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kottke.org posts about medicine

Living with Delta

posted by Jason Kottke   Jul 21, 2021

This piece by Susan Matthews is really helpful for those of us who are vaccinated and trying to figure out what their risks are regarding the much more transmissible delta variant of SARS-CoV-2. Covid-19 is endemic now — how do we live with that? What reasonable actions should we take to keep ourselves, our communities, and our loved ones safe?

All of this is making people — yes, probably mostly vaccinated people — rethink the basic questions they thought their vaccine had answered for them: Can I go to restaurants and bars unmasked? Can I go back to the office? Can I see my grandma? Can I go on vacation? Can I unmask at my people-facing job? Can I have a wedding, or a party? The answer to those questions is not quite as easy as “yes, if you’re vaccinated.” It depends partly on how many in your group are vaccinated, but the actual answer is basically the same as it’s been all pandemic: It depends on your risk tolerance, it depends on what is happening with case counts locally (though, as more people travel, this might become a less reliable tool), and it depends on any unique risk factors in your group. Kass’ perspective felt novel to me: She said she suspects that in the end, a lot of people are going to end up boosting their immunity by suffering through a mild case of COVID. So no one should feel that bad about getting sick after they’re vaxxed. What matters is getting the order right: “If everyone who gets vaccinated still gets COVID but doesn’t die, that’s a success,” she said. The issue is that it doesn’t feel like a success for vaccinated people. Plus, “if you get infected after you’re vaxxed, it’s all you talk about,” she said. And right now, that’s understandably freaking out a lot of vaccinated people who thought they were in the clear.

Long Covid isn’t mentioned anywhere in here though — surely that has to be part of the conversation here (although anecdotally it doesn’t seem like too much of a worry).

“It’s Too Late”

posted by Jason Kottke   Jul 21, 2021

Dr. Brytney Cobia treats Covid-19 patients at the Grandview Medical Center in Birmingham, Alabama, a state that ranks last in the US in fully vaccinated adults. In a recent Facebook post, Cobia shares that people are willing to get vaccinated after having to watch an unvaccinated member of their family die from Covid.

I’ve made a LOT of progress encouraging people to get vaccinated lately!!! Do you want to know how? I’m admitting young healthy people to the hospital with very serious COVID infections. One of the last things they do before they’re intubated is beg me for the vaccine. I hold their hand and tell them that I’m sorry, but it’s too late. A few days later when I call time of death, I hug their family members and I tell them the best way to honor their loved one is to go get vaccinated and encourage everyone they know to do the same. They cry. And they tell me they didn’t know. They thought it was a hoax. They thought it was political. They thought because they had a certain blood type or a certain skin color they wouldn’t get as sick. They thought it was ‘just the flu’. But they were wrong. And they wish they could go back. But they can’t. So they thank me and they go get the vaccine. And I go back to my office, write their death note, and say a small prayer that this loss will save more lives.

Heartbreaking.

The US Isn’t Ready for Another Pandemic

posted by Jason Kottke   Jul 02, 2021

Olga Khazan writing for The Atlantic:

After an inept coronavirus response, will the United States do better when the next pandemic strikes? Experts generally agree that America learned from the past year, and that the next public-health crisis won’t be quite as bewildering. But America’s pandemic preparedness still has major gaps, some of which are too big for any one administration to fix. In recent weeks, I’ve called back many of the experts I interviewed over the past 18 months about masks, testing, contact tracing, quarantine, and more. I asked them, “Are we ready for another one?” The short answer is “Not quite.” The long answer is that being truly “ready” will be harder than anyone realizes.

The Trump administration mishandled the American response to Covid-19 so completely that it’s tempting to pin most of the pandemic carnage on him. But the more I read about the pandemic (Michael Lewis’s The Premonition is a recent example), the more I have come to believe that the majority of the American pandemic deaths were baked in, no matter who was President. Trump was definitely a worst-case scenario, but even a more competent person in the White House in Jan 2020 (like Clinton or Sanders or Romney) would not have done so much better. Poor public health infrastructure, politicized government agencies, no mandatory paid leave, an overpriced healthcare system that only works for some, uncoordinated national response (+ federalism), years of defunding government programs, a reactive (rather than proactive) CDC, unhealthy populace, poverty, systemic racism in medicine, entitled individualism, high rate of uninsured people, growing anti-science sentiment — the pandemic was destined to race through the United States like a brush fire no matter what.

Even the European Union, whose member nations do not share many of America’s aforementioned challenges (but have other issues), did only marginally better than the US in preventing Covid deaths. The UK did worse:

a chart showing the cumulative covid deaths per million of the US, UK, EU, and world

Where Did SARS-CoV-2 Come From?

posted by Jason Kottke   Jun 28, 2021

Over the past several months, I’ve read several pieces about the possible origins of SARS-CoV-2 and have been frustrated with the certainty with which folks who should know better have embraced the “lab leak hypothesis”. So, I was happy to see Zeynep Tufekci’s characteristically even-handed and comprehensive overview of the evidence about the virus’s origins in the NY Times.

While the Chinese government’s obstruction may keep us from knowing for sure whether the virus, SARS-CoV-2, came from the wild directly or through a lab in Wuhan or if genetic experimentation was involved, what we know already is troubling.

Years of research on the dangers of coronaviruses, and the broader history of lab accidents and errors around the world, provided scientists with plenty of reasons to proceed with caution as they investigated this class of pathogens. But troubling safety practices persisted.

Worse, researchers’ success at uncovering new threats did not always translate into preparedness.

Even if the coronavirus jumped from animal to human without the involvement of research activities, the groundwork for a potential disaster had been laid for years, and learning its lessons is essential to preventing others.

Is it possible that SARS-CoV-2 came from a lab? Yes. Is it probable? We can’t know that right now. It’s a tantalizing puzzle involving a possible cover-up, but irresponsibly assigning certainty to the situation does no one but attention-seeking pundits any good.

11 Reasons to Keep Wearing a Mask After You’re Vaccinated and the Pandemic is “Over”

posted by Jason Kottke   May 12, 2021

two people wearing face masks

  1. You 100% do not want to get Covid-19.
  2. You are immunocompromised. Millions of people have immune conditions that make contracting Covid-19 much more dangerous for them.
  3. You’re traumatized from “the mental and emotional toll of the last year”.
  4. Because you need to be around people you suspect may not be vaccinated or taking Covid-19 seriously (e.g. as part of your job).
  5. You’re not feeling well and want to make sure to protect others around you.
  6. Because you want to signal to others that you are being safe and thinking of the health and wellness of those around you.
  7. You live in a household with unvaccinated people (kids, for example) and want to make sure to protect them.
  8. Because your personal risk tolerance is lower than other people’s.
  9. You need some time to feel comfortable enough taking your mask off around others after more than a year of that very behavior being dangerous.
  10. Because you want to.
  11. But mostly because it is NONE OF ANYONE’S GODDAMN CONCERN if you choose to keep wearing a mask. Fuck off! Mind your own business!

The Pantone Pee Chart

posted by Jason Kottke   May 11, 2021

chart of 5 gradations of urine color that relate to hydration level

Urine color is an indicator of how hydrated you are and Pantone are the color experts, so of course they’ve teamed up with a Scottish bottled water company to produce a chart with 5 color gradations that help you determine your hydration level. But 10 glasses of water a day?! I’m not sure the science supports that, particularly since we get a lot of our recommended intake from regular food & beverage consumption.

It remains unclear where the “8 x 8” water intake recommendation comes from. Perhaps, this two-liter intake threshold is derived from a misinterpretation of original recommendations offered by the U.S. Food and Nutrition Board in 1945 as well as the 2017 European Food Safety Authority, which states the daily recommended amount of water includes all beverages plus the moisture contained in foods.

