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.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.
You are welcome to share this.
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Breastfeeding still not proven to be a vector of transmission. "Breastfeeding offers numerous immunological, developmental, and psychological advantages to the infant–mother dyad. The risks posed to infant and maternal health through any loss of support for breastfeeding mean that public health messaging during the COVID-19 pandemic should be careful. As academic leads of human milk banks, we are acutely aware of the importance of understanding the risks posed by novel infectious pathogens in human milk and the mitigation of risk to susceptible infants.
It is therefore essential that published data related to COVID-19 are valid beyond question. In their Correspondence, Rüdiger Groß and colleagues1 describe the detection of viral particles in human breastmilk, but no cell culture to measure viral viability was done. Furthermore, the likelihood of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) being introduced into milk samples from the infant saliva via retrograde milk flow was not considered.2, 3 Personal communication with Groß and colleagues confirmed that the infant was fed just before sample collections. SARS-CoV-2 is present in saliva during the first week of signs,4, 5 and the baby showed signs of infection that coincided precisely with the period in which positive milk samplings were collected.
The haste to publish has created possible false narratives associated with major harm (two of the four cited articles in the aforementioned Correspondence1 were non-peer-reviewed preprints). Since the Correspondence by Groß and colleagues1 was published, results of larger studies have shown no viable infectious virus in breastmilk and that breastfeeding is probably not a mode of SARS-CoV-2 transmission.6 Mothers should be supported to establish and continue breastfeeding if they are positive for COVID-19.7 Epidemiological evidence suggests the harms of breastfeeding cessation disproportionately outweigh the risk of COVID-19 transmission."
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32071-7/fulltext
Commentary: As far as we know, breastfeeding is still safe. The papers examined above indicate some serious problems with new pre-prints saying breast milk is a vector, so unless otherwise directed by your primary care provider, keep breastfeeding.
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How did China beat COVID-19 so quickly? "As of Oct 4, 2020, China had confirmed 90 604 cases of COVID-19 and 4739 deaths, while the USA had registered 7 382 194 cases and 209 382 deaths. The UK has a population 20 times smaller than China, yet it has seen five times as many cases of COVID-19 and almost ten times as many deaths. All of which raises the question: how has China managed to wrest control of its pandemic?
Despite being the first place to be hit by COVID-19, China was well-placed to tackle the disease. It has a centralised epidemic response system. Most Chinese adults remember SARS-CoV and the high mortality rate that was associated with it. “The society was very alert as to what can happen in a coronavirus outbreak”, said Xi Chen (Yale School of Public Health, New Haven, Connecticut, USA). “Other countries do not have such fresh memories of a pandemic”. Ageing parents tend to live with their children, or alone but nearby. Only 3% of China's elderly population live in care homes, whereas in several western countries, such facilities have been major sources of infection.
“The speed of China's response was the crucial factor”, explains Gregory Poland, director of the Vaccine Research Group at the Mayo Clinic (Rochester, Minnesota, USA). “They moved very quickly to stop transmission. Other countries, even though they had much longer to prepare for the arrival of the virus, delayed their response and that meant they lost control”. The first reported cases of the disease that came to be known as COVID-19 occurred in Wuhan, Hubei province, in late December 2019. China released the genomic sequence of the virus on Jan 10, 2020, and began enacting a raft of rigorous countermeasures later in the same month.
Wuhan was placed under a strict lockdown that lasted 76 days. Public transport was suspended. Soon afterwards, similar measures were implemented in every city in Hubei province. Across the country, 14 000 health checkpoints were established at public transport hubs. School re-openings after the winter vacation were delayed and population movements were severely curtailed. Dozens of cities implemented family outdoor restrictions, which typically meant that only one member of each household was permitted to leave the home every couple of days to collect necessary supplies. Within weeks, China had managed to test 9 million people for SARS-CoV-2 in Wuhan. It set up an effective national system of contact tracing. By contrast, the UK's capacity for contact tracing was overwhelmed soon after the pandemic struck the country.
As the world's largest manufacturer of personal protective equipment, it was relatively straightforward for China to ramp up production of clinical gowns and surgical masks. Moreover, the Chinese readily adopted mask wearing. “Compliance was very high”, said Chen. “Compare that with the USA, where even in June and July, when the virus was surging, people were still refusing to wear masks. Even in late September, President Trump still treated Joe Biden's mask-wearing as a weakness to be ridiculed”.
