Judge Emmet Sullivan Makes A Serious Holiday Move on DOJ and Flynn

/216 Comments/in , , , , /by

I have expressed some qualms over Judge Sullivan naming John Gleeson as the court’s amicus on the crazy Flynn situation. But today there is a new player on the pitch, Beth Wilkinson.

Judge Sullivan has engaged a hired gun.

Folks need to understand the Yoda like move Emmet Sullivan made in hiring Beth Wilkinson.

First off, she is an absolutely fantastic advocate and tough as hell.

Second, she has serious DOJ cred.

Third, she still has major friends at Paul Weiss, and that counts below the surface.

Fourth, Brett Kavanaugh may well owe his Supreme Court seat to her.

Fifth, her husband is David Gregory, the former NBC guy and now senior political guy at CNN. That is some media contact potential whether direct or indirect.

Also, again, she is really kick ass. Beth Wilkinson is a serious player, and a killer advocate. Judge Emmet Sullivan is not going quietly into the night. I actually thought that, given the short response time the DC Circuit ordered, Sullivan and his clerks might do the response themselves. Obviously they will still have major input, but this battle is joined, and in a very big way.

How to (Not) Hydroxychloroquine COVID-19

/47 Comments/in , , , , /by

The medical journal The Lancet published a study Friday which showed anti-malarial drug hydroxychloroquine (HCQ) — the same drug repeatedly pushed by Trump — does not work as intended against the virus which causes COVID-19.

Hydroxychloroquine’s precursor drug, chloroquine, has shown mild antiviral action in vitro against the Borna disease virus (an orthobornavirus), the minute virus of mice MVMp (a parvovirus), and the avian leukosis virus (a retrovirus) as well as the coronavirus which causes SARS. It has also shown promise against Hepatitis A (a hepatovirus).

But both hydroxychloroquine and chloroquine posed inherent risks to patients as they increased the risk of heart arrhythmia.

Ideally, HCQ’s antiviral effect would prevent the coronavirus SARS-CoV-2 from replicating, allowing the body to attack and remove the virus before it could attack human cells and spread through the body, resulting in earlier recovery from the infection.

Patients who received both HCQ, or its precursor chloroquine, with or without an additional antibiotic, did not recover faster than the cohort which didn’t receive chloroquine.

Further, the patients receiving the drug therapies were more likely to die than those who didn’t.

This study is the latest showing HCQ or chloroquine both didn’t work and increased patient mortality. Previous negative studies included:

Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection – A Randomized Clinical Trial
Mayla Gabriela Silva Borba, MD; Fernando Fonseca Almeida Val, PhD; Vanderson Souza Sampaio, PhD; et al
JAMA Network Open. 2020;3(4):e208857. doi:10.1001/jamanetworkopen.2020.8857
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2765499

Of particular note:

Findings In this phase IIb randomized clinical trial of 81 patients with COVID-19, an unplanned interim analysis recommended by an independent data safety and monitoring board found that a higher dosage of chloroquine diphosphate for 10 days was associated with more toxic effects and lethality, particularly affecting QTc interval prolongation. The limited sample size did not allow the study to show any benefit overall regarding treatment efficacy.

Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19
Joseph Magagnoli, Siddharth Narendran, et al
Pre-print; posted April 23, 2020. medRxiv 2020.04.16.20065920; doi: https://doi.org/10.1101/2020.04.16.20065920
https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v2

Of particular note:

CONCLUSIONS: In this study, we found no evidence that use of hydroxychloroquine, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19. An association of increased overall mortality was identified in patients treated with hydroxychloroquine alone. These findings highlight the importance of awaiting the results of ongoing prospective, randomized, controlled studies before widespread adoption of these drugs.

We still don’t know why Trump is pushing this drug. It’s no longer under a patent and now a generic medication; it’s cheap to produce. If there’s money to be made by promotion of this medication it’s not clear how Trump profits.

We still can’t be certain he’s taking it himself though he claims he is; the letter from his doctor does not clearly state that Trump has been prescribed HCQ and at what dosage for what period of time nor has there been any information provided with regard to the nature of monitoring Trump receives while taking HCQ.

We don’t know why Trump would claim to take HCQ on the advice of some unknown person alleging to be a doctor. We’ve no further information about the letter, the letter’s author, whether a letter even existed since Trump has a proven propensity for making up shit.

All we can be sure of at this point is that more patients with COVID-19 may have died, potentially because of HCQ’s promotion by Trump, than may have died had he refrained from practicing medicine without a license by pushing HCQ.

In the case of the study of HCQ at Veterans Health Administration medical centers, former service persons who’ve already paid a price for our freedoms have been used in human experimentation in what might have been an attempt to validate Trump’s claims about HCQ — and some of them died for it.

It seems odd VA doctors used it out of the clear blue when the Food and Drug Administration hadn’t formally approved this drug for COVID-19 patients. (It’s probably just a coincidence the Center for Disease Control lifted its guidance on off-label use of HCQ two weeks before the VA study was published, right?)

It’d be nice to know if Trump’s three golf buddies at Mar-a-Lago — one of then a doctor — had anything to do with the use of HCQ and chloroquine at VA hospitals on COVID-19 patients.

There’s simply no good reason for Trump’s plugging this particular drug therapy except to harm and kill Americans.

Trump Pride and DOJ Prejudice: The Flynn Volume

/106 Comments/in , , , , , /by

As Marcy has already reported, the DOJ has formally moved to dismiss the Flynn case. Here is the pleading they filed. (Marcy also addressed here) Trump is, of course, calling the DOJ who just did his command influence bidding “scum” and accusing them of “treason”.

Let’s start with a little Q and A:

Q: Can DOJ do that?

A: Sure, but it is bizarre beyond belief.

Q: Does this mean the case is over?

A: No. As I have repeatedly said, the plea has been accepted, after full allocution, not just once (Judge Contreras), but twice (Judge Sullivan) and, arguably thrice (also Judge Sullivan). There is a technical difference between a plea being entered and a plea being accepted. The Flynn plea was very much accepted. Multiple times.

