June 22, 2020 Monday
Another weekend of complex events. Indeed, a full plate of the pandemic, Father's Day, political machinations, and an ongoing focus on injustice. Overall, I would like to think it was a ratio of about 6,000:1,000,000 good to bad, but it is hard to quantify. A bright spot for me was clinic. Despite the masks, face shields, and gallons of hand sanitizer, restarting face to face office visits on Friday was very fulfilling. I suspect my patients were annoyed at the joy I was taking from in-person interactions.
-----
Latest data
Our case count is going up, driven by numerous hot spots. Death rates have not started to increase, yet.
Our world in data has interactive features.
https://ourworldindata.org/coronavirus-data-explorer?yScale=log&zoomToSelection=true&time=2020-04-16..&country=USA~GBR~CAN~BRA~AUS~IND~DEU~FRA~ITA~SWE&deathsMetric=true&dailyFreq=true&aligned=true&perCapita=true&smoothing=7
FT data is still the best visualization I have found for country comparisons.
https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&cumulative=0&logScale=1&perMillion=0&values=deaths
The NY Times has hotspot map is an excellent quick glace of rolling 2-week case change
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
State Details:
https://public.tableau.com/views/Coronavirus-ChangeovertimeintheUSA/2_Corona?:display_count=y&:origin=viz_share_link
Rt data
https://rt.live/
The tableau data is from The COVID Tracking Project, which compiles and rates state-reported data. Please review https://covidtracking.com/ to understand the quality of the data.
------
One of our readers sent a 13-minute local talk radio interview with a physician in MO who reported on his experience with HCQ. He is a family doc and a nursing home medical director who, with the appropriate patient and family approval, provided HCQ to patients suspected of having COVID. It is unclear what protocol he used, what doses he chose, or how the duration of therapy worked if people were PCR negative. He reports no deaths in his treated population. There was no control group. He states he observed no complications. Appropriately, he repeatedly speaks about his efforts as "non-scientific" and observational. He sounds like a thoughtful, caring doctor trying to do what is best for his patients in a pandemic. And yet, the physician's data is observational and cannot be meaningfully interpreted. (But that does not stop radio talk show host from attempting to do so. The host's comments hint at conclusions looking for data rather than evaluating the data on its own merits.) This interview is a great example of the struggle in understanding personal experience vs. more rigorous scientific evidence. Please be clear - several studies indicate no improvement (and sometimes harm) with HCQ. These are reasonably designed studies demonstrating a lack of efficacy in prevention, post-exposure prophylaxis, mildly ill, and critically ill patients.
Most recent overview: https://www.statnews.com/2020/06/17/who-drops-hydroxychloroquine-covid-19-clinical-trial/
Interview: https://omny.fm/shows/fm-newstalk-97-1-on-demand-audio/dr-steven-crawford-of-festus-manor-on-enormous-suc#description
Since testing was, once again, brought up in a public forum, it is worth reviewing what testing can and cannot tell us. Dr. Bergstrom had a well-articulated Twitter thread on this over the weekend:
https://twitter.com/CT_Bergstrom/status/1274576193333850112
The Atlantic offers an in-depth discussion of the meaning of a negative test. If nothing else, a broader understanding of sensitivity and specificity would be a considerable value derived from the pandemic.
https://www.theatlantic.com/science/archive/2020/06/how-negative-covid-19-test-can-mislead/613246/
And, FiveThirtyEight offers a comprehensive review of COVID predictive models with many interactive features. Most importantly, the discussion of how forecasting works is well done.
https://projects.fivethirtyeight.com/covid-forecasts/
The financial times offers data on minority populations in the UK that are disproportionately impacted by COVID. Multi-generational housing (with a smaller # of square feet per person) and health literacy seem to be drivers of this data.
https://www.ft.com/content/aaa2c3cd-eea6-4cfa-a918-9eb7d1c230f4
While not about COVID, this Science article discusses using RNA changes over time to determine the origins of the measles virus - 600-500 BC.
https://science.sciencemag.org/content/368/6497/1367
What were humans up to back then? https://en.wikipedia.org/wiki/6th_century_BC
Infographic(s) of the day - The Juneteenth review of various racial disparity data in the US - from the NY Times. It has some unique interactive features, so take your time scrolling.
https://www.nytimes.com/interactive/2020/06/19/opinion/politics/opportunity-gaps-race-inequality.html
Infographic of the day#2 - Use the Right Onion
https://i.redd.it/hvbxktdd82t41.jpg
I had no idea about the strong opinions surrounding Onions. Sadly, the language of onion choice sounds like a political movement to which I have been blind. My veil of onion ignorance is lifted.
https://www.onegreenplanet.org/vegan-food/know-your-onions-use-the-right-onion-for-the-right-recipe/
----Bonus Round--- James Baldwin edition
Over the weekend, I had a chance to spend some time revisiting James Baldwin. My interest stemmed from finding I Am Not Your Negro, a documentary on Baldwin and the American Civil Rights movement from 2016. It reminded me how articulate, thoughtful, and complex a person Baldwin was. Moreover, it demonstrates how little has changed—specifically, the struggle to find one's voice and identity in a world of categories and labels. And, how becoming a public persona makes the battle even harder. Most importantly, this documentary is an excellent look at how prescient Baldwin was - or perhaps wasn't. I suspect it is more that he was a great writer, and the world has not changed much.
