Three Things: Breathing, Thinking, Mating and COVID-19

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

Breathing, thinking, mating.

At least one of these three things are important to you, no matter your age. COVID-19 can affect one or more of them, and we don’t yet know to what extent.

More importantly, it’s not getting through to the general public that COVID-19 can affect one or more of infected persons’ lungs, brain, and reproductive organs even if they are young, not to mention their heart and vascular system.

And by young I mean students in school, whether K-12 or tertiary (college/university) education.

~ ~ 3 ~ ~

But first, let’s talk about bad assumptions and biases.

We’ve heard since the earliest media reports from China that COVID-19 affected the lungs. It was characterized as a “pneumonia-like illness,” and unfortunately this characterization limited the public’s earliest perceptions of the disease.

“Pneumonia-like illness” allowed misinformation and disinformation to flourish — it’s just another flu, the propagandists propelled, ignoring the much greater mortality rate and the insufficient data about SARS-CoV-2’s transmissibility.

The health care system geared itself toward treating a “pneumonia-like illness,” demanding ventilators when ventilators might be fine for pneumonia, but might pose new risks with a disease like COVID-19. Health care workers performing endotracheal intubation, extubation, noninvasive ventilation were and are exposed to aerosolized virus material, requiring much greater rigor in personal protection due to these aerosol-generating procedures and the volume of virus they are exposed to each shift.

Even with increasing awareness that personal protection must be stepped up for COVID-19 as compared to influenza, hospitals still don’t have a handle on infection control. The Wall Street Journal reported:

“…Researchers at University of Nebraska Medical Center found the coronavirus in hallway air outside negative-pressure Covid-19 rooms. The Omaha hospital revamped its ventilation system to protect people in hallways by creating negative air flow there, too. …”

Existing negative air pressure rooms — Airborne Infection Isolation Rooms (AIIR) — might have been enough for influenza. It’s clearly not when 5,000 cases of COVID-19 may be related to inadequate infection controls in hospital settings in spite of like that used in dedicated COVID-19 treatment rooms. Hospitals would have changed their infection control protocols long ago had they seen nosocomial transmission of flu within hospitals approaching the rate of transmission with COVID-19, but perhaps the health care system has relied too heavily on annual flu vaccinations. Perhaps nosocomial transmission of flu and other pneumonia-like illness would have been much higher without vaccinations, revealing how flawed existing infection controls have been.

Our health care systems too slowly recognized COVID-19 isn’t like influenza or a pneumonia-like illness. It’s far more insidious. It’s now cost at least 600 health care workers their lives.

In addition to flawed assumptions, bias has also screwed up screening for COVID-19. Many of our community members know of people who were denied tests for COVID-19 because they didn’t meet certain criteria; one of the early criteria was whether the subject had traveled to China or been in contact with anyone who had been to China. Trump and his xenophobic followers have continued to exacerbate bias with racist framing of COVID-19.

Except that many cases of COVID-19 can be traced to Europe. It can be seen in the emergence and dominance of the G-lineage of the virus versus the D-lineage which was first common along the west coast. Everyone who had any one of the symptoms identified by China should have been tested for COVID-19, no matter where they had been or with whom they had been in contact.

I can’t begin to think about the number of lives which could have been saved had this country launched effective testing more widely, in concert with quarantine. But we didn’t in no small part because of limited, faulty thinking about COVID-19.

What other biases have similarly shaped our ability to address COVID-19 effectively?

The racist, ageist, ableist bias which informs inaction because it only negatively affects those people?

~ ~ 2 ~ ~

We still don’t know what the repercussions are for recovered COVID-19 patients, including those who were asymptomatic.

Lung damage, which initially shaped health care professionals’ treatment as if COVID-19 was a pneumonia-like illness, appears to be long term.

Drillinger, M., Chesak, J. (fact checker) (2020, June 22). Lifelong Lung Damage: A Serious COVID-19 Complication. Retrieved July 27, 2020, from

Damage was also seen in lungs of infected individuals who appeared to be asymptomatic or only mildly ill with COVID-19.

Prevalence of Asymptomatic SARS-CoV-2 Infection
Daniel P. Oran and Eric J. Topol
Annals of Internal Medicine, Reviews 3 Jun 2020

But it’s not just patients’ lungs affected; more than 36% of COVID-19 patients had neurological impairment.

Mao L, Jin H, Wang M, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683–690.

Delirium, brain inflammation, stroke, and nerve damage occurred as well as a rare condition, acute disseminated encephalomyelitis (ADEM) — an inflammatory disorder which is sometimes fatal.

R W Paterson, R L Brown, L Benjamin et al, The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings, Brain, awaa240, Published: 08 July 2020

The virus causes heart damage, even in patients who had no pre-existing cardiac disease:

In this global survey, cardiac abnormalities were observed in half of all COVID-19 patients undergoing echocardiography. Abnormalities were often unheralded or severe, and imaging changed management in one-third of patients.

Marc R Dweck, Anda Bularga, Rebecca T Hahn, Rong Bing, Kuan Ken Lee, Andrew R Chapman, Audrey White, Giovanni Di Salvo, Leyla Elif Sade, Keith Pearce, David E Newby, Bogdan A Popescu, Erwan Donal, Bernard Cosyns, Thor Edvardsen, Nicholas L Mills, Kristina Haugaa, Global evaluation of echocardiography in patients with COVID-19, European Heart Journal – Cardiovascular Imaging, , jeaa178,

Abnormalities found included myocardial infarction (heart attack), myocarditis (inflammation of heart tissue), takotsubo cardiomyopathy (temporary deformation of heart chamber), as well as elevated natriuretic peptides and cardiac troponin.

Scientific American published an article this weekend which offered even more anecdotal evidence of cardiac damage from COVID-19 even in asymptomatic persons.

