A Virus Does Not Care

There’s a right way to deal with a pandemic, and a wrong way to deal with a pandemic

A virus does not care. A virus simply wants to reproduce, and for that it needs a host. A virus does not care about who that host is. A virus just wants a place to live, eat, and reproduce. A virus does not care if it makes the host sick. A virus does not care if it kills the host. This is the First Rule of Viruses: A virus does not care.

In 1918, as WWI was being fought in Europe, a virus emerged at Camp Funston, in the area of Fort Riley, Kansas. This virus did not care about the war. The virus did not care about Our Boys who were preparing to go fight that war. The virus did not care about the farmers in the Kansas fields, who dropped at their plows in the fields when the virus attacked.

A virus does not care.

The soldiers from Fort Riley went to the front lines in Europe with their guns, their ammo, their packs, and their gear, and they took that virus with them. It attacked their comrades in arms, and it attacked their enemies across the trenches.

A virus does not care.

The virus attacked King Alphonso XIII of Spain. Wherever the virus appeared, people began to speak of “the Spanish Flu,” going back to the widely-reported news of the mighty king it brought low. But the virus didn’t care. The virus attacked soldiers. The virus attacked ordinary villagers. Some lived, and some died.

A virus does not care.

The virus spread across the US, just as the war was beginning to come to an end. Bonds were being sold to pay for the war, and soldiers were starting to come home. The virus did not care about the bonds. The virus did not care about the homecoming celebrations being planned.

A virus does not care.

But people care, and they care about lots of things, and that’s where things got worse. People care about their status. People care about their businesses and their livelihoods. People care about parades the celebrate the end of a long and ugly war. People care about gathering in the corner bar with their friends, and playing sports in the local parks. People care about staying safe when danger threatens. People care about singing and dancing and enjoying life. People care about a million and one things, but a virus does not care about any of those things.

A virus does not care.

By 1918, people knew how to deal with a spreading virus in two broad ways: quit interacting so closely with others and practice good hygiene (both individually and as a community). They knew that beating a virus requires that a community care about itself just as much as the virus does not care at all. Give the virus an inch, and it will continue its deadly spread.

Because a virus does not care.

Some communities enacted a wide variety of what epidemiologists today call “nonpharmaceutical interventions” – prohibiting large public gatherings, closing businesses, shutting down churches, suspending schools, and so on. Other communities enacted some of these measures, but not all of them. Some communities took few measures, or decided “We’ll prohibit large gatherings, but not until after the big parade next week.” On the spectrum from “we need to shut everything down” to “we need business as usual,” St. Louis was on one end of the spectrum, and Philadelphia was in the other.

St. Louis:

By late September, Jefferson Barracks [a US military post in St. Louis] went under quarantine as the first soldiers came down with the flu.

In early October, city health commissioner Dr. Max C. Starkloff ordered the closure of schools, movie theaters, saloons, sporting events and other public gathering spots. Churches were told to suspend Sunday services. At the time, with nearly 800,000 residents, St. Louis was among the top 10 largest American cities. . . .

Theater owners, as some of the largest taxpayers at the time, protested the closures. Musicians and entertainers claimed the quarantine threatened their careers. Others were delighted — anti-alcohol leagues that were forming in the runup to Prohibition went on the lookout for taverns that violated the shutdown, [director of library and collections at the Missouri History Museum Chris] Gordon said.

Within two days of the quarantine, eight soldiers at Jefferson Barracks were dead, another eight residents died at St. Louis City Hospital and the number of area flu cases topped 1,150.

Jacob Meeker, a St. Louis congressman, died Oct. 16, six days after touring Jefferson Barracks. He was 40.

With the flu continuing its rampage, Starkloff imposed a stricter quarantine in November, closing down all businesses with few exceptions including banks, newspapers, embalmers and coffin makers, according to Post-Dispatch archives.

The American Red Cross shifted from making bandages to face masks. Volunteers passed around blankets and vats of broth to flu sufferers. An ambulance waited at Union Station to take any sickly train passengers directly to the hospital upon arrival. Police officers and mail carriers wore masks on their daily routes.

And as these measures took hold, it slowed the virus down.

Philadelphia:

In an effort to boost morale for the war and also to sell bonds, the city of Philadelphia threw a parade that drew 200,000 people, despite warnings that the Spanish flu was spreading among the soldiers who were about to head off to World War I and would be in the parade.

That didn’t turn out to be a good idea.

Days later, hospitals in the area were filled with patients suffering or dying from the Spanish flu.

Weeks later, more than 4,500 people in the Philadelphia area died from the virus.

The graph at the top of the post, from a 2007 article in the Proceedings of the National Academy of Sciences, paints the picture of these two approaches in stark, and by now familiar, terms.

Unlike a virus, people get to choose what they care about and how that care will be expressed. In 1918, to borrow from the Grail Knight, the leaders of Philadephia chose . . . poorly, while the leaders in St. Louis chose wisely.

Today, like many places, I and my neighbors in metro Kansas City (on both sides of the state line) are living under a locally-imposed “stay-at-home” order, with school buildings closed, business activity limited to those deemed essential and curtailing large public gatherings completely, including weddings and funerals.

You see, the leaders here know that a virus does not care. Other leaders, however . . .

From an interview on Fox:

Trump: I saw wouldn’t it be great to have all of the churches full—you know the churches aren’t allowed to have much of a congregation there. And most of them, I watched on Sunday online—and it was terrific, by the way—but online is never going to be like being there. So I think Easter Sunday and you’ll have packed churches all over our country—I think it will be a beautiful time. And it’s just about the timeline that I think is right.

A virus does not care about whether churches are full or empty on Easter. A virus doesn’t care if it is beautiful. A virus doesn’t care about your personal faith or lack thereof. In Omaha in 1918, Rev. Siefke S. de Freese, a seemingly healthy 35 year old pastor, led worship on a Sunday, then quickly died days later. A virus does not care.

From yesterday’s coronavirus task force presser:

Q: Mr President, you just reiterated that you hope to have the country reopened by Easter. You said earlier you would like to see churches packed on that day. My question is, you have two doctors on stage with you. Have either of them told you that’s a realistic timeline?

Trump: I think we’re looking at a timeline, we’re discussing it. We had a very good meeting today. If you add it all up. That’s probably nine days plus another two and a half weeks. It’s a period of time that’s longer than the original two weeks, so we’re going to look at it. We’ll only do it if it’s good and maybe we do sections of the country. We do large sections of the country. That could be too, but we’re very much in touch with Tony and with Deborah whenever they [crosstalk].

Q: Who suggested Easter? Who suggested that day?

Trump: I Just thought it was a beautiful time, a beautiful timeline. It’s a great day. . . . I’d love to see it come even sooner, but I just think it would be a beautiful timeline.

A virus does not care if it is a beautiful time. A virus does not care if it is a great day. A virus does not care what you think. A virus does not care what you love.

A virus Does. Not. Care.

