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For most people Coronavirus is like the flu or even a cold, but for 20% it’s something awful. Even in younger patients — a few seemingly fit and healthy 40 and 50 year olds are gasping for air as their lungs fill with blood and fluid and it’s “like a near death drowning” or “inhaling caustic gas”. Forgive the language in the headline — those were this docs exact words. He’s working at a New Orleans hospital and his whole attitude to the virus has changed dramatically. h/t Analitik A Medical Worker Describes Terrifying Lung Failure From COVID-19 — Even in His Young Patientsby Lixzzie Presser, ProPublica “It first struck me how different it was when I saw my first coronavirus patient go bad. I was like, Holy shit, this is not the flu. Watching this relatively young guy, gasping for air, pink frothy secretions coming out of his tube and out of his mouth. The ventilator should have been doing the work of breathing but he was still gasping for air, moving his mouth, moving his body, struggling. We had to restrain him. With all the coronavirus patients, we’ve had to restrain them. They really hyperventilate, really struggle to breathe. When you’re in that mindstate of struggling to breathe and delirious with fever, you don’t know when someone is trying to help you, so you’ll try to rip the breathing tube out because you feel it is choking you, but you are drowning. If you don’t feel motivated to stay home and order online, then go read all of this story at ProPublica from end to end. Most likely, if you catch Coronavirus, this won’t happen to you. But the whole pain of quarantine might look like a small price to pay. How many people in each cohort does this dire situation occur too? Perhaps it’s only 1 in a 1000. Or perhaps it’s more. Can someone find the latest stats from Italy on how many need ICU in different cohorts. Presumably, if the mortality rate is 40% with ARDS, then this happens to 2.5 times whatever the mortality rate is. UPDATE: In comments Lee Valentine points out the doc’s in New Orleans should not have restrained the patient. They should have been paralyzed and unconscious (as the other ICU specialist described in this video). I was disappointed to read this report of the corona virus ARDS cases. Disappointed because the cases were mismanaged. ARDS victims should NOT be restrained, EVER. They MUST be paralyzed with drugs. So far, I have had only one corona ARDS patient. He arrived four days ago. There are two now in my hospital. It’s a serious worry that if Los Angeles gets many more we’ll not have enough specialists who know how to manage them. If our current rate of new cases continues, we’ll have all ventilators available in use for corona ARDS in a few weeks.” — Lee Valentine This is knocking out what should be perfectly fit, healthy people.
…then all of a sudden, they go into complete respiratory arrest, shut down and can’t breathe at all.” “It’s called acute respiratory distress syndrome, ARDS. That means the lungs are filled with fluid. And it’s notable for the way the X-ray looks: The entire lung is basically whited out from fluid. Patients with ARDS are extremely difficult to oxygenate. It has a really high mortality rate, about 40%. Keep reading → Look at State by State outcomes: visit Covid Act NowIts an excellent display of modeled outcomes across the US*. Click on each state in the US to find out predicted death tolls and the day hospitals will be overwhelmed with too little action. Dear readers, get out of the way of this virus. My advice is to stay home. Order online. Wear masks if you have to venture out. Keep kids home from school. Don’t visit anyone or allow visitors in to your home who have not strictly quarantined for the last two weeks. We started this last week. h/t Bill in Oz. Eg It’s too late now for New York State to avoid losing control of hospitalsBut they could still Crush the Curve and save a lot of people, but even that action now will have far higher death tolls that it would if it had been started last week. New York State has a population of 20 million. So the figures in the table below are directly comparable to Australian outcomes with a population of 25m (with the hope that lower population density, warmer weather, and two weeks warning could be an advantage.)  New York outcomes. There are four levels of action modeled here (from March 19th). The final death tolls are very different.  New York outcomes. The advantage of “Crushing the Curve” now means we can wait to find out which treatments work. It’s always possible to ease up on the level of quarantine and pick the higher death toll options, but it isn’t possible to choose the low death futures if we do too little too late. If we are headed for the Wuhan Style lockdown anyhow, sooner is better, and we can release it later when extra hospital beds or drugs or treatments are available. Figure that even if we choose “Social distancing” now, once people see the lists of obituaries and queues of coffins, and desperation in hospital wards as awful choices are made, many people will voluntarily stay housebound. The CCP was ordering workers to go back to work, but they didn’t want to. Eg. California needs to act this week
 California outcomes. …  California outcomes. *All models are still wrong. But discuss the assumptions, don’t shoot the messenger. ______________________________________________ Coronavirus Background: ☀ The Demographics: the severity increases with age, and slightly more for men than women. ☀ The Ro is 2 – 3 and exponential curves are steep. How Coronavirus kills: why the number of ICU units matters so much. ☀ Illness progression: Dry coughs and Fevers, Aches. In 15% of people, by day 5 breathing trouble starts. In 3% (?) by day 8 they may need an ICU (intensive care unit). ☀ The good case of Singapore but the ominous calculations of how fast the ICU beds may run out. ☀ Proof that viruses don’t have wings and we should have stopped all flights so much earlier. ☀ The story of how American Samoa avoided Flu Deaths with quarantine in 1918. ☀ The story of Vo, the Italian town that stopped the virus. ☀ Delay = Death, statistics show mortality rates rise tenfold if hospitals are overwhelmed. ☀ Projections of all US States death tolls depending on quarantine levels and the date that hospitals could be overwhelmed ☀ One doctor describes his “Holy S***” moment ☀ ☀ ☀ We must Crush the Curve to save lives and the economy. Economics: ☀ The huge impact on the Chinese economy ☀ the awful case of Iran.☀ Beware UN advice: ☀ Ethiopian WHO chief was part of China’s debt trap diplomacy ☀ Stats and Data: ☀ John Hopkins Live Map ☀ Worldometer ☀ Coronavirus data in Australia ☀
