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Masked Up, Ready to Go (Nowhere)

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[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.

Research Misinfo/Disinfo: Check Experts’ Homework

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[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.

Three Things: Shit Got Real with Family and COVID-19

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[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:

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.

Craig Simpson [CC BY 2.0])">CC by 2.0

Straddling the COVID-19 Barbed Wire Fence in Kansas

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Pro Tip: Don’t sit on this fence. (photo h/t to Craig Simpson [CC BY 2.0])

The Democratic governor of Kansas, Laura Kelly, has put her finger in the eye of conservatives in Kansas by issuing a state-wide stay-at-home order yesterday in the face of the growing COVID-19 epidemic. Out in the western part of the state, the wingnuts have already been saying “this is an urban problem – we’re just fine – we don’t have any Chinese people here – why did she close all our schools?” and now they’ll scream just a little harder.

Note, however, that Kelly does not have the last word on this. When she issued her initial state of emergency declaration at the end of February, it lasted for 30 days. To extend it, the GOP-dominated legislature had to consent . . . which they did, but not without a fight. From the AP’s John Hanna in Topeka:

The [KS] Senate voted 39-0 and the House 115-0 to approve a resolution to extend the state of emergency until May 1 and to allow legislative leaders to extend it further every 30 days. Kelly declared a state of emergency last week, and without the resolution, it would have expired March 27.

But the resolution also requires legislative leaders to review all of Kelly’s executive orders and allows them to overturn many of them within days. It also prohibits Kelly from having guns and ammunition seized or blocking their sale.

The unanimity of those two votes is almost unheard of these days in Topeka, and it was a sign that the GOP was willing to go along with closing the schools for the rest of the year and take other measures as the COVID-19 outbreak began to surface across the state. But they sure didn’t like it, and wanted to make damn sure that they could shut down an out of control governor (in other words, a Democrat) when they did something they considered outrageous. The guns and ammo provision is another sign of how fearful the rightwing is of folks coming for their weaponry.
That was ten days ago. As soon as Kelly’s Stay-At-Home order came out yesterday, so did the folks on the right, waving around that provision that provides for a veto those orders. Again from John Hanna:

Conservatives in the Republican-controlled Legislature said Kelly overreached this month when she ordered public schools closed for the rest of the semester and complained that the state’s economy was being damaged too much. Legislative leaders have the power to revoke her orders related to the coronavirus pandemic.

Kansas House Speaker Ron Ryckman, Majority Leader Dan Hawkins and Speaker Pro Tem Blaine Finch, all Republicans, said in a joint statement that the new order “will no doubt impact our families and our businesses. As members of the Legislative Coordinating Council we have a duty to carefully assess this executive order and the reasons for it. Over the coming days we will consult with the Attorney General, health care professionals, the business community, and the state’s emergency management team to make sure we are on the right path.”

Kansas Senate President Susan Wagle, a Wichita Republican, said she was concerned about a “one size fits all” solution.

“I want to assure Kansans, particularly those in rural areas, the legislature is actively working to thoroughly review the Governor’s orders and ensure the specific needs of rural Kansans are addressed,” Wagle said in a statement.

Kansas Congressional Districts

[Note to the folks worried that the state’s economy was being damaged too much: a virus does not care.]

Speaking of those rural areas, let me direct your attention to OB-GYN Roger Marshall, who also serves as the US Representative from KS-01 (the large green area on the map to the right). Marshall is running to replace Pat Roberts in the US Senate, and he is trying to straddle a barbed wire fence on all this. He’s been loud about backing Trump’s “close the borders” stuff, but he’s still enough of a physician that he realizes that science actually matters. He doesn’t like the “big government” approach at all, but he has conspicuously not condemned Kelly for closing the schools. From an story two weeks ago in the Manhattan KS paper “The Mercury”:

Following Gov. Laura Kelly’s recent decision to close K-12 school buildings for the rest of the school year, halt mortgage foreclosures and evictions, and ban gatherings of more than 50 people, Marshall said he would rather people exercise an overabundance of caution at the moment.

