Thursday, April 2, 2020

Time on Your Hands: Something to Do (for 40 years)

https://www.youtube.com/embed/HyuE1XnYO0

Compromising on Corona

George Freeman, GeoPolitical Futures
March 11, 2020

Battling the coronavirus is essential. But the battle has costs, which are invariably measured against the gain. “No matter what the cost” – the approach many countries appear to be taking – is a principle that can be disastrous, particularly when the cost is so high that it cannot be borne socially. With the coronavirus, like all new and lethal diseases, alarm shapes the responses. As the cost starts to emerge, there is an inevitable recalibration. We are approaching that point of recalibration.

First the risk. The coronavirus seems as difficult to contain as other coronaviruses like the common cold. Some people do not know they have been infected, and many who never fall ill carry the disease. Everyone is suspect. The only safe course is complete social isolation. That is of course impossible. Jobs must be worked, children must go to school, food must be bought and consumed, and so on. Humans are inherently social animals, and the perpetual threat of infection undermines a fundamental human imperative: to be with other people.

Coronaviruses are persistent; they appear, disappear, reappear, mutate. There will be no clear moment at which the virus is eradicated, no moment at which the dread of a handshake or of a kiss on the cheek will go away. Obviously, there may eventually be a vaccine that can minimize if not eradicate the virus, but that is a ways away. In the meantime, fear will continue to haunt.

The virus is deadly, of course. In South Korea, which has maintained by far the most comprehensive statistics on the disease, the mortality rate for those infected is about 0.7 percent as compared to 0.1 percent for the flu. As with the flu, the death rate is higher among the elderly, especially those with other afflictions. As someone over 70, I can be permitted to say that this is a bearable risk compared to other risks.

In the United States, about 39,000 people died in automotive accidents in 2018. That is a bit over 3,000 people per month or 100 per day. It is a significant risk that most of us accept daily. We understand the risk, we take prudent precautions like not drinking while driving, and we live with it. We live with it because the price of not living with it is more than we are prepared to pay.

Life is a calculated risk, and the question is whether protection against the coronavirus is possible, and if possible, whether it is worth it. I raise the number of automobile deaths to drive home the fact that we do take calculated risks. There has not been an overwhelming demand to create automobiles that allow passengers to survive crashes beyond the point where we are – with airbags, seatbelts and better engineering. We demanded steps within the framework of the cost of increased protection, and the price of decreased mobility.

When the virus first appeared, the natural public response was to demand that the government stop it. Governments are useful things, but public expectations are sometimes extravagant. The next phase was to blame the government for failing to protect them. The third phase will be attacking the government for taking the steps it took to protect them. We are not there yet, but we are close.

The cost of the protections is not merely disruption of how we live, but also a significant economic cost.

The crisis has contributed to massive damage to the Chinese economy and, to some degree, to the decline in oil prices, since China is the leading oil importer. It has almost certainly contributed to the massive decline in equity prices. All of these will extract human costs as global economies move toward recession.

Recessions are common. Uncommon is the refusal to attend public gatherings, which has caused significant economic loss. Here in Austin, South by Southwest laid off a third of its staff on Tuesday after the festival’s cancellation. In New York, the governor has decreed that containment sites be set up to protect people from people who have the disease. In Italy, the solution has been to divide the country into different parts and forbid the movement of people between them.

The more sequestered the population is, the less efficient the economy becomes not merely for financial reasons but also because to produce things, even ideas, workers must be at their jobs, goods must be moved freely and so on. The coronavirus is frightening, but a recession that is more than just a cyclical event is also frightening, for it can extract a massive social cost as jobs are lost, banks fail and so on. The sequestration of larger and larger groups of the population cannot become a long-term feature of society without repercussions.

If the virus has a higher mortality rate than it does now, the risk-reward calculus changes. If the virus can be quickly eradicated by current measures, the calculus changes. But if the mortality rate remains the same, and if the virus persists in spite of best efforts, the risk-reward ratio remains in place. What will emerge is not a bloodthirsty indifference to life. All our lives are at risk. Rather, it will be the process of accepting a new risk and staying our social and economic courses.

The current imposition of increasingly intense measures, unless successful or unless the disease proves more dangerous, will lead to social adjustment and, of course, holding the government responsible for all prior fears.

Wednesday, April 1, 2020

Friday, March 27, 2020

Simply Southern: Now on our Vimeo Channel

In case you haven’t yet seen this feature, you can watch it now.

Monday, March 16, 2020

Public health

Seth Godin

[For members of the public, staying at home and sheltering in place isn’t selfish, it’s generous. Social distancing helps keep the virus from infecting others at the same time that it flattens the curve of the spread of the pandemic, giving health facilities a chance to provide care over time.]

