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temporaryreality) wrote2021-08-11 09:42 pm
IM Doc pt6
Please see the updated link in the topmost IM-Doc related post on this blog to find the current discussion location.).
anon in so cal
DorothyT Thanks for introducing the immunocompromised patient aspect of the Covid-19 mutations/variants. Recommend reading through this Science article about recent UK findings including potential importance re: vaccines. The U.S. is said to have inadequate viral evolution research and tracing.
To (WHO epidemiologist) Van Kerkhove, the arrival of B.1.1.7 shows how important it is to follow viral evolution closely. The United Kingdom has one of the most elaborate monitoring systems in the world, she says. “My worry is: How much of this is happening globally, where we don’t have sequencing capacity?” Other countries should beef up their efforts, she says. And all countries should do what they can to minimize transmission of SARS-CoV-2 in the months ahead, Van Kerkhove says. “The more of this virus circulates, the more opportunity it will have to change,” she says. “We’re playing a very dangerous game here.”
IM Doc In an effort to make sure all know the sources from which their information comes, I would like to make sure the following is known about Dr. Eric Feigl-Ding. I have seen him repeatedly quoted on multiple websites and all over my social media feeds.
I have tried in vain to find anything this man has ever published in research journals about virology or pandemics. Indeed his main research focus is on the epidemiology of nutrition. I am not so sure we should be listening so much to a nutritionist and his “insights” on a viral pandemic at the level of exposure he seems to have. Would also encourage all to look into his political background. I think there is something more going on here than meets the eye. His musings have been the most panic-inducing hysteria of any “expert” I have been reading this year. Furthermore, at least one colleague of mine who is at Harvard has reported to me that he was associated with Harvard at best tangentially. You can take that as a little tip from an anonymous Internet commenter. But please do your own research.
You can start here – with this comment from Dr. Mark Lipsitch, a real professor of epidemiology at Harvard University. –
I have not looked into your other twitter feed’s background, but just on the face of it, that individual seems to be a much more trustworthy source.
PlutoniumKun I can’t comment on Feigl-Dings credentials, but so far as I’m aware he has kept most of his commentary to his own area of expertise, which include meta analysis and the mathematical aspects of epidemiology. I’m always a little cautious about ‘experts’ who seem to love public attention too much, although arguably in the pandemic we’ve been harmed by the number of specialists who have been reluctant to speak out about areas of concern for fear of being accused of fear mongering or conspiracy theorising (you, of course, are a very honourable exception).
This is always one of the most difficult things for those of us outside of research and academia. Degrees and titles aren’t really enough – the history of science is littered with fine scientists who made fools of themselves when they strayed outside their own expertise, just as many insights and breakthroughs have come those who came to a problem from outside of a particular paradigm. On a practical level, as I’m sure you know from medical practice this is precisely one of the reasons why big research hospitals invariably provide better treatment than small specialist ones – it is the mix of expertise that enriches the individual specialisms. This applies as much to hard science as to the softer sciences and humanities.
One of the things that has disturbed me so much about commentary around Covid is that so much discussion has been ring fenced and politicised, and consequently much misinformation has come from so called specialists as much as conspiracy theorists. The calamitous early opposition to face masks being an early obvious example, in addition to the extreme slowness of public health officials outside of Asia to accept that aerosols may be the primary mode of transmission. Just last week, the Guardian had an article written by a virologist arguing that air travel bans were unnecessary. I’m still trying to work out the logic of that one (unless somehow the virus has learned to fly across oceans).
I doubt it will happen, but I hope when this happens there will be a long, careful post mortem into the broader fields of public health and research to see exactly why so many errors were made, and still are (WHO, for example, is still hedging on travel bans and masks). Unfortunately, judging from the ‘science has saved us!’ and ‘if only those stupid politicians had listened’ type things I read in the media and social media, I’ve a feeling this won’t happen. It’s all too easy to blame everything that went wrong on Trump types, and everything that went right to heroic scientists.
m Thank You IM Doc
anon in so cal F-D’s credentials, or purported lack thereof, do not invalidate the hypothesis that some of the new virus variants may have originated in immunocompromised patients with protracted cases of Covid. F-D is not generating the hypothesis; rather, he is merely reporting it; F-D linked to the author of the article who discussed the hypothesis (the second twitter feed link).
In the link you provided, Dr. Mark Lipsitch appears concerned to impugn F-D’s credentials. He also claims F-D’s twitter followers are Trump supporters. This seems a questionable claim, since F-D has consistently criticized T’s handling of the pandemic and has advocated for Biden.
Otherwise, why not focus on the actual hypothesis, rather than on the background or personal characteristics of the individual who communicated it?IM Doc I have found multiple web sites today that absolutely are hypothesizing the same thing as Dr. Ding, from very accomplished folks. I think we should go about affirming or falsifying this hypothesis right away; it is indeed a very important piece of the puzzle. The same sort of thing occurred in the AIDS era, not just with HIV but with many of the other bugs associated with it, like mycobacteria and fungus.
