Coronavirus and Pandemics

On ABC's This Week Dr. Deborah Birx just said this:

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So you don't know who's infected, so we really want to be clear all the time that social distancing is absolutely critical. And if you can't social distance and you're outside you must wear a mask.

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[AbE]Dr. Birx was also on Fox News Sunday with Chris Wallace where she said pretty much the same thing:

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And we know that it's important for people to socially interact, but we also know it's important that we have to have masks on if we're less than six feet, and that we have to maintain that six feet distance.

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[/AbE]There you have it. Social distancing applies when there are no masks. When everyone has a mask on you can get closer. How close? Still not known.And a shout out to NosyNed for his comment in Message 756, which was right on.--PercyEdited by Percy, : AbE.

On Fox News Sunday with Chris Wallace Dr. Deborah Birx mentioned that it's okay to play tennis with marked balls so that you don't use each other's balls, and I'd like to offer some clarification.First, what does she mean by using marked balls. She means you mark the balls by who is allowed to touch them with magic markers or sharpies, say a red dot for one player and a green dot for the other. Whether you use three balls (one can) or six balls (two cans), the red player can only touch balls with a red dot, and the green player can only touch balls with a green dot.This is the approach used by the USTA in the first professional tennis event in the United States since the shutdown. The men's event was staged at a solo private court in West Palm Beach, Florida, a couple weeks ago, and the women's event is being staged this weekend at the same location. There were no spectators and no ball boys. Linespeople were on chairs outside the fence.The red player is never supposed to touch a green ball, and vice versa. So how does the red player return a green ball to the other side? Easy. Those with few racket skills can just roll it back with a kick or a sweep of their racket. For those with more skills there are a variety of ways to pick up a ball without touching it, and those with soccer skills are particularly amazing. Once the ball is off the ground you just hit it back to the other side with your racket.But what about doubles? Everybody has to serve. You'd need four sets of balls to play doubles. That's absurd.So what are we amateur tennis players doing? From everything I've seen so far, nothing, other than maintaining social distancing. I'm the only person I know who brings isopropyl alcohol in a spray bottle and hand sanitizer in a squeeze bottle. Everyone playing uses one or the other. The balls are, of course, coronavirus free since they've just come out of the can (we never play with used balls, even before the pandemic). So the only possible source of coronavirus is player's pockets. We've decided that's an acceptable risk.By the way, about the possibility of catching covid-19 from a tennis ball, touching the ball is probably the least likely way. But any strong player with a hefty stroke who's played when the sun is at the right angle, usually a low angle near sundown, knows that every whack of the ball sends a torrent of tiny nap particles into the air. Think tennis players never breath those in? Think again. It's inevitable.So that USTA tournament down in West Palm Beach that thought they had covered all the most significant infection vectors with their distancing and marked balls and all that? Dead wrong. If one of the players was infected then he could not help but get droplets on the balls. When the other player struck the ball he would send virus covered nap particles into the air which he would then breath in.The lesson here is that it's not possible to be 100% safe. All we can do is the best we can and hope that that's enough to protect ourselves and others.--Percy

How old is elderly? The figure for covid-19 deaths among those 65 and older is around 80%. To get to 90% you'd probably have to include those over 60 and maybe even younger, but that is no longer what you would call an elderly population.The figure is skewed toward the elderly more than just age would cause by their high infection rate because of assisted living facilities and nursing homes. This causes the elderly to be overrepresented among the infected population. Among the elderly not living in large groups the infection rate is much lower.Here in New Hampshire the state is funding testing for everyone in assisted living facilities and nursing homes, but I don't know how frequently each patient is tested. In other words, you can't just test each patient once. You have to test each one periodically.--Percy

Americans defy Covid-19 social distancing rules to celebrate Memorial Day holiday | Coronavirus | The Guardian, says the headline at The Guardian. Are the images in that article typical, or are they isolated occurrences that required effort on the part of photographers to find? The first image doesn't identify the location, but it's the Ocean City, MD, boardwalk: If the images are typical of gatherings across the US then there will be a clear spike in cases in 2-3 weeks (June 8 through June 22) and in deaths in 3-5 weeks (June 22 through July 6).Mitigating the deaths will be increasing experience of the medical establishment in dealing with the viral symptoms.Numbers should be down for the next few days because reporting of cases and deaths will be slowed by the holiday. I probably won't report numbers again before Wednesday.--PercyEdited by Percy, : Typo.

