Thursday, April 16, 2020
Some days it feels like the negative data outweighs the positive. But it is essential to keep in mind that we have a flood of data, updated in near real-time, that is often hard to put into a broader context. Maintaining the long view while wading through the details is tough. I take comfort in knowing that we are far from the first people in history to face adversity. While we talk about what de-quarantining may look like in the next few weeks or months, I am also beginning to wonder how many of us will be interviewed for school projects by our grandkids one day. I wonder what we will say? Either way, lots of data to review and often challenging to know what all the implications are. Staying appropriately critical and skeptical is the lesson I continue to learn.
------------
FT data (No change in the presentation)
https://www.ft.com/coronavirus-latest
Death vs Cases in the U.S.
https://ourworldindata.org/grapher/daily-covid-cases-deaths?country=USA
As a wise someone pointed out that a lot of the day to day variation here (especially in the confirmed cases) is a function of the testing.
There is data starting to emerge on some of the therapy trials.
Here is some data to further suggest that HCQ's is probably not THE answer:
https://www.nytimes.com/2020/04/12/health/chloroquine-coronavirus-trump.html
Gilead is having trouble recruiting enough severe cases in China. On the one hand, this is good (fewer severe cases). On the other hand, it is frustrating since the data we have so far lacked a control arm. (you will recall the tweets and article from earlier this week)
https://www.fiercebiotech.com/biotech/gilead-shares-slip-as-a-second-remdesivir-covid-19-trial-halted-china
A reader asked about the reported shortage of dialysis supplies reported in this article:
https://www.politico.com/news/2020/04/15/dialysis-kidney-coronavirus-188840
The short answer is, yes. Coronavirus treatment demands a huge amount of resources to support those that become very ill. Prolonged, difficult to manage respiratory status (think about all the articles on ventilator and lung pressures and how often ECMO machines are mentioned). A hypercoagulable state that makes using blood-based dialysis machines (the filters) challenging. There are more patients with new kidney injury and prolonged periods of illness, outstripping the typical hospital volume of dialysis machines. As a result, the supplies for slow, continuous dialysis (CRRT) and peritoneal dialysis (which can be used as an emergency dialysis therapy) are in very high demand. The companies that make these materials are struggling to meet demand. And, as you would imagine, hospital-based dialysis nurses have been immensely stressed in the hardest-hit areas as well (described at the end of the article). So Adam's take is: supplies are in high demand as reported, but sentiments on staffing may not reflect the range of sentiment I am hearing.
Is history repeating itself?
https://twitter.com/AdamRodmanMD/status/1250462389369221121
Watching people interpret data in real-time is both horrifying and fascinating (like Tiger King!).
https://twitter.com/KlausKblog/status/1249048902495592450
THIS IS FOR ENTERTAINMENT PURPOSES ONLY. The notion that smoking is protective in some way is not born out by this data. At best, it is a confusing mess of information that seems to say 1) former smokers seem to be hospitalized less, but 2) former smokers who were hospitalized died at a higher rate. This data does not appear to be controlled for all sorts of confounders. The key is to enjoy the twitter discussion amongst people of varying backgrounds and agendas.
This article is all sorts of crazy. I would not sign up for a "jailbroken" ventilator. And, to be clear, BiPap and CPAP are not the same things as ventilators. And, just because the firmware has certain features, doesn't mean the hardware can support those features. Adam's take: beware of articles that play the "corporate greed is the barrier" to an overly simple solution. And just because the FDA, CMS, or other regulatory authority says you can do something, doesn't mean you should (it may not be safe!).
https://arstechnica.com/information-technology/2020/04/firmware-jailbreak-lets-low-cost-medical-devices-act-like-ventilators/
Here is my favorite heart-wrenching article of the day. https://www.theatlantic.com/international/archive/2020/04/italy-patient-one-family-coronavirus-covid19/610039/
My favorite discovered infographic of the last 24 hours. A highly editorialized comprehensive guide to Yellow Stripey Things
https://i.redd.it/pvd2jzjkwxs41.jpg
Culinary infographic of the day!
https://ringhilterra.github.io/dessert-flavor-pairings/
I was surprised by the clove pairing frequency (albeit smaller than other flavors). Perhaps I bring bias to my clove assumptions.
----- Bonus round - People who faced adversity edition
Emilie du Châtelet showed up in my internet wanderings last night. An early 18th-century philosopher and mathematician, she had a long relationship with Voltaire. She published numerous works of her own, including advancing concepts on conservation of energy, as described by Newton. And she was in the French aristocracy with parties, affairs and children. Given the social barriers and obligations of the time, she seems to have had an incredible intellect. And she died at age 42, just after giving birth to her 4th child.
https://en.wikipedia.org/wiki/%C3%89milie_du_Ch%C3%A2telet
https://narratively.com/the-pregnant-scientist-who-raced-against-death-to-transform-physics/
I had also not read about Giovanni Boccaccio's Decameron until recently. Another delightful discovery, both the author and his work are interesting. He was a Florentine author and politician in the early renaissance. His work represents an effort at re-invigorating literature in the classical style, but reflective of 14th century Italy. All the while, he was rooted in the rough and tumbled politics of the Italian city-states. More interestingly, his work probably inspired Chaucer's structure of The Canterbury Tales, and he told dirty jokes too. Everyone likes dirty jokes, including the Italians and the English of the 14th century.
https://en.wikipedia.org/wiki/Giovanni_Boccaccio
https://publicdomainreview.org/collection/the-decameron
https://chaucer.fas.harvard.edu/pages/giovanni-boccaccio-1313-1375
Clean hands and sharp minds
-Adam
Some days it feels like the negative data outweighs the positive. But it is essential to keep in mind that we have a flood of data, updated in near real-time, that is often hard to put into a broader context. Maintaining the long view while wading through the details is tough. I take comfort in knowing that we are far from the first people in history to face adversity. While we talk about what de-quarantining may look like in the next few weeks or months, I am also beginning to wonder how many of us will be interviewed for school projects by our grandkids one day. I wonder what we will say? Either way, lots of data to review and often challenging to know what all the implications are. Staying appropriately critical and skeptical is the lesson I continue to learn.
