Finally, one world leader calls a spade a turkey. The US is the largest funder to the World Health Organisation, yet the WHO acts in China’s best interests. On January 31 the WHO could have saved the world by isolating China. Instead, the chief raved about President Xi and advised that flights should stay open because it will harm the economy:
“Travel restrictions can cause more harm than good by hindering info-sharing, medical supply chains and harming economies,” the head of the World Health Organization (WHO) said on Friday. [Jan 31]
“We want to look into the World Health Organization because they really called it wrong,” Trump said. “They missed the call, they could have called it months earlier, they would have known, they should have known, and they probably did know.”
The president noted that the WHO actually criticized his travel ban from China that he set in late January.
“Such restrictions can have the effect of increasing fear and stigma, with little public health benefit,” WHO Director-General Dr. Tedros Adhanom Ghebreyesus said about travel bans just days after Trump banned travel from China.
“They seem to be very China-centric,” he said. “That’s a nice way of saying it, but they seem to be very China-centric, and they seem to err always on the side of China.
It’s a warning shot across the bows. He may keep funding them, or he may not. By exposing them, he’s letting the WHO and China know that game is up. But he’s staying at the table, so expecting Tedros-the-belt-and-road-rep-from-China to come up with some goods. What’s on Trumps wish list: Chloroquine? PPE? Antibiotics?
It’s about time.
In other news, Trump is saving Boris Johnson from his own medical system:
President Trump is so worried about the health of Prime Minister Boris Johnson — currently in intensive care with Chinese Coronavirus — that he has offered U.S. medical support.
The chief medical officer, Professor Chris Whitty, has banned doctors from treating Covid-19 with anything other than paracetamol and in severe cases, oxygen.
According to the Guardian, President Trump said shortly after PM Johnson was moved to intensive care:
“I’ve asked two of the leading companies … They’ve come with the solutions and just have done incredible jobs – and I’ve asked him to contact London immediately,” Trump said. “They’ve really advanced therapeutics … and they have arrived in London already. The London office has whatever they need. We’ll see if we can be of help. We’ve contacted all of Boris’s doctors, and we’ll see what is going to take place, but they are ready to go.”
“They’ve had meetings with the doctors, and we’ll see whether or not they want to go that route,” Trump added. “But when you’re in intensive care it’s a big deal. So they’re there and they’re ready.
“Low vitamin D status in winter permits viral epidemics.”
Vitamin D levels also correlate with lower rates of cancer, diabetes, high blood pressure, asthma,heart disease, dental caries, preeclampsia, autoimmune disease, depression, anxiety, and sleep disorders. Vitamin D influences over 200 genes. It’s so crucial, it was likely the reason northern Europeans evolved whiter skin. The lack of sunlight and the introduction of grains in diets (as opposed to eating liver and whales) meant that Europeans weren’t getting enough D from either food or sun. The selective pressure was so strong that lighter skin rapidly took over all the northern communities. Eskimos didn’t need to go white — they were still getting D from offal and plenty of fish.
Unlike most vitamins, D is also correlated with “that holy grail” — a reduction in all cause mortality. So even if a D supplement doesn’t help against coronavirus, side effects include less cancer and fewer heart attacks. Not too shabby for a five cent supplement.
The cost of one night in intensive care would provide vitamin D supplements for a month for 3,000 people.
…
Vitamin D or Cholecalciferol, is probably one of the main reasons that coughs and colds and death itself, almost always peak in winter when people have lower vitamin D levels. Of course, winter is also a happy-hour for most viruses because temperatures are cooler and people crowd indoors more.
Researchers Grant et al, put out a call for people to supplement with D during this pandemic, pointing out that this will reduce the incidence of the co-morbidities that are hit hardest by Coronavirus. They also point out that D reduces respiratory tract infections, and is actively involved in our own anti-viral defences in at least three different ways. Vitamin D induces cathelicidin and defensins (polypeptides that our immune system uses like surface-to-air missiles against bacteria or enveloped viruses). D also reduces production of proinflammatory cytokines (the messengers that elict the deadly cascade of inflammation).
...more and more evidence indicates that vitamin D is involved in regulating various cells of the innate and adaptive immune system [13]. Vitamin D has a broad role in regulating inflammatory responses in models of inflammations [14], [15], [16]. Vitamin D receptor knockout mice which were treated with LPS, displayed a more distinct inflammatory response than wildtype mice [17]. In addition, we previously demonstrated that vitamin D deficiency (VDD) contributed directly to the ARDS…
Using serum 25(OH)D <50 nmol/L in the same surveys would translate to 44.9, 2.1, and 32.6 million individuals in Germany, Ireland, and the United Kingdom, respectively, having deficiency as defined by this threshold.
Deficiencies are more likely in older people which may also contribute to the demographics of Covid-19.
Obviously, deficiencies are much more likely in people with darker skins, especially in high latitude areas. If D were important in Covid cases, we’d expect to see a higher rate in blacks in higher latitude winter climates, and sadly that’s exactly what we see. It’s confounded by a squadron of factors but in Chicago, Blacks have four times the chance of dying from Covid-19 as whites do despite being a similar percentage of the population. Obviously poverty and co-morbidities increase the risk, but low Vitamin D also helps create the co-mobidities. h/t Bill in Oz
If D3 supplements reduced the risk of ARDS by even 10% it would be a bargain.
Lest you think this is just weak correlation, the bane of so many nutritional studies, there is not only a mechanism to explain why D might matter, but three:
Vitamin D Supplementation Could Prevent and Treat Influenza, Coronavirus, and Pneumonia Infections
Grant W.B. et al
Low vitamin D status in winter permits viral epidemics. During winter, people who do not take vitamin D supplements are likely to have low serum 25-hydroxyvitamin D [25(OH)D] concentrations. Vitamin D can reduce the risk of viral epidemics and pandemics in several ways. First, higher 25(OH)D concentrations reduce the risk of many chronic diseases, including cancers, cardiovascular disease, chronic respiratory tract infections (RTIs), diabetes mellitus, and hypertension. Patients with chronic diseases have significantly higher risk of death from RTIs than otherwise healthy people. Second, vitamin D reduces risk of RTIs through three mechanisms: maintaining tight junctions, killing enveloped viruses through induction of cathelicidin and defensins, and reducing production of proinflammatory cytokines by the innate immune system, thereby reducing the risk of a cytokine storm leading to pneumonia. Observational and supplementation trials have reported higher 25(OH)D concentrations associated with reduced risk of dengue, hepatitis, herpesvirus, hepatitis B and C viruses, human immunodeficiency virus, influenza, respiratory syncytial virus infections, and pneumonia. Results of a community field trial reported herein indicated that 25(OH)D concentrations above 50 ng/ml (125 nmol/l) vs. <20 ng/ml were associated with a 27% reduction in influenza-like illnesses. From the available evidence, we hypothesize that raising serum 25(OH)D concentrations through vitamin D supplementation could reduce the incidence, severity, and risk of death from influenza, pneumonia, and the current COVID-19 epidemic.
Vitamin D levels are also lower in people who have heart attacks, diabetes, pnumonia, and they’re low in China, Italy and South Korea:
More important, people with chronic diseases have lower 25(OH)D concentrations and increased
inflammation. A study in Triese, Italy, reported that patients with a mean age of 67 ± 12 years
who developed acute myocardial infarction had mean serum 25(OH)D concentrations in winter
of 11 ± 2 ng/ml [52]. A study conducted in Wenzhou, China (28°N), on diabetics and control
subjects aged 43 ± 11 years reported that diabetics had mean 25(OH)D concentration of 13 vs.
