Coronavirus and Pandemics

Here's more in my continuing series on why you do not want to catch this virus, taken from Doctors express glimmers of hope as they try out new approaches against coronavirus.While it's not impossible it could happen earlier, in all likelihood there will not be a vaccine until early next year at the earliest. Even after a vaccine is developed, tested and deemed safe there will still be the problem of ramping up manufacturing to hundreds of millions of doses.The best that we can probably reasonably hope for is for a toolbox of drugs and treatments by fall that diminish the virus's risks to an acceptable level so that we can completely reopen the country and simply treat people as they catch it. In the meantime, this is a very dangerous virus, and here are some of the reasons why:

• The body's own immune system can be sent into overdrive, attacking the very body it is intended to protect.
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• The virus attacks the walls of the bloodstream, creating clots that can lodge in any organ and cause catastrophic and even fatal problems.
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• A partial list or organs the virus can attack: kidneys, liver, intestines, skin, brain.
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• The virus can cause unusual clots in patients as young as in their 30's and 40's.
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• The virus can cause "an unusual pattern of high carbon dioxide levels." This is one reason why one moment patients seem to be breathing comfortably on their own and the next are dying with a team of doctors trying desperately to save their lives.
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• If the virus attacks the kidneys and dialysis is required, something about the virus can cause dialysis machines to clog.
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• The virus can cause throat inflammation, an additional hinder to breathing.
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• "The havoc cause by the virus seems to last a long time - in some patients two, three or even six weeks."

This virus is not just the flu with a bigger whack. It's not even in the same virus family as the flu. It is virulent and dangerous at the current level of medical knowledge and expertise.--Percy

Here's today's graph of deaths per day from The Washington Post Coronavirus Page, 83,614 so far. It still appears to show a clear downward trend. They've added a 7-day moving average: Here's the bar graph of new cases from ArcGIS Dashboards Classic as of yesterday. There's still a clear downward trend in this graph too: Will this downward trend continue? Given that nothing has changed in terms of testing and contact tracing, and given that a vaccine is still far off, the number of cases should start ramping up again in another week or two. And given that no new treatments for those infected have become available, the number of deaths should begin ramping up within a few weeks after that.Other countries that began loosening up before we did are already beginning to see new outbreaks. There's no reason to expect that won't happen here. The Wisconsin Supreme Court just yesterday struck down the governor's stay-at-home order, and reports say that bars and restaurants are jammed. The eventual outcome is predictable.Here in New Hampshire reopenings have begun. Malls, retail stores, hair salons and golf courses reopened this week. Restaurants can open for outdoor seating next week. Beaches will remain closed. There's been no ruling one way or the other on public tennis courts, but most of the local courts are locked or the nets haven't been put up yet. Tennis clubs are closed, but a consortium of clubs in the state have appealed to the governor to reopen.--Percy

Another in my continuing series of why you do not want to catch this virus: Coronavirus May Pose a New Risk to Younger Patients: Strokes - The New York Times. This NYT article tells the story of 27-year old medical technician Ravi Sharma who was sheltering at home with the virus when he suffered a stroke. He spent a month in the hospital, more than half on a ventilator, and is still relearning how to walk and regaining his energy.--Percy

Another in the continuing series, "Why you do not want to catch this virus," again from the NYT: Opinion | Coronavirus Is Making Young People Very Sick. I Was One of Them. - The New York Times. This one's very moving. A couple excerpts:

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I want Americans to understand that this virus is making otherwise young, healthy people very, very sick. I want them to know, this is no flu.
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Maybe you don’t live in a big city. Maybe you don’t know anybody who is sick. Maybe you think we are crazy for living in New York. That’s fine. You don’t have to live like us or vote like us. But please learn from us. Please take this virus seriously.
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Many of my neighbors didn’t make it. I know because I heard the ambulances come for them late at night. The reports from the city’s heroic E.M.T. force suggest that for many of these New Yorkers, it was already too late.

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--Percy

One of the obvious questions about the coronavirus is what viral load is necessary to cause an infection. Viral load is the amount of virus taken in through a droplet or similar means. This comment from Can You Catch the Virus Outdoors? Here's What We Know - The New York Times offers a slight amount of clarification:

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The virus load is important, said Eugene Chudnovsky, a physicist at Lehman College and the City University of New York’s Graduate Center. A single virus will not make anyone sick; it will be immediately destroyed by the immune system. The belief is that one needs a few hundred to a few thousand of SARS-CoV-2 viruses to overwhelm the immune response.