I believe there are other things happening in the world still. The wave coming is not just a “bit bigger” than hospitals can handle Western Australian specialists estimate that at present rate, in 45 days Coronavirus cases will fill up their entire state hospital system. Two weeks later Covid patients will also fill all the beds in the extra two copies of their entire state hospital network that haven’t been built yet. Hospitals will need 20 times as many ventilators as they have. “Peak need for ventilators will be over four thousands in a system where we have less than two hundred. Again, most of those needing a ventilator will die. “ Perhaps we are overreacting?Western Australia is an example of what the rest of the West faces. There are 2.5m people here, but only 120 confirmed cases. In a state which took six years to build one hospital all we need to do is triple our hospital capacity in 6 weeks. Laughing… The Doctors call for the immediate closure of borders. Which was impossible a few days ago, in a state that only has two sealed roads out, but is now happening on Tuesday “at 1:30pm”. (Presumably the new border guards have to drive out from Perth.) Amazing how fast the world changes once other leaders act. Doctors want schools closed immediately and social distancing halved “at a minimum”. They warn “Social isolation measures are manifestly inadequate”. “People will forgive the imposed hardships they may suffer but they will not forgive us if we, knowingly, do not act now to stop the demise of thousands of Western Australians.”  Hospital beds required, Western Australia, (Click to enlarge)
These dreadful numbers will not pan out, but only because the unfolding disaster will spark all the draconian lock-downs (shelter in place) and quarantine conditions I’ve been saying would come. People will do it voluntarily out of fear anyway once more stories start to hit the news. We will slow this, and keep deaths far below these tallies. After which I expect the naysayers will pop up and mock the big numbers and tell us they were right all along. “It was nothing”. “See I told you it would peter out. ” The Docs are not mincing words:Almost 50 of WA’s top specialists have penned a chilling open letter to Premier Mark McGowan, warning of thousands of WA coronavirus deaths “without strong and decisive leadership”. “Most of these deaths will be in the course of just a few weeks. There will be many who will become critically ill and die with hospital staff unable to do anything to prevent their demise. “We will have colleagues who die. “We will have nurses, business leaders, school teachers, mothers, fathers, and our grandparents who will die with us unable to do anything but watch it happen. “We will run out of ventilators and those who need them will then die. This modeling* estimates that if people cut their social contacts in half the total peak ventilators and hospital admissions will decrease by about six fold. Notice that the dates of the peaks stretch out by another three months with “social distancing”.  Table, model estimate of peak cases coronavirus, WA (Click to enlarge) I still say Crush The Curve, the slow bleed is still awful. Declare War and get rid of this. With serious social distancing the state might “only” need an extra 50 ventilators a day: Nathan Hondros, WA Today This would mean there would be an extra 400 Intensive Care Unit ventilators required a day to meet the demand. But if every West Australian reduced their normal social contact by half, infections would peak in mid-to-late August and only 52 new ICU ventilators a day would be needed. If tough measures are not put in place, the doctors estimate the number of hospital beds required would be three times those currently available.
The list of surgeons and specialists includes many respiratory experts, but what would they know? Prepared as well as anywhere in the world (which means “hopeless”)The state has almost run out of testing kits. Like the US and Italy, community transmission will be expertly identified right after people turn up needing intensive care for pneumonia. A “grand round” meeting of doctors at Fiona Stanley Hospital on Wednesday heard questions about whether transmission was already happening given the strict testing criteria. A shortage of reagents needed for testing means only people with a fever or respiratory illness and have either returned from overseas or had close contact with a known case are eligible. Health or aged workers are also tested. In the United States and northern Italy, the first indicator of widespread transmission was when patients started to arrive at hospital that required intensive care. That has yet to happen in WA hospitals, but if it does, by that point the disease is “out of the bag”, the FSH meeting heard. Not so. At that point, the disease will have been “out of the bag” for one or two weeks already. Dumb bit of code is still weeks ahead of bureaucrats. If we don’t have community spread in WA, and we did lock down, we would get rid of it. Now is exactly the time to close everything. Whereever you live, if they are not quarantining everything, write to your politicians and media. We must Crush the Curve. *All models are still wrong. The first epicentre in Italy was Vò, a little town of 3,000. It was shut down, fully tested and twice and nine days apart. By testing, isolating, and tracking, they reduced the spread to almost nothing, and this is despite the extraordinary discovery that when the first death happened, already 3% of the town had the disease. At that point surely the Italian government should have immediately closed everything? https://www.livescience.com/small-italian-town-cuts-coronavirus-cases-testing.html Italian village reports no new infections for days after blanket testingZoe Tidman, Independent Mr Zaia, Veneto’s governor, said the trial was “criticised by most sides” but that isolating numbers of undetected positive cases has resulted in Vo Euganeo being today “the safest place in Italy”. h/t Bill H In one Italian town, we showed mass testing could eradicate the coronavirusAndrea Crisanti and Antonio Cassone, The Guardian, March 20. Our experiment came to be by chance. The Italian authorities had a strong emotional reaction to news of the country’s first death – which was in Vò. The whole town was put into quarantine and every inhabitant was tested. In the first round of testing, 89 people tested positive. In the second round, the number had dropped to six, who remained in isolation. In this way, we managed to eradicate coronavirus from Vò, achieving a 100% recovery rate for those previously infected while recording no further cases of transmission. The headline is a bit silly — mass testing doesn’t eradicate anything, but it does make strict isolation and containment easier to achieve. Now we probably need mass blind shutdowns to achieve the same effect when earlier action and mass testing then could have crushed the curve with much less effort. 