These days we’re drowning in information about the pandemic, but without much context for understanding the virus causing it. With a never-before-seen virus, the best place to get that context is from looking at the history of previous diseases, and by understanding what they’ve done to our biology and society, as we try to figure out what this one does to our biology and society.

One of the first and most important questions is how Covid-19 infects people, and this disease is pretty damn infectious. Not as bad as diseases like Measles, Mumps, and Rubella, but worse than most flus. (The most infectious diseases tend to become the diseases of childhood because you’re born, and BAM! you get them, they’re so infectious.) Transmission is measured with the R₀ (“R-naught”) we keep seeing in news stories, measuring how many people one infected person will infect in a given time period. But it’s not a number that just exists without context — lowering that number is why so many of us are staying at home, trying to figure out how we’re going to pay the bills right now. But without the social distancing, Covid-19 is more infectious than anything most of us have experienced in our lives.

What makes Covid-19 infectious has a lot to do with how well the particular virus that causes it, SARS-CoV-2, survives in the world, along with how good SARS-CoV-2 is at finding the kind of cell it uses as a host and then invading it.

To contrast Covid-19 with the most recent nasty pandemic, AIDS, it is much more likely to spread and much less likely to kill those it spreads to. HIV, the virus that causes AIDS, is a delicate virus, despite causing a nasty disease. HIV dies if you blow on it.

The only fomite (the word for inanimate objects that can pass infections) that transmits HIV in the normal course of life is a needle full of HIV-infected blood, and that’s not easy to accidentally infect yourself with on your way to a restaurant. Other than direct blood transmission, it has to be transmitted person to person through intimate contact.

HIV is also good, but not great, at finding and infecting its target cells, and it happens to use the same kind of cells that Yersinia pestis, better known as the plague, and one of the worst pandemics ever, likes to invade. (This fact becomes very important in the story of contemporary civilization, hold on to your hats.)

So the limits to HIV spreading come from how hard it is for the virus to survive when it’s not in an ideal environment, and how hard it is to invade certain immune cells, its host of choice. This is why it is much easier to catch it from needle/blood transfer than anything else, and why some sex is more likely to transmit it than other sex is. For all the gay plague talk, the absolute safest sexually active group in the AIDS epidemic was lesbians. (I guess God loves lesbians the most?)

HIV is not passed via the respiratory system. The entrance to the respiratory system is the leaky liquidy parts of your face: eyes, nose, and mouth. This is an extremely important point. If HIV was transmitted that way, if it was a little hardier and could live in droplets you expel from your face, everything, and I do mean everything, would be terrible.

This isn’t because a respiratory infection couldn’t do what HIV does – there is a respiratory version of the plague that’s completely horrific. Pneumonic plague is in that category of diseases so bad that they burn themselves out by being so horrible and deadly that they run out of hosts, if not for the fact that it has other ways to spread, namely fleas. (Y. pestis is the worst.)

So while HIV is terrible and has cost the world immeasurably, it’s not the plague. Also, because of the plague, HIV is considerably worse at infecting immune cells in populations that were genetically impacted by the plague. HIV uses a receptor on immune cells called CCR5. The “receptor” here is a little protein lock that opens up a cell. A bit like a tiny door with lock and doorknob. Seven hundred years before HIV came around, Y. pestis, despite being a bacterium rather than a virus, was using the same CCR5 to get inside immune cells. It killed somewhere around half of Europe and came back and kept killing for hundreds of years until the human genome declared FUCK THIS and mutated CCR5 out of service in a portion of the population, a portion that then had the chance to have more kids.

 

This is why despite having similar chances to spread, HIV is less prevalent in European populations that went through that plague-induced genetic narrowing than in sub-Saharan Africa, which was probably never seriously afflicted by Y. pestis in the way Europe, western Asia, and North Africa were. This made them far more vulnerable to HIV, with the tragic results we see now.

To bring it back to our current bug: SARS-CoV-2’s infectiousness is closer to pneumonic plague than HIV in infectiousness, but also different because there’s no insect vector.

This little bugger can hang on in the environment. SARS-CoV-2 can survive for days on common surfaces like steel or plastic. It survives for four hours on copper. Copper is basically the Purell of metals. That’s not good.

SARS-CoV-2 is very good at accessing and infecting its target cells, which are generally surface tissue (epithelial) cells with ACE2 protein receptors, analogous to the CCR5 that Y. pestis and HIV use. Anything with that ACE2 receptor will work for SAR-CoV-2, but lung cells are the tissues they most likely encounter when someone breathes in the virus. It’s harder for it to get to those same receptors in your intestines from your nose. But it’s entirely possible that for the people who do experience intestinal symptoms like diarrhea, SARS-CoV-2 got to those ACE2 receptors as well.

You can think of the ACE2 receptor as a little locked door on the surface of the cell. In order for the useful things that the cell makes to get out, or for the cell to get a useful thing it needs to get in, other cells will come by with the key that fits into the receptor and unlock it.

A coronavirus is a small ball of fat and protein covered in lock picks, which in this case are little “spike” proteins that fit into the ACE2 receptor and open the door for the virus’s RNA to come in.

That’s it, that’s how it works. It’s amazing how much, when you get biology down to the micro level, bodies work like legos and tinker toys, but wet.

The thing about this virus, which makes it more infectious than the flu or even classic SARS or MERS, is that the spike protein on the surface of SARS-CoV-2 picks the lock of the ACE2 receptor very well. As soon as it hits it, it locks in. That means fewer viruses are needed to infect a person.

That, along with how well it survives and travels in droplets, is what stopped the world.

The good news is for most people Covid-19 doesn’t do much. In many cases, it does even less than the flu or a normal cold. It’s good news for people who get Covid-19, but not great news for a planet trying to find and isolate asymptomatic cases. You win some, you lose some.

There are two kinds of immune systems at play in responding to anything that threatens the body: the innate immune system, and the adaptive immune system.

The innate is your first level of defense, looking for and eliminating baddies like SARS-CoV-2. But the innate system isn’t where you get immunity. Immunity comes from a process where the innate system reacts to a novel bug it has never seen, and learns about it. Then a certain kind of innate immune cell, called a dendritic cell, presents the shape of a coronavirus, or whatever other nasty pathogen the body is fighting, to the T and B cells of the adaptive immune system, which then go all Terminator and hunt down and kill whatever is shaped like the thing they got from the innate system.

That process is what we call acquiring immunity, and it’s why no one can, by definition, be immune to a novel virus, including this one. Immune is not the same as showing no symptoms, even though many people, including journalists, keep using those terms interchangeably. That is a dangerous mistake, so let me repeat this: the only people on our beloved blue-green world who are immune to Covid-19 are those who have had it and recovered from it, and we’re not even sure how immune they are. So why do some people seem immune?

Covid-19 seems to have some way of calming down some innate immune responses (mechanisms which seem work strangely in children, that’s still unclear). It doesn’t usually win against the learned immune response in most people who get infected, who clear out the virus and become immune. Of course, this isn’t how it goes for everyone… but thankfully for most of us, it’s mild to asymptomatic.

