[Check the byline, thanks! /~Rayne]
This is a hurricane. You recognize the threat such a storm poses especially if you live in a coastal region; you know that you must be ready by the time the outer bands begin to lash your home. You must be hunkered down and ready to ride it out.
This, too, is a hurricane. Our nation’s problem is that an overwhelming number of Americans didn’t recognize this impending storm when this first man-made outer band hit the airports the weekend of March 15.
Thanks to the incredible incompetence and/or malignancy of Trump’s minions Jared Kushner and Stephen Miller, this hurricane gathered energy in airport terminals across the country.
All the people who were exposed to those who were contagious in these confined and inadequately vented airport spaces are now into their first week of their own contagious state, with and without symptoms.
All the people in this photograph who are going to experience moderate/severe/critical symptoms are beginning to do so now and over the next week.
All the people in this picture who are asymptomatic or have mild, cold-like symptoms are still functioning as they did before their trips which took them through the airports. They are contagious and have no clue that they are for the most part.
The hurricane has only just begun and you had better be hunkered down, staying in your shelter.
The hurricane has only just begun and states need to lock down these contagious persons.
The White House’s bullshit 15-day period is just that, bullshit. The public has NO idea when those inept and corrupt jackasses began counting their 15 days. More importantly, to break this contagion will require MORE than 15 days because there hasn’t been a uniformly-applied, well-communicated lockdown, and because the federal government continues to yank us around on both testing and personal protection equipment.
I’m begging businesses small and large to understand there is NO economy ahead if this hurricane wipes a broad swath of consumers off the map, if this hurricane sweeps away resources through sustained illness and dealing with the fallout from deaths.
Small and large businesses must also come to the same conclusion as governors and other state leaders: the Trump administration has failed, is failing, and will continue to fail just as it did in 2017 before, during, and after Hurricane Maria.
Thousands of Americans died on a small island because of gross negligence by Donald Trump and his administration. They were in better shape then, had more resources than they do now, because there has been continued gross neglect of the government systems required to respond to emergencies and disasters.
The tests are not coming. The personal protection equipment isn’t coming. Assume you must find alternatives in your own backyard. Build them and protect your own. Work with state and local government to identify shortfalls and fill them. Do what the Trump administration has refused to do — be competent, be pro-active, care for your state and communities.
Do it right the fuck now before the next band of this hurricane comes within the week.
Not everyone will be able to take shelter even as states like Michigan order lockdown — it’s expected at 11:00 a.m. today that Gov. Gretchen Whitmer will announce all non-essential businesses shut down. Those folks who must continue to work need our understanding and our efforts to protect them.
So, too, do the folks who can’t afford to take time off work but will and have been forced to do so. Their bills continue even as their work stops.
Call your representatives and senators and ask them to pass aid packages which help the working people of this country, those in the lower 50% of income, because money given to them in aid is immediately plowed back into the economy.
The Trump tax cuts clearly didn’t put money back into the economy; savings from the cuts were used to buy back stock and boost share prices rather than create jobs or invest in equipment. Corporations received aid with those cuts; they shouldn’t get more after having abused the chance to build more robust business able to withstand this hurricane.
Nor should any business which pays zero taxes or operate in a different country — like cruise ship lines operating under foreign flags to avoid U.S. taxes — receive any consideration.
The Senate is scheduled to reconvene at noon E.T. — contact your representatives and senators NOW, whether by phone, fax, or @Resistbot.
Congressional switchboard: (202) 224-3121
Above all, #StayTheFuckHome.
Please stay the fuck home.#StayTheFuckHome #COVID19malaysia pic.twitter.com/vKIkXJARr0
— Fahmi Reza (@kuasasiswa) March 18, 2020
This is an open thread.
Kentuckyians, Mitch McConnell MUST go. He must be replaced this November. His continued cocksuckery for the oligarchic class and the far-right Christianist fundamentalists is going to do more damage to the economy at the same time he kills people supporting Trumpian failure. Vote him the fuck out and save lives, preserve what will be left of the economy after the storm.
Amy McGrath is running against him:
There were a lot of health-care places that would NOT have gotten funding.
This too, since Collins is trying to gut abortions again, there will be collateral damage to non-abortion operations:
She needed to go last time, and maybe she understands that bootlicking will cost her the election and she’s going out with a bang.
9:59 PM · Mar 22, 2020
Cheryl Rofer retweeted this response to LLOYD, and I agree with it:
12:21 AM · Mar 23, 2020
DEMS MUST HOLD THEIR GROUND TODAY!
I’m beyond being polite any longer. These assholes like Lloyd Blankfein deserve to face the worst of COVID-19 on a personal basis.
No one in this country is going to go untouched. Everyone will lose someone they know because of Trump’s massive fuck-ups during his entire administration. Going back to work should be a worry only after the country has begun to digest its first massive losses.
Fuck Lloyd Blankfein. It’s bullshit like his from other business organizations like the Michigan Chamber of Commerce which caused Michigan to delay the necessary lockdown. People are literally going to die this week because profits über alles.
Thank you for that Urban Dictionary link. It’s a relief to have that spelled out so clearly.
While wishing ill(ness) on anyone is beyond the pale, I’ve been thinking similar things. The best thing that could happen in the next week or two would be for a titan of business or two, a few of POTUS’ inner sanctum, a couple dozen senators & HoRs, and a young superstar in sports or entertainment to end up in the ICU.
That might get many (never all) of the nay-sayers to realize exactly how serious this situation is and how much worse it might become if they don’t wake up and smell the coffee.
Not coffee, embalming fluid.
As I said on an earlier thread, I think that last quote is exactly right. Expanding public assistance and making it work for Americans who need it – today, a vast number and on par with the Great Depression – would undo the neoliberal project of the past forty years. The Business Roundtable, the US Chamber of Commerce, and Wall Street would consider that an existential threat to their hegemony and world view.
It would show that government is not the problem, it is an essential part of any cure, just as it is an essential part of making any business profitable. Businesses – meaning the people who own and run them – are often the problem, as well as part of the cure.
People are more important than what they buy. Promoting their well-being is part of government’s responsiility to promote Justice, domestic Tranquility, and the general Welfare. Those define the Blessings that government is meant to defend.
That preamble is a command, not a description.
