Thursday, Aug 27, 2020
Clinical guidelines can be based on many factors and often must account for resource utilization, incomplete or imperfect data, and the practicalities of what is possible. The recent CDC guidelines on testing seem to be plagued by a lack of transparency, at best. It is deeply unsettling to see the CDC downplay the need for testing in asymptomatic, but exposed, individuals. Doing so without communicating the policy shift to all stakeholders is foolish. This certainly projects the appearance that the goal is to either decrease the use of tests (perhaps because we have a limited testing capacity) or reduce the number of positive cases. These recommendations are not what I would advocate for my patients or my family. Willful ignorance does not make a pandemic go away.
https://www.washingtonpost.com/health/cdc-testing-guidelines-coronavirus/2020/08/26/eb653028-e7af-11ea-97e0-94d2e46e759b_story.html
or
https://www.medscape.com/viewarticle/936379
----------------
Latest Data
Global-View:
https://www.ft.com/content/a2901ce8-5eb7-4633-b89c-cbdf5b386938
Nationally:
There is a continued slow decline in new cases in the US (40,000 a day, still) and stable deaths @ 2.9-3.0 per million (or about 900 deaths per day), but the data varies by state and region.
https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&areasRegional=usny&areasRegional=usca&areasRegional=usfl&areasRegional=ustx&areasRegional=usco&cumulative=0&logScale=0&perMillion=1&values=cases
Also, look at https://covidtracking.com/data
The US Regionally:
The NY Times state-level data visualization:
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
About the data:
https://covidtracking.com/about-data/visualization-guide is the best resource to understand data visualization and data integrity.
-----------
Here is an MMWR article about mass testing in asymptomatic, exposed populations of patients. CDC epidemiologists are authors. This report demonstrated a 12x increase in identifying cases compared to symptomatic testing alone in 16 prison populations.
https://www.cdc.gov/mmwr/volumes/69/wr/mm6933a3.htm?s_cid=mm6933a3_w#contribAff
Some of the Operation Warp Speed team members published an editorial in the New England Journal of Medicine about their work and thoughts. I suspect vaccines will be an increasingly public conversation in the coming months. Good to arm yourself with knowledge before the topic enters more of the media maw.
https://www.nejm.org/doi/full/10.1056/NEJMp2027405
Here is my favorite critical analysis of some fuzzy medical claims from yesterday. Fitbit claims they can identify some early symptoms of COVID.
https://twitter.com/deaneckles/status/1298384958344630286
I love my Fitbit as a dedicated step tracker. I would not rely on their sensors as a precise means of measuring anything else.
CMS also released some new very heavy-handed mandates about COVID data reporting from hospitals on Tuesday. This is the sixth rule change about hospital data reporting in the last six months.
https://www.medscape.com/viewarticle/936375
The American Hospital Association offers an infographic on these changes: https://twitter.com/ahahospitals/status/1298624729977360394
and
https://www.aha.org/press-releases/2020-08-25-statement-cms-interim-final-rule-data-collection-and-medicare-conditions
I am not sure I fully appreciate the implications of this issue, but a sage history professor once told me, "when you see lots of rules or laws addressing the same issue, look for larger and systemic issues."
Infographic of the day - Venn Diagrams Gone Wild.
I don't know what I would use this for, but the fact that someone made this complex diagram broadens my horizons. You could use such a construct to offer a 1-hour, 1-slide talk. And you will still run out of time.
https://i.redd.it/nfbtyspcvhj51.jpg
-----Bonus Round - Misinfodemic
This weekend, when you get a chance, I suggest investing an hour in watching Carl Bergstrom's recent closing talk on the misuse of quantitative misinformation at the Society for Mathematical Biology's annual meeting. You know how much I like him.
https://www.youtube.com/watch?v=ZSp-k6C9qBw
One other article of note. My wife doesn't like cilantro - like a visceral disgust. I feel similar but with a touch less intensity, about Hershey's chocolate. I ran into this article about the science of disliking Hershey's chocolate. Castor oil and butyric acid are the culprits.
https://12tomatoes.com/hersheys-chocolate-taste/
Clean hands and sharp minds,
Adam
Have a safe weekend. I'll be back on Monday.
