What I'm Reading (Apr. 1)

By Chuck Dinerstein, MD, MBA — Apr 01, 2021
The pandemic is not a monolithic event; it is a dance of the virus and our behavior. What we have learned about pandemics from the mistakes in our models. What about “long” COVID? Why does “if it bleeds, it leads” make sense?
Image by Peter Pruzina from Pixabay

“The pandemic today is almost unrecognizably different. In the United States, an acute, terrifying catastrophe has given way to the monotony of lowered expectations. There are no makeshift morgues in the streets. Businesses are opening despite a thousand American deaths a day. This week, Mayor Bill de Blasio ordered New York City employees back to work, regardless of their vaccination status, while case counts in the city are on a high plateau. The pervasive sense is that we can’t wait forever for the pandemic to end.

When, exactly, will we reach a point that could be considered a finish line? It’s the natural question, but I think it’s a counterproductive one. Not only because, as Anthony Fauci told me recently, the most honest answer is “We just don’t know.” The inability to give a definitive answer is contributing to misperception of risk, conflating better with good enough. It’s also true that much of what defined the COVID-19 crisis at its worst is no longer an issue. Many health-care workers are vaccinated, and the need to “flatten the curve” is in the past. Tests are widely available, and there are better treatments for the disease. Death rates are falling quickly.”

Indeed, both COVID-19’s and our behavior continue to change as with interact with one another. What will COVID-19 in the year 2021 look like? Certainly, far different than 2020’s version. From The Atlantic, COVID-19 Is Different Now

“Variables in epidemiological models aren’t usually well known to the general public, but one has had a genuine movie star moment. “What we need to determine is this,” says a scientist played by Kate Winslet in the film Contagion. “For every person who gets sick, how many other people are they likely to infect?” On a whiteboard, she writes down the answer for several familiar diseases: around 1 for seasonal flu, upward of 3 for smallpox, between 4 and 6 for polio.

That value is the basic reproduction number, R0 (pronounced “R-naught”) — the average number of infections that one case generates in a completely susceptible population.”

With this preamble, it is time to do a post-mortem of sorts on modeling. Forget the actual numbers; there is a lot of hidden calculation in that R0. From Quanta, Chasing the Elusive Numbers That Define Epidemics

“Long COVID, with its constellation of debilitating, life-altering symptoms, is one of the most serious outcomes of a coronavirus infection. But it remains one of the least understood parts of the pandemic. A year into the greatest global health crisis in a century, scientists still have not settled on a consensus definition for long COVID, let alone a standard set of tests or treatments. Now long-haulers are tackling one of the biggest data vacuums yet: the collision of their condition with vaccines.”

Long-Haulers Are Pushing the Limits of COVID-19 Vaccines

“This theory helps us make sense of why newspapers cover the most abnormal crimes most aggressively, rather than try to paint a more accurate portrait of a world that is essentially safer and more law-abiding, and far less spectacular in its transgressions. The newspaper is interested in, and its readers want, the aberrations as a contrast to the ordinary—precisely to affirm the ordinary.”

From the Hedgehog Review, The Press and the Police

Chuck Dinerstein, MD, MBA

Director of Medicine

Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.

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