Come for the politics, stay for the snark.

This is a big f—–g deal.

Technically true, but collectively nonsense.

We still have time to mess this up!

Gastritis Broke My Calculator

Han shot first.

Yes we did.

Wetsuit optional.

An army of rabid, anonymous commenters

Impressively dumb. Congratulations.

Hot Air and Ill Informed Banter

Peak wingnut was a lie.

Just a few bad apples.

Our job is not to persuade Republicans but to defeat them.

I personally stopped the public option…

Shocking, but not surprising.

We can agree to disagree, but I’m right.

Word salad with all caps

Is it irresponsible to speculate? It is irresponsible not to.

Reality always wins in the end.

An almost top 10,000 blog!

Good luck with your asparagus.

Nevertheless, she persisted

Where tasty lettuce and good mustard aren’t elitist.

How has Obama failed you today?

You are here: Home / Archives for Healthcare / COVID-19 Coronavirus
“COVID-19 is a novel disease for which treatment protocols are evolving and remain imperfect. With the internet’s eternal tropism towards bullshit, there will be plenty of false or misleading claims about ways of preventing, enduring or “curing” COVID-19 infections. Please don’t amplify them here. If you do have knowledge or experience you feel is of interest to the jackaltariat, please make sure you make it clear where that information comes from: sources, expertise, and so on.  It’s easy to get stuff wrong in a crisis and mistakes can create real harm. So be careful out there…and in here.”

I Say Again

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Now is a terrible time to have hypochondriacal tendencies and a chest cold. Had one of those “wake up feel fine, three hours later feel like shit and nap, rinse and repeat” colds for several days, now it is in my chest and throat and I am on meds. No fever, loss of appetite, or anything corona related, but still irritating as all hell.

Looks like April is going to be a real bad one this year. Do we all know anyone working in one of the hot zones who would could group together and help out?

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It Could Be Worse (Gallows Humor, Kinda-Not-Really Respite)

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There are actually worse ways to respond to the epidemic than those attempted by serial sexual criminal and bankrupt Donald Trump. He’s bad; terrible. But Belarusan President Alexander Lukashenko is undeniably worse.

As death tolls have skyrocketed globally and many countries have closed their borders and shut down nonessential businesses, Lukashenko has advanced his own solutions to the crisis, urging citizens to drink vodka and visit saunas.

It Could Be Worse (Gallows Humor, Kinda-Not-Really Respite

Not for such a manly man (or his deeply unfortunate country) are vapid, bourgeois trifles like epidemiology and public health.  The measures undertaken by just about everyone else, including, however imperfectly, the US are to Lukashenko, “frenzy and psychosis.”

What to do, then, to lead la vida Lukashenko?

“It is better to die on your feet than live on your knees!” he told a reporter just before the game. “Sport, especially on ice, is better than any antiviral medication. It is the real thing.”

It isn’t funny, not really. Such insanity is a death sentence for too many Belarussians–a country that has seen way more than its share of misrule and misery.

But viciously, bitterly humorous? Maybe a little.

Open thread, especially for jokes of the oppressed.

Image: Annibale Caracci, Boy Drinking, 1582-1583.

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Tuesday Morning Open Thread: Take Your Friends Where You Find Them

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(Explanation at the bottom of this post)

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Good for the workers, if less so for those of us in self-isolation:

Good explainer, from the Washington Post, here.

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COVID-19 Coronavirus Update (International) – Monday/Tuesday, March 30/31

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COVID-19 Coronavirus Update (Domestic) – Monday/Tuesday, March 30/31

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Retweeted by James Palmer, Deputy editor at Foreign Policy, ex-Beijing :

Elsewhere in the same city:

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GOP Venality Open Thread: Hey, It’s National Doctors Day!

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And he doubled down today! Per ABC News:

As health care workers on the front lines of the coronavirus crisis warn about shortages of masks and other protective equipment, President Donald Trump insinuated over the weekend people might be taking masks from hospitals “out the back door,” suggesting they might be being sold on the black market.

He was reacting to an account by a mask company executive who said the demand had skyrocketed at one New York City hospital, which they did not name, from 10,000 to 20,000 a week to 200,000 to 300,000 masks a week.

The New York Greater Hospital Association and New York Democratic Gov. Andrew Cuomo have since pushed back on Trump’s claims…

Trump implied, without evidence, that there was a nefarious reason for the shortage in masks, which states have criticized the federal government for not providing. Meanwhile, nurses and doctors across the country have resorted to re-using protective equipment, accepting donations, buying their own PPE (personal protective equipment) and other workarounds to keep themselves safe.

