US COVID-19 Cases Now Spreading Due To Trump’s Testing Restrictions And Dismantling Of Pandemic Response Teams

Back on January 31, Pulitzer Prize winner Laurie Garrett warned us how Donald Trump has dismantled the country’s ability to respond to a pandemic. Her Foreign Policy piece, headlined “Trump Has Sabotaged America’s Coronavirus Response“, Garrett opened with a description of the extreme measures taken in China:

The epidemic control efforts unfolding today in China—including placing some 100 million citizens on lockdown, shutting down a national holiday, building enormous quarantine hospitals in days’ time, and ramping up 24-hour manufacturing of medical equipment—are indeed gargantuan. It’s impossible to watch them without wondering, “What would we do? How would my government respond if this virus spread across my country?”

The problem, though, is that although Barack Obama built a working pandemic response structure during the Ebola outbreak (which of course Trump criticized incessantly on Twitter), that structure has now been obliterated:

In the spring of 2018, the White House pushed Congress to cut funding for Obama-era disease security programs, proposing to eliminate $252 million in previously committed resources for rebuilding health systems in Ebola-ravaged Liberia, Sierra Leone, and Guinea. Under fire from both sides of the aisle, President Donald Trump dropped the proposal to eliminate Ebola funds a month later. But other White House efforts included reducing $15 billion in national health spending and cutting the global disease-fighting operational budgets of the CDC, NSC, DHS, and HHS. And the government’s $30 million Complex Crises Fund was eliminated.

In May 2018, Trump ordered the NSC’s entire global health security unit shut down, calling for reassignment of Rear Adm. Timothy Ziemer and dissolution of his team inside the agency. The month before, then-White House National Security Advisor John Bolton pressured Ziemer’s DHS counterpart, Tom Bossert, to resign along with his team. Neither the NSC nor DHS epidemic teams have been replaced. The global health section of the CDC was so drastically cut in 2018 that much of its staff was laid off and the number of countries it was working in was reduced from 49 to merely 10. Meanwhile, throughout 2018, the U.S. Agency for International Development and its director, Mark Green, came repeatedly under fire from both the White House and Secretary of State Mike Pompeo. And though Congress has so far managed to block Trump administration plans to cut the U.S. Public Health Service Commissioned Corps by 40 percent, the disease-fighting cadres have steadily eroded as retiring officers go unreplaced.

But it’s even worse than that. Until sometime over this last weekend, the Trump Administartion, through the CDC, blocked all entities other than CDC from running tests for COVID-19. They only allowed testing under such extremely narrow circumstances that pitifully few tests have been carried out to this point.

In an interview yesterday on KPFA (that I’m only halfway through listening to but just had to stop and write this part up) Garrett pointed out that New York City has had its own dedicated lab ready to go for testing for the past six weeks. Coupling that with the various reports coming out today on just how long it’s going to take for testing kits to get widespread distribution now that manufacturing is FINALLY kicking into high gear, we are presented with direct evidence of just how much damage Trump’s COVID-19 policies have done.

As Garrett points out, we are now seeing “community transmission” of the virus, meaning that cases are appearing in patients who have not traveled to known hot spots and who are not known to have had direct contact with someone confirmed to have the virus. Once community transmission is seen, the correct public health policy with respect to testing is to switch from narrow testing criteria to widespread testing. China was remarkably quick in developing and mass manufacturing DNA-based tests for the virus as soon as the sequence became available. That this was not done in the US is criminal, and the mounting death toll, now at 9, will drive this point home. That’s because, if you listen to the early part of Garrett’s interview, she compares COVID-19 to the 1918 flu pandemic. She describes characteristics of the spread of the virus that make widespread testing an incredibly important tool in containing its spread. Today’s news says we are weeks away from widespread testing. I fear just what we will see when wider testing is available.


157 replies
  1. ThomasH says:

    By reflexively dismantling the Obama public health infrastructure, trump has compounded his bungling. In addition to loosing critical feedback about the spread of the COVID-19 virus because of the lack of access to testing, by closing down the departments and teams set up handle infectious disease outbreaks causes delays in containing the spread since these entities have to be reconstituted and brought up to speed. I cringed when trump responded to a question about this at his news conference last week. Paraphrasing from memory he said something like “I’m a businessman and I don’t like thousands of people sitting around doing nothing.” I guess we should wait until the house is on fire before we hire some firefighters to put it out by that line of reasoning.

    • P J Evans says:

      It’s another demonstration of how incompetent Trmp is as a manager. Real managers are aware that planning ahead requires time and people who aren’t doing obviously-productive work.

      • earlofhuntingdon says:

        Trump could not manage his way out of a wet paper bag. He throws money at problems, he rages at them, he tries to cajole, threaten or ignore them. But he cannot manage them, let alone prevent them. As a junior trainee in any organization he didn’t own, he would not have lasted a week.

        Under Trump’s obscene version of the patently unviable just-in-time manufacturing system, he would devote no resources to a fire department until fire raged out of control. Then he would blame the owner of the woodland or the house on fire. He would never tolerate paying to employ and train people and provide them equipment when they spend most of their time hanging around the fire house.

        But by all means, let us continue to employ him as the country’s chief executive. God wills it.

        • P J Evans says:

          Maybe the “god” of the fundies, but not mine. Mine expects people to think and to do the groundwork for fixing stuff.

        • LeeNLP says:

          “He throws money at problems, he rages at them, he tries to cajole, threaten or ignore them. But he cannot manage them, let alone prevent them.”

          Moreover, he doesn’t try to actually fix problems, like Obama, but to get rich off them, like the parasite he is. For him a public tragedy is just a personal opportunity.

    • Old Antarctic Explorer says:

      The Fire Department is an apt analogy. The fire department’s job is NOT to put out the fire in your house (although they will do their best to do so); their job is to keep the CITY from burning down. Many cities in ancient times burned to the ground, some multiple times. We all know the line about Nero playing his fiddle while Rome burned. The Vigili’s (correct Latin?) job was to keep the fire from spreading, not save your structure. Scottsdale, AZ found this out the hard way in the late 50’s. They shut down the city fire department and started a private fire company that would only put out fires of registered subscribers. If you didn’t have a subscription and you called them they would accept your check before putting out the fire. Naturally lots of people decided they would take their chances and save the subscription money. The insurance companies had a completely different view of things and saw Scottsdale burning to the ground and them having to pay out lots of claims. So they promptly raised the insurance rates drastically. Everyone, apparently, saw the light and the private company disappeared and the city went back to running a fire department. Pandemics are similar. Medical insurance works fine for you breaking your leg or having a heart attack, but if you contract a disease like Ebola, flu or Covid-19 it’s your friends and neighbors and workplace colleagues who are at risk and that’s the job of Public Health Departments to address. Trump’s understanding of public health is zero, which is probably true of most the rich elites who have the money to take care of almost any problem. But, wait until the first billionaire dies of Covid-19. They they might just see the light!

      • PhoneInducedPinkEye says:

        Wow seriously, privatised firefighting? I can’t believe this example of gop philosophy isn’t more widely known and held up as the results of their crusade.

      • P J Evans says:

        Some areas still have private fire companies. The other route for doing it “on the cheap” is lots of volunteer FDs – San Diego county was doing it that way, and it didn’t work well for them in 2003. They may have a real county FD now, but I’m not going to bet on it.

