Month: September 2020

Of course the Internet is full of information, sadly most of it unreliable. The pandemic has amplified the problem, with mounting concerns that previously reliable sources might be tainted by political and social issues that obscure scientific data. Below I list 3 sites that I think are generally useful and reliable resources for clinicians. There are many more sites that I check regularly, but it can get overwhelming to keep up with multiple data sources.

1. New York Times graphs - These interactive graphs demonstrate important changes across the US. Be prepared to put up with pleas to subscribe to the NYT and other unwanted advertisements. See https://www.nytimes.com/interactive/2020/04/23/upshot/five-ways-to-monitor-coronavirus-outbreak-us.html.
2. American Academy of Pediatrics/Children's Hospital Association COVID-19 Report - I call this a one-stop shopping site for pediatric healthcare providers. You can access individual state data regarding pediatric infections, updated every 2 weeks, plus link to state and regional health departments, among many other sites. Try it out at https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/.
3. Centers for Disease Control and Prevention - Yes, the CDC has taken a hit recently, under fire for undue political influence, internal plotting, and who knows what else. Still, they have a lot of great information both for clinicians and for the public. If you feel some of the advice doesn't make sense and you are worried about accepting it, send me a comment through the Blog and I'll look into it. Access the CDC COVID-19 site at https://www.cdc.gov/coronavirus/2019-ncov/index.html.

This question was submitted by a primary care pediatrician during my last live webinar update to Children's National Hospital's Pediatric Health Network (PHN) on September 1, 2020. (You can view the entire presentation if you want, about an hour.)

That was a pretty daunting question to answer on the fly, and the answer becomes more difficult as time goes on. Some of you may have seen the story by Lena Sun in the Washington Post on September 13 (online on September 12) detailing some political squabbling about publications in the CDC's Morbidity and Mortality Weekly Report (MMWR). Some in the Department of Health and Human Services apparently have felt for some time that MMWR reports are biased against the current administration and that such reports are sometimes politically motivated rather than purely scientifically driven.

I have subscribed to MMWR for as long as I can remember, I receive the weekly reports electronically as well as any advance reports ahead of publication. The Post commentary focused on a report from July of extensive SARS-CoV-2 spread within a summer camp in Georgia. The commentary didn't mention another MMWR description about a good camp outcome in Rhode Island, published in August, where the camp administrators adhered more stringently to infection control measures. I happened to have mentioned both reports in my September 1 PHN presentation because I thought it very effectively showed us what preventive health measures worked and what didn't work in camp settings. These experiences could offer some important lessons to apply in other settings such as schools.

In the midst of all this squabbling it may help to understand how MMWR features differ from traditional original medical articles in journals. The MMWR discussions are relatively brief and in particular generally do not go into great detail explaining methodology. The methodology is key to assessing validity of results of any study. Sometimes the MMWR features end up being published in more traditional journals with more details provided. Having said this, in general I have found the MMWR to have very useful information with only rare instances where findings subsequently were found to be in error. (One instance of error I remember very well was a published association of a household mold, Stachybotrys chartarum, with cases of pulmonary hemosiderosis in infants in Cleveland. The methodology was flawed, and CDC retracted the findings a few years later.)

Of course we also are challenged by potential political influences at the US Food and Drug Administration (FDA) already involving hydroxychloroquine, convalescent plasma, and now COVID-19 vaccines. I do need to mention a potential conflict of interest with the FDA: we have had a joint pediatric infectious diseases fellowship with the FDA since the late 1980's, highly successful, and I know many of the scientists and physicians at the FDA now working on SARS-CoV-2 antiviral, biologic, and vaccine evaluations. Of course I know nothing about the details of their deliberations, but I do feel comfortable knowing the rank and file personnel there will make their recommendations based on science. It remains to be seen whether those recommendations change based on political considerations, but as long as the process and the findings are transparent we can all reach our own conclusions and provide recommendations to our patients and families.

So, to answer the original question posed to me, I do trust both the CDC and FDA to give us fair and accurate information about SARS-CoV-2, just as they have done in the past through many other outbreaks.