Lunchtime pandemic reading.
Standard disclaimer: this is a roundup of informative pieces I've read that interest me on the severity of the crisis and how to manage it. I am not a qualified medical expert in ANY sense; at best I am reasonably well-read laity. ALWAYS prioritize advice from qualified healthcare experts over some person on Facebook.
This is also available as an email newsletter at https://lunchtimepandemic.
You are welcome to share this.
The price of the pandemic will be felt for decades. "The COVID-19 pandemic is well into its second year, but countries are only beginning to grapple with the lasting health crisis. In March, a UK consortium reported that 1 in 5 people who were hospitalized with the disease had a new disability after discharge1. A large US study found similar effects for both hospitalized and non-hospitalized people2. Among adults who were not hospitalized, 1 in 10 have ongoing symptoms 12 weeks after a positive test3. Treatment services for the long-term consequences of COVID-19 are already having to be absorbed into health and care systems urgently. Tackling this requires a much clearer picture of the burden of the disease than currently exists.
To tackle the pandemic’s inequitable impact, researchers must also count how COVID-19 contributes to ill health, and do so comprehensively. If scarce resources are allocated with only the death count in mind, low- and middle-income countries (LMICs) with younger populations might not receive their fair share. This could be devastating for countries that rely on the productivity of people of working age for economic development. Choosing the right metrics can also help to identify and address inequity within countries. Evidence from many nations suggest that members of minority ethnic communities are more likely to catch COVID-19 and die from it, as well as being more likely to die at a younger age4 (see also Nature 592, 674–680; 2021).
Fortunately, metrics of illness exist. They inform much health policy — from cancer screening and treatment to attempts to eradicate tuberculosis. Called DALYs and QALYs (disability-adjusted life years and quality-adjusted life years), these measures capture the impact of ill health on a person’s life course — combining the years of life lost because of premature death, and the years lived while experiencing the disabling consequences of disease.
As health economists, we use these metrics to understand the global burden of disease. They help us to compare the effects of prevention, treatment and social action (such as education or housing initiatives) on tackling the HIV pandemic, for example. In a recent study5, we used these metrics to estimate that a death from COVID-19 results in around 5 QALYs lost, on average. We have previously used similar estimates to inform COVID-19 vaccine policy in the United Kingdom6.
Here we offer a very rough first estimate, based on simple assumptions, that as much as 30% of the COVID-19 health burden could be due to COVID-induced disability, not death. Much more needs to be done to improve such estimates so they can be acted on effectively. To design the right policies now, and invest well to deal with COVID-19 (and other pandemics) in the future, we need to use metrics that encapsulate all the consequences of a disease."
Commentary: This is one of two pieces today on the impact of COVID-19 over the long term. 30% of the health burden of COVID-19 will be survivors with disability, by this study.
How common is long-haul COVID-19? 73% of patients experience it. "Infection with COVID-19 has been associated with long-term symptoms, but the frequency, variety, and severity of these complications are not well understood. Many published commentaries have proposed plans for pandemic control that are primarily based on mortality rates among older individuals without considering long-term morbidity among individuals of all ages. Reliable estimates of such morbidity are important for patient care, prognosis, and development of public health policy.
In this systematic review of 45 studies including 9751 participants with COVID-19, the median proportion of individuals who experienced at least 1 persistent symptom was 73%; symptoms occurring most frequently included shortness of breath or dyspnea, fatigue or exhaustion, and sleep disorders or insomnia. However, the studies were highly heterogeneous and needed longer follow-up and more standardized designs."
Commentary: COVID-19 has created a massive population of people who now have some kind of pre-existing condition, be it something mild like a distorted sense of smell, or something severe like permanent heart or lung damage. This has massive healthcare implications, not only from the treatment side, but from the cost side as well. All governments should be looking at what the expense will be to provide care for citizens affected – and if you're affected and living in a nation where healthcare isn't able to provide for you, you may want to investigate emigration to a different country.