70% asymptomatic or mild — good but ominous dataItaly’s death rate of known cases is shockingly high (which is why I gave up calculating it weeks ago). These numbers are similarish to the Chinese rates where roughly 80% were described as asymptomatic or mild. It probably just depends on the definition of “mild”: … asymptomatic or quasi-symptomatic subjects represent a good 70% of all virus-infected people and, still worse, an unknown, yet impossible to ignore portion of them can transmit the virus to others… It shows it’s possible to Crush the Curve and get rid of this virus, but it takes mass testing which we now can’t do because we didn’t act soon enough. But we may be able to do if we ramp up production of tests kits like our lives (and our economy) depended upon it. On the plus side, this reduces the mortality rate but even so, if we lose control of hospitals we know 3 to 5 times as many people will die if we can’t offer everyone who needs it an ICU unit. If the fact that only those presenting with the virus were being tested was accounted for, the mortality percentage would fall to more “normal” levels. This is shown by the mortality in the Veneto region, which is steadily around 2.5-3%, still high but threefold less than the ones in Lombardy and Emilia-Romagna. In Veneto about 8% of the total population was tested. So we still don’t know what the death rate really is. From the beginning I’ve said that hidden asymptomatic cases will reduce the fatality rate. We aren’t going to get good numbers on that til we do mass blood testing looking for antibodies that show people have fought off an infection. These have to be done before antibody titres fall (and we don’t know how fast that happens, and whether people carry some protection for a long period or not. SARS responses appear to stay for longer, but the common cold Coronavirus infections last in the order of one year. Estimating mortality rates is still a guessing gameThe best estimates we have are from The Diamond Princess where everyone was tested and South Korea which has done more testing per capita than anywhere. Respectively, the mortality rates were 1% and 0.9%. Given that the Diamond Princess passengers were older the mortality rate in a normal demographic group might be as low as 0.5%. On the Diamond Princess half the people who tested positive were asymptomatic (49%). But the idea that 80% of the ship didn’t catch the virus is nothing to cheer about. On board the Diamond Princess one infection became 712 in just four weeks –– two of which were supposedly under quarantine conditions. The cruise ship Diamond Princess set off from Yokohama on January 20, with about 3,700 passengers and crew. On Jan 23 a man got sick and left the boat in Hong Kong on Jan 25th. It took four weeks to infect 20% of the ship and half that time was spent under quarantine conditions. Of the infected, fully 178 people have still not recovered and 14 remain classed as “severe/critical”. This is a bugger of a virus. Stay out of the way of this virus, stay home if you can, get your kids out of school. Just stop mixing for the next few weeks and see what unfolds.
______________________________________________ Coronavirus Background: ☀ The Demographics: the young are spared, but the severity increases with age, and slightly more for men than women. ☀ The Ro is 2 – 3 and exponential curves are steep. How Coronavirus kills: why the number of ICU units matters so much. ☀ Illness progression: Dry coughs and Fevers, Aches. In 15% of people, by day 5 breathing trouble starts. In 3% (?) by day 8 they may need an ICU (intensive care unit). ☀ The good case of Singapore but the ominous calculations of how fast the ICU beds may run out. ☀ Proof that viruses don’t have wings and we should have stopped all flights so much earlier. ☀ The story of how American Samoa avoided Flu Deaths with quarantine in 1918. ☀ The story of Vo, the Italian town that stopped the virus. ☀ Delay = Death, statistics show mortality rates rise tenfold if hospitals are overwhelmed. ☀ Economics: ☀ The huge impact on the Chinese economy, the awful case of Iran.☀ Beware UN advice: ☀ Ethiopian WHO chief was part of China’s debt trap diplomacy ☀ Stats and Data: ☀ John Hopkins Live Map ☀ Worldometer ☀ Coronavirus data in Australia ☀
Traitors to the people?Some in the Republican Party knew what was coming. At least four Senators in the US are being accused of insider trading, selling stocks before the crash, but not warning the public or making sure the US was prepared. Senator Richard Burr sold something like a million dollars in their own stocks on Feb 13th. At private briefings his message was that this virus was aggressive, more like the Spanish Flu, “the military might be mobilized”. Burr was probably more aware than most because he “helped to write the Pandemic and All-Hazards Preparedness Act (PAHPA).” On the other hand Senator Loeffer says she was not involved in choosing the stocks that were sold on her portfolio. But others say some of these blind trusts sold shares the same day the Senators were briefed in some cases as early as Jan 24th. The Senators claim they were only acting on public news services. Possibly, even if they knew, they may have been bound by some Party ruling not to contradict the President. Rod Dreher, The American Conservative “They Knew, And Didn’t Tell Us”Think about it: Trump certainly knew how bad it was going to get, but kept on downplaying it, at a time when being straightforward would have given people time and impetus to prepare. Trump’s most loyal backers then were calling it a hoax, and dunking on people like me for hyping panic, and so forth. This top Senate Republican (and no doubt other Senate Republicans) knew that the president was misleading the public, and said nothing. If he felt comfortable telling wealthy donors about this, why didn’t he tell the general public? Because it would contradict the president’s messaging? Why? Having senior Republican lawmakers contradicting the president at that relatively early stage, based on information they knew, would have been in the country’s best interest. Sen. Burr told rich, well-connected supporters what was coming, but not the people who elected him. He owes them an explanation. And I would like to know why the Senate Republicans, all of whom surely had the same information, did not challenge the president, and warn the public while we still had time. …To be honest, it’s not [Burr’s] stock-selling that bothers me — it’s that he had reason to believe the coronavirus crisis was going to be a lot worse than he was letting on in public. He ought to have been warning us all. Has Trump thrown away the 2020 election? Which day did he realize the trainwreck was coming? Weeks Before Virus Panic, Intelligence Chairman Privately Raised Alarm, Sold Stocksby Tim Mak, NPR The chairman of the Senate Intelligence Committee warned a small group of well-connected constituents three weeks ago to prepare for dire economic and societal effects of the coronavirus, according to a secret recording obtained by NPR. The remarks from U.S. Sen. Richard Burr were more stark than any he had delivered in more public forums. On Feb. 27, when the United States had 15 confirmed cases of COVID-19, President Trump was