Week of July 25, 2022
Despite masks (and the surging case rates), my office hours last week felt pre-pandemic normal. The younger patients are back at work; many patients have resumed travel; even the COVID skeptics are less angry. But, my immunosuppressed and elderly patients are still cautious - many are minimizing social activities and indoor events. In effect, these patients are navigating a society where the collective acceptance of risk is greater than their health allows. I am not sure I have the best answer to this struggle, but I would like to see more discussion about the balance of individual rights vs. collective responsibility.
One article on this topic from April:
https://www.commonwealthfund.org/blog/2022/what-do-we-owe-each-other-balancing-personal-freedom-and-collective-responsibility-age
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Case rates, hospitalizations, and deaths are still rising.
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=eur&areas=usa&areas=twn&areas=nzl&areas=e92000001&areas=fra&areasRegional=usny&areasRegional=usnm&areasRegional=uspr&areasRegional=ushi&areasRegional=usfl&areasRegional=usco&cumulative=0&logScale=1&per100K=0&startDate=2021-06-01&values=deaths
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Forbes offered a succinct analysis of the disconnect between case rates and death with Omicron BA.5. We do not have a complete picture of what is happening due to numerous data collection issues. For instance, positive home antigen test cases are generally not reported. Data on hospitalized patients found to have COVID vs. admissions due to respiratory illness due to COVID is probably confounding the data as well. https://www.forbes.com/sites/roberthart/2022/07/19/ba5-is-driving-a-wave-of-covid-infections-but-not-deaths-heres-why-experts-say-we-should-still-be-cautious/
Dr. Topol offers a Substack blog post that dives deeper into the impact of an evolving virus and the BA.5 variant data.
https://erictopol.substack.com/p/its-the-virus-stupid
Eric Topol also discusses nasal spray-based COVID vaccines on his Twitter feed and in a published editorial in Science Immunology.
https://www.science.org/doi/10.1126/sciimmunol.add9947
and
https://twitter.com/EricTopol/status/1550185795436232704
This week, the CDC approved Novavax's recombinant protein COVID-19 vaccine for adults aged 18 or older. STAT News offered a good summary of the trade-offs of this vaccine.
https://www.statnews.com/2022/07/19/novavaxs-covid-19-vaccine-wins-backing-of-cdc-advisory-panel/
Wired published a good article on the struggle to keep vaccines updated to the latest coronavirus variants. It is remarkable how quickly we can adapt mRNA vaccines, but it does not feel fast enough.
https://www.wired.com/story/the-covid-virus-keeps-evolving-why-havent-vaccines/
Dr. Jeremy Faust interviewed former White House Advisor Dr. Deborah Birx. She helped guide the COVID response during the Trump administration. There are three parts to this interview (among Dr. Faust's other interviews):
https://www.medpagetoday.com/opinion/faustfiles
Random Medical Technologies and Realities
One of the struggles of doctoring is offering manageable concrete suggestions about exercise and diet during a 20 min visit. There are numerous resources for kidney disease patients on low sodium/potassium/phosphorus foods and moderate protein intake. It turns out that encouraging patients to exercise is more challenging - there are often too many variables and not enough time. (How much? How often? What type?). WebMD (free registration required) offered this summary of the data on the value of multiple, intermittent, moderately intense bursts of activity. The notion of "exercise snacks" is catchy and a clear justification for walking meetings and treadmill desks.
https://www.medscape.com/viewarticle/977666
and
https://www.huffpost.com/entry/workout-exercise-snacking_l_62bafdaae4b094be76a86a39
and
Here are the kinds of resources I share with my older patients:
Gentle Strength Workouts with Bob (which is hokey and practical)
https://www.youtube.com/channel/UCAII3voqhJEgoU8boVs7Ubw
Infographics!
The chemistry of frozen desserts.
https://cen.acs.org/articles/95/i29/Periodic-graphics-chemistry-frozen-desserts.html
I don't think I realized fat content AND air are the differences in the spectrum of soft serve to traditional ice cream.
Things I learned this week
Monitoring controlled substance prescriptions reduced the use of narcotics. There is good data and a long history behind why both states and the DEA have controlled substance monitoring programs. Thanks to Malcolm Gladwell's Revisionist History (season 7, episode 3), I learned about the history of prescription monitoring and why California, Idaho, Illinois, Indiana, Michigan, New York, and Texas had 50% less distribution of Oxycontin than other states. Unfortunately, the opioid overdose death rates have not aligned with these Oxycontin distribution rates since the trafficking of synthetic opioids has become more common. Nevertheless, comparing states with and without prescription monitoring around the time Oxycontin came to the market is an interesting, naturally occurring case-control study.
Episode
https://www.pushkin.fm/podcasts/revisionist-history/in-triplicate
and the study
https://www.nber.org/system/files/working_papers/w26500/w26500.pdf
Several published medical studies examine whether using the word "quiet" or being overly upbeat when working at the hospital is associated with an increased volume of emergency room patient visits. Seriously. These are studies looking at superstitions.
https://pubmed.ncbi.nlm.nih.gov/35339973/
and
https://pubmed.ncbi.nlm.nih.gov/31852676/
and
https://pubmed.ncbi.nlm.nih.gov/27936189/
and
https://pubmed.ncbi.nlm.nih.gov/33279295/
Lots of entertaining comments
https://twitter.com/jtrebach/status/1550131892661301248?s=10&t=838G8MVpSyF2liy4QUh58A
Clean hands and sharp minds,
Adam
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