Back in 2016, a commonly accepted prediction based on opinion polls was that Hillary Clinton had an 80% chance of winning the presidential election. This is actually worse than one in six, which is the chance of any particular number coming up when one throws a die.
So people who were “shocked” that Hillary lost have not played with dice much. Her chances were, even if the 80% prediction was correct, not really that good. This was because the right-wing propaganda machine was uncommonly effective during the 2016 campaign and long before. For 25 years, the propagandists had inveighed against Hillary, making her extremely unlikeable among even middle-of-the-road voters. Right-wing voters despised her, not because of her actual characteristics, but because they had been indoctrinated for years.
Most people were unaware of the virulent propaganda campaign being waged against Hillary, in part because it was so comprehensive. The invective was subsumed into popular discourse and infiltrated national media to such a degree that no-one noticed how extensive it was.
The campaign was already in high gear when Hillary said, “…the vast right-wing conspiracy” and people laughed… because they didn’t know it was true. They did know that Hillary had been duped by her own husband and that Monica was doing the dirty deed with Bill. A long story, better left untold, but few people know:
A holdover from the George HW Bush administration, Linda Tripp held a “low level” position in the Defense Department. She used her position to get Monica to confide in her, then she took the information she had gleaned to Ken Starr. He was the “independent counsel” (actually a right-wing conspiracist lawyer) who was “investigating” the failed Whitewater land deal. After finding nothing there, he broadened his investigation to Bill Clinton personally. Linda Tripp gave him the infamous dress with semen stains, and the impeachment was born.
Bill Clinton was impeached for lying about his sexual relationship with Monica Lewinsky. Today, the Department of Justice (DOJ) is personally protecting the president from a civil suit that claims that he defamed a woman that he (allegedly) raped many years ago… my, how things have changed in our government. Back then, a president was impeached for lying about a consensual sexual relationship; now, a president is defended by his own DOJ against a civil suit that claims he defamed a woman by lying about her claims that he raped her, saying “she’s not my type.” (Any unprotected woman is his type.)
Back to 2016, four years before a woman came forward with claims that the now-president raped her in a department store many years ago. How far our government has fallen.
I was recovering from major surgery: a laminectomy and fusion with hardware that included a rod extending from S1 to T10, roughly twelve inches. I had to have the surgery because I had spinal stenosis and severe compression of my spinal nerves (look it up if you don’t know how painful this is.)
The surgery was on August 8 and 9, 2016 (yes, two days in a row); the first surgery, from the front, was to insert spacers to restore the collapsed disks at several lumbar segments, and the second surgery, from the back, was to cut off the backs of the lumbar vertebrae (all five) and screw them to a rod that extended from the last two thoracic vertebrae across all five lumbar vertebrae to end at the top of the sacrum.
It took three weeks in the hospital to learn to walk again, with a walker and then with two canes. After that, it took three months of daily exercise to graduate to walking with a single cane.
At the time, I posted on this blog a picture of myself in a brace in the town where the surgery was done, my home town in fact, San Francisco, California.
During this time, I was blissfully unaware of the presidential campaign between Hillary Clinton and he-who-must-not-be-named. I can honestly say that I enjoyed the pain much more than I would have enjoyed the constant fighting, insults, and lies (mainly by he-who-must-not-be-named) that characterized that campaign.
I was not invested in the campaign, although I supported the Democratic side. I was deeply disappointed by the result, but I did not pay as much attention as I should have to the evil Republican who won.
Now, I am deeply invested in this campaign and I have done what I can to prevent a repeat of 2016. Not having any money as I am still disabled, I supported my wife in contributing what she could to Joe Biden’s campaign.
I can only hope and pray that Joe Biden, without the 25 years of propaganda and lies that Hillary Clinton was weighed down by, and not being a woman (which was still a major disadvantage, 96 years after women had gained the right to vote) will win the election that concludes in twelve days.
If you have not already voted, then mask up, bring a chair, snacks, and your favorite music, and go vote in person at the first opportunity. Do not use the mail. It is worth dying from the novel coronavirus to make sure your vote counts on November 3. Having read this far, I am confident that you, dear reader, will do the right thing and vote for Joe Biden.
