•From David Leonhardt’s 5/21 Morning Newsletter.  Let’s hope the trend continues!

•Pay attention to what Tom Friedman says in his NYT opinion piece, “The Trump G.O.P.’s Plot Against Liz Cheney — and Our Democracy.” An excerpt:

“In effect, the Trump G.O.P. has declared that winning the next elections for the House, Senate and presidency is so crucial — and Trump’s ability to energize its base so irreplaceable — that it justifies both accepting his Big Lie about the 2020 election and leveraging that lie to impose new voter-suppression laws and changes in the rules of who can certify elections in order to lock in minority rule for Republicans if need be. It is hard to accept that this is happening in today’s America, but it is.”

And be very afraid.

Gina Kolata has an interesting story in the Times – Imagine, Surgery Without a Scar.  The researchers, in an article published in the April 23 Science, found that inhibiting Engrailed-1 activation in fibroblasts remarkably inhibits scarring after wounding in mice.  If similar results are found in humans, this would be a great boon for many patients.

From the paper:

Wounds in adult mammals typically heal by forming fibrotic scars. Mascharak et al. found that a specific population of skin fibroblasts (Engrailed-1 lineage–negative fibroblasts) activate expression of Engrailed-1 and turn on profibrotic cellular programs in response to local tissue mechanics in wounds (see the Perspective by Konieczny and Naik). When mechanical signaling was inhibited in these cells (using either genetic deletion or small-molecule inhibition), skin wounds in mice no longer formed scars but instead healed by regeneration, restoring skin with normal hair follicles and glands, extracellular matrix, and mechanical strength.

•George Floyd mattered.   Let’s hope the long awaited accountability provided by this verdict is a first of many steps toward restorative justice for all Americans.

John Gruber, posting in his Daring Fireball:

“So seven people get blood clots after getting the J&J vaccine and we pull it, but eight people get killed by a crazed gun owner and it’s just another Friday in America. Makes sense.”

Elizabeth Rosenthal has it right in her Washington Post commentary, I was a teenage gun owner, then an ER doctor. Assault-style weapons make me sick.:

4/8/21 AMA statement on curbing gun violence

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.