Ventilation, ventilation, ventilation. "In cracking the puzzle of superspreading, researchers have had to re-evaluate their understanding of SARS-CoV-2’s transmission. Most documented superspreadings have happened indoors and involved large groups gathered in poorly ventilated spaces. That points to SARS-CoV-2 being a virus which travels easily through the air, in contradistinction to the early belief that short-range encounters and infected surfaces were the main risks. This, in turn, suggests that paying attention to the need for good ventilation will be important in managing the next phase of the pandemic, as people return to mixing with each other inside homes, offices, gyms and restaurants.
It has taken a long time for public-health experts to acknowledge that covid-19 routinely spreads through the air in this way. Social distancing and mask-wearing were recommended with the intention of cutting direct, close-range transmission by virus-carrying droplets of mucus or saliva breathed out by infected individuals. The main risk of spreading the illness indirectly was thought to come not from these droplets being carried long distances by air currents, but rather by their landing on nearby surfaces, on which viruses they were harbouring might survive for hours, or even days. Anyone who touched such an infected surface could then transfer those viruses, via their fingers, to their mouth, eyes or nose. This makes sense if SARS-CoV-2 spreads in the same way as influenza—which was indeed the hypothesis in March 2020, when the World Health Organisation (WHO) declared the start of the covid-19 pandemic. Hence the advice to disinfect surfaces and wash hands frequently."
Commentary: It's interesting to note that we have known these issues for some time – and in the case of respiratory diseases, for over a century. Many buildings in major cities were designed to mitigate the flu pandemic, with radiators that operated at crazy high heat so you could have the windows open at the same time in the winter.
My biggest concern right now is schools. Schools are typically built with poor or no ventilation to begin with, and we're sending concentrated clusters of little unvaccinated humans with already questionable hygiene into high risk situations. Until your kids are vaccinated, if you are able to do so, keep your kids at home.
A reminder of the simple daily habits we should all be taking.
1. Wear the best mask available to you when you'll be around other people, even after you've been vaccinated. Respirators are back in stock at online retailers, too. Wear an N95/FFP2/KN95 that's NIOSH-approved or better mask if you can obtain it. If you can't get an N95 mask, wear a surgical mask with a cloth mask over it.
2. Get vaccinated as soon as you're able to, and fulfill the full vaccine regimen. Remember that you are not vaccinated until everyone you live with is vaccinated.
3. Wash/sanitize your hands every time you are in or out of your home.
4. Stay home as much as practical. Minimize your contact with others and avoid indoor places as much as you can; indoor spaces spread the disease through aerosols and distance is less effective at mitigating your risks.
5. Get your personal finances in order now. Cut all unnecessary costs.
6. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
7. Ventilate your home as frequently as weather and circumstances permit, except when you share close airspaces with other residences (like a window less than a meter away from a neighboring window).
8. Masks must fit properly to work. Here's how to properly fit a mask:
Common misinformation debunked!
There is no basis in fact that COVID-19 vaccines can shed or otherwise harm people around you.
There is no mercury or other heavy metals in the Pfizer mRNA vaccine.
There is no basis in fact that COVID-19 vaccines pose additional risks to pregnant women.
There is no genomic evidence at all that COVID-19 arrived before 2020 in the United States and therefore no hidden herd immunity:
There is no evidence SARS-CoV-2 was engineered, nor that it escaped a lab somewhere.
There is no evidence a flu shot increases your COVID-19 risk.
Disclosures and Disclaimers
To be clear, I declare no competing interests on anything I share related to COVID-19. I am employed by and am a co-owner in TrustInsights.ai, an analytics and management consulting firm. I have no clients and no business interests in anything related to COVID-19, nor do I financially benefit in any way from sharing information about COVID-19.
A common request I'm asked is who I follow. Here's a public Twitter list of many of the sources I read.
This list is biased by design. It is limited to authors who predominantly post in the English language. It is heavily biased towards individual researchers and away from institutions. It is biased towards those who publish or share research, data, papers, etc. I have made an attempt to follow researchers from different countries, and also to make the list reasonably gender-balanced, because multiple, diverse perspectives on research data are essential.
This is also available as an email newsletter at https://lunchtimepandemic.
If you liked this post from Lunchtime Pandemic Reading, why not share it?