Vilka nationella eller regionala åtgärder mot coronavirus är evidensbaserade?

[dann]

And this is in spite of people in the USA still masking up on the subway and in many other public places, unlike Scandinavia. For instance on talkshows, you see the audiences are all wearing face masks - and yet two talkshow hosts have come down with Covid-19 in recent weeks: Stephen Colbert and Jimmy Kimmel. I guess Trevor Noah is next:

Trevor Noah Mocks Washington for Hosting ‘Superspreader' Event at Correspondents' Dinner
https://www.nbcwashington.com/entertainment/entertainment-news/trevor-noah-mocks-washington-for-hosting-superspreader-event-at-correspondents-dinner/3039704/

So yes, det kan bli en värre situation i framtiden, in particular, if the CDC starts talking about having left the pandemic phase, which seems to be a bit premature when the number of new daily cases is rising. They could have said the same thing in the summer of 2021 when the numbers were lower than now.

It looks like Colbert may be in for the long haul:

Stephen Colbert (Twitter, April 21, 2022)
Yep! I tested positive for Covid, but basically I’m feeling fine- grateful to be vaxxed and boosted. Thank you for the well wishes. This just proves that I will do anything to avoid interviewing Jason Bateman.
https://twitter.com/StephenAtHome/status/1517214298245939201

Stephen Colbert (Twitter, May 9, 2022)
WORST. SEQUEL. EVER.
https://twitter.com/StephenAtHome/status/1523767394233368577

Stephen Colbert halts more ‘Late Show’ episodes due to recurrence of COVID (L.A.Times, May 9, 2022)
https://www.latimes.com/entertainment-arts/tv/story/2022-05-09/stephen-colbert-covid-19-recurrence-cancels-late-show-episodes

The Late Show on pause following Stephen Colbert's COVID "recurrence" (AV Club, May 10, 2022)
https://www.avclub.com/late-show-paused-following-stephen-colbert-covid-recurr-1848908606

And unlike many other Americans, guys like this have access to full health care.

[Nemesis]

New Scientist är ungefär motsvarigheten till Illustrerad vetenskap. Den ägs av Daily Mail, en tabloid av ungefär samma skrot och korn som "svensk kvällspress". Daily Mail är bannad som källa på Wikipedia. Michael Marshall som skrivit artikeln du hänvisar till som "vetenskaplig källa" är inte vetenskapsman. Han har en grundexamen i psykologi och en Master i kommunikation.

Michael Marshall är vetenskapsjournalist, en sådan behöver inte nödvändigtvis ha forskarbakgrund? Vilka kvalifikationer har din favoritjournalist(?) Amina Manzoor?

Se Danns länk. New Scientist är måhända inte Scientific American, men tycks vara en fullt pålitlig källa.

[Nemesis]

Steven Novellas bloggpost från Science-Based Medicine idag. Mycket läsvärd:

The Toll of COVID

We can’t take our eyes off the ball just yet – what’s the state of the pandemic?

Last week the US passed what many are calling a “grim milestone” – over one million deaths related to the COVID-19 pandemic. While this was dutifully reported in mainstream media, there was little fanfare or handwringing, a testament to the level of pandemic fatigue we are also experiencing. As has also been widely reported, people may be done with the pandemic, but the pandemic is not done with us. Many people I speak to, including some fellow healthcare providers, have the attitude – I’ve already caught COVID, I’m fully vaccinated, I’m just going to live my life and not worry about it anymore. This is understandable, but we have to be realistic about what this will mean.

What we are experiencing is what a world-wide pandemic looks like. The 1918 flu pandemic lasted two years and killed an estimated 50 million people worldwide. Improved medical care is mitigating the death toll of this pandemic, but perhaps it is also extending its duration. We have passed the two year mark, and experts are warning of a potential new wave this Fall. The problem, of course, is the new variants of SARS-Cov-2, with the Omicron subvariant BA.2 being of special concern.

Pandemic fatigue is everywhere as restrictions are being lifted, and Congress is stalled on passing new funding for pandemic relief. The sense of urgency is apparently gone. People want life to get back to normal, and are willing to live with COVID. At some point we do need to make this transition, just like we live with the flu every year. But timing is important, and we simply may not be ready for the consequences of what living with COVID will mean at this time.

...

