Week of July 12, 2021
Despite moving to our house in November 2020, we repeatedly called ourselves (and were called) "the new family in the neighborhood" on Saturday afternoon. After introducing ourselves for the sixth time in an hour while mingling at our first vaccine-enabled neighborhood block party, I began to wonder when we would no longer be "new." I guess the pandemic has made newness a longer-term proposition. After all, novelty is relative to when you meet the people giving you the label?
Some social idiosyncrasies are unchanged by the pandemic. The news that I was a kidney doctor moved at lightspeed through the neighborhood crowd - certainly faster than I could work my way through the group. And while I may not remember all of my neighbor's names, I now know one has IgA nephropathy, one has a sister who developed life-threatening hyponatremia after a 1993 marathon, and a third wanted to explore the renal implications of a keto diet. My mind buckets people by their pathology. And, these neighbors are now irrevocably linked to the diseases in my head. I am grateful no one showed me any rashes. In other words, I did not have to navigate the social minefield of "I just met you, you have made me aware that part of your body is red and bumpy, I think I know why, and it is nice to meet your spouse (but better not shake their hand)."
------
Missouri, Arkansas, and Florida are turning into COVID hotspots with both increasing case rates and hospitalizations. Deaths are still down, but it is a lagging indicator. Where cases and hospitalizations trend, so does mortality.
U.S. Hotspot Map via N.Y. Times
https://www.nytimes.com/interactive/2021/us/covid-cases.html
CDC Weekly Review of Data and Variant Tracking
https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
-----
I have personally found it hard to reconcile the data on case rates and the anecdotes of fully vaccinated individuals becoming infected (but not seriously ill or hospitalized) with the pervasive sentiment that the pandemic is over. Outdoor activities feel safe. Indoor activities give me pause, especially with unvaccinated individuals (who can asymptomatically spread the virus). To be sure, there are increasing incidents where it is hard to know the best course of action.
What we know:
The vaccines work against the delta variant:
https://twitter.com/EricTopol/status/1413968623815647235
The data from Israel last week (regarding breakthrough cases) was an outlier relative to other studies which demonstrated more effectiveness in fully vaccinated individuals.
https://twitter.com/EricTopol/status/1413483794535915525?s=20
Pfizer and the FDA do NOT agree on the need for a booster at this time.
https://www.cnn.com/2021/07/08/health/pfizer-waning-immunity-bn/index.html
My takeaways:
-Pfizer and Moderna continue to offer high levels of protection against severe illness and death.
-Symptomatic infection for fully vaccinated individuals is more likely with newer variants.
-There is some time-dependence to this that we do not fully understand - those further out from their second dose may have waning immunity - which may vary from person to person and is not easily measured.
Two other articles of note:
There is a lack of good data on measuring if someone is well-immunized from the coronavirus. Antibody levels do seem to correlate with protection in the immediate post-vaccination time frame. Longer-term, it is still unclear. This thread is a great discussion based on some newer publications:
https://twitter.com/EricTopol/status/1413483794535915525?s=20
Here is the nature commentary from Florian Krammer:
https://www.nature.com/articles/s41591-021-01432-4
New data on the pathophysiology of COVID continues to demonstrate there is a robust autoimmune component. Essentially, COVID induces antibodies against a protein (Annexin A2) that helps keep clotting pathways in balance (don't clot inappropriately, only when needed). Having less of this protein (when the body inappropriately generates antibodies to Annexin A2) creates an out-of-balance situation in the various tissues (such as the lungs) as small clots begin to form.
https://twitter.com/DaveLeeERMD/status/1413816137570205697
If you have the time, I highly recommend perusing Dr. Lee's feed.
https://twitter.com/DaveLeeERMD
Infographics!
The chemistry of things you smell at the beach.
https://twitter.com/compoundchem/status/1413430121801818112/photo/1
Make organic chemistry fun again! A 12 minute series of infographics in a YouTube video about the chemistry of esters. It opens with a delightful exploration of scurvy. And the way the narrator talks about P-orbital overlap makes this almost NSFW.
https://www.youtube.com/watch?v=7etoyWYdGiQ
-----Things I learned this week
It is not socially acceptable to drill holes in your neighbor's head (especially if you are the new family on the block). But this was not always the case. Ancient humans used trepanation for both reasonable and superstitious medical reasons. Attempting to relieve pressure after a skull-crushing mammoth kick feels right. Aiming to let out evil spirits is probably a less solid an indication. I invite you to share in the intellectual joy of "Why our ancestors drilled holes in each other's skulls."
http://www.bbc.com/earth/story/20160826-why-our-ancestors-drilled-holes-in-each-others-skulls
I am now appropriately respectful of the human body's maximal tolerated wet-bulb temperature. Maybe that whole buying Greenland thing wasn't such a bad idea after all‽
https://advances.sciencemag.org/content/6/19/eaaw1838
or
https://thehill.com/changing-america/sustainability/environment/562165-scientists-now-racing-to-study-heat-conditions
Clean hands and sharp minds, team
Adam
Despite moving to our house in November 2020, we repeatedly called ourselves (and were called) "the new family in the neighborhood" on Saturday afternoon. After introducing ourselves for the sixth time in an hour while mingling at our first vaccine-enabled neighborhood block party, I began to wonder when we would no longer be "new." I guess the pandemic has made newness a longer-term proposition. After all, novelty is relative to when you meet the people giving you the label?