We can choose how we respond to an uncaring virus. We can choose like St. Louis did, or we can choose like Philadelphia. And for far too many people, my friends, that is a choice between life and death. And in 1918, even St. Louis didn’t get it completely right:

The quarantine was temporarily lifted Nov. 18 but reinstated when the flu roared back in December. By Dec. 10 the flu peaked in the city with 60 deaths in one day. After illnesses declined sharply, the quarantine was lifted just after Christmas.

Look at that graph again, and you can see the bump at the end of November when the quarantine was prematurely lifted. The virus came back, because a virus does not care.

I’m a pastor. I’d love to see my church packed to the rafters on Easter. I’d love to hear the trumpets leading a 1000 voices in grand hymns of celebration. But that’s not going to happen, because while a virus does not care, I do.

We’re going to be closed this year. Not because we want to be. Not because we lack faith. Not because we don’t care about worship. Not because we’re giving in to the virus. It’s because we care about ourselves and our community so much that we’ll give up this kind of gathering to defeat the virus. Anything less than a full community commitment to a choice like that, and the virus will not be slowed, because the virus does not care.

I pray that more local leaders, state leaders, and national leaders choose wisely, even as Trump seems determined to choose . . . poorly.

I pray this, because I know the First Rule of Viruses: a virus does not care.

Three Things: The GOP’s Trumpian Death Panels [UPDATE-1]

[Check the byline, thanks! Update at the bottom of this post. /~Rayne]

Remember all the squealing by conservatives and Republican members of Congress back in 2009-2010 during the debate about health care, crying crocodile tears about “death panels“?

Well here they are, death panels brought to you by the same whiny selfish leeches who claimed socialized medicine would result in Democratic bureaucrats picking off Americans to limit health care.

~ 3 ~

I won’t embed video here. Open these links at your own risk, knowing these may be triggering to those who’ve had bad experiences in hospitals.

1 — Bergamo Italy hospital

2 — Brescia and Rome Italy hospitals

But this I’m going to share.

Those are Italian military trucks carrying away the dead to churches and cremation facilities, some outside of Bergamo because Bergamo’s own facilities are at capacity.

This, in a very much pro-life country which is predominantly Catholic.

This, in a country which has more hospital beds per 1000 persons than the U.S.

Some of those patients who are not in ICU have likely been labeled “codice nero” — death is imminent, do not resuscitate — during triage due to the shortage of ventilators. They are more likely to be over 60 years old because they are prioritizing critical care services and equipment for those more likely to survive.

This is what conservatives and Republicans really wanted: death panels, but conducted by the poor overtaxed health care workers who are themselves at risk because of incompetent governance by conservatives and Republicans.

I hope Americans are ready to see the dead hauled away by the truck load after the GOP’s death panel is through with them.

~ 2 ~

$34,927.43.

That’s the price for multiple tests and trips to the ER over seven days for COVID-19 an uninsured Boston-area patient was charged. You can imagine some people aren’t going to want to deal with that bill — or that swamped hospitals may discourage the uninsured — leading to a lack of treatment and more deaths. Many patients will be too sick to hassle with chasing a lower cost approach as charges can vary widely across many health care providers.

A death panel by health care expense.

Capitalism unto death.

~ 1 ~

Death panels may be composed of single individuals.

John Bolton, with Trump’s imprimatur, chose to kill the National Security Council’s pandemic response team, which has now lead to the deaths of Americans.

Mike Pompeo’s crappy diplomatic work failed to develop and build relationships with China, South Korea, other countries facing the same pandemic threat in order to obtain and share usable information and assistance to reduce American deaths.

Jared Kushner and Stephen Miller pulled a grossly negligent EU travel ban out of their asses, executing it so poorly that the resulting crush of travelers in the airports last week will sure increase American deaths in the weeks ahead many times over.

And the malignant narcissist-in-chief continues to push bad information jeopardizing lives both here and abroad after more than two months of inaction. Trump pushed a non-peer reviewed study on hydrochloroquine and azithromycin by tweet today after pushing this drug combo during a presser. There’s already been a run on the anti-malarial potentially hurting lupus patients for whom this has been prescribed; there’ve also been reports of poisonings in Nigeria after users self-medicated with the anti-malarial.

Trump has also mentioned and then lied about the Defense Production Act. There has been no real effort to order production of personal protection equipment for health care workers under the DPA. He’s choosing to expose first responders to COVID-19.

Mass death panels by Trumpism.

~ 0 ~

Sadly, it’s not just Americans who will face so-called conservatives’ death panels. The UK is already entering a state of crisis as its hospitals’ ICUs exceed capacity. There is no sign of constructive decision making by Boris Johnson to alleviate the capacity problem nor realistically halt the rate of infection.

Instead, Johnson’s government and now Trump’s Department of Justice are seeking powers to detain people instead of doing what is already within their ability and purview to do to stem contagion and aid respective health care systems.

Death panels by Tory conservatives and Trump fascists.

By the way, where’s Sarah Palin now? Still licking her polyester-pink wounds after her recent fiasco appearance on The Masked Singer when the show’s death panel gave her the much-deserved axe?

This is an open thread.

UPDATE-1 — 22-MAR-2020 — 11:00 P.M. ET

This video features Rep. Katie Porter’s sister who’s an emergency room physician. She breaks down what the Trump-GOP death panel will decide by the numbers.

Are you one in 50? Or are you one of the 49 which Trump and the GOP have decided in their pro-life hypocrisy won’t be saved?

Three Things: Racist Redirects as GOP Clings to Its Brand

[Check the byline, thanks!/~Rayne]

No news on the family front with regard to COVID-19 — at least with my family. No news is good news here.

I feel so very sorry for the New Jersey family which lost three of its family members * to COVID-19 this week. It was a blessing to the matriarch she didn’t know she lost her two oldest children; the heartbreak on top of the virus would have been torture beyond human ken.

None of this had to happen, either. Not a lick of it.

And it’s really only just beginning.

~ 3 ~

Let’s get this out of the way: Donald Trump is a racist jerk. He can’t read anything but inch-high print prepared for his ease; he had to go out of his way to make absolutely certain that he referred to COVID-19 as “Chinese.”

This is wholly intentional, deliberate as hell.

The fact COVID-19 emerged from China to become pandemic was sheer dumb luck. Spare us the racist bullshit talking down about eating unfamiliar animals and wet markets.

For Christ’s sake people here in the U.S. eat road kill and celebrate those animals with a festival.

They eat organ meats, blood sausages from across their many ethnic heritages, and they do odd-looking things with products made of proteins extracted from cartilage.

Americans and all the cultures from which they emerged have their own relationships with animals which have spawned biological crises over millennia. Just read Jared Diamond’s Guns, Germs and Steel.

It was simply a crap shoot this pandemic originated in China and not from a hantavirus in the American Southwest, or a flavivirus from South America or Africa. Chances are good we may yet see another emergent threat like a virulent Zika as the climate continues to warm.