“We have to assume that the virus is out in every community,” he said. “I hope there’s not, but we have to assume that. Kids and young adults, they’re super infectors so if one child has the virus, they’re going to transmit it a bunch more often than say an older person who just doesn’t have as many social contacts. Think of senior citizens, for the sake of people with illnesses.

“I hope in a couple of weeks you can say we did too much,” Marshall continued, “but I think right now, it’s so critical that this is the acceleration phase of the spread of this virus. Every virus we prevent spreading today is going to prevent dozens in the future and save many, many Kansas lives.”

Yesterday, Marshall retweeted John Hanna’s story about the Stay-At-Home order to his followers, perhaps trying to signal them that the GOP is watching this. He did not, however, attack or even question Kelly’s judgment for ordering this. To borrow from Sherlock Holmes, this is the dog that did not bark, and the silence is deafening.

And then there’s Marshall’s big opposition in the GOP primary (this was before Kelly’s order was issued yesterday):

U.S. Senate contender Kris Kobach reached for campaign gold amid the coronavirus pandemic by promising to intensify construction of a border wall to defend the country against illegal immigrants from China who may import deadly viruses.

“Over 12,000 Chinese nationals snuck across the border into the United States last year,” Kobach said in a video fundraising appeal delivered Thursday to potential voters in Kansas. “No checks. No visas. No health screening. In times of global pandemic, borders matter.”

The fence in Kansas between science and wingnuttery is made of very sharp barbed wire. Kobach is planted firmly on the Wingnuttery side of that fence, and Marshall does not want to cede all those voters to him by planting his feet firmly on the side of science. But Marshall is is going to find that straddling a barbed wire fence is not comfortable, to say the least.

The KS senate race will be very very interesting this November.

 

New Orleans Is Drowning. Again.

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August 29 will mark 15 years since Hurricane Katrina struck New Orleans. The next day the country watched in horror as the levees broke and thousands of residents who could have been evacuated but were neglected by many levels of government and public safety officials, were forced onto rooftops to await rescue. Many of the rescues were not by government agencies but by fellow citizens with boats in what became the Cajun Navy. For days, people pleaded for rescue. Many did get moved to safety. Many did not. The “official” death toll states that 1577 died in Louisiana. That figure is widely believed to be a large underestimate, as many of the dead and missing came from the neglected fringes of society.

I often return to Mary Gauthier’s poetic description of the the losses and displacement suffered by those affected by the flooding, with many of them evacuated as far away as Houston with no means to return and nothing left in New Orleans to return to after their homes were destroyed.

Although there were too many to count, one of the most tragic developments during the flood was at Memorial Medical Center. The hospital was not evacuated before the storm. It appears that there were at least 45 deaths at the hospital during the time that it was marooned and without electricity, supplies or rescuers. The choices the marooned staff faced were stark and ugly. From a New York Times description in 2009:

Within days, the grisly tableau became the focus of an investigation into what happened when the floodwaters of Hurricane Katrina marooned Memorial Medical Center in Uptown New Orleans. The hurricane knocked out power and running water and sent the temperatures inside above 100 degrees. Still, investigators were surprised at the number of bodies in the makeshift morgue and were stunned when health care workers charged that a well-regarded doctor and two respected nurses had hastened the deaths of some patients by injecting them with lethal doses of drugs. Mortuary workers eventually carried 45 corpses from Memorial, more than from any comparable-size hospital in the drowned city.

Charges were filed by the state in 2006 against the doctor and two nurses. The Times continues:

The physician, Anna Pou, defended herself on national television, saying her role was to “help” patients “through their pain,” a position she maintains today. After a New Orleans grand jury declined to indict her on second-degree murder charges, the case faded from view.

In the four years since Katrina, Pou has helped write and pass three laws in Louisiana that offer immunity to health care professionals from most civil lawsuits — though not in cases of willful misconduct — for their work in future disasters, from hurricanes to terrorist attacks to pandemic influenza.

I don’t want to go into details of what might have led Pou and the nurses to hasten death for these patients or even if they did. Instead, let’s just focus on the fact that in such a situation, the health care workers are faced with helping those they can help while knowing that there are some who are destined to die no matter what they do. Further, with such limited resources, effort spent on those destined to die runs the risk of harming those who have a shot at recovery.

