Coronavirus pandemic non-socio-political discussions

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wrenhal

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I just can't even...

March 30, 2020
Possible Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in a Public Bath Center in Huai’an, Jiangsu Province, China
Chao Luo, MD, PhD1; Lun Yao, MD2; Li Zhang, MD, PhD1; et alMengchu Yao, MD3; Xiaofei Chen, MD, PhD3; Qilong Wang, MD, PhD1; Hongbing Shen, MD, PhD4

JAMA Netw Open. 2020;3(3):e204583. doi:10.1001/jamanetworkopen.2020.4583

Introduction
In December 2019, a novel pneumonia named coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan, China, and has since spread to 25 countries. Current reports show that SARS-CoV-2 is closely related to severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)1,2 and that it has a greater transmissibility than other coronaviruses. The confirmed transmission modes of SARS-CoV-2 include respiratory droplets and physical contact, and the incubation period for the virus is approximately 3 to 7 days, but it can be as long as 24 days.3 In this case series, we report a cluster-spreading event in Huai’an (700 km northeast of Wuhan) in Jiangsu Province, China, in which a patient with SARS-CoV-2 may have transmitted the virus to 8 other healthy individuals via bathing in a public bath center.

Methods
Data were collected from Huai’an No. 4 Hospital of Jiangsu Province, China. A total of 9 patients who had been to the same bath center were hospitalized and enrolled from January 25, 2020, to February 10, 2020. Throat swab samples were collected, and SARS-CoV-2 was detected using a quantitative reverse transcription–polymerase chain reaction assay. Computed tomography and hematological examinations were performed for auxiliary diagnoses. Data were analyzed with Prism version 7.00 (GraphPad). This study was approved by the ethics committee of Huai’an No. 4 Hospital, and written informed consent was obtained from all patients. This study followed the reporting guideline for case series. No prespecified threshold for statistical significance was set.

Results
The bath center for men was approximately 300 m2, with temperatures from 25 to 41 °C and humidity of approximately 60%. It contained a swimming pool, showers, and sauna. The first patient (patient 1) had traveled to Wuhan. He went to the bath center and showered on January 18, 2020. He started experiencing a fever on January 19, 2020, and was diagnosed with COVID-19 on January 25, 2020. The next 7 patients showered, used the sauna, and swam in the same center on January 19 (patients 2, 3, and 4), January 20 (patient 5), January 23 (patients 6 and 7), and January 24 (patient 8). The symptoms associated with COVID-19, including fever, cough, headache, and chest congestion, appeared between 6 and 9 days after visiting the bath center. Patient 9 was working in the bath center and experienced onset on January 30. Infection in all patients was confirmed by positive reverse transcription–polymerase chain reaction assay results (Figure).

The median (interquartile range) age of the patients was 35 (24-50) years. A total of 8 patients (89%) reported fever (mean [SD] duration, 5.78 [2.99] days), and 7 patients (78%) reported a cough. Few patients (3 [33%]) showed debilitation, chest distress (2 [22%]), or anorexia (1 [11%]). Diarrhea, myalgia, rhinorrhea, and headache were not reported. C-reactive protein levels were elevated in 9 patients (100%; mean [SD], 3.34 [3.18] mg/dL; to convert to milligrams per liter, multiply by 10). Lymphopenia occurred in 3 patients (33%), lactate dehydrogenase was increased in 3 patients (33%; mean [SD], 225.56 [85.33] U/L; to convert to microkatals per liter, multiply by 0.0167), and glutamic oxaloacetic transaminase was increased in 2 patients (22%; mean [SD], 30.22 [13.94] U/L) (Table).

Computed tomography examinations were performed, and the ground glass opacities were observed in all 9 patients. As of February 10, 2020, no patients required respiratory support.

Discussion
Previous studies have demonstrated that the transmission rate of a virus is significantly weakened in an environment with high temperature and humidity.4 However, judging from the results of this study, the transmissibility of SARS-CoV-2 showed no signs of weakening in warm and humid conditions. We noticed a clustered case occurring in a public bath center with high temperature and humidity. A total of 8 individuals who used or worked in the bath center experienced symptoms within 6 to 9 days of their visit to the center, suggesting that SARS-CoV-2 could spread and cause infection in such an environment. The transmission routes may also be respiratory droplets or contact, but our results suggest that the cluster transmission of SARS-CoV-2 can still arise in an environment with high temperature and humidity. These results provide a potential epidemiological clue for this novel coronavirus. This study was limited by a lack of detail regarding the transmission routes of the patients in the bath center.

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Article Information
Accepted for Publication: March 6, 2020.

Published: March 30, 2020. doi:10.1001/jamanetworkopen.2020.4583
In places like China that are densely populated, how can they say these people caught the virus from one person a day after he showered there?

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RxCowboy

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In places like China that are densely populated, how can they say these people caught the virus from one person a day after he showered there?

Sent from my Moto Z (2) using Tapatalk
That would be a better question for my epidemiologist friend, but to my understanding, they would trace contacts back until they found a common denominator. Find what they all had in common with patient zero, the one who traveled to Wuhan.
 

RxCowboy

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April 8, 2020
Sudden and Complete Olfactory Loss Function as a Possible Symptom of COVID-19
Michael Eliezer, MD1; Charlotte Hautefort, MD2; Anne-Laure Hamel, MD2; et alBenjamin Verillaud, MD2; Philippe Herman, MD, PhD2; Emmanuel Houdart, MD, PhD1; Corinne Eloit, MD2

JAMA Otolaryngol Head Neck Surg. Published online April 8, 2020. doi:10.1001/jamaoto.2020.0832
The novel coronavirus disease 2019 (COVD-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects the human respiratory epithelial cells. The clinical features of patients infected with SARS-CoV-2 included lower respiratory tract infection with fever, dry cough, and dyspnea.1 In contrast, upper respiratory tract symptoms are less common, suggesting that the cells targeted by the virus could be located in the lower respiratory tract.1

Herein we present a case where the main symptom expressed by the patient infected by SARS-CoV-2 was the sudden and complete loss of the olfactory function without nasal obstruction.

Report of a Case

A woman in her 40s presented with an acute loss of the olfactory function without nasal obstruction. There was no dysgeusia because the patient reported no changes in salty, sweet, sour, and bitter. A few days before presentation, she also experienced a dry cough associated with cephalalgia and myalgia. She had no fever or rhinorrhea. The otoscopic and anterior rhinoscopic examination results (without endoscopic examination) were normal.

The ability to detect and identify odorants was estimated using 5 odorants commonly used to test human olfaction: phenyl-ethyl-alcohol (flower rose), cyclotene (caramel), isovaleric acid (goat cheese), undecalactone (fruits), and skatole (manure). The task was to detect and try to identify each odorant. None of these odorants were identified or detected by the patient.

The patient underwent a computed tomographic scan of the nasal cavity (Figure 1) that showed bilateral inflammatory obstruction of the olfactory clefts that was confirmed on magnetic resonance imaging (MRI) of the nasal cavity (Figure 2). There were no anomalies of the olfactory bulbs and tracts. Because her husband was also suspected to be infected by SARS-CoV-2, the patient underwent real-time polymerase chain reaction (RT-PCR) for SARS-CoV-2, which yielded positive results.

Figure 1. Nasal Cavity Computed Tomographic Image of Coronal Section
1586387432773.png

Nasal Cavity Computed Tomographic Image of Coronal Section
Bilateral obstruction of the olfactory cleft (yellow arrowheads) without obstruction in the rest of the nasal cavities.