16 ng/ml for control subjects [53]. An observational study conducted in Qinhuangdao, China,
compared serum 25(OH)D concentrations for hospital patients with pneumonia vs. those without
[54]. Serum 25(OH)D concentrations for those with pneumonia were 9 ± 2 ng/ml, whereas those
for the nonpneumonia group were 14 ± 4 ng/ml, p = 0.000.
People with low Vitamin D levels are twice as likely to die:
Bluntly, blood levels of Vitamin D are associated with all cause mortality. Your odds of dying from just about anything, except maybe car accidents, are almost twice as high if your blood serum levels are in the lowest quantile (0-9ng/ml) compared to the top quantile (above 35ng/ml). Mortality levels off around 36ng/ml and higher (which is 90 nmol/l.)
Twenty-five studies identified a significant inverse relationship between 25(OH)D concentration and age-adjusted all-cause mortality hazard rates (Figure 2). In 5 studies,21,34,35,37,47 an inverse trend was present, but was not statistically significant. In 2 studies, 1 in the United States48 and 1 in Linxian, China,50 no association was seen. — Garland, 2014
Dose — 1000IU per day
A target range of 25(OH)D of greater than 30 ng/mL could be achieved in most individuals by intake of approximately 1000 IU per day of vitamin D3,12 which is one quarter the National Academy of Sciences–Institute of Medicine tolerable upper level of intake of 4000 IU per day at ages 9 years and older.69
Vitamin D levels in pregnant women affects a childs lungs six years later, brains ten years later and bones twenty years after they are born:
Vitamin D deficiency during pregnancy affects offspring. In a community-based study of 901 mother and offspring pairs, researchers found that maternal vitamin D deficiency (serum 25-hydroxyvitamin D < 50 nmol/L) at 18 weeks’ pregnancy was associated with impaired lung development at age 6 in offspring, neurocognitive difficulties at age 10, increased risk of eating disorders in adolescence, and lower peak bone mass at age 20. [12, 13, 14]
Vitamins mostly help people who are deficient (though as stated above, this is quite common with D). Any sole vitamin will have some downstream effect on other essential molecules which may be depleted.
The form D3 (cholecalciferol) is likely to help more than D2 (ergocalciferol). D3 is associated with a reduction in all cause mortality and a reduction of cancer risk, but D2 is not. High dose, longer term D supplements can cause deficiencies in other vitamins, like, Vitamin A. Ideally take Vitamin K as well (more on that at some other point). If you happen to supplement with boron beware that it may help bodies hang on to D3 levels for longer. There are, no doubt, a lot of other examples of complex interactions.
Ideally, we’d get a blood test to see if any supplement was needed, but it probably isn’t worth the risk in the current pandemic. Most of our Vitamin D comes from sun exposure, not from diet, though some people have lower levels due to genetic variations. Are you getting enough (and obviously, in Australia, not too much?) Most sunscreens will stop vitamin D production, and glass windows do too.
TILDA researchers in Ireland have put out a Covid and Vit D report recommending 400IU – 1000IU as a winter supplement or for high risk groups or housebound people. Ireland does not fortify foods with Vitamin D. Nor does China or South Korea.
If you want to eat your Vitamin D, head for Salmon, sardines, tuna, and Cod liver oil. Eggs, too. But it’s difficult to get enough D from your diet. You need something like 9 oz of salmon a day.
PS: Best not drive out to get your vitamin D. People can post it.
George Pell was on the wrong side of every fashionable cause: An old white man, a christian, and a climate skeptic. He threatened the religion of political correctness in every way, and a witch hunt made him target number one. Despite his position of power and influence, the best evidence the pogrom could find was the word of one boy, decades later, with no corroborating evidence. The irrational groupthink fashion swept through juries, judges and even the Victorian Court of Appeal. But today in Australia the High Court, the final last chance for justice, freed George Pell from jail 7-0.
Great news, Australia still has a justice system.
He was convicted and imprisoned over the most heinous of all crimes on the word of one anonymous complainant, whose testimony was unsupported by any other witnesses, or any forensic evidence. The same fate could befall any Victorian.
The media lynch mob and the entire Victorian legal system stand condemned. The unanimous decision of the High Court is a conclusive repudiation of everyone involved in the false imprisonment of Cardinal George Pell, every politician, every cop, every lawyer, every journalist, every coward…
It seems distant and forgotten but in 2011, Pell was not just a little bit skeptical, he was a well informed and outspoken skeptic (see his impeccable reasoning carefully stated in a GWPF speech below). He was also at one point third highest ranking Cardinal at the Vatican.
Pell would have been a target no matter whether he was a climate skeptic, but imagine he had embraced the climate scare wholeheartedly. Would it have protected him? Would that have meant the witchhunt would have picked a different high ranking Catholic?
In his first statement since his conviction Cardinal Pell, 78, said he had no ill-will towards his accuser, whose story was rejected 7-0 by the High Court.
And if being a climate believer can hold off the wolves, would that mean those who are guilty of real crimes are more likely to wear the believer cloak?
Those who used real victims of sexual assault as mascots in their political pogrom have done so much damage to that cause. The ghost of repressed memories still haunt the quest for justice.
Pell is brave and intelligent and powerful, and he had to be cut down:
The irony is that a man calling for climate change to be decided on evidence was jailed and demonized for years, based on no evidence, bar the word of one.
Cardinal George Pell in The Australian, October 2011
I first became interested in the question in the 1990s when studying the anti-human claims of the “deep greens”. Mine is not an appeal to the authority of any religious truth in the face of contrary scientific evidence. Neither is it even remotely tinged by a postmodernist hostility to rationality.
My appeal is to reason and evidence, and in my view the evidence is insufficient to achieve practical certainty on many of these scientific issues.
…
The basic issue is not whether the science is settled but whether the evidence and explanations are adequate in that paradigm.
I fear, too, that many politicians have never investigated the primary evidence.
Much is opaque to non-specialists, but persistent inquiry and study can produce useful clarifications, similar to the nine errors identified by the British High Court in Al Gore’s propaganda film, An Inconvenient Truth.
The complacent appeal to scientific consensus is simply one more appeal to authority, quite inappropriate in science or philosophy.
It is not generally realised that in 2001 at least, one of the Intergovernmental Panel on Climate Change Third Assessment Report’s workinggroups agreed: “In climate research and modelling, we are dealing with a coupled, non-linear, chaotic system, and therefore that the long-term prediction of future climate states is not possible.”
Claims of atmospheric warming often appear to conflict and depend upon the period of time under consideration.
► The earth has cooled during the past 10,000 years since the Holocene climate optimum.
► The earth has cooled since 1000 years ago, not yet achieving the temperatures of the Medieval Warm Period.
► The earth has warmed since 400 years ago after the Little Ice Age three centuries ago.
► The earth warmed between 1979 and 1998 and has cooled slightly since 2001.
The following facts are additional reasons for scepticism.
► In many places, most of the 11,700 years since the end of the last ice age were warmer than the present by up to 2C.
