When major decisions must be made amid high scientific uncertainty, as is the case with Covid-19, we cant afford to silence or demonize professional colleagues with heterodox views. Even worse, we cant allow questions of science, medicine, and public health to become captives of tribalized politics. Today, more than ever, we need vigorous academic debate.
To be clear, Americans have no obligation to take every scientists idea seriously. Misinformation about Covid-19 is abundant. From snake-oil cures to conspiracy theories about the origin of SARS-CoV-2, the virus that causes the disease, the internet is awash with baseless, often harmful ideas. We denounce these: Some ideas and people can and should be dismissed.
At the same time, we are concerned by a chilling attitude among some scholars and academics, who are wrongly ascribing legitimate disagreements about Covid-19 to ignorance or to questionable political or other motivations.
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A case in point involves the response to John Ioannidis, a professor of medicine at Stanford University, who was thrust into the spotlight after writing a provocative article in STAT on Covid-19. He argued in mid-March that we didnt have enough information on the prevalence of Covid-19 and the consequences of the infection on a population basis to justify the most extreme lockdown measures which, he hypothesized, could have dangerous consequences of their own.
We have followed the dialogue about his article from fellow academics on social media, and been concerned with personal attacks and general disparaging comments. While neither of us shares all of Ioannidis views on Covid-19, we both believe his voice and those of other legitimate scientists is important to consider, even when we ultimately disagree with some of his specific analyses or predictions.
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We are two academic physicians with different career interests who sometimes disagree on substantive issues. But we share the view that vigorous debate is fundamental to the existence of universities, where individuals with different ideas who have a commitment to reason compete to persuade others based on evidence, data, and reason. Now is the time to foster not stifle open dialogue among academic physicians and scientists about the current pandemic and the best tactical responses to it, each of which involve enormous trade-offs and unanticipated consequences.
Since Covid-19 first emerged at the end of 2019, thousands of superb scientists have been working to answer fundamental, vital, and unprecedented questions. How fast does the virus spread if left unabated? How lethal is it? How many people have already had it? If so, are they now immune? What drugs can fight it? What can societies do to slow it? What happens when we selectively evolve and relax our public health interventions? Can we develop a vaccine to stop it? Should governments mandate universal cloth masks?
For each of these questions, there are emerging answers and we tend to share the consensus views: Without social distancing, Covid-19 would be a cataclysmic problem and millions would die. The best current estimate of infection fatality rates may be between 0.4% and 1.5%, varying substantially among age groups and populations. Some fraction of the population has already been infected by SARS-CoV-2 and cleared the virus. For reasons that arent yet totally clear, rates of infection have been much higher in Lombardy, Italy, and New York City than in Alaska and San Francisco. To date no drug has shown to be beneficial in randomized trials the gold standard of medicine. And scientists agree that it will likely take 18 months or longer to develop a vaccine, if one ever succeeds. As for cloth masks, we see arguments on both sides.
At the same time, academics must be able to express a broad range of interpretations and opinions. Some argue the fatality rate will be closer to 0.2% or 0.3% when we look back on this at a distance; others believe it will approach or eclipse 1%. Some believe that nations like Sweden, which instituted social distancing but with fewer lockdown restrictions, are pursuing the wisest course at least for that country while others favor the strictest lockdown measures possible. We think it is important to hear, consider, and debate these views without ad hominem attacks or animus.
Covid-19 has toppled a branching chain of dominoes that will affect health and survival in myriad ways. Health care is facing unprecedented disruption. Some consequences, like missed heart attack treatment, have more immediate effects while others, like poorer health through economic damage, are no less certain but their magnitude wont immediately become evident. It will take years, and the work of many scientists, to make sense of the full effects of Covid-19 and our responses to it.
When the dust settles, few if any scientists no matter where they work and whatever their academic titles will have been 100% correct about the effects of Covid-19 and our responses to it. Acknowledging this fact does not require policy paralysis by local and national governments, which must take decisive action despite uncertainty. But admitting this truth requires willingness to listen to and consider ideas, even many that most initially consider totally wrong.