Figure 2. Magnetic Resonance Images
1586387462174.png

Coronal section of the olfactory clefts and bulbs on (A) 2-dimensional T2-weighted, and (B) 3-dimensional T2-weighted sequences. The olfactory bulbs (blue arrowheads) are normal, whereas a bilateral inflammatory obstruction (yellow arrowheads) of the olfactory clefts is observed. There is a slight hyperplasia of the mucosa of the right maxillary cavity.

Discussion

Upper respiratory tract infection is one of the most commonly identified causes of olfactory loss, accounting for 22% to 36% of cases.2 Herein, we describe a patient with COVID-19 who presented with bilateral obstructive inflammation of olfactory clefts on imaging, which severely impaired the olfactory function by preventing odorant molecules from reaching the olfactory epithelium.

The origin of this obstruction remains unknown and has been reported in patients following a severe nasopharyngeal infection.3 However, in this patient no nasal obstruction or rhinorrhea was noticed. Trotier et al3 have reported persistence of the symptoms despite inhaled corticosteroids or oral corticoid treatments associated with antibiotics. In addition, corticosteroids should be avoided in patients infected by SARS-CoV-2.

Most coronaviruses share a similar structure and infection pathway; thus, one can expect the similar infection mechanisms for SARS-CoV-2.4 Coronaviruses could invade the brain via the cribriform plate close to the olfactory bulb and the olfactory epithelium. We could expect some structural changes in the olfactory bulb that were not observed in this case. However, it is important to assess the volume of the olfactory bulb that might be, at this this stage, too subtle to be detected on MRI results. Moreover, Yao et al5 have reported that the volume of the olfactory bulb is decreased in patients with postinfectious olfactory loss and is inversely related to the duration of olfactory loss.

Recently Ligget et al6 described an expression of the olfactory receptor family on central cortical neurons, vascular smooth muscle, and upper and lower airway epithelium. Because SARS-CoV-2 infects the human respiratory epithelial cells through an impairment of the angiotensin-converting enzyme 2 receptor, we believe that this olfactory receptor family could also be selectively impaired.1

To our knowledge, this is the first report of a patient with COVID-19 presenting essentially with an olfactory function loss. As reported by the French Society of ENT (https://www.snorl.org/category-acces-libre/alerte-anosmie-covid-19-20-mars-2020/), we believe that the association of a sudden and complete olfactory function loss, without nasal obstruction in a patient with other symptoms, such as cough or fever, should alert the clinician to suspect SARS-CoV-2 infection.

Article Information
Corresponding Author: Michael Eliezer, MD, Neuroradiology Unit, Lariboisière University Hospital, 75010 Paris, France (michael.eliezer@aphp.fr).

Published Online: April 8, 2020. doi:10.1001/jamaoto.2020.0832

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.
 

RxCowboy

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April 9

Covid19 Update: Today I would like to address the question that is on most of our minds, "now what?" What happens after we hit our peak?

First, I think it is important that you know that the peak is not going to be a single day event and the next day everything starts getting better. The peak just means it will be the highest point. We will stay there for a little while. How long is impossible to say. It could be days, it could be a a week or two. But either way we will sit at the peak for awhile before starting our descent. It's more of a plateau.

Also worth noting, different people calculate the peak point according to different outcomes. Some people are considering the peak to be when cases peak (i.e. total new infections in a single day) other people are measuring it according to peak deaths (i.e. highest number of deaths in a single day). And some people are looking at it as a combination of both. When looking at a model it helps to know which way they are reporting.

Finally, before we really get started, it is worth remembering that our efforts to "flatten the curve" had two goals.

Goal 1: reduce serious/critical/fatal cases,

Goal 2: Don't overwhelm the system, instead buy time so we can ramp up. We seem to be on track with this, which is great. One known consequence of this approach is that we lengthen the duration of the outbreak. Meaning, we stretch it out. By stretching it out, we assure that we don't overwhelm hospitals and medical staff but instead give them time to prepare, get equipment, develop a treatment plan, manage numbers they can actually accommodate and of course people can start working on treatments, cures and vaccines. In exchange, we deal with this a little longer.

So how does it end? One day do we wake up and they say we can go out and we shield our eyes as we emerge from isolation? No. First, we aren't all in caves so we won't need to shield our eyes. Second, It won't be ending for all of us at the same time. Different states will peak at different times. Based on the start pattern, I would say there will be about 4-6 weeks between when the first state peaks and the last. And how long the peak lasts will also vary from state to state. As will the ramping down period. So we won't all get the "all clear" at the same time.

If we act too soon we will see a resurgence of cases. Keep in mind when this first round is over, about 95-97% of Americans will still be susceptible. (This is of course highly dependent on how many of us get it in round one. As we begin ramping down (by state), we need to accomplish 3 things in order to return to "normal."

1. The anticipated case load will have to be low enough to no longer overwhelm the system. Health events that overwhelm the system are considered a public health crisis. So we can't be in crisis mode. We have to move slowly enough that the cases funneled into the system don't overwhelm it, that is the very thing this quarantine was designed to prevent. Be prepared that if a resurgence begins in your area, you may have to return to quarantine while it is controlled. We would be looking for manageable numbers for 14 consecutive days. That is the point in the "downward slope" where we could start talking about our 'reentry program"

2. We need to know who has it, who has had it and who hasn't. This can only be accomplished through mass testing with quality, dependent tests. Serological tests (essentially blood tests) are in development and really are preferred for this level of quality testing. This allows us to figure out if it is safe for you to be out and around others, because you may have actually had a mild case without even knowing it. Or you may have known you had it but got a false negative when you were tested. Either way, by knowing who has and has not been exposed - we will then know who is still vulnerable. During this phase you may see recommendations that vary for those who have already had it , those who actively have it, and those who haven't yet been exposed/tested. This will be a massive undertaking and could look very different in different places, but the most practical course would be drive-up testing sites. For my former students, this would be those PODs (points of dispensing) we discussed.

3. We will need to implement contact tracing and isolation. This is a simple outbreak 101 activity that means if we test you and you have it, we then isolate you and track down everyone you have been in contact with and quarantine them. They too would undergo testing and monitoring for 14 days. If you are currently staying home, this process will be pretty simple. If you have had to go out to work, or have been ignoring the quarantine, it will require a bit more leg work to trace down everyone you have been in contact with. One major hindrance here is the manpower required to do this. Most states do not have anywhere near enough public health professionals to do this at this level, so it may have to be done in stages. Rest assured they are currently working on plans.

This is the textbook version of what needs to happen. And some countries have started doing these things. Some countries, smaller ones, started with these things from the beginning. But just how these end up looking in America, will probably vary from place to place. Resources will play a big role (material, financial and human) as will the tolerance of the people in a given area as well as how severe the outbreak has been in an area. Then other factors could complicate things - like travel, adherence and moving too quickly.
The main takeaway is that this will be a slow, gradual process that will most likely take months as it moves state to state. "Normal" may not show up until June or July for some of us. But it also shouldn't still look like this. I would anticipate that through late April into mid to late May most of us should be moving into stage 2 activities. We just have to be patient a little longer.

FINAL THOUGHT: Every so often, events happen that become markers in our lives collective experiences we all share. Events so powerful we measure time according to "before" xyz event or "after." Events that we tell shared stories about, "where were you during the quarantine of 2020?" This is clearly one of those events. When my grandchildren ask me about it, I want to be able to tell stories of being part of the solution, not part of the problem. I want to share stories of triumph and compassion and kindness and so those are the stories I focus on. Bypass the anger, rage, fear and blame, there will be plenty of time for all that. Instead, focus on the good. Stand shoulder to shoulder with your neighbors (metaphorically of course during social distancing) as one nation, united. Now is not the time for division but for unity. Our souls need it, our nerves need it, our mental health needs it. We can resume the fighting later.
 