Americans don’t have room to criticize. Their president being a racist moron to China about a crappy draw of luck is just plain stupid.

So is his and his party’s escalation of tension with the other largest economy in the world which both owns a lot of our debt. It’s incredibly shortsighted to bash the country which has been incredibly generous with research data based on their harrowing national experience with COVID-19.

I can’t begin to imagine how bad off the U.S. and other countries fighting COVID-19 would be if China hadn’t shared genomic and epidemiological data with the world.

We would not only be as far behind as we are because this administration felt winning re-election was more important than doing its job. We would have had to do much of the genomic and epidemiological research ourselves, on the fly, while our country’s health was in meltdown.

One need only look at how little research material has been published by other countries during this epidemic for comparison. They, too, have relied on China’s research.

Or look at how we continue to rely on China to do human testing – likely cutting corners on human experimentation ethics – just so Americans can obtain the benefit of a successful drug therapy while an American company reaps benefits.

No one of Asian ethnicity and heritage should have to put up with the hate unleashed by that slack-assed racist in the White House and the team of inept and bigoted enablers who are propping him up.

We may have legitimate concerns with China about supply chain integrity and intellectual property theft, but it’s on the U.S. that this is an issue to begin with. Outsourcing so much of what should be critical infrastructure is our own fault.

And failing to act in a responsible timely manner to a pandemic threat is solely that of the racist scumbag at the podium.

~ 2 ~

Speaking of failing to respond to pandemic threat…

If Senator Richard Burr knew by February 13 — when he sold $1.6 million worth of stock — that COVID-19 posed a potential national emergency, who else did and did nothing?

By “did nothing” I mean the way Burr lied to our faces and said, “the United States today is better prepared than ever before to face emerging public health threats, like the coronavirus,” a day before he voted to acquit Trump and six days before he sold his stock.

Think back to the earliest time you heard about the viral illness in China. Do remember when you first heard or read about it?

I do. I had just read about two high-profile deaths from pneumonia in middle and late December. A Chinese actress died, noted in Chinese media. She wasn’t known well to the U.S. so no mention here had been made. Only days later, right around Christmas, a young ESPN anchor also died of an odd pneumonia. This time there was news in the U.S. about his passing.

A week later on New Year’s Eve there was a report in English-language Chinese media about an odd cluster of pneumonia-like illness in Wuhan, China. My awareness of pneumonia had been heightened by the two high-profile deaths so close together.

If I could see a cluster of pneumonia in China by New Year’s Day, you know somebody within the U.S. intelligence community saw it even earlier.

We know now that the Senate Intelligence Committee chair had been briefed, based on a recording made of a meeting Burr had with large-ticket donors. Who else holding elected or appointed office were also briefed by intelligence and then refused to do the right thing to protect the American public?

Now you know why there’s been a full court press from the White House through the GOP congressional caucus to the right-wing media and punditry pushing racist invective against China about the pandemic.

It’s to distract and redirect the public’s attention away from the GOP’s wholesale betrayal of the American public and its allies while COVID-19 ramped up into a pandemic.

By the middle of summer thousands, perhaps tens of thousands of American lives will be lost because Richard Burr and others as yet unnamed helped Donald Trump fuck us over for their own venal aims.

Trump and the GOP had absolutely no intention of doing anything about COVID-19, which explains why Trump has only mentioned but still not used the Defense Production Act to ensure health care workers have adequate personal protection equipment. Crafters across the country are sewing homemade masks of irregular specifications right now to make up the shortfall while health care workers scavenge hardware supplies for mashed-up PPE.

Can’t help wonder how much PPE that $1.6 million would buy.

Or how much the profits from Sen. Kelly Loeffler’s stock sale would buy, or Sen. James Inhofe’s or Sen. Ron Johnson’s stock sale profits. (Sen. Dianne Feinstein’s household also recently liquidated stock but her press secretary said it was in a blind trust with the rest of her assets.)

Loeffler’s financial moves are egregious not only because of profit taking on inside information not shared with the public and then lying directly to the public on camera about the country’s condition. She then acquired stock in a business specializing in remote work, and her spouse is the chairman and CEO of the New York Stock Exchange. There’s absolutely NO excuse for not having her assets in a blind trust to avoid the appearance of a conflict of interest, particularly because of her spouse’s role. But I guess when you’re worth half a billion dollars you just don’t give a shit about annoying little details like ethics.

~ 1 ~

In previous posts I’ve discussed the different drugs being studied as potential therapies for COVID-19. This is an extremely important point which must be emphasized: all drugs, whether antivirals or monoclonal antibodies or anti-inflammatory meds are subjects of study. Some are being used off-label as last ditch efforts.

By off-label I mean they are NOT approved by the Food and Drug Administration as safe and effective for treatment of COVID-19 infections.

We are relying on off-label medications applied by doctors in desperate conditions in China and Italy on patients who are in dire shape to tell us about their effectiveness. We are literally relying on human experimentation without a consistent ethical framework

Yesterday’s presser with Trump was a disaster not only because of his racist bullshit aimed at China, but because he fucked up and discussed off-label drug therapies. He should have left that all together to the Center for Disease Control and the Food and Drug Administration.

His half-assed, poorly-framed remarks about an anti-malarial drug set off a run on black market chloroquine in Nigeria. The drug had been removed from the Nigerian market more than a decade ago because of the risks it poses to patients. It’s quite likely people will die because of misplaced trust in Trump’s words about this drug.

Two antivirals, lopinavir and ritonavir, used as a cocktail in a study in China failed to perform as needed against COVID-19. A study announcing these unfortunate results was published just Wednesday in  the New England Journal of Medicine. (Yet another example of Chinese researchers providing a benefit to the U.S. and the world, I’ll point out. Can only wonder what happened to the subjects of the test.)

And another antiviral discussed here before, remdesivir, is still under study, and still poses an unexamined conflict of interest for at least one person in the Trump administration.

The media did not catch how bad Trump’s remarks on drugs were — that hack Chris Cillizza offers an example, failing to mention the gross and dangerous errors about these medications in his list of fail.

Trump’s words and deeds, likely the output of his inept team including his son-in-law Jared Kushner and his pet Nazi Stephen Miller, are going to kill more people here and abroad on top of COVID-19. Given Miller’s history with this administration, this may be the desired result.

~ 0 ~

* I started writing this post Thursday mid-day. Before I finished it a fourth family member died.

Meanwhile, in neighboring New York, Gov. Cuomo doesn’t want a “shelter in place” order because it sounds too much like nuclear war and might scare people.

New York City is a COVID-19 hot spot rapidly become an American Wuhan cell. More people are likely to die there of COVID-19 than died during 9/11, and we changed our society dramatically out of fear of another such event. New Yorkers and the rest of the U.S. whose banking is centered in NYC need more than Cuomo’s personal concerns about a turn of phrase.

