230 Matching Annotations
  1. Last 7 days
  2. May 2021
  3. Apr 2021
    1. Dr Kamna Kakkar. (2021, April 20). If things come down to this, doctors are going to be at the recieving end of all patient wrath. As much as I pray for Delhi patients’ lives, I pray for the safety of my colleagues. #DelhiLockdown https://t.co/Q7RaIj68RB [Tweet]. @drkamnakakkar. https://twitter.com/drkamnakakkar/status/1384535301243109380

    1. Graham, M. S., Sudre, C. H., May, A., Antonelli, M., Murray, B., Varsavsky, T., Kläser, K., Canas, L. S., Molteni, E., Modat, M., Drew, D. A., Nguyen, L. H., Polidori, L., Selvachandran, S., Hu, C., Capdevila, J., Koshy, C., Ash, A., Wise, E., … Ourselin, S. (2021). Changes in symptomatology, reinfection, and transmissibility associated with the SARS-CoV-2 variant B.1.1.7: An ecological study. The Lancet Public Health, 0(0). https://doi.org/10.1016/S2468-2667(21)00055-4

  4. Mar 2021
  5. Feb 2021
    1. Aknin, L., Neve, J.-E. D., Dunn, E., Fancourt, D., Goldberg, E., Helliwell, J., Jones, S. P., Karam, E., Layard, R., Lyubomirsky, S., Rzepa, A., Saxena, S., Thornton, E., VanderWeele, T., Whillans, A., Zaki, J., Caman, O. K., & Amour, Y. B. (2021). A Review and Response to the Early Mental Health and Neurological Consequences of the COVID-19 Pandemic. PsyArXiv. https://doi.org/10.31234/osf.io/zw93g

  6. Jan 2021
  7. Dec 2020
    1. The official definition of a “close contact” — 15 minutes, within six feet — isn’t foolproof.

      The takeaway: The official definition of a "close contact" for COVID-19 is not foolproof.

      The claim: The official definition of a "close contact" - 15 minutes, within six feet - isn't foolproof.

      The evidence: In Korea, a person sitting in a restaurant 6.5 meters (>20ft) away from the COVID index case for five minutes was infected, most likely because airflow from the air conditioner carried droplets with COVID-19 from the infected person to the person who became infected (1). How common transmission across large distances occurs is still debated (2). As several indoor outbreaks were attributed to airborne transmission, precautions to prevent airborne COVID transmission are needed (3). Examples include better air filtration/UV to kill virus in the system, increased air flow from outside, avoidance of recirculating interior air, and avoiding overcrowding in interior spaces.


      1) https://jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e415

      2) https://www.sciencedirect.com/science/article/pii/S0166093420302858?via%3Dihub

      3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454469/pdf/ciaa939.pdf

  8. Nov 2020
    1. The recommendation to wear surgical masks to supplement other public health measures did not reduce the SARS-CoV-2 infection rate among wearers by more than 50% in a community with modest infection rates, some degree of social distancing, and uncommon general mask use.

      The takeaway: While minimal protection occurs when a mask is worn in a place where many others are not wearing a mask, community masking is associated with a reduction in COVID cases.

      The claim: In a community with modest infection rates, some social distancing, and most people not wearing masks, wearing a surgical mask did not reduce the SARS-CoV-2 infection rate by more than 50%.

      The evidence: This study showed that wearing a mask in a community where most people did not wear a mask, did not reduce the risk of getting infected by 50%. Fewer COVID infections were reported in the mask group than in the unmasked group. This study agrees with a meta analysis which showed that masks resulted in a decrease in infections but did not prevent all infections (1) According to the CDC, seven studies have shown community level benefit when masking recommendations were made (2).

      When most in the community are not wearing masks, social distancing, and washing hands, wearing a mask alone provides minimal protection to the mask wearer. Community wide masking is associated with a reduction in COVID cases (2).