Q: So, what does that mean?

A: It means that there was a formal finding of guilt entered by the court.

Q: So is that finding of guilt gone now?

A: No. The DOJ can file whatever it wants, the final decision still remains with Judge Emmet Sullivan.

Q: Does that mean “Flynn is an innocent man” as Trump is bellowing?

A: No. Flynn has sworn to his guilt under oath and penalty of perjury multiple times, and the court accepted his sworn guilt.

Q: So, what happens now?

A: Yeah, I don’t know the answer to that. We shall have to await Judge Sullivan entering in with his thoughts. I have no idea where Judge Sullivan will go. For the sake of the rule of law, and, frankly, legal sanity, I hope Judge Sullivan takes this as the full on broadside to law and intelligence that it really is. As I importune relentlessly, courts and law are a function of men and women. They are us. They speak and act for us. Judge Emmet Sullivan is not a man that will take this affront to justice lightly. Nor should he. It is absurd, the court should treat it that way, and, if anything, sanctions ought be imposed on Powell and Flynn.

Okay, where does that leave things? Now that is not a very easy question to answer. Here are a few thoughts though. The first one is “prejudice”. It is absolutely critical whether a dismissal request by the DOJ (or any prosecutor for that matter) is “with prejudice” or “without prejudice”. Here, Tim Shea, and it is crystal clear that means Bill Barr, demands that any dismissal be “with prejudice”. That means that no case based on these facts could ever be brought again. It is a pardon by a corrupt DOJ, without Trump ever having to even issue a pardon. Anybody, including the national press, that describes it differently is straight up lying.

The statute of limitations on a 18 USC §1001 charge for false statements is (as pretty much any charge possible against Flynn save for an ongoing conspiracy allegation) is five years, which is the general statute in federal criminal law. But, you see, that exceeds the time of Trump and Barr if Trump is not reelected. And therein lies the problem and why Mr. Barr and his lackeys Shea and Jensen, are apoplectic to make any dismissal “with prejudice”. Does this ever occur in real criminal justice life? No. Hell no. Of course not, in fact it is always “without prejudice”. Always, unless the government is caught by incontrovertible facts beyond dispute, and even then they usually demur to “without prejudice” dismissal.

But, wait, there’s more, I have other questions! Let’s talk about “materiality” for a moment. It is replete in the position taken by Bill Barr, through his cutout, Tim Shea. To be kind to Mr. Shea, he is an eggplant installed by Trump and Barr. And, here, the eggplant has signed this pleading on his own. Normally any such pleading would be signed by underlings, including career prosecutors. But not here. Why? That is not clear, but apparently no career track lawyer in DOJ would undersign this garbage. So there is that.

Back to “materiality”: Peruse pages 12-20 of the DOJ motion. Good grief, law review articles will spend hundreds of pages in the future laughing at the arguments Tim Shea has signed off on. Because, presumably nobody but a Trump/Barr appointed toady would even touch that. Yes, it is truly that absurd.

Okay, a parting shot: Normally, when a client puts an attorney’s work in dispute through claims of malpractice, all attorney/client privilege is waived. That is generally how it works. And if Flynn and his Fox News addled lawyer Sid Powell have not accused Rob Kelner and Covington & Burling of malpractice, then there has never been such an accusation. Privilege is waived.

While I thought Judge Sullivan should have disregarded the nonsense, denied all the the Powell crazy (arguably unethical conduct) and just sentenced Flynn. Marcy was right, and I underestimated just how sick the DOJ could be under Barr.

Well, here we are. Flynn and Powell have waived privilege. The DOJ under Barr and, here, Shea, is corrupt beyond comprehension.

But the irreducible minimum is that Judge Emmet Sullivan is the one with jurisdiction and control of this case. Not Trump. Not Barr. An honest and good judge, and one that has proven that over decades. Sidney Powell was right about one, and only one, thing: The Stevens case is a template for the court to find the truth.

Emmet Sullivan is a judge that can appoint an honest and independent special prosecutor to make sure real justice is done. Trump and Barr cannot fire the truth if Judge Sullivan seeks the truth and justice. And he should, for all of us. Judge Sullivan is a lion of justice that has done this before, and he should again.

Michigan’s Militia-Like Morons Can’t Math [UPDATE]

/151 Comments/in , , , , /by

[Check the byline, thanks. /~Rayne]

They didn’t look very smart, the armed motley mess which staged a protest last Thursday on Michigan’s capitol steps culminating in a tantrum in the rotunda.

The protest reminded me of GOP representatives storming of a closed-door House hearing on the Ukraine quid pro quo — a staged protest meant to interfere and interrupt official governmental proceedings while providing a photo op for media and distracting the public from the underlying problem.

But last week’s armed protesters looked bad even if they were merely a distracting photo op. How does this serve their interests? They’ve undermined any credibility their right-wing ‘Blue Lives Matter’ brethren pushed since Ferguson protests in 2014.

Photo: Jeff Kowalsky, AFP-Getty Images. Shared here under Fair Use.
They’re an embarrassment to this state just as their whiny predecessors were during their Gridlock protest on April 15, violating the executive Stay Home order to rally on the capitol building’s steps, waving their Confederate flags and talking smack about the governor while puling about their lawns not getting cut and their roots not getting colored. Both protests two weeks apart violated the state’s laws related to the governor’s executive powers under a state of emergency.

But the embarrassment doesn’t end at the sight of the right-wing monkey horde barking like mad dogs at public servants who are only doing what they’re paid to do. It’s the horde’s inability to do basic math which makes them look deeply stupid.

The math:

Key:

Pink: 21 days from exposure at Easter to likely recovery.

Blue: 21 days from exposure at Gridlock protest to likely recovery.

Yellow: 21 days from exposure at Armed protest to likely recovery.

Lavender: 21 days from latest likely secondary exposure via Armed protest to likely recovery.

The period from exposure to COVID-19 carriers to average date clear of virus is about 21 days. The two protest rallies are marked off, Easter included since at least one church planned to hold service in spite of Governor Whitmer’s Stay Home order.

