Week of December 12, 2022
Our oldest son started getting college acceptance letters last week. Thanks to being a doctor, I often think of aging (from birth to old age) as a "parabola of decrepitude" - an ascent up of functional gains until some peak and then a decline. The problem is, for much of life, you don't know when you peak; you only notice the descent. (Moments of clarity like, "I used to not spill on myself while eating" or "I recently started making weird grunting noises when sitting down.") But some peaks you recognize, and my son getting into college certainly feels like one. Moreover, I need to rethink my assumptions - my current parabolic model seems flawed in describing what comes next.
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COVID cases, hospitalizations, and death rates are rising rapidly (25-50% increases over the last 14 days).
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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The CDC weekly round-up reviews the data on paxlovid. "In a new CDC study, adults who were prescribed Paxlovid for mild to moderate COVID-19 were over 50% less likely to be hospitalized with COVID-19. CDC researchers assessed electronic health record data and found that receiving Paxlovid was associated with a lower overall hospitalization rate across age groups, whether they were vaccinated or not. Paxlovid is recommended for people who are more likely to get very sick and hospitalized with COVID-19, especially older adults and those with multiple medical conditions, regardless of vaccination status." https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
Vaccination, masking, and ventilation are still the key to reducing the spread of COVID, flu, RSV, and other illnesses (like measles!). Dr. Jeremy Faust interviewed air quality researcher Joseph Allen (https://twitter.com/j_g_allen) about all things ventilation, filtration, and CO2 monitoring. It is an excellent review of how to decrease risk during group gatherings.
https://insidemedicine.substack.com/p/voices-dr-joseph-allen-on-indoor
A meta-analysis (with all the limitations these bring) recently demonstrated that "COVID-19 vaccination both before and after having COVID-19 significantly decreased post–COVID-19 [syndrome] for the circulating variants during the study period although vaccine effectiveness [at preventing long COVID] was low." These data are helpful, but many questions persist - who is at the highest risk, and is there any difference in immunocompromised individuals? Is there any improved protection from long-COVID in people with multiple boosters or between when the time from the last vaccine dose and infection is shorter?
https://www.cambridge.org/core/journals/antimicrobial-stewardship-and-healthcare-epidemiology/article/effectiveness-of-coronavirus-disease-2019-covid19-vaccine-in-the-prevention-of-postcovid19-conditions-a-systematic-literature-review-and-metaanalysis/0AD0EDEC8C9CC9DF455752E32D73147B
and analysis
https://www.medscape.com/viewarticle/985222
The New York City health department is suggesting a return to indoor masking.
https://twitter.com/DrEricDing/status/1601286509289578496
Dr. Perry Wilson offers a fantastic review of how to think through clinical evidence. He walks step-by-step through data suggesting that ursodeoxycholic acid (UDCA) (an older, generic drug typically used in dissolving gallstones in people with bile production or elimination problems) is a potential treatment for COVID.
https://www.mdedge.com/internalmedicine/article/260003/covid-19-updates/how-cheap-liver-drug-may-be-key-preventing-covid
based on this Nature article
https://www.nature.com/articles/s41586-022-05594-0
Medical Trends and Technology
One of the most sought-after treatments in medicine is pills for weight loss. Though the first versions are injectable medications (rather than oral), they are safe and effective. Dr. Eric Topol wrote an excellent review of GIP and GLP-1 drugs used for weight reduction. He covers the intersection of science, equitable healthcare, and economics.
https://erictopol.substack.com/p/the-new-obesity-breakthrough-drugs
Infographics
I would have liked to have been in the room in 2014 when someone pitched the idea for this article and graphic to the consumer-facing University of Pittsburgh Medical Center (UPMC) magazine editors.
Author: "How about we write about the actual trauma that could be inflicted by Kevin McAllister's traps in the movie Home Alone?"
Editor: "That is a great idea. There are zero issues in helping our readers optomize injury with readily available tools and supplies at home. Can you include an infographic?"
Here is Home Alone: The Truth Behind the Booby Traps
https://share-cdn-prod.azureedge.net/wp-content/uploads/2014/12/HomeAlone.png.webp
from https://share.upmc.com/2014/12/home-alone-truth-behind-booby-traps/
Topics from the newsletter through the "eyes" of our A.I. Overlords!
(What is this section? - https://openai.com/dall-e-2/)
"Krampus eating a cheese steak sandwich and holding a beer in a lawn chair."
https://labs.openai.com/s/BhmDbWDWxtNCVG3ZSmaILmSV
By the way, A.I. image generation tech can now easily create life-wrecking deep-fakes.
https://arstechnica.com/information-technology/2022/12/thanks-to-ai-its-probably-time-to-take-your-photos-off-the-internet/
Things I learned this week
Twitter Explorations
Irrespective of your opinion of the Federal government, several agencies have surprisingly entertaining social media managers.
• U.S. Fish and Wildlife unilaterally declares cardinals as "the best holiday season bird" and shuts down discussion. USFAW is light and pro-nature.
https://twitter.com/usfws/status/1601321117586784260
• The U.S. Consumer Product Safety Commission is the most consistently funny-weird. It is a fine example of post-modern snark applied to home safety. Here, CPSC suggests holding press conferences with inanimate objects in front of a podium and then doing a hidden voice-over to discuss ladder safety.
https://twitter.com/USCPSC/status/1600168956982984704
• And while not intentionally funny, you can see where @AskTSA is a door to all sorts of unironic and intriguing questions, such as, "Can I pack a flare gun for a flight?" Unfortunately, they are a bit too earnest and miss the best deadpan opportunities for a response like "Why?"
https://twitter.com/AskTSA/status/1596937126305734656
• Sadly, none of these compare to the surprisingly thought-provoking Steak-umm account. But different missions and different content? (I do not know frozen sheets of beef could be so wise.)
https://twitter.com/steak_umm
I am a fan of low-key gonzo journalism. And I am a sucker for any article that combines Milwaukee, the Austrian Christmas season goat demon Krampus, and the opening line, "It's the first time I'm wearing the dog muzzle in public." Atlas Obscura writer Gemma Tarlach is all in on reporting about Milwaukee's 5th Annual Krampusnacht - a celebration of the scarier characters of 16th-century European Christmas.
https://www.atlasobscura.com/articles/what-is-krampus
Clean hands and sharp minds,
Adam
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