Coronavirus Tidbits #65 7/10/20

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Announcements:

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

Tidbits will likely be a bit shorter and a little less frequent for the next little bit. I have been immersed in it and I need to spend a little more time on self-care, which for me means seeing the spring flowers emerge and digging in the dirt.

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

My talk for the Camden Public Library on Resilience–my family’s Holocaust story–and parallels to current events was quite well-received. You can watch it here: https://www.youtube.com/watch?time_continue=1&v=m4_D-IUGEIM&feature=emb_logo&t=8s

 

News 

Chinese Embassy warns of unknown pneumonia deadlier than COVID-19 in Kazakhstan – ?disinformation/spread the blame or real?

The unknown pneumonia in Kazakhstan caused 1,772 deaths in the first six months of the year, including 628 people in June alone. “The fatality rate of the disease is much higher than COVID-19,”

https://www.globaltimes.cn/content/1194082.shtml

7/10 am update: Kazakh government points to WHO guidelines on registering cases with Covid-like symptoms as pneumonia “when the coronavirus infection is diagnosed clinically or epidemiologically but is not confirmed by laboratory testing” https://cnn.it/38FWBzs

Unclear if this is due to problems w testing and reporting (most likely) or something new.

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Women are most affected by pandemics — lessons from past outbreaks

The social and economic impacts of COVID-19 fall harder on women than on men. Governments need to gather data and target policy to keep all citizens equally safe, sheltered and secure.

Nature Clare Wenham, et al. 08 JULY 2020

Women are affected more than men by the social and economic effects of infectious-disease outbreaks. They bear the brunt of care responsibilities as schools close and family members fall ill1,2. They are at greater risk of domestic violence3 and are disproportionately disadvantaged by reduced access to sexual- and reproductive-health services. Because women are more likely than men to have fewer hours of employed work and be on insecure or zero-hour contracts, they are more affected by job losses in times of economic instability2.

https://www.nature.com/articles/d41586-020-02006-z

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COVID-19 imperils access to HIV drugs

In a survey to gauge the impact of the COVID-19 pandemic on access to HIV drugs, the WHO found that 73 countries reported they are at risk of stock-outs, with 24 reporting critically low drug levels or supply disruptions resulting from travel restrictions and limited access to regular health services. The WHO described the findings of the survey, done in advance of the International AIDS Society biannual conference, today in a statement.

An earlier modeling study conducted by the WHO and UNAIDS projected that a 6-month disruption in access to antiretroviral medicines could double AIDS-related deaths in sub-Saharan Africa in 2020. In today’s statement, the WHO said one-third of all people on HIV treatment globally are from the 24 countries already experiencing shortages.

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Hospital ratings depend on hospitality, not results. 

“A study of 50,000 patients throughout the United States showed that those who were the most satisfied with their care (the top quartile) were 26 percent more likely to be dead six months later than patients who gave lower ratings to their care.

I certainly saw this at multiple hospitals where I’ve worked. Redesigned and rebuilt to look like hotels, at the expense of functional patient care.

https://www.washingtonpost.com/health/hospital-ratings-often-depend-more-on-nice-rooms-than-on-health-care/2020/07/02/ac138fc8-b582-11ea-aca5-ebb63d27e1ff_story.html

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WHO coronavirus inquiry aims to ‘stop the world being blindsided again’

Former New Zealand prime minister Helen Clark says WHO director general said during early days he was ‘screaming every day but no one is listening’

She adds, “This isn’t going anywhere anytime soon. I am told by informed sources in Geneva that it will be at least two-and-a-half years until there could be a widely available vaccine – at least. That’s not very encouraging really.”

https://www.theguardian.com/world/2020/jul/10/helen-clark-who-coronavirus-inquiry-aims-to-stop-the-world-being-blindsided-again?CMP=Share_iOSApp_Other

Drugs:

Sobering Data on Risks of Short-Term Oral Corticosteroids

— Short steroid bursts (like a Medrol Dose-Pak) linked to serious adverse events within a month

For people taking oral steroids over a median 3 days, the risk of such events was elevated in the 5-30 days after steroid therapy initiation compared with the reference period (5-90 days before initiation):

  • GI bleeding: 27.1 per 1,000 person-years (incidence rate ratio 1.80, 95% CI 1.75-1.84)
  • Sepsis: 1.5 per 1,000 person-years (IRR 1.99, 95% CI 1.70-2.32)
  • Heart failure: 1.3 per 1,000 person-years (IRR 2.37, 95% CI 2.13-2.63)

 

Diagnostics:

still an incredible, negligent lack of testing.

