Now, with two co-workers under 4-years constantly trying to “help” me during business hours, most of my ‘spare’ time (see: when they are sleeping) has been dedicated to catching up on work, but I do think it’s important to stay informed on what’s going on with this (hopefully) once in a lifetime black swan event. And, since mainstream news insists on providing infotainment, instead of education and our government entities (WHO, CDC, U.S. Surgeon’s General, et al.) have all shared misinformation (see: let us down), I’ve sought out my own sources and shared them with you below.
I will continue to update as time permits. [Last Update: 9/13/2020]
[Photo by Edwin Hooper]
[Study]: “Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study”
The first RCT on Vitamin D & COVID. 50 patients received Vitamin D, 26 did not. Only ONE patient in the Vitamin D group was admitted to the ICU. Whereas, 13 patients or HALF in the control group were. Vitamin D supplementation reduced ICU risk 25 TIMES
It probably makes more sense to compare the U.S. death toll to similarly positioned and sized countries — meaning the biggest countries in Western Europe and our major neighbors in the Americas — than to compare us to a global average. And when you compare deaths as a share of population within that group of peer countries, the U.S. starts to look more mediocre and less uniquely catastrophic.
Spanish researchers tracked 1,900 kids and adults at camp for five weeks. 30 kids had infections acquired outside camp. Those 30 infected a total of 12 fellow campers (out of 253 contacts) – an R far below 1.
In encouraging news, new research indicates that human immune system cells are storing information about the coronavirus so they can fight it off again.
Three crew members aboard were spared when the virus spread through the boat. They were the only ones who had antibodies at the beginning of the trip.
A new study from King’s College London inspired a raft of headlines suggesting that immunity might vanish in months. The truth is a lot more complicated—and, thankfully, less dire.
Spread of SARS-CoV-2 in the Icelandic Population – New England Journal of Medicine
As the debates around sending teachers and students back to school, this is an important study and conclusion: “[E]ven if children do get infected, they are less likely to transmit the disease to others than adults. We have not found a single instance of a child infecting parents.”
Here’s a good Twitter thread outlining some of the highlights and implications from the study.
U.S. medical centers have reported 5,000-plus cases of patients likely catching the coronavirus once admitted for other conditions, adding to the strain of the pandemic itself.
Clinical Research Fellow and Pediatric Infectious disease expert Alasdair Munro shares an great Twitter thread on the evidence we have so far on schools, children, teachers, and #SARSCoV2 plus some additional thoughts/considerations
A handful of Big Studies Came Out Recently in Support of Hydroxycholorquine:
- COVID-19 Outpatients – Early Risk-Stratified Treatment with Zinc Plus Low Dose Hydroxychloroquine and Azithromycin: A Retrospective Case Series Study
- Treatment with Hydroxychloroquine, Azithromycin, and Combination in Patients Hospitalized with COVID-19
- Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: A retrospective analysis
- Risk Factors for Mortality in Patients with COVID-19 in New York City
Note: This article is a preprint and has not (yet) been certified by peer review, but it confirms a lot of what I’ve seen and read to date. The gist that a lack of Vitamin D correlates with higher mortality rate. In short: Get outside and get sunlight. If you live somewhere this isn’t possible, consider Vitamin D supplementation.
In a large population of patients admitted to hospital with COVID-19, disease outcomes were better predicted by frailty than either age or comorbidity. Or, as Alexander Juan Antonio Cortes always tells us, “The stronger you are, the harder you are to kill.”
The number of excess deaths is substantially less than the official reports of 1,709 COVID-19-related deaths over the same period. This means that officially-reported COVID-19 deaths likely overestimates the true burden of excess deaths caused by the virus. The report also points out that the changes to healthcare delivery during the epidemic, such as the suspension of elective activity in public acute hospitals, may have a lasting impact on health outcomes, which may take years to be seen.
Invisible outbreaks sprang up everywhere. The United States ignored the warning signs. The New York Times analyzed travel patterns, hidden infections and genetic data to show how the epidemic spun out of control.
For ages from 50-64, a “1 in 852,000 chance of being hospitalized or a 1 in 19.1 million chance of dying.”
“We were surprised how low the relative risk was” UCLA-Stanford study shows.