Drones equipped with echoing loudspeakers rebuked Chinese citizens who were not following the rules. The state-run Xinhua news agency has released footage taken from the drones. “Yes Auntie, this drone is talking to you”, one device proclaimed to a surprised woman in Inner Mongolia. “You shouldn't walk around without wearing a mask. You'd better go home and don't forget to wash your hands”. In the UK, 150 000 people were permitted to attend a horse racing meet in mid-March, 10 days before the country went into lockdown. In August, 460 000 Americans congregated in Sturgis, South Dakota, for a motorcycle rally."
Source: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30800-8/fulltext
Commentary: When you have drones flying over people, telling them to wear masks, you know you're taking it seriously.
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This is the new normal, and it's here to stay. "Recently there has been a gradual shift in the COVID-19 discourse based on an acknowledgement that clearer communication is needed to manage public expectations. Although not directly factored into this shift of tone, the so-called fatalism effect can teach us something. This concept essentially warns that if a problem is characterised as nearly insurmountable then many people will just give up. These people surmise that the cost of the intervention is not worth it, given they perceive that the cost yields little benefit. Conversely, it is also important to guard against overly optimistic assessments, such as those from certain governments relating to a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. Many governments have confidently asserted, without due consideration of the consequences, that a vaccine will abruptly end the pandemic.
Given the potential for misunderstanding at this point, let us be clear: an approved vaccine will be beneficial and its uptake should be strongly encouraged, but it can only be a part of the solution. The reason a vaccine cannot be the complete solution is illustrated with the three vaccine scenarios recently put forth by Zain Chagla, Isaac Bogoch, and Sumon Chakrabarti: a vaccine that prevents nearly all person-to-person spread (presumably also halting illness; scenario 1), one that prevents some spread and reduces severe illness and death (scenario 2), and one that does not prevent spread but reduces severe illness and death (scenario 3). At this stage of clinical assessment it is difficult to be certain whether the real vaccines will fit into scenario 2 or 3. They are unlikely to fit into scenario 1, although even this scenario would not be an instantaneous solution given the mind-boggling logistics of delivering a vaccine to over 7 billion people.
For months many governments have proclaimed that a vaccine is the complete solution, without any mention that not all potential vaccines will fill this role. Nonetheless, some quarters will push to roll out a vaccine, irrespective of its properties, and abandon other measures. It is not unreasonable for the public to expect this drive, given the failure to manage expectations to date. In this setting most people would experience little disease but those who currently are at greatest risk would find themselves completely exposed. This would be an inversion of the underlying principles guiding current interventions. Some might see this characterisation as absurd, but we have seen the world over how easily physical distancing seems to have been abandoned when people are led to believe, deliberately or otherwise, that new measures replace rather than complement earlier interventions.
Often it is difficult to offer solutions, but it is straightforward in this case: interventions that have been in use since early in the pandemic, most crucially physical distancing and hand hygiene, must continue indefinitely. The benefits of these simple measures will have far-reaching implications as shown in a news story in this issue by Paul Adepoju, which describes how work to control neglected tropical diseases has benefitted from the drive for improved hygiene in response to the pandemic. It might be that the vaccines that ultimately become available are more like those described under scenario 2: slowing transmission in addition to limiting illness and death. This scenario will be more welcome than scenario 3 but will not change the need to maintain earlier interventions in place. It is time to forcefully impress on people that basic measures to limit the transmission of SARS-CoV-2 are here to stay. This is the new normal."
Source: https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30151-8/fulltext
Commentary: How long will it take to vaccinate your nation? Assuming it can be vaccinated at all. How long will the vaccine last? When we talk about opening up or going back to normal, the normal that existed before March 2020 is gone and is not coming back. The first wave of vaccines, successfully deployed, may not allow for full reopening if they don't stop transmission.
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The FDA beats the politicians. "For the past several weeks the White House has been fighting the release of vaccine guidelines developed by the Food and Drug Administration (FDA), calling them too restrictive. On the other side, a joint letter from more than sixty public health experts and physicians (including the editor-in-chief of Brief19) called for stricter requirements, including two months of monitoring after trials for all vaccine candidates.
Amidst this, the White House’s budget office on Tuesday released the final Emergency Use Authorization (EUA) guidelines. In addition to requiring applicants to have completed a Phase III trial showing efficacy, the recommendations emphasize continuing data collection for two months after vaccine administration before applying for EUA approval."
Source: https://mailchi.mp/db91b15003d1/your-daily-roundup-from-brief19-5839072?e=87f5efcbeb
Commentary: Glad to see that the FDA triumphed over the politicians and that any vaccine will not be able to take shortcuts to market and still receive FDA approval.
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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.
6. Participate in your local political process. For Americans, go to Vote.org and register/verify your vote.
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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.
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This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.
You are welcome to share this.