► Between 1695 and 1730, the temperature in England rose by 2.2C. That rapid warming, unparalleled since, occurred long before the Industrial Revolution.
► From 1976 to 2001, “the global warming rate was 0.16C per decade”, as it was from 1860 to 1880 and again from 1910 to 1940.
My suspicions have been deepened through the years by the climate movement’s totalitarian approach to opposing views. Those secure in their explanations do not need to be abusive.
The term “climate change denier”, however expedient as an insult or propaganda weapon, with its deliberate overtones of comparison with Holocaust denial, is not a useful description of any significant participant in the discussion.
The real crime here is what Victorian politicians did to the justice system.
Miranda Devine: The onus of proof has been turned on its head in Victoria
His false conviction raises urgent questions about the jury system, for so long the bedrock of our criminal justice. But that system was perverted by politicians pursuing ideological outcomes, who created legislation in Victoria that altered the balance of justice, so that defendants in sex trials now have to prove their innocence, turning the onus of proof on its head.
The US can no longer even make vitamin C or aspirin any more, or 80% of their antibiotics. Something like 90% of the starting chemicals for essential US medicines are made in Chinese factories. And there aren’t many alternatives — fully 70% of competing products from India start with chemicals from China too. And now Chinese companies are shifting up into generic drugs as well.
The West, asleep, let the takeover happen. Western companies were driven out of business trying to compete with Chinese companies which were are subsidized by the CCP. But we were happy to take the cheaper drugs. That was, until we discovered what huge leverage we have given China. It’s a
As Gibson points out — personnel of the US Navy in the South China Sea are thus “dependent on their adversary for their medicine.”
Azithromycin (the antibiotic in the favourite Coronavirus treatment trio) is made in China. So is propofol which is used with ventilators.
Last year, China accounted for 95 percent of U.S. imports of ibuprofen, 91 percent of U.S. imports of hydrocortisone, 70 percent of U.S. imports of acetaminophen, 40 to 45 percent of U.S. imports of penicillin and 40 percent of U.S. imports of heparin, according to Commerce Department data. In all, 80 percent of the U.S. supply of antibiotics are made in China.
A Chinese Professor candidly explains the trade imbalances:
China’s cartels fueled by government subsidies undercut U.S. and other companies, driving them out of business. Western firms aren’t competing against Chinese companies. They are competing against the Chinese government.
China is moving up the value chain and makes 10 percent of the generic drugs in the U.S.
India has a very large generic drug industry, it depends on China for 70 percent of the chemical starting materials to make drugs…
There’s a pattern here of faulty goods:
Rocket Fuel in Generic Drugs
This testimony triggered a spellbinding account by a commissioner, a retired Army colonel with a distinguished record of military service. He talked about his three different blood pressure medicines whose key ingredients were made in China and contained rocket fuel. If he was getting contaminated drugs, active duty military people were probably getting them too, he opined.
The retired Army colonel was one of millions of Americans whose blood pressure medicines were contaminated with carcinogens. In July 2018, the FDA announced the first of many recalls. While many manufacturers recalled their products, the most troubling was the manufacturer in China whose active ingredient contained more than 200 times the acceptable limit of the rocket fuel carcinogen, per pill. Even worse, the company knew its product did not meet U.S. standards but sold it anyway.
Make no mistake, the United States faces an existential threat posed by China’s control over the global supply of the ingredients and chemical materials to manufacture critical drugs. In the hands of an adversary, medicines can be weaponized. They can be made with lethal contaminants or sold without any real medicine in them, rendering them ineffective.
Zhejiang Huahai Pharmaceutical (ZHP), producer of the contaminated valsartan, disclosed in a 2018 annual report that it had received $44.4 million (312 million yuan) in government subsidies. Over the first half of this year, it had received an additional 92 million yuan in state funding.
Doctors need to check those supplies are what they think they are:
A number of hospitals are having to test certain medicines because physicians see that there’s just something not working,” stated Gibson.
The 1.2 million Chinese antibody tests that the Slovak government bought from local middlemen for 15 million euros ($16 million) are inaccurate and unable to detect Covid-19 in its early stages, according to Prime Minister Igor Matovic, who only took office last month. “We have a ton and no use for them,” he said. They should “just be thrown straight into the Danube.”
On Saturday, the Dutch health ministry announced it had recalled 600,000 face masks. The equipment had arrived from a Chinese manufacturer on 21 March, and had already been distributed to front-line medical teams.
Dutch officials said that the masks did not fit and that their filters did not work as intended, even though they had a quality certificate….
Spain’s government encountered similar problems with testing kits ordered from a Chinese company.
It announced it had bought hundreds of thousands of tests to combat the virus, but revealed in the following days that nearly 60,000 could not accurately determine if a patient had the virus.
“Nobody [in politics] did anything about it,” lamented Gibson. “This has been going on for almost 20 years. In fact, no one wanted to even expose it. That’s why it took so long to figure this out and to put it out there, to reveal our dependence. It’s really quite remarkable. The American public’s been thrown under the bus.”
Mansour asked why American politicians allowed domestic manufacturing of medicines and medical supplies to be outsourced to China.
Gibson replied, “There was country-of-origin legislation introduced in Congress around 2008 that would require companies to state on their packages where their product is made, and it was killed immediately. So I asked someone in the industry, someone who worked there for more than 30 years, ‘So, what’s going on here?’ and this person said, ‘Well, the industry thought it probably wouldn’t be good for business if their customers knew where their medicines were coming from.’”
Gibson continued, “Our military is dependent on China. So the young men and women in the South China Sea on those aircraft carriers, they’re dependent on their adversary for their medicine.
We know if the squid in the supermarket was caught in New Zealand and packed in China, but we don’t know where the drugs in the asthma puffer our children use were produced.
“These medicines are then imported into Australia after journeying around the world.”
The report says it is a “significant problem” that there is no public information on the origin of the critical ingredients because drug companies consider such information to be proprietary. It is difficult, therefore, to even assess the resilience of Australia’s medicine supply chain.
“A single treatment able to effect ∼5000-fold reduction in virus at 48h in cell culture.”
–Caly et al 2020
It’s another day in freaky chemistry — researchers at Monash University found that one of the main components of sheep drench is also very good at reducing Coronavirus, at least in test tubes. Ivermectin’s an unsung hero of the world of biochemistry, called a “Wonder Drug” and a “Blockbuster” because it works against roundworms, lungworms, mites, lice, scabies and hornflies, as well as cattle-ticks. Most importantly, it kills the worm that causes River Blindness, saving the vision of thousands in sub-saharan Africa, and places like Ecuador.
That’s doesn’t mean it will work in vivo — and it may be a month before human trials begin so we can find out.
Possibly, in a few months you might be able to kill off Coronavirus and deworm yourself at the same time.
Though the human experiment is already probably happening in countries where it is being used already and coronavirus is circulating. Surely we can track those cases?
And at least in Australia, unlike Chloroquine — which we don’t have much of — with 70 million sheep I can’t see us running out of sheep dip. (If indeed Ivermectin turns out to be useful against coronavirus). They won’t run out in New Zealand either where there are 6 sheep for every person.
How long will it be before some unfortunate sod drinks sheep drench like the man who drank fish tank cleaner.
