Wednesday, April 22, 2020
Homeostasis (big and small) is on my mind today. We have been watching One Strange Rock (with Will Smith), and I am reminded of why I love physiology so much. Keeping in mind that living systems require mechanisms of correction and balance over time is critical to assessing data at any given moment. It is a crucial intellectual tenant of nephrology. I love finding other examples of this balancing in the things I read and watch.
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FT data (No change in the presentation)
https://www.ft.com/coronavirus-latest
Death vs. Cases in the US.
https://ourworldindata.org/grapher/daily-covid-cases-deaths?country=US
remember the reasons for variable daily reporting, look for the trends.
I am adding an estimate of effective reproduction number to my "go-to" graphics as it appears to be a way to contemplate when we could start to dial back on the lockdown. It is not a straightforward measure. I strongly recommend you read the blog post to understand the assumptions and potential sources of error.
https://rt.live/
blogpost http://systrom.com/topic/coronavirus/
Here is a discussion about the daily count data and the variability I want us all to keep in mind.
https://twitter.com/florian_krammer/status/1252750695314403329?s=12
I wandered into a twitter discussion about the NHS and their problems with "federalism" of sorts. It seems that they too, depend on regional and local PPE purchasing, which is creating bidding wars and exposing the weakness of de-centralization in times of emergency. Lots to ponder on how to balance the best of local vs. central control under different use cases, huh?
https://twitter.com/lewis_goodall/status/1252701841135226880
Dr. Krishnan sent a Fast Company article on the rapid and likely permanent push toward telehealth. I, too, believe we are not going back to pre-COVID rules on telehealth but have many reservations and concerns about what the unanticipated (and anticipated) consequences are for good care.
https://www.fastcompany.com/90490988/covid-19-is-normalizing-telehealth-and-thats-a-good-thing?mc_cid=96d9407335&mc_eid=03931920e6
Despite using it, I have mixed feelings about Twitter as a useful communication tool. However, I am often surprised about how it can be a forcing function for concise statements on complex topics. Here is an outstanding analysis of the NEJM article on Remdesivir. The author is a sharp-minded physician who we should all emulate in how we break down medical reports. YOU MUST read to tweet 16-18 to get the most value - his analysis.
https://twitter.com/rbganatra/status/1251558062357389312
Testing continues to be a source of vexation in so many ways. There are not enough tests, PCR that take too long, antibody testing with low sensitivity, etc. etc.. To be fair, it is not easy to ramp up quickly and the U.S., in particular, got a late start. Here is an article outlining some other sources of testing error that were identified as testing was being ramped up.
https://www.nytimes.com/2020/04/18/health/cdc-coronavirus-lab-contamination-testing.html
The hardest part of this event is coming to terms with the notion that 1st line success - slowing the spread of disease - looks like an overreaction. Here is an article on some political leaders who moved quickly. You can find data on their respective cities or countries in my data links at the top.
https://www.theatlantic.com/newsletters/archive/2020/04/ardern-merkel-breed-newsom/610351/
There are several ways to frame the "why" of this epidemic. One set of thoughts is that this isn't a unique event but a consequence of globalization, environmental change, and interconnectivity. If one is spending time trying to think systemically about unintended consequences in closed systems, this article presents a reasonable analysis. Fair warning - you may not agree with the offered solutions.
https://www.newyorker.com/news/daily-comment/the-pandemic-isnt-a-black-swan-but-a-portent-of-a-more-fragile-global-system
My favorite infographic of the day - words, history, and visuals
https://i.redd.it/672p2mwuwbu41.jpg
----Bonus Rounds - Understanding Homeostasis and respecting closed systems edition
Claude Bernard was a French physician who framed the concepts around homeostasis - the idea that closed biologic systems (like human bodies) have mechanisms of internal regulation and balance. The kidneys are one of the KEY regulatory mechanisms in the body. This guy articulated the underlying concepts first. He was also an early advocate for applying the scientific method to medicine. He lived in France of the mid-19th century. Not only did he help found the department of physiology at the Sorbonne be he was recognized, by the end of his life, for many of his intellectual achievements.
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2014000400322&lng=en&nrm=iso&tlng=en
In 1814, the post-Napoleonic nations in Europe negotiated alliances that were dependent on the concept of homeostasis (of sorts), called often called the Concert of Europe. The Austrian representative to these discussions was Klemens von Metternich. He had an innate sense of diplomacy and clearly understood that international relations are an amoral game of balancing competing interests. He is remembered for being a conservative, blocking reforms and social progress. I have found a lot of value in understanding his ability to work in a system without clear rules, with high stakes, and for which there are always compromises.
https://en.wikipedia.org/wiki/Klemens_von_Metternich
There is tons written about him, but this is my favorite book that includes him as a central actor in the Concert of Europe chapter: https://www.goodreads.com/book/show/781183.Diplomacy
Clean hands and sharp minds
-Adam
Homeostasis (big and small) is on my mind today. We have been watching One Strange Rock (with Will Smith), and I am reminded of why I love physiology so much. Keeping in mind that living systems require mechanisms of correction and balance over time is critical to assessing data at any given moment. It is a crucial intellectual tenant of nephrology. I love finding other examples of this balancing in the things I read and watch.
