Just curious, anyone have a plan, or preps for global pandemic?

[Ron Put]

1 hour ago, TomBAvoider said:

Does that mean Sweden will see an explosion of lung cancer in the future, tied to their laissez faire attitude to the spread of CV-19 in their country?...

No, not really. One's present fears do indeed distort our perception of risk. It seems that the hysteria has moved from "millions are going to die and the healthcare system is overwhelmed and about to collapse" to "let's scare ourselves with potential longer term side effects," as evidenced by the trending posts here.

As to opacity nodules, they have been noted in the other corona viruses before, which are now endemic and part of the "flu."   A quick search finds all sorts of similar stuff about past pandemics and viruses which now circulate every season:

Study: H1N1 Flu Causes 'Unusual' Damage to Lungs

One middle-aged man who died was not diagnosed until after death, but unusual findings on his X-rays may be able to help doctors save other, similar patients.

Mollura's team found irregularities called ground-glass opacities in the patient's lungs using a CT scan. Although the patient was severely ill and had a fever, he tested negative for flu and doctors did not treat him for it.

The man died five days after he went into the hospital and the autopsy confirmed he had swine flu. The lung lesions seen on his CT scan matched lung damage done by the virus, Mollura and colleagues said.

In another study in the same journal, CT scans of patients with severe cases of swine flu showed many had pulmonary emboli, which block the arteries in the lungs, a team at the University of Michigan found."

Pulmonary sequelae in a patient recovered from swine flu

"The pandemic of swine flu (H1N1) influenza spread to involve the whole world rapidly. Many patients manifested a mild clinical illness but some developed pneumonia and respiratory failure. High mortality was observed in patients with severe disease. Among survivors, studies are limited. Ground-glass opacities on a high-resolution computerized tomography scan and reduced diffusion capacity were noted after 3 months in a study. But long-term complications in patients with swine flu pneumonia have not been studied well. We are presenting an unusual case of swine flu pneumonia who developed interstitial lung disease after recovery."

[Ron Put]

22 hours ago, corybroo said:

A link that allows you to see the stats for your city.  ...

The New York numbers published have been quite manipulative, as the majority chose a time slice to make the numbers appear horrific,  without providing appropriate context. 

"New York City" as used to count the death toll is in fact the Tri-State area, which has a total population of over 20 million people (New York City itself is about 8.5 million).

I just tried to find historical mortality data for the TriState area and found nothing. New York State, which at just about 19 million is a million short of the Tri-State area, shows that about 155,000 people died of all causes in 2017, which was generally an uneventful year.

Now, let's compare the 22,275 deaths attributed to Covid-19 (including the 6-7 thousand of possibles), to the approximately 160,000 who die in an average year in the Tri-State area. Hm, suddenly it doesn't seem as scary and it may even be quite normal....

 

2 hours ago, Gordo said:

... ADDENDUM: It will probably not surprise you to learn I think Senator Tom Cotton has the assessment of the likelihood of SARS-CoV-2 arising from an accidental exposure of a naturally occurring virus just about right:...

While possible and while it should be investigated properly, I don't believe it's likely.

China, in my opinion, got lucky. It had a vital piece in place (it had established influence over WHO through the election of Tedros) and it used it well.  WHO both absolved the Chinese cover-up and promoted the perceived danger of Covid-19, and the Chinese approach to dealing with it, while accusing the Western governments of being lax.  Which was used by populists in Europe and the US to attack their opponents, show "leadership" and impose what in places is effectively marshal law.

China scored huge with this, politically, but also economy-wise: it's economy is generally predicted to recover much faster than the West's. This is a glimpse of one likely consequence:

The Pandemic Could Tighten China’s Grip on Eurasia

Edited April 26, 2020 by Ron Put

[Ron Put]

This is a rather good interview:
 

 

[Dean Pomerleau]

4 hours ago, Gordo said:

While the Chinese government denies the possibility of a lab leak, its actions tell a different story. 

For anyone interested in a deep dive into the hypothesis that SARS-CoV-2 was created in a lab by "gain-of-function" experiments in coronaviruses that have been going on for many years in labs both in the US and Wuhan, this is a really interesting (very long) article on the subject by someone with a lot of knowledge on the topic who was initially quite skeptical about the possibility. 

The author argues it is possible the virus was synthesized in a lab by combining specific segments of bat and pangolin coronavirus RNA, created to study just how virulent such combinations can get and in hopes of finding a way to stop such combinations should they ever emerge. Then a mistake in the lab could have resulted in a human infection and release of the virus.

Here is his concluding paragraph, warning against the kind of gain-of-function research that could have created the virus and that has been occurring for many years:

I hope this post is not used to prematurely assign blame or propagate one-sided theories. What I do hope it highlights is the scale of dangerous gain-of-function research that has been and is going on in virology. The Covid-19 pandemic really exposed its huge risks in the face of few benefits: GOF research hasn’t protected us from this outbreak, hasn’t provided us with any effective treatments or vaccines in time to save hundreds of thousands of lives lost to CoV2, and if there is even a 0.1% chance GOF research caused the whole thing, that chance is too high. 

Such gain-of-function virology experiments were apparently banned in the US for a few years but the ban was lifted in 2017. No such ban occurred in China and it appears that a lab in Texas has been competing with the Wuhan lab to see who can make the most "interesting" coronavirus chimera. 

--Dean 

 

[Gordo]

So Trump was the butt of many jokes and took quite the flogging over his recent comments about wild potential treatments ideas.  Then this surprising 2014 story showed up in my google newsfeed: Virginia Man Struggling to Breathe Gets Lungs 'Washed'

OK, has nothing to do with COVID-19 but still, maybe the idea of “a lung cleaning” is actually not as crazy as everyone seems to think! Anyway, thought the article was kind of fascinating, I’ve never heard of this treatment before.

