I’m still not a doctor. Which is good. Because during the operation, I’d be too busy staring out the window at passing clouds than focusing on the task at hand.
I am just a conduit of information.
The goal of these updates is to give some insight into new research, the latest numbers and the updated advice from the medical community. This is a fact-based, evidence-based approach to medical information. I will not offer any personal analysis here. I don’t have the expertise to even attempt such a thing. Any advice or guidance offered here will be directly from the medical community.
How science works, how it relates to COVID-19
I spent most of my Thursday trying to help folks understand that science and the medical community has always been pretty straight-forward with their messaging with COVID-19. And after some interesting rebuttals, I got to thinking that maybe a lot of people just don’t remember how science works.
I mean, that’s understandable. Science class was a long time ago for some folks. So I thought I would take a few seconds and re-introduce you to what science is…
Science is great. It takes a complex and – at times – chaotic world and explains it. Science is basically, produce an experiment that is reproducible while doing everything you can to make sure you didn’t fool yourself.
For those curious what my lapel pin says… #Science! pic.twitter.com/v1WuPKqOJT
— Nick Lilja (@NickLilja) February 21, 2020
That is it.
But awesome things happen when you can do that. We can use science to answer a lot of great questions. It is how we found out that the thing that makes an apple fall from a tree toward the ground is the same thing that keeps the moon in orbit. It is how we learned how to forecast the weather. It is how we found the cure to polio. Reproducible experiments without fooling ourselves.
That also means if there is no evidence of a reproducible event, it can’t be used by science.
When people who claim COVID-19 isn’t as bad as the world is making it out to be, science asks, “what’s the evidence?”
A youtube video is not evidence. Conjecture and extrapolation are not evidence. Even first-hand accounts without any documentation isn’t evidence.
Science needs evidence. Science needs findings that can be reproduced by others who look at the same evidence.
Without that, it isn’t science. And it doesn’t belong in the science conversation.
And for some of you, it may feel tough to trust scientists. But it okay. Scientists spend their entire career, and in some cases have worked their whole lives, on the very topic that is being discussed. They aren’t going to mess it up or lie about the findings. And if they do, other scientists call them out about it. That is the beauty of peer review! Scientists make sure that other scientists get it right!
Here is an example:
This is an article written by a group of scientists about the effectiveness of N95 masks. And another scientist, disagreed with a portion of their claim. Asking for more evidence to support it.
And that prompted the original authors to provide more evidence.
That is how it works. Scientists produce findings and ask for other scientists to “beat it up!” and make sure the findings are as accurate as possible.
This is another reason why “pre-print” articles need to be looked at with an extra-skeptical eye. Because those papers have not been through peer review yet.
Contextualizing new numbers
If you keep up with the numbers, the total number of cases in Mississippi is up around 30,000 since this all started. But a lot of people are left wondering, “How many people are sick right now?”
I used some math, based on past research and guidance from the CDC to attempt to estimate that number. And I’ve only done this for Mississippi, but if you would like this to be done for other states, let me know.
Recall, from past articles I’ve posted, that the number of asymptomatic people was originally documented at about 18-percent from one of the cruise ships. Since that time research has suggested numbers as high as 40-percent. But the recent research is a bit more disputed than the original cruise ship research, so I will stick with that for now. And the 18-percent number is one I’ve been using for months.
But based on the math in the study, you can’t just say for every 100 tested, 18 more people are asymptomatic. It is actually more like for every 100 people that test positive another 33 are asymptomatic.
The CDC has noted that research shows the sickness lasts – on average – about 12 to 16 days. But that viral loads (the ability to be contagious) can linger past 21 days, but we will cut our estimate off at 21 days.
So now, we just need to run the numbers…
Going back 21 days looking at the total number of cases, you end up with 13,834 people possibly contagious right now in Mississippi. That counts the total number of positive tests with the number of potentially asymptomatic people.
But Nick, you’re exaggerating. That’s just a guess!
It is an estimate. You are right. It is not perfect. By any means. It may not be within 100 or even 500 of the actual number. It is a rough estimate based on past research.
And I want to really point out here that this isn’t me pulling numbers out of thin air, or offering “my take” on this. I am doing algebra “plug and chug” from middle school with past research and applying it to a specific area.