Public health is efficient, a culture changer and a commitment. It’s not simply a more expensive version of private health.

When the water supply is reliable, the air is clean and the public health system is working well, we hardly notice it. Nutrition, access to healthcare and the safety of transport are easy to take for granted. When we hire the government to be responsible for public health, we give up small amounts of independence and money. But it creates enormous benefits, worth far more than they cost.

First, it’s cheaper and more reliable for a few trained engineers to test and maintain the water etc. than it is for each person who consumes it to do so.

Second, health, like the weather, is something that people bring up in conversation but rarely do anything about. By centralizing action, we make it more likely that something actually gets done.

Third, individual humans are bad at long-term thinking. Patient systems often outperform individual actions when it comes to public health.

Often, it’s only coordinated action that can help the entire community. And coordinated action rarely happens without intentional coordination. Don’t do it because you finally got around to it. Don’t do it because it is in your short-term interest. Do it because we all need it done.

It’s difficult to overinvest in building and running competent public health systems and management. And sometimes we don’t realize how important the system is until we see how unprepared we are. [Which is why, alas, today is a good day to stay home].

Thank you to every public health worker and medical professional who is on the front lines right now. We’re grateful for a lifetime of sacrifices and commitment.

Thursday, March 12, 2020

People ‘shed’ high levels of coronavirus, study finds, but most are likely not infectious after recovery begin

Helen Branswell, Staff Writer, STAT


People who contract the novel coronavirus emit high amounts of virus very early on in their infection, according to a new study from Germany that helps to explain the rapid and efficient way in which the virus has spread around the world.

At the same time, the study suggests that while people with mild infections can still test positive by throat swabs for days and even weeks after their illness, those who are only mildly sick are likely not still infectious by about 10 days after they start to experience symptoms.

The study, by scientists in Berlin and Munich, is one of the first outside China to look at clinical data from patients who have been diagnosed with Covid-19, the disease caused by the coronavirus, and one of the first to try to map when people infected with the virus can infect others.

It was published Monday on a preprint server, meaning it has not yet been peer-reviewed, but it could still provide key information that the public health response has been lacking.

“This is a very important contribution to understanding both the natural history of Covid-19 clinical disease as well as the public health implications of viral shedding,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy.

The researchers monitored the viral shedding of nine people infected with the virus. In addition to tests looking for fragments of the virus’s RNA, they also tried to grow viruses from sputum, blood, urine, and stool samples taken from the patients. The latter type of testing — trying to grow viruses — is critical in the quest to determine how people infect one another and how long an infected person poses a risk to others.

Importantly, the scientists could not grow viruses from throat swabs or sputum specimens after day 8 of illness from people who had mild infections.

“Based on the present findings, early discharge with ensuing home isolation could be chosen for patients who are beyond day 10 of symptoms with less than 100,000 viral RNA copies per ml of sputum,” the authors said, suggesting that at that point “there is little residual risk of infectivity, based on cell culture.”

Public health officials and hospitals have been trying to make sense of patients who seem to have recovered from Covid-19 but who still test positive for the virus-based in throat swabs and sputum samples. In some cases, people test positive for weeks after recovery, the World Health Organization has noted.

Those tests are conducted using PCR — polymerase chain reaction — which looks for tiny sections of the RNA of the virus. That type of test can indicate whether a patient is still shedding viral debris, but cannot indicate whether the person is still infectious.

The researchers found very high levels of virus emitted from the throat of patients from the earliest point in their illness —when people are generally still going about their daily routines. Viral shedding dropped after day 5 in all but two of the patients, who had more serious illness. The two, who developed early signs of pneumonia, continued to shed high levels of the virus from the throat until about day 10 or 11.

This pattern of virus shedding is a marked departure from what was seen with the SARS coronavirus, which ignited an outbreak in 2002-2003. With that disease, peak shedding of the virus occurred later, when the virus had moved into the deep lungs.

Shedding from the upper airways early in infection makes for a virus that is much harder to contain. The scientists said at peak shedding, people with Covid-19 are emitting more than 1,000 times more virus than was emitted during peak shedding of SARS infection, a fact that likely explains the rapid spread of the virus. The SARS outbreak was contained after about 8,000 cases; the global count of confirmed Covid-19 cases has already topped 110,000.

Osterholm said the data in the paper confirm what the spread of the disease has been signaling — “early and potentially highly efficient transmission of the virus occurs before clinical symptoms or in conjunction with the very first mild symptoms.”

The study also looked at whether people who have been infected shed infectious virus in their stool. The report of last month’s international mission to China — co-led by the WHO and China — said that in several case studies in China, “viable virus” had been recovered from stool but that isn’t likely driving transmission of the virus.

