1. From what I’m seeing so far, this coronavirus has a huge range of outcomes.
It’s looking like roughly half of those who test positive might have no symptoms, based on info from other countries or cruise ship outbreaks. But this isn’t certain. They’re testing for the virus’s genetic material, not the virus itself, so everyone who tests positive might not really be infected.
Other people have mild symptoms, or a moderate flu-like illness or, in the worst cases, a very serious disease that seems to go downhill very, very fast even when it’s treated with the standard protocols for viral pneumonia. So this seems to be an unusually nasty virus for certain susceptible people. This is not to say everyone, and not even everyone who’s elderly.
It still looks like the early information holds – most serious cases are in those over 60-65 and deaths are concentrated in the elderly, though the media is clearly trying to spook the young into following orders by emphasizing every healthy person who dies. If anyone has been paying attention during flu season, there are a few serious cases and deaths in young healthy people then too. The media also have a little trick of telling you breathlessly that “most of the cases we’ve had are in people under 50” while omitting the condition of those people (How sick are they?) and not considering what percentage of the total cases in their age group they represent. This is not to say that the death rate is going to be zero in people under 50 (no one said that in the first place) but, statistically speaking, it still looks like the chances of skating through are very good unless they have some other problem like lung disease or cancer. I wouldn’t be surprised if smoking is a factor too.
2. The latest media fuss seems to be to scare people about those who have no symptoms but are infected. What none of them seems to mention is that people who have infectious diseases without symptoms usually put out much less virus than someone who’s sick. It’s also important to remember that dose matters. I don’t know what dose it takes to infect someone with this coronavirus but, on general principles, the lower the exposure, the less likely you are to get sick. So, yeah, they could be spreading it. How much of a problem this is, is anybody’s guess.
The little research on fabric masks says they’re crappy in terms of letting viruses through. Surgical masks - which aren’t great either, but better than fabric - are sort of a toss-up as far as usefulness against respiratory viruses, unless you need to block coughs and sneezes (then they’re valuable.). The CDC didn’t recommend people wear them all the time in the swine flu pandemic for good reason and they didn’t recommend them earlier in this pandemic either. Supposedly the thinking now is that they might block coronaviruses breathed out by asymptomatic people, though I know of no research to support this.
And I’m even wondering if fabric masks could be counterproductive, by putting a nice warm, moist, dark (UV-protected) space in front of an asymptomatic person, where viruses can be concentrated and survive longer. Then the person scratches their nose or pulls down the face mask to talk to someone (I’ve seen mask-wearers do this a lot) and, boom, there’s a nice big dose of virus for someone. I don’t know, but I sure hope someone considered this and they didn’t just decide “Hey, Asia does it. Let’s do it too!”. But I do know there’s this study on fabric masks, the only “real world,” properly controlled study I know of :
BMJ Open. 2015 Apr 22;5(4):e006577. doi: 10.1136/bmjopen-2014-006577.
A cluster randomised trial of cloth masks compared with medical masks in healthcare workers.
MacIntyre CR1, Seale H1, Dung TC2, Hien NT2, Nga PT2, Chughtai AA1, Rahman B1, Dwyer DE3, Wang Q4.
Author information
Abstract
OBJECTIVE: The aim of this study was to compare the efficacy of cloth masks to medical masks in hospital healthcare workers (HCWs). The null hypothesis is that there is no difference between medical masks and cloth masks.
SETTING: 14 secondary-level/tertiary-level hospitals in Hanoi, Vietnam.
PARTICIPANTS: 1607 hospital HCWs aged ≥18 years working full-time in selected high-risk wards.
INTERVENTION: Hospital wards were randomised to: medical masks, cloth masks or a control group (usual practice, which included mask wearing). Participants used the mask on every shift for 4 consecutive weeks.
MAIN OUTCOME MEASURE: Clinical respiratory illness (CRI), influenza-like illness (ILI) and laboratory-confirmed respiratory virus infection.
RESULTS: The rates of all infection outcomes were highest in the cloth mask arm, with the rate of ILI statistically significantly higher in the cloth mask arm (relative risk (RR)=13.00, 95% CI 1.69 to 100.07) compared with the medical mask arm. Cloth masks also had significantly higher rates of ILI compared with the control arm. An analysis by mask use showed ILI (RR=6.64, 95% CI 1.45 to 28.65) and laboratory-confirmed virus (RR=1.72, 95% CI 1.01 to 2.94) were significantly higher in the cloth masks group compared with the medical masks group. Penetration of cloth masks by particles was almost 97% and medical masks 44%.
