Science Says Sunday – Long-Haul COVID-19

For months now, we have heard of COVID-19 cases that persist past the usual time course of COVID-19. People have reported loss of taste and smell for months, continued fatigue, joint pain, among other symptoms. One of my favorite writers, Ed Yong of The Atlantic, wrote about individuals experiencing long-haul symptoms after COVID-19 diagnosis, back in August 2020. His piece starts by detailing the experience of Ms. Lauren Nichols:

When we spoke on day 150, she was on her fifth month of gastrointestinal problems and severe morning nausea. She still has extreme fatigue, bulging veins, excessive bruising, an erratic heartbeat, short-term memory loss, gynecological problems, sensitivity to light and sounds, and brain fog.

Ed Yong, The Atlantic, https://www.theatlantic.com/health/archive/2020/08/long-haulers-covid-19-recognition-support-groups-symptoms/615382/

A number of groups of individuals who have had COVID-19 and continue to suffer post-infection syndrome, communicate via social media discussing and detailing their respective cases. Several articles have also captured the growing number of reports of long-haul COVID-19, including a piece in STAT and another in Science. A third piece caught my eye: One written by a physician, Dr. Pooja Yeramilli. She details her own experience with COVID-19 and the continuation of symptoms afterwards, but also strikingly, her own uncertainty about labeling herself a ‘long-hauler’.

Much like with COVID-19 infection, there appears to be an element of shame associated with having persistent symptoms. However, in some cases, shame is not the only reason for keeping silent about these symptoms. In fact, in some cases, people are more than willing to share their experiences, but feel that they are not being heard or taken seriously when they share their experiences with their primary care doctors, family, friends, or anyone who will listen.

On December 3, 2020, the NIAID held a two day meeting to discuss what is currently known about Long-Haul COVID-19. Since then, the Centers for Disease Control have also provided information about Long-Haul COVID-19 on their website, titled “Long-Term Effects of COVID-19.

Much remains to be understood about COVID-19 long-term effects. For example, we don’t currently know:

  • Who is affected?
  • How are they affected?
  • How many people have long-term effects after COVID-19?
  • Are there risk factors associated with having long-term effects after COVID-19?

Luckily, some have begun to pay closer attention to this course of events, such that places like my university have established clinics to follow and treat individuals with persistent symptoms after having COVID-19. The clinic at the University of Alabama at Birmingham is called the “Post COVID Treatment Program” and aims to help patients who have had COVID-19 receive proper follow-up care during their recovery process.

There is much to learn about this long-term experience that individuals who had COVID-19 experience. For now, one thing is remains true: It is very important that if you haven’t yet had COVID-19, that you take the virus seriously. Many focus on the percentages reported by viral social media posts indicating that COVID-19 and infection generally with sars-cov-2 isn’t a big deal.

The reality is that 1 out of 1000 people in the US have now died due to COVID-19.

But as discussed above, death isn’t the only outcome. So are long-term effects after hospitalization due to COVID-19, or even having had COVID-19 without hospitalization. So, it’s important to take this virus seriously and not think too lightly about the consequences of becoming exposed, infected, passing it along to others, and ultimately – if lucky – recovering from it.

For the time being, remember the importance of timespacepeopleplace (credit to Dr. Bill Miller of The Ohio State University):

And most importantly, don’t forget to continue to:

Wash your hands

Wear your mask

Watch your distance

Avoid indoor spaces

Like you, I can’t wait to get my COVID-19 vaccine, but until we do, taking this virus seriously and doing everything we know to work, is super important!

For more information visit, cdc.gov, and watch this webcast hosted by NIAID on the long-term effects of COVID-19.

Science Says Sunday – How to Spot Misinformation

Many of you may not be old enough to remember when myths would go viral via email. Inevitably it would be a super long email, with poor grammar and formatting. Viral misinformation has become far more sophisticated as popularity for social media has grown. EVERY SINGLE DAY I get messages asking if the latest video on Tik Tok/Instagram/YouTube is true, or if the Facebook post someone shared is also true. Anyone can start a blog and share whatever is on their mind that day. There is inevitably a great deal of misinformation on Instagram too. More and more people are sharing non-factual information, especially as people have noticed that sharing COVID-19 information leads to growth in numbers. To some, fame – even if it’s just social media fame – can be quite alluring.

