Infectious Disease physician Jake Scott joins TWiV to provide a west coast clinical perspective on the evolution of the COVID-19 pandemic with respect to the impact of vaccines, antivirals, variants of concern and mortality.
Hosts: Vincent Racaniello, Alan Dove, Rich Condit, and Kathy Spindler
Guest: Jake Scott
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Show notes at microbe.tv/twiv
Dr . Racaniello- I wanted to thank you for all the work you do to teach us on TWiV and the other programs.I very much appreciate what you do.
My husband went to Columbia . So I also have a special place in my heart for the school and those who teach there. Keep up the good work.
Lisa
Somewhat disappointing to not see more pushback during this interview. Not to say that Jake was wrong, but that his positions could have been interrogated more robustly. The one area where that did happen tobskme degree was with respect to metrics – and on that issue Jake offered no real insight. Of course the metrics currently used are flawed – but any metric would be. The flaws really need to be discussed in the context of what would you do if you don’t use existing metrics. It’s not particularly meaningful to focus on the flaws of the current metrics if no realistic and feasible alternative is offered, as then basically its like saying we shouldn’t measure at all. That might even be a viable option – but if that’s the alternative then you need to make that argument so it can be interrogated.
I agree with Joshua. Dr. Scott has a lot of insight, and I genuinely appreciated the take-home point that the horrific ARDS of Wuhan through Delta has receded and that shift should be made clearer to non-healthcare providers.
But.
An infectious disease physician should be more *curious* about the increases in diabetes and vascular pathologies. We know that following a Covid infection people are more likely to be diagnosed with diabetes. We know that stroke risk increases after Covid infection. We know Covid can cause reactivation of TB. And we know all-cause mortality is elevated after Covid.
It doesn’t make any logical sense to champion “nuance” in finding the false-positive deaths labeled as Covid that had a lot of underlying contributors, but not seek to find any false-negative deaths labeled as “strokes”, “cardiac arrest” or “tuberculosis” occurring in people whose bodies were weakened by Covid.
It’s not wrong to argue for categorizing cause of death by examination of a patient’s entire chart. I’m reminded of Arsenic and Old Lace- “he wouldn’t have died of pneumonia if I hadn’t shot him!”. However, excess deaths are still elevated by the thousands- it does not appear to me that deaths falsely attributed to Covid outnumber the inverse.
And something our esteemed hosts of TWiV has seemed to struggle with is the scale of that death. If we’d kept deaths to their lowest point, at about 2k a week as they were in mid-June- that would still have resulted in over 100,000 deaths a year. That is almost 3X higher than all car accidents. Covid is a much bigger threat then driving down the highway. Covid- IN THE VACCINATED OMICRON ERA- is killing more people than pneumonia or shootings. It’s not close.
Most irritatingly, Jake Scott appears to be woefully behind on the Paxlovid literature. For one thing, he seemed to bolster the narrative that Paxlovid can’t help unvaccinated individuals- this is several studies out of date. The most recent preprint I’ve seen actually says Paxlovid reduced rates of long Covid in vaccinated individuals, which is welcome news https://www.medrxiv.org/content/10.1101/2022.11.03.22281783v1.full.pdf. People working in long Covid clinical trial networks ought to strive to stay on top of the literature.