Monday, April 27, 2020
I took Sunday off from email for some focused family time. As someone told me in the last few days, "Take some time for yourself, COVID will still be here." Sure enough, when I woke up this morning, the virus is still here.
More broadly, I sense that the mood is changing from fear to frustration regarding quarantine and prevention. At least in the U.S. press, it feels like the mean sensibility has shifted from the "all hands on deck emergency phase" to the "we better pace ourselves, cause this is going to be a while" phase. The hard part is, amongst the various feelings, we must concentrate on using good data to make reliable decisions, both at an individual level and population level.
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Latest data
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
An estimate of the effective reproduction number by state (not updated daily)
What is this analysis about? http://systrom.com/topic/coronavirus/
Keep in mind the day to day variability for the above data and how dependent it is on variations in reporting. HOWEVER, the Rt plots are looking better across many U.S. states, as of this morning's data.
Here are some Twitter comments from Saturday from the Financial Times visualization guy.
https://twitter.com/jburnmurdoch/status/1254134874929332224?s=12
While a physician wrote this editorial, the sentiment is true of every healthcare worker (and I'm sure others).
https://www.kevinmd.com/blog/2020/04/the-hippocratic-oath-versus-my-oath-as-a-mother.html
It appears the mortality rate in kidney transplant patients is very high. Almost as high as nursing homes - 30%(!) in this reported case series. I am glad I have suspended many of my kidney transplant patient labs for now...
https://twitter.com/poyanmehr/status/1253887124182458369
https://www.nejm.org/doi/full/10.1056/NEJMc2011117
Another Transplant article - but the data is sliced and diced a bit differently. There is a lot more granular data from a shorter time window - 3 weeks. No major conclusions but a good description of the population of patients.
https://twitter.com/germhuntermd/status/1254087249668366336?s=12
https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajt.15941#.XqRk3DKPhi0.twitter
UptoDate.com is an innovative and comprehensive guide of the latest information on a fantastic array of topics in medicine. It is for doctors, by doctors. It was started by a nephrologist, Bud Rose, who died last week from COVID.
Here is a review of him and his life's work.
https://www.statnews.com/2020/04/25/remembering-uptodate-creator-burton-bud-rose/
Again, Twitter is not my favorite. And again, Twitter has some very good use cases. Here is a Tweetorial by a hematologist on the clotting issues in COVID. It is highly technical, but data-driven and covers a lot of lab and physiology data. My favorite part is her username - Shematologist. Clever.
https://twitter.com/acweyand/status/1254269725355528192
Antibody-based testing's high false-negative rate continues to be documented. Rapid PCR or more sensitive and specific testing is going to be needed. Hence both my interest and skepticism about the Siemen's press release from Saturday.
https://pubmed.ncbi.nlm.nih.gov/32334183/
Infographic of the day. I am deeply skeptical of the metrics that drove this rating system.
https://twitter.com/CriminelleLaw/status/873581299818270721/photo/1
My favorite parody journal article of the last few days
https://twitter.com/ozvascdoc/status/1253812242249740288/photo/1
Bonus round - Really clean hands, clean (and sharp) minds edition
John Harvey Kellogg was a physician and social activist who represented a fascinating array of views - deeply religious, pro-science and hygiene, pro-celibacy and a staunch vegetarian. He was part of the larger positivist movement of the late 1800's in America. He invented a variety of medical devices and foods, including breakfast cereals like Corn Flakes (that Kellogg!). Though his views on sexuality and race are way out of step with today's norms, some of his medical ideas have withstood the test of time. Either way, he is a fascinating guy and a symbol of what some parts of the "liberal" movement looked like in the late 1800s - deeply religious, socially conservative, but pro-science and progress through human understanding.
Background: https://en.wikipedia.org/wiki/John_Harvey_Kellogg
A quicker read, with a click-bait headline:
https://www.mentalfloss.com/article/32042/corn-flakes-were-invented-part-anti-masturbation-crusade
I was recently reminded of Dr. Ignaz Semmelweis (thanks, Dr. Kaplan!). He was a Hungarian physician working in Austria in the 1840's. He observed large differences in post-partum death rates between the physician-only training ward (high mortality) and the midwife-only training ward (lower mortality). He proceeded to undertake a data-driven investigation. Here are the interesting bits:
- Physicians in training were doing autopsies and then, with unwashed hands, attending to patients.
- Midwives were not doing autopsies.
- He imposed - gasp - hand washing as the solution. Mortality rates fell in the doctors-only ward.
- He was mocked for his publication of this data, to the point of mental breakdown.
- He was sent to a sanitarium where he was beaten and died from sepsis - due to an infected wound.
- His theories and data were later validated (as you know) by Lister and Pasteur (amongst others).
- His data-gathering and thought process were sharp. (And his hands were clean.) In the 1840s.
- The observations and understanding of infection were still not accepted and misunderstood in the 1840s. 180 years ago. Wow. And it took another 80+ years (late 1928) to get penicillin.
Great overview – you need to read the parts about the other variables he considered.
Take a look at the Wikipedia section on his observations.
https://en.wikipedia.org/wiki/Ignaz_Semmelweis#Work_on_cause_of_childbed_fever_mortality
Clean hands and sharp minds (Semmelweisian?),
-Adam
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