Doesn’t that sound familiar? Right now, various hospitals are drawing up their priority lists for allocating life-saving resources when the COVID-19 outbreak overwhelms staff, space and equipment. Note that even in this 2009 article, Pau mentions how the Katrina situation will not be unique and that a pandemic could lead to the very same scenario.

And with that, we come to the NOLA.com story from which the feature image of this post is derived:

A woman who identifies herself an Ochsner Medical Center nurse has published a gut-wrenching post on social media, going into detail about how she has seen coronavirus overwhelm a patient and pleading with the public to say inside “as if your life depended on it.”

Claudia Griffith’s 416-word Facebook post explains how the disease can take over a person’s lungs and kidneys. And “if it makes it to your kidneys, you’re lucky to be alive because your liver is next,” Griffith explains.

The story continues:

“As a nurse you cry at the window knowing there’s nothing you can do,” she writes.

/snip/

“You spend hours in your (patient’s) room gowned up head to toe sweating and not able to breathe. Then you realize…this is it. I can’t save this patient anymore. You sit there and say your goodbyes while they pass without family or loved ones because nobody is allowed in the hospital for everyone’s safety. You are their only contact and hope. You sit and watch as the (heart rate) and (blood pressure) can’t read anymore. You lost your patient to COVID19. You don’t even know how this virus works but you watch as it kills your patient,” she says.

In a very real sense, those patients she is describing are drowning as the pneumonia from COVID-19 relentlessly fills their lungs just as relentlessly as the Katrina floodwaters rose.

The best I can tell, Ochsner Medical Center in Jefferson and Memorial Medical Center in New Orleans are only four miles from one another. It is such a tragedy that they find themselves in the same dilemma just shy of 15 years apart.

Note that Louisiana doesn’t even make it into the list in the Washington Post article detailing huge disparities in how the Trump Administration is allocating emergency reserves of supplies and ventilators. And you can read here about the dire situation Louisiana hospitals are facing, with maximum capacity likely to be reached by this time next week. The people of New Orleans and all of Louisiana desperately need help, but I fear that we as a country can’t find the way.

Dispatch from the War on COVID-19 [UPDATE-1]

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[Check the byline, thanks. Update at the bottom. / ~Rayne]

If you’re a regular here you know I don’t like to share stuff from Fox or affiliates. But local station Fox5NY picked up and republished a video online I haven’t been able to capture elsewhere. It’s extremely important.

She isn’t the only nurse we’ve heard from here in Michigan about the “war zone” in which they now work. I shared a link earlier today in a previous post; I’ll share it as an embed here so you can hear these health care workers back to back.

 

View this post on Instagram

 

Dear Family, Friends and Complete Strangers, Please STAY HOME!! Love, an ER Nurse

A post shared by Mary Macdonald (@marymac019) on

Now, a word to Sen. Lindsey Graham who denigrated nurses because of the possibility they may collect $24 an hour on unemployment.

Senator Graham:

Nurses are degreed professionals who not unlike lawyers must pass a state licensing test and earn continuing education credits on top of their regular job. The ICU nurse has had very specific training as has the ER nurse; both have likely had to add more training to cross over to do the jobs they’ve performed this week.

They are our foot soldiers in the war on COVID-19. We will not have enough of these soldiers because they will get sick from a combination of exposure to high viral loads, especially when they don’t have adequate protection, and from the heightened, sustained stress of this pandemic war.

They do not deserve your disrespect. These professionals will treat every patient as someone worthy of their efforts. They will do their level best to save whomever they can provided they have the resources. The least you can do is treat them with the same respect they’d treat you as a patient. For all you know you will find yourself sick with this virus and you’ll be on the business end of one of these professionals who are in such high demand there won’t be any unemployed nurses in this country for more than a year.

Get over yourself, Graham. And stop taking social cues from that rude, nasty cretin in White House. Your friend McCain would be ashamed of you if he were still alive.

