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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Long COVID (now referred to as PACS, Post Acute COVID-1 Syndrome) from Dr. Akiko Iwasaki: "An important thread from @PutrinoLab about why we should not be excluding PCR/Ab negative #LongCovid from analysis. So proud of @PutrinoLab for refusing to succumb to reviewers’ demand -which would have resulted in exclusion of data from underrepresented minorities. (1/)
I wish to highlight the importance of their study in this short thread and why I think it should be published ASAP. 84 people with long covid were examined for various symptoms in a retrospective cross-sectional observational study.(2/)
https://www.medrxiv.org/content/10.1101/2020.11.04.20226126v1.full.pdf+html
First, look at the demographic data of those with #LongCovid. Compared to acute severe COVID (in older adults, male>female), long haulers appear more skewed towards women of younger age. (3/)
Second, of the participants (92%) with antibody test, only 39% were positive at the time of testing. This suggests that long haulers may be inducing suboptimal/short-lived Ab responses compared to other convalescent people. Only 28% PCR+: likely missed test time window. (4/)
Now look at the lingering symptoms. In addition to those shared during acute illness, others include fatigue, dizziness, irregular heart beat & temperature, numbness, heart palpitations, sleeping difficulty, hair loss, menstrual cycle issues…etc. Debilitating symptoms. (5/)
Importantly, symptoms are similar between those with confirmed (PCR+ or Ab+) and presumed (confirmed by a medical doctor) long COVID cases. These results support the inclusion of presumed long COVID patients who for one reason or another do not have a positive test. (6/)
As we move forward with scientific and clinical investigation into post-acute COVID-19 syndrome (PACS), this study provides important evidence for inclusion of presumed COVID cases and motivates the community to come to a consensus regarding inclusion criteria for PACS. (End)"
Source:
Source: https://www.medrxiv.org/content/10.1101/2020.11.04.20226126v1
Commentary: PACS - which is a lot easier to say than long-haul COVID - is going to be a problem we'll have to deal with for years to come. This is important because [a] women are more affected (no surprise, women also suffer from auto-immune disorders more) and [b] just because you tested negative doesn't mean you didn't get hit.
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What about summer vacation with the unvaccinated kids? "Although the Centers for Disease Control and Prevention have spent the better part of a year discouraging nonessential travel to prevent further virus transmission, on Friday the agency announced that fully vaccinated people can now travel safely on mass transportation, including planes, in the United States.
But at a White House news conference announcing the new guidance, C.D.C. officials hedged, saying that they would prefer that people avoid travel because of the rising number of coronavirus cases, even though domestic travel is considered “low-risk” for those who are fully vaccinated. Most of the experts we spoke with plan to drive to their destinations, in part because their children are not vaccinated.
Sadie Costello, an occupational and environmental epidemiologist at the School of Public Health at the University of California, Berkeley, has two road trips planned — a camping trip with friends where the adults are vaccinated and the kids are not, and a family trip to a rental vacation house with a private pool.
You don’t necessarily need to sequester in your hometown, go camping or rent a house with a private pool like you might have done last year — although those are all fine, lower-risk options. Hotels or resorts can be safe for families, too, provided that you ask yourself a crucial question: Can you take the right precautions and keep distance between your family and other people while you’re there?
Think about the various spots within a hotel or its surroundings where you or your family would be most likely to get infected, suggested Dr. Abraar Karan, an internal medicine physician at the Brigham and Women’s Hospital and Harvard Medical School.
It might be in a crowded elevator, an indoor restaurant or the lobby. If you are traveling with people who aren’t fully vaccinated, try to avoid these areas as much as possible, he said.
If you’re outdoors in a crowded place where your family cannot maintain six feet of distance from people outside your household, wearing a mask is still a good idea for your kids and yourself, too, even if you’re fully vaccinated.
But if you are outdoors and can maintain distance from other people, the risk of infection is very low if you choose not to wear a mask outdoors, regardless of whether you’re vaccinated or not, the experts said.
