Coronavirus Tidbits #75 8/20/20

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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 asking.

My new post on Forbes:

What Do Coronavirus And Lyme Disease Have In Common? More Than You Might Think

https://www.forbes.com/sites/judystone/2020/08/18/what-do-coronavirus-and-lyme-disease-have-in-common-more-than-you-might-think/#3b12660137e3

News 

wave of myocarditis (heart inflammation) in young athletes caused cancellation of some sports

In a new study from Germany, researchers studied 100 individuals, with a median age of just 49, who had recovered from Covid-19. Most were asymptomatic or had mild symptoms.

An average of two months after they received the diagnosis, the researchers performed M.R.I. scans of their hearts and made some alarming discoveries: Nearly 80 percent had persistent abnormalities and 60 percent had evidence of myocarditis. The degree of myocarditis was not explained by the severity of the initial illness.

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MGH researchers show children are silent spreaders of SARS-CoV-2

The infected children were shown to have a significantly higher level of virus in their airways than hospitalized adults in ICUs for COVID-19.

the viral loads of these hospitalized patients are significantly lower than a ‘healthy child’ who is walking around with a high SARS-CoV-2 viral load.”

“Kids are not immune from this infection, and their symptoms don’t correlate with exposure and infection,”

http://outbreaknewstoday.com/massachusetts-general-hospital-researchers-show-children-are-silent-spreaders-of-sars-cov-2-49362/

https://www.jpeds.com/article/S0022-3476(20)31023-4/fulltext

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Two decades of pandemic war games failed to account for Donald Trump

The scenarios foresaw leaky travel bans, a scramble for vaccines and disputes between state and federal leaders, but none could anticipate the current levels of dysfunction in the United States.

https://www.nature.com/articles/d41586-020-02277-6

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Diagnostics:

still an incredible, negligent lack of testing.

A group of epidemiologists, economists, and dreamers is plotting a new strategy to defeat the virus, even before a vaccine is found.

Excellent long-read on diagnostic testing aspects:

PCR very sensitive, but impractical d/t delayed results and detecting infections ~Day 3 of illness.

Pooled testing: is straightforward: Instead of testing each sample individually, laboratories combine some samples, then test that “pooled” sample as one. The technique was invented by Robert Dorfman, a Harvard statistician, to test American soldiers for syphilis during World War II. Today it is commonly used by public-health labs to test for HIV. It works as follows: A lab technician mixes 50 HIV samples together, then tests this pool. If the result is negative, then none of the patients has HIV—and the researcher has evaluated 50 samples with the same materials it takes to run one test.

But if the pooled sample is positive, a new phase starts. The technician pools the same specimens again, this time into smaller groups of 10, and retests them. When one of these smaller pools is positive, she tests each individual sample in it. By the end of the process, she has tested 50 people for HIV, but used only a dozen or so tests. This approach saves her hundreds of tests over the course of a day.

Pooling is a great first step to maximizing our test supply…but works best for diseases that are relatively rare,

Antigen tests: most less sensitive and less accurate, but fast and cheaper

e25 Bio has an antigen test to the spike protein part of the virus–test is like a pregnancy test — and detects infectious virus

Rate-limiting now is that the FDA requires tests to be 80% as accurate as PCR, and this is not. Also, would require a huge scale up, likely via the Defense Production Act, and this administration has not been aggressive about testing.

https://www.theatlantic.com/health/archive/2020/08/how-to-test-every-american-for-covid-19-every-day/615217/

Drugs:

More Evidence Heartburn Drug Famotidine May Help COVID-19 Patients

Small study, but adds to other small suggestive studies.

famotidine is being evaluated in a randomized clinical trial in combination with either hydroxychloroquine or remdesivir.

https://www.medpagetoday.com/infectiousdisease/covid19/88119?

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Also avoid pre-prints!

COVID-19 ‘infodemic’ persists, could worsen

As COVID-19 spread early this year, experts voiced concerns about the spread of misinformation related to the disease on social media.

For some physicians, this anxiety persists, fed by new misinformation campaigns.

“The anti-vaccine movement has enlarged its remit to also campaign against contact tracing and social distancing,” Peter J. Hotez, MD, PhD, professor of pediatrics and dean of the National School of Tropical Medicine at Baylor College of Medicine, told Healio. “It is now a full-blown anti-science movement.”

An editorial published in The Lancet Infectious Diseases warned of the dangers of the COVID-19 “infodemic” and noted that the circulation of medical information beyond expert circles before it has been reviewed can be particularly dangerous.

 “Fake news, misinformation and conspiracy theories have become prevalent in the age of social media and have skyrocketed since the beginning of the COVID-19 pandemic,” the authors wrote. “This situation is extremely concerning because it undermines trust in health institutions and programs.”

https://www.healio.com/news/infectious-disease/20200814/covid19-infodemic-persists-could-worsen

Devices:

More on benefits of face shields, this time in addition to masks

Before face shields, 62 workers (40 women) visited 5880 homes with 31 164 persons (in Chennai, India) From the 5880 homes visited, 222 persons tested positive for SARS-CoV-2, between May 4 to May 13. Twelve workers (19%) were infected during this period. Eight developed symptoms (fever, cough, sore throat, myalgia, and anosmia) and 4 were asymptomatic.