CONCLUSIONS: This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. Further research is needed to inform the widespread use of cloth masks globally. However, as a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated.
TRIAL REGISTRATION NUMBER:Australian New Zealand Clinical Trials Registry: ACTRN12610000887077.
I also must admit to a morbid sense of curiosity: what is the average person going to do when, rather than sneezing into their elbow, they sneeze into their mask (what doesn't leak out around the edges or spray through the cloth, of course), let's say if they have allergies? Walk around the store for the rest of the time with snot all over their face and the inside of their mask? Or take off the mask, contaminating their hands and face, wipe their face with a tissue, then put the mask back on? I strongly suspect the latter.
3. The media is really pushing the “hospitals are overwhelmed” scenario. Outside some localized areas like New York, I’m not sure if that’s true. I personally know of at least two hospitals in rural areas, one in the Midwest and one on the East Coast, that are underwhelmed though well-prepared. I also know of a major city hospital in Oregon that has been doing fine in keeping up with the cases. And at one time in late March, I looked for news about hospitals in Washington state, out of curiosity to how they were coping after weeks of spread. All I found was that one hospital near the nursing home was close to capacity and news media were warning other hospitals might be overwhelmed in the future. And California had a couple of hundred deaths, the last time I looked, which sounds far, far from overwhelmed.
It seems that others are starting to wonder too. I saw one news article earlier, because someone posted it, but can’t seem to find it again even if I put in all the keywords. The guy who had surveyed hospitals throughout the country didn’t sound like an idiot – not a partisan Republican or Democrat, Yale degree, wrote for a major newspaper at one point. So I’m also wondering if search engines are actively promoting some views and suppressing others. I'm sure Google is.
EDIT: Sorry, I remembered incorrectly. He's actually looking at whether the actual cases match up with the models and finding that they mostly don't, outside the hotspots like New York.
https://www.foxnews.com/politics/ex-nyt ... -narrative
(Yeah, I know it's Fox, but it's interesting and the article/ analysis seems reasonable. Wouldn't surprise me, either. I saw one write-up on 538 of the many models' different predictions for COVID-19 and the enormous variation was amazing. Not surprising to me, though. But politicians adore modelers, because they can give them numbers and a "scientific" justification for doing something. All an infectious disease expert can tell you is what typically happens, while cautioning you that not every outbreak and virus is typical. That doesn't give the politician enough cover in case things go south. )
EDIT: Also, something to consider as far as New York's experiences:
https://www.thedailybeast.com/new-york- ... mo-ignored
Quote: New York City’s 2018 Flu Was a Near-Death Experience for Its Medical System
“When we asked, ‘How much worse could it have been before you couldn’t handle it?’ it was very clear that there wasn’t much left in the system.”
So New York had ample warning 2 years ago. And now their politicians are howling over something that's partly their own fault. They knew there were issues but they ignored it. And I'm sure I'm not the only person who saw what was on the horizon when the COVID cases started appearing in larger numbers outside China, earlier this year. It was exactly the same pattern of events as swine flu in 2009. Any politician that didn't see it and prepare, especially Cuomo (given this story) was an idiot.
Don’t forget that the entire point of this whole “flatten the curve” exercise is just to stretch things out and delay some cases so everyone who needs advanced care can get it. It’s pretty likely that one-size-fits-all for an entire state or an entire large country is not the most effective way to do this.
The virus itself will still be out there waiting when people emerge. And sooner or later, most of us will have to, or we'll end up with massive economic destruction to real people. A vaccine is unlikely to come before that happens.
4. Some people are praising countries like Singapore or Hong Kong for managing to suppress the virus, and suggesting we can all do the same things they did. But islands can sometimes keep diseases out with constant vigilance when no one else can. (Mostly animal diseases, since it’s easier to control animals than people. It takes money and resources for lots of testing, too.) And, as long as the virus exists in the world, these countries are at constant risk unless they either get natural immunity in enough people to slow down virus spread and/or get a decent vaccine. And this strategy simply won’t work in most of the world where you have land borders and constant travel.
Even in South Korea, I’m wondering what’s happening in the remote rural areas where there’s a lot of illicit cross-border trading with China. I know that some areas are so remote and poor that vaccines to control animal disease outbreaks have to be brought into these areas by motorcycle courier. Are they doing the same thing for COVID-19 as the big cities? I wonder.
