Tom writes:
Dear Twiv, and Dr. Griffin;
I hope you will raise some extremely important points I make below with your audience.
Part I
This is a horrible story that involves the death of a promising young man in his 20’s. He had no known pre-existing conditions. On October 3rd he had flu like symptoms…on October 10th he was PCR tested along with a roommate who was also sick with flu like symptoms. At 4am on October 18th he died. He was being treated at a very well known hospital (Yale/NH…please redact if letter is published). At the time he arrived at the hospital (mid-day October 17th), his blood pressure was not manageable. He had complained of abdominal pain. It was determined his spleen had ruptured, it was removed, but because of abdominal compartmentalization both the kidney and liver damage had occurred. Post-Operative bleeding could also not be controlled even with administering platelets etc. It was discussed that he had “leukemia-like” signs (the term “blast crisis” was used and it was noted he had almost no RBC’s). It was noted that the October 10th PCR test result was never received, and that the roommate’s test was negative (he had been recovering by the 10th). In discussing the case with the family the doctors stated that a viral infection could be responsible for the “leukemia-like” signs (but confirmation would need a marrow sample). The doctors stated that a SARS-CoV-2 antibody test would NOT be ordered, and stated other viruses like EBV could be responsible. This statement did not change even when “stages of COVID” was raised and the question of what virus is currently circulating in the community. Discussion was had concerning post operative chemotherapy depending on marrow results. Questions: Are you aware of SARS-CoV-2 triggering “leukemia-like” signs? Could SARS-CoV-2 accelerate a leukemia case? It would seem doing a PCR and antibody test would be “standard” at this point, since both tests could assist with treatment, is this correct?
Part II
This is the true horror of the situation. Funeral preparations and service. Yes, there will be “inside” calling hours and a service “because this is what people expect”! Yes, “rituals” will be followed “because that is what we do”! People will attend calling hours because they “must”! When you “must” do something, will you ignore being run down, achy, not feeling 100%? The family (and others grieving) are now rundown, and I believe lack of sleep and poor diet decreases the effectiveness of the innate immune system? (Is that correct?). How does that make a difference? Masks and “social distancing” (that magical 6 feet…every virus has been issued a tape measure) will be part of the service. We have all seen how well masks are worn/or are simply not worn at all! I wonder about the effect of dabbing teary eyes with tissue held ready in the hands? I wonder what effect teary eyes have over all? Lysozyme versus an open duct and wet surface for droplet capture? That “one” hug and touch will be multiplied how many times as people stand in a receiving line (a serial dilution or magnification line????). And of course the negative test you had yesterday, three days ago, or a week ago means you don’t have the virus!
We need individuals to be leaders, that mosquito that can make a difference! Not attending is an actual option, but “because people expect” attendance and behaviors they will do what is idiotic anyway. Some are being the mosquito, many are not. How many of the over 200k PEOPLE/LIVES/FAMILIES really have the epitaph: “because this is what people expect” on their headstones? I truly hope you will provide your thoughts (both in the clinical update and TWIV discussion). You have an audience of clinicians and “only” regular people looking for real information. If you provide science based opinions to both those groups, they may learn something to spread and act on. I look forward to listening Sunday morning.
One final point….I understand Dr. Griffin has written up a “Stages” of COVID-19 summary…maybe this should be mailed out to every Dr. treating patients as a public service?
Best, and Stay Healthy!
Tom
Mona writes:
Dear TWiV team,
I have a question for Dr Griffin: you say there is a growing problem with school reopenings and more new infections. How do you think this can square with the upsetting data from the American Academy of Pediatrics and the Children’s Hospital Association that show the COVID cases in children have been rising steadily since April without a jump in August or September? Gatherings such as birthday parties, which have resulted in the COVID-19 cases you have told us about, aren’t necessarily related to school reopenings.
