photo by Peter H courtesy of pixabay.com– chosen for its cheerful “vibe”
This post is based on an article published on the website Vox.com on May 13, titled “Expert’s 7 best ideas on how to beat Covid-19 and save the economy”. These ideas are not new or unusual, and most of them have been mentioned before, multiple times. Here they are, again, with reasons why:
- Everyone should wear masks. Not because they protect you from catching the virus– they don’t– but because they prevent you from passing it on to others. If you have the virus, and you are asymptomatic or minimally symptomatic, you are breathing it out with every breath. You especially send it out when you speak, whether or not you cough or sneeze. This could be particularly problematic in an enclosed space, like an elevator or a car or bus. Anywhere that you are within six feet of another person, they are at risk of receiving significant quantities of virus when they breathe in your exhaled air, unless the respired particles are trapped by your mask. Transmission levels have been calculated to be reduced to one-twelfth if 80 percent of the population were to wear masks, according to Vox. One study that supports mask use is from 2009, looking at the H5N1 influenza pandemic, reported in the Journal of Emerging Infectious Diseases. The federal government should be supporting companies that produce protective equipment here in the US and guaranteeing that they will purchase all the equipment that is manufactured, even if it is not immediately needed; whatever is left over will go into a stockpile for future use.
- Use all available means to accelerate vaccine production. This includes methods that carry some risk of “barking up the wrong tree” but that could “bear fruit”. For example, we could recruit a group of young, healthy (at low risk of serious disease) vaccine recipients to deliberately expose themselves to the virus. This would greatly accelerate the development of effective vaccines because most of the lag time, once a vaccine is found to be safe, involves waiting for vaccine recipients to be exposed to the virus to find out if it works or not. If vaccine recipients were exposed reliably to the virus six weeks after receipt, effectiveness levels would become evident in a few days. This step alone could save six months of development time (phase III of trials). Another expedient measure is to stockpile ingredients that will be needed for all vaccines: the glass vials, rubber stoppers, syringes, and needles used for storage and administration. The specialized glass needed for vaccine bottles is already known to be in shortage. A third measure is to scale up production of vaccines known to be safe before they are found to be effective. Scaling up production is a major bottleneck for vaccines. The latter two of these expedient measures require investment by the federal government in guaranteed markets for the vaccines and supplies.
- More and smarter testing. Advocates for more testing are legion, and there is no point in repeating their arguments here. Smarter testing, however, should be emphasized. It is not enough to test people after they get sick. Persons who are at high risk, either of being infected or after infection, should be prioritized before they develop symptoms. This includes people who work in hospitals, not just doctors and nurses but all ancillary personnel. Also included are grocery store workers, cab drivers, police and fire responders, residents of nursing homes, and elderly people who live at home. People with severe obesity, high blood pressure, diabetes, chronic lung disease, and heart disease should be proactively tested. Again, the federal government should be buying every test and supply item that is made, encouraging all producers to ramp up their capabilities, and stockpiling whatever is left over.
- Hiring and training an army of contact tracers. At least 300,000 people should be brought on and their jobs guaranteed for the next two years by the federal government. This will help control transmission of the virus and reduce unemployment as well.
- Stop the spread of virus within households. With people mostly confined at home, the virus efficiently spreads through households. When it is introduced to the house by the one person who has to go out to work in contact with the public, or go grocery shopping for the rest, the virus will rapidly spread because people at home are closely confined and can’t isolate from one another. This is especially true in poor households where people don’t have the room to reserve one bathroom and one bedroom for each person. When one household member is old or chronically ill, even if they don’t leave the home, they will catch the virus from others who do go out– especially if they need personal care. Successful quarantining requires that those who are identified as having the virus be removed from the home and isolated elsewhere– perhaps in a newly empty hotel room (there are plenty of those available with the collapse of the hospitality industry).
- Allow everyone to use the outdoors– public parks, for example. There is little risk of virus transmission outdoors, especially if people wear masks. This will have the benefit of helping people’s mental health: a little fresh air and exercise will go a long way towards relieving quarantine fatigue. Closing parks and recreation areas does little to help reduce transmission and increases people’s anxiety about being cooped up.