The problem is with the virus calming the innate immune response is that the innate immune system is what gives you symptoms. Viruses don’t give you fevers and headaches, coughs, aches, and the desire to stay in bed, your immune response does that.

Without those symptoms infected people spread this very hardy virus all over until the immune system catches up with making them feel sick. We don’t know how long asymptomatic carriers shed virus this way. It could be a day, it could be two weeks.

In the end, it’s likely most of us are either going to get Covid-19 or get a vaccine. With this much global spread, the disease is headed to be the next coronoavirus to be endemic in humanity (the common cold is caused by other coronaviruses between 15-20% of the time).

Endemic means this is a disease the floats around the population, with pretty much one infected person infecting one more person (R=1). Many endemic diseases in history are nasty, like Smallpox, which in its prime regularly killed a third of children in Europe.

Endemic diseases can also flare into epidemics, when they encounter a large group of people without immunity, and then calm down again once they’ve done their damage. Diseases going from epidemic to endemic don’t just change our lifestyles and our societies, they change us at the genetic level, and we change them back.

We see that with the HIV and plague connection, and with European explorers accidentally (mostly) wiping out the vast majority of the new world, for whom the Smallpox virus was, like Covid-19, novel, and consequently far more deadly.

I hope we get the vaccine, and the news is good there, so far. SARS-CoV-2 doesn’t seem to be a fast mutator, unlike HIV, which has dodged all of our attempts to vaccinate for it.

Covid-19 might be treatable with some kind of antiviral medications, which would be nice, but that needs to go through trials first before any more unscrupulous doctors and incompetent politicians make up things about malaria meds, and people start eating fish tank cleaner en masse.

But in general, this is a bit like plague-level nightmare transmission, but with novel influenza lethality. Not great, but it could be much worse. At its most terrible, Y. pestis could kill up to 80% of its victims. (Y. pestis is the worst.)

How long we stay immune is another question, and we are far from answering it.

There’s two factors at play – one is that some immunity (like Smallpox) is for life, but for some other diseases, the adaptive immune system forgets about them after enough time passes. The second factor is how much the virus changes as it mutates going through hosts. The more people it infects, the more chances there are for the virus’s genes to drift as it reproduces. That makes more chances for it to become different enough that the body has to learn about it again, which unfortunately gets done by getting re-infected. It’s early days, but so far SARS-CoV-2 doesn’t seem to be prone to drifting.

SARS-CoV-2’s apparent genetic stability is some of the best news we’ve had for beating this disease in the long term, but it’s still early days. When bugs become endemic, they tend to lose some of their virulence as well. Killing your hosts isn’t very adaptive for a parasite, and dying isn’t very adaptive for us. But that is generations away.

For now, keep washing your hands and staying home for everything but essential work, store runs, exercise, and medical care. This is going to be very hard for everyone, but humanity will get through it together.

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My work for Emptywheel is supported by my wonderful patrons on Patreon. You can find out more, and support my work, at Patreon.

[Check the byline, thanks! /~Rayne]

When certain folks all push the same angle — Trump, Giuliani, Solomon, et al — one may think immediately it’s a scam.

Like the Ukraine quid pro quo scam on which the very same players worked together, singing from the same hymnal.

The scam is more obvious because two of the people involved are promoting a pharmaceutical and they’re not medical doctors — they may be practicing medicine without a license by encouraging the use of a medication which isn’t approved for the use they advocate.

The drug is hydroxychloroquine, an antimalarial drug which has also been approved for a small number of autoimmune disorders like lupus.

Something is clearly not right when so many of the same players are pushing a drug using the power of the presidency to do so.

~ ~ ~

Interregnum: I’ve had to put this post up now, out of order. I had originally intended to write two posts about misinfo/disinfo about research related to COVID-19 and the underlying virus, but push has come to shove with Trump pushing hydroxychloroquine again today, admitting the U.S. has not purchased ventilators or personal protection equipment on a timely basis but instead bought and stockpiled 29 million doses of hydroxychloroquine.

Trump just said that the FDA approved hydroxychloroquine for use against Covid-19.

That is medical misinformation:

The FDA gave an emergency use authorization, with a fact sheet that explicitly says there is no approved product to treat Covid-19. https://t.co/PptuczxVn7 pic.twitter.com/vVv55eP8mr

— Adam Klasfeld (@KlasfeldReports) April 5, 2020

Something is really wrong and it must be addressed immediately, before more people get hurt.

My post about the problematic background of research behind hydroxychloroquine will have to come next. Right now we need to talk about the scam in progress.

~ ~ ~

It took me a while to figure out what the angle might be on a drug which is old and cheap but I think this is the way this works.

Of course you all know Trump wants and NEEDS to stay in office or he’s up the creek without a paddle. This scam isn’t about making money but instead about serving his need not to be investigated and prosecuted for all manner of tax, bank, wire fraud and more beginning ten months from now.

So…Team Trump picks a drug which when administered in safe dose, doesn’t do much constructively for anybody except people they don’t give a shit about like patients with lupus and autoimmune disorders.

Weak sauce studies on hydroxychloroquine to date suggest it’s a 50/50 crap shoot that the critically-ill patients qualifying for compassionate use and receiving this drug will recover. Somebody external to the White House, possibly external to the U.S., maybe even the drug company/ies which makes this, may have made have chosen this drug because they did this math. They have just enough iffy research by iffy researchers to encourage its use.

They end up with just enough people who’ll recover and claim it’s a miracle drug that saved their lives, and the other half are dead or disabled so they won’t appear on camera to say otherwise. Handpicked survivors become testimonials to Trump’s ‘Wile E. Coyote super genius‘ and his prospective worth as our two-term conman-in-chief.

Even Dr. Fauci has said there’s no proof this drug cocktail works; he’s been clearly frustrated with Trump’s handling of COVID-19.

Trump cut off attempts to ask Dr. Fauci more questions about this drug today.

But Team Trump counters Fauci’s doubts by launching a character assassination attack in social media, calling Fauci part of the “deep state” out to get Trump.

At the same time there’s a continuous social media swarm pushing the drug.

Team Trump haven’t fired Fauci because they still need him to save Trump from making bigger mistakes and Fauci has much higher credibility ratings than any of the rest of Team Trump appearing before cameras.

But Trump’s current pandemic response failures are already projected to cost at least 100-240,000 American lives which Team Trump are now calling a goal, or success.

That’s part of the scam, too, the framing of what success will look like, long after Trump blew by the true benchmark of zero American deaths.

All this to boost his approval rating so he can use it for his re-election campaign. That’s the scam.

Just like the quid pro quo for which Trump was impeached — manipulate the situation so that false information boosts Trump’s approval with voters, abusing his power for his own personal gain.

~ ~ ~

What gave me pause wasn’t just the crappy research. Or the problematic French research with which this all began.

It was the fact that Rudy Giuliani, John Solomon, Charlie Kirk and a bunch of other right-wing support players were also doing their bit repeatedly to push this drug cocktail as well as a Russian doctor.

