Monday, July 20, 2020
Good morning. Tradeoffs seemed to be the theme of the last few days in my world. If you want to move, you must pack. Packing is labor-intensive and often excludes other activities. Wearing in-ear headphones for more prolonged periods causes atypically high levels of cerumen (ear wax) buildup. (One of my patients had problems with this one.) If you want kids, parents, and teachers to feel confident about going back to school, you need to stop spreading COVID. And if you don't promote and enforce behaviors that halt the spread of coronavirus, your case and death rates continue to rise. I am unsure when the notion of tradeoff-free choices became an expectation. Understanding tradeoffs is a mark of maturity. Disagreeing over the prioritization of different tradeoffs is probably the more healthy and rational framing. It does not feel like rational is a "thing" at this time.
(in case you are wondering about the earwax thing - have a look here: https://www.wellandgood.com/do-headphones-increase-ear-wax/)
---Latest Data---
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 - the second graph down now has state-level data - I suggest setting it to cases, per million, linear, and add your state to the highlighted list.
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/
COVID risk by US county: https://globalepidemics.org/key-metrics-for-covid-suppression/
Each of the above sites reports its source data. Please review sources like https://covidtracking.com/ to understand the quality of that data.
------------
A loyal reader offered this new data source, which I like. A county by county risk estimator for gatherings lets you set the number of people you will encounter and the likelihood that at least 1 has COVID19. Play with it. Think. Is, as my friend Rob B. says, the juice worth this squeeze? (tradeoffs!)
https://covid19risk.biosci.gatech.edu/
One way to obfuscate the tradeoffs we make is to change the data visualization. I encountered two examples of data display changes that appear to better fit a narrative of "COVID is controlled."
You can flip the Y-axis (such as in Pike County, KY)
https://policyviz.com/2020/06/16/the-inverted-vertical-axes/
(NOTE - Pike County has since updated its graph by removing it.)
If you are Georgia, you can adjust the scale over time, modify the measure (cases per 100,000), and use soothing colors:
https://twitter.com/futurebird/status/1284888224268259333
Some additional commentary from one of my favorite Tweeters(?!?), Carl Bergstrom:
https://twitter.com/CT_Bergstrom/status/1284515454585720837
I recently discovered the International Society for Aerosols in Medicine (ISAM) and their June 2020 webinar slides on comparing mask effectiveness. I can only imagine the delta in their web traffic thanks to COVID. The presentation is a detailed discussion of measuring mask effectiveness, about 1 hour in length - but you can review the slides.
https://www.isam.org/announcements/new-covid-19-resource
Here is a retrospective cohort study from China on the impact of various household behaviors and characteristics and the likelihood of secondary spread of COVID when a household occupant becomes COVID positive. It is worth seeing how strong a correlate cleaning, masking, and distancing were.
https://gh.bmj.com/content/5/5/e002794f
Dexamethasone, a widely available intravenous steroid, continues to demonstrate effectiveness in decreasing mortality amongst COVID patients requiring oxygen or mechanical ventilation.
Article: https://www.nejm.org/doi/full/10.1056/NEJMoa2021436
Check out Figure 3, for a great visual summary of what this article is about.
Here is a STAT news overview of three randomized controlled studies on HCQ. I offer this to keep the lack of value fresh in our minds. Read the comments for those that offer faith-based views of HCQ. Scary.
https://www.statnews.com/2020/07/16/new-covid-19-study-despite-flaws-adds-to-case-against-hydroxychloroquine/
here are the data and articles discussed:
https://www.medrxiv.org/content/10.1101/2020.07.15.20151852v1
There is an increasing understanding of how little we understand the immune system. A Nature article offers more data around coronavirus immune response. This data implies that previous coronavirus (non SARS-CoV2) exposure via memory T-cells may confer some protection. The point is, we don't know as much as we would want or need to.