    • bmaz says:

      That private fire company is Rural Metro. They are still located in Scottsdale as too their company headquarters, and still are the fire department for much of the unincorporated areas and smaller towns that are not big enough to have their own.

        • Rayne says:

          I want to point out the link you shared is to a 2010 story. It would be nice to know if there was any change locally in Obion County, Tennessee after that particular fire. “Compassionate conservatives” debated the situation but to the best of my knowledge nothing came of it. It would all have to burn down before the compassionate conservatives could muster enough moral fortitude to fix things and go against their anarcho-libertarian brethren on the right.

          • bmaz says:

            It is. That said, it is still the case, and I believe the Tennessee company is Rural Metro, which started here. They are subscription only primarily. If you are not a member and request them to put out your fire, or the local law enforcement deems it an emergency and orders them to, they send huge bills, often $25,000 to $50,000 depending on resources applied. If you don’t pay, they lien your property and sue you.

  2. BobCon says:

    Meanwhile large swaths of the media are completely burying this story, notably the NY Times.

    Alex Pareene has a strong take on the problem:

    “the White House and the political desk of The New York Times view coronavirus in much the same way: as a messaging problem. Trump is concerned with managing how the political press covers his response to the crisis; the Times will judge him on how well he succeeds at controlling the narrative. All of this posturing will come to a crashing halt if the virus spreads and scores of Americans begin to die, but unless that comes to pass, the possibility of that dire outcome will remain merely a future headline or chyron in the mind of Trump and Baker alike.”

    One point I disagree with: Even if many Americans die, I suspect the NY Times will continue to judge Trump on how he controls messaging, with the obvious irony that by refusing to consider substance, as gatekeepers to public opinion they give him control over messaging by default. The politics desk has given up holding the GOP to account for anything, really, and I can’t see a national spread of the virus changing that.

    • P J Evans says:

      maybe when they’re dealing with it in their offices and the management has it as well….

      • BobCon says:

        They way the bedbug problem in their offices turned into a monumental farce that only highlighted the crappy hiring done by one of their top editors doesn’t give me a lot of confidence.

  3. Eureka says:

    Great hand-washing video, reminiscent of those old red chewable tablets they used to use to teach teeth-brushing. I am proud of my hand-washing skills because a woman at a rest stop once told her little girl to “watch and do it how she does”, I will have to check my ~ tumbling-together/rolling/interweaving methods with these:

    Philip Bump: “I’ve thought about this video six times a day since I first watched it. …”

    Ali Noorani: “Very informative! Iranian health professional uses paint to demonstrate spots we often miss when washing hands in the wake of #Coronavirus outbreak. At the end she shows how to safely remove disposable gloves without touching the polluted surface. [video]”

    • Eureka says:

      point of that anecdote: wash like the littles are watching you (I of course felt ‘pressure’ to do a _really_ good job with eyes on me).

      • P J Evans says:

        Places people tend to miss: backs of hands and between fingers. Also length is important: at least 30 seconds. Scrub, don’t be gentle.

          • P J Evans says:

            I saw a tweet with an image of this text:
            Wash your hands like you
            just got done slicing
            jalapenos for a batch of
            nachos and you need to
            take your contacts out.

        • cavenewt says:

          I read once that you need to mentally sing the entirety of “Happy Birthday To You” to wash hands long enough. That’s more entertaining than counting to 30-bananas in your head.

  4. jamie mack says:

    Hi! Frequent visitor, first time contributor.
    I’m an immunologist, with experience in both vaccine research and assay development, and I’ve been following the COVID story with some concern.

    Regarding the CDC assay — from what I’ve read, I have to conclude that this process was not driven by anybody with experience in matters like this.
    The technique employed, PCR (polymerase chain reaction), is an astoundingly sensitive method for detecting the presence of a specific DNA (or RNA) sequence in a sample. [Coronaviruses contain RNA instead of DNA, which introduces an extra step to the detection assay.] It’s possible, but rather twitchy to employ PCR as a quantitative tool; but that’s not the aim here. What’s wanted for clinical use is a +/-, yes-or-no assay. Is there viral RNA present in the sample, or not?
    In theory, once you know the sequence of the virus’s RNA, you can design a PCR assay (specifically, you can design oligonucleotide primers — hereafter, ‘primers’) to test for the presence of that sequence in a test sample. In practice, theory is wildly overoptimistic. In practice, there’s a lot of tweaking and fiddling with various steps in the PCR reaction cycle involved in optimizing the reaction for a particular set of primers. In particular, the annealing cycle — ramp slope, final temp, dwell time. . .

    It’s one thing to design an assay, in theory. It’s another thing to validate it’s performance.
    But completely missing from any media discussions of ‘virus detection’ and ‘virus assay’ I’ve seen is the matter of assay validation.
    In the context of an assay with a +/- readout, two matters are critical: False positives, and false negatives. If you look at it from a public health perspective, a false positive (misidentifying an uninfected individual as infected) is a benign error, while a false negative (misidentification of an infected individual) is a system failure. At this stage of the game, I don’t know that any test or development lab has a sufficient library of well-characterized human samples to definitively determine where best to draw this line.
    More profoundly, there’s another issue with validating an assay–what’s referred to as ‘robustness’. Does the assay perform the same from one test lab to another? What if the PCR thermocycler (the device used to carry out these assays) in my lab isn’t calibrated (time, temperature, ramp profiles) quite the same as that in your lab? What if the samples your lab is testing were processed using sample kit A, while our jurisdiction uses sample kit C, but does an ethanol precipitation with added tRNA as carrier? What if your lab is at sea level, while mine is at 1500 m? All of these and many other factors might contribute to shifting where the line between + and – ought to go.
    Apparently, somebody at CDC decided that instead of a simple, provisional test for the pathogen at hand, it would be a good thing to create a test which, at the same time, tested for the presence of other known human coronaviruses. In theory, such a thing can be done. But here, theory and practice diverge exponentially with each added element to the mix. Nobody with any experience in either assay design or public health would have pursued such a course. The simplest possible assay (with the simplest possible controls) is what’s called for.

    As to vaccine development. . . whoa, don’t get me started. . .

    * * * * * * * *
    Marcy or Jim or whomever — I realize that it’s rude to simply step in an claim expertise in something, using a false name. I don’t think any current clients would be upset by my comments here, but I’ve got to keep possible future clients in mind . . .
    Please ping me at the e-mail I’ve listed, and I’ll point you to my linked-in page.

    • Jim White says:

      Thanks. I don’t see a need to ping, your info is valuable and welcome. We’ve had experts in other areas drop in to help us in the past while maintaining confidentiality.

      One thing I’ve heard tossed around but haven’t seen all the details on is that a component of the CDC test kit was contaminated. The government is claiming the issue has been resolved, but if you run across info on which component was contaminated and what the contaminant was, it would be great to share. As you point out, PCR is incredibly sensitive, so even the faintest trace of the wrong DNA sequence in any component can be a disaster.

      • viget says:


        It’s the negative control, see this article from Science.

        Apparently, this was discovered serendipitously when a senior FDA official visiting the Atlanta CDC lab just happened to see how they were putting together the kits, and noticed that the techs were likely contaminating the negative control, which is easy to do if you’re not careful. He wasn’t even formally inspecting the lab either.