“How do you go from 10 to 20 to 300,000? 10 to 20,000 masks to 300,000? Even though this is different, something’s going on. And you ought to look into it as reporters,” Trump said. “Where are the masks going? Are they going out the back door? How do you go from 10,000 to 300,000 — and we have that in a lot of different places,” he said, though he didn’t mention any other examples of hospitals that have reported stolen masks.

“I hope I didn’t get any of your clients in trouble, but it could be that they are in trouble,” Trump said, referring to hospitals as “clients” and speaking to the CEO of the mask-production company, who accompanied Trump at the briefing.

While there have been a handful of small-scale reports of people stealing masks, gloves and hand sanitizer from hospital waiting areas or other health centers across the country as anxieties over supply shortages rose, many quickly criticized Trump for seeming to put the blame on hospital workers…

At his daily coronavirus briefing in New York on Monday, Cuomo deflect questions about Trump’s comments, saying, “I don’t know what he’s trying to say.”

“In terms of a suggestion that the PPE equipment is not going to a correct place, I don’t know what that means. I don’t know what he’s trying to say. If he wants to make an accusation then let him make an accusation. But I don’t know what he’s trying to say by inference,” Cuomo said…

Dr. Anthony Fauci, the nation’s top expert on infectious diseases and a key member of the White House coronavirus task force, said Monday morning that he wasn’t familiar with the issue but suggested that there could be more demand because “many more” patients need them.

“You know, I have not looked at that carefully, so I can’t really can’t comment. I mean, it could be that there are many more patients there that need them and they’re actually not walking out the door, they’re actually being utilized. I don’t know. I mean, that discussion came yesterday. I really didn’t know what was going on. I’d have to check that out later and find out what they were talking about,” Fauci said on CNN…

[Side note: Dr. Fauci’s not long for this administration, and is all too aware of that fact.]

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Praise the lord and pass the snakes…

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There’s a large evangelical complex off I-75 in Tampa that I’ve passed by in transit occasionally for several years. I knew nothing about it but have always assumed it was grift enterprise because megachurch and because of its propensity to plaster its married couple co-pastors’ faces all over area billboards. Turns out those charitable assumptions were far too kind.  Via The Tampa Bay Times:

Tampa church holds packed service, draws warning from Sheriff’s Office

The River at Tampa Bay Church’s pastor claims that the church has a right to practice free speech and to freely assemble.

TAMPA — Scores of worshipers gathered at a Tampa megachurch for service on Sunday, drawing a warning from the Hillsborough County Sheriff’s Office about violating the safer-at-home order in place to limit the spread of coronavirus…

“I know that they’re trying to beat me up, you know, having the church operational, but we are not a non-essential service,” Rodney Howard-Browne said at the start of the Sunday morning sermon. He claimed the church is “covered by the law.”

“Not only the right of free speech but the right to peaceful assembly and to practice what we believe,” he said. “Suddenly we are demonized because we believe God heals, that the Lord sets people free, and they make us out to be some sort of kooks.”

Yeah, that’s because you are a bunch of kooks, Typhoid Reverend.

You’ll be unsurprised to learn that this same kooky preacher was one of the pack of prosperity gospel grifters invited to the White House to “lay hands” on Donald Trump, shares the Shitgibbon’s affinity for InfoWars, gun nuttery, climate change denial and perpetrating fraud on poor people.

This country was founded by religious zealots, and as a result, our laws and our customs are far too accommodating to dangerously stupid/evil hucksters like Howard-Browne. They should be taxed like any other business and prosecuted when they rip people off. And newspapers shouldn’t fail to include the relevant context (i.e., mention the thievery and crackpottery) when these organizations make news.

Open thread.

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Success is the 2nd derivative

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The New York Times has some comparative good COVID-19 news from Washington State:

While each infected person was spreading the virus to an average of 2.7 other people earlier in March, that number appears to have dropped, with one projection suggesting that it was now down to 1.4…

Washington State’s coronavirus figures have continued to grow steadily, but not as fast as other states’. The death toll has been doubling about every eight days in Washington, compared with every two or three days in New York, Michigan, New Jersey and Louisiana.

Washington State shut down hard and shut down fast compared to the rest of the country. This is what success looks like right now. The death rate is still increasing, the infection rate is still increasing, but the rates of increases are slower than the rest of the country. This is success on the second derivative.
As I mentioned in my first post this morning, most of the people who are are hospitalized this morning were infected at least two weeks ago. Washington State has been able to shrink the number of people who were exposed and infected two weeks ago with aggressive and early public health measures that were several doubling cycles ahead of many regions shutting down.

