Tuesday, July 14, 2020

From my clutter: oddments from the pandemic

Since we seem, once again, to be entering a dire phase of this disease outbreak, let's earnestly hope there will be no more of this:
No, Mr. Trump, it's not just going away. And killing the messenger (that would be Dr. Fauci) won't end the pandemic either.

It turns out that smoking and vaping are risk factors.
I wonder about this when I pass, six feet or more away, someone smoking on the sidewalk. If I can smell smoke through my mask, might there be aerosolized coronavirus out there? You can't smoke wearing a mask.

One-third of young people across the country may be at risk of getting seriously sick with COVID-19, especially if they smoke or vape, according to a UCSF study published Monday in the Journal of Adolescent Health. Smoking was the most common risk factor for severe COVID-19 complications among otherwise largely healthy young people, the study found.

Some health workers feel ever closer to breaking down. Listen to a doc in Arizona.

In a medical crisis, my job is to manage a clinical team, problem-solve and be in control. It is hard to admit that I feel vulnerable and scared when I think of the Covid-19 surge we are facing now and the combined Covid-19 and influenza tsunami expected later this year. But I am admitting it because you need to know how close health care workers are to breaking.

... Emergency medical and critical-care team members are canaries in the coal mine. When we are understaffed and overworked, when there is no staff to triage patients, when more and more patients are piling up at the emergency department door, the system breaks down, then people break down. You can borrow ventilators (until you can’t) and make more personal protective equipment (we hope). You cannot magically produce more nurses, respiratory therapists, physicians or other professionals.

Researchers are beginning to understand how the virus spreads. Fortunately not every infected person passes it on -- but wow, this disease can flare up fast.

Most infected people don’t pass on the coronavirus to someone else. But a small number pass it on to many others in so-called superspreading events.

“You can think about throwing a match at kindling,” said Ben Althouse, principal research scientist at the Institute for Disease Modeling in Bellevue, Wash. “You throw one match, it may not light the kindling. You throw another match, it may not light the kindling. But then one match hits in the right spot, and all of a sudden the fire goes up.”

Some of the worst fires seem to be ignited in bars. Gov. Gavin has just shut down the bars in California again. Might help slow this thing. Meanwhile Jordan Weissmann proposes "We need a national bar rescue."

People who've lived through coronavirus infections probably have some immunity, but researchers fear immunity is not lasting. Studies are still preliminary and may change with more information, but if this finding holds, it is going to make it difficult to develop a vaccine.

People who have recovered from Covid-19 may lose their immunity to the disease within months, according to research suggesting the virus could reinfect people year after year, like common colds.

The immune system has multiple ways to fight the coronavirus but if antibodies are the main line of defense, the findings suggested people could become reinfected in seasonal waves and that vaccines may not protect them for long.

Here in the San Francisco Mission, a testing study documented that a vastly disproportionate number of local cases of COVID happen among the Latinx population. Elsewhere, authorities are having trouble documenting which groups are most afflicted because of confusion about who should be counted as Latinx, according to the Washington Post.

Federal and local governments and hospitals all count race and ethnicity differently.  In many critical forms and submissions, including the census, the government race category forces Latinos to choose among white, black or African American, Asian, American Indian and Alaska Native, Native Hawaiian and Pacific Islander. There is nothing for a Latino to check except the lonely box marked “other.” Latinos are literally “othered” in these official government counts. Federal forms allow Hispanics to be counted in the ethnicity category, but this is not always the number used for policy development or resource allocations. 

Let's just hope somehow the work of the Census is accomplished during the pandemic; the feds have extended the response deadline to October 31. Maybe some of New York City's rich Upper East Side residents who fled the coronavirus outbreak will come back by then and get with the program. As of now, they are not completing their Census forms.

Dr. Larry Brilliant, the Marin County public health guru who is given credit for a major role in eradicating smallpox, finds the COVID pandemic both terrifying and exciting.

... This is a big fucking deal. If I would not be excommunicated from the world of science, I would call this an evil virus, but I can’t do that because I can’t [impute] motives to it. But if I could, I would call it that. It’s certainly pernicious. This is the worst pandemic in our lifetime. And it is the first time we have had a pandemic in the United States in which we have had such a total, abysmal failure of our federal government.

... When you get a vaccine, you get a vaccine campaign. We have around 160 vaccines today in various stages of trial or hypothesis or funding, with maybe a dozen candidates emerging. Several are from China. China is looking at its ability to rapidly produce a vaccine as a demonstration of modernity, scientific acumen, and a little bit of redemption, because they were the place at which Covid emerged. When one or two or three of those vaccines are declared workable and we have made sufficient quantities, you don’t get rainbows and unicorns. What you will most likely get is a food fight.

... You can be really optimistic that science is moving at a pace unknown before. Just as the virus is growing exponentially, science is growing exponentially. MIT has recorded over 20,000 scientific papers that are on the virus. We have taken a page out of Silicon Valley, and we are exchanging money for speed. And we are doing things now in parallel instead of in sequence.

We are simultaneously testing the safety and the efficacy and the efficiency of vaccine candidates. You may begrudge the fact that it’s not days or months, but you have to be optimistic about creating a novel vaccine in the length of time that Tony Fauci is talking about, 12 to 18 months. ...

We can certainly hope he's right.

Dean Maurice Charles of the Rockefeller Chapel at the University of Chicago urges patience.

I already made the decision at Rockefeller Chapel to suspend services for the duration of the summer term and interim despite guidelines to the contrary offered by the state and city based on politics, not science. Faithful people long to gather, I know. But I have it on good authority that viruses are agnostic. Masks and physical distancing indoors only reduce the possibility of transmission. They do not eliminate it. Those of us who lived through the height of the HIV/AIDs pandemic (which we still cannot discuss in many churches, to our detriment and our shame) have dealt with this before. We need to be patient as scientists and medical professionals learn more about this virus.

Those who lived through the panic and confusion of the early days of AIDs have lessons to offer in this time -- and still have to ask, does anyone want to listen?

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