Monday, July 27, 2020

Safe back to school? as a swede and microbiologist in USA

There's a few times more that others when I get more attention. I remember the last pandemic - swine flu 2008 - when a bunch of friends (and not so close friends) from high school and uni contacted me to ask "should we give our kids the new vaccine?". My answer, starting with a disclaimer asking what their pediatrician said and why/if they trusted the MD whom they went to consult about their children with, was that I am pro-vaccines in general - against virus especially - and that I would take the swine flu vaccine when it was offered since I deemed it safe.*

In general, that's what I do; I defer to the experts and then I offer my point of view and what I will do and what I recommend my family to do. All in the same idea as the saying when I was a child "do as I do, not only what I say".

So, last week was a flutter of emails, texts and phone calls from a number of coworkers and friends asking "what do you think about going back to school? Is it safe? In Sweden they had school all through spring!".

I think the answer requires a multipoint explanation. I had a twitter thread the other day where I worked through some of the key points. (That thread started with a reaction of how some data is presenting as comparison between days and that there is no thought on having consistency between groups when comparing them. I'll write a separate post of stats, need to be consistent and attention to detail.)

Anyway, the thread can be found here

The relevant tweets for my this blog post start with number 5. It has to do with statistics ( percentage, likelihood, distribution) and then actual numbers.
In short, a lot of epidemiology concerns population based research, trends and breaking down distribution in larger cohorts. It doesn't really say much about one singular case. It is about distribution and likelihood, percentages and other general numbers that for many people is hard to understand when drawn to a single case.

I mean some of this is almost like explaining the likelihood of winning the powerball... (1 in 292,201,338) which is quite ridiculous and people still play it since "there's a chance to win". Yet same people might have a hard time accepting they have a 1:2.5(41%) of getting cancer after age 60 and not worry too much about that. Let's not get into the likelihood of getting SARS-CoV-2 virus in community spread without any mitigation technique like mask or physical distancing (like sports practicing like normal, indoors in teams).

To get back to point. A lot of these questions last week were directed at me since I am a Swede. My family is in Sweden, a lot of my friends are there and I live in the USA so I have "knowledge from both worlds". In this pandemic there's been a lot of polarizing news (some true, some not) and one of them has been the constant comment about "Sweden's experiment" (let's not get caught up in the fact that the whole world are doing some kind of experiment here and there, or the "United States of America's experiment"). Two parts that have been reported pretty heavily were that Sweden didn't close their schools in the spring, and that the country didn't have a lock down.Let's start with facts:

  • Sweden moved high school and universites to online only in March/April.
  • Sweden kept elementary and middle schoold open the whole time before summer break.
  • Sweden kept daycare open the whole time, and kept it during summer break.
  • While Sweden didn't have a mandatory lock down - there is no provision in the law during peace time to do this from congress - a lot of people worked from home, didn't travel, kept children at home, didn't visit grand parents and so on. (side note; Swedes are pretty good at following so called "governmental recommendations" as well as having a relatively big amount of single households in the country -world leading)

However, it's part of this fact checking that Sweden didn't see vast community spread outside of specific suburbs of Stockholm. And that the majority of people who have died so far have been people over 70 who lived in nursing homes/elder cares. It's a tragedy in itself, and should have been prevented.

Why am I mentioning this? Well, simply because I would say that the evidence in April looking at the metrics on who was infected, hospitalized and in ICU pointed at that there was a large group of "people over 60, definitely over 70" who were mainly affected of the virus. Other groups were showing low incidences.

However, like all epidemiologists (and some microbiologists) know there is that thing of "incidence bias". In short terms; as you look, you shall find. (how you test will bias the results you look at)

How many young adults were tested in the spring? How many people were really infected? How many people who had no symptoms were tested? (I bring this up since that's another group that has been shifting in interest the longer the pandemic and data gathering have been going on.)

There is this thing with incidence and drawing conclusions. It's fairly safe to presume that if a large group ends up in hospital during an outbreak - it's a high likelihood that that group is more susceptible than the rest of the population. It is sometimes "simple things" as "the people who have eaten at one restaurant", sometimes "an overabundance of people who are older".

However, it doesn't mean that the groups that aren't found in the hospital are safe. It means that they are either safe OR the outbreak hasn't touched them in large enough numbers for them to get sick. Depending on the numbers, the distribution of sick people might change, and the numbers of sick will people will change.

These details, as well as knowing the difference between an isolated outbreak, an ongoing epidemic and a move to a raging pandemic.... that's why I listen to experts. It's complex to break down all these parameters into bite size morsels of information that people can and want to digest. It requires trust with diseases specialists who work with this everyday. And most of all, it requires an understanding that whatever the data shows in the beginning of an outbreak/pandemic will most likely change with time and amount of people getting infected and that it is crucial to stay nimble, gather more information and reanalyze the results.

Anyway, to make a long story short. Looking at the facts of infection rate and age groups in the USA today it's pretty clear that

a) there's ongoing community spread in a lot of counties (% positive of tested over 10% in a conservative view)
b) actual numbers of infected children, youth and younger age groups are going up
c) there's been fatalities in the groups "under 25", even in "under 17" - which wasn't the case in EU
d) the situation in USA today (in various counties/states or as a nation) is not comparative to the situation in Sweden in the spring
e) the situation in USA today (in various counties/states or as a nation) is not comparative to the situation in EU at the moment where countries are opening up and preparing for school

I don't feel that this complex conversation is taking place - at least not in a bigger context as "the situation in the USA right now is completely different from the EU situation". (I know, northeast are looking more like EU and keeping the numbers pretty good with their continuing partial lock down and limited openness.) I have had a lot of various emotions about this, especially since there are so many things that could be done to mitigate and stop the spread.