- Spend the money needed to stimulate the economy. Rather than just bailing out corporations, money should be delivered to people who need it to pay their rent and buy food. The simplest way to do that is to give $2000 a month to everyone who has lost their jobs and doesn’t have enough savings to tide them over. The second place where money is urgently needed is to support state and local governments, who are unable to operate in the red and are likely to lay off essential workers if they are not paid. Thirdly, small businesses who don’t have “existing banking relationships” have been frozen out of the federal stimulus program by its basic terms. A guarantee to pay all expenses, including payroll, up to $5 million yearly for the next two years (or until the situation returns to something resembling the prior normal) for companies that do not have existing small business loans, helps relieve economic hardship and prevents wholesale bankruptcies and closure of businesses. The federal government is able to borrow money at less interest than the recent inflation rate, essentially for free, so there is little to be lost and much to be gained in terms of future economic growth to pay back all that borrowed money.
These are some simple, yet radical ideas that will go a long way towards helping us to recover from this pandemic without risking the destruction of society as we used to know it. All it takes is for the Congress to act. (Easy to describe, hard to imagine that it will happen.) If we don’t do something like this, then we will face a spreading depression that will resemble the Great Depression except that it will come on much more suddenly. That’s on top of the deaths of 150,000 to 200,000 people over the next year.
How the Buddha got a face, continued
(Gandhara Buddha, Tokyo, 0-100 CE, courtesy wikimedia commons)
FOR THE FIRST six centuries after his death, the Buddha was never depicted in human form. He was only ever represented aniconically by a sacred synecdoche — his footprints, for example; or a parasol, an auspicious mark of kingship and spirituality; or the Wisdom Tree, also known as the Bodhi Tree, under which he gained enlightenment.
How does one give a human face to god, especially to he who was never meant to be a god nor ever said one word about god?
The other problem with representing the Buddha in human form, as the great Sri Lankan art historian Ananda K. Coomaraswamy points out in his 1918 essay “Buddhist Primitives,” is that early Buddhism was disdainful of art itself. He writes: “The arts were looked upon as physical luxuries and loveliness a snare.” Quoting the Dasa Dhamma Sutta, an early Buddhist text, Coomaraswamy adds: “Beauty is nothing to me, neither the beauty of the body nor that that comes of dress.”
“In the omission of the figure of the Buddha,” writes Coomaraswamy, “the Early Buddhist art is truly Buddhist: For the rest, it is an art about Buddhism, rather than Buddhist art.”
Kushans were descendants of pastoral nomads who settled in India during the second century BC– pushed out of China into Afghanistan, then finally reaching India. They developed a form of Buddhism called Mahayana (“Great Vehicle”). They were heirs to Greek, Chinese, Persian, and Indian ancestors. They spread their religion along the trade routes that extended into China and Korea, and eventually Japan.
The Kushans were syncretic, that is, they mixed and synthesized cultural and religious traditions from all four of the areas they entered: Greece, China, Persia, and India. They adopted Bactrian (a middle Iranian language), which they called “the Aryan language”. They adopted Buddhism but venerated the gods of Greece, India, and the Zoroastrians.
The greatest Kushan king was Kanishka, great-grandson of Kujula Kadphises, who conquered Greek Bactria (Afghanistan) in the first century A.D. A headless statue of him in the Mathura museum carries the inscription, “The Great King, King of Kings, Son of a God, Kanishka.” He was something of a narcissist– a quality with which most kings are endowed.
The Kushans established two centers of statuary production, Mathura (which has a speckled red sandstone), and Gandhara (which has an ash-colored schist). Both centers produced Buddhas, with heads. The Gandhara center’s Buddhas have a Hellenistic (Greek) appearance, slender (and idealistic?); the Mathura statues are fuller-bodied, with soft stomachs. The latter resemble the Buddhas of the East, more obese-looking. They have a slight smile.
Under Kanishka, monasteries and other Buddhist centers were established, and the Buddhist texts were translated into Sanskrit. This became the major language of Buddhism.
Kanishka issued coins bearing the image of Buddha– his face. He was recognized as the great patron of Buddhism in China and is related to the establishment of the first Buddhist temple in China, the White Horse Temple near Luoyang.