Researchers at Monash University found Ivermectin can kills COVID-19 cells
The anti-parasite drug killed off the cells within two days and is widely available
An anti-parasitic head lice drug available around the world has been found to kill COVID-19 in the lab within 48 hours.
A Monash University-led study has shown a single dose of the drug Ivermectin could stop the SARS-CoV-2 virus growing in cell culture.
‘We found that even a single dose could essentially remove all viral RNA (effectively removed all genetic material of the virus) by 48 hours and that even at 24 hours there was a really significant reduction in it,’ Monash Biomedicine Discovery Institute’s Dr Kylie Wagstaff said on Friday.
…Merck has donated well over 2.5 billion Mectizan® tablets for Onchocerciasis treatment, with in excess of 700 million treatments authorised. Currently, some 80–90 million people are taking the drug annually through MDA in Africa, Latin America and Yemen. A further 300 million total treatments have been approved for lymphatic filariasis, with around 90 million treatments being administered annually (Fig. (Fig.8 ).8 ).
The drug was discovered in 1975 derived from a microbe in Japanese soil. By 2011 some $4 billion dollars worth of Ivermectin have been donated to the third world.
It is used humans, even in children:
Ivermectin, while paralyzing body-wall and pharyngeal muscle in nematodes has no such impact in mammals, as it cannot cross the blood-brain barrier into the mammalian Central Nervous System, where GABA receptors are located.
It can be taken orally to kill head lice. It just means a lot of safety testing has been done already.
Why antiviral and antiparasitic?
When Ivvermectin binds to “Imp B” the viral protein can’t get across the BPC into the nucleus.
There is no obvious reason why these should be connected, but apparently Ivermectin is useful against other viruses too, including HIV, Dengue, West Nile, and influenza. (As an nice spin off from covid-19 we might find ways to cure the flu.)
RNA viruses seem to need to use a molecule called “importin” to get themselves into the nucleus of the cell, and Ivermectin blocks that.
Ivermectin has since been confirmed to inhibit IN nuclear importand HIV-1 replication5. Other actions of ivermectin have been reported7, but ivermectin has been shown to inhibit nuclear import of host (eg.8,9) and viral proteins, including simian virus SV40 large tumour antigen (T-ag) and dengue virus (DENV) non-structural protein 55, 6. Importantly, it has been demonstrated to limit infection by RNA viruses such as DENV 1-44, West Nile Virus10, Venezuelan equine encephalitis virus (VEEV)3 and influenza2, with this broad spectrum activity believed to be due to the reliance by many different RNA viruses on IMPα/β1 during infection11,12
But to show how fickle these things can be, even though it made it to phase III clinical trials against Dengue in Thailand, and it reduced the viral count in vivo, it still didn’t produce a clinical benefit.
So keep a sober mind that reducing viral loads in test tubes may not translate into saving lives in the ICU ward.
But even if Ivermectin is not the answer — something else will be, and hammering this virus is helping us buy the time to find what that is. We will figure this out and it may be sooner than people think.
There’s never been a time like this, with modern biotech, a trillion dollar life-and-death-carrot, and labs focused on this all around the world.
UPDATE: Norm der Ploom April 6, 2020 at 10:58 am points out that Ivermectin is a sheep anthelmintec which is a drench not a dip. Drenches are administered orally to kill internal parasites whilst sheep are dipped in other chemicals to kill external parasites.
Plain Jane uses Ivermectin and other treatments and has details on which is used and where in agriculture. It is not used as an oral sheep drench any more, but is for horses, and is poured on the backs of cattle. She hopes no one drinks this. See April 6, 2020 at 8:26 am
h/t Steve McIntyre @ClimateAudit, via Willie S, Another Ian, Bill in Oz, El Gordo, OriginalSteve
Ignore the mixed, junk messaging, if the WHO tells you not to wear a mask, that’s President Xi speaking. It’s a reason to wear one. We should all be wearing masks in public. It may be the cheapest way to reduce the R0, and get us out of coronavirus-jail fast.
Countries which wear masks have lower transmission. Taiwan, Japan, Hong Kong, South Korea. UPDATE: Australia’s Deputy Chief Medical Officer says Australians shouldn’t use masks because they are not clever enough to use them properly or something like that. Seriously. Don’t wait for bureaucrats to get the message right.
It protects other people from those who don’t even have symptoms who are shedding virus.
It protects you: It reduces your chance of breathing in droplets of virus that float in the air. Viruses are tiny, but studies show that masks work, even a thin surgical mask prevented nearly 3 out 4 parents from catching influenza from their infected children. The N95 style are better but any mask is better than nothing.
There are no guarantees –– the virus can sneak in the side, and still enter through your eyes (wear glasses to reduce at least to stop you touching your eyes). Goggles are better.
Take it off very carefully. Assume the front is contaminated. Don’t touch the front, hold it by the straps, and take off the bottom strap first. Let the mask fall forward. Be wary of shaking loose particles and then breathing them in. Think about where you will put it before you take it off and do it there. Here are short CDC instructions on mask use. The CDC video on donning and doffing. There are longer CDC instructions on fitting N95 masks. Wash hands before, after, and every ten minutes for the rest of the year. Don’t get OCD. 😉
To reuse: Boil cloth masks for 5 minutes to sterilize, or steam it. If it can’t be washed, hang outside in the sun for 48 hours, or leave it on a hot car dashboard.
Survival times of Coronavirus are shorter on cardboard and material compared to hard surfaces. I’m guessing porous material (like paper, card or cotton) dry and dehydrate the virus. For masks, the word is that the best material to use (apart from a HEPA filter) is a tight weave cotton sheet (a high thread count) — which might be better than synthetic material because of its ability to absorb water.
DIY: No sewing, disposable paper mask, suggested by Hong Kong’s consumer council
MATERIALS: Paper towels, tissue paper, rubber bands, masking tape, hole punch, binder clips aka “bulldog clips”, (plus glasses, wire and a clear plastic file folder if you want to make a face shield!)
Skip to 2:20 for instructions. A paper clip can be threaded into the pre-stitched hems of a bed sheet. Uses 13 inch x 5 inch pieces. Washable as long as the clips don’t rust.
DIY: Just fold it — the ultra simple Japanese style
This Japanese no-sew mask uses something that looks like a tea towel or handkerchief. It can be done with a bandana.
MATERIALS: Cotton tea towel, plus two elastic bands. 2 mins — plus fiddling to get it the right length to fit.
Best quality, sewn mask with HEPA filter
If you can sew, this is what Dr. Ryan Southworth is asking home handy-people to make for use on the front line. If you don’t have a machine, this could still be hand sewn. (It’s not impossible. I still have a hand sewn item my grandmother made which I keep just because of the incredibly fine stitching. Once upon a time, not so long ago, it’s all people could do.)
This is another style designed by a lab technician using hot glue, or heat sealing, and good quality filters. These are professional quality disposable masks.
For serious sewing types— the Olsen Mask is designed for hospital use: See the Youtube from UnityPoint Health, Cedar Rapids. The Olsen Mask is meant as a backup for frontline teams, and has complete patterns online. The hospital will provide materials. They will be reusable and washable.
Then there are people who are even using bra cups: Eg this woman.
OK, so we look weird in the shops. Think how relaxing it will be at home for the next two weeks where you don’t have to wonder if every dry cough is the start of something bad.
