Week of October 24, 2022
One of my long-term patients, Mr. A, passed away last week. He had no close relatives. A social worker from the county, who helped him for many years, asked me to stop by his house and select an item by which to remember him. Typical of my rural patients, Mr. A could do anything - he built his house by hand, built and flew airplanes, and repaired engines. He also painted. Amongst the piles of books, tools, and a lifetime of possessions, I chose to take one of his landscape paintings - an acrylic of the New Mexico desert at sunset, where he drove frequently. It is often challenging to see beyond the labs and office notes to the complexity and nuance of my patients' lives. The New Mexico desert painting is a fantastic reminder of how much there is to explore.
See the painting: https://bit.ly/3z3P3Vu
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N.Y. Times Tracker
https://www.nytimes.com/interactive/2021/us/covid-cases.html
Financial Times Data
https://ig.ft.com/coronavirus-chart/?areas=eur&areas=usa&areas=e92000001&areasRegional=usny&areasRegional=usnm&areasRegional=uspr&areasRegional=usaz&areasRegional=usfl&areasRegional=usnd&cumulative=0&logScale=0&per100K=1&startDate=2021-09-01&values=deaths
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Please get your updated boosters.
Data from a study of essential frontline workers in six U.S. states suggests that fully vaccinated and boosted individuals had significantly milder infections and lower viral loads than their unvaccinated peers:
from
https://www.cidrap.umn.edu/news-perspective/2022/10/study-milder-covid-cases-lower-viral-loads-vaccinated-frontline-workers
and
https://jamanetwork.com/journals/jama/fullarticle/2797418
The Daily Beast did an excellent job summarizing the latest information on Omicron variants like BQ.1.1 and XBB. "The bivalent boosters should work pretty well against forms of the virus that are closely related to BA.5, including [BQ.1.1 and XBB].
https://www.thedailybeast.com/the-nightmare-xbb-covid-variant-that-beats-our-immunity-is-finally-here?source=articles&via=twitter_page
The FDA and CDC granted an EUA for Novavax, the coronavirus sub-protein (non-mRNA) vaccine. Adults aged 18 years or older who are at least six months out from receiving an initial two-dose series of the Novavax vaccine or one of the two mRNA vaccines are approved for this vaccine. However, it is NOT yet approved for those who have received at least one previous COVID-19 booster shot."
https://www.healio.com/news/infectious-disease/20221020/us-gives-nod-to-novavaxs-covid19-booster-as-alternative-to-mrna-shots
Because Novavax is a protein (and not anti-spike mRNA) vaccine, Novavax may offer a broader array of antibodies as a third shot- the first booster after the initial two-shot series of any vaccine. It is unclear how much benefit there is for those with 1 or 2 mRNA boosters.
https://www.yalemedicine.org/news/novavax-covid-vaccine
Medical Trends and Technology
The use of predictive models is essential in population health. Models designed to find subsets of patients who are "high risk" [for some health event] and preemptively offering that target group some intense care designed to avoid severe and costly health outcomes. For instance, a known association exists between a patient's ability (or inability) to get up and walk and the likelihood of dying in the next 1- or five years. Measuring this takes time, a deliberate effort by clinicians, and is not always easy to address in a typical medical setting. Researchers have been focusing on using data from cell phones (motion sensors) and step-measurement devices (like Fitbit) to see if this data can mimic the known formal testing and allow for the same early identification of at-risk patients. Several articles discuss this "passively collected" movement data and how well it predicts mortality.
Sensational Clickbait Version: "Scientists Found a Way to Predict Your Death by How You Walk"
https://www.thedailybeast.com/scientists-found-a-way-to-predict-your-death-by-how-you-walk
Actual Journal Articles:
Using Fitbit-like data - Objective measures of physical activity derived from wrist-worn accelerometers compared with traditional risk factors in terms of mortality prediction performance in the U.K. Biobank.
https://academic.oup.com/biomedgerontology/article/76/8/1486/5916368
Cell phone movement data - Predictive models from passive monitors using motion sensors for 100,000 UK Biobank participants
https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0000045
Here is the takeaway - correlations between risk factors (like a diminished ability to move) and events (like death) can be scary. Still, any individual's actual health trajectory is hard to know. These are not perfect correlations and do not give a lot of information in any one case. Ideally, a good relationship with a doctor who addresses modifiable risk factors is the best we can do. And keep in mind that a plethora of known protective correlations can address those risk factors. For instance, moderate aerobic movement and weight lifting may extend life:
https://www.cnn.com/2022/10/17/health/strength-training-live-longer-wellness/index.html
Infographics
Gummy Bear genetics makes me smile
https://www.sciencealert.com/images/2021-01/gummy_bear_genetics_colour_corrected_body_2.jpg
from
https://www.sciencealert.com/gummy-bear-inheritance-is-definitely-the-yummiest-way-to-learn-genetics
Topics from the newsletter through the "eyes" of our A.I. Overlords!
(What is this section? - https://openai.com/dall-e-2/)
"Gummy Bear administering a vaccine to another gummy bear"
https://labs.openai.com/s/5v3MapueHYOeKrR2xsb8eRCJ
and
"Gummy Bear administering a vaccine to another gummy bear in the New Mexico desert at sunset"
https://labs.openai.com/s/zIa7P3q8BOu3fSxLjIunB23s
Things I learned this week
Lots of controversies.
Daylight savings time continues to be a controversial issue. However, amongst the myriad of topics discussed by those running for office, there is a deafening silence on our annual lost hour. To be sure, I saw no mention of this in any senatorial debate. Maybe the onset of "falling back" an hour on November 6 will highlight this issue for our November 8th midterm elections.
https://www.sleepfoundation.org/sleep-news/latest-updates-daylight-saving-time-legislation-change
But be wary - sleep is both essential for health and a time for manipulating memories (apparently).
"Association of sleep duration at age 50, 60, and 70 years with risk of multimorbidity in the U.K."
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004109
"Specific memories can be erased while you sleep."
https://www.york.ac.uk/news-and-events/news/2022/research/sound-sleep-memory/
At a family wedding, a cousin mentioned some rabbit holes of religious history that were too interesting not to explore. I learned that Reindeer urine, ancient religions, and the hallucinogenic mushroom Amanita muscaria might be the cultural progenitor of Christmas.
Consumer-friendly article on this topic:
https://www.theguardian.com/science/blog/2017/dec/21/we-need-to-talk-about-rudolph-sex-drugs-and-aerodynamic-reindeer
A book on the subject is more controversial (read the Good Reads reviews for a slew of criticism and discussion).
https://www.goodreads.com/en/book/show/368632.The_Sacred_Mushroom_and_the_Cross
Clean hands and sharp minds,
Adam
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