It’s pretty clear by now that Trump, Pence, and their task force has been stalling the whole time. Playing a game of <a href="https://www.youtube.com/watch?v=uT3OQECSDoQ" cheese shop with the American public to delay action until the virus has spread so thoroughly among the populace that social distancing can be declared as too little, too late. The absurd precaution of using classification to hide discussions of pandemic planning indicates that these discussions had nothing to do with continuity of government, let alone continuity of life, but rather everything to do with continuity of oligarchy. At some point we really will have to hang the rich because they’re not going to share without some incentives that extend beyond the reach of practical politics in the current environment of democratic capture.
I don’t think anyone should be deliberately exposed for schadenfreude purposes, but the following would probably and unfortunately be true:
This gaslighting will go on until Ivanka comes down with COVID-19, which is not a zero chance given the denial and her presence (I’m sure) at CPAC and various Mar-A-Lago fetes.
I suspect the “let’s not make the cure worse than the disease” gambit has many purposes. It’s an old familiar phrase, easy to remember, which is important, because one purpose of it will be to place blame on government for whatever happens.
Trump is a horrible manager, a pandemic is a horrible thing to manage. The US and global economies will tank, perhaps on par with the 1930s or worse. A lot of pain will go round because of it. So, they’re setting the stage now for who to blame, which includes anyone but Trump, the GOP, and neoliberals.
Neoliberals leap to adopt their always ready agenda when inevitable crises appear. That will also cause a lot of pain. Blame for that needs to be properly allocated elsewhere before the pain hits.
This is set up to be the leverage to get rid of Social Security and Medicare that the GOP always hated. It’s an old playbook seen in KS and WI where tax cuts lead to a crisis that has to be solved by cutting social programs. Same old, same old, and why the details of the bill are important. I see that McConnell couldn’t get a cloture vote, again.
I am not seeing many photos or videos of US hospitals inundated by COVID-19 patients. Is there some kind of media blackout like with returning dead servicemen from Iraq in 2002? Is our “Free Press” still failing us, this time during a pandemic?
Come on, Williams. Use your head. It’s called HIPAA. You can gawk at Spain if you must have bodies.
Start thinking about what media can report within the limits of the law protecting patients’ privacy. Media should already be interviewing chiefs of staff — if they can commandeer their time because they are probably working as hard and as fast as they can.
I don’t need to see more pictures from Spain. It is the people who think the US response to the coronavirus is “overblown” or “doing more harm than good” who need to see what is actually happening in hospitals around the world and in the USA.
EFFF “privacy”, people NEED to know.
Your right to know can be satisfied without violating the privacy rights of others. Figure out how to get your information someplace else.
Last thing I want if I’m lying in a pool of my own lung fluids is somebody’s goddamned need-to-know camera stuck in my face. Jesus fucking Christ, I don’t want to have a Nightcrawler vampirically capturing my tortured breaths as proof society is in crisis. Like we don’t know that already from the testimony of health care workers, including some community members here.
Media are stretched as badly as good people in government. I have the horrible situation of a 90 year old mother in assisted living in Seattle, a stone’s throw from Kirkland Care.
10 days ago 1 staff member there became ill. The remaining, exposed, staff, could not be tested. 6 days ago 3 staff, 2 residents. Still no testing available for staff who prepare the food and so forth, we aren’t even asking residents be tested. Today 3 staff, 6 residents. No testing yet but the residence says they think staff will now be tested. If all of them test positive, I wonder what will happen. There are 80 residents. Think what that could do to the ICU units in town.
I called around government and everyone I spoke to was besieged, utterly impotent and exhausted if not near tears. Nobody to yell at there as far as I could tell.
I sent notices to media in the hopes that they could shame the system into doing something. I finally got a call from the Seattle Times yesterday, (6 days after I contacted them) to follow up. They are doing a story which should be out by the weekend. The reporter was conducting interviews pertaining to 8 other facilities with stories of infected residents. She absolutely understood what was happening and how urgent and awful it is. She did say that our situation is the most egregious, but not miles beyond how bad others are. On the other hand, she said some facilities have even had all the residents tested, so there remain harsh incongruities which may be coincidental, or pertain more to wealth and political connection. But unfortunately newspapers don’t have an infrastructure that is any more set up to deal with this, than anyone else is. And the blogosphere just isn’t as influential as the printed press in terms of getting public attention.
(Among other things this obviously reveals how far we are, given the infuriatingly MASSIVE FAILURE of the government to providing testing, from knowing a damn thing about what this will look like in 4 or 6 or 8 weeks. And my situation is in the first US epicenter of the disease, with a lot of medical research resources, including a proactive university hospital system that has been pretty stellar in terms of a public health in the past. That’s how bad things are. So it cant be stressed enough that not one word out of the WH, for instance, has a single shred of credibility in terms of prediction. They know nothing yet, just as we don’t know about the people who were smashed together into airports because of another inept administration policy.)
The media are not going to be allowed into ERs, and patients who start taking pictures will be immediately asked to stop. If you’re on staff, taking a single photo can get you fired. Patient privacy is taken VERY seriously in the US. I live about a mile from Texas Medical Center in Houston, and people get fired on a fairly regular basis for violating patient privacy.
So people don’t really know what is happening.
They’re telling us on Twitter. You don’t have to sign up to read people. KagroX and DemFromCt are both good.
Famines only get serious coverage when they reach Cecil B deMille optics, in other words only when it is too late does the public become concerned.
If I’m interpreting correctly, her concern is not that she is a voyeur or herself uninformed, but that the general public is, and that is why she had the instinct to want to have more graphic imagery out there, so that the gravity could impact public perception of the dangers, public policy, or perhaps alter the disposition of unending clowning in the press briefings of the administration. I understand that this isn’t possible but it doesn’t mean she’s foolish for wanting imagery out there.
Today there were images published on twitter of faces of Italian health professionals. These are the healers, and they had a pallor that reminded me of patients in the AIDS epidemic, dark circles that looked like bruises, and thick purple lines where the edges of their masks fit their faces. It was good information for people to see.
The expectation still requires a respect for privacy. The images you’re mentioning as an example had the permission of the Italian health care workers.
I realize that.
7:53 AM · Mar 23, 2020
8:31 AM · Mar 23, 2020
It’s as if Trump and the GOP won’t be happy until there are carts trundling through the streets with their drivers calling, “Bring out your dead! Bring out your dead!”
I put most of my thoughts about this so far on the previous post:
I hope the senators who voted to leave Trmp in office lose their jobs in the next two years. (Better sooner, but I don’t actually want them dead. Yet.)