        Of course, no good negative control means the test is useless because you don’t know if a positive result is a true positive or the result of a contaminated common reagent.

        • Eureka says:

          Cohen added some details on twitter (Feb 28th– this is what I had bookmarked, could be additional discussion of interest on that date):

          “Yes. There are 3 primer/probe sets of viral nucelocapsid gene: N1,2,3. N3 had a problem with negative control. It coded for N of any coronavirus and was just a double check. So they ditched N3…”

          “Thanks. No, I didn’t hear about N1 problems, but each lab has to validate independently and it wouldn’t surprise me….”

          • Eureka says:

            Just to be explicit/clarify: links I added were further detail to article viget linked, but NOT meant to speak to “contamination” issue per se — I have not read of that (the N3 neg control /reagent issue) being verified as related to the alleged contamination problem, perhaps others are aware of more details.

        • Eureka says:

          Fears about possible contamination at CDC and the known fault(s) with CDC’s tests are two different things at this point. While these two separate storylines may later evidentiarily converge — or the investigation could reveal multiple, or potentially overlapping problems — I think it’s important to clarify what’s out there now (especially so someone reading the linked article isn’t confused as to why certain info isn’t there).

          From what I understand, the “fear of possible contamination” is thus far not established as related to the faulty tests — it’s an empirical question, investigation ongoing, and the linked 2-28 Science article does not address contamination. The problem with the negative control — addressed in Science, the Cohen tweets, and in Jaime Mack’s comment here — is so far a separate issue (a methodological /design one that could occur absent contamination).

          I have seen nothing reported to substantiate this, or this level of detail about the feared possible contamination, or a definitive link between the flawed negative control and contamination:

          senior FDA official visiting the Atlanta CDC lab just happened to see how they were putting together the kits, and noticed that the techs were likely contaminating the negative control

          I would love to read more if anyone has a link.

          Aside: per senior Trump admin official to Axios: CDC “engaged with” a third party contractor to do the kits as of Feb. 20th; per Politico (3-3), FDA entered CDC lab on Feb. 23rd (arrived Saturday 22nd ~7pm).

          To give this issue justice, the reportage really needs a Marcy-style dissection with attention to the sourcing, science, and subsequent language leaps, with games of telephone as others picked it up.

          Since the initial Sunday (3-1-20) report, I was alert to the fact that the contamination story was: a Jonathan Swan “scoop”; was written very carefully with Axios health care reporter Caitlin Owens; cited internal Trump admin and Azar pressures; ends with FDA head Hahn statements that do not relate or confirm that contamination = the testing problem. (Open to interpretation, but I read them as NOT ‘non-denial denials’, btw.)

          Dr. Nancy Messonnier yesterday (3-3-20):

          “Contamination is one possible explanation but there are others, and I can’t comment on what is an ongoing investigation,” Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, told reporters on a Tuesday conference call.

          Caveat: I meant to comment in am, who knows what has changed already today — besides what else I may have missed. Links to follow.

    • BobCon says:

      This is really interesting, thanks.

      From a public health standpoint, in my limited understanding aren’t false positives potentially a big issue? If you start pushing people into quarantine situations who shouldn’t be there, don’t you run the risk of various backlashes along with costs to individuals?

      I realize that calibrating tests is often difficult, and there is often a tendency to see greater numbers of false positives if you try to reduce the number of false negatives. I would assume that in a fairly novel situation like this, the costs and benefits of how far you go to find all cases are tough to hammer down,

      • PhoneInducedPinkEye says:

        I worked in the diagnostics field in “software as a medical device”, specially using supervised machine learning to develop flagging algorithms from raw channel data from flow cytometers. I’m a SW/math guy and know little about the medical side of things, but what they told me was that false negatives could actually harm someone, whereas false positives may lead to further confirmation testing in the worst case.

        You are right about the trade-off, see ROC-AUC which is a common metric for the performance of binary classifiers and a great illustration of that phenomenon for many types of algorithms.

        • BobCon says:

          Thanks for the clarification. I’m guessing that there’s probably a connection to the ease of retesting and the severity of the condition. If someone gets a high cholesterol test result, nobody stresses and the MD just orders additional testing.

          There are probably different communication challenges when you’re addressing the issue of potential false positives with Coronavirus.

          • Frank Probst says:

            Your analogy is good but not quite on the nose. The first test that gets run is usually simple and cheap. Let’s say that you run this test on everyone who comes into the ER worried that they have Coronavirus. A false positive means that the test is wrong. It’s saying that you have Coronavirus when you don’t. The outcome there is that you get sent into home quarantine until a more expensive but more accurate test can be done to confirm the result or to label it as a false positive. (They’d probably do multiple rounds of testing, as well as test everyone else in your household, but you get the idea.) If your first test turns out to be wrong, the only harm that’s been done is scaring the shit out of you and keeping you in home quarantine for a few days. That bad for you, but it doesn’t hurt the community.

            If the test is a false negative, it means you’re infected, but the test says that you’re not. That doesn’t sound so bad for you, because it’s probably not. You get told that you’re negative, and you go about your normal routine. The reason it’s a catastrophic result is that you’re out in the community infecting other people, and you don’t realize that you’re doing it. In fact, you’re probably confidant that you’re NOT doing it, because you’ve just gotten a negative test result.

            This is all for a screening test, though, meaning you’re sick enough that you might go to the ER, but not sick enough to need to be admitted for an overnight stay. If you’re sick enough to be hospitalized, then you need to be hospitalized, no matter what the test shows. So if you’re having symptoms that would normally lead you to go to the ER, then go to the ER.

            (If you get hospitalized, you’ll probably have the screening test done as well as the more sensitive tests with the more expensive equipment. You’re contained in the hospital already, so the reason for the testing at that point it to is to determine how strict the precautions need to be when the staff comes in the room to see you, and what needs to happen when you’re discharged, which will probably be home quarantine.)

        • cavenewt says:

          Damn right false negatives cause harm. I’m not an expert, only that I had Lyme disease a couple of years ago and learned way too much about the crappy screening test the CDC insists on using (with a very high percentage of false negatives). The whole experience made me wary of trusting medical tests implicitly, and heartily skeptical about the CDC.

    • bmaz says:

      Jamie, you are fine, you clearly know what you are talking about. And welcome to comments, please join us more often.

    • CCM says:

      Thank you so much for your post. I am a practicing Critical Care physician and this is just the sort of information I need. Please do start on vaccine development, I would love to hear your thoughts.
      By the way, our hospital system has introduced a new respiratory viral panel and he results are just wildly unexpected at times.

    • Pete T says:

      Dr. John Campbell (Not an MD) on YouTube today caught my attention as he talks about COVD-19 testing.

      Now, I may very well get this wrong so look for yourself, but the PCR tests will/would work best on sputum and less so on nose swabs and he goes on to explain why.

      However, he mentions that a preferred test would be an “antibody” test and not a PCR-RNA test for reasons he states and reasons no doubt “jamie” and other’s point out. There is no antibody test available yet though they are being developed/tested.

      What he was not clear on is whether a better PCR test or antibody test would be better as an earliest detectable test. If an antibody test is preferred but only has efficacy after you are walking around infectious for a while making antibodies that can be detected (he mentioned generally two weeks) then it’s maybe not as good a thing IMHO.