This means that the moisture contained in foods, especially fresh fruits, sodas, juices, soups, milk, coffee and, yes, even beer, contributes to this daily recommended water requirement. These guidelines go on to suggest that most of the recommended water content can be accomplished without drinking additional cups of plain water.

(via print)

Case Closed: SARS-CoV-2 Spreads Primarily by Aerosols

posted by Jason Kottke   Apr 16, 2021

In a letter published in The Lancet, a group of scholars argue, with an extensive review of the available evidence, that the primary mode of transmission from human to human of the virus responsible for Covid-19 is via aerosols, not through larger particles called droplets or through fomites (transfer from surfaces). Here are three of their ten reasons why:

Third, asymptomatic or presymptomatic transmission of SARS-CoV-2 from people who are not coughing or sneezing is likely to account for at least a third, and perhaps up to 59%, of all transmission globally and is a key way SARS-CoV-2 has spread around the world, supportive of a predominantly airborne mode of transmission. Direct measurements show that speaking produces thousands of aerosol particles and few large droplets, which supports the airborne route.

Fourth, transmission of SARS-CoV-2 is higher indoors than outdoors and is substantially reduced by indoor ventilation. Both observations support a predominantly airborne route of transmission.

Fifth, nosocomial infections have been documented in health-care organisations, where there have been strict contact-and-droplet precautions and use of personal protective equipment (PPE) designed to protect against droplet but not aerosol exposure.

The letter concludes with a plea by the authors for public health officials to finally embrace this reality: “The public health community should act accordingly and without further delay.”

I can’t believe we’re actually still arguing about this. One of the authors, Jose-Luis Jimenez, wrote this seminal Time magazine piece that provided the smoke analogy that is the mental model I’ve been using to think about potential risks during the pandemic.

When it comes to COVID-19, the evidence overwhelmingly supports aerosol transmission, and there are no strong arguments against it. For example, contact tracing has found that much COVID-19 transmission occurs in close proximity, but that many people who share the same home with an infected person do not get the disease. To understand why, it is useful to use cigarette or vaping smoke (which is also an aerosol) as an analog. Imagine sharing a home with a smoker: if you stood close to the smoker while talking, you would inhale a great deal of smoke. Replace the smoke with virus-containing aerosols, which behave very similarly, and the impact is similar: the closer you are to someone releasing virus-carrying aerosols, the more likely you are to breathe in larger amounts of virus. We know from detailed, rigorous studies that when individuals talk in close proximity, aerosols dominate transmission and droplets are nearly negligible.

Another of the authors, Zeynep Tufekci, has been arguing the case for aerosols (and masks & overdispersion) since early in the pandemic, and she succinctly explained in a Twitter thread how predominantly aerosol transmission fits with the mitigation methods that have really worked around the world:

Airborne transmission unites three things crucial to recognize for effective COVID-19 mitigation: transmission without symptoms (thus aerosols), clusters driving the epidemic (also aerosols) and masks/ventilation indoors being key (hey, also aerosols). This framework is coherent.

Her whole thread is worth a read — like this bit about how other respiratory pathogens are likely spread by aerosols and not droplets (as commonly believed):

Fascinatingly, you search the scientific record high and low, but there really is little to no direct evidence for gravity-sprayed droplets being predominant mode of transmission for respiratory illnesses outside of coughing/sneezing. It’s many… assumptions. Like a tradition.

If any good comes out of the pandemic at all, a better and more useful scientific understanding of how respiratory pathogens are transmitted would be a good start.

Update: One of the authors, Trisha Greenhalgh, responds succinctly to criticisms of the paper in this Twitter thread.

Criticism 1: “The paper is just opinion, and several authors aren’t even doctors.”

Response: No. It’s well-researched scholarly argument, produced by an interdisciplinary team of 6 professors including 3 docs, 2 aerosol scientists and 1 social scientist.

‘The Last Time a Vaccine Saved America’

posted by Jason Kottke   Apr 15, 2021

In 1955, epidemiologist Thomas Francis Jr. announced the results of a field trial of the polio vaccine that Jonas Salk had developed. America erupted in joy.

Now a phalanx of bulky television cameras focussed on Francis as he prepared to report on the efficacy of the vaccine. He had good news to share: to cheers from the audience, he explained that the Salk vaccine was sixty to seventy per cent effective against the most prevalent strain of poliovirus, and ninety per cent effective against the other, less common strains. All this had been shown through what was, at that time, the largest vaccine trial ever conducted.

All afternoon and evening, church bells rang out across America. People flooded into the streets, kissing and embracing; parents hugged their kids with joy and relief. Salk became an instant national hero, turning down the offer of a ticker-tape parade in New York City; President Dwight D. Eisenhower invited him to the White House and, later, asked Congress to award him a Congressional Gold Medal. That night, from the kitchen of a colleague’s house, Salk — whose name was being touted in newspapers, magazines, radio reports, and television news broadcasts around the world — gave his first network-TV interview to Edward R. Murrow, whose show “See It Now” had exposed the tactics of Senator Joseph McCarthy a year earlier. Blushing in admiration, Murrow asked the doctor, “Who owns the patent on this vaccine?” “The people,” Salk said, nobly. “There is no patent. Could you patent the sun?”

In the days that followed, schoolchildren were instructed by their teachers to write thank-you notes to Salk. Universities lined up to offer him honorary degrees. Millions of American doctors, nurses, and parents got down to the serious business of vaccinating their children against polio, using a shot they’d been anticipating for seventeen years.

But the polio vaccine rollout had its challenges, including a manufacturing negligence & oversight failure that resulted in tens of thousands of polio cases in otherwise healthy children.

In May, the polio vaccination drive was temporarily suspended. Leonard Scheele, the U.S. Surgeon General, inspected the facilities of all six vaccine companies and fired the government officials he considered to be culpable; the director of the N.I.H. and the Secretary of Health voluntarily resigned. New safety procedures were developed, including an improved means of filtering the viral mix just before the formaldehyde was added. Better tests were developed to detect live virus, and stricter record-keeping was instituted. The incident could have created a vaccine-hesitancy crisis. But, incredibly, the American public readily accepted the medical establishment’s explanation for the failure, and its pledges to right the situation. The nation’s trust in medical progress and in Dr. Salk was so resolute that, when it was announced that a new, safe polio vaccine was available, parents pushed their children back to the head of the line. It’s hard to imagine such an outcome today.

Katalin Kariko, the Scientist Behind the Groundbreaking mRNA Vaccines

posted by Jason Kottke   Apr 09, 2021

The NY Times has a profile of Dr. Katalin Kariko, who struggled for decades against a system unwilling to consider and fund her ideas about how messenger RNA could be used to instruct cells inside human bodies to “make their own medicines”. Her work has culminated in two highly effective vaccines for Covid-19 and is being extended to produce possible vaccines for HIV, the flu, tuberculosis, and malaria.

Now Katalin Kariko, 66, known to colleagues as Kati, has emerged as one of the heroes of Covid-19 vaccine development. Her work, with her close collaborator, Dr. Drew Weissman of the University of Pennsylvania, laid the foundation for the stunningly successful vaccines made by Pfizer-BioNTech and Moderna.

For her entire career, Dr. Kariko has focused on messenger RNA, or mRNA — the genetic script that carries DNA instructions to each cell’s protein-making machinery. She was convinced mRNA could be used to instruct cells to make their own medicines, including vaccines.

Stat also wrote a piece about Kariko and the development of the mRNA vaccines. It seems like Kariko will be strongly considered for a Nobel Prize in Chemistry for her achievements. The Covid vaccines will save hundreds of thousands of lives alone, and if mRNA can indeed be harnessed to protect against HIV and malaria, the effect on the world will be immense. Give Kariko all the prizes and whatever she wants to be happy in life — she’s earned it and more.

Update: From Derek Thompson at The Atlantic, How mRNA Technology Could Change the World.

