Tag Archives: COVID-19

People Have Said This Is the Best Article About the Virus

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A science and health reporter, Donald McNeill, who specializes in “plagues and pestilences”, consulted “more than 20 experts in public health, medicine, epidemiology and history” and then wrote a long article for The New York Times. It’s called “ The Coronavirus in America: The Year Ahead”. It’s received a lot of praise. These are the parts (2,200 words or so) I found most interesting. The article has many links that aren’t included below.

What follows is divided into sections:

How Many Will Die
The Lockdowns Will End, But Haltingly
Immunity Will Become an Advantage in Society
A Vaccine Is Not Coming Soon
Treatments Are Likely To Arrive First
We Will Need International Cooperation

[ How Many Will Die ]

In fast-moving epidemics, far more victims pour into hospitals or die at home than doctors can test; at the same time, the mildly ill or asymptomatic never get tested. Those two factors distort the true fatality rate in opposite ways. If you don’t know how many people are infected, you don’t know how deadly a virus is.

Only when tens of thousands of antibody tests are done will we know how many silent carriers there may be in the United States. The C.D.C.  has suggested it might be 25 percent  of those who test positive. Researchers in Iceland  said it might be double that.

China is also revising its own estimates. In February, a  major study  concluded that only 1 percent of cases in Wuhan were asymptomatic.  New research  says  perhaps 60 percent  were. Our knowledge gaps are still wide enough to make epidemiologists weep.

“All models are just models,” Dr. Anthony S. Fauci, science adviser to the White House coronavirus task force, has said. “When you get new data, you change them.”

There may be good news buried in this inconsistency: The virus may also be mutating to cause fewer symptoms. In the movies, viruses become more deadly. In reality, they usually become less so, because asymptomatic strains reach more hosts. Even the 1918 Spanish flu virus eventually  faded into the seasonal H1N1 flu.

At the moment, however, we do not know  exactly how transmissible  or lethal the virus is. But refrigerated trucks parked outside hospitals tell us all we need to know: It is far worse than a bad flu season.

[ The Lockdowns Will End, But Haltingly ]

The next two years will proceed in fits and starts, experts said. As more immune people get back to work, more of the economy will recover.

But if too many people get infected at once, new lockdowns will become inevitable. To avoid that, widespread testing will be imperative.

Dr. Fauci has said “the virus will tell us” when it’s safe. He means that once a national baseline of hundreds of thousands of daily tests is established across the nation, any viral spread can be spotted when the percentage of positive results rises.

Detecting rising fevers as they are mapped by … smart thermometers may give an earlier signal…

But diagnostic testing has been troubled from the beginning. Despite assurances from the White House, doctors and patients continue to complain of delays and shortages.

To keep the virus in check, several experts insisted, the country also must start isolating all the ill — including mild cases.

In this country, patients who test positive are asked to stay in their homes, but keep away from their families.

Television news has been filled with recuperating personalities like CNN’s Chris Cuomo, sweating alone in his basement while his wife left food atop the stairs…

But even Mr. Cuomo ended up illustrating why the W.H.O. strongly opposes home isolation. On Wednesday, he revealed that his wife had the virus.

“If I was forced to select only one intervention, it would be the rapid isolation of all cases,” said Dr. Bruce Aylward, who led the W.H.O. observer team to China.

In China, anyone testing positive, no matter how mild their symptoms, was required to immediately enter an infirmary-style hospital — often set up in a gymnasium or community center outfitted with oxygen tanks and CT scanners.

There, they recuperated under the eyes of nurses. That reduced the risk to families, and being with other victims relieved some patients’ fears…

Still, experts were divided on the idea of such wards. [One called for] mandatory but “humane quarantine processes.”

By contrast, [a Harvard epidemiologist] opposed the idea, saying: “I don’t trust our government to remove people from their families by force.”

Ultimately, suppressing a virus requires testing all the contacts of every known case. But the United States is far short of that goal.

Someone working in a restaurant or factory may have dozens or even hundreds of contacts. In China’s Sichuan Province, for example, each known case had an average of 45 contacts.

