Coronavirus and Pandemics

Here's today's graph of infections in the US from ArcGIS Dashboards Classic as of 4/13. There's a slight sign of slowing at 580,200, a rise of only 25,000 over a single day, but tracing the data back reveals Mondays to be a typical down day, perhaps because it is the first day after a weekend when data gathering might not be at its most robust: Here's today's graph of deaths in the US from Cumulative Cases - Johns Hopkins Coronavirus Resource Center as of 4/13. It shows signs of slowing at with an increase of 1500, down from a nearly 2000 increase the day before: Here's a map of infection cases across the US: --Percy

This is a response to Message 5781 in the The Right Side of the News thread to correct some misinformation. I only respond to information directly bearing on the pandemic. This was a little hard to follow, but the basic point seems to be that we should reopen the country while making the greatest effort to protect those most vulnerable. But while it is true that older people are more vulnerable than younger people, people in every age group are vulnerable: A significant factor in deadliness is suspected to be viral load, meaning that small initial doses cause minor symptoms while large initial doses cause serious illness and death.We do not yet know what, if any, the permanent effects might be, but there are anecdotal reports of marathon runners getting winded from crossing the room even after a few weeks out of the hospital. There is no possibility that California has herd immunity (nor any country in the world, for that matter). California has 24,732 cases out of a population 39.5 million for an infection rate of .06%. Herd immunity requires around 70%. Even if infections in California were undercounted by a factor of 10 it would still be a factor of 100 too small to provide herd immunity.Also, it has not been established that surviving coronavirus confers immunity, and if it does for how long. While it would be surprising and unexpected if it conferred little or no immunity, it is still important to recognize that these are things we can only assume at this time and that we cannot know with certainty. Widespread opinion is that surviving the coronavirus confers at least several months of immunity. This is true. We need hugely more numbers of coronavirus tests and coronavirus antibody tests than we have, enough to test significant proportions of the country every day. This is true, but a more precise way of saying this is that the risk of exposure increases with increasing social contact and with the rate of penetration in your locale. Walking unprotected around the streets of New York City is much more risky than of Casper, Wyoming. A new flu vaccine is developed every year for the latest strain of flu. Millions of people take the vaccine providing them a level of immunity and giving the population a degree of herd immunity.There is no coronavirus vaccine. When the vaccine becomes available in about 18 months then there will be no need to fear the coronavirus, but until then it remains both ferocious and dangerous. Carrying on life as normal would result in millions of deaths directly due to the coronavirus, and millions more due to the unavailability of medical resources sucked up by the coronavirus. There is no evidence of "dramatic results" from hydroychloroquine, and preliminary data indicates serous potential side effects. No one should be taking any prescription medications for any reason other than under the care of a responsible doctor. Neither chloroquine nor hydroxychloroquine has been shown safe and effective for the treatment of coronavirus.--PercyEdited by Percy, : Typos.

We're still in the middle of the pandemic, there is little time now for detailed analysis as we deal with the daily crisis, but initial indications as recounted in Coronavirus destroys lungs. But doctors are finding its damage in kidneys, hearts and elsewhere are that the Coronavirus attacks far more than just the lungs. Here's a list:

• Pneumonia
• Heart inflammation
• Acute kidney disease including complete renal failure
• Neurological malfunction
• Blood clots potentially causing organ and brain damage
• Intestinal damage
• Liver damage

How much of this damage is permanent? The article doesn't say, but let's hypothetically consider that at least in some cases it is permanent. Coronavirus could, in some instances, place a previously healthy person on dialysis for life and in need of a kidney transplant, or a liver transplant, or could cause blood clots that cause death or permanent brain damage, or permanently weaken the heart.In the US over a hundred thousand people have experienced severe enough symptoms to become hospitalized. There have been over 26,000 deaths so far.I hope I am preaching to the choir about the terrible dangers of coronavirus and why it must be taken very seriously.--Percy

How much social distancing is enough? The rule of thumb is six feet, but as I have long argued, it is not as simple as that. Human exhalation mechanisms are not some precise process producing only large droplets that fall immediately to the floor within six feet. Human exhalations consist of breath, coughs, and sneezes, and they all produce a wide variety of droplet sizes, from large droplets that fall immediately to the floor to individual molecules that float on vortices of air whither and yon.As Stay 6 Feet Apart, We’re Told. But How Far Can Air Carry Coronavirus? - The New York Times accurately states, three feet is not as good as six feet is not as good as nine feet and so forth. The article gets into a lot of back and forth which seems to be an attempt at all-sides-ism, but it does have a bottom line: Do everything you can do to minimize exposure to air that other people have been breathing into, because some of what people exhale can remain suspended in the air for long periods and travel long distances. For some strange reason the article doesn't mention masks, but if you're out and about among people you should be wearing a mask.I was at the grocery store this past Saturday, and while maybe 50% of customers were wearing some sort of facial covering, none of the employees were wearing any. It's safe to predict that within a month at least one employee of this 80-store grocery chain will die. I wish I could have grabbed a handful of my wife's masks and given one to everyone without one, but we don't have the manpower nor the financial means to produce masks at this volume. Most of our masks are going to the local hospital. Friends and neighbors get the rest.So take this message: Six feet is not enough. And wear a mask.--PercyEdited by Percy, : Punctuation.

