(image courtesy of pixabay)
Cough, usually dry, upper respiratory symptoms, chest pain and tightness, and dyspnea (shortness of breath) are typical symptoms of the novel coronavirus known as SARS-COV-2 (the disease it causes is officially called COVID-19). The official WHO (World Health Organization) list of symptoms includes headache (I think) and nausea, but it does not include vomiting, abdominal pain, or diarrhea. It also does not include anosmia (loss of the sense of smell), although this is a common symptom of many infections that are caused by other coronaviruses like the common cold.
There may be an evolution of symptoms, from runny nose to sore throat to cough, with a delay in the development of cough and shortness of breath related to lung infection. It may take a week or more for pneumonia to develop. The original case reports from Wuhan were specifically for an atypical form of pneumonia (reticulonodular densities on the CAT scan) and this drove most people’s thinking from the beginning. But pneumonia is only an extreme end of the symptom spectrum.
It is said that 80% of people will have “mild” symptoms, but this elides the possibility that one may have no symptoms at all. Asymptomatic persons may transmit the infection to other people, with an unknown degree of risk. Probably an asymptomatic person would carry less virus and thus be less contagious to others, but this is not guaranteed. The virus will see an advantage in having a proportion of its victims have no symptoms, yet be contagious. Because of this advantage, it is likely that the virus has already evolved the ability to go through some people with no symptoms and spread to others. If it has not already evolved, it is almost certain that eventually the virus will acquire this ability and learn to circulate throughout the human population without causing symptoms or only trivial symptoms. Then it will be just another form of the common cold, of which four different coronaviruses already cause a third of cases.
There is a good theoretical basis for thinking that the virus also infects the GI (gastrointestinal) tract, and virus can be detected in the feces. In rare cases, patients who are proven to have COVID-19 may have (or have had) vomiting and diarrhea; this is usually ignored by doctors but not by patients. Abdominal pain, although it could be present in those cases, should not be significant unless the bowel wall is penetrated. It may be that a few people, whether due to their route of exposure or due to their peculiar genetic makeup, have virus infection localized to the GI tract. Only close study over a period of time will resolve this question. It is important for us to know if transmission through feces is likely, because we have to take precautions in handling our waste water.
He uses the Defense Production Act selectively, once only, to punish a company he doesn’t like: GM
(photo courtesy of pixabay)
Once again, the Incompetent Narcissist shows his true colors. Despite signing and supposedly putting the Defense Production Act into motion, our Fearless Leader has used it only once: to force GM into a contract to produce ventilators at scale. He claimed the dispute was over the premium price supposedly demanded, but other reporting shows that negotiations over various options to produce over 10,000 ventilators a month in the next couple of months were ongoing before he broke them off. As usual, he revealed his true motivation by complaining about a US auto manufacturing plant that GM had closed and sold to another automaker a year ago: a sore point that he still hasn’t gotten over and probably never will. Since the jobs done by that shuttered plant were shifted to Mexico, he thought he could browbeat GM into bringing the jobs back to the US. This could only have been done by raising the price of popular GM vehicles, particularly those that are sold at the lowest price point to poor people.
In fact, any fool can see that he should have signed up a supply chain expert a month ago to comprehensively promote the development and production, followed by distribution, of multiple pieces of protective gear, such as N95 masks and rapid diagnostic tests. All this could have been done under the Defense Production Act from 1950– an act signed at the beginning of the Korean War emergency by President Truman and put to good use as recently as the previous administration.
Like my previous post, I say (from Theodore Roethke and Allison Glock) to those who still support this narcissistic sociopath or are wavering: “In a dark time, the eye begins to see.”
PS another report says that a company has been developing a ventilator that can sell for as little as $10,000– a stripped-down, bare bones version, but better than a CPAP machine. No word on how long it would take to bring this to scale, but one would imagine that the Defense Production Act administered by a competent supply chain expert could do this quite quickly.