According to this paper (based on the same data as I sent earlier, from the AAP&CHA compiled from Health Department data from the individual states and published in Pediatrics): https://pediatrics.aappublications.org/content/pediatrics/early/2020/09/23/peds.2020-027425.full.pdf, from April 23 to September 10, the percent of cumulative total cases which are in children has gone up steadily from 2.2% to 10.0%, and the percent of weekly new cases which are in children has gone up from 2.6% to 15.9%.
This is the same data as is on the (updated) AAP&CHA page which includes a month-worth more data (to October 15).
There are caveats, like that there are differences in the way “children” are defined by age since the upper age limit varies from 14 – 20 in different states and that some states have changed the way they report on age distribution.
We need our children to be able to go to school, so this increase is alarming! Over 300% more cases in children since April! Perhaps it has to do with more testing but, according to the Pediatrics article, “… CDC data from public and commercial laboratories show the share of all tests administered to children ages 0-17 has remained stable at 5-7% since late April.”
Data from the CDC (https://www.cdc.gov/mmwr/volumes/69/wr/mm6939e2.htm) shows a similar increase. Their data from March 1 to September 19 show weekly cases for those 5-17 years old increasing from 0 to about 25 per 100,000 children. This first increased to about 35 for mid-July through mid-August but has gone down since then. (The data are also broken down into subgroups of 5-11 and 12-17, showing that the younger children, while less likely to get COVID-19 than older children, have still experienced an increasing level of infection over the same period of time.)
Mona
Simon writes:
Love you guys,
Here in Santa Clara county California – Bay Area – where days are still warm to hot nights getting cooler.
To be allowed into China you may need an invite. My wife was Chinese now American as China doesn’t allow dual citizenship. She’s arranging a trip. She needed an invite letter. When she arrives in China she has to quarantine for two weeks in the hotel.
By the way, Santa Clara county and California are obsessed with testing positivity rates. This is driving I believe a bad behavior which is to open up they encourage lots of testing as more testing will improve the positivity rate. Scc just moved from red to orange through this so can open up more. However the last two weeks infected numbers have drifted up and our R reference is hovering between 0.95 and 1 as an average various estimates between 0.9 and 1.1. The California measure just uses infected per 100k and testing positivity rate as the only numbers we care about.
Ron writes:
Hello Dr Racaniello and team! I am a listener for the past 3 years and have enjoyed your podcasts immensely pre Pandemic Era to the present. Thank you! Like Dr Griffin, I am a physician specializing in Infectious Diseases in San Francisco Bay Area and have been immersed in this Pandemic for months. Many times I have thought to contribute but haven’t. I’ll get to why now is the time in a minute. First, I want to put a little wrinkle in the school reopening
controversy. Certainly rapid testing would be ideal and truly minimize transmission in the school environment. But I question whether it is a necessary requirement in order to send kids to school. I draw on our experience in the hospital setting. I spend much of my time in a health system with 500-600 acute care beds and thousands of employees. We have had in total 5 employee infections due to occupational exposure. There have been 77 community acquired cases in our employees over the same period of time. None of the 5 Occupational exposure cases were contracted from other employees. This supports the effectiveness of measures that can be done at schools: masking, hygiene, efforts to distance (although not fully achievable in a hospital) and not working when sick.
My second reason for writing is an anecdote regarding the CDC that I would like to share. At the height of the Ebola scare in October 2015, I was called to go into the hospital for a febrile patient who had just returned from Nigeria. The entire ER was in an uproar and no one would go into the exam room. Two VPs for the health system were camped out by the room at 3am when I arrived wringing their hands. I spoke to the CDC hot line regarding whether there were any cases of Ebola in Nigeria and they assured me that there was not (as you may recall the 3 countries of concern were neighboring Liberia, Sierra Leone, and Guinea). I waltzed into the exam room obtained a history and blood and diagnosed falciparum Malaria. If this same event occurred now, I don’t think that I would be quite so accepting of their word that just because this man was from Nigeria that he did not have Ebola. But the REAL reason why I am writing is that I very much enjoyed hearing Amy Rosenfeld. She added so much to the discussion and loved her wit. I suggest that next time she is a guest, her mother should join in!