Point-of-care antibody tests – podcast – Not ready for prime time

There are three different types of serologic testing: one called an enzyme-linked immunosorbent assay, called an ELISA, one called a lateral flow immunoassay, or an LFIA, or a chemiluminescent immunoassay, called a CLIA. What they discovered, first of all, is how sensitive they are — that is, if you have it, are these tests sensitive enough to determine whether that’s true or not? It ranged as low as 66% for the LFIA test to the highest of 97.8% in CLIA. Then they looked at also the specificity — that is, if it says it’s positive, is it truly positive? There was a variety among those as well.

Also, by the way, it determines on when you get the test. If you get the test within the first 2 weeks of infection, you’re not likely to detect it. You have to wait for at least 3 weeks after the infection. In essence, what they concluded is that the current available evidence does not support continued use of existing point-of-care serologic testing.

Devices:

Increasingly sound data on value of masks, and yet we also have more problems w freedumb fighters refusing to mask and/or threatening others.

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FDA Official Casts Doubt on ‘Challenge Trials’ for COVID Vaccine (Politico) A top FDA official overseeing vaccine approvals raised doubts Wednesday about the possibility of intentionally infecting people with the coronavirus to see whether vaccines work, saying that could represent “ethical heartburn” because there’s still no easy way to treat the potentially severe disease.

Epidemiology/Infection control:

@WHO amended it’s official assessment of how #SARSCoV2 is spread.

Yes, it’s microscopic droplets that linger suspended in enclosed airspaces so, yes, you can catch it in a restaurant, bar, jail cell, cocktail party…

https://www.who.int/news-room/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions

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Also more outbreaks in prisons, no surprise.

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Prison COVID-19 cases five times higher and prison COVID-19 death rate three times higher than general population

July 8, 2020

A new analysis led by researchers at Johns Hopkins Bloomberg School of Public Health found that the number of U.S. prison residents who tested positive for COVID-19 was 5.5 times higher than the general U.S. population, with a prisoner case rate of 3,251 per 100,000 residents as compared to 587 cases per 100,000 in the general population.

The researchers also found the death rate of U.S. prisoners was 39 deaths per 100,000 prison residents, higher than that of the U.S. population at 29 deaths per 100,000 people. After adjusting for age and sex differences between the two groups, the death rate would be three times higher for prisoners compared to the general U.S. population.

The findings were published online in a research letter July 8 in JAMA.

http://outbreaknewstoday.com/prison-covid-19-cases-five-times-higher-and-prison-covid-19-death-rate-three-times-higher-than-general-population-68245/

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It’s Time to Begin a National Wastewater Testing Program for Covid-19 (STAT)

With states hitting their limits on testing, we need new tools for understanding Covid-19 transmission. A national wastewater surveillance program offers a cost-effective approach to track Covid-19 across the majority of the U.S. population and provide early warnings of resurgence.

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In the new paper (not yet peer reviewed), the team analyzed real-time data from four sources, in addition to Google: Covid-related Twitter posts, geotagged for location; doctors’ searches on a physician platform called UpToDate; anonymous mobility data from smartphones; and readings from the Kinsa Smart Thermometer, which uploads to an app. It integrated those data streams with a sophisticated prediction model developed at Northeastern University, based on how people move and interact in communities.

https://www.nytimes.com/2020/07/02/health/santillana-coronavirus-model-forecast.html?

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Long Haulers

new study from @JAMA_current: of 143 patients discharged from hospital with #COVID19 (average age 56), only 13% were symptom-free an average of 2 months later. Fatigue, trouble breathing, joint pain, chest pain in >20%. https://bit.ly/2BXSCST

Tips, general reading for public:

StayAtHome

Wash your hands.

Rinse and repeat.

Resources on whether/how schools should reopen: 

the overall incidence of COVID-19 cases was 51 per 100,000 population among children 0-9 years old and 118 per 100,000 among those 10-19, compared to 492 per 100,000 among those 30-39 years old and 902 per 100,000 among those over 80 years old.

A lower rate of reported COVID-19 among children, however, does not mean a lower rate of infection. Children may be more likely to have asymptomatic or milder disease.

number of deaths in those under age 15 remains very low—less than 30 as of June 20, 2020—with underlying conditions playing a central role in these relatively isolated poor outcomes.