But mRNA’s story likely will not end with COVID-19: Its potential stretches far beyond this pandemic. This year, a team at Yale patented a similar RNA-based technology to vaccinate against malaria, perhaps the world’s most devastating disease. Because mRNA is so easy to edit, Pfizer says that it is planning to use it against seasonal flu, which mutates constantly and kills hundreds of thousands of people around the world every year. The company that partnered with Pfizer last year, BioNTech, is developing individualized therapies that would create on-demand proteins associated with specific tumors to teach the body to fight off advanced cancer. In mouse trials, synthetic-mRNA therapies have been shown to slow and reverse the effects of multiple sclerosis. “I’m fully convinced now even more than before that mRNA can be broadly transformational,” Özlem Türeci, BioNTech’s chief medical officer, told me. “In principle, everything you can do with protein can be substituted by mRNA.”

Why Comparing Different Covid-19 Vaccines is Difficult

posted by Jason Kottke   Mar 24, 2021

Related to my post from last month about what a 95% or 66% efficacy rate of a vaccine even means, Vox made a clear and concise video about why comparing vaccine efficacy rates is difficult — trials were done in different countries with different variants under different conditions with different levels of disease — and why protection against severe illness, hospitalization and death is a better way to compare and evaluate these vaccines. As this chart from Dr. Eric Topol shows, all of the major vaccines show strong protection against severe illness.

Vaccine Chart Illness

Life After Vaccination

posted by Jason Kottke   Mar 16, 2021

I thought this interview with Dr. Ashish K. Jha, dean of the Brown University School of Public Health, was really good and useful in terms of calibrating expectations with regard to the “end” of the pandemic, vaccines, and variants. On the guidance that vaccinated people should be getting:

I think it is essential that we give guidance to people. And I think we should give guidance to people on what they can do safely once they are vaccinated. People say, “Can your behavior change?” My answer is: absolutely! That’s a major motivation for getting vaccinated. First of all, what’s very clear to me is vaccinated people hanging out with other vaccinated people is pretty darn close to normal. You don’t have to wear a mask. You can share a meal. The chance that a fully vaccinated person will transmit the virus to another fully vaccinated person who then will get sick and die … I mean, sure, people get struck by lightning, too. But you don’t make policy based on that. And we need to remind people that there is a huge benefit to getting vaccinated, which is that you are safe enough to do the things you love with other vaccinated people.

How Were the Covid-19 Vaccines Developed So Quickly?

posted by Jason Kottke   Mar 12, 2021

According to a study conducted by the Pew Research Center, among those people who said they probably or definitely won’t get a Covid-19 vaccine, the top two reasons given were “concern about side effects” and “the vaccines were developed and tested too quickly”. For our purposes here, I’m going to ignore the first concern — the data is pretty conclusive that, on average, the vaccine side effects are minimal when compared to the effects of actually contracting Covid-19 — and focus on the quick development timeline. If you’re among those who are apprehensive about the unprecedented speed at which the world’s governments and scientific community mobilized to create several effective Covid-19 vaccines, I hope the following will help you make a good decision.

In reading a bunch of different resources (linked below throughout), I identified six main reasons why the Covid-19 vaccines were developed so quickly compared to past efforts.

1. The need was urgent. Covid-19 changed the entire world in a very short span of time and it was evident in the absence of an effective vaccine, tens of millions more people would unnecessarily die and/or suffer and the rest of us would be living in fear of disease and death. This urgency drove several of the other factors here: the availability of funding, resources, and collaboration.

2. Funding & focus. Companies and governments threw billions and billions of dollars at this. Companies, research centers, and scientists dropped other stuff they were working on to study SARS-CoV-2 and Covid-19. Governments prioritized regulatory approval for trials, etc. From a thread by Dr. Kat Arney:

Relatively few in the scientific, pharma & policy worlds care about vaccines compared w/ drugs. Most vaccine programmes are underfunded as they’re perceived as not profitable, only relevant to LMICs, & have few research groups/companies working on them. Getting funding & research capacity for vax usually takes months/years. COVID-19 vaccine was a massive global research effort w/ $millions for multiple groups/projects in weeks. Years of funding cycles & lab research happened in months, huge amount of time saved.

And from a presentation given by Dr. Anthony Fauci:

We proceeded at risk. So people say, what do you mean by “at risk”? Are you risking safety? Are you risking scientific integrity? No, it’s a financial risk. In other words, you invest in things that cost a lot of money before you even have an answer to whether the prior step worked.

And a classic example is the production of large scale amounts of clinical lots, which have been produced and are being produced before you even know that your vaccine works, so that you have hundreds of millions of doses ready to go. If the vaccine works, you’ve saved many months. If the vaccine doesn’t, you lost a lot of money, to the tune of hundreds of millions if not billions of dollars. But it was felt it was worth that investment and that risk financially in order to save time.

More on that here. As Dr. Faheem Younus put it, “We didn’t cut corners; we cut the crap!”

3. Availability of volunteers & high incidence of disease. In order to statistically show the vaccine works, you need people to test it on and you need enough people in the studies to get sick. Kat Arney again:

To show vax effectiveness, you need a high number of people with the disease in the population — big problem with the Ebola vax is that it took so long to develop the outbreak was over & the couldn’t get enough numbers to conclusively show it worked

We’re in a global pandemic — the vaccine is being tested in places with very high community prevalence, so trials can hit pre-determined statistical milestones very quickly. Huge amount of time saved.

Hundreds of thousands of people around the world volunteered to test these vaccines — without them, we’d be months and years away from a safe, tested vaccine.

4. International & corporate collaboration. Countries and companies shared research, data, and resources because the primary goal was to develop effective vaccines and save lives, not make a profit. For instance, Chinese researchers posted the genome for SARS-CoV-2 on January 11, 2020, allowing the effort to develop a vaccine to begin.

5. We knew a lot about coronaviruses from previous work. This wasn’t an effort that started from scratch. From Bloomberg:

The Pfizer-BioNTech and Moderna vaccines may seem brand new, but they are the culmination of more than a decade of work that started during the SARS and MERS outbreaks. Vaccines were even developed against MERS but were never needed. Nevertheless, scientists learned a huge amount from working with that virus, which is from the same family as the one that causes Covid-19.

From Dr. Habibul Ahsan:

Really, most of the vaccine platform development work is already done. You just have to do the remaining part, which is adding the right viral antigens to the already-proven platform and making sure it’s safe and effective in humans. Even in just the last five to 10 years, we’ve made big leaps in developing new kinds of vaccine platforms like those being tested for SARS-CoV-2.

6. Scientific and technological capability. Ok, we know a lot about coronaviruses but humanity’s general scientific and technological abilities have never been stronger or more powerful. Again from Bloomberg:

Remember also that technology has evolved rapidly — for example, we’re now about able to sequence the genomes of every mutant version of the virus in less than a day. That helps in speeding up vaccine development.

Dr. Mark Toshner sums up the effort:

However we have collectively now shown that with money no object, some clever and highly motivated people, an unlimited pool of altruistic volunteers, and sensible regulators that we can do amazing things.

Further reading: The lightning-fast quest for COVID vaccines — and what it means for other diseases (Nature), How were researchers able to develop COVID-19 vaccines so quickly? (Univ. of Chicago), The race for the COVID-19 vaccine: A story of innovation and collaboration (Carnall Farrar), COVID-19 vaccines: development, evaluation, approval and monitoring (European Medicines Agency).

What the End of the Pandemic Looks Like

posted by Jason Kottke   Mar 08, 2021

Stat’s Andrew Joseph and Helen Branswell on the short-term, middle-term, and long-term future of the coronavirus in the US. The short-term outlook is dominated by vaccination & variants; some parts of the country will continue to be affected by outbreaks:

Conditions may be ripe for a better summer, however. Vaccine supplies should be flowing more freely, at least in the U.S.; the Biden administration now expects enough vaccine doses in hand for all adults by the end of May. With most vulnerable populations protected, there should be fewer hospitalizations and deaths. And with warmer weather, people can return to outdoor life.

