Coronavirus Tidbits #105 12/20/20
News Diagnostics Drugs Devices Epidemiology/Infection control Tips Politics Feel good du jour Comic relief Perspective/Poem Bits of beauty
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.
Racial disparities in O2 monitoring
“Black patients had nearly three times the frequency of occult hypoxemia that was not detected by pulse oximetry as White patients“— Aidan Baron (@Aidan_Baron) December 17, 2020
This is shattering https://t.co/aZMJmJIt2z
More thorough explanation of pervasiveness of racial bias–even in oximeters–at:
Here is the medical journal article:
Must read.— Utibe R. Essien, MD MPH (@UREssien) December 17, 2020
“Black patients had ~3x more hypoxemia that was not detected by pulse oximetry as White patients.
…reliance on pulse oximetry to triage patients and adjust supplemental oxygen levels may place Black patients at ⬆️ risk for hypoxemia.”
Link: https://t.co/qqwal7GKHg pic.twitter.com/cC8HnjNuFv
~ ~ ~
A new mutation appeared in southern England. It does not appear more deadly or resistant to vaccines, but has been spreading more rapidly.
This study looked back almost 40 years to see how 229E, a common cold coronavirus, evolved relative to antibodies collected at different times. Antibodies collected recently neutralized all historical 229E isolates, but those in the past couldn't neutralize more recent 229E CoVs.— Dr. Angela Rasmussen (@angie_rasmussen) December 18, 2020
While the talk of mutations is somewhat disturbing, thoughts are currently that a) the vaccines are very effective but might have to have minor changes =>
b) so may be like the flu vaccine, which needs a slight change in formulation each year
~ ~ ~
Full text of their important publication and link to the @NICEComms guideline https://t.co/e7Ks1ISkaR pic.twitter.com/FfbJWIdXt5— Eric Topol (@EricTopol) December 19, 2020
~ ~ ~
Fiasco with Pfizer vaccine distribution
states told they would receive between 25%-40% fewer vaccine doses than originally projected. . . and Trump blamed Pfizer for not shipping the vaccine…and Pfizer said they were awaiting orders from the Feds.
raising questions of a) was Trump retaliating against Governors who had crossed him? b) Is Jared diverting doses to their cronies?
What happened to the Pfizer vaccine that was supposed to be shipped?
Tens of thousands of Americans who might not have to die being put at inexplicable risk of it while vaccine that's good to go sits on the shelves with nowhere to go because the federal government won't tell the company that makes and stores that vaccine where to ship it. (?!) pic.twitter.com/lRvLxrnzMB— Maddow Blog (@MaddowBlog) December 18, 2020
~ ~ ~
Now General Gus Perna, who runs logistics for Operation Warp Speed, says he made a forecasting error. This follows “labeling confusion that caused hospital pharmacists at several health systems to throw away one in every six doses of the first vaccines distributed.”
Ellume–1st at-home diagnostic
still an incredible, negligent lack of testing.
Ellume diagnostic correctly identified 96 percent of positive samples and all negative samples in patients displaying symptoms of COVID-19. Results dropped slightly in those without symptoms, to 91 percent for positive samples and 96 percent for negative samples.
~ ~ ~
Disparities mounting in testing:
FDA issued an EUA for the first over-the-counter, at-home, rapid diagnostic test for COVID-19. The Ellume COVID-19 Home Test, authorized for individuals 2 years old and older, with or without symptoms, detects proteins of the SARS-CoV-2 virus from a nasal swab sample. It can be used completely at home without a prescription and requires the use of a compatible smartphone and a downloadable app.
This will again leave poor and rural communities in the dust.
Moderna vax receives EUA (Emergency Use Authorization) as expected, by FDA
Data looks excellent re efficacy and suggests the vaccine may protect against asymptomatic infections, a key consideration in a vaccine’s usefulness for preventing the spread of the virus to others.