Multisystem inflammatory syndrome (MIS-C) in children is rare, affecting two per 100,000 compared to COVID-19 infection which affects 322 per 100,000 for the same age group.

children are more likely infected by their parents or other adults in the household rather than the reverse.

https://preventepidemics.org/wp-content/uploads/2020/07/Reopening-Americas-Schools_07-08-2020-Final.pdf

This appears to be the most detailed and thoughtful one.

See also:

Continued closures risk “scarring the life chances of a generation of young people,” according to an open letter published this month and signed by more than 1500 members of the United Kingdom’s Royal College of Paediatrics and Child Health (RCPCH). Virtual education is often a pale shadow of the real thing and left many parents juggling jobs and childcare. Lower-income children who depend on school meals were going hungry. And there were hints that children were suffering increased abuse, now that school staff could no longer spot and report early signs of it. It was time, a growing chorus said, to bring children back to school.

So far, with some changes to schools’ daily routines, he says, the benefits of attending school seem to outweigh the risks—at least where community infection rates are low and officials are standing by to identify and isolate cases and close contacts.

https://www.sciencemag.org/news/2020/07/school-openings-across-globe-suggest-ways-keep-coronavirus-bay-despite-outbreaks

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EPA Approves First Surface Disinfectant Products Tested on the SARS-CoV-2 virus

Last week, EPA approved two products, Lysol Disinfectant Spray (EPA Reg No. 777-99) and Lysol Disinfectant Max Cover Mist (EPA Reg No. 777-127), based on laboratory testing that shows the products are effective against SARS-CoV-2.

https://wasteadvantagemag.com/epa-approves-first-surface-disinfectant-products-tested-on-the-sars-cov-2-virus/

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Methanol (toxic) contaminating some hand sanitizers

FDA notes sharp increase in hand sanitizer products that are labeled to contain ethanol (also known as ethyl alcohol) but that have tested positive for methanol contamination.

Methanol, or wood alcohol, is a substance that can be toxic when absorbed through the skin as well as life-threatening when ingested. Methanol is not an acceptable active ingredient for hand sanitizers and must not be used due to its toxic effects. Pls report adverse events or quality problems experienced with the use of hand sanitizers to FDA’s MedWatch Adverse Event Reporting program.

A list of products/mfg is here: https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitizers-methanol#products

includes Bluemen, Assured, Hello Kitty, Honeykeeper Hand Sanitizer, Klar and Danver, and more.

 

Politics:

The sh*t show continues unabated…

As the country passed 3 million cases, NIAID Director Anthony Fauci cautioned against the “false narrative” of a falling death rate, which President Trump later announced on twitter(New York Times).

From Fauci being excluded from Covid meetings and being muzzled to this:

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and the escalation in lies and interference with medical experts re school reopening and everything else.

“I’m not going to get into who’s right and who is wrong,” FDA Commissioner Dr. Stephen Hahn says when pressed about the misleading claim President Trump made — that 99% of coronavirus cases in America are “totally harmless” https://cnn.it/3gufw2Y #CNNSOTU

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Trump lied that 99 percent of coronavirus cases are “totally harmless.” “I’m trying to figure out where the president got that number,” Fauci “That’s obviously not the case.”

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Update: COVID-19 among Workers in Meat and Poultry Processing Facilities

Trump declared meat processors essential workers w/o providing any additional protections…part of his contempt for POC. 

Why has he done nothing re protections or securing PPE for anyone? Criminal neglect, imho.

Among 23 states reporting COVID-19 outbreaks in meat and poultry processing facilities, 16,233 cases in 239 facilities occurred, including 86 (0.5%) COVID-19–related deaths. Among cases with race/ethnicity reported, 87% occurred among racial or ethnic minorities. Commonly implemented interventions included worker screening, source control measures (universal face coverings), engineering controls (physical barriers), and infection prevention measures (additional hand hygiene stations).

https://www.cdc.gov/mmwr/volumes/69/wr/mm6927e2.htm

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Feel good du jour:

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Comic relief:

https://twitter.com/adams2011/status/1281234006256898048?s=20

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Perspective/Poem

Great perspective from Andy Slavitt:

https://twitter.com/ASlavitt/status/1280641665997438978?s=20

see https://threadreaderapp.com/thread/1280641665997438978.html for the whole thread

Bits of beauty:

 

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