August 25, 2020
Tuesday
We spent the last few days at a rented house in the woods of northern Pennsylvania. It was a socially distanced vacation, our first since late 2019. Despite the PA mandatory mask order, I did not see many people wearing masks, and the few restaurants were full, but with spaced tables. We chose this area based on outdoor activities, including the superb conditions for biking/hiking and astrophotography. It was great to be out of the house for a few days and see some new areas. But, the time away was a bit sad - it was hard to get a feel for the community when so many establishments were closed. I felt a void left by the allure of darkened quirky restaurants, and the empty parking lots of the Pennsylvania Lumber Museum and the Elliot Ness Museum. All would be on my typical to-do list for such a trip. And I refuse to dwell on the missed entertainment opportunities the gift shops of such places offer.
Some of our efforts at astrophotography from the darkest place on the east coast, Cherry Springs State Park, PA https://nigelworks.smugmug.com/2020/Astro-2020/
----------------
Latest Data
Global-View:
https://www.ft.com/content/a2901ce8-5eb7-4633-b89c-cbdf5b386938
Nationally:
a continued slow decline in new cases in the US (40,000 a day, now)
stable deaths @ 3.0 per million (or about 900 deaths per day) in the US for the last few days
https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&areasRegional=usny&areasRegional=usca&areasRegional=usfl&areasRegional=ustx&areasRegional=usco&cumulative=0&logScale=0&perMillion=1&values=cases
Also, look at https://covidtracking.com/data
The US Regionally:
The NY Times state-level data visualization:
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
About the data:
https://covidtracking.com/about-data/visualization-guide is the best resource to understand data visualization and data integrity.
-----------
Over the weekend, our President announced that the FDA issued an Emergency Use Authorization (EUA) for convalescent plasma (CP). I have offered articles on this topic before, and the existing data on CP from observational studies that are problematic in their design and data reporting. Moreover, the EUA does not change current use patterns - CP is in extensive use throughout the US. It does, however, make it harder to recruit patients for controlled trials. On the upside, CP is less likely to cause harm, unlike HCQ. But time and prospective data from randomized trials will be useful.
https://www.statnews.com/2020/08/23/fda-under-pressure-from-trump-expected-to-authorize-blood-plasma-as-covid-19-treatment/
This topic spawned my favorite tweet of the weekend on the irony of being in a politicized healthcare environment: https://twitter.com/CT_Bergstrom/status/1252532314715811842
"Infectious disease epidemiologists find ourselves in the odd position of criticizing irresponsible claims that we desperately hope to be true."
There were also published case reports of documented re-infection with SARS-CoV-2. The case report is well documented and illustrates that infection does not confer prolonged immunity. However, the recurrent infection was asymptomatic. This lack of response indicates an appropriate immune response to coronavirus re-exposure.
Here is the best overview I found: https://twitter.com/VirusesImmunity/status/1297890418168860674
I was intrigued by an article from The Lancet on a milder strain of SARS-CoV-2 with identified genomic deletions. Here is a helpful discussion by Eric Topol:
https://twitter.com/EricTopol/status/1295861620573257729
There was other FDA news last week that quickly appeared and disappeared. Here is a WaPo article on the FDA's changing role in the oversight of laboratory-based coronavirus testing. It is a highly technical topic worthy of following. The ramifications of less testing oversight may be a debate over setting the degree of government oversight, but there are frequently unintended (or intended) consequences.
https://www.washingtonpost.com/health/2020/08/20/trump-fda-tests-coronavirus/
There continues to be a discussion about the lower reported rates of hospitalization and death in the summer waves of COVID. STAT News offers some data. I am still unsatisfied with what we do not know. The difficulties of variable data reporting, missing data, and varying operational definitions make this topic much more challenging.
https://www.statnews.com/2020/08/24/infection-fatality-rate-shows-covid-19-isnt-getting-less-deadly/
Infographic of the day: Back to the Future
I love it when I find graphics about topics I have spent many hours since childhood pondering. I just wish it increased my understanding, which I am not sure this does.
https://i.redd.it/asfve740kzi51.jpg
------ Bonus Round - The one-legged spy
Audiobooks filled our long drive to and from Pennsylvania. I learned about the Maryland native Virginia Hall - a disabled woman who was the most successful British intelligence agent in France in 1941. Her story is remarkable, harrowing, and a testament to how strong the drive to succeed can be. You could not write a believable script with facts from her time as an intelligence coordinator in Vichy France. Her Wikipedia page does not do her justice but is a good overview. Sadly, she lived near me in retirement and I could have met her, had I known about her.
https://en.wikipedia.org/wiki/Virginia_Hall
The book about her life, A Woman of No Importance, paints a much more vivid picture.