------------
FT data (No change in the presentation)
https://www.ft.com/coronavirus-latest
Death vs Cases in the U.S.
https://ourworldindata.org/grapher/daily-covid-cases-deaths?country=USA
As a wise someone pointed out that a lot of the day to day variation here (especially in the confirmed cases) is a function of the testing.
There is data starting to emerge on some of the therapy trials.
Here is some data to further suggest that HCQ's is probably not THE answer:
https://www.nytimes.com/2020/04/12/health/chloroquine-coronavirus-trump.html
Gilead is having trouble recruiting enough severe cases in China. On the one hand, this is good (fewer severe cases). On the other hand, it is frustrating since the data we have so far lacked a control arm. (you will recall the tweets and article from earlier this week)
https://www.fiercebiotech.com/biotech/gilead-shares-slip-as-a-second-remdesivir-covid-19-trial-halted-china
A reader asked about the reported shortage of dialysis supplies reported in this article:
https://www.politico.com/news/2020/04/15/dialysis-kidney-coronavirus-188840
The short answer is, yes. Coronavirus treatment demands a huge amount of resources to support those that become very ill. Prolonged, difficult to manage respiratory status (think about all the articles on ventilator and lung pressures and how often ECMO machines are mentioned). A hypercoagulable state that makes using blood-based dialysis machines (the filters) challenging. There are more patients with new kidney injury and prolonged periods of illness, outstripping the typical hospital volume of dialysis machines. As a result, the supplies for slow, continuous dialysis (CRRT) and peritoneal dialysis (which can be used as an emergency dialysis therapy) are in very high demand. The companies that make these materials are struggling to meet demand. And, as you would imagine, hospital-based dialysis nurses have been immensely stressed in the hardest-hit areas as well (described at the end of the article). So Adam's take is: supplies are in high demand as reported, but sentiments on staffing may not reflect the range of sentiment I am hearing.
Is history repeating itself?
https://twitter.com/AdamRodmanMD/status/1250462389369221121
Watching people interpret data in real-time is both horrifying and fascinating (like Tiger King!).
https://twitter.com/KlausKblog/status/1249048902495592450
THIS IS FOR ENTERTAINMENT PURPOSES ONLY. The notion that smoking is protective in some way is not born out by this data. At best, it is a confusing mess of information that seems to say 1) former smokers seem to be hospitalized less, but 2) former smokers who were hospitalized died at a higher rate. This data does not appear to be controlled for all sorts of confounders. The key is to enjoy the twitter discussion amongst people of varying backgrounds and agendas.
This article is all sorts of crazy. I would not sign up for a "jailbroken" ventilator. And, to be clear, BiPap and CPAP are not the same things as ventilators. And, just because the firmware has certain features, doesn't mean the hardware can support those features. Adam's take: beware of articles that play the "corporate greed is the barrier" to an overly simple solution. And just because the FDA, CMS, or other regulatory authority says you can do something, doesn't mean you should (it may not be safe!).
https://arstechnica.com/information-technology/2020/04/firmware-jailbreak-lets-low-cost-medical-devices-act-like-ventilators/
Here is my favorite heart-wrenching article of the day. https://www.theatlantic.com/international/archive/2020/04/italy-patient-one-family-coronavirus-covid19/610039/
My favorite discovered infographic of the last 24 hours. A highly editorialized comprehensive guide to Yellow Stripey Things
https://i.redd.it/pvd2jzjkwxs41.jpg
Culinary infographic of the day!
https://ringhilterra.github.io/dessert-flavor-pairings/
I was surprised by the clove pairing frequency (albeit smaller than other flavors). Perhaps I bring bias to my clove assumptions.
----- Bonus round - People who faced adversity edition
Emilie du Châtelet showed up in my internet wanderings last night. An early 18th-century philosopher and mathematician, she had a long relationship with Voltaire. She published numerous works of her own, including advancing concepts on conservation of energy, as described by Newton. And she was in the French aristocracy with parties, affairs and children. Given the social barriers and obligations of the time, she seems to have had an incredible intellect. And she died at age 42, just after giving birth to her 4th child.
https://en.wikipedia.org/wiki/%C3%89milie_du_Ch%C3%A2telet
https://narratively.com/the-pregnant-scientist-who-raced-against-death-to-transform-physics/
I had also not read about Giovanni Boccaccio's Decameron until recently. Another delightful discovery, both the author and his work are interesting. He was a Florentine author and politician in the early renaissance. His work represents an effort at re-invigorating literature in the classical style, but reflective of 14th century Italy. All the while, he was rooted in the rough and tumbled politics of the Italian city-states. More interestingly, his work probably inspired Chaucer's structure of The Canterbury Tales, and he told dirty jokes too. Everyone likes dirty jokes, including the Italians and the English of the 14th century.
https://en.wikipedia.org/wiki/Giovanni_Boccaccio
https://publicdomainreview.org/collection/the-decameron
https://chaucer.fas.harvard.edu/pages/giovanni-boccaccio-1313-1375
Clean hands and sharp minds
-Adam
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