(Note a boo-boo on my part, should have marked April 30 as the first of 21 days ending on June 10.)

If Michiganders hadn’t had their little Gridlock tantrum on April 15, we’d have been done with Stay Home and more Michiganders would be alive today.

If all Michiganders stayed home uniformly as ordered and scrupulously obeyed the Stay Home order instead of a few hundred protesters having an armed conniption fit last Thursday, had they rigorously used masks whenever venturing into public spaces for essential business only, we’d have been done with the Stay Home order on the very day these rabid cretins protested in Lansing.

But no.

It’s bad enough that Easter observations in violation of the Stay Home order may have caused a spike in deaths 9-10 days later. But a protest which was supposed to be confined to cars?

Deaths were trending downward until the idiots’ Gridlock protest. It would be nice to know how many of the spike in deaths were people who attended the protest, or who broke the Stay Home order because they were inspired by Gridlock to do so. We may never know how many deaths were because of asymptomatic carriers exposed on that date unless researchers conduct a forensic genetic examination some time in the future.

To ignore this calculus and show up in the capitol without masks, ranting and exhaling in a confined space where law enforcement and lawmakers work is just plain moronic, risking personal health and life in a manner which also threatened others.

Or it’s something far worse — a deliberate attempt not only to interfere with the deliberative process in which all Michiganders have a stake and are represented by their democratically elected officials, but a terror attack intended to hurt and possibly kill the targets of protesters’ ire.

How many of the Michigan State Police, capitol police, lawmakers and staff will come down with COVID-19 as a direct result of this protest?

How many will represent minority majority regions of the state, disproportionately affected by COVID-19?

And how long will the rest of Michigan put up with the death cultists who threaten others, waving guns around inside our representatives’ workplace while blowing contagious viral material at others?

At this rate we’ll be under some form of quarantine all damned summer because these spoiled, stupid wretches can’t make the connection between their bad behavior and Michiganders’ deaths.

This is an open thread.

UPDATE — 05-MAY-2020 2:45 PM EST —

It doesn’t seem obvious to some people why Stay Home/shelter-in-place/lockdown is necessary in the absence of either proven pharmaceutical interventions to treat COVID-19 or a proven safe and effective vaccine targeting the underlying virus SARS-CoV-2. This tweet sums up the primary reason why Stay Home orders are necessary:

Henry Ford and Beaumont hospitals in the Detroit area experienced a month ago what happens to our health care system when people aren’t restricted from their former normal behavior. ICU beds are swamped, overflow capacity is likewise exceeded, ventilators and other respiratory aids are in short supply, painkiller and other drug inventory is decimated. Health care workers are overwhelmed and more likely to become sick themselves from a combination of stress, too many hours exposed to massive viral loads especially after personal protective gear has been depleted.

Lockdown to slow down the rate of contagion buys time for the health care system to handle the additional demand COVID-19 places on it — not to mention easing the pressure on other peripheral systems like refrigerated trucking and mortuary services.

It’s as if these armed cretins have already forgotten bodies piled up in hallways in at least on Michigan hospital.

But one additional benefit from a firm, well-enforced, and rigorously-observed lockdown: a change in citizens’ perspective. A societal reset, a reboot of our expectations.

There will be no return to what we once called normal. It’s done, gone, like poodle skirts and Brylcreem, rotary-dial phones and Betamax video, along with home parties hawking baby shit gold Tupperware.

These assholes spraying saliva as they scream at police — some of them out-of-state provocateurs — aren’t saving anything with their assault weapon intimidation. They are hanging onto a past by their fingernails while the virus has its mindless and predictable way with our population.

As contributor Peterr wrote, a virus doesn’t care. Those of us staying at home do. We don’t want to excessively burden our health care workers and system, we don’t want to hurt our friends and families by infecting them or causing them sorrow.

We want our state to get through this protracted period of discomfort and come out on the other side healthy and alive.

We’ll observe the lockdown orders long enough to break the growth of contagion. We’ll learn how to make and wear masks, and our lawmakers will learn how to ensure our law enforcement have the framework they need to maintain the break in contagion. If confirmed cases and deaths increase again, we’ll go back into another lockdown until we break it again.

This will be our new normal, our new social compact, until drug therapy and/or vaccines are ready in a year or two if we are lucky.

Lastly, we’ll observe the lockdowns because this isn’t the end of it. COVID-19 is only our here and now. Something else is out there waiting for us in the future once our new normal has been built.

These saliva-speckled jackasses screaming about their freedom while interfering with our democracy demonstrate our society isn’t ready if another pathogen like SARS-CoV-2 emerged as the climate crisis worsens.

Stay home. Wear a mask when you can’t. Keep your distance. Wash your hands.

Research Misinfo/Disinfo: Ain’t No Sunshine Kill COVID-19 Gone

/83 Comments/in , , , /by

[Check the byline, thanks! /Rayne]

I thought this series would end after three posts but clearly the misinfo/disinfo related to research studies on COVID-19 continues.

This time Department of Homeland Security is one of the problem children.

By now you know about Trump’s wrong-headed comments about light and disinfectants used in and on humans’ bodies to eliminate SARS-CoV-19. You’ve also heard he gaslighted the public by claiming he was being sarcastic during Thursday’s briefing about light and disinfectants, followed by even more dog-ate-my-homework excuses.

You may have heard speculation that bleach as a COVID-19 therapy specifically may have been the result of communications with Trump by some crackpot who sells this re-labeled chlorine dioxide product as a miracle cure-all.

What you probably haven’t seen is the DHS’s “study” which may also have spurred Trump’s idiotic remarks about light or sunlight. Yahoo News reported about the “study” a week ago, sharing a link to the DHS document it received outlining DHS’s findings.

It’s not a paper. It’s a goddamned slide presentation of which stability of SARS-CoV-19 on surfaces was only a portion.

No peer-reviewed study has been published by DHS in any of the articles since Trump’s ridiculously inappropriate comments last evening.

