Three Things: More Family Fun with COVID-19

[NB: Check the byline, thanks! / ~Rayne]

My second kid, who attends a Big 10 university, is sick. They’re running a temp, have a headache and sore throat. Fortunately they have no other symptoms like a dry cough and chest congestion. They wouldn’t meet the criteria for COVID-19 testing even if they develop a dry cough common to 68% of those infected with the virus

We had the awkward conversation about avoiding coming home for at least two weeks — even if the school shuts down, which it now has. This scenario is increasingly likely for all other Michigan and Midwestern colleges/universities. With the damage to my lungs from an autoimmune disorder we can’t take the chance my kid has something besides a common cold. I never expected to have to tell one of my kids not to come home.

~ 3 ~

By now you’ve probably heard about the initial quarantine of Lombardy region of Italy, and then the subsequent quarantine of the entire country. It’s bad. Italy is about two weeks ahead of Washington state in the virus’s spread.

Twitter thread by a UK anesthesia and intensive care registrar passes on a report from a friend in A&E (ER department) in northern Italy (includes Lombardy).

Tweets by an academic in Austria (next to Italy):

The “codice nero” or “black code” to which she refers is a label applied to patients who are DOA or for whom death is imminent. During triage they are apparently applying this to patients over 60-65 years old who arrive in respiratory distress because they have no equipment for them. Other accounts from Italy mirror both the news reports about hospital conditions.

A news report from France covering Italy’s crisis (open in Chrome and translate) notes concerns about COVID-19’s possible impact on southern Italy because it has even fewer resources. Hence the failed quarantine in the north.

In this news report from Brescia which is in northern Italy (open in Chrome and translate) you’ll note they are out of beds and are putting patients on cots, evident in the photo at the top  of the page.

Some better news: China agreed to supply Italy with 1,000 ventilators and 2 million masks. Additionally, they are donating 100K respirators, 20K protective suits, and 50K test kits as part of an aid package. Must have leftover supplies now that China is closing down their rapidly-built emergency COVID-19 dedicated hospital. See story (open in Chrome and translate).

These purchases and aid will not be enough fast enough, though. The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care has now published a guidance document today which appears to codify triage under current conditions. It’s grim.

Tom Bossert, Trump’s first Homeland Security Advisor, wrote an op-ed for the Washington Post published yesterday. He told Ken Dilanian/NBC, “We are 10 days from the hospitals getting creamed.”

ER doctor Rob Davidson from Ottawa County in West Michigan spelled out the anticipated challenge at video in this link:

Up to this video, Michigan had been lucky, having 39 negative tests out of the 375 tests it was allotted by CDC. Last night the state announced there had been two positive cases; Gov. Gretchen Whitmer then declared a state of emergency. In an email today, Michigan State University indicated a third likely case was associated with its campus — hence an announcement moving coursework offline as of noon today. MSU is one of four Michigan schools to make such a move.

We need to see more moves like this to increase social distance if we are going to “flatten the curve” of demand for medical services. It will not be just COVID-19 cases affected by the additional demand on the system, but all other health care needs including emergencies. If we don’t slow down the spread of the virus, ALL mortality may increase in addition to COVID-19 cases.

~ 2 ~

Particularly aggravating as the U.S. tries to wrap its head around this growing crisis is the active, malign action of the White House.

A House Oversight and Reform Committee (HORC) hearing today focused on U.S. coronavirus response; the White House interfered with its continuation by calling an emergency meeting requiring the attendance of the hearing’s witnesses, including CDC Director Robert Redfield, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and Terry Rauch, director of the defense medical research and development program for the National Institute of Health.

The HORC meeting was cut short without having answered all questions the committee had, although not before Dr. Fauci was able to provide a reality check to the committee.

“Is the worst yet to come, Dr. Fauci?” Rep. Carolyn Maloney, chairwoman of the House Committee on Oversight and Reform, asked Fauci on Wednesday.

“Yes, it is,” Fauci replied.

While this coronavirus is being contained in some respects, he testified, the U.S. is seeing more cases emerge through community spread as well as international travel.

“I can say we will see more cases, and things will get worse than they are right now,” Fauci said. “How much worse we’ll get will depend on our ability to do two things: to contain the influx of people who are infected coming from the outside, and the ability to contain and mitigate within our own country.”

He added: “Bottom line, it’s going to get worse.”

A report published at 12:29 p.m. after the meeting was suspended revealed the Trump White House ordered public health officials to treat certain meetings on COVID-19 as classified.

The sources said the National Security Council (NSC), which advises the president on security issues, ordered the classification.”This came directly from the White House,” one official said.

This is absolutely unacceptable. The public has both a right and need to know about the course of the virus’s spread and its government’s response. There is no constructive, positive reason for secrecy apart from hiding corrupt or incompetent decisions, which in this case could result in Americans’ deaths.

In fact, this arbitrary secrecy may already have resulted in Americans’ deaths if state and local public health authorities could not make informed decisions because necessary information was denied them.

U.S. Vice-President Mike Pence, the administration’s point person on coronavirus, vowed on March 3 to offer “real-time information in a steady pace and be fully transparent.” The vice president, appointed by President Donald Trump in late February, is holding regular news briefings and also has pledged to rely on expert guidance.

The classification order also makes Pence’s vow look like a lie to the public if on March 3 Pence knew there was information about the government’s response withheld by classification.

Constituents should demand their representatives and senators address this both by holding more investigative hearings into this unwarranted secrecy, and by disclosing whatever information they can obtain about COVID-19 and executive branch response so that the public and their health care system can act appropriately. Further, they need to provide support in a way that states can use without interference by the White House.

Congressional switchboard: (202) 224-3121

~ 1 ~

This weekend’s real live drama revolving around cruise ship Grand Princess’s docking at the port of Oakland hints at a solution to the bullshit obstruction and abuse of power surrounding the federal government’s COVID-19 response.

Note in the video that California’s Gov. Gavin Newsom takes center stage, leads and directs the release of information.

And yet the docking and debarking and transportation to quarantine facilities required considerable effort on the part of federal officials. Newsom thanked Pence, saying “His team is truly exceptional.”

Gilding the lily a bit, because the real work was done much farther below Pence’s office.

What was particularly interesting was the lack of response from Trump. We could have expected him to badmouth Newsom the way he badmouthed Inslee, but he didn’t. Perhaps Trump was too busy playing golf.

Or perhaps he didn’t want to draw attention to Newsom.

The docking happened, people were moved, and it happened without a lot of hullabaloo.

That’s exactly what we want — effective, speedy resolution meeting the problem head on.

This same model could work across the entire country if governors work cooperatively and collaboratively to share information and best practices, and are willing to be the point person out in front. The National Governors Association could provide the bipartisan vehicle for networking; it’s outside the purview of the White House, can’t be forced to operate under federal classification.

Granted, taking this approach means governors run the risk of mean tweets from Trump. Screw him and his germy iPhone. Residents in every state want calm and effective leadership they can trust and see in the days ahead. Governors should provide it — particularly since governors are a lot closer to their constituents than Trump is.

Every state should already have in place a process by which their residents can decide what action to take if they believe that they or their family members are infected with COVID-19. There have been far too many reports of individuals making calls to 911 and asking for ambulance rides to the hospital for testing. Such unnecessary use of resources, from calls to 911 operators to ambulance response to demands on hospital personnel represent heightening the curve, not flattening it.

States’ departments of health should have a published decision tree online for residents to use to decide their next course of action. It’s clearly not enough to tell the public “What to do if you’re sick” if they are calling 911 for non-emergency situations.

Website design has also been poor, forcing people who may already be panicky for lack of information to wade through a website to get what they need to make a health care decision, and in some cases design ignores that many residents rely on mobile devices.

Nor has the information process made it all the way down to county and city level.

More effective outreach across broadcast and social media is also needed to manage expectations in the days and weeks ahead.

A collaborative effort by governors could reduce costs to create a comprehensive communication plan across each state and across the U.S. — all while avoiding the obstructive influence of the White House.

Until governors catch on, though, each of us will have to push our state and local health departments to do better BEFORE the coming crisis. There is no extra time, there is no room for failure. Check to see how your state and local health departments are working right now.

And in saying this I’ll tell you my own county is screwed up. The web page with FAQ about COVID-19 doesn’t render on mobile devices. It doesn’t tell residents what to do if they have symptoms matching COVID-19. I really need to call and have a little constructive chat with them because the county hospital is less than a mile from my house. I don’t want problems I can anticipate on my back porch.

A pretty good example of how a county health department’s COVID-19 website should look is Santa Clara County, CA. See SCCPHD — the only nit I have with the site is that it needs a decision tree, something a little less fuzzy to help residents who are either panicky or not well educated.

Santa Clara County has also published a nice handout on social distancing. Really worth copying by other state and local health departments.

Wish I could give you a link to the websites and phone numbers you’ll need to address this personal assignment but I can’t. Do share in comments what you’ve learned in your search.

~ 0 ~

One more thing for the physicians among us who might be willing to translate this into layperson’s English:

Threadroll link here.

This is an open thread.

270 replies
  1. FunnyDiva says:

    re-posting from Quinn’s thread:
    OK, here’s the latest from WA state.
    Press conference in Seattle this morning with Gov Inslee, King Co Exec Constantine, King Co Health Officer Dr. Jeff Duchin, Seattle Mayor Durkan, and Execs and Mayors from Pierce and Snohomish counties. King, Pierce and Snohomish are contiguous, and home to half the population of WA state. I hope the video of the press conference will be available at some point. Gov Inslee really was not having any “but how will you enforce it?” from the press: “This is a lawful order from the elected Governor” and he essentially said that if you don’t comply, vulnerable people like our grandpas and uncles or immune-compromised friends WILL DIE. “And I trust the citizens of WA to understand that and take it VERY seriously and do everything they can to protect other people, and to ‘flatten the curve’ so our hospitals can care for everyone who needs them.”
    though, yes, there are also legal implications, but through a complaint model, there won’t be Social Distancing Police roaming around measuring 6-foot distances…

    Anyway, some links

    Also, Seattle Public Schools have closed for at least 2 weeks.

    • Thomasa says:

      I listened to the entire WA State governor’s presser on our NPR affiliate this AM. The tri-county leadership repeatedly made the point that this is serious business, eg. no public gatherings of more than 250 and then only if specified health criteria are met. The county execs called on their respective medical professionals to explain in lay terms what it going on, including a reasonable on-radio explanation of flattening the curve. I was impressed! This is everything the federal response is not: cogent, informative, and directive – Here is what we are going to do……. and is isn’t waiting around for a federal response or permission from CDC. That is so last-week. You may have read that Seattle-local researchers had many samples and had applied to CDC for permission to repurpose an ongoing flu study. They were denied. Someone in the lab tested anyway and got a positive hit. They went to management, who was then told to “Keep it under your hat.” More people died until the hat was removed. My sense is the Inslee et al are done being toyed with by the feds. I’m looking to other local officials to follow suit. BTW Nusome in Oakland was just a impressive.

      • Rayne says:

        Yeah, there’s a serious concern about that end run made around the test related to the flu study. Violated human experimentation ethics. We’re going to have an ongoing discussion about the limits of protecting experiment subjects when there is a compelling state security interest in breaching subjects’ privacy and other rights. I’d like to know how the subject(s) were/will be informed and what mitigation will be performed to protect them. At the same time it’s clear the state (as proxy for the public) needed to know; can’t imagine how much worse matters would be if there hadn’t been an indication there were cryptic cases.

        • Thomasa says:

          “I’d like to know how the subject(s) were/will be informed and what mitigation will be performed to protect them.”

          I may be able to find that out. I have a friend working on the human subjects committee at UW. I’ll let you know if I do.

          • Rayne says:

            Thanks, Thomasa. I can imagine we’ll be up against this same challenge again, would be nice to know if researchers are ready to mitigate while serving the greater public interest.

      • FunnyDiva says:

        I also watched the whole thing on the King Co livestream. Glad I did.
        The urgency really came through. And also compassion and empathy.
        No sugar-coating, but honestly, as empowering and encouraging as something so very serious could have been made.
        And what you couldn’t see via radio was the ASL (American Sign Language) interpreter. I thought he made great use of facial expression and body language in addition to the gestures…though I can’t speak to the “translation” itself. My impression is that it was also probably very good.

        Guess I’m going to have to do a little searching and maybe asking around for more on the Flu Study research testing. Sounds like it’s going to make a very interesting bioethics case study to say the least.