After the collapse of the Han empire, the Chinese warlords embraced Buddhism as being more egalitarian than Confucianism, which made them feel disrespected as commoners. Between the fourth century BC until after the sixth century AD, when Buddhism was fully established in China, Buddhist texts were translated into Chinese and became the source of Chinese knowledge about Buddha’s life.
The traffic of monks and scholars between India and China lasted well until the 12th century, when Muhammad bin Bakhtiyar Khalji, a Turkic chieftain, destroyed the great Buddhist university of Nalanda, in what is today the eastern Indian state of Bihar.
The statues of the Kushan empire and the coins of Kanishka represent the first time the Buddha’s face was pictured– six centuries after his death. Buddhism started as a religion without art. It was not until the Kushan, with their syncretism, that he became visualized.
(From the New York Times magazine, “How the Buddha got a face”, Sunday, May 10)
picture by DarkWorkX courtesy of pixabay.com
I chose the picture for this blog post because it takes us back to the first contact between Europeans and Native Americans. This contact unintentionally set off epidemics of influenza, smallpox, hepatitis, and other diseases that wiped out up to 90-95% of the population of the Americas. These epidemics occurred even before the Spanish conquest. The indigenous peoples had no immunity and weak inherent resistance to these diseases (due to a relative lack of genetic diversity) and almost all of them died as a result. Estimates of the native population of the Americas before Columbus run to roughly 100 million people– of which 4.5 million in the US claim ancestry today. (Sorry, you’ll have to look up the references to this information yourself; I suggest you begin with the book “1491: New Revelations of the Americas Before Columbus” by Charles C Mann. “Guns, Germs, and Steel” also has information about the infections that caused this near-extinction.)
Doctors Without Borders has sent medical help to the Navajo nation to assist in treatment of COVID-19 patients at the overwhelmed hospitals there, according to a piece published May 12 on WTHR (Indiana) and attributed to the Associated Press. This organization, which normally helps at locations outside the US during medical emergencies, has been dispatched to the hardest-hit site in New Mexico.
According to the article, the virus was seeded in a religious service at the remote Navajo reservation by a man who had been to a basketball tournament in Tucson, Arizona and then returned to his homeland. He attended a service at the “Chilchinbeto Church of the Nazarene” and passed the infection on to locals there. Since mid-March, the virus has spread everywhere, and these numbers are surely an undercount due to lack of testing:
With roughly 175,000 people on the reservation, which straddles Arizona, New Mexico and a small corner of Utah, the Navajo Nation has seen 3,122 cases – a rate of nearly 18 cases per 1,000 people. At least 100 people have died.
Once started, the virus spread rapidly among households on the reservation, where a third of the houses have no running water. The precious liquid is stored in tanks that are refilled sporadically by truck. Washing one’s hands, much less taking baths, is a luxury that is rationed. Large families live together in tiny houses that become hotbeds for virus transmission once seeded.
Another story, from “New Mexico in Depth” dated May 11, states that Native Americans make up 50% of the deaths (and 57% of confirmed cases, according to the NYT) in that state as compared to 11% of the total population. The following story discusses the suicide rate among the same population, which is double that of non-natives.
People who live on these reservations all over America are disproportionately poor and suffer from “co-morbid” conditions like obesity, high blood pressure, diabetes, and alcoholism. Access to health care and medical treatment is critically limited, mostly to clinics run by the Indian Health Service (their coronavirus statistics page is here, showing 5,467 positive tests of a total 57,252 tested). This is a seriously underfunded part of the federal government’s Native American treaty obligations going back to the establishment of the United States. The level of response to this crisis may be understood from the title of this NBC story: “… health center asked for [coronavirus] supplies. It got body bags…”
Indian reservations obtain most of their money from running casinos, which have been established across the US over the last thirty years as the federal government further limited its already weak funding for Native American internment. Nearly 500 casinos, according to this NYT story, have been shut down completely since the pandemic struck. These casinos had been creating $17.7 billion a year in tax revenues in 2019. 40% of reservations operate casinos.
The unemployment rate on reservations has always been greater than 50%, and according to a private communication from a Jesuit who worked there, approaches 80%– while 70% of casino employees are not natives (thus, the burden of casino closings falls upon local whites even more than on natives).