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I also read a couple days ago that when a sample tests positive for the viral RNA that it doesn't tell you how much live virus there are. Dead virus still cause tests to indicate positive because of the presence of the dead virus's RNA. The article said that it is common for only one out of a thousand virus to be live when the test is positive.I would treat this information as interesting but not helpful because of how much information is missing. For example, it didn't say how much virus is live in a nasal swab versus on a grocery store cereal box a half hour after someone sneezed on it. That is, how fast does the virus die once outside the body? We already know that the virus can survive up to three days on plastic, but virus begin dying right away once outside the body. Is the decline in the number of live virus slow and gradual and mostly linear, or is it fairly rapid initially and mostly exponential?--Percy

Here's today's graph of deaths per day from The Washington Post Coronavirus Page. There is a clear downward trend: Here's the bar graph of new cases from ArcGIS Dashboards Classic as of yesterday. There's still a clear downward trend in this graph too: I did the grocery shopping this morning and the number of people wearing masks appeared little changed from last week. Almost everyone was wearing a mask. There were maybe 2 or 3 employees without masks, and maybe 2 or 3 customers.--Percy

For the mathematically minded, here's a Washington Post article that explains with examples why the wide error bars in disease modeling: Disease modelers are wary of reopening the U.S. Here’s how they reach their verdict.--Percy

Coronavirus Infections: Talking Can Generate Droplets That Linger Up to 14 Minutes - The New York Times, reports a New York Times article about a new study.We still don't know how much virus it takes to cause an infection. Is one large droplet of virus sufficient? Several? Thousands of tiny droplets? Any of these? A combination? We don't know.Most likely much is a result of serendipity. Where do the droplets land and how many and under what conditions? A few tiny droplets in a fertile place for the virus and you're infected, while large droplets in an insensitive area and you're fine. Droplets sitting for a while at the back of the throat and you're infected, while droplets exposed to a spray of other particles from eating and drinking get washed into the digestive system leaving you fine.What we do know: wear a mask and remove most doubt.--Percy

Here's today's graph of deaths per day from The Washington Post Coronavirus Page. There remains a clear downward trend: Here's the bar graph of new cases from ArcGIS Dashboards Classic as of yesterday. There's remains a clear downward trend in this graph, too: It has been about two weeks since gradual reopening of the country began when I said that we could expect cases to begin rising again in two to three weeks, and deaths in three to five. The only thing that could prevent this from happening is if the images of people enjoying restaurants and beaches and so forth without masks are the exception rather than the rule, and that most people are continuing to wear masks and practice social distancing. The next couple weeks will tell.What we want is for R₀ to drop below 1. R₀ is the number of people each infected person infects. When that number drops below 1 then the contagion begins to decline. Widespread mask-wearing and social distancing can accomplish this.--PercyEdited by Percy, : Grammar.

Here's a Washington Post video that explains why covid-19 is so much worse than the flu: More evidence emerges on why covid-19 is so much worse than the flu. It has to be a video because it is mostly visual animations and microscope videos.You do not want to catch this virus.--PercyEdited by Percy, : Add title.

Virus ‘does not spread easily’ from surfaces or animals, revised CDC website states explains that the CDC has found that the primary mode of transmission of the novel cornoavirus is through respiration and not through contact with potentially virus laden surfaces such as mail or delivered packages. How Coronavirus Spreads | CDC is the CDC webpage.As evidence the WAPO article cites the high number of infections found in nursing homes and in meat packing plants where people are packed closely together in enclosed places. This is strong anecdotal evidence, but it is not a peer reviewed scientific study, and that bothers me. Nowhere does the article cite any new scientific studies. It is based on perception of what anecdotal experience so far tells us.The CDC webpage states that a safe distance is 6 feet and still doesn't distinguish between whether masks are being worn or not. In fact, strangely, it doesn't mention masks at all. In the absence of studies 6 feet seems prudent, but with masks it must be less and we don't yet know how much less.Other CDC reports still state that the virus survives up to 24-hours on cardboard and up to 72-hours on plastic, for instance Coronavirus can stay infectious for days on surfaces. But it’s still okay to check your mail.Out of an abundance of caution we will be maintaining our current practices. Mail and groceries will still be quarantined. Any time a potential warren of coronavirus is entered like a grocery store or Home Depot, clothes will be washed and bodies will be showered.--Percy