The media needs to stop attending Trump’s pressers now.
Aside from the well-documented propaganda mess they are creating, they are a huge risk to the health of the press and White House staff.
I was lucky to get to see the briefing room once when it was out of operation, and it’s tiny. It’s about the size of a typical high school classroom. These photos give a sense of how small and crowded it is:
Although the number of reporters attending has been cut in half, you can tell how much risk there is to everyone in that confined space if one infected person shows up.
It is simply nuts that the press is putting its people at risk for this junk. It is a sign of how bad the execs are at their job, and how they still can’t get their heads around what we’re facing. It shows up in their coverage.
Maybe it’s because I’m in the midwest, but the image I keep coming back to is a historic flood, like the flooding along the Missouri and Mississippi Rivers far too often in the last 20 years. You know the snowpack starts to melt in the spring, and you can see the river slowly start to rise. You know it’s raining upstream, and you can see the river continue to rise. You see it keep raining, and the river keeps rising. You hear of a levee break somewhere, and the rise slows for a moment. You see it keep raining, and suddenly it’s over YOUR levee, into YOUR fields, over YOUR roads, and into YOUR home.
And then you wait.
You wait for the rains to stop, and that takes time. Then you wait for the waters to begin receding, which takes time. Then you wait for the roads to be rebuilt, and that takes time. Then — only then — can you start to get back into your home, and sort through the debris and detritus.
And then you wait for the river to get back into its banks, so you can start to fix the levees. With luck — with a lot of luck — that will happen before next Spring’s flood season arrives.
From the Des Moines Register last month, as Iowa recovers from record flooding last year:
Per the National Weather Service’s current spring flooding projections along the Mississippi:
They may not have two months, let alone two years.
An earthquake hits without warning and the damage is immediate, as are the efforts to dig out and rebuilt. A tornado may come with a short warning, allowing folks to get to shelter, and when it hits and moves on, you come out and get to work. A hurricane is different, as it comes with plenty of warning these days, allowing for preparations, evacuations, and pre-positioning of recovery assets, and it can spend anywhere from hours to days pounding on any given place before moving on and/or dissipating. But a massive river system flooding? That kind of disaster takes time to arrive and show its devastating power, stays for months before finally flowing away, and only then can folks begin to rebuild.
We’re looking at a flood, people.
“And then you wait for the river to get back into its banks, so you can start to fix the levees.”
And you hope and pray it doesn’t rain again before the levees are fixed. The levees can’t be fixed for 12-18 months in this case.
p.s. WE HAD AMPLE WARNING. We had an asshole in the White House who chose to do nothing.
There are still signs of the damage from the Northridge earthquake in 1994. Some things haven’t yet been rebuilt, some still had visible repairs in 2012.
I *assume* people waiting for the flood DO take whatever precautions possible, and demand that their local, state, and federal governments also work to deal with the flooding? They don’t deny there is a flood coming, and just sit on their butts talking about TV shows and sports, I hope.
Shit. Amy Klobuchar’s husband is coughing up blood and just tested positive for coronavirus. Coughing up blood is BAD. It’s possible that it’s just from coughing so much, but just based on her description, it sounds like he’s in pretty bad shape.
Sen. Klobuchar’s Husband, a Baltimore Law Prof, Tests Positive for COVID-19
The Minnesota Democrat described her husband, John Bessler, as “exhausted and sick but a very strong and resilient person.”
He’s on oxygen, but not a ventilator. He self-quarantined when the fever hit.
On oxygen but not intubated is a good sign. One of the things that will make you cough up blood is simply doing a lot of coughing. Hopefully, that’s what he’s got.
She wrote that he had had severe coughing.
Al Franken spoke with him today:
5:43 PM · Mar 23, 2020
I do not know the stats (that comes after the disease post mortem in a year or so), but there are plenty of anecdotes:
1) Many who go on ventilators don’t make it anyhow. Their lungs are too far gone and their immune system likely cannot keep up much less turn the tide.
2) Many who do survive with severe cases – vented or not – likely have severe lung damage and will require some type of long term respiratory therapy/assist in their remaining years. That includes youngerish folks.
This not a 15 day event even if you started counting today. This is not a rocket back economy in 15 days even if you started counting today.
We are but in the first inning of an extra inning game to borrow a baseball metaphor.
This is exactly the type of misinformation that needs to stop. Stop, stop, stop. Please
Yes. I thought yesterday when I saw that tenor opera star Placido Domingo had COVID-19 that we will not only see many deaths but deaths of careers. How will an opera star perform at their usual level of proficiency if they have sustained permanent lung damage?
How many other careers like those of athletes will be ruined by this virus?
We don’t know. We won’t know for at least half a year.
Longer, I have seen survivors of ARDS take 2 years to get back. Way too early to tell whether COVID produces a garden variety ARDS or a new clinical syndrome.
I meant we won’t know the breadth of careers to be affected, not how long it will take individual patients to recover and to what degree.
And two more videos listed in the Drs. Intro/Description of the posted video.
And my new favorite site: https://www.youtube.com/watch?v=okg7uq_HrhQ
A follow-on piece from Tomas Pueyo, a must read. Arguing for supression (“the Hammer”) not mitigation, and then living with the virus until a vaccine is widely available (“the Dance”).
Here in Germany the Robert Koch Institute in this morning’s update, indicated that there was no shortage here of test capabilities or testing. I believe the low mortality rate reflects a broad testing field.
Yesterday a country-wide policy went into effect forbidding groups of more than 2 people, unless it can be proven the group is made up of family members who live together. Although it is not officially called “lockdown” or “supression”, it is getting pretty close.
Stay inside. Io sto a casa.
With a 2 month lead there should be enough tests for every person on the planet.
We don’t have two months’ lead time. We need a test for antibodies like yesterday — these tests are cheaper and faster to produce. Then we can identify those who’ve had the virus and now have some immunity, ask them for volunteers to donate plasma with antibodies to treat persons who are in the severe category of illness so they don’t have to be intubated.
We did, that was what I meant
Those here with more knowledge than I might help by elucidating the current status of an antibody test.
Development and Clinical Application of A Rapid IgM‐IgG Combined Antibody Test for SARS‐CoV‐2 Infection Diagnosis:
Others here with connections to news organizations might encourage a reporter to question Dr. Fauci on the subject.
It would seem that, unlike in the case of HIV, the presence of Covid-19 antibodies for a certain period of time would indicate immunity. Correct? If so, it would be vitally important for mapping the virus. Why is this not widely discussed? Or have I missed something?