-------------
FT data (No change in the presentation)
https://www.ft.com/coronavirus-latest
Death vs. Cases in the US.
https://ourworldindata.org/grapher/daily-covid-cases-deaths?country=US
remember the reasons for variable daily reporting, look for the trends.
I am adding an estimate of effective reproduction number to my "go-to" graphics as it appears to be a way to contemplate when we could start to dial back on the lockdown. It is not a straightforward measure. I strongly recommend you read the blog post to understand the assumptions and potential sources of error.
https://rt.live/
blogpost http://systrom.com/topic/coronavirus/
Here is a discussion about the daily count data and the variability I want us all to keep in mind.
https://twitter.com/florian_krammer/status/1252750695314403329?s=12
I wandered into a twitter discussion about the NHS and their problems with "federalism" of sorts. It seems that they too, depend on regional and local PPE purchasing, which is creating bidding wars and exposing the weakness of de-centralization in times of emergency. Lots to ponder on how to balance the best of local vs. central control under different use cases, huh?
https://twitter.com/lewis_goodall/status/1252701841135226880
Dr. Krishnan sent a Fast Company article on the rapid and likely permanent push toward telehealth. I, too, believe we are not going back to pre-COVID rules on telehealth but have many reservations and concerns about what the unanticipated (and anticipated) consequences are for good care.
https://www.fastcompany.com/90490988/covid-19-is-normalizing-telehealth-and-thats-a-good-thing?mc_cid=96d9407335&mc_eid=03931920e6
Despite using it, I have mixed feelings about Twitter as a useful communication tool. However, I am often surprised about how it can be a forcing function for concise statements on complex topics. Here is an outstanding analysis of the NEJM article on Remdesivir. The author is a sharp-minded physician who we should all emulate in how we break down medical reports. YOU MUST read to tweet 16-18 to get the most value - his analysis.
https://twitter.com/rbganatra/status/1251558062357389312
Testing continues to be a source of vexation in so many ways. There are not enough tests, PCR that take too long, antibody testing with low sensitivity, etc. etc.. To be fair, it is not easy to ramp up quickly and the U.S., in particular, got a late start. Here is an article outlining some other sources of testing error that were identified as testing was being ramped up.
https://www.nytimes.com/2020/04/18/health/cdc-coronavirus-lab-contamination-testing.html
The hardest part of this event is coming to terms with the notion that 1st line success - slowing the spread of disease - looks like an overreaction. Here is an article on some political leaders who moved quickly. You can find data on their respective cities or countries in my data links at the top.
https://www.theatlantic.com/newsletters/archive/2020/04/ardern-merkel-breed-newsom/610351/
There are several ways to frame the "why" of this epidemic. One set of thoughts is that this isn't a unique event but a consequence of globalization, environmental change, and interconnectivity. If one is spending time trying to think systemically about unintended consequences in closed systems, this article presents a reasonable analysis. Fair warning - you may not agree with the offered solutions.
https://www.newyorker.com/news/daily-comment/the-pandemic-isnt-a-black-swan-but-a-portent-of-a-more-fragile-global-system
My favorite infographic of the day - words, history, and visuals
https://i.redd.it/672p2mwuwbu41.jpg
----Bonus Rounds - Understanding Homeostasis and respecting closed systems edition
Claude Bernard was a French physician who framed the concepts around homeostasis - the idea that closed biologic systems (like human bodies) have mechanisms of internal regulation and balance. The kidneys are one of the KEY regulatory mechanisms in the body. This guy articulated the underlying concepts first. He was also an early advocate for applying the scientific method to medicine. He lived in France of the mid-19th century. Not only did he help found the department of physiology at the Sorbonne be he was recognized, by the end of his life, for many of his intellectual achievements.
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2014000400322&lng=en&nrm=iso&tlng=en
In 1814, the post-Napoleonic nations in Europe negotiated alliances that were dependent on the concept of homeostasis (of sorts), called often called the Concert of Europe. The Austrian representative to these discussions was Klemens von Metternich. He had an innate sense of diplomacy and clearly understood that international relations are an amoral game of balancing competing interests. He is remembered for being a conservative, blocking reforms and social progress. I have found a lot of value in understanding his ability to work in a system without clear rules, with high stakes, and for which there are always compromises.
https://en.wikipedia.org/wiki/Klemens_von_Metternich
There is tons written about him, but this is my favorite book that includes him as a central actor in the Concert of Europe chapter: https://www.goodreads.com/book/show/781183.Diplomacy
Clean hands and sharp minds
-Adam
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