      • greengiant says:

        Sadly, if I recall correctly according to the NYTimes article someone from the Washington State health authority went back to the Seattle Flu study and told them to stop completely. After UW ok’ed the end run. The last in many cycles of interference. Here is part of an analysis of their after the fact work The histogram of 7 or 8 cases found before March 4th was also out on twitter at one point.

  2. Rugger9 says:

    Jared’s holding up the declaration of emergency to do “research”. I’m sure the work product will be as brilliant as all of the other stuff he’s done like the Mideast peace initiative that managed to annoy Bibi in addition to the Palestinians. That ticket has to be punched to allow some waivers (1135) that would let WA get more done.

    But they’re blue and the governor’s a “snake” which is of course completely coincidental to the slow-walking of the declaration.

    On other stuff, the WH is doing a speech at 9 PM EDT. I’d say drink for every lie, but then everyone will get DUIs like Alex Jones did unless they made responsible arrangements.

    And the grift continues with ProPublica reporting that there was bribery involved in tweaking the tax bill in NYC. This is the kind of thing that the NYS AG can and will be able to investigate without being hindered by the SDNY Feebs since property taxes are a local issue, not federal.

  3. Rugger9 says:

    Stanford closed in-person instruction for the Spring Quarter and told the undergrads that they need to stay home and learn online. Testing ought to be fun, since I’m pretty sure short answer questions will be out.

    Empty arenas and canceled events will continue, the latest is that the world figure skating championships in Montreal are canceled. Santa Clara County in CA has banned gatherings over 1000 people so the Minnows are playing in an empty Shark Tank. The NCAA might follow them for March Madness. All because we do not know exactly where the virus is because we do not test for it. It’s been a business motto for a long time: it can’t fail if it’s not tested.

    • BobCon says:

      Public schools are starting to deal with the problem that if they close, a lot of kids don’t have the tech at home to handle remote learning, and it’s not really appropriate for a lot of younger kids anyway. Places are scrambling to figure out what to do with kids with parents who aren’t ready to have kids released months early.

      Standardized testing season is approaching, so that will have to be sorted out too. Fortunately the impact is somewhat less than it was a few years ago, but it still plays a major role in a lot of places in resource allocation and staff assessments. Remote assessment isn’t an option for a lot of places.

      • FunnyDiva says:

        And that’s just the academic piece.
        There’s also the kids who depend on school for 2 meals a day and even a safe place to be for those hours.
        Inslee and Newsom have recognized this in WA and CA respectively. I hope other governors are learning from their example.

        • BobCon says:

          Yes, they are a key hub for all kinds of social services in districts covering all demographics. People are going to be in an uproar where they close.

      • orionATL says:

        echoing funnydiva –

        schools in the south do so much for children we don’t even think about. they may serve breakfast and lunch for many, many poorer children in some districts. they essentially provide free daycare for working parents, a place where the children are safe and under constant adult supervision (we all remember the dumb things we did when alone or with our siblings, e.g., with matches). this is especially important for children in kindergarden who are too young to care for themselves as latchkey kids.

        in appalachia, even today, even in the summertime, school bus drivers may carry packed lunches for children. poverty and need are everywhere we don’t look.

  4. Pajaro says:

    Rayne, I hope your child gets better. This fellow
    has some seemingly good analysis, looking into the experience, and data, from other countries. He makes good points it seems, especially about the consequence of early steps of an outbreak. Also very lucid explanation, something perhaps the moron in the white house could understand. Oh yeah, he can’t read…so much for that hope! My state just announced first new cases. I’m going to go out less, evaluate what to stock up on for 2-3 weeks in.

    • Pajaro says:

      Per Tomas Pueyo, cited above, countries who botched or purposely avoided early effective response, like USA USA(!), will likely see a 5-6% overall mortality event. Those who respond fast and effectively much, much less mortality rate overall. Seniors with complications are still the most vulnerable.

    • Max404 says:

      I found the article by Pueyo very informative and full of good arguments for early action. However he did not describe the situation in Germany with, at the moment, more than 1500 cases but only 3 deaths. This is a mystery. I tried to post a question to Pueyo on Medium but found no way to do that. Do any of the experts here have ideas that would explain the German numbers? If it holds, there may be wisdom for other countries.

      • it's complicated says:

        It’s a bit intriguing for me, too, as a German:)
        It might just be that most of the positive diagnoses are of people early into their infection. Deaths seem to take ~4-6 weeks (I don’t remember from which point, transmission, first symptoms, or hospitalization).
        I’m seeing a very chaotic response so far, every state and sometimes even every city doing their own thing.
        If I would pray, I would pray, but as I don’t, I can only hope we will be able to make this into a Korea, not an Italy. I’m pretty skeptical, sadly.

      • Rayne says:

        Accurate. And that will work with some portion of the base because they’ll have something to aim their fear at instead of reasonable, measured action which might cut into some donor’s/Trump org’s profits.

    • greengiant says:

      Things I learned. The banks and finance industry are not well capitalized. Companies are going to fail. Trump has nothing for people who lose their jobs or who don’t have more than 400 dollars in the bank. The gambit to pork Gilead did not work. The US will be like Italy getting virus tests and med supplies and equipment from China and Trump’s royalties will be nil.

  5. MB says:

    I understand that some of the exposed-but-symptomless passengers from the cruise ship will be doing their quarantine at an unused corner of the Asilomar Conference Center in Pacific Grove (near Monterey). Unclear whether other regularly-scheduled events will continue at Asilomar or not. I understand GS Warrior basketball games will play to an empty arena for the next 2 weeks. Already the Coachella festival has been “postponed”, and the LA Times has cancelled its annual “Festival of Books” event. I’ve gotten e-mails from the local yoga studio I used to practice at telling people to bring their own mats and props, stay home if you’re sick and they’ll have ample amounts of hand sanitizer on hand for people that do show up and that they’re taking extra efforts to disinfect the studio on a daily basis. I got another e-mail today from the Wallis Theatre in Beverly Hills announcing their cancelling all performance events from now until March 31. Tomorrow I have a regularly-scheduled physical therapy appointment at the Kaiser West LA medical center and it will be interesting to see what changes have taken place since I was there last 3 weeks ago. They had one of the first COVID-19 cases diagnosed in the LA area there about a month ago.

    • leu2500 says:

      re Asilomar. I follow a quilt teacher. She was getting ready for 2 weeks teaching at Empty Spools there. She made the call to cancel. Shortly after she made the call Empty Spools was cancelled because Asilomar is closing.

  6. Katherine M Williams says:

    •In Italy the virus is starting to make young people quite sick, sick enough to need hospitalization. Like a lot of diseases, COVID-19 first attacks the weak and elderly, but works it way up to the healthier people. This is common phenomenon in epidemics.
    •It is estimated, extrapolating by the death rate in Iran, that Iran has a million or more cases of coronavirus.
    •It is being hypothesized that Iran and Italy have a more virulent strain of COVID-19. Italy, BTW, gets a huge number of Chinese tourists. It’s a very popular destination with the Chinese, especially Northern Italy and their ski resorts.
    •The U.S. does not have enough of “the right chemicals” to make or process test kits.
    •The president has classified info COVID-19 and the U.S. response. Anyone who tells the truth about what is being done is subject to prosecution.

    You know what I could do with right now? A really FUNNY joke.

    • Rayne says:

      Responding slightly out of order. With regard to virulence, I don’t think that’s a legit claim. Italy just plain didn’t mount an adequate response in time and their culture exacerbates it. Not certain what Iran’s issues are but the fact leadership was infected early says its government didn’t respect what we could see happening in China. If the leadership doesn’t grok the threat, well…

      With regard to younger patients — who is infected when is a matter of happenstance. Why did the index case in Washington affect a nursing home so early? Wasn’t because people were most vulnerable or elderly but because of relationships between the index case and persons in the contact chain. That said, the relative dismissal of threat against younger persons is inexcusable. We haven’t seen data yet indicating whether there are long-term effects on persons who’ve been asymptomatic or experience mild symptoms. We also see cases affecting younger people who have no co-morbidities and they are just as bad off as elderly. See this excerpt from that threadrolled observation by a physician in WA:

      Okay…I don’t have a joke, only a tweet that was worth a giggle this morning.

      • FunnyDiva says:

        This morning my brain juxtaposed
        findings of cardiomyopathy in COVID-19 patients
        Some fit, healthy 20-somethings getting very sick with COVID-19 and needing hospitalization.

        We all see news periodically of a student athlete who dropped dead on, say, the basketball court and was later found to have cardiomyopathy.

        So now I’m wondering if that might not be a cryptic (unknown/unrecognized/undiagnosed) underlying morbidity.
        I hope there won’t be enough cases to say with any certainty, but it doesn’t seem beyond the realm of possibility.

        • Rayne says:

          Could be either a past viral infection caused an undetected cardiomyopathy, or there was an undetected genetic heart defect. Young people shouldn’t assume they will not be affected for this reason alone.

  7. Jim White says:

    UF classes will all be online only by Monday and students have been encouraged to go home at least through the end of the month.

    The campus will remain open and employees will still report for work.

    I haven’t seen any announcements regarding athletic events on campus, but I don’t plan on attending any for now.

    • Rayne says:

      Thanks for letting us know. And no athletic event is worth risking your health, glad you’re not going. We need you here. :-)

  8. Raven Eye says:

    Thinking about Newsom’s Oakland press conference…He did things that leaders are supposed to do

    — Give the mayor of Oakland some top cover. Newsom is very much aware of the political dynamics of the Bay Area, and knew that stepping up and speaking directly to the issues and concerns, and sharing some to the thinking, would spread a little daylight around.

    — Let the Feds on the ground know how much they are appreciated, and how grateful the state and local staffs are for the federal contribution. I wouldn’t be surprised if some letters of appreciation went out from the governor’s office.

    — Know who has expertise and experience and then let them speak to their respective areas.

    — Recognize the dynamics of the situation. You can start heading in a certain direction (the old NAS Alameda “seemed” like the solution, until they looked at water depths in at some of those piers, and especially the entrance channel) but reality sometimes means you have to make a course change. So you do.

    I can’t imagine what a blathering mess Trump would have made in that situation.

    • Rayne says:

      Trump wouldn’t have done it. He already said he liked the numbers the way they were — with the known cases and the exposed offshore.


      • BobCon says:

        It is really hard to imagine him in charge for the next eight months, and the GOP had better get their heads around it.

        • Katherine M Williams says:

          Is there any politician, repub or dem, in D.C. who can handle things in an efficient and effective way? I can’t think of any.

          • BobCon says:

            Hillary Clinton would have been way ahead of the curve. Biden would have had pros in place and the budgets would have been a lot better. Ditto for Sanders.

            Ditto for Warren, Klobuchar, Harris, Booker, Bennet, Buttigieg, Bloomberg, Steyer, Yang, Castro, O’Rourke…

            Obama handled Ebola the way health experts recommended and beefed up the US preparedness for future outbreaks.

            There is no way to categorize this as a both sides issue. That’s absolute nonsense.

    • FunnyDiva says:

      Newsom has the added advantage of knowing the “neighborhood” very well, having been mayor of San Francisco 2004-2011.

  9. person1597 says:

    From #1 daughter at vet school…this am…front lines of the pandemic:

    “The nurse got back to me. She said tests are in very limited supply and that i should just stay home unless i get worse then come in. She said they are only doing random testing when people come in for similar symptoms.”

  10. punaise says:

    Newsom gets some flack for being a bit wonky, but I’m generally supportive. I listened to his press conference on the car radio (on the way to meet a potential client whom I had to remind to “elbow tap” instead of shaking hands), and I found his competence and transparency reassuring.
    Oakland mayor Libby Schaaf has been saying the right things, too. West Oakland – where the port is located – has a history of serious environmental inequality for its relatively poor, mostly POC population, and she was sensitive to that. The district’s councilperson had her back.

    punasiette’s classes at Berkeley Law (and all of UC Berkeley) have all been put online for two weeks, no live classes.

    Some friends and I have tix to a concert at The Fillmore in SF on Friday. With a capacity of 1,315 it would seem to fall under Mayor Breed’s directive to shut down (events > 1000 people). Yet in today’s paper the concert promoter said shows will go on. Something is out of sync there.

    I had some mild allergy-related sniffles this morning, and my staff was giving me the evil eye like I was Typhoid F’ing Mary. Fortunately the Claritin kicked in while I self-quarantined in my office.

  11. StarRN says:

    Rayne, I hope your child gets better very soon! Thank you for writing this post.