Article: https://www.nature.com/articles/s41586-020-2550-z
Commentary: https://twitter.com/MackayIM/status/1283995575063461888?s=20
A physician colleague in the American Cancer Society's leadership shares some thoughts on his daughter, who is an ICU nurse in Atlanta.
https://twitter.com/DrLen/status/1284445238627643392
Infographic of the day #1: The relative speed and information density of different languages. Fascinating. I love this stuff.
https://i.redd.it/f86wdjkwfub51.png
Article: http://content.time.com/time/health/article/0,8599,2091477,00.html
Infographics of the day #2: politics in art
I found several Instagram posts about Piotr Szyhalski art being put up on the streets around Baltimore this weekend. Tracking down the artist who is making these provocative political posters was easier than I imagined. I believe others are hanging these posters, but I was interested in the artist. There is a very retro-Soviet, stark, and severe feel to his art, whether or not you agree with the messaging.
https://walkerart.org/magazine/piotr-szyhalskis-no-holds-barred-covid-19-art
----Bonus Round - A little bit more Lewis in your life.
John Lewis lived a full and meaningful life. The more recent discussions on race highlight how much work he contributed and how far we still have to go. Amongst the various tributes about his life, I found this article (from 2015) on the books he carried in his backpack, to be the most impactful. I find understanding what others choose to read and think about to be so powerful a window to understand their choices and the tradeoffs they accepted.
https://medium.com/@history1800s/john-lewis-the-books-in-his-knapsack-ceec7077080
Here are two books from the article that are worthy of note:
The American Political Tradition, by Richard Hofstadter and The Seven Storey Mountain, by Thomas Merton. I have read parts of the former but only learned about the latter from this article. Both of these books offer a view of Lewis's thinking, specifically some of the personal and political struggles that underly his work in the civil rights movement.
Related readings:
An Atlantic article from 1998 on The American Political Tradition
https://www.theatlantic.com/magazine/archive/1998/11/richard-hofstadters-tradition/377296/
Here is what The Seven Storey Mountain meant to another reader:
https://www.ncronline.org/blogs/ncr-today/take-and-read-seven-storey-mountain
Clean hands and sharp minds,
-Adam
Good morning. Tradeoffs seemed to be the theme of the last few days in my world. If you want to move, you must pack. Packing is labor-intensive and often excludes other activities. Wearing in-ear headphones for more prolonged periods causes atypically high levels of cerumen (ear wax) buildup. (One of my patients had problems with this one.) If you want kids, parents, and teachers to feel confident about going back to school, you need to stop spreading COVID. And if you don't promote and enforce behaviors that halt the spread of coronavirus, your case and death rates continue to rise. I am unsure when the notion of tradeoff-free choices became an expectation. Understanding tradeoffs is a mark of maturity. Disagreeing over the prioritization of different tradeoffs is probably the more healthy and rational framing. It does not feel like rational is a "thing" at this time.
(in case you are wondering about the earwax thing - have a look here: https://www.wellandgood.com/do-headphones-increase-ear-wax/)
---Latest Data---
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 - the second graph down now has state-level data - I suggest setting it to cases, per million, linear, and add your state to the highlighted list.
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/
COVID risk by US county: https://globalepidemics.org/key-metrics-for-covid-suppression/
Each of the above sites reports its source data. Please review sources like https://covidtracking.com/ to understand the quality of that data.
------------
A loyal reader offered this new data source, which I like. A county by county risk estimator for gatherings lets you set the number of people you will encounter and the likelihood that at least 1 has COVID19. Play with it. Think. Is, as my friend Rob B. says, the juice worth this squeeze? (tradeoffs!)
https://covid19risk.biosci.gatech.edu/
One way to obfuscate the tradeoffs we make is to change the data visualization. I encountered two examples of data display changes that appear to better fit a narrative of "COVID is controlled."
You can flip the Y-axis (such as in Pike County, KY)
https://policyviz.com/2020/06/16/the-inverted-vertical-axes/
(NOTE - Pike County has since updated its graph by removing it.)