There is, of course, another way to gain resistance to infection without getting infected – vaccines. Vaccines remain our best weapon against the virus and the single most effective way to bring this pandemic to a close. In the US about 78% of the population has received at least one dose of a COVID vaccine, while about two thirds are considered fully vaccinated. While these numbers are high enough to reduce the severity of the pandemic, and have certainly helped reduce hospital admissions, they are not high enough to provide a solid herd immunity effect that would prevent waves of spreading virus. These relatively low vaccination numbers are nothing short of a self-inflicted tragedy.

...

There is absolutely no logistical reason why the US and every industrialized nation cannot have vaccination rates higher than 95%, enough to effectively shut down this pandemic. We are experiencing a societal failure that we need to examine and remedy. This pandemic is not over, and it may not be over for a long time. Further, this will not be the last pandemic, and it likely won’t be a century until the next one.

https://sciencebasedmedicine.org/the-toll-of-covid/

[Nemesis]

Vad som sannolikt väntar i höst och vinter, när relativt lång tid har gått från senaste vågen och vaccineringen, och immuniteten sjunkit i befolkningen:

Coronavirus wave this fall could infect 100 million, administration warns

The projections for fall and winter are part of a pitch for additional funding for vaccines, treatments and tests

The Biden administration is warning the United States could see 100 million coronavirus infections and a potentially significant wave of deaths this fall and winter, driven by new omicron subvariants that have shown a remarkable ability to escape immunity.

The projection, made Friday by a senior administration official during a background briefing as the nation approaches a covid death toll of 1 million, is part of a broader push to boost the nation’s readiness and persuade lawmakers to appropriate billions of dollars to purchase a new tranche of vaccines, tests and therapeutics.

In forecasting 100 million potential infections during a cold-weather wave later this year and early next, the official did not present new data or make a formal projection. Instead, he described the fall and winter wave as a scenario based on a range of outside models of the pandemic. Those projections assume that omicron and its subvariants will continue to dominate community spread, and there will not be a dramatically different strain of the virus, the official said, acknowledging the pandemic’s course could be altered by many factors.

Several experts agreed that a major wave this fall and winter is possible given waning immunity from vaccines and infections, loosened restrictions and the rise of variants better able to escape immune protections.

Many have warned that the return to more relaxed behaviors, from going maskless to participating in crowded indoor social gatherings, would lead to more infections. The seven-day national average of new infections more than doubled from 29,312 on March 30 to nearly 71,000 Friday, a little more than five weeks later.

https://www.washingtonpost.com/health/2022/05/06/fall-winter-coronavirus-wave/

[dann]

I don't think Steven Novella is right about this: "vaccination rates higher than 95%, enough to effectively shut down this pandemic."
The first part, yes. It should have been possible for all industrialized nations to have achieved vaccination rates higher than 95%, and at that level, it would have been pretty easy to effectively shut down the pandemic if it had also been achieved in the rest of the world early on. But at this point, with an infectious disease that is as contagious as the Omicron variants, vaccines are no longer enough to stamp out the spread.

It requires additional measures like masking up in public places, improved ventilation and TTI, but they have been abandoned again in most places.

But a developing country like Cuba shows that it is possible to suppress even the Omicron variants with a combination of vaccines, face masks and other measures:
http://www.internationalskeptics.com/forums/showthread.php?postid=13800837#post13800837
http://www.internationalskeptics.com/forums/showthread.php?postid=13784884#post13784884
https://ourworldindata.org/covid-vaccinations

In Scandinavia's industrialized countries, we show the futility of trying to live with the virus.

[Nemesis]

Omikron jämförs ofta med mässlingen i smittsamhet. VI har ett effektivt vaccin mot mässlingen, och har därmed minimalt med spridning av sjukdomen i de länder med hög vaccinationstäckning. Sjukdomen sprids väl i västvärlden princip endast bland grupper som av olika skäl är anti-vaxxare.

Något liknande borde vara möjligt att uppnå med Omikron, om vi hade samma höga vaccinationstäckning. Nu kompliceras detta av att vaccinen mot Covid, som är anpassade efter ursprungsvarianten, inte biter lika bra på Omikron som mässlingvaccinet gör på mässlingen, och att immuniteten snabbt minskar, medan skyddet mot mässlingen från vaccin är livslångt, eller iaf mycket långvarigt.

Om nästa generations Covidvaccin ger mer långvarig immunitet och biter bättre på alla varianter så borde vi kunna uppnå samma sak med Covid som vi uppnått med mässlingen.