4. People on the internet are throwing out figures for “herd immunity,” saying things like “oh, but we need X percent of the population immune to stop the virus.” But it probably isn’t realistic to think of stopping the virus, just getting enough immune people to slow it down. In other words, the “we need this much” figures from bloggers are probably meaningless.
What we could really use is a picture of how many people have already been exposed in outbreak areas (by doing a survey for antibodies to the virus), but no one seems to be in any hurry to do this. Instead, it's all silly stuff like proposing that everyone get an antibody test before they are allowed to go out in public (yeah, like that'll be practical and cost-effective, taking blood samples from the entire population, again and again, until they test positive).
And some people on social media seem to think that the 1918 H1N1 virus or the 2009 H1N1 virus disappeared after the pandemics. They didn’t. All the new flu viruses kept circulating in people for many years. And they still caused the same effects as when we first met them; there were just a lot fewer people getting infected at any one time. Another thing that happens with established viruses is that people usually get them for the first time when they’re young and healthy and nothing much happens. This helps protect them later in life when they meet the same virus again. I won’t be at all surprised if that eventually happens with this particular coronavirus.
5. As far as the economic effects on businesses, here are two stories. It’s quite possible that we’re creating a bigger crisis in the future by demanding that our politicians protect us with the “nuclear option” now.
The first is the prettied up, hopeful version from a major news organization, about what's happening to small, specialized farms and agriculture right now. Here, I'm already seeing some local small businesses throw in the towel in spite of the 2 trillion dollar (so far) bailout / addition to our national debt. Those closures will affect real people. And if there are too many of them, the effects might be catastrophic.
Note they mention in passing that the US has stopped processing worker visas for immigrant labor during the pandemic. This means agriculture will soon be facing a big problem. I’ve also seen where some slaughterhouses had to shut down if a single person gets infected. And I don’t know what state the supply chains are for food in packages, but some businesspeople have been complaining that governors shut everything down without thinking about the interconnectedness of supply chains.
https://www.baltimoresun.com/coronaviru ... story.html
The second is a personal view from a small business owner in Canada who's concerned about the effects of both the virus and the loss of work on her family and employees, and what they're trying to do. It's very much worth reading, especially for those of us who don't have to wrestle with their issues.
https://quillette.com/2020/04/02/i-run- ... -my-world/
I’d also suggest looking up the news from southern Italy, where they’ve had to send the army down because some people are out of work, have run out of money, and are demanding that grocery stores give them food.
And, lastly, an editorial with some interesting questions. Personally, I don’t think enough people are asking them:
https://thehill.com/opinion/civil-right ... g-covid-19
Quote: The first area of expertise is the epidemiology of COVID-19. It entails questions of the virus’s contagiousness and deadliness. There are questions on which there are very significant disagreements (with important policy implications) and, importantly, very poor data.
A second question is whether cost-benefit analyses favor the draconian measure of coercively shutting down all of civil society, one that is fundamentally unanswerable. This question is unanswerable because we cannot know how much the forcible suppression of civil society will cost and we won't know the benefits.
Quote: Politics is plagued by a do-something bias, which drives elected officials and bureaucrats to act hastily, scrambling to enact some policy even when faced with a complete lack of evidence about that policy’s long term effects.
Economist Robert Higgs has presented the theory of a “ratchet effect” to explain the growth in the power and scope of government during times of crisis. Higgs shows that crisis situations afford the state the opportunity to stretch its power into areas of life that were before beyond its reach.
The lesson from his work is clear. These layers of government power do not go away when the crisis subsides, but rather remain, becoming the new normal.
And Google is tracking cell phones and giving (selling?) the information to governments. They claim there is no personal information and paint this as a good thing, so governments can see where people are disobeying orders and congregating. I find it disturbing.
Maybe those people I used to think were tin-foil-hat levels of paranoid for putting their cell phones in Faraday pouches were not so crazy after all....
One thing I can say, it’s been interesting watching what people will do out of fear –cheer on draconian measures, turn in their neighbors to the authorities (even sometimes when they’re just technically breaking rules, like walking on a deserted beach or going for a hike in the wilderness), physically attack a little group of congregating teenagers, etc. Anyone who condemns the Germans in the 1930s and thinks Americans would have resisted Hitler should took a good hard look at how most people act when they get scared.
