Issue ~100~

Poop for public health, your bravest organs, and excess pandemic deaths

Nov. 1, 2020

Hello friend! Welcome to Scrap Facts.

I'm a reporter covering health and science with insatiable curiosity. I love everything I learn, not all of which gets its own story. Each week, I'll bring you some of my favorite facts that I picked up on the job or while out living life.

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A few words of inspiration, should you need them:

When I feel mentally, emotionally, and physically drained, as you may be entering November, I feel a strong desire to give up entirely and burrito myself in a weighted blanket.

Usually, this isn’t a practical option (or solution). To keep going, I like to think about tiny gifts I can give myself—little adjustments that enable me to keep going not forever, but a little longer. It’s a tip I picked up from ultra-running: Sometimes, when you think that there is no way you can keep going for dozens more miles, you just need to eat a snack, drink some water, or change your socks and voila—10 minutes later, you realize you’ve got enough juice in you after all, and you are glad that you didn’t quit.

Perhaps this week, your little refresher is a walk around a block; designated time scrolling through TikTok; stretching away from screens; taking time to put on some clothes that make you feel fancy; reading a book or listening to an audiobook for a few minutes; a bike ride; chocolate; drawing a bath; a face mask; or even just cranking out some stress pushups. The options are endless! Hopefully, those tiny gifts are just enough to get you to keep going until the next one. That’s all you have to do—just make it to the next little relief.

I encourage you to think today about what little gifts you may need this week, and to stock up on them ahead of time if you can. Make a plan—know you’re going to feel tired and maybe upset. But you are also not alone, and we all will get through this. Be nice to yourself and those in your immediate circles this week and always.

The truth is always in your poop.

Found while reporting: Old sewers are becoming a modern Covid-19 watchdog.

Just a few short months into the pandemic, scientists realized that everyone who contracts the virus sheds little bits of its genetic material in their stool, regardless of whether they get sick. And they seem to do so within days of contracting the virus, which means poop could act like a canary in a coal mine. Wastewater could signal which areas are about to have outbreaks and need testing or more social distancing methods. It can’t track who is sick—so it’d never replace proper testing. But it could make spot testing way more effective by acting as a spotlight.

A group of scientists, sewer specialists, and local public health departments in the greater Louisville, Kentucky area in the US are setting an example of how a wastewater monitoring program could work—but it’s gonna be a heck of a challenge to get plans for a national system like the US Centers for Disease Control and Prevention wants in place. It involves an alphabet soup of US federal government agencies (including the Department of Homeland Security), private companies, college campuses, hundreds of cities across the US, and wastewater treatment specialists who described to me in great detail the look and smell of cracking open a manhole.

I’ve reported this feature for months; I can’t pick just one fact from it. So, here’s some nuggets to pique your interest:

  • If your toothbrush is within three feet of an open toilet when it flushes, it’s covered in microscopic fecal matter. Sorry. Chuck Gerba, a University of Arizona microbiologist whose career “started in the toilet” (his words), told me that from a droplet perspective, toilet flushes look like the fireworks on the 4th of July.

  • Despite the fact that Israel declared that it had eradicated polio in 1989, scientists monitoring their wastewater found pockets of the virus in 2013, which led the government to mandate vaccines for all children under 10.

  • Human waste gives off hydrogen sulfide in sewers, which produces a mucky rust-looking brown color that tends to creep up pipe walls.

  • Manhole covers weigh about 60 pounds—but they vary a LOT.

  • Your poop can even show your exposure to different kinds of air pollutants, in addition to what you’ve eaten and drank in the past 24 hours.

Don’t want to read 3,000 words on wastewater? Read my Twitter thread instead.

Your lungs are your bravest organ—which makes them the hardest to transplant.

Found while reporting: Demand for Covid-19 lung transplants is about to shoot up.

Your five lung lobes may be tucked safely behind the protection of your rib cage, but that does not mean they’re free from danger. In fact, of all your internal organs, the lungs get the most exposure to the dangers of the outside world.

