Chuck writes:
Hello TWIV,
I am a retail pharmacist in CT. My two sons, 5 and 8, are slated to return to school next week full time, in-person. The district’s COVID return plan relies on monitoring local case counts and positivity rates as well as symptom surveillance, with no mention of testing.
At the end of TWiV 656, the penultimate email answered was from a school nurse in Massachusetts lamenting the cost of testing. The question was answered by Dr. Daniel Griffin, in which he spoke of ProHealth’s “Testinator” program (I forgot the official name of the program, it was much less exciting than “Testinator”). He encouraged those interested within the tri-state area to reach out and inquire about the program.
How?
Once I convince my district’s superintendent and my wife’s (an educator) union leaders that testing CAN BE DONE, how do I direct them to reach out to ProHealth to inquire about this program? I feel like having a contact would go much further than just saying “Well, Daniel Griffin said…”
Thank you for all you do.
-Chuck
P.S. I believe Daniel Griffin is mispronouncing “Testinator”. I believe the word is intended to be said with a certain inflection and accent, that is lacking in his pronunciation. I mean, if he intends to facilitate access to testing in the entire tri-state area, he could at least correctly say the name of his most recent invention for us to behold. </sarcasm>
Andrew writes:
Hello Vincent,
Still loving TWiV. Keep up the good work and banter. Getting colder and more autumnal in Kent, UK, day by day. Not liking it.
Not sure if you have covered it yet (I am catching up on a couple of episodes). I’d be interested in your and Daniel Griffins thoughts on the bradykinin hypothesis and the proposed therapeutics. Any trials on these already going that you know of? Here are links to a couple of articles and the paper behind them.
A Supercomputer Analyzed Covid-19 — and an Interesting New Theory Has Emerged A closer look at the Bradykinin hypothesis
Is a Bradykinin Storm Brewing in COVID-19?
https://www.the-scientist.com/news-opinion/is-a-bradykinin-storm-brewing-in-covid-19–67876
A mechanistic model and therapeutic interventions for COVID-19 involving a RAS-mediated bradykinin storm
https://elifesciences.org/articles/59177
The list of proposed therapeutics are (drug, target, predicted effect):
Danazol, Stanozolol, SERPING1, Reduce Bradykinin production
Icatibant, BKB2R, Reduce Bradykinin signaling
Ecallantide, KLKB1, Reduce Bradykinin production
Berinert,Cinryze,Haegarda, SERPING1, Reduce Bradykinin production
Vitamin D, REN, Reduce Renin production
Hymecromone, HAS1,HAS2, HAS3, Reduce hyaluronan
Timbetasin, TMSB4X, Increase fibrinolysis
All the best, Andrew
Kent, UK
Stephen writes:
Hi Twiv Team,
My second email in a week, and I’ll try not to “bug” you (is that word politically correct for microbiologists??) too much in the future.
A few follow up questions to Dr. Griffin’s excellent summary on testing, especially surveillance testing.
1) Dr. Griffin, you recommended confirmation of positive results when doing surveillance/screening testing:
a) Is there a rough community prevalence level you use to guide this? Or just anytime you’re doing surveillance testing?
b) When you repeat the test, do you always use a different test or is it okay to use the same testing method a second time (with a different sample, of course)? I presume you don’t save samples for re-testing them with a different lab or machine.
2) One of the things I’ve been particularly interested in is the idea of trying to calculate sensitivity and specificity for “contagiousness” versus the sensitivity and specificity of diagnosing the infection, because my guess is that the antigen tests are very slightly less sensitive but actually a fair amount more specific for contagiousness. Have you or your colleagues tried to estimate these values, or have any studies or models been published that tried to do this?
And thanks again for all your great work in this field.
Stephen R. Bickel, MD, MPH
Medical Director, Flagler and Volusia County Health Departments
Andrew writes:
Hi TWIVers,
I’m writing from Redwood City, California, where it’s 60°F (15°C) and the air quality index (AQI) is moderate at 52 due to the historic CA wildfires.