Och även om det inte skulle gå att uppnå detta så är det ändå en klar förbättring ju fler som är vaccinerade mot Covid. Det finns ingen ursäkt att vara emot Covid-vaccin för någon grupp som det visat sig säkert för, inklusive 5-11-åringar.

[dann]

Remember that hope is not a strategy!
We don't know if the next batch of vaccines against SARS-CoV-2 will be any more effective than the current ones. And we don't know if the immunity they provide will last any longer. There is reason to assume that it won't.

However, this is not an argument against vaccines. They do offer some protection and with very few side effects. It is an argument against relying solely on vaccines. And I see no reason why children younger than 12 shouldn't be vaccinated. It offers children a pretty good protection from long Covid, MIS-C and even the new hepatitis. Cuba has been vaccinating children 2+ since last year, and they are currently testing their vaccines on children younger than 2:

Cuba quiere a todos sus niños protegidos: Ensayarán vacunación anti-COVID-19 en niños menores de dos años (Granma.cu, May 12, 2022)
https://www.granma.cu/cuba/2022-05-12/cuba-quiere-a-todos-sus-ninos-protegidos-12-05-2022-00-05-41

Cuban children are masking up, too, and they don't seem to have any problems with it. It seems to be doing the trick in Cuba, and their face masks are not even FFP2/N95.

[dann]

Cuba wants its children protected: Clinical trials set to begin to determine the effectiveness and safety of Cuba´s anti-COVID-19 vaccines in children under two years of age (Granma.cu, May 12, 2022)
https://en.granma.cu/cuba/2022-05-12/cuba-wants-its-children-protected

[dann]

USA og Europa runder grumme corona-milepæle (TV2.dk, May 12, 2022)
Flagene stod torsdag på halvt ved Det Hvide Hus og andre offentlige bygninger i USA.
Anledningen var, at præsident Joe Biden ville markere det, han kalder en ”tragisk milepæl”: En million amerikanere døde med coronavirus.
Det er flere, end der bor i storbyer som San Francisco og Seattle. Det er også flere amerikanere, end der døde i Første Verdenskrig, Anden Verdenskrig, Koreakrigen og Vietnamkrigen tilsammen, skriver ABC News.
(...)
Samtidig rundede Europa i denne uge også en ”grum milepæl”, skriver Verdenssundhedsorganisationen WHO’s europæiske kontor torsdag i en pressemeddelelse.
To millioner personer er nu bekræftet døde med coronavirus i WHO's europæiske region.
(...)
På verdensplan har WHO registreret 6,26 millioner dødsfald. Men reelt kan pandemien have været langt mere dødbringende, når man gør det op i personer, der er døde med sygdommen, og personer, der er døde som følge af pandemiens indvirkning på sundhedssystemer og samfund, især i fattige lande.
For nylig estimerede WHO, at omkring 14,9 millioner mennesker er døde som konsekvens af pandemien mellem 1. januar 2020 og 31. december.
https://nyheder.tv2.dk/udland/2022-05-12-usa-og-europa-runder-grumme-corona-milepaele

[Nemesis]

Remember that hope is not a strategy!
We don't know if the next batch of vaccines against SARS-CoV-2 will be any more effective than the current ones. And we don't know if the immunity they provide will last any longer. There is reason to assume that it won't.

However, this is not an argument against vaccines. They do offer some protection and with very few side effects. It is an argument against relying solely on vaccines. And I see no reason why children younger than 12 shouldn't be vaccinated. It offers children a pretty good protection from long Covid, MIS-C and even the new hepatitis. Cuba has been vaccinating children 2+ since last year, and they are currently testing their vaccines on children younger than 2:

Cuba quiere a todos sus niños protegidos: Ensayarán vacunación anti-COVID-19 en niños menores de dos años (Granma.cu, May 12, 2022)
https://www.granma.cu/cuba/2022-05-12/cuba-quiere-a-todos-sus-ninos-protegidos-12-05-2022-00-05-41

Cuban children are masking up, too, and they don't seem to have any problems with it. It seems to be doing the trick in Cuba, and their face masks are not even FFP2/N95.

Det är fullt möjligt att nästa generations vaccin inte gör någon skillnad. Det är också fullt möjligt att även om 95% vore vaccinerade så skulle det ändå inte stänga ner pandemin (iaf lokalt).

Oavsett vad är det bedrövligt att vaccinationstäckningen är låg. Att Sverige väljer att inte vaccinera 5-11-åringar med väldigt tveksam argumentation borde vara en politisk skandal.