But as I said earlier, none of this had to happen, either. Not a lick of it. It makes the ongoing daily failures even more ridiculous because most are unforced errors. Much of the daily fail could be so easily stopped if Trump just shut up and left handling COVID-19 to ethical professionals.

This is an open thread.

Three Things: Even More Family Fun with COVID-19

[Check the byline, thanks!/~Rayne]

I figured it would be the oldsters in the family who would be my first worry. The grandparents still go to church, play bridge and golf, volunteer; they’re living typical retirees’ lives. They haven’t stopped mingling socially until this week.

But no. Last week I had to worry about my younger kid at college first. Fortunately they only had strep.

Last night the older adult child called, complaining of a migraine, dry cough, wheezing, and a tight chest. They’d already called the doctor about their symptoms; the doctor wouldn’t order a test because older adult child didn’t have a temperature.

All the other symptoms of COVID-19 except for a temperature. With so few tests available in Michigan, unless my kid checked ALL the boxes, there’s no way they’d be tested.

We’re pretty sure it’s not flu because the symptoms were slow onset rather than fast and adult child had a flu shot this year.

The kicker is that someone at work tested positive for COVID-19. It just hadn’t been announced across the business, likely because the business still needed to finish its plan for handling this situation.

Because my adult child couldn’t get a test, their spouse can’t say they’ve been exposed to COVID-19 and is likely now at work, probably spreading this around if indeed my adult child has COVID-19.

I won’t see my older kid or their spouse for a least a month now since we don’t yet know for certain if they have COVID-19 let alone how long exposed persons may be contagious. I dare not take the chance to see them because of my autoimmune disorder — not just because I might come down with COVID-19, but because hospitals may not be able to offer me an adequate level of care if there are no hospital beds or ventilators if one was needed.

When I saw this bullshit tweet this morning I almost levitated.

All the stress of our not knowing individual infection status and potentially exposing even more Michiganders is due to Trump, who instead directs his animosity toward an effective governor who isn’t getting the support she needs from the federal government.

My family and many others in Michigan and across the country are going through this Kafkaesque circus of uncertainty because the grossly-incompetent-when-not-corrupt Trump administration chose not to do the right thing and roll out testing back in January-February so that community acquired infections could be pinpointed earlier.

The one piece missing in this equation: why is it some people can get tested and others can’t? What arbitrary ju-ju allows Oklahoma to offer up a sizable percentage of its available tests for the Utah Jazz basketball players? Why are some political figures able to summon a test when others can’t?

Is this an additional layer of fuckery, not only the limitations on the number of tests available but an invisible prioritization of who can be tested? Does one’s political party affiliation make a difference, or the color of their state when it comes to getting a test for COVID-19 on a timely basis?

~ 3 ~

The UK did an about-face in its approach toward COVID-19. Boris Johnson backed off the idiocy of allowing the virus to simply run amok through the population to kill its most vulnerable citizens as well as those with the misfortune of being severly to critically ill while UK hospitals are overwhelmed by COVID-19 case load.

However, in spite of the noise made over the Imperial College’s latest assessment of COVID-19’s impact on the UK, nothing is being done. Leadership may have made some noises of surprise over the published mortality numbers but there have been no orders to lock down the country the way France has this past week, or Italy before that.

Instead, Johnson urged Britons to avoid pubs, restaurants and theaters.

He asked that the public only use the NHS “where we really need to.”

Britons were asked to avoid non-essential travel.

In short, a guidance was issued which appears wholly optional. It has no teeth.

Most importantly, Johnson did not order the country’s schools shut down, though young people are believed to be vectors for the virus. Murdoch’s tabloid-y outlet The Sun reports Johnson “hints” at shutting down schools in a few days, though a petition gathered more than 650,000 signatures asking for Johnson to do so immediately.

These numbers were pointedly ignored, though there was moaning at the number of deaths projected by Imperial College’s report — an estimated 250,000 souls. Johnson’s actions to date do little to mitigate let alone suppress COVID-19’S contagion, choices Imperial College explained as approaches to minimizing deaths.

The number of deaths even if Johnson implemented a more aggressive suppression regime in Great Britain* is staggering…

(*Great Britain versus United Kingdom may explain why the numbers shown are lower than a thumbnail analysis based on 67M UK residents x 40% infection rate x 2% case fatality rate.)

\Johnson’s action to date fails to respond adequately to the swamping of UK’s health care system, particularly its intensive care systems.

This past weekend the country continued to go to pubs and concerts, looking much like the revelers partying at the Masque while the Red Death roamed outside the walls of the palace.

Being on an island will not protect them, nor will having expressed a desire to leave the EU.

We won’t be able to help them, either; Trump has done little more than Johnson has for the U.S., relying instead on the states to do the heavy lifting of saving American lives.

If we survive this next year, those of us who are most at risk will owe our lives to the efforts of governors like Gretchen Whitmer, who must not only make the impossible happen with limited resources, but with an ignorant, mean asshat president whining about them at the same time.

~ 2 ~

One of our community members Surfer2099 has been digging away at pharma company Gilead Sciences; the company makes an antiviral drug, remdesivir, which has been used off-label to treat COVID-19 patients. As noted before in previous posts, the medication was shipped to China for tests without normal approval of the FDA.

Bloomberg reported yesterday that China wants to patent remdesivir (link to story at Reddit). It looks like China wants the patent in exchange for having allowed Gilead to test its drug on COVID-19 patients, bypassing the FDA’s test protocols in the U.S.

Surfer2099 noted that Gilead coincidentally launched a merger and acquisition the first week of March. How does such a move fit into the negotiations with China?

Don’t look away from this as remdesivir appears to have widening support in the treatment of COVID-19. If it’s the only drug approved by drug agencies including the FDA, there’s considerable money to be made with tens of millions of COVID-19 patients anticipated over the next 1-2 years.

~ 1 ~

Fortunately there was a little good news yesterday. A COVID-19 vaccine was injected into the first human volunteer in a Phase 1 trial. If successful, the vaccine will not be available for the public for at least a year and likely longer.

NIH Clinical Trial of Investigational Vaccine for COVID-19 Begins

The realistic time frame from this first injection to a public vaccine is at least 12 to 20 months under the best conditions, i.e., no reactions, no other hiccups like supply problems, no interference from outside entities like the Trump administration.

That’s how long we need to practice social distancing — at least 12 to 20 months. Settle in and develop a routine for the long haul.

~ 0 ~

This is an open thread. How are your friends and family doing with the changes we’ve had to make to our lifestyles?

Three Things: Good (Family) News, Bad (COVID-19) News

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

It’s absurd that I’m happy my college student child tested positive for strep throat. Whew, what a freaking relief that they only had a bacterial infection which has killed humans throughout history! Thanks to science we have effective antibiotics to treat this kind of infection, one of which is already working away and making said student feel better. …

Literally just heard from my student that Michigan State University now has one confirmed case associated with its campus. I can’t find a published report yet, more details later; so much for the brief respite provided by streptococcus.

Brace yourself for the bad news which so far is the nature of COVID-19.