RxCowboy

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April 10

Covid19 - Update: It's Friday! We made it through another work week. We are one day closer to this all coming to an end.

Yesterday was a quieter day so I have very little to share but there were two articles that came out about adjusting the R0. You may recall, R0 is the rate we expect people to spread the disease (technically the basic reproductive number) but it means for each person who gets it, they will spread it to x number of people.

Originally the R0 was estimated at 2.2. This was just an estimate based off numbers from China and other coronaviruses. We couldn't know for sure because we had never had an outbreak of it before. Well now we have a lot more numbers from all over the world and that 2.2 was wrong. Just how wrong is up for debate.

The two reports that came out yesterday didn't agree on the exact number but they did agree that 2.2 was off. One of them said it could be as high as 25. That's a big number. So each person could give it to 25 others. Yikes. Measles is an 18 and we considered that one of the fastest spreading diseases known to man. But 25 could be skewed by outliers (like the guy in Boston who gave it to 60 people). The report said at minimum it would be 5-6 but they thought more likely around 15.

The second report said 5.5 - which is still more than we thought. Keep in mind it is an average for the entire world, so most likely some areas will have a higher number while others are lower - with the average falling around 5-7. For instance, you would expect someone in Montana to give it to less people than someone in Shanghai simply because of the population density and the number of people you encounter. A hugger will give it to more than a home body (the Chicago case in point). Nations that shake hands will spread it more than nations that bow. When you average it all together what do you get? We aren't 100% sure yet, but we do know it is at least 5.7.

In practical terms, this changes nothing about what we are doing. But it does help explain why the disease is spreading so quickly. If each person were only giving it to 2 people - we would expect a slower spread than what we are seeing (still faster than the flu). If each person is giving it to 15 people - well that moves pretty quick. That makes our social distancing efforts even more important. It means you are saving even more lives than you thought by simply staying home.

I have already seen this sensationalized in the news feeds so don't buy into the hype. The disease hasn't changed, the approach hasn't changed - just what we know about it. This new knowledge helps explains some things.

FINAL THOUGHTS: By staying home you have potentially saved 25 lives! And those 25 lives each saved 25 lives. That number adds up quick - and that pretty much makes you a hero.
 

RxCowboy

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April 10, 2020
Seasonal Influenza Activity During the SARS-CoV-2 Outbreak in Japan
Haruka Sakamoto, MD, MPH1; Masahiro Ishikane, MD, PhD2; Peter Ueda, MD, PhD1

JAMA. Published online April 10, 2020. doi:10.1001/jama.2020.6173

Since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak began, measures for avoiding disease transmission have been widely promoted in Japan, such as use of masks and handwashing, remote work, and cancellation of large events. If effective, these measures may also reduce the spread of other infectious diseases, such as seasonal influenza. We compared the weekly influenza activity in the 2019/2020 season vs 5 previous seasons.

Methods
We used data from 2014 to 2020 from the National Institute of Infectious Diseases Japan, which gathers the number of cases of seasonal influenza weekly, diagnosed by physicians based on clinical symptoms or laboratory findings, from approximately 5000 sentinel centers, including hospitals and clinics (60% pediatrics and 40% internal or general medicine clinics).1,2 We grouped the weekly reports into seasons (week 40 of the year through week 11 of the following year [September 30, 2019, through March 15, 2020, for the 2019/2020 season]; the season was truncated after week 11 because this was the latest available data for 2020). In each season we assessed the weekly influenza activity, presented as a crude standardized estimate of influenza activity nationally, calculated by multiplying the mean number of reported cases per sentinel center with a constant number (n?=?72?201) representing the number of outpatient visits to hospitals and clinics in the country in 20193 vs the health care institutions in the surveillance system.1,4 We estimated the change in influenza activity after the SARS-CoV-2 outbreak using a “difference-in-difference” regression model that included a variable for each week, a variable representing the average difference in influenza activity per week for the 2019/2020 season vs the 2014 to 2019 seasons before the outbreak (week 1-11), and interaction variables for each week after the outbreak and the 2019/2020 season. The difference-in-difference value was considered statistically significant if the 95% CI did not overlap 0. Approximately 10% of the sentinel centers provided samples from a subset of influenza cases from week 36 through week 7 in the 2019/2020 season and from week 36 through week 35 in the 2014 to 2019 seasons for analysis using polymerase chain reaction (PCR) testing. Using these data we assessed the predominant subtype of the influenza virus and compared the distribution of cases by age group (aged <15, 15-54, and =55 y) in the 2019/2020 season vs the 2014 to 2019 seasons (not including the 2015/2016 season, for which age-specific data were not available) using the ?2 test. Stata version 16.1 (StataCorp) was used. Institutional board review was not required because no individual-level data were used.

Results
Analyses were based on 8?414?693 cases of influenza (981?373 from the 2019/2020 season). Across all seasons, influenza activity increased toward the end of the year. While influenza activity reached its peak between week 4 and 6 in the 2014 to 2019 seasons, there was a plateau in the beginning of the year and a decrease from week 5 onwards in the 2019/2020 season (Figure). In the difference-in-difference analysis, influenza activity was significantly lower from week 3 through week 7 in the 2019/2020 season vs the 2014 to 2019 seasons (Table). PCR test results were available on 51?847 samples. The predominant subtypes of influenza virus are shown in the Figure. The number of PCR-confirmed cases in the 2014 to 2019 seasons was 25?930 (63.3%) in individuals younger than 15 years, 10?215 (24.9%) in individuals aged 15 to 54 years, and 4801 (11.7%) in individuals aged at least 55 years; in the 2019/2020 season, the numbers were 2267 (68.9%) in individuals younger than 15 years, 770 (23.4%) in individuals aged 15 to 54 years, and 254 (7.7%) in individuals aged at least 55 years. A lower proportion of cases in the 2019/2020 season vs previous seasons included individuals aged at least 15 years (P?<?.001).

Discussion
Seasonal influenza activity was lower in 2020 than in previous years in Japan. Influenza activity may have been affected by temperature5 or virulence (although influenza activity in the 2019/2020 season was moderately severe in other parts of the world6), but also by measures taken to constrain the SARS-CoV-2 outbreak. While closure of schools and suspension of large events occurred late in the influenza season, awareness regarding measures to reduce the risk of disease transmission was high among the Japanese public from early in the year. Limitations of this study include lack of availability of age-specific weekly data on influenza activity and information regarding means of diagnosis. Concerns regarding the SARS-CoV-2 outbreak may have changed detection of influenza through changes in symptomatic individuals seeking medical attention or in physicians’ inclination to test for influenza.

Section Editor: Jody W. Zylke, MD, Deputy Editor.

Article Information
Corresponding Author: Peter Ueda, MD, PhD, Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, 113-0033, Tokyo, Japan (peter.ueda@gmail.com).

Accepted for Publication: April 6, 2020.

Published Online: April 10, 2020. doi:10.1001/jama.2020.6173

Author Contributions: Dr Ueda had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Sakamoto, Ueda.

Administrative, technical, or material support: Sakamoto, Ishikane.

Supervision: Sakamoto, Ishikane.
 

RxCowboy

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April 13

Covid19 Update: Happy Monday. Here are a few things that came out over the weekend that seem significant. These are not great news so if you are having a rough start to the week - don't stop - just cruise on by.

1) In NYC an estimated 180-195 people are dying each day in their home from Covid19. These individuals are not being counted in the official numbers. Originally they were trying to test them, but now they no longer can (resource issue). These are just estimates based on how many cases they were originally testing when they could.

