July 30, 2020
Thursday
I have a small observation today. My older son, the nearly 15-year-old, likes to bake. During the pandemic, he has become skilled at perogies, rugelach, babka, artisanal bread, and bagels. He bakes in tandem, with friends, over facetime. Sometimes we meet the other kid's parents in parking lots to exchange baked goods (which feels like a yeasty drug deal or a bad spy drama). Yesterday, during the latest bagel birthing session in my kitchen, I was struck by how being home has facilitated Jack's interest and skill at a more rapid pace. And I have been able to watch all this. This experience is odd. I have rarely had the opportunity to observe daily progression in my kids so carefully. (Granted, this also means I get to see the exhibition of mirrored parental traits - like quickly becoming annoyed by interruptions to his "artistic process," even if his father just needs coffee between conference calls). I am not sure why I had not previously appreciated this unintended byproduct of the pandemic - watching his skill development. Perhaps it is because it is hard to be sentimental when his eye-rolling has enough momentum to cause whiplash.
-------Latest Data
http://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/
Estimate your risk of exposure to a COVID positive person based on your county and the size of gathering: https://covid19risk.biosci.gatech.edu/
Each of the above sites reports its source data. Please review sources like https://covidtracking.com/ to understand the quality of that data.
-----
Data observations: Based on the comments about hospitalization data in a blog from 7/28 on the COVID tracking project (https://covidtracking.com/blog/whats-going-on-with-covid-19-hospitalization-data) I think the data represents a few things:
There may be fewer deaths than during the previous peak, or it is a longer lag time. Death rates are still rising, albeit with less intensity than March/April in many states. Case rates are seemingly starting to drop in some southern states.
Hospitalization data is not reliable in some states due to the new HHS reporting methodology. Please see the above blog post for details.
The summer 2020 issue of UCSF Magazine has a comprehensive and readable overview of the pathophysiology of COVID.
https://www.ucsf.edu/magazine/covid-body
Not directly related to COVID, but certainly in the category of "how can government fine-tune its tools," I offer this local news story of what happened when a Kentucky town hired social workers instead of more police. There are four years of measurable outcomes. Good to have a variety of tools in the tool chest, eh?
https://www.wave3.com/2020/07/28/kentucky-town-hires-social-workers-instead-more-officers-results-are-surprising/
A California ER doctor tweeted about working with a challenging patient yesterday. His thoughts illustrate how often medicine is about understanding people more than knowing facts and information. A reasonable diagnosis is often the easy part. Delivering care is the hard work.
https://twitter.com/NickSawyerMD/status/1288489565058080772
I found a thorough analysis of two recent papers (peer-reviewed, reasonably-powered studies) that present conflicting information on the relative transmission of COVID in children vs. adults. Here is the thing about data - it takes time to analyze and often presents stories that are difficult to interpret, much less apply. Dr. Kilpatrick does an excellent job discussing each paper's value and coming to some thoughtful comments about how to put these data into perspective. The responses are well-reasoned and discuss potential sources of bias. Read the whole thread.
https://twitter.com/DiseaseEcology/status/1286826597916401666
STAT News offers an overview of the strategy and tactics of rapid vaccine development. Amazing what humans can do when we can organize. https://www.statnews.com/2020/07/30/a-huge-experiment-how-the-world-made-so-much-progress-on-a-covid-19-vaccine-so-fast/
And, of course, this all costs money. Moderna is in negotiations with European countries about the per-dose vaccine costs for their upcoming COVID vaccine. https://www.fiercepharma.com/pharma/moderna-s-rumored-50-plus-price-covid-19-vaccine-draws-ire-as-company-touts-new-animal-data
I found this discussion on the utility of eye protection from Dr. Feigl-Ding, an epidemiologist and health economist. He was responding to some public comments from Dr. Fauci yesterday. I am not an advocate for the general public wearing eye protection, but I use a face shield or goggles when performing physical exams on my patients. The whole conversation seems a little like the telephone game (an over-interpretation of Dr. Fauci's comments spawning a more extensive discussion). It will be interesting to see if this line of thinking (we should be more generally use eye protection) gets any traction in the medical or lay press. Considering the reactions to masks, I doubt it.