      But I am out of my lane here to have at it.

      On an unrelated note, no ref but it looks like the CDC test costs about $3,000 – and then think about false positives. However Medicare part B (USA) will cover it: and so Medicare Plus providers will too (although mines didn’t have a clue when I called them).


      • cavenewt says:

        The crappy Lyme screening test I mentioned above is an antibody (ELISA) test. It has a very high percentage of false negatives, but I had thought that was due to the specific nature of the Lyme bacterium (which suppresses the immune system to protect itself). I believe this kind of test is cheaper and quicker to do, but if it allows infected people to walk around thinking they’re OK then it’s not so great.

    • cavenewt says:

      Do we know what kind of test they are using in places like China and South Korea?

      I really came to this page find out if it was true that the CDC insisted on developing its own test rather than taking advantage of what WHO is providing or advising.

    • P J Evans says:

      First sentence in “Prevention” has a “not” that, I think, shouldn’t be there. (It makes much more sense without that “not”.)

      This is a relatively reassuring comment. I’ve also read elseweb that the virus is less contagious/infectious (they said “contagious”, not sure if that’s correct) than flu.

      • Jim White says:

        Laurie Garrett addresses relative “contagiousness” of COVID-19 and flu in her interview. I’d go with her nuanced take and won’t try to summarize it here.

        As for the part on runny nose or not, I hope we confirmation of that soon because it would seem to be a good tool for differential diagnosis in this interim time until the test kits are more widely available, but I’d wait for verification on something that important before relying on it.

        • P J Evans says:

          I have dry eyes and nose, which my system deals with by overproducing fluid; my nose runs most of the time (and so do my eyes). I have to rely on other signs. Fortunately my immune system is fairly good. (I also spend a lot of time at home.)

    • CCM says:

      Could you be more specific as to the source of this info? As a clinician this is important. Should I take this with a grain of salt or is this solid?

      • punaise says:

        “…from someone who has lived in China and I think is now in Hong Kong and was CNN’s Asia bureau chief for some time… if that path lends credibility.”

        Like I said, FWIW. I have no expertise in this area.

    • Tom R. says:

      This is the sort of nonsense that should *NOT* be spread here or anywhere else.
      — Most importantly: The clinical presentation of covid-19 is NON-SPECIFIC. That means that you CANNOT determine, based on your symptoms, whether you have the virus or not. Your doctor CANNOT tell either. Nobody can tell without a CT scan or (better) a PCR test.
      — Does anybody really think that a temperature of 26-27 °C will kill a virus?
      — Does anybody really think that “hot beverages” are significantly more “effective” than other beverages?
      — Does anybody really think that going “out in the sun” will be effective against a viral infection? Standard advice is to stay *inside*, to minimize contact with other persons.
      — Does anybody really think that “several degrees of separation from a seemingly credible source” is adequate vetting?
      — And so on.

      STOP SPREADING MISINFORMATION. Lives are at stake. Many lives.

      • cavenewt says:

        “— Does anybody really think that a temperature of 26-27 °C will kill a virus?”

        I wondered about that point. That’s *way* below normal body temperature, so how could the virus survive in a living human at all?

        It would be helpful to know why punaise asked for the comment to be deleted. Presumably because it turned out the information was not trustworthy?

        • punaise says:

          It was an ill-advises passing along of low quality (dis?)information whose veracity I had no basis for assessing. And folks smarter than I weighed in accordingly. So, yes – trying to clean up the mess…

    • Viget says:

      The symptoms information is definitely congruent with all the case reports I’ve read, and what was provided in a briefing to the hospital staff where I work. Basically, fever + DRY cough = suspicion of COVID-19, fever + sore throat + runny nose +/- PRODUCTIVE cough = likely influenza or other respiratory pathogen.

      From what I can piece together, while the viral load appears to be high in the upper respiratory tract (hence positive nasopharyngeal and oropharyngeal swabs), the virus does not seem to elicit a big time immune response there, nor does it kill a lot of the cells lining the throat, hence no sore throat, nor early fever. This is unusual for a respiratory virus.

      I’m not sure what to make of the heat inactivation claim… the body’s normal temp is 37 degrees C so I cannot fathom how a virus inactivated around 28C could ever maintain a productive infection. If this is true, then one shouldn’t also be able to grow the virus in tissue culture either under normal conditions.

      • Rayne says:

        I suspect the heat inactivation claim is relevant to surfaces only. Early observations indicated fomite transmission — contact with contaminated surfaces and objects versus direct contact with contagious persons — was responsible for many cases.

        Fomite transmission may also explain why so many health care workers were infected. They didn’t know what they were handling (may have assumed influenza for which they were vaccinated), used objects like stethoscopes which picked up virus, then contacted themselves with the same objects. Ditto so many apparent nosocomial infections — hospital-acquired transmissions. This may be critical to the cluster in a Seattle-area nursing home.

        Warmer weather may reduce the spread of the virus but so many social contacts are made in climate-controlled environments that we can’t count on seasonal change to break transmissions.

        ADDER: Just dawned on me fomite transmission and person-to-person transmission may play a bigger role in early contagious phase because cases are characterized as lacking a productive cough. There may be less droplet transmission, more transference between person to objects to persons in public shared spaces.

        Should also add I am not a health care worker or in public health; I’m open to debate on infection control.

    • paulpfixion says:

      I live in China, so this advice elicited a chuckle.

      “Therefore, drink more hot water or other hot beverages. Drinking warm water is effective for all viruses Go out into the sun.”

      There is an obsession here with drinking hot water. Anyone who has ever lived in China will back me up. I am told to drink more hot water at least once or twice a week by random people. Doctors believe it. Also, lots of Chinese folks believe that drying your clothes in sunlight kills bad stuff.

      I have not heard anything about runny nose vs. no runny nose. At all.

      i can’t comment one way or the other on the rest of the post, but I can 100% confirm that the advice likely originated in China. heheh

  5. Garbonzo Beans says:

    I’ve posted here before but am intentionally using a new name and email address for reasons that will become obvious after you read the post. Real life dilemmas: Just started feeling ill, not that ill, just basic “bug” symptoms . Contacted health care provider and asked whether I should come in for testing given a) my age, b) my auto-immune disorder, c) I have a trial around the corner, followed by an event that I am expected to attend along with a couple hundred other people. Neither the trial nor the other event can be easily “blown off.” Both events will be attended by people coming from various places around the US. As of now, health care provider is not inviting me to come in for testing, as they say I don’t have enough of the warning signs for it to be corona. I have taken steps to escalate the refusal to have me come in for testing. If there was testing easily available this could be easily dealt with. If I test positive, I’m grounded and the trial is postponed. Otherwise I go to trial and decide later whether I bow out of the event. If no testing becomes available, do I cause the world to stop, or risk infecting others with corona. This is completely insane.

    • Rayne says:

      Thanks for sharing your challenge with us. This is an example of the Trump administration’s gross failure on pandemic response. We should have a system in place already for conducting day-to-day business but with heightened social isolation — but alas, Trump.