Autopsies of COVID-19 victims showed damage to testicles:

Yang M, et al. Pathological Findings in the Testes of COVID-19 Patients: Clinical Implications. Eur
Urol Focus (2020),

Based on findings, not only should kidney function and hormone levels be monitored but younger men should receive fertility counseling for family planning:

Wang, S., Zhou, X., Zhang, T. et al. The need for urogenital tract monitoring in COVID-19. Nat Rev Urol 17, 314–315 (2020). Published 20 April 2020 Issue Date June 2020

There have been many anecdotes of patients with sequelae lasting months after their initial illness. A large enough number exist for them to form groups in social media to compare notes about their experience. As the underlying SARS-CoV-2 virus is novel, we don’t have years of experience to look back upon for trends. We can’t yet predict whether there will be lifelong disability though many patients have reported development of diabetes, kidney dysfunction, heart disease, neurological impairment which have lasted months after they were technically deemed recovered. Studies on COVID-19’s long term effects have only recently begun and may last months to years.

We also don’t know how long any immunity post-infection will last, let alone whether most individuals can expect not to be re-infected within a year of their first infection. Brazil’s President Jair Bolsonaro is a recent obvious case raising questions about immunity; he tested positive for COVID-19 a third time two weeks after testing positive the first time.

So much for Bolsonaro’s faith in hydroxychloroquine as a therapy for COVID-19.

A British study showed immunity dropping within three months after recovery:

… In the first longitudinal study of its kind, scientists analysed the immune response of more than 90 patients and healthcare workers at Guy’s and St Thomas’ NHS foundation trust and found levels of antibodies that can destroy the virus peaked about three weeks after the onset of symptoms then swiftly declined.

Blood tests revealed that while 60% of people marshalled a “potent” antibody response at the height of their battle with the virus, only 17% retained the same potency three months later. Antibody levels fell as much as 23-fold over the period. In some cases, they became undetectable. …

Longitudinal evaluation and decline of antibody responses in SARS-CoV-2 infection
J Seow, C Graham, B Merrick, et al
medRxiv 2020.07.09.20148429; doi:

We’ve now seen cases where persons have recovered from COVID-19 only to be reinfected and sickened by a different strain. In a Hong Kong patient who had recovered in March but was reinfected during later travel to Spain, we see the problem of making assumptions based on bias about the “China flu.” COVID-19 isn’t just a single coronavirus strain originating in China.

The possibility of reinfection with different strains combined with decreasing immunity over time means reliance on “herd immunity” is foolhardy, and vaccines may not work as long as intended. Mitigating the spread of the disease remains crucial until a safe, effective, and durable vaccine has been developed, tested, and prepared for global distribution.

~ ~ 1 ~ ~

If hearts and lungs, neurological and reproductive systems are permanently affected by COVID-19 even in younger patients who may remain asymptomatic, why risk exposing children and college-age students to COVID-19 by returning them back to in-classroom schooling?

You’d think white nationalists would clue in that their precious ideal of a white power future is threatened by this virus, literally neutered by testicular damage, but no — they insist students must return to school.

Worse, they insist on sports, demanding college football right now, even though athletes have been infected, sickened, suffered heart damage, and died from COVID-19 in spite of their youth and health.

Why are we even allowing in-classroom schooling at all when there has been zero effort to fund and implement modifications to HVAC systems though we have known for months now that aerosolized exhalation in poorly-ventilated enclosed spaces is the greatest risk factor to mass infection?

The only answer seems to be in the lack of any answer at all — the choice to do nothing is a choice.

And the choice the Trump administration, GOP legislators and state governors have made is to maim and kill more Americans.

~ ~ 0 ~ ~

There’s an incredibly stupid tweet making the rounds, published by Students for Trump. They share a photo of Trump standing before burned-out buildings in Kenosha, Wisconsin. The tweet reads, “President @realDonaldTrump tours what Biden will do to America.

Most tweeters who comment remark on the idiocy of this projection: Trump stands before the wreckage he helped spur during the waning election year cycle as he runs for re-election.

I can’t help wonder if the stupidity of the tweet is a reflection of the damage exposure to COVID-19 may have already wrought on Students for Trump.

This is the future of the Republican Party: too brain damaged to recognize their reflection in the mirror.

Too impaired to recognize the self-inflicted injury, too messed up to save themselves and their future.


This is an open thread, though COVID-19 content is preferred.

67 replies
  1. Rayne says:

    I’ll admit I piddled around with this post for roughly eight weeks, reading more and more COVID-19 research as it was published. The first time I saw research about testicular damage was back in March and subsequent papers only reaffirmed what the Chinese found in postmortem analysis.

    Which is why it still amazes me that the entire bastion of right-wing men haven’t yet clued in that COVID-19 may damage men’s testicles and fertility. It’s been at least five months since that first study.

    But get students back on campus and give us college football now!

  2. Eureka says:

    An FYI aside before I read (glad you tweeted it and I happened to check): since Monday (so perhaps due to WP updates) there is some new thing where the home page isn’t updating/ed.

    I ruled out caching on my end yesterday (though it would appear to be some type of caching problem elsewhere maybe), and then again today when I first came to the site Marcy’s new post was listed, but said it had zero comments; the actual post had ten on it (and so forth: home page not caught up to post pages, have to click every open post page to check; also “Recent Comments” at page sides not updating).

    Returning to see your new post, it says yours has zero comments (when there is at least one) and Marcy’s now says ten .. so I am further inferring that maybe it updates when you guys post something new, like a reset, then ~ static thereafter.

    • Rayne says:

      Thanks for the heads up. Not certain if this is platform based or if this is a residual problem with caching on DNS servers in wake of CenturyLink crash. Let me know if you still see this problem in another 24 hours. I didn’t notice it at my end.

      EDIT: Anybody else experiencing the same problem, please reply and let me know. I have a theory but I need more data. Thanks!

      • Eureka says:

        Ah CenturyLink — makes sense! Well I have to unscramble my brains for more precise feedback, but it seems to be improved yet still happening/variable. Some post-sides are updating with newer comments, some not (tho that in itself is not entirely unusual, esp. with older posts — tho those had been more updated of late than usual, prior to whatever’s up now); homepage still behind (and just reopened to check — says Ed’s post with 2c, has 6c as far as I can see; homepage lists PJ’s 952p comment as the most recent one: P J Evans on Billy Barr Signs a Memo That Wouldn’t Have Helped Carter Page).

