Category: Covid-19

What the Heck is a Shewhart Chart?

This is just a post from a retired psychiatrist who barely passed the statistics course in medical school, so take it with a big grain of salt. I found an article written by Rocco J. Perla about something called Shewhart control charts to monitor the course of pandemic fluctuations. I noticed it because of what Perla commented on, which is the tendency of the press to make sensational headlines about every squeak in the turning wheel of COVID-19, including CDC making changes in masking guidelines leading to congressmen calling for investigations of the CDC for making the changes. It makes it look as though we don’t know what we’re doing.

I don’t know if Shewhart charts can help us make better decisions about what to advise us to do at the community level to help monitor and predict outbreaks. But it looks like we need to try something better soon. Because I can’t stand the pop-up ads at the U.S. News & World Report web site and limitations on how many articles I can view for free where I first saw Perla’s story, I looked up his original article published in the Int J Qual Health Care.

This led to my discovering the web site ISQua (International Society for Quality in Health Care). There I found a Shewchart for my state of Iowa, which shows what happened here this month. I don’t know if the Iowa Department of Public Health (IDPH) is already using it and I’m not qualified to tell them what to do. By the way, I think that mindset of “Don’t tell me what to do” crankiness might be an epiphenomenon of the COVID-19 pandemic. Nobody wants to be told to wear masks or to get a vaccine. It just leads to a pandemic of backlashes. I don’t know if Rocco is right about the Shewhart chart method not being in use by public health officials. But I want to go on record as not telling anybody what to do.

The Shewhart charts look labor intensive and maybe that’s why some public health departments don’t use them. They’re understaffed and overworked. Iowa has been scaling back the collection and reporting of COVID-19 data, partly because things appeared to be so rosy early in July. I’m not so sure how rosy they’ll be after the Iowa State Fair in August, which is expected to draw about a million visitors.

But I’m not telling anyone not to go to the state fair and I’m not telling anyone to wear a mask and I’m not telling anyone to get vaccinated. I’m not even telling anyone to pay any attention to Perla’s article on the Shewhart chart. I am telling you that I’m too old and cranky to be getting backlashes about any of this business.

Have fun at the fair.

Perla RJ, Provost SM, Parry GJ, Little K, Provost LP. Understanding variation in reported covid-19 deaths with a novel Shewhart chart application. Int J Qual Health Care. 2021;33(1): mzaa069. doi:10.1093/intqhc/mzaa069

Inkelas M, Blair C, Furukawa D, Manuel VG, Malenfant JH, Martin E, et al. (2021) Using control charts to understand community variation in COVID-19. PLoS ONE 16(4): e0248500. https://doi.org/10.1371/journal.pone.0248500

Listening to the CDC

Like everyone else, I groaned aloud about the revised CDC mask guidelines yesterday. I still trust the CDC guidance, and I’m sure many might disagree with me. I think some headlines overstate the CDC mask change. I don’t believe it’s a “reversal” per se. I think it’s common sense to wear a mask if you’re inside somewhere with a lot of people whose vaccination status you know nothing about.

I think it’s worthwhile to actually read the CDC web site’s mask guidance in the section entitled “When You’ve Been Fully Vaccinated.” What it says is:

“To maximize protection from the Delta variant and prevent possibly spreading it to others, wear a mask indoor in public if you are in an area of substantial transmission.”

It’s a good idea to check your geographical area (COVID-19 Integrated County View) to see what the transmission situation is. It’s moderate where we live in Iowa. That’s enough for me to go back to wearing a mask in tight quarters with people I don’t know.

I was dismayed to read an opinion piece entitled “Stop listening to the CDC,” in which the author said that “the vaccinated are not responsible for the unvaccinated, and vice versa.”

That made me remember my former pastor, Reverend Glen Bandel, who is now in his 90s. When my mother was very sick, he spent a long night sitting up with her. My brother and I were too little to manage the crisis by ourselves. She was unable to keep any food or fluid down and he made many trips from her room to the bathroom, to empty her bucket of vomit in the toilet. You could have made a case for hospitalizing her, but we somehow got by without it.

If we all believed that we are not responsible for each other, we would have been extinct long ago, let alone getting through this pandemic in the last 18 months. Not all of us who got the COVID-19 vaccine did it just for ourselves. I think a great many also did it for those they loved and for whom they felt responsible. This is called altruism and I think humans are still capable of it, despite what you read in the news.

Update on Advisory Committee On Immunization Practices Meeting July 22, 2021

Presentation slides for the ACIP meeting today are available here. Updates to clinical communication indicate that, while patients with a history of Guillain-Barre Syndrome (GBS) are eligible for any of the authorized vaccines, they should discuss with their clinical teams the availability of mRNA vaccines given the association of GBS with the J&J vaccine.

For the summary of the issues regarding giving booster vaccine doses to immunocompromised patients, see data from slide 15 onwards.

Vaccines and Shirt Pocket Flap Puckers

This morning I put on my shirt and noticed the pocket flap puckers for the umpteenth time. I also got a reminder about how difficult it is to keep fingernail clippings from zinging all over the bathroom. I did a quick web search and saw that both problems are perennial with no great solutions. There’s an eerie resemblance to the COVID-19 vaccine hesitancy challenges.

