Sunday, March 29, 2020

Join Me At Mass

For context on why I worship the way I do, you'll need to read all my original blogging before the Russia Hoax. :-)

Today is Passion Sunday. You can follow along here with facing English/Latin: Dominica I Passionis. Normally Father Tom has a wonderful organist and choir, as well as acolytes:

COVID19: Ranking The States

This morning I have a table to summarize some of the COVID19 stats for the US as a whole. It's a bit rough and ready, as you can see, but I hope it may allow us to clarify a few things--including expectations for next week. Let me explain what we have here, first.

I've basically taken the Worldometer summary table. The states (and DC) are ranked by total cases, but in parentheses I've added the rank of each state by population. (If you notice a ranking discrepancy, it's because I deleted PR, without changing the numbered ranking.) Then I added a far right hand column with total tests performed. (H/T Ray So-Cal).

A perusal of the ranking by Covid10 compared to population ranking provides a rough and ready idea of where the states stand--at the present time--on a per capita basis. Keep in mind something rather important in this regard. The main ports of entry into the US from foreign countries that might import Covid19 prominently include these:

NY, LA, SF, Seattle, Chicago, DC, Miami, Dallas, Houston, Boston, Detroit.

You'd expect the states that contain those cities to rank high up on the total cases. You might also want to add in neighboring states in some cases--NJ, next to NY, for example.

Next you'll want to compare total testing with population ranking. That will tell you which states are more or less on the ball with their testing programs (we're all behind and playing catch up) and which states have dropped the ball.

If a state ranks pretty high on total cases but has done little testing as compared to its population ranking you could probably expect--if you're a betting type of person--that in the coming week or two as lots more testing gets done those states are gonna get hammered.

For example.

Michigan and California rank near the top of the table, but are way, way, behind other states in terms of testing if you compare them to their population ranking. Both states--but especially California--are top destinations for foreign travelers from China. Texas (2) is more down toward the middle of the chart and is home to two top ports of entry, but has been slow to get testing going--when you consider its population. Louisiana (25) has been hard hit. On the other hand, it has been doing a fair amount of testing on a per capita basis. Georgia (8) is also behind on its testing. These are the states I'll be watching for dramatic developments, although the entire top third of the table bears watching. IL and FL have top ports of entry, for example. They've been testing, doing a better job than CA and MI, but it's still relatively early days.

Maybe some other aspects of these stats will jump out at you. The stats aren't totally up to date, but they mostly reflect yesterday and won't be much off on a comparative basis.

Saturday, March 28, 2020

COVID19 Roundup--Mostly Good News

Today we'll try to stay focused beyond the numbers and provide links to articles and blogs that discuss developments and trends that will play out increasingly in the coming weeks.

Obviously, the questions of more widespread testing and potential specific treatments for COVID19 lead the way.

Naturally politics is involved at every step of the way. Don Surber has done the hard work--slogging through liberal propaganda--to arrive at the truth:

Democrats fear a cure

The biggest fear for Democrats today are chloroquine and hydroxychloroquine. Democrat governors in Michigan and Nevada have banned their use to fight COVID-19, not because the drugs may harm people but because the drugs may work.
The party's flying monkeys in the press are casting shade on this possible cure.

Surprised? Me neither. Trading on the deaths of innocent people is par for the course for The Despicable Party. The liberal flying monkeys are doing their best to paint Trump as anti-science and worse but, as we've discussed for weeks now, the knowledge of chloroquine's (and its derivatives) potent antiviral action has been known for well over a decade. The drug itself and its potential side effects have been known for many decades as well. Who should get chloroquine+ treatment and when is a question that can be easily sorted out:

Friday, March 27, 2020

What About Herd Immunity?

Everybody talks about 'herd' immunity, but do we really know what we're talking about? The concept is simple enough--it's a bit like vaccination, only the vaccine is developed naturally through enough people acquiring the disease and recovering with an acquired immunity. If enough people develop that 'natural' immunity the disease is thwarted of new victims and stops spreading--or, ideally, dies out.

However, there are problems with using this as a deliberate strategy.

* The most obvious problem is calculating the percentage of a given population that must develop an immunity in order to protect the non-immune portion of the population. A good example of that balance would be the flu vaccine. 
* Another problem has to do with whether the vaccine is or is not highly immunogenic. If it's not, it may be relatively ineffective in building up immunity in the general population. A good example of that, again, is the flu vaccine. 
* Since a large percentage of the given population must become infected to develop a 'natural' immunity and produce a 'herd' immunity effect, the possibility that a large number of people will die becomes a consideration. Even a 'low' mortality rate translates into large numbers of dead people if the disease spreads widely enough. 
* The question also arises, How long will any acquired immunity last? If you forgo social distancing instead adopt the quest for 'herd' immunity as a deliberate strategy--in the absence of a vaccine or a specific medication, which is  the situation we're currently in--but the acquired immunity is short lived, then you'll have killed off a substantial number of people for no particular benefit.

These are the questions that experts in epidemiology and infectious disease are wrestling with. Back on March 13, 2020, Science Media Centre published the views of a fairly large number of UK experts--expert comments about herd immunity--seeking answers to just these questions.

Because so many people have advocated living life as 'normal' while waiting for 'herd' immunity to kick in, I wanted to address this issue so we all know more or less what we're talking about while evaluating policies for dealing with this pandemic. To accomplish this I've taken the liberty of pasting in some (not all) of the responses and editing them. There's a certain amount of repetition, but I think that's a good thing.

One reminder. Comparison is regularly made in these responses to the flu. But, as these scientists all know, This Is Not The Flu! Also, you will see that not all of these scientists are on the same page with one another.