The C.D.C. has about 600 contact tracers and, until recently, state and local health departments employed about 1,600, mostly for tracing syphilis and tuberculosis cases.

China hired and trained 9,000 in Wuhan alone. [It’s been] estimated that the United States will need at least 300,000.

[ Immunity Will Become an Advantage in Society ]

Imagine an America divided into two classes: those who have recovered from infection with the coronavirus and presumably have some immunity to it; and those who are still vulnerable.

“It will be a frightening schism,” … a World Health Organization special envoy on Covid-19, predicted. “Those with antibodies will be able to travel and work, and the rest will be discriminated against.”

Already, people with presumed immunity are very much in demand, asked to donate their blood for antibodies and doing risky medical jobs fearlessly.

Soon the government will have to invent a way to certify who is truly immune. A test for IgG antibodies, which are produced once immunity is established, would make sense… Many companies are working on them.

Dr. Fauci has said the White House was discussing certificates like those proposed in Germany. China uses cellphone QR codes linked to the owner’s personal details so others cannot borrow them….

As Americans stuck in lockdown see their immune neighbors resuming their lives and perhaps even taking the jobs they lost, it is not hard to imagine the enormous temptation to join them through self-infection, experts predicted. Younger citizens in particular will calculate that risking a serious illness may still be better than impoverishment and isolation.

“My daughter, who is a Harvard economist, keeps telling me her age group needs to have Covid-19 parties to develop immunity and keep the economy going,” said Dr. Michele Barry…

It would be a gamble [since] even slim, healthy young Americans have died of Covid-19.

[ A Vaccine Is Not Coming Soon ]

Even though limited human trials of three candidates — two here and one in China — have already begun, [Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases] has repeatedly said that any effort to make a vaccine will take at least a year to 18 months.

All the experts familiar with vaccine production agreed that … that timeline was optimistic… The record is four years, for the mumps vaccine.

Researchers differed sharply over what should be done to speed the process. Modern biotechnology techniques using RNA or DNA platforms make it possible to develop candidate vaccines faster than ever before.

But clinical trials take time, in part because there is no way to rush the production of antibodies in the human body.

Also, for unclear reasons, some previous vaccine candidates against coronaviruses like SARS have triggered “antibody-dependent enhancement,” which makes recipients more susceptible to infection, rather than less….

A new vaccine is usually first tested in fewer than 100 young, healthy volunteers. If it appears safe and produces antibodies, thousands more volunteers — in this case, probably front-line workers at the highest risk — will get either it or a placebo in what is called a Phase 3 trial.

It is possible to speed up that process with “challenge trials.” Scientists vaccinate small numbers of volunteers, wait until they develop antibodies, and then “challenge” them with a deliberate infection to see if the vaccine protects them.

Challenge trials are used only when a disease is completely curable, such as malaria or typhoid fever. Normally, it is ethically unthinkable to challenge subjects with a disease with no cure, such as Covid-19.

But in these abnormal times, several experts argued that putting a few Americans at high risk for fast results could be more ethical than leaving millions at risk for years….

As arduous as testing a vaccine is, producing hundreds of millions of doses is even tougher, experts said.

Most American vaccine plants produce only about 5 million to 10 million doses a year, needed largely by the 4 million babies born and 4 million people who reach age 65 annually…

But if a vaccine is invented, the United States could need 300 million doses [assuming 30 million of us are immune] — or 600 million if two shots are required. And just as many syringes.

“People have to start thinking big,” [one doctor] said. “With that volume, you’ve got to start cranking it out pretty soon.”

Flu vaccine plants are large, but those that grow the vaccines in chicken eggs are not suitable for modern vaccines…

European countries have plants but will need them for their own citizens. China has a large vaccine industry, and may be able to expand it over the coming months. It might be able to make vaccines for the United States…

India and Brazil also have large vaccine industries. If the virus moves rapidly through their crowded populations, they may lose millions of citizens but achieve widespread herd immunity well before the United States does. In that case, they might have spare vaccine plant capacity.

Alternatively, [another doctor said] the government might take over and sterilize existing liquor or beer plants, which have large fermentation vats: “ any distillery could be converted”.