tamping down fears and suggesting that the virus could be seasonal. “It’s going to disappear. One day, it’s like a miracle. It will disappear,” the president said then, before adding, “it could get worse before it gets better. It could maybe go away. We’ll see what happens.” On that same day, Burr attended a luncheon held at a social club called the Capitol Hill Club. And he delivered a much more alarming message. Burr sold personal stocks worth between $628,000 and $1.72 million in 33 separate transactions on a single day, February 13th, according to public disclosures. See also this https://www.youtube.com/watch?v=M2BPXybIGGI … … Remember back in February when the mainstream media was telling us this was “just like the flu”? They weren’t asking the Health Minister “how many Australians might die” or “why don’t we close the borders”. They didn’t want to know whether the PM had calculated the cost of leaving the borders open? They weren’t estimating how many weeks it would be before we ran out of ICU beds. Nor were they demanding to know whether Australians could make more medical masks, had enough ventilators, or should be stocking up with weeks to go, so we could avoid last minute shopper panic. Australians were still booking holidays on cruise ships and flights to Bali instead of putting spare toilet paper in the shed. While the tidal wave was weeks away the media was more concerned about protecting the image of China, not calling this the Wuhan-Flu, and making sure we know how wrong it was to make jokes about not shaking hands of Chinese-Australian doctors. Which is poor taste but hardly a national prime time event. The irony being that now we’re not supposed to shake anyone’s hands anyway. Australians were blindsided by the incompetent media. That’s why they are panic shopping now. And now the media still wont ask the borders question — those who sold the country into this mess which could have been so easily avoided. The media doesn’t want to go there because it would be to admit they failed too. They kept it off the table — presumably to stay fashionably aligned with their academic buddies who were shedding tears about 65,000 student cash cows being stuck at home in China. Watch the advert at 3:00 minutes –China Global Television Network promoted the spread of coronavirus with a advert. It’s almost like the media were bought by China…. In Australia yesterday the ABC or SBS chopped Trumps answer so Australians mostly won’t know that Trump calls it the Chinese Virus because China is calling it a virus from American Soldier. Australian Medical Association WA President Andrew Miller said Western Australia was headed for a situation like Italy and are 8 – 10 days behind Sydney. Read his scathing comments below. The tally in Australia is now about 900, the same as Italy had on Feb 28th, just three weeks ago. Now Italy has 41,000 cases and 3,405 people have died. Their population is three times larger than Australia and slightly older, it’s colder and packed in closer. At a guess, with the present SlowMo/SlowState response, maybe only 10-20,000 Australians will catch this in the next three weeks? “Great”. UPDATE: Hospitals in Italy are no longer intubating anyone over 60 years old. h/t nezy Italian politicians could have been better prepared, but there’s no excuse for the rest of the world now. Coronavirus crisis: Australian Medical Association WA President Andrew Miller slams WA Government response to COVID-19 pandemicJohn Flint The West Australian [Miller said:] …“And we’re not doing any of the things that the countries that are being successful are doing like Hong Kong. “They are using fever monitoring in public, they lock people down away from their families if they’re positive, whereas here we send them home.”Dr Miller said the WA Government knew before today’s announcement that community spread was happening. “They’re in a state of disbelief, confusion and chaos,” he said. The AMA has called for the State’s borders to be closed. Dr Miller said: “They said, ‘that’s ridiculous, we’re not closing them. And it’s impossible and unnecessary because no one gets infected on a plane’. “And the next day, the Premier comes out and says, “it should be non-essential travel only, interstate (but) we can’t close the borders, that would require a national agreement that contravenes the constitution.’ “The next day Tasmania closes its borders. They’re full of s**t. You can quote me on that.” He has since apologized for being disrespectful.* No one should waste words on anything except the main problem at hand which is not manners and ettiquette when lives are at stake. “The AMA (WA) has always recommended that we should be taking ALL measures to flatten the curve of the spread outlined by the World Health Organisation. This includes closing borders, slowing community spread and most importantly — being prepared. Keep reading → There is a third way — Why are we so fatalistic?It’s not a choice between Let It Rip and the slow bleed of “Flatten the Curve”. It’s not a choice of health versus money. The third option no one is mentioning is to Crush The Curve: we go hard, fast, and do a major short sharp quarantine. It’s not radical, it’s just textbook epidemiology, it saves more lives and it saves the economy too. SlowMo, Boris and Trump are still two weeks behind the virus. It’s time to get the Third Option on the table. Flattening the Curve is a fatalistic slow bleed that must last months. It rescues us from the demolition derby that the Let It Rip disaster is cursing on Italian hospitals, but it’s deadly for the economy. All leaders who are keeping schools open while turning student dorms into triage units are locked into this limited thinking. It’s the Influenza-plan rejigged. There is another way — (as I’ve been saying) — we stop dithering and acting two-weeks-late, and jump ahead of this inanimate code. We aim for extinction — hunt every infection down, keep most people at home, reduce the spread, then finish by following every contact, track and trace. It’s not that big a deal. When we said “close the borders” people said it was unthinkable, but they’re closed now. Somehow life goes on without the trip to Bali, and the dinner at the Hyatt. The slow-bleed keeps people going to work and dinner parties, and keeps the kids in school, but we walk the tightrope of Hospital Doom with an exponential foe — people dying drip, drip, drop all the way.  