I've been holding off posting the latest charts of cases and deaths because of the Memorial Day holiday and it's likely interference with reporting, but here now are the latest.Here's today's graph of deaths per day from The Washington Post Coronavirus Page. There remains a clear downward trend, but this graph shows the expected pop up from renewed reporting after the Memorial Day holiday. We passed the 100,000 death mark yesterday: Here's the bar graph of new cases from ArcGIS Dashboards Classic as of yesterday. There's remains a clear downward trend, but obviously the most recent few days are underreported. Yesterday should have popped up as cases from the holiday period that weren't reported finally made it into the data, but it didn't. If the data doesn't pop up tomorrow or the next day then it means our efforts at mitigation (masks mostly) are highly successful, which would be a very good sign. I think it's too early to conclude this because there may be a Memorial Day week effect (meaning many people took the entire week off, including people involved in reporting), but we'll keep our fingers crossed that this holds up: --Percy

I think the Memorial Day holiday is still affecting reporting, but here's the latest data.Here's today's graph of deaths per day from The Washington Post Coronavirus Page. The formerly clear downward trend is a bit less obvious now. We're over 102,000 deaths now: Here's the bar graph of new cases from ArcGIS Dashboards Classic as of yesterday. Here, too, the downward trend has become less obvious. As someone has noted several times, in this national-level chart the rapid decline of cases in New York State is masking increases across the rest of the country: I have no statistical data about degree of mask wearing, but anecdotal data gathered from the news says that many, many people are forgoing masks in indoor public venues like stores and churches, and given that nothing has changed then the only possible outcome is an increase in cases. The only thing that could hold back an increase in cases is a decrease in testing, something the Trump administration is pushing. If they're successful in cutting back testing then we'll have the contradictory situation of a decrease in cases while hospitalizations and deaths increase.Yesterday was grocery day, here's my anecdotal report. Grocery store capacity was set at 150 (it didn't say whether that included staff). I only saw three people without masks.Pharmacy had one person with no mask.Home Depot had three people without masks, a family unit.WalMart I'd estimate that about 65% we were wearing masks, way up from last week. All employees wore masksI saw a number of people who think a mask across the tip of the nose is effective.--Percy

Comparisons might be difficult because each year a vaccine is developed for that year's annual flu virus strain (the vaccine is more effective some years than others) but not for the SARS-Cov-2 virus. The three assisted living/nursing home facilities I've dealt with over the years all administered the flu vaccine to patients every fall, and I think this is probably true of virtually all of them.Vaccines for H1N1, H1N2 and H3N2 can be developed and manufactured to scale on an annual basis because the differences from one annual strain to the next is usually small, and we have a great deal of experience and expertise in gearing up for the latest one each year.--Percy

Another in the continuing series about why you do not want to catch this virus. Researchers warn covid-19 could cause debilitating long-term illness in some patients describes how the virus can not only do "damage to lungs, kidneys and hearts" but also cause "ongoing crushing fatigue, muscle pain, cognitive problems and other symptoms that anyone with ME/CFS is very familiar with." Also:

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If symptoms continue for six months or longer, post-viral fatigue syndrome can convert to a diagnosis of ME/CFS, which is usually lifelong and often devastating. Up to 25 percent of ME/CFS patients are housebound or bedbound for years. There are no treatments approved by the Food and Drug Administration.

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A Virus-Hunter Falls Prey to a Virus He Underestimated - The New York Times describes how virus researcher Peter Piot, 71, became ill with covid-19 after a lifetime of relative health:

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In early March, he went to Boston,...and he was asked 100 questions about the virus.

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No. 79: Should I be worried that I’m going to get Covid-19? How worried are you, Peter?

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He advised: I would do everything I can to avoid becoming infected as you don’t know individual outcomes.

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He became a living illustration of that.
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It hit me like a bus. Extreme exhaustion, like every cell in your body is tired. And my scalp was very sensitive it hurt if Heidi touched it. That’s a neurological symptom.
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I was particularly anxious that I not be put on a ventilator, he said. Ventilators can save lives, but they can also do a lot of harm. Once you’re on one, your chances of surviving are the same as of surviving Ebola about one third.
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He may have to take anticoagulants for the rest of his life, he said, and parts of his lungs may permanently be scarred.

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You do not want to catch this virus.--Percy

Here's today's graph of deaths per day from The Washington Post Coronavirus Page. There is no clear trend in any direction at present. We're over 104,000 deaths now: Here's the bar graph of new cases from ArcGIS Dashboards Classic as of yesterday. Here, too, there is no clear trend. But news reports appear to indicate that the gradual reopening has tempted many to cease wearing masks. Given that the penetration of the virus into the population remains too meager to provide any kind of mitigation and that the situation is essentially the same as in January, it seems unavoidable that the number of cases will begin trending upward soon. The only thing that could stop the upward trend from appearing in the data is a reduction in testing, something the Trump administration greatly desires. But they can't really hide it because rising hospitalizations and deaths will follow within a few weeks.The inadequacy of our contact tracing also leaves us vulnerable. Japan was able to minimize the pandemic's impact by emphasizing contact tracing over testing. With neither aggressive testing or contact tracing we remain vulnerable.--Percy

The provenance and accuracy of data provided by Surgisphere about Covid-19 patients is being called into question. A study based on this data found increased mortality among Covid-19 patients who used chloroquine or hydroxychloroquine, causing randomized clinical trials of these drugs to be halted.Another study using this data found no ill effects among users of ACE inhibitor type blood pressure medications.Questions about the data and about these studies will have to be answered. If the data is found insufficiently accurate then the two studies based on them will be invalidated and we'll be back to square one with regard to understanding the safety and efficacy of chloroquine and hydroxychloroquine with regard to Covid-19.Source: Scientists Question Medical Data Used in Second Coronavirus Study - The New York Times--PercyEdited by Percy, : Fix title.