    Not a physician, but PhD, RN here. The thread published by DocBurke has a lot to unpack, including some things I hadn’t heard about as of yet. He noted two important take-aways: First, according to the author of the thread, some patient deaths are due to viral infection of heart muscle (what DocBurke is calling “fulminating viral cardiomyopathy”) and subsequent cardiac arrest, as opposed to hypoxia (decreased tissue oxygenation) due to an inability to ventilate (breath in and out) adequately. Second, steroids seem to make things worse for some patients. This is important because steroids are used to reduce inflammation, and the thread author also noted that there are questions about increased mortality associated with widespread steroid use in China (i.e., ventilator associated pneumonia/hospital acquired pneumonia secondary to treating all COVID-19 patients with steroids).

    On DocBurke’s Twitter there is another long thread by “Hi, I’m Dr. Chen and older than I look”. I apologize for not linking, I’m not sure of how to do that correctly. It’s worth a read. Dr. Chen attended the Infectious Disease Association of California Northern California Winter Symposium on March 7, and shared information from that meeting. He also noted that “…there may be a component of cardiomyopathy from direct viral infection as well”.

    Apologies for the very basic information here and if I have misunderstood the authors. There is certainly more to these anecdotal stories that needs to be understood. I couldn’t find anything peer-reviewed and published about COVID-19 and cardiomyopathy yet on PubMed, but it was a quick and dirty search and I may have missed something.

    • Rayne says:

      Thanks for looking at that physician’s observations. The cardiomyopathy is likely why the mortality rate is higher among cases with cardiovascular disease as their hearts are already compromised to some degree. I wish I understood the inflammation mechanism since diabetics are also at higher risk and there must be some key difference in their inflammatory response to the virus. Explains why a comment I saw in another thread mentioned tocilizumab, an anti-inflammatory medication used to treat rheumatoid arthritis, as a treatment used in northern Italy (probably a desperate measure which worked).

      I’ll look at Dr. Chen’s thread, thanks much. Link to that thread for anyone else interested.

      • Parker Dooley says:

        Tocilizumab, a monoclonal antibody directed against the receptor for the inflammatory cytokine IL-6, is FDA approved for treatment of cytokine release syndrome (cytokine storm) which was thought to have been responsible for deaths of young people in the 1918 pandemic. I am assuming that this is the rationale for its use in the Covid-19 context.

        • Rayne says:

          Oh wow. That right there. Bingo. I’m no doctor but that mechanism makes perfect sense to me. Thanks, Parker.

          I wonder if they hit on that therapy in part because doctors other than the usual general practitioners/internists/hospitalists were called upon to serve patients due to the shortage of physicians from excess patient load and illness.

        • Rayne says:

          Looks like tocilizumab could become the method of treatment for certain patients though its use is off-label. See this article from Italian outlet Le Giornale (open in Chrome and translate) — as I suspected, a doctor working on COVID-19 outside his specialty suspected tocilizumab would work on what looks like a cytokine storm. Fascinating how serendipitous this was, forced by the collapse of health care system both in Italy and China.

          There’s a preprint, unreviewed study on tocilizumab’s application in China, need to hunt it down again after I accidentally closed the link last night in an incognito mode window (dammitall). We will owe a massive debt to China for their studies on COVID-19 patients in the middle of their own crisis if we are able to save American lives because of what they learned and shared.

      • StarRN says:

        You’re welcome, Rayne. Tocilizumab use is interesting and makes sense. I couldn’t find the pre-print publication you mentioned below either, but I did take a look at and I couldn’t find any registered studies. Hopefully someone is formally looking at this so results can be shared, one way or the other.

        • Rayne says:

          I found a post at the blog for Infectious Disease Society of America in which there’s a link to a study, “A multicenter, randomized controlled trial for the efficacy and safety of tocilizumab in the treatment of novel coronavirus pneumonia (COVID-19)” which I think is the one I was reading last night. Unfortunately I can’t open the link to the study now (which is worrying me). Working on writing another post in which this drug will be discussed. More later!

    • LillyH says:

      Trying to understand the thread from Doc Burke. Sounds like some patients with respiratory failure get intubated and ventilated, and improve. Then, late in the course, have the virus attack the heart resulting in cardiomyopathy which can prove lethal. Some patients have had normal “ejection fraction” (how much blood the heart is pumping out to the body) on admission which decreases when the virus attacks the heart. Seems like there is no acute hepatitis caused by the virus and the increase in liver enzymes is transient. ?not sure about kidneys. Still looking up stuff.
      So, being old with underlying lung or heart problems or other chronic conditions such as diabetes may not be the only determinant of mortality rates. Not if, just when you start looking better like you might survive, the virus attacks your heart.
      This is exactly the kind of information that must be widely shared by the doctors in the clusters with those who will soon be needing all the information they can get.
      The drug treatment sounds promising. Wonder who makes that.
      Thanks for that thread.
      I’m a cancer survivor (20 yrs) and only have half a lung on the right side. Unless we flatten this curve, they won’t even bother to intubate me. YOLO so I’m off to Florida for vacation tomorrow with 3 friends. May spend some time sitting on the beach – 6 feet from anybody. :-)

    • FunnyDiva says:

      Thanks for that, StarRN.

      I can’t read the abbreviations well enough to translate the medical details. One thing did jump out at me, though.
      “thank goodness Evergreen has isolation rooms”
      That’s the hospital that treated so many from that first nursing home in Kirkland. It’s possible some of those cases are described in that thread.

  12. Pajaro says:

    Watched the short speech, not enuf booze in the house for all the lies… Included: Ban on all Europeans travel to US for 30 days (UK excepted). Some sort of SBA loans to small business affected by virus (fracking drillers affected by market panic?). Will await other’s analysis and transcript. Now my eyes need 20 second wash with soap for watching that crap!

    • Rugger9 says:

      It has been noticed by Politico (among others) that the exemptions are for places where Trump Org properties are, because the UK yesterday reported the highest number on new cases yet.

      Follow the money….

      • Vicks says:

        I stated somewhere else on this page that i can’t imagine Trump having any interest in running this country in times of struggle, and it seems as if he has thrown many of his corporate sponsors he needs for a re-election to the wolves.
        I think we need to carefully examine how he benefits from any of these strategies he is throwing out there. They could all could be part of his exit strategy.
        Many of his plans seem they would benefit the vultures who will scrape failing business off the floor.
        I have a visual of Trump in a captains hat pretending to “drive” a giant gold plated luxury cruise ship flying a “Trump” flag (similar to the other eleven) he bought at a fire sale with the money he borrowed for practically nothing thanks to his hammering Powell.
        Surely he has reorganized his debt at least once since the fed caved?

        • Vicks says:

          I also believe the delay in testing was and this odd travel ban should both be investigated for their use as leverage for Trump’s political or financial gain.
          The delay in access to working test kits makes zero sense for a country with our money and resources and I think it reeks of Trump’s Ukraine grift

  13. BobCon says:

    Financial reporters are really struggling to get it through their heads that the virus doesn’t respond to action by the Fed or the Ways and Means Committee.

    They seem stuck on the idea that markets are somehow only thinking about interest rates and fiscal plans, and not taking a look at the state of the US response. You can bet that every big investment company is calculating how many people in the US are projected to catch Coronavirus in different containment scenarios, and right now they are trending toward the pessimistic options based on Trump.

    Similarly, political reporters are hung up on the idea that voters are only influenced by PR around the virus and not its progression in the US. They’re wedded to the concept that Trump’s failures are irrelevant as long as he can talk his way out of them, as if people won’t be influenced by the number of cases and their outcomes.

    I have to assume these reporters will eventually face reality, but I’m not sure it will ever really sink in that their rote approach is broken.

    • Rayne says:

      It’s too big for financial reporters, has too many moving parts of which some are outside their field of expertise. It’s worse than their systemic failure in 2007-2008 because they could have and should have seen the collapse coming. They had explicit warning from the 49 states’ attorneys general via Eliot Spitzer’s op-ed in Washington Post, February 2008, one month before Bear Stearns crashed. But no — they just plain ignored it, too eager to chase both Spitzer’s scandal and Bear Stearns’ crash a month later.

      They’re still chasing the wrong things now. They were even warned last July things were dicey, but misogyny blinded them as always. All the problems needed just a little push and *boom*.

      • BobCon says:

        I think a lot of the entrenched, hackish side was annoyed that she was smarter than them and wanted to end business as usual.

        The running irony is that would have meant boom business for the media; but the threat to the status quo with even a small amount of personal risk was more than they could bear.

    • e.a.f. says:

      what ever the political reporters “difficulties” the public will not be swayed by P.R. and such once their friends and family are dying.
      When the reporters themselves come down with the COVID 19 they will realize they were off on the wrong track.

  14. harpie says:

    So, about FAUCI, I had a thread on Quinn’s post

    There are examples of Fauci telling Sean Hannity last night and House Oversight this morning that COVID-19 is 10x more lethal than the flu.

    Trump pulled him from the oversight hearing today.
    Now there is this:

    Trump fears emergency declaration would contradict coronavirus message
    Trump is concerned that declaring an emergency would hamper his narrative that the coronavirus is similar to the seasonal flu.
    03/11/2020 04:12 PM EDT Updated: 03/11/2020 06:46 PM

    […] Trump’s concern at this point is that going further could hamper his narrative that the coronavirus is similar to the seasonal flu and could further agitate Wall Street, said the three people familiar with the discussions.

    “The president isn’t persuaded because [an emergency declaration] contradicts his message that this is the flu,” said a Republican who speaks to Trump.

    Health experts have rigorously disputed any assertion that the coronavirus is equivalent to the seasonal flu, noting it is much more lethal and particularly dangerous to the elderly and those with other health conditions. […]

  15. Vicks says:

    Did Trump just make promises that if amount to anything, will bankrupt our country?
    Did he just point to Europe (but not the UK!) as a new target for his followers? Does he or his family need something from XI?
    50 billion dollars for sba loans?
    Is Trump going to co-sign them?
    It doesn’t matter how low the interest rate, The SBA does not loan money to failing businesses.
    Yippee! no copays!
    What if you don’t have ANY FREAKING INSURANCE because you lost your job?
    I’m sorry, I know there was some good in what he said, but I know damn well that most will end up being a shit ton of lies meant for his base so they can run around defending him, while he and his “organization” figure out a way to use this as cover to pursue whatever swamp deals they are cooking up while our country burns

    • Rayne says:

      He targeted EU sans UK because that’s what both his buddy Putin and his Nazi aide want. Serves their interests.

      I want to make it clear I think the US should have banned travel to/from Italy when Italy put Lombardy in quarantine. We did not need to add to Italy’s burden; we had no system in place to quarantine travelers from Italy on arrival. It doesn’t matter that we already have many cryptic COVID-19 cases in the US as of last week; the point is not to balloon the number of cases here and in over-taxed Italy.

      Banning travel to the rest of the EU which has so far not become as stressed as Italy isn’t productive. Nor is pretending nothing is wrong in the UK, which has fewer hospital beds per 1000 persons than we have in the US and may see an explosion of cases within the next 10 days. Only common thread running through Trump/Kushner/Miller speech is racist nationalist populism.

      • Katherine M Williams says:

        Yes, the UK exception to the travel ban is rather eyebrow raising. The UK is struggling with COVID-19, their hospitals are already becoming overwhelmed. They keep expanding their beds-for-COVID-19 patients, and the beds are instantly filled, same day.

        But Russia has already pretty much wrecked the UK with their Brexit success, so no need to further upset them, I guess. Now they’re concentrating on the EU & NATO. With help from the GOP.

        However, Russia is also suffering from COVID-19, although there is no believable information being reported, they are probably worse off than Europe or the USA. Taking down the Western countries alliances may not work out so great for them after all.

        It’s a good example of why even rogue nations have never practiced germ warfare. Too much backwash.

        • Rayne says:

          I forgot that tangerine hellbeast’s goddamned golf courses in Scotland and Ireland. That’s the reason why travel isn’t restricted along with kissing up to that stupid feck Boris Johnson.

          It’s all about that malignant narcissist — that’s the rule of thumb for his decisions. It’s never about the safety and security of the American people or our allies.

          • P J Evans says:

            I don’t think he has any property in Northern Ireland – the one he has is in Eire, which isn’t part of the UK. He’s most likely thinking only of the two money sinks he owns in Scotland.

            • Frank Probst says:

              I think (and it may have changed while I was writing this, so please double check it) that the countries that are part of the ban are the ones in the Schengen Area. Ireland is not part of the Schengen Area, so it won’t be included in the ban.

      • e.a.f. says:

        The U.K.. health care system has been in trouble for the past several years and won’t be in good shape to deal with this crisis.