Widespread transmission of the virus could be replaced by more sporadic and localized outbreaks. There’s also growing evidence that vaccines don’t just protect people from getting symptomatic Covid-19, but can reduce transmission.

And in the long-term, well, SARS-CoV-2 will be around for years and even decades to come:

Years from now, SARS-CoV-2 could join the ranks of OC43, 229E, NL63, and HKU1 — the four endemic, seasonal coronaviruses that cause a chunk of common colds every year. Essentially, our immune systems — primed by vaccines, boosters, and previous encounters with the coronavirus — will be ready to knock back SARS-2 when we see it again, potentially blocking an infection or leading to one that causes no symptoms or maybe just the sniffles.

It’s good to read stuff like this — it provides a basis to use when calibrating your optimism or pessimism for future activities and desires.

Learning from the Five Pandemic Mistakes We Keep Making

posted by Jason Kottke   Mar 01, 2021

Zeynep Tufekci has written an important piece for The Atlantic on the mistakes that the media, public health officials, and the public keep making during the pandemic and how we can learn from them. A big one for me is how scientists & other public health officials and agencies communicate their knowledge to the public and how the media interprets and amplifies those messages.

Thus, on January 14, 2020, the WHO stated that there was “no clear evidence of human-to-human transmission.” It should have said, “There is increasing likelihood that human-to-human transmission is taking place, but we haven’t yet proven this, because we have no access to Wuhan, China.” (Cases were already popping up around the world at that point.) Acting as if there was human-to-human transmission during the early weeks of the pandemic would have been wise and preventive.

Later that spring, WHO officials stated that there was “currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection,” producing many articles laden with panic and despair. Instead, it should have said: “We expect the immune system to function against this virus, and to provide some immunity for some period of time, but it is still hard to know specifics because it is so early.”

Similarly, since the vaccines were announced, too many statements have emphasized that we don’t yet know if vaccines prevent transmission. Instead, public-health authorities should have said that we have many reasons to expect, and increasing amounts of data to suggest, that vaccines will blunt infectiousness, but that we’re waiting for additional data to be more precise about it. That’s been unfortunate, because while many, many things have gone wrong during this pandemic, the vaccines are one thing that has gone very, very right.

This pair of statements she highlights — “no clear evidence of human-to-human transmission” and “There is increasing likelihood that human-to-human transmission is taking place, but we haven’t yet proven this, because we have no access to Wuhan, China” — are both factually true but the second statement is so much more helpful, useful, and far less likely to be misinterpreted by people who aren’t scientists that making the first statement is almost negligent.

Inside a Covid ICU, Through a Nurse’s Eyes

posted by Jason Kottke   Mar 01, 2021

A film crew from the NY Times recently spent several days in the Covid-19 ICU in Arizona, at the time one of the hardest hit places in the world. Two of the nurses wore GoPro cameras while working to witness what they did on a daily basis — the 12-hour days, the grief, the care, the constant death. This video is incredible and incredibly difficult to watch — you actually see a patient die on camera, surrounded by nurses and family (virtually).

So many Americans have died in hospitals without family by their side, but they were not alone. Nurses brush patients’ teeth, change their catheters and hold their hands in their final moments.

At the beginning of the video, one of the nurses says, “Unless you’re actually in there, you have no idea.” Thanks to their willingness to share their experiences, now we at least have some idea.

Update: Vox talked to some ICU doctors about what it’s like for their patients when they die from Covid-19. Because of patient confidentiality and the contagious nature of the disease, society (and even the families) has been “protected and sheltered from seeing the worst of this disease”.

Imagine trying to breathe through a very narrow straw, says Jess Mandel, chief of pulmonary, critical care, and sleep medicine at UC San Diego Health. “You can do that for 15 to 20 seconds, but try doing it for two hours.” Or for days or weeks.

Patients struggling through low oxygen levels like this have told Kenneth Remy, an assistant professor of critical care medicine at Washington University School of Medicine in St. Louis, that it feels like a band across their chest or that their lungs are on fire. Or like a thousand bees stinging them inside their chest. Others might have thick secretions in their lungs that make it feel like they are trying to breathe through muck. Many people say it feels like they’re being smothered.

The ordeal is so taxing that many wish for death. “You hear the patients say, ‘I just want to die because this is so excruciating,’” Remy says. “That’s what this virus does.”

Let’s Clear This Up: What Does 95% Covid-19 Vaccine Efficacy Actually Mean?

posted by Jason Kottke   Feb 18, 2021

In popular press and social media, there’s been a misunderstanding of what is actually meant when scientists say that the Pfizer and Moderna Covid-19 vaccines have an efficacy of 94-95%. It does not mean that 95% of vaccinated people are protected from infection — these vaccines are better than that. Dr. Piero Olliaro explains in a letter to The Lancet:

The mRNA-based Pfizer and Moderna vaccines were shown to have 94-95% efficacy in preventing symptomatic COVID-19, calculated as 100 x (1 minus the attack rate with vaccine divided by the attack rate with placebo). It means that in a population such as the one enrolled in the trials, with a cumulated COVID-19 attack rate over a period of 3 months of about 1% without a vaccine, we would expect roughly 0.05% of vaccinated people would get diseased.

Another way to put it: you’re 20 times less likely to get Covid-19 with a vaccine than without. (And again, data indicates these are safe vaccines.) Olliaro explains with some simple math:

If we vaccinated a population of 100,000 and protected 95% of them, that would leave 5000 individuals diseased over 3 months, which is almost the current overall COVID-19 case rate in the UK. Rather, a 95% vaccine efficacy means that instead of 1000 COVID-19 cases in a population of 100,000 without vaccine (from the placebo arm of the abovementioned trials, approximately 1% would be ill with COVID-19 and 99% would not) we would expect 50 cases (99.95% of the population is disease-free, at least for 3 months).

And of course if you vaccinate widely, it becomes a compounding situation because the virus just runs out of people to infect.

Why Are Covid-19 Cases Declining So Quickly in the US?

posted by Jason Kottke   Feb 17, 2021

Over the past week or two, I’ve read a number of articles and threads about why Covid-19 cases are falling so rapidly in the US. The explanations have all been somewhat unsatisfying to me. Cases have indeed dropped off quite quickly and it happened pretty uniformly all over the country. Look at the mini state graphs on the NY Times Covid page — they all look about the same. Hospitalizations and positivity rates have dropped too, so while the number of daily tests has fallen too, this appears to be a real drop and not just an artifact of a lack of testing. Which is great news! Imagine a February and March that looked like December — a disaster compounded.

So what’s going on here? For The Atlantic, Derek Thompson lists four reasons for the decline in cases and hospitalizations that mirror the arguments I’ve seen elsewhere: “social distancing, seasonality, seroprevalence, and shots”.

The vaccine explanation is the weakest one for me: not enough people outside of healthcare workers had gotten them early enough to start bending that curve sharply downward in early January. But as Thompson notes, it could be having more of an effect on hospitalizations because the folks getting shots (and therefore immunity against severe infection) are those most likely to end up in hospitals due to infection. And obviously, vaccines are going to become the dominant factor in falling case numbers as more and more people get jabbed.

I’m also skeptical of the seasonality argument, but (again, as Thompson notes) there’s a lot we don’t know about how temperature, sunlight, humidity, and this specific coronavirus interact. Obviously Covid-19 is a seasonal thing and that’s definitely a contributing factor here, but that sharp of a drop in early January? I don’t know if it’s the primary driver here. Also, the seasonal flu typically peaks in February in the US.