A reminder that this vaccine, which Moderna will market and profit from, was made from taxpayer funded discoveries, as I wrote about in “The People’s Vaccine”
~ ~ ~
Crafty pharmacists found that five-dose vials of Pfizer's vaccine contained enough for six or seven doses.— Lauren Morello (@lmorello_dc) December 16, 2020
Now, after a whole bunch of confusion, FDA says those extra doses can be used — boosting supply by up to 40%, @owermohle & @rachel_roubein report. https://t.co/gLjFhu6TlI
~ ~ ~
“However, since the vials are preservative free, it is critical to note that any further remaining product that does not constitute a full dose should not be pooled from multiple vials to create one,” the FDA said in a statement.
~ ~ ~
“Of course, it’s painless… it’s convenient, and getting in touch and meeting NHS staff and saying thank you to them for how hard they’ve been working is a bonus, I would have no hesitation in recommending it to anyone. I feel very lucky to have had the vaccine.”— Jack Blackburn (@HackBlackburn) December 16, 2020
~ ~ ~
NEW: Stanford used an algorithm to decide who got the #COVID #vaccine first, and the result was only 7 of the first 5,000 slots went to residents… the same week they were asked to volunteer for ICU coverage in anticipation of a surge in COVID-19 cases.https://t.co/tupAeyHudx pic.twitter.com/gr5CaPoV7G— Caroline Chen (@CarolineYLChen) December 18, 2020
~ ~ ~
Pfizer’s temperature sensors fiasco. What’s an extra $25 million when people are hungry and homeless?
Pfizer “planned to disconnect temperature-monitoring sensors on the containers once they were delivered to health care providers — though many of the providers needed to use the boxes to store the vials for up to 30 days. Without the monitoring systems, providers would have no way of knowing if the vials had thawed prematurely, rendering the vaccine unusable.
In the end, the U.S. government’s Operation Warp Speed scrambled to address the problem, signing a $25 million deal in mid-November with Controlant Global, an Icelandic company that created the proprietary temperature-monitoring platform for all Pfizer’s shipping containers. Under this agreement, Pfizer will discontinue its temperature monitoring once the boxes arrive at their destination, and the federal government will simultaneously turn the system back on.”
~ ~ ~
Major differences between Pfizer and Moderna vaccines:
So far, efficacy and side effects are ~same.
“Moderna vaccine will be far easier to use than Pfizer’s. For starters, Moderna’s must be shipped at -4 Fahrenheit; Pfizer’s must be shipped and stored at -94 Fahrenheit. The former is the temperature of a regular refrigerator freezer; the latter requires special ultra-cold freezers that need to be topped up with dry ice every five days. Doctors’ offices do not have ultracold freezers; neighborhood pharmacies don’t either.
After thawing, a vial of the Pfizer vaccine must be used within five days; Moderna’s is stable at fridge temperature for 30 days and at room temperature for 12 hours.
Pfizer vaccine. The minimum amount of vaccine a location can order is 975 doses. A large teaching hospital might need several of those. But there are plenty of places across the country that don’t need 975 doses to vaccinate the people currently eligible for vaccination — health workers and nursing home residents. This is the vaccine that needs to be kept at -94 F. The minimum order size will limit the locations in which this vaccine can be used.
The Moderna vaccine’s minimum order is 100 doses, a much more manageable number.
The Pfizer vaccine is shipped in five-dose vials; Moderna’s vaccine is shipped in 10-dose vials.
see Diagnostics — Ellume test
Infuriating, self-centered people
lede of the day, possibly the year https://t.co/U6GjPeLk1Z pic.twitter.com/ZGaNmGxB7B— Johann Gambolputty de von Ausfernschplenden(con't) (@samthielman) December 16, 2020
~ ~ ~
Disaster waiting to unfold: A wild mink has Covid-19
“It started in nature. A coronavirus that originated in bats has wound up in humans, causing the Covid-19 pandemic.
And it can go back to nature.
The SARS-CoV-2 virus can jump again, from humans, back into animals, back into wildlife, where it can wait, mutate, and change. Perhaps, years from now, it can infect people again.