A plausible objection to the argument we are making that opposing ideas need to be heard is that, by giving false equivalence to incorrect ideas, lives may be lost. Scientists who are incorrect or misguided, or who misinterpret data, might wrongly persuade others, causing more to die when salutatory actions are rejected or delayed. While we are sympathetic to this view, there are many uncertainties as to the best course of action. More lives may be lost by suppressing or ignoring alternate perspectives, some of which may at least in part ultimately prove correct.
Thats why we believe that the bar to stifling or ignoring academics who are willing to debate their alternative positions in public and in good faith must be very high. Since different states and nations are already making distinct choices, there exist many natural experiments to identify what helped, what hurt, and what in the end didnt matter.
We believe that the bar to stifling or ignoring academics who are willing to debate their alternative positions in public and in good faith must be very high.
Society faces a risk even more toxic and deadly than Covid-19: that the conduct of science becomes indistinguishable from politics. The tensions between the two policy poles of rapidly and systematically reopening society versus maximizing sheltering in place and social isolation must not be reduced to Republican and Democratic talking points, even as many media outlets promote such simplistic narratives.
These critical decisions should be influenced by scientific insights independent of political philosophies and party affiliations. They must be freely debated in the academic world without insult or malice to those with differing views. As always, it is essential to examine and disclose conflicts of interest and salient biases, but if none are apparent or clearly demonstrated, the temptation to speculate about malignant motivations must be resisted.
At this moment of massive uncertainty, with data and analyses shifting daily, honest disagreements among academic experts with different training, scientific backgrounds, and perspectives are both unavoidable and desirable. Its the job of policymakers, academics, and interested members of the public to consider differing point of views and decide, at each moment, the best courses of action. A minority view, even if it is ultimately mistaken, may beneficially temper excessive enthusiasm or insert needed caveats. This process, which reflects the scientific method and the culture that supports it, must be repeated tomorrow and the next day and the next.
Scientific consensus is important, but it isnt uncommon when some of the most important voices turn out to be those of independent thinkers, like John Ioannidis, whose views were initially doubted. Thats not an argument for prematurely accepting his contestable views, but it is a sound argument for keeping him, and others like him, at the table.
Vinay Prasad is a hematologist-oncologist and associate professor of medicine at the Oregon Health and Science University and author of Malignant: How Bad Policy and Bad Evidence Harm People with Cancer (Johns Hopkins University Press, April 2020). Jeffrey Flier is an endocrinologist, professor of medicine, and former dean of Harvard Medical School.
The progressive advocacy group FWD.US recommends Arizona release at least 10,000 inmates, or one-quarter of the prison population, to make a significant impact in stopping the spread of the virus. Jimmy Jenkins/KJZZ hide caption
The progressive advocacy group FWD.US recommends Arizona release at least 10,000 inmates, or one-quarter of the prison population, to make a significant impact in stopping the spread of the virus.
In Arizona, a woman behind bars at the Perryville women's prison reports hearing coughing echoing through the warehouse-style dorms all night.
In New Jersey, an immigrant detainee being held in the Essex County jail has been put on quarantine cleaning duty even though he's been sick. He fears he's spreading the coronavirus.
And at the Etowah County jail in Alabama, Karim Golding, an immigrant detainee who's fighting deportation to Jamaica, says he's been feeling short of breath and worries he got coronavirus from the guards or new detainees coming in and out.
"At the end of the day I want to be tested because I want to know did you give me the coronavirus?" Golding said. "Did you willfully give me the coronavirus and put my life at risk?"
Across the country, the spread of coronavirus behind bars is likely much more rampant than what's known right now. In prisons, jails and immigration detention centers, there is very little diagnostic testing.
And when widespread testing has been done in a few places, the results show the virus has infected huge numbers of the confined population. One Ohio prison recently found that more than 70% of inmates are positive for COVID-19.
Felicity Rose, director of research and policy for criminal justice reform at the progressive advocacy group FWD.US, says the lack of testing is leading to a false sense of security.
"We know that it's spreading among staff and that staff are bringing it into and out of the facilities," Rose said. "We know there are people who are asymptomatic and are able to pass it along, but we just don't know how many. So it's a ticking time bomb."
Inmates, detainees and their advocates say it's impossible to maintain social distancing behind bars, and they say masks as well as soap and cleaning supplies are limited and sometimes not available at all. In some places, if inmates try to make their own masks out of their T-shirts, they can be disciplined for "destruction of state property."