It’s being done small-scale, but mostly there aren’t enough people available to do it.
SPOILER: Things are going to look a lot fucking worse in 15 days.
Where I am we are in the calm before the storm, gettin our feet wet, working out our protocols, stumbling along. Everyone has a plan until they get hit in the face.
I am flat out scared.
I think anyone who is sane, conscious, gifted with adequate intelligence is likewise terrified. You’re not alone here, Mary, and I’m glad to see you.
Just hoping to avoid it. So far, I’m okay – but I wasn’t going out more than necessary anyway. I worry about some of my family, though.
Be scared wisely
My dumb Democratic Governor in Connecticut made a bold proclamation about ordering people inside. Then the lobbyists swept in to make sure their businesses were declared “essential”. When the smoke cleared, there was a 6 page list of “exemptions” so broad that it seems only hair salons, tattoo parlors and movie theaters have to close. That map line from the 10,000 new cases in New York yesterday will not protect us. I’m so sad that potentially people will have to die because of the politics of this all
Link to an article listing the essential services in CT:
In Italy some unions are going on strike to insist that some businesses get closed. Guess they had the same problem with the exemptions list.
Heard this live on rainews24.
The list I got for DeKalb County looked a lot narrower than this irrc. I know someone who knows someone etc. in the Gov’s office. First I want to compare the lists.
We’ll need a program at least as comprehensive as the Works Progress Administration to deal with the economic recovery from hurricane COVID-19. Not too many businesses can survive on being closed for up to 18 months.
Is there any way you can pin your post explaining cytokine storms? I think it was quite prescient. This is all anecdotal at this point, but I’m hearing a lot about patients developing acute respiratory distress syndrome (ARDS), which is looking like a major cause of death in COVID-19, especially for people with no underlying health issues. It sounds like fairly healthy patients who need only mild respiratory support are suddenly getting much sicker and developing ARDS. ARDS is very difficult to manage and will pull a lot of resources away from other patients. I’m digging around trying to find good info on it now, and I’ll link to it when I’ve found something that’s accurate and understandable to non-medical folks.
I wish I could pin it but I think what I need to do is not only re-up the explanation of the “cytokine storm” but take a whack at that lying tangerine hellbeast’s attempts to practice medicine without a license by pushing chloroquine from the podium.
I dare not call my mother for fear of hearing my own rage echoed about the depth of his stupidity and the enormity of danger he poses to the country because he can’t shut his fucking mouth and leave medicine and public health to experts.
Okay, here we go. First pass:
Peer-reviewed description of ARDS in plain English (pdf):
Johns Hopkins Treatment Guidance Writing Group (pdf):
This one is in medicalese, but it talks about ARDS in COVID-19 patients, although not much. (They also talk about the use of hydroxychloroquine (which is available) and chloroquine (which isn’t) in patients with VERY severe disease, but they stress that the evidence for its efficancy is weak and its use should ONLY be considered in critically ill patients. My take on this is that they’re saying, “We’re know some of you are going to use it no matter what we say, so we’re offering guidelines to keep you from overdosing someone.” I’ll talk about this a bit more below.):
Clinical trials for the drug remdesivir are now in progress. If you have COVID-19, you can get information on how to enroll in one of these trials here:
Hydroxychloroquine and chloroquine are NOT FDA-approved for COVID-19. Off-label use is consideration only for the sickest of patients. If you have mild or moderate COVID-19, and you want to try it anyway, I would suggest enrolling in a clinical trial. Those are listed here:
Please note that if you’re taking hydroxychloroquine for COVID-19 even though you (a) don’t meet the Hopkins criteria for off-label use, or (b) you are enrolled in one of the above studies, you are an ASSHOLE. There’s a relatively limited supply of the drug available, and there are people out there with very nasty diseases who need it. You’re basically taking their meds from them.
I’ll try to get a few more links to show that COVID-19 is linked to ARDS, and ARDS is linked to cytokine storm.
Sigh. The should be ‘We know…’, not ‘We’re know…’
Thanks, Frank. Probably need to boldface font this for that jackhole in the White House: Hydroxychloroquine and chloroquine are NOT FDA-approved for COVID-19.
Hope people are reading between the lines and coming to the conclusion that using anti-malarials off-label is an absolute last-ditch effort for some patients, a fucking Hail Mary pass flung in desperation.
Yeah, you’re pretty at the “Maybe this anvil will help.” stage of treatment. My friends who work in adult medicine, particularly the ones in critical care, have been posting about how hard it is to treat.
Reports are coming in about self-medicating people in Nigeria getting hospitalized for chloroquinone overdoses. I had read that the lethal dose is quite close to the effective dose (i.e. for malaria), something like double.
So, Trump will really kill some people this way if these reports are true.
So far the ARDS seems garden variety. Varying degrees of difficulty in ventilation. Responds as usual to increased PEEP, recruitment, proning. ECMO works. The terror is if they develop myocarditis. They have VT/VF, EF drops to 10% and game over. Frank can translate into English for me.
ARDS — acute respiratory distress syndrome
PEEP — Positive end-expiratory pressure
ECMO — Extracorporeal membrane oxygenation
VT/VF — ventricular tachycardia (VT) and ventricular fibrillation (VF)
ER — ejection fraction
CCM has described the pneumonia-like effect COVID-19 has on the lungs. The myocarditis — fulminant myocarditis — is inflammation of the heart tissues. Patients are dealing with a two-pronged attack on their systems: they can’t pull in enough oxygen through their lungs while their heart may swell from immune-system triggered inflammatory response, reducing the amount of already-lowered oxygen the heart can push through the body.
I’ve read that this particular virus gets into cells because the spikes come apart easily in the presence of furin, and humans have furin in almost every tissue. (It cleaves proteins so they can become activated. Thus the problem with this virus.)
Yeah, you probably read this piece or something based on it:
Researchers don’t know how important that detail is. The ACE-2 receptor may be far more important and may also be an angle of approach researchers can take more quickly given how much work has already been done wrt ACE-2 and coronaviruses’ spike protein.
I suspect they’re looking at everything they can try. ACE-2 is a good place to start.
I’ll let you know what I hear straight from research after Thursday. My kid is still in school, supposed to meet with microbiology prof on Thurs. though it will probably be a remote meeting. ACE-2 will figure largely in discussion along with COVID-19. Their prof is working in this area of study right now.
