tldr wear a mask and avoid crowds

twitter thread on a reddit thread on foods being tasteless now

not great news

this seems like something you do not want

one of the best MR comments sections I have seen

Adapting to solitude, and downsides of getting stuck there

not particularly

The results demonstrate a statistically significant depletion of CGM volume in 24 COVID-19 infected patients.

These seems to underplay the fact that it was reduced in all of them.

Very unfortunate

Invention is overrated, implementation underrated. Both in difficulty, and importance.

I know many of you like to say “No worse than the common cold!” Well, the thing is…the common cold imposes considerable costs on the world. Imagine a new common cold, which you catch a few times a year, with some sliver of the population getting some form of Long Covid.

ongoing scary stuff. Read the same day as “the gut makes your serotonin”

Filed under “moderately concerning”. Still waiting on those variant-based boosters.

A study funded by #Pfizer shows that, within months, third shot of their vaccine now only cuts your risk of being hospitalized for Covid-19 by about half.

https://thelancet.com/journals/lanres/article/PIIS2213-2600(22)00101-1/fulltext

More depressing covid takes. The final paragraph:

The countries that have stopped the virus, that is, cannot keep stopping the virus, because the experts say there is already too much of the virus circulating. China is a pandemic waiting to happen because the United States is wholeheartedly committed to being a pandemic. The American program, they say, will be the program for the entire world.

Depressing read. In part because much of it won’t happen and we’ll keep flailing and yoyoing

My (non-expert) opinion is still in favor of fractional dosing. Really needed more non-industry research on it though.

Australia’s anti-antigen insanity

Update [28 Sept]: At-home testing planned to be available by end of year. The delay was apparently deliberate.

Australia still does not allow rapid antigen testing for home use. This seems ridiculous to me, that we have basically ignored a valuable tool in helping detect and prevent outbreaks.

Some quotes from the TGA FAQ on Antigen Tests.

There is also a potential risk that some individuals could be motivated to conceal or not report a positive test, especially if they felt that their symptoms were mild and, for example they might lose employment income, be unable to go on holiday, or miss an important family event.

This seems absurd to me. Ignoring non-compliant people (who are unlikely to get PCR tested anyway!), you are missing out of tests for asymptomatic and mild-symptom people. People with mild symptoms aren’t going to go wait 2 hours in a queue for a PCR test either, convincing them to have a quick test at home seems like an easier ask…

The “be unable go on holiday, or miss an important family event” bit also seems to disregard millions of people being restricted to their homes for months at a time.

Although these tests can detect the virus in the acute phase of infection from symptomatic patients, in community settings where there are low rates of COVID-19 there is a high risk of false positive and false negative results and therefore the results can be susceptible to misinterpretation.

Every positive test is indeed very significant, but so is every positive case! Antigen tests are less accurate in asymptomatic people, around ~60% for a single test. But since the current advice is get tested when you have symptoms, our current detection rate of asymptomatic cases is closer to 0%! So false negatives are still likely to be less frequent that what we get.

And for false positives - if you test positive with rapid test, then you go get a PCR test to verify. This gives you confirmation, and more data on the accuracy of antigen tests (lack of data being yet another reason given for not having rolled them out).

Even the lower bound on asymptomatic cases suggest 15%, and you then have a 3-5 day lag period of them infecting people!

This risk increases with inadequate sample collection.

This seems like a more compelling argument. People may not wash their hands before the test, or get too much mucus on their sample or other things to decrease accuracy. But again, false positives are pretty cheap when the entire state is in lockdown - most people are basically isolating already.

Work is being progressed that may allow the provision of self-tests for COVID-19 in the future. Any change to the current prohibition on the supply of self or ‘home’ tests will require regulatory change. The timing of introduction of self-testing is critically dependent on achieving specific higher vaccination rates as outlined in the National Plan to Australia’s COVID-19 response, and for the states and territories having established systems for reporting positive self-test results and directing individuals to have immediate PCR confirmatory tests.

This is a particularly ridiculous reason. “It will require regulatory change oh no this could take years”. The government is somehow able to rush through sweeping surveillance changes virtually overnight, can extend the maximum length of a state of emergency as needed, lockdowns and travel bans can come into effect the same damn day. But allowing people to self-administer a test used in dozens of other countries in the world? I imagine this will need several decades and many committees.