And while about 13,000 people may seem tiny compared to the 3 million people that live in Mississippi because the virus spreads so easily, it becomes a bit more concerning. Because if those 13,000 people are left to wander around with an R0 value of 3, they can easily turn 13,000 into 39,000 very quickly if the proper precautions are not taken.
That is why the CDC asks everyone to wear a mask, socially distance, and wash your hands. Those small steps can have a big impact.
Looking at MIS-C in children
According to the CDC, Multisystem inflammatory syndrome in children (MIS-C) is a condition where different body parts can become swollen/inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. Researchers do not yet know what causes MIS-C, however, evidence is pointing to a connection with COVID-19. MIS-C can be serious, even deadly. Thankfully, the CDC reports that most children who were diagnosed with this condition have gotten better with medical care.
In a paper published in the New England Journal of Medicine titled, “Multisystem Inflammatory Syndrome in Children in New York State” a handful of doctors and medical researchers broke down the numbers in New York. They wrote: “Hospitals in New York State reported cases of Kawasaki’s disease, toxic shock syndrome, myocarditis, and potential MIS-C in hospitalized patients younger than 21 years of age and sent medical records to the NYSDOH. We carried out descriptive analyses that summarized the clinical presentation, complications, and outcomes of patients who met the NYSDOH case definition for MIS-C between March 1 and May 10, 2020.”
A review of some of the stats included…
95 patients were confirmed MIS-C (laboratory-confirmed acute or recent severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection).
4 with suspected MIS-C (met clinical and epidemiologic criteria)53 were male
46 were female31 of 78 (40%) were black
31 of 85 (36%) were Hispanic31 patients (31%) were 0 to 5 years of age
42 (42%) were 6 to 12 years of age
26 (26%) were 13 to 20 years of age
Elevated levels of C-reactive protein, d-dimer, and troponin were found in 100%, 91%, and 71% of the patients, respectively100% had subjective fever or chills
97% had tachycardia
80% had gastrointestinal symptoms
60% had rash
56% had conjunctival injection
27% had mucosal changes62% received vasopressor support
53% had evidence of myocarditis
80% were admitted to an intensive care unit
2 diedThe median length of hospital stay was 6 days.
A couple of things that stand out is that 80-percent ended up int he ICU and that the average stay was six days. Which says that if kids are getting this and they are sick enough to be hospitalized, many of them who are that sick, become very sick.
The authors noted that a rise in MIS-C cases was realized as the number of actual cases of COVID-19 stated to decline.
The authors noted that during the six weeks leading up to hospitalization, 24 of the children had a Covid-19–compatible illness “a median of 21 days (interquartile range, 10 to 31) before” hospitalization. And 38 had exposure to a person with confirmed Covid-19. Another 22 had direct contact with a person who had a “clinically compatible Covid-19–like” illness.
This is a reasonably small sample size, but this is the first – of likely many – larger studies of some of the data on MIS-C.
So, if you live with or met up with someone who had COVID-19, and your kids never showed symptoms, you may want to watch them closely for up to six weeks after the interaction with the person with COVID-19.
The CDC notes to seek emergency care right away if your child is showing any of these emergency warning signs of MIS-C or other concerning signs:
— Trouble breathing
— Pain or pressure in the chest that does not go away
— New confusion
— Inability to wake or stay awake
— Bluish lips or face
— Severe abdominal pain
Vaccine notes
In a new paper titled, “Phase 1/2 Study to Describe the Safety and Immunogenicity of a COVID-19 RNA Vaccine Candidate (BNT162b1) in Adults 18 to 55 Years of Age: Interim Report” currently in pre-print and not yet peer-reviewed offered a glimpse into the testing and results of some of the clinical trials for a vaccine.
This paper gets a bit too medical for me, honestly. I read this thing a handful of times and I couldn’t quite wrap my brain around the terminology. I think I know what they were getting at, but “I think I got it” and “I get it” are two completely different things and I don’t want to steer anyone wrong.
But what I did understand is that the trial shows that there is a reasonable amount of effectiveness within the vaccine tested. And that there was no difference shown between the two highest doses. That means a lower dose may still provide protection.
But it also noted that more research and monitoring is needed. This isn’t ready to be a vaccine anytime “soon” anyway.