The message remains the same. If you're not wearing a mask, six feet is not enough. And wear a mask.Here's social distancing as implemented in the Trump briefing room where he tells us every day about the wonderful job he's doing: The distancing is less than six feet, but even if it were six feet or ten feet or twenty feet, it is not enough. It is a bunch of people in a room, and there should never be a bunch of people in a room who are not wearing masks.Coronavirus is highly contagious, and its ravages can cause permanent damage and even death. Our current numbers (see COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)) tell us that 4.8% of those who contract coronavirus in the US die. Fortunately it can't actually be as bad as 4.8%. Our lack of testing capabilities means that many more are infected than we know. The mortality rate when adequate healthcare is available is probably below 2%.By the way, in case it isn't obvious, the "maintain a safe distance" rule only applies when you're out and about without a mask or with people you don't live with. DO NOT INVITE NON-CORESIDENTS INTO YOUR HOME OR APARTMENT IF THEY'RE NOT WEARING A MASK, AND DON'T DO IT ANYWAY. Treat your domicile as a coronavirus-free temple by maintaining safe practices that guarantee as much as is possible that no virus ever enters.--Percy

Al Jazeera reports on how coronavirus can cause permanent damage. Some excerpts:

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Lungs

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...some scientists believe evidence is mounting to show that those on the moderate to severe end of the spectrum (who experience breathing difficulties and pneumonia) may be left with permanent lung damage.
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It is this process of excess inflammation brought on by an overreacting immune system that is the biggest danger to the lungs. It can cause irreversible damage to the air sacs on the periphery of the lungs known as alveoli.
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The inflammation caused by the body's immune response to the virus can cause the alveoli to pop, giving the lungs a honeycomb-type appearance, or to harden so they are no longer able to do their job. When this happens, a condition similar to fibrosis or hardening of the lungs occurs.

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According to WHO, SARS, a type of coronavirus that behaves similarly to COVID-19, did the same thing to the lungs of those affected by it and led to permanent damage to these people's ability to breathe normally.

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All this would suggest that for a small number of people who are severely affected by the disease, breathing normally may never be the same again and getting short of breath on minimal exertion or requiring medication to help you breathe may become the norm.

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Kidneys

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When sepsis takes hold, there is a danger that blood vessels throughout the body will dilate (get wider) in response to the infection and pressure within them will fall.

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This sudden drop in pressure stops the kidneys from receiving the flow of blood at the right pressure they need to do their complex set of jobs. Their sensitive cells can die off very quickly, leading to permanent kidney damage.

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This is from https://www.medicinenet.com/script/main/art.asp?articleke...:

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Liver impairment is another emerging concern with COVID-19, as it was with the similar novel coronavirus, severe acute respiratory syndrome (SARS). According to a 2004 report, up to 60% of patients with SARS had liver impairment, with liver biopsy specimens demonstrating viral nucleic acids and injury. These authors noted that this may have been the result of drug-induced liver injury, given that most of these patients were treated with high doses of potentially hepatotoxic antivirals, antibiotics, and steroids.

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More simply, we do not yet know if coronavirus can directly cause liver damage, but the drugs used to treat a coronavirus infection can definitely cause liver damage.--Percy