One author says the shirt pocket flap pucker problem (say that three times quickly right now!) is caused by shirt manufacturers who fail to hem correctly and by shirt wearers who fail to properly launder them. Various solutions to the nail clipping problem involves innovative modifications to clipper design and other ingenious suggestions you can try yourself, including clipping with your digits inside a sandwich bag to catch the flying parings.

In other words, there are system changes and user changes, which seems to apply to the vaccines as well. For example, there are some researchers investigating the use of intranasal immunization. This has a few advantages, including maybe helping those who are afraid of needles, which is a population probably bigger than we think.

There are systems advantages as well as challenges to the intranasal route. It capitalizes on the IgA immunity cells in the nasal mucosa, which could help prevent travel of the virus to the lungs. The University of Iowa Hospitals & Clinics research team has found that this works in mice. On the other hand, other researchers are abandoning the approach because they haven’t had success in early human trials. And the vaccine injections are highly effective by comparison. Side effects of the intranasal might include more than just wanting to make you sneeze. Although you could cover your nose with a sandwich bag or maybe pinch your nostrils shut with a pair of nail clippers (but what to do with the nostril parings?). Some raise concerns about how close you get to the brain. There was a reported case of Bell’s Palsy after an intranasal influenza vaccination in 2002. Incidentally, the likelihood of getting Bell’s Palsy after the COVID-19 jab is less than getting it from the virus infection itself (MedPage Today report June 2021).

Congress could pass laws preventing shirt manufacturers from making them with pocket flaps in the first place. After all, what pickpocket would be bold enough to try to pick your shirt pocket, assuming you buttoned it? Or the President could write an executive order mandating the owners of shirts with pocket flaps launder them properly, or at least iron them. There could be a door-to-door campaign to distribute innovative nail clippers, or offer free pedicure and manicure services (only after full licensing, of course).

Well, anytime you need my innovative suggestions you can always choose to opt out.

Advisory Committee On Immunization Practices Meeting July 22, 2021

The Advisory Committee on Immunization Practices (ACIP) will meet with the CDC July 22, 2021 to discuss COVID-19 vaccine boosters for immunocompromised individuals and the association of the J&J vaccine with Guillain-Barre Syndrome. See the draft agenda here.

New FDA Warning Regarding association of Guillain-Barre Syndrome with J&J Covid-19 Vaccine

On July 13, 2021, the FDA issued a revision to the J&J COVID-19 vaccine fact sheets regarding the increased risk of Guillain-Barre Syndrome (GBS) with the vaccine. According to the announcement, the benefits still outweigh the risks for getting the vaccine and so far no causal association has been found. GBS is rare and has been associated with other vaccines, including the flu vaccine. GBS has not been associated with the mRNA vaccines, so far.

Results of CDC Emergency Meeting Today on COVID-19 Vaccine Safety

The ACIP presentation slide sets available for June 23, 2021 regarding safety of COVID-19 vaccine including myocarditis and pericarditis and booster doses are here. Updated CDC recommendations for myocarditis and pericarditis following mRNA COVID-19 vaccination are here. Data does not support recommending booster doses currently although monitoring will continue.

Update: CDC Emergency Meeting June 23-25, 2021 on COVID-19 Vaccine Safety Including Myocarditis

The CDC Advisory Committee on Immunization Practices (ACIP) emergency meeting is re-scheduled for June 23-25, 2021 to discuss COVID-19 vaccine safety including myocarditis after Vaccine Safety Technical Work Group assessment. You can find a webcast link and the draft of the working agenda details here. The Vaccines and Related Biological Products Advisory Committee report slide set summary as of May 31, 2021 is on slide 26. The American Academy of Pediatrics (AAP) news story is here.

Magnetically Speaking

Today I saw the story about a nurse practitioner in the Ohio state legislature who tried to demonstrate how the COVID-19 vaccine magnetized her. However, she was like Teflon—nothing stuck. This occurred during the Ohio state legislature hearing about House Bill 248, which would prohibit mandatory vaccinations. I gather it is still being considered, although not on the strength of the scientific evidence favoring any magneto-genic properties of the vaccine. Even the CDC has a web page debunking this.

You know, when we were grade school kids, we used to do this trick of placing a spoon on our noses. The spoon sticks to your nose mainly because of the oil on your skin. The school lunchroom monitors did not get a big kick out of this, for some reason. They would make us sit in the bleachers. They also caught us stuffing spinach and fruitcake into our milk cartons, which brought the same penalty.

The CDC forgot to mention the other important issue, though. Aliens are installing tracking devices into the injection site. They want to see how many people are going to the marijuana shops in the states where it’s legal to get free joints for getting the jabs. Those aliens got it all wrong. In fact, I guess it’s tough to get the jab in the first place. You only get the marijuana for actually getting the shot in the pot shop (try saying that three times really fast), not for proving that you already got one by showing your vaccination card (like at beer gardens). It turns out that health care professionals are leery of administering the injections at pot shops because of some federal law against using or selling marijuana. Imagine that.

Anyway, there is no scientific evidence for COVID-19 vaccines making you magnetic. And they won’t make you like fruitcake, either. Is there any evidence for human magnetism at all, meaning can you make metal objects stick to you as if you’re a human magnet? Probably not. There are some colorful characters out there who claim they’re magnetic, though.

But is there evidence for humans having magnetoreception or some kind of magnetic sense? There might be some evidence although definite conclusions can’t be made yet. In an earlier post I mentioned that scientists believe there is evidence supporting a magnetic sense in some animals including foxes.

Try the sticky spoon trick at home.