The NYT story also discusses the delays in disbursement of $8 billion which was authorized by Congress in aid to Native American reservations. The money was included in relief bills passed over a month ago, but it has been delayed by problems with the applications for payment. Alaskan natives, who depend upon oil leases for much of their revenue, were included in the relief payments. Political appointments to the administration’s team running the Indian agencies have been accused of routing money to corporations with which they have relationships.
Meanwhile, the Republican governor of South Dakota has demanded that checkpoints at the entrances to reservations there be removed. Tribal leaders have refused, citing the threats from outsiders. There is little that a checkpoint can do to stop the virus; the sites are primarily political statements that hearken back to the Wounded Knee demonstrators of the 1970’s.
The threat to Native American life is real and overwhelming. The NYT article compares it to the demise of the buffalo in the late 1800’s, which forced indigenous peoples to move to reservations (run more like internment camps) and made them dependent on distribution of cattle meat by the federal government.
The extreme threat to Native American survival compares well with the threat that this pandemic poses to poor people. Those people who were well-off and able to “shelter in place” with sufficient food and other resources will experience this virus as merely a “damned nuisance”. The people who were already on the edge will be tipped over into the abyss.
How the Buddha got a face
photo by Einfach-Eve courtesy of pixabay.com
[Somewhere in India, now known as Sarnath] It was here, scarcely 15 miles from the airport, among fields now yellow with mustard flowers, that a renunciant prince had, upon gaining enlightenment some 25 centuries ago, given his first sermon, setting what Buddhists call the Wheel of Dharma into motion. At a deer park once called Isipatana, now Sarnath, a 35-year-old Gautama Buddha, hardly older than Christ when he climbed the hill of Calvary, revealed the eightfold path to liberation from suffering, his four noble truths and the doctrine of the impermanence of everything, including the Self.
FOR THE FIRST six centuries after his death, the Buddha was never depicted in human form. He was only ever represented aniconically by a sacred synecdoche — his footprints, for example; or a parasol, an auspicious mark of kingship and spirituality; or the Wisdom Tree, also known as the Bodhi Tree, under which he gained enlightenment.
How does one give a human face to god, especially to he who was never meant to be a god nor ever said one word about god?
(From the New York Times magazine, “How the Buddha got a face”, Sunday, May 10)
clown face nebula by 272447 courtesy of pixabay.com
Severe virus infections have caused or at least been associated with development of psychiatric disorders like schizophrenia and bipolar disorder. A new article in Medscape.com published May 8 adds COVID-19 to the list of possible cofactors. Researchers Emily Severance, PhD, and Robert Yolken, MD at Johns Hopkins University in Baltimore are studying a possible association of the new virus with psychiatric disorders.
“Over the years there have been data showing an association between exposure to general respiratory viruses such as the flu and subsequent psychotic episodes. This association was especially evident in studies of the aftermath of the great influenza of 1918,” Severance, assistant professor of pediatrics, Johns Hopkins University, Baltimore, Maryland, told Medscape Medical News.
In a 2011 study, an association was found between common coronaviruses that cause colds and the development of psychiatric problems. Two of these viruses, known as HKU1 and NL63 (that cause cold symptoms), were found to show particularly higher levels of antibodies in the blood of sufferers than in controls. The researchers are building on this to start a new study comparing the four common cold viruses and the new coronaviruses– SARS (now known as SARS-COV-1), MERS, and SARS-COV-2 and their association with psychiatric disorders.
The best-known association between infection and mental disorder is the parasite Toxoplasma gondii (found in cat feces) and schizophrenia in the offspring of women who were pregnant when they came down with this infection. A journal review study from 2018 tells us many details of the relationship of schizophrenia to this parasitic infection. The relationship between other infections and psychiatric disorders is not as clear cut, but there are reasons to suspect that viral infections can cause mental problems.
The novel coronavirus is particularly sneaky, and preliminary anecdotal reports suggest that psychosis and hallucinations can occur during the course of acute infection. Night-time hallucinations have been reported by many who are ill with fever. There are suggestions that this virus can directly infect nerve and brain structures, causing breakdown of normal signalling. The loss of smell is one well-publicized example.
