Claudio writes:

Hello TWiV-people!

Regarding those neverending ongoing stories, like the Florida sheriff and so many others of people not wanting to follow the common sense rules, for political or whatever reasons, it reminds me of some long ago wartime stories.

In World War II, when Germans started bombing London, when the alarm went off at night, people were supposed to shut down their lights. A total dark city would obviously make it more difficult for the enemy to spot their neighborhood, and hence to bomb them. If you, for any stupid reason, would be the person to say – or even think about – something like “I HAVE THE RIGHT TO KEEP MY LIGHTS ON”, well … you can imagine what would happen …??

So … like Vincent says … THIS IS WAR, PEOPLE!!!

cheers from Brazil,

Claudio 

Charles writes:

Hello TWiVers;

Just a pissed off human living in Chapel Hill where the weather is nice at 85F (29C) with a chance of rain later today.

I did listen to all of 654, as I am sure most of your listeners did.  I just sent the following short and to the point correspondence to my Congress Critters.  I hope to get a more meaningful response this time around.  My first response from Senator Thom Tillis talked about what a great job we have done.  In other words pure BS.  Senator Burr was not much better, he talked about how much PPE we had produced.  Representative David Price was a bit better, but not good enough.

Thanks,

Charles Fischer  

PS, about the ignorant sheriff and chief of police.  I have lived in some diverse places (Lexington and Murray KY, Burlingame and San Francisco CA, Durham and Chapel Hill NC and Ocala (Marion County Florida, just south of Gainesville)).  I would live in any of them again, except for Ocala.  The sheriff banning masks and the chief of police deciding which laws to enforce, without being fired, should tell you all you need to know about that area.

PPS, because of the language in this email, Dr.Brianne Barker may want to read this one.  If that is a micro-aggression, sorry.

PPPS, a question for TWiG.  Salt hay had me baffled.  I assumed it was hay that had salt added to it to keep the seeds from sprouting.  Turns out I think it is Salt Marsh Hay, which needs salt to sprout.  Is that correct? 

ddd: do you mean Spartina?

Salt marsh grass is Spartina patens and also known as saltmeadow cordgrass and SALT HAY

Found from Newfoundland along the Eastern US to the Caribbean and northeast Mexico

For at least some species of Spartina, salt is not necessary; they are salt tolerant, but too much salt can make them stubby

Finally the letter to my Congress Critters:

Dear Senator;

This is my second correspondence with you about the need for point of entry SARS-CoV-2 testing.  If we want to open the country before a safe and effective vaccine is ready we must have rapid at home or point of entry testing.

WE NEED TO USE WARP SPEED AND ACTIV TO FUND DEVELOPMENT OF AT HOME ANTIGEN TESTS FOR SARS-COV-2.

After these tests have emergency approval from the FDA, we must use the Defense Procurement Act to produce and distribute them.

TESTING IS OUR ONLY WAY OUT OF THIS MESS BEFORE A SAFE AND EFFECTIVE VACCINE HAS WIDE SPREAD DISTRIBUTION.

Please get onboard with public statements and bipartisan leadership to make it happen, ASAP.

I was not impressed with your response to my first correspondence.  Please do better this time, our lives depend on it.

Esa-Pekka writes:

Dear TWiV,

I have a fairly simple question that came to me while listening to TWiV 652 about transmission of SARS-CoV2. Is it possible that the incubation time for the onset of symptoms and for transmissibility are decoupled in SARS-CoV2? I suppose with my limited understanding of SARS-CoV2 biology that there may be a component that suppresses the immune response which causes a period of asymptomatic transmission. Could the level of immune suppression and therefore the delay from peak transmissibility to symptom onset be a significant indicator of disease severity? I’m a humble non-viral structural biologist, so I might be overlooking some obvious facts here. 

Regarding home testing, I hope the preprint below has caught your eye. In it they describe an open source approach to produce a LAMP based test that can also be used at home.

https://www.biorxiv.org/content/10.1101/2020.06.23.166397v2

Thanks and keep up the good show!

