Hello, everyone.
This is a COVID-19 (aka SARS-cov-2, aka “novel coronavirus”) thread. Post what you like, including resources. I may incorporate the best of those into this original post so that people have them available. Initially, I’m working from memory, but I’ll edit the post and insert sources as I comb back through my communications and find them.
We are at the start of a global pandemic. The virus is highly contagious. Epidemiologists estimate that, in roughly the next year, 30% to 70% of the human beings on the planet will be infected with it. Initial reports suggest an approximately 2% fatality rate, overall (weighted heavily toward the elderly, but not entirely). If half of us get it, and of those, 2% die from it, we’re looking at, very roughly, 1% of the human population dead from it. In round figures, for a planetary population of almost 8 billion, that’s 80 million dead people in the next year. Even if, in the end, it’s half that lethal, that’s 40 million dead people. That’s with medical care, of course; it’s perfectly possible that, as it overwhelms the medical systems of countries all over the world, that it will be much more lethal than 2%. In China, about 15% of people with COVID-19 required hospitalization, and about 5% of the infected required intensive care, while in Italy, more than half of people with COVID-19 needed hospitalization, and 10% needed the ICU. ((https://www.statnews.com/2020/03/10/simple-math-alarming-answers-covid-19/)) People who need ventilators and don’t get them typically die. Let’s say 90% of them. So, if 4 billion people get COVID-19, and 5% of them need intensive care, and most of those don’t get it, we’re looking at a mortality rate of around 4.5%, or about 200 million people dead worldwide.
That figure does not include people who need critical care for other reasons but won’t get it because the system is overwhelmed.
Note that these are not worst-case figures. Worst case: 70% of humans get it, and the mortality rate turns out to be 4.5% because the medical systems are overwhelmed. In round figures, that’s 250 million dead people, still not including people who need critical care for other reasons who don’t get it.
In people aged 20-29, this virus appears to ride along symptom-free at high rates. ((See the image below, a comparison of South Korean cases versus Italian cases. In South Korea, they are testing everyone. In Italy, they are testing only people with symptoms. Look how many more cases in the 20-29 age cohort they are finding in South Korea.)) That means that, by the time many people in that age cohort have symptoms, they have already been infecting other people for the incubation period, which is around 5-14 days. That makes it very hard to contain.
It does not appear to be transmitted in a passively airborne fashion, like measles. However, viruses of this type can apparently survive for up to nine days on hard surfaces ((https://www.sciencedirect.com/science/article/pii/S0195670120300463)), and this specific virus has been shown to survive at least three days ((various media sources, easily searched)). So it’s not just people; it’s things which people touch, including handrails and elevator buttons.
As of today, 03-16, the United States has no way to test widely for it. (We were offered tests, but we refused the offers of help and tried to develop our own, but then developed a faulty test kit which had to be redesigned, which meant substantive delays.) Initial testing protocol was pointless, because no test kits were available. Now that they are starting to become available, there aren’t enough, and people are still being refused testing unless they have had contact with a confirmed case or travelled from a known hotspot, like Iran or Italy. In other words, we are flying blind, having no good measurement of size of the problem.
One way to try to infer the size of the infected-but-undetected population is to look at the number of tests of suspected cases which are positive. Based on that work, as of roughly 03-12, we probably had 100,000 infected people in the United States already. ((I’m looking for the cite on this))
The United States has prepared very poorly. First, in 2018 we eliminated our federal pandemic response agency. Then, in the earliest days, we didn’t socially distance early enough, and we still aren’t; a large percentage of the population is being encouraged by some media to go out and mingle.
Also, we have a population without universal health care, many with high-deductible coverage. Our population is used to rationing healthcare themselves, to deciding for themselves whether it’s worth the cost to seek medical help. One result of such a system is that many people who should seek help or screening don’t do so.
Also, we have a population in which large numbers of people don’t have sick leave or employment protections. It is absolutely routine for people in service sector jobs to work even when they know they’re sick. Restaurant servers, for instance, when they do call in sick are routinely asked, “When can you come in?” or told to pop DayQuil and come in or lose their jobs. This means a large number of people have serious short-term incentives to engage in behavior which will result is a high rate of transmission.