Influenza (not a coronavirus disease) can cause an increased risk of bipolar disorder by nearly four times in children of women who were acutely ill during pregnancy. The risk for schizophrenia was even greater: a seven times increase occurred if women were infected in the first trimester.
The new study will use stored blood from patients with psychiatric disorders and collect new samples from those with and without COVID-19. A barrier to this work is the higher priority of studies looking at treatments for, and susceptibility to, COVID-19. Nonetheless, the researchers hope to complete sample collection within the year, possibly piggy-backed on other, more acute studies.
The aftermath of the pandemic may find us with post-traumatic stress symptoms among hospital workers as well as the general public who are exposed to others dying around them and the uncertainty surrounding this situation. In addition, we will likely find an increase in serious psychiatric disorders after the pandemic has died out.
As a family physician and potential patient, I find that the multifarious manifestations of COVID-19 are especially disturbing. Who knows when one of us will fall victim to this virus, or if not the virus, to the economic fallout from having to quarantine ourselves to avoid it? Who knows what odd symptom may be a harbinger of acute infection?
photo by SamWilliamsPhotos courtesy of pixabay.com
“There is a cult of ignorance in the United States, and there has
always been. The strain of anti-intellectualism has been a constant
thread winding its way through our political and cultural life,
nurtured by the false notion that democracy means that ‘my
ignorance is just as good as your knowledge.”
―
I got this quote from a comment to an article in the Washington Post, but you can also find it here.
Rant begins here:
The comment containing the quote refers to an article about a woman named Judy Mikovits (who has a PhD and used to be a researcher in a former life). She came out with a movie called “Plandemic”, which you should definitely avoid. It has been knocked off of Facebook and several other web sites despite being extremely popular, especially among right-wing-nuts. The reason for the ban? The movie pushes a number of conspiracy theories and other nonsense, related to vaccines and to the pandemic. She claims that the virus is a conspiracy by wealthy people to further burden the poor, who as we know are already suffering disproportionately from the novel coronavirus.
If this were a conspiracy, it would certainly be a clever one. It may backfire. The United States, as well as much of the developed world, even (or especially) China, is in danger of a revolt by the poor against the rich. This danger is brought on by excessive wealth and income inequality, which has left a large proportion of the world unable to afford basic necessities.
At the same time, a small percentage (let’s say 0.1%) is doing exceedingly well, and in some cases likely to advance their wealthy status. They get richer either because of good investment strategies or by subsidies from the federal government, which seems bent on passing out money, first come, first served.
It seems to me as if I’m making this up. I’m not. Despite all my caution and skepticism, I must believe it. I’m shocked– shocked, I tell you– that the government not only allows gambling in the back room (see “Casablanca” with Humphrey Bogart and Claude Rains) but actually encourages poor people to throw away what little money they have on ineluctably losing bets. I’m talking here about state-sponsored “sweepstakes” that keep half of their receipts as a hidden tax that disingenuously claims to be giving “extra” funds to schools (which is deducted from the schools’ normal funding).
Take the payday loan industry. They have been making money hand over fist for years (ever since bosses stopped paying their employees in cash) with loans that carry as much as 400% a year interest. I was disgusted with a convenient small, revolving loan that carried 22.5% interest. I figured I could afford to keep up the payments. I could and did (and still do, because it’s to my advantage in other ways).
Consider the person who has no money for food until the next payday, so they take out a loan (to be paid back on payday, hence the name) that will allow them to feed their families. That loan will have to be rolled over on payday, because paying it back will mean no money for food for another two weeks. The carrying charges on such loans amount to an interest rate well in excess of that which Mafia/Cosa Nostra (Italian: “our thing”) thugs charge to their least stable clients. That’s illegal– isn’t it?
No. It’s perfectly legal. In many cases, the operations are financed by banks that are chartered in South Dakota (or other small states, which allow virtually unlimited interest rates, disguised as “fees”) but that operate all over the US. Many poor people don’t know it, but they can cash their paychecks at the same bank (a long bus ride away) that the check is drawn on, for a “small” fee ($5 and up), even if they don’t have a bank account of any kind anywhere.
Banks don’t advertise this– why should they? They don’t want to provide services at a relatively low, uncompetitive (limited by government regulations) rate. They would prefer to hand that business over to the predatory lending firms that call themselves check-cashing outlets (this keeps the riff-raff– poor employees– out of their lobbies and limits the amount of cash they have to keep on hand).