News outlets have been all over Trump’s remarks, which as Marcy said elicited justifiable uproar. But outlets are doing a pissy job covering the sources of Trump’s practice of medicine without a license at the podium.

Newsweek offers a great example:

Fortunately, CNN got it right:

If DHS’s science and technology advisor Bill Bryan isn’t qualified to make declarative statements relying on research, who is?

Who did the research and where’s their data and output?

Why did the American public have to hear what DHS learned filtered through Trump who has proven himself to be incapable of understanding science let alone demonstrate respect for it?

We need to see the work because there are other studies which do not appear to agree with DHS’s presentation.

This widely cited piece tested the viability of SARS-CoV-2 on different surfaces after exposure to aerosolized virus. The temperature of the study was comparable to a nice spring day — 21-23 degrees Celsius or 69-73 degrees Fahrenheit — with 40% relative humidity.

Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1
van Doremalen N, Bushmaker T, Morris DH, et al.
March 17, 2020
DOI: 10.1056/NEJMc2004973
https://www.nejm.org/doi/full/10.1056/NEJMc2004973

SARS-CoV-2 is quite stable in conditions one might find in an air-conditioned indoor setting according to this study. This much agrees with what DHS presented.

This study looked at viability of the virus over time at different increasing temperatures and exposure to ultraviolet light — like solar radiation.

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

Here’s a table from the study addressing viability of SARS-CoV-2 at different temperatures:

You can see the virus is viable at 37 degrees C — that’s coincidentally 98.6F, the old average temperature for humans. The virus is stable at that temp for as long as a day. It’s not stable for long at 56C (132.8F) and not at all at 70C (158F) but then neither are humans.

Unsurprisingly, disinfectants disinfect according to the study’s results shown in the table above. Only one little burp with hand soap solution — one of three attempts showed some viability.

This study looked at the differences in number of outbreaks over time in a particular region of China, as the season changed and both temperature and amount of sunlight increased.

No Association of COVID-19 transmission with temperature or UV radiation in Chinese cities
Ye Yao, Jinhua Pan, Zhixi Liu, Xia Meng, Weidong Wang, Haidong Kan, Weibing Wang
Published online April 8, 2020.
European Respiratory Journal 2020, 2000517; DOI: 10.1183/13993003.00517-2020
https://erj.ersjournals.com/content/early/2020/04/01/13993003.00517-2020

These researchers hypothesized that COVID-19 transmission may decrease or even disappear when the temperature and UV radiation increase in the summer.

They collected the confirmed case numbers of 224 cities from China’s National Health Commission, the daily mean temperature and relative humidity collected from the China Meteorological Data Sharing Service System, and daily erythemally-weighted daily dose of UV radiation data extracted from the Dutch-Finnish Ozone Monitoring Instrument aboard NASA’s Aurora satellite. After adjustment for relative humidity and UV, they found temperature held no significant associations with cumulative incidence rate, and that UV was not significantly associated with cumulative incidence rate after adjustment for temperature and relative humidity.

These studies — though some are pre-print and in peer review — do not agree with what DHS’s Bill Bryan or the DHS presentation published a week ago said.

And none of them match what Trump said, whatsoever.

Media outlets really need to have a science reporter covering Trump’s briefings rather than the usual White House correspondents — people who are already highly versed in COVID-19 research and are able to put Trump on the spot.

Or the media needs to give up covering Trump’s briefings live if they can’t do real time pushback and demand better of the guy occupying the White House. Carrying his unfiltered bullshit will get somebody killed and damage businesses which are doing their best to operate under the strain of pandemic conditions.

~ ~ ~

We know now from the Washington Post that Trump’s unacceptable remarks on light and disinfectant therapy for treatment of COVID-19 may have been inspired by a briefing about a DHS study:

Trump’s commentary seemed to be inspired by a presentation from a Department of Homeland Security official about a promising but still inconclusive government study exploring the possibility of heat, humidity and light to kill the virus, as well as the effectiveness of disinfectants in killing it on surfaces such as tables, countertops and office workspaces.

Emphasis mine. An in-fucking-conclusive study, the same one on which Bill Bryan gave a presentation. Why was it offered at all? To provide happy talk for the daily propaganda program?

William Bryan, the department’s acting undersecretary for science and technology, first shared the study with members of the White House coronavirus task force on Wednesday and returned Thursday. He said his department had studied the virus in an air chamber and never said chemicals or UV light had been studied on humans nor suggested they be used in humans, according to several administration officials.

Why did he come back? Did some asshat on the White House coronavirus task force think Bryan could finesse this inconclusive report?

Others on the task force, including Birx, White House chief of staff Mark Meadows, as well as McEnany and others in the communications and press shops, were concerned that the Department of Homeland Security study had not been thoroughly vetted. “It was not ready at all to go to the president,” the senior official said. “There was no guideline. There was no data. There was nothing.”

Oh. Now we have sources named. At least one of these people and/or Dr. Fauci are most likely to have said this “study” was not ready to go to Trump. If these three and Dr. Fauci didn’t think it was ready, how did it end up getting in front of Trump?

Still, Vice President Pence and his team wanted Bryan to present the information to the president and to the public, eager to have something positive to share. They hoped the study would help encourage people to spend more time outdoors and to disinfect their homes, aides said.

Oh great — Mr. HIV-outbreak-of Indiana Pence with a history of ignoring public health officials’ advice to the public’s detriment, probably ignored the opinions of task force members who felt the DHS “study” was not ready for Trump’s propaganda show.

This time Pence’s bad decision-making resulted in an onslaught of calls to poison control center numbers and at least 20 people in New York alone who ingested bleach or disinfectant.

No word yet as to whether someone has fried themselves crispy outdoors in an effort to get rid of SARS-CoV-2 using ultraviolet light having relied on the misinfo/disinfo served up by the idiocracy in the White House.

Research Misinfo/Disinfo: Off-Label COVID-19 Therapy Has No Proof

/62 Comments/in , , , , /by

[Check the byline, thanks! /~Rayne]

Funny enough, this COVID-19 post originally came about because of one of my family members.