This is the Ukraine scam all over again, only this time the players are going to push a crappy drug and assassinate Dr. Fauci’s character, instead of pushing a false meme about Hunter Biden and assassinating Marie Yovanovitch’s character while she was ambassador to Ukraine.

Dr. Fauci has received death threats now because of this nonsense and his security detail has been increased because of it.

Michigan’s Governor Gretchen Whitmer has also been criticized by right-wingers about hydroxychloroquine. The state’s Department of Licensing and Regulatory Affairs throttled off-label prescriptions of the antimalarial drug because doctors and pharmacists were abusing their licenses by writing scripts for themselves and their families, hoarding the drug while depleting inventories.

But Dr. Fauci and Gov. Whitmer aren’t the only ones affected by this. There are so many stories about lupus and other autoimmune disorder patients who haven’t been able to fill their prescriptions because of a run on hydroxychloroquine because of Team Trump’s unlicensed practice of medicine at the podium — or unregistered lobbying for pharmaceutical company or companies.

Not to mention the strong possibility that although the Food and Drug Administration caved under pressure from Team Trump and now allows “compassionate use” of the drug for COVID-19, the drug could easily kill patients who are already under stress from SARS-CoV-2’s attack on their systems.

Hydroxychloroquine requires additional caution when used on females, geriatric patients, patients with diabetes — this describes a considerable number of COVID-19 patients in critical care! — thyroid disease, malnutrition, liver impairment, or those who drink alcohol to excess — for starters. The drug must be used with caution in persons with cardiac arrhythmias, congenital long QT syndrome, heart failure, bradycardia, myocardial infarction, hypertension, coronary artery disease, hypomagnesemia, hypokalemia, hypocalcemia, or in patients receiving medications known to prolong the QT interval or cause electrolyte imbalances.

This is only part a portion of the contraindications and precautions for hydroxychloroquine.

It may also cause permanent eye damage.

Imagine monitoring the patients receiving hydroxychloroquine even more closely when hospitals are overwhelmed and understaffed.

None of the research so far has been performed in vivo in a large, randomized trial. We really do not know what it will do except for what it has done for malaria patients and for autoimmune disorders — hardly the same things as patients in extremis from COVID-19.

Trump’s pushing drugs from the presidential podium must stop because Americans are being hurt for the sake of whatever scam Team Trump is pulling off this time.

We can see part of the potential reasoning Team Trump has used, but who else is benefiting from this? How do pharmaceutical companies fit into this, particularly Novartis which may be the sole source for the stockpile of hydroxychloroquine the federal government acquired. We don’t know the total amount the U.S. holds, how much might have been donated, and how much has been bought.

We don’t know whether this was part of conversations which may have happened at Davos around January 22, when pharmaceutical companies like Novartis were present and when business leaders were already concerned about COVID-19 outbreak in China.

We just don’t have all the facts yet to know every angle of this particular artless deal.

~ ~ ~

Part 3 will address the research behind hydroxychloroquine in relation to COVID-19.

[Check the byline, thanks! /~Rayne]

You’ve probably heard the U.S. Center for Disease Control is expected to reverse its position on the public wearing masks a little over a month after this meltdown on February 29:

The CDC’s reversal on policy is a result of several things, though one of the biggest issues is a push to get everyone ready to go back to their workplaces at the end of April. There’s resistance to going any longer than that, based on U.S. for Care’s Andy Slavitt on Twitter last night, attributing this deadline to governors (but I think we know it’s not the governors who are pressing for an end to Stay Home orders).

I have no idea how parents with kids out of school will handle this; we need some sort of an exemption for parents to continue to work at home if they have children who would have been in school into June but whose schools have now closed for the rest of the school year.

I also think it’s too soon to lift the Stay-Home orders given how goddamned sloppy states like Florida have been in executing them. Spring breakers were still congregating this past week in some southern states which means these stupid fools who were exposed will travel home, get sick in 2-3 weeks, infect others during that time and a mini-wave of successive infections will follow that.

Anyhow…the CDC has acknowledged the larger role respiratory droplets play in infection. Many anecdotes from community acquired infections support this. From CDC:

“COVID-19 is thought to spread mainly through close contact from person-to-person in respiratory droplets from someone who is infected. People who are infected often have symptoms of illness. Some people without symptoms may be able to spread virus.”

There are two studies about viability of the virus causing COVID-19 on surfaces; the researchers also noted the hang time of aerosolized virus and its viability. This study is cited most often:

van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1
March 17, 2020. doi: 10.1056/NEJMc2004973
https://www.nejm.org/doi/full/10.1056/NEJMc2004973

The active virus could hang in the air for as long as 3 hours according to this study, from which we can infer the exhalations of infected persons carrying the virus will also hang about.

This study found the respiratory material from infected patients could cover objects and surfaces all over a room:

Ong SWX, Tan YK, Chia PY, et al. Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient.
JAMA. Published online March 04, 2020. doi:10.1001/jama.2020.3227
https://jamanetwork.com/journals/jama/fullarticle/2762692

While not about the virus underlying COVID-19, this paper discusses the exhaled infectious material and how far it spreads — nice graphics included, a nice read:

Bourouiba L. Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19.
JAMA. Published online March 26, 2020. doi:10.1001/jama.2020.4756
https://jamanetwork.com/journals/jama/fullarticle/2763852

Science writer Ed Yong at The Atlantic tries to summarizes everything in his article, Everyone Thinks They’re Right About Masks: How the coronavirus travels through the air has become one of the most divisive debates in this pandemic.

Yong notes as I have that countries which use masks more regularly — like Japan — have had lower rates of COVID-19. But these countries also were more aggressive about dealing with containment much earlier.

Need more perspectives? Molecular biologist Sui Huang of Institute for Systems Biology in Washington state has an overview in support of mask wearing at Medium; science writer Ferris Jabr has a pro-mask article at WIRED.

This DIY Cloth Face Mask page at Instructables has not only information to sew your own mask but discussion about wearing masks and filters in them. The page is changing fairly often because of feedback — it didn’t have filter information in February.

It’s important to think about masks not just as protection for yourself. It’s possible some of us have already had asymptomatic cases and may even be contagious as I type this. Wearing a mask can protect others.

In Asia wearing a mask is also seen as a sign of respect for others’ well-being. Americans have had a skewed perspective about masks and have until now viewed them negatively when worn outside health care settings as a hallmark of illness. We’re going to have to change that.

Because I’m in the at-risk group due to my autoimmune disorder, I have to wear a mask. Family members with heart disease and diabetes likewise need to wear masks. I’ve sewn my own for myself and family members alike. While the first masks I sewed for us were two-layer cotton, I’m now making another batch with non-woven poly fiber — baby wipes and cleaning wipes are just two examples of this fabric in use around us all the time. The non-woven poly inside a reusable fabric mask can reduce the amount of material shed or inhaled by the wearer beyond what two layers of cotton fabric can limit.

If you choose to wear a mask, leave surgical masks and N95 to health care professionals because shortages of these commercial masks are severe and likely won’t be relieved for more than a month. Make your own instead. There are plenty of How-To and DIY instructions out there for sewn and non-sewn masks.