But now a wild mink in Utah tested positive for the coronavirus. A genetic analysis of the virus suggested the wild mink picked it up from a nearby mink farm, perhaps via wastewater runoff from the farm.”
~ ~ ~
COVID-19 Vaccines and Herd Immunity
A very detailed explanation by Marc Lipsitch, Director Harvard’s @CCDD_HSPH (Center for Communicable Disease Dynamics)
Tips, general reading for public:
Wash your hands.
Rinse and repeat.
We live in a system where the people who most fervently denied and downplayed the coronavirus are among the first to receive the vaccine. This is so despicable. https://t.co/zOZknFFR8i— Gabrielle (@GabsOnClarkSt) December 18, 2020
~ ~ ~
Blocking critical funds in a pandemic is an act that knowingly creates hunger, eviction, & desperation.— Alexandria Ocasio-Cortez (@AOC) December 18, 2020
Republicans fearmonger about “violence,” but what is knowingly creating hunger, eviction, sickness if not violence?
If you care about deficits so much, then tax the rich. https://t.co/8voFkLrLx2
~ ~ ~
Wal Mart's Walton Family have pocketed $48 billion since March.— Ilhan Omar (@IlhanMN) December 17, 2020
They recently stopped paying hazard pay.
Jeff Bezos has made $90 billion.
2,000 of his workers have been infected with COVID.
Meanwhile, millions of out of work Americans have not gotten any support since March.
~ ~ ~
Can I let you in on a secret? We have the money to extend unemployment benefits and send the American people $1,200 direct payments.— Robert Reich (@RBReich) December 17, 2020
The Pentagon spends $2,000,000,000 a day.
~ ~ ~
“We want them infected.”— Dan Diamond (@ddiamond) December 16, 2020
Trump appointee repeatedly urged top health officials to let millions of Americans contract Covid-19. His plan? “Herd immunity,” per a @COVIDOversight probe.
~ ~ ~
~ ~ ~
Wow: Florida manipulated their Covid-19 death reporting to make it seem like their deaths were dropping precipitously in the weeks before the election, when, in fact they were holding steady. https://t.co/3hwOqqJHiG pic.twitter.com/UA8olrMneE— Jud Lounsbury (@JudLounsbury) December 16, 2020
~ ~ ~
Feel good du jour:
Brilliant strategy, but tragic that it was necessary for an individual to take this on:
Surgeon Fills COVID-19 Testing Gap in Philadelphia’s Black Neighborhoods https://t.co/KcAayPj849 via @JAMA_current part of @JAMANetwork— Madhu⚕️ Singh, MD (@thinkalot) December 16, 2020
Well done! I wish individuals didn't have to step in but our #covid19 response has been abysmal in so many, many ways
~ ~ ~
This cute mofo right here. pic.twitter.com/aS0sJi1dcQ— roxane gay (@rgay) December 19, 2020
~ ~ ~
Santa Claus will be coming to town this year, Dr. Anthony Fauci says.— CNN (@CNN) December 19, 2020
“I took care of that for you,” he says. “…I took a trip up there to the North Pole; I went there and I vaccinated Santa Claus myself. I measured his level of immunity, and he is good to go.” #CNNSesameStreet pic.twitter.com/CNJ520XTew
~ ~ ~
This is really nice to see. Thanks for calling my attn to it @DrRobertGlatter and @scopedbylarry #Music healing the soul https://t.co/uiTlkckBwW— Judy Stone (@DrJudyStone) December 19, 2020
~ ~ ~
~ ~ ~
Bits of beauty:
Joe R McDaniel
What about using the Ellume test for batch testing? At $5/test, I would just test individually (assuming readily-available test kits], but at $30 and with availability, why not test everyone in the family with one test and only do individual testing if anyone was positive?
You could readily do batched tests with saliva samples, but Ellume uses a nasal swab, which you wouldn’t want to share. I don’t know if you could use different swabs in the same solution, or too much would be absorbed by multiple swabs and give erroneous results. Some tests require specific kind of material for the swab (e.g. calcium alginate). Interesting idea, but saliva would be the way to go.