(photo courtesy of pixabay)
Yesterday’s Washington Post carried an article telling the story of Birdie Shelton, a woman who returned rental cars for servicing to their central locations. In her job, she was exposed to secretions and excretions from people who had driven and ridden in cars that they had rented. In part, their motives were to prevent exposure through riding on public transportation. Her job, which she was forced to do by economic necessity, probably killed her.
The story was particularly affecting and effective because it was told by her partner, who dictated his recollections of her sudden illness and demise within days of its onset. These people, Indiana residents and members of the lower middle class, are helpless in the face of economic and epidemiological pressures that prevent them from taking time off when they are sick and massively expose them in the course of their work.
Never mind that she had multiple risk factors for severe disease. Never mind that she voluntarily chose this job. The rental car companies are responsible for their employee’s well-being.
First, the story shows how massive exposure can result in sudden, fatal symptoms. Second, this story shows why the capitalist system, without sufficient regulation and supervision, will be the death of us all (except the lucky 0.1%).
PS at the time the story was published, Birdie’s partner was also ill and confined to his home. He was unable to access her cell phone because she was too sick to give him the password. His electricity had been turned off (he got it back on, luckily). He was in danger because she had handled the finances for the two of them, and he was unable to find work. He will probably die too, because his exposure to her was of the same magnitude as her exposure to others.
(photo courtesy of pixabay)
An article in today’s New York Times demonstrates that the profit motive, manifested as industry consolidation, has handicapped preparations for today’s pandemic of novel coronavirus:
Government officials and executives at rival ventilator companies said they suspected that Covidien had acquired Newport to prevent it from building a cheaper product that would undermine Covidien’s profits from its existing ventilator business.
Back in April 2012, a small specialty manufacturer of ventilators (devices that inflate the lungs with oxygenated air to relieve shortness of breath due to weakened lung function) demonstrated a working model of a $3,000 ventilator that had been commissioned by the Centers for Disease Control (CDC) to fill the national stockpile. Projections that the US would need 70,000 ventilators in case of a flu pandemic (H1N1 had just passed through the world) alarmed experts at CDC, and they developed with Newport a contract to produce 40,000 of them, redesigned to be simpler and more portable.
Just as the demonstrator working models were rolled out, Newport was bought out by a larger generalist producer of medical equipment, Covidien, for $100 million. In May 2012, apparently fearing that the cheap ventilator would cut into its profits on selling larger, more complex ones, Covidien demanded more front money and a higher price for the new machine. The project fell apart, and no new ventilators that could be stockpiled for use in emergencies were produced.
Once again, the profit motive has over-ruled the altruistic motive in the boardroom. We can see that capitalism without regulation and oversight is deadly to the human race. Communism, with its totalitarian tendencies and its use of unrealistically high expectations to prod superhuman efforts from motivated “commies”, would be even worse. Don’t tell that to our Commander in Cheat: he’s too busy preening in front of his bathroom mirror. Time and time again, projects that use our motives for the common good to spur low-profit production have been derailed by Tea Partiers crying “communism!” to tar socialist policies with the unwarranted slur of totalitarianism. When will these red-baiters learn that we are all in this together?
(image courtesy of pixabay and TheDigitalArtist)
Research on COVID-19 revealed viruses contaminating all surfaces in hospital rooms before cleaning that was removed by using 5000 ppm of sodium dichloroisocyanurate for “high-touch areas” and 1000 ppm on floors. Areas where viruses were recovered included the blades of exhaust fans and toilet seats. Recovery from exhaust fans showed that air is contaminated with droplets from exhaling (breathing out), coughing, and sneezing. The size of these droplets varies from visible to extremely tiny, small enough so that only one or a few viruses could fit within a single particle. Smaller particles can float in the air for long periods of time. From the experience with measles transmission, we know that air remaining in a room for as long as two hours after a patient has left can contain infectious virus. Whether SARS-COV-2 is as efficient as measles is unknown but considered unlikely.
Implications are that low-level infectiousness of ambient (remaining) air in areas through which patients have passed is entirely possible. How long these infectious particles persist is unknown, but experts downplay the risks of transmission through the air after the larger droplets have settled out.
There is a significant risk of low-level exposure for susceptible individuals who pass through areas in which infectious patients have been breathing. Whether this low-level exposure might lead to mild or inapparent disease is unknown. I think that there is substantial risk for mild exposure, which might actually be a good thing, since patients with asymptomatic infection are likely to obtain immunity which might be sufficient to prevent later severe disease.
(image courtesy of pixabay and TheDigitalArtist)
A German study of nine patients with COVID-19 published on March 5 on a pre-print server looked at cell culture to determine infectiousness before and during illness. Seven of the nine had only upper respiratory (sore throat and runny nose) symptoms and two had mild lower respiratory (cough) symptoms. All showed infectious virus shedding on days one through five of illness; after day eight, no infectious virus appeared. Although virus was detected in the feces, it was not infectious and could not have transmitted disease. Antibodies were found in the blood serum after about one week of illness.
While this study has not yet been peer-reviewed, it looks solid and I believe it can be depended upon to guide our decision-making.
“Conclusions: the present study shows that COVID-19 can often present as a common-cold type illness.” This small but thorough study indicates that everyone who says this virus presents as pneumonia is wrong. Most symptomatic patients only have upper respiratory symptoms (URI) and are infectious, with high levels of viral shedding, very early and possibly even before symptoms appear.
Apparently, this virus has swept the world because of its nearly unique features. First, it is highly infectious early in the illness, even 24 hours before symptoms appear. Second, most patients have mild or even trivial symptoms that might be ignored if there is not adequate support for sick leave and isolation. Third, it is antigenically different enough from previous coronaviruses that no-one in the world has pre-existing immunity.
The problem is that a small percentage of patients who fall ill develop pneumonia, respiratory distress, and low blood oxygen (deoxygenation). These patients represent the real burden of illness for the health system because they require hospitalization, intubation, and artificial respiration, that is they will need those ventilators that the Commander in Cheat thinks are unnecessary. Anywhere from five to twenty percent of patients fall into this latter group, and they will overwhelm the medical care system if “stay at home” orders are not followed.
The issue of gastrointestinal illness appears to be confined to a tiny percentage of patients and feces are unlikely to pass on the virus.
The level of exposure related to seriousness of illness has not been settled. If this virus is like most others, small exposures are likely to lead to mild illness and massive exposures may result in death from pneumonia and “cytokine storm” (massive over-reaction of the immune system to the virus).
As the pandemic spreads I am learning exponentially more about the SARS-COV2 problem and I am deeply concerned that people are not taking it seriously enough. I had an inkling that something was seriously wrong when I heard the first reports, and it seems that my instincts were correct. This virus will infect most of the world. It will have a massive effect on our economy that will last for years. It is too late to prevent major disruption of our lives. Universal testing is essential to limit the damage.
(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.”
