Week of January 10, 2022
During last week's office visits, my vaccine-skeptical patients (about 15-25% of my panel) presented a different tone. Though one cited a dislike of our president as to why they are refusing vaccination, others reported they "just didn't know what was true." They all expressed distrust of news sources. Yet, all acknowledged local hospitals were overwhelmed and are aware of ill friends and family (with varying severity). Moreover, they all agreed to get vaccinated or boosted after 5-10 minutes of discussion. In some ways, it felt like I was giving them time and space to merge their observable reality with a version of reality they consume elsewhere. I have tried to be more empathetic and calm during these conversations. Maybe a moderated tone and the intensity of the Omicron surge eased the conversation? We shall see if these patients get vaccinated. Either way, the appointments felt like small victories. I look forward to entirely focusing on kidney disease in my nephrology office one day.
---- Latest Data
Case rates, hospitalizations, and death rates continue to rise across the US.
https://www.nytimes.com/interactive/2021/us/covid-cases.html
and
https://theuscovidatlas.org/map
(You need to look at the variables on this one to see how they vary.)
Country Comparison from FT.com
https://ig.ft.com/coronavirus-chart/?areas=eur&areas=usa&areas=gbr&areas=rus&areas=rou&areas=lva&areasRegional=usny&areasRegional=usla&areasRegional=usnv&areasRegional=usar&areasRegional=usks&areasRegional=usmo&cumulative=0&logScale=1&per100K=1&startDate=2021-06-01&values=cases
The CDC weekly review discusses the CDC guidelines in detail, amongst other data.
https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
------------------
The relationship between Omicron cases, hospitalizations, and ICU rates, by State:
https://twitter.com/jburnmurdoch/status/1479218302954221570/photo/1
discussion
UK COVID patients critical care admission rates by vaccination status (none, 2x and 2x+booster):
https://twitter.com/PaulMainwood/status/1479528897259712513/photo/1
Dr. Wachter reports on his 28-year-old son's experience with COVID this week. The son is vaccinated x 3, had an early false negative antigen test but is symptomatic. It reminds me of many stories I am hearing:
https://twitter.com/Bob_Wachter/status/1479913165039095810
Follow up article on swabbing the throat AND nose with home antigen test from the Washington Post:
https://www.washingtonpost.com/wellness/2022/01/06/adding-throat-swab-covid-test/
Here is a small (non-peer-reviewed) study discussing the observed higher false-negative rates of home antigen tests with Omicron:
https://www.statnews.com/2022/01/05/study-raises-doubts-about-rapid-covid-tests-reliability-in-early-days-after-infection/
The referenced study:
https://www.medrxiv.org/content/10.1101/2022.01.04.22268770v1
And Twitter commentary from Dr. Michael Mina
https://twitter.com/michaelmina_lab/status/1478798030618906632
And one last bit about the relationship between contagiousness, testing in Omicron, and pre-Omicron variants. In other words, why do antigen testing and PCR testing have different sensitivity and specificity for Omicron as compared to other variants?
https://twitter.com/michaelmina_lab/status/1478282520869359616
Wired offered a very consumer-friendly article about the best KF94/KN95/N95 masks on the market, along with a discussion on counterfeits and how to understand this confusing topic.
https://www.wired.com/story/best-disposable-face-masks-n95-kn95-kf94-surgical/
Israel reported preliminary data on antibody response rates (5-fold increase) and side effects (all mild) in immunocompromised patients receiving a fourth dose of the Pfizer vaccine.
https://www.mdedge.com/rheumatology/article/250493/covid-19-updates/fourth-covid-19-vaccine-dose-boosts-antibodies-fivefold
Part of the reason my patients report "they don't know what to believe" is because data (and its analysis) is often messy and nuanced. Take a look at this Twitter discussion about two MMWR articles from last week. The conversation touches on how a detailed analysis of definitions, data sources, and conclusions can make any study hard to interpret. Yet, despite the studies' imperfections, signals in these data advance our understanding and provoke further inquiry.
https://twitter.com/walidgellad/status/1479585898387939333
Articles:
COVID increases the risk of diabetes in children
https://www.cdc.gov/mmwr/volumes/71/wr/mm7102e2.htm?s_cid=mm7102e2_w
The Pfizer vaccine decreases the risk of Multisystem Inflammatory Syndrome in Children (MIS-C)
https://www.cdc.gov/mmwr/volumes/71/wr/mm7102e1.htm?s_cid=mm7102e1_w
There were articles on two new variations of COVID.
A variant of Delta with significant portions of the Omicron genome mutations. It is unclear what this means quite yet.
https://www.cnbc.com/2022/01/08/cyprus-reportedly-discovers-a-covid-variant-that-combines-omicron-and-delta.html
And a series of patients co-infected with both COVID and influenza - "flurona" (Note - this is two viruses - not a single variant, but sounds very unpleasant). Don't forget to get your flu vaccine!
https://www.mdedge.com/hematology-oncology/article/250499/covid-19-updates/first-flurona-cases-reported-us
Infographics!
Why don't birds fall off trees when they sleep?
https://www.scienceabc.com/wp-content/uploads/2020/12/The-Automatic-locking-mechanism-768x808.jpg
from
https://www.scienceabc.com/nature/animals/why-dont-birds-fall-off-branches-when-they-sleep.html
Things I learned this week
There is no good data on treatments or cures for an alcohol-induced hangover. Here are the conclusions from a recently published attempted meta-analysis:
"21 studies were included reporting on 386 participants. No two studies reported on the same intervention; as such, a meta-analysis could not be undertaken. Methodological concerns and imprecision resulted in all studied efficacy outcomes being rated as very low quality. When compared with placebo, individual studies reported a statistically significant reduction in the mean percentage overall hangover symptom score for clove extract(42.5%vs. 19.0%, p<0.001), tolfenamic acid(84.0% vs. 50.0%, p<0.001), pyritinol(34.1% vs. 16.2%, p<0.01), Hovenia Dulcis fruit extract(p=0.029), L-cysteine (p=0.043), red ginseng (21.1% vs. 14.0%, p<0.05) and Korean pear juice (41.5% vs 33.3%, p<0.05). All studied tolerability outcomes were of low or very low quality with no studies reporting any drop-outs due to adverse events."
https://onlinelibrary.wiley.com/doi/10.1111/add.15786
The Rich Earth Institute (a 501(c)3 non-profit with the mission to advance and promote the use of human waste as a resource) exists. As a nephrologist, this seems eminently logical. The seven-year-old in me giggles. The adult in me wonders about logistics and the practicality of "collection, aggregation, and transport" but admires the environmentally-friendly ideas. Enjoy!
https://richearthinstitute.org/about-us/history/
and the article that got me down this rabbit hole, the shortage of urea-based fertilizer for food production:
https://richearthinstitute.org/global-shortage-bodily-abundance-urine-fertilizer-could-help-address-urea-crisis/
LiveScience offers a detailed description of living in a kangaroo's pouch. At some level, this feels like the joey equivalent of a gossip column.
https://www.livescience.com/whats-it-like-inside-a-kangaroo-pouch
Clean hands and sharp minds,
Adam
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