Larry Johnson: Cuomo's Corona Panic

Earlier this morning I referred in a comment to Cuomo's hysteria. Larry Johnson goes into that a bit, with some very informational details. It probably explains why the American public appreciates Trump's performance in this crisis, as opposed to hysterical panic mongers among the media and ruling elite. Johnson also provides some much needed details that also explain the daunting task facing our healthcare system in attempting to come to grips with this pandemic. The risk of system overload is very real.

Johnson begins Cuomo's Corona Panic by quoting Cuomo's juvenile--and deeply ignorant--tirade from yesterday:

[Cuomo] is now accusing the Feds of dragging their feet in getting NYC 30,000 ventilators. Here is the quote: 
"What are you doing sending 400 when I need 30,000 ventilators," Cuomo said. "You're missing the magnitude of the problem." 
No Cuomo, you do not understand. For starters, you do not have 10,000 patients on a ventilator now. The number of patients who test positive does not mean that all will require a ventilator. The numbers available so far indicate most who test positive for corona virus are not being hospitalized. That means the numbers for ventilators are not going to skyrocket and immediately outstrip the existing capability.
Shame on him. He has a duty to help educate his constituency. Let us start with the production reality--you cannot magically produce ventilators overnight. The existing manufacturers have limited, not UNLIMITED, capabilities to expand production.

That's good, but then Johnson digs deeper, based on his own experience as working his way through college as a Respiratory Therapy Tech and handling patients on ventilators.

Thursday, March 26, 2020

UPDATED: New England Journal of Medicine: Where We Are, What To Expect

The venerable New England Journal of Medicine (NEJM) published an editorial today that was authored by Anthony S. Fauci, M.D., H. Clifford Lane, M.D., and Robert R. Redfield, M.D.: Covid-19 — Navigating the Uncharted. The authors of the editorial discuss an article, also appearing in the NEJM, by a team of Chinese doctors: Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. While Fauci and his co-authors don't explicitly say so, it seems clear from what they do say that they believe the COVID19 pandemic will play out in the US in a very similar way to what is described by the Chinese doctors.

Before providing what I view as the highlights of the editorial, I want to point out that the editorial confirms the basic features of SARS-CoV-2 that we've been discussing for the past month. Compared to SARS-Classic--the 2003 version--COVID19 or SARS2 is 1) considerably less deadly than SARS-Classic but deadlier than seasonal flu, while 2) possessing a high "efficiency of transmission." Those combined factors make SARS2 a very worrisome disease. Its ease of transmission allows it to spread rapidly and that fact has already allowed it to kill far more people than the deadlier SARS-Classic.

Of particular note, Dr. Fauci states that SARS2 in the US "may ultimately be more akin to those of a severe seasonal influenza ... or a pandemic influenza". That mirrors what President Trump has said. Before anyone starts high fiving, however, realize that a severe seasonal influenza in the US kills around 60K people. Since we don't take the kind of measures against seasonal flu that are being taken against SARS2--to limit the spread of the disease--we can assume that Fauci believes that without the measures that are being taken the death toll might be considerably higher.

So, the highlights--beginning with references to the conclusions presented by the Chinese doctors in their article:

On the basis of a case definition requiring a diagnosis of pneumonia, the currently reported case fatality rate is approximately 2%. In another article in the Journal, Guan et al. report mortality of 1.4% among 1099 patients with laboratory-confirmed Covid-19; these patients had a wide spectrum of disease severity. If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively. 
The efficiency of transmission for any respiratory virus has important implications for containment and mitigation strategies. The current study indicates an estimated basic reproduction number (R0) of 2.2, which means that, on average, each infected person spreads the infection to an additional two persons. As the authors note, until this number falls below 1.0, it is likely that the outbreak will continue to spread. Recent reports of high titers of virus in the oropharynx early in the course of disease arouse concern about increased infectivity during the period of minimal symptoms. 
China, the United States, and several other countries have instituted temporary restrictions on travel with an eye toward slowing the spread of this new disease within China and throughout the rest of the world. The United States has seen a dramatic reduction in the number of travelers from China, especially from Hubei province. At least on a temporary basis, such restrictions may have helped slow the spread of the virus: whereas 78,191 laboratory-confirmed cases had been identified in China as of February 26, 2020, a total of 2918 cases had been confirmed in 37 other countries or territories. As of February 26, 2020, there had been 14 cases detected in the United States involving travel to China or close contacts with travelers, 3 cases among U.S. citizens repatriated from China, and 42 cases among U.S. passengers repatriated from a cruise ship where the infection had spread. However, given the efficiency of transmission as indicated in the current report, we should be prepared for Covid-19 to gain a foothold throughout the world, including in the United States. Community spread in the United States could require a shift from containment to mitigation strategies such as social distancing in order to reduce transmission.

The speculation I've read, presumably on the basis of informed opinions, is that the pandemic may--due to our preventive measures--peak in the US in about the second week of April. Below is a self explanatory video of Dr. Deborah Birx, pleading for just a bit of responsibility from the MSM:

And here's Sen. Tom Cotton:

UPDATE 1: Pandemonium In The Pacific: US Carrier Diverts To Guam As COVID-19 Cases Spike Among Crew.

Who wants to be the one to fly out there and tell them that they'll soon have developed 'herd immunity,' so just suck it up?

UPDATE 2: To be clear, I'm not saying Fauci's projections are correct. We'll find that out probably within 2-3 weeks. But this is the type of thinking that's behind government policy making, that's being given to Trump.