John writes:
Hello TWIV,
I am a hospitalist physician in New Mexico who has been deeply involved in our hospital’s response to the pandemic, and also I have been involved in advising the local schools. I was turned on to TWIV early in the pandemic by my biophysicist brother-in-law, and I have learned a tremendous amount from you. Thank you so much for what you are doing.
I have two questions, one about science and one about policy.
The policy question is for Daniel Griffin: I have drunk the cool-aid about using cheap rapid tests frequently to more safely open up our schools. The closest test I’ve seen so far that fits the bill is the new Binax Now rapid antigen test – which is projected to cost about $5 per test – not cheap enough, but close. The other problem is that the EUA from the FDA for this test and the information from Abbott specifically states it is to be used for symptomatic people as opposed to for screening. Why is that? Dr. Griffin has mentioned large screening initiatives by ProHealth in the NY area. What test are they using? The EUA for the ID Now is also specifically restricted to symptomatic patients. These restrictions do not appear to be science based. Is there any way around them? OK, I guess that was more than one question.
My other question is regarding the discussion of far-UVC light in episode 666. Since the human microbiome is only beginning to be understood – don’t you think there a chance that frequent long exposure to far-UVC that kills the normal bacteria on the skin could potentially have unintended consequences?
Keep up the good work, TWIV has been a great benefit to me and I’m sure many others.
-John Foster, MD
Taos, New Mexico
David writes:
Hello TWiV,
This question is for Daniel Griffin. Is it unusual that Trump hasn’t been given an anticoagulant other than aspirin? What would be the reasoning behind this?
Thanks,
David
Steve writes:
question for Dr. Griffin.
you were trying to explain early decadron tx. in trumps course. Did you consider he had a transfusion reaction to regeneron infusion which caused pressure drop and a little pulmonary wheeze with mild desaturation. That might be why he was transferred to Walter Reed and given Famotadine ( H2 blocker) and steroid and not in second week protocol.
Interestingly decadron was not mentioned as ongoing therapy with 5 more days of Remdesivir. just a thought
might look bad to have reaction to compassionate use drug in stage 2 testing for drs. or regeneron and skew trial results.
Robert writes:
Dear TWIV,
Really appreciate your efforts in getting this special episode out in a timely manner.
What I understood from Dr. Griffin’s presentation was that because the President received dexamethasone treatment on Oct 4, this suggests he was ALREADY in roughly the SECOND week of infection. Working backwards, this suggests that he was ALREADY infected around the time of the first debate with Biden. Can we assume he is tested regularly and knew he was infected during the debate? Did the public only learn about the infection when it became clear he was having a symptomatic infection? [These are rhetorical questions that I fully recognize don’t require your expert knowledge of virology to answer!]
The only other alternative I can see is that the President received dexamethasone much earlier in his infection course than is recommended, but given how Dr. Griffin made it clear that receiving steroids too early is dangerous, I can’t imagine the President’s medical team would have done this.
Keep up the great work!
Robert
San Bruno, CA 57degF and sunny; thankfully not smoky!
Jenny writes:
Why can’t we have cheap rapid result antigen test like this in the US?
Jenny
SFRC/UF
Dave writes:
Y’all make fun of Dr. Fauci that Ct are not available. Let me challenge you further. If I am not mistaken, most qpcr SARS-CoV-2 tests approved by WHO/CDC/FDA use TWO primer pairs. I do not recall this ever being discussed. As you know each qpcr primer pair is unique with its own Ct sensitivity. Please explain why you would be satisfied with a single Ct value. Also comment on the BEST primer pairs for qpcr for SARS-CoV-2. Furthermore please comment on efficacy of single versus double primer pair tests with regard to detecting infectious patients.
Thank you! I enjoy the show!
Dave
Vincent writes:
Hi Dr. Rac! Consider this email question for an upcoming TWIV broadcast. Tx-Vr
Hello Twiv Crew!
This is Vincent Racaniello, the lesser, Vincent’s doppel-name-ganger.
Recently I heard a guest on a popular midday radio show about health and nutrition claim that flu vaccinations can both make one susceptible to respiratory illnesses and increase one’s risk of contracting Covid 19.