To whoever is bashing Governor Whitmer about her performance, a word:

Just like these health care workers who are pleading for supplies, so has Whitmer pleaded for assistance. Her constituents in the state of Michigan deserve all the services they’ve funded their federal government to provide. They are already getting what the state of Michigan can provide because Whitmer is ensuring this happens.

You cannot hide the fact that the federal reserve for supplies should have been ordering and collecting materials in January after China told WHO that a novel coronavirus posed a pandemic risk. Attacking Whitmer won’t change the fact that it is the federal government, directed ultimately by the president, which was responsible for detecting pandemic risk and responding proactively to it, informing states of the risk as early as possible.

That didn’t happen and now governors like Whitmer are forced to do both the job their states have elected them to do and more, taking responsibilities which belong to federal agencies, while Trump denies states the Honest Services they are entitled to because he has not received some sign of obeisance.

To use an aphorism well-known former Michigander Lee Iacocca enjoyed, “Lead, follow, or get out of the way.” Bashing Governor Whitmer is none of those things. Pick one of the three.

To everyone else: pay heed to what these health care workers are saying. Overall mortality will go up, not just from COVID-19, because first responders will be overwhelmed by both the demands this virus places on our systems, and by illness and death as their own ranks are infected and sickened. Stay home. Keep your distance. Heighten your hygiene practices to reduce risk of infection. Wash your hands. Help your loved ones, friends, community as best you can.

To health care workers and all other first responders: do the best you can. That’s all we can ask of you. If the best you can do is allow someone you cannot save to die in peace, so be it. We should have done more for you before this war began.

And someone should have told us all when that war started instead of lying to us until it was nearly too late.

UPDATE-1 — 7:00 P.M. ET —

I am suitably chastened by this video by a doctor at Emory:

YOU are the frontline, the foot soldiers. What you do during this period of necessary social distancing makes the difference counted in lives. We may have to be patient longer because we didn’t start early enough, but our loved ones, friends, their futures depend on it.

And the lives of health care workers also rely on us. We’ve lost a number of nurses and doctors, people like these women in these videos. We can’t afford to lose more.

Trump’s Death Panel Comes for Detroit [UPDATE-1]

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[Update at bottom of post, thanks. /~Rayne]

Ordinarily I wouldn’t step on Marcy’s posts by putting another one up so soon and one so short, but I am both FURIOUS and scared sick about this.

Since last night, Detroit Free Press confirmed yesterday’s rumors about the number of ventilators at one chain of Detroit hospitals — that area hospitals had run out of ventilators and patients were notified on arrival they may not have access to a ventilator if needed.

Without ventilators, those suffering from acute respiratory distress syndrome in critical need may die.

Trump decided to kill Detroiters by withholding essential equipment. He’s chosen not to act in a timely fashion and interfered with the state’s ability to obtain equipment, while trash talking about Michigan’s governor in the process.

Welcome to Trump’s death panel.

Michigan’s Governor Whitmer couldn’t make it any more plain how urgent the situation was, just as Governor Cuomo has.

Trump’s gross negligence isn’t hurting just black Detroiters, either — yeah, I went there, you know damned well Trump doesn’t care about the woman who is our governor or the black people who are the majority in Detroit.

Trump is hurting rural white Michiganders in areas that voted for him in 2016.

If this is how he’s setting out to win swing states, I hate to see what more harm he’ll cause to solidly blue states.

UPDATE — 1:10 P.M. ET —

You need to watch this video produced by an ER nurse in Oakland County, Michigan. The county straddles four congressional districts, two of which recently flipped blue. This is where white flight settled pre-2000, leaving Detroit behind.

They don’t even have acetaminophen to give patients when they put the ventilator tube down their throats — assuming they still have ventilators right now.

Trump’s death panel won’t just kill you. It will make sure you suffer along the way.

 

The Tick-Tock to COVID-19’s Explosion

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[Check the byline, thanks! /~Rayne]

When epidemiologists, virologists, and public health officials first began talking about flattening the curve — using social distancing to reduce the number of COVID-19 cases needing hospitalization at any one time to prevent collapse of hospitals and massive mortality — I kept a running mental tick-tock, resetting this clock as data emerged and events unfolded. We learned from Washington state how the virus spread rapidly because of cryptic transmission, but tracking the virus’s dispersion hasn’t been clear to observers let alone elected officials and business leaders. Missing a concrete picture of how the virus emerges and spreads over time to affect our health care systems, officials have been easily badgered to issue delayed and weak containment orders to suppress COVID-19’S contagion.