I think my issue with Dr. Ding more than anything else has been his tendency to really notch up the panic/hysteria to level 10 in the past. That is why I have so much trouble with him. And on top of that, he just should not have the standing to do so, but Twitter and Facebook have allowed this to continue. For example, his Twitter feed was screaming in the early stages of this pandemic that this was the most contagious virus ever encountered by humanity, over and over and over again. This is a grotesque falsehood now and it was so then, but it sure scared the hell out of many of my Facebook friends and family. On the other side of the coin, I can point to statements being made by well-known scientists like Dr. Offitt, in early March, stating this was all going to blow over very soon. My profession, its leadership, and public health in general has certainly not covered itself in glory during this entire affair. When this is all over, I believe what is called a “root cause analysis” will be in order for this country’s entire health system, both the medical side and the public health side. We find ourselves in the credibility problems we have today because of enormous blunders that our health leaders have been making all year long.
I am talking all day and every day to dozens of patients about these vaccines. I can assure you the credibility of our health system is just destroyed with a huge chunk of the general public. It may be destroyed to the point that not near enough people are willing to trust our medical leaders to take the vaccine. Only time will tell.
Phillip Cross Those early posts by Ding were featured on links here. I don’t think you are characterising him fairly at all.
He simply linked to the data which was showing that the virus was spreading with r2.5, and explained that it was bad news because it is much higher r number than flu. the medical establishment was telling us that flu was a much bigger threat than covid at the time.
In the end Ding was right to stick his neck out and raise the alarm, and the establishment was wrong.
Phillip Cross r0 3.8 not r0 2.5
Yves Smith His commentary about the R0 being 3.8 was indeed on dialing it to 11 level of hysteria. And that was before one study suggested the R0 with no intervention was 5.4.
He has since removed that tweet, because it was widely criticized, but it was reproduced in The Atlantic:
HOLY MOTHER OF GOD—the new coronavirus is a 3.8!!!” Feigl-Ding’s tweet read. “How bad is that reproductive R0 value? It is thermonuclear pandemic level bad—never seen an actual virality coefficient outside of Twitter in my entire career. I’m not exaggerating.” During the next five minutes, Feigl-Ding put together a thread on Twitter, mostly quoting the paper itself, that declared we were “faced with the most virulent virus epidemic the world has ever seen.”
I find IM Doc to be accurate on the topic of Dr. Feigl-Ding histrionics.
Phillip Cross Don’t forget that this was in January, the only data available was coming from Wuhan, and he was quoting it, not making it up.
Is an unknown virus, reportedly showing an r0 of 2.5 – 3.8, that seems to fatal in some relatively high % of cases, “thermonuclear pandemic level bad”? I would say so.
In the same thread he said “we are potentially faced with possibly an unchecked pandemic that the world has not seen since the 1918 Spanish Influenza. Let’s hope it doesn’t reach that level but we now live in the modern world
with faster 
+ 
than 1918. @WHO and @CDCgov needs to declare public health emergency ASAP!”He was a concerned citizen who stuck his neck out, trying to raise the alarm early, whilst the mainstream public health organizations were still ignoring or dismissing the threat.
He got your attention, because you posted it here at the time. Perhaps he helped give us all a head start to prepare for what happened next?
It reminds me of back in March, when Bernie was panned as an alarmist for saying the potential deaths and economic impacts of the coronavirus are “on a scale of a major war.”. And yet here we are well on track to exceed the US WWII casualties and costs.
Yves Smith Sorry, Dr. Fengl-Ding was most assuredly Making Shit Up on that R0 being off the charts. Measles has as R0 of 12 to 18!!!
And the Chinese locking down 70% of the country had nothing to do with Dr. Fengl-Ding either. That was the data point this site took seriously and I am sure that was true of others.
And it is not fatal in a high percentage of cases. SARS has a not much lower R0 and a much higher fatality rate, 9.7%. For reasons still not known, it died out after a few very scary months, and experts assume we got luck with how it mutated.
The uncontrolled R0 of SARS was between 2 and 3. This Lancet article puts it as almost identical to SARS-2, the former at 2.4 and the latter at 2.5. But due to the high fatality rate of SARS, very aggressive containment measures were implemented.
https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(20)30484-9.pdf
By contrast, SARS-2 isn’t anywhere near as lethal but produces a high level of morbidity. And I can’t prove it, but it seems that it takes a fairly high level of hospital intervention to keep the fatality rate down, but there’s no way even uncontrolled that it’s as lethal as SARS.
The fact that we may have fallen for some of his early commentary on actual news does not make his over-egging the pudding defensible, particularly with the benefit of hindsight. Recall that Nassim Nicholas Taleb was warning in January about the need for intervention, particularly masking, since once case numbers got beyond a certain, not high level, strategies like contract tracing would become ineffective. So he was hardly the only one to raise early alarms.