Also, our supply of ICU beds, and ventilators, is much lower than what will be necessary for a pandemic of this size, so we’re probably headed into a situation where we have to look at the “no ventilator” death rates, above.
To make matters worse, President Trump declared a travel ban in a manner which prompted a lot of people abroad to panic and fly home at the earliest opportunity, creating huge logjams of people in United States airports where people were packed closely for six hours or more. There are reports that the lines of suspected infected were queued up inches away from people who showed no sign of infection. It would have been hard to create a better system for spreading the virus among incoming travellers.
And here we are. Say what you need to say, being mindful of the commenting policy. Citations are helpful, and if anyone can help me source references or correct numbers, I’ll be grateful; I wasn’t planning on writing this, and didn’t take good notes as I educated myself.
Finally, because humor will be one of the things which gets most of us through this: remember that it’s only a quarantine if it’s from the Quara region of France. From anywhere else, it’s “sparkling isolation”.
Grace
Resources:
First, the best overall summary piece I’ve seen yet, as of 03-10.
The best hand washing video I’ve seen yet. You may have thought you knew how, but unless you’re a scrub nurse or a surgeon, I’ll bet that you didn’t.
Current status, presented graphically.
COVID-19 community calculator. Put your ZIP code in and see how your community will fare.
President Trump and his team were trained specifically on pandemic response:
https://www.politico.com/news/2020/03/16/trump-inauguration-warning-scenario-pandemic-132797
Grace
Thanks for making this thread, Grace!
So we have a friend who last visited here ten days ago. One of that friend’s housemates has come down sick with covid-19 like symptoms (a high fever with trouble breathing) and was recently (after the friend visited us) exposed to a confirmed case.
So their household is quarantining themselves in their home for the foreseeable future.
We’re doing the same thing for a while – although, honestly, we pretty much already were. I decided to stop leaving my house except for urgent needs a while ago. The Portland schools are closed, and the mall (where one of our tenants works a retail job) is closing as of tomorrow. (We’ve told the tenant not to worry if he can’t pay rent).
I’m feeling very lucky to live in a large household – nine people gives me a lot of chances for social interaction without having to step outside. Last night we played “7 Wonders,” which is a surprisingly addictive game. I’ve begun rewatching the Lord of the Rings movies (extended editions) and begun watching “Altered Carbon” and “Gentrified” on Netflix. I’m feeling oddly tempted to reread “The Stand.”
At least two people in this house – me included – would not make the cut if we were very ill and the hospitals were having to triage care. That’s not a comforting thought.
So how are your lives going? Are you self-isolating, and how are you finding that?
Oh, and a link I’ve found useful – a twitter list a journalist made of “epidemiologists, researchers, public health experts & journalists tracking COVID-19.” I’ve been checking it once or twice a day just to see what new things actual experts are talking about.
We’re mostly quarantined here except for the inevitable shopping trips and the handling of mail being delivered.
I am screaming into the void that is fb while seeing just how badly we are fucked. Fucked, in large part, because a lot of people currently have the choice of go to work and risk exposure/exposing others or be homeless. Fucked, in lesser part, because even people with access to a lot of info are not socially isolating – see, for example, the dozens of kids on the local elementary school playground, playing together today. Fucked in a larger part, again, because we have no way to stop the Republicans from slow walking the bills and mitigation measures we need or to stop them from eliminating elements that are vital. I’d be much more sympathetic to their “Economy, uber alles,” philosophy if they had any, you know, competence for that.
We’ll be fine at house Squid as we paid off the mortgage several years ago, have a good amount of savings since I had semi-planned for a decent amount of time off/a second retirement recently. I am among the most fortunate folks in the country and I know it. If I can be useful, I’ll probably find a way to volunteer at the hospital in the neighborhood.
But this does allow me to, once again or again, continuously, think about death. I’m always surprised by how much people don’t want to die given that I’m more or less okay with my own death. I’m not significant, I don’t matter overly much, there are much better people than me, etc. Pain, however, I really try to avoid. Since I’m not working and have a very limited number of people I’m liable to expose so long as our home is self isolating, that acceptance of my unavoidable death makes me suited to volunteering where I can as the hospital becomes overwhelmed where others may not be.
