“Mild” Is Sometimes Damn Bad

Mildness is relative. From The Guardian:

Conventional wisdom suggests that when a sickness is mild, it’s not too much to worry about. But if you’re taking comfort in World Health Organization reports that over 80% of global Covid-19 cases are mild or asymptomatic, think again. As virologists race to understand the biomechanics of Sars-CoV-2, one thing is becoming increasingly clear: even “mild” cases can be more complicated, dangerous and harder to shake than many first thought.

Throughout the pandemic, a notion has persevered that people who have “mild” cases of Covid-19 and do not require an ICU stay or the use of a ventilator are spared from serious health repercussions. Just last week, . . . the US vice-president claimed it’s “a good thing” that nearly half of the new Covid-19 cases surging in 16 states are young Americans, who are at less risk of becoming severely ill than their older counterparts. This kind of rhetoric would lead you to believe that the ordeal of “mildly infected” patients ends within two weeks of becoming ill, at which point they recover and everything goes back to normal.

While that may be the case for some people who get Covid-19, emerging medical research as well as anecdotal evidence from recovery support groups suggest that many survivors of “mild” Covid-19 are not so lucky. They experience lasting side-effects, and doctors are still trying to understand the ramifications.

Some of these side effects can be fatal. Otherwise healthy people who thought they had recovered from coronavirus are reporting persistent and strange symptoms – including strokes.

According to Dr Christopher Kellner, a professor of neurosurgery at Mount Sinai hospital in New York, “mild” cases of Covid-19 in which the patient was not hospitalized for the virus have been linked to blood clotting and severe strokes in people as young as 30. In May, Kellner told Healthline that Mount Sinai had implemented a plan to give anticoagulant drugs to people with Covid-19 to prevent the strokes they were seeing in “younger patients with no or mild symptoms”.

Doctors now know that Covid-19 not only affects the lungs and blood, but kidneys, liver and brain – the last potentially resulting in chronic fatigue and depression, among other symptoms. Although the virus is not yet old enough for long-term effects on those organs to be well understood, they may manifest regardless of whether a patient ever required hospitalization, hindering their recovery process.

Another troubling phenomenon now coming into focus is that of “long-haul” Covid-19 sufferers – people whose experience of the illness has lasted months. For a Dutch report published earlier this month (an excerpt is translated here) researchers surveyed 1,622 Covid-19 patients with an average age of 53, who reported a number of enduring symptoms, including intense fatigue (88%) persistent shortness of breath (75%) and chest pressure (45%). Ninety-one per cent of the patients weren’t hospitalized, suggesting they suffered these side-effects despite their cases of Covid-19 qualifying as “mild”. While 85% of the surveyed patients considered themselves generally healthy before having Covid-19, only 6% still did so one month or more after getting the virus. . . .

“To me, and I think most people, the definition of ‘mild’, passed down from the WHO and other authorities, meant any case that didn’t require hospitalization at all, that anyone who wasn’t hospitalized was just going to have a small cold and could take care of it at home,” [said ] Hannah Davis, the author of a patient-led survey. “From my point of view, this has been a really harmful narrative and absolutely has misinformed the public. . . .

At this stage, when medical professionals and the public alike are learning about Covid-19 as the pandemic unfolds, it’s important to keep in mind how little we truly know about this vastly complicated [and highly contagious] disease . . . .

Unquote.

Broadway actor Nick Cordero, 41, died yesterday after 90 days in the hospital. According to The Guardian, “Cordero entered the emergency room on 30 March and had a succession of health setbacks including mini-strokes, blood clots, sepsis infections, a tracheostomy and a temporary pacemaker implant. He had been on a ventilator and unconscious and had his right leg amputated. A double lung transplant was being explored”.

But remember, he said we’re getting it under control.

America the Extraordinary

“Reddit shut down its popular but controversial forum devoted to supporting President Txxxx on Monday, following years in which the social media company tried but often failed to control the racism, misogyny, anti-Semitism, glorification of violence and conspiracy theories that flourished there” (The Washington Post).

“The US is ‘unlikely’ to achieve herd immunity to the coronavirus even with a vaccine, according to the country’s leading public health expert, who warned that a ‘general anti-science, anti-authority, anti-vaccine feeling’ is likely to thwart vaccination efforts. In an interview with CNN, Dr Anthony Fauci also said people not wearing masks was ‘a recipe for disaster’”… (The Guardian).

“The videos are now showing up in your social media feed every hour or two, each one more over-the-top than the one before — viral missives from a world that seems to have gone mad and yet somehow exists right in our backyard. These ‘forgotten Americans’ are at the lectern at your county commission meeting if they’re not yelling at you in the produce aisle — screaming that the elected officials and their so-called scientific experts demanding they wear a mask to prevent the spread of coronavirus are really part of a vast conspiracy to take away their freedoms” (Will Bunch for The Philadelphia Inquirer).