        The other thing I had noticed (which seems to be WP-related) is that when one replies to someone now, it says “Reply to (e.g. here) Rayne” after you click the “Reply” link and the box pops up (that may have been present for me in the distant past but not recently until these last days/change). And when I first replied to your post there was no edit button (but all of my subsequent comments did come with an edit button. Of which I failed to avail myself, lol).

      • Rayne says:

        Thanks. May have shot my theory in the butt. Please do us a favor and check again in the evening and tomorrow morning.

        If it’s due to cache servers responding after the CenturyLink fail cascade, it may resolve itself inside another 12 hours.

        • MB says:

          Still happening, as other are reporting. This article said “24 comments” at the top but only 5 were showing. Had to hit refresh and now 24 are showing. Also the main page wasn’t showing newly-published articles until refresh was clicked. Noticed the crash yesterday morning (or the day before?) when the site was down completely for a brief time.

          As well, the 5 “most recent” comment links in the right-hand column of the main page would just go to the top of the article rather than to the specific comment, as it usually does…

  3. posaune says:

    Great post, Rayne.
    One would think that the male fertility & testicular effects of Covid-19 would make the maga-types run run run for home and bolt the doors. Maybe it will wipe out their progeny. But, really . . . just wow about the reach of this virus.

    • rip says:

      Not sure the maga-types really want to procreate as much as they want to force subservience.

      They certainly don’t want to make sure there is a healthy society in case their spawn survives.

  4. posaune says:

    Our cousin in Denver got the virus (50-yo wife & mom) — very quickly and violently. She had a sore throat on the morning of Thursday 7/23. By Friday evening, she was hospitalized, sedated and on a vent. Very fast and very scary. Extremely slow progress, despite remdesivir, probing, etc. They finally tried to wean her from the vent 10 days ago. Managed to get an MRI, but re-emergence of primary symptoms and she was re-sedated and back on the vent the same day. Finally taken off the vent at the end of last week; fitted with a trach. She cannot walk, talk or swallow AT ALL. This is going to be a very, very long haul in rehab — estimates a year. Family suffering as the two teenagers came down with the virus, recovering at home. Spouse completely spent in every way, despite testing negative! Taking care of the kids, making meals, conferring with physicians for all three patients, burning leave at work like a forest fire. Desperate for his wife to get well. Family trying to help long distance with food deliveries and funds. It is a deep, dark hole to dig out of.

    • Rayne says:

      So sorry to hear this, posaune. Thanks for sharing this. Unacceptable that the US is still not prepared to help families affected directly by COVID-19.

  5. fubar jack says:

    COVID 19 is certainly not a flu. In addition to that frightening list is abnormal blot clotting
    Unfortunately educating the general public ,in real time about the science that is coming out about this is being hampered by the tsunami of bullshit that is flying around our discourse. We are being hit with a plague of disinformation as well as a virus… I feel powerless in the face of such stupidity…when confronted by my friends, neighbours and strangers who share dubious ‘takes’ on the virus , I admit that there is a lot that I don’t know and I refer them to the Wikipedia page on COVID .

  6. Eureka says:

    Thanks for writing, Rayne. In projecting my exhaustion with all things to rant about wrt this topic I appreciate your smooth hand here.

    The doomsday cult don’t appear to be worried about their fucked up man junk from Koch-guzzling plastics (endocrine disruptors including phthalates), either, and appropriately dealing with COVID is so much less convenient for them in any case.

    Shortly before the Hong Kong (and few other) sequence-based repeat cases were acknowledged, a local woman in her 20s was featured on the news (6abc) for having COVID twice, four months apart, presenting each time with acute febrile illness. With asymptomatics and general lack of resources, who knows the true incidence — but I doubt it to be rare.

    The whole thing with Trump using his DOJ to attack blue state responses (NY NJ MI PA) re _state-run_ nursing home deaths has not only infuriated me but dug up some real PTSD, again, remembering what it was like back in (January forward, but really in ) March+. In fear for our lives, inadequate testing … Fuck him. FUCK HIM. Not up for getting into all of the utter baselessness of this pre-investigation, but Ryan J. Reilly’s HuffPo piece is an excellent start towards addressing the BS. Also, one of the state run veterans homes in PA had notorious problems including the residents being blanket treated (test or no test) with hydroxychloroquine, and I partly suspect that this ‘possible’ investigation is payback for that angle of bad press on Trump and his COVID conspiracies as well.

    Then there is the issue of Hahn* supposedly agreeing in principle — after the whole convalescent plasma debacle — to EUA (a) vaccine(s) not even out of Phase 3 trials? What a disaster. Paul Offit — the most dogmatically pro-vaccine voice in this country — is even expressing strong concern. The significance of his speaking out cannot be overstated:

    “What keeps me up at night is that the first vaccines are going to roll off the assembly line, or gonna roll off first, because they were the easiest to construct and the fastest to mass-produce,” not the most effective or best ones, Children’s Hospital of Philadelphia vaccine expert Paul Offit said at a medical press briefing on Monday [August 24, 2020; August 27 date of article].


    Trump DOJ Targets Democratic Governors For COVID-19 Outbreaks In Veterans Homes

    *I don’t have that Hahn quote handy (in the same recent tweet swill, a person claiming to be in the Moderna trial said she was yet to, though about to, receive her second dose), but here’s an explanation of the process and timing that goes with it:

    Here’s how the U.S. could release a COVID-19 vaccine before the election—and why that scares some

    • Eureka says:

      Offit quote from article below (he is also mentioned in Science above).

      Healthcare workers will be among the first forced to get these vaccines — or lose their jobs, unless administrators truly consider the nature of the landscape here and go gray (all the chiaroscuros) on the mandates. We can only hope for loud (and prestigious) advocates of science, evidence based medicine, and standards of care…

      The H1N1 Vaccine Is A Cautionary Tale For The Coronavirus

        • Eureka says:

          I see what you mean — and I’ve called out Fauci for incautious statements before — but it’s hard to ding him for this one because he’s just restating the normal rules for clinical trials (and probably in response to a question ~ Is it possible for X? Yes, here are the conditions…). Then, because the COVID situation is complicated by a dangling EUA and desperate POTUS, the authors moved on to quote other people on the other angles. Fine, ding him for it (lol).