They sent me a link to an op-ed from the Detroit News — the more conservative of the two major Detroit-based papers in this state — in which the author took Michigan’s Gov. Gretchen Whitmer to task because the state’s Department of Licensing and Regulatory Affairs clamped down on off-label prescriptions of an antimalarial drug.

“Any thoughts on the mandate against hydroxychloroquine?” they asked along with the link.

“Oh no,” I replied, “the author is going to regret writing that op-ed.”

They really had no idea what they were writing about. But then Trump doesn’t either.

~ ~ ~

We’re desperate. Trump and his minions don’t want to admit it, carrying on with Trump’s daily self-fluffing at the podium in front of his narcissistic supply, I mean, select White House press pool as if everything is under control.

We the public know it’s not. On Wednesday March 25, actor and activist George Takei pointed out a person died of COVID-19 in New York City every six minutes the previous day. The numbers have only grown worse.

We are that measurably desperate.

We’re grabbing at any kind of research, peer-reviewed and not, to find a way to shut down this fire hose of death because the other realistic alternative is at least 18 months of alternating levels of social distancing until a vaccine for COVID-19 has made it through multiple trials.

In a previous post I did homework and laid out some of the off-label approaches which have been taken in other equally desperate countries — like the antiviral remdesivir and the rheumatoid arthritis medication tocilizumab. These are in studies and haven’t been approved for use against COVID-19. We can only hope that other countries’ desperate, compassionate use of drugs off-label will add to the body of knowledge we have about effective treatments between now and the vaccine to come.

Our desperation makes us sloppy. We forget that what looks too good to be true often is just that.

Like the combined drug cocktail hydroxychloroquine and azithromycin.

~ ~ ~

Back on March 13 while writing about drug therapies in research, I wrote:

A number of existing drugs have been revisited for repurposing against COVID-19 instead of their original intended purpose. Antiviral remdesivir and antimalarial chloroquine are among them.

Chinese researchers posted a paper about in vitro results, not peer reviewed (at least I didn’t see that it was).

There’s a paper about chloroquine alone; in vitro studies suggest it may work against COVID-19. Chinese researchers have a number of in vivo studies in progress, but no data has been released.

Chloroquine by itself as an effective therapy would be a miracle in that it’s an old drug now off patent and available as a generic, super cheap to produce. Can’t imagine Big Pharma would like this. But we won’t even face this conflict if we don’t get data from in vivo studies.

Data. We needed data from peer-reviewed in vivo studies before any pronouncement could be made about the antimalarial medication as a therapy for COVID-19.

Published March 2 in Science Direct, a commentary by researchers at Aix Marseille University said essentially the same thing after examining an announcement by Chinese researchers that chloroquine phosphate was better than a control in treating SARS-CoV-2 (COVID-19) pneumonia — an announcement which had no supporting data:

In conclusion, the option of using chloroquine in the treatment of SARS-CoV-2 should be examined with attention in light of the recent promising announcements, but also of the potential detrimental effect of the drug observed in previous attempts to treat acute viral diseases. We urge Chinese scientists to report the interim trial results currently running in China as soon as they are available. This should be preferentially done in a peer-reviewed publication with detailed information to allow the international scientific community to analyse the results, to confirm in prospective trials the efficacy of the proposed treatment and to guide future clinical practice.

(Emphasis mine.)

These researchers are literally begging the Chinese researchers to provide data as soon as possible, after noting that while hydroxychloroquine’s precursor chloroquine appeared effective as an antiviral in vitro against different viruses, it has shown no benefit in animal models. (They also noted in a study of its efficacy against chikungunya virus, chloroquine actual “enhanced” viral replication in animal models. Not good.)

A study was published around the March 24 but reports said it was unfavorable for the antimalarial. (I haven’t been able to get my hands on the study; the link from each news source citing it has failed.) The size of the group studied was very small — only 30 patients with a control group of 15.

And yet sandwiched in time between the first Chinese study and this most recent one was another one submitted for publication on March 17:

Gautret et al. (2020) Hydroxychloroquine and azithromycin as a treatment of
COVID‐19: results of an open‐label non‐randomized clinical trial. International Journal of
Antimicrobial Agents – In Press 17 March 2020 – DOI : 10.1016/j.ijantimicag.2020.105949
https://www.mediterranee-infection.com/wp content/uploads/2020/03/Hydroxychloroquine_final_DOI_IJAA.pdf

The researchers from Aix Marseille University made no mention of this study though it must have been underway in their own backyard, so to speak.

No one noticed this — the dog that didn’t bark.

Meanwhile, on March 19, Trump talked about hydroxychloroquine from the podium during a briefing before a White House press pool. He not only mentioned it in glowing terms but he tweeted about it. Mike Pence also promoted the antimalarial two days later.

On March 24 an Arizona man died and his wife was hospitalized after taking hydroxychloroquine’s precursor, chloroquine — used to maintain their fish tank — having heard Trump talk about it so positively. The couple poisoned themselves; Trump scored two casualties with his misinformation.

~ ~ ~

A critical threat to U.S. health security is its monoculture — specifically, its complete investment in English excluding other languages. Back when we worried about Zika virus posing a threat to Americans traveling to South America and when Zika arrived in Florida, we were combing through research from other countries. The Chinese fortunately published much of their work in both Mandarin and English, but Brazil had a considerable amount in Portuguese. Their work was ignored in favor of less credible work which appeared in English.

This same dynamic is at work with regard to potential drug therapies — hydroxychloroquine in particular.

The study Gautret et al. (2020) was published in French and English, you’ll note. Many people picked up on it because it was so accessible.

What wasn’t picked up readily was the problems with an affiliated researcher. Many reported problems have been documented online where the world can read them, in of all places, Wikipedia.

But that’s Wikipedia France — a different address than we use in the U.S., published in French.