      If you must go into public situations while you’re experiencing “bug” symptoms, I think a face mask is warranted to reduce droplet transmission — treat situation as if you were a symptomatic flu patient. Carry facial tissues and hand sanitizer for when you can’t get to a restroom to wash your hands well. Key will be using mask without touching your face and removing carefully as well as tissue disposal without increasing risk of transmission to others. IANAD however, no warranties implied or expressed. Jim White might have more feedback on how to reduce transmission.

    • bmaz says:

      Hi Garbanzo, we can see exactly who you are, and that is absolutely fine to use the different handle for this. If you read the last corona post, you know about the situation here in our house. Our daughter won’t pass the 14 day threshold from returning from Milan Italy until Friday. She wants to get tested, but prior to Monday, there was no testing available in AZ. Now we are informed that the tests sent to AZ were among the defective ones, so there still is no testing in state. The South Koreans are testing about 10,000 people per day at no cost to the individual. The entire US has tested about 500 people. It is stupefying.

      I didn’t see you mention temperature, so guess that is a very good thing. But, jeebus, you can’t do a trial with a face mask on! I don’t know what I would do. I think set up a conference call with the court and opposing counsel and just disclose and discuss. Even if the decision is to leave it on the calendar, there is a record in case things really do go south. What a nightmare. And let us know how it goes. Best of luck.

      • Frank Probst says:

        My guess as to why they dropped the Cases Tested number from yesterday’s report is that the testing is STILL not happening very quickly. If it were, people would be bragging about it. They’re not. Instead, they’ve stopped telling us how many tests are getting run. Somebody needs to ask Fauci about this with a very direct question and insist on numbers.

    • Pajaro says:

      I find it fascinating and encouraging that Chinese MDs, virologists and researchers found the time to publish in the scientific literature their findings and facts. Sharing with the world important information on which science progress is built. They should see reward for their professionalism.
      Contrast this profession’s caring and social conscience with that of our government leaders, where generally all you can expect is BS, squared.

  6. Eureka says:

    It takes a village/ all hands on deck: good threads via @sciencecohen on some of the ways people from different backgrounds can help — also stimulating as to what needs to be done, what a thoughtful taskforce effort would look like (and I felt some confidence after reading that our gov effort would never be this well-coordinated):

    Jon Cohen: “This is an important thread. I see both POVs. “Expert” is a fuzzy term that I dislike–but use sparingly. When the discourse devolves, as it has with COVID-19, and politicians who have no grounding in science start speaking with authority, I think the word gains currency. …”

    Abraar Karan MD, MPH, DTM&H: “THREAD What constitutes an “expert” in a novel epidemic? Serious question. Many laypeople and even doctors are looking to “experts” on #COVID19. Who do we turn to? For what? Some thoughts:”

    Continued by another here (scroll up, the threads join, IIRC; roles for lawyers, historians…)

    • Rayne says:

      Slow down. Re-read that DailyKos piece again:

      In a preliminary study published Tuesday, scientists at Peking University’s School of Life Sciences and the Institut Pasteur of Shanghai found that a more aggressive type of the new coronavirus had accounted for roughly 70% of analyzed strains, while 30% had been linked to a less aggressive type.

      PRELIMINARY. As in not peer reviewed.

      Please use more caution when sharing information.

      The researchers said their results indicate the development of new variations of the spike in COVID-19 cases was “likely caused by mutations and natural selection besides recombination.”

      “likely” is carrying a huge load here. The next graf says more studies are needed, which is absolutely the truth — we don’t know enough.

      • Rayne says:

        This twitter thread by Nathan Grubagh along with the commentary published in Nature Microbiology is the counterpoint to that PRELIMINARY study.

        • Frank Probst says:

          This looks like a pretty accurate summary to me. Geneticists will quibble over the meaning of “mutation”, but in regular conversation, it just means that something in the DNA/RNA has changed. For practical purposes, most changes like this don’t really do anything. They’re useful to people who study the virus, because they let you draw a sort of ancestry map of whatever you’re studying (like they did in Washington state), but otherwise, they just sit there. A handful of the changes will make the virus LESS infectious or LESS virulent, which is good for us but bad for the virus. Viruses with changes like this usually don’t stay around very long, because natural selection removes them from the viral population. Only a very small number of changes will make the virus worse for people, and those are usually a mixed bag. They make some things worse for us and some things better. For example, a change that makes the virus grow faster may also make the virus “weaker” in terms of its ability to cause disease. Viruses that end up killing a larger percentage of people that they infect also become more easily tracked by contact tracing. And so on.

          (Needless to say, this is a very simplified take on “mutations”, and there are textbooks that are devoted to this subject, but it’s good enough for general explanations and conversations.)

          • CCM says:

            When a virus mutates this is bad. Think of the flu virus. Mutates left and right, some are more deadly, think Spanish flu. Makes vaccine development very hard as different strains make for a moving target. Mutations allow change which in turn allows survival in different circumstances. Mutations resulted in the present virus whose existence we are all lamenting.

              • CCM says:

                Frank is right in the sense most mutations will make the virus less lethal and less transmissible. However, the more rapidly it mutates, the greater the chance a of a mutation with undesired effects. The more it mutates the more it presents a moving target for antivirals and vaccines. This is an issue with influenza, trying to cope with the many strains, a consequence of its ability to mutate.

            • P J Evans says:

              Mutations aren’t necessarily bad. Nectarines are a happy mutation of peaches.
              Frank’s got it correct.
              (Pathogens that usually kill their hosts tend to die out or become less virulent.)

            • bmaz says:

              Frank, I second what Eureka said. And that goes to all the others with actual expertise that have contributed to this discussion, and there are many of those, you know who you are.

              That has always been one of the hallmarks of Emptywheel…there are very smart people that hang out here, and always have been. When the Macondo well blew, there were experts here in oil and gas, not to mention underwater operations. When Fukushima breached, we had honest to god nuclear physicists on hand already. Now we have expert doctors and biology professors (Hi Valley Girl!) on hand. Sometimes they are regular commenters, sometimes lurkers that come out when needed.

              So, I just want to say thank you to all for your expertise shared, and to everybody’s ability to have sane, sober and constructive discussion. This blog would not be what it is without you, and it is appreciated. You guys rock.

      • DrFunguy says:

        The vast majority of mutations have no observable effect (except in DNA/RNA sequence, by definition), i.e. are neutral. Read a basic genetics text.

        • LeeNLP says:

          Even though mutations would be generally neutral, would one not expect some degree of natural selection favoring transmissibility? How might this play out over time?

          (Disclosure: Not a biologist.)

        • CCM says:

          Yes, most have no observable effect, are neutral. Most DNA is non-coded, the minority is coded. So most mutations never results in any change in protein sequencing. But lethality, be it a virus, a snakes poison, a saber tooth tigers teeth arise by means of evolution. Selective pressures influence which mutations persist in nature. The more mutations, the greater the likelihood of a phenotype undesirable from the human point of view. Or at least that is what my textbook said. Thanks for the snark, how about a reasoned response next time.

          • Eureka says:

            This is a general comment to all readers, rather than a reply per se.

            This is an interesting thread in that all from different backgrounds may agree on the fundamentals but alarms are set for different reasons. From my POV, my alarm was at the species jump-and-spread, period, because future evolution would be along for the ride.

