Dr. Irwin Redlener (IR)
Randy Larsen (RL)
June 17, 2020
Dr. Irwin Redlener is the founding director of the National Center for Disaster Preparedness, part of the Earth Institute at Columbia University where he holds professorships in public health and pediatrics. In a wide ranging interview, Dr. Redlener discusses key COVID-19 issues: underlying medical conditions, therapeutics, vaccines, the age issue, communicating with the public, alternative standards of care, lockdown and reopening, schools and daycare, and nursing homes.
Dr. Amesh Adalja (AA)
Randy Larsen (RL)
June 22, 2020
We are pleased to have with us a scientist and frontline physician, Dr. Amesh Adalja. He is a Senior Scholar at the Johns Hopkins University Center for Health Security, a Fellow of the Infectious Diseases Society of America, the American College of Physicians, and the American College of Emergency Physicians. He practices infectious disease, critical care, and emergency medicine in the Pittsburgh metropolitan area.
Our interview with Dr. Adalja covered a wide-range of topics including: Lessons Learned During First Four Months of the COVID-19 Pandemic, Testing (virus and antibody), Reopening the Economy, Therapeutics, MMR and TB Vaccines, The Age Issue, Schools and Daycare, I Think I May Have Been Exposed–What to Do?, and more.
Written by Leigh Henderson
COVID-19 has dominated the headlines, quarantined much of the U.S. population, and devastated the U.S. economy. As of June 12, the United States reported 2 million confirmed and probable cases with 111,000 deaths.1 There were, an estimated 271,000 hospitalizations.2
When COVID-19 was first reported, most of the population was self-quarantined and non-essential businesses were closed. We were told that this would ‘flatten’ the epidemic curve. It would extend the duration of the epidemic but would ease the burden on overtaxed hospitals. The number of patients would be distributed over a longer period, but there would be fewer at any one time.
Why did we not take the most obvious step to ‘ease the burden’?
Written by John Hoffman
I am not sure that leaders at all levels fully appreciate the grave danger we face with our food supply, our economy and our nation. The food system in the United States represents one sixth of our economy. Historically, as the food system goes, so goes the economy. The national food infrastructure has always had a direct impact on confidence in government.
Many in our nation face growing food supply insecurity today. This is particularly true in the large cities. Today we have broad shortages that are in the range of 20% of key protein products. Food prices are rising as a consequence of production cuts that have created these shortages and supply disruptions. This is all the result of the COVID-19 pandemic and the failure of the federal interagency team to take the necessary steps to assure full access to the things every family needs every day. What we are seeing today need not have been the case.
Written by Dennis Haugh, Dave Morgan and Ron Scott
Everyone in the United States has now become painfully aware of how computer models can impact their lives. We can no longer ignore their existence. Every citizen needs to have a rudimentary understanding, not of modeling itself—but of when it can be trusted and when it cannot.
There is a fundamental question of knowing the future. In 2007, The Black Swan explored the bounds of our knowledge in a world of uncertainty and introduced the “ludic fallacy”—using the past to predict the future. This paper puts some of the concepts from that book into the context of computer modeling.
The response to the Covid-19 pandemic response has largely been based upon the published predictions from models like the ones constructed by the Imperial College and the Institute for Health Metrics and Evaluation (IHME). Had these models not produced the fear they did, the impact of the pandemic would have been reduced significantly.
Combined with standard testing protocols, challenge studies could accelerate development of a safe and effective vaccine.
Challenge studies involve giving a developmental vaccine to volunteers followed by infecting those volunteers with the SARS-CoV-2 virus. Challenge studies are rare but the National Institutes of Health has been doing them for a few years for a mild strain of influenza.
From 1954-1973, during The Cold War, the U. S. Army conducted a series of challenge studies on more than 2000 Seventh-day Adventist volunteers. Operation Whitecoat was created to protect against the threat of Soviet bioweapons. The studies were conducted at Ft Detrick MD and set the gold standard for the use of human volunteers in medical experiments. In 2018, I directed & produced a documentary film about these incredibly patriotic young men.