I’ve been a weekly listener to the podcast since March 21, 2020, and you and your guests have been, by far, the best source of information on the SARS-CoV-2 virus and COVID-19 disease. Information from your shows has gone into my letters to my school superintendent and members of Congress. Thank you, thank you.
The reason I’m writing is that I’m AFRAID that the Trump administration will pressure the FDA into approving a vaccine for emergency use before the November presidential election. I predict that sometime in October, Trump will announce approval of this “miracle vaccine’ and claim that it’s 100% safe and effective for all ages and ethnicities. They will misrepresent the science for maximum political benefit.
To combat this misinformation campaign, I hope that scientists and public health experts are ready to fairly and honestly analyze the vaccine data, giving a fact-based assessment and explain the pros/cons of its use at this point.
In the next few weeks, could you bring more guests on the show to answer these questions:
(1) If you compress a vaccine development timeline, where can the timeline be safely compressed, and where can it not? What’s the gray area and what’s black and white?
(2) When the new vaccine is proposed, how should we evaluate it? What rubric should we use? safety, immune response, durability, what populations have been tested, etc?
In a nutshell, what would you need to see in the vaccine efficacy and safety for you to feel it’s ready for use among priority groups like healthcare workers and the elderly? When would you and your family members get it?
So many journalists and policy makers watch and listen to you, and getting this out in advance of the announcement will be so helpful to the American people and our nation.
Thank you, stay safe, and stay grumpy,
– Andrew
Lisa writes:
Hi TWiV team.
First – thank you SO MUCH for your work and contributions to spreading knowledge and awareness. I’m very grateful for all your podcasts, and share with everyone I know.
Second – my institution is implementing a “return to learn” program that involves testing everyone (staff, faculty, students) once per month. I, personally, don’t feel this is frequent enough to catch or prevent outbreaks. A group from my Uni recently put out this work and I would love to hear your expert thoughts on it:
https://www.medrxiv.org/content/10.1101/2020.06.01.20118885v1
I am concerned that this will be used as a reason to not test more frequently.
Thank you for your time.
Lisa
Lisa McDonnell
Associate Teaching Professor
Division of Biological Sciences
University of California San Diego
Anne writes:
Hey, Prof. Racaniello- an update on Cornell, which you may have already heard (my daughter recently received her PhD from the school – plant biology – so still gets campus emails).
Regards,
Anne
“As previously communicated, last Friday evening the Tompkins County Health Department (TCHD) identified a cluster of nine COVID-19 cases among the Cornell student population, related to student gatherings where masks were not worn nor physical distancing observed. TCHD has defined a COVID-19 cluster as five or more connected cases. Over the ensuing four days, the number of cases in this cluster grew by 12, and late yesterday evening, after President Pollack’s community message was sent, the president’s leadership team learned that the size of this and a related cluster had grown to a total of 39 cases. We expect the size of the clusters to grow further over the coming days as we learn the results of pending tests.
“With the exception of eight non-cluster-related cases, the remaining 39 positive cases from the last six days mainly comprise a particular cohort of students – student athletes (36 of the clustered cases). While these clusters represent approximately only 0.1% of our campus population, and a very small percentage of our student athletes, it points to a dangerous disregard by a group of students for the behavioral guidelines that we established to protect the public health of our community.”
State rules making it hard for larger universities in NY to have online classes:
Cornell:
Last Friday, the State of New York issued new guidelines for universities and colleges. These guidelines require significant changes in operation whenever the number of positive COVID-19 cases over a two-week period on a college campus exceeds 100 or 5% of the campus population (faculty, staff, and students), whichever is smaller. They do not require the university to shut down in that circumstance, nor do they require students to quarantine in their rooms, except for those who are in quarantine for cause, e.g., because of a contact with a known positive case. But they do require that for a two-week period, all teaching moves online, dining halls move to take-out meals only, and a variety of other campus activities are reduced or suspended.