Closed rooms with many people talking are hot-beds of infection. Invisible clouds of virus hang suspended in the air. Open the windows. Turn up the airflow. Wear masks. (Wear goggles too, if you are high risk, the virus can get in through the wet surface of your eyes).
Blow that virus outdoors where the sun will fry it. We need to change the way we handle air in planes and on cruise ships, and public transport — even when there is no pandemic.
This is why I am not shopping without PPE. Make a mask. Mail order and delivery is so much safer. Do carpark pick ups. It’s also why eating uncooked fruit and vege that people may have breathed on is still a risk. The virus will likely survive 28 days in the fridge at 4 degrees C and even longer in the freezer. At 40 degrees it will last about 6 hours. Time will not protect you unless things are warm.
When I did research in a lab, if we wanted to save viruses we’d put them in a freezer (minus 70C).
A virus is more like a chemical than a living thing.
Heat helps bacteria but heat “kills” viruses by shaking them apart on a molecular level. I’m putting mail in plastic bags and leaving it in the Australian sun, or a hot car.
h/t Richard K (with thanks to his son for working on the front line)
Ancient technology wins: Not only are quarantine and isolation measures useful, they’re the best tools we have.
Some people don’t seem to realize that the only reason the daily growth of infections is slowing anywhere, is thanks to drastic quarantine measures or changes in human behaviour. We can see this in graphs from Italy, Spain, Norway, South Korea, Switzerland, Germany, and China, but not in Sweden or Brazil where there’s not much quarantine and not much slowing of growth curves either. In all of the former, the big meaningful actions were followed around 12 days later by an obvious slow down.
Willis Eschenbach, for example, wondered If Lockdowns Worked, but counted subdivisions of any quarantine type action as a measure of the severity when it’s more a measure of the wordsmithiness or indecision of leaders.
To see if major action matters, it’s better to look at the dates that borders, schools and shops were closed. The graphs of daily new cases below show that around 12 days later in so many countries, the growth in cases slows too. The delay is due to both the incubation period of Covid-19 and testing. By the time a lockdown is declared (or any such measure) a large expansion in cases is already “in the can”.
Japan did a lot more than just wear facemasks. Shinzo Abe shut the entire national school system down from March 2nd. He closed flights from China and South Korea on March 5th. Japanese cases peaked around the 14th of March — twelve days after schools closed, though it was probably due to a lot more than just school closure. The act of announcing something as drastic as that would inspire many behaviour changes, like hand-washing and distancing and working from home, and mask wearing.
Abe made that call, which astonished the schools, when Japan had less than 200 cases. Remember, at the time, Tokyo was still hoping to hold the 2020 Olympic Games in 2020. There was no messing around, and it kept the virus under control.
At some point a thousand PhD’s will pore over all the nations and different responses and they’ll figure out which forms of isolation or lockdown were the winners in the cost benefit stakes. Locking up the old folks may sound good (probably not if you are one), but this horrible virus hits the young, the fit, and even kills children (aged 13). It swallows whole hospitals. (See estimates here too). It’s not viable to sacrifice some in the 30 – 70 group, or give up having working hospitals either. That’s why every nation ends up crushing the curve anyhow.
At the moment, we have to hammer that curve, buy us time, and armour up to tackle this properly with treatments, monoclonals, antivirals, tests and proper PPE. Lockdown doesn’t have to last forever: weeks right now, are like gold. Then we beat this thing, one county at a time if we have to.
… and new daily cases peaked 12 days later on March 27th
..
Germany
In late February a few schools were closed in the one town (pop 40,000) where there was a cluster of cases. But travel to Italy was deemed A-OK. By March 8th, events of over 1,000 were banned, but not a lot else. Then on March 12, Donald Trump banned flights from the EU to the US and sent everyone into a flap. At this point some parts of the German government woke up.
On 13 March, most German states decided to close their schools. Some states added wider closures the next day. The national government suddenly ordered 10,000 ventilators. On the 15th of March Bavaria had local elections “luckily” just one day before the same state dissolved into an emergency with very complicated rules. Meanwhile people still flew in freely from Iran. On March 16th the public got angry and the flights were stopped. Later that same day, the Bavarian rules were extended over the whole country. Shops were mostly shut, buses were out, as was church, playgrounds or tourism. But it wasn’t called a “shutdown”. Finally on March 18th Germany closed borders to Italy, France, Switzerland and Denmark. Though flights to Iran and China apparently continued despite being stopped. The following week the rules got even tighter and curfews were introduced.
Germany peaked (maybe) on March 27th, sort of 11 days after flights were stopped (or not) from Iran and China, shops were shut, and a complicated set of social distancing rules came in.
The Spanish government imposed a nationwide lockdown on March 14th. Shops and businesses closed and all residents asked to stay home on March 15th. A State of Alarm was declared. In Spain cases peaked March 26th — 12 days after the lockdown was imposed.
Isolation and distancing measures were gradually phased in.
On the 28th of Feb large events with more than 1000 people were closed. On the 6th March Switzerland changed strategy to protect older persons and vulnerable groups. On 13th March classes were stopped. All events were banned of more than 100 people. Borders were partially closed. On 16th March bars and most shops were closed. March 20 the government announced no lock down policy would be pursued but all events with more than 5 people were banned. Since March 6th the Swiss Government policy was not to test anyone with mild symptoms. The daily new cases peaked on March 20th and has stayed level ever since.
So decisive moves were either to isolate vulnerable people on March 6th or closing schools on March 13. The peak was around March 20.
..
Australia
In Australia growth slowed on March 23 and peaked by March 28th (so far). The timeline of quarantine moves was incremental but most Covid cases were related to flights and cruise ships, so the border changes would have been more influential. And flights were banned from Iran on March 1, South Korea on March 5, Italy on March 11. On 13th March all gatherings over 500 were banned. On 15th March all incoming travellers were asked to self isolate for 14 days. On 20th March all borders were closed. On 21st March social distancing rules of 4 m2 per person were introduced. March 23 saw the closure of most cinemas, nightclubs, pubs, casinos. Restaurants ordered to do “Takeaway only”. Schools closed in Victoria from March 24, but parents were withdrawing children across the country even though other schools were technically open.
The peak on March 22 may have related to the reduction in flights from Italy 11 days earlier, though the Ruby Princess Cruise ship adds a lot of noise. I’m not convinced this is an easy peak to tie to any day, but the major action in Australia was in the middle two weeks of March.
Australian daily new cases (Click to enlarge).
Sweden
In Sweden there’s been no organised quarantine, just partial voluntary withdrawal, and there’s also been no peak yet.
..
Brazil
In Brazil, President Bolsonaro seems to favour doing nothing, but the governors of Sao Paulo and Rio De Janeiro banned gatherings and closed schools and many are pleading for action.
It’s not looking good. Not enough testing for starters.
On January 23: Wuhan placed under lockdown. Other Chinese provinces would follow during the next week. Despite the doctored official numbers, the rapid growth rate peaked twelve days later on Feb 4th. The spike around Feb 12th was due to definition changes.
On Feb 18th patient #31 went to religious meetings and cases escalated. By Feb 20th the streets of Daegu were empty. South Korean officials tracked and isolated cases at military bases, at the church group, and one hospital. Interviews were done on, wow, 230,000 members of the church at the centre of the outbreak which accounted for 60% of the national cases. The outbreak peaked by March 3rd, 12 days after the streets of Daegu were emptied.