Alas, I ended up writing this blog post to put words to my frustration. 

The final point. There is still time to do things to stop this virus from spreading. To be inconvenienced for another time in order to mitigate the spread and give us less infected, less in hospital, less lingering effects from people who have been infected. 

Why is this so important? Because if there is something that drives me completely bonkers right now is the statement "the virus will go away someday [so we don't need to do anything extra]".

(I am sorry about the caps lock) 


The ONLY way we would've eradicated it would've been to quell it completely before it spread into an endemic virus. If it was a "truth" that viruses go away "after awhile" we wouldn't have as many diseases, rare and all, that pop up every so often. 

There's been documented two viruses that have "gone away"; SARS-1 and Small Pox. (First because of effective lock downs and controls, with a virus that was highly deadly. Second because of a world wide joint effort of mass vaccinations and travel bans without showing proof of vaccinations.)

We haven't even eradicated measles even though we have a vaccine since 1970 (and a better one since 1986), and it affects and kills children. Just asking a simple question; if we haven't been able to eradicate a disease that is that deadly and horrible to children - what makes you think that SARS-Cov-2 "will just go away"? There's got to be a solid plan (including distribution of a made efficacious vaccine - this is for another post)

I'll stop since this post is too long, too upset and touching on a lot of different things. Let me know in the comments if there is something I should elaborate or remove. Thanks for reading and being there. 

*there were a number of younger Swedes and Finns who got bad side effects from the swine flu vaccine. It was, over all in hindsight, impossible to have anticipated these side effects. It was about 200 children in Sweden and about 100 in Finland if I remember correctly. Out of a combined population of 13 million at the time. It's difficult to know how this part would've been discovered in the way "we" establish vaccines to be safe in this day and age. Most safety trials require relatively few, and then in the Phase III part of the trials - the more rare side effects are gathered as informational. Still though, it was a huge break in trust and it effected them in a life altering way.

Wednesday, July 01, 2020

dealing with accidental death

It's been a weird couple of days. Well, to be honest - maybe it's more about it's been a weird couple of weeks and months where the "normal" has been exchanged to something new and uncertain, a lot of new experiences that aren't what we all are  used to, or even know what they mean.

I'm grateful that I'm part of a team at my place of worship where we contact and talk to people who are terminal and their relatives.
I'm grateful to work in a place where we experience death and have people around who help with the process and help support the acceptance of the grieving process.
I'm grateful to use my experience with unexpected death, and suicide, in my circle of friends and acquaintances for something good as in at least I don't shy away of talking about it, or being there when someone else experience it.
I'm grateful that I have friends and acquaintances who have explained their experience with virtual funerals and memorials, especially in this covid time (it's such an odd, new concept that turns a lot of the old traditional ways upside down)

This is all to say that I'm grateful that I have been thinking about death and what I would like my relatives and friends to deal with, and that I think and hope I'm doing something good for people who are in this situation.

However, as everyone who knows, it's a different situation when you know the person in question. And it's never easy to deal with a friend taken away too soon, too fast, who has her whole life ahead of her.

It's one of those things though, so typical me, that when it happened - and people around me who didn't know her - said "I'm so sorry for your loss". I didn't know what to say. It's part of that I don't feel that it is my loss per se. It's her parent's loss. It's her partner's loss. It's the best friends' loss. It's the universe's loss. But it's not mine as a personal only loss. Only when I have unpackaged this I've realized that it's partly a language thing, partly a need to de-personal the loss. I want to answer them "It's all of our loss, cause she was a fantastic force and would do may great things".

I heard from a friend in the morning, she is dead. I was startled and I cried. I started with the negotiation with grief steps and got a fair bit on them. My issue? (As always) it's when you have to vocalize it to others. That's when it becomes real. That's when you have to handle the fall out and the others' feelings. And your own. When you have to tell others; "they are dead". There is no negotiation of that. And there is emotion from the other person. And you get to face that. For good or bad, you have to face your own feelings in that moment.

And yes. It is my loss. I will miss her. I will miss her laugh, stories, shared happy times with me and with others. She was such a joy and a great scientist. And such a wonderful person. She had a huge heart. And she wanted to make it possible for others to succeed in science, regardless of where you came from. She was a member of SACNAS and her friends there told wonderful memories of her. And she made the work day a brighter place with her laughter and her voice.

And in this covid times, I will have to get over the fact that we hadn't been in the same space since midMarch when campus closed down. It will be difficult understanding she is really gone, I will not see her when going to her lab space, the cell culture hood she used, or that she will pick up the phone - they way we have communicated the last couple of months.

I wish this was a better written post - a well written one to her memory. Maybe in the future I will be able to do her justice in an eloquent post with her wisdoms. Or I'll amplify her eulogy when it happens. But for now, I would like to simply say -

I miss you. You were such a great person to have around and you made life just a little brighter. You were brave and loud and so caring for people around you and for people you didn't even know when you went to the US-Mexican border to interpret for the people needing help. And that you were compassionate enough to allow me to feel that I helped, even if it was only with money and not physically being there since I don't know Spanish and I'm not a physician. You gave me courage and heart to keep on trying to help people around me. And you told me you wanted to be like me when you grew up. I joked it off since I didn't know how to deal with it - but I pulled up the texts and you said it several times. I will never forget you. And I will be an even better person in the future, the person you wanted to be, making you proud. Thank you for letting me getting to know you and being touched by your being.