We’re really not that far mentally from the cave and the tribe, when it comes down to it. Only now we’re all compartmentalized in our states and countries, yelling “go away, you might infect me!” to outsiders and grabbing scarce resources from each other in any way possible. Both governments grabbing medical supplies and individuals grabbing food. And sometimes getting upset and angry at anyone who doesn’t follow the herd.
Truthfully, I've lost a lot of respect for certain liberal posters (on a political messageboard) whose political opinions I generally agreed with before. Out of their own personal fear of the unknown, they're cheering on authoritarianism with amazing zeal, and even complaining that Trump isn't as authoritarian as they'd like.* Surprisingly, it's many of the conservatives who've kept their heads and can look at the whole picture analytically and rationally, instead of succumbing to emotional arguments.
In all fairness, I've seen this epidemic bring out the best in some people, too. But how fear negatively affects people and makes them afraid to differ publicly with "the herd," even when they do have private misgivings and doubts, is what has really struck me.
*Trump is actually surprising me with his restraint during the pandemic, given his emergency powers. He's still an ass and a conman and responds to the things he sees on Fox news without thinking things through or consulting experts. And, behind the scenes, he's still systematically firing anyone who might oppose his aims or expose his corruption. But he doesn't seem especially eager to play dictator right now. The state governors and mayors seem far worse. Like Cuomo confiscating ventilators from rural hospitals to give to New York City, or the governor of Maryland putting a $5000 fine and/or jail time on violations of his "stay at home" order, or the mayor of Los Angeles forcing everyone to wear fabric masks in public. And several governors shutting down every single public greenspace where people could get some fresh air and exercise ... Or, for that matter, Quebec and Nova Scotia preventing people from crossing their borders.
Some points in addition to those I've already made. This was written by a physician, signed by 4 other physicians:
https://medium.com/@jbgeach/eight-reaso ... bb0bc94f00
Quote: Eight Reasons to End the Lockdowns As Soon as Possible
Quote: ... Lockdowns also slow the development of herd immunity, which helps a society move past the virus.
... By the time the lockdowns began, COVID-19 had already been seeded in the US for months, limiting the effectiveness of the lockdowns in the first place as the virus was already widespread.
Quote: We have not saturated the health care system...
Quote: ... What we really need to know is the infection mortality rate (IFR). Fortunately we have some good clues. Looking at the data from the Diamond Princess cruise ship, the infection fatality rate on the cruise ship was 1%. However, the average age of people on the cruise ship was much higher than the age of the average American. When you adjust for the differences in age between the cruise ship and America, you see that the IFR should be about 0.1%. There was a recent study out of Germany in the city of Gangelt where they tested 80% of the population, the IFR there was about 0.37%. .... Antibody testing is needed to know the true number of people who have been infected. There is a good chance this number is well above 10 million, which drives the IFR down even further.
Quote: ....[meanwhile] countless patients are not receiving the care they need in a timely manner. In medicine, timing is of the essence, so even receiving the same exact in the future comes at a price. Many important services are being delayed: blood donations, organ donations, screening colonoscopies, and many other elective procedures. It is very important to note that elective medical care is not useless medical care; rather, it’s simply meaningful and necessary medical care that is scheduled in advance and not performed on an emergency basis....
And even they are afraid to openly say that lockdowns (in other words, copying authoritarian China's method of dealing with a disease, which is something I never thought I'd see in the western world) might not have been the right thing to do. They (or the editors of Medium) felt the need to add a disclaimer, even though one of their statements, quoted above, suggests that the lockdowns might not have done much good.
Quote: Those who want to continue the lockdown indefinitely should show clear evidence regarding the benefits of indefinite lockdown. There needs to be a clear reliable model that shows how many additional lives will be saved considering we have already flattened the curve and there is essentially no further risk of overwhelming the health care system. The previous models were wrong. The consequences of indefinite lockdown are quite staggering, to the tune of one million jobs lost per day.
Frankly, no one is ever going to admit it now, especially not the politicians, though it's quite possible it's the truth. The models assumed either all or nothing. It' could be that a plethora of lesser commonsense measures like banning large indoor crowds and too large outdoor gatherings, mandating that openly sick people stay home, encouraging telecommuting as much as practical, figuring out ways to isolate nursing homes, etc. would have done as much good without putting millions of people out of work. And possibly putting them on the road to becoming homeless once this all ends. Many people in the US don't have savings and some continued to live beyond their means after things recovered from 2008. The U.S. economy seems like a fragile one to me, built on people constantly spending money. It doesn't seem like it would take much to knock it to pieces.