Saturday, May 02, 2020

Weekend Reading: The Mostly Hopeful Edition

Last night after dinner, we all got in our car and drove to the neighborhood my husband and I lived in before we had kids (Pacific Beach). We found a parking spot not far from the beach, put on our masks, and walked down to the beach to see the glowing waves.

We're having a particularly good bioluminescence show here right now. If you aren't familiar with the phenomenon, it is caused by a bloom of phytoplankton in the water. We get these blooms from time to time, but can't predict when. The waves glow when they break, and you can get cool effects in the sand. During the first bioluminescence event I ever saw (back in grad school!) if you walked in the wet sand, you left glowing footprints. It was magical. We didn't get glowing footprints last night, but we could make the wet sand glow briefly by dragging our feet through it.

We all had fun watching the glowing waves and playing in the sand. It was also nice just to be out as a family again. For the most part, just the grownups have been going out, and just to go do the shopping.

Most other people at the beach were wearing masks and trying to keep their distance from other groups. Our beaches only opened on Monday, and there isn't supposed to be any standing around or lounging on the beach. People were standing in little groups to watch the waves and take pictures, but I only saw one couple sitting on the beach. There were police present, and I suppose they would have intervened if it looked like people weren't following social distancing rules.

We're lucky that this bloom didn't happen two weeks ago, when none of us would have been allowed on the beach to enjoy it! From my informal survey of friends and colleagues, I think that the opening of the beaches for surfing and running/walking is a really big deal to us. We all got a little scare on Thursday, when a memo leaked indicating that the governor was going to close all beaches because there had been large crowds at several Orange County beaches last weekend. Instead, he closed just the Orange County beaches. I believe there is a legal challenge underway on that. Whatever the merits of that order, I think it may have given San Diegans extra incentive to follow the rules our county and city officials have put in place. We don't want to see our beaches close again!

Anyway, I do have some things for you to read this weekend:

If you read only one thing, make it Ed Yong's latest piece about the pandemic, in which he explains why there's so much uncertainty about everything. As I mentioned in my last post, I think that living with this level of uncertainty is hard on a lot of people (it is hard on me!) and this piece does a good job of explaining why we can't have more certainty, which may help people figure out how to make decisions in this uncertain time.

My second choice would be David Frum's helpful explanation about why Mitch McConnell has been talking about letting states go bankrupt. Honestly, this might be the most infuriating thing I read all week, but it is important.

There were a lot of things written about remdesivir and what we know about the results of the NIAID trial of it. Derek Lowe does his usual stellar job of explaining it all. Since his post was written, the FDA announced emergency authorization for the use of remdesivir in severe COVID-19 cases. I assume additional trials will be done now to figure out how best to use remdesivir. A lot of people really want to see trials earlier in the disease, because that is typically when antivirals are most effective. Administering remdesivir early will be hard in most cases, though, because it is an IV drug. My opinion is that the way around that issue is to do the trials of early use in skilled nursing homes, which have been particularly hard hit by this epidemic and in which it should be possible to reliably administer an IV drug. Honestly, I think we should investigate whether it would be beneficial to administer remdesivir prophylactically in any group care situation in which there is a confirmed case of COVID-19, similar to what is done with Tamiflu and flu outbreaks (here's the CDC guidance on that - search on "antiviral chemoprophylaxis" to find the relevant info).

But we have a limited supply of remdesivir. Gilead has been working to increase supplies for awhile, but this is not an easy undertaking. STAT has a good writeup of the manufacturing efforts. I suspect we'll have limited supply of remdesivir for awhile. The people figuring out how best to use that supply know more about infectious disease treatment and clinical trial design than I do, so we'll just wait and see what comes next for that drug, and hope that more effective drugs come along as soon as possible.

Doctors are also learning more about how best to treat COVID-19 patients. Here's an article from the University of Chicago about using high-flow oxygen cannulas instead of ventilators.

New York has provided some data about which pre-existing conditions were most common comorbidities in patients who died from COVID-19. Asthma is surprisingly low on the list. That data made me feel better about my personal risk (my only relevant pre-existing condition is asthma).

Meanwhile, different areas are starting to experiment with what can be reopened. I am glad I live in a place that is taking a slow and deliberate approach to reopening, both because that just feels safer to me and because I hope it allows us to gather some actual evidence about which activities are relatively safe and which we should continue to avoid. Other states are moving faster. I don't think we really know how that will turn out, but this article describes how some people feel about it in Georgia. (Spoiler: worried.)

Here's California's plan for reopening. We're in Stage 1, starting to edge into Stage 2.

And here's a writeup about Washington state's plan.

I've mentioned the discussions about why New York City and Seattle had such different coronavirus outcomes. There was a long write-up in the New Yorker arguing that it was because the state of Washington and Seattle let the scientists lead the response.

I am trying to read obituaries of the people we've lost to COVID-19, to keep the numbers from making me numb to the tragedy. This one for Cesar Quirumbay hit me particularly hard.

David Roberts at Vox argues that we should electrify the postal fleet. I found it to be a convincing argument!

Now for some things that made me smile this week:

I love the flamingos out and about at the Denver Zoo. This was my favorite take on it:

Apparently, when someone asked Dr. Fauci who should play him in the movie, he jokingly said Brad Pitt. Brad Pitt obliged:

I knew before I looked that this had to be in Australia:

Also me:
This is beautiful:

This thread about Rebecca Black made me happy. So we went and listened to some of her recent music last night and it is pretty good!

I love this:

Prince Edward Island is taking the bear hunt idea seriously!


Happy weekend, everyone! I think our trip to the beach last night will be our only outing, but the weather is nice and my hammock calls to me....


  1. Thank you for all those links! I find your idea about doing the remdesivir trial as prophylaxis in elderly people particularly fascinating. I hope someone does that. And now I understand where the blue glowy pictures of the beaches were coming from too!

  2. I'm not even sure I'm totally comfortable with our moving into Stage 2 right now when we still don't seem to have any solid ideas on how to effectively treat it (according to check-ins with my practicing medical doc relatives). But I AM really glad that we have some kind of slow reopening plan instead of just trying to throw things wide open again.


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