Mr. Bunch continues:

It was another great day for liberty — and yet a horrible one for tens of thousands of Americans who now may die needlessly because so many cling to a warped idea of freedom that apparently means not caring whether others in your community get sick.

The reality is that those devil-worshiping elected officials and their mad scientists are trying to mandate masks in public for the same reasons they don’t let 12-year-olds drive and they close bars at 2 a.m.: They actually want to keep their constituents alive.

There’s a plethora of reasons why countries across Europe — even Boris Johnson’s United Kingdom, for God’s sake — crushed their coronavirus curve while the United States didn’t. Their shutdowns were somewhat longer, their reopenings came with better testing and contact tracing, their leaders set good examples, and their people showed common sense about social distancing and masks. But especially masks.

The most comprehensive study published in the journal Lancet found mask-wearing could reduce the risk of coronavirus transmission from 17% to 3%. No wonder the University of Washington says universal mask-wearing in the United States would reduce the coronavirus death toll between now and October by a whopping 33,000 human beings.

Just think of all the restrictions on freedom and liberty — from the government seeing what you checked out at the library to invasive searches at the airport — to prevent another attack like 9/11 that killed 3,000 people, or less than one-tenth the toll from not wearing masks. But for millions of Americans — not a majority, mind you, but enough to cause a public-health hazard in a pandemic — the idea of masks has been launched into a different orbit where freedom talk is injected with the uniquely American viruses of free-market capitalism and media manipulation, maybe with a dollop of white supremacy….

But … too much of the warped notion of freedom promoted by the aggressively not-mask-wearing President Txxxx and his No. 2, Mike Pence, and their prophets like Rush Limbaugh and Sean Hannity won’t just get you high — to continue with the Sweet analogy — but could also kill you by an overdose. What the radio hucksters, and the wannabe dictators they installed, won’t tell you is that freedom without any social responsibility or empathy for others is ultimately hollow.

But let’s remember that American people — even the damaged souls that you’re laughing at on Twitter today — didn’t pervert the meaning of freedom on their own. The warped modern version of liberty was sold to them, first by right-wing public intellectuals like Ayn Rand, who killed thousands of trees to wrap unbridled selfishness in her endless tomes about freedom, and later by the salesmen of Big Capitalism.

Protecting your freedom became the ideal branding for what these pitchmen really wanted, which was political cover to dramatically lower taxes on millionaires (who, thanks to that, would become billionaires) and to crush unions and their demands for higher pay, freeing up profits to now pay CEOs 350 times what the average worker makes. Talk about finding the cost of freedom! With the help of academics like the Nobel economist James McGill Buchanan, backed by billionaires like the Koch brothers, warped freedom capitalism got a fancy name — free-market libertarianism…..

Confronted with scientific realities like man-made climate change, the forces of conservative libertarianism turned their guns toward expertise, with the goals of thwarting environmentalism and keeping corporate profits high. The bills for global warming are starting to come due, but that has been superseded for the time being by the COVID-19 crisis; the lack of trust for medical expertise from Main Street all the way to an ignorant president whom 62 million Main Streeters installed at 1600 Pennsylvania Avenue has proved lethal.

No other nation has botched its coronavirus response so badly because no other nation holds science in such low esteem. “Who made you perpetrators over my life?” the self-proclaimed Txxxx Girl demanded of the experts at the Palm Beach County meeting. In a recent Washington Post op-ed, Stanford psychiatry prof Keith Humphreys noted that the United States simply can’t impose a coronavirus testing regimen like South Korea or Singapore because we don’t trust the government on public health. “Clusters of gun-toting protesters opposing public health measures are a real — and uniquely American — problem,” he wrote, “but it’s the much more prevalent distrust in government’s role in public health that would curtail the success of any test, trace and isolate program.”

In a functioning society, freedom can flourish when it’s part of a broader social compact, when liberty is not abused because its practitioners also see themselves as part of a community, where they care about others — even, or especially, when it comes to wearing a mask and not spreading germs to your neighbor. But has there ever been a branding campaign as successful as America repackaging selfishness, self-interest, and extreme inequality as personal freedom?

That’s even true of the freedom that’s so central to my work life: the free press that exists under the First Amendment. I’ve seen how that only works well when publishers fuel their press freedom with common sense and an understanding of responsibility to the readers. In the internet age, the promise of an even greater media freedom has been polluted by billionaires from Fox’s Rupert Murdoch to Facebook’s Mark Zuckerberg, who made bigger profits off lies and unchecked conspiracy theories than off fact-checking in the public interest. The filth of Zuckerberg’s Facebook is what’s spewing, unmasked, from the self-styled “patriots” of Palm Beach County….