So, what’s a person to do when the onslaught of factual information is mixed in with non-factual information?? It can be tough. Especially when it’s about a topic we might not be too familiar with (eg, the latest is whether viral mutations will affect vaccine effectiveness. Short answer is…we don’t yet know. Stay tuned.)

So, how do you identify misinformation? Science and experts say:

  1. Consider the source
    1. Are you familiar with this source?
    2. Is it legitimate?
    3. Has it been reliable in the past?
  2. Read beyond the headlines
    1. Sometimes headlines are pretty compelling. They want you to click on the link and read the article, but sometimes the headline alone doesn’t tell the whole story. Sometimes the story is completely opposite of what’s suggested in the headline!
    2. If a headline is interesting, read the article, check #1 above, then decide whether or not you should share. In this case, sharing does not always mean caring. Sharing may mean you are contributing to the problem.
  3. Verify who the author is
    1. What credentials do they have? Are they experts in the topic? Are they really affiliated with the institution they say they are affiliated with? If they are affiliated with a big-name institution, are they qualified to speak on the topic?
  4. Is there support for the claim?
    1. Some viral rumors or myths originate from blog/Facebook or other social media posts. Some originate from extreme-leaning websites, with faulty sources. Is there support for the claim from both sides of the aisle? Make sure you also check the sources cited by the author. Sometimes the sources sound official, but they’re actually made up! I mean, how do people do these things?!
  5. Check the date of the story. 

I can’t tell you how many people have shared articles that were written years ago. As they say “old news”. Sometimes the claims are not at all relevant to current events.

  1. Is it meant to be funny or even satire? 

The Onion is notorious for sharing satirical stories, but sometimes people share them thinking they are real. For an explainer on satire, check out this video from Oregon State University

  1. Check your bias. 

We’re all guilty of it, especially confirmation bias. Confirmation bias is the tendency to believe or favor an idea or information that confirms what we believe. Sometimes it’s super subtle. We’ve seen confirmation bias played out in topics like how many deaths are actually due to COVID-19, but also more hotly debated topics like school reopenings and whether kids can get and transmit SARS-CoV-2.

  1. What other stories have been posted about the topic? What are their conclusions? Do they seem real or feasible?
  2. Check with the experts. 

Debunking all these myths, rumors, and pieces of misinformation can take a lot of time. It’s super easy to simply click ‘share’ and be done with it. BUT, in order for us to make progress in this pandemic, or whatever other topic is susceptible to misinformation, we need to work together to share factual information. Conspiracy theories abound and have been a source of misinformation for centuries. Let’s all do our part to tease apart the sensational from that which will help us all make progress and ensure better lives for all at stake. Some examples of well-established fact-checkers include:

Factcheck.org

Snopes.com

Washington Post Fact Checker

Politifact.com

Fact-checking scientific claims is a bit harder. For example, just because you found an article on Pubmed, does not make your claim fact. There are several layers to reaching causal inference about a topic (eg smoking causes lung cancer) beyond finding a paper on pubmed that says so. In epidemiology, we use a number of criteria and metrics to determine whether something causes something else. Among them are Hill’s Criteria for Causality, mathematical and epidemiologic analytical tools (eg diacyclic graphs), counterfactual analyses, and much more. A lot of analyses and shoe-leather epidemiology had to happen in order to determine that SARS-COV-2 causes COVID-19. And still, we don’t fully understand why some people become sicker than others, for example. That’s something many of us continue to study. So before you make a claim or assert something as fact, know that there is a lot of work that must go into backing up your claim, beyond citing a single article or blog post, but especially the latest viral Facebook or Tik Tok post. 

I found three awesome fact-checking websites you may consider perusing when you have some time. 

Video: How to Spot Fake News

Overcoming confirmation bias during COVID-19

Dr. Murray’s Causal Lab

We’re all tired and especially tired of the pandemic. At this point, we’re all a lot more susceptible to cognitive bias than we have, maybe ever before. But before sharing that next article or social media post, do a bit of the leg work described above. If you can, help stop the misinformation train and help scientists and others dedicate much needed time to advancing scientific discovery rather than having to debunk yet another viral misinformation claim.

Please and thank you.