See: https://fr.wikipedia.org/wiki/Didier_Raoult

Use Google Translate and read the section on COVID-19. The translation isn’t entirely smooth but it does well enough for the average English speaker to figure out Raoult is a character.

He also has a history of sexual harassment and possible abuse according to a number of accusers, also documented in this Wikipedia entry.

(I’ve scraped that entry and translated it out of concerns it might change over time. You can read the portion of the French Wikipedia entry on Raoult and COVID-19 at this link. You can compare it against the Wikipedia page’s editing history though you’ll need to reverse translate it.)

It could be said in the MeToo age that many accused abusers are competent at their professions and are simply jerks when it comes to managing their attitude toward co-workers. But in Raoult’s case the accusations are smoke and where there’s smoke there’s an ethical fire.

It seems Raoult’s research has had a problem with data which looks artificial in at least two other studies, noted during peer review.

He’d previously been banned from publishing in microbiology journals.

Complaints about a hostile work environment in his lab do not offer reassurance about the credibility of his work. Were subordinates pressured for results?

It also seems odd this one study from France has been relied on so heavily by others, when the underlying drug is manufactured by a French manufacturer (though not the only company which does).

None of this passes the smell test.

Gautret et al. also didn’t pass the sniff test with the journal in which it was published though it did not retract the study:

The April 3, 2020, notice, from the International Journal of Antimicrobial Agents, states that the March 20 article, “Hydroxychloroquine and azithromycin as a treatment of Covid-19: results of an open-label non-randomized clinical trial”

does not meet the [International Society of Antimicrobial Chemotherapy’s] expected standard, especially relating to the lack of better explanations of the inclusion criteria and the triage of patients to ensure patient safety.

The notice, which is from the ISAC and not the journal itself, is a bit ambiguous. The society says it “shares the concerns” about the paper, but it doesn’t appear to be taking additional action.

It’s unclear what took the journal nearly a month to make this statement of doubt. Because it hasn’t been retracted references are still made to Gautret et al. (2020).

~ ~ ~

Studies to date on hydroxychloroquine or its precursor chloroquine have been small or flawed; the merits of these antimalarials were thin to begin with.

Zumla, A., Chan, J., Azhar, E. et al. Coronaviruses — drug discovery and therapeutic options. Nat Rev Drug Discov 15, 327–347 (2016).
Published: 12 February 2016
https://doi.org/10.1038/nrd.2015.37
https://rdcu.be/b3uhd

An excerpt from this review of drug therapies notes chloroquine had limited promise against SARS-CoV-1:

…Chloroquine is an anti-malarial drug that sequesters protons into lysosomes to increase the intracellular pH. It has broad-spectrum antiviral activities against numerous CoVs (SARS-CoV, MERS-CoV, HCoV-229E and HCoV-OC43) and other RNA viruses in vitro 123, 210, 211, 212, 213, 214. However, it did not substantially reduce viral replication in SARS-CoV-infected mice, possibly because the cell surface pathway was not simultaneously blocked. …

This study of antiviral remdesivir with antimalarial chloroquine was in vitro, not in vivo:

Wang, M., Cao, R., Zhang, L. et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 30, 269–271 (2020).
Published: 04 February 2020
https://doi.org/10.1038/s41422-020-0282-0

Remdesivir may act alone as antiviral. Conclusion is that these two drugs “should be assessed in human patients suffering from the novel coronavirus disease.” The drugs were assessed but not employed as a protocol.

This next study is again in vitro, not in vivo:

Liu, J., Cao, R., Xu, M. et al. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov 6, 16 (2020).
Published: 18 March 2020
https://doi.org/10.1038/s41421-020-0156-0
https://www.nature.com/articles/s41421-020-0156-0

Its conclusion calls for more testing, while implying hydroxychloroquine’s use would be better as an anti-inflammatory during cytokine storm though this study didn’t examine its anti-inflammatory effects:

…HCQ is a safe and successful anti-inflammatory agent that has been used extensively in autoimmune diseases and can significantly decrease the production of cytokines and, in particular, pro-inflammatory factors. … In combination with its anti-inflammatory function, we predict that the drug has a good potential to combat the disease. This possibility awaits confirmation by clinical trials. We need to point out, although HCQ is less toxic than CQ, prolonged and overdose usage can still cause poisoning. And the relatively low SI of HCQ requires careful designing and conducting of clinical trials to achieve efficient and safe control of the SARS-CoV-2 infection.

Hydroxychloroquine is toxic and it needs carefully designed clinical trials — this prediction of its “good potential” is happy talk until there’s data to prove its effectiveness for its intended purpose.

A pre-proof study about the two-drug hydroxychloroquine and azithromycin cocktail published on March 30 is small but makes a more declarative statement right in its title:

Molina JM, Delaugerre C, Goff JL, Mela-Lima B, Ponscarme D,
Goldwirt L, de Castro N, No Evidence of Rapid Antiviral Clearance or Clinical Benefit with the
Combination of Hydroxychloroquine and Azithromycin in Patients with Severe COVID-19
Infection, Medecine et Maladies Infectieuses (2020),
doi: https://doi.org/10.1016/j.medmal.2020.03.006
https://www.sciencedirect.com/science/article/pii/S0399077X20300858

The summary:

In summary, despite a reported antiviral activity of chloroquine against COVID-19 in vitro, we found no evidence of a strong antiviral activity or clinical benefit of the combination of hydroxychloroquine and azithromycin for the treatment of our hospitalized patients with severe COVID-19. Ongoing randomized clinical trials with hydroxychloroquine should provide a definitive answer regarding the alleged efficacy of this combination and will assess its safety.

This study was in vivo, using the same dosing regimen reported by Gautret et
al. study on a cohort of patients similar to the same study. The results were unsatisfactory:

At the time of treatment initiation, 10/11 had fever and received nasal oxygen therapy. Within 5 days, one patient died, two were transferred to the ICU. In one patient, hydroxychloroquine and azithromycin were discontinued after 4 days because of a prolongation of the QT interval from 405 ms before treatment to 460 and 470 ms under the combination. Mean through blood concentration of hydroxychloroquine was 678 ng/mL (range: 381-891) at days 3-7 after treatment initiation.