Trump has completely abandoned his Monday claim that as president he has total power. He now says that he is authorizing the governors, under federal supervision, to decide the manner and pace of reopening. In other news Trump has authorized the sun to rise in the east each morning.I think the governors would be more than willing to grant the federal government a significant amount of control and coordination in reopening the country if they believed that someone sane and competent were in charge.Trump is chomping on the bit to reopen the country, but we are not ready, not even close. Here's a bar chart of the daily number of new coronavirus cases as of April 16 (yesterday). It indicates that we may have plateaued, with the emphasis on "may". Over the last eight days the number dropped four consecutive days, then rose four consecutive days: This means that mitigation efforts are having a positive impact but that there is no trend up or down.But that interpretation ignores our inability to conduct widespread testing. This very likely played a significant role in causing the plateau, meaning that the plateau represents saturation of our ability to test, not a plateauing in the rate of spread. There are still huge parts of the country to which the virus has yet to make any significant inroads. News reports indicate that significant portions of rural America are not closing businesses, practicing social distancing, or wearing facial coverings or gloves.The number of infections in rural America will of course never reach the levels of the country's population centers, but unless rural America gets very serious very quickly about protecting themselves they will have the same level of infections per hundred thousand as more urban areas of America.There is a way to make coronavirus disappear from our shores in just two or three weeks, but we lack the means to carry it out. If today we tested and obtained the results for everyone in America then we could quarantine those who test positive. Doing this is, of course, impossible. There aren't enough test kits, there aren't enough trained professionals to conduct them (The cotton swab you've heard so much about? It is carefully extended inches deep into winding nasal passages - the person doing this has to know what they're doing. My retired doctor friend who volunteered just tested a bunch of kids who are under state care a couple days ago.), and there aren't enough labs or lab personnel to analyze them.The federal government should make it a top national priority to dramatically increase our ability to conduct widespread testing. By regularly testing broad random samples of the population we can quickly identify new hotspots and conduct investigative tracing and intensive testing there. This would be very, very effective at ending the pandemic in this country. If we maintained this intensive level of testing then the country could return to normal.But under Trump it is unlikely the national resources to conduct this intensive level of testing will be mobilized soon, so the other necessary component for reopening the country is for everyone to wear facial coverings whenever out among other people.Again, the six-foot safe distance is nonsense. It's impossible to maintain in many places such as grocery stores and pharmacies, and breezes and drafts and tiny droplets and molecules and people walking around into each other's exhalations render it meaningless. The wearing of facial coverings is essential for ending the pandemic.How long will the testing and facial coverings be necessary? For as long as it takes to develop a vaccine. How long will that take? The earliest a vaccine can be available is the summer of 2021. You'll hear lots of promising news stories about earlier availability, but ignore them. Developing a new vaccine that is safe and effective is a major effort. It's going to take a while.By necessity there will have to be far more testing because Trump will eventually and after costly (in terms of lives) delays be dragged kicking and screaming into a national effort to make widespread testing possible. When it's in place then in order for it to work there will have to be edicts that people accede to randomized testing when asked or be quarantined for two weeks.And wear a facial covering whenever you go out.This will have to go on for at least another year minimum, because every time the unfortunately inevitable efforts at premature loosening occur the infection rate will rise again.Here's a final piece of data for people who for whatever inexplicable reason think we're getting closer to reopening the country. This is the number of deaths plotted over time. The rate of dying is rising: --Percy

With Trump touting chloroquine and hydroxychloroquine there's been a lot of baseless nonsense about possible drug solutions that have no science behind them. Here's a promising report about a scientific remdesivir study. Keep in mind that it is not peer-reviewed nor statistically significant, just promising. Other similar studies are ongoing: Gilead data suggests coronavirus patients are responding to treatment--Percy

I just returned from doing this week's grocery shopping. I'd say the number of customers wearing masks was about the same as last week, around 40%. Of the grocery store employees I saw, only one wore a mask. Perhaps they have not seen these articles: Or perhaps they've been listening to Trump describing how soon the country will reopen?Or maybe they saw the anti-mitigation demonstrations in the midwest.We know what will happen. With no vaccine and with no widespread testing, decreased mitigation efforts will mean increased infections.--Percy

?--Percy

Years ago I lived in Maynard in Rosie's Apartments on Railroad Street across the street from DEC where I worked. Route 27 was just down Main Street a bit.Up here in NH only about half the people seem to be modifying their behavior.--Percy

Most people (meaning anyone not in the White House or in the rightwing echo chamber) seem to understand testing. Unless you know who's infected and who's not, unless you know where the hotspots are and where they're not, those resuming normal activities and behavior risk infection. The situation is no different now than before mitigation efforts began. If mitigation efforts cease then the infection rate will increase, unless we have massive testing. That means millions of tests per day. Currently we're at around 150,000 tests per day, about where we've been since before the beginning of April.Trump could mobilize the country to produce PPE and test kits, and to recruit testers, test labs and infection investigators, but he won't. He played the governors like a fiddle. He claimed total power and the governors pushed back, giving him exactly what he wanted. He backed away and told the governors it was up to them to decide when to reopen, and if things go bad then it's on them. Oh, and by the way, he's wants the country reopened, he stands with the protesters, but it's all on the governors.The governors don't have the power to build the test capabilities we need, so we will not have them. When (not if) governors begin giving in to pressure and begin loosening mitigation guidances (May 1 is a frequently cited date, just as Easter was frequently cited as a potential reopening date a few weeks ago) then the infection rate will again begin climbing. Here's today's bar graph of newly detected infections up through yesterday: This is not what a declining infection rate looks like. At best it's a plateau, and at worst, as I've been saying, it's an artifact of inadequate testing, as recently echoed in the Atlantic in How Bad Is the Coronavirus Outbreak? Here’s a Key Number. - The Atlantic:

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The high positivity rate also suggests that new cases in the U.S. have plateaued only because the country has hit a ceiling in its testing capacity.