 

In other news, the Financial Times released some interesting mortality analysis which concludes: Global coronavirus death toll could be 60% higher than reported

[Ron Put]

1 hour ago, Dean Pomerleau said:

For anyone interested in a deep dive into the hypothesis that SARS-CoV-2 was created in a lab by "gain-of-function" experiments in coronaviruses that have been going on for many years in labs both in the US and Wuhan, this is a really interesting (very long) article on the subject by someone with a lot of knowledge on the topic who was initially quite skeptical about the possibility. ...

 

This same narrative has been floating around for a while now.  I'd be cautious with articles like this. Some truth, a lot of innuendo to leave you confused and open to possibilities, which may be introduced later, or by others.

Putin’s Long War Against American Science

An investigation by The New York Times — involving scores of interviews as well as a review of scholarly papers, news reports, and Russian documents, tweets and TV shows — found that Mr. Putin has spread misinformation on issues of personal health for more than a decade.

His agents have repeatedly planted and spread the idea that viral epidemics — including flu outbreaks, Ebola and now the coronavirus — were sown by American scientists. The disinformers have also sought to undermine faith in the safety of vaccines, a triumph of public health that Mr. Putin himself promotes at home.

Moscow’s aim, experts say, is to portray American officials as downplaying the health alarms and thus posing serious threats to public safety.

Chinese Agents Helped Spread Messages That Sowed Virus Panic in U.S., Officials Say

The propaganda efforts go beyond text messages and social media posts directed at Americans. In China, top officials have issued directives to agencies to engage in a global disinformation campaign around the virus, the American officials said.

Some American intelligence officers are especially concerned about disinformation aimed at Europeans that pro-China actors appear to have helped spread. The messages stress the idea of disunity among European nations during the crisis and praise China’s “donation diplomacy,” American officials said. Left unmentioned are reports of Chinese companies delivering shoddy equipment and European leaders expressing skepticism over China’s handling of its outbreak.

[Dean Pomerleau]

From a new New York Times article on the implications of recent antibody surveys, particularly the New York one:

The results in New York State offer an early glimpse of the promise and pitfalls of widespread antibody testing.

Public health officials tested 3,000 residents at grocery stores and big-box retailers throughout the state. In New York City, about 21 percent of participants were found to carry coronavirus antibodies.

The rate was about 17 percent on Long Island, nearly 12 percent in Westchester County and Rockland County, and less than 4 percent in the rest of the state.

New York’s survey was reasonably well designed and the results largely credible, experts said. But unlike Mr. Cuomo, few saw happy news in the numbers.

“I just don’t see any way to put a silver lining on any of these results,” said Carl Bergstrom, an infectious diseases expert at the University of Washington in Seattle. “I think that the efforts to spin it that way are irresponsible.”

If one in five residents in hard-hit New York City has been exposed to the virus, he and others said, then four in five are still vulnerable — and that underscores how far we are from the pandemic’s end.

New York’s results suggested a death rate of between 0.5 and 1 percent, figures some conservative commentators have argued is too low to justify statewide lockdowns.

Public health experts like Dr. Bergstrom took the opposite view. “If the mortality rate is 1 percent, we’re looking at 2 million deaths, which is unprecedented in our nation’s history and unimaginable,” he said.

“Anyone talking about the death rate as ‘only 1 percent and so we should not worry about it’ has an extraordinarily callous view.”

The New York survey confirms what experts have long believed: that because of the lack of tests, the state has undercounted the true number infections by about a factor of 10.

Reopening society with such a huge vulnerable population, and without careful consideration, could be disastrous, allowing the virus to sweep through the country, Dr. Bergstrom and others said.

Another lesson from the survey: New York is far from attaining “herd immunity” — a proportion of the community immune to the virus that is so large that the pathogen cannot maintain a toehold.

For that to happen, experts have estimated that 60 to 70 percent of the population would need to be immune. Even then, the coronavirus would continue to spread, just at a slower rate.

“Honestly, from an ethical vantage point, herd immunity in the absence of a vaccine is not something we should be aiming to achieve,” said Maimuna Majumder, a computational epidemiologist at Harvard Medical School.

To get there, “that’s a lot of sick people — and a lot of deaths,” she added.

 

I continue to think it won't be possible to keep the current level of social distancing in place, or, sadly, to effectively reinstate such measures when cases start climbing. It seems to me like we'll need to settle for protecting the vulnerable as best we can, protecting ourselves as best we can and hoping we can keep the daily death toll not much above where it is now until an effective prophylactic, treatment or vaccine becomes available. Or maybe we'll get lucky and the warmer weather will help reduce the spread.

I think we could become inured to this level of tragedy. After all we accept ~1800 deaths per day from heart disease. But besides the direct loss of life and the heartache they will cause, I think perhaps the hardest part will be so many people knowing they were causally responsible for the death of a friend, colleague or family member, when they inadvertently transmit the virus to them. I drive for meals-on-wheels and it worries me on every delivery that I might infect one of my elderly clients.

--Dean

[Gordo]

4 hours ago, Dean Pomerleau said:

it worries me on every delivery that I might be infect one of my elderly clients.

One of the most liked comments on an article I read today was:

”asked my grandfather what he thought of us shutting down society to save his wrinkly ass. He called us morons.”

😉

Flip side: 

San Francisco had the 1918 flu under control. And then it lifted the restrictions.

A cautionary tale about the dangers of reopening too soon.

In other news:

More food issues documented: Coronavirus Forces Farmers to Destroy Their Crops

Edited April 27, 2020 by Gordo

[Sthira]

3 hours ago, Dean Pomerleau said:

I think we could become inured to this level of tragedy. 

Might be helpful to revisit Camus’ The Plague. Covid seems a good example of Camus’ idea that life is pretty much absurd. We find little justice regarding who gets to live and who must die from this virus. No meaning is to be derived. Wishful thinking doesn’t help, miracle cures won’t work and real cures — slow-paced science — aren’t anywhere near us. Life is fleeting, fragile — lives are ephemeral. Nothing saves us — not wealth, not dreams of lifespan extension, education can’t shield us from mindlessly stupid microscopic pathogens.  
 