      • BobCon says:

        I would not be surprised if Miller is trying to set the table for a massive crackdown on non-whites with this as cover for Trump not being racist.

        I doubt anyone there has any idea how to do that without making many things worse, but I’m not sure they care.

        • Vicks says:

          Trump’s entire act made my skin crawl.
          “What is the self serving agent of satan up to now?” was my response to every word that came out of his mouth.
          I’m watching Pence on CNN right now obviously comforted by the fact that “lying to the media is not a crime”
          There is something off to the test delays, there is something off on the travel ban, there is something off in 50 billion of taxpayer dollars going to the SBA for business loans.
          The SBA DOESN’T fund loans, they partially guarantee them and negotiate extended terms and lower interests with banks.
          These loans are very difficult to qualify for and It takes months (and months) from application to funding. In simple terms, if a business qualifies for an sba loan, the owners can walk into ANY bank and painlessly get a low interest loan or a line of credit, and just like a bank the sba will instantly disqualify companies struggling because they lost their customers and don’t know when they will come back.
          Something is up with Trump’s transparent repackaging of his desire to lower interest rates. He also went off his prompter to again mention cutting payroll taxes despite getting a universal thumbs down, adding in pure mafia style “he hopes congress will consider it”
          Neither of these will help a company or people under duress, what then justifies the pressure?
          Trump has thrown certain industries that he once protected to the wolves and is dancing near the edge of xenophobia, it’s important to keep an eye on who and what his “policies” hurt and who and what they are helping.
          Keep in mind the scavengers of the business world, both corporate and private looking to pick off weak or failing businesses would reap huge benefits from cheap money on extended terms.
          Sorry for the ramble but I am confident that we are watching Trump get his ducks in a row so if this virus costs him the election, (frankly it’s easy to see him losing interest in the job if things stay as they are) he will still come out a “winner”

          • cavenewt says:

            “The SBA DOESN’T fund loans…”

            Well, on rare occasions they do, or at least they did. Because I got one during the Jimmy Carter administration. Carter had a program to encourage women in business and I got a direct SBA loan for $20,000 to open a custom photo lab. It did, however, take a phone call to my senator to loosen up the actual funding.

  16. Eureka says:

    The NBA just suspended the rest of the season. Utah Jazz player presumptive positive had delayed that game, then just now the league-wide announcement.

    • Eureka says:

      Yeah it was on post game live after Pistons at Sixers so I pretty much heard right away. Jazz and Thunder teams all in quarantine now, they also said.

    • BobCon says:

      Tom Hanks and his wife Rita Wilson tested positive in Australia. He’s said they both haven’t had bad cases to date.

      • Vicks says:

        If it can happen to an NBA basketball team it can sure as hell happen to a fire department or some other urgent service group.
        I have been hunting around for any proof of Europe (but not the UK!) being a larger than normal contributor to the local outbreaks we are having here, and there really isn’t a lot of info available, we have only had one tourist that got sick here, there rest seem to be locals that brought it back and infected others, two people that came back from Australia that got 9 people sick, 4 or five cruisers who quickly knew to quarantine, and a whole lot of people that had returned from “international travel”

        • e.a.f. says:

          the last figures on western Europe was that the countries didn’t have many COVID 19 cases but that was last week and as Gov. Inslee’s figures reflected in news conferences, the numbers can jump just over night.
          For European news some times checking the Guardian helps. Me, I’ve go to email the cousins and check out how they’re doing.

        • Rugger9 says:

          Or the ICE facilities, jails and prisons, where the standards for maintenance are not strictly enforced. This will spread like wildfire there.

      • cat herder says:

        I know it would be bad (or, like, whatever) if a few million of us die from this, but we have to remember what’s truly important in life: celebrities and sportsball.

        • Vicks says:

          The arenas where they play these “ball sports” employ thousands (and thousands) of hourly employees.
          They offer flexible schedules that allow not just steady work, but an opportunity for families that can’t afford child care a way for the second parent to work.
          I think we all have to take a step back and see that when one piece of this puzzle falls, it does not fall by itself, it will almost always take other pieces of the picture down with it.

    • Eureka says:

      Since they share arenas, NHL to announce a decision tomorrow, they just reported.


      Bobcon: I was relieved to see that that is why Betty White is trending! [Folks wanting to bubble-up her (and RBG and others) on the Hanks-WIlson news.]

      Vicks, we do have a local area cop infected. (Also a doctor- pediatric cardiologist: lots of schools were closed for disinfection over that one.)

      • FunnyDiva says:

        First responders to that first nursing facility cluster in WA also coming in positive, iirc. Also self quarantining since many responded to cases before anyone was told by the facility what they were dealing with and that they needed PPE. And early reporting was that the STAFF wasn’t informed until after the first responders said “Hey, where’s your PPE, you’ve got coronavirus!”

        I can dig up the KUOW reporting if it hasn’t been linked here before now.

        • Eureka says:

          It’s tragically sad, but it sounds like all of those horrible lessons from WA are being heeded very carefully elsewhere now (public health/other officials are regularly telling people to call ahead to Dr/ER / tell 911 so responders can prepare in advance, etc.)

          • FunnyDiva says:

            Yes. It’s still tragic and frightening here at the epicenter of the Pacific Northwest.

            Good on any other state and local (hey, even federal) officials who are watching WA and learning the lessons.
            get cracking, there’s very little time to act based on those examples and lessons.

    • Eureka says:

      Welp, that’s one way for Brett Brown to keep his job.

      [Sorry Katherine 816p (comment above seeking humor): this *is* a really funny joke if you are a Sixers fan, but I’m guessing that that is not one of your crosses to bear ;). Every time they lose, usually on the road, “Fire (coach) Brett Brown” trends. Take the home W and quietly slink away.]

      And in all seriousness, there is real worry for how all of the arena workers in cities all over the country are going to earn a living.

  17. harpie says:

    A series of observations from a few days ago:

    1] Americans divided on party lines over risk from coronavirus:
    Reuters/Ipsos poll
    Brad Heath MARCH 6, 2020 / 2:24 PM

    “About four of every 10 Democrats said they thought the new coronavirus poses an imminent threat, compared to about two of every 10 Republicans.“

    10:25 AM · Mar 7, 2020

    Political divide might shift rapidly as the effects of the pandemic become more visible & felt. There’s a real possibility that Trump will shift from “positive thinking” mode to “fear-mongering” mode: blaming coronavirus on foreigners, immigration, globalization, big cities etc

    3] Robert Wright [link in next comment]
    10:41 AM · Mar 7, 2020

    Already seeing signs of this tactical shift, with Pompeo now insisting on calling it the “Wuhan virus.”

    • FunnyDiva says:

      Holy CRAP, though.
      that’s still 60% of *Democrats* DON’T think it’s an imminent threat.
      All I can say is I hope these people will pay attention to how things unfold in WA state over the next several weeks.
      But, you know. I’m biased. I’m in the county with the VAST majority of the state’s confirmed COVID-19 deaths to date. I don’t think I live even 10 miles from that nursing facility in Kirkland where that first cluster of patients died.

      Ai yi yi.

      • Rayne says:

        That report about the survey was March 6. Opinion is going to shift as quickly as the virus spreads and the market tanks.

        Bet the next survey says at least 70% of Dems say the virus is an imminent threat.

      • Katherine M Williams says:

        “…that’s still 60% of *Democrats* DON’T think it’s an imminent threat. Wow.”

        Well, they’re voting for dementia-patient Biden. Dem voters brighter than repub voters, but that doesn’t mean much, I guess.

        • P J Evans says:

          Biden doesn’t have dementia. Trmp seems to have it – and projects more than an IMAX theater. You’re repeating GOP propaganda with that one.

        • Vicks says:

          It’s a processing thing, Biden has struggled with it since he was a kid, yet somehow despite what is clearly a disability, he now finds himself in the position to take out the current president of the United States.
          a man-baby who is still hasn’t grown up from the vile, juvenile bully who desperate for attention, mocks people like Biden to show off and deflect from his own insecurities.
          All I can say is Karma is a bitch and he/she/it is jamming up our current “leader” in ways many of us never saw coming.

          • cavenewt says:

            ‘All I can say is Karma is a bitch and he/she/it is jamming up our current “leader” in ways many of us never saw coming.’

            I keep thinking of War of the Worlds. Substitute Trump for the terrifying and relentless invaders, and the end of the story writes itself.

      • Vicks says:

        I think most people are still looking at this from the narrow lens of “me and mine”
        I don’t think it’s necessarily from a selfish perspective, but just because it takes some more thinking and information to see the bigger implications.
        My local news is talking a lot about hand washing and the latest on the numbers but nothing about what happens when a whole lot of people get sick, (and 20% of those really sick) at the same time.
        I’m not even sure if those reading the news get it.

  18. cat herder says:

    Went to the grocery store earlier today and everything seemed completely normal, which is absolute insanity. Mississippi is still free of any confirmed cases, I would guess because of not testing anyone, because why test when there aren’t any confirmed cases here, right?

    p.s. Ever thought about how impossible a trip to the grocery store is from a contagion viewpoint? The carts don’t get disinfected, at least not in this part of the country, and at least not in any way that would kill a virus that can live for days on hard surfaces. If you wear gloves that doesn’t help. Cart contaminates your gloves, your gloves contaminate everything you put in the cart. You unload the stuff into the car and now the car’s contaminated. When you get the stuff home, how the hell do you decon a bag of potato chips?

    • Eureka says:

      Best I could figure out for that one is to shop a week ahead and let the stuff sit and ‘dry out’ for awhile before using. But who can really do that for most stuff? And how long would it linger in the fridge (assuming even a set-aside space available in there). Would love to hear suggestions.

      • Rayne says:

        I’ve rinsed off the milk jug before I put it in the fridge, using just soap and water. Most canned+jarred goods go into my pantry and sit more than a week so I don’t worry about them.

        I rinse all my fruits and veggies in a solution of water and white vinegar, dry well. I rinse well and spin dry my greens — and eat when desired. I’ve done this for all my produce because there’s been a risk of E. coli and salmonella all along, as well as bacteria which hasten spoilage. If I haven’t gotten food poisoning from produce cleaned this way, I’m probably not going to get a viral infection from it.

        Anything else I’m worried about I spray with either isopropyl alcohol (if not edible) or white vinegar, or a solution of bleach and water (if not edible). See this article for more discussion as well as the bleach/water ratio.

        • Eureka says:

          That’s a good rubric. I usually use vinegar and isopropyl for stuff like that/general cleaning but couldn’t get the latter last try. Hopefully restocked.

          I need to cook some real damn food, too much menu by Wawa lately.

          • Rayne says:

            Could look for denatured alcohol, but you’ll have to check the alcohol content as it must be over 60% to be effective as a disinfectant if used undiluted.

        • cavenewt says:

          I have not seen vinegar mentioned as something that can kill the virus. Does it? Because that’s what I use for cleaning anyway.

          • Rayne says:

            It’s not registered with the EPA as a disinfectant and I’m not certain what percentage of acetic acid is necessary to kill viruses. But it has been been used as a disinfectant. I buy cleaning vinegar which is 6% strength as compared to 5% white vinegar (food grade); Kroger sells the 6%, stocked in cleaning aisle near ammonia.

    • Vicks says:

      I really think that it’s going to be fairly direct contact with someone carrying the virus that will be responsible for the most of the spread.
      I have a pretty active imagination but I can’t quite see someone sick spreading contamination like a sheet over every bag of potato chips that goes into every box on every pallet, and then have the intensity carry on at a level that could continue to infect your car your home and eventually you.
      On the other hand if you reach into a bag of chips you are sharing with someone that has the virus or who has been in close contact with someone who is sick it’s a different story….

    • cat herder says:

      Mississippi reports first presumptive positive COVID-19 case

      “The Mississippi State Department of Health Wednesday evening reported its first presumptive positive case of coronavirus or COVID-19. The individual is a Forrest county man who recently traveled to Florida, the agency said in a news release. Final verification will come from the Centers for Disease Control and Prevention.”–case/article_a66d98ea-5727-5cbc-a756-5625074ec774.html
      (no, that’s not a tracking hash at the end)

    • Katherine M Williams says:

      You can make wipes from paper towels cut into squares (or any shape you like) and isopropyl alcohol, keep them in a baggie in your purse or pocket.

      • Parker Dooley says:

        If you can’t find isopropyl alcohol at the usual sources, you can probably get denatured alcohol at the hardware, paint or boating store. Not good for martinis!
        Probably should be reduced to 70% (7 parts alc. to 3 parts water) for use.