Article on what Dr. Fauci said: https://www.forbes.com/sites/brucelee/2020/07/30/did-dr-fauci-recommend-wearing-eye-shields-goggles-for-covid-19-coronavirus/#65f6935dda2e
Twitter discussion:
https://twitter.com/DrEricDing/status/1288523940046962688
Infographic of the day: The Power of Sleep
https://www.onlinemattressreview.com/power-of-sleep/
Read on with care - keep your mind sharp! Onlinemattressreview.com compiled this set of data on sleep. It must be inherently biased - don't be a tool of the Mattress-industrial complex!
Infographic of the Day #2 - Types of tired. In case the mattress-industrial complex is not just lying to you, there may be utility in better describing your fatigue. This graphic is amusing >> scientific and is much more an exercise in visualizing synonyms.
https://i.redd.it/xqbrc6azqxd51.jpg
-----Bonus Round - Cool Ephemera
Yesterday morning I did not know I had an interest in artwork painted on the inside of 19th century Japanese fireman's coats. As of this morning, I do. Maybe you will too.
https://publicdomainreview.org/collection/japanese-firemans-coats-19th-century
Likewise, I challenge you to sit through 11 minutes of animated, month-month top google search terms by state. I made it to minute 3:40 and gave up. The data is unsettling, voyeuristic, and, at times, shockingly uniform. How can a country that uniformly seeks information on Adele (03 Feb 2011) or Fidget Spinners (18 May 2017) be divided? E Pluribus Unum! (Even if the "one" is Googling for Kim Kardashian.)
https://www.visualcapitalist.com/top-google-search-trends-of-the-decade-us/
Clean hands and sharp minds,
Adam
PS - Back in clinic tomorrow, have a safe weekend. More on Monday.
I have a small observation today. My older son, the nearly 15-year-old, likes to bake. During the pandemic, he has become skilled at perogies, rugelach, babka, artisanal bread, and bagels. He bakes in tandem, with friends, over facetime. Sometimes we meet the other kid's parents in parking lots to exchange baked goods (which feels like a yeasty drug deal or a bad spy drama). Yesterday, during the latest bagel birthing session in my kitchen, I was struck by how being home has facilitated Jack's interest and skill at a more rapid pace. And I have been able to watch all this. This experience is odd. I have rarely had the opportunity to observe daily progression in my kids so carefully. (Granted, this also means I get to see the exhibition of mirrored parental traits - like quickly becoming annoyed by interruptions to his "artistic process," even if his father just needs coffee between conference calls). I am not sure why I had not previously appreciated this unintended byproduct of the pandemic - watching his skill development. Perhaps it is because it is hard to be sentimental when his eye-rolling has enough momentum to cause whiplash.
-------Latest Data
http://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/
Estimate your risk of exposure to a COVID positive person based on your county and the size of gathering: https://covid19risk.biosci.gatech.edu/
Each of the above sites reports its source data. Please review sources like https://covidtracking.com/ to understand the quality of that data.
-----
Data observations: Based on the comments about hospitalization data in a blog from 7/28 on the COVID tracking project (https://covidtracking.com/blog/whats-going-on-with-covid-19-hospitalization-data) I think the data represents a few things:
There may be fewer deaths than during the previous peak, or it is a longer lag time. Death rates are still rising, albeit with less intensity than March/April in many states. Case rates are seemingly starting to drop in some southern states.
Hospitalization data is not reliable in some states due to the new HHS reporting methodology. Please see the above blog post for details.