The German researchers found high levels of viral fragments in 13 stool samples from four patients in their study, but they were unable to grow virus from any of them. The paper noted, though, that all the patients had mild illness, and the fact that they could not find virus in their stool doesn’t rule out that it could happen in other cases.

“Further studies should therefore address whether SARS-CoV-2 shed in stool is rendered non-infectious though contact with the gut environment,” they wrote, adding that their findings suggest measures to try to stop spread of the virus should focus on respiratory tract transmission — protecting others from the coughs and sneezes of people infected with the virus.

Virus could not be grown from blood or urine samples taken from the patients, the authors reported.

The study also noted that people who are infected begin to develop antibodies to the virus quickly, typically within six to 12 days. The rapid rise of antibodies may explain why about 80% of people infected with the virus do not develop severe disease.

About the Author

Helen Branswell

Senior Writer, Infectious Disease

Helen covers issues broadly related to infectious diseases, including outbreaks, preparedness, research, and vaccine development.

Wednesday, March 4, 2020

More Advice: REGARDING CORONAVIRUS from Dr James Robb - February 26, 2020

“As some of you may recall, when I was a professor of pathology at the University of California San Diego, I was one of the first molecular virologists in the world to work on coronaviruses (the 1970s). I was the first to demonstrate the number of genes the virus contained. Since then, I have kept up with the coronavirus field and its multiple clinical transfers into the human population (e.g., SARS, MERS), from different animal sources.

The current projections for its expansion in the US are only probable, due to continued insufficient worldwide data, but it is most likely to be widespread in the US by mid to late March and April.

Here is what I have done and the precautions that I take and will take. These are the same precautions I currently use during our influenza seasons, except for the mask and gloves.:

1) NO HANDSHAKING! Use a fist bump, slight bow, elbow bump, etc.

2) Use ONLY your knuckle to touch light switches. elevator buttons, etc.. Lift the gasoline dispenser with a paper towel or use a disposable glove.

3) Open doors with your closed fist or hip - do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors.

4) Use disinfectant wipes at the stores when they are available, including wiping the handle and child seat in grocery carts.

5) Wash your hands with soap for 10-20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from ANY activity that involves locations where other people have been.

6) Keep a bottle of sanitizer available at each of your home's entrances. AND in your car for use after getting gas or touching other contaminated objects when you can't immediately wash your hands.

7) If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you have to. The clothing on your elbow will contain infectious virus that can be passed on for up to a week or more!

What I have stocked in preparation for the pandemic spread to the US:

1) Latex or nitrile latex disposable gloves for use when going shopping, using the gasoline pump, and all other outside activity when you come in contact with contaminated areas.

Note: This virus is spread in large droplets by coughing and sneezing. This means that the air will not infect you! BUT all the surfaces where these droplets land are infectious for about a week on average - everything that is associated with infected people will be contaminated and potentially infectious. The virus is on surfaces and you will not be infected unless your unprotected face is directly coughed or sneezed upon.

This virus only has cell receptors for lung cells (it only infects your lungs) The only way for the virus to infect you is through your nose or mouth via your hands or an infected cough or sneeze onto or into your nose or mouth.

2) Stock up now with disposable surgical masks and use them to prevent you from touching your nose and/or mouth (We touch our nose/mouth 90X/day without knowing it!). This is the only way this virus can infect you - it is lung-specific. The mask will not prevent the virus in a direct sneeze from getting into your nose or mouth - it is only to keep you from touching your nose or mouth.


3) Stock up now with hand sanitizers and latex/nitrile gloves (get the appropriate sizes for your family). The hand sanitizers must be alcohol-based and greater than 60% alcohol to be effective.


4) Stock up now with zinc lozenges. These lozenges have been proven to be effective in blocking coronavirus (and most other viruses) from multiplying in your throat and nasopharynx. Use as directed several times each day when you begin to feel ANY "cold-like" symptoms beginning. It is best to lie down and let the lozenge dissolve in the back of your throat and nasopharynx. Cold-Eeze lozenges is one brand available, but there are other brands available.

I, as many others do, hope that this pandemic will be reasonably contained, BUT I personally do not think it will be. Humans have never seen this (edited: animal)-associated virus before and have no internal defense against it.

Tremendous worldwide efforts are being made to understand the molecular and clinical virology of this virus. Unbelievable molecular knowledge about the genomics, structure, and virulence of this virus has already been achieved. BUT, there will be NO drugs or vaccines available this year to protect us or limit the infection within us. Only symptomatic support is available.

I hope these personal thoughts will be helpful during this potentially catastrophic pandemic. You are welcome to share.

Good luck to all of us!”