As I’ve said elsewhere, this is not the apocalypse that I was expecting. But, given who’s running our country and the trends of the last 50 years, it isn’t entirely surprising to see happen now.
Best of luck to all. Do your best to stay safe and keep others safe and, for those of us who survive, please make this a catalyst to create a more equitable and just society that minimizes the rewards for sociopathic behavior.
SO just for future reference, what will the moderation policy be re: commenters making jokes about Covid? I had assumed that this would be generally unwelcome, but I see Grace is talking about humour, so I would infer from her example that jokes about the situation in general are OK but making fun of people suffering/potentially suffering/feeling stress from Covid are not acceptable targets of humour?
I have serious issues with the WHO’s guide to mental health during the outbreak that Barry referenced on his twitter feed:
https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf?sfvrsn=6d3578af_8
“Minimize watching, reading or listening to news that causes you to feel anxious or distressed”
That might be fine for an ordinary person but the entire POINT of an anxiety/ OCD disorder is that it gets worse the more you try to avoid an anxiety. It’s the same problem with trigger warnings. And often several years pass between the start of symptoms and a diagnosis. So they’re giving advice that might be helpful for people with minor anxieties but that is actually harmful to the worst cases.
Apparently, contrary to earlier understanding, the COVID-19 virus has now been show to be viable in aerosol form for up to three hours. In other words, it can linger in the air. However, we don’t yet know whether it is functionally infectious in that form.
https://thehill.com/policy/healthcare/487110-tests-indicate-coronavirus-can-survive-in-the-air
Grace
Gracchus:
Humor requires judgement. Looks like you’ve got judgement.
In general, the more the humor targets human suffering, and the less sympathetic it is, and the more it targets specific groups or specific people, the more likely it is to be moderated.
Grace
And today a new term has entered my vocabulary: “patent troll”.
From https://www.techdirt.com/articles/20200316/14584244111/softbank-owned-patent-troll-using-monkey-selfie-law-firm-sues-to-block-covid-19-testing-using-theranos-patents.shtml
And we thought the Purell profiteers were reprehensible, but… wow. During a global pandemic, these folks are going to muck with people designing critically-needed medical tools.
Grace
https://apnews.com/Business%20Wire/eee1dd86883a4c22a6d6a661e43852f3
Labrador Diagnostics LLC (“Labrador”) today announced that it will offer to grant royalty-free licenses to third parties to use its patented diagnostics technology for use in tests directed to COVID-19. Labrador fully supports efforts to assess and ultimately end this pandemic and hopes that more tests will be created, disseminated, and used to quickly and effectively protect our communities through its offer of a royalty-free license during the current crisis.
Apparently the American public has become LESS convinced that COVID-19 is a threat, not more, thanks to the push from conservative media.
https://www.theamericanconservative.com/larison/public-opinion-and-the-pandemic/
Grace
Well, that’s awful news, Grace. But this is the end result of 30 years of non-stop, far right propaganda on cable and talk radio and the mainstream media’s need to avoid criticism by the far right by skewing their own coverage in that direction.
Tim Morrison, a former senior director for counterproliferation and biodefense in the National Security Council, says that Pres. Trump did NOT eliminate our federal pandemic response agency. Here is his side of the story. And as far as not having a national healthcare system being a big issue in this regard, I note that Italy and China each do have one and look what’s happened there.
The lack of tests is certainly a problem, but then developing tests locally rather than taking the ones from WHO was a CDC decision, not a White House decision – these are the experts that we’ve all been calling for Pres. Trump to listen to.
Politics is not the point here, folks, and it’s absurd to try to claim it is. No matter who was President or what party they belonged to this virus was going to come to America. As as been cited repeatedly, the only thing that the government can do is help flatten the curve so that the peak number of people needing intensive care doesn’t overwhelm the system’s ability to provide such care.