Many mass immunization efforts worldwide were halted this spring to prevent spread of the virus at crowded inoculation sites. The consequences have been alarming.
Complete coronavirus primer. “In this article we provide a one-stop, curated graphical source for the key numbers (based mostly on the peer-reviewed literature) about the SARS–CoV–2 virus that is responsible for the pandemic. The discussion is framed around two broad themes: The biology of the virus itself, and the characteristics of the infection of a single human host.”
The alphabet agencies continue to fail us via their incompetence. The government’s disease-fighting agency is conflating viral and antibody tests, compromising a few crucial metrics that governors depend on to reopen their economies. Lumping together tests for active coronavirus with those for recovered patients, muddies the process of tracking the pandemic’s course.
Even small differences in timing would have prevented the worst exponential growth, which by April had subsumed New York City, New Orleans and other major cities, researchers found.
What’s happening is not one crisis, but many interconnected ones. As we shall see, it will be harder to come to terms with such a crisis. It will be harder to bring it to heel. And it will be harder to grapple with the historical legacies that have shaped today’s patchwork.
An impressively clear explanation of how the virus often spreads inside confined spaces, like restaurants, churches, workplaces and schools.
Even when people remain more than six feet apart, they can become infected by breathing the same air as an infected person for an extended period of time, Bromage explains. Those scenarios, he argues, are more worrisome than a quick trip to the grocery store or almost any outdoor activity.
A retrospective study found that for each standard deviation increase in serum vitamin D people were 7.94 times more likely to have a mild rather than severe COVID-19 outcome and were 19.61 times more likely to have a mild rather than critical outcome.
A simple way to understand why experts believe the official count is actually understated: The number of Americans who have died in recent weeks is much higher than normal.
COVID-19: What’s Wrong with the Models? – Peter Attia
“We’re not there yet.”
The re-opening process needs to happen gradually. Think of it like turning a dial vs. flipping a light switch.
What do we need to re-open?
- Contact tracing
- The ability to test broadly (750,000+ people/week)
- Ability to reserve capacity in our healthcare facilities
Scott is a fellow at the American Enterprise Institute, a public policy think tank. He was the 23rd Commissioner of the U.S. FDA (serving from 2017 to 2019) and his Twitter coverage has been the best, most informative that I’ve discovered regarding COVID19.
The fight against the coronavirus won’t be over when the U.S. reopens. This article does a good job outlining how the nation must prepare itself.
What is convalescent plasma and can it help patients with
#COVID19? – Jennifer Spicer, Assistant Professor of Medicine, Infectious Diseases, Emory University
Max Roser and his team at Our World in Data are consistently one of my favorite resources for curating and interpreting data. Only on the basis of clearly presented and well-documented data can governments, organizations and individuals hope to respond appropriately to the COVID-19 pandemic. The goal of their work is to present the best available data and clarify what can – and can not be said – based on this data.
If you’re getting restless and starting to wonder, “How will we get our lives back?” this article is worth your time. We still need more time to get better therapeutics in our toolkit, serological testing, contact tracing, etc. before we can start re-opening and, even then, it should be done in phases.
This page presents all our content related to the COVID-19 crisis and other useful resources. It covers key information about the crisis, how to use your time and money to help the world tackle it effectively, ideas on how to personally cope, and how to use your career to help prevent future pandemics.
Discussion on Covid19 hypoxia/hemoglobinopathy theory – Peter Attia
This is a nice compliment to the John’s Hopkins case count dashboard. No governmental or institutional source is publishing complete testing data—including not just identified cases, but how many people have been tested, and where. Without this data, we can’t make informed decisions or accurately communicate risks. The Covid tracking project aims to remedy this.
Study of 318 outbreaks in China found transmission occurred out-of-doors in only one, involving just 2 cases. Most occurred in home or public transport. Raises key chance for states to move services outdoors (religious, gym classes, restaurants, etc)
- Leora Horwitz – Director, Center for Healthcare Innovation and Delivery Science at highly ranked NYU Langone Health
- Vineet Chopra – Chief, Associate Prof, Researcher, Author, Editor, Teacher, University of Michigan
- Clinical Pearls Covid-19 for ER practitioners from an Aggie ER Doc on the front-lines in New Orleans
Using cell phone location data, Unacast created this interactive Scoreboard, updated daily, to empower organizations to measure and understand the efficacy of social distancing initiatives at the local level.