Nor had the virus been cleared 5-6 days after treatment began in 8 of 10 surviving patients. The study’s authors made a point to compare their findings against the Gautret et al. study:

These virologic results stand in contrast with those reported by Gautret et al. and cast doubts about the strong antiviral efficacy of this combination. Furthermore, in their report Gautret et al also reported one death and three transfers to the ICU among the 26 patients who received hydroxychloroquine, also underlining the poor clinical outcome with this combination.

Hydroxychloroquine doesn’t work against SARS-CoV-19 even when paired with the antibiotic azithromycin, but a larger, randomized clinical trial with appropriate controls is still necessary to beat it through the heads of people pushing this therapy.

~ ~ ~

But out of desperation, hospitals have been using hydroxychloroquine anyhow, only to discover it doesn’t work against COVID-19 — it may even make patients sick.

That last French study above squelched further use of hydroxychloroquine at the St. Louis Hospital in Paris.

Hospitals in Sweden stopped using it after negative effects (open link in Chrome and use Google Translate to read in English) including impaired vision.

On Sunday, Dr. Sanjum S. Sethi, Vascular Medicine and Interventional Cardiology Columbia University Irving Medical Center, shared that ALL patients treated in the ICU for COVID-19 have received hydroxychloroquine:

Dr. Sethi doesn’t say how many patients have been treated with the drug so far — there could be as many as 1,000 patients in ICU at one time based on a newsletter by Surgeon-in-Chief Craig R. Smith, MD for NYP/CUIMC — but it didn’t work for severe-to-critical patients in ICU.

Which means the Chinese researchers’ suggestion that hydroxychloroquine’s anti-inflammatory qualities may help with cytokine storms didn’t pan out.

~ ~ ~

Meanwhile, Trump continues to tout hydroxychloroquine, as does his best buddy in Brazil, Jair Bolsonaro.

Brazil, like other tropical countries has ongoing incidence of malaria. It’s endemic along the Amazon River and treated with chloroquine or hydroxychloroquine. The drug has also been used prophylatically.

And yet Brazil is experiencing a growth in COVID-19 cases even along the Amazon River, suggesting hydroxychloroquine or its precursor are not effective in the early stages of the disease, failing to fend off infection and contagious pre-symptomatic progression to mild, severe, and critical cases.

Further assessment is difficult because like Trump, Bolsonaro has undermined reporting and efforts to limit contagion.

Brazil’s Minister of Health Luiz Henrique Mandetta nearly lost his job late last week when he refused to authorize a protocol prescribing hydroxychloroquine for COVID-19 patients. A few doctors continued to press him on this after he survived a heated cabinet meeting in which this pharmaceutical was discussed.

Two days later a small study was published; chloroquine as therapy for COVID-19 patients had been halted early after more than 25% of the subjects died:

Borba M, Almeida Val F, Sousa Sampaio Vanderson, CloroCovid-19 Team, et al. Chloroquine diphosphate in two different dosages as adjunctive therapy of hospitalized patients with severe respiratory syndrome in the context of coronavirus (SARS-CoV-2) infection: Preliminary safety results of a randomized, double-blinded, phase IIb clinical trial (CloroCovid-19 Study)
Published: April 11, 2020
medRxiv 2020.04.07.20056424; doi: https://doi.org/10.1101/2020.04.07.20056424
https://www.medrxiv.org/content/10.1101/2020.04.07.20056424v1

~ ~ ~

The bottom line is that we are still without an effective pharmaceutical antiviral therapy, no matter what Trump says.

What he’s said from the podium has only encouraged risk-taking pushing past the limits of ethics guiding the practice of medicine and human experimentation. The Texas City nursing home administration who has dispensed hydroxychloroquine without advanced informed consent is a perfect example of ethics collapsing under Trump’s equally unethical practice of medicine and pharmaceutical lobbying from the presidential podium.

Though we know more now than we did at the beginning of March about hydrochloroquine as a tool for treating COVID-19 — and we know that no study to date has suggested the drug will be effective for a majority of COVID-19 patients — we still do not know why Trump is so invested in this generic medication.

Who told Trump this drug was an effective treatment for COVID-19?

Has someone continued to reinforce this fallacy though Dr. Fauci has yet to reverse his own professional opinion about hydroxychloroquine?

Who likewise sold Bolsonaro on this drug? It likely wasn’t Fox News though the network may have irresponsibly reinforced Trump’s lobbying for hydroxychloroquine.

Why are talking heads on Fox News still promoting this drug with impunity — like Laura Ingraham who is not a medical professional?

Why are other right-leaning pundits continuing to press for this drug though they do not have medical background, and while other experts continue to express doubts about hydroxychloroquine?

None of this makes sense; we lack information. As I said before, we need data from peer-reviewed in vivo studies before any pronouncement can be made about the antimalarial medication as a therapy for COVID-19.

And we need to know more about Trump’s reasons for promoting this drug while ignoring the risks hydroxychloroquine poses.

Research Misinfo/Disinfo: It’s a Scam

/229 Comments/in , , /by

[Check the byline, thanks! /~Rayne]

When certain folks all push the same angle — Trump, Giuliani, Solomon, et al — one may think immediately it’s a scam.

Like the Ukraine quid pro quo scam on which the very same players worked together, singing from the same hymnal.

The scam is more obvious because two of the people involved are promoting a pharmaceutical and they’re not medical doctors — they may be practicing medicine without a license by encouraging the use of a medication which isn’t approved for the use they advocate.

The drug is hydroxychloroquine, an antimalarial drug which has also been approved for a small number of autoimmune disorders like lupus.

Something is clearly not right when so many of the same players are pushing a drug using the power of the presidency to do so.

~ ~ ~

Interregnum: I’ve had to put this post up now, out of order. I had originally intended to write two posts about misinfo/disinfo about research related to COVID-19 and the underlying virus, but push has come to shove with Trump pushing hydroxychloroquine again today, admitting the U.S. has not purchased ventilators or personal protection equipment on a timely basis but instead bought and stockpiled 29 million doses of hydroxychloroquine.


