Thursday, July 9, 2020
Making decisions in the face of uncertainty is hard. Nothing novel about this thought, but as my family considers moving closer to my kids' school, the amplified risk of home sales, macroeconomics, and personal safety in the middle of a pandemic makes the uncertainty that much greater. Physicians (and investment advisors and lawyers and many others) make numerous decisions in the absence of full knowledge of the future. Articulating the risks vs. benefits and doing our best to interpret the data we have is often the best we can do. Asking the same of our leaders - articulating risks and benefits, being transparent about data and data quality, and demonstrating a modicum of critical analysis skills seems like a small expectation.
---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.
------------
I am not sure how I missed this article in early June, but it turns out the issues around mandating vaccines and face masks (and other public health measures) have been brought before the supreme court - as far back as 1905. It appears rational thinking and public health have some sort of priority over individual liberty during times of public health crisis, especially within local and state jurisdictions.
https://www.acslaw.org/expertforum/face-covering-requirements-and-the-constitution/
I expect we will see a large volume of going back to school in the fall articles over the weekend. Here is a preview article I found:
https://www.theatlantic.com/ideas/archive/2020/07/reopening-bars-easy-schools-are-difficult/613861/
Andy Slavitt, the former CMS administrator, offers a summary of his thoughts to the MN State House committee on the pandemic. It is nice to see a public official with a rational and reasonable approach to thinking through a problem.
https://twitter.com/ASlavitt/status/1281014305631109121
Fivethirtyeight offers some data on the current, increasing, and still inadequate testing for COVID. To be sure, there are testing supply constraints emerging in the last few weeks.
https://fivethirtyeight.com/features/america-is-testing-for-covid-19-more-than-ever-and-it-still-isnt-enough/
Here is an outstanding editorial highlighting some critical pieces of known unknowns regarding individual immunity (and, therefore, herd immunity). It is a continuation of the conversation on Twitter from Eric Topol earlier this week. Here is a summary:
True: low rates of IgG antibodies to COVID are found in numerous high-prevalence areas (Spain, NY State).
True: we DO NOT fully understand the immune system
True: T-cell response is important in response to viral infections, but with a lot of individual variation.
True: we don't have enough knowledge or data to draw sweeping conclusions about how "immune" someone is (or groups of someones are) from coronavirus.
Sometimes the world is complex, and binary answers, while comforting, are a logical fallacy that is easy to fall into. Immunity, at this point, is not a yes/no issue.
https://blogs.sciencemag.org/pipeline/archives/2020/07/07/more-on-t-cells-antibody-levels-and-our-ignorance
While not related to COVID, here was an interesting scientific article from the week further justifying my scotch collection: Does moderate drinking slow cognitive decline? To be clear, low to moderate alcohol intake was defined in the paper as <8 drinks per week for women and <15 drinks per week for men. This degree of consumption seems high to me (AND VERY WELL MAY HAVE OTHER CONSEQUENCES). Either way, the seemingly endless debate on the tradeoffs of alcohol intake continues.
Read the article: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767693
More importantly, read some criticism of the article:
https://www.mdedge.com/neurology/article/225150/alzheimers-cognition/does-moderate-drinking-slow-cognitive-decline
And here is a helpful Q&A with a doctor on handling requests for "mask exemptions."
https://www.mdedge.com/internalmedicine/article/225157/coronavirus-updates/doc-can-i-get-mask-exemption
There is an increasing number of articles about understanding the population prevalence of COVID through wastewater testing. For this testing to be maximally useful, a federal-level response is required. Unfortunately, this kind of national action seems outside the mindset and capacity of current thinking.
https://www.statnews.com/2020/07/09/wastewater-testing-early-warning-covid-19-infection-communities/?utm_campaign=rss
Fun fact: We have over 14,000 wastewater treatment plants in the US.
Infographic of the day #1: Penguin love lives.
Today, I learned that at numerous Japanese zoos, keeping track of penguins' social and sexual lives is a big deal. I offer my newfound knowledge to you:
1) Start with the article:
https://www.animenewsnetwork.com/interest/2018-11-10/kyoto-aquarium-penguin-relationship-chart-reveals-incest-turbulent-love-lives/.139254
or
https://www.cnn.com/travel/article/aquarium-penguins-japan/index.html
2) see the charts in the CNN article or here:
https://nerdist.com/wp-content/uploads/2020/07/Aquarium-Penguin-Flow-Chart-Feature-IMage-06072020.jpg
Infographic of the day #2: Critical Thinking skills for everyone.
Here is a great cheat sheet on critical thinking - suitable to start conversations with kids at home.
Graphic: https://lenscleaner.files.wordpress.com/2017/01/picture.png
Article: https://wabisabilearning.com/blogs/critical-thinking/critical-thinking-skills-cheatsheet-infographic#erid2592060
---- Bonus Round --- Courage is moving forward in the face of uncertainty.
June and July is the start of medical training for doctors. "My first day as a doctor," stories have been filling Twitter for the last few weeks. It is also remarkable how pervasive imposter syndrome, fear of failure, and self-doubt seem to be amongst healthcare workers. So, rather than write about a famous person, I have chosen a decidedly not famous person today - Prerana Chatty, MD - a 1st-year pediatrics resident at Children's Hospital of Philadelphia (CHOP). She is delightful, honest, and vulnerable. The best part is the replies. It is good to remind ourselves of how many decent people there are.
Thread on imposter syndrome: https://twitter.com/preranachatty/status/1281023490792083457
About Dr. Chatty: https://twitter.com/preranachatty
Clean hands and sharp minds,
Adam
I have early clinic hours tomorrow. I'll be back on Monday. Stay safe.