After face shields, 50 workers (previously uninfected) continued to provide counseling, visiting 18 228 homes. Among the counseled, 118 428 persons, 2682 subsequently tested positive for SARS-CoV-2. No worker developed asymptomatic or symptomatic infection.

https://jamanetwork.com/journals/jama/fullarticle/2769693?

Epidemiology/Infection control:

Healthcare institutions have put pressure on COVID-positive employees to return to work before public health standards suggest it’s safe, Emmarie Huetteman writes ~ Nurses and Doctors Sick With COVID Feel Pressured to Get Back to Work(Kaiser Health News/The Guardian)

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https://twitter.com/ASlavitt/status/1295486410288496640?s=20

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School reopenings:

Reopening classrooms “has turned into a slow-motion train wreck, with at least 2,400 students and staff either infected with COVID-19 or self-isolating because of exposure,” while most school districts are sticking with online only. (ABC News)

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Hybrid schooling could be a public health disaster

Alternating schedules could cause children to ebb and flow within an expanded network, transitioning from home to school to child-care centers and thus having a greater risk of exposure or transmission. ” Hybrid schooling actually produces more networks by which the virus can spread.” – Dr. Wm Hanage

parents who cannot do their jobs remotely and those too busy to oversee at-home learning will still rely on external child-care solutions two to three days a week, further widening the child’s circle of exposure. With fully remote or all in-person learning, children are spending the majority of their time in one or two places with a consistent group. With a hybrid plan, that number balloons to three or more.

Dr. Helen Jenkins, a biostatistician with Boston University’s School of Public Health and adviser on the Cambridge Public Schools’ COVID-19 task force, envisions the most tenable solution as full-time in-person instruction for children with special needs or parents deemed essential workers and remote instruction for the rest of the student body.

https://www.bostonglobe.com/2020/08/13/metro/some-mass-schools-are-pursuing-hybrid-schooling-plan-could-be-public-health-disaster/?outputType=amp

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Tips, general reading for public:

StayAtHome

Wash your hands.

Rinse and repeat.

Using a public restroom? Mask up!

Flushing public restroom toilets or urinals can spew clouds of particles carrying viruses, including COVID-19

Computer simulation research shows public restrooms can be dangerous places for potentially becoming infected from a virus, especially during the COVID-19 pandemic. Other work has shown that both feces- and urine-based virus transmission is possible.

https://www.eurekalert.org/pub_releases/2020-08/aiop-uap081820.php

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Breastfeeding

A study led by Tina Chambers at UCSD looked to see if #SARSCoV2, which causes #Covid19, could be found in breast milk. They tested samples from 18 infected women; found no virus. https://jamanetwork.com/journals/jama/fullarticle/2769825?

Politics:

Voting machines:

8/19/20 Speaker Pelosi says she spoke to DeJoy: “The Postmaster General frankly admitted that he had no intention of replacing the sorting machines, blue mailboxes and other key mail infrastructure that have been removed and that plans for adequate overtime … are not in the works.” – Kyle Griffin

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“Michael Vick served more time in jail for killing dogs than the last 493 cops combined did for killing unarmed Black Men” – Etan Thomas

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NIH research relying on fetal tissue being rejected by HHS

Health and Human Services (HHS) Secretary Alex Azar’s The Human Fetal Tissue Research Ethics Advisory Board reviewed the 14 proposals last month at its only meeting so far. Its recommendations that 13 of them be rejected,

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Feel good du jour:

https://twitter.com/dodo/status/1295465424558018560?s=20

Comic relief:

Perspective/Poem

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Interesting thread by Julia L Marcus:

https://twitter.com/JuliaLMarcus/status/1294629832186265600?s=20

Enforcement may be ramping up now, but let’s be real: we’ve already spent months policing each other. People have been widely shamed for enjoying themselves—even when their fun is low-risk. The message is clear: pleasure is not essential in a pandemic.

The instinct to yell at people for being careless and selfish is perfectly understandable. But public health is a service industry, and it can’t serve customers without first trying to understand them. Let’s start by asking *why* people are partying.

People are socializing not out of selfishness but because, like the grocery store, human connection is essential. Are there safer ways to connect than indoor parties? Of course. Let’s figure out how to minimize infection while maximizing well-being.

As long as new infections are linked to parties, public-health officials need to help people avoid them. But as we’ve learned from HIV, criminalization only deepens inequities and drives risky behavior underground, where it’s even harder to address.

Instead of turning partygoers into criminals, we can encourage safer ways for people to stay connected: think more outdoor space with music, food trucks, drinks to go. Policing won’t make Americans safer or healthier—compassion and creativity will.

Bits of beauty:

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