Speaking of social distancing, many prominent U.S. voices have are worried the “cure” (i.e. social distancing) is worse than the impact of COVID. Tom Inglesby, the Director of the The Johns Hopkins Center for Health Security, argues that with the exponential growth of the virus, social distancing is critical to prevent our health care system from becoming overwhelmed. (Tom has been out in front of this from the onset. His Twitter is a great resource for COVID19 information right now.)
Cambridge scientists test effectiveness of household materials at protecting against virus 5x smaller than coronavirus. (Spoiler alert: As I’ve been screaming to anyone who will listen since mid-February, masks work.)
It’s true that the risk of dying from coronavirus is higher for the elderly and those with pre-existing conditions but, as evidenced by the article above, this is not just something older people should be worried about. (I try to be careful with n=1’s, but was alarmed that 42-year old healthy lawyer and marathoner, David Lat, was ventilated for 6 days with coronavirus—one of very few people who have been put on a ventilator that lived. He’s documented the experience in full on Twitter.)
The Next Steps – Benjamin Bidder et al | Spiegel | 27th March 2020
Very interesting read: The crisis viewed from Germany; a plain-worded exploration of the trade-offs between public health and productivity. Governments have handed authority to scientists who understand the mathematics and biology of epidemics but not necessarily the social and political fundamentals. By locking down cities and countries we can reduce the spread of disease; but we also encourage “fear, isolation, depression and domestic violence”. Should one paper — from Imperial College — change a billion lives?
This paper theorizes how and why coronavirus reduces blood O2 and causes “crushed glass” lung imagery (kicks out heme from RBCs), risk factors (high A1C, blood sugar, hemoglobin), and why certain treatments, like chloroquine, seem to work. Twitter user, Yishan, expands and extracts key insights here.
Coronavirus: The Hammer and the Dance– Tomas Pueyo
Strong coronavirus measures today should only last a few weeks, there shouldn’t be a big peak of infections afterwards, and it can all be done for a reasonable cost to society, saving millions of lives along the way. If we don’t take these measures, tens of millions will be infected, many will die, along with anybody else that requires intensive care, because the healthcare system will have collapsed.
Outbreak Simulation – Kevin Simler
Amazing Covid-19 related simulation from the always brilliant Kevin Simler. It’s a “playable simulation,” meaning that you can tweak the parameters (like transmission and mortality rates) to visualize how they impact the spread of a disease and how the epidemic might unfold. If you “play,” you’ll likely develop a better understanding for what it will take to contain this virus.
The death and economic damage sweeping the United States could have been avoided—if only we had started testing for the virus sooner.
One of the most pernicious parts of the COVID-19 crisis is how uncertain everything is. Researchers and officials cite statistical models that estimate infection rates, death counts and when things will go back to normal, but those estimates are changing rapidly. And as the forecasts bounce around, so do the rest of us living through the crisis.
How the Virus Got Out– NY Times
Great data visualization that illustrations why the most extensive travel restrictions to stop an outbreak in human history haven’t been enough. We analyzed the movements of hundreds of millions of people to show why.
“…we are learning that hospitals might be the main Covid-19 carriers, as they are rapidly populated by infected patients, facilitating transmission to uninfected patients…”
“In the CDC report, even super-spreaders can’t seem to infect people effectively in open spaces, even in areas with high population density.” “With closed environments…the odds for transmission…were 18.7 times higher than in open-air environments.”
If one thing is clear about the coronavirus, it’s that you’re safer outdoors.
Hypertension(74%), then diabetes (33.9%), Heart Disease (30.1%), Atrial Fibrillation (30.1%), and Renal failure (20.2%).
- The first strategy revolves around a massive rollout of testing capacity.
- The second, related, strategy is using cell phone location data combined with data on known positive cases to alert possible exposures to self isolate and get tested.