If you do wear a reusable fabric mask, make sure to shut your eyes and hold your breath when taking a used mask off because it will have collected potentially infectious material. Immediately wash it thoroughly in hand soap and water — the soap is all that’s needed to deactivate any virus. Then wash your face and then hands carefully, again with soap and water. Rinse your mask well with water and hang to dry or put the mask in the wash with your other laundry.

If you see somebody at the grocery store picking up milk while wearing a mask, it might be me. I’ll be going nowhere else even with a mask long after April 30 except for the occasional but necessary venture out to pick up groceries.

On Monday, the CEO of Spectrum Health, Tina Freese Decker, sent out an update on COVID-19. After explaining how they’re modeling the virus, she said that the model they’re using says our peak (presumably meaning Grand Rapids and environs, not Michigan as a whole) would be in early May.

[W]e are closely studying our models, which include learnings and data from across the state, country and world. These models project the spread of COVID-19 and enable us to estimate how many people in our communities will need hospitalization and intensive care services. They also allow us to understand the collective resources that would then be necessary to serve those needs. These are just estimates and we hope for the best, but our job is to plan for the worst.

At present, based on the information available, the rate of growth of deaths from COVID-19 in Michigan is at least as fast as New York, if not faster. The modeling for our area shows that, at its current rate, we would exceed demand for hospital and intensive care services in early May and this would last many, many weeks. This peak in cases would be more than our health care system, or any health care system, could handle.

That conflicts with the IHME projection for the state by several weeks.

I thought, at first, that that might just reflect the fact that cases in my county, Kent County, have been increasing at a more gradual pace than in SE MI. That is, it might reflect that our curve is flatter than the state as a whole, and while Kent is the state’s fourth biggest county, the population of those hardest hit county still dwarfs ours.

Except that Governor Whitmer has twice used the same estimate for our curve — early May. In both a press conference yesterday and in a town hall, she and MI’s Chief Medical Executive Joneigh Khaldun said our peak will be a month from now, not a week.

Maybe Whitmer and Spectrum and everyone else are trying to prepare for the worst. Or maybe they’re seeing something in the state-level data that is not making it into the public data IHME is using.

A physician leader at a major academic medical school in the south walked me through some of what the IHME model may not fully incorporate, based on what he’s seeing in a hard-hit city: how long patients are kept on ventilators.

As you know I am exec leadership at a large University Hospital, so I have access to our Covid data.

I suspect one of the factors driving the later projected peaks is related to estimates of time in hospital. While some non-critical patients are admitted and discharged over 3-7 days, the ones admitted to the ICU are taking much longer to move.

The peak of detecting infection precedes the peak need for hospitalization by 7-10 days.

If you look at the IMHE data, their curves for hospitalization and need for ICU and ventilators are temporally aligned. I think this is going to be very wrong.

The issue is that once a patient is in the ICU or on a ventilator, they stay for a very long time, remaining on the ventilator. Since mid-March, we have intubated numerous patients. 10% have been extubated, 20% have died, and 70% remain intubated and are still parked in the ICU.

Thus the peak need for ICU/Ventilator curve should probably be pushed back several weeks as the tail end of the infections will just accumulate more ICU/vent need in the weeks subsequent to the infection/hospitalization peaks. I suspect the local governments are figuring this out, and the math guys at IMHE have not plugged this factor into their models yet.

The burden on health care capacity will persist long after the infections abate- necessitating much longer control measures to avoid and reemergence in volume.

If this is right, then it may reflect differing goals. Whitmer and Spectrum Health need to identify how many ventilators they’ll need for how long, whereas the federal government needs to identify how long it’ll take to get the first wave of people who’ve contracted the virus either into hospitals or through the period of contagion. Though if that’s right, it may explain why Jared Kushner and others at the White House think governors are exaggerating the number of ventilators they need: because Kushner isn’t accounting for how long a patient stays on a ventilator.

But if Michigan is right and IHME is wrong, it matters that the White House has largely endorsed the IHME model. Even ignoring the possibility that IHME is not sufficiently accounting for the time patients spend on ventilators, there are parts of the projections that do not match reality. The IHME model assumes every state will have a stay-at-home order, but a bunch still don’t and the White House recommendations still fall far short of that. The IHME model assumes everyone will remain on stay-at-home until June (an assumption it made far more prominent on its site after the White House endorsed the model), but Trump promised it would be just 30 more days. While IHME uses deaths to project the curve — justifiably treating that as a more reliable measure of COVID rates than tested positives — there’s reason to believe that even death rates are unreliable (for example, some areas are showing spiking pneumonia deaths not otherwise attributed to COVID-19).

As it is, Trump promised that everything would start to get better in two weeks (though later in his presser, he admitted it might be three weeks). He did so while falsely suggesting that the IHME projections match the recommendations of his White House, which they don’t.

But if hard-hit states like NY (for which IHME has already significantly adjusted its model) and MI are as much as a month out from peak, then Trump’s rosy projections could, once again, lead to recklessness.

The New York Times is out with another set of jaw-dropping cell phone data. This time, the analysis addresses, on a county by county basis, when various areas reduced their average travel below two miles a day. When I saw the map, it immediately looked to me like the map for the 2016 presidential election results. Because the areas where people still had not curtailed travel by March 26 were primarily in the South, I grabbed that section of the map and pulled a similar cut from a map of the 2016 voting results.

There really isn’t much that needs to be added to this, other than to point out that Southern Republican governors, by delaying statewide stay home orders, allowed control to devolve to the county and city level. The small pockets of blue you see in the 2016 election results overlay almost perfectly on the pockets which shut down despite the lack of action by Republican governors. My little island of blue, Alachua County, stands out nicely in north central Florida. Note also how isolated the Birmingham area is in Alabama. This map makes it not at all surprising that Birmingham elected a progressive mayor in 2017.

The correlation is not complete, as I’m a bit stumped by St. John’s county appearing to have shut down travel around the same time as Alachua County. I don’t think they ever did a county shut down, and in fact they didn’t even close their beaches until March 29, after a viral photo showed massive numbers of people on the beach on the St. Johns side of the line at Duval County on March 28.

What the Times map shows, though, is that we have a massive social experiment underway. In the South, red counties have been much slower about curtailing travel (and presumably social contact) than blue counties. According to Marcy’s constantly updated list, Florida, Georgia, Mississipi and Texas have statewide shut down or stay home orders going into effect today or tomorrow. I do hope that the cell phone tracking data collection continues, so that we can see if there even is compliance in these deep red areas. Considering Trump’s early rhetoric and the blather from Fox News, it would not surprise me in the least if compliance is much slower and spottier in these areas.

It almost goes without saying that the longer these areas continue social mixing, the longer the rest of us who are already isolating will have to wait before there can be a consideration of a general easing of restrictions. And, of course, we can sadly expect the death toll to stay high longer in those areas continuing to travel. The end result of this is that Trump’s failure to move quickly on a national stay home order, coupled with red state Republican governors parroting that rhetoric, means that in the South, counties that vote predominantly Republican could see deaths stretching out much farther into the summer than in counties and cities controlled by Democrats who enacted social distancing much earlier.

