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Sunday, March 15. 2020
Exposure can be tested, whether ill or not. However, very few people will be tested for exposure if they feel fine or have the sniffles, and it would be absurd (except for a limited study of the general population) to randomly test people. I'd be interested in those results but it's academic.
One epidemiologist said yesterday that the majority of people in the NYC metro area (NY, NJ, CT) and in MA have been exposed. A guess, though. Exposed but not ill is good. You get herd immunity. It is happening now, for sure. Probably in CA too. Most viral spread is probably by people without symptoms who assume they are clear.
My point is that, without a number for people exposed and unexposed within a given general population, you have no denominators. If the only data you have is dead people (not many thus far) divided by sick people getting tested, you have minimally-useful information from a public health standpoint. From a doctor's standpoint, it's useful to know risk of sick to dead even though there is no treatment, other than supportive, for viral pneumonia.
So what is a "death rate" based on in the absence of relevant data, ie deaths/exposed? So the danger of this virus, right now, can not be determined or even estimated. That might be knowable in a few months.
I am not an ID doc, so I'll just tell you what I am doing. I am hoarding nothing. I am taking walks or hikes daily in the sunshine. I wash my hands, but I always did. I am going to the gym and working out (improves immune response). I am not going to church (because it's closed at the moment.) Small meals are my normal anyway (improves immune response and generally healthier).
If you've been exposed (probably) and feel entirely well, you are still infectious but if you aren't coughing or sneezing, it's sort-of ok.
We'll all be fine, unless frail, with preexisting serious ailments, or elderly. Those things apply also to the ordinary seasonal flu. However, there is really no way to insulate them because staff help, family help, etc. can be exposed but without any symptoms. There have been a few cases of otherwise healthy people becoming ill enough to need hospital care, but not many.
Please correct my thinking if I am in error.
This makes sense to me: Coronavirus going to hit its peak and start falling sooner than you think.
As we have said before, the goal is to try to flatten the exposure curve (speed of exposure), not to prevent exposure because that really cannot be done unless you isolate on an island somewhere for 6 months.
Addendum: Flattening the curve of an infection slows the rate of exposure. But how is a "case" defined?
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Thanks Dr. Bliss. The link you gave helps
explain why we see such mild cases of the
flu here in Florida if we see them at all. Warm
moist climate. I've always suspected this to
be the case.
Warm weather might help, as it does with flu, but that does not apply to all other viruses.
Recently analysis has shown further splitting and evolution of the virus, with slightly different but competing strains. In the early months people showed symptoms quickly after being exposed. Some of the strains now do not show this behavior.
If you think about it, it makes evolutionary sense. A strain that masks itself has more chance to spread before the host becomes ill.
Are the pneumonia deaths from primary viral or secondary bacterial infection?
Powerline links to an article (link is now dead) that shows all the Covid-19 hotspots to be in a particular ambient temperature range.
The association between temperature in the cities affected with COVID-19 deserves special attention. There is a similarity in the measures of average temperature (5-11 degrees C) and RH (47-79%) in the affected cities and known laboratory conditions that are conducive to coronavirus survival (4 degrees C and 20-80% RH). In the time we have written up these results, new centers of significant community outbreak include parts of Northeastern United States, Spain, Germany, and England, all of which had seen average temperatures between 5-11 degrees C in January and February 2020, and included in either the Jan-Feb 2020 map. . .
In the coming 2 months, temperatures will rise dramatically across many areas in the Northern Hemisphere. However, areas to the north which develop temperature profiles that may now overlap the current areas at risk only transiently as they rapidly warm (with possible exception of areas such as the Northwest United States and British Columbia, which can show prolonged cyclical nadirs). Furthermore, as the virus moves further north it will encounter sequentially less human population densities. The above factors, climate variables not considered or analyzed (cloud cover, maximum temperature, etc.), human factors not considered or analyzed (impact of epidemiologic interventions, concentrated outbreaks like cruise ships, travel, etc.), viral factors not considered or analyzed (mutation rate, pathogenesis, etc.), mean that although the current correlations with latitude and temperature seem strong, a direct causation has not been proven and predictions in the near term are speculative and have to be considered with extreme caution.