          To spell it out (see also Science): manufacturers can go around this and seek an EUA for a COVID vaccine if they show 50% efficacy, but with the 95% confidence interval not dipping below 30%. Meaning, overall, that they would be _willing_ to EUA something where 95% of the study population fell between 70% and 30% efficacy — if the margins are that wide on a min. 50% outcome. And if they are that wide with the alleged sample sizes they have, then we have a problem (IMO, and likely due at least in part to subpopulation* variation; could also be storage/stability issues, but I’d suspect those to be likelier post-trial; consult a vaccine expert) and should keep working on something better. While wearing our masks &c… (and that’s besides the potential post-market and other problems identified by Offit and others, and the problem of TIME — whotf knows how long any immunity would last, if achieved).

          *For example, white males could drag up the efficacy numbers. But subpopulation doesn’t mean only things like age/ sex/ race/ ethnicity/ etc. here, but all of the unmeasured variables lurking happily among us (I don’t know what all they are measuring, but it’s a safe bet it’s not enough this early in the game. SARS2 is a gnarly beast).

          As of three days ago:

          Moderna increases minority numbers in its vaccine trial, but still not meeting Fauci’s goal [note: nor are the numbers yet even representative of the US population]

    • Eureka says:

      Jake Tapper interviewed Offit on August 19, 2020:

      Video {4:47, range of COVID-19 policy topics]:

      CNN poll: 56% of Americans willing to receive COVID vaccine

      “Rush” Transcript [excerpted below re vaccine]:

      Dr. Paul Offit, the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia joins me now.


      TAPPER: The CNN poll that found only 56 percent of people surveyed say they will try to get a COVID vaccine if and when one is developed. Is that enough in a perfect world? What percentage of the population should be vaccinated, 56 percent enough or not enough?

      OFFIT: Well, it depends on how effective the vaccine is. If the vaccine, let’s say, is 75 percent effective, then you would need to vaccinate about two-thirds of the American population to stop spread. But I do think that these polls aren’t asking the right question. I mean, the questions are being asked is would you get a theoretical COVID-19 vaccine. My answer of that question would be no. I would wait to see what the data are.

      But I think if you go to people, you say, we have a vaccine that’s 75 percent effective, it will protect you for at least six months [if] not longer. It’s been shown to be safe in 20,000 people. Would you get that vaccine? I think most people would say yes to that question.


      And to that aside re “consult a vaccine expert”, here’s one example:

      Vaccine Education Center | Children’s Hospital of Philadelphia

      • bmaz says:

        Yep. I have no issue with vaccines at all, been getting them forever for the various things. Including yearly flu and pneumonia ones still. But even I would not blithely answer the simplistic question yes. I too want to see the data.

        The other issue is that until it evolves and is refined, the odds of any initial vaccine being 75% effective are almost zero.

        • Eureka says:

          Exactly — very pro-vaccine per my own behavior: with this one, show me the data.

          Left implicit, but a major issue as to % efficacy endpoints is the Do The Math problem: if something squeaks in with that 50% EUA standard, even if, implausibly, 100% of the population got vaccinated near-instantly (and twice, per current late-stage trials), that leaves 50% (at best) of the population ‘covered’ (for some unknown period of time). That is not anywhere near “herd” aka community immunity [Fauci has said, using the figures in that Offit quote of a better vaccine with 75% efficacy and a more likely, if time-scaled, ~ 2/3 of the population getting it, that would not achieve community immunity (same math: ~ 50%). (Like other experts, Fauci has also said his floor for efficacy is ~ 70-75%…)].

          And besides, a lot of trial participants would be wearing masks and all that, too, confounding “efficacy.”

          TL;DR we need a good vaccine. _And still_ our masks &c.

  7. Nehoa says:

    I re-wrote the lyrics to “Breathe” the song made popular by Faith Hill to (I Can’t) Breathe. As I worked on this, I realized that White people took breathing for granted, while Black people could not because of the threat of lynching. Covid-19 brought the threat of loss of breath to White people for the first time in a very long time.
    I don’t know how to attach the music to this post, but the lyrics are as follows:

    There was a gentle giant of a man
    The world knew of him as George
    His brother called him by a different name
    But he won’t answer anymore

    Like you and I he made his way through life
    Until that fateful day in May
    When a knee held upon his neck
    A copy took his life away
    I can’t breathe….I cannot breathe….

    I tried posting this hours ago, but it was held up in moderation.

  8. JonKnowsNothing says:

    The following website tracks the phylogenic tree for a number of virus including COVID-19

    The site is primarily a repository of genome analysis done globally but also has some excellent “non science type” explanations with graphs and timeline animations. There are more than 4,000 genome sequences in the database.

    Generically COVID-19 gene traces are grouped A B C and many sub branches trace from these. As the virus passes through a population it picks up unique genetic markers along the way, a fingerprint of where it has been. All countries have all the main versions but every country has a dominant version.

    A = USA, Spain, Australia, China
    B = Europe, Japan, China, Brazil
    C = Hong Kong, Singapore, Italy

    The phylogenetic tree research published on the person from Hong Kong who had double infections indicated it was from two branches of the “B” tree.

    There are other reports of multiple re-infections but they are not as well documented. Some newer studies are in progress.

    ht tps://
    (url fractured to prevent autorun)

  9. Tom says:

    The longer the Trump administration’s bungling of the COVID-19 pandemic persists, the more alarming the situation becomes for the rest of the world, especially given the recent talk of “going herd”. There is a letter in the September 2020 issue of “The Atlantic” that captures my own feelings:

    “While it is incredibly sad to see our great southern neighbor sink into irrelevancy, the real disturbing thing for Canadians is that our neighbor may drag our nation into the abyss with it.”
    — from Maurice Coombs of Toronto, Ontario

    • readerOfTeaLeaves says:

      A friend who is originally from Taiwan had a call from a cousin, who had seen a report about recent US city conflicts, people with no masks, and honestly called to say, “Hey, I just saw this bogus news report…”

      My friend said, “No. That is exactly what is happening here.”
      I’m not sure what Taiwanese is for ‘OMFG!!’, but that was the general response.
      Now repeat that in an endless loop all over the globe…

  10. graham firchlis says:

    As Rayne”s analysis demonstrates, we are still woefully ignorant about Covid19. But we do know much more about the natural history of many other Corona viruses including the four that are endemic in humans.