Update: I am too angry to address this any further than to give this link and a couple of paragraphs:

Hours after Gov. Ron DeSantis issued a statewide stay-at-home order Wednesday, he quietly signed a second order to override restrictions put in place by local governments to halt the spread of coronavirus.

The second order states that new state guidelines that take effect Friday morning “shall supersede any conflicting official action or order issued by local officials in response to COVID-19.” In other words, local governments cannot place any limitations that would be more strict than the statewide guidelines.

Locally, it means Hillsborough County cannot mandate churches close their doors, a rule that drew national attention and the ire of the local Republican Party after Tampa megachurch The River of Tampa Bay held two Sunday services, leading to the arrest of pastor Rodney Howard Browne.

Seriously though, fuck Ron DeSantis very thoroughly.

One of President Trump’s current attempts to dodge accountability is to blame New York’s spiking COVID-19 deaths on its late start.

New York — and the nation, and the world — would have been far better off if Andrew Cuomo had imposed a shut-down on March 7, when he declared an emergency. But that was six days before Trump declared an emergency, perhaps because he was busy throwing a party on March 7 at which COVID was probably spread among his guests.

New York would have been far better off if it had imposed a state-wide shutdown instead of imposing a containment zone in New Rochelle on March 10. It would have been better off had Cuomo issued a stay-at-home order on March 16 instead of simply shutting down non-essential businesses and canceling gatherings of more than 50 people. But from that day on, Cuomo’s measures were more severe than anything Trump has recommended, which to this day only recommends seniors and those with pre-existing conditions stay at home.

It was probably too late when Cuomo issued a full stay-at-home order on March 20. Nevertheless, it was just one day after California’s, the only earlier full-state stay-at-home order, and it was actually before Washington’s (Tuesday Dr. Birx repeatedly commended Washington’s response).

So yes, New York didn’t respond as early as it should have (and Bill De Blasio in particular was irresponsible and slow).

But New York has always been — and remains — far ahead of what Trump has done.

So if Trump wants to accuse New York of responding slowly, he should first explain why he has always lagged New York’s response.

Court transcribers like Peter Baker and Mike Allen were very impressed with what they deemed a very somber new Donald Trump in yesterday’s COVID rally. At it, Trump warned that we’re going to have a hard two weeks ahead of us (and then, over an hour later, admitted in an offhand comment it might actually be three). He warned there were going to be a lot of deaths — then stepped aside so someone not up for election could explain that means upwards of 100,000 deaths. And so, Trump implored while promising everything would get better in two weeks (or maybe three), we need to follow White House 30 Days to Slow the Spread guidelines to ensure we can limit deaths to 100,000.

There are a couple of major problems with that.

First, those guidelines ask for 30 days, but Trump is just asking for two more weeks (or three, if you manage to watch over an hour of this stuff).

Then, as Dr. Deborah Birx noted repeatedly, that 100,000 best case scenario is based off the IHME projections. But the IMHE projections are based off adopting a more stringent level of social distancing than White House 30 Days to Slow the Spread guidelines — basically, stay at home orders — and they assume those orders will remain in place until the end of May, not April.

To be fair, starting before the time Trump was pushing to reopen the economy, a bunch of governors (most of them Democrats, including people like Jay Inslee, whom Trump has repeatedly attacked) decided to impose more stringent requirements than Trump was recommending. As of yesterday, 29 Governors had stay-at-home measures in place to match the IMHE projections. Republican die-hards Doug Ducey of Arizona and Greg Abbott of Texas even capitulated yesterday and imposed state-wide orders (though on second review Abbott’s is just a non-essential business closure).

But even as this presser was going on, Trump’s closest ally among the governors, Ron DeSantis, was digging in, claiming that the White House task force had never suggested to him that they should impose a stay-at-home.

“I’m in contact with (the White House task force) and I’ve said, are you recommending this?” DeSantis said. “The task force has not recommended that to me. If they do, obviously that would be something that carries a lot of weight with me. If any of those task force folks tell me that we should do X, Y or Z, of course we’re going to consider it. But nobody has said that to me thus far.”

Trump was even asked about this. In a presser where Trump and Birx suggested that New York had been really late in adopting social distancing (that’s not true: Andrew Cuomo imposed an order more stringent than Trump’s current guidelines on March 18, just two days after Trump first called for social distancing, and imposed a full stay-at-home on March 20, effective March 22, which was among the earliest full state shut-downs), Trump and Mike Pence also had nice things to say about DeSantis, with Georgia’s Brian Kemp, the last of the major state governors not have one.

Reporter: I wanted to ask you about individual states issuing stay at home or what do you think, for instance, in Florida, Ron DeSantis has resisted urges to issue one of those, but he said moments ago that if you and the rest of the task force recommended one, that would weigh on him heavily. What sort of circumstances need to be in place for you to make that call and say this is something you should consider?

Trump: Different kind of a state, also great Governor, knows exactly what he’s doing, has a very strong view on it, and we have spoken to Ron. Mike, you want to just to tell him a little bit about that.

Pence: Well, let me echo our appreciation for Governor DeSantis’ leadership in Florida. He’s been taking decisive steps from early on and working closely with our team at the federal level. But let me be very clear on this. The recommendation of our health experts was to take the 15 days to slow the spread, and have the President extend that to 30 days for every American. Now, that being said, we recognize that when you’re dealing with a health crisis in the country, it is locally executed by healthcare workers, but it’s state managed. And so we continue to flow information to state governors. We continue to hear about the data that they’re analyzing and consult with them. But at the President’s direction, the White House Coronavirus Task Force will continue to take the posture that we will defer to state and local health authorities on any measures that they deem appropriate. But for the next 30 days, this is what we believe every American and every state should be doing at a minimum to slow the spread.

Trump: So, unless we see something obviously wrong, we’re going to let these governors good. Now, it’s obviously wrong, I mean, people can make things, they can make a decision that we think is so far out that it’s wrong, we will stop that. But in the case of DeSantis, there’s two thoughts to it, and two very good thoughts to it, and he’s been doing a great job in every respect, so we’ll see what happens. But we only would exercise if we thought somebody was very obviously wrong.

Aside from some rural states and Georgia, just about the only entity in the country not telling DeSantis to shut his state full of especially vulnerable seniors down is the President.

According to the IHME projections (and assuming those aren’t hopelessly optimistic because of a known lag of test results in places like California), we might still make that 100,000 projection if DeSantis imposes a true lockdown within seven days. But he says he’ll only do that if President Trump gives him political cover to do so.

Effectively, then, the allegedly sober President yesterday said we might only have 100,000 deaths if people ignore him and one of his closest political allies, Ron DeSantis.

Update: DeSantis is announcing a stay-at-home order within the hour.

[Check the byline, thanks. /~Rayne]

This is the first of two posts about research information and the disease COVID-19. I want to point out upfront I’m not a scientist/medical professional/public health expert. However I spend a lot of time reading fine print.

One thing I should set straight here is that we tend to use COVID-19 to refer to the disease and to the virus which causes it. This isn’t really accurate; I’ll be referring to SARS-CoV-2 as the virus underlying the disease called COVID-19 in this post.