~ 3 ~

Drugs. Let’s get into them.

Beleaguered Italy is using the rheumatoid arthritis medication tocilizumab off-label to treat patients in ICU. It may become their protocol for treatment of patients who develop acute respiratory distress syndrome (ARDS).

COVID-19 apparently spawns a “cytokine storm” the same way the 1918 Spanish flu virus did. Health care professionals say COVID-19 kills via fulminating viral cardiomyopathy, (inflamed heart tissue), not hypoxia (suffocation due to lung failure).

The onset of inflammation can be sudden with the cytokine action but at a later stage in the infection, which is different from the 1918 bug. The Spanish flu affected mostly younger people whose immune systems over-responded to the virus, where COVID-19 affects older people whose bodies may already have inflammatory responses at work because of cardio vascular disease or diabetes.

(We don’t know yet why some young people without preexisting conditions have become very ill and in some cases have died. Some may be related to smoking, others could be related to an undiagnosed condition. More study will be necessary; in the mean time, young people should protect both themselves and the older and sicker people who could catch COVID-19 from them.)

China tried tocilizumab on roughly 20 patients and found this monoclonal antibody halted the storm, acting on interleukin 6. There’s a preprint unreviewed study online but I can’t open it now or would include it. An immunologist in Italy came to similar conclusion about the use of this med and consulted with Chinese docs. See this story in an Italian news outlet (open in Chrome and translate).

There are other meds being tested in China — antivirals remdesivir (mentioned in a previous post), favipiravir, lopinavir/ritonavir, umifenovir — but there I haven’t seen any information about their application treating COVID-19 cases as detailed as there is for tocilizumab.

Pharma manufacturer Roche has agreed to provide to Italy the tocilizumab which should not only help reduce burden on hospitals’ intensive care units but build a body of data about the drug’s success in short order. China has also approved the drug’s use on certain COVID-19 patients.

I want to emphasize here this is NOT a cure for COVID-19. It’s a treatment for patients whose heart and lungs are in distress, requiring intensive care and a ventilator. What this drug may do for many of these patients is prevent them from needing ICU and ventilation, while their bodies continue to fight off the virus.

~ 2 ~

And more drugs — this time, antivirals.

A number of existing drugs have been revisited for repurposing against COVID-19 instead of their original intended purpose. Antiviral remdesivir and antimalarial chloroquine are among them.

Chinese researchers posted a paper about in vitro results, not peer reviewed (at least I didn’t see that it was).

There’s a paper about chloroquine alone; in vitro studies suggest it may work against COVID-19. Chinese researchers have a number of in vivo studies in progress, but no data has been released.

Chloroquine by itself as an effective therapy would be a miracle in that it’s an old drug now off patent and available as a generic, super cheap to produce. Can’t imagine Big Pharma would like this. But we won’t even face this conflict if we don’t get data from in vivo studies.

What I haven’t seen yet is adequate research related to the ACE2 receptor to which the COVID-19 binds itself to attack the body. There’s a study under way about a decoy protein drug called APN01, but I haven’t seen any details yet. A discussion about the ACE2 receptor can be found at this link.

I’d like to see more work done in related to ACE2 receptor mechanism. I’m worried we’ll end up too focused on antiviral remdesivir because there may be some political hijinks behind this drug.

Gilead Sciences, the drug’s manufacturer, shipped a bunch of this drug to China without federal approval, for tests which I assume mean human experimentation on actual COVID-19 patients.

About the same time this happened two weeks ago Gilead launched a merger/acquisition of Forty-Seven Inc, a clinical-stage immuno-oncology firm. It looks fishy yet likely to go unexamined because of the mounting desperation to have a drug therapy in hand before the anticipated explosion of cases arrives at hospital doors. In short, it’d be too easy to extort the U.S. into using this drug.

What really takes the cake is that a former Gilead lobbyist, Joe Grogan, is now the director of White House Domestic Policy Council. Grogan has already undermined Trump’s drug pricing initiative to the benefit of pharmaceutical companies. How do we know Grogan isn’t still representing Gilead’s interests, perhaps encouraging the government to turn a blind eye to corner-cutting on remdesivir?

~ 1 ~

Now it’s time for some more blunt talk with the family members.

I have a health care power of attorney or a health care directive prepared, signed, witnessed, copies distributed with one copy in my fire safe. If the worst should happen and the doctors need direction if I become incapacitated, my patient advocate is authorized to order what I want done. I have more than one advocate in a chain in case the primary advocate can’t act on my behalf.

I also have a will prepared, signed, witnessed, etc. If I’m picked off this month my kids will be disappointed that I haven’t yet finished Swedish Death Cleaning in the basement, but such is life and death. (Sorry, kids. You’re stuck dealing with all of the grandmas’ china sets and fragile antique lamps. Heh.)

I put the question to you now: are you ready? Have you done the legal legwork to help your loved ones whether family and/or friends if you’re incapacitated or *knock-on-wood* die?

Get it done if you haven’t. Stop putting it off because there’s no more time for lollygagging. We’d all like to deny we could get very sick, lose control of our lives, even die, but nature has a way of having the very last word if you don’t provide one.

Need a resource for that health care directive? See the folks at AARP — they have links to free resources for each state.

Just as important is establishing a plan for what friends/family should do if they can’t reach you. Trusted friends/family members should have current phone numbers, addresses, alternate key locations, emergency contacts, so on. They should also know who the patient advocates are and how to obtain access to the relevant documents if advocates don’t already have them.

This doesn’t have to be heavy; some of this effort we should have been doing all along as part of your disaster preparedness planning. Think about the families and friends affected by hurricanes Katrina and Maria, and imagine COVID-19 as a kind of hurricane which won’t flood your house but could certainly upend your life. You’d be prepared for a hurricane. Be ready for this one.

~ 0 ~

Treat this as an open thread. Tell us what’s in your basement or closets you need to unload because no one in your family wants it.

Three Things: More Family Fun with COVID-19

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

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

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

~ 3 ~

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

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

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

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

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

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

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

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

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

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

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

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

~ 2 ~

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

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

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

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

“Yes, it is,” Fauci replied.

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

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

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

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

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

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

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

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

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

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

Congressional switchboard: (202) 224-3121

~ 1 ~

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

~ 0 ~

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

Threadroll link here.

This is an open thread.

Three Things: Endemic COVID-19 Edition

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

By now we’ve all seen that disastrous presser with dementia-addled Trump at the Center for Disease Control yesterday, his yes men all standing around him bobbing their heads like useless bobble-head dog figurines folks used to put in their car’s rear window deck.

It was really bad when my 79-year-old mother, a retired RN, SCREAMED about that presser in her email this morning, yelling, “He has NO business spouting anything about this health situation!”

Yup. The man should leave it to the public health experts.

Mom’s not a Democrat. Neither is my dad. They will NOT be voting for Trump this November, if they manage to stay away from COVID-19 on their own.

Here are three things that I consider must-reads. We need to know more about what we’re up against.

