Finding conflicting information in the media, students and clients have asked me what COVID-19 resources I trust. I'm maintaining these COVID-19 notes as an answer to that question. Updated August 1, 2021.

WHERE AM I GETTING MY COVID-19 NEWS?

I limit my COVID-19 news diet to the following three sources because I trust them to elevate science quality above other agendas:

• When I have an hour per week I listen to Dr. Osterholm's weekly podcast. He is director of University of Minnesota's Center for Infectious Disease Research Policy (CIDRAP). I find his analysis to be thorough, he is not shy about uncertainty, and he doesn't assume all listeners have a scientific background.

• When I have an additional 2-4 hours per week I listen to This Week in Virology (TWiV). Hosted by researchers and physicians, this long-running YouTube series / podcast goes into greater detail about virus news and often includes the hosts' scientific appraisal of the choices being made in government, industry, and lay media.

• On Twitter I follow this short (< 10) list of physicians, researchers, and institutions I trust. I access that list with the inexpensive commercial app Tweetbot so that I don't see ads and I'm not subject to Twitter algorithms that might otherwise hide some of those accounts' tweets.

Nothing else for me. No facebook. No browsing lay media. Zero interest in non-data claims made by policy-makers. All are too vulnerable to non-scientific agendas.

WHOSE COVID-19 DATA DO I MONITOR?

I think it's hard to interpret the published testing and prevalence data for many reasons, but especially so because we are not typically provided information about how much of a region's testing is from 1) folks with symptoms, 2) folks who had known exposures but are feeling fine, or 3) general population screening. These huge unreported confounds differ between regions and constantly change. Nevertheless, motivated by anxiety and magical thinking, I watch the following data:

• The per-nation 7-day rolling averages that I trust are organized by Oxford's Our World in Data. Naturally those data should be interpreted in the context of how much testing each nation is performing because large, sudden changes in testing rate can influence the reported infection data. I watch the 7-day rolling averages instead of daily data because the daily data suffer from the peaks and troughs of reporting delays.

• The Gainesville and North Florida data I watch is from a mix of sources, including the Florida Department of Health, whose choices have not been uncontroversial. I'm understating.. Mostly I monitor for hospital ICU utilization so that I know whether to be worried or super worried about Gainesville.

  • Alachua County COVID-19 Dashboard
  • CDC COVID-19 Integrated County View
  • Hospital Occupancy: North Florida Regional Medical Center
  • Hospital Occupancy: UF Health Shands
  • UF links to local resources
  • Marion County data assembled by Trinity Clinic

WHAT SCHOOL REOPENING GUIDANCE DO I FIND CREDIBLE?

It will be simple to reopen all schools once we have inexpensive everyday rapid saliva testing for contagiousness. Until then, CIDRAP's Dr. Osterholm is promoting model-based guidance intended to maximize in-person classroom time while avoiding exponential spread. This model indicates that there are acceptable transmission risks for masked physical classroom reopening when a county is reporting 0-5 new cases per day per 100k population. The model has also been recalculated for smaller units of population (10k). Here are the guidelines Dr. Osterholm is promoting based on the number of new cases per 14 days per 10k population:

• 0-9: masked in-person classrooms for all ages
• 10-19: masked in-person classrooms for elementary school, hybrid classrooms for older
• 20-29: masked hybrid classrooms for all ages
• 30-49: masked hybrid classrooms for elementary school, distance learning for older
• >= 50: distance learning for all ages

This excludes vulnerable students with pre-existing conditions: they should have access to distance learning.

WHAT FACTS ANCHOR MY PERSONAL CHOICES?

As of July 2021 we don't know enough to meaningfully quantify individual risk of infection for those of us walking around outside of hospitals and prisons. So instead of making decisions based on some false sense of infection probability, I'm erring on the side of health-promoting choices and maintaining awareness of the unpredictable disease outcomes that have been documented:

1. Infected people may die from the virus, regardless of demographics. Some people mistakenly believe that they are excluded from the risk of death because of youth, sex, or race. Not true:

   • The deaths of young patients were known as early as April, when the Washington Post reported nine deaths in patients younger than 20, as well as "at least 45 deaths among people in their 20s, at least 190 deaths among people in their 30s, and at least 413 deaths among people in their 40s."
   • In October the CDC examined United States COVID-19 deaths during May 1 - August 31, 2020. Their analysis of the 114411 COVID-19 deaths from that four-month period found:
     • 22.8% of deaths were patients younger than 65
     • 46.7% of deaths were women
     • 51.3% of deaths were non-Hispanic White

2. Even young, previously healthy patients may suffer serious clotting-related outcomes like stroke, pulmonary embolism, and deep-vein thrombosis (DVT):

   • By March I was seeing physicians tweet about young COVID-19 patients presenting with stroke. Some of that case data has now reached the literature, like this April 2020 NEJM case report of five young COVID-19 patients with large-vessel stroke.
   • Personal stories about stroke appeared early in the lay media, including this April NY Times article, and this April Washington Post article.
   • A September review published in the journal Neurology found that 42.9% of young COVID-19 patients with stroke had no previous clotting risk factors or comorbidities. In many of those patients the stroke occurred before any other COVID-19 symptoms, ruling out the possibility that the stroke was caused by treatment or advanced stages of the disease.

3. There is preliminary evidence that COVID-19 causes or accelerates brain abnormalities that are well-known for increasing the risk of dementia. These abnormalities ("white matter hyperintensities", or "leukoaraiosis") occur without causing acute stroke symptoms, can be seen on brain MRI, and usually reflect cumulative age-related damage to the brain's white matter. An October 2020 review of the COVID-19 case literature found that COVID-19 patients appear to have more of this white matter damage than expected for their age. As these patients age, it is reasonable to predict that they will experience the onset of dementia earlier than they otherwise would have.

4. Mechanical ventilators can produce poor health outcomes in surviving patients: PTSD, cognitive deficits, depression, orthopedic problems, and lung and airway problems caused by the ventilator itself.

5. Medical errors in hospitals are the third leading cause of death in the United States, as measured during pre-pandemic years when hospital capacity was less stretched than it is now. In addition to death, any number of poor outcomes can result from medical errors. Something as tragic as permanent arm paralysis can be caused simply by improperly turning an ICU patient, tearing the nerves of the arm from the spine as described in a recent case.

WHAT'S MY BIAS IN ALL OF THIS?

1. I think we should make science-based choices about COVID-19. Yes, bad science happens, but science is still our best set of strategies. Bad cooking happens, but we don't reject cooking as a strategy for getting nutrients.
2. In the absence of good data, saying "we don't know yet" provides clarity, and creates a virtuous cycle in which other people see it's OK to acknowledge uncertainty.
3. While waiting for good data it's OK to err towards less risky, heath-promoting choices (economics allowing); optimizing for long-term quality of life at the cost of some short-term discomfort.
4. Our highest priority -- individually and politically -- should be preventing conditions that lead to overwhelmed hospitals (PPE, personnel, beds, equipment, drugs, tests and reagents). Most healthcare systems are not equipped to handle a pandemic of this scale, and exceeding hospital capacities will lead to the maximum possible suffering.