Yet we forget this, don’t we? We’re surprised to discover we’re vulnerable, too, that our healthy lifestyles, our calorie restriction, our devoted exercise, all our careful attention to micronutrients and obscure little anti-oxidant rich berries or whatever — none of it provides sufficient immunity. Are we surprised?

So what are we supposed to do, Camus asks of us. Care, he says. Care about each other, help one another in the face of blind absurdity. The novel’s hero, Dr. Rieux, accepts the stupidity of all this useless suffering, death, and meaninglessness. Yet he battles on, pointlessly, with courage and heroism. Camus’ Dr. Rieux, does he remind me of Dr. Fauci? 

Dr. Rieux treats his patients only because he sympathizes with their undeserved plight. Our own shared undeserved plight. All of us have this plague, we live in it, we will get it no matter how much we wash hands and wear masks, gloves, no matter how much social distancing we practice, in the end it gets us. If not this plague then the next. Or death. We don’t deserve it, but it doesn’t matter, and little about these lives we live make much sense.

What we may do, though, is give a damn about each other during the time we have remaining.

[TomBAvoider]

It's all a matter of scale. Camus had valuable insights into a limited pandemic. But differential effects were dominant during the Bubonic Plague.

We really are not that different from our ancestors. Press us a little, and you'll often get generosity, but sometimes pressing us a lot gives you darkness.

With all due respect to the awfulness of CV-19, I think it's a relative lightweight as pandemics go, classes milder the 1918 Spanish Flu and a different universe from the Bubonic Plague.

Care, he says - rightly, in these circumstances, for that's how we'll most likely respond. We're lucky the plague is not much worse, or we might read a different author, whom the bubonic plauge inspired to write a wholly different text - The Decameron. 

And ther are always those who believe après nous le déluge. 

[Thomas G]

 

This is terrifying. We really don't understand what this virus does to our bodies. It is like a horror movie in which there is some kind of alien illness.

Young and middle-aged people, barely sick with covid-19, are dying of strokes

 

Quote

 

As Oxley, an interventional neurologist, began the procedure to remove the clot, he observed something he had never seen before. On the monitors, the brain typically shows up as a tangle of black squiggles — “like a can of spaghetti,” he said — that provide a map of blood vessels. A clot shows up as a blank spot. As he used a needlelike device to pull out the clot, he saw new clots forming in real-time around it.

“This is crazy,” he remembers telling his boss.

 

 

[Sibiriak]

On 4/25/2020 at 10:09 AM, Ron Put said:

Some common sense, sent to me by my own internist.  [video:   Dr. Erickson COVID-19 Briefing  ]

 

I ran across a short part 2 video of that interview at  Zerohedge.

Whistleblowing ER Docs Urge "Open Up Society Now" Because "Lockdowns Are Weakening Our Immune Systems"

I confess I haven't watched the videos yet,  by I did read the Zerohedge article which provides quotes, which I post without comment.
 

Quote

 

They are experienced medical professionals who have 40 years of hands-on experience in dealing with viruses and respiratory infections. 

Watching the news in China in January, they knew the virus was on its way. They ordered many COVID-19 tests because they knew they would need them. They tested many thousands of people, and discovered for themselves what epidemiologists around the world are saying:  COVID-19 came here earlier than previously believed, is more ubiquitous, and ultimately for the general population less deadly than we thought.

While this realization is gradually dawning on people around the world, they went public with their findings, which are not generated out of a predictive model but rather the actual facts of the case. In the course of their press conference, they addressed the question of whether or not California should have shut down much of its economy. Their answer is no. They conclude with the need to open up immediately, on grounds of health and human rights. 

“If you’re going to dance on someone’s constitutional rights you better have a good reason, you better have a really good reason, not just a theory,” he said.  “The data is showing us it’s time to lift (the stay-at-home orders) so if we don’t lift, what is the reason?”

Here are some selected quotes from their interview with a hostile reporter (emphasis added).

We’d like to look at how we’ve responded as a nation, and why you responded. Our first initial response two months ago was a little bit of fear: [the government] decided to shut down travel to and from China. These are good ideas when you don’t have any facts. [Governments] decided to keep people at home and isolate them. Typically you quarantine the sick. When someone has measles you quarantine them. We’ve never seen where we quarantine the healthy. 

So that’s kind of how we started. We don’t know what’s going on, we see this new virus. How should we respond? So we did that initially, and over the last couple months we’ve gained a lot of data typically. We’re going to go over the numbers a little bit to kind of help you see how widespread COVID is, and see how we should be responding to it based on its prevalence throughout society—or the existence of the cases that we already know about….

So if you look at California—these numbers are from yesterday—we have 33,865 COVID cases, out of a total of 280,900 total tested. That’s 12% of Californians were positive for COVID. So we don’t, the initial—as you guys know, the initial models were woefully inaccurate. They predicted millions of cases of death - not of prevalence or incidence - but death.

That is not materializing. What is materializing is, in the state of California is 12% positives.

You have a 0.03% chance of dying from COVID in the state of California. Does that necessitate sheltering in place? Does that necessitate shutting down medical systems? Does that necessitate people being out of work?

96% of people in California who get COVID would recover, with almost no significant sequelae;  or no significant continuing medical problems. Two months ago we didn’t know this. The more you test, the more positives you get. The prevalence number goes up, and the death rate stays the same. So [the death rate] gets smaller and smaller and smaller. And as we move through this data—what I want you to see is—millions of cases, small death. Millions of cases, small death. 