~ 3 ~

Here’s a tweet thread which runs the numbers based on our current understanding of COVID-19.

If you don’t get through this, the kicker is that this is an engineer running the numbers. She calls herself an engineer but this is a minimization of a Chemical & Biomolecular Engineering degree from Johns Hopkins and her PhD from UCSD. This is no lightweight assessment.

The follow-on gut punch: if the states and federal government do not develop and implement a comprehensive plan to mitigate contagion, the U.S. will run out of hospital beds in early May.

That’s in a little over eight weeks.

If we don’t have adequate beds let alone mechanical ventilators and intubation equipment, the mortality rate will jump from an estimated 2-2.3% to at least 5%.

~ 2 ~

Jackasses like Rep. Matt Gaetz will make fun of the numbers, calling it overreaction. (By the way, how’s that crow tasting today, Gaetz, after one of your constituents died of COVID-19 since you made fun of it by wearing a gas mask the day before?)

But hospitals are taking COVID-19 seriously. They have also run the numbers and discussed among themselves what the increasingly endemic virus will demand of them. Here’s a summary from a presentation made in a webinar on February 26 by the American Hospital Association (AHA):

Here’s a comparison between influenza burden on hospitals versus AHA’s anticipated COVID-19 burden:

COVID-19

Influenza, 2018-2019 season

96,000,000 infections 35,500,000 infections
4,800,000 hospitalizations 490,600 hospitalizations
1,900,000 ICU admissions 49,000 ICU admissions
480,000 deaths 34,200 deaths

Flu data from CDC.

Grim — 14 times more deaths than the flu based on data currently available about COVID-19.

What the hospitals see confirms we will run out of hospital resources and more if there is no more aggressive effort made to slow contagion.

We don’t need to wait for proof. We can see it in Lombardy region of Italy as they quarantine 10-16 million people to prevent worse from happening.

~ 1 ~

We know something has been very wrong about the way in which the Trump administration responded to COVID-19, particularly its approach to testing. What’s not clear is why this was such a problem when the U.S. has responded to SARS, MERS, Ebola, Zika, H5N1, so on. Clearly this administration is not up to the job; clearly Trump is an idiot who shouldn’t be allowed near crises like hurricanes, fires, and pandemic threats. We can all see something is very off each time there’s a report that a credible claim of COVID-19 infection has been denied testing — including first responders.

But something more is going on here besides a bunch of yes men propping up a malignant narcissist with dementia. Jon Stokes laid down his thoughts in a tweet thread:


Has the delay in testing been due to Trump’s dementia-addled decision making, waiting out what he believes is a different kind of influenza? Has he been told by some hostile entity, foreign or domestic to wait and let the virus burn itself out? Has one of the crypto-fascist end-times Christianists around him advocated letting God take the wheel?

Or is the failure to act a result of Trump’s manifold conflicts of interest, this time a possible investment in a drug or testing manufacturer?

Amee Vanderpool wonders if Trump or his family is poised to profiteer from COVID-19:

Axios reported this evening that Gilead Sciences shipped an antiviral drug to China — without CDC approval required by law.

Does some member of Team Trump have an interest in Gilead? Or has Gilead invested in Trump, perhaps through his campaign?

Or is this some dark means of fucking with the Census, anticipating urban centers which trend blue to suffer the worst of this pandemic, killing off people who’d rely on government funding and congressional representation in the next decade?

Is this a means to ratfuck voter turnout this fall, literally killing voters by neglect with the anticipation of depressing turnout?

Is this a shadowy method to weaken the public before Team Trump decides they aren’t going to vacate the White House should they be voted out of office? You’ll note CBP has ramped up and militarized their presence in sanctuary cities — why now?

Whatever is driving Trump and his minions to do nothing to deter contagion and help the public already suffering from COVID-19, it’s a dereliction of his duties to the nation, a rapidly growing national security threat which demands Congress’s immediate attention.

Investigate Trump right now and find out why he’s failing the country yet again.

And every member of the GOP congressional caucus owns this disaster because they’ve failed their oath of office.

~ 0 ~

A lagniappe, if not a happy bonus: watch this video interview from Channel 4-UK with Dr. Richard Hatchett, CEO of the foundation Coalition for Epidemic Preparedness Innovations (CEPI).

Distasteful as the idea may be, a war footing may be necessary to fight this pandemic.

COVID-19: The Gift of Family Discussion Topics [UPDATE-1]

[NB: Note the byline – I’m stepping on Jim White’s beat today. Updates will appear at the bottom. /~Rayne]

There’s nothing quite like receiving an email from my father first thing in the morning. He’s not a chatty dude; I can count on two hands the number of emails I’ve received from him in the last five years. When he pops me a note I know he’s been stewing on whatever he sent.

Today he sent me and my siblings a link to a report about study of CT scans used to screen COVID-19 patients:

CT provides best diagnosis for COVID-19
Date: February 26, 2020
Source: Radiological Society of North America
Summary: In a study of more than 1,000 patients published in the journal Radiology, chest CT outperformed lab testing in the diagnosis of 2019 novel coronavirus disease (COVID-19). The researchers concluded that CT should be used as the primary screening tool for COVID-19.

Dad was also worried about the reliability of Chinese tests. Okay, so noted — if I go to China any time soon I’ll treat them with suspicion. Thanks for the email, Pop, and thanks to my siblings for the flurry of follow-up messages.

~ ~ ~

I’m far more worried about the U.S. tests which are still extremely limited after the CDC’s screw up by devising its own test instead of using effective tests already available.

The CDC designed a flawed test for COVID-19, then took weeks to figure out a fix so state and local labs could use it. New York still doesn’t trust the test’s accuracy.
by Caroline Chen, Marshall Allen, Lexi Churchill and Isaac Arnsdorf Feb. 28, 12:13 a.m. EST

There’s been a contamination issue in the government lab responsible for the tests as well — negative control reagent not handled properly in kits.

By Jon Cohen Feb. 28, 2020 , 5:45 PM – ScienceDaily

. . .

by Jonathan Swan, Caitlin Owens for Axios
Updated Mar 1, 2020 – Health

I don’t have a lot of faith this problem will be fixed promptly. FDA is supposed to approve the tests, but…

Sent to help the administration’s coronavirus response, a test specialist was stopped at CDC’s door and made to wait overnight.
By DAN DIAMOND 03/03/2020 03:23 PM EST – Updated: 03/03/2020 03:53 PM EST

We’re also seeing continued problems with testing due to lack of supply affecting first responders. Here’s a letter from a quarantined nurse in California who has had symptoms matching COVID-19, whose doctor and county public health officer signed off on getting her tested, and the CDC refused to test her.