[ Treatment Is Likely To Arrive First ]

In the short term, experts were more optimistic about treatments than vaccines. Several felt that so-called convalescent serum could work.

The basic technique has been used for over a century: Blood is drawn from people who have recovered from a disease, then filtered to remove everything but the antibodies. The antibody-rich immunoglobulin is injected into patients.

The obstacle is that there are now relatively few survivors to harvest blood from [note: in New Jersey at least, you have to be under 60, among other requirements]….

[A treatment involving] monoclonal antibodies … recently came very close to conquering the Ebola epidemic in eastern Congo, [and] are the most likely short-term game changer…

The most effective antibodies are chosen, and the genes that produce them are spliced into a benign virus that will grow in a cellular broth.

But, as with vaccines, growing and purifying monoclonal antibodies takes time. In theory, with enough production, they could be used not just to save lives but to protect front-line workers….

Having a daily preventive pill would be an even better solution, because pills can be synthesized in factories far faster than vaccines or antibodies can be grown and purified.

But even if one were invented, production would have to ramp up until it was as ubiquitous as aspirin, so 300 million Americans could take it daily.

[Some keep suggesting] hydroxychloroquine and azithromycin… All the experts agreed … that no decision should be made until clinical trials are completed.

Some recalled that in the 1950s inadequate testing of thalidomide caused thousands of children to be born with malformed limbs. More than one hydroxychloroquine study has been halted after patients who got high doses developed abnormal heart rhythms.

“I doubt anyone will tolerate high doses, and there are vision issues if it accumulates,” [one doctor] said. “But it would be interesting to see if it could work [like pills used to prevent H.I.V.].

Others were harsher… “It’s total nonsense,” said … a former director of medical and biodefense preparedness at the National Security Council. “I told my family, if I get Covid, do not give me this combo.”

Chloroquine might protect patients hospitalized with pneumonia against lethal cytokine storms because it damps down immune reactions, several doctors said.

That does not, however, make it useful for preventing infections, as [some have] implied it would be, because it has no known antiviral properties.

Several antivirals, including remdesivir, favipiravir and baloxavir, are being tested against the coronavirus; the latter two are flu drugs.

Trials of various combinations in China are set to issue results by next month, but they will be small and possibly inconclusive…

[ We Will Need International Cooperation ]

A public health crisis of this magnitude requires international cooperation on a scale not seen in decades. Yet [the president] is moving to defund the W.H.O., the only organization capable of coordinating such a response.

And he spent most of this year antagonizing China, which now has the world’s most powerful functioning economy and may become the dominant supplier of drugs and vaccines. China has used the pandemic to extend its global influence, and says it has sent medical gear and equipment to nearly 120 countries [including the United States]….

“If [the president] cares about stepping up the public health efforts here, he should look for avenues to collaborate with China and stop the insults,” said … an economic historian… [A doctor added:] “What if they come up with the first vaccine? They have a choice about who they sell it to. Are we top of the list? Why would we be?”

Once the pandemic has passed, the national recovery may be swift…

The psychological fallout will be harder to gauge. The isolation and poverty caused by a long shutdown may drive up rates of domestic abuse, depression and suicide.

Even political perspectives may shift…. In the periods after both wars, society and incomes became more equal. Funds created for veterans’ and widows’ pensions led to social safety nets, measures like the G.I. Bill and V.A. home loans were adopted, unions grew stronger, and tax benefits for the wealthy withered.

If a vaccine saves lives, many Americans may become less suspicious of conventional medicine and more accepting of science in general…

 

Poor Grammar Leads to Justified Ridicule

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One of the worst members of Congress expressed himself on Twitter last night with these words:

The United States has tested more than anyone in the world by far. Txxxx is the greatest testing President God has ever created.

You could read the second sentence as suggesting that President God — whoever that might be — created Txxxx as the greatest testing ever. This president has certainly tested us in many ways. But a Republican member of Congress would never acknowledge that reality.

Instead, thousands of Twitter-based smart alecks seized on the words “President God” as a great opportunity to express themselves. As well they should have.

Now, we sticklers will point out that the congressman should have put in a hyphen and used lower case, making it “the greatest-testing president” or maybe “the greatest testing-president”. He could have avoided some of the justified ridicule, but not completely.

