1/ Covid (@UCSF) Chronicles, Day 80
Local update: @UCSFHospitals, just 8 pts, 3 vented, no change from yesterday. In SF, cases still steady at ~20-30/d; and still no new deaths in a week (cumulative cases in Fig). 43 pts in hospitals, up 4 from yest; ICU pts 16, down from 19.
Local update: @UCSFHospitals, just 8 pts, 3 vented, no change from yesterday. In SF, cases still steady at ~20-30/d; and still no new deaths in a week (cumulative cases in Fig). 43 pts in hospitals, up 4 from yest; ICU pts 16, down from 19.
2/ What caught my eye this week:
US cases downtrending a bit (Fig L). It's a little better than it looks, since + test rate is falling faster (Fig R)(ie, some cases due to ↑ testing). But still hotspots, & we’ve not yet seen full effects of reopening & protest-related cases.
US cases downtrending a bit (Fig L). It's a little better than it looks, since + test rate is falling faster (Fig R)(ie, some cases due to ↑ testing). But still hotspots, & we’ve not yet seen full effects of reopening & protest-related cases.
3/ On the other hand, getting worse outside U.S., w/ major surges in South America (mostly Brazil; also Peru, Chile, & Colombia) and India (Fig). Also in Sweden; architect of the widely criticized “herd immunity” plan said he was “reconsidering” approach: bit.ly/3h1eVXl
4/ In other news:
All industries need to balance speed and safety. In matters that pertain to human health, we tend to lean toward safety, because wrong moves can harm or kill people. But in a pandemic, there’s a natural, and correct, inclination to shift the dial toward speed.
All industries need to balance speed and safety. In matters that pertain to human health, we tend to lean toward safety, because wrong moves can harm or kill people. But in a pandemic, there’s a natural, and correct, inclination to shift the dial toward speed.
5/ It would be naïve to believe that this shift would be risk-free. Now we’re seeing the risks. First, an unknown company ("Surgisphere") pitched an improbably huge dataset to researchers, promising answers to Covid questions. Racing for results, they bit. Hook, line & sinker...
6/ This week, two studies published from that dataset (the researchers hadn’t seen the primary data, a huge corner-cutting faux pas) crumbled under scrutiny; the papers were ultimately retracted by two of the world’s top journals: @NEJM and @TheLancet bit.ly/2zWHIMk
7/ To expedite publication, many Covid studies come out in preprints (no peer-review), or press releases, or via leaks. Others w/ very small #'s published in major journals. Motivations mixed: to help patients, sure, but also competition to be 1st, for reasons of fame or fortune.
8/ Moreover, @US_FDA, normally hardwired for safety, cleared 25 antibody tests without serious vetting abc7.ws/3cCuEJ1 FDA has since tightened up, but not before some spurious results caused confusion. There's no Covid-#Theranos yet, but conditions feel ripe for cheating.
9/ Speed IS important, especially re: vaccine. 5 vaccines now fast-tracked to test nyti.ms/2Y9o7QQ. Good, but govt's lack of transparency, disregard for science & failure to engage experts are all causing concerns re process of choosing the winners bit.ly/2XzzJxC
10/ That said, let's hope we find out in the next 6-9 months whether any of these vaccines work and are safe. In this @JAMA_current interview bit.ly/2XB1QMF Tony Fauci describes the big federal investment in capacity-building for vaccine production and distribution.
11/ While people will say we've wasted money if vaccines are duds, this seems like smart investment. The alternative would be to wait until we’re sure which vaccine to bet on, then start ramping up production. That would cause a several-month delay: too costly in lives & dollars.
12/ We still await a game-changing drug. First rigorous study of convalescent plasma finds no benefit bit.ly/375gDCw But you wouldn’t have known it from last week’s @60Minutes “Promise of Plasma” puff piece: all schmaltz, no data. Great critique: bit.ly/2XEg2F0
13/ A study of hydroxycholoquine (HCQ) for prophylaxis also found no benefit bit.ly/2UfeVt2 Not a perfect study – it used symptoms of Covid as the diagnostic criteria, which means that many patients deemed to have Covid in the study didn’t actually have it….
14/ But, as my soon-to-be @UCSF colleague @VPrasadMDMPH argued, that would bias the study to favor HCQ bit.ly/3eU4HGn Even if cardiac risk is overstated in now-retracted Lancet study bit.ly/2UdDDdx, still no reason for anyone to use HCQ to treat/prevent Covid.
15/ Another fine piece @edyong209 on “long-haulers”: Covid pts who stay ill for mnths bit.ly/2BuuJBF Because MDs don’t understand cause, pts often tagged as being anxious/stressed. I’ve heard of similar cases & they seem very credible. We need to learn more. @TheAtlantic
16/ So add long-haulers to the list of Covid’s clinical surprises, along with the abnormal clotting, vascular injury, multi-system inflammatory syndrome in children (MIS-C), and, of course, the high frequency of asymptomatic disease. Covid continues to teach multitudes.
17/ Question of opening schools & camps remains huge & controversial. I still feel that benefits outweigh risks… if done carefully, w/ masks, distancing, cohorting & testing. My opinion rides on evidence that kids are both unlikely to get sick and to transmit disease to adults.
18/ But this week, we learned of Covid outbreak in Israeli schools: 220 cases, including 150 in 1 school on.ft.com/2MxOnPt This doesn’t change my opinion on opening schools & camps, but it clearly highlights the need to open in the right way, & be willing to close promptly.
19/ Part of the generally awful federal response to Covid (including the fuzzy public health messaging; ie, on masks) is due to the lack of clear and consistent voice (or, in many cases, utter silence) coming from @CDCgov, which usually takes the lead in infectious epidemics.
20/ Terrific @nytimes exposé nyti.ms/3eZhSpL chronicles the CDC’s lame response, due to bureaucracy, poor data & tech, & obstruction from Trump. Knowing many who work there, I'm sure this is brutally painful for them – they’ve spent their career training for a pandemic.
21/ What a gloomy, painful week.
Stay well. Be kind. Back Monday.
Stay well. Be kind. Back Monday.
