Starting up is hard
Over the last 2.5 years, I’ve read, and written a lot for primarily one rather large non-profit organization. I’ve taken advantage of Katelyn Jetalina’s “Your Local Epidemiologist” writings in my work, often because she does a lot of the leg work of producing the good graphics, and because the vast majority of the time she and I have reached similar conclusions fully independently. Katelyn’s brilliant, dedicated, well trained, and a good communicator overall.
I have been accused of being a polymath or a "Renaissance Man”. I’ve had careers in medical research, worked at NASA (admittedly as a contractor; I still had a major experiment fly on Spacelab) and learned a bit about spaceflight medicine and hyper- and hypobaric medicine. A long time ago, I trained as an EMT, and then a Paramedic, and instructed for a long time in the EMS arena. I’ve been a practical meteorologist with an interest in Atlantic Basin tropical cyclones, and a computational scientist for numerical modeling associated with weather prediction… but not limited to it.
On 18 JAN 2020, I boarded a flight at Boston Logan Airport and flew home from the annual American Meteorological Society conference (yes, in Boston on the Harbor). I’d been active in one of the symposia and had paid scant attention to the news from China about unusual pneumonias. At the airport and waiting to board, the iPad gave me a chance to start catching up on what’d happened in the world and the outbreak stories piqued my interest. I purchased the internet option for the flight and spent nearly 4 hours devouring everything I could find about the Chinese outbreak. I got off the plane convinced we were looking at a global health emergency, and as convinced most of the people charged with noticing things like this had not done so quite yet. My first comment to my wife, when she asked if I’d slept on the plane (my usual pattern) was to tell her about the things I’d learned, and, “This is gonna be bad.”
Little did I know that 2 electives from college, in public health and epidemiology, were going to play a big role in my life.
During my days of medical research, I was afforded the opportunity to have a LOT of patient contact, including spending a lot time in a major tertiary care pediatric emergency room. This time changed a lot of my views on universal health care. Other aspects of my research work involved partial and total artificial heart development and implementation, transplant research, research into mechanical support of the failing circulation, and new procedures in diagnostic cardiac work. I was assigned some clinical duties when the AIDS outbreak took hold; I still have some scars from that. My NASA days included designing and developing a way to create intravenous solutions, on-orbit, starting with regular Space Station “tap” water and a package of sterile liquid concentrate, AND a system using commercial off-the-shelf hardware to infuse it into a patient. I worked with some powerhouses in water purification and healthcare to make this work. I see some of the benefits of one of my ideas all over hospitals now when I go into a patient room and see their IV setup.
And, as a Paramedic, I was on the street before there was a national Registry or licensure. I got off the street but continued teaching, when the things I was learning and doing in-hospital made it difficult to remain in my scope-of-practice as a paramedic. That said, paramedicine gave me a lot of insight into human behavior that’s been useful over the years, and taught me how to talk to patients and families.
Today, I’m part of a team of doctors, nurses, an epidemiologist or two, and the occasional hospital administrator who advise the Leadership team of a 60,000-strong non-profit with members ranging from 12 to over 100 years. We reflect a large swath of the US public in demographics… and political leanings. Our team tries to provide guidance to allow our members and organization to stay healthy and provide all the services our charter sets forth. To say there’s been pushback at times, from individual members as well as leadership, might be an understatement. Yet, we try to provide factual data backed up by research and to cite the appropriate literature.
Throughout the Pandemic, I’ve noticed an interesting phenomenon. Ignoring, for the moment, political leaders and talk-show hosts making wild and usually unsubstantiated claims about COVID, the science has changed rapidly. I’ve had days where I’ve suffered whiplash, reading a series of articles, which were in fact a body of work on the disease process but were often contradictory in part on in whole. I had to read each article as if I were reviewing it for publication, which often meant even more research before I decided what I believed and what I though was less ready for prime time. What’t fascinating about this, though, is that the public was seeing this in real time and having to make the same value judgments I was making.
Medicine in general, and the various specialties involved in the Pandemic, all use and seem to suffer from, jargon. Lots of abbreviations, a bunch of acronyms, and use of the English language in ways no rational English professor would have tolerated. In other words, while the words of some of the online discussions might look familiar to someone in, say, business, but the jargon completely changes the meaning of the discussion. I have encountered all too many cases where someone challenged what a topic was discussing because the plain-language interpretation didn’t seem to support the conclusions. Well, the reason was plain: There was no plain-language discussion. This was a specialized discussion, and it did cause problems for scientists.
Scientific research is messy. It’s rarely flashy and breakthroughs are often hidden in the mundane work of cleaning up the results. We’ll argue over statistical significance occurs at p=.05 or p=.0001 based on the statistics at hand, or whether a T-C base swap to T-T was significant if it only occurred at a single point on a DNA sequence. And we rarely work in facts. We work in theories which are only considered solid until disproven by further work. Then we change our minds. We complain about each other loudly and often, sometimes in the most sanctimonious language you can find.
But most important, although we all (well, most of us) try to do good work and not produce junk or unsupportable results, we’re not used to doing all this in front of the public at large.
And, that’s what happened here. All the science, access to the preprint servers (which some pundits quote as final authority) and the bickering on Twitter are seen and reported by people who don’t necessarily share our skillsets or backgrounds. We’ve been accosted for saying something, then having to retract it sooner than later (“Masks are of little value”; “Masks can help prevent the spread of disease”: We learned that transmission occurred prior to symptoms and was airborne although we weren’t yet clear on what size droplets were involved).