As the global pandemic advanced and as evidence mounted that COVID-19 is most lethal not just for the elderly but also for Black and brown Americans, it seems clear that for some white people, not wearing a mask isn’t just a freedom song but a defiant proclamation of their superiority. That’s validated every day by America’s white-supremacist-in-chief, whose refusal to wear a mask in public is in fact a different kind of mask, one of his deep insecurity. This toxic blend of narcissism and white privilege is Dxxxx Txxxx’s idea of leadership — even as he leads some of his voters to an early grave.

The flip side is that the millions who’ve marched in America’s streets after George Floyd’s murder — many, although not all, from the under-35 generation — are making the case that a better world, built around empathy and compassion for people who don’t look like ourselves, is coming. They are using their freedom of speech and assembly to forge a more perfect union, and I fervently wish that the 33,000 Americans who may be doomed by a lethal injection of phony liberty can somehow live to see it.

Data Analysis, Surprising and Not

Surprising news from The New York Times:

— Actual Coronavirus Infections Vastly Undercounted, C.D.C. Data Shows —

The prevalence of infections is more than 10 times higher than the counted number of cases in six regions of the United States.

The analysis is part of a wide-ranging set of surveys started by the Centers for Disease Control and Prevention to estimate how widely the virus has spread. Similar studies, sponsored by universities, national governments and the World Health Organization, are continuing all over the world….

“This study underscores that there are probably a lot of people infected without knowing it, likely because they have mild or asymptomatic infection,” said Dr. Fiona Havers, who led the C.D.C. study. “But those people could still spread it to others.”

She emphasized the importance of hand-washing, wearing cloth masks and social distancing to stop the spread of the virus from people without symptoms. [Getting tested is an excellent idea too, even if you have no symptoms.]

The numbers indicate that even in areas hit hard by the virus, an overwhelming majority of people have not yet been infected, said Scott Hensley, a viral immunologist at the University of Pennsylvania….

“Many of us are sitting ducks who are still susceptible …,” he said.

Not surprising news (not surprising at all) from The Washington Post:

Three serious research efforts have put numerical weight — yes, data-driven evidence — behind what many suspected all along: Americans who relied on Fox News, or similar right-wing sources, were duped as the coronavirus began its deadly spread.

Dangerously duped.

The studies “paint a picture of a media ecosystem that amplifies misinformation, entertains conspiracy theories and discourages audiences from taking concrete steps to protect themselves and others,” wrote [The Post’s] Christopher Ingraham in an analysis last week.

Here’s the reality, now backed by numbers:

Those who relied on mainstream sources — the network evening newscasts or national newspapers that President Txxxx constantly blasts as “fake news” — got an accurate assessment of the pandemic’s risks. Those were the news consumers who were more likely to respond accordingly, protecting themselves and others against the disease that has now killed more than 123,000 in the United States with no end in sight.

Those who [like the “Leader of the Free World”] relied on Fox or, say, radio personality Rush Limbaugh, came to believe that vitamin C was a possible remedy, that the Chinese government created the virus in a lab, and that government health agencies were exaggerating the dangers in the hopes of damaging Txxxx politically, a survey showed….

“That’s the real evil of this type of programming,” Arthur West of the Washington League for Increased Transparency and Ethics, … told the Times of San Diego. “We believe it delayed and interfered with a prompt and adequate response to this coronavirus pandemic.”

Unquote.

Mass manslaughter, anyone?

Maybe It’s All Jelly

From The New York Times:

It would be one thing to concede that science may never be able to explain, say, the subjective experiences of the human mind. But the standard take on quantum mechanics suggests something far more surprising: that a complete understanding of even the objective, physical world is beyond science’s reach, since it’s impossible to translate into words how the theory’s math relates to the world we live in.

[Angelo] Bassi, a 47-year-old theoretical physicist at the University of Trieste, in northeastern Italy, is prominent among a tiny minority of rebels in the discipline who reject this conclusion. “I strongly believe that physics is words, in a sense,” he said across the picnic table. [He makes] a case for what a vast majority of his colleagues consider a highly implausible idea: that the theory upon which nearly all of modern physics rests must have something wrong with it — precisely because it can’t be put into words.

Of course, much about quantum mechanics can be said with words. Like the fact that a particle’s future whereabouts can’t be specified by the theory, only predicted with probabilities. And that those probabilities derive from each particle’s “wave function,” a set of numbers that varies over time, as per an equation devised by Erwin Schrödinger in 1925. But because the wave function’s numbers have no obvious meaning, the theory only predicts what scientists may see at the instant of observation — when all the wave function’s latent possibilities appear to collapse to one definitive outcome — and provides no narrative at all for what particles actually do before or after that, or even how much the word “particle” is apropos to the unobserved world. The theory, in fact, suggests that particles, while they’re not being observed, behave more like waves — a fact called “wave-particle duality” that’s related to how all those latent possibilities seem to indicate that an unobserved particle can exist in several places at once….