Human coronaviruses (HCoV-229E, HCoV-HKU1, HCoV-NL63, and HCoV-OC43), which usually cause common cold symptoms, have been shown to display strong winter seasonality between environmental survival and spreading. . .
All of the above points to a potential direct relation between temperature and SARS-CoV infection. . .
Although it would be even more difficult to make a long-term prediction at this stage, it is tempting to expect COVID-19 to diminish considerably in affected areas (above the 30 degrees N) in the coming months and into the summer.
another interesting development
A good post and I agree 100%.
Here is what you did not say: People are dying unnecessarily. By that I mean they would have lived with typical 1st world hospital care. Many more people will die for the same reason. This was true in China, in Italy, in Spain and it will be true here as well. The hospitals and our health care system was not set up to handle this.
Here is what is wrong with our system:
1. They don't want and cannot handle a lot of very sick patients with covid19 in the hospital. The risk is that it will spread to other patients AND to medical staff.
2. They are asking people top stay home and if really sick call ahead. When they show up at the hospital they will be kept out and 'maybe' shunted off to a holding building/tent where they can get palliative care but not lifesaving care. Because they don't have enough equipment and specialist to take care of everyone.
3. Those who cannot recover on their own will die. For fear of lawsuits and bad press the healthcare system is going to keep this quiet.
Here is what the hospitals should do to save more lives:
1. Find an appropriate facility where they can treat seriously ill (viral pneumonia) covid19 patients.
2. Staff it with qualified nurses and doctors who can administer and monitor the ventilators that can save lives. This would be health care staff who are already covid19 positive and/or young enough to handle the illness and who volunteer.
3. Get more respirators!!!
Italy is in deep trouble.
This stuff is hard to accept.
Predictions don't look good.
Why is there not more reports of homeless/drug users/ indigent cases?
Could it be a lack of heat doesn't allow it to incubate?
My son (in the Navy) and pregnant daughter-in-law are in Italy. They're concerned, but not unduly.
BL: The elderly are at high risk and Italy has a high proportion of elderly.
Overall, I predict, a really, really bad flu/illness season, and little more.
As our Priest mentioned today, we will all die. Even if we don't like the timing (see the movie 1917), we will die.
Prepare as well as you can the inevitable, and enjoy life daily.
Every day is a gift from God.
Eternity in Heaven is a gift from God earned (undeservedly) through the sacrifice of Christ Jesus.
Work to deserve eternity in Heaven.
Without more data it is unclear that flattening the exposure curve is the best policy. Maybe, maybe not. The graph, if valid, shows flattening the exposure curve reduces the number of cases per day at the expense of prolonging the outbreak. The total area under each curve represents the total number of cases & without data, the flatter curve could involve any number of more cases. That’s just math. Docs may know more about tradeoffs, like severity of illness in the 2 cases. Also, disregarding unspecified med wisdom, a prolonged outbreak could cause more economic & other sorts of damage. At best, if it is really bad, flattening the curve gives us more time to bury the dead so we won’t need mass graves.
I'm taking the headlines from an interview with an ex-Obama official with a significant amount of salt.
I understand the morbid way you put that but the idea is to keep from overwhelming the healthcare system with C19 cases that are at least somewhat preventable to save capacity for all the normal stuff that happens. The lengthening is of course the key variable. Is it going to be two months instead of two weeks, or more like six months instead of three weeks? I don't think anybody knows right now.
(a) Not enough beds, let alone ICU beds, or neg pressure rooms.
(b) Not enough intubation respirators.
(c) Not enough Docs or Nurses.
(d) Not enough safety equipment for Medical Staff (Masks, etc).
"Could have, Should have, Would have" -- but it is what it is.
prediction are worth no more than the paper they're printed on until they happen. We've been inundated with predictions of doom as long as I can remember (I'm 71) and none of it has happened.
