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The takeaway: Global COVID-19 deaths over the past year and a half are 3X more than the annual deaths due to traffic accidents and roughly equal to the population of the city of Los Angeles or the country of Georgia.

The claim: Covid-19 deaths are approximately equal to the population of Los Angeles or the nation of Georgia and are three times the global traffic accident death.

The evidence:

The global number of deaths due to COVID as reported to the World Health Organization (WHO) on July 8, 2021 is 4,002,209 (1). The estimated population of the city of Los Angeles in 2019 was 3,979,576 (2). The estimated population of Los Angeles county in 2019 was 10,039,107 (2). The population of the nation of Georgia is 3,979,549 (3). Per WHO data from 2018, 1.35 million are killed annually by traffic accidents around the world (4).

Global COVID deaths are approximately equal to the population of the city of Los Angeles or nation of Georgia. Globally, COVID deaths are 3X the number of global traffic accident deaths.

Sources:

1) https://covid19.who.int/

2) https://www.census.gov/quickfacts/fact/table/losangelescountycalifornia,losangelescitycalifornia,CA/BZA010219

3) https://worldpopulationreview.com/countries/georgia-population

4) https://www.cdc.gov/injury/features/global-road-safety/index.html

The takeaway: Amino acids, represented by single letters such as N or Y make up proteins which are part of the coronavirus (as well as other biology such as animals, plants, microorganisms, etc.). Mutations are written with the original amino acid letter followed by the number of the amino acid and the new amino acid letter.

The claim: Proteins are made up of building blocks called amino acids. N501Y means that the 501st amino acid was originally an N, which stands for the amino acid asparagine, but has been changed to a Y, which stands for tyrosine.

The evidence:

Coronavirus is made up of greater than 20 proteins (1). The spike protein helps coronavirus attach and enter human cells which leads to infection and disease (1). The spike protein on SARS-CoV-2, the virus that causes COVID-19, is the target of many antibodies produced by the human body to fight the SARS-CoV-2 infection (2). Changes in the spike protein sequence may necessitate a change in the human immune system to produce antibodies which stop SARS-CoV-2 from infecting human cells. Changes in the amino acid sequence are written as was stated in the claim: original amino acid, number of the amino acid in the sequence, new amino acid.

Sources:

1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247499/

2) https://pubmed.ncbi.nlm.nih.gov/33448402/

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.

Sources:

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

The takeaway: COVID-19 survivors are at a higher risk for mental illness.

The claim: COVID-19 survivors are at a higher risk for mental illness.

The evidence: Infection by SARS-CoV-2 was associated with an increase in anxiety disorders, insomnia, and dementia (1). Prior mental illness was also associated with an increased risk of SARS-CoV-2 infection (1). Approximately 1/3 of COVID patients were reported to have central nervous symptom issues in a study of 214 hospitalized Chinese patients (2). SARS-CoV-2 has been found in the brain and cerebral spinal fluid (3). Social isolation, pathology of SARS-CoV-2, and sedation are a few of the reasons why ICU patients experience delirium and the subsequent mental health risks (4).

All of these factors support the statement that COVID-19 survivors are at a higher risk of mental illness.

As a reminder, there is help for suicide. National Suicide Prevention Lifeline is a toll-free number for those in a suicidal crisis or emotional distress. The number is: 1-800-273-8255

Disclaimer: This content is not intended as a substitute for professional medical advice. Always seek the advice of a qualified health provider with any questions regarding a medical condition.

Sources:

1) https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30462-4/fulltext

2) https://pubmed.ncbi.nlm.nih.gov/32399719/

3) https://pubmed.ncbi.nlm.nih.gov/32240762/

4) https://www.termedia.pl/COVID-19-What-do-we-need-to-know-about-ICU-delirium-during-the-SARS-CoV-2-pandemic-,118,40590,1,1.html

Takeaway: Mink are capable of contracting and transmitting SARS-CoV-2 to each other and to humans which had resulted in mutated SARS-CoV-2.

The claim: Mink are now considered a public health risk.