And I do mean “help”. Mayor Lightfoot of Chicago closed all the bars after seeing huge crowds of oblivious young drunks flooding the streets in Wrigleyville for St. Patrick’s Day celebrations even after she cancelled all the parades. All of them should have known better, but they were out there anyway. The bottom line is that, as you pointed out, individual actions matter. This pandemic can best be fought at the individual level. That’s where it starts. If people don’t take personal responsibility there’s little that government can do.
[Edited to fix broken link. -&]
https://science.sciencemag.org/content/early/2020/03/13/science.abb3221?rss=1
Grace
BTW – if you follow the home recipes for making your own hand sanitizer (2/3 alcohol, 1/3 aloe vera gel), be sure that the alcohol is 90% (190 proof) or higher. The most common grade of isopropanol that you find in the drug stores is 70%, not 91%, and that won’t work once diluted 2:1. The resultant mixture must be 60% alcohol or greater. At that point it’ll work just as well as any commercial product you can buy.
Soap and water are best, though. It’s not just physically washing away the virus particles. Coronaviruses are a kind of virus that is enveloped by a lipid layer – a layer of fat. Floating in that layer are molecules made up of protein and carbohydrates. Like icebergs in the ocean, most of the molecule is in the lipid layer but part of it sticks out. The part that sticks out (shaped like a crown, or a corona, hence the name) has a structure such that they have an affinity for molecules found on the surface of the cells lining your nose, mouth, lungs, etc. If they get a chance they link together. Then the membranes of the cells and the membranes of the viruses merge (think of two soap bubbles touching and then becoming one bigger soap bubble) and the contents of the virus enters the cell. At that point the virus’ contents take advantage of the cell’s various mechanisms to make a huge amount of virus particles, which leave the cell (taking part of the cell’s membrane to envelop them) to go infect more cells. This inhibits the cell from functioning normally, etc., etc. I say all this to illustrate that if you use soap it disrupts the virus’ membrane. The bare virus contents are not infectious, so it stops infection and transmission at that point. Alcohol disrupts the virus membranes as well, but not as well in and of itself and also doesn’t work as well if your hands are dirty.
RonF:
Sources encouraged, Ron. Got one?
Snopes says that the claim
is True.
https://www.snopes.com/fact-check/trump-fire-pandemic-team/
ForeignPolicy.com says
Here’s The Detroit News: https://www.detroitnews.com/story/news/nation/2020/03/14/trump-disbanded-pandemic-unit/111427174/
And here’s an article from Vox, in February of 2018, with details and explaining why it was a bad idea to budget-cut the CDC.
https://www.vox.com/science-and-health/2018/2/23/16974012/trump-pandemic-disease-response
Back to RonF:
Yes. Frightening, isn’t it, considering that we simply do not have the ability to respond with anything like the intensity they did. Just because something bad happened in the presence of something doesn’t mean that the presence of something had no effect, or a positive effect, on the bad thing; the bad thing might have been worse.
Feel free to point to where I said it was a White House decision. I was pointing out why we’re in a bad position, and the lack of tests is one of the big reasons.
Of course. That doesn’t mean that the administration in power didn’t undercut our ability to respond well, and isn’t still doing so. Since politics determines federal and state responses to emergencies, of course politics is part of the discussion.
Of course individual actions matter. So does government action; individuals can’t prepare a coordinated, federally-funded disaster response in advance of a disaster. But governments can.
Grace
“Sparkling isolation!”
Lovin’ it!
@RonF: Nobody is claiming that having a national healthcare system will prevent Covid being a very serious problem, so “well Italy has a national healthcare system and people are still dying so therefore there’s no point in national healthcare systems” is rebutting a point literally nobody is making. No matter how a national healthcare system is set up, the problem of going over its capacity – the problem Italy is right now facing – exists. That’s indisputable, and in some alternative universe where the USA had one, the risk would still exist.
But if critics of the US healthcare system are correct, the USA is going to face even bigger problems, because nobody has the responsibility of making sure that the overall healthcare system is sufficient for a public health emergency. In Italy they weren’t successful in ensuring sufficient capacity. But in the USA, nobody has been trying, because the raison d’etre of healthcare providers in the USA is private profit, not public safety.
“Feel free to point to where I said it was a White House decision. I was pointing out why we’re in a bad position, and the lack of tests is one of the big reasons.”