The headline Antimalarial drug touted by Trump is linked to increased risk of death in virus patients says it all.Everyone hopes for a miracle cure for covid-19, and it can be tempting to listen to promising reports from non-medical sources, but this kind of evidence, the kind offered by Trump that begins with "People are saying..." and "A lot of people are telling me..." and "I heard...," is the worst kind of evidence.There is an incredible amount of naivet out there about what is the proper way to make sure information is reliable. Most people get through most aspects of life by listening to what their friends and neighbors say. But when it comes to matters of life and death, particularly in medicine, this is usually a very bad approach.Even if your close friend and neighbor gives you very clear and specific information like, "Did you hear about the new study? It found that lycipatrinedilaxilate administered in 10 mg doses twice daily minimizes the chances of catching coronavirus by 62%, and that if you did catch the virus that it reduces the mortality rate by 84%." How can you doubt that?But you can and should doubt that. Unless you hear this from a doctor or read it in some reliable news outlet (AP, the New York Times, The Chicago Tribune, The Boston Globe, the Washington Post, etc.) and it provides links to the studies and you read the study's conclusions, don't believe it. Once you confirm it you should only seek out medications from a doctor. A real doctor, not one Trump has compromised.This study is not conclusive because it is not the gold standard of a double blind study. It is a retrospective study that examined coronavirus patient outcomes. But it was a large study, and it would be extremely unusual for the eventual double blind studies to contradict it. For now this drug should be approached with extreme caution. Here's a summary of the study results:

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For those given hydroxychloroquine, there was a 34 percent increase in risk of mortality and a 137 percent increased risk of a serious heart arrhythmias. For those receiving hydroxychloroquine and an antibiotic the cocktail endorsed by Trump there was a 45 percent increased risk of death and a 411 percent increased risk of serious heart arrhythmias.

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Those given chloroquine had a 37 percent increased risk of death and a 256 percent increased risk of serious heart arrhythmias. For those taking chloroquine and an antibiotic, there was a 37 percent increased risk of death and a 301 percent increased risk of serious heart arrhythmias.

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That's very damning. I don't believe Trump is taking hydroxycholorquine. I think he's just using the claim that he is to do what he always does, double down on an absurd claim until people give up while not caring about the effects on Americans of his dangerous advice. But if he is taking it, and if his doctors have any influence at all, he should stop taking it immediately.Trump's incredibly poor judgment on things medical is just a microcosm of his poor judgment on almost everything. His gifts lie in the area of lying with a straight face, persuasion, browbeating and pressure tactics, not in anything related to truth and accuracy.--Percy

Here's today's graph of deaths per day from The Washington Post Coronavirus Page. There remains a clear downward trend: Here's the bar graph of new cases from ArcGIS Dashboards Classic as of yesterday. There's remains a clear downward trend in this graph, too: These graphs do not contain any firm indication either way of the impact of the recent reopenings. What we hope is that the news coverage of all the people not wearing masks is making it look like more people are going maskless than really are. And we hope that cloth masks sufficiently curtail spread of the virus, enough to get R₀ below 1. If these two things are true then the reopening of the country will be able to continue without interruption and the recovery can really begin.In today's grocery shopping report, everyone in the supermarket was wearing a mask. Then I went to Walmart. There were more people without masks than with, not counting the help who are required to wear masks.I saw more than several people who did not have their masks high enough on their nose, creating large gaps on either side.--Percy

Does this mean that angiotensin-converting enzyme 2 is not found on exposed areas that might be touched or rubbed like skin, lips, eyes, etc., and so the virus cannot find purchase there? We're hopeful that enough evidence soon mounts that we can cease some of the measures we're talking.--Percy

The argument that the cure shouldn't be worse than the disease has been noted many times, and more recently many have began seriously making this argument as a form of persuasion of how critical it is to reopen the country, but the argument doesn't have to be qualitative. Scientists and statisticians have had available for many years a way to make such comparisons. It is, for example, often used when comparing the cost of new car safety regulations against the cost in terms of human life.This method assigns an actual cost to a human life, and the commonly accepted figure is about $10 million. If the novel coronavirus ends up costing a hundred thousand lives (it is already certain it will exceed that by quite a bit) then the cost of the virus so far in terms of human life is $1 trillion.The cost to the government so far is several trillion, and to the economy several more trillion, which argues that we've already spent too much. But that's the wrong way to look at it. You have to compare it to the cost in human life had we spent nothing.Most estimates are that around 2-3 million will have died by the end of the pandemic if did not shut down the economy. That cost in human life in terms of dollars would be $20-30 trillion.We're probably not that far off from spending somewhere in that neighborhood. The government will add to the trillions they've spent so far, and the economy will continue to shed trillions of dollars. We did the right thing by shutting down back in March (though shutting down earlier would have save many more lives), and we're doing the right thing now in carefully (in some places more than others) reopening.--Percy