      1) https://pubmed.ncbi.nlm.nih.gov/29140516/

      2) https://www.cdc.gov/coronavirus/2019-ncov/more/masking-science-sars-cov2.html

    1. Anxiety From Reactions to Covid-19 Will Destroy At Least Seven Times More Years of Life Than Can Be Saved by Lockdowns

      Take away: Though the number of COVID deaths prevented and the exact number of years lost due directly to decreases in mental health from lockdowns is at best a rough estimate, several facts are known. Lockdowns decrease mental health, and a decrease in mental health shortens lives too.

      The claim: Anxiety from reactions to COVID-19 will destroy at least seven times more years of life than can be saved by lockdowns.

      The evidence: This article references many studies detailing the anxiety surrounding COVID-19 (1-4). These studies indicate that many people have increased stress due to COVID. Nature Public Health Emergency Collection reports that the mental health cost of widespread lockdowns may negate the lives saved by this policy (5). This article lists many articles which describe the effect of stay-at-home orders on mental health. Additionally, the effect of poor mental health on physical outcomes is well-defined. Poor mental health shortens lives. Other factors with COVID such as negative media coverage and dealing with job loss and death are also described as negatively affecting mental health. It is unclear how much of the negative mental health outcomes is directly related to lockdowns and what is contributed to the disease, job loss, future uncertainty, and continuous media coverage.

      Several supporting facts used in this article are now outdated or could use clarification. Many assumptions are detailed in this article to estimate the number of years lost due to mental harm caused by lockdowns. One example is the authors used a survey of 1,266 patients to estimate the number of people in the United States who have suffered mental harm from lockdowns. These estimates are challenging to conclusively verify. The authors did choose the conservative estimate for each of their numbers. One example of an outdated number is the predicted number of deaths was 114,228 by August 4th. The actual number of deaths per Johns Hopkins was 157,500 (6).

      Based on the facts, anxiety and mental disorders can be deadly. Lockdowns result in an increase in poor mental health. The exact number of years lost due to poor mental health directly resulting from lockdowns is less clear. Poor mental health may also result from constant media coverage, loss of loved ones and fear of the future.

      The sources:

      1) https://www.psychiatry.org/newsroom/news-releases/new-poll-covid-19-impacting-mental-well-being-americans-feeling-anxious-especially-for-loved-ones-older-adults-are-less-anxious

      2) https://www.kff.org/health-reform/report/kff-health-tracking-poll-early-april-2020/

      3) https://www.bsgco.com/post/coronavirus-and-americans-mental-health-insights-from-bsg-s-pulse-of-america-poll

      4) https://www.kff.org/report-section/kff-health-tracking-poll-late-april-2020-economic-and-mental-health-impacts-of-coronavirus/

      5) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431738/#

      6) https://coronavirus.jhu.edu/us-map

  9. Oct 2020
    1. Experts say closing borders early and tightly regulating travel have gone a long way toward fighting the virus. Other factors include rigorous contact tracing, technology-enforced quarantine and universal mask wearing. Further, Taiwan’s deadly experience with SARS has scared people into compliance.

      The Takeaway: The combination of closing borders, tightly regulating travel, effective quarantine of all exposed people using cell phone data for enforcement, and universal mask wearing contributed to effectively keeping COVID-19 from infecting most of Taiwan's population.

      The claim: Closing borders early, tightly regulating travel, contact tracing, technology-enforced quarantine, universal mask wearing, and Taiwan's previous deadly experience with SARS resulted in control of SARS-CoV-2 in Taiwan.

      The evidence: The earlier COVID-19 cases are stopped from entering a country, the fewer cases will be present to spread the disease to others. To illustrate, it is easier to stop a trickle of water than to try to dam up a flood and easier to extinguish a candle than a forest fire. Taiwan closed its borders on January 23rd, 2020 (1). The Philippines closed their borders on February 2nd, 2020 (2). Tightly regulating travel will help to stop cases before they enter the country. Effective quarantining the few cases and contacts of the cases which do enter a country is critical to preventing the spread of the disease within the country. Taiwan used mobile telephone data to enforce quarantine (1). Without quarantine, each infected person will spread COVID-19 to 2-6 additional people based on the R0 (3, 4). Universal masking will help slow the spread of disease (5). Previous experience with controlling a deadly disease will most likely increase compliance to methods to control the disease.

