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Three Things: Endemic COVID-19 Edition

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

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

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

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

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

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

~ 3 ~

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

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

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

That’s in a little over eight weeks.

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

~ 2 ~

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

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

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

COVID-19

Influenza, 2018-2019 season
96,000,000 infections 35,500,000 infections
4,800,000 hospitalizations 490,600 hospitalizations
1,900,000 ICU admissions 49,000 ICU admissions
480,000 deaths 34,200 deaths

Flu data from CDC.

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

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

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

~ 1 ~

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

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


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

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

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

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

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

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

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

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

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

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

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

~ 0 ~

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

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

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

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

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

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

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

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

~ ~ ~

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

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

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

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

. . .

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2 Mar 2020 by Trevor Bedford – Bedford Lab

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

UPDATE-1 — 2:10 P.M. ET —

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

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

Preparing For The Inevitable Coronavirus Disease 2019 Outbreak

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Jim here.

I am quite late to getting to a post on the new coronavirus, but headlines yesterday finally forced me to move ahead and gather info today. First, watch this incredibly informative video from the World Health Organization. It gives very good information on the biology of the virus and what’s going on in the outbreak:

Although Donald Trump and his media partners have been denying that Coronavirus Disease 2019 (COVID-19) is a real cause for concern, there were multiple statements yesterday from US health officials that ranged from quite alarming to somewhat more reassuring. The announcements were summarized well by the Washington Post. Perhaps the most attention was paid to portions of what Dr. Nancy Messonnier provided in a telephone briefing yesterday morning. Dr. Messonnier is the Director of the National Center for Immunization and Respiratory Diseases. A recording of the briefing and a full transcript can be found here.

Of most note from the briefing is when Messonnier stated:

Ultimately, we expect we will see community spread in this country.  It’s not so much a question of if this will happen anymore but rather more a question of exactly when this will happen and how many people in this country will have severe illness.

So, yes, spread of COVID-19 in the US is inevitable. Messonnier continued, discussing what can be done to try to contain the disease. Because there’s no vaccine or specific treatment for the virus, control has to be through what is termed non-pharmaceutical interventions or NPIs:

There are three categories of NPIs.  Personal NPIs which include personal protective measures you can take every day and personal protective measures reserved for pandemics.  Community NPIs which include social distancing measures designed to keep people who are sick away from others.  And school closures and dismissals.  And environmental NPIs which includes surface cleaning measures.

It’s in the category of potential community NPIs where the biggest concerns start to appear:

Now I’d like to talk through some examples of what community NPIs look like.  These are practical measures that can help limit exposure by reducing exposure in community settings.  Students in smaller groups or in a severe pandemic, closing schools and using internet-based teleschooling to continue education.  For adults, businesses can replace in-person meetings with video or telephone conferences and increase teleworking options.  On a larger scale, communities may need to modify, postpone, or cancel mass gatherings.

Messonnier expanded on the disruptions:

Secondary consequences of some of these measures might include missed work and loss of income.  I understand this whole situation may seem overwhelming and that disruption to everyday life may be severe. But these are things that people need to start thinking about now.

So, yes, there may well be significant disruptions to everyday life in parts of the US. We of course don’t know when this would occur, or where in the US it would be. But this is a good time to start thinking about how a disruption to moving around for a couple of weeks would affect you. Here in Florida, we regularly have to prepare for a week or more of loss of electricity during hurricane season. Preparing for community control measures would be a bit different. Right now, my thoughts for our household are that I will stockpile a few extra large cuts of meat in the freezer. These are things I’d eventually use anyway, so it won’t hurt to have them around. I’ll increase a few of the pantry items that I wouldn’t otherwise increase until the start of hurricane season. I’ll beef up my supplies for baking bread. If a disruption starts looking more likely locally, I’ll even add some frozen veggies to my stockpile, but for now I’m going to rely mostly on my ongoing CSA supply.

But I’m not going to rush out and buy an N95 respirator facemask. The current recommendations from CDC do not recommend facemasks for the general public. They are only recommended for people who are sick or for those who are caring for someone who is sick. This and the other CDC recommendations for treatment and prevention can be found on this helpful page.

The key thing to remember in trying to avoid catching COVID-19, as described in the video above and on the CDC page linked just above, is to avoid being very close to sick people. The guideline mentioned is six feet. If you see someone who looks symptomatic, it shouldn’t be too hard to stay six feet from them. Also, if the virus is known or suspected to be in the area where you are, be especially careful to keep your hands below your shoulders at all times and to wash your hands frequently if visiting public places. As CDC describes here, transmission is thought primarily to be through aerosol droplets such as sneezes and coughs, but it remains possible that the virus could be picked up by touching contaminated surfaces.

Finally, people are also quite concerned about the prediction discussed here by Professor Marc Lipsich, an epidemiologist at Harvard. He has stated that it’s possible that a COVID-19 pandemic could result in 40-70% of people world-wide becoming infected. As Lipsich points out, however, that estimate must be coupled with the realization that we currently have no good estimate for what percentage of people who become infected develop few or no symptoms. In fact, moving out from his discussion, there currently are widely ranging estimates of what percentage of infected people die. Inside Wuhan, where the virus first emerged, estimates now are that 2.8% of those infected die. Outside Wuhan, however, that number drops to 0.18%, a difference of over 15-fold. For a discussion of how early we are in the process of understanding the epidemiology of this virus and why these numbers differ, see this paper.

For perspective, it appears that COVID-19 spreads far more efficiently than SARS and MERS, but conversely, SARS and MERS killed a higher percentage of those infected. We see more COVID-19 deaths because many more people have been infected.

The featured image for this post is in the public domain and comes from CDC. Here is the caption CDC provides: “This illustration, created at the Centers for Disease Control and Prevention (CDC), reveals ultrastructural morphology exhibited by coronaviruses. Note the spikes that adorn the outer surface of the virus, which impart the look of a corona surrounding the virion, when viewed electron microscopically. A novel coronavirus, named Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), was identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China in 2019. The illness caused by this virus has been named coronavirus disease 2019 (COVID-19).” Credit for the image goes to Alissa Eckert, MS, Dan Higgins, MAM.