The evidence: SARS-CoV-2 infects and kills mink (1). The lung damage in mink from SARS-CoV-2 is similar to the damage in human lungs from SARS-CoV-2. The range of symptoms from asymptomatic to deadly is exhibited by the mink. Based on this pre-print article, SARS-CoV-2 is mutating in mink farms and had documented transmission from mink to humans (2).

Extensive sequencing of SARS-CoV-2 genomes has been done (3). Mutations tend to occur in certain hot spots of the genome. The stated purpose of the sequencing research is to identify relatively stable parts of the genome to use as vaccine targets to help avoid mutant escape. The genomes of SARS-CoV-2 from mink infections had more nucleotide differences than SARS-CoV-2 from human COVID outbreaks (2). This may be due to a faster mutation rate or to the fact that so many mink were infected.

Sources:

1) https://journals.sagepub.com/doi/10.1177/0300985820943535?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed&

2) https://www.biorxiv.org/content/10.1101/2020.09.01.277152v1

3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199730/

The takeaway: Nursing home residents are the most vulnerable population though others with similar age and comorbidities may be at a similar risk.

The claim: Nursing home residents are the most vulnerable population.

The evidence: Older, more vulnerable people live in nursing homes (1). The setting is also communal which leads to rapid spread once the virus is in the home (1). The CDC reports 61,765 deaths (2, accessed 11/2/2020). A significant percentage of the deaths occurred in nursing homes which makes sense because older people live in the homes often with multiple comorbidities (3). Probability of death from COVID-19 increases with age and comorbidity (4-5). COVID spreads easier inside than outside (6).

Considering all of these factors, nursing home residents are the most vulnerable population. Others with similar age and comorbidities may be at a similar risk if they interact with many people.

Sources:

1) https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-in-nursing-homes.html

2) https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg

3) https://onlinelibrary.wiley.com/doi/10.1111/jgs.16784

4) https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-age.html

5) https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm#Comorbidities

6) https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/deciding-to-go-out.html

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).

Sources:

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

2)https://www.pharmaceutical-technology.com/features/coronavirus-affected-countries-philippines-measures-impact-tourism-economy/#:~:text=The%20government%20announced%20earlier%20on,barred%20from%20entering%20the%20country.

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

Take away: The humanitarian fallout from prolonged lockdowns to control COVID-19 could be worse than the deaths due to COVID-19.

The claim: The humanitarian fallout from COVID-19 could be worse than the deaths caused directly by the disease.

The evidence: Food supply chains have been disrupted due to COVID-19 (1). The World Health Organization predicts that 130 million additional people could become chronically hungry due to COVID-19 (2). Per the International Labor Organization, 1.6 billion workers have the prospect of their employment destroyed, at least partially due to the prolonged lockdowns (3).

“For millions of workers, no income means no food, no security and no future. [...] As the pandemic and the jobs crisis evolve, the need to protect the most vulnerable becomes even more urgent."

Guy Ryder, ILO Director-General

A number of socio-economic consequences have resulted from COVID-19 lock-down measures to control the virus (4). 900 million learners are affected by lockdowns which results in high risk children lacking access to free meals provided by school systems, drop out rates, and social isolation/mental health (4). Affects have been seen in the agricultural, manufacturing, petroleum and oil, finance industry, travel and aviation industry, hospitality, and others (4).

Considering the drastic increase in job loss with resulting hunger from financial instability and other social-economic factors resulting from lock-downs, the fall out from prolonged lockdowns to control COVID-19 will most likely be worse than the number of deaths due to COVID-19 directly.

Disclaimer: This annotation is not intended to downplay the seriousness of COVID-19. Rather it is intended to put the seriousness of the disease in context of other problems that are resulting from measures to control COVID-19.

Sources:

1) https://www.nature.com/articles/d41586-020-01181-3

2) https://www.who.int/news/item/13-07-2020-as-more-go-hungry-and-malnutrition-persists-achieving-zero-hunger-by-2030-in-doubt-un-report-warns#:~:text=Across%20the%20planet%2C%20the%20report,by%20the%20end%20of%202020.&text=further%20at%20times.)-,The%20State%20of%20Food%20Security%20and%20Nutrition%20in%20the%20World,towards%20ending%20hunger%20and%20malnutrition.

