Inside Medicine: Five on Friday (March 8, 2024).
This week in medicine, what I'm thinking about, etc. You know, an actual newsletter.
We are back with “Five on Friday", the feature where Inside Medicine behaves like an actual medical/health/science newsletter. Below are some top-of-mind things that I’m thinking about right now. And please vote in the poll at the end!
If you value this feature—and Inside Medicine in general…
Thanks and here we go…
Item 1. CDC Covid isolation guidelines.
We probably all saw that the CDC changed its guidance on Covid-19 isolation to align with its flu and RSV policies (which themselves got a little spruce up). The CDC now says that people can return to normal activities when their symptoms have been improving overall for at least 24 hours and “if a fever was present, it has been gone without use of a fever-reducing medication.”
The science on this is not clear, as I’ve written before. I have further thoughts on this, some of which I shared in the Wall Street Journal last week. I’ll try to flesh this out for you next week. Sorry for the teaser here. I’ve been working a bunch clinically, and also finishing a massive research manuscript (which I did submit!), so I did not get to this yet. But I have opinions on this—some spicy, some nuanced. At this point, I have more questions than answers about the how well the new policy will work, and am a little confused by the CDC’s stated rationale.
Item 2. RSV immunizations for infants worked!
A new study out just yesterday from the CDC in its Weekly Report reveals that infant immunization against RSV (an antibody injection called Nirsevimab) showed 90% effectiveness against hospitalization. Huge news! The study is one piece of promising news, although the data are fairly limited. For example, we don’t know how effective the shots were against all symptomatic RSV. Also, uptake in infants was low this season, owing to limited availability of the injections (this was the first year the shots were rolled out, and there were delays and, also, shortages). Still, we like good news on RSV.
Item 3: AI will soon be listening to doctors and their patients. This is a good thing!
One of the biggest pain points for ER doctors like me is medical documentation. Everything I do has to be documented in the electronic medical record. Studies show that docs like me spend more time documenting than actually seeing patients. Certainly that is my experience for some kinds of care. When a patient is very ill, the opposite is true; I can spend an hour in the patient’s room, and then document what happened in 15 minutes after.
If I didn’t have to document everything I thought and did in the ER so assiduously, I could see many more patients each day. AI may change the game here. Some local colleagues of mine are actually studying how well AI can generate documentation of ER visits by listening in on doctor-patient encounters (with consent, of course). They’re not alone. This is an area of active study. There are always privacy concerns, but I’m very optimistic that this is an area where AI will make being a physician more enjoyable by taking out some of the drudgery.
Item 4: Some guy got 217 doses of the Covid-19 vaccine.
Strange paper of the week: “Adaptive immune responses are larger and functionally preserved in a hypervaccinated individual.” The study appeared in Lancet Infectious Diseases. Long story short, some guy in Germany managed to get 217 doses of various Covid-19 vaccines between 2021 and 2023. Once he was caught, researchers asked him if they could study his immune system. He agreed. The work generated some interesting findings:
The patient has never gotten Covid. (That said, neither have many people who have taken precautions.)
His immune system appears to be okay—over immunizing has theoretical risks. I was glad to see that, so far, he has not suffered any untoward consequences. Still, I would not be surprised if there are as-yet undiscovered problems from over-vaccinating like this.
His Covid immunity was higher than that of people who had only had 3 doses (not surprising). By some measures, he had far higher levels (e.g., certain types of immunity like antibodies in his saliva). But in other tests, the return on investment was not as high as one might have imagined.
He didn’t get sick for other reasons, nor did he keel over and die at any point. Honestly, 217 doses of any vaccine is unwise. So, I suppose this is some indicator of the safety of these vaccines.
Do not try this at home. Or anywhere.
Item 5. Poll of the Week results.
Here are the results of last week’s Inside Medicine poll. Looks like many of you who had New Year’s Resolutions are finding success! I’m glad because—unlike my friend, epidemiologist, Substack writer, and stick-in-the-mud Dr. Gideon Meyerowitz-Katz—I think New Year’s Resolutions are awesome. (Especially absurdly easy ones to achieve.)
Item 5a. Poll of the Week for this week!
And here is this week’s poll. With the 4th anniversary of the official declaration of the Covid-19 pandemic, I was thinking about hand hygiene and how great everyone was with hand washing during the spring of 2020.
Have you maintained your early 2020 practices? Answer honestly!
That’s it. Your “Friday Five!”
Feedback! Do you like the “Five on Friday” format? Have any ideas for next week’s Poll of the Week? Any great articles you read elsewhere that you want to share with the Inside Medicine community? Other musings or thoughts?
Please contribute to the Comments!
Circling back to one of your previous articles "New insights: How much does air exchange really matter for Covid-19 transmission? "
It made me think about all the businesses that invested in new ventilation systems at the beginning of Covid. Why don't we have a sticker on the door or some way of knowing where these systems have been upgraded? There is no reward for the businesses who went the extra mile to protect their customers. Seems like such a waste of the momentum that Covid sparked in the the movement for cleaner air spaces. Sounds like a job for Inside Medicine:)
Thanks for taking on the new "respiratory isolation" guidelines: my issue with them is lumping all respiratory viruses together and the lack of clarity and actual guidance.
I looked at Canada/France/UK and everyone else stopped recommending 5 days of isolation, but no one lumped Covid in with RSV. Canada has a nice interactive site to give personalized guidance about isolation and masking.
As someone who still tries not to get infected, I find the rolling back of all public health supports and lack of acknowledgement of Covid as still, currently, a more infectious and damaging/dangerous virus than the other "respiratory viruses" quite discouraging and disingenuous.
Katherine Wu wrote a nice article in The Atlantic about the false equivalence of flu/Covid and her final paragraphs were about how we could have ended up with more public health/health but no.