Being a seasoned TWIV listener my BS meter immediately went into the red, as did my temper. I found myself Racan-yelling at the radio. I have to admit it had a cathartic effect perhaps more so since I count myself among the rarified few who can adopt that expression as their own. Literally!
A quick internet search revealed that the association with respiratory illness stems from a 2012 study the results of which could not be replicated, while the Covid 19 risk association was from a 2020 study that under peer review was found to be incorrect.
And in what dark recess of the internet did I have to search to find this debunking trove?
The CDC web site itself. https://www.cdc.gov/flu/prevent/misconceptions.htm
Since this is the time of year when many people begin to get their flu shots, could you please, as a public service, explain yet again, why it is vitally important to obtain a flu shot this year and how they are both safe and efficacious.
Thank you all for all that you do.
Sending you my grumpy best,
Vincent Racaniello
Gordon writes:
Dear Vincent and TWIV et al,
I thoroughly enjoyed your interview in #666 on the exciting prospects of Far UVC light.
A few various thoughts…
1- Most UV items found online are junk UV-C devices, and to the extent they are effective, are also unsafe.
2- there are companies which do sell effective handheld UV-C devices, such as
This requires proper skin and eye protection, so safe use around the home is a concern. Despite the good amount of power I find it takes a couple minutes with this for me to fully scan our newspaper front page.
3- the Columbia U lab has also studied the use of Far UV in a “leaky” fiber optic setup with a catheter to keep the wound clean. This was mentioned to me by Dr Buonanno when I asked if there might be a way to introduce Far UV into the upper airway and respiratory tract.
4- product literature from Ushio Japan regarding Care222 Far UV lamps indicated it takes several minutes to deactivate airborne pathogens.
This seems comparable to another technology for use in HVAC, the Needlepoint Bipolar Ionization systems from GPS inc which generates hydroxyls and neutralizes airborne pathogens.Their literature mentions having installed this in the White House.
They test results for SARS Cov-2 are here:
Thanks very much for being such a welcome source of healthy information.
Gordon
Melissa writes:
Dear TWiV gang,
I’m writing from Bellmore, New York (out on “the Island”, not too far from Jones Beach) where it is currently 24 C and overcast. I just wanted to start off by saying how happy I am to have found TWiV a few months ago. It has allowed me to be happily reconnected to my former scientific life. I earned a PhD in Biological Sciences from our dear Columbia University in 2007, where I worked in the lab of Dr. Carol Prives. I had to leave research during my post-doc in 2010 because my daughter was born with medical issues, and I miss it everyday. I love tuning into TWiV and feeling “at home” again. I love the journal club feel of the podcasts, as it was one of my favorite parts of being in a lab. (However, I don’t miss giving lab meetings! Emoji)
I am currently on a new career path that is completely different from what I did in my “former life”. Thankfully, this new path still uses the analytical part of my brain that I developed after nearly 15 years of lab work. I am finishing a training program to become a certified reading specialist for children with dyslexia and other language-based reading and writing disabilities. My training is in the Orton-Gillingham approach; this is considered the “gold standard” methodology for remediating reading difficulties. It involves an explicit, systematic and multisensory approach to teaching the English language. It instructs kids how to “break the code” and apply systematic rules to reading. These rules are needed to cement the neurological pathways in their brains to make reading fluent and automatic. Writing my Orton-Gillingham lesson plans feels very much like when I used to design experiments, as there is much attention to data analysis and using that data to guide your future steps (it is a highly diagnostic and prescriptive approach). Lest you believe that the current epidemic of science denying is limited to climate change and COVID19, rest assured! The science of reading is equally maligned and disregarded by the masses, despite strong evidence in support of the techniques it proposes. I don’t understand how or when science became the enemy in this world.
A few things mentioned last week really resonated with me. I loved Alan Dove’s mild rant on the lack of curation with NCBI/PubMed. Having worked in a p53 lab for my PhD, I understand the pain of having to weed through dozens of questionable publications with every PubMed search. At the time of my thesis defense in 2007 there were approximately 40,000 publications with p53 in the title; a quick search today reveals over 102,000 publications. Yikes! I remember the mythical rule-of-thumb that was circulating around my lab at the time I wrote my thesis– that my advisor wouldn’t even read your draft unless you cited 1% of the publications (or 400 articles in my thesis). I can’t imagine having to cite over 1,000 articles today!
