Category Archives: Healthcare

Looming pandemic of bicycling-related injuries in post Covid-19 world?

Thousands of cooped-up Americans have been snapping up new bicycles or dusting off decades-old bikes to stay fit, keep their sanity or have a safe alternative to public transportation.

Source: Pandemic a boon for the bicycle as thousands snap them up | KOIN.com

Additional points left out of that story:

  • Bicycling has a high incidence of crashes and injuries.
  • Vehicle accidents are the only segment for which there is good data so this is what nearly all news stories cover.
  • Vehicle accidents account for a fraction of bike related accidents and injuries.
  • Most bike crashes (probably 90%) involve roadway hazards, debris, potholes, sewer grates, collisions with other bicyclists, pedestrians, dogs, other animals, bike break downs, etc – or alcohol on board the bicyclist, or other bicyclist or vehicle driver, or on board everyone.
  • Fatalities are rare (less than 1,000 per year) but most  involve a collision with a vehicle. (Pedestrian versus vehicle fatalities are about 8x more than vehicle versus bike-related fatalities.)
  • About 1/2 million bicycle-related injuries are treated by ERs (ER’s collect and report this data). An unknown number are treated by individual physicians (not in ERs) and an unknown number are not treated at all. Some estimate total injuries in the 1-2 million per year range. Keep in mind – we have no hard data on how many people ride bikes, how many miles they travel, the nature of their riding nor a count of injuries-we have to rely on surveys. Hard data on crashes not involving vehicles is nonexistent. There is tons of research on fatal bike accidents and vehicle-related crashes but little on  non-vehicle crashes. And like the data here, it is not weighted by participation rates.
  • Almost all bike safety initiatives are geared to reducing car versus bike crashes. Almost none address bike versus roadway hazards, which account for most bike crashes. Bicycling advocates are focused on the bike versus vehicle category, unfortunately. 
  • In the U.S. the use of bike helmets is estimated to cut the risk of brain injury in half. Bike helmets distribute impact over a wider area of the head, reducing the incidence of bone fractures but may not reduce brain injuries by as much – brain injuries often come from the brain’s movement inside the skull.

An increase in bicyclists, as suggested by the article, if continued long term will lead to an increase in injuries and an increased demand for (expensive) medical care services. If the trend continues as  post-pandemic response, this will lead to an increase in injuries and costs as a consequence of the pandemic.

There is support for that conclusion in published literature, including this example:

Continue reading Looming pandemic of bicycling-related injuries in post Covid-19 world?

Does brain damage lead to people becoming “sudden geniuses”?

Don’t think it worked for me:

There’s mounting evidence that brain damage has the power to unlock extraordinary creative talents. What can this teach us about how geniuses are made?

Source: The Mystery of Why Some People Become Sudden Geniuses

Having had 5 mild TBI and one moderate TBI, it’s hard to think about this 🙂 Also, I do not recommend injuring your brain as an approach to becoming smarter.

While my life turned out well, many opportunities went missing due to dealing with gremlins of past brain injuries that were not diagnosed and treated until about 18 months ago.

Covid tracking apps summarized

When people mention “Covid tracking apps” it would be useful to first define what is meant by “Covid tracking app”. There are many approaches in use and many that are proposed. The various methods are remarkably different. When you hear that “Country X used a tracking app and they have fewer cases”, this does not mean they used a tracking app like you have in mind.

Most apps use location data provided by the cellular network itself or on GPS/Wi-Fi position fixes stored on the phone and shared directly with public health authorities.  Some use the data for contact tracing, coupled with free Covid-19 testing, while others use location data to enforce strict geo-fenced quarantine procedures that if violated, may result in arrest and imprisonment. Few existing apps use  close contact tracing based on Bluetooth.

Contact tracing apps, by themselves, appear to provide little value. As we will see, to be useful there needs to be supporting infrastructure outside the app – such as Korea offering Covid-19 testing to those in close contact. And the app must be installed by nearly all smart phone users (and this will miss about 15% of phones that are not smart phones). Most countries are not using  phone-based apps to track location – they are using the phone network to report locations on 100% of phones in use, which is very different than voluntary installation of a tracking  app.

Consequently, when you hear someone refer to “contact tracing app”, you need to ask them to define what they mean by “contact tracing app”.

What follows is a review of various “contact tracing” apps used in different countries.

