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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What endemic means. "Everyone keeps talking about covid becoming endemic, but as I listen to the conversation, it’s becoming more & more clear to me that very few of you know what “endemic” means.
So here’s a thread on how pandemics end.
In the beginning of any pandemic, we have 4 options for what could happen:
1) continually occurring disease, with small or large surges
2) local elimination of disease
3) global eradication of disease
4) complete extinction of the pathogen
Option 4 (extinction) is absolutely the hardest, but long-term would mean we could all completely forget about the disease.
We have basically never done this in the entire history of humans—but, if we’re being honest, a big reason we haven’t is fear & mistrust of other humans.
Option 3 (eradication) is also very hard but long-term just about everyone could forget about the disease.
You & I aren’t worried about smallpox, no matter where we travel or what we do — unless you’re a researcher at one of the 2 super high biosecurity labs that have a sample.
Option 2 (elimination) is still pretty hard, and long-term not everyone can forget about the disease.
For lots of the world, this is measles is — we’ve got great vaccines & most of us don’t need to worry about measles, but public health officials still monitor for it everywhere.
Now we get to Option 1 (continually occurring disease). This is easier short-term but it’s the hardest *long-term*.
It’s also super vague: it could mean anything from hundreds or thousands per day to one or two per year.
The other name for this is, you guessed it, “endemic”.
In more technical terms “endemic” means: “Controlled at or below an ‘acceptable’ level”
What level is “acceptable” differs from place to place, over time & between diseases, and it may not always be explicit, but when a disease is endemic, there is a threshold!
If a disease is really bad, ‘acceptable’ is very low—potentially even indistinguishable from elimination.
The plague (yes that one!) is kinda common among rodents in parts of the US, but if even ONE person shows up to a doctor with symptoms, public health jumps into action!
On the other hand, if a disease is not really that bad at all, the acceptable level can be really very high.
Up to 80% of US adults are infected by the virus that causes cold sores (aka oral herpes)!
But public health takes *nearly* no action, except to protect infants.
You might have noticed something important here, and it’s something I think MANY of the people shrugging off covid becoming endemic get wrong:
“Endemic” does NOT mean “harmless”.
Whether a disease is endemic, epidemic, eliminated, or eradicated does NOT tell us how serious it is, and does NOT tell us how many people get sick or die.
We have to CHOOSE that number.
So here’s the kicker: “endemic” doesn’t mean “never think about covid again”. It’s exactly the opposite!
Endemic means someone is ALWAYS thinking about covid.
Endemic means public health is always monitoring disease & always intervening when cases cross the “acceptable” level.
Every time I tweet about this I get people in mentions saying “but we don’t take precautions for the flu!”
Those people are 100% WRONG!
Thousands of people work daily to monitor, prepare for, & respond to fluctuations in flu number and in the flu virus itself! It’s a HUGE task!
Sure, maybe the flu doesnt impact *your* life, except some years you get a flu shot, or maybe you have once or twice really actually gotten the flu & not just a bad cold you *called* the flu.
(Pro-tip: if you dont feel like you’ve been hit by a train, it’s probably not the flu).
But that is because PUBLIC HEALTH KNOWS WHAT IT’S DOING!!!
There are clearly defined “acceptable” levels for different strains of the flu, and we spend so so much time & energy & money working to keep the flu below those levels. So that YOU don’t get sick.
When flu cases cross the threshold & the public health lever switches from “monitor flu activity” to “take action YOU don’t notice.
But not because it isnt happening — because the acceptable level is LOW ENOUGH that those actions happen before it impacts your daily life.
If you work somewhere like a daycare, or a nursing home, or (like me) a School of Public Health that shares a campus with a hospital, you probably DO sometimes notice.
Because those are places where flu is most problematic & so they are also where we focus our interventions.
So what does this tell us about how pandemics end?
Well, it tells us that we CAN put in the work to really get rid of it once & for all, if we have the will and the strength and the interest and the resources.