…The new limit is less than half of the peak infection level that we had predicted and for which we prepared. But we are all here now, and this is our newest new reality, so we need to do what Cornellians have always done when faced with an enormous challenge: rise up to do everything we can to meet it. –letter from Cornell President, Martha Pollack
Jake writes:
Hello Twivers,
Listening to episode 659. I feel that Dr. Drosten’s dismissive attitude towards saliva testing comes from the viewpoint of someone from a society without a large population of positive individuals. Especially in light of the evidence that saliva testing is almost as good as the brain tickling method. They can use the more sensitive, expensive, and time consuming PCR tests. We on the other hand need to use the faster and cheaper tests to try and get the virus under control. Or am I wrong.
Jake
[Daniel told me last night that saliva is comparable to NPT in RNA levels – and here is an article to back that up https://www.nejm.org/doi/pdf/10.1056/NEJMc2016359?articleTools=true ]
Sam writes:
Dear TWiVers,
Your recent, appropriate lambasting of Brett Giroir, the Assistant Secretary for Health, underlined something for me. If I may speak frankly, I think you still tiptoe around the festering rot at the center of all this; you still tend to avoid turning the full firehose of criticism directly on the one person who’s responsible for appointing all these incompetent people and handicapping the CDC. It’s Trump. Dr. Racaniello, on an episode a while back you said you were done being nice, done being afraid to offend. I don’t think you are. I’m afraid you’re stuck in the paradigm of being unwilling to directly attack the president, because that’s too divisive for a general audience–as if Trump is a real president, a professional anything, a real person who deserves a minimal level of respect. You know he’s none of those things. And as you’ve acknowledged many times, when politics affect epidemiology, it’s absolutely within your purview to call it out.
You’re unafraid to attack others–even Pence. But every time the conversation is approaching a place where it makes sense to criticize Trump, by name, for what he’s done, it seems like you veer off and avoid a direct criticism. To be fair, I think you’ve gotten closer and closer–Dr. Racaniello said “the administration” in a recent episode, and Rich or Dickson might have actually gone the full mile and attacked Trump at one point. But I still think you feel that you have to treat it delicately.
I want you to feel free to call Trump what he is: a public health crisis. The best thing that all your listeners can do to end the pandemic is to vote for Biden on November 3rd, and that is not a political opinion. But it still feels too political to say, doesn’t it?
The thing that makes this hard for me, as a listener, is that when content creators treat this like a normal time–as though it’s proper decorum to avoid attacking the president when you speak to a general audience–it makes me feel like I’m the crazy one. It amplifies the Kafka-esque cognitive dissonance that I’ve felt for the last four years as we’ve all gotten to think of the unimaginable insanity of a Trump presidency as normal.
Thanks, love the podcast, kudos etc.
Sam
Avital writes:
Hello TWiV team!
I am only a graduate student studying psychology in Pittsburgh, PA where it is 82 degrees and too humid for my taste (I moved here from Montana).
Hoping for some more discussion on the dose-response relationship. A few episodes ago, I believe I heard you dismiss the idea of a dose-response relationship with SARS-CoV-2: either there is enough virus to cause an infection or there isn’t.
However, I recently listened to an episode of Public Health On Call where Dr. Monica Gandhi describes a direct link between viral dose and severity of sickness.
Where does the truth lie?
In the next few weeks, could you bring more guests on the show to answer these questions:
(1) If you compress a vaccine development timeline, where can the timeline be safely compressed, and where can it not? What’s the gray area and what’s black and white?
(2) When the new vaccine is proposed, how should we evaluate it? What rubric should we use? safety, immune response, durability, what populations have been tested, etc?
In a nutshell, what would you need to see in the vaccine efficacy and safety for you to feel it’s ready for use among priority groups like healthcare workers and the elderly? When would you and your family members get it?