Continue reading Covid tracking apps summarized

App-based Covid tracking in Iceland does not work well

“The technology is more or less … I wouldn’t say useless,” says Gestur Pálmason, a detective inspector with the Icelandic Police Service who is overseeing contact tracing efforts. “But it’s the integration of the two that gives you results. I would say it [Rakning] has proven useful in a few cases, but it wasn’t a game changer for us.”

….

He says there have been instances where the data was useful, but that the impact of automated tracing has been exaggerated by people eager to find technological solutions to the pandemic.

Source: Nearly 40% of Icelanders are using a covid app—and it hasn’t helped much | MIT Technology Review

Continue reading App-based Covid tracking in Iceland does not work well

A look at travel issues over the next 12-24 months

Mandatory physical distancing measures, temperature checks and filling out medical history questionnaires prior to airplane flights, possible Covid-19 testing before boarding, limited or non-existent meal and beverage service on airlines, no more free hot breakfasts at hotels, restaurants allowed to use only 25-50% of their seats, mandatory face mask wearing at all times … and higher prices. Airlines can not keep flying idled seats – someone has to pay for it.. Hotels, restaurants and car rental agencies will have to charge more to fewer customers in order to cover their fixed costs.

Source: What travel will look like for the next year or two – SFGate

What does this mean for travel? It means recreational travel will be limited until a vaccine is widely distributed and people have confidence in its effectiveness. Many will choose to avoid the “new normal” hassles of travel during this time.

Continue reading A look at travel issues over the next 12-24 months

Why I made my covid-19 posts private

Asking a common sense question is a thought crime now. Asking a question about Covid-19 or the government’s response is to deny the authority of experts. This is apparent on social media!

Twitter censors anything construed as a “Denial of expert guidance“. Thus, questions inspired by cited peer reviewed literature are not permitted on Twitter. To ask a question is to deny expert guidance – you are thereby guilty of thought crimes!

I stopped using Twitter a while ago so no big loss.

Satirist JP Sears has a funny commentary on this – thou shalt not question anything – hah hah.

Asking questions that might cast doubt on conventional wisdom is a thought crime. “Experts” including the CDC and WHO, have, many times over the past few months, made inconsistent, contradictory and incoherent statements. How does their erroneous content fit with in Twitter guidelines?

The issue goes beyond Twitter; anyone who notes an oddity, an observation or has a question about an unclear expert or government pronouncement is committing a thought crime.

Per Twitter (and popular view today), it is a thought crime to ask questions. In this environment, we must adhere to the “officials” and the “experts”. To ask questions is to doubt their authority.

A month ago I received push back for sharing hopeful “good news” items about vaccines in development, declining trends in new cases in my state, and so forth. I was perplexed why good news was considered heretical. How odd!

Amid a world filled by news media fear mongering, often weeks out of date or focused solely on the most fearful interpretations, many people are overcome with anxiety.

They appear to seek out ever more scary news as a way to validate their anxiety. That’s the only explanation I could think of to explain resistance to good news. But I am not an expert. Pointing out positive news or potentially positive news is “bad” – it is a thought crime against conventional wisdom and devalues the “experts”.

Update: Yes, that is the case: “Confirmation bias is the idea that we will actively seek out, remember, and favor information that confirms something we already believe.” People are intentionally seeking the scariest possible news stories about Covid-19. The news media is more than happy to provide daily scary news interpretations. I’ve read several today that were so wrong and misleading as to be fake news – but at least they were scary! Fear is one of the most powerful motivators used in propaganda messaging. This further persuades people to adopt the common conventional wisdom – and to denigrate those who question any aspect of it.

Anyone may have a viewpoint on say, computer hardware or software. But some fields, like health care – are off limits to the laity. Only those who wear the right robes may make comments or ask uncomfortable questions.

Asking questions, noting oddities, peculiarities, inconsistencies, posting hopeful information – saying anything having to do with Covid-19 other than quoting official government experts – is a thought crime, a commission against the zeitgeist.

If you are confused, it is your fault – not that the experts have provided poor explanations and communications to the public.

Consequently, I have marked all of my nearly one hundred or so Covid-19 related posts as private so as not to commit more thought crimes!

The only posts I am leaving are those that primarily intersect with technology or business topics:

  • links to “expert” views on Neil Ferguson’s Covid Sim model code (I wrote my own extensive review but marked it private because how dare I criticize his code)
  • Summary of Covid-tracking apps (intersects with tech I’ve worked with)
  • Business topics like why is the stock marketing going up? How will we pay for economic stimulus packages? How will this effect the travel industry?
  • I left up the post about whether or not HEPA vacuum bags contain fiberglass.
  • And also the one about “Why a shortage of toilet paper?” Interesting topic actually!