2) A report came out of University of Texas at Austin suggesting that only 1 in 10 of all cases in the United States is actually being tested and reported. So in areas where there is one case detected there is a strong chance there is an outbreak happening. This is of course based on statistical modeling and analysis of the numbers they have seen so it's just an estimate - but it is an estimate worth knowing.

3) Several meat processing plants in the United States have had to shutter their doors due to illness among the workers. So far this represents a small portion of our meat supply but its something to watch.

4) We still don't seem to have the test quite right in America. If it is any comfort to you, we are not the only country with this issue. But getting the test to have the right sensitivity and specificity (the ability to correctly and consistently get accurate results) is critical to our next steps. This is frustrating to all of us. But keep in mind it is a complex scientific and engineering process that they are trying to rush (for obvious reasons). When you rush - sometimes the quality isn't what you want. Or production can't keep up with demand. So we must continue to be patient here.

5) Initial testing among possible treatments is going very well with many options seeming to show promise. Hopefully, these will result is multiple, high quality, treatment and prevention options. They aren't ready yet (these things take time) but there are quite a few options that seem to be performing well, so that's a bit of good news.

FINAL THOUGHTS: Yesterday was Easter and many of us celebrated a different kind of Easter than we normally do. Some were in total isolation - and that takes a toll. Some had to try to explain it all to young children. Some had to endure the snarly looks of teens who just want to go hang out with their friends. Some had to forgo visits with their loved ones. Some faced storms and frightening weather and power outages. Many, felt disappointment and let down. Many struggled with internet connection issues, just one more frustration to test their already thin nerves. This situation is rolling into yet another week and it is easy to grow discouraged, frustrated and "over it." Emotions may once again be running high while spirits are running low and I just added to it by sharing a list full of mostly bad (or at least not good) news. It is in those moments that it is important to consider all that you have to be thankful for. To focus on the positive things, to reach out to family and friends (phone, FaceTime, Zoom) to get in your car and go for a drive, play cards, go for a run, take a long shower, bake cookies, check on your family and friends, especially those who are truly alone. But don't let go of hope. This is a marathon, not a sprint. Let's cheer each other on, hold each other up and carry each other through.
 

RxCowboy

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April 14

COVID-19 Update:
1) Yesterday's numbers were promising. Things seem to be slowing in some areas which made the number overall look better. The social distancing is working. Of course, that doesn't mean we can rush back out to "normal" activities but it is promising and a little glimmer of light in the tunnel. We will need those numbers to continue improving to truly know we are on the downward slope so watch for that.

2) We have been discussing if you could get it twice, you may recall there were a couple of cases where people tested negative then positive and we were trying to sort that out. Well in further good news, it appears those were faulty tests. Research that is currently underway has been looking at the antibodies present after you fight it off and the situation is good. Current estimates are that you will have 1-2 years of immunity. Long enough for a vaccine or effective treatment to be developed, so that is very good news. It could be longer, we don't know for sure yet. Remember, we haven't had anyone whose recovered for that long so we have to model it and make educated guesses.

3) Over 100 companies all around the world are working on a vaccine. Personally, I am hoping for the nanopatch - for no real reason other than I think it is amazing. Vaccines take time so it won't be ready anytime soon, but again, it is light on the horizon.

4) Men continue to be at increased risk of dying from the disease compared to women. The exact reason for this is still being researched but some prevailing theories are that men are more likely to have some form of lung damage such as damage from smoking or exposure to harmful chemicals/pollutants. This is only a working theory - more research is underway.

FINAL THOUGHTS: Hope is a beautiful thing. Yesterday there was plenty of bad news around the nation. Tornadoes ripped through states leaving destruction, and snow dumped down on people desperate for just a little sunshine. But despite the hardships, today we are met with a small ray of hope. In celebration, it may be time to put away those elastic waistband pants, grab a hairbrush, some deodorant, a razor and find the toothpaste. Trust me, you'll be glad you did.
 

RxCowboy

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#70
April 15
Covid-19 Update: We need to discuss a few difficult things today - so again, do a mental health check and if you aren't in a good place, save this for later or just skip to the Final Thoughts.

1) We hit 2 million cases globally. And while US numbers overall are improving, we are, of course, still in quarantine. In fact, your state may still be getting worse. All of these things were expected but that doesn't make them easier to bear. Remember that we will all start to improve at different times and passing the peak for each place will be bumpy with ups and downs after the peak - and even then we can't just resume "normal" we have to implement our exit strategy, which, at the moment, we don't have the resources to implement. (see prior post for the exit strategy) Some good news is that states are working together to pool resources and coordinate how it will all work. There is a whirlwind of activity starting to happen around this, which is good, we just have to sit tight a while longer. Hopefully, only about another month.

2) A issue that has arisen is the lack of Advanced Directives. Because people hospitalized with Covid-19 aren't allowed to have any family or loved ones with them, knowing their medical wishes can be difficult. This is a particularly difficult topic, but you need to prepare an Advanced Directive or at least have that conversation with someone in your home. It's better to write it down. You can Google, "Free Advanced Directives" and find simple forms to download and fill out. Doctors need to know what your care preferences are. In those moments, when family and loved ones are already grieving, already distraught because they can't be there with you, they are not in the best state of mind to be making life and death decisions. Having discussed those decisions before hand will ease things a little for them, for you, and for the medical providers. It is a difficult conversation, but one you need to have.

3) I saw a headline yesterday from multiple news sources that was alarming and completely false so I wanted to share that in case you too see the same headline. It stated that 20% of all Covid cases were healthcare professionals - or something similar. The articles all referred back to a CDC report - so I pulled and read the CDC report. Let me tell you why this is a big deal - 20% of 600k cases (US case count rounded) would be roughly 120k healthcare workers infected. Roughly (morning math from my head - has to be rough - maybe after another cup of coffee I will grab a calculator). Let me say again, this is not true. But the headline would be quite concerning were it true. 120K sick healthcare workers would be very bad. Fortunately that is not what the report actually said. The CDC report actually says that of the 300k (rounded number) cases reported between 2/12 and 4/9 36% of them (50k - also rounded) included information on if the person sick was a healthcare worker. Of that 36% - 19% were healthcare workers. This represented about 9k people. We don't want 9k healthcare workers to be sick, we don't want any sick. But 9k is not 120k. The 20% was of the 36% which was of a larger 50%. I have heard a lot of people say numbers are numbers. True. But data isn't data and lots of people are misusing data, some perhaps intentionally but just as many because they aren't paying attention or aren't trained on how to read and interpret the data. Be leery of headlines that are designed to incite worry, fear, anger, etc. And if you are reading anything that says, "I'm not an expert in xyz, but I do know"....and then the list something totally unrelated, just stop reading right there.

FINAL THOUGHTS: there will always be a contingent of people who will not do what is right or what is in the best interest of others. Those who are selfish. Those who will not listen to reason. And it is frustrating to those who are sacrificing. It is easy to allow this to discourage us, to make us weary or angry or bitter. Don't let their ignorance discourage you. Sometimes we do what is right and fight the good fight for those who are not strong enough, sometimes we carry the wounded, sometimes we battle for the underdog, sometimes we sacrifice for those who are grateful and thank us, and sometimes - we drag along the unwilling - the ones who fight us and mock us and seem clueless and yet will benefit by what we do - never appreciating it or even recognizing it. We do what is right for all of them. But doing what is right is rarely easy. Do not grow weary. Even if some people never "get it" we will just have to drag them along. And even if they never understand or appreciate it, there are those who do. So, thank you. Thank you for your sacrifices. Thank you to those who are staying home and trying to figure that madness out. Thank you to those who are still having to go to work despite the threat every time you step outside your door. Thank you for not spreading misinformation - it takes time to fact check and to care enough to make sure information is correct. Thank you for the million little ways you are contributing to making things better. It is not unnoticed.

