Aloke writes:
Hi,
Please comment on this article by Dr. Siddhartha Mukherjee:
https://www.newyorker.com/magazine/2020/04/06/how-does-the-coronavirus-behave-inside-a-patient
Some sentences taken without any surrounding context:
“… three questions deserve particular attention, because their answers could change the way we isolate, treat, and manage patients. First, what can we learn about the “dose-response curve” for the initial infection—that is, can we quantify the increase in the risk of infection as people are exposed to higher doses of the virus? Second, is there a relationship between that initial “dose” of virus and the severity of the disease—that is, does more exposure result in graver illness? And, third, are there quantitative measures of how the virus behaves in infected patients (e.g., the peak of your body’s viral load, the patterns of its rise and fall) that predict the severity of their illness and how infectious they are to others?”
Are the answers to these Q’s: “To be Decided”,
or do we know that the initial dose of exposure has no effect on a) risk, b) severity, c) infectiousness
Aloke
PS: Another sentence from the article: “as a graduate student, I was trained in viral immunology”
Charles writes:
Hello TWiVers;
Great job on the “PANTS ON FIRE” fact check (see link).
Not many people give as much of their time to the public good as you do. That by itself is enough to make each of you very special. TWiV is special in that as a group it’s as good as the sum of its parts. That is high praise. Most groups are only as good as their average part. Some, like the current GOP, are only as good as their worst part.
Thanks and please keep up the great work,
Charles
Bill writes:
Wide rebuttal online to Dr. Li-Meng Yan conspiracy theory
AP agrees – https://apnews.com/afs:Content:9391149002
Newsweek agrees – https://apnews.com/afs:Content:9391149002
Independent agrees – https://www.independent.co.uk/news/world/americas/coronavirus-dr-li-meng-yan-twitter-account-suspended-wuhan-b454268.html
Tech Times agrees – https://www.techtimes.com/articles/252635/20200917/fact-check-research-paper-by-li-meng-yan-backed-up-by-rule-of-law-foundation-who-are-behind-this-organization.htm & https://www.techtimes.com/articles/252635/20200917/fact-check-research-paper-by-li-meng-yan-backed-up-by-rule-of-law-foundation-who-are-behind-this-organization.htm
Suzanne writes:
I believe there is a case to make against screening tests for mass gatherings. The false negatives could create spreading situations in places where people might crowd together and choose not to wear masks because of a false sense of security. The false positives could at the very least be a hassle.
On the other hand, they’re perfect for schools and businesses where people are generally in smaller groups and can be tested multiple times during the week.
IMO, Ideally, don’t have the mass gatherings. But if you must, few false negatives less a problem than the many untested asymptomatic positives.
Jake writes:
Misinformation is still rampant.
Hello twivers,
I work as a machinist and as my particular job is rather boring I listen to a number of podcasts. I was listening to the Indicator from NPR the other day, and they had Greg Ip on. He was discussing an article he had written for the Wall Street Journal in which he claimed that the lockdowns were too blunt and we could and should do a more targeted approach. He made a number of claims with dubious legitimacy, but the one that made my head explode was his claim that there is no reason to keep schools closed because kids can’t get sick. I just couldn’t believe there are still people who think this is true and there was zero pushback from the interviewer. This is exactly why we are in the mess that we are in.
Anyways, keep up the good work. Every week I learn a little more and understand a little more.
Jake
Dawn writes:
Dear TWiV,
Hello! I live in Wisconsin and and have chosen to keep my 2nd and 3rd grade girls home for virtual learning this year as we continue to have increasing numbers of COVID-19, and because I observe that most in my community do not seem to hold the reality of the pandemic as part of their “belief system”. I have a feeling that WI, among other states, is in for a bad time in the coming months. My sanity is kept in check by my daily walks as my husband watches the girls and I listen to podcasts for some mental relief. You all are at the top of the list!
My question comes from a conversation I had with another family member over the weekend. He, like my family, took the flu vaccine earlier than usual (about a week ago), since we have no idea where our state will be in another month or two. We know there is an effective window on the flu vaccine. My family member informed us that he planned to get a second vaccine in about 6 mo just to make sure he was protected. I said I hadn’t heard of anyone being advised to do that, but this is not my area of expertise, and wondered what the experts (you all) would say about that.
Furthermore, he said he read an article that likened the immune system to a “muscle” that needs to be used to remain strong, and that getting an additional flu vaccine might “bolster” his immune system to be more prepared for a possible Covid 19 infection. I don’t know the source of this article, but it goes against my understanding of the immune system. (My background is laboratory medicine and then dentistry). It is my understanding that first of all, a person would not want a “bolstered” immune system or response, but instead a “precise” and “accurate” response to fight COVID-19, as it is the immune response that is really the thing killing patients in many forms throughout the body. Secondly, the idea of the immune system being compared to a muscle that needs to be used to stay strong does not ring true.
