Week of September 19, 2022
Seeing patients this week was marked by an unusually high number of complex situations - several patients soon to be on dialysis or who needed end-of-life conversations. Squeezing these emotionally and logistically dense topics into back-to-back scheduled time blocks is taxing. My end-of-the-day weariness must have been showing. Following one detailed discussion, the patient paused and said, "But, how are you doing?"
---
In the U.S., COVID case rates, hospitalizations, and deaths are declining in almost all states. On average last week, 465 people died daily, with 32,000 hospitalized patients.
N.Y. Times Tracker
https://www.nytimes.com/interactive/2021/us/covid-cases.html
Dr. Jonathan Reiner sums up my ongoing distress - "I don't understand how 3,000 COVID deaths per week is consistent with being at the end of the pandemic. Seems like we're adjusting to dying with the virus. We've become death blind."
https://twitter.com/JReinerMD/status/1570937698302689280?s=20&t=buWIlYjPPIRdPoX5NbDWmg
------
The CDC published data on getting both the bivalent COVID vaccine booster and the 2022/2023 flu vaccine. CDC data "suggests people who [receive] a flu vaccine and an mRNA COVID-19 booster at the same time were slightly more likely (8% to 11%) to report [temporary] reactions like fatigue, headache, and muscle ache than people who received only the COVID-19 booster."
STAT News highlighted some considerations on the timing of receiving the flu vaccine. Unfortunately, trying to time the flu vaccine strategically may lead to missing it for some patients. But getting the flu vaccine too early may limit its effectiveness during a late flu peak (in February/March).
https://www.statnews.com/2022/09/09/doubling-up-on-covid-booster-flu-shot-may-have-downside/
The COVID vaccine's effectiveness in mitigating severe illness is remarkable. JAMA published a study from more than 250 hospitals in the COVID-19–Associated Hospitalization Surveillance Network, reviewing close to 200,000 hospitalizations. "From January 2022 to April 2022...COVID-associated hospitalization rates were 10.5 times higher in unvaccinated persons and 2.5 times higher in vaccinated [but unboosted] persons compared with those who had received a booster."
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2796235
Austrian molecular biologist Ulrich Elling shared a thoughtful thread on how the coronavirus continues to evolve and how our immune system responds.
https://twitter.com/EllingUlrich/status/1571051885506985984
Medical Trends and Technology
I am increasingly intrigued by the microbiome - a mix of data suggests weight, mental health, eating behaviors, and some autoimmune disorders are related to the distribution and types of bacteria in a person's gut. However, there are many unknowns - can you alter the bacterial equilibrium? If so, what do you replace? What are the downstream consequences? Here is a series of interesting articles I found in the last few weeks:
A well-written LA Times layman's overview of microbiome data:
https://www.latimes.com/california/newsletter/2022-09-13/group-therapy-mind-gut-connection-group-therapy
WebMD reviewed the work of nonprofit OpenBiome - striving to understand and research what differences in the microbiome mean - from diagnosis to broader prognosis across a range of illnesses.
https://www.webmd.com/digestive-disorders/news/20220913/poop-may-hold-secret-long-life
There is some data on treating obesity with microbiome transplants. "With the potential for negative side effects, the use of FMT for conditions other than recurrent C. difficile infections is ill-advised at this current time. However, the evidence from studies showing remedial effects such as weight loss and better glycemic control are promising and beg the need for further research into the role of FMT in the pathophysiology of metabolic syndrome."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693552/
There are examples of unanswered questions about the microbiome in kidney diseases. The immune dysregulation of IgA nephropathy - a widespread autoimmune kidney disease - may be linked to the gut. If you read the discussion section, you can see just how complex this topic is.
https://kidney360.asnjournals.org/content/2/8/1261
Infographics!
The pleural of fish: A YouTube moving infographic
https://www.woodwardenglish.com/lesson/plural-of-fish-fish-or-fishes/
Things I learned this week
The mapping of human history to linguistics is fascinating. I found a series of Tweets discussing the controversies of click languages. Though not universally recognized, some linguists view these languages as the oldest examples of human speech.
https://twitter.com/incunabula/status/1571460103013908480
I have driven a plug-in hybrid vehicle since 2015. I am only NOW starting to see articles highlighting the etiquette of charging your EV car - like "don't unplug another car."
https://thenextweb.com/news/yes-there-is-ev-charging-etiquette-so-listen-up
I have yet to see my dream of magnetic dry-erase notes used for unattended EV cars. It would be ideal for letting others know when your car started charging and when it is OK to remove the charger from your vehicle.
Clean hands and sharp minds,
Adam
Comments
Post a Comment