State, local and federal officials say they are taking steps to protect the detained population and staff, and that people behind bars can get immediate medical treatment when needed. To force social distancing, many facilities have stopped visitation and lock detainees in cells for at least 23 hours a day to limit the amount of time in common areas.
But one epidemiological model suggests coronavirus will spread rapidly in prisons, jails and detention centers unless more steps are taken, according to FWD.US, which advocates for changes to the criminal justice and immigration systems.
In Arizona, for instance, the model predicts that 99% of the Arizona inmate population will be infected within the next few weeks. But so far, less than 1% of 42,000 in Arizona prisons have been tested for COVID-19. The state reported on Monday that 44 inmates have tested positive.
Officials there do not disclose any information about staff testing or results. According to unions representing correctional officers in the state, at least 20 officers have tested positive, though union leaders believe the number is much higher. They say hundreds of employees have shown up to work with COVID-19 symptoms and been sent home.
Compounding the problem, union leaders say, is that the correctional officers were barred for a time from wearing masks for fear that would cause panic among the inmates. Officers can now bring their own masks in, but inmates are not allowed to wear any kind of mask. Some have been tasked with making cloth masks for the officers.
Testing also has been limited among detainees being held by Immigration and Customs Enforcement, which often contracts with county jails for space. Overall, about 2% of 32,000 immigrants detained by ICE have been tested. When they are tested, about 50% are coming back positive.
The agency says more than 300 detainees and 35 employees at ICE detention centers have tested positive. But ICE does not report how many contractors have gotten sick, including medical and corrections staff.
Officials at many prisons, jails and detention centers say they are following guidelines from the Centers for Disease Control and Prevention, and that testing can only be done when there are symptoms. At the Etowah County jail, for instance, an ICE spokesman says there are no suspected cases of COVID-19.
But critics say the lack of testing is masking the problem.
The ACLU warns that as many as 200,000 people could die in the U.S. from COVID-19 double the government estimate unless more steps are taken to reduce prison and jail populations.
A number of states and localities have released older, medically compromised inmates who are not considered safety or flight risks.
ICE also has released hundreds of detainees, and in some cases federal judges have intervened and ordered their release. Most immigrant detainees have no criminal record. They are being held on civil immigration violations, and judges have found their detention during a pandemic to be excessive punishment.
But some states, such as Arizona, have refused to release inmates. Instead, police and sheriff's deputies are choosing to cite people rather than book them, and prosecutors are agreeing to hold fewer people awaiting trial in jail.
As a result, jail populations have declined. In Maricopa County, which operates the fourth largest jail system in the United States, the daily population has shrunk from 8,000 inmates to 5,000 in recent weeks.
Still, advocates say that's not enough. In Arizona, FWD.US recommends the state release at least 10,000 inmates, or one-quarter of the prison population, to make a significant impact in stopping the spread of the virus.
Jimmy Jenkins is a reporter for KJZZ. Matt Katz is a reporter for WNYC.
DES MOINES, Iowa (KTIV) -- Iowa health officials are reporting 467 additional cases of COVID-19, bringing the statewide total to 6,843.
As of April 29, health officials say 2,428 of Iowa's COVID-19 cases have recovered. That's about 35% of all of the state's confirmed cases.
According to the Iowa Department of Public Health, there have been 12 additional deaths due to COVID-19, bringing the state's total to 148.
The IDPH says these deaths were reported between April 27 and April 28 and occurred in the following counties:
Officials say out of the 41,337 Iowans tested for COVID-19, 34,494 of them have come back negative.
In northwest Iowa, designated as RMCC Region 3 by state officials, there are currently 50 hospitalized COVID-19 patients.
Iowa health officials say 16 of those patients were admitted within the last 24 hours.
Of those 50 patients, officials say 21 are in intensive care units, that's an increase of four since Tuesday's report. There are also 18 patients now on ventilators, on Tuesday officials reported 15 northwest Iowa patients were on ventilators.
As of April 29, officials say northwest Iowa still has 528 inpatient beds, 57 ICU beds and 39 ventilators available.