Getting the public involved is, overall, a potentially good thing IF they’ll let us make our pronouncements and recognize that changing our minds is what we do, as we learn more.
Then there’s the communications aspect. Overall, both the political entities and scientists have done a pretty poor job of communicating with the public. Instead of speaking at the level of the public, we’ve either tried to talk down to the people who need information, or we’ve completely retreated into our jargon. I’ve had trouble with this as well, as I’ve been reading and critiquing between 5 and 20 articles per day, as well as talking to friends and colleagues who are working the pandemic clinically. Somewhere in there, until last September, I also had to produce a solid 8-10 hours of paid work, and all the other activities of daily living… like sleep. I was able to communicate with my team but barely able to communicate the nuances with my wife, a trained medical professional but in another field.
A lot of what I do today is skim literature and produce updates for my organization’s leadership. I’m going to close this missive with what I recently amassed. It has some of the recommendations and such plucked out; read the articles and draw your own conclusions… or ask.
COVID-19 deaths fall 9% this week as omicron subvariant BA.5 dominates. The U.S. reported modest increases in COVID-19 cases and admissions this week as the highly transmissible BA.5 accounts for nearly 78 percent of infections nationwide, according to the CDC's COVID-19 data tracker weekly review published July 22.
https://www.beckershospitalreview.com/public-health/covid-19-deaths-fall-9-this-week-as-ba-5-dominates-10-cdc-findings.html?origin=BHRSUN&utm_source=BHRSUN&utm_medium=email&utm_content=newsletter&oly_enc_id=0484G1216456I5U
Sore throat and hoarse voice are now the top omicron symptoms, study suggests. The top symptoms of COVID-19 from the omicron variant, a sore throat and hoarse voice, differ from common symptoms from other variants, CBSNews reported July 19.
A June 15 study from U.K.-based Zoe Health examined the symptoms of more than 62,000 positive COVID-19 tests between June 1 and Nov. 27, 2021, when the delta variant was dominant, and Dec. 20, 2021, to Jan. 17, when the omicron variant was dominant.
https://www.beckershospitalreview.com/patient-safety-outcomes/sore-throat-hoarse-voice-top-omicron-symptoms-study-suggests.html?origin=BHRSUN&utm_source=BHRSUN&utm_medium=email&utm_content=newsletter&oly_enc_id=0484G1216456I5U
The rapid rollout of COVID-19 vaccines from December 2020 averted infection and reduced absences related to the virus for patient-facing NHS hospital workers in England during the second wave of the pandemic, according to research published in The BMJ.
The study authors compared the efficacy of the Pfizer BioNTech and the Oxford-AstraZeneca COVID-19 vaccines against infection in health care and social care workers in England using data from the OpenSAFELY research platform. The 317,341 participants were vaccinated between January 4, 2021, and February 28, 2021.
The results showed strong protection from both vaccines with no substantial differences between the 2 vaccines in rates of infection or COVID-19-related hospital attendance and admission. These findings provide insight into SARS-CoV-2 infection in health care and social care workers.
https://www.pharmacytimes.com/view/covid-vaccination-prevented-infection-reduced-absence-for-health-care-workers-during-second-wave-studies-findSan Francisco and New York City have declared monkeypox emergencies as the cities continue to see cases surge.
https://www.cidrap.umn.edu/news-perspective/2022/07/san-francisco-new-york-declare-monkeypox-emergencies
Although the predominate case distribution remains with men who have sex with men (MSM), this is reminiscent of the original HIV/AIDS outbreak. In fact, by the time researchers started seeing a widespread disease outbreak, there was already significant cross-population spread that was not appreciated for several years. 2 cases in children have now been reported.
There is little doubt that monkeypox virus (MPV) has been spreading since a Nigerian outbreak in the 2018/2019 timeframe. At this time, over 70 countries are reporting cases, and the World Health Organization has declared the MPV outbreak a Public Health Emergency of International Concern.
In the US, clinicians are either not seeing cases, or are failing to send specimens for laboratory diagnosis as the five commercial/public labs authorized for MPV testing by CDC have reported few samples, if any, over the last week.
As of July 28, 2022, the Centers for Disease Control and Prevention (CDC) and state and local public health partners are reporting 4,907 cases of monkeypox in the United States across 46 states, Washington, D.C., and Puerto Rico. CDC is also tracking multiple clusters of monkeypox that have been reported globally, including in 71 countries that normally do not report monkeypox.
https://emergency.cdc.gov/han/2022/han00471.asp?ACSTrackingID=DM86859&ACSTrackingLabel=Copy%20of%20NCEZID%20Updates%20July%2022%2C%202022%3A%20Responding%20to%20infectious%20disease%20threats&deliveryName=DM86859
The public health response to monkeypox depends on timely and comprehensive laboratory testing and reporting of those results.Severe weather extremes including significant flash flooding have affected major portions of the Country. The potential health impacts from flooding include - contamination of water supplies, loss of power causing increases in heat illnesses, as well as the obvious danger of injury and death.
We have become aware of significant misunderstandings about the use and interpretation of over-the-counter, home-administered, rapid antigen testing kits. Those involved with our activities have indicated misconceptions of the sensitivity and specificity of these tests and as a result have not utilized them in an appropriate manner in several cases, despite good intentions.
Note that there were also recommendations to our Leadership. Because we’re advisory in nature, Leadership makes the final decisions. And just so you know, in today’s world that’s pretty much how Public Health works today, too.