Exactly: "Good job Brownie!" You must work for the government. What we need is fewer people like you in charge. You have proved my point, the health care system is inadequate, the bureaucrats don't really care and all they are concerned with is avoiding the blame when it all goes to hell. The correct way to attack this problem is balls to the wall. Your approach is lack of balls. Think outside the box. Lead, follow or get out of the way. We need solutions not excuses. Small minds need not apply. If we don't step up and take this virus on it will step all over us.
What we do know:
1.That graph has no scales. It is merely a graphic to make you think it is showing something true.
2. SOME nursing facilities can be/have less than high standards of care. Not saying Kirkland is, but have heard stories of places I wouldn't kennel a pet because that's how bad it can be. Couple that with the staff being reduced because they are not allowed to work because they have something not covid19. Or that they are under staffed anyway because it is not a great place to work.
3. If it is like the assisted living unit my dad is in, the whole building is 75 degrees. Perfect breeding ground for lung issues.
4. Many people have health challenges. If that was not the case, you would not have the death rate from regular flu.
Is Wuhan one of those cities they rarely see the sun from the smog, and as someone else said, they're 2 pack a day smokers anyway. Even if you're not a 2 pack person, if the smog is that bad, you don't have healthy lungs.
So lets ask the question How many normally healthy people are stricken with a morbid case of covid19? It's not sounding to be a general population event. Lots of hype "We Have to Control this so it doesn't fill all the beds when it does get serious.
By that reasoning, we should also be bulldozing Mt Rainer shorter so it has less mass to explode when the big eruption comes.
As I have posted elsewhere, we have three facts.
1. Nursing home deaths, closed space
2. From the aids time; the connect between viral load and death
3. The function of an effective ICU tent; oxygen hard in and exhalant hard out.
To explain these I propose the stewing in your own juices theory of flu death. Sure you want to avoid virus from others, but worse is reloading virus already in you. The solution maybe, hand washing, vigorous outdoor exercise and sunshine.
The modern energy efficient home may not have sufficient air volume to allow the exhaled virus to degrade. Quarantines will not help the sick or exposed.
From a policy standpoint; to get a rate, you need a denominator; we have numerators for hospitalizations, serious cases etc; but total incidences, no N.
How long can even the United States suppress its economy? If there is no expansion of herd immunity in the meanwhile, what is to stop it from coming back? The Brits, up til now, were hoping to game the virus but it is risky. They have been accused of being reckless.
Well then, for the first time in my life I'm glad Alberta Canada had -31 C (-24F) yesterday.
I'm following the same life-system the doc advocates, no hoarding, walking, work-outs etc., the only differences being I go to a tanning studio twice a week for a jolt of UV (Never mind the skin cancer, 31 below, lots of sun, but I'm not a polar bear) and take more care at the gym with the disinfectant spray.
The quarantined cruise ships showed an infection rate of 20% after two whole weeks of mingling and interacting.
In order to spread out the cases, which will not reduce either the total number of sick people or the number of deaths, we are going to artificially collapse the economy and create a Second Great Depression. We are bankrupting everyone's pension, whether public or private. And we are stopping the wages of low income service workers.
The logical outcome is that in November we get a full-blown Communist government.
Something I don't understand. South Korea is being held up as doing everything right on the virus and having unprecedented success. Yet with a population less than 1/6th ours their death toll exceeds ours. What are they doing right???
This article is pure presumption and speculation. And that's after discussing the data gaps!
What we need but won't have for quite a while is a measure of excess deaths this year compared to prior years. That is the only data that will tell us how severe this year has been.
With the lack of testing there is no other way to measure that makes sense.
I live in King County Washington, ground zero for COVID-19 cases. What our statistics show is increasing numbers of "confirmed cases" which tells me that a lot more people are being tested, which is good.
Also scientists here have developed a vaccine, which has started the human-testing program. Also good.
This is progress, though few have noticed.