~ ~ ~

Family members shared with me a link they received from a health care professional we know and trust. This professional told my family a Stanford researcher said “heat and sunshine will help to diminish the virus that causes COVID-19.”

You can imagine my family members’ concern because they’re in Florida where it’s quite warm already and yet COVID-19 cases continue to mount.

This situation provides a good example of how experts misunderstand and/or misuse research information and how lay people can be further misled or confused.

Direct link to video: https://youtu.be/xUGwGgV7r5Y

Note the researcher Dr. Lin’s background, Associate Professor in Neurology and Bioengineering at Stanford. He’s degreed in biochemistry and neurobiology, did postdoctoral work in fluorescent protein engineering. Sharp guy, great CV, but he isn’t a virologist or an epidemiologist.

At 6:45 in the video he refers to the outside of the virus as a “plasma membrane” — that’s just another less frequently-used term referring to a cell membrane. Virologists are more specific when discussing the coronavirus which causes COVID-19; it’s an RNA virus with a lipid membrane, attacked readily by soap though he does mention detergents.

When talking about sunshine or UV effects he discusses coronaviruses as a class, not SARS-CoV-2 specifically; he actually uses the word “estimate” with regard to timing.

Here is the first PubMed study Dr. Lin referred to in his video:

Photochem Photobiol. 2007 Sep-Oct;83(5):1278-82.
Inactivation of influenza virus by solar radiation.
Sagripanti JL, Lytle CD.
https://www.ncbi.nlm.nih.gov/pubmed/17880524

Emphasis mine. It’s not a study about *any* coronaviruses at all.

This is the second PubMed doc he cited:

J Virol. 2005 Nov;79(22):14244-52.
Predicted inactivation of viruses of relevance to biodefense by solar radiation.
Lytle CD, Sagripanti JL.
https://www.ncbi.nlm.nih.gov/pubmed/16254359

This study doesn’t even mention coronaviruses and was published *before* the MERS outbreak — another SARS-like variant of coronavirus which was first identified in 2012 in the Middle East, which I’ll point out is both sunny and hot compared to the northern U.S.

When Dr. Lin discussed temperature he referred to this study on the specific corona virus which causes the disease SARS:

Adv Virol. 2011;2011:734690. doi: 10.1155/2011/734690. Epub 2011 Oct 1.
The Effects of Temperature and Relative Humidity on the Viability of the SARS Coronavirus.
Chan KH, Peiris JS, Lam SY, Poon LL, Yuen KY, Seto WH.
https://www.ncbi.nlm.nih.gov/pubmed/22312351

Emphasis mine. Note this is a study of the virus which causes SARS, not the viruses which cause influenza or COVID-19. This is the abstract:

The main route of transmission of SARS CoV infection is presumed to be respiratory droplets. However the virus is also detectable in other body fluids and excreta. The stability of the virus at different temperatures and relative humidity on smooth surfaces were studied. The dried virus on smooth surfaces retained its viability for over 5 days at temperatures of 22-25°C and relative humidity of 40-50%, that is, typical air-conditioned environments. However, virus viability was rapidly lost (>3 log(10)) at higher temperatures and higher relative humidity (e.g., 38°C, and relative humidity of >95%). The better stability of SARS coronavirus at low temperature and low humidity environment may facilitate its transmission in community in subtropical area (such as Hong Kong) during the spring and in air-conditioned environments. It may also explain why some Asian countries in tropical area (such as Malaysia, Indonesia or Thailand) with high temperature and high relative humidity environment did not have major community outbreaks of SARS.

38C = 100F degrees.

People avoid being tightly clustered in confined spaces at that temperature. Note especially the first sentence about inhaled droplets. It’s not just that the virus may lose viability in a shorter period of time which reduces cases but the proximity of humans during the time the virus is active. Temperature alone is not a factor in reducing transmission rates.

The second study about temperature he cited:

Biomed Environ Sci. 2003 Sep;16(3):246-55.
Stability of SARS coronavirus in human specimens and environment and its sensitivity to heating and UV irradiation.
Duan SM, Zhao XS, Wen RF, Huang JJ, Pi GH, Zhang SX, Han J, Bi SL, Ruan L, Dong XP; SARS Research Team.
https://www.ncbi.nlm.nih.gov/pubmed/14631830

Emphasis mine — this is yet another study of the virus which causes SARS. This is a fairly early study dated 2003; the SARS outbreak began in 2002 with the first epidemic ending in June 2003. Here’s the results in the abstract:

RESULTS:
The results showed that SARS coronavirus in the testing condition could survive in serum, 1:20 diluted sputum and feces for at least 96 h, whereas it could remain alive in urine for at least 72 h with a low level of infectivity. The survival abilities on the surfaces of eight different materials and in water were quite comparable, revealing reduction of infectivity after 72 to 96 h exposure. Viruses stayed stable at 4 degrees C, at room temperature (20 degrees C) and at 37 degrees C for at least 2 h without remarkable change in the infectious ability in cells, but were converted to be non-infectious after 90-, 60- and 30-min exposure at 56 degrees C, at 67 degrees C and at 75 degrees C, respectively. Irradiation of UV for 60 min on the virus in culture medium resulted in the destruction of viral infectivity at an undetectable level.

37C = 98.6F (This made me laugh – it’s the temperature used for many years as a baseline for the average healthy human.)

Sure, heat deactivates the SARS coronavirus at temperatures fatal to humans, but it’s active at least a couple hours at temperatures in which humans live.

The last study cited was:

Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1
March 17, 2020
DOI: 10.1056/NEJMc2004973
https://www.nejm.org/doi/full/10.1056/NEJMc2004973
https://www.ncbi.nlm.nih.gov/pubmed/32182409

I’ve referred to this several times in comments with regard to hang time of the aerosolized virus. This study is a pre-print, not peer reviewed I should point out. It’s worth reading this study in particular because it’s about SARS-CoV-2 not SARS-CoV-1 and the findings have been misreported or misused a number of times in the media.

Rely on that last study the most because it’s about SARS-CoV-2, not SARS-CoV-1. It confirms that like the virus which causes SARS that SARS-CoV-2 can hang in the air as aerosol, and in this case the study showed it was viable for 3 hours:

SARS-CoV-2 remained viable in aerosols throughout the duration of our experiment (3 hours), with a reduction in infectious titer from 103.5 to 102.7 TCID50 per liter of air. This reduction was similar to that observed with SARS-CoV-1, from 104.3 to 103.5 TCID50 per milliliter (Figure 1A).

A friend sent me a link to this new pre-print study, not peer reviewed yet, published Friday March 27:

Stability of SARS-CoV-2 in different environmental conditions
Alex W.H. Chin, Julie T.S. Chu, Mahen R.A. Perera, Kenrie P.Y. Hui, Hui-Ling Yen, Michael C.W.
Chan, Malik Peiris, Leo L.M. Poon
https://www.medrxiv.org/content/10.1101/2020.03.15.20036673v2.full.pdf

This work confirms the viability of SARS-CoV-2 virus drops with increases in temperature and over time, but do note the data table provided in the study.