            You have to consider host-pathogen coevolution, and that there are evolutionary constraints on the virus which include e.g. not killing too many hosts. Natural selection and other evolutionary forces aren’t all going towards bigger-faster-stronger (Other comments already address this: Rayne incl linked thread, Frank comment, PJ Evans comment, etc.)

            True, zoonoses can be tougher — with cross-species hosts, they can evolve to kill a ton of one species and reservoir in (an)other(s).

            But on the whole, if this becomes “our” (human) virus, we can expect perhaps more variability over time (as with the flu).

            Problems with vaccine development are generally inherent to dealing with RNA viruses: they evolve, no way getting around that, that’s part of why I don’t see mutations (even if “meaningful”) with quite such alarm: it’s to be expected, the way it is.

            I am more concerned that *we will never reliably know* if a new variant (meaningful mutation/s) is more or less this or that because we do not have base rates for the current US outbreak, and we have issues with data transparency from some other countries. And even if some more ethnically homogeneous countries do a better job at that, we still have the issue of world-wide human variation and subpopulation susceptibilities to measure (besides viral variation). Unmeasured host variation can confound how we interpret viral effects.

  7. rip says:

    From TheRegister – a bit of digestible background:

    Analysis The fate of the man accused of leaking top-secret CIA hacking tools – software that gave the American spy agency access to targets’ phones and computer across the world – is in now in the hands of a jury. Friend, they have their work cut out for them.

    Joshua Schulte stands accused of stealing the highly valuable materials directly from the CIA’s innermost sanctum and slipping them to WikiLeaks to share with the rest of the planet. Prosecutors have spent the past four weeks explaining exactly why they believe that to be the case. And Uncle Sam’s lawyers have developed a compelling case to send Schulte away for most of the rest of his life.

  8. Eureka says:

    Trump on Hannity just now with (dangerous) misinformation:

    Aaron Rupar: “In this clip, Trump: 1. Denies WHO’s coronavirus death rate based on “hunch” 2. Calls coronavirus “corona flu” 3. Suggests it’s fine for people w/ Covid-19 to go to work 4. Compares coronavirus to “the regular flu,” indicating he doesn’t get the difference [clip]

    Daniel Dale: “Trump on the coronavirus: “It wasn’t something that was going to affect us. You know, you don’t think of it in terms — when you first heard it in China, you don’t think our country’s gonna be affected.””

    ^ see Dale timeline for a couple more not threaded

    • Eureka says:

      The thing is, he was actually logically correct on the simple point that death rates can be overestimated if (mild- really, any-) cases aren’t counted. But whose fault is that re surveillance & rates & dismantling agencies & thinking “it won’t happen here” &c..

      And-also-interesting that he can keep info straight when motivated to suit his PR interests.

      • 200Toros says:

        Did you see that he also said there will be “positive” impacts of the epidemic, since people won’t vacation outside the country, they will stay here, and spend their money here. While virtually at the same time, Ted Cruz was talking about how badly the airlines and travel industry will get hit,as they did during the SARS pandemic.

        Every single time he talks about this, he displays a total lack of understanding of even the most basic of market dynamics. Really, total ignorance of anything the rest of us might call reality. Every time he talks, he puts more people in danger.

  9. CD54 says:

    I don’t mean to be an alarmist, but I’ve not seen any discussion so far about the imminent Spring Break (either HS or college).

    I mean what could be a greater vector explosion of community transmission than Spring Break — forget the SXSW risk (of which organizers are currently pushing the theory that “they’re coming here anyway, so it’s best that we have them within the SXSW structure to minimize uncontrolled exposures”).

    • Rayne says:

      As if classrooms, libraries, lecture theaters, and campus cafeterias aren’t perfectly suited to transmission of viruses.

      Especially on campuses with a large number of students who’ve traveled abroad over the last three months.


  10. Frank Probst says:

    So has anyone anywhere seen any report on any news outlet of anyone in the government saying that the US has done more than 500 tests for Coronavirus?

    • Molly Pitcher says:

      I heard a reference to that on the morning news on KQED FM in San Francisco this morning.

    • Geoguy says:

      US congressman Ami Bera was on the Michelangelo Signorile radio show this afternoon. I hope I am remembering this correctly but I think he said it was around 500 tests, (federal only?)

  11. harpie says:

    Some good thread [all via Cheryl Rofer]:
    12:09 AM · Mar 5, 2020

    Thanks to @seattleflustudy and @UWVirology, we have new genomic data on the spread of #COVID19 in Washington State with 2 new #SARSCoV2 genomes sequenced today, bringing the total number of WA genomes to five. 1/8 […]

    11:09 PM · Mar 4, 2020

    A few thoughts to close out what I’ve found to be a pretty jarring day of COVID-19 news. Why jarring? The growing disconnect between the narrative pushed by the White House and the reality we can see developing around us. […]

    3] LINK in next comment
    9:11 AM · Mar 5, 2020

    THREAD: In our federal system, local leaders get lot of discretion in reacting to local public health crisis. But #coronavirus, which may start regionally, is national threat. […]

    These outbreaks are local public health crises with direct national consequence. It’s a time for Congress to consider how we encourage states and cities to take tough local measures that sacrifice local economic activity for sake of nation. It’s time for collective action. 3/n [more]

  12. Molly Pitcher says:


    Thank you very much for your usual dilligent research. This is particularly helpful in that my husband’s company was sending him to Seattle in two weeks. They are headquartered in Buffalo and do not hear what is happening on the West Coast. He was able to share this information and get them to cancel the seminar.

  13. P J Evans says:

    The Senate has passed the Coronavirus funding bill, 96-1. (The 1 was Rand Paul. *sigh* )

        • Rayne says:

          Yeah, about that…I am still waiting for the free market to clean the dioxin out of the nearby river +20 years after an economics professor at a libertarian private college swore to me the free market was best suited to do so.

          Good thing I didn’t hold my breath, going to need it when free market solves COVID-19.

  14. BobCon says:

    Peter Baker and the NY Times politics desk is getting even worse. They are being absolutely irresponsible:

    “If you want to know why Trump tells lies, this is why …

    … sometimes if you say something untrue you can get a headline, a dek, and a two-paragraph lede repeating your lie only to have it debunked further down.”

      • BobCon says:

        They need to stop atomizing the story and dealing with each nugget in isolation.

        The story every day until they get their act together needs to be Trump is mangling the response and lying to cover his tracks.

        They have no problem creating narratives out of nothing about nothing. They refuse to do it when it is a real story with real consequences. It is past the point of institutional caution. They are deliberately protecting the GOP.

  15. LP says:

    I am curious how the govt funding, reaction, press conferences etc. differ for this virus over Zika, ,SARS, MRSA, EBOLA etc. For instance I am a government contractor and have been for some 20 years. Agencies have asked us to develop contingency plans to remain operational. I don’t remember that happening before this. As a primary caregiver for my 87 year old mom with COPD, I am concerned but wonder if my concern is based more upon the ineptitude of this administration than with the virus?