Washington State is what success could look like for the next month or two, and it is still going to be rough.

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Monday Morning Open Thread: Walk in Beauty

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Some upcoming events of possible interest:

And this guy, in the future, will confine his off-hour hobbies to “… building shelves, making furniture and doing some tiling”:

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Exponential growth and death date delays

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I’ve been at Duke and in academic research for a little more than three years. There are two important categories of helpful questions that I always need to think about:

  • “What exactly are you counting and are you counting what you think you are counting?”
  • “What, exactly, is your denominator?

We need to ask these questions when we think about COVID-19 right now as we know two things about it. First, we are still in an exponential growth phase of infection spread where success at this point is merely slowly the exponent of the growth function in the United States at this time.

Right now, it seems like the US is seeing a doubling of cases every two to three days. Some of this is a function of testing starting to come online picking up lower acuity cases, but a lot is probably new cases.

The other thing that we know is about COVID 19 is that there is a significant lag between infection and symptoms and then symptoms to hospitalization for the people who are hit the hardest by the disease.

Annals of Internal Medicine## estimated the time from infection to detectable symptoms was a median of 5 days.

After symptoms were detected in China, hospital admissions were usually happening a median of seven days for all hospitalized patients and eight days for patients who went to an ICU.

If we can safely add up median time from infection to symptoms and then symptoms to hospitalization, that sums to a back of the envelope span of 12 to 13 days.  In the United States, that translates to between 4 and 6 doubling cycles.  Most of the people who are presenting ICUs were infected by the time significant social distancing started in the United States.  The ACC basketball tournament was still being played in front of 8,000 fans on March 12.  New York City public schools were still open on March 15.  Spring Break and Mardi Gras were in full swing.

From a March 12, 2020 Lancet article**, a very good point is made about death rates as a function of time infected:

However, these mortality rate estimates are based on the number of deaths relative to the number of confirmed cases of infection, which is not representative of the actual death rate; patients who die on any given day were infected much earlier, and thus the denominator of the mortality rate should be the total number of patients infected at the same time as those who died…

All of this is a long way to say that I am extremely perplexed by this following tweet:

If this is Total Hospitalizations/Total Cases or Total Ventilation/Total Cases, then we have a huge timing problem as most cases (50%) are cases that happened in the past doubling  and 87.5% of the cases are from individuals who were infected in the past three doublings.  People who have been infected in the past two or three doubling cycles are (at this time) extremely unlikely to be already dead, already ventilated or already hospitalized.

The CDC has a good summary of the complete case outcome from Diamond Princess where there was a effectively a single infection event and significant follow-up:

Among 3,711 Diamond Princess passengers and crew, 712 (19.2%) had positive test results for SARS-CoV-2 (Figure 1). Of these, 331 (46.5%) were asymptomatic at the time of testing. Among 381 symptomatic patients, 37 (9.7%) required intensive care, and nine (1.3%) died (8). Infections also occurred among three Japanese responders, including one nurse, one quarantine officer, and one administrative officer (9). As of March 13, among 428 U.S. passengers and crew, 107 (25.0%) had positive test results for COVID-19; 11 U.S. passengers remain hospitalized in Japan (median age = 75 years), including seven in serious condition (median age = 76 years).

In that case the denominator does not have time variation and the Case Fatality Rate (CFR) is not complete as there are still people in the ICU who could quite plausibly die, but there has been enough time to establish a somewhat reliable number.

When we see reporting that is a function of division, we always need to ask what are we counting, and are we counting what we think we are counting and finally are we using the right denominator?

 

## DOI: 10.7326/M20-0504

** Lancet Infect Dis 2020 Published Online
March 12, 2020 https://doi.org/10.1016/S1473-3099(20)30195-X

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COVID-19 Coronavirus Update (International) – Sunday/Monday, March 29/30

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Looks like Russia’s response will combine all the worst features of China *and* Italy:

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COVID-19 Update (Domestic) – Sunday/Monday, March 29/30

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New York:

Maine –

Thread, from the Land of Lincoln:

Bleeding Kansas:

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The Most Selfish Motherfuckers on the Planet

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Evangelicals:

As Liberty University’s spring break was drawing to a close this month, Jerry Falwell Jr., its president, spoke with the physician who runs Liberty’s student health service about the rampaging coronavirus.

“We’ve lost the ability to corral this thing,” Dr. Thomas W. Eppes Jr. said he told Mr. Falwell. But he did not urge him to close the school. “I just am not going to be so presumptuous as to say, ‘This is what you should do and this is what you shouldn’t do,’” Dr. Eppes said in an interview.