    All four circulate continuously, evolving all the while. Individual immunity to each appears to be transient, with all four contributing to our annual cold season.

    If Covid19 adapts similarly to its new host, herd immunity may be unachievable and vaccination benefit minimal.

  11. graham firchlis says:

    Relevant article on coronavirus natural history is open source on Science Direct.

    Hosts and Sources of Endemic Human Coronaviruses, VM Corman and C Drosten in Advances in Virus Research, 2018, vol 100, Chapter 8, pp 163-188

    The url copies accurately to the comment box, but after pressing the Post Comment bar the url appears truncated. What more can I do?

  12. blueedredcounty says:

    Rayne, you said: “I can’t begin to think about the number of lives which could have been saved had this country launched effective testing more widely, in concert with quarantine.”

    To me, this is still the biggest hurdle we face. You can’t stop the spread, measure the true impact, or figure out the true effectiveness of vaccines or treatments without effective testing.

    I read this article last week:
    “I Had COVID-19 But Tested Negative 5 Times. Here’s What You Should Know About Testing.”

    “As an emergency physician, I’m often asked about the coronavirus. When I was exposed and my tests kept coming back negative, even I wasn’t sure what to think.”

    Quick summary: The author and her husband are both doctors. Her husband developed fever and fatigue, tested positive, and isolated himself. Her first three tests, prior to any symptoms of her own, came back negative. But even when she started getting symptoms (minor cough and chills, no fever) her fourth test came back negative.

    Two points from the article:
    “Viral and antigen tests commonly used in hospital emergency departments detect active infection, whereas antibody tests are used to detect previous exposure or infection. However, if viral and antigen tests have weak sensitivity or are administered too soon, patients may receive false-negative results.”

    “While it’s true that widespread testing can help determine where the disease is most prevalent and how to react, this strategy is most useful when robust contact tracing and educational procedures are also put in place. Unfortunately, these programs are currently severely lacking in the United States. If widespread testing is available without proper tracing and education, patients with negative results, especially those with mild symptoms, may mistakenly assume they do not have the disease and therefore cannot transmit it and may not continue recommended isolation procedures when these are needed most.”

    What I would like an update about was a test developed in Israel that was like a breathalyzer, that is supposed to be undergoing trials to get FDA approval, possibly by this month.

    I saw this article in July, but it was from the end of May. My sister, who is a retired nurse, said that she had also seen a mention of this test in the international news section of the American Journal of Nursing, but we have not seen anything else about it since. It seems like it would be a huge advance, because based on how it works (spectral analysis of the aerosolized particles you are breathing out) it would detect you when you are contagious, whether or not you have any other symptoms or are asymptomatic.

    The cynic in me was thinking this test will never make it to the US unless/until Trump could figure out a way to make a buck off it. Also, he would want it hoarded and available only for his supporters.

    Sorry, did find this article now:,7340,L-3840593,00.html – it’s in court over a patent and funding dispute.

    • Rayne says:

      While the limited news about the Israeli test is interesting, I’d avoid it because the approach requires those being tested to exhale particles which may be infectious. Unless these tests are integral to an entire system which captures exhalations from tests and disinfects them before releasing them to surrounding area, this sounds too risky for test administrators.

      With regard to the false negatives/false positives in current testing: we just went through a Chinese fire drill over the last two weeks related to testing. My younger adult child who lives with us had a second degree exposure to a co-worker who tested positive. My spouse happened to spend time in the same area as the person who tested positive. Both kid and spouse had to get tested and we went into in-home quarantine. They received both a rapid test and a regular test; they were both negative. But the co-worker had a positive rapid test and a negative regular test, which meant they had to quarantine for two weeks. And because my daughter had a 3rd degree contact through her brother and father, she had to get tested. Fortunately negative as well, but considering her job in a closed office space she didn’t have a choice but to get tested and work from home.

      I thought about the rapid vs regular test and the differences between the results the one co-worker had. I think we could see the difference between asymptomatic COVID in which the infected person has been exposed to a very small viral load, and one of the two tests picks it up because of sensitivity and the other doesn’t. The viral loads may have been smaller with the mandatory mask wearing here. IMO, we’re going to need more sensitive tests to help identify infected persons on a scale wrt viral load as load may predict severity of sickness and the likelihood of long-term disability related to COVID.

      • blueedredcounty says:

        I’m not sure I’m following your reasoning about risk here, Rayne. You are blowing into a tube, like a breathalyzer, which has to capture and contain the sample. You’re not blowing into the air and someone has to stand in front of you holding a wand trying to pick up random particles. I don’t understand how this is worse or more risky to the testing personnel than having to shove a swab down someone’s nose and throat while they actually are exhaling particles all around them.

        • Rayne says:

          You’re sure that people who do breathalyzer tests even when sober never blow material that misses the tube (like the sober people do in this video). You’re absolutely certain that the person being tested will not exhale outside the tube at all, will be given a clip for their nose which will fit like those used in pulmonary fitness tests, and the person will wear it for the duration of the test. You’re absolutely certain that the person won’t blow first before blowing in the tube, that if the person being tested isn’t feeling well they won’t screw up blowing into a tube.


          Using a tube will increase the amount of exposure to the test administrator. The amount of exposure before the text and after the test will be the same as the current swab test because they’ll have to spend the same amount of time, maybe even a bit more explaining what to do within arm’s length. But the administrator’s exposure will increase with any additional blown exhalation which doesn’t go into the tube. It’s the forced exhalation, like loud talking or singing at close range, which increases the risk to the test administrator.

          … Breathing out, singing, coughing, and sneezing generate warm, moist, high momentum gas clouds of exhaled air containing respiratory droplets. This moves the droplets faster than typical background air ventilation flows, keeps them concentrated, and can extend their range up to 7-8 m within a few seconds.128

          These findings from fluid dynamic studies help explain why at one choir practice in the US, a symptomatic person infected at least 32 other singers, with 20 further probable cases, despite physical distancing.27 Other indoor case clusters have been reported within fitness gyms, boxing matches, call centres, and churches, where people might sing, pant, or talk loudly.282930 Interestingly, there have been few reports of outbreaks on aeroplanes,31 which may reflect current low volume of passengers, lack of contact tracing, or relatively low risk because speaking is limited. Although publication bias is likely (events linked to outbreaks are more likely to be reported than events where no outbreak occurred), well documented stories of outbreaks demand a scientific explanation.