Most infections in March were from travellers. South Korea put in stronger self isolation measures for travellers from April 1. Timeline for South Korea.
..Worldometer
The bell curve is all man-made
In a natural exponential growth situation with no lockdowns the infections keep spreading until most of the population has had it. This will eventually produce “that flattening” on a log graph, but we’re not remotely there yet (we are not even close). That only starts to happen when we reach well over half the population.
When graphing infectious growth on a log graph, any curve away from linear towards horizontal is good news.
And crushing an exponential daily growth curve down is no mean feat.
NEWS: A group say they have developed five antibodies from the old SARS antibody stocks that with tweaking can now bind well to the SARS-2 novel coronavirus.
An antibody is a long string of molecules that binds only to the exact target (we hope). Wikimedia Bioconjugator
If they get through all the testing phases and ramp up production, in theory, these could be ready for mass use in September (but everything would need to go right). They could be injected into patients and within 20 minutes these antibodies would bind to the virus and stop it entering cells. The protection might last 8 – 10 weeks before someone would need another dose.
This could be a gamechanger, but beware before anyone gets too excited, this is very early days — “protoplasm” days. There are a lot of steps to rush through.This group have searched and evolved the protein with their supercomputer which has a huge library of antibodies. They claim to be certain it binds to the virus — and to exactly the right part of the virus, but they haven’t actually done that yet — they’ll send the antibody to a military secure lab to do that. Then it still needs to be tested in tissue culture, animals, and people, and then more people. We don’t want it to bind to any other cells in our bodies, or trigger the wrong immune response. Side effects can include allergies, anaphylaxis, autoimmune disease, and even their own cytokine cascade.
But don’t write it off — the idea is sound, and if this group haven’t got the right combination, some other group will. It’s another reason to do the serious lock down now because there will be a way of defeating this virus. A tool like this will change the odds, save lives and make tracking and tracing contacts so much more effective, so we can wipe it out.
The hunt for antibodies mimics what our own immune systems do
As soon as a human body gets infected our immune system hunts for the right antibody in the toolkit. We have thousands of different ones circulating. Within days, victims are usually starting to mass produce the antibodies that bind to the virus. Survivors of coronavirus will carry some forms of antibodies, likely for a few months after infection at least. Using their blood plasma is one of the few weapons we have right now. NBL players say they will donate plasma, but there is only so much blood one person can give, and plasma comes with other risks like germs we don’t want to share. Plus recovery to covid-19 takes weeks and many recovering people need their own blood.
It’s also how an antivenom or antivenin works — we collect antibodies from a sheep or horse to a snake venom and have them ready to use in case of snake bite.
The idea here is to find then clone the right antibody and produce it en masse — a monoclonal antibody.
Dr Jacob Glanville, CEO of Distribute Bio, has revealed he and his team have adopted a pioneering approach which offered the potential for dramatic results. He tweeted: “After 9 weeks we have generated extremely potent picomolar antibodies that block known #neutralizing #ACE2 #epitopes, blocking the novel #coronavirus from infecting human cells.”
The diagram shows the complicated protein chains that fold into antibodies, which hopefully stick in a lock and key type way to important parts of the virus and stop it getting into cells. Antibodies also act as a flag to other branches of the immune system. This is heavy molecular level chemistry. Is that supercomputer modelling really that good?
Swedish people are still going to schools, restaurants and gyms. Even the cinemas are running. Apparently Sweden is taking the punt that there are many asymptomatic infections out there, despite having no data, and not doing any structured screening to get some either. They are also betting that immunity to this form of coronavirus will last a lot longer than the coronavirus colds where herd immunity is irrelevant one year later.
All recommendations are made by the Public Health Agency. Apparently they are learning from the 1918 influenza spread, and thus successfully “fighting the last war”. Swedish doctors are reportedly not happy about it. Probably because their idea of being doctors is not where you choose which 60 year old mother lives and which one dies, or where the doctors work round the clock and many of them get sick themselves, and some die. Gruelling is not the word.
Gatherings of 50+ people are banned, and the 70+ age group have been told to avoid social contact.
I predict that as the ICU units overflow, or even before, they will move to serious measures like the rest of the world as the inhumanity of the inadequate care becomes obvious. They will be dragged into tightening the rules daily as curves flatten everywhere else, but theirs continues to rise. People will hate it.
See Norway for example which appears to have peaked on March 27th. They are getting on top of the load. Currently Sweden has 4,700 cases and about 240 deaths. But Norway with the same number of cases has only 43 deaths, suggesting Norway is doing a lot more testing, or has a younger caseload.
In the last few hours Swedish authorities have updated their recommendations to vaguely warn people off peak hour buses, to postpone sporting matches, and to tell shops not to let as many people in, but not to let them queue tightly outside either. It won’t be enough. Though Swedish people are doing a part lockdown anyway voluntarily with passenger numbers down 50%. And unlike Italy, they don’t live in multigenerational homes, where teens can come home and infect grandma. Astonishingly 50% of Swede households are single occupants.
But the numbers still climb:
….
As Swedes watch other countries plateau, politically, they will not be able to allow their own death toll to rise without following suit. Those pressures are growing rapidly.
Panic, though, is exactly what many within Sweden’s scientific and medical community are starting to feel. A petition signed by more than 2,000 doctors, scientists, and professors last week – including the chairman of the Nobel Foundation, ProfCarl-Henrik Heldin – called on the government to introduce more stringent containment measures. “We’re not testing enough, we’re not tracking, we’re not isolating enough – we have let the virus loose,” said Prof Cecilia Söderberg-Nauclér, a virus immunology researcher at the Karolinska Institute. “They are leading us to catastrophe.”
Anders Tegnell, Sweden’s chief epidemiologist, who is leading the government’s handling of the crisis, advocates a strategy of mitigation: allow the virus to spread slowly without overwhelming the health system, and without recourse to draconian restrictions.
The government thinks they can’t stop it, so they’ve decided to let people die,” Söderberg-Nauclér said. “They don’t want to listen to the scientific data that’s presented to them. They trust the Public Health Agency [Folkhälsomyndigheten] blindly, but the data they have is weak – embarrassing even.
Sweden has the lowest number of acute care beds (general hospital beds) per capita in Europe. Interestingly, second lowest acute care beds is the UK, then Denmark, Spain and Italy. The highest number per capita is Germany.
Sweden with 10 million people has only 550 ICU beds which is about 1 ICU bed per 18,000 people (compared to 1 per 12,000 in Australia).
The WHO recommends “3 feet”, the CDC recommends 6 feet, but new research shows they got the model wrong and we might need to be 30 feet apart. Not to mention that the cloud of aerosols can wander suspended for hours. So we may need to be 30 feet and three hours apart.
They aren’t sure if their new findings have clinical implications, which says a lot about how much we don’t know. The 27 ft distance applies to sneezes, so if the other party isn’t sneezing you might not have to be so far. Lucky sneezing isn’t that common, though the dry cough is. Personal trainers at 27 feet is going to be tricky.