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That is, things are not getting better, they're getting worse, and this is happening at the same time that increasing numbers of people are chaffing at the constraints on their right to work and move about freely. They will likely get their wish that mitigation orders be lessened and perhaps even dropped, and then they'll learn that epidemiologists really do know what they're talking about, though we'll all suffer because, just as we already saw in early March, the newly infected will be carriers until they show sufficient symptoms to get tested.That is, if they can get a test. Again, we're suffering from a severe lack of test capacity, and so it's very difficult to get a test. If you have no symptoms then you'll be turned down for testing. If you have mild symptoms then your doctor, urgent care and the emergency room will all likely tell you the same thing: remain home, take some Tylenol, and call again if the symptoms worsen. If your symptoms worsen they'll tell you the same thing. If your symptoms get worse yet they will still give the same advice. Finally, when your temperature has spiked at 104° and your chest feels like a band of steel is crushing it making it impossible to breath, they'll tell you to come in and take the test.Why is it done this way? Because the country can only test about 150,000 people per day. Health professionals cannot afford to use their scarce test kits on any but those who from all appearances have a fair chance of actually being infected. That's why, on average, 20% of the people receiving the test get back positive results. In reality nowhere near 20% of the country is infected. It's actually only a tiny percentage.It seems unlikely that all 50 governors and the mayor of Washington D.C. will see the inadvisability of going against professional medical advice and giving in to those protesting against mitigation rules. Some states will begin loosening up. When they do it will take about three weeks before infection rates begin climbing again. Since people can pass freely across state boundaries we will all pay the price.If my own state drops the mitigation rules I will not change my behavior one bit. I will continue to wear a mask and gloves when I am out and about among people. I will continue to assume that all stores are hotbeds of virus. Groceries, mail and packages will get quarantined in the garage for three days before opening. And in a few weeks the negative impact will become apparent and everyone will resume their mitigation behavior. Maybe then, probably sometime around the second half of June, we can begin to have a serious conversation about testing and get some action out of the dolt in the White House.There's another possibility that I hope likely. Just as when Easter approached it became clear that reopening was not in the cards, so will it become obvious as May 1 approaches. Perhaps this time it will also become clear, to enough conservatives, that we need more testing.And there's yet another possibility. Though the states have nowhere near the resources of the federal government, they are making progress toward increased test capacity. Perhaps it will be enough to make a difference.--PercyEdited by Percy, : Typo.

AbE: Okay.Edited by Percy, : AbE: Didn't realize it was the Czech Republic's president.

Broadway star Nick Cordero has leg amputated after complications from the coronavirus, reports the Washington Post. Blood clots are a complication of coronavirus.I've seen no estimates or statistics of the variety of ways people experience the coronavirus, but here are my guestimates: I also think that the 20% worst cases have a fair chance of some type of permanent effect, such as diminished lung capacity, heart damage, kidney damage, liver damage, amputation, etc., and of course death.The demonstrators against mitigation efforts don't seem to understand what they're risking, not just for themselves but for everyone they come in contact with. Given his tweets I count the president among the demonstrators. Underneath it all he does understand the risks and is just playing political games with people's lives. He would not dare meet the demonstrators face to face without screening each one for temperature and without using the White House's handy-dandy automatic coronavirus detector machine, which I bet he isn't using the Defense Production Act to ramp up production of.--Percy

Turns out the information for comparisons is easily available. The densest part of New York City is Manhattan at 66,940 people per square mile. It sounds like a lot but it isn't. If you spread that many people evenly across a square mile they'd be about 20 feet apart. The odds are good that many corners of Vancouver are much denser than that.Of course, many corners of Manhattan are also denser than that. Way denser. Steinway Tower's on a 60-foot base with 77 apartments. If about 4 people live in each apartment for a total of 300 residents then that's a density of over 2 million people per square mile.For the curious, prices for apartments in Steinway Tower (most have views of Central Park) begin around $30 million. The penthouse is over $200 million.--Percy