Crush the Curve instead, enough with the fatalism We’ve already given up sport, holidays and big parties — it’s not the end of the world to just call a halt to work and school and stay home for a few weeks. I predict we’ll end up there anyway, so the sooner the better. As long as people have food, it’s not exactly “survival camp” struggle to stay home for a few weeks. Regions can still trade with care. We drop the containers at the border, swap cabs and use local drivers. Planes with cargo can be quarantined or cleaned. We do food deliveries, so no one goes hungry. We test those delivery guys, and the packer girls. We guard the supply chain people — the farmers, health workers, and all essential services. We live without lawyers and accountants for a few weeks, and look after the supply chain people. We expect the delivery team to be as isolated as possible (apart from the delivery rounds), and tested often, so we pay them more temporarily. The last thing we want are deliveries of coronavirus. (Like in Italy). In this future we build holiday homes, not hospitals. The secret is strict walls. We stop feeding the virus fresh bodies and simply outwait the code. Its big weakness is that it can’t repair from daily wear and tear. Heat will break the bonds. So will UV. Sooner or later (nine days?) we don’t have to do anything and the code disintegrates. One snip and it’s powerless. The great thing about this is certainty and speedDo it once and do it well, then maintain the barrier around the Virus Zone as it shrinks bit by bit. Imagine nations split into mosaics of small regions and we clean one at a time and build from there. As each small region is cleared of the virus it can be opened to other clean regions, then clean states join clean states, and finally clean nations connect. This quarantine is only as good as its walls, but it can be done. And it can be maintained and it will keep airlines, events and restaurants alive. Footy games too. Schools have to go skeleton minimalist (briefly) — all kids who can stay home should stay home. South Korea had emergency classes for children of essential workers and kept class sizes to 10. After the state is clean, schools can run normally again. In the six month Slow-Bleed-Plan schools will have no certainty that they won’t be shut down due to infection any day. Flights can’t be restored quickly, and businesses go bust. How realistic is it to aim for extinction?This is not 1918. We don’t have to give up before we even start. Thousands of medical researchers are working on this from scores of different angles. There are plenty of interventions in the pipeline to improve the odds. It will take a special kind of determination. It will take thousands of tests and discipline, but we won’t have to keep it up for six months. Keeping the virus out would have been a snap a few weeks ago, but now we need to over reach to aim for zero. Instead of slowly sliding belatedly into greater and greater restrictions, just do them all now temporarily. Make it top priority to get the Ro under 1 and keep it there. Declare a war on this virus. As a side benefit, even if we don’t achieve extinction we stop more countries losing control. And we discover what makes this virus tick and which restrictions matter the most. Crushing it now buys us time to find ways to improve the odds. Being defeatist now just makes it harder to use the new tools when they come. And they will come, we know the code. Any antivirals (chloroquine, anti-HIV drugs) can be used as preventatives on the contacts to ring-fence the virus. New biotech solutions with potential to make this easier include mass production of monoclonal antibodies, or small copies of the infectious spike protein or stem cell treatments and RNAi. We declare war on this virus. We study it to the nth, do gene assays, figure out which people are most at risk of infection or at risk of being carriers or at risk of getting the severe disease. But we don’t need hi-tech, we need a clear mission, and some time… States with the fewest infections have the best chance to lead the way — New Zealand, Tasmania, Hong Kong. West Australia. Russia, Macao, Taiwan. India? After the curve is crushed, freedom is mostly fixed fastInside the No-corona-state everyone has all the freedom that they usually have, they just can’t leave and come straight back without a two week quarantine. But restaurants, schools, clubs and pubs are all back on again. The proviso is that that walls must stay strong. A No-corona state can only afford open travel with other proven No-corona nations. All arrivals from the virus zone will have to be quarantined and not with polite requests but mandatory checks and carefully enforced. But every nation will want to be on the clean list — there is a big incentive to get there and maintain it, and to be honest. Countries caught hiding infections will be dropped like hot potatoes, and lose the right to get back on the list quickly. Poor nations will need help but big clean nations will have healthy economies, and they can assist. There is better futureUntil there is a vaccine or a serious treatment we live with constant vigilance looking for an outbreak. But when it happens, we know what to do. Short, sharp and fast. Obviously we test, test, test, and then test again.
______________________________________________ Coronavirus Background: ☀ The Demographics: the young are spared, but the severity increases with age, and slightly more for men than women. ☀ The Ro is 2 – 3 and exponential curves are steep. How Coronavirus kills: why the number of ICU units matters so much. ☀ Illness progression: Dry coughs and Fevers, Aches. In 15% of people, by day 5 breathing trouble starts. In 3% (?) by day 8 they may need an ICU (intensive care unit). ☀ The good case of Singapore but the ominous calculations of how fast the ICU beds may run out. ☀ The story of how American Samoa avoided Flu Deaths with quarantine in 1918. ☀ Economics: ☀ The huge impact on the Chinese economy, the awful case of Iran.☀ Beware UN advice: ☀ Ethiopian WHO chief was part of China’s debt trap diplomacy ☀ Stats and Data: ☀ John Hopkins Live Map ☀ Worldometer ☀
March 19th, 2020 | Tags: Coronavirus | Category: Global Warming, Health, Medicine, Microbiology, Mortality |  Print This Post | | I’ve said from the start that anti-virals were always going to be more useful to us this year than vaccines, which take so long to test and be ready for use. What we really need are anti-virals which also happen to be preapproved and tested and hopefully in mass production. Chloroquine is cheap too, though I doubt Australian stocks of the drug are very high, or that our genius rulers have arranged more. This may be a godsend in Africa where chloroquine use is already high and may reduce the spread of Covid-19 somewhat. The UK banned export of chloroquine a few weeks ago. Clearly someone there thought it might be useful. Wang et al reported on Feb 4th that Chloroquine (anti-Malarial) and Remdesivir (anti HIV) may be useful against Coronavirus. They used lab experiments on cells in glass, which had promise. But “in vitro” doesn’t always mean “in vivo”. So I’ve been waiting for some results on people. Early reports were ambiguous. Recently this was hyped as an “Australian cure” which really just meant the start of a proper trial. There are links to papers and discussion below but I can’t beat this great description explaining how inside the cells zinc stops a major viral protein from copying the virus. Chloroquine is a zinc ionophore — it opens