Giving a lecture at @NYUStern tonight and students were asked to submit questions. A theme has emerged: "How do you get people who are emotionally exhausted by coronavirus to take precautions seriously?"
A few thoughts: 1/
If you really want to engage someone, you have to know their point of view. For me, this means going down some truly gnarly rabbit holes of misinformation. (I know the case against masks inside and out). Occasionally, I hit on something interesting. This happened the other day...
...when a staff writer from the @NewYorker pushed me on the origins of coronavirus. I've trapped bats with some of the scientists featured in "Spillover" by @DavidQuammen and for most of this year, I have been of the opinion that #coronavirus leapt from animal to man.
After the interview, I did some digging & discovered how porous my spillover argument really was. There's more than a two-decade evolutionary gap between the closest bat virus and SARS-CoV-2. We've focused on bats and civets, but the true animal reservoir remains a mystery.
A top scientist, David Relman, summarized the problem: "We need to identify the immediate parent(s) of SARS-CoV-2, and they’re missing." He's called for an investigation to determine what really happened: Spillover? Lab accident? Something intentional? The truth is we don't know.
You can find his argument, and why the spillover explanation doesn't quite work, here: pnas.org/content/117/47…
I haven't become a conspiracy theorist (yet!) but I am mostly grateful for those who push me on my beliefs. I answer the origin story differently now.
The challenge for these students, and for all of us, is to figure out what challenges are worthy of our attention.

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More from @DrMattMcCarthy

4 Dec
COVID Question: Will vaccination be a yearly thing? Maybe. After the rollout, we'll do surveillance to determine: 1) How long protection lasts and 2) If mass inoculation causes coronavirus to mutate.
It's an RNA virus, and replication is often sloppy, so it could change. 1/
We don't yet know if #coronavirus will behave more like measles or influenza. Both are RNA viruses, but they require vastly different vaccination strategies. Most people are protected from measles by childhood shots; by contrast, influenza requires yearly vaccination. 2/
The difference has to do with how these viruses mutate. Measles has one serotype; influenza has several.  3/
Read 5 tweets
4 Dec
Vaccine Dilemma: When should volunteers who received placebo get the real thing? If vaccines are highly effective, it seems unethical to withhold inoculation from people who bravely volunteered for a study. But that’s what some researchers want. 1/
mRNA vaccines are reportedly 95% effective, but it’s possible that number will degrade over time. Allowing volunteers to cross over from placebo to vaccine unblinds these trial and ends the collection of randomized data.
That prevents us from learning crucial information... 2/
...about the degradation of vaccine efficacy, durability of protection, and long-term safety data. Some argue that volunteers who received placebo should be among the LAST to get vaccinated.
This preserves the integrity of ongoing trials. 3/
nejm.org/doi/full/10.10…
Read 5 tweets
3 Dec
Question today: A man develops a fever and is diagnosed with #COVID19. How long should his wife quarantine?
After her initial exposure, she is careful to stay six feet away from him, but they live in a small(ish) apartment. 1/
Until recently, the recommendation was for her to quarantine for 14 days. But the CDC just changed guidance and now indicates that 7 days (with a negative test) or 10 days (no test) is also sufficient.
But is it?
Roughly 97.5% of patients will develop symptoms 11.5 days after exposure, so the new recommendation is good, but not airtight. And not all exposures are alike; she lives with the guy. Letting her out of quarantine after 10 days with no test seems unwise and potentially dangerous.
Read 5 tweets
1 Dec
During a #COVID19 lecture, I often get this question: “How do we reach herd immunity when there’s so much vaccine skepticism?” The number willing to be vaccinated appears well below the target threshold (~70%) to get back to normal life.
Here’s what I say: 1/
First, I try to meet skeptics where they’re at. That begins by acknowledging a few things:
1. The National Vaccine Injury Compensation Program exists for a reason.
2. The leading #COVID vaccine platforms are new and we don’t have long-term safety data.
3. Emergency authorization will likely curb manufacturer liability.
4. Vaccines have been rushed in the past (influenza, 1976) & the result wasn't good.
5. We don’t know how long protection will last or whether the shot will be a yearly thing (jury’s still out on antigenic drift)
Read 9 tweets
30 Nov
Here's an advance that would mean a great deal to the more than 30 million American adults with hearing impairment: the FDA must establish a new class of over-the-counter hearing aids.
Masks and social distancing can be a challenge for those with hearing loss & aids are often 1/
prohibitively expensive and not covered by insurance. In 2017, the bipartisan Over-the-Counter Hearing Aid Act gave the FDA 3 years to propose regulations governing over-the-counter hearing aids but the pandemic derailed the timeline. A statutory deadline was missed in August. 2/
The FDA has a lot on its plate but this story should not get lost in the shuffle. It is a straightforward process that could improve the lives of millions.
Over-the-counter hearing aids are already available in other countries.
nidcd.nih.gov/health/over-co…
Read 4 tweets
28 Nov
Vitamin D is in the news today because: 1) England is giving it out for free and 2) This article minimizes its role in the pandemic. But there are some very smart people who think it is not just important for #COVID19 but essential. Here's how the argument was presented to me: 1/
Many of the chronic diseases identified as #COVID19 risk factors (high blood pressure, diabetes) are potentially associated with vitamin D deficiency.
pubmed.ncbi.nlm.nih.gov/20031348/
D deficiency is associated with increased risk for some respiratory infections. In one study, people with low levels were more likely to have had a respiratory infection in the month before having their blood drawn compared to people with normal levels.  
pubmed.ncbi.nlm.nih.gov/25781219/
Read 8 tweets

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