Cheers from Finland,

Esa-Pekka

Esa-Pekka Kumpula, PhD

Postdoctoral Researcher

Laboratory of Structural Biology

Helsinki Institute of Life Science HiLIFE

University of Helsinki

Suzanne writes:

ProPublica usually does a pretty good job of investigating things but this really seems like scare mongering to me. I believe they’re well meaning and they may have a point about the lack of transparency but the rest sounds more to me like things are working the way they should. I was wondering what y’all thought. 

https://www.propublica.org/article/here-are-six-accidents-unc-researchers-had-with-lab-created-coronaviruses

Paula writes:

I’m a new TWIV listener in Minnesota USA. Currently It’s sunny and 67F/19.4C where I am, and the humidity is 66%, with calm winds.

I’m a 50 yr old stay at home mom who started college at Michigan Tech ages ago majoring in med tech with an eye toward vet school, before getting married and working to get my husband through his school. I did not finish my degree. Yes we are still married 29 years this coming November, and raised three wonderful kids and have two sweet grandsons now.

Regarding the sudden spike in New Zealand cases, many are saying that the virus isn’t likely to be transmitted on surfaces (including frozen food which they think may be the source for these new cases there), but I haven’t found any story that mentioned anything about the phenomenon of sublimation of the frost crystals on the surface of frozen items.

If you are  handling frozen food and some of it is contaminated with coronavirus from other workers breathing, coughing,or sneezing on it, then every time air passes over those packages, especially as they pass into a slightly warmer environment during shipment you get some sublimation. And you are likely to inhale some of the sublimated vapor, Wouldn’t you think ?

Thanks for helping to oil my rusty brain… lots of the discussion is going over my head but it sure makes me feel more intelligent!

😉

Paula in MN

John writes:

Dear TWIVer’s,

As a Jesuit priest AND a huge Doctor Who fan, I felt the need to write in response to episode 654. I teach Parasitology at Creighton University and have been an avid listener of TWIP, which I recommend to all of your listeners. Although I have listened to a few TWIV episodes sporadically in the past, I have listened to all of this year’s episodes and have thoroughly enjoyed them. Episode 640 brought me a great deal of hope and so I want to thank you for countering a miasma of desolation. I also want to thank Daniel Griffin who not only has good taste in sci-fi, but generously gives his time to share critical first hand clinical knowledge on Covid-19. I also love his case studies on TWIP and use them in my class. Until we get this pandemic under control, stay grumpy and keep up the great work! 

Sincerely,

John Shea in Omaha, NE where it has been sunny and in the mid 80’s.

John Shea, SJ, Ph.D.

Jesuit Community Creighton University

Earl writes:

Dear Vincent and other TWiV hosts,

I’m sure you’ve seen this article by now, but since it so clearly and persuasively echos what TWiV has advocated since the Michael Mina episode (TWiV 640), I could not resist sending along a copy.

Keep TWiVing

Regards, Earl

From The Atlantic online:

https://www.theatlantic.com/health/archive/2020/08/how-to-test-every-american-for-covid-19-every-day/615217/

Editor’s Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here.

Maria writes:

Dear TWiV Team,

I am a Quality Assurance Lead for a Diagnostics Company.  I learned about TWiV from a grad professor of mine, and want to thank you all for keeping me sane and informed during this crazy time.  

A couple of weeks ago, my 17-year-old nephew started feeling ill, and soon thereafter lost his sense of taste and smell.  He had access to an Abbott ID Now test, and his results came back positive.  He has spent the summer working in a restaurant, and three of his co-workers were also diagnosed positive soon thereafter.  

All of his friends and family who have had exposure to him have since been tested using lab PCR. All of their tests came back negative, including those of his immediate family, and of his girlfriend, who he was “swapping spit” with the day before his positive test result.  

Do you have any explanation for this?  My brother is now convinced that there is a “different strain” of SARS-CoV-2 in our hometown that is less transmissible. I ineloquently told him that he was wrong,  but couldn’t explain how my nephew did not infect any of his friends and family.   

Please keep up the excellent work.  My gratitude is expressed in the following Haiku.  