Some social idiosyncrasies are unchanged by the pandemic. The news that I was a kidney doctor moved at lightspeed through the neighborhood crowd - certainly faster than I could work my way through the group. And while I may not remember all of my neighbor's names, I now know one has IgA nephropathy, one has a sister who developed life-threatening hyponatremia after a 1993 marathon, and a third wanted to explore the renal implications of a keto diet. My mind buckets people by their pathology. And, these neighbors are now irrevocably linked to the diseases in my head. I am grateful no one showed me any rashes. In other words, I did not have to navigate the social minefield of "I just met you, you have made me aware that part of your body is red and bumpy, I think I know why, and it is nice to meet your spouse (but better not shake their hand)."
------
Missouri, Arkansas, and Florida are turning into COVID hotspots with both increasing case rates and hospitalizations. Deaths are still down, but it is a lagging indicator. Where cases and hospitalizations trend, so does mortality.
U.S. Hotspot Map via N.Y. Times
https://www.nytimes.com/interactive/2021/us/covid-cases.html
CDC Weekly Review of Data and Variant Tracking
https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
-----
I have personally found it hard to reconcile the data on case rates and the anecdotes of fully vaccinated individuals becoming infected (but not seriously ill or hospitalized) with the pervasive sentiment that the pandemic is over. Outdoor activities feel safe. Indoor activities give me pause, especially with unvaccinated individuals (who can asymptomatically spread the virus). To be sure, there are increasing incidents where it is hard to know the best course of action.
What we know:
The vaccines work against the delta variant:
https://twitter.com/EricTopol/status/1413968623815647235
The data from Israel last week (regarding breakthrough cases) was an outlier relative to other studies which demonstrated more effectiveness in fully vaccinated individuals.
https://twitter.com/EricTopol/status/1413483794535915525?s=20
Pfizer and the FDA do NOT agree on the need for a booster at this time.
https://www.cnn.com/2021/07/08/health/pfizer-waning-immunity-bn/index.html
My takeaways:
-Pfizer and Moderna continue to offer high levels of protection against severe illness and death.
-Symptomatic infection for fully vaccinated individuals is more likely with newer variants.
-There is some time-dependence to this that we do not fully understand - those further out from their second dose may have waning immunity - which may vary from person to person and is not easily measured.
Two other articles of note:
There is a lack of good data on measuring if someone is well-immunized from the coronavirus. Antibody levels do seem to correlate with protection in the immediate post-vaccination time frame. Longer-term, it is still unclear. This thread is a great discussion based on some newer publications:
https://twitter.com/EricTopol/status/1413483794535915525?s=20
Here is the nature commentary from Florian Krammer:
https://www.nature.com/articles/s41591-021-01432-4
New data on the pathophysiology of COVID continues to demonstrate there is a robust autoimmune component. Essentially, COVID induces antibodies against a protein (Annexin A2) that helps keep clotting pathways in balance (don't clot inappropriately, only when needed). Having less of this protein (when the body inappropriately generates antibodies to Annexin A2) creates an out-of-balance situation in the various tissues (such as the lungs) as small clots begin to form.
https://twitter.com/DaveLeeERMD/status/1413816137570205697
If you have the time, I highly recommend perusing Dr. Lee's feed.
https://twitter.com/DaveLeeERMD
Infographics!
The chemistry of things you smell at the beach.
https://twitter.com/compoundchem/status/1413430121801818112/photo/1
Make organic chemistry fun again! A 12 minute series of infographics in a YouTube video about the chemistry of esters. It opens with a delightful exploration of scurvy. And the way the narrator talks about P-orbital overlap makes this almost NSFW.
https://www.youtube.com/watch?v=7etoyWYdGiQ
-----Things I learned this week
It is not socially acceptable to drill holes in your neighbor's head (especially if you are the new family on the block). But this was not always the case. Ancient humans used trepanation for both reasonable and superstitious medical reasons. Attempting to relieve pressure after a skull-crushing mammoth kick feels right. Aiming to let out evil spirits is probably a less solid an indication. I invite you to share in the intellectual joy of "Why our ancestors drilled holes in each other's skulls."
http://www.bbc.com/earth/story/20160826-why-our-ancestors-drilled-holes-in-each-others-skulls
I am now appropriately respectful of the human body's maximal tolerated wet-bulb temperature. Maybe that whole buying Greenland thing wasn't such a bad idea after all‽
https://advances.sciencemag.org/content/6/19/eaaw1838
or
https://thehill.com/changing-america/sustainability/environment/562165-scientists-now-racing-to-study-heat-conditions
Clean hands and sharp minds, team
Adam
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