ELKHORN
Walworth County has seen another rise in confirmed COVID-19 cases, jumping from 140 reported Monday to 158 in the countys latest update shared Tuesday afternoon.
County health officials on Monday said the increase seen over the weekendfrom 116 on Fridays updateis linked to increased testing following recent outbreaks at facilities in the county.
There are 100 patients isolating themselves at their homes, while four are hospitalized.
The county has seen 46 patients recover, up from 41 in Mondays update.
The death toll remains at eight, all of whom were older than 65. Five of the eight were older than 80.
All had pre-existing medical conditions.
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COVID-19 has already hurt a lot of Americans financially, and with cases still popping up by the thousands, it's clear that life may need to stay on hold longer than we'd like it to. That's bad news from an economic standpoint, because the longer businesses stay closed and Americans remain out of work, the harder our recovery will be.
Thankfully, there's some relief to be had in the form of the CARES (Coronavirus Aid, Relief, and Economic Security) Act -- namely, one-time $1,200 stimulus payments that have already started going out to desperate Americans, boosts in unemployment benefits, small business funding, and more relaxed rules with regard to retirement plan withdrawals.
IMAGE SOURCE: GETTY IMAGES.
Normally, removing money from an IRA or 401(k) prior to age 59 1/2 results in a 10% early withdrawal penalty (though there are some exceptions). Under the CARES Act, however, you can now withdraw up to $100,000 from your retirement plan penalty-free if you've been negatively affected by COVID-19. But here are three reasons it's unwise to go that route.
You're no doubt aware that any money you remove from your IRA or 401(k) today is money you won't have on hand once retirement rolls around. But you may be surprised at how a seemingly modest withdrawal results in a much greater loss over time.
The money you have in a retirement plan generally doesn't just sit in cash. Rather, it's invested for added growth. And if you load up on stocks in your IRA or 401(k), you're likely to generate an average annual 7% return over time, since that's a few percentage points below the market's average.
Now, let's say you withdraw $10,000 from your retirement plan today to pay some near-term bills. If you're 35 years away from leaving the workforce, you'll actually end up losing out on almost $107,000 in retirement income when we factor in that 7% return. And that's a lot of money to give up.
Being in debt isn't fun, and in some cases, it can be costly. But before you raid your retirement plan, it does pay to explore the low-cost borrowing options you may be privy to.
If you own a home you have equity in, a home equity loan or line of credit is fairly easy to qualify for, and you generally won't be charged an exorbitant amount of interest on either. If you don't own a home, you can look at getting a personal loan -- a viable option if your credit is strong.
All of these options allow you to use your loan proceeds for any purpose, and they're worth looking into if you're struggling. And in many cases, the interest you pay on one of these loans will be less than the return your retirement plan generates.
If your income has taken a hit in the past month and change, you may be having a hard time keeping up with your bills. But before you withdraw money from your retirement savings to cover them, talk to the people you owe money to and ask for some leeway. Your mortgage lender may agree to let you put your home loan into forbearance for a period of time, thereby effectively pausing payments on it. Meanwhile, you may be given more time to pay your auto loan, internet bill, or electric company. It never hurts to reach out and ask for help, and doing so could help you avoid an early retirement plan withdrawal -- or perhaps enable you to remove less money than you initially planned on.
Let's be clear: If you really have no choice but to remove money from your IRA or 401(k) to pay for your basic needs, then there's no need to beat yourself up for it. Many people have been thrust into a desperate situation because of COVID-19, which is why penalty-free withdrawals are now on the table. But before you rush to take that withdrawal, recognize the drawbacks of going that route, and explore other options for borrowing money affordably while getting relief from your bills.
Oregon's deaths related to COVID-19 are significantly undercountedby a factor of as much as four.
That's the conclusion of Ken Stokes, a retired local economist who compared the historical average number of deaths in Oregon to deaths recorded so far in 2020.
Stokes read a story in the Financial Times that found deaths around the world were significantly higher than normal, adjusted for officially reported COVID-19-caused deaths. He then took the five-year average of reported deaths from the Oregon Health Authority database and compared it to this year's deaths.