Making decisions in the face of uncertainty is hard. Nothing novel about this thought, but as my family considers moving closer to my kids' school, the amplified risk of home sales, macroeconomics, and personal safety in the middle of a pandemic makes the uncertainty that much greater. Physicians (and investment advisors and lawyers and many others) make numerous decisions in the absence of full knowledge of the future. Articulating the risks vs. benefits and doing our best to interpret the data we have is often the best we can do. Asking the same of our leaders - articulating risks and benefits, being transparent about data and data quality, and demonstrating a modicum of critical analysis skills seems like a small expectation.
---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.
------------
I am not sure how I missed this article in early June, but it turns out the issues around mandating vaccines and face masks (and other public health measures) have been brought before the supreme court - as far back as 1905. It appears rational thinking and public health have some sort of priority over individual liberty during times of public health crisis, especially within local and state jurisdictions.
https://www.acslaw.org/expertforum/face-covering-requirements-and-the-constitution/
I expect we will see a large volume of going back to school in the fall articles over the weekend. Here is a preview article I found:
https://www.theatlantic.com/ideas/archive/2020/07/reopening-bars-easy-schools-are-difficult/613861/
Andy Slavitt, the former CMS administrator, offers a summary of his thoughts to the MN State House committee on the pandemic. It is nice to see a public official with a rational and reasonable approach to thinking through a problem.
https://twitter.com/ASlavitt/status/1281014305631109121
Fivethirtyeight offers some data on the current, increasing, and still inadequate testing for COVID. To be sure, there are testing supply constraints emerging in the last few weeks.
https://fivethirtyeight.com/features/america-is-testing-for-covid-19-more-than-ever-and-it-still-isnt-enough/
Here is an outstanding editorial highlighting some critical pieces of known unknowns regarding individual immunity (and, therefore, herd immunity). It is a continuation of the conversation on Twitter from Eric Topol earlier this week. Here is a summary:
True: low rates of IgG antibodies to COVID are found in numerous high-prevalence areas (Spain, NY State).
True: we DO NOT fully understand the immune system
True: T-cell response is important in response to viral infections, but with a lot of individual variation.
True: we don't have enough knowledge or data to draw sweeping conclusions about how "immune" someone is (or groups of someones are) from coronavirus.
Sometimes the world is complex, and binary answers, while comforting, are a logical fallacy that is easy to fall into. Immunity, at this point, is not a yes/no issue.
https://blogs.sciencemag.org/pipeline/archives/2020/07/07/more-on-t-cells-antibody-levels-and-our-ignorance
While not related to COVID, here was an interesting scientific article from the week further justifying my scotch collection: Does moderate drinking slow cognitive decline? To be clear, low to moderate alcohol intake was defined in the paper as <8 drinks per week for women and <15 drinks per week for men. This degree of consumption seems high to me (AND VERY WELL MAY HAVE OTHER CONSEQUENCES). Either way, the seemingly endless debate on the tradeoffs of alcohol intake continues.
Read the article: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767693
More importantly, read some criticism of the article:
https://www.mdedge.com/neurology/article/225150/alzheimers-cognition/does-moderate-drinking-slow-cognitive-decline
And here is a helpful Q&A with a doctor on handling requests for "mask exemptions."
https://www.mdedge.com/internalmedicine/article/225157/coronavirus-updates/doc-can-i-get-mask-exemption
There is an increasing number of articles about understanding the population prevalence of COVID through wastewater testing. For this testing to be maximally useful, a federal-level response is required. Unfortunately, this kind of national action seems outside the mindset and capacity of current thinking.
https://www.statnews.com/2020/07/09/wastewater-testing-early-warning-covid-19-infection-communities/?utm_campaign=rss
Fun fact: We have over 14,000 wastewater treatment plants in the US.
Infographic of the day #1: Penguin love lives.
Today, I learned that at numerous Japanese zoos, keeping track of penguins' social and sexual lives is a big deal. I offer my newfound knowledge to you:
1) Start with the article:
https://www.animenewsnetwork.com/interest/2018-11-10/kyoto-aquarium-penguin-relationship-chart-reveals-incest-turbulent-love-lives/.139254
or
https://www.cnn.com/travel/article/aquarium-penguins-japan/index.html
2) see the charts in the CNN article or here:
https://nerdist.com/wp-content/uploads/2020/07/Aquarium-Penguin-Flow-Chart-Feature-IMage-06072020.jpg
Infographic of the day #2: Critical Thinking skills for everyone.
Here is a great cheat sheet on critical thinking - suitable to start conversations with kids at home.
Graphic: https://lenscleaner.files.wordpress.com/2017/01/picture.png
Article: https://wabisabilearning.com/blogs/critical-thinking/critical-thinking-skills-cheatsheet-infographic#erid2592060
---- Bonus Round --- Courage is moving forward in the face of uncertainty.
June and July is the start of medical training for doctors. "My first day as a doctor," stories have been filling Twitter for the last few weeks. It is also remarkable how pervasive imposter syndrome, fear of failure, and self-doubt seem to be amongst healthcare workers. So, rather than write about a famous person, I have chosen a decidedly not famous person today - Prerana Chatty, MD - a 1st-year pediatrics resident at Children's Hospital of Philadelphia (CHOP). She is delightful, honest, and vulnerable. The best part is the replies. It is good to remind ourselves of how many decent people there are.
Thread on imposter syndrome: https://twitter.com/preranachatty/status/1281023490792083457
About Dr. Chatty: https://twitter.com/preranachatty
Clean hands and sharp minds,
Adam
I have early clinic hours tomorrow. I'll be back on Monday. Stay safe.
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