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.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.
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Commentary: I recently attended a conference in Cleveland - a city with very high rates of community transmission - and came back without COVID. How? Here were the steps I took.
1. I wore a mask almost all of the time, from the moment I left my hotel room. The only time I didn't wear a mask was when I was on stage speaking.
2. The mask I wore was a P100 mask, the highest rated mask available without resorting to something crazy like a powered respirator.
3. When I was on stage speaking, I had a request the event organizers accommodated: I brought two 20" box fans with HEPA MERV13 filters strapped to them, blowing out filtered air on stage behind me as I spoke.
4. I brought a CO2 monitor with me and monitored the air quality the entire time. The venue was roughly 880 PPM most of the time (over 800 means you should probably wear a mask, over 1000 means you should DEFINITELY wear a mask).
5. I ate meals in my room or outdoors except the lunch break at the event. I ate my lunch sitting directly in front of the fans I had set up so that while unmasked, I was still breathing in relatively clean, filtered air.
6. I specifically did not attend the large after event karaoke party, because that environment is just unsafe even with a great mask. A densely packed, poorly ventilated room where no one is wearing a mask and shouting/singing at the top of their lungs?
7. I kept one of the fans operational in my hotel room. The air in the room was about 900 PPM without me in it, and 1600 PPM with me in it. My hotel did NOT exchange fresh air with the outside, so that was important to have filtering there.
8. I drove to the event instead of flying in order to bring all this gear. It was a 10 hour drive each way, but it was worth it.
9. I tested myself every day before going to the event to make sure I wasn't part of the problem, and I've been testing myself every day since the event to make sure I didn't bring home the worst souvenir ever. 4 days later, I'm still negative. I'll continue to test until day 8.
Most important, I still got benefit out of the event, was still able to talk to people, still able to enjoy 95% of the event (minus the crazy party), so precautions do not preclude fun or ability to benefit from events.
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BA.2.75 could be the new sheriff in town. "BREAKINGš The 13th preprint from G2P-JapanšÆšµ is out @biorxivpreprint. #Omicron BA.2.75 (aka #Centaurus) seems to be more contagious than BA.5 and more pathogenic than the original BA.2. Please RT. 1/7
BA.2.75, emerged in Indiaš®š³, is classified as VOC-LUM (variant of concern linage under monitoring) by WHO on July 7. Here we elucidated the effective reproduction number, sensitivity to antiviral immunity & drugs and intrinsic pathogenicity of BA.2.75. 2/7
Both BA.2.75 and BA.5 are descendants of BA.2. However, BA.2.75 is phylogenetically different from BA.5, the currently predominant BA.2 descendant. BA.2.75 spike bears nine substitutions, but only one substitution (R493Q) is shared with BA.5 spike. 3/7
First, our mathematical/statistical analysis revealed that the effective reproduction number ("Re" in the figure) of BA.2.75 is greater than that of BA.5, suggesting that BA.2.75 is more contagious than BA.5. 4/7
While the sensitivity of BA.2.75 to vaccine- & BA.1/2 breakthrough infection-induced immunity was comparable to that of BA.2, the BA.5-induced immunity (*in hamsters) was ineffective against BA.2.75. Three clinically-available antiviral drugs were effective against BA.2.75. 5/7
Using clinical isolates of BA.2, BA.2.75, BA.2 & Delta and a hamster model, we demonstrated that the intrinsic pathogenicity of BA.2.75 is comparable to that of BA.5 but is greater than that of the original BA.2. 6/7
ā¶ļø Our multiscale investigations suggest that BA.2.75 acquired virological properties independently of BA.5, and the potential risk of BA.2.75 to global health is greater than that of BA.5. 7/7 "
Source: https://www.biorxiv.org/content/10.1101/2022.08.07.503115v1
Commentary: BA.2.75 can apparently sidestep immunity from BA.5. It's more contagious, and it has potentially more severe outcomes. Stay masked.
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The primary method of transmission of monkeypox is skin to skin contact. "The evidence available to date suggests that skin-to-skin contact is the dominant transmission route of the monkeypox virus in this outbreak, whereas respiratory transmission is probably less relevant, encouraging the revision of isolation measures in these participants. Additionally, the presence of atypical manifestations, which might be associated with the body site of viral entry, encourages a low threshold for clinical suspicion of monkeypox, particularly in areas with high transmission rates or in individuals who might be at high risk of contagion. The short incubation period suggests that postexposure vaccination strategies are unlikely to be effective."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01436-2/fulltext
Commentary: The key takeaway here is that monkeypox's mode of transmission is by skin cells. Thus, fears about inhalation/aerosols are probably not as serious. Preventing it means good hygiene and avoiding individuals who have lesions that could spread it.
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Test to exit is the only data-driven route for ending isolation. "It strikes me that if we had followed the CDCās guidelines for people without access to tests, it would have made things worse for our community overall, albeit maybe a little less painful for ourselves by hastening a return to normal. But the CDCās job is to think at the population level. And itās the governmentās job to ensure that people can afford to do the best thing (read: guaranteed paid sick leave for parents, for example). In my view, the current CDC guidance and public policies inadequately support parents and communities, leading both to more illness and more days of disruption. It would be one thing if the guidance balanced these concerns. But as long as the reproductive number of Covid-19 remains at or above 1 (meaning that the average infected person is expected to spread the virus to at least one other person) during the post-CDC-recommended isolation period, the current policy is poised to backfire on a systemic level, even through the lens of days of disruption, let alone in terms of improving public health."
Source: https://insidemedicine.bulletin.com/keeping-kids-with-covid-home-a-few-days-longer-helps-communities-we-still-need-to-support-parents-to-make-that-possible/
Commentary: The reality few are willing to accept is that time-based isolation makes no sense with COVID. As long as tests are available, test to exit is the surest way to avoid spreading COVID to others.
If you have COVID, do everyone around you a favor and test, test, test until you are negative for two days in a row.
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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. 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.
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 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.
4. 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.
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 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 pandemics give another crazy plot twist to the economy, or you know, a global war breaks out.
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 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.
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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 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.
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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.