Coronavirus Tidbits #102 12/9/20

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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.

Chanukah begins tomorrow night at sundown. In that spirit, this seemed apt:

News 

Greatly encouraging results from Pfizer released today.

Red = Covid infections in Placebo group; Blue = vaccine group. Darker spots are severe cases.

See Drugs section, below for details

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President-elect Biden brings hope back by naming competent people to important roles:

I can’t remember when I’ve seen such rejoicing in #MedTwitter #IDTwitter communities!

I wrote about his Covid Task Force picks here, incl Drs. Vivek Murthy, Marcella Nunez-Smith, David Kessler, Celine Gounder, Rick Bright, and more…

 

Diagnostics:

still an incredible, negligent last of testing.

Drugs:

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The Art of the Deal guru turned down 100 million doses of the Pfizer vaccine, knowing preliminary data showed good efficacy. Was it because they refused to be part of Operation Warp Speed–though 45 is claiming credit? Or because they didn’t release results before the election? Or simply because of stupidity?

Reportedly also turned down more of Moderna’s.

Gottlieb says that some of Pfizer’s supply *manufactured in Michigan* will be exported to satisfy foreign contracts by April. Months before most Americans are expected to get a vaccine.

And the Feds are ill-prepared to distribute the vaccine, especially to rural America:

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Instead, the feds developed this mess of a system – a “fumbling” effort by “inexperienced” people with no background in supply chain logistics, manufacturing, disaster preparedness, or healthcare.

We learned very early in this pandemic that our national strategy was one of bluster & photo ops — not one of doing the hard work to get supplies in the hands of those who need them.

For PPE, we set up workarounds – groups like @getusppe developed data networks & equitable distribution strategies. https://getusppe.org/data For testing, the country relied on public-private partnerships, like RI’s work with CVS. https://cnbc.com/2020/04/06/cvs-launches-drive-thru-rapid-testing-in-rhode-island-and-georgia.html

But let’s be clear: these efforts are simply SUBSTITUTES for a federal strategy. And there is no way that they are equivalent to a good, organized, all-50-state, publicly-funded effort.

Which brings me to vaccines. Alarm bells have been ringing about the lack of strategy for vaccine manufacturing, distribution, & messaging, for months.

In September, @healthyamerica1  & @DavidLakey_MD  wrote a piece in @statnews

imploring “Operation Warp Speed” to come up with a plan. Simultaneously, potential breakdowns in the cold-storage distribution chain were highlighted, by @pharmalot  and others:

In OCTOBER, @ASTHO  sounded the alarm that they *still* had no funds & no federal guidance on strategy. https://astho.org/Press-Room/Public-Health-Leaders-Request-COVID-19-Vaccine-Infrastructure-and-Administration-Funding/10-15-20/… (pdf from 11/20: https://astho.org/COVID-19/Vaccine-Distribution-and-Implementation-in-States-and-Territories-Brief/…)

As of NOVEMBER – despite knowing that multiple Phase 3 trials were nearing the end, & despite earlier promises to release vaccines pre-election – there was still no central repository for distribution plans, according to @KHNews Not to mention that months on, NO ONE is talking about how to handle longstanding, well-founded mistrust from Black & brown communities, as outlined so beautifully by @DrBrittaniJ. Without trust, even the best supply chain is useless. Let’s be clear: Almost 300K Americans have died. Another 300K will likely die before inauguration. And a vaccine is *the best chance we have* at getting things back to normal, quickly. But what good is a vaccine, if it stays on the shelves? ~ ~ ~

More on the story behind mRNA’s development: 

https://www.statnews.com/2020/11/10/the-story-of-mrna-how-a-once-dismissed-idea-became-a-leading-technology-in-the-covid-vaccine-race/

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Devices:

Interesting jury-rigged room air filter. 

https://www.wired.com/story/could-a-janky-jury-rigged-air-purifier-help-fight-covid-19/

Sounds promising; Linsey Marr, VT airborne transmission expert, responded to my inquiry:

Yes, there is theoretical and observational evidence that it works. It’s the @CorsIAQ box!

This was also rec by another: https://www.texairfilters.com/how-to-improve-the-efficiency-of-the-box-fan-and-merv-13-filter-air-cleaner/

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CDC has new guideline on ventilation

incl: Use fans to increase the effectiveness of open windows. To safely achieve this, fan placement is important and will vary based on room configuration. Avoid placing fans in a way that could potentially cause contaminated air to flow directly from one person over another. One helpful strategy is to use a window fan, placed safely and securely in a window, to exhaust room air to the outdoors. This will help draw fresh air into room via other open windows and doors without generating strong room air currents.