PPS a diagnostic company announces the FDA approval (expedited) of a fifteen minute diagnostic test for novel coronavirus that can be done on a table-top machine that is now used to give rapid tests for influenza and several other viral diseases. Since this is being done independently of government support, its introduction will depend on the profit motive for individual laboratories– hardly the best motivation for universal use across the US and the world.
(image courtesy of pixabay and TheDigitalArtist)
Two New Yorker articles recently have provided me with new ideas about the information being developed by scientists on the new coronavirus. The first, by Siddharta Mukherjee, describes the ancient practice of variolation for smallpox in India. He introduces us to the concept of infectious load, or the number of virus particles to which a person has been exposed. There is some evidence that the smaller the number of particles with which one is confronted (hundreds to thousands), the milder the resulting infection and the longer it takes to become ill. This makes sense. The article is worth reading, although it leaves out the advances by Jenner. This country doctor discovered that those who had been infected with cowpox (a very mild disease carried by cows) obtained lasting immunity from smallpox. This led to the practice of inoculation, which eventually superseded variolation because of its greater safety (although variolation practiced by experienced specialists was relatively safe).
The second, by Carolyn Kormann, explains how prior research on coronaviruses has led to new knowledge on the current outbreak of the novel virus. There are too many details to mention here, but the most important are that these viruses have circulated in bats for thousands of years or more, they are among the largest RNA viruses around, and that for every confirmed case there are probably five to ten inapparent cases. Four species of horseshoe bats carry a coronavirus which is more than ninety percent identical to the novel virus. Bats can simultaneously carry multiple types of coronavirus, and when these viruses coinfect a single cell, they recombine in unforeseen ways. In 2013, one such virus was found which shared ninety-six percent of its RNA sequence with the novel virus.
That virus has further mutated, possibly through pangolins (the scaly anteater, about the size of a cat) and jumped into a human sometime in November. Since then, it has spread undetected, until forty-one cases of severe pneumonia were described in Wuhan, China that were caused by the novel virus. Many, but not all, of these cases were linked to one of the infamous “wet markets”, giant animal retail facilities, in which multiple species of wild and tame animals are housed together for sale to those seeking delicacy meats. This virus was found in blood and other matter left over from slaughtering these animals. The wet markets were closed, but secret traffic in various animals continues.
While the uninformed among us may blame the Chinese taste for bats, pangolins, civet cats, and other unusual animals, in fact the blame lies with careless storage of live animals and slaughtering at the time of sale– which could happen anywhere. China is one of the two largest countries in the world, with more than 1.3 billion humans, many crowded together into cities larger than New York. Careful slaughtering and disposal of blood and fecal matter could have prevented this jump from animals to humans because cooking destroys the virus.
That’s all I have for today. If you can access these two articles, I suggest you read them carefully. Nonsubscribers can get a few articles for free.
PS the quote comes from the head of an article by Allison Glock on CNN (it’s basically a very well written tearjerker), which you can pick up for free on the newsfeed of an Apple iphone.
(cartoon courtesy of pixabay)
Open at Easter?
Can’t be done. He will reverse himself at the last minute, as he has done before under intense public pressure. Public health experts say at least eight to twelve weeks of effective quarantine are needed to “flatten the curve.”
If he says “open” on Easter, first, many people won’t follow his advice; second, those who do follow him will spread more infection. It won’t restart the economy if people are still afraid to go out and fly and stay in hotels or go to Disneyland.
There is a company that has been producing thermometers with smartphone apps that report their temperature and location; they have been in business for some eight years.
Their data were shown last night on Rachel Maddow’s show and they indicate that quarantines almost immediately reduce the rates of fevers. Their maps show hot spots in New York and other places that are reporting high rates of COVID-19 positive test results. One surprise is that Florida is an even hotter spot than NYC, even though positive tests haven’t yet spiked there. It seems that spring break has led to increases in fevers.