Now comes the federal government in response to the pandemic. The feds have passed a law that provides forgivable loans to companies with fewer than 500 employees (a loophole allows companies with much larger employee numbers, only at separate physical locations, to benefit from the loans). The loans turn into grants if the money is primarily used to keep employees on the payroll instead of firing them.
A clause in this law (which was passed so quickly and was so large that it became a mare’s nest of provisions, loopholes, and exceptions) excludes companies that obtain more than 50% of their income through making and administering loans. The news story (which I won’t reference as I haven’t time to climb down from this rant) states that these companies get 60% of their income from the loans they make rather than from the fees that they charge to cash checks.
It’s a shame that predatory lenders may have to close up shop because their clients are “welshing” (failing to pay) their payday loans after being laid off. Allow me to indulge in some schadenfreude (German: “joy at another’s misfortune”). Thank you. I enjoyed that.
I realize that the employees of these predatory lenders are living paycheck to paycheck and they may starve if they lose their jobs. Wouldn’t it be just too bad if some of these scamster-led companies were forced to board up their places of business?
What if people who didn’t have enough money to keep a checking account would have to go to the bank which their employer uses and cash their paychecks for a semi-reasonable fee? Someone’s going to have to die to make this happen, and as long as it’s not me that dies, I’m all in favor of it (sarcasm intended).
End of rant [limited to 1000 words].
radial tree of genetic divergence from Balloux et al paper
A ScienceDirect article published May 5 reports that:
Phylogenetic estimates support that the COVID-2 pandemic started sometimes around 6 October 2019–11 December 2019, which corresponds to the time of the host-jump into humans.
The corresponding author, Francois Balloux of the Genetics Institute at the University College London, UK, describes in this paper how the team “curated” 7666 separate virus genomes to reach its conclusions. The pattern of mutations showed that there were introductions from animal to human hosts (zoonotic transmission) in late 2019, somewhere between October 6 and December 11.
Since then, there have been repeated mutations– the team studied 198 different changes (homoplasies– mutations that have emerged independently multiple times) that resulted in changes to the proteins in the virus. Nearly 80% of the mutations resulted in “non-synonymous” amino acid changes in proteins that the virus uses as part of its structure or enzymes used in virus replication or assembly. The mutations at four sites studied on the virus genome result in what is called “convergent evolution”, in which independent changes create similar features in descendants of the original virus.
These mutation sites indicate that the virus has been undergoing further adaptation to its human host since the jump from animal to human. These adaptations are of unknown significance at present, but some may have resulted in increased transmissibility (spread from one host to the next). Another, disputed paper claims that a mutation causing increased spread has taken over. Note that this virus type has the ability to proofread its new creations with an “exonuclease” enzyme, reducing its mutation rate (quote from the first-cited paper):
…Coronaviridae having the unusual capacity amongst viruses of proofreading during nucleotide replication, thanks to the non-structural protein nsp14 exonuclease, which excises erroneous nucleotides inserted by their main RNA polymerase nsp12…
The analysis explained in this paper leads to the conclusion that the virus appeared among humans no earlier than August 2019 (at the absolute earliest) and most likely around October 6, 2019. This analysis shows that the virus has spread all over the Earth rapidly and completely, notwithstanding our surveillance only identifying roughly 3.8 million infections worldwide as of today. The virus has spread quickly due to its high transmissibility and its low impact on human health– most cases are asymptomatic, and they do not hinder a person’s ability to travel or conduct normal business. Only the least healthy among us have been severely affected: the old and the infirm. Many of those who are struck down are people who harbor hidden vulnerabilities, like autoimmune disorders and genetic susceptibility to overwhelming hyperimmune reactions.
The more we learn about the novel coronavirus, the more we find that it is at the pinnacle of evolution: its viral “intelligence” presents the greatest challenge we have ever faced as a human species. Only our most enlightened and humane efforts will overcome the threat the virus poses to humanity. This is no time to disintegrate into squabbling nationalities and political parties; we must now unite and face the situation as one human race.