3) https://www.ilo.org/global/about-the-ilo/newsroom/news/WCMS_743036/lang--en/index.htm

4) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162753/

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.

Take Away

Transmission of viable SARS-CoV-2 RNA can occur even from an infected but asymptomatic individual. Some people never become symptomatic. That group usually becomes non-infectious after 14 days from initial infection. For persons displaying symptoms , the SARS-CoV-2 RNA can be detected for 1 to 2 days prior to symptomatology. (1)

The Claim

Asymptomatic people who had SARS-CoV-2 contact should be tested.

The Evidence

Yes, this is a reversal of August 2020 advice. What is the importance of asymptomatic testing?

Studies show that asymptomatic individuals have infected others prior to displaying symptoms. (1)

According to the CDC’s September 10th 2020 update approximately 40% of infected Americans are asymptomatic at time of testing. Those persons are still contagious and are estimated to have already transmitted the virus to some of their close contacts. (2)

In a report appearing in the July 2020 Journal of Medical Virology, 15.6% of SARS-CoV-2 positive patients in China are asymptomatic at time of testing. (3)

Asymptomatic infection also varies by age group as older persons often have more comorbidities causing them to be susceptible to displaying symptoms earlier. A larger percentage of children remain asymptomatic but are still able to transmit the virus to their contacts. (1) (3)

Transmission modes

Droplet transmission is the primary proven mode of transmission of the SARS-CoV-2 virus, although it is believed that touching a contaminated surface then touching mucous membranes, for example, the mouth and nose can also serve to transmit the virus. (1)

It is still unclear how big or small a dose of exposure to viable viral particles is needed for transmission; more research is needed to elucidate this. (1)

Citations

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

(2) https://www.cdc.gov/coronavirus/2019- ncov/hcp/planning-scenarios.html

(3) He J, Guo Y, Mao R, Zhang J. Proportion of asymptomatic coronavirus disease 2019: A systematic review and metaanalysis. J Med Virol. 2020;1– 11.https://doi.org/10.1002/jmv.26326

Take away: Mass infection without vaccination to achieve herd immunity will result in millions of deaths based on the observed death rate and may not result in herd immunity due to virus mutation. Historically, vaccination results in less deaths than the disease.

The claim: Herd immunity from widespread disease instead of vaccination will lead to many people dying.

The evidence: Approximately 50-67% of a given population is estimated to need to be infected for herd immunity to COVID-19 to exist which will result in millions of deaths. This is supported by additional publications (1, 2). This number assumes that the virus will not mutate to the point where re-infection is possible. If mutation occurs, COVID could become established in the general population similar to influenza or the common cold (3). A third publication estimates a needed infected percentage of 29-74% (4). These publications support the statement that millions will die if herd immunity is achieved via infection without vaccination. Historically, vaccination results in fewer deaths/disease on a population level than the disease for which the vaccine is designed to prevent (5-7).

Sources:

1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314002/

2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262166/pdf/JMV-9999-na.pdf

3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164482/

4 https://www.cambridge.org/core/services/aop-cambridge-core/content/view/A1480DAE803D4CD4A3E9F79B82309584/S1935789320001913a.pdf/covid19_reflections.pdf

5 https://pubmed.ncbi.nlm.nih.gov/28708957/

6 https://pubmed.ncbi.nlm.nih.gov/29668817/

7 https://pubmed.ncbi.nlm.nih.gov/12531323/

Take away: Though not a guarantee of health, wearing masks reduces the number of respiratory infections compared to no/inconsistent mask wearing.

The claim: Masks are protective against clinical respiratory illness.

The evidence: The authors performed a meta-analysis of random controlled trials and observational studies examining mask use in health care workers. The results showed that wearing masks resulted in fewer infections compared to people without masks. These results agree with other publications (1, 2). One pre-print article which performed meta-analysis showed inconclusive results concerning the effectiveness of masks (3). Based on these meta-analyses, mask wearing results in fewer respiratory infections, though it will not prevent all infections when used as the sole protective measure.

Sources:

1) https://pubmed.ncbi.nlm.nih.gov/32497510/

2) https://pubmed.ncbi.nlm.nih.gov/27632416/

3) https://www.medrxiv.org/content/10.1101/2020.03.30.20047217v2