    • e.a.f. says:

      have never seen grocery carts be disinfected. As to the handles, last week started using antiseptic wipes to clear the handles and then my hands. Got back to the vehicle, then used wipes again to clean hands, unloaded cart, cleaned hands, keys, etc. again.

      In flu season some grocery stores do have hand sanitizer at the door. Banks machines ought to have hand sanitizer also.

      As to cleaning salad stuff, stopped eating salad. It was easier.

  19. Donna says:

    “I never expected to have to tell one of my kids not to come home.“

    Rent a Winnebago – park it in your driveway or backyard – and stick him in it for 3 weeks. Just leave him food on the steps with a tub full of soapy water for dirty dishes.

    • Rayne says:

      LOL That’s a good one — which of you folks was going to end up in a van down by the river? Can I rent your van for my kid?

      Thanks, Donna, might be the first good laugh I’ve had today.

      • Eureka says:

        LOL, you are not playing Nat King Cole for me today? (I also offered to loan it to you — before you specified the kid’s news. Kid could take it, but am not sure its navigability for long distances. Leftover WC van, but it has a place to sleep.)

        • Rayne says:

          That van down by the river is going to be crowded at the rate we’re going, Eureka. You might be able to list it on AirbNb. LOL

          • Eureka says:

            Come to find out, local chipmunks have taken up residence, declaring it their “safe space.” They don’t want to catch our filthy zoonosis, either!

  20. Rayne says:

    I need to stash this link someplace — thread by Director of Johns Hopkins SPH Center for Health Security re social distancing. Note tweet 3 in the series.

    Threadroll link for above.

    His points are really quite late at this point in the emerging epidemic. Should have discussed this on/before March 1 to have any chance of slowing Washington state’s cluster.

    Adder-1: Link to threadroll, ICU physician Dr. Daniele Macchini in Bergamo, Italy via Silvia Strighini.

  21. paulpfixion says:

    emptywheel continues to be the most rational and clear source of information during this crisis. thank you to everyone who runs the site, and to the very informed commenters who take the time to share their thoughts.

    one note–would love it if the blog team ever made a podcast! something to consider? I’m quickly running out of benjamin walker the theory of everything shows as the house repairs in the time of cholera continue.

  22. e.a.f. says:

    It was the second child? Our middle sibling always says the middle child is the well adjusted one.

    Saw Dr. F. answering questions at some sort of political Q & A. thing and this politicians was getting quite nasty regarding the responses from Dr. F. What Dr. F. was even doing there answering questions from a bunch of politicians is beyond me. Oh right the politicians want to be seen to be doing something while doing nothing.

    This evening the C.B.C., (Canada Broadcasting Corporation) listed the non emergency numbers for each province. People were directed to call there to discuss their questions. In B.C. the phones are answered by Register Nurses, 24/7. You call 911 to have the police, fire or ambulance come, that is it. O.K. some times the questions can get weird but when it comes to health we call 811 and the R.N. will provide you with a lot of good answers. We’ve used the line and gotten answers like: go see you G.P., Call the Ambulance Now, if you can drive to the E.R. if not call an ambulance.

    Can’t figure out why Trump is banning travel from Europe and not G.B., except perhaps the Queen had him over for dinner and he wants another invite. Some countries in Europe have fewer cases than G.B. Trump’s statement doesn’t provide clarity on a number questions I would have. Can a person travel from Amsterdam to London and then the U.S.A. Can a person travel from Germany to Canada and then cross into the U.S.A. My suspicion is Trump will use this to get the deal he would like for a Free Trade Agreement with Europe. He won’t remove the ban until the E. U. caves to his demands. Its interesting he hasn’t “banned” people from S. Korea or Japan from travelling to the U.S.A.

    My take on it is, Americans might as well forget about the federal government being of much help in this. Trump is trying to figure out how much money he and his friends can make from this. If this work goes to a couple of large chain labs, is he or his friends going to be buying stock in them first? Why after all this time doesn’t the federal government have enough tests. S. Korea is testing 10K a day and they don’t have the money, resources or population the U.S.A. has.

    Saw Inslee on the evening news and they seem to be fairly organized in Washington State. Guess Trump has stopped call him a snake and a very bad man.

    Today Vancouver Island had its first confirmed case of CO VID 19. Man who had returned from Egypt. Tomorrow the things I’ve been practising for the past week start for real.

    • MB says:

      Where on Vancouver Island precisely? I have a friend who lives in Nanaimo that hadn’t heard of this…

  23. pdaly says:

    I got home late and so I’m late to this thread.
    I’ve gone through the first twitter feed Rayne linked to above and compiled a list of acronyms to help others to understand it.
    It took longer than I expected so I will put the list here for now and come back later on Thursday to comment more (when I can see straight).
    But a brief impression: agree with the two main points made that viral cardiomyopathy seems more commonly the cause of death and not the easier than expected to treat low oxygenation, and that we should avoid using steroids (both IV or inhaled) which may be allowing the virus to grow faster.
    Also concerned reading that hale 20 year olds sometimes succumbed to the virus.

    Medical acronyms

    1L NC. This is not an acronym but rather a shorthand for “1 liter of oxygen per minute via nasal cannula.” This is the plastic tubing with prongs for the nostrils.
The rate of oxygen flow can range from 1 liter (low) to 10 (highest) liters/min. 

    AE-COPD. (my guess)

    Acute Exacerbation of COPD

Airborne iso Airborne isolation. It is a designation in the hospital or outpatient setting for what type of PPE medical providers should wear when approaching a sick patient. Airborne implies the infection is in the air and can be inhaled if you are not careful. Airborne precautions require an N95 mask, goggles or face shield, gown, gloves. It also requires a specialized negative pressure room with air filters so that if the door to the patient’s room is opened even briefly, the negative air pressure in the room sucks air in from the hallway and thus prevents the pathogens from escaping from the patient’s room. 

    AKI. Acute kidney injury. It can have a variety of causes

ARDS acute respiratory distress syndrome: signs and symptoms include audible labored breathing at a faster than normal rate, low oxygen levels. Fluid fills in the small air sacs of the lungs making it hard to obtain a breath. Lungs suffering from ARDS often shows hazy white opacities (normally the lungs should look black in a normal chest X-ray)
ARDS can be triggered by a variety of things, including inhaling caustic fumes, choking on vomit, sepsis from bacteria, or idiopathic (no cause known)

BAL broncoalveolar lavage. A procedure using a bronchoscope to obtain a sample of the bronchial secretions for culture or pathology testing.

    Bronching. Performing a bronchoscopy. (a diagnostic procedure in which a flexible fiberoptic tube is temporarily inserted into the windpipe and the Left and Right bronchus to view the airways, sample secretions or obtain biopsy.

    Cap leak. Capillary leak

    CAPR Controlled Air Purifying Respirator.

    CDC. Centers for Disease Control and Prevention. Officially it was changed to CDCP, but people still drop the P from the acronym

    Comfort care. A choice by patient ahead of time or by the patient’s health care proxy to treat for comfort and eliminate all other interventions and testing. Used for someone who is at the end of life. Someone on comfort care would not be intubated. Morphine drips help take away air hunger even in someone struggling to breathe, so morphine is often used in comfort care.

    COPD: chronic obstructive pulmonary disease. People with COPD have breathlessness (emphysema is one type of COPD)

    COVID-19. Corona virus-19, the name of the disease caused by the novel corona virus named SARS-CoV-2, because this 2019 virus resembles the first SARS virus, also a coronavirus

    CT CT scan, computed tomography, also known as C.A.T scan (computerized axial tomography). A radiology test using a series of X-rays to obtain a cross sectional view (or sometimes 3 dimensional view) of a body part. In the context of this twitter thread, CT is being used as short hand for Chest CT (ct scan of the chest).
Chinese doctors had found that in China the Chest CT seemed like a better indicator of COVID-19 than the nasal swabs when the two results conflicted.

    CT’ing. Obtaining a CT 

    d/c discontinue (in other instances, DC can mean “discharge” as in ‘send home from the hospital’

    DNI. Do Not Intubate. (one of the options for a DNR or do not resuscitate order)

    Droplet iso. Droplet isolation. It is a designation in the hospital or outpatient setting for what type of PPE medical providers should wear when approaching a sick patient. 
Droplet precautions normally require just a surgical mask. However, more recently eye protection with goggles is also required.

dz disease

    EF. Ejection fraction of the heart ventricle (usually the left ventricle). It is an estimate of the percentage of the blood volume that is pushed out with each heart beat.
    A normal EF is a reading above 50%. An EF of 40% is abnormal but still close to normal. By comparison an EF 10% is very low and the heart is barely pushing blood out of the ventricle with each heart beat. This leads to heart failure.
You can develop a decreased EF from accumulated damage from a heart attack or from cardiomyopathy (including acute viral infection)

    EOL End-of-Life

    ETT. endotracheal tube (in this context). 
ETT can also mean “exercise tolerance test” in cardiology notes

    FLOLAN (epoprostenol)
    A vasodilator to help patients with pulmonary hypertension.
    Avoid use when the heart’s ejection fraction (EF) is low.

    FM face mask. Used to deliver more oxygen than the standard nasal cannula

    GNR. Gram negative rods (these are a type of bacteria.)

    HC 100IV Q8 This is not an acronym but rather a shorthand for “Hydrocortisone 100 mg by

    IV every 8 hours”. This is a high dose anti-inflammatory steroid treatment that some think can decrease lung inflammation.

    HD Center. Hemodialysis center

    HFNC Highi Flow Nasal Cannula. It is actually a heat and humidified high flow nasal canula, but shortened to HFNC. Helps children and adults in respiratory failure.
    By heating and humidifying the oxygenated air, the mucus membranes remain moist and the warmth decreases the calories the body needs to expend to stay warm (compared to the drying action of non humidified oxygen delivered by regular nasal cannula.

    ICS Inhaled corticosteroids. (examples, Flovent, betamethasone)

    Idiopathic relating to a disease of unknown cause

    Infxn abbreviation of infection

    Iso. Isolation (in this tweet). Other cases i/s/o or iso can means “in [the] setting of”

    LAD Lymphadenopathy

    LFT Liver function tests which include the tranasaminases ALT and AST and bilirubin level

    LVO. Large vessel occlusion

    MOSF. Multi-organ system failure. This is obviously a bad sign that the patient is critically ill. Could imply evidence of kidney, liver, heart and/or lung function worsening.

    NIH National Institutes of Health

    nl normal

    NPPV Noninvasive positive-pressure ventilation. A tight fitting face mask or nasal mask used to help provide ventilation without using an endotracheal tube in the windpipe. CPAP and BiPAP are usually mentioned in this setting

NRB. non-rebreather mask. It is face mask with a bag of oxygen to deliver more oxygen to a patient than a nasal cannula. 

PAPR powered, air-purifying respirator It is a type of PPE that includes a mask or hood, fan and filter to protect medical providers dealing with high risk pathogens or volatile compounds, depending on the type of filter used.

    PCR polymerase chain reaction. It is a lab technique to analyze short sequences of DNA or RNA even when present in minute quantities.

    PEA. Pulseless electrical activity. This is a medical emergency. The tele monitor will show electrical pulses of the heart but there is no pulse or blood pressure. The patient is effectively dead without chest compressions and a quick survey to look for reversible causes of no pulse. Electric shocks will not help.

    PNA. Pneumonia

    PPE. Personal Protective Equipment. (anything from gloves, mask, face shield, gown). Various level of PPE exist depending on the perceived danger to the examiner to be infected or spread the infection to other subsequent patients. Air tight biohazard suits with their own air filtration is the highest level of PPE.

    ProCalc. Procalcitonin. It is a pro hormone produced by cells in the body often in response to bacterial infections. So a high procalcitonin level often indicates a bacterial infection, perhaps even bacteria in the bloodstream. 
HOWEVER when you have a LOW procalcitonin level in a critically ill patient, it can be a strong indication that bacteria are NOT the cause of the illness but rather a virus or some other cause.

    resp. Respiratory

    Resp Path PCR Respiratory pathogen panel PCR test: screening test for common viruses causing a respiratory infection. SARS-CoV-2 is not a virus included on the standard screening test.

    RV. Right ventricle of the heart

    SARS2. Abbreviation of SARS-CoV-2, the official name of the virus that causes the disease COVID-19

    SNF. Skilled Nursing Facility. Ex., a nursing home or an inpatient rehabilitation facility

    sx. symptoms

    Tpn. Troponin (blood test to rule it or to rule out a heart attack)

    Tube (noun: endotracheal tube, verb: intubate a person and manually or mechanically ventilate a patient)

    VAP. Ventilator associated pneumonia. A pneumonia likely related to use of the ventilator as the endotracheal tube may enable bacteria to get past the epiglottis and into the lungs.