I offer this article as a pretty good albeit technical description of quite a few of the cellular components you guys have been talking about. Please ignore the supplement recommendations near the end which are probably speculative.
“COVID-19, Pneumonia, and Inflammasomes”
https: //www .evolutamente .it/covid-19-pneumonia-inflammasomes-the-melatonin-connection/
[FYI, link ‘broken’ with blank spaces to prevent unintentional clickthrough. Site is not vetted. /~Rayne]
Um, that’s a wacky site really intended to push woo-woo holistic medicine by glomming onto copy-pasted research. I think I’ll stick with the research published at reputable sites.
Thanks, Rayne. I thought the technical bits were ok, and there were sources cited. Sorry.
A note on ECMO (extra-corporeal membrane oxygenation): We don’t have that many ECMO machines in the country, so not many people will be able to get it. They’re mainly at academic tertiary care centers. I doubt that most ICUs have access to one. The complication rate from ECMO is extremely high, and it’s a HUGE drain on hospital resources. There’s literally one person who has to sit at the machine 24/7. In order to get it, I think most people would have to be transferred out of the ICU that they’re in, by ambulance or helicopter, and those are not going to be as readily available as they are in “normal” times.
Garden-variety ARDS is accurate, BTW, and I’m guessing that the pharmaceutical companies working on anti-ARDS medications are probably filling up all of their research studies as we speak. But it’s kind of like calling it a “garden-variety plane crash”. It’s going to seem mundane to people who are used to treating ARDS patients, but the mortality rate is going to be enormous.
Reading this now it sounds wrong. Garden variety probably not the best verbiage. Did not mean to minimize. But meant to say there are many people out there who are treat ARDS everyday and are comfortable doing so. The real issue is numbers and resources. Yes ECMO is in very tight supply.
LOL I think I read it the way a person who was around medical professionals a lot would have read it. Shop talk is very different, seems glib at times. I didn’t take it that way, though. No worries.
I wasn’t really criticizing. Just wanted to make sure that folks know that ARDS = BAD. I think the term itself is a little misleading. When you hear “acute respiratory distress syndrome”, you think rapid onset, but you also tend to think rapid recovery. And “respiratory distress” just feels wrong. Yes, it’s accurate, but it sounds like an asthma attack. ” Oh, you’re intubating? So we’ll be here one or two days?”
Well, maybe, but only if you’re headed to the morgue.
People do die from asthma attacks. It’s not something to take lightly. (I describe mine as mild. That’s because I don’t need medication. It doeesn’t mean I don’t notice it.)
This is true, so perhaps it wasn’t a good choice for a comparison, but I think most people think that for an asthma attack, you just take a few puffs from an inhaler and you’re done. In extreme cases, you have to go to the ER.
The reality is that people are hospitalized all the time for asthma attacks, and if you end up getting intubated, the outcomes are dismal.
This is a “cytokine storm” review from the bird flu days. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3294426/. Maybe of use.
I am like many of us here who have some pre existing conditions. I already have been expressing my OCD via diving in the medical information available on the internet relative to what my situation is. Uric acid arthritis (gout) can express itself in a cytokine storm. For me, those symptoms in particularly brutal, long lasting and the ungodly uncontrollable inflammatory response can happen and spread through large body segments (whole leg toes to top of pelvis) which can result in significant tissue destruction. I take Colchicine to shut down the storm and the HAVE TO take NSAIDS. ibuprofen 800 every 8hrs to get rid of the residual inflammation. The biochemical communicators that triggers the inflammatory responses are similar/same or fall under the same branch or category. I hope the colchicine provides some prophylaxis but, hope in one hand and shite in the other is how I describe Trumps new version of medicine.
Some us have a Governor who has bee proactive. Lucky for now.
There are good ethical, and integrity filled business people in the world. Business people make decisions with concerns about asset accrual and body counts are not going to matter to them like a real servant of the people.
We are getting exactly what they said they would deliver.
Even though I brought this up on the other post, I’ll bring it here as well:
Mckay Coppins observes [I think he’s responding to the reports of Trump talking bout 15 day limit]:
8:41 AM · Mar 23, 2020
…to which Steve Vladeck responds:
9:20 AM · Mar 23, 2020
This is how LA Times reporter Matt Pearce responded to Coppins:
12:59 PM · Mar 23, 2020
As the coronavirus pandemic grows, gun sales are surging in many states
MARCH 16, 2020
Called my local gun store, a popular one, they had a recording stating restricted number of customers in at a time and listing all the popular pistol calibers that were out of stock.
Ordered seeds for my garden late this year because of moving residences. My usual supplier is out of all my favorites. says they are overwhelmed so shipping is 7 days not 2 as usual. might be easier to buy a gun — haven’t checked.
May I ask which supplier you’re using? I’m going to have to order mine as well, don’t dare go to my usual greenhouse because it’s PACKED cheek and jowl once the season begins in earnest. I don’t know now whether to use Burpee or Johnny’s or another company.
Then, there’s this:
White supremacists encouraging their members to spread coronavirus to cops, Jews, FBI says
The alert was sent to local police agencies by federal officials.
March 23, 2020, 1:41 PM
[I hate that I’m not sure how much credence I should give to “FBI’s New York office”, but I’m not.]
They were the ones who thought that Clinton Cash was a good basis for starting investigations.
He wants to go back to the way things were in late February where nobody in the federal government dared to talk about it, make any preparations, or telework.
He wants the Pentagon filled with tens of thousands of employees again, the Statue of Liberty swarming with visitors, and every federal courthouse packed to make up for lost time.
These idiots are impossibly bad at math and basic science, and I am apalled that the press seems to be not far behind.
Hello all. Thank you for as always keeping the commentary mostly positive, forward thinking and real.
I’m on a small Ashram in the Sierra Nevada Foothills. We’ve closed our doors to any new staff or guests until…
In the meantime we’ve started webcasting classes. The link will be at the bottom of my post.
There are four classes a day, two basic classes and two gentle classes.
The yoga is a classical Hatha Yoga practice. It’s two hours long and includes pranayamic breathing and a lot of relaxation.
At this point the classes we’re webcasting are 1) our normal twice daily practice, and 2) twice daily ‘Gentle Yoga’ practice. If you take one, just follow along best you can; if you start to get lost, just lie down on your back, relax, join back in when you’re ready.