A study posted on MedRxiv on October 15 showed no benefit for remdesivir on mortality for hospitalized patients with COVID-19:
Death rate ratios (with 95% CIs and numbers dead/randomized, each drug vs its control) were: Remdesivir RR=0.95 (0.81-1.11, p=0.50; 301/2743 active vs 303/2708 control), Hydroxychloroquine RR=1.19 (0.89-1.59, p=0.23; 104/947 vs 84/906), Lopinavir RR=1.00 (0.79-1.25, p=0.97; 148/1399 vs 146/1372) and Interferon RR=1.16 (0.96-1.39, p=0.11; 243/2050 vs 216/2050). No study drug definitely reduced mortality (in unventilated patients or any other subgroup of entry characteristics), initiation of ventilation or hospitalisation duration. CONCLUSIONS These Remdesivir, Hydroxychloroquine, Lopinavir and Interferon regimens appeared to have little or no effect on hospitalized COVID-19, as indicated by overall mortality, initiation of ventilation and duration of hospital stay. The mortality findings contain most of the randomized evidence on Remdesivir and Interferon, and are consistent with meta-analyses of mortality in all major trials.
https://www.medrxiv.org/content/10.1101/2020.10.15.20209817v1
This large study, called SOLIDARITY, looked at four drugs approved or proposed for use against SARS-COV-2. It included 2743 patients and 2708 controls with remdesivir, and thousands more with hydroxychloroquine (HCQ), lopinavir, and interferon.
None of these four drugs showed a significant benefit on mortality rates, prevention of ventilator use, or length of hospitalization. Remdesivir showed an insignificant improvement over placebo. HCQ and interferon actually showed worse results than placebo, although the differences were not significant.
This study is very disappointing for adherents of remdesivir and contradicts previous studies that showed benefits in smaller groups of patients. Unless close examination of the study finds flaws (which is possible given that it was not yet peer-reviewed) another, larger study will be needed to further evaluate remdesivir versus placebo.
It should be noted that Gilead, the maker of remdesivir, disputed the results of this study. This is noted in the New York Times story about this report.
A possible flaw in the study might be the fact that drugs were given depending on “whichever study drugs were locally available” and the dates of the patients may have differed. It is possible that use of dexamethasone or other drugs may have differed between study drug and placebo. This factor did cause bias in a study of the use of HCQ that was debunked earlier. Review of these issues will require close examination of the raw data.
At the very least, studies with monoclonal antibodies will be needed to evaluate their benefits against those of remdesivir. New monoclonal antibody treatments are becoming available, and these show dramatic promise for early treatment and prevention of disease in those exposed to the virus. Monoclonal antibodies are slow and expensive to produce, but they may prove to be the most effective against the novel coronavirus.
The Washington Post reported on 10/20/20 that a British research study will attempt to infect healthy young volunteers with measured amounts of SARS-COV-2 virus to determine the minimum infectious inoculum, as a prelude to studying vaccines against COVID-19:
The British experiment is scheduled to begin in January. Volunteers will have a purified, laboratory-grown strain of the live virus blown into their noses, while quarantined in a 22-bed biosecure unit at the Royal Free Hospital in London, where they will undergo daily, even hourly, tests over two to three weeks.
The initial phase of the study, involving fewer than 100 healthy young adults between ages 18 and 30, will seek to determine the minimal amount of virus necessary to cause an active, measurable infection in the upper respiratory system.
https://www.washingtonpost.com/world/europe/covid-challenge-trials-uk/2020/10/20/00a31136-026c-11eb-b92e-029676f9ebec_story.html
PS I would like to see the study confined to volunteers between eighteen and twenty-five, make them all female (better immune systems), and evaluate them for known inherited immune disorders before-hand. Just my personal preference.
Good news: studies indicate drop in death rates among hospitalized patients with COVID-19: NPR
National Public Radio (NPR) reported on October 20 that a peer-reviewed study of death rates in hospitalized patients with COVID-19 will appear in next week’s Journal of Hospital Medicine. A preprint was shared online in August.
Death rates dropped from 25.6% at the start of the pandemic to 7.6% as of July 14. 4,689 hospitalizations were evaluated in a single hospital system in New York City.