    VF. Ventricular fibrillation. This is a medical emergency, Code Blue. Without cardiac defibrillation with the electric paddles to reset the heart, the patient is likely to die.

    VT. Ventricular tachycardia. This abnormal and fast heart rate will set off alarms. If it is not quickly corrected and lasts too long it can lead to VF and death.

    WMA. Wall Motion Abnormality

      • pdaly says:

        You’re welcome. Some of the formatting didn’t survive when I transferred from my notes to here, so you’ll find a few entries embedded in what look like larger paragraphs above.

    • Rayne says:

      When you put it that way it looks really, REALLY bad, huh? Thanks for taking the time and effort to put all that together. It will be very helpful for folks who don’t understand what happens when a COVID-19 patient begins to show signs of fulminating viral cardiomyopathy — which is in the simplest terms, severe inflammation of heart tissue.

  24. Eureka says:

    My rep last night had a nice telephone town hall on COVID-19, with a group of county and state public health officials, a VP of a hospital (preparedness) association, and a former director of the CDC (we’ve got a little bit of a hotspots situation going on here). Emphasis was on the usual preventative advice with *flatten the curve* being a main theme. (I didn’t get my question in the queue soon enough, and they prob wouldn’t have taken it anyway — too scary ~~ re the Italy model; also a case they haven’t traced to known source yet).

    At the federal level, I still haven’t gotten a look at their appropriations bill (it was in rules committee last night), but that and a million masks were mentioned.

    They also emphasized going by only reliable sources on social media: WHO, CDC, and the state department of health were the only ones offered.

    Anyway, by coincidence this all kind of goes with the meat of one of your three things, and caused me to check out the county website (had been going with state, JHU, local news, etc). Turns out they have a nice little arcgis map modeled after JHU — good on them! Avail in other languages, too.

    I’d wondered when JHU’s map abandoned the county designations if they were ~ driving people to local resources — who knows — but the county is now showing the finer-grained data, at the level of municipality.

    Separately, in the news, officials have talked with the vulture capitalists who shut down a local hospital, as a potential source of beds should the need arise. There might be more of them scattered about the country for potential re-commission.

    • harpie says:

      I think there may be a lot of shut-down hospital availability, especially in rural areas. This is one idea that should really be pursued. I don’t know how feasible…but it’s got to be faster than building a whole new hospital, as China did.

      • P J Evans says:

        The town where my mother grew up has one that was shut down a year or so back – they could probably reactivate it to handle this, as the active hospital in that county is miles away.

      • Eureka says:

        Yeah and I keep thinking of the commenter here who has written about retro-fitting negative pressure ventilation — they could be doing that to whole (closed) wings right now.

  25. Eureka says:

    FYI, addresses myths apparently going around (hmm, I wonder if Putin’s chef is helping to prepare this meal):

    Don’t believe the myth that blacks can’t get coronavirus | Jenice Armstrong

    Which reminded me of this, written by a popular TV anchorwoman re discrimination that was going on before even any cases around here:

    Nydia Han: Being Asian doesn’t mean I have coronavirus | Perspective

      • P J Evans says:

        So are Japanese restaurants. (Sushi and teriyaki aren’t Chinese. But bigots may not know that, or care even if they do.)

        Reminds me of the Iran hostage thing – people weren’t patronizing restaurants in the US, apparently on the assumption that “they’re all the same”. The one my family supported was run by people who had left to get away from the shah. They became citizens in 1979 – my parents were their sponsors, ad the celebration dinner afterward was apparently a real feast.

  26. Pete T says:

    Rayne – are your parents ready?

    One maybe two in Lee Coutny. Three now in Broward – all seem to be Port Everglades Princess cruise related, but part time workers for Princess. No doubt more to be reported today and no doubt many more will go unreported.

    My wife FINALLY cancelled her 10 day trip to London set to start this Saturday. Her travel mate has now also cancelled. They were chaperones for a college group set to study the Black Plague. How apropos.

    Daughter, hubby, and two grand daughters set for a long weekend at Disney Orlando starting today. Not sure yet if they are going.

    Everyone do what you should be doing and take care. Several more months to go – maybe many more months.

    • Rayne says:

      My folks and I have been exchanging a lot of emails, no confirmed cases in their FL county — yet. I know they have their health care directives and other documents prepared. They earned their paralegal certifications nearly 20 years ago to ensure they were up to preparing the documents they needed (lot of complex family stuff including disabilities). That’s the responsible thing EVERY ADULT regardless of age should have prepared: health care directives with a chain of authorized advocates in case of disability, and a will.

      Thank goodness your spouse isn’t going to London. Those Tory jackasses are Trumpian, just not as addled by dementia. Johnson and his henchman Dominic Cummings want the UK to acquire herd immunity through exposure. YES. I AM NOT JOKING, THEY ARE THAT FUCKED UP.
      Link: They have fewer hospital beds per 1000 persons than the US (and we are so going to be fucked) and they’ve lost health care workers due to Brexit, but they think they can have a controlled exposure to COVID-19 so what if it culls the herd…Jesus Christ, I can’t.

      Really hope your family doesn’t go to Orlando, though it will be difficult to explain to kids why not. Good luck.

    • harpie says:
      8:12 AM · Mar 12, 2020

      So Kushner and Miller wrote a speech that
      1) endorsed a policy that is utterly pointless which
      2) they made clear by including exceptions that swallow the rule which
      3) they then tried to claim didn’t say what Trump read from a script which also
      4) misstated insurers commitments.

      By putting his Clown Prince and favorite racist in charge of this speech rather than putting experts in charge of it Trump caused a trillion dollars of damage to the world economy.

      Republicans, it should be said, have tacitly agreed to putting Kushner in charge of things he couldn’t hope to understand, in part, by doing nothing after Trump gave him clearance over the judgment of FBI.

      HIRING and allowing MILLER to run roughshod over US is IN ITSELF the ONLY reason necessary to FIRE TRUMP. [IMveryHO]

    • harpie says:

      [Includes link to “Families First Coronavirus Response Act,” H.R. 6201 and link to Summary]

    • harpie says:

      Also, via Laura Rosen:
      11:45 PM · Mar 11, 2020

      For the budget folks, let’s all read this section from the Emergency Paid Leave section of the summary (page 4 of the doc: [link] [screenshot of section 603 and 604]

      should note that the paid leave applies to companies with 50 or more employees and is temporary. But this is still a pretty sweeping proposal.

      I also note that 604 SPECIFICALLY protects Social Security funds.

      • harpie says:

        604: Social Security’s Trust Funds and regular administration will be kept separate from this new program and cannot be used to administer or fund it

    • harpie says:

      9:13 AM · Mar 12, 2020

      NEW … Several House Republicans tell me they have no idea if the W.H. is going to support the House Dem coronavirus bill. Lots of frustration in the GOP ranks right now, as lawmakers look for guidance from the president.

      10:03 AM · Mar 12, 2020

      and here it is officially we’re standing by for McCarthy’s presser in the Capitol


      ANSWER IS:

      “LOL, LOL, LOL”…NO

    • harpie says:
      11:34 AM · Mar 12, 2020

      McConnell ally says Senate won’t take up House #coronavirus bill until after recess. “The Senate will act when we come back and we have a clearer idea of what extra steps we need to take,” Sen. Lamar Alexander told reporters.

      Responding: [David Waldman]
      11:52 AM · Mar 12, 2020

      Stop looking for hand sanitizer and buy pitchforks.

      • e.a.f. says:

        they’re going to wait until after a recess???????? are these people nuts or what. By the time the recess is over there could be over a 100,000 cases in the U.S.A. Inslee, Washington St., advised they could have 60K cases in 7 weeks. so yes, it would be more than 100,000 cases after a recess. So lets see 60K times 50 equals, I think 3 million cases. Oh, the funeral homes are going to make just so much money!

      • Eureka says:

        Thank you harpie, here and throughout, for updates (I can always tell from your threads how the story evolved). (Also, what a pack of assholes = GOP.)

        Un-be-fuckin-lievable abdication of their responsibility. They are holding our lives hostage, this is crazy.

  27. gulageten says:

    Just an anecdote to add to the mix. I am a regular vendor at a large bi-monthly record show in my city. I decided a few days ago that I wouldn’t be going on Sunday, but I waited to see if it would just be canceled outright. It draws all types, but a large portion of attendees are wheezy, poorly-washed, and/or aged 60+. And again, it’s a record show: the very purpose of the gathering is to handle each others’ stuff. Cash moving around, etc. It’s a germ hazard under normal conditions, but it’s what we do.

    So yesterday, not having heard anything about it being canceled, I let the organizer know that I would not be attending. Much to my surprise, he said I was the only vendor out of 75 to cancel. Made some comment about the media having gotten people worked up, etc. I did not reconsider.

    • Rayne says:

      Oh my god oh my god…stay clear, please, not worth your health and life. Do keep an eye peeled on what happens in about three weeks.

      • gulageten says:

        Oh for sure, it was an easy decision for me. I was surprised but unmoved by the prickish reply to my cancelation.

        • bmaz says:

          Yikes. Do you have an online catalog? I still buy vinyl! And am a habitual at record store day, and you are right, it is all a total incubation ground.

          • gulageten says:

            Yeah most of what I sell is new and very niche and happens online or to my local regulars. I have also bought and flipped a few collections though, and for someone without a retail space, the record fairs are really the only option for getting rid of the dollar-bin / thrift-store level stuff that inevitably accumulates.

    • vvv says:

      In your honor:
      “Doctor, Doctor” – UFO – ht tps://
      “Bad Case of Loving You” -Robt. Palmer – ht tps://
      “Infected” – The The – ht tps://

      (Yes, I took the day off.)

      • bmaz says:

        Whoa, I haver seen anybody but me here mention UFO. And the original off of Phenomenon to boot. Well done. I did a post with Lights Out long ago, but can’t find it now.

        • vvv says:

          I have two copies of the live CD – one is remastered – but I really should dig out the double LP, see how much green dust is in the fold …

          • bmaz says:

            Oh, I have the the Strangers In The Night double on vinyl, and even a somewhat rare now early vinyl of Phenomenon. Lights Out too. I still have a couple of boxes full of CDs out in the workshop/storage room. But I haven’t listened to any except a few on drives down to the border for legal cases or over to San Diego/Orange County on vacation. At home, it is all vinyl.

            • vvv says:

              Ah, vinyl. I have a cuppla thou out in the garage, for about the last 17 years. They’re likely much damaged, altho’ well-packed from my last move. I also have a lot of CD’s (3k?) which is what I listen to, including a Discman on the train. Speaking of which, UFO’s version of “Train, Train” is kinda interesting. Moggs got one of those voices …

        • bmaz says:

          Yeah, it is kind of seminal. Every song on Phenomeno is great though. Have, in addition to Doctor Doctor, also really loved Oh My and Too Young to Know especially.

          • gulageten says:

            For sure. All of the Schenker era albums have some great stuff, I’ve only dabbled outside of that but it seems more misses than hits.

            • bmaz says:

              I think I have at least one UFO album post-Schenker (maybe two? Not sure). But, no it was not the same. Though I did see them live a couple of times without Michael, and they were still pretty kick ass. I also have the first Scorpions album, Lonesome Crow, which he was on, and one by MSG after he initially left UFO. The first MSG is absolutely killer.

  28. BobCon says:

    The NY Times politics desk fiddles while the virus burns:

    “Presidents Forge Their Legacies in Crises
    It is too early to say how President Trump’s actions in the coronavirus outbreak will affect his legacy, but history is filled with lessons”
    By Peter Baker

    Yeah, too soon to tell. We’re only months into this and Trump is still in denial. But we don’t have a time machine, so how can we *really* judge? Maybe in a thousand years nobody will think this is a big deal….

    Freaking Baker is taking the long view so he can deliberately dodge asking any hard questions. What a joke.

    • earlofhuntingdon says:

      If Donald Trump is flailing and fiddling while his country burns, Peter Baker is tuning the strings. Neither he nor the NYT has any business selling this normalizing drivel. They should, instead, be demanding competent performance from this never-do-anything-right president.

      The NYT should also be warning about the neoliberal propensity to never let a serious crisis go to waste, when it can use them to obtain desires otherwise rightly forbidden to them by the electorate. On that topic, I don’t see the NYT publishing many OpEd’s from MIrowski or Klein.

