1,828 Matching Annotations
  1. Sep 2020
    1. That’s what happened in Florida. Hurricane Andrew reduced parts of cities to landfill and cost insurers nearly $16 billion in payouts. Many insurance companies, recognizing the likelihood that it would happen again, declined to renew policies and left the state. So the Florida Legislature created a state-run company to insure properties itself, preventing both an exodus and an economic collapse by essentially pretending that the climate vulnerabilities didn’t exist.

      This is an interesting and telling example.

    1. Take away: People are infectious for only part of the time they test positive. The tests for COVID-19 were granted emergency status by the FDA so some debate concerning the most ideal number of cycles is to be expected. It is worth noting that the FDA has the disclaimer "Negative results do not preclude 2019-nCoV infection and should not be used as the sole basis for treatment or other patient management decisions. Negative results must be combined with clinical observations, patient history, and epidemiological information (2)."

      The claim: Up to 90 percent of people diagnosed with coronavirus may not be carrying enough of it to infect anyone else

      The evidence: Per Walsh et al. (1), SARS-CoV-2 virus (COVID-19) is most likely infectious if the number of PCR cycles is <24 and the symptom onset to test is <8 days. RT-PCR detects the RNA, not the infectious virus. Therefore, setting the cycle threshold at 37-40 cycles will most likely result in detecting some samples with virus which is not infectious. As the PCR tests were granted emergency use by the FDA (samples include 2-9), it is not surprising that some debate exists currently about where the cycle threshold should be. Thresholds need to be set and validated for dozens of PCR tests currently in use. If identifying only infectious individuals is the goal, a lower cycle number may be justified. If detection of as many cases as possible to get closer to the most accurate death rate is the goal, setting the cycle threshold at 37-40 makes sense. A lower threshold will result in fewer COVID-19 positive samples being identified. It is worth noting that the emergency use approval granted by the FDA includes the disclaimer that a negative test does not guarantee that a person is not infected with COVID-19. RNA degrades easily. If samples are not kept cold or properly processed, the virus can degrade and result in a false negative result.

      Source: 1 https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa638/5842165

      2 https://www.fda.gov/media/134922/download

      3 https://www.fda.gov/media/138150/download

      4 https://www.fda.gov/media/137120/download

      5 https://www.fda.gov/media/136231/download

      6 https://www.fda.gov/media/136472/download

      7 https://www.fda.gov/media/139279/download

      8 https://www.fda.gov/media/136314/download

      9 https://www.fda.gov/media/140776/download

  2. Aug 2020
    1. Lozano, R., Fullman, N., Mumford, J. E., Knight, M., Barthelemy, C. M., Abbafati, C., Abbastabar, H., Abd-Allah, F., Abdollahi, M., Abedi, A., Abolhassani, H., Abosetugn, A. E., Abreu, L. G., Abrigo, M. R. M., Haimed, A. K. A., Abushouk, A. I., Adabi, M., Adebayo, O. M., Adekanmbi, V., … Murray, C. J. L. (2020). Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 0(0). https://doi.org/10.1016/S0140-6736(20)30750-9

    1. Ray, E. L., Wattanachit, N., Niemi, J., Kanji, A. H., House, K., Cramer, E. Y., Bracher, J., Zheng, A., Yamana, T. K., Xiong, X., Woody, S., Wang, Y., Wang, L., Walraven, R. L., Tomar, V., Sherratt, K., Sheldon, D., Reiner, R. C., Prakash, B. A., … Consortium, C.-19 F. H. (2020). Ensemble Forecasts of Coronavirus Disease 2019 (COVID-19) in the U.S. MedRxiv, 2020.08.19.20177493. https://doi.org/10.1101/2020.08.19.20177493

    1. Malani, A., Soman, S., Asher, S., Novosad, P., Imbert, C., Tandel, V., Agarwal, A., Alomar, A., Sarker, A., Shah, D., Shen, D., Gruber, J., Sachdeva, S., Kaiser, D., & Bettencourt, L. M. A. (2020). Adaptive Control of COVID-19 Outbreaks in India: Local, Gradual, and Trigger-based Exit Paths from Lockdown (Working Paper No. 27532; Working Paper Series). National Bureau of Economic Research. https://doi.org/10.3386/w27532

    1. Though important, social distancing could be reduced to one metre instead of 2m

      Take away: As with most things in nature, there are always exceptions – transmission occurring at greater distances than 3 ft and evidence of aerosolization have been reported.

      Discussion: In scientific terms, this virus is still very new so the data supporting an optimal physical distance to prevent transmission remains scarce. In the absence of data, public health agencies have used what they understand about this virus and similar viruses to infer a “best” answer. Public health agencies try to simplify the recommendation to a single answer, but the reality is much more complex.

      According to reports the WHO bases their recommendation for 1 meter (~3 ft) distancing off of an understanding that SARS-CoV-2 behaves like similar respiratory viruses that are primarily transmitted via larger droplets (as opposed to smaller aerosols). Assuming most spread is via droplets, the WHO reportedly follows the results of a 1934 study indicating most respiratory droplets fall to the ground within 3 feet.

      However, as with most things in nature, there are always exceptions – transmission occurring at greater distances than 3 ft and evidence of aerosolization have been reported.

      The evidence basis for the CDCs guidance for 6 feet of separation is less clear, but probably reflects lower risk tolerance, or greater weight to evidence of aerosolization or wider droplet spread.

      Even with further study, there may never be a clear answer for optimal physical distancing. This is because, (1) the area of high risk for transmission is probably dependent on the specific conditions of the interaction (e.g. loud talking, windy environment), and (2) the “optimal” distance is based on risk tolerance. There is no single distance between individuals where risk of transmission drops off precipitously to zero.

      All evidence indicates that greater distances are safer but, for example, consider how restrictive a physical distancing recommendation of >50 ft would be. In the end, because we can’t control how far others stand away from us, we ask governments to consider these tradeoffs and deliver a “best” answer to guide their citizenry.

  3. Jul 2020