The thing is Grace, just because Trump is the head of the executive branch of the United States government, of which the CDC is part, it doesn’t mean he is responsible for what the United States government does. Unless it does something good, like blow up a terrorist, then he’s 100% responsible.
It’s like Harry Truman said – the buck stops here (for the good things).
Ron, Tim Morrison is a hardline conservative who dismisses even calm, respectful criticism of his view as “Trump derangement syndrome.” I’m not convinced that there’s any criticism of Trump’s actions, however meritorious, that he wouldn’t dismiss out of hand.
Beth Cameron ran the office that Trump disbanded; I think she’d know. And as this tweet thread points out, dissolving an office and making it just part of another office has real consequences. (The author of that thread is Loren DeJonge Schulman, who has extensive executive branch experience.)
Also here’s a video of Trump talking about firing them: https://www.independent.co.uk/news/world/americas/us-politics/coronavirus-video-trump-pandemic-team-cut-2018-a9405191.html
Opinion | They Went Off the Grid. They Came Back to the Coronavirus. – The New York Times
Alternate link.
RonF:
Right. South Korea has gotten the epidemic under control because of individuals manufacturing tests themselves, then testing themselves, then going out and finding all the people they’ve recently been in contact with and asking them nicely to please manufacture a test, test themselves and then go out and contact everyone they’ve recently been in contact with.
No wait, that makes no sense and would be a fantastic way to spread the epidemic even further. In fact, government employees developed detailed emergency response plans for situations that most people never give much thought, then government employees identified that the emergency response plans needed to be activated, then government employees ordered the manufacture of test kits, then other government employees tested people, then other government employees went out and traced their connections, then, when a small group who were spreading the disease irresponsibly wouldn’t comply voluntarily, other government employees made them quarantine and self isolate. It was all boring and bureaucratic and just a huge waste of tax payer money, until it wasn’t.
But obviously the government had nothing to do with that. It was all just personal responsibility undertaken in the name of Libertarian Jesus. Thank god no one had to pay any taxes towards any sort of public health system!
RonF, you do understand that this is going to kill people you know and like, right? That if we had the sort of government systems in place you’ve spent years decrying, that this could have been controlled at a level where they wouldn’t have to die? It wasn’t irresponsible young people who prevented us from having a functioning public health system, it was people like you. When this kills your friends, you’ll be sitting there thinking, “Welp, it sucks that young people are so stupid and irresponsible,” and you’ll never recognize that it was you and yours who did this to us.
But of course, personal responsibility doesn’t extend to Trump who somehow has no responsibility for what the CDC does or doesn’t do in the middle of a crisis. It’s not like the president has any sway over the CDC or any way of monitoring its decision making process, I mean who could have imagined that it might be a good idea to have a group on the National Security Council who could keep an eye on how we are handling novel pandemics. It’s not like some lazy former president made sure that our new president’s transition team ran through a training exercise specifically about this specific threat. Nope, when we say that the president should listen to the scientists, obviously we mean that the president should be an inert lump in general, rather than that he shouldn’t constantly lie and make shit up and ignore the real and present danger because it makes him look bad. Nope, nothing the president could have done, unlike those irresponsible young people…
The Imperial College has released its initial report modelling the course of the disease.
https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf
Figure 2 is on page 8. Here it is:
Note how tiny the distance is between the critical care bed capacity and the peak of the curve is, in each and every scenario, including the ones which are more isolating than we can probably achieve as a society.
Grace
I’m sort of beginning to realize that this is going to last a long, long time, and trying to manage that by not thinking about it too much. I mean, I’m thinking about it, but I’m deliberately avoiding spending all day obsessing on it.
I’m also stepping up my binge-watching. I’ve almost finished the first season of “Altered Carbon,” and I just watched the first episode of “Berlin Babylon” (both on Netflix).
There were a couple of comments about “Altered Carbon” and “Berlin Babylon.” My fault, obviously; but rather than let that discussion happen on this thread, I’ve moved those comments to the new open thread.
From The Guardian, at https://www.theguardian.com/world/2020/mar/18/japanese-flu-drug-clearly-effective-in-treating-coronavirus-says-china:
Grace
That’s really exciting, Grace! Fingers crossed that this pans out.