Be safe and be well! Happy Holidays!

SCIENCE SAYS SUNDAY – What does the Pfizer/BioNTech EUA mean?

So much vaccine talk leads to much confusion!

In the US, the FDA has issued emergency use authorization (EUA) for a single vaccine so far: The Pfizer/BioNTech COVID-19 vaccine. You can learn more about what an EUA means here. You may have heard about the FDA meeting that happened live via YouTube this week, as well as the vote that happened Saturday (12/12/2020). All the information about these meetings, including details about the vote for approve the EUA can be found here.

You may have also heard about the Moderna vaccine, but as of today (12/13/2020) we do not yet have emergency use authorization for that vaccine, however, we anticipate that it is forthcoming SOON! Meetings about that EUA are expected this coming week.

In the meantime, here’s what you need to know. States are coordinating with the federal government to roll out vaccination programs for certain individuals. Based on the Pfizer data, FDA EUA, and CDC recommendations, the EUA for the Pfizer/BioNTech vaccine is currently only recommended for the following individuals, if supply is in short demand (which for this specific vaccine and the number of doses that were purchased by the US, yes, it is in short demand):

  • Healthcare personnel
  • Workers in essential and critical industries
  • People at high risk for severe COVID-19 illness due to underlying medical conditions
  • People 65 years and older

There’s a super comprehensive Atlantic article that lays down the hammer on what we should REALLY be expecting in 2021. An excerpt from that article is quite telling:

“Because the first shipments of vaccines will not cover all 24 million people in these two groups, the CDC has recommended sub-prioritizations too. Hospital workers who are in contact with patients are first on the list—including janitorial and support staff. The CDC also asks hospitals to consider that people who have recovered from COVID-19 likely have some immunity, so they do not need to be vaccinated first, though they won’t be prevented from getting vaccinated when doses are available later. For long-term care facilities, the CDC recommends putting skilled-nursing facilities, which have the sickest patients, before assisted-living facilities.”

Sarah Zhang, December 11, 2020, The Atlantic

24 million out of 328.2 million means these first doses will only reach 7.3%, when we actually need between 196-230 million people vaccinated. That means we have a ways to go logistically, but again, SUCH great news that we have this vaccine available to get started!

If there is significant supply (like sometime in the summer/fall), the Pfizer/BioNTech vaccine will be recommended for:

“persons 16 years of age and older in the U.S. population under the FDA’s Emergency Use Authorization.”

There are some exceptions. For example, we do not currently have data for the following populations:

  • Individuals aged less than 16 years of age
  • Immunocompromised individuals
  • Individuals who have severe allergic reactions to one of the ingredients in the vaccine
  • Women who are pregnant/lactating

There is a trial ongoing in 12-18 year olds, and results from that trial should be available some time in 2021. For women who are pregnant or lactating, there also isn’t a lot of data at this time, however, early animal studies are promising. The ACIP for example says the following about women who are pregnant or lactating:

At this time, we know that two trial endpoints were met:

  1. Individuals in the trial who got the vaccine did not develop symptoms consistent with COVID-19
  2. Individuals in the trial who got the vaccine did not develop severe COVID-19, such that they required hospitalization, for example.

We don’t yet know – though data is coming to tell us – whether the vaccine prevents people from becoming infected with sars-cov-2 (the virus that causes COVID-19), and/or if it prevents people from transmitting sars-cov-2 to others, even if they themselves don’t become super sick. We will know more about these two specific questions/endpoints in the coming weeks/months, but AT THIS TIME, we do not know the answers to these questions.

Therefore, it’s important to know that when you have access to the Pfizer/BioNTech vaccine (lucky you!), until we know otherwise, you will still need to wear your mask, watch your distance, and wash your hands. However, it does mean you will be less likely to have symptoms and/or severe disease, which is so amazing since we still don’t fully understand why some people become so sick and why some die.

Also keep in mind that if you are lucky enough to get a vaccine in the first or second round, it is not uncommon for you to experience some symptoms including fever, aches, or headache for example. That means the vaccine is working! Most people reported symptoms for no longer than 12 hours, most often the second day, and felt fine after.

For more information, feel free to read last week’s #sciencesayssunday post, which cites tons of literature about how the vaccine was developed and how it works.