April 16
Covid19 Update: There was so much to choose from today it was difficult to know just what to share. You may want to grab a snack.

1) The United States is going to temporarily withhold payment to the WHO. Politics aside - what you want to watch is the impact this has on the overall outbreak. Currently there are lots of other countries depending on that funding to combat the outbreak. Particularly vulnerable are developing countries where they don't have the infrastructure to track, treat, or contain the disease, without the assistance of countries like America. The United States is currently the largest contributor to those efforts. The impact of our withheld payment would not be immediate for those countries as there is a natural delay between when they run out of the funds we already sent and when our next payment would arrive. But, as you know, this isn't over until it is over everywhere as it is only one plane ride away until it is contained globally. This has the potential to really change the trajectory for lots of nations, at the same time, if resolved quickly, it could have a limited impact, so it is something to be aware of.

2) China is back (or still) in the news. You may recall we have discussed some prior theories about China intentionally creating the disease. Those have been researched by at least two independent American teams. One was civilian researchers and one military. Both came to the same conclusion - it is not man made. Then there were theories that it was released intentionally from a lab in Wuhan. Then the theory that it was accidentally released from the lab in Wuhan. Yesterday the idea was refined more, shifted a little and is now the most plausible version I have heard. The newest theory is that scientist in Wuhan were studying bats and had some in their lab. This would not be unusual or alarming. According to the theory they did not realize one of the bats had the virus and one of the scientist was infected. Before they knew he was infected, he had spread it to people outside the lab. When they discovered what had happened they tried to hide it. This is the most plausible version of the story I have heard to date. But remember, it is still theory with no true evidence as of yet. It may prove to be true, it may not, we will have to stay tuned. But also keep in mind that it doesn't change what is happening now or how we manage the outbreak, it just clarifies what happened in the past. Certainly knowing the truth will be important but for us, it is not our current priority. Consider if your child, roommate, spouse, etc. set the house on fire. You would most likely prioritize putting the fire out and/or getting to safety before figuring out how they did it.

3) Currently it is taking people, on average, 3-6 weeks to recover if they get the virus.

4) A study came out yesterday from Harvard that is being misused and misrepresented. I want to address this because it is causing a lot of anxiety. Headlines are claiming that Harvard said we would need to be socially distanced until 2022. This is again a misrepresentation of what the study actually said. Here is what they actually said, and I quote, "Absent other interventions...social distancing may be necessary into 2022" "Absent other interventions" is a very important part of that statement. The study went on to talk about the fact that the virus would resurge and we would see "flair ups" of the outbreak (my quotes and words not theirs). This is to be expected. We are not killing the disease right now so it will still be there. We have actually only eradicated one disease in the history of the World, small pox. So it is highly unlikely this will be the second, but of course it is possible. Even if we do, it won't happen right away. So of course we are going to see a little resurge when we all reenter "normal" that is expected. We have flu season every year too and allergy season and cold season. In addition, and more importantly - we won't be without other interventions. Those are being worked on now. So don't think you are going to be quarantined until 2022. If the resurgence gets too big in pockets/areas, they may ask people in those areas to socially distance for a short time - but not years and that would be focused areas.

5) In regards to entering "stage 2" as I like to call it (starting the process of reentering "normal") we have discussed what is needed - but there are lots of questions regarding what is taking so long so I wanted to share a little about that. First, we don't have the manpower. To conduct contact tracing we need about 300k tracers (the public health people that do that) and we have about 2500. So that's a challenge. States are aware of this and are working on it - which is good news. Second we need the tests - and lots of them. Try to keep in mind this was a disease we did not have and therefore we didn't have a test to detect it. We have had to create that very very quickly - and then try to manufacturer it en masse. The factories can only make so many a day - from a capacity perspective there are just limits. Then, the test itself needs to have a certain sensitivity and specificity rating to work right. Meaning, it has to be sensitive enough to detect the virus even in relatively small viral loads and it has to be accurate enough not to be giving lots of false negatives. Consider at home pregnancy tests. Most people are familiar with these. Today, at home pregnancy tests are highly accurate - something in the 99% range. And we know if it says you are pregnant - you are. You may get a false negative occasionally, but not a false positive. But they haven't always been that accurate. There was a time when the results were pretty iffy. Consider how long it took for them to get the pregnancy test perfected. We are asking for the Covid-19 tests to be perfected and widely distributed in a very short period of time. There are people working day and night on this - factories running 24 hours a day - but it takes time.

FINAL THOUGHTS: We are only 1/2 way through this week and it has certainly been a bumpy one. As Americans, we are accustomed to moving at a fast and furious pace and having most things being available to us at the click of a mouse. At the least, we are accustomed to moving about freely - doing as we will. This is stressful to our physical, mental and social health. So turn it off. Turn off the negativity and in-fighting and finger pointing and anger. Just turn it off and give yourself a break. If you bathe in it, it will seep into your soul. Instead, focus on the good things that are happening. Focus on the small light in the distance. Focus on being the person of reason. It isn't easy, but it is worth it for you - and for all those around you.
 

Duke Silver

Find safe haven in a warm bathtub full of my jazz.
A/V Subscriber
Sep 17, 2004
27,752
14,008
1,743
Cozy's Bar
#72
April 15
Covid-19 Update: We need to discuss a few difficult things today - so again, do a mental health check and if you aren't in a good place, save this for later or just skip to the Final Thoughts.

1) We hit 2 million cases globally. And while US numbers overall are improving, we are, of course, still in quarantine. In fact, your state may still be getting worse. All of these things were expected but that doesn't make them easier to bear. Remember that we will all start to improve at different times and passing the peak for each place will be bumpy with ups and downs after the peak - and even then we can't just resume "normal" we have to implement our exit strategy, which, at the moment, we don't have the resources to implement. (see prior post for the exit strategy) Some good news is that states are working together to pool resources and coordinate how it will all work. There is a whirlwind of activity starting to happen around this, which is good, we just have to sit tight a while longer. Hopefully, only about another month.

2) A issue that has arisen is the lack of Advanced Directives. Because people hospitalized with Covid-19 aren't allowed to have any family or loved ones with them, knowing their medical wishes can be difficult. This is a particularly difficult topic, but you need to prepare an Advanced Directive or at least have that conversation with someone in your home. It's better to write it down. You can Google, "Free Advanced Directives" and find simple forms to download and fill out. Doctors need to know what your care preferences are. In those moments, when family and loved ones are already grieving, already distraught because they can't be there with you, they are not in the best state of mind to be making life and death decisions. Having discussed those decisions before hand will ease things a little for them, for you, and for the medical providers. It is a difficult conversation, but one you need to have.

3) I saw a headline yesterday from multiple news sources that was alarming and completely false so I wanted to share that in case you too see the same headline. It stated that 20% of all Covid cases were healthcare professionals - or something similar. The articles all referred back to a CDC report - so I pulled and read the CDC report. Let me tell you why this is a big deal - 20% of 600k cases (US case count rounded) would be roughly 120k healthcare workers infected. Roughly (morning math from my head - has to be rough - maybe after another cup of coffee I will grab a calculator). Let me say again, this is not true. But the headline would be quite concerning were it true. 120K sick healthcare workers would be very bad. Fortunately that is not what the report actually said. The CDC report actually says that of the 300k (rounded number) cases reported between 2/12 and 4/9 36% of them (50k - also rounded) included information on if the person sick was a healthcare worker. Of that 36% - 19% were healthcare workers. This represented about 9k people. We don't want 9k healthcare workers to be sick, we don't want any sick. But 9k is not 120k. The 20% was of the 36% which was of a larger 50%. I have heard a lot of people say numbers are numbers. True. But data isn't data and lots of people are misusing data, some perhaps intentionally but just as many because they aren't paying attention or aren't trained on how to read and interpret the data. Be leery of headlines that are designed to incite worry, fear, anger, etc. And if you are reading anything that says, "I'm not an expert in xyz, but I do know"....and then the list something totally unrelated, just stop reading right there.