The seroprevalence argument is an interesting one. Here’s Johns Hopkins infectious disease epidemiologist David Dowdy in a great Twitter thread about the US case decline:

I think the most logical explanation is one proposed initially by @mgmgomes1 and others — namely that we are seeing the effects of population immunity with heterogeneous mixing + strong behavioral effects. Take a(n overly) simple example. Assume 60% of a population has zero respiratory contacts, while the other 40% lives life as normal. If 75% of that high-mixing group has immunity (e.g., 30% population seroprevalence), you could easily see herd effects.

Basically, a large percentage of the folks at the greatest risk of getting Covid-19 in the US (i.e. folks who aren’t able or willing to keep from seeing other people and/or take proper precautions) have gotten it, resulting in a sort of localized “herd immunity” among those folks. After the massive holiday surge in cases (more on that in a sec), this hypothesis suggests, the virus started running out of people to infect and rates dropped quickly. This is the first explanation I read that really made sense to me.

Thompson leads off his piece with the behavioral explanation: “Maybe Americans finally got the hang of this mask and social-distancing thing.” I do not buy that people who previously weren’t doing so before suddenly started wearing masks (or better masks), keeping distant, spending less time indoors with others, and staying home from work started doing so in numbers large enough to cause such a sharp downturn. But you can’t consider the decline without also looking at how cases got so high in the first place. Here’s Steven Johnson on Twitter, zooming out a few months:

[It’s] not so much that people got the hang of social distancing, but rather that the holiday season compelled people to relax social distancing for in-person family gatherings. So the current decline is mostly reversion to where we were in Oct-Nov.

Yes, this. Without these holidays, we may have seen much more of a winter plateau than a spike. So here’s what seems plausible to me. As the cold weather made the coronavirus more effective at infection, people gathered for Halloween, Thanksgiving, Hanukkah, Christmas, and New Year’s — each subsequent holiday building on the previous one — and it pushed cases much higher than they would have been without those major gatherings. After two months of massive infection rates, the virus burned itself out among the high-mixing group and everyone else retreated back into their homes and pods to hunker down, resulting in the steep decline we’re seeing.

Obviously, careful scientific study will be necessary to tease out how significant each of these (and other!) causes were to the holiday spike and subsequent decline. But for now, the way forward is continuing to social distance, wear (better) masks, limit close contacts, and get people vaccinated — before B.1.1.7 and the other variants hit.

The American Health Care System Cares Not for Your Health

posted by Jason Kottke   Feb 16, 2021

So, I got a link to this video from a reader and didn’t know anything about it going in, aside from the title (“Chris Finds Out If He Has HIV”) and the reader’s comment (“American health care system”). Here’s the deal — radiologist Dr. Chris Nicholas was accidentally exposed to HIV at work and this video documents a twin journey: 1) he learns way more about HIV/AIDS than he did in medical school while trying to understand what the exposure means for his health, and b) the absolutely maddening battle that he, an actual doctor and very knowledgable & capable patient, has with the absurd “system” of American health care that works to bury people in circuitous phone calls, gotta-be-perfect paperwork, and pass-the-buck bureaucracy to avoid providing necessary medical care. The phone call with the pharmacist at the 27:05 mark would be the height of absurdist humor if it weren’t so infuriating.

If an actual health care professional had to work this hard to get what he needed, what are the chances that someone without his level of knowledge, time, and resources is going to be able to? This whole extractive, regressive system needs to fucking go. (thx, matt)

A Lego-Illustrated Guide to Covid-19 Variants

posted by Jason Kottke   Feb 04, 2021

This guide to Covid-19 variants (SARS-CoV-2 viruses that have evolved changes to meaningfully alter their behavior) by Michaeleen Doucleff and Meredith Rizzo at NPR cleverly visualizes how mutations of the virus’s spike proteins help bind it more easily to ACE2 receptors on human cells. The key to the visualization is Meredith Miotke’s illustrations of the viruses using Lego pieces to represent the virus spikes and cell receptors. The usual SARS-CoV-2 has 1x1 Lego pieces that can bind with 1x2 pieces, like so:

Covid-19 variants illustrated through Lego

But, as everyone who has ever worked with a Lego set knows, a 1x1 piece stuck to a 1x2 piece is not super stable. So when a version of the virus with a 1x2 piece shows up, it’s able to form a better connection to the 1x2 receptor:

Covid-19 variants illustrated through Lego

The analogy breaks down if you look too hard at it1 but for many people, it can be a quick way to get the gist of the mechanism at work here. (via @EricTopol)

  1. This is a huge pet peeve of mine when people try to poke holes in analogies: by definition, all analogies break down if you examine them too deeply. An analogy is a comparison of two different things that are similar in significant respects. If they were the same in every respect, it’s not an analogy…you’d just be describing one thing.

The Covid-19 Vaccines Are Amazing. Let’s Quickly Get Them into People’s Arms.

posted by Jason Kottke   Jan 26, 2021

Moderna Vaccine

You probably read something yesterday, maybe just a headline, about Moderna’s Covid-19 vaccine being “six times less effective” against the B.1.351 coronavirus variant first identified in South Africa. This is, to put it plainly, a bullshit take on what is actually excellent news. This is the important bit, via Stat:

Both the Moderna vaccine and the immunization from Pfizer-BioNTech produce such powerful levels of immune protection — generating higher levels of antibodies on average than people who recover from a Covid-19 infection have — that they should be able to withstand some drop in their potency without really losing their ability to guard people from getting sick.

“There is a very slight, modest diminution in the efficacy of a vaccine against it, but there’s enough cushion with the vaccines that we have that we still consider them to be effective,” Anthony Fauci, the top U.S. infectious diseases official, said Monday on the “Today” show.

Let’s hear that again: “Both the Moderna vaccine and the immunization from Pfizer-BioNTech produce such powerful levels of immune protection…” These vaccines are so good, so potent, that even this sixfold drop in one measure of the vaccines’ ability to neutralize this one SARS-CoV-2 variant isn’t even enough to significantly reduce their overall protective power.1 That’s the important news here, that’s the very good news, that’s what you should be taking away from this. We have miraculously developed a near-perfect medicine for a plague that has significantly disrupted all human life on Earth and we’re flipping out over some technical details that the experts assure us don’t mean much in terms of overall effectiveness?! No thank you. Not today.

In a Twitter thread, Zeynep Tufekci is tearing her hair out because of the media’s misunderstanding and sensationalization of the “sixfold drop”.

I know people are tired but needless anxiety isn’t helping us. Let’s focus on getting through these months — better masks if indoors with others, more strict attention to our precautions — and the real problem: making more of these amazing vaccines quickly & getting them out there!

I get it, we want to understand but not how it works. Stop worrying about Nab titers. That does NOT mean the vaccine is six times less effective. People whose job it is to worry about it are on it & we just got confirmation: it works against the variants.

Plea to media: this isn’t a good headline. It makes people think the vaccine is six times less effective against the new variants (FALSE!) when the news today is *excellent*: The vaccine continues to work well against the new variants. That’s the headline.

For a much more technical take on the efficacy of the vaccines against variants, see virologist Florian Krammer’s long thread. His conclusion:

mRNA vaccines induce very high neutralizing antibodies after the second shot (consistently in the upper 25-30% of what we see with convalescent sera). If that activity is reduced by 10-fold, it is still decent neutralizing activity that will very likely protect. Furthermore, we know that the mRNA vaccines are already protective after the first shot when neutralizing antibody titers are low or undetectable in most individuals.

There is a concern here and it’s that B.1.351 or B.1.1.7 might mutate into variants that are significantly resistant against the vaccines’ good effects. Krammer again:

First, we need to do what every good scientist is praying for a year now: We need to cut down on virus circulation. The more the virus replicates, the more infections there are the higher are the chances for new variants to arise. Also, we need to try and contain B.1.351 and B.1.1.248/P.1 as much as possible.

That’s why, aside from preventing hundreds of thousands of deaths in the next several months, getting these vaccines into people’s arms is so important: the less the virus spreads, the less opportunity it will have to mutate into something even more dangerous. The US vaccination effort is slowly ramping up — we’re at an average of 1.3 million doses per day right now and the trend is heading in the right direction. We can get this done!