What the March 17 and March 27 studies say is that SARS-CoV-2 does weaken and become inactive with heat and over time.

What these and the other studies above do NOT say is that “heat and sunshine will diminish the virus.” There haven’t been any studies about SARS-CoV-2 viability over time with exposure to UV that I’m aware of . And while heat does speed the inactivation of SARS-CoV-2, the virus is still active for 2-3 hours in aerosolized form.

Like exhalation from infected humans, whether symptomatic or not.

It’s critically important that the public understands this virus SARS-CoV-2 is different from its relative, SARS-CoV-1. We can see this difference in both the ease with which it spreads and its much lower case fatality rate. Using studies of SARS and SARS-CoV-1 to extrapolate what SARS-CoV-2 will do has limits because of these key differences.

The same goes for anyone claiming SARS-CoV-2 is just another flu bug, that COVID-19 is just another influenza. It’s definitely not — anecdotal evidence of dead Americans by the truckloads tell you this is not just another flu. This difference is so obvious you should reject any such claims as propaganda. And any researcher making claims about SARS-CoV-2’s viability under certain conditions based on influenza viruses isn’t helping the public.

It’s as unhelpful as telling people erroneously that “heat and sunshine will help to diminish the virus that causes COVID-19.”

~ ~ ~

The bottom line: STAY HOME because aerosolized virus from asymptomatic and pre-symptomatic carriers in closed spaces has resulted in a significant number of confirmed cases versus fomite transmission — virus left on surfaces — though fomite transmission is still possible.

I’ll point to the story the Los Angeles Times published this week — sharing The Daily Beast’s summary because the LAT article is behind a paywall:

The Los Angeles Times reports that 45 out of 60 Skagit Valley Chorale who gathered at the Mount Vernon Presbyterian Church have tested positive. Three have been hospitalized and two have died.
https://www.thedailybeast.com/coronavirus-strikes-45-of-60-people-who-went-to-mount-vernon-washington-choir-practice

These people were careful; they observed social distancing techniques and heightened hygiene. But aerosolized virus got them, and it can get to others even when the weather is warm.

~ ~ ~

Next: the lack of solid research behind a particular off-label therapy.

Maryland Governor Larry Hogan has been one of the most proactive governors — of either party — in his response to the COVID-19 crisis. But until yesterday, he nevertheless had not issued a stay at home order yet. He did so yesterday. By the end of the day, Virginia Governor Ralph Northam and DC Mayor Muriel Bowser had done the same.

In Hogan’s statement announcing the stay-at-home order, he emphasized the import of workers within the DC Metro Area in sustaining the country’s national security, both those generally considered national security workers (he mentioned NSA and CyberCommand) and those specifically fighting this virus (he mentioned NIH and FDA).

In that context, Hogan mentioned that two weeks ago, Northam, Bowser, and he asked the President to designate DC Metro as a priority for response to the crisis, including by setting up a federal testing site so federal workers have a way to avoid getting their colleagues sick.

Two weeks ago, the three of us sent a joint letter to the President requesting that the national capital region be designated as a priority location for a federally supported COVID-19 testing site.  The Washington region is where national leaders are actually fighting this battle for the nation, and this region is about to be hit with the virus in the same way that some other major metropolitan areas have been.

We are home to more than 404,000 federal workers in Maryland, D.C., and Virginia.  The NIH and FDA are headquartered in Maryland, and these agencies are on the front lines of the battle against the coronavirus.

Maryland is also home to institutions that are critical to the security of our nation, including the NSA and the U.S. Cyber Command.

Last week four employees at Fort Meade tested positive for COVID-19.

Federal workers at these institutions and all agencies of the federal government are and will continue to be getting sick.  And a major outbreak among our critical federal workforce could be catastrophic, crippling the national response.

In his statement, Hogan didn’t explicitly say that Trump had not yet delivered on that Federal testing site. But by end of day, Hogan published an op-ed with Michigan Governor Gretchen Whitmer — President Trump’s current target of choice. In it, he repeated his request for a Federal testing site.

Keep “mission critical” federal workers healthy: While millions of Americans have begun working from home, “mission critical” federal employees and contractors are still reporting to work every day. More than 400,000 federal workers are based in the national capital region of Washington, Maryland and Virginia, including workers at the National Institutes of Health and FEMA. We can’t risk them getting sick when the nation is depending on their work and expertise to fight the pandemic. President Trump can help by establishing a federal testing site in the national capital region — an important step to identify sick federal workers and prevent them from infecting their colleagues.

I’m in flyover country, and I’m loathe to imagine that DC’s workers are any more important than my neighbors.

Nevertheless, the entire point of doing social distancing, for those of us who are either non-essential or can work from home, is to limit exposure for those who either need to keep vital parts of our economy running (like doctors and nurses, Amazon delivery drivers, and grocery store workers) or those who need to protect the country in other ways, even including the NSA.

Hogan’s comments yesterday suggest that President Trump didn’t even manage something really obvious and manageable: to make sure that critical federal workers have a way to ensure that they don’t infect other federal workers before they become symptomatic.

Indeed, hours after Hogan’s declaration, in Trump’s daily COVID rally, the President repeatedly bragged about our testing regime and — in yet another question from Yamiche Alcindor he tried to dodge — not only misstated the population of Seoul (possibly misreading the elevation for Seoul in its Wikipedia entry for its population), but also blamed Obama, and then insisted our testing is better than any other country’s.

Q Thank you, Mr. President. You said several times that the United States has ramped up testing. I’ll just talk a little quicker — or a little louder.

Mr. President, you said several times that the United States has ramped up testing, but the United States is still not testing per capita as many people as other countries like South Korea. Why is that? And when do you think that that number will be on par with other countries?

And Dr. —

THE PRESIDENT: Yeah, well, it’s — it’s very much on par.

Q Not per capita —

THE PRESIDENT: Look — look — per capita. We have areas of country that’s very tight. I know South Korea better than anybody. It’s a — very tight. Do you know how many people are in Seoul? Do you know how big the city of Seoul is?

Q But the question is about (inaudible).

THE PRESIDENT: Thirty-eight million people. That’s bigger than anything we have. Thirty-eight million people all tightly wound together.

We have vast farmlands. We have vast areas where they don’t have much of a problem. In some cases, they have no problem whatsoever. We have done more tests. What I didn’t — I didn’t talk about per capita. We have done more tests, by far, than any country in the world, by far.

Our testing is also better than any country in the world. And when you look at that, as simple as that looks, that’s something that’s a game changer, and every country wants that. Every country.

So rather than asking a question like that, you should congratulate the people that have done this testing, because we inherited — this administration inherited a broken system, a system that was obsolete, a system that didn’t work. It was okay for a tiny, small group of people, but once you got beyond that, it didn’t work.

We have built an incredible system to the fact, where we have now done more tests than any other country in the world. And now the technology is really booming.

I just spoke to — well, I spoke to a lot. I’m not going to even mention. I spoke to a number of different testing companies today, and the job that they’ve done and the job that they’re doing is incredible.