From the abstract, the discussion says:
In this 16-week study of Covid-19 mortality at a single health system, we found that changes in demographics and severity of illness at presentation account for some, but not all, of the decrease in unadjusted mortality. Even after risk adjustment for a variety of clinical and demographic factors, mortality was significantly lower towards the end of the study period. Incremental improvements in outcomes are likely a combination of increasing clinical experience, decreasing hospital volume, growing use of new pharmacologic treatments (such as corticosteroids, remdesivir and anti-cytokine treatments), non-pharmacologic treatments (such as proning), earlier intervention, community awareness, and lower viral load exposure from increasing mask wearing and social distancing.
https://www.medrxiv.org/content/10.1101/2020.08.11.20172775v1
While the later hospitalizations represented younger patients with lower viral loads, improvements in treatment also reduced mortality rates significantly. This is good news for anyone who gets sick with COVID-19.
A second study, of 14,958 hospitalizations in England, was reported as a preprint on August 3. This study included people admitted from March 1 through May 30. It found adjusted mortality risk dropped by 11% for regular admissions and 9% for intensive care unit (ICU) admissions.
These studies were also discussed in two blog posts: WhatsNew2Day and KPCC (public radio.)
Even if you survive a bout of illness, there is still a problem with lingering after-effects. This is now called “long covid.” Patients often report brain fog, exhaustion, reduced exercise tolerance, and other problems that continue for weeks or months after the virus has been eliminated from the system.
5-10% of patients report continued problems. Imaging has also revealed heart damage, lung injuries, and other problems (I posted earlier about an MRI study which said over 70% of patients had signs of heart damage.) BBC yesterday reported on a study due to be published soon, which says 5% of patients have symptoms for at least eight weeks.
The Washington Post says that there have been nearly 300,000 excess deaths between January 26 and October 3 this year. The average death rate by year in the US has been roughly 2.85 million for the last five years. Today, the CDC reported an excess of 299,000 deaths in eight months, with about 2/3 of those deaths accounted for by COVID-19 diagnoses. The total of excess deaths for this year (not necessarily directly due to the virus) will probably exceed 400,000.
The cause of death for about 200,000 of those people was COVID-19, according to CDC. The other 99,000? Unknown. Many of those excess deaths were reported as at-home or in a nursing home and attributed to Alzheimer’s Disease, coronary (heart) disease, stroke, or diabetes. How many such deaths were due to rapid deterioration because of the isolation precautions have not been concluded.
Weekly excess deaths were highest for the weeks ending April 11 (40%) and August 8 (23%.) The greatest excess death rate overall was for Hispanics, and peaks during those same periods were greater than 100% above normal. Figures showing the increases are presented in the CDC report.
The excess death rate for 25 to 44 year olds has gone up 26%; 5,707 of those deaths were confirmed to be due to the virus. How much suicide and homicide rates have increased has not been determined. The total excess deaths for whites increased 11%, while for Hispanics it increased 53%.
The good news is that, over the whole country, hospitalization rates have stayed flat even as daily case counts have increased. Hospitals in the upper Midwest have been swamped, but the rate has not increased commensurate with the increase in cases.
COVID-19 surges in previously untouched places: Poland, Czechoslovakia, Paraguay– even North Dakota.
The Washington Post on October 20 reported new surges in countries that had avoided the virus in the past: Eastern Europe, including Poland and Czechoslovakia were described in this new article. Multiple media have already reported that the northern Midwest US, including the states of North and South Dakota, Montana, Wyoming, and Wisconsin are particularly hard hit.
These areas were previously spared the effects of the pandemic. New measures include the transformation of the National Stadium in Warsaw, Poland into a field hospital. Wisconsin has also set up a field hospital (source: Wisconsin Public Radio) at the site of its state fair in a suburb of Milwaukee. The Wisconsin field hospital could hold about 500 people; nearly a thousand people are currently hospitalized in the state with COVID-19.
There are multiple reasons for the outbreak of pandemic in the northern Midwest. One reason is the Sturgis motorcycle rally in August, where over 400,000 people gathered for an annual event that featured mass parties, drinking, and concerts. One estimate suggested as many as a quarter of a million infections could have been spread by the motorcycle rally (multiple sources.)
Another example is a party held in Prague, Czechoslovakia in early July to “say farewell” to the virus, which was attended by over 12,000 people.
Small multi-family gatherings have been blamed for the spread of virus to many groups who have otherwise remained isolated until this summer.