Looking forward, after a COVID-19 vaccine completes Phase I safety testing, volunteers for a challenge study would be vaccinated and later infected with the COV-SARS-2 virus. Initially, only young, healthy volunteers would be selected. They would be closely monitored in a medical facility.
Donna Shalala (D-FL), a former secretary of Health and Human Services, along with 33 other members of Congress from both parties, have expressed support for the use of human challenge trials. The World Health Organization and National Institutes of Health are currently examining the issue.
This is not a common procedure for vaccine development.
These are not common times.
During the past few months, how many times have you heard a pundit on TV say, “We must listen to the experts.” Every time I hear this, I wonder if the pundit has ever sat around a conference table with a group of scientists—or for that fact, lawyers, economists, senior military leaders or other such “experts”.
During the past two decades I have spent many hours—in fact, entire days, listening to distinguished experts engage in exhausting, ferocious debates while failing to reach consensus on a wide variety of national security issues. This is in no way a criticism–it is the essence of policy debates. Such “real-time peer review” is even more pronounced when dealing with the COVID-19 pandemic. There is so much we don’t yet know about the virus, the disease and the social and economic consequences–and no one dealing with the current pandemic has ever faced such a challenging crisis–at least not in the “real world”.
When we began this blog, our lead article was written by A. J. Kay stating the ban on elective procedures (which includes things like heart valve replacements, bone marrow transplants, organ donations, and cancer screenings) could kill more Americans than COVID-19. Today’s op-ed in the Washington Post by the Secretary of Health and Human Services adds even more information to this argument.
Since the stay-at-home orders and ban on elective procedures began—which we fully supported at the time to prevent the potential overloading of the healthcare system—the unintended consequences have grown at an alarming rate.
- mammograms down 87 %
- colonoscopies down 90%
- breast cancer surgeries reduced by 66%
- vaccinations down 60%
These are all classed as elective procedures.
Additionally, many hospitals have experienced a 60% reduction in revenue due to the cancellation of elective procedures resulting in the furloughing of healthcare providers and creating a situation in which many rural hospitals are on the brink of bankruptcy and may be forced to close—permanently.
One has to wonder if the epidemic modelers add these and other unemployment heath risks (increases in suicides, opioid deaths and spousal abuse plus loss of healthcare benefits) to their equations?
There are not any “no-risk” solutions, but Secretary Azar makes it very clear—this is not an argument about health vs the economy. It is about health vs health.
We recommend you read Secretary Azar’s op-ed.
Written by Leigh Henderson
One of the most significant anniversaries in human history passed recently with little fanfare. Forty years ago, on May 8, 1980, the World Health Assembly declared that smallpox had been eradicated.
Smallpox had been transmitted in an uninterrupted chain from person to person for at least 3,000 years. Unlike bubonic plague, it was endemic—always present—killing some 20-30% of those infected and leaving many of the survivors blind and most horribly scarred. Children bore the brunt of smallpox—many adults had survived the disease or been successfully vaccinated. Children under 15 could account for 75% of all deaths in an epidemic.
On January 1, 1967, the World Health Organization (WHO) started a global smallpox eradication program. Smallpox control efforts had ended endemic smallpox in much of the world, but epidemics introduced by travellers were rife. Smallpox was conservatively estimated to infect 10 million people annually, causing 2 million deaths.
On October 26, 1977, a Somali man became the last victim of smallpox in the world. Two years of exhaustive searches for any remaining smallpox reservoirs followed. A global commission reviewed the evidence and concluded that smallpox had indeed been eradicated.
Dr. Mike Osterholm has been a colleague and good friend for 20 years. He is not only a world-class epidemiologist, but also a fabulous communicator. You have probably seen him on TV during the past few months, but in this podcast he has the time to explain the details behind the headlines and sound bites. I will be listening to his weekly podcasts, and so should you.