Stokes found the number of reported deaths in Oregon from February through mid-April exceeded the five-year average for that time period by 348about 5 percent. At the time he did his calculations, Oregon had just 72 officially reported COVID-19 deaths. That means there were 276 "excess" deaths that require further investigation.
"This year's numbers are radically out of line," Stokes says.
WW asked professor Charles Rynerson, a demographer who heads Portland State University's Population Research Center, to review Stokes' findings. Rynerson says the math is solid but notes there are a variety of factors that could contribute to the higher death total.
"The population in Oregon, and in most of the countries in the FT analysis, is rapidly aging, so there likely would have been more deaths in 2020 than in 2015-19 even without the virus," Rynerson says. "My understanding is that deaths from other causes may have increased due to limited medical resources, canceling appointments and surgeries, and distress." (OHA senior adviser Dr. Melissa Sutton agrees with Rynerson and says the numbers require further investigation.)
Stokes' takeaway: The larger-than-expected death totals (which The New York Times documented in other states and countries) should prompt caution.
"This suggests we should act with an abundance of caution because of the unknowns," Stokes says. "For us to dash back to reopen when doctors are saying we don't know what this [COVID-19] is yetthat could be a mistake."
Excess Deaths: Far more Oregonians have died this year than expected, even adjusting for officially reported COVID-19 deaths.
MISSOULA Local health officials are expanding the criteria of who can be tested at the drive-thru COVID-19 testing facility at the Missoula County Fairgrounds.
The US Centers for Disease Control and Prevention (CDC) confirmed additional common symptoms of COVID-19 which prompted the Missoula County testing site to expand testing criteria.
In addition to cough, fever, and difficulty breathing, the health department added chills, repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell.
We hope that this expansion will help us identify milder cases in our population so that we can do contact tracing, said Cindy Farr, Incident Commander for the health departments COVID-19 response.
Now included are Missoula County residents and healthcare workers having any of the symptoms listed on the CDC website including the following:
Tests are free and by appointment only. Anyone who has symptoms -- or are caring for someone with symptoms -- and would like to schedule a test can call (406) 258-INFO and select Option 2 to speak to a nurse.
The testing site call center is taking calls on Mondays-Thursdays to schedule appointments for Tuesdays-Fridays.
Farr points out that with businesses opening up and the stay at home order rescinded that prevention comes down to social distancing and contact tracing, we need a broader ability to test, and expanding symptoms allows us to do that.
Local health officials say they are concerned that as things open up, unidentified milder cases could spread the illness to others, including those who are at higher risk for complications.
We could end up with a spike in cases and some very sick individuals," Farr said.
A pulse oximeter attaches to a finger and uses light to detect the level of oxygen in your blood.
Ascoronavirus testing efforts continue to ramp up and face masksbecome part of everyday life, a tiny diagnostic tool that clips to your finger is quickly becoming a must-have gadget in thefight against COVID-19. It's called a pulse oximeter, and it checks your blood oxygen level.
The device was already beginning to surge in popularity as the public learned that people with the coronavirus oftenarrive at the hospital with abnormally low oxygen levels. After anop-ed piece in The New York Timeson April 20 recommended that pulse oximeters be used to identify the sickest among COVID-19 patients and detect the frightening condition known as "silent hypoxia," sales of the devicesskyrocketed. Right now, most are sold out in stores and online.
Keep track of the coronavirus pandemic.
But questions and controversy have arisen around the at-home use of pulse oximeters, which painlessly measure heart rate and oxygen levels. It's not entirely clear if pulse oximeters can help detect a coronavirus infection or whether their widespread use can helpcurb the spread of COVID-19.
Whether you already have a pulse oximeter or you're thinking about buying one, here's what you need to know about what they do, how they work, what the results mean and how accurate they might be.
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A pulse oximeter is a small medical device that measures heart rate and blood oxygen saturation. It's usually clipped to your finger, but it can also attach to your ear, nose, toe or forehead. Some are battery powered and provide real-time results on a small LED display on the device itself. Others connect with a wire to a separate vital sign monitor that records even more precise information about your heart rhythm, body temperature and blood pressure using other sensors connected to your body.
A pulse oximeter measures your blood oxygen saturation and heart rate by shining a light through your skin and detecting both the color and movement of your blood cells. Oxygenated blood cells are bright red, deoxygenated cells are dark red.
