It seems to me that there is no worse time for public, scientific discourse to be polarized than in the midst of a deadly pandemic that is affecting us all, directly and indirectly. I’ve decided to share a few examples of what I consider to be unhelpful “friendly fire,” though other examples are sadly too…
COVID-19: Major study shows dexamethasone improves mortality among ventilated patients
The use of corticosteroids in systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) isn’t new, so it isn’t surprising that treatment of critically ill COVID-19 patients in the ICU has increasingly involved dexamethasone. Nevertheless, the first major results showing improvement in survival among ventilated COVID-19 patients given dexamethasone comes as very welcome…
“Conversation is the essence of palliative care”
A recent episode of Scott Weingart’s excellent EMCrit podcast featured a thoughtful discussion with Kei Ouchi, MD, on one of the most important aspects of emergency medicine and critical care; conservations regarding end-of-life care. The focus here is on rapid code status conversation. The podcast page offers a slew of useful links, and references the…
COVID-19: Why were some hospitals in NYC overwhelmed but not others?
ICYMI, I recently came across an NYT article that revealed some facts that are frankly shocking. “At Elmhurst Hospital in Queens, hundreds of Covid-19 patients arrived in need of more help than besieged medical workers could give. Patients were found dead in rooms. One medical resident described conditions as ‘apocalyptic.’ Yet at the same time,…
COVID-19: Could exposure to ‘common cold’ coronaviruses offer some protection against SARS-CoV-2?
Although not all that surprising in hindsight, the results of a paper recently published in Cell are nevertheless stunning: 40-60% of a group of individuals not exposed to SARS-CoV-2 were found to have T helper cells that were reactive to SARS-CoV-2. The article summary: “Understanding adaptive immunity to SARS-CoV-2 is important for vaccine development, interpreting…
COVID-19: Remdesivir apparently shows “a clear-cut, significant positive effect,” but where’s the evidence?
There have been some bizarre, troubling developments regarding the purported anti-COVID drug, remdesivir. At the end of April, Anthony Fauci told reporters in the oval office that the NIH’s remdesivir trial showed “a clear-cut, significant positive effect.” From now on, remdesivir “will be the standard of care,” meaning that any new potential drugs to treat…
COVID-19: Smoking protective? ACE-inhibitors harmful? (TLDR: No) Let’s talk about collider bias
Collider bias is an under-appreciated source of distortion in research, and there seems to be quite a lot of it in the deluge of COVID-19 literature. Oxford CEBM’s Catalogue of Bias has an excellent article on collider bias here: “When an exposure and an outcome independently cause a third variable, that variable is termed a…
Worth reading: Suicidality is increasing in the US
More bad news. Between 2005 and 2015, the suicide fatality rate in the US increased 13% among those aged 20-64. Suicide attempts increased among all age groups. “Suicide attempts increased in females, adolescents, and older people, while suicide fatalities (mainly shootings and hangings) increased in those aged 20 to 64. The finding that both incidence…
COVID-19 is not the “great equalizer”
Maria Abi-Habib writing for NYT, “For the first time since 1998, the World Bank says, global poverty rates are forecast to rise. By the end of the year, half a billion people may be pushed into destitution, largely because of the pandemic, the United Nations estimates. … Since 2000, Bangladesh brought 33 million people —…
Worth reading: Less is more in intensive care
Catherine Auriemma et al. writing in Intensive Care Medicine: “The notion that ‘less is (or may be) more’ in intensive care medicine has been contemplated by experts for decades. However, not until Kox and Pickkers’ review in 2013 had there been careful consideration of the evidence supporting this theory.1 Their thought-provoking article focused specifically on…