Demographic Shift in Covid-19 (not just for old folks anymore)

An October 2 Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report documented COVID-19’s demographic changes. Between May and July, the median age of confirmed US cases fell from 46 years to 37 years. The pandemic’s age distribution had already shifted by June, when new cases were highest among people aged 20 through 29 years. From August 2 to September 5, the weekly incidence among people aged 18 through 22 years roughly doubled from 10.5% to 22.5% of total new cases, some of which was likely due to college students going back to school.

Of the almost 7 million COVID-19 cases included in the CDC’s COVID Data Tracker, about 76% have occurred among adults younger than 65 years, with 18- through 29-year-olds making up the largest chunk. The hospitalization and death rates continue to be far greater among seniors but, importantly, not all younger adults experience mild disease. As of late October, death certificate data show that COVID-19 has killed almost 45 000 people aged 15 through 64 years, including about 6300 adolescents and adults younger than 45 years.

Younger Adults Caught in COVID-19 Crosshairs as Demographics Shift — Abbasi J. Younger Adults Caught in COVID-19 Crosshairs as Demographics Shift. JAMA. 2020;324(21):2141–2143. doi:10.1001/jama.2020.21913 –

Please stop all comparisons with the flu.

CDC estimates that the burden of illness during the 2019–2020 season was moderate with an estimated 38 million people sick with flu, 18 million visits to a health care provider for flu, 400,000 hospitalizations for flu, and 22,000 flu deaths

Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States — 2019–2020 Influenza Season —

No comparison in my opinion.

Shhh…Want to help stop COVID? Be quiet.

There’s another extremely simple thing that might help reduce COVID transmission – quieting down.  This is a bit of a sensitive topic, because we all talk.  And sometimes we all talk too loudly.  But hospitals are filling up so, well, it’s time to talk about talking.

Human beings are wind instrument that generate aerosols.  Small particles are produced as exhaled gas rushes past vibrating vocal cords.  As this gas passes further through the tongue, lips, and teeth, sounds from the vocal cords are modulated – generating additional particles.​1​ Aerosol generation is exacerbated by speaking at higher volumes and at higher pitches.​2,3​ Scientists have dissected this down to specific sounds which generate more particles than others.​4​

There’s no solid, RCT-level evidence that being quiet reduces the spread of COVID. Nor will there ever be (some things are just too difficult to study with an RCT). But quieting down makes sense and it’s very easy and safe to do. There is literally zero cost or risk involved.

PulmCrit – Want to help stop COVID? Be quiet —


Covid-19 Jeopardy – Green Tea, Two Varieties of Muscadine Grapes, Cacao Powder and Dark Chocolate

Chemical compounds in foods or beverages like green tea, muscadine grapes and dark chocolate can bind to and block the function of a particular enzyme, or protease, in the SARS-CoV-2 virus, according to a new study by plant biologists at North Carolina State University.

North Carolina State University. “Chemical compounds in foods can inhibit a key SARS-CoV-2 enzyme, study finds.” ScienceDaily. (accessed November 30, 2020).

Journal Reference:

  1. Yue Zhu, De-Yu Xie. Docking Characterization and in vitro Inhibitory Activity of Flavan-3-ols and Dimeric Proanthocyanidins Against the Main Protease Activity of SARS-Cov-2. Frontiers in Plant Science, 2020; 11 DOI: 10.3389/fpls.2020.601316

I don’t think this is a game changer but it is interesting nonetheless.

Blood Glucose on Admission Predicts COVID-19 Severity

The retrospective, multicenter study was based on data from 11,312 adult patients with confirmed COVID-19 in 109 hospitals participating in Spain’s SEMI-COVID-19 registry as of May 29, 2020. They had a mean age of 67 years, 57% were male, and 19% had a diagnosis of diabetes. A total of 20% (n = 2289) died during hospitalization.

Overall all-cause mortality was 41.1% among those with admission blood glucose levels above 180 mg/dL, 33.0% for those with glucose levels 140-180 mg/dL, and 15.7% for levels below 140 mg/dL. All differences were significant (P < .0001), but there were no differences in mortality rates within each blood glucose category between patients with or without a previous diagnosis of diabetes.

