Week of October 4, 2021
My clinic time was atypically challenging this past week. I had several "I would rather die than be told to get vaccinated" individuals on my schedule. In other circumstances, I label these patients non-adherent, document their refusal in a progress note, and move on. But about this topic, I struggle to find the right balance of advocacy for all my patients while respecting any one patient's autonomy. I know many in the medical community share my frustration. But it is lonely in the exam room with an obstinate, unvaccinated patient and the screaming voice in my head urging me in the Sisyphean struggle to change their mind. (I am trying to protect my many immunosuppressed patients). COVID has amplified my sense that healthcare often feels like convincing toddlers to eat broccoli. If only I had Velveeta for the vaccine.
---- Latest Data
Deaths appear to be in decline. Cases and hospitalizations are falling as well. Hopefully, colder weather does not stop this trend.
https://www.nytimes.com/interactive/2021/us/covid-cases.html
Note that the hotspots are migrating north
https://twitter.com/EricTopol/status/1444727604179730434/photo/1
Mayo Clinic offers a very coarse animated map with forward-looking forecasts:
https://www.mayoclinic.org/coronavirus-covid-19/map
or this version with finer detail:
https://theuscovidatlas.org/map?src=county_usfacts&var=Confirmed_Count_per_100K_Population&mthd=lisa&v=2
Country Comparison from FT.com
https://ig.ft.com/coronavirus-chart/?areas=eur&areas=usa&areas=gbr&areasRegional=usny&areasRegional=usla&areasRegional=usnv&areasRegional=usar&areasRegional=usks&areasRegional=usmo&cumulative=0&logScale=1&per100K=1&startDate=2021-06-01&values=cases
CDC Weekly Review of Data and Variant Tracking
https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
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Dr. Faust offers a fantastic rundown on the challenges of patients with unique situations or atypical circumstances regarding boosters.
https://insidemedicine.bulletin.com/288603806435052/
Here is some of the data on boosters from Israel.
In this study involving participants who were 60 years of age or older and had received two doses of the BNT162b2 vaccine at least five months earlier, we found that the rates of confirmed Covid-19 and severe illness were substantially lower among those who received a booster (third) dose of the BNT162b2 vaccine. At least 12 days after the booster dose, the rate of confirmed infection was lower in the booster group than in the non-booster group by a factor of 11.3 (95% confidence interval [CI], 10.4 to 12.3); the rate of severe illness was lower by a factor of 19.5 (95% CI, 12.9 to 29.5)
https://www.nejm.org/doi/full/10.1056/NEJMoa2114255
The NY Times had a sobering article on deaths due to the Delta Variant and that more than 700,000 Americans have died from COVID. Unvaccinated people were 10x likely to die of the Delta variant virus. The deceased are now younger and from the Southern US. The states with the LOWEST vaccination rates have the HIGHEST death rates.
https://www.nytimes.com/2021/10/01/us/us-covid-deaths-700k.html
Molnupiravir is the oral medication for COVID that demonstrated a marked reduction in hospitalizations. Merck shared very favorable preliminary data (in the form of a press release).
https://twitter.com/EricTopol/status/1443913955202650116
My favorite Tweet this week:
Molnupiravir. Because if you didn't like the 30ug of nucleotides in the mRNA vaccine, we have this one weird 800mg RNA nucleotide for you.
https://twitter.com/erlichya/status/1444172920440463360?s=10
In addition to snark, Yaniv Erlich offered a fantastic Tweetorial on the molnupiravir's mechanism of action:
https://twitter.com/erlichya/status/1444747352611467265?s=10
Dr. Eric Feigl-Ding shared this data comparing compare reinfection breakthroughs (in people that had COVID but no vaccine) vs. vaccine breakthroughs. Spoiler: unvaccinated individuals with infection-induced antibodies were 2x more likely to experience reinfection. And the study cited includes data suggesting boosters offer additional protection against breakthrough illness.
https://twitter.com/drericding/status/1443411199920594956?s=21
Here are some interesting pre-release data on the cross-protection offered by the recombinant adjuvant zoster virus vaccine (RZV). These data, looking at 149,244 RZV recipients (and 298,488 RZV unvaccinated individuals), demonstrated RZV vaccination was associated with a 16% lower risk of COVID-19 diagnosis and 32% lower risk of hospitalization
https://www.medrxiv.org/content/10.1101/2021.10.01.21264400v1
Some commentary:
https://twitter.com/erictopol/status/1444807655030067201?s=10
Flu Vaccine and MMR may offer similar cross-protection.
https://www.sciencedaily.com/releases/2021/08/210804123547.htm
and
https://www.sciencedaily.com/releases/2021/08/210831142423.htm
It is getting harder to help people avoid vaccination.
https://twitter.com/wfkars/status/1443335571229773831?s=10
Infographics!
Coffee Drinks.
https://twitter.com/TasteAtlas/status/1444007407085096977/photo/1
I need to find an egg coffee.
https://www.tasteatlas.com/egg-coffee
all from
https://www.tasteatlas.com/coffee
Things I learned this week
You can obtain a master's degree in The Beatles.
https://www.nytimes.com/2021/10/01/arts/music/beatles-masters-degree-liverpool-university.html
"llinois man dies of rabies after waking up with bat on his neck [and refusing rabies immunoglobulin]." Sad, preventable, and it seems like an intellectual race to the bottom. To be clear, I cannot find any documented reason for his unwillingness to be treated, but succumbing to rabies is amazingly foolish.
https://www.npr.org/2021/09/29/1041457232/rabies-illinois-man-death-rare-public-health
William Dampier was an English pirate in the 18th century who wrote a then-famous and comprehensive book about his travel observations, including many culinary finds from around the Pacific and South America. He was the first European to write about chopsticks, barbecue, cashews, kumquats, tortillas, soy sauce, breadfruit, and guacamole. Among various culinary adventures, he highly recommended grilled manatee, flamingo tongue, and Galapagos penguin eggs. His writings inspired numerous other authors and explorers.
https://www.atlasobscura.com/articles/first-food-writer
Read his book, A New Voyage Round the World at
https://gutenberg.net.au/ebooks05/0500461h.html#ch3
Clean hands and sharp minds,
Adam
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