Something is really wrong and it must be addressed immediately, before more people get hurt.

My post about the problematic background of research behind hydroxychloroquine will have to come next. Right now we need to talk about the scam in progress.

~ ~ ~

It took me a while to figure out what the angle might be on a drug which is old and cheap but I think this is the way this works.

Of course you all know Trump wants and NEEDS to stay in office or he’s up the creek without a paddle. This scam isn’t about making money but instead about serving his need not to be investigated and prosecuted for all manner of tax, bank, wire fraud and more beginning ten months from now.

So…Team Trump picks a drug which when administered in safe dose, doesn’t do much constructively for anybody except people they don’t give a shit about like patients with lupus and autoimmune disorders.

Weak sauce studies on hydroxychloroquine to date suggest it’s a 50/50 crap shoot that the critically-ill patients qualifying for compassionate use and receiving this drug will recover. Somebody external to the White House, possibly external to the U.S., maybe even the drug company/ies which makes this, may have made have chosen this drug because they did this math. They have just enough iffy research by iffy researchers to encourage its use.

They end up with just enough people who’ll recover and claim it’s a miracle drug that saved their lives, and the other half are dead or disabled so they won’t appear on camera to say otherwise. Handpicked survivors become testimonials to Trump’s ‘Wile E. Coyote super genius‘ and his prospective worth as our two-term conman-in-chief.

Even Dr. Fauci has said there’s no proof this drug cocktail works; he’s been clearly frustrated with Trump’s handling of COVID-19.

Trump cut off attempts to ask Dr. Fauci more questions about this drug today.

But Team Trump counters Fauci’s doubts by launching a character assassination attack in social media, calling Fauci part of the “deep state” out to get Trump.

At the same time there’s a continuous social media swarm pushing the drug.

Team Trump haven’t fired Fauci because they still need him to save Trump from making bigger mistakes and Fauci has much higher credibility ratings than any of the rest of Team Trump appearing before cameras.

But Trump’s current pandemic response failures are already projected to cost at least 100-240,000 American lives which Team Trump are now calling a goal, or success.

That’s part of the scam, too, the framing of what success will look like, long after Trump blew by the true benchmark of zero American deaths.

All this to boost his approval rating so he can use it for his re-election campaign. That’s the scam.

Just like the quid pro quo for which Trump was impeached — manipulate the situation so that false information boosts Trump’s approval with voters, abusing his power for his own personal gain.

~ ~ ~

What gave me pause wasn’t just the crappy research. Or the problematic French research with which this all began.

It was the fact that Rudy Giuliani, John Solomon, Charlie Kirk and a bunch of other right-wing support players were also doing their bit repeatedly to push this drug cocktail as well as a Russian doctor.

This is the Ukraine scam all over again, only this time the players are going to push a crappy drug and assassinate Dr. Fauci’s character, instead of pushing a false meme about Hunter Biden and assassinating Marie Yovanovitch’s character while she was ambassador to Ukraine.

Dr. Fauci has received death threats now because of this nonsense and his security detail has been increased because of it.

Michigan’s Governor Gretchen Whitmer has also been criticized by right-wingers about hydroxychloroquine. The state’s Department of Licensing and Regulatory Affairs throttled off-label prescriptions of the antimalarial drug because doctors and pharmacists were abusing their licenses by writing scripts for themselves and their families, hoarding the drug while depleting inventories.

But Dr. Fauci and Gov. Whitmer aren’t the only ones affected by this. There are so many stories about lupus and other autoimmune disorder patients who haven’t been able to fill their prescriptions because of a run on hydroxychloroquine because of Team Trump’s unlicensed practice of medicine at the podium — or unregistered lobbying for pharmaceutical company or companies.

Not to mention the strong possibility that although the Food and Drug Administration caved under pressure from Team Trump and now allows “compassionate use” of the drug for COVID-19, the drug could easily kill patients who are already under stress from SARS-CoV-2’s attack on their systems.

Hydroxychloroquine requires additional caution when used on females, geriatric patients, patients with diabetes — this describes a considerable number of COVID-19 patients in critical care! — thyroid disease, malnutrition, liver impairment, or those who drink alcohol to excess — for starters. The drug must be used with caution in persons with cardiac arrhythmias, congenital long QT syndrome, heart failure, bradycardia, myocardial infarction, hypertension, coronary artery disease, hypomagnesemia, hypokalemia, hypocalcemia, or in patients receiving medications known to prolong the QT interval or cause electrolyte imbalances.

This is only part a portion of the contraindications and precautions for hydroxychloroquine.

It may also cause permanent eye damage.

Imagine monitoring the patients receiving hydroxychloroquine even more closely when hospitals are overwhelmed and understaffed.

None of the research so far has been performed in vivo in a large, randomized trial. We really do not know what it will do except for what it has done for malaria patients and for autoimmune disorders — hardly the same things as patients in extremis from COVID-19.

Trump’s pushing drugs from the presidential podium must stop because Americans are being hurt for the sake of whatever scam Team Trump is pulling off this time.

We can see part of the potential reasoning Team Trump has used, but who else is benefiting from this? How do pharmaceutical companies fit into this, particularly Novartis which may be the sole source for the stockpile of hydroxychloroquine the federal government acquired. We don’t know the total amount the U.S. holds, how much might have been donated, and how much has been bought.

We don’t know whether this was part of conversations which may have happened at Davos around January 22, when pharmaceutical companies like Novartis were present and when business leaders were already concerned about COVID-19 outbreak in China.

We just don’t have all the facts yet to know every angle of this particular artless deal.

~ ~ ~

Part 3 will address the research behind hydroxychloroquine in relation to COVID-19.

Masked Up, Ready to Go (Nowhere)

/155 Comments/in , , /by

[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.

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

/130 Comments/in , , , , /by

[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.

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

/124 Comments/in , , , , /by

[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.