Coronavirus Tidbits #100 12-3-20

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Announcements:

First, there is now a Resources Page here for the most commonly asked questions I’m getting.

Happy to continue to answer your questions/concerns as best I can, so don’t be shy about that.

News 

More good news about Moderna’s vaccine. See below in Drugs.

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Change in recs from CDC

CDC is cutting quarantine for potential exposure to 10 or seven days, depending on one’s test results and symptoms.

If individuals do not develop symptoms, they need only quarantine for 10 days; if they test negative, that period can be reduced to just one week.

(This change is not ideal, but is pragmatic decision, hoping more people will comply if the period is shortened.)

For the upcoming holiday season, the CDC is recommending people stay home — just as it did before the Thanksgiving holiday.

But if people do travel, the guidelines are that individuals should get a coronavirus test one to three days before travel and then three to five days after travel, combined with quarantine for seven days after arriving.

https://www.npr.org/2020/12/02/941355347/cdc-shortens-its-covid-19-quarantine-recommendations?

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2/Underlying causes are complex. Low oxygen; metabolic irregularities. Inflammatory response in the brain—activation of microglia & cytotoxic T cells—and other signs of neuropathy have also been observed.

3/Loss of smell/taste: 40-60% of patients develop loss of smell; ~90% have alteration of smell. Many recover sense of smell, others have more severe cases, possibly permanent loss of smell. Virus invades cells in vicinity of olfactory nerve; unclear if it directly invades nerve

4/Long COVID: ~10-35% suffer persistent symptoms, mostly neurological: autonomic nervous system dysfunction, sleep disturbance, pain syndromes, dizziness, cognitive difficulties. In one series of hospitalization, 1/3 suffered memory loss post-discharge/

https://www.sciencedirect.com/science/article/pii/S030439402030803X?via%3Dihub

Worth looking at the entire thread w illustrations

Diagnostics:

still an incredible, negligent lack of testing.

Drugs:

Excellent news about Moderna’s vaccine:

The two-dose vaccine was 94.1% effective based on a total of 196 cases of symptomatic Covid-19 occurring in the company’s 30,000-volunteer study. That means that 185 cases of Covid-19 occurred in those who received a placebo injection, which was given to half the volunteers. Just 11 cases occurred in those volunteers who received the vaccine. NO severe cases occurred in the vaccine group.

Pfizer has said it will be able to provide the U.S. government 25 million doses in December — enough to vaccinate 12.5 million people. Moderna expects to hand over 15 million doses this year, which would cover 7.5 million vaccinations.

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FDA’s scientific advisers are holding a public meeting Dec. 10 to review Pfizer’s request for an Emergency Use Authorization (EUA), and send a recommendation to the FDA.

They have also scheduled a meeting of its Vaccines and Related Biological Products Advisory Committee (VRBPAC) on Dec. 17 to discuss the request for emergency use authorization (EUA) for a COVID-19 vaccine from Moderna Inc.

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CDC panel moves health workers, nursing home residents to front of COVID vaccine line

The Advisory Committee on Immunization Practices (ACIP) said there is no preferential order between HCWs and long-term care residents!

They also raised the possibility that, for the 1b phase, essential workers could be placed ahead of seniors and those with underlying medical conditions as a way to get people of color, known to be disproportionately affected by COVID-19 complications, higher on the priority list.

The CDC usually adopts ACIP’s guidance. States aren’t bound by ACIP recommendations (and Azar said distribution would be up to Governors).

The first available vaccine doses won’t cover all of those in the phase 1a group. Federal officials have projected that 40 million doses will be available by the end of December, which could vaccinate 20 million people, given that immunization requires two doses given about a month apart. The CDC estimates there are about 21 million US healthcare workers and 3 million people living in long-term care facilities

https://www.cidrap.umn.edu/news-perspective/2020/12/cdc-panel-moves-health-workers-nursing-home-residents-front-covid-vaccine

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Trump admin’s HHS Secretary Alex Azar and Dr. Birx reportedly want seniors at #1 to get the vaccine, as does CDC’s Redfield.

But “I recognize that they have suffered some of the greatest burden. But … we have no efficacy data in this population because it hasn’t been studied,” said Robert Atmar, an infectious diseases professor at Baylor College of Medicine. “We know from flu vaccine studies that this population tends to have less efficacy of flu vaccine compared to other persons.”

Earlier this fall, an expert panel established by the National Academy of Medicine also recommended that high-risk health care workers — who are now struggling to cope with a massive increase in cases — should be given access to Covid vaccines first.

https://www.statnews.com/2020/11/30/divisions-emerge-among-u-s-officials-over-when-first-covid-19-vaccine-doses-will-be-available-and-for-whom/?

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Oh and for those saying “but what about long term effects like in two years?” Covid has known long term effects. Many people who were sick in the spring are still having effects now. And the long-term risks remain unknown, though precedent with viruses is not encouraging.

Nothing in life is risk free, but in this case the risk calculus, both for others and completely selfishly, is simple and overwhelmingly in favor of getting vaccinated

Devices:

PPE supplies still desperately short – grassroots supply networks are trying to fill the void

(HCWs reusing N-95s for days…still.)

An analysis by Get Us PPE, a nonprofit group, found that while the PPE requests it received were almost evenly split between hospitals and nonhospital settings in April, in October over 90% of requests were from facilities such as homeless shelters, natural disaster relief groups, and nurses’ offices in schools. Smaller hospitals are also struggling.