          The heavy panting from jogging and other sports produces violent exhalations with higher momentum than tidal breathing, closer to coughs in some instances. This increases the distance reached by the droplets trapped within the exhaled cloud and supports additional distancing during vigorous exercise.2 However, respiratory droplets tend to be more quickly diluted in well aerated outdoor settings, reducing transmission risk (a preprint from Japan reports an 18.7-fold higher risk of transmission in indoor environments than outdoors).28 …


          The BMJ – Analysis
          Two metres or one: what is the evidence for physical distancing in covid-19?
          BMJ 2020; 370 doi: (Published 25 August 2020)
          Cite this as: BMJ 2020;370:m3223

          • blueedredcounty says:

            Thanks for the additional information. I don’t think your objections to this test are valid, and it wasn’t the point of my post. We need a fast and accurate test that lets us identify when people are spreading the virus. We are over seven months into this and we still don’t have accurate testing for large periods of time when people are pre- or asymptomatic and they have no idea they are contagious.

            There is a significant difference in the amount of aerosols that are going to be generated from singing, yelling, chanting, coughing, and sneezing than there is from blowing into a tube. How can you tell? Each of these actions produces more and louder sound, meaning more energy is being expended, so the capacity to generate aerosol particles is going to increase and they are going to carry farther. Indoors, once they lose momentum, they are mostly going to hang in place. I did commercial/industrial HVAC systems design about 25 years ago. It is easy to force air into a space. It is difficult to design an effective exhaust system. You need a hood or some other method to confine waste gases so they can be vented from a subspace.

            What is the difference in the volume/spread of aerosols from the cited high-risk activities and spillage from a forced exhalation into a breathalyzer tube? I don’t know, and neither do you; it hasn’t been measured or checked. How often does the current testing of shoving a swab down your nose and throat trigger a sneeze or a cough or other involuntary high-volume exhalation and spray the tester? I don’t know, I haven’t seen any documentation or studies about that, either. I only know the studies that keep citing all the false negatives from the existing tests that make them either worthless or harmful because they provide a false sense of security.

            Putting breathalyzer snark aside, it isn’t possible to “absolutely” ensure there are zero escaped aerosol particles unless we insist everyone wears N95 masks all the time. Given the design parameters of maximum exhalation capture (for sample size and safety reasons) and ease of use (simple enough for a Trump supporter), using a tube you stick in your mouth is a lousy idea. If I was designing this thing, I would be replace the tube with a mask that fits over the nose and mouth and feeds the device instead. Instruct the person to take off their regular face mask, hold this mask tightly over their nose and mouth, take a deep breath, and cough. Make the masks disposable/single use as well. No more complicated than the instructions you get on an airplane for using the emergency oxygen masks. And you’d probably need different sizes to allow for physical differences.

            The test isn’t available, and with it tied up in court and not approved, who knows if it ever will be.
            As Joey would say on Friends, “It’s a moo point.”

            • Rayne says:

              What is the difference in the volume/spread of aerosols from the cited high-risk activities and spillage from a forced exhalation into a breathalyzer tube? I don’t know, and neither do you; it hasn’t been measured or checked.

              Researchers already have a pretty good guess based on breathing and coughing:

              Results The mean estimated viral load in microdroplets emitted by simulated individuals while breathing regularly was 0.0000049 copies/cm3, with a range of 0.0000000049 to 0.637 copies/cm3. The corresponding estimates for simulated coughing individuals were a mean of 0.277 copies/cm3 per cough, with a range of 0.000277 to 36 030 copies/cm3 per cough. The estimated concentrations in a room with an individual who was coughing frequently were very high, with a maximum of 7.44 million copies/m3 from an individual who was a high emitter. However, regular breathing from an individual who was a high emitter was modeled to result in lower room concentrations of up to 1248 copies/m3.


              Riediker M, Tsai D. Estimation of Viral Aerosol Emissions From Simulated Individuals With Asymptomatic to Moderate Coronavirus Disease 2019. JAMA Netw Open. 2020;3(7):e2013807. doi:10.1001/jamanetworkopen.2020.13807

              Do check the works cited; they’re only a fraction of the work done to date measuring output and dispersion.

              I wouldn’t ask health care professionals to administer a breathalyzer-like test until they come up with a comprehensive system to protect them.

        • Eureka says:

          Just want to mention here the options of self-administered saliva tests (and self-administered _nasal_ swab tests — not nasopharyngeal/ to the back of the throat). They’ve been in use for awhile around here with sharp public health personnel at the helm, i.e. places motivated to use good/ unshitty tests and labs (I know the saliva-based ones are picking up steam because of the NBA offshoot, but they’ve been around).

  13. vicks says:

    Science isn’t my thing so forgive me if what I am stating is obvious, but there are connective tissue diseases that fall under the category of autoimmune disease that have symptoms similar to Covid-19, may of these diseases require a triggering event, and once triggered, they are also quite capable of the same type of damage being described here.
    Some people are affected by an autoimmune disease thier entire life, but many don’t display any symptoms until adulthood, and others can be diagnosed with Lupus or something equally scary (because of a doctors visit to look at an skin markings, but live out their lives with no other symptoms.
    My question is, what if the damage being done isn’t so much by the intensity of the virus itself, but something about the virus that is acting as a trigger to those who may not even know they have autoimmune issues?

    • To be continued says:

      Many people feel that some auto-immune diseases are initially precipitated by an undiagnosed pathogen such as Epstein Barr virus, bacteria such as Lyme, etc. and then the body develops antibodies to that initial organism that it confuses with antigens or “immune”-stimulating particles on its own cells and then a cascade starts with the initial precipitator long gone and staying undiagnosed so it is as you say more of a chronic disorder. Covid is slightly different in that it is precipitating clotting cascades acutely, not haywire antibodies. These cascades are ocurring often in people that are hyper-coagulable (clot-prone) already, due to underlying diseases such as hypertension and diabetes, but also scarily in people with no underlying conditions.