the ion gates and pumps zinc into the cell, just what we want if we have virus trying to take over the cellular machinery. The South Korean results are not based on a randomized blind trial so we can’t be sure if it works. But the South Korean death rates are lower. Perhaps they are doing a better treatment than Italy. Perhaps the viral strains are different. Perhaps the population is different, older, have higher blood pressure, etc etc. h/t to Bulldust, Geoff S, Willie Soon, Eric Worrall, David E, Hugh P, Colin A, Chris D. Please send a letter to incompetent Health Ministers to make sure they are looking at how to maximize stocks now, and to remove bureaucratic hurdles to using this for the most severe cases, which may help reduce the ICU load as well as keep people alive. This is yet another reason to go hard, go fast, reduce the rate of infections.If treatments are just around the corner, the financial and “lives” advantage will be amplified if we stop the explosive exponential curve as fast as possible. Brendan-let-them-die-Murphy our fatalistic Chief Medical Officer seems to have given up on saving as many Australians as possible. New Chloroquine study in France A renowned research professor in France has reported successful results from a new treatment for Covid-19, with early tests suggesting it can stop the virus from being contagious in just six days. Professor Didier Raoult from infection hospital l’Institut Hospitalo-Universitaire (IHU) Méditerranée Infection in Marseille (Bouches-du-Rhône, Provence-Alpes-Côte d’Azur), published a video explaining the trials on Monday March 16. This was a small study on only 24 patients. Doses were 600mcg/day for ten days. “We were able to ascertain that patients who had not received Plaquenil (the drug containing hydroxychloroquine) were still contagious after six days, but of those that had received Plaquenil, after six days, only 25% were still contagious.” On March 13 another paper wrote up the guidelines from South Korean doctors and Chinese medical teams. Treatment Guidelines from South Korea[7]
Mechanism of action — increases intracellular pH to clogs up cells machinery which stops viral replication.A different view on how it works (I prefer the video description above). Keep reading → March 18th, 2020 | Tags: Antiviral, Coronavirus, Hydroxychloroquine (HCQ) | Category: Global Warming | Print This Post | | Oops. Forgot Tuesday. Sorry. Australia has only one mask factory, and the Army was only sent in yesterday to start helping to ramp up production? Six weeks after this disaster was obvious to bloggers-watching-twitter-feeds, the entirely predictable shortage of masks is only just starting to be addressed? Why weren’t they doing this a month ago? Australian Defence Force soldiers have been deployed to help Australia’s only mask manufacturer, Med-Con, near Shepparton. The Federal Government confirmed on Tuesday about a dozen ADF personnel would be called out under the Defence Assistance to the Civil Community rules to help Med-Con ramp up production of personal protective equipment. Three army trucks were seen heading north on Old Dookie Rd about 7.20 am Wednesday morning. Australians are panic buying because the sheer incompetence of our medical advice and management is obvious to everyone. It didn’t occur to me to suggest the government get local mask production running because any sensible ten year old would have seen that coming. The Greg Hunt mantra on Jan 31: WHO declares emergency. “We are prepared.” March 5th: Dental practices face closure because of shortage of surgical masks. March 18th: doctors are warning a promised influx of almost 100,000 COVID-19 test kits in the coming week, won’t be enough.
Incompetence.
Dithering politicians push the fatality from 0.5% toward 5%A gritty analysis by Tomas Pueyo shows how leaders inertia is killing people every day. Some of the victims of tomorrows Virus Get-Togethers won’t die for a few weeks, but the next batch starts tomorrow (and every day until the nation self-isolates, stops the pox-parties, the cough-shopping, and pneumonia-planes. ). And each day there are more than the day before. Sounds macabre, but at this point in an exponential epidemic, it’s just how it is. Since we didn’t stop the Airbussed virus, we’re going to have to shut everything down anyhow, the later we do it, the larger the cost, and the longer it takes. We have to get ahead of this virus. Meanwhile in Australia, the average punter seems to realize this and the mood is hitting feverish notes with tramplings in supermarkets — The government is calling for calm, but doctors are calling for borders to close, and schools to go online, they’re standing outside schools with signs telling parents not to send their children to school. Doctors are warning that we are the next “Italy” if we don’t get our act together. But the government says it’s too early to close schools (apparently we have to kill some more people first). The keep-schools-open excuses are bizarre: parents are being told to send kids to school so that kids don’t stay home and infect grandparents — which implies that they will infect parents and somehow that is OK. Ministers doesn’t seem to realize that if kids stay home with grandparents early, and we stop this spreading, no one gets sick in the first place. The other excuse to keep the schools open is that healthcare workers need the childcare which South Korea solved by holding small “emergency” classes of under ten students. Better for healthworkers kids and the teachers. In some schools in NSW and Victoria a quarter to a half of all students are already absent as parents keep them home. The Catholic School system (which huge here) is calling for stoppages. Teachers, not surprisingly are not too happy about being sacrificial child minders. They don’t understand why a crowd of 500 is not OK, but a school of 1000 is. And finally some cancer patients, disabled folk and longer lived humans are identifying as the 1-4% who “Are expected to die” and they don’t like being referred to as a casual-nevermind-addendum. When’s the best time to stop an epidemic? Before it becomes one. Pueyo calculates the likely final death rates in different areas by converging two different ways to estimate it. Far in the future some countries are headed for a 0.5% while others are aiming for 4% — it depends on the day they start. How many people will start down a path to dying tomorrow… Peuyo has a handy method to guesstimate the “percentage of infected employees” or odds of getting infected in your own state — he’s trying to help people answer the question “when should you lock down”. Read it all. h/t to Orson Olsen for the excellent tip. Coronavirus: Why You Must Act NowThis is what you can conclude:
Put in another way: Countries that act fast can reduce the number of deaths by a factor of ten. And that’s just counting the fatality rate. Acting fast also drastically reduces the cases, making this even more of a no-brainer.