So Mr. Falwell — a staunch ally of President Trump and an influential voice in the evangelical world — reopened the university last week, igniting a firestorm. As of Friday, Dr. Eppes said, nearly a dozen Liberty students were sick with symptoms that suggested Covid-19, the disease caused by the virus. Three were referred to local hospital centers for testing. Another eight were told to self-isolate.

If one person dies from this and it can be traced back to a Liberty “university” student, Falwell should be charged with negligent homicide or whatever charge applies. It’s not enough they follow a religious philosophy that kills, now they’ve embraced a political one.

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What Do The Models Say About What Happens Next?

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We are now isolating ourselves, at least the non-MAGA portion of the population. The numbers of cases of Covid-19 – and deaths – are mounting. What can we expect? What happens next?

Lots of us are wondering what comes next in the SARS-CoV-2 pandemic. We already have an indication in New York City. At the same time, many states and countries are instituting lockdown measures that should decrease the numbers of sick and dead. I’ll use the Imperial College paper to discuss what is likely to come next.

A few words first about the Imperial College model, and models in general.

Neil Ferguson, one of the modeling team,  testified to Parliament that he was becoming “reasonably confident” that the UK would be able to handle the peak of the epidemic in two or three weeks, with a death toll unlikely to exceed 20,000. This is being spun among those who want to send the US back to work as an indication that the model is wrong. IT IS NOT. What Ferguson is saying is that the UK is now taking measures to change the worst-case modeling scenario. THAT’S THE PURPOSE OF MODELING – to work out possibilities and recommend a path forward.

The Imperial College paper modeled the spread of the virus uncontrolled, and then investigated the effect of social distancing measures. The conclusion was that all the measures studied were required to suppress the growth of COVID-19 cases and avoid overloading the hospital system. I summarized that part of it in my earlier post.

Because the SARS-CoV-2  virus is new to the human race, nobody had immunity to it when it was first introduced. It can spread with no barriers to every human on the planet. As people are infected and recover, they become immune to the virus and cannot become ill from it again. It’s not clear how long that immunity lasts, but if it is even for a few months, it will slow down the spread of the virus.

Social distancing measures also slow down the spread of the virus, but they don’t confer immunity, leaving enough of the population susceptible to the virus that, when the distancing measures are lifted, the virus can spread again. The more successful the distancing measures are, the fewer people will become immune, and thus, the larger the secondary peak. The secondary peak can be controlled by reimposing distancing measures. A target might be set, and a series of secondary peaks at levels that will not break the hospital system would result  (Figure 4 of the Imperial College paper).

As a modeling projection goes further into the future, its results become less reliable. This is partly because of uncertainties in the parameters, but it is also because we are taking measures to control the spread of the disease. Distancing helps. If we can make testing general for both the virus itself and for immunity to it, that will change things significantly.

There are several things we don’t know that make a difference in how things will play out. We have some idea about them, but as we learn more, the model predictions may change.

How long do people spread the virus?

How many people are infected by the virus and never show any symptoms but become immune? This is important because the more people become immune this way, the lower the peaks in the model and the faster they die out. When enough people are immune, the virus cannot propagate. That’s herd immunity. We don’t know what percent of the population must be immune to establish herd immunity.

What kind of immunity do people develop after having the virus? How long does it last. Is it a strong immunity, or do some people remain susceptible to reinfection?

Does the virus becomes less infective during the summer? If it does, infections could decrease but peak again in the fall and winter. Or the virus could weaken to cause a less dangerous disease. That’s not unknown in pandemics.

The single biggest factor in filling in what we don’t know now is testing. Test people with symptoms. Test people without symptoms. Test adults. Test children. Test people near the people with symptoms. Test medical workers, them especially. Tracking cases to determine who should be quarantined.

A new test promises results within five minutes. That is a test for the virus itself. We also need serology tests, to determine if people are immune to the virus.

Testing will give individuals and their medical support more information about their next actions. It will also provide information about the course of the disease and information that can be used in modeling.

We are buying time with the measures we are taking now. We can’t shut down the economy for long, and Trump and his admirers are already pressing to open things up again. Some of them are ignoring distancing now.

The answer, eventually, will be a vaccine. Several groups are working on vaccines, and one clinical trial is in progress. Eighteen  months is commonly cited as the time period, but it could take longer. We don’t know.

Cross-posted to Nuclear Diner

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COVID-19 Coronavirus Update (International) – Saturday/Sunday, March 28/29

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