      In many pathology reports they are not finding much virus at the sites of damage (e.g. brain, kidney and lungs) but a lot of platelets, fibrin (forms scars when they age) and more megakaryocytes than you would normally expect. The virus is causing megakaryocytes (momma platelets) to leave the bone marrow which I find quite baffling.
      A friend lost 3/4 of his entire intestine due to a 6-inch clot in his abdomen cutting of blood flow. It is a clotting disease masquerading as a respiratory infection…
      Again this infection is not the ‘flu’. Unlike influenza where people often succumb to secondary bacterial infections there are few signs of these more ‘treatable’ infections in covid cases.

      Lastly I am so bothered, as those above have all mentioned, about the long-term neurological, cardiac and pulmonary side effects from all these ‘mini-strokes’.
      My 2 cents anyway so 1.54 cents after the exchange…

      • P J Evans says:

        I’ve seen it described as a vascular disease that enters through the respiratory tract.
        Wear a mask, or be prepared to die (or wish you had died).

      • Rayne says:

        You might be interested in this pre-print from late July discussing megakaryocytes. Important to note, “Megakaryocytes [MK] are normally present in the lung where they play a role in platelet homeostasis. …” — I’m not sure the issue is MK cells from the marrow but MK cells normally found in lungs and rest of pulmonary system. One study indicated inflammation triggered changes in MK cells which in turn produced “hyperactive” platelets. Inflammation may also trigger increased von Willebrand factor production, making platelets stickier which in turn may cause the diffuse alveolar damage by gumming up the works, more or less.

        Add that on top of endothelial inflammation and yikes…

    • Rayne says:

      You’re fielding a guess about a disease which science has only recognized since January, about which researchers are still learning considerable amount. Nothing they have found so far in vivo and in postmortem analysis suggests this disease triggers latent autoimmune diseases. Commenter ‘to be continued’ offered a very nice distillation of what has been found instead. COVID-19 is simply not like any other viral disease including its sequelae or there’d be more successful drug therapies.

      How the disease damages organs is still being studied. Much damage appears to be related to the virus’s attacks on the endothelial cells lining the blood vessels through out the body, causing inflammation which chokes off blood flow starving the tissues (vasculitis). It may look like dysregulated clotting because blood backs up and clots with resulting loss of oxygen to tissues, but attack isn’t necessarily on blood cells. In some organs like the intestines, the virus attacks both endothelial tissue lining blood vessels within the gut, while attacking the endothelial tissue in the intestines themselves.

      The study at the link above says, “Further studies will be required to define the different mechanisms through which SARS-CoV-2 infection causes such marked endothelial cell effects, particularly within the pulmonary microvasculature…Irrespective of the mechanisms of endothelial cell activation and associated pulmonary intravascular coagulopathy in COVID-19, it will be interesting to see whether immunosuppressive therapy including corticosteroids and tocilizumab actually improve endothelial cell function towards reversal of in-situ immunothrombosis and survival improvement.” The two corticosteroids which have had the most promise for patients with the most severe cases are dexamethasone and hydrocortisone, both cheap, widely available, and in use a long time. We should see some drop in mortality for the worst cases as these two steroids are used more often, and these drugs are coincidentally used for some autoimmune diseases.

      But this is another example of bias which has hurt our response to COVID-19. In early March there was a lot of chatter in Europe about steroids not being effective in treating patients. Steroids were avoided for months after that, right during the worst surge in cases in the US. In hindsight the problem was when steroids were used during the course of the disease, and on which patients in terms of severity. Had more effort been spent on examining the cases in which steroids didn’t work, more lives could have been saved sooner. We need to learn to drop assumptions and biases when studying this disease.

      • Vicks says:

        I am not arguing for or against, just pointing out the similarities between the descriptions of the damage done to the body during an aggressive battle with Covid -19, and the damage done in severe cases of connective tissue disease (when the body turns against itself and starts using inflammation to attack its own tissues)
        One example is vasculitis, which in your response you described as what happens when inflammation “chokes off the blood flow starving the tissues”
        Perhaps just another coincidence, but it turns out Vasculitis is also the name of group of autoimmune diseases that attacks the blood vessels
        I had to look that up BTW, but my limited knowledge of autoimmune diseases does include the fact that some can be latent, but science doesn’t seem to know much about where the majority of them come from, just that they often seem to show up in response to a triggering event like an injury or medication,
        I’m in over my head here for sure but it seemed worth considering that maybe it’s not Covid-19 literally attacking the body in the way commonly described but the virus is triggering a response in some people that is causing the body to attack itself.

        • Rayne says:

          You’ve said “Science isn’t my thing” and “I’m in over my head.” Great. Acknowledge the fact that you’re guessing at a possible link between COVID-19 and autoimmune diseases and then stop because you’re strewing incorrect information in this thread.

          For example, this remark: “but science doesn’t seem to know much about where the majority of them come from, just that they often seem to show up in response to a triggering event like an injury or medication,” is incorrect, and it’s a good reason why you need to let it go.

          I’d care a lot less about this if I didn’t have an autoimmune disorder, which is why I have been following COVID-19 research closely.

          Re-read the comment ‘To be continued’ left you in this thread. They have the appropriate level of science for this topic.

          EDIT: Do yourself a favor and Google “genetics and epigenetics of autoimmune disease” which should provide you with more than a decade of research. You’re done in this thread.

          • vicks says:

            There was nothing wrong with my post, put it up please.

            [MODERATOR’S NOTE: Auto-moderation was triggered by multiple active URLs included in your comment. Do NOT argue with moderators about this; it’s security feature to prevent phishing attacks on community members. Unwarranted complaints like this may lead to blacklisting. / ~Rayne]

            • bmaz says:

              Listen, you have been spewing a boatload of garbage lately. NEVER demand that your bleating bullshit be posted here. Rayne does not owe you anything, and neither does anybody else. That kind of demand will go only in the wrong direction for you. Happy holidays!

