Week of May 9, 2022
Recently, a patient decided to take our scheduled telehealth appointment from a restaurant mid-meal. Despite taking the time to introduce his dining companions and giving me a visual tour of his half-eaten plate, I felt compelled to reschedule (while pointing out the inappropriate setting for health care). But not before he asked for some reassurances about his lab values. Despite verbal and other consent, I suspect neither patients nor providers have fully considered the etiquette and implications of remote care - for instance, what's in the background or who is hearing the conversation. Telehealth has been one of many rapid healthcare changes in the last two years. And a final point on strategy - if you bring your kidney doctor into your dining experience, do so while ordering - not while eating. I can't help you un-swallow the salt from the sausage.
---- Latest Data
Case rates and hospitalizations are still rising. Death rates, which were declining, are plateauing. I expect we will see a rising death rate next week.
N.Y. Times Tracker
https://www.nytimes.com/interactive/2021/us/covid-cases.html
Country Comparison from FT.com
https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&areas=hkg&areas=chn&areas=jpn&areas=aus&areasRegional=usny&areasRegional=usla&areasRegional=usnv&areasRegional=usar&areasRegional=usks&areasRegional=usmo&cumulative=0&logScale=1&per100K=0&startDate=2021-06-01&values=cases
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The Atlantic published this article on the numerous data, messaging, and perspective problems with the BA.2 surge. We are, sadly, flying blind into the latest rising wave of COVID.
https://www.theatlantic.com/health/archive/2022/05/omicron-us-covid-surge-meaning/629765/
A pithier case in point
https://twitter.com/medriva/status/1523450193189826560
I see some interesting reports of coronavirus rebound AFTER treatment with Paxlovid. When combined with reports of side effects, the problems of complex data start to emerge. The good continues to outweigh the bad. Here is what I understand:
- 5-day treatments of Paxlovid offered a significant reduction in the risk of hospitalization and death for patients with mild-to-moderate COVID-19 who are at high risk of disease progression.
- A small number of patients (1-2%, but may vary depending on the source) treated with Paxlovid who test negative may become PCR positive, sometimes with symptoms a few days after treatment.
https://www.fda.gov/drugs/news-events-human-drugs/fda-updates-paxlovid-health-care-providers
and
Dr. Michael Mina offers a good review:
https://twitter.com/michaelmina_lab/status/1522712422318067719
Scott Gottlieb discussed data on the variant to variant antibody effectiveness against BA.4 and BA.5 from South Africa. It is challenging to keep up with the volume of data. However, a consistent theme of the pandemic continues - infection-induced antibodies generated by a variant both wane over time and offer less protection from newer variants.
(For reference, BA.2 is currently predominant in the U.S.)
https://twitter.com/ScottGottliebMD/status/1523083978265219078
Random Medical Realities and Technologies
Clinical trials of Brain-computer interfaces for paralyzed patients are starting in the U.S. Synchron, the manufacturer running the trial, is a competitor to Elon Musk's Neuralink (which is not yet conducting human studies, as far as I can tell).
https://www.businesswire.com/news/home/20220504005281/en/Synchron-Announces-Enrollment-of-First-Patient-in-U.S.-Endovascular-Brain-Computer-Interface-Study-COMMAND-in-Patients-With-Severe-Paralysis
and
https://www.dailymail.co.uk/sciencetech/article-10785963/Elon-Musks-Neuralink-rival-Synchron-begins-human-trials-brain-implant.html
One more topic on data. Dr. John Mandrola started a thread looking for examples of Randomized Controlled Trials (RCTs) that reversed the findings of observational studies. The ensuing discussion (which spans numerous medical specialties) is an excellent example of how nuanced data can be and why medical recommendations change over time.
https://twitter.com/drjohnm/status/1523268634243571713
Infographics
Breakfast dishes from around the world
https://www.kulickspancakerecipes.com/around-the-world-in-50-breakfast-dishes/
Things I learned this week
The Samuel J. Heyman Medals - the Sammies - are the "Oscars" of government service. The medals recognize federal employees for specific achievements or overall career excellence. While many of the most recent awards are related to the pandemic, going back a few years illustrates a fantastic array of highly detailed, technical, and operational achievements that only happen through government programs.
https://servicetoamericamedals.org/about/
Example: 2015 winner Jacob Moss from EPA for his program to bring cleaner and more efficient cookstoves to third world countries.
https://servicetoamericamedals.org/honorees/jacob-e-moss/
And there is a People's Choice voting section - with a process that seems questionable:
"You may vote for as many finalists as you want, and you may submit your votes once every 24 hours. Throughout the voting period, we will narrow the field and reset the poll for the remaining top contenders."
https://servicetoamericamedals.org/peoples-choice-award/
Take a look at Orra White Hitchcock's Scientific Illustrations for the Classroom (1828–40). She married a geologist (and 3rd President of Amherst College), Edward Hitchcock. She produced hundreds of illustrations for her husband's work but made more than sixty hand-colored scientific illustrations on poster-sized linen swaths designed for classroom walls.
https://publicdomainreview.org/collection/hitchcock-illustrations
and
https://en.wikipedia.org/wiki/Orra_White_Hitchcock
Cellphone geolocation data is an increasingly provocative topic. I learned that there are data brokers who pre-tag and merge multiple data sets, including phone geolocation data, with specific locations (like medical facilities). The companies sell the data to any interested party. Some articles are alarmist, and others are more neutral. It is an interesting contrast.
A neutral article
https://techcrunch.com/2021/03/16/safegraph-series-b/
Articles that convey concern:
https://www.vice.com/en/article/m7vzjb/location-data-abortion-clinics-safegraph-planned-parenthood
CDC is one purchaser of this data.
https://www.vice.com/en/article/m7vymn/cdc-tracked-phones-location-data-curfews
Clean hands and sharp minds, team
Adam
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