UPDATE:Some readers ask whether one new study is even worth reporting, accusing me of “scare tactics”. I’ve been reading medical papers now for over 20 years, so forgive me if I found the results here so banal that I didn’t mention that this result is barely new, and very well corroborated. Indeed it is not at all surprising to me that in some circumstances (right temp, humidity and airdraft) these viral particles would stay suspended for hours and travel much more than “6 feet”. In the last two months I’ve seen the same essential results posted by the CDC, Korean Profs, Chinese doctors and for anyone trained in microbiology, this is hardly news. I remain surprised that after ten years of being data driven in a field outside my training and primary interest, readers leap to declare astrological or political when I return to a field I got my degree in. I am still the same skeptic I always was. Stick with the data.
MIT associate professor Lydia Bourouiba, who has researched the dynamics of coughs and sneezes for years, warns in newly published research that the current guidelines are based on outdated models from the 1930s.
Rather than the assumed safety of 6 foot, Bourouiba warns that “pathogen-bearing droplets of all sizes can travel 23 to 27 feet.”
Right now Australia has one of the lowest death rates from coronavirus in the world. With 4,561 cases but only 19 deaths, the clumsy Case Fatality Rate is only 0.4% — lower even than Germany. While some commentators think that’s a reason to ease up it may be partly due to temporary good geographical luck. Plus winter is coming…
1. Australians with Coronavirus are younger (for the moment).
Most infections in Australia came from overseas travel — something the 20 to 70 year olds do a lot of, but apparently the 80+ age group aren’t flying on 20 hour long haul trips across the Pacific. (Last week the most common source of Australia’s cases was the USA, especially Aspen). This week the main source is Europe, and the nation called “cruise ships”. If and when the virus starts to spread among the older cohorts the death rates will rise. (Unless we figure out that treatment first).
As of March 14, South Korea reported that nearly 30% of its confirmed coronavirus cases were in patients ages 20 to 29. In Italy, by comparison, 3.7% of coronavirus patients fell into that age range, according to a report from Andreas Backhaus, a research fellow at the Centre for European Policy Studies.
2. Australia has done a lot of testing —
Australia has tested 230,000 people or about 1% of the population, and since most of those tests were aimed at travellers they have found the infected younger cohort, unlike countries with less testing. Australia has done slightly more tests per capita than South Korea (which has done about 400,000 tests on a population of 52m).
Germany also also has low rates — largely due to lots of testing and a younger group of patients
Good. Real signs of the flattening of new daily cases of Coronavirus or #CCPVirus in Italy, and possibly in Spain. Instead, ponder that if Italy didn’t slow the spread the 6,500 new cases on March 21 could have become 17,000 new cases every day by now.
Italy appears to have peaked — starting on March 21st — but may need to stop keeping sick people at home
On March 9th when Italy had about 9,000 cases in total, and 500 deaths, the government declared a quarantine across the whole nation. By March 11 everything that could be shut down, was. These changes appear, finally, to have stopped the exponential growth in new cases about 10 days later. But even after three weeks of lockdown there are still 5000 new people getting infected every day. One professor, Andrew Chrisanti, thinks it is because they are telling infected people to stay home instead of isolating them from their families. Presumably if Italians live in larger extended families, they must get the infected out of homes.
“In our opinion, the infections are happening at home.” Crisanti helped coordinate the coronavirus response in Italy’s affluent northeastern region of Veneto, where blanket testing was introduced at the start of Italy’s outbreak in the second half of February. That helped identify cases and limit contagion much more successfully than in the neighboring Lombardy region where only people with severe symptoms are tested, and only in hospitals.
Lombardy has since been hit with 6,360 registered coronavirus deaths, far more than any other Italian region, whereas Veneto has recorded just 392 fatalities. However, the Lombardy outbreak was much bigger from the outset. — Stefano Bernabi, Reuters
In the three weeks since the nationwide quarantine was called, the total cases expanded from 9,000 to 100,000, and deaths increased from 500 to 10,000.
The UK is expecting numbers to rise rapidly in the next two weeks
“It was announced today one in four NHS doctors are off work sick or in isolation. Professor Andrew Goddard, president of the Royal College of Physicians, said about 25 per cent of the doctor workforce is off, either with coronavirus or because a family member or housemate is ill.”
….
USA — 20,000 new infections a day — growing 16% a day
This is likely a real plateau, but due to slowing down international arrivals — it may be temporary. Community spread could still take off in the next few weeks. Since we aren’t testing “out there” we don’t know. And with 900 House Parties in Brisbane on the weekend (that we know of) the virus might be quietly partying too.
Thanks to some luck, Australia has closed borders, mandatory quarantine, mostly closed schools, and a lot of people are staying home, so perhaps the toll won’t rise further. Watch this space. In this case luck means — we’re lucky it’s not winter. We’re lucky those infected are in younger age groups so the death rate is lower. Mostly we’re lucky we could learn some harsh lessons from Italy, Spain and the rest of the world first, and still get away with being unprepared and incompetent.
Now is not the time to lift the restrictions. But here’s hoping we don’t need them for too many weeks.
Professor Kim Woo-Ju, Professor Infectious Diseases, Korea, says that masks are “definitely effective”. “I find it quite odd” that the west people don’t wear masks.” “People wearing a mask have a significantly lower chance of getting infected than those who don’t.” WHO says not to wear masks, he says “I disagree.”
Around the middle of the interview he says that one of the reasons Korea has low rate of infection is because they wear masks — as good as N95 (P2) — this is the same type as what the doctors wear.
He says Korea, and all the South East Asian countries are also experienced because they went through the SARS and MERS outbreaks. They knew what to do, they knew they needed tests fast.
“In 30 years of pandemics, Ebola, MERS, Swine Flu … the Covid-19 epidemic is the most challenging”.
In the 80+ age group the death rate is 11%
With the largest number of tests anywhere, they find 20% have no symptoms. But it is still not random testing. And the number may be different in other countries due to genes, climate (which affects vitamin D levels) or diet.
About 30% of cases the patients cannot smell or taste. That can last 5 – 10 days. (It’s good to know their senses come back).
They are seeing reactivation of cases released from hospital — people who tested negative and have been released. This is occurring a week or later and is very unusual. (5 – 6 minutes)
At 5 – 10 degrees and 30% humidity the virus can survive a long time at least 5 – 7 days on a table.
20% of their new cases in Korea are from flights.
Anti-virals are the most promising form of treatment, including the anti-HIV and Chloroquine related ones. He didn’t rave about them, but said they are somewhat useful.
Airborne transmission can happen in churches or where people are singing and shouting loudly. The airborne droplets can stay elevated longer, can dry out, and that means people will be infected much further away. This explains why churches or mosques can be the largest sources of infection. Presumably rock concerts would be too.
They use phones to track people in self quarantine and expect them to enter their symptoms daily. (!)
Schools have been delayed, but many young people are still studying at academies at night time and people are still going to night clubs, but 10% of their cases are in their 20-something group.
Does anyone here want to make masks and sell them to readers? I’m happy to connect up supply and demand if you know someone with a sewing machine. There must be a way to solve this. If we got people wearing masks and it reduced spread by 50% that means we all get out of this faster…. (and in that last post there was a study of Australian parents looking after kids with influenza and if they wore masks they prevented 3 out of 4 infections in parents.)
If you only read one serious page about how to deal with this crisis read Coronavirus: The Hammer and the Dance. The countries that “get this” approach will be the first to recover.
It’s all the things I’ve been suggesting but done on big scale with an expert team.
