COVID Transmissions for 12-7-2020
Does the vaccine prevent transmission?
Good morning! It has been 386 days since the first documented human case of COVID-19.
I still owe you all an ending to that walkthrough of the immunity-duration paper I was doing before Thanksgiving; I’ll try to wrap that up this week. For today, though, headlines only. Let’s try to have a good week—with as much staying at home as possible.
As usual, bolded terms are linked to the running newsletter glossary.
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Now, let’s talk COVID.
CDC finally recommends mask-wearing indoors
A day after the US recorded record highs for new COVID-19 cases and for deaths, the CDC recommended universal wearing of masks in all indoor locations except for individuals’ own homes: https://www.cidrap.umn.edu/news-perspective/2020/12/cdc-beefs-indoor-mask-advice-covid-19-cases-surge
The formal recommendation on this is embarrassingly late. This should have come in April of this year, at the very latest. I imagine that there were political reasons that it did not, and that is unacceptable. There is no political party consideration that should limit the issuance of sensible, well-supported public health recommendations by the CDC.
Perhaps, even this late in the game, this new recommendation will do some good.
Pfizer’s Bourla unsure if vaccine can prevent transmission
In an episode of Dateline last week, as reported here by The Hill, Pfizer CEO Albert Bourla indicated that his company is not sure if their vaccine can prevent transmission of SARS-CoV-2: https://thehill.com/news-by-subject/healthcare/528619-pfizer-chairman-were-not-sure-if-someone-can-transmit-virus-after
This has a lot of implications. If the vaccine prevents disease in 95% of people, but it cannot impact transmission, what is the effect on the 5% of people in whom the vaccine isn’t all that effective?
Must they remain inside…forever?
We have more questions than answers on this topic at this point. This is going to be the big topic in COVID-19 vaccinology for the foreseeable future, and it will be part of an eventual in-depth piece I will be writing regarding our future as the vaccines are rolled out.
If there really is no effect on transmission, masks might be here to stay.
California reinstates stay-at-home orders
Much of the state of California is reentering a stay-at-home scenario as COVID-19 cases surge around the state, and ICU capacity is rapidly filled: https://www.bloomberg.com/news/articles/2020-12-06/much-of-california-to-be-homebound-for-holidays-as-virus-worsens
With rising, uncontrolled community spread, this seems to be necessary. Disappointing though it is, we’ve seen several countries around the world implement temporary measures like this and get their disease spread under control. I hope that the same applies for California.
What am I doing to cope with the pandemic? This:
Duck soup continued
Duck broth is a fantastic tool. It’s got a lot of body, and it takes well to having a bunch of ingredients thrown into it.
Last night, I turned ours into a robust udon soup using, of course, udon noodles, but also some shiitake mushrooms, broccoli, bok choy, and cauliflower, as well as some boneless chicken breasts.
The chicken was cubed and marinated in soy sauce, liquid smoke, and a little apple cider vinegar, for about an hour at room temperature. Then I stir fried it at high temperature to help it hold up better in the soup.
I seasoned the broth a little further with some soy sauce, sriracha, and five spice, then sliced the mushrooms and added those. After some time boiling, I added the noodles until cooked and then shortly thereafter, the chicken.
The vegetables were added last, and given only a few minutes in the boiling soup, to keep them from getting really hammered to death. Since I had the broth already, this whole process was super easy and yielded something that’ll be good for at least two full meals. Not bad considering it started as leftover duck bones from another meal entirely, and great for these winter months of staying inside.
On Friday’s newsletter, I got a comment from Carl Fink, who I know from Philcon. I appreciated Carl’s politely-asked question about my gym-going—I was expecting a little bit of pushback, because I think talking about what constitutes a “safe” activity is a good conversation to provoke. Here’s what Carl said:
So .... what exactly do you do at a gym that you couldn't do, or do the equivalent of, at home? For a few bucks you can get some resistance tubes for anaerobic exercise and a mat for bodyweight stuff. Cheaper than the gym and (if you're interested mostly in health) just as effective, and you don't risk getting or spreading a deadly virus.
I"m not judging, I'm wondering what your reasoning is, because you inevitably knew everything I just posted. You're smarter and better-educated than me, after all. (Hi, this is Carl from that panel at Philcon.)
When it comes to science, I am very anti-exclusivity. I don’t think my education indicates anything except a certain number of hours of practice; anyone can raise a question like this, and I’d be a bad scientist if I merely shot it down. You’re right to ask, Carl. You’re right to question. It’s possible I didn’t think it through enough; it’s possible I have a blind spot here. There’s no way to know without asking.