https://www.amazon.com/Woman-No-Importance-Untold-American/dp/073522529X/ref=asc_df_073522529X/
or
https://www.goodreads.com/book/show/40595446-a-woman-of-no-importance
Clean hands and sharp minds,
Adam
We spent the last few days at a rented house in the woods of northern Pennsylvania. It was a socially distanced vacation, our first since late 2019. Despite the PA mandatory mask order, I did not see many people wearing masks, and the few restaurants were full, but with spaced tables. We chose this area based on outdoor activities, including the superb conditions for biking/hiking and astrophotography. It was great to be out of the house for a few days and see some new areas. But, the time away was a bit sad - it was hard to get a feel for the community when so many establishments were closed. I felt a void left by the allure of darkened quirky restaurants, and the empty parking lots of the Pennsylvania Lumber Museum and the Elliot Ness Museum. All would be on my typical to-do list for such a trip. And I refuse to dwell on the missed entertainment opportunities the gift shops of such places offer.
Some of our efforts at astrophotography from the darkest place on the east coast, Cherry Springs State Park, PA https://nigelworks.smugmug.com/2020/Astro-2020/
----------------
Latest Data
Global-View:
https://www.ft.com/content/a2901ce8-5eb7-4633-b89c-cbdf5b386938
Nationally:
a continued slow decline in new cases in the US (40,000 a day, now)
stable deaths @ 3.0 per million (or about 900 deaths per day) in the US for the last few days
https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&areasRegional=usny&areasRegional=usca&areasRegional=usfl&areasRegional=ustx&areasRegional=usco&cumulative=0&logScale=0&perMillion=1&values=cases
Also, look at https://covidtracking.com/data
The US Regionally:
The NY Times state-level data visualization:
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
About the data:
https://covidtracking.com/about-data/visualization-guide is the best resource to understand data visualization and data integrity.
-----------
Over the weekend, our President announced that the FDA issued an Emergency Use Authorization (EUA) for convalescent plasma (CP). I have offered articles on this topic before, and the existing data on CP from observational studies that are problematic in their design and data reporting. Moreover, the EUA does not change current use patterns - CP is in extensive use throughout the US. It does, however, make it harder to recruit patients for controlled trials. On the upside, CP is less likely to cause harm, unlike HCQ. But time and prospective data from randomized trials will be useful.
https://www.statnews.com/2020/08/23/fda-under-pressure-from-trump-expected-to-authorize-blood-plasma-as-covid-19-treatment/
This topic spawned my favorite tweet of the weekend on the irony of being in a politicized healthcare environment: https://twitter.com/CT_Bergstrom/status/1252532314715811842
"Infectious disease epidemiologists find ourselves in the odd position of criticizing irresponsible claims that we desperately hope to be true."
There were also published case reports of documented re-infection with SARS-CoV-2. The case report is well documented and illustrates that infection does not confer prolonged immunity. However, the recurrent infection was asymptomatic. This lack of response indicates an appropriate immune response to coronavirus re-exposure.
Here is the best overview I found: https://twitter.com/VirusesImmunity/status/1297890418168860674
I was intrigued by an article from The Lancet on a milder strain of SARS-CoV-2 with identified genomic deletions. Here is a helpful discussion by Eric Topol:
https://twitter.com/EricTopol/status/1295861620573257729
There was other FDA news last week that quickly appeared and disappeared. Here is a WaPo article on the FDA's changing role in the oversight of laboratory-based coronavirus testing. It is a highly technical topic worthy of following. The ramifications of less testing oversight may be a debate over setting the degree of government oversight, but there are frequently unintended (or intended) consequences.
https://www.washingtonpost.com/health/2020/08/20/trump-fda-tests-coronavirus/
There continues to be a discussion about the lower reported rates of hospitalization and death in the summer waves of COVID. STAT News offers some data. I am still unsatisfied with what we do not know. The difficulties of variable data reporting, missing data, and varying operational definitions make this topic much more challenging.
https://www.statnews.com/2020/08/24/infection-fatality-rate-shows-covid-19-isnt-getting-less-deadly/
Infographic of the day: Back to the Future
I love it when I find graphics about topics I have spent many hours since childhood pondering. I just wish it increased my understanding, which I am not sure this does.
https://i.redd.it/asfve740kzi51.jpg
------ Bonus Round - The one-legged spy
Audiobooks filled our long drive to and from Pennsylvania. I learned about the Maryland native Virginia Hall - a disabled woman who was the most successful British intelligence agent in France in 1941. Her story is remarkable, harrowing, and a testament to how strong the drive to succeed can be. You could not write a believable script with facts from her time as an intelligence coordinator in Vichy France. Her Wikipedia page does not do her justice but is a good overview. Sadly, she lived near me in retirement and I could have met her, had I known about her.
https://en.wikipedia.org/wiki/Virginia_Hall
The book about her life, A Woman of No Importance, paints a much more vivid picture.
https://www.amazon.com/Woman-No-Importance-Untold-American/dp/073522529X/ref=asc_df_073522529X/
or
https://www.goodreads.com/book/show/40595446-a-woman-of-no-importance
Clean hands and sharp minds,
Adam
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