Clinical guidelines can be based on many factors and often must account for resource utilization, incomplete or imperfect data, and the practicalities of what is possible. The recent CDC guidelines on testing seem to be plagued by a lack of transparency, at best. It is deeply unsettling to see the CDC downplay the need for testing in asymptomatic, but exposed, individuals. Doing so without communicating the policy shift to all stakeholders is foolish. This certainly projects the appearance that the goal is to either decrease the use of tests (perhaps because we have a limited testing capacity) or reduce the number of positive cases. These recommendations are not what I would advocate for my patients or my family. Willful ignorance does not make a pandemic go away.
https://www.washingtonpost.com/health/cdc-testing-guidelines-coronavirus/2020/08/26/eb653028-e7af-11ea-97e0-94d2e46e759b_story.html
or
https://www.medscape.com/viewarticle/936379
----------------
Latest Data
Global-View:
https://www.ft.com/content/a2901ce8-5eb7-4633-b89c-cbdf5b386938
Nationally:
There is a continued slow decline in new cases in the US (40,000 a day, still) and stable deaths @ 2.9-3.0 per million (or about 900 deaths per day), but the data varies by state and region.
https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&areasRegional=usny&areasRegional=usca&areasRegional=usfl&areasRegional=ustx&areasRegional=usco&cumulative=0&logScale=0&perMillion=1&values=cases
Also, look at https://covidtracking.com/data
The US Regionally:
The NY Times state-level data visualization:
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
About the data:
https://covidtracking.com/about-data/visualization-guide is the best resource to understand data visualization and data integrity.
-----------
Here is an MMWR article about mass testing in asymptomatic, exposed populations of patients. CDC epidemiologists are authors. This report demonstrated a 12x increase in identifying cases compared to symptomatic testing alone in 16 prison populations.
https://www.cdc.gov/mmwr/volumes/69/wr/mm6933a3.htm?s_cid=mm6933a3_w#contribAff
Some of the Operation Warp Speed team members published an editorial in the New England Journal of Medicine about their work and thoughts. I suspect vaccines will be an increasingly public conversation in the coming months. Good to arm yourself with knowledge before the topic enters more of the media maw.
https://www.nejm.org/doi/full/10.1056/NEJMp2027405
Here is my favorite critical analysis of some fuzzy medical claims from yesterday. Fitbit claims they can identify some early symptoms of COVID.
https://twitter.com/deaneckles/status/1298384958344630286
I love my Fitbit as a dedicated step tracker. I would not rely on their sensors as a precise means of measuring anything else.
CMS also released some new very heavy-handed mandates about COVID data reporting from hospitals on Tuesday. This is the sixth rule change about hospital data reporting in the last six months.
https://www.medscape.com/viewarticle/936375
The American Hospital Association offers an infographic on these changes: https://twitter.com/ahahospitals/status/1298624729977360394
and
https://www.aha.org/press-releases/2020-08-25-statement-cms-interim-final-rule-data-collection-and-medicare-conditions
I am not sure I fully appreciate the implications of this issue, but a sage history professor once told me, "when you see lots of rules or laws addressing the same issue, look for larger and systemic issues."
Infographic of the day - Venn Diagrams Gone Wild.
I don't know what I would use this for, but the fact that someone made this complex diagram broadens my horizons. You could use such a construct to offer a 1-hour, 1-slide talk. And you will still run out of time.
https://i.redd.it/nfbtyspcvhj51.jpg
-----Bonus Round - Misinfodemic
This weekend, when you get a chance, I suggest investing an hour in watching Carl Bergstrom's recent closing talk on the misuse of quantitative misinformation at the Society for Mathematical Biology's annual meeting. You know how much I like him.
https://www.youtube.com/watch?v=ZSp-k6C9qBw
One other article of note. My wife doesn't like cilantro - like a visceral disgust. I feel similar but with a touch less intensity, about Hershey's chocolate. I ran into this article about the science of disliking Hershey's chocolate. Castor oil and butyric acid are the culprits.
https://12tomatoes.com/hersheys-chocolate-taste/
Clean hands and sharp minds,
Adam
Have a safe weekend. I'll be back on Monday.
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