From further in the article….
Part of me is going “May? MAY?!?!?!” If the drug has already been used widely and is known to be safe, I’d hope they could get it approved quicker.
I think that, if we want to save thousands to millions of lives, we need to be prepared to isolate for months to years. That would require a wholesale change in how our – very much slowed down – economy distributes resources among the population. That’s not likely, but it isn’t impossible, either and is certainly worth fighting for.
Ampersand:
Yes, it’s exceedingly odd. LGBT people know from the AIDS epidemic that the FDA is usually so good at acting swiftly in emergencies, and expeditiously weighing the lives lost by delay against the lives lost by inaction.
Grace
The Imperial College had a model in which the disease comes and goes in waves, and between waves people can go out and socialize.
But it also depends on if, and how much, treatments for COVID improve.
Peeking my head out of the quagmire of trying to put my courses online, get in touch with students who were not expecting to have to take courses online—some significant minority of whom are vulnerable to the current situation in all kinds of serious ways. We are more or less self-quarantining and we’re waiting to hear about one of my son’s friends, who started to get sick with what could just be (what we all hope is) a regular cold. Before I dive back in, though, I have to share this for any of you who are teachers, who are in the same situation I’m in. It’s gone viral, but in case you haven’t seen it:
https://www.youtube.com/embed/CCe5PaeAeew
Ampersand:
One of the things I wondered, about that model: did it account for pent-up demand? Because when released from restrictions, people tend to want to catch up. If that were included in the model, I wonder if it would shorten the length of the time during which people would be permitted to interact freely.
Grace
I think that massive testing efforts are the thing that will make it possible to go out and cautiously socialize and do non-essential jobs, once we manage to bend the curve on the initial exponential growth through self-isolation. If we can test anyone who has any symptoms and then, if they test positive, test and isolate anyone they’ve been in contact with, and continue contact tracing with anyone who tests positive, then we can shelter in place a much smaller part of the community, while letting most people move about more freely (just maintaining moderate social distancing). It’s worked in South Korea. If we tested everyone in the country at once, and did that every few days for a month or two, we could probably clear every case in the country, and then just need to maintain 14 day quarantine for international travelers. So we need a testing capacity of about 3 billion tests. It looks like we are a few weeks away from having 10 million + tests a week, so that’s only off by a factor of 100. Even 10 million tests a week ought to be enough to start doing serious contact tracing.
That will be a lot of effort, but it seems far less bad than killing 2+ million people and locking everyone else in their homes for a year, which would kill a lot of people as well.
Charles S:
I’m inclined to agree. It’s possible that we will see a one-hour test with portable equipment which doesn’t need to be sanitized:
https://www.bizjournals.com/losangeles/news/2020/03/17/1-hr-coronavirus-test-made-by-irvine-s-fluxergy.html
…though I have no idea how fast they can scale those up. But with those, it might be possible to test people very frequently (every few days) and do contact-tracing.
It’s clear that with the long incubation period and the high percentage of people who are asymptomatic, nothing but testing everyone will get COVID-19 under control.
Grace
And now we can’t do the needed tests because it would deplete our supply of Personal Protective Equipment:
https://www.cnn.com/world/live-news/coronavirus-outbreak-03-21-20-intl-hnk/h_78c431662464112a27434663a0860cdc
Frankly, I’m spending a lot of time in bed hiding under the covers and hoping my workplace closes, even if I end up out of work for a while.
I have coworkers in their 20s and until this past week we were still allowing clients into the building (now we collect the cat or dog outside). My husband is in his late 60s with cardiac disease and diabetes. I am terrified of bringing this disease home to him. I am social distancing in my home with my husband. This is untenable long-term.
It is also creating tensions at work between those who are more worried and those who are less so, and though I know I shouldn’t feed into that my anxiety keeps coming out.
I am exhausted.
Excellent post summarizing what we know about face masks. (There’s no evidence the CDC deliberately liked about face mask effectiveness, btw.)
https://slatestarcodex.com/2020/03/23/face-masks-much-more-than-you-wanted-to-know/