The Biogen management conference offered a discrete example of how COVID-19 contagion spread and the time from exposure to illness to new infection:

26-27 February — Biogen, a biotech company, held a management conference in Boston at the Marriott Long Wharf hotel [Day 1-2]

01 March — Biogen employee of Chinese heritage who attended the conference developed a cough. [Day 5]

02 March — A Biogen employee from Indiana developed symptoms; they traveled to Biogen’s facility in Research Triangle Park, NC.

03 March — Biogen conference attendees were notified of a potential COVID-19 exposure [7 days after conference began]

06 March — Attendees received confirmation that they were exposed to COVID-19. Four cases were identified in Boston; two had symptoms. The Biogen employee from Indiana drove home. [10 days after conference began]

09 March — At least 32 cases of COVID-19 of 41 total in Massachusetts on this date were associated with the Biogen conference. [13 days after conference began]

11 March — Chinese Biogen employee flew from Boston to Los Angeles with spouse and child.

12 March — Chinese Biogen employee flew from LA to Beijing with spouse and child.

12 March — 82 cases in Massachusetts have both been confirmed and associated with the Biogen conference. The Marriott hotel at which the conference was held closed for disinfection.

13 March — Chinese Biogen employee tested positive for COVID-19 on arrival.

14 March — 104 of 138 total COVID-19 cases in Massachusetts were associated with the Biogen conference. Two new cases related to Biogen appeared in the cities of  Worcester and Malden.

16 March — Spouse of Biogen employee tested positive for COVID-19 in Beijing. [20 days after conference began]

The case of Biogen’s Chinese employee is incredibly important. The woman visited a hospital in Boston repeatedly for her symptoms, potentially infecting multiple people including health care workers, was given an ineffective antiviral (technically off label for COVID-19), and ended up flying to China, exposing other passengers and airline employees to COVID-19 en route because she couldn’t get tested for the virus until she arrived in Beijing.  She risked prosecution by Chinese authorities for failing to disclose her health status in order to get tested.

The U.S. literally exported two new cases of COVID-19 to China because Trump has dicked around with testing and lied to us about their availability since he first learned about the virus and risk of pandemic.

~ ~ ~

I’ve made up a calendar — not exactly pretty, mind you, since I didn’t quite know how I wanted to present this when I started. But you’ll see the Biogen-based outbreak, the airport terminal debacle thanks to the Trump EU travel ban, and the last holiday during which people gathered en masse in closed quarters (that’s St. Patrick’s Day).

Four states with the largest populations out of the top 11 most populous states issued shelter-in-place/stay home orders after March 17. You’ll see those effective dates noted on the calendar here as well.

Calender - COVID-19 contagion, Feb-April 2020

Note carefully the weekend of March 14-15 when airports across the U.S. were crammed with people, many of whom were likely exposed to COVID-19. As I said in a previous post, this is a hurricane; the mounting deaths over the last couple of days are only the leading edge of a hurricane-like explosion fomented by Trump’s minions’ ineptitude. Every death is on their heads and hands.

The reason for my mental tick-tock and the calendar is the course of the virus and its contagion: exposed persons are contagious about five days after infection; infected persons may begin to show symptoms from 5 to 14 days after exposure; persons who recover are contagious for at least another seven days.

The total 21 days from exposure to the point where an infected person is  clear of virus is optimistic. The WHO China mission report indicated persons may shed COVID-19 for 4-5 weeks in total.

Which brings me to the ultimate point of this post: In no fucking way is it safe to assume the risk of contagion will have been broken by Easter.

No matter what Trump wants or needs to believe, especially since shelter-in-place/stay home orders have not been given across the entire country and not to a uniform standard since states assumed the responsibility to issue these orders and not the federal government.

Perhaps the contagion will be stemmed by the states which gave shelter-in-place/stay home orders, but COVID-19’s spread could resume as rapidly as a trucker can cross a state line or an airplane land at an airport.