So many false facts
Nowhere to turn, so confused
Then TWiV cleared the fog

Best, 

Maria

Ken writes:

The UCSF press release ( https://www.ucsf.edu/news/2020/08/418241/aeronabs-promise-powerful-inhalable-protection-against-covid-19 ) makes this sound like potentially a real game changer. It references this preprint:

https://www.biorxiv.org/content/10.1101/2020.08.08.238469v1

It would be great to hear what the TWIV team thinks of this.

Best,

-ken

P.S. Rainy and 17C near Oxford, England. Not unusual. 

Laurie writes:

My name is Laurie Schultz and I am a pediatrician in San Francisco and I received a MPH in epi at UC Berkeley  My sister, who is a microbiologist, turned me on to TWiV and I started with the MIchael Mina episode and I was an immediate convert.  I have told anyone and everyone from colleagues to friends to patient families to watch it and I have been shocked that this has not hit the front page of every major newspaper.  However, over the last week, I have heard more references to it on the radio, and from colleagues.  Michael Mina was featured on the UCSF townhall last week and that created a local buzz.  I think it is starting to happen.  Please do not stop, do not discourage, you guys are amazing.  You are going to change the world.  Thank You!

(not sure about reading this next part – I worry about mask-shaming specific people!) OH! maybe it’s only shaming someone in the photo

Also, I heard Rajiv Shah on NPR.  He also mentioned the quick tests.  I went to the Rockefeller Foundation website and was a little surprised to see the background photo highlighting a man who was wearing his mask below his nose!!!  These are the people that are supposed to be providing the leadership that we are so sadly lacking and they can’t find a pic with someone wearing a mask correctly!!!  Optics are important!  If any of you know him, can you please ask him to modify the pic?  Thank you.  (I already sent them an email to no effect.)

I would love to do something to move the quick spit test forward.  I have two sons who are in college and this is no way to learn, they need to get back in the classroom, but of course they also need to be safe.    Please let me know if there is anything me or my colleagues can do to fan this fire.

Thanks again!  I am such a fan 🙂

Laurie Schultz MD, MPH

Golden Gate Pediatrics

San Francisco, CA

Lizzy writes:

Dear TWIV, 

In episode 654 you read my email about convincing friends and family not to tell their Congress Critters to buy the Russian vaccine.

An important part of my question however was how to communicate that vaccines coming out of Operation Warp Speed will be fully tested for safety and efficacy by spending money and resources instead of time. Fast, expensive, safe and effective.

The Russians did a combined phase 1-2 trial and declared victory. Fast being the only shared virtue. 

How do I explain the difference without putting people off vaccines altogether?

Daniel  writes:

I’ve started following your podcast after hearing about episode 640 with Michael Mina. 

I wanted to get your thoughts on COVID transmission among young children and implications for sending them back to school.  We have a 5 year old and are contemplating sending him to a school that only has very young children (ages 2-6).  The school will be practicing social distancing and mask wearing, hand washing and holding 75% of class time outside. Class size is limited to 13 kids and two teachers.

We had felt pretty good about sending our child there in light of news we heard about studies that young children (under 10) are much less likely to catch and spread the virus (although we understand that can still happen) and when they do become infected, have much milder symptoms.

We were particularly encouraged by news regarding a study from South Korea showing much lower rates of infection in younger children. https://wwwnc.cdc.gov/eid/article/26/10/20-1315_article.

But Sanjay Gupta on CNN today pointed out that the South Korean study only had a very small cohort  in the  under age 10 group.  So he said he was disregarding this study and keeping his kids home from school.  https://www.cnn.com/2020/08/12/health/covid-kids-school-gupta-essay/index.html

Although I found this study from Iceland https://www.nejm.org/doi/full/10.1056/NEJMoa2006100 which used larger samples of children under ten and found much lower rates of infections than in the rest of the population.