I enjoyed your recent discussion with David Brenner regarding the use of far UVC light as a possibility for continuous anti-microbial treatment in public spaces. One question that came to mind is if there is any possibility for microbes to gain resistance to the widespread use of far UVC? Could there be selection pressure to circumvent the mechanisms that lead to microbial death, and allow replication despite DNA damage? Also, because the far UVC would kill all types of microbes (both pathogenic and non-pathogenic) could there be other unintended consequences to the ecological balance with such a widespread approach? I feel like I may have better known how to answer to these questions when I was still in the lab, but these days the information I need is in the far recesses of my mind.
Thank you so much for your always intelligent and fun podcast. I have learned so much and try to pass it on to my non-scientific friends and family whenever I can. (I have held several informal seminars in my kitchen to explain PCR vs lick-a-stick testing for SARS-CoV2. I think my husband is getting sick of hearing me say “Ct value”.)
Stay well, Melissa
PS- I was also “today” years-old when I learned that the UV light in the cell culture hood isn’t blue. Emoji
————————
Melissa Mattia-Sansobrino, PhD
Anonymous writes:
Dear TWIV Team,
A friend of mine recommended TWIV back in February and I have been listening ever since. I live in Hong Kong, so I listened to Episode 665 where you discussed the paper on superspreading events with interest.
I’d like to fill in some details on why we have been pretty successful in controlling the spread of SARS-CoV-2 despite being a highly densely populated city and without having to go into full lockdown. We did close schools and a lot of public venues, but shops stayed open and restaurants were still allowed to seat customers before 5 p.m..
1. We adopted near-universal masking as soon as we heard about the virus in Wuhan back in February, without being told. Our previous experience with SARS made it impossible for anyone to be an anti-masker no matter how they distrusted the government. In fact, at the time the government was telling civil servants not to wear masks to conserve the supply, and was still defending a ban on masks at public gatherings in court (intended to stop protesters from hiding their faces). People masked up anyway, and political activists organized to distribute them to low-income and elderly residents.
https://www.theatlantic.com/technology/archive/2020/05/how-hong-kong-beating-coronavirus/611524/
2. Travel was shut down in March. Only Hong Kong residents were allowed to enter and everyone arriving had to be quarantined for 14 days. People have to spit in a tube and get tested at the airport. In fact medical workers went on strike in early February to demand a complete border closure and better supplies of PPE because they thought the government wasn’t being aggressive enough. After weeks with virtually no cases, we had a second spike in July because it turned out flight crews, sailors, and corporate executives among others were exempt from quarantine requirements, so of course the virus got back in.
https://www.coronavirus.gov.hk/eng/inbound-travel.html
https://www.ft.com/content/2f4034e5-2151-480e-8684-0ae8016ddbf1
3. TETRIS. We have a pretty robust public health infrastructure. Everyone who tests positive is hospitalized or put in a temporary medical facility regardless of symptoms. Their close contacts are also tested and required to live in a quarantine facility until their test results come back. That’s why all the infection chains terminated once they got to family clusters. The unpopular political leadership has mostly had the sense not to turn testing into a partisan issue, that is until recently, when Chief Executive Carrie Lam accused medical professionals who criticized the government’s mass PCR testing scheme on grounds of privacy and usefulness of being “politically motivated” and “conspiring to smear the government”.
https://qz.com/1895851/why-hong-kongers-are-suspicious-of-universal-covid-19-testing/
I suppose if there is any lesson to be drawn from Hong Kong, it is that decent public health institutions combined with a strong community spirit can make up for lacklustre political leadership. Also, while I’m glad that testing is finally gaining traction in the US, I feel like the “”trace” and “isolate” parts still don’t get enough attention. Our testing capacity actually was lower than Macau’s (a city with less than 1/10 of our population), but we sure did trace and isolate people.
Anyway, love the show. Stay grumpy!
Anonymous