 Some countries have kept the exponential curve at bay…
Notice the main rise and fall plays out over four weeks of lockdowns. And also that it takes 12 days from major action to slow the ship and start to see a difference.  … He estimates that the true rate of infections (grey lines) rises much faster than the recognised cases. The two estimates of death rates converge on under 1% or close to 4%. The difference comes down to the day the leader gets their act together. No country on Earth has enough ICU beds for this virus. The later they stop the spread the sooner the hospital wards overflow. The death rate in central China will end up around 5%. The rate in the rest of China is more like 1%.  … The rate in South Korea is tending towards 0.5%. (Though it is a pretty “out there” graph — South Korea is one of a kind.) In Italy the curves are headed towards 4%. The hospitals are totally overrun. Here’s hoping they can bring that back fast. But suddenly it’s clear why the semi lock down one day became a nation lockdown the next. I heard tonight that Italy has more hospital beds per capita than the US does.  … Wow. What China did. The lengths at which it went to contain the virus are mind-boggling. For example, they had up to 1,800 teams of 5 people each tracking every infected person, everybody they got interacted with, then everybody those people interacted with, and isolating the bunch. That’s how they were able to contain the virus across a billion-people country. This is not what Western countries have done. And now it’s too late. I do have a reservation with the Pueyo analysis — he doesn’t seem to realize the Chinese stats are computer modeled CCP estimates of something probably ten fold higher. But the rates in China match elsewhere — they might have been using the real ratios, even they faked the numbers to hide the scale. There are only a couple of sentences that hinge on the actuals – -I don’t think Wuhan was really locked down when infections were . Otherwise, the trend is King, unfortunately.
______________________________________________ Coronavirus Background: ☀ The Demographics: the young are spared, but the severity increases with age, and slightly more for men than women. ☀ The Ro is 2 – 3 and exponential curves are steep. How Coronavirus kills: why the number of ICU units matters so much. ☀ Illness progression: Dry coughs and Fevers, Aches. In 15% of people, by day 5 breathing trouble starts. In 3% (?) by day 8 they may need an ICU (intensive care unit). ☀ The good case of Singapore but the ominous calculations of how fast the ICU beds may run out. ☀ Proof that viruses don’t have wings and we should have stopped all flights so much earlier. ☀ The story of how American Samoa avoided Flu Deaths with quarantine in 1918. ☀ The story of Vo, the Italian town that stopped the virus. ☀ Delay = Death, statistics show mortality rates rise tenfold if hospitals are overwhelmed. ☀ Economics: ☀ The huge impact on the Chinese economy, the awful case of Iran.☀ Beware UN advice: ☀ Ethiopian WHO chief was part of China’s debt trap diplomacy ☀ Stats and Data: ☀ John Hopkins Live Map ☀ Worldometer ☀ Coronavirus data in Australia ☀
WA hospitals call for state border closures to deal with coronavirus fears (COVID-19)Top doctors across WA’s biggest hospitals are sensationally calling for the state to effectively close its borders to protect West Australians from the coronavirus pandemic. In a remarkable letter obtained by The West Live to be discussed exclusively on this morning’s show, it can be revealed the Combined Medical Leads Advisory Group has raised concerns about the “extremely limited” availability of testing infrastructure and supplies in WA. The group, which includes senior medicos from FSH, RPH and SCGH, also warns there is “limited evidence of effective anti-viral treatment”, “no effective vaccine” and that rationing is already in place at hospitals. It recommends that to “flatten the curve” that attention should be paid to “extending isolation restrictions to all personal interstate travel”. Just to spell this out, all states without community transmission have the chance to quickly put this virus back in the box. The first thing they need to stop is stop flying in the virus. Then they track and isolate all current cases, and if appropriate, tell people to stay home, call off all movement in the state and suspend everything bar essential services. Then within three to four weeks said state will be in blissful nirvana where all citizens can fly inside the state, take holidays, resume their normal jobs, send their kids to normal schools, and get elective surgery, medical care and all the normal things we hope for. After this point border quarantine must be maintained. The state must be vigilant for any outbreak. When outbreaks occur, we track and trace. As I said two days ago, trucks and trade still cross the border even during the lockdown but the drivers (fresh virus fuel) are either swapped at the border or kept only in special sealed hotels before they return. So if you want to save the local economy, thousands of lives and our very way of life — Close the Borders Now. I remain baffled as to why so many people think we have to let this virus run wild, and why the cost of domestic door to door lock down is not seen as hideously expensive and therefore state border closures are a bargain compared to the inevitable pain and suffering coming. In the UK and US, Canada there will still be regions where there is no community spread yet. These can be saved, and then as more clean regions are achieved more flights and movement between these safe regions will rescue airlines, tourism agents, etc etc. The world will soon be divided into the countries or states which have beaten this virus and those which haven’t. The Clean World = Taiwan, South Korea, New Zealand, Russia, Hong Kong, Singapore. Imagine your home state there and start working on that future. Note from blogger: For fed up readers — yes, I get it. Normal transmission will resume soon. In comments, I’ve explained that the area of science I was always most passionate about was virology, disease, and genes (my majors and research)*. I would never have guessed in a billion years that I would end up writing a blog on climate science. And just as I feel in the climate debate that I can help the hands-on experts explain their case with renewable energy and meteorology, in this medical debate there are thousands of doctors and medical researcher nerds who are political and media naffs that seem to need some help. *Also prevention of such, which means nutrition etc — don’t get me started, take your D, Zn, and Se. :- )
March 17th, 2020 | Tags: Coronavirus, Virus | Category: Global Warming, Medicine | Print This Post | | Scuttlebutt that crossed my desk today says “”US to have nationwide quarantine for 14 days'”. h/t Scott.I hope this is correct. My reply:”Brilliant”. Finally, a hint of an attitude determined to beat this. It’s so refreshing after all the defeatist fatalism telling us this is a disease we have to have. I predict if the US does this, other countries will follow. This is the fastest way to get borders open, and people back to work, and reduce the death toll. Flights will be able to reopen among countries that have done this and done this well. UPDATE: Officially denied already? The Whitehouse has been forced to deny national shutdown rumours.(A search for “Rumor US two week lockdown” turns up almost no news items?) Don’t believe anything til it is officially denied… but don’t believe the rumours. The fact is there are no facts. Forgive me if I repeat: A virus is just an inanimate chemical code. It can’t reproduce and it can’t repair itself. To beat it, all we have to do is out-wait it. Without machinery to copy the code it will degrade into foodsafe ingredients. Air, oxygen, time and light will crack the code. The longer we feed it, the stronger it gets. A perfect quarantine needs two weeks. An imperfect one will need longer. But giving up social contact, income, parties and holidays isn’t the end of the world. Obviously, some people will bear a larger cost than others. (Hope temporary measures can look out for them). But everyone will bear a smaller cost in the long run if we go hard, go early and get serious. No more feeding it free bodies. Except apparently in the UK, where that is actual policy…. ? Seriously?