Every time you breathe in, your lungs perform a chemical trick to separate the oxygen out of the air, and excrete your wasted CO2 to prevent acid from building up in your blood. In doing so, their spongey tissue comes into contact with all the other muck in the air, like pollution. Things like smoking put this gunk directly into this delicate tissue. And yet, our lungs fearlessly persist with a comforting reliability.

This doesn’t mean that they’re always in great shape, though; because they’re exposed to so much over the course of our lives, they may be technically working but are unsafe to be used as donor organs if their original owner dies.

The way a person dies often directly damages the lungs, too: Drug overdoses may cause someone to aspirate, or accidentally inhale their own vomit. Car crashes may break the ribs and bruise the lungs. Even the process of resuscitating someone could bruise the lungs, as can the process of putting someone on a ventilator.

There have always been organ shortages, but these extra vulnerabilities mean that lungs are especially in high demand. This is particularly bad during a pandemic caused by a primarily respiratory illness. For a while, doctors were worried that it wouldn’t even be safe to perform lung transplants for patients whose lungs had been destroyed by Covid-19; what if the infection jumped into their new set of lungs? Could those donated organs have been given to someone else who had a better chance of survival? As a result of these questions, lung transplants actually slowed down during the start of the pandemic back in March.

But luckily, we now know that transplants for Covid-19 patients can help them survive—it’s only as risky as any other major surgery now (which is very risky, but better than the alternative). As the pandemic continues, I suspect lung transplant rates will continue to rise, too; transplant surgeons are already thinking of ways they can medically spruce up lungs that normally wouldn’t be donated—including using a fancy machine called a ex vivo lung perfusion, or EVLP, which is basically an incubator for the organs.

Bonus fact: Wanna learn even more about these fascinating organs? Check out this entire obsession email I wrote on lungs.

The next time someone tells you that Covid-19 is “just the flu,” show them this graph of expected vs. actual US deaths in 2020:

Found while reporting: Covid-19 indirectly killed far more older adults than we thought.

This is data from the US Centers for Disease Control. (The weeks after August are subject to change because it takes some time to finalize death certificates)

As you can see, the spike of hundreds of thousands of excess deaths (deaths higher than expected) right around the end of March and April. there was a second spike around July when the second major wave of the pandemic hit in the US.

Sadly, this spike isn’t attributed to Covid-19 alone; the pandemic has exacerbated the fatality of other health conditions, particularly Alzheimer’s and other forms of dementia.

While Covid-19 may not directly cause these deaths, we saw an increase in dementia deaths because of disrupted care. Without regular access to caregivers or doctor’s visits, people living with dementia can develop other health issues that are completely preventable, like a bedsore that becomes infected, a fall, or even simply missed meals or medication. No single health issue exists in isolation.

Other work you may have missed:

To get a sense of how the two presidential candidates are thinking about the serious crises around the country, consider the questions asked to them in their individual town halls. And please, please vote if you haven’t already (we did by mail on October 5!)

That said, it is a surreal experience talking to public health experts in South Korea about Covid-19 case counts in the US. Since last issue, I’ve appeared on Arirang, a South Korean news network, twice to talk about the intersection of Covid-19 and the upcoming election. You can watch the clips, which were recorded live here and here.

Antigen testing could be used to improve contact tracing if we could just think about how to deploy it correctly.

There is still time to get your flu shot. Here’s how.

Language analysis could be used to spot mild cognitive impairment early.

No president will be able to mandate Covid-19 vaccines. They can sure as heck incentivize states to do so, though! But in either case, the US will have 50 million doses of potential Covid-19 vaccines by the end of the year, regardless of what the FDA authorizes by that time.

And finally, the superb bird of paradise lives in New Guinea and parts of Indonesia, but two (2) were spotted yesterday by a few folks in a backyard in Washington, DC.

Our Halloween costume as superb birds of paradise. The males have super black feathers they spread out in a crest over their heads, with bright blue coloring in a horizontal shape that sort of looks like a smile across the bottom. You can watch their famous mating dance here.

That’s all for now—stay curious, friend ❤️

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Top image by E. Y. Smith, headshot drawing by Richard Howard.