Week of May 23, 2022
One of my chronically ill patients has difficulty maintaining weight due to poor appetite and low blood pressure. In the clinic last week, after months of minimal success with more routine interventions, I suggested he consume milkshakes, cannabis edibles, and high-salt foods. To be sure, the little kidney doctor in my head was screaming at these recommendations. But so much of healthcare is context. Sometimes, the wrong thing is right, and you get to be the doctor recommending a stoner diet.
---- Latest Data
Case rates and hospitalizations are still rising. Death rates are still falling. I wonder if there have been enough vaccinations and prior infections to disconnect death rates from case rates? Probably too early to know for sure.
N.Y. Times Tracker
https://www.nytimes.com/interactive/2021/us/covid-cases.html
The U.K. Office of National Statistics offers a clear set of graphics on hospitalizations, infections, and deaths over time and by age group.
https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19latestinsights/overview
Country Comparison from FT.com
https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&areas=hkg&areas=chn&areas=jpn&areas=aus&areasRegional=usny&areasRegional=usla&areasRegional=usnv&areasRegional=usar&areasRegional=usks&areasRegional=usmo&cumulative=0&logScale=1&per100K=0&startDate=2021-06-01&values=cases
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Brown University published an analysis demonstrating that more than 300,000 (of the 1 million!) deaths due to COVID were likely preventable if those individuals had chosen to receive the vaccine.
https://www.npr.org/sections/health-shots/2022/05/13/1098071284/this-is-how-many-lives-could-have-been-saved-with-covid-vaccinations-in-each-sta
This data was cross-referenced with voting patterns to demonstrate a correlation between political party preference and death rates.
https://www.npr.org/2022/05/19/1098543849/pro-trump-counties-continue-to-suffer-far-higher-covid-death-tolls
In the U.S., political affiliation continues to be a strong predictor of vaccination status and mask usage. (See figures 5 and 6)
https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-april-2022/
Physicians out of Honk Kong published a pre-release retrospective cohort study of patients who received the antivirals Paxlovid or Molnupiravir vs. individuals who did not. "Against Omicron BA.2, initiation of novel oral antiviral treatment in hospitalized patients not requiring any oxygen therapy was associated with lower risks of disease progression and all-cause mortality, in addition to achieving low viral load faster."
https://www.medrxiv.org/content/10.1101/2022.05.19.22275291v1
Analysis with some good discussion and lots of anecdotes:
https://twitter.com/EricTopol/status/1528026709341065217
Take-home message: in hospitalized COVID patients, antivirals are helpful.
I see more articles discussing post-acute sequelae of SARS-CoV-2 infection (PASC) or long COVID. This Nature Medicine review discusses the knowns and unknowns of various post-viral syndromes, including COVID.
https://www.nature.com/articles/s41591-022-01810-6
Eric Topol shared data and links about nasal vaccines against COVID.
https://twitter.com/EricTopol/status/1526600667040690176?s=20&t=aYj8kh7tAOyFLTS9qMtR7w
I am saddened and unsettled to add "monkeypox" to my vocabulary.
Here are the most comprehensive roundups of information and data I have seen so far:
https://insidemedicine.bulletin.com/is-this-monkeypox-strain-more-contagious-what-have-we-learned-and-how-worried-should-we-be
and
https://www.nature.com/articles/d41586-022-01421-8
and
https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385
Random Medical Technology and Realities
This week, I learned about "the club of invisible female doctors on planes." It takes minimal effort to find numerous stories of dismissed, questioned, and ignored female physicians who volunteer to assist in a medical emergency. It is an excellent example of a forcing function (medical crisis on a plane) emphasizing what is often more subtle bias.
https://www.washingtonpost.com/national/health-science/tamika-cross-is-not-the-only-black-doctor-ignored-in-an-airplane-emergency/2016/10/20/3f59ac08-9544-11e6-bc79-af1cd3d2984b_story.html
and
https://feminem.org/2016/09/01/doctor-on-plane/
and
https://www.cbc.ca/radio/sunday/doctors-on-planes-the-end-of-the-world-poet-and-therapist-switch-roles-afghan-ambassador-shinkai-karokhail-1.4026266/for-inflight-medical-emergencies-no-female-doctors-need-apply-michael-s-essay-1.4026270
Infographics!
I discovered a new "edutainment infographics" source. This double contraction of 4 words made me look for the verb form of a portmanteau (portmanteauation? portmanteautication?). It doesn't exist. But the cartoon infographics about sampling bias and the dangers of averaging do:
https://twitter.com/sketchplanator/status/1409175698166763528/photo/1
and
https://twitter.com/sketchplanator/status/1523282595538034694/photo/1
Things I learned this week
Last week, I binged season three of Michael Lewis's podcast Against the Rules. (He is the author of Money Ball and The Blind Side). Lewis offered numerous insights into experts and why experts can be so provocative these days. (Like experts that offer COVID advice?) If you are short on time, start with episodes one (Six Levels Down) and four (Respect the Polygon).
https://www.pushkin.fm/show/against-the-rules-with-michael-lewis/
one follow up
https://www.youtube.com/watch?v=8hDa9CFja1A
The New England Journal of Medicine has a COVID critical care educational game. Dr. Nick Mark wrote a fantastic review:
https://twitter.com/nickmmark/status/1421679170124271617?s=20&t=TIlEVrWt3H0jF6z7PtwTNw
Are you looking to dress as a vegetable for your next costume event? Look no further than 19th-century Italian opera costume designs in the Victoria and Albert Museum collection. The picture descriptions (such as "Leek with face at the top of the foliage, the leaves covering the body from which protrude green hands and arms and legs.") are particularly entertaining.
https://collections.vam.ac.uk/search/?q=Croce,%20P%20costume&page=1&page_size=15
Clean hands and sharp minds,
Adam
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