In Asia, Sri Lanka (formerly Ceylon) developed an outbreak recently. Jordan and Lebanon have been forced to institute measures, including curfews and shutting down bars and nightclubs.
The novel coronavirus has inexorably spread throughout the world, reaching areas that seemed to have been spared in the spring and summer. This winter is almost certain to see continued spread and quite possibly worsening in the US and all over the world.
The US has been a “hot spot” during the entire pandemic. There has been no relief. Daily new cases are averaging over 50,000. Death rates, however, have gone down– a new estimate by the Centers for Disease Control states that the rate is now 0.65% including all asymptomatic and mild disease.
The death rates at the onset of the pandemic were as high as 7 percent, but have gradually trended downwards as many milder infections were found. No one is certain why the severity of illness seems to be less. Nonetheless, the US has seen an average of 700 deaths a day for the last month.
North Dakota, a tiny state of 762,062 people, has had 4 deaths a day recently, almost a 50% increase in the last two weeks, with a 70% increase in cases. People in this state are widely dispersed and don’t travel much; cases are spread from person to person in families and at lunch counters where farmers gather for coffee.
Very few people wear masks even now. I lived there for a couple of years, and I know how far apart people there naturally are– so it’s shocking to me to see an infectious disease travel in that state. There are very few hospital beds per capita and even fewer intensive care or isolation beds.
If North Dakota is being hit, that means that it’s everywhere. If you haven’t gotten it yet, you have been running between the rain drops.
According to the LA Times on October 17, a survey by UC Davis found that, by mid-July, 110,000 new firearms were purchased in California; 57% of them were obtained by gun-owners and 43% by previously non-owners.
This is a dramatic increase and it overshadows the surges reported after other incidents that prompted new purchases, such as threats perceived to “Second Amendment Rights” that were prompted by media scares.
What possible use could a gun be for defense against a virus? Worse than using a cannon on a mosquito. Isn’t that irrational? Doesn’t it suggest that fear is overwhelming many people? Or does it mean that people will do anything they can when nothing can be done?
It seems that people fear unrest or the breakdown of law and order in the wake of the pandemic. One unintended consequence will be an increase in accidents, especially among those who have never owned a gun before and don’t know how to handle or store them.
Another unintended consequence will be an increase in suicides. The availability of a gun is a major factor in the increases in lethal suicide attempts that have been seen over the last twenty years. Most people don’t know that the suicide rate has increased over 50% in the new century.
Firearms are not inherently bad, but they are potentially dangerous, especially to their owners. Unfortunately, ownership of a gun seems to result in accidental and suicidal deaths far more than it does in deaths of home invaders or other miscreants.
Everyone who buys a gun should invest in secure, locked storage for their firearm to prevent misuse (especially by children, who seem to be unduly attracted to them) and keep the weapon out of sight when not needed.
This article from Science magazine, September 24, 2020, in which I have to look up a lot of words… IFN is short for interferon, for example, and TLR is short for toll-like receptor; IRF is short for interferon regulatory factor. That doesn’t clear it up, much. Here is the abstract:
Clinical outcome upon infection with SARS-CoV-2 ranges from silent infection to lethal COVID-19. We have found an enrichment in rare variants predicted to be loss-of-function (LOF) at the 13 human loci known to govern TLR3- and IRF7-dependent type I interferon (IFN) immunity to influenza virus, in 659 patients with life-threatening COVID-19 pneumonia, relative to 534 subjects with asymptomatic or benign infection. By testing these and other rare variants at these 13 loci, we experimentally define LOF variants in 23 patients (3.5%), aged 17 to 77 years, underlying autosomal recessive or dominant deficiencies. We show that human fibroblasts with mutations affecting this pathway are vulnerable to SARS-CoV-2. Inborn errors of TLR3- and IRF7-dependent type I IFN immunity can underlie life-threatening COVID-19 pneumonia in patients with no prior severe infection.
https://science.sciencemag.org/content/early/2020/09/29/science.abd4570
It’s not peer-reviewed yet, so the TLR3- and IRF7-dependent type 1 IFN immunity is not certain.. there’s only 3.5% of patients with severe disease who have loss-of-function genetic variants in specific areas; the other patients don’t have explanations for their severe illness in genetic variants, at least not those that were defined. One small step…
This tweet courtesy of Buzzfeed, dated October 17, 2020 at 5:48 AM.
