Lunchtime Pandemic Reading, 9-September-2020
College students not exempt, Sturgis, phase 3 trial on hold
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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Excellent expert commentary on the Sturgis rally. "According to Elizabeth Stuart, a statistician and associate dean at the Johns Hopkins Bloomberg School of Public Health, the basic methodology used by the team is commonly deployed to evaluate the effects of policy interventions. But there’s a lot of uncertainty in applying these tools to studying how a never-before-seen disease like covid-19 might spread through a population—uncertainty that she felt the researchers could have done a better job of showing.
“I think they did a reasonable analysis. But there were many choices made along the way that could have been made differently,” said Stuart, who is not affiliated with the research.
One example she brought up was how the team compared South Dakota to other states like Vermont and New Hampshire in trying to create a “synthetic control,” a statistical tool that tries its best to imagine what would have happened in the same place had variable A (the rally happening in Sturgis in this case) never occurred. Because the states used were relatively small and may be different from South Dakota in many important ways, Stuart said, the exact numbers produced by the team’s model might not be as stable as they appear, even if the basic finding that the rally created a superspreading event is true.
“So the big, high-level conclusion from the study is that there were over 200,000 cases from this and that it accounted for 20% percent of cases nationwide. But there’s no uncertainty given to that—there’s no confidence interval,” Stuart said, referring to a common statistical method used to present the likely range of possibilities for any one result. “And I really think it’s important in these contexts to convey the uncertainty, both the statistical uncertainty and also the more fundamental uncertainty of their model.”
Joshua Salomon, a health policy researcher and professor of medicine at Stanford University, told Gizmodo via email that the team’s analysis is “thoughtfully designed” and that he agrees with the general conclusion that the rally likely led to a large number of infections. But he said comparing counties that did or didn’t have people who went to Sturgis as a way to estimate the number of cases caused by the rally, as the authors also did, has its shortcomings too.
“A key limitation is that these sets of counties appear to have been on different trajectories before the rally, which makes it much harder to compare the trends after the rally and attribute the difference to the rally,” he said. “So, the 250,000 estimate is a nice headline-grabber but pretty likely to be an overestimate.”"
Source: https://gizmodo.com/how-to-read-that-damning-sturgis-motorcycle-rally-super-1844987945
Commentary: The Sturgis rally analysis is done with a technique - based on the description in the article - called propensity score matching, where you try to create two similar audiences, one with the 'treatment' (in this case a rally attendee) and one without, then look for the clinical differences.
The likely outcome is somewhere between "nothing happened" and "massive one of a kind superspreader event", and probably leans more towards the latter than the former because attendees didn't watch their distance, wear masks, or withdraw from indoor spaces.
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New study on young adults 18-34 and COVID-19 outcomes. "Coronavirus disease 2019 (COVID-19) is increasing rapidly among young adults in the US.1 Often described as a disease affecting older adults, to our knowledge, few studies have included younger patients to better understand their anticipated clinical trajectory. We investigated the clinical profile and outcomes of 3222 young adults (defined by the US Census as age 18-34 years) who required hospitalization for COVID-19 in the US.
Young adults age 18 to 34 years hospitalized with COVID-19 experienced substantial rates of adverse outcomes: 21% required intensive care, 10% required mechanical ventilation, and 2.7% died. This in-hospital mortality rate is lower than that reported for older adults with COVID-19, but approximately double that of young adults with acute myocardial infarction.4 Morbid obesity, hypertension, and diabetes were common and associated with greater risks of adverse events. Young adults with more than 1 of these conditions faced risks comparable with those observed in middle-aged adults without them. More than half of these patients requiring hospitalization were Black or Hispanic, consistent with prior findings of disproportionate illness severity in these demographic groups."
Source: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2770542
Commentary: Turns out young adults aren't exempt from COVID-19's consequences after all. That's not a surprise to anyone who has been following the disease since the early days, but it bodes ill for colleges and universities that have opened up on the presumption that younger people will be less impacted.
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AstraZeneca's phase 3 trial on hold. "The participant who triggered a global shutdown of AstraZeneca’s Phase 3 Covid-19 vaccine trials was a woman in the United Kingdom who experienced neurological symptoms consistent with a rare but serious spinal inflammatory disorder called transverse myelitis, the drug maker’s chief executive, Pascal Soriot, said during a private conference call with investors on Wednesday morning.
The woman’s diagnosis has not been confirmed yet, but she is improving and will likely be discharged from the hospital as early as Wednesday, Soriot said.
The board tasked with overseeing the data and safety components of the AstraZeneca clinical trials confirmed that the participant was injected with the company’s Covid-19 vaccine and not a placebo, Soriot said on the conference call, which was set up by the investment bank J.P. Morgan.
Soriot also confirmed that the clinical trial was halted once previously in July after a participant experienced neurological symptoms. Upon further examination, that participant was diagnosed with multiple sclerosis, deemed to be unrelated to the Covid-19 vaccine treatment, he said.
On Wednesday, the company issued a statement, attributed to Soriot, saying AstraZeneca would be guided by a committee of independent experts in determining when to lift the hold on the trial “so that we can continue our work at the earliest opportunity to provide this vaccine broadly, equitably and at no profit during this pandemic.”
AstraZeneca’s is the first Phase 3 Covid-19 vaccine trial known to have been put on hold. Such holds are not uncommon, and it’s not clear yet how long AstraZeneca’s will last.
“To have a clinical hold, as has been placed on AstraZeneca as of yesterday, because of a single serious adverse event is not at all unprecedented,” Francis Collins, the director of the National Institutes of Health, told a Senate panel on Wednesday. “This certainly happens in any large-scale trial where you have tens of thousands of people invested in taking part, some of them may get ill and you always have to try to figure out: Is that because of the vaccine, or were they going to get that illness anyway?”"
Source: https://www.statnews.com/2020/09/09/astrazeneca-covid19-vaccine-trial-hold-patient-report/
Commentary: Despite how it sounds, this is a good thing. This means the process is working as intended, that safety checks and safeguards are not being suppressed or overrun in the name of expediency or political convenience. Phase 3 trials unearth rare but serious complications of any medicine, and it's good to see that the trials are finding what they're supposed to find - and that the manufacturer is being transparent about it.
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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.