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