COVID Transmissions for 11-13-2020

Nov 13, 2020

Good morning! It has been 362 days since the first documented human case of COVID-19. Almost at a year from the first emergence of this virus. It’s amazing that a year has passed, but it’s also amazing what we have learned about this virus. As a species we have gone from knowing nothing to knowing quite a lot about SARS-CoV-2.

Headlines are pretty doom and gloom today; sorry. Go outside this weekend if you can to get some sun—but keep distancing and masking at high discipline; the morale boost from a good walk outside is important.

As usual, bolded terms are linked to the running newsletter glossary.

Keep the newsletter growing by sharing it! I love talking about science and explaining important concepts in human health, but I rely on all of you to grow the audience for this:

Share COVID Transmissions

Now, let’s talk COVID.

US case rise continues unabated

We topped 150,000 new daily cases yesterday in the US.

This is very bad news. If you have Thanksgiving plans that involve seeing family, cancel them. If you have plans that involve traveling for any reason other than immediate needs like burying someone or seeking medical care, cancel it.

Don’t go out and panic-buy toilet paper, but be prepared for life to be disrupted. At a federal level, and in many states, nothing is being done to deal with this. For example, the next story.

North Dakota allowing SARS-CoV-2 positive healthcare workers to continue working

The state of North Dakota has made a decision that asymptomatic healthcare workers who have tested positive for SARS-CoV-2 infection should be allowed to continue working despite this: https://www.nbcnews.com/news/us-news/north-dakota-lets-healthcare-workers-covid-stay-job-record-surge-n1247487

As you might imagine, I think this is a pretty bad idea! On the other hand, hospitals in North Dakota are essentially at 100% capacity and they need all hands on deck. I think their concern is that if they take these workers off the line, they won’t have any workers left to deal with the surge.

That’s one of the most depressing sentences I’ve ever written. How did it get this bad in the wealthiest country to ever have existed? We have a lot of soul-searching to do about how we got here.

Chinese vaccine trial (in Brazil) halted for a safety issue

In Brazil, a trial of the Chinese company Sinovac’s vaccine (“Coronavac”) has been halted due to a safety event: https://www.bloomberg.com/news/articles/2020-11-10/brazil-pauses-trial-of-china-vaccine-after-serious-adverse-event

This actually happened a few days ago, but there has been a LOT of news this week.

I don’t think these isolated safety events should be taken with any overweight concern, but as mentioned before, halting trials in response to serious adverse events is normal and wise. The reason I highlight this particular situation is that Coronavac is already “approved” in China, and that’s a big problem.

Early on in the development of the vaccine, the Chinese government decided to approve it for experimental use in their soldiers. Myself and others had big problems with this, because there is dubious ability for there to be informed consent in a situation where members of a military are being used as subjects for an experimental vaccine.

This safety event highlights the irresponsibility of this experimental use of a vaccine. At least in the Brazilian trial there is some expectation of informed consent by the participants because they are volunteers. Among members of the Chinese military this informed consent is probably not possible.

Anyway, this is me on a soapbox. Time to hop off.

What am I doing to cope with the pandemic? This:

Olive oil poaching

Look, I really like to cook fish. And I particularly like to cook it in creative ways, which is why I’m fond of olive oil poaching. In this technique, you submerge a piece of fish in olive oil, bring it up to a low heat above boiling (in Fahrenheit, about 250-300 degrees will work), and then leave it submerged until it has cooked through.

Last night, I did this with a few pieces of Chilean sea bass that I’d rubbed with a little bit of an artisanal Old Bay-style seasoning that a friend gave me. Here’s how it turned out, on a bed of sautéed greens and onions:

Image is a piece of Chilean sea bass on a bed of greens, all sitting on a beige plate with a red rim.

The nice thing about this technique is that you can still relatively crisp the skin (I actually didn’t manage that this time, but I was in a hurry) while keeping the flesh extremely moist. Really recommend this, particularly for fish that are easily overcooked—works very well with salmon, particularly, but I was getting bored of salmon and wanted to go a little fancy. After all, when you’re staying home in a pandemic, a little variation can keep things interesting.

Reader David Rendsburg asked the following on yesterday’s newsletter:

Couple of questions for you -
What is a good test/population rate to be able to "trust" the positivity rate?
Meaning, when NYC was only testing people with symptoms the rate was through the roof, so we sort of know not to use it as a basis for anything.
My zip code is currently 5.2% positivity in the last 2 weeks (https://www.phila.gov/programs/coronavirus-disease-2019-covid-19/testing-and-data/#/ - I am 19147). There have been 582 tests / 10,000 people, or 5% of people have had a test. Is that enough tests to consider that number really high? Or, is it inflated because of a lack of tests?
10025 is testing 700/100,000 per day based on the NYC dashboard. Over 2 weeks that would be 980/10,000, so nearly 10% of residents are getting tested in a 2 week period - and the positivity rate is much lower (even if you halved my zipcode, the UWS is still better, but its not as stark a difference).
So, should I be totally freaked out by a 5.2% positive rate? Or is that inflated because of not enough testing? (And yes, I know we should be freaked out because relative numbers are skyrocketing.)
Also, not sure if you noticed, but NYT now has # hospitalized nationally as one of their metrics. Given the lag with deaths, and the fluctuation of #s based on testing, I know Cuomo liked to talk about hospitalizations during his briefings. I assume this is NYT finally getting national numbers to start to use this as a metric to counter the "it's because we are testing more" rhetoric, which I think its great.
Thanks!
-david

I answered as follows:

I think you're touching on something that is a fundamental issue with testing programs. How do we contextualize them?
One of the problems is that there tends to be considerable selection bias in testing. People get tested much more often if they have a suspicion of having COVID--either due to symptoms or suspected exposure. So it's rather difficult to assess how representative these samples are.
New York State has come to a decision about the thresholds that they consider serious, and I think this is based on testing availability within the state. I don't know what PA's assessment is, but I will admit that a 5% rate sounds concerning to me personally if the overall trend is also positive.
One resource I like to use is the Cerner Resurgence Risk Index, which you can find for certain individual localities here: https://www.cerner.com/covid-19/predictive-models/reopening-projections
I think it's a good resource because it uses the effective reproduction coefficient (an assessment of how many cases are generated for each case identified) as well as other factors to assess the risk of a resurgence in a given location. Currently, Philadelphia is in dangerous territory according to this measurement. If I were you I'd be very careful, based on that. New York isn't in much better shape, either, by this measure, for what it's worth, and I'm starting to act a lot more carefully as a result.

I know I owe some of you responses still—they’re coming! Next week. I answer in order of complexity; David’s comment was one I responded to quickly and the others I’d like to give a little more time. Please keep the comments and questions coming.

Join the conversation, and what you say will impact what I talk about in the next issue.

Also, let me know any other thoughts you might have about the newsletter. I’d like to make sure you’re getting what you want out of this.

Viral Transmissions

Discussion about this post