We extrapolate data, we test people, and then we extrapolate for the entire community based on the numbers. The initial models were so inaccurate they’re not even correct. And some of them were based on social distancing and still predicted hundreds of thousands of deaths, which has been inaccurate. In New York the ones they tested they found 39% positive. So if they tested the whole state would we indeed have 7.5 million cases? We don’t know; we will never test the entire state. So we extrapolate out; we use the data we have because it’s the most we have versus a predictive model that has been nowhere in the ballpark of accurate. How many deaths do they have? 19,410 out of 19 million people, which is a 0.1% chance of dying from COVID in the state of New York. If you are indeed diagnosed with COVID-19, 92% of you will recover.

We’ve tested over 4 million… which gives us a 19.6% positive out of those who are tested for COVID-19. So if this is a typical extrapolation 328 million people times 19.6 is 64 million. That’s a significant amount of people with COVID; it’s similar to the flu. If you study the numbers in 2017 and 2018 we had 50 to 60 million with the flu. And we had a similar death rate in the deaths the United States were 43,545—similar to the flu of 2017-2018. We always have between 37,000 and 60,000 deaths in the United States, every single year. No pandemic talk. No shelter-in-place. No shutting down businesses… 

We do thousands of flu tests every year. We don’t report every one, because the flu is ubiquitous and to that note we have a flu vaccine. How many people even get the flu vaccine? The flu is dangerous, it kills people. Just because you have a vaccine doesn’t mean it’s gonna be everywhere and it doesn’t mean everyone’s going to take it… I would say probably 50% of the public doesn’t even want it. Just because you have a vaccine—unless you forced it on the public—doesn’t mean they’re going to take it.

Norway has locked down; Sweden does not have lock down. What happened in those two countries? Are they vastly different? Did Sweden have a massive outbreak of cases? Did Norway have nothing? Let’s look at the numbers. Sweden has 15,322 cases of COVID—21% of all those tested came out positive for COVID. What’s the population of Sweden? About 10.4 million. So if we extrapolate out the data about 2 million cases of COVID in Sweden. They did a little bit of social distancing; they would wear masks and separate; they went to schools; stores were open. They were almost about their normal daily life with a little bit of social distancing. They had how many deaths? 1,765. California’s had 1,220 with isolation. No isolation: 1,765. We have more people. Norway: its next-door neighbor. These are two Scandinavian nations; we can compare them as they are similar. 4.9% of all COVID tests were positive in Norway. Population of Norway: 5.4 million. So if we extrapolate the data, as we’ve been doing, which is the best we can do at this point, they have about 1.3 million cases. Now their deaths as a total number, were 182. So you have a 0.003 chance of death as a citizen of Norway and a 97% recovery. Their numbers are a little bit better. Does it necessitate shutdown, loss of jobs, destruction of the oil company, furloughing doctors?

I wanted to talk about the effects of COVID-19, the secondary effects. COVID-19 is one aspect of our health sector. What has it caused to have us be involved in social isolation?  What does it cause that we are seeing the community respond to? Child molestation is increasing at a severe rate. We could go over multiple cases of children who have been molested due to angry family members who are intoxicated, who are home, who have no paycheck. Spousal abuse: we are seeing people coming in here with black eyes and cuts on their face. It’s an obvious abuse of case. These are things that will affect them for a lifetime, not for a season. Alcoholism, anxiety, depression, suicide. Suicide is spiking; education is dropped off; economic collapse. Medical industry we’re all suffering because our staff isn’t here and we have no volume. We have clinics from Fresno to San Diego and these things are spiking in our community. These things will affect people for a lifetime, not for a season. 

I’d like to go over some basic things about how the immune system functions so people have a good understanding. The immune system is built by exposure to antigens: viruses, bacteria.  When you’re a little child crawling on the ground, putting stuff in your mouth, viruses and bacteria come in. You form an antigen antibody complex. You form IgG IgM. This is how your immune system is built. You don’t take a small child put them in bubble wrap in a room and say, “go have a healthy immune system.” 

This is immunology, microbiology 101. This is the basis of what we’ve known for years. When you take human beings and you say, “go into your house, clean all your counters—Lysol them down you’re gonna kill 99% of viruses and bacteria; wear a mask; don’t go outside,” what does it do to our immune system? Our immune system is used to touching. We share bacteria. Staphylococcus, streptococcal, bacteria, viruses. 

Sheltering in place decreases your immune system. And then as we all come out of shelter in place with a lower immune system and start trading viruses, bacteria—what do you think is going to happen? Disease is going to spike. And then you’ve got diseases spike—amongst a hospital system with furloughed doctors and nurses. This is not the combination we want to set up for a healthy society. It doesn’t make any sense.

…Did we respond appropriately? Initially the response, fine shut it down, but as the data comes across—and we say now, wait a second, we’ve never, ever responded like this in the history of the country why are we doing this now? Any time you have something new in the community medical community it sparks fear—and I would have done what Dr. Fauci did—so we both would have initially. Because the first thing you do is, you want to make sure you limit liability—and deaths—and I think what they did was brilliant, initially. But you know, looking at theories and models—which is what these folks use—is very different than the way the actual virus presents itself throughout communities….

Nobody talks about the fact that coronavirus lives on plastics for three days and we’re all sheltering in place. Where’d you get your water bottles from? Costco. Where did you get that plastic shovel from? Home Depot. If I swab things in your home I would likely find COVID-19. And so you think you’re protected. Do you see the lack of consistency here? Do you think you’re protected from COVID when you wear gloves that transfer disease everywhere? Those gloves have bacteria all over them. We wear masks in an acute setting to protect us. We’re not wearing masks. Why is that? Because we understand microbiology; we understand immunology; and we want strong immune systems. I don’t want to hide in my home, develop a weak immune system, and then come out and get disease.

When someone dies in this country right now they’re not talking about the high blood pressure, the diabetes, the stroke. They say they died from COVID. We’ve been to hundreds of autopsies. You don’t talk about one thing, you talk about comorbidities. COVID was part of it, it is not the reason they died folks. When I’m writing up my death report I’m being pressured to add COVID. 