After adjustment for confounding factors, elevated admission blood glucose level remained a significant predictor of death. Compared to < 140 mg/dL, the hazard ratios for 140-180 mg/dL and > 180 mg/dL were 1.48 and 1.50, respectively (both P < .001). (Adjustments included age, gender, hypertension, diabetes, chronic obstructive pulmonary disease, lymphopenia, anemia (hemoglobin < 10 g/dL), serum creatinine, C-reactive protein > 60 mg/L, lactate dehydrogenase > 400 U/L and D-dimer >1000 ng/mL.)

Cite this: Blood Glucose on Admission Predicts COVID-19 Severity in All – Medscape – Nov 30, 2020. —

Journal abstract link –

Failure to Launch – 2020

Failure to Launch was a movie released in 2006 starring Matthew McConaughey. Failure to Launch 2020 version is summarized in this chart:

Failure to Launch 2020 – Over Half of U.S. Young Adults Now Live With Their Parents –

“Everybody has a plan until they get punched in the mouth”

“Everybody has a plan until they get punched in the mouth.”

Mike Tyson

The drop in the volume of employment in a given sector always has a ripple effect in the national economy. The loss of so many high-paying jobs in a short time will be a dent in the coffers of Los Angeles County and for New York state in the short term. Michele Evermore, senior policy analyst for the Washington, D.C.-based National Employment Law Project, says it hits at a time when other industries are undergoing similar sweeping realignments with huge human toll.

“Nobody’s got a plan for how to transition these massive sectors of the workforce into a different thing,” Evermore says.

Hollywood Grapples With Mass Layoffs as the Biz Redefines Itself for Streaming Future —

I sat for a few minutes thinking about what to write next when Charlie Hunter popped into my head. Hunter titled one of his albums with the Tyson quote.

Which was then followed by some great advice from Charlie on his strategy for success and survival in the years to come.

Don’t wait until you get punched in the mouth to make your Plan B. And while you’re at it you might want to come up with a Plan C as well.

Mugged at Thanksgiving!

A mug every four years to commemorate milestones in a physician’s career.

Just another Saturday morning except this day starts the second half of a long four day Thanksgiving holiday break. We have given our thanks for the things we are grateful for. Today I’m asking all who read this post to give thanks for all of our front line healthcare workers for whom there is no break from work. We have many dedicated people who are spending the holiday away from their families while most of us are spending time with our families. These brave souls are putting their own health and safety on the line for the rest of us.

  • Thanksgiving – 3:00-11:00 PM
  • Friday Nov. 27 – 1:00-9:00 PM
  • Saturday Nov. 28 – 1:00-9:00 PM
  • Sunday Nov. 29 – 6:00 AM-2:00 PM
  • Is it too hard to wear a mask?

I’m getting better at writing effective click-bait blog post titles.

First It Was Masks; Now Some Refuse Testing for SARS-CoV-2

Test avoidance appears to be a growing problem, at least anecdotally. Many of the same people who dismiss the need to test feel the same way about wearing a mask, in part because they think no one has the right to tell them to do either.

First It Was Masks; Now Some Refuse Testing for SARS-CoV-2 – JAMA. 2020;324(20):2015-2016. doi:10.1001/jama.2020.22003 –

I am speechless.

Taking a Road Trip? Here’s Your Checklist

This article has not been edited and the article was originally published on The Conversation.

Planning a road trip in a pandemic? 11 tips for before you leave, on the road and when you arrive
November 26, 2020

Author – Thea van de Mortel
Professor, Nursing and Deputy Head (Learning & Teaching), School of Nursing and Midwifery, Griffith University

As restrictions ease around the country and the prospect of travel beckons, many of us will be planning road trips for the holiday season.

To ensure your trip is memorable in the best rather than the worst way, here are some things you and your fellow travellers can do to reduce the risk of becoming infected with, or spreading, COVID on your trip.