Of the few replies I looked at, this was my favorite:

EV4kxNuXgAIETCA

A perhaps more apt reply was this:

Every time President God brags about how well he has done combating COVID-19, remember these FACTS:

The United States has just 1/23 of the world’s population.

The United States has had 1/4 of all COVID-19 deaths.

Actually, it’s 1/5 of all deaths (based on the available statistics), but the point remains.

Melting Down? Is It Stroke City Yet?

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Some networks (they know who they are) are still broadcasting the Toddler’s demented “briefings” — despite many calls for them to stop. According to the internet, yesterday’s performance was especially toxic. Maybe the guy will finally have a stroke? Here’s most of an account from The Guardian that gets bonus points for (1) referring to him as a “toddler” and (2) bringing up his resignation (it’s gratifying to see that a talented journalist reads Whereof One Can Speak religiously, as everyone should!):

A toddler threw a self-pitying tantrum on live television on Monday night. Unfortunately he was 73 years old, wearing a long red tie and running the world’s most powerful country.

[DT], starved of campaign rallies, Mar-a-Lago weekends and golf, and goaded by a bombshell newspaper report, couldn’t take it any more. Years of accreted grievance and resentment towards the media came gushing out in a torrent. He ranted, he raved, he melted down and he blew up the internet with one of the most jaw-dropping performances of his presidency.

This was, as he likes to put it, “a 10”.

[His] Easter had evidently been ruined by a damning 5,500-word New York Times investigation showing that [he] squandered precious time in January and February as numerous government figures were sounding the alarm about the coronavirus.

With more than 23,000 American lives lost in such circumstances, some presidents might now be considering resignation. Not [him]. He arrived in the West Wing briefing room determined to tell the world, or at least his base, that he was not to blame. Instead it was a new and bloody phase of his war against the “enemy of the people”: the media. Families grieving loved ones lost to the virus were in for cold comfort here.

A CNN chyron is a worth a thousand words: “[DT] refuses to acknowledge any mistakes”; “[He] uses task force briefing to try and rewrite history on coronavirus response”; “[He] melts down in angry response to reports he ignored virus warnings”; “Angry [DT] turns briefing into propaganda session”.

The thin-skinned president lashed out at reporters, swiped at Democrat Joe Biden and refused to accept that he had put a foot wrong. “So the story in the New York Times is a total fake, it’s a fake newspaper and they write fake stories. And someday, hopefully in five years when I’m not here, those papers are all going out of business because nobody’s going to read them,” [he] said.

With a dramatic flourish, the president ordered the briefing room lights dimmed. In a James Bond film, it would be the moment that poisoned gas is piped into the room. What happened wasn’t far off: a campaign-style montage of video clips, shown on screens set up behind the podium. There was footage of doctors saying in January that the coronavirus did not pose an imminent threat, Trump declaring a national emergency, and Democratic governors praising him for providing federal assistance.

Veteran White House reporters said they could never remember such a film being played in that room….

Jon Karl of ABC News asked in consternation: “Why did you feel the need to do that?”

[DT] replied: “Because we’re getting fake news and I like to have it corrected … Everything we did was right.”

Over and over, [he] highlighted his decision to ban some flights from China in late January before there were any virus-related deaths confirmed in the US – even though nearly 400,000 people travelled to the US from China before the restrictions were in place and 40,000 people have arrived there since.

The CBS News correspondent Paula Reid was having none of it and cut to the chase. “The argument is that you bought yourself some time,” she said “You didn’t use it to prepare hospitals. You didn’t use it to ramp up testing. Right now, nearly 20 million people are unemployed. Tens of thousands of Americans are dead.”

[The president] talked over her: “You’re so disgraceful. It’s so disgraceful the way you say that.”

Reid demanded: “How is this newsreel or this rant supposed to make people feel confident in an unprecedented crisis?”