In homes and buildings where the HVAC fan operation can be controlled at the thermostat, set the fan to the “on” position instead of “auto,”

https://www.cdc.gov/coronavirus/2019-ncov/community/ventilation.html

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Epidemiology/Infection control:

Fascinating study:

Original Korean journal article: https://jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e415

“Per Zeynep: https://zeynep.substack.com/p/small-data-big-implications

If you just want the results: one person (Case B) infected two other people (case A and C) from a distance away of 6.5 meters (~21 feet) and 4.8m (~15 feet). Case B and case A overlapped for just five minutes at quite a distance away. These people were well beyond the current 6 feet / 2 meter guidelines of CDC and much further than the current 3 feet / one meter distance advocated by the WHO. And they still transmitted the virus.

[When is the last time you heard this phrase?:] First, just reading the study is an exercise in what it means to do a study really, really well, with the resources of a government that’s committed to generating useful information…

the initial case infected others the day before his symptom began—the fact that the window of highest infectivity includes the day before symptoms start has made this a very challenging pandemic.

This study confirms the results of an earlier fascinating study highlighting the risk of indoor dining…There, too, people were infected at far greater distances than 6 feet.

What we consider close contact for purposes of tracing and testing in this country (generally an unmasked interaction within less than six feet for more than fifteen minutes) is inadequate.

People sitting the next table over who had their backs to the airflow were not infected,

‘Only the visitors (cases A and C) sitting in the air flow path of case B were infected with COVID-19, while other visitors (V2, V3) closer to the infector for a longer period of time but in the absence of direct air flow did not become infected. In addition, the visitors sitting at tables with cases A and C (V1, V6, and V7) were not infected with COVID-19 because they faced away from the infector’s face.’

I (Zeynep) have not found a single outbreak traced to a movie theater.

We should follow Japan’s lead and discourage talking, especially loud talking indoors or on public transportation.””

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Tips, general reading for public:

StayAtHome

Wash your hands.

Rinse and repeat.

Politics:

This is going to be the story to watch in the near future.

This is what happens to scientists who do their job honestly. This is what happens to people who speak truth to power. I tell them my husband and my two children are upstairs… and THEN one of them draws his gun. On my children. This is Desantis’ Florida.

If Desantis thought pointing a gun in my face was a good way to get me to shut up, he’s about to learn just how wrong he was. I’ll have a new computer tomorrow. And then I’m going to get back to work. If you want to help, my website is still at floridacovidaction.com

[I’m not an attorney nor a computer geek, but two things immediately struck me about this:

Reports: “users in the StateESF-8.Planning group all use the same username and passwords⁠, but says, “once they are no longer associated…they are no longer allowed to access… the group.”

So if she did send an unauthorized message, she used an unsecured system with her old credentials…

How irresponsible for a government agency (or anyone) to have such lax security!

And for this, heavily armed goons raid her house?]

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Feel good du jour:

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https://twitter.com/InactionNever/status/1335720904131743748?s=20

Comic relief:

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Perspective/Poem

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This must have taken enormous determination:

More about Mr. Wilhelmsen at https://abc7news.com/covid-patient-plays-violin-health-care-workers-utah-hospital-icu/8100070/ He has since died…

Here is a lovely profile of him:

…One memorable repair came when Wilhelmsen began a new teaching assignment. He found a violin under his desk that had been sitting there for several years. The case had been crushed, run over by a car tire, and half of the violin was a mesh of pieces. Wilhelmsen figured he would try to put it back together, spending hours piecing and gluing the pieces, one time even holding two pieces together while he conducted so the pieces could dry because he didn’t have a small enough clamp. The violin is still being played by students up in the Bear River area, Wilhelmsen said.

“Some violins are not worth resurrecting, but forgive me for saying this,” as Wilhelmsen got slightly emotional, “each instrument has a soul, and it speaks to me. There are ones that say, ‘I’m done,’ so I find something else for them to do, like using parts from it. But for the most part, most musical instruments in a school setting can’t afford to be replaced, so teachers say, ‘What can you do to repair them?’”

‘Music is not what I do, it’s who I am.’

https://www.standard.net/entertainment/music/harrisville-violin-doctor-strings-along-his-patients/article_f620a0ae-7646-5dd3-bd60-d59fd35cf8ba.html

Bits of beauty:

Latest piece by Mark Skinner. Cherry, abalone, and infinite patience.

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