Bassi’s research is focused on a possible alternative to quantum mechanics, a class of theories called “objective collapse models”…. And [he is] now leading the most ambitious experiment to date that could show that objective collapse actually happens….

The hard part [was making sure the new theory didn’t] contradict any of quantum mechanics’ many unerring predictions. The trick, it turned out, was to endow fundamental particles with some funky new properties.

“You should remove the word ‘particle’ from your vocabulary,” Bassi explains. “It’s all about gelatin. An electron can be here and there and that’s it.”

In this theory, particles are replaced by a sort of hybrid between particles and waves: gelatinous blobs that can spread out in space, split and recombine. And, crucially, the blobs have a kind of built-in bashfulness that explains wave-particle duality in a way that is independent of human observation: When one blob encounters a crowd of others, it reacts by quickly shrinking to a point.

“It’s like an octopus that when you touch them: Whoop!” Bassi says, collapsing his fingertips to a tight bunch to evoke tentacles doing the same.

If objective collapse were to be confirmed, … the way the world works will once again be expressible in words. “Jelly that reacts like an octopus” will be the new “particles subject to forces.” New, exotic phenomena will be identified that could spawn currently inconceivable technologies. Schrödinger’s cat will live or die regardless of who looks or who doesn’t. Even the unpredictability of the subatomic world could turn out to be illusory, a false impression given by our ignorance of octopoid innards.

The Economy, the Virus and Us

Annie Lowery of The Atlantic says that economists have four major concerns regarding the US economy.

(1) The household fiscal cliff:  Government stimulus payments have kept the economy in fairly good shape this spring, despite massive unemployment. However, the stimulus is supposed to end a month from now. Republicans don’t favor renewing it. That will mean  “millions of families just keeping their head above water will sink”. Consumer spending will plummet.

(2) The great business die-off:  “This steep decline in consumer spending will hasten mass business failure… An estimated 100,000 small companies have shut permanently. On top of that, numerous businesses—airlines, restaurants, live-events businesses, hotels, private schools, oil and gas companies—face severe and stubborn slumps….Economists expect that 42 percent of people recently let go will not return to their former employers.

(3) The state and local budget shortfall:  Every state except Vermont is required to balance its budget, but “sales taxes, real-estate-transfer taxes, income taxes, fines and fees—they are all collapsing, leaving local governments with a budget gap expected to total $1 trillion next year. Without help from Washington, this will necessarily mean massive service cuts and job losses: namely, an estimated 5.3 million job losses.

(4) The lingering health crisis:  “The catastrophe of the American government’s management of the … pandemic …  has led to the unnecessary deaths of tens of thousands of people…. The country is reopening with the disease still spreading and maiming and killing, as several states experience a dramatic surge in caseloads. Never getting the pandemic under control means never unleashing the economy…. Ending the pandemic would have been the single best thing the federal government could have done to preserve the country’s wealth, health, and economic functioning. The Txxxx administration, in its hubris, obstinacy, and incompetence, failed to do it.”

“Congress could extend unemployment insurance, offer new help to flailing businesses, send monthly cash grants to poor families, offer fiscal relief to the states, and implement a nationwide test-and-trace program.” Or things may get a lot worse.

From Stat News:

The “respiratory” virus that causes Covid-19 made some patients nauseous. It left others unable to smell. In some, it caused acute kidney injury….The Centers for Disease Control and Prevention constantly scrambled to update its list [of symptoms] in an effort to help clinicians identify likely cases.

[But] in late January, … scientists in China identified one of the two receptors by which the coronavirus, SARS-CoV-2, enters cells. It was the same gateway, called the ACE2 receptor, that the original SARS virus used. Studies going back some two decades had mapped the body’s ACE2 receptors, showing that they’re in cells that line the insides of blood vessels — in what are called vascular endothelial cells — in cells of the kidney’s tubules, in the gastrointestinal tract, and even in the testes.

Given that, it’s not clear why the new coronavirus’ ability to wreak havoc from head to toe came as a surprise to clinicians. Since “ACE2 is also the receptor for SARS, its expression in other organs and cell types has been well-known”….

The assumption that infection would first and foremost cause respiratory symptoms was misplaced. In the week before they were diagnosed, Covid-19 patients were 27 times more likely than people who tested negative for the virus to have lost their sense of smell. They were only 2.6 times more likely to have fever or chills, 2.2 times more likely to have trouble breathing or to be coughing, and twice as likely to have muscle aches. For months, government guidelines kept people not experiencing such typical signs of a respiratory infection from getting tested.

Faced with a disease the world had never seen before, physicians are learning as they go. By following the trail of ACE2 receptors, they are more and more prepared to look for, and treat, consequences of SARS-CoV-2 infection well beyond the obvious.