      • BobCon says:

        I can guess how the meeting for this went:

        Patrick Healy: So, Peter, what do you have for us on Coronavirus? Any breaking news from the White House?

        Peter Baker: I’ve got something great! You won’t believe who I got on the record.

        Healy: Meadows, talking about reorg? Conway talking media strategy? Kushner talking about turf battles with CDC?

        Baker: Even better! I have Doris Kearns Goodwin talking about FDR’s speechwriter!

        Healy: Wow, what a get. But that’s not enough, dammit. Baker, get me two different quotes ON THE RECORD about the flu outbreak of 1919, and drop whatever else you’re doing to get them!

        Baker: You bet, sir. Nothing says NY Times like draining time from the chief White House reporter and top DC editor to push urgent news about White House failures out of today’s paper in order to provide century-old context. I’m proud to be a Timesman today!

  29. orionATL says:

    if you believe there is more truth in numbers than words 😉, don’t forget to check in here around noon today (and everyday) to get your daily cobid-19 case increases info:

    this will either give you new, higher numbers (3/11 #s were 938) or it will let you know when cdc has been muzzled.

    a stray thought –

    is it not the case that the vice-president of the united states is the only person in the executive branch that the president cannot fire, i.e., who can, within reason, act independently of the president’s wishes should the v-p think it in the national interest to do so?

    • Fran of the North says:

      As they say at the bar, “It’s noon somewhere!”

      No update as of yet. Surprise, surprise.

    • orionATL says:

      here is the best (most information/state) map i’ve found:

      note that new york has suddenly bevome a major locus along with washington state and california.

      of course the info we get depends on the federal government, and i mean specifically the presidency, providing us with accurate, uncensored data on cases as they occur, as well as some best estimate of untested cases.

      if the presidency seems to be sabotaging this job, then it may be necessary to set up a state-by-state clearing house to get accurate info on the spread of covid-19.

  30. pdaly says:

    At medical grand rounds in Boston today experts state (which we have been saying already) that America is in the mitigation phase now (as opposed to “containment” phase of contact tracing) and that social distancing has to be the major technique to buy us time as researchers race to find treatments and a vaccine.

    Some intriguing news.

    The ACE2 receptor is the mechanism by which SARS-CoV-2 virus gets into the human cells. ACE stands for “angioconverting enzyme.” There is ACE-1 and ACE-2

    The ACE2 receptors are present everywhere in the body but especially in the colon, gallbladder, heart muscle, kidney and (to a lesser extent) in the epithelial cells lining the lungs.

    The gene that encodes the ACE2 enzyme is located on the X chromosome. ACE2 enzyme may protect against virus entry and protect against developing ARDS (this is not my field of expertise so someone who is more conversant, please step forward).

    Since women have two copies of the X chromosome and men have only one X chromosome, this may partly explain why men are more likely to die of COVID-19 than women.

    Hospitals are ramping up testing ability for COVID-19 on sick patients that need to be hospitalized and to check on hospital workers who think they have been exposed to the virus. The in-house test will be very sensitive and will have a quick turn around time. This will help enormously in identifying which potentially exposed hospital workers must remain home on quarantine and which are disease free and can continue working in the hospital. It won’t be used to test the community at large however.

    Case fatality rate still difficult to calculate given that we are only seeing the sickest cases be tested for COVID-19. However, case fatality rate for “symptomatic cases” may be 1-2%. (Sounds low to me but hoping these experts are correct).
    Largest risk factors for COVID-19 death: elderly, heart disease, cancer (no idea which ones)

    No specific antiviral therapy available.
    Treatment is still supportive care: treat concomitant infections, ventilation as needed.
    Antibody to IL-6 may be helpful

    Repurposed agents still being investigated for COVID-19:
    lopinavir/ritonavir, chloroquine, penciclovir, ribavirin
    ARB/ACE inhibitors

    Experimental medications:
    favipiravir (T-705), remdesivir, monoclonal antibodies

    Steroids: uncertain.

    Long term sequelae of COVID-19 patients is unclear.

    50% of the population must become immune to stop the spread of COVID-19.
    Antibody testing of the population (looking for antibodies of recovery from COVID-19) will be the only way to know the denominator for this infection.

    Antibodies from patients who recovered from COVID-19 has in vitro activity against COVID-19.
    Not a lot of those patients here, but China?
    Also the antibodies cloned from patients who recovered from the 2002 SARS virus also show in vitro activity against COVID-19.

    Continue social distancing, hand washing, contacting the emergency department or doctors’ office by phone before coming in if you think you have COVID-19.

    • Rayne says:

      Did you have links to supporting material for this? I want to share this if I can.

      Smoking is related to higher expression of ACE2, and in China more men than women are smokers. This is the likely reason why mortality is higher among men than women, at least in China. Other countries and populations that don’t smoke as much may see different trends in mortality for this reason.

      The observation, antibody to IL-6 may be helpful, may be critically important. See discussion in thread about the drug tocilizumab, a monoclonal antibody med.

      • pdaly says:

        Sorry, Rayne, I don’t think there is a link to provide. It was broadcast live from Massachusetts General Hospital this morning. We were all asked to view it remotely. Even some of the presenters were broadcasting from home. I think only 3 doctors, the ones running the grand rounds, were physically in the auditorium coordinating the talks.

        Nevertheless, I think the person who mentioned the ARB2 data was
        Galit Alter, PhD (Professor of Medicine, Harvard Medical School) and member of the Ragon Institute of MGH, MIT and Harvard.

        Perhaps she has a contact link in her bio. I cannot stop to check right now.
        Case fatality rate (%) just under 3% for men and just under 2% for women.
        I cannot recall if this is all data known to date, or data from China or elsewhere that she was analyzing.

        Other speakers included (I missed some names)
        Pardis Sabeti, MGh Phil (Professor of Medicine Harvard Medical School and member of Broad Institute of MIT and Harvard),

        Marc Lipsitch, Phil (Director, Center for Communicable Disease Dynamics; Professor of Epidemiology Harvard T.H. Chan School of Public Health)

        Mark Namchuk, PhD (Executive Director of Therapeutics Translation, Harvard Medical School)

    • orionATL says:


      let’s see now, ace-1 and ace-2 receptors are the virus’s entryway into a cell.

      and if i recall correctly angiotensin converting enzyme (ace) inhibitors and angiotensin receptor blockers are blood pressure medicines.

      is “angioconverting enzyme” the same as “angiotensin converting enzyme” ?

      all related to h-p-a axis.

      • pdaly says:

        Yes, orionATL.
        It was a rushed typing mistake on my part.
        That should be “angiotensin converting enzyme”

        • orionATL says:

          thank you for the clarfication.

          the xx vs xy has come up in the press recently as connected to female longevity vs male. fascinating stuff we are thinking about these days.

  31. Frank Probst says:

    Can someone help me out here? Why does China think that they’re doing well enough to send 1,000 ventilators to Italy? They still have an enormous number of people on lockdown. You’re going to have to let them out eventually, and there’s going to be a few cases of coronavirus infection here and there, no matter how good their quarantine was/is.

    • paulpfixion says:

      1.4 billion people. The outbreaks have been relatively well contained once total lockdown went into effect (at least it appears that way on the surface here). My guess is they have been manufacturing ventilators round the clock and now are looking to “give” them to other countries, i.e. panda diplomacy (the ventilators are not free).

  32. harpie says:

    [Also via Laura Rosen, whose last name I have been unfortunately misspelling today …:-{ ]
    9:36 AM · Mar 12, 2020

    NEW: Our deep dive into how the national security machine is staring down coronavirus, with new details about the intel community’s role—it’s extensive—and how NSC is managing the crisis without a global health security directorate, eliminated by Bolton: [Politico link]

      • Vicks says:

        He’s throwing his big oil pals under the bus.
        “low gas prices are like another tax cut”
        Low prices will also put the frackers and overly leveraged out of business (yay)
        It adds another piece to my conspiracy theory,
        Trump buys a fleet of cruise ships, at fire sale prices, with money borrowed at zero interest, fills them with fuel “at prices, the likes of which this world has never seen” and sails away from what would obviously be a drag of a second term, and straight to the first country without an extradition agreement.
        Perhaps he will use his travel ban or a trade deal as leverage to cut a deal with his country of choice. Watch for where any bailout money or resources go as well.

  33. paulpfixion says:

    Is the Senate really going into recess??? I’m absolutely befuddled–are they 1. stupid 2. ignorant 3. malicious 4. all of the above?

    • Rayne says:

      All of the above. Apparently they need to go home and be confronted by voters. The incredibly risky part is that more of them may become exposed because of going home and then they may never come back.

      I’d like to see the Democrats figure out that staying in DC, staying in isolation together, may present them with an opportunity if centrist GOP are the only ones who make it back. Think about it.

    • Rayne says:

      Yeah, saw that, but wow, what an awful lot of nothing in that article. It’s such a massive tease I wonder if it’s real.

    • earlofhuntingdon says:

      “[W]ill soon have….”

      The Clinic is first rate, but it has a distinct MBA twang to its speech.

    • harpie says:

      Just went to Clinic website:

      Statement from Cleveland Clinic on Testing for COVID-19 – March 12 2020 /

      We want to clarify misinformation that has been trending on social media related to Cleveland Clinic testing for COVID-19. Our organization will soon have the capabilities to conduct on-site testing, as will other hospitals and academic medical centers across the country. We are in the process of validating our testing capabilities and will soon send out more information. We anticipate test results will be available within a day. Please continue to look for updates on [link] for updates on this rapidly evolving situation. []

  34. P J Evans says:

    It’s just been announced that Bolsonaro has tested positive for COVID-19. He was at Mar-al-Ego last weekend, shaking hands with everyone, including Pence and Trmp.

  35. harpie says:

    9:45 AM · Mar 12, 2020

    Sen. Tom Cotton release this morning:
    “We will emerge stronger from this challenge, we will hold accountable those who inflicted it on the world.”

    What does that mean?

    Answer: John Weaver Retweeted
    10:55 AM · Mar 12, 2020

    Cotton has suggested coronavirus might have come from a Chinese “super-lab” near Wuhan

    today the senator from Arkansas is launching an ad in Ohio accusing Joe Biden of being “weak on China”

    …weird place/race for a Senator from Arkansas to be spending campaign money…

    • P J Evans says:

      Cotton is ignorant of how science works, and will do anything to protect Trmp and his gravy train.

    • harpie says:

      1] [via bmaz]
      9:50 PM · Mar 12, 2020

      Senator Cotton announces, with a tone that can best be described as angry resolve, that

      China is “not going to get away with infecting the world with this Chinese coronavirus.”

      Cotton is all but accusing China of unleashing COVID-19 as a bioweapon on live TV. […]

      The phrases “bullshit” “Wuhan virus from Wuhan” and “cheap shots at Stephen Miller” were heard,
      but reader, I could not decipher more than that. [LOL!]

      I wasn’t the only one watching Hannity tonight I see. [link]

      links to:

      10:20 PM · Mar 12, 2020

      Sleepy Joe Biden was in charge of the H1N1 Swine Flu epidemic which killed thousands of people. The response was one of the worst on record. Our response is one of the best, with fast action of border closings & a 78% Approval Rating, the highest on record. His was lowest!

    • Jenny says:

      Representative Porter’s show and tell helps to get her point across every time. Excellent questions and preparation.

      • Jenny says:

        Oops forgot to add from source:
        Michael McAuliff on Twitter: 12:26 PM · Mar 12, 2020
        Wow. Katie Porter cites law that lets CDC pay for costs of diagnostic testing for anyone when needed. Asks CDC’s Redfield if he’ll commit to invoke that authority to make it free of charge for anyone. Redfield ducks, but Porter badgers him into saying “Yes.”

    • BobCon says:

      She is fantastic. The difference in quality between the best House Democrats and the best House Republicans is so vast it starts getting scary.

      • bmaz says:

        When Porter was running for her current seat, but not there yet, I was in Irvine on vacation. A friend came into town to interview her. They met at a restaurant there, and another friend and I were sitting out on the patio waiting for said reporter to emerge so we could go get a couple of beers and some food. She exited with said friend/reporter and hung around for maybe ten minutes talking to all of us. You could tell immediately how special she was, but never figured she could really win in that district. Neither did friend two, who lives there. We were all “jeebus, she would be incredible, sucks it is so unlikely”. Then she up and won!

        • BobCon says:

          There are members who will never say anything except scripted talking points, and there are members who will say anything but spew long strings of nonsense. But there is a relatively small number who are capable of actually conversing normally and intelligently. I think about 90% are Democrats.