[Nemesis]

Torsdagens bloggpost från Science-Based Medicine. Mycket läsvärd. Jag tror att Johannes här på forumet, liksom Amina Manzoor, skulle bli bättre informerade av att läsa den.

Methodolatry and COVID

Doctors who call for an RCT for everything generally haven’t run a single RCT on anything. Why is this?

I love RCTs. All doctors do. In a fantasy world with unlimited time and money, but without ethics, an RCT would yield the optimal answer for many medical questions. They are the gold-standard for their ability to randomize patients and minimize bias. They are truly a remarkable achievement with a fascinating history. I firmly believe that every intervention that can be studied via an RCT should be.

However, in the real world, significant ethical and practical limitations prevent us from doing this. Having an idea for an RCT is infinitely easier than actually doing an RCT.

...

These RCTs were medical science at its best, and there absolutely should have been more of them. Hopefully before the next pandemic, the CDC will have established an “RCT Strike Force” that is capable of rapidly testing interventions. Citizens also need to know that signing up for RCTs is a heroic and vital effort where their safety is a priority. Without these brave volunteers, medical progress would stop.

Everyone who worked on or volunteered for an RCT this pandemic deserves our gratitude. It was really hard work.

Though I wish more interventions had been studied via enormous RCTs, I recognize that we can’t study every intervention this way. Sadly, we don’t have an RCT Strike Force today, so our public health leaders had to make choices. You may disagree with their choices, but they couldn’t have studied everything via an RCT despite what some contrarian doctors claim. Moreover, there is an opportunity cost. Every dollar and hour spent running an RCT for boosters would be a money and time not spent convincing people to get the first two doses.

It’s not easy to say exactly which interventions can and should be studied via an RCT in a raging pandemic. They are necessary to properly evaluate new vaccines. I’m glad that this was our top priority. They are necessary to properly evaluate medications. I didn’t give my COVID patients hydroxychloroquine or ivermectin based on a few lousy, even fraudulent, observational studies. Without a well-done RCT showing otherwise, except for patients facing certain death, I assumed these drugs would result in more harm than benefit.

But other interventions have an entirely different risk/benefit profile and favor their use even absent large RCTs. We often have to do our best with solid but imperfect data obtained via observational studies or small RCTs. Early in the pandemic, decisions had to be made with no data at all. Such is life. Time is not an unlimited luxury in a pandemic and we can’t let perfect be the enemy of good when forklifts are needed to move dead bodies to overflowing morgues.

https://sciencebasedmedicine.org/methodolatry-and-covid/

[dann]

He is right, of course, but as Johannes showed us, there is an easy way to dismiss "solid but imperfect data": You simply refer to the hierarchy of medical evidence and insist that imperfect can't be solid. Instead of data, it is much better to rely on the magkänsla of old guys like Tegnell and Gisele: Face masks are dangerous, the pandemic is harmless, and it will be over nest week anyway. That is the true Swedish version of evidensbaserade åtgärder. You should never tamper with perfection!

[dann]

Folksagomyndigheten (May 14, 2022)

Det ökande antalet covidorsakad hepatit bland barn och unga
har något slags mystisk orsak.
- - -
Varje gång du infekteras med covid ökar risken för diabetes.
Och diabetes ökar risken för svår covid.
De tar liksom ut varandra.
https://twitter.com/JonasHell1

[Nemesis]

He is right, of course, but as Johannes showed us, there is an easy way to dismiss "solid but imperfect data": You simply refer to the hierarchy of medical evidence and insist that imperfect can't be solid. Instead of data, it is much better to rely on the magkänsla of old guys like Tegnell and Gisele: Face masks are dangerous, the pandemic is harmless, and it will be over nest week anyway. That is the true Swedish version of evidensbaserade åtgärder. You should never tamper with perfection!

Det skulle vara intressant att se Johannes redogöra för hur forskningsläget ser ut för hur handtvätt skyddar mot Covid.

[dann]

If it was good enough for Semmelweis, it must be a panacea and thus effective against Covid-19 and all its variants.
The lack of proper RCTs gives us the freedom to simply make up stuff, and our vanity and arrogance prevent us from saying that we were wrong.
Thus ZeroCovid was impossible with the early variants even when it was actually accomplished, over and over, and any difficulty doing it again with the much more contagious Omicron variants just goes to show how right we were.