So what can you do about this right now? 1. Stop worrying about the variants until the experts let us know we have something to worry about. 2. If you are eligible for the vaccine, get it! 3. Spread the word about vaccine availability in your area. Yesterday Vermont opened signups for vaccination appointments for all Vermonters 75 and older, and I texted/emailed everyone I could think of who was over 75 or who had parents/relatives/friends who are over 75 to urge them to sign up or spread the word. 4. Continue to wear a mask (a better one if possible), wash your hands, social distance, stay home when possible, don’t spend time indoors w/ strangers, etc. Thanks to these remarkable vaccines, real relief is in sight — let’s keep on track and see this thing through.

  1. Obviously, this could change! But the situation right now w/r/t variants is very good.

Come With Me If You Want to Live!

posted by Jason Kottke   Jan 21, 2021

In response to comments about a video of him getting the Covid-19 vaccine — “Come with me if you want to live!” — Arnold Schwarzenegger says that if you want to build biceps, you should listen to him. He’s the expert. But if you want to know what to do about Covid-19, you should listen to epidemiologists and doctors.

Dr. Fauci and all of the virologists and epidemiologists and doctors have studied diseases and vaccines for their entire lives, so I listen to them and I urge you to do the same. None of us are going to learn more than them by watching a few hours of videos. It’s simple: if your house is on fire, you don’t go on YouTube, you call the damn fire department. If you have a heart attack, you don’t check your Facebook group, you call an ambulance. If 9 doctors tell you you have cancer and need to treat it or you will die, and 1 doctor says the cancer will disappear, you should always side with the 9. In this case, virtually all of the real experts around the world are telling us the vaccine is safe and some people on Facebook are saying it isn’t.

In general, I think if the circle of people you trust gets smaller and smaller and you find yourself more and more isolated, it should be a warning sign that you’re going down a rabbit hole of misinformation. Some people say it is weak to listen to experts. That’s bogus. It takes strength to admit you don’t know everything. Weakness is thinking you don’t need expert advice and only listening to sources that confirm what you want to believe.

“Can We Do Twice as Many Vaccinations as We Thought?”

posted by Jason Kottke   Dec 18, 2020

In an opinion piece for the NY Times, Zeynep Tufekci and epidemiologist Michael Mina are urging for new trials of the Moderna and Pfizer/BioNTech Covid-19 vaccines to begin immediately to see how effective a single dose might be in preventing new infections. If the trials do indicate that a single dose works, that would effectively double the number of people we could vaccinate within a certain time period, saving countless lives in the US and worldwide.

Both vaccines are supposed to be administered in two doses, a prime and a booster, 21 days apart for Pfizer and 28 days for Moderna. However, in data provided to the F.D.A., there are clues for a tantalizing possibility: that even a single dose may provide significant levels of protection against the disease.

If that’s shown to be the case, this would be a game changer, allowing us to vaccinate up to twice the number of people and greatly alleviating the suffering not just in the United States, but also in countries where vaccine shortages may take years to resolve.

But to get there — to test this possibility — we must act fast and must quickly acquire more data.

For both vaccines, the sharp drop in disease in the vaccinated group started about 10 to 14 days after the first dose, before receiving the second. Moderna reported the initial dose to be 92.1 percent efficacious in preventing Covid-19 starting two weeks after the initial shot, when the immune system effects from the vaccine kick in, before the second injection on the 28th day

That raises the question of whether we should already be administrating only a single dose. But while the data is suggestive, it is also limited; important questions remain, and approval would require high standards and more trials.

The piece concludes: “The possibility of adding hundreds of millions to those who can be vaccinated immediately in the coming year is not something to be dismissed.”

Returning to Normal

posted by Jason Kottke   Dec 04, 2020

cats wearing masks while social distancing

The NY Times recently surveyed 700 epidemiologists about how they are personally living during the pandemic and what they think is going to happen next. Epidemiologists should have a better idea than most of us about how to act during a viral pandemic, so there’s lots of good information in there about vaccines and high-risk behaviors. But I found their answers to a pair of speculative questions about a return to normalcy most interesting.

How and when will life go back to normal?

“For some, it has gone back to normal, and because of this, it will be two to three years before things are back to normal for the cautious, at least in the U.S.”

- Cathryn Bock, associate professor, Wayne State University

“The new normal will be continued masking for the next 12 to 18 months and possibly the next few years. This is a paradigm shift.”

- Roberta Bruhn, co-director, Vitalant Research Institute

What will never return to normal?

“My relationships with people who have taken this pandemic lightly and ignored public health messages and recommendations.”

- Victoria Holt, professor emeritus, University of Washington

“Every part of my daily life that involves interaction with anyone other than my spouse.”

- Charles Poole, associate professor, University of North Carolina

For many people, the pandemic has altered almost every aspect of their lives. If we listen to what epidemiologists are telling us (like we should have back in early 2020 to avoid much of our present hardship), it could help us accept that the pandemic will continue to affect most aspects of our lives even after it is “over”.

Free Covid-19 illustration courtesy of Pixel True.

Korean Study: Indoor SARS-CoV-2 Transmission from 21 Feet Away in Just 5 Minutes

posted by Jason Kottke   Dec 04, 2020

Zeynep Tufekci reports on a small study from Korea that has big implications on how we think about transmission of SARS-CoV-2. Scientists traced two cases back to a restaurant and discovered that transmission had occurred over quite a long distance in a very short period of time.

If you just want the results: one person (Case B) infected two other people (case A and C) from a distance away of 6.5 meters (~21 feet) and 4.8m (~15 feet). Case B and case A overlapped for just five minutes at quite a distance away. These people were well beyond the current 6 feet / 2 meter guidelines of CDC and much further than the current 3 feet / one meter distance advocated by the WHO. And they still transmitted the virus.

As Tufekci goes on to explain, the way they figured this out was quite clever: they contact traced, used CCTV footage from the restaurant, recreated the airflow in the space, and verified the transmission chain with genome sequencing. Here’s a seating diagram that shows the airflow in relation to where everyone was sitting:

seating diagram of a restaurant that shows how SARS-CoV-2 was transmitted across the room

Someone infecting another person 21 feet away in only five minutes while others who were closer for longer went uninfected is an extraordinary claim and they absolutely nailed it down. As Sherlock Holmes said: “Once you eliminate the impossible, whatever remains, no matter how improbable, must be the truth.” And the truth is that in some cases, the recommended 6 feet of distance indoors is not sufficient when people aren’t wearing masks. Airflow matters. Ventilation matters. Which way people are facing matters. How much people are talking/laughing/yelling/singing matters. Masks matter. 6 feet of distance does not confer magical protection. All that can make it tough to figure out if certain situations are safe or not, but for me it’s an easy calculation: absolutely no time indoors with other people not wearing masks. Period. As Tufekci concludes:

I think there are three broad lessons here. One, small data can be extremely illuminating. Two, air flow and talking seem to matter a great deal. Three, sadly, indoor dining and any activity where people are either singing or huffing and puffing (like a gym) indoors, especially with poor ventilation, clearly remains high risk.

Read her whole post — as she says, it’s “perhaps one of the finest examples of shoe-leather epidemiology I’ve seen since the beginning of the pandemic”.

How Children Took the Smallpox Vaccine Around the World

posted by Jason Kottke   Dec 03, 2020

With the first approved Covid-19 vaccines set to roll out in the US soon, some of the focus has shifted to how the vaccine will be distributed and its equitable allocation. Part of the distribution logistics puzzle is making sure there are enough glass vials to hold and transport the vaccine around the nation to those waiting to be vaccinated. For the New Yorker, Christopher Payne took some photos of two Corning factories that are manufacturing vials as fast as they can.