Why is that? Why are we being pressured to add COVID? To maybe increase the numbers, and make it look a little bit worse than it is. We’re being pressured in-house to add COVID to the diagnostic list when we think it has nothing to do with the actual cause of death. The actual cause of death was not COVID, but it’s being reported as one of the disease processes and being added to the death list. COVID didn’t kill them, 25 years of tobacco use killed.

There’s two ways to get rid of virus: either burns itself out or herd immunity. For hundreds of years we relied on herd immunity. Viruses kill people, end of story. The flu kills people. COVID kills people. But for the rest of us we develop herd immunity. We developed the ability to take this virus in and defeat it and for the vast majority 95% of those around the globe. Do you want your immune system built or do you want it not built? The building blocks of your immune system is a virus and bacteria. There’s normal bacteria in normal flora that we have to be exposed to bacteria and viruses that are not virulent are our friends. They protect us against bad bacteria and bad viruses. 

Right now, if you look at Dr. Erikson’s skin or my skin we have strep, we have stuff—they protect us against opportunistic infections. That’s why for the first three to six months [babies are] extremely vulnerable to opportunistic infection. Which is why, when we see a little baby in the ER with fever who is one month old, you do a spinal tap, you do a chest x-ray, you do blood cultures, you do urine cultures. But if you had a fever I wouldn’t do that for you. Why? Because that baby does not have the normal bacteria and flora from the community, whereas you do. I guarantee when we reopen there’s going to be a huge, huge amount of illness that’s going to be rampant because our immune systems have weakened. That’s just basic immunology.

Do we need to still shelter in place? Our answer is emphatically no. Do we need businesses to be shut down? Emphatically no. Do we need to have it, do we need to test them, and get them back to work? Yes, we do. The the secondary effects that we went over—the child abuse, alcoholism, loss of revenue—all these are, in our opinion, a significantly more detrimental thing to society than a virus that has proven similar in nature to the seasonal flu we have every year. 

We also need to put measures in place so economic shutdown like this does not happen again. We want to make sure we understand that quarantining the sick is what we do, not quarantine the healthy. We need to make sure if you’re gonna dance on someone’s constitutional rights you better have a good reason. You better have a really good scientific reason, and not just theory. 

One of the most important things is we need our hospitals back up. We need our furloughed doctors back. We need our nurses back. Because when we lift this thing, we’re gonna need all hands on deck. I know the local hospitals have closed two floors. Folks, that’s not the situation you want. We’re essentially setting ourselves up to have minimal staff, and we’re going to have significant disease. That’s the wrong combination. 

I’ve talked to our local head of the Health Department and he’s waiting… for the powers that be to lift. Because the data is showing it’s time to lift. I would start slowly [open up schools sporting events] I think we need to open up the schools start getting kids back to the immune system you know and the major events the sporting events these are non-essential let’s get back to those slowly let’s start with schools let’s start with cafe Rio and the pizza place here… Does that make sense to you guys and I think I can go into Costco and I can shop with people and there’s probably a couple hundred people but I can’t go in Cafe Rio so big businesses are open little businesses are not….

Eventually we treat this like we treat flu. Which is if you have the flu and you’re feeling fever and body aches you just stay home if you have coughing or shortness of breath—COVID is more of a respiratory thing—you stay home. You don’t get tested, even when people come with flu a lot of times we don’t test them. We go, “you have flu. Here’s a medication.” You have COVID, go home, let it resolve and come back negative. 

If you have no symptoms you should be able to return to work. Are you an asymptomatic viral spreader? Maybe, but we can’t test all of humanity. Sure we’re gonna miss cases of coronavirus, just like we miss cases of the flu. It would be nice to capture every coronavirus patient, but is that realistic? Are we gonna keep the economy shut down for two years and vaccinate everybody? That’s an unrealistic expectation. You’re going to cause financial ruin, domestic violence, suicide, rape, violence and what are you going to get out of it? You’re still going to miss a lot of cases. So we need to treat this like the flu, which is familiar, and eventually this will mutate and become less and less virulent… 

I don’t need a double-blind clinically controlled trial to tell me if sheltering in place is appropriate, that is a college-level understanding of microbiology. A lot of times in medicine you have to make you have to make educated decisions with the data that you have. I can sit up in the 47th-floor in the penthouse and say we should do this, this, and this, but I haven’t seen a patient for 20 years—that’s not realistic. 

If you’re healthy and you don’t have significant comorbidities and you know you’re not immunodeficient and you’re not elderly you should be able to go out without any gloves and without a mask. If you are those things you should either shelter in place or wear a mask and gloves. I don’t think everybody needs to wear the masks and gloves because it reduces your bacterial flora… and your bacterial flora and your viruses your friends that protect you from other diseases [if they] end up going away and now you’re more likely to get opportunistic infections infections that are hoping you don’t have your good bugs fighting for you.

 

 

[Gordo]

1 hour ago, Sibiriak said:

 [Sweden] were almost about their normal daily life with a little bit of social distancing. They had how many deaths? 1,765. California’s had 1,220 with isolation. No isolation: 1,765

There is a reason experts talk in terms of deaths per million population. California has a population around 40 million vs. 10 million for Sweden.

Today Sweden has 2,274 deaths from Covid-19 (225 deaths per million)

California has 1,720 deaths from Covid-19 (44 deaths per million)

In other words... California is kicking Sweden’s ass in terms of deaths from this pandemic, at least for the moment (same can be said of Sweden’s neighbors).  Now you could still certainly argue that the cost benefit does not justify the lockdowns, and you could also argue that eventually California is going to “catch up” to Sweden, they are just slowing the inevitable... jury is still out. Another important consideration is percentage of population that is at elevated risk — the US has significantly higher percentage of population that is overweight vs. Sweden.  Using the US as a whole, I think the lockdowns might save 35k to 100k lives, mostly older and diseased people (by using the difference in deaths per million and projecting out likely grand totals under each scenario). I’m not convinced it’s worth the enormous toll. Also many of the elderly or at risk can seriously lock down on their own if they really want to, many just choose not to. Nursing homes could take much stronger precautions than they’ve been taking. It is probably possible to achieve a similar number of lives saved without lockdowns if the at risk are hard core about it - but it’s hard to convince people to change their behavior. We couldn’t get them to stop eating an atherogenic diet either.