The key symptom distinguishing COVID-19 from influenza is the chest pressure and cough. Influenza has a productive ‘wet’ cough where COVID-19 infection is more likely to manifest a dry cough with more chest pressure and shortness of breath as the virus moves down the body. From WHO’s China Mission report:

Symptoms of COVID-19 are non-specific and the disease presentation can range from no symptoms (asymptomatic) to severe pneumonia and death.As of 20 February 2020 and based on 55924 laboratory confirmed cases, typical signs and symptoms include: fever (87.9%), dry cough (67.7%), fatigue (38.1%), sputum production (33.4%), shortness of breath (18.6%), sore throat (13.9%), headache (13.6%), myalgia or arthralgia (14.8%), chills(11.4%), nausea or vomiting (5.0%), nasal congestion (4.8%), diarrhea (3.7%), and hemoptysis (0.9%), and conjunctival congestion (0.8%).

People with COVID-19 generally develop signs and symptoms,including mild respiratory symptoms and fever, on an average of 5-6 days after infection (mean incubation period 5-6 days, range 1-14 days). …

(Source: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf, page 11-12)

Because we can’t expect adequate numbers of test kits for weeks — no matter what those goddamned lying jackasses in the White House say — asking for a CT scan if you need treatment can be a good move. Haven’t seen other reports yet whether other forms of imaging like chest x-ray will work. However, the results of CT will change during course of infection:

Varied CT, clinical findings
In the second study, researchers at Sun Yat-sen University in Guangzhou, China, detailed the CT findings and clinical characteristics of six women 27 to 63 years old with COVID-19.None of the patients had such underlying diseases as diabetes, cancer, or respiratory disease. Five had had Wuhan or Hubei exposures.

They found that COVID-19’s wide variety of manifestations on CT can vary over time. Early in the disease, lesions can appear round and nodular in the central lung, unlike their common patchy appearance between the membrane surrounding the lung and the body wall. One patient had 3 follow-up scans 4 to 14 days later that showed diverse lesions and that the primary lesions had been absorbed and replaced elsewhere by new ones.

On testing blood samples, the researchers observed normal or slightly decreased counts of leucocytes and lymphocytes and identified mildly decreased eosinophil counts in four of the patients. Four days later, follow-up testing revealed that the low eosinophil counts remained abnormal and had dropped even further. “The decrease of eosinophil count may be helpful for the early diagnosis of the disease,” they wrote, calling for further study of the phenomenon. …

(Source: http://www.cidrap.umn.edu/news-perspective/2020/03/study-reveals-sharp-increase-covid-19-kids-shenzhen)

Blood test may work in tandem with CT, certainly faster to get than a CDC test for COVID-19.

Another potentially predictive risk factor for severe-critical cases: smoking, whether current or a past history. Explains why more men than women were severe-critical cases in China as men smoke more than women.

Guoshuai Cai
Version 1 : Received: 3 February 2020 / Approved: 5 February 2020 / Online: 5 February 2020 (02:56:53 CET)

Americans overall may have fewer severe-critical cases because tobacco smoking has dropped considerably over the last three decades. A good thing since severe-critical cases need mechanical ventilators or intubation and we simply don’t have enough equipment in our crappy health care system.

We don’t know yet if vaping is another risk factor; it may depend on substances in vapor, with tobacco being most suspect. I haven’t seen anything about marijuana use yet, whether smoked or vaped.

And disinfect (not just clean) your cell phones. Rather high nosocomial (hospital-acquired) infection rate with this bug in spite of aggressive PPE like full suits with hoods, booties, gloves, face shields means we’re dealing with possible airborne bug OR there’s some other fomite (surface) transmission not being documented.

As of Monday it was estimated there were ~600 asymptomatic cases walking around Seattle. This short-ish piece is a must-read, especially the paragraph which begins, “We know that Wuhan went from an index case”

2 Mar 2020 by Trevor Bedford – Bedford Lab

The Emerald City Comic Con convention begins on March 12 in Seattle, at which ~100K people from around the country and world are expected; the event has not been canceled.

March 5, 2020 at 6:00 am Updated March 5, 2020 at 7:08 pm

Wouldn’t want to cancel this massive social event and cause stock market disruption, oh no. *shaking my head*

I’d expect an explosion of cases across the U.S. in about 9 weeks based on Bedford’s estimate.

I know CT test may be inconclusive for me if I get this crap because an autoimmune disorder did a number on my chest ten years ago. I’m at high risk because of this pre-existing condition, as are family members because of their CVD and diabetes.

Must say there’s nothing like a documented mortality rate of 7-13% for CVD and diabetes to put the fear of god in certain at-risk family members about vigorous frequent handwashing.

Now I have to stop family from going full apocalyptic prepper. Somebody bought this household a half gallon of Lysol concentrate and three times more bleach than I’ve used in a year’s time.

I can hardly wait to hear from my family again first thing in the morning.

~ ~ ~
I do want to make one point perfectly clear, all snark aside.

** The Republican Party is responsible for every COVID-19 fatality in the U.S. **

They could have done the right thing and removed Trump by convicting him for obvious abuse of power and obstruction of Congress instead of being chickenshits afraid of Trump’s mean tweets. He’s a clear and present national security threat — this pandemic proves it.

VP Mike Pence has done a crappy job so far but we can’t tell how much of this disaster is his alone, or a result of also trying to keep his malignant narcissist from melting down while handling a mounting pandemic. As long as Trump’s in office they will both continue to screw this up.

The GOP could have done more to assure the pandemic response team remained in place with funding after Trump’s Senate-approved appointee John Bolton rejiggered the National Security Council in May 2018.

But no, the Republican Party is as incompetent and unequal to the job of protecting the American people as their leader in the White House.

Vote these walking disasters out of office in November; the life you save in doing so may be your own.

UPDATE-1 — 2:10 P.M. ET —

Wouldn’t you know it but as soon as I pressed Publish there was a message in my inbox that Emerald City Comic Con will be rescheduled to later this year, some time this summer.

This is the right thing to do given the number of cryptic COVID-19 cases in Seattle. It’s unfortunate the burden of this decision fell solely on the convention organizers in the absence of public guidelines about social isolation from the federal government.

My Corona

Okay, at nearly 350 Comments, Jim White’s excellent post, “PREPARING FOR THE INEVITABLE CORONAVIRUS DISEASE 2019 OUTBREAK”, is getting a little long in the comment tooth. So, I am going to add a new post, even if a short one, to allow continuous commentary on this subject that is of such import and interest.

To set the scene, I have had a touch of walking pneumonia for the last, give or take, 10 days. I finally listened to Mrs. bmaz and went to the doctor early last week and got some prescriptions, most importantly steroids and antibiotics. Things are improving, albeit it slowly.

There is a new wrinkle though! Very late Friday night, actually very early Saturday morning, our daughter flew in and is home now. Why, you ask? Well, about eight days ago, she was in Italy for a week and flew out of Milan (a Level 3 containment area) to return to Boston, where she works. Her employer said “Lol, take two weeks off before coming into work again”. So, she came home to visit.