You are Orion and we are but the arrows of knowledge that you send worldwide to disseminate science and attack illogical thought processes. Your listeners are a Quiver of Twivers 🙂
Ron
Carla writes:
Dear Vincent et al.,
One of the greatest sources of frustration to me during this pandemic has been the difficulty of obtaining information. Obviously, part of the problem is that this is a new virus and much remains unknown. However, much of the media sells by generating an outsized emotional response (like fear, for example) and government officials need to use information to gain acceptance for their policy choices, making it very difficult to sort out the information that comes through news channels. In the midst of the madness, finding TWiV has been a gift. You are presenting important information to so many of us who are only asking to struggle alongside the scientists in an attempt to understand this virus and its implications. Thank you!!!
One of the things that I’ve learned from you is the difference between immunity to disease and immunity to infection. My question is: if a vaccine like polio protects people from complications of polio but does not block transmission, can it still contribute to “herd immunity” if administered to enough of the population? Your conversations suggest that it can but I’m wondering what the mechanism is.
Thank you for dedicating so much time to educating the public. I sincerely hope that you are able to build further on the platform that you have created. Your efforts are sorely needed (and much appreciated).
Best,
Carla
Perry writes:
Hi TWiV,
Hello from a colder 13C here in Sheffield, UK:
You all won’t believe that a UK Govt-sponsored SARS-CoV-2 human challenge trial has been proposed.
“Using controlled doses of virus, the aim of the research team will initially be to discover the smallest amount of virus it takes to cause COVID-19 infection in small groups of healthy young people, aged between 18 and 30, who are at the lowest risk of harm. Up to 90 volunteers, who are compensated for the time they spend in the study, could be involved at this stage.”
“If approved by regulators and the ethics committee, the studies would start in January with results expected by May 2021.”
Here is the complete link: https://www.gov.uk/government/news/expert-partnership-to-explore-and-establish-human-challenge-studies-of-covid-19-in-the-uk
I recall your disapproval in doing human challenge for a novel virus.
Please comment on this UK trial.
Thank you, and keep up the good work!
Best regards,
Perry
Ben writes:
Dear TWIV,
During Daniel Griffin’s clinical update from episode 673, Vincent asked if the increased cases in the US and Europe were due, in part, to school reopening. Dr. Griffin conveyed what I understand to be the current state of the evidence; namely, that the precautions schools are taking appear to be effective and schools are not driving increased cases in their communities. Of course, new evidence could emerge tomorrow and change my understanding. But for some reason, Dr. Griffin was not content to stop where the evidence stopped; it seemed to me that he felt that one way or another, he had to get to the conclusion that schools were responsible, and if the evidence did not support it, he would find a way to get there. And thus he suggested that reopened schools “sent a message” to the community that wider precautions could be relaxed and that this indirect effect was driving infections. My understanding, and indeed what Dr. Griffin and others on the podcast later said, is that virus spread is occurring not in the classroom, but during the students’ social interactions outside of class. Meanwhile, places where spread is known to occur – e.g. restaurants, bars, and coffeeshops – are largely open, albeit with restrictions like outdoor seating, capacity limits, and masks. But they’re open. And schools, in many parts of the country, including here in California, are closed. This is causing significant harm that many others have enumerated better than I could. If those harms are necessary to control the pandemic, then so be it. But if they’re not, let’s not continue them. I’m not suggesting Dr. Griffin’s hypothesis is unreasonable, but I do think it’s just that, an hypothesis, and if it’s supposed to be an argument to keep schools closed, I think it’s a poor one. Consider another hypothesis: while anti-racism protests in the spring didn’t directly lead to outbreaks in the cities where they occurred, they sent a message to the community that lockdowns and other precautions didn’t need to be followed if it was for something you felt was important, and this led to increased cases through the summer. Good argument?
Ben
USAF Retired
Palmdale, CA
Sonrisa writes:
Billboard in NYC about wearing masks
