Week of March 4, 2024
For the third time in 3 years, I had COVID last week. Thankfully, symptoms were minor - limited to some congestion and fatigue. Our household contagion control efforts (sleeping in separate bedrooms, eating alone in a room with open windows, and being confined to my open-windowed office) felt worse than the illness this time - like an invisible "Cone of Shame." Of course, the most concerning aspect of coronavirus is the potential for long-term health effects (like heart, lung, and brain damage) - even with mild cases. But, as my son pointed out, how do you know if you lose five or ten I.Q. points?
(P.S. I am fine now, testing negative by day eight, and symptom-free.)
I feel newfound solidarity with medically-afflicted pets!
https://www.sydney.edu.au/news-opinion/news/2020/03/13/the-cone-of-shame-makes-pets-miserable.html
And while I may not have long COVID, the data on cognitive disturbances is concerning.
https://erictopol.substack.com/p/long-covid-and-cognitive-deficits
and
https://twitter.com/zalaly/status/1763941638479528367
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Wastewater levels suggest that case rates will decline again over the next two weeks. Hospitalization rates continue to be lower, reflecting the lower wastewater concentrations over the last few weeks.
The Pandemic Mitigation Collaborative (PMC) website uses wastewater levels to forecast 4-week predictions of COVID rates.
based upon https://biobot.io/data/
The N.Y. Times COVID Tracker reflects only CDC-gathered hospital data. Hospitalization data are a (lagging) indicator.
https://www.nytimes.com/interactive/2023/us/covid-cases.html
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COVID articles
The CDC published two announcements last week:
1) Individuals 65 and older should receive a SECOND dose of the fall 2023 XBB COVID booster in the spring.
2) Infected but symptom-free individuals can return to daily activities sooner than the (previously) recommended five days of isolation. Thus, if someone has been fever-free for 24 hours and other symptoms are improving, they can leave isolation. And those without symptoms or fever would never be isolated, even while testing positive. While the CDC still recommends using masks and "added precautions," the new advice is nuanced. Media and others are anchoring on the shortened duration of isolation based on symptoms alone.
Those of us who care for chronically ill, immunosuppressed, and elderly patients are very concerned about the new isolation recommendations. The New Republic offered a good summary of the concerns (some of which I paraphrased above). To reduce the likelihood of spread, I encourage my patients to isolate while symptomatic and still test positive and mask for 9-11 days from the onset of symptoms if still testing positive.
CDC guidelines
https://www.cdc.gov/respiratory-viruses/prevention/precautions-when-sick.html
Article discussing the challenges of navigating the new CDC guidelines.
https://newrepublic.com/article/179304/covid-cdc-guidelines-isolation-symptoms
Data from the last few years indicates the trend of transmissible viral shedding over a 15-day time window.
https://twitter.com/ejustin46/status/1764168425805345140
and
https://www.nature.com/articles/s41579-022-00822-w
Diluted iodine nasal sprays and aerosols are anecdotally valuable for killing many bacteria and viruses. I have previously commented on the one limited study looking at Iota-Carrrageenan successfully preventing COVID in healthcare workers with known exposure to COVID+ individuals. This week (thanks to science journalist Chris Turnbull), I found a 2023 study looking at the speed, mechanism, and efficacy of iodine-based viricidal agents. The data indicate aerosolized iodine is highly efficacious at killing infectious organisms. Given the limited risks, I think iodinated nasal sprays offer another layer of protection, especially for travel and exposure to other densely populated environments with poor ventilation. While the study below discusses using aerosolized iodine to decrease pathogens in an entire room, the described mechanisms apply to various iodinated nasal sprays.
https://x.com/enemyinastate/status/1763322395203346590
and
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0279027
Per my opening - here is a discussion about the observed impact of COVID on the brain.
https://x.com/DaniBeckman/status/1763523807648886898
Medical Trends and Technology
More data indicates that cannabis use (independent of tobacco use) may be a dose-dependent, independent risk factor for cardiovascular disease. This study is not perfect, but I am less and less confident that routinely using inhaled cannabis products is safe. It is unclear if this is related to inhaling burning organic materials or more related to any ingestion of THC. In other words, this study does not clarify if edibles are safer.
https://www.ahajournals.org/doi/full/10.1161/JAHA.123.030178
and
https://www.medscape.com/viewarticle/cannabis-use-tied-increased-cardiovascular-risk-2024a10003yr
The FDA is now using A.I. tools to parse the large volume of adverse event reports received each year.