 

Edited April 27, 2020 by Gordo

[Mike41]

1 hour ago, Gordo said:

There is a reason experts talk in terms of deaths per million population. California has a population around 40 million vs. 10 million for Sweden.

Today Sweden has 2,274 deaths from Covid-19 (225 deaths per million)

California has 1,720 deaths from Covid-19 (44 deaths per million)

In other words... California is kicking Sweden’s ass in terms of deaths from this pandemic, at least for the moment (same can be said of Sweden’s neighbors).  Now you could still certainly argue that the cost benefit does not justify the lockdowns, and you could also argue that eventually California is going to “catch up” to Sweden, they are just slowing the inevitable... jury is still out. Another important consideration is percentage of population that is at elevated risk — the US has significantly higher percentage of population that is overweight vs. Sweden.  Using the US as a whole, I think the lockdowns might save 35k to 100k lives, mostly older and diseased people (by using the difference in deaths per million and projecting out likely grand totals under each scenario). I’m not convinced it’s worth the enormous toll. Also many of the elderly or at risk can seriously lock down on their own if they really want to, many just choose not to. Nursing homes could take much stronger precautions than they’ve been taking. It is probably possible to achieve a similar number of lives saved without lockdowns if the at risk are hard core about it - but it’s hard to convince people to change their behavior. We couldn’t get them to stop eating an atherogenic diet either.

 

Assumptions, many of which may end up to be meaningless.  I do like what the Swede Doctor told the reporter in the video Ron Put posted yesterday. He said to the question wrt which ideas are working better for containing the virus. “Ask me a year from now” he is so right! He also pointed out that the models being used are based on too many unknowns. It’s like trying to predict the weather for next month. Another point he made is that the carnage economically Could lead to a lot of human suffering and many deaths. His overall point was that very small risk to healthy people and that we should protect the vulnerable, but ease off and allow the healthy segments of the population to function with some reasonable constraints like social distancing and avoiding huge gatherings of 50 or more.

Edited April 27, 2020 by Mike41

[mccoy]

By the way, since it has been cited, I took the opportunity to look up  Wikipedia on the bubonic plague (Yersinia Pestis aka black death). Well, this SARS-COV2 is a total piece of cake in comparison! During the middle age epidemics Florence lost maybe 80% of its population. About one in two people died on average. Lymph nodes bloat grotesquely and gangrene occurs, turning the skin black...

Edited April 27, 2020 by mccoy

[Gordo]

Americans on Cusp of Meat Shortage With Food Chain Breaking Down

 

I still don't really know if all the destruction of food that has been documented recently will lead to famine or if we just have so much extra food to spare that it doesn't matter?  We need some hard core investigative work to answer that question.

I do find one quote from this article humorous: "Plant shutdowns are leaving Americans dangerously close to seeing meat shortages at grocery stores."

What is this "dangerously close" bit?  I don't know if I just live in an outlier area, but I've witnessed multiple grocery stores with nearly empty meat sections and this has been for a couple weeks at least, we are well past "close".  Do any of you see something different where you live?

 

Leave it to the government to come up with a solution like this!

As meat plants slow, U.S. will help growers kill livestock

 

 

[BrianA]

In Race for a Coronavirus Vaccine, an Oxford Group Leaps Ahead

https://www.nytimes.com/2020/04/27/world/europe/coronavirus-vaccine-update-oxford.html

[Dean Pomerleau]

Time has an informative article on the experience of one Japanese province with opening up after a lockdown:

Japan’s northern island of Hokkaido offers a grim lesson in the next phase of the battle against COVID-19. It acted quickly and contained an early outbreak of the coronavirus with a 3-week lockdown. But, when the governor lifted restrictions, a second wave of infections hit even harder. Twenty-six days later, the island was forced back into lockdown.

A doctor who helped coordinate the government response says he wishes they’d done things differently. “Now I regret it, we should not have lifted the first state of emergency,” Dr. Kiyoshi Nagase, chairman of the Hokkaido Medical Association, tells TIME.

Hokkaido’s story is a sobering reality check for leaders across the world as they consider easing coronavirus lockdowns: Experts say restrictions were lifted too quickly and too soon because of pressure from local businesses, coupled with a false sense of security in its declining infection rate.

 ...

The announcement lifting restrictions came just before a three-day weekend; Hokkaido residents spilled onto streets and lingered in cafes, celebrating the conclusion of their weeks-long confinement. That likely kicked off the second wave of infections, says Nagase.

By April 9—exactly three weeks after the lockdown was lifted—there was a record number of new cases: 18 in one day. “Officials thought about people coming from overseas but never considered that domestic migration could bring the virus back,” said Hironori Sasada, professor of Japanese politics at Hokkaido University.

On April 14, Hokkaido was forced to announce a state of emergency for a second time. The island had 279 reported cases, an increase of about 80% from when the governor lifted the first lockdown less than a month before. As of Wednesday, there were 495 cases in Hokkaido.

....

As for Nagase, the doctor involved in Hokkaido’s response, the hard lesson he and the prefecture have learned, he says, is that until there’s a vaccine or medicine, everyone has to take personal responsibility and understand that, “it really may not be until next year that we can safely lift these lockdowns.”