Do HEPA Vacuum bags contain fiberglass?

A UK doctor posted a Youtube video claiming that HEPA vacuum filter bags contain fiberglass. That claim has since been disputed by many.

Further, the UK doctor, Simon Freilich, has backed off his claims.

After some pushback from YouTube viewers saying the bags they’d checked didn’t have dangerous glass fibers in them, Freilich posted that he couldn’t research “every possible type” and that there “are clearly various types of filters and materials out on the market.”

https://www.oregonlive.com/coronavirus/2020/04/is-it-safe-to-make-a-diy-mask-out-of-a-vacuum-bag-debate-erupts.html

Vacuum bag makers say they have never used fiberglass materials.

Many have to say “not suitable for any other uses” (or similar) due to liability concerns. If someone uses a product in a way that the manufacturer has not tested, the manufacturer does not wish to be accused of liability for any harm that may occur.

Freilich said he got his info from an unnamed random Youtube video – because, you know, social media is a highly reliable source of information.

Freilich has updated his own social media with this:

The unfortunate reality, having looked through the research, is that home made masks are only marginally better than no masks at all, and the effects are difficult to isolate as usually a range of measures are simultaneously enacted. Hence the best protection is to stay away from other people, as far as possible. Obviously, this is difficult for many but that’s literally the best method.

He acknowledged that he has no expertise in mask design or materials.

What happened: a social media post used the “appeal to authority” method of argument and then went viral and got picked up by the news media.

We tend to treat “facts” promoted by authorities, “experts”, celebrities and politicians as truth. As Bertrand Russell said (I’m paraphrasing): facts are true (or false) regardless of who says they are true or false. But most people fall for the “appeal to authority” argument which is why it is one of the top most used forms of persuasion. Russell viewed such arguments as the worst form of argument possible and insisted on facts and logic as the only valid forms of argument.

Once Doctor Freilich posted his video, his “assertion” became a “fact”. Once established as “fact” it is very difficult to undo the public perception of that topic. In this way, untrue “facts” become “true facts”, even though they are not true.

From my grandmother’s diary: Spanish flu 1918

Selected text from my Grandmother’s diary in which she documented the Spanish Flu of 1918 (as well as family life and the end of World War 1). I have included here selected excerpts about the Spanish Flu, with some comments as an afterword.

Mon. Oct 14. Well, I see I have not written in a whole week but is seems as if I have been very busy. The schools were closed, also theatres etc. on account of the influenza epidemic. The churches held no services yesterday it seemed strange not to hear the church bells ring. I do not recall any Sunday in my life when the churches have not held services.

            Alice and Ernest Holland are somewhat improved. There are not quite so many new cases of influenza. Six nurses up at the Rome Hospital have it.

….

Fri Nov 1 – I went down to have Dr. Stranahan inoculate me against influenza but he was not in his office so I had to have Dr. R. Morris do it. In five days I will have to have the second injection.

Fri Nov 3 – During the past week, Robert Scott (34) 519 ½ W. Thomas, Irene Brodbeck (14), 509 W Thomas, and Mr. I. Seblowitz, 43, W Thomas died of pneumonia following an attack of that dreadful influenza.

They are inoculating men in the mills against it. So many happy homes have been broken up, we can not understand it, but some day we’ll understand.             Over 4000 deaths occurred in Boston and nearly 400 in Utica

Nov 6 – I had my second inoculation in my left arm today. Dr. Stranahan inoculated me.

Nov 12. Tuesday – Another fair day, crisp and cool, a clear blue sky. Children go to school again after the influenza epidemic. They have missed 22 school days.

Thurs Nov 14 – I had my third and last inoculation.

Sat Dec 28 – Our furniture mahogany bedroom suite and oak dining-room suites we moved up here this afternoon to be stored downstairs in Grandpas’ front room.

           This influenza epidemic is terrible so many good people are being taken from us, it seems now as if it would not be a hard thing to die and go to heaven. So many good people have gone, there’d be a lot of them there that I know. Clara Karlen (Mrs. Clayton Mowry) died last Monday. She is a distant cousin of mine. Alice Meier (Mrs. Stuart Preston) died on Christmas night – I simply can’t believe it. She was always so cheerful & jolly, she was married last September.