FINAL THOUGHTS: there will always be a contingent of people who will not do what is right or what is in the best interest of others. Those who are selfish. Those who will not listen to reason. And it is frustrating to those who are sacrificing. It is easy to allow this to discourage us, to make us weary or angry or bitter. Don't let their ignorance discourage you. Sometimes we do what is right and fight the good fight for those who are not strong enough, sometimes we carry the wounded, sometimes we battle for the underdog, sometimes we sacrifice for those who are grateful and thank us, and sometimes - we drag along the unwilling - the ones who fight us and mock us and seem clueless and yet will benefit by what we do - never appreciating it or even recognizing it. We do what is right for all of them. But doing what is right is rarely easy. Do not grow weary. Even if some people never "get it" we will just have to drag them along. And even if they never understand or appreciate it, there are those who do. So, thank you. Thank you for your sacrifices. Thank you to those who are staying home and trying to figure that madness out. Thank you to those who are still having to go to work despite the threat every time you step outside your door. Thank you for not spreading misinformation - it takes time to fact check and to care enough to make sure information is correct. Thank you for the million little ways you are contributing to making things better. It is not unnoticed.

April 16
Covid19 Update: There was so much to choose from today it was difficult to know just what to share. You may want to grab a snack.

1) The United States is going to temporarily withhold payment to the WHO. Politics aside - what you want to watch is the impact this has on the overall outbreak. Currently there are lots of other countries depending on that funding to combat the outbreak. Particularly vulnerable are developing countries where they don't have the infrastructure to track, treat, or contain the disease, without the assistance of countries like America. The United States is currently the largest contributor to those efforts. The impact of our withheld payment would not be immediate for those countries as there is a natural delay between when they run out of the funds we already sent and when our next payment would arrive. But, as you know, this isn't over until it is over everywhere as it is only one plane ride away until it is contained globally. This has the potential to really change the trajectory for lots of nations, at the same time, if resolved quickly, it could have a limited impact, so it is something to be aware of.

2) China is back (or still) in the news. You may recall we have discussed some prior theories about China intentionally creating the disease. Those have been researched by at least two independent American teams. One was civilian researchers and one military. Both came to the same conclusion - it is not man made. Then there were theories that it was released intentionally from a lab in Wuhan. Then the theory that it was accidentally released from the lab in Wuhan. Yesterday the idea was refined more, shifted a little and is now the most plausible version I have heard. The newest theory is that scientist in Wuhan were studying bats and had some in their lab. This would not be unusual or alarming. According to the theory they did not realize one of the bats had the virus and one of the scientist was infected. Before they knew he was infected, he had spread it to people outside the lab. When they discovered what had happened they tried to hide it. This is the most plausible version of the story I have heard to date. But remember, it is still theory with no true evidence as of yet. It may prove to be true, it may not, we will have to stay tuned. But also keep in mind that it doesn't change what is happening now or how we manage the outbreak, it just clarifies what happened in the past. Certainly knowing the truth will be important but for us, it is not our current priority. Consider if your child, roommate, spouse, etc. set the house on fire. You would most likely prioritize putting the fire out and/or getting to safety before figuring out how they did it.

3) Currently it is taking people, on average, 3-6 weeks to recover if they get the virus.

4) A study came out yesterday from Harvard that is being misused and misrepresented. I want to address this because it is causing a lot of anxiety. Headlines are claiming that Harvard said we would need to be socially distanced until 2022. This is again a misrepresentation of what the study actually said. Here is what they actually said, and I quote, "Absent other interventions...social distancing may be necessary into 2022" "Absent other interventions" is a very important part of that statement. The study went on to talk about the fact that the virus would resurge and we would see "flair ups" of the outbreak (my quotes and words not theirs). This is to be expected. We are not killing the disease right now so it will still be there. We have actually only eradicated one disease in the history of the World, small pox. So it is highly unlikely this will be the second, but of course it is possible. Even if we do, it won't happen right away. So of course we are going to see a little resurge when we all reenter "normal" that is expected. We have flu season every year too and allergy season and cold season. In addition, and more importantly - we won't be without other interventions. Those are being worked on now. So don't think you are going to be quarantined until 2022. If the resurgence gets too big in pockets/areas, they may ask people in those areas to socially distance for a short time - but not years and that would be focused areas.

5) In regards to entering "stage 2" as I like to call it (starting the process of reentering "normal") we have discussed what is needed - but there are lots of questions regarding what is taking so long so I wanted to share a little about that. First, we don't have the manpower. To conduct contact tracing we need about 300k tracers (the public health people that do that) and we have about 2500. So that's a challenge. States are aware of this and are working on it - which is good news. Second we need the tests - and lots of them. Try to keep in mind this was a disease we did not have and therefore we didn't have a test to detect it. We have had to create that very very quickly - and then try to manufacturer it en masse. The factories can only make so many a day - from a capacity perspective there are just limits. Then, the test itself needs to have a certain sensitivity and specificity rating to work right. Meaning, it has to be sensitive enough to detect the virus even in relatively small viral loads and it has to be accurate enough not to be giving lots of false negatives. Consider at home pregnancy tests. Most people are familiar with these. Today, at home pregnancy tests are highly accurate - something in the 99% range. And we know if it says you are pregnant - you are. You may get a false negative occasionally, but not a false positive. But they haven't always been that accurate. There was a time when the results were pretty iffy. Consider how long it took for them to get the pregnancy test perfected. We are asking for the Covid-19 tests to be perfected and widely distributed in a very short period of time. There are people working day and night on this - factories running 24 hours a day - but it takes time.

FINAL THOUGHTS: We are only 1/2 way through this week and it has certainly been a bumpy one. As Americans, we are accustomed to moving at a fast and furious pace and having most things being available to us at the click of a mouse. At the least, we are accustomed to moving about freely - doing as we will. This is stressful to our physical, mental and social health. So turn it off. Turn off the negativity and in-fighting and finger pointing and anger. Just turn it off and give yourself a break. If you bathe in it, it will seep into your soul. Instead, focus on the good things that are happening. Focus on the small light in the distance. Focus on being the person of reason. It isn't easy, but it is worth it for you - and for all those around you.
This is starting to back door into reality. It came from that lab.
 

Well

This is how I spend time.
A/V Subscriber
Dec 17, 2009
702
283
1,613
#74
I think the most likely scenario is that it leaked from the lab, the leak was accidental, and that we will never be able to prove it because the CCP covered it up.
There is a rather long, but interesting, investigative journalist story on youtube, that talks about the negligent security barriers at the P4 biolab in Wuhan. But I'm more curious currently about how the virus crossed from animal to human. And why now?
 

RxCowboy

Has no Rx for his orange obsession.
A/V Subscriber
Nov 8, 2004
74,684
52,247
1,743
Wishing I was in Stillwater
#75
There is a rather long, but interesting, investigative journalist story on youtube, that talks about the negligent security barriers at the P4 biolab in Wuhan. But I'm more curious currently about how the virus crossed from animal to human. And why now?
Lab carelessness... accidental exposure... touched face... open cut on hands and no gloves... something along those lines.
 

SLVRBK

Johnny 8ball's PR Manager
Staff
A/V Subscriber
Oct 16, 2003
14,799
5,446
1,743
Katy, TX
#76
April 15
Covid-19 Update: We need to discuss a few difficult things today - so again, do a mental health check and if you aren't in a good place, save this for later or just skip to the Final Thoughts.