- 96% of local businesses already adversely impacted by the outbreak
- 51% say their business will only be able to continue to operate for 0-3 months
- 13% are confident about their contingency plans to maintain
- 25% expected GDP drop in Q2
Without any measures to slow it down, covid-19 will continue to spread exponentially for months. To understand why, it is instructive to simulate the spread of a fake disease through a population.
The coronavirus is coming to you. It’s coming at an exponential speed: gradually, and then suddenly. It’s a matter of days. Maybe a week or two. When it does, your healthcare system will be overwhelmed. Your fellow citizens will be treated in the hallways. Exhausted healthcare workers will break down. Some will die. They will have to decide which patient gets the oxygen and which one dies. The only way to prevent this is social distancing today. Not tomorrow. Today. That means keeping as many people home as possible, starting now.
In this episode, Dr. Paul Grewal, M.D. joins Peter to discuss what they have learned in the past week in the midst of the rapid changes surrounding the COVID-19 pandemic. Their conversation touches on both optimism and uncertainty: actionable steps we can take to improve the situation with the understanding that it is too late for viral containment. Specifically, Peter and Paul discuss some promising drug treatments, reasons for isolating-behavior adoption, and what they are personally instituting in their own lives.
Why You’re Harming Others By Not Overreacting – Nassim Taleb
Nassim’s law: The amount of regret you feel later is inversely proportionate to the amount of panic you act on now.
Balaji is one of the reasons I was sounding the alarm about the coronavirus in late Jan/early February. He was way out in front of this thing. This special pop-up episode explores Covid-19, with Balaji Srinivasan. Balaji and Shane are two of the more thought-provoking, interesting, and multi-disciplinary thinkers I know and they do a deep dive, which includes possible second and third-order consequences.
Yale professor and Physician Nicholas A. Christakistalk discusses about what happens if you get COVID19 and recover. He answers questions like: Are you immune to the disease? How long does the immunity last? And what does that mean for your life and for the public health and economy of our society?
Brent’s one of the smartest and most astute thinkers I’ve encountered and his expertise on the small business economy is unparalleled.
If you’re a small business owner, or interested in how the Coronavirus will impact small businesses, Brent’s company Permanent Equity has been putting out amazing content. Check the articles out here.
Dr. Bruce Aylward, of the W.H.O., got a rare glimpse into Beijing’s campaign to stop the epidemic. This article indicates what he saw.
Paper examining patients from Wuhan admitted to the hospital who met endpoint of either making it to discharge or dying. Median time from illness onset to discharge was 22 days; to death was 18.5 days. 32 of the 191 (17%) required a ventilator. 31 of the 32 on a ventilator died (97%).
Harvard Med grad and doctor Bigham Women’s Dr. Abraar Karan shares additional highlights and takeaways here.
Mass testing means they can detect the virus early, and that means early intervention. The first few days of treatment for those with underlying conditions appears to be crucial. The worst effects of the virus seems to be in the 2nd week. This is all STILL very early to be making a conclusion about mortality rates.
Taylor Pearson pulls together the following:
- What we know (about the coronavirus) so far.
- Why he thinks it’s important for individuals to prepare and how to think about it in a way that reduces the chance of a bad outcome for you or others.
- Suggests some reasonable action steps you can take personally, professionally and financially.
This is an on-the-ground report of an American living in Japan, their corona situation, what the rest of the world can learn from Japan, and what Japan needs to still be concerned about.
All round sharp guy Tren Griffen indicates that inverting a problem can lead to better answers and solutions and, using this exercise, formulates a list of questions we should be asking.
We are in the midst of a public health crisis that is causing massive economic disruption. While corporate consequences may be seen in the stock exchanges, the small businesses (less than 500 employees) that employ 59 million Americans are suffering. Demand is collapsing, production is nearing a standstill, and the credit needed to survive is in dwindling supply. Without immediate intervention, this suffering could manifest itself in record levels of unemployment, untenable levels of default in the credit markets, abandoned commercial real estate, and a resulting market of extreme concentration and limited products and services. For what it’s worth, I completely agree with this tweet.
“I have no idea yet what the future holds, but I’m absolutely confident great entrepreneurs will help build a world that incorporates the lessons of this very difficult time to build a better world for everyone.”
This is a thread about how to interpret the sudden appearance of respiratory infections in NYC and how that can serve as a model for the rest of the country.