But back in the early 19th century, for a colonial empire dealing with overseas smallpox epidemics, glass vials were not an option. Smallpox vaccination at that time was most reliably accomplished by transferring material from cowpox blisters on one person (or cow) to another person. The freshly inoculated person got a little sick but later proved to be immune to the much deadlier smallpox. So when Spain’s Royal Philanthropic Vaccine Expedition set sail in 1803 to inoculate the inhabitants of their overseas colonies for smallpox, they used the bodies of human beings to transport the vaccine. To be more specific, they used “twenty-two orphan boys, ages three to nine”.1

And so it was that, “in the era before refrigeration, freeze-dried vaccines, and jet aircraft,” writes medical historian John Bowers, “the successful circumnavigation of the globe with the vaccine…rested on a single medium — little boys.” During the long crossing, approximately twenty-two orphans who had not previously contracted smallpox or cowpox were “vaccinated in pairs every ninth or tenth day,” via arm-to-arm inoculation (taking lymph from an unbroken pustule on a recently vaccinated boy and introducing it under the skin of another). This created a vaccine chain — the vaccine remained active and viable for the entire journey.

The three-year expedition was success and an early & effective example of philanthropic healthcare, but you also have to note here that the reason the Americas were ravaged by smallpox was because Spain brought it there in the first place.

Update: In The Atlantic, Sam Kean provides some more detail on the vaccination effort.

Given the era, it’s likely that no one asked the orphans whether they wanted to participate — and some seemed too young to consent anyway. They’d been abandoned by their parents, were living in institutions, and had no power to resist. But the Spanish king, Carlos IV, decided to make them a few promises: They would be stuffed with food on the voyage over to make sure they looked hearty and hale upon arrival. After all, no one would want lymph from the arm of a sickly child. Appearance mattered. And they’d get a free education in the colonies, plus the chance at a new life there with an adoptive family. It was a far better shake than they’d get in Spain.

  1. The article describes these children as “orphaned” but I wonder if it’s not more accurate to describe them as “enslaved”. Surely these kids didn’t have a real choice in whether they wanted to be infected with cowpox and carried overseas in a cramped ship.

Science Gave us a Vaccine. Now to Turn That Into Vaccinations…

posted by Jason Kottke   Dec 02, 2020

In an incredible effort, science has provided the world with what looks like an incredibly effective vaccine for Covid-19. For Stat, Helen Braswell writes about the challenges of turning that vaccine into vaccinations. In the US, despite heroic work from individuals and individual groups, our public health system has proved unequal to the challenge of addressing the pandemic, and we’re now turning, in part, to that system to distribute and administer the vaccines, as well as to educate the public and drum up support for vaccination. The people that we’re counting on are public officials and healthcare workers worn out from what is essentially one 9-month-long wave of illness, hospitalizations, and death across the country. Misinformation and skepticism of science and government has sowed “justified distrust” about vaccines in many people:

Concern about the vaccines, however, cuts across ethnic and socioeconomic groups. President Trump’s overt efforts to pressure the FDA to issue EUAs before the Nov. 3 election — before the vaccine trials were finished — has deepened the sense of unease. The CDC’s early pandemic testing fiasco, coupled with its sidelining by the Trump administration, has eroded its standing as a trusted source of information.

Alison Buttenheim, an associate professor of nursing and health policy at the University of Pennsylvania, refers to the current situation as a perfect storm of “justified distrust.”

“People who don’t think twice about vaccinating their kids totally on time, who get their flu shot every year, are in the sort of, ‘Hmmm. Might wait six months on this one,’” Buttenheim, who works on vaccine acceptance, told STAT. “I’ve heard people say, ‘I’ll get the European one,’” she said, adding other people have said they would get vaccinated after Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, gets vaccinated.

And it’s not just the general public. A recent survey of 2,000 doctors and nurses in New Jersey found that 60% of doctors planned to take a Covid vaccine, but only 40% of nurses intended to, Health Commissioner Judith Persichilli said in a recent “60 Minutes” segment about Operation Warp Speed.

Fauci, along with other respected public health officials and workers, should get vaccinated live on CNN. Stream it on YouTube and Twitch. It won’t convert the anti-vax, anti-mask, QAnon wingnuts (nothing will) but if you can at least get healthcare workers and at-risk folks on board, it would be time well spent.

But that’s only one small piece of the puzzle. Braswell’s piece is long and comprehensive look at the challenges regarding the Covid-19 vaccines and is worth reading all the way through.

Speculation: Scented Candle Ratings Down Due to Covid-19 Loss of Smell

posted by Jason Kottke   Nov 30, 2020

After Terri Nelson noticed people complaining online about a lack of scent from newly purchased scented candles, Kate Petrova analyzed Amazon reviews for candles from the past three years and found a drop in ratings for scented candles beginning in January 2020 (compared to a smaller ratings decline for unscented candles).

graph showing a ratings decline for scented candles since January 2020

The hypothesis is that some of these buyers have lost their sense of smell due to Covid-19 infections and that’s showing up in the ratings.

A Framework for the Equitable Allocation of a COVID-19 Vaccine

posted by Jason Kottke   Nov 24, 2020

Now that the preliminary results of various Covid-19 vaccine trials are coming out (and looking promising), attention is turning to the eventual distribution of the vaccines. The logistics of getting the doses out to hospitals, clinics, and doctor’s offices is one concern but so is the question of who should get vaccinated first. Supplies of the vaccines will be limited at first, so we’ll need to decide as a society what distribution method is most fair and is of the most benefit to the greatest number of people.

To this end, and in response to a request by the CDC and NIH, the National Academies of Sciences, Engineering, and Medicine formed a committee to produce a report called Framework for Equitable Allocation of COVID-19 Vaccine. The 252-page report is available to the public for free to read online or download.

In addition several recommendations — including that the vaccine be distributed to everyone free of charge — a central feature of the report is a four-phase system of vaccine distribution, summarized in this graphic:

Four-phase framework for the equitable allocation of a COVID-19 vaccine

I’d like to stress that this graphic does not show all groups of people included in each phase — please consult the text of the report for that before you go sharing that graphic on social media without context. For example, here’s the full description for “high-risk health workers” in Phase 1a:

This group includes frontline health care workers (who are in hospitals, nursing homes, or providing home care) who either (1) work in situations where the risk of SARS-CoV-2 transmission is higher, or (2) are at an elevated risk of transmitting the infection to patients at higher risk of mortality and severe morbidity. These individuals — who are themselves unable to avoid exposure to the virus — play a critical role in ensuring that the health system can care for COVID-19 patients.

These groups include not only clinicians (e.g., nurses, physicians, respiratory technicians, dentists and hygienists) but also other workers in health care settings who meet the Phase 1a risk criteria (e.g., nursing assistants, environmental services staff, assisted living facility staff, long-term care facility staff, group home staff, and home caregivers). The health care settings employing these workers who are at increased risk of exposure to the virus may also include ambulatory and urgent care clinics; dialysis centers; blood, organ, and tissue donation facilities; and other non-hospital health care facilities. Finally, there are community and family settings where care for infected patients occurs. Not all the workers in these settings are paid for their labor, but, while they are caring for infected people, they all need to be protected from the virus.

Situations associated with higher risk of transmission include caring for COVID-19 patients, cleaning areas where COVID-19 patients are admitted, treated, and housed, and performing procedures with higher risk of aerosolization such as endotracheal intubation, bronchoscopy, suctioning, turning the patient to the prone position, disconnecting the patient from the ventilator, invasive dental procedures and exams, invasive specimen collection, and cardiopulmonary resuscitation. In addition, there are other frontline health care workers who, if they have uncontrolled exposure to the patients or the public in the course of their work, should be in this initial phase. This group includes those individuals distributing or administering the vaccine — especially in areas of higher community transmission — such as pharmacists, plasma and blood donation workers, public health nurses, and other public health and emergency preparedness workers. The committee also includes morticians, funeral home workers, and other death care professionals involved in handling bodies as part of this high-risk group.