1) We hit 2 million cases globally. And while US numbers overall are improving, we are, of course, still in quarantine. In fact, your state may still be getting worse. All of these things were expected but that doesn't make them easier to bear. Remember that we will all start to improve at different times and passing the peak for each place will be bumpy with ups and downs after the peak - and even then we can't just resume "normal" we have to implement our exit strategy, which, at the moment, we don't have the resources to implement. (see prior post for the exit strategy) Some good news is that states are working together to pool resources and coordinate how it will all work. There is a whirlwind of activity starting to happen around this, which is good, we just have to sit tight a while longer. Hopefully, only about another month.

2) A issue that has arisen is the lack of Advanced Directives. Because people hospitalized with Covid-19 aren't allowed to have any family or loved ones with them, knowing their medical wishes can be difficult. This is a particularly difficult topic, but you need to prepare an Advanced Directive or at least have that conversation with someone in your home. It's better to write it down. You can Google, "Free Advanced Directives" and find simple forms to download and fill out. Doctors need to know what your care preferences are. In those moments, when family and loved ones are already grieving, already distraught because they can't be there with you, they are not in the best state of mind to be making life and death decisions. Having discussed those decisions before hand will ease things a little for them, for you, and for the medical providers. It is a difficult conversation, but one you need to have.

3) I saw a headline yesterday from multiple news sources that was alarming and completely false so I wanted to share that in case you too see the same headline. It stated that 20% of all Covid cases were healthcare professionals - or something similar. The articles all referred back to a CDC report - so I pulled and read the CDC report. Let me tell you why this is a big deal - 20% of 600k cases (US case count rounded) would be roughly 120k healthcare workers infected. Roughly (morning math from my head - has to be rough - maybe after another cup of coffee I will grab a calculator). Let me say again, this is not true. But the headline would be quite concerning were it true. 120K sick healthcare workers would be very bad. Fortunately that is not what the report actually said. The CDC report actually says that of the 300k (rounded number) cases reported between 2/12 and 4/9 36% of them (50k - also rounded) included information on if the person sick was a healthcare worker. Of that 36% - 19% were healthcare workers. This represented about 9k people. We don't want 9k healthcare workers to be sick, we don't want any sick. But 9k is not 120k. The 20% was of the 36% which was of a larger 50%. I have heard a lot of people say numbers are numbers. True. But data isn't data and lots of people are misusing data, some perhaps intentionally but just as many because they aren't paying attention or aren't trained on how to read and interpret the data. Be leery of headlines that are designed to incite worry, fear, anger, etc. And if you are reading anything that says, "I'm not an expert in xyz, but I do know"....and then the list something totally unrelated, just stop reading right there.

FINAL THOUGHTS: there will always be a contingent of people who will not do what is right or what is in the best interest of others. Those who are selfish. Those who will not listen to reason. And it is frustrating to those who are sacrificing. It is easy to allow this to discourage us, to make us weary or angry or bitter. Don't let their ignorance discourage you. Sometimes we do what is right and fight the good fight for those who are not strong enough, sometimes we carry the wounded, sometimes we battle for the underdog, sometimes we sacrifice for those who are grateful and thank us, and sometimes - we drag along the unwilling - the ones who fight us and mock us and seem clueless and yet will benefit by what we do - never appreciating it or even recognizing it. We do what is right for all of them. But doing what is right is rarely easy. Do not grow weary. Even if some people never "get it" we will just have to drag them along. And even if they never understand or appreciate it, there are those who do. So, thank you. Thank you for your sacrifices. Thank you to those who are staying home and trying to figure that madness out. Thank you to those who are still having to go to work despite the threat every time you step outside your door. Thank you for not spreading misinformation - it takes time to fact check and to care enough to make sure information is correct. Thank you for the million little ways you are contributing to making things better. It is not unnoticed.

April 16
Covid19 Update: There was so much to choose from today it was difficult to know just what to share. You may want to grab a snack.

1) The United States is going to temporarily withhold payment to the WHO. Politics aside - what you want to watch is the impact this has on the overall outbreak. Currently there are lots of other countries depending on that funding to combat the outbreak. Particularly vulnerable are developing countries where they don't have the infrastructure to track, treat, or contain the disease, without the assistance of countries like America. The United States is currently the largest contributor to those efforts. The impact of our withheld payment would not be immediate for those countries as there is a natural delay between when they run out of the funds we already sent and when our next payment would arrive. But, as you know, this isn't over until it is over everywhere as it is only one plane ride away until it is contained globally. This has the potential to really change the trajectory for lots of nations, at the same time, if resolved quickly, it could have a limited impact, so it is something to be aware of.

2) China is back (or still) in the news. You may recall we have discussed some prior theories about China intentionally creating the disease. Those have been researched by at least two independent American teams. One was civilian researchers and one military. Both came to the same conclusion - it is not man made. Then there were theories that it was released intentionally from a lab in Wuhan. Then the theory that it was accidentally released from the lab in Wuhan. Yesterday the idea was refined more, shifted a little and is now the most plausible version I have heard. The newest theory is that scientist in Wuhan were studying bats and had some in their lab. This would not be unusual or alarming. According to the theory they did not realize one of the bats had the virus and one of the scientist was infected. Before they knew he was infected, he had spread it to people outside the lab. When they discovered what had happened they tried to hide it. This is the most plausible version of the story I have heard to date. But remember, it is still theory with no true evidence as of yet. It may prove to be true, it may not, we will have to stay tuned. But also keep in mind that it doesn't change what is happening now or how we manage the outbreak, it just clarifies what happened in the past. Certainly knowing the truth will be important but for us, it is not our current priority. Consider if your child, roommate, spouse, etc. set the house on fire. You would most likely prioritize putting the fire out and/or getting to safety before figuring out how they did it.

3) Currently it is taking people, on average, 3-6 weeks to recover if they get the virus.

4) A study came out yesterday from Harvard that is being misused and misrepresented. I want to address this because it is causing a lot of anxiety. Headlines are claiming that Harvard said we would need to be socially distanced until 2022. This is again a misrepresentation of what the study actually said. Here is what they actually said, and I quote, "Absent other interventions...social distancing may be necessary into 2022" "Absent other interventions" is a very important part of that statement. The study went on to talk about the fact that the virus would resurge and we would see "flair ups" of the outbreak (my quotes and words not theirs). This is to be expected. We are not killing the disease right now so it will still be there. We have actually only eradicated one disease in the history of the World, small pox. So it is highly unlikely this will be the second, but of course it is possible. Even if we do, it won't happen right away. So of course we are going to see a little resurge when we all reenter "normal" that is expected. We have flu season every year too and allergy season and cold season. In addition, and more importantly - we won't be without other interventions. Those are being worked on now. So don't think you are going to be quarantined until 2022. If the resurgence gets too big in pockets/areas, they may ask people in those areas to socially distance for a short time - but not years and that would be focused areas.

5) In regards to entering "stage 2" as I like to call it (starting the process of reentering "normal") we have discussed what is needed - but there are lots of questions regarding what is taking so long so I wanted to share a little about that. First, we don't have the manpower. To conduct contact tracing we need about 300k tracers (the public health people that do that) and we have about 2500. So that's a challenge. States are aware of this and are working on it - which is good news. Second we need the tests - and lots of them. Try to keep in mind this was a disease we did not have and therefore we didn't have a test to detect it. We have had to create that very very quickly - and then try to manufacturer it en masse. The factories can only make so many a day - from a capacity perspective there are just limits. Then, the test itself needs to have a certain sensitivity and specificity rating to work right. Meaning, it has to be sensitive enough to detect the virus even in relatively small viral loads and it has to be accurate enough not to be giving lots of false negatives. Consider at home pregnancy tests. Most people are familiar with these. Today, at home pregnancy tests are highly accurate - something in the 99% range. And we know if it says you are pregnant - you are. You may get a false negative occasionally, but not a false positive. But they haven't always been that accurate. There was a time when the results were pretty iffy. Consider how long it took for them to get the pregnancy test perfected. We are asking for the Covid-19 tests to be perfected and widely distributed in a very short period of time. There are people working day and night on this - factories running 24 hours a day - but it takes time.

