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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Convalescent plasma shows no impact, good or bad, in a pre-print study. "Objectives: Convalescent plasma (CP) as a passive source of neutralizing antibodies and immunomodulators is a century-old therapeutic option used for the management of viral diseases. We investigated its effectiveness for the treatment of COVID-19. Design: Open-label, parallel-arm, phase II, multicentre, randomized controlled trial. Setting: Thirty-nine public and private hospitals across India. Participants: Hospitalized, moderately ill confirmed COVID-19 patients (PaO2/FiO2: 200-300 or respiratory rate > 24/min and SpO2 ≤ 93% on room air). Intervention: Participants were randomized to either control (best standard of care (BSC)) or intervention (CP + BSC) arm. Two doses of 200 mL CP was transfused 24 hours apart in the intervention arm. Main Outcome Measure: Composite of progression to severe disease (PaO2/FiO2<100) or all-cause mortality at 28 days post-enrolment. Results: Between 22 nd April to 14 th July 2020, 464 participants were enrolled; 235 and 229 in intervention and control arm, respectively. Composite primary outcome was achieved in 44 (18.7%) participants in the intervention arm and 41 (17.9%) in the control arm [aOR: 1.09; 95% CI: 0.67, 1.77]. Mortality was documented in 34 (13.6%) and 31 (14.6%) participants in intervention and control arm, respectively [aOR) 1.06 95% CI: -0.61 to 1.83].
Interpretation: CP was not associated with reduction in mortality or progression to severe COVID-19. This trial has high generalizability and approximates real-life setting of CP therapy in settings with limited laboratory capacity. A priori measurement of neutralizing antibody titres in donors and participants may further clarify the role of CP in management of COVID-19."
Source: https://www.medrxiv.org/content/10.1101/2020.09.03.20187252v1
Commentary: Bad news for convalescent plasma. Folks who have pinned hopes on it are likely to be disappointed. The good news is that it doesn't make things worse, as hydroxychloroquine did with azithromycin, so someone being treated with it isn't at increased risk of a bad outcome.
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NYC schools will go virtual at 3% community spread. Department of Education chancellor Richard Carranza: "I think one of the biggest lessons is opening school when you don't have the lowered community spread percentage of positive cases, as we've looked at other states, other cities Other countries, the successful reopenings have been when that community spread is very suppressed or very low level. I think the World Health Organization said it could be under 5%. The CDC is that 5% and state in New York, I said 5%, we've said if it gets to 3%, we will shut in person learning down and pivot immediately to 100% remote. That's probably been the biggest factor that all medical experts have said you should consider when thinking about in person learning.
Secondly, Mark, I would also say that one of the big lessons learned is that you have to limit the movement within the schools. So while it sounds harsh, that's usually their breakfast and their lunch in his classroom. It's incredibly important because if there is a positive case that develops, you now have the group that that person whether it's a student or adult has spent their time with so our testing trace investigators men do their jobs. To see if there's any other connections and get to the root of community spread.
The third thing I would say is very important is the requiring of face masks. But what we've seen is especially where it's been masks not required, you seen that there's been an uptick in positive cases. And we've been very clear with our community, that if you are in a blended learning environment, in other words, you're coming into in person or in school, you will be required to wear your face mask at all times, and we're going to help you understand especially our youngest children, why that's important, why that's an act of love how you're serving each other. But make no mistake, if a student refuses to wear their face mask or our family says we just don't believe in wearing a face mask. Then they have elected 100% remote learning because in a pandemic, you cannot make the decision to consciously not follow the medical advice."
Source:
Commentary: Those positivity numbers are good benchmarks for all school districts - as long as enough testing is being done. Testing is the key - without it, you have no idea what is or is not safe.
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Dr. Scott Gottlieb on the current situation. "Well, if you look at where we are heading into labor day relative to where we were heading into Memorial Day, we have an equivalent amount, if not more infection heading into labor day right now. And we're heading into a more difficult season. We're heading into the fall in the winter when we would expect the respiratory pathogen like a coronavirus to start spreading more aggressively than it would in the summertime looking at Memorial Day. We had about 40,000 people hospitalized we were diagnosing about 21,000 new cases a day and had about 1100 deaths. Now notwithstanding the fact that we've made really significant gains in reducing in hospital mortality and reducing length of stay in the hospitals for patients who are hospitalized for covid.
Right now, as of yesterday, we had about 35,000 people hospitalized, we're diagnosing about 40,000 infections. A day. And on a seven day moving average, we have about 850 tragic deaths a day. So that's a lot of infection to be taking into a season, when we know a respiratory pathogens going to want to spread more aggressively. And the other backdrop here is that people are exhausted. People have been social distancing and wearing masks and staying home for a long period of time right now, small businesses are hurting. So I think that people's willingness to comply with the simple things that we know can reduce spread is going to start to fray as we head into the fall in the winter. And that's another challenge trying to keep up our vigilance at a time when we know that this can spread more aggressively.