Something to make you feel better: bioluminescent waves on California beaches via the Guardian
photo by the Guardian
The Guardian has published a story about the wave of bioluminescence washing over the beaches in southern California. The video that accompanies the story is something to watch: a lone dolphin swimming through the waves, followed by a group of dolphins, each with a wake of bright blue following. If you never look at videos on the internet, this is the one to see. I guarantee it will make you feel better.
This is not paywalled. The Guardian asks for donations, and I do send them something every month. But they don’t force you. Just a blurb at the bottom of every page.
I was personally witness to this phenomenon once, many years ago, and I was deeply impressed.
Here’s a link to the video from the story: https://youtu.be/bJcTWr8-mFo
US testing and surveillance failures have led to political, economic, and medical disaster
em coronavirus from NIAID– CC license
What happened to cause 1.25 million cases and 73,000+ deaths from the novel coronavirus in the US as of this morning? There were nearly 3.8 million cases and over 260,000 deaths recorded worldwide at the same time. So the US, with 4 percent of the world’s population, has nearly a third of the cases– and that’s just the ones we can confirm. What went wrong?
There are a few things that we can be fairly certain did NOT occur. The first is the conspiracy theory that the virus was accidentally released from a high-security laboratory in Wuhan. According to the researchers working there, this virus was not being studied so it could not have been released; it simply wasn’t there to get out. Other, similar viruses were the subject of intense study, but none of them were released.
We can also be certain that the virus was not deliberately engineered or released. There is simply no logical motive for Chinese military scientists to create a virus with such a bizarre combination of features– asymptomatic in a large percentage of cases, highly transmissible, and indistinguishable from influenza clinically. What military use would this virus have? Then there is the impact that this had within China. It was devastating– to the very country which would have created it. Simply not credible.
Another theory, that the virus originated in a “wet market” in Wuhan, is more likely, but still uncertain. One factor arguing against this is that only 27 of the more than 40 initially diagnosed patients had some connection to the market. The situation in France, where a case dating to December 27, 2019 was just announced, might be similar to the situation in Wuhan. In that case, it is probable that this virus was circulating there for weeks before it was found when a minority of the patients infected showed up at a hospital with severe disease.
The ultimate origin of this novel coronavirus, patient Zero, will probably never be found. Most likely, there were several people who were infected in the initial jump from animal to man, and most of them had no symptoms at all. The virus is so contagious that they didn’t have to be bitten to be infected. Their contact could have been so trivial that they won’t remember it at all. This makes pinning down the origin next to impossible.
Whatever the origin, once the virus began to circulate internationally, the responsibility for containing it rests with each country affected. After all, the action taken by the US to close its borders to China, Europe, Mexico, and finally, Canada, should have prevented us from being exposed to the rest of the world (I’m not saying that’s true, I’m just saying that’s what some people claim).
China has done its authoritarian best to control the spread within its own country. The escape to other countries, through international travel by US citizens, makes surveillance a vital measure to reduce its impact on the US. What did we do inside the US to control the virus?
The United States made several crucial mistakes in the early stages. The first mistake was in refusing to use the test that the World Health Organization had developed during the initial months. Using this test allowed other countries to see that the virus was spreading rapidly. We simply wanted our own test– there was no other excuse. The test we developed had near-fatal flaws and its use was highly restricted. Not having any test at all made it impossible to see how quickly people here were getting infected.
The second mistake, which followed inevitably from the first, was the failure to do contact tracing or isolation of those exposed. Not having a test made it impossible to identify who was infected or see who was exposed, which meant we couldn’t trace their contacts.
Without testing, the only way to find out we had a problem (besides clinical diagnosis by exclusion) was to look at how many more people were dying than usual. This type of surveillance is always six to eight weeks behind, because that’s how long it takes to collect and collate death certificates.
We know that the overall death rate has increased dramatically. The average daily death rate last year was about 8,000 people (it’s higher in January: 8,300 — than in June: 7,150) and about 1,150 people died on April 29 (that we know of) due to the virus. We won’t know for some months how many people died each day this month. We can only guess that the overall death rate is increased because people are dying from coronavirus.
These two errors, lack of testing and lack of contact tracing, caused us to be blinded to the pandemic’s nature in its early stages. Not knowing that the virus was spreading rapidly made it possible for our leaders to pretend that nothing was wrong.