The report declines to list specific industries which would be covered in Phase 2’s “critical workers in high-risk settings” but generally says:

The industries in which these critical workers are employed are essential to keeping society and the economy functioning. Since the beginning of the pandemic, millions of people have been going to work and risking exposure to the virus to ensure that markets have food; drug stores have pharmaceutical products; public safety and order are maintained; mail and packages are delivered; and buses, trains, and planes are operating.

Note also the text at the bottom of the graphic: they recommend that within each phase, priority be given to geographic areas where folks are more socially vulnerable in situations like these (e.g. as represented in the CDC’s Social Vulnerability Index).

In developing this phased approach, the committee focused on those who are at the most risk of exposure, severe illness or death, and passing along the virus to others as well as critical workers:

Risk of acquiring infection: Individuals have higher priority to the extent that they have a greater probability of being in settings where SARS-CoV-2 is circulating and of being exposed to a sufficient dose of the virus.

Risk of severe morbidity and mortality: Individuals have higher priority to the extent that they have a greater probability of severe disease or death if they acquire infection.

Risk of negative societal impact: Individuals have higher priority to the extent that societal function and other individuals’ lives and livelihood depend on them directly and would be imperiled if they fell ill.

Risk of transmitting infection to others: Individuals have higher priority to the extent that there is a higher probability of their transmitting the infection to others.

You should read (or at least skim) the full report for more information about the plan and the rationale behind it.

On a personal parting note, as someone who is squarely in the 5-15% of Americans covered in Phase 4 — more specifically: as a 40-something straight white man who non-essentially works from home, isn’t low-income, doesn’t socialize widely even under normal circumstances, and should probably be the very last person on this whole Earth scheduled to be vaccinated under an equitable framework — I am content to wait my turn should the US adopt this framework or something like it.1 Distributing vaccines to those who need them most is absolutely the right thing to do, both ethically and from the standpoint of getting society “back to normal” as quickly as possible and with as little additional death and suffering as possible.

  1. Being that equity often isn’t America’s thing, especially during the pandemic, I could see this going either way. And even if this framework is adopted, those who can afford it will undoubtably be able to procure themselves a dose right alongside those medical workers in Phase 1a.

Oxford-AstraZeneca’s Covid-19 Vaccine Up to 90% Effective

posted by Jason Kottke   Nov 23, 2020

Preliminary results from the trials of the Covid-19 vaccine jointly developed by the University of Oxford and AstraZeneca indicate that the vaccine’s overall efficacy is 70% but that a regimen that calls for a lower first dose is 90% effective.

The preliminary results on the AstraZeneca vaccine were based on a total of 131 Covid-19 cases in a study involving 11,363 participants. The findings were perplexing. Two full doses of the vaccine appeared to be only 62% effective at preventing disease, while a half dose, followed by a full dose, was about 90% effective. That latter analysis was conducted on a small subset of the study participants, only 2,741.

Hopefully more study will be done on that dosage question. From the AP:

“The report that an initial half-dose is better than a full dose seems counterintuitive for those of us thinking of vaccines as normal drugs: With drugs, we expect that higher doses have bigger effects, and more side-effects,” he said. “But the immune system does not work like that.”

The seemingly lower efficacy comes with some perhaps significant benefits: this vaccine is cheaper to produce and doesn’t require any special refrigeration.

The vaccine can be transported under “normal refrigerated conditions” of 2 to 8 degrees Celsius (36 to 46 degrees Fahrenheit), AstraZeneca said. By comparison, Pfizer plans to distribute its vaccine using specially designed “thermal shippers” that use dry ice to maintain temperatures of minus-70 degrees Celsius (minus-94 degrees Fahrenheit).

The Pfizer and Moderna vaccines were pretty similar in many respects and this one seems quite different. These results were just released a few hours ago, so it will be interesting to follow the debate and expert commentary on this. Stay tuned…

Update: This is amazing: the seemingly more effective 1/2 dose + full dose regimen was a mistake.

Around the time when Astra was initiating its partnership with Oxford at the end of April, university researchers were administering doses to trial participants in Britain.

They soon noticed expected side effects such as fatigue, headaches or arm aches were milder than expected, he said.

“So we went back and checked … and we found out that they had underpredicted the dose of the vaccine by half,” said Pangalos.

A far smaller number of participants was given the initial half-dose, so more research will need to be done to determine if this mistake will be added to the long list of scientific discoveries made because of errors. There’s a good piece in Nature that talks about what we know and don’t know about the vaccine results so far along with some informed speculation.

But, if the differences are bona fide, researchers are eager to understand why. “I don’t think it’s an anomaly,” says Katie Ewer, an immunologist at Oxford’s Jenner Institute who is working on the vaccine. “I’m keen to get into the lab and start thinking about how we address that question.” She has two leading theories for why a lower first dose might have led to better protection against COVID. It’s possible that lower doses of vaccine do a better job at stimulating the subset of immune cells called T cells that support the production of antibodies, she says.

Another potential explanation is the immune system’s response against the chimpanzee virus. The vaccine triggers an immune response not only to the SARS-CoV-2 spike protein, but also to components of the viral vector. It’s possible that the full first dose blunted this reaction, says Ewer. She plans to look at antibody responses against the chimpanzee virus to help address this question.

Update: A short thread by Dr. Natalie Dean, which leads with “AstraZeneca/Oxford get a poor grade for transparency and rigor when it comes to the vaccine trial results they have reported”.

A Secret to Vermont’s Pandemic Success

posted by Jason Kottke   Nov 19, 2020

For Vox, Julia Belluz takes a look at the approach that’s made Vermont more successful than most other US states in combatting Covid-19. The big thing? State officials recognized that those most at risk needed more support.

There’s a fatal flaw embedded in the basic Covid-19 test, trace, and isolate trifecta used around the world: It doesn’t account for the fact that the coronavirus is not an equal-opportunity pathogen. The people who are most likely to be tested, and to have the easiest time quarantining or isolating, are also the least likely to get sick and die from the virus.

From the United Kingdom to Sweden to Canada, we have evidence that the virus preys on people employed in “essential service” jobs (bus drivers, nurses, factory workers), which don’t allow for telecommuting or paid sick leave; people in low-income neighborhoods; and people in “congregate housing” like shelters, prisons, and retirement homes.

People of color tend to be overrepresented in these groups — but there’s no biological reason they’re more likely to get sick and die from the virus. Simply put: They tend to work jobs that bring them outside the home and into close contact with other people, live in crowded environments ideal for coronavirus contagion, or both.

The state then directed efforts, resources, and money to nursing homes, the unhoused, prisons, and essential workers to make it easier for those folks to stay safe.

I also thought this bit was really interesting:

There’s a simple adage in public health: “Never do a test without offering something in exchange,” said Johns Hopkins’s Stefan Baral. So when a patient gets tested for HIV, for example, they’re offered treatment, support, or contact tracing. “We’re not just doing the testing to get information but also providing a clear service,” Baral added, and potentially preventing that person from spreading the virus any further. “This is basic public health.”

With Covid-19, the US has failed at basic public health. Across the country, people have been asked to get tested without anything offered in exchange.

“If we are asking people to stay home and not work, we have to make sure society is supporting them,” Baral said. “An equitable program would support people to do the right thing.”

“Never do a test without offering something in exchange.” To the extent that federal and state governments have been asking to people to stay home, get tested, and wear a mask, many of those same governments have been unwilling or unable to provide people with much in return for doing so. And so, here we are months into this, paying for that inaction with 250,000 lives.

Update: How NYC does “never do a test without offering something in exchange”:

You can access a free hotel room to safely isolate from your family, which include meals, Rx delivery, free wi-fi, medical staff on site, and transportation to and from hotel and medical appointments.

(via @agoX)