I would appreciate it if you could clear up these misconceptions that I believe some people may have about vaccines, how many flu shots they can/should receive in the flu season and what , if anything, optimizes our immune system to fight “precisely and accurately”. I have always believed it was a combination of good nutrition, good sleep and managing stress levels.
You all are great! I am always impressed with how you handle yourselves and the integrity of the show. I look to you for the “real deal” when it comes to what science is telling us about both SARS CoV 2, COVID-19 and vaccine progression. Keep up the great work!!
Warmly,
Dawn in Wisconsin
We discussed the “repeat flu vax” issue several weeks ago. I think we came down on “only for the most vulnerable”?
Ted writes:
Alabama highcoo.
What’s the difference
Ignorance and apathy
I don’t know, don’t care.
Lisa writes:
Hi TWIV Rock Stars,
Writing from sunny Sarasota, FL where it has finally cooled off to below 90 degrees. Feeling quite grumpy today as I send off the below letter to our local school superintendent, Governor, and both the administrator and epidemiologist at my county health department. To me, the current policy referenced in the letter seems positively nonsensical. Curious as to your thoughts. Keep up the great work helping us all to stay informed through this crazy time!
Dear —— ,
I am both a mom to a Sarasota County School student, as well as a pediatric nurse practitioner in Sarasota. Since becoming aware of the seriousness of the COVID-19 pandemic, I have been working hard in both these roles to provide needed healthcare and to minimize spread.
Policies understandably change frequently, often on a daily basis. We are watching science evolve in real time as our knowledge about this rapidly grows.
Once schools shut down in March, our office saw what was an extraordinary number of patients with respiratory illnesses immediately drop to almost none. This continued through the summer.
I believe all of us have felt some trepidation as the decision to allow in-person schooling to resume in Florida was made. I believe we all feel the challenge of weighing the educational and emotional costs of having our children not attend in-person school, with the costs of potential increased cases and deaths by allowing them to gather together.
Traditionally, once school resumes in the fall we begin seeing an increase in illnesses. Despite all the measures with masks and distancing and hand washing, this has proven to be the case this year as well.
My office is providing rapid SARS-CoV-2 testing. As current evidence suggests that children in particular may have varied and less serious symptoms with this infection, and that folks may be contagious either without or before showing symptoms, our criteria to test is low.
Fortunately, our results have mostly been negative, which is a reflection of the current lowered prevalence in this area. However, I believe that frequent testing with rapid results remains one of the cornerstones of our efforts to keep rates low. If we are able to quickly identify those who are infected, we can quarantine and contact trace to minimize spread.
When we test patients in our office and obtain a negative result, we provide a return to school note advising of the negative test. Clearly, with a known exposure current policy calls for a 14 day quarantine, regardless of a negative test.
We test patients and provide this note of a negative result as it seems best medical and epidemiological practice. Both to prevent spread and to let our local schools know how many students are being tested and the results of those tests, as they also work to prevent spread.
Today the policy of the Sarasota County Schools regarding return to school with a negative test, along with no known exposure, came to my attention. I thought surely the person telling me this policy must be mistaken and so I called the School Board to confirm.
If a student has been home ill and has either not sought medical care or not been tested, a note from a parent or a healthcare provider is sufficient to return to school once symptoms are mostly improved and they have had no fever without fever reducers for the past 24 hours. However, if a student has been tested – even if they have had no known exposure and their test is negative – they cannot return to school without clearance and a letter from the Department of Health.
This does not make sense to me. Asking parents who have sought medical care and testing to then have to jump through this additional hoop to get their child safely back in school seems to encourage exactly the opposite of what we ought to be encouraging. It encourages not seeking testing and merely sending their student back as soon as they are feeling better, without knowing if they are infected and thus potentially still contagious.
Regards,
Lisa Patterson, APRN, CPNP-PC, DNP
Venice, FL
Keep reading…
Hello again,
As an update to the email I sent yesterday to the Superintendent of our county school system, the epidemiologist and administrator of our county health department, and our Governor.
This afternoon I received a reply from the epidemiologist at the health department. They are changing the return to school policy so that students without a known exposure are able to return to school once afebrile and asymptomatic for 24 hours and will not continue to then have to obtain a clearance letter from the health department simply because they also were tested for SARS-CoV-2. Obviously this is for students who test negative. Those with either a known exposure or a positive test will be subject to either a 10 or 14 day question, regardless of test results.
Felt good to be able to use science and logic to effect a policy change at the county level!
Lisa