FINAL THOUGHTS: We are only 1/2 way through this week and it has certainly been a bumpy one. As Americans, we are accustomed to moving at a fast and furious pace and having most things being available to us at the click of a mouse. At the least, we are accustomed to moving about freely - doing as we will. This is stressful to our physical, mental and social health. So turn it off. Turn off the negativity and in-fighting and finger pointing and anger. Just turn it off and give yourself a break. If you bathe in it, it will seep into your soul. Instead, focus on the good things that are happening. Focus on the small light in the distance. Focus on being the person of reason. It isn't easy, but it is worth it for you - and for all those around you.
This is starting to back door into reality. It came from that lab.
The article linked below was published in The Daily Mail on Feb 16, 2020. The article is quotng from a study into the origin of the outbreak by South China University Study make the case that the outbreak is from lab tech's who were working with the bats. In the 2 months since this was published I have never understood why the story/study didn't get more traction...simple assumption was CCP quashed it.

https://www.dailymail.co.uk/news/ar...-originate-Chinese-government-laboratory.html
 
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RxCowboy

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#77
April 17

Covid-19 Update: How we count deaths and why this is still in the news.

There are two primary things that are happening in reporting deaths that are causing some number issues - both of them are resulting in under-reporting so I want to spend a little time on this issue. The first issue, which we have already discussed so I won't spend any additional time today - is coding the death as something other than Covid when the person has an underlying health issue. For example, heart disease.

You may recall that this is what China was doing.

The second issue is probably much more prolific and is making the headlines so it seems like it is worth our time to explore.

There are three classifications of cases. There are:
1)suspected cases - those who may or may not have it, we don't know yet but they are reporting symptoms. We would treat them as if they do have it until we know. If you called your doctors office and told them you were sick with Covid systems you would be a suspected case. We would follow our standards for what to do (different places are doing different things). Then, there are
2) probable cases - these are people the doctor has examined and determined they have it, but....they don't have a laboratory confirmed test. There could be many reasons for this. One - they could have gotten a false negative on the test but by the doctors exam it is clear they have it. They could be waiting for the test results (remember in some places this is taking weeks). They may not have any tests available (remember we have a shortage in many places). Whatever the case may be - the physician knows you have it - you know you have it, but we don't have the test to prove it yet. Joe Bob with the sniffles is not a probable case. But Joe Bob who is a textbook case (if this disease has such as thing) and had to be ventilated but died before the test came back from the lab - would be. Probable cases are those a physician has determined have the disease even if they doesn't have the test to prove it. Physicians, working this outbreak are qualified to do this and it is normal procedure. And then there is the third group
3) confirmed cases. These are the ones confirmed by the test.

Here is where the sticking point comes in. Doctors are diagnosing patients with Covid-19 and recording that on the death certificate (for those who die) but some places/people are not reporting probable cases to the health department - they are only reporting confirmed cases. So more people are having Covid listed on the death certificate than are being reported and this discrepancy was discovered and investigated.

This does not seem to have nefarious roots - but instead seems to be a misunderstanding. I have sat in on public health calls for multiple states and several countries during this outbreak and this issue has come up in nearly every state and country I have been involved with. And in every case, where this came up, people simply didn't realize they needed to report probable cases. Every outbreak looks different and is handled differently. If we had plenty of tests and they were highly reliable then this course of action may be appropriate. But this situation isn't typical and we don't have tons of reliable tests. And getting results in many cases takes time. At the beginning of this - it took considerable time in every case.

On the 14th - New York had to revise their numbers because of it and that is making its way into the headlines. They most likely aren't the only ones. When you see those numbers increase don't let it alarm you, it is just a correction of what already happened.

This is a moving target situation - and we can all agree that it is unprecedented in our lifetime. Mistakes will happen. Think about some policy change or website change, or reporting change at your work. Think about how long it takes for everyone to realize it and to make the change. Think about how many times you have to remind people. In epidemiology we know and expect this (remember the apple orchard and the wild horses??). Physicians are scrambling to save lives and treat patients and find equipment and supplies - public health reporting is not their specialty. Public Health people monitor these things and when they notice an error they reach out and help get it corrected. This is one of those errors.

FINAL THOUGHTS: We recognize how difficult this situation is. We recognize how stressful and irritating it can be, and hopefully we have cut ourselves some slack. But we need to do the same for others. Everyone is stressed. Everyone is tired. Everyone is stretched thin. Everyone. Our struggles may not look the same. What we are battling may not be the same, but the result is. Some people may carry it better than others, some may hide it better, some may handle it better, but it is there for everyone. Perhaps it manifests as anger, bitterness, depression, grief, rebellion, compulsiveness, restlessness, exhaustion, lack of motivation, tears, nervousness, suspicion, silliness, energy, loneliness, disorganization, resoluteness, focus, determination, extreme productivity, sadness. The possibilities are endless but the root cause is the same. So let's cut each other some slack, let's not start by assuming the worst.
 

Duke Silver

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#78
The article linked below was published in The Daily Mail on Feb 16, 2020. The article is quotng from a study into the origin of the outbreak by South China University Study make the case that the outbreak is from lab tech's who were working with the bats. In the 2 months since this was published I have never understood why the story/study didn't get more traction...simple assumption was CCP quashed it.

https://www.dailymail.co.uk/news/ar...-originate-Chinese-government-laboratory.html
Yep. To believe this thing was not made in that lab is to believe chinese propaganda. The only debate was whether they were making it as a weapon or studying it to keep up with the joneses and like everything else china, it was shitty practices and half assed and complete junk science. Then the inevitable happened.
 

kaboy42

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#79
FINAL THOUGHTS: We recognize how difficult this situation is. We recognize how stressful and irritating it can be, and hopefully we have cut ourselves some slack. But we need to do the same for others. Everyone is stressed. Everyone is tired. Everyone is stretched thin. Everyone. Our struggles may not look the same. What we are battling may not be the same, but the result is. Some people may carry it better than others, some may hide it better, some may handle it better, but it is there for everyone. Perhaps it manifests as anger, bitterness, depression, grief, rebellion, compulsiveness, restlessness, exhaustion, lack of motivation, tears, nervousness, suspicion, silliness, energy, loneliness, disorganization, resoluteness, focus, determination, extreme productivity, sadness. The possibilities are endless but the root cause is the same. So let's cut each other some slack, let's not start by assuming the worst.
This.

If there's one thing I'm MORE OVER than this pandemic/quarantine, it's the rampant shaming.

All the Karen's (and Karl's) out there shaming any one and everyone for anything and everything needs to seriously stop. Soooo sick of it when no one really knows what others are going thru or what they are doing just to get through this. Worry about your damned self and your family and quit the asinine finger-pointing and shaming. Find some freaking grace people.
 

RxCowboy

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#80
Yep. To believe this thing was not made in that lab is to believe chinese propaganda. The only debate was whether they were making it as a weapon or studying it to keep up with the joneses and like everything else china, it was shitty practices and half assed and complete junk science. Then the inevitable happened.
"Made in the lab" and "leaked from the lab" are two different things. There is no evidence at present that it was bioengineered.