A partial lifting of the shelter-in-place/stay home orders might work if everyone had been screened with an antibody test for exposure, and only those persons with active COVID-19 infections were quarantined for the full 4-5 weeks.

But no — we don’t yet have antibody tests. We still don’t have adequate numbers of tests for COVID-19 infections.

Without testing and uniform shelter-in-place/stay home orders across the country, lifting shelter-in-place/stay home orders by Easter only increases the odds there will be another wave of infections on the heels of the first wave. Hospitals and health care workers would not have a break between these successive waves, further stressing the system.

~ ~ ~

Let’s cut through the bullshit here. If Trump wanted to look like a hero to the American public, he’d listen to virologists, epidemiologists, and public health experts.

He’d make sure the health care system had the resources it needs to protect themselves, to treat those who were ill, and to test everyone so the public, their first responders, and their elected state officials knew the status of the virus and where to direct their attentions most effectively.

He’d make sure every American stayed home and had no reason to leave until the contagion was broken.

But this is exactly what he isn’t doing.

He’s even withholding funds from states which are battling to save Americans’ lives from COVID-19 while containing the virus’s spread.

Why?

Why is Trump not doing what he’s supposed to do to insure domestic Tranquility, provide for the common defense, promote the general Welfare as executive of the United States?

Why has he ignored the hundreds of deaths to date, all of which can be blamed on his ongoing failures?

Why has Trump only been able to maintain kayfabe — the appearance of being a president without actually being one, like professional wrestlers who don’t actually wrestle?

If this was the reality TV show The Apprentice, Trump should have been fired already for dereliction of his duties and escorted off studio property by security personnel for deliberately hurting cast and crew.

~ ~ ~

Finally, two more groups of people need to be asked why they aren’t acting in the best interests of the country, let alone their constituents whether voters, donors, or shareholders.

Republican senators have rejected the math — like that selfish yard-waste-pile Rand Paul who continued to use the Senate pool in spite of his exposure to COVID-19.

Why are they actively refusing to do the right things to save Americans’ lives including their own?

Corporate leaders like Lloyd Blankfein whine about getting American workers back on the job instead of worrying whether there will be an economy left if workers continue to get sick in the workplace and die.

Why can’t a fucking investment banker like Blankfein and other business leaders responsible for P&L figure out the numbers?

Fire them all come November.

A Virus Does Not Care

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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.

Donald Trump Just Killed A Man. Now He Wants To Kill A Million Americans.

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It wasn’t in the middle of Fifth Avenue, but yesterday, Donald Trump killed a man. The man’s wife survived, and did not have good things to say about him. Here’s NBC News on the death:

An Arizona man has died after ingesting chloroquine phosphate — believing it would protect him from becoming infected with the coronavirus. The man’s wife also ingested the substance and is under critical care.

The toxic ingredient they consumed was not the medication form of chloroquine, used to treat malaria in humans. Instead, it was an ingredient listed on a parasite treatment for fish.

The man’s wife told NBC News she’d watched televised briefings during which President Trump talked about the potential benefits of chloroquine.

The wife talked further with NBC:

This death and near-death drive home the danger of Trump’s daily “press briefings” which he is now using as a replacement for his political rallies. His touting of chloroquine on Friday has now killed someone in the US. Recall that Nigeria had to put out a warning Friday as well, as NBC in the same article reported that there were at least two known chloroquine poisonings there right after Trump’s presser. (Chloroquine is more widely available in areas where malaria is endemic.)

But the chloroquine story is far from the biggest problem with Trump’s daily gaslighter. It’s hard to believe that we are only at one week since the publishing of the epidemiological model that really seemed to get the attention of even those who felt COVID-19 fears were overblown. Here’s a summary of the US findings of this modeling, as written by University of Minnesota researchers:

To understand how mitigation or suppression would play out, the Imperial College team, led by Neil Ferguson, OBE, ran a model based on three scenarios. In the first, US officials do nothing to mitigate the spread of COVID-19, schools and businesses are kept open, and the virus is allowed to move through the population.