The pulse oximeter compares the number of bright red cells to dark red cells to calculate your oxygen saturation as a percentage. So, for example, a reading of 99% means only 1% of the blood cells in your bloodstream have been depleted of oxygen.
Every time your heart beats, it pushes your blood through your body in a quick pulse (which is why "pulse" is another word for "heart rate"). A pulse oximeter, using light, detects this movement and calculates your heart rate in beats per minute, or BPM.
According to the Mayo Clinic, a normal pulse oximeter oxygen level reading is between95% and 100%, and anything less than 90% is considered dangerously low, or hypoxic. Some doctors have reported COVID-19 patients entering the hospital withoxygen levels at 50% or below.
A normal resting heart rate is between 60 and 100 BPM. Typically, lower is better, as a slower heart rate is usually an indication of a strong cardiovascular system.
Not exactly. Although many doctors report that patients with COVID-19 are presenting with dangerously low blood oxygen levels, COVID-19 isn't the only disease that can cause such a problem. Chronic lung diseases, like COPD, asthma and other non-COVID-19 lung infections can also result in a low oxygen count.
A low oxygen reading by itself is not enough to diagnose COVID-19, but your doctor would want to know about it, especially if you notice the level decreasing over time. And if you've been diagnosed with COVID-19, your doctor may want you to monitor your oxygen level to determine whether your condition is worsening or improving.
Although medical professionals continue to rely on temperature checks as an indication of a coronavirus infection, many patients with COVID-19 do not have fevers.
Like with any electronic equipment, not all pulse oximeters are created equal. A 2016 study of low-cost pulse oximeters concluded several inexpensive consumer-grade devicesprovided highly inaccurate readings.
Some pulse oximeters have been cleared by the FDA, which means they should meet FDA standards for accuracy. Note that there is a distinction between "FDA-approved" and "FDA-cleared," with "cleared" being the less rigorous of the two. That said, Class II medical devices like pulse oximeters are usually "cleared" rather than "approved."
You can look for pulse oximeters on the FDA-cleared list by visiting the FDA'sPremarket Notification website and searching for "pulse oximeter" in the Device Name field, with or without a manufacturer's name.
Although retailers like Amazon and Walmart still have pulse oximeters available, they're often unbranded and of questionable accuracy.
In the2016 study that found most low-cost pulse oximeters to be relatively inaccurate, "low-cost" was defined as costing less than $50. Pulse oximeters that have been cleared by the FDA tend to range in price from around $50 to $60 to well into the hundreds and even thousands of dollars.
You can still find pulse oximeters on sale online atWalmart,Amazon andeBay, but most of the name-brand devices you'll find on various best lists, like those atDigitalTrends,The Wirecutter andConsumer Reports, are either sold out completely or on backorder, with shipping estimates weeks or sometimes months away.
This week, the CDC added five more official COVID-19 symptoms for a total of seven, which are detailed here. However, symptoms, vital signs and statistics aren't the only way to track the pandemic: Memes and social media chatter are relevant data points, too. Depression and anxiety may not be symptoms of the disease itself, but as the pandemic continues, you're not the only one feeling down about it.
Harrison, with the health department, also was not able to say how many residents of the facility, if any, remained hospitalized.
Though Fahoum declined to answer specific questions, she said that GreenTrees focus remains, as it always has, on providing excellent care and service to our residents and transparent communication with our families.
Like many other senior living communities in Illinois and across the country, GreenTree at Mt. Vernon has been impacted significantly by the virus, she said.
Fahoum said staff is working around-the-clock to provide care to residents. The company, she said, was very pleased to be able to get all residents and team members tested quickly and has been encouraged by the number of residents and staff who remain asymptomatic or who have had only mild symptoms. The health department reported on Tuesday that 13 residents of the facility have been released from isolation. To be released from isolation, individuals who test positive for COVID-19 must have isolated for a minimum of seven days from the onset of symptoms and can be released once they have been fever-free and feeling well for at least 72 hours, the health department said.
While the recoveries are positive news, Fahoum said there have been residents whose symptoms from the virus have become more severe, and our hearts go out to these residents and their families.