More information about masks comes from Medical Workers Should Use Respirator Masks, Not Surgical Masks - The New York Times. Here are the key quotes:

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N95 and other respirator masks are far superior to surgical or cloth masks in protecting essential medical workers against the coronavirus.
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N95 masks offered 96 percent protection, the analysis found, while the figure for surgical masks was 67 percent.

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If you can find an N95 mask then wear an N95 mask.According to Six Months of Coronavirus: Here’s Some of What We’ve Learned - The New York Times, cloth masks are next to useless, blocking only "10 to 30 percent of tiny particles."I'll repeat one more advisory that is mine and mine alone. I have seen it nowhere else. Masks should be worn by everyone, not just the infected. A droplet produced during exhalation and caught by a mask worn by an infected person would also be caught by a mask worn by anyone else during inhalation. Masks prevent the infected from infecting others, and they prevent the uninfected from becoming infected. By "masks" I'm of course referring to effective masks, namely N95 masks. It is a disgrace (Trump's favorite word) that our federal government has not made production of N95 masks one of its highest priorities. You should be able to find them at Rite-Aid, Walgreens, CVS, Walmart and all the rest, but you can't.--Percy

Here's another in the continuing series about why you do not want to catch this virus. Opinion | Covid-19 Survivors Need Care. That's the Next Challenge. - The New York Times provides an overview of what the healthcare system will have to deal with because of those suffering longterm debilitating effects from their bout with Covid-19. One excerpt:

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The surge of Covid-19 patients is declining in New York and several other cities, but in its wake, another surge is underway. Many Covid-19 survivors are suffering serious medical problems that will continue to tax the resources of hospitals, rehab centers and other medical providers.

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You do not want to catch this virus.--Percy

Here's another in the continuing series about why you do not want to catch this virus: Hugo Sosa survived the ICU. But for many like him, that’s just the start of recovery. Hugo Sosa, age 53, still struggles at simple tasks like making change. Large clots lodged in his brain. The virus damaged his kidneys, inflamed his liver, substantially weakened his hands, and left him with deep lesions on his face and buttocks. He lost 32 pounds.You do not want to catch this virus.--Percy

Here's another in the continuing series about why you do not want to catch this virus: Opinion | ‘This Is Not the Flu’: What Doctors Say About Their Fight Against Coronavirus - The New York TimesAuthor Ron Suskind used video to document the feelings and reactions of doctors and nurses during the height of the pandemic at two hospitals, New York Presbyterian and Mass General in Boston. It is the saddest thing you will read/see in a long time. You likely *will* cry.It's long, so if you're short of time just scroll down to the first video and watch that. It's 10 minutes long.Full disclosure: I only watched the first video. Believing the rest would be just as sad I stopped. I couldn't take any more.You do not want to catch this virus.--Percy

Here's today's graph of deaths per day from The Washington Post Coronavirus Page. The trend is mildly downward. We're over 114,000 deaths now, 10,000 in just the past two weeks. If we continue at the current rate there will be at least 130,000 additional deaths by the end of year for a total of nearly 250,000 deaths: Here's the bar graph of new cases from ArcGIS Dashboards Classic as of yesterday. The trend that was at one time downward, then ambiguous, and now is slightly, but unmistakingly, upward: A few weeks ago I predicted that cases would spike in 2-3 weeks (June 8 through June 22) and in deaths in 3-5 weeks (June 22 through July 6). These upward spikes would be mitigated, potentially significantly, by social distancing and mask wearing. It's hard to judge the degree to which media coverage exaggerates how much these safety measures are being ignored, but it's safe to say that the more strictly and widely they're followed the more the spikes will be mitigated or even eliminated. Deaths will also be mitigated by increasing medical experience with the virus.The above graphs are mildly consistent with my predictions, but I hope people in general avoid risky behavior and that my predictions prove false. It would be wonderful if we could get on the downside of this.I went shopping a couple days ago on Saturday. Mask wearing at the grocery store was 100% (excepting children under 10), a first. I forgot to pay attention to mask wearing at Home Depot. Mask wearing at Walmart was maybe 60%, but it's a big place and you can only ballpark it.--Percy