The data showed school closures and stay at home orders resulted in declines of fever within two or three days. These data probably are the result of lowered infections with much shorter incubation periods than COVID-19: influenza, cold coronaviruses, and the like. The same data, however, will probably show reductions in novel coronavirus transmission with a lag time of five to fourteen days if they are continued effectively.
A nationwide stay at home order still has not been implemented; only eighteen states are under state-wide orders. Thus, more is needed, including a nationwide order that lasts eight to twelve weeks— just as was done in China (if you believe their reports, which is another subject entirely).
The effects on the economy are already baked-in: fear of the virus has shut down the dine-out, stay-out, and travel economy. Prolonging the quarantine won’t make things any worse than they already are.
The right thing to do is to really use the Defense Production Act to mandate that manufacturers produce the equipment we need to treat infected patients without all the healthcare providers becoming ill. The right thing to do is to issue a nationwide stay at home order. Two trillion dollars in economic stimulus may only be the beginning of the federal government support that is needed.
Easter is too soon. Let’s intensify the quarantine and shoot for Independence Day as a target for re-opening. By then, we’ll know just how bad it is.
(This rant was also posted on Quora in answer to the question, “How will [redacted] reopen the country by Easter?”)
(thanks to pixabay and Arcaion for this photo)
You know the commander in chief is suffering from a massive conflict of interest: he is losing half a million dollars a day because his hotels are almost all closed by the current pandemic. So he is pulled by his private business interests to try to open things up again as soon as possible. At the same time, all the public health people are telling him many more will die if we don’t get this thing under control. So the Republicans are trying to hand him control (through Mnuchin) of a half trillion dollar slush fund that he can freely draw from. Who has our best interests at heart? Anthony Fauci, who seems to have disappeared from the daily briefings. “Be wary then; best safety lies in fear.”
(cartoon courtesy of pixabay)
Let’s start with a federal “shelter in place” order– get serious, people. Voluntary, at first. If not working, make it mandatory (by then the scale of the pandemic will have become obvious.)
50,000 ventilators at $50K apiece is $2.5 billion– peanuts to the US government. Surely they would offer a quantity discount for such a large order? Add another $500 million for training. After it’s over, put them in mothballs for the next time. It won’t be long before we need them again.
The states simply cannot do this kind of thing when they are required to balance their budgets every year. The US government is uniquely positioned to get in front of this pandemic and order the equipment. For staff, you add all the doctors and nurses in school right now, plus recruit laid-off baristas to do the grunt work like emptying bedpans.
There are also many retired medical people (like me) who could be coaxed back to work by offering free malpractice insurance and other goodies, like a Good Samaritan clause. A lot of them are older (I’m 65) but some could still be recruited.
What’s wrong with this back-of-the-envelope calculation? Oh, too forward-looking. Never mind.
(Enlarged from a post to the comments line from an article about the ventilator shortage in the Washington Post.)
“Keep your head down until you’re ready to fire.” (I said that) (photo courtesy of 024-657-834)
(photo courtesy of 024-657-834 and pixabay)
photo courtesy of Kevin_Snyman through pixabay
This quote comes from an article in today’s Washington Post. This is something I have feared for years, ever since I started this blog. Other than one or two unpleasant comments, I haven’t been “hated” yet. But I see it could happen to me, just as it happened to everyone who has courted exposure through controversial comments, or even just put themselves out there as a friendly face.
Like Cassandra, I can see the inevitable and I don’t want it to happen (and no-one believes me anyway). Therefore, my posts will continue to be few and far between. I’m sorry I ran out of old photographs to post (I didn’t really run out, but they got harder and harder to find unique images….) So while I may post something now and then, when the urge strikes me, it may not be something that looks controversial to you– just to me.
Apparently the route to having many followers on the net is to be as controversial as possible. That’s not my way. So to the fifty or so people who claim to be following me: Keep your head down until you’re ready to fire.
Conrad Theodore Seitz 