What’s worse, our testing is still limited to roughly 150,000 people a day and we found over 24,000 new cases (that’s about 16%). We need enough tests so that less than 16% of the tests turn out positive– it should be less than 5%, especially given that testing is only 70-80% sensitive.
This lack of tests and thus lack of known cases made it politically attractive for Republicans to claim that the whole thing was a Democratic “hoax”– which lead to the situation in which we find ourselves today. Large segments of our country (fortunately not a majority) are still claiming that the whole thing is made up, that our death toll is grossly exaggerated, and so on. They will wake up too late, to a savagely dented country.
We are headed for a national depression. When the Republicans realize how badly they are going to lose, they will stop any attempts to spend money for stimulus or relief. They will pivot towards fiscal conservatism and then lay the blame on the Democrats for the slow economic recovery that will result.
They will even blame the Democrats for the deficit brought on by the stimulus spending that they voted for in the first place. They will use the deficit to push cuts to social spending and restrictions on Medicare, Medicaid, and Social Security, just as they did in 2009-2013. Do you remember when the Republicans caused a government shutdown to force the Democrats to accept an austerity budget?
This is the same playbook that worked so well at the outset of the Obama administration. It will work again this time if the Republicans realize that they are bound to lose this election by a landslide, and throw the brakes on spending as early as this summer. Poor people will suffer even more, and the uneducated and unintelligent among them will believe One America News Network, which will say the Democrats did it.
Electron micrograph of SARS-COV-2 virions in vitro
From Science Direct, published online May 3:
We report here a case of a patient hospitalized in December 2019 in our intensive care, of our hospital in the north of Paris, for hemoptysis with no etiological diagnosis and for which RT-PCR was performed retrospectively on the stored respiratory sample which confirmed the diagnosis of COVID-19 infection.
The first two cases previously reported in France were found January 24; both patients had a recent travel history to Wuhan, believed to be the source of the pandemic. The clinical picture for patients with COVID-19 and seasonal influenza is virtually indistinguishable. French scientists recently looked at samples taken from patients between December 2 and January 16, using stored swabs and specifically checking those patients who had tested negative for influenza and other common respiratory viruses. The hospital involved has had a practice of storing samples taken from patients in a deep freeze for four years, looking forward to situations just like this, where they would need to go back and re-analyze old cases.
Of 124 samples, 14 had influenza-positive tests, 28 had other viruses, and one had a co-infection. Of the other 80 patients, 66 were excluded because of their “COVID-19 non-typical medical record[s]”, leaving 14 with influenza-like illnesses. Of these, one only, from December 27, 2019, was found to be positive for SARS-COV-2 on highly sensitive and specific testing. This patient “presented to the emergency ward on December 27 2019 with hemoptysis, cough, headache and fever, evolving for 4 days.” He was 42 years old and had type 2 diabetes mellitus and asthma. One of his children had presented with similar (though milder) symptoms (a few days?) previously.
His medical reports were typical of COVID-19: CT scan of the lungs showed “ground glass” opacities on both sides. He had a low lymphocyte count. His C-reactive protein (a sign of acute inflammation) and fibrinogen (a sign of activated clotting system) levels were increased. A culture from his sputum showed “no pathogens”. He did well and was released from the hospital on December 29. We can guess that he was not well isolated from the hospital staff or from family and friends, and that his infection was passed on.
This patient had no history of recent travel, and no known exposure to travellers from China. He worked as a “fishmonger”. His case was added to the known total of over 86,000 infections in France, 55% of which were passed on from persons unknown.
The highly restrictive nature of the case-finding procedure in this case suggests that there were many more patients who presented with milder illnesses during December 2019 in France, who would have been found to have COVID-19 if they were tested. We can only guess that an unknown person from Wuhan, China brought SARS-COV-2 to France in early or mid-December. That person may have been asymptomatic, as the paper cites a figure of 18-23% of patients without symptoms; other researchers have suggested that this proportion is much larger.
Further retrospective analysis or surveillance may reveal who caused this spread or when it happened. Until then, we speculate that the virus was circulating as early as September 2019 (according to some researchers) or as late as early December. Just where it appeared in humans, and when, will probably never be known for certain; these dates may be the closest we will come.