The summer 2020 issue of UCSF Magazine has a comprehensive and readable overview of the pathophysiology of COVID.
https://www.ucsf.edu/magazine/covid-body
Not directly related to COVID, but certainly in the category of "how can government fine-tune its tools," I offer this local news story of what happened when a Kentucky town hired social workers instead of more police. There are four years of measurable outcomes. Good to have a variety of tools in the tool chest, eh?
https://www.wave3.com/2020/07/28/kentucky-town-hires-social-workers-instead-more-officers-results-are-surprising/
A California ER doctor tweeted about working with a challenging patient yesterday. His thoughts illustrate how often medicine is about understanding people more than knowing facts and information. A reasonable diagnosis is often the easy part. Delivering care is the hard work.
https://twitter.com/NickSawyerMD/status/1288489565058080772
I found a thorough analysis of two recent papers (peer-reviewed, reasonably-powered studies) that present conflicting information on the relative transmission of COVID in children vs. adults. Here is the thing about data - it takes time to analyze and often presents stories that are difficult to interpret, much less apply. Dr. Kilpatrick does an excellent job discussing each paper's value and coming to some thoughtful comments about how to put these data into perspective. The responses are well-reasoned and discuss potential sources of bias. Read the whole thread.
https://twitter.com/DiseaseEcology/status/1286826597916401666
STAT News offers an overview of the strategy and tactics of rapid vaccine development. Amazing what humans can do when we can organize. https://www.statnews.com/2020/07/30/a-huge-experiment-how-the-world-made-so-much-progress-on-a-covid-19-vaccine-so-fast/
And, of course, this all costs money. Moderna is in negotiations with European countries about the per-dose vaccine costs for their upcoming COVID vaccine. https://www.fiercepharma.com/pharma/moderna-s-rumored-50-plus-price-covid-19-vaccine-draws-ire-as-company-touts-new-animal-data
I found this discussion on the utility of eye protection from Dr. Feigl-Ding, an epidemiologist and health economist. He was responding to some public comments from Dr. Fauci yesterday. I am not an advocate for the general public wearing eye protection, but I use a face shield or goggles when performing physical exams on my patients. The whole conversation seems a little like the telephone game (an over-interpretation of Dr. Fauci's comments spawning a more extensive discussion). It will be interesting to see if this line of thinking (we should be more generally use eye protection) gets any traction in the medical or lay press. Considering the reactions to masks, I doubt it.
Article on what Dr. Fauci said: https://www.forbes.com/sites/brucelee/2020/07/30/did-dr-fauci-recommend-wearing-eye-shields-goggles-for-covid-19-coronavirus/#65f6935dda2e
Twitter discussion:
https://twitter.com/DrEricDing/status/1288523940046962688
Infographic of the day: The Power of Sleep
https://www.onlinemattressreview.com/power-of-sleep/
Read on with care - keep your mind sharp! Onlinemattressreview.com compiled this set of data on sleep. It must be inherently biased - don't be a tool of the Mattress-industrial complex!
Infographic of the Day #2 - Types of tired. In case the mattress-industrial complex is not just lying to you, there may be utility in better describing your fatigue. This graphic is amusing >> scientific and is much more an exercise in visualizing synonyms.
https://i.redd.it/xqbrc6azqxd51.jpg
-----Bonus Round - Cool Ephemera
Yesterday morning I did not know I had an interest in artwork painted on the inside of 19th century Japanese fireman's coats. As of this morning, I do. Maybe you will too.
https://publicdomainreview.org/collection/japanese-firemans-coats-19th-century
Likewise, I challenge you to sit through 11 minutes of animated, month-month top google search terms by state. I made it to minute 3:40 and gave up. The data is unsettling, voyeuristic, and, at times, shockingly uniform. How can a country that uniformly seeks information on Adele (03 Feb 2011) or Fidget Spinners (18 May 2017) be divided? E Pluribus Unum! (Even if the "one" is Googling for Kim Kardashian.)
https://www.visualcapitalist.com/top-google-search-trends-of-the-decade-us/
Clean hands and sharp minds,
Adam
PS - Back in clinic tomorrow, have a safe weekend. More on Monday.
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