It probably gets harder & harder the longer we wait, though.
Smallpox was around for a very long time before we took action & it took a long time to defeat.
Similarly, polio eradication is long overdue, but we’re still trying and I’m certain we will get there.
Yes, eradication is HARD but we could still choose to make it our moonshot if we wanted to.
It would definitely take time. It would probably take new science, new ideas, & new tools. And it would take both leaders & everyday people actively committing to doing what it takes.
Realistically, despite New Zealand’s valiant efforts, we are not going to do that.
We don’t have the political or social will to eliminate or eradicate covid.
But that means we HAVE TO continue to CONTROL covid!
That’s the only other option. THAT is what endemic means!
So, yes, our only viable choice left is covid becoming endemic. It didn’t have to be this way, but our leaders MADE a choice.
And now they need to make another choice: They need to choose an “acceptable” level of COVID death & disease.
Because pandemics don’t end by a disease just fading away, & pandemics don’t end with everyone able to completely forget about the disease.
Pandemics end when we decide how much death and disease we’re satisfied with.
A good addendum here that, mathematically, “endemic” depends on Re & the relative changes in protected & susceptible populations.
Re isn’t completely up to us, but one goal of a control program is very often to get & keep it below 1."
Source:
Commentary: The question for all of us, at a personal as well as societal level, is what level of disease and death is acceptable, versus what we're willing to trade off. Getting vaccinated certainly changes that calculus; once everyone in my family is fully vaccinated, I will feel comfortable attending events again (masked). I still don't feel comfortable eating in restaurants, and won't even after everyone's fully vaccinated, until we see whether severity remains low for the vaccinated.
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Vaccine mandates work. "The White House says early evidence shows that vaccine mandates work. United Airlines, which announced a mandate in August, recently reported that 99 percent of its workers had been vaccinated and that it had received 20,000 applications for about 2,000 flight attendant positions, a much higher ratio than before the pandemic. Tyson Foods reported a 91 percent vaccination rate ahead of a November deadline, compared with less than half before its mandate announcement in August. Those figures will probably be cited in efforts to address concerns among employers that mandates would cause workers to quit, particularly in industries facing labor shortages."
Source: https://www.nytimes.com/2021/10/07/business/dealbook/biden-vaccine-mandate-covid.html?smid=tw-share
Commentary: Interesting that their job applications are that much higher at United. Workers want to be safe, and vaccination is an easy choice to make, especially if companies permit time off and/or facilitate the vaccinations.
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120,000 USA kids orphaned so far. "The number of U.S. children orphaned during the COVID-19 pandemic may be larger than previously estimated, and the toll has been far greater among Black and Hispanic Americans, a new study suggests.
More than half the children who lost a primary caregiver during the pandemic belonged to those two racial groups, which make up about 40% of the U.S. population, according to the study published Thursday by the medical journal Pediatrics.
“These findings really highlight those children who have been left most vulnerable by the pandemic, and where additional resources should be directed,” one of the study’s authors, Dr. Alexandra Blenkinsop of Imperial College London, said in a statement.
During 15 months of the nearly 19-month COVID-19 pandemic, more than 120,000 U.S. children lost a parent or grandparent who was a primary provider of financial support and care, the study found. Another 22,000 children experienced the death of a secondary caregiver — for example, a grandparent who provided housing but not a child’s other basic needs.
In many instances, surviving parents or other relatives remained to provide for these children. But the researchers used the term “orphanhood” in their study as they attempted to estimate how many children’s lives were upended.
Federal statistics are not yet available on how many U.S. children went into foster care last year. Researchers estimate COVID-19 drove a 15% increase in orphaned children."
Source: https://apnews.com/article/coronavirus-pandemic-science-pandemics-covid-19-pandemic-race-and-ethnicity-72ab35ef81250e5007f5674d7e0af73d
Commentary: Caregivers especially should make sure they are fully vaccinated.
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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.