I guess we discussed in a nutshell
______________________________________________
Tim writes:
Hi TWiV superheroes:
Accolades are not enough for all that you achieve. I and my husky look forward to each episode (me for the information and her because of the length of the walk). Almost makes me wish I was young enough to start another career.
Three notes.
First, Daniel’s regular clinical information is wonderful and made me feel particularly prepared earlier in the week with the announcement of the EUA on convalescent plasma. The potential risks not disclosed in the regular press had me yelling at various podcasts for the poorly informed journalism. Your podcasts need to be required listening by mainstream media.
Second, Vincent’s comment on paywall issues made me attach this essay from the Economist in last week’s edition. (Please do not pass on the attachment). Viruses are hot stuff when the Economist writes about it. There are several articles on viruses in the issue but the attached one has enough meat for me.
I do not believe I have heard you discuss the potential evolutionary significance and impacts of viruses (I still have 600+ archived podcasts to go thru).
Third, a podcast on CBC Ideas about “Psychologists confront impossible finding, triggering a revolution in the field”
The discussions around replication of results, scrutinizing and verifying results and methodology prompted some questions in my mind that I wonder if you can quiet.
- Open Science Collaboration failure to validate 64% of results of 100 experiments (admittedly psychology oriented) gives me pause around validation processes in natural science
- references to two sigma and five sigma confidence levels particularly referencing physics experiments that were originally judged significant that were not at a different sigma level
- most importantly the effects of data manipulation to achieve significant results and how to shield against that
- finally, does “pre-registration” get practised with vaccine-candidate Phase III trials especially with respect to analysis of data
Love the podcast. I send out links every week. I am not sure how many converts I have achieved.
—————————————————-
Thanks
Tim Wilson
OSMicroTrends Inc.
Kenner writes:
Yes, yes it is..TWiV 658
your conversational format that is so attractive to your audience. We are right there on the edge of this smart and agreeable group, a little fire in the night.
Sam writes:
Dear TWiV Team,
I wanted to ask a contrarian question. I think that one of the silver linings to this pandemic is the increased awareness that many people have to basic hygiene like hand washing. However, you’ve talked several times about how fomites are not a significant route of infection. Given that, do you think that more frequent hand washing makes a noticeable difference in slowing the spread of Covid-19? Or is it another example of “hygiene theater” as you say?
Note that I’m not in any way advocating that we stop washing our hands. It’s obviously good hygiene for a number of other pathogens. I just wonder if “wash your hands to slow the spread of COVID-19” is a) sound advice that has additional collateral public health benefits or b) a lie. . . that has additional collateral public health benefits. Either way, I’m going to keep washing my hands.
Thanks,
Sam
Zuzana writes:
Dear TWiV hosts, guests, Jolene and Ronald,
I have to shout out a loud THANK YOU! to all of you for such an incredible podcast. I love it because of the science, the format, you all sharing your expertise, humor and all the wonderful guests. TWiV was mentioned to me by my boss and PI (of 22 years :^)) in the middle of March 2020 and I became addicted… I am excited when I see the new episode is 2.5 hrs + long! I am a plant biologist at Oregon State University (plant cellular/molecular biology and genetics) and our group is mostly focusing on basic biology of pollen development these days. My PI (John – but didn’t ask for a permission to mention his name…) mentioned to me that his first biology job as a undergrad at the University of Georgia was with Kathy Spindler and it definitely influenced his passion for science! I have to mention that many SARS-CoV-2 and COVID -19 news sources I hear or read are already old news for me due to listening to TWiV. I can’t thank you and your wonderful guests enough!
Today, during my field work (sunny, blue sky and about 95F (35C)), I was listening to TWiV 659 episode with Christian Drosten.
While trying to find out major differences between the US and German responses to SARS-CoV-2 epidemic with such different outcomes (at least for now), I could not stop wondering about the role of a general population health of the two countries. Although I have heard about many cases of healthy people coming down with COVID-19, I tend to think that overall healthier population would have an advantage in fighting the virus off in earlier stages. Any thoughts?
Many thanks,
Zuzana