What I call the Slow Bleed is officially known as Mitigation. It’s the 6 month Flu strategy that kills people and the economy.
When I said Crush the Curve, they call it The Hammer, the hardest form of suppression. The Dance is the delicate recovery process until we get a vaccine, a treatment or a nicer mutant version of the virus.
1. Hammer and Dance — there is a better plan (click to enlarge)
Eventually we’ll all get to the Hammer Crush approach because the alternative is so horrible.
Even Imperial College concludes that slow “Mitigation” is just not viable: in the UK the demand for ICU beds would exceed capacity 8-fold, and there would be something like a quarter of a million UK deaths, and over a million in the US. They conclude that epidemic suppression is the only strategy, yet their predictions on that are dire. Their March 16 report has a chilling dystopian graph that hammers the infection then bounces up and down through cycles of suppression and release. But it ignores the key advantages of buying us time. We are not doomed to repeat each infection cycle. Right now we are unprepared, unarmoured, but some are headed into battle already — there aren’t enough beds, ventilators, specialists, drugs, masks, results, trials, or anything but guesses and hints. A two month pause would help so much more. Even a two week pause would.
Stanford Engineer Tomas Pueyo and a “group of normal citizens” which includes epidemiologists and experts have spelled it out in detail. It’s already been translated into 30 languages, and almost 35,000 people have signed their Petition to the Whitehouse.
At the moment Spain, Italy are facing the fight of their lives, but some of the rest of the West are almost giving up without a fight.
The red line in the graph below is not an error
The red line marks the size of the ICU capacity. This is the size of the challenge we face and it’s why there is no other realistic choice. Would we like to have a hospital system, or would we rather stone age luck?
2. Hospitals will be overwhelmed (click to enlarge)
Their summary:
When you’re done reading the article, this is what you’ll take away:
Our healthcare system is already collapsing.
Countries have two options: either they fight it hard now, or they will suffer a massive epidemic.
If they choose the epidemic, hundreds of thousands will die. In some countries, millions.
And that might not even eliminate further waves of infections.
If we fight hard now, we will curb the deaths.
We will relieve our healthcare system.
We will prepare better.
We will learn.
The world has never learned as fast about anything, ever.
And we need it, because we know so little about this virus.
All of this will achieve something critical: Buy Us Time.
If we choose to fight hard, the fight will be sudden, then gradual.
We will be locked in for weeks, not months.
Then, we will get more and more freedoms back.
It might not be back to normal immediately.
But it will be close, and eventually back to normal.
And we can do all that while considering the rest of the economy too.
Ok, let’s do this.
Spain, Germany, France and the US all have more cases than Italy when it ordered the lockdown.
Collateral damage could mean 1.5m more deaths in the US
There are 4 million admissions to the ICU in the US every year, and 500k (~13%) of them die. Without ICU beds, that share would likely go much closer to 80%. Even if only 50% died, in a year-long epidemic you go from 500k deaths a year to 2M, so you’re adding 1.5M deaths, just with collateral damage.
The case for South Korea
Because it was started so fast, the hard part was done in three weeks, and it wasn’t as hard as it will be in slower countries.
3. South Korea, case-load managed and is now doing the dance to keep it under control. (click to enlarge)
Feeding this virus comes with a risk
The more mutations there are the more versions of this virus we get:
Not only that, but the best way for this virus to mutate is to have millions of opportunities to do so, which is exactly what a mitigation strategy would provide: hundreds of millions of people infected.
Under a suppression strategy, after the first wave is done, the death toll is in the thousands, and not in the millions.
It’s a no brainer, but
Suppression would get us:
Fewer total cases of Coronavirus
Immediate relief for the healthcare system and the humans who run it
Reduction in fatality rate
Reduction in collateral damage
Ability for infected, isolated and quarantined healthcare workers to get better and back to work. In Italy, healthcare workers represent 8% of all contagions.
The Imperial College graph from mid March shows just how far beyond our hospital capacity we are even with quite serious measures to slow the spread.
Imprisoning the over 70s and closing schools still won’t save us from the Hospital Bed Bomb. That’s why we need to do more, go hard, go fast and wage War from our strongest advantage point — time. Without fresh bodies the virus doesn’t survive longer than a couple of weeks at room temperature. And the hotter it is, the shorter the viral “lifespan”.
4. Imperial College estimates of the effect of various forms of mitigation. (click to enlarge)
My favourite quote:
What if it turned out that in two months we discovered a treatment for the coronavirus? How stupid would we look if we already had millions of deaths following a mitigation strategy?
The speed of medical research is unprecedented. Labs all over the world are onto this, and because of the huge cost — there is a huge incentive to solve this. Note that the most promising avenues are in mass testing approaches and anti-virals or anti-inflammatory lines. Vaccine research can not be sped up to the same extent. There are inevitable bottlenecks in testing and waiting for humans to react and in being sure that all risks are being checked. Testing of other approaches is much faster.
We have The Code. We understand the biological alphabet. We will find a way to treat or neutralize this virus. It’s just a question of when.
5. The escalation of medical knowledge (click to enlarge)
This is no time to just give up
On one side, countries can go the mitigation route: create a massive epidemic, overwhelm the healthcare system, drive the death of millions of people, and release new mutations of this virus in the wild.
On the other, countries can fight. They can lock down for a few weeks to buy us time, create an educated action plan, and control this virus until we have a vaccine.
If you agree with this article and want the US Government to take action, please sign the White House petition to implement a Hammer-and-Dance Suppression strategy.
Here’s the latest mutation map. Many of these changes are just “decoration” — they don’t necessarily change the virus in a meaningful way, but they do mark the “heritage” of each subgroup of viruses.
Evolution is at work in the virus world. We know the virus will mutate to become more infectious, but we don’t know whether it will be more or less deadly.
6. The branching chains of Coronavirus around the world. (click to enlarge)
Buy Us Time to Fight the Coronavirus and Save Millions of Lives with a Hammer-and-Dance Suppression…
Our healthcare system is collapsing. It will only get worse. Mitigation-“flattening the curve”-isn’t enough. We must…
This is not just a bit better, it’s an order of magnitude (or three) better.
Every day we delay starting the hammer means more total deaths and many more days on the other side before the hammer ends and the dance begins. Exponential curves are so unforgiving when they are rising, but they can collapse just as fast on the downside. The further we drag the Ro (rate of infection) down, the faster we bring new cases down.
The payoffs from making Ro close to zero are astronomical at this point. We ought be prepared to throw everything at hammering this flat.
8. The Hammer and Dance (click to enlarge)
This is the group to follow, to share, to discuss:
This article has been the result of a herculean effort by a group of normal citizens working around the clock to find all the relevant research available to structure it into one piece, in case it can help others process all the information that is out there about the coronavirus.
On Modelling: It’s still wrong. These are estimated projections, based on assumptions and incomplete information. But data from nations all over the world already shows the trends and patterns are correct. The nations that got on top of things fast are already doing the dance — like South Korea and Taiwan. The nations that tried the slow bleed reactive approach have had catastrophic outcomes (if not in actual total death — its been measured in disruption and pain, and we have not even tried to count the collateral losses).
And all the nations that tried mitigating get overwhelmed and end up doing the hammer anyway. It’s inevitable so do it now. It’ll never be faster or more effective than starting today.
There’s a lot more detail at the original — read it all there. Hammer and the Dance
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