Here’s what I replied:
Hi Carl! I appreciate the question.
It's a space problem. Living in a very small space as I live in with another person, I just don't have room for much equipment. I do a lot of work with weights, and while early in the pandemic I purchased some in-home weights, I can't get and store more here. I also don't have a lot of space to physically work out; I can't actually get a lot of footprint. I certainly can't do anything resembling aerobic exercise inside, and that's really what's most important for long term health anyway.
I tried to make it work (and will again try in future) when the gym was closed due to high background COVID-19 transmission, but there was a definitive negative impact on my fitness. I lost muscle mass, no question. However, it wasn't safe to be in the gym at that time so that's how it had to be. It was also a fair bit warmer and less rainy at the time, with sunlight outside of my working hours, so outdoor aerobic exercise was a substantially more viable option. Indoors, I don't love wearing a mask during aerobic exercise, but it's a necessary disease control measure and I can make do.
A gym may seem like a luxury, and in our society it is treated like one, but to be quite honest, it's really not. Everyone should have access to one because it provides a health service that keeps people healthy. It's not just about "living longer," but about getting the benefits of exercise--including substantial benefits to immunity, lung function, and other things that are quite handy during a global pandemic.
We know--based on studies like the one that I linked--that with physical distancing and masking, a gym is not a particularly risky environment, as long as background transmission is low. If I lived elsewhere, with different transmission dynamics, I'd act differently.
I don't feel that everything needs to be closed all the time while we ride this out. The big difference between going to the grocery store for an hour for me, vs going to the gym for an hour, is that the grocery store doesn't enforce physical distancing nearly as well as the gym does, particularly here in NYC. Put in perspective, I should be marginally more worried about getting groceries than I should be about using a gym. I think there's a certain amount of carried-over worry about gyms because they were closed early on in the pandemic, but that isn't a rational concern--when they were closed early on, it was because we didn't know what the worst environments for transmission were and we had no studies on the dynamics of different locations. We now have that information, and we know the circumstance under which gyms can be safely open.
What I'm more concerned about is the fact that indoor dining and bars are still open anywhere. These two things cannot be made safe, and it's not only obvious but scientifically supported that they cannot be made safe. It's a disaster for the restaurant and nightlife industries, but they do need to be closed, with policies in place that help their employees survive that situation.
I want to elaborate on this further, though. My locality really impacts my thinking on this. I wouldn’t go to a gym right now in South Dakota, for example. There’s a lot of COVID-19 there, and even if I were living in an equivalent space in that part of the US, I would skip it. I also would not feel more at-risk at a grocery store than I do at the gym if I lived in the suburbs. In New York City, grocery stores are practically a maze of tunnels between walls of food. When I visit a grocery store in the suburbs, as I used to do in the Before Times, one of the first things I do there is stretch out my arms perpendicular to my sides in one of the aisles because it’s a fantastic luxury that is not possible in a Manhattan grocery store. For these reasons, there’s a certain hyperlocal thinking that I’m applying to my calculus here.
Where you are, things may be different from where I am. Your life may involve different health circumstances than mine. Your mileage will vary, but I can do my best to offer you my thinking in the event that it proves useful.
You might have some questions! Send them in.
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See you all next time.
Always,
JS
You note that the CDC recommendation regarding mask wearing is long overdue, and should have happened in April. You "imagine that there were political reasons that it did not." I believe you may have forgotten that there were technical and logistical, not political, reasons that it did not. First, back in April, the general consensus was that only N95 masks could effectively protect people from getting infected. Second, there was no published premise, as yet, that wearing masks could prevent the wearer from infecting others. And finally, there was a concern that if a mask mandate or recommendation were issued, it would result in a rush to horde whatever N95 masks remained in what was, at that time, a very limited supply that was sorely needed by front line workers.
So, as long as you encourage questioning ...
You wrote, "This has a lot of implications. If the vaccine prevents disease in 95% of people, but it cannot impact transmission, what is the effect on the 5% of people in whom the vaccine isn’t all that effective? Must they remain inside…forever?"
There's a big assumption in there ... that you know you are one of the 5%. It might be possible in principle (by measuring antibody and t-memory cell levels) but in practice, almost nobody outside research studies will get those tests after a vaccination.
So in practice ... the 5% will get SARS-CoV-2. And a fraction of that 1/20 (say, 1%) will get serious disease. It's an imperfect world. Note that the Moderna vaccine, at least, seems to prevent nearly 100% of serious disease in the tested population--all the serious cases were in the placebo arm.