Critical Review: https://www.nytimes.com/2017/02/02/movies/review-i-am-not-your-negro-review-james-baldwin.html
Documentary (Amazon Prime): https://www.amazon.com/dp/B01MS6J619/
Clean hands and sharp minds,
Adam
Another weekend of complex events. Indeed, a full plate of the pandemic, Father's Day, political machinations, and an ongoing focus on injustice. Overall, I would like to think it was a ratio of about 6,000:1,000,000 good to bad, but it is hard to quantify. A bright spot for me was clinic. Despite the masks, face shields, and gallons of hand sanitizer, restarting face to face office visits on Friday was very fulfilling. I suspect my patients were annoyed at the joy I was taking from in-person interactions.
-----
Latest data
Our case count is going up, driven by numerous hot spots. Death rates have not started to increase, yet.
Our world in data has interactive features.
https://ourworldindata.org/coronavirus-data-explorer?yScale=log&zoomToSelection=true&time=2020-04-16..&country=USA~GBR~CAN~BRA~AUS~IND~DEU~FRA~ITA~SWE&deathsMetric=true&dailyFreq=true&aligned=true&perCapita=true&smoothing=7
FT data is still the best visualization I have found for country comparisons.
https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&cumulative=0&logScale=1&perMillion=0&values=deaths
The NY Times has hotspot map is an excellent quick glace of rolling 2-week case change
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
State Details:
https://public.tableau.com/views/Coronavirus-ChangeovertimeintheUSA/2_Corona?:display_count=y&:origin=viz_share_link
Rt data
https://rt.live/
The tableau data is from The COVID Tracking Project, which compiles and rates state-reported data. Please review https://covidtracking.com/ to understand the quality of the data.
------
One of our readers sent a 13-minute local talk radio interview with a physician in MO who reported on his experience with HCQ. He is a family doc and a nursing home medical director who, with the appropriate patient and family approval, provided HCQ to patients suspected of having COVID. It is unclear what protocol he used, what doses he chose, or how the duration of therapy worked if people were PCR negative. He reports no deaths in his treated population. There was no control group. He states he observed no complications. Appropriately, he repeatedly speaks about his efforts as "non-scientific" and observational. He sounds like a thoughtful, caring doctor trying to do what is best for his patients in a pandemic. And yet, the physician's data is observational and cannot be meaningfully interpreted. (But that does not stop radio talk show host from attempting to do so. The host's comments hint at conclusions looking for data rather than evaluating the data on its own merits.) This interview is a great example of the struggle in understanding personal experience vs. more rigorous scientific evidence. Please be clear - several studies indicate no improvement (and sometimes harm) with HCQ. These are reasonably designed studies demonstrating a lack of efficacy in prevention, post-exposure prophylaxis, mildly ill, and critically ill patients.
Most recent overview: https://www.statnews.com/2020/06/17/who-drops-hydroxychloroquine-covid-19-clinical-trial/
Interview: https://omny.fm/shows/fm-newstalk-97-1-on-demand-audio/dr-steven-crawford-of-festus-manor-on-enormous-suc#description
Since testing was, once again, brought up in a public forum, it is worth reviewing what testing can and cannot tell us. Dr. Bergstrom had a well-articulated Twitter thread on this over the weekend:
https://twitter.com/CT_Bergstrom/status/1274576193333850112
The Atlantic offers an in-depth discussion of the meaning of a negative test. If nothing else, a broader understanding of sensitivity and specificity would be a considerable value derived from the pandemic.
https://www.theatlantic.com/science/archive/2020/06/how-negative-covid-19-test-can-mislead/613246/
And, FiveThirtyEight offers a comprehensive review of COVID predictive models with many interactive features. Most importantly, the discussion of how forecasting works is well done.
https://projects.fivethirtyeight.com/covid-forecasts/
The financial times offers data on minority populations in the UK that are disproportionately impacted by COVID. Multi-generational housing (with a smaller # of square feet per person) and health literacy seem to be drivers of this data.
https://www.ft.com/content/aaa2c3cd-eea6-4cfa-a918-9eb7d1c230f4
While not about COVID, this Science article discusses using RNA changes over time to determine the origins of the measles virus - 600-500 BC.
https://science.sciencemag.org/content/368/6497/1367
What were humans up to back then? https://en.wikipedia.org/wiki/6th_century_BC
Infographic(s) of the day - The Juneteenth review of various racial disparity data in the US - from the NY Times. It has some unique interactive features, so take your time scrolling.
https://www.nytimes.com/interactive/2020/06/19/opinion/politics/opportunity-gaps-race-inequality.html
Infographic of the day#2 - Use the Right Onion
https://i.redd.it/hvbxktdd82t41.jpg
I had no idea about the strong opinions surrounding Onions. Sadly, the language of onion choice sounds like a political movement to which I have been blind. My veil of onion ignorance is lifted.
https://www.onegreenplanet.org/vegan-food/know-your-onions-use-the-right-onion-for-the-right-recipe/
----Bonus Round--- James Baldwin edition
Over the weekend, I had a chance to spend some time revisiting James Baldwin. My interest stemmed from finding I Am Not Your Negro, a documentary on Baldwin and the American Civil Rights movement from 2016. It reminded me how articulate, thoughtful, and complex a person Baldwin was. Moreover, it demonstrates how little has changed—specifically, the struggle to find one's voice and identity in a world of categories and labels. And, how becoming a public persona makes the battle even harder. Most importantly, this documentary is an excellent look at how prescient Baldwin was - or perhaps wasn't. I suspect it is more that he was a great writer, and the world has not changed much.
Critical Review: https://www.nytimes.com/2017/02/02/movies/review-i-am-not-your-negro-review-james-baldwin.html
Documentary (Amazon Prime): https://www.amazon.com/dp/B01MS6J619/
Clean hands and sharp minds,
Adam
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