    • Rayne says:

      It’s several things. First, COVID-19 compared to the others you cite as an example poses risks the others didn’t pose.
      — Zika’s transmission was limited by geography as it was carried by Aedes genus mosquitoes which only survive in subtropics. Most at risk were pregnant women as the virus was linked to fetal death and microcephaly.
      — Ebola has an extremely high mortality rate, 50-90%, based in part on limitations to local treatment in African countries. Ebola has a low R0 of 1-2; because African countries’ economies are less integrated with U.S. economy, it was less difficult to monitor and limit air traffic.
      — SARS had a very high mortality rate, but its transmissibility was fairly low at R0=2.2, making it easy to contain.
      — MERS was very similar to SARS mortality but with a much lower R0 in the 0.3-0.8 range; aggressive containment learned from SARS outbreak may have prevented it from becoming epidemic.

      For comparison, influenza is R0=2, meaning 1 person gives it to 2 people, usually via airborne droplets. Measles is very bad, at R0 range 12-18 because it’s airborne (not just droplets).

      COVID-19 is currently rated R0=2.28 but there isn’t a solid grasp of this because of the number of asymptomatic contagious persons. 2.28 is worse than flu with a mortality rate 20-30 times greater than flu (0.7% versus 2.3% in China, 3.4% globally, across all identified cases). The challenge to the US is the percentage of infected persons who will require hospitalization, roughly 20% of all identified cases. We can’t afford to have this many people out of the work place let alone admitted to the health care system. Of the 20% of patients with severe-to-critical cases, about a third will need intubation and we simply don’t have enough equipment.

      Agencies may have been more ready to take action because of awareness from the other diseases and some prep work during the Obama administration. It may also be just plain fear driving agencies to be more proactive; it’s not unreasonable given the huge disconnect between the top of Trump admin and public health experts.

      • LP says:

        Thank you, Rayne. Just turned off the presser with the VP saying risks are very low due to the president’s early action. Such BS. Three people in my county in MD now positive and kids activities being cancelled left and right. I appreciate your very informative reply.

  16. pdaly says:

    Ventilators are, as Rayne mentions above, a limited resource in a pandemic that causes respiratory failure among the sickest patients.

    I’m curious if anyone here has critical care medicine background and can comment on the possibility, I’ve heard about recently, of hooking up two people to the SAME ventilator.

    It seems you would need to pair patients by similar lung size so that the settings would be appropriate for both people. Or have some way of alternating the ventilator settings every other breath?
    I would also think the alarms would be hard to interpret. When the machine alarms, it is for patient A or B? Nevertheless, glad to hear ICU doctors have been thinking about catastrophic scenarios.

    • Frank Probst says:

      I can give you a very small bit of good news here: I haven’t seen a report of ANY pediatric patient requiring mechanical ventilation, so unlike a flu outbreak, you’ll have a little bit of extra capacity from the PICU that you can draw from. It won’t be much, and everything Rayne says is still true, but if you’re one of the few people that gets a PICU ventilator, it’s going to matter a hell of lot for you.

    • Eureka says:

      [My experience/pov as to this question includes caring for a ventilator-dependent person in my home and managing all of the equipment, and hospital work unrelated to that. ]

      I’ll let a respiratory therapist answer in more detail, but “lung size” would be the least of concerns — vent settings are far more complicated than that (and personalized, and must often be adjusted due to changing medical status when the vent-dependent are acutely ill). In lay terms, breath timing, depth, when and whether the machine initiates or controls breath, the O2 settings, on and etc.

      In addition, the tubing inputs/outputs are designed for one person: I don’t know how they would suddenly approve and manufacture new tubing and all (and how and where they would do it).

      That would be a very worst-case scenario and difficult to match patients to share, medically and ethically risky as to each patient’s interests, and likely not an approvable experiment (basically) for so many reasons. That’s MASH-unit + Macguyver- type stuff that I see hard getting by in a modern hospital with regulations, etc. Who knows, maybe there is some shared tubing made for other countries but I would be suspect that the flows could go right trying to do something like this on the fly.

      I’m curious how anyone is talking about this being a possibility, like how this could possibly be done. Maybe they mean “sharing vents” by taking turns for periods of time, and bagging the other person during their time off?

      • Eureka says:

        ^ and by “taking turns” at end of comment — if that is what they are talking about — all of the tubing could be changed out and the vent settings and O2 adjusted per person, etc. _That_ I see as entirely plausible.

      • pdaly says:

        All good points, Eureka. I was wondering the same.
        Frank Probst, that’s a good point about the pedi vents being available.

        I heard about the shared ventilator scenario in passing on a news broadcast this week. The doctor being interviewed was Paul Biddinger, MD, Medical Director for Emergency Preparedness at the Massachusetts General Hospital in Boston. I’ll look for a link.

        On a google search, you can find research papers from 2006-2008 that tried it with pigs — somehow hooking up 4 to one ventilator. The idea is to have surge capacity for a short period ‘until more help arrives’ in the form of more equipment, I suppose.

        I haven’t found any information about tests in humans. Maybe it’s only theoretical to be deployed in a catastrophe. I’ve emailed a friend who is a pulmonologist and waiting to hear back.

        • Eureka says:

          Thanks, pdaly, I’m interested in what the pulmonology community is doing around this in general. It’s been on my mind since sharing a link here which included –> a paper re the Strategic National Stockpile (includes vents, and hospitals, other facilities, and states also have stockpiles/set-asides). CDC and AARC (American Assoc for Respiratory Care, and their journal — Respiratory Care –) have some additional info/pubs.

          Continuing to think aloud since you raised the topic, I can also see milder (or especially, recovering/ weaning) cases sharing time on/off vent, other periodic on/off options like that (I’ve spent _a lot_ of time in vent facilities, acute care and otherwise); also thinking about all of the tubing/supplies and when that type of stuff runs out due to supply chain issues. Tho WHO has recs on how to clean the plastic tubing, it’s generally treated as disposable: when and how would the medical community “decide” to do that differently? One place to start may be to take the longest standard of care guideline between them (and I forget now what they are, but hospital/ acute care facility /LTAC vs. SNF / Medicare home care guidelines can differ substantially on, say, the number of days to change out a disposable part, like tubing or a trach, and the differences are not all uniform — e.g. home vs SNF guidelines may be longer on some things, shorter on others).

          Ugh. And now flashbacks to all of the trachs, vent / suction / O2 tubings/ parts / sterile cleaning trays, etc. that we had to *throw away* after the person’s death because they are prescription items (many dozens of separate items). Lots of developing world medical orgs could have and do use that type of stuff but there was no way to get it to them, long story short.

          • Jim White says:

            in my MacGuyver moments, I wonder if my CPAP would be helpful if I were in the very early stages and awaiting a vent slot. I also keep thinking about the fact that my CPAP is my only access right now to an N95-equivalent filter that fits my face (with any :”leaks” being under pressure from the inside),and perhaps useful if I had to home-treat an infected person.

              • Eureka says:

                Sliding over to yell more personally: WHAT ARE YOU DOING TO MRS. & DAUGHTER BMAZ AND Q WITH THIS STRESS, USE THE DAMN CPAP. E-V-E-R-Y N-I-G-H-T.

                It’s a sign from the blawg gawds that I have received an edit button for this comment so I can add more missives: what would happen to the trolls under and over the bridges here, are you gonna leave all of that to Rayne? Turn this place into a den of idiocracy?

                I still have more time but am lackluster on the epithets rn, lack of sleep.