China — the source of over 40% of the world’s PPE imports…

As of early November, Get Us PPE has been able to fulfill only about 10% of PPE requests received since March.

Epidemiology/Infection control:

Curious relationship between Mumps titers and Covid

What does it mean?

COVID-19 has presented various paradoxes that, if understood better, may provide clues to controlling the pandemic, even before a COVID-19 vaccine is widely available. First, young children are largely spared from severe disease. Second, numerous countries have COVID-19 death rates that are as low as 1% of the death rates of other countries. Third, many people, despite prolonged close contact with someone who is COVID-19 positive, never test positive themselves. Fourth, nearly half of people who test positive for COVID-19 are asymptomatic. Some researchers have theorized that the measles-mumps-rubella (MMR) vaccine may be responsible for these disparities. The significance of our study is that it showed that mumps titers related to the MMR II vaccine are significantly and inversely correlated with the severity of COVID-19-related symptoms, supporting the theorized association between the MMR vaccine and COVID-19 severity.

https://mbio.asm.org/content/11/6/e02628-20

SARS-CoV-2 infectiousness peaks in first week after symptom onset

mean viral shedding duration of 17 days (95% CI, 15.5-18.6). Seven studies reported on the shedding in the lower respiratory tract, with a mean of 14.6 days (95% CI, 9.3-20). In 13 studies, the mean duration of viral shedding in stool samples was 17.2 days (95% CI, 14.4-20.1)

https://www.healio.com/news/primary-care/20201130/sarscov2-infectiousness-peaks-in-first-week-after-symptom-onset

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Rates of influenza and even norovirus, a GI bug, are less than expected.

? if this is (in part) from benefits of social distancing, masks, and improved hand hygiene

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Wastewater testing predicts new COVID-19 cases five to 11 days before clinical testing identifies them.

AquaVitas (AZ State U) Partners With HHS, CDC on Wastewater Coronavirus Study

HHS will fund the procurement and testing of wastewater samples from water treatment plants of large and small communities nationwide. The first phase of the effort, which will last about six weeks, will analyze wastewater from up to 100 treatment plants serving about 10 percent of the US population.

Under a potential second phase, testing will continue for another nine weeks and include treatment plants in up to 42 states serving at least 30 percent of the US population.

AquaVitas, a spinout of Arizona State University, stands to receive up to $5.4 million in funding under the arrangement if both phases are completed, according to a company representative.

As the SARS-CoV-2 pandemic continues, wastewater epidemiology is increasingly being used to track the virus and potentially localize hotspots.

https://www.genomeweb.com/infectious-disease/aquavitas-partners-hhs-cdc-wastewater-coronavirus-study#.X8Yga86SnIU

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New Study Explains Why Africa Defied Dire Predictions to Survive Deadly Covid-19

This Day – By Onyebuchi Ezigbo

A new study by a consortium of African medical doctors has given reasons why the COVID-19 pandemic appeared not to have had the catastrophic effect on the health indices in most African countries, as earlier predicted. Factors, such as low population density in cities and communities, large young population, previous experience in epidemic control, and effects of medication used for related diseases in the past, were said to have produced the success rate some African countries have recorded so far.

The findings were contained in a 2020 research journal published by the Nigerian Medical Association (NMA). This is the first comprehensive research by African medical scientific research team to offer scientific explanation why the continent seems to have largely escaped doomsday predictions. Before the publication of the research findings, Western countries have been baffled why Africa with its weak healthcare infrastructure was spared the devastation the COVID-19 wrought on the West.

Africa was a feared destination of the killer coronavirus scourge due to poor health infrastructure heightened by hard-biting economic realities. Predictions by experts and credible organisations, such as the World Health Organisation (WHO), sent warning signals of an impending doom threatening to eclipse the continent should COVID-19 pandemic hit the countries in the region.

But 11 months down the line, absence of exponential growth and low mortality rates, contrary to the experience of other continents and projections for Africa by various agencies, has become a puzzle to many.

The study showed, “Despite weaker health care facilities and systems, the growth of cases in Africa has defied most predictions and has remained geometric and not exponential. Available data and statistics continue to reflect consistently lower numbers than those in other continents, except for the Oceania.

https://www.thisdaylive.com/index.php/2020/11/29/new-study-explains-why-africa-defied-dire-predictions-to-survive-deadly-covid-19/

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There are six new Covid cas​es every second. One American dies of COVID-19 every minute  

Tips, general reading for public:

StayAtHome

Wash your hands.

Rinse and repeat.

Politics:

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https://twitter.com/_Rawilcox/status/1332763344550367234?s=20

Coronavirus has been spread by prison guards coming and exiting the prison, and inmates are now on lockdown for it.

They haven’t been allowed to speak to loved ones via phone and letters they have written to loved ones are being held up. A letter that was written on November 10th still has not been sent out.

Inmates decided to throw away their food trays, in hopes that a hunger strike will get them a 30 minute phone call…

Long and sad thread.

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This is interesting since @UPMC wouldn’t even say if they would be quarantining the nurses who went, unmasked, on a bus to the Trump rally recently.

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Feel good du jour:

Worth a read…

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Comic relief:

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Perspective

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For more about this remarkable woman, see Women of Valor: Polish Jewish Resisters to the Third Reich by Joanne Gilbert

Bits of beauty:

 

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