UK recycles old measles/flu policy to come up with Very Stupid (Sounding) PlanUPDATED: UK Local, Stephen Wilde warns it was a bit more complicated and Hanage at The Guardian spun a side comment for political effect. But the stories about the Herd Immunity Plan went right across the Atlantic and popped up downunder too and given what Sir Patrick Vallance said, seem to fit. The U.K.’s Coronavirus ‘Herd Immunity’ DebacleEd young The Atlantic: The country is not aiming for 60 percent of the populace to get COVID-19, but you’d be forgiven for thinking so based on how badly the actual plan has been explained. This sstill sounds like the influenza “we have to have” plan. Not the deadly virus plan: With the peak of the pandemic still weeks away, the time hadn’t come yet for stricter measures, Johnson and his advisers said. They worried about “behavioral fatigue”—if restrictions come into force too early, people could become increasingly uncooperative and less vigilant, just as the outbreak swings into high gear. (As of yesterday, the U.K. has identified 1,391 cases, although thousands more are likely undetected.) And while suppressing the virus through draconian measures might be successful for months, when they lift, the virus will return, said Sir Patrick Vallance, the U.K.’s chief scientific adviser. To avoid a second peak in the winter, Vallance said the U.K. would suppress the virus “but not get rid of it completely,” while focusing on protecting vulnerable groups, such as the elderly. In the meantime, other people would get sick. But since the virus causes milder illness in younger age groups, most would recover and subsequently be immune to the virus. This “herd immunity” would reduce transmission in the event of a winter resurgence. On Sky News, Vallance said that “probably about 60 percent” of people would need to be infected to achieve herd immunity. Half-baked quarantines don’t work very well. But a serious quarantine can save thousands of lives. Why not aim high? Keep reading → BREAKING NEWS: Since writing this Scott Morrison has finally moved to quarantine all arrivals including planes and ships. He’s still two weeks behind the virus, and playing catch up with Jacinda Ardern, the real leader. But finally the bleeding obvious has dawned. He won’t close schools, and perhaps, suddenly that will now be a viable option, though Sydney still needs short sharp major action to save lives. Could they bear doing no sport or social events for two weeks? The big risk to most states are now flights from Sydney. Will NSW aim for the “slow bleed” eking out infections over months, hoping none accidentally go wild, or will it aim to wipe this out in three weeks so life gets back to normal, and Australia can play sport again against New Zealand, asap? With this news, just in the nick of time, the future is now looking better. My prediction: Watch as leaders all round the world pick this up. This is a good boost for nation states and sovereign borders. All eyes are on the EU now where the open border policy has been disastrous — Spain (6,300), Germany (4500) and France (4,500) are where Italy was on 7th March, just over one week ago. Even if they lock-down seriously now their hospitals are set to reach breaking point. Tell me again how flight bans and quarantines don’t help. When there is an epidemic coming, flat lines are our Christmas-glitter-favourite trend. This graph from Coronavirus data in Australia shows infections arriving here followed by mysterious long flat lines. The dates are unreadable but we all know what happened and when. h/t Travis and Chris D How many thousands of Australians were saved by that one call to stop flights from China? Italy had the same number of cases as Australia does now (250) on the 24th of February. Now 1,500 Italians are dead and 20,000 are infected. That’s three weeks “progress”. UPDATE: Will NSW follow Italy? On Feb 23rd Italy had 134 cases and 2 deaths. By 7 days later, the tally was 1,700 and 34 deaths. Sun, warmth and a lower population density mean it will be lower in Australia. Obviously flights from the USA and Italy should have been quarantined a week ago. For all these discovered infections there only needed to be a few that went unnoticed and seeded the community spread we are now seeing in NSW. The only planes we want right now come from Russia, Israel, Taiwan and New Zealand. Across the Tasman, just like that yesterday — all flight arrivals to New Zealand were quarantined. Voila. New Zealand may end up being the best place on Earth to be in the next month. After this is over, a few leaders will be seen to have saved tens of thousands of lives. Jacinda Ardern will look like a hero. SlowMo will look like a Slow Mo. NZ could’ve allowed flights from Australia but we’re too high risk. Slow leaders are choosing to kill people and the economyTo protect people in the rest of Australia, interstate travel could be quarantined. [UPDATE: Maybe this is not necessary now. But the nation would beat this faster if we did]. People could return to their home state with a two-week isolation. If borders were closed now WA, SA, Tas, NT would quickly get a tiny epidemic back under control with contact tracing. Then they could send spare masks and doctors and ventilators to NSW to save lives. Trucks could unload trailers and containers at border stops to be picked up by local drivers in local semi cabs. Or they could be allowed to drive right through but stay in designated secure hotels before returning home. We could build holiday homes instead of hospitals. Some genius economist needs to explain how the economy benefits from allowing a mass outbreak-that-we-don’t-have-to-have. Interstate travel, restaurants, schools, businesses in the smaller states could reopen for business with domestic sales and travel in perhaps four weeks time saving thousands of businesses from going under. High risk vulnerable Australians could take a one month holiday in a safe state to wait out any mess in NSW etc. All this is achievable, but which state leader has the balls to stand against the Open Border Bullies and deadly fatalistic medicos like Brendan-we-have-to-die-Murphy? NEWS Sunday morning in Australia:
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