Afterward Comments

What is the inoculation she describes in her diary? They lived in Rome, New York at the time such this description may be relevant – note the dates of the inoculations, above, with this:

Those true believers had some reason to be hopeful that a vaccine could prevent influenza as the disease began its second appearance in the United States in early fall 1918. By October 2, 1918, William H. Park, MD, head bacteriologist of the New York City Health Department, was working on a Pfeiffer’s bacteria influenza vaccine. The New York Times reported that Royal S. Copeland, Health Commissioner of New York City, described the vaccine as an influenza preventive and an “application of an old idea to a new disease.” Park was making his vaccine from heat-killed Pfeiffer’s bacilli isolated from ill individuals and testing it on volunteers from Health Department staff (New York Times, October 2, 1918). Three doses were given 48 hours apart. By October 12, he wrote in the New York Medical Journal that he was vaccinating employees from large companies and soldiers in army camps. He hoped to have evidence to demonstrate the effectiveness of the vaccine in a few weeks (Park WH, 1918).

https://www.historyofvaccines.org/content/blog/vaccine-development-spanish-flu
Chart showing deaths from influenza in Chicago in the fall of 1918
Number of influenza cases reported to November 2, 1918, in Chicago. AJPH, 1918.

In November, the Newark Evening News reported that 39,000 doses of Leary-Park influenza vaccine had been prepared and that most doses were used. (Timothy Leary was a professor at Tufts University School of Medicine.) Though it was too soon to tell if the vaccine was effective, “…the average person need have no fear of the results of the vaccine. Neurotic and rheumatic individuals, however, appear to be sensitive to the vaccine, while children take it with less disturbance than adults” (Newark Evening News, 1918).

https://www.historyofvaccines.org/content/blog/vaccine-development-spanish-flu

Judging from the dates, her “innoculation” sequence would appear to have made her part of a very early group to receive this treatment.

Numerous groups, as described at the source above, were working on developing their own vaccines. Sound familiar?

None of these vaccines worked. Why? Because they thought this “flu” was caused by a bacterial infection. It was, in fact, a virus – something not understood until the 1930s. The vaccines they created were for various bacterial infections, not the virus.

The following comments echo our current situation with regards to drug treatments such as hydroxychloroquine. Many politicians, some doctors, are advocating quick use of HCQ – without waiting for trials.

The Editorial Committee of the American Journal of Public Health tried to put a damper on people’s expectations about the vaccines. They wrote in January 1919 that the causative organism of the current influenza was still unknown, and therefore the vaccines being produced had only a chance at being directed at the right target. They noted that vaccines for secondary infections made some sense, but that all the vaccine being produced must be viewed as experimental. Acknowledging the somewhat ad hoc nature vaccine development in the current crisis, they urged that control groups be used with all the vaccines, and that the differences between control and experimental group be minimized, as to risk of exposure, time of exposure during epidemic, and so on (Editorial Committee of the American Journal of Public Health, 1919).

Certainly none of the vaccines described above prevented viral influenza infection – we know now that influenza is caused by a virus, and none of the vaccines protected against it. But were any of them protective against the bacterial infections that developed secondary to influenza? Vaccinologist Stanley A. Plotkin, MD, thinks they were not.

https://www.historyofvaccines.org/content/blog/vaccine-development-spanish-flu

A surprising take away from the diary comments and the historical record is incredible similarity between 1918 and 2020. In 102 years it appears that very, very little has changed in regards to a pandemic response. And that is not encouraging at all.

Even the cause of the global pandemic was similar – global travel. Soldiers who fought in WW II (officially ended in Nov 2018) were traveling back home and are believed to have spread the Spanish Flu more widely.

The virus did not originate in Spain but was first publicized as being in Spain. The Spanish, in fact, called it the French flu.

Disease: Good summary of coronavirus COVID-19 situation

Summarizes possible impacts to the U.S. and economic issues. CDC is planning for possible school and business closure mandates, summer Olympics could be canceled, and hoping the disease, like many, subsides during warm summer conditions.

The total number of COVID-19 cases climbed above 80,200 as of Tuesday with deaths climbing to at least 2,704.

Source: Coronavirus live updates: US confirms 53 cases, CDC outlines pandemic planning

U.S. firms discouraging or prohibiting travel by employees to affected areas now including China, Italy, South Korea and southeast Asia including Australia.