If interested, go to the general website sivanandayogafarm.org, for classes in meditation, vedanta, chanting, etc. I think there’s a very small charge to register for most of the classes.
We’re insularly cloistered in a beautiful location and traditionallyhave encouraged people to come here. It appears the global predicament has given us an opportunity to share an uplifting practice beyond those already familiar with us. Om Namah Sivaya.
I’ve been periodically following your community since FDL times. Thanks again, for keeping me thinking.
Howdy, Robert. I’ll allow this through once because we clearly have some community members in need of stress management techniques. However we typically do not allow promotion of businesses nor do we accept advertising in order to remain independent. Thanks for stopping in.
Plus not to say that the yoga practices offered are not beneficial (I’m a long-time independent yoga practitioner) in and of themselves, but now the Sivananda community has joined the long list of spiritual organizations now confronting posthumous Me Too revelations regarding their long-deceased founder (d. 1993) and others still living. And from what I can tell, they are seriously behind the curve in coming to grips with that unfolding situation-within-a-situation.
Hurricane, flood, whatever metaphor one chooses, we are well into a very dangerous storm. Shelter ing in place involves finding a calm place in your mind and taking stock of your situation. But maybe you need to shelter somewhere else. NYT travel graphics of this AM show a burst of travel last week then quiet. Here’s a process that I’ve gone through.
What do you see around you? What are your known risks? What do you not know that you need to know? How much information is enough to make a plan of action? Is your information credible? Or is it disinformation?
What are your resources? Can you band together with friends and neighbors? How can you acquire what you need? If you can’t get it, can you create a work-around? If not, can you do without? So many questions. Write down your answers. Discuss with family members. Plan to act. Make every effort not to be paralyzed by fear or anger. Do not confuse motions with actions.
What are unnecessary actions? Don’t do what’s unnecessary. How do we decide?
Here’s my situation: last fall We acquired a chunk of rural property, not good farmland but has pockets of good soil and a good well, lots of sagebrush. We are high-risk elders. Seattle is not a good place for us. Last weekend we took our two trucks to our house in the city and loaded the tools we may need for a year or more away on our own. It is sad to leave established gardens and fruit trees. We’ve put our city place in trust of a robust teenager and his Ukrainian girl friend. She seems bright and level headed for a fifteen-year-old.
Being of Mormon heritage, I was taught to keep a little stash of whatever for uncertain times. These are those times. So, we have food enough till a new garden comes in.
We have friends at our rural town and I have skills to trade. People in the area are self-reliant. We are lucky but we’ve made a good bit of our own luck. Now if our health holds and we avoid injuries we’ll be alright for the foreseeable future.
Losartan is an ACE-2 receptor blocker that is commonly prescribed for hypertension. To my knowledge , it’s role in treating COVID-19 is unknown. To be clear, I am not advocating it’s use, just passing along some basic information.
Thanks much for that. Could be the reason why patients with pre-existing high blood pressure have been more likely to be severe/critical; virus may be intercepting ACE-2 receptors before their Lorsartan can block the same receptors.
Actually losartan may be protective by blocking the receptor needed by the virus to enter the cells. However, another class of BP and cardiac medication is an ACE inhibitor which blocks the production of angiotensin II. Perhaps (my pure speculation) leaving more open receptors for the virus by blocking ACE 2 is not a good thing. I would be very interested to know the percentage of people with bad outcomes with SARS-2 and having cardiovascular and hypertension disease as co-morbidities were taking an ACE inhibitor.
You might find this of interest.
How unusual is this virus, WRT what seems to be a super-high percentage of asymptomatic cases?
We are still defining “asymptomatic” — apparently quite a number of COVID-19 cases experience loss of smell and taste. More appropriate to say “cryptic” in that we can’t see some of these cases.
If there’s a virologist or microbiologist (hello Jim) out there who can speak to viruses in humans without symptoms, a reply here would be awesome.
Not my part of the sandbox, so I’ll just make a general comment. “Asymptomatic” just means that the patient isn’t complaining of anything unusual or wrong. It doesn’t mean that the virus isn’t spreading and causing damage to the body. If you did CT scans on the lungs of all of your “asymptomatic” cases, and you found abnormalities in half of them, those people are all STILL “asymptomatic”. The term has a very specific meaning when used in medicine (although doctors often screw it up). “Symptoms” are things that the patient tell you about. “Signs” are things that you see as a physician. An abnormal lab test is usually considered a “sign”. Some things can be symptoms but not signs (like pain), some things can be signs but not symptoms (like abnormal lab tests), and some things can be either or both (like fever).
For a bit of context, the understanding of percentage of asymptomatic influenza cases varies a lot.
This meta analysis published by NIH has a good introduction to some of the issues involved:
So in addition to definitions of asymptomatic varying a lot, so do the populations studied and the variables that are controlled. It’s clearly much too early to say much about coronavirus.
Sorry for the late response.
Viruses in humans have an incredibly wide range of possible actions. Note that the virus that causes chicken pox can go dormant, only to pop back out decades later in the same person as shingles.
The other thing that we always need to keep in mind is that although the genetics of the virus itself are quite simple with so little genetic material involved, humans are incredibly complex genetically and are outbred. We have very little to go on to predict how the virus will affect large groups of individuals under otherwise identical conditions and even related to one another.
So that means we shouldn’t be too surprised by what we think now is cryptic behavior, even if it doesn’t fit what we see with other viruses we hear more about.
Thanks, Jim. Completely forgot about varicella-zoster virus — chicken pox and its later-in-life version, shingles — as just one example of a virus that can go dormant in humans.
Super high percentage of asymptomatic cases? Lot of Bull shit narratives going around with that tag line. We won’t know until we do antibody testing. The wing nuts talking about it that it has been in the US since November have even got alleged China trolls chiming in.
Two studies, the village in Italy half the positives were asymptomatic. The Diamond Princess 51 percent of positives were asymptomatic. https://www.niid.go.jp/niid/en/2019-ncov-e/9417-covid-dp-fe-02.html
Iceland is testing *everyone* and they’re finding about 50% are asymptomatic.
They intend to test everyone, but so far less that 3% of the population has been tested with only 48 people among the non-quarantined population testing positive (half of them were asymptomatic, the other half had cold-like symptoms). Still too early to claim that there is an unnaturally high number of infected by asymptomatic people (though obviously we should assume that for safety).