            • Eureka says:

              That sounds like a clever idea (I am told BiPAP is even better as to matching what a vent does — CPAP is more passive — and leaving aside supplemental O2 needs in these MacGuyver chats. So that sounds like another reservoir of machines, too — the BiPAPs). [I also wonder if we should have more widely distributed ambu bags in the general population, like how defibrillators are all over but very low-tech lifesaving potential here.]

              Even with the pressure, if you have a beard or other facial hair intersecting with the seal, I’d shave it.

              Thank you for alerting me to the fact that bmaz needs to be yelled at to USE HIS FUCKING CPAP.

              • Jim White says:

                Heh. I had to cajole him to even do the sleep study.

                My machine, from Philips, has “auto-flex”, which means it automatically detects the exhale and adjusts pressure accordingly. It’s also on automatic for the pressure it applies, based on the resistance in my airway at the time. I’m thinking that feature could be very valuable, especially if adjusted to raise the upper level in an emergency beyond where things sit now (the provider can reprogram it remotely, on order from the doc).

                Not planning to shave the beard yet. I cut it really short and strap the mask down REALLY tight, per what I experienced when repeating my sleep study with a really helpful tech.

                Last time I shaved the beard was back in grad school. Someone from the lab next door asked if I felt okay because I looked pale…

                • Eureka says:

                  Thank goodness for persuasive friends.

                  That’s a fancy machine, and yes super valuable features here. LOL that you trimmed the beard down, I was thinking of the bushiness factor — it’s handy that you’ve already got test feedback on seal quality (and are not a CPAP scofflaw).

                  You guys do look funny when you shave. My husband’s had been seasonal for many years, until he just kept it. He hasn’t shaved his for an N95 fit and his unheeded wife wishes he would.

                  That’s it — between the food and in-house equipment you’ve got, we’re decamping to FL.

    • Jim White says:

      Thanks, that is indeed a powerful story.

      Of note in the story is the explanation that a CT scan can sometimes be more useful than the PCR test. So I did a little googling and two references for us on this:

      The bottom line is that the PCR test, while highly specific, at least for the version used in China, sometimes gives false negatives in patients early in the course of their disease. These patients often then progress to a positive PCR test (presumably an issue relating to the concentration of virus in the patient’s body being too low for detection early in the disease).

      CT scans, however, saw the disease in many of these patients who later had a positive PCR test. The problem here is that the CT finding is non-specific in that pneumonia from many different causative agents can give the same appearance. But when coupled with a patient’s history, this can be powerfully presumptive evidence.

      So the bottom line is, are US patients being evaluated by CT while the SNAFU on test kit availability plays out? I don’t think I’ve seen this discussed as a viable interim path to identifying patients to isolate.

      • Valley girl says:

        Thanks Jim. I hadn’t seen any reference to this either- CT scans being done in Wuhan. I’m glad you did the googling- you know a lot more on the issue than I do. Also, shows the heroism and human toll on health workers in China.

      • Rayne says:

        I think I read something in my Coronavirus List on Twitter about chest imaging as an early screening tool, but I can’t recall if it was CT in particular versus other imaging method like x-ray.

        Probably wouldn’t work in my case because an autoimmune disorder did a number on my lungs. I’d be a candidate for a PCR test earlier rather than later. Patient history will definitely be key.

        • Jim White says:

          Yes, I have a lot of damage from a couple of childhood bouts with severe pneumonia, but I think that what they’re seeing on the CT scans included the lungs being fairly full of fluid, and so maybe they could distinguish the fluid from scarring. But I changed departments out of medical physics in grad school after the first year (back when CT was entirely newfangled), so I don’t know the details of reading these scans.

  17. P J Evans says:

    I just ran across someone elseweb saying that people who go to work with the virus because they don’t know they have it don’t get counted in the mortality rate. It Doesn’t Work That Way.

    • Eureka says:

      Thanks so much, just saw this down here — of course it cuts off then!

      I can only imagine the level of security at warehouses like that, given potentially interested “enterprising individuals” and all.

      • pdaly says:

        I know! I sat up as soon as Dr. Biddinger mentioned it and was shocked there was no time for discussion!

        I assume he’s busy explaining the plan to his ICU teams, but I’ll see if I can get an answer from him directly.

        • Eureka says:

          It did occur to me after — esp. the way he answered — that such plans might not be for public consumption. Lots of emergency preparedness plans are internal use only, as they say, esp. any that might overlap with e.g. bioterrorism preparedness. (But share what you can get!)

  18. Eureka says:

    I was going to submit this without comment:

    Coronavirus cases identified in Pennsylvania in Delaware and Wayne Counties

    Gov. Tom Wolf announced Friday that two people in Pennsylvania have tested positive for coronavirus, including one in Delaware County and one in Wayne County, near where President Trump held a rally Thursday night.

    Emphasis on “rally” and “germophobe”–

    But now I see on the live updates page for PA & NJ (and general news) that Trump had cancelled that CDC trip because of a suspected case at CDC, and has rescheduled the trip today after the person was negative, apparently:

    Coronavirus live updates for Philadelphia, New Jersey, and Pennsylvania

    We only need a pandemic where X% of us die to shut down these fucking rallies. Next, his patrons will rent out MSG for pay-per-view-style (it’ll seem more Exclusive!), but only after all of the audience actors get tested and quarantined for purity.

    The also closed five local schools because a COVID-19 positive person from out of state visited the schools recently.

    Sorry for you west coast folks and other areas getting hit harder in the forward waves.

    I finally hoarded-up a bunch of stuff just before the news AKA price-jack / empty shelves in my area, but still missing some items and need that cheap gin all-purpose tonic (cheap gin reference via Marcy rt of Quinn Norton’s thread).

    • P J Evans says:

      My apt management people dropped off information statements about the virus and what they’re looking at doing if necessary. I’m not reassured when they say to look to CDC for information.

      • Frank Probst says:

        The CDC is more or less useless, because nobody there can say anything that President Pissypants might hear on Fox News and then get upset about. Local health departments looks like they’re doing a much better job. King County’s website is pretty good. It’s worth looking at, just to see what it looks like when they’re doing it right.

      • Eureka says:

        Ugh, I’m sorry to hear that but glad at least your apt. place is trying to be on the ball.

        And different states (locals) have different guidelines from each other, and CDC, from what I’ve read. So frustrating.

        Agree with Frank on the source of CDC’s knee-capping, beyond the prior staffing guts, that whole thing awhile back on “words that CDC can’t use anymore”…the long brewing internecine with the FDA, etc.

        Whatever else is going on at CDC for which they must take responsibility, it is clear that they are being set up to be the fall guys for all of this, with FDA posed in POTUS-friendly press as the savior. Except that’s not quite the story.

  19. Jim White says:

    Science just published a paper on epidemiological modeling of COVID-19 (, and it appears not to be behind their usual paywall. Here’s my highlight of it, but the whole thing is worth a read:

    The model indicates that while the Wuhan travel ban was initially effective at reducing international case importations, the number of cases observed outside Mainland China will resume its growth after 2-3 weeks from cases that originated elsewhere. Furthermore, the modeling study shows that additional travel limitations up to 90% of the traffic have a modest effect unless paired with public health interventions and behavioral changes that achieve a considerable reduction in the disease transmissibility.

    Given how invested Dear Leader is in his claim that “we shut it down”, the odds of real public health interventions and behavioral changes are zilch.

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