controlled. Pandemic and seasonal influenza provide the most appropriate models to aid in developing strategies going forward.
As with SARS-CoV-2, when a novel pandemic influenza strain appears, its spread can overwhelm the health care system. Waves of infection go through a city in weeks and a country in months, but there is scant evidence that superspreading events occur. Thereafter, the pandemic virus persists as a new seasonal strain, and antigenic changes occur — albeit probably not as quickly as we are seeing with SARS-CoV-2. The new strain joins the other seasonal influenza types and subtypes that reappear each year. The goal of vaccination becomes managing the inevitable outbreaks and reducing the rates of moderate-to-severe illness and death. Preventing mild disease, though important, is less critical.
Though there may be similarities between SARS-CoV-2 and influenza, there are also meaningful differences. The most obvious difference is the efficacy of SARS-CoV-2 vaccines, which is currently much higher than we can achieve with influenza vaccines. Whether that degree of efficacy will continue is one of the many open questions that can only be answered over time. It is clear, however, that revaccination will be necessary, for the same reasons that influenza revaccination is necessary: antigenic variation and waning immunity. Data on the frequency of reinfection with seasonal coronaviruses may not be relevant, but they suggest that protection is relatively short term even after natural infection.5 Revaccination frequency and consequences will need to be determined."
Source: https://www.nejm.org/doi/full/10.1056/NEJMp2113403
Commentary: We are slowly but surely reaching the "you just have to live with it" stage of COVID-19, where the disease becomes endemic. This is my perspective as a layperson with ZERO medical experience, but based on how the disease has worked for the last 18 months and how people have reacted, it seems reasonable that we'll get through another major surge this winter in the Northern Hemisphere, and then for nations where vaccines are readily available, the disease will likely retreat to being endemic like influenza. By mid 2022, COVID-19 will simply be another part of the roster of diseases we get vaccines for.
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The Mu variant shows greater resistance. "During the current pandemic, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (Covid-19), has diversified considerably. As of September 2021, the World Health Organization had defined four variants of concern (alpha [B.1.1.7], beta [B.1.351], gamma [P.1], and delta [B.1.617.2 and AY]), as well as five variants of interest (eta [B.1.525], iota [B.1.526], kappa [B.1.617.1], lambda [C.37], and mu [B.1.621]).1
To assess the sensitivity of the mu variant to antibodies induced by SARS-CoV-2 infection and by vaccination, we generated pseudoviruses harboring the spike protein of the mu variant or the spike protein of other variants of concern or variants of interest. Virus neutralization assays, performed with the use of serum samples obtained from 13 persons who had recovered from Covid-19 who were infected early in the pandemic (April through September 2020), showed that the mu variant was 10.6 times as resistant to neutralization as the B.1 lineage virus (parental virus), which bears the D614G mutation (Figure 1B). Assays performed with serum samples obtained from 14 persons who had received the BNT162b2 vaccine showed that the mu variant was 9.1 as resistant as the parental virus (Figure 1C). Although the beta variant (a variant of concern) was thought to be the most resistant variant to date,3,4 the mu variant was 2.0 as resistant to neutralization by convalescent serum (Figure 1B) and 1.5 times as resistant to neutralization by vaccine serum as the beta variant (Figure 1C). Thus, the mu variant shows a pronounced resistance to antibodies elicited by natural SARS-CoV-2 infection and by the BNT162b2 mRNA vaccine. Because breakthrough infections are a major threat of newly emerging SARS-CoV-2 variants,5 we suggest that further characterization and monitoring of this variant of interest is warranted."
Source: https://www.nejm.org/doi/full/10.1056/NEJMc2114706
Commentary: The mu variant shows substantially greater immune resistance than other variants. It has not shown increased transmissibility like Delta and its cohorts, so in that respect it's not as dangerous - but it does show that Delta and its progeny could probably evolve that resistance themselves at some point down the road. That's important and adds urgency to worldwide deployment of vaccines. The more cases there are, the more probable new variants become.
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Vaccinated people shed for shorter durations. "New evidence shows that even though fully vaccinated people remain at risk for SARS-CoV-2 infection, they are substantially less prone to carry SARS-CoV-2 compared with unvaccinated people. A point-prevalence survey of almost 100 000 people conducted in England in June-July 2021 during the height of that country’s spring Delta variant surge found that fully vaccinated people (n = 55 962) were two-thirds less likely to harbor SARS-CoV-2 compared with unvaccinated people (n = 15 135), with absolute rates of 0.40% vs 1.21%, respectively.5 Likewise, in a randomized trial of the mRNA-1273 vaccine (Moderna) vs placebo, vaccinated participants (n = 14 287) were two-thirds less likely to be asymptomatic carriers than unvaccinated participants (n = 14 164), with absolute rates of 1.5% vs 3.5%, respectively (estimated vaccine effectiveness against asymptomatic infection, 63.0% [95% CI, 56.6%-68.5%]).6
Studies of viral dynamics further suggest that while viral loads in breakthrough infections may be as high in vaccinated individuals as they are in unvaccinated individuals, viral loads in those who are vaccinated decline more rapidly, and the virus that they shed is less likely to be culture-positive than virus shed by unvaccinated individuals.7,8 This suggests that people who are fully vaccinated are less likely to become infected and if infected, will be contagious for shorter periods than unvaccinated people. This is supported by transmission studies that confirm that vaccinated people are less likely to transmit SARS-CoV-2 to close contacts compared with unvaccinated people, including the Delta variant.9 In a study of 7771 household contacts of 4921 index cases in the Netherlands, the rate of transmission from fully vaccinated household members was 13% vs 22% from unvaccinated household members (estimated vaccine effectiveness against transmission, 63% [95% CI, 46%-75%]).10 Similarly, in an English study of 151 821 contacts of 99 567 index patients, the rate of transmission from people fully vaccinated with BNT162b2 (Pfizer-BioNTech) was 23% vs 49% for transmission from unvaccinated people (adjusted odds ratio [aOR], 0.35 [95% CI, 0.26-0.48] for transmission of Delta to unvaccinated contacts; aOR, 0.10 [95% CI, 0.08-0.13] for transmission of Delta to fully vaccinated contacts).11"
Source: https://jamanetwork.com/journals/jama/fullarticle/2786040
Commentary: The ability to transmit virus for a shorter period of time benefits everyone around you. The ability to reduce disease severity benefits you. Vaccination works very well.
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A reminder of the simple daily habits we should all be taking.
1. Wear the best mask available to you when you'll be around people you don't live with, even after you've been vaccinated. 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. Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
3. Get vaccinated as soon as you're able to, and fulfill the full vaccine regimen. Remember that you are not vaccinated until everyone you live with is vaccinated. If you received an adenovirus vaccine (J&J/AstraZeneca), consider getting an mRNA single shot booster (Pfizer/Moderna) if permitted.
4. Wash/sanitize your hands every time you are in or out of your home.
5. 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 the disease through aerosols and distance is less effective at mitigating your risks.
6. Aim to have 3-6 months of living expenses on hand in case the pandemic gives another crazy plot twist to the economy.
7. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
8. 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).
9. Masks must fit properly to work. Here's how to properly fit a mask:
10. If you think you may have been exposed to COVID-19, purchase a rapid antigen test. This will detect COVID-19 only when you're contagious, so follow the directions clearly. https://amzn.to/3fLAoor
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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
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Disclosures and Disclaimers
I declare no competing interests on anything I share related to COVID-19. 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, nor do I financially benefit in any way from sharing information about COVID-19.
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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.