Before you go

  1. Check for any travel or other COVID-specific restrictions or rules in the areas you will be travelling through or to, before you go. These can change rapidly and may include restrictions on how far you can travel, how many people per square metre are allowed in public spaces, and whether you need border passes or to wear a mask. Each state or territory has its own health department or government COVID website you can check.
  2. Don’t take COVID with you. If anyone in your group has COVID-like symptoms, however mild, it is important to be tested and cleared for COVID before leaving. Common symptoms may include fever or chills, muscle aches, sore throat, cough, runny nose, difficulty breathing, new loss of taste or smell, and vomiting or diarrhoea.
  3. Pack masks, disinfectant wipes and hand sanitiser. The two most likely ways of catching COVID are inhaling viral particles an infected person sheds when they cough, sneeze, laugh, talk or breathe; and ingesting particles by touching contaminated objects and then touching your face or food. Masks (and social distancing) can help reduce the former risk, while avoiding touching your face, frequent hand hygiene and cleaning surfaces can reduce the latter. So pack masks, wipes and hand sanitiser. Hand sanitiser should contain at least 60% alcohol.
  4. Pack your own pillows and linen. We know people infected with SARS-CoV-2, the virus that causes COVID, can shed virus onto linen and pillows (and other surfaces), even when asymptomatic. We also know respiratory viruses can penetrate pillow covers and get into the microfibre stuffing. So you might want to consider bringing your own pillows and linen.

On your trip

  1. Use disinfectant wipes to clean high-touch surfaces in your hire car. These would include door and window handles or buttons, light switches, seat adjuster controls, radio controls, the steering wheel, glove box button, gear/drive and handbrake levers, rear-view mirrors and mirror controls.
  2. How about singing in the car? The more vigorous the activity, the greater the opportunity to release droplets and aerosols and the further these will travel. So, laughing and singing will release more of these than talking, and talking will release more than breathing. However, if you are travelling in a family group, or with your housemates, then you have been in close contact with one another at home and the additional risk would be low.
  3. Maintain social distancing at service stations. Leave at least 1.5 metres between you and the next person while paying for fuel, ordering food and when using the bathroom. Make sure you wash or sanitise your hands after touching surfaces such as petrol pumps, door handles, bathroom taps, and before getting back in your car.
    Filling car up with petrol at service station
    Wash or sanitise your hands after using the petrol pump. Shutterstock
  4. Pay with cards rather than cash to avoid touching money. Many people can handle bills and coins over a long duration of time, providing many opportunities to transfer disease-causing microbes from one person to the next. Using contactless payment also helps maintain social distancing.
  5. It’s safer to eat outdoors than indoors if stopping for a snack or lunch. That’s because large volumes of air dilute the density of viral particles in the air. Evidence from a study of COVID clusters in Japan suggests the chance of transmitting COVID is more than 18 times higher inside than outside.

When you arrive

  1. Is your hotel or rented accommodation COVID-safe? Ask the accommodation provider what steps they have taken to make the place less conducive to spreading COVID. For example, have they introduced extra cleaning or disinfection?
  2. Use disinfectant wipes in rented accommodation to clean high-touch surfaces such as door handles, light switches, cupboard handles, taps and toilet flush buttons. You can also put dishes and cutlery through the dishwasher on a hot cycle. This is because the virus can remain viable (able to cause infection) on surfaces for many days.

Following these simple steps can help to keep your trip memorable in the best possible way. Happy holidays!

Copyright © 2010–2020, The Conversation US, Inc.

Personality Traits Linked to Toilet Paper Stockpiling

The most robust predictor of toilet paper stockpiling was the perceived threat posed by the pandemic; people who felt more threatened tended to stockpile more toilet paper. Around 20 percent of this effect was also based on the personality factor of emotionality — people who generally tend to worry a lot and feel anxious are most likely to feel threatened and stockpile toilet paper. The personality domain of conscientiousness — which includes traits of organization, diligence, perfectionism and prudence — was also a predictor of stockpiling.

Max Planck Institute for Evolutionary Anthropology. “Personality traits linked to toilet paper stockpiling: High levels of emotionality and conscientiousness are indicators for stockpiling behavior.” ScienceDaily. (accessed November 25, 2020).

In case you haven’t noticed it’s happening again. Where’s the toilet paper?