[TomBAvoider]

Anecdote time. Back in the 70's and 80's the countries of Eastern Europe in the Communist Block were experiencing certain food shortages. In particular meat was scarce, it was even card rationed in some countries. And then of course, communism fell and food shortages disappeared and the populace went back to eating meat. However, the epidemiological signature of those times remained. It transpired to be a great paradox - in times of food shortages, and particularly meat shortages, the population was HEALTHIER than before or after when they had plenty of food, especially in regards to diseases of affluence, and that was reflected in mortality and morbidity. Similarly a natural experiment happened in the dying Soviet Union - Gorbachev decided that productivity was so low because people drank too much, so he made it harder to obtain vodka. The campaign lasted a few years before failing and when freedom arrived, drinking went back to high levels. However, health statistics showed very clearly that the population massively benefitted from the Gorbachev vodka limiting.

Similarly, I wonder if there is going to be some kind of effect from this pandemic in changed dietary habits and the longer term impact on health. Maybe less meat consumption might translate into a healthier diet overall? Perhaps even less than due to the meat itself as to the displacement and substitution effect, if folks replace meat and saturated fats with fruits and vegetables. I guess we'll have to wait and see. 

[Dean Pomerleau]

 The folks at RT.live have done an update to the way they calculate the effective coronavirus reproduction rate (R_t) to take into account the rate of change in testing in each state. As states increase their rate of testing they will discover more cases and so the case count will go up even if the virus isn't reproducing any more quickly. Here is the much more encouraging graphic of R_t for each state:

All the green shows states with an R_t less than one. These more favorable estimates of the effective reproduction rate will give states more leeway to keep the virus under control as they start to open up.

--Dean 

[Dean Pomerleau]

New data reported on in the New York Times shows the total number of deaths in New York City since March have reached 6x the rate that is normal for this time of year. Here is graph:

Here are some excerpts from the article:

More than 27,000 New Yorkers have died since the start of the novel coronavirus outbreak in March — 20,900 more than would be expected over this period and thousands more than have been captured by official coronavirus death statistics.

As of Sunday, the city had attributed 16,673 deaths to coronavirus, either because people had tested positive for the virus, or because the circumstances of their death meant that city health officials believed the virus to be the most likely cause of death.

But there remains a large gap between this number and the total deaths above typical levels in the last six and a half weeks: more than 4,200 people whose deaths are not captured by the official coronavirus toll.

The recent death count reached six times the normal number of deaths for the city at this time of year, a surge in deaths much larger than what could be attributed to normal seasonal variations from influenza, heart disease or other more common causes. 

It is too soon to know the precise causes of death for New Yorkers in this period. Although many of the deaths not currently attributed to coronavirus may represent an undercount of the outbreak’s direct toll, the broader effects of the pandemic might have also increased deaths indirectly. Throughout the city, emergency rooms have been overcrowded, ambulance response has been slowed, and many residents might have been reluctant to seek medical care because of fears of contracting the virus. Hospitals around the country have reported reductions in admission for heart attacks, one sign that some people may be dying at home from ailments they would survive during more normal times.

It seems like we'll never know with any certainty what fraction died from covid-19 directly, with covid-19 or from some other cause entirely which they might have survived if they had received appropriate medical care in a timely fashion. But it is a terrible tragedy regardless.

If the antibody data from NYC is correct (at ~25% positive), they are only between a third and one half way to the number of previously infected people required for herd immunity.

--Dean

[Sibiriak]

23 hours ago, Gordo said:

Also many of the elderly or at risk can seriously lock down on their own if they really want to, many just choose not to. Nursing homes could take much stronger precautions than they’ve been taking. It is probably possible to achieve a similar number of lives saved without lockdowns if the at risk are hard core about it....

Yes.   Shielding the vulnerable should have been the top priority for governments,  not something way down on the list.  Largely unregulated nursing homes, many shoddily run,  could not be expected  to take on their own the serious measure required .  Governments should have developed battle plans and stepped in and mandated specific protective measures,  eg. control of visitors,  mask-wearing, disinfection regimes, medical protocols for hospitalization and so on  The same goes for vulnerable individuals-- they needed to be identified, contacted, and told of their high risk status and how they could and would die if infected, and then given a protocol for self-protection etc..  Yes,  we are talking about  millions of people, and yes,  not everyone would comply.  But it needed, and still needs to be, done.  IMO.

 

Sweden

Quote

[Anders Tegnell:] The big debate we are facing right now is around care homes for older people, where we registered very unfortunate outbreaks of the coronavirus. This accounts for Sweden’s higher death rate, compared with our neighbours. Investigations are ongoing, because we must understand which reccommendations have not been followed, and why.

What would you have done differently?

We underestimated the issues at care homes, and how the measures would be applied. We should have controlled this more thoroughly. By contrast, the health system, which is under unusual pressure, has nevertheless always been ahead of the curve.

 

At least 5,500 care home residents in England have died with coronavirus, says ONS official

Quote

Nick Stripe, head of the health analysis and life events division at the ONS, has been speaking to the BBC about today’s coronavirus death figures released this morning. He said there have now been around 27,000 excess deaths - that is more deaths than you would expect on average for this time of year - in the four most recent weeks for which figures are available.   Of the 12,000 excess deaths in the most recent week (see 9.42am), he said that around 25% of those did not involve coronavirus being mentioned on the death certificate.  He also said that the total number of coronavirus deaths in care homes in England was probably now at least 5,500 - which is higher than the official most recent ONS figure [...]

 

'My mom's life was disposable': inside the California nursing homes unable to contain Covid-19

A poorly regulated industry, chronic understaffing, and inadequate infection control combined for an inevitable public health catastrophe

Quote

Linda Maynard sounded upbeat in a voicemail to her daughter on 21 March, joking about her fried chicken cravings and threatening to go “on strike” until she got fast food. There were no signs coronavirus had entered the nursing home facility in Hayward, California, where she was living.  Seven days later, the 74-year-old woman suffocated to death from Covid-19, and by mid-April, the virus had also killed two of her friends at the facility. Arena Burke, Maynard’s daughter, told the Guardian her family heard little from the staff at Gateway Care and Rehabilitation Center as the infection spread to encompass at least 100 residents and employees at the facility. Precautions to curb the outbreak at the center seemed non-existent, Burke said. So far, at least 13 residents have succumbed to the virus.

