Embedded in out historical mindset was the toll taken by the influenza pandemic of 1918-1919. Estimates of the deaths caused by that pandemic hover around 50 million worldwide, and 675,00 in the US; it’s too early to have really accurate data, but there are currently estimated to be about 3 million confirmed COVID deaths worldwide and some 560,000 in the U.S.  The American population was lower in the 1918 pandemic, and there was a much higher mortality among infants and young adults than that seen with SARS-CoV-2. Fortunately, we have much better medical care today with the widespread availability of supplemental oxygen, therapeutic intubation, ventilators, ECMO, pressors, etc., not to mention the incredibly rapid development and manufacture of highly effective vaccines. One can only speculate what the mortality rate for COVID might be if supportive medical care had remained in its early 20th century state.  Of course, the national approach to public health measures also matters a great deal, and it’s evident that the U.S. could have done better.

Cumulative confirmed COVID-19 deaths

Cumulative COVID deaths per million

Tara Parker-Pope does a nice (and accurate) job of reviewing Covid-19 vaccine side effects and addressing related common questions in this NYT article.

A timely video discussion of the current state of vaccines and their administration in the U.S.; Paul Sax MD and Carlos del Rio MD are the discussants and Deborah Cotton, MD MPH the moderator.  Free access from the Annals of Internal Medicine.

• I thought this was worth noting – The “T-Detect Covid” test uses T cell receptor matching comparisons to population based panels developed with the aid of machine learning to detect previous COVID-19 infection, supposedly with 97.1% sensitivity and 100% specificity. They (Adaptive Biotechnologies in a partnership with Microsoft – I have no financial interest in either) are continuing to refine their models as variants appear and hope to improve those numbers (and, I’m guessing, apply the same methodology to the diagnosis of other infections).
https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-adaptive-biotechnologies-t-detect-covid-test
https://www.statnews.com/2021/03/05/adapative-biotechnologies-covid19-test-microsoft/
It will be interesting to learn what test results are in patients who have been vaccinated but not had actual disease, how long the positive result persists, and how well such a positive result correlates with immunity in comparison to more standard antibody tests.

The latest economic stimulus bill has officially made its way through Congress, and only awaits the President’s signature for passage. There were ZERO (yes, that’s 0) Republican votes for this measure in the House and Senate. “Handouts”were apparently OK when your party could claim credit, but not so much otherwise. Oh, and that spirit of bipartisanship present when Democrats voted for Republican sponsored stimulus bills? Gone…

From Ezra Klein’s “Texas Is a Rich State in a Rich Country, and Look What Happened” piece in the NYT:

Texas will not prove unique, or even all that bad, in terms of how fragile the assumptions beneath its critical infrastructure really were. Most of its mistakes are familiar to anyone who has ever covered the politics of infrastructure and disaster preparation. Shalini Vajjhala, who worked on climate resilience in the Obama administration and is now the chief executive of re:focus partners, a firm that helps cities prepare for climate change, put it sharply to me. “When I am successful, that means something hasn’t happened. That’s good policy, but it’s lousy politics. The first year, you’re applauded. The second year, your budget is cut. The third year, your staff goes away.”

Yes, indeed, the US approach to preventative maintenance encapsulated.  Respond to a crisis, decide whew, this is expensive, stick head in sand, underfund, eliminate, repeat.  Witness public health before the pandemic.  We’re not always particularly smart.

In an cohort study published in JAMA Internal Medicine by Harvey, Rassen, Kabelac et al., the authors looked at more than 3.2 million US patients who obtained SARS-CoV-2  antibody tests and followed the group for results of subsequent nucleic acid testing for the virus.  The proportion of patients with positive PCR tests was initially higher in the group positive for antibodies, a result consistent with post-infection shedding, but then declined steadily over time and ended up being markedly reduced overall in the antibody positive group; after 90 days, 3% of the group without antibodies had a positive NAAT as opposed to only 0.3% of the antibody positive group, a 10-fold reduction.  This study did not go on long enough to help answer the question of how long the reduction in risk persists, but it does support other studies that have found similar decreases in the risk of subsequent SARS-CoV-2 infection following naturally acquired illness. We’ll need more time and data to help sort out how durable the protection from natural illness and vaccines will ultimately be, but these results help reinforce the notion that COVID antibodies can be protective.

Harvey RA, Rassen JA, Kabelac CA, et al. Association of SARS-CoV-2 Seropositive Antibody Test With Risk of Future Infection. JAMA Intern Med. Published online February 24, 2021. doi:10.1001/jamainternmed.2021.0366

Can’t argue with this one:

Insane stat via @atausanovitch: 34 GOP senators representing just 14.5% of population can block conviction of president who tried to violently overthrow American democracy. US Senate & American politics deeply broken

— Ari Berman (@AriBerman) February 13, 2021

Richard North Patterson has it right when he advises that “Republicans play hardball—and, all too often, lie. Far better for Democrats to play hardball with the truth. The party of extremism deserves no less.” in his opinion piece in the Bulwark.