COVID Transmissions for 2-2-2021

Feb 02, 2021

Good morning and welcome to COVID Transmissions.

It has been 442 days since the first documented human case of COVID-19. Welcome back from the weekend.

Bit of a slow news day today for COVID-19, but I’m going to call that a good thing. In the headlines today we’ll look back on January (not such a good thing) and we’ll discuss a story I’ve been following for a while, about the US public health system.

Also, a reader comment that I think is pretty important.

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

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Now, let’s talk COVID.

January was the deadliest month for COVID-19 in the US

Now that January is behind us, we have full COVID-19 death statistics.

January did start to see a decrease in hospitalizations, meaning potentially that the country has crested the wave—for now—but death usually lags things like hospitalizations and new cases.

The reason being that people who die usually do so after being hospitalized, and even more often after being detected as a case. That isn’t always true, but it’s often enough true that spikes in deaths tend to follow after spikes in hospitalizations and new cases.

So, even as the US reached a peak in hospitalizations in January, the country continued to see high death numbers. In total, more than 95,000 people died of COVID-19 in the US in January. That is approximately 3,000 people each day.

On the other hand, hospitalizations due to COVID-19 are finally below 100,000 again in the US.

You can read more about this at CNN: https://www.cnn.com/2021/01/31/health/us-coronavirus-sunday/index.html

The Public Health Service Commissioned Corps Ready Reserve is recruiting

Not everyone realizes this, but the US has eight uniformed services. You can probably count to five or six from memory—Army, Air Force, Navy, Marines, Coast Guard…and Space Force! Don’t forget Space Force.

That’s six. The other two are not armed forces, but uniformed services nonetheless. One is the National Oceanographic and Atmospheric Administration Commissioned Officer Corps, which is an officers-only force of technical specialists and scientists who monitor US waterways and weather conditions, among other things.

Then, finally, there is the US Public Health Service Commissioned Corps. This force consists of healthcare professionals and scientists, and reports to the Assistant Secretary for Health, who is, officially, an Admiral in the Commissioned Corps. The Surgeon General is a Vice Admiral in the service. The PHS Commissioned Corps has thousands of officers, who work all over the federal government. They engage in key personal and public health work that supports the US and the other uniformed services. They can be militarized in times of war and deployed rapidly during emergencies. Frequently they serve alongside US Navy personnel on the two Navy hospital ships—the USNS Comfort and the USNS Mercy.

I have, for a long time, been interested in the PHS Commissioned Corps, and considered joining them after graduate school. As a smaller force, though, the PHS Commissioned Corps does not always have the resources to keep everyone on staff that it might need in every situation.

In 2010, with the passage of the Affordable Care Act, the government created a solution to this problem—a reserve force for the PHS Commissioned Corps, which could be called to action if the nation required additional healthcare personnel due to an emergency like a hurricane, an industrial accident, or a pandemic. This was to be called the “Ready Reserve,” and would also commission officers with rare skillsets who might not otherwise be supportable as full-time officers within the Corps, including folks like scientists and public health experts.

Unfortunately, while Affordable Care Act created this reserve, it didn’t provide it with any funding to actually be implemented. So the Ready Reserve sat in limbo, unfilled, for a decade.

The passage of the CARES Act—better known as the first COVID-19 stimulus bill—changed that. The Ready Reserve was officially funded and could begin recruiting.

Which is why I’m writing this now; this is not just an interesting history lesson. As of the fall of 2020 and winter of 2021, the US Public Health Service Commissioned Corps Ready Reserve is officially recruiting. I’m sure that there are at least some healthcare providers, scientists, or public health-inclined people who read this newsletter. Perhaps there are some readers who are still training in undergrad or a postgraduate program like medical school. If it interests you, and you are a US citizen, you should consider an application to serve in the PHS Commissioned Corps, either full time or in the Ready Reserve. It is clear that healthcare emergencies can really damage the country, and this service offers the US a way to keep personnel on hand who can respond to those emergencies. If interested, you can find out more about the Ready Reserve here (and about full time programs elsewhere on that site): https://www.usphs.gov/ready-reserve

And if you’re not interested, maybe you know someone who would be.

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

IT SNOWED

Well, actually, as I write this, it’s still snowing.

There’s a lot of it. We took a walk in it earlier, and it was very pretty.

I’m glad I’ve been working from home, though.

Photo is the Firemen's memorial (a large stone monument with a bronze relief plaque) on Riverside Drive, covered in snow, which accentuates the team of horses on the bronze plaque, as snow continues to fall all around.

Reader Molly left the following comment on yesterday’s issue:

Thanks for the great newsletter! Just a semantic point, but one that I think matters... It's probably generally better to say "pregnant people" as opposed to pregnant women. While all of the people in the study may have identified as women (or maybe not), there are certainly people who get pregnant who don't identify as women. I see no reason this research wouldn't apply to them as well. Gender rules are shifting, and it's exciting!

Thank you, Molly. And I do think this is an important comment. I actually agonized over how to report that story for this exact reason. You know what I settled on, but here’s my explanation of what I did:

Thank you for your words. I agree with you that this matters.

Generally speaking, I prefer to say "pregnant patients" or "pregnant subjects" when discussing research findings about pregnancy. Unfortunately, the study I was sharing was conducted exclusively in women and reported all subjects as women, so I chose to report the study itself the way that the authors reported it--I have no further information beyond that regarding the gender identity of the subjects. I wish I did, or that the study authors had at least considered this issue in reporting their findings.
Sadly the medical literature on this issue tends to lag best practices in society.
You'll note, though, that in discussing the general principle of passive transfer, I did not use the word "women"--that was on purpose, because I wholeheartedly agree that "pregnant women" is not a phrase that captures the full spectrum of the human experience. In this case I favored the word "parent" because it required the least acrobatics linguistically, though generally I might have used "patient" or "subject."

It’s problematic, to say the least, when medical studies use gender-based terms. Gender is not a biological condition. It is a social identity. There are biological conditions that are more common in broad groups classified according to biological sex, but even sex is a categorical variable that is trying to capture a number of conditions that are far more nuanced than “M” and “F.” In truth, the tendency of biological studies to report patient sex as a major characteristic is representative of a certain amount of generalization that we normalize as medical professionals, and I’m not a huge fan of generalizations. In general.

However, there’s another side to this. Both broad biological categories and social identities do have an impact on people’s health. When a study reports its results in “pregnant women,” I am faced with a real problem. Do I change the words that the study used, or do I take the authors at their word that they only enrolled women? Do I allow myself to presume that the results may be generalized beyond “women,” when the results might actually have been different if trans people were highly represented in the study?

I try as hard as I can to strike a balance here. I prefer to report study results as they were reported—which is why I called this news about “pregnant women.” However, when I know for certain that gender identity has no impact on a biological process being discussed, I avoid the use of gendered terms entirely—which is why I shifted to use the word “parent” when talking about the overall biology motivating the study.

This isn’t an easy situation to navigate, and I don’t feel entirely good about it. But, really, I’m resentful of study authors who conduct trials about pregnancy that enroll only people who identify as women—or worse, that erase the identities of enrolled subjects who do not identify as women. It’s that decision, one that is inherently founded on erasure, that puts me in a position where I have to choose between faithful reporting of results vs appropriate terminology on a sensitive topic. The medical literature can—and should—do better.

You might have some questions or comments! Send them in. As several folks have figured out, you can also email me if you have a comment that you don’t want to share with the whole group.

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.

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