This would result in 81% of the US population, about 264 million people, contracting the disease. Of those, 2.2 million would die, including 4% to 8% of Americans over age 70. More important, by the second week in April, the demand for critical care beds would be 30 times greater than supply.

If mitigation practices are put in place, including a combination of case isolation, home quarantine, and social distancing of those most at risk (over age 70), the peak critical care demand would reduce by 60%, and there would be half the number of deaths. But this scenario still produces an eightfold demand on critical care beds above surge capacity.

In order to suppress the pandemic to an R0 of below 1, a country would need to combine case isolation, social distancing of the entire population, and either household quarantine or school and university closure, the authors found. These measures “are assumed to be in place for a 5-month duration,” they wrote.

So, with no social distancing, this model predicts over 2 million deaths in the US. Even with fairly strong mitigation practices, there are still over a million deaths and we will need more than 8 times the number of ICU beds we have now. Sadly, from what I can tell, we are somewhere around that level of mitigation with perhaps a few states going a bit more stringent. The UK just yesterday went to social distancing of the entire population, a move that Trump has resisted. Note also that even should the US move to full distancing, the model suggests a need to do so for five months. I’ve seen some pushback against this model, but I would argue instead that if anything, it is an underestimate because I fully expect compliance to fall far short of the assumptions in the model. I’ve seen suggestions that lack of compliance with early distancing orders drove much of the rapid outbreak in Italy.

It appears that the World Health Organization agrees that the US is far short of the level of distancing needed to quash the outbreak here. From Reuters:

The World Health Organization said on Tuesday it was seeing a “very large acceleration” in coronavirus infections in the United States which had the potential of becoming the new epicentre. Asked whether the United States could become the new epicentre, WHO spokeswoman Margaret Harris told reporters: “We are now seeing a very large acceleration in cases in the U.S. So it does have that potential.”

I can only imagine Trump’s presser on the day we become “number one” for the virus.

So even though there was a push for distancing as the Imperial College model was released, we’re already hearing that Trump has had enough. To be fair, Trump and his team were only talking about a 15 day process from the start, but any fool can see that we are still moving in the wrong direction in terms of new cases being discovered to even contemplate letting up on social distancing.

David Farenthold suggests one reason Trump wants to ease restrictions in the Washington Post:

President Trump’s private business has shut down six of its top seven revenue-producing clubs and hotels because of restrictions meant to slow the spread of the novel coronavirus, potentially depriving Trump’s company of millions of dollars in revenue.

Those closures come as Trump is considering easing restrictions on movement sooner than federal public health experts recommend, in the name of reducing the virus’s economic damage.

In a tweet late Sunday, Trump said the measures could be lifted as soon as March 30. “WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF,” he wrote on Twitter.

Heaven forbid that Trump should lose a few dollars to save some lives. Sadly, though, Trump isn’t the only one spouting the bullshit. In fact, it’s pretty clear that Trump’s tweet about the cure being worse than the problem came right after he heard that phrase on Fox News. And to soften the territory for easing distancing, Fox yesterday had the Lieutenant Governor of Texas on to suggest that old grandparents like me need to be prepared to sacrifice our lives so that the economy can get going again. Of course, that’s complete bullshit, as once distancing is reduced anywhere, the effects will be spread over a huge area and across age groups. Anyway, here it is:

So that’s where we find ourselves today. We are perched at a spot where WHO is convinced that the US will be the epicenter of the outbreak within a few days. Instead of moving ahead with the full nationwide lockdown that will be needed actually flatten the curve, Fox News is helping Donald Trump to prepare the public for losing grandma and grandpa so that Trump properties can generate income again and Trump can hold his ego-stoking rallies. If distancing is reduced in a week, as Trump is wanting, the death toll in the US will reach catastrophic levels somewhere between the 1 and 2 million mark Imperial College calculated.

What is likely to interrupt Trump’s desire here, though, is the rate at which New York hospitals are filling. It sounds like they will be overwhelmed as soon as this weekend, so I’d like to think that there will be too much pressure to increase rather than decrease distancing once that reality strikes.

With Trump, though, there are no guarantees and reality often gets left in the dust.