              • vicks says:

                Calling a polite request a “demand” and using words like “bleating bullshit” and garbage to justify blocking my reply to an accusation that I was “strewing incorrect information” seems disingenuous, considering my reply was polite and addressed each issue I was being attacked on, and included links to reliable sources.
                Before realizing information that supported my “guess” about a link between Covid-19 and the autoimmune response found in connective tissue disease was going to be blocked, I discovered that there are already studies investigating this connection underway.
                Knowing this makes whether or not you post the links below on this site irrelevant to me, but since I spent the time, here they are.

                It has been suggested that the shared pathogenetic mechanisms and clinical-radiological aspects between the hyper-inflammatory diseases and Covid-19 may suggest that SARS-CoV-2 could act as a triggering factor for the development of a rapid autoimmune and/or autoinflammatory dysregulation, leading to the severe interstitial pneumonia, in genetic predisposed individuals [26]. Furthermore, in an online pre-published study from Germany the authors studied prospectively a group of 22 patients for the possible role of autoimmunity in SARS-CoV-2 -associated respiratory failure. Based on serological, radiological and histomorphological similarities between Covid-19-associated ARDS and acute exacerbation of connective tissue disease induced interstitial lung disease, the authors suggest that SARS-CoV-2 infection might trigger or simulate a form of organ specific autoimmunity in predisposed patients [2

                Covid-19 and autoimmunity
                It has been suggested that the shared pathogenetic mechanisms and clinical-radiological aspects between the hyper-inflammatory diseases and Covid-19 may suggest that SARS-CoV-2 could act as a triggering factor for the development of a rapid autoimmune and/or autoinflammatory dysregulation, leading to the severe interstitial pneumonia, in genetic predisposed individuals [26]. Furthermore, in an online pre-published study from Germany the authors studied prospectively a group of 22 patients for the possible role of autoimmunity in SARS-CoV-2 -associated respiratory failure. Based on serological, radiological and histomorphological similarities between Covid-19-associated ARDS and acute exacerbation of connective tissue disease induced interstitial lung disease, the authors suggest that SARS-CoV-2 infection might trigger or simulate a form of organ specific autoimmunity in predisposed patients [27]. In a similar retrospective study from China of 21 patients with critical SARS-CoV-2 pneumonia, the authors showed a prevalence of between 20 and 50% of autoimmune disease related autoantibodies, suggesting the rational for immunosupression in such cases of Covid-19 [28].

                Emerging reports show that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection precedes the appearance of various autoimmune and autoinflammatory diseases, including paediatric inflammatory multisystemic syndrome (PIMS) or multisystem inflammatory syndrome in children (MIS-C), thus adding to the growing mystery of this virus and raising questions about the nature of its link with autoimmune and autoinflammatory sequelae.

                Preliminary results by the Covid-ip project identified two prominent immunological signatures in the blood of Covid-19 patients that could be used to identify the patients most likely to do worse and require additional treatment.

                In a study published in Clinical Immunology, researchers studied the epigenetic regulation of cytokines in people suffering from Systemic lupus erythematosus (SLE), a chronic autoimmune disease. They found that key cytokine genes were hypomethylated in lupus patients, meaning that they were set to produce cytokines in larger quantities. The different epigenetic regulation of cytokines thus could explain why many lupus patients suffer from severe forms of COVID-19.

                • bmaz says:

                  Nobody “blocked” you, and certainly I did not. You have turned into a real pain in the ass that is all over the place, including with your ever evolving log in points and manipulations.

                  And, no, you made a clear demand. Rayne is away right this moment, and I really do not care about your demands. Keep this up and you just may end up with the status you wrongly blurted out about.

  14. Godfree Roberts says:

    [I’m happy to provide links to the following news items but refrained here in case links trigger spam filters]

    Francis Collins, director of the US National Institutes of Health, said the virus might have been spreading quietly in humans for years, or even decades, without causing a detectable outbreak. (SCMP)

    University of Calgary research shows SARS-CoV-2 may have been evolving slowly since 2013.

    Dr Tom Jefferson, tutor at the Centre for Evidence-Based Medicine at Oxford University, says there is growing evidence the virus was elsewhere before it emerged in Asia. 

    Italian scientists have also found evidence of the virus in sewage samples in Milan and Turin, from mid-December, many weeks before the first case was detected, while experts have found traces in Brazil from November.

    Spanish virologists announced they had found traces of COVID-19 in samples of waste water collected in March 2019, nine months before the disease was seen in China.

    [FYI, I am adding a link to the story here because it’s important enough to read the entire piece and not just excerpts given the amount of politicization behind the virus’s origins. /~Rayne ]

    • Eureka says:

      Sigh, whatever happened to politesse in propagandizing?

      It’s disingenuous to (again) cite SCMP to misrepresent and put words in Collins’ mouth when it was already pointed out to you that those words come from a blog summary of one of two scenarios others had proposed wrt natural origins, and are not Collins’ assertion, but a repetition:

      Your comment comes off worse for the doubling down on distortions of fact, then using that — with a sunshine glide on Collins’ authority — to frame other findings or models (omitting key details in some other of your line-items as well).

      Why do you suppose that Spain sample from March 2019, isolated from the rest of the series, kicked back positive? Consensus thus far points to a spurious result. Did that study ever make it through peer review? Has the finding been replicated?

      Note I am not invested in any particular outcome and am sympathetic to the possibility of proximate viral evolution in human hosts (as opposed to an intermediate).

  15. punaise says:

    Will the Supreme Court of the Republican Onanistic Theology of Unified Mayhem have have the cojones to rule on this?

    • Rayne says:

      Every time I read about upticks in COVID-19 cases related to university students I wonder if we will see a dramatic drop in fertility over the next decade primarily among white post-grads. COVID-19 may have done a number on working poor who don’t have better access to health care and are more often persons of color, but the long tail may be an acceleration of whites as a minority group in the U.S.

      All because of the racist Donald Trump.

      One more reason why he and his minions have attempted to bork the 2020 Census, to suppress an accurate picture of this country’s demographics. Wonder what the 2030 Census will reveal in comparison.

  16. harpie says:

    [fking] RIC [fking] SNYDER writes he “won’t support Trump”, but:

    I will continue to support and stand up for Republican policies and values, and support Republican candidates, but I will not support Donald Trump for reelection.

    HOW do you think we GOT IN THIS MESS to begin with?
    YOU poisoned the people of Flint because of those “Republican policies and values”.


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