“There are so many people there who should not have died,” Burke said. “They cheated us out of so many good times.”

Quote

Like facilities in New York and New Jersey, nursing homes in California have been hit hard by coronavirus. Gateway is one of more than 250 skilled nursing homes in the state suffering from coronavirus outbreaks, with a total of more than 5,700 confirmed cases inside the facilities.

Every corner of California is hit. In Los Angeles county, nursing home residents have accounted for more than 30% of Covid-19 deaths and 72% in the city of Long Beach. At one Central Valley facility, nearly all 167 residents and staff tested positive, and at a home in Riverside, nearly 100 residents were evacuated after staff failed to show up due to an outbreak. The Gateway Center is now under criminal investigation.

Behind the staggering numbers, advocates say, is a poorly regulated industry with a long history of chronic understaffing, inadequate infection control, a lack of critical equipment and weak labor standards. Experts and attorneys say the public health catastrophe was preventable, and that the botched response of some nursing homes constitutes criminal neglect.

Skilled nursing facilities care for older residents with advanced medical needs, a population that is uniquely vulnerable to Covid-19 and at higher risk of death regardless of the standards of care. But experts say the crisis in these care facilities is exacerbated by long-standing problems with staffing and training, and because of a massive delay in testing.

[N.B. Ron Put:]  Even before corona, nearly 400,000 people die each year from infections inside long-term care facilities in America, said Charlene Harrington, a University of California, San Francisco professor emerita and an expert on nursing homes. Undertrained staff are responsible for too many patients with complex challenges, which means they rush from room to room and skip basic steps such as proper handwashing, she said.

In the case of a pandemic, the emergency quickly spirals. “When a virus comes along, they just aren’t able to cope. The nursing homes should have immediately staffed up, but they don’t want to spend the money,” she said. “The staff is calling in sick. They are skimming on care … And now a lot of them are trying to cover it up.”Nearly one in every ten nursing homes across the US is reporting coronavirus cases. But the situation is worse in California where the vast majority of the facilities are for-profit operations incentivized to make cost-cutting decisions with potentially fatal consequences, said Tony Chicotel, a California nursing home reform advocate.

“For years and years, we’ve tolerated really bad infection control, which has killed a lot of people. It’s not surprising once Covid-19 enters the building, it spreads like wildfire.”

Like hospitals, the nursing facilities have recently struggled with a lack of personal protective equipment (PPE) with staff forced to take care of patients without masks and gloves, labor officials said. But unlike doctors and nurses, many long-term facility workers are low-wage workers who may not be trained to handle a virus outbreak and who frequently work multiple jobs to make ends meet, sometimes at different nursing homes. That means in some cases they may be bringing Covid-19 from one facility to another.

[...] The California public health department began publicizing a list of nursing homes with coronavirus outbreaks [only!] last week, after weeks of intense public pressure.The state is also sending teams of nurses to facilities with outbreaks “to ensure infection measures are in place, mitigate further infections, isolate residents, and assess for exposures”, a spokesperson said in an email. The health department is further working to place positive patients in alternative sites when they don’t require hospitalization. But because of Covid-19, the department has stopped doing routine in-person inspections, a development that has deeply worried advocates. The spokesperson said the state was still doing on-site investigations for “issues that might cause serious risk to residents”.

Lobbyists for the nursing home industry are now pushing for California governor Gavin Newsom to grant the facilities broad immunity from civil lawsuits and criminal prosecution, arguing that liability laws should be waived and they should be shielding from litigation while fighting the pandemic [...]

 

 

Edited April 28, 2020 by Sibiriak

[mccoy]

14 hours ago, Dean Pomerleau said:

It seems like we'll never know with any certainty what fraction died from covid-19 directly, with covid-19 or from some other cause entirely which they might have survived if they had received appropriate medical care in a timely fashion. But it is a terrible tragedy regardless.

As a first approximation, the people who have died because of the emergency AND not of the COVID-19, might be hypothesized to be equal in number to those who did not die because of the emergency (for example, far less car accidents, far less death at work and so on). 

I still see the concept of the excess deaths the most valid parameter we have now, as far as COVID-19 mortality goes.

[Dean Pomerleau]

The latest Medcram video is a really interesting look at the cardiovascular complications (including strokes and heart attacks) that emergency room doctors are seeing in covid-19 patients. 

Dr. Seheult explains that endothelial cells in our blood vessels have ACE2 receptors like in the lungs. When the virus gets into the bloodstream it binds with these receptors and triggers a cascade of harmful events including vasoconstriction, oxidative damage & inflammation and perhaps most troubling, the release of blood clotting factors that can lead to blood vessel occlusions resulting in strokes and heart attacks.

He says the virus' tendency to attack the cardiovascular system may be the reason why people who already have compromised vascular systems due to hypertension, CVD, diabetes and obesity may at greater risk of bad outcomes when they get the virus.

These strokes and heart attacks even seem to be happening in people who don't appear very sick in terms of traditional respiratory symptoms.

--Dean

 

 

[Dean Pomerleau]

Germany has begun relaxing some of their restrictions:

Germany, like Spain and Italy and a handful of other European countries, has tentatively started to lift its lockdown measures by allowing smaller retail stores to re-open last Monday as long as hygiene and social-distancing measures could be maintained. Larger car dealerships, bike shops and book shops have also been allowed to open their doors.

It looks like their effective reproduction rate has also started to climb as a result of these loosened measures:

Germany’s virus reproduction rate, called the “R” rate or value, is now at 1.0 in Germany, according to Lothar Wieler, the president of the Robert Koch Institute, having risen from 0.7 earlier this month.

It seems like we in the US are in a slight worse place than Germany was when it started relaxing some of the closures, with the average R_e in the US of around 0.9. This would suggest that as states start to relax they'll likely go back to an R_e above 1.0 and we'll see a return to growth in number of new cases.

--Dean