I’m a trial attorney and while I’m accustomed to diving into new complex areas to learn them quickly, I don’t have a scientific background and it’s a bit difficult to decipher the various incomplete data out there.  So my questions are;

1.  Do you believe there is substantially lower infection and transmission rates among young children?

2.  Given the school set up described in my email, would you send your child to school?

I should add that I presume this calculus will change if the Michael Mina type testing is made available.  I saw over the weekend that Yale and the NBA have developed something similar and I’ve already made inquiries to see if the school can use those on staff and kids.

Thanks again for all your work,

Dan S.  (Washington, DC)

Steve writes:

Thanks for being a (maybe THE) voice of reason in these chaotic times.  I am an Internist and Hospitalist caring for Covid-19 patients on a regular basis.  Your podcast has been a great source of information and reasonable opinion for me and my group.  I suspect this question asks for an opinion because I think it is something that cannot be known yet.  To what degree do you believe the improvements in morbidity and mortality among Covid-19 patients can be attributed to the natural selection of the virus toward a less lethal phenotype versus the changes in how we are managing them medically?  Is what we are doing medically really helping patients that much or are we just watching the natural course of a viral pandemic as it evolves?

Thanks for any insights you can offer.

Steve

Stephen Berry, MD

Athens, GA

Thalia writes:

Dear TWIV team,

Hello from Berlin, Germany, where things feel *relatively* normal. In fact, if you go to the lakes and beer gardens, which are packed, you can easily forget there is a global pandemic going on. Groups of friends are meeting, people are hugging, going to routine doctor’s appointments, and the subways are getting crowded (though everyone wears a mask). The biggest news item recently was a naked bather who chased a wild boar around a lake in Berlin (yes, there are pictures): https://www.theguardian.com/world/2020/aug/07/german-nudist-chases-wild-boar-that-stole-laptop-berlin-teufelssee  But I think everyone is bracing themselves for the Fall, so it feels a bit like the calm before the storm—infection numbers have been on the rise for the past few weeks. (Yesterday, with over 1700 cases registered in the past 24 hours, was the highest it has been in Germany since the end of April.)

My husband and I traveled here from Newark, NJ, in early June. It was not the most pleasant experience—we wore our N95 masks for 15 hours straight, and our flight from Newark to Frankfurt was completely full. But, somehow we survived without getting infected, and are now happily drinking beer in beer gardens and dodging wild boars :-).

I don’t have any sophisticated virus questions, but I did have two puns I wanted to share with you. They came to me the other day in a rare moment of inspiration when I was listening to your interview with Adam Kucharski. I think they would make fun logos for TWIV merchandise (t-shirts?).

Viruses R0 Alive
Viruses R-naughty

All the best from Germany, where it is currently 78 degrees Fahrenheit,

Thalia

MJ writes:

Don had recently asked about the need for many to avoid complying with any reasonable actions or standards of care in the address of protecting others from infection now with Covid19 and presumably for any other bad infection or Pandemic.

If I may suggest: The old Freudian defense mechanism of Denial is the best solution to Don’s query. The inability to face some bad past event or some potential harm or one’s own potential responsibility or the potential for such responsibility is met by the inability to either acknowledge the risk or the situation behind the risk itself.   

In a manner analogous to Holocaust Denial, denial that Covid19 can exist as severe (‘The business is no more than a simple case of Flu’) or that it exists (Trump’s use of ‘It’s a Democratic hoax’) or that it is transient (Trump’s use here of “It will just go away’) or the lack of need to respond to it as the person speaking believes that he or she (or they) could not harbor the virus and would not likely transmit it due to a lack of contact or lack of symptoms or both.  

All of these are patently false, but the need to maintain one’s own ego gratification while acting in a possibly juvenile and self-centered manner overrides any concept of responsibility.   

All of this jives with Freud’s mechanism of ” a person is faced with a fact that is too uncomfortable to accept and rejects it instead, insisting that it is not true despite what may be overwhelming evidence.” {‘Defenses’, http://www.psychpage.com  -referencing the Nov. 3, 2008 page construction, currently rewritten less elegantly by Richard Niolan April 8, 2011 but documented by https://psychology.wikia.org/wiki/Denial

Keep up your wonderful work!!!