But when Abbott comes out and does this so quickly, it’s really unreal. In fact, one company, I have to say, that stands out in the job — and I think I can say this; I don’t want to insult anybody else — but Roche. Roche has been incredible in the testing job they’ve done. And they’re ramping it up exponentially. It’s up, up, up, up. And you should be saying congratulations instead of asking a really snarky question, because I know exactly what you mean by that.

You should be saying congratulations to the men and women who have done this job, who have inherited a broken testing system, and who have made it great. And if you don’t say it, I’ll say it. I want to congratulate all of the people. You have done a fantastic job.

And we will see you all tomorrow. Thank you very much. Thank you. Thank you.

In a call with governors yesterday, Trump claimed that he hadn’t “heard about testing in weeks.”

The subtext of yesterday’s decision by the DC metro region’s elected leadership is that Trump couldn’t even manage a no-brainer request made two weeks ago that would help to keep this country’s most essential workers safe. Sure, Larry Hogan didn’t say that explicitly. But by partnering with someone whose complaints are sure to get noticed, Hogan made it clear that Trump is still failing to deliver on the most obvious requests.

[Check the byline, thanks. /~Rayne]

I spent last night crying off and on all evening.

Right now some parent or parents are experiencing the nightmare I have hoped and still hope I won’t have to face.

A chemical engineering student at a state university died Sunday. He was only weeks away from graduating — just like my younger adult child at another state university.

This didn’t fucking have to happen. This bright promise didn’t have to be swept away in this human-made disaster. Don’t tell me this was natural, not when that narcissistic wretch in the White House treated the governor of my state like crap this week after her persistent pleading for federal assistance. Not after he failed from the time he was first told of this potential pandemic threat in December.

This death is on that miserable wretch’s head, and on the head of every GOP senator who looked the other way after Trump abused his power and solicited a quid pro quo. He did it again to our governor after the GOP senate gave him a permission slip instead of removing his unethical, greedy ass from office.

The horror isn’t over, either. There’s no telling how many more parents will face this same nightmare because one man just plain failed to do his job in a big and repeated way, because roughly 20 senators are spineless if not equally incompetent and corrupt.

~ 3 ~

You can guess what preoccupied my time last evening when I wasn’t crying. Text messages and phone calls were flying furiously between my house and my two kids’ homes downstate.

A capital city newspaper reported a 65-year-old man was confirmed with COVID-19. Nothing remarkable about this story on the face of it; so far he’s a living statistic.

But to this family this particular story is important. The man lives three miles from from my older adult child. Some of the folks who work with my older child live in the same neighborhood development. While the company for which my child works will implement screening body temperature at the door today, it’s a couple weeks late and pretty useless for asymptomatic cases. It would have been useless on this man up until he became sick, three days before Michigan’s Stay Home order took effect.

The patient developed symptoms on March 21 and has been sick since then. Before he developed symptoms he had been shopping at Sam’s Club, Costco, Meijer — three of the most popular grocery stores in the area. My child and their spouse shop at the latter two stores.

My younger college-student child had planned to go to Costco yesterday.

You might think, “Whoa, big spacious stores, no big deal,” right? But a study from China found two COVID-19 cases in Wenzhou traced shared one common trait — both patients had shopped in the same mall on two different floors. They had a low-intensity indirect transmission without prolonged contact.

COVID-19 appears nearly as bad as measles in terms of transmission. It’s spread mainly by exhalation of asymptomatic/pre-symptomatic people as well as those with symptoms. A recent frequently-cited study showed the virus can hang in the air, active, for three hours. This weekend’s story about a church choir which observed all the social distancing rules — apart from staying home — illustrates how easily this virus spreads in the air in closed spaces.

The 65-year-old patient said he doesn’t know where he was infected. “I don’t go to a lot of parties or hang around with a lot of different people,” he told the reporter, “I probably caught it from a public place.” But he did go to the grocery stores and he visited a rehabilitation facility in Ann Arbor to drop off supplies for a family member. The rehab facility was likely not a source since no known COVID-19 case arising from the facility was mentioned in the article.

Kudos to this gent for wanting to share his situation with the public. He’s been quite sick; he admitted, “I can’t imagine anyone with a compromised immune system, I can’t imagine them going through this…My lack of taking it seriously, versus wearing a mask or gloves or both probably contributed to me getting this. I kind of regret it now.”

So now we wait and wonder whether anyone who works with my older child has a community acquired infection from their neighbor.

And we wonder and wait to see if my older child along with their spouse has been infected, too.

Just stay the fuck at home. Don’t put yourself in this situation where you, too, must wait and wonder. You don’t need any more stress than that wretch in the White House has forced on us.

~ 2 ~

Speaking of that wretch, after comparing notes with Marcy this past week, I have a theory about the White House’s abuses of power denying or obstructing aid to certain states under emergency declarations.

See if you can spot what I think has happened in the context of a table Marcy prepared; I added a few more columns to it.

It’s not just that “the woman in Michigan” was mean to poor baby Trump. Her state has a very tight senate race and no Trump hotel, golf course, or Trump organization business within its borders.

One thing I didn’t add but makes sense to me about the tribal governments’ federal emergency declaration: Marth McSally’s Senate seat. What do you think?

~ 1 ~

This pandemic crisis has pushed our system past its limits, exposing all the cracks in a hyper-capitalist system. I know I’m probably preaching to the choir in saying that, or at least if you’re a regular here you’re unsurprised to see that I’ve written this.

But how quickly people have been pushed to their personal breaking point hasn’t really been plumbed. I’ve written before over the last few years that nearly 50% of Americans haven’t had $400-600 cash for emergencies, that rent across the country was beyond what minimum wage workers were paid, and health care insurance let alone health care was simply out of reach even with the Affordable Care Act.

The emergency is here, and any time now the dam is going to break. One-time checks from the government will come too late for many. Read this thread by Yashar Ali explaining one person’s crisis:

1. I’ve never had a hard time sleeping. But the past three nights I have slept a total of 3 hours. I’m writing this so I can sleep.

I am very angry. And I’ve realized during that having the space to be angry is a privilege because many people are too busy being terrified.

— Yashar Ali 🐘 (@yashar) March 30, 2020

Some of us can’t afford to help; we know this from the data and anecdotes we’ve seen. But those of us who can very much need to right now. Find a local soup kitchen or food pantry and make a donation of cash because people may already be experiencing food insecurity. Hunt down charitable programs delivering meals to children, elderly, and even groceries for hospital workers. As hard as we’re expecting health care folks to work, they may not have time to shop for themselves.

The U.S. didn’t become a great nation based solely on personal greed but by what Alexis de Toqueville called our “self-interest rightly understood.” The diminishment of investment in our country through a combination of taxes and giving to ensure we all do well is why country is falling, why we now find ourselves in this mortal mess. Take immediate corrective action and help others if you can with cash.

~ 0 ~

Keep in mind as we go forward this is both a shared national crisis, and an intensely personal crisis. The odds are stacked against any of us getting through the next 12 months without losing someone we know, like, love, and without someone within our personal spheres suffering hardship.

This is an open thread. Bring it here, back up the truck and dump it in comments.