[He] reverted to his China travel restrictions but Reid continued to push him on his inaction in February. [He] was unable to muster a reasonable response. It was a case study in how, when he loses an argument, his instinct is to attack the accuser. He trotted out his frayed, timeworn insult: “You know you’re a fake, your whole network the way you cover it is fake … That’s why you have a lower approval rating than probably you’ve ever had before …”

…. The briefing went on for well over two hours. Even Fox News gave up before the end. Adam Schiff, the chair of the House intelligence committee, spoke for many when he tweeted: “Why do reputable news organizations carry these daily Trump press conferences live?

“They are filled with misinformation and propaganda. From the president himself, no less. The country would be far better served and informed if they used highlights [Note: I wouldn’t use that word] later. Enough is enough.”

A Man Without Qualities

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Well, I’ve had the virus, been hospitalized and am now very, very happy to be back home, seeing sunshine again.

In a hospital bed, you have a lot of free time. Hanging around; waiting for your next meal (Saint Barnabas’s simple offering of a plain, almost juiceless cheeseburger, a side of macaroni and cheese, steamed broccoli and a brownie was almost sublime); being visited every so often by hospital staff, well-guarded and unrecognizable deep inside their personal protective gear; them giving you “just a little pinch”, checking your vital signs or asking about your current state of affairs; being given that anti-malaria drug for a while apparently for no good reason; “wearing” that silly “gown” that won’t stay on; dozing off; occasionally losing an electrode; wondering when the hell you will get out of there.

I didn’t turn on the TV in the eight days I was there. (Nor, after they moved me to a double room, did my roommate, who was in worse shape than I was.)

I did look at news on my phone. It wasn’t good.

Aside from the obvious, the thing that got me the most was how people who have power or cultural significance are being so nice and respectful to the monster child.

Of course, they do point out his deficiencies. Larry David quoted in The New York Times:

You know, it’s an amazing thing. The man has not one redeeming quality. You could take some of the worst dictators in history and I’m sure that all of them, you could find one decent quality. Stalin could have had one decent quality, we don’t know!

Fran Lebowitz in The New Yorker:

Every single thing that could be wrong with a human being is wrong with him.

Tom Nichols in The Atlantic:

[He] is a spiritual black hole.

But have you ever seen a quote in which someone demanded that he resign? The acting Secretary of the Navy said something very bad and was quickly hit with demands to go. He left. Why not call on the worst president in our history to go too? If someone is so totally and dangerously unfit for a job, shouldn’t our political and cultural leaders have demanded his resignation, over and over again?

I know, the Electoral College put him there and (of course) odds are he wouldn’t go. Nevertheless, it’s remarkable how his resignation never comes up in our national conversation.

Another aspect of his benign treatment that especially bothered me (from my prone position) was (and still is) the daily “briefings” he’s been doing. I don’t know which organizations are part of it, but he’s allowed to spew and blather, unfiltered, to America whenever he chooses. It is truly outrageous. They broadcast his rallies from beginning to end during the 2016 campaign. Now they’re repeating the offense with these mini-rallies. He promotes himself, attacks and attacks, lies, spreads nonsense and they’re allowing him to do it. He is the president, but that makes it worse, since he speaks to some of us with authority. It is amazingly reckless that they’re letting him do it.

It’s a beautiful spring day here in New Jersey from an aesthetic perspective. Governor Murphy reports we’re at 58,000 cases, with 7,600 hospitalized, 1,700 in critical condition and 2,200 dead.

Please be safe and be kind.

The President Is a Monster

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This morning, Gov. Andrew Cuomo of New York patiently explained why the president  should have already invoked the Defense Production Act, compelling firms to begin producing ventilators and other medical equipment, and should immediately send thousands of ventilators to New York from the federal stockpile. Cuomo estimated that New York will need 30,000 ventilators to cope with the worst COVID-19 outbreak in the country. So far they’ve been able to acquire 7,000.

The president, purportedly an adult human being, responded this morning:

Usually, we’ll have 50 governors on the conference call at the same time. I think we’re doing very well. But, you know, it’s a two-way street. They have to treat us well also. They can’t say, Oh gee we should get this, we should get that. Like in New York, we’re building four hospitals… And then, I hear, you know, there’s a problem with ventilators. We sent them ventilators. And they could have had 15 or 16,000. All they had to do was order them two years ago. But they decided not to do it. They can’t blame us for that.