PS. File “super high percentage of asymptomatic cases” under Lies Trump is saying to justify killing more Americans for “the economy”
~50% asymptomatic seems pretty goddamn high for a disease that kills a not-insignificant number of victims. But I am not a doctor. Also, I am not repeating some bullshit I heard being hyped somewhere else. I am genuinely not informed enough to know if there are other viral diseases where this pattern is typical.
And, for some context, the reason I asked is because our limited testing resources seem to be being wasted by restricting tests to those who are obviously sick, celebrities, and politicians, and not using them on the apparently healthy but possibly infected and asymptomatic, which is the group we should be identifying and quarantining.
Banner Health experts warn against self-medicating to prevent or treat COVID-19
Oh my god. I don’t even have words for this horror. That jackass in the White House killed this guy.
And EVERY.SINGLE.REPUBLICAN. in the House and the Senate is OK with that.
Well, they are the ones who told us elections have consequences.
Let’s not forget Jared too, since he is running a parallel response team that has said precisely nothing. Pence is complaining to Trump about Jared’s interference (good luck with that, Mike), after getting co-opted by POTUS because Pence actually got some good press at the “news” conferences. Trump can’t have that, or Dr. Fauci undermining his optimism, or anyone looking back at what he said (really, Ms. Grisham?) that might interfere with his groove. There’s an election to steal.
Jared’s contributing stuff he hears from his friends from social-media and other tech companies – not the hardware people, I think, but the software people. Which isn’t vetted, of course, and tends to CT.
Bill Barr will be attending the WH press briefing today to recommend smearing lamb’s blood around the entrance to your home as a way of warding off the COVID-19 virus.
So now Trump isn’t just shooting on 5th Ave. — he’s spree killing in all 50 states.
And FOX News says what . . . ?
That was quick. Researchers can’t get enough hydroxychloroquine to run even research trials on it.
Have to wonder if that was the intent. It’s not like Trump hasn’t used pump-and-dump techniques before to screw with the stock market.
It’s a prescription drug, with limited on-label uses, so who’s getting all of it?
Hoarders. People who are using it as a prophylactic. People with mild or moderate cases of COVID-19. Like I said above, assholes.
Plaquenil is sold out at every pharmacy within 20 miles of me. I have lupus and rheumatoid arthritis. I’ve had a P script for a few years. Pharmacist said doctors were calling in and ordering hundreds of the tablets, and they’re hoarding them. The guy who owns the dog grooming salon down the street got a prescription for himself, his wife and his daughter, and was sharing the prescribing doc info, despite none of them having any medical reason. I was furious, and read them the riot act about stealing meds from people who actually have a reason for taking them. I then reported the doctor to the medical board and the attorney general.
I’ll be honest, I was cranky that I can’t find flour, sugar, eggs, or toilet paper, but it never even occurred to me that people would hoard prescription drugs.
Charles Pierce does the absolute best live tweeting of daily TRUMP-SPIN-Time [but he doesn’t thread his tweets]. This is while BARR was s peaking:
6:26 PM · Mar 23, 2020
And as usual, Daniel Dale is great, too:
7:36 PM · Mar 23, 2020
Just watched the WH presser. Trump has really boxed himself in with the 15 day self imposed limit on mitigation efforts. Then the bla, bla, bla, unending bla, bla. The effect is he has made the pandemic his pandemic. By hogging the podium his previous “strategy” of setting “Mike” up as the fall guy is undercut. Trump is even stupider than the mind-numingly stupid he seemed just yesterday.
Finaly “Deborah” got to answer a question or two. Did I hear her say, a sample group of tests in NYC show a 27% infection rate? At 1% mortality over 8,000,000 people = 21,600 ! I must have heard wrong …
Did you notice Trump’s incessant citation of the figure “50,000 deaths from the flu this year” ? This must be his next cya setup: someone must have told him maybe 50,000 people will die from Covid-19, so he is setting it up for an equivalence. Just like the flu, folks, just as I said, he will say.
Finally some potentially interesting questions for Birx on antibidy testing and CNN cuts the feed. All they want to show is the surreal drama of Trump. Even a little tiny but of science is not useful for the narrative, or the click bait, or the high-volume screaming, so cut it.
numingly -> numbingly
antibidy -> antibody
and the whining that more people die in auto accidents than flu – missing points left and left. (We do everything possible to prevent those, too. Including closing highways when conditions are unsafe, sometimes for days or weeks.)
I work for a mega-corp that works with the FAA. The FAA has limited capacity to deal with their airport traffic controllers (ATC) in dealing with the corona virus. If someone gets it, towers/airports will shut down (like Las Vegas last week). The beatings will continue until morale improves.
Just parking this video here in case any medical providers find a brief refresher course helpful for setup and use of the newer ventilators out there.
The cynicism of the Trump Gang and his GOP apologists is clear. It’s better that as many of us die right now so that the market “slump” and bulk of the dying will be over closer to the November election. And who at this point would be truly surprised if these vampires have formed a trust to control the coffin market and sell ‘baptismal gas’ to crematorias?
(And rumors are that Barr is hatching some scheme to allow political opponents to thus be denied habeas corpus for a year…nice.)
Here in the UK, we’re now in a three-week lockdown because people just would not stop going out. Much like the US, a certain percentage of people think it’s all made up or overhyped and want to invoke the spirit of the Blitz that none of them lived through. Training people up to disbelieve science is having unintended consequences.
The thing that’s really getting to me is the silence. Granted, it’s the middle of the night here at the moment, but I live near one of the UK’s major airports and usually hear planes all the time. There’s very little traffic and the streets have been deserted since Friday, so it seems my tiny corner of the world is taking it seriously.
Wishing all of you the very best.
Hi Cat, welcome to Emptywheel! Please join us often.
I’m in Los Angeles, and there’s less street traffic (and fewer people on the buses).
And the air pollution index is way down compared to its “usual” numbers. I live near LAX and planes are still regularly taking off. It’s hard to say that I notice less air traffic here…
Apparently due to crowds last weekend at Santa Monica and Venice Beaches, beach parking lots are now closed. That now includes Dockweiler Beach (there’s a quarantine center set up in the Dockweiler RV parking lot awaiting occupants), the gigantic parking lot at Dockweiler Youth Center, and El Segundo Beach. El Porto Beach in northern Manhattan Beach was open today but a hastily-installed highway message sign now sits at the bottom of the driveway that says “6 ft Social Distance” in large electronic letters…
I wonder what they’re doing at Sepulveda. There are some areas of it I think they’d have to close, but much of it is open space and you can be quite a way from the next person.