I think I think in terms of thinking about the vaccine, at least as far as this year is concerned, 2020 the fall in the winter, I think that if there is a vaccine made available, it's likely to be a very staged introduction of the vaccine, under an emergency use authorization where there's going to be a lot of data collection around the use of that vaccine is just going to be for very select groups of people who are either at very high risk of contracting coronavirus because of what they do, for example, health care workers, or very high risk of a bad outcome. Think of people for example, in a nursing home so you can almost think of the vaccine being used in a therapeutic sense to try to protect very high risk populations and not in the way we traditionally think about a vaccine in terms of trying to provide broad based immunity in a population and really quell an epidemic, I think the likelihood that we're going to have a vaccine for widespread use in 2020 is extremely low, I think we need to think of that as largely a 2021 event. And if we do have a vaccine available 2020 is likely to be used in a much more targeted fashion, almost in a therapeutic sense to protect very high risk populations.
You know, the reality is that if we continue to see spread at the rate that we're seeing it now or something higher than what we're seeing it now, by the end of the year, upwards of 20% of the population in us could have been exposed to this coronavirus. And we're likely to see the virus itself start to slow down just because of the natural progression of the epidemic. And the fact that we're heading out of the winter into this into the spring in the summertime as we enter 2021. And so this could run its course in 2020. And as we get into 2021 start to slow down. I think the tragic consequence of that is that there's going to be a lot of death and disease along the way. But I think by the end of this year, we're likely to be through at least the most acute phase of this epidemic, in part because it's going to end up infecting a lot more people between now and then."
Source:
Commentary: Dr. Gottlieb's words are sobering. In the absence of any federal leadership, each state in the US is left to its own devices. Some will have much better outcomes than others. But know going into the fall and winter that we are heading into high risk territory in all of the Northern Hemisphere. What vigilance we've been practicing, we must be even more vigilant now because conditions favor the virus.
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India is in a lot of trouble.
Source: https://ourworldindata.org/coronavirus#all-charts-preview
Commentary: India is now approaching almost 90,000 cases per day. It's the new global hotspot, and unfortunately it doesn't look like their countermeasures are having any effect.
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STAT News reviews Operation Warp Speed's progress. "Roughly five months after top U.S. health officials coalesced around the idea of a public-private effort to accelerate the development, manufacturing, and distribution of Covid-19 vaccines, therapeutics, and diagnostics, an answer to that question remains out of reach. But with billions of federal dollars already spent on the effort, it’s possible to take stock of the initiative’s progress, or lack thereof.
If all goes well, the fast-tracking of vaccine development, which normally takes years, will have been telescoped down to about a year. To date, the fastest a vaccine was ever developed was four years.
There have been ripple effects, however. In placing itself at the front of the line to receive vaccine doses from the OWS manufacturers, the United States has ignited a vaccine nationalism wildfire, which is reaching conflagration status. Wealthy governments have locked down more than 4 billion doses of vaccines so far, with the United States topping the list with commitments for 800 million initial doses and options on another 1.6 billion doses; new bilateral purchase agreements are announced almost daily.
The inability to manufacture and provide widespread access to diagnostics has been one of the biggest failures of the U.S. response to the pandemic. Responsibility for that failure is spread across both the public and private sector.
On its site, OWS lists the development and testing of diagnostics as one of its five focus areas. The reality is that the initiative appears to have stayed largely on the sidelines, with the National Institutes of Health taking the lead.
An NIH effort, the Rapid Acceleration of Diagnostics (RADx), is funded with $1.5 billion, a sixth the OWS budget. By the end of the year, that program aims to have its awardees add 6 million tests per day to the number that can currently be conducted.
Basic questions about what is being done and why are often not laid out. It’s not crystal clear, for instance, why OWS picked the vaccine projects to fund that it did, or how the process was handled.
The trial protocols for the studies, which would explain what and how analyses are being done, have not been published. However, for the trial of Moderna’s vaccine, data on the diversity of the participants are being regularly made public.
Key public health professionals across the country have been in the dark about how Covid-19 vaccines, once available, will be distributed and administered."
Source: https://www.statnews.com/2020/09/08/operation-warp-speed-promised-to-do-the-impossible-how-far-has-it-come/
Commentary: Overall, a blistering indictment of federal mismanagement in the United States. Unsurprising, but still disheartening. Let's hope we make more, better progress in the next few months.
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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.
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.
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.
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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.