If you are Georgia, you can adjust the scale over time, modify the measure (cases per 100,000), and use soothing colors:
https://twitter.com/futurebird/status/1284888224268259333
Some additional commentary from one of my favorite Tweeters(?!?), Carl Bergstrom:
https://twitter.com/CT_Bergstrom/status/1284515454585720837
I recently discovered the International Society for Aerosols in Medicine (ISAM) and their June 2020 webinar slides on comparing mask effectiveness. I can only imagine the delta in their web traffic thanks to COVID. The presentation is a detailed discussion of measuring mask effectiveness, about 1 hour in length - but you can review the slides.
https://www.isam.org/announcements/new-covid-19-resource
Here is a retrospective cohort study from China on the impact of various household behaviors and characteristics and the likelihood of secondary spread of COVID when a household occupant becomes COVID positive. It is worth seeing how strong a correlate cleaning, masking, and distancing were.
https://gh.bmj.com/content/5/5/e002794f
Dexamethasone, a widely available intravenous steroid, continues to demonstrate effectiveness in decreasing mortality amongst COVID patients requiring oxygen or mechanical ventilation.
Article: https://www.nejm.org/doi/full/10.1056/NEJMoa2021436
Check out Figure 3, for a great visual summary of what this article is about.
Here is a STAT news overview of three randomized controlled studies on HCQ. I offer this to keep the lack of value fresh in our minds. Read the comments for those that offer faith-based views of HCQ. Scary.
https://www.statnews.com/2020/07/16/new-covid-19-study-despite-flaws-adds-to-case-against-hydroxychloroquine/
here are the data and articles discussed:
https://www.medrxiv.org/content/10.1101/2020.07.15.20151852v1
There is an increasing understanding of how little we understand the immune system. A Nature article offers more data around coronavirus immune response. This data implies that previous coronavirus (non SARS-CoV2) exposure via memory T-cells may confer some protection. The point is, we don't know as much as we would want or need to.
Article: https://www.nature.com/articles/s41586-020-2550-z
Commentary: https://twitter.com/MackayIM/status/1283995575063461888?s=20
A physician colleague in the American Cancer Society's leadership shares some thoughts on his daughter, who is an ICU nurse in Atlanta.
https://twitter.com/DrLen/status/1284445238627643392
Infographic of the day #1: The relative speed and information density of different languages. Fascinating. I love this stuff.
https://i.redd.it/f86wdjkwfub51.png
Article: http://content.time.com/time/health/article/0,8599,2091477,00.html
Infographics of the day #2: politics in art
I found several Instagram posts about Piotr Szyhalski art being put up on the streets around Baltimore this weekend. Tracking down the artist who is making these provocative political posters was easier than I imagined. I believe others are hanging these posters, but I was interested in the artist. There is a very retro-Soviet, stark, and severe feel to his art, whether or not you agree with the messaging.
https://walkerart.org/magazine/piotr-szyhalskis-no-holds-barred-covid-19-art
----Bonus Round - A little bit more Lewis in your life.
John Lewis lived a full and meaningful life. The more recent discussions on race highlight how much work he contributed and how far we still have to go. Amongst the various tributes about his life, I found this article (from 2015) on the books he carried in his backpack, to be the most impactful. I find understanding what others choose to read and think about to be so powerful a window to understand their choices and the tradeoffs they accepted.
https://medium.com/@history1800s/john-lewis-the-books-in-his-knapsack-ceec7077080
Here are two books from the article that are worthy of note:
The American Political Tradition, by Richard Hofstadter and The Seven Storey Mountain, by Thomas Merton. I have read parts of the former but only learned about the latter from this article. Both of these books offer a view of Lewis's thinking, specifically some of the personal and political struggles that underly his work in the civil rights movement.
Related readings:
An Atlantic article from 1998 on The American Political Tradition
https://www.theatlantic.com/magazine/archive/1998/11/richard-hofstadters-tradition/377296/
Here is what The Seven Storey Mountain meant to another reader:
https://www.ncronline.org/blogs/ncr-today/take-and-read-seven-storey-mountain
Clean hands and sharp minds,
-Adam
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