She is asymptomatic to date other than some sniffles and sore throat, which is not uncommon for her generally. No temperature. But she is considering getting tested anyway. Turns out there was literally no real capacity for testing in Arizona until….today. Apparently. The state DHS announced they could start today, but there are no good instructions on how to do it, or if you will get billed thousands of dollars for doing so. It is maddening. The woman who runs the DHS effort here is not bad, this appears to be caused by the lack of competent interaction by the federal government. Will she get tested? We don’t know. Should she even worry about it? We don’t know that either. And trying to talk to somebody about it is impossible, I can seriously get US Senators and Representatives on the phone easier.

We shall see. Thankfully we have a big enough house that we can mostly keep a distance. But there has to be a better way to respond to this than what the Trump Administration has engendered.

So, for all things Corona, have at it some more. You folks have engaged in marvelous discussion so far, keep it up.

Biden’s Opposition to Medicare for All: It’s All About the Billionaires, Baby

[Editor’s Note – this is a guest post by a friend of ours here at the Emptywheel Blog, Bob Lord. Bob is a longtime tax and finance attorney with some very salient thoughts on why the centrist Democrats are pushing back so hard on Medicare For All. One other note, we here at Emptywheel have purposefully not engaged on behalf of any particular candidate in the primary process, but the issues in play are fair game.]

By Robert J. Lord

Joe Biden has lots of reasons why he opposes the Medicare for All plan favored by Bernie Sanders and Elizabeth Warren.

The cost runs too high, the former vice-president tells us. People will have to give up their private health insurance. People will lose the right to choose their health insurance provider.

The list goes on, but do these reasons reflect Biden’s actual worries? Surely, he’s seen the studies that show Medicare for All would drive costs down, not up, as removing health insurance company profits and administrative costs from American health care totally changes the system’s accounting dynamics. Yes, an expanded Medicare would require administrative expenses, but nowhere close to the expenses that our current system requires.

Biden also knows Americans would welcome the chance to swap their private health insurance for Medicare. Don’t believe me? Speak to someone between the ages of 60 and 64 who’s relatively healthy. Ten to one she has her fingers crossed hoping to make it to age 65 without a major health challenge, so she can qualify for Medicare and never have to confront the insufficiency of her wonderful private insurance plan.

And very few Americans, we must keep in mind, choose their health insurance provider. Most of us get insurance through our employers. Employers choose the least expensive plan for all employees collectively, without regard to the needs and desires of individuals.

Given that Joe Biden’s stated reasons for opposing Medicare for All don’t pass the smell test, what could be the real reason for his opposition?

Could Biden simply be beholden to the health insurance industry and Big Pharma? Perhaps, but I suspect that something larger — the overall wealth of our wealthy — may be at play. After all, it’s not like health insurers and pharmaceutical companies are going to have his back come general election time.

Consider the difference between how Joe Biden, on the one hand, and Bernie Sanders and Elizabeth Warren, on the other, view the billionaires and centimillionaires who make up America’s super rich. Sanders believes the greed of America’s billionaire class threatens the social fabric of our country and has proposed a significant increase in the federal estate tax on grand fortunes. Warren has proposed a 2 percent annual wealth tax on all fortunes in excess of $50 million.

Biden’s differences with Warren and Sanders go deep. He has assured his rich donors — at big-dollar fundraising events — that their lifestyles will not change if he’s elected. Biden, whose donor list includes at least 13 ten-digit fortunes, has made it clear that he doesn’t think billionaires bear any more responsibility for America’s woes than any of the rest of us.

Just this week, he voiced his opposition to policies that would make it harder to become a billionaire.

But why would billionaires and centimillionaires particularly care whether we have Medicare for All versus the Obamacare-with-a-public-option plan Biden favors?

To answer that question, consider the fundamental difference between Obamacare and Medicare for All: who pays. Under Obamacare, individuals pay for their health care, through the insurance premiums they pay and their out-of-pocket expenses for the charges their insurance policies don’t cover. The government subsidizes insurance for lower income Americans through Medicaid, but the bulk of health insurance costs are paid by individuals or their employers.

The public option, Biden’s proposed fix to Obamacare, won’t change any of this. Even if every American healthcare consumer chose the public option, putting the private health insurance industry out of business in the process, individuals still would be responsible for their own health care costs.

Medicare works differently. Under Medicare, the government insures healthcare costs directly. Individuals don’t pay premiums or co-pays. Instead, tax dollars fund the cost of the program.

All this means that the transition from Obamacare to Medicare for All would transfer the burden of health care costs from health care consumers, who share in costs based on how sick or healthy they happen to be, to taxpayers, who would share in costs based on their respective incomes and tax rates.

The great majority of Americans live their lives as both health care consumers and taxpayers. Under Medicare for All, they would see an elimination of both insurance premiums and out-of-pocket medical costs. They would also see a tax increase, but ordinary Americans would save substantially more in health care costs than they’d pay in increased taxes.

But those billionaires and centimillionaires on Joe Biden’s donor list? Their tax increases would dwarf any savings they see in personal healthcare expense. Some could see seven figure tax increases.

Viewed through the billionaire lens, Biden’s loud opposition to Medicare for All makes distinct political sense. He needs billionaires to fund his White House aspirations, which still drive him three decades out from his first presidential run in 1988. He’s not only convinced himself that his billionaire supporters pose no threat to our social fabric, he even seems to believe that any health care reform that puts the squeeze on billionaire fortunes does pose a threat.

All in all, a classic case of why ambition often blinds us. In a 2018 speech, just a sentence or two after saying the billionaires he’s courting aren’t a problem, Biden lamented that the income gap in America is yawning.

What Biden’s ambition won’t let him see: Billionaires don’t exist in isolation. We have approximately 700 billionaires today in the United States. We have a larger number of half-billionaires and a still larger deep-pocket cohort of centimillionaires. And so on. Which leaves our top 1 percent controlling close to half the country’s wealth and the country with an income gap that Biden openly recognizes is “yawning” and, obviously, a problem.

In other words, those billionaires Biden’s won’t let himself see as a worry really are inseparable from the yawning income gap that he knows is a problem.

Sanders and Warren, by comparison, are clear-eyed. They can see that when the gap is so yawning that treatable or preventable injuries and illnesses are killing Americans who can’t afford healthcare and bankrupting millions of others, the only answer is that society — through taxation — must assume the cost of healthcare. Other countries, like Canada, recognized this reality decades ago.

And when America’s billionaires, with Joe Biden as one of their many mouthpieces, stand in the way of that process because they don’t want their taxes to increase, their greed tears at the fabric of American society.

Joe Biden can’t see that. His two leading rivals sure do.

[Robert J. Lord, a tax lawyer and former Congressional candidate, is an associate fellow at the Institute for Policy Studies. Bob previously served as an adjunct faculty member at the Arizona State University School of Law. Bob’s work focuses on the relationship of tax law to inequality. He contributes to both the Inequality.org website and to OtherWords, the Institute’s national syndicated editorial service. Bob also is a staff member at Blog For Arizona, the leading political blog in Arizona.]

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