          The aggravating thing is they tend not to end up on talk shows and cable because the producers don’t want nuance, logic and detail, they want Lyndsey Graham confidently repeating Trump’s lies and whatever moonman stuff Paul Gosar can come up with.

          • bmaz says:

            That is exactly what is so special about some of the 2018 freshmen. AOC may, out of nowhere, be a once in a generation level politician. Katie Porter is that and has even better and longer thought out positions, and is ridiculously good.

            In a time where there is fluctuating thought, there really are some folks that give hope for the future. There are many more too. My local Congressperson is Greg Stanton. He has not made the impact Porter and AOC have, but he is extremely good. There is a lot of that if you look. And that is a good thing

            • orionATL says:

              you’re right. alexandria ocasio-cortez is indeed a once in a generation political talent.

              for one, she is extremely articulate. in this regard she reminds me of another superb dem speaking talent, mario cuomo. for another, she is a true politician, not an ideologue, as indicated by her ability to work with dem speaker nancy pelosi while holding what are surely very different views. finally, ocasio-cortez has what could be called political imagination – she comes up with new ways to solve who gets what from politics.

              • Rugger9 says:

                I wonder how much of that was honed from her days tending bar, since I would guess one hears about everything and gets to deal with everything.

                • bmaz says:

                  Maybe some of it? You are right about the spectrum of everything you can hear working a bar/restaurant. But she has something above that.

                  I’m sure there are others that have hit Congress on the fly AOC has, but there are not that many in recent memory. Maybe Liz Warren in the Senate, but she had a deep history prior to election. AOC is really a breakout thing. And it is a good thing.

    • Raven Eye says:

      When I watched that video, I couldn’t help but wonder where we would be right now if the Republicans had kept the House.

  36. white-rose says:

    On the technical side, but the best open-source discussions, projects, thoughts on SOLUTIONS to this pandemic here https:// app. jogl. io/project/118?#news
    It just got started, but is growing fast with some good people and good ideas and expertise.

    [Welcome to emptywheel. Link is “broken” to prevent accidental clickthrough by readers. The site has not been vetted, use with caution. I suggest checking out Just One Giant Lab at their main page first, https:// www. jogl. io /~Rayne]

  37. harpie says:

    This seems like it will be a good read [via Quinta Jurecic]:

    The Dos and Don’ts of ‘Social Distancing’
    Experts weigh in on whether you should cancel your dates, dinner parties, and gym sessions.

    […] If you’re confused about what to do right now, you’re not alone—even these experts occasionally disagreed on the answers to my questions. Where there were discrepancies, I’ve included all different answers as fully as possible. This guide is aimed toward those who are symptom-free and not part of an at-risk group, with an addendum at the end for those in quarantine. If you are symptom-free but are over 60 years old; have asthma, heart disease, or diabetes; or are otherwise at risk, experts recommend defaulting to the most conservative response to each of these questions. […]

    • P J Evans says:

      I tend to only go out two or three times a week – picking up mail, buying groceries, the occasional necessary appointment.

    • Ken Muldrew says:

      The speculation that trizol availability is preventing people from being tested is absurd. There are easily 100,000 people in the US who use trizol every day in their normal work. I’m pretty sure they would share to help out in a health crisis. It just seems like these unnamed people at CDC and FDA who are restricting access to testing are lying as badly as Trump. The inability to get testing done in the US is very confusing.

      • e.a.f. says:

        they either want to ensure they and their friends are going to make money from producing the tests or they don’t want to test so no one will know how many people are ill. they want to wait until the bodies are stacked up three quarters of the way to the ceilings and then they will try something to benefit trump and the up coming election.

        trump looks very unbalanced or demented, but the man certainly is not well. to those republicans who voted not to impeach him and get the virus, it will be what goes around, comes around

        there is nothing to worry about, Lindsay Graham was tested.

  38. BobCon says:

    After Peter Baker of the NY Times left behind his skidmark “analysis” of the historical lessons applying to the current disaster, Peter Balz of the Washington Post wrote a blunt piece clearly repudiating Baker.

    Balz is a peer of Baker — former political editor and White House correspondent for the Post. He is not a Twitter rando. And he is angry.

    Where Baker writes “It is too early to say how President Trump’s actions in the coronavirus outbreak will affect his legacy, but history is filled with lessons” we get this answer from Balz “Historians will eventually assess the president’s prime-time effort to calm a scared and nervous nation that is taking unprecedented steps to deal with the coronavirus pandemic. In the moment and in the immediate aftermath of the speech, the judgments were as harsh as at any time in Trump’s presidency.”

    Baker tries to draw parallels with Trump and Coronavirus and Bush and Katrina. But Balz retorts “This has been described as akin to President George W. Bush’s “Katrina moment,” the botched handling of the storm that flooded New Orleans. But for all the devastation that storm did, the coronavirus is far worse in its impacts and disruptions, and the consequences for Trump are potentially enormous.”

    Baker tries to fall back on a Ted Baxter/Kent Brockman styke hack newscaster phrasing of how will this turn out? None can say. Only time will tell.

    Balz says instead rejects the historical perspective, expressing instead “a desire for the president to provide the leadership the moment demands.”

    I only wish Balz had called out Baker by name, but there is no question he reads Baker. And he is not having the 1000 year perspective.

    • P J Evans says:

      Hurricane Maria was Trmp’s Katrina. And he failed even worse than Bush did. Trmp is still not sending them aid, even when it’s been approved by Congress.

  39. harpie says:

    5:53 PM · Mar 12, 2020

    Kevin Love commits $100,000 to the Cavs’ arena and support staff due to the suspension of the NBA season.

    6:05 PM · Mar 12, 2020

    In times of crisis people are exposed for who they really are. Kevin Love is a world class human being. More of this, please.

    But let’s not forget that while professional sports players may be millionaires, most professional sports owners are billionaires. Let’s hope they all step up.

  40. pdaly says:


    Below I’ve added an active link to the recorded Medical Grand Rounds today at Massachusetts General Hospital, Boston, MA. I think it is viewable for the public.

    “A Coordinated Boston-wide Response to COVID-19”

    Brief introduction by Katrina Armstrong, MD
    Chair of the Dept. of Medicine and Physician-in-Chief, MGH

    Speakers list:

    Bruce D. Walker, MD
    Director of the Ragon Institute of MGH, MIT and Harvard

    Marc Lipsitch, DPhil
    Director, Center for Communicable Disease Dynamics;
    Professor of Epidemiology, Harvard T.H. Chan School of Public Health

    Pardis Sabeti, MD, DPhil
    Professor of Medicine, Harvard Medical School
    and member of the Broad Institute of MIT and Harvard

    Galit Alter, PhD
    Professor of Medicine, Harvard Medical School,
    and member of the Ragon Institute of MGH, MIT and Harvard

    Mark Namchuk, PhD
    Executive Director, Therapeutics Translation, Harvard Medical School

    Dan Barouch, MD, PhD
    Professor of Medicine, Harvard Medical School,
    Director, Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center
    and member of the Ragon Institute of MGH, MIT and Harvard

    Mark Schwartz
    MGH Trustee

          • pdaly says:


            I just restored the video and see that they added a speaker that wasn’t on the printed program.
            First speaker is

            Lindsey Baden

            Professor of Medicine, Harvard Medical School
            Editor, New England Journal of Medicine

            The title cards introduce each speaker so if the order on my list is off you will still know who is speaking when.

    • Rayne says:

      That is so awesome, thanks so much! Boston’s medical professionals’ perspectives are important because they’re already facing a growing cluster thanks to that misbegotten Biogen management conference February 26-27.

      • pdaly says:

        My pleasure.

        It’s funny, I’ve had trouble pinning down the dates of the Biogen conference. I have seen just 2 days and in other articles it is listed as 2/24/20-2/27/20.
        I wonder if there was a pre-conference that lead into the actual conference?

        The picture at the beginning of the video, with of all these experts packed close together for a group shot, nearly gave me a heart attack. I wonder if any of them cringed today when they saw it!

        • Rayne says:

          I’m watching that video now and YEESH all those people in one room and then at 1:25 discussing keeping hospital workers and patients more widely separated…like zero self awareness. Yikes!

          No idea where Feb. 24-25 figured into the Biogen picture, have only seen 26-27th including on Wikipedia entry.

          ADDER: Okay, have watched the entire presentation 2X now. I am concerned about 2 things: the (over)emphasis on antivirals, and the excessive optimism of vaccine development. Can’t help but think money influences the amount of attention and emphasis.

            • Rayne says:

              Huh. That’s interesting. I wonder if they’re having difficulty identifying the index case within Biogen and might think it’s hotel staff or another guest? I don’t recall seeing any mention of a source who infected the rest of the Biogen team. Thanks for sharing that.

              • pdaly says:

                The articles never mentioned the index case but also never got more granular than 2 from Europe and 1 from Tennessee when the story first broke.

                In every article, however, the government officials would insist the Biogen conference was not an example of community spread–even when it seemed to break the R0 of 2.2 for SARS-CoV-2 virus.

                It seemed one of the European travellers was the presumed source, and I only once saw a mention of Italy as the country involved but no one was named.

                Kept wondering when hotel staff would have a chance to be screened for COVID-19.

                • Rayne says:

                  I don’t know about Italy. When Biogen announced sites would work remotely the only EU site mentioned was in Switzerland. Maybe someone flew through an Italian airport, or on an Italian plane?

    • pasha says:

      @pdaly. thanks! what a resource!
      the coda was chilling. “don’t want to alarm people, but:”
      1. italy is ten days to two weeks ahead of us, we are following similar curves due to late testing.
      2. hospitals beds in lombardy and milan are filled beyond capacity.
      3. they are dealing only with COVID-19. stabilized stroke and heart patients must recuperate at home.
      4. triage is in effect: ventilators go to younger patients.
      5. hospital care in italy is comparable to that in the u.s.

  41. harpie says:

    More from BOSTON:
    6:09 PM · Mar 12, 2020

    “Worse than Iran” which is currently digging trenches for mass graves.

    Links to:
    5:37 PM · Mar 12, 2020

    Director of Harvard Global Health Institute:
    “This is an unmitigated disaster that the administration has brought upon the population, and I don’t say this lightly.” “We have had a much worse response than Iran, than Italy, than China and South Korea”

    Links to
    U.S. Virus Response Marred by Overconfidence and Delays
    Despite reassurances, testing has been limited and health officials are contradicting White House statements.
    March 12, 2020, 4:00 AM EDT

    • pdaly says:

      Thanks for your consistently great links, harpie.

      I am constantly learning from the ones you provide.

  42. posaune says:

    Gov Hogan, Maryland closes schools & state offices for 2 weeks.
    So our teenager will be home for 2 weeks, starting Monday.
    His school, a small private HS (40 kids, ten each class), will start Google Hang-outs classes on Monday: 4 hours of class per day. Follow up 2-hr period daily for student-faculty consults. Trying to keep him home all this weekend to avoid exposure. He was supposed to go to the Caps game, but that’s been cancelled (whew! avoided that argument). Spouse and I have to be careful: we’re old parents and asthmatic.

      • P J Evans says:

        They have several bundles available right now, but some will be disappearing in the next few days. (I’ve bought stuff through them. A couple of months ago they had a package with knitting and crochet books.)

  43. American Abroad says:

    I just want to thank everyone for these posts and comments. As the name states, I live overseas and find it very difficult to get English language information on this crisis – I try to read everything in the native language, my fluency is just not that good. I have been following the advice listed here, I am prepared and I share info with my colleagues. Luckily, the school I work for has a Head Teacher who trusts science; the school has a protocol to follow and we will be implementing distance learning for all grades. We are on our term break and do not expect to return for 2-4 weeks.

    My wish is for everyone to stay vigilant and safe; and please know how much you are appreciated by this one citizen, and I am sure, many others!

    • pdaly says:

      Glad to hear you were able to make people safe.
      Two to four weeks is a great start, but I fear this pathogen is going to be around more weeks than that. Hoping we flatten that infection curve with every action we take.

      • American Abroad says:

        Yes, a great start, but not the end. The management of the school keeps us updated (regularly) with information; I have spearheaded this move because we all know – lack of information is dangerous. They assess on a daily basis and update the plan accordingly. As the HT mentioned to us all today in an update….”the Covid-19 situation in Indonesia is only going to get worse….” No wishful thinking, no miracles..

        • American Abroad says:

          I should mention the update was electronically. We are tele-commuting now. Online learning for the foreseeable future.

  44. harpie says:

    ((((Rayne)))), thinking of you and sending hugs.

    …and to you and everyone else, THANK YOU for being here.

Comments are closed.