      Per Our World in Data website, Taiwan had one of the least stringent government responses to COVID-19 (6). The biweekly number of COVID-19 cases in Taiwan was 23 on October 29, 2020 (7). Neighboring countries had biweekly COVID-19 cases of 372 (China), 28,644 (Philippines), 11,871 (Malaysia), 51 (Vietnam), and 8,142 (Japan). These neighboring countries had more stringent government responses to COVID-19 (6).


      1) https://focustaiwan.tw/society/202001230011


      3) https://pubmed.ncbi.nlm.nih.gov/32234343/

      4) https://pubmed.ncbi.nlm.nih.gov/32097725/

      5) https://www.nature.com/articles/s41591-020-1132-9#annotations:7jRWRheWEeuY8x_rXDuRjg

      6) https://ourworldindata.org/grapher/covid-stringency-index

      7) https://ourworldindata.org/grapher/biweekly-confirmed-covid-19-cases

    1. 50 percent effective

      Take away: Cloth face masks filter approximately 50% of bacteriophage five times smaller than one SARS-CoV-2 virus. Therefore it is reasonable to assume that masks, including cloth masks, are 50% effective.

      The claim: Masks are assumed to be 50% effective.

      The evidence: Face masks, including home made face masks, were shown to reduce aerosol exposure (1). Masks made from various materials were shown to filter 50-68% of Bacteriophage CS2 which is 20 nm (2). When NaCl aerosols were used instead of a bacteriophage, penetration by NaCl occurred 9-98% of the time depending on the size of the particles (3). Two well written reviews detail the efficacy of facemasks (4, 5). SARS-CoV-2 virus is ~100 nm in size (6).

      Sources: 1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440799/

      2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7108646/

      3 https://academic.oup.com/annweh/article/54/7/789/202744

      4 https://www.preprints.org/manuscript/202004.0203/v1

      5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7497125/#ref23

      6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7224694/#:~:text=SARS%2DCoV%2D2%20is%20an,they%20do%20more%20than%20that.

    1. In comparison, the ratio is approximately 2.5 times greater than the estimated IFR for seasonal influenza

      Take away:

      If correct numerators and denominators are used, COVID-19 is at least 10 times as deadly as seasonal influenza.

      The claim:

      The Infection Fatality Ratio for COVID-19 is “approximately 2.5 times higher than the estimated IFR for seasonal influenza.”

      The evidence:

      Blackburn et al. report an infection fatality ratio among community-living adults of 0.26% (1). If institutionalized adults had been included the ratio would be higher, likely approximating the 0.6% mortality rate among exposed individuals readily calculated by combining official death tolls, the known 30% undercount (2), and a definitive CDC study that found 10 times as many people have been exposed to the novel coronavirus than are reported as cases (3). Among the elderly, Blackburn et al. calculate COVID-19 is 2.5 times deadlier than seasonal flu. This is clearly an underestimate:

      1) Blackburn et al. use CDC estimates of case-fatality rates calculated on the basis of all Americans, including the institutionalized, not limited to much healthier community-dwellers.

      2) The seasonal influenza case fatality rates reported by the CDC, including the often cited 0.1% overall, are for symptomatic cases. Their denominators are estimated by using the reported number of influenza hospitalizations to guess the burden of clinical illness (4). But antibody studies show that 65%-85% of people infected with influenza never develop symptoms (5). The 0.6% mortality rate calculated here for SARS-CoV-2-exposed individuals is 6 times higher than the 0.1% usually cited for seasonal influenza. Given the overestimation of commonly accepted influenza mortality rates due to failure to take asymptomatic infections into account, SARS-CoV-2 can be seen to be not 2.5 times, or even 6 times, but at least 10 times as lethal as seasonal flu.


      1 http://www.acpjournals.org/doi/10.7326/M20-5352

      2 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2767980

      3 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2768834

      4 https://www.cdc.gov/flu/about/burden/how-cdc-estimates.htm

      5 https://pubmed.ncbi.nlm.nih.gov/26133025/

  10. www.thelancet.com www.thelancet.com