Today NM Governor initiated a lock down as Dr. Wheeler has tweeted. All non-essential businesses are to close until April 10.. Essential is defined. Friend of mine is a car body shop owner/operator, he is halted in middle of a surge where he had to employ 3 other people. Lots of customers gonna be unhappy with delay. Wonder what insurance companies are going to do about this?
This morning went to early senior hour at local supermarket: lotta masks, lots of people looked quite worried…I guess that is appropriate. There were paper products available, all the store’s brand. Cheese was in short supply, darn. My ex-wife’s married daughters ran out of TP, saved at last minute as she had mailed them some.
Son (age 29 and vigorous) reports greatly diminished lung function after 9 days of Covid19 symptoms, test administered in AZ was negative. He said today the tech who took the swab was clearly rattled and fumbling in the sample, even the Dr. seemed apprehensive. The test is sensitive to many things. Given that false positives could endanger a lot of people, seems follow-up sampling (by pros) would be a good idea. That presumes an adequate supply of testing kits and techs who can run them. We are so screwed with this mal-administration and the senate…
I ordered some bandanas from a surplus store that I’ve patronized in the past. They may be olive drab, but better than no bandana. (They’re not as good as real masks, but more available.)
I have a friend who works for a small insurance brokerage here in southern California and he told me today that they are considered to be an “essential” business (don’t ask me why) as they act as an interface between several insurance companies and their various customers, both private and corporate. He said they’re not set up to have employees telecommute, but they are splitting the difference by sending half of their employees home at any given time so that the office is less crowded than normal on a daily basis. So my friend is now basically getting 2 days off (paid) and going into the office the other 3…
That sounds interesting, but also sounds like it might could work. There have to be things the ones at home could do with a computer and a phone though, doesn’t there?
I dunno, but when I asked my friend about that, he simply said that his company “didn’t have the laptops” to pass out to employees to take home and do work with. I suggested they might want to make that investment (in additional laptops) so they can stay productive while their employees are at home. But it’s something they’ve never had to face before, so they may figure out alternate logistics after a while…
Mine didn’t have that many laptops, either. But I don’t think my job would have been workable with one – we needed two screens to be able to see what we needed to see.
There might be some security issues involved and the business might not have the wherewithal to deal with them to get people set up to work remotely.
Personally I’d get each employee a VPN account, a Chromebook, and reimburse them for 50% of their internet service. No personal work on Chromebook, though, business only or they forfeit right to work at home.
If forced to work on a Chromebook, I’d quit.
LOL Buh-bye! Don’t let the door hit ya, mistah!
But seriously, not every business has the money and human resources to dick around with maintenance. Don’t Apple-me anything because they are pricey and still need maintenance. Chromebook updates automatically and without the bloody hassle that comes with Win10 updates, limits what people can put on their device if a smaller hard drive is provided, limits the software one can load and run. And the price can be as little as 25% of an Apple laptop — if it breaks, chuck a new one at an employee.
Let’s face it, you’re a old dog and you just don’t want to learn new tricks.
Oh yeah. Long ago and far away, I knew someone that warned me about auto updates. Yahtehey, old dogs don’t need new tricks.
The silence will grow overhead as more air traffic controllers get sick. Stay safe, Cat, thanks for dropping in. Keep us posted on how things are going in your neck of the woods.
I’m frustrated as hell. I know for a fact that there are thousands of N95 masks and gloves (a a kajillion of those sterile triangular bandages that no one ever uses but that could be repurposed) gathering dust in first aid/earthquake kits in mostly shuttered offices all over my massive public university, and that no one is reclaiming them for redistribution to facilities and programs (private care facilities, homeless shelters, etc.) that are so low on the official distribution lists that they are closing for lack of PPE.
I wrote and called disaster management and volunteered THREE WEEKS ago, and again every week since, to contact every department’s admin and ask that they make these kits available for collection. Now, nearly all of those admins and the staff they supervise (including me) are working from home, making it that much more difficult to reclaim these supplies.
Also, to my knowledge, no one is spearheading an effort to redistribute supplies they don’t immediately need, now that all non-essential dental care has been suspended after a number of the 14,500 attendees at the March 5-7 (WTF were they even thinking?) Pacific Dental Conference tested positive for COVID-19. Maybe this is happening informally, but if so, none of the dentists I know (and I know many, having worked at the dental school for five years) are aware of it.
It just makes me weep that homeless shelters are closing because they can’t provide their staff with adequate PPE, and that the staff of those that remain open are terrified – less for their own immediate well-being, but by the idea that they could be infected but asymptomatic and spreading this virus (and/or staph, e-difficile, MRSA, hepatitis and all those other nosocomial infections that haven’t graciously disappeared just because this one’s joined the party) to their clients and to their own families at home.
And I’m in Canada. The situation in the US is, on every possible level, several orders of magnitude worse.
Here are some links that may help you benchmark your own state and federal responses.
Scroll down to the BC Government Statements. Our Health Minister Adrian Dix and Provincial Health Officer Dr Bonnie Henry are top notch:
Figures 2 & 3 are particularly interesting. Also worth just nosing around some of the links:
The epi-curve in the latest WHO sit-rep is terrifying. US is ramping up to be the next Europe:
Thank you to the great contributors and commenters here. You bring cogent analysis, keen anecdotal observation, snark, whimsy and many other wonderful human qualities to this dire and tragic situation.
My partner, tonight at dinner, referring to Trump: “We are now beginning to see the true extent of his mental illness”.
Take care and good luck!
NY-Presbyterian doctors give a daily video update for strategies that NYC hospitals are using wrt COVID-19 (coordination, combatting racism, testing, PPE for health care workers). This link is Monday’s broadcast 3/23/20.
NY Presbyterian’s video at the above link will update each day at 10am.
Thanks for sharing that. Hearing directly from medical professionals and the hospitals will be much needed to cut through the blizzard of bullshit emanating from the Trump machine.
I noticed the video is no longer playing.
I learned today, unfortunately, that the hospitals have decided to make their subsequent videos private.
I asked a friend to send them a request to reconsider and to think of themselves as reliable eye witnesses for the rest of us.
I can understand their concerns given the climate. Just look at what Trump has done with a little information about a potential drug therapy; what would he do if he got his hands on a video from a hospital in NY, or what would the influence operation supporting his campaign do with it? I think openness is better for the public but then Trump.