Phillip Cross Sorry if I wasn’t clear when I said “relatively”. I was trying to say that in January it was fatal in a high % of cases and showed a much higher r0 relative to the flu, which our medical establishment was telling us was far bigger threat at the time.
The difference in the ultimate attack rate of r0 1.3 (flu) vs r0 3+ is massive, resulting in orders of magnitude more infections.
Luckily we have a comprehensive vaccination program against existing diseases, like measles, with a potentially higher r0, so they aren’t a pandemic threat in the same way as a novel virus.
What sort of COVID narrative do you think we should be hearing? The people who made the Great Barrington Declaration include lots of reputable scientists, especially those in public health. My problem with them isn’t that they make this statement in bad faith or that they don’t have expertise in the field; I don’t feel we know enough about this disease to really open things up the way they favor.
semiconscious see my response above. i’d say that experiencing periodic pandemics appears to be part of the price of being human beings living on this planet. &, looking back on the asian flu & hong kong flu, this seems to’ve been pretty much everyone’s attitude at the time, as well…
we currently are being led by a group of individuals who’ve become convinced, & who cannot stop reassuring us, that, with enough tinkering & tweaking, they can somehow ‘fix’ this. i, personally, do not trust these people…
IM Doc There was a time and day not that long ago – even in the early days of my professional career – where these issues were discussed rationally. I distinctly remember a lecture given by one of the best “Infectious Disease” minds of this country stating that pandemics were a price of admission on this planet, that viruses and their occasional introduction were part of our own genetic heritage, and tinkering with that could cause great harm to not only our species but the entire biosphere.
I point you to this lecture, given by a Nobel Laureate in 1988. I doubt this lecture would be met well in today’s world; however, it is more germane than ever if one is trying to think through our current situation.
Another day, another Grand Rounds.
This pandemic is bringing back so many memories I have of being a young doc in the AIDS pandemic. One of those memories is trying to make sense of staggeringly unobvious data points flying in from every direction. In the AIDS years, putting together these disparate pieces from the ether led to some of the most profound insights in modern medicine. This pandemic is no different, and the Grand Rounds yesterday was all about how much we do NOT know about what is going on right now. And also about a lot of very curious things that are happening.
I am in internist. Along with family physicians and pediatricians, we are the literal “windshield” to the medical profession and public health. When things start happening, we are going to see and hear them first. This is why getting together with other primary care docs and comparing notes is so infinitely valuable.
First of all, in 2018 by December 31, I had 73 positive influenza A or B tests. In 2019, I had 57 positive Influenza A or B tests by December 31. This year I have had zero – ZERO. There has not been a recorded influenza case in the entire half of my state. The first rush of influenza always begins after the Thanksgiving Holiday and by mid-December or so is well in place. Guess what, none of the PCPs from various states in that meeting had seen a single case. This is going on all over the country. Interestingly, the places that even have influenza are places that are heavily locked down with stringent masking and social distancing. Large swaths of the interior that are not nearly as demanding with public health measures are still at zero. I have no explanation for this whatsoever. And for those Reynolds Wrap investors, believe me, it is not because of a lack of testing – they are just not there. Bringing up the next point. It is not just influenza. By this point in December, for 30 years, my office has been filled with coughs, colds, sniffles, sinuses, etc. Dozens and Dozens. I have seen a grand total of 2. I just cannot fathom that the limited masking and social distancing in my community has produced these results. I am dumbfounded. This too was a common theme among those in attendance at the Grand Rounds.
The hospital rush we had in my small town 3 weeks ago was just at the point of overwhelming the hospital. Since then, cases have dropped off the cliff to the point of being minimal background noise. The hospital has only 1 mild COVID case. This too is being repeated all over the country. But it stands in sharp contrast to hospitals in similar demographic and climate communities that have been absolutely monkey-hammered and continue to be so weeks later. There is no rhyme nor reason to this. This is not normal epidemic behavior. There is clearly much that we do not know about this virus and its behavior.
We have a lot to learn. This is fascinating for those of us in medicine. Unfortunately, this is being litigated nightly on the cable political shows and greatly increases the unease in the populace. The news programs seem much more happy to scare than to inform.
To everyone on this website – have a HAPPY NEW YEAR. I am glad to put 2020 in the rearview mirror.
>Covid new variants
Excellent information from the twitter feeds of various virologists and epidemiologists. Some hypothesize that mutations could have occurred during the protracted illness of an immuno-compromised patient. In one instance, 17 mutations apparently occurred at one time, some in crucial docking locations on the spike protein. This is a race to get the population vaccinated before the vaccinations are ineffective against the new variants.
https://twitter.com/DrEricDing/status/1340911640376651778
https://twitter.com/kakape/status/1342072319402012672