As for needing to “establish systems for reporting positive self-test results”. Here you go: “if you self-test positive, get a PCR test immediately to confirm the result”.

Use of the test by untrained persons and testing performed outside the supervision of a health practitioner would mean that the person or organisation could be liable if something goes wrong with the performance or interpretation of the test.

Surely irrelevant for self-testing? Are health practitioners liable for the interpretation of PCR tests?If I get a negative test result but am symptomatic the next day can I sue? “Surely you should have known, doctor!”. Has this been a concern anywhere in the world yet? If so, add a clause about liability while you are changing the law around approval.

How could we use rapid tests?

Combined with wastewater testing, as a screening test

Wastewater testing is a useful indicator, but can’t really be narrowed down. Currently it is reported and then you get the same advice as anyone else - “if you have symptoms go get tested”. It could be used for targeting areas to mass-deploy antigen tests as a screening tool. As someone that’s lived in what is basically a permanent hotspot, either a local pickup spot or tests in my mailbox would be a welcome addition to the neighbourhood.

More regular testing of people in isolation

Tests every 3 days rather than every two weeks could hugely reduce contact tracing lag! Currently there are tests on Day 1 and Day 13, then 12 days of “well maybe I guess I sure hope I didn’t infect a bunch of people in the 5 days since that exposure site was announced”.t

Adding some intermittent self-tests through that period could give quicker results for contact tracing, and actually try containment while it’s still relevant.

Regular testing of schoolchildren / employees

Schools are a perfect opportunity for regular rapid tests. Lower risk, but higher value of catching cases early (before they infect too many people in more vulnerable groups). If you are going to return to a regular indoor group activity, it is an easy way to screen that you can do from work! This is again being introduced now, but crazy that it was not considered a year ago. This idea is not new new.

For ticketed events or busy places (supermarkets etc)

Again, for stores that have been outbreak risks we currently wait on finding someone with PCR tests. You could test people on their way to the supermarket, and then have a test result before they’ve even finished their shopping! Announce over the overhead speakers “we just detected a positive case, please get PCR tested immediately”. Would stores do this? Would customers listen? Both probably unlikely. But that would give much faster indication than the current multi-day lag of a PCR test and then publishing the exposure site and having other people get tests.

Voluntary tests for hypochondriacs

As we open up, people could self-test as their social bubble expands. After seeing some people out this weekend, I would have loved to have a test at home sometime this week. Instead I am supposed to wait until I am symptomatic, then drive to a testing centre and wait a day?

Absurd comparisons with PCR

The obsession with 100% perfection guarantees - both in test accuracy and vaccine safety - has been an infuriating part of the response to COVID. Expected value is apparently ignored, leaving us with vaccine supply shortages, public fears about vaccine safety and weird preferential choices, and just in general terrible decisions.

They are not meant to replace PCR, but should definitely be part of our toolkit.

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Last updated: Mon 28 Sep, 2021

Disclaimer: I am not any kind of doctor or expert, potentially wrong about plenty of this.

More notes and links on this here

Aiming for 60% global vaccination rate by next March. Some interesting facts and notes around which countries produce/export vaccines.

Pending peer review, but apparently large benefit in waiting 12 weeks rather than three.

In donors without evidence of previous infection the peak antibody response was 3.5-fold higher in donors who had undergone delayed interval vaccination. Cellular immune responses were 3.6-fold lower.

Some loose-ish estimates, but some staggering figures in there.

16% of the world bought 70% of the vaccines. What force on earth could stop them? None, so we needed the massive supply increases, which were effectively banned.

What fraction of all vaccines were wasted?

• by excessive dosing. No sign of the dosing regimes changing despite strong evidence. 50-75%?**
• by bad needle design. 10-30% more.

Also includes some good links and references. And honest disclaimer from the author:

Note: I’m not a engineer, I’m not an economist, I’m not a pharmacologist, I’m not an epidemiologist. There will be something wrong with the above, no doubt in misunderstanding the nature of vaccine engineering bottlenecks.

Maybe unsurprising, still disappointing

Article raises a lot of the things I don’t like about tourism: locals being priced out, areas being ruined and overrun by visitors, and useful stores being replaced by junkshops selling shitty trinkets.