“If you’re more than 6 feet from somebody outdoors, I don’t think your mask is going to make that much of a marginal difference at that point, because the risk is already so low,” Dr. Karan said.
“The pool is a question mark,” said Dr. Smith, who said most of her vacation will be spent at the beach. “If it’s very crowded we won’t be going into it.”"
Source: https://www.nytimes.com/2021/04/09/well/family/covid-vaccine-kids-vacation.html
Commentary: Staying in private residences, visiting other vaccinated relatives, not going out to eat, and generally maintaining a bubble are the best ways to keep unvaccinated family members at low risk. Later this year, once all the adults in my household are vaccinated, we'll have 1 member too young, but a road trip to the grandparents with no stops save for rest areas (and double masking at those rest areas) should be safe, as we won't be dining out or doing anything except staying in the relatives' house.
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AstraZeneca vaccine severe side effects rare but real. "Two highly concerning papers now live in the New England Journal of Medicine regarding the adenovirus-based AstraZeneca/Oxford vaccine.
A small number of patients appear to have had serious clotting events with implications.
https://www.nejm.org/doi/full/10.1056/NEJMoa2104882?query=featured_home
First, the top-line findings are concerning.
In Germany and Austria, 11 patients developed clotting problems and of these 6 died. The median age was 36.
In Norway, 5 had the condition, 3 died.
Some if not many of these patients were previously healthy.
Keep in mind that in these nations, several million AZ doses have been given.
So this is rare.
But, it looks real.
There's a well described bio-molecular explanation described in these papers that is plausible and consistently measured here.
Impressive and important work.
The way it is being described, it is similar to other rare conditions, caused by medications that thin the blood (heparin-induced thrombocytopenia).
The researchers are calling this vaccine-induced immune thrombotic thrombocytopenia (VITT).
The issue of course is that we need to know how common this is *versus* serious COVID.
In young and middle aged adults, COVID has a mortality rate that may be 1 in 1000.
We do not know how rare THIS condition is.
It is likely far MORE common than severe COVID in this age group
Given that, here's my take on "what I'd do myself":
Option 1: AstraZeneca vs nothing. I'd STILL chose the vaccine. My odds of COVID-related illness are still way greater than a rare VITT event.
Option 2: AstraZeneca vs other vaccine: I'd specifically chose another vaccine.
One interesting point here is that there now appears to be a fairly reliable way to TEST for this (after it occurs). There's no current way to predict who might be at risk.
There are also treatment options, with varying degrees of success.
Lastly, I am confident that this is both real AND rare.
Why?
Because the trials were large.
They did not pick this up.
If they had, we'd know that this was more common.
It was detected only after scale-up (millions of doses, not tens of thousands)
That reveals a lot.
This shows us why we need very close post-trial surveillance AND a variety of vaccine options.
These vaccines have and will save millions of lives.
But this process won't be without its setbacks.
As setbacks go, this is important, but statistically still small.
More soon. "
Source:
Commentary: Dr. Faust's decision tree is sensible. Given a choice between a very rare risk and a known common risk (COVID-19), take any vaccine if it's the only one available. If you have a choice, take something other than the AstraZeneca vaccine while investigators figure out what's up. But the message is clear: any vaccine is better than none, and the odds of getting in a car crash on the way to your vaccination are approximately 1,000 times higher than any severe side effect from the vaccine itself.
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A reminder of the simple daily habits we should all be taking.
1. Always wear the best mask available to you when out of your home and you'll be around other people. 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. Get vaccinated as soon as you're able to.
3. Wash/sanitize your hands every time you are in or out of your home for any reason.
4. 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.
5. Get your personal finances in order now. Cut all unnecessary costs.
6. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
7. 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).
8. Masks must fit properly to work. Here's how to properly fit a mask:
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Common misinformation debunked!
There is no mercury or other heavy metals in the Pfizer mRNA vaccine. https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
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.