What's more interesting is how the MedPage Today article below (my first point of entry into this topic) paints the FDA as "behind the wave" of clinically useful A.I. tools. I think it is hard to know just how useful many of the A.I.-driven tools are and that the FDA is quite as behind as the article implies.
https://www.medpagetoday.com/special-reports/features/108954
Infographics
February 26 was the birthday of Nobel Prize winner Ahmed Zewail, a chemist who used lasers to capture the speed and nature of chemical reactions (which happen in femtosecond (10^-15) time-frame). I note that there are one quadrillion femtoseconds in the 1 second it takes to say "femtosecond."
https://twitter.com/compoundchem/status/1762163328611176869/photo/1
and
https://www.nobelprize.org/prizes/chemistry/1999/zewail/facts/
Things I learned this week
People who use foul language (aka those with greater "taboo word fluency") tend to be more articulate and have a more extensive vocabulary. Or, as the study authors put it, "Overall, the findings suggest that, with the exception of female-sex-related slurs, taboo expressives and general pejoratives comprise the core of the category of taboo words while slurs tend to occupy the periphery, and the ability to generate taboo language is not an index of overall language poverty." This study supports striving to be a more thorough "taboo word" user. (f$# yeah!)
https://www.sciencedirect.com/science/article/abs/pii/S038800011400151X
I learned that ketchup has a pressure-dependent viscosity. Heinz has spent millions of dollars re-engineering a squeezable bottle cap to achieve function, sustainability, and customer experience. As such, the new cap had 1) cleanly dispenses the appropriate volume of ketchup (across the viscosity range of the product) and 2) be made of a single type of plastic (older caps had non-recyclable silicone valves). Lumafield, a design engineering company using C.T. scanning to enhance products and packaging, highlights its Heinz case study. While I know nothing about this industry, the extent of thought and energy put into something as mundane as ketchup bottle caps is striking.
https://www.lumafield.com/article/heinzs-sustainable-ketchup-cap
I was fascinated by Wendy's announcement of Uber-like surge/demand pricing for their food. The concept drove deep introspection—what magnitude of change in fast food pricing would shape my behavior? One loyal reader (with whom I discussed this) suggested it is all a marketing and engagement tactic. Given Wendy's Twitter account, I could see that.
https://www.cbsnews.com/news/wendys-surge-pricing-dynamic-pricing-uber/
A little more investigation demonstrates that Wendy's has reversed its decision:
https://x.com/trungtphan/status/1764462941775004066?s=42&t=cHtDhpWgAdi0UhIayqsoag
Living with A.I.
Dystopian themes again this week. A.I. feels like an emotional rollercoaster - lots to be excited about while simultaneously watching a real-life mashup of 40+ years of sci-fi.
I believe there is no science fiction — just science fact and not-yet-reality. With that in mind (and I hope I am wrong):
"[A recent paper described execises during which] researchers ran international conflict simulations with five different A.I.s. [They] found that the programs tended to escalate war, sometimes out of nowhere. In several instances, the A.I.s deployed nuclear weapons without warning."
and
https://arxiv.org/pdf/2401.03408.pdf
I vaguely recall several movies that have explored this topic.
OpenAI is partnering with Figure, a startup robotics company, to build "embodied A.I." I look forward to my general-purpose A.I. humanoid. I would suggest that Figure.ai's website might seem less ominous if the link to their roadmap was not labeled "Master Plan."
https://twitter.com/rowancheung/status/1763237918578180165
It may be an excellent time to remind ourselves of Isaac Asimov's "Three Laws of Robotics."
https://webhome.auburn.edu/~vestmon/robotics.html
Here is more upbeat A.I. information - The Journal of the American Medical Association (JAMA) offers a collection of papers, interviews, and studies on the clinical deployment of healthcare A.I.
https://jamanetwork.com/channels/ai
I've made it through one article, "A.I. Developers Should Understand the Risks of Deploying Their Clinical Tools." Dr. Ghassemi (from MIT) discusses (amongst other things) ethical machine learning, automation bias, and overreliance bias.
https://jamanetwork.com/journals/jama/fullarticle/2815046
A.I. art of the week
As Bob Ross says, "There are no mistakes, only happy accidents."
https://www.calm.com/blog/the-10-greatest-bob-ross-quotes-of-all-time
What I prompted: "In the style of Titian, I would like the portrait of a man in Elizabethan costume, but the frilly collar should extend upward like a dog cone protector. Rapid antigen tests should float above the man, and humanoid robots should be in the background bringing ketchup bottles on silver platters."
What I got: